5 DEARBORN LANE - CONSERVATION COMMISSION 5 Dearborn Lane
4
SPECIAL ORDER FORM --- A
ease fill in the information requested below:
FACIFICPOOLS SPECIAL
RADIUS CORNERS: [1 6" El Other rerwersev✓ySNAKE HAD.LAW HAM,xv mea L HOPPER
rrrevxoxr isunorns
SIDEWALL: ❑ Plain ❑ Print Color Design LINER
BOTTOM: ❑ Plain ❑ Print Color Design (-
BEAD: ❑ Blue 1-JWhite EN�1�--' M N
OVERLAP: ❑ 12" ❑ Other
WHITE SAFETY STRIPE: ❑ Yes ❑ No E D C
BOTTOM CONFIGURATION: ❑ Hopper ❑ Wedge ❑ Flat
❑ Other
mansions:
A 12- F K
B Lo / G L
C7- H M B
�, –
D �/,
I N —
ER //
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E
sketch and appropriate dimensions must accompany all orders for liners. If the sketches at SPECIAL DGE LINER
it do not apply to the liner you need, read and sign this form, and sketch your liner on a
arate sheet and fill in all necessary dimensions.
N
aler Name:
M
eet A
Y -- State - Zip
tributor. N
me: Pool Owner:
ereby authorize Pacific Pools to produce as a special order, a vinyl liner for an 8
ound pool in accordance with the design and specifications which I have pro-
d. The undelsigned hereby acknowledges that Pacific Pool Industries, Inc. has
i
participated in either the design or formulation of this liner and accept full r t— C
tonsibility for the same. I further agree to hold Pacific Pool Industries, Inc. L
mess, that is, I will pay it in full for any and all claims and expenses that may
z out of-the design or use of said special liner. F
Dealer Signature Date G
i r
4 Form 2
DEOE file No.
(Tobe provided by DEOE)
=J Commonwealth ciryrtown
SALEM
of Massachusetts ppPlicartt Leonard Paopalardo
Determination of Applicability
Massachusetts Wetlands Protection Act, G.L. 0. 131 , §40
From SALEM CONSERVATION COMMISSION Issuing Authority
To Leonard Pappalardo same
(Name of person making request) (Name of property owner)
Address 6 Dearborn Lane, Salem Address same
This determination is issued and delivered as follows:
❑ by hand delivery to person making requast on (date)
I by certified mail, return receipt requested on (date)
't
Pursuant to the authority of G.L. c. 131, §40,the
has considered your request for a Determination of Applicability and its supporting documentation, and has
made the following determination (check whichever is applicable):
This Determination is positive:
1. Cl The area described below,which includes all/part of the area described in your request,is an Area
Subject to Protection Under the Act.Therefore, any removing,filling,dredging or altering of that
area requires the filing of a Notice of Intent.
2. ❑ The work described below, which includes all/part of the work described in your request, is within
an Area Subject to Protection Under the Act and will remove,fill, dredge or alter that area-There-
fore, said work requires the filing of a Notice of Intent.
2-1
3. ❑ The work described below,which includes all/part of the work described in your request, is within
the Buffer Zone as defined in the regulations, and will alter an Area Subject to Protection Under
the Act.Therefore, said work requires the filing of a Notice of Intent.
This Determination is negative:
1. �G The area described in your request is not an Area Subject to Protection Under the Act.
2. ❑ The work described in your 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 your 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.
4. ❑ The area described in your request is Subject to Protection Under the Act,but 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:
SALEM Conservation Commission
Issued by
i
Signatur�e(s)
This Determination must be signed by a majority of the Conservation Commission.
On this 8 day of November 19 84 before me
personally appeared the above-named to me known to be the
person described,in, and who executed, the foregoing instrument,and acknowledged that he/she executed
the same as his/her free act and deed.
9-9-88
Notary Public My commission expires
This Determination does not relieve the applicant from complying with all other applicable federal,state or local statutes.ordinances,
bylaws or regulations.This Determination shall be valid for three years form the date of issuance.
The applicant,the 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 len residents of the city or town in which such land is located,are hereby notified of their right to request the
Department of Environmental Quality Engineering to issue a Superseding Determination of Applicability,providing the request is made
by certified mail or hand delivery to the Department within ten 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 the apps cant. -
2-2A
7S
Form 1
_ DEOE File No.
(To be provided by OEOE)
city/-r w
Commonwealth
of Massachusetts APPlicarrt •+U PLLj7ld1
Request for a Determination of Applicability
Massachusetts Wetlands Protection Act, G.L. c. 131, §40
1. I, the undersigned, hereby request that the
Conservation Commission make a determination as to whether the area,described below,or work to be
performed on said area,also described below, is subject to the jurisdiction of the Wetlands Protection
Act,G.L: c. 131, §40.
2. The area is described as follows. (Use maps or plans,if necessary,to provide a description and the
location of^theararea subject to this request)
3. The work in said area is described below. (Use additional paper,if necessary,to describe the
proposed work.) r
11
l
79
4. The owner(s)of the area, if not the person making this request, has been given written notification of this
requeston (date)
The name(s)and address(es)of the owner(s):
5. 1 have filed a complete copy of this request with the appropriate regional office of the Massachusetts
Department of Environmental Quality Engineering on (date)
Northeast Southeast
323 New Boston Street Lakeville Hospital
Woburn, MA 01801 Lakeville, MA 02346
Central Western
75 Grove Street Public Health Center
Worcester, MA 01605 University of Massachusetts
Amherst, MA 01003
6. 1 understand that notification of this request will be placed in a local newspaper at my expense in accor-
dance with Section 10.05(3) (b) 1 of the regulations by the Conservation Commission and that I will be
billed accordingly.
Signature -. Name
Address r Tel.
12
�`oN coi,
{ 'S. Conservadon Commissim
Salem. Massachusetts 01970
CITY OF SALEM
CONSERVATION COMMISSION
At a regularly-scheduled of the Conservation Commission to be held on Thursday,
November 0, 1584, at 7:30 p.m. , One Salem Green, second floor conference room,
a Determination of the Significance of the Wetlands Protection Act, Mass.
G. L. Chap. 131, Section 40 will be made on a proposal to construct a swimming
pool at 5 Dearborn Lane, Salem.
Philip D. Moran, Chairman
Nov. 1