31 STATION ROAD - CONSERVATION COMMISSION _ � -
t
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands
WPA Form 2 — Determination of Applicability
. w
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 Timothy&Tara Boucher Same
return key. Name Name
y&`� 31 Station
Address Road
Mallin Mailing Address
Salem MA 01970
rw.n City/rown State Zip Code Citylrown State Zip Code
1. Title and Date of Final Plans and Other Documents:
Plot Plan, New Two Car Garage, Boucher Residence, 31 Station April 8, 2002
Road, Salem, MA, 01970 Final Date(or Revised Date if applicable)
Tdle
2. Date Request Filed:
May 28 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 25'x 25'two car garage and extension of a mud room area 5' 8" in front and 7' in
rear.
Project Location:
31 Station Road Salem
Street Address City/Town
Map 22 Parcel 0069
Assessors Map/Plat Number Parcel/Lot Number
WPA Form 2
Rev,02100 Page t of 5
i
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 2 — Determination of Applicability
ty W
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.02/00 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
W
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 owners 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).
Condition: 1. Staked haybales and silt fence shall be installed along the edge of the wetland prior
to the commencement of work. 2. The Conservation Commission shall be notified 48 hours prior
to the start of work.
❑ 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 Frnm2
Rev.02/00 Page 3 of 5
Massachusetts Department of Environmental Protection
I 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.)
❑ 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:
F�cempt AGivdy(sRe applicable statuatory/regulatory provisions) I,
❑ 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
-4, 20014,
Date Dat�
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 t ,property owner(if different from the
applicant).
Signatures:
Dale
WPA Forth 2
Rev.O]00 Pepe 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 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.
WPA Form 2
Rev.02!00 Page 5&5
(DomesticU.S. Postal Service
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cle at the post office for postmarking. If a postmark on the Certified Mail
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IMPORTANT:Save this receipt and present it when making an inquiry.
PS Form 3800,July 1999(Reverse) I I 102595-99-M-2087
U.S. Postal Service
CERTIFIED MAIL RECEIPT
` (Domestic Mail Only, No Insurance Coverage .ed)
Artir,le Sent T.:
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C3 Certified Fee
Postmark
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C3Total Postage&Fees $
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fTl Name(Please Print Clearly)(to be completed by mailer)
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C3 Ciry,State,ZIP+4 - ----------------
r
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.
■ 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 3811)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".
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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
i
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
yourcursor-
Property Owner(if different from applicant):
do not use theTimothy&Tara Boucher Same
return key. Name Name
31 Station Road
Maihn A
9 tldress Mailing Address
Salem MA 01970
city/rown State Zip Code Citylrown State Zip Code
1. Title and Date of Final Plans and Other Documents:
Plot Plan, New Two Car Garage, Boucher Residence, 31 Station April 8 2002
Road, Salem, MA, 01970 Final Date(or Revised Date If applicable)
Title
2. Date Request Filed:
May 28 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 25'x 25'two car garage and extension of a mud room area 5' 8" in front and 7' in
rear.
Project Location:
31 Station Road Salem
Street Address Citylrown
Map 22 Parcel 0069
Assessors Map/Plat Number Parcel/Lot Number
WPA Forth 2
Re,MOD 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
W ¢
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 (Le., Conservation Commission or the Department of
Environmental Protection).
❑ t 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.02/00 Page 2 of 5
i
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).
Condition: 1. Staked haybales and silt fence shall be installed along the edge of the wetland prior
to the commencement of work. 2. The Conservation Commission shall be notified 48 hours prior
to the start of work.
❑ 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 Form 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 ACrvay(sae 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 CRation li
C. Authorization
This Determination is issued to the applicant and delivered as follows:
❑ by hand delivery on by certified mail, return receipt requested on
Date
Date� nt 2a�'
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 t ,property owner(if different from the
applicant).
Signatures:
Dale
WPA Form 2
Rev.p2 W Papa 4 of 5
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
W
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.
NPA Form 2
Rev.02/00 Page 5 of 5
SENDER:� COMPLETE
■ Complete items 1,2,and 3.Also complete A. Received by(Please Print Clearly) B. Date of Delivery
