The URL can be used to link to this page

37 INTERVALE ROAD - CONSERVATION COMMISSION (2) 37 �dv�-lam. (:�l ROS. `� Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands Salem ' WPA Form 1 - Request for Determination of ApplicabilitCity/Town y Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 J A. General Information Important: When filling out 1. Applicant: forms on the Mildred Marie O. Ananayo mmananayo@hotmail.com computer, use Name E-Mail Address only the tab key to move your 37 Intervale Road cursor-do not Mailing Address use the return Salem MA 01970 key. City/Town State Zip Code 978-930-9507 °d Phone Number Fax Number(if applicable) 2. Representative (if any): rctvn Firm Contact Name E-Mail Address Mailing Address City/Town State Zip Code ® Z � e `0 W L Phone Number Fax Number(if applicable) o iQq W N a o B. Determinations u c::) � 1. I request the Salem make the following determination(s). Check any that apply: WConservation Commission cc cg ❑ 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: Salem Name of Municipality ❑ e. whether the following scope of alternatives is adequate for work in the Riverfront Area as depicted on referenced plan(s). wpaforml.doc - Page 1 of 4 r ' Massachusetts Department of Environmental Protection �^ Bureau of Resource Protection - Wetlands Salem WPA Form 1 - Request for Determination of Applicability City/Town Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 C. Project Description r 1. a. Project Location (use maps and plans to identify the location of the area subject to this request): 37 and 39 Intervale Road Salem Street Address City/Town 21 67, 68 Assessors Map/Plat Number Parcel/Lot Number b. Area Description (use additional paper, if necessary): Single family home and abutting undeveloped Conservation Commission property within buffer zone to bordering vegetated wetlands located across Intervale Road. House construction and associated work was approved by the Conservation Commission through a negative determination of applicability issued 10/3/2001. c. Plan and/or Map Reference(s): EXIBIT PLAN OF LAND IN SALEM, MA PREPARED FOR PATRICIA A. 9/7/2011 CONNER Date Title Date Title Date 2. a. Work Description (use additional paper and/or provide plan(s) of work, if necessary): Remove tree marked on plan as "36 OAK"from outer edge of buffer zone. Clear additional trees from buffer zone per Commission approval. wpaformi.doc Page 2 of 4 f LlMassachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands Salem WPA Form 1 - Request for Determination of Applicability City/Town Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 C. Project Description (cont.) 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). 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.) naforml.doc Page 3 of 4 t ' Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands Salem WPA Form 1 - Request for Determination of Applicability City/Town 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 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: Mildred Marie 0. Ananayo Name 37 Intervale Road Mailing Address Salem City/Town MA 01970 State Zip Code Signatures: I also understand that notification of this Request will be placed in a local newspaper at my expense in accordance with Section 10.05(3)(b)(1) of the Wetlands Protection Act regulations. Signature of Applicant Date Signature of Representative(if any) Date wpaforml.tloc Page 4 of 4 PHOTO . ROAD,37 &39 INTERVALE Large oak tree(trunk just F x 5 a vlr" wK'fx h � q ..4�� 1i• �4.Y5 .,a �r ,` M .S A 1� iiFF 'i i -s.�^ ��S i. }• 9 •� VT•�to 'F' � X44 ��q� '� -�4 1M � Y �', r aG '*s Yl�� , � nada w � `•i�_ G •.4�j�1�+ d i left of center) looming _ house CAV FaHen branches on A+ �. . rid... roof 9141, ,v.aYr 1 r h s yi �i e""a':yt ft _• ! , ' 4r„ !, F thl!c_. Y� ' 1 ^fir el' I^¢ M NF.J,t _fyPdj,_ s r p .� }IVF P • 6 1 S ic por W. tt R 'y 7.}+° P, j. .'�.._.wh-' F �c r J { +u dl Y M �^ � 1 er�f �T. PYp#. � L• r� 1 r , ` y '� ..q:+.-s. � .,bt(s�'` aII. ,**��y�y;i ,�Yyifir r*3 « y, � ,�,_;,�"r"�,5•. I Y r -Al 1 l•� `si r� � �5 1;nl I- 110, i '-. �r� � • ( } �.x „ 7-'"^ t x )v �G � �Y��««rrrrs�' SY�'p�&iY'�'�, 4 a I -" ys.,f�" •^.a �,.�4'r1�, v"� �. 7,� x fia 7 s ��a;k f ��♦ e SY x. .� tifY ° �¢{!