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Home My WebLink AboutNOI 2.20.2025Yarmouth Conservation Commission • 1146 Route 28 South Yarmouth, MA 02664-4492 Tel. (508)-398-2231 Ext. 1288 Rev 12/2024 Page 1 of 2 Administrative Checklist Notice of Intent General Information: 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. Submitting an Application: Does the property have any outstanding/expired Orders of Conditions? If so, please file a Request for Certificate of Compliance for each outstanding/expired Order, as the Commission may not issue a new Order until any outstanding/expired Orders have been closed and recorded. (*see page 2) Hardcopy filing dropped off or mailed to the Conservation Office including: 1 Administrative Checklist 1 complete NOI application WPA form 3 with original signatures. Typed signatures will not be accepted. Detailed narrative of the project including existing & proposed conditions, construction sequence, type of equipment, staging locations, drainage and stormwater, erosion controls, invasive species management and alternative analysis. The narrative shall include how the project meets performance standards per 310 CMR 10.0 & TOY Wetland Regulations, delineation sheets (if BVW or vegetated wetlands are present) or other resource area calculations, and supporting information. 1 100’ radius map, current abutters list identifying the property owners who are to be notified per 310 CMR 10.00 and abutter notification form. Abutters list must be certified by the Town Assessor’s office. The Assessor’s office requires 7 days advance notice. All abutters must be notified via certified mail. Certified Mail Receipts (PS Form 3800) for all abutters. Green cards to be submitted at the hearing. 1 original and 6 copies of the plan, folded separately, right side out with title and project address visible. All plans shall reference NAVD1988 unless otherwise noted. See plan requirements Yarmouth’s share of State filing fee: Separate check made payable to “Town of Yarmouth” (refer to NOI Wetland Fee Transmittal Form) By-law filing fee: Separate check made payable to “Town of Yarmouth” Legal ad fee: Separate check made payable to “Town of Yarmouth” Please list project property’s street address on checks. Refer to Fee Schedule DEP share of the fee (refer to NOI form) shall be sent to: Dept. of Environmental Protection Box 4062 Boston, MA 02211 CONSERVATION OFFICE X X X X X X X X X X Yarmouth Conservation Commission • 1146 Route 28 South Yarmouth, MA 02664-4492 Tel. (508)-398-2231 Ext. 1288 Rev 12/2024 Page 2 of 2 DEP Submittal and Digital filing If you are filing with MassDEP using eDEP, please include a copy of the submittal confirmation with your application. If not filing via eDEP, a PDF of your application, plan, and all other supporting information must be sent VIA EMAIL the same day to DEP, Southeast Region at SERO_NOI@mass.gov with the subject line in the email per DEP’s request listed as “YARMOUTH - NOI - Street Address - Applicant Name” and copied bdirienzo@yarmouth.ma.us and jjerolimo@yarmouth.ma.us. We must receive a copy of this email with the application as proof that it has been submitted to DEP. 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. Without proper staking your project may be deemed incomplete and be continued to the next hearing date. I understand that in person representation is required at the scheduled hearing to present to the conservation commission If Applicable 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 bdirienzo@yarmouth.ma.us and jjerolimo@yarmouth.ma.us Waterway’s jurisdiction – Any coastal projects such as, but not limited to, docks, piers, bulkheads, revetments, dredging and boardwalks shall require submittal of all Notice of Intent, plans and supplemental information to the Town of Yarmouth Waterways/Shellfish Committee via the Natural Resources office by certified mail or hand delivery. The applicant or his/her representative must provide the Conservation office with proof that this has been done or the filing will not be accepted. Other Requirements o Does the proposed project meet the applicable regulations of