HomeMy Public PortalAboutWater Quality Certificate ApplicationFORM A
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APPLICATION FOR A CERTIFICATE OF WATER QUALITY COMPLIANCE
Brewster Zoning Bylaw 179-53
Application Fee: $100.00/Renewal $50.00
(Please Print)
PROPERTY OWNER’S NAME PHONE ( )
BUSINESS NAME+OWNER _______________________________________________________________PHONE_________________________
MAILING ADDRESS
E-MAIL ADDRESS________________________________________________________________
PROPERTY LOCATION: MAP: LOT: STREET ADDRESS:
PLEASE PROVIDE 7 COPIES OF THIS COMPLETED APPLICATION AND ALL ATTACHED DOCUMENTS & PLANS
1. Attach minutes of Development Plan Review Committee meeting or proposed hearing date, or provide written
determination of the Building and Zoning Commissioner that DPRC review is not required.
2. Attach engineered site plan(s) showing:
a.) all property lines and ownership of abutting lots
b.) current conditions and proposed finished grades and conditions, including all structures, fencing, signage, paved
areas, parking areas (with number of parking spaces delineate) and improvements, including re-vegetation and
landscaping plans. Include location of any existing and/or proposed groundwater wells and provide most recent
well testing data.
c.) all surface and subsurface treatments for the direction and retention of storm water and waste water, including
existing or proposed drains. Provide most recent monitoring or pumping data.
3. Attach description of all activities proposed including construction and approximate timelines. If clearing and
excavation are proposed, include a description of sedimentation and erosion control measures that will be taken
and indicate on the current “condition plan” where such measures will be applied.
4. Describe nature of any and all proposed continuing commercial activity or activities and proposed periods and times
of operation. ________________________________________________________________________________
TOWN OF BREWSTER
WATER QUALITY REVIEW COMMITTEE
2198 Main Street
Brewster, Massachusetts 02631-1898
(508) 896-3701
FAX (508) 896-8089
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5. Describe the nature of any agricultural activity proposed, including the size of areas proposed to be cultivated
and/or the number of any animals to be kept on the premises. If you have a fertilizer and Integrated Pest
Management (IPM) plan, please submit a copy with this application. If you have a manure or animal waste
management plan please include that with this application.___________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
6. Provide a list of all equipment anticipated to be on site during construction.
_________________________________________________________________________________________
7. Provide a list of all equipment proposed to be stored onsite and indicate where such equipment will be stored on a
“finished conditions” site plan.
__________________________________________________________________________________________
8. Provide site plan indicating internal traffic circulation pattern and the number and type of vehicle trips anticipated
per day with certification of legal access
9. Provide a description of measures that will be taken to protect the premises from vandalism
___________________________________________________________________________________________
10. If equipment is intended to be fueled on-site, indicate on the site plans where fueling is proposed to occur and
describe the precautions that will be taken to prevent spills and the actions proposed in the event a spill occurs.
________________________________________________________________________________________
11. Provide a list of all chemicals, pesticides, fuels, and other potentially toxic or hazardous materials to be used or
stored on the premises in quantities greater that those associated with normal household use
________________________________________________________________________________________
12. Provide a description of potentially toxic or hazardous wastes to be generated on site or stored on site, indicating
storage containment and disposal methods.
_________________________________________________________________________________________
13. Provide a description of measures that will be taken to protect materials and storage structures from corrosion and
leakage
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14. Provide a description of measures that will be taken to control and contain spills of all potentially hazardous
materials including fuels.
______________________________________________________________________________________
______________________________________________________________________________________
15. Identify and describe any existing or proposed floor drains and dry wells.
_______________________________________________________________________________________
_______________________________________________________________________________________
16. List any non-sanitary wastewater generated at the property as a result of residential, commercial or agricultural
activities conducted at the property (services, maintenance, manufacturing, processing).
________________________________________________________________________________________
17. Provide copies of any other approvals for which you have applied, or which you have received.
Signature of Applicant
______________________________________________
Printed name of Applicant
Date