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Massachusetts Department of Environmental Protection Provided by MassDEP:
Bureau of Resource Protection - Wetlands 64-564
WPA Form 5 — Order of Conditions MassDEP File#
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 eDEP Transaction#
Salem
City/Town
A. General Information
Please note: Salem
this form has 1. From. Conservation Commission
been modified
with added 2. This issuance is for
space to a. ®Order of Conditions b. Amended Order of Conditions
accommodate (check one).
the Registry
of Deeds 3. To: Applicant:
Requirements
Robert King
a. First Name b.Last Name
Important:
When filling
out forms on c.Organization
the 81 Laconia Circle
computer, d. Mailing Address
use only the
tab key to North Andover MA 01845
move your e.City/Town f.State g.Zip Code
cursor-do
not use the 4. Property Owner(if different from applicant):
return key.
r� a. First Name b. Last Name
c.Organization
remm
d.Mailing Address
e.City/Town I.State g.Zip Code
5. Project Location:
86 Bay View Ave. Salem
a. Street Address b. City/Town
44 133
c.Assessors Map/Plat Number d. Parcel/Lot Number
d m s, d m s
Latitude and Longitude, if known:
d. Latitude e. Longitude
wpaform5.tloc• rev.OS/19I2010 Page 1 of 12
Massachusetts Department of Environmental Protection Provided by MassDEP:
Bureau of Resource Protection - Wetlands 64-564
WPA Form 5 — Order of Conditions MassDEP File#
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 eDEP-Transaction#
Salem
Citylrown
A. General Information (cont.)
6. Property recorded at the Registry of Deeds for(attach additional information if more than
one parcel):
South Essex
a. County b.Certificate Number(if registered land)
33016 101
c. Book d.Page
2/27/2014 3/13/2014 3/18/2014
7. Dates: a. Date Notice of Intent Filed b. Date Public Hearing Closed c. Date of Issuance
6. Final Approved Plans and Other Documents (attach additional plan or document references
as needed):
See attached
a. Plan Title
b. Prepared By c.Signed and Stamped by
d. Final Revision Date e.Scale
f.Additional Plan or Document Title g. Date
B. Findings
1. Findings pursuant to the Massachusetts Wetlands Protection Act:
Following the review of the above-referenced Notice of Intent and based on the information
provided in this application and presented at the public hearing, this Commission finds that
the areas in which work is proposed is significant to the following interests of the Wetlands
Protection Act(the Act). Check all that apply:
a. ❑ Public Water Supply b. ❑ Land Containing Shellfish c. ® Prevention of
Pollution
d. E] Private Water Supply e. ElFisheries f. Wi Protection of
Wildlife Habitat
g. ❑ Groundwater Supply h. ® Storm Damage Prevention i. ❑ Flood Control
2. This Commission hereby finds the project, as proposed, is: (check one of the following boxes)
Approved subject to:
a. ® the following conditions which are necessary in accordance with the performance
standards set forth in the wetlands regulations. This Commission orders that all work shall
be performed in accordance with the Notice of Intent referenced above, the following
General Conditions, and any other special conditions attached to this Order. To the extent
that the following conditions modify or differ from the plans, specifications, or other
proposals submitted with the Notice of Intent, these conditions shall control.
wpaform5.doc• rev.05119/2010 Page 2 of 12
1
Massachusetts.Department of Environmental Protection Provided by MassDEP:
Bureau of Resource Protection - Wetlands 64-564
WPA Form 5 - Order of Conditions MassDEP File#
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 eDEP Transaction#
Salem
City/Town
B. Findings (cont.)
Denied because:
b. ❑ the proposed work cannot be conditioned to meet the performance standards set forth
in the wetland regulations. Therefore, work on this project may not go forward unless and
until a new Notice of Intent is submitted which provides measures which are adequate to
protect the interests of the Act, and a final Order of Conditions is issued. A description of
the performance standards which the proposed work cannot meet is attached to this
Order.
c. ❑ the information submitted by the applicant is not sufficient to describe the site, the work,
or the effect of the work on the interests identified in the Wetlands Protection Act.
Therefore, work on this project may not go forward unless and until a revised Notice of
Intent is submitted which provides sufficient information and includes measures which are
adequate to protect the Act's interests, and a final Order of Conditions is issued. A
description of the specific information which is lacking and why it is necessary is
attached to this Order as per 310 CMR 10.05(6)(c).
3. ❑ Buffer Zone Impacts: Shortest distance between limit of project
disturbance and the wetland resource area specified in 310 CMR 10.02(1)(a) a. linear feet
Inland Resource Area Impacts: Check all that apply below. (For Approvals Only)
Resource Area Proposed Permitted Proposed Permitted
Alteration Alteration Replacement -Replacement
b. linear feet c. linear feet d. linear feet
4. El Bank a. linear feet
e. ❑ Bordering
Vegetated Wetland a.square feet b.square feet c.square feet d.square feet
6. ❑ Land Under
Waterbodies and a.square feet b.square feet c.square feet d.square feet
Waterways
e.c/y dredged f.Gy dredged
7. ❑ Bordering Land
Subject to Flooding a.square feet b.square feet c.square feet d.square feet
Cubic Feet Flood Storage e.cubic feet f.cubic feet g.cubic feet h.cubic feet
e. ❑ Isolated Land
Subject to Flooding a.square feet b.square feet
Cubic Feet Flood Storage c.cubic feet d.cubic feet e.cubic feet f.cubic feet
g. ❑ Riverfront Area
a.total sq.feet b.total sq.feet
Sq ft within 100 ft
c.square feet d.square feet e.square feet f.square feet
Sq ft between 100-
200 ft g,square feet h.square feet i.square feet I.square feet
vvpaform5.doc- rev.05/19M10 Page 3 of 12
I
Massachusetts Department of Environmental Protection Provided by MassDEP:
Bureau of Resource Protection - Wetlands 64-564
WPA Form 5 — Order of Conditions MassDEP File#
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 eDEP Transaction#
Salem
City/Town
B. Findings (cont.)
Coastal Resource Area Impacts: Check all that apply below. (For Approvals Only)
Proposed Permitted Proposed Permitted
Alteration Alteration Replacement Replacement
1o. ❑ Designated Port Indicate size under Land Under the Ocean, below
Areas
11. ❑ Land Under the
Ocean a.square feet b.square feet
c.Gy-dredged d.c/y dredged
1z. E] Barrier Beaches Indicate size under Coastal Beaches and/or Coastal Dunes
below
13. El Coastal Beaches cucu yd
a.square feet b.square feet c. nourishment d. nourishment
yd
a. El Coastal Dunes cu ecu
a.square feet b.square feet c.nourishmennt d. nourishment
15. ❑ Coastal Banks a. linearfeet b. linearfeet
15. ❑ Rocky Intertidal
Shores a.square feet b.square feet
17. ❑ Salt Marshes a.square feet b.square feet c.square feet J.square feet
16. ❑ Land Under Salt
Ponds a.square feet b.square feet
c.Gy dredged d.c/y dredged
19. ❑ Land Containing
Shellfish a.square feet b.square feet c.square feet d.square feet
zo. ❑ Fish Runs Indicate,size under Coastal Banks, Inland Bank, Land Under
the Ocean, and/or inland Land Under Waterbodies and
Waterways, above
a. c1y dredged b.Gy dredged
21. ® Land Subject to approx. 500 approx. 500
Coastal Storm a.square feet b.square feet
Flowage
wpaform5.doc. rev.05I19I2010 Page 4 of 12
Massachusetts Department of Environmental Protection Provided by MassDEP:
Bureau of Resource Protection -Wetlands 64-564
/ WPA Form 5 - Order of Conditions MassDEP File#
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 eDEP Transaction#
Salem
City/Town
B. Findings (cont.)
*#22. If the 22 ❑ Restoration/Enhancement*:
project is for
the purpose of
restoring or a.square feel of BVW b.square feet of salt marsh
enhancing a
wetland
resource area 23. ❑ Stream Crossing(s):
in addition to
the square
footage that a.number of new stream crossings b.number of replacement stream crossings
has been C. General Conditions Under Massachusetts Wetlands Protection Act
entered in
Section 6.5.c
(BVW)or The following conditions are only applicable to Approved projects.