the Town of Yarmouth Zoning bylaws? Do you need to file with the Yarmouth Board of Appeals? If so, you must file with ZBA after conservation permitting is completed. o If a vacant lot, have you completed and received a determination for the Building Department for a lot inquiry form? *To view all Conservation files/permits for the property address online, go to www.yarmouth.ma.us/LF X X X Zoning Board has approved this project, pending conservation. ATTACHMENT A FIGURES MAPS Figure 1 -Topographic Map Property Tax Parcels USGS Topographic Maps SITE National Flood Hazard Layer FIRMette 0 500 1,000 1,500 2,000250 Feet Ü SEE FIS REPORT FOR DETAILED LEGEND AND INDEX MAP FOR FIRM PANEL LAYOUT SPECIAL FLOOD HAZARD AREAS Without Base Flood Elevation (BFE) Zone A, V, A99 With BFE or Depth Zone AE, AO, AH, VE, AR Regulatory Floodway 0.2% Annual Chance Flood Hazard, Areas of 1% annual chance flood with average depth less than one foot or with drainage areas of less than one square mile Zone X Future Conditions 1% Annual Chance Flood Hazard Zone X Area with Reduced Flood Risk due to Levee. See Notes.Zone X Area with Flood Risk due to Levee Zone D NO SCREEN Area of Minimal Flood Hazard Zone X Area of Undetermined Flood Hazard Zone D Channel, Culvert, or Storm Sewer Levee, Dike, or Floodwall Cross Sections with 1% Annual Chance 17.5 Water Surface Elevation Coastal Transect Coastal Transect Baseline Profile Baseline Hydrographic Feature Base Flood Elevation Line (BFE) Effective LOMRs Limit of Study Jurisdiction Boundary Digital Data Available No Digital Data Available Unmapped This map complies with FEMA's standards for the use of digital flood maps if it is not void as described below. The basemap shown complies with FEMA's basemap accuracy standards The flood hazard information is derived directly from the authoritative NFHL web services provided by FEMA. This map was exported on 2/12/2025 at 12:52 PM and does not reflect changes or amendments subsequent to this date and time. The NFHL and effective information may change or become superseded by new data over time. This map image is void if the one or more of the following map elements do not appear: basemap imagery, flood zone labels, legend, scale bar, map creation date, community identifiers, FIRM panel number, and FIRM effective date. Map images for unmapped and unmodernized areas cannot be used for regulatory purposes. Legend THER AREAS OFO FLOOD HAZARD OTHER AREAS GENERAL STRUCTURES OTHER FEATURES MAP PANELS 8 B 20.2 The pin displayed on the map is an approximate point selected by the user and does not represent an authoritative property location. 1:6,000 70°14'14"W 41°38'19"N 70°13'36"W 41°37'52"N Basemap Imagery Source: USGS National Map 2023 FIGURE 2 -FLOOD MAP Figure 3-Wetlands, ACEC and NHESP Areas Areas of Critical Environmental Concern ACECs Property Tax Parcels NHESP Priority Habitats of Rare Species NHESP Estimated Habitats of Rare Wildlife DEP Wetlands Detailed With Outlines SITE Soil Map—Barnstable County, Massachusetts Natural Resources Conservation Service Web Soil Survey National Cooperative Soil Survey 2/12/2025 Page 1 of 34609942460994946099564609963460997046099774609935460994246099494609956460996346099704609977397359397366397373397380397387397394397401397408397415397422 397359 397366 397373 397380 397387 397394 397401 397408 397415 397422 41° 38' 5'' N 70° 13' 56'' W41° 38' 5'' N70° 13' 53'' W41° 38' 4'' N 70° 13' 56'' W41° 38' 4'' N 70° 13' 53'' WN Map projection: Web Mercator Corner coordinates: WGS84 Edge tics: UTM Zone 19N WGS84 604020100 Feet 2416840 Meters Map Scale: 1:300 if printed on A landscape (11" x 8.5") sheet. Soil Map may not be valid at this scale. FIGURE 4 MAP LEGEND MAP INFORMATION Area of Interest (AOI) Area of Interest (AOI) Soils Soil Map Unit Polygons Soil Map Unit Lines Soil Map Unit Points Special Point Features Blowout Borrow Pit Clay Spot Closed Depression Gravel Pit Gravelly Spot Landfill Lava Flow Marsh or swamp Mine or Quarry Miscellaneous Water Perennial Water Rock Outcrop Saline Spot Sandy Spot Severely Eroded Spot Sinkhole Slide or Slip Sodic Spot Spoil Area Stony Spot Very Stony Spot Wet Spot Other