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you. atumJUL 0 6
■ Attach this card to the back of the mailpiece, X D Agent
or on the front if space permits. 0 Addressee
D. Is delivery address different from item 17 0 Yes
1. Article Addressed to: If YES,enter delivery address below: 0 No
�CeT, OC' �hJ�M1MNwti4z�,�
5 3. Service Type
Of � 'Certified Mail 0 Express Mail
w 1 00 ❑ Registered 0 Return Receipt for Merchandise
0 Insured Mail 0 C.O.D.
4. Restricted Delivery?(Extra Fee) 0 Yes
2. Article Number /
.(transfer from service label) 'j/b'� 0006 C' x12 T—) fi
PS Form 3811, March 2001 Domestic Return Receipt 102595-01-M-1424
UNITED STATES POSTAL SERVICE First-Class Mail
Postage&Fees Paid
USPS
Permit No. G-10
r - -- _
'Sender: Please print your name, address, and ZIP+4 in this box
Salem Conservation Commission
120 Washingbri Street,3rd A
Salem,MA 01870
Ito 3, skr.� Ra
SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
■ Complete items 1,2,and 3.Also complete A. Received by(Please Print Clearly) B. Date of Delivery
item 4 if Restricted Delivery is desired. _O
■ Print your name and address on the reverse
so that we can return the card to you. 1 re
■ Attach this card to the back of the mailpiece, X ❑Agent
or on the front if space permits. ❑Addressee
D. Is delivery Addifferent from item 1? ❑Yes
1. Article Addressed to: y� If YES,ente elivery address below: ❑ No
\Mca � (C rc" tddwC�Q�
3. Service Type
Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) ❑ Yes
2. Article Number ' e'
(Transfer from service label) O 3 y(jd dv 5 2 5-�-.a
PS F6U381 1, [it 102595-01-M-1424
IGNITED 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
Saliln'Conservabon Commission
120 Washington Street,3rd A
Satem,MA 01970
ow s
ti Massachusetts Department of Environmental Protection j Q SL ttt
Bureau of Resource Protection -Wetlands citylrown
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 the tY,4),V � --TVOL �JU C hI/
computer, use
only the tab key Name 11 E-Mail Address(if applicable)
I1 -n
to move your 3t StQ� IvYt Rn('�J
cursor-do not Mailing Address
use the return 5 XY\ Q I Q 1 D
key. City(rown State Zip Code
q�k - 1 � 1 - It�195 9ik- N5 - 3 (4u $
Phone Number Fax Number(if applicable)
2. Representative (if any):
Firm
Contact Name E-Mail Address(if applicable)
Mailing Address
Cityrrown State Zip Code
Phone Number Fax Number(if applicable)
B. Determinations
• � orn mt5`-I��t
1. I request the CO n-.ky U n 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.
dc. 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).
WPA Forml Page 1 of d
Rev.02100
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
C. Project Description
1. a. Project Location (use maps and plans to identify the location of the area subject to this request):
31 5a l,,p,rn
Street Address Cityrrown
00 - O olG
Assessors Map/Plat Number Parcet/Lot Number
b. Area Description (use additional paper, if necessary):
'1 tv CL( P �f f ,� l✓ h ��1� r-1
(y�rraJn'1a e i5 ��
Lon �l1,C, r1 G � ( Pnr1, SIS� � X14 3 �p� gr1
dd C .n r{ t ('-� Gnr n 5!E'.? C1 C1 1 J a
c. Plan and/or Map Reference(s):
Title Date
2. a. Work Description (use additional paper and/or provide plan(s) of work, if necessary):
CAI
Qf -Qc 5 + inCli , In 1Ibfk wlrl 1 ✓ t
lard nktfl5s
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).
V.PA Fo 1 Page 2 of 4
Fev.02100
Massachusetts Department of Environmental Protection 0 �
City/rown
- Bureau of Resource Protection - Wetlands
W Pd4 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 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 A Form1
Rev.02100 Page 3 a(4
Massachusetts Department of Environmental Protection SQA
Bureau of Resource Protection - Wetlands�>. Citylrown
Y y WPA Form 1 - Request for Determination of Applicability
0 4r 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:
`I i rnc�� hU �l �Q(R
Name
Mailing Address
� l.ihn
CitylTown 1 A
mFk Ou
Slate Zip Code
Signatures:
I also understand that notification of this Request will be placed in a local newspaper at my expense
in accordance with Sect on 10 05(3)(b)(1 cf the Wetlands Protection Act regulations.
I
Signatur:71#1ant Date
Signature of Representative(if any) Date
V AForm
1 Page 4014
Rev.02100
i
Massachusetts Department of Environmental Protection j Q R rf,
Bureau of Resource Protection - Wetlands cityffown
WPA Form 1 - Request for Determination mtnation of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
A. General Information
Important:
When filling out 1. Applicant: a
forms the
computer, use Name
only the tab key II E-Mail Address(if applicable)
to move your _3i )101, Oft _R n a�d
cursor-do not Mailing Address A
use the return Q ZAn
key. Cityrrown StateZip Code
qlk - -14l - lUQ _5 91k - -745 - 3ijiU
rm Phone Number Fax Number(if applicable)
2. Representative (if any):
Firm
Contact Name E-Mail Address(if applicable)
Mailing Address
City/Town State Zip Code
Phone Number Fax Number(if applicable)
B. Determinations
1. 1 request the i Grn make the following determination(s). Check an that apply:
q CO Un�rp„ 9Y
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.
d 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 pian(s).