3.1 Tc(Salt
Marsh)above, 1. Failure to comply with all conditions stated herein, and with all related statutes and other
please enter
the additional regulatory res, shall be deemed cause to revoke or modifythis Order.
g y measu
amount here. 2. The Order does not grant any property rights or any exclusive privileges; it does not
authorize any injury to private property or invasion of private rights.
3. This Order does not relieve the permittee or any other person of the necessity of complying
with all other applicable federal, state, or local statutes, ordinances, bylaws, or regulations.
4. The work authorized hereunder shall be completed within three years from the date of this
Order unless either of the following apply:
a. the work is a maintenance dredging project as provided for in the Act; or
b. the time for completion has been extended to a specified date more than three years,
but less than five years, from the date of issuance. If this Order is intended to be valid
for more than three years, the extension date and the special circumstances warranting
the extended time period are set forth as a special condition in this Order.
5. This Order may be extended by the issuing authority for one or more periods of up to three
years each upon application to the issuing authority at least 30 days prior to the expiration
date of the Order.
6. If this Order constitutes an Amended Order of Conditions, this Amended Order of
Conditions does not extend the issuance date of the original Final Order of Conditions and
the Order will expire on 3/18/2017 unless extended in writing by the Department.
7. Any fill used in connection with this project shall be clean fill. Any fill shall contain no trash,
refuse, rubbish, or debris, including but not limited to lumber, bricks, plaster, wire, lath,
paper, cardboard, pipe, tires, ashes, refrigerators, motor vehicles, or parts of any of the
foregoing.
8. This Order is not final until all administrative appeal periods from this Order have elapsed,
or if such an appeal has been taken, until all proceedings before the Department have been
completed.
"aforra5.doc• rev.05/1912010 Page 5 of 12 -
Massachusetts Department of Environmental Protection Provided by MassDEP:
Bureau of Resource Protection -Wetlands 64-564
WPA Form 5 - Order of Conditions MassDEP File#
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 eDEP Transaction#
Salem
City/-own
C. General Conditions Under Massachusetts Wetlands Protection Act (cont.)
9. No work shall be undertaken until the Order has become final and then has been recorded
in the Registry of Deeds or the Land Court for the district in which the land is located, within
the chain of title of the affected property. In the case of recorded land, the Final Order shall
also be noted in the Registry's Grantor Index under the name of the owner of the land upon
which the proposed work is to be done. In the case of the registered land, the Final Order
shall also be noted on the Land Court Certificate of Title of the owner of the land upon
which the proposed work is done. The recording information shall be submitted to the
Conservation Commission on the form at the end of this Order, which form must be
stamped by the Registry of Deeds, prior to the commencement of work.
10. A sign shall be displayed at the site not less then two square feet or more than three
square feet in size bearing the words,
"Massachusetts Department of Environmental Protection" for, "MassDEP"]
"File Number 64-564
11. Where the Department of Environmental Protection is requested to issue a Superseding
Order, the Conservation Commission shall be a party to all agency proceedings and
hearings before MassDEP.
12. Upon completion of the work described herein, the applicant shall submit a Request for
Certificate of Compliance (WPA Form 8A)to the Conservation Commission.
13. The work shall conform to the plans and special conditions referenced in this order.
14. Any change to the plans identified in Condition#13 above shall require the applicant to
inquire of the Conservation Commission in writing whether the change is significant enough
to require the filing of a hew Notice of Intent.
15. The Agent or members of the Conservation Commission and the Department of
Environmental Protection shall have the right to enter and inspect the area subject to this
Order at reasonable hours to evaluate compliance with the conditions stated in this Order,
and may require the submittal of any data deemed necessary by the Conservation
Commission or Department for that evaluation.
16. This Order of Conditions shall apply to any successor in interest or successor in control of
the property subject to this Order and to any contractor or other person performing work
conditioned by this Order.
17. Prior to the start of work, and if the project involves work adjacent to a Bordering Vegetated
Wetland, the boundary of the wetland in the vicinity of the proposed work area shall be
marked by wooden stakes or flagging. Once in place, the wetland boundary markers shall
be maintained until a Certificate of Compliance has been issued by the Conservation
Commission.
wpaform5.doc• rev.05/192010 Page 6 of 12
g0(J�ITgq:�
CITY OF SALEM
(C T
CONSERVATION COMMISSION
SITE VISIT FORM
PROJECT LOCATION: DATE OF SITE VISIT•
PROJECT PROPONENT: DEP FILE NUMBER:
PROPOSED WORK: I o� !C Co+dV bA k""r" .
v
IN ATTENDANCE:
Commission Members/Agent: Abutters:
Applicant/Property Owner/Representative:• jj� h SITE VISIT-VISIT lJ -1A,`I`
SITE VISIT DOCUMENTATION:
❑Photos ❑ Site Map ❑Other:
OBSERVATIONS:
Take into account relevant aspects or features such as: natural or piped drainage or obvious pollution;
topography; existing vegetation; possible alternative sites; signs of wildlife, possible vernal pools, r e species
habitat; landmarks; recent or historical disturbances; proximity to other water bodies or drain a areas;
adjacent la uses.
(IIIA >\
RECOMMENDATIONS:
it—
G-r- re-j"
Massachusetts Department of Environmental Protection Provided by MassDEP:
Bureau of Resource Protection - Wetlands 64-564
WPA Form 5 — Order of Conditions MassDEP File#
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 eDEP Transaction#
Salem
Cityfrown
C. General Conditions Under Massachusetts Wetlands Protection Act (cont.)
18. All sedimentation barriers shall be maintained in good repair until all disturbed areas have
been fully stabilized with vegetation or other means. At no time shall sediments be
deposited in a wetland or water body. During construction, the applicant or his/her designee
shall inspect the erosion controls on a daily basis and shall remove accumulated sediments
as needed. The applicant shall immediately control any erosion problems that occur at the
site and shall also immediately notify the Conservation Commission, which reserves the
right to require additional erosion and/or damage prevention controls it may deem
necessary. Sedimentation barriers shall serve as the limit of work unless another limit of
work line has been approved by this Order.