�,y��(�j1 r,�`et�{y4s�.fp'��`a✓"*R`'fy�(i'"+�7��5' t'4.::L � � � Y•' j��]��y�s�yMy�y�Alj +'� ',cr ti�i~sS T'�[ �)2.W��F'n!•*+�A., ern��_�fY' �7 •I n:, �yyy� J .4 4, ,r • � ''2, '��. »a � yJ p �r4C.'h ca„'.Y"BS'�'. f, t Y r ` s411 r� � a,F,:..,. !£ S. ��(e•rF's Y d' t at T.3 h""t�J `Rr r4 12 t.�6,;fw Fp ;W4, ,Y"x , �M1 l ♦ f t l >P zF i... I4'Pluf #' M M1 %1fllll�li, �•` pr'�'� > x p w E 411 (� �•'y; ' +x..xggy�a*rd° ,q; •x +h .v"nw•4 l{ '�p7 '�i, A r P �" ilkNc:"f xa P so 1� W' 4i P A �r �sRs� 1' {'vp � 'i"�rwr@�R`4. �l.`..'.. , 1 `t `.®'_'_�e'`�q. 1 ✓i`F• a`rte Yd m 7 xzw IV ro a F .�VjU4 !• S.n. F��. rf Project Status Sheet Address: 39 Jr-)IVY- ) DEP #: Application Type: k0A Contact Name: ;" , 'O Phone: Q 7P - TO-7 Date Submitted:[i-a 21 Application Complete X Correct Fee Received e —9—Rece;ve gLegal Notice Sent Z Legal Notice Confirmed tOnline KAdded to Agenda Z6Agenda to Applicant aAgent Comments to Commission 0 Hearing Opened: Continued: O?� —Site Visit: —B ANotice Confirmed *e6rder of Coni 'ons Sent to Applicant and DEP p-C-ofi irm�of Delivery pp scant Recorded OoC with Registry Preconstruction Meeting: ❑ Certificate of Compliance Sent to Applicant and DEP ❑ Confirmation of Delivery ❑ Applicant Recorded CoC with Registry Notes: r`b � �rnvx�P CONSERVATION COMMISSION Salem Conservation Commission 978-619-5685 Will hold a public hearing for a Request for Determination of Applicability under the Wetlands Protection Act MGL c131§40 and Salem Wetlands Protection and Conservation Ordinance at the request of Mildred Marie O.Ananayo,37 Intervale Rd Salem MA.Purpose of hearing is to discuss proposed removal of trees within buffer zone to bordering vegetated wetlands at 37&39 Intervale Rd. Hearing will be Thursday,December 8,2011 at 6:OOpm at City Hall Annex, 120 Washington St Rm 313. Julia Knisel Chair Please print legal ad on: December 1, 2011 Please remit bill to: Mildred Marie O. Ananayo 37 Intervale Road.. Salem, MA 01970 978-930-9507 �cor�wr� 40, CITY OF SALEM CONSERVATION COMMISSION December 13, 2011 Mildred Marie O. Ananayo 37 Intervale Road Salem, MA 01970 Re: Determination of Applicability Tree removal at 37 &39 Intervale Road,Salem,Massachusetts Dear Ms. Ananayo: Enclosed, please find the determination of applicability for the above referenced activity. This document indicates that no further permit is required for this work under the Wetlands Protection Act or Salem's local wetlands protection ordinance. This determination is issued with the following conditions: 1. The tree on the property located at 37 Intervale Road and labeled 36" OAK on the September 7, 2001 plan submitted with the November 23, 2011 request for determination may be removed. However, the Conservation Commission strongly recommends obtaining guidance from an arborist regarding whether a viable alternative to removal of the tree exists. 2.No tree on the Conservation Commission property at 39 Intervale Road may be removed. Following the 10-business-day appeal period and provided that this determination is not appealed, you may proceed with the permitted activity. This determination is effective for three years from its date of issuance. If you have any further questions, please feel free to contact me 978-619-5685. Sincerely, T m Devine Conservation Agent/Staff Planner Enclosures CC: DEP Northeast Regional Office 04 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 Mildred Marie O. Ananayo Homeower(listed at left), and: return key. Name City of Salem Conservation Commission 37 Intervale Road 120 Washington Street, SO floor VQ Mailing Address Mailing Address Salem MA 0p Cod Salem Mat 01970 Cod City/Town State Zip Code City/Town State Zip Code 1. Title and Date (or Revised Date if applicable)of Final Plans and Other Documents: EXHIBIT PLAN OF LAN IN SALEM, MA; PREPARED FOR PATRICIA A. 9/7/2011 CONNER Date Title Date Title Date 2. Date Request Filed: 11/23/11 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): Remove tree marked on plan as '36" OAK'from out edge of buffer zone. Clear additional trees from buffer zone. Project Location: 37 and 39 Intervale Road . Salem Street Address City/Town 21 67, 68 Assessors Map/Plat Number Parcel/Lot Number wpaforan2.doc•Determination of Applicability•rev.10/6104 Page 