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64-561 - 25 WINTER ISLAND ROAD - CONSERVATION COMMISSION w V.uy au4tl PbUY`J tl3iY13M7J1SW P 3iv IVWNI \ iml 3RtlNN15f15 "filla" SZ O VANn • N x Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands DEP File Number: WPA Form 8B — Certificate of Compliance 64-561 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 provided by DEP D. Recording Confirmation The applicant is responsible for ensuring that this Certificate of Compliance is recorded in the Registry of Deeds or the Land Court for the district in which the land is located. Detach on dotted line and submit to the Conservation Commission. To: ------------------------------------------------------ Ccnserva:ion Commission. Please be advised that the Certificate of Compliance for the project at: ,5 015 G)14le4e Zs lane/ Rd #� L Project Location DEP File Number Has been recorded at the Registry of Deeds of: AL C5yX --- &u 7i County for: Property Ownef and has been "noted in the chain of title of the affected property on: Date Book Page If recorded land, the instrument number which identifies this transaction is: If registered land, the document number which identifies this transaction is: Dou e Numbe� 'gnatu of Ap r ant wpafrm8b Boc•rev.5129114 WPA Form 8B,Certificate of Compliance•Page 3 of 3 { 4� OCG n August 19,2014 Project 12046 Salem Conservation Commission City Hall Annex 120 Washington Street,3`d Floor Salem, Massachusetts 01970 RE: Request for Certificate of Compliance 25 Winter Island Road Salem, Massachusetts MA DEP File No. 64-561 Dear Commissioners: On behalf of Douglas and Jean Karam(Applicant), Oak Consulting Group, LLC is submitting the following Request for Certificate of Compliance with the Order of Conditions issued for the above- referenced project. A completed Massachusetts Department of Environmental Protection (MA DEP) WPA Form 8A,Request for Certificate of Compliance is enclosed as Attachment A and a certification statement is enclosed as Attachment B. Also enclosed is As-Built Plan AB-I dated August 19, 2014. As depicted on the As-Built Plan,the project has been constructed in substantial compliance with the Order of Conditions as approved by the Salem Conservation Commission. Variations from the plans accompanying the Notice of Intent are limited to the configuration of the landscape stone in the lawn area at the top of the bank. Fewer stones were placed than proposed on the approved plan. A site visit can be scheduled up on request. Please contact me if questions or comments regarding this request. Otherwise,we will be waiting to hear from you for a hearing date with the Conservation Commission. Sincerely, OAK CONSLJL34NG GROUP, LLC aul F. Ave ,P.E. President ec: Douglas and Jean Karam 1' 0 y-. . .-., '�_ -i MA ' ,,..., _1 , 4h(10 I, ATTACHMENT A WPA Form 8A Request for Certificate of Compliance 25 Winter Island Road Salem, Massachusetts Oak Consulting Group,LLC Project 12046 i Massachusetts Department of Environmental Protection DEP File Number: — Bureau of Resource Protection -Wetlands WPA Form 8A — Request for Certificate of Compliance 64-561 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP A. Project Information Important: When filling out 1. This request is being made by: forms on the Douglas and Jean Karam computer,use Name only the tab key to move 25 Winter Island Road your cursor- Mailing Address do not use the Salem MA 01970 return key. City/Town State Zip Code a+ Phone Number 2. This request is in reference to work regulated by a final Order of Conditions issued to: """ Douglas and Jean Karam Applicant January 24,2014 64-561 Dated DEP File Number Upon completion of the work 3. The project site is located at: authorized in 25 Winter Island Road Salem an Order of Street Address City/Town Conditions,the 44 25 & 26 property owner must request a Assessors Map/Plat Number Parcel/Lot Number Certificate of 4 The final Order of Conditions was recorded at the Registry of Deeds for: Compliance from the issuing authority stating Property Owner(if different) that the work or Essex 33108 545 portion of the work has been County Book Page satisfactorily completed. Certificate(if registered land) 5. This request is for certification that(check one): ® the work regulated by the above-referenced Order of Conditions has been satisfactorily completed. ❑ the following portions of the work regulated by the above-referenced Order of Conditions have been satisfactorily