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Randolph Place storm drain to Historic Mill River 32C-163 WetlandsNotice of intent 7?row-/6 Under the Massachusetts Wetlands Protection Act, G.L. c. 131, §40 and Application for a Department of the Army Permit Part I: General Information 1. Location: Street Address West Lot Number 2. Project: Type drainage outfall into Old Mill River. of stone rip -rap headwall. 3. Registry: County Certificate (If Registered Land) Board of Public Works Address Commonwealth of Massachusetts on stream bed to of Pleas old railroad bed Inst 1 Description Construction Applicant Address 125 Locust Richard Boyle 5: Property Owner Northampton Street, Eastham Almer Huntley, Jr. Assoc. Inc. DEGE File No. (To be provided by OEGE) CitylTown Applicant ^f Eul,l i r 14 of headwall and lacement control possible erosion in immediate area around Current Boo Page Tel 586 -1850 Te1 527-1580 T -7444 6. Representative 125 Pleasant Street, Northampton Address 7. Have the Conservation Commission and the DEGE Regional Office each been sent, by certified mail or hand delivery, 2 copies of completed Notice of Intent, with supporting p lans and documents? Yes Ca No L L_ approvals required by local by-law been obtained? Have an obtainable permits, variances and Yes NO 0 None required by local by -law 9. Is any portion of the site subject to a Wetlands Restriction Order pursuant to G.L c. 131, §40A or G.L c. 130, §105? Yes No] 10. List all plans and supporting documents submitted with this Notice of Intent. Identifying Title, Date Number /Letter A Cross Country Sta. 0+77 to L_ Locus 11. Check those resource areas within which work is proposed: (a) (I Buffer Zone (b) Inland: 0 Bank' Bordering Vegetated Wetland' 0 Land Under Water Body Waterway* (c) Coastal: Land Under the Ocean' Coastal Beach* 0 Obtained: Barrier Beach Rocky Intertidal Shore' Land Under Salt Pond' Fish Run' Applied For: Calculation sheets and plan Erosion Control Diagrams 1 Designated Port Area Coastal Dune Coastal Bank Salt Marsh' Land Containing Shellfish' Land Subject to Flooding, Bordering Isolated 3 -2 Not Applied For sta. 0 +40, Oct. 1983 Soil conservation map, borings, and soil description 200 scale of project locus 'Likely to involve U.S. Army Corps of Engineers concurrent jurisdiction. See General Instructions for Completing Notice of Intent. Part II: Site Description Indicate which of the following information has been provided (on a plan, in narrative description or calcula- tions) to clearly, completely and accurately describe existing site conditions. Identifying Number /Letter (of plan, narrative or calculations) E A B A B A Man -made Features: 'Structures (such as buildings, piers, towers and headwalls) Drainage and flood control facilities at the site and immediately off the site, including culverts and open channels (with inverts), dams and dikes Subsurface sewage disposal systems Underground utilities 4 Roadways and parking areas A Property boundaries, easements and rights -of -way Other Part III: Work Description Indicate which of the following information has been provided (on a plan, in narrative description or calcula- tions) to clearly, completely and accurately describe work proposed within each of the resource areas checked in Part I, item 11 above. Identifying Number /Letter (of plan, narrative or calculations) A A A A &E F C *See below Natural Features: SoRS Vegetation Topography Open water bodies (including ponds and lakes) Flowing water bodies (including streams and rivers) Public and private surface water and ground water supplies on or