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64-467 - 3 EVERETT ROAD - CONSERVATION COMMISSION R00A PATROWICZ LAND DEVELOPMENT ENGINEEPJNG TRANSMITTAL 14 BROWN STREET SALEM, MA 01970 DATE JOB NO. C2b7 TEL. (978) 836-6400 FAX(978)745-4110 PROJECT NAME E-mail: scott.patrowicz@verizon.net & T0 ............ two NL.Mrbrq TRANSMITTING: *Attached IkRegular Mail U Overnight Express El Hand Delivered L) Picked Up U Plans/Prints Q Original Mylar El Computer Disk El Specifications Q Calculations LI Letter Ll Report % -rC\CbQr- ez-A I COPIES DATE DESCRIPTION - P'um F OF II -e C.X F THESE ARE TRANSMITTED as checked below: U For Approval ;b For Your Use 01k As Requested C3 For Review And Comment L) LJ For Bids Due: LJ Please call me to discuss. Q REMARKS — ----MAY 3 --ouT,or-PLANNING-6 -CGMMUNiTYDEVFLIc_,FWP_14T COPYTO _%ZW U CDP+ COPYTO COPY TO ;&A 51 F-Ill r SIGNED Scott Patrowicz, P.E. If enclosures are not as noted,kindly notify us at once. RRORDS.I ROM B-.Y FSSISS FORMS WWELL-MA-I OW M 572 IIIIIIIIIIIIIIIIIIIII IIIIIIIIIIIIIIIIIIIIIIIII 2011040500013 BkC30331 PPg'�Q39 Massachusetts Department of Environmental Protection Bureau of Resource Protection -,Wetlands DEP File Number. WPA Form 8B — Certificate of Compliance Massachusetts Wetlands Protection Act M.G.L. c. 131, 40 64-467 Provided by DEP A. Project Information Important: When filling out I. This Certificate of Compliance is issued to: forms on the computer,use Eleanor Lee Hughes only the tab key Name. to move your 3 Everett Rd. cursor-do not use the return Mailing Address key. Salem MA 01970 CltyTrown State Zip Code 2. This Certificate of Compliance is issued for work regulated by a final Order of a AV Conditions issued to: Eleanor Lee.Hughes Name. 10i2/2007 64-467 Dated - DEP File Number 3. The project site is located at: 3.Everett Rd. Salem Street Address _ Citylrown 27 622 Assessors Map/Plat Number Parcel/Lot Number the final Order of Condition was recorded at the Registry of Deeds for. Property Owner(if different) - Essex 27258 514 County Book Page. - Certificate 4.. A_site inspection was made in the presence of the applicant, or the applicants agent, on: 3/2,2011 Dare wpe meeacc rev tzrzaog wPA rOnM1 BB,Cenifltafe of Compliance•Page 1 M 3 I Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands CEP File Number: WPA Form 8B — Certificate of Compliance 64-467 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Providedb 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: Conservation Commission Date of Issuance This Certificate must be signed by a majority of the Conservation Commission and a copy sent to the applicant and appropriate DEP Regional Office �S e http://www.mass.-6ov/dep/about/region/findvour.htm). Sig u s C N wpafrm8b.doc•rev.12123/09 WPA Form 8B,Certificate of Compliance•Page 2 of_3 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands DEP File Number: WPA Form 8B — Certificate of Compliance 64-467 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided 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: - ---------— ------- -- ----- - ---—------------------------ ----------- ------------------ Salem Conservation Commission Please be advised that the Certificate of Compliance for the project at: 3 Everett Rd. Salem, MA 64-467 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: %4 vv3, __39 Date Book Page If recorded land, the instrument number which identifies this transaction is: 13 If registered land, the docume t t umber which identifies this transaction is: t I — — Document Number i -- Signature of Applicant vvpafrm8b.doc•rev.12I23I09 �1 WPA Form 8e Certificate of Compliance•.Page 3 of 3 t Nr is a ,yM y�V Essex Southern District Registry of Deeds 45 Congress Street Suite 4100 Salem, MA 01970 04/05/2011 08:22 AM Station: ESSX-REC06 Operator: jjag Time:8:22 Type: COMPLI Loc: SALEM Inst 13 BK 30331-439 FEE 55.00 ENV FEE 20.00 Check 8068 75.00 t PATROWICZ LAND DEVELOPMENT ENGINEERING March 3, 2011 City of Salem Conservation Commission 120 Washington Street Salem, MA 01970 RE: Request for Certificate of Compliance House addition and landscaping #3 Everett Road Assessor's Map 27, Lot 622 MassDEP File#64-467 PLDE#07-01 Dear Commission Members: On behalf of Eleanor Lee Hughes (owner), I respectfully request that you review the attached request for Certificate of Compliance application (WPA form 8a) in compliance with the Massachusetts Wetlands Protection Act and the City of Salem Wetlands By-Law. I have inspected the site with Tom Devine on 3/2/11 and hereby certify that the permitted work for