10 BLANEY STREET - ZONING (2) Enter your transmittal number X224359
Transmittal Number
� Your unique Transmittal Number can be accessed online: htto:Hmass.gov/dep/Service/online/trasmfrm.shtml or call
MassDEP's Infol-ine at 617-338-2255 or 800-462-0444 (from 508, 781, and 978 area codes).
Massachusetts Department of Environmental Protection
Transmittal Form for Permit Application and Payment
1. Please type or A. Permit Information
print.A separate
Transmittal Form BRP W W01 General Water Dependent License
must be completed 1,Permit Code:7 or 8 character code from permit instructions
for each permit 2.Name of Permit Category
The City of-Salem-is-proposing-to construct a multi use water trans ortationfacilit In the Salem
application. --s.. P Y - -
Hartior Desighate`d PortArea! _._
2. Make your
check payable to B. Applicant Information - Firm or Individual
the Commonwealth
of Massachusetts City of Salem
and mail it with a 1.Name of Firm-Or,if party needing this approval is an individual enter name below:
copy of this form to:
DEP, P.O.Box
4062,Boston,MA 2. Last Name of Individual 3.First Name of Individual 4.MI
02211, 120 Washington Street
5.Street Address
3. Three copies of Salem MA 019710 978-619-5685
this form will be 6.Cit /Town
7.
needed. y State 8.Zip Code 9.Telephone# 10. Ext.#
Kathleen Winn kwinn(a)_salem.com
Copy 1 -the 11.Contact Person - 12.e-mail address(optional)
original must
accompany your
permit application. C. Facility, Site or Individual Requiring Approval
Copy 2 must
accompany your
fee payment. 1. Name of Facility,Site Or Individual
Copy 3 should be 10 Blaney Street
retained for your 2.Street Address
records Salem
MA 01970
4. Both fee-paying 3.City/Town T.State 5.Zip Code 6.Telephone# 7.Ext.#
and exempt
applicants must 8. DEP Facility Number(if Known) 9.Federal I.D.Number(if Known)
mail a copy of this 10. BWSC Tracking#(if Known)
transmittal farm to: D. Application Prepared by (if different from Section B)*
P.O. o Box
4062 Bourne Consulting Engineering
P.O.
Boston,MA 1. Name of Firm Or Individual
02211 3 Bent Street
2.Address
Franklin MA 02038 508-533-6666
Note: 3.Cit /Town
For BWSC Permits, y 4.State 5.Zip Code 6.Telephone# 7.Ext.#
enter the LSP. Alyssa Richard
8.Contact Person 9.LSP Number(BWSC Permits only)
E. Permit - Project Coordination
1. Is this project subject to MEPA review? ® yes ❑ no
If yes, enter the project's EDEA file number-assigned when an
Environmental Notification Form is submitted to the MEPA unit: 14234
EOEA File Number
F. Amount Due
DEP Use On/y Special Provisions:
1. ®Fee Exempt(city,town or municipal housing authority)(state agency if fee is$100 or less).
Permit No: There are no fee exemptions for BWSC permits, regardless of applicant status.
2. ❑ Hardship Request-payment extensions according to 310 CMR 4.04(3)(c).
Recd Date.* 3. ❑Alternative Schedule Project(according to 310 CMR 4.05 and 4.10).
4. ❑Homeowner(according to 310 CMR 4.02).
Reviewer: Municipal Exemption Municipal Exemption Municipal Exemption
Check Number Dollar Amount Date
tr-formw 91 28705.doc•rev. 1/07 Page 1 of 1
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Waterways Regulation Programx224359
Chapter 91 Waterways License Application -310 CMR 9.00 Transmittal No.
