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3A WINTER ISLAND ROAD - CONSERVATION COMMISSION (2) 3A Winter Island Road CITY OF SALEM CONSERVATION COMMISSION May 29, 2007 Mr. Peter Haywood Winter Island Yacht Yard 3A Winter Island Road Salem, Massachusetts 01970 Re: Determination of Applicability 3A Winter Island Road,Salem, Massachusetts Dear Mr. Haywood: Enclosed, please find the Determination of Applicability for the above referenced project. Following the 10-day appeal period (as of June 8, 2007), you may proceed with your project. This Determination is good for three years from the date of issuance, May 17, 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 D ues Conservation Agent/Staff Planner Enclosures CC: DEP Northeast Regional Office 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 Peter Haywood return key. Name Name 3A Winter Island Rd � Mailing Address Mailing Address Salem Mat 01970 City/rown State Zip Code City/Town State Zip Code 1. Title and Date (or Revised Date if applicable) of Final Plans and Other Documents: Title Date Title Date Title Date 2. Date Request Filed:: M N�� 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): Repair an exisiting rip rap slope located within a buffer zone to a coastal bank and land subject to coastal storm flowage. The repairs include pouring a concrete berm using slump cement 2 feet above mean high tide. The dimensions of the concrete berm are 32 feet long by 15 inches deep by 3 feet wide. All work will be done from the land side and all precautions will be taken to protect the waterway. Project Location: 3 A Winter Island Road Salem Street Address City/rown 44 0013 Assessors Map/Plat Number Parcel/Lot Number w0alorm2.doc•rev.3/1/05 Pa0e i of 5 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Determination (cont.) The following Determination(s) is/are applicable to the proposed site and/or project relative to the Wetlands Protection Act and regulations: Positive Determination Note: No work within the jurisdiction of the Wetlands Protection Act may proceed until a final Order of Conditions(issued following submittal of a Notice of Intent or Abbreviated Notice of Intent) or Order of Resource Area Delineation (issued following submittal of Simplified Review ANRAD) has been received from the issuing authority(i.e., Conservation Commission or the Department of Environmental Protection). ❑ 1. The area described on the referenced plan(s) is an area subject to protection under the Act. Removing, filling,dredging,or altering of the area requires the filing of a Notice of Intent. ❑ 2a.The boundary delineations of the following resource areas described on the referenced plan(s)are confirmed as accurate. Therefore, the resource area boundaries confirmed in this Determination are binding as to all decisions rendered pursuant to the Wetlands Protection Act and its regulations regarding such boundaries for as long as this Determination is valid. ❑ 2b.The boundaries of resource areas listed below are not confirmed by this Determination, regardless of whether such boundaries are contained on the plans attached to this Determination or to the Request for Determination. ❑ 3.The work described on referenced plan(s) and document(s) is within an area subject to protection under the Act and will remove, fill, dredge, or alter that area. Therefore, said work requires the filing of a Notice of Intent. ❑ 4. The work described on referenced plan(s) and document(s) is within the Buffer Zone and will alter an Area subject to protection under the Act. Therefore, said work requires the filing of a Notice of Intent or ANRAD Simplified Review (if work is limited to the Buffer Zone). ❑ 5. The area and/or work described on referenced plan(s) and document(s) is subject to review and approval by: Name of Municipality Pursuant to the following municipal wetland ordinance or bylaw: Name Ordinance or Bylaw Citation w atorm .dw•rev.3/1/05 Page 2 015 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Determination (cont.) ❑ 6. The following area and/or work, if any, is subject to a municipal ordinance or bylaw but not subject to the Massachusetts Wetlands Protection Act: ❑ 7. If a Notice of Intent is filed for the work in the Riverfront Area described on referenced plan(s) and document(s), which includes all or part of the work described in the Request,the applicant must consider the following alternatives. (Refer to the wetland regulations at 10.58(4)c. for more information about the scope of alternatives requirements): ❑ Alternatives limited to the lot on which the project is located. ❑ Alternatives limited to the lot on which the project is located, the subdivided lots, and any adjacent lots formerly or presently owned by the same owner. ❑ Alternatives limited to the original