289 DERBY STREET - ZONING (4) �wGriffin
Engineering
Group, LLC
September 29, 2017
Ms. Amanda Chiancola, Staff Planner
City of Salem Planning Department
120 Washington Street, 3d Floor
Salem, MA 01970
By Hand Delivery
Subject: Ch. 91 Waterways License Application
289 Derby Street,
Salem, MA
Dear Ms. Chiancola:
On behalf of the Applicant, City of Salem, LLC, this letter notifies you of their
pending Chapter 91 permit application for the subject project and requests that
you acknowledge, by signature on page 7 of 13 that the plans have been
submitted to the Planning Board. An extra copy of page 7 is attached for your
convenience.
The application is for the public park on filled tidelands of the South River Canal.
The project was approved by Salem Conservation Commission in September
2017. Please review the application, complete page 7, and contact our office for
pick-up (978-927-5111).
Thank you for your assistance in this matter. Please do not hesitate to contact
the undersigned with any questions or comments.
Sincerely,
Griffin Engineering roup, LLC
Robert H. Gri � , P.E.
Enclosure: Ch. 91 Waterways License Application
Chapter 91 Plans
Extra Page 7 of 13
Phone 978-927-5111 Fax 978-927-5103 www.griffineng.com
495 Cabot Street 2nd Floor Beverly, MA 01915
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Waterways Regulation Program x276340
Chapter 91 Waterways License Application -310 CZAR 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 289 Derby Street South River Canal. Salem
be completed and Project street address Waterway CityrTown
submitted along
with the original Description of use or change in use:
application material.
Construction of a public park with associated concrete walkways, retaining walls, landscaping, and
stormwater management system.
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 have been submitted by the applicant to the municipal planning board."
Printed Name of Municipal Official Date
Signature of Municipal Official Title Cityrrown
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.03/17 Page 7 of 13
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Waterways Regulation Program x276340
Chapter 91 Waterways License Application -310 CMR 9.00 Transmittal No.
Water-Dependent, Nonwater-Dependent,Amendment
Immo outf rens A. Application Information (Check one)
filling out forms
on the computer, NOTE: For Chapter 91 Simplified License application form and information see the Self Licensing
use only the tab P p Pp 9
key to move your Package for BRP WW06.
cursor-do not
use the return Name (Complete Application Sections) Check One Fee Application #
key.
VQ WATER-DEPENDENT -
General (A-H) ❑ Residential with < 4 units $215.00 BRP WW01a
® Other $330.00 BRP WW01b
For assistance ❑ Extended Term $3,350.00 BRP WW01c
incompleting this ...............................---------................_..___..........._.._.._._._........................................
application,please Amendment (A-H) ❑ Residential with <4 units $100.00 BRP WW03a
see the
"Instructions".
❑ Other $125.00 BRP WW03b
NONWATER-DEPENDENT-
Full (A-H) ❑ Residential with <4 units $665.00 BRP WWI 5a
❑ Other $2,005.00 BRP WW15b
❑ Extended Term $3,350.00 BRP WWI 5c
.._.._.._.._.._.._.._.._.._....._.._.._.._.._.._.._.._.._.._.._.........................
Partial (A-H) ❑ Residential with <4 units $665.00 BRP WW14a
❑ Other $2,005.00 BRP WW14b
❑ Extended Term $3,350.00 BRP WW14c
............................... _.._ _.._
Municipal Harbor Plan (A-H) ❑ Residential with <4 units $665.00 BRP WW16a
❑ Other $2,005.00 BRP WW16b
❑ Extended Term $3,350.00 BRP WW16c
_..___.._.._.._.._.._____..___.._.._.._.._.._.._.._.._._._.._.._.._..___.._.._.._.._.._.._.._.._._._.._.._..___.___._.._.._.._____._..___...
