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41 INTERVALE ROAD - CONSERVATION COMMISSION (��� — ail i.�,�v�,�. R�. } Massachusetts Department of Environmental.Protection t Bureau of Resource Protection - Wetlands Cayrrown 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 maltgs and p�ljns to identify the locatio33of the area subject to this request): /2 St et Address �a 1 Citylr7- Assessors Parcel/Lotlat NumbParcel/LotNN,umber b. Area Description (use additional paper, if necessary !0. 00)t�-T D7 © � �D TTi J—r, /fnrti7e ro L42 J1)c,4 Pr Aff&koo c. Plan and/or Map Reference(s): TRIe Date 2. a. Work Description (use addition/al paper and//or provide plan(s) of work, if necessary): //11 m tpb 2 d��� (! Ct c_CCrcl/,lJ(' 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). WPA Fmml - Page 2 W 4 Rev.02MO - r, Massachusetts Department of Environmental Protection f Bureau of Resource Protection -Wetlands cayrrown 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 Rive nt Area, indicate the one classification below that best describes the project. Sing lee 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 femily 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.) WPAFa l _. .. Page 3 of Rev.02M Massachusetts Department of Environmental Protection t Bureau of Resource Protection - Wetlands _ cityirewn 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 addr ss of the property owner: Name 3 i v2 Mailing Address L�tiA-� State d = ()zp 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 App'cant Date Sign ture of Representative(if any) Date i i WPA Fo I - - _ Page 4 of Rev.02= - Z 011 914- 859 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do ntotpatt use for Intennational Mail�See reverse sent Street&Number 9.r-5 tCr $tate,BLPC O\�� Postage Certified Fee Spada]Delivery Fee Restricted Delivery Fee N � Return Receipt Slwvring to Whom&Date Delivered Realm Receipt Showing to Wh=, Date,&Addressee's Address mTOTAL Postage&Fees s 0) Posomark or Date E 0 LL N a Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the aAde at a post office service ^y window or hand it to your mreI carrier(no extra charge). d 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return address of the article,date,detach,and retain the receipt,and mail the anide. CIC N ' 3. H you want a return receipt,write the certified mail number and your name and address m on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends H space permits. Otherwise,all ix to back of article. Endorse front of article ' RETURN RECEIPT REQUESTED adjacent to the number. 4. If you want delivery restricted to the addressee, or to an authorized agent of the G addressee,endorse RESTRICTED DELIVERY on the front of the article. M 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. If return receipt is requested,check the applicable blocks in hem 1 of Form 3811. LL 6. Save this receipt and present it if you make an inquiry. 102595-97-6-0145 a . COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Received by(Please Print Clearly) B. Date of Delivery item 4 if Restricted Delivery is desired. ■ Print your name and address on the reverse C. Signature so that we can return the card to you. ■ Attach this card to the back of the mailpiece, X DEP DEC 2 ZOOS ❑Agent or on the front if space permits. 