completed(use additional paper if necessary). ❑ the above-referenced Order of Conditions has lapsed and is therefore no longer valid, and the work regulated by it was never started. wpaform8a doe--rev.7I1 3In4 Page 1 of 2 i j Massachusetts Department of Environmental Protection DEP File Number: Bureau of Resource Protection -Wetlands WPA Form 8A — Request for Certificate of Compliance 64-561 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Prodded by DEP A. Project Information (cont.) 6. Did the Order of Conditions for this project, or the portion of the project subject to this request, contain an approval of any plans stamped by a registered professional engineer, architect, landscape architect, or land surveyor? ® Yes If yes, attach a written statement by such a professional certifying substantial compliance with the plans and describing what deviation, if any, exists from the plans approved in the Order. ❑ No B. Submittal Requirements Requests for Certificates of Compliance should be directed to the issuing authority that issued the final Order of Conditions(OOC). If the project received an DOC from the Conservation Commission, submit this request to that Commission. If the project was issued a Superseding Order of Conditions or was the subject of an Adjudicatory Hearing Final Decision, submit this request to the appropriate DEP Regional Office (see http://www.mass.gov/del)/about/region/findvour.htm). wpefor"a doc—rev.7113104 Page 2 of 2 i ATTACHMENT B Engineer's Certification Request for Certificate of Compliance 25 Winter Island Road Salem, Massachusetts Oak Consulting Group, LLC Project 12046 o ENGINEER'S CERTIFICATION REQUEST FOR CERTIFICATE OF COMPLIANCE TO: Salem Conservation Commission: RE: Wall Construction Project Karam Residence 25 Winter Island Road Salem. Massachusetts MA DEP File No. 64-561 I certify that to the best of my knowledge, information and belief, the Wall Construction Project at 25 Winter Island Road in Salem;Massachusetts has been constructed in substantial compliance with the plans accompanying the Notices of Intent and the Order of Conditions as approved by the Salem Conservation Commission. Paul F. Avery, P.E #34975 JJI"A,i PROFESSIONAL ENGINEER -MASS. REG. NO. ��►��SN OF dogs to 9 ®' °c pAUL I- ` Oak Consulting Group, LLC a°D AVE COMPANY do.f1a9 P.O. Box 1123 NewbunTort, MA 01950 oNnt �� ADDRESS ` 508-284-4800 PHONE August 19, 2014 L DATE OCG Oak Consulting Group January 9, 2014 Project 12046 Salem Conservation Commission City Hall Annex 120 Washington Street, 3'd Floor Salem, Massachusetts 01970 RE: Notice of Intent 25 Winter Island Road Salem,Massachusetts Dear Commissioners: On behalf of Douglas and Jean Karam(Applicant), Oak Consulting Group, LLC is submitting eight(8) copies of the following Notice of Intent(NOI) to construct approximately 18 linear feet(It)of rip-rap wall to reinforce existing coastal bank at 25 Winter Island Road. Enclosed are the following attachments: Attachment A: WPA Form 3 —Notice of Intent and NOI Fee Transmittal Form; Attachment B: Site Location Map and drawing Sheet C-l; and Attachment C: Abutter Notification Documentation. Also enclosed is a check in the amount of$62.50 for the local share of the state filing fee. Since the project is a single-family residence, it is not subject to the provisions of the Massachusetts Department of Environmental Protection (MA DEP)Stormwater Management Standards and a stormwater report has not been prepared. EXISTING CONDITIONS The subject property is located at 25 Winter Island Road and occupied by a single-family house with water frontage on Juniper Cove. The shoreline in this area is generally comprised of a vegetated intertidal zone,rocky beach and coastal bank. There are numerous areas of exposed ledge; however most of the coastal bank at the subject site and other properties along Juniper Cove is either vegetated or has been reinforced with constructed walls or reveunents. In 2008 the Applicant received an Order of Conditions to reinforce a portion of the coastal bank in the eastern portion of the property with rip-rap in response to storm damage. The work was completed according to the plan submitted with the NOI at that time. At approximately the same time, the abutting property to the west performed similar coastal bank reinforcement with flat rip-rap. As a result of these two projects, there remains and area of approximately 18 If of coastal bank which is not protected by either exposed