Site Inspection � , }Airks. 400 Slocum Road • P.O. Box79399 11 !
North Dartmouth, Massachusetts 02747 JAN I 3 :O^+
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CONSFNO. C MON
:ONSERVATION COMMISSION A—J. SITE INSPECTION FORM c5081999.0722
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Name of Person Making Request . Date
/7V .'ni seh 51- S;hle „is/4.Kd I4.he
Address of Applicant StreetLocation of
Property
City\Town, state, Zip Plat and Lot Number
67 yS9a3 Dwel/ in q
Telephone ( Day & Evening ) Proposed Use &f Land
( Dwelling, Addition etc . )
SSP s �;:fl y 3 k
Owner Name Signature of Owner or
,�C Owners prrJesentt ive
Address �gh�ks�/ /�/=—`
ignature of Applicant
LOCATION OF PROPERTY : Please attach a site plan . If a site plan
is not available, a hand drawn map showing the exact
location and size of property to be inspected is acceptable .
The map shall include the following information : street
name, house number on abutting lots, property bound
locations , and any natural or man-made features which will
allow the inspector to find the site . Tice the space
provided below to draw a map or attach an extra sheet .
Property boundaries should be clearly marked in the field
prior to requesting site inspection .
i
.. . . •L•3Yl\10 AUY nrc;UMMLNUAT ONS 'Y
_ Wetlands exist on (North, South, East, West) of site.
_ Edge of wetland has been marked on site by Inspector. Flag numbers -
kV/Any activity (clearing, digging, removal of vegetation, etc. ) in a wetland
or within 100 feet of a wetland requires a permit from the Conservation
Commission. • No work shell begin until permit is received.
_ A Notice of Intent should be filed with the Conservation commission before any
work begins on site.
_ A Request for Determination should be filed with the Conservation Commission
before any work begins on site.
_ No wetlands or other areas subject to the jurisdiction of the conservation
Commission exist on site or within 100 feet of site. No forms need to be
filed with the Conservation Commission.
_ A survey plan of the wetland delineation should be, submi.tted to the
Conservation Commission office.
✓other Comments:: 5 ( ( i r�GdJ F or Ij d_ e�' �j/��
o n S� f� 4�. S R� c�1.+� 6 �c l G (lc/ ( r
Note: The A-1 Site Inspection is a procedure outlined in the Dartmouth Wetlands
Protection Bylaw. It is a service available for the purpose of identifying
wetland areas on a site. The issuance of this completed site Inspection is NOT
a final determination of wetland boundaries or their jurisdictional status under
the Massachusetts Wetlands Protection Act (MGL Ch. 131 S40) or the Dartmouth
Wetlands Protection Bylaw. only the issuance of a Determination of Applicability
or order of Conditions by the Conservation commission finalizes the determination
of wetland boundaries and\or their jurisdictional status under these Laws. The
completion of this Site Inspection is not an authorization to proceed with work.
This
Thisw)ite inspection expires three (3) years from the date of issuance (shown
All filing forms are available in the Conservation Commission office, room 107
at the Dartmouth Town Hall, 400 Slocum Rd. from 9AM - 4PM Mondays and 8:45AM -
4:30PM Tuesday through Friday.
Site InspectionDFees.:
1-5 Acres $50.00; 5-10 Acres $75.00; 10-100 Acres $200.00;
Above 100 acres $400.00
•
The conservation Inspector will flag the wetland edge for sites from 1-5 acres
only. The conservation commission reserves the right to refuse to perform a site
inspection on areas less than 5 acres where abnormal site conditions would
require an excessive amount of time be spent by the conservation Inspector in
making a determination of the wetland areas present. sites over 5 acres must
be flagged by a wetland scientist, botanist or other qualified person prior to
submitting of site inspection. The conservation Inspector will then review the
flagging in the field and make adjustments where necessary. The Conservation
commission may require proof of the qualifications of the person performing the
delineation on sites larger than 5 acres.
s7
Date of Issuance
co servation officer
(Rev. 9-1-94 MJO1
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