NOTICE OF STORMWATER CONTROL AND MAINTENANCE REQUIREMENTS
19. The work associated with this Order(the"Project') is (t) ❑ is not (2) ® subject to the
Massachusetts Stormwater Standards. If the work is subject to the Stormwater
Standards,then the project is subject to the following conditions:
a) All work, including site preparation, land disturbance, construction and redevelopment,
shall be implemented in accordance with the construction period pollution prevention and
erosion and sedimentation control plan and, if applicable, the Stormwater Pollution
Prevention Plan required by the National Pollution Discharge Elimination System
Construction General Permit as required by Stormwater Condition 8. Construction period
erosion, sedimentation and pollution control measures and best management practices
(BMPs) shall remain in place until the site is fully stabilized.
b) No stormwater runoff may be discharged to the post-construction stormwater BMPs
unless and until a Registered Professional Engineer provides a Certification that:
i. all construction period BMPs have been removed or will be removed by a date certain
specified in the Certification. For any construction period BMPs intended to be converted
to post construction operation for stormwater attenuation, recharge, and/or treatment, the
conversion is allowed by the MassDEP Stormwater Handbook BMP specifications and that
the BMP has been properly cleaned or prepared for post construction operation, including
removal of all construction period sediment trapped in inlet and outlet control structures,
ii. as-built final construction BMP plans are included, signed and stamped by a Registered
Professional Engineer, certifying the site is fully stabilized;
iii. any illicit discharges to the stormwater management system have been removed, as per
the requirements of Stormwater Standard 10;
iv. all post-construction stormwater BMPs are installed in accordance with the plans
(including all planting plans) approved by the issuing authority, and have been inspected to
ensure that they are not damaged and that they are in proper working condition;
v. any vegetation associated with post-construction BMPs is suitably established to
withstand erosion.
wpaformsdoc• rev.05/19/2010 Page 7 of 12
Massachusetts Department of Environmental Protection Provided by MassDEP:
Bureau of Resource Protection -Wetlands 64-564
WPA Form 5 - Order of Conditions MassDEP File#
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 eDEP Transaction#
Salem
City/Town
C. General Conditions Under Massachusetts Wetlands Protection Act (cont.)
c) The landowner is responsible for BMP maintenance until the issuing authority is notified
that another party has legally assumed responsibility for BMP maintenance. Prior to
requesting a Certificate of Compliance, or Partial Certificate of Compliance, the responsible
party (defined in General Condition 18(e)) shall execute and submit to the issuing authority
an Operation and Maintenance Compliance Statement("O&M Statement) for the
Stormwater BMPs identifying the party responsible for implementing the stormwater BMP
Operation and Maintenance Plan ("O&M Plan") and certifying the following: i.) the O&M
Plan is complete and will be implemented upon receipt of the Certificate of Compliance,
and if.) the future responsible parties shall be notified in writing of their ongoing legal
responsibility to operate and maintain the stormwater management BMPs and implement
the Stormwater Pollution Prevention Plan.
d) Post-construction pollution prevention and source control shall be implemented in
accordance with the long-term pollution prevention plan section of the approved
Stormwater Report and, if applicable, the Stormwater Pollution Prevention Plan required by
the National Pollution Discharge Elimination System Multi-Sector General Permit.
e) Unless and until another party accepts responsibility, the landowner, or owner of any
drainage easement, assumes responsibility for maintaining each BMP. To overcome this
presumption, the landowner of the property must submit to the issuing authority a legally
binding agreement of record, acceptable to the issuing authority, evidencing that another
entity has accepted responsibility for maintaining the BMP, and that the proposed
responsible party shall be treated as a permittee for purposes of implementing the
requirements of Conditions 18(f) through 18(k)with respect to that BMP. Any failure of the
proposed responsible party to implement the requirements of Conditions 18(f) through
18(k) with respect to that BMP shall be a violation of the Order of Conditions or Certificate
of Compliance. In the case of stormwater BMPs that are serving more than one lot, the
legally binding agreement shall also identify the lots that will be serviced by the stormwater
BMPs. A plan and easement deed that grants the responsible party access to perform the
required operation and maintenance must be submitted along with the legally binding
agreement
f) The responsible party shall operate and maintain all stormwater BMPs in accordance
with the design plans, the O&M Plan, and the requirements of the Massachusetts
Stormwater Handbook.
wpaform5.doc• rev.05119/2010 Page 8 of 12
Massachusetts Department of Environmental Protection Provided by MassDEP:
Bureau of Resource Protection - Wetlands 64-564
WPA Form 5 — Order of Conditions MassDEP File#
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 eDEP Transaction#
Salem
City/Town
C. General Conditions Under Massachusetts Wetlands Protection Act (cont.)
g) The responsible party shall:
1. Maintain an operation and maintenance log for the last three (3) consecutive
calendar years of inspections, repairs, maintenance and/or replacement of the
stormwater management system or any part thereof, and disposal (for disposal the
log shall indicate the type of material and the disposal location),
2. Make the maintenance log available to MassDEP and the Conservation
Commission ("Commission") upon request; and
3. Allow members and agents of the MassDEP and the Commission to enter and
inspect the site to evaluate and ensure that the responsible party is in compliance
with the requirements for each BMP established in the O&M Plan approved by the
issuing authority.
h) All sediment or other contaminants removed from stormwater BMPs shall be disposed
of in accordance with all applicable federal, state, and local laws and regulations.
i) Illicit discharges to the stormwater management system as defined in 310 CMR 10.04
are prohibited.
j) The stormwater management system approved in the Order of Conditions shall not be
changed without the prior written approval of the issuing authority.
k) Areas designated as qualifying pervious areas for the purpose of the Low Impact Site
Design Credit(as defined in the MassDEP Stormwater Handbook, Volume 3, Chapter 1,
Low Impact Development Site Design Credits) shall not be altered without the prior written
approval of the issuing authority.
1) Access for maintenance, repair, and/or replacement of BMPs shall not be withheld.
Any fencing constructed around stormwater BMPs shall include access gates and shall be
at least six inches above grade to allow for wildlife passage.
Special Conditions (if you need more space for additional conditions, please attach a text
document):
wpaform5.doc• rev.0 511 9/201 0 Page 9 of 12
Massachusetts Department of Environmental Protection Provided by MassDEP:
Bureau of Resource Protection -Wetlands 64-564
WPA Form 5 — Order of Conditions MassDEP File#
1 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 eDEP Transaction#
Salem
City/Town
D. Findings Under Municipal Wetlands Bylaw or Ordinance
1. Is a municipal wetlands bylaw or ordinance applicable? ® Yes ❑ No
2. The Salem hereby finds (check one that applies):
Conservation Commission
a. ❑ that the proposed work cannot be conditioned to meet the standards set forth in a
municipal ordinance or bylaw, specifically:
1. Municipal Ordinance or Bylaw 2.Citation
Therefore, work on this project may not go forward unless and until a revised Notice of
Intent is submitted which provides measures which are adequate to meet these
standards, and a final Order of Conditions is issued.
b. ® that the following additional conditions are necessary to comply with a municipal
ordinance or bylaw:
Wetlands Protection and Conservation Ordinance c. 50
1.Municipal Ordinance or Bylaw 2.Citation
3. The Commission orders that all work shall be performed in accordance with the following
conditions and with the Notice of Intent referenced above. To the extent that the following
conditions modify or differ from the plans, specifications, or other proposals submitted with
the Notice of Intent, the conditions shall control.
