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OSBORNE HILL DRIVE - CONSERVATION COMMISSION RDA Lot-13 Osborne Hill Dr. I SENDER:-COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. SignatuW item 4 if Restricted Delivery is desired. ❑Agent so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailplece, or on the front if space permits. 1. Article Addressed to: D. Is delivery address different from Rem 17 ❑Yes If YES,enter delivery address below: ❑No The Commonwealth of Massachusetts Department of Environmental Protection Northeast Regional Office 13. Servicerype 205B Lowell Street 1 ❑Certified Mail 0xpress Mail Wilmington,MA 01887 I ❑Registered 0 Return Recelpt for Merchandise ❑Insured Mall ❑C.O.D. 4. Restricted Delivery!(Extra Fee) ❑vas 2. Article Number (Transfer from service labeo 1 i7 0 0 5 d 3110 ;O 0,0 G 7:17 6 7.4 21 fS Forth 3811,February 2004 Domestic Return Receipt 10259502-M-1540 { UNITED STATES POffl1R RME`''Ek6-- E . ta`A ('} $.'n. -row+u �at t • Sender: Please print your name, address, and ZIP+4 in this box o I 71 �o Salem Conservation CommissionZ—a C 120 Washington Street,3rd FI C, r— Salem,MA 01970MM 0 <M III III I I Nl II 1 1 I l II I I I I Ill - nnn 1 n ul �rnl n 1 111 i n , 1 „ � na 1 SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A ature item 4 if Restricted Delivery is desired. 0 Agent ■ Print your name and address on the reverse T7 0 Addressee so that we can return the card to you. B. scejAdl by(Punted Narmej C. Daty of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from Rem 1?10 Y s 1. Article Addressed to: If YES,enter delivery address below: ❑No .Eastern Land Survey Attn: Jim McDowell 104 Lowell Street Peabody, Ma 01960 3. Service Type 0 Certified Mail 0 Express Mail 0 Registered 0 Return Receipt for Merchandise 0 Insured Mail 0 C.O.D. 4. Restricted Delivery?Pdra ree) ❑Yes 2. Article Number - - -_ (Transfer from service iabeo 1! `r r 70057 3110; 0 0 0 PS Form 3811,February 2004 Domestic Return Receipt 10259502-M-1540 „4 UNITED STATES�PO3T%IiLass RCICE �"'''- `..,^'Suw It No.. . j • Sender: Please print your name, address, and ZIP+4 in this box C” , �T Salem Conservation Commission M C 1 1 120 Washington Street,3rd FI z o r— Salem,MA 01970 0 bz T la 9 ' 1 Mz 0-49-700352301 IIIIIII„III,it)(„,III,IM lite I'll 1161111►,JJ„I,I„I1IJI SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION . ■ Complete items 1,2,and 3.Also complete A. Signature /�,/� item 4 if Restricted Delivery is desired. X I ct Agent ■ Print your name and address on the reverse l/" ❑Addressee so that we can return the card to you. S. Received by(Printed Name) G,D e of bellry ■ Attach this card to the back of the mailpiece, 16 O I or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: 0 No iMr. Paul D Biase PO Box 780 IBynnfieldr Ma 01940 3. Service Type O Certified Mail 0 Express Mail 0 Registered 0 Return Receipt for Merchandise 0 Insured Mail 0 C.O.D. 4. Restricted Delivery?(Entre Fee) O Yes 2. Article Number (Transfer from service(abed 7005 3110 0000 717 6 7438 PS Form 3811,February 2004 Domestic Return Receipt tours-oz-M-tsao UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 Sender: Phase print your name, address, and ZIP+4 in this box W O C o z O zW M �w CQ Salem Conservation Commission 120 Washington Street,3rd FI w Salem,MA 01970 oC) 0 KqA L4V 0 Ili,III$IIII OSBORNE HILLS LOTS 13-15 & 35-36 Lot Filing Type Maximum Distance Distance Roof Impervious Impervious Comments Wall Height Work to Dwelling to Recharge Coverage as Coverage as Resource Resource Shown on Proposed Area Area Definitive May 2007 Plan (SF) (SF) 13 RDA ----- 67 FT. 112 FT. No 1,920 1,925 ----- 14 NOI 7 FT. 36 FT. 80 FT. Yes 1,920 2,160 Increase 240 SF 15 NOI 11.5 FT. 15 FT. 52 FT. Yes 1,920 2,160 Increase 240 SF 35 NOI 8 FT. 38 FT. 98 FT. Yes 1,920 2,160 Increase 240 SF 36 NOI 14 FT. 16 FT. 75 FT. Yes 1,920 2,160 Increase 240 SF r CONDITION NO. The deed for lot 13 shall contain the