HomeMy WebLinkAboutRDAMassachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WRA Form 1- Request for Determination of A
ii
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
A. General Information
Important:
When filling out
1- Applicant:
forms on the
Curtis YS Diggs
computer, use
Name
only the tab key
to move your
310 Long Pond Drive
cursor - do not
Mailing Address
use the return
S Yarmouth
key.
City/Town
774 994 7909
f�
Phone Number
2. Representative (if any):
Contact Name
Mailing Address
City/Town
Phone Number
B. Determinations
Address
MA
State
Yarmouth
&WTown
MEN
02664
Zip Code
Fax Number (if applicable)
E-Mail Address
State
Zip Code
Fax Number (if applicable)
1. 1 request the Conservation Commission make the following determination(s). Check any that apply:
Conservation Commission
❑ a. whether the area depicted on plan(s) and/or map(s) referenced below is an area subject to
jurisdiction of the Wetlands Protection Act.
❑ b. whether the boundaries of resource area(s) depicted on plan(s) and/or map(s) referenced
below are accurately delineated.
t9--c. whether the work depicted on plan(s) referenced below is subject to the Wetlands Protection Act.
❑--d. whether the area and/or work depicted on plan(s) referenced below is subject to the jurisdiction
of any municipal wetlands ordinance or bylaw of:
Name of
❑ e. whether the following scope of alternatives is adequate for work in the Riverfront Area as
depicted on referenced plan(s).
wpaforml.doc • rev. 7127/2020 WPA Form 1 — Request for Determination of Applicability • Page 1 of 4
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands Yarmouth
Cityfrown
�\ WPA Form 1- Request for Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
C. Project Description (cont.)
b. Identify provisions of the Wetlands Protection Act or regulations which may exempt the applicant
from having to file a Notice of Intent for all or part of the described work (use additional paper, if
necessary).
3. a. If this application is a Request for Determination of Scope of Alternatives for work in the
Riverfront Area, indicate the one classification below that best describes the project.
✓❑ Single family house on a lot recorded on or before 8/1/96
❑ Single family house on a lot recorded after 8/1/96
❑ Expansion of an existing structure on a lot recorded after 8/1/96
❑ Project, other than a single-family house or public project, where the applicant owned the lot
before 8/7/96
❑ New agriculture or aquaculture project
❑ Public project where funds were appropriated prior to 817/96
❑ Project on a lot shown on an approved, definitive subdivision plan where there is a recorded deed
restriction limiting total alteration of the Riverfront Area for the entire subdivision
❑ Residential subdivision; institutional, industrial, or commercial project
❑ Municipal project
❑ District, county, state, or federal government project
❑ Project required to evaluate off -site alternatives in more than one municipality in an
Environmental Impact Report under MEPA or in an alternatives analysis pursuant to an
application for a 404 permit from the U.S. Army Corps of Engineers or 401 Water Quality
Certification from the Department of Environmental Protection.
b. Provide evidence (e.g., record of date subdivision lot was recorded) supporting the classification
above (use additional paper and/or attach appropriate documents, if necessary.)
Wpajgrm1.doc • rev. 7/27/2020 WPA Form 1— Request for Determination of Applicability - Page 3 of 4
Massachusetts Department of Environmental Protection
`< Bureau of Resource Protection - Wetlands Yarmouth
City/Town
?� WPA Form 1- Request for Determination of Applicability
` Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
D. Signatures and Submittal Requirements
I hereby certify under the penalties of perjury that the foregoing Request for Determination of Applicability
and accompanying plans, documents, and supporting data are true and complete to the best of my
knowledge.
I further certify that the property owner, if different from the applicant, and the appropriate DEP Regional
Office were sent a complete copy of this Request (including all appropriate documentation)
simultaneously with the submittal of this Request to the Conservation Commission.
Failure by the applicant to send copies in a timely manner may result in dismissal of the Request for
Determination of Applicability.
Name and address of the property owner:
Curtis YS Diggs / Lynnda M Ignacio
310 Long Pond Drive
Mailing Address
S Yarmouth
City/Town
MA
State
Signatures:
02664
Zip Code
I also understand that n - ation of this Request will be placed in a local newspaper at my expense
in accordance wit ction .05(3)(b)(1) the Wetlands Protection Act regulati ns. �J
Sig ture o pica i` Date
I e
Signature of Representative (if any)
Date
wpaformt.doc rev. 7/27/2020 WPA Form 1 —Request for Determination of Applicability • Page 4 of 4