1 0l 5 J Massachusetts Department of Environmental Protection j Bureau of Resource Protection - Wetlands �-'JWPA 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) or Order of Resource Area Delineation(issued following submittal of Simplified Review ANRAD) 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 or ANRAD Simplified Review (if work is limited to the Buffer Zone). ❑ 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 wpalorm2Aoc•Determination of Applicability•rev.I(Y&N 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). See attached letter ❑ 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. wpaform2.tloc•Determination of Applicability•rev.10/6/N Page 3 of 5 r r.. 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 pp a municipal wetlands ordinance or bylaw. d.-„) l,O n.SC./Y��/•� C�_ S�� 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 appropriate DEP Regional Office(see htto://www.mass.gov/dep/about/reaion.findvour.html and the property owner(if different from the applicant). ig a Date wpaform2,doc•Determinalion of Applicability•rev.10/6/0.1 Page 4 at 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 http://www.mass.gov/dep/about/region.findvour.htm) 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. wpaf0rm2.dcc•Determination of Applicability•rev.1W6/04 Page 5 of 5 f Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands Request for Departmental Action Fee Transmittal Form Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 A. Request Information Important: When filling out 1. Person or party making request(if appropriate, name the citizen group's representative): forms on the computer, use Name only the tab key to move your cursor- Mailing Address do not use the return key. City/Town State Zip Code VV Phone Number Fax Number(if applicable) Project Location Mailing Address City/Town State Zip Code 2. Applicant (as shown on Notice of Intent(Form 3), Abbreviated Notice of Resource Area Delineation (Form 4A); or Request for Determination of Applicability(Form 1)): Name Mailing Address City/Town State Zip Code Phone Number Fax Number(if applicable) 3. DEP File Number: B. Instructions 1. When the Departmental action request is for(check one): ❑ Superseding Order of Conditions ($100 for individual single family homes with associated structures; $200 for all other projects) ❑ Superseding Determination of Applicability($100) ❑ Superseding Order of Resource Area Delineation ($100) Send this form and check or money order for the appropriate amount, payable to the Commonwealth of Massachusetts to: Department of Environmental Protection Box 4062 Boston, MA 02211 %vpaform2.tloc•Request For Departmental Action Fee Transmittal Form•rev.10/fv0 Page 1 of 2 LIMassachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands ( Request for Departmental Action Fee Transmittal Form Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Instructions (cont.) 2. On a separate sheet attached to this form, state clearly and concisely the objections to the Determination or Order which is being appealed. To the extent that the Determination or Order is based on a municipal bylaw, and not on the Massachusetts Wetlands Protection Act or regulations, the Department has no appellate jurisdiction. 3. Send a copy of this form and a copy of the check or money order with the Request for a Superseding Determination or Order by certified mail or hand delivery to the appropriate DEP Regional Office (see http://www.mass.gov/dei)/about/reciion/findvour.htm). 4. 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. wpaform2.doc•Request for Departmental Action Fee Transmittal Form•rev.10/EV04 Page 2 of 2 � J r z: Vr * 1s x i qv x" G 4 }f P ' IA �y =J k e: ce a b 8.2 da � _ *Me Salem News ...... ....... REQUEST FOR LEGAL NOTICE I understand that by signing this form I am agreeing to the cost of the legal notice to be published in the newspaper. Payment is required at the time of the legal notice being received by the city and before it is published in the newspaper. Please make checks payable to the SALEM NEWS and mail immediately to SALEM NEWS Attention Gloria Pobiedzinski 32 DUNHAM ROAD BEVERLY,MA 01915 **Average legal notice costs are estimated **Customer will either be refunded or billed when the legal notice is published Salem News= $250.00 per day Check# Credit Card please call Gloria @ the Salem News 978-338-2512 If payment is not received the Legal Notice will be cancelled �.