3010-FM-IWO0005 Rev. 3/2013
    COMMONWEALTH OF PENNSYLVANIA
    Instructions
    DEPARTMENT OF ENVIRONMENTAL PROTECTION
    INTERSTATE WATERS OFFICE
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    Remove and recycle these instructions prior to sending the completed forms to DEP.
    Instructions for the Lake Erie Bluff Recession and Setback Act
    Activity Summary Form and Detailed Activity Report
    PURPOSE
    Local municipalities along the shoreline of Lake Erie in Pennsylvania are responsible for primary enforcement of the Bluff
    Recession and Setback regulations (Pa. Code Title 25, Chapter 85). Each municipality with a designated Bluff Recession
    Hazard Area (BRHA) is required to enact and enforce a bluff setback ordinance that meets the minimum requirements set
    forth in the regulation. In order to facilitate Department oversight of municipalities’ enforcement of their bluff recession
    and setback ordinances and to allow proper Department accountability to the National Oceanic and Atmospheric
    Administration (NOAA, the source of federal funding for all Bluff Recession and Setback Act activities in Pennsylvania),
    municipalities are required to annually submit the following records with respect to activities occurring within designated
    BRHAs:
    1. Applications for Permits
    Name and address for applicant
    2. Locations and descriptions of:
    New construction activities within minimum bluff setback distance (MBSD)
    Improvement projects (including substantial improvements) within MBSD
    All records relating to variances granted within BRHAs
    3. Records of issuance or denial permits
    4. All correspondence related to permitting activity within designated BRHAs
    Table 1: Municipal* Minimum Bluff Setback Distances (MBSD) and Bluff Recession Hazard Areas (BRHA)
    *Municipal-enacted MBSDs are shown in Table 1 and may be more stringent than those appearing in the Chapter 85
    regulations. Municipal-enacted MBSDs are subject to change. Please confirm the MBSD by consulting the most recent
    municipal ordinances.
    **
    Industrial includes institutions, government buildings, schools, country clubs, amusement parks, and other public service
    facilities.
    ***Bluff Recession Hazard Area (BRHA) is defined as the area comprised of the bluff face and tableland and for setback
    purposes is the distance from the bluff line to the landward measurement of the industrial setback.
    Municipality
    Residential MBSD
    Commercial MBSD
    Industrial** MBSD
    BRHA***
    Springfield Twp.
    100
    150
    200
    200
    Girard Twp.
    200
    200
    200
    200
    Lake City Boro.
    150
    150
    150
    150
    Fairview Twp.
    100
    100
    100
    100
    Millcreek Twp.
    50
    75
    100
    100
    City of Erie
    25
    25
    25
    25
    Lawrence Park Twp.
    75
    75
    100
    100
    Harborcreek Twp.
    50
    75
    100
    100
    North East Twp.
    50
    75
    100
    100

