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HomeMy WebLinkAboutSOC 3.16.20004 DEP : i ne 0 fis DeaIffient d Preftladw DEP File Number Bureau of Resource Protecdon - Wedands MODIFIED - II WPA Form 5 = Order of Conditions for OEPuse only Massachusetts Wetlands Protection Act M.G.L. C. 131, §40 Applicant Information From: YARMOUTH crosv Lion Commission For: SE 83-1352 ftleaFaeNumtr To: Siddharth Siddharth AppliarNN" 283 Weymouth Street WffingMmss Holbrook, cdy/rown MA 02343 state Irp Code The project site is located at: South Yarmouth C41Town 101 J2 Assessors A601at / P&MA01 J and the property is recorded at the Registry of Deeds for. Barnstable 10204 0080 County Book Page aV= (it m9 steW land) U Findings Findings pursuant to the Massachusetts Wetlands Protection Act. Following the review of the above -referenced Notice of Intent and based on the information provided in this application and presented at the public hearing, this commission finds that the area in which work is proposed is significant to the following interests of the Wetlands Protection Act (check all that apply): = Public Water Supply • Private Water Supply Groundwater Supply X Rood Control = Land Containing Shellfish = Fisheries B Storm Damage Prevention XPrevention of Pollution XProtection of Wildlife Habitat The Notice of Intent for this project was filed on: 2/8/96 Do The public hearing was closed on: 3/16/00 Date Title and Date of final Plans and Other Documents: Plan of land, Curve Hill Rd., So.Yarmouth - Lot J2 - prepared for Siddharth Siddharth by Yunits Engineering Co., Holbrook, MA - REV. 2/22/00 Furthermore, this Commission hereby finds that the project, as proposed, is: (check one of the following boxes) Approved subject to: )'the following conditions which are necessary, in accordance with the performance standards set forth in the wetlands regulations, to protect those interests checked above. This Commission orders that all the work shall be performed in accordance with the Notice of Intent referenced above, the following General Conditions, and any other special conditions attached to this Order. To the extent that the following conditions modify or differ from the plans, specifications, or other proposals submitted with the Notice of Intent, these conditions shall control. Rev. 10/98 Page 1 of 5 Massachusetle Department of Enlvironmenta/ Proiectfon Town of Yarmouth Bureau of Resource Protection- Wetlands MODIFIED - II Wetland By -Law WPA Form 5 - Order of Conditions Chapter 143 Massachusetts Wetlands Protection Act M. G. L. G. 131, §40 1;� Findings (coot.) debris, including but not limited to lumber, bricks, plaster, Denied because: wire, lath, paper, cardboard, pipe, tires, ashes, refrigerators, motor vehicles, or parts of any of the foregoing. the proposed work cannot be conditioned to meet the Performance standards set forth in the wetlands regulations to protect those interests checked above. Therefore, work on this project may not go forward unless and until a new Notice of Intent is submitted which provides measures which are adequate to protect these interests, and a final Order of Conditions is issued. ED the information submitted by the applicant is not sufficient to describe the site, the work, or the effect of the work on the interests identified in the Wetlands Protection Act. Therefore, work on this project may not go forward unless and until a revised Notice of Intent is submitted which provides sufficient information and includes measures which are adequate to protect the Act's interests, and a final Order of Conditions is issued. A description of the specific information which is lacking and why it is necessary is attached to this Order as per 310 CMR 10.05(b)(c). General Conditions 1. Failure to comply with all conditions stated herein, and with all related statutes and other regulatory measures, shall be deemed cause to revoke or modify this Order. 2. The Order does not grant any property rights or any exclusive privileges; it does not authorize any injury to private property or invasion of private rights. 3. This Order does not relieve the permittee or any other person of the necessity of complying with all other applicable federal, state, or local statutes, ordinances, bylaws, or regulations. 4. The work authorized hereunder shall be completed within three years from the date of this Order unless either of the following apply: (a) the work is a maintenance dredging project as provided for in the Act; or (b) the time for completion has been extended to a specified date more than three years, but less than five years, from the date of issuance. If this Order is intended to be valid for more than three years, the extention date and the special circumstances warranting the extended time period are set forth as a special condition in this Order. 5. This Order may be extended by the issuing authority for one or more periods of up to three years each upon application to the issuing authority at least 30 days prior to the expiration date of the Order. 6. Any fill used in connection with this project shall be clean fill. Any fill shall contain no trash, refuse, rubbish, or 7. This Order does not become final until all administrative appeal periods from this Order have elapsed, or if such an appeal has been taken, until all proceedings before the Department have been completed. 