64-530 - 1 GOOD CIRCLE - CONSERVATION COMMISSION C. Lt , c7
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 8B — Certificate of Compliance 64-530
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:
J'vtfrk &L'6, fnq` 530
Project Location DEP File Number
Has been recorded at the Registry of Deeds of:
County
for:
54A.(- n n��iw�lPtii
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:
SgfS23s (06a-7-75 See &Axekad
Document/N/umber'
Si re of Applicant
wpafrm8b.doc•rev.12/23/09 WPA Form 813,Certificate of Compliance•Page 3 of 3
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Massachusetts Department of Environmental Protection
Bureau of Resource Protection-Wetlands DEP Rio Number:
WPA Form 8B — Certificate of Compliance 64-530
(1 Massachusetts Wetlands Protection Act M.G.L. c. 131,§40 Prevketlby DEP
A. Project Information
when fukng om 1. This Certificate of Compliance is issued to:
tons on the
eomputer.use Salem Homebuilders i
only the tab key Name
to move your 100 Cabot Street
cursor-donot Mailing Address
we the return
keyyl. Beverly MA 01915
ke�1�^! Cilyrrown stale Zip Code
^^ 2. This Certificate of Compliance is issued for work regulated by a final Order of
Conditionst issued to:
Kenneneth G.Steadman
M101 Name
9/17/2012 64.630
Dated DER File Number
3. The project site is located at:
5 Goad Circle(like 1 Good Cirloo,lot 230) Salem
Street address cityrrovm
9 334
Assessors Map/Plat Number PameliWt Number
the final Order of Condition was recorded at the Registry of Deeds for.
Kenneth G.Steadman
Property Owner(It deferent)
South Essex
County Book Page
80815(Doc.#536273)
Cedekate
4. A site inspection was made in the presence of the applicant,or the applicant's agent,
on:
7/8(2013
Date
uye1ru00.0ap•rrrAZWKp wPe Fqm Be Cenlfigled Cmgllenn•Pepe r d J
http://www.satemdeeds.com/lcmtifs/2013/08/02/00545235.tif Page 1 of 1
�cSrm�r,�
i ti �q
CITY OF SALEM
CONSERVATION COMMISSION
July 15, 2013
Salem Homebuilders LLC
Attn: Jeff Holloran
100 Cabot Street
Beverly, MA 01915
Witch Hill Subdivision Certificates of Compliance: #64-528 (lot 231), 3 Good
Circle; #64-529 (lot 232), 1 Good Circle; #64-530 (lot 230), 5 Good Circle; #64-533
(lot 233), 5 Nurse Way; #64-535 (lot 234), 3 Nurse Way; #64-536 (lot 215), 2 Nurse
Way
Dear Mr. Holloran:
Please find the enclosed certificates of compliance for the above-referenced projects.
These certificates must be recorded at the South Essex County Registry of Deeds, 45
Congress Street (Shetland Park) #4100 in Salem. Please fill out and return the Recording
Information on page 3 of the certificates, which will indicate to the Salem Conservation
Commission that the documents have been recorded.
If you have any further questions please feel free to contact me at 978-619-5685.
Sincerely,
Tom evine
Conservation Agent/Staff Planner
Enclosures
CC: Kenneth Steadman
DEP Northeast Regional Office
i
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 64-52b
Provided by DEP _
A. Project Information
Important:•
When filling out 1. This Certificate of Compliance is issued to:
forms on the
computer,use Salem Homebuilders LLC
only the tab key Name
to move your cursor.do not 100 Cabot Street
use the return . . Mailing Address. _
key. Beverly MA 01915
C,ty/Town State Zip Code
2. This Certificate of Compliance is issued for work regulated by a final Order of
Conditions issued to:
Kenneth G. Steadman
nm Name
9/17/2012 64-528
Dated - DEP File Number
3, The project site is located at:
3 Good Circle(fka 3 Good Circle lot 231) Salem
Street Address Clty/Town -
9 333
Assessors Map/Plat Number Parcel/Lot Number
the final Order of Condition was recorded at the Registry of Deeds for:
Kenneth G. Steadman
Property Owner(if different) -
South Essex
County Book _ Page
80815 (Doc: #536271)
Certificate
4. A site inspection was made in the presence of the applicant, or the applicant's agent,
on:
7/8/2013
Date
wpalrm8d.dw-rev.IN23 09
WPA Form 813,Cenillwte of Compliance•Page 1 013
l
MLFassachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 8B - Certificate of Compliance 64-
Massachusetts Wetlands Protection Act M.G.L. c. 131, 40 529 _
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
Conservation Commission D e of Iss ance
This Certificate must be signed by a majority of the Conservation Commission and a
copy sent to the applicant and appropriate DEP Regional Office(See
htII2://www.mass-gov/dep/about/region/findyour.htm).
ig tjres:
Cf �
wpatooftdoo•rev.1&3"
WPA Form 88.Cenifioete of Complianm•Page 2 of 3
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 s4-528
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:
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
wPalrmao-doc•rev,i w3rp9
WPA Form 8B,Ce&6=e of Compliance.Page 3 of 3
a
'low
� 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 84-529
7 Provided by DEP,
A. Project Information
Important:.
When filling out 1. This Certificate of Compliance is issued to:
forms on the
computer,use Salem Homebuilders LLC
only the tab key Name
to move your 100 Cabot Street -
cursor-do not
use the return Mailing Address -
key.
Beverly MA 01915
Clry/Town State -Zip Code
n0 2. This Certificate of Compliance is issued for work regulated by a final Order of
Conditions to.issued -e
Kenneth G. Steadman
Name
9/17/2012 64-529
Dated - - DEP File Number
3. The project site is located at:
1 Goad Circle(fka 2 Good Circle lot 232) Salem
Street Address Cilylrown
9 332
Assessors Map/Plat Number Parcel/Lot Number the final Order of Condition was recorded at the Registry of Deeds for:
Kenneth G. Steadman
Property Owner(if different)
South Essex
County Book Page
80815 (Doc. #536272)
Certificate
4. A site inspection was made in the presence of the applicant, or the applicant's agent,
on:
7/8/2013
Date
wPafrmeb.Joc•rev.12/23/W WPA Form 88,Cmfifreale of Campllance•Page i of 3
i
F_L71- 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 64-529
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
Conservation Commtsston uam of issw6nce
This Certificate must be signed by a majority of the Cons7i, 7
tim
copy sent to the applicant and appropriate DEP Regiona
ht g://www.mass Dov/deo/about/reaio findvour htm).
Sig tares:
i
_ wpatrmab.dat rev,1b23109
W PA Foaa ft Certificate of Compliance•Page 2 m 3
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 sa-52s
r 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:
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
wpaf m8b,dm-rev,M23M - WPA FOrm 88,Cenlfiwe w Compliant¢•Page 3013
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 64-530
_ � Provided by DEP
A. Project Information
Important:
When filling out 1. This Certificate of Compliance is issued to:
forms on the.
computer,use Salem Homebuilders LLC
only the tab key Name
to move your 100 Cabot Street
cursor-do not
use the return - Malting Address -
key. - Beverly - MA - 01915
Cltyrrown State Zip Code
n0 2. This Certificate of Compliance is issued for work regulated by a final Order of
Conditions issued to:
Kenneth G. Steadman
Name
9/17/2012 64-530
Dated DEP File Number
3. The project site is located at
5 Good Circle(fka 1 Good Cirlce, lot 230) Salem
Street Address City/Tom
9 334
Assessors Map/Plat Number Parcel/Lot Number
the final Order of Condition was recorded at the Registry of Deeds for:
Kenneth G. Steadman
Property Owner(if different)
South Essex
County - Book Page
80815(Doc. #536273)
Certificate
4. A site inspection was made in the presence of the applicant, or the applicant's agent,
on:
7/8/2013
Date
wpafrmBbdac•rev.@.23I)9 WPA Form 8e,Cenifi.,of Campli,mm•Page 1 of 3
L71Massachusetts Department of Environmental Protection
— Bureau of Resource Protection - Wetlands DEP He Number:
WPA Form 8B Certificate of Compliance
Massachusetts Wetlands Protection Act M.G.L. c:131, 40 64-530
. - . . � 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 /ISs(� �j 3
Conservation Commission —�i ,ce
This Certificate must be signed by a majority of the Conservation Co D�e ofmmission and a
copy sent to the applicant and appropriate DEP Regional Office(See
http://www.mass.goyLdeg/about/region/findvour.htm).
Signatures:
"-_
wpafrm8b.doc•rev.1PJ &N WPA Form Oe.Cetfl-te of C-nPlwce•Page 2 M 3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number.
WPA Form 8B — Certificate of Compliance 64_53O
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:
Protect 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
wpalrm8odoc•rev.12/23W WPA Fotm 8e.Certificate of CemPloree•Page 3 of 3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection-Wetlands DEP File Number
WPA Form 813 — Certificate of Compliance
Massachusetts Wetlands Protection Act M.G.L. c. 131, 40ill 64 533
Provided by DEP
A. Project Information
Important:... _
When filling out 1. This Certificate of Compliance is issued to.
forms on the -
computer,use Salem Homebuilders LLC
only the tab key Name -- ---- _
to move your 100 Cabot Street
cursor-do not A ddre- ss
— --- ----- ------
use the return
Mailing ' ---- --
key. - .Beverly MA_ 01915-
City/Town State - Zlp Code
2. This Certificate of Compliance is issued for work regulated by a final Order of
Conditions issued
Kenneth G. Steadman
— — —
Name
9/17/2012 64-533
---- _.
- - Dated - --
__...- ----.-- DEP File Number
3. The project site is located at:
5 Nurse Wayyy�fka 4 Nurse Way_lot,233j Salem
-- — — -
- - Street Address Ciryfrown
9 m 331
-------Assessors Ma plPlat Nuber Parcel/Lot Number
the final Order of Condition was recorded at the Registry of Deeds for:
Kenneth G. Steadman
Property Owner(if different)
South Essex
Coun
h' Book .__-_.. Page__ .,... .._
80815(Doc,#536276�__
Certificate .. ............. ........_.......:„:.
4. A site inspection was made in the presence of the applicant, or the applicant's agent,
on:
7/8/2013
_ ..
Date _..___ . ....__.
wpafr,rOb.we-rev 12123M9
WPA Form 88,Cen�,,,,a 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
Massachusetts Wetlands Protection Act M.G.C. e, 131, §40 64 533
Provided by DEP
B. Certification
Check all that apply;
qbComplete 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 ..
Conservation Commission D of Iss nce
This Certificate must be signed by a majority of the Conservation Commission and a
copy sent to the applicant and appropriate DEP Regional Office (See
httg//www mass aov/deo/ab nil Vregion/findyour htm).
ig t`ires:
wpafrmBE tlnr. rev 1223N9 MA Form 88.ceolr=e 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
33
Massachusetts Wetlands Protection Act M.G.L. c. 131 0 sa- d
r 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
Project Location DEP File Number -
Has been recorded at the Registry of Deeds of:
_...,u— ----
...-- — —
Conty
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
Sig nature of Applicant
wParrm9b d.•rev.12123N9 - VJPp Form aB.fenifcare of ComPbance•Page 3 0(3 -
Massachusetts Department of Environmental Protection
Bureau of�r Resource Protection - Wetlands�. - DEP File Number: -
WPA Form 8B — Certificate of Compliance
Massachusetts Wetlands Protection Act M.G.L. c. 131, �40 64"535
_ Provided by DEP
A. Project Information
Important:
When filling out 1. This Certificate of Compliance is issued to:
forms on the
computer,use Salem Homebuilders LLC
only the tab key Name ----
to move your 100 Cabot Street
cursor-do not -
use the return Mailing Address -
key. Beverly — ...----- -------- MA 01915
city/Town State Zip Code
m 2. This Certificate of Compliance is issued for work regulated by a final Order of °
Conditions issued to:
Kenneth G. Steadman
— —
Name ...._.._...._ _.
9/17/2012 64-535
Dated DEP File Number
3. The project site is located at:
3 Nurse Way(fka 2 Nurse Waylot 234) Salem
Street Address - CiryRown
9 330
- Assessors Map/Plat Number Parcel/lot Number
the final Order of Condition was recorded at the Registry of Deeds for:
Kenneth G. Steadman
................
- Property Owner(if different)
South Essex
_ County. - Book Page.
80815 Loc.# 36278)_"____ . _..-..._
Certificate ------- --,:...___
4. A site inspection was made in the presence of the applicant, or the applicant's agent,
on:
7/8/2013
_ . _.-.
Date '_.,....... ...__........
wpafrm8b d.•rev 12MM WPA Form 8B.Cenifleate of Comptianw•Pagel of 3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection-Wetlands DEP File Number
WPA Form 8B Certificate of Compliance
535
Massachusetts Wetlands Protection Act M.G.L. c. 131, 40 64 '
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 continuer
(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: 7 Salem J .f Vnl (3
--
Conse rvation Commission ����� e of Iss nce
This Certificate must be signed by a majority of the Conservation Commission and a
copy sent to the applicant and appropriate DEP Regional Office(See
http://www.mass.ciov/dep/about/region/findvour.htm). ) )
ig tures:
c
wpafrm8b.doc-rev 12123N9 - WPF Form 88,Cetli(IWle of Compliance•Page 2 of 3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File number,
WPA Form 86 — Certificate of Compliance
Massachusetts Wetlands Protection Act M.G.L. c.',131, 40 64-535
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,
- - - - - ----- - -- --- -- -
Salem
_ Conservation Commission.