the house addition and landscaping have been performed in substantial compliance with the Order of Conditions issued on October 2, 2007 (recorded at the Essex County Registry of Deeds: Book 27258, Page 514). Thank you for taking this matter under consideration. If you have any questions, please do not hesitate to call me. Sincerely, PATRO LAND DEVELOPMENT ENGINEERING Scott Patrowicz, P.E. cc. Eleanor Lee Hughes w/attachments cc. Peter Strout w/attachments 14 Brown Street, Salem, Massachusetts 01970 Cell: 978-836-6400 Fax: 978-745-4110 Email: scott.patrowicz@verizon.net Massachusetts Department of Environmental Protection DEP File Number: Bureau of Resource Protection -Wetlands WPA Form 8A — Request for Certificate of Compliance 064467 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP A. Project Information Important: When filling out 1. This request is being made by: forms on the Scott Patrowicz, P.E. computer, use Name the tab key to move Patrowicz Land Development Engineering, 14 Brown Street key your cursor- Mailing Address do not use the Salem MA 01970 return key. City/Town State Zip Code 978-836-6400 (cell) Phone Number 2. This request is in reference to work regulated by a final Order of Conditions issued to: Eleanor Lee Hughes Applicant 10/2/07 064-467 Dated DEP File Number Upon completion of the work 3. The project site is located at: authorized in #3 Everett Road Salem an Order of Street Address City/rown Conditions,the 27 622 property owner must request a Assessors Map/Plat Number Parcel/Lot Number Certificate of Compliance 4. The final Order of Conditions was recorded at the Registry of Deeds for: from the issuing Eleanor Lee Hughes authority stating Property Owner(if different) that the work or Essex 27258 514 work hass been portion the County Book Page satisfactorily completed. Certificate(if registered land) 5. This request is for certification that(check one): ® the work regulated by the above-referenced Order of Conditions has been satisfactorily completed. ❑ the following portions of the work regulated by the above-referenced Order of Conditions have been satisfactorily completed (use additional paper if necessary). ❑ the above-referenced Order of Conditions has lapsed and is therefore no longer valid, and the work regulated by it was never started. w f..Ba.do.••rev.7113104 Page 1 of 2 Massachusetts Department of Environmental Protection i DEP File Number: Bureau of Resource Protection - Wetlands WPA Form 8A — Request for Certificate of Compliance 064-467 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP A. Project Information (cont.) 6. Did the Order of Conditions for this project, or the portion of the project subject to this request, contain an approval of any plans stamped by a registered professional engineer, architect, landscape architect, or land surveyor? ® Yes If yes, attach a written statement by such a professional certifying substantial compliance with the plans and describing what deviation, if any, exists from the plans approved in the Order. ❑ No B. Submittal Requirements Requests for Certificates of Compliance should be directed to the issuing authority that issued the final Order of Conditions(OOC). If the project received an OOC from the Conservation Commission, submit this request to that Commission. If the project was issued a Superseding Order of Conditions or was the subject of an Adjudicatory Hearing Final Decision, submit this request to the appropriate DEP Regional Office(see http://www.mass.gov/dep/abouttregion/findyour.htm). wpaformea.dm••rev.7113104 Page 2 of 2 `y�ONWP CITY OF SALEM CONSERVATION COMMISSION October 2, 2007 Eleanor Lee Hughes 3 Everett Road Salem, MA 01970 Re: Order of Conditions—DEP#64-467 3 Everett Road, Salem,Massachusetts Dear Ms. Hughes: Enclosed, please find the Order of Conditions for the above referenced project. Following the 10-day appeal period (as of October 12, 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#64-467 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. Sincerely, d Carey Duq es Conservati Agent Is taff Planner Enclosures CC: Scott Patrowicz, Engineer DEP Northeast Regional Office Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands DEP File Number: WPA Form 5 - Order of Conditions 64-467 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 A. General Information Important: Salem When fillip From: 9 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 Eleanor Lee Hughes use the return a.First Name b. Last Name c.Company key. 3 Everett Road I� d.Mailing Address 8° Salem