83 NORTH STREET - CONSERVATION COMMISSION i 93
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CITY OF SALEM
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1 %`' CONSERVATION COMMISSION
August 31, 2017
Seger Architects, Inc.
c/o John Seger
10 Derby Square
Salem, MA 01970
Re: Determination of Applicability-83 North Street
Dear Mr. Seger:
Please find the enclosed Determination of Applicability for the above-referenced project.
This document is effective for three years from its date of issuance. If you have any
further questions please feel free to contact me at 978-619-5685.
Sincerely,
Ashley Green
Conservation Agent
Enclosure
cc: DEP Northeast Regional Office
Michael Blier
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 Michael Blier
return key. Name Name
112 Shawmut Ave
ab Mailing Address Mailing Address
+r Boston MA 02118
® City/Town State Zip Code City/Town State Zip Code
�m 1. Title and Date (or Revised Date K applicable)of Final Plans and Other Documents:
Building Renovations 183 North St Salem MA I Existing Site Conditions i 8/24/2017
Site Plan Date
Title Date
Title Date
2. Date Request Filed:
8/3/2017
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):
Renovation of existing one story building for use as an office and rental space. Exterior will be re-clad,
new roof, windows, doors and overhead doors. Existing footprints will be maintained. Rear addition of
front building to be demolished and new addition to be installed in existing footprint. Parking area will be
maintained. Existing shed to removed.Topography will not be altered.
Project Location:
83 North St Salem
Street Address City/rown
26 0059
Assessors Map/Plat Number Parcel/Lot Number
wpaform2.doc•Determination of Applicability•rev.12114 Page 1 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.)
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
wpafor 2.doc•Determination of Applicability•rev.12114 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.
X2. 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.
wpafom2Aw•Determination of Applicability•rev.12114 Page 3 of 5
Massachusetts Department of Environmental Protection
`• Bureau of Resource Protection - Wetlands
WPA Form 2 — Determination of Applicability 11
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:
5ON
Name of Municipality
Pursuant to a municipal wetlands ordinance or bylaw.
Mga„r)S �Y $L�n aW (�pyl�f�o�m L 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
31 1Ifi
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/eea/agencies/massdel)/about/contacts/)
and the property owner(if different from the plicant).
Signature
s �
Date
wpaform2Aw•Determination of Applicability•rev.12114 Page 4 of 5
Massachusetts Department of Environmental Protection .
Bureau of Resource Protection - Wetlands
WPA Form 2 — Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
D. Appeals
The applicant, owner, any person aggrieved by this Determination, any owner of land abutting the land
upon which the proposed work is to be done, or any ten residents of the city or town in which such land is
located, are hereby notified of their right to request the appropriate Department of Environmental
Protection Regional Office (see htto://www.mass.gov/eea/agencies/massdeo/about/contacts/)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.
wpaforrn2.doc•Determination of Applicability•rev.12/14 Page 5 of 5
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands DEP File Number.
Request for Departmental Action Fee
Transmittal Form Provided by DEP
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
A. Request Information
1. Location of Project
a.Street Address b.Cityrrown,Zip
c.Check number d.Fee amount
Important:
When filling 2 Person or party making request(if appropriate, name the citizen group's representative):
out forms on
the computer, Name
use only the
tab key to Mailing Address
move your
cursor-do Cityrrown Stale Zip Code
not use the
return key. Phone Number Fax Number(if applicable)
3. Applicant(as shown on Determination of Applicability(Form 2), Order of Resource Area Delineation
(Form 4B), Order of Conditions (Form 5), Restoration Order of Conditions(Form 5A), or Notice of
Non-Significance(Form 6)):
rens
Name
Mailing Address
Cityrrown State Zip Code
Phone Number Fax Number(if applicable)
4. DEP File Number:
B. Instructions
1. When the Departmental action request is for(check one):
❑ Superseding Order of Conditions—Fee: $120.00(single family house projects)or$245(all other
projects)
❑ Superseding Determination of Applicability—Fee: $120
❑ Superseding Order of Resource Area Delineation—Fee: $120
Send this form and check or money order, payable to the Commonwealth of Massachusetts,to:
Department of Environmental Protection
Box 4062
Boston, MA 02211
wpaform2.d=•Request for DepaMrental Action Fee Transmdtal Form•rev.17/14 Page 1 of 2
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands DEP File Number: y
Request for Departmental Action Fee
Transmittal Form Provided by DEP
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 htto://www.mass.gov/eea/agencies/massdeo/about/contacts/).
