27 PIERCE RD - BUILDING INSPECTION t
13 - 1 t-r CV) N C b
The Commonwealth of Massachusetts
I'a Board of Building Regulations and Standards CEf Y OF
\� ! Massachusetts State Building Code, 780 CMR IagPEC � NAL OhC�$
Revised Mar Z 7
Building Permit Application To Construct, Repair, Renovate Or Demflli,S,h�UN 20 A I) 3
One-or Two-Family Dwelling t91V
This Section For Official Use Only
Building Permit Number: Date P p�plied: 1
Building Official(Print Name) Signature VDate
SECTION l: SITE INFORMATION
1.1 Property Address: n 1.2 Assessors Map& Parcel Numbers
I.I a Is this an accepted street?yes--pC no Map Number Parcel Number
. e.° 7os,in E; 2nform:!ti<>u: --- 1:t i'eopt:rty t➢inx•nsions
Zoning District Proposed Use Lot Area(sq fQ Frontage(R)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided R,qttired Provided
1.6 Water Supply:(M.G.1,a 40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public Private❑ Zone: _ Outside Flood Zone'? MunicipalAK On site disposal system Cl if yes❑
SECTION 2: PROPERTY OWNERSHIP'
22 wnej of Record:C/o, X, ^� �/ 1W
. ,
J ft )�
City,State.ZIIP('
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Buildingjlt Owner-Occupied:9 1 Repairs(s) ❑ 1 Alteration(s) W Addition M
Demolition ❑ Accessory Bldg.❑ Number ofUnits_L I Other ❑ Specify:
Brief Description of Prop sed Work-:
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1. Building $ p8' — 1. Building Permit Fee: $ _Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical $ /a. 1co-
0 Total Project Cos[ (Item 6)x multiplier x
3. Plumbing $ 174 6 00 — 2. Other Fees: $
4. Mechanical (HVAC) $ U — List:
5. Mechanical (Fire $ -
Su tression�_ Total All Fees: $
.11 Check No. Check Amount Cash Amount:
G. Total Project Cost: $ _ ❑paid in Full ❑Outstanding Balance Due:
Q6 0,00
I y
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction gupervisor License(CSL)
10171
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
CityTown,Stafe,ZIP M Mason
ry
RoofingCovering
OC,ra4gA/Gl WS Window and Sid in
SF Solid Fuel Burning Appliances
r� I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(1IIC) IVY J y
I �"'d'� `i6'"'� LLC _ HIC Registration Number Expiration Date
HIC Company N ame or HIC Registrant Nano /
.2 /J/e.r, �j.�cu.G�Joir.✓iie tuni�/�w ��. r,
No.�nd Street // A,^ Email address
Cit /Tow ,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. § 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes .......... ❑ No...........A
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property, hereby authorize /.�/'�CL Zr /GiaoF/�t
to act on my behalf,in all matters relat�authorized by this building permit application.
7 ' T-/L
Print Owners ame(Electronic Signature) Date
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.n
Print Owner's or Authorized Agents Name(Electronic Signature) Data
NOTES:
I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC) Program), will not have access to the arbitration
program or guaranty fund under M.G.L.a I42A.Other important information on the HIC Program can be found at
www.mass. ov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dps
2. When substantial work is planned,provide the information below:
Total Floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area.(sq. ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
i
CITY OF'S:ULEM, ANSSACHUSETTS
S BUILDING DEPARTMEINT
tt??PP i
� YI'6 7 5r 120 WASHLNGTON STREET, 3w FLOOR
aY TEL (978) 745-9595
F.kx(978) 740-9846
KI\IBERLEY DRISCOLL
LiYOR THmus ST.PIERRH
DIRECTOR OF PUBLIC PROPERTY/BI:ILDMG CO\L\IISSIONER
Workers' Compensation Insurance Affidavit: Dnild.Crs/Contractors/Electricians/Plum6ero,
Applicant Information Please l PrriC.�
innt'1 l egihiy
Name (Ilusinass.Organiralion,'Individual): - / ��Or//e, .r ZG
Address: � �/n /� fl—
City/State/Zip: srww.+r�io �l /r/`IM0.7Phone #: 74/— IW IWO
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ 1 am a employer with 4. 6.1 am a general contractor and 1 6. ❑New constriction
employees(full and/or part-time).• have hired the sub-contractors
2.❑ lama sole proprietor or partner- listed on the attached sheet.' 7. ®'Remodeling
ship and have no employees These sub-contractors have 0. ❑ Demolition
working for me in any capacity. workers'comp. insurance, y. Building addition
[,No workers' comp. insurance 5. El We are a corporation mid its
required.] officers have exercised their 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL I! CI Plumbing repairs or additions
myself. (No workers'comp.. C. 152, §1(4),and we have no 12.❑ Roof repairs
insurance required.] t employees. (No workers' 13,(� Other
comp.insurance required.]
•Any applicant tlur dncka box tt moat also rill out the section below thawing their workers'eumpemadun pulicy inllnmatiun.
'1lumeawners ahu suhmit this amdnvih indicating they ore doing all work and then hire uWfide conitactan most.nihmit a new afr dzvit indicating such
$'namewn Ihut shack this bux most anaehev!an additiuwl ahevl showing the name of hhe sub<amneors and their worken'camp.pulley information.
I ant can employer that is providing workers'compensaton insurance for my employees. Below Is the policy and job site -
iuforrnation.
In.aur:mce Company Name: i" f 7—
Policy 4 or Sclf-iim Lie.