    3010-FM-IWO0005 Rev. 3/2013
    Instructions
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    The Department created the Activity Summary Form and companion Detailed Activity Report to aid municipalities in
    meeting the reporting requirements and to standardize the format in which the Department receives the required
    information. The Activity Summary Form provides an overview of the total number of permits and variances issued and
    denied within each municipality’s BRHA during each calendar year. It is supplemented by the Detailed Activity Report,
    which provides more detailed information on each applicable permitting action taken by the municipality. These forms are
    available on the Department’s eLibrary website
    (
    http://www.elibrary.dep.state.pa.us
    ).
    Each municipality with designated BRHAs must complete one (1) Activity Summary Form for each calendar year and
    one (1) Detailed Activity Report for each permit approved and each permit denied within its formally adopted MBSD during
    that calendar year. The completed reports are due to the Department annually, no later than February 28
    th
    . Reporting to
    the Department is coordinated through the Erie County Department of Planning and municipalities must submit the
    completed forms with all appropriate enclosures to that office no later than January 31
    st
    . Contact the Coastal Zone
    representative for the Erie County Department of Planning for more information on reporting procedures (contact details
    are provided at the end of these instructions).
    ACTIVITY SUMMARY FORM – ITEM-BY-ITEM INSTRUCTIONS
    The Lake Erie Bluff Recession and Setback Act Activity Summary Form is organized into five sections. The following
    instructions provide additional information regarding the information that the Department is requesting for each data field.
    Section I: General Information
    Municipality
    : Name of the municipality submitting the report.
    Reporting Year
    : The calendar year to which the submitted data and permitting information apply. Reporting is
    coordinated through the Erie County Department of Planning. Municipalities must complete the forms described
    within these instructions and submit them, along with the appropriate enclosures, to the Erie County Department of
    Planning no later than January 31 of the calendar year immediately following the reporting year (e.g., a municipality
    reporting data for permitting activities within 2011 must submit completed forms and enclosures to the Erie County
    Department of Planning by Jan 31, 2012).
    Contact Name/Title
    : Name and position title of the municipal representative completing the report.
    Mailing Address, City/State, ZIP, Telephone Number, E-mail, Mobile, and Fax
    : The contact details of the
    municipality offices. Include the telephone and mobile phone numbers of the municipality contact person
    responsible for the completion of this report.
    Section II: Indicate the number of permits issued under each activity for the reporting year:
    A. Within the Minimum Bluff Setback Distance (MBSD):
    Indicate the total number of residential, commercial,
    and industrial permits issued during the reporting year for activities or structures within or bisected by the
    minimum bluff setback line.
    B. Outside of the Minimum Bluff Setback Distance (MBSD) but within the Bluff Recession Hazard Area
    (BRHA):
    Indicate the total number of residential, commercial, and industrial permits issued during the reporting
    year for activities or structures within the designated bluff recession hazard areas but
    not
    within or bisected by
    the minimum bluff setback line.
    Section III: Indicate the number of permits denied under each activity for the reporting year:
    A. Within the Minimum Bluff Setback Distance (MBSD):
    Indicate the total number of residential, commercial,
    and industrial permits denied during the reporting year for activities or structures within or bisected by the
    minimum bluff setback line.

    3010-FM-IWO0005 Rev. 3/2013
    Instructions
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    B. Outside of the Minimum Bluff Setback Distance (MBSD) but within the Bluff Recession Hazard Area
    (BRHA):
    Indicate the total number of residential, commercial, and industrial permits denied during the reporting
    year for activities or structures within the designated bluff recession hazard areas but
    not
    within or bisected by
    the minimum bluff setback line.
    Section IV: Submit with this summary form one completed Lake Erie Bluff Recession and Setback Act Detailed
    Activity Report Form (#3010-FM-IWO0004) for each permitting action taken within the MBSD during the reporting
    year:
    The municipality must attach one (1) completed BRSA Detailed Activity Report Form (#3010-FM-IWO0004) for each
    permitting action within the MBSD taken by the municipality within the reporting year.
    Section V: CERTIFICATION AND SIGNATURES:
    The municipal representative who completed or oversaw the completion of this form must sign and date the form,
    certifying the accuracy and completeness of the information submitted on the summary report as well as any
    included BRSA Detailed Activity Reports and associated supplemental enclosures.
    DETAILED ACTIVITY REPORT – ITEM-BY-ITEM INSTRUCTIONS
    Section I: General Information:
    Municipality
    : Name of the municipality submitting the report.
    Reporting Year
    : The calendar year to which the submitted data and permitting information apply. Reporting is
    coordinated through the Erie County Department of Planning. Municipalities must complete the forms described
    within these instructions and submit them, along with the appropriate enclosures, to the Erie County Department of
    Planning no later than January 31 of the calendar year immediately following the reporting year (e.g., a municipality
    reporting data for permitting activities within 2011 must submit completed forms and enclosures to the Erie County
    Department of Planning by Jan 31, 2012).
    Section II: Applicant Contact Information:
    Contact Name/Title
    : Name and position title of the applicant contact for the permit/variance application.
    Company:
    The business, association, government or other entity sponsoring the project to which the
    permit/variance application applies, if the applicant is other than a homeowner or residential landowner.
    Mailing Address, City/State, ZIP, Telephone Number, E-mail, Mobile, and Fax
    : The contact details of the
    applicant. Include the telephone and mobile phone numbers of the contact person responsible for the submission of
    the permit/variance application.
    Section III: Address Zoning Application Information:
    Date of Application:
    Indicate the date that the zoning application was submitted by the applicant.
    County Tax Number, Date Property Established:
    Provide that tax identification number of the parcel to which the
    application pertains. The official tax map of the property and a copy of the permit application must also be attached
    to the report. The tax map, parcel ID, and property owner information can be obtained from the Erie County
    Assessment Office located at the Erie County Courthouse, or you may have these tax ID numbers at your Township
    office. The date reported must be the date that the land parcel was established – not the date that the structure was
    built. Parcel information may also be obtained from:
    http://eriecountygov.org/government/assessment/parcelsearch.aspx

