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Home My WebLink AboutNOII W Massachusetts Department of Environmental Protection Provided by MasSDEP: Bureau of Resource Protection -- Wetlands MassDEP File Number ,ice WPA Form 3 -- Notice of Intent Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Document Transaction Number YARMOUTH Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. - Q Note: Before completing this form consult yourlocal Conservation Commission regarding any municipal bylaw or ordinance. City/Town A. General Information 1. Project Location (Note. electronic filers will click on button to locate project site): 122 Exeter Road West Yarmouth _ 02673 a. Street Address b. CityTTown c. Zip Code Latitude and Longitude: 41.646050-70.235150 23 f. Assessors Map/Plat Number 2. Applicant: Stephen a. First Name c. organization 179 Train Street d. Street Address Dorchester e. City/Town 857-302-9389 d. Latitude 147 g. Parcel /Lot Nu Bickerton MA f. State b. Last Name e. Longitude 02122 g. Zip Code h. Phone Number i. Fax Number j. Email Address 3_ Property owner (required if different from applicant): ❑ Check if more than one owner Same as Above a. First Name b. Last Name c. Organization G. street Haaress e. CityTrown f. State g. Zip Code h. Phone Number i. Fax Number 4. Representative (if any): Robin W. address Wilcox a. First Name b. Last Name Sweetser Engineering c. Company ------- P.O. Box 713 d. Street Address _South Dennis - MA 02660 e. Citylrown - f. State - g. Zip Code 508-385-6900 508-385-6991 sweetsereng@aol.com h. Phone Number i. Fax Number i. Email address 5. Total WPA Fee Paid (from NOI Wetland Fee Transmittal Form): $500, 00 $237.50 $262.50 a. Total Fee Paid b. State Fee Paid c. CityTrown Fee Paid wpaform3.doc • rev. 611612020 Page 1 of 9 4 LlMassachusetts department of Environmental Protection provided by MassDEP: Bureau of Resource Protection - Wetlands NlassC]Ep File number WPA Form 3 �- Notice of Intent Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 f]°cumentTransactian Number YARMOUTH City/Town A. General Information (continued) 6. General Project Description: Vacant Lot, construction of a single family dwelling, septic system, driveway, landscaping, utilities, grading and appurtenances 7a. Project Type Checklist: (Limited Project Types see Section A. 7b.) 1. ® Single Family Home 3. ❑ Commercial/industrial 5. ❑ Utilities 7. ❑ Agriculture (e.g., cranberries, forestry) 9. ❑ Other 2. ❑ Residential Subdivision 4. ❑ Dock/Pier 6. ❑ Coastal engineering Structure 8. ❑ Transportation 7b_ is any portion of the proposed activity eligible to be treated as a limited project (including Ecological Restoration Limited Project) subject to 310 CMR 10.24 (coastal) or 310 CMR 10.53 (inland)? 1. ❑ Yes ® No If yes, describe which limited project applies to this project. (See 310 CMR 10.24 and 10.53 for a complete list and description of limited project types) 2. Limited Project Type If the proposed activity is eligible to be treated as an Ecological Restoration Limited Project (310 CMR10.24(8), 310 CMR 10.53(4)), complete and attach Appendix A: Ecological Restoration Limited Project Checklist and Signed Certification. 8. Property recorded at the Registry of Deeds for: Barnstable a. County C. 226991 b. Certificate # (if registered land) d. Page Number B. Buffer Zone & Resource Area Impacts (temporary & permanent) 1. ® Buffer Zone Only -- Check if the project is located only in the Buffer Zone of a Bordering Vegetated Wetland, Inland Bank, or Coastal Resource Area. 2. ❑ Inland Resource Areas (see 310 CMR 10.54-10.58; if not applicable, go to Section B.3, Coastal Resource Areas). Check all that apply below. Attach narrative and any supporting documentation describing how the project will meet all performance standards for each of the resource areas altered, including standards requiring consideration of alternative project design or location. wpaform3.doc • rev. 6/18/2020 Page 2 of 9 4 For all projects affecting other Resource Areas, please attach a narrative explaining how the resource area was delineated. Massachusetts Department of Environmental Protection Provided by MassDEP! Bureau of Resource Protection - Wetlands MassDEP File Number WPA Form 3 -- Notice of Intent Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Document Transaction Number YARMOUTH City/Town r Zone & Resource Area Impacts (temporary & permanent) (cont'd) a Area Size of Proposed Alteration Proposed Replacement if an a. ❑Xd b. ❑g Vegetated c. ❑der ies andyResourd. ❑g Landto Floodin e_ ❑ Isolated Land Subject to Flooding f. ❑ Riverfront Area 1. linear feet 1. square feel 1. square feet 3 cubic yardsdredged Size of