HomeMy WebLinkAboutRDA 4.28.2025wpaform1.doc • rev. 7/27/2020
WPA Form 1 – Request for Determination of Applicability • Page 1 of 4
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 1- Request for Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
City/Town
A. General Information
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
1. Applicant:
Name
E-Mail Address
Mailing Address
City/Town
State
Zip Code
Phone Number
Fax Number (if applicable)
2. Representative (if any):
Firm
Contact Name
E-Mail Address
Mailing Address
City/Town
State
Zip Code
Phone Number
Fax Number (if applicable)
B. 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 below 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
below are accurately delineated.
c. whether the work depicted on plan(s) referenced below is subject to the Wetlands Protection Act.
d. whether the area and/or work depicted on plan(s) referenced below 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 work in the Riverfront Area as
depicted on referenced plan(s).
YarmouthYarmouth
wpaform1.doc • rev. 7/27/2020
WPA Form 1 – Request for Determination of Applicability • Page 2 of 4
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 1- Request for Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
City/Town
C. Project Description
1. a. Project Location (use maps and plans to identify the location of the area subject to this request):
Street Address
City/Town
Assessors Map/Plat Number
Parcel/Lot Number
b. Area Description (use additional paper, if necessary):
c. Plan and/or Map Reference(s):
Title
Date
Title
Date
Title
Date
2. a. Work Description (use additional paper and/or provide plan(s) of work, if necessary):
wpaform1.doc • rev. 7/27/2020
WPA Form 1 – Request for Determination of Applicability • Page 3 of 4
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 1- Request for Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
City/Town
C. Project Description (cont.)
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. 7/27/2020
WPA Form 1 – Request for Determination of Applicability • Page 4 of 4
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 1- Request for Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
City/Town
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.
Name and address of the property owner:
Name
Mailing Address
City/Town
State
Zip Code
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
17/ 89/ / /
STEDMAN KATHLEEN A
12 THATCHER ST
QUINCY, MA 02170-1924
23/ 337/ / /
CICCARELLI JOHN F
PO BOX 9645
AMHERST , MA 01059-9645
23/ 336/ / /
CICCARELLI JOHN F
P O BOX 9645
AMHERST, MA 01059-9645
17/ 88/ / /
DENARO MICHAEL J JR
1580 COMMONWEALTH AVE
NEWTON, MA 02465
17/ 90.2/ / /
WRIGHT ALFRED P JR
P O BOX 414
WEST YARMOUTH, MA 02673
9
SEPTIC PROFILE
T.O.F. AT EL. 1 3.4'(
NOT TO SCALE)
ACCESS COVER TO WITHIN 6- OF FIN. GRADE ACCESS COVER (WATERTIGHT) TOJ
WITHIN 6" OF FIN. GRADE
uwluuM .75' OF COVER OVER PRECAST
RUN PIPE LEVEL
j -FOR FIRST 2'
10.96'
10.43jjjj8CAFF8LE 9 /,
76' 9 99
J 6 CRUSHED STONE ORMECHANICAL2 %SLOPE) COMPACTION. (15.221 [
21) DEPTH OF
FLOW 44 SLOPE) (-L-7
SLOPE) TEE
SIZES:
10" INLET
DEPTH OUTLET
DEPTH =
14" FOUNDATION- 26.5' - SEPTIC TANK
25 5' REMOVAL OF UNSUITABLE SOIL REWIREDAROUNDPERIMETEROFSYSTEMDOWNTOMED/COS LAYER. HIGHPOINTREPLACEWITHCLEANMED.
SAND. LEACH
FIELD
O
AREA
O/
S ALL
5, %•
C`2 Q / C 1
f_
5k PROP. GRAVEL DRIVE.
RES PROP. SILT FENCE BA1CI(6Q
BY I _ - -
UNDIST(
X
BUFFER
6
O
2> .
6X
35' \\
7 98-
242 2% SLOPE REQUIRED OVER SYSTEM 10.
75' CULTEC FILTER FABRIC PER
SPECb WITH 2" PEASTON i ON TOP OF
FABRIC 10.
0' 0 0 0 0 0 0 0 0 0 0 o a o 0 0 0 0 0 0 0 0 0
0 9.
35' I CULTEC C4 FIELD DRAIN
PANELS 3/4" TO 1 1/27 DOUBLE WASHED
STONE
5'
LEACHING D' BOX 10'
FACILITY ADJUSTED WATER EL. 4.
35' WELL: MIW
29 ZONE:
A ADJ: 0.
4' BENCHMARK - TOP OF
I CONC. BIND. EL= 11.28 (NGVD)
1 TOP OF FNDN IS.3.4',ABOVE THE
HIGH POINT IN THE
ROAD
sx 9.
