64-390 - 26 HARDY STREET - CONSERVATION COMMISSION a _ �
6v-310 ab Nzdy S
Y
' Massachel��"'Ats Department of Environmental Protection
Bureatro''Source Protection - Wetlands DEP File Number:
WPA Form 8B — Certificate of Compliance 964-390
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:
26 Hardy Street #64-390
Project Location DEP File Number
Has been recorded at the Registry of Deeds of:
ESSEX
County
for:
Mark &Sandra Connelly
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:
3 � 5
If registered land, the document number which identifies this transaction is:
f
Do4natuof
er
glicant
natorm 8edoc•rev.7/13/04 Page 4 of 4
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 8B — Certificate of Compliance #64-390
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
A. Project Information
Important:When filling out 1. This Certificate of Compliance is issued to:
forms on the Mark& Sandra Connelly
computer, use Name
only the tab key to move 26 Hardy Street
your cursor- Mailing Address
do not use the Salem MA 01970
return key. Cityrrown State Zip Code
.dI M I I 2. This Certificate of Compliance is issued for work regulated by a final Order of Conditions issued to:
Mark& Sandra Connelly
Name
March 10,2005 #64-390
Dated DEP File Number
3. The project site is located at:
26 Hardy Street Salem
Street Address Cityrrown
MAP 41 LOT 0307
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 24089 89
County Book Page
Certificate
4. A site inspection was made in the presence of the applicant, or the applicant's agent, on:
September 19 2005
Date
B. Certification
Check ail 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:
wpafor 81o.doo•rev.7/13/04 Page 1 of 4
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 8B — Certificate of Compliance #64-390
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
B. Certification (cont.)
❑ 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 September 22, 2005
Conservation Commission Date of Issuance
This Certificate must be ' ned b a ma' rity of the Conservation Commission and a copy sent to the
applicant and ap riot DEP a al ffice(See Attach nt).
Signatures:
wpaform 8b.aoc•rev.7113104 Page 2 of 4
I '
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 8B — Certificate of Compliance
#64-390
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
C. Authorization (cont.)
Notary Acknowledgement
Commonwealth of Massachusetts County of ESSEX
22nd September 2005
On this Day Of Month Year
before me, the undersigned Notary Public, personally appeared
Kevin Cornacchio, Joe Furnari, David Pabich, Keith Glidden, Kevin Carr, & Michael Blier,
Name of Document Signer
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
Cityf'rown
,
FRANKTAORMINA Sig atureo o Public , r
Notary Public
Commonwealth of Massachusetls Printed Name of Notary Public
My Commission Expires
April 27,2012
My mmis Ex s(D
Place notary seal and/or any stamp above
Sig" e of No ary Public
w afom Bb.doc•rev.7/13/04 Page 3 of 4
r
ILIMassachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 8B — Certificate of Compliance #64-390
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:
26 Hardy Street #64-390
Project Location DEP File Number
Has been recorded at the Registry of Deeds of:
ESSEX
Count
y
for:
Mark&Sandra Connelly
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
wpaform 8b.dw•rev.7/13104 Page 4 of 4
-ti
Massachusetts Department of Environmental Protection DEP File Number:
Bureau of Resource Protection - Wetlands
WPA Form 8A — Request for Certificate of Compliance u-3a0
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
A. Project Information
Important:
When filling out t. This request is being made by:forms on the Marr--' Sin4 l/�oliyl e(� `/
' ,
computer, use Na^
only the tab Ol
key to move
your Cursor- Mailing.F�d?dress I[�/t
do not use the t\1 'K ILJAG O{_L_I�
return key. City/roy+q /_ 1 p 54 D State Zip Code
(� � 17
r� Phone Number
2. This request is in reference to wof regulated �y a final Order of Conditions issued to:
re� (Y1CuK,f SQ.rY9xtt. l-.�t1►'1e� �
AlSplicant / 6 1l`39 O
Dated J DEP File Number
Upon completion
of the work 3. The project site l located at: - '//�^
authorized in dLn .LI S� S�.Q.m Salon,
on,
an Order of Street Address City/To
Conditions,the (`TI Il
property owner O O
must request a Assessors Map/Plat Number Parcel/Lot Number
Certificate of 4. The final Order of Corlrfitions was recorded at the Registry of Deeds for:
Compliance g 1144&� 7 j4
from the ice fi �i f
authority stating Pro rty Owner(if different)
that the work or Sly K= (� I �
portion of the work has been County Book Page
satisfactorily
completed. Certificate(if registered land)
5. This request is for certification that (check one):
Xthe 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.
