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Home My WebLink AboutRDA compiledMassachusetts 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 When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. teb renvne, 2. Applicant: j First Name r Address City/ I own Phone Number Property Owner (if different from Applicant): rst Name Last Name State Zip Code Email Address — ' Last Name city/ i own State Zlp Code Phone Number Email Address (if known) 3. Representative (if any) First Name Last Name Company Name Address City/Town 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): Ls Li/1 r✓C4 S' 'i2 ( s mql Street Address City/Town How to find Latitude _V/1 6IVt/i t �� and Longitude Latitude (Decimal Degrees Format with 5 digits after decimal Longitude (Decimal Degrees Format with 5 digits after e.g. XX.XXXXX) decimal e.g.-XX.XXXXX) and how to convert 22 to decimal degrees Assessors' Map Number Assessors' Lot/Parcel Number b. Area Description (use additional paper, if necessary): c. Plan and/or Map Reference(s): (use additional paper if necessary) Title Title Date Date wpaform1.doc • rev. 4/10/2023 WPA Form 1 — Request for Determination of Applicability • Page 1 of 3 ILIMassachusetts Department of Environmental Protection 'Bureau of Water Resources - Wetlands WPA Form 1- Request for Determination of Ap licabili Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Municipality B. Project Description (cont.) 2. a. Actii.1vity/ Wo��r��k Description (use additional paper and/or provide plan(s) off Activity, if necessary): ,� ' `TIU n/ 74" fJ *k- "y Pj1; 07' clei v,- i` /°�'d �i /� � �/`:V� �•z f1�/`�'��r9- � � � r � �� «,C rr `c� � r�F S ®` -�v a� t�� t !�'��C 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.) wpaform1.doc • rev. 4/10/2023 VVPA 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. I request the Conservation Commission make the following determination (s). Check any that apply: ❑ 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: me of Mu ❑ 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 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 with Section 10.05(3)(b)(1) of the Wetlands Protection Act regulations. Signature of Applicant Date Signature of Representative (if any) Date wpaform1.doc • rev. 4/10/2023 WPA Form 1 — Request for Determination of Applicability • Page 3 of 3 O� YAK `,AneH Es Town of Yarmouth Conservation Commission 21-DAY WAIVER CONSERVATION OFFICE Please complete this form, sign at the bottom and return to the Conservation Office. I, ��/ r ev , hereby waive the 21-day time period for a public hearing/meeting and/or issuance of the: OOC / DOA / COC / ORAD following receipt of my filing of a: ❑ Notice of Intent ❑ Request for Determination of Applicability ❑ Request for Certificate of Compliance ❑ Other by the Yarmouth Conservation Commission under Massachusetts General Laws, Ch. 131, sec. 40, and/or under Yarmouth Wetland Bylaw. The application was submitted on for work at (date received by Conservation Office) �projec[ aaaress/location) I am the: Applicant ❑ Applicant's Representative Property Owner Signature / 3 Date NOTE: Please be advised that you will be notified of the meeting date once this application has been assigned to a Conservation Meeting Agenda at the email address listed on the application. 21 day waiver DEPARTMENT OF CONSERVATION ite aczPlS o ��ca�' ,�n,�a1r.�tu+ttitsn� 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: , A)z Gvn . lx" Assessors Map/Lot: --",02 /", 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: 7F�Z/ f" Date: 1117 115w-3 Please Print Name: `!gey If other than owner, please state whether tenant, agent, or other: Mailing Address: Phone: v we4 xy � 7� Cell: 5.22F ?E-dl Email: ; jgi' Celt! �Jj�g40 Fax: 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 WHiA _ / e Pro 21a0 _____- I /n 7 sco z+> m� I �= I as I �' IC o DEP Bordering Vegetated Wetland(310 CMR 10.55)Delineation Field Data Form03 x i� 'D tJ Applicant: e Imo rLC) Prepared by:3 rcio )U-1 I Project location:51 tdi+Lc.ives 4r C r.DEP Fits II: w w yar40iJ4-11 a Check all That apply: a Q tLl/ Vegetstion alone presumed adequate to delineate BVW boundary: fill out Section I only ❑ Vegetation and other Indicators of hydrology used to delineate BVW boundary:fill out Sections I and II ❑ Method other than dominance test used(attach additional Information) Section I. Vegetation Observation Plot Number:�([G() o?- Transect Number: Date of Delineation:/I I6'42.3 A.Sample Layer and Plant Species B.Percent Cover C.Percent D.Dominant Plant E. Wetland (by common/scientific name) (or basal area) Dominance (yes or no) Indicator /v U k e Category' Sl rt) —ye wel4we ' 3, O Zva�o ( U U t vt e S = t5 i4--p rstat-t- 63- O `e oX r a a^to -, N u 1'tc 3 -o or m ill or A. rn c 'Use an asterisk to mark wetland Indicator plants:plant species listed In the Wetlands Protection Act(MDL c.131,s.40);plants In lino genus Sphagnum plants listed as n FAC,FAC+,FACW-,FACW,FACW+,or OBL;or plants with physiological or morphological adaptations.II any plants are Identified as wetland Indicator plants due to o physiological or morphological adaptations,describe the adaptation next to the asterisk. m cn Vegetation conclusion: m Number of dominant wetland Indicator plants: / Number of dominant non-wetland Indicator plants: / v cf Is the number of dominant wetland plants equal to or greater than the number of dominant non-wetland plants?yes no If vegetation stone Is presumed adequate to dellneele the BV{V boundary,submit this form with the Request for Determination of Applicability or Notice of Intent. MA MI',3195