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31 REVENNA AVENUE - CONSERVATION COMMISSION 3 1 (Z��w� ���- ��� t ��CONUIT,j J, CITY OF SALEM CONSERVATION COMMISSION May 11, 2012 Michael E. Pellitier 31 Ravenna Ave. Salem, MA 01970 Re: Determination of Applicability-31 Ravenna Ave. Dear Mr. Pellitier: Enclosed, please find the Determination of Applicability for the above referenced property. This permits the activity described in your Request for Determination of Applicability to commence after a ten day appeal period. This document is effective for three years from its date of issuance. If you have any further questions please feel free to contact me at 978-619-5685. Sincerely, l� Tom Devine Conservation Agent/Staff Planner Enclosure 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 Michael E. Pellitier return key. Name Name 31 Ravenna Ave. Mailing Address Mailing Address Salem MA 01970 CirylTown State Zip Code City/Town State Zip Code 1. Title and Date (or Revised Date if applicable) of Final Plans and Other Documents: Proposed Replacement Skimmer to Filter Line by Anne Pelletier 4/26/2012 Title Date Title Date Title Dale 2. Date Request Filed: 4/26/2012 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): Intallation of a new line for a pool skimmer with 6" by i' deep trench within approximately 30'from wetland resource area. Project Location: 31 Ravenna Ave. Salem Street Address City/Town - 4 10 Assessors Map/Plat Number Parcel/Lot Number wpaform2.doe•Determination of Applicability•rev.IW6/04 Page I of 5 Project Status Sheet Address: 3 ( DEP #: Application Type: Date Submitted: i Contact Name: k ll� � Phone: 7 `fly 6 O 6 Proposed activity: i�,� $-Application Complete Correct Fee Received Legal Ad Sent 'Legal Ad Confirmed .�LDnline i$Added to Agenda -(�--Agenda to Applicant Agent Comments to Commission Hearing Opened: S Continued: Site Visit: ea g Ope e ��la/(/� ❑ Abutters Notice Confirmed ❑ Order of Conditions ent to Applicant and D ❑ Confirmation of Delivery ❑ Expiration date added to calendar ❑ Added to data ase ❑ Applicant Recorded OoC with R istry Preconstruction eeting: ❑ Certificate of Co pli ce Sent to Applicant and DEP ❑ Confirmatio of Delivery ❑ Applicant Recorded CoC with Registry r Notes: SALEM CONSERVATION ry COMMISSION 978.619-5685 E Will hold a public hearing for a Request for Determination of Appli- cability under the Wetlands Protec- tion Act MGL c131§40 and Salm Wetlands Protection&Conservation Ordinance at the request of Michael E Pelletier,31 Ravenna Ave,Salem' MA. Purpose of hearing is to dis- cuss installation of a pool skimmer "line within buffer zone to a wetlands resource area at 31 Ravenna Ave. .Hearing will be 5/10/12 at 6 p.m. in City Hall Annex Rm 313, 120 Wash- ington St. SN-5/3/12 UNITED STATEk,,P 5Tk,§kPFEy First-Class Mail P ass Paid Irk -Po. Sender: Please print your name, address, and ZIP+4 in this box Salem Conservation Commission 120 Washington street,3rd Fl Salem,MA 01970 ko�/e vt vA c) r IRII III IM 111,11 I'll',I IIIIIIIIIA011111 MIMI i1th 11M 111 SENDER: DELIVERY ■ Complete items 1,2,and 3.Also complete A. ' nature item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse lYlr ❑Addressee ■ Attach this card to the back of the mailpiece, so that we can return the card to you. B.fleceivecl by(Printed Name) Date livery or on the front if space permits. C D. Is delivery address different from Rem 1? 