Please be advised that the Certificate of Compliance for the project at:
Project Location - - - -
1 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 -
wpafrm8b doc•rev.12/23109 WPA Form 89.Cerlihoete of Compliance•Page 3 of 3
Massachusetts Department of Environmental Protection
!-- Bureau of Resource Protection - Wetlands DEP File Number.
WPA Form 813 — Certificate of Compliance
Massachusetts Wetlands Protection Act M.G.L. c. 131, 40 Provide
Provided by DEP
A. Project Information --
Important:When filling out 1. This Certificate of.Compliance is issued to:
forms on the -
computer,use Salem Homebuilders LLC
only the tab key Name ---'-- "---- -----
to move your cursor-do not 100 Cabot Street
`use the return Mailing Address '--:---
key. Beverly MA 01915'
�I CityTrown —__--- _-_ -- State Zip code
n° 2. This Certificate of Compliance is issued for work regulated by a final Order of
Conditions issued to:
Kenneth G. Steadman
9/17/2012 _ 64-536
Dated ,_-______ -___
- - �� DEP File Number
3. The project site is located at
2 Nurse Way fka 1_Nurse Way, lot 215j Salem
---
Street Address ----
14 324
Assessors Ma /Plat Number -'---- ---- -
- P Parcel/Lot Number
the final Order of Condition was recorded at the Registry of Deeds for
Kenneth G. Steadman
Property Owner(if different)
South Essex
.County --
Boo-k Page ..--
80815 Doc. #536279
Certificate - ..___._ ......,.. ...
4. A site inspection was made in the presence of the applicant, or the applicant's agent,
on:
7/8/2013
- Date. :.. ..__... .._..,.._...__
wpafrm3bd.-Iov 12123g9 WPA Form 88.C60,,,Ala of Compliance,Paget of
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands DEP File Number.
WPA Form 813 - Certificate of Compliance 64 536
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
Provided.by DEP
B. Certification
Check all that apply:
2 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 ��
Conservation Commission a of Iss ce
This Certificate must be signed by a majority of the Conservation Commission and a
copy sent to the applicant and appropriate DEP Regional Office(See
http//www mass gov/dep/aboutiregion/findvour htm).
Sign ures
V4,
+PefrmBD.d.•rov 12123109 MA Form BB Cadificale 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
Massachusetts Wetlands Protection Act M.G.L. c. 131, 40 sa-83s
Provitletlby 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:
— — ---—Project Location � � DEP File Number --. --
Has been recorded at the Registry of Deeds of:
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 - ° "-°- -- -
w afrm8e dac•rev 12123Z9 WPA Pope BB.CenffE et of Compliance•Page 3 of 3
Attachment to Order of Conditions # 64-530
Page 1 of 5
SALEM CONSERVATION COMMISSION
DEP FILE #64-530
1 Good Circle
City of Salem, Massachusetts
ADDITIONAL FINDINGS
Based on the Estimated Habitats of Rare Wildlife and Certified Vernal Pools Map (October 1, 2008) 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 and Conservation Ordinance,Salem Code Chapter 50.
This order permits the construction of a single-family house and appurtenances per Notice of Intent submitted June
20, 2012.
SPECIAL CONDITIONS
1. This Order of Conditions must be recorded in its entirety(including all 5 pages of Special Conditions)
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 and Conservation Ordinance, Salem Code Chapter 50.
3. All work shall be performed in accordance with this Order of Conditions and approved site plants). 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 on site, a DEP Sign showing DEP File#64-530 must be installed at the
entrance to the site and seen from the public way, but not placed on a living tree.
5. No work approved in this Order may commence until the ten(10)business 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.
�muSy L,
Attachment to Order of Conditions # 64-530
Page 2 of 5
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. 21 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.).
I0. If there are conflicting conditions within this Order, the stricter condition(s) shall rule.
l I. 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 Development Permit Plan Located in Salem, Mass.
(Title)
9/7/2012
(Dated)
Clayton Morin
(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
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
s Attachment to Order of Conditions # 64-530
aFi Page 3 of 5
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
must be a Pre-Construction Meeting on site between the project supervisor, the contractor responsible
for the work, and the Conservation Agent and/or a member of the Conservation Commission 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 Agent at
(978)619-5685 at least forty-eight(48) hours prior to construction 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 Agent 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.
20. There shall be sufficient erosion controls stored undercover on the site to be used for emergency
erosion control purposes.
EROSION CONTROL
21. Appropriate erosion control devices shall be in place prior to the beginning of any phase of construction,
and shall be maintained during construction in any wetland resource area and/or buffer zones. The
erosion control measures shown on the approval plan(s)and provisions in the Order will be the minimum
standards for this project; the Commission or its Agent may require additional measures.
22. 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.
23. 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.
24. The area of construction shall remain in a stable condition at the close of each construction day.
25. 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 # 64-530
<r Page 4 of 5
.gym.
26. 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.
27. If soils are to be disturbed for longer than 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
28. 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.
29. No alteration or activity shall occur beyond the limit of work as defined by the siltation barriers shown on
the approved plan(s).
30. 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.
31. 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.
32. 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.
33. 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.
34. There shall be no pumping of water from wetland resource areas.
35. All equipment shall be inspected regularly for leaks. Any leaking hydraulic lines,cylinders or any other
components shall be fixed immediately.
36. During construction, all drainage structures shall be inspected regularly and cleaned as necessary.
37. 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
38. 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 # 64-530
s.
Page 5 of 5
(a) All wetland resource area boundaries with associated buffer zones and regulatory setback
areas taken from the plants)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;
39. When issued, the Certificate of Compliance must be recorded at the Southern Essex County Registry of
Deeds and a copy of the recording submitted to the Salem Conservation Commission.
40. 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.
41. 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 Agent has authorized
their removal.
ADDITIONAL CONDITIONS
42. Prior to construction, a plantings plan developed by a wetlands scientist must be submitted to the
conservation commission for review and approval.