Joint MEPA/EIR(A-H) ❑ Residential with <4 units $665.00 BRP WWI 7a
❑ Other $2,005.00 BRP WW17b
❑ Extended Term $3,350.00 BRP WW17c
_._..___._.._.._._.._.._.._..___._.._.._.._.._ .....................................
Amendment(A-H) ❑ Residential with < 4 units $530.00 BRP WW03c
❑ Other $1,000.00 BRP WW03d
❑ Extended Term $1,335.00 BRP WW03e
CH91App.doc•Rev.03/17 Page 1 of 13
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Waterways Regulation Program X276340
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 KWinn@salem.com
Name E-mail Address
120 Washington Street
Mailing Address
Note:Please refer Salem MA 01970
to the"Instructions" City/Town State Zip Code
978-619-5684 IRM
Telephone Number Fax Number
2. Authorized Agent(if any):
Robert H. Griffin, P.E. bgriffin@griffineng.com
Name E-mail Address
495 Cabot Street, 2nd Floor
Mailing Address
Beverly MA 01915
City/Town State Zip Code
978-927-5111 978-927-5103
Telephone Number Fax Number
C. Proposed Project/Use Information
1. Property Information (all information must be provided):
City of Salem
Owner Name(if different from applicant)
Map 34 Lot 441 N4201'11" W70d53'30"
Tax Assessor's Map and Parcel Numbers Latitude Longitude
289 Derby Street Salem MA 01970
Street Address and City/rown State Zip Code
2. Registered Land ❑ Yes ® No
3. Name of the water body where the project site is located:
South River Canal- Coastal
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.03/17 Page 2 of 13
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Waterways Regulation Program x276340
Chapter 91 Waterways License Application -310 CMR 9.00 Transmittal No.
Water-Dependent, Nonwater-Dependent,Amendment
C. Proposed Project/Use Information (cont.)
Select use(s)from
Project Type Table 5. Proposed Use/Activity description
on pg.2 of the
"Instructions" The proposed project consists of constructing a public park with associated walkways, retaining walls,
landscaping, & stormwater management system. The entire project site is located on historical filled
tidelands. A small rip-rap splash pad (3'x5') is proposed within the tidal flats to prevent erosion from
the proposed stormwater discharge
6. What is the estimated total cost of proposed work (including materials & labor)?
$900,000 to $950,000
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.
See List of Abutters on Plan Sheet 4 of 4
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
Date of Issuance
® Wetlands 064-0638
File Number
❑ Jurisdictional Determination JD-
File Number
❑ MEPA
File Number
❑ EDEA Secretary Certificate
Date
1-121 E Waste Site Cleanup 3-15479
RTN Number
CH91App.doc•Rev.03/17 Page 3 o 13
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Waterways Regulation Program X276340
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."
Applicant's signature Date
Property Owner's signature(if different than applicant) Date
Agent's signature(if applicable) Date
CH91App.doc•Rev.03117 Page 4 of 13
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Waterways Regulation Program x276340
Transmittal No.
Chapter 91 Waterways License Application -310 CMR 9.00
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
NA
Purpose of Dredging
2. What is the volume (cubic yards) of material to be dredged?
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)
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.
CH91App.doc•Rev.03/17 Page 5 of 13
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Waterways Regulation Program X276340
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
289 Derby Street South River Canal Salem
Project street address Waterway Cityrrown
Description of use or change in use:
Construction of a public park with associated concrete walkways, retaining walls, landscaping, and
stormwater management system.
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."
Printed Name of Municipal Official Date
Signature of Municipal Official Title City/Town
CH91App.doc•Rev.03/17 Page 6 of 13
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Waterways Regulation Program x276340
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 289 Derby Street South River Canal. Salem
be completed and Project street address Waterway City/Town
submitted along
with the original Description of use or change in use:
application material.
Construction of a public park with associated concrete walkways, retaining walls, landscaping, and
stormwater management system.
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 have been submitted by the applicant to the municipal planning board."
