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Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 2 — Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
A. General Information
Important:
When filling out From:
forms on the SALEM
computer, use Conservation Commission
only the,-tab
key to move To: Applicant Property Owner(if different from applicant):
your cursor-
do not use the Dr. Barbara Poremba
return key. Name Name
22 Sunset Road
m Mailing Address Mailing Address
Salem MA 01970
Citylrown State Zip Code City/rown State Zip Code
1. Title and Date (or Revised Date if applicable)of Final Plans and Other Documents:
Proposed Residential Addition April 2004
Title Date
Title Date
ix
Tide Date
2. Date Request Filed:
June 24, 2004
B. Determination
Pursuant to the authority of M.G.L. c. 131, §40, the Conservation Commission considered your
Request for Determination of Applicability, with its supporting documentation, and made the following
Determination.
Project Description (if applicable):
The construction of a two story addition and a first floor exterior deck to an existing single family
residendial structure.
Project Location:
22 Sunset Road Salem
Street Address City/Town
Map 31 Lot 0251
Assessors Map/Plat Number Parcel/Lot Number
wpaforrn2.dw•rev.12/15/00 Page 1 of 5
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 2 — Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Determination (cont.)
The following Determination(s)is/are applicable to the proposed site and/or project relative to the
Wetlands Protection Act and regulations:
Positive Determination
Note: No work within the jurisdiction of the Wetlands Protection Act may proceed until a final Order of
Conditions (issued following submittal of a Notice of Intent or Abbreviated Notice of Intent)has been
received from the issuing authority(i.e., Conservation Commission or the Department of
Environmental Protection).
❑ 1. The area described on the referenced plan(s)is an area subject to protection under the Act.
Removing,filling,dredging,or altering of the area requires the filing of a Notice of Intent.
❑ 2a.The boundary delineations of the following resource areas described on the referenced
plan(s)are confirmed as accurate. Therefore, the resource area boundaries confirmed in this
Determination are binding as to all decisions rendered pursuant to the Wetlands Protection Act and its
regulations regarding such boundaries for as long as this Determination is valid.
❑ 2b. The boundaries of resource areas listed below are not confirmed by this Determination,
regardless of whether such boundaries are contained on the plans attached to this Determination or
to the Request for Determination.
❑ 3.The work described on referenced plan(s)and document(s) is within an area subject to
protection under the Act and will remove,fill, dredge, or alter that area. Therefore, said work
requires the filing of a Notice of Intent.
❑ 4.The work described on referenced plan(s)and document(s) is within the Buffer Zone and will
alter an Area subject to protection under the Act. Therefore, said work requires the filing of a
Notice of Intent.
❑ 5.The area and/or work described on referenced plan(s) and document(s)is subject to review
and approval by:
Name of Municipality
Pursuant to the following municipal wetland ordinance or bylaw:
Name Ordinance or Bylaw Citation
wp form2.dw•rev.12115MO Page 2 of 5
i
7LMassachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands
WPA Form 2 — Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Determination (cont.)
❑ 6.The following area and/or work, if any, is subject to a municipal ordinance or bylaw but not
subject to the Massachusetts Wetlands Protection Act:
❑ 7. If a Notice of Intent is filed for the work in the Riverfront Area described on referenced plan(s)
and document(s),which includes all or part of the work described in the Request, the applicant
must consider the following alternatives. (Refer to the wetland regulations at 10.58(4)c.for more
information about the scope of alternatives requirements):
❑ Alternatives limited to the lot on which the project is located.
❑ Alternatives limited to the lot on which the project is located, the subdivided lots, and any
adjacent lots formerly or presently owned by the same owner.'
❑ Alternatives limited to the original parcel on which the project is located,the subdivided
parcels, any adjacent parcels, and any other land which can reasonably be obtained within
the municipality.
❑ Alternatives extend to any sites which can reasonably be obtained withirf the appropriate
region of the state.
Negative Determination
Note: No further action under the Wetlands Protection Act is required by the applicant. However, if the
Department is requested to issue a Superseding Determination of Applicability,work may not proceed
on this project unless the Department fails to act on such request within 35 days of the date the
request is post-marked for certified mail or hand delivered to the Department.Work may then proceed
at the owner's risk only upon notice to the Department and to the Conservation Commission.
Requirements for requests for Superseding Determinations are listed at the end of this document.
❑ 1.The area described in the Request is not an area subject to protection under the Act or the
Buffer Zone.
❑ 2.The work described in the Request is within an area subject to protection under the Act, but will
not remove,fill, dredge, or alter that area.Therefore, said work does not require the filing of a
Notice of Intent.