Water-Dependent, Nonwater-Dependent,Amendment
Important: Application IIC
When filling out pp ation Information (Check one)
forms on the
computer,use NOTE: For Chapter 91 Simplified License application form and information see the Self Licensing
only the tab key Package for BRP WW06.
to move your
cursor-do not Name (Complete Application Sections) Check One Fee Application#
use the return PP
key' WATER-DEPENDENT-
r
General (A-H) ❑ Residential with < 4 units $175.00 BRP WW01a
® Other $270.00 BRP WW01b
❑ Extended Term $2730.00 BRP WW01c
Forassistance _____.._.._...........___._.._.............._.._ _........... _
in completing this Amendment(A-H) ❑ Residential with <4 units $85.00 BRP WW03a
application,please —
see the
"Instructions". ❑ Other $105.00 BRP WW03b
NONWATER-DEPENDENT -
Full (A-H) ❑ Residential with < 4 units $545.00 BRP WW15a
❑ Other $1635.00 BRP WW15b
❑ Extended Term $2730.00 BRP WW15c
......................_...................._._.._.._.._._.._.._______.._.._..___._.._.._.._.._.._..___.._.._.
Partial (A-H) ❑ Residential with <4 units $545.00 BRP WW14a
❑ Other $1635.00 BRP WW14b
❑ Extended Term $2730.00 BRP WW14c
.................. ____.._.._.._.._..__.........___..___._._.._.._.._.._.............
Municipal Harbor Plan (A-H) ❑ Residential with <4 units $545.00 BRP WW1 6a
❑ Other $1635.00 BRP WW16b
❑ Extended Term $2730.00 BRP WW16c
_.._.._.._.._-_.._.._.._.._.._.._.._.._.._.._.._.._.._.._.
Joint MEPA/EIR (A-H) ❑ Residential with < 4 units $545.00 BRP WW1 7a
❑ Other $1635.00 BRP WW17b
❑ Extended Term $2730.00 BRP WW17c
_.._.._._.......___._.._.._.._.._______.._._.._._.._._.__._.._.._..___..
Amendment(A-H) ❑ Residential with <4 units $435.00 BRP WW03c
❑ Other $815.00 BRP WW03d
❑ Extended Term $1090.00 BRP WW03e
CH91App.doc•Rev.6/06 Page 1 of 13
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Waterways Regulation Program x224359
Chapter 91 Waterways License Application -310 CMR 9.00 Transmittal No.
Water-Dependent, Nonwater-Dependent, Amendment
B. Applicant Information Proposed Project/Use Information
1. Applicant:
City of Salem, Kathleen Winn __ kwinn@salem.com _
Name E-mail Address
City Hall Annex, 120 Washington Street
Mailing Address
Note: Please refer Salem
to the"Instructions" _ MA 01970
City(rown State Zip Code
9786195685
Telephone Number Fax Number
2. Authorized Agent (if any):
Alyssa Richard arichard@bournece.com
Name - E-mail Address
Bourne Consulting Engineering 3 Bent Street
Mailing Address -
Franklin MA 02038
City/Town State Zip Code
5085336666 5085330600
Telephone Number Fax Number
C. Proposed Project/Use Information
1. Property Information (all information must be provided):
Dominion Energy Salem
Owner Name(if different from applicant)
41-0278-0 42.52 70.88
Tax Assessor's Map and Parcel Numbers Latitude Longitude
10 Blaney Street Salem 01970
Street Address and City/Town State Zip Code
2. Registered Land ❑ Yes ® No
3. Name of the water body where the project site is located:
Salem Harbor
4. Description of the water body in which the project site is located (check all that apply):
Type Nature Designation
❑ Nontidal river/stream ❑ Natural ❑Area of Critical Environmental Concern
® Flowed tidelands ❑ Enlarged/dammed ® Designated Port Area
® Filled tidelands ❑ Uncertain ® Ocean Sanctuary
❑ Great Pond ❑Uncertain
❑ Uncertain
CH91App.doc•Rev.6/06 Page 2 of 13
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Waterways Regulation Program x224359
Chapter 91 Waterways License Application -310 CMR 9.00 Transmittal No.
Water-Dependent, Nonwater-Dependent,Amendment
C. Proposed Pro'
p Project/Use Information (cont.)
Select use(s)from
Project Type Table 5. Proposed Use/Activity description
on pg.2 of the
"Instructions" The City of Salem is proposing to construct a multi use water transportation facility in the Salem
Harbor Designated Port Area. The proposed plan will be developed in two phases. Phase One
includes the construction and associated dredging of a water transportation terminal and a pier to be
used for various passenger vessels
6. What is the estimated total cost of proposed work (including materials & labor)?
$12.5 million
7. List the name & complete mailing address of each abutter(attach additional sheets, if necessary). An
abutter is defined as the owner of land that shares a common boundary with the project site, as well
as the owner of land that lies within 50' across a waterbody from the project.