following restrictive language: Lot 13 is subject to an Order of Conditions issued by the Salem Conservation Commission (DEP File# ), recorded at Essex South Registry of Deeds at Book Page . The owners of Lot , pursuant to said Order of Conditions and the Massachusetts Wetlands Protection Act, are prohibited from certain activities. Certain prohibited activities shall remain in affect notwithstanding the issuance of a Certificate of Compliance relating to the Order of Conditions. These prohibited activities include: installation of a swimming pool, re-grading or filling of the lot, adding additional impervious material such as bituminous concrete or regular concrete or any other activity that would be regulated by the Massachusetts Wetlands Protection Act. The activities that are prohibited, however, may occur upon appropriate approvals obtained from the Salem Conservation Commission or the Massachusetts Department of Environmental Protection or any successor entity. ARTICLE XII CONSERVATION COMNUSSION The subdivision is developed within and around Wetland areas that are subject to the jurisdiction of the Salem Conservation Commission. The dumping of leaves, yard waste, debris or any other material into any Wetland area or into the Open Space or Common Parcels is prohibited. The Owners of any Lot responsible for violating this prohibition shall be responsible financially and criminally for any violation of this prohibition, including all costs (including court costs and attorney fees) associated with the restoration of the disturbed area. GONW7' �- CITY OF SALEM CONSERVATION COMMISSION July 18, 2007 Mr. Paul DiBiase PO Box 780 Lynnfield, Massachusetts 01940 Re: Determination of Applicability Lot 13 Sub Division off Marlborough Road, Salem,Massachusetts Dear Mr. DiBiase: Enclosed,please find the Determination of Applicability for the above referenced project. Following the 10-day appeal period (as of July 28, 2007), you may proceed with your project. This Determination is good for three years from the date of issuance, July 18, 2007, except in Areas Subject Protection as stated in the Wetlands Protection Act under MGL c. 131, Section 40. If you have any further questions,please feel free to contact me 978-619-5685. Sincerely, Carey Jes ):�tx� Conservation Agent/Staff Planner Enclosures CC: Eastern Land Survey DEP Northeast Regional Office L1Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands 1 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 Osborne Hills Realty Trust. return key. Name Name PO Box 780 m Mailing Address Mailing Address Lro ed Mat 01940 Ciry/ityrTown State Zip Code Cirylfown State Zip Code 1. Title and Date (or Revised Date if applicable) of Final Plans and Other Documents: Site Development Permit Plan Lots 13-15&35-36 May 3, 2007 Title Date Title Date Title Date 2. Date Request Filed: May 31, 2007 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): The proposed project includes grading and landscaping within the buffer zone of BVW on Lot 13 on Osborne Hills Drive. Project Location: Lot 13 Osborne Hills Drive Salem Street Address Cityfrown Map 9 Parcel 1 (portion) Assessors Map/Plat Number Parcel/Lot Number w afornV,dm•rev.311/05 Page 1 of 5 LIMassachusetts 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. resource areas described on the referenced plan(s) are of the following resou P ( ) ❑ 2a. The boundary delineations g 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 w af.,rnLdoc•rev.3/1/05 Page 2 of 5 L1Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands 1 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). Installation of wetlands sign behind the lot between the yard and the protected open space. Addition of language on deed prohibiting dumping in wetlands and notice that work completed on property within 100 foot buffer zone needs to come before the Conservation Commission. ❑ 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. w aform .doc•rev.3/1/05 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 A by certified mail, return receipt requested on �,,� 16 200? 