1 ❑Addressee D. Is delivery address different from item 19 11 yes 1. Article Addressed to: ` If YES,enter delivery address below: ❑ No Y. a' los / ' SNA 3. Service Type �r, .�` G��� ertified Mail El Express Mail M 0 ❑ egistered ❑ Return Receipt for Merchandise ❑ Insured Mail. ❑ C.O.D. 4. Restricted Delivery?(Extra.Fee), { ❑Yes U.2. Article Num6er',(Copj frgm service label){ f 1 1 i{ ?1 i i. i l f t l i t it l l f l: I PS Form 3511,July 1999 - Domestic Return Receipt 102595-00-M-0952 UNITED STATES POSTAL SERVICE I II II I Sm91No.PPaid ^a; • Sender: Please print,your name, address, and ZIP+4 in this box _u � ��LEtids Citi: < tt!n .Inp+ nn, L_! �}TI SALEM G!'EEN bSdEM, MASS. 01370 I fill],ii1111,111111 1111111111,.1fill!1111,11,611 9' _ Massachusetts Department of Environmental Protection t 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 John Conner Real Estate Same return key. Name Name 137 Euclid Ave. Mailing Address Mailing Address Lynn MA 01904 City/Town State Zip Code City/Town State Zip Code 1. Title and Date of Final Plans and Other Documents: Site Plan N/A Title Final Date(or Revised Date if applicable) 2. Date Request Filed: December 14, 2000 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): Construction of a single family home. Project Location: 41 Intervale Road Salem Street Address City/Town - Map 21 Lot 66 Assessors Map/Plat Number Parcel/Lot Number WPA Form 2 Page 1 of 5 Rev.02100 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 2 — Determination of Applicability W 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. M ❑ 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 WPA Form 2 Page 2 of 5 Rev.02/00 - . Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands y 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 fled 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). 1. No work or cutting shall occur within the adjacent properties which are conservation land. 2. Caution tape shall be placed around the perimeter of the property to indicate limit of work(see condition 1). ❑ 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. WPA Fom 2 Page 3 of 5 Rev.02/00 I 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 deliveryDa.6-6 Mc'C`1< 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 Appendix A)and the property owner(if different from the applicant). Signatures: Al ate WPA Form 2 Page 4 of 5 Rev.02/00 L_ F Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 D. Appeals The applicant, owner, any person aggrieved by this Determination, any owner of land abutting the land upon which the proposed work is to be done, or any ten residents of the city or town in which such land is located, are hereby notified of their right to request the appropriate Department of Environmental Protection Regional Office (see Appendix A)to issue a Superseding Determination of Applicability. The request must be made by certified mail or hand delivery to the Department, with the appropriate filing fee and Fee Transmittal Form (see Appendix E: Request for Departmental Action Fee Transmittal Form) as provided in 310 CMR 10.03(7)within ten business days from the date of issuance of this Determination. A copy of the request shall at the same time be sent by certified mail or hand delivery to the