05-055 Kennedy Rd Con ComThe origincal CertificatF ,f Compliance was hand delivers j Christensen- Howard Inc.
Received Feb_ /, 1989 by
�_ dC-0EFb NO. 246 -211
ITobemw bybEOEI
Commonwealth - 6ryy ? pen Northampton
of Massachusetts r A m ,�, Christensen- Howard. Inc.
Certificate of Compliance
Massachusetts Wetlands Protection Act, G.L. c. 131, §40
From Northampton Conservation Commission Issuing Authonty
Christensen- Howard, Inc. 76 King Street, Northampton, NA 01060
To ,
(Name) (Address)
Date of Issuance 2/13/89
This Certificate is issued for work regulated by an Order of Conditions issued to Chris tensen- Howard, Inc..
dated Nov. 10, 1988 1 dissuedbythe N'hamoton Conservation Commission
1. ❑ It is hereby certified that the work regulated by the above - referenced Order of Conditions has
` been satisfactorily completed. _
2. 0 It is hereby certified that only the following portions of the worts regulated by the above- refer - _......
anced Order of Conditions have been satisfactorily completed: (it the Certificate of Compliance
does not include the entire project, specify what portions are included.)
All work on Lot 1 and the common driveway serving lots 1 and 51, but not
other work on lot 51.
3. ❑ It is hereby certified that the work regulated by the above - referenced Order of Conditions was
never commenced The Orderof Conditions has lapsed and is therefore no longervalid. No future "
work subject to regulation under the Act may be commenced without Ming a new Notice of Intent
and receiving a new Orderof Conditions
............._............_................................................................_......._.......................................... _.....................__......_ -.
8 -1
Effective 11 /1 /87
6. Z This cerliflcate shall be recorded in the Regmtry of Deeds or the Land Court for fire distnct in
whiotithe land is located. The Orderwas ongumify recorded on
atthegegda of Hampshire County l ie)
Bock P egs (da a nd book and age
never sent to Commrzlon)
5. CZ The following conditlons of the Ordershad condrue: )Setfonh arty condiffons conmineo m Vhe
Frei Order. such as maintenance or mOndoring, which are to conf nue for alonger Penod.)
Order of COndi-tions remains in effect for lot 51 and project engineer must state
work was done in compliance with Order of Conditions before a Certificate of
Compliance is issued for that lot. Special conditions in the Order of Conditions
remain in effect for lot 1, eLRecially that individual driveways (driving surface)
shall not exceed 10' width nor planed in areas other than shown on the 8/8/88
plans.( Driveway to drilled well site most be removed after well is completed,),
Driveway de -icing may he done only with untreated sand,
lasueo by NORTHAMPTON CONSERVATION COMMISSION
r-
When issued by the Conservator Commision this Cer0cate must be i ed
On tts /37� �9n hyamajoritS. ctamembers.
,n f9 befm rne...
p er3onatY aooeaed - Pf /�LV�i FYnR /Gk tomeknowntobethe..,
Person fir ed in anhd whoa eated fhe foregOi g
m tmoumerhtarhdaUmowledged tat helyas executed
the same his/lerr frse act a4 deed_.
Notary Public f' My commission ehpves
O�un denbtl Ilneand aaEntltb tlti
Pleasf alVpOd aft Cle I—.0
(:BrtlflObofCmcYarw fSltbaCwwer_
R.Nw -- Oew,mcatleda NenaD�W of
aw tm¢Ltal Mlee in abrlan of EVad Neabcted wwwm
r9
neecortlea law. mes om , renlmnmarwtlC,id « mXy dw namer5an9 —_.
n "yela,e kll4 lM ecavllart mvlMa wltiU kaluna ale naimrxv.:.
8 -2
OECE Fle Na.
Form 5 ITO De Oro'^�d EY OECEI
- CiryrTOVm �
-rh t n
Commonwealth rl -
of Massachusetts 1 A°PI�t
Order of Condition i
Massachusetts Wetlands Protection Act
G.L. c. 1.31, §40
From N �A flt'l'
To - (Name of property owner)
(Name of Applicant)
r h nrn MA Address
Address
This Order is issued and delivered as follows: (date)
❑ by hand delivery to aPPlicant or representative on (date)
by certified mail, return receipt requested on / , y
655e anr�
This projectis located a side of Kennedy Road)
The property is recorded at the Registry of
Boo 3206 page
Certificate (if registered)
Th Notice of Intent for this Protect was bled on
9 127/88 (date)
(date)
The public hearing was closed on _ ..
