2. NOTE: This form may be submitted anytime to the Building Department, but it must still be signed in person and any permit fee must be paid in person at Pepperell Town Hall.
4. Applicant's Name
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5. Date
   Date
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7. Construction Address
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9. REFERENCE: SECTION 6170 of the Zoning By-Law of the Town of Pepperell
11. All applications for a building permit shall be accompanied by a plan stamped by a registered professional civil engineer or land surveyor showing the existing (as taken from the U.S. Geological Survey topographical data) and proposed post construction contours of the lot at 5 foot intervals and showing the proposed final sill elevation of the buildings to be constructed. However, no such topographical plans shall be required if the applicant certifies on the building permit application that:
13. a) No soil, loam, sand, gravel or other fill will be removed from the lot OR
15. b) The amount to be removed does not exceed the amount displaced by the building’s foundation and subsurface sewage disposal system.
17. If a comparison of the existing and post construction contours indicate that the proposed construction will involve the removal of soil, loam, sand, gravel or other fill from the parcel in EXCESS of 1000 cubic yards (including displaced materials from the foundation and sewage system excavation) per building lot, no building permit shall be issued without a SPECIAL PERMIT for soil removal incidental to building issued by the Board of Selectmen allowing such removal, which permit shall not be granted unless the applicant is able to show that the removal of soil, loam, sand, gravel or other fill from the building lot is necessary to the proposed construction and that all other requirements for the granting of a special permit under Section 9300 are met.
21. 1. SOIL REMOVAL NOT TO EXCEED AMOUNT DISPLACED BY FOUNDATION AND SEWAGE SYSTEM: SINGLE FAMILY HOUSE
23. I hereby certify that:
25. a) No soil, loam, sand, gravel or other fill will be removed from the lot.
27. OR
29. b) The amount to be removed does not exceed the amount displaced by the building foundation and subsurface sewerage system, thereby nullifying the need for a plan stamped by a registered civil engineer.
31. Initial
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32. Date
    Date
37. 2. SOIL REMOVAL IN EXCESS OF 1000 CUBIC YARDS
39. A comparison of existing and post construction contours indicates the proposed construction will involve the removal of soil, loam, sand, gravel or other fill from the parcel in excess of 1000 cubic yards (including displaced materials from the foundation and septic system excavation) per building lot and I therefore recognize that no building permit shall be issued without a Selectmen's Special Permit for soil removal incidental to building.
41. Initials
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42. Date
    Date
47. 3. SOIL REMOVAL LESS THAN 1000 CUBIC YARDS BUT MORE THAN THE AMOUNT DISPLACED BY FOUNDATION AND SEWERAGE SYSTEM
49. I hereby submit a plan stamped by a registered professional civil engineer or land surveyor showing the existing (as taken from the U.S. Geological Survey Topographical data) and proposed post construction contours of the lot at 5 foot intervals and showing the proposed final sill elevation of the buildings to be constructed.
51. Initials
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52. Date
    Date
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55. 1. Receive an email copy of this form.
56. Email address

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57. Submit

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