Conservation Commission and to the applicant if he/she is not the appellant. The request shall state clearly and concisely the objections to the Determination which is being appealed. To the extent that the Determination is based on a municipal ordinance or bylaw and not on the Massachusetts Wetlands Protection Act or regulations, the Department of Environmental Protection has no appellate jurisdiction. WPA Form 2 Page 5 of 5 Rev.02100 >� Massachusetts Department of Environmental Protection t klug Bureau of Resource Protection Wetlands cityrroxrn WPA Form 1- Request for Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 A. General Information Important 1. Applicant When filling out pP J forms the �' YjN l i9VXY✓ computeto r,use only the tab key Name E-Mail Address(if applicable)3 to move your t ,2/-)�d Cl cursor-do not MailAddress use the return VA-1 ✓ key. C' IT n State Zip Code YIIm II one�e� Fax Number(K applicable) ( 7 ( ova �1 2. Replre9qsentatve(if an ): Firm AV, V1JUtrAl/)j�r Contact Name E-Mail Address(d applicable) .S 2�r r Ma'ling Address CitylT StateQZip JCCode TSM '5/?iz P\ y�Q, .�(� _ Phon Numbe Faxumbe (1�cable) B. Determinations 1. I request the $,„)e..+-, make the following determination(s). Check any that apply: Conservation Commission ❑ a.whether the area depicted on plan(s)and/or map(s) referenced below is an area subject to jurisdiction of the Wetlands Protection Act. ❑ b. whether the boundaries of resource area(s)depicted on plan(s) and/or map(s) referenced Blow are accurately delineated. whether the work depicted on plan(s)referenced below is subject to the Wetlands Protection Act. ❑ d. whether the area and/or work depicted on plan(s) referenced below is subject to the jurisdiction of any municipal wetlands ordinance or bylaw of. Name of Municipality ❑ e. whether the following scope of alternatives is adequate for work in the Riverfront Area as depicted on referenced plan(s). VRA Fm l - Page 1 of a Ret.02100 INTTRT-,4LL' 14o'Wic�'ef I�O,4,0 To (formerly Rsvermew st Rive 45 41 SO 00' -; 50.00' _ , 50.00' 1 Pro vosed w owelling j - za. o• Lot 64 Lot 65 Lot 66 Lot 67 Lot 68 A ea = 76'60tS.F. Vacant Lot er 50.17' J So>T s01T J - s.oauQ M30=C77 — -- — M22-L/78 r y - M22-L/78 - d 84 _llL 3.8 AC. __ _ 05 /.YAC. 86 ; J A C. 8T ME 0o -------- ----- __ -- to �'� o• so O .' ROAD 39 .--------- D -------------s� ����\ pOp /SYi ` � � ss so sl 77- °p 00 e° ioo +a-� +rs 72 64 6400 830 ssT3eo 6a 66 87 O `+• 9JJ 7J 66 ' i4 so �;ss ss�3 TO 1880 I rip' 8262 71 00 /3/40 6� ;b I es 240,, 78. Y48� 8b4C `oo Ibt1A via too ►Lhl1 • PS .� i /O.5AIL ALL- - - _- x / r /00 x 997.3 / F LYNN QUADRANGLE STATE OF MASSACHUSETTS MASSACHUSETTS P��y DEPARTMENT.OF PUBLIC WORKS IPSWICH 14 MI. 7.5 MINUTE SERIES (TOPOGRAPHIC) SALEM (✓UNC MAS$. IA) 2.3 M/ SALEM (COMMON) I MI (SALEM) 55 60000 FEET IA 0.4 Ml. TO MASS IA 70°52'30/' - u4 -0 42030' A I �p - lli r �\�� oc M Golf`Cn4Vse iINA •�\ ta� ,Odl J Y r P O�T'1 - 'a L.Fd A > . . (�p,'� C\Ci..•.;, A D < I . : � f�� � x � � � A:�� � 1ra r r1�L sow 4l /Ji � • � o ,!,N9 1 150 -.1• � �: ��'\,1J'.' � s/✓ll I ,.'�y0+ 1� K ✓ .�\�"�j c ��/ �5�i' � i 1 _ �)\ � '^ fl � {�' ,�` •t. 1 .,.�� �: : - �� 2 lP�io�p�h � ) has ��' < t .,. ..•' [ ♦ 7v^• >' - 0l�V'1St r9-e'!� rr at .;loo J �>g \ I II \ I -�XS � -v/r � �S r.. I �I� o ��°� 1�• II'•4�'�' 1 - 1 S'• � � T -� \ .