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Home My WebLink AboutNOIOF •Ye�R DEPARTMENT OF CONSERVATION ��l�fl.�1%1�►1T rf r All filings must be made on Town of Yarmouth forms found at www.varmouth.ma.us/325/Conservation. The filing deadline is two weeks prior to the next scheduled Conservation Commission meeting. No new information may be accepted into the Commissioners' packets within the week before a meeting. Failure to follow this Checklist shall result in an Administrative Incomplete Application and will not be advertised for a Public Hearing. Refer to the meeting and fee schedule. Contact the Conservation Office if you need assistance. f r 1, Vfflmi c No Does the property have any outstanding/expired Orders of Conditions? If so, please file a Request for Certificate of Compliance for each outstanding/expired Order, as the Commission may not issue a new Order until any outstanding/expired Orders have been closed and recorded. (*see page 2) 1 original application with original signatures (double sided). x A comprehensive and detailed narrative of the project including existing 8t proposed conditions, construction sequence, type of equipment, staging locations, drainage and stormwater, erosion controls, invasive species management and alternative analysis. The narrative shall document how the project meets performance standards per 310 CMR 10.0 & TOY Wetland Bylaw, Chapter 143, BVW delineation sheets or other supporting information. 1 original and 7 copies of the plan, folded separately, right side out with title visible. All plans shall reference NAVD1988 unless otherwise noted. Landscape plans shall be detailed to show proposed & existing conditions, native species, size and spacing. x A 100' radius map, current abutters list and abutters notification identifying the property owners who are to be notified per 310 CMR 10.00. Abutters list must be certified by the Town Assessor's office. The Assessors office requires 7 days advance notice. A pdf copy of signed application, supporting information, and plan emailed to kprantayarmouth.ma.us. Please list project property's street address in the pdf file name. Submit Certified Mail Receipts (PS Form 3800) for all abutters. N/A Submit Certified Mail Receipts for Massachusetts Natural Heritage and Endangered Species Program and Massachusetts Division of Marine Fisheries. Alternatively, you may visit their websites for electronic filing information. If filed electronically, please copy kgrant(a�yarmouth.ma.us. N/A Waterway's jurisdiction — Any coastal projects such as, but not limited to, docks, piers, bulkheads, revetments, dredging and boardwalks shall require submittal of all Notice of Intent, plans and supplemental information to the Town of Yarmouth Waterways/Shellfish Committee via the Natural Resources office by certified mail or hand delivery. The applicant or his/her representative must provide the Conservation office proof that this has been done or the filing will not be accepted. Yarmouth Conservation Commission • 1146 Route 28 • South Yarmouth, MA 02664-4492 Tel. (508)-398-2231 Ext. 1288 • Fax (508)-398-0836 • TTD# (508) 398-2231 Rev 9/2021 Page 1 of 2 X State filing fee: separate check, Refer to Wetland Fee Transmittal Form X By-law filing fee: separate check made payable to "Town of Yarmouth" X Legal ad fee: separate check made payable to "Town of Yarmouth" Please list project property's street address on checks. Refer to Fee Schedule at https://www.varmouth.ma.us/696/Filing-Forms N/A If you are filing with MassDEP using eDEP, please include a copy of the filing confirmation with your application. X If not filing via eDEP, a copy of your application, plan, and all other supporting information must be sent VIA EMAIL to DEP, Southeast Region at SERO NOI(a)mass.00v with a subject line showing "YARMOUTH - NOI - Street Address - Applicant Name" and copied to kArant@yarmouth.ma.us. We must receive a