64-450 - 6 DEARBORN LANE - CONSERVATION COMMISSION pr f 450 M -- m
E RV ATtON COMMISSION
X ) NIS 1::�C
April 26, 2010
Lenny Papalardo
6 Dearborn Lane
Salem, MA 01970
Re: Certificate of Compliance—DEP #64-450— 6 Dearrhom Lane, Salem, MA
Dear Mr. Papalardo:
Enclosed, please find the Certificate of Compliance for the above referenced project. This
Document must be recorded at the Essex County Registry of Deeds, Shetland Park 45
Congress Street, Suite 4100 Salem, Massachusetts. Please fill out and return the Recording
Information on page 4 of the Certificate of Compliance, which will indicate to the Salem
Conservation Commission that the document has been recorded.
If you have any further questions please feel free to contact me at (978) 619-5685.
Sincerely,
Carey Du Lies
Conservation Agent/ Staff Planner
Enclosures
CC: DEP Northeast Regional Office
Massachusetts Department of Environmental Protection
`r -- Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 8B - Certificate of Compliance 64-450
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Providedby DEP
A. Project Information
Important:
When filling out 1. This Certificate of Compliance is issued to:
forms on the
computer,use Samuel L Papalardo
only the tab key Name
to move your 6 Dearborn Lane
cursor-do not Mailing Address
use the return
key. Salem MA 01970
p City/Town State Zip Code
2. This Certificate of Compliance is issued for work regulated by a final Order of
Conditions issued to:
Samuel L. Papalardo
Name
June 26, 2007 64-450
Dated DEP File Number
3. The project site is located at:
6 Dearborn Lane Salem
Street Address Citylrown
36 502
Assessors Map/Plat Number Parcel/Lot Number
the final Order of Condition was recorded at the Registry of Deeds for:
Samuel L. P_aLalardo _
Property Owner(if different)
Essex 26994 416 _
County Book Page
Certificate
4. A site inspection was made in the presence of the applicant, or the applicant's agent,
on:
March 11, 2010
Date
wpafrmBb.doc-rev.12123109 J WPA Form Be,Certificate of Compliance-Page 1 of 3
Massachusetts Department of Environmental Protection
— Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 8B — Certificate of Compliance 64-450
I '
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 p o ided by DEP
D. Recording Confirmation
The applicant is responsible for ensuring that this Certificate of Compliance is recorded in
the Registry of Deeds or the Land Court for the district in which the land is located.
Detach on dotted line and submit to the Conservation Commission.
To:------- --- - --- - - ----- - - ------ -- - --- - --- --- -- --------- ----------
Conservation Commission
Please be advised that the Certificate of Compliance for the project at:
Project Location DEP File Number
Has been recorded at the Registry of Deeds of:
County
for:
Property Owner
and has been noted in the chain of title of the affected property on:
Date Book Page
If recorded land, the instrument number which identifies this transaction is:
If registered land, the document number which identifies this transaction is:
Document Number
Signature of Applicant
wpatrm8b.boc•rev.1223I09 WPA Form 88,Certificate of Compliance-Page 3 of 3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 8B — Certificate of Compliance
64-450
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 provided by DEP
B. Certification
Check all that apply: .
® Complete Certification: It is hereby certified that the work regulated by the
above-referenced Order of Conditions has been satisfactorily completed.
❑ Partial Certification: It is hereby certified that only the following portions of work
regulated by the above-referenced Order of Conditions have been satisfactorily
completed. The project areas or work subject to this partial certification that have
been completed and are released from this Order are:
❑ Invalid Order of Conditions: It is hereby certified that the work regulated by the
above-referenced Order of Conditions never commenced. The Order of
Conditions has lapsed and is therefore no longer valid. No future work subject to
regulation under the Wetlands Protection Act may commence without filing a new
Notice of Intent and receiving a new Order of Conditions.
❑ Ongoing Conditions: The following conditions of the Order shall continue:
(Include any conditions contained in the Final Order, such as maintenance or
monitoring, that should continue for a longer period).
Condition Numbers:
C. Authorization
Issued by:
Salem Z(Q 10
Consery n Commission Da a of Is uance
Thi Certificate must be signed by a majority of the Conservatl Commission and a
cop sent to the applic nt and appropriate DEP Regional Office (See
htt : www.mass. ov/ e /about/re ion/find our.htm).
Sign es:
� vv
wpalrm8b.dcc•rev.12/23M WPA Form Be,Certificate of Compliance•Page 2 of 3
��CONWT�
3 CITY OF SALEM
CONSERVATION COMMISSION
July 5, 2007
Lenny Papalardo
6 Dearborn Lane
Salem, MA 01970
Re: Notice of Project Change—DEP#64-450
6 Dearborn Lane, Salem,Massachusetts
Dear Mr. Papalardo:
As you are aware, at the last Conservation Commission Meeting, held June 28, 2007, the
Commission approved your request for a Notice of Project change to an existing Order of
Conditions under DEP #64-450.
The approved change in your proposed project was to add a ten (10) foot by ten (10) foot
deck to the existing seawall, including four additional pilings, which will connect to a
proposed staircase, gangway and associated float. The Commission voted unanimously
four (4) in favor zero (0) against that the project change did not require an amendment to
the existing Order of Conditions which had been voted on at the regularly scheduled
meeting held June 14,2007.
The Order of Conditions and Special Conditions issued under DEP #64-450 apply to this
updated project. Revised plans
P� P J p shall be submitted to DEP s Wetland Division at the
Wilmington office as well as DEP's Regional Office in Boston in order to file for a
Chapter 91 license.
If you have any further questions,please feel free to contact me 978-619-5685.
Sincere]
Carey Duq es
Conservatio Agent/Staff Planner
CC: DEP Northeast Regional Office
"0(pNOIr.
of � "'P
CITY OF SALEM
CONSERVATION COMMISSION
June 26, 2007
Lenny Papalardo
6 Dearborn Lane
Salem, MA 01970
Re: Order of Conditions—DEP#64-450
6 Dearborn Lane, Salem,Massachusetts
Dear Mr. Papalardo:
Enclosed, please find the Order of Conditions for the above referenced project.
Following the 10-day appeal period (as of July 6, 2007), this document and the attached
Special Conditions must be recorded at the Essex County Registry of Deeds (36 Federal
Street, Salem, MA). Once recorded, please return a copy of Page 9 of the Order, which
will indicate to the Commission that the document has been recorded.
As indicated in the Order, prior to any work commencing:
1. this Order must be recorded,
2. a sign shall be displayed showing DEP File# 64-450 within public view, and
3. contact me at least 48 hours prior to any activity to schedule a pre-construction
meeting to review the Order with your hired contractor.
