Site Alteration Permit Application - Township of Puslinch

Effective August 13, 2015, the Township has placed a moratorium to restrict site alteration projects to no more than 1000m3. If your project requires more than 1000m3 do not fill out this form and please contact the Township.

Owner/Applicant Information

Name of Property Owner/Applicant *

First

Last

Property Owner/Applicant's Phone Number *

Property Owner/Applicant's Email *

Property Owner'/Applicant's Address *

Address Line 1

Address Line 2

City

Province

Postal Code

Agent/Contractor

Agent/Contractor's Name *

First

Last

Agent/Contractor's Email *

Agent/Contractor's Phone Number *

Agent/Contractor's Address *

Address Line 1

Address Line 2

City

Province

Postal Code

Engineers Information

Engineer's Name *

First

Last

Engineer's Email *

Engineer's Phone Number *

Engineer's Address *

Address Line 1

Address Line 2

City

Province

Postal Code

Property Information

Address of proposed Site Alteration Permit Application *

Address Line 1

Address Line 2

City

Province

Postal Code

What is the current use of the property? *

Example: Residential purposes, business or farming purposes.

What is the size of the property? *

What is the zoning of the property? *

Indicate if unknown.

Is any part of the property regulated by a conservation authority? *

Yes
No
Unknown

What conservation authority regulates the property? *

Grand River Conservation Authority
Halton Conservation Authority
Hamilton Conservation Authority

Does any part of the site contain a watercourse? *

Yes
No

Are trees being removed as part of the site alteration project? *

Yes
No

Is the Site Alteration Permit application associated with a building permit? *

Yes
No

Is the Site Alteration Permit associated with a By-law Enforcement Order? *

Yes
No

Is the Site Alteration Permit associated with an approved Site Plan Control Agreement? *

Yes
No

Site Alteration Application Requirements

Note: Once a complete application including payment is submitted it can take a minimum of four weeks to issue a Site Alteration Permit. If the Site Alteration Application requires further reports this process may take longer than four weeks to complete.

Anticipated start date of the work? *

Anticipated compeletion date of the work? *

Are you applying for an exemption under Normal Farm Practices per the Farming and Food Production Protection Act, 1998? *

Yes
No

Name of farmer responsible for the agricultural operation *

First

Last

Email of farmer responsible for the agricultural operation *

Phone number of farmer responsible for the agricultural operation *

Provide a statement of the nature of the agricultural operation. *

Provide the farm business registration number of the agricultural operation. *

Provide a brief description of the proposed works that have been identified on the Plan or Site Plan. *

Example: Constructing a laneway, building a retaining wall, filling an impression

Provide a description of the normal farm pratice. *

Upload any plans or evidence supporting the normal farm practice, including the qualifications of any person providing such plans or evidence.

Click or drag files to this area to upload. You can upload up to 5 files.

What is the size of the proposed work area of the site alteration in hectares? *

What is the source of fill for this project? *

Imported fill (Imported from secondary location)
Native fill (Fill that is being moved from one part of the property to another)

Has any imported fill already been brought into the property? *

Yes
No

Proof from an accredited laboratory that any fill being imported to the site complies with the clean fill parameters as set out in Table 1 of the Ontario Regulation 153/04 as amended.

Click or drag files to this area to upload. You can upload up to 5 files.

This report must be stamped and signed by a Qualified Person under Ontario Regulation 153/04. This a required document for the application, if you are having issues uploading it, you may email the document to admin@puslinch.ca.

Letter of permission from all property owners that the fill being received will be in accordance with the Site Alteration Permit.

Click or drag files to this area to upload. You can upload up to 5 files.

This a required document for the application, if you are having issues uploading it, you may email the document to admin@puslinch.ca.

Describe the composition of fill being imported to the property. *

Provide the source of the fill including the name of the supplier, source location address and contact information of the supplier. *

Provide the amount of fill to be brought into the property in cubic metres (m3). *

Effective August 13, 2015, the Township has placed a moratorium to restrict site alteration projects to no more than 1000m3.

Provide the haul route for the fill.

