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Username: NORTON010
Transaction ID: 1581665
Document: WPA Form 3 - NOI
Size of File: 247.36K
Status of Transaction: In Process
Date and Time Created: 6/21/2023:11:35:06 PM
Note: This file only includes forms that were part of your
transaction as of the date and time indicated above. If you need
a more current copy of your transaction, return to eDEP and
select to "Download a Copy" from the Current Submittals page.
Massachusetts Department of Environmental Provided by MassDEP:
Protection MassDEP File #:
Bureau of Resource Protection - Wetlands eDEP Transaction #:1581665
WPA Form 3 - Notice of Intent City/Town:YARMOUTH
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
A. General Information
1. Project Location:
a. Street Address
b. City/Town
d. Latitude
f. Map/Plat #
2. Applicant:
r Individual r Organization
52 PRINCE ROAD
YARMOUTH
41.65027N
29
a. First Name
PAUL AND NANCY
c. Organization
d. Mailing Address
574 SLOCUM RD
e. City/Town
NORTH DARTMOUTH
h. Phone Number
774-930-5339
3.Property Owner:
l— more than one owner
a. First Name
c. Organization
d. Mailing Address
e. City/Town
h. Phone Number
4.Representative:
a. First Name
c. Organization
d. Mailing Address
e. City/Town
h.Phone Number
c. Zip Code
e. Longitude
g.Parcel/Lot #
b.Last Name CRUZ
02673
70.25696W
88
f. State MA g. Zip Code 02747
i. Fax j. Email pcniz@ccstaff.net
PAUL AND NANCY b. Last Name CRUZ
574 SLOCUM RD
NORTH DARTMOUTH f State MA g. Zip Code 02747
774-930-5339 i. Fax j.Email peruz@ccstaff.net
ROY b. Last Name OKUROWSKI
WRS ENGINEERING
67 STETSON STREET
HYANNIS f. State MA g. Zip Code 02601
508-776-0956 i.Fax j.Email royokurowski@gmail.com
5.Total WPA Fee Paid (Automatically inserted from NOI Wetland Fee Transmittal Form):
a.Total Fee Paid 312.00 b.State Fee Paid 143.50 c.City/Town Fee Paid 168.50
6.General Project Description:
PROPOSED PIER AND LIFT
7a.Project Type:
1. rv- Single Family Home 2. r- Residential Subdivision
3. r- Limited Project Driveway Crossing 4. r- Commercial/Industrial
5. r- Dock/Pier 6. r- Utilities
7. r- Coastal Engineering Structure 8. r- Agriculture (eg., cranberries, forestry)
9. r- Transportation 10. V— Other
7b.Is any portion of the proposed activity eligible to be treated as a limited project subject to 310 CMR 10.24 (coastal) or 310
CMR 10.53 (inland)?
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Massachusetts Department of Environmental Provided by MassDEP:
Protection MassDEP File #:
Bureau of Resource Protection - Wetlands eDEP Transaction #:1581665
WPA Form 3 - Notice of Intent City/Town:YARMOUTH
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
1. r Yes r No If yes, describe which limited project applies to this project:
2. Limited Project
8.Property recorded at the Registry of Deeds for:
a.County: b.Certificate: c.Book: d.Page:
BARNSTABLE 33762 139
BARNSTABLE 146 135
B. Buffer Zone & Resource Area Impacts (temporary & permanent)
1.Buffer Zone & Resource Area Impacts (temporary & permanent):
r This is a Buffer Zone only project - 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)
Resource Area
a. r Bank
b. r Bordering Vegetated Wetland
c. r Land under Waterbodies and Waterways
d. F- Bordering Land Subject to Flooding
e. F Isolated Land Subject to Flooding
Size of Proposed Alteration Proposed Replacement (if any)
1. linear feet 2. linear feet
1. square feet 2. square feet
1. Square feet 2. square feet
3. cubic yards dredged
1. square feet 2. square feet
3. cubic feet of flood storage lost 4. cubic feet replaced
1. square feet
2. cubic feet of flood storage lost 3. cubic feet replaced
£ r Riverfront Area
1. Name of Waterway (if any)
2. Width of Riverfront Area (check one) r 25 ft. - Designated Densely Developed Areas only
r 100 ft. - New agricultural projects only
r 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 feet b. square feet within 100 ft. c. square feet between 100 ft.
and 200 ft.