within 100 feet of site Maximum annual ground water elevations with dates and Location of test Boundaries of resource areas checked under Part I, item 11 above Other Planview and Cross Section of: Structures (such as buildings, piers, towers and headwalls) Drainage and flood control facilities, including culverts and open channels (with inverts), darns and dikes Subsurface sewage disposal systems underground utilities Filling, dredging and excavating, indicating volume and composition of material Compensatory storage areas, where required in accordance with Part III, Section 10:57 (4) of the regulations Other Point Source Discharge Description of characteristics of discharge from point source (both closed and open channel), when point of discharge falls within resource area checked under Part I, item 1 1 above, as supported by standard engineering calculations, data and plans, including *None required. Rip -rap but not limited to the following: and headwall w ill not 1 Coastal Resource Area Type: O Inland Land under water wa Proposed headwall will have a velosity reduction structure located between the pipe opening and the actual edge of the River channel. Location of the proposed headwall was chosen because of a natural cove in the existing bank. This cove as shown on document "A" will be used for the installation of the headwall and the necessary bank rip -rap to protect the existing bank and river bottom from future erosion and iltation. Identifying number or letter of support documents 1. Delineation of the drainage area contributing to the point of discharge; F c 2. Pre and post- development peak run-off from the drainage area, at the point of discharge, for at least the 10 -year and 100 -year frequency storm; 3. Pre and post development rate of infiltration contributing to the resource area checked under Part l, item 11 above; 4. Estimated water quality characteristics of pre- and post development run -off at the point of discharge. Water quality characteristics should not change. Discharge presently entering Part IV: Mitigating Measures Mill River downstream. 1. Clearly, completely and accurately describe, with reference to supporting plans and calculations where necessary: (a) AU measures and designs proposed to meet the performance standards set forth under each re- source area specified in Part II or Part III of the regulations; or (b) why the presumptions set forth under each resource area specified in Part II or Part III of the regula- tions do not apply. Coastal Resource Area Type: Inland Bank Proposed headwall entering bank in an existing cove in the ban Area to be disturbed exhibits signs of previous dumping.and filling. Bank above and below headwall will be excavated_ and faced w;th stone rip -rap back to their original grade. Siltation checks and ponds will_ be established to control siltation immediately down stream of proposed work area and work will proceed according to the attached recommended work pro'cedure and /or as instructed by the Engineer. Identifying number or letter of support documents k. r D Inland 0 Coastal Resource Area Type: Coastal Resource Area Type Bordered Sy 100-Foot Discretionary Zone: Lf Inland Bank Proper siltation controls will be instituted throughout construction as spelled out in documents "D" Identifying number or letter of support documents 2: Clearly, completely and accurately describe, with reference to supporting plans and calculations where necessary: (a) all measures and designs to regulate work within the, Buffer Zone so as to insure that said work does not alter an area specified in Part I, Section 10.02(1) (a) of these regulations; or (b) if work in the Buffer Zone will alter such an area all measures and designs proposed to meet the performance standards established for the adjacent resource area specified in Part II or Part III of these regulations. Identifying number or letter of support documents Put V: Additional Information for a Department of the Army Permit pled Mill River channel. 