Please see attached
Name Address
Name Address
Name Address
D. Project Plans
1. I have attached plans for my project in accordance with the instructions contained in (check one):
® Appendix A(License plan) ❑ Appendix B (Permit plan)
2. Other State and Local Approvals/Certifications
®401 Water Quality Certificate In process
Date of Issuance
® Wetlands In process
File Number
❑ Jurisdictional Determination JD-
File Number
® MEPA 14234
File Number
® EOEA Secretary Certificate 7/11/08
Date
❑21 E Waste Site Cleanup
RTN Number
CH91App.doc•Rev. 6/06 Page 3 of 13
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Waterways Regulation Program ZZ93
Chapter 91 Waterways License Application -310 CMR 9.00 Transmittal No.
Water-Dependent, Nonwater-Dependent,Amendment
E. Certification
All applicants, property owners and authorized agents must sign this page. All future application
correspondence may be signed by the authorized agent alone.
"I hereby make application for a permit or license to authorize the activities I have described herein. Upon
my signature, I agree to allow the duly authorized representatives of the Massachusetts Department of
Environmental Protection and the Massachusetts Coastal Zone Management Program to enter upon the
premises of the project site at reasonable times for the purpose of inspection."
"I hereby certify that the information submitted in this application is true and accurate to the best of my
knowledge."
9pplicanrs signature Date
Property Owner's signature(if different than applicant) Date
Ngenry ignature(If applicable) Date
CH91App.doc•Rev.6/06 Page 4 of 13
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Waterways Regulation Program x224359
Chapter 91 Waterways License Application - 310 CMR 9.00 Transmittal No.
Water-Dependent, Nonwater-Dependent, Amendment
F. Waterways Dredging Addendum
1. Provide a description of the dredging project
❑ Maintenance Dredging (include last dredge date & permit no.) ® Improvement Dredging
To provide safe berthing at the new pier. _
Purpose of Dredging
2. What is the volume (cubic yards)of material to be dredged?
115,117 cys
3. What method will be used to dredge?
❑ Hydraulic ® Mechanical ❑ Other
4. Describe disposal method and provide disposal location (include separate disposal site location map)
The dredge material will be disposed of at the Massachusetts Bay Disposal Site (MBDS)
5. Provide copy of grain size analysis. If grain size is compatible for beach nourishment purposes, the
Department recommends that the dredged material be used as beach nourishment for public
beaches. Note: In the event beach nourishment is proposed for private property, pursuant to 310
CMR 9.40(4)(a)1, public access easements below the existing high water mark shall be secured by
applicant and submitted to the Department.
CH91 App.doc-Rev.6/06 Page 5 of 13
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Waterways Regulation Program x224359
Chapter 91 Waterways License Application -310 CMR 9.00 Transmittal No.
Water-Dependent, Nonwater-Dependent,Amendment
G. Municipal Zoning Certificate
City of Salem
Name of Applicant
10 Blaney Street Salem Harbor Salem
Project street address Waterway City/Town
Description of use or change in use:
The City of Salem is proposing to construct a multi use water transportation facility in the Salem
Harbor Designated Port Area. The proposed plan will be developed in two phases. Phase One
includes the construction and associated dredging of a water transportation terminal and a pier to be
used for various passenger vessels.
To be completed by municipal clerk or appropriate municipal official:
"I hereby certify that the project described above and more fully detailed in the applicant's waterways
license application and plans is not in violation of local zoning ordinances and bylaws."
Print arae of Municipal Official Date
V"/1�+�
Signature of Mu cipal Official Title City/Town
CH91App.doc-Rev.6/06 Page 6 of 13
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Waterways Regulation Program x224359 _
Chapter 91 Waterways License Application -310 cMR 9.00 Transmittal No.
