Town of Winchester Planning Board
Earth Excavation Checklist
I. GENERAL INFORMATION/CONTACT INFORMATION
Primary Contact:________________________________________________________________
Project Name: __________________________________________________________________
Project Location:________________________________________________________________
(address) (map/lot #)
Applicant Name:________________________________________________________________
Address:_______________________________________________________________________
City:_________________________State:__________________Zip code:___________________
Applicant’s Email:_________________@__________________Phone #:___________________
Owner’s Name__________________________________________________________________
Owner’s Address: _______________________________________________________________
City:_________________________State:__________________Zip code:___________________
Owner’s Email:____________________@__________________Phone#:___________________
NH Licensed Engineer Name:__________________________License #____________________
Address: ______________________________________________________________________
City: _________________________State:__________________Zip code:__________________
Engineer’s Email:___________________@__________________Phone#:__________________
NH Certified Soil Scientist Name:________________________License #___________________
Address:_______________________________________________________________________
City: _________________________State:__________________Zip code: __________________
Scientist’s Email ___________________@__________________Phone#: __________________
NH Licensed Surveyor Name: ___________________________License #___________________
Address: ______________________________________________________________________
City: __________________________State: _________________Zip code: _________________
Surveyor’s Email ___________________@__________________Phone#: _________________
II. GENERAL REQUIREMENTS (Applicant check Y, N or N/A)(LUA check same)
(Applicant) (LUA)
_____ _____ Completed application form submitted
____ ____ Owners signature or Authorization Letter
____ ____ Complete Abutters List
____ ____ All required fees
____ ____ Draft copies of any proposed easements or other legal docs
____ ____ Copy of any deed restrictions/easements
____ ____ Is excavation permitted in this district?
____ ____ Any waiver requests submitted in writing
____ ____ Copy of any ZBA/Historic/CC approvals
____ ____ Copy of Alteration of Terrain Permit
III. MINIMUM PLAN REQUIREMENTS (Applicant check Y, N, N/A)(LUA same)
(Applicant) (LUA)
____ ____ Name of project, name & address of owner
____ ____ Location including town, state, streets, map & lot #’s
____ ____ Four sets of plans (scale of 1”=100)
____ ____ Date of plan, scale and revision block
____ ____ Scale, zoning designation w/in 200ft, property lines, and
north arrow.
____ ____ Names of abutting properties including map & lot #’s
____ ____ Location and size of disturbed area(s) in acres and sq.ft.
including setbacks
____ ____ Existing buildings, watercourses, stonewalls & similar
____ ____ Location of water, septic, electric, tests pits & like
____ ____ Minimum plan size is 11”x14”
____ ____ Breath, depth & slope of proposed area
____ ____ Scale per regulations, noted POB, and locus map
____ ____ Planning Board Chairman Signature Block
____ ____ Sheet numbers on all pages and numbered sequentially
____ ____ Match Lines shown on all sheets
____ ____ Sheets stamped by all licensed professionals
____ Location of existing conditions including buildings, natural features, easements, streets, driveways, septics, and tree lines on project lot w/in 200ft of disturbed area.
____ ____ Location of proposed access road w/surface materials
____ ____ Contour lines at five foot intervals,
____ ____ Soil data and designation of wetlands
____ ____ All plans referenced are noted
____ ____ Flood elevations (if applicable)
____ ____ Plan for erosion & sedimentation control
____ ____ Surface drainage patterns w/ wetlands & standing water
____ ____ Estimate of total cubic yards to be removed.
By signing below the applicant agrees this excavation is not/will not:
1. Within 50ft of a disapproving abutter,
2. Unduly hazardous to the public welfare,
3. Remove existing barriers except to gain access to the excavation,
4. Substantially damage a known aquifer,
5. Within a 150ft of an existing dwelling or to a site for which a building permit has been issued,
6. Go below road level, in depth, within 50ft. of a public right of way,
7. Disturb the vegetation within the peripheral areas,
8. House fuels, lubricants or similar substances on site,
9. Allow temporary slopes greater than 1:1 unless an appropriate barrier is provided,
10. Allow freestanding water for prolonged periods of time,
11. Within 75 of any great pond, navigable river, or other body of water greater than 10acres,
12. Within 25 ft of any stream, river, brook which normally flows throughout the year, or any naturally occurring standing body of water less than 10 acres, prime wetland, or any other wetland grater than 5 acres in area.
_____________________
Applicant or authorized representative signature of agreement
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