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Massachusetts Department of Environmental Provided by MassDEP:
Protection MassDEP File #:
Bureau of Resource Protection - Wetlands eDEP Transaction #:1581665
WPA Form 3 - Notice of Intent City/Town:YARMOUTH
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
5. Has an alternatives analysis been done and is it attached to this NOV r Yesr No
6. Was the lot where the activity is proposed created prior to August 1, 1996? r Yesr No
3.Coastal Resource Areas: (See 310 CMR 10.25 - 10.35)
Resource Area
a. r Designated Port Areas Indicate size under
b. r Land Under the Ocean 14.14
1. square feet
Size of Proposed Alteration Proposed Replacement (if any)
Land under the ocean below,
2. cubic yards dredged
c. f Barrier Beaches
Indicate size under Coastal Beaches and/or Coatstal Dunes, below
d. r Coastal Beaches
3.14
1. square feet 2. cubic yards beach nourishment
e. r Coastal Dunes
1. square feet 2. cubic yards dune nourishment
£ r Coastal Banks
1. linear feet
g. r Rocky Intertidal Shores
1. square feet
h. r Salt Marshes
1. square feet 2. sq ft restoration, rehab, crea.
i r Land Under Salt Ponds
1. square feet
2. cubic yards dredged
j. r 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
Lr Land Subject to Coastal 454
Storm Flowage 1. square feet
4.Restomtion/Enhancement
r- Restoration/Replacement
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 entered the additional amount here.
a. square feet of BVW b. square feet of Salt Marsh
5.Projects Involves Stream Crossings
r Project Involves Streams Crossings
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Massachusetts Department of Environmental Provided by MassDEP:
Protection MassDEP File #:
Bureau of Resource Protection - Wetlands eDEP Transaction #:1581665
WPA Form 3 - Notice of Intent City/Town:YARMOUTH
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
If the project involves Stream Crossings, please enter the number of new stream crossings/number of replacement stream crossings.
a. number of new stream crossings
b. number of replacement stream crossings
C. Other Applicable Standards and Requirements
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 of Endangered Species program
(NHESP)?
a. r Yes r No
If yes, include proof of mailing or hand delivery of NOI to:
Natural Heritage and Endangered Species
Program
Division of Fisheries and Wildlife
1 Rabbit Hill Road
Westborough, MA 01581
b. Date of map:FROM MAP VIEWER
If yes, the project is also subject to Massachusetts Endangered Species Act (MESA) review (321 CMR 10.18)....
c. Submit Supplemental Information for Endangered Species Review * (Check boxes as they apply)
1. r Percentage/acreage of property to be altered:
(a) within Wetland Resource Area
(b) outside Resource Area
percentage/acreage
percentage/acreage
2. r Assessor's Map or right-of-way plan of site
3. r Project plans for entire project site, including wetland resource areas and areas outside of wetland jurisdiction, showing
existing and proposed conditions, existing and proposed tree/vegetation clearing line, and clearly demarcated limits of work **
a. r Project description (including description of impacts outside of wetland resource area & buffer zone)
b. r Photographs representative of the site
c. r MESA filing fee (fee information available at: hU://www.mass.gov/eea/agencies/df�,/dfw/natural-heritage/re atom
review/mass-endangered-species-act-mesa/mesa-fee-schedule.html )
Make check payable to "Natural Heritage & Endangered Species Fund" and mail to NHESP at above address
Projects altering 10 or more acres of land, also submit:
d. r Vegetation cover type map of site
e. r- Project plans showing Priority & Estimated Habitat boundaries
d. OR Check One of the following
1. r Project is exempt from MESA review. Attach applicant letter indicating which MESA exemption applies. (See 321
CMR 10.14, bnp://www.mass.gQv/eea/agencies/dfgldfw/laws-re,g gations/cmr/321-cmr-1000-massachusetts-endaneg red-
snecies-act.html#10.14; 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. r Separate MESA review ongoing.
a. NHESP Tracking Number
b. Date submitted to NHESP
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Massachusetts Department of Environmental Provided by MassDEP:
Protection MassDEP File #:
Bureau of Resource Protection - Wetlands eDEP Transaction #:1581665
WPA Form 3 - Notice of Intent City/Town:YARMOUTH
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
3. r Separate MESA review completed.
Include copy of NHESP "no Take" determination or valid Conservation & Management Permit with approved plan.
* Some projects not in Estimated Habitat may be located in Priority Habitat, and require NHESP review...
2. For coastal projects only, is any portion of the proposed project located below the mean high waterline or in a fish run?
a. r Not applicable - project is in inland resource area only
b. r Yes r No
If yes, include proof of mailing or hand delivery of NOI to either:
South Shore - Cohasset to Rhode Island, and the Cape & Islands:
Division of Marine Fisheries -
Southeast Marine Fisheries Station
Attn: Environmental Reviewer
836 S. Rodney French Blvd
New Bedford, MA 02744
North Shore - Hull to New Hampshire:
Division of Marine Fisheries -
North Shore Office
Attn: Environmental Reviewer
30 Emerson Avenue
Gloucester, MA 01930
If yes, it 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.