Flndfri s the abwe-reterenced Notice of
The Northampton. C on onservheld ion - Commission.... tlaSS rontheG information available to the
o
Intent and plans and has he a public hearing on the Project Based the olect �issi n has determined that
Conservation Commission at this time. the nirparlt to the fdbwingmteresmmaccordance with
the area on which the proposed work is m be done m sig
the Presumptions of Significance set forth in the regulations foreach Area Subiectto Protection Under the
Act (check as WPOOPrlate): C2 Flood control Land containing shellfish
® Public water supply � Storm damage prevention ❑ Fisheries
>_>
[I Private water supply ❑ Prevention of pollution ❑ Protection of wildlife habitat
❑ Ground water supply
5 -1
Effective 11/1/87
Therefore,the Northampton Conservation COsmissi tsilreby finds that the following conditions are
necessary, in accordance with the Performance Standards set forth in the regulations, to protect those inter -
estscheckedabove.The furs Pr,. r orders that all work shall be performed
in accordance with said conditions and with the Notice of Intent referenced above. To the extent that the fol-
lowing conditions modify or dider from the plans, specifications or other proposals submitted with the Notice
of Intent, the conditions shall control.
General Conditions
1 . Failure to comply with all conditions stated herein, and with all related statutes and other regulatory meas-
ures, shall be deemed cause to revoke or modify this Order.
2. This 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 perr ittee or any other person of the necessity of complying with all
other applicable federal, state or local statutes, ordinances, by -laws or regulations.
4. The work authorized hereunder shall be completed within three years from the sate 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 and both that date and the special circumstances warranfing
the extended time period are set forth in this Order.
5. This Order maybe 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. containing no trash, refuse, rubbish or de-
bris, including but net limited to lumber, bricks, plaster, wire, lath, paper, cardboard, pipe, tires. ashes,
refrigerators, motor vehicles or parts of any of the foregoing.
7. No work shall be undertaken unfit all administrative appeal periods from this Order have elapsed or, if
such an appeal has been filed, until all proceedings before the Department have been completed.
8. No work shall be undertaken until the Fnal Order has been recorded in the Registry of Deeds or the Land
Court for the distract in which the land is located, within the chain of title of the aff ected 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 registered land, the
Foal Order shall also be noted on the Land Court Certificate of Title of the owner of the land upon which
the proposed work is to be done. The recording information shall be submitted to the Commission
on the form at the end of this Order prior to commencement of the work.
9. A sign shall be displayed at the site not less than two square feet or more than three square feet in size
bearing the words, "Massachusetts Department of Environmental Quality Engineering,
File Number 246- -4 /1
10. Where the Department of Environmental Quality Engineering is requested to make a determination and
to issue a Superseding order, the Conservation Commission shall be a party to all agency proceedings
and hearings before the Department.
11. Upon completion of the work described herein, the applicant shall forthwith request in writing that a
Certificate of Compliance be issued staling that the work has been satisfactorily completed.
12. The work shall conform to the following plans and special conditions:
5 -2
plans:
Title Bated Signed and Stamped by: on Pile with:
Kennedy Road Wetlands Pla 9/22/88 William D. Pharmer N'ton Corso. Comm
(Subdivision for Christensen- Howard)
Special C®ditio s (US, additional paper if necessary)
1) All construction areas shall be restored to original condition or better upon completion of the project,
including vegetation]
2) No areas within the 100 year flocdplain nor within 100 feet of a wetland area, as defined in Chapter 131,
Section, N.G.L., shall be permissahle disposal sites, unless otherwise approved by the Conservation
Commisci an
3) Excavated material and topsoil stockpiles shall he located and stabilized so as to minimize - washing into
wetland areas or waterways;
4) Adequate measures shall be taken to prevent erasion and siltation of all disturbed areas;
'( 5 )
l This Order of Conditions shall apply to any successor in interest or successor in control;
6) Members and agents of the Conservation Condission shall have the right to enter and inspect the premises
to evaluate compliance with the Conditions and to require she submittal of any data deemed necessary by
the Commission for that evaluation;
7) (if checked) Upon completion of the project, she Applicant shall submit a statement from the Project
Engineer that all work has been done in conformance with the provisions of the approved order of
Conditions.
( )� YES ( ) 10
......................................................... ............... ................ .......:...............
