10-008 19 Audubon Conservationth ton Conserva Commissi xtocommencementofwork.
Detach on dotted line and submit to ttf�„r r c_ .
rn F= rrt
a G) ¢. M
th ton Conservation Commission Issuinc�'�uttftt�ntY
To
_rt
19 Audubon (10 -8) ;
Ptease be 6,ised C1e Order of Conditions for the project at �
a6� Hampshire Co.
aria
P rt
N��rr+bAr �?,,,,� _ has been recorded at the Registry of c'
1.
with General Condition 8 on .
has b90 notes in the Chart of title of the affected property in accordant a ( — /� —�� ,r =. : '
r q
L1 r
If recdrdlo,land.' the instrument number which identifies this transaction is
- -- -
L.IJ C7
1... If recj,stered land. th document number which identifies this transaction is
,,. Applicant
Signature
m�'4M r
L.►
City of Northampton, Massachusetts
Office of Planning and Development
City Hall . 210 Main Street
Northampton, MA 01060 . (413) 586 -6950
• Community and Economic Development
• Conservation • Historic Preservation
• Planning Board* Zoning Board of Appeals
June 28, 1989
Robert Berniche
4 Ellis Street
Windsor Locks, CT 06096
Dear Mr. Berniche:
Enclosed is your permit for the work that you have already
completed. This permit must immediately be recorded in the
Hampshire County Registry of Deeds on King Street in Northampton
(you can record it yourself). You must fill in the Attachment A
section of the order before recording the order.
When you record the order, make sure you cut out the bottom
half of the last page and fill in the blank lines on that form.
You must then send that half page form to this office, along with
a request that we issue a certificate of compliance.
Please undertake the above steps as soon as possible so that
this matter can be resolved. If you have any questions, please
call me.
Sincerely,
Wayne M. Feiden
Planner
0
Form 5
Commonwealth
of Massachusetts
../
DEQE File No.
(To be provided by DEQE)
otyiTown Northampton
Applicant
Berniche
Order of Conditions
Massachusetts Wetlands Protection Act
G.L. c. 131, §40
From Northampton Conservation Commission
To
Robert S. and Billie M. Berniche Same
(Name of Applicant)
(Name of property owner)
4 Ellis Street
Address Windsor Locks C1 06096 Address-
This Order is issued and delivered as follows:
CI by hand delivery to applicant or representative on (date)
MX by certified mail, return receipt requested on
7 -30 -89 (date)
This project is located at 19 Audubon, Leeds - Map #10, Parcel #8
The property is recorded at the Registry of Hampshire County
Map 10 Parcel 8
Boo Page
Certificate (if registered)
The Notice of Intent for this project was filed on
June 12, 1989 (date)
The public hearing was closed on June 26, 1989 (date)
Findings
The Northam ton Conservation Commission has reviewed the above-referenced Notice of
Intent and plans and has held a public hearing on the project. Based on the information available to the
conservation Commission at this time. the Commission has determined that
the area on which the proposed work is to be done is significant to the following interests in accordance with
the Presumptions of Significance set forth in the regulations for each Area Subject to Protection Under the
Act (check as appropriate):
❑ Public water supply
❑ Private water supply
❑ Ground water supply
❑ Flood control
❑ Storm damage prevention
❑ Prevention of pollution
5 -1
Effective 11 /1 /87
❑ land containing shellfish
❑ Fisheries
❑ Protection of wildlife habitat
Therefore, the
Conservation Commission
I J
hereby finds that the following conditions are
necessary, in accordance with the Performance Standards set forth in the regulations, to protect those inter-
ests checked above. The Conservation Commission 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 differ 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 ad 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 permittee 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 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 and both that date and the special circumstances warranting
the extended time period are set forth 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 fig. containing no trash, refuse, rubbish or de-
bris, 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. No work shall be undertaken until ad 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 shad be undertaken until the Final Order 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 shad 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
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 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- ?P3 0
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 stating that the work has been satisfactorily completed.
12. The work shall conform to the following plans and special conditions:
5 -2
Plans.
Title Dated
Boundary Map 6/79 (revised)
Signed and Stamped by:
On File with:
special conditions (Use additional paper if 7fecessary
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 floodplain nor within 100 feet of a wetland area, as defined in Chapter 131,
Section, M.G.L., shall be permissable disposal sites, unless otherwise approved by the Conservation
Commission;
3) Excavated material and topsoil stockpiles shall be located and stabilized so as to minimi washing into
wetland areas or waterways;
4) Adequate measures shall be taken to prevent erosion and siltation of all disturbed areas;
5)
This Order of Conditions shall apply to any successor in interest or successor in control;
6) Members and agents of the Conservation Commission shall have the right to enter and inspect the premises
to evaluate compliance with the Conditions and to require the submittal of any data deemed necessary by
the Commission for that evaluation;
7) (if checked) Upon completion of the project, the 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 (K$ NO
..................................................... ...............................