Massachusetts Department of Environmental Protection Provided by MassOEP:
Bureau of Resource Protection - Wetlands 64-530
WPA Form 5 — Order of Conditions MassDEP File#
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
eDEP Transaction#
Salem
City/Town
A. General Information
Please note: Salem
this form has 1. From:
been modified Conservation Commission
with added 2. This issuance is for
space to a.®Order of Conditions b.❑Amended Order of Conditions
accommodate (check one):
the Registry
of Deeds 3. To: Applicant:
Requirements
Kenneth G. Steadman
Important: a. First Name b. Last Name
When filling
out forms C.Organization
on the 67 Village Street
computer,
use only the d. Mailing Address
tab key to Marblehead m MA 01945
o your e.Clty/Town f.State
cursor
r-do g.Zip Cade
not use the 4, Property Owner(if different from applicant):
return key.
ra+ a. First Name b.Last Name
c.Organization
anm ;
d. Mailing Address
e. City/Town f.State
g.Zip Code
5. Project Location:
1 Good Circle Salem
a.Street Address b.City/Town
9 230
C.Assessors Map/Plat Number d. Parcel/Lot Number
Latitude and Longitude, if known: 42d30m35s 70d55mO9s
d. Latitude e. Longitude
wpaform5.doc• rev.o5/19/2oio
Page t of 12
Massachusetts Department of Environmental Protection Provided by MassDEP:
i
Bureau of Resource Protection - Wetlands 64-530
WPA Form 5 — Order of Conditions MassDEP File#
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
eDEP Transaction#
Salem
Cityrrown
A. General Information (cont.)
6. Property recorded at the Registry of Deeds for(attach additional information if more than
one parcel):
Southern Essex 80814 & 80815
a.County b.certificate Number(if registered land)
c.Book d. Page
7. Dates: 6/20/2012 9/13/2012 9/17/2012
a. Date Notice of Intent Filed b.Date Public Hearing closed c.Date of Issuance
a. Final Approved Plans and Other Documents (attach additional plan or document references
as needed):
Site Development Permit Plan Located in Salem Mass
a. Plan Title
_Eastern Land Survey Associates Clayton A. Morin
J. Prepared By c.Signed and Stamped by
9/7/2012 1"=20-
d. Final Revision Date e.Scale
f.Additional Plan or Document Title g. Date
B. Findings
t. 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(the Act). Check all that apply:
a. ® Public Water Supply b. ❑ Land Containing Shellfish c, ® Prevention of
Pollution
J. .® 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.
wpaform5.00c• rev.05A92010
Page 2 of 12
Massachusetts Department of Environmental Protection Provided by MassDEP:
Bureau of Resource Protection - Wetlands 64-530
WPA Form 5 - Order of Conditions MassDEP File
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
eDEP Transaction N
Salem
Cityrrown
B. Findings (cont.)
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 the interests of the Act, 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).
3. ® Buffer Zone Impacts: Shortest distance between limit of project 10' +/-
disturbance and the wetland resource area specified in 310 CMR 10.02(1)(a a.linear feet
Inland Resource Area Impacts: Check all that apply below. (For Approvals Only)
Resource Area Proposed Permitted Proposed Permitted
Alteration Alteration Replacement Replacement
4. ❑ Bank
a.linear feet b.linear feet c.linear feet J.linear feet
e. El Bordering
Vegetated Wetland a.square feet b.square feet c.square feet d.square feet
s. ❑ Land Under
Waterbodies and a.square feet b.square feet c.square feet d.square feet
Waterways
e.c/y dredged f.c/y dredged
z El Bordering Land
Subject to 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 Pi-cubic feet
e. ❑ 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
9. ❑ Riverfront Area
fr,tn ;^ ,,t b. total sq.feet
Sq ft within 100 It
Sq it between 100• d.square feet = ,e fom f. square feet
^ "
200 it h.square feet
1 feet j.square feet
wpaform5.doc• rev.0 511 9/2 01 0
Page 3 of 12
l -
I
Massachusetts Department of Environmental Protection Provided by MassDEP:
Bureau of Resource Protection - Wetlands 64-530
WPA Form 5 — Order of Conditions MasSDEPFile#
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
eDEP Transaction It
Salem
B. Findings (cont.) City/Town
Coastal Resource Area Impacts: Check all that apply below. (For Approvals Only)
Proposed Permitted Proposed Permitted
Alteration Alteration Replacement Replacement
10. ❑ Designated Port Areas Indicate size under Land Under the Ocean, below
11. ❑ Land Under the
Ocean a.square feet b.square feet
c.c/y dredged d.c/y dredged
12. ❑ Barrier Beaches Indicate size under Coastal Beaches and/or Coastal Dunes
below
13. ❑ Coastal Beaches cu yd cu yd
a.square feet b.square feet c.nourishment d.nourishment
14. ❑ Coastal Dunes cu yd cu yd
a.square feet b.square feet c.nourishment d.nourishment
15. ❑ Coastal Banks
a.linear feet b. linear feet
16. ❑ Rocky Intertidal
Shores a.square feet b.square feet
n. ❑ Salt Marshes
a.square feet square feet c.square feet d.square feet
18. ❑ Land Under Salt b.
Ponds a.square feet b.square feet
c.c dredged d.c/Y 9 -dredged
Y
1s. El 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.cly dredged b.c/y dredged
21. ❑ Land Subject to
Coastal Storm a.square feet b.square feet
Flowage
wpaform5.doc• rev.05/19/2010
Page 4 of 12
Massachusetts Department of Environmental Protection Provided by MassDEP:
Bureau of Resource Protection - Wetlands 64-530
WPA Form 5 — Order of Conditions MasSDEPFile#
1 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
eDEP Transaction k
Salem
B. Findings (cont.) City/Town
#22. If the
project is for 22• EJ Restoration/Enhancement
the purpose of
restoring or
enhancing a a.square feet of BVW b.square feet of salt marsh
wetland
resource area 23. ❑ Stream Crossing(s):
in addition to
the square
footage that a.number of new stream crossings b.number of replacement stream crossings
has been entered in C. General Conditions Under Massachusetts Wetlands Protection Act
Section B.5.c
B.ITol(salt The following conditions are only applicable to Approved projects.
plea ei ntteere 1. Failure to Comply with all conditions stated herein, and with all related statutes and other
the additional regulatory measures, shall be deemed cause to revoke or modify this Order.
amount here. 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. If this Order constitutes an Amended Order of Conditions, this Amended Order of
Conditions does not extend the issuance date of the original Final Order of Conditions and
the Order will expire on 9/17/2012 unless extended in writing by the Department.
7. 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.
8. 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.
wpaform5.doc• rev.0 511 912 01 0
Page 5 of 12
r.
i-
d
1
I
Massachusetts Department of Environmental Protection Provided by MassDEP:
Bureau of Resource Protection - Wetlands 64-530
WPA Form 5 - Order of Conditions MassDEPFIIe#
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 ----
- eDEP Transactionn#
Salem
wn
C. General Conditions under Massachusetts Wetlands Protection e Act (cont.)
9. 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 the
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.