17 Y 1. ArtidelIAdtlre l\dto: I1 � If YES,enter delivery address below: 0N �'GAJ P3- "`�f��✓ �i 3. Service Type ($Certified Mail ❑Express Mail ❑ Registered ❑Return Reoeipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (rransfer from service Iabeq �i Ps Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1 MO Massachusetts Department of Environmental Protection I 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,,-'-Intent. r ❑ 4. The work described on referee, `,qnd document(s) is within the Buffer Zone and will alter an Area subject to protection uritle .. ' q more, said work requires the filing of a Notice of Intent or ANRAD Simplified Review't,t. Witted to the Buffer Zone). r. El5. The area and/or work described on referenced "plan(s)ano._ ` "q1 its subject to review and approval by: \\__t Name of Municipality _ Pursuant to the following municipal wetland ordinance or bylaw: Name Ordinance or Bylaw Citation wpaform2.doc•Oeterrai nation of Applicability•rev.1 W&Gf Page 2 of 5 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Determination (cont.) ❑ 6. The following area and/or work, if any, is subject to a municipal ordinance or bylaw but not subject to the Massachusetts Wetlands Protection Act: ❑ 7. If a Notice of Intent is filed for the work in the Riverfront Area described on referenced plan(s) and document(s), which includes all or part of the work described in the Request, the applicant must consider the following alternatives. (Refer to the wetland regulations at 10.58(4)c. for more information about the scope of alternatives requirements): ❑ Alternatives limited to the lot on which the project is located. ❑ Alternatives limited to the lot on which the project is located, the subdivided lots, and any, adjacent lots formerly or presently owned by the same owner. ❑ Alternatives limited to the original parcel on which the project is located, the subdivided parcels, any adjacent parcels, and any other land which can reasonably be obtained within the municipality. ❑ Alternatives extend to any sites which can reasonably be obtained within the appropriate region of the state. Negative Determination Note: No further action under the Wetlands Protection Act is required by the applicant. However, if the Department is requested to issue a Superseding Determination of Applicability, work may not proceed on this project unless the Department fails to act on such request within 35 days of the date the request is post-marked for certified mail or hand delivered to the Department.Work may then proceed at the owner's risk only upon notice to the Department and to the Conservation Commission. Requirements for requests for Superseding Determinations are listed at the end of this document. ❑ 1. The area described in the Request is not an area subject to protection under the Act or the Buffer Zone. 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. wpaform2.doc•Determination of Applicabitily•rev.1 W&04 Page 3 of 5 LlMassachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Determination (cont.) ❑ 5. The area described in the Request is subject to protection under the Act. Since the work described therein meets the requirements for the following exemption, as specified in the Act and the regulations, no Notice of Intent is required: Exempt Activity(site applicable statuatory/regulatory provisions) 5T 6. The area and/or work described in the Request is not subject to review and approval by: Name of Municipality Pursuant to a municipalwetlandsdinsnce or byla11w. �2�'Lcv'UL� Prc1d�-C�41c ll' "I ( r k' e}/0„� C N - Name Ordinance or Bylaw Citation C. Authorization This Determination is issued to the applicant and delivered as follows: ❑ by hand delivery on E" by certified mail, return receipt requested on 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 Conservatp' p Commissiocopy must be sent to the appropriate DEP Regional Office(see htti)://www. ass. o /d /about/re ior5.find our.htm and the property owner ' ren the applicant). I s C Date wpaform2.doc•Determination of Applicability•rev.10/6/04 Page 4 of 5 . l 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 http://www.mass.oov/dei)/about/region.findvour.htm) to issue a Superseding Determination of Applicability.The request must be made by certified mail or hand delivery to the Department, with the appropriate filing fee and Fee Transmittal Form (see Request for Departmental Action Fee Transmittal Form) as provided in 310 CMR 10.03(7) within ten business days from the date of issuance of