The special conditions relating to municipal ordinance or bylaw are as follows (if you need
more space for additional conditions, attach a text document):
Attached special conditions are issued under the Wetlands Protection Act and are sufficient
for compliance with the local ordinance
"aform5 doe- rev.05/192010 Page 10 of 12
Massachusetts Department of Environmental Protection Provided by MassDEP:
Bureau of Resource Protection - Wetlands -
564
MassDEP File#
El WPA Form 5 — Order of Conditions
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 eDEP Transaction#
Salem
City/Town
E. Signatures
Important:When This Order is valid for three years, unless otherwise specified as a special
filling out forms condition pursuant to General Conditions#4,from the date of issuance. 1. ate Issuance
on the computer, S
use only the tab Please indicate the number of members who will sign this form.
key to move your This Order must be signed by a majority of the Conservation Commission. 2. Number of Signers
cursor-do not
use the return The Order must be mailed by certified mail (return receipt requested) or hand deli red to
key. the applicant. A copy must be mailed, hand delivered or filed ele tro Ily t t ame time
r�
with the appropriate MassDEP Regional Office.
Signatur _
reran a
E] by hand delivery on (�by certified mail, return receipt
requested, on
��1���-% /!��
Date Dal
F. Appeals
The applicant, the owner, any person aggrieved by this Order, any owner of land abutting
the land subject to this Order, 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 MassDEP Regional
Office to issue a Superseding Order of Conditions. The request must be made by certified
mail or hand delivery to the Department, with the appropriate filing fee and a completed
Request of Departmental Action Fee Transmittal Form, as provided in 310 CMR 10.03(7)
within ten business days from the date of issuance of this Order. 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.
Any appellants seeking to appeal the Department's Superseding Order associated with this
appeal will be required to demonstrate prior participation in the review of this project. Previous
participation in the permit proceeding means the submission of written information to the
Conservation Commission prior to the close of the public hearing, requesting a
Superseding Order, or providing written information to the Department prior to issuance of
a Superseding Order.
The request shall state clearly and concisely the objections to the Order which is being
appealed and how the Order does not contribute to the protection of the interests identified
in the Massachusetts Wetlands Protection Act(M.G.L. c. 131, §40), and is inconsistent
with the wetlands regulations (310 CMR 10.00). To the extent that the Order is based on a
municipal ordinance or bylaw, and not on the Massachusetts Wetlands Protection Act or
regulations, the Department has no appellate jurisdiction.
wra5sigs.doc• rev.0 212 512 01 0 _ Pag.JF of f
' Attachment to Order of Conditions # 6564
It Page lof 5
SALEM CONSERVATION COMMISSION
DEP FILE #64-564
86 Bay View Avenue
City of Salem, Massachusetts
ADDITIONAL FINDINGS
Based on the Estimated Habitats of Rare Wildlife and Certified Vernal Pools Map (3/6/2014, online) from Natural
Heritage & Endangered Species Program (NHESP) of the Massachusetts Division of Fisheries and Wildlife, it has
been determined that this project does not occur near any habitat of state-listed rare wildlife species nor contains any
vernal pools.
This order permits the demolition and reconstruction of a residential structure and appurtenances at the location
listed above.
GENERAL CONDITIONS
1. This Order of Conditions must be recorded in its entirety(including all 5 pages of Special Conditions)
at the Essex County Registry of Deeds or the Land Court for the district in which the land is located,
after the expiration of the 10-day appeal period and within 30 days of the issuance. A copy of the
recording information must be submitted to the Salem Conservation Commission before any
work approved in this Order commences.
2. Approval of this application does not constitute compliance with any law or regulation other than
M.G.L Chapter 131, Section 40,Wetlands Regulations 310 CMR 10.00 and the City of Salem Wetlands
Protection Ordinance, Salem Code Chapter 50.
3. All work shall be performed in accordance with this Order of Conditions and approved site plan(s). No
alteration of wetland resource areas or associated buffer zones, other than that approved in this Order,
shall occur on this property without prior approval from the Commission.
4. Prior to any work commencing on site, a DEP Sign showing DEP File#64-564 must be installed at the
entrance to the site and seen from the public way, but not placed on a living tree.
5. No work approved in this Order may commence until the ten(10)business day appeal period has lapsed
from the date of the issuance of this Order.
6. With respect to this Order,the Commission designates the Conservation Agent as its agent with powers
to act on its behalf in administering and enforcing this Order.
7. The Commission or its Agent, officers,or employees shall have the right to enter and inspect the property at
any time for compliance with the conditions of this Order,the Wetlands Protection Act MGL Chapter 131,
Section 40,the Wetlands Regulations 310 CMR 10.00,and shall have the right to require any data or
documentation that it deems necessary for that evaluation.
8. The term "Applicant'as used in this Order of Conditions shall refer to the owner, any successor in
interest or successor in control of the property referenced in the Notice of intent, supporting documents
Attachment to Order of Conditions # 64-564
9 Page 2of 5
and this Order of Conditions. The Commission shall be notified in writing within 30 days of all
transfers of title of any portion of the property that takes place prior to issuance of the Certificate of
Compliance.
9. It is the responsibility of the applicant to procure all other applicable federal, state and local permits and
approvals associated with this project. These permits may include but are not necessarily limited to the
following:
(1) Section 404 of the Federal Water Pollution Control Act(P.L. 92-500, 86 stat. 816),U.S. Army
Corps of Engineers.
(2) Water Quality Certification in accordance with the Federal Water Pollution Control under authority
of sec. 27(5) of Chapter 21 of the Massachusetts General Laws as codified in 314 CMR 9.00.
(3) Sewer Extension Permit from the DEP Division of Water Pollution Control under G. L. Ch. 21A ss7
and 314 CMR 7.00. Any Board of Health permit for septic system design for any portion of the
septic system within 100 feet of wetlands shall be submitted to the Commission prior to
construction initiation.
(4) Design Requirements for Construction in Floodplains under the State Building Code(780 CMR
744.).
10. If there are conflicting conditions within this Order,the stricter condition(s) shall rule.
11. All work shall be performed so as to ensure that there will be no sedimentation into wetlands and
surface waters during construction or after completion of the project.
12. The Commission or its Agent shall have the discretion to modify the erosion/siltation control methods
and boundary during construction if necessary.
13. The Commission reserves the right to impose additional conditions on portions of this project or this site
to mitigate any actual or potential impacts resulting from the work herein permitted.
14. The work shall conform to the following attached plans and special conditions:
Final Approved Plans
Unlabeled plan submitted with Notice of Intent
(Title)
Undated
(Dated)
None
(Signed and Stamped by)
City of Salem Conservation Commission
(On file with)
15. Any proposed changes in the approved plan(s)or any deviation in construction from the approved
plan(s) shall require the applicant to file a Notice of Project Change with the Commission. The Notice
shall be accompanied by a written inquiry prior to their implementation in the field, as to whether the
change(s) is substantial enough to require filing a new Notice of Intent or a request to correct or amend
this Order of Conditions. A copy of such request shall at the same time be sent to the Department of
Environmental Protection.
Attachment to Order of Conditions # 64-564
A� Page 3of 5
»na,mr
16. In conjunction with the sale of this property or any portion thereof before a Certificate of Compliance has
been issued,the applicant or current landowner shall submit to the Commission a statement signed by the
buyer that he/she is aware of an outstanding Order of Conditions on the property and has received a copy of
the Order of Conditions.
17. [Reserved]
PRIOR TO CONSTRUCTION
18. Prior to the commencement of any activity on this site other than activities listed above,there
must be a Pre-Construction Meeting on site between the project supervisor,the contractor responsible
for the work, and the Conservation Agent and/or a member of the Conservation Commission to ensure
that the requirements of the Order of Conditions are understood. The staked erosion control line shall be
adjusted,if necessary, during the pre-construction meeting. Please contact the Conservation Agent at
(978) 619-5685 at least forty-eight (48) hours prior to construction to arrange for the Pre-
Construction Meeting.