® 3. The work described in the Request is within the Buffer Zone, as defined in the regulations, but
will not alter an Area subject to protection under the Act. Therefore, said work does not require
the filing of a Notice of Intent, sub'ecj t to the following conditioner any).
1. Silt fencing and haybales will be install prior to construction.
2. NO building material or excavated material shall be stockpiled within the buffer zone to the
resource area.
3 NO construction machinery will be left on site at the end of each work day.
❑ 4. The work described in the Request is not within an Area subject to protection under the Act
(including the Buffer Zone).Therefore, said work does not require the filing of a Notice of Intent,
unless and until said work alters an Area subject to protection under the Act.
Page 3 al
gafort 2.doc•rev.12JI5100
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 2 — Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Determination (cont.)
❑ 5.The area described in the Request is subject to protection under the Act. Since the work
described therein meets the requirements for the following exemption, as specified in the Act and
the regulations, no Notice of Intent is required:
Exam t Activity(stte applicable statuatory/reguWtory provisions)
❑ 6.The area and/or work described in the Request is not subject to review and approval by:
Name of Municipality
Pursuant to a municipal wetlands ordinance or bylaw.
Name Ordinance or Bylaw Citation
C. Authorization
This Determination is issued to the applicant and delivered as follows:
❑ by hand delivery on by certified mail, return receipt requested on
Date Date
This Determination is valid for three years from the date of issuance (except Determinations for
Vegetation Management Plans which are valid for the duration of the Plan).This Determination does not
relieve the applicant from complying with all other applicable federal, state, or local statutes, ordinances,
bylaws, or regulations.
This Determination must be signed by a majority of the Conservation Commission. A copy must be sent
to the appro ri nal Office (see Appendix A)an the roperty owner(if different from the
applican . • net s:
/�/oy
Dates
Page 4 of
wpafm 2.dac•rev.121151W
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 2 — Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
D. Appeals
The applicant, owner, any person aggrieved by this Determination, any owner of land abutting the land
upon which the proposed work is to be done, 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 Department of Environmental
Protection Regional Office(see Appendix A)to issue a Superseding Determination of Applicability.The
request must be made by certified mail or hand delivery to the Department,with the appropriate filing fee
and Fee Transmittal Form (see Appendix E: Request for Departmental Action Fee Transmittal Form)as
provided in 310 CMR 10.03(7)within ten business days from the date of issuance of this Determination. 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.The request shall state clearly and
concisely the objections to the Determination which is being appealed. To the extent that the
Determination is based on a municipal ordinance or bylaw and not on the Massachusetts Wetlands
Protection Act or regulations, the Department of Environmental Protection has no appellate jurisdiction.
Page 5 of 5
wpafor .doc•rev.12115MO ,
CITY OF SALEM
IRON ROD
SET - IRON ROD
70,00' SET
Y!
0.4 .CONCRETE SLAB D�•
MAP 31
LOT 251
MAP 31 P„ MAP 31
AREA — 7,337t S.F. $ LOT 252
LOT 250 IRON ROD
gg 5.0 S ET
P
DECK
IRON ROD > Q
SET 7 g• 'i
1-1/2 STORY 9
DWELLING
IRON ROD
7.8 k 22 s I SET
8 ` v
0 o
IRON ROO
65.00, SEr
IRON L
RODS
SET EDGE OF PAVEMENT
SUNSET ROAD
2 t*01i Of
44,re
H
ca PLOT PLAN OF LAND
I CERTIFY THAT THE BUILDINGS No 36043 22 SUNSET ROAD
HEREON ARE LOCATED ON 4fCI SALEM. MA
THE GROUND AS SHOWN. fs' Y OF
Ios°" BARBARPROPERT A. POREMBA