this Determination. A copy of the request shall at the same time be sent by certified mail or hand delivery to the Conservation Commission and to the applicant if he/she is not the appellant. The request shall state clearly and concisely the objections to the Determination which is being appealed. To the extent that the Determination is based on a municipal ordinance or bylaw and not on the Massachusetts Wetlands Protection Act or regulations, the Department of Environmental Protection has no appellate jurisdiction. wpaform2.doe•Determination of Applicability•rev.10/6/04 Page 5 of 5 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands Request for Departmental Action Fee Transmittal Form Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 A. Request Information Important: When filling out 1. Person or party making request(if appropriate, name the citizen group's representative): forms on the computer, use Name only the tab key to move your cursor- Mailing Address do not use the reettuur,`en kkeey��. CityfTown State Zip Code �V Phone Number Fax Number(if applicable) Project Location Mailing Address Cityrrown State Zip Code 2. Applicant(as shown on Notice of Intent(Form 3), Abbreviated Notice of Resource Area Delineation (Form 4A); or Request for Determination of Applicability(Form 1)): Name Mailing Address Cityfrown State Zip Code Phone Number Fax Number(if applicable) 3. DEP File Number: B. Instructions 1. When the Departmental action request is for(check one): ❑ Superseding Order of Conditions ($100 for individual single family homes with associated structures; $200 for all other projects) ❑ Superseding Determination of Applicability($100) ❑ Superseding Order of Resource Area Delineation ($100) Send this form and check or money order for the appropriate amount, payable to the Commonwealth of Massachusetts to: Department of Environmental Protection Box 4062 Boston, MA 02211 wpafurm2.doc•Request for Departmental Action Fee Transmittal Form•rev.10/&04 Page 1 of 2 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands Request for Departmental Action Fee Transmittal Form Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 :L1 B. Instructions (cont.) 2. On a separate sheet attached to this form, state clearly and concisely the objections to the Determination or Order which is being appealed. To the extent that the Determination or Order is based on a municipal bylaw, and not on the Massachusetts Wetlands Protection Act or regulations, the Department has no appellate jurisdiction. 3. Send a copy of this form and a copy of the check or money order with the Request for a Superseding Determination or Order by certified mail or hand delivery to the appropriate DEP Regional Office (see http://www.mass.gov/der)/abouVregion/findvour.htm). 4. A copy of the request shall at the same time be sent by certified mail or hand delivery to the Conservation Commission and to the applicant, if he/she is not the appellant. wpaform2.doc•Request lot Departmental Anion Fee Transmittal Form•rev.10/&04 Page 2 of 2 � VED Massachusetts Department of Environmental Protec - S� Bureadof Resource Protection - Wetlands ppR 2 6 2012 Cityrrown L71] WPA Form 1 - Request for Determination of o� licability Massachusetts Wetlands Protection Act M.G.L. c. 13� MUNrry DEVELOPMENT 'A. General Information Important: 1. Applicant':` _ When filling out !` G forms on the / nGnA G n computer, use Name E- it Address only the tab key 31 4�VF� y d I+y� to move your M cursor-do not /ling Address ^A a Q! n D use the returnrl 7 key. City/Town 7/7`�,7/ State Zip Code 9,17F— " D Fax Number(if applicable) ro Phone Number 2. Representative (if any): Firm Contact Name E-Mail Address Mailing Address City/Town State Zip Code t , Phone Number Fax Number(if applicable) B. Determinations /�/l 1. I request the S%L G /" make the following determination(s). Check any that apply: Conservation Commission 91a. 