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0472
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P%aA 3
AuUNITEL) STATES
A05T/!L SERVICE.
STOUGHTON
31 PORTER ST
STOUGHTON, MA 02072-9998
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UFN: 247922-0472
Receipt #: 840-50280036-2-6024483-1
Clerk: 22
admiabitimnaeteed{(. E CONSERVATION
OFFICE
All filings must be made on Town of Yarmouth forms. The filing deadline is two weeks prior to the next
scheduled Conservation Commission meeting for new applications. Failure to follow this Checklist shall result
in an Administratively Incomplete Application and will not be advertised for a Public Hearing. Refer to the
meeting schedule. Contact the Conservation Office if you need assistance.
Su&69jgg att ppikahan•
Hardcopy filing dropped off or mailed to the Conservation Office including:
X RDA Administrative Checklist
X Complete RDA application with original signatures (double sided). "
X Detailed narrative of the project with sufficient information to enable the Commission to determine
N/A whether the proposed work will alter an area subject to protection.
BVW delineation sheet(s), coastal bank calculation and other relevant material if applicable (not
applicable for flood zone only projects).
X Yarmouth Assessor's locator map highlighting parcel(s) where work is proposed, including map and
parcel numbers
X 1 original and 7 photocopies of the plan/sketch, folded separately, right side out with title and address
visible. All plans shall reference NAVD1988 unless otherwise noted. Landscape plans shall be
detailed to show proposed and existing conditions, native species, size and spacing.
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.
Digital and DEP filing
_X—A pdf of the entire application emailed to bdirienzo(cDyarmouth ma us, kbrooks(a)yarmouth ma us
and DEP Southeast Region at SERO NOI ((@massgov in the same email. Subject line shall be
"YARMOUTH - RDA — Street Address - Applicant Name"
Please list project property's street address in the pdf file name.
Initial below
X I CERTIFY that all on -site requirements will be completed by noon on the Friday prior to the
hearing date. All proposed structures must be staked, and all relevant resource areas and buffer
zones must be staked or flagged. Please consult the Yarmouth Wetland Regulations, page 17.
If the applicant is NOT the property owner:
X Please submit a signed Site Access Authorization Form; AND
X The owner must be sent a copy of the application via Certified Mail on the same day it is filed with this
office. Please submit a copy of the Certified Mail receipt with application.
If Applicable
IV/A Certified Mail Receipt for Massachusetts Natural Heritage and Endangered Species Program
N/A Certified Mail Receipt for Massachusetts Division of Marine Fisheries.
If filing via email, CC bdirienzo(dvarmouth ma us and kbrooks(ct)yarmouth ma us
Yarmouth Conservation Commission • 1146 Route 28 • South Yarmouth, MA 026644492
Tel. (508)-398-2231 Ext. 1288 • Fax (508)-398-0836 • TTD# (508) 398-2231 • bdinenzoavarmouth ma us
Rev. 312023
OF Y
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`F\'O 4yM 1T
DEPARTMENT
OF
CONSERVATION
LQ1UYe .%il�l!/lfiTtpl(tIi'
If the applicant is not the property owner, please submit this form with your application. The owner
must be sent a copy of the application on the same day it is filed with this office.
Property Address: 225 MA-28 West Yarmouth,MA 02673
Assessors Map/Lot: Map 37 Lot 71 3.95
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: ',god Date: 6/29/23
Please Print Name: Rod Sroczenski
If other than owner, please state whether tenant, agent, or other:
Mailing Address: 225 MA-28
West Yarmouth, MA 02673
Phone: 508-775-5669
Email:
Cell:
Fax:
Yarmouth Conservation Commission • 1146 Route 28 • South Yarmouth, MA 02664-4492
Tel. (508)-398-2231 Ext. 1288 9 Fax (508)-398-0836 • TTD# (508) 398-2231
Massachusetts Department of Environmental Protection
Bureau of Water Resources - Wetlands
WPA Form 1- Request for Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Municipality
A. General information
Important: 1.
Applicant:
When filling out
forms on the
Daniel
computer, use only
First Name
the lab key to move
181 Tosca Drive
your cursor - do not
Address
use the return key.
Stoughton
Cityrrown
IL�I
1781)344-0522
Phone Number
2.
Property Owner ('If different from Applicant):
Kennedy
Last Name
MA 02072
Stale Zip Code
dkennedy@ohburg.com
Email Address
Rod Sroczenski
First Name Last Name
225 Ma-28
West Yarmouth
MA
State
508-775-5669
Phone Number Email Address (if known)
3. Representative (if any)
First Name
Company
Cityrrown
Last Name
02673
Zip Code
State Zip Code
Phone Number Email Address (if known)
B. Project Description
1. a. Project Location (use maps and plans to identify the location of the area subject to this request):
225 Ma-28
West Yarmouth
Street Address
City/town
How to find Latitude
41.65498
-70.25698
and Longitude
Latitude (Decimal Degrees Format with 5 digits after decimal
Longitude (Decimal Degrees Format with 5 digits after
e.g. XX.)00000
decimal e.g.-XX.X)D000)
and how to convert
37
71 3.95
to decimal degrees
Assessors Map Number
Assessors' Lot/Parcel Number
b. Area Description (use additional paper, if necessary):
Resort Hotel
c. Plan and/or Map Reference(s): (use additional paper if necessary)
Mass Mapper
Bayside Resort Site Plan EV Chargers
Title
5-30-23
Dale
5-30-23
Dale
wpefoml,doc• rev. 4/1=023 WPA Fov 1— Request for Determination of Applicability •Page 1 or
