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Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands
WPA Form 2 — Determination of Applicability
1 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
A. General Information
Important:
When filling out From:
forms on the North Andover
computer, use Conservation Commission
only the tab
key to move To: Applicant Property Owner(if different from applicant):
your cursor-
do not use the George Sears Same
return key. Name Name
1580 Salem Street
r� Mailing Address Mailing Address
North Andover MA. 01845
City/Town State Zip Code Cityrrown State Zip Code
1. Title and Date(or Revised Date if applicable) of Final Plans and Other Documents:
Proposed Subsurface Sewage Disposal System, sheets 1 &2 7/8/04, revised
Title 8/9/04
Title Date
Title Date
2. Date Request Filed:
7/23/04
B. Determination
Pursuant to the authority of M.G.L. c. 131, §40, the Conservation Commission considered your
Request for Determination of Applicability,with its supporting documentation, and made the following
Determination.
Project Description (if applicable):
The installation of a septic tank, loose boulder retaining wall and grading associated with a
subsurface sewage disposal system in the Buffer Zone of a bordering vegetated wetland.
Project Location:
1580 SAlem Street North Andover
Street Address City/Town
Map 106B Parcel 56
Assessors Map/Plat Number Parcel/Lot Number
wpaform2.doc•rev.12/15/00 Page 1 of 5
L1Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
1 WPA Form 2 — Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Determination (cont.)
The following Determination(s) is/are applicable to the proposed site and/or project relative to the
Wetlands Protection Act and regulations:
Positive Determination
Note: No work within the jurisdiction of the Wetlands Protection Act may proceed until a final Order of
Conditions (issued following submittal of a Notice of Intent or Abbreviated Notice of Intent) has been
received from the issuing authority (i.e., Conservation Commission or the Department of
Environmental Protection).
❑ 1. The area described on the referenced plan(s) is an area subject to protection under the Act.
Removing, filling, dredging, or altering of the area requires the filing of a Notice of Intent.
❑ 2a. The boundary delineations of the following resource areas described on the referenced
plan(s) are confirmed as accurate. Therefore, the resource area boundaries confirmed in this
Determination are binding as to all decisions rendered pursuant to the Wetlands Protection Act and its
regulations regarding such boundaries for as long as this Determination is valid.
❑ 2b. The boundaries of resource areas listed below are not confirmed by this Determination,
regardless of whether such boundaries are contained on the plans attached to this Determination or
to the Request for Determination.
❑ 3. The work described on referenced plan(s) and document(s) is within an area subject to
protection under the Act and will remove, fill, dredge, or alter that area. Therefore, said work
requires the filing of a Notice of Intent.
❑ 4. The work described on referenced plan(s)and document(s) is within the Buffer Zone and will
alter an Area subject to protection under the Act. Therefore, said work requires the filing of a
Notice of Intent.
❑ 5. The area and/or work described on referenced plan(s) and document(s) is subject to review
and approval by:
Name of Municipality
Pursuant to the following municipal wetland ordinance or bylaw:
Name Ordinance or Bylaw Citation
wpaform2.doc•rev.12/15/00 Page 2 of 5
L1Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
1 WPA Form 2 — Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Determination (cont.)
❑ 6. The following area and/or work, if any, is subject to a municipal ordinance or bylaw but not
subject to the Massachusetts Wetlands Protection Act:
❑ 7. If a Notice of Intent is filed for the work in the Riverfront Area described on referenced plan(s)
and document(s), which includes all or part of the work described in the Request, the applicant
must consider the following alternatives. (Refer to the wetland regulations at 10.58(4)c. for more
information about the scope of alternatives requirements):
❑ Alternatives limited to the lot on which the project is located.
❑ Alternatives limited to the lot on which the project is located, the subdivided lots, and any
adjacent lots formerly or presently owned by the same owner.