10. 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, "MassDEP"]
"File Number 64-530 11
11. 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 MassDEP.
12. Upon completion of the work described herein, the applicant shall submit a Request for
Certificate of Compliance(WPA Form 8A)to the Conservation Commission.
13. The work shall conform to the plans and special conditions referenced in this order.
14. Any change to the plans identified in Condition #13 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.
15. 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.
16. 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.
17. 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.
wpaform5.doc• rev.M19/2010
Page 6 of 12
Massachusetts Department of Environmental Protection Provided by MassDEP:
Bureau of Resource Protection - Wetlands 64-530
WPA Form 5 - Order of Conditions MassDEPFile#
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
eDEP Transaction k
Salem
City/Town
C. General Conditions Under Massachusetts Wetlands Protection Act (cont.)
18. All sedimentation barriers shall be maintaine
d 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.
NOTICE OF STORMWATER CONTROL AND MAINTENANCE REQUIREMENTS
19. The work associated with this Order(the"Project") is ltl❑ is not(2) ® subject to the
Massachusetts Stormwater Standards. If the work is subject to the Stormwater
Standards, then the project is subject to the following conditions:
a) All work, including site preparation, land disturbance, construction and redevelopment,
shall be implemented in accordance with the construction period pollution prevention and
erosion and sedimentation control plan and, if applicable, the Stormwater Pollution
Prevention Plan required by the National Pollution Discharge Elimination System
Construction General Permit as required by Stormwater Condition 8. Construction period
erosion, sedimentation and pollution control measures and best management practices
(BMPs) shall remain in place until the site is fully stabilized.
b) No stormwater runoff may be discharged to the post-construction stormwater BMPs
unless and until a Registered Professional Engineer provides a Certification that:
i. all construction period BMPs have been removed or will be removed by a date certain
specified in the Certification. For any construction period BMPs intended to be converted
to post construction operation for stormwater attenuation, recharge, and/or treatment, the
conversion is allowed by the MassDEP Stormwater Handbook BMP specifications and that
the 8MP has been properly cleaned or prepared for post construction operation, including
removal of all construction period sediment trapped in inlet and outlet control structures;
ii. as-built final construction BMP plans are included, signed and stamped by a Registered
Professional Engineer, certifying the site is fully stabilized;
N. any illicit discharges to the stormwater management system have been removed, as per
the requirements of Stormwater Standard 10;
iv. all post-construction stormwater BMPs are installed in accordance with the plans
(including all planting plans) approved by the issuing authority, and have been inspected to
ensure that they are not damaged and that they are in proper working condition;
v. any vegetation associated with post-construction BMPs is suitably established to
withstand erosion.
wpaform5.doe,• rev.05/19/2010
Page 7 of 12
Massachusetts Department of Environmental Protection Provided by MassDEP:
�l Bureau of Resource Protection - Wetlands 64-530
\�\ WPA Form 5 - Order of Conditions MassDEPFle#
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
eDEP Transaction#
Salem
C. City/Town
General Conditions Under Massachusetts Wetlands Protecti n Act (cont.)
c) The landowner is responsible for BMP maintenance until the issuing authority is
notified that another party has legally assumed responsibility for BMP maintenance. Prior
to requesting a Certificate of Compliance, or Partial Certificate of Compliance, the
responsible party(defined in General Condition 18(e)) shall execute and submit to the
issuing authority an Operation and Maintenance Compliance Statement ("O&M Statement)
for the Stormwater BMPs identifying the party responsible for implementing the stormwater
BMP Operation and Maintenance Plan ("O&M Plan") and certifying the following: i.) the
O&M Plan is complete and will be implemented upon receipt of the Certificate of
Compliance, and if.) the future responsible parties shall be notified in writing of their
ongoing legal responsibility to operate and maintain the stormwater management BMPs
and implement the Stormwater Pollution Prevention Plan.
d) Post-construction pollution prevention and source control shall be implemented in
accordance with the long-term pollution prevention plan section of the approved
Stormwater Report and, if applicable, the Stormwater Pollution Prevention Plan required by
the National Pollution Discharge Elimination System Multi-Sector General Permit.
e) Unless and until another party accepts responsibility, the landowner, or owner of any
drainage easement, assumes responsibility for maintaining each BMP. To overcome this
presumption, the landowner of the property must submit to the issuing authority a legally
binding agreement of record, acceptable to the issuing authority, evidencing that another
entity has accepted responsibility for maintaining the BMP, and that the proposed
responsible party shall be treated as a permittee for purposes of implementing the
requirements of Conditions 18(f)through 18(k) with respect to that BMP. Any failure of the
proposed responsible party to implement the requirements of Conditions 18(f)through
18(k) with respect to that BMP shall be a violation of the Order of Conditions or Certificate
of Compliance. In the case of stormwater BMPs that are serving more than one lot, the
legally binding agreement shall also identify the lots that will be serviced by the stormwater
BMPs. A plan and easement deed that grants the responsible party access to perform the
required operation and maintenance must be submitted along with the legally binding
agreement.
f) The responsible party shall operate and maintain all stormwater BMPs in accordance
with the design plans, the 0&M Plan, and the requirements of the Massachusetts
Stormwater Handbook.
wpaform5.doc• rev.05/192o10
Page 0 of 12
Massachusetts Department of Environmental Protection Provided by MassDEP:
Bureau of Resource Protection - Wetlands 64-530
WPA Form 5 - Order of Conditions MassDEPFIIe#
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
eDEP Transaction#
Salem
City/Town
C. General Conditions Under Massachusetts Wetlands Protection Act (cont.)
g) The responsible party shall:
1. Maintain an operation and maintenance log for the last three (3) consecutive
calendar years of inspections, repairs, maintenance and/or replacement of the
stormwater management system or any part thereof, and disposal (for disposal the
log shall indicate the type of material and the disposal location);
2. Make the maintenance log available to MassDEP and the Conservation
Commission ("Commission") upon request; and
3. Allow members and agents of the MassDEP and the Commission to enter and
inspect the site to evaluate and ensure that the responsible party is in compliance
with the requirements for each BMP established in the O&M Plan approved by the
issuing authority.
h) All sediment or other contaminants removed from stormwater BMPs shall be disposed
of in accordance with all applicable federal, state, and local laws and regulations.
i) Illicit discharges to the stormwater management system as defined in 310 CMR 10.04
are prohibited.
j) The stormwater management system approved in the Order of Conditions shall not be
changed without the prior written approval of the issuing authority.
k) Areas designated as qualifying pervious areas for the purpose of the Low Impact Site
Design Credit(as defined in the MassDEP Stormwater Handbook, Volume 3, Chapter 1,
Low Impact Development Site Design Credits) shall not be altered without the prior written
approval of the issuing authority.