4
DECK / 9.
0 8.
6 LOT
17A Area = 42,270± sq.
ft. 0.97
Acres
60 TEST
HOLE TITLE 5 "MAXIMUM FEASIBLE
COMPLIANCE" UNDER 15.005, TRANSITION RULES
FOR
ENGINEER: D.
A. ISOLATED
LOT) 15.405 10: REDUCTION IN SETBACK
TO PROPERTY LINES (10' TO
5') VON HONE,
RS TOWN OF YARMOUTH REG. 3.7: LEACH FACILITY TO BE 86'
TO THE EDGE OF WETLAND (14' VARIANCE
REQ.) YARMOUTHTOWN
OF
RESERVE(
SEEO 28' VARIANCE REQ.) NOTE
BELOW) EDGE OF
WETLAND PERC.
RATE _ IF PRIMARY SYSTEM SHOULD
FAIL, CONTAMINATED SOILS,
PLACE
PER
REMOVE CLEAN FILL AND PLACE NEW
LEACH FACILITY IN AREA OF PRIMARY
SYSTEM. I &
III 98-
242 2% SLOPE REQUIRED OVER SYSTEM 10.
75' CULTEC FILTER FABRIC PER
SPECb WITH 2" PEASTON i ON TOP OF
FABRIC 10.
0' 0 0 0 0 0 0 0 0 0 0 o a o 0 0 0 0 0 0 0 0 0
0 9.
35' I CULTEC C4 FIELD DRAIN
PANELS 3/4" TO 1 1/27 DOUBLE WASHED
STONE
5'
LEACHING D' BOX 10'
FACILITY ADJUSTED WATER EL. 4.
35' WELL: MIW
29 ZONE:
A ADJ: 0.
4' BENCHMARK - TOP OF
I CONC. BIND. EL= 11.28 (NGVD)
1 TOP OF FNDN IS.3.4',ABOVE THE
HIGH POINT IN THE
ROAD
sx 9.
4
DECK / 9.
0 8.
6 LOT
17A Area = 42,270± sq.
ft. 0.97
Acres
60 TEST HOLE
LOGS
ENGINEER: D.A. OJALA,
SE
WITNESS: AMY VON HONE,
RS DATE: 5/28/
98 PERC. RATE _ 2 MIN PER
INCH I & III N/
A CLASS SOILS P#
5 6 _
I C ELEV. Q 10.
2'
N 0^ 9.7_
C 2 LOCATION MAP SCALE
1"
ApLS0YR
L5 4/2 7" 10YR 4/2 ASSESSORS MAP 13 PARCEL Q17-1 18" B ZONING DISTRICT: R-
25B
B LS YARD
SETBACKS: 10YR 6/8 7'
4 28" 10YR 6/8 7.9' FRONT =
30'
C1 SIDE =
6' Cl MED/COS REAR =
20' MED/
COS 84•. obs. water 3.2' PLAN REF. -56/9
1925 gg" obs: water 3.95' 2.5Y 6/6 FLOOD ZONE: A ELEV. 10.
0' 2.5Y 6/6 114" 0.
7' 108" 0.
7'
C2
C2 SILT
LOAM SILT
LOAM 2.5Y 7/2 2.5Y 7/
2 120" 0_3' 126" 0.
45
NOTES. SEPTIC DESIGN_ (GARBAGE DISPOSER IS NOT
ALLOWED DESIGN FLOW: 3 BEDROOMS (110 GPD) = 330
GPD USE A 330 APD DFSIrN
FLOW SEPTI_ 330 GPD (Z-) =
660 USE15OD-GALLON SEPTIC
TANK
LEACHING: N/
A SIDES: =
346 26 x 18 (.
74)
BOTTOM:
TOTAL: 468 S.F. 346
GPD USE LEACH FIELD OF 2 ROWS OF (3) C4
CULTEC FIELD DRAIN PANELS, WITH 4' OF STONE BETWEEN
ROWS 3' AT SIDES AND 1' AT
ENDS
LEGEND 100.0 PROPOSED SPOT
ELEVATION 100x0 EXISTING SPOT
ELEVATION F1 001 PROPOSED
CONTOUR 100- - EXISTING
CONTOUR PROP.
DRYWELL BOARD OF
HEALTH ROVED
DATEoft iox 55,W M2-
9880 down cape engineering,
inc. CIVIL
ENGINEERS LAND
SURVEYORS 939 main St. yarmouth, ma
02675 1. DATUM
IS
NGVD 2. MUNICIPAL WATER
IS AVAILABLE
t0 3. MINIMUM PIPE PITCH TO BE 1/5' PER
FOOT. & 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASFIO
1
20 5. PIPE JOINTS TO BE MADE
WATERTIGHT, