Land Disturbance Permit

2. Land Disturbance Permit Instructions

   Purpose:

   To eliminate any non-allowable discharges to Portland’s Municipal Separate Storm Sewer System (MS4) that may adversely affect impact water quality.

   Who must submit a Land Disturbance Permit Application?

   Land development that disturbs ¼ acre or are otherwise required to have a permit per the City’s Stormwater ordinance, Title 21. The Stormwater Administrator can require a Land Disturbance Permit no matter the amount of disturbance. Any other required state, federal or local permits must be issued before this permit. 

   Completing the form: 

   Type or print clearly, using ink and not markers or pencil.   Initial each blank item signifying that you have read these sections and will comply with them.  The entire application must be completed, and every blank filled in, or the application will be void. Submitting this Land Disturbance Permit application does not exempt you from complying with all aspects of the city of Portland’s Stormwater Management Ordinance.  This form does not exempt you from obtaining any other state, local or federal required permits. 

   Land Disturbance Permit Guide

   • A pre-construction meeting is required for all commercial, industrial, or major subdivision projects. Contact the City of Portland Planning Department for scheduling. 
   • Grading work must commence within 60 days of issuance or permit will be void.
   • The permit is valid for one (1) year from date of issue ---- after that date, you must contact the Stormwater Department for renewal.
   • Grading shall conform to lines and grades as shown on the approved drawing and shall be in accordance with the specifications as approved by the City of Portland, it’s Stormwater Management Ordinance, and approved Best Management Practice Manual.
   • No grading, clearing and/or any other construction activity is allowed before issuance of this permit. Preliminary erosion and sediment control devices must in place before issuance of this permit. These devices shall be in place and maintained throughout the construction period. A Land Disturbance Permit must be posted at the project site at all times.
   • All EP&SC devices are to remain in place until the site has been stabilized and, at minimum, 75% vegetative growth has been established.
   • The primary permittee will be held responsible for ALL aspects of the site. This includes, but is not limited to, any fines that may occur from noncompliance with this permit, costs associated with clean-up efforts, and/or corrective actions.
   • Priority sites that disturb one (1) acre or greater, or as identified by City staff, must be self-inspected twice weekly by a qualified inspector. Copies of the inspections must be made available to City staff at any time. 
   • A final inspection by all departments is required before a Certificate of Occupancy will be issued. All inspections must be scheduled at least 24 hours in advance. No temporary C.O.’s will be granted. 
6. Pre-Construction Check off list:

   Please initial that the following requirements have been accomplished before issuance of Land Disturbance Permit (put N/A if not applicable):

8. A pre-construction meeting has been held with all necessary City staff relevant to the project*

   1. Accomplished
   2. N/A
10. Silt fence or other sediment barriers are installed properly along topographical contour downslopes of the area to be disturbed. Excavated topsoil to be reused must be stockpiled and encircled with silt fencing as soon as practicable.*

    1. Accomplished
    2. N/A
12. This site contains a temporary stone construction entrance that conforms to the City of Portland’s Stormwater Ordinance and Best Management Practice Manual. The stone shall be 2 – 4 inches in diameter and shall be kept clean by adding stone as needed. It shall be at least 8 inches deep underlain with filter fabric and 20 feet wide x 50 feet long. *

    1. Accomplished
    2. N/A
14. Riparian buffers or other protection are provided along all water resources according to section 21-106 of the Portland Stormwater Ordinance. *

    1. Accomplished
    2. N/A
16. Stabilization measures will be performed within fourteen (14) days in portions of the site where construction activities have temporarily or permanently ceased.*

    1. Accomplished
    2. N/A
18. Sediment that has escaped the construction site and has collected in the street or drainage structures will be removed immediately.*

    1. Accomplished
    2. N/A
20. All construction trash and debris will be properly managed at all times. Building and waste materials and non-storm water discharges, such as concrete washout, paint wash-water, or machinery leakage or spillage must be immediately contained to prevent them from entering the stormwater system, ground water or nearby water body.*

    1. Accomplished
    2. N/A
22. The site will be inspected and closely monitored by the primary permittee, or their qualified designee, no less than twice weekly, 72 hours apart. *

    1. Accomplished
    2. N/A
24. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    
    

    I certify, under penalty of law, that I have reviewed this document and understand the erosion prevention and sediment control requirements here in. I agree to implement and follow the provisions of the Land Disturbance Permit for the construction site. I understand that these requirements will be inspected and enforced by the City of Portland and failure to comply may result in the issuance of a “stop work order” and/or other penalties until compliance is accomplished.  The undersigned is identified as the primary permittee of the site and will be responsible for complying with this permit and any applicable provision of the Portland Stormwater Management Ordinance including Civil Penalties of $50 to $5,000 per day, per violation of noncompliance.

    1. I agree.
26. Primary Permittee Print Name
27. Date*
    Date
29. Electronic Signature*
33. Land Disturbance Permit Fee Schedule

    The City of Portland authorized rate structures for Stormwater Land Disturbance Permits and Stormwater Engineering Plans Review fees per Ordinance No. 22-57. These fees took effect on October 1, 2022. All fees must be paid in full prior to issuance of the Land Disturbance Permit. Fees can be paid at the Business Office located in Portland City Hall, 100 S Russell Street, Portland, TN 37148 or by phone at 615-325-6776 ext. 555. ALL new Land Disturbance Permit applications received after October 1, 2022, are subject to the following fees*:

35. Effective October 1, 2022

    Land Disturbance Permit Fee

    Residential	$200 per residential lot
    Commercial / Industrial	$200 + $50 per each additional acre

     

     

    Stormwater Engineering Plan Review Fee

    Less than one (1) acre	Minor Subdivisions and minor plats	$100
    Less than one (1) acre	Major Subdivisions, Commercial, and Industrial	$250
    Greater than one (1) acre	Major Subdivisions, Commercial, and Industrial	$450 + $25 each additional acre

     

    *Fee applies to all new permit applications

    *Fee is not required for permit renewals or extensions

39. Date
    Date
40. Choose One

    1. Residential
    2. Commercial
41. Project Name
43. Owner/Developer (Primary Permittee):
45. Email Address
46. Phone Number
48. Owner (Primary Permittee) Address:
50. City
51. State
52. Zip Code
54. Property Address:
56. City
57. State
58. Zip Code
60. Subdivision
61. Map & Parcel #
63. Contractor Name
64. Contractor Email Address
66. Contractor Address
68. City
69. State
70. Zip Code
72. Phone Number
74. Lot #
75. TDEC Permit #
77. EPSC Contact Information
79. Land Area Disturbed
80. Start and Complete Dates
82. Additional Comments
Leave This Blank:


84. 1. Receive an email copy of this form.
85. Email address

    This field is not part of the form submission.

86. Submit

* indicates a required field