�fl: �/���� �/O�oL�_ Expiration Date: 0.2.. IIJ-1.'y�/f
/
lob Site Address: /� /leACe— // City/State/Zip:,..Js�n �/�•
Attach a Copy of the workers'compensation policy deciaratlan page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A ot'NIGL c. 152 can lead to the imposition of criminal penalties of a
fine up to S1.500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and aline
of up to$230.00 a day against the violator. lie advised that a copy of this statement may be furwardcd to the Office of
Investigations ofthe DIA for insurance coverage verification.
/do/rereby certify wider dos/pains auud ppenalties of perjury that the information provided above is true and correct.
sI,Fmlu e' /—l7w.ry� 1-2
Phone 1 �/!� 7--��(, (5
Ojjiciul use Will. Do not write in this area, to be completed by city or town njjiviul
City ar'I'mvn: __ I'ermitl.lcensc R
Issuing Authority(circle one): -- _— _--- --
l. Board of Ilealth 2. Building Beparlotent 11.Cityfrimn Clerk 4. Electrieal IWspector 5. Plumbing luspector
6. Other
Phone ti:
PATR°NTEN TRANSMITTAL
LAND DEVELOPMENT ENGINEERING
14 BROWN STREET DATE JOB NO. 3_ /
SALEM, MA 01970
TEL. (978)836-6400 FAX(978)745-4110 PROJECT NAME
E-mail: scott.patrowicz@verizon.net
ToC� .. ........_ __.... . ..
__S�l�t �•aP`�s.._f--- �r ram .14
_.......... S '_ ,. 1_-N-2 ± .........---.....
..........owg_o0._....
._.
TRANSMITTING: -Attached Ategular Mail ❑Overnight Express ❑ Hand Delivered ❑ Picked Up
jt,Plans/Prints ❑Original Mylar ❑Computer Disk ❑ Specifications ❑Calculations
❑ Letter ❑Report CeD C.
COPIES DATE / DESCRIPTION
_._._.._._.........
_-------- _
_�------'-�-�-.3i-�!-�'- -0� of ���i'lon1�-- �c,/�;`c�i"► i
THESE ARE TRANSMITTED as checked below:
❑ For Approval For Your Use JAAs Requested ❑ For Review And Comment ❑
❑ For Bids Due: ❑ Please call me to discuss. ❑
REMARKS
--- -- - �_ .. __. -.. . -
COPY TOc�k~
COPY TO3.
3%4
- -- —
COPYTO_O .�1t''
SIGNED
Scott Patrowicz, P.E.
I/enclosures are not as noted, kindly notify us at once.
IIEO RFPOM:B WMNESS FONMSLO\ -W-180b93MR
t Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
_.Construction Super isor
License: CS-040208 '
BRUCE E PARAD)SE
21 ELM PLACE ;
SWAMPSCOTT MA 01907 -
I ;
Expiration
Commissioner 10/31/2014
��O�PiM/E9i000I60G'CGIt�O�C✓t'�!lJJC/[J!(6JCQ� r
Office of Consumer Affairs&Business Regulation I
&JOME IMPROVEMENT CONTRACTOR
.t egistration 103634 Type:
Expiration 7/9/2014 . Individual
BRUCE E.PARADISE
Bruce Paradise _
21 ELM PL.
Swampscott, MA 01907
Undersecreta—
ry
I }.
CITY OF SAL.EM, A-1S&kCRUSETTS
8l:[LI]LNc; DEPARTMENT
120 WASHLNGTON S-mUT 1'O FLOOR
TaL (979) 745-9595
KIMOERLEY DRISCOLL FAA(973) 74MS45
NLAYoa
1 i-+osct3 Sr.Pt`�tg
DIRECTOR OF PLOLIC PROPERTY/aMOLNG CONLNUSSIONER
Construction Debris Disposal Aftldavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 730 C"JR section l l
Debris, cuid die provisions of tMOL e 40, S 54; 1.5
Building Permit /# is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as dafiacd by ,1(CL c
I If, S I50A.
The debris will be transported by:
y
(name ut hauler) ZZ,
The debris will bc.disposed ot.in
_At�/I f�
(nano of facility) �--
(aJJtess of tauluy)
9
siynaturr ufpa'rnit applicant
J.ur --
V
i
1
5
t'
tl�
y
}
{ r
Essex Southern District
i Registry of Deeds
45 Congress Street I
Suite 4100 li
Salem, MA 01970
04/16/2014 11:03 AM
Station: ESSX-REC10
Time:11:03 Type: CONDN Loc: SALEM
Inst 197 BK 33221-167
FEE 55.00 _
` ENV FEE 20.00
i Check 8931 PATROWICZ 75.00
��n � III IIIII III IIIII�I� IIIIIIII I I IIIIII
2014041600197 H:33221 Pg:167
04116/2014 11:03 CONDN Pe 1116
I
Massachusetts Department of Environmental Protection Provided by MassDEP:
Bureau of Resource Protection -Wetlands 64-563
WPA Form 5 — Order of Conditions MassDEP File#
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 eDEP Transaction#
Salem
City/Town
A. General Information
Please note: Salem
this form has 1. From: Conservation Commission
been modlfied
with added 2.This issuance is for
apace to a.®Order of Conditions b.❑Amended Order of Conditions
accommodate (check one):
the Registry
of Deeds 3. To: Applicant:
Requirements
Charles A. Smith
a.First Name b.Last Name
Important: - -
When filling
out fortes on c.Organization
the 4 Gal loupes Point Road
computer, d.Mailing Address
use only the
tab key to Swampscott MA 01907
move your e.City/rown I.State g.Zip Code
cursor-do
not use the 4. Property Owner(if different from applicant):
return key.