1. COE Application No. (to be provided by COE) 3. Names and addresses of property owners adjoining your property: Phyllis Zalesky, 95 Pine Street, Westfield, MA 01085 Mass. Electric Co., P.O. Box 305, Florence, MA. Karl J. Zalesky, 43 Wilson Ave., Northampton, MA George A. Spence and Marvin J. Spence 6 -A Randolph Place, Northampton, MA Richard J., Gerry Margaret T. Risciott, 36 Wilson Ave.., Northampton, MA 01060 4. Document other project alternatives (i.e., other locations and /or construction methods, particularly those• that would eliminate the discharge of dredged or fill material into waters or wetlands). 5. 8'/ x 11" drawings in planview and cross section, showing the resource area and the proposed activ- ity within the resource area. Drawings must be to scale and should be clear enough for photocopying. Certifications required from the DNtsbn of Water Parton Control before the Federal permit can be issued. Certification may be obtain b centactrg the Don of Water Pollution Control, 1 Writer Street Massacn tts 02108. Where the actMj will take place wthin the area under the Massachusetts approved Coastal Zone rrt certifies that his proposed activity cornpees with and will be conducted Management Program. the app n a manner that •s consistentwith the approved program. the non e for a permit and s made a matter of put�6c Information provided will be used in evaluating appica record through issuance of a pubic notice. Dscbsure of this information is voluntary. however if necessary information is not provided. the appicaticn cannot be processed nor can a permit be issued. hereby certify under the pains and penalties of perjury that the foregoing Notice of Intent and accompanying plans, documents and supporting data are true and complete, to the best of my knowledge. e/83 6;211-61(9 C)?& Signature of Applicant MED FORM 100 (TEST) 1 MAY 82 2. (Name of waterway) Date Signature of Applicant's Representative "Exception to ENG Form 4345 approved by HQUSACE, 6 May 1961". "This document contains joint Dep•rtment of the Army and State o(M ►usetta applieatiow for permit t• obtain permission to parlors activities is United States waters. The Ofrct oI M•nageTsent and Budget (OMB) has approved those Questions required by the US Army Corps of Engineers. OMB Number 0102-0038 and expiration d•t• of 30 Septesb•r 1983 applies This statement will b• set in 6 point type- 3 -6 0 EASTHAMPTON QUADRANGLE MASSACHUSETTS. 7.5 'MINUTE SERIES (TOPOGRAPHIC M n h a rt {v{ esc avrs- z. Meado.ws d IsIO-RTHAliPT •tNorthampton for Girls %l Williavta St ach Pt ul, !i .Sancr.23 'Y .1: i p p Elwell., Island\ i ILYOKE QUADRANGLE MASSACHUSETTS MINUTE SERIES (TOPOGRAPHIC) I i II 1 1 La`FleUN 'A Y CoRPoRAre ShephE Isla Loo, flu +►st IS C. 0 E I-1 1 L N. U lZ T W X Y A,A 3 C Ea. Ft- 42.0 34.0 21 LIO 10, 'S 3.2 2. t� 0.9 3. o 3.0 {a 1.3 0.8 I.0 1.2 4.1 2 =:3 l.o 0.9 0,7 0,(0 5�. 1.1 1.4 o.4 o.0 1,0 1,1 1. Almer Huntley Jr. Assocs. Inc. Surveyors Engineers Landscape Architects 125 Pleasant St. P. O. Box 568 NORTHAMPTON, MA 01060 (413) 584-7444 euN oFi' ‘1 gWA•1tS JOB 03 0.3 0.3 0.4 0,4 0.3 0, 0,4 a. U•4r 0.4 J,C J.7 d.43 o. a v.7 0.7 0.7 0.(, 0.(o 0.G 0.1 0, S' o.