If you have any further questions,please feel free to contact me 978-619-5685.
erely,
Carey uques
Cone ation A nt/Staff Planner
Enclosures
CC: DEP Northeast Regional Office
r
L1Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
1 WPA Form 5 _ Order of Conditions 64-450
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
A. General Information
Important: Salem
When filling From: 1.Conservation Commission
out forms on
the computer, 2.This issuance is for (check one): a. ® Order of Conditions b. ❑ Amended Order of Conditions
use only the
tab key to 3.To: Applicant:
move your
cursor-do not Samuel Papalardo
use the return a. First Name b.Last Name c.Company
key. 6 Dearborn Lane
d. Mailing Address
m Salem MA 01970
e.City/Town I.State g.Zip Code
4. Property Owner(if different from applicant):
a. First Name b. Last Name c.Company
d. Mailing Address
e.City/Town I.State g.Zip Code
s. Project Location:
6 Dearborn Lane Salem
a.Street Address b.City/Town
36 502
c.Assessors Map/Plat Number d. Parcel/Lot Number
Latitude and Longitude, if known (note: 42 31' 57" 70 53 43"
electronic filers will click for GIS locator): e.Latitude I.Longitude
s. Property recorded at the Registry of Deeds for (attach additional information if more than one parcel):
Essex
a.County b.Certificate(if registered land)
6351 169
c.Book d.Page
May 31, 2007 May 31, 2007 June 26, 2007
7. Dates: a. Date Notice of Intent Filed b. Date Public Hearing Closed c.Date of Issuance
B. Final Approved Plans and Other Documents (attach additional plan or document references as
needed):
6 Dearborn Lane proposed staircase, 36' long-4' wide deck, proposed 40' long gangway, and 12' by
20'float
Rafic Y. Khalil Rafic Y. Khalil
b. Prepared By c.Signed and Stamped by
November 2, 2006 1"=20'
d. Final Revision Date e. Scale
I.Additional Plan or Document Title g. Date
vvpaforrrS.doo• rev.3/1/05 Page 1 of 9
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 5 - Order of Conditions 64-450
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Findings
1. Findings pursuant to the Massachusetts Wetlands Protection Act:
Following the review of the above-referenced Notice of Intent and based on the information provided
in this application and presented at the public hearing, this Commission finds that the areas in which
work is proposed is significant to the following interests of the Wetlands Protection Act. Check all that
apply:
a. ® Public Water Supply b. ® Land Containing Shellfish c. ® Prevention of Pollution
d. ® Private Water Supply a. ® Fisheries I. ® Protection of Wildlife
Habitat
g. ® Groundwater Supply h. ® Storm Damage Prevention i. ® Flood Control
2. This Commission hereby finds the project, as proposed, is: (check one of the following boxes)
Approved subject to:
a. ® the following conditions which are necessary in accordance with the performance standards set
forth in the wetlands regulations. This Commission orders that all work shall be performed in
accordance with the Notice of Intent referenced above, the following General Conditions, and any
other special conditions attached to this Order.To the extent that the following conditions modify or
differ from the plans, specifications, or other proposals submitted with the Notice of Intent, these
conditions shall control.
Denied because:
b. ❑ the proposed work cannot be conditioned to meet the performance standards set forth in the
wetland regulations.Therefore, work on this project may not go forward unless and until a new Notice
of Intent is submitted which provides measures which are adequate to protect these interests, and a
final Order of Conditions is issued. A description of the performance standards which the
proposed work cannot meet is attached to this Order.
c. ❑ the information submitted by the applicant is not sufficient to describe the site, the work, or the
effect of the work on the interests identified in the Wetlands Protection Act. Therefore, work on this
project may not go forward unless and until a revised Notice of Intent is submitted which provides
sufficient information and includes measures which are adequate to protect the Act's interests, and a
final Order of Conditions is issued. A description of the specific information which is lacking and
why it is necessary is attached to this Order as per 310 CMR 10.05(6)(c).
Inland Resource Area Impacts: Check all that apply below. (For Approvals Only)
3. ❑ Buffer Zone Impacts: Shortest distance between limit of project disturbance and
wetland boundary (if available) a.linear feet
Resource Area Proposed Permitted Proposed Permitted
Alteration Alteration Replacement Replacement
4. ❑ Bank a.linear-feet b.linear(feet c.linear(feet d.linear feet
5. ❑ Bordering Vegetated
Wetland a.square feet b.square feet c.square feet d.square feet
6. ElLand Under W aterbodies a.square feet b.square feet c.square feet d.square feet
and Waterways
e.cu.yd dredged f.cu.yd dredged
vvpaform5.dx• rev.3/1/05 Page 2 of 9
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 5 - Order of Conditions 64.450
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Findings (cont.)
Resource Area Proposed Permitted Proposed Permitted
Alteration Alteration Replacement Replacement
7. ❑ Bordering Land
Subject t0 Flooding a.square feet b.square feet c.square feet d.square feet
Cubic Feet Flood Storage e.cubic feet f.cubic feet g.cubic feet h.cubic feet
a. ❑ Isolated Land Subject
to Flooding a.square feet b.square feet
Cubic Feet Flood Storage c.cubic feet d.cubic feet e.cubic feet f.cubic feet
560 Sao
s. ® Rivertront area
a.total sq.feet b.total sq.teat
Sq ft within 100 It c.square feet d.square feet e.square feet f.square feet
Sq ft between 100-200 ft
g.square feet h.square feet L square feet j.square feet
Coastal Resource Area Impacts: Check all that apply below. (For Approvals Only)
1o. ❑ Designated Port Areas Indicate size under Land Under the Ocean, below
11. ® Land Under the Ocean a,square rest b.square feet
c.cu.yd dredged d.cu.yd dredged
12. ❑ Barrier Beaches Indicate size under Coastal Beaches and/or Coastal Dunes below
13. ❑ Coastal Beaches a.square feet b.square feet c.c/y nourishmt d.c/y nourishmt.
14. El Coastal Dunes a.square feet b.square feet c.c/y nourishmt, d.c/y nourishmt
15. ❑ Coastal Banks a.linear feet b.linear feet
16. ❑ Rocky Intertidal Shores a.square feet b.square feet
17. ❑ Salt Marshes a.square feet b.square feet c.square feet d.square feet
1e. ❑ Land Under Salt Ponds a.square feet b.square feet
c.cu.yd dredged d.cu.yd dredged
19. ❑ Land Containing
Shellfish a.square feet b.square feet c.square feet d.square feet
20. ❑ Fish Runs Indicate size under Coastal Banks, inland Bank, Land Under the
Ocean, and/or inland Land Under Waterbodies and Waterways,
above
a.cu.yd dredged b.cu.yd dredged
21. ❑ Land Subject to Coastal
Storm Flowage a.square feet b.square feet
wpafomS.tloc• rev.3/1/06 Page 3 of 9
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 5 - Order of Conditions 64-450
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
C. General Conditions Under Massachusetts Wetlands Protection Act
(only applicable to approved projects)
1. Failure to comply with all conditions stated herein, and with all related statutes and other regulatory
measures, shall be deemed cause to revoke or modify this Order.
2. The Order does not grant any property rights or any exclusive privileges; it does not authorize any
injury to private property or invasion of private rights.
3. This Order does not relieve the permittee or any other person of the necessity of complying with all
other applicable federal, state, or local statutes, ordinances, bylaws, or regulations.
