64-459 - Lot 16, Amanda Way - CONSERVATION COMMISSION Dep-64 V NSl
iot-16 Amanda Way M
` CONM'
CITY OF SALEM
011PIA CONSERVATION COM
MISSION
August 7, 2007
Mr. Paul DiBiase
Osborne Hills Realty Trust
PO Box 780
Lynnfield, Massachusetts 01940
Re: Order of Conditions—DEP#64-459
Lot 16 Amanda Way, Salem MA
Dear Mr. DiBiase:
Enclosed, lease find the Order of Conditions
p for the above reference
d project.
Following the 10-day appeal period (as of August 16, 2007), this document and the
attached Special Conditions must be recorded at the Essex County Registry of Deeds (36
Federal Street, Salem, MA). Once recorded, please return a copy of Page 9 of the Order,
which will indicate to the Commission that the document has been recorded.
As indicated in the Order, prior to any work commencing, this Order must be recorded, a
sign shall be displayed showing DEP File# 64459 within public view, and contact me at
least 48 hours prior to any activity to schedule a pre-construction meeting to review the
Order with your hired contractor.
If you have any further questions,please feel free to contact me 978.619.5685.
Sincerely,
}
Carey Duqu
Conservation Agent/Staff Planner
Enclosures
CC: DEP Northeast Regional Office
L11Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands DEP File Number:
WPA Form 5 - Order of Conditions 64-459
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
A. General Information
Important Salem
When filling From: t,Conservation Commission
out forms on
the computer, 2. This issuance is for(check one): a. ® Order of Conditions b. ❑ Amended Order of Conditions
use only the
tab key to 3. To: Applicant:
move your
cursor-do not Osborne Hills Realty Trust
use the return a.First Name b. Last Name
c.Company
key. PO Box 780
d. Mailing Address
0/ Lynnfield MA 01940
e.City/Town f.State g.Zip Code
^� 4. Property Owner(if different from applicant):
a.First Name b.Last Name c.Company
d.Mailing Address
e.C tylrown f.State g.Zip Code
5. Project Location:
Lot 16 Amanda Way Salem
a.Street Address b.CityrTown
Map 9 Parcel 1 (portion)
c.Assessors Map/Plat Number d.Paroel/Lot Number
Latitude and Longitude, if known (note: 42-30-23 70-55-40
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)
c.Book d.Page
�. Dates: May 21, 2007 July 26, 2007 August 7 2007
a.Date Notice of Intent Filed b.Date Public Hearing Closed c.Date of Issuance
8. Final Approved Plans and Other Documents(attach additional plan or document references as
needed):
Site Development Permit Plan
a.Plan Title
Eastern Land Survey Associates Chris Mello Christopher Mello Land Surveyor
b.Prepared By c.Signed and Stamped by
May 3 2007 1"=20'
d.Final Revision Date a.Scale
f.Additional Plan or DowmeM Title g.Date
vpsfimn& oe• rev.wm
Page 1 of 9
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands DEP File Number:
WPA Form 5 - Order of Conditions 64-459
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
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. Check all that
apply:
a. ® Public Water Supply b. ❑ Land Containing Shellfish c. ® Prevention of Pollution
d. ® Private Water Supply e. ❑ Fisheries f. ® Protection of Wildlife
Habitat
g. ® Groundwater Supply h. ® Storm Damage Prevention i. ® Flood Control
2. This Commission hereby finds the project, as proposed, is:(check one of the following boxes)
Approved subject to:
a. ® the following conditions which are necessary in accordance with the performance standards set
forth in the wetlands regulations. This Commission orders that all work shall be performed in
accordance with the Notice of Intent referenced above, the following General Conditions, and any
other special conditions attached to this Order. To the extent that the following conditions modify or
differ from the plans, specifications, or other proposals submitted with the Notice of Intent, these
conditions shall control.
Denied because:
b. ❑ the proposed work cannot be conditioned to meet the performance standards set forth in the
wetland regulations. Therefore, work on this project may not go forward unless and until a new Notice
of Intent is submitted which provides measures which are adequate to protect these interests, and a
final Order of Conditions is issued. A description of the performance standards which the
proposed work cannot meet Is attached to this Order.
c. ❑ the information submitted by the applicant is not sufficient to describe the site, the work, or the
effect of the work on the interests identified in the Wetlands Protection Act. Therefore, work on this
project may not go forward unless and until a revised Notice of Intent is submitted which provides
sufficient information and includes measures which are adequate to protect the Act's interests, and a
final Order of Conditions is issued. A description of the specific information which Is lacking and
why it is necessary is attached to this Order as per 310 CMR 10.05(6)(c).