� 0.8 0.9 v.q 0.9 CHECKED BY SCALE 33. 19. G 8.0 IZ•(. Z•9 3.5 I.1 4.r 3.0 3.1 4.0 I.1 2.4 2.i 4. 1 2..1 itCp j., L 1. Si o 1 7 3.4- •s4 L% 2.7 j.0 DRA(NR L (AV 04- .n0.r i k i r-t, Sr SHEET NO OF CALCULATED BY 3MV DATE' 1 Si DATE euNoFf. c s 4= 4$oo 14 41 Sari C Cu€F, t* y2wNu& UltITEZS. 1.c T) .i t F M. 4. 33 3Z Almer Huntley Jr. Assocs. Inc. Surveyors Engineers Landscape Architects 125 Pleasant St. `P. O. Box "568 NORTHAMPTON, MA 01060 (413) 584 -7444 Di ST. 112— 1 �Z 2Z. 2 2.4 ..1-►- D R.An t.r. Arb€... pipit.-r7 1(cs 6 0. Q. f UD k-3; u..... Ni?........ suR $0 Ge-QV. Ps, ra.. t..) -.17. tic;110,J ay. S t) 2.c.1 4 2-b sl c: F t,. w pie. \.k. C.RL) 6.VA -P o ►J Z. INV• R es, ,t sx►si tNy PtPCL.►NvCS sLze f_ o .a► 0 .0o 4- C -�2NQ. 1 4( O 144,1 44. Co 14c. 144.1 JOB 2. V D241,04 AL CAL.c uuten S 4r.) (2, ST 2 SHEET NO. CALCULATED BY SMV CHECKED BY DATE SCALE Q RUNaP- 1c -S) 2.4 P 2• cR 2 8 c� 1 1 s 14, X Pi P*._ 5 tz lS OF DATE /I P1�4_ StZt p4-. 12!u►N t3S'Nb MAN EyJ)4 O J 83 2 8i._ 21 2l0 2s ZS 2ZA 2.2 1 74 l7 Almer Huntley Jr. Assocs. Inc. Surveyors Engineers Landscape Architects 125 Pleasant St. P,'0. Box 5 NORTHAMPTON, MA 01060 (413) 584 -7444 F —o,.- i N N sw st4:s r ■s,... 139 1 280 Cos 2,3B I SZ ZS a 3►3 90 325 24(.0 S il 290 !NI* 134.34 ,N Z9. 0.014 O. 004 2.8.4/ 6.0c. 4- 27.9S 0.0o 4- /Z7 O.004 0,004 12S". 34- CD. oo4 ZS�� p. OD 4 /21.32 0.004- 14, 37 6.004- /Z3.76 O• 0 04- /4 2,1' Z /.S/ Z/. /S /Or 11 7. 9 143. 3 1 +1.4- JOB I�TLAIN CALGULg1,ONS K,Nt� Sr. 3 OF S M DATE 11 3 CALCULATED BY CHECKED BY DATE SCALE SHEET NO. (c.*C Cc) 139,0 138,C 1,40 V S9 3 38.3 S. (36;3 1.1 /58.1 1. I-t14 138.1 1 z,l F 137,) 3,4 AA l 3-C 3.:9 N 135 4.s- 135.$ 13 S'• 15.v 1i. b 1 .4 4 Cl 3o. C 2 3, 6 P+ slat C^.) 3a 42 4 2 4 4 2 g S4- S S4 S4 60 Co G6 Aimer Huntley Jr. Assocs. Inc. _Surveyors Surve ors Engineers Landscape Architects 125 Pleasant St. P. O. _Box 568 NORTHAMPTON, MA 01060 (413) 584 -7444 F Low I N N PJ P *-1-4 Drs- SLoPf �0 G.2.NP. Q 24.740 FE s CI PIN (c fs) Free SrZe, CIN) It 29 Ho a 150 I27 130 x. c 10 (0G 234 I2� 248 )ib ,.41. 1� 15.61 o .00j 1 1 4 $(o 114. 113. 12-5, is Ar Divl:2sION i 3,1 bt.00. 00 1Z1.•7 3.4 I V,,to 0.00(0 0. 0. t 1 t(4 b jNA-bi- .ALOJL aN.S k.103 STa 4 CALCULATED BY M V DATE' II"' 3 JOB SHEET NO CHECKED BY SCALE )21,`6 3.0 OF Co o cE s 4 2' 160 c k- s (act DATE 1(0 t(00.0 1.(00, t( o 01 0 Goo (00 Go G GC* (o (off Almer Huntley Jr. Assocs. Inc. JOB D RAI P.JAe G9i..c.CLA41 a 5— ►G► ■b S Surveyors Engineers Landscape Architects SHEET NO 5 OF 125 Pleasant St. P. O. Box 568 NORTHAMPTON, MA 01060 CALCULATED BY S M DATE I 3 49 (413) 584 -7444 2 20 cfS CHECKED BY DATE SCALE M., 1 o. (00 c fS 6 O c-Fs 'f }.t t 3 -36 CONCRETE PIPE HANDBOOK CO 0 cam T_ 1 0 MO 13 30 H1d30 Figure 3.22. Relative Velocity and Flow in Circular Pipe for Any Depth of Flow. :.7 3 -J Selection of a value fc tial step in determining ly high value results in in hydraulically inadey efficient for the exam quantity of flow and ti and 0.3 feet per 100fe increased from 54 to Values for the coef of investigations for m ject. Presently accept :`Car :o he sufficient. b mined is important materials significantl that is needed is the o erties of the held inst The difference bet‘ pt::d design alues ;,pe a t. mately 2.5 to 3 times In laboratory tests, ranging between 0.00' of smooth wall cbncra of safety, 20 -30 perce ratory smooth wall p safety factors is good recommended design. The values for cord of bituminous linings! bituminous linings ha t 9 Sewers should be de_ sewer, however. vari velocity also change check for self cleanin velocity of 2 feet per entering a storm sew sewage, therefore a.r ified. The dopes red second and 3 feet pe Table 3.5. 