1) Access for maintenance, repair, and/or replacement of BMPs shall not be withheld.
Any fencing constructed around stormwater BMPs shall include access gates and shall be
at least six inches above grade to allow for wildlife passage.
Special Conditions (if you need more space for additional conditions, please attach a text
document):
wpafo,m5.tloc• rev.05/192010
Page 9 of 12
1
Massachusetts Department of Environmental Protection Provided by MassDEP:
�^ Bureau of Resource Protection - Wetlands 64-530
WPA Form 5 - Order of Conditions MassDEP File A
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
eDEP Transaction#
Salem
City/Town
D. Findings Under Municipal Wetlands Bylaw or Ordinance
I. Is a municipal wetlands bylaw or ordinance applicable? ® Yes ❑ No
2. The Salem hereby finds (check one that applies):
Conservation Commission
a. ❑that the proposed work cannot be conditioned to meet the standards set forth in a
municipal ordinance or bylaw, specifically:
i. Municipal Ordinance or Bylaw
2.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.
b. ®that the following additional conditions are necessary to comply with a municipal
ordinance or bylaw:
Wetlands Protection and Conservation c.50
1.Munlapal Ordinance or Bylaw
2.Citation
3. 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.
The special conditions relating to municipal ordinance or bylaw are as follows (if you need
more space for additional conditions, attach a text document):
Attached special conditions are issued under the Wetlands Protection Act and are sufficient
for compliance with the local ordinance (c 50)
wpalorm5.doc• rev.M 9/2010
Page 10 of 12
Massachusetts Department of Environmental Protection Provided by MassDEP:
Bureau of Resource Protection - Wetlands Gcf— s 1a
WPA Form 5 - Order of Conditions MaSsDEP File#
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 eDEPTransaction#
E. Signatures City/Town
Important: This Order is valid for three years, unless otherwise specified as a special
When filling out condition pursuant to General Conditions#4, from the ate of issuance. t. Date of Issuance
forms on the
computer,use Please indicate the number of members who will sign this form.
only the tab key This Order must be signed by a majority of the Conservation Commission. 2.Numb r of Signers
to move your
cursor-do not The Order must be mailed by certified mail (return receipt requ ' ted) or haaddeliveM to
e the return the applicant.A copy must be mailed, hand delivered or ifdel c nic ly he drt{e
key.
time with the appro assDEP Regional Office.
d /
i r
i,
—�
❑ by hand delivery on by certified mail, return receipt
requested, on
Dale
Dale
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 MassDEP 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 providing written information to the Department prior to issuance of
a Superseding Order.
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.
wpassigs.doc• rev.0212 512 01 0
Page J of
� r
Massachusetts Department of Environmental Protection Provided by MassDEP:
Bureau of Resource Protection - Wetlands 64-530
WPA Form 5 - Order of Conditions MassDEP File k
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
eDEP Transaction#
Salem
G. Recor City/Town
ding Information
Prior to commencement of work, 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 this page
shall be submitted to the Conservation Commission listed below.
Conservation Commission
Detach on dotted line, have stamped by the Registry of Deeds and submit to the Conservation
Commission.
-
--------------------------------------------------------------------------------------------
----
To:
Conservation Commission
Please be advised that the Order of Conditions for the Project at:
Project Location
MassDEP 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
wpaform5.tloc• rev.05/19/2010
Page 12 of 12
Massachusetts Department of Environmental Protection Provided by MassDEP:
Bureau of Resource Protection - Wetlands
L11
SMassDEP,File Number
WPA Form 3 — Notice of Intent
DocMassachusetts Wetlands Protection Act M.G.L. c. 131, §40 Salem nt Transaction Number
Salem
Cityrrown
Important:When filling out A. General Information
forms on the
computer,use 1. Project Location (Note: electronic filers will click on button to locate project site):
only the tab key
to move your 1 Good Circle Salem 01970
cursor-do not use the return dY c.Zi/Town a.Street Address b.C' Code
P
key' Latitude and Longitude: 42-30-35 70-55-09
d.Latitude e.Longitude
Map 9 Part Parcel 30 Lot 230
f.Assessors Map/Plat Number g.Parcel/Lot Number
2. Applicant:
Kenneth G. Steadman
a.First Name b.Last Name
Note:
Before c.Organization
completing this form consult 67 Village Street
your local d.Street Address
Conservation Marblehead MA 01945
Commission e,City/Town f.State g.Zip Code
regarding any 781631-3751
municipal bylaw
or ordinance. h.Phone Number i.Fax Number j.Email Address
3. Property owner(required if different from applicant): ❑ Check if more than one owner
Same
a.First Name b.Last Name
c.Organization
d.Street Address
e.City/Town f.State g.Zip Code
h.Phone Number i. Fax Number j.Email address
4. Representative (if any):
Attorney George W. Atkins III
a.First Name b.Last Name
Ronan, Segal & Harrington
c.Company
59 Federal Street
d.Street Address
Salem MA 01970
e.City/Town f.State g.Zip Code
978-744-0350
h.Phone Number I. Fax Number j.Email address
5. Total WPA Fee Paid (from N01 Wetland Fee Transmittal Form):
500.00 237.50 262.50
a.Total Fee Paid b.State Fee Paid c.City/Town Fee Paid
wpaform3.doc•rev.11/16/09 Page 1 of 8
ILIMassachusetts Department of Environmental Protection Provided by MassDEP:
Bureau of Resource Protection - Wetlands MasaDeP File Number
WPA Form 3 — Notice of Intent DocumentTransactlonNumber
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Salem
CWTown
A. General Information (continued)
6. General Project Description:
Construction of single family dwelling, driveway, utilities grading and landscaping
7a. Project Type Checklist:
1. ® Single Family Home 2. ❑ Residential Subdivision
3. ❑ Limited Project Driveway Crossing 4. ❑ Commercial/Industrial
5. ❑ Dock/Pier 6. ❑ Utilities
7. ❑ Coastal Engineering Structure 8. ❑ Agriculture (e.g., cranberries, forestry)
9. ❑ Transportation 10. ❑ Other
7b. Is any portion of the proposed activity eligible to be treated as a limited project subject to 310 CMR
10.24 (coastal)or 310 CMR 10.53 (inland)?
1. ❑ Yes ® No If yes, describe which limited project applies to this project:
2.Limited Project
8. Property recorded at the Registry of Deeds for:
Essex South 80814 & 80815
a.County b.Certificate#(if registered land)
c.Book d.Page Number
B. Buffer Zone & Resource Area Impacts (temporary & permanent)
1. ® Buffer Zone Only—Check if the project is located only in the Buffer Zone of a Bordering
Vegetated Wetland, Inland Bank, or Coastal Resource Area.