Massacauhusetts Department of Environmental Protection
Bureof Water Resources - Wetlands
WPA Form 1- Request for Determination of Applicability
_I Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Municipality
B. Project Description (cont.)
2. a. Activity/Work Description (use additional paper and/or provide plan(s) of Activity, if necessary):
Installation of (4) Electric Vehicle Chargers in Rear Parking Lot. Project will involve
trenching (18" wide by 30" deep) of approx 200 linear feet from utility pole to
proposed chargers along property as shown on supplied drawing. Trench to allow
PVC conduit 3" or less and associated electrical conductors to feed proposed
equipment. Distribution/Service equipment to be installed on 4'x4'x.5' concrete pad.
Each charger to be set on its own 2'x2'x2' concrete pad.
b. Identify provisions of the Wetlands Protection Actor 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 8/7/96
❑ 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
applicatioh 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.)
WPafmm t.doc - rev. 4/10/2023
WPA Form 1 - Repuesl for Determination &Applicability - Page 2 m :,
LIMassachusetts Department of Environmental Protection
Bureau of Water Resources - Wetlands
WPA Form 1- Request for Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Municipality
C. Determinations
1. 1 request the west Yarmouth make the following determination(s). Check any that apply:
Conservation Commission
0 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.
❑� b. whether the boundaries of resource area(s) depicted on plan(s) and/or map(s) referenced
above are accurately delineated.
❑ c. whether the Activities depicted on plan(s) referenced above is subject to the Wetlands
Protection Act and its regulations.
d. 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:
Town of West Yarmouth
Name of Municipality
❑ e. whether the following scope of alternatives is adequate for Activities in the Riverfront Area as
depicted on referenced plan(s).
U. 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.
Signatures:
I also understand that notification of this Request will be placed in a local newspaper at my expense
in accordance wit Section 10. ( )(1) of the Wetlands Protection Act regulations.
�( 6-30-23
Signatl re`o Appli ant Date
Signature of Representative (if any)
wpafornl.tloc• rev. 4R0I2023
WPA Form 1 - Request for Determination of Applicability • Page 3 of 3
Bayside Resort Hotel EV Chargers
June 30, 2023
o.heburg corp.
Attn: Town of Yarmouth Conservation Commission
Re: Bayside Resort Hotel EV Chargers
225 MA-28
West Yarmouth, MA 02673
Project Narrative
Scope of Work:
181 Tosca Drive
Stoughton, MA 02072
Tel: 781-344-0522
Fax: 781-344-5922
DKennedy@ohburg.com
The intent of this project is to install (4) Level Two Electric Vehicle (EV) Chargers along the
South-West edge of the parking lot at the rear of the site. This will require a new utility pole to be set
along the Western property edge to allow for the installation of (1) new electrical service conduit. A
shallow trench will be created from the proposed utility pole to the proposed electrical equipment and
chargers. The trench will be 30" deep x 18" wide, except where new concrete bases/pad are installed
where the trench will increase in width to accommodate the concrete, but remain no deeper than 30".
The trench will run directly against the existing asphalt parking lot, around the rear of the existing
dumpster location, and to the proposed electrical equipment
A 4" conduit will run from the proposed utility pole, through the shallow trench along the
parking lot edge, to the proposed electrical service equipment location. A 3" conduit will then be run
from the service equipment to (2) hand holes, and from each hand hole, to the proposed EV chargers.
The conduit pathway is identified on the supplied drawings along with the proposed electrical
equipment and utility pole. The trench and equipment locations are further than 35' away from the
protected area (they are >35' away from the edge of the existing phragmites).
A 4" deep concrete pad will be installed for the electrical service equipment cabinet to sit on.
Each of the EV chargers will also receive a concrete base, each to be 24"x24"x24" cube of 4000 psi
concrete. Each piece of equipment shall also have (2) 6" concrete filled bollards to protect them from
vehicle strikes. A base layer of gravel shall be installed under the concrete. All electrical equipment will
be secured to concrete.
(5) New Native Plantings are to be installed as part of this installation in an effort to ensure that
this Green Project benefits both the environment directly and in the future, as well as the end users.
The quantity was selected based on the number of proposed electrical structures. These plantings are
to be (2) Gallon Marsh Elder (Iva Fuctescens) shrubs, and are to be planted along the sloped edge of the
Bayside Resort Hotel EV Chargers
June 30, 2023
parking area, facing the conservation area, between the existing Phragmites and the parking area. This
location will allow the plantings to grow to full height without interfering with the scenic views.
Sincerely,
Z)"z( ^BIZ
Daniel Kennedy
O.H. Burg Corporation
181 Tosca Drive
Stoughton, MA 02072
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