=� I JV- - l9- l ih� Signed Applicant/Authorized Agent VDate Print Name t'1 Qn WK 0. Address 3} 1 Kg ` D� Atllay\ I Phone q:Te- 32 DUNHAM ROAD ADVERTISING FAX 978.922.4330 BEVERLY, MA 01913-1895 NEWSROOM FAX 978-927-4524 TELEPHONE 978-922-1234 E-MAIL ECNNEWS.COM Massachusetts Department of Environmental Protection Bureau of Resource Protection — Wetlands Program i\ WPA Form l Request for Determination of Applicability) Massachusetts Wetlands Protection Act (M.G.L. Chapter 131, Section 40) Instructions and Supporting Materials Instructions for Completing Application WPA Form 1 — Request for Determination of Applicability Please read these instructions before completing the Request for Determination of Applicability(WPA Form 1) for more information on certain items that are not self-explanatory. Purpose of the Request for Determination of Applicability The Request for Determination of Applicability is a process which provides applicants with the option of seeking a determination on the applicability of the Wetlands Protection Act(the Act)to a proposed site or activity. Before filing this form to confirm the boundary delineation of a resource area, the applicant should discuss other delineation review options with the Conservation Commission. The Commission may require the submission of WPA Form 4A(Abbreviated Notice of Resource Area Delineation), WPA Form 3(Notice of Intent), or WPA Form 4 (Abbreviated Notice of Intent). The applicant is responsible for providing the information required for the review of this application to the issuing authority(Conservation Commission or the Department of Environmental Protection). The submittal of a complete and accurate description of the site and project will minimize requests for additional information by the issuing authority which may result in an unnecessary delay in the issuance of a Determination of Applicability. The issuing authority also may require that supporting materials (plans and calculations) be prepared by professionals including, but not limited to, a registered engineer, registered architect, registered landscape architect, registered land surveyor, registered sanitarian biologist, environmental scientist, geologist, or hydrologist when the complexity of the proposed work warrants specialized expertise. To complete this form, the applicant should refer to the wetlands regulations(310 CMR 10.00)which can be obtained from the Department's web site at www.state.ma.usidep. Regulations are available for " viewing at public libraries and county law libraries across the state, as well as at the Department's Regional Service Centers. Regulations also are available for sale from the State House Bookstore (617.727.2834)and State House Bookstore West (413.784.1378). Completing WPA Form 1 Section B: Determinations.The Request for Determination of Applicability can be used for a variety of purposes. Check one or more of the boxes under the following circumstances. 1 a. To determine whether the Act applies to a particular area of land.Areas subject to jurisdiction are described in the wetlands regulations at 310 CMR 10.02. 1b. To confirm the precise boundaries of any delineated wetland resource area. NOTE: before checking 1 b., consult the Commission to determine whether it will provide confirmation of wetland resource area boundaries in response to the filing of WPA Form 1. If the request is filed for a determination of Bordering Vegetated Wetlands (BVW) boundary,the Commission may require applicants to file WPA Form 4A (Abbreviated Notice of Resource Area Delineation), WPA Form 3 (Notice of Intent), or WPA Form 4 (Abbreviated Notice of Intent)to obtain confirmation. 