2. ❑ Inland Resource Areas(see 310 CMR 10.54-10.58; if not applicable, go to Section B.3,
Coastal 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.
For all projects
affecting other Resource Area Size of Proposed Alteration Proposed Replacement(if any)
Resource Areas,
please attach a
narrative a. ❑ Bank 1.linear feet 2.linear feet
explaining how b.
the resource ❑ Bordering Vegetated
area was Wetland 1.square feet 2.square feet
delineated. c. ❑ Land Under
i.square feet 2.square feet
Waterbodies and
Waterways 3.cubic yards dredged
wpaform3.doc•rev. 11/16/09 Page 2 of 8
Massachusetts Department of Environmental Protection Provided,by;IvlasSDEP
Bureau of Resource Protection - Wetlands rmaseDEP File Number
WPA Form 3 — Notice of Intent
focument Transaction Number
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Salem
City/Town
B. Buffer Zone & Resource Area Impacts (temporary & permanent) (cont'd)
Resource Area Size of Proposed Alteration Proposed Replacement(if any)
d. ❑ Bordering Land
Subject to Flooding 1.square feet 2.square feet
3.cubic feet of flood storage lost 4.cubic feet replaced
e. ❑ Isolated Land
Subject to Flooding 1.square feet
2.cubic feet of flood storage lost 3.cubic feet replaced
f. ❑ Riverfront Area 1.Name of Waterway(if available)
2.Width of Riverfront Area(check one):
❑ 25 ft. - Designated Densely Developed Areas only
❑ 100 ft. -New agricultural projects only
❑ 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. G.square feet between 100 ft.and 200 ft.
5. Has an alternatives analysis been done and is it attached to this NO[? ❑ Yes❑ No
6.Was the lot where the activity is proposed created prior to August 1, 1996? ❑ Yes❑ No
3. ❑ Coastal Resource Areas: (See 310 CMR 10.25-10.35)
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 altemative project design or location.
Online Users:
Include your Resource Area Size of Proposed Alteration - Proposed Replacement (if any)
document
transaction number a. ❑ Designated Port Areas Indicate size under Land Under the Ocean, below
(provided on
your receipt b. ❑ Land Under the Ocean
page)with all 1.square feet
supplementary
information you 2.cubic yards dredged
submit to the
Department. c. ❑ Barrier Beach Indicate size under Coastal Beaches and/or Coastal Dunes below
d. ❑ Coastal Beaches 1.square feet 2.cubic yards beach nourishment
e. ❑ Coastal Dunes 1.square feet 2.cubic yards dune nourishment
wpaform3.doc•rev. 11/16/09 Page 3 of 8
Massachusetts Department of Environmental Protection Provided by MassDER
Bureau Of R2SOUrCe Protection - Wetlands MassDEP File Number
WPA Form 3 — Notice of intent
Document Transactlon Number
L11 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Salem
cityrrown
B. Buffer Zone & Resource Area Impacts (temporary & permanent) (cont'd)
Size of Proposed Alteration Proposed Reolacement(if any)
f. ❑ Coastal Banks 1.linear feet
g. ❑ Rocky Intertidal
Shores 1.square feet
h.❑ Salt Marshes 1,square feet 2.sq ft restoration,rehab.,creation
i. ❑ Land Under Salt
Ponds 1.square feet
2.cubic yards dredged
I. ❑ Land Containing
Shellfish 1.square feet
it. ❑ 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
4. ❑ Restoration/Enhancement
If the project is for the purpose of restoring or enhancing a wetland resource area in addition to the
square footage that has been entered in Section B.2.b or B.3.h above, please enter the additional
amount here.
a.square feet of BVW b.square feet of Salt Marsh
5. ❑ Project Involves Stream Crossings
a.number of new stream crossings b.number of replacement stream crossings
C. Other Applicable Standards and Requirements
Streamlined Massachusetts Endangered Species Act/Wetlands Protection Act Review
1. Is any portion of the proposed project located in Estimated Habitat of Rare Wildlife as indicated on
the most recent Estimated Habitat Map of State-Listed Rare Wetland Wildlife published by the Natural
Heritage and Endangered Species Program (NHESP)?To view habitat maps, see the Massachusetts
Natural Heritage Atlas or go to
http://www.mass.gov/dfwele/dfw/nhesp/re_qulatory review/priority habitat/online viewer htm.
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
2006 Route 135, North Drive
b.Date of map Westborough, MA 01581
wpaform3.doc•rev. 11/16/09 Page 4 of 8
Massachusetts Department of Environmental Protection Provided by MessDEP:
Bureau of Resource Protection - Wetlands MaseDEP.File Number
WPA Form 3 — Notice of Intent
Document Transaction Number
L11 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Salem
city/rown
C. Other Applicable Standards and Requirements (cont'd)
If yes, the project is also subject to Massachusetts Endangered Species Act(MESA) review(321
CMR 10.18). To qualify for a streamlined, 30-day, MESA/Wetlands Protection Act review, please
complete Section CAL, and include requested materials with this Notice of Intent (NOI); OR
complete Section C.1.d, if applicable. if MESA supplemental information is not included
pp pp dad with the N01,
by completing Section f of this form, the NHESP will require a separate MESA filing which may take
up to 90 days to review(unless noted exceptions in Section 2 apply, see below).
1. c. Submit Supplemental Information for Endangered Species Review*
1. ❑ Percentage/acreage of property to be altered:
(a)within wetland Resource Area percentage/acreage
(b) outside Resource Area
percentage/acreage
2. ❑ Assessor's Map or right-of-way plan of site
3. ❑ Project plans for entire project site, including wetland resource areas and areas outside of
wetlands jurisdiction, showing existing and proposed conditions, existing and proposed
tree/vegetation clearing line, and clearly demarcated limits of work****
(a)❑ Project description (including description of impacts outside of wetland resource area&
buffer zone)
(b) ❑ Photographs representative of the site
(c)❑ MESA filing fee (fee information available at:
http://www.mass.,clov/dfwele/dfw/nhesp/regulatory review/mesa/mesa fee schedule htm).
Make check payable to"Commonwealth of Massachusetts- NHESP" and mail to
NHESP at above address
Projects altering f0 or more acres of land, also submit.,
(d)❑ Vegetation cover type map of site
(e)❑ Project plans showing Priority& Estimated Habitat boundaries
d. OR Check One of the Following
1.❑ Project is exempt from MESA review.