Qualified Persons Information

A Qualified Person (QP) within the meaning of Section 5 of Ontario Regulation 153/04. QPs are professional geoscientists and professional engineers. A QP who is retained should be someone who can exercise professional judgement based on his or her experience in order to advise on appropriate reuse options for the excavated social or excess soil, and make these decisions based on appropriate analysis and characterization of the soil. The QP should use a risk-based approach and take into consideration the effects of loading associated with the concentration of individual contaminates in soil and the impacts on the pre-existing, ambient conditions at the site. This will likely require a QP who is qualified to prepare or supervise a risk assessment, as set out in Section 6 of Ontario Regulation 153/04. Depending upon the intended beneficial reuse of the excess soil, the QP may need to consult with others to make decisions on the appropriateness of the excess soil reuse.

Qualified Person's Name *

First

Last

Qualified Person's Email *

Qualified Person's Phone Number *

Qualified Person's Address *

Address Line 1

Address Line 2

City

Province

Postal Code

Is the QP qualified under the Professional Engineers Act or the Professional Geoscientists Act, 2000?

Professional Engineers Act
Professional Geoscientists Act, 2000

Provide Licence Number under the Professional Engineers Act

Provide Certificate Number under the Professional Geoscientists Act, 2000

Upload a letter signed and dated by the QP as defined in O. Reg. 153/04, as amended, confirming that all fill imported to the property is in compliance with O. Reg. 153/04 and the amount of fill to be imported to the property in cubic metres (m3).

Click or drag files to this area to upload. You can upload up to 5 files.

This a required document for the application, if you are having issues uploading it, you may email the document to admin@puslinch.ca.

Does this project include a retaining wall? *

Yes
No

Please upload a plan showing the design details to proper scale of any retaining wall.

Click or drag files to this area to upload. You can upload up to 5 files.

This a required document for the application, if you are having issues uploading it, you may email the document to admin@puslinch.ca.

Please upload a plan and supporting documents which meets the requirements from Section 5 of the Site Alteration By-law outlined below

Click or drag files to this area to upload. You can upload up to 5 files.

This a required document for the application, if you are having issues uploading it, you may email the document to admin@puslinch.ca.

Please check that you have satisfied all the required components for the plan and support documents submitted above. *

Applications that do not include all of the required information above will be returned to the applicant for revisions. The Chief Building Official may require additional information depending on the nature of the application.

Terms and Conditions

That this application and all studies submitted in support of this Application may be made available for public review, pursuant to the provisions of the Municipal Freedom of Information and Protection of Privacy Act.

I shall not submit or cause or permit my application for a Permit to be submitted to the Township that is misleading or contains false information. Where it is revealed that the applicant or a Permit contained misleading or false information, the said Permit may be revoked by the Chief Building Official and the Permit Holder shall forthwith cease all work which was the subject of the revoked Permit.

I understand that, effective August 13, 2015, the Township has placed a moratorium to restrict site alteration projects to no more than 1000m3. Applications for Site Alterations with an excess of 1000m3 of fill will not be approved. Save and except projects deemed Normal Farm Practices under Farming and Food Production Protection Act, 1998.

I agree that I have reviewed and understand the Township’s Site Alteration By-Law 031/2012 and further that I will comply with all requirements set out in that By-Law.

I understand further requirements may be imposed by the Chief Building Official that may be included as conditions to the approval of the permit.

I understand that it is the responsibility of the owner/applicant to ensure the Township is notified when the Site Alterations project is complete and provide the Township with as-built engineering drawings for final inspection by the Township’s Engineers.

In accordance with the Township’s User Fees and Charges By-law 052/2021, I agree to pay all third party costs associated with any necessary third party review of the application as deemed necessary by the Township. This includes applications made under Normal Farm Practices. Outstanding amounts not paid will be treated in the same manner as unpaid taxes in accordance with the provisions of the Municipal Act.

The owner will, both during and following the term of the Permit indemnify and save harmless the Township from all costs, losses, damages, judgements, claims, demands, suits, actions, complaints or other proceedings in any manner based upon, occasioned by or attribute to anything done or omitted to be done by the Owner, its directors, officers, employees, agents, sub-contractors or volunteers in connection with site alteration and fill activities conducted pursuant to the Permit.

I have read, understood, and will comply to the attached Terms & Conditions which form part of this permit application.

Terms and Conditions *

I have read, understood and agree to the Terms and Conditions.

Signature *

Conservation Authority Regulation Maps

Owner/Applicant Information

Agent/Contractor

Engineers Information

Property Information

Site Alteration Application Requirements

Qualified Persons Information

Terms and Conditions