Site Inspection r I
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400 Slocum Road • P.Q..Box '1 + ,4%1
North Dartmouth, Massachi*etts 2747
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CONSERVATION COMMISSION A-1 SITE I NSPECTIONF• ,, r){Of 15081 999-0722
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Name of Person Making Request ate
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Lathe
Address of Applicant S reet Loc tion of
Property
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City\Town, State, Ztp Plat and Lot Number
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Telephone (Day :k Evening ) Proposed Use of Land
(Dwelling, Ad ition etc . )
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Owner Name Signature of Over or
Owners RepresPn ative
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Address Signatur�(f 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 . Use 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 .
CONSERVATION COMMISSION INSPECTOR COMMENTS AND RECOMMENDATIONS
_ Activity described in this A-1 site inspection is in an area
subject to the protection of the Mass. Wetlands Protection Act
(CMR Ch. 131 S . 40 ) and the Dartmouth Wetlands Protection By-Law.
A Notice of Intent must be filed with the Dartmouth Conservation
Commission before activity\work begins .
Activity described is within the 100 foot buffer zone to an area
subject to protection and will likely effect that area. A
Notice of Intent should be filed before activtiy\work begins .
Activity described is within the 100 foot buffer zone to an area
subject to protection. A Request for Determination of_
Applicability of the Act and the Dartmouth Wetlands Protection
By-Law must be filed with the Conservation Commission before
activity\work begins . '
C4lNo wetlands or other areas subject to the protection of the
Wetlands Protection Act or the Dartmouth Wetlands Protection
By-Law exist on site or within 100 feet of site. No forms need
to be filed with the Conservation Commission.
Other Comments : O
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NOTE: The A-1 Site Inspection is intended to inform the applicant of
the proper procedures which need to be followed in order to comply
with the Dartmouth Wetlands Protection By-Law and the Mass . Wetlands
Protection Act (CMR Ch . 131 S . 40 ) . It is not a final determination
under the Act. THIS INSPECTION EXPIRES THREE ( 3 ) YEARS FROM THE DATE
OF ISSUANCE ( SHOWN BELOW) .
All forms referred to are available in the Conservation Commission
Office, Room 107, Dartmouth Town Hall, 400 Slocum Rd. Office hours
are from 9AM - 4PM Monday through Friday.
Site Inspection Fees :
1-5 acres $50 . 00; 5-10 acres $75 . 00; 10 acres and above &200 .00 .
Conservation inspector will flag wetland edge for sites from 1-5
acres only. Sites over 5 acres must be flagged by a wetland
scientist, botanist or other qualified person prior to submitting
the site inspection. The Conservation Inspector will then verify
the wetland flagging existing in the field and make any
adjustments necessary.
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Date of Issuance Dartmouth Conservat '
Inspector
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For .....snot' Nunn. JAMES W. SE
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