Special Line Features Water Features Streams and Canals Transportation Rails Interstate Highways US Routes Major Roads Local Roads Background Aerial Photography The soil surveys that comprise your AOI were mapped at 1:25,000. Warning: Soil Map may not be valid at this scale. Enlargement of maps beyond the scale of mapping can cause misunderstanding of the detail of mapping and accuracy of soil line placement. The maps do not show the small areas of contrasting soils that could have been shown at a more detailed scale. Please rely on the bar scale on each map sheet for map measurements. Source of Map: Natural Resources Conservation Service Web Soil Survey URL: Coordinate System: Web Mercator (EPSG:3857) Maps from the Web Soil Survey are based on the Web Mercator projection, which preserves direction and shape but distorts distance and area. A projection that preserves area, such as the Albers equal-area conic projection, should be used if more accurate calculations of distance or area are required. This product is generated from the USDA-NRCS certified data as of the version date(s) listed below. Soil Survey Area: Barnstable County, Massachusetts Survey Area Data: Version 23, Sep 17, 2024 Soil map units are labeled (as space allows) for map scales 1:50,000 or larger. Date(s) aerial images were photographed: Jun 10, 2022—Jun 30, 2022 The orthophoto or other base map on which the soil lines were compiled and digitized probably differs from the background imagery displayed on these maps. As a result, some minor shifting of map unit boundaries may be evident. Soil Map—Barnstable County, Massachusetts Natural Resources Conservation Service Web Soil Survey National Cooperative Soil Survey 2/12/2025 Page 2 of 3 Map Unit Legend Map Unit Symbol Map Unit Name Acres in AOI Percent of AOI 613C Hooksan-Dune land complex, 15 to 35 percent slopes 0.2 100.0% Totals for Area of Interest 0.2 100.0% Soil Map—Barnstable County, Massachusetts Natural Resources Conservation Service Web Soil Survey National Cooperative Soil Survey 2/12/2025 Page 3 of 3 B ATTACHMENT B PHOTOGRAPHIC LOG ATTACHMENT D ABUTTERS LIST AND LETTER 14/ 54/ / / BADRIGIAN BRIAN C TRS BADRIGIAN JUDITH S TRS 11 LORING ST NEWTON CENTER, MA 02459 14/ 85/ / / LAGERHOLM SUSAN M TRS 49 BURBANK ST MILLBURY, MA 01527 14/ 86/ / / SMITH COLLEEN 53 TADMUCK RD WESTFORD, MA 01886 14/ 55/ / / CALOGGERO MARIE G (LIFE EST) 29 PIGEON LN WALTHAM, MA 02452-4741 14/ 56/ / / CARRON JAMES F P O BOX 606 SOUTH YARMOUTH, MA 02664-0606 14/ 51/ / / CAREY EDWARD F TRS CAREY MARY L TRS 16 FOREST PARK DR LAKEVILLE, MA 02347 14/ 52/ / / CLANCY JOSEPH PATRICK TR JPC BARNSTABLE REALTY TRUST 457 MAIN ST WEYMOUTH, MA 02190 14/ 53/ / / LOPILATO ALFREDO G LOPILATO JANEL M 4 ALBERT ST CANTON, MA 02021 14/ 96/ / / ANDERSON JON C 496 WEYMOUTH DR WYCKOFF, NJ 07481 14/ 95/ / / CERVIN RONALD CERVIN NOELENE 22 TELEVISION LN WEST YARMOUTH, MA 02673 14/ 94/ / / KURTH REYNOLD KURTH MAUREEN J 18 STUYVESANT OVAL APT MA NEW YORK, NY 10009-2256 14/ 93/ / / MCFARLAND JAMES E MCFARLAND YVONNE V 8 BAYBERRY LN BEVERLY, MA 01915-1156 14/ 97/ / / BROWN ANNE M TR ANNE M BROWN REV TRUST 23 NELSON ST WEBSTER, MA 01570 Please use this signature to certify this list of propertiesabutting within 100' of the parcel located at:21 Television Ln ., West Yarmouth, MA 02673Assessors Map 14, Lot 53______________________________________Andy Machado, Director of AssessingFebruary 4, 2025 NOTIFICATION TO ABUTTERS UNDER THE MASSACHUSETTS WETLANDS PROTECTION ACT & TOWN OF YARMOUTH WETLAND BY-LAW, CHAPTER 143 In accordance with the second paragraph of the Massachusetts General Laws Chapter 131, Section 40, you are hereby notified of the following: A. The name of the applicant is __ALFREDO G. LOPILATO_______________________________ B. The applicant has filed a Notice of Intent with the Yarmouth Conservation Commission, seeking permission to remove, fill, dredge or alter an Area Subject to Protection under the Wetlands Protection Act (MGL c. 131 s. 40 & Town of Yarmouth Wetland By-Law, Chapter 143). C. The address of the lot where the activity is proposed is _21 TELEVISION LANE_____________ D. Proposed work is __TO LIFT