ledge or rip-rap reinforcement. This area is occupied by miscellaneous vegetation and subject to erosion from both coastal storms and surface runoff since the topography of the landward lawn area slopes downward directing storm water to this area of coastal bank. P.O. Ito, 1129 • Ne"I"u'Ypor[, MA 0191`0 5U9 294_b�00 Salem Conservation Commission City Hall Annex PROJECT DESCRIPTION The project proposes to construct a rip-rap wall along the approximately 18 If of coastal bank which has not been reinforced by recent projects. As shown on Sheet C-1,the proposed rip-rap wall will be approximately three to five feet high and constructed with rounded stones to match the previous wall construction performed in 2008. The wall will serve to protect the bank and also support minor re- grading proposed to create a more level lawn area landward of the bank. Proposed lawn area improvements also include placing large flat landscape stones as shown on Sheet C-1. All disturbed areas not subject to stone placement will be restored with loam and seed. A sedimentation barrier will be placed between the bottom of the wall and mean high water as shown on Sheet C-l. The contractor will install the barrier prior to starting construction and maintain it until construction is complete and the site is stabilized. ACTIVITIES SUBJECT TO REGULATION Resource areas at the site include Coastal Bank and Land Subject to Coastal Storm Flowage (LSCSF)as determined from site survey performed for the 2008 NOT. Coastal Bank The project proposes to construct approximately 18 If of rip-rap wall along a vegetated coastal bank. This section of coastal bank is an isolated section of bank located between two recently-constructed rip-rap walls and areas of exposed ledge. Based on the limited extent of the bank and the rocky nature of the Juniper Cove shoreline,the coastal bank is not considered a source of sediment for coastal beaches, coastal dunes or barrier beaches and therefore not subject to the provisions of 310 CMR 10.30(3)through (5) The coastal bank is considered significant to storm damage prevention because it is a vertical buffer to stormwater. The proposed rip-rap wall will serve to enhance that function and have a beneficial impact on the stability of the coastal bank. The project site is not located within an estimated habitat indicated on the most recent Estimated Habitat Map of State-Listed Rare Wetlands Wildlife published by the Natural Heritage and Endangered Species Program. Land Subject to Coastal Storm Flowage Approximately 100 square feet of wall construction will be performed within LSCSF as mapped on FEMA flood insurance rate map(FIRM)Map Number 25009CO436F effective July 3, 2012. The revised Preliminary FIRM issued on June 13, 2013 shows much of the site being part of an AE14 flood zone. This higher flood elevation of 14(NA VD88)would include the entire project work area of approximately 650 square feet. There are no performance standards for work within LSCSF. Nevertheless, the project does not propose significant filling or altering of topography which would adversely affect coastal storm impacts to the site or surrounding properties. OCG Project 12046 Page 2 January 9, 2014 Salem Conservation Commission City Hall Annex We look forward to meeting with the Conservation Commission on January 23. 2014 to discuss the project in greater detail. Should you have any immediate comments or concerns, please contact me at (508)284-4800. Sincerely, OAK CONSULTING GROUP,LLC Paul F. Avery P.E. President PFA: OCG Project 12046 Page 3 January 9, 2014 ATTACHMENT A WPA Form 3—Notice of Intent and NOI Fee Transmittal Form Notice of Intent 25 Winter Island Road Salem,Massachusetts Oak Consulting Group,LLC Project 12046 Massachusetts Department of Environmental Protection Provided by MassOEP: Bureau of Resource Protection -Wetlands MassDEP File Number WPA Form 3 — Notice of Intent Document Transaction Number Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Salem City/Town Important:When filling out A. General Information fors on the computer,use only the tab key 1 Project Location (Note: electronic filers will click on button to locate project site): to move your 25 Winter Island Salem 01970 cursor-do not .Street Address b.City/Tom/Town c.Zi use the return a lY P Code key. 42 deg 31'- 53" N 70 deg 52' 06" Latitude and Longitude: d.Latitude e. Longitude m 44 25 &26 f.Assessors Map/Plat Number g.Parcel/Lot Number 2. Applicant: