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70 DEARBORN STREET - CONSERVATION COMMISSION p 1.I�DR — � Uea�h��� s�• M 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 Francis & Maura Murphy return key. Name Name 70 Dearborne Street VQ Mailing Address Mailing Address Salem Ma 0p 70 Cod Salem State Zip Code Citylrown State Zip Code �. 1. Title and Date (or Revised Date if applicable)of Final Plans and Other Documents: Proposed Plot Plan 70 Dearborn Street July 16, 2004 Title Date Title Date Title Date 2. Date Request Filed: 8/23/04 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): 26'x 39'addition to an existing single family dwelling Project Location: 70 Dearborn Street Salem Street Address Cityfrown Map 36 Lot 0486 Assessors Map/Plat Number Parcel/Lot Number wpaform2.dm•rev.7113/04 Page 1 of 5 J' 1 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands Ll 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 wpafom2.dm•rev.7/13104 Page 2 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.) ❑ 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 within 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, subject to the following conditions (if any). ❑ 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. wpafam2 doc•rev.7/13/04 Page 3 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.) ❑ 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: Exempt Activity(site applicable statuatory/regulatory 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 Z by certified mail, return receipt requested on 9/13/OY Date I 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 appropriate DEP Regional Office (see Attachment)and the property owner(if different from the applicant). Signature . WA6 /000 9�9/o y Dale wpaform2.dm•rev.7/13/04 Page 4 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 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 Attachment)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 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. wpaform2.d=•rev.7113104 Page 5 of 5 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box I I I I I Salem Conservation Commission 120 Washington Street,3rd FI Salem,MA 01970 I I I II&I=19 I a]ZI COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Si at item 4 if Restricted Delivery is desired. 0 Agent ■ Print your name and address on the reverse X . 0 Addressee so that we can return the card to you. el ad not Nam C to of Delivery ■ Attach this card to the back of the mailpiece, _ s II or on the front if space permits. xlw deliv addre di nt fro m l? 0 Yes 1. Article Addressed to: If YES,enter delivery address ow: 0 No Lnnclk Grp owlrorn , MA. C)19�0 3. Service Type 1/ 1 I Certified Mail 0 Express Mail 0 Registered 0 Return Receipt for Merchandise 0 Insured Mail 0 C.O.D. 4. Restricted Delivery?(Extra Fee) 0 Yes 2. Article Number 7002 2410 0003 2794 5378 (Transfer them service labefl PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 ender: Please print your name, address, and ZIP+4 in this box SEP 1 7 2004 DEPT.OF PLANNING& OMMUNITY DEVELOPMENT Salem Conservatlon Commleslon 120 Washington Street,3rd FI Salem,MA 01970 01 Il�nnnll�i�n+nil��nni��u���nil��nll�lrluli�un�e�� I&J1 4 0191=1 I.f I Ws] COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. 13 Agent ■ Print your name and address on the reverse X ❑Addressee so that we can return the card to you. nn a eme Date of elivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery ads Tess different from Rem 17 ❑Yes t. Article Addressed to: If Y renlertl 0 No DEP SEP 1 5 2004 f Neap-a# la4ds +We,-&ways I s°FlIOX OA i✓frilri Sf 3. Service Type DEP I I n „�T' ' rs r lqn O Ui}18dR41211 D.Fxpress Mair �Ol i '7 0 Registered, -'0Return Receipt for Merchandise L--O Insured Mail—0 Go:). 4. Restricted Delivery?(Extra Fee) 0 yes ' 2. Article Number 7002 2410 0003 2794 5385 (Transfer from service label) PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 U.S. Postal Servicer:. CERTIFIED MAILr•, RECEIPT s (Domestic Mail Only;No Insurance Coverage Provided) For delivery information visit our website at www.usps.comr r D FFICIAL ru Postage 1:3 Return Red Fee PS Form 3800,June 2002 See Reverse for Instructions Certified Mail Provides: zest-w-zo-seszot • A mailing receipt (asianay)zepa eunr'OOeE wio0J Sd ■ A unique identifier for your mailpiece ■ A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mall may ONLY be combined with First-Class Mail®or Priority Mall, ■ Certified Mall is not available for any class of international mall. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■ For an additional fee,a Retum Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,passe complete antl attach a Retum Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mall receipt is required. • For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mallpiece with the '.. endorsement"RestnctedDefivery". ■ If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt andpresent it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. U.S. Postal Service,M., CERTIFIED MAIL,., RLLC EPT (Domestic Mail Only;No Insurance Coverage PSS r o v idE d ) For delivery information visit our website at www.usps.corrtro r 3 - s PS Form 3000,June 2002 See Reverse for Instructions Certified Mall Provides: ~' zest-N-za sesaot ■ A mailing receipt (e wad)aooa eunr'ooec uuod ad ■ A unique Identifier for your mallplece ■ A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mall may ONLY be combined with First-Class Mails or Priority Mail& ■ Certified Mail Is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■ For an additional fee,a Return Rece/pt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Retum Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mallpiece"Rehm Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery'. ■ If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt Is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt andpresent It when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. 0 CITY OF SALEM CONSERVATION COMMISSION City of Salem Conservation Commission Will hold a public hearing for a Request for a Determination of Applicability under the Wetlands Protection Act, Massachusetts General Laws, Chapter 131, Section 40 and Salem's Ordinance Pertaining to General Wetlands at the request of Frank Murphy, 70 Dearborn Street, Salem, MA 01970. The purpose of this hearing is for the determination of work related to the construction of a 26' x 39' addition to a single-family dwelling located in a Riverfront Area at 70 Dearborn Street. This hearing will be held on Thursday, September 9,2004 at 6:00 p.m.in Room 313,Third Floor, 120 Washington Street. 244wo • • • Kevin P. Comacchio Chairman September 2, 2004 Please send bill to: Francis J. Murphy 70 Dearborn Street Salem, MA 01970 978-741-0005 120 WASHINGTON .STREET, SALEM, MASSACHUSETTS 01970 TEL: 978.745.9595 FAx: 978.740.0404 WWW.SALEM.COM M1�a � �. �� y mf .^f Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands cSalem rrroowft Y: WPA Form 1 - Request for Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 A. General Information Important: Men filling out 1. Applicant: forms on the Computer, use FranCia T- and Macara A_ Murphyr only the tab key Name E-Mail Address(if applicable) to move your 70 Dearborn Street cursor-do not Mailing Address use the return Salem, Ma. 01970 key. City/Tom State Zip Code 978 741 0005 978 741 3676 VQ Phone Number Fax Number(if applicable) 2. Representative(if any): �.e N /A Firm Contact Name E-Mail Address(if applicable) Mailing Address City/Tom State Zip Code Phone Number Fax Number(if applicable) B. Determinations 1. I request the Salem make the following determination(s). Check any that apply: Conservation Commission - ❑ a. whether the area depicted on plan(s)and/or map(s)referenced below is an area subject to jurisdiction of the Wetlands Protection Act. ❑ b. whether the boundaries of resource area(s)depicted on plan(s)and/or map(s) referenced below are accurately delineated. ® c. whether the work depicted on plan(s)referenced below is subject to the Wetlands Protection Act. ❑ d. whether the area and/or work depicted on plan(s) referenced below is subject to the jurisdiction of any municipal wetlands ordinance or bylaw of: Name of Municipality ❑ e. whether the following scope of alternatives is adequate for work in the Riverfront Area as depicted on referenced plan(s). wpaforrol doc•rev.02/00. Page 1 of 4 • Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands sA>Pre WPA Form 1- Request for Determination of Applicability cityfrown Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 C. Project Description 1. a. Project Location(use maps and plans to identify the location of the area subject to this request): 70 Dearborn Street Salem Street Address City/Town 36-0486 Assessors Map/Plat Number Parcel/Lot Number b. Area Description (use additional paper, if necessary): Lot consist of lot 8 Plan Book 128 Plan 6 and Lot B P1an. 588 in 1966 for City of Salem. Total area of approx 3X000Sq' c. Plan and/or Map Reference(s): Plan 8 Plan Book 128 Plan 6 Title Date Lot B Plan 588-1966 2. a. Work Description(use additional paper and/or provide plan(s)of work, if necessary): Attacha 26' X 39' addition to existing structure b. Identify provisions of the Wetlands Protection Act or regulations which may exempt the applicant from having to file a Notice of Intent for all or part of the described work(use additional paper, if necessary). wlefoimlAm•rm 02/00. Page 2 of 4 Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands Salem WPA Form 1 - Request for Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 C. Project Description (cont.) 3. a. If this application is a Request for Determination of Scope of Alternatives for work in the Riverfront Area, indicate the one classification below that best describes the project. ❑ Single