119. Prior to the pre-construction meeting and commencement of any activity on this site, sedimentation and
erosion control barriers shall be installed as shown on the approval plants)and detail drawings. The
Commission and/or its Agent shall inspect and approve such installation at the pre-construction
meeting.
20. No clearing of vegetation, including trees, or disturbance of soil shall occur prior to the pre-construction
meeting. Minimal disturbance of shrubs and herbaceous plants shall be allowed prior to the pre-
construction meeting if absolutely necessary in order to place erosion control stakes where required.
21. There shall be adequate additional erosion control devices stored under cover on the site to be used for
emergency erosion control purposes.
EROSION CONTROL
22. Appropriate erosion control devices shall be in place prior to the beginning of any phase of construction,
and shall be maintained during construction in any wetland resource area and/or buffer zones. The
erosion control measures shown on the approval plants)and provisions in the Order will be the minimum
standards for this project; the Commission or its Agent may require additional measures.
23. All debris, fill and excavated material shall be stockpiled a location far enough away from the wetland
resource areas to prevent sediment from entering wetland resource areas.
24. Erosion and sedimentation control devices shall be inspected after each storm event and repaired or
replaced as necessary. Any accumulated silt adjacent to the barriers shall be removed.
25. The area of construction shall remain in a stable condition at the close of each construction day.
26. Any de-watering of trenches or other excavation required during construction shall be conducted so as
to prevent siltation of wetland resource areas. All discharge from de-watering activities shall be filtered
through hay bale sediment traps, silt filter bags or other means approved by the Commission or its
Administrator.
27. Within thirty(30) days of completion of construction on any given portion of the project, all disturbed
areas in the completed portion of the site shall be permanently stabilized with rapidly growing
vegetative cover, using sufficient top soil to assure long-term stabilization of disturbed areas.
�,y Attachment to Order of Conditions # 64-564
Page 4of 5
28. If soils are to be disturbed for longer than two(2)months, a temporary cover of rye or other grass
should be established to prevent erosion and sedimentation. If the season is not appropriate for plant
growth, exposed surface shall be stabilized by other appropriate erosion control measures, firmly
anchored,to prevent soils from being washed by rain or flooding.
DURING CONSTRUCTION
29. A copy of this Order of Conditions and the plan(s)approved in this Order shall be available on site at all
times when work is in progress.
30. No alteration or activity shall occur beyond the limit of work as defined by the siltation barriers shown on
the approved plan(s).
31. All waste products, grubbed stumps,slash;construction materials,etc.shall be deposited at least 100 feet
from wetland resource areas and 200 feet from river.
32. Cement trucks shall not be washed out in any wetland resource or buffer zone area,nor into any drainage
system. Any deposit of cement or concrete products into a buffer zone or wetland resource area shall be
immediately removed.
33. All exposed sub-soils shall be covered by a minimum of three(3)inches of quality screened loam topsoil
prior to seeding and final stabilization.
34. Immediately following drainage structure installation all inlets shall be protected by silt fence,haybale
barriers and/or silt bags to filter silt from stormwater before it enters the drainage system.
35. There shall be no pumping of water from wetland resource areas.
36. All equipment shall be inspected regularly for leaks. Any leaking hydraulic lines, cylinders or any other
components shall be fixed immediately.
37. During construction,all drainage structures shall be inspected regularly and cleaned as necessary.
38. The applicant is herby notified that failure to comply with all requirements herein may result in the issuance
of enforcement actions by the Conservation Commission including,but not limited to,civil administrative
penalties under M.G.L Chapter 21A, section 16.
AFTER CONSTRUCTION
39. Upon completion of construction and final soil stabilization, the applicant shall submit the following to
the Conservation Commission to request a Certificate of Compliance(COC):
(1) A Completed Request for a Certificate of Compliance form(WPA Form 8A or other form if
required by the Conservation Commission at the time of request).
(2) A letter from a Registered Professional Engineer certifying compliance of the property with this
Order of Conditions.
(3) An "As-Built' plan signed and stamped by a Registered Professional Engineer or Land Surveyor
showing post-construction conditions within all areas under the jurisdiction of the Massachusetts
Wetlands Protection Act. This plan shall include at a minimum:
(a) All wetland resource area boundaries with associated buffer zones and regulatory setback
areas taken from the plan(s)approved in this Order of Conditions;
Attachment to Order of Conditions # 64-564
Q �
Page 5of 5
(b) Locations and elevations of all stormwater management conveyances, structures and best
management designs, including foundation drains,constructed under this Order within any
wetland resource area or buffer zone;
(c) Distances from any structures constructed under this Order to wetland resource areas-
"structures" include,but are not limited to,all buildings,septic system components,wells,
utility lines,fences,retaining walls,and roads/driveways;
(d) A line delineating the limit of work-"work"includes any filling,excavating and/or
disturbance of soils or vegetation approved under this Order;
40. When issued,the Certificate of Compliance must be recorded at the Essex County Registry of Deeds
and a copy of the recording submitted to the Salem Conservation Commission.
41. If the completed work differs from that in the original plans and conditions,the report must specify how
the work differs; at which time the applicant shall first request a modification to the Order. Only upon
review and approval by the Commission, may the applicant request in writing a Certificate of
Compliance as described above.
42. Erosion control devices shall remain in place and properly functioning until all exposed soils have been
stabilized with final vegetative cover and the Conservation Commission and/or its Agent has authorized
their removal.
ADDITIONAL CONDITIONS
43. Rear patio surface shall be a pervious material and no larger than 120 square feet.
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COMMONWEALTH OF MASSACHUSETTS
ESSEX SS /►1C�� OS SgIIST.,SALEM,MASS
ATOFREGARp,/ 20�}
BOOK PAGE I
ATTEST:
REGISTER
I
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�P CITY OF SALEM
CONSERVATION COMMISSION
SITE VISIT FORM
PROJECT LOCATION: /DATE OF SITE VISIT �y
PROJECT PROPONENT: DEP FILE NUMBER: 4- s-c4r
PROPOSED WORK: �e _ ✓eco a�/ �/�
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Commission Members/Agent: Abutters:
Applicant/Property Owner/Representative: gj,
❑Photos ❑ Site Map ❑Other:
Take into account relevant aspects or features such as: natural or piped drainage or obvious pollution;
topography; existing vegetation; possible alternative sites; signs of wildlife, possible vernal pools, rare species
habitat; landmarks; recent or historical disturbances; proximity to other water bodies or drainage areas;
adjacent land uses.
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Massachusetts Department of Environmental Protection Provided by MassDEP F
�— Bureau of Resource Protection - Wetlands
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MassDEP File Number
WPA Form 3 — Notice of Intent
" r Document Transaction Number`
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 ._.