Douglas and Jean Karam a.First Name b.Last Name Note: Before c.Organization completing this 25 Winter Island Road for consult your local d.Street Address Conservation Salem MA 01970 Commission regarding any e.City/Tom f.State g.Zip Code municipal bylaw 978 741-2179 karamfour@gmail.com or ordinance. h.Phone Number i. Fax Number j.Email Address 3. Property owner(required if different from applicant): ❑ Check if more than one owner a. First Name b.Last Name c.Organization d.Street Address e.City/Town L State g.Zip Code h. Phone Number i. Fax Number j.Email address 4. Representative (if any): Paul Avery a.First Name b.Last Name Oak Consulting Group, LLC c.Company P.O. Box 1123 d.Street Address Newburyport MA 01950 e.Cily/Town f.State g.Zip Code 508 284-4800 paavery.ocg@gmail.com h.Phone Number i.Fax Number j.Email address 5. Total WPA Fee Paid (from NOI Wetland Fee Transmittal Form): $100.00 $37.50 $62.50 a.Total Fee Paid b.State Fee Paid c.City/Town Fee Paid wpaform3.doc-rev. 1/3/2013 Page 1 of 8 Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands NOI Wetland Fee Transmittal Form Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Fees (continued) Step 1rrype of Activity Step 2/Number Step Step 4/Subtotal Activity of Activities 3/Individual Fee Activity Fee Category 4: Work on Revetment 18 $4/If $100 (minimum fee) Step 5/Total Project Fee: $100 Step 6/Fee Payments: Total Project Fee: $100 a.Total Fee from Step 5 State share of filing Fee: $37.50 b. 1/2 Total Fee less$12.50 City/Town share of filling Fee: $62.50 c.1/2 Total Fee plus$12.50 C. Submittal Requirements a.) Complete pages 1 and 2 and send with a check or money order for the state share of the fee, payable to the Commonwealth of Massachusetts. Department of Environmental Protection Box 4062 Boston, MA 02211 b.) To the Conservation Commission: Send the Notice of Intent or Abbreviated Notice of Intent; a copy of this form; and the city/town fee payment. To MassDEP Regional Office(see Instructions):Send a copy of the Notice of Intent or Abbreviated Notice of Intent; a copy of this form, and a copy of the state fee payment. (E-filers of Notices of Intent may submit these electronically.) noifeetf.aoc•Wetland Fee Transmittal Form•rev.10/1711 Page 2 of 2 Massachusetts Department of Environmental Protection Provided by MassDEP: Bureau of Resource Protection -Wetlands MassDEP File Number WPA Form 3 — Notice of Intent Document Transaction Number Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Salem City/Town A. General Information (continued) 6. General Project Description: Construct approximately 18 linear feet of stone wall along coastal and minor regrading landward of the wall. 7a. Project Type Checklist: 1. ® Single Family Home 2. ❑ Residential Subdivision 3. ❑ Limited Project Driveway Crossing 4. ❑ Commercial/Industrial 5. ❑ Dock/Pier 6. ❑ Utilities 7. ❑ Coastal Engineering Structure 8. ❑ Agriculture (e.g., cranberries, forestry) 9. ❑ Transportation 10. ❑ Other 7b. Is any portion of the proposed activity eligible to be treated as a limited project subject to 310 CMR 10.24 (coastal) or 310 CMR 10.53 (inland)? 1. ❑ Yes ® No If yes, describe which limited project applies to this project: 2. Limited Project 8. Property recorded at the Registry of Deeds for: Essex a.County b.Certificate#(if registered land) 23597 239 c.Book d.Page Number B. Buffer Zone & Resource Area Impacts (temporary & permanent) 1. ❑ Buffer Zone Only—Check if the project is located only in the Buffer Zone of a Bordering Vegetated Wetland, Inland Bank, or Coastal Resource Area. 2. ❑ Inland Resource Areas (see 310 CMR 10.54-10.58; if not applicable, go to Section B.3, Coastal Resource Areas). Check all that apply below. Attach narrative and any supporting documentation describing how the project will meet all performance standards for each of the resource areas altered, including standards requiring consideration of alternative project design or location. Resource Area Size of Proposed Alteration Proposed Replacement(if any) For all projects affecting other Resource Areas, a. ❑ Bank 1.linear feet 2.linear feet please attach a b. narrative ❑ Bordering Vegetated explaining how Wetland 1.square feet 2.square feet the resource area was c. ❑ Land Under 1,square feet 2.square feet delineated. Waterbodies and Waterways 3.cubic yards dredged wpaform3.doc•rev. 1/3/2013 Page 2 of 8 Massachusetts Department of Environmental Protection Provided by MassDEP: Bureau of Resource Protection -Wetlands i MassDEP File Number 1 WPA Form 3 — Notice of Intent ( Document Transaction Number Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Salem City/Tom B. Buffer Zone & Resource Area Impacts (temporary & permanent) (cont'd) Resource Area Size of Proposed Alteration Proposed Replacement(if any) d. ❑ Bordering Land Subject to Flooding 1.square feet 2.square feet 3.cubic feet of flood storage lost 4.cubic feet replaced e. ❑ Isolated Land Subject to Flooding 1.square feet 2.cubic feet of flood storage lost 3.cubic feet replaced f. ❑ Riverfront Area 1.Name of Waterway(if available) 2. Width of Riverfront Area (check one): ❑ 25 ft. - Designated Densely Developed Areas only ❑ 100 ft. - New agricultural projects only ❑ 200 ft. -All other projects 3.Total area of Riverfront Area on the site of the proposed project: square feet 4. Proposed alteration of the Riverfront Area: a.total square feet b.square feet within 100 ft. c.square feet between 100 ft.and 200 ft. 5. Has an alternatives analysis been done and is it attached to this NOI? ❑ Yes❑ No s.Was the lot where the activity is proposed created prior to August 1, 1996? ❑ Yes❑ No 3. ® Coastal Resource Areas: (See 310 CMR 10.25-10.35) Check all that apply below. Attach narrative and supporting documentation describing how the project will meet all performance standards for each of the resource areas altered, including standards requiring consideration of alternative project design or location. Online Users: Include your Resource Area Size of Proposed Alteration Proposed Replacement(if any) document transaction number a. ElDesignated Port Areas Indicate size under Land Under the Ocean, below (provided on your receipt page) b. ❑ Land Under the Ocean with all 1.square feet supplementary information you 2.cubic yards dredged submit to the Department. c. ❑ Barrier Beach Indicate size under Coastal Beaches and/or Coastal Dunes below d. ❑ Coastal Beaches 1.square feet 2.cubic yards beach nourishment e. ❑ Coastal Dunes 1.square feet 2.cubic yards dune nourishment wpaform3.doc•rev. 1/3/2013 Page 3 of 8 Massachusetts Department of Environmental Protection Provided by MassDEP: Bureau of Resource Protection -Wetlands MassDEP File Number 1 WPA Form 3 — Notice of Intent Document Transaction Number Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Salem City/Town B. Buffer Zone & Resource Area Impacts (temporary & permanent) (cont'd) Size of Proposed Alteration Proposed Replacement(if any) f. Z Coastal Banks 18 1.linear feet g. ❑ Rocky Intertidal Shores 1.square feet h. ❑ Salt Marshes 1.square feet 2.sq ft restoration,rehab.,creation i. ❑ Land Under Salt Ponds 1.square feet 2.cubic yards dredged j. ❑ Land Containing Shellfish 1.square feet k. ❑ Fish Runs Indicate size under Coastal Banks, inland Bank, Land Under the Ocean, and/or inland Land Under Waterbodies and Waterways, above 1.cubic yards dredged I. Z Land Subject to 100 Coastal Storm Flowage 1.square feet 4. ❑ Restoration/Enhancement If the project is for the purpose of restoring or enhancing a wetland resource area in addition to the square footage that has been entered in Section B.2.b or B.3.h above, please enter the additional amount here. a.square feet of BWy b.square feet of Salt Marsh 5. ❑ Project Involves Stream Crossings a.number of new stream crossings b.number of replacement stream crossings C. Other Applicable Standards and Requirements Streamlined Massachusetts Endangered Species ActlWetlands Protection Act Review 1. Is any portion of the proposed project located in Estimated Habitat of Rare Wildlife as indicated on the most recent Estimated Habitat Map of State-Listed Rare Wetland Wildlife published by the Natural Heritage and Endangered Species Program (NHESP)?To view habitat maps, see the Massachusetts Natural Heritage Atlas or go to http://www.mass.gov/dfwele/dfw/nhesp/regulatory review/priority habitat/online viewer htm. a. ❑ Yes Z No If yes, include proof of mailing or hand delivery of NOI to: Natural Heritage and Endangered Species Program Division of Fisheries and Wildlife 2008 100 Hartwell Street,Suite 230 b.Date of map West Boylston, MA 01583 wpaform3.doc•rev. 1/3/2013 Page 4 of 8 Massachusetts Department of Environmental Protection Provided by MassDEP: Bureau of Resource Protection -Wetlands MassDEP File Number WPA Form 3 — Notice of Intent Document Transaction Number' Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Salem city/Town C. Other Applicable Standards and Requirements (cont'd) If yes, the project is also subject to Massachusetts Endangered Species Act(MESA) review(321 CMR 10.18). To qualify for a streamlined, 30-day, MESA/Wetlands Protection Act review, please complete Section C.1.C, and include requested materials with this Notice of Intent (NOI); OR complete Section C.1.d, if applicable. If MESA supplemental information is not included with the NOI, by completing Section 1 of this form, the NHESP will require a separate MESA filing which may take up to 90 days to review(unless noted exceptions in Section 2 apply, see below). 