13 LOCUST STREET - CONSERVATION COMMISSION (2) [ZD Pt _ �g Lockst 5c --
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 Pamela Burns& Edward Pliner Same
return key. Name Name
Locust Street
Ma
Mailing Address Mailing Address
+' Salem MA 01970
® City/Town State Zip Code Cily/Town State Zip Code
Title and Date of Final Plans and Other Documents:
Site Plan NA
Title Final Date(or Revised Date if applicable)
2. Date Request Filed:
- June 27, 2002
B. Determination
a 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 120 sq. ft. addition to the existing single-family home
Project Location:
13 Locust Street Salem
Street Address Cityrrown
Map 37 Parcel 0010
Assessors Map/Plat Number Parcel/Lot Number
WPA Form 2
Rev.02100 Page 1 ars
T
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.)
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
WPA Form 2
Rev.OVW 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.
WPA Fo.2
Rev.02/00 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 by certified mail, return receipt requested on
\l 2oo"L
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*
�.L. ►\. 2eaZ '
Date
wPA Fo 2 Page 4 of
Ray.om
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.
MA Fmm 2 Page 5 of 5
Rev.02/00
Postal
(DomesticCERTIFIED MAIL RECEIPT
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1:17 Postage $
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0 Certified Fee
Postmark
..0 Retum Receipt Fee Here
C3 (Endorsement Required)
M Restricted Delivery Fee
O (Endorsement Required)
0 Total Postage&Fees
S N (Please Pringlea_ dy)do be completed by mailer) a r!h
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City,State.ZIP+4------------------------------ -----------------------------------------
�
Certified Mail Provides:
■ A mailing receipt
■ A unique identifier for your mailpiece
■ A signature upon delivery, „
■ A record of delivery kept by the Postal Service for two years
Important Reminders.
■ Certified Mail may ONLY be combined with First-Class Mail or Priority Mail.
■ Certified Mail is not available for any class of international mail.
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valuables,please consider Insured or Registered Mail.
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fee.Endorse mailpiece 'Return Receipt Requested".To receive a fee waiver for
a duplicate return receipt,a USPS postmark on your Certified Mail receipt is
required.
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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 and present it when making an inquiry. . {
PS Form 3800,July 1999(Reverse) 102595-99-M-2087
U.S. Postal Service
CERTIFIED MAIL RECEIPT
(Domestic Mail Oniy;No Insurance Coverage Provided)
ru Postage $
xr
ra Certified Fee
O
Postmark
Return Receipt Fee Here
E3 (Endorsement Required)
M Restricted Delivery Fee
O (Endorsement Required)
0 Total Postage&Fees $
S
m Name(Please Print Clearly)(to be completed by mailer)
---------------------------------------------------------------------------------------_--
tT $haeq Apt.No.;or Po Box No.
IT'
ry
City Stale.ZIP+d--_..............._---------........-----.-------------------__._...
t
k
Certified Mail Provides:
■ A mailing receipt
■ A unique identifier for your mailpiece
■ A signaturevpon deligry �
■ A record of delivery kept by the Postal Service for two years
Important Reminders:
■ Certified Mail may ONLY be combined with First-Class Mail 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 Receipt may be requested to provide proof of
delivery.To obtain Return Receipt service,please complete antl attach a Return
Receipt(PS Form 38111 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 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 and present it when making an inquiry.
PS Form 3800,July 1999(Reverse) 102595-99-M-2087
V}. 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
only the tab Conservation Commission
key to move To: Applicant Property Owner(if different from applicant):
your cursor-
do not use the Pamela Burns& Edward Pliner Same
return key. Name Name
13 Locust Street
VQ
Mailing Address Mailing Address
Salem MA 01970
Citylrown State Zip Code City/Town State Zip Code
1. Title and Date of Final Plans and Other Documents:
Site Plan NA
Title Final Date(or Revised Date if applicable)
2. Date Request Filed:
June 27, 2002
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 120 sq. ft. addition to the existing single-family home
Project Location:
13 Locust Street Salem
Street Address City/Town
Map 37 Parcel 0010
Assessors Map/Plat Number ParceVLot Number
WPA Forth 2 Page t of 5
Rev.02/00
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.)
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
WPA Form 2
Rev.0&00 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.
WPA Forth 2
Rev,02100 Pelle 3 of 5
Massachusetts Department of Environmental Protection
Y 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 by certified mail, return receipt requested on
1'1 2.00-L
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 allotherapplicable 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,
�.020"
Date
WPA Form 2 Page d of 5
Rev.02810
t) 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 Determinationis 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
EDWARD S.PLINERrv. ' v 5-7515/11
PAMELA B:BURNS• 3 ° 67300010163 , t 161}$
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Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands Cityirown
WPA Form 1- Request for Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
A. General Information
Important i
When filling out t Applicant
fortms on puter, a 17kMFLA QUOS �, �DWAR.1� l0L/n)Ef2-
computer, use r D --
only the tab key Name E-Mail Address(A applicable)
to move your 13 l o GVST Sr..
cursor-do not Mailing Address
use the return LeWWI t'Y) 1970
key. Cdy/rown State Zip Code
q1X - 7 q l -9 L44S 978 - 7 N,4 ce 1 3 1
Phone Number Fax Number(d applimble)
2. Representative (if any):
/VOA1 e
Firm
Contact Name E-Mail Address(rf applicable)
Mailing Address
City/town State
Zip Code
Phone Number Fax Number(if applicable)
B. Determinations
1. I request the SA feM 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
❑ a.whether the following scope of alternatives is adequate for work in the Riverfront Area as
depicted on referenced plan(s).