parcel on which the project is located, the subdivided parcels, any adjacent parcels, and any other land which can reasonably be obtained within the municipality. ❑ Alternatives extend to any sites which can reasonably be obtained within the appropriate region of the state. Negative Determination Note: No further action under the Wetlands Protection Act is required by the applicant. However, if the Department is requested to issue a Superseding Determination of Applicability, work may not proceed on this project unless the Department fails to act on such request within 35 days of the date the request is post-marked for certified mail or hand delivered to the Department. Work may then proceed at the owner's risk only upon notice to the Department and to the Conservation Commission. Requirements for requests for Superseding Determinations are listed at the end of this document. ❑ 1. The area described in the Request is not an area subject to protection under the Act or the Buffer Zone. 2. The work described in the Request is within an area subject to protection under the Act, but will not remove, fill, dredge, or alter that area. Therefore, said work does not require the filing of a Notice of Intent. ❑ 3. The work described in the Request is within the Buffer Zone, as defined in the regulations, but will not alter an Area subject to protection under the Act. Therefore, said work does not require the filing of a Notice of Intent, subject to the following conditions (if any). ❑ 4. The work described in the Request is not within an Area subject to protection under the Act (including the Buffer Zone). Therefore, said work does not require the filing of a Notice of Intent, unless and until said work alters an Area subject to protection under the Act. wpaform doc•rev.3/1105 Pape 3 of 5 Massachusetts 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.) ❑ 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 �k by certified mail, return receipt requested on HaA A = 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). Signature Date w atorm2.tloc•rev.3/1/05 Pape 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 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. v v,paloreV doc•rev.3/1/05 Page 5 015 e ire 1 ..ry �°e a r�i �� -� ��;g � �` �' a'. �r•.�--. NZ 41, 49 �,,.,�; �, .�x^f`r •'M1t tSR y� ard,,',,►g�en 1� 1Cyy��,�, � {{}}� *E • I' • •TIT, •1 ' 1 1 • I • I q F •, I . � �, �.m•:.,�,r>^'' I.� t �'"� " is t �, Y� +� {•aw,.x 4F'Y.�„u.,��',,(((jjj^^'yyyppp M aS' T � � ''j?i f W •g�� ` i f- ay au • •1 '1 • • 11. • • 111, a 1 ¢x ^v gy, o-�s .au• .r ♦ �' sr � er ja �� A m^ •� .m Y". 4 •¢J 11' ,.':.. �::#T.Jn.3.�1 �?..#.✓rtlD ... �a,Lv. r. ._`' w,:: SS�':4�:'. � .u ' 1 1 /" # �k. i •4 r _ a ..�It., X `�'Mt.:l .. i, .,,"yip F)1�"'" Mrd ;..• .� ask-L'. .a .�^ �✓ d >. \ ?,-u. laa+4 �1^'-- {.."�o./,n' -v� ;.y ��,+4_%�" xy-. �'„"��. Y`y"I�-yt- 3-iF dw * .r:a��k'�!-�� 'i✓'ka. �' �`�w ^,sic m+•.�'. s r r t UNITED STATES PaVI� �5S'TA"d91'! F31" ,7ft[?7 , ennil b^ .71C�^' I • Sender: Please print your name, address, and ZIP+4 in this box 1s Z W W Q> eM W o a� Salem Conservation Commission U Z o L 120 Washington Street,3rd FI II Salem,MA 01970 � w� cCLC) Icc V W� !! SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION . ■ Complete items 1,2,and 3.Also complete.,,:- A. Sig re item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X ' 0 Addressee so that we can return the card to you. B. Received by(Printed Name) C. DataofDelivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: D. Is delivery address different from Rem 17 11 Yes If YES,enter delivery address below: 0 No The Commonwealth of Massachusetts Department of Environmental Protection Northeast Regional Office - 205B Lowell Street 3. Service Type Wilmington,MA 01887 KCarrified Mail 0 Express Mail -- 0 Registered 0 Return Receipt for Merchandise ❑Insured Mail 0 C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 1 ( t t i v •' (Dansfer from service label) 0 it ii7.0051t3irll}t0{u'0r0001+7176i'69181I PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1 540' n UNITED STATES PWIqlW� -E,�X-FSS 3;ICI FAA.Y ,'..4.)37 PfA Ofnder: Pleasiprint your name, address, and ZIP+4 in this box LU CDP CD > LU CD Wo Conservation Commission �--- 120 Washington Street,3rd Fl WM F Z= Salem,MA 01970 M C) f SENDER: •• •N COMPLETE THIS SECTION ON DELIVERYI ■ Complete items 1,2,and 3.Also complete A. Si ature ,,/t, item 4 if Restricted Delivery is desired. ✓ Agent X ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Received by(Printed e) C. Dat of (very ■ Attach this card to the back of the mailpiece, U or on the front If space permits. '3A D. Is delivery address different from item 1 13s 1. Article Addressed to: If YES,enter delivery address below: ❑ No 3� Wtcr�E�Z .SSLAND