INITIAL NOTIFICATION OF A
PRIVATE RESTRICTED LANDING AREA (“PRLA”)
Instructions:
Please complete this form in its entirety, sign, date, and return this form to:
MassDOT Aeronautics Division, Logan Office Center, One Harborside Drive, Suite 205N, East Boston, MA 02128-2909
Owner: (Legal Owner of Property)
Operator: (If other than Owner)
Name:
Address:
City, State, Zip:
Phone Number:
Type of Landing Area:
(Helipad, Airstrip, etc…)
Landing Area Name:
Location (City/Town):
Landing Area elevation above mean sea level (msl):
Nearest Public Airport:
Distance to Nearest Public Airport:
Direction to Nearest Public Airport:
Runway
/
/
/
Length
ft.
ft.
ft.
Wind Indicator:
Fuel Available:
Yes
Yes
Width
ft.
ft.
ft.
No
No
msl
Degrees
Latitude–N
Longitude–W
Datum:
Surface Type
Paved
Paved
Paved
Turf
Turf
Turf
Communications:
List type(s) of fuel:
R/W Markings
Gravel
Gravel
Gravel
Yes
Yes
Yes
Yes
No
NAD 83
Minutes
NAD 27
Describe type of Markings
No
No
No
Seconds
Other
R/W Lighting
Yes
Yes
Yes
No
No
No
Unicom Frequency:
Description of Proposed Activity:
List “N” Numbers of all based aircraft:
FAA Reg. No.:
Model & Mfg. of Aircraft
1
2
3
FAA Reg. No.:
Model & Mfg. of Aircraft
4
5
6
Estimated Number of Aircraft Movements per year (take offs & landings):
Important:
1.
2.
3.
4.
5.
If the landing area is not owned by the Operator, a copy of the agreement covering use of the property must be attached.
Include a diagram and overhead photo of the proposed airfield. The Aeronautics Division recommends the PRLA not be shown on
Aeronautical Charts.
All aircraft based at this facility shall be registered with MassDOT Aeronautics Division.
The Owner shall assure compliance with applicable local, state, and federal requirements for establishment of this PRLA.
Submit one signed copy of this form as noted above; please keep a copy for your records.
As required by MASS. GEN. LAWS ch. 90, §39B, I hereby submit this notice to the MassDOT Aeronautics Division for the
establishment of a restricted landing area, intended for non-commercial, Private-Use Only. I also hereby certify that this airfield is
in compliance with applicable state standards for a private restricted landing area pursuant to 702 CMR §5.03(3)(c).
Signature
MassDOT Aero PRLA-151
REV 07-13-2011
Date
Signature of Operator
Date