Clayton W. and Jean L. Smith
1�1 a.First Name b.Last Name
c.Organization
27 PierceeRoad
d.Mailing Address
Salem MA 01970
e.City/Tovm f.State g.Zip Code
s. Project Location:
27 Pierce Road Salem
a.Street Address b.City/Town
31 319
c.Assessors Map/Plat Number d.Parcemot Number
Latitude and Longitude, if known: d m s it m s
d.Latitude e.Longitude
wpaforms,doc- W.05na2010 Pape 1 of 12
Massachusetts Department of Environmental Protection Provided by MassDEP:
Bureau of Resource Protection -Wetlands 64-563
WPA Form 5 — Order of Conditions MassDEP File ft
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 eDEP Transaction#
Salem
Cityrrown
A. General Information (cont.) .
6. Property recorded at the Registry of Deeds for(attach additional information if more than
one parcel):
South Essex
a.County b.Certificate Number(if registered land)
6803 527
c.Book d.Page
2/27/2014 3/27/2014 3/31/2014
7. Dates: a.Date Notice of Intent Filed b.Date Public Hearing Closed c.Date of Issuance
8. Final Approved Plans and Other Documents(attach additional plan or document references
as needed):
See attached
a.Plan Title
b.Prepared By c.Signed and Stamped by
d.Final Revision Date e.Scale
I.Additional Plan or Document Tale g.Date
B. Findings
i. Findings pursuant to the Massachusetts Wetlands Protection Act:
Following the review of the above-referenced Notice of Intent and based on the information
provided in this application and presented at the public hearing, this Commission finds that
the areas in which work is proposed is significant to the following interests of the Wetlands
Protection Act(the Act).Check all that apply:
a. ® Public Water Supply b. Z Land Containing Shellfish c. ® Prevention of
Pollution
d. ® Private Water Supply e. ® Fisheries I. Wi Protection of
Wildlife Habitat
g. ® Groundwater Supply h. ® Storm Damage Prevention i. ® Flood Control
2. This Commission hereby finds the project,as proposed,is:(check one of the following boxes)
Approved subject to:
a. ® the following conditions which are necessary in accordance with the performance
standards set forth in the wetlands regulations.This Commission orders that all work shall
be performed in accordance with the Notice of Intent referenced above, the following
General Conditions, and any other special conditions attached to this Order.To the extent
that the following conditions modify or differ from the plans, specifications, or other
proposals submitted with the Notice of Intent,these conditions shall control.
wparwrasow• Psg112cf I2
Massachusetts Department of Environmental Protection Provided by MassDEP:
Bureau of Resource Protection -Wetlands 64-563
WPA Form 5 — Order of Conditions MmDEP Fit-#
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 eDEP Transaction#
Salem
cityrrown
B. Findings (cont.)
Denied because:
b. ❑ the proposed work cannot be conditioned to meet the performance standards set forth
in the wetland regulations. Therefore, work on this project may not go forward unless and
until a new Notice of Intent is submitted which provides measures which are adequate to
protect the interests of the Act, and a final Order of Conditions is issued. A description of
the performance standards which the proposed work cannot meet Is attached to this
Order.
c. ❑ the information submitted by the applicant is not sufficient to describe the site, the work,
or the effect of the work on the interests identified in the Wetlands Protection Act.
Therefore,work on this project may not go forward unless and until a revised Notice of
Intent is submitted which provides sufficient information and includes measures which are
adequate to protect the Act's interests, and a final Order of Conditions is issued. A
description of the specific information which is lacking and why it is necessary is
attached to this Order as per 310 CMR 10.05(6)(c).
3. ❑ Buffer Zone Impacts: Shortest distance between limit of project
disturbance and the wetland resource area specified in 310 CMR 10.02(1)(a) a.linear feet
Inland Resource Area Impacts: Check all that apply below. (For Approvals Only)
Resource Area Proposed Permitted Proposed Permitted
Alteration Alteration Replacement Replacement
4. ❑ Bank a.linearfeet b.linear-feet c.linear-feet d.linear feet
s. ❑ Bordering
a.
Vegetated Wetland square feet b.-square feet c.square feet d.square feet
6. ❑ Land Under
Waterbodies and a.square feet b.square feet c.square feet d.square feet
Waterways
a.c/y dredged f.dy dredged
7. ❑ Bordering Land
Subject to Flooding a.square feet b.square feet c.square feet d.square feel
Cubic Feet Flood Storage e.cubic feet T.cubic feet 9.cubic feet h.cubic feet
a., ❑ Isolated Land
Subject to Flooding a.square feet b.square feet
Cubic Feet Flood Storage c.cubic feel d.cubic feet e.cubic feet f,cubic feel
3130+/- 3130+/-
e. ® Riverfront Area
a.total sq.feet b,total sq.feet
Sq ft within 100 it 310+/- 310+/-
c.square feel d.square feet e.square feet f.square feet
Sq ft between 100- 2820+/- 2320+/-
200 ft g.square feet h.square feet I.square feet I.square feet
aparorms.doc• row.051IM010 Page 3of 1.2
Massachusetts Department of Environmental Protection Provided by MassDEP:
