Site Inspection l
• it=:__,ik 5own, O2artmoug :IV i
jut. 5 2000 ►s-
,. rf- 400 Slocum Road • R O. Box 79399
� Dartmouth, Massachusetts 02747-0985
CONSERVATION COMMISSION coNS.F Rej1 'L + ''�;:uPl
(508)999-0722
A-1 Site Inspection Form FAX: (508)999-0797
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of Person Making Req st Date
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Mailing Address
Street Location Of Property To Be Viewed
/(/di>1- .hal'6/76//1 g
City/Town, State D Zip Co e Dartmouth Assessors Map and Lot N fiber
. (r. iP"5-z091'7
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Telephone-Day Proposed Use of Lund use, addition,garage, etc.)
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. Telephone-Evening Signature f Person Making Request
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Name of Owner of Site To Be Viewed Print Name
Owner's address Signature of Owner of Site to be Viewed
Print Name
Site Inspection Fees:
1-5 Acres $50.00; 5-10 Acres $75.00; 10-100 Acres $200.00; Above 100 acres $400.00
All tiling forms arc available in the Conservation Conunission office,room 107 at the Dartmouth Town I Lill,400 Slocum Rd.from
9AM-4PM Monday and 8:45AM-4:30PM Tuesday through Friday.
For parcels from I to 5 acres only,the Conservation Inspector is available to flag the wetland edge. However it is thne Applicant's
option to acquire the services of a private consultant to delineate the wetlands on a parcel of that size. The Inspector has the right
to require the Applicant to obtain the services of a private consultant to perform a wetland delineation on areas less than 5 acres
where abnormal site conditions or extensive use of soils evaluation 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 the A-1 site inspection form. Thc 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.
Note:The A-I Site Inspection is a procedure outlined in the Dartmouth Wetlands Protection l3ylaw. 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(MGI. Ch. 131 ;-Jtl)or the
Dartmouth Wetlands Protection Bylaw. Only the issuarnx of a Determination of Applicability or Order of Conditions bs. the
Conservation Commission finalizes the determination of wetland boundaries andkx their jurisdictional status under these Lass s
The completion of this Site Inspection is not an authorization to proceed with work This site inspection expires three i 3 i sears ruin
the date of issuance.
CONSERVATION COMMISSION INSPECTOR COMMENTS AND RECOMMENDATIONS
No wetlands or other areas subject to the jurisdiction of the Conservation Commission exist on site or within 100 fee, •
of site. No other filing with the Conservation Commission required t•
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The proposed work is not located within 100-feet of a wetland area. Other wetlands may exist on site. Any further
work to be located outside of inspected area requires the filing of an additional A-1.
Wetlands exist on( No . Sout R, ast, West )of site.Please refer to drawing(if provided by inspector)for location
information. All locations on sketch provided by inspector are approximate.
747 Edge of wetland has been marked on site by Inspector. Flag numbers:
/
(� Wet / Through ( 7 4 J ll J t
1 ' %/01
Additional wetlands marked
wet Through wet : wet Through wet
wet Through wet : wet Through wet
Wetland delineated using: � Vegetation only Soils and vegetation
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 shall begin until permit is received. This completed form
is not a permit.
A Requsst for Determination should be filed with the Conservation Commission before any work begins on site.
A Notice of Intent shorp d be filed with the Conservation Commission before any work begins on site.
Coastal Bank exists on site. Engineer must delineate Coastal Bank per DEP Wetland Program Policy 92-1.
Delineation must be submitted to the Conscr•auc,►C; ._,ussion office for •view and approval.
100-year flood plain may be present on site. Engineer or Dartmouth Building Department must determine if proposed
work is located within flood plain. If work is locat._j in f ,od plain then a further filing with Conservation Conunission
is required.
A survey plan of the wetland delineation should be submitted to the Conservation Commission office.
Due to abnormal site conditions and/or the necessity of gathering an extensive amount of soils information to
adequatcl describe the wetlands on site the applicant must obtain the services of a private consultant to perform a
wetland delineauon. The delineation must be submitted to the Conservation Commission for review and approval.
Other Co emus: gl+
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4er, 419 -(01 67'') 11 ZVOI f5-1
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Date o �
Issuance Michael O'Reilly
Environmental Affairs Coordinator
izabeth H Leidhold
R _ Conservation Officer
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