TOWN OF GOSHEN
42A North Street, Goshen, CT 06756
APPLICATION FOR INLAND WETLANDS PERMIT
Date of Application: ________________________________ Application Fee (See Schedule): ____________
This is an application for permission to conduct a regulated activity affecting an inland wetlands, watercourse, or
an upland regulated area in accordance with section 22a-36 to 45 inclusive of the General Statutes as amended
and the Inland Wetlands Regulations of the Town of Goshen.
Property Location: _____________________________________________________________________________
Tax Assessor’s Record Map #:________________________________Lot #: _______________________________
Applicant Information:
Name: __________________________________________________________
Address: __________________________________________________________
Phone: __________________________________________________________
FAX: __________________________________________________________
Email: __________________________________________________________
Applicant’s Interest in Property: __________________________________________________________
Property Owner Information:
Name: __________________________________________________________
Address: __________________________________________________________
Phone: __________________________________________________________
FAX: __________________________________________________________
Email: __________________________________________________________
(If more than one owner, attach list to application)
Proposed Regulated Activities: ________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Nature and Purpose of Project: ________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Is there a conservation or preservation easement on any part of this property? _____ YES _____ NO
Total Property Acreage: __________ Total Acreage of Development:__________________
Total Acreage of Wetlands on Site: __________ Total Acreage Altered: ___________________
Total Acreage of Open Water Body on Site: __________ Total Acreage Altered: ___________________
Total Linear Feet of Watercourses on Site: __________ Total Linear Feet Altered: ___________________
Total Buffer/Upland Review Area Altered: __________
Total Area of Wetlands and/or Watercourses Restored, Enhanced, or Created: ___________________
Were there prudent and feasible alternatives to the proposed wetland, watercourse, and upland review area
alterations? _____ YES _____ NO
If yes, what were they? _____________________________________________________________________________
_____________________________________________________________________________
If no, why not? _____________________________________________________________________________
_____________________________________________________________________________
Is this property within 500 feet of a town line? _____ YES _____ NO
(If yes, the applicant must notify the adjacent municipal wetlands agency by certified mail, return receipt requested, on the
same day of filing this application with the Goshen Inland Wetlands Commission/Land Use Office. Documentation of this
notice shall be provided to the Commission.)
Does any portion of this proposed project fall within a Public Watershed Protection Zone (R-WP)?
_____ YES _____ NO
(If yes, the applicant must notify the Water Company by certified mail, return receipt requested, on the same day of filing
this application with the Goshen Inland Wetlands Commission/Land Use Office. Documentation of this notice shall be
provided to the Commission.)
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The undersigned owners of the subject property (if not applicant), being all owners of record of said property, hereby
authorize the undersigned applicant to make this application as their agent, and hereby consent to all activities described
in said application.
The undersigned owners of the subject property hereby consent to necessary and proper inspections of said property by
members of the Goshen Inland Wetlands Commission and/or agents of the Commission at reasonable times both before
and after a final decision has been issued by the Commission.
The undersigned applicant and owners of the subject property hereby warrant the truth of all statements contained herein
and in all supporting documents according to their best knowledge, information, and belief.
Applicant’s Signature: _______________________________________ Date: ___________________
Owner’s Signature: _______________________________________ Date: ___________________
INLAND WETLANDS APPLICATION REQUIREMENTS:
Applicants are to submit 3 copies of the application along with the proper application fee unless an agent
determination is being sought (see attached fee schedule). Payment should be made out to Town of Goshen.
Applicants must submit 3 copies of supportive data for their application in the form of site plans and/or reports.
A suggested list is included with this application. The Commission reserves the right to request additional
information at any time during the review process.
To help facilitate the application and review process, applicants are urged to contact the Inland Wetlands
Officer before planning and applying for the proposed project.
If a Public Hearing is required, the applicant must pay an additional $100.00 public hearing fee. Payment
should be made out to Town of Goshen.