WPA Form 1 Page 1 of 4
Rev.02100
. . Massachusetts Department of Environmental Protection Q L L VV'\
- Bureau of Resource Protection - Wetlands Cityrrmn
WPA Form 1 - Request for Determination of Applicability
W= 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):
31 5a I, A-n
Street Address City/Town
as - oo�cq
Assessors Map/Plat Number ParceVLot Number
b. Area Description (use additional paper, 'rf necessary):
r •
1 h.a ac e A OV-r,-1 Q o i's tc�
0- 0n4n,c1-9d Q � (.•PA A, COn5tS� 5 ,2� 3�� rQdyr1
Qr\ t ( � Cn/ 5 R ! i n
c. Plan and/or Map Reference(s):
'Plod -P\OA ` N-RW a CAj Gfuno ,�
Title 0 Date
2. a. Work Description (use additional paper and/or provide plan(s) of work, if necessary):
01 C, J !� I aC� iUji C ('U
Q2_ ( GOP, e Lind \JAAAslon Or M (Id fcn ,r
Q.-( -Pa n < k, 1n 1r(b I 4.nH �l f4 , 1n
1 V a ,Ci.( d OJ_t' 0 5 S t°6) m
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).
\NPA F..1 Page 2 of 4
Rev.02100
Massachusetts Department of Environmental Protection 0.wyn '_
Bureau of Resource Protection - Wetlands cayrrown
WPA Form 1 - Request for Determination of Applicability
su 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 8/1196
❑ 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 Riverrront 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.)
WPA Forml
Rev,02/00 Page 3 of 4
f l _ 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 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:
tmbo hu d 7TiIq tc )u r e
Name
Mailing Address
Q l�l�rV\
City/Town `
O (Glu
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.
Signature of ant Date
Signature of Representative(if any) Date
V AFormt Page 4 of
Rev.02100
i
TIMOTHY-,-446U
CHER saass'n"'
PH.978 741 1695 : �2BOO
31 STATION ROAD
SALEMM.4 01970 - � ,
;.PAY ry
{
DO&l R3 B
St Joseph Credit Union `
si�nu e�s�o.w•w.,U :.e+i
6 t�• : 2i.`L3855L4�: 0770000760��•
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 the Timothy& Tara Boucher, 31 Station Road,
Salem, MA. The purpose of this hearing is to discuss the construction of an addition of a 2-car
garage to the existing single family home. The proposed garage will be approximately 625 square
feet in size and be located within the 100-foot buffer zone. This hearing will be held on
Thursday, June 13,2002 at 7:00 p.m. in Room 313, third floor at 120 Washington Street.
Kevin P. Cornacchio
Chairman
June 6, 2002
Please send bill to:
Timothy Boucher
31 Station Road
Salem, MA 01970
978-741-1695
April 9, 2002
We the undersigned hereby support Timothy J. and Tara C. Boucher for
the proposed residence addition of a garage to the residence at 31-33
Station Road.
Name:-fin-' c/ �, Address: o
b 32. `
f
May 16, 2002
Mr. Donald Cefalo
Senior Planner
One Salem Green
Salem, MA 01970
Dear Mr. Cefalo
As the owners of the residence located at 31-33 Station Road, we being Timothy
and Tara Boucher, are requesting to amend our permit for DEP file#X64-0292 in order to
construct an attached 2 car garage to said residence.
Since there was not an official plan of the wetland, we have bad the wetland re-
flagged by Basbanes and Associates. We have also had a plot plan prepared by Neponset
Valley Surveyors to show placement of the house and proposed garage in relationship to
the wetland.
As per the order of conditions with regard to the construction of our house, we
would continue to comply with these conditions by discharging all roof run off toward the
street and not into the yard or wetland area. We would also as before, protect the wetland
by placing hay bales and silt fence around it.
May 16, 2002
4&. Donald Cefalo
Senior Planner
One Salem Green
Salem, MA 01970
Dear Mr. Cefalo
As the owners of the residence located at 31-33 Station Road, we being Timothy
and Tara Boucher, are requesting to amend our permit for DEP file #X64-0292 in order to
construct an attached 2 car garage to said residence.
Since there was not an official plan of the wetland, we have had the wetland re-
flagged by Basbanes and Associates. We have also had a plot plan prepared by Neponset
Valley Surveyors to show placement of the house and proposed garage in relationship to
the wetland.
As per the order of conditions with regard to the construction of our house, we
would continue to comply with these conditions by discharging all roof run off toward the
street and not into the yard or wetland area. We would also as before, protect the wetland
by placing hay bales and silt fence around it.
May 16, 2002
. Mr. Donald Cefalo
Senior Planner
One Salem Green
Salem, MA 01970
Dear Mr. Cefalo
As the owners of the residence located at 31-33 Station Road, we being Timothy
and Tara Boucher, are requesting to amend our permit for DEP file #X64-0292 in order to
construct an attached 2 car garage to said residence.
Since there was not an official plan of the wetland, we have had the wetland re-
flagged by Basbanes and Associates. We have also had a plot plan prepared by Neponset
Valley Surveyors to show placement of the house and proposed garage in relationship to
the wetland.
As per the order of conditions with regard to the construction of our house, we
would continue to comply with these conditions by discharging all roof run off toward the
street and not into the yard or wetland area. We would also as before, protect the wetland
by placing hay bales and silt fence around it.
tot
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