copy of this email as proof that it has been sent to DEP. x DEP share of the fee (refer to NOI form) shall be sent to: Dept. of Environmental Protection Box 4062 Boston, MA 02211 Other Comments: • Does the proposed project meet all of the applicable regulations of the Town of Yarmouth Zoning bylaws? Do you need to file with the Yarmouth Board of Appeals? If so, you must file with both boards at the same time. • If a vacant lot, have you completed and received a determination for the Building Department for a lot inquiry form? *To view all Conservation files for the property address online: Go to www.varmouth.ma.us and click on: Yarmouth Online Town Services Town Record Search with Weblink Browse Our Parcel Related Documents First letter of street name to open file Street name Property address Conservation Click on the folder you want to view Yarmouth Conservation Commission • 1146 Route 28 • South Yarmouth, MA 02664-4492 Tel. (508)-398-2231 Ext. 1288 • Fax (508)-398-0836 • TTD# (508) 398-2231 Rev 9/2021 Page 2 of 2 ASSESSORS MAP 34 LYNDALE ROAD IN SOUTH YARMOUTH, MASSACHUSETTS IIA Pi NE GROVE RD Near <jIll" i.'. I I7 11 PEFIE (d PEREGRINE Ul 9 PEREr,RIHE LH 5PEREGRINE LH LII 26 ,1 I tooArr ROAD RROAD ROAD )I LYNDALE RD 29 LYNDALE RD 22AFTRD 14AFT RD 15AFT RD TARMOUT11 Att Road r )� L' D 0 O 2 A tIll, )0 Cl/1DA LOCAL LOCUS MAP 34 LYNDALE ROAD IN SOUTH YARMOUTH, MASSACHUSETTS U.S.G.S. MAP 34 LYNDALE ROAD IN SOUTH YARMOUTH, MASSACHUSETTS at - ``/ 644 t arr 'u /043 DL IV ,M us LOCUS MAP 34 LYNDALE ROAD IN SOUTH YARMOUTH, MASSACHUSETTS FEMA MAP 34 LYNDALE ROAD IN SOUTH YARMOUTH) MASSACHUSETTS Legend NHESP Priority Habitats of Rare Species NHESP Estimated Habitats of Rare Wildlife Certified Vernal Pools Potential Vernal Pools - 4 �p5� P 4 NuaY e� n - g 5 nue. u. 6 osi ° 34 dale Xoed. South Yamouth. ssro�� E T Me ehuseM. 02&4 f e l 4q NHESP — ESTIMATED HABITAT OF RARE SPECIES. 34 LYNDALE ROAD IN SOUTH YARMOUTH, MASSACHUSETTS Legend NHESP Priority Habitats of Rare Species `..-' NHESP Estimated Habitats of Rare Wildlife Certified Vernal Pools Potential Vernal Pools s a a , 'e Ma ch. 026" _. n NHESP — PRIORITY HABITAT OF RARE SPECIES. 34 LYNDALE ROAD IN SOUTH YARMOUTH, MASSACHUSETTS o -YA you DEPARTMENT OF CONSERVATION Form General Information: If the applicant is not the property owner, please submit this form with your application. The owner mast be sent a copy of the application on the same day it is filed with this office. Property Address: _34 Lyndale Assessors Map/Lot: I (we) hereby authorize the individual members of the Yarmouth Conservation Commission and its agents to enter upon the referenced property for the purpose of gathering information regarding the application filed with the Commission pursuant to the Wetlands Protection Act (M.G.L. Ch. 131, s. 40) and/or the Yarmouth Wetlands Protection Bylaw (Chapter 143). Authorized Signature: Date: 3 2/ 2Pliiz Please Print Name: Edward A. Stone If other than owner, please state whether tenant, agent, or other: Agent Mailing Address: _P.O. Box 1729 Sandwich, MA Phone: 508-527-3600 Email: Eas.Survey@yahoo.com Yarmouth Conservation Commission • 1146 Route 28 • South Yarmouth, MA 02664-4492 Tel. (508)-398-2231 Ext. 1288 • Fax (508)-398-0836 • TTD# (508) 398-2231 251 228/ / / 25/ 238.1/ CAMPBELL LINDA A NEUMANN RICHARD E 647 PLEASANT ST NEUMANN J MARLBOROUGH , MA 01752 21 MACKENZIE ROAD SOUTH YARMOUTH , MA 02664 25/ 229/ / / 25/ 238.31 ADZIGIREY STANISLAV TIERNEY JOHN ADZIGIREY LILIYA TIERNEY PATRICIA 9 NICHOLAS LN 48 BEAVER ST SOUTH HAMPTON , MA 01073 WALTHAM , MA 02453 25/ 230/ FEINSTEIN ALLEN S ELIZABETH CLARK 74 STUARTRD Please use this signature to certify this list of properties 74 STU NEWTON CENTER, MA 02459 abutting within 100' of the parcel located at: 34 Lyndale Rd., South Yarmouth, MA 02664 25/ 252/ / / Assessors Map 25, Lot 239 DERRICO MATTHEW / DERRICO LAURIE� 17 ELIOT ST Andy Machado, Director of Assessing NATICK , MA 01760 g February 4, 2022 25/ 251/ LAMALVA FRANCES 29 LYNDALE RD SOUTH YARMOUTH , MA 02664 25/ 239/ / / BRUNDAGE FREDERICK J BRUNDAGE DAWN M 66 OXFORD ST SOMERVILLE , MA 02143 25/ 240/ COSTIGAN ELAINE F (LIFE EST) 30 LYNDALE RD, SOUTH YARMOUTH , MA 02664 25/ 241/ MALONEY PAUL S MALONEY CAROL J 85 RUSSELL LN ABINGTON , MA 02351.1236 251 231/ PURCELL ROBERT A TR PURCELL ROBERTA C TR 59 FREMONT ST PROVIDENCE , RI 02906 25/ 238.2/ / / WARREN ELAINE VICTORIA 25 MACKENZIE RD SOUTH YARMOUTH , MA 02660 4 Massachusetts Department of Environmental Protection Provided by MassDEP Bureau of Resource Protection - Wetlands MassDEP File Number WPA Form 3 — Notice of Intent LMassachusetts Wetlands Protection Act M.G.L. c. 131, §40 Document Transaction Number Yarmouth Cityrrown Important: When fillinout forms on A. General Information g the computer, use only the tab key to 1. Project Location (Note: electronic filers will click on button to locate project site): move your cursor - do not use the tukey. return Note: Before completing this form consult yourlocal Conservation Commission regarding any municipal bylaw or ordinance. 34 Lyndale Road South Yarmouth 2. Applicant: Frederick & a. First Name C. Organization 34 Lyndale Road d. Street Address South Yarmouth e. City/Town h. Phone Number i. Fax Number Brundage b. Last Name Mass 02664 f. State g. Zip Code j. Email Address 3. Property owner (required if different from applicant): ❑ Check if more than one owner Frederick & Dawn Brundage a. First Name b. Last Name c. Address e. Cityrrown f. State h. Phone Number 4. Representative (if any): Edward A. a. First Name EAS Survey Inc. c. Company P.O. Box 1729 I. Fax Number j. Email address Stone b. Last Name g. Zip Code wpaform3.doc • rev. 6/1812020 Page 1 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 City/Town d. Street Address Sandwich MA 02563 e. City/fown f. State g. Zip Code 508-527-3600 h. Phone Number i. Fax Number eas.survey@yahoo.com j. Email address 5. Total WPA Fee Paid (from NOI Wetland Fee Transmittal Form): $500 $237.50 $262.50 a. Total Fee Paid b. Slate Fee Paid c. City/fown Fee Paid A. General Information (continued) 6. General Project Description: Raze and Replace of a single family dwelling 7a. Project Type Checklist: (Limited Project Types see Section A. 7b.) 1. X Single Family Home 2. ❑ Residential Subdivision 3. ❑ Commercial/Industrial 4. ❑ Dock/Pier 5. ❑ Utilities 6. ❑ Coastal engineering Structure 7. ❑ Agriculture (e.g., cranberries, forestry) 8. ❑ Transportation 9. ❑ Other 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 ❑ If yes, describe which limited project applies to this project. (See 310 CMR 10.24 No X 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 b. Certificate # (If registered land) wpaform3.doc • rev. 6/18/2020 Page 2 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 ILI Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Document Transaction Number Yarmouth Cityrrown 31337 194 c. Book d. Page Number B. Buffer Zone & Resource Area Impacts (temporary & permanent) 1. x 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. B. Buffer Zone & Resource Area Impacts (temporary & permanent) (cont'd) For all projects b. ❑ Bordering Vegetated affecting other Wetland Resource Areas, please attach a narrative c. ❑Land Under Waterbodies explaining how the resource area was and Waterways delineated. d. X Bordering Land Subject to Flooding Size of Proposed Alteration Proposed Replacement (if any) 1. linear feet 2. linear feet 1. square feet 2. square feet square 3. cubic yards dredged - • ••• -• • 2,000 1. square feet square 2. square feet 3. cubic feet of flood storage lost 4. cubic feet replaced e. ❑ Isolated Land Subject to 1. square feet Flooding 2. cubic feet of flood storage lost 3. cubic feet replaced f. ❑ Riverfront Area 1. Name of waterway (if available) - specify coastal or Inland 2. Width of Riverfront Area (check one): wpaform3.doc • rev. 6/18/2020 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 L11 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Document Transaction Number Yarmouth City/Town Online Users: Include your document transaction number (provided on your receipt page) with all supplementary information you submit to the Department. ❑ 25 ft. - Designated Densely Developed Areas only ❑ 100 ft. -New agricultural projects only ❑ 200 ft. - All other projects 3. Total area of Riverfront Area on the site of the proposed project: square feet 4. Proposed alteration of the Riverfront Area: a. total square feel b. square feet within 100 ft. c. square feet between 100 ft. and 200 ft. 5. Has an alternatives analysis been done and is it attached to this NOI? ❑ Yes ❑ No 6. Was the lot where the activity is proposed created prior to August 1, 1996? ❑ Yes ❑ No 3. ❑ Coastal Resource Areas: (See 310 CMR 10.25-10.35) Note: for coastal riverfront areas, please complete Section B.2.f. above. 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. Resource Area Size of Proposed Alteration Proposed Replacement (if any) a. ❑ Designated Port Areas b. ❑ Land Under the Ocean c. ❑Barrier Beach d. ❑ Coastal Beaches e. ❑ Indicate size under Land Under the Ocean, below 1. square feet 2. cubic yards dredged Indicate size under Coastal Beaches and/or Coastal Dunes below 1. square feet 2. cubic yards beach nourishment Coastal Dunes 1. square feet 2. cubic yards dune nourishment Size of Proposed Alteration Proposed Replacement (if any) wpaform3.doc • rev. 6/18/2020 Page 4 of 9 4 mber ction Number Massachusetts Department of Environmental Protection Provided by MassDEP Bureau of Resource Protection - Wetlands MassDEP File Nu WPA Form 3 — Notice of Intent Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Document Transa Yarmouth City/Town f. ❑ Coastal Banks 1. linear feet g. ❑ Rocky Intertidal Shores 1. square feet h. ❑Sa Marshes 1. square feet 2. sq ft restoration, rehab., creation I. ❑ Land Under Salt Ponds j. ❑ Land Containing Shellfish k. ❑Fish Runs I. ❑ Land Subject to Coastal Storm Flowage 1. square feel 2. cubic yards dredged square Indicate size under Coastal Banks, inland Bank, Land Under the Ocean, and/or inland Land Under Waterbodies and Waterways, above 1. cubic yards dredged 2,000 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 B.2.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 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://mai)s.rnassgis.state.ma.us/PRI EST HAB/viewer.htm. wpaformIdoc • rev. 6/1812020 Page 5 of 9 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 a. ❑ Yes ❑ If yes, include proof of mailing or hand delivery of NOI to: No X Natural Heritage and Endangered Species Program Division of Fisheries and Wildlife 1 Rabbit Hill Road Westborough, MA 01581 b. Date of map Phone: (508) 389-6360 If yes, the project is also subject to Massachusetts Endangered Species Act (MESA) review (321 CMR 10.18). To qualify for a streamlined, 30-day, MESA/Wetlands Protection Act review, please complete Section C.1.c, and include requested materials with this Notice of Intent (NOI); OR complete Section C.2.f, if applicable. If MESA supplemental information is not included with the NOI, by completing Section 1 of this form, the NHESP will require a separate MESA filing which may take up to 90 days to review (unless noted exceptions in Section 2 apply, see below). c. Submit Supplemental Information for Endangered Species Review'` ❑ Percentage/acreage of property to be altered: (a) within wetland Resource Area percentage/acreage (b) outside Resource Area percentage/acreage 2. ❑ Assessor's Map or right-of-way plan of site 2. ❑ Project plans for entire project site, including wetland resource areas and areas outside of wetlands jurisdiction, showing existing and proposed conditions, existing and proposed tree/vegetation clearing line, and clearly demarcated limits of work 2" (a) ❑ Project