4. The work authorized hereunder shall be completed within three years from the date of this Order
unless either of the following apply:
a. the work is a maintenance dredging project as provided for in the Act; or
b. the time for completion has been extended to a specified date more than three years, but less
than five years, from the date of issuance. If this Order is intended to be valid for more than three
years, the extension date and the special circumstances warranting the extended time period are
set forth as a special condition in this Order.
5. This Order may be extended by the issuing authority for one or more periods of up to three years each
upon application to the issuing authority at least 30 days prior to the expiration date of the Order.
6. Any fill used in connection with this project shall be clean fill. Any fill shall contain no trash, refuse,
rubbish, or debris, including but not limited to lumber, bricks, plaster, wire, lath, paper, cardboard,
pipe, tires, ashes, refrigerators, motor vehicles, or parts of any of the foregoing.
7. This Order is not final until all administrative appeal periods from this Order have elapsed, or if such
an appeal has been taken, until all proceedings before the Department have been completed.
8. No work shall be undertaken until the Order has become final and then has been recorded in the
Registry of Deeds or the Land Court for the district in which the land is located, within the chain of title
of the affected property. In the case of recorded land, the Final Order shall also be noted in the
Registry's Grantor Index under the name of the owner of the land upon which the proposed work is to
be done. In the case of the registered land, the Final Order shall also be noted on the Land Court
Certificate of Title of the owner of the land upon which the proposed work is done. The recording
information shall be submitted to this Conservation Commission on the form at the end of this Order,
which form must be stamped by the Registry of Deeds, prior to the commencement of work.
9. A sign shall be displayed at the site not less then two square feet or more than three square feet in
size bearing the words,
"Massachusetts Department of Environmental Protection" [or, "MA DEP"j
"File Number 64-450 "
wpaform5AX• rev.3/1/05 Page 4 of 9
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 5 - Order of Conditions 64-450
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
C. General Conditions Under Massachusetts Wetlands Protection Act
10. Where the Department of Environmental Protection is requested to issue a Superseding Order, the
Conservation Commission shall be a party to all agency proceedings and hearings before DEP.
11. Upon completion of the work described herein, the applicant shall submit a Request for Certificate of
Compliance (WPA Form 8A)to the Conservation Commission.
12. The work shall conform to the plans and special conditions referenced in this order.
13. Any change to the plans identified in Condition #12 above shall require the applicant to inquire of the
Conservation Commission in writing whether the change is significant enough to require the filing of a
new Notice of Intent.
14. The Agent or members of the Conservation Commission and the Department of Environmental
Protection shall have the right to enter and inspect the area subject to this Order at reasonable hours
to evaluate compliance with the conditions stated in this Order, and may require the submittal of any
data deemed necessary by the Conservation Commission or Department for that evaluation.
15. This Order of Conditions shall apply to any successor in interest or successor in control of the
property subject to this Order and to any contractor or other person performing work conditioned by
this Order.
16. Prior to the start of work, and if the project involves work adjacent to a Bordering Vegetated Wetland,
the boundary of the wetland in the vicinity of the proposed work area shall be marked by wooden
stakes or flagging. Once in place, the wetland boundary markers shall be maintained until a Certificate
of Compliance has been issued by the Conservation Commission.
17. All sedimentation barriers shall be maintained in good repair until all disturbed areas have been fully
stabilized with vegetation or other means. At no time shall sediments be deposited in a wetland or
water body. During construction, the applicant or his/her designee shall inspect the erosion controls
on a daily basis and shall remove accumulated sediments as needed. The applicant shall immediately
control any erosion problems that occur at the site and shall also immediately notify the Conservation
Commission, which reserves the right to require additional erosion and/or damage prevention controls
it may deem necessary. Sedimentation barriers shall serve as the limit of work unless another limit of
work line has been approved by this Order.
18. All work associated with this Order is required to comply with the Massachusetts Stormwater Policy
Standards.
Special Conditions:
If you need more
space for
additional
conditions,
select box to
attach a text
document
vvpaform5.dm• rev.3/1/05 Page 5 of 9
LIMassachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 5 - Order of Conditions 64-450
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
D. Findings Under Municipal Wetlands Bylaw or Ordinance
1. Is a municipal wetlands bylaw or ordinance applicable? ® Yes ❑ No
z. The hereby finds (check one that applies):
Conservation Commission
3. ❑ that the proposed work cannot be conditioned to meet the standards set forth in a municipal
ordinance or bylaw specifically:
a.Municipal Ordinance or Bylaw b.Citation
Therefore, work on this project may not go forward unless and until a revised Notice of Intent is
submitted which provides measures which are adequate to meet these standards, and a final Order of
Conditions is issued.
4. ❑ that the following additional conditions are necessary to comply with a municipal ordinance or
bylaw:
a.Municipal Ordinance or Bylaw b.Citation
The Commission orders that all work shall be performed in accordance with the following conditions
and with the Notice of Intent referenced above. To the extent that the following conditions modify or
differ from the plans, specifications, or other proposals submitted with the Notice of Intent, the
conditions shall control.
If you need more space for c. The special conditions relating to municipal ordinance or bylaw are as follows:
additional The special conditions attached to this Order of Conditions relate to both the City of Salem's local
conditions,select box to ordinance and the Massachusetts Wetlands Protection Act.
attach a text
document
Maform5.dw• rev.311/05 Page 6 of 9
Massachusetts Department of Environmental Protection
DEP File Number:
Bureau of Resource Protection - Wetlands
7L
WPA Form 5 — Order of Conditions 64-450
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
E. Issuance
This Order is valid for three years, unless otherwise specified as a special G .?Ip A4
condition pursuant to General Conditions #4,from the date of issuance. 1. ate of Iss ace
Please indicate the number of members who will sign this form: 5i k fo
This Order must be signed by a majority of the Conservation Commission. 2. Number df Sicffiers
The Order must be mailed by certified mail (return receipt requested) or hand delivered to the applicant. A
copy also must be mailed or hand delivered at the same time to the appropriate Department of
Environmental Prote tion Regional Office, if not ing electronically, and the property owner, if different
from applicant.
Signatures
4
Notary Acknowledgement
Commonwealth of Massachusetts County of Essex
14 June 2007
On this Day �f Month Year
Before me, the undersigned Notary Public, K. Cornacchio, D. Pabich, M. Blier, K. Glidden,
personally appeared D. Summer, A. Hamilton
proved to me through satisfactory evidence of identification, which was/were
personally known
Description of evidence of identification
to be the person whose name is signed on the preceding or attached document, and acknowledged to
me that he/she signed it voluntarily for its stated purpose.