WPA F.1
Rev.02100 Page 1 of 4
r
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands city/rowo
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):
13 L-OGus7 ST. 3ALE7✓1
Street Address City/Town
3 '7 S11;'00/0
Assessors Mapfftt Number ParceULot Number
b. Area Description (use additional paper, if necessary):
13 Lo(✓usT s-n2-l;-F-r wvowAr- Ad LOT z 9A) A Rt, I
AA--, OF' MUST, =.3 IUL3 r FFD.. 6200 UAISkI "
Kf CO20£a ESSEX x SO tm1 1>111. 9E6 o F DF(DS 804)te- S-13 P&LE 3.
c. Plan and/or Map Reference(s):
—_&ok- )3 4082 + PWIS E /s AWL DEER o 12 3G P + O ' tis s?
Title Date
PA-TWO -7�7g4
2. a. Work Description (use additional paper and/or provide plan(s)of work,if necessary):
Vff_A%42 OF 1-11tS 480-SE 1s SU&M 4xt3,)A� te Er OVE IT
L-IFJL IJP ►,JtTH T''i£ ear of 'f2'If_ &ftcK. WAr.t_• i7ttt
EXTW S t DA) LO i LL gf FOdL 114L O S 1 tZytcl f-LOOK?& t W i Lt_
5E P i r L. rrw P S)n (�Le Lt P Qa 6 4x poy-r - cA&1 T i Lrc t& D
--.VVM >tFL AA&E-MF rr- FLM(L No F UA)D4-n0AJgX&M-
0 IL 1ii- Po S i Qi LL- 6 E i9-e Q 0 i (-L L7
M(D)SE L*-S &)1 L.T lAJ THL SP2[NQ OF-)J&J-
b.
F )J&Jb. 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),
� w E7 jww ft-xc. VV'4J Amf abVIDF exEm»new r-0/2 7IK
011eggibrJ DF L.AWA) (/At 7)11.5 CAJ4 824Gk IXUPM94-1,) 7D A ils�
HCCESSo(Ly TO AN EX.117714J4 atJ(hLt= i?I+MILV thOSS /A) D1J7FO(-F-
ON AVr7 / 1�9G (IUF: 310rt- 2 JO.S-r(&) JLXH 4Crivi7y
rw17ST OCcurL MO2.E, /'7�'t1AT SoFUT FfeP T74L ANA)ML Hi41q
wPA F.1 i'4,►L U n1 f
RPage 2&4
ev.0?/00
Massachusetts Department of Environmental Protection
lugBureau of Resource Protection -Wetlands city/Tom
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
14 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 lof was recorded) supporting the classification
above(use additional paper and/or attach appropriate documents, if necessary.)
_ Lor z wft✓S .ot�p itif 77�t.y /9(03 St:t: I 6 a5d✓e
MA Fm l
Rev.02=
Page 3 of 4
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands cityrrmn
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. /1
Na�A'M�7Jt- A(Je?.JJS
Mailing Address
l3 dress ST fr
4ALZM MA- 0/970
Cdyrrown
State Zip Code
Signatures:
I also understand that notification of this Request will be placed in a local newspaper at my expense
in acco ance with Section 10.05(3)(b)(1)of the Wetlands Protection Act regulations.
ignalure of App6pM Date
Signature of Representative(d any) Date
WPA Fpm?
Page<p4
Rev.07Ap
Tz
2 1
l
I _
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ROAD CLASSIFICATION
I MILEprimary highway,
Light duty road, hard or
hard surface improved surface
00 5000 5000 70M FEET
Secondary highway,
hard surface
I KILOMETER Unimproved road
FEET interstate Route U.S Route State Route
IATUM OF 1929 MASS
IATUM IS MEAN LOW WATER
,ATOMS IS VARIABLE
E LINE U MEAN HIGH WATER
(IRATELY 9 FEET SALEM, MASS.