❑ Alternatives limited to the original parcel on which the project is located, the subdivided
parcels, any adjacent parcels, and any other land which can reasonably be obtained within
the municipality.
❑ Alternatives extend to any sites which can reasonably be obtained within the appropriate
region of the state.
Negative Determination
Note: No further action under the Wetlands Protection Act is required by the applicant. However, if the
Department is requested to issue a Superseding Determination of Applicability, work may not proceed
on this project unless the Department fails to act on such request within 35 days of the date the
request is post-marked for certified mail or hand delivered to the Department. Work may then proceed
at the owner's risk only upon notice to the Department and to the Conservation Commission.
Requirements for requests for Superseding Determinations are listed at the end of this document.
❑ 1. The area described in the Request is not an area subject to protection under the Act or the
Buffer Zone.
❑ .2. The work described in the Request is within an area subject to protection under the Act, but will
not remove, fill, dredge, or alter that area. Therefore, said work does not require the filing of a
Notice of Intent.
® 3. The work described in the Request is within the Buffer Zone, as defined in the regulations, but
will not alter an Area subject to protection under the Act. Therefore, said work does not require
the filing of a Notice of Intent, subject to the following conditions (if any).
See attached condition
❑ 4. The work described in the Request is not within an Area subject to protection under the Act
(including the Buffer Zone). Therefore, said work does not require the filing of a Notice of Intent,
unless and until said work alters an Area subject to protection under the Act.
wpaf orm2.doc•rev.12115/00 Page 3 of 5
Negative Determination of Applicability
1580 Salem Street
Conservation Conditions
Record Documentation: Request for Determination of Applicability, received date
7/23/04; Plan entitled "Proposed Subsurface Sewage Disposal System", prepared for
George & Marjorie Sears, dated July 8, 2004, Revised 8/9/04 prepared by New England
Engineering Services, Inc., stamped &signed by Benjamin C. Osgood, Jr., P.E.
Pre-construction Conditions
• Prior to the commencement of work the applicant shall install erosion controls in
the locations depicted on the above referenced approved site plan. Said erosion
controls shall be installed in accordance with the approved erosion control detail
and app y roved b the Conservation Administrator.
• Prior to the commencement of work, the yard waste debris pile of grass clippings
and leaves between wetland flags A4 and A-5 shall be removed by hand to a
location outside of the 25' No-Disturbance Zone.
• Prior to the commencement of work, permanent wetland markers shall be
installed along the 25' No-Disturbance Zone, or along the limit of disturbance in
those locations were the 25' No-Disturbance Zone is not being maintained, every
25 feet. These markers can be purchased at the Conservation Department for$2
each.
• Immediately following completion of the above, the applicant shall contact the
Conservation Department, at least 72 hours in advance, to schedule an on-site
pre-construction meeting.
Post Construction Conditions
• Upon completion of substantial germination of the disturbed areas, the applicant
shall contact the Conservation Department for a post-construction inspection to
i stabilization.
ensure completed s to stab ation.
• Upon completion of work, the applicant shall submit 2 copies of the As-built
Plan to the Conservation Department.
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L1Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
1 WPA Form 2 — Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Determination (cont.)
❑ 5. The area described in the Request is subject to protection under the Act. Since the work
described therein meets the requirements for the following exemption, as specified in the Act and
the regulations, no Notice of Intent is required:
Exempt Activity(site applicable statuatory/regulatory provisions)
❑ 6. The area and/or work described in the Request is not subject to review and approval by:
Name of Municipality
Pursuant to a municipal wetlands ordinance or bylaw.
Name Ordinance or Bylaw Citation
C. Authorization
This Determination is issued to the applicant and delivered as follows:
j ❑ by hand delivery on [Jf by certified mail, return receipt requested on
9 OLI
Date Date
This Determination is valid for three years from the date of issuance (except Determinations for
Vegetation Management Plans which are valid for the duration of the Plan). This Determination does not
relieve the applicant from complying with all other applicable federal, state, or local statutes, ordinances,
bylaws, or regulations.