Cityrrown
Important:
Whenfilling out A. General Information
When
forms on the
computer,use 1. Project Location(Note: electronic filers will click on button to locate project site):
only the tab key �j7 (� A /
to move your Rv BYy iEw AVE SAL E A/1 O I q 70
cursor-do not a.Street Address K� b.CityrTown l c.Zip Code
use the return
key. Latitude and Longitude:
d.Latitude Y e.Longitude
f.Assessors MaplPlat Number g.Parcel/Lot Numbercz3n I
2. Applicant:
R08ERT Ki NG
a.First Name b.Last Name
Note:
Before c.Organization
completing this 1 J A/ jA11 /f Jar L E
form consult e !'/7_l.(/ ( � K
your local diet Address
Conservation AlORTHND�I/E N5
Commission e.Cityrrown L S ate g. ip Code _
regarding any
municipal bylaw
'S .J I�7 (;.
or ordinance. h. one Number i.Fax Number j.Email AddresY -
3. Property owner(required if different from applicant): ❑ Check if more than one owner
a.First Name b.Last Name
c.Organization !1
d.Street Address
e.Cityrrown f.State g.Zip Code
h.Phone N er i.Fax Number j.Email address
4. Representative (if any):
a.First Name b.Last Name
c.Company
d.Street Address
e.City/Town I.State g.Zip Code
h.Phone Number i.Fax Number j.Email address
5. Total WPA Fee Paid (from NCI Wetland Fee Transmittal Form). D
ADD 23�.�0
a.Total Fee Paid b.State Fee Paid c.City/Town Fee Paid
wpaform3.doc•rev.1/3/2013 Page 1 of 8
Massachusetts Department of Environmental Protection Provided by MassDEP.
Bureau of Resource Protection - Wetlands ) "" ' N
MassDEP File Number
WPA Form 3 — Notice of Intent �t} r=
'.�Dowm 'rt Transaction Number
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 - _
Cityrl own
A. General Information (continued)
6. General Project Description:
Re00A LE104 :Hie exjsfy, 537TdG1�v(L' 67-r ���e.V
`<t�i�il�
7a. Project Type Checklist:
1. -ingle Family Home 2. ❑ Residential Subdivision
3. ❑ Limited Project Driveway Crossing 4. ❑ Commercial/Industrial
5. ❑ Dock/Pier 6. ❑ Utilities
7. ❑ Coastal Engineering Structure 8. ❑ Agriculture(e.g., cranberries, forestry)
9. ❑ Transportation 10. ❑ Other
71b. Is any portion of the proposed activity eligible to be treated as a limited project subject to 310 CMR
10.24 (coastal)or 310 CMR 10.53(inland)?
1. El ✓
Yes D� No If yes, describe which limited project applies to this project:
2.Limited Project
8. Property recorded at the Registry of Deeds for:
a.County '� 506�/� b.certificate#(if registered land)
c.Book d.Page f�1umb�er1
B. Buffer Zone & Resource Area Impacts (temporary & permanent)
1. ❑ Buffer Zone Only—Check if the project is located only in the Buffer Zone of a Bordering
Vegetated Wetland, Inland Bank, or Coastal Resource Area.
2. ❑ Inland Resource Areas(see 310 CMR 10.54-10.58; if not applicable, go to Section B.3,
Coastal Resource Areas).
Check all that apply below. Attach narrative and any supporting documentation describing how the
project will meet all performance standards for each of the resource areas altered, including standards
requiring consideration of alternative project design or location.
Resource Area Size of Proposed Alteration Proposed Replacement(if any)
For all projects
affecting other
Resource Areas, a. ❑ Bank 1.linear feet 2.linear feet
please attach a b. ❑ Bordering Vegetated
narrative
explaining how Wetland 1.square feet 2.square feet
the resource
area was c. ❑ Land Under 1.square feet 2.square feet
delineated. Waterbodies and
Waterways 3.cubic yards dredged
wpaform3.doc•rev. 1/3/2013 Page 2 of 8
Massachusetts Department of Environmental Protection Provided by MassDEP� 1'
- Bureau of Resource Protection - Wetlands
j \ MassDEP File Number ,
! WPA Form 3 - Notice of Intent w , k =.
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Document Transaction Numberfi- -- - ---
Cityrrown
B. Buffer Zone & Resource Area Impacts (temporary & permanent) (contra)
Resource Area Size of Proposed Alteration Proposed Replacement(if any)
d. ❑ Bordering Land
Subject to Flooding 1.square feet 2.square feet -
3.cubic feet of flood storage lost 4.cubic feet replaced
e. ❑ Isolated Land
Subject to Flooding 1.square feet
2.cubic feet of flood storage lost 3.cubic feet replaced
f. ❑ Riverfront Area 1,Name of Waterway(if available)
2.Width of Riverfront Area (check one):
❑ 25 ft.-Designated Densely Developed Areas only
❑ 100 ft. - New agricultural projects only
❑ 200 ft. -All other projects
3.Total area of Riverfront Area on the site of the proposed project: square feet
4. Proposed alteration of the Riverfront Area:
a.total square feet b.square feet within 100 ft. c.square feet between 100 ft.and 200 ft.
5. Has an alternatives analysis been done and is it attached to this NOI? ❑ Yes❑ No
s.Was the lot where the activity is proposed created prior to August 1, 1996? ❑ Yes❑ No
3. ❑ Coastal Resource Areas: (See 310 CMR 10.25-10.35)
Check all that apply below. Attach narrative and supporting documentation describing how the project
will meet all performance standards for each of the resource areas altered, including standards
requiring consideration of alternative project design or location.
Online Users:
Include your Resource Area Size of Proposed Alteration Proposed Replacement(if any)
document
transaction a. ❑ Designated Port Areas Indicate size under Land Under the Ocean, below
number
(provided on your
receipt page) b. ❑ Land Under the Ocean
with all 1.square feet
supplementary
information you 2.cubic yards dredged
submit to the
Department. c. ❑ Barrier Beach Indicate size under Coastal Beaches and/or Coastal Dunes below
d. ❑ Coastal Beaches 1.square feet 2.cubic yards beach nourishment
e. ❑ Coastal Dunes 1.square feet 2.cubic yards dune nourishment
wpaform3.doc•rev. 1/3/2013 Page 3 of 8
Massachusetts Department of Environmental Protection Provided by MassDEP `4
Bureau of Resource Protection - Wetlands
f
MassDEP File Number �a
WPA Form 3 - Notice of Intent ''
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 ,_mDocument Transaction Number f,... ..
City/town
B. Buffer Zone & Resource Area Impacts (temporary& permanent) (cont'd)
Size of Proposed Alteration Proposed Replacement(if any)
f. ❑ Coastal Banks 1.linear feet
g. ❑ Rocky Intertidal
Shores 1.square feet
h.❑ Salt Marshes 1.square feet 2.sq ft restoration,rehab.,creation
i. ❑ Land Under Salt
Ponds 1.square feet
2.cubic yards dredged
j. ❑ Land Containing
Shellfish 1.square feet
k.❑ Fish Runs Indicate size under Coastal Banks, inland Bank, Land Under the
Ocean, and/or inland Land Under Waterbodies and Waterways,
above
1.cubic yards dredged
I.� Land Subject to I I SS 1 �OU I D1G1
_
Coastal Storm Flowage 1.square feet —C
4. ❑ Restoration/Enhancement
If the project is for the purpose of restoring or enhancing a wetland resource area in addition to the
square footage that has been entered in Section B.2.b or B.3.h above, please enter the additional
amount here.
a.square feet of BVW b.square feet of Salt Marsh
5. ❑ Project Involves Stream Crossings
a.number of new stream crossings b.number of replacement stream crossings
C. Other Applicable Standards and Requirements
Streamlined Massachusetts Endangered Species Act/Wetlands Protection Act Review
1. Is any portion of the proposed project located in Estimated Habitat of Rare Wildlife as indicated on
the most recent Estimated Habitat Map of State-Listed Rare Wetland Wildlife published by the Natural
Heritage and Endangered Species Program (NHESP)?To view habitat maps, see the Massachusetts
Natural Heritage Atlas or go to
htt ://www.mass, ov/dfwele/dfw/nhes /re ulator review/priority habitat/online viewer.htm.
