Qualified Person for Site Alteration Permit Application

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.

Name of QP *

First

Last

QP's Email *

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

Professional Engineers Act
Professional Geoscientists Act, 2000

Provide the address of the property for the Site Alteration Permit that the QP is taking responsibility of. *

Address Line 1

Address Line 2

City

Province

Postal Code

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.

Personal information on this form is collected under the authority of the Municipal Act and will be used to determine the eligibility of a permit. The information is used for the purpose of processing this application and administering the entrance permit program and is maintained in accordance with the Municipal Freedom of Information and Protection of Privacy Act. Questions regarding the collection of this information may be directed to the Township Clerk’s office.

The Township of Puslinch is committed to providing accessible formats and communication supports for people with a disability. If another format would work better for you, please contact the Township Clerk’s office for assistance.