Wetland Site Inspection „v,, �y,:: -v ^ siwrz o .:
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Dartmou ssachusetts 02747-09
CONSERVATION COMMISSION ,..1 1 rI;'�� 4 U ' (508)910-1822
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Wetland Site Inspection (Form A-1k 0 '; --�- ' ;;ttp: v.w .mwn.dartmoutit.ma.us
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Randall Medeiros n 3
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Name of Person Making Request t.; , 1`". Date
i',JiJ
822 State Road .'' ' ed iros Lane
Mailing Address
u"N Street Location Of Property To Be Viewed
Dartmouth, MA 02747 Y Ot`tril �t014 `�";�
,�i d�+ p 79 — Lot 6-12
City/Town, State Zip Code Dartmouth Assessors Map and Lot Number
508-264-2212 House Construction
Telephone-Day Reason for Inspection:
508-264-2212
h ,a 'tic ,sept'_ sys r ai etc.)
Telephone-Evening Signature of Person M ' Request_,.
r
Randall Medeiros Randall Medeiros
Name of Owner of Site To Be Viewed We n.:_..r__..
822 State Road
Owner's address Signaof Owner of Site to be Viewed
(if not Applicant)
Dartmouth, MA 02747
City/Town, State Zip Code Print Name
If person making request is NOT the owner;the-person is:
❑Real Estate Broker 0 Engineer 0 Contractor 0 Consultant 0 Real Estate Appraiser 0 Other(explain)
All filing forms are available in the Conservation Conmmissian.ofl'lce,room 107 at the Dartmouth Town Hall,400 Slocum Rd from 9AM-4PM Monday and
9:00AM-4:30PM Tuesday through Friday.
For parcels twin 1 t0 5 aces only,the Conservation-Inspector isavailable 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 ertbrma wetland&lineatinn on areas ri-q than S acreswhere abnormal site conditions or.evtonsive use of soils evaluation would require an
excessive amount ottiiYne be spent by the Conservation Inspector in making a determination ofthe wetland areas present. Sites over 5 acres must be flagged by a
wetlandseien st;botanist or other qualifed Berson-Brier to.submjingthe A-1 site inspection-form The-Conservation-Inspector will then review the-flagging in
the field and make adjustments where nrrnecsry. The Conservation Commission may require proof of the qualifications ofthe person performing the delineation.
Note:The A-/Site Inspection is a procedure_matinenin the TYarimouth Wetlands Protection Bylaw..Lisa service available for the purpose of identifying wetland
areas on_a site. The issuance ofthis completed Site Inspection is NOT a fmal determination of wetland boundaries or their jurisdictional status under the
Massachu efts Wetlands Protection Act(MGL at:1-3-1-j40)ofthe Dartmouth-Wetlands-Protection Bylaw: Only-the-issuance of a Determination of
Applicability,Order of Resource Area Delineation or Order of Conditions by the Conservation Commission finalizes the determination of wetland boundaries
anchor their jurisdictional status under these taw/ The completion_of this Site Inspection is notan_amtho ization to proceed with work.This site inspection
. expires three(3)years-from the date of issuance.
FILING FEES:
$50.00 Improvement to existing,non-conunerrial-ctn,r tare jsepticrepair,addition,in-ground pool,garage,barn,etc.) Inspection limited to within
250 feet of existing structure(s),area to be inspected must be clearly marked on a site plan submitted with the application and area to be
inspected must be easily identifiable the-in-the field-(staked-;flagged,etc.)
$100.00 Up to 2 acres-wetland inspection with or without wetland delineation,or verification of wetland delineation by applicants consultant)
(residential,no sub rvision of land no evicting tnrcpge),
$200.00 Up to 2 acres-wetland inspection with or without wetland delineation,or verification of wetland delineation by applicants
oonsultant(commercial;orreal-estate subdivision)
$250.00 2-5 acres-wetland inspection with or without wetland delineation,or verification of wetland delineation by applicants consultant
$400.00 5-10 acres-verification ofwetland fietineation_by.apptimntc consultant
$800.00 10-20 acres-verification of wetland delineation by applicants consultant
$1200.00 20-100.acres—verification e€wetlanddelineatier-by applicants-consultant
$2500.00 above_10a acres-ve ifiCation.ofwetland delineation by applicants consultant
❑ 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.