Inland Resource Area Impacts: Check all that apply below. (For Approvals Only)
3. ® Buffer Zone Impacts: Shortest distance between limit of project disturbance and 48
wetland boundary (if available) a.linear feet
Resource Area Proposed Permitted Proposed Permitted
Alteration Alteration Replacement Replacement
4. ❑ Bank a. linear feet b. linear feet c.linear feet d.linear feet
5. ❑ Bordering Vegetated
Wetland a.square feet b.square feet c square feet d.square feet
6. ❑ Land Under Waterbodies a.square feet b.square feet c.square feet d.square feet
and Waterways
e.cu.yd dredged f.cu.yd dredged
wpelam5Aa• rev.311/05
Pepe 2 W 9
L11Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands DEP File Number.
WPA Form 5 - Order of Conditions 64-459
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Findings (cunt.)
Resource Area Proposed Permitted Proposed Permitted
Alteration Alteration Replacement Replacement
7. 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 h.cubic feet
a. ❑ Isolated Land Subject
to Flooding a.square feet b.square feet
Cubic Feet Flood Storage c.cubic feet d.cubic feet e.cubic feet f.cubic feet
s. ❑ 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
g.square feet h.square feet i.square feet i.square feet
Coastal Resource Area Impacts: Check all that apply below. (For Approvals Only)
10. ❑ Designated Port Areas Indicate size under Land Under the Ocean, below
1. ❑ Land Under the Ocean
a.square feet b.square feet
c.cu.yd dredged d.cu.yd dredged
12. ❑ Barrier Beaches Indicate size under Coastal Beaches and/or Coastal Dunes below
13. ❑ Coastal Beaches
a.square feet b.square feet c.cty nourishmt. d.cry nourishmt.
14. ❑ Coastal Dunes a.square feet b.square feet c.c/y nourishmt. d.Gy nourishmt
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 b.square feet c.square feet d.square feet
is. ❑ Land Under Salt Ponds a.square feet b.square feet
c.cu.yd dredged d.ou.yd dredged
19. ❑ Land Containing
Shellfish a.square feet b.square feet c.square feet d.square feet
20. ❑ Fish Runs Indicate size under Coastal Banks, inland Bank, Land Under the
Ocean, and/or inland Land Under Waterbodies and Waterways,
above
a.cu.yd dredged b.cu.yd dredged
21. ❑ Land Subject to Coastal
Storm Flowage a.square feet b.square feet
»perorrrs.aoc• rev.arlros
Peas 3 or 9
Massachusetts Departrnent of Environmental Protection
Bureau of Resource Protection -Wetlands DEP File Number:
WPA Form 5 - Order of Conditions 64-459
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 Omer 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 64-459
wyeform5.dw- rev.VIM
Page 4 of 9
LlMassachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands DEP File Number.
WPA Form 5 - Order of Conditions 64459
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
Comm
ission, which reserves the right to require additional erosion and/or damage prevention controls
it may deem necessary. Sedimentation barriers
Y ry a ers shall serve as
the limit of work unl
ess another limit of
work line has been approved by this Order.
18. All work associated with this Order is required to comply with the Massachusetts Stormwater Policy
Standards.
Special Conditions:
If you need more
space for
additional
conditions,
select box to
attach a text
document
wpalam5.dcc• rev.311105
P"s 5 of
ILIMassachusetts Department of Environmental Protection DEP File Number:
Bureau of Resource Protection -Wetlands
WPA Form 5 - Order of Conditions 64-459
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
D. Findings Under Municipal Wetlands Bylaw or Ordinance
1. Is a municipal wetlands bylaw or ordinance applicable? ® Yes ❑ No
2. 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.
a. ❑ that the following additional conditions are necessary to comply with a municipal ordinance or
bylaw:
a.Municipal Ordinance or Bylaw b.Citation
The Commission orders that all work shall be performed in accordance with the following conditions
and with the Notice of Intent referenced above. To the extent that the following conditions modify or
differ from the plans, specifications, or other proposals submitted with the Notice of Intent, the
conditions shall control.
If you need more space for c. The special conditions relating to municipal ordinance or bylaw are as follows:
additional The special conditions attached to this Order of Conditions relate to both the City of Salem's local
conditions,salad box to ordinance and the Massachusetts Wetlands Protection Act.
attach a text
document
wpalarm5.d%• rev.311105 Pape a of
l
LeiMassachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 5 - Order of Conditions 64-459
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
condition pursuant to General Conditions#4, from the date of issuance. 1.D*of Issuance
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 sign
The Order must be mailed by certified mail (return receipt requested) or hand delivered to the applicant. A
copy also must be mailed or hand delivered at the same time to the appropriate Department of
Environmental Protection Regional Office, if not filing electronically, and the property owner, if different
from applicant.
