419 LAFAYETTE STREET - CONSERVATION COMMISSION WL419 Lafayette Street
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Form 2 .: • _ _ -.-. . - DEME Fie No.
– -OlbRown Salem
(? Commonwealth
of Massachusetts John Brennan
ApW�
Determination of Applicability
Massachusetts Wetlands Protection Act, G.L c. 131, §40
Fro Salem Conservation Commi Issuing Authority
(Name of person making request) (Name of property owner)
Address
419 Lafayette "St. —" Address same
This determination is issued and delivered as follows:
[2by hand delivery to person making request on (date)
o, by certified mad.return receipt requested on (date)
• Salem Conservation Commission
Pursuant to the authority of G.L o. 131, §40,the
has considered your request for a Determination of Applicability and its supporting documentation, and has
made the following determination(check whichever is applicable):
This Determination is positive:
1, ❑ The area described below,which includes alVpart of the area described in your request, is an Area
Subject to Protc.:tion Under the Act.Therefore, any removing,filling, dredging or altering of that
area requires the filing of a Notice of Intent
2, The work described below;which includes alVpart of the work described m your request is within
an Area Subject to Protection Under the Act and will remove,fill,dredge or alter that area There
fore,said work requires the firing of a Notice of Intent
2.1
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3. ❑ The work described below,which includes all/part of the work described in your request;is within
the Buffer Zone as defined in the regulations,and will alter an Area Subject to Protection Under
the Act.Therefore,said work requires the firing of a Notice of Intent-
This Determination is negative::
1. ❑ The area described in your request is not an Area Subject to Protection Under the Act. '
2, ❑ The work described in your request is within an Area Subject to Protection Under the Act, but will
not remove,fill, dredge,or alter that area.Therefore, said work does not require the filing of a
Notice of Intent
3. ❑ The work described in your request is within the Buffer Zone,as defined in the regulations,but will
not alter an Area Subject to Protection Under the Act Therefore,said work does not require the
firing of a Notice of Intent
4. ❑ The area described in your request is Subject to Protection Under the Act,but since the work
described therein meets the requirements for the following exemption,as specified in the Act and-
the regulations, no Notice of Intent is required:
Issued by \� Co servation Commission.
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Signature(s)
`This Determination must be signed 2 by a m- rity of the Conservation Commission.
• On this � 6 ay of r) 19 O before me
personalty appeared to me known to be the
person described in, and who executed,the foregoing instrument,and acknowledged that he/she executed
the same as islher free a d d ed G r
Notary.Public My commission expires
Thii Ueterminatton does not relieve the applicant trom complying with all other applicable federal•state or local statutes.ordinances.
Cv-tows xrequlans.This Determination shall be valid for three yes form the da
fioarte of issuance.
Thi apptiG'nt,the owner,any parson aggrieved by thisDetermination,any owner of land abutting the two upon whim the proposed
work is to be done,or any len residents of the city or;own in which such land is located,are hereby notified of their right to request the
6ell of Environmental Ouality Engineering to issue a Superseding Determination of Applicability.providing the request is made
by certified mail or hand delivery to the Department within ten days from the date of issuance of this Determination.A copy of the request
Shall at the same time be sent by certified mail or hand delivery to the Conservation Commission and the applicant.
2.2A
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Form 1
_ DEQE F1e No.
(To be promed by OEOE)
Cityrrown —5�4 L L M
Commonwealth `f QH^1 W. 8R6AINAM
of Massachusetts Apvuear,t_
Request for a Determination of Applicability
Massachusetts Wetlands Protection Act, G.L. c. 131, §40
a.i h �y r� s�tNL rhe S ^4,Qwl
Conservation Commission make a determination as to whether the area,described below,or work to be s,
performed on said area,also described below, is subject to the jurisdiction of the Wetlands Protection
Act,G.L c. 131, §40.
vi
2. The area is described as follows.(Use maps or plans,if necessary,to provide a description and the
location of the area subject to this request)
THS P.r2oPo�Em h'REA /S 710EGr/.97€/F' L✓ AI-P.
/N FA' 6R/>
/A,' �s f�2a oE/� y By
F.4BASTE
S. The work in said area is described below. (UlGe aCdditi:?t.'0..'paper, l necesrzry,to describe the
proposed work.)
76 Oo,�s�iC i:T ti9 �7flTim�A�%
f9 FL.a T, E 6k.4IV6 k14y e9,,�j FGo 9T WAI-e.
8E aQ�kroli, 8� �' �9rs20
am 7 ®F/�" �'!� Via . SEE ':f—w fOs6"!:) ��
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4. The owner(s) of the area,if not the person making this request, has been given written notification of this
request on (date)
The and address(es)of the owner(s):
�J6 G(N ,'ieENN.eN
5. 1 have filed a complete copy of this request with the appropriate regional office of the Massachusetts
Department of Environmental Quality Engineering on J 4-'V E 198.5- (date)
Northeast Southeast -
323 New Boston Street Lakeville Hospital
Woburn, MA 01801 Lakeville, MA 02346
Central Western
75 Grove Street Public Health Center
Worcester, MA 01605 University of Massachusetts
Amherst, MA 01003
6. 1 understand that notification of this request will be placed in a local newspaper at my expense in accor-
-dance with Section 10.05(3) (b) 1 of the regulations by the Conservation Commission and that I will be
billed accordingly.
Signature // __ ° Name
Address 'T�g /ArXI Y622-C' 5726:T Tel. �� !K '11,38
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