1c. To determine whether the Act applies to work which is planned within a wetland resource area or within the Buffer Zone to a resource area. Work subject to jurisdiction is described in the wetlands regulations at 310 CMR 10.02. wpa1 inst.doc—rev.6/07 Page 1 of Massachusetts Department of Environmental Protection Bureau of Resource Protection —Wetlands Program WPA Form l Request for Determination of Applicability) Massachusetts Wetlands Protection Act (M.G.L. Chapter 131, Section 40) Instructions and Supporting Materials 1 d. To determine whether the city or town has a local wetlands ordinance or bylaw which applies to any particular area of land and/or to work which is planned within this area of land. le. To determine the scope of alternatives to be considered for work in the Riverfront Area. The scope of alternatives which must be considered for various types of projects in the Riverfront Area is contained in the wetland regulations at 310 CMR 10.58(4)(c)2. In order for the reviewing agency to obtain a complete description of the project site, resource area boundaries must be clearly delineated. Further explanation of Boxes la— le follows. Resource Areas: Boundaries. For boundaries o bou da es of inland resource areas (including the Riverfront Area, which may be either inland or coastal), refer to subsection (2), "Definitions, Critical Characteristics and Boundaries'for each resource area covered under 310 CMR 10.54— 10.58. For boundaries of coastal resource areas, refer to the definitions in 310 CMR 10.04 and 10.24 for each resource area covered under 310 CMR 10.25—10.35, as well as in the text of Section 10.25—10.35. The boundary of the Buffer Zone is determined by measuring 100 feet horizontally from those areas specified in 310 CMR 10.02(1)(a). la. Describe the site and, if possible, the boundary of any area that may be subject to protection under the Act(including the Buffer Zone). 1 b.As noted earlier, 1 b, should only be checked with approval of the Conservation Commission. If checked, submit: • plans identifying the precise boundaries of the resource area(s)delineated; • method used to determine the boundaries of Bordering Vegetated Wetland. Note whether the boundary was delineated based on the presence of one or more of the following: • 50% or more wetland indicator plants • Saturated/inundated conditions • Groundwater Indicators • Direct Observation Hydric soil indicators For disturbed sites: specific, credible evidence of conditions prior to disturbance. Use one of the methods indicated above to determine the boundaries of Bordering Vegetated Wetlands (BVW). On the form, check all the methods that are used to determine the boundary. These methods are discussed in the wetland regulations at 310 CMR 10.55(2)(c). When undertaking BVW delineations, whether by vegetation alone or by vegetation and other indicators of wetland hydrology, applicants are encouraged to use the Department's BVW Handbook: Delineating Bordering Vegetated Wetlands Under the Massachusetts Wetlands Protection Act(1995). This document is available for purchase from the State House Bookstore(617.727.2834) and State House Bookstore West(413.784.1378). The Department encourages applicants to complete the BVW Field Data Form contained in the handbook and submit it with the Request for Determination of Applicability. If detailed vegetative assessments are not required for a particular site, the reasons should be noted on the Field Data Form. 1c. Describe the boundaries of all resource areas and Buffer Zones where work will occur or which could be impacted by the work. weal inst.doc—rev.6/07 Page 2 of 4 Massachusetts Department of Environmental Protection Bureau of Resource Protection —Wetlands Program WPA Form l Request for Determination of Applicability) Massachusetts Wetlands Protection Act (M.G.L. Chapter 131, Section 40) Instructions and Supporting Materials 1d. Describe the site, and if possible, the boundary of any area that may be subject to a municipal Wetlands ordinance or bylaw. If there are areas on the site which are not subject to the Wetlands Protection Act, but which may be subject to a municipal wetlands ordinance or bylaw(if any), specifically note the boundaries of such areas. Describe all areas where work is planned if such work may be subject to a municipal wetlands ordinance or bylaw. le. Indicate the precise location of all work relative to the boundaries of the Riverfront Area. Section C: Project Description. In this section, the applicant must describe the area and proposed work (if any)subject to the Request. The type of information required depends, in part, on the type of determination requested in Section B. In all cases, the applicant should describe the site based on resource areas jurisdiction and boundaries under the Wetlands Protection Act and regulations. la. Location. Include a street address(if one exists)and, if known, the Assessors map or plat number, the parcel number, and the lot number. The map or plat, parcel, and lot numbers must be included if the lot subject to the Request does not contain a residence, school, or commercial or industrial establishment, or if the lot is being subdivided. 