Loading...
7 RIVERBANK ROAD - CONSERVATION COMMISSION 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 Alex Brown retum key. Name Name 7 Riverbank Road 'r Mailing Addr6ss Mailing Address Salem MA 01970 City/Town StaOs Lp Code City/Town State Zip Code e.. 1. Title and Date(or Revised Date it applicable)of Final Plans and Other Documents: Mortgage Inspection Plan August 12,2004 Too Date Idle Date Title Date 2. Date Request Filed: 11/14/05 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 construction of a second floor addition to an existing dwelling Project Location: 7 Riverbank Road Salem Sbast Address City/town MAP31 LOT 0248 Assessors Map/Plat Number Parcelll.ot Number wpaam2.dw•rev.antis Pegs 7 an 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 Aci Removing,filling,dredging.or altering of the area requires the filing of a Notice of Inter. ❑ 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 ggl 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 Inter. ❑ 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 Inter 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 mwkwaoy, Pursuant to the following municipal wetland ordinance or bylaw. Name Ordmance or Bylaw citation wpolomi 0oe•w.3roo5 Peas20f5 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 aftemaWes. (Refer lo the wetland regulations at 10.58(4)a for more information about the scope of aftematives requirements): ❑ Afiematives limited to the lot on which the project is located. ❑ Altematives 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 lo 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 ownees 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 Ad 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 atter an Area subject lo 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 afters an Area subject to protection under the Act wpdom dw•rev.3MA5 Pep3a5 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: l9owW Actp*(site WbcaW$WW t0ryJMp jWM Pte) ❑ 6.The area and/or work described in the Request is not subject tO review and approval by. Name of Mgmlcality Pursuant to a municipal wetlands ordinance or bylaw. Name - Offtarm 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 Dabs 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). i Signatures lie Ile- January 12, 2006 Date •pefam2Gx•mr.31105 Pape4 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 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'rf he/she is not the appelW t The request shag 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. .p0xffQ.doe.Fay.3Hi05 pap 5 MS 5 Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands DEP Regional Addresses Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Mail transmittal forms and DEP payments,payable to: Commonwealth of Massachusetts Departrnent of ErnironmeMal Protection Box 4062 Boston,MA 02211 DEP Western Region Adams cn:n Macedon ltoaae Pdslbld Tyrighsn 436 Dyright Street Allower" come"Affind Dlar � -La q vwwrPoo e Suite 402 Mkwa Dann Hawley Lkmseor WY Fmw Wae'ldn SPrtrgfleld,MA 01103 nalea oasFi/e "one &t W Russell Phone:413-784-1100 eBeIdNartme, � � Fax 4137841149 Bernardslon �Blandbrd i New, sirs Woolvarnow Sprouid Bnodow Florida lamaborough Norm Mere Slabaary yyea SlUddridp! eutldsrd GO Lee Northampton aupton smaWhddy Chaeroorl God= lam -, .0e, Sale Hadley Wba m Chau, Graig Leame one" Salawk wwmn*ug Cleda Grum-w Leyden Obs Spwl-eM Wlffowowbwn Clmsafiele Gree am hewn laorieado+ Palmer Seddsioea wean- Chkdpoo Greafetl Ludlow Perows 9m16o1ad W mil"on CLmbbug ltols► Ieeldetl Pau Tool d DEP Central Region Acton charter, Hopwrion MONEY Rudwel Dinidas 627 Main Skeet As burnran Cfilm nlbodore Leans. Showy Warm Worce50 60 MA-18 Phorw 50&792-7650 yelorn D.nlmle Lara" Nondbidge, smeftla a wee Be~ Ph0�: Fax 508.792-7621 Saler E®tBmddeto Leoar Nor Batldem sperm Brooldield Bare Gallup Lenin 04" sarin weaba TDD:508-767-2788 eesnyran Gardner Umem -odea