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. � . . _ cwhether the work depicted on plan(s) referenced below is subject to the Wetlands Protection Act. [l�/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 i ' ❑ e.whether the following scope of alternatives is adequate for work in the Riverfront Area as depicted on referenced plan(s). .. Page 1 of 4 wpafamt doc Massachusetts Department of Environmental ProtectiU�" Bureau of Resource Protection - Wetlands ri� LE.` iwn +t WPA Form 1- Request for Determination of Ap"C84 V, Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 _._ DL-FT. OF PLR,VNINO C. Project Description 1Y DcVELOPAgENT 1. a. Project Location (use maps and plans to identify the location of the area subject to this request): 3 / RA✓EA1 NAr ffl/E SyQ . Street Address City/Town AA-P IV _LD T /O Assessors Map/Plat Number Parcel/Lot Number b. Area Description (use additional paper, if necessary): 1 M�' Ppb �0 5CD T2EA/<-- H j _'5 R FFCT P(LoM TWE- 6'4-'� GE of 7-HC /.t)4�TL_1 /U> P.ESoo /: C '� Ae" c. Plan and/or Map Reference(s): �2f'o R�P/Ac�MFAl► sK�rv1M1✓2 Tb �f a(o n/� Title p LT 2 C/N BY AN A) E -PoL L_6-F(,6(_ oat Title Date ®F N s,4 E £ _6/ 91 Title(AtCAEL E AMD /l/ G M fc'G`r'T/E2 oat 2. a. Work Description (use additional paper and/or provide plan(s)of work, if necessary):7-141,6 C-0 m 2FAU r ­59 IM ME('- LIN C W H / e Fl- fs A55y rn G D To RON r) "Fg= TH,6 CDA1G2ETC_ j)EC� HAS A 4EA1� Ifo LA F !S Poo LS MA Wil-t-- Re V I kE rd UN A N nee) 'r/-i 6:1_64 & AV / Fr TKEAt Cfl 045 DW G J aCyr Td THE C MG ►T-, Pt Alb R� KIA! n IN SH - >1g FiZoM TNF SK /MME2 To Tf4e �r iE2�— �} DrSTAMGE t�F ALO-r /hD�'� THAN N /On CET TH15 COO OS CT [J !L[ T r /Y1= .pL_E1 b�p /ry OAl£ -DAY , 7RE GP_OUA./D COV�5)11 W f L1- [36 2CfKbV ]p f SET f}Sf -PE/ i4cp f�e- wpafonntd= TV t_A E�D 7-0 /7-1< 1,O C A I /O 1L1 bN T HyJT ''relt 1Page o 4 t>{^}Y/ Massachusetts Department of Environmental Protection �4� ' � - Bureau of Resource Protection - Wetlands APR Town WPA`Forffli 1- Request for Determination of AIWOcaOF b ,� G ICC ( t OUMU Jl7 Y p fJl Massachusetts Wetlands Protection Act M.G.L. c. 131, §40c 04NG It 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 ❑ Single family house on a lot recorded on or before 8/1/96 r ❑ 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.) Page 3 of 4 wpafonl.doc REQ " IVSD Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands APR 26 2012 SALE( { WPA Form 1- Request for Determination,�WA1.0 ioabiut, Cit'y[rown Massachusetts Wetlands Protection Act M.G.L. c. 131, /n 0,-VELOPMENT D. Signatures and Submittal Requirements I hereby certify under the penalties of perjury that the foregoing Request for Determination of Applicability and accompanying plans, documents, and supporting data are true and complete to the best of my knowledge. I further certify that the property owner, if different from the applicant, and the appropriate DEP Regional Office were sent a complete copy of this Request(including all appropriate documentation) simultaneously with the submittal of this Request to the Conservation Commission. Failure by the applicant to send copies in a timely manner may result in dismissal of the Request for Determination of Applicability. Name and address of the property owner: I C4i F_ ` -{FLICT/C-Z fvame =31 2A V6A) NA &e �54M City/Town AAtate Di97d Lip Code Signa. -/{— I also undo 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 Wetl nds Protection Act re ulations. l r l C��Gt Q� �Lo Lam—/ Lf a(D Signature of Applicant Date Signature of Representative(if any) - Date wpafo mI.doc Page 4 of 4 RECD IVEJ'P—OFO.-S .p (ZE PL C?F/ iii i APR 2-6:',201 t To T0 CUhiTY`D TYLp � t�.4 VELOPAAEIdT \ S . E[ N4Y S 3! let Val A hot 04 fit. OfoSE� F t I aY 1T4 � �r1T f h i 7,4 yfown,KS ul :t 1 f i d}_ l t 1 \ ��.'.y, T .'� f / Z• `" •FwS �}'`��- '4 ��s {•511 '.. 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"AlS ¢ r ✓ c If kly /u P hV GROVNp x ` Pa FaNov < ✓, .