As member of Salem Conservation Commission
City/Town
6 CANY 11.-�vw�wori
r./y Ca.r M�far Eiplrm
g„' Signatur of Notary Public
Carey . Duques
Printed Name of Notary Public
16 13
Place notary seal and/or any stamp above August
My Commisssioonn Expires(Date)
This Order is issued to the applicant as follows:
❑ by hand delivery on by certified mail, return receipt requested, on
14A A , Jbo�
Date Date
wpatorm5.00c• rev.X1/05 Page 7 of 9
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 5 - Order of Conditions 64-450
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
F. Appeals
The applicant, the owner, any person aggrieved by this Order, any owner of land abutting the land subject
to this Order, or any ten residents of the city or town in which such land is located, are hereby notified of
their right to request the appropriate DEP R i
9 QRegional Office to issue a Superseding Order of 9 p g Conditions.
Therequest
e uest must be made b certified mail or hand delivery
q Y e to the Department, with the appropriate rY P filing
fee and a completed Request of Departmental Action Fee Transmittal Form, as provided in 310 CMR
10.03(7) within ten business days from the date of issuance of this Order. A copy of the request shall at
the same time be sent by certified mail or hand delivery to the Conservation Commission and to the
applicant, if he/she is not the appellant. Any appellants seeking to appeal the Department's Superseding
Order associated with this appeal will be required to demonstrate prior participation in the review of this project.
Previous participation in the permit proceeding means the submission of written information to the
Conservation Commission prior to the close of the public hearing, requesting a Superseding Order or
Determination, or providing written information to the Department prior to issuance of a Superseding Order
or Determination.
The request shall state clearly and concisely the objections to the Order which is being appealed and how
the Order does not contribute to the protection of the interests identified in the Massachusetts Wetlands
Protection Act, (M.G.L. c. 131, § 40) and is inconsistent with the wetlands regulations (310 CMR 10.00).
To the extent that the Order is based on a municipal ordinance or bylaw, and not on the Massachusetts
Wetlands Protection Act or regulations, the Department has no appellate jurisdiction.
Section G, Recording Information is available on the following page.
wpaform5.ow• rev.3/1/08
Page 8 of 9
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 5 - Order of Conditions 64-450
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
G. Recording Information
This Order of Conditions must be recorded in the Registry of Deeds or the Land Court for the district in
which the land is located, within the chain of title of the affected property. In the case of recorded land, the
Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land
subject to the Order. In the case of registered land, this Order shall also be noted on the Land Court
Certificate of Title of the owner of the land subject to the Order of Conditions. The recording information
on Page 7 of this form shall be submitted to the Conservation Commission listed below.
Salem
Conservation Commission
Detach on dotted line, have stamped by the Registry of Deeds and submit to the Conservation Commission.
- -----------------------------------------------
To:
Salem
Conservation Commission
Please be advised that the Order of Conditions for the Project at:
6 Dearborn Lane 64-450
Project Location DEP File Number
Has been recorded at the Registry of Deeds of:
County Book Page
for:
Property Owner
and has been noted in the chain of title of the affected property in:
Book Page
In accordance with the Order of Conditions issued on:
Date
If recorded land, the instrument number identifying this transaction is:
Instrument Number
If registered land, the document number identifying this transaction is:
Document Number
Signature of Applicant
wpalorr 5.00c• rev.3/1/05 Page 9 at 9
Attachment to Order of Conditions # 64-450
Page lof 5
SALEM CONSERVATION COMMISSION
DEP FILE #64-450
6 Dearborn Lane
City of Salem, Massachusetts
ADDITIONAL FINDINGS
Based on the Estimated Habitats or Rare Wildlife and Certified Venial Pools Map (June 1, 2003) from Natural
Heritage &Endangered Species Program(NHESP) of the Massachusetts Division of Fisheries and Wildlife, it has
been determined that this project does not occur near any habitat of state-listed rare wildlife species nor contains any
vernal pools.
This Order is issued under the Massachusetts Wetlands Protection Act,M.G.L. Chapter 131,Section 40 and the City
of Salem Wetlands Protection Ordinance, Salem Code Chapter 34,Section 34-1—34-13.
This Order permits the construction of a 36 foot long by four foot deck pier with associated wooden access stairs , a
40 foot long gangway and 12 foot by 20 foot float at 6 Dearborn Lane. The pilings are to be 10 feet by 10 feet in
diameter. All work is to be done from the water side at high tide. The machinery may have to remain on the mud
flats during one tide cycle. The float is not to be left on the salt marsh during the winter months.
GENERAL CONDITIONS
1. This Order of Conditions must be recorded in its entirety(all 5 pages) at the Essex County Registry of
Deeds or the Land Court for the district in which the land is located, after the expiration of the 10-day
appeal period and within 30 days of the issuance. A copy of the recording information must be
submitted to the Salem Conservation Commission before any work approved in this Order
commences.
2. Approval of this application does not constitute compliance with any law or regulation other than
M.G.L Chapter 131, Section 40, Wetlands Regulations 310 CMR 10.00 and the City of Salem Wetlands
Protection Ordinance, Salem Code Chapter 34,Section 34-1 —34-13.
3. All work shall be performed in accordance with this Order of Conditions and approved site plan(s). No
alteration of wetland resource areas or associated buffer zones, other than that approved in this Order,
shall occur on this property without prior approval from the Commission.
4. Prior to any work commencing, a sign shall be displayed showing DEP File#64-450, and not placed on
a living tree.
5. No work approved in this Order may commence until the ten(10)day appeal period has lapsed from the
date of the issuance of this Order.
6. With respect to this Order, the Commission designates the Conservation Agent as its agent with powers
to act on its behalf in administering and enforcing this Order.
7. The Commission or its Agent, officers,or employees shall have the right to enter and inspect the property at
any time for compliance with the conditions of this Order,the Wetlands Protection Act MGL Chapter 131,
Attachment to Order of Conditions # 64-450
Page 2of 5
Section 40,the Wetlands Regulations 310 CMR 10.00,and shall have the right to require any data or
documentation that it deems necessary for that evaluation.
8. The term"Applicant"as used in this Order of Conditions shall refer to the owner, any successor in
interest or successor in control of the property referenced in the Notice of intent, supporting documents
and this Order of Conditions. The Commission shall be notified in writing within 30 days of all
transfers of title of any portion of the property that takes place prior to issuance of the Certificate of
Compliance.
9. It is the responsibility of the applicant to procure all other applicable federal, state and local permits and
approvals associated with this project. These permits may include but are not necessarily limited to the
following:
(1) Section 404 of the Federal Water Pollution Control Act(P.L. 92-500, 86 stat. 816), U.S. Army
Corps of Engineers.
(2) Water Quality Certification in accordance with the Federal Water Pollution Control under authority
of sec. 27(5)of Chapter 21 of the Massachusetts General Laws as codified in 314 CMR 9.00.
(3) Sewer Extension Permit from the DEP Division of Water Pollution Control under G. L. Ch. 21A ss7
and 314 CMR 7.00. Any Board of Health permit for septic system design for any portion of the
septic system within 100 feet of wetlands shall be submitted to the Commission prior to
construction initiation.
(4) Design Requirements for Construction in Floodplains under the State Building Code(780 CMR
744.).
10. If there are conflicting conditions within this Order,the stricter condition(s) shall rule.
II. All work shall be performed so as to ensure that there will be no sedimentation into wetlands and
surface waters during construction or after completion of the project.
12. The Commission or its Agent shall have the discretion to modify the erosion/siltation control methods
and boundary during construction if necessary.
13. The Commission reserves the right to impose additional conditions on portions of this project or this site
to mitigate any actual or potential impacts resulting from the work herein permitted.