AND REPOSITION THE HOUSE, REPLACE THE SEPTIC TANK, ADD AN ELEVATED DECK, RAISE THE YARD TO ABOVE FLOOD ELEVATION AND ADD A RETAINING WALL E. Copies of the Notice of Intent may be examined at the Yarmouth Town Hall at the Conservation Commission office between the hours of 9:00 a.m. and 4:00 p.m. Monday thru Friday. For more information, call (508) 398- 2231 ext. 1288. F. Copies of the Notice of Intent may be obtained from either the applicant or applicant’s representative. Applicant’s phone number _(617) 653-9571____________________ Or Applicant’s representatives phone number _Katerina, Strong Tree Engineering: (774) 994-1385 G. Information regarding the date, time and place of the public hearing may be obtained by calling the Yarmouth Conservation Commission office at (508) 398-2231 ext. 1288 H. Person sending this notification (applicant, representative or other) Name ___Katerina Korolov_______________________________________ Address ___PO Box 977_____________________________________ Town _East Sandwich________________ State ___MA____ Zip _02537________ Telephone ___(774) 994-1385____________________________________ NOTES :  Notice of the public hearing, including date, time and place will be published at least five (5) days in advance in a newspaper of general circulation.  Notice of the public hearing, including date, time and place will be posted in the Town Hall not less than forty- eight hours in advance.  You may also contact the Southeast Regional Office of the Department of Environmental Protection at (508) 946-2800 for more information about this application. ATTACHMENT E SUPPLEMENTAL TOWN FORMS 21 day waiver Rev July 2024 New Logo CONSERVATION OFFICE Town of Yarmouth Conservation Commission 21-DAY WAIVER Please complete this form, sign at the bottom and return to the Conservation Office. I, , 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 (date received by Conservation Office) for work at (project address/location) I am the: Applicant Applicant's Representative Property Owner Signature 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. Katerina Korolov X February 20, 2025 21 Television Lane X 2.19.2025 Yarmouth Conservation Commission • 1146 Route 28 • South Yarmouth, MA 02664-4492 Tel (508) 398-2231 Ext. 1288 • kgrant@yarmouth.ma.us • TTD# (508) 398-2231 Updated 8/2021 T O W N OF Y A R M O U T H CONSERVATION COMMISISON REVISED FEE SCHEDULE The new fee schedule began on July 1, 2011. Permit fees are made payable at the time of application submission. Payments can be made in the form of a check payable to “Town of Yarmouth”. (Please write the project property address on the check.) Wetlands Protection Regulations Permit Type Fee $ Request for Determination of Applicability $75.00 Notice of Intent- Category 1 $100.00 Notice of Intent- Category 2 $200.00 Notice of Intent- Category 3 $300.00 Notice of Intent- Category 4 $400.00 Notice of Intent- Category 5 $ 2.00/linear foot Notice of Intent- Category 6/ ANRAD $ 2.00/linear foot of each Resource Area delineated, $200 cap for single family dwelling Extension Permit $75.00 Certificate of Compliance $75.00 Legal Advertising $10.00 Stormwater Management Regulations Stormwater Management Permit Application* $200.00 Legal Advertising $10.00 *Applicants shall also pay review fees sufficient to cover expenses connected with review of the application before the review process commences (see Ch. 145 section 1.04(5)). ATTACHMENT F WPA FORM 3 wpaform3.doc • rev. 12/4/2023 Page 1 of 9 4 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 3 – Notice of Intent Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by MassDEP: MassDEP File Number Document Transaction Number City/Town Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Note: Before completing this form consult your local Conservation Commission regarding any municipal bylaw or ordinance. A. General Information 1. Project Location (Note: electronic filers will click on button to locate project site): a. Street Address b. City/Town c. Zip Code Latitude and Longitude: d. Latitude e. Longitude f. Assessors Map/Plat Number g. Parcel /Lot Number 2. Applicant: a. First Name