v aforruBa.doc•rev.7/13/04 Page 1 of 2
f
Massachusetts Department of Environmental Protection DEP File Number:
Bureau of Resource Protection - Wetlands
WPA Form 8A — Request for Certificate of Compliance 310
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 CDC 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 Attachment).
a,paform8a.doc•rev.7/18/04 Page 2 of 2
CITY OF SALEM
r
CONSERVATION COMMISSION
August 29, 2005
Mark& Sandra Connelly
26 Hardy Street
Salem,MA 01970
RE: Request for Certificate of Compliance-26 Hardy Street—DEP #64-390
Dear Mr. &Mrs. Connelly,
As requested, I have enclosed a Request for Certificate of Compliance application for the
above referenced property. As discussed during our phone conversation,upon completion
of construction and final soil stabilization, the applicant shall submit the following to the r�
Salem Conservation Commission to request a Certificate of Compliance (COC):
• A Completed Request for a Certificate of Compliance form WA Form 8A
• A letter from a Registered Professional Engineer,Land Surveyor,or Architect certifying
compliance of the property with the Order of Conditions DEP #64-390.
• An "As-Built" plan signed and stamped by a Registered Professional Engineer,Land
Surveyor,or Architect showing post-construction conditions within all areas under the
jurisdiction of the Massachusetts Wetlands Protection Act.
Once your lawn has stabilized (grass has began to grow) and you have completed and
obtained the above referenced material please contact me to set up_a site inspection. Should
you have any further questions regarding this matter,please feel free to contact me at (978)
745-9595 x 311.
Sincerely,
yaonlk a min —
Planner/ Conservation Agent
City of Salem
120 WASHINGTON STREET, SALEM, MASSACHUSETTS 01970 • TEL: 978.745.9595 FAX: 978.740.0404 • WWW.SALEM.COM
CITY OF SALEM
CONSERVATION COMMISSION
March 14, 2005
Mark & Sandra Connelly
19 College Pond Drive
Danvers, MA 01923
Re: Order of Conditions—DEP#64-390-26 Hardy Street
Dear Mr. &Mrs. Connelly,
Enclosed, please find the Order of Conditions for 26 Hardy Street (DEP #64-390).
Following the 10-day appeal period, this document and the attached Special Conditions
must be recorded at the Essex County Registry of Deeds. Once recorded, please return a
copy of Page 9 of the Order of Conditions,which will indicate to the Salem Conservation
Commission that the document has been recorded.
If you have any further questions or concerns,please feel free to contact me at 978-745-
9595 x 311.
Sincerely,
rank/Colnserv�ation
Plann Agent
Enclosures
120 WASHINGTON STREET, SALEM, MASSACHUSETTS 01970 • TEL: 978.745.9595 FAx: 978.740.0404 ♦ WWW.SALEM.COM
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands DEP File Number:
WPA Form 5 - Order of Conditions #64-390
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
A. General information
Important: Salem
When filling From: 1.Conservation Commission
out forms on
the computer, 2.This issuance is for(check one): ® Order of Conditions ❑ Amended Order of Conditions
use only the
tab key to 3.To: Applicant:
move your
cursor-do not Mark& Sandra Connelly
use the return a. First Name b.Last Name c.Company
key. 19 College Pond Drive
Mailing Address
°° Danvers
anvers MA 01923
e.Citylrown f.Stale g.Zip Code
4. Property Owner(if different from applicant):
a. First Name b.Last Name c.Company
d.Mailing Address
e.City/Town f.State g.Zip Code
5. Project Location:
26 Hardy Street Salem
a.Street Address b.City/Town
MAP 41 LOT 0307
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)
16491 567
c. Book d.Page
February 28, 2005 March 10, 2005 March 10, 2005
7. Dates: 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):
Plot Plan 26 Hardy Street
a.Plan Title
LeBlanc Survey Associates, Inc. Vernon J. LeBlanc
b. Prepared By c.Signed and Stamped by
December 7, 2004 1" = 20'
d.Final Revision Date e.Scale
Site Plan 26 Hardy Street 1217/04
f.Additional Plan or Document Title g.Date
9 $500.00 $237.50 $262.50
. Total WPA Fee Paid:
a.Total Fee Paid b.State Fee Paid c.City/Town Fee Paid
wpaf0005.doo• rev.3/1105 Page 1 of 9
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 5 - Order of Conditions 964-390
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:
® 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:
❑ 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.