8. No work shall be undertaken until the Order has become final and then has been recorded in the Registry of Deeds or the Land Court for the district in which the land is located, within the chain of title of the affected property. In the case of recorded land, the Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land upon which the proposed work is to be done. In the case of registered land, the Final Order shall also be noted on the Land Court Certificate of Title of the owner of the land upon which the proposed work is done. The recording information shall be submitted to this Conservation Commission on the form at the end of this Order, which form must be stamped by the Registry of Deeds, prior to the commencement of the work. 9. A sign shall be displayed at the site not less than two square feet or more than three square feet in size bearing the words, "Massachusetts Department of Environmental Protection" [or, "MA DEP"] "File Number SE 83-1352 ,. Project File Number 10.Where the Department of Environmental Protection is requested to issue a Superseding Order, the Conservation Commission shall be a party to all agency proceedings and hearings before the Department. 11. Upon completion of the work described herein, the applicant shall submit a Request for Certificate of Compliance (WPA Form 8A) to the Conservation Commission. 12.The work shall conform to the following attached plans and special conditions: Final Approved Plans (attach additional plan references as needed): Plan of land -Curve Hill Road Title REV. 2/22/00 Dated Terrence J. Chase, P.E. SignedandSlampedby Rbt, Backman, PLS Con Com On file Witt If, -.t-cachuseft Depjrftent of Enuironmentai Protect%n Town of Yarmouth Bureau of Resource Protection - Wetlands MODIFIED - II Wetland By -Law WPA Form 5 - Order of Conditions Chapter 143 Massachusetts Wetlands Protection Act M.G. L. c. 131, §40 U Findings (coot.) 13. Any changes to the plans identified in Condition # 12 above shall require the applicant to inquire of the Conservation Commission in writing whether the change is significant enough to require the filing of a new Notice of Intent. 14. The Agent or members of the Conservation Commission and Department of Environmental Protection shall have the right to enter and inspect the area subject to this Order at reasonable hours to evaluate compliance with the condi- tions stated in this Order, and may require the submittal of any data deemed necessary by the Conservation Commis- sion or Department for that evaluation. 15. This Order of Conditions shall apply to any successor in interest or successor in control of the property subject to this Order and to any contractor or other person perform- ing work conditioned by this Order. 16. Prior to the start of work, and if the project involves work adjacent to a Bordering Vegetated Wetland, the boundary of the wetland in the vicinity of the proposed work area shall be marked by wooden stakes or flagging. Once in place, the wetland boundary markers shall serve as the limit of work (unless another limit of work line has been noted in the plans of record) and be maintained until a Certificate of Compliance has been issued by the Conservation Commis- sion. 17. All sedimentation barriers shall be maintained in good repair until all disturbed areas have been fully stabilized with vegetation or other means. At no time shall sediments be deposited in a wetland or water body. During construc- tion, the applicant or his/her designee shall inspect the erosion controls on a daily basis and shall remove accumulated sediments as needed. The applicant shall immediately control any erosion problems that occur at the site and shall also immediately notify the Conservation Commission, which reserves the right to require additional erosion and/or damage prevention controls it may deem necessary. Special Conditions (Use additional paper if necessary) SEE ATTACHED SHEETS - PAGES 3-A & 3-B Findings as to municipal law, bylaw, or ordinance Furthermore, the YARMOUTH Conservation Commission hereby finds (check one that applies): that the proposed work cannot be conditioned to meet the standards set forth in a municipal law, ordinance, or bylaw, specifically Name and citation of municipal law, bylaw, or ordinance Therefore, work on this project may not go forward unless and until a revised Notice of Intent is submitted which provides measures which are adequate to meet these standards, and a final Order of Conditions is issued. that the following additional conditions are necessary to comply with a municipal law, bylaw, or ordinance, specifi- cally Name and citation ot municipal law, bylaw, or ordinance. The Commission orders that all the work shall be performed in accordance with the said additional conditions and with the Notice of Intent referenced above. To the extent that the following conditions modify or differ from the plans, specifications, or other proposals submitted with the Notice of Intent, the conditions shall control. Additional conditions relating to municipal law, bylaw, or ordinance: SPECIAL CONDITIONS - PAGE 3-A SIDDHARTH SIDDHARTH SE 83-1352 The applicant shall be held responsible to advise the contractor of all these Orders of Conditions. 