14. The work shall conform to the following attached plans and special conditions:
Final Approved Plans
6 Dearborn Lane showing addition of staircase 36 foot Ion deck,eck proposed 40 foot lone
gangway, and 12' X 20' float
(Title)
September 15, 2006
(Dated)
Rafic Y. Khalil
(Signed and Stamped by)
City of Salem Conservation Commission
(On file with)
15. Any proposed changes in the approved plan(s) or any deviation in construction from the approved
plan(s) shall require the applicant to file a Notice of Project Change with the Commission. The Notice
Attachment to Order of Conditions # 64-450
Page 3of 5
shall be accompanied by a written inquiry prior to their implementation in the field, as to whether the
change(s) is substantial enough to require filing a new Notice of Intent or a request to correct or amend
this Order of Conditions. A copy of such request shall at the same time be sent to the Department of
Environmental Protection.
16. In conjunction with the sale of this property or any portion thereof before a Certificate of Compliance has
been issued, the applicant or current landowner shall submit to the Commission a statement signed by the
buyer that he/she is aware of an outstanding Order of Conditions on the property and has received a copy of
the Order of Conditions.
PRIOR TO CONSTRUCTION
17. Prior to the commencement of any activity on this site other than activities listed above,there
shall be a Pre-Construction Meeting between the project supervisor, the contractor responsible for the
work, and a member of the Conservation Commission or its Administrator to ensure that the
requirements of the Order of Conditions are understood. The staked erosion control line shall be
adjusted,if necessary,during the pre-construction meeting. Please contact the Conservation Commission
Agent at(978)745-9595 ext 311 at least forty-eight (48)hours prior to any activity to arrange for the
pre-construction meeting.
18. Prior to the pre-construction meeting and commencement of any activity on this site,sedimentation and
erosion control barriers shall be installed as shown on the approval plan(s)and detail drawings. The
Commission and/or its Administrator shall inspect and approve such installation at the pre-construction
meeting.
19. No clearing of vegetation, including trees, or disturbance of soil shall occur prior to the pre-construction
meeting. Minimal disturbance of shrubs and herbaceous plants shall be allowed prior to the pre-
construction meeting if absolutely necessary in order to place erosion control stakes where required.
EROSION CONTROL
20. Appropriate erosion control devices shall be in place prior to the beginning of any phase of construction,
and shall be maintained during construction in the wetland areas and buffer zones. The erosion control
specifications provided in the Notice of Intent and the erosion control provision in the Order will be the
minimum standards for this project; the Commission may require additional measures.
21. All debris, fill and excavated material shall be stockpiled a location far enough away from the wetland
resource areas to prevent sediment from entering wetland resource areas.
22. Erosion and sedimentation control devices shall be inspected after each storm event and repaired or
replaced as necessary. Any accumulated silt adjacent to the barriers shall be removed.
23. The area of construction shall remain in a stable condition at the close of each construction day.
24. Any de-watering of trenches or other excavation required during construction shall be conducted so as
to prevent siltation of wetland resource areas. All discharge from de-watering activities shall be filtered
through hay bale sediment traps, silt filter bags or other means approved by the Commission or its
Administrator.
Attachment to Order of Conditions # 64-450
Page 4of 5
25. Within thirty(30)days of completion of construction on any given portion of the project,all disturbed
areas in the completed portion of the site shall be permanently stabilized with rapidly growing
vegetative cover, using sufficient top soil to assure long-term stabilization of disturbed areas.
26. If soils are to be disturbed for longer that two(2)months, a temporary cover of rye or other grass should
be established to prevent erosion and sedimentation. If the season is not appropriate for plant growth,
exposed surface shall be stabilized by other appropriate erosion control measures, firmly anchored, to
prevent soils from being washed by rain or flooding.
DURING CONSTRUCTION
27. A copy of this Order of Conditions and the plan(s)approved in this Order shall be available on site at all
times when work is in progress.
28. No alteration or activity shall occur beyond the limit of work as defined by the siltation barriers shown on
the approved plan(s).
29. All waste products,grubbed stumps, slash;construction materials,etc. shall be deposited at least 100 feet
from wetland resource areas and 200 feet from river.
30. Cement trucks shall not be washed out in any wetland resource or buffer zone area,nor into any drainage
system. Any deposit of cement or concrete products into a buffer zone or wetland resource area shall be
immediately removed.
31. All exposed sub-soils shall be covered by a minimum of three(3)inches of quality screened loam topsoil
prior to seeding and final stabilization.
32. Immediately following drainage structure installation all inlets shall be protected by silt fence,haybale
barriers and/or silt bags to filter silt from stormwater before it enters the drainage system.
33. There shall be no pumping of water from wetland resource areas.
34. All equipment shall be inspected regularly for leaks. Any leaking hydraulic lines,cylinders or any other
components shall be fixed immediately.
35. During construction, all drainage structures shall be inspected regularly and cleaned as necessary.
36. The applicant is herby notified that failure to comply with all requirements herein may result in the issuance
of enforcement actions by the Conservation Commission including, but not limited to,civil administrative
penalties under M.G.L Chapter 21A, section 16.
AFTER CONSTRUCTION
37. Upon completion of construction and final soil stabilization, the applicant shall submit the following to
the Conservation Commission to request a Certificate of Compliance (COC):
(1) A Completed Request for a Certificate of Compliance form(WPA Form 8A or other form if
required by the Conservation Commission at the time of request).
(2) A letter from a Registered Professional Engineer certifying compliance of the property with this
Order of Conditions.
(3) An "As-Built" plan signed and stamped by a Registered Professional Engineer or Land Surveyor
showing post-construction conditions within all areas under the jurisdiction of the Massachusetts
Wetlands Protection Act. This plan shall include at a minimum:
Attachment to Order of Conditions # 64-450
Page 5of 5
(a) All wetland resource area boundaries with associated buffer zones and regulatory setback
areas taken from the plan(s)approved in this Order of Conditions;
(b) Locations and elevations of all stormwater management conveyances, structures and best
management designs,including foundation drains,constructed under this Order within any
wetland resource area or buffer zone;
(c) Distances from any structures constructed under this Order to wetland resource areas-
"structures"include,but are not limited to,all buildings, septic system components,wells,
utility lines,fences,retaining walls,and roads/driveways;
(d) A line delineating the limit of work-"work"includes any filling,excavating and/or
disturbance of soils or vegetation approved under this Order;
38. When issued, the Certificate of Compliance must be recorded at the Essex County Registry of Deeds
and a copy of the recording submitted to the Salem Conservation Cormission.
39. If the completed work differs from that in the original plans and conditions, the report must specify how
the work differs; at which time the applicant shall first request a modification to the Order. Only upon
review and approval by the Commission, may the applicant request in writing a Certificate of
Compliance as described above.
40. Erosion control devices shall remain in place and properly functioning until all exposed soils have been
stabilized with final vegetative cover and the Conservation Commission and/or its Administrator has
authorized their removal.
ADDITIONAL CONDITIONS
41. Applicant shall obtain all necessary federal, state, and local permits prior to construction of the proposed
structure.
Massachusetts Department of Environmental Protection F�ruvdedEyDEPc
P -�ice?