Bureau of Resource Protection Wetlands 64-563
WPA Form 5 — Order of Conditions MassDEP File#
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 eDEP Transaction#
Salem
• City/town
B. Findings (cont.)
Coastal Resource Area Impacts:Check all that apply below. (For Approvals Only)
Proposed Permitted Proposed Permitted
Alteration Alteration Replacement Replacement
to. ❑ Designated Port Indicate size under Land Under the Ocean, below
Areas
it. ❑ Land Under the
Ocean. a.square feet b.square feet
c.dy dredged d.cry dredged
1z. ❑ Barrier Beaches Indicate size under Coastal Beaches and/or Coastal Dunes
below
yd
13. El Coastal Beaches
a.square feet b.square feel c.nourishment d,nourishment
nt
cued cu yd
14. ElCoastal Dunes
a.square feel_ b.square feet e.nourishment d.nourishment
15. ❑ Coastal Banks a.linear-feet b.linear feet
16. ❑ Rocky Intertidal -
Shores a.square feet b.square feet
n. ❑ Salt Marshes a.square feet b.square feet c.square feet d.square feet
ie. ❑ Land Under Salt
Ponds a.square feet b.square feet
c.c-dredged d.cry dredged
ig. ❑ Land Containing
Shellfish a.square feet b.square feet c.square feet d.square feet
20. ❑ Fish Runs Indicate size under Coastal Banks, Inland Bank, Land Under
the Ocean, and/or inland Land Under Waterbodies and
Waterways, above
a.vy dredged b.cty dredged
21. ❑ Land Subject to I •
Coastal Storm a.square feet b.square feet '
Flowage
nyMerms,1"- lee e5faQef a Page 4 of 12
Massachusetts Department of Environmental Protection Provided by MassDEP:
Bureau of Resource Protection -Wetlands 64-663
WPA .Form 5 - Order of Conditions MassDEP File If
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 eDEP Transaction#
Salem
Cityrrown
B. Findings (cont.)
p# . Itthect ist 22• ❑ Restoration/Enhancement':
the purpose of
square or restoring a. uare feet of BVW b.
enhancing ng a q square feet of sett marsh
wetland
resource area 23. ❑. Stream Crossing(s):
in addition to
the square
footage that a.number of new stream crossings b.number of replacement stream crossings
has been C. General Conditions Under Massachusetts Wetlands Protection Act
entered in
Section B.5.c
(Bvw)
6.17.c(Salt The following conditions are only applicable to Approved projects.
Marsh)above, 1 Failure to comply with all conditions stated herein, and with all related statutes and other
please enter regulatory the additional r ulato measures, shall be deemed cause to revoke or modify this Order.
amount here. 2. The Order does not grant any property rights or any exclusive privileges; it does not
authorize any injury to private property or invasion of private rights.
3. This Order does not relieve the permittee or any other person of the necessity of complying
with all other applicable federal, state, or local statutes, ordinances, bylaws, or regulations.
4. The work authorized hereunder shall be completed within three years from the date of this
Order unless either of the following apply:
a. the work is a maintenance dredging project as provided for in the Act; or
b. the time for completion has been extended to a specified date more than three years,
but less than five years, from the date of issuance. If this Order is intended to be valid
for more than three years, the extension date and the special circumstances warranting
the extended time period are set forth as a special condition in this Order.
5. This Order may be extended by the issuing authority for one or more periods of up to three
years each upon application to the issuing authority at least 30 days prior to the expiration
date of the Order.
6. If this Order constitutes an Amended Order of Conditions, this Amended Order of
Conditions does not extend the issuance date of the original Final Order of Conditions and
the Order will expire on 3/31/2017 unless extended in writing by the Department.
7. Any fill used in connection with this project shall be clean fill. Any fill shall contain no trash,
refuse, rubbish, or debris, including but not limited to lumber, bricks, plaster, wire, lath,
paper, cardboard, pipe, tires, ashes;refrigerators, motor vehicles, or parts of any of the
foregoing.
8. This Order is not final until all administrative appeal periods from this Order have elapsed,
or if such an appeal has been taken, until all proceedings before the Department have been
completed.
wMafwm5.d=• ror.e5na2010 Page 5 of 12
Massachusetts Department of Environmental Protection Provided by MassDEP;
\ Bureau of Resource Protection -Wetlands 64-563
WPA Form 5 — Order of Conditions MassDEP File#
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 eDEP Transaction#
Salem
Cityrrown
C. General Conditions Under Massachusetts Wetlands Protection Act(cont.)
9. No work shall be undertaken until the Order has become final and then has been recorded
in the Registry of Deeds or the Land Court for the district in which the land is located, within
the chain of title of the affected property. In the case of recorded land,the Final Order shall
also be noted in the Registry's Grantor Index under the name of the owner of the land upon
which the proposed work is to be done. In the case of the registered land, the Final Order
shall also be noted on the Land Court Certificate of Title of the owner of the land upon
which the proposed work is done. The recording information shall be submitted to the
Conservation Commission on the form at the end of this Order, which form must be
stamped by the Registry of Deeds, prior to the commencement of work.
% A sign shall be displayed at the site not less then two square feet or more than three
square feet in size bearing the words,
"Massachusetts Department of Environmental Protection" [or, "MassDEP"]
"File Number 64-563
11. Where the Department of Environmental Protection is requested to issue a Superseding
Order, the Conservation Commission shall be a party to all agency proceedings and
hearings before MassDEP.
12. Upon completion of the work described herein, the applicant shall submit a Request for
Certificate of Compliance(WPA Form 8A)to the Conservation Commission.
13. The work shall conform to the plans and special conditions referenced in this order.
14. Any change to the plans identified in Condition#13 above shall require the applicant to
inquire of the Conservation Commission in writing whether the change is significant enough
to require the filing of a new Notice of Intent.
15. The Agent or members of the Conservation Commission and the Department of
Environmental Protection shall have the right to enter and inspect the area subject to this
Order at reasonable hours to evaluate compliance with the conditions stated in this Order,
and may require the submittal of any data deemed necessary by the Conservation
Commission or Department for that evaluation.
16. This Order of Conditions shall apply to any successor in interest or successor in control of
the property subject to this Order and to any contractor or other person performing work
conditioned by this Order.