see wwwwon Bah Grown uwabep Paden Seebupe Wimlradorn Bsesmre Orornd NsrEaauplr Peppero Sr/mn Woroesea Umbo Marded Maynard Pebrararr, Townsend Soybean n laid¢, Model Phar Townsend Soybean Holler Malar prYaw 7ynPbord4/r 9aolded wpeeee I�e1prA wyeseon upon DEP Southeast Region Margkon Damom Freetown Lmdapdwe Proavemowr Two" 20 RrveLside Drive Pavel Damm Gey Hmd LedlebowtO Rwflmm Truk Wareham L*Avbe,MA MU7 aa�a m D dx H.110, New Belad nos Wessel Phoma:508.946-VOO " E@dImm llamw NamAddwaVh RaWad wed 9dpewda Fax 506947$557 sold" Ead eoopevn Normal r Name salaam vks4 a ¢awe Ea on 1wWdn Norwell Small wed TUG" TDD:5084)462795 Smolder Edman lGwft Oak Skills Seelowec Whsrowr Brupemela Fedonen Lakeville s Oft" Slower Wrarreown O adOw Fall Few L. a- Pembroke smrorad Yo mom Caw Feknaln LMrkrr pkwwae Stoughton Chdoard ha, Fmer Mera.I Plynatlr Seemed, CNrak Fruft ¢seams PFynpbn Taunor DEP Northeast Region AdemMy Chdmdnd OAVY wareada 1 Winter skeet 4ndmor Choose Nmnm Ltm.m NaMdpin wave. Boston.MA 02106 Ads Corm aw.mn L � w� Phone:617-654.6500 Sedated Darvon taverna Iseon Podqxxt Wayland Fax 617-5561049 Be1ioY Deman Leriglon Nehad wvley Monday makk Salem TDD:617-574.68611 Sharon Beawly Or wer bide Meadow- seFdEw Vftg weWy Beam Enam yen Newbuy Serpa Wadm Boxford Everee LW~ NeaWypw Slowbon werte nd Braintree FnamViom -wean Nawaar Somerville Weynnm tkaddre Georgetown Wrrlreeea-By-TheSes Norto1r 9uehan Wilmington Buaspear Glamasr Merbldnead NormAdea Srmrry Wirdressa aMad Lkedleld Norm r4ml wmmup Reeding 9ea CLa carom dpe Flarelar Madod Norwood To-mboy Wobun Cafele Hewli Mmkoow Peabody TOPAW Wpe(am loo•DEP Addressee•rev.10601 Page 1d1 SENDER: COMPLETE THIS SECTION CGMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete ig atw Item 4 if Restricted Delivery is desired. O Agent ■ Print your name and address on the reverse ❑Addressee so that we can-returh the card to you. B. (Ponied Name) . Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery addl different from Rem 17 ❑Yes 1. Article Addressed to: If YES,enter delivery address below: 0 No The Commonwealth of Massachusetts Department of Environmental Protection i Northeast Regional Office 3. Service Type 205B Lowell Street 0 Certified Mall 0 Express Mail Wilmington,MA 01887 I ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) 0 Yes 2. Article Number f iii 700511 8`2 0 } (rmnsterfrom service III' 0000 87951ti308si s Ps Form 3811,February 2004 Domestic Return Receipt 10259su2-re-1540 i UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box Salem Conservation Commission 120 Washington Street,3rd A Salem,MA 01970 1L Kd SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION . ■ Complete items 1,2,and 3.Also complete A Sign i item 4 if Restricted Delivery is desired. 0 Agent 1 ■ Print your name and address on the reverse X Addressee so that we can return the card to you. B. Freceived by(Printed Name) C. Date f Deli ry 1 ■ Attach this card to the back of the mailpiece, 7 /r� or on the front if space permits. / G� 1. Article Addressed to: D. Is delivery address different from Rem 1T Yes If YES,enter delivery address below: 0 No ✓ 59 lest HA C)/97-e) 3. Service Type Certified Mail 0 Express Mall Reglstemd 0 Return Receipt for Merchandise 0 Insured Mail 0 C.O.D. 4. Restricted Delivery?(Extra Fee) 0 Yes 2. Article Number f'' ,1 .7005: 1820 `0000 879511179 (transfer/ram ser .. PS Form 381 1,February 2004 Domestic Return Receipt 102595o2-tn4540 UNITED STATES i,;,. 