❑ 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)
❑ Buffer Zone Impacts: Shortest distance between limit of project disturbance and
wetland boundary (if available) linear feet
Resource Area Proposed Permitted Proposed Permitted
Alteration Alteration Replacement Replacement
3. ❑ Bank a.linear feet b.linear feet c.linear feet d.linear feet
4. ❑ Bordering Vegetated
Wetland a.square feet b.square feet c.square feet d.square feet
5. ❑ Land Under a.square feet b.square feet c.square feet d.square feet
Waterbodies and
Waterways e.cu.yd dredged f.cu.yd dredged
wpafonn5.dw• rev.311105 Page 2 of 9
LlMassachusetts Department of Environmental Protection DEP File Number:
Bureau of Resource Protection - Wetlands
WPA Form 5 - Order of Conditions #64-390
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Findings (cont.)
Resource Area Proposed Permitted Proposed Permitted
Alteration Alteration Replacement Replacement
6. ❑ 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 h.cubic feet
7. ❑ 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
8. ❑ Riverfront area a.total sq.feet b.total sq.feet
Sq ft within 100 ft c.square feet d.square feet e.square feet f.square feet
Sq ft between 100-200 ft e,square feet f.square feet e square feet f.square feet
Coastal Resource Area Impacts: Check all that apply below. (For Approvals Only)
9. ❑ Designated Port Indicate size under Land Under the Ocean, below
Areas
to. ❑ Land Under the
Ocean a.square feet b.square feet
c.cu.yd dredged d.cu.yd dredged
11. ❑ Barrier Beaches Indicate size under Coastal Beaches and/or Coastal Dunes below
12. ❑ Coastal Beaches a.square feet b.square feet c.dy nourishmt. ci.dy nourishmt.
13. ❑ Coastal Dunes a.square feet b.square feet c.dy nourishmt. d.dy nourishmt
14. ❑ Coastal Banks a.linear feet b.linear feel
15. ❑ Rocky Intertidal
Shores a.square feet b.square feet
16. ❑ Salt Marshes a.square feet b.square feet c.square feet d.square feet
17. ❑ Land Under Salt
Ponds a.square feet b.square feet
c.cu.yd dredged d.cu.yd dredged
18. ❑ Land Containing
Shellfish a.square feet b.square feet c.square feet d.square feet
19. ❑ 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
20. ❑ Land Subject to
Coastal Storm Flowage a.square feet b.square feet
wpafo"5.doc• rev.311/05 Page 3 of 9
i
LiMassachusetts Department of Environmental Protection DEP File Number:
Bureau of Resource Protection - Wetlands
t WPA Form 5 - Order of Conditions #64-390
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"for, "MA DEP"]
"File Number #64-390 "
wpaform5.doc• rev.311/05 Page 4 of 9
I -
Massachusetts Department of Environmental Protection DEP File Number:
Bureau of Resource Protection -Wetlands
WPA Form 5 - Order of Conditions #64-390
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 SEE ATTACHED
space for
additional
conditions,
select box to
attach a text
document
Page 5 of 9
wpafprm5.d=• rev.311105
I .
ElMassachusetts Department of Environmental Protection DEP File Number:
Bureau of Resource Protection - Wetlands
WPA Form 5 - Order of Conditions #64-390
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 special conditions relating to municipal ordinance or bylaw are as follows:
space for
c. The p 9 P
additional
conditions,
select box to
attach a text
document ❑
wpafom5.dm- rev.311/05 Page 6 of
Massachusetts Department of Environmental Protection DEP File Number:
Bureau of Resource Protection - Wetlands
WPA Form 5 — Order of Conditions #34-390
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
E. Issuance
This Order is valid for three years, unless otherwise specified as a special March 10, 2005
condition pursuant to General Conditions#4, from the date of issuance. 1.Date of issuan
Please indicate the number of members who will sign this form:
This Order must be signed by a majority of the Conservation Commission. 2.Number of Signers
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 Protecti n Re i 1 Office, if not filing electronically, and the property owner, if different
from applicant.