b. Last Name c. Organization d. Street Address e. City/Town f. State g. Zip Code h. Phone Number i. Fax Number j. Email Address 3. Property owner (required if different from applicant): Check if more than one owner a. First Name b. Last Name c. Organization d. Street Address e. City/Town f. State g. Zip Code h. Phone Number i. Fax Number j. Email address 4. Representative (if any): a. First Name b. Last Name c. Company d. Street Address e. City/Town f. State g. Zip Code h. Phone Number i. Fax Number j. Email address 5. Total WPA Fee Paid (from NOI Wetland Fee Transmittal Form): a. Total Fee Paid b. State Fee Paid c. City/Town Fee Paid wpaform3.doc • rev. 12/4/2023 Page 2 of 9 4 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 3 – Notice of Intent Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by MassDEP: MassDEP File Number Document Transaction Number City/Town A. General Information (continued) 6.General Project Description: 7a. Project Type Checklist: (Limited Project Types see Section A. 7b.) 1. Single Family Home 2. Residential Subdivision 3. Commercial/Industrial 4. Dock/Pier 5. Utilities 6. Coastal engineering Structure 7. Agriculture (e.g., cranberries, forestry) 8. Transportation 9. Other 7b. Is any portion of the proposed activity eligible to be treated as a limited project (including Ecological Restoration Limited Project) subject to 310 CMR 10.24 (coastal) or 310 CMR 10.53 (inland)? 1. Yes No If yes, describe which limited project applies to this project. (See 310 CMR 10.24 and 10.53 for a complete list and description of limited project types) 2. Limited Project Type If the proposed activity is eligible to be treated as an Ecological Restoration Limited Project (310 CMR10.24(8), 310 CMR 10.53(4)), complete and attach Appendix A: Ecological Restoration Limited Project Checklist and Signed Certification. 8.Property recorded at the Registry of Deeds for: a. County b. Certificate # (if registered land) c. Book d. Page Number B. Buffer Zone & Resource Area Impacts (temporary & permanent) 1. Buffer Zone Only – 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). Check all that apply below. Attach narrative and any supporting documentation describing how the project will meet all performance standards for each of the resource areas altered, including standards requiring consideration of alternative project design or location. wpaform3.doc • rev. 12/4/2023 Page 3 of 9 4 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 3 – Notice of Intent Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by MassDEP: MassDEP File Number Document Transaction Number City/Town B. Buffer Zone & Resource Area Impacts (temporary & permanent) (cont’d) For all projects affecting other Resource Areas, please attach a narrative explaining how the resource area was delineated. Resource Area Size of Proposed Alteration Proposed Replacement (if any) a. Bank 1. linear feet 2. linear feet b. Bordering Vegetated Wetland 1. square feet 2. square feet c. Land Under Waterbodies and Waterways 1. square feet 2. square feet 3. cubic yards dredged Resource Area Size of Proposed Alteration Proposed Replacement (if any) d. Bordering Land Subject to Flooding 1. square feet 2. square feet 3. cubic feet of flood storage lost 4. cubic feet replaced e. Isolated Land Subject to Flooding 1. square feet 2. cubic feet of flood storage lost 3. cubic feet replaced f. Riverfront Area 1. Name of Waterway (if available) - specify coastal or inland 2. Width of Riverfront Area (check one): 25 ft. - Designated Densely Developed Areas only 100 ft. - New agricultural projects only 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. 