MA 01970 e.City/Town f.State Zip P Code 4. Property Owner(if different from applicant): a. First Name b. Last Name c.Company Cf. Mailing Address e.Cdy/Town f.State g.Zip Code 5. Project Location: 3 Everett Road Salem a.Street Address b.City/Town 27 622 c.Assessors Map/Plat Number d. Parcel/Lot Number Latitude and Longitude, if known (note: electronic filers will click for GIS locator): e. Latitude f. Longitude 6. Property recorded at the Registry of Deeds for(attach additional information if more than one parcel): Essex a.County b.Certificate(if registered land) 5644 69 c.Book d.Page 7. Dates: August 24 2007 September 27 2007 October 2, 2007 a.Date Notice of Intent Filed b.Date Public Hearing Closed c.Date of Issuance 3. Final Approved Plans and Other Documents (attach additional plan or document references as needed): Site Plan of Land 3 Everett Rd Salem a. Plan Title North Shore Survey Corporation Gail L. Smith b.Prepared By c.Signed and Stamped by August 14, 2007 V-20- d. Final Revision Date e.Scale --------------- f.Additional Plan or Document Title g.Date aform5.o wP oc rev.3/1/05 Page i of 9 L11Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands DEP File Number: WPA Form 5 - Order of Conditions 64-467 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 e. ❑ Fisheries f. ® 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 21' 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. ❑ Land Under Waterbodies a.square feet b.square feet c.square feet d.square feet and Waterways e.cu.yd dredged f.cu.yd dredged vpafwrn5.d0c• rev.3/1105 Page 2 of 9 Massachusetts Department of Environmental Protection L7)JBureau of Resource Protection -Wetlands DEP File Number: WPA Form 5 - Order of Conditions 64-467 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Findings (cost.) Resource Area Proposed Permitted Proposed Permitted Alteration Alteration Replacement Replacement z ❑ Bordering Land Subject to Flooding a.square feet b.square feet c.square feet d.square feet Cubic Feet Flood Storage W.cubic feet f.cubic feet g.cubic feet h.cubic feet 8. ❑ 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 150 150 9. ® Riverfront area a.total sq.feet b.total sq.feet 150 150 Sq ft within 100 ft c.square feet d.square feet e.square feet t.square feet Q 0 Sq ft between 100-200 ft s uare feet h.square feet T.square feet 9 q q q j.square feet Coastal Resource Area Impacts: Check all that apply below. (For Approvals Only) to. ❑ Designated Port Areas Indicate size under Land Under the Ocean, below 11. ❑ Land Under the Ocean a.square feet 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.cly nourishmt. d.cly nourishmt. 14. El Coastal Dunes a.square feet b.square feet c.cly nourishmt. d.cly 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 feel c.square feet d.square feet 18. ElLand 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 feel 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 wparorn5.doc• rev.311105 Page 3 of 9 LEIMassachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands DEP File Number: WPA Form 5 - Order of Conditions 64-467 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 64-467 " wpaform5.doc• rev.311105 Page 4 of 9 ILIMassachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands DEP File Number: WPA Form 5 - Order of Conditions 64-467 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 wpafomi5 dx• rev.3/1105 Page 5 of 9 r LlMassachusetts Department of Environmental Protection DEP File Number: Bureau of Resource Protection -Wetlands WPA Form 5 - Order of Conditions 64-467 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 D. Findings Under Municipal Wetlands Bylaw or Ordinance i. 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 ❑ wpaform5.tloc• rev.311J05 Page 6 of 9 Massachusetts Department of Environmental Protection DEP File Number: Bureau of Resource Protection - Wetlands ` WPA Form 5 — Order of Conditions 64-467 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 E. Issuance I l This Order is valid for three years, unless otherwise specified as a special ()c'6 QA' �, 20011 condition pursuant to General Conditions#4, from the date of issuance. 1.D to of Iss rice Please indicate the number of members who will sign this form: 4 y This Order must be signed by a majority of the Conservation Commission. 