1b.Area Description. The area should be described in narrative form. If needed, attach additional sheets for a more complete description of the area; a map or plan may also be used as part of the area description (see instructions for 1c for plan and map requirements). 1c. Plan and/or map reference(s). On the application form, list the titles of all attached plans and maps, as well as, the most recent revision date. Submit an 8.5"x 11"section of the U.S. Geologic Survey(USGS) quadrangle 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. Plans should be of adequate size, scale, and detail to completely and accurately describe the site, resource area boundaries, and proposed work. The following guidelines are provided to encourage uniformity: Sheet Size • Maximum 24"x 36" • If more than one sheet is required to describe the proposed site and/or proposed work, provide an additional sheet indexing all other sheets and showing a general composite of all work proposed within the Buffer Zone and areas subject to protection under the Act Scale • Not more than 1" = 50' • If plans are displayed, include graphical scales Title Block • Included on all plans • Located at the lower right hand corner, oriented to be read from the bottom when bound at the left margin. • Include original date plus additional space to reference the title and dates of revised plans typal inst doc—rev.6/07 Page 3 of 4 • Massachusetts Department of Environmental Protection Bureau of Resource Protection —Wetlands Program 11 WPA Form l Request for Determination of Applicability) Massachusetts Wetlands Protection Act (M.G.L. Chapter 131, Section 40) Instructions and Supporting Materials 2a. Work Description. Work subject to the jurisdiction of the Wetlands Protection Act is described in 310 CMR 10.02. If the Request is for determining jurisdiction over proposed work, the applicant is asked to describe the work in detail. Proposed work can be described in narrative form. If needed, attach additional sheets for a more complete description of the work; a map or plan may also be used to describe the work(see instructions in 1c for plan and map requirements). Provide the following information, depending on which boxes were checked under Section B: 1c. Describe the proposed work and its precise location relative to the boundaries of each wetland resource area and the Buffer Zone on the site. 1d. Describe the proposed work and its precise location relative to the boundaries of areas which may be subject to municipal wetland ordinance or bylaw. 1 e. Describe the proposed work and its precise location relative to the boundaries of the Riverfront Area. 2b. Exemptions. Exemptions are allowed under the Wetlands Protection Act for certain mosquito control, commercial cranberry bogs, agricultural, and aquacultural projects and for projects authorized by Special Act prior to 1/1/73. These exemptions are defined, in part, in 310 CMR 10.03(6) and in the definitions of agriculture and aquaculture in 310 CMR 10.04. In addition, there are exemptions for certain stormwater management projects(310 CMR 10.02(3)); specific minor activities in the Buffer Zone(310 CMR 10.02(2)(b)); and certain other projects in the Riverfront Area(310 CMR 10.58(6(b)). 