PB_30 Leavitt Street Palmer Cove Park - Chapter 91 Notice - 2020.10.20
CH91App.doc • Rev. 03/17
Page 1 of 13
3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Waterways Regulation Program
Chapter 91 Waterways License Application - 310 CMR 9.00
Water-Dependent, Nonwater-Dependent, Amendment
X286614
Transmittal No.
Important: When
filling out forms
on the computer,
use only the tab
key to move your
cursor - do not
use the return
key.
For assistance
in completing this
application, please
see the
“Instructions”.
A. Application Information (Check one)
NOTE: For Chapter 91 Simplified License application form and information see the Self Licensing
Package for BRP WW06.
Name (Complete Application Sections) Check One Fee Application #
WATER-DEPENDENT -
General (A-H) Residential with < 4 units $215.00 BRP WW01a
Other $330.00 BRP WW01b
Extended Term $3,350.00 BRP WW01c
Amendment (A-H) Residential with < 4 units $100.00 BRP WW03a
Other $125.00 BRP WW03b
NONWATER-DEPENDENT -
Full (A-H) Residential with < 4 units $665.00 BRP WW15a
Other $2,005.00 BRP WW15b
Extended Term $3,350.00 BRP WW15c
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 WW17a
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 2 of 13
3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Waterways Regulation Program
Chapter 91 Waterways License Application - 310 CMR 9.00
Water-Dependent, Nonwater-Dependent, Amendment
X286614
Transmittal No.
B. Applicant Information Proposed Project/Use Information
1. Applicant:
Note: Please refer
to the “Instructions”
City of Salem
Name
slattrell@salem.com
E-mail Address
98 Washington Street, 2nd Floor
Mailing Address
Salem
City/Town
MA
State
01970
Zip Code
978-619-5685
Telephone Number
Fax Number
2. Authorized Agent (if any):
Robert H. Grffin, P.E.
Name
bgriffin@griffineng.com
E-mail Address
495 Cabot Street, 2nd Floor
Mailing Address
Beverly
City/Town
MA
State
01915
Zip Code
9789275111
Telephone Number
978 927 5103
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 455
Tax Assessor’s Map and Parcel Numbers
42°30'50.3"N
Latitude
70°53'21.5"
W
30 Leavitt Street, Salem
Street Address and City/Town
MA
State
01970
Zip Code
2. Registered Land Yes No
3. Name of the water body where the project site is located:
Palmer's Cove
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 3 of 13
3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Waterways Regulation Program
Chapter 91 Waterways License Application - 310 CMR 9.00
Water-Dependent, Nonwater-Dependent, Amendment
X286614
Transmittal No.
C. Proposed Project/Use Information (cont.)
Select use(s) from
Project Type Table
on pg. 2 of the
“Instructions”
5. Proposed Use/Activity description
Proposed renovation and public access improvements to City of Salem Palmer Cove Park. The
project involves removing an existing tennis court and baseball field; relocating Community Gardens;
construction of associated parking area;basketball court and softball field construction; and
constuction of various walkways and pathways throughout the park.
6. What is the estimated total cost of proposed work (including materials & labor)?
$
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 attached plans)
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 064-0700
File Number
Jurisdictional Determination JD-
File Number
MEPA
File Number
EOEA Secretary Certificate
Date
21E Waste Site Cleanup
RTN Number
CH91App.doc • Rev. 03/17
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3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Waterways Regulation Program
Chapter 91 Waterways License Application - 310 CMR 9.00
Water-Dependent, Nonwater-Dependent, Amendment
X286614
Transmittal No.
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. 03/17
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Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Waterways Regulation Program
Chapter 91 Waterways License Application - 310 CMR 9.00
Water-Dependent, Nonwater-Dependent, Amendment
X286614
Transmittal No.
F. Waterways Dredging Addendum
1. Provide a description of the dredging project
Maintenance Dredging (include last dredge date & permit no.) Improvement Dredging
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
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3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Waterways Regulation Program
Chapter 91 Waterways License Application - 310 CMR 9.00
Water-Dependent, Nonwater-Dependent, Amendment
X286614
Transmittal No.
G. Municipal Zoning Certificate
City of Salem
Name of Applicant
30 Leavitt Street (Palmer Cove Park)
Project street address
Palmer Cove
Waterway
Salem
City/Town
Description of use or change in use:
Proposed renovation and public access improvements to Palmer Cove Park
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
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3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Waterways Regulation Program
Chapter 91 Waterways License Application - 310 CMR 9.00
Water-Dependent, Nonwater-Dependent, Amendment
X286614
Transmittal No.
H. Municipal Planning Board Notification
Notice to
Applicant:
Section H should
be completed and
submitted along
with the original
application material.
City of Salem
Name of Applicant
30 Leavitt Street (Palmer Cove Park)
Project street address
Palmer Cove
Waterway
Salem
City/Town
Description of use or change in use:
Proposed renovation and public access improvements to Palmer Cove Park
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
City/Town
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.
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3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Waterways Regulation Program
Chapter 91 Waterways License Application - 310 CMR 9.00
Water-Dependent, Nonwater-Dependent, Amendment
X286614
Transmittal No.
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.
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Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Waterways Regulation Program
Chapter 91 Waterways License Application - 310 CMR 9.00
Water-Dependent, Nonwater-Dependent, Amendment
X286614
Transmittal No.
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.
CH91App.doc • Rev. 03/17
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3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Waterways Regulation Program
Chapter 91 Waterways License Application - 310 CMR 9.00
Water-Dependent, Nonwater-Dependent, Amendment
X286614
Transmittal No.
Appendix A: License Plan Checklist Cont.
CH91App.doc • Rev. 03/17
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3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Waterways Regulation Program
Chapter 91 Waterways License Application - 310 CMR 9.00
Water-Dependent, Nonwater-Dependent, Amendment
X286614
Transmittal No.
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).
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3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Waterways Regulation Program
Chapter 91 Waterways License Application - 310 CMR 9.00
Water-Dependent, Nonwater-Dependent, Amendment
X286614
Transmittal No.
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)(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.
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 15th and 30th of each month.
CH91App.doc • Rev. 03/17
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3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Waterways Regulation Program
Chapter 91 Waterways License Application - 310 CMR 9.00
Water-Dependent, Nonwater-Dependent, Amendment
X286614
Transmittal No.
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 7 of 13
3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Waterways Regulation Program
Chapter 91 Waterways License Application - 310 CMR 9.00
Water-Dependent, Nonwater-Dependent, Amendment
X286614
Transmittal No.
H. Municipal Planning Board Notification
Notice to
Applicant:
Section H should
be completed and
submitted along
with the original
application material.
City of Salem
Name of Applicant
30 Leavitt Street (Palmer Cove Park)
Project street address
Palmer Cove
Waterway
Salem
City/Town
Description of use or change in use:
Proposed renovation and public access improvements to Palmer Cove Park
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
City/Town
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.