2. Number o i ners 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 Protection Regional Office, if not filing electronically, and the property owner, if different from applicant. Signatures: Notary Acknowledgement Commonwealth of Massachusetts County of Essex 27 September 2007 On this Day Of Month Year Before me, the undersigned Notary Public, K. Cornacchio, d:-Fnrfleri, D. Pabich, M. Slier, K. personally appeared Glidden, 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 Cityrrovm CAiEY E OUGUEB Na1rY AIEb M Y a m 1*1k Signature of otary Public Carey R. uques Printed Name of Notary Public + , Place notary seal and/or any stamp above August 16 2013 My Commission Expires(Date) This Order is issued to the applicant as follows: ❑ by hand delivery on by certified mail, return receipt requested,on 2 0607 Date Date wpalorrtS.tloo• rev.311/05 Page 7 of 9 LlMassachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands DEP File Number: WPA Form 5 - Order of Conditions 64-467 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 Regional Office to issue a Superseding Order of Conditions. The request must be made by certified mail or hand delivery to the Department,with the appropriate 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. wpaforin5.tloo• rev.3/1/05 Page B of 9 L71Massachusetts Department of Environmental Protection DEP File Number: Bureau of Resource Protection -Wetlands WPA Form 5 - Order of Conditions 64-467 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: 3 Everett Road 64-467 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 wpaforni&dw• rev. JVDS Page 9 of 9 Attachment to Order of Conditions# 64-467 Page lof 5 SALEM CONSERVATION COMMISSION DEP FILE #64-467 3 Everett Road City of Salem,Massachusetts ADDITIONAL FINDINGS Based on the Estimated Habitats or Rare Wildlife and Certified Vernal 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 an addition and deck to an existing structure to the rear of an existing single- family house. The approved project includes the demolition of 300 square feet of existing impervious structure; development of a 450 square feet impervious structure; resulting in a net increase of 150 square feet of impervious structure located within the Inner Riparian Zone. All work to be performed is also located within the buffer zone of a coastal bank, defined by an existing seawall. The addition is a deck to be located 21 feet from the existing seawall. The Conservation Commission approved this project with the understanding that erosion control measures, consisting of silt fence and not hay bales, for concern of spreading grass and invasive species seeds into the sea grass located on the water side of the seawall. The approved project will result in gravel being located under the deck providing area for stormwater to recharge into the ground. The project shall not impair groundwater or surface water quality. The Commission requested that a pre and post visual inspection of the beach be completed to ensure that no construction debris was deposited in the sea grass. The crimson maple located on the eastern side of the property is to be protected by 2'X 4' timbers to prevent damage to the tree by the construction equipment. 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#64-467, and not placed on a living tree. Attachment to Order of Conditions N 64-467 Page 2of 5 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, 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. 2 1 A 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. 11. 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 Site Plan of Land 3 Everett Road (Title) August 14 2007 (Dated) Attachment to Order of Conditions # 64-467 Page 3of 5 Gail L. Smith (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 Chanee with the Commission. The Notice 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. Attachment to Order of Conditions N 64-467 Page 4of 5 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. 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). Attachment to Order of Conditions # 64-467 Page 5of 5 (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: (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 Commission. 