(I¢ave S paz'P Blank)
5 -3A
i DE^v File No. 246- --
Special Conditions (continued)
8) The Applicant shall notify the Conservation Commission, in writing, as to the date that work will be
commencing on the project. Said written notification must be received by the Commission no sooner than
tan (10) days and no later than seven (7) days prior to the commencement of the approved activity.
9) (if checked) Me Applicant shall complete and execute the attached ATTACE0= 'P/NOTICE OF POSSIBLE
WIlLINDS RESTRICTIONS UNDFdt M.G.L. C. 131, 5.40 relative to Lot 1 & 51 on the p rior.
referenced p lan
Said ATTACIF'&9 "A" shall be attached to, beoc— a part of, and shall be filed with this Order Of
Conditions at the Registry of Deeds. The Applicant shall return a copy of the completed and notarized
ATTa C33MENT "A" to the Conservation Commission when the bottom portion of Page 5-4A of this Order of
Conditions Of Conditions' is returned. (X) YES ( ) NO
10) For Lot 51:
a) the driveway turn- around should moved to the other (easterly) side of the driveway,
b) no work shall take place beyond the haybale barrier, which shall serve as a non- encroach-
ment Line,
c) roof drains shall be connected to dry - wells,
d) a 15" culvert shall be used for the drainage pipe under the driveway,
11) For Lot 1:
C for the drainage pipe under the driveway,
a) a 12" culvert shall be used
12) The common driveway shall not exceed a width of 18' and the individual driveways shall
not exceed a width of 10',
13) Driveway de -icing may only be done by using untreated sand, and a restriction so stated
shall be placed on the deeds to both lots,
14) This Order Of Conditions shall be referenced on the cover sheet of the construction plans
for this project.
15) Nay bales shall be installed in accordance with Attachment "B ".
5-38
(" Issued By
Conservation Commission
This Order must be signed by a majority of the Conservation Commission.
n this day of
P appeared_ t g before me
Pe!SOndescnbe to me known to be the
, Ir and who xecuted the foregoing instrument and acknowleed that he/ shpe executed
e carne �IS/nerfreeectandde d. ClLZSTudF
NOTARY PUBLIC
y YIY COMMISSION EsPIXES
NO ic, _ EH l4 1990
_
My commission expires
The applkOnt. IM owner. shy perapn aggrieved by n's omler, any owrrer of land abutting the I upon whkh Me pr xxxioO work s to
O done --y ten resaenro of the city ortown in which Such Ond'u Iocar,d are hereby notified of thek right to realest the Debarment
Of Elrvnonmental Quality Ergkreering roiswea Superseding Order, prvridmg the (B —t by q made certified mail or Land delivery to
the Peberbneritvnfkn ten days "mn" tM data of issuance of nm Order. A copy of "regueatsfratl at the same time besent by certified
maJ anand delivery M the conservation Comrmsslon and the a kant.
petrreb"d� IIM an0 submit fu t
prbr to cammancemsnt of wink.
awnry n.M.Il
Reese be advised that ft Order ofoandi6orm fartM Prgect e[
Fie Number Ir4i bemrrecorded at dra Regetrypf
and
Yres Oemr.1ndin"ct oftitieoftheaffecrodpropenymacp Cdr C.,U.8
If recorded land, the insaument number which identifies Iris Iransactlon is 19
If registered land, the documont number which identliiea lhls transacllon Is
Anpfcant
5 -4A
✓n i�L6 -yKIlll ,
Revision
r.. ^ 2. tC-0EFas NS —^
Northampton
Qlyliwn
Commortwealth
Christensen- Howard
of Massachusetts - Aadkant --�"
Determination of Applicability
Massachusetts Wetlands protection Act, G.L c. 131, §40
r^rgm Northamoton Conservation Commission
Issuing AuthontY
W S C` t 'en a nd Mi1 COn B How
7o Christensen - Howard, Inc. (Name of property owner)'
(Name or Person making requesil
Northam_oton, MA same
Address 76 King St. , 01060 Address
This determination is issued and delivered m fgOOwa:
try hand deliverY to Pen,omnraldng request on
12 by certified mail. mtum receipt requested on A crust 23 1988 _(date)
( pursuant to the authority of G-L- C. 131, §40. the Northampton Conservation Commission
andits supponvfgdoarmerFMOn' and has
- has considered your requestfora Oetermmation afApphtab�' _
made the following detertnirlation (checkwhlcrlever is appiirable):
This Oetentlinatign is Positive:
indudes aWPart of the area cr
describetl in Yoaltg a a
1. C$X The area described below, wnich
Sublet. to Protection Under the Act Therefore, any removmg.f�g, dredging or
area requires the fifmg of a Notice of Intent.