Water-Dependent, Nonwater-Dependent,Amendment
H. Municipal Planning Board Notification
Notice to City of Salem
Applicant: Name of Applicant
Section H should 10 Blaney Street Salem Harbor Salem
be completed and Project street address Waterway Cilylrown
submitted along
with the original Description of use or change in use:
application material.
The City of Salem is proposing to construct a multi use water transportation facility in the Salem
Harbor Designated Port Area. The proposed plan will be developed in two phases. Phase One
includes the construction and associated dredging of a water transportation terminal and a pier to be
used for various passenger vessels.
To be completed by municipal clerk orappropriate municipal official:
"I hereby certify that the project described above and more fully detailed in the applicant's waterways
license application and plans have been submitted by the applicant to the municipal planning board."
LYNN AvY)00 Ls og
Jig
N me of Municipal Oficial Date
�i/ec I00 Sa l e
re of Mu icipal Official Title CitylTown
Note: Any comments, including but not limited to written comments, by the general public, applicant,
municipality, and/or an interested party submitted after the close of the public comment period
pertaining to this Application shall not be considered, and shall not constitute a basis for standing in
any further appeal pursuant to 310 CMR 9.13(4)and/or 310 CMR 9.17.
CH91App.doc•Rev.6106 Page 7 of 13
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Waterways Regulation Program x224359
Chapter 91 Waterways License Application -310 CMR 9.00 Transmittal No.
Water-Dependent, Nonwater-Dependent,Amendment
Appendix A: License Plan Checklist
General View
® PE or RLS, as deemed appropriate by the Department, stamped and signed, in ink, each sheet
within 8 1/2 inch by 11 inch border
® Format and dimensions conform to "Sample Plan" (attached)
® Minimum letter size is 1/8 of an inch if freehand lettering, 1/10 of an inch if letter guides are used
® Sheet number with total number in set on each sheet
® Title sheet contains the following in lower left: Plans accompanying Petition of[Applicant's name,
structures and/or fill or change in use, waterway and municipality)
® North arrow
® Scale is suitable to clearly show proposed structures and enough of shoreline existing structures
9 9
and roadways to define its exact location
® Scale is stated & shown by graphic bar scale on each sheet
® Initial plans may be printed on bond; final plans due before License issuance must be on 3mil
Mylar.
Structures and Fill
® All Structures and Fill shown in full BLACK lines, clearly labeling which portions are existing,
which are Proposed and indicating Existing Waterways Licenses
® Cross Section Views show MHW* and MLW*and structure finish elevations
® Dredge or Fill, actual cubic yardage must be stated and typical cross sections shown
® All Structures and Fill shown in full BLACK lines, clearly labeling which portions are existing,
which are Proposed and indicating Existing Waterways Licenses
® Cross Section Views show MHW*and MLW*and structure finish elevations
® Dredge or Fill, actual cubic yardage must be stated and typical cross sections shown
® Actual dimensions of structures(s)and or fill and the distance which they extend beyond MHW*
or OHW*
® Change in Use of any structures on site must be stated
* See 310 CMR 9.02, Waterways Regulations definitions of High Water Mark, Historic High Water
Mark, Historic Low Water Mark, and Low Water Mark. Note: DEP may, at its discretion, accept
appropriately scaled preliminary plans in lieu of the plans described above. In general, DEP will
accept preliminary plans only for non-water dependent projects and projects covered by MEPA to
address site design components such as visual access, landscaping &site coverage. Anyone wishing
to submit preliminary plans must obtain prior approval of the DEP Waterways Program before
C H91 App.doc-Rev.6/06 Page 8 or 13
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Waterways Regulation Program x224359
Chapter 91 Waterways License Application -310 CMR 9.00 Transmittal No.
Water-Dependent, Nonwater-Dependent,Amendment
Appendix A: License Plan Checklist (cont.)
Boundaries
® Property lines, full black lines, , along with abutters' names and addresses
® Mean High Water(MHW)*or Ordinary High Water(OHW)*, full black line
® Mean Low Water(MLW)*, black dotted line, (.............)
❑ Historic MHW* or OHW* (---- )
❑ Historic MLW* (..._...
_.._)
❑ State Harbor Lines, black dot-dash line (—.—. — . — )with indication of Chapter&Act
establishing them (Ch. , Acts of)
❑ Reference datum is National Geodetic Vertical Datum (NGVD) or(NAVD).