Signatures:
C
Notary Acknowledgement
Commonwealth of Massachusetts County of Essex
On this 26 of July 2007
Day Month Year
Before me, the undersigned Notary Public, K. Cornacchio, A. Hamilton, D. Pabich, D.
personally appeared Summer, and-K-G#ditn-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
City/rows Conservation Commission
r a DUQUES
wclokollisorz aon
»
it sins Sig ure of otary Public
Carey R. ques
Printed Name of Notary Public
Place notary seal and/or any stamp above August 16, 2013
My Commission fires(Date)
This Order is issued to the applicant as follows:
❑ by hand delivery on by certified mail, return receipt requested, on
Date Date'
wpafom5.doc• rev.3/1/05 Pape 7 of 9
Massachusetts Department of Environmental Protection DEP File Number:
Bureau of Resource Protection -Wetlands
WPA Form 5 - Order of Conditions 64-459
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.
wpakmi&doc• rev.3/IW
Pepe B N 9
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands DEP File Number.
WPA Form 5 - Order of Conditions 64-459
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:
Lot 16 Amanda Way 64-459
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 .w
If registered land, the document number identifying this transaction is:
Document Number
Signature of Applicant
wpefartnS.Aoc• rev.31105 Page 9 of 9
Attachment to Order of Conditions#64-459
Pagel of 6
SALEM CONSERVATION COMMISSION
DEP FILE#64-459
Lot 16 Amanda Way(off Marlborough Road)
City of Salem,Massachusetts
ADDITIONAL FINDINGS
Based on the Estimated Habitats or Rare Wildlife and Certified Vernal Pools Map (June 1, 2003) from Natural
Heritage & Endangered Species Program (NHESP)of the Massachusetts Division of Fisheries and Wildlife, it has
been determined that this project does not occur near any habitat of state listed rare wildlife species nor contains any
vernal pools.
This Order is issued under the Massachusetts Wetlands Protection Act,M.G.L.Chapter 131,Section 40 and the City
of Salem Wetlands Protection Ordinance, Salem Code Chapter 34,Section 34-1—34-13.
This Order permits the construction of a single family dwelling,roof recharge,retaining wall,grading and
landscaping on Lot 16 located on Amanda Way in Salem. The approved work is noted on the approved plans
cited on the Order of Conditions. The proposed retaining wall requires an approval from the building inspector
for the retaining wall proposed on the property. The applicant shall install a City of Salem wetland marker on a
post located along the property line abutting the wetland resource area. The Conservation Commission approves
the proposed work so long as the applicant obtains the necessary 401 Water Quality Permit as deemed necessary
by the DEP. A site walk with the Conservation Agent will determine the number of trees that need to be
removed and replaced. Applicant shall plant trees in strategic locations,to replace those removed, ultimately
providing canopy to adjacent wetland; in locations to be approved by the Conservation Agent. The trees are to
be planted within the buffer zone of the BV W,along the property line. The Commission issued this Order with
the condition that for every tree removed from Lot 16 it will be replaced with 3 trees of the same species 2 %:-3"
in caliper. The trees are to be planted within the buffer zone of the BV W,along the property line. The
Commission determined that language shall be included in the deed for Lot 16 located on Amanda Way, stating
that the owner(s)of Lot 16,pursuant to said Order of Conditions and the Massachusetts Wetlands Protection
Act,are prohibited from certain activities. Certain prohibited activities shall remain in affect notwithstanding
the issuance of a Certificate of Compliance relating to the Order of Conditions. These prohibited activities
include: installation of a swimming pool, re-grading or filling of the lot, adding additional impervious material
such as bituminous concrete or regular concrete or any other activity that would be regulated by the
Massachusetts Wetlands Protection Act. The activities that are prohibited,however,may occur upon
appropriate approvals obtained from the Salem Conservation Commission or the Massachusetts Department of
Environmental Protection or any successor entity. Proposed and approved work will occur within the Buffer
Zone of Bordering Vegetated Wetlands. Language shall also be included in the association documents stating
"The subdivision is developed within and around Wetland areas that are subject to the jurisdiction J ) sdretion of the Salem
Conservation Commission. The dumping of leaves,yard waste,debris or any other material into any Wetland
area or into the Open Space or Common Parcels is prohibited. The Owners of any Lot responsible for violating
this prohibition shall be responsible financially and criminally for any violation of this prohibition, including all
costs(including court costs and attorney fees)associated with the restoration of the disturbed area."
GENERAL CONDITIONS
1. This Order of Conditions must be recorded in its entirety(all 6 pages)at the Essex County Registry of
Deeds or the Land Court for the district in which the land is located,after the expiration of the 10-day
Attachment to Order of Conditions#64-459
Page 2of 6
appeal period and within 30 days of the issuance. A copy of the recording information must be
submitted to the Salem Conservation Commission before any work approved in this Order
commences.