1. c. Submit Supplemental Information for Endangered Species Review' 1. ❑ Percentage/acreage of property to be altered: (a)within wetland Resource Area percentage/acreage (b)outside Resource Area percentage/acreage 2. ❑ Assessor's Map or right-of-way plan of site 3. ❑ Project plans for entire project site, including wetland resource areas and areas outside of wetlands jurisdiction, showing existing and proposed conditions, existing and proposed tree/vegetation clearing line, and clearly demarcated limits of work**" (a)❑ Project description (including description of impacts outside of wetland resource area & buffer zone) (b) ❑ Photographs representative of the site (c)❑ MESA filing fee(fee information available at: http://www.mass.goy/dfwele/dfw/nhesp/regulatory review/mesa/mesa fee schedule.htm). Make check payable to"Commonwealth of Massachusetts- NHESP" and mail to NHESP at above address Projects altering 10 or more acres of land, also submit: d Vegetation covert a ma of site 9 YP P (e)❑ Project plans showing Priority& Estimated Habitat boundaries d. OR Check One of the Following 1.❑ Project is exempt from MESA review. Attach applicant letter indicating which MESA exemption applies. (See 321 CMR 10.14, http://www.mass.qov/dfweleldfw/nhesp/regulatory review/mesa/mesa exemotions.htm; the NOI must still be sent to NHESP if the project is within estimated habitat pursuant to 310 CMR 10.37 and 10.59.) 2.❑ Separate MESA review ongoing. a.NHESP Tracking# b.Date submitted to NHESP R Some projects not in Estimated Habitat may be located in Priority Habitat, and require NHESP review(see http://www.mass.gov/dfwele/dfw/nhesp/nhesp.htm, regulatory review tab). Priority Habitat includes habitat for state-listed plants and strictly upland species not protected by the Wetlands Protection Act. MESA projects may not be segmented (321 CMR 10.16).The applicant must disclose full development plans even if such plans are . not required as part of the Notice of Intent process. wpaform3.doc•rev.1/3I2013 Page 5 of 8 Massachusetts Department of Environmental Protection Provided by MassDEP: Bureau of Resource Protection -Wetlands MassDEP File Number WPA Form 3 — Notice of Intent Document Transaction Number Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Salem City/Town C. Other Applicable Standards and Requirements (cont'd) 3. ❑ Separate MESA review completed. Include copy of NHESP"no Take"determination or valid Conservation & Management Permit with approved plan. 2. For coastal projects only, is any portion of the proposed project located below the mean high water line or in a fish run? a. ❑ Not applicable—project is in inland resource area only b.❑ Yes ® No If yes, include proof of mailing or hand delivery of NOI to either: South Shore-Cohasset to Rhode North Shore-Hull to New Hampshire: Island, and the Cape&Islands: Division of Marine Fisheries- Division of Marine Fisheries- Southeast Marine Fisheries Station North Shore Office Attn: Environmental Reviewer Attn: Environmental Reviewer 1213 Purchase Street—3rd Floor 30 Emerson Avenue New Bedford, MA 02740-6694 Gloucester, MA 01930 Also if yes, the project may require a Chapter 91 license. For coastal towns in the Northeast Region, please contact MassDEP's Boston Office. For coastal towns in the Southeast Region, please contact MassDEP's Southeast Regional Office. 3. Is any portion of the proposed project within an Area of Critical Environmental Concern (ACEC)? Online users: a. ❑ Yes ® No If yes, provide name of ACEC (see instructions to WPA Form 3 or MassDEP Include your Website for ACEC locations). Note: electronic filers click on Website. document transaction b.ACEC number (provided on your 4. Is any portion of the proposed project within an area designated as an Outstanding Resource Water receipt page) (ORW)as designated in the Massachusetts Surface Water Quality Standards, 314 CMR 4.00? with all supplementary a. ❑ Yes ® No information you submit to the 5. Is any portion of the site subject to a Wetlands Restriction Order under the Inland Wetlands Department. Restriction Act(M.G.L. c. 131, §40A) or the Coastal Wetlands Restriction Act(M.G.L. c. 130, § 105)? a. ❑ Yes ® No 6. Is this project subject to provisions of the MassDEP Stormwater Management Standards? a. ❑ Yes. Attach a copy of the Stormwater Report as required by the Stormwater Management Standards per 310 CMR 10.05(6)(k)-(q) and check if: 1.