® Floodplain Boundaries according to most recent FEMA maps
❑ Proposed & Existing Easements described in metes& bounds
Water-Dependent Structures
® Distance from adjacent piers, ramps or floats (minimum distance of 25'from property line, where
feasible)
❑ Distance from nearest opposite shoreline
❑ Distance from outside edge of any Navigable Channel
❑ Access stairs at MHW for lateral public passage, or 5 feet of clearance under structure at MHW.
Non Water-Dependent Structures
❑ Depict extent of"Water-dependent Use Zone'.
See Waterways Regulations at 310 CMR 9.51-9.53 for additional standards for non water-dependent
use projects.
Note: Final Mylar project site plans will be required upon notice from the Department, prior to issuance of
the Chapter 91 Waterways License.
CH91 App.doc•Rev.6/06 Page 9 of 13
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Waterways Regulation Program x224359
Chapter 91 Waterways License Application - 310 CMR 9.00 Transmural No.
Water-Dependent, Nonwater-Dependent,Amendment
Appendix A: License Plan Checklist Cont.
W Registry
Statement
31/2 inche 5 i n c h e
A 4L
�+ Locus
p Map
First Sheet Only
318
o
1 „ -2114 inche
Sample Plan
U
8 1/2 inches
P.E.
or
R.LS
stamp
3 3/4 inch e
Plan Accompany irg T
Petition of... T DEP
Stamp
First Sheet Only
3/4 " Border
CH91App.doc• Rev. 6/06 Page 10 of 13
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Waterways Regulation Program x224359
Chapter 91 Waterways License Application - 310 cMR 9.00 Transmittal No.
Water-Dependent, Nonwater-Dependent, Amendment
Appendix C: Application Completeness Checklist
Please answer all questions in the General Waterways Application form. If a question does not
apply to your project write "not applicable" (n/a) in that block. Please print or type all information
provided on the form. Use black ink (blue ink or pencil are not easily reproducible, therefore,
neither will be accepted). If additional space is needed, attach extra 8-1/2" x 11" sheets of paper.
® Proper Public Purpose:For nonwater-dependent projects, a statement must be included that
explains how the project serves a proper public purpose that provides greater benefit than
detriment to public rights in tidelands or great ponds and the manner in which the project meets the
applicable standards. If the project is a nonwater-dependent project located in the coastal zone, the
statement should explain how the project complies with the standard governing consistency of the
policies of the Massachusetts Coastal Zone Management Program, according to 310 CMR 9.54. If
the project is located in an area covered by a Municipal Harbor Plan, the statement should describe
how the project conforms to any applicable provisions of such plan pursuant to 310 CMR 9.34(2).
® Plans: Prepared in accordance with the applicable instructions contained in Appendix A-B of this
application. For initial filing, meet the requirements of 310 CMR 9.11(2)(b)(3).
❑ Applicant Certification:All applications must be signed by"the landowner if other than the applicant.
In lieu of the landowner's signature,the applicant may provide other evidence of legal authority to
submit an application for the project site."If the project is entirely on land owned by the
Commonwealth (e.g. most areas below the current low water mark in tidelands and below the historic
high water mark of Great Ponds),you may simply state this in lieu of the"landowner's signature".
❑ Municipal Zoning Certification: If required, applicants must submit a completed and signed
Section E of this application by the municipal clerk or appropriate municipal official or,for the
initial filing, an explanation of why the form is not included with the initial application. If the project
is a public service project subject to zoning but will not require any municipal approvals, submit a
certification to that effect pursuant to 310 CMR 9.34(1).
❑ Municipal Planning Board Notification: Applicants must submit a copy of this application to the
municipal planning board for the municipality where the project is located. Submittal of the
complete application to DEP must include Section H signed by the municipal clerk, or appropriate
municipal official for the town where the work is to be performed, except in the case of a
proposed bridge, dam, or similar structure across a river, cove, or inlet, in which case it must be
certified by every municipality into which the tidewater of said river, cove, or inlet extends.