When a Public Hearing is scheduled, the applicant shall notify persons whose property abuts the property of
the proposed activity (include those parcels across roadways, right-of-ways, and watercourses) by certified
mail, return receipt requested. All evidence of the certified mail is to be given to the Inland Wetlands/Land Use
Office no sooner than three (3) municipal business days before the date of the Public Hearing regarding the
applicant’s proposed activity. The notice should include the date, time, and exact location of the public
hearing, a description of the proposed activity, and the exact location of the property where the activity is
proposed.
FEE SCHEDULE:
Basic Inland Wetlands Application $125.00
Permit Extension or Transfer $125.00
Each After-the-Fact Activity $225.00
Subdivisions $100.00 per lot
Agent Determinations $125.00
All applications requiring a public hearing will be an additional $200.00
The fees set forth above are the minimum application fees required. When the actual cost of processing an
application exceeds the minimum application fee due to the need for outside consulting services, the
Commission shall charge the applicant a surcharge fee to fund the approximate actual cost of processing the
application.
The expenses for such outside consultants (for example, but not limited to, engineering, traffic, environmental,
and planning professionals) may be estimated by the Commission upon receipt of the application based upon
the projected expenses of reviewing, evaluating, and processing the application. The reasonable estimate,
together with the appropriate application fees set forth above, shall be paid forthwith, and the application shall
be deemed incomplete until these fees have been submitted.
Any portion of the surcharge fee not expended by the Town on the application shall be rebated to the applicant
upon completion of the review, evaluation, and processing of the application.
The Commission shall bill the applicant for any costs incurred by the Town in excess of the surcharge fee paid
by the applicant. The bill shall be paid by the applicant prior to the issuance of any permits.
***NO PERMIT WILL BE ISSUED UNTIL ALL FEES ARE PAID***
SUGGESTED SUPPORTIVE DATA FOR INLAND WETLANDS APPLICATIONS:
Site Plans:
Scale no greater than 1” = 100’
Survey provided of existing conditions at A-2 Survey standards.
Plans stamped by Connecticut state licensed engineer, surveyor, and/or architect.
Boundary lines of wetland soil types with adjacent soil type information. Show and
number individual wetland flags on the map. Verify that the wetland flags are still intact
in the field; if not, re-flag wetland boundary. Soils information should be shown on the
map and signed by a Certified Soil Scientist. Indicate upland review area boundary
indicated 100’ from wetland soils.
Indicate area of activity detailing improvements. Include existing and proposed
stormwater discharge locations, utilities, paving, streets and/or drives, grading,
landscaping, any structures with finish floor elevations, etc.
Existing and proposed contours/elevations to be shown at either 1- or 2-foot intervals.
Establish elevations referring to mean sea elevation as established by the U.S. Coast
and Geodetic Survey.
Show the storm drainage with design details and specifications.
Show sewage disposal with design details and specifications. Provide Torrington Area
Health District approvals if septic.
Show the 100-year flood elevation, existing and proposed.
Indicate on drawings any watercourses, intermittent and/or perennial (see definitions)
and vernal pools or other water bodies. Indicate upland review area boundary indicated
100’ from watercourses/water bodies.
Show watershed drainage areas.
Provide storm drainage calculations, existing and proposed.
Provide a sedimentation and erosion control plan showing location of all erosion
controls and construction schedule. Include erosion control narrative indicating
stabilization methods, seeding recommendations, and timing.
If filling or removing material from site, provide a description of material to be removed
or brought in, including type and quantity.
Show source of water supply and/or location of well. Provide Torrington Area Health
District approvals.
Provide a copy of any other permits that were granted for this project by any other agency
(examples: Water Quality Certificate, US Army Corps of Engineers 404 permit, DEP Dam
Permit, DEP Water Diversion Permit, DEP Wetlands Permit for drainage area over 100 acres,
etc.).
Provide an Environmental Impact Statement (if requested); include Soil Scientist Report,
Engineering Report, an evaluation of plant and animal species associated with the project site,
and the probable effect of the proposed activity on the ecosystem.
Anything else deemed necessary by the Commission to fully evaluate the application and its
potential impacts on wetlands or watercourses.
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