2. The Conservation Officer shall be notified at least 48 hours prior to the commencement of the proposed work. Telephone number is 398-2231 ext. 283. 3. These Orders of Conditions shall apply to any successor in interest or successor in control. 4. Any fill required, (See General Order #6 in Order of Conditions) shall be of clean sand and contain no material over 12 inches in diameter. 5. The existing silt fence and haybales shall remain in place. No work whatsoever shall occur on the wetland side of this line. 6. Any area proposed for removal of vegetation for a period of more than seven days, shall be mulched or otherwise treated to prevent erosion. 7. The deck shall not be closed in without a filing of either a Notice of Intent or a Request for Determination of Applicability. 8. The back yard shall be planted with indigenous ground covers shrubs, trees etc. Lawn will not be allowed. 9. The general contractor shall arrange an on site meeting with the Conservation Administrator prior to the start of any work. 10. The applicant shall be responsible for having a copy of the Orders of Conditions on the job site at all times. Failure to do so could possibly result in a revocation of the Order, a fine or both. 11. The Conservation Commission, its agents or assign, shall have the express right of entry upon the property for the purposes of establishing compliance to the conditions stated herein. CONTINUED......... SPECIAL CONDITIONS CONTINUED - PAGE 3-B SIDDHARTH SIDDHARTH SE SE 83-1352 12. Upon completion of the project a Certificate of Compliance shall be requested. This Order shall be considered incomplete until the Certificate of Compliance is recorded. 13. Any changes whatsoever form the plan dated 2/22/00 shall be approved by the Conservation Commission prior to implementation. Ifo -q achnsetts Department of "--drenmentai Prot on Town of Yarmouth Bureau of Resource Protection - Wetlands MODIFIED - II wetland By -Law WPA Form 5 - Order of Conditions Chapter143 DEP Massachusetts Wetlands Protection Act M.G. L. c. 131, §40 Findings (coot.) This Order is valid for three years, unless otherwise specified as a special condition pursuant to General Conditions #4, from the date of issuance. March 22, 2000 Date This Order must be signed by a majority of the conservation commission. The Order must be mailed by certified mail (return receipt requested) or hand delivered to the applicant. A copy also must be mailed or hand delivered at the same time to the appropriate regional office of the Department of Environmental Protection. Appeals The applicant, the owner, any person aggrieved by this Order, any owner of land abutting the land subject to this Order, or any ten residents of the city or town in which such land is located, are hereby notified of their right to request the appropriate Department of Environmental Protection Regional Office to issue a Superseding Order of Conditions. The request must be made by certified mail or hand delivery to the Department, with the appropriate filing fee and a completed Appendix E: Request for Departmental Action Fee Transmittal Form, as provided in 310 CMR 10.03(7) within ten business days from the date of issuance of this Order. A copy of the request shall at the same time be sent by certified mail or hand delivery to the conservation commission and to the applicant, if he/she is not the appellant. On this 16 In day of Month YOU before me personally appeared "k --,/� 1 �- � K" if�tr'f tss1 q-s1 to me known to be the person described in and who executed the foregoing instrument and acknowledged that he/she executed the same as his/her free act and deed. _ No" Public I`-. '-1-v AA- A �? .9—d.2 * commission evims This Order is issued to the applicant as follows: by hand delivery on Date MX by certified mail, return receipt requested, on March 22, 2000 Date The request shall state clearly and concisely the objections to the Order which is being appealed and how the Order does not contribute to the protection of the interests identified in the Massachusetts Wetlands Protection Act (M.G.L. c.131, §40 and is inconsistent with the wetlands regulations (310 CMR 10.00). To the extent that the Order is based on a municipal bylaw, and not on the Massachusetts Wetlands Protection Act or regulations, the Department of Environmental Protection has no appellate jurisdiction. Massachiusetle Deparbuent of Environmental Proteetion Town of Yarmouth Bureau of Resource Protection - Wetlands MOD IF•I ED - II Wetland By -Law WPA Form 5 - Order of Conditions Chapter 143 Massachusetts Wetlands Protection Act M.G. L. c. 131, §40 W Recording Information This Order of Conditions must be recorded in the Registry of Deeds or the Land Court for the district in which the land is located, within the chain of title of the affected property. In the case of recorded land, the Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land subject to the Order. In the case of registered land, this Order shall also be noted on the land Court Certificate of idle of the owner of the land subject to the Order of Conditions. The recording information shall be submitted to the YARMOUTH Conservation Commission on the form below, which must be stamped by the Registry of Deeds. Detach