(Leave Space Blank)
5 -3A
I
1..,
Special Conditions (continued)
DEOE File No. 246- as 3
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
ten (10) days and no later than seven (7) days prior to the commencement of the approved activity.
9) (if checked) The Applicant shall complete and execute the attached ATTACHMENT "A" /NOTICE OF POSSIBLE
WETLANDS RESTRICTIONS UNDER M.G.L. C. 131, 5.40 relative to entire lot
Said ATTACHMENT "A" shall be attached to, become 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
ATTACHMENT "A" to the Conservation Commission when the bottom portion of Page 5 -4A of this Order of
Conditions Of Conditions' is returned. (4 YES ( ) NO
10) Any fill used in this project shall be clean fill only, which can include earth, sand, gravel, rock, and
loam. The applicant is prohibited from using demolition materials, asphalt, large chunks of concrete,
tree stumps and limbs, and general refuse.
11) This order of condition only permits the logging and tree clearing that was completed
prior to its issuance. Any additional work will require a new permit.
5 -3B
N twe
ATTACHMENT "A"
I, , the owner of certain property
located at Northampton, Hampshire County,
Massachusetts, being the same property described in a deed from
to
dated and recorded in the Hampshire County
Registry of Deeds at Book , Page , do hereby state that
said property may be subject to the provisions of the Wetlands
Protection Act , an Order of Conditions and /or a determination of
applicability from the Conservation Commission of the City of
Northampton. Any construction upon or alteration to said
property may require action by said Conservation Commission.
NOTICE
OF
POSSIBLE WETLAND RESTRICTIONS
UNDER M.G.L. C.131, S.40
I hereby agree and state that any instrument conveying any
or all of my interest in said property or any portion thereof
shall contain language substantially as follows:
This property may be subject to the Wetlands
Protection Act , an Order of Conditions, and /or
a determination of applicability from the
Conservation Commission of the City of Northampton.
COMMONWEALTH OF MASSACHUSETTS
HAMPSHIRE, ss
1988
Then appeared personally the above named
and acknowledged the foregoing to be his /her free act and deed,
before me.
Notary Public
My commission expires
I'
Issued ;,, — th�aton Conservation Commission
a
This Order must be signed by a majority of the Conservation Commission.
On this 26th day o f June 19 89 , before me
personally appear David Gengler . to me known to be the
person described in and who executed the foregoing instrument and acknowledged that he /she executed
the same as his/her free act and deed.
January 18, 1989
Notary Public Wayne M. Feiden My commission expires
The applicant. the owner, any person aggrieved by this Order, any owner of land abutting the land upon which the Proposed work is to
be done or any ten residents of the city or town in which such land is located are hereby notified of thew right to request the Department
of Environmental Quality Engineering to issue a Superseding Order, providing the request is made by certified mail or hand delivery to
the Department within ten days from the date of issuance of this Order. A copy of the request shell at the same time be sent by certified
mail or hand delivery to the Conservation Commission and the applicant.
Detach an dotted line and submit to the Northampton Conservation Commissio ww - tocommenaementofwork.
To Northampton Conservation Commission Issuing Authority
Please be advised that the Order of Conditions for the project at
19 Audubon (10 - 8)
File Number 246 has been recorded at the Registry of
Hampshire Co. an d
has been noted in the chain of title of the affected property in accordance with General Condition 8 on . t 9
If recorded land. the instrument number which identifies this transaction is
If registered land. the document number which identifies this transaction is
Signature
5 -4A
Applicant
`,
*./
Form 3
DEQE File No. 246 - v
Commonwealth (To be provided by DEQE)
of Massachusetts N orthampton
_ City /Town
C\ APPOCwt �1 i �C7ZA/iC f�L
Notice of Intent
Under the
Massachusetts Wetlands Protection Act, G.L. c. 131, §40
and
Application for a Department of the Army Permit
Part I: General Information
1. Location: Street Address k4lde -0, 41 4 - 0 �S
Lot Number Map # 1Z)_ Parcel #
2. Project: Type ! AeQt l VM A/G Description 4040 4 ODC-" &"P /-'-
J NO 6 f�L Dom? ?7Z&?ES� 14449W N &w 6 0WW7 -
3. Registry: County Hampshire Current Boo tl Page
Certificate (If Registered Land) /�
4. Applicant ]`Ofj�:/'7' -+- /J��t /L 1 194= 4,21 -IZ Tel. - 61 S
S:
y
5. Property Owner SAIn r Tel. ?
Address
6. Representative Tel.
Address
7. Have the Conservation Commission and the DEQE Regional Office each been sent, by certified mail or
hand delivery, 2 copies of completed Notice of Intent, with supporting plans and documents?