Printed Name of Municipal Official Date
Signature of Municipal Official Title Cityrrown
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.03/17 Page 7 of 13
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Waterways Regulation Program X276340
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
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
submitting them with their application.
CHMpp.doc•Rev.03/17 Page 8 of 13
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Waterways Regulation Program X278340
Transmittal No.
Chapter 91 Waterways License Application -310 CMR 9.00
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*orOHW* (----)
❑ 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.
CH91App.doc•Rev.03117 Page 9 of 13
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Waterways Regulation Program X276340
Chapter 91 Waterways License Application -310 CMR 9.00 Transmittal No.
Water-Dependent, Nonwater-Dependent,Amendment
Appendix A: License Plan Checklist Cont.
cs Registry
Statement
3112 inche 6 inche
rIj Locus
Map
First Sheet Only
a
1 „ +21/4 inches--0-
Sample Plan
U
C
8112 inch e
P.E.
4r
R.LS
Stamp
33/4 inche
Plan Accompanying
Petition of... DEP
Stamp
First Sheet Only
314 " Border
CH91App.doc-Rev.03/17 Page 10 of 13
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Waterways Regulation Program x276340
Chapter 91 Waterways License Application - 310 CMR 9.00 Transmittal No.
Water-Dependent, Nonwater-Dependent,Amendment
Appendix B: Dredging Permit Plan Checklist
For projects applying for dredging permits only, enclose drawings with the General Waterways
Application that include the following information:
General View
❑ Submit one original of all drawings. Submit the fewest number of sheets necessary to adequately
illustrate the project on 8-1/2 inch X 11 inch paper.
❑ A 1-inch margin should be left at the top edge of each drawing for purposes of reproduction and
binding. A 1/2 inch margin is required in the three other edges.
❑ A complete title block on each drawing submitted should identify the project and contain: the
name of the waterway; name of the applicant; number of the sheet and total number of sheets in
the set; and the date the drawing was prepared.
❑ Use only dot shading, hatching, and dashed or dotted line to show or indicate particular features
of the site on the drawings.
❑ If deemed appropriate by the Department, certification by the Registered Professional Engineer
or Land Surveyor is included.
Plan View
❑ North Arrow
❑ Locus Map
❑ Standard engineering scale.
❑ Distances from channel lines and structures if appropriate.
❑ Mean high water and mean low water shorelines (see definitions of"High Water Mark" and "Low
Water Mark"at 310 CMR 9.02, C. 91 Regulations).
❑ Dimensions of area proposed to be dredged or excavated.
❑ Notation or indication of disposal site.
❑ Volume of proposed dredging or excavation.
❑ Ordinary high water, proposed drawdown level, and natural (historic) high water(for projects
lowering waters of Great Ponds).
Section Views
❑ Existing bottom and bank profiles.
❑ Vertical and/or horizontal scales.
❑ Proposed and existing depths relative to an indicated datum.
❑ Elevation and details of control structure (for projects lowering waters of Great Ponds).
CH91App.doc•Rev.03/17 Page 11 of 13
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Waterways Regulation Program x276340
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(3)(1b)(3).
® Applicant Certification:All applications must be signed by"the landowner if other than the applicant.
In lieu of the landowners 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"landowners 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.
Note: If the project is subject to MEPA,the Chapter 91 Public Notice must also be submitted to MEPA for
publication in the"Environmental Monitor". MEPA filing deadlines are the 15`"and 30`"of each month.
CH91 App.doc•Rev. 03117 Page 12 of 13
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Waterways Regulation Program X276340
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 Boston or 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.03/17 Page 13 of 13
Enter your transmittal number 0 x276340
Transmittal:Number
Your unique Transmittal Number can be accessed online:
1`\ http://www mass goy/eea/agencies/massdep/service/approvals/transmittal-form-for-payment html
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 WW01 b Water Dependant Use-Other
must be completed 1.Permit Code:4 to 7 character code from per md instmctions 2.Name of Permit Category -
for each permit Construct a Public Park
application.