❑ Applying for Low Impact Development(LID) site design credits (as described in Stormwater Management Handbook Vol. 2, Chapter 3) 2.❑ A portion of the site constitutes redevelopment 3.❑ Proprietary BMPs are included in the Stormwater Management System. b.® No. Check why the project is exempt: 1.® Single-family house wpaform3.doc•rev. 1/3/2013 Page 6 of 8 Massachusetts Department of Environmental Protection Provided by MassDEP: Bureau of Resource Protection -Wetlands MassDEP File Number WPA Form 3 — Notice of Intent Document ent Transaction Number.\ Massachusetts Wetlands Protection Act M.G.L. c. 131 40 ocu Salem City/Tom C. Other Applicable Standards and Requirements (cont'd) 2. ❑ Emergency road repair 3.❑ Small Residential Subdivision (less than or equal to 4 single-family houses or less than or equal to 4 units in multi-family housing project)with no discharge to Critical Areas. D. Additional Information Applicants must include the following with this Notice of Intent(NOI). See instructions for details. Online Users: Attach the document transaction number(provided on your receipt page)for any of the following information you submit to the Department. 1. ® USGS or other map of the area (along with a narrative description, if necessary) containing sufficient information for the Conservation Commission and the Department to locate the site. (Electronic filers may omit this item.) 2. ® Plans identifying the location of proposed activities (including activities proposed to serve as a Bordering Vegetated Wetland [BVW] replication area or other mitigating measure) relative to the boundaries of each affected resource area. 3. ❑ Identify the method for BVW and other resource area boundary delineations (MassDEP BVW Field Data Form(s), Determination of Applicability, Order of Resource Area Delineation, etc.), and attach documentation of the methodology. 4. ® List the titles and dates for all plans and other materials submitted with this NOI. C-1 Site Plan a.Plan Title Oak Consulting Group, LLC Paul F.Avery, P.E. b.Prepared By c.Signed and Stamped by 12/20/13 As Noted d.Final Revision Date e.Scale f.Additional Plan or Document Title g. Date 5. ❑ If there is more than one property owner, please attach a list of these property owners not listed on this form. 5. ❑ Attach proof of mailing for Natural Heritage and Endangered Species Program, if needed. 7. ❑ Attach proof of mailing for Massachusetts Division of Marine Fisheries, if needed. a. ® Attach NOI Wetland Fee Transmittal Form s. ❑ Attach Stormwater Report, if needed. wpaform3.doc•rev. 1/3/2013 Page 7 of 8 Massachusetts Department of Environmental Protection Provided by MassDEP: Bureau of Resource Protection -Wetlands MassDEP File Number WPA Form 3 - Notice of Intent Document Transaction Number Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Salem CIry/Town E. Fees 1. ❑ Fee Exempt: No filing fee shall be assessed for projects of any city, town, county, or district of the Commonwealth, federally recognized Indian tribe housing authority, municipal housing authority, or the Massachusetts Bay Transportation Authority. Applicants must submit the following information (in addition to pages 1 and 2 of the N01 Wetland Fee Transmittal Form)to confirm fee payment: "10 JGtK 2 ZdI �F 2.Municipal Check NU0 N 3.Check V � L o r b 7-0 ( 4.State Check Number �� I 5.Check date 6.Payor name on check:First Name 7.Payor name on check:Last Name F. Signatures and Submittal Requirements I hereby certify under the penalties of perjury that the foregoing Notice of Intent and accompanying plans, documents, and supporting data are true and complete to the best of my knowledge. I understand that the Conservation Commission will place notification of this Notice in a local newspaper at the expense of the applicant in accordance with the wetlands regulations, 310 CMR 10.05(5)(a). further certify under penalties of perjury that all abutters were notified of this application, pursuant