5. Has an alternatives analysis been done and is it attached to this NOI? Yes No 6. Was the lot where the activity is proposed created prior to August 1, 1996? Yes No 3. Coastal Resource Areas: (See 310 CMR 10.25-10.35) Note: for coastal riverfront areas, please complete Section B.2.f. above. wpaform3.doc • rev. 12/4/2023 Page 4 of 9 4 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 3 – Notice of Intent Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by MassDEP: MassDEP File Number Document Transaction Number City/Town B.Buffer Zone & Resource Area Impacts (temporary & permanent) (cont’d) Check all that apply below. Attach narrative and supporting documentation describing how the project will meet all performance standards for each of the resource areas altered, including standards requiring consideration of alternative project design or location. Online Users: Include your document transaction number (provided on your receipt page) with all supplementary information you submit to the Department. Resource Area Size of Proposed Alteration Proposed Replacement (if any) a. Designated Port Areas Indicate size under Land Under the Ocean, below b.Land Under the Ocean 1. square feet 2. cubic yards dredged c.Barrier Beach Indicate size under Coastal Beaches and/or Coastal Dunes below d.Coastal Beaches 1. square feet 2. cubic yards beach nourishment e.Coastal Dunes 1. square feet 2. cubic yards dune nourishment Size of Proposed Alteration Proposed Replacement (if any) f.Coastal Banks 1. linear feet g.Rocky Intertidal Shores 1. square feet h. Salt Marshes 1. square feet 2. sq ft restoration, rehab., creation i.Land Under Salt Ponds 1. square feet 2. cubic yards dredged j. 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 l.Land Subject to Coastal Storm Flowage 1. square feet 4. Restoration/Enhancement 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 enter the additional amount here. a. square feet of BVW b. square feet of Salt Marsh 5. Project Involves Stream Crossings a. number of new stream crossings b. number of replacement stream crossings wpaform3.doc • rev. 12/4/2023 Page 5 of 9 4 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 3 – Notice of Intent Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by MassDEP: MassDEP File Number Document Transaction Number City/Town C.Other Applicable Standards and Requirements This is a proposal for an Ecological Restoration Limited Project. Skip Section C and complete Appendix A: Ecological Restoration Limited Project Checklists – Required Actions (310 CMR 10.11). 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 and Endangered Species Program (NHESP)? To view habitat maps, see the Massachusetts Natural Heritage Atlas or go to http://maps.massgis.state.ma.us/PRI_EST_HAB/viewer.htm. a. Yes 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 If yes, the project is also subject to Massachusetts Endangered Species Act (MESA) review (321 CMR 10.18). To qualify for a streamlined, 30-day, MESA/Wetlands Protection Act review, please complete Section C.1.c, and include requested materials with this Notice of Intent (NOI); OR complete Section C.2.f, if applicable. If MESA supplemental information is not included with the NOI, by completing Section 1 of this form, the NHESP will require a separate MESA filing which may take up to 90 days to review (unless noted exceptions in Section 2 apply, see below). c.Submit Supplemental Information for Endangered Species Review∗ 1. Percentage/acreage of property to be altered: (a)within wetland Resource Area percentage/acreage (b)outside Resource Area percentage/acreage 2. Assessor’s Map or right-of-way plan of site 2. Project plans for entire project site, including wetland resource areas and areas outside of wetlands jurisdiction, showing existing and proposed conditions, existing and proposed tree/vegetation clearing line, and clearly demarcated limits of work ∗∗ (a) Project description (including description of impacts outside of wetland resource area & buffer zone) (b)Photographs representative of the site ∗ Some projects not in Estimated Habitat may be located in Priority Habitat, and require NHESP review (see https://www.mass.gov/ma- endangered-species-act-mesa-regulatory-review). Priority Habitat includes habitat for state-listed plants and strictly upland species not protected by the Wetlands Protection Act. ∗∗ MESA projects may not be segmented (321 CMR 10.16). The applicant must disclose full development plans even if such plans are not required as part of the Notice of Intent process. wpaform3.doc • rev. 12/4/2023 Page 6 of 9 4 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 