Attach applicant letter indicating which MESA exemption applies. (See 321 CMR 10.14,
http://www.mass.gov/dfwele/dfw/nheso/re.gulatory review/mesa/mesa exemptions htm;
the NOI must still be sent to NHESP if the project is within estimated habitat pursuant to
310 CMR 10.37 and 10.59.)
2.❑ Separate MESA review ongoing. a.NHESP Tracking# b.Date submitted to NHESP
Some projects not in Estimated Habitat may be located in Priority Habitat,and require NHESP review(see
http://www.mass.gov/dfwele/dfwlnheso/nhesp.ht , regulatory review tab). Priority Habitat includes habitat for state-listed plants and
strictly upland species not protected by the Wetlands Protection Act.
** MESA projects may not be segmented (321 CMR 10.16).The applicant must disclose full development plans even if such plans are
not required as part of the Notice of Intent process.
wpaform3.doc*rev. 11/16/09 Page 5 of 8
LlMassachusetts Department of Environmental Protection Provided by MassDEP:
Bureau of Resource Protection - Wetlands MassDEP File Number
WPA Form 3 — Notice of Intent
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Document Transaction NumberSalem
C ty/Town
C. Other Applicable Standards and Requirements (cont'd)
3.❑ Separate MESA review completed.
Include copy of NHESP"no Take" determination or valid Conservation & Management
Permit with approved plan.
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. ❑ Not applicable—project is in inland resource area only
b.❑ Yes ❑ No If yes, include proof of mailing or hand delivery of NOI to either:
South Shore-Cohasset to Rhode North Shore- Hull to New Hampshire:
Island, and the Cape&Islands:
Division of Marine Fisheries- Division of Marine Fisheries-
Soulheast Marine Fisheries Station North Shore Office
Attn: Environmental Reviewer Attn: Environmental Reviewer
1213 Purchase Street—3rd Floor 30 Emerson Avenue
New Bedford, MA 02740-6694 Gloucester, MA 01930
Also if yes, the project may require a Chapter 91 license. For coastal towns in the Northeast Region,
please contact MassDEP's Boston Office. For coastal towns in the Southeast Region, please contact
MassDEP's Southeast Regional Office.
3. Is any portion of the proposed project within an Area of Critical Environmental Concern(ACEC)?
online Users: a. ❑ Yes ® No If yes, provide name of ACEC (see instructions to WPA Form 3 or MassDEP
Include your Website for ACEC locations). Note: electronic filers click on Website,
document
transaction b.ACEC
number
(provided on 4. Is any portion of the proposed project within an area designated as an Outstanding Resource Water
your receipt (ORW)as designated in the Massachusetts Surface Water Quality Standards, 314 CMR 4.00?
page)with all
supplementary a. ❑ Yes ® No
Information you
submit to the 5. Is any portion of the site subject to a Wetlands Restriction Order under the Inland Wetlands
Department. Restriction Act(M.G.L. c. 131, §40A) or the Coastal Wetlands Restriction Act(M.G.L. c. 130, § 105)?
a. ❑ Yes ® No
6. Is this project subject to provisions of the MassDEP Stormwater Management Standards?
a. ® Yes. Attach a copy of the Stormwater Report as required by the Stormwater Management
Standards per 310 CMR 10.05(6)(k)-(q)and check if:
1.❑ Applying for Low Impact Development(LID) site design credits (as described in
Stormwater Management Handbook Vol. 2, Chapter 3)
2.❑ A portion of the site constitutes redevelopment
3.❑ Proprietary BMPs are included in the Stormwater Management System.
b.❑ No. Check why the project is exempt: Project Stormwater Management was
[I Single-family house addressed under DEP File No. 64-391
t.
wpaform1cloc•rev. 11/16/09
Page 6 of 8
Massachusetts Department of Environmental Protection Provided by MassDEP,
Bureau of Resource Protection Wetlands WasDEP.F,ile Number.
WPA Form 3 — Notice of intent
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Document Transact on Number
ILISalem
C tyrrown
C. Other Applicable Standards and Requirements (cont'd)
2.❑ Emergency road repair
3.❑ Small Residential Subdivision(less than or equal to 4 single-family houses or less than or
equal to 4 units in multi-family housing project)with no discharge to Critical Areas
D. Additional Information
Applicants must include the following with this Notice of Intent (N01). 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.)
2. ® 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.
3. ❑ Identify the method for BVW and other resource area boundary delineations(MassDEP BVW
Field Data Form(s), Determination of Applicability, Order of Resource Area Delineation, etc.),
and attach documentation of the methodology.
4. ® List the titles and dates for all plans and other materials submitted with this NOI.
Site Development Permit Plan
a.Plan Title
Eastern Land Survey Associates Inc. Christopher R. Mello PLS
b.Prepared By c.Signed and Stamped by
May 15 2012 1 = 20'
d.Final Revision Date e.Scale
f.Additional Plan,or Document Title g.Date
5. ❑ 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.
i. ❑ Attach proof of mailing for Massachusetts Division of Marine Fisheries, if needed.
s. ® Attach NOI Wetland Fee Transmittal Form
9. ❑ Attach Stormwater Report, if needed.
wpaform3.doc•rev.11/16/09
Page 7 of 8
Massachusetts Department of Environmental Protection Provided by.MsssOEP:
Bureau of Resource Protection - Wetlands MassDEP File Number
L71]
WPA Form 3 - Notice of Intent
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 -SalemntTransactionNumtier
Salem
City/Town
E. Fees
1. ❑ Fee Exempt: 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:
_//Gr 6h
2.Municipal Check Number 3.Check date
4.State Check Number S.Check date
�ei1/I P �Sf�iO77�G'�
U.Payor name on check:First Name 7.Payor name on check:Last Name
F. 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
requirements of M.G.L. c. 131, §40. Notice must be made by Certificate of Mailing or in writing by hand
delivery or certified mail (return receipt requested)to all abutters within 100 feet of the property line of the
project locati
gn a of Applicant 2.Date
3.Signature of Property Owner(if different) 4.Date
S.Signature of Representative(if any) 6.Date
For Conservation Commission:
Two copies of the completed Notice of Intent(Form 3), including supporting plans and documents, two
copies of the NOI Wetland Fee Transmittal Form, and the city/town fee payment, to the Conservation
Commission by certified mail or hand delivery.
For MassDEP:
One copy of the completed Notice of Intent(Form 3), including supporting plans and documents, one
copy of the NOI Wetland Fee Transmittal Form, and a copy of the state fee payment to the MassDEP
Regional Office (see Instructions) by certified mail or hand delivery.
Other:
If the applicant has checked the"yes" box in any part of Section C, 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.
wpaform3.doc•rev. 11/16/09 Page 8 of 8
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