2. Approval of this application does not constitute compliance with any law or regulation other than
M.G.L Chapter 131, Section 40, Wetlands Regulations 310 CMR 10.00 and the City of Salem Wetlands
Protection Ordinance,Salem Code Chapter 34, Section 34-1 —34-13.
3. All work shall be performed in accordance with this Order of Conditions and approved site plan(s). No
alteration of wetland resource areas or associated buffer zones,other than that approved in this Order,
shall occur on this property without prior approval from the Commission.
4. Prior to any work commencing,a sign shall be displayed showing DEP File#64-459,and not placed on
a living tree.
5. No work approved in this Order may commence until the ten(10)day appeal period has lapsed from the
date of the issuance of this Order.
6. With respect to this Order,the Commission designates the Conservation Agent as its agent with powers
to act on its behalf in administering and enforcing this Order.
7. The Commission or its Agent,officers,or employees shall have the right to enter and inspect the property at
any time for compliance with the conditions of this Order,the Wetlands Protection Act MGL Chapter 131,
Section 40,the Wetlands Regulations 310 CMR 10.00,and shall have the right to require any data or
documentation that it deems necessary for that evaluation.
8. The term"Applicant"as used in this Order of Conditions shall refer to the owner,any successor in
interest or successor in control of the property referenced in the Notice of intent, supporting documents
and this Order of Conditions. The Commission shall be notified in writing within 30 days of all
transfers of title of any portion of the property that takes place prior to issuance of the Certificate of
Compliance.
9. It is the responsibility of the applicant to procure all other applicable federal,state and local permits and
approvals associated with this project. These permits may include but are not necessarily limited to the
following:
(1) Section 404 of the Federal Water Pollution Control Act(P.L.92-500, 86 stat. 816), U.S.Army
Corps of Engineers.
(2) Water Quality Certification in accordance with the Federal Water Pollution Control under authority
of sec. 27(5)of Chapter 21 of the Massachusetts General Laws as codified in 314 CMR 9.00.
(3) Sewer Extension Permit from the DEP Division of Water Pollution Control under G.L. Ch.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.).
10. If there are conflicting conditions within this Order, the stricter condition(s)shall rule.
IL 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.
Attachment to Order of Conditions# 64-459
Page 3of 6
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
Lots 16-19 and 37-39 Site Development Permit Plan Located in Salem, MA
(Title)
May 3 2007
(Dated)
Christopher R.Mello Land Surveyor
(Signed and Stamped by)
City of Salem Conservation Commission
(On J7le 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 Chance 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 We of this property or any portion thereof before a Certificate of Compliance has
been issued,the applicant or current landowner shall submit to the Commission a statement signed by the
buyer that he/she is aware of an outstanding Order of Conditions on the property and has received a copy of
the Order of Conditions.
PRIOR TO CONSTRUCTION
17. Prior to the commencement of any activity on this site other than activities listed above,there
shall be a Pre-Construction Meeting between the project supervisor,the contractor responsible for the
work, and a member of the Conservation Commission or its Administrator to ensure that the
requirements of the Order of Conditions are understood. The staked erosion control line shall be
adjusted,if necessary,during the pre-construction meeting. Please contact the Conservation Commission
Agent at(978)745-9595 ext 311 at least forty-eight(48)hours prior to any activity to arrange for the
pre-construction meeting.
18. Prior to the pre-construction meeting and commencement of any activity on this site,sedimentation and
erosion control barriers shall be installed as shown on the approval plan(s)and detail drawings. The
Commission and/or its Administrator shall inspect and approve such installation at the pre-construction
meeting.
19. No clearing of vegetation,including trees,or disturbance of soil shall occur prior to the pre-construction
meeting. Minimal disturbance of shrubs and herbaceous plants shall be allowed prior to the pre-
construction meeting if absolutely necessary in order to place erosion control stakes where required.
Attachment to Order of Conditions#64-459
Page 4of 6
20. There shall be 20 hay bales and wooden stakes under cover on the site to be used only for emergency
erosion control.
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 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.
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.
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 that two(2)months,a temporary cover of rye or other grass should
be established to prevent erosion and sedimentation. If the season is not appropriate for plant growth,
exposed surface shall be stabilized by other appropriate erosion control measures, firmly anchored,to
prevent soils from being washed by rain or flooding.
DURING CONSTRUCTION
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 storrnwater before it enters the drainage system.
34. There shall be no pumping of water from wetland resource areas.
Attachment to Order of Conditions#64-459
Page 5of 6
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 21 A,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:
(a) All wetland resource area boundaries with associated buffer zones and regulatory setback
areas taken from the plan(s)approved in this Order of Conditions;
(b) Locations and elevations of all stormwater management conveyances,structures and best
management designs,including foundation drains,constructed under this Order within any
wetland resource area or buffer zone;
(c) Distances from any structures constructed under this Order to wetland resource areas-
"structures"include,but are not limited to,all buildings,septic system components,wells,
utility lines,fences,retaining walls,and roads/driveways;
(d) A line delineating the limit of work-"work"includes any filling,excavating and/or
disturbance of soils or vegetation approved under this Order,
39. 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.