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 Attachment) and the property owner (if different from the applicant). Signatures: (�^ tVTV — 1 July 12, 2007 Date wpaformg.doc•rev.3/1/05 Page 4 of 5 LIMassachusetts 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 Attachment)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. wpaform2.dm•rev.3/1/05 Page 5 of 5 CITY OF SALEM 4 CONSERVATION COMMISSION SITE VISIT FORM PROJECT LOCATION: Osborne Hills Sub-Division DATE OF SITE VISIT: 6/30/07 PROJECT PROPONENT: DEP FILE NUMBER: 64-451 -64- 459 PROPOSED WORK: Appearing before the Commission to obtain permits for single family homes located within the buffer zone or BVW. CN ATTENDAEs/ nt� Abutter n aAv, n,a.•�'' � . sion // — � ,X Y//y i Applicant/Property Owner/Representatives Ji. Y'n f 4C 1lCT.n�EL< E `� A`" _SITE VISIT7PURPOSE: ❑Request for Determination ❑Abbreviated Notice of Resource Area Delineation X Notice of Intent ❑Certificate of Compliance ❑Enforcement/Violation ❑Emergency ❑ Informal AREAS OF]URIS.DICTION: ,,, INLAND RESOURCE AREAS COASTAL RESOURCE AREAS ❑Bank ❑ Land Subject to Coastal ❑Land Under the Ocean Storm Flowage ❑Bordering Vegetated Wetland ❑ Designated Port Area ❑Coastal Beach ❑Land Subject to Flooding ElCoastal Dune ❑Barrier Beach ElLand Under Water Bodies or Waterway Name: ❑ Coastal Bank ❑ Rocky Intertidal Shore ❑Riverfront Area ❑ Salt Marsh ❑ Land Under Salt Pond Veinal Pools ❑ ❑ Land Containing ❑Anadromous/Cata- � ,��I o� �� .�� - � � . � . � .. . .. , � Shellfish dromous Fish Run El_ BorderingVegetateL Wr etlan"d.,in_C.oasta 1.Area eEBLiZONE_(wthin100-feet) tV ❑Water Body X Bordering Vegetated Wetland ❑Bank ❑Coastal Beach ❑Coastal Dune INTERESIS_P_RO_T.ECTED: ❑ Protection of Water Supply ❑ Protection of Groundwater Supply X Flood Control X Storm Damage Prevention X Prevention of Pollution X Protection of Fisheries X Protection of Wildlife Habitat ❑ Protection of Land Containing Shellfish Is this an exempt project:If so,why? Are resource area boundaries delineated correctly? If not,explain. ISIT-E-VISIT-DOCUMENTATIONS ' '�� "' ' � � ❑Photos ❑ Site Map ❑Other: ,OBSERVATIONS: Take into account relevant aspects or features such as: natural or piped drainage or obvious pollution; topography; existing vegetation; possible alternative sites; signs of wildlife, possible vernal pools, rare species habitat; landmarks; recent or historical disturbances; proximity to other water bodies or drainage areas; adjacent land uses. RECOMMENDATIONS: CITY OF SALEM CONSERVATION COMMISSION City of Salem Conservation Commission Will hold a public hearing for a Request for 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 the Osborne Hills Realty Trust, P.O Box 780, Lynnfield, MA 01940. The purpose of the hearing is to discuss the proposed grading and landscaping of in the buffer zone of BVW on Lot 13 on Osborne Hill Drive off of Marlborough Road. This hearing will be held on Thursday,June 14, 2007 at 6:00 pm in Room 313, City Hall Annex, 120 Washington Street�& ? . Kevin P. Comacchio Chairman Please print legal advertisement on: June 7, 2007 Please send bill to: Attorney John Keilty 40 Lowell Street Peabody, MA 01960 978-531-7900 City of Salem Department of Planning flit CommunityDevelopment Check/Cash Receipt and Tracking Form Please complete firm and make two copies Date Received / 0 7 Amount Received SO-0 Form of Payment �ched: Cash CHECK PAYMENTSs write check number CASH PAYMENT& write client Initials 0 Sign Permit Application Fee [f Comervation Commbsion Fee Payment received for what service? Pfannirg frd Fee Q Old Town Half Rental Fee 0 other Name of staff person receiving payMtes Additional i TATEP -_ INVOICEO�l AMOUN(— JOHNR -KEILA, ESQUIRE' 1 = 1>s 'f�llil1 II eV U' GiertRe Trust Account' '11 I ��+ �� 11i 1 i i `il �� 11401LOWEI,L'STREEi1 111`( a 4 ; 1. 