Pro osed Alteration 1. square feet 3. cubic feet of flood storage lost 1. square feet 2. c2rbic feet storage lost 1. Name\Area-. ailable) speci 2_ Width of Riverfront Area (check on ❑ 25 ft. - Designated Densely Donly ❑ 100 ft. -New agricultural proje ❑ 200 ft. - All other projects 3. Total area of Riverfront Area on the s project: a. Proposed alteration of the Riverfront 2. linear feet 2. square feet 2. square feet Proposed Replacement (if any) 2. square feet 4. cubic feet replaced 3. cubic feet replaced y coastal or inland square feet a. total square feet b. square feet within 100 ft. _ \-m et between 100 ft. and 200 ff. 5. Has an alternatives analysis been done and Is it attached to th❑ Yes ❑ No s. Was the lot where the activity is proposed created prior to Aug6? ❑ Yes ❑ No 3. ❑ Coastal Resource Areas: (See 310 CMR 10.25-10.35) Note. for coastal riverfront areas, please complete Section 113.21 above. wpaform3.doc • rev. 6t18/2020 Page 3 of 9 4 Massachusetts Department of Environmental Protection provided by MassDEP: Bureau of Resource Protection - Wetlands MassDEP File Number WPA Form 3 -- Notice of Intent Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Document Transaction Number YARMOUTH CityMown B. Buffer Zone & Resource Area Impacts (temporary & permanent) (cont'd) Check all that apply below. Attach narrative and supporting documentation describing how the project will meet all performance standards for each of the resource areas altered, including standards requiring consideration of alternative project design or location. Online Users: Include your Resource Area Size of Proposed Alteration Proposed Replacement if an document transaction a. [] Designated Port Areas Indicate size under Land Under the Ocean, below number (provided on your receipt page) b. ❑ Land Under the Ocean with all 1. square feet supplementary information you 2. cubic yards dredged submit to the Department. c. ❑ Barrier Beach Indicate size under Coastal Beaches and/or Coastal Dunes below d. ❑ Coastal Beaches 1. square feet q 2. cubic yards beach nourishment e. ❑ Coastal Dunes 1. square feet 2. cubic yards dune nourishment Size of Proposed Alteration Proposed Replacement (if any) f. ❑ Coastal Banks 1. linear feet g. ❑ Rocky Intertidal Shores 1, square feet h. ❑ Salt Marshes 1. square feet 2. sq ft restoration, rehab., creation i. ❑ Land Under Salt Ponds 1. square feet 2. cubic yards dredged j. ❑ Land Containing Shellfish 1. square feet k. ❑ Fish Runs Indicate size under Coastal Banks, inland Bank, Land Under the Ocean, and/or inland Land Under Waterbodies and Waterways, above 1. cubic yards dredged 1.0 Land Subject to 9000 Coastal Storm Flowage 1. square feet 4. ❑ Restoration/Enhancement If the project is for the purpose of restoring or enhancing a wetland resource area in addition to the square footage that has been entered in Section B2.b or B.3.h above, please enter the additional amount here. a. square feet of BVW b. square feet of Salt Marsh 5. ❑ Project Involves Stream Crossings a. number of new -stream crossings b. number of replacement stream crossings wpaform3.doe • rev. 6/18I2020 Page 4 of 9 4 Massachusetts Department of Environmental Protection Provided by MassDEP: Bureau of Resource Protection - Wetlands MassDEP File Number t . WPA Form 3 - Nonce of Intent Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Document Transaction NumberYARMOUTH City/Town C. Other Applicable Standards and Requirements ❑ This is a proposal for an Ecological Restoration Limited Project. Skip Section C and complete Appendix A: Ecological Restoration Limited Project Checklists -- Required Actions (310 CMR 10.11). Streamlined Massachusetts Endangered Species Act/Wetlands Protection Act Review 1. is any portion of the proposed project located in Estimated Habitat of Rare Wildlife as indicated on the most recent Estimated Habitat Map of State -Listed Rare Wetland Wildlife published by the Natural Heritage and Endangered Species Program (NHESP)? To view habitat maps, see the Massachusetts Natural Heritage Atlas or go to http://maps.massgis.state"ma.usIPRI EST _HABlviewer htm. a. ❑ Yes ® No If yes, include proof of mailing or hand delivery of NOI to: Natural Heritage and Endangered Species Program Division of Fisheries and Wildlife Online - 2021 1 Rabbit Hill Road b" Date of -map Westborough, MA 01581 es, the project is also subject to Massachusetts Endangered Species Act (MESA) review (321 G 10.18 . To qualify for a streamlined, 30-day, MESAIWetlands Protection Act review, please comp! Section C.1.c, and include requested materials with this Notice of Intent (NOI); OR complete ction C.2.f, if applicable. if MESA supplemental information