on dotted line and submit to the Conservation Commission. _ _ _ _ ---------- TO: YARMOUTH Conservation Commission MODIFIED — II Please be advised that the Order of Conditions or the project at _Lot J2, Curve Hill Road, So. Yarmouth ftiectLocanon D9ReNumber SE 8 3 —13 5 2 has been recorded at the Registry of Deeds of BARNSTABLE county and has been noted in the chain of tide of the affected property in Book PW in accordance with the Order of Conditions issued on 3-22-00 Date If recorded land, the instrument number which identifies this transaction is IMUMentMober If registered land, the document number which identifies this transaction is Document Number Signature of Applicant • COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION SOUTHEAST REGIONAL OFFICE ARGEO PAUL CELLUCCI Governor f! �= f`` r Michael B. Stusse 25 Mid -Tech Drive, Suite C W. Yarmouth, Massachusetts 02673 Dear Mr. Stusse: April 9, 1998 TRUDY COXE Secretary DAVID B. STRUHS Commissioner RE: YARMOUTH -- Wetlands File No. SE 83-1352 Superseding "Modified" Order of Conditions Following an in depth review of the above referenced file and in accordance with Massachusetts General Laws, Chapter 131, Section 40, the Department of Environmental Protection has issued the enclosed Superseding Order of Conditions (SOC). This Order approves the proposed project subject to certain conditions. The Department has determined that the project site abuts a bordering vegetated wetland (BVW), as defined in 310 CMR 10.55(2). The proposed project consists of constructing a retaining wall between a single-family dwelling and a BVW to prevent the slope from constantly eroding, resulting in siltation of the BVW and destabilization of the building foundation. The enclosed SOC requires that the erosion control barrier installed between the wetland resource area and the work area, be maintained until the construction of the retaining wall is completed. The SOC directs that all disturbed areas be stabilized prior to removing the erosion control barrier. The SOC contains additional requirements to protect the - interests of the Act. It is the opinion of the Department that, as conditioned herein, the proposed project adequately protects the above -noted interests of the Act. In the opinion of the Department the reasons given here are sufficient to justify the enclosed SOC. However, the Department reserves the right to raise additional issues and present further evidence as may be appropriate should there be further proceedings in this matter. 20 Riverside Drive • Lakeville, Massachusetts 02347 • FAX (508) 947-6557 • Telephone (508) 946-2700 0 Printed on Recycled Paper -2- If you have any questions regarding this SOC, please contact Daniel F. Gilmore at (508) 946-2808. Very truly yours, -'Tena Y/Davies Regiodal Watershed Coordinator Bureau of Resource Protection D/DFG/dg /bh Enclosure CC: Yarmouth Conservation Commission Siddharth Siddharth 283 Weymouth Street Holbrook, MA 02343 Certified Mail # Z 333 585 685 RETURN RECEIPT REQUESTED 310 CMR 10.99 Form 5 DEP File No SE 83-1352 (To be provided by DEP) City/Town YARMOUTH Applicant Siddharth Siddharth Superseding "Modified" Order of Conditions Massachusetts Wetlands Protection Act G.L. c.131, 540 From Department of Environmental Protection To Siddharth Siddharth (Name of Applicant) Address 283 Weymouth Street, Hingham, MA 02343 (applicant) To Same (Name of Property Owner) Address Same (owner) This Order is issued and delivered as follows: ❑ by hand delivery to applicant or representative on (date) ® by certified mail, return receipt requested on A=J 1 9, 1998 (date) # Z 333 585 685 This project is located at Lot 2 Curve Hill Road The property is recorded at the Registry of Deeds, Barnstable County Book 10849 Page 306 Certificate (if registered) The Notice of Intent for this project was filed on 2/8/96 (date) The public hearing was closed on 2/5/98 (date) Findings The Department of Environmental Protection has reviewed the above -referenced Notice of Intent and plans and has held a public hearing on the project. Based on the information available to the Department of Environmental Protection at this time, the Department of Environmental Protection has determined that the area on which the proposed work is to be done is significant to the following interests in accordance with the Presumptions of Significance set forth in the regulations for each Area Subject to Protection Under the Act (check as appropriate): ❑ Public water supply ® Flood control ❑ Land containing shellfish ❑ Private water supply ® Storm damage prevention ❑ Fisheries ® Ground water supply ® Prevention of pollution ® Protection of wildlife habitat Total Filing Fee Submitted $250 State Share $112.50 City/Town Share $137.50 04 fee in excess of $25) Total Refund Due $ 0 City/Town Portion $ 0 State Portion $ 0 N total) (M total) Effective 11/20/92 5-1 Therefore, the Department of Environmental Protection hereby finds that the following conditions are necessary, in accordance with the Performance Standards set forth in the regulations, to protect those interests checked above. The Department of Environmental Protection orders that all work shall be performed in accordance with said conditions and with the Notice of Intent referenced above. To the extent that the following conditions modify or differ from the plans, specifications or other proposals submitted with the Notice of Intent, the conditions shall control. General Conditions 1. Failure to comply with all conditions stated herein, and with all related statutes and other regulatory measures, shall be deemed cause to revoke or modify this Order. 