Any work in the following areas re
area bet W 1
he5 505-ft- contoureinflotsent:
all of lots 4, 51, and 51A;
1, 2 and 3 as shown on the applicant's plan, "Kennedy Road Developn
met:
wetl and Delineation Plan;" submitted to the Conservation Commission on
August 22, 1988.
2_ ❑ The work described beiow, whidrindudesaWpmtat the work described in Your request. is wdhm. .
an Area Sunect to Protection Under the Act and w" remove, f0, dredge q after that area. There-
fom, said work requires the fi9ng of a Notice of Inter.
2 -1
Eget, 11 /1/ 87
3. C The wancame,oea below. wloCrvztadesaue + raf Vls warx aa�ermeairt ymaremms. �v aaerr
tae 8rafr as aeireainthe re tlme. adwiameraAraaSuapeCCr PraisOMUndrr
Ca! AG Thavicm ma womrommes me On of aNad= hOEM
This Oaevem=:l= m negabc
I. C - Ths area v�yaurrnm�tb +eo<ar:+�Sa�jec2afkvurW�aerfieac
Z.. C The =PrvUC:JWUWWTM AG Cruwe7
— remove. fib. anoge, armrCmearee_TTrereime. xwt mx4aeartatremme am ffkq ara
4 admen
S_ t The waru 6edirt ymarem+emb wilts Cis 9WterZae. a =Qe iff me•regimm==wi
mat alfBf of Area SuowC to ra>eCfOn. U3nlerCle AG Theraim��warkaaef rmtreaUre Cee -
I18ngai a Natl� at Int®f[
<. C The art� -.. is ymare0usaiaSumeCCr p!aQem5mrWtaerfisPG=mw:oasa
aegar:bea Cfetear mesa ms remmeamsai W t1W tCdCWW7g eamanmr.aa mad M TA AC:
Vie rggL=icrM = Nam:a ar Iramrro remmeC
isluedL-V :TOr�a� to n Cams C=M==
� irb atawrp w> �.+... Crs {aey0� :emr....nr �apepaAatl�2Clattlalal0e eiec.COQ
Ctes>RpanteelherfreeaCartC�eea_ - CNItrmrre _SICORUPS€I
/ J� 0 NOTARY PUBLIC 77
� '�CSaO®fr6�' W �YfE1078341990
T1YaO�vevoraeamarwawm�emavmeomrlwiq .veat�vmesalaav¢b'iAVOLa ®R- _ . .
atle¢raplemi i}YeO�eal b��tmrava9lelam a1 ®¢tale!
7LVamieae asa��armm> Qom.. egrswreala >,ralrarmasm9mvlsuamwamva®u
iat60avYA a�nneraOwot9w�1'¢mlwwr�amlu nl®zaee/lrn ®inot9�n4emrmaa�
Osawvot5n.vaavOaly 6meeweq mvovSmwasraalm� etAmledlY. ya�mq a�imavmar
6rabamar¢fwmelwam amaalw�mwOrlama moat ®a iov¢ mrarlmca®rameima.
S/ Yalas0a4�4a• ISOral�aaID✓ ofle ♦pa�a�ma�Caa•��r
2-ZA
NNEDY ROAD DEVELOPEMENT /
Wetland Delineation Plan
oKTH scale: 1° =100'
a�A .77D
�,,, 2 -� 1988
51A
i
te
I �
I1�
B
I Zone �
e
_�g8s r roposed House Local
( Approximate)
k q0
' 1.495 Prop H ay B B
Propo Driv w/
(2) Drainage Pipes
—.720
X575
100 �\
o
ne��:. E xisting Wetle�nds
-
/
_
-'- --
2
e
_�g8s r roposed House Local
( Approximate)
k q0
' 1.495 Prop H ay B B
Propo Driv w/
(2) Drainage Pipes
—.720
X575
100 �\
o
ne��:. E xisting Wetle�nds
-
310 CMR: DEPARTMENT OF ENVIRONMENTAL QUALITY ENGINEERING
10.99: continued
Farm 3
,✓.\ - oEOE Fee No. 1
..�.. (Ta ev w ovoeo oy a W El
Cammcmvea h tOR
of Massachusetts - chrTO'" "�` Inc.