_ C pC 5C� 0 SCALE 1" - 20' JUNE 8, 2004
A REG. PROF. LAND SURVEYOR NORTH SHORE SURVEY CORPORATION
L 47 LINDEN ST., SALEM, MA
-...,. I-Tjgn,,I 35S Ga:8ZP99Ls Ee:eT reazicriSo
CITY OF SALEM
IRON ROD
SET - IRON ROD
70,00' SET
0.4' CONCRETE SLAB 0 �•
i�
MAP 31
LOT 251
MAP 31 MAP 31LOT 252
LOT 250 AREA - 7,337t S,F. $
IRON ROD
Q 5.0 f T
P
DECK
IRON ROD D
SET 7.5' j $
1-1/2 STORY 5
DWELLING
IRON
7.6 ROD
22 I a I SET
$ o
<
ct
IRON ROD
a5.00' AVSET
IRON I
_ RODS �. �. _J L_ —
SET EDGE OF PAVEMENT
SUNSET ROAD
�tp`tH O f'A,3J'�C
2 tiL
cN PLOT PLAN OF LAND
I CERTIFY THAT THE BUILDINGS No. o<3 22 SUNSET ROAD
HEREON ARE LOCATED ON $ SALEM, MA
°F 9fG,S E0.tG p� PROPERT
THE GROUND AS SHOWN. Y OF
�r'OMe,., uo so BARBART A. POREMBA
� / a�s�r 1� SCALE 1" - 20' JUNE B, 2004
DATE REG. PROF. LAND SURVEYOR NORTH SHORE SURVEY CORPORATION
47 LINDEN ST., SALEM, MA
• �78
-- ^„An,� oss 9aZ8ZV98LG ee:Ei ooaueTieo
Ltty uj outern, :wassacnusetts
' ,dire Department
\ Mn� 48 Lafayette Street 29 Fort Avi
Robert W turner Satem,Massachusetts.Q1970-3695
Cf 4e(978-744-1235 Tre Prevention
of
978.744-6990 FaX 978-745-4646
'Bureau
978-745-7777
FIRE DEPARTMENT CERTIFICATE OF APPROVAL. FOR A BUILDING PERMIT`
IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE
AND THE SALEM FIRE CODE, APPLICATION IS HEREBY MADE FOR IRE APPROVAL OF PLANS
° AND THE ISSUANCE OF A CERTIFICATE OF APPROVAL FOR A BUILDINGPERMIT BY THE
SALEH FIRE DEPARTMENT, ( Ref. Section LIM of the Mass.�Bldg. Code)",
JOB LOCATION:
OWNER/OCCUPANT: C � O V ri ? ,#
ELECTRICAL CONTRACTOR:'°
0
FIRE SUPPRESSION CONTRACTOR:
SIGNATURE OF
APPLICANT; PHONE 0:
ADDRESS OF
APPLICANT: ] J J+ ✓�( j� 'CITY OT x
TOWN:
� APPROVAL DATE: Jo -'J �LuO�
g
Certificate,of approval is hereby granted. on approvad ,plans`or'submittal of 4 x
project details, by the SALEM FIRE DEPARTMENT. All plaas`ara approved'solely
for identification of'type and location;of fire protection devices and equipment w "
All plans are subject to approval of any other. authority having jurisdiction,. `
Upon completion,' the applicant or installer(s) shall, request an inspection and/or
test of the fire protection devices and equipment. (ADDITTIONAL REQUIREMENTS,
SEE REVERSE SIDE, e*e) `
�J - . NEW CONSTRUCTION. .
PROPERTY LOCATION HAS NO COMPLIANCE WITH THE PROVISIONS OF {"
CHAPTER 148, SECTION 26 C/E, M.G.L: , RELATIVE TO THE INSTALA-
TION OF APPROVED FIRE ALa9M DEVICES. S
THE OWNER PRO-
PERTY T1ti PR S
' PERTY IS REQUIRED TO OBTAIN COMPLIANCE AS A CONDITION OF
OBTAINING A BUILDING PERMIT.
I—D PRO^:,RTY LOCATION IS I Ci1FiPLIACNF, S4I'111 171r PROVISION OF CHAPTEP
143, SECTION ZG
. 00
$5 1.00
- CHF.CF_;1
(V compliance with the: prevision of Section 112, 5 of rr3 :�".a. ....::1:',)?F'.Lt
Scale Oi £ r We, and under guidelines . lVor, ry ia'la 7r"� 3 1 dg.
WsPect3r and the Salem Fire Chief, Lhe appl }y ,.n Co.- a building i_aYth
shall obtain Lha Certificate,.kite of npprg al f Q' evr)r e a4idej id k' .s.p"`d
av
plan appral m the Sallof4!. Fi''�
Said application and approval W regWred before a building permV may W
issued. The Massachusetts State Building Code requires eamplinuce
WWII Of the Salem Fire Department, with r'eferflAce to. Provia''ialns of
Articleg 4 and 12 of the Building Code, the Fire I,-ode, � s,,G}2uset.tfa
e ' General Last, and 527 Code of wassachu_etts ileglalstionso
The applicant shall submit this application with three (3) sets Cat plansp
drnvn in sufficient clarity, to obtain st&wpe?s approval of the Salem 57.r+'
Department. Thiz ayglies for all newconstructaoan, siah`ntantEci
alterations, chOng€° Of '.age land/Or Occupancy, and amr other approvals
required by the Massachusetts General Laws, W the Salem Fire Code.
Kcaption: Plans will not be required for Structural work when the
4 proposed work to be performed larunez the building permit Hal
t . aOt, in the opinion of the Buildlnsg Inspector, r*quiire a
plan to show the nature ,:Hard character of the work to be
performed.
