Town of Shelburne, Vermont CHARTERED 1763

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1 Town of Shelburne, Vermont CHARTERED 1763 P.O. BOX SHELBURNE ROAD SHELBURNE, VT EXCAVATION AND FILL APPLICATION* * Also available in alternate formats in accordance with the Americans With Disability Act. PLEASE USE THIS FORM TO REQUEST APPROVAL OF EXCAVATION AND FILL The excavating or filling of areas larger than 1,000 square feet (or 500 square feet within 100 feet of 102 elevation contour at Lake Champlain) is allowed only upon issuance of a special zoning permit. For purposes of local review, excavating includes extraction of earth materials for use off site. Filling includes filling with loam, gravel, stone, fill, topsoil, sod or other similar materials. Applications seeking approval of excavation or filling must be accompanied an Erosion and Sediment Control Plan. No permit will be issued the Administrative officer (AO) unless an Erosion and Sediment Control Plan has been presented and accepted. At the sole discretion of the AO, the AO may determine that, owing to the minor scale of a particular proposal and the limited potential for offsite impacts, provision of one or more items requested this application is not necessary. Note: The zoning law does not authorize the establishment of commercial gravel pits or quarries. Also: excavation and filling requirements shall not apply to the removal of natural resources from a farm operation where necessary to the farm operation. APPLICANT INFO APPLICANT First Name Last Name Signature GAF Number Request PRIMARY CONSULTANT (If any) Name Mailing address City State Zip Phone Please provide or attach a concise description of your project: Date received FOR OFFICE USE ONLY Referral (s) Form continues on reverse side Fee received Forms offered Permit # Hearing date

2 PROJECT INFO Size (in square feet) of area filled or excavated? Date of Erosion and Sediment Control Plan Was application prepared Certified Erosion Control Professional? Did applicant contact Natural Resource Conservation Service? If filling is to take place, what is nature of material? Did applicant discuss project w/ Highway staff, e.g., routes traveled trucks? Will hours of activity be limited as indicated in zoning law? (e.g., 7 AM-6PM M-F) Will suitable security be provided to assure compliance with the provisions of law? Did applicant contact Army Corps Of Engineers? CONFORMANCE WITH REVIEW CRITERIA Applications for Excavation and Fill approval must meet several criteria contained in the zoning law. The review process will tend to function more smoothly when you provide thorough responses to the following items. The application is substantially responsive to comments the U.S.D.A. Natural Resource Conservation Service (NRCS) and the U.S. Army Corps of Engineers (COE), if any. It shall be the obligation of the applicant to demonstrate that input from NRCS and COE staff has been solicited. Any excavation or filling proposed in the application will not undermine or threaten the stability of public or private roads or adjacent properties. The application does not propose final grades in excess of 20 percent over runs exceeding 10 meters. Excavation and/or filling is not proposed to occur at times of year, such as spring thaw, when work on the project site would pose increased risk of erosion, slumping, or other potentially adverse effects upon public health and safety and welfare.

3 CONFORMANCE WITH REVIEW CRITERIA (CONTINUED) Applications to for site plan approval must meet several criteria contained in the zoning law. The review process will tend to function more smoothly when you provide thorough responses to the following items. The application, as evidenced the Erosion and Sediment Control Plan, minimizes erosion potential caused the removal of vegetative cover. The application meets noise, dust or vibration performance standards contained in Article IX, Section 1950 of this law The application will not have an undue adverse impact on traffic safety or congestion on public rights of way. No excavation of earth materials is proposed within the 100 year flood plain of the LaPlatte River, McCabe's Brook, or Monroe Brook, where the activity proposed would lower the level of the water table, interfere with the natural flow patterns, or reduce the flood stage capacity.

4 NAMES AND ADDRESSES OF ADJOINING PROPERTY OWNERS A list of list of current adjoining and cross-street property owners must be submitted in conjunction with this application, along with a set of stamped and addressed envelopes including one for each adjoining and cross-street property. Adjoiner 1 Adjoiner 5 Adjoiner 2 Adjoiner 6 Adjoiner 3 Adjoiner 7 Adjoiner 4 Adjoiner 8 Use additional copies of this form as required

5 EXCAVATION AND FILL SITE PLAN CHECKLIST AND PROCEDURE An Excavation and Fill Site Plan must be submitted in conjunction with this application. The features depicted on such Plan must include the following*: A. A context map or orthophoto showing the applicant s entire property, adjacent properties, streets within 200 feet of the site, and approximate location on the site and on adjacent properties within 100 feet of the site boundary. B. The names and addresses of owners of record of all abutting or facing properties, as listed in the Town s tax records. C. A natural resources map identifying soils, forest cover, class two wetlands and related buffers, vernal pools over 1,000 square feet in area, natural heritage sites on record with the Vermont Natural Heritage program, and any previously mapped significant habitats such as deer wintering areas. This map should be at a scale no smaller than 1"=100'. D. A sequence of construction of the development site, including stripping and clearing; rough grading; construction of utilities, infrastructure, and buildings; and final grading and landscaping. Sequencing shall identify the expected date on which clearing will begin, the estimated duration of installation of temporary erosion and sediment control measures, and establishment of permanent vegetation. E. All erosion and sediment control measures necessary to meet the objectives of this local regulation throughout all phases of construction and after completion of development of the site. Depending upon the complexity of the project, the drafting of intermediate plans may be required at the close of each season.. F. Seeding mixtures and rates, types of sod, method of seedbed preparation, expected seeding dates, type and rate of lime and fertilizer application, and kind and quantity of mulching for both temporary and permanent vegetative control measures. G Provisions for maintenance of control facilities, including easements and estimates of the cost of maintenance. H. Grading, erosion control practices, sediment control practices, and waterway crossings shall meet the design criteria set forth in the most recent version of (erosion and sediment control manual), and shall be adequate to prevent transportation of sediment from the site to the satisfaction of (erosion and sediment control agency). Cut and fill slopes shall be no greater than 2:1, except as approved (erosion and sediment control agency) to meet other community or environmental objectives. I. Estimated daily and peak hour traffic generation the proposed development. A detailed traffic impact analysis is required for any application that is expected to add 75 or more peak hour (AM or PM) vehicle trip ends to the transportation system. The requirement for a traffic impact study may be waived the DRB upon a finding that an application would have a de minimis impact on traffic congestion and safety. J. Statement that any land clearing, construction, or development involving the movement of earth shall be in accordance with the Erosion and Sediment Control Plan and that a Certified Erosion Control Professional shall be on site on all days when construction or grading activity takes place K. The period of time in which all site improvements will be completed. M. Other information* * Note: Application for such a special zoning permit shall include such special information as the administrative officer may deem reasonably necessary for evaluating the application. A permit authorizing the Extraction, Filling or Removal of Natural Resource may be issued the administrative officer only following approval of the application and acceptance of an Erosion Control Plan. The administrative officer shall send copies of the permit approval to the applicant and all adjoining landowners, and shall advise each of the right to appeal the decision to the Development Review Board under the Vermont Planning and Development Act. SUBMIT