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 complete a pre-and post-construction inspection of the beach and adjacent sea grass to confirm that construction debris, trash, etc. are removed and properly disposed of outside of the resource area. 42. Applicant shall install protection around the existing Crimson Maple tree located on the southeastern portion of the property to prevent damage from construction equipment. PATROWICZ LAND DEVELOPMENT ENGINEERING RECEIVED August 23, 2007 AUG 2 4 Z007 DEPT. OF PLANNING& City of Salem COMMUNITY DEVELOPMENT Conservation Commission 120 Washington Street-Third Floor Salem, MA 01970 RE: Notice of Intent Application Proposed Addition and Deck to an existing single-family house (Buffer Zone work only) #3 Everett Road, Salem, MA Assessor's Map 27, Lot 622 PLDE#07-01 Dear Commission Members: On behalf of my client: Eleanor Lee Hughes (land owner and applicant), I respectfully request that you review the attached Notice of Intent application for a proposed addition and deck to the rear of an existing single-family house. All work is to be performed in a buffer zone. The nearest wetland resource area is a Top of Coastal Bank defined by the existing seawall (shown on the attached Site Plan). I respectfully submit nine (9) copies of the Notice of Intent application to include the following: •NOI Application (WPA Form 3), •NOI Wetland Fee Transmittal Form, •Copy of check for$42.50 (NOI filing fee made payable to the Commonwealth of Mass), *Check for$67.50 (NOI filing fee made payable to the City of Salem), •List of abutters (prepared by Salem Assessor's), •Abutter Notification Form, •USGS Locus Map, *Salem GIS Locus Map, •Bird's Eye photographs and aerial photograph (from Windows Live), •Plan entitled: "Site Plan of Land" prepared by NSSC dated August 14, 2007 (folded). It is my understanding that I will notify the abutter's via certified (RRR) mail with the attached Abutter Notification Form. I will submit the "green cards" (RRR) to the Commission the night of the public hearing. It is also my understanding that you will prepare the legal advertisement and will submit it to the Salem Evening Newspaper for publication of the hearing date. My client will receive the invoice for the legal advertisement. One copy of the above NOI package is being sent to DEP-Wetlands, Northeast Regional Office, 205E Lowell Street, Wilmington, MA 01887. The NOI Wetland Fee Transmittal Form and the State portion of the filing fee have been sent to DEP, P.O. Box 4062, Boston, MA 02211. 14 Brown Street, Salem, Massachusetts 01970 Cell: 978-836-6400 Fax: 978-745-4110 Email: scott.patrowicz@verizon.net Thank you for taking this matter under consideration. We look forward to the public hearing on September 13, 2007. If you have any questions, please do not hesitate to call me. Sincerely, PATRO LAND DEVELOPMENT ENGINEERING Scott Patrowicz, P.E. i cc. Eleanor Lee Hughes w/attachments cc. Peter Strout w/attachments cc. DEP-Wetlands, Northeast Regional Office PATROWICZ LAND DEVELOPMENT ENGINEERING Massachusetts Department of Environmental Protection Provided by DER Bureau of Resource Protection -Wetlands DEP File Number WPA Form 3 - Notice of Intent Document Transaction Number Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Salem Cityrrown hpon hen ffilliilling out A. General Information "s on the )mputer,use 1. Project Location (Note: electronic filers will click on button for GIS locator): hly the tab key move your 3 Everett Road Salem 01970 ';e or the return�e -do not a.Street Address - b.Cityrrown c.Zip Code the "y' Latitude and Longitude: d. Latitude e.Longdude m 27 622 f.Assessors MaplPlat Number g.Parcel/Lot Number m 2- Applicant: Eleanor Lee. Hughes a..First Name b.Last Name c.Company 'ote: 3 Everett Road efore d.Mailing Address ompleting this Salem MA 01970 arm consult our local e.City/Town f.State g.Zip Code onservation 978-744-8385 commission h.Phone Number i.Fax Number j.Email address :garding any umicipal bylaw 3. Property owner(if different from applicant): ❑ Check if more than one owner r ordinance. a. First Name b. Last Name c.Company - d.Mailing Address e.Cityrrown if.State g.Zip Code h.Phone Number i.Fax Number j.Email address 4. Representative(if any): Patrowicz Land Development Engineering a.Firm Scott Patrowicz, P.E. b.Contact Person First Name c.Contact Person Last Name 14 Brown Street d.Mailing Address Salem MA 01970 e.City/Town f.State g.Zip Code 978-836-6400 978-745-4110 scott.patrowicz@verizon.net h.Phone Number i.Fax Number j.Email address 5. Total WPA Fee Paid (from NO] Wetland Fee Transmittal Form): $110 $42.50 $67.50 a.Total Fee Paid b.State Fee Paid c.Cityrrown Fee Paid 6. General Project Description: Applicant(land owner) proposes to construct a building addition and deck to the rear of an existing single-family house. All work is within a buffer zone. No work is within any wetland resouce area. aform3.doc•rev.4/12106 Page 1 of 7 Massachusetts Department of Environmental Protection Provided by DER Bureau of Resource Protection -Wetlands DEP File Number WPA Form 3 — Notice of Intent