Notice., Plans are normally required for fire suppression systems,
# < fire alarm cyst 1s, tank instaliatiorna9 and Fire Cone
requirements.
a Under the Provisions of Article 22 of the Massachusetts State Building
Code, certain proposed projects may not require submission of plans or
complete compilance with new construction requirements. In theme
cases, provisions of article 22, Appendix Tp and Tables applicable
'• shall apply. This section shrill not, however, saapersede the
9 Provisions outlined in the aalecs Eire Prevention Regulations, Chapter
XGL, or 527 Code of :Massachusetts Regulations. All pacmits for
fire code use and/ter occupancy shall apply for than entire structure;
fire alarms and/or smoke detector incatallation shall apple to the
entire structure based upon current requirements As per Laws and/or
. - Crudes, but the existing str'uctf➢le way c4+. }l.y with r6ejulation
app, -able for existing stvuctures.
No t: is e: Sub-contractors may Wo be ;b( t.i:";E to file
u_a k' i ati ns foe .a Fire Department t ertific. e e.lt ippruv al
:Irv_ tivi aL.gq, of their work .,., . Sub-contractors. shall F . . _
an :li;pl.ication co Enstall with We !sire ur9verntion Buren ;
prior to 4Amen . any wo-_k tci^ those AR'en5
ru�uc rNvrprrll DirARTMtNT
120 vAUSHIM ON WMENr 3RD FLOOR
srALSN.w�►of Aso
TRL.(978)745-MM RtT.iab
FAX Wf)7404MI"
STAIel.tr�JJ..rtNOy1CZ. JA. __---.-_ - _ ---
DISPOSAL OF DEN AFFIDAVIT
12 so urft ee with the provisions ofMM a 4%SA I aclmowledte dW r a condition
of Bmmg Permit/ .an debris rankbq am the omwoc"scow
pninM by this BWftPermit"be dispaed otin&pop*&m "sol WOW
disposal A'We m defined by UM c in SISQ&
The debris w M be ftmW of it
Locm"ofFa ft
tine of Pesmit ARIi Dow
FMY MUUM�
aR iofomion:l elcwjd . 1 : N olsi2
rTime ofPesmie AppBoW
lm?huoo inns
Addntsrs sty t sterns
The above statute iegnira that debris from the demohdM nmWW016 rA*or odes
shmadw 8 of defined byeing be disposed in a p mpaly_licsosed solid-w t mgxw (
50&and the bW t pa»rid or Ne mses ate to
indicate the locsdon of the balky.
. � �ffasmontuuaQli of�Ja�,K�►w.ttd
� � •�.P.ai...d.�.�afirYrid�esTf..b•
boo w..[I.�r.Sw •
as 1 ca.Is 86fw M .dri 021 If
Workers' Compensadn lummum AffMirivig
LJ OA* I� M. r 0sxl,�
. . who" pritdpsl place of bodaso so
t
do hereby-CF* Under SIR paint awd peniMn of pol.wo dm
O 1 am an employer providing workers' eompemstkw covep/e for NW eir0a)0 wetkie an
Inswaaase Congaq► Faft Number
1 an:sole propriaoi and have ee own we king fear me in mW opedry.
1 awl a so'k ara proprfeaor, general eowtraoor or hommowner (ch-1 am) and hove bored the
s
cetetoa lined bebelowwho•hsys the feNorriwg worker ' caimpeRS8410111 pollIdw
fJ Im�,d Gg4 kcal 14c, 03 a i O
CEO Insurance Co /P Nuwier
PCi Yz17 c it ew,�l A^IV� 9yi Q29/17�yob
Co snot Insurance ConsPOSIFIFefty NuMbW
Conersaer Intwance Company/Follia Nunlies
() 1 am a homeowner performing all the work mysaM.
•I a.aan""a.a a an al OiY naaeaaw.e N IWWWS" ■ iq Oliva A MroftMw d Oct M 10 ea.wae ..mate.SW M MM O NO"
tawpp a rwaaa~fRi 21A of WA 15 1 ea.kag r ao wMeaiea tf ebuwe.a.ae cuuabq d a ear of a ni I JC0Oi aa.Iea am
real'iaa+eaw"M Al qa a el.t..d in ow Iam of a STOP WORK ORDER aas a 6a of r ICOAO. ON atiw MIL
signed this . dv' of —
:icersetiFermittee BUalding Gepartn.ent
Jtensing fioalC
Selefsmew Office
=ealth Gepat-.mer:
- - _-.ccCC Ye : _ 90A epc spe 77!