• r „�.r'- _moo '7.'� '. I_ Q tB•,r e X warQp4°a�t - t R VI,� �ade,a�oo�. a IX st'eT� >I emLou"q-10, \� ._1 � I� �:• '('0166 -"G� 7� � . a� �� BB .:l )� fir.. 50 � �m •�� � �I 2 Rta � y .t i� i •.. i0C1 I �I� 14 y sc• ; �� \�� 1 / 4 \ 0. ( t1F •• i � �1 \ � '. 540000 a o FEET Memorial - esu Park 1 P, 7 b ��.' �1 / R..Sta" ( _ 2 ♦� � �I�� (� . .I i A 2r 50 f0 E �>: J•'�S � / I I Qom. l :Fbsh4rrnan (zsHead 1 -_ 1IaneY c Beach if ( ° r zJ z 4e � �� � z I� - J p'es*F� �� Imo" •' � � i 38 i e Fishing Pt s0 I -'-Te esazo , �.,ION COM qG, Conservation Comnimion 7e�� Salem, Massachusetts 01970 '��ASSAG�5 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 John Conner Real Estate, 137 Euclid Avenue, Lynn, MA 01904. The purpose of the hearing is for a determination to the construction of a single-family home at the former 41 Intervale Road. This hearing will be held on Thursday, December 14, 2000 at 7:00 p.m. in the second floor conference room at One Salem Green. Debra A. Hurlburt Chairperson December 7, 2000 Please send bill to: John Conner Real Estate 137 Euclid Ave Lynn, MA 01904 I Massachusetts Department of Environmental Protection SQ4", Bureau of Resource Protection -Wetlands Cltyrrown WPA Form 1- Request for Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 A. General Information Important: When filling out 1. Applicant' (J forms cJ42L �A computer,ter, use Name E-Mail Address(if applicable) only the tab key I /�J/ / /1 U to move your C� /� cursor-do notaill ng Address use the return L key.. c rr� / State Zip Code ones NLhber Fax Number(if applicable) 2. Representat've (if ani) ©r �� VI By 2 1 P S Firm ✓�Adc ovv �vi�✓ Contact Name E-Mail Address(if applicable) Ma'ling Address cityrr T State Zip Code Phon Number - Fax Number/(If applicable) B. Determinations 1. I request the Sg is vy 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. 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). WPA Forml Page 1 of 4 Rev.07/00 Massachusetts Department of Environmental Protection `1 Bureau of Resource Protection -Wetlands cityrrown 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 locatio of the area subject to this request): �� �tifPrr L2�1e Rd r���e� Str et Address city/ro n MA12 al � � � Assessors p/Plat Number ParceVLot Number b. Area Description (use additional paper, if necessary): a-L6 s. r f f 4? . Oz)'t:-r /5y /-7- /. - o�L' ro/�cl To /i�cKa? Lo f �Jc�-��Pv cerassps -�Va.</�o of /o> c. Plan and/or Map Reference(s): app al Lot 64 Title Date 2. a. Work Description (use additional paper and/or provide plan(s) of work, if necessary): A)&4) §19m y ro �-e hu lL C( c c-CrCIIAL74 '7?) 41169 /0' 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). WPA Fo.1 Page 2 of 4 P.ev.02/00 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands ctyrrown WPA Form 1 - Request for Determination of Applicability g 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 7ng nt Area, indicate the one classification below that best describes the project. le 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.) WPA Forml Page 3 of 4 Rev.07100 • Massachusetts Department of Environmental Protection �i Bureau of Resource Protection - Wetlands cityrrown 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 