Ll Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Document Transaction Number Salem 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. ❑ Dock/Pier f. ❑ Utilities g. ❑ Coastal Engineering Structure h. ❑ Agriculture—cranberries, forestry i. ❑ Transportation j. ❑ Other 8. Property recorded at the Registry of Deeds for: Essex 69 a.County b.Page Number 5644 a Book d.Certificate#(if registered land) 9. Has work been performed on the property under an Order of Resource Area Delineation involving Simplified Review within 3 years of the date of this application? a. ❑Yes b. ® No If yes, no Notice of Intent or Request for Determination of Applicability may be filed for work within the 50-foot-wide area in the Buffer Zone along the resource area during the three-year term of an Order of Resource Area Delineation, or any Extended Order, or until the applicant receives a Certificate of Compliance,whichever is later. 10. Buffer Zone Only-Is the project located only in the Buffer Zone of a bordering vegetated wetland, inland bank, or coastal resource area? a. N Yes-answer 11 below, then skip to Section C. b. ❑ No-skip to Section B. 11. Buffer Zone Setback—For projects that involve work only in the buffer zone, select the applicable adjacent resource area (check one): a. ❑ BVW b. ❑ inland bank c. ® coastal resource area The distance between the closest project disturbance and the associated resource area is: 21'to deck post, 2' to staging area aforrn3.doc•rev.4/12/06 Page 2 of 7 Massachusetts Department of Environmental Protection Provided by DEP: Bureau of Resource Protection -Wetlands I DEP File Number WPA Form 3 - Notice of intent Document Transaction Number Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Salem City/rown 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. Mine Users: Resource Area Size of Pro clude your posed Alteration Proposed Replacement(if any) Pcument nsaction a. ❑ Bank 1.linear feet 2.linear feet tuber b. ❑ Bordering Vegetated rovlded on Wetland 1.square feet 2.square feet ur receipt age) with all C. ❑ Land Under 1.square feet 2.square feet upplementary Waterbodies and formation ou Waterways y 3.cubic yards dredged jbmit to the d. ❑ Bordering Land epartment. 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 For f. ❑ Riverfront area 1.Name of Waterway(if available) ojects pacted by 1. Width of Riverfront Area(check one): e riverfront ea and a ❑ 25 ft. - Designated Densely Developed Areas only Offer zone of other ❑ 100 ft. - New agricultural projects only source ea, add ❑ 200 ft. -All other projects %to the tal fee. 2.Total area of Riverfront Area on the site of the proposed project: Square Feet 3. Proposed alteration of the Riverfront Area: a.Total Square Feet b.Square Feet within 100 ft. c.Square Feet between 100 ft.and 200 ft. 4. Has an alternatives analysis been done and is it attached to this NOI? ❑ Yes❑ No 5. Was the lot where the activity is proposed created prior to August 1, 1996? ❑ Yes❑ No aform3.doc•rev.4/12/06 Page 3 of 7 LlMassachusetts Department of Environmental Protection Provided by DER Bureau of Resource Protection - Wetlands DEP File Number WPA Form 3 - Notice of Intent Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Document Transaction NumberSalem C ty/rown B. Resource Area Effects 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. rnline Users: rclude your Resource Area Size of Proposed Alteration Proposed Replacement(if any) ocument ansaction a. ❑ Designated Port Areas Indicate size under Land Under the Ocean, below umber xovided on b. ❑ Land Under the Ocean 1_Square feet cur receipt age)with all 2.Cubic yards dredged upplementary Indicate size under Coastal Beaches and/or Coastal Dunes iformation you C. ❑ Barrier Beach below ubmit 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 it 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 i. ❑ 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 aform3.doc•rev.4112I06 Page 4 of 7 Massachusetts Department of Environmental Protection Provided by DEP: Bureau of Resource Protection -Wetlands DEP File Number WPA Form 3 — Notice of Intent Document Transaction Number Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Salem Cityrrown C. Bordering Vegetated Wetland Delineation Methodology Check all methods used to delineate the Bordering Vegetated Wetland (BVW) boundary: pfnline Users: 1. ❑ Final Order of Resource Area Delineation issued by Conservation Commission or DEP lclude your (attached) cument ansaction 2. ❑ DEP BVW Field Data Form (attached) tuber rovided on 3. ❑ Final Determination of Applicability issued by Conservation Commission or DEP (attached) ur receipt age)with all 4. ® Other Methods for Determining the BVW Boundary (attach documentation): pplementary formation you a. ❑ 50% or more wetland indicator plants bmit to the epartment. b. ❑ Saturated/inundated conditions exist c. ❑ Groundwater indicators d. ® Direct observation or all projects ecting other e. ❑ Hydric soil indicators esource reas, please f. ❑ Credible evidence of conditions prior to disturbance ach a The top of coastal bank is the top of the existing seawall rrative 5. Other resource areas delineated: e resource how D. Other Applicable Standards and Requirements ea was lineated. 