17. Prior to the start of worts, and if the project involves work adjacent to a Bordering Vegetated
Wetland, the boundary of the wetland in the vicinity of the proposed work area shall be
marked by wooden stakes or flagging. Once in place, the wetland boundary markers shall
be maintained until a Certificate of Compliance has been issued by the Conservation
Commission.
wpafarm6Aa•rev.OWIM2010 Page 6 or 12
Massachusetts Department of Environmental Protection Prodded by MassDEP:
Bureau of Resource Protection -Wetlands 64-563
WPA Form 5 — Order of Conditions MassDEP File#
1 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 eDEP Transaction#
Salem
Cityrrown
C. General Conditions Under Massachusetts Wetlands Protection Act(cont.)
18. All sedimentation barriers shall be maintained in good repair until all disturbed areas have
been fully stabilized with vegetation or other means.Al no time shall sediments be
deposited in a wetland or water body. During construction, the applicant or his/her designee
shall inspect the erosion controls on a daily basis and shall remove accumulated sediments
as needed. The applicant shall immediately control any erosion problems that occur at the
site and shall also immediately notify the Conservation Commission, which reserves the
right to require additional erosion and/or damage prevention controls it may deem
necessary. Sedimentation barriers shall serve as the limit of work unless another limit of
work line has been approved by this Order.
NOTICE OF STORMWATER CONTROL AND MAINTENANCE REQUIREMENTS
19. The work associated with this Order(the"Project')is(1)❑ Is not(2)®subject to the
Massachusetts Stormwater Standards. If the work is subject to the Stormwater
Standards,then the project Is subject to the following conditions:
a) All work, including site preparation, land disturbance, construction and redevelopment,
shall be implemented in accordance with the construction period pollution prevention and
erosion and sedimentation control plan and, if applicable, the Stormwater Pollution
Prevention Plan required by the National Pollution Discharge Elimination System
Construction General Permit as required by Stormwater Condition 8. Construction period
erosion, sedimentation and pollution control measures and best management practices
(BMPs)shall remain in place until the site is fully stabilized.
b) No stormwater runoff maybe discharged to the post-construction stormwater.BMPs
unless and until a Registered Professional Engineer provides a Certification that:
L all construction period BMPs have been removed or will be removed by a date certain
specified in the Certification. For any construction period BMPs intended to be converted
to post construction operation for stormwater attenuation, recharge, and/or treatment,the
conversion is allowed by the MassDEP Stormwater Handbook BMP specifications and that
the BMP has been properly cleaned or prepared for post construction operation, including
removal of all construction period sediment trapped in inlet and outlet control structures;
ii. as-built final construction BMP plans are included, signed and stamped by a Registered
Professional Engineer, certifying the site is fully stabilized;
iii. any illicit discharges to the stormwater management system have been removed, as per
the requirements of Stormwater Standard 10;
iv. all post-construction stormwater BMPs are installed in accordance with the plans
(including all planting plans)approved by the issuing authority,and have been inspected to
ensure that they are not damaged and that they are in proper working condition;
v. any vegetation associated with post-construction BMPs,is suitably established to
withstand erosion.
wpefa S.dw- rer.0&1=010 Page 7 d 12
Massachusetts Department of Environmental Protection Provided by MassDEP:
\ Bureau of Resource Protection -Wetlands 64-563
WPA Form 5 — Order of Conditions MassDEP File#
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 eDEP Transaction#
Salem
Cily/Town
C. General Conditions Under Massachusetts Wetlands Protection Act(cont.)
c) The landowner is responsible for BMP maintenance until the issuing authority is notified
that another party has legally assumed responsibility for BMP maintenance. Prior to
requesting a Certificate of Compliance, or Partial Certificate of Compliance, the responsible
party(defined in General Condition 18(e))shall execute and submit to the issuing authority
an Operation and Maintenance Compliance Statement("O&M Statement)for the
Stormwater BMPs identifying the party responsible for implementing the stormwater BMP
Operation and Maintenance Plan("O&M Plan")and certifying the following: i.) the 0&M
Plan is complete and will be implemented upon receipt of the Certificate of Compliance,
and fi.)the future responsible parties shall be notified in writing of their ongoing legal
responsibility to operate and maintain the stormwater management BMPs and implement
the Stormwater Pollution Prevention Plan.
d) Post-construction pollution prevention and source control shall be implemented in
accordance with the long-term pollution prevention plan section of the approved
Stormwater Report and, if applicable, the Stormwater Pollution Prevention Plan required by
the National Pollution Discharge Elimination System Multi-Sector General Permit.
e) Unless and until another party accepts responsibility, the landowner, or owner of any
drainage easement,assumes responsibility for maintaining each BMP. To overcome this
presumption, the landowner of the property must submit to the issuing authority a legally
binding agreement of record,acceptable to the issuing authority, evidencing that another
entity has accepted responsibility for maintaining the BMP, and that the proposed
responsible party shall be treated as a permittee for purposes of implementing the
requirements of Conditions 18(f)through 18(k)with respect to that BMP. Any failure of the
proposed responsible party to implement the requirements of Conditions 18(f)through
18(k)with respect to that BMP shall be a violation of the Order of Conditions or Certificate
of Compliance. In the case of stormwater BMPs that are serving more than one lot, the
legally binding agreement shall also identify the lots that will be serviced by the stormwater
BMPs. A plan and easement deed that grants the responsible party access to perform the
required operation and maintenance must be submitted along with the legally binding
agreement.
f) The responsible party shall operate and maintain all stormwater BMPs in accordance
with the design plans, the O&M Plan, and the requirements of the Massachusetts
Stormwater Handbook.
