FitzwilliamNH Wireless Communications Facilities Application

Applicant Name ______

Submission deadlines: 20 days prior to Public Hearing Date

This application must be accompanied by 1) Per Chapter 219 of the Code of Fitzwilliam a complete site plan as specified in the site plan regulations and completed checklist; 2) a list of names and mailing addresses for all abutters within 200 feet of all boundary lines of subject property; 3) all application fees and noticing costs – checks payable to the Town of Fitzwilliam.

Checklist for a complete application(Check items submitted)

Each applicant requesting a conditional use permit under WCFOD 127-16.2 shall submit a scaled plan in accordance with the Site Plan Review regulations. The following additional information must be indicated on the plan:

______1. Scaled elevation view

______2. Topography

______3. Radio frequency report and coverage map

______4. Tower height

______5. Setbacks

______6. Access ways

______7. Adjacent uses (up to 200 feet away)

______8. Surrounding tree cover and foliage

______9. Map of applicant’s facilities within 20 mile radius

Estimated start date ______Estimated completion date ______

Estimated cost of construction/improvements ______

Briefly describe nature of work to be undertaken ______

______.

Waivers(to determine if waivers are needed mark Y = Yes or N = waiver needed)

______1. Is facility within the Wireless Communications Facilities Overlay District?

______2. Is the proposed facility outside the Floodplain Overlay District, Wetlands Protection Overlay District, Recreational or Conservation lands?

______3. Is the height of the proposed tower lessthan 80 feet?

______4. Is the proposed facility located on property that is notowned, leased or otherwise controlled by the Town?

______5. Is proposed tower setback at least 125% of tower height from boundary?

______6. If the tower is 80 feet in height or taller, is it located more than ¼ mile from any existing towers 80 feet in height or taller?

______7. Is the proposed tower enclosed by security fencing?

______8. Is the proposed tower compound screened from adjacent residential properties?

Other information that must be provided prior to approval by the Board:

  • Demonstration of realistic analysis of multiple alternative sites and need for proposed height.
  • Written proof that proposed use complies with FCC regulations on RF exposure guidelines.
  • Written report that facility satisfies National Environmental Policy Act (NEPA).
  • Inventory of existing towers owned by applicant within the jurisdiction of the Town and those within 2 miles of the border thereof, including specifics on towers, and economic/technological feasibility of co-location on these towers.
  • Written evidence that no existing structure can accommodate the proposed antenna.
  • Agreement that allows for maximum co-location on proposed new tower, at reasonable cost.
  • Engineering information detailing the size and coverage for the facility location.
  • Written report documenting coverage area and coverage gap.
  • Viewshed analysis.
  • Documentation that project meets construction performance standards and is in compliance with all federal regulations, building codes and safety standards.
  • Documentation that project is designed to minimize visual impact.

______

Signature of OwnerDate

______

Signature of Owner’s AgentDate

Land Use OfficePage 1Date created 11/2/2018