Wetland Site Inspection Imo/ . NMI)Town2 Lill f.
400 •
Slocum Road P. O. Box 79399
"in riT� _ Dartmouth, Massachusetts 02747-0985 1.......,........:_DART,r,7911TH
CONSERVATION COMMISSION • (508)999-0722
A-1 Site Inspection Form FAX:(508)999-0797
0--;9121,-,5 4a-rter-5 FILE COPY /-3/-0,
Name of Person Making Request Date
30 j�fr anre Wel 20 S1 ,6(ypIce /el
Mailing Address Steet Location Of Property To Be Viewed
X, fAr7-ir,rru t t_ O;74/7 (Alp 79 'tie-30
City/Town, State Zip Code Dartmouth Assessors Map and Lot Number
(,voC 6 r76/4 t (/)/i43fr6/ ,,e.) /7-2kyie a i -Zpoi Telephone-Day Proposed Use of Land(house, ad ' oti,garage, etc.)
r
J —^vas-�—:7 f� �e� �--
Telephone-Evening Signature of Person Making Request
19":'!'.J // / .,�t,-rs, �}1,rnr3 /9 r'.Jt,n(ar'l'
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 filing forms are available in the Conservation Commission office,room 107 at the Dartmouth Town Hall,400 Sloewn Rd.from
9AM-4PM Monday and 8:45AM-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 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. 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.
Note:The A-I 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 §40)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 anchor their jurisdictional status wider these Laws.
The completion of this Site Inspection is not an authorization to proceed with work.This site inspection expires three(3)years from
the date of issuance.
CONSERVATION COMMISSION INSPECTOR COMMENTS AND RECOMMENb.
❑ No wetlands or other areas subject to the jurisdiction of the Conservation Commission exist on site or within _
•
f '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 markedon site by Inspector. Flag numbers:
wet Through wet
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 been until permit is received. This completed form
is not a permit.
❑ A Request for Determination should be filed with the Conservation Conunission before any work begins on site.
❑ 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 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 located in flood plain 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 for review and approval.
I?' Other Comments: cc
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--7 7 Aug,t9
Date of Issuance Michael O'Reilly
Environmental Affairs Coordinator
Elizabeth H. Leidhold
Conservation Officer
(Revised 9-8-98 RC)A:A-1Fomm Rev 12-28-99