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'13 =1 1 1 O CU w. 1 cu y1 N 4.1 nS 0 al b 4 0 T1 0 30 a P 0 C C 0 m N 4 0 14 0 U o 01 O 0 N Id la 0 C 0 O 11 a •r► 0 0 0 rd 4..) U B 3 4 1 O yj r d 'o 0 0 0 0) �C L W O 5 AdsOCIAT[D BORINGS CO., INC. I 7 MAItIARCT CIRCLE r NAUOATUCK. CONN. 00770 PHONIC 729-3430 '"I r 0 1. �12 0 0.9 1 :0 0 21 .0 BORING NO. 1 LINE a STA OFFSET GR. ELEV. DATE November a, 1983 �LOWf DENSITY tL0 DENSITY A STRATUM DESCRIPTION O ST. 8 A STRATUM DESCRIPTION comsat, B Topsoil bar r ayey Sand C F. Sane r, Gray r M -rS n Sand, some M- F.:Gray. tus t Br F. n Gr. F. Sand,Tr. Sand tndof Boring -21.0 G'.40 13.0 Market Street Drain, Northampton Massachusetts PROD T ST BORING RFP -OAT CLItNT ALMER HUN TL JR. ASSOC- IA-TES, INI M.Comp Dry 12 15 M.Comp 3 ap 1 0 M.Comp 9 Wet 9-9 1 COI. A 411 ,,w, e+^ Colin, TIRTT,T, TP€ PFR FOCI' BORING NO. 2 LINE rA STA. OFFSET GR. ELEV. DATE November 8, .1983 Black M -F Si Sand and cinders,Tr. F: Gray. Pcs. Coal _Fra_gs r CT a y r y e y r Sand. 13.0. 21.5 Tr, F. S,3nd,Tr. -i- S Fibers. I End of Boring -21 .-5 GWO None No accumulation Loose Wet Loose_ Loos -Wet 2 -1 1 3 -3 4 Form 5 Commonwealth of Massachusetts a'r /6 From _Northam ton Conservation Commission To Northampton Board of Pnhl i r Wnrkc (Name of Applicant) Address Book T,nrust Street, Northampton Certificate (if registered) ___Page The Notice of Intent for this project was filed on 1 1 29 /83 The public hearing was dosed on Public water supply Private water supply Ground water supply Flood control 19/17/$1,3 5 -1 Order of Conditions Massachusetts Wetlands Protection Act Q.L. c. 131, §40 Ri rhard Rnyl e DEQE File No. fl Storm damage prevention Prevention of pollution Land containing shellfish Fisheries (To bo provided by D City Timm Northamntori City D.P.W. /9 //r //2 /i_ (Name of property owner) Addfess Nnrthamptnn Street Easthampton, This Order Is issued and delivered as follows: l i by hand delivery to applicant or representative on (date) by certified mail, return receipt requested on (date) This project is located at_ ea terl y of phL2l are/ Srnrther1y of the old railrnRri had The property is recoiled at the Registry of Tiamp ch 1 r e f rn r n t y (date) (date) Findings The North amp t nn Cnn c e rva t i nn (r4 1 has reviewed the above referenced Notice or Intent and plans and has held a public hearing on the project. Based on the information available to the Con Rerun tinn Cnrrlmi scion at this time, the CnriTpiSs 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): Therefore, the Conservari on Commi s s i on hereby finds that the following conditions are necessary, in accordance with the Performance Standards set forth in the regulations, to protect those inter- ests checked above. The ConsPrva r i on Cnmrpi c i nn 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 fol- lowing 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 meas- ures, shall be deemed cause to revoke or modify this Order. 2. This 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 focal 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 de- bris, 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 Commi s s ion 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 Quality Engineering, File Number 246 -113 10. Where the Department of Environmental Quality Engineering 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. 1 1. 