Christensen Ho ward,
Aoo��cani �----
�� Notice of Intent
Under the
Massachusetts Wetlands arnottection Act, G.L. c.131, §40
Application for a Department of the Army Permit
partl:Generaltnlormctlon 9n A
1. locauvii.. --
55 & 51'
Lot Numbers -
Subdivision Description Within 100' buffer. of wetlands:
2. Project: TYPO � - ith y�nent stabilization
(2) driveway crossings of drain e swale w
Of banks at crossings;
and installation of temporary erosion
sedimentation control measures..
3206 3page 1
3. Registry:County Hamp Curren) ecok.�� —
Certificate III Registered Lanbl� 566 - 7222
Christensen - Howard, Inc.
Tel.
a. Applicant 01060
76 King Street, Northampton NA
Address
. same as above Tel.
5. Property
Address - — 586 -9541
6. Representative The Berkshire Desi m Grou
Tel.
Address 4 Allen Place,
Northampton, MA 01060 een sent, by
7 hand delivery. ConerationommisseledN I ce of Intent, with Suppotlingaplans and documents ? detailor
Yes Q No ❑
3.1
310 CMA - 200.17
10/1607 (Effective 11/1107)
310 CMR: DE?MRTMENT OF ENVIRONMENTAL QUALITY L . NEERING
d 10.99: continued
8. wave all obtainable permits. variances and approvals required by local by law been obtainedt
(es ® No ❑
Obtained: Applied For: Not Applied For:
9. Is any portion of the site subject to a Wetlands Restriction Order pursuant to G.L c. 131, §40A or G.L.
c. 130, §1051 Yes ❑ No D
10. List all plans and supporting documents submitted with this Notice of Intent.
Identifying
Title. Dale
Number /Letter
Sheet 1/1 KEnnedv Road Wetlands Plan 9 -22 -88
11. Check those resource areas within which work is proposed:
(a)L3 Buller Zone
(b) Inland:
Land Subject to Flooding.
I3 Bank*
❑ Bordering Vegetated Welland'
❑ Bordering
❑ Land Under Water Body & Waterway
❑ Isolated
(c) Coastal:
[3 Designated Port Nea'
❑ Land Under the Ocean
❑ Coastal Beach'
❑ Coastal Dune
❑ Barrier Beach
❑ Coastal Bank
❑ Rocky Intertidal Shore •
❑ Salt Marsh'
'
❑ land Containing Shellfish'
❑ Land Und er Salt Pond'
❑ 1 Run'
° Likely to involve U.S. Army Corps of Engineers conwrwnl jndsd;cfion. See General Instructions for
Completing Notice el Intent.
3.2
' 310 CMR - 260.18
10/16/87 (Effective 11/1/6])
310CMR: DEPARTMENTOF ENVIRONMENTAL QUALITY CINEERINC
1 0,99; continued
Part 11: Site oescrlptlon
Indicate which of the following information has been provided (on a plan. in narrative description or calcula-
tions) to clearly, completely and accurately describe existing site conditions.
Identifying
Number /Letter
( plan, nerratiye
or calculations)
Natural Features:
Soils
Vegetation '
may. t /1 Topography
Sheet 1/1 Open water bodies (Including ponds and lakes)
Sheet 1 1 Flowing water bodies (including streams and rivers)
Public and private surface water and ground water supplies on or within 100 feet of site
Maximum annual ground water elevations with dales and location of test
Sheet 1/1 Boundaries of resource areas checked under Part 1, item ll above
_ Other
Man -made Features:
4h t 1/1 Slrgctures(such as buildings. plers, towers and headwalls)
Sheet 1/1 Drainage and flood control facilities at the site and immediately it the site. including
culverts and open channels (with Inverts), dams and dikes
Subsurface sewage disposal systems
Underground utilities
Sheet 1/1 Roadways and parking areas
Sheet 1/1 property boundaries, easements and rights -of -way
Other
Part lth Work Description
Indicate which of the following Information has been provided (on a plan, In narrative description or calcula-
llons) to clearly, completely and accurately describe work proposed within each of the resource areas
checked in Part i, item 11 above.