is not included with the NOI, by completin ection 1 of this form, the NHESP will require a separate MESA filing which may take up to 90 days to view (unless noted exceptions in Section 2 apply, see below). c. Submit Supplemerffw Information for Endangered Species Review` l 1. ❑ Percentage/acre of property to be altered: (a) within wetland a Resource"'Ire ��,, percentage/acreage (b) outside Resource Area 2. ❑ Assessor's Map or right-of-way plan percentage/acreage 2. ❑ Project plans for entire project site, including wetiand"'resource areas and areas outside of wetlands jurisdiction, showing existing and proposed conditions, existing and proposed tree/vegetation clearing line, and clearly demarcated limits ofwori;C'* (a) ❑ Project description (including description of impacts outside of wetland resource area & buffer zone) (b) ❑ Photographs representative of the site . Some projects not in Estimated Habitat may be located in Priority Habitat, and require NHESP review (see httus://www.mass.gov/ma- endangered-species-act-mesa-regulatory-review). Priority Habitat includes habitat for state -listed plants and strictly upland species not protected by the Wetlands Protection Act. " MESA projects may not be segmented (321 CMR 10.16)" The applicant must disclose full development plans even if such plans are not required as part of the Notice of Intent process. wpaform1doc - rev. 6/18/2020 Page 5 of 9 4 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 3 - Notice of intent ` Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by MassDEP: MassDEP File Number DocumentTransactionNumber YARMOUTH City/Town C. Other Applicable Standards and Requirements (cont'd) MESA filing fee (fee information available at https://www.mass.govihow-tolhow-to-file-for- Make clteck payable to "Commonwealth of Massachusetts - NHESP" and mail to NHESP at above address Projects altering 10 or ingre acres of land also subrnit.- (d) ❑ Vegetation cover type dap of site (e) ❑ Project plans showing Priority.,& Estimated Habitat boundaries (f OR Check One of the Following t. ❑ Project is exempt from MESA review. Attach applicant letter indicating which MESAmption applies. (See 321 CMR 10.14, https://www.mass.qov/service-details/exemptions--review-for- roiectsactivities-in- priority-habitat; the NOI must still be sent to NHESP if project is within estimated habitat pursuant to 310 CMR 10.37 and 10.59.) 2. ❑ Separate MESA review ongoing. a. NHESP Tracking # b. a submitted to NHESI 3. ❑ Separate MESA review completed. Include copy of NHESP "no Take" determination or valid Conservation & Man ement Permit with approved plan. 3. For coastal projects only, is any portion of the proposed project located below the mean high water line or in a fish run? a. ® Not applicable — project is in inland resource area only b. ❑ Yes ❑ No If yes, include proof of mailing, hand delivery, or electronic delivery of NOI to either: South Shore - Cohasset to Rhode Island border, and the Cape & Islands: Division of Marine Fisheries - Southeast Marine Fisheries Station Attn: Environmental Reviewer 836 South Rodney French Blvd. New Bedford, MA 02744 Email: dmf.envreview-south(omass;gov North Shore - Hull to New Hampshire border: Division of Marine Fisheries - North Shore Office Attn: Environmental Reviewer 30 Emerson Avenue Gloucester, MA 01930 Email: dmf.envreview-northPmass.gov Also if yes, the project may require a Chapter 91 license. For coastal towns in the Northeast Region, please contact MassDl P's Boston Office. For coastal towns in the Southeast Region, please contact MassDEP's Southeast Regional Office. c. ❑ Is this an aquaculture project? d. ❑ Yes ❑ No If yes, include a copy of the Division of Marine Fisheries Certification Letter (M.G.L. c. 130, § 57). wpatorm3.doc • rev. 611812020 Page 6 of 9 4 Massachusetts Department of Environmental Protection Provided by MassDEP: Bureau of Resource Protection - Wetlanrls WPA Form 3 -- Notice of Intent Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 MassDEP File Number Document Transaction Number YARMOUTH City Town C. Other Applicable Standards and Requirements (cont'd) 4. Is any portion of the proposed project within an Area of Critical Environmental Concern (ACEC)? Online users: a. ❑ Yes ® No If yes, provide name of ACEC (see instructions to WPA Form 3 or MassDEP Include your Website for ACEC locations)_ Note: electronic filers click on Website. document transaction b. ACEC - number (provided on your 5. Is any portion of the proposed project within an area designated as an Outstanding Resource Water receipt page) (ORW) as designated in the Massachusetts Surface Water Quality Standards, 314 CMR 4.00? with all