to the requirements of M.G.L. c. 131, §40. Notice must be made by Certificate of Mailing or in writing by hand delivery or certified mail (return receipt requested)to all abutters within 100 feet of the property line of the project location. — /l6/i ¢ 1.Signature of Applicant - 2.Date 3.Signature of Property Owner(if different) 4.Date 5.Signature of Representative(if any) 6.Date For Conservation Commission: Two copies of the completed Notice of Intent(Form 3), including supporting plans and documents, two copies of the N01 Wetland Fee Transmittal Form, and the city/town fee payment,to the Conservation Commission by certified mail or hand delivery. For MassDEP: One copy of the completed Notice of Intent(Form 3), including supporting plans and documents, one copy of the N01 Wetland Fee Transmittal Form, and a copy of the state fee payment to the MassDEP Regional Office (see Instructions) by certified mail or hand delivery. Other: If the applicant has checked the"yes" box in any part of Section C, Item 3, above, refer to that section and the Instructions for additional submittal requirements. The original and copies must be sent simultaneously. Failure by the applicant to send copies in a timely manner may result in dismissal of the Notice of Intent. wpaform3.doc•rev. 1/3/2013 Page 8 of 8 LlMassachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands NOI Wetland Fee Transmittal Form Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Important:When A. Applicant Information. filling out forms on the computer, 1. Location of Project: use only the tab key to move your 25 Winter Island Road Salem cursor-do not a.Street Address b.City/Tom use the return key. c.Check number d.Fee amount 2. Applicant Mailing Address: Douglas and Jean Karam a.First Name b.Last Name a Organization 25 Winter Island Road d. Mailing Address Salem MA 01970 e.City/Town I.State g.Zip Code 978 741-2179 karamfour@gmail.com h.Phone Number i.Fax Number j.Email Address 3. Property Owner(if different): a.First Name - b.Last Name c.Organization d. Mailing Address e.City/Town f.State g.Zip Code h. Phone Number i.Fax Number j.Email Address To calculate B. Fees filing fees,refer to the category fee list and Fee should be calculated using the following process &worksheet. Please see Instructions before examples in the filling out worksheet. instructions for filling out WPA Step 1/Type of Activity: Describe each type of activity that will occur in wetland resource area and buffer zone. Form 3(Notice of Intent). Step 2/Number of Activities: Identify the number of each type of activity. Step 3/Individual Activity Fee: Identify each activity fee from the six project categories listed in the instructions. Step 4/Subtotal Activity Fee: Multiply the number of activities(identified in Step 2)times the fee per category (identified in Step 3)to reach a subtotal fee amount. Note: If any of these activities are in a Riverfront Area in addition to another Resource Area or the Buffer Zone,the fee per activity should be multiplied by 1.5 and then added to the subtotal amount. Step S/Total Project Fee: Determine the total project fee by adding the subtotal amounts from Step 4. Step 6/Fee Payments:To calculate the state share of the fee, divide the total fee in half and subtract$12.50.To calculate the city/town share of the fee, divide the total fee in half and add$12.50. noileelf.doc•Welland Fee Transmittal Fenn•rev.10/17/11 Page 1 al2 ATTACHMENT B Site Location Map and Drawing Sheet C-I Notice of Intent 25 Winter Island Road Salem, Massachusetts Oak Consulting Group,LLC Project 12046 �FRST N? T� p r � 'Bev rly Cove 127 ��, Central o ern I O / a ��m a tch�l 3 � Q �Endicott� 62 ❑ each; n Cm munity. N]i lie g e o6ER sT�' ,r:Be�erl 0 �o 9e BE Nlaekerel' IF�IIospltal'P)`oint''' ' CoveCurtis Black ock Point - "t Hospital Hospital Poir t Range ;Poiht SE Light 4 rgfithouse J Dane Street Beach Woc dbtiry Beverly Channel Point porter Rock Monument i Bar Haste Shoal Rams Horn Old Hospit 1 Rock Point Hospital Point L416 Pic,' ne �ea`ch o ,ll Little Haste , e� 'Ne C Ju iper Point Great Haste Islam haste i �Juniner Site Salem Abbot Rock Neck ' Middle Ground C inter Islan p �i Grew Little I a _,: '' Aquavitae Cove. South Channel Aquavitae'` Triangle " Sto a Rock Rocks Halftide Salem Caswell Rock Harbor A Rock Endeavors F_ndea.vncs cater.' O C G SITE LOCATION MAP H 25 Winter Island Road Oak Consulting Group P.O.Bm 112S Salem, MA N—b.,, ,MA 0195 Ph Figure 1 I