Raj 1�,1 3. rS,eervice Type _5ko \ CMN (Allo KiDenMied Mall ❑Express Mail ❑Registered ❑ Return Receipt for Merchandise ❑Insured Mall ❑C.O.D. 4. Restricted.Delivery!Pdra Fee) ❑Yes 2. Article Number i(j j j i i :i 'i i -j . ::::- )E :° (transfer ZtarvIce label) 7 o'O 5' 311'0 �Ot ON 17 6 6 9 6 7 PS Form 3811,February 2004 Domestic Return Recelpt 102595-02-M-15,40 Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands Salem ` WPA Form 1- Request for Determination of Applicability CityRown Massachusetts Wetlands Protection Act M.G.L c. 131, §40 A. General Information Important When filling out 1. Applicant torms on the Winter Island Yacht Yard, Inc. dhaywood@wiyy.net use Name E-Mailess .net only the tab key to move your 3A Winter Island Rd cursor-do not Maims Address use the return Salem MA 01970 key. CWTown State Zip Code 978 748-3797 97R 740-1808 Phone Number Fax Number(if applicable) 2. Representative(if any): Firm Contact Name E-Mail Address Mailing Address tiny/i own State Zip Code Phone Number Fax Number(a 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 ordimince or bylaw of Name of Munirapality ❑ e. whether the following scope of alternatives is adequate for work in the Riverfront Area as depicted on referenced plan(s), wpa rnlxbc Pape 1&4 Massachusetts Department of Environmental Protection Salem ILI] Bureau of Resource Protection-Wetlands Corrown WPA Form 1- Request for Determination of Applicability Massachusetts Wetlands Protection Qct M.G.L. c. 131, §40 C. Project Description 1. a. Project Location(use maps and plans W identify the location of the area subject to this request): 3A Winter island Rd C$lern StreetA drress Cityrrown 44 0013 Assessors Map/Plat Number Parce"Number b. Area Description (use additional paper, if necessary): Existing rip rap and enlarged rock slope,above high tide subject to coastal flowage and wave action in a flood zone A. c. Plan and/or Map Reference(s): Tine Date Title Dale Title Date L.. .'.In 1 / \ f.gi�h ifnereecanil' 2. a. Work Description (use addirionar paper andior p ovi&-plan\ar C ........nml' Repair e)(sting, storm damaged,rip rap slope by pouring a concrete berm using low slump cement, 2 feet above mean high tide. The dimensions of the concrete berm are 32 feet Long X 15'Deep X 3 feet Wide All work will be done from land side and all precautions will be taken to protect the waterway. w fermi.ow Page 2 aro Massachusetts Department of Environmental Protection Bureau of Resource Protection-Wetlands _ - Salem 17 Gttyrrown WPA Form 1- Request for Determination of Applicability L � Massachusetts Wetlands Protection Act M.G.L. a. 13i, §4tt 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 PP eq p 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 aquacul ure project ❑ Public project where funds were appropriated prior to 8r7M ❑ 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. rot ion.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.) .wemm,.m� Pepe 30/9 Massachusetts Deaarhment of Environmental Protection Bureau of Resource Protection-Wetlands Salem VIty�V'1.11 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 Droperty 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: Winter Island Yacht Yard, Inc_ Name 3A Winter Island Rd Mailing Address Salem Cityrrovm MA 01970 State - 2p Cade Signatures: I also understand that notification of ths Request Will he Placed in a',..ce:nawspa;er my expense. -in accordari�e with Section 10.05(3)(b)(1)of the Wetlands Protection Act reguhafions. 05/08/07 Sgnature of Applicaint Date Signature of Representative('d any) Date w of r I.doe 'ave a M4 i r\ fi 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 Peter and Diane Haywood,3 A Winter Island Road,Salem,MA. The purpose of this hearing is to discuss repairs to an existing rip rap slope within Buffer Zone to a Coastal Bank,and Land Subject to Coastal Storm Flowage at 3 A Winter Island Road. This hearing will be held on Thursday,May 17,2007 at 6:00 pm in City Hall Annex, Room 313, 120 Washington Street. Kevin P. Cornacchio Conservation Commission Chairman Please run legal advertisement on: May 10, 2007 Please mail bill to: Diane and Peter Haywood 3A Winter Island Road Salem, Massachusetts 01970 (978) 745-3797 City of Salem Department of Planning & Community Development Check/Cash Receipt and Tracking Form Please complete form and make two copies. Date Received9 0 Amount Received s ao Form of Payment Check Cash CHECK PAYMENTS: write check number 1�()j Z CASH PAYMENTS: write client initials 0 sign Permit Appikation Fee Conservation commission Fee AA Payment received for 0 Plannkg Board Fee what service? Q Old Town Hag Rental Fee Q Other Name of staff person receiving payment Additional Notes .' r _ SALEM FIVE;` ": .4032 WINER . TISLAND YACHT YARD INC. SALEM,MA oTs7o �=x; DATE PETER..AND DIANE HAYWOOD . .A .