This Determination must be signed by a majority of the Conservation Com ' on must be sent
to the propriate DEP Regional Offi ( ee Appendix A)and the prop ow di rent from the
applic t). Signatur s*
Date
wpaform2.doc•rev.12/15/00 Page 4 of 5
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 2 — Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
D. Appeals
The applicant, owner, any person aggrieved by this Determination, 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 their right to request the appropriate Department of Environmental
Protection Regional Office(see Appendix A)to issue a Superseding Determination of Applicability. The
request must be made by certified mail or hand delivery to the Department, with the appropriate filing fee
and Fee Transmittal Form (see Appendix E: Request for Departmental Action Fee Transmittal Form) as
provided in 310 CMR 10.03(7)within ten business days from the date of issuance of this Determination. 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. The request shall state clearly and
concisely the objections to the Determination which is being appealed. To the extent that the
Determination is based on a municipal ordinance or bylaw and not on the Massachusetts Wetlands
Protection Act or regulations, the Department of Environmental Protection has no appellate jurisdiction.
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Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
WPA Appendix A — DEP Regional Addresses
Mail transmittal forms and DEP payments,payable to:
Commonwealth of Massachusetts
Department of Environmental Protection
Box 4062
Boston, MA 02211
DEP Western Region Adams Colrain Hampden Monroe Pittsfield Tyringham
436 Dwight Street Agawam Conway Hancock Montague Plainfield Wales
g Alford Cumminglon Hatfield Monterey Richmond Ware
Suite 402 Amherst Dalton Hawley Montgomery Rowe Warwick
Springfield,MA 01103 Ashfield Deerfield Heath Monson Russell Washington
Phone:413-784-1100 Becket Easthampton Hinsdale Mount Washington Sandisfield Wendell
Belchertown East Longmeadow Holland New Ashford Savoy Westfield
Fax:413-784-1149 Bernardston Egremont Holyoke New Marlborough Sheffield Westhampton
Blandford Erving Huntington New Salem Shelburne West Springfield
Brimfield Florida Lanesborough North Adams Shulesbury West Stockbridge
Buckland Gill Lee Northampton Southampton Whately
Charlemont Goshen Lenox Northfield South Hadley Wilbraham
Cheshire Granby Leverett Orange Southwick Williamsburg
Chester Granville Leyden Otis Springfield Williamstown
Chesterfield Great Barrington Longmeadow Palmer Stockbridge Windsor
Chicopee Greenfield Ludlow Pelham Sunderland Worthington
Clarksburg Hadley Middlefield Peru Tolland
DEP Central Region
Acton Charlton Hopkinton Millbury Rutland Uxbridge
627 Main Street Ashburnham Clinton Hubbardston Millville Shirley Warren
Ashby Douglas Hudson New Braintree Shrewsbury Webster
Worcester,MA 01605 Athol Dudley Holliston Northborough Southborough Westborough
Phone:508-792-7650 Auburn Dunstable Lancater Northbridge Southbridge West Boylston
Fax:508-792-7621 Ayer East Brookfield Leicester North Brookfield Spencer West Brookfield
Barre Fitchburg Leominster Oakham Sterling Westford
TDD:508-767-2788 Bellingham Gardner Littleton Oxford Stow Westminster
Berlin Grafton Lunenburg Paxton Sturbridge Winchendon
Blackstone Groton Marlborough Pepperell Sutton Worcester
Bolton - Harvard Maynard Petersham Templeton
Boxborough Hardwick Medway Phillipston Townsend
Boylston Holden Mendon Princeton Tyngsborough
Brookfield Hopedale Milford Royalston Upton
DEP Southeast Region Abington Dartmouth Freetown Mattapoisett Provincetown Tisbury
20 Riverside Drive Acushnet Dennis Gay Head Middleborough Raynham Truro
Attleboro Dighton Gosnold Nantucket Rehoboth Wareham