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.
wpaform2Am•Request for Departmental Adion Fee Transmittal Fonn•rev.12/14 Page 2 of 2
AFFIDAVIT OF SERVICE
City of Salem provision M.G.L., Chapter 39, Section 23D.
(For a City Councilor, Board, or Commission Member, to sign upon listening to the
audio of a missed meeting and examining all evidence.)
Per the City of Salem provision M.G.L., Chapter 39 Section 23D,
hereby certify under the pains and penalties of perjury that I have examined all evidence
perta ming to 3 An Shod ( which was
distributed at the single missed session on ° which evidence
included an audio recording of the missed session. This certification was submitted prior
to the undersigned's participation in a vote on the matter and shall become part of the
record of the hearing.
Name: &e-�aLDate: o
Board or Commission: Salem Conservation Commission
i
Massachusetts Department of Environmental Protection
rA, Bureau of Resource Protection - Wetlands Salem
tWPA 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:
forms on the Michael Blier mblier@landworks-studio.com _
onlyth t use Name E-Mail Address
only the tab key
to move your 112 Shawmut Ave
cursor-do not Mailing Address
use the return Boston MA 02118
key. City/Tom state Zip Code
y Ji 617-426-3030
!t _
�—� Phone Number� fax Number applicable)
2. Representative(if any):
Sager Architects, Inc.
Firm
John Segeroh) naseger@segerarchitects.com
Contact Name E-Mail Address
10 Derby Square
Mating Address
Salem MA 01970
Chy/rown State Zip Code
978-744-0208 _
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:
Salem, MA
Name of Municipality
❑ e. whether the following scope of altematives is adequate for work in the Riverfront Area as
depicted on referenced plan(s).
wpatorml.d= Page 1 ora.
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands Salem i
WPA Form 1 - Request for Determination of Applicability Cily/rown
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
G. Project Description
1. a. Project Location(use maps and plans to identify the location of the area subject to this request):
83 North Street Salem, MA
Street Address C4rrown
26 26-0059-0
Assessors.Map/Plat Number PareellLofNumber
b. Area Description(use additional paper, if necessary):
A 13,284 S:f lot containing a former repair garage in the North River Canal Corridor District to be
reused as office space. Current site is mostly developed with paved parking areas over predominantly
the entire site not occupied by building footprint. Some small rear yard behind each building exist as
undeveloped and will.remain un-paved and open space.
c. Plan and/or Map Reference(s):
s
Title Data
TNe Date
TNe Date
2. a. Work Description(use additional paper and/or provide plan(s)of work, if necessary):
renovation of existing one story building for use an an office and rental space. Exterior will be re-Gad,
new roof, windows, doors and overhead'doors.Paving to be removed in select areas for pervious patio
space. Existing footprints will be maintained. Rear addtion of front building to be demolished and new
addition to be installed in existing footprint. No increase in footprint is planned.
Parking area will be maintained.Paving at select landscaped areas adjacent to the buildings will be
removed as shown on submitted plans. Paving to remain will satisfy proposed parking and will not have
its topography altered.
wparormidK Page 2 aro
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetland's Salem
WPA Form 1- Request for Determination of Applicability Ctty/fown
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).
Interior reniovations and improvements to and within existing structures and replacement of an
unsafe structure in kind and within the existing footprint without disturbing any paving or earth does
not constitute removal or alteration of a resource area withing the meaning of the Wetland Protection
Act.
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 8/1196
❑ Single family house on a lot recorded after 611/96
❑ Expansion of an existing structure on a lot recorded after 8/1196
❑ 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 Rivenront 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.)
xpatoirtit.Uoc Page 3 of 0
A
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands Salem 0
WPA Form 1- Request for Determination of Applicability Cityrrown
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:
Michael Slier, Landworks Studio
Name
112 Shawmut Ave
Mailing Address
Boston
Cityrrown
MA 02118
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.
_ 7f 3ilLof�
Sig re of Appli nt Date
Signature of Representative(if any) Date
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CONSERVATION COMMISION REVIEW AUGUST24,2Q17
BUILDING RENOVATIONS 183 NORTH ST, SALEM, MA I EXISTING SITE CONDITIONS
PREPARED BY: SEGER ARCHITECTS+LANDWORKS STUDIO SegaVroitectS,inC landworks?studio_
PREPARED FOR: NORTH FIELDS DEVELOPMENT LLC
SITE PLAN
0 32 64 128 FT
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'~ LIMITED PARTNERSHIP i PLA`�T�dG I ADDITION I OFFICE RENOVATION
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LANDMARK
ENGINEERING & SURVEYING, INC.
