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Home My WebLink AboutRDA ApplicationMassachusetts Department of E nvironme nta I Protection Bureau of Water Resources - Wetlands WPA Form 1- Request for Determination of Applicability Yarmouth Massachusetts Wetlands Protection Act M.G.L. c. 131 A. General lnformation 1. Applicant: Tom Dwyer Municipality lmportantl When filling out forms on the computer, use only the tab key to move your cursor - do not use the retum key. First Name 1 lntervale Rd Last Name Address Dedham MA 02026 City/Town 617-293-1835 State Zip Code tdwyer501@Gmail.com Phone Number 2. Property Owner (if different ftom Applicant): Email Address First Name Last Name Address City/Town State Zip Code Phone Number Email Address (if known) 3. Representative (if any) First Name Last Name Company Name Address Cityffown state Zip Code Phone Number Email Address (if known) B. Project Description 1. a. Project Location (use maps and plans to identiff the location of the area subject to this request): 160 Mayflower Terrace South Yarmouth Street Address 41.69598 City/Town -70.17383How to find Latitude and Lonqitude Latitude (Decimal Degrees Format with 5 digits after decimal e.g. XX)OfiXX) '120 Longitude (Decimal Degrees Format with 5 digits after decimal e.g. -)OOOOOC() 12and how to convert to decimal deqrees Assessors' LoUParcel NumberAssessors'Map Number b. Area Description (use additional paper, if necessary): Single family house on Dinah's Pond c. Plan and/or Map Reference(s): (use additional paper if necessary) Site plan 8t14t2020for 160 Mayflower Tenace (Used for dock plan) Title Date Tltle wpofoml.doc. r€Y. q1M\UA Date WPA Form 1 - Rque6l for Ostorminalion of Apdicability' Page 1 ol 3 Massachusetts Department of Environmental Protection Bureau of Water Resources - Wetlands WPA Form 1- Request for Determination of Applicability Yarmouth Massachusetts Wetlands Protection Act M.G.L. c. 131, $40 Municiparitv B. Project Description (cont.) 2. a. ActivityMork Description (use additional paper and/or provide plan(s) of Activity, if necessary): Build and install a 10x15 shed on Northerly side of lot. Set back 6' from N. property line and approximately 30'from top of bank. b. ldentify provisions of the Wetlands Protection Act or regulations which may exempt the applicant from having to file a Notice of lntent for all or part of the described work (use additional paper, if necessary). 3. a. lf 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. D Single family house on a lot recorded on or before 8/1/96 D Single family house on a lot recorded after 8/1/96 E Expansion of an existing structure on a lot recorded afrer 8/1/96 I Project, other than a single-family house or public proiect, where the applicant owned the lot before 8fl96 f] New agriculture or aquaculture project ! Public project where funds were appropriated prior to 8/7/96 fl Prolect 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 E Residential subdivision; institutional, industrial, or commercial project ! Municipal project E District, county, state, or federal government project f] Project required to evaluate off-site alternatives in more than one municipality in an Environmental lmpact Report under MEpA or in an alternatives analysis pursuant to an qpplication lor a 404 permit from the U.S. Army Corps of Engineers or 401 Water euality Certification from the Department of Environmental protection. b. Provide evidence (e.9., record of date subdivision lot was recorded) supporting the classification above (use additional paper and/or attach appropriate documents, if ne'cessary.) - woaform 1 .doc . rav. 4102023 lryPA Form 1 - R€que6t Ior Dst€.mjnalion ofApdicabitity . palto 2 of 3 Massachusetts Departme nt of E nvi ronmenta I Protecti on Bureau of Water Resources - Wetlands WPA Form 1- Request for Determination of Applicability Yarmouth Municipality C. Determinations 1. I request the Yarmouth make the following determination(s). Check any that apply: Conservation Commission f] a. whether the area depicted on plan(s) and/or map(s) referenced above is an area subject to jurisdiction of the Wetlands Protection Act. I U. wnetner the boundarles of resource area(s) depicted on plan(s) and/or map(s) referenced above are accurately delineated. fl c. whether the Activitles depicted on plan(s) referenced above is subject to the Wetlands Protection Act and its regulatons. E O. whether the area and/or Activities depicted on plan(s) referenced above is subject to the jurisdiction of any municipal wetlands' ordinance or bylaw of: Name of Municipality fl e. whether the following scope of alternatlves is adequate for Activities in the Riverfront Area as depicted on referenced plan(s). D. Signatures and Submittal Requirements I hereby certfy 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 propefi 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. Signatures: I also understand that notification of this Request will be placed in a local newspaper at my expense in accordance )(1) of the Wetlands Protection Act regulations. :; I ,a- Signature of Applicant Date Date wpaform 1.doc . rev. 41 1 Ol2g23 Signature of Representative (if any) WPA Form 1 - Request for O€termination of Applicability. page 3 of 3 Massachusetts Wetlands Protection Act M.G.L. c. 131, S40 L a = Propot-J sL:J L oc.,-Il o n ( Scola l"- 20' 1Jv r.- /- LOC1JS MAP scAtt l'.zrl0o't roclrs 13 TrL{ taa fLqD z,.E r & aE (E 0) ^s $oril ot cofil[tw Plr€L lzsrco:tlJJ 0 rEo 7na,/2ora M)lE8 r. oanx E llll!{l 2 B U 6 ?6 Fl(POl@ Ffr O.LY lro lor Io-*rrlE tc urr t G $^tila 4 ffi Onam6a J. 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