Yes k No 0
3 -1
Effective 11 /1 /87
_�
ITOWA
8. Have ail obtainable permits, variances and approvals required by local by -law been obtained?
Yes x No ❑ No O P,697 r 0_5 oe&
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, § 105? Yes ❑ No X
10. List all plans and supporting documents submitted with this Notice of Intent.
Identifying
Number /Letter Title, Date
J
S'E 061OWDAK A A P
v
,'o 14 s ryl "
11 . Check those resource areas within which work is proposed:
(a) X Buffer Zone
(b) Inland:
• Bank Land Subject to Flooding,
• Bordering Vegetated Wetland* ❑ Bordering
❑ Land Under Water Body 8 Waterway' ❑ Isolated
(c) Coastal:
❑
Land Under the Ocean'
❑
Coastal Beach'
❑
Barrier Beach
❑
Rocky Intertidal Shore'
❑
Land Under Salt Pond'
❑
Fish Run'
❑
Designated Port Area •
❑
Coastal Dune
❑
Coastal Bank
❑
Salt Marsh •
❑
Land Containing Shellfish'
' Likely to involve U.S. Army Corps of Engineers concurrent jurisdiction. See General Instructions for
Completing Notice of Intent.
3 -2
,%..
..►`
12 Is the wetland resource area to be altered by the proposed work located on the most recent
Estimated Habitat Map (if any) of rare, "state - listed" vertebrate and invertebrate animal species
occurrences provided to the conservation commission by the Natural Heritage and Endangered
Species Program?
YES [ ] NO (J Date printed on the Estimated Habitat Map issued
NO MAP AVAILABLE [ ] (if any)
If yes, have you completed an Appendix A and a Notice of Intent and filed them, along with
supporting documentation with the Natural Heritage and Endangered Species Program by
certified mail or hand delivery, so that the Program shall have received Appendix A prior to the
filing of this Notice of Intent?
YES [ I NO [ J
3 -3
N■.. .Wl'
Part II: Site Description
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
(of plan, narrative
or calculations)
Natural Features:
S S ot AP Soils
Vegetation
Topography
SfE Open water bodies (including ponds and lakes)
r �au,Jpc -Y Flowing water bodies (including streams and rivers)
ante Public and private surface water and ground water supplies on or within 100 feet of site
Maximum annual ground water elevations with dates and location of test
Boundaries of resource areas checked under Part I, item 11 above
Other
Man -made Features:
Structures (such as buildings, piers, towers and headwalls)
Drainage and flood control facilities at the site and immediately off the site, including
culverts and open channels (with inverts), dams and dikes
Subsurface sewage disposal systems
Underground utilities
J 60 WD* ?K oadways and parking areas
Property boundaries, easements and rights -of -way
Other
Part 111: Work Description
Indicate which of the following information has been provided (on a plan, in narrative description or calcula-
tions) to clearly, completely and accurately describe work proposed within each of the resource areas
checked in Part 1, item 11 above.
Identifying
Number /Letter
(of plan, narrative
or calculations)
Planview and Cross Section of:
Structures (such as buildings, piers, towers and headwalls)
Drainage and flood control facilities, including culverts and open channels (with inverts),
dams and dikes
Subsurface sewage disposal systems $ underground utilities
Filling, dredging and excavating, indicating volume and composition of material
Compensatory storage areas, where required in accordance with Part III, Section 10:57
(4) of the regulations
Wildlife habitat restoration or replication areas
- Other
or- 01 Point Source Discharge
1 Description of characteristics of discharge from point source (both closed and open
Ff?lRE loCAVIHChannel), when point of discharge falls within resource area checked under Part I, item
11 above, as supported by standard engineering calculations, data and plans, including
but not limited to the following:
3 -4
on
•Wr
1. Delineation of the drainage area contributing to the point of discharge;
2. Pre - and post - development peak run-off from the drainage area, at the point of discharge, for at least the
10 -year and 100 -year frequency storm;
3. Pre - and post - development rate of infiltration contributing to the resource area checked under Part I, item
11 above;
4. Estimated water quality characteristics of pre - and post - development run -off at the point of discharge.
Part IV: Mitigating Measures
1. 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 II or Part III of the regulations; or
(b) why the presumptions set forth under each resource area specified in Part II or Part III of the regula-
tions do not apply.