Identifying
Number /Letter
jet plan, narrative _
or calculations)
Planvlew and Cross Section of:
-Sheet 1 1 Structures (such as buildings. piers, towers and headwalls)
Sheet 1/ 1 Drainage and hood control facilities, including culverts and open channels (with inverts),
dams and dikes
Subsurface sewage disposal systems d underground utilities
Sheet 1 1 Filling, dredging and excavating. indicating volume and composition of material
Compensatory storage areas. where required In adcordance with Part III, Section 10:57
(4) of the regulations
Wildlife habitat restoration or replication areas
Other
Point Source Discharge
Description of characteristics of discharge from point Source (both closed and open
channel), when point of discharge falls within resource area checked under Part), item
11 above, as supported by standard engine a ring calculations, data and plans. Including
but not limited to the following: 3.4
310 CMR - 280.20
10 118 /87 (Efteclive 11/1/8])
310 CMR: DEPARTMENT OF ENVIRONMENTAL QUALITY ENGINEERING
1. Delineation of the drainage area contributing to the point of discharge; for at least the
p. Pre. and post-development peak run-off from the drainage area, at the point of discharge,
10-year and 100year frequency storm:
3. Pre - and poshdevelopmen t rate of infilrallon contributing to the resource area checked under Pa
rl l ,item
11 above;
4. Estimated water quality characteristics of pre- and post-developmen t runoff at the point of discharge.
Part IV: Mitigating Measures
i. Clearly, completely and accurately describe. with reference to supporting plans and calculations where
necessary:
(a) All measures and designs proposed to meet the performance standards set forth under each re
source area specified in Part It or Part III of the regulations; or
(b) why the presumptions set forth under each resource area specified In Part It or Part III of the regula
Lane do not apply.
Id.nelyinumeer or 11,1161
❑ Cocelal Pe6wrce Nea Type: Buffer Zone pl eupp documenu
® hland
During construction and as final soil stabilization, .
Sheet 1/1
anti - siltation /erosion techniques shall be applied
on all disturbed areas in accordance with the
specifications in Erosion 6 Sedimentation Control
in Site Develo ment, Massachusetts Conservation
Guide volume 1, U.S.D.A., September, 1983. Specific
techniques to include haybal,es, spreading straw,
rip -rap and seeding.
w.nelyi gnumeetorl6ler
❑, C..val Resource Nea Type: a;rlk al rvppoll dpcumenu
$I Inland
* Carr in capacity of existing channel will be Sheet 1/1
resL to .original condition.
* Culverts to be 12" RCP, w 12" gravel base.
* Baybale dikes will be used on the.downstream
side to prevent siltation or sedimentation,
erosion, or contamination of any water present.
* Rip rap will be placed along stream banks in
accordance with specifications on Kennedy Road
lic-tlands Plan.
3.5
910 CMR - 290.21
10/16/97 (Effective
31D CMR: DEPARTMENT OF ENVIRONMENTAL QUALITY ENGINEERING
10,99: continued
part V: Additional Inlarmallon fora Department of the Army Permit
1, COE Application NO.� -- (Name of waterway)
(to be provided by COE)
3. Names and addresses of property owners adjoining your property:
4. Document other project alternatives (i.e.. other locations and /or construction methods, particularly those
that would eliminate the discharge of dredged or fill material into waters or we
5 8 • , I I - drawings in planview and cross - ,¢,lion, showing the resource area and the proposed activ-
ity within the resource area. Drawings must be to scale and should be clear enough for photocopying.
Certification is required from the Division of Water Pollution. Control before the Federal permit can be
Issued. Certification maybe obtained by contacting the Division of Water pollution Control,) Winter Street,
Boston, Massachusetts 02100.
Where the activity will lake place within the area under the Massachusetts approved Costal Zone
Management Program, the applicant certifies that his proposed activity complies with and will be conducted
in a manner that is consistent with the approved program.
Information provided will be used In evaluating the application fora permit and Is made a matter of public
recur d is root uance of sppGoatloo cannot be processed o a permit be h issued.
necessary
I hereby certify under the pains and penalties of perjury that the foregoing o f intent wledga a nd accompanying
plans, doc. is and supporting data a re W o
e and complete, to the best of MY I e
Dale
Signature of A Ilca t
Tae Vr ue� �sfoj GEeI`rP aI2Hle —
�� � Date
Signature s Representative
-e..q,l•... CMO Lrs U4 •pprnJ b Npe9ACL. 1 Wr ILLS"
FORM 100 (TEST) ,.1...1•Lp O.p•,. L fZh•A..1.`e 53 "' °f M.u..AU... ...........
H ID -... e......, ... .,i....a,.u;.. I. u. u.. m..., ..,., Th.
1 MAY 82 L, . v...i a .e..;. v •a'•" a „I,d er m. 11 A..1 c.
s..aL' JL s•p,..e.,
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