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: 5 -2 Plans: Title Dated Signed and Stamped by: On File with: Market St. Drainage Diversion Crnss Cn„ntry Ont. 1983 Stephen M. Vukovich STA. -0 +77 to STA.0 +40 Runoff Areas Drain Profile All of th erosion control measures inrinded in the snhmitted Notire Of Tntent Special Conditions (Use additional paper if necessary) 1) All construction areas shall be restored to roginal condition or better upon completion of the project, including vegetation; 2) No areas within the 100 year floodplain nor within 100 feet of a wetland area, as defined in Chapter 131, Section 40, M.G.L., shall be permissable disposal sites, unless otherwise approved by the Conservation Commission; 3) Excavated material and topsoil stockpiles shall be located and stabilized so as to minimize washing into wetland areas or waterways; 4) Adequate measures shall be taken to prevent erosion and siltation of all disturbed areas; 5) This Order Of Conditions shall apply to any successor in interest or successor in control; 11/23/83 Appvd: S.M.V. Conservation Commission 6) Members and agents of the Conservation Commission shall have the right to enter and inspect the premises to evaluate compliance with the Conditions and to require the submittal of any data deemed necessary by the Commission for that evaluation; 7) This projectbshall not .result in an increase in the flood levels,—Tno:the :old Mi11c:River bed, which would violate. conflict with, or require an alteration of the Assurances signed by the Mayor of Northampton on January 21, 1940 with the Army Corps of Engineers in conncection with the proposed pumping station storage pond. (Leave Space Blank) 5 -3A Conservation Commission SPECIAL CONDITIONS CONTINUED 8) There shall be an unrestricted flow•of storm water, in the old Mill River bed; from this purposed new outfall to, and through, the existing culvert under Pound Lane and Pleasant Street. Sid existing culvert shall Iiicleared and made totally operational. 9) Energy Dissipator's shall be placed at the outfall to break the force of- the storm water run -off before it reached the old Mill River bed. 1 Issued By Northa tn Conservatio. Commission Conservation Commission 9 ,1° Signature(s) ■s'" $a• This Order must be signed by a majority e Conservation Commission. On th da of i 19 SV before me personally appeare O_ ,.�.rrii aa!f f i I to me known to be the son described in and who executed the foregoing Instrument and acknowledged that he /she executed same as his /her free t and deed. otary Public My commission expires The applicant, the owner, any person aggrieved by this Order, any owner of land abutting the land upon which the proposed work is to be done or any ten residents of the city or town In which such land is located are hereby notified of their right to request the Department of Environmental Quality Engineering to issue a Superseding Order, providing the request is made by certified mail or hand delivery to the Department within ten days from the date of Issuance of this Order. A copy of the request shall at the same time be sent by certified mall or hand delivery to the Conservation Commission and the applicant. Detach on dotted line and submit to the Northampton Conservation Commissi gttlorto commencement ofwork. To ;Issuing 'Authority Please be advised that the Order of Conditions for the project at File Number has been recorded at the Registry of and has been noted in the chain of title of the affected property in accordance with General Condition 8 on 19 If recorded land, the instrument number which identifies this transaction is If registered land, the document number which identifies this transaction Is Signature Applicant 5-4A 5 -4A