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 ® No If yes, include proof of mailing or hand delivery of NOI to: Natural Heritage and Endangered Species Program Division of Fisheries and Wildlife 10/1106 Route 135, North Drive b.Date of Map Westborough, MA 01581 2. For coastal projects only, is any portion of the proposed project located below the mean high water line or in a fish run? a. ❑ Yes ® No If yes, include proof of mailing or hand delivery of NOI to: Division of Marine Fisheries-Southeast Marine Fisheries Station 50A Portside Drive Pocasset, MA 02559 b. ❑ Not applicable—project is in inland resource area only 3. Is any portion of the proposed project within an Area of Critical Environmental Concern (ACEC)? a. ❑ Yes M 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 aform3.doc•rev.4/12/06 Page 5 of 7 Massachusetts Department of Environmental Protection Provided by DEP: Bureau of Resource Protection - Wetlands DEP File Number WPA Form 3 — Notice of Intent Document Transaction Number Li Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Salem citylrown D. Other Applicable Standards and Requirements nline Users: 4. Is any portion of the site subject to a Wetlands Restriction Order under the Inland Wetlands clude your Restriction Act(M.G.L. c. 131, §40A) or the Coastal Wetlands Restriction Act(M.G.L. c. 130, § 105)? Xument nsaction a. ❑ Yes ® No mber rovided on ur receipt 5. Is any activity within any Resource Area or Buffer Zone exempt from performance standards of the ge)with all wetlands regulations, 310 CMR 10.00. pplementary formation you a. El Yes ® No If yes, describe which exemption applies to this project: bmit to the apartment. b.Exemption 6. Is this project subject to the DEP Stormwater Policy? a. ❑ Yes ® No If yes, stormwater management measures are required. Applicants should complete the Stormwater Management Form and submit it with this form. b. If no, explain why the project is exempt: The project proposed is a new building addition and deck to the rear of an existing single-family house. The backyard exists as a flat lawn to the existing seawall. 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.) I l 2. ® Plans identifying the location of proposed activities(including activities proposed to serve as a Bordering Vegetated Wetland [BVWj replication area or other mitigating measure) relative to the boundaries of each affected resource area. 3. ® Other material identifying and explaining the determination of resource area boundaries shown on plans (e.g., a DEP BVW Field Data Form). 4. 0 List the titles and dates for all plans and other materials submitted with this NOI. 6. ❑ If there is more than one property owner, please attach a list of these property owners not listed on this form. 6. ❑ Attach proof of mailing for Natural Heritage and Endangered Species Program, if needed. 7. ❑ Attach proof of mailing for Massachusetts Division of Marine Fisheries, if needed. a. ® Attach NOI Wetland Fee Transmittal Form g. ❑ Attach Stormwater Management Form, if needed. afonn3.doc•rev.4112/06 Page 6 of 7 Massachusetts Department of Environmental Protection Provided by DEP: Bureau of Resource Protection -Wetlands DEP File Number WPA Form 3 - Notice of intent Document Transaction Number Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Salem Cityrrown 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 NOI Wetland Fee Transmittal Form). No filing fee shall be assessed for projects of any city, town, county, or district of the Commonwealth, federally recognized Indian tribe housing authority, municipal housing authority, or the Massachusetts Bay Transportation Authority. Applicants must submit the following information (in addition to pages 1 and 2 of the NOI Wetland Fee Transmittal Form)to confirm fee payment: 8123/07 1.Municipal Check Number 2.Check date 8/23107 3.State Check Number, 4.Check date - Eleanor Lee Hughes 5. Payor name on check:First Name 6. Payor name on check:Last Name 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 certi and r penalties of perjury that all abutters were notified of this application, pursuant to the requirements of G.L. c. 131, §40. Notice must be made in writing by hand delivery or certified mail (return receipt quested)to all abutters wit in 100 feet of the property line of the project location. 