❑ 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.
a
❑ Wetlands exist on( North, South, East, West )of site.Please refer to drawing(if provided by inspector)for location
information. All locations on sketch-provided by inspector are-approximate.
❑ Edge of wetland has been marked on site by Inspector. Flag numbers:
wet Through wet
Additional wetlands marked
wet Through wet wet Through wet
❑ A Request for Determination(permit application)should be filed with the Conservation Commission before any work
begins on site.
❑ A Notice of Intent(permit application)-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.
❑ Riverfront Area may exist on site. If work is located in Riverfront Area then a further filing with Conservation
Commission is required before any work begins on site.
❑ 100 year flood plain may be present-on site. Engineer and/or Dartmouth Building Department must determine if
proposed work is located within flood plain. If work is located in flood plain then a further filing with Conservation
Commission is required-before-any work begins-on site.
❑ Asurvey 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. Thedelin-at-- i -',be_submitted-.to-the-Consewaation Commission for review and approval.
® Other Comments: Any hand-drawn cl w++ on-the.atiached.plan-by the.Conservation Inspector is not to scale. To
determine the actual extent of the wetlands on the site it is recommended-that the applicant/owner have the flag line
surveyed onto a plan,
IMPORTANT: Any activity(clearing,digging,removal ofvegetation,etc.)in a wetland Resource Area(as noted by
inspector on this form)or within 100 feet of a wetland requires a permit from the Conservation Commission pursuant
to Massachusetts Wetlands ProtecdonAct(MOI1_Ch/Irsection.40)and/or the Dartmouth Wetlands Protection Bylaw.
No work shall beetin until permit is received. This completed/ form is not a permit. ,y�
1 art C��-J JET� Y lC S ��`t l/�-1( ,
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Date of Issuance Michael O'Reilly
Environmental Affairs Coordinator
(Revised 05/06/03 MJ0)
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400 Slocum Road • P.O. Box 79399
f6,, Dartmoutlj ssliaIL fltts_ 02747-0985 _
CONSERVATION COMMISSION 1 n i i5 - (508)910-1822
J
a 1 hi•• FAX:(508)910-1897
Wetland Site Inspection (Form A- AUG 16 n0135 !i/y,
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Randall Medei cos —`;T:'.------ -- August 15, 2005
Name of Person Making Request *n Date
822 State Road Medeiros Lane
Mailing Address Street Location Of Property To Be Viewed
Dartmouth, MA 02747 Map 79 — Lot 6-18 & Map 81 — Lot 2-5
City/Town, State Zip Code Dartmouth Assessors Map and Lot Number
508-264-2212 Residential
Telephone-Day Reason for Inspection:
(ho ad ' ' n, tic stem reps' etc.)
508-264-2212
Telephone-Evening 6.-- Si e of Person ' g.B.egtt
Randall Medeiros & Timothy Medeiros Randall Medeiros
Name of Owner of Site To Be Viewed Print Name
822 State Road 360 Faunce Corner Road sy1
Owner's address Si�of Ownerf Site o bey Viewed
(if not Applicant)
Dartmouth, MA 02747 Timothy Medeiros
City/Town, State Zip Code Print Name
If person m ;tlg request is NOT the owner,the-person is:
❑Real Estate'Broker 0 Engineer 0 Contractor 0 Consultant 0 Real Estate Appraiser 0 Other(explain)
All filing forms are available in the Conservation Commission ofce,room 107 at the Dartmouth Town Hall,400 Slocum Rd from 9AM-4PM Monday and
9:00AM-4:30PM Tuesday through Friday.
