Fillable Stormwater Management Permit Application (SELCO)

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Stormwater Management Permit Application (SELCO)

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The Stormwater Management Permit Application (SELCO) form is 2 pages long and contains:

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  • 25 check-boxes
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Revised July 12, 2019 Questions? E-mail stormwater@shrewsburyma.gov Page 1 of 2
Town of Shrewsbury – Department of Public Works - Engineering
Stormwater Management Permit Application
Stormwater Management Rules & Regulations, Adopted February 19, 2019
A. General Information
Project Location
Street Address:
Assessors Map/Plat Number
Parcel/Lot Number
Book Number
Page Number
If there is more than one parcel, please attach a list to application.
Property Owner / Condominium
Name
Name
Mailing Address
Mailing Address
City/Town, State, Zip
City/Town, State, Zip
Phone
Email
Phone
Email
Applicant (if different from owner or contractor)
Name* (required) (same as owner or contractor)
Name
Company Name
Company Name
Mailing Address
Mailing Address
City/Town, State, Zip
City/Town, State, Zip
Phone
Email
Phone
Email
B. Plan and/or Map Reference(s) and Minimum Submittal Requirements
Estimated Area to be Disturbed (sq.ft.)
Total Area of Impervious Surfaces (sq.ft.)
Existing
Application Review & Inspection Fee $
Proposed
1.
Plan Title
Plan Date
Number of Plan Sheets
Prepared By
Signed and Stamped by
2.
Drainage Calculations Title
Signed and Stamped by
Date
3.
Erosion and Sediment Control Plan
Signed and Stamped by
4.
Stormwater Pollution Prevention Plan
Included Not Included
Date
5.
Post Construction Stormwater Management Plan
Included Not Included
Date
6.
Long Term Operations & Maintenance Plan
Included Not Included
Date
7.
Electronic Submission of Plans to stormwater@shrewsburyma.gov (PDF preferred)
Date
Date Received
(For Office Use Only)
Revised July 12, 2019 Questions? E-mail stormwater@shrewsburyma.gov Page 2 of 2
C. Stormwater Management Standards
comply with MADEP Stormwater Standards to the maximum extent practicable (if not, explain which standards cannot be met and why) AND
BMPs optimized for phosphorus removal and O&M addresses proper disposal of grass clipping and leaf litter, encourage proper use of slow
release phosphorus or no use of fertilizers and addresses proper pet waste management AND
NEW DEVELOPMENT drainage calculations:
The first inch of runoff from impervious areas shall be retained onsite OR
removes 90% of the average annual load of total suspended solids (TSS) AND removes 60% of the average annual load of total phosphorus
REDEVELOPMENT (as defined by the Massachusetts MS4 General Permit) drainage calculations:
The first 0.8 inch of runoff from impervious areas shall be retained onsite OR
The treatment shall be designed such that 80% of the average annual load of total suspended solids (TSS) AND 50% of the average annual
load of total phosphorus generated from the impervious area on the site is removed prior to discharge.
Offsite mitigation within the same USGS HUC10 may be allowed (Refer to MassGIS datalayer).
D. Water Quality Questions
1.
Identify the receiving
water
The project discharges to the following unnamed or named wetland or waterbody ________________________
within the _____________________________ watershed.
2.
Does the project
discharge to:
Outstanding resource waters http://www.mass.gov/eea/docs/dep/service/regulations/314cmr04.pdf or
High Quality Stream https://streamcontinuity.org/assessing_crossing_structures/prioritizing_crossings.htm
Water on most recent MA Integrated List of Waters
https://www.mass.gov/files/documents/2017/08/zu/16ilwplist.pdf (or Clean Water Act 303(d) list)
E. Low Impact Development (LID) Statement
LID techniques are innovative stormwater management systems that are modeled after natural hydrologic features, to manage rainfall at the source
using uniformly distributed decentralized micro-scale controls and use small cost-effective landscape features at the lot level. To demonstrate
compliance with the Stormwater Management Standards, projects requiring stormwater management must complete an evaluation of possible
stormwater management measures including environmentally sensitive site design and low impact development techniques that minimize land
disturbance and impervious surfaces, structural stormwater management practices, pollution prevention, erosion and sedimentation control and
proper operation and maintenance of stormwater BMPs. Check all provided in this project:
Reducing impervious surfaces
Disconnecting flow paths
Treating stormwater at the source
Minimizing disturbance
Protecting natural features and processes
Maximizing open space
F. Signatures and Submittal Requirements
I hereby certify under the penalties of perjury that the foregoing Storm Water Permit Application and accompanying plans, documents, and
supporting data are true and complete to the best of my knowledge. I certify that I have reviewed the Stormwater Management Rules & Regulations
and Stormwater Management Application Review & Inspection Fee. I certify that I have fully evaluated all LID techniques available and have
utilized LID to the extent practicable.
Signature of Applicant
Date
Signature of Representative
Date
Please submit three (3) Town of Shrewsbury For Office Use Only: Administratively Complete (Y/N): ___________
physical copies to… DPW – Engineering Division
100 Maple Avenue Date: ___________________________________
Shrewsbury, MA 01545-5338
SUBJ: Stormwater Permit Application Initials: _________________________________
and electronic copies to… stormwater@shrewsburyma.gov SW Permit No: ___________________________
(PDF format preferred)
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Stormwater Management Permit Application (SELCO)

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Completed 5 August 2020

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