supplementary a. ❑ Yes ® No information you submit to the 6_ Is any portion of the site subject to a Wetlands Restriction Order under the Inland Wetlands Department. Restriction Act (M.G.L. c. 131, § 40A) or the Coastal Wetlands Restriction Act (M.G.L. c. 130, § 105)? a. ❑ Yes ® No 7_ Is this project subject to provisions of the MassDEP Stormwater Management Standards? a. ❑ Yes. Attach a copy of the Stormwater Report as required by the Stormwater Management Standards per 310 CMR 10.05(6)(k)-(q) and check if: 1_ ❑ Applying for Low Impact Development (LID) site design credits (as described in Stormwater Management Handbook Vol. 2, Chapter 3) 2. ❑ A portion of the site constitutes redevelopment 3. ❑ Proprietary BMPs are included in the Stormwater Management System. b. ® No. Check why the project is exempt: 1.0 Single-family house 2. ❑ Emergency road repair 3. ❑ Small Residential Subdivision (less than or equal to 4 single-family houses or less than or equal to 4 units in multi -family housing project) with no discharge to Critical Areas. D. Additional Information ❑ This is a proposal for an Ecological Restoration Limited Project_ Skip Section D and complete Appendix A: Ecological Restoration Notice of Intent — Minimum Required Documents (310 CMR 10.12). Applicants must include the following with this Notice of Intent (NOI). See instructions for details. Online Users: Attach the document transaction number (provided on your receipt page) for any of the following information you submit to the Department. t. ® USGS or other map of the area (along with a narrative description, if necessary) containing sufficient information for the Conservation Commission and the Department to locate the site. (Electronic filers may omit this item.) 2. ® Plans identifying the location of proposed activities (including activities proposed to serve as a Bordering Vegetated Wetland (BVWj replication area or other mitigating measure) relative to the boundaries of each affected resource area. wpafortn3.doc • rev. 5/18/2020 Page 7 of 9 4 WPA Form 3 — Notice of Intent Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 D. Additional Information (cont'd) Massachusetts Department of Environmental Protection Provided by MassDEP: Bureau of Resource Protection - Wetlands MassDEP File Number Document Transaction Number YARMOUTH Cityirown 3. ❑ Identify the method for BVW and other resource area boundary delineations (MassDEP BVW Field Data Form(s), Determination of Applicability, Order of Resource Area Delineation, etc.), and attach documentation of the methodology. 4. ❑ List the titles and dates for all plans and other materials submitted with this NOI. Proposed_ Septic Design for Stephen Bickerton a. Plan Title Sweetser Engineering Robin W. Wilcox, PLS / Terence M. Hayes, R.S. b. Prepared By c. Signed and Stamped by February 7, 2022 1 "=20' d. Final Revision Date e. Scale f. Additional Plan or Document Title g. Date 5. ❑ If there is more than one property owner, please attach a list of these property owners not listed on this form. 6. ❑ Attach proof of mailing for Natural Heritage and Endangered Species Program, if needed. 7. ❑ Attach proof of mailing for Massachusetts Division of Marine Fisheries, if needed. 8.0 Attach NOI Wetland Fee Transmittal Form 9. ❑ Attach Stormwater Report, if needed. E. Fees �. ❑ Fee Exempt: No filing fee shall be assessed for projects of any city, town, county, or district of the Commonwealth, federally recognized Indian tribe housing authority, municipal housing authority, or the Massachusetts Bay Transportation Authority. Applicants must submit the following information (in addition to pages 1 and 2 of the NOI Wetland Fee Transmittal Form) to confirm fee payment: 21503 2. Municipal Check Number 21504 4. State Check Number Sweetser 6. Payor name on check: First February 23, 2022 3. Check date February 23, 2022 5. Check date Engineering 7. Payor name on check: Last Name wpaform3.doc • rev, 611812020 Page 8 of 9 4 (Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 3 -- Notice of Intent Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 F. Signatures and Submittal Requirements Provided by MassDEP: MassDEP File Number Document Transaction Number YARMOUTH City/Town I hereby certify under the 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. I understand that the Conservation Commission will place notification of this Notice in a local newspaper, at the expense of the applicant in accordance with the wetlands regulations, 310 CMR 10.05(5)(a). I further certify under penalties of perjury that all abutters were notified of this application, pursuant to the requirements of M.G.L. c. 131, § 4€3. Notice must be made by Certificate of Mailing or in writing by hand delivery or certified mail (return receipt requested) to all abutters within 100 feet of the property line of the project location. 