family house on a lot recorded on or before 8/1/96 ❑ Single family house on a lot recorded after 8/1196 ❑ Expansion of an existing structure on a lot recorded after 8/1/96 ® Project, other than a single family house or public project, where the applicant owned the lot before 8/7/96 ❑ New agriculture or aquaculture project ❑ Public project where funds were appropriated prior to 8/7/96 ❑ Project on a lot shown on an approved, definitive subdivision plan where there is a recorded deed restriction limiting total alteration of the Riverfront Area for the entire subdivision ❑ Residential subdivision; institutional, industrial, or commercial project ❑ Municipal project ❑ District, county, state, or federal government project ❑ Project required to evaluate off-site alternatives in more than one municipality in an Environmental Impact Report under MEPA or in an alternatives analysis pursuant to an application for a 404 permit from the U.S. Army Corps of Engineers or 401 Water Quality Certification from the Department of Environmental Protection. b. Provide evidence(e.g., record of date subdivision lot was recorded)supporting the classification above(use additional paper and/or attach appropriate documents, if necessary.) wpofom l.doc•w WOO. Page 3 of 4 Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands ca lout �. City/Tom w "\ WPA Form 1- Request for Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 D. Signatures and Submittal Requirements I hereby certify under the penalties of perjury that the foregoing Request for Determination of Applicability and accompanying plans,documents, and supporting data are true and complete to the best of my knowledge. I further certify that the property owner, if different from the applicant, and the appropriate DEP Regional Office(see Appendix A)were sent a complete copy of this Request(including all appropriate documentation)simultaneously with the submittal of this Request to the Conservation Commission. Failure by the applicant to send copies in a timely manner may result in dismissal of the Request for Determination of Applicability. Name and address of the property owner: Francis J and Maura A. Murphy Name 70 Dearborn Street Mailing Address Salem cityrrom Ma 01970 state Zip Code Signatures: I also understand that notification of this Request will be placed in a local newspaper at my expense aporclan ""thSectonI0gcordance with Section 10.05(3 (b)(1 of the.Wetlands Protection Act regulations. August 23, 2004 Signature Applicant6 I Date Signature of Representative(if any) Date wpaformldw-rev.02M.. Page laf4 - City of Salem Department of Planning & Community Development Check/Cash Receipt and Tracking Form Please comp/efe/form and make two copies. Date Received L o Amount Received 2S om Form of Payment Check F-1 Cash CHECK PAYMENTS: l Sys L ✓U write chedc number CASH PAYMENTS: - write dient initials 0 Sign Permit Application Fee Conservation Commission Fee Payment received for Planning Board Fee what service? 0 Oki Town Hall Rental Fee Q Other Name of staff person , receiving payment 00 Additional Notes EASTERN BANK 15456 SINCE 1893 LYNN, MA MURPHY FUNERAL HOME 85 FEDERAL STREET 53.179/113 8/23/2004 - SALEM, MA 01970 PAY TO THE CITY OF SALEM ORDER OF $ **25'00. � Twenty-Five and 00/100:**:F«***s***ss ks kr*rsrs«sv:s**+*tr*r r•�*ss*rr*rr «ar***r«.r DOLLARS City of Salem N 8 MEMO H ZED Sicca. RE 1100 l 54 5611' 1:0 i L30 0981: 60 008 588011' Original Check and Form: DPCD Finance Copy 1: Client I Copy 2: Application Fib J I Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands Salem u 1 WPA Form 1- Request for Determination of Applicability CitylTovm Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 A. General Information Important: When filling out 1- Applicant: forms on the computer, use - Franrig T_ And Maurer A- Murphy, only the tab key Name E-Mail Address(if applicable) to move your 70 Dearborn Street cursor-do not Mailing Address use the return Salem, Ma, 01970 key. Cltyrrom State Zip Code 978 741 0005 978 741 3676 1e Phone Number Fax Number(if applicable) I 2. Representative(if any): l N /A Firm Contact Name E-Mail Address(if applipble) Mailing Address Cityfrom State Zip Code Phone Number Fax Number(if applicable) B. Determinations 1. I request the Salem make the following determination(s). Check any that apply: Conservation Commission ❑ a. whether the area depicted on plan(s)and/or map(s)referenced below is an area subject to jurisdiction of the Wetlands Protection Act. ❑ b. whether the boundaries of resource area(s)depicted on plan(s)and/or map(s)referenced below are accurately delineated. ® c.whether the work depicted on plan(s)referenced below is subject to the Wetlands Protection Act. ❑ d. whether the area and/or work depicted on plan(s) referenced below is subject to the jurisdiction of any municipal wetlands ordinance or bylaw of. Name of Municipality ❑ e. whether the following scope of alternatives is