3.Type of Project or Activity
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:
MassDEP,P.O.
Box 4062, Boston, 2. Last Name of Individual 3. First Name of Individual 4.MI
MA 02211. 120 Washington Street
5.Street Address
3. Three copies of Salem MA01970 978-61905684
this form will be 6.City/Town 7.State 8.Zip Code 9.Telephone# 10.Ext.#
needed. Kathleen Winn KWinn@salem.com
Copy 1 -the 11.Contact Person 12.e-mail address
original must
accompany your
permit application. C. Facility, Site or Individual Requiring Approval
Copy 2 must Derby accompany your Y Street Park
fee payment. 1. Name of Facility,Site Or Individual
Copy 3 should be 289 Derby Street
retained for your 2.Street Address
records Salem MA 01970
4. Both fee-paying 3.CitylTown A.State 5.Zip Code 6.Telephone# 7.Ext.#
and exempt 064-0638 NA NA
applicants must 8.DEP Facility Number(if Known) 9.Federal I.D. Number(if Known) 10. BWSC Tracking#(if Known)
mail a copy of this
transmittal form to. D. Application Prepared by (if different from Section B)*
P
P.O.Box 4062 Griffin Engineering Group LLC
P.O.Bo
Boston,MA 1.Name of Firm Or Individual
02211 495 Cabot Street, 2 n Floor
2.Address
Beverly MA 01915 978-927-5111
"Note:
For BWSC Permits, 3.City/Town 4.State 5.Zip Code 6.Telephone# 7.EM.#
enter the LSP. Robert H. Griffin, P.E. NA
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 EOEA file number-assigned when an
Environmental Notification Form is submitted to the MEPA unit:
EOEA File Number
F. Amount Due
DEP Use Only 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).
Rec'd Date: 3. ❑Alternative Schedule Project(according to 310 CMR 4.05 and 4.10).
4. ❑Homeowner(according to 310 CMR 4.02).
Reviewer
Check Number Dollar Amount Date
tr-formw.doc•rev. 12117 Page 1 of 1
FOR REGISTRY USE ONLY I CERTIFY THAT THIS PLAN CONFORMS TO THE RULES
AND REGULATIONS OF THE REGISTERS OF DEEDS.
I CERTIFY THAT THE PROPERTY LINES SHOWN HEREON
ARE THE LINES DIVIDING EXISTING OWNERSHIP, AND THE
LINES OF STREETS AND WAYS SHOWN ARE THOSE OF
PUBLIC AND PRIVATE STREETS ALREADY ESTABLISHED,
AND THAT NO NEW LINES FOR DIVISION OF EXISTING
OWNERSHIP OR FOR NEW WAYS ARE SHOWN.
DATE ROBERT H. GRIFFIN, P.E.
APPLICATION FOR WATER DEPENDENT USE
LIST OF ABUTTERS - NOW OR FORMERLY
1O ADDRESS: 295 DERBY STREET
HESS RETAIL STORES, LLC
C/O HESS CORPORATION
539 SOUTH MAIN STREET
FINDLAY, OH 45840
MAP 34, LOT 442
O2 ADDRESS: 295 DERBY STREET
SOUTH HARBOR HOLDING, LLC
P.O. BOX 829
SALEM, MA 01970
MAP 34, LOT 440
NOTES AND REFERENCES:
1. EXIST. CONDITIONS AND BOUNDARY SURVEY BY NORTH
SHORE SURVEY CORPORATION OF SALEM, MA.
2. FEMA 100-YEAR FLOOD ZONE AE- ELEV. 10' (1988 NAVD).
3. HISTORIC HIGH WATER LINE DEVELOPED FROM MASSDEP
PRESUMPTIVE LINES (MASSGIS ONLINE MAPPING TOOL).