2. The Order does not grant any property rights or any exclusive privileges; it does not authorize any injury to private property or invasion of private rights. 3. This Order does not relieve the permittee or any other person of the necessity of complying with all other applicable federal, state or local statutes, ordinances, by-laws or regulations. 4. The work authorized hereunder shall be completed within three years from the date of this Order unless either of the following apply: (a) the work is a maintenance dredging project as provided for in the Act; or (b) the time for completion has been extended to a specified date more than three years, but less than five years, from the date of issuance and both that date and the special circumstances warranting the extended time period are set forth in this Order. 5. This Order may be extended by the issuing authority for one or more periods of up to three years each upon application to the issuing authority at least 30 days prior to the expiration date of the Order. 6. Any fill used in connection with this project shall be clean fill, containing no trash, refuse, rubbish or debris, including but not limited to lumber, bricks, plaster, wire, lath, paper, cardboard, pipe, tires, ashes, refrigerators, motor vehicles or parts of any of the foregoing. 7. No work shall be undertaken until all administrative appeal periods from this Order have elapsed or, if such an appeal has been filed, until all proceedings before the Department have been completed. 8. No work shall be undertaken until the Final Order has been recorded in the Registry of Deeds or the Land Court for the district in which the land is located, within the chain of title of the affected property. In the case of recorded land, the Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land upon which the proposed work is to be done. In the case of registered land, the Final Order shall also be noted on the Land Court Certificate of Title of the owner of the land upon which the proposed work is to be done. The recording information shall be submitted to the Department of Environmental Protection on the form at the end of this Order prior to commencement of the work. 9. A sign shall be displayed at the site not less than two square feet or more than three square feet in size bearing the words, "Massachusetts Department of Environmental Protection, File Number SE 83-1352 " 10. Where the Department of Environmental Protection is requested to make a determination and to issue a Superseding Order, the Conservation Commission shall be a party to all agency proceedings and hearings before the Department. 5-2 11. Upon completion of the work described herein, the applicant shall forthwith request in writing that a Certificate of Compliance be issued stating that the work has been satisfactorily completed. 12. The work shall conform to the following plans and special conditions: Plans: Title: Revised Site Plan in South Yarmouth, MA for Siddharth Siddharth Dated: January 28 1998 Signed & Stamped by: Edward E. Kelley, RPLS & Francis E. LaJoie, RPE & T. Varnum Philbrook RPE On File With: DEP Special Conditions (Use additional paper if necessary) 1. Prior to the commencement of construction, General Condition No. 8, above, must be complied with. 2. All construction must comply with the above -referenced plans and the conditions of this Order. For any proposed change in the approved plans or in the work, the applicant shall file a new Notice of Intent or inquire, in writing, of the Department whether the change is substantial enough to require a new Notice of Intent. No change in plan, under this filing, is permissible without prior written approval from the Department allowing this change. 3. It is the responsibility of the applicant, owner and/or successor(s) to ensure that all conditions of this Order are complied with. The project engineer and contractors are to be provided with a copy of this Order and referenced documents before commencement of construction. 4. Members and agents of the local Conservation Commission and the Department shall have the right to enter and inspect the property at all reasonable times to evaluate compliance with the conditions stated in this Superseding Order, and may require the submittal of any data deemed necessary by this Department for that submittal. 5. A copy of this Order and the above -referenced plans shall be kept available on site during all phases of construction, until a Certificate of Compliance has been issued by the Department. 6. This Superseding Order of Conditions does not relieve the applicant from obtaining approval under, and complying with any requirements of, the Town of Yarmouth by-laws. 7. The erosion control barrier, as shown on the plan of record and established on the site, shall be maintained until all construction has been completed and all disturbed areas have been stabilized. 