description (including description of impacts outside of wetland resource area & buffer zone) (b) ❑ Photographs representative of the site C. Other Applicable Standards and Requirements (cont'd) (c) ❑ MESA filing fee (fee information available at https://www. mass.aov/how-to/how-to-file-for-a-mesa-protect-review). Make check payable to "Commonwealth of Massachusetts - NHESP" and mail to NHESP at above address " Some projects not in Estimated Habitat may be located in Priority Habitat, and require NHESP review (see httos://www. mass.aov/ma-en danaered-species-act-mesa-rea u latory-review). Priority Habitat includes habitat for state -listed plants and strictly upland species not protected by the Wetlands Protection Act. 2.. 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 6 of 9 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 Cityfrown Projects altering 10 or more acres of land, also submit: (d) ❑ Vegetation cover type map of site (a) ❑ Project plans showing Priority & Estimated Habitat boundaries M OR Check One of the Following 1. x Project is exempt from MESA review. Attach applicant letter indicating which MESA exemption applies. (See 321 CMR 10.14, httDs://www. mass.aov/service-details/exemptions-from-review-for-Droiectsactivities-in-Driority-ha bitat; the NOI must still be sent to NHESP if the project is within estimated habitat pursuant to 310 CMR 10.37 and 10.59.) 2. ❑ Separate MESA review ongoing. a. NHESP Tracking # b. Date submitted to NHESP 3. ❑ Separate MESA review completed. Include copy of NHESP "no Take' determination or valid Conservation & Management 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 OX 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 North Shore - Hull to New Hampshire border: 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(cDmass.gov Division of Marine Fisheries - North Shore Office Attn: Environmental Reviewer 30 Emerson Avenue Gloucester, MA 01930 Email: dmf.envreview-northCa)mass.00v Also if yes, the project may require a Chapter 91 license. For coastal towns in the Northeast Region, please contact MassDEP'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 OX No If yes, include a copy of the Division of Marine Fisheries Certification Letter (M.G.L. c. 130, § 57). C. Other Applicable Standards and Requirements (cont'd) wpaform3.doc • rev. 6/1812020 Page 7 of 9 Department of Environmental Protection Provided by MassDEP: Bureau of Resource Protection - Wetlands MassDEP File Number L11Massachusetts WPA Form 3 — Notice of Intent Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Document Transaction Number Yarmouth City/Town 4. Is any portion of the proposed project within an Area of Critical Environmental Concern (ACEC)? a. ❑ Yes ❑ If yes, provide name of ACEC (see instructions to WPA Form 3 or MassDEP Online users: Include your No X Website for ACEC locations). Note: electronic filers click on Website. document transaction b. ACEC number receipt on your receipt 5. Is an portion of the proposed project within an area designated as an Outstanding Resource Water Y P P P P 1 9 9 page) with all (ORW) as designated in the Massachusetts Surface Water Quality Standards, 314 CMR 4.00? supplementary information you a. ❑ Yes ❑ X No submit to the Department. 6. Is any portion of the site subject to a Wetlands Restriction Order under the Inland Wetlands Restriction Act (M.G.L. c. 131, § 40A) or the Coastal Wetlands Restriction Act (M.G.L. c. 130, § 105)? a. ❑ Yes ❑ X 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. ONO. Check why the project is exempt: 1. ❑ X Single-family house 2. ❑ Emergency road repair 3. ❑ Small Residential Subdivision or eaual to 4 units in multi -fan D. Additional Information than or equal to 4 single-family houses or less than using project) with no discharge to Critical Areas. ❑ 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. 