• Coastal Resource Area Type:
• Inland
Identifying number or letter
of support documents
❑ Coastal Resource Area Type:
❑ Inland
Identifying number or letter
of support documents
3 -5
i
../
2. Cleariy, completely and accurately describe, with reference to supporting plans and calculations where
necessary: -
(a) all measures and designs to regulate work within the Buffer Zone so as to ensure that said work
does not alter an area specified in Part I, Section 10.02(1) (a) of these regulations; or
(b) if work in the Buffer Zone will alter such an area. all measures and designs proposed to meet the
performance standards established for the adjacent resource area specified in Part it or
Part III of these regulations.
Coastal Resource Area Type Bordered By t 00 -Foot Diacmwnery Zone: Identifying documents I er
Inland
5; '
.L,o 6G 6ZD J tv G /f,re--r Ede �01�
/40P 1,WP
� Ol 4�eqI/ oA/
3 -6
NVOW N,00,
Part V- Additional Information for a Department of the Army Permit
1.. COE Application No,
2.
(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 wetlands).
5. 8' /z " x 11 " drawings in planview and cross - section, 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 may be obtained by contacting the Division of Water Pollution Control,1 Winter Street.
Boston, Massachusetts 02108.
Where the activity will take place within the area under the Massachusetts approved Coastal 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 for a permit and is made a matter of public
record through issuance of a public notice. Disclosure of this information is voluntary, however, if necessary
information is not provided, the application cannot be processed nor can a permit be issued.
I hereby certify under the pains and 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.
Signature of Applicant Date
Signature of Applicant's Representative Date
FORM • zsceptiou to 6NG Form 4346 approved by BQUSACE. 6 May 1964 ".
NED 100 +TEST). -M,o document contains a joint Department of the Army and state of Massachusetts application
1 MAY 8 2 for a permit to obtain permission to perform activities is United States waters. The Office
of Management and Budget (OMB) has approved thee* Questions required by the US Army Corps
of 6agineere. OMB Number 0702 -0036 and expiration date of 30 September 1963 applies ". This
statement will be set is 6 point type.
3 -7
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.wo
DEQEFileNo. 246- a
(To be provi ed y OEQE)
City /Town N orthampton
Applicant oto fw
Notice of Intent
Under the
Massachusetts Wetlands Protection Act, G.L. c. 131,.§40
and
Application for a Department of the Army Permit
Part 1: General Information koag P/t/ 6 Lra 5'
1. Location: Street Address
Map # /1) , Parcel #
Lot Number
Form 3
} Commonwealth
of Massachusetts
2. Project: Type 1 6t Description 1,0a go.OD� � -
4.
— Tff I/vN /luow) mw 6"&v7- - *
3. Registry: County Hampshire Current Boo & Page
Certificate (if Registered Land)
Address
>
i�
a
Tel. r�g'�l�
L) 4i G
5. Property Owner Skm - T el.
Address
6. Representative
Tel,
Address
7. Have the Conservation Commission and the DEOE Regional Office each been sent, by certified mail or
hand delivery, 2 copies of completed Notice of Intent, with supporting plans and documents?
Yes '` No M
3 -1
Effective 11 /1 /87
t
8. Have all obtainable permits, variances and approvals required by local by -law been obtained?
Yes No ❑ Nd olyz t
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, § 105? Yes ❑ No X
10. List all plans and supporting documents submitted with this Notice of Intent.
Identifying
Number /Letter Title, Date
�J
11. Check those resource areas within which work is proposed:
(a) X Buffer Zone
(b) Inland:
• Bank'
Land Subject to Flooding,
• Bordering Vegetated Wetland
❑
Bordering
❑ Land Under Water Body & Waterway'
❑
Isolated
(c) Coastal:
• Land Under the Ocean'
❑
Designated Port Area'
• Coastal Beach'
❑
Coastal Dune
❑ Barrier Beach
❑
Coastal Bank
❑ Rocky Intertidal Shore
❑
Salt Marsh'
❑ Land Under Salt Pond'
❑
Land Containing Shellfish'
❑ Fish Run'
"Likely to involve U.S. Army Corps of Engineers concurrent jurisdiction. See General Instructions for
Completing Notice of Intent.
3 -2
*%W'
...1
t 2. Is the wetland resource area to be altered by the proposed work located on the most recent
Estimated Habitat Map (if any) of rare, "state- vertebrate and invertebrate animal species
occurrences provided to the conservation commission by the Natural Heritage and Endangered
Species Program?