For parcels from 1 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
mncrrrtant rnperfiorm.a wetland delineation on at-one rice than.5-acres-where abnormal site conditions or.extensive use of soils evaluation would require an
excessive amount oftime 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,be sat-or sshfled.perSenpssoc4o.submlttingtheA4 site inspection-form: The-Conservation-Inspector will then review the-flagging in
the field and make adjustments where ne.v-scary. The Conservation Commission may require proof of the qualifications of the person performing the delineation.
Note:The A I Site Inspection is a procedure outtin'd in trip rtarimnnth Wetlands Protection Bytaw..It isa 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
Massachocerts Wetlands Protection Aet(MOl Ch 1-31-j40}erthe Darireeutlr WetlandrProtectien Bylaw: Only-the issuance of a Determination of
Applicability,Order of Resource Area Delineation or Order of Conditions by the Conservation Commission fmalizes the determination of wetland boundaries
and lor their jurisdictional status under these,tawe T7,.mmpl inn-of this Site Inspection is not an.anthori7ationto.proceed with work.This site inspection
expires three(3)years from the date of issuance.
FILING FEES:
$50.00 Improvement to existing,non {septic repair,addition,in-ground pool,garage,barn,etc.) Inspection limited to within
250 feet of existing structure(s),area to be inspected must be clearly marked on a site plan submitted with the application and area to be
inspected must be easily identifiable the-inthetield-(staked;flagged,e.c.)
$100.00 Up to 2 acres-wetland inspection with or without wetland delineation,or verification of wetland delineation by applicants consultant)
(residential,no suhdivicinn of land nn ex:dt in�etmctr re)
$200.00 Up to 2 acres-wetland inspection with or without wetland delineation,or verification of wetland delineation by applicants
consultant(commercial,or-real-estate subdivision)
$250.00 2-5 acres-wetland inspection with or without wetland delineation,or verification of wetland delineation by applicants consultant
$400.00 5-10 acres-verification ofwetland dPlineation.by.applirnntq consultant
$800.00 10-20 acres-verification of wetland delineation by applicants consultant
$1200.00 20-100 acres—verification--of wetland-delineation-by applicants-consultant
$2500.00 above.If/O acres-verification ofwetland delineation by applicants consultant
.:.,..0.--.,.:.st.caatvt. arr.l.1VIil.V1V11VIE1V1 R1y1) KrA.V1VIMI 1VllA11UM.
❑ 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.
❑ 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( North, South, East, West )of site.Please refer to drawing(if provided by inspector)for location
information. All locations-on sketch-provided by inspector are approximate.
❑ Edge of wetland has been marked on site by Inspector. Flag numbers:
wet Through wet
Additional wetlands marked
wet Through wet ; wet Through wet
❑ A Request for Determination(permit application)should be filed with the Conservation Commission before any work
begins on site.
❑ A Notice of Intent(permit application)-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.
❑ Riverfront Area may exist on site. If work is located in Riverfront Area then a further filing with Conservation
Commission is required before any work begins on site.
❑ 100 year flood plain may be present-on-site. Engineer and/or Dartmouth Building Department must determine if
proposed work is located within flood plain. If work is located in flood plain then a further filing with Conservation
Commission is required-before—any work
begins.on site,
❑ Asurvey 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. Thedeliaeation .be_su ted.to the-Conservation Commission for review and approval.
Other Comments: Any hand-drawn.sketch on the-attached-plan by the.Conservation Inspector is not to scale. To
determine the actual extent of the wetlands on the site it is recommended the applicant/owner have the flag line
surveyed onto a plan,
IMPORTANT: Any activity(clearing,digging,removal ofvegetation,etc.)in a wetland Resource Area(as noted by
inspector on this form)or within 100 feet of a wetland requires a permit from the Conservation Commission pursuant
to Massachusetts Wetlands Protection-Act(MUL Ch-I3tsection40)and/or the Dartmouth Wetlands Protection Bylaw.
No work shall begin until permit is received. This completed form is not a permit.
el-knt dr /I eq",c. ‘ his h /V r�eot if(,(
Date of Issuance Michael O'Reilly
Environmental Affairs Coordinator
(Revised 05/06/O5 M10)