wpatann54oc• rev.051912010 Page Sol 12
Massachusetts Department of Environmental Protection Provided by MassDEP:
Bureau of Resource Protection -Wetlands 64-563
WPA Form 5 - Order of Conditions MassDEPFile
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 eDEP Transaction#
Salem
City/Town
C. General Conditions Under Massachusetts Wetlands Protection Act (cont.)
g) The responsible party shall:
1. Maintain an operation and maintenance log for the last three(3)consecutive
calendar years of inspections, repairs, maintenance and/or replacement of the
stormwater management system or any part thereof, and disposal(for disposal the
log shall indicate the type of material and the disposal location);
2: Make the maintenance log available to MassDEP and the Conservation
Commission ("Commission")upon request; and
3. Allow members and agents of the MassDEP and the Commission to enter and
inspect the site to evaluate and ensure that the responsible party is in compliance
with the requirements for each BMP established in the O&M Plan approved by the
issuing authority.
h) All sediment or other contaminants removed from stormwater BMPs shall be disposed
of in accordance with all applicable federal, state, and local laws and regulations.
i) Illicit discharges to the stormwater management system as defined in 310 CMR 10.04
are prohibited.
j) The stormwater management system approved in the Order of Conditions shall not be
changed without the prior written approval of the issuing authority.
k) Areas designated as qualifying pervious areas for the purpose of the Low Impact Site
Design Credit(as defined in the MassDEP Stormwater Handbook,Volume 3,Chapter 1,
Low Impact Development Site Design Credits)shall not be altered without the prior written
approval of the issuing authority.
1) Access for maintenance, repair, and/or replacement of BMPs shall not be withheld.
Any fencing constructed around stormwater BMPs shall include access gates and shall be
at least six inches above grade to allow for wildlife passage.
Special Conditions(if you need more space for additional conditions, please attach a text
document):
wy2}mm4.d=- w.0190 0 Pape 9d 12
Massachusetts Department of Environmental Protection Provided by MassDEP
Bureau of Resource Protection -Wetlands 64-563
MassDE
WPA Form 5 - Order of Conditions MasaDEP File#
1 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 eDEP Transaction 0
Salem
city/town
D. Findings Under Municipal Wetlands Bylaw or Ordinance
1. Is a municipal wetlands bylaw or ordinance applicable? ® Yes ❑ No
2. The Salem hereby finds(check one that applies):
Conservation Commission
a. ❑ that the proposed work cannot be conditioned to meet the standards set forth in a
municipal ordinance or bylaw, specifically:
1.Municipal Ordinance or Bylaw 2.Citation
Therefore,work on this project may not go forward unless and until a revised Notice of
Intent is submitted which provides measures which are adequate to meet these
standards, and a final Order of Conditions is issued.
b. ®that the following additional conditions are necessary to comply with a municipal
ordinance or bylaw:
Wetlands Protection and Conservation Ordinance c. 50
1.Municipal Ordinance or Bylaw 2.Citation
a. The Commission orders that all work shall be performed in accordance with the following
conditions and with the Notice of Intent referenced above. To the extent that the following
conditions modify or differ from the plans, specifications, or other proposals submitted with
the Notice of Intent, the conditions shall control.
The special conditions relating to municipal ordinance or bylaw are as follows(if you need
more space for additional conditions, attach a text document):
The attached special conditions are issued under the Wetlands Protection Act and are
sufficient for compliance with the local ordinance
wpalwm5.tloc• rer.OSr1920t0 Page 10 of 12
Massachusetts Department of Environmental Protection Provided by MassDEP:
^ Bureau of Resource Protection -Wetlands 64-5
DE
WPA Form 5 — Order of Conditions MassP File#
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 eDEP Transaction#
Salem
CityrTown
E. Signatures
Important:when This Order is valid for three years,unless otherwise specified as a special
filling out forms condition pursuant to General Conditions#4,from the date of issuance. t. ate oil Issuance
on the computer,
use only the tab Please indicate the number of members who will sign this form. S
key to move your This Orderesignajority of the Conservation Commission. 2.Number of Signers
cursor-do not
use the return The Ordey rtified mail (return receipt r qt este r and elivered to
key. the applice ailed, hand delivered or filed elec oni Ily he same time
with the aRegional Office.
Signature
FA
2K by hand delivery on ❑ by certified mail,return receipt
14 P / �Ot`� requested,on
Date Date
F. Appeals
The applicant, the owner, any person aggrieved by this Order, any owner of land abutting
the land subject to this Order,or any ten residents of the city or town in which such land is
located, are hereby notified of their right to request the appropriate MassDEP Regional
Office to issue a Superseding Order of Conditions. The request must be made by certified
mail or hand delivery to the Department,with the appropriate filing fee and a completed
Request of Departmental Action Fee Transmittal Form, as provided in 310 CMR 10.03(7)
within ten business days from the date of issuance of this Order. A copy of the request shall
at the same time be sent by certified mail or hand delivery to the Conservation Commission
and to the applicant, if he/she is not the appellant.
Any appellants seeking to appeal the Department's Superseding Order associated with this
appeal will be required to demonstrate prior participation in the review of this project. Previous
participation in the permit proceeding means the submission of written information to the
Conservation Commission prior to the close of the public hearing, requesting a
Superseding Order, or providing written information to the Department prior to issuance of
a Superseding Order.