8. In any area where erosion has encroached into the bordering vegetated wetland (BVW), the applicant shall remove the sediment from the BVW using hand tools and manual labor. 9. Upon completion of the project, a Certificate of Compliance shall be requested in accordance with General Condition No. 11, and under the provisions of 310 CMR 10.05 (9)(d). An "AS- BUILT" plan and a statement from a Registered Professional Engineer certifying compliance with the conditions of this Order shall accompany the request for a Certificate of Compliance. There are no attached sheets with additional conditions. 5-3B Issued by the department of ironmental Protection Signature Tena J. Davies, -Regional Watershed Coordinator v On this 9th day of April 1998 before me personally appeared Tena J. Davies to me known to be the person described in ana wno execuLeu L.11c ��L�s��•7 instrument and acknowledged that he/she executed the same as his/her free act and deed. NotarysPubli My commission expires u,r4c��_ The applicant, the owner, any person aggrieved by the Superseding Order, any owner of land abutting the land upon which the proposed work is to.be done, or any ten persons pursuant to G.L. c.30A §10A, are hereby notified of their right to request an adjudicatory hearing pursuant to G.L. c.30A, §10, providing the request is made by certified mail or hand delivery to the Department, with the appropriate filing fee and Fee Transmittal Form as provided in 310 CMR 10.03(7), within ten days from the date of issuance of this Superseding Order, and is addressed to: Docket Clerk, Office of General Counsel, Department of Environmental Protection, One Winter Street, Boston, MA 02108. A copy of the request shall at the same time be sent by certified mail or hand delivery to the Conservation Commission, the applicant, and any other party. A Notice of Claim for an Adjudicatory Hearing shall comply with the Department's Rules for Adjudicatory Proceedings. 310 CMR 1.01(6), and shall contain the following information: (a) the DEP Wetlands File Number, name of the applicant and address of the project. (b) the complete name, address and telephone number of the party filing the request, and, if represented by counsel, the name and address of the attorney; (c) the names and addresses of all other parties, if known; (d) a clear and concise statement of (1) the facts which are grounds for the proceedings, (2) the objections to this Superseding Order, including specifically the manner in which it is alleged to be inconsistent with the Department's Wetlands Regulations (310 CMR 10.00) and does not contribute to the protection of the interests identified in the Act, and (3) the relief sought through the adjudicatory hearing, including specifically the changes desired in the Superseding Order; (e) a statement that a copy of the request has been sent to the applicant, the conservation commission and each other party or representative of such party, if known. Failure to submit all necessary information may result in a dismissal by the Department of the Notice of Claim for an Adjudicatory Hearing. Detach on dotted line and submit to the Department of Environmental Protection prior to commencement of work. To Department of Environmental Protection, Issuing Authority. Please be advised that the Order of Conditions for the project at Lot 2 Curve Hill Road , File Number SE 83-1352, has been recorded at the Registry of Deeds Barnstable County and has—been noted in the chain of title of the affected propertyinaccordance with General Condition 8 on ' If recorded land, the instrument number which identifies this transaction is If registered land, the document number which identifies this transaction is Signature Applicant K/DFG/dg /bh 5-4B NOTICE OF APPEAL RIGHTS/ADMINISTRATIVE ORDER/DETERMINATION APPEAL RIGHTS AND TIME LIMITS This Order/Determination is an action of the Department. If you are aggrieved by this action, you may request an adjudicatory hearing. A request for a hearing must be made in writing within and postmarked within ten (10) days of the date this Order/Determination was issued. CONTENTS OF HEARING REQUEST Under 310 CMR 1.01(6)(b), the request must state clearly and concisely the facts which are the grounds for the request, and the relief sought. Additionally, the request must state why the Order/Determination is not consistent with applicable laws and regulations. FILING FEE AND ADDRESS The hearing request along with a valid check payable to Commonwealth of Massachusetts in the amount of $100 must be mailed to: Commonwealth of Massachusetts Department of Environmental Protection P.O. Box 4062 Boston, MA 02211 The request will be dismissed if the filing fee is not paid, unless the appellant is exempt or granted a waiver as described below. The filing fee is not required if the appellant is a city or town (or municipal agency), county, or district of the Commonwealth of Massachusetts, or a municipal housing authority. WAIVER The Department may waive the adjudicatory hearing filing fee for a person who shows that paying the fee will create an undue financial hardship. A person seeking a waiver must file, together with the hearing request as provided above, an affidavit setting forth the facts believed to support the claim of undue financial hardship.