4. DATUM = NAVD 88
LEGEND
PROPERTY LINE
- - - - - - HISTORICAL HIGH WATER
MEAN HIGH WATER
. . . . . . . . . . . . . MEAN LOW WATER
- - - - - - - FEMA FLOOD LINE
-- -- -- --- RIVERFRONT
EXIST. BUILDING
- EXIST. EDGE OF PAVEMENT
EXIST. GRANITE CURB
CHAINLINK FENCE
PROP. RETAINING WALL
PROP. PLANTING BED ABUTTERS LIST,
----- -- - PROP. CURB LEGEND, & NOTES
SCALE: N.T.S.
LICENSE PLANS ACCOMPANYING PETITION
OF CITY OF SALEM TO CONSTRUCT A
PUBLIC PARK ON FILLED TIDELANDS OF THE
SOUTH RIVER CANAL, SALEM, MA.
OCTOBER 2, 2017 SHEET 4 OF 4
FOR REGISTRY USE ONLY I CERTIFY THAT THIS PLAN CONFORMS TO THE RULES
AND REGULATIONS OF THE REGISTERS OF DEEDS.
I CERTIFY THAT THE PROPERTY LINES SHOWN HEREON
ARE THE LINES DIVIDING EXISTING OWNERSHIP, AND THE
LINES OF STREETS AND WAYS SHOWN ARE THOSE OF
PUBLIC AND PRIVATE STREETS ALREADY ESTABLISHED,
AND THAT NO NEW LINES FOR DIVISION OF EXISTING
OWNERSHIP OR FOR NEW WAYS ARE SHOWN.
DATE ROBERT H. GRIFFIN, P.E.
APPLICATION FOR WATER DEPENDENT USE
10.0'
12 ..._... .... .......... . .. _..... .. ...... ................. ..... ...
. ............................ ........................................................................................................
CONCRETEGUARDRAIL PER FEMA 100-YR
WALKWAY BUILDING CODE
10 .... ....._....._.....-....._.... _ _.....-....V FLOOD ZONE
TOP OF
8 COASTAL BANK
✓ - - SOUTH RIVER CANAL
6 x ....
---EXIST. 'SEAWALL
-1.........................................._...._EL....4.2t..................
LXIST. APPROX.
.... .....I......._,. ......... �"x20 VOID
_ <
2 ....._....1.2.,. i
DRAIN PIPE I / 'D'u �
> S_15 � DUCKBILL
.. Oq TIDE. GA.TE.-......................
W � 3'x5'x1.5' TH
-2 ... .. ........ ... ... ... ... ..... . ........ ........ ... ... .. ........ .... ........... ..... ........... ....... . ...5..0.'.-...__ . ... .......-BOULDER................
INV.
^- SPLASH PAD
-0.6f - - - D50=12..
4 ---
12"TH. 1.5" CRUSHED _ _MLW _
STONE BEDDING WRAPPED - EL 5.34
-6 . .. . .... ......... ....... . . .......... .. .
IN NON-WOVEN
GEOTEXTILE FABRIC
SITE SECTION "A-All
JI I G
SCALE: 1" =4'
NOTES AND REFERENCES:
1. ELEVATIONS BASED ON N.A.V.D. 88 DATUM. 0 2 4 8
SCALE 1"=4'
LICENSE PLANS ACCOMPANYING PETITION
OF CITY OF SALEM TO CONSTRUCT A
PUBLIC PARK ON FILLED TIDELANDS OF THE
SOUTH RIVER CANAL, SALEM, MA.
OCTOBER 28, 2017 SHEET 3 OF 4
FOR REGISTRY USE ONLY I CERTIFY
THAT THIS PLAN CONFORMS TO THE RULES
AND REGULATIONS OF THE REGISTERS OF DEEDS.