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 fast 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 Administrator has
authorized their removal.
ADDITIONAL CONDITIONS
42. Applicant shall obtain necessary permits from the building inspector for the construction of the retaining
wall on Lot 16.
43. Applicant shall obtains the necessary 401 Water Quality Permit as deemed necessary by the DEP.
Attachment to Order of Conditions#64-459
Page 6of 6
44. Applicant shall hold a site walk with the Conservation Agent to determine which trees of large caliper
need to be removed. Applicant shall plant three(3)trees for every tree removed within the buffer zone.
The trees are to be replaced with the same species tree and the tree shall be 2 'h-3" in caliper. The trees
shall be planted along the rear property line within the buffer zone,locations to be approved by the
Conservation Agent. Number of trees to be planted to be approved by the Conservation Agent and/or
the Conservation Commission.
45. The applicant shall include the following language in the deed for Lot 16 located on Amanda Way: "the
owner(s)of Lot 16,pursuant to said Order of Conditions and the Massachusetts Wetlands Protection
Act,are prohibited from certain activities.Certain prohibited activities shall remain in affect
notwithstanding the issuance of a Certificate of Compliance relating to the Order of Conditions. These
prohibited activities include: installation of a swimming pool,re-grading or filling of the lot,adding
additional impervious material such as bituminous concrete or regular concrete or any other activity that
would be regulated by the Massachusetts Wetlands Protection Act. The activities that are prohibited,
however,may occur upon appropriate approvals obtained from the Salem Conservation Commission or
the Massachusetts Department of Environmental Protection or any successor entity." A copy of the
deed shall be submitted to the Conservation Agent to be included in the project file for DEP#64-459.
46. The applicant shall include language in the association documents stating"The subdivision is developed
within and around Wetland areas that are subject to the jurisdiction of the Salem Conservation
Commission. The dumping of leaves,yard waste,debris or any other material into any Wetland area or
into the Open Space or Common Parcels is prohibited. The Owners of any Lot responsible for violating
this prohibition shall be responsible financially and criminally for any violation of this prohibition,
including all costs(including court costs and attorney fees)associated with the restoration of the
disturbed area." A copy of the association documents shall be submitted to the Conservation Agent to
be included in the project file for DEP#64-459.
47. The applicant shall install a City of Salem wetland marker on a post located along the property line
abutting the wetland resource area.
Massachusetts Department of Environmental Protection Provided by DER
Bureau of Resource Protection -Wetlands DEP File Number
WPA Form 3 - Notice of Intent 4
:Document Transaction.Number.
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Salem
City/Town
Important:When i
hen filling out
A. General Information
W
forms on the
computer, use only the tab key 1. Project Location (Note: electronic filers will click on button for GIS locator):
to move your Lot 16 Amanda Way Salem 01970
cursor-do not a.Street Address b. Cit frown c.Zip Code
use the return Y p
key. Latitude and Longitude: 42-30-23 70-55-40
d. Latitude e. Longitude
9 1 (portion)
f.Assessors Map/Plat Number g. Parcel/Lot Number
2. Applicant:
Osborne Hills Realty Trust
a. First Name b. Last Name c.Company
Note: P. O. Box 780
Before J. Mailing Address
completing this L nnfield
form consult y MA 01940
your local e.Cityfrown f.State g.Zip Code
Conservation 781-844-7026
Commission h. Phone Number i. Fax Number j. Email address
regarding any
municipal bylaw 3. Property owner(if different from applicant): ❑ Check if more than one owner
or ordinance.
a. First Name b. Last Name c.Company
d. Mailing Address
e. City/Town f.State g.Zip Code
h. Phone Number i. Fax Number j. Email address
4. Representative (if any):
a.Firm
Attorney John Keilty
b. Contact Person First Name c.Contact Person Last Name
40 Lowell Street
d. Mailing Address
Peabody MA 01960
e.City/Town f.State g.Zip Code
978-531-7900
h. Phone Number i. Fax Number j. Email address
5. Total WPA Fee Paid (from NOI Wetland Fee Transmittal Form):
$500.00 $237.50 $262.50
a.Total Fee Paid b. State Fee Paid c.Cityfrown Fee Paid
6. General Project Description:
Construction of single family dwelling, retaining wall grading and landscaping in the Buffer Zone
wpaform3.doc•rev.4112/06 Page 1 of 7
Massachusetts Department of Environmental Protection Provided by DER
Bureau of Resource Protection - Wetlands DEP File Number
WPA Form 3 — Notice of Intent
ry Document Transaction Number
Ll 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 j. ❑ Other
8. Property recorded at the Registry of Deeds for:
Essex So. District 313
a. County b. Page Number
17338
c. Book d.Certificate#(if registered land)
9. Has work been performed on the property under an Order of Resource Area Delineation involving
Simplified Review within 3 years of the date of this application?
a. ❑ Yes b. ® No
If yes, no Notice of Intent or Request for Determination of Applicability may be filed for work within the
50-foot-wide area in the Buffer Zone along the resource area during the three-year term of an Order
of Resource Area Delineation, or any Extended Order, or until the applicant receives a Certificate of
Compliance, whichever is later.