3ah'iiYj:26`:J:4ki"r • Sender: Please print your name, address, and ZIP+4 in this box Salem Conservation Commission 120 Washington Street,3rd FI Salem,ASA 01970 II I I2,wtti�L ed . E n 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 Alex Brown, 7 Riverbank Road, Salem, MA 01970. The purpose of this hearing is for the determination of work related to the construction of a second floor addition to a single-family dwelling within a Riverfront Area at 7 Riverbank Road.This hearing will be held on Thursday, December 8, 2005 at 6:00 p.m. in City Hall Annex, Room 313, 120 Washington Street. A Kevin P. Cornacchio Conservation Commission Chairman Please run legal advertisement on: December 1, 2005 Please send bill to: Alex Brown 7 Riverbank Road Salem,MA 01970 (978) 744-5183 120 WASHINGTON STREET, SALEM, MASSACHUSETTS 01970 .TEL: 978.745.9595 FAX: 978.740.0404 4 WWW.SALEM.COM City of Salem Department of Planning & Community Development Check/Cash Receipt and Tracking Form Please Complete rarm and make two copes. Date Received 10i} US Amount Received ac) Form of Payment Check Elcash CHECK PAYMENTS: write chedc number l0/0 CASH PAYMENTS: write client initials A , L� . Q Sign Permit Application Fee C`` Conservatlon Commission Fee Payment received for ```77777T'"''''' ��,��, what service? ❑ Planning Board Fee Q Old Town Hall Rental Fee Q Other Name of staff person ' receiving payment fa-4 Additional Notes 4F MOLLY C". BROWN% 4l i . '.i r 1010:, ` ALEXANDER'R BROWN i` 7 WMANK SALEM MA 01970 azno;\s -� Pay to the . 'C' o� S�.te� Order of Il $ ZS 00 �i.✓e✓/ ` a• (/>:.'` , .;; t.,;=�`'> Dollars 8 BankofMierl ; r AC H 0.R 01100013! it ". r '( r r i..• �:�}i00D;138�... OD946:L75599211 ' 1D , i Original Check and Form: DPCD Finance Copy 1: Client Copy 2:Application File Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands City/Town WPA Form 1- Request for Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 A. General Information Important: When filling out 1. Applic /! ` farms on the &W &--0 LJ R/�(r 1-oLiA@ (bMegfIlleI computer, use Name "/` E-Mail Address only the tab key 0 ✓�� � 1 to move your cursor-do not Mailing Ad ress use the return I C dYl f ' l 1z O key. Cityrrown State Zip Code Phone Number Fax Number(if applicable) 2. Representative (if any): Firm Contact Name E-Mail Address Mailing Address City/Town State Zip Code 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: Name of Municipality e. whether the following scope of alternatives is adequate for work in the Riverfront Area as depicted on referenced plan(s). Wt_ Dk C\ �PSruo .\�f bt.; 1� C< �i OA__ t ASuli nA O(- 5-, Wo - Lu-k Il0Lye lr4 a 0. `{r im-K in "alonnl.dac•rev.07/74109. Page 1 of 4 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands Cityrrown WPA Form 1- Request for Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 C. Project Description 1. a. Project Location (use maps and plans to identify the location of the area subject to this request): '7 0, � ��ihCx4K street Address city/rows Oncc D 21 i l.o-\:- 024 Assessori Map/Plat Number Parcel/Lot Number b. Area Description (use additional paper, if necessary): c. Plan and/or Map Reference(s): Tie Date Title Date Title Date 2. a. Work Description (use additional paper and/or provide plan(s) of work, if necessary): �<4 At 1 ^oma a � S'lte� d 0 Y /- �-V i S� Cam er17 tet/ and Ar wpafo I.d=•rev.0711004. Page 2 of 4 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands c47rown WPA Form 1- Request for Determination of Applicability 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 Riverfront Area, indicate the one classification below that best describes the project. XSingle family house on a lot recorded on or before 8/1/96 ❑ Single family house on a lot recorded after 8/1/96 ❑ Expansion of an existing structure on a lot recorded after 8/1/96 ❑ Project, other than a single family house or public project, where the applicant owned the lot before 8!7/96 ❑ New agriculture or aquaculture project ❑ Public project where funds were appropriated prior to 8[7/96 ❑ Project on a lot shown on an approved, definitive subdivision plan where there is a recorded deed restriction limiting total alteration of the Riverfront Area for the entire subdivision ❑ Residential subdivision; institutional, industrial, or commercial project ❑ Municipal project ❑ District, county, state, or federal government project ❑ Project required