Bureau of Resource Protection -Wetlands KPH
WPA Form 3 - Notice of Intent R
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Dowmeltt7ran acbonNnmterj
City/Town
A. General Information
1. Project Location (Note: electronic filers will click on button for GIS locator):
i pz�BDRN zAA✓t S,4L61+ Oi970
a.Street Address - b.City/Town c.Zip Code
Latitude and Longitude, if Known: HZ" �)I ' 57 n -ho S3` q31/
d.Latitude e.Longitude
f.Assessors Map/Plat Number g.Paroel/Lot Number
Important:
When filling out 2. Applicant:
fortes on the ,!�;4/nvEL &4t4q'fbp
computer,use a.First Name b.Last Name c.Company
only the tab
move
�E
key to move
your cursor- d. Mailing Address
do not use the 441f70
return key. e.City/Town f.State g.Zip Code
"^ h.Phone Number i. Fax Number j.Email address
3. Property owner(if different from applicant): ❑ Check if more than one owner
a.First Name b. Last Name c.Company
d.Mailing Address
Note:
Before e.City/Town f.State g.Zip Code
completing this
form consult h.Phone Number i.Fax Number j.Email address
your local
Conservation 4. Representative (if any):
Commission
regarding any a.Fir,
municipal bylaw
or ordinance. b.Contact Person First Name c.Contact Person Last Name
d.Mailing Address
e.City/Town f.State g.Zip Code
h.Phone Number i.Fax Number I.Email address
❑ Select if 5. Total WPA Fee Paid (from Appendix A,Wetland Fee Transmittal Form):
you want to see
Wetland Fee
Transmittal a.Total Fee Paid b.State Fee Paid a City/rown Fee Paid
Form.
6. General Project Description:
A- P(ee. 4 Dbcl< � DeC� , 6f l4ovk 1=40A:i
wyararlld«•rev.06M Pace t of a
Massachusetts Department of Environmental Protection Pro !k � ,
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Bureau of Resource Protection -Wetlands `
WPA Form 3 - Notice of Intent
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 °ot"""am'2raasaaortr�umber
Cityrrown
A. General Information (continued)
7. Project Type Checklist:
a. Single Family Home
b. ❑ Residential Subdivision
c. ❑ Limited Project Driveway Crossing
d. ❑ Commercial/Industrial
e. 9 Dock/Pier
f. ❑ Utilities
g. ❑ Coastal Engineering Structure
h. ❑ Agriculture—cranberries, forestry
ry
i. ❑ Transportation
j. ❑ Other
8. Property recorded at the Registry of Deeds for:
163ze
a.County
6.3si
b.Book
/69
c.Page Number
d.Certificate#(if registered land)
9. Buffer Zone Only
Is the project located only in the Buffer Zone of a bordering vegetated wetland, inland bank, or
coastal bank, coastal beach, coastal dune, or salt marsh?
a. ❑ Yes If yes, skip to Section C.
b. ❑ No If no, check the resource areas to be affected by this project, directly below.
wpaformsdoc•rev.06W Page 2 of 8
i
Massachusetts Department of Environmental Protection oEp
Bureau of Resource Protection -Wetlands '
EPfNe Nurriler'
WPA Form 3 — Notice of Intent - , .14
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
Cityrrown
B. Resource Area Effects
1. Inland Resource Areas
Check all that apply below. Attach narrative and any supporting documentation describing how the
project will meet all performance standards for each of the resource areas altered, including
standards requiring consideration of alternative project design or location.
Online Users: Resource Area Size of Proposed Alteration Proposed Replacement(if any)
Include your
document
transaction a. ❑ Bank 1. linear feet 2. linear feet
number b. ❑ Bordering Vegetated
(provided on Wetland 1.square feet 2.square feet
your receipt
page)with all c. ❑ Land Under 1.square feet 2.square feet
supplementary Waterbodies and
information you Waterways 3.cubic yards dredged
submit to the d. ❑ Bordering Land
Department. Subject to Flooding 1.square feet 2.square feet
3.cubic feet of flood storage lost 4.cubic feet of flood storage replaced
e. ❑ Isolated Land Subject
to_Flooding 1.square feet
2.cubic feet of flood storage lost 3.cubic feet of flood storage replaced
f. Riverfront area
1. Name of Waterway(if available):
No2T-1. K I U Oc CA Al
2.Width of Riverfront Area(check one):
❑ 25 ft. - Designated Densely Developed Areas only
❑ 100 ft. -New agricultural projects only IJ
❑ 200 ft. -All other projects
3.Total area of Riverfront Area on the site of the proposed project:
Square Feet
4. Proposed alteration of the Riverfront Area:
a.Total Square Feet -b.Square Feet within 100 ft. a Square Feet between 100 ft and 200IL
5. Has an alternatives analysis been done and is it attached to this NOI? ❑ Yes❑ No
6.Was the lot where the activity is proposed created prior to August 1, 1996? ❑ Yes❑ No
vparorm3.doc•nw,e6K3 Pape 3 or a
PrwMed y DEP' ' ... "`„ ;
Massachusetts Department of Environmental Protection tr ���
' f
Bureau of Resource Protection -Wetlands
WPA Form 3 - Notice of Intent k�,�-DoeurrrenthapsacharN
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 - `
Cityrrown
B. Resource Area Effects (continued)
2. Coastal Resource Areas:
Check all that apply below. Attach narrative and supporting documentation describing how the
project will meet all performance standards for each of the resource areas altered, including
standards requiring consideration of alternative project design or location.
Online Users:Include your Resource Area Size of Proposed Alteration Proposed Replacement(if any)
document
transaction a. ❑ Designated Port Areas Indicate size under Land Under the Ocean, below
number
(provided on b. ❑ Land Under the Ocean 1.Square feet
your receipt
page)with all 2.Cubic yards dredged
supplementary Indicate size under Coastal Beaches and/or Coastal Dunes
information you c. ❑ Barrier Beach below
submit to the
Department. d. ❑ Coastal Beaches 1.Square feet 2.Cubic yards beach nourishment
e. ❑ Coastal Dunes 1.Square feet 2.Cubic yards dune nourishment
f. ❑ Coastal Banks 1.Linear feet
g. ❑ Rocky Intertidal Shores 1.Square feet
h. ❑ Salt Marshes 1.Square feet 2.Sq ft restoration, rehab.,or creation
i. ❑ Land Under Salt Ponds 1.Square feet
2.Cubic yards dredged
j. ❑ Land Containing
Shellfish ;"' 1.Square feet 2.Square feet restoration,rehab.
k. ❑ Fish Runs Indicate size under Coastal Banks, inland Bank, Land Under the
)� Ocean, and/or inland Land Under Waterbodies and Waterways,
above
1.Cubic yards dredged
L ❑ Land Subject to Coastal
Storm Flowage 1.Square feet
3. Limited Project:
Is any portion of the proposed activity eligible to be treated as a limited project subject to 310 CMR
10.24 or 310 CMR 10.53?