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    Section IV: Address of Property Requesting Zoning Permit (if different than contact information):
    Address:
    The street address of the property where the proposed activity was planned to occur. This may be
    substituted with GPS coordinates of the proposed project, if applicable.
    City/State, and Zip:
    The city, state and Zip code where the proposed activity was planned to occur.
    Section V: Type of Structure:
    Indicate whether the proposed structure or structure to be improved is residential, commercial, or industrial.
    Residential structures are defined as a place providing habitation for an individual or group of individuals.
    Commercial structures are defined as a place where commodities are exchanged, bought or sold. Industrial
    structures are defined as a place where materials are refined, produced or fabricated and stored prior to shipment
    to commercial establishments.
    Section VI: Specific Type of Structure:
    Check all that apply to the submitted permit/variance application.
    Section VII: Type of Construction:
    For planned improvements to an existing structure, check the first box and proceed to Section VIII. Do NOT
    complete Section IX.
    For new structures, go to Section IX. Do NOT complete Section VIII.
    Be sure to attach before and after color photographs of the improvements or new construction with descriptive and
    directional captions.
    Section VIII: Improvement to an Existing Structure:
    Indicate the market value of the
    structure
    – not including land – and attach a copy of the certified appraisal. The
    market value of the structure may also be determined using property assessment records and applying the
    appropriate Common Level Ratio in lieu of a certified appraisal. Attach a copy of the assessment record, indicating
    the Common Level Ratio used. A new appraisal or assessment is required if the most recent established market
    value is more than 5 years old.
    Also include the estimated cost of construction determined by applying the latest “minimum square foot cost” for
    Erie County as reported in the latest edition of the
    Building Officials and Code Administrators International, Inc.
    Building Valuation Data Report
    and the 5-year aggregate cost of improvements, which are not to exceed 50% of the
    structure’s market value unless authorized by a Department or municipal variance.
    Section IX: New/Replacement Structure:
    For new structures or replacements of destroyed structures, indicate the shortest distance from the bluff line to the
    closest point on the planned structure. For replacement structures, indicate whether the replacement was
    constructed on the original footprint. If it was not, explain the surrounding circumstances. Also for replacement
    structures, indicate whether the improvements were made to the replacement relative to the original structure’s form
    and condition prior to being damaged or destroyed and complete Section VIII, if applicable.

    3010-FM-IWO0005 Rev. 3/2013
    Instructions
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    Section X. Municipal Action (check appropriate line and fill in the relevant information):
    Check the box that indicates whether the permit or variance application was issued or denied, and provide the
    appropriate dates. Provide a narrative describing the details surrounding the issuance or denial. Attach additional
    sheets if necessary.
    MAILING OF THE SUBMISSION
    Municipalities must complete these reporting forms and submit them, along with the appropriate enclosures, to the Erie
    County Department of Planning no later than January 31. The Erie County Department of Planning coordinates final
    reporting to the Department’s Interstate Waters Office, Coastal Resources Management Program for all affected
    municipalities.
    Erie County Department of Planning
    Erie County Courthouse
    140 West 6th Street, Room 111
    Erie, PA 16501
    Phone: (814) 451-6336
    Fax: (814) 451-7000
    Pennsylvania Department of
    Environmental Protection
    Interstate Waters Office
    P.O. Box 8465
    400 Market Street, 11th Floor
    Harrisburg, PA 17105-8465

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