Town of Douglas Planning Board ANR Submittal Review Form

Town of Douglas Planning Board ANR Submittal Review Form Town Engineer Review Comments June 5, 2013 I. ADMINISTRATIVE Submittal Date: 06/03/2013 Submittal No.: 2013 09 21 Day Timeline: 06/24/2013* Map(s)/Parcel(s): 166/21 Project Location: 81 Uxbridge Street Applicant: Patrick J. Shay, 81 West Street, Uxbridge, MA 01569 Owner: Patrick J. Shay, 81 West Street, Uxbridge, MA 01569 * Decision must be made on or before the date shown. II. GENERAL This ANR Plan creates two reduced frontage lots, adjacent to one another, both with frontage on Uxbridge Street. January 9, 2007 Planning Board Meeting Minutes state under discussion: "8:35 DISCUSSION: Reduced Lot Frontage Bylaw Scott Medeiros was present to discuss his e mail dated January 4, 2007 regarding Mr. Patrick Shay s 18+acre parcel of land. Marks, Rosenkrantz and Swenson stated that it was a good idea on the surface. Brown and Mungeam would like to wait and see a proposed plan." III. REGULATORY 1. The names and addresses of the Record Owner and the Applicant, the name and seal of the land surveyor who prepared the plan, and the names of all property abutters including map and parcel references and appropriate plan and deed references; 2. The statement Approval under Subdivision Control Law is Not Required, and with sufficient space for the date and signatures of all members of the Planning Board; 3. A locus map showing the location of the subject parcel; 4. The statement Planning Board Endorsement does not necessarily mean that this plan conforms to the current zoning requirements; 5. Plan and Deed references of Record Owner(s), as appropriate; 6. The plan shall be prepared in conformance with the requirements of 250 CMR 6.00 including, but not limited to the existing boundary with reference to at least two permanent boundary monuments on or off the land to which the plan relates. Providing a reference to previous submittals or plans is not adequate to show a relationship to the relevant monuments; Page 1 of 3

Town of Douglas Planning Board ANR Submittal Review Form Town Engineer Review Comments June 5, 2013 7. The boundary lines of proposed lots, with accurate areas and dimensions, bearings and distances to permanent monuments; Comments: No Comments 8. Existing and proposed easement dimensions and purpose; 9. The names, locations and identification of ways as public or private; 10. Highway Monuments within 500 feet of the lot and Highway Layout Stationing along the lot frontage; 11. Existing structures, bounds, walls and other monuments; 12. Existing culverts with size and type clearly labeled on the plan; 13. North arrow, date of survey and scale; Comments: No date of Suvey is indicated on the drawing. 14. Any pertinent information such as zoning and overlay districts, clearly indicating limits of each; 15. Notice of any decisions or variances issued by the Zoning Board of Appeals, including but not limited to variances and special permits regarding the land and any buildings thereon; 16. Access limiting features including, but not necessarily limited to ledge, wetlands (in accordance with 310 CMR 10.00), water bodies, topography, and corner sight distance on the way access is being obtained; 17. Table showing zoning dimensional requirements for relevant zoning districts; 18. Limits of relevant overlay districts. 3.3.4 The area from the street line to the proposed building area shall be mapped for the full width showing the following features; Topography over 10%; wetlands; site line triangles appropriate to the travel speeds of the road in accordance with AASHTO standards. Comments: No Topography has been provided. USGS maps indicate that Totgraphy may be steep in certain areas of the subject site. Please confirm whether or not grades exceed 10% between the street and the building area. Page 2 of 3

Town of Douglas Planning Board ANR Submittal Review Form Town Engineer Review Comments June 5, 2013 IV. LOT FRONTAGE EXEMPTION REQUIREMENTS Section 4.3.4 Lot Width states: "... Egress over the frontage shall create no greater hazard owing to grade and visibility limitations than would be normal for a standard lot in the same area or safe access must be demonstrated via an easement or common drive from an adjacent parcel." Again, please confirm topography. 4.3.5 Limits states: "Not more than one (1) rear lot shall be created from a property, or a set of contiguous properties held in common ownership as of [May 17, 2005]. Documentation to this effect shall be submitted to the Building Inspector. The Building Inspector shall not issue a building permit for any rear lot without first consulting with the Planning Board to verify compliance with this provision. No lot having less than normally required frontage shall be endorsed by the Planning Board if it abuts another such lot, except that the Planning Board may approve one and only one such abutting lot if it determines that such approval will not derogate from the purpose of the Zoning Bylaw and will result in responsible development of the subject property. The Planning Board shall not, under any circumstances, endorse any Plan as "Approved for Reduced Lot Frontage" where endorsement of such a Plan would create more than two contiguous reduced frontage lots." This submittal is for two adjacent Lot Frontage Exception Lots created from the same parcel. V. DRAWINGS Page 3 of 3