1. ❑ 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 [BVW] replication area or other mitigating measure) relative to the boundaries of each affected resource area. wpaform3.doc • rev. 6/18/2020 Page 8 of 9 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 D. Additional Information (cont'd) 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. CERTIFIED a. Plan Title EAS SURVEY INC. Edward A. Stone b. Prepared By c. Signed and Stamped by Jan. 24, 2022 1" = 20' d. Final Revision Date e. Scale Plan or Document 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. s. ❑X Attach NOI Wetland Fee Transmittal Form 9. ❑ Attach Stormwater Report, if needed. E. Fees I. ❑ 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: 4234 2. Municipal Check Number 4233 4. State Check Number SHAWME HILL CORP. 6. Payor name on check: First Name 2-24-2022 3. Check date 2-24-2022 5. Check date name on check: Last Name wpaform3.doc • rev. 6/18/2020 Page 9 of 9 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 1-. bignatures and Submittal Requirements Provided by MassDEP: ManDEP File Number Document Transaction Number Yarmouth City/Tom 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, § 40. Notice must be made by Certificate of Mailing or in writing by hand delivery or certified mail (return reyeipt requested) to all abutters within 100 feet of the property line of the project location. i A. L� 2. Date 4. Date February 23 2022 6. Date 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 MassDEP: One copy of the completed Notice of Intent (Form 3), including supporting plans and documents, one copy of the-NOI Welland 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. weaform&doc - rev. 6/18/2020 Page 10 of 9 Important: When filling out forms on the computer, use only the tab key to move your cursor- do not use the return key. PON, I To calculate filing fees, refer to the category fee list and examples in the instructions for filling out WPA Form 3 (Notice of Intent). 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 A. Applicant Information Location of Project: 34 Lyndale Road a Street Address c. Check number 2. Applicant Mailing Address: South Yarmouth b. City/rown $237.50 d. Fee amount Frederick Brund a. First Name age b. Last Name South Yarmouth e. Cityfrown MA 02664 f. State g. Zip Code h. Phone Number i. Fax Number j. Email Atldress 3. Property Owner (if different): a. First Name b. Last Name d. Mailing Address e. h. Phone Number B. Fees noifeeBAoo . Wetland Fee TrensmiMi Form. re, toil, f. State g. Zip Code I. Fax Number j. Email Address Page i of 2 Massachusetts Department of Environmental Protection _- Bureau of Resource Protection - Wetlands NO1 Wetland Fee Transmittal Form Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 uc calculated using the following process &worksheet. Please see fi/ling out worksheet. Step 1/Type of Activity: Describe each type of activity that will occur in wetland resource area and buffer zone. Step 2/Number of Activities: Identify the number of each type of activity. Step 3/Individual 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 5/Total 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. B. Fees (continued) Step 1/Type of Activity Step 2/Number of Activities Step Step 4/Subtotal Activity 3/Individual Fee Activity Fee Single family dwelling 1 $500 $500 Step 5/Total Project Fee: Payments: Step 6/Fee Total Project Fee: noifeelfdo • Welland Fee TralemNal Form • rev. iom $500 a. Total Fee from Step 5 Page 2 of 2 Massachusetts Department of Environmental Protection T-- Bureau of Resource Protection - Wetlands ?� NOI Wetland Fee Transmittal Form Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 State share of filingFee: $2ee l b. 1/2 Totall Fee less City/Town share of fillip Fee: $2ee p 9 c. 1/2 Totall Fee plus $12.50 U. auDmlttai Kequirements 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.) noifeeff.doc • Welland Fee Transmittal Form •rev. 10111 Page 3 of 2