OUADRANGLE LOCATION 1n171149 F/7 5
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands cityrrom
WPA Form 1- Request for Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
A. Generallnformation
Important:
When filling out t Applicant
formsa
compputer,uter. use 4�
ftAeIBl7Rn1S t WAR1> l0(-lNE2
only the tab key Name E-Mail Address(rf applicable)
to move your 13 LO GIST ST.
cursor-do not Mailing Address
use the return �,�LIEW1 tY) A 01970
key. Cnylrown State
Zip Code
mq1,P - 74i -yy4�S 9�8 - �y4 c�rai
Phone Number Fax Number(ifapplicable)
2. Representative (if any):
/vonl e
Firm
Contact Name E-Mail Address(if applicable)
Mailing Address
C�tyROM'^ State -
Zip Code
Phone Number Fax Number(if applicable)
B. Determinations
1. I request the SA L l%4 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).
NPA Fo l
Rev.02100 Page 1 of 4
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands clty/Twn
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):
13 L-Ocus7 ST. SALENV1
treet Address
SCityrrmn
37 SW00/0
Assessors Map/Plat Number ParceVLot Number
b. Area Description (use additional paper, if necessary):
13 LoLUS i S7-R-C 1:T 1cNotAA1- &S LOT Z 9N ,4 RL
EpQTfrlem " LWb OF MOST ;M&I 1463 t FD aQUPZYAISk/ "
9.f.Co24X O . USES, SOUTH 1>LST-. gfiCk DF'D6CbS l oo te- S'l3q Pf} 6E 3.
c. Plan and/or Map Reference(s):
Title_tic I3 (0 82 P46 E Lf FW r;t t of Ou + P I ►s
Date
PA-TE1� '►�a11Lq �
2. a. Work Description (use additional paper and/or provide plan(s)of work, if necessary):
T? S 4-£R2 OF -c SUAM 9—%1110ET� (.r? AUT TD
L[NE, 11P L..rtTH IVI L f LT- OF THL &ft. .. tAtAu
UTf wa i LOA) Lo i L.t_ 13F Fort Tl:-[L 11ST' 7ZrtcL 'F t.00rCS + W t LL_
fie- 'pjQ]6-r {Ar1'tu A I nS 61.E 11 D 6 6 E ff geiT - C"T I Lre O2f.A
12VM TZ+L AffieWEur F109- No FdUA T164 U)r&-P7-
"(L IW- POST LJt t-(- ISE f2 E Q U I r ILD
1H C- 16 L&*4 QW, L-T Im TZ+L SP"r. OF )iy
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).
&(4 S 007KLG VDAI Rebs POVIDF £XE7VUO/1LW GbQ TPX
CON✓E12S16n) OF LAW/ (/At 7HIS CAA 82KklASPHAc►„) 7P A• u- --
/}QZ&So(Ly 10 AN EX1177AJE, CZ1j16U P-"ILV &LUS iN f OZEA)(6-
0/j AV& 7 f I` 966(UP: 31ort-m 10.5- '(� PaptsoLo JLWH ACT7v/ry
fut'vsr OCCUYL (Moe& I7+Axr Svz)r*, .T �M 7WL AWAWAL H16,q
WPA Foam W 4 � tt U AI ` -
WP 02/00 Page 2 of 4
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands cny/Tmn
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 8/1/96
❑ 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 817/96
❑ 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 lof was recorded) supporting the classification
above(use additional paper and/or attach appropriate documents, if necessary.)
Or Z wRd /I ARD if1 77hy 1963 SEE 1 6 aao✓e
WPA Form?
Rev.02/00 Pepe 3 A 4
Massachusetts Department of Environmental Protection
• Bureau of Resource Protection -Wetlands cnr?orn
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:
a �j ct�1S f- t�DL.>�r2I� PL/Il�F1L�
Name
Mailing Address
.SA-Lem MA- 01170
City/town
State Zip Code
Signatures:
I also understand that notification of this Request will be placed in a local newspaper at my expense
in accor ance with Section 10.05(3)(b)(1) of the Wetlands Protection Act regulations.
ignature of Appheant Date
Signature of Representative(if any) Date
APA Fonts
Rev.07/00 Page 4 M 4
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ROAD CLASSIFICATION vp
I MILE Primary highway, Light duty road, hard or
hard surface improved surface
GO 5000 6000 7000 FEET
Secondary highway,
I KILOMETER
hard surface Unimproved road
o FEET interstate Route
U. S Route State Route
)ATOM OF 1929
)ATUM IS MEAN LOW WATER MASS F-1 4-.
IATUMS IS VARIABLE
E LINE of MEAN HIGH WATER
el"TELY 9 FEET SALEM, MASS.
OUACRANGLE LOCATION ...non le/7 1,
f
�,PKION(�O�7i
Conservation Commi%ion
Salem, Massachusetts 01970
C��'�1ASSACP
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 Pamela Burns & Edward Pliner, 13 Locust
Street, Salem, MA 01940. The purpose of this hearing is for a determination for the construction
of a 120 sq. ft. addition to the single-family home at 13 Locust Street. This hearing will be held
on Thursday, July 11,2002 at 7:00 p.m. in Room 313, Third Floor, 120 Washington Street.
Kevin Cornacchio
Chairman
July 3, 2002
Please send bill to:
Pamela Burns
13 Locust Street
Salem, MA 01970
978-741-4445