{ t 1VQZ fi3 F1:4 y�$i'�y x* ,� � t y}x �e 3Ew ._..t ¢ ':i � ry Z{ s ,�,a r rt _ th pa - f r f J �O� M 4 F 4I.tl° o d d T ; A J ry as r� 3 ea„ 2 _'V V le s .1 r,F,t�y tk'P x �' , e 1 rm OOtJRLt 1i 3v!li i�rr`" +.]�jJSc c� .z< ,Mj v, 'i a' DE�r ,'�Y • ;J 5 ; [ *� V \ a 31 n'n t tI u ! t tr ti { Y �y § #•, T j;0 An ayy ( iii rf T.Y MAYin } .`` 4 . a i f f'A' '°5 asb T §" r.' •�M `T9y�d `F 7 R A � r Ak •q1 Y act;.a 4 t+ fiy,. i� ' . r t �,$ i�v�N �x,'!ls 4:, ry„�k .�,, �a f�a�.4 xF�.• � �.�� %+a�3o���v� '�" �� � ��. i ��j ; �'���Y'_�3 "9E' ��s }"M1n r��'�• `.�R' �`r�"#v�i3°,U�t� � °.�s ':Y � p s � ?tom NdF y� 4 Al FrECO'r-OVER APR 26 2012 C. he Salem News r-PT.OF PLAN.NINC,& COL4MUNiTV f�c`JELOPFAENT REQUEST FOR LEGAL NOTICE I understand that by signing this form I am agreeing to the cost of the legal notice to be published in the newspaper. Payment is required at the time of the legal notice being received by the city and before it is published in the newspaper. Please make checks payable to the SALEM NEWS and mail immediately to SALEM NEWS Attention Gloria Pobiedzinski 32 DUNHAM ROAD BEVERLY,MA 01915 **Average legal notice costs are estimated "Customer will either be refunded or billed when the legal notice is published Salem News=$250.00 per day Check# Credit Card please call Gloria @ the Salem News 978-338-2512 e -� ///1-.5/20/a If payment is not received the Legal Notice will be cancelled /�1 � c `� , %�! lei✓ �/lwr !1 Signed Applicant/Authorized Agent Date Print Name/R<C tlfgCL E Address -3l_ F4V'EyA64 AVb7 s44 eF t M /F 0197D Phone QJ 7 g — 7q `/ —( (o 32 DUNHAM ROAD ADVERTISING FAX 978-922-4330 BEVERLY, MA 0191 s-1998 NEWSROOM FA%978-927.4$24 TELEPHONE 978-922-1234 E-MAIL ECNNEWS.COM CITY OF SALEM Salem Conservation Commission 978-619-5685 Will hold a public hearing for a Request for Determination of Applicability under the Wetlands Protection Act MGL c131§40 and Salem Wetlands Protection & Conservation Ordinance at the request of Michael E. Pelletier, 31 Ravenna Ave, Salem MA. Purpose of hearing is to discuss installation of a pool skimmer line within buffer zone to a wetlands resource area at 3 Ravenna Ave. Hearing will be 5/10/12 at 6pm in City Hall Annex Rm 313, 120 Washington St. Please print legal ad on: May 3,•2012 Please remit bill to: Michael E. Pelletier 31 Ravenna Ave. Salem, MA 01970 978-144-6906 THE FOLLOWING IS/ARE THE BEST i IMAGES FROM POOR QUALITY ORIGINALS) IM ^� � DATA I — City of Salem Department of Planning & Community Development Check/Cash Receipt and Tracking Form Please complete form and make two copies. Date Received �— Amount Received Form of Payment Check �] Cash Client Information CASH PAYMENTS: client initials Sign Permit Application Fee [Conservation Commission Fee / Payment received for what Planning Board Fee ZBA service? ❑ SRA/DRB Fee Copies Other: Name of staff person receiving payment N— . Additional Notes II 5W12�z„3 5032 t i MICHAEL E. PELLETIER 1 ANNE M. PELLETIER k 31 RAVENNA AVE. PH. 970-744-6906 20/1 SALEM, MA j y �.0/j1.970GC �'1� T Y To l, The Order h te �HCr1U5...8 o.ro.ra NORTH SHORE BANK Ii NNJW NORTHSNno M it For - It y 1: 21137129131: 8006 >,070721" _5032 vJ I I Original Check and Form. DPCD Finance Copy 1: Client Copy 2: Application File IID PL�� r00 r \ . V ,NCfA1-r A. �' Ngtvcy T swrNrucy e2 � 3 \ 112 (aei\ P¢o Post.0 �t _ S7omi wgtc �yf, h m O Q _ DH (FDl (SE1) N v O/ a 7'0 BE REMOVED T ? oG x SHED �OPOseL w l / / at" op 0 0 0 40T 375 H= 19,544=S.ruj oFr9, IN GROVND w / tT\ e PROPOSED T£RRRCiA7C- �... I bwo o (VAtz r `J �J MPH 6 � VaGiAji.Ft vi-To Rs� LiAtt Y - D£�K t A 31 w csct. / p ��Pty G.fdAgsgc GAILL. 9G�m 1 Q FF SMITH , No.35043 l 9oFFSS QNAS LAN)O L5t'I)` �V ELEVATIONS BASED ON SEWER INVERTS CHANGED TO MEAN SEA LEVEL DATUM. PLAN OF LAND IN SALEM PROPERTY OF fir- ^ MICHAEL E - & ANNE M . PEL L ETI ER RECEIVED SCALE 1 '= 20 ' MAY 6, 1991 APR 2 6 2012 NMTH stOW SMS' C". DEFT. OFP JJ 1 INCH =20FEETtAANIIr,lG6 20 0 20 40 209 WASHIN6TON STREET - SALEM, MA. COUAAWTY,DEVELOPMENT -=-J_J-L�� #662