17 HEMENWAY ROAD - ZONING Massachusetts Department of Environmental Protection
- Bureau of Resource Protection -Waterways Regulation Program WO 1;0 1 top,
Chapter 91 Waterways License Application -310 CIVIR 9.00 Transmittal No.
Simplified,Water-Dependent, Nonwater-Depenclent,Amendment
H. Municipal Planning Board Notification
Notice to M'Lg[J6�lLill)
Applicant: Name of Ap licant
Section H should 17 006INIUl" RC> .4 ga n
be completed and Project street address i /I
submitted along Waterway cityrrown
with the original Description of use or change in use:
application material. I?F_F!ftUR 'FOR
MZ01ME?=011) Oir E)L15MO051 157TIRO 3A�IE<, 00�:rf AJC,- pact-, 15
F:OFZ F-91NIAals,
P RO eog;tap
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."
Witive 51
Pd d-Na Date
k&,- ic—al 9 o,
Sig a ure of nicipall icial 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 CIVIR 9.13(4)and/or 310 CIVIR 9.17.
CH91App.doc:-Rev. 10/02 Page 7 of 17
CITY OF SALEM
PLANNING BOARD
MEMORANDUM
TO: Planning Board Members
FROM: Valerie Gingrich
DATE: May 6, 2004
RE: Chapter 91 Application for 17 Hemenway Road
Enclosed you will find a copy of the Chapter 91 application submitted by Jeanette McLaughlin
to the Massachusetts Department of Environmental Protection (DEP) for their project located at
17 Hemenway Road. The project involves the repair of a seawall for shoreline stabilization to
protect existing structures, and the installation of a thirty-two foot gangway with a 12'x 20'
floating timber dock.
The Conservation Commission is reviewing the application at this time. There is no action
required of the Planning Board. This application is being sent as a notification to the Board of
the project, as required under 310 CMR 9.24. If you have any comments, please contact me at
978-745-9595 Ext. 311 or vgingrich@salem.com, and I will forward them to DEP.
120 WASHINGTON STREET, SALEM, MASSACHUSETTS 01970 *TEL: 978.745.9595 FAx: 978.740.0404 * WWW.SALEM.COM
JEANETTE McLAUGHLIN
17 Hemenway Road
Salem, MA 01970
April 9, 2004
APR 3 2004
DEPT.�,:-!P�......'r�
Planning Board
City of Salem
120 Washington Street
Salem, MA 0 1970
Attn: Chairman
RE: Waterways License Application Transmittal W050168
Jeanette McLaughlin, 17 Hemenway Road
Dear Sir or Madame:
I am currently seeking a DEP Waterways License BRP WWO I a for the replacement of an
existing seawall which is in disrepair, using the same footprint, and the installation of a
30' gangway with a 12'x2O' floating dock located in Salem Harbor. One requirement of
said license is for the Local Planning Board to be notified. As proof of being notified, a
form has been enclosed for the Planning Board's signature.
Please find enclosed one complete copy of the Waterways License Application. Please
sign the attached sheet as proof of notification and return it to me in the enclosed stamped
envelope at your earliest convenience.
Thank you for your assistance in this matter.
Very truly yours,
Jeane Mc
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Waterways Regulation Program waso
Transmittal No.
Chapter 91 Waterways License Application -310 CIVIR 9.00
Simplified,Water-Dependent, Nonwater-Dependent,Amendment
Important:
When filling out A. Application Information (Check one)
forms on the
computer,use Name (Complete Application Sections) Check One Fee Application #
only the tab key
to move your SIMPLIFIED -
cursor-do not
use the return Water-dependent and
key. Nonwater-dependent(A-E) Residential with <4 units $55.00 BRP WW06a
VU D Other $55.00 BRP WW06b
WATER-DEPENDENT -
General (A-H) P(Residential with <4 units $125. 0 BRPWWOla
For assistance
in completing this E] Other $250.00 BRP WWO1 b
application,please
see the EI Extended Term $2500.00 BRPWWOlc
"Instructions". ...................................... -----------------------------------
Amendment(A-H) D Residential with <4 units $60.00 BRP WW03a
El Other $100.00 BRP WW03b
NONWATER-DEPENDENT -
Full (A-H) E] Residential with <4 units $500.00 BRPWW15a
El Other $1500.00 BRPWW15b
El Extended Term $2500.00 BRPWW15c
----------------------- ............................................................................................................................
Partial (A-H) [I Residential with <4 units $500.00 BRP WW14a
El Other $1500.00 BRPWW14b
0 Extended Term $2500.00 BRPWW14c
Municipal Harbor Plan (A-H) El Residential with <4 units $500.00 BRPWW16a
Other $1500.00 BRPWW16b
ElExtended Term $2500..00 BRPWW16c
............................................... ..........................................................................................-----------
Joint MEPA/EIR(A-H) El Residential with <4 units $500.00 BRPWW17a
[I Other $1500.00 BRPWW17b
El Extended Term $2500.00 BRPWW17c
............................................................................................................................................................
Amendment(A-H) Ej Residential with <4 units $310.00 BRP WW03c
El Other $750.00 BRP WW03d
El Extended Term $1000.00 BRP WW03e
CH91App.doc-Rev. 10/02 Page 1 of 17
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Waterways Regulation Program
Chapter 91 Waterways License Application -310 CIVIR 9.00 Transmittal No.
