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1 of 3 CITY OF SALEM APPLICATION FORM FLOOD HAZARD OVERLAY DISTRICT SPECIAL PERMIT Location of Property: Map & Lot: Owner: Applicant: Address/PO Box: Address/PO Box: City, State, Zip Code: City, State, Zip Code: Telephone: Telephone: I. Project Description: II. It has been determined by the Building Inspector that the above property lies in the following area(s): A. Wetlands District: Wetlands Buffer Zone B. Flood Hazard District: Zone A Zone AE Zone VE III. Submission Requirements: Application form and attached reports, statements, and narratives: Three hard copies shall be brought by the applicant to the City Clerk to be “date stamped”. The City Clerk will retain the original; the remaining two copies shall be filed with the Planning Board by the applicant. Plans and drawings: Three full-size (24” x 36”) sets of all plans and drawings and nine half-size (11”x17”) sets of all plans and drawing shall be filed with the Planning Board by the applicant. Electronic submission: One electronic copy of all application materials, including the application form and attached reports, statements, and narratives, and all project plans and drawings, shall be filed in .pdf format with the Planning Board by the applicant A. Required Plans and Drawings: A site plan at a scale of 1” equals 20’ prepared by a registered land surveyor or registered professional engineer and showing at least the following: 1. Lot lines within which the development is proposed and the tie-in to the nearest road intersection. CITY OF SALEM PLANNING BOARD ---PAGE BREAK--- 2 of 3 2. The location, boundaries, and dimensions of each lot in question. 3. Two-foot contours of the existing and proposed land surface. 4. Location of existing and proposed structures, water-courses, drainage and drainage easements, means of access, utilities, and sewer disposal facilities including leaching fields, if any. Proposed elevations should be noted. 5. Boundaries of all districts, areas and zones as noted in Section II. B. A written report describing the proposed development or use relative to each of the conditions set forth in Section 8.1.4 Special Permit Uses of the Salem Zoning Ordinance. C. In cases of flood-proofing or pile construction, certification by a registered professional engineer or architect as to the elevation of flood-proofing measures and as to compliance with the applicable sections of the Massachusetts State Building Code concerned with flood depths, pressures, velocities, impact and uplift forces, and other factors associated with the base flood. Where specific methods or techniques have been previously certified, the Planning Board may waive this requirement. D. Permits: A list of Federal, State, and other local permits required by the applicant. E. Descriptions relative to all conditions applicable in Section IV below. IV. Conditions (Complete those sections indicated by the Building Inspector) In the Flood Hazard District no structure or building, including pipes and wells, shall be erected, constructed, substantially improved, enlarged, or otherwise created or moved and no area shall be paved; no earth or other material shall be stored, dumped, used as fill, excavated, or transferred; unless all the following conditions are found to exist as part of the granting of a Special Permit by the Planning Board (use additional pages if necessary): 1. The proposed use will comply in all respects to the uses and provisions of the underlying district in which the land is located. Yes No 2. There are adequate convenience and safety of vehicular and pedestrian movement within the site and in relation to adjacent streets and property, particularly in the event of flooding of the lot(s) or adjacent lot(s) caused by either overspill from water bodies or high runoff. 3. Utilities, including gas, electricity, fuel, water and sewage disposal, shall be located and constructed so as to protect against breaking, leaking, short-circuiting, grounding or igniting or any other damage due to flooding. (Provide details) ---PAGE BREAK--- 3 of 3 4. Where the proposed use will be located within a coastal high hazard area (Zone VE on the FEMA Flood Insurance Rate Maps): a. New structures or substantial improvements shall be located landwards of the reach of mean high tide. Yes No b. The support of new structures or substantial improvements shall not be, in whole or in part, by the use of fill. Yes No 5. All subdivision proposals must be designed to assure that: a. Such proposals minimize flood damage; Yes No b. All public utilities and facilities are located and constructed to minimize or eliminate flood damage; Yes No c. Adequate drainage is provided to reduce exposure to flood hazards Yes No V. Procedure The Planning Board shall, within 7 days after the filing of this application, transmit one copy of said application, plans and all other submitted information to the Inspector of Buildings, City Engineer, Board of Health, Conservation Commission and Fire Prevention Officer who may, at their discretion, investigate the application and report in writing their recommendations to the Planning Board. The Planning Board shall not take final action on such application until it has received a report thereon from the Inspector of Buildings, City Engineer, Board of Health, Conservation Commission and Fire Prevention Officer or until thirty-five (35) days have elapsed after distribution of such application without a submission of a report. The Planning Board shall hold a Public Hearing on said application as soon as possible after receiving the above reports, in accordance with Chapter 40A of the Massachusetts General Laws. The Planning Board shall notify the applicant in writing of its decision on the special permit. The decision shall document the proposed development or use and the grounds for granting or refusing the special permit. The Planning Board may, as a condition of approval, require that the applicant give effective notice to prospective purchasers by signs or by recording the special permit at the Registry of Deeds, of the wetland or flood hazard conditions associated with said premises and the steps undertaken by the petitioner or his successor in title to alleviate the effects of same. Signature of Applicant Signature of Owner (attached consent letter is also acceptable) Date Date FEE PAID: SIGN SIGN