�-' •r, '__�, " . ' :..3A WINTER ISLAND ROAD - _ �..° May8; 2007 SALEM;MASSACHUSETTS 01970`.. - =g (978)745.3797. - - - AMOUNT a $ $25 . 00" M Twenty-,Five and 00/100. Dollars,, ' <" 2 TO THE. . ". ORDER.' .. ,... - .may,. r+' OF: City of Salem - F 93 Washington Street . Salem,MA 01970 ' A� Memo: WPA Form. 1 AUrRORIZED TORE 1110 140 3 2111' 1: 2 11 70 5 581: 9000 306 211' Original Check and Form: DPCD Finance Copy 1: Olent Copy 3:Application File Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands Salem WPA Form 1- Request for Determination of Applicability cityrrown Massachusetts Wetlands Protection Act M.G_L G 131, §40 A. General Information Important When filling out 1. Applicant Corms on the Winter island Yacht Yard, Inc. dhaywoodgwlyy.nei computer, use only the tab key Name E-Mail Address to move your 3A Winter Island Rd cursor-do not Mailing Address use the return Salem RA 01 970 key. City/rown State Zip Code 978 7453797 978 740-1808 L Phone Number Fax Numberd f apptirable) 2. Representative(rt any): linin Firm Contact Name E-Mail Address Mailing Address chyrrown State Zip Code Phone Number Fax Number(il applicable) B. Determinations 1. I request the Salem make the following determination(s). Check any that apply: Conservation Comm'ss6on ❑ a. whether the area depicted on plan(s)and/or maps) 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.wnether the following scope of alternatives is adequate for work in the Riverfmnt Area as depicted on referenced plan(s). wpawmi.doc Page 1 at 4 t Massachusetts Department of Environmental Protection ' Bureau of Resource Protection -Wetlands Salem cltvrrowm 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): 3A Winter Island Rd Salem Street Address Cdy/rown 44 0013 Assessors Map/Plat Number ParoeUW Number b. Area Description (use additional paper, if necessary): Existing rip rap and enlarged rock slope,above high tide subject to coastal flowage and wave action in a flood zone A. 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): Repair existing, storm damaged, rip rap slope by pouring a concrete berm using low slump cement, 2 feet above mean high tide. The dimensions of the concrete berm are 32 feet Long X 15' Deep X 3 feet Wide All work will be done from land side and all precautions will be taken to protect the waterway. Peg.2 d 4 i 011assachusetls Departrnent of Environmental Protection Bureau of Resource Protection-WeBands Salem City/rown WPA Form 'I- Request for Determination of Applicability Massachusetts Wetlands Protection Act M.6.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 a8 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. ❑ Single family house on a lot recorded on or before 8/1/96 ❑ Single family house on a lot recorded after a ii96 ❑ Expansion of an existing stricture on a lot recorded after 8/1196 ❑ Project, other than a single family house or public project where the applicant owned the let before 8/7/96 ❑ New agriculture or aquaculture project ❑ Public project where funds were appropriated prior to 817/96 ❑ Project on a lot shown on an approved, definitive subdivision plan where there is a recorded deed restriction limiting total alteration of the Riverfront Area for the entire subdivision ❑ Residential subdivision; institutional, industrial, or commercial project ❑ Municipal project ❑ District, county, state,or federal government project I-1 Prnipot rp i iirpd in pvaluatp nff- iM alMmativpc in rn m Wh n nna munirinslity in nn . ...�........ti_.._,. ... ..._...wv_.. -............._............w... u..... ..u,. uwuw.runy n. — Environmental Impact Report under MEPA or in an aftemabves 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 Environmentat 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.) mmn.mx mama Massachusetts Department of Environmental Protection Bureau of Resource Protection-Wetlands Salem Cialem n WPA Form 1- Request for Determination of Applicability J�Aj Massachusetts Wets Pro on Act M.G.L G iii, 9-410 D. Signatures and Submittal Requirements I hereby i$iuly,unuer tu.cx:w .: o .,a . .o f.mmyn.i.n.yn R., mtuact Me-naf ewP inntinnoAnrrnl.i.cahility PWI U, . to.Y u. r 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 Itis Request(including all appropriate documentation) simultaneously with the submMal 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: Winter Island Yacht Yard,Inc. Name 3A Winter Island Rd Mailing Adnress Salem Cityfrown MA 01970 state Zip Code Signatures: I also understand that notification of this Request will be placed in a local newspaper at my expense -in accor4anpewith Section 10.05(3)(b)(1)of fheWetlands Protectidrt Ad regulations_ 05/08/07 Signature of Applicsint Date Signature of Representative(if any) Date pose a ma