Site Inspection O s t: 2artmo t� ���� i i?
_. ¢s= 400 Slocum Road • P. O. Box 793 A 20 n(
.N' l666' � Y
DartmofH,•Massachusetts 02747-09
F.to k.,
CONSERVATION COMM SS1ci.1 •t A l `-' 9: 4 :f =1�3 � ,
. ,, . , r,''.., -0722
A-1 Site Inspection Form L : (508)999-0797
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Name of Person Making Request Date
3o s- mil( N/us �o/P ea gin (_0 7- .e b e t ra y LN -
Mailing Address Street Location Of Property To Be Viewed
b4rt o07L A44- o 27 7 �t � M*79 L(9 -/ /
City/Town, State Zip Code Dartmouth Assessors Map and Lot Number
S)Y 9 / 2373 Moose
Telephone - Day Proposed Use of Land (house, addition, garage, etc.)
Telephone - Evening Signature of Person Making Re ucst
A-vDA (( vt-t .P .De I leaS Filw) A-C( /yi , .-e c a--C
Name of Owner of Site To Be Viewed Print Name
SD Ce U7p.--s Co I Ai-e/ 7Z . 7 z--_
Owner's address Signature of Owner of Site to be Viewed
/19'/V1J (( /4-e /col
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 filing forms are available in the Conservation Commission office,room 107 at the Dartmouth Town Hall,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 the 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-I site inspection form. The Conservation Inspector will then
review the flagging in the field and make adjustments where necessary. Thc Conservation Conunission may require proof of the
qualifications of the person performing the delineation.
Note: The A-1 Site Itspeeuon is a procedure outlined in the Dartmouth Wetlands Protection Bylaw.It is a service available for the
purpose of idwuil}ing 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 ti40) or the I
Darunouth 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 andlor their jurisdictional status under these Laws.
"The completion of this Site hispection is not an auihonzation to proceed with work.This site inspection expires three i 3)years from
the dale tit issuaiiee.
CONSERVATION COMMISSION INSPECTOR COMMENTS AND RECOMMENDATIONS t
❑ No wetlands or other areas subject to the jurisdiction of the Conservation Commission exist on site or
within 100-feet of site. No other filing with the Conservation Commission required.
CI The proposed work is not located in or within 100-feet of a wetland resource 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 ( North, South, East, West ) of site. Please refer to drawing (if provided by
inspector) for location infoilkiatibitlkAlllotittibns on sketch provided by inspector are approximate.
11,41
❑ Edge of wetland has been marked on site by Inspector. Flag numbers:
DCC wet Through DCC wet
Additional wetlands marked:
DCC wet Through DCC wet ; DCC wet Through DCC wet
DCC wet Through DCC wet ; DCC wet Through DCC 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.
45' A Request for Determination should be filed with the Conservation Commission before any work
begins on site. c-c. Cvc,�� �,fG, i��. — v� ,„E(-6,s
❑ A Notice of Intent should 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 Conservation Commission office for review and approval.
❑ 100-year floodplain may be present on site. Engineer or Dartmouth Building Department must
determine if proposed work is located within floodplain. If work is located in floodplain then a further
filing with Conservation Commission 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 adequately describe the wetlands on site, the applicant must obtain the services of a
private consultant to perform a wetland delineation. The delineation must be submitted to the
/ Conservation Commission office for review and approval.
Li Other Comments:
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Date of Issuance ichael O' el
Environmental Affairs Coordinator
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