3. Is any portion of the proposed project within an Area of Critical Environmental Concern (ACEC)?
a. r Yes P No
b. ACEC Name
If yes, provide name of ACEC (see instructions to WPA
Form 3 or DEP Website for ACEC locations). Note:
electronic filers click on Website.
4. Is any portion of the proposed project within an area designated as an Outstanding Resource Water (ORW) as designated in the
Massachusetts Surface Water Quality Standards, 314 CMR 4.00?
a. r Yes r No
5. 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. r Yes r No
6. Is this project subject to provisions of the MassDEP Stormwater Management Standards?
a. r 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
r Vol.2, Chapter 3)
2. A portion of the site constitutes redevelopment
r
3. Proprietary BMPs are included in the Stormwater Management System
r
b. r No, Explain why the project is exempt:
1. Single Family Home
r
r- Emergency Road Repair
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Massachusetts Department of Environmental Provided by MassDEP:
Protection MassDEP File #:
Bureau of Resource Protection - Wetlands eDEP Transaction #:1581665
WPA Form 3 - Notice of Intent City/Town:YARMOUTH
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
3. Small Residential Subdivision (less than or equal to 4 single-family houses or less than or equal to 4 units in multi -family
r housing project) with no discharge to Critical Areas.
D. Additional Information
Applicants must include the following with this Notice of hitent (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 by regular mail delivery.
1. USGS or other map of the area (along with a narrative description, if necessary) containing sufficient information for the
r 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
P7 [BV W] replication area or other mitigating measure) relative to the boundaries of each affected resource area.
3. Identify the method for BV W and other resource area boundary delineations (MassDEP BV W Field Data Form(s).
r 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.
r
a. Plan Title: b. Plan Prepared By: c. Plan Signed/Stamped By: c. Revised Final Date: e. Scale:
PROPOSED PIER
AND BOAT LIFT (2 ROY OKUROWSKI 6-19-23
PLANS)
5. If there is more than one property owner, please attach a list of these property owners not listed on this form.
r
6. Attach proof of mailing for Natural Heritage and Endangered Species Program, if needed.
r
7. Attach proof of mailing for Massachusetts Division of Marine Fisheries, if needed.
r
8. Attach NOI Wetland Fee Transmittal Form.
r
9. Attach Stormwater Report, if needed.
r
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Massachusetts Department of Environmental Provided by MassDEP:
Protection MassDEP File #:
Bureau of Resource Protection - Wetlands eDEP Transaction #:1581665
WPA Form 3 - Notice of Intent City/Town:YARMOUTH
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
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:
2. Municipal Check Number
4. State Check Number
3. Check date
5. Check date
6. Payer name on check: First Name 7. Payer name on check: Last Name
F. Signatures and Submittal Requirements
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 receipt requested) to all abutters within 100 feet
of the property line of the project location.
Paul Cruz
6/21/2023
1. Signature of Applicant 2. Date
Paul Cruz 6/21/2023
3. Signature of Property Owner(if different) 4. Date
Roy Okurowski 6/21/2023
5. Signature of Representative (if any) 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 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 Section C, Items 1-3, 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.
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Massachusetts Department of Environmental Protection Provided by MassDEP:
Bureau of Resource Protection - Wetlands MassDEP File #:
WPA Form 3 - Notice of Wetland FeeTransmittal eDEP Transaction #:1581665
Form City/Town:YARMOUTH
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
A. Applicant Information
1. Applicant:
a. First Name AUL AND NANCY
c. Organization
d. Mailing Address 574 SLOCUM RD
e. City/Town NORTH DARTMOUTH
h. Phone Number 7749305339
2.Property Owner:(if different)
a. First Name AUL AND NANCY
c. Organization
d. Mailing Address 574 SLOCUM RD
e. City/Town NORTH DARTMOUTH
h. Phone Number 7749305339
3. Project Location:
a. Street Address 52 PRINCE ROAD
Are you exempted from Fee? r
Note: Fee will be exempted if you are one of the following:
• City/Town/County/District
• Municipal Housing Authority
• Indian Tribe Housing Authority
• MBTA
State agencies are only exempt if the fee is less than $100
B. Fees
b.Last Name RUZ
f. State . Zip Code 02747
i. Fax j. Email peruz@ccstaffnet
b. Last Name RUZ
f.State . Zip Code 02747
i. Fax j.Email pcniz@ccstaffnet
b. City/Town YARMOUTH
Activity Type Activity Activity Fee RF Multiplier Sub Total
Number
A.) WORK ON DOCKS, PIERS, REVETMENTS, 78 4.00 312.00
DIKES, ETC. (COASTAL OR INLAND).
City/Town share of filling fee State share of filing fee Total Project Fee
$168.50 $143.50 $312.00
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