a. ❑ Yes ❑ No If yes, describe which limited project applies to this project:
b.Limited Project
wpeformldx•rev.oa/W Page 4 of 8
.. Massachusetts Department of Environmental Protection by wz
Bureau of Resource Protection -Wetlands " Deat
k
WPA Form 3 - Notice of Intent
'=DowmentTransacbon`Ntlmber
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
City/rown
C. Bordering Vegetated Wetland Delineation Methodology
Check all methods used to delineate the Bordering Vegetated Wetland (BVW) boundary:
Online Users: 1. ❑ Final Order of Resource Area Delineation issued by Conservation Commission or DEP
Include your (attached)
document
transaction 2. ❑ DEP BVW Field Data Form(attached)
number
(provided on 3. ❑ Final Determination of Applicability issued by Conservation Commission or DEP(attached)
your receipt
page)with all 4. ❑ Other Methods for Determining the BVW Boundary(attach documentation):
supplementary
information you a. ❑ 50%or more wetland indicator plants
submit to the
Department. b. ❑ Saturated/inundated conditions exist
c. ❑ Groundwater indicators
d. ❑ Direct observation
For all projects
affecting other e. ❑ Hydric soil indicators
Resource
Areas, please f. ❑ Credible evidence of conditions prior to disturbance
attach a
narrative
explaining how
the resource
area was D. Other Applicable Standards and Requirements
delineated. pp q
1. Is any portion of the proposed project located in estimated habitat as indicated on the most recent
Estimated Habitat Map of State-Listed Rare Wetland Wildlife published by the Natural Heritage and
Endangered Species Program?
a. ❑ Yes X No If yes, include proof of mailing or hand delivery of NOI to:
Natural Heritage and Endangered Species Program
Division of Fisheries and Wildlife
Route 135, North Drive
Westborough, MA 01581
b.Date of Map
2. For coastal projects only, is any portion of the proposed project located below the mean high water
line or in a fish run?
Yes❑ No If yes, include proof of mailing or hand delivery of NOI to:
Massachusetts Division of Marine Fisheries
251 Causeway Street, Suite 400
Boston, MA 02114
❑ Not applicable—project is in inland resource area only
rpform3.eoc•rev.06/03 Pep 5 of a
Massachusetts Department of Environmental Protection Pl"m byoEP`
Bureau of Resource Protection -Wetlands 7 nra*ke N E N#6� K
, r
WPA Form 3 - Notice of Intent{
LI' l Massachusetts Wetlands Protection Act M.G.L. c. 131, §40oa�,B�cra
City/town
D. Other Applicable Standards and Requirements (continued)
3. Is any portion of the proposed project within an Area of Critical Environmental Concern (ACEC)?
a. El Yes No If yes, provide.name of ACEC (see instructions to WPA Form 3 or DEP
Website for ACEC locations). Note: electronic filers click on Website.
b.ACEC
Online Users: 4. Is any portion of the site subject to a Wetlands Restriction Order under the Inland Wetlands
Include your Restriction Act(M.G.L. c. 131, §40A) or the Coastal Wetlands Restriction Act(M.G.L. c. 130, § 105)?
document eee---���
transaction a. ❑ Yes Lip No
number
(provided on
your receipt 5. Is any activity within any Resource Area or Buffer Zone exempt from performance standards of the
page)with all wetlands regulations, 310 CMR 10.00.
supplementary
information you a. ❑ Yes '7�No If yes, describe which exemption applies to this project:
submit to the
Department. b. Exemption
6. Is this project subject to the DEP Stormwater Policy? a. ❑ Yes No
b. If yes, stormwater management measures are required. Applicants should complete Appendix B:
Stormwater Management Form and submit it with this forma
c. If no, explain why the project is exempt:
E. Additional Information
Applicants must include the following with this Notice of Intent(NOI). See instructions for details.
Online Users:Attach the document transaction number(provided on your receipt page)for any of
the following information you submit to the Department.
1. ❑ USGS or other map of the area (along with a narrative description, if necessary)containing
sufficient information for the Conservation Commission and the Department to locate the site.
(Electronic filers may omit this item.)
z. ❑ Plans identifying the location of proposed activities(including activities proposed to serve as
a Bordering Vegetated Wetland [BVW]replication area or other mitigating measure) relative to
the boundaries of each affected resource area.
wps mm3.d=•rev.06M Pepe 6 et a
aronaed by
Massachusetts Department of Environmental Protection nEp �
' Bureau of Resource Protection -Wetlands
a
Hti" !110
WPA Form 3 - Notice of Intent �` �E '
��;y. me�fiiwnsaclion Numb..
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
City/rown
E. Additional Information (continued)
3. ❑ Other material identifying and explaining the determination of resource area boundaries
shown on plans(e.g., a DEP BVW Field Data Form).
Online Users:
Include your 4. ❑ List the titles and dates for all plans and other materials submitted with this NO].
document 5. ❑ If there is more than one property owner, please attach a list of these property owners not
transaction listed on this form.
number
(provided on 6.❑ Attach proof of mailing for Natural Heritage and Endangered Species Program, if needed.
your receipt
page)with all 7 ❑ Attach proof of mailing for Massachusetts Division of Marine Fisheries, if needed.
supplementary
information you e. ❑ Attach Appendix A, see next page.
submit to the
Department. s. ❑ Attach Appendix B, if needed.
F. Fees
The fees for work proposed under each Notice of Intent must be calculated and submitted to the
Conservation Commission and the Department(see Instructions and Appendix B. Wetland Fee
Transmittal Form).
No fee shall be assessed for projects of the federal government, the Department, or cities and towns
of the Commonwealth.
Applicants must submit the following information (in addition to pages 1 and 2 of Appendix B)to
confirm fee payment:
zrat —
1.Municipal Chid/c Number 2.Check dat
6�� �j�fr 7
3.State Check Number 4.Check dare
5.Payor name on check:First Name 6.Payor name on check:Last Name
wperam&. -rer.06M peae7a5
Massachusetts Department of Environmental Protection arogee-by°EP' > �,
Bureau of Resource Protection -Wetlands
WPA Form 3 - Notice of Intent
Massachusetts Wetlands Wetlands Protection Act M.G.L. c. 131, §40
City/rown
G. Signatures and Submittal Requirements
I hereby certify under the penalties of perjury that the foregoing Notice of Intent and accompanying
plans, documents, and supporting data are true and complete to the best of my knowledge. I understand
that the Conservation Commission will place notification of this Notice in a local newspaper at the
expense of the applicant in accordance with the wetlands regulations, 310 CMR 10.05(5)(a).
I further certify under penalties of perjury that all abutters were notified of this application, pursuant to the
requireme is of M.G.L. c. 131, §40. Notice must be made in writing by hand delivery or certified mail
(return r i req e )to all abutters within 100 feet of the property line of the project location.
Slynituib ofA plioant Date
Signature of Property Owner(if different) Date
Signature of Representative(ff any) Date
For Conservation Commission:
Two copies of the completed Notice of Intent(Form 3), including supporting plans and documents; two
copies of pages 1 and 2 of Appendix B; and the city/town fee payment must be sent to the Conservation
Commission by certified mail or hand delivery.