Simplified,Water-Dependent, Nonwater-Dependent,Amendment
B. Applicant Information Proposed Project/Use Information
1. Applicant:
W C a L)q a_.-Ptc.,
Name E-mail Addressf
ff ArahixoaV Rr>
Note:Please refer iling Address
to the"Instructions" ienA
m M
Cityrf-own State Zip Code
M, q7R - 7qS- �2,qqq M
Telephone Number Fax Number
2. Authorized Agent(if any):
M
Name E-mail Address
Mailing Address
WPM
City[Town
State Zip Code
1 elephone Number Fax Number
C. Proposed Project/Use Information
I. Property Information (all information must be provided):
Raa
(�
Tax Assessors MaAJ21 Numa Latitude Longitude
WIM V73q ROM
Street Address and Cityrrown state Zip Code
2. Registered Land Yes IX No
3. Name of the water body w re the project site is located:
JL-r--wo
4. Description of the water body in which the project site is located (check all that apply):
Type Nature Designation
Nontidal river/stream Natural EJ Area of Critical Environmental Concern
Flowed tidelands Enlarged/dammed El Designated Port Area
EJ Filled tidelands Uncertain F1 Ocean Sanctuary
El Great Pond E] Uncertain
[:] Uncertain
CH91 App.doc-Rev. 10/02 Page 2 of 17
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Waterways Regulation Program
Chapter 91 Waterways License Application .310 CIVIR 9.00 Transmittal No.
Simplified,Water-Dependent, Nonwater-Depenclent,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" 6�1 61109, rOCT-fm7e it I rr 0!5 11 ler,
V�R c6mc e e*e ULLOC ��J_i a' C4&i OAY [AJ 1�n,[ I;X Y --V
1�7t-Os:�-r-iNG,,-n m acie--
6. Is the project a pre-1 984 existing structure AND less than 600 square feet?
;4 Yes F-1 No
7. Is the project a post-1 984 existing or new structure, less than 300 square feet AND water dependent?
El Yes D No
8. What is the estimated total cost of proposed work (including materials &labor)?
9. 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.
Name Address
Name Address
Name Address
D. Project Plans
1. 1 have attached plans for my project in accordance with the instructions contained in (check one):
Appendix A(License plan) El Appendix B (Simplified License plan) El Appendix C (Permit plan)
2. Other State and Local Approvals/Certifications
El 401 Water Quality Certificate
Date of Issuance
El Wetlands
File Number
El Jurisdictional Determination JD-
File Number
Ll MEPA
File Number
EOEA Secretary Certificate
Date
El 21 E Waste Site Cleanup
RTN Number
CH91App.doc-Rev. 10/02 Page 3 of 17
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Waterways Regulation Program
Chapter 91 Waterways License Application -310 CIVIR 9.00
Simplified,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 h s true and accurate to the best of my
kn
Date'
Property Owne�s signature(if different than'aPPlicant) Date
Agent's signatu Date
APPLICANTS FILING A SIMPLIFIED APPLICATION STOP HERE
CHMpp.doc-Rev. 10/02 Page 4 of 17
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Waterways Regulation Program W10,50 16
Chapter 91 Waterways License Application -310 CMR 9.00 Transmittal No.
Simplified,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
Purpt!RrEd�ing
2. What is the volume (cubic yards)of material to be dredged?
3. What method will be used to dredge?
El Hydraulic El Mechanical E-1 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)l, public access easements below the existing high water mark shall be secured by
applicant and submitted to the Department.
CH91App.doc-Rev. 10/02 Page 5 of 17
Massachusetts Department of E rivirommental Protection
Bureau of Resource Protection -Waterways Regulation Program
Chapter 91 Waterways License Application -310 CIVIR 9.00 Transmittal No.
Simplified,Water-Dependent, Nonwater-Depenclent,Amendment
G. Municipal Zoning Certificate
t--tTc—_— M � L
INdine o Applicant
V7 He-MENWLq Rr--) 5q L-t=:;
ProJect street aciaress Sw'aLteFr�way �� Cityrrown
Description of use or change in use:
0
05z-55 ,
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— Qt_y�own
CH91App.doc-Rev. 10/02 Page 6 of 17
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Waterways Regulation Program wo go I top,
Chapter 91 Waterways License Application -310 CIVIR 9.00 Transmittal No.
Simplified,Water-Dependent, Nonwater-Dependent,Amendment
H. Municipal Planning Board Notification
Notice to I
Applicant: OEANEZITE M%9lJ6!ltJL, ll)
Name of Ap licant
Section H should 17 gmezi U laij
be completed ana Project street address I Waterway Cityrrown
submitted along
with the orignal Description of use or change in use:
application mate rial.
Fotz u5E� WO Cl4QKYoE 10 (�61a- fS
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 wate ays
license application and plans have been submitted by the applicant to the municipal planning borward."
Tn—ntej,Name-of Municipal'official -6-a—te
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 CIVIR 9.13(4) and/or 310 CIVIR 9.17.
CH91App.doc-Rev. 10102 Page 7 of 17
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