HomeMy WebLinkAboutRDA applicationCONSERVATION
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
meetina schedule. Contact the Conservation Office if you need assistance.
lia
ropy filing dropped off or mailed to the Conservation Office including:
RDA Administrative Checklist
1 complete RDA application with original signatures (double sided). '
V Detailed narrative of the project with sufficient information to enable the Commission to determine
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).
Yarmouth Assessor's locator map highlighting parcel(s) where work is proposed, including map and
`parcel numbers
�1 1 original and 5 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.
L1 By-law filing fee: Separate check made payable to Town of Yarmouth"
LLegal ad fee: Separate check made payable to "Town of Yarmouth"
Please list project property's street address on checks. Refer to Fee Schedule.
�Digi and DEP filing
A pdf of the entire application emailed to bdirienzoO-)tarmouth.ma.us, kbrooksO-varmouth.ma.us
and DEP Southeast Region at SERO NOIAmass.aov 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
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:
Please submit a signed Site Access Authorization Form; AND
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 Apolicable
Certified Mail Receipt for Massachusetts Natural Heritage and Endangered Species Program
Certified Mail Receipt for Massachusetts Division of Marine Fisheries.
If filing via email, CC bdirienzoCc�varmouth.ma.us and kbrooks(a'-)yarmouth.ma.us
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 • bdirienzo a,varmouth.ma.us
Rev. 3/2023
Important:
When filling out
forms on the
computer, use only
the tab key to move
your cursor - do not
use the return key.
rab
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
boovA
First Name n Last Name
Phone Number
6�4 �
State Zip Code
mail Address
2. ProV
ty Owner if different from Applicant):
0 C) L C. bPA
First Name Last Name
Address <"'a,�+ /�
Cityrrown State Zip Code
Phone Number
Email Address (if known)
3. Re resentative (if any)
Als MPgf*oi S
First Nam4lj Last Name
d ess
0 � �" � �r�� l3
City/Town State Zip Code
Phone u ber Email Address (if know
B. Project Description
1. a. Project Location (use maps and plans to identify the ocation of the area ubject.to this request):
In M , t
Street Address �] ity/Town
How to find Latitude ( "7` 401 ' `J 1 40
and Longitude Latitude (Decimal Degrees ormat with 5 digits after decimal e.g. Longitude (Decimal Degrees o(mat with 5 digits after
XX.XXXXX) decimal e.g.-XX.XXXXX)
and how to convert , � (0 1 o l
to decimal degrees Assessors' Map Number Assessors' Lot/Parcdl Number
b. Area Description (use additional paper, if necessary):
r,_..,c. Plan and/or Map Reference(s): (use additional paper if necessary)
i'l-V1f, , - = 1
Title V IDate
A 'PLtan i®� I Ig6R
Title Date
wpaforml.doc • rev. 4/28/2023 WPA Form 1 — Request for Determination of Applicability - Page 1 of 3
Massachusetts Department of Environmental Protection
-- Bureau of Water Resources - Wetlands
WPA Form 1- ReqUest for Determination of Applicability
� Municipality
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Project Description (cont.)
2. a. ActivityfWork Description (use additional paper and/or provide plan(s) of Activity, if necessary):
Y UkOt_ OR' 4,Nk WINJ k 0 7�kci -2�mlu
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 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
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.)
wpaforml.doc • rev. 4/28/2023 1NPA Form 1 — Request for Determination of Applicability • Page 2 of 3
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
C. Determinations
1. 1 request the Oil I h make the following determination(s). Check any that apply:
Conservation Commission
Ua. 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.
Q. whether the area and/or Activities depicted on plan(s) referenced above is subject to the
urisdiction of any municipal wetlands' ordinance or bylaw of:
Name of Municipality
❑ e. whether the following scope of alternatives is adequate for Activities in the Riverfront Area as
depicted on referenced plan(s).
D. Signatures and Submittal Requirements
1 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 with kection 10.05(3)(b)(1) of the Wetlands Protection Act regulations.
-v L. 1
Is'nre of Applicant Date
Signat f Representative (if any) Date
e
wpaform1.doc • rev. 4128/2023 WPA Form 1 — Request for Determination of Applicability • Page 3 of 3
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