10. Buffer Zone Only - Is the project located only in the Buffer Zone of a bordering vegetated wetland,
inland bank, or coastal resource area?
a. ® Yes-answer 11 below, then skip to Section C.
b. ❑ No -skip to Section B.
11. Buffer Zone Setback— For projects that involve work only in the buffer zone, select the applicable
adjacent resource area (check one):
a. ® BVW b. ❑ inland bank c. ❑ coastal resource area
The distance between the closest project disturbance and the associated resource area is:
48 feet
d. linear feet
wpaform3.doc•rev.4112/06 Page 2 of 7
Massachusetts Department of Environmental Protection Provided by DER
Bureau of Resource Protection - Wetlands DEP File Number
WPA Form 3 — Notice of Intent
.. Document Transaction,Number
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 ;Salem
cityrrown
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
(proyour idedreceipt
pt 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
Department. d. ❑ Bordering Land
Subject to Flooding 1.square feet 2.square feet
3.cubic feet of flood storage lost 4.cubic feet of flood storage replaced
e. ❑ Isolated Land Subject
to Flooding 1.square feet
2.cubic feet of flood storage lost 3.cubic feet of flood storage replaced
❑ For f. ❑ Riverfront area 1. Name of Waterway(if available)
projects
impacted by 1.Width of Riverfront Area (check one):
the riverfront
area and a ❑ 25 ft. - Designated Densely Developed Areas only
buffer zone of
another ❑ 100 ft. -New agricultural projects only
resource
area, add ❑ 200 ft. -All other projects
50% to the
total fee. 2. Total area of Riverfront Area on the site of the proposed project:
Square Feet
3. Proposed alteration of the Riverfront Area:
a.Total Square Feet b.Square Feet within 100 ft. c.Square Feet between 100 ft.and 200 ft.
4. Has an alternatives analysis been done and is it attached to this NO[? ❑ Yes❑ No
5. Was the lot where the activity is proposed created prior to August 1, 1996? ❑ Yes❑ No
wpaform3.doc•rev.4112106 Page 3 of 7
Massachusetts Department of Environmental Protection Provided by oEP: ;
Bureau of Resource Protection - Wetlands pEP File Number
WPA Form 3 — Notice of Intent
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 S0cumenrTransaction Num6er
Salem
City/Town
B. Resource Area Effects
2. Coastal Resource Areas:
Check all that apply below. Attach narrative and supporting documentation describing how the
project will meet all performance standards for each of the resource areas altered, including
standards requiring consideration of alternative project design or location.
Online Users:Include your Resource Area Size of Proposed Alteration Proposed Replacement(if any)
document
transaction a. ❑ Designated Port Areas Indicate size under Land Under the Ocean, below
number
(provided on b. ❑ Land Under the Ocean 1. square feet
your receipt
page)with all 2.Cubic yards dredged
supplementary
information you C. Barrier Beach Indicate size under Coastal Beaches and/or Coastal Dunes
❑
submit to the below
Department. d. ❑ Coastal Beaches 1. square feet 2.Cubic yards beach nourishment
e. ❑ Coastal Dunes 1.Square feet 2.Cubic yards dune nourishment
f. ❑ Coastal Banks 1. Linear feet
g. ❑ Rocky Intertidal Shores 1.Square feet
h.❑ Salt Marshes 1.Square feet 2.Sq ft restoration, rehab.,or creation
i. ❑ Land Under Salt Ponds 1.Square feet
2.Cubic yards dredged
j. ❑ Land Containing
Shellfish 1. Square feet 2.Square feet restoration, rehab.