TOWN OF DOUGLAS FORM A Approval Not Required Plan APPLICATION FORM OFFICE. USE ONLY APPL No. Zfcfc.f0: SUBMITTED FEE I. Applicant Information Patrick.. Shay Owners Name 81 West Street Street Address Uxbridge City/Town (508) 341-3421 Telephone Number Fax Number Contact Person Additional Address MA State Email Address 01569 Zip Code Other Comments II. Owner Information (If different from applicant information) Name Street Address City/Town Contact Person Additional Address State Zip Code Telephone Number Other Comments III. Plan Information Fax Number Email Address Title of PlanPlan of Land in Douglas. MAssachusetts owned by Patrick J. Shay Drawn By: Andrews Survey & Engineering PLS registration #: 47389 Date on Plan: March 20, 2007 IV. Site Information 11..66 Assessors Map 21 Assessors Parcel 5907 Deed Book 81 Uxbridge Street Street Address Douglas Additional Address Are taxes current on the property? Yes.257. Deed Page Revised Sept 2010 Page 1 of 3 Douglas Planning Board Please attach supplemental documentation, as necessary.

TOWN OF DOUGLAS FORM A Approval Not Required Plan APPLICATION FORM OFFICE USE ONLY APPL No. SUBMITTED. FEE V. TITLE TO THE PROPERTY The Owner's title to the land that is the subject matter of this application is derived from deed/will/other of Raymond & Alice Hall dated 2/21/76, recorded in Worcester Registry of Deeds, Volume 5907, Page 257 or as land court certificate of title no. VL FRONTAGE REQUIRMENTS The land is Zoned [RA RC-1 RC-2 VR CB COMM IND The frontage required under zoning is 200 feet Frontage is located on Uxbridge Street (name of way), which is A public way A way certified by the city/town clerk as being maintained and used as a public way 1:1 A way shown on a subdivision plan entitled: and previously endorsed as an approved plan by the planning board on A way in existence before adoption of the subdivision control law in the city/town that has adequate width, grade, and construction to provide vehicular access to the lot(s) for their intended purpose of and to permit the installation of municipal services to serve the lot(s) and any buildings thereon because: (Provide support below:) VII. FEES Applicants must submit the following information to confirm fee payment: $150 Fee Calculations 552 5/20/2013 Check Number Check date Patrick J. Shay Payor name on check Applicant name (if different from payor * Please make all checks payable to the Town of Douglas * Revised Sept 2010 Page 2 of 3 Douglas Planning Board Please attach supplemental documentation, as necessary.

TOWN OF DOUGLAS FORM A Approval Not Required Plan APPLICATION FORM OFFICE USE ONLY APPL No. SUBMITTED FEE VIII. SIGNATURES I hereby certify under the penalties of perjury that the foregoing Special Permit Application and accompanying plans, documents, and supporting data are true and complete to the best of my knowledge. I understand that the Planning Board will place notification of this Submittal in a local newspaper at the expense of the applicant in accordance with the requirements of the State Zoning Act. I further certify under penalties of perjury that a current list of all abutters and other relevant parties of interest were provided to the Planning Board office with current mailing addresses. These parties will be notified by the Douglas Planning Board pursuant to the requirements of the State Zoning Act. Notice must be made in writing by hand delivery or certified mail (return receipt requested) to all abutters within 300 feet of the property line of the project location. C46.-/ Signature of Applicant Date /3/ 49/3 Signature of Property Owner (if different i Date Signature of Representative (if any) Date Filed with the Town Clerk on Town Clerk Revised Sept 2010 Page 3 of 3 Douglas Planning Board Please attach supplemental documentation, as necessary.

TOWN OF DOUGLAS Planning Board Tax Verification Form Please complete your section below and return to the Planning Board Office Address 41.44 r/e/t Map / 4 Parcel 1 / Lot Owner Telephone 568. 9/ Applicant in Telephone tifry/ L FOR OFFICE USE ONLY: TAX COLLECTOR Are the taxes on this lot paid up to date? Yes No Comments: Signed: da,,,,&,6 Ca cade.,1/4_ Title: 4v.Y (/)0//ec-eov Date: 6 ---,2.0-/ 3 * For multiple parcels associated with a project, please fill out a separate Tax Verification Form for each individual parcel.