3 – Notice of Intent Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by MassDEP: MassDEP File Number Document Transaction Number City/Town C. Other Applicable Standards and Requirements (cont’d) (c) MESA filing fee (fee information available at https://www.mass.gov/how-to/how-to-file-for- a-mesa-project-review). Make check payable to “Commonwealth of Massachusetts - NHESP” and mail to NHESP at above address Projects altering 10 or more acres of land, also submit: (d) Vegetation cover type map of site (e) Project plans showing Priority & Estimated Habitat boundaries (f) OR Check One of the Following 1. Project is exempt from MESA review. Attach applicant letter indicating which MESA exemption applies. (See 321 CMR 10.14, https://www.mass.gov/service-details/exemptions-from-review-for-projectsactivities-in- priority-habitat; 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. Separate MESA review ongoing. a. NHESP Tracking # b. Date submitted to NHESP 3. Separate MESA review completed. Include copy of NHESP “no Take” determination or valid Conservation & Management Permit with approved plan. 3. For coastal projects only, is any portion of the proposed project located below the mean high water line or in a fish run? a. Not applicable – project is in inland resource area only b. Yes No If yes, include proof of mailing, hand delivery, or electronic delivery of NOI to either: South Shore - Bourne to Rhode Island border, and the Cape & Islands: Division of Marine Fisheries - Southeast Marine Fisheries Station Attn: Environmental Reviewer 836 South Rodney French Blvd. New Bedford, MA 02744 Email: dmf.envreview-south@mass.gov North Shore - Plymouth to New Hampshire border: Division of Marine Fisheries - North Shore Office Attn: Environmental Reviewer 30 Emerson Avenue Gloucester, MA 01930 Email: dmf.envreview-north@mass.gov Also if yes, the project 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. c. Is this an aquaculture project? d. Yes No If yes, include a copy of the Division of Marine Fisheries Certification Letter (M.G.L. c. 130, § 57). wpaform3.doc • rev. 12/4/2023 Page 7 of 9 4 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 3 – Notice of Intent Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by MassDEP: MassDEP File Number Document Transaction Number City/Town C. Other Applicable Standards and Requirements (cont’d) Online Users: Include your document transaction number (provided on your receipt page) with all supplementary information you submit to the Department. 4. Is any portion of the proposed project within an Area of Critical Environmental Concern (ACEC)? a. Yes No If yes, provide name of ACEC (see instructions to WPA Form 3 or MassDEP Website for ACEC locations). Note: electronic filers click on Website. b. ACEC 5. 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. Yes No 6. 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. Yes No 7. Is this project subject to provisions of the MassDEP Stormwater Management Standards? a. 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 Vol. 2, Chapter 3) 2. A portion of the site constitutes redevelopment 3. Proprietary BMPs are included in the Stormwater Management System. b. No. Check why the project is exempt: 1. Single-family house 2. Emergency road repair 3. Small Residential Subdivision (less than or equal to 4 single-family houses or less than or equal to 4 units in multi-family housing project) with no discharge to Critical Areas. D. Additional Information This is a proposal for an Ecological Restoration Limited Project. Skip Section D and complete Appendix A: Ecological Restoration Notice of Intent – Minimum Required Documents (310 CMR 10.12). Applicants must include the following with this Notice of Intent (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. 