8/23/07 Signature of Applicant Date Signature of Property Ow if i er nt) �`H OF Mq Date P ss 8/23/07 Signature of Rep entative(rf any) �� p TR T TANICZ _ Date For Conservation Commission: Z CIVIL Two copies of the completed Notice n I&Ma) i ng supporting plans and documents; two copies of pages 1 and 2 of the NOI Wetland mi nd the city/town fee payment must be sent to the Conservation Commission by certified s/ONAL EN 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 the NOI Wetland Fee Transmittal Form; 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. paform3.doc•rev.4/12/06 Page 7 of 7 Massachusetts Department of Environmental Protection PBureau of Resource Protection -Wetlands NOI Wetland Fee Transmittal Form Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 portant: A. Applicant Information /hen filling out arms on the 1. Applicant: 3mpute ilythe tab r, use Eleanor Lee Hughes ily the �y to move a.First Name b. Last Name c.Company rur cursor- #3 Everett Road h not use the d.Mailing Address .turn lynl. Salem MA 01970 I I e.Cityrrown f.State g.Zip Code mCC 978-744-8385 h.Phone Number 2. Property Owner(if different): a.First Name b.Last Name c.Company d.Mailing Address e.City/town f.State g.Zip Code h.Phone Number 3. Project Location: #3 Everett Road Salem a.Street Address b.Citylrown calculate . B. Fees ing fees, refer the category Notice of Intent(Form 3)or Abbreviated Notice of Intent(Form 4): e list and amples in the The fee should be calculated using the following six-step process and worksheet. Please see I-ing out for Instructions before filling out worksheet. ling out WPA ma 3(Notice of tent). Step i/Type of Activity: Describe each type of activity that will occur in wetland resource area and buffer zone. Step 21Number 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 6Rotal 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. paform3.doc•NOI Wetland Fee Traneminal Forth•rev.3/1/05 Page 1 of 2 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands NOI Wetland Fee Transmittal Form Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Fees (continued) Step 7frype of Activity Step 21Number Step Step 4/Subtotal Activity of Activities 3/Individual Fee Activity Fee la: Addition and deck to a existing 1 $110 $110 single-family house Step 51Total Project Fee: Step Was Payments: Total Project Fee: $110 a.Total fee from Step 5 State share of filing fee: $42.50 b. 1/2 total fee less$12.50 City/Town share of filling fee: $6 c. 1//22 total fee plus$12.50 C. Submittal Requirements a.) Complete pages 1 and 2 and send with a check or money order for the state share of the fee, payable to the Commonwealth of Massachusetts. Department of/Environmental Protection Box 4062 Boston, MA 02211 b.) To the Conservation Commission: Send the Notice of Intent or Abbreviated Notice of Intent; a copy of this form; and the city/town fee payment. c.) To DEP Regional Office (see Instructions): Send a copy of the Notice of Intent or Abbreviated Notice of Intent; a copy of this form; and a copy of the state fee payment. (E-filers of Notices of Intent may submit these electronically.) pafomn3.doc•N01 Welland Fee Transmidal Form•rev.311105 Page 2 of 2 SCALE 1.25 000 ATROWICZ LAND DEVELOPMENT ENGINEERING I CENTIMETER ON THE MAP REPRES;Z 250 METERS ON THE GROU d Planning,Civil Engineering,Environmental Permitting CONTOUR INTERVAL 3 METERS DATE: " BJECT Site Locus (U.S.G.S. map) Z SHEET NO.: _°o JOB NO.: SIX 0 1000 . 2000 3000 4000 METERS 10000 - 12000 rFEET KILOMETERS 1 s 0 1 2 3 MILES \ \ � � N T i rSa fi, : m Y = � � '\ 'E"`IFi7 �" • `, ' ���' �+ U 9 12 i, I�� '`��r I � -$ r, 4'�' 1 y/ � z fs�+,. tgi,�e,• O T r � � ' �:t,e„�& � �.,.p4 �1 a,g,r �T' z.�y x'� ht ■ , �T -� �a�ca� � 6 I r o L � '�\ `'Pa� �✓` �• 1 ��ts � r t:'V � � � e.- # ��C Vey' a # t O • • ®: r erpla I de �QaC(i . u oek"�ii v +L.L B ip• Co° t ,q r/ n • Sal m Termiarf n i 1 Site\. m 0 6 rf ht;. 3 < � of er�r� III Point ''rt CC t ode R�O L ;>�Palme 3' ` >s �7 ■ I� � fi_v.� it _s 'tte. 2, rA r� - a' JB-..*- jE Q ®Back - 0 - �. 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