YES [ ] NO (] Date printed on the Estimated Habitat Map issued
NO MAP AVAILABLE [ ] (if any)
If yes, have you completed an Appendix A and a Notice of Intent and filed them, along with
supporting documentation with the Natural Heritage and Endangered Species Program by
certified mail or hand delivery, so that the Program shall have received Appendix A prior to the
filing of this Notice of Intent?
YES [ ] NO [ ]
3 -3
N
N..r/
Part II: Site Description
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
(of plan, narrative
or calculations)
S'�E Sol ti
v S'EE
J3auAJppr( -Y
7" tP
Natural Features:
Soils
Vegetation
Topography
Open water bodies (including ponds and lakes)
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 dates and location of test
Boundaries of resource areas checked under Part I, item 11 above
Other
Man -made Features:
Structures (such as buildings, piers, towers and headwalls)
Drainage and flood control facilities at the site and immediately off the site, including
culverts and open channels (with inverts), dams and dikes
Subsurface sewage disposal systems
Underground utilities
S AOWDI oadways and parking areas
i'n�IP Property boundaries, easements and rights -of -way
Other
Part III: Work Description
Indicate which of the following information has been provided (on a plan, in narrative description or calcula-
tions) to clearly, completely and accurately describe work proposed within each of the resource areas
checked in Part I, item 11 above.
Identifying
Number/Letter
(of plan, narrative
or calculations)
Planview and Cross Section of:
Structures (such as buildings, piers, towers and headwalls)
Drainage and flood control facilities, including culverts and open channels (with inverts),
dams and dikes
Subsurface sewage disposal systems & underground utilities
Filling, dredging and excavating, indicating volume and composition of material
Compensatory storage areas, where required in accordance with Part III, Section 10:57
(4) of the regulations
Wildlife habitat restoration or replication areas
low 1 Other
or- rnr WAW Point Source Discharge
7 IV
Description of characteristics of discharge from point source (both closed and open
rViTRE &eaffOchannel), when point of discharge fails within resource area checked under Part I, item
11 above, as supported by standard engineering calculations, data and plans, including
but not limited to the following:
3 -4
1. Delineation of the drainage area contributing to the point of discharge;
2. Pre - and post - development peak run -off from the drainage area, at the point of discharge, for at least the
10 -year and 100 -year frequency storm;
3. Pre - and post - development rate of infiltration contributing to the resource area checked under Part I, item
11 above;
4. Estimated water quality characteristics of pre - and post - development run -off at the point of discharge.
Part IV: Mitigating Measures
1. 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 II or Part III of the regulations; or
(b) why the presumptions set forth under each resource area specified in Part II or Part III of the regula-
tions do not apply.
❑ Coastal Resource Area Type:
Inland
Identifying number or letter
of support documents
❑ coastal Resource Area Type:
❑ Inland
Identifying number or letter
of support documents
3 -5
I
Coastal Resource Area Type:
Inland
Identifying number or letter.
of support documents
5;4 �
2. Clearly, completely and accurately describe, with reference to supporting plans and calculations where
necessary:
(a) all measures and designs to regulate work within the Buffer Zone so as to ensure that said work
does not alter an area specified in Part I, Section 10.02(1) (a) of these regulations; or
(b) if work in the Buffer Zone will alter such an area, all measures and designs proposed to meet the
performance standards established for the adjacent resource area specified in Part li or
Part III of these regulations.
- Coastal Resource Area Type Bordered By 100 -Foot Discretionary Zone:
Inland
Identifying number or letter
of support documents
5;4 �
X0,9, P 9//a•" fl/l o�tn�
3 -6
i
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Part V: Additional Information for a Department of the Army Permit
1. COE Application No.
(to be provided by COE)
2.
(Name of waterway)
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 wetiands).
5. 8%" x 11 " drawings in pla iview and cross - section, 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 may be obtained by contacting the Division of Water Pollution Control,1 Winter Street,
Boston, Massachusetts 02108.
'Where the activity will take place within the area under the Massachusetts approved Coastal 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 for a permit and is made a matter of public
record through issuance of a public notice. Disclosure of this information is voluntary, however, if necessary
information is not provided, the application cannot be processed nor can a permit be issued.
I hereby certify under the pains and 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.
>ignature of Applicant Date
Signature of Applicant's Representative Date
FORM Exception to ENG Form 4346 approved by HQUSACE. 6 May 1982 ".
NED 0 100 (TEST)
1 MAY $ 2 This document contain& a joint Department of the Army and State of Massachusetts application
for a permit to obtain permission to perform activities in United States waters. The Office
of Management and Budget (OMB) has approved those Question& required by the US Army Corps
of Engineers. OMB Number 0702 -0036 and expiration date of 30 September 1983 applies ". This
statement will be set in 6 point type.
3 -7
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