I CERTIFY THAT THE PROPERTY LINES SHOWN HEREON
ARE THE LINES DIVIDING EXISTING OWNERSHIP, AND THE
LINES OF STREETS AND WAYS SHOWN ARE THOSE OF
PUBLIC AND PRIVATE STREETS ALREADY ESTABLISHED,
AND THAT NO NEW LINES FOR DIVISION OF EXISTING
OWNERSHIP OR FOR NEW WAYS ARE SHOWN.
DATE ROBERT H. GRIFFIN, P.E.
APPLICATION FOR WATER DEPENDENT USE NOTES:
1. SEE SHEET 5 FOR LEGEND.
` - - - - EXIST. FILLED
TIDELANDS
DERBY
STREET AGI (24,943± SF)
/
-_-- - AREA LIGHT 200' OUTER
PLANT;::, (TYP. OF 6) RIPARIAN
BED > :
> WATER
CABINET #
'' PLANT'
BED
#
LAWN CURVED GRANITE LAWN
✓- RETAINING WALL
Z-
CONCRETE INNER
RIPARIA
PLANT'
BED
#
HARBORWALK
LIGH
vva:- ,wa Ir
M
CONCRETE HW .--..__„ _. . . ._ .. __ WALKWAY. ..._ .. PROPOSED
GUARDRAIL - - - SITE PLAN
MHW
3'x5' RIP-RAP
SPASH PAD ON SOUTH RIVER CANAL MLW 0 15 30 60
FLOWED TIDELANDS SCALE 1” = 30'
LICENSE PLANS ACCOMPANYING PETITION
OF CITY OF SALEM TO CONSTRUCT A
PUBLIC PARK ON FILLED TIDELANDS OF THE
SOUTH RIVER CANAL, SALEM, MA.
OCTOBER 2, 2017 SHEET 2 OF 4
FOR REGISTRY USE ONLY I CERTIFY THAT THIS PLAN CONFORMS TO THE RULES
AND REGULATIONS OF THE REGISTERS OF DEEDS.
I CERTIFY THAT THE PROPERTY LINES SHOWN HEREON
ARE THE LINES DIVIDING EXISTING OWNERSHIP, AND THE
LINES OF STREETS AND WAYS SHOWN ARE THOSE OF
PUBLIC AND PRIVATE STREETS ALREADY ESTABLISHED,
AND THAT NO NEW LINES FOR DIVISION OF EXISTING
OWNERSHIP OR FOR NEW WAYS ARE SHOWN.
DATE ROBERT H. GRIFFIN, P.E.
APPLICATION FOR WATER DEPENDENT USE NOTES:
1. SEE SHEET 5 FOR LEGEND.
FEMA FLOOD ZONE - - - - - \ EXIST. FILLED
(EL. 10') �/ TIDELANDS
(24,943± SF)
STREE -
DERBY T rl� 71
i
= i T ❑ /i -
L.J 200' OUTER
APPROX. HISTORIC PAVEMENT
HIGH WATER LINE
0
z
0
r�
m -
v #289 DERBY ST.
0.574 ACRES
-c
24,982± S.F.
#285
100' INN
RIPgRIgNR
#29 RECLAIMED PAVEMENT
EXISTING CONDITIONS
& SITE CONTEXT PLAN
SCALE: 1" = 30'
SITE
CONC
r
Dn =
v+Lr: y EXIST. GRANITE U7
D
SEAWALL ➢ D
MHW _ m w m
112±' TO -1 O K:
OPPOSITE
SOUTH RIVER CANAL MHW
SEAWALL . . . . . . .. . . . .. . . . . .
VICINITY MAP
FLOOD SCALE 1"= 1,400'
0 15 30 60 APPROX' M�y� SITE LOCATION:
SCALE 1" = 30' EBB N420 31' 11'; W700 53'30"
LICENSE PLANS ACCOMPANYING PETITION
OF CITY OF SALEM TO CONSTRUCT A
PUBLIC PARK ON FILLED TIDELANDS OF THE
SOUTH RIVER CANAL, SALEM, MA.
OCTOBER 2, 2017 SHEET 1 OF 4