k. ❑ Fish Runs Indicate size under Coastal Banks, inland Bank, Land Under the
Ocean, and/or inland Land Under Waterbodies and Waterways,
above
1.Cubic yards dredged
i. ❑ Land Subject to Coastal
Storm Flowage 1.Square feet
3. Limited Project:
Is any portion of the proposed activity eligible to be treated as a limited project subject to 310 CMR
10.24 or 310 CMR 10.537
a. ❑ Yes ® No If yes, describe which limited project applies to this project:
b.Limited Protect
wpaform3,doc•rev.4/12/06 Page 4 of 7
Massachusetts Department of Environmental Protection Provided by DEP:
Bureau of Resource Protection -Wetlands DEP FiieNumber
WPA Form 3 - Notice of Intent
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 „-Document Transaction NumberSalem"
City/Town
C. Bordering Vegetated Wetland Delineation Methodology
Check all methods used to delineate the Bordering Vegetated Wetland (BVW) boundary:
Online Users: 1. ® Final Order of Resource Area Delineation issued by Conservation Commission or DEP
Include your (attached)
document
transaction 2. ❑ DEP BVW Field Data Form (attached)
number
(provided on 3. ❑ Final Determination of Applicability issued by Conservation Commission or DEP (attached)
your receipt
page)with all 4. ❑ Other Methods for Determining the BVW Boundary (attach documentation):
supplementary
information you a. ❑ 50%or more wetland indicator plants
submit to the
Department. b. ❑ Saturated/inundated conditions exist
c. ❑ Groundwater indicators
d. ❑ Direct observation
For all projects
affecting other e. ❑ Hydric soil indicators
Resource
Areas, please f. ❑ Credible evidence of conditions prior to disturbance
attach a
narrative 5. Other resource areas delineated:
thereeso reow D. Other Applicable Standards and Requirements
area was
delineated. 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
2006 Atlas Route 135, North Drive
b. Date of Map Westborough, MA 01581
2. For coastal projects only, is any portion of the proposed project located below the mean high water
line or in a fish run?
a. ❑ Yes ® No If yes, include proof of mailing or hand delivery of NOI to:
Division of Marine Fisheries-Southeast Marine Fisheries Station
50A Portside Drive
Pocasset, MA 02559
b. ❑ Not applicable—project is in inland resource area only
3. Is any portion of the proposed project within an Area of Critical Environmental Concern (ACEC)?
a. ❑ Yes M No If yes, provide name of ACEC (see instructions to WPA Form 3 or DEP
Website for ACEC locations). Note: electronic filers click on Website.
b.ACEC
wpaform3.doc•rev.4/12/06 Page 5 of 7
Massachusetts Department of Environmental Protection Provided by DEP:
Bureau Of Resource Protection -Wetlands DEP File Number
WPA Form 3 — Notice of intent '=
"Document Transaction Number
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Salem
City/Town
D. Other Applicable Standards and Requirements
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
If yes, stormwater management measures are required. Applicants should complete the Stormwater
Management Form and submit it with this form.
b. If no, explain why the project is exempt:
Stormwater management was addressed in the NOI for the subdivision -See O.O.C. DEP File#64-
418.
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.)
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. ❑ Other material identifying and explaining the determination of resource area boundaries
shown on plans (e.g., a DEP BVW Field Data Form).
4. ❑ List the titles and dates for all plans and other materials submitted with this NOI.
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.
7. ❑ Attach proof of mailing for Massachusetts Division of Marine Fisheries, if needed.
e. ❑ Attach NOI Wetland Fee Transmittal Form
s. ❑ Attach Stormwater Management Form, if needed.
wpaform3.doc•rev.4/12/06 Page 6 of 7
Massachusetts Department of Environmental Protection Provided by DER
Bureau of Resource Protection - Wetlands DEP File Number
WPA Form 3 - Notice of Intent
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Salem nt Transaction Number
Salem
City/Town
F. Fees
The fees for work proposed under each Notice of Intent must be calculated and submitted to the
Conservation Commission and the Department(see Instructions and NOI Wetland Fee Transmittal
Form).
No filing fee shall be assessed for projects of any city, town, county, or district of the Commonwealth,
federally recognized Indian tribe housing authority, municipal housing authority, or the Massachusetts
Bay Transportation Authority.
Applicants must submit the following information (in addition to pages 1 and 2 of the NOI Wetland
Fee Transmittal Form)to confirm fee payment:
i7 O
1.Municipal Check Numb i 2.Check date
8225 77 d am
3.State Check Number 4. Check date
5. Payor name on't,t ec c:First Name 6. Payor name on check:Last Nyfie
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
requir f M.G.L. c. 131, §40. Notice must be made in writing by hand delivery or certified mail
(retu n rece' re a to to all abytters within 100 fee f the property line of the project location.
Sig a ure of pplicant Date
Signatu o ro ner if ifferen Date
ign of pre ntative ff ny) Date l 7
F C servatio Co ion:
T o opies of the completed Notice of Intent(Form 3), including supporting plans and documents; two copies
ages 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 NOI Wetland Fee Transmittal Form; and a copy of the state fee payment must be sent to
the DEP Regional Office(see Instructions) by certified mail or hand delivery. (E-filers may submit these
electronically.)