Lakeville, MA 02347 Avon Duxbury Halifax NewBedford Rochester Wellfleet
Phone:508-946-2700 Barnstable Eastham Hanover North Attleborough Rockland West Bridgewater
Fax:508-947-6557 Berkley East Bridgewater Hanson Norton Sandwich Westport
Bourne Easton Harwich Norwell Scituate West Tisbury
TDD:508-946-2795 Brewster Edgartown Kingston Oak Bluffs Seekonk Whitman
Bridgewater Fairhaven Lakeville Orleans Sharon Wrentham
Brockton Fall River Mansfield Pembroke Somerset Yarmouth
Carver Falmouth Marion Plainville Stoughton
Chatham Foxborough Marshfield Plymouth Swansea
Chilmark Franklin Mashpee Plympton Taunton
DEP Northeast Region Amesbury Chelmsford Hingham Merrimac Quincy Wakefield
205 Lowell Street Andover Chelsea Holbrook Methuen Randolph Walpole
Arlington Cohasset Hull Middleton Reading Waltham
Wilmington,MA 01887 Ashland Concord Ipswich Millis Revere Watertown
Phone:978-661-7600 Bedford Danvers Lawrence Milton Rockport Wayland
Fax: 978-661-7615 Belmont Dedham Lexington Nahanl Rowley Wellesley
Beverly Dover Lincoln Natick Salem Wenham
TDD:978-661-7679 Billerica Dracut Lowell Needham Salisbury West Newbury
Boston Essex Lynn Newbury Saugus Weston
Boxford Everett Lynnfield Newburyport Sherborn Westwood
Braintree Framingham Malden Newton Somerville Weymouth
Brookline Georgetown Manchester-By-The-Sea Norfolk Stoneham Wilmington
Burlington Gloucester Marblehead North Andover Sudbury Winchester
Cambridge Groveland Medfield North Reading Swampscott Winthrop
Canton Hamilton Medford Norwood Tewksbury Woburn
Carlisle Haverhill Melrose Peabody Topsfield
Wpaform2.doc•Appendix A•rev.11/22/00 Page 1 o 1
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Appendix E — Request for Departmental Action Fee Transmittal Form
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
A. Request Information
Important:
When filling out 1. Person or party making request(if appropriate, name the citizen group's representative):
forms on the
computer, use Name
only the tab
key to move
your cursor- Mailing Address
do not use the
return key. City/Town State Zip Code
Phone Number Fax Number(if applicable)
Project Location
Mailing Address
Cityrrown State Zip Code
2. Applicant(as shown on Notice of Intent(Form 3), Abbreviated Notice of Resource Area Delineation
(Form 4A); or Request for Determination of Applicability (Form 1)):
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Name
Mailing Address
City/Town State Zip Code
Phone Number Fax Number(if applicable)
3. DEP File Number:
B. Instructions
1. When the Departmental action request is for(check one):
❑ Superseding Order of Conditions
❑ Superseding Determination of Applicability
❑
Superseding Order of Resource Area Delineation p 9
Send this form and check or money order for$50.00, payable to the Commonwealth of Massachusetts to:
Department of Environmental Protection
Box 4062
Boston, MA 02211
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L1Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
1 WPA Appendix E — Request for Departmental Action Fee Transmittal Form
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Instructions (cont.)
2. On a separate sheet attached to this form, state clearly and concisely the objections to the
Determination or Order which is being appealed. To the extent that the Determination or Order is
based on a municipal bylaw, and not on the Massachusetts Wetlands Protection Act or regulations,
the Department has no appellate jurisdiction.
3. Send a co of this form and a co of the check or money order with the Request for a Superseding
t'Y NY Y � N g
Determination or Order by certified mail or hand delivery to the appropriate DEP Regional Office(see
Appendix A).
4. 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.
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