a. ❑ Yes No If yes, include proof of mailing or hand delivery of NOI to:
Natural Heritage and Endangered Species Program
Division of Fisheries and Wildlife
100 Hartwell Street,Suite 230
b.Date of map West Boylston,MA 01583
wpaform3.doc•rev. 1/3/2013 Page 4 of 8
Massachusetts Department of Environmental Protection Provided by MassDE,P
(� Bureau of Resource Protection -Wetlands
MassDEP File Number Ig'TAL
WPA Form 3 - Notice of Intent ICY
"J Document Transaction Number
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 -
Ctyrfown
C. Other Applicable Standards and Requirements (cont'd)
If yes, the project is also subject to Massachusetts Endangered Species Act(MESA) review(321
CMR 10.18). To qualify for a streamlined, 30-day, MESANVetlands Protection Act review, please
complete Section CA.C, and include requested materials with this Notice of Intent(NOI); OR complete
Section CA.d, if applicable. If MESA supplemental information is not included with the NOI, by
completing Section 1 of this form, the NHESP will require a separate MESA riling which may take up
to 90 days to review(unless noted exceptions in Section 2 apply, see below).
1. c. Submit Supplemental Information for Endangered Species Review*
1. ❑ Percentage/acreage of property to be altered:
(a)within wetland Resource Area percentage/acreage
(b)outside Resource Area percentage/acreage
2. ❑ Assessor's Map or right-of-way plan of site
3. ❑ Project plans for entire project site, including wetland resource areas and areas outside of
wetlands jurisdiction, showing existing and proposed conditions, existing and proposed
tree/vegetation clearing line, and clearly demarcated limits of work**"
(a)❑ Project description(including description of impacts outside of wetland resource area&
bufferzone)
(b)❑ Photographs representative of the site
(c)❑ MESA fling fee(fee information available at:
http://www.mass.qov/dfwele/dfw/nhesi)/regulatory review/mesa/mesa fee schedule.htm).
Make check payable to"Commonwealth of Massachusetts- NHESP"and mail to
NHESP at above address
Projects altering 10 or more acres of land, also submit.,
(d)❑ Vegetation cover type map of site
(e)❑ Project plans showing Priority&Estimated Habitat boundaries
d. OR Check One of the Following
1.❑ Project is exempt from MESA review.
Attach applicant letter indicating which MESA exemption applies. (See 321 CMR 10.14,
http://www.mass.qov/dfwele/dfw/nhesp/regulatory review/mesa/mesa exemptions.htm;
the NOI must still be sent to NHESP if the project is within estimated habitat pursuant to
310 CMR 10.37 and 10.59.)
2.❑ Separate MESA review ongoing. a.NHESP Tracking# b.Date submitted to NHESP
Some projects not in Estimated Habitat may be located in Priority Habitat,and require NHESP review(see
http://www.mass.gov/dfwele/dfw/nhesp/nhesp.htm, regulatory review tab). Priority Habitat includes habitat for state-listed plants and
strictly upland species not protected by the Wetlands Protection Act.
- MESA projects may not be segmented(321 CMR 10.16).The applicant must disclose full development plans even if such plans are
not required as part of the Notice of Intent process.
wpaform3.doc•rev. 1/3/2013 Page 5 of 8
Massachusetts Department of Environmental Protection Provided by MassDEP:
4 tmiir
Bureau of Resource Protection - Wetlands 1
4 'pMassDEP File Number t
f� WPA Form 3 - Notice of Intent
n� r
M
` Document Transaction Number
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 -- - - - -
City/Town
C. Other Applicable Standards and Requirements (cont'd)
3.❑ Separate MESA review completed.
Include copy of NHESP"no Take"determination or valid Conservation& Management
Permit with approved plan.
2. For coastal projects only, is any portion of the proposed project located below the mean high water
line or in a fish run?
a. Not applicable—project is in inland resource area only
b.❑ Yes ❑ No If yes, include proof of mailing or hand delivery of NOI to either:
South Shore-Cohasset to Rhode North Shore-Hull to New Hampshire:
Island, and the Cape&Islands:
Division of Marine Fisheries- Division of Marine Fisheries-
Southeast Marine Fisheries Station North Shore Office
Attn: Environmental Reviewer Attn: Environmental Reviewer
1213 Purchase Street—3rd Floor 30 Emerson Avenue
New Bedford,MA 02740-6694 Gloucester, MA 01930
Also if yes,the project may require a Chapter 91 license. For coastal towns in the Northeast Region,
please contact MassDEP's Boston Office. For coastal towns in the Southeast Region, please contact
MassDEP's Southeast Regional Office.
3. Is any portion of the proposed project within an Area of Critical Environmental Concern (ACEC)?
Online users: a. E] Yes No If yes, provide name of ACEC (see instructions to WPA Form 3 or MassDEP
Include your Website for ACEC locations). Note: electronic filers click on Website.
document
transaction b.ACEC
number
(provided on your 4. Is any portion of the proposed project within an area designated as an Outstanding Resource Water
receipt page) (ORW)as desd ted in the Massachusetts Surface Water Quality Standards, 314 CMR 4.00?
with all
supplementary a. [-] Yes No
information you
submit to the 5. Is any portion of the site subject to a Wetlands Restriction Order under the Inland Wetlands
Department. Restriction Acct.(M.G.L. c. 131, §40A)or the Coastal Wetlands Restriction Act(M.G.L. c. 130, § 105)?
a. E] Yes Lam'No
6. Is this project subject to provisions of the MassDEP Stormwater Management Standards?
a. ❑ Yes.Attach a copy of the Stormwater Report as required by the Stormwater Management
Standards per 310 CMR 10.05(6)(k)-(q)and check if:
1.❑ Applying for Low Impact Development(LID) site design credits(as described in
Stormwater Management Handbook Vol. 2, Chapter 3)
2.❑ A portion of the site constitutes redevelopment
�
3.El Proprietary BMPs are included in the Stormwater Management System.
b<" No. Check why the project is exempt:
�5,.g I Single-family house
wpaform3.doc•rev. 1/3/2013 X11 Page 6 of 8
Massachusetts Department of Environmental Protection Provided byMassDEP-a q ^Tr°t
Bureau of Resource Protection - Wetlands
^ MassDEP File Number
WPA Form 3 - Notice of Intent = . i
t Document Transaction Number
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 _.
Cityrrown
C. Other Applicable Standards and Requirements (cont'd)
2.❑ Emergency road repair
3.❑ Small Residential Subdivision (less than or equal to 4 single-family houses or less than or
equal to 4 units in multi-family housing project)with no discharge to Critical Areas.
D. Additional Information
Applicants must include the following with this Notice of Intent(NOI). See instructions for details.
Online Users:Attach the document transaction number(provided on your receipt page)for any of the
following information you submit to the Department.
1. USGS or other map of the area(along with a narrative description, if necessary)containing
sufficient information for the Conservation Commission and the Department to locate the site.
(Electronic filers may omit this item.)