Other:
If the applicant has checked the"yes"box in any part of Section D, Item 3, above, refer to that section and the
Instructions for additional submittal requirements.
The original and copies must be sent simultaneously. Failure by the applicant to send copies in a timely
manner may result in dismissal of the Notice of Intent.
wpaform3.doc•rev.4/12106 Page 7 of 7
LI7Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands
NOI Wetland Fee Transmittal Form
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
Important: A. Applicant Information
When filling out
forms on the 1. Applicant:
computer, use
only the tab Osborne Hills Realty Trust
key to move a. First Name b. Last Name c.Company
your cursor- P. O. Box 780
do not use the d. Mailing Address
return key. Lynnfield MA 01940
e. City/Town I.State g.Zip Code
781-844-7026
h. Phone Number
2. Property Owner(if different):
a.First Name b. Last Name c.Company
d. Mailing Address
e. City/Town f.State g.Zip Code
h. Phone Number
3. Project Location:
Lot 16 Amanda Way Salem
a.Street Address b.City/Town
To calculate B. Fees
filing fees, refer
to the category Notice of Intent(Form 3) or Abbreviated Notice of Intent(Form 4):
fee list and
examples in the The fee should be calculated using the following six-step instructions for 9 9 p process and worksheet. Please see
filling out WPA Instructions before filling out worksheet.
Form 3(Notice of
Intent). Step 1/Type of Activity: Describe each type of activity that will occur in wetland resource area and
buffer zone.
Step 2/Number of Activities: Identify the number of each type of activity.
Step 3/Individual Activity Fee: Identify each activity fee from the six project categories listed in the
instructions.
Step 4/Subtotal Activity Fee: Multiply the number of activities (identified in Step 2) times the fee per
category (identified in Step 3) to reach a subtotal fee amount. Note: If any of these activities are in a
Rivertront Area in addition to another Resource Area or the Buffer Zone, the fee per activity should be
multiplied by 1.5 and then added to the subtotal amount.
Step 5/1rotal Project Fee: Determine the total project fee by adding the subtotal amounts from Step 4.
Step 6/Fee Payments: To calculate the state share of the fee, divide the total fee in half and subtract
$12.50. To calculate the city/town share of the fee, divide the total fee in half and add $12.50.
Wpaform3.doc•N01 Wetland Fee Transmittal Form•rev.311/05 Page 1 of 2
LlMassachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
NOI Wetland Fee Transmittal Form
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Fees (continued)
Step f/Type of Activity Step 2/Number Step Step 4/Subtotal Activity
of Activities 3/Individual Fee
Activity Fee
Category 2 1 $500.00 $500.00
(Single Family Dwelling)
Step 5/1rotal Project Fee: $500.00
Step 6/Fee Payments:
Total Project Fee: $500.00
a.Total fee from Step 5
State share of filing fee: $237.50
b. 1/2 total fee less$12.50
City/Town share of filling fee: $262.50
c. 1/2 total fee plus$12.50
C. Submittal Requirements
a.) Complete pages 1 and 2 and send with a check or money order for the state share of the fee,
payable to the Commonwealth of Massachusetts.
Department of Environmental Protection
Box 4062
Boston, MA 02211
b.) To the Conservation Commission: Send the Notice of Intent or Abbreviated Notice of Intent;
a copy of this form; and the city/town fee payment.
c.) To DEP Regional Office (see Instructions): Send a copy of the Notice of Intent or Abbreviated
Notice of Intent; a copy of this form; and a copy of the state fee payment. (E-filers of Notices of
Intent may submit these electronically.)
Wpafonn3.doc-NO I Wetland Fee Transmittal Form•rev.31V05 Page 2 of 2
DATE INVOICE AMOUNT 53-179
JOHN R. KEILTY, ESQUIRE 113
Clients Trust Account
40 L0WELL STREET N° 1894
PEABODY, MASSACHUSETTS 01960
PAY AMOUNT OLLARS
_._.DATE------ _. _._.......__-....._iUTHEORDE OF._.____ .____,._._._➢ROSSAMT.__. .._DES.CPIPTION.,__,_____.
a:
�(U Eastern Bank —Lynn, MA
D■00L894D■ i:0LL30L7981: 40 L3244
DATE INVOICE AMOUNT 53-179
JOHN R. KEILTY, ESQUIRE 113
Clients Trust Account
40 LOWELL STREET N o 1895
PEABODY, MASSACHUSETTS 01960
PAMOUNT -vu"LLARS
._TO_THEORDEROF _ ._._ __ _-_.__.- __G SSAMT..___ _.___..-_-__-DESCRIPTI➢N___,._,-...._ _._,____NET_AMOUNT.,
Eastern Bank —Lynn, MA
11100 L89 5R■ 1:0 L L 30 L 7981: 40 L 3 244 L 311'
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