The request shall state clearly and concisely the objections to the Order which is being
appealed and how the Order does not contribute to the protection of the interests identified
in the Massachusetts Wetlands Protection Act(M.G.L. c. 131, §40), and is inconsistent
with the wetlands regulations(310 CMR 10.00). To the extent that the Order is based on a
municipal ordinance or bylaw, and not on the Massachusetts Wetlands Protection Act or
regulations, the Department has no appellate jurisdiction. 1
wpa5slgsAm- rev,=25f20te Pepe II r -tQ-
Attachment to Order of Conditions#64-563
Page 1 of 5
SALEM CONSERVATION COMMISSION
DEP FILE #64-563
27 Pierce Road
City of Salem, Massachusetts
ADDITIONAL FINDINGS
Based on the Estimated Habitats of Rare Wildlife and Certified Vernal Pools Map(3/6/2014, online)from Natural
Heritage & Endangered Species Program(NHESP) of the Massachusetts Division of Fisheries and Wildlife, it has
been determined that this project does not occur near any habitat of state-listed rare wildlife species nor contains any
vernal pools.
This order permits the construction of a house addition and appurtenances at 27 Pierce Road.
GENERAL CONDITIONS
1. This Order of Conditions must be recorded in its entirety(including all 5 pages of Special Conditions)
at the Essex County Registry of Deeds or the Land Court for the district in which the land is located,
after the expiration of the 10-day appeal period and within 30 days of the issuance. A copy of the
recording information must be submitted to the Salem Conservation Commission before any
work approved in this Order commences.
2. Approval of this application does not constitute compliance with any law or regulation other than
M.G.L Chapter 131, Section 40,Wetlands Regulations 310 CMR 10.00 and the City of Salem Wetlands
Protection Ordinance,Salem Code Chapter 50.
3. All work shall be performed in accordance with this Order of Conditions and approved site plan(s). No
alteration of wetland resource areas or associated buffer zones, other than that approved in this Order,
shall occur on this property without prior approval from the Commission.
4. Prior to any work commencing on site,a DEP Sign showing DEP File#64-563 must be installed at the
entrance to the site and seen from the public way, but not placed on a living tree.
5. No work approved in this Order may commence until the ten(10)business day appeal period has lapsed
from the date of the issuance of this Order.
6. With respect to this Order,the Commission designates the Conservation Agent as its agent with powers
to act on its behalf in administering and enforcing this Order.
7. The Commission or its Agent,officers,or employees shall have the right to enter and inspect the property at
any time for compliance with the conditions of this Order,the Wetlands Protection Act MGL Chapter 131,
Section 40,the Wetlands Regulations 310 CMR 10.00,and shall have the right to require any data or
documentation that it deems necessary for that evaluation.
8. The term "Applicant'as used in this Order of Conditions shall refer to the owner,any successor in
interest or successor in control of the property referenced in the Notice of intent,supporting documents
and this Order of Conditions. The Commission shall be notified in writing within 30 days of all
Attachment to Order of Conditions#64-563
ip Page 2of 5
Z.
transfers of title of any portion of the property that takes place prior to issuance of the Certificate of
Compliance.
9. It is the responsibility of the applicant.to procure all other applicable federal, state and local permits and
approvals associated with this project. These permits may include but are not necessarily limited to the
following:
(1) Section 404 of the Federal Water Pollution Control Act(P.L. 92-500, 86 scat. 816),U.S.Army
Corps of Engineers.
(2) Water Quality Certification in accordance with the Federal Water Pollution Control under authority
of sec. 27(5)of Chapter 21 of the Massachusetts General Laws as codified in 314 CMR 9.00.
(3) Sewer Extension Permit from the DEP Division of Water Pollution Control under G. L. Ch.21 A ss7
and 314 CMR 7.00. Any Board of Health permit for septic system design for any portion of the
septic system within 100 feet of wetlands shall be submitted to the Commission prior to
construction initiation.
(4) Design Requirements for Construction in Floodplains under the State Building Code(780 CMR
744.).
10. If there are conflicting conditions within this Order,the stricter condition(s)shall rule.
11. All work shall be performed so as to ensure that there will be no sedimentation into wetlands and
surface waters during construction or after completion of the project.
12. The Commission or its Agent shall have the discretion to modify the erosion/siltation control methods
and boundary during construction if necessary.
13. The Commission reserves the right to impose additional conditions on portions of this project or this site
to mitigate any actual or potential impacts resulting from the work herein permitted.
14. The work shall conform to the following attached plans and special conditions:
Final Approved Plans
SITE PLAN TO ACCOMPANY A NOTICE OF INTENT APPLICATION
(Title)
3/18/2014
(Dared)
Scott Patrowicz
(Signed and Stamped by)
City of Salem Conservation Commission
(on file will))
15. Any proposed changes in the approved plan(s)or any deviation in construction from the approved
plan(s)shall require the applicant to file a Notice of Project Change with the Commission. The Notice
shall be accompanied by a written inquiry prior to their implementation in the field,as to whether the
change(s) is substantial enough to require filing a new Notice of Intent or a request to correct or amend
this Order of Conditions. A copy of such request shall at the same time be sent to the Department of
Environmental Protection.
16. In conjunction with the sale of this property or any portion thereof before a Certificate of Compliance has
been issued,the applicant or current landowner shall submit to the Commission a statement signed by the
P'✓L� Attachment to Order of Conditions#64-563
Page 3of 5
buyer that he/she is aware of an outstanding Order of Conditions on the property and has received a copy of
the Order of Conditions.
17. [Reserved)
PRIOR TO CONSTRUCTION
18. Prior to the commencement of any activity on this site other than activities listed above,there
must be a Pre-Construction Meeting on site between the project supervisor,the contractor responsible
for the work, and the Conservation Agent and/or a member of the Conservation Commission to ensure
that the requirements of the Order of Conditions are understood. The staked erosion control line shall be
adjusted, if necessary,during the pre-construction meeting. Please contact the Conservation Agent at
(978)619-5685 at least forty-eight(48)hours prior to construction to arrange for the Pre-
Construction Meeting.