Signatures:
5
O
Notary Acknowledgement �—
Commonwealth of Massachusetts County of
On this pay l�K Of Month R� e Year
Before me, the undersigned Notary Public,
personally appeared Name of Document Signer
proved to me through satisfactory evidence of identification,which was/were
,Chardjn
Description of evierenre 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 py cstated rpose.
Q � Conservation Commission
As member of CityrtowSo
-� JULIA D. MEDINA
IfNotary Public
Commorweatth ot Massacnusetb My CO"Mrission Expires May 5,2011 Si nature of Notary Public
Printed Name of Notary Public
Place notary seal and/or any stamp above My Commission Expires(Date)
This Order is issued to the applicant as follows:
❑ by hand delivery on by certified il,r turn receipt requested,on
?7AI6s
Date Date
wpaforrrr5.dm• rev.3/1105 Page 7 of 9
L
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 5 - Order of Conditions #64-390
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.
wpafonn5.dw• rev.311105 Page 8 of 9
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 5 - Order of Conditions #64-390
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:
26 Hardy Street #64-390
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
wpaforrn5.doc• rev.3/1/05 Page 9 of 9
i
Attachment to Order of Conditions# 64-390
Page Tof 5
SALEM CONSERVATION COMMISSION
DEP FILE #64-390
26 Hardy Street
City of Salem, Massachusetts
ADDITIONAL FINDINGS
Based on the Estimated Habitats of Rare Wildlife and Certified Vernal Pools Map (June 2003)by Natural Heritage
& Endangered Species Program (NHESP) of the Massachusetts Division of Fisheries and Wildlife, it has been
determined that this project does not include habitat of rare wildlife,nor does it contain certified venial pools,and is
therefore in compliance with the rare wildlife species section of the Massachusetts Wetlands Protection Act
Regulations(310 CMR 10.58(4)(b),& 10.59).
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 demolition of a two-car garage and a portion of the existing house and the construction of a
new addition and deck at 26 Hardy Street.
SPECIAL CONDITIONS
1. This Order of Conditions must be recorded in its entirety(all 5 pages) at the Essex 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; and recording information must be submitted to the Salem Conservation Commission in
writing,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.
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#64-390,and not placed on
a living tree.
5. No work approved in this Order may commence until the ten(10)day appeal period has lapsed from the
date of the issuance of this Order.
6. 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.
7. 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:
Attachment to Order of Conditions H 64-390
Page gof 5
(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) The City of Salem Wetlands Protection Ordinance and its Regulations
8. If there are conflicting conditions within this Order, the stricter condition(s) shall rule.
9. 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.
10. The Commission and its Administrator shall have the discretion to modify the erosion/siltation control
methods and boundary during construction if necessary.
11. The Commission or its Administrator,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.
12. The Commission or its Administrator 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
26 Hardy Street Site Plan
Title
December 7,2004
Dated
David F. Jaquith
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
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.
Attachment to Order of Conditions# 64-390
Page 31of d
Condition Number as indicated shall continue in force beyond the Certificate of Compliance,in
17. Y
perpetuity, and shall be referenced to in all future deeds to this property.
PRIOR TO CONSTRUCTION
18. 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.
19. 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.
20. 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.
21. There shall be_hay bales and wooden stakes under cover on the site to be used only for emergency
erosion control.
EROSION CONTROL
22. 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.
23. All debris, fill and excavated material shall be stockpiled a location far enough away from the wetland
resource areas to prevent sediment form entering wetland resource areas.
24. 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.
25. The area of construction shall remain in a stable condition at the close of each construction day.
26. 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.
27. 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.
28. If soils are to be disturbed for longer that two 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.
Attachment to Order of Conditions# 64-390
Page 4of 5
DURING CONSTRUCTION
29. 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.
30. No alteration or activity shall occur beyond the limit of work as defined by the siltation barriers shown on
the approved plan(s).