adequate for work in the Riverfront Area as depicted on referenced plan(s). wpato"l.00c•m.MOO. Page 1 of 4 r4 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands ciiren 4 b WPA Form 1- Request for Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 C. Project Description 1. a. Project Location(use maps and plans to identify the location of the area subject to this request): 70 Dearborn Street Salem Street Address City?own 36-0486 Assessors Map/Plat Number Parcel/lot Number b. Area Description (use additional paper, if necessary): Lot consist of lot 8 Plan Book 128 Plan 6 and Lot B Plan 588 in 1966 for City of Salem. Total area of approx 336000Sq' c. Plan and/or Map Reference(s): Plan 8 PLan Book 128 Plan 6 Title Date Lot B Plan 588-1966 2. a. Work Description(use additional paper and/or provide plan(s)of work, if necessary): Attacha 26' X 39' addition to existing structure b. Identify provisions of the Wetlands Protection Actor regulations which may exempt the applicant from having to file a Notice of Intent for all or part of the described work(use additional paper, if necessary). wpeforrnf.dm•rV.02/00. Page 2 of C Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands Salem W WPA Form 1- Request for Determination of Applicability Tom Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 C. Project Description (cont.) 3. a. If this application is a Request for Determination of Scope of Alternatives for work in the Riverfront Area, indicate the one classification below that best describes the project. ❑ Single family house on a lot recorded on or before 8/1/96 ❑ Single family house on a lot recorded after 8/1/96 ❑ Expansion of an existing structure on a lot recorded after 8/1/96 ® Project, other than a single family house or public project, where the applicant owned the lot before 8/7/96 ❑ New agriculture or aquaculture project ❑ Public project where funds were appropriated prior to 8/7/96 ❑ Project on a lot shown on an approved, definitive subdivision plan where there is a recorded deed restriction limiting total alteration of the Riverfront Area for the entire subdivision ❑ Residential subdivision, institutional, industrial, or commercial project ❑ Municipal project ❑ District, county, state, or federal government project ❑ Project required to evaluate off-site alternatives in more than one municipality in an Environmental Impact Report under MEPA or in an alternatives analysis pursuant to an application for a 404 permit from the U.S. Army Corps of Engineers or 401 Water Quality Certification from the Department of Environmental Protection. b. Provide evidence(e.g., record of date subdivision lot was recorded)supporting the classification above(use additional paper and/or attach appropriate documents, if necessary.) wFafortnt.tloc•re..O&OO. Page 3 of 4 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands $A l City?own w WPA Form 1- Request for Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 D. Signatures and Submittal Requirements I hereby certify under the penalties of perjury that the foregoing Request for Determination of Applicability and accompanying plans, documents, and supporting data are true and complete to the best of my knowledge. I further certify that the property owner, if different from the applicant, and the appropriate DEP Regional Office(see Appendix A)were sent a complete copy of this Request(including all appropriate documentation)simultaneously with the submittal of this Request to the Conservation Commission. Failure by the applicant to send copies in a timely manner may result in dismissal of the Request for Determination of Applicability. Name and address of the property owner: Francis J and Maura A. Murphy Name 70 Dearborn Street Mailing Address Salem city?own Ma 01970 State Zip Code Signatures: I also understand that notification of this Request will be placed in a local newspaper at my expense apordance with Section 10.05(3 (b)(1 of the.Wetlands Protection Act regulations. M1I August 23, 2004 Signature Applicant 6 Date Signature of Representative(if any) Date wpafonnl da•rev.WOO. v,g,a or a RIVER NORTH H N N N s�o�C �C AREA 32, 000 SF-` �o6c I D 5 cn of At CoT Lc:;T d ,� � � Eou fp�as 'o �� CoA-_ G( z�= PROPOSED PL OT PL AN �o X19 70 DEARBORN STREET -�� DGA IL p- � $� pCI ) l-0�.8% = N t SALEM MASSACHUSETTS SCALE.• / " = 20 JULY /6 2004 PIJRSONS AND FAIA /NC. DEARBORN STREET so LEWIS srREEr LYNN , MASS. 0 20 40 60 90 /00 * ll ^^ N Of Mqs� Iv�� •• �F ��ol � l U �l � Sc��.�1 I s 5�1�.�-�� �rj_/ � � �°A . �,a .q� _ 77 .p .. y fib Carl 1=�IZM ��O,J'll4 E� • �--''��:�/ �t'y�ejrrcaEa �,. �`�� SLRVEyO r. _.._- RIVER NOR NO a 3 n1 5Loc II /C AREA 32, 000 S.F fi06�� C.o� o s•�� a a a P _ SC6� of 107"o At 10 Al o� ZGPROPOSED PLOT PLAN 70 DEARBORN STREET LA-o E IS� SALEM , MASSACHUSETTS Ego = SCAL E.' I =20 JULY /6 2004 PARSONS AND FAIA /NC. DEARBORIV STREET 60 LEWIS sm= LYNN , MASS. O 20 40 60 BO /00 ^ / NOF�AS^ ����,SURVEy