1. 5igytule of pp li nt 2. Date 3:' Fe fo e Ow r .fdi r 4. Da e Signature of Representative (i any) 6. D to For Conservation Commission: Two copies of the completed Notice of Intent (Form 3), including supporting plans and documents, two copies of the NOI Wetland Fee Transmittal Form, and the city/town fee payment, to the Conservation Commission by certified mail or hand delivery. For MassIDEP: One copy of the completed Notice of Intent (Form 3), including supporting plans and documents, one copy of the NOI Wetland Fee Transmittal Form, and a copy of the state fee payment to the MassDEP Regional Office (see Instructions) by certified mail or hand delivery. Other: If the applicant has checked the "yes" box in any part of Section C, Item 3, above, refer to that section and the Instructions for additional submittal requirements_ The original and copies must be sent simultaneously. Failure by the applicant to send copies in a timely manner may result in dismissal of the Notice of Intent. wpaforrnIdoc • rev. 611 B/2020 Page 9 of 9 Massachusetts Department of Environmental Protection \` Bureau of Resource Protection - Wetlands NOI Wetland Fee Transmittal Form Massachusetts Wetlands Protection Act M.G.L, c. 131, §40 ti A. Applicant Information Important: When filling out forms on the computer, 1. Location of Project. - use only the tab Ivey to move your 122 Exeter Road West Yarmouth cursor - do not use the return a. Street Address b. Ci ty !Town Key. 21503 $237.50 c. Check number----"-- d. Fee amount tetr 2. Applicant Mailing Address: Stephen Bickerton, Sr. a. First Name b. Last Name c. urganization 179 Train Street d. Mailing Address Dorchester e. CitylTown 857-302-9389 h. Phone Number i. Fax Number 3. Property Owner (if different): Same as Above a. First Name c. Orga u. nnauing f+oaress e. [:Ity! I own MA f. State j. Email Address b. Last Name h_ Phone Number i. Fax Number j. Email Address f. State 02122 g. Zip Code g. Zip Code To calculate B. Fees filing fees, refer to the category fee list and Fee should be calculated using the following process & worksheet. Please see Instructions before examples in the filling out worksheet. instructions for filling out WPA Step I/Type of Activity: Describe each type of activity that will occur in wetland resource area and buffer zone. Form 3 (Notice of Intent). Step 2/Number of Activities: Identify the number of each type of activity. Step 311ndividual Activity Fee: Identify each activity fee from the six project categories listed in the instructions. Step 4/Subtotal Activity Fee: Multiply the number of activities (identified in Step 2) times the fee per category (identified in Step 3) to reach a subtotal fee amount. Note: If any of these activities are in a Riverfront Area in addition to another Resource Area or the Buffer Zone, the fee per activity should be multiplied by 1.5 and then added to the subtotal amount. Step 517otal Project Fee: Determine the total project fee by adding the subtotal amounts from Step 4. Step 6/Fee Payments: To calculate the state share of the fee, divide the total fee in half and subtract $12.50. To calculate the city/town share of the fee, divide the total fee in half and add $12.50. noifeetf.doc • wetland Fee Transmittal Form • rev. 10111 Page 1 of 2 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands NQI Wetland Fee Transmittal Form Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Fees (continued) Step I/Type of Activity 2a C. Submittal Requirements Step 2/Number Step Step 4/Subtotal Activity of Activities 3/11ndividual Fee Activity Fee $500.00 $500,00 Step S/Total Project Fee: Step 6/Fee Payments: Total Project Fee: State share of filing Fee: City/Town share of filling Fee: $500.00 $500.00 a. Total Fee from Step 5 $237.50 b. 112 Total Fee less $12.50 $262.50 _ c. 112 Total Fee plus $12.50 a_) Complete pages 1 and 2 and send with a check or money order for the state share of the fee, payable to the Commonwealth of Massachusetts. Department of Environmental Protection Box 4062 Boston, MA 02211 b.) To the Conservation Commission: Send the Notice of Intent or Abbreviated Notice of Intent; a copy of this form; and the city/town fee payment. To MassDEP Regional Office (see Instructions): Send a copy of the Notice of Intent or Abbreviated Notice of Intent; a copy of this form; and a copy of the state fee payment. (E-filers of Notices of Intent may submit these electronically.) noifeelf.doc • Wetland Fee Transmittal Form • rev. 10111 Page 2 of 2