to evaluate off-site alternatives in more than one municipality in an Environmental Impact Report under MEPA or in an alternatives analysis pursuant to an application for a 404 permit from the U.S.Army Corps of Engineers or 401 Water Quality Certification from the Department of Environmental Protection. b. Provide evidence (e.g., record of date subdivision lot was recorded) supporting the classification above (use additional paper and/or attach appropriate documents, if necessary.) wpafo.tdw•rev.07/14/04. Page 3 of 4 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands City/Town WPA Form 1- Request for Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 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 Attachment) 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: Name Mailing Addre`s�._, Citylrown 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 7Section 10.05(3)(b)(1) of the Wetlands Protection Act regulations. Signature App icanl Date Signature of Representative(if any) Date mafo.l.tl -rev.07114/O4. Page 4 of 4 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands 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. Applic ` forms on the �pnl ®�(� R� /6row/I � CyMC47f�/f2�' computer, use only the tab key Name // E-Mail Address ✓�� � !� 1 to move your 7 cursor-do not Mailing Ad ress use the return �� /Yf t /}�/� 0070 key. `'�I,y/Cityrro7 Q State Zip Code wn9 yII as Phone Number Fax Number(if applicable) 2. Representative (if any): 2Ml Firm Contact Name E-Mail Address Mailing Address City/Town State Zip Code Phone Number Fax Number(if applicable) i 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: Name of Municipality e. whether the following scope of alternatives is adequate for work in the Riverfront Area as depicted on referenced plan(s). f W E I 'JD\ar\ 4� (esr�o� 1�f �Dt.; 1� �: i i ori C�✓I St l/i tq J�t 66 .ve LJ& d-15Pb5a I . w aforml.doc•rev.07/14/04. Page 1 of 4 LIMassachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 1- Request for Determination of Applicability City/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): �c ��l bar �.. e,� st Street Address City/Town Oka 0 1 G..- - 024 S Assessor Map/Plat Number Parcel/Lot Number b. Area Description (use additional paper, if necessary): c. Plan and/or Map Reference(s): Title Date Title Date Title Date 2. a. Work Description (use additional paper and/or provide plan(s) of work, if necessary): � lLg I f oma n+ rDv� add ; , �,� f /; �,�� s q wpafor l.d.•rev.07/14/04. Page 2 of 4 LlMassachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 1- 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 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). 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. XSingle family house on a lot recorded on or before 8/1/96 ❑ Single family house on a lot recorded after 8/1/96 ❑ Expansion of an existing structure on a lot recorded after 8/1/96 ❑ Project, other than a single family house or public project, where the applicant owned the lot before 8/7/96 ❑ New agriculture or aquaculture project ❑ Public project where funds were appropriated prior to 8/7/96 ❑ Project on a lot shown on an approved, definitive subdivision plan where there is a recorded deed restriction limiting total alteration of the Riverfront Area for the entire subdivision ❑ Residential subdivision; institutional, industrial, or commercial project ❑ Municipal project ❑ District, county, state, or federal government project ❑ Project required to evaluate off-site alternatives in more than one municipality in an Environmental Impact Report under MEPA or in an alternatives analysis pursuant to an application for a 404 permit from the U.S. Army Corps of Engineers or 401 Water Quality Certification from the Department of Environmental Protection. b. Provide evidence (e.g., record of date subdivision lot was recorded) supporting the classification above (use additional paper and/or attach appropriate documents, if necessary.) w afar l.d.