31. 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.
32. 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.
33. 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.
34. 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.
35. There shall be no pumping of water from wetland resource areas.
36. All equipment shall be inspected regularly for leaks. Any leaking hydraulic lines,cylinders or any other
components shall be fixed immediately.
37. During construction,all drainage structures shall be inspected regularly and cleaned as necessary.
38. 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
39. 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:
(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;
Attachment to Order of Conditions# 64-390
Page 9of
(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;
40. 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.
41. 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.
42. 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
43. All construction vehicles shall be equipped with emergency spill kits during the duration of the project.
44. At the end of each working day, all excavated material stockpiled on site located within the buffer zone
shall be covered with a tarp,polyethylene, or similar substance.
L
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
City/Town
A. General Information
1. Project Location(Note: electronic filers will click on button for GIS locator):
26 Hardy Street Salem 01970
a.Street Address b.Cityrrown c.Zip Code
Latitude and Longitude, if Known: d.Latitude e.Longitude
41 0307
f.Assessors Map/Plat Number g.Parcel/Lot Number
Important:
When filling out 2. Applicant:
forms on the Mark&Sandra Connelly
computer, use a.First Name b.Last Name c.Company
only the tab
key to move 19 College Pond Drive
your cursor- d.Mailing Address
do not use the Danvers MA 01923
return key. e.City/Town f.State g.Zip Code
978739-2377
10 h.Phone Nu r i.Fax Number j.Email address
q (�ty -oS90
3. Prope'ky owner(if different from applicant): El Check if more than one owner
nap
a.First Name b.Last Name c.Company
d.Mailing Address
Note:
Before e.City/Town f.State g.Zip Code
completing this
form Consult h.Phone Number i.Fax Number. j.Email address
your local
Conservation 4. Representative (if any):
Commission David F. Jaquith AIA Architects& Planners
regarding any a.Firm
municipal bylaw David Jaquith
or ordinance. b.Contact Person First Name c.Contact Person Last Name
8 Enon Street
d.Mailing Address
Beverly MA 01915
e.City/Town f.Stale g.Zip Code
978 927 7501
h.Phone Number i.Fax Number j. Email address
❑ Select if you want to see 5. Total WPA Fee Paid (from NOI Wetland Fee Transmittal Form):
Wetland Fee $ 500.00 $ 237.50 $262.50
Transmittal a.Total Fee Paid b.State Fee Paid c.City/Town Fee Paid
Form.
6. General Project Description: %O e 6i nOV4. Qn�l r 5fi'7� 2 (�/.�-t(J, 6U61re ,Sla i r ell G1hci G�eGIL
To Fldd a 2eau Icn-frt4 ,Fa",t y fjoom 4 ;:rra/t Oec,, ,/1lso remove Fhe &k'ji5h'nn ih�Pu�I ovs
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Massachusetts Department of Environmental Protection Provided byDER
Bureau of Resource Protection - Wetlands DEP Fib Number
WPA Form 3 - Notice of Intent Document Transaction Number
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Salem
City/Town
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
I. ❑ Other
8. Property recorded at the Registry of Deeds for:
Essex County
a.County
16491
b.Book
567
c.Page Number
d.Certificate#(if registered land)
9. Buffer Zone Only
Is the project located only in the Buffer Zone of a bordering vegetated wetland, inland bank, or
coastal bank, coastal beach, coastal dune, or salt marsh?
a. ® Yes If yes, skip to Section C.
b. ❑ No If no, check the resource areas to be affected by this project, directly below.
w om3 eoc•rep.0711you Pepe 2 dB
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
City/Town
B. Resource Area Effects
1. Inland Resource Areas
Check all that apply below.Attach narrative and any supporting documentation describing how the
project will meet all performance standards for each of the resource areas altered, including
standards requiring consideration of alternative project design or location.
Online Users:Include your Resource Area Size of Proposed Alteration Proposed Replacement(if any)
document
transaction a. ❑ Bank 1.linear feet - 2,linear feet
number b.❑ Bordering Vegetated
(provided on Wetland 1.square feet 2.square feet
your receipt
page)with all c. ❑ Land Under 1.square feet 2.square feet
supplementary Waterbodies and
information you Waterways
3.cubic yards dredged
submit to the d. El Bordering Land
Department. Subject to Flooding 1.square feet 2.square feet
3.cubic feel of flood storage lost 4.cubic feel of flood storage replaced
e. ❑ Isolated Land Subject
to Flooding 1.square feet
2.cubic feet of flood storage lost 3.cubic feel of flood storage 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 Feel within 100 ft. c.Square Feet between 100 ft.and 200 ft.