addr ss of the property owner: V Name /3 r- i v� Mailing Address City/Town State ,N,/ ' 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 � ©6 SignAture of Representative(if any) Date MA Form1 Page 4 of 4 Rev.02100 j�T�l�V4LE 140wl ridel f OWD formerly Riverview St 45 43 4> 50.00, ,i 50.00, 1 50.490, lam•` _ _f - 43 0 X30 � -T1 Proposed I. � w Dwelling »f »t d za o' °o Lot 64 Lot 65 Lot 66 Lot 67 Lol 68 A e¢ = 7560tS.F Vacant Lot 87' SO>T so f- SO�r so>r g� N e os M5e-L77 M22-L/78 _ M22-L /78 -� - ALL.- 64 3.e Ac. N ; — — 86 j /.YAC. 86 ,x, 3 AC. AN 87 /./AC. �����---:---- ---- ROAD ------------------ --- S S° //�/ 60..1• �• so 41 •• -- -------------- s0 S0 soioai' •i `oo so o 46-6 ♦rs 72 64 6400 4 66 O -� 62 9A0 9�so ?� mosso s87 as s� � �TO Q 1880 0 .' B26P 71 A 00 /3/40 --80 40 25240 78 p g BS40 goo eZ0 lot g:4 ._ .Sop 10 ion IRS P6'i4,�Y • 731-3 es 'l •n / ! is • • e • �� P iY 4 . kv - _ l _ ..-/'• '�'�'r�� -- ;r� - X11,. iLLLL - 7- - - loo v 1 X 75 /ACO r P LYNN QUADRANGLE STATE OF MASSACHUSETTS MASSACHUSETTS �PaO DEPARTMENT OF PUBLIC WORKS IPSWICH 14 MI. 7.5 MINUTE SERIES (TOPOGRAPHIC) SALEM (✓UNC. MASS. IA) 2 3 Ml. SALEM (COMMON) 1.8 Ml. 1n 70°52'30" (SALEM) 55 160000 FEET 0.4 MI. o MASS IA 42030' T, �� •_ ��� .vr � �., I � �. "MuniCpal � ( -_ o� AN � � IIV�� J71�)^-A i�5 ��/1J ~ l� r �S� � IL •U , ((f\'1�� `I y W_ �J �� � � J •�v ` �s \� \ �i—\5� � � Q � VVI ° f�✓t • I� C �� }, A r I � 111' � 1'i`\�� fi�r_�J\� Jl�l� \�� \ 11T� ,// - � •S 4 �� � � �O p V b� Prop) Cem \ / 1 ����I))) � � °�� -: /,71. �..�g '-' ';oC �` o° �-y i - (��Joro�� _,� z. 'Lf g/�o.I s'' \�0:�• �dp. I /•.����1 � -.{ -_o-\� - f ) / so Ili.. �Lp l2zi°� •I �__ O /� I. r ••" \ l�\``� , J \ -s\ ^ c �c COY �'S5 ?''•` � y�i ) � I 1 � ;, \ F )r L c l r E S I a •• 1 I ` b°� �� �� �ilv� �� .� L•. \�.V � �j � 1�� i 1 w Pte)� . 1E � � � �/ I O �1N '� W81{Id5 t L y') - le ffi ¢ St emo UVi ❑I. eb, U Y j ��z ` ••1�� ,•\ nQ, / �� �f 1 ,p,� w• m\C\\ 1 �� _ R ° J 1 540-000 �� :C �✓-'C� „ V� i���1 r/0 , A�� L� ��1 FEET O, � ��b / o9ta n�P a -�/� �I��l``-^ .�/f��� �"�•�� ��� �-J so i_ 1 c` ) •t', zs j5 I �•:,_ � � � � >��r 1 h �- � � .,./'�1 / =0 mow" 4r 1'" Q 19 d fYshertnao Blaney o Beach ° //�O, ( o - / - r 'ss Head 6 ISh10 P v I s0 �( 17 -Tedesco g _� ock s r .,�. §R Massachusetts Department of Environmental Protection r Bureau of Resource Protection -Wetlands City/Town WPA Form 1- Request for Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 A. General Information Important: 1. Applicant, When filling out pp r forms on the �� `jN l 19.i/NP✓ ��'Al eS�/q e computer, use Name E-Mail Address(if applicable) - only the tab,key to moveour 3 V Y Cursor-do not Mail i g Address use the return ?V,t/nJ key. C' R state Zip Code 97 —ILS one NUfnber Fax Number(d applicable) V� 2. Representafve(if an ) Or 9r-a, bui ldP rS Firm MAY- DU(r.V/e2Y Contact Name E-Mail Address(if applicable) .5" e�� r Ma'ling Address - Q CityfT - StateZip Code Phond Number Fax umbe (if applicable) B. Determinations 1. 1 request the Sedan.. make the following determination(s). Check any that apply: Conservation Commission d on plan(s) and/or ma s referenced below is an area subject to ❑ a. whether the area depicted p ( ) map(s) jurisdiction of the Wetlands Protection Act. ❑ b.whether the boundaries of resource area(s)depicted on plan(s) and/or map(s) referenced Zlow are accurately delineated. 