2. Plans identifying the location of proposed activities(including activities proposed to serve as a
Bordering Vegetated Wetland[BVW] replication area or other mitigating measure) relative to
the boundaries of each affected resource area.
3. ❑ Identify the method for BVW and other resource area boundary delineations (MassDEP BVW
Field Data Form(s), Determination of Applicability, Order of Resource Area Delineation, etc.),
andattach documentation of the methodology.
4. ❑ List the titles and dates for all plans and other materials submitted with this NOI.
praUgry
a.Plan Titld �—
b.Prepared By c.Signed and Stamped by
d.Final Revision Date e.Scale
f.Additional Plan or Document Title g.Date
5 rl5 1 &4nore than one property owner, please attach a list of these property owners not
listed on this form.
_a-EI.—,4tteeh proof of mailing for Natural Heritage and Endangered Species Program, if needed.
L h proof of mailing for Massachusetts Division of Marine Fisheries, if needed.
8.g Attach NOI Wetland Fee Transmittal Form
9_Q,O,A�vater Report, if needed.
wpaform3.doc•rev. 1/3/2013 Page 7 of 8
Massachusetts Department of Environmental Protection Provided byMassDEP:
Bureau of Resource Protection - Wetlands " s
� �t�MassDEP File Number
WPA Form 3 - Notice of Intent
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Document Transaction Number-�-
City/Town
E. Fees
1. ❑ Fee Exempt: No filing fee shall be assessed for projects of any city,town, county,or district of
the Commonwealth,federally recognized Indian tribe housing authority, municipal housing
authority, or the Massachusetts Bay Transportation Authority.
Applicants must submit the following information (in addition to pages 1 and 2 of the NOI Wetland Fee
Transmittal Form)to confirm fee payment: 2� /
�f,C7 �7 �
2.Municipal Check Number 3.Check /
SI,( Z>
4.State Che9k Number 5.Ch date
HoR/=fc�' �in/G
6.Payor name on check:First Name 7.Pay r name on check:Last Name
F. Signatures and Submittal Requirements
I hereby certify under the penalties of perjury that the foregoing Notice of Intent and accompanying plans,
documents, and supporting data are true and complete to the best of my knowledge. I understand that
the Conservation Commission will place notification of this Notice in a local newspaper at the expense of
the applicant in accordance with the wetlands regulations, 310 CMR 10.05(5)(a).
I further certify under penalties of perjury that all abutters were notified of this application, pursuant to the
requirements of M.G.L. c. 131, §40. Notice must be made by Certificate of Mailing or in writing by hand
delivery or certified mail (retur eceipt requested)to all abutters within 100 feet of the property line of the
project location.
.Z i
1.Signature of Applicant 2.Dat
3.Signature of Property Owner(if different) 4.Date
5.Signature of Representative(if any) 6.Date
For Conservation Commission:
Two copies of the completed Notice of Intent(Form 3), including supporting plans and documents,two
copies of the NOI Wetland Fee Transmittal Form, and the city/town fee payment, to the Conservation
Commission by certified mail or hand delivery.
For MassDEP:
One copy of the completed Notice of Intent(Form 3), including supporting plans and documents, one
copy of the NO1 Wetland Fee Transmittal Form, and a copy of the state fee payment to the MassDEP
Regional Office(see Instructions)by certified mail or hand delivery.
Other:
If the applicant has checked the"yes" box in any part of Section C, Item 3, above, refer to that section
and the Instructions for additional submittal requirements.
The original and copies must be sent simultaneously. Failure by the applicant to send copies in a
timely manner may result in dismissal of the Notice of Intent.
wpaform3.doc•rev. 1/3/2013 Page 8 of 8
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Address: DEP #:
Application Type: AfO0 Date Submitted: a7 ILI
Contact Name: 6" k( Phone: 47P 6 6q d S�
Proposed activity: �„�� �l•. {�,��
Application Complete
Correct Fee Received
�-Abutters List Requested 9-Received
'Legal Ad Sent A Legal Ad Confirmed Online
:'Added to Agenda [d,Agenda to Applicant
7&Agent Comments to Commission
ZZ Comments
Hearing Opened: ��Ycf Continued: mite Visit:
butters Notice Confirmed
ermit Sent to Applicant and DEP
'Confirmation of Delivery
Expiration date added to calendar
madded to database
G/Applicant Recorded OoC with Registry
Preconstruction Meeting:
❑ Certificate of Compliance Sent to Applicant and DEP
❑ Confirmation of Delivery
❑ Applicant Recorded CoC with Registry
Notes:
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New Property Search Property Record Card A H ELP
Property Viewer /
36 lfeet 83 N
Property ID 440133_O
i Address 86 BAY VIEW AVENUE
" 1 Land Use 104
Book and Page 28591.478
, 44_013 : Lot Size(Acres) 0.07
0 01 1 Assessed Value $478,200.00
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Salem City Hall 93 , o01970
Phone:978-745-9595
City Hall Hours of Operation: Monday,Tuesday&Wednesday 8AM-4PM Thursday 8AM-7PM Friday SAM-12PM
Site designed by AppGeo.
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MORTGAGE INSPECTION PLAN •13-09092
LOCATION: 84-86 BAYVIEW AVENUE BOSTON
CITY,STATE: SALEM,MA
APPLICANT: ROBERT&CHRISTINE KING SURVEY, INC.
CERTIFIED TO: MORTGAGE MASTER INC.
SCALE: SEE( * ) F.O.SOX 290220
PREPARED: NOV. 18,2013 CkMLESTOWN,MA 02128
T(317)242-1313:F(617)242.1613
WWW.BOSTONSURVEYINC.COM
ATLANTIC ,i'"�•
OCEAN %
(parcel 2) b
ATLANTIC
OCEAN
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11 '
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1
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2 STORY
#84-89
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LOT 6
12 (Parcel 1)
�c$ *LOCUS NOT
JJJ oTIP TO SCALE BAYVIEW AVENUE
T
*SCALE: 1"=20'
!!
90
�O
LOT 10 }J
X\vM
G 400 SF+%-
,garage
tips
FLOOD DETERMINATION REFERENCES
According ro Federal Emergency Management Agency maps,the
major improvements on"Property fall in as am designated as DEED/CERT: 28591478 p�1P OF yq
ZONE: X PLAN REF: PL#15 BK:I �A� cyG
COMMUNITY PANEL No.-70 6?C0917 F NOTE: ToshowanAccurate mate this plan most beprinted o GEORGE '(a
EFFECTIVE DATE: m iegelsiaedpaper(g.5•x 14^) ,�
7 —3 —/Z- COLLINS
The pamunent an==ere approximately located on the ground as shown. 7hoyeitharmnfnmxdxthosetbackmqui=rots No. 41764
of the local Boning ordinances in affmi at the time ofmastmcdon,orate exempt Item violadan enformmenl action under
M.O.L Tide Vll,Chalner40A,Section 7,and that am no enuoaahments ofrnejorimprovements either wayaeteMproperty e OFESS
How escapt as shown and noted hereon.
NOTE:This is not s boundaryor title imumoe survey. Thlepiao was pmpamd iu amordmco fo prmedurd and taehniwl
standards for Mortgage Loan Inspections as adopxd by the Massachusmq Board of Registration ofprormiunel engmaera and
Land Suiveyom,250 CMR 6.05,and use formy other purpose leprobibited. Thisplan isnot robe used formeordin& GC $e C. Collinse PLS
preparing deed descriptions,or mnsYrvmion