5. Has an alternatives analysis been done and is it attached to this NOI? ❑ Yes❑ No
6.Was the lot where the activity is proposed created prior to August 1, 1996? ❑ Yes❑ No
.frnm3.do •rev.07/13 Pan.3&0
Massachusetts Department of Environmental Protection Pmvufed 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
City/town
B. Resource Area Effects (continued)
2. Coastal Resource Areas:
Check all that apply below. Attach narrative and supporting documentation describing how the
project will meet all performance standards for each of the resource areas altered, including
standards requiring consideration of alternative project design or location.
Online Users:Include your Resource Area Size of Proposed Alteration Proposed Replacement(if any)
document
transaction a. ❑ Designated Port Areas Indicate size under Land Under the Ocean, below
number
(provided on b. ❑ Land Under the Ocean 1_square feet
your receipt
page)with all 2.Cubic yams dredged
supplementary Indicate size under Coastal Beaches and/or Coastal Dunes
information you c. ❑ Barrier Beach below
submit to the
Department. d. ❑ Coastal Beaches 1.Square feet 2.Cubic yams beach nourishment
e. ❑ Coastal Dunes 1.Square feet 2.Cubic yams dune nourishment
f. ❑ Coastal Banks 1.Linear feet
g. ❑ Rocky Intertidal Shores 1.square feet
h.❑ Salt Marshes 1.Square feet 2.Sq ft restoration,rehab.,or creation
i. ❑ Land Under Salt Ponds 1.Square feet
2.Cubic yams 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 yams dredged
1. ❑ 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
w.Wr 3.tloc•rev.07/13ro4 Pepe 4 or B
Massachusetts Department of Environmental Protection Provided by DEP:
Bureau of Resource Protection -Wetlands DEP File Number
WPA Form 3 — Notice of Intent Document Transact Salem
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:
Online Users: 1. ❑ Final Order of Resource Area Delineation issued by Conservation Commission or DEP
Include your (attached)
document
transaction 2. ❑ DEP BVW Field Data Form (attached)
number
(provided on 3. ❑ Final Determination of Applicability issued by Conservation Commission or DEP (attached)
your receipt
page)with all 4. ❑ Other Methods for Determining the BVW Boundary(attach documentation):
supplementary
information you a. ❑ 50%or more wetland indicator plants
submit to the
Department. b. ❑ SaturatedAnundated conditions exist
c. ❑ Groundwater indicators
d. ❑ Direct observation
For all projects
affecting other a. ❑ Hydric soil indicators
Resource
Areas, please f. ❑ Credible evidence of conditions prior to disturbance
attach a
narrative
explaining how
the resource
area was D. Other Applicable pp II'cable Standards and Requirements
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
Route 135, North Drive
Westborough, MA 01581
b. Date of Map
2. For coastal projects only, is any portion of the proposed project located below the mean high water
line or in a fish run?
❑ Yes® No If yes, include proof of mailing or hand delivery of NOI to:
Massachusetts Division of Marine Fisheries
251 Causeway Street, Suite 400
Boston, MA 02114
❑ Not applicable—project is in inland resource area only
woe.3 dr.•rnv.071INU Pena 5 d a
Massachusetts Department of Environmental Protection ProvidW by DEP:
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 Number
Salem
City/rown
D. Other Applicable Standards and Requirements (continued)
3. Is any portion of the proposed project within an Area of Critical Environmental Concern (ACEC)?
a. ❑ Yes ® No If yes, provide name of ACEC(see instructions to WPA Form 3 or DEP
Website for ACEC locations). Note: electronic filers click on Website.
b.ACEC
Online Users: 4. Is any portion of the site subject to a Wetlands Restriction Order under the Inland Wetlands
Include your Restriction Act(M.G.L. c. 131, §40A)or the Coastal Wetlands Restriction Act(M.G.L. c. 130, § 105)?
