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Home My WebLink About30 thimbleberry RDAImportant: When filling out forms on the computer, use only the tab key to move your cursor - do nol use the return key. rob How to find Latitude and Longitude and how to convert to decimal degrees wpaforml.doc • rev. 4/1( 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 1. Applicant: i— i Yl First Name Last Name v Address r0 6 G ✓• '12a 'jam J7/� P; mu tH �2 � -t Ci y/Town State Zip Code l! p, 1 �� Phone ,Q A3/ 17Cff r? JG i1(e+L�� f G rGw 45yfifi7 Number Email Address 2. Property Owner (if different from Applicant): rrc, First 17 vim" Name Last Name :3 o Tk" YAhl bew c LA-, Address yr�,�wi�:/�� } 8"Ll�le� Ci frown State Zip Code le 7 Ph, ne Num er Email Address (if known) 3. Representative (if any) First Name Last Name I Company Name Adliress 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): 12 _T4 b� 4q/ 4 tin Y-4eM0 "ILh Street City/Town 41 -V1811--7pyi&1 1 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) 8 13b 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 Date Title I Date /2023 WPA Form 1 — Request for Determination of Applicability • Page 1 of 3 Massachusetts Department of Environmental Protection Bureau of Water Resources - Wetlands WF IA Form 1- Request for Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Municipality B. Project Description (cont.) 2. a.l Activity/Work Description (use additional paper and/or provide plan(s) of Activity, if necessary): �If - tce*� trq.5 40 hac�# 1'1e3: �e � !J2 i c �n Jet v r� �✓l ,�t �, , cR �cn }lvt�,z. )) r do 50 L'eOS1 5`i'0.'M ji)r'eje `jr 4UL z-f2. �PU�45,11q t1t��lipv► ai..s�e.f j t+e�o%tJ T�Z sUiii��i i7c�52 iv ri"2.v4'"4 ..��M�vt.t Q.rU�aiGJJvI . "%lily L��'� ia�C:°�Gt be- Pi�� b� hc.K�11 Ylo i¢,�v;J'eH�,ev,� G''�' �zE.�� v�G�(',11)t��?✓ .� 1 y 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 ne,,cessary). 3. a. I 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. I 9 01 gle 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. I 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. 4/10/2023 1 WPA Form 1 — Request for Determination of Applicability • Page 2 of 3 Mass.achusetts Department of Environmental Protection Bureau of Water Resources - Wetlands (1 WIIA Form 1- Request for Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Municipality C. � Determinations 1. I iequest the yU,rw.U-'i'k make the following determination(s). Check any that apply: Conservation Commission l 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: 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 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 knowledoe. 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. Sign 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. rcz/10 %.3 Sigj ature applicant Date Representative (if any) Date wpaform 1.doc • rev. 4/10/2023 WPA Form 1 —Request for Determination of Applicability • Page 3 of 3