•rev.07/14/04. Page 3 of 4 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands 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 (see Attachment) 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: _ 14te4 Name � fit_✓���� � ,fid . Mailing Addres City/Town ori 7d 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 Se tion 10.05(3)(b)(1) of the Wetlands Protection Act regulations. Signature App icant Date Signature of Representative(if any) Date wpafoanl.doc•rev.07/14/04. Page 4 of 4 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands DEP Regional Addresses Massachusetts Wetlands Protection Act M.G.L, c. 131 , §40 Mail transmittal forms and DEP payments,payable to: Commonwealth of Massachusetts Department of Environmental Protection Box 4062 Boston, MA 02211 DEP Western Region Adams Colrain Hamden Monroe Pittsfield Tyringham 436 Dwight Street Agawam Conway Hancock Montague Plainfield Wales Afford Cummington Hatfield Monterey Richmond Ware Suite 402 Amherst Dalton Hawley Montgomery Rowe Warwick Springfield,MA 01103 Ashfield Deerfield Heath Monson Russell Washington Phone:413-784-1100 Becket Easthampto Hinsdale Mount Sandisfield Wendell Belchertown a Holland Washington Savoy WesttieM Fax:413-784-1149 Bernardi East Holyoke New Ashford Sheffield Westhampton Blandlord Longmeado Huntington New Malborough Shelburne West Springfield Brimfield wEgrei 1-wesborough New Salem Shutesbury West Stockbndge Buckland Erving Lee North Adams Southampton Whately Chademont Florida Lenox Northampton South Hadley Wilbraham Cheshire Gill Levered Northfield Southwick Williamsburg Chester Goshen Leyden Orange Springfield Williarnstown Chesterfield Granby Loagmadow Otis Stockbridge Windsor Chicopee Granville Ludlow Palmer Sunderlanti Worthington Clarksburg Great Middlefield Pelham Tolland Barrington Peru Greenfield Hadley DEP Central Region Acton Chariton Hopkinton Millbury Rutland Uxbridge 627 Main Street Ashbumham Clinton Hubbardston WMP. Shirley Warren Ashby Douglas Hudson New Braintree Shrewsbury Webster Worcester,MA 01608 Athol Dudley Holliston Northborough Southborough Westborough Phone:508-792-7650 Auburn Dunstable Lancaster Northbridge Souffic itlge West Boylston Fax:508-792-7621 Ayer East Leicester North Brookfield Spencer West Brookfield Barre Brookfield Leominster Oakham Sterling Westford TDD:508-767-2788 Bellingham Fitchburg Littleton Oxford Stow Westminster Berlin Gardner Lunenburg Paxton Sturbridge Winchentlon Blackstone Grafton Malborough Pepperell Sutton Worcester Bolton Groton Maynard Petersham Templeton Boxtoorough Harvard Medway Phillipston Townsend Boylston Hardwick Mention Princeton Tyngsborough Brookfield Holden Milford Royalston Upton Hopedale DEP Southeast Region Abington Dartnputh Freetown Mattapoisett Provincetown Tisbury, 20 Riverside Drive Acushnet Dennis Gay Head Middleborough Raynham Truro Attleboro Dighton Gosnold Nantucket Rehoboth Wareham Lakeville, MA 02347 Avon Duxbury Halifax New Bedford Rochester Welllleet Phone:508-946-2700 Barnstable Eastham Hanover North Rockland West Bridgewater Fax:508-947-6557 Berkley East Hanson Attleborough Sandwich Wasiport Bourne Bridgewater Harwich Norton Scituate West Tsbury, TDD:508-946-2795 Brewster Easton Kingston Norwell Seekonk Whitman Bridgewater Edgartown Lakeville Oak Bluffs Sharon Wrentham Brockton Fairhaven Mansfield Orleans Somerset Vermouth Carver Fall River Marion Pembroke Stoughton Chatham Falowuth Marshtieltl Plainville Swansea Chilmark Foxborough Mashpee Plymouth Taunton Franklin Plympton DEPNortheast Region Amesbury Chelmsford Hingham Merrimac Quincy Wakefield 1 Winter Street Ancover Chelsea Holbrook Methuen Randolph Walpole Adington Cohasset Hull Middleton Pleading Waltham Boston,MA 02108 Ashland Concord Ipswich Millis Revere Watertown Phone:617-654-6500 B.d,.'d Danvers Lawrence Milton Rockport Wayland Fax: 617-556-1049 