document
transaction a. ❑ Yes ® No
number
(provided on
your receipt 5. Is any activity within any Resource Area or Buffer Zone exempt from performance standards of the
page)with all wetlands regulations, 310 CMR 10.00.
supplementary
information you a. ❑ Yes ® No If yes, describe which exemption applies to this project:
submit to the
Department.
b.Exemption
6. Is this project subject to the DEP Stormwater Policy? a. ❑ Yes ® No
b. If yes, stormwater management measures are required.Applicants should complete the
Stormwater Management Form and submit it with this form.
c. If no, explain why the project is exempt:
E. Additional Information
Applicants must include the following with this Notice of Intent(NOI). See instructions for details.
Online Users:Attach the document transaction number(provided on your receipt page)for any of
the following information you submit to the Department.
1. ❑ USGS or other map of the area(along with a narrative description, if necessary)containing
sufficient information for the Conservation Commission and the Department to locate the site.
(Electronic filers may omit this item.)
z. ❑ Plans identifying the location of proposed activities(including activities proposed to serve as
a Bordering Vegetated Wetland [BVW[ replication area or other mitigating measure) relative to
the boundaries of each affected resource area.
wo ob ado-rev 07/i3 P.ad9
• Provided DEP:
Massachusetts Department of Environmental Protection �
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
City/rown
E. Additional Information (continued)
3. ❑ Other material identifying and explaining the determination of resource area boundaries
shown on plans (e.g., a DEP BVW Field Data Form).
Online Users:
Include your 4. ❑ List the titles and dates for all plans and other materials submitted with this NOI.
document 5. ❑ If there is more than one property owner, please attach a list of these property owners not
transaction listed on this form.
number
(provided on 6.❑ Attach proof of mailing for Natural Heritage and Endangered Species Program, if needed.
your receipt
page)with all 7 ❑ Attach proof of mailing for Massachusetts Division of Marine Fisheries, if needed.
supplementary
information you e. ❑ Attach NOI Wetland Fee Transmittal Form
submit to the
Department. 9. ❑ Attach Stormwater Management Form, if needed.
F. Fees
The fees for work proposed under each Notice of Intent must be calculated and submitted to the
Conservation Commission and the Department(see Instructions and NOI Wetland Fee Transmittal
Form).
No fee shall be assessed for projects of the federal government, the Department, or cities and towns
of the Commonwealth.
Applicants must submit the following information (in addition to pages 1 and 2 of the NOI Wetland
Fee Transmittal Form)to confirm fee payment:
809 2*25*05
1.Municipal Check Number 2.Check date
810 2*25*05
3.State Check Number 4.Check date
David Jaquith
5.Payor name on check:First Name 6.Payor name on check:Last Name
wnalam3.tloc•rev.07113104 P..7 d 9
Massachusetts Department of Environmental Protection Provided by DEP:
LF IBureau 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 Number
City/Town
G. Signatures and Submittal Requirements
I hereby certify under the penalties of perjury that the foregoing Notice of Intent and accompanying
plans, documents, and supporting data are true and complete to the best of my knowledge. I understand
that the Conservation Commission will place notification of this Notice in a local newspaper at the
expense of the applicant in accordance with the wetlands regulations, 310 CMR 10.05(5)(a).
I further certify under penalties of perjury that all abutters were notified of this application, pursuant to the
requirements of M.G.L. c. 131, §40. Notice must be made in writing by hand delivery or certified mail
(return receipt quested)�t�o�a�ll butters thin 100 feet of the property line of the prof t location.
x!�, 1�„ �Q� a�a�/as
Signature o p scant Date
Sign Lure Of,Pro er(if different)' Date !,
Signature of Repr en five(' ny) Date /a��V
For Conservation Commission:
Two copies of the completed Notice of Intent (Form 3), including supporting plans and documents; two
copies of pages 1 and 2 of the NOI Wetland Fee Transmittal Form; and the city/town fee payment must
be sent to the Conservation Commission by certified mail or hand delivery.
For DEP:
One copy of the completed Notice of Intent(Form 3), including'supporting plans and documents; one
copy of pages 1 and 2 of the NO[ 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.
wpaformldoc•rev.07113104
Page 8 0l 8
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