583 CHESTNUT STREET
LYNN, MA 01904-
n/f JOHN OROURKE (781) 592-7016
CONSERVATION COMMISION REVIEW AUGUST24.2017
BUILDING RENOVATIONS 183 NORTH ST, SALEM, MA I EXISTING SITE CONDITIONS
PREPARED BY: SEGER ARCHITECTS+ LANDWORKS STUDIO CegerrteQS, Inc Iandworks�studio-
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CONSERVATION COMMISSION
Salem Conservation Commission
978-619-5685
Will hold a public hearing for a Request for Determination of Applicability for Michael Blier,
112 Shawmut Ave, Boston MA. Purpose of hearing is to discuss proposed demolition of portion
of building, construction of addition, removal of pavement, construction of pervious patio, and
associated improvements at 83 North St within an area subject to protection under the Wetlands
Protection Act MGL cl31§40 and Salem Wetlands Protection & Conservation Ordinance.
Hearing will be 8/10/17 at 6:30pm in City Hall Annex, 3 d floor conference room, 120
Washington St.
Salem News publication date:
August 3, 2017
Deposit to be arranged by:
John Seger
Seger Architects, Inc.
10 Derby Square
Salem, MA 01970
978-744-0208
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+ Plan t
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LANDMARK
REALTY TRU STREET
ENGINEERING & SURVEYING, INC.
583 CHESTNUT STREET STN
LYNN, MA 01904
(781) 592-7016 Site Plan - Option Ba3
All,
1
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
A. General Information
Important:
When filling out 1. Applicant:
forms on the Michael Blier mblier@landworks-studio.com
computer, use
only the tab key Name E-Mail Address
to move your 112 Shawmut Ave
cursor-do not Mailing Address
use the return Boston MA 02118
key. Citylrom state Zip Code
617A26-3030
Nu 3030
ca Phone Number 'Fax Number(ff applicable)
2. Representative(if any):
Seger Architects, Inc.
Firm
John Seger johnaseger segerarchitects.com�
Contact Name E-Mail Address
10- Derby Square
Mailing Address
Salem MA 01970
Cityrrown ��--� State Zip Code
978-744-0208
Phone Number - Fax Number(if applicable)
B. Determinations
1. I request the make the following detennination(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:
Salem,_MA
Name of Municipality
❑ e. whether the following scope of alternatives is adequate for work in the Riverfront Area as
depicted on referenced plan(s).
-wpafarml Am Nge 1 of q.
_ &
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands Salem
Cilyn"own
1 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):
83 North Street Salem, MA _
Street Address Cityffown
26 26-0059-0
Assessors MaplPlat Number Parcel/Lot Number
b. Area Description(use additional paper, if necessary):
A 13,284 s.f. lot containing a former repair garage in the North River Canal Corridor District to be
reused as office space, Current site is mostly developed with paved parking areas over predominantly
the entire site not occupied by building footprint. Some small rear yard behind each building exist as
undeveloped and will.remain un-paved and open space.
c. Plan and/or Map Reference(s):
S
Title Date
Title Date
TNe Date
2. a. Work Description(use additional paper and/or provide plan(s)of work, if necessary):
renovation of existing one story building for use an an office and rental space. Exterior will be re-Gad,
new roof, windows, doors and overhead doors,Paving to be removed in select areas for pervious patio
space. Existing footprints will be maintained. Rear addtion of front building to be demolished and new
addition to be installed in existing footprint. No increase in footprint is planned.
Parking area will be maintained.paving at select landscaped areas adjacent to the buildings will be
removed as shown on submitted plans.Paving to remain will satisfy proposed parking and will not have
its topography altered.
wgafofmi.tloc Page 2 of 4
I �
Massachusetts Department of Environmental Protection
Salem
Bureau of Resource Protection - Wetlands
r
WPA Form 1 - Request for Determination of Applicability cftyrrom
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).
Interior reniovations and improvements to and within existing structures and replacement of an
unsafe structure in kind and within the existing footprint without disturbing any paving or earth does
not constitute removal or alteration of a resource area withing the meaning of the Wetland Protection
Act.
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 8/7196
❑ 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.)
wpef=t.Eoc Page 3.ot 4
i
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:
Michael Slier, Landworks Studio
Name
112 Shawmut Ave —
Mailing Address
Boston _
Cttyfrown
MA 02118
State 7Jp 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.
7 31ILot "7
Sign re of Appli nt Date
Signature of Representative(if any) Date
xyarorml.tlx. Page 4 of 4
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■ Attach this card to the back of the mallpiece, B. Received by(Panted Name) C Date of Delivery
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1. Article Addressed to: D. Is delivery address different from Item 17 13 Yes
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