11 E i - 111 '. PEABODY, IvtASSACHUSITS 01960 '� ' '{• N� _1 11908 _ `' iii ` 1 '!i u I I t i n:-- 1 !.� I1 q1 � flit 11!=�1 1�}`-=Ili ��-•—II! 1i r1 ilL a Tb . OE9.gF+ !Il 111 I fiBO71 $SSMEI :NETAMOUNT- n Z.ti 1 1 CEastern Bank Lynn MA � l "II 11 u•00 > 908n' "i:0 1--t. di 798►' _ t( _ COrin3al CChe and Form: DPCD Finance Copy 2:Application File r Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands Salem City/Town 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: forms on the Osborne Hills Realty Trust computer, use Name Address- only the tab key E-Mail Address to move your P. O. Box 780 cursor-do not Mailing Address use the return Lynnfield MA 01940 key. City/Town State Zip Code 781-844-7026 Phone Number Fax Number(if applicable) 2. Representative (if any): Firm Attorney John Keilty Contact Name E-Mail Address 40 Lowell Street Mailing Address Peabody MA 01960 CitylTown State Zip Code 978-531-7900 Phone Number Fax Number(if applicable) B. Determinations 1. I request the Salem 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). wpaforml.doe Page 1 of Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands Salem WPA Form 1- Request for Determination of Applicability Cly/Town Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 C. Project Description 1. a. Project Location (use maps and plans to identify the location of the area subject to this request): Lot 13 Osborne Hill Drive Salem Street Address City/Town 9 (portion) Assessors Map/Plat Number Parcel/Lot Number b. Area Description (use additional paper, if necessary): Approximately 1,250 SF of land in the northwest portion of Lot 13 Osborne Hill Drive. c. Plan and/or Map Reference(s): Site Development Permit Plan May 3, 2007 Title Date Title Date Title Date 2. a. Work Description (use additional paper and/or provide plans) of work, if necessary): Grading and landscaping. wpaforml.tloc Pa9 e 2 of 4 Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands Salem � n WPA Form I- Request for Determination of Applicability City/Town Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 C. Project Description (cont.) b. Identify provisions of the Wetlands Protection Act or regulations which may exempt the applicant from having to file a Notice of Intent for all or part of the described work (use additional paper, if necessary). 3. a. If this application is a Request for Determination of Scope of Alternatives for work in the Rivertront Area, indicate the one classification below that best describes the project. ❑ Single family house on a lot recorded on or before 8/1/96 ❑ Single family house on a lot recorded after 8/1/96 ❑ Expansion of an existing structure on a lot recorded after 8/1/96 ❑ Project, other than a single family house or public project, where the applicant owned the lot before 8/7/96 ❑ New agriculture or aquaculture project ❑ Public project where funds were appropriated prior to 8/7/96 ❑ Project on a lot shown on an approved, definitive subdivision plan where there is a recorded deed restriction limiting total alteration of the Rivertront 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.) wpaforml d.e Page 3 of 4 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: Osborne Hills Realty Trust Name P. 0. Box 780 Mailing Address Lynnfield CityTTown MA 01940 State Zip Code Signatures: I also understand that notification of this Request will be placed in a local newspaper at my expense in accordan 1 e tion 10.05(3)(b)(1) of the Wetlands Protection Act regulations. Signa pelican Date �-i7 -off Si ture of presentative(i any) Date wpaforml.d.o Page 4 of 4 �emrag WWWRIM MEMO pi! wr f 11 NO Z.yCSti' vv. 'V�Kny OM R'� R11 Per, ra. TZM PN muo --N V�'It 1".4 7 04ri"p fr lk V, �NV nj 4-F 4� 11 In il 4 '1. �11 11 IZ ji 14.1 0 A 4lay�I "IN IN k -W T. -17 Oc '10 zz!.U5 v q "G.m '-m agAf gl) 'mlw- Ift gil 4 '�vw' (P.)r RM- Fri Aj a ^».( N V40 Tz j v ; gp"ma 707 z fr vIR lit