1. USGS or other map of the area (along with a narrative description, if necessary) containing sufficient information for the 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 [BVW] replication area or other mitigating measure) relative to the boundaries of each affected resource area. wpaform3.doc • rev. 12/4/2023 Page 8 of 9 4 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 3 – Notice of Intent Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by MassDEP: MassDEP File Number Document Transaction Number City/Town D. Additional Information (cont’d) 3. Identify the method for BVW and other resource area boundary delineations (MassDEP BVW Field Data Form(s), 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. a. Plan Title b. Prepared By c. Signed and Stamped by d. Final Revision Date e. Scale f. Additional Plan or Document Title g. Date 5. If there is more than one property owner, please attach a list of these property owners not listed on this form. 6. Attach proof of mailing for Natural Heritage and Endangered Species Program, if needed. 7. Attach proof of mailing for Massachusetts Division of Marine Fisheries, if needed. 8. Attach NOI Wetland Fee Transmittal Form 9. Attach Stormwater Report, if needed. E. Fees 1. 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 3. Check date 4. State Check Number 5. Check date 6. Payor name on check: First Name 7. Payor name on check: Last Name noifeetf.doc • Wetland Fee Transmittal Form • rev. 10/11 Page 1 of 2 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands NOI Wetland Fee Transmittal Form Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. A. Applicant Information 1. Location of Project: a. Street Address b. City/Town c. Check number d. Fee amount 2. Applicant Mailing Address: a. First Name b. Last Name c. Organization d. Mailing Address e. City/Town f. State g. Zip Code h. Phone Number i. Fax Number j. Email Address 3. Property Owner (if different): a. First Name b. Last Name c. Organization d. Mailing Address e. City/Town f. State g. Zip Code h. Phone Number i. Fax Number j. Email Address To calculate filing fees, refer to the category fee list and examples in the instructions for filling out WPA Form 3 (Notice of Intent). B. Fees Fee should be calculated using the following process & worksheet. Please see Instructions before filling out worksheet. Step 1/Type of Activity: Describe each type of activity that will occur in wetland resource area and buffer zone. Step 2/Number of Activities: Identify the number of each type of activity. Step 3/Individual Activity Fee: Identify each activity fee from the six project categories listed in the instructions. Step 4/Subtotal Activity Fee: Multiply the number of activities (identified in Step 2) times the fee per category (identified in Step 3) to reach a subtotal fee amount. Note: If any of these activities are in a Riverfront Area in addition to another Resource Area or the Buffer Zone, the fee per activity should be multiplied by 1.5 and then added to the subtotal amount. Step 5/Total Project Fee: Determine the total project fee by adding the subtotal amounts from Step 4. Step 6/Fee Payments: To calculate the state share of the fee, divide the total fee in half and subtract $12.50. To calculate the city/town share of the fee, divide the total fee in half and add $12.50. noifeetf.doc • Wetland Fee Transmittal Form • rev. 10/11 Page 2 of 2 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands NOI Wetland Fee Transmittal Form Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Fees (continued) Step 1/Type of Activity Step 2/Number of Activities Step 3/Individual Activity Fee Step 4/Subtotal Activity Fee Step 5/Total Project Fee: Step 6/Fee Payments: Total Project Fee: a. Total Fee from Step 5 State share of filing Fee: b. 1/2 Total Fee less $12.50 City/Town share of filling Fee: c. 1/2 Total Fee plus $12.50 C. Submittal Requirements a.) Complete pages 1 and 2 and send with a check or money order for the state share of the fee, payable to the Commonwealth of Massachusetts. Department of Environmental Protection Box 4062 Boston, MA 02211 b.) To the Conservation Commission: Send the Notice of Intent or Abbreviated Notice of Intent; a copy of this form; and the city/town fee payment. To MassDEP Regional Office (see Instructions): Send a copy of the Notice of Intent or Abbreviated Notice of Intent; a copy of this form; and a copy of the state fee payment. (E-filers of Notices of Intent may submit these electronically.)