Wetland Site Inspection 2004 t ''s 4' gieit r •- NOxZ.'•?tl 1 <`7��r ��•/I�r��i����i s/V�`•r1�/��V
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~ 1 -, 400 Slocum Road • P.O. Box 79399 C E l
°�, • f Dartmouth,Massachusetts 02747-0985 t)
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�1; 2 508) '10-1822
3 ,^ O8) 14-189 i
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CONSERVATION COMMISSION r
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Wetland Site Inspection
4444- Tl�ux �'�r
// j (Form A-1) `coRif s
/'obiV 4p le-1 .
023 rc
Name of Person Making Request Date
a 7 pre I5/t n el 8p, 02 7 Pine X n d 4d
Mailing Address Street Location Of Property To Be Viewed
Da r) Ynemili/ P1 h 0,27y7 P14r ?° Ze ¢ 6
City/Town, State p Zip Code Dartmouth Assessors Map and Lot Number
SO F ! g`s / / 7 i t Pig esec1 /GX32/ /oat Ari,i p / /
Telephone-Day Reason for Inspection: !! h
• (house, ad;�ition,septic system repair etc.)
Telephone-Evening i
Signature of '-rson Making Request
ii (if not the Applicant)
Ro. i ,t1 ,1 ZT n 5vev/es fAA
<` SA,/e--1
Name of Owner of Site To Be Viewed
Print Name
Owner's address Signature of Owner of Site to be Viewed
(if not the Applicant)
City/Town, State Zip Code Print Name
If person making request is NOT the owner,the person is(check one):
Project Category(check one):
[ ]Real Estate Broker [ ] Engineer [ ] Contractor [ ] Consultant ( ) Subdivision of Land
[ ]Real Estate Appraiser [ ]Commercial
[ ] Other(explain): I l Single Family Home Project
Site Inspection Fees -see attached sheet for detailed fee schedule. All fees are non-refundable.
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 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 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,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-1 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 Cli.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 andlor their jurisdictional status under these Laws. The suu,wletion 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 RECOMMENDATIONS
[ ] No wetlands or other areas subject to the jurisdiction of the Conservation Commission exist on site or within 100 feet of
the site. No other filing with the Conservation Commission required.
[ I The pioposed 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 or other wetland verification procedure.
[ ] Wetlands exist on( North, South, East, West )of site.Please refer to drawing(if provided by inspector)for location
information. All wetland flag locations on sketch provided by inspector are approximate. Only a survey of the actual
field locations of wetland flags should be used for planning purposes.
[ ] Edge of wetland has been marked on 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 [ j 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.,
j)(J A Request for Determination must be filed with the Conservation Commission before any work begins on site.
�[ `] A Notice of Intent must 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 Conunission office for review and approval.
[14 100-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.
[ ] Riverfront Area as defined by 310CMR 10.58(Massachusetts Wetlands Protection Act,the"Act")may exist on site.
Applicant must submit information to the Commission as required by the Act to determine presence of Riverfront Area.
[ ] 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.
[X] Other Comments: Any rough sketch hand drawn on the attached plan by the Conservation Inspector is NOT TO
SCALE. The applicant/owner should have the flag line surveyed onto a plan to determine the actual extent of the wetlands
on the site. 5914A
+17_
Micha ei ,E viro e ' Coordinator
to Issuance
(Revised 12/27/02 MJO/RC) E a eth H. idhol , C ns ation Officer
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DATE OF AERIAL pgTOGM,,T 3-AS-SO
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