Belmont Dedham Lexington Nahum Rowley Wellesley Beverly Dover Lincoln Natick Salem Wonham TDD:617-574-6868 Billerica Dracut Lowell Needham Salisbury West Newbury BostonEssex Lynn Newbury Saugus Weston ...to Everett Lynnfield Newburyport Sherbom Westvrood Braintree Framingham Malden Newton Somerville Weymouth Brookline Georgetown Manchester-By- Norfolk Stoneham Wilmington Budington Gloucester The-Sea North Andover Sudbury Winchester Cambridge Groveland Marblehead North Reading Swampscott Winthrop Canton Hamilton McWieltl Ni Tewksbury Woburn Carlisle Haverhill Medford Peabody Topsfield Melrose maforml.d.•DEP Addresses•rev.7/14/04 Page lot 1 Massachusetts Wetlands Protection Act M.G.L. ch 131 §40 1. Notice of Intent File Fees Category Activities and Fees Category l(Fee for each,activity is$110); a.) work on single family lot;addition,pool,etc.; b.) site work without a house; C.) control vegetation; d.) resource improvement; e.) work on septic system separate from house; f.) monitoring well activities minus roadway; g.) new agricultural or aquacultural projects. Category,2(Fee for each activity is$500): a.) construction of single family house; b.) parking lot; C.) beach nourishment; d.) electric generating facility activities; e.) inland limited projects minus road crossings and agriculture; f.) each crossing for driveway to single family house; g.) each project source(storm drain)discharge; h.) control vegetation in development; i.) water level variations; j.) any other activity not in Category 1,3,4,5,or 6; k.) water supply exploration. Category:3(Fee for each activity is$1,050); a.) site preparation(for development)beyond Notice of Intent scope; b.) each building(for development) including site; C.) road construction not crossing or driveway; d.) hazardous cleanup; e.) water supply development. Category 4(Fee foi eachactivity is$1;450): a.) each crossing for development or commercial road; b.) dam,sluiceway,tidegate(safety) work; C.) landfills operation/closures; d.) sand and gravel operations; e.) railroad line construction; f.) bridge; gJ hazardous waste alterations to resource areas; h.) dredging; i.) package treatment plant and discharge j.) airport tree clearing; k.) oil and/or hazardous material release response actions. Category 5(Fee is$4 per linear foot;total fee not less than$100 or more than$2,000): a.) work on docks,piers,revetments,dikes,etc. (coastal or inland). Category 6(Fee is$2 per linear foot;but not to exceed$200 for activities associated with a single family house and not to exceed $2,000 for all other activities) a.) boundary delineations for Bordering Vegetated Wetlands. qj ..Request for Determination of Applicability a.) Local filing fee is $25.00 R� I 69, s2' _ry I I 00 -,IREA- 6382± 5,f, MACK0 I. I% 5-ro g t Me LL, 7 w r I g'i fo' VC REFERENCE: DEED: REC.BK. 'LZa�0 PG. Zq(o PLAN: TO: NE ROVES M09JcRGC- - THIS PLOT PLAN WAS NOT MADE FROM I CERTIFY THAT THE BUILDING(S)SHOWN HEREON AN INSTRUMENT SURVEYAND IS FOR ARE LOCATED ON THE GROUND AS SHOWN AND THAT THEY THE PURPOSES OF THE BANK ONLY. CONFORM TO THE HORIZONTAL DIMENSIONAL REGULATIONS UNDER NO CIRCUMSTANCES ARE OFFSETS OF THE ZONING BYLAWS OF THE CITy O( CALIFM TO BE USED FOR ESTABLISHMENT OF AT THE TIME OF CONSTRUCTION OR ARE PROTECTED UNDER FENCES, WALLS,HEDGES,ETC. GENERAL LAWS CHAPTER 40A SECTION 7. 1 ALSO CERTIFY THAT THE DWELLING SHOWN IS NOT - MORTGAGE INSPECTION PLAN LOCATED WITHIN A FLOOD HAZARD ZONE AS LOCATED AT DELINEATED ON THE MAP OF COMMUNITY i 2S 0101 ' ZN OF MAS SALEM S� 7 RIVERBANK ROAD ,MA,EFFECTIVE SALEM BY THE FEDERAL EMERGENCY MANAGEMENT AGENCY. F GAIL m PREPARED FOR SMITH y ALEX gRov40 & MOLLI BRDwrd No.35043 I p�-� Z �4� RFGiS ERS C SCALE I"= 20 AvsUST P. 2004 NORTH SHORE SURVEY CORP. D /}2EG.PROFESSIONAL LAND SURVEYOR SinN4 IIp 47 LINDEN STREET, - SALEM,MA 1112341 F . i I jI � I - -� - 1 f � t tj AL r i tl Y � irPllBAswsHt31_f f c , FAA 4 , l � t i ,i I ' s � - T