3a. Riverfront Area Scope of Alternatives. Complete this section only if 1 e. under Section B is checked. In 3a, check one box that best describes the project. The classifications listed in 3a and the scope of alternatives which projects in each classification must analyze are explained in 310 CMR 10.58(4)(c)2. Section D: Signatures and Submittal Requirements A completed WPA Form 1, with all attachments, must be submitted to the Conservation Commission. Applicants also must send a copy of WPA Form 1 and all attachment to the appropriate DEP Regional Office(see http://www.mass.gov/dep/about/region/findvour.htm for locations of regional offices and the communities they serve)and to the property owner, if different from the applicant. The original and copies must be sent simultaneously. Failure by the applicant to send the copies in a timely manner may result in dismissal of the Request for Determination of Applicability Fees There is no application fee for the Request for Determination of Applicability. However, a notice of the application must be placed in a local newspaper, and published at least five days prior to the hearing, at the applicant's expense. Please contact your Conservation Commission regarding the procedure for public newspaper notice. wpalinstdoc—rev.6/07 Page 4 of 4 I • Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands ,. WPA Form 1- Request for Determination of Applicability City/Town Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 A. General Information Important: When filling out 1. Applicant: forms on the computer, use Name E-Mail Address only the tab key to move your cursor-do not Mailing Address use the return kkeefyy..m�� City/Town State Zip Code Phone Number - Fax Number(if applicable) . 2. Representative(if any): Firm Contact Name E-Mail Address Mailing Address City/Town State Zip Code Phone Number Fax Number(if applicable) B. Determinations 1. I request the 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). wpafonl Eoc Pagel or 4 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands / WPA Form I- Request for Determination of Applicability City/Town 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): Street Address City/Town Assessors Map/Plat Number Parcel/Lot Number b. Area Description (use additional paper, if necessary): c. Plan and/or Map Reference(s): Title Date Title Date Title Date 2. a. Work Description (use additional paper and/or provide plan(s)of work, if necessary): wpafao tdoc Page 2 of 4 r Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands j WPA Form 1 - Request for Determination of Applicability City/Town Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 C. Project Description (cont.) 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). 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.) wpeloent aoc - Page 3 of 4 5 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 1- Request for Determination of Applicability City/Town 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 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: Name Mailing Address City/Town r State Zip Code Signatures: I also understand that notification of this Request will be placed in a local newspaper at my expense in accordance with Section 10.05(3)(b)(1)of the Wetlands Protection Act regulations. Signature of Applicant Date Signature of Representative(if any) Date wpafon Eoc Page 4 of 4 I I ASSESSORS: MAP 21, LOT 68 iv�Trwfl �1ac AL ZONING: ill'DGSlitik-TI 5 A L AL R-1 7(F.K.A. P Pti �` �` �` REFERENCES: 95� �1E �0° �` g58A� �` PLAN BOOK 36, PLAN 17 NOTES: 1) WETLANDS SHOWN HEREON WERE INTERVALE ROAD g4 DEUNEATED BY HANCOCK ENVIRONMENTAL (40' WIDE) 9P5 CONSULTANTS AND LOCATED BY FIELD Wf SURVEY ON 9/6/2001. RIVERVIEW STREET) INV.--97.8 2) ELEVATIONS SHOWN HEREON ARE BASED P OPOSED SILT FEN-E g$5 ON AN ASSUMED DATUM. 99.5 99.5 99.6 BIT. CONC. ROAD /U 99.5 _ 99.6 99.7 I/ 50' WETI AND i` 50.00' INV.=98.7 z BUFFER ZONE 0 2 — 0 Q," PROPOSED 73 B Z ,7—,, \�` app+ SILT FENCE C, v n PROPOSED - �� z BIT. CONC. \ +1 m + app• DRIVEWAY , ,8 ` EXISTING \SPOT GRADE 7. (TYP.) a 2• � z �oti8 PROPOSED'/ 36" FOUNDATION N A pI1 + a OAKS > K `pg 1 n 1 > 11'1T0,� 10.0'(MI11'N.) 10.0(MIN.) [{�• 0 En O 00 w 1�56,N1m O to Qn J X218 �1g 9 6 LOT 409 7,973± S.F. ° VACLAV V,\s'y� gr TALACKO m <n 00 'o M Q / I llllll 50.17' 1 EXHIBIT PLAN OF LAND IN LOT 428 LOT 429 SALEM, MA OF PREPARED FOR � PATRICIA A. CONNOR a SCALE: 1 " = 20' SEPTEMBER 7, 2001 . JIL.BERT ', M0.36118 1 0 10 20 40 80 e HSA SURVEY ASSOCIATES, INC. jO O/ 235 NEWBURY STREET, DANVERS, MASSACHUSETTS 01923 PROFESS[ NAL LA D SURVEYOR VOICE 978-777-3050 FAX 978-774-7816 CHECKED BY: www.hancockassociates.com 9170