For DEP:
One copy of the completed Notice of Intent(Form 3), including supporting plans and documents; one
copy of pages 1 and 2 of Appendix B; and a copy of the state fee payment must be sent to the DEP
Regional Office (see Instructions) by certified mail or hand delivery. (E-filers may submit these
electronically.
Other:
If the applicant has checked the "yes" box in any part of Section D, Item 3, above, refer to that section
and the Instructions for additional submittal requirements.
The original and copies must be sent simultaneously. Failure by the applicant to send copies in a timely
manner may result in dismissal of the Notice of Intent.
wpelxm3Ax•rev.06M Pape a of s
LMassachusetts Department of Environmental Protection
IBureau of Resource Protection -Wetlands
WPA Appendix A —Wetland Fee Transmittal Form
= Massachusetts Wetlands Protection Act AL. c..131 §40
Empertant: A. Appi leant Information
When filling out
forms on the 1. Applicant:
computer, use
only the tab
key to move a.First Name b. Last Name c.Company
your cursor- k POV26CIXr' LNG
do not use the d.Mai!ing Address,
return key. 5; �_74
e.Citylrown f.State g.Zip Code
h.Phone Number
��.r' 2. Property Owner(if different):
a.First Name b.Last Name C.Company
d.Mailing Address
e.Cityfrown f.State g.Zip Code
h. Phone Number
3. Pect Location:
a.Street Address b.City/Town
To calculate B. Fees
filing fees,refer
to the category Notice of Intent(Form 3) or Abbreviated Notice of Intent(Form 4):
fee list and
examples in The fee should be calculated using the following six-step process and worksheet. Please see
Section D of
this form. Instructions before filling out worksheet.
Step lrrype of Activity: Describe each type of activity that will occur in wetland resource area and
buffer zone.
Stets 2lNumber of Activities: Identify the number of each type of activity.
Step 3/Individual Activity Fee: Identify each activity fee from the six project categories listed in the
instructions.
Step 4/Subtotal Activity Fee: Multiply the number of activities(identified in Step 2)times the fee per
category (identified in Step 3)to reach a subtotal fee amount. Note: If any of these activities are in a
Riverfront Area in addition to another Resource Area or the Buffer Zone, the fee per activity should be
multiplied by 1.5 and then added to the subtotal amount
Step 5/Total Project Fee: Determine the total project fee by adding the subtotal amounts from Step 4.
Step 6/Fee Payments: To calculate the state share of the fee, divide the total fee in half and subtract
$12.50. To calculate the city/town share of the fee, divide the total fee in half and add$12.50.
:Wa 3.da:,+,P bx 8•rev.arg= Page/W3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection Wetlands
WPA Appendix A - Wetiand fee Transmittal Form
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
Be Fees (continued)
Step 1IType of Activity Step 21Number Step . Step 418ubtotal Activity
of Activities 3/individual Fee
Activity Fee
Step 5frotal Project Fee: t5
Step 61Fee Payments:
. !w r
Total Project Fee: . a.Total fee frog step s
State share of film fee:
g 0.�9/2 total fee less$12.50
Cityrrown share of filling fee: c.lrz total fee plus$12.50
Abbreviated Notice of Resource Area Delineation (Form 4A).
The fee is calculated as follows(check applicable project type):
1.t,__... single family.
house project a.feet of BV W x$1.00= b.Total fee not to exceed$1,040
2,,_,� all other
projects _ a.feet of BVIN x$1.00= b.,Total fee not to exceed$1.000
State share of filing fee: 3.1r2 of total fee Irk$12.50
Cityftown share of filing fee: 4.1/2 of total fee Plus$tz.5o
WpaftmG d=-Appordx 8•m.SUM pag3 2 a`3
city of Salem Department of Planning & Community Development
Check/Cash Receipt and Tracking Form _
Please complete form and make two coples.
Date Received 4
Amount Received
Form of Payment Check Cash
CHECK PAYMENTS:
write chedc number 65b l
CASH PAYMENTSi
write client initials 157
0 Sign Permit Application Fee
Conservation Commission Fee — Npl
Payment received for Penning Board Fee
what service?
Q Old Town Hall Rental Fee
Othw
Name of staff person
receiving payment
Additional Notes
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Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands
WPA Appendix A — Wetland Fee Transmittal Form
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
Important: A. Applicant Information
When filling out
fors on the 1. Applicant:
computer,use S ✓EL
only the tab &9#Z/J,e�o
key to move a.First Name b. Last Name
your cursor- 6 DE�B�' &vC c.Company
do not use the d.Mailing Address
return key. S /U( Ai /2Jf} O)PIO
e.CdylTown f.State
r p'�' 7,ff��� 9.2ip Code
h. Phone Number
^•^ 2. Property Owner(if different):
a.First Name b. Last Name c.Company
d. Mailing Address
e.City/rown
f.State g.Zip Code
h.Phone Number
3. Project Location:
a.Street Address b.City/Town
To calculate B. Fees
filing fees, refer
to the category Notice of Intent(Form 3)or Abbreviated Notice of Intent Form 4 :
fee list and ( )
examples in
Section D of The fee should be calculated usingthe following six-step process and worksheet. Please see
this for. Instructions before filling out worksheet.
Step 1/Type of Activity: Describe each type of activity that will occur in wetland resource area and
buffer zone.
Step 2/Number of Activities: Identify the number of each type of activity.
Step 3/Individual Activity Fee: Identify each activity fee from the six project categories listed in the
instructions.
Step 4/Subtotal Activity Fee: Multiply the number of activities (identified in Step 2)times the fee per
category (identified in Step 3)to reach a subtotal fee amount Note: If any of these activities are in a
Riverfront Area in addition to another Resource Area or the Buffer Zone, the fee per activity should be
multiplied by 1.5 and then added to the subtotal amount
Step 5/Total Project Fee: Determine the total project fee by adding the subtotal amounts from Step 4.
Step 6/Fee Payments: To calculate the state share of the fee, divide the total fee in half and subtract
$12.50. To calculate the city/town share of the fee, divide the total fee in half and add$12.50.
wp.toma.aa•appsnae 0•rep.eases _ /
Massachusetts Departrnent of Environmental Protection
LINBureau of Resource Protection -Wetlands
WPA Appendix A — Wetland Fee Transmittal Form
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Fees (continued)
Step 11Type of Activity Step 2INumber Step Step 4/Subtotal Activity
of Activities 311ndividual Fee
Activity Fee
&w.am-G 4 -01*CK—
Step 5/Total Project Fee:
Step 6/Fee Payments:
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Total Project Fee: a.Total fee from step 5
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State share of filing fee: b. 112 total fee leas f12.5o
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Cityrrown share of filling fee: c.1n total fee plus$12.so
Abbreviated Notice of Resource Area Delineation (Form 4A):
The fee is calculated as follows (check applicable project type):
1. t single family
house project
a.feel of BVW x$1.00= b.Total fee not to exceed 81.000
2.,,_-,, all other
projects a.feet of BV W x$1.00= b.Total fee not to exceed$1,000
State share of filing fee: 3. 1n of total fee less$12.50
Cityrrown share of filing fee: 4. 1n of total fee plus$12.50
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