❑ Final Order of Conditions: A copy of one of the following three documents is required with the
filing of a General Waterways Application: (1)the Final Order of Conditions (with accompanying
plan) under the Wetlands Protection Act; (2)a final Determination of Applicability under that Act
stating that an Order of Conditions is not required for the project; or(3)the Notice of Intent for the
initial filing (if the project does not trigger review under MEPA).
® Massachusetts Environmental Protection Act(MEPA): MGL 30, subsections 61-61A and 301
CMR 11.00, submit as appropriate: a copy of the Environmental Notification Form (ENF)and a
Certificate of the Secretary of Environmental Affairs thereon, or a copy of the final Environmental
Impact Report (EIR)and Certificate of the Secretary stating that it adequately and properly
complies with MEPA; and any subsequent Notice of Project change and any determination
issued thereon in accordance with MEPA. For the initial filing, only a copy of the ENF and the
Certificate of the Secretary thereon must be submitted.
CH91App.doc•Rev.6106 Page 12 of 13
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Waterways Regulation Program x224359
Chapter 91 Waterways License Application -310 CMR 9.00 Transmittal No.
Water-Dependent, Nonwater-Dependent, Amendment
Appendix C: Application Completeness Checklist (cont.)
❑ Water Quality Certificate: if applicable, pursuant to 310 CMR 9.33, is included.
❑ Other Approvals: as applicable pursuant to 310 CMR 9.33 or, for the initial filing, a list of such
approvals which must be obtained.
Projects involving dredging:
❑ The term "dredging" means the removal of materials including, but not limited to, rocks,
bottom sediments, debris, sand, refuse, plant or animal matter, in any excavating, clearing,
deepening,widening or lengthening, either permanently or temporarily, of any flowed
tidelands, rivers, streams, ponds or other waters of the Commonwealth. Dredging includes
improvement dredging, maintenance dredging, excavating and backfilling or other dredging
and subsequent refilling. Included is a completed and signed copy of Part F of the
application.
Filing your Completed General Waterways Application:
® For all Water-Dependent applications—submit a completed General Waterways Application
and all required documentation with a photocopy of both payment check and DEP's Transmittal
Form for Permit Application & Payment to the appropriate DEP regional office (please refer to Pg.
10 of the "Instructions"for the addresses of DEP Regional Offices).
❑ For all Non Water-Dependent applications—submit a completed General Waterways
Application and all required documentation with a photocopy of both payment check and DEP's
Transmittal Form for Permit Application & Payment to DEP's Boston office.
Department of Environmental Protection
Waterways Regulation Program
One Winter Street
Boston, MA 02108
® Application Fee Payment for ALL Waterways Applications: Send the appropriate Application
fee' (please refer to Page 1 of the"Application"), in the form of a check or money order, along
with DEP's Transmittal Form for Permit Application & Payment:
Department of Environmental Protection
P.O. Box 4062
Boston, MA 02211
Under extreme circumstances, DEP grants extended time periods for payment of license and
permit application fees. If you qualify, check the box entitles "Hardship Request"on the
Transmittal Form for Permit Application & Payment. See 310 CMR 4.04(3)(c)to identify
procedures for making a hardship request. Send hardship request and supporting documentation
to the above address.
NOTE: You may be subject to a double application fee if your application for Chapter 91
authorization results from an enforcement action by the Department or another agency of the
Commonwealth or its subdivisions, or if your application seeks authorization for an existing
unauthorized structure or use.
CH91App.doc• Rev.6/06 Page 13 of 13
I CERTIFY THAT THIS PLAN
AS PREPARED CONFORMS TO
THE RULES AND REGULATIONS
OF THE REGISTERS OF DEEDS.
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SHEET 1 OF 8
PLANS ACCOMPANYING PETITION OF
CITY OF SALEM FOR CONSTRUCTION
AND MAINTENENCE OF THE PORT
FACILITY EXPANSION AT BLANEY
STREET, SALEM, MA IN SALEM
HARBOR.
a PREPARED BY
`1 BOURNE CONSULTING ENGINEERING,
I CERTIFY THAT THIS PLAN AS PREPARED CONFORMS
TO THE RULES AND REGULATIONS OF THE
REGISTERS OF DEEDS.
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