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). WPA Fo l - Pepe t of Rev.02M Massachusetts Department of Environmental Protection . Bureau of Resource Protection -Wetlands cityrrown 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 malts and pl ns to identify the locatiog of the area subject to this request): St e �{/ �tifP� Ute-/� �c� �S�l t Address cityrro n y),4a �a I Assessors p/Plat Number Parcelll-ot Number b. Area Description (use additional paper, if necessary): 2:5 L p -- S. F 1,0- 00/:7 �rr�ti/iia 2 /S�7 /-7-z3l,�c O�.P road T 6mk o I& f 6ct IFPv LC rc)55p sL',-�//o o ZD / L0 iao! Arse �o A, JDcAT d&f4ffkkop/ 8/0 c. Plan and/or Map Reference(s): v✓J9.1 LO ¢ G � Title - Date 2. a. Work Description (use additional paper and/ rovide plan(s) of work, if necessary): A)pk) EfCLr7 T ke dig/ Cl_ccAr�i fJ� T� / �o 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). WPA Fo l Page 2 of Rev.0200 Massachusetts Department of Environmental Protection _ Bureau of Resource Protection -Wetlands City/Town 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 7Rive nt 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 811/96 ❑ Project, other than a single family house or public project,where the applicant owned the lot before 8/7/96 9 ❑ 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.) I WPA Fo l - Page 3of4 _ Rev.02100 Massachusetts Department of Environmental Protection ! _ Bureau of Resource Protection -Wetlands cltyrTown 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 brie 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 addr ss of the property owner: Name /32 4 1i cs� Mailing Address - / .- City/rown 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 App icant Date zn� - Sign ture of Representative(if any) Mte i I Rev.0200 . 'Nide z I1VTZ'RIl,-Z,67 }iew RO,4,0 ro € merl Rivery St R:vE .for y � 43 41 45 - SQ 00' SO 00• 50.00• �� . a"•i �3D' l Proposed Dwelling >1f »f h Lot 64 Lot 65 Lot 66 Lol 67 Lot 68 A ea = 7560±S.F. !Vacant Lot gr s4• 5017' J - 50 17• • t oil � _ ,. M30-L77 -- — M22-L/78 M22-L /78 Au 84 1 3.6 AC. 74R:— — Am . /.t AC. 86 F; – . 3 AC. _.. /./AC .- _ __ _ 41 at pea • r so ss •� oo s �� //ice •0 30 so 100 •O-t ♦rt 84 6400 O p 88 8 62 0 94 s�eo r 6 3 saeo "Si TO ED8 t 9 ?is0 262 T' A 00 6N /3/40 %% Y�5 80 is X640 25240 78 i- 8S goo sst 78 9�,�0 18r /� V • I A152 I P7 77 a vii • Z`�\' roe too • its �II t6.I,Ip x - f - _ y / i _ 97.3. 1XI /00 X LYNN QUADRANGLE STATE OF MASSACHUSETTS MASSACHUSETTS Po-Oy DEPARTMENT OF PUBLIC WORKS IPSWICH 14 MI. 7.5 MINUTE SERIES (TOPOGRAPHIC) (SALEM SALEM (✓UNC MASS IA) 2.3 MI SALEM (COMMON) 1.8 MI. ) - 55' 760000 FEET le 0.4 Ml. TO MASS IA 70'52'30" �\�� 42°301 4 _ < w MunimpaI rI- i -��(o x l b, 1�,oq ) so f(v �/5� F' v •• �' . _6° r 18 �istei, v 10 a '> t� - \ U ° '�-y- — - • - Aim Sea f 55 Cem -�. � � ��,, ,��,.yT 9��\ his° (io ". � 7(�() s� � �- _ � �✓ s. S 1 r l� ' q .\��y o� • ) a: MI e sao 000 FEET �� '•' 0 I �� e �i6 rl (�� e U !/ Memorial � -'). .) �' � s�,"` �1 - ..> __�.� �✓D�IIG / \- ) �s 36 3 ,f --. o/� �/ ,a . .8laney c�F'a��geeoh .: , _0 16Jo� �/ o �� yo :• rSS Head 23 X50 ob q -- I/� 39 / 0 i ' - Fishing Pt 50 Te guars- �4 �.�OE�� ./a . � I 9 Rocksdescd I ).