19. Prior to the pre-construction meeting and commencement of any activity on this site,sedimentation and
erosion control barriers shall be installed as shown on the approval plan(s)and detail drawings. The
Commission and/or its Agent shall inspect and approve such installation at the pre-construction
meeting.
20. No clearing of vegetation,including trees,or disturbance of soil shall occur prior to the pre-construction
meeting. Minimal disturbance of shrubs and herbaceous plants shall be allowed prior to the pre-
construction meeting if absolutely necessary in order to place erosion control stakes where required.
21. There shall be adequate additional erosion control devices stored under cover on the site to be used for
emergency erosion control purposes.
EROSION CONTROL
22. Appropriate erosion control devices shall be in place prior to the beginning of any phase of construction,
and shall be maintained during construction in any wetland resource area and/or buffer zones. The
erosion control measures shown on the approval plan(s)and provisions in the Order will be the minimum
standards for this project; the Commission or its Agent may require additional measures.
23. All debris, fill and excavated material shall be stockpiled a location far enough away from the wetland
resource areas to prevent sediment from entering wetland resource areas.
24. Erosion and sedimentation control devices shall be inspected after each storm event and repaired or
replaced as necessary. Any accumulated silt adjacent to the barriers shall be removed.
25. The area of construction shall remain in a stable condition at the close of each construction day.
26. Any de-watering of trenches or other excavation required during construction shall be conducted so as
to prevent siltation of wetland resource areas. All discharge from de-watering activities shall be filtered
through hay bale sediment traps,silt filter bags or other means approved by the Commission or its
Administrator.
27. Within thirty(30)days of completion of construction on any given portion of the project, all disturbed
areas in the completed portion of the site shall be permanently stabilized with rapidly growing
vegetative cover, using sufficient top soil to assure long-term stabilization of disturbed areas.
��. Attachment to Order of Conditions # 64-563
Page 4of 5
28. If soils are to be disturbed for longer than two(2)months,a temporary cover of rye or other grass
should be established to prevent erosion and sedimentation. If the season is not appropriate for plant
growth,exposed surface shall be stabilized by other appropriate erosion control measures,firmly
anchored,to prevent soils from being washed by rain or flooding.
DURING CONSTRUCTION
29. A copy of this Order of Conditions and the plan(s)approved in this Order shall be available on site at all
times when work is in progress.
30. No alteration or activity shall occur beyond the limit of work as defined by the siltation barriers shown on
the approved plan(s).
31. All waste products,grubbed stumps,slash;construction materials,etc.shall be deposited at least 100 feet
from wetland resource areas and 200 feet from river.
32. Cement trucks shall not be washed out in any wetland resource or buffer zone area,nor into any drainage
system. Any deposit of cement or concrete products into a buffer zone or wetland resource area shall be
immediately removed.
33. All exposed sub-soils shall be covered by a minimum of three(3)inches of quality screened loam topsoil
prior to seeding and final stabilization.
34. Immediately following drainage structure installation all inlets shall be protected by silt fence,haybale
barriers and/or silt bags to filter silt from stormwater before it enters the drainage system.
35. There shall be no pumping of water from wetland resource areas.
36. All equipment shall be inspected regularly for leaks. Any leaking hydraulic lines,cylinders or any other
components shall be fixed immediately.
37. During construction,all drainage structures shall be inspected regularly and cleaned as necessary.
38. The applicant is herby notified that failure to comply with all requirements herein may result in the issuance
of enforcement actions by the Conservation Commission including,but not limited to,civil administrative
penalties under M.G.L Chapter 21A,section 16.
AFTER CONSTRUCTION
39. Upon completion of construction and final soil stabilization,the applicant shall submit the following to
the Conservation Commission to request a Certificate of Compliance(COC):
(1) A Completed Request for a Certificate of Compliance form(WPA Form 8A or other form if
required by the Conservation Commission at the time of request).
(2) A letter from a Registered Professional Engineer certifying compliance of the property with this
Order of Conditions.
(3) An "As-Built'plan signed and stamped by a Registered Professional Engineer or Land Surveyor
showing post-construction conditions within all areas under the jurisdiction of the Massachusetts
Wetlands Protection Act. This plan shall include at a minimum:
(a) All wetland resource area boundaries with associated buffer zones and regulatory setback
areas taken from the plan(s)approved in this Order of Conditions;
Attachment to Order of Conditions#64-563
t Page 5of 5
(b) Locations and elevations of all stormwater management conveyances,structures and best
management designs,including foundation drains,constructed under this Order within any
wetland resource area or.buffer zone;
(c) Distances from any structures constructed under this Order to wetland resource areas-
"structures"include,but are not limited to,all buildings,septic system components,wells,
utility lines,fences,retaining walls,and roads/driveways;
(d) A line delineating the limit of work-"work"includes any filling,excavating and/or
disturbance of soils or vegetation approved under this Order;
40. When issued,the Certificate of Compliance must be recorded at the Essex County Registry of Deeds
and a copy of the recording submitted to the Salem Conservation Commission.
41. If the completed work differs from that in the original plans and conditions,the report must specify how
the work differs;at which time the applicant shall first request a modification to the Order. Only upon
review and approval by the Commission, may the applicant request in writing a Certificate of
Compliance as described above.
42. Erosion control devices shall remain in place and properly functioning until all exposed soils have been
stabilized with final vegetative cover and the Conservation Commission and/or its Agent has authorized .
their removal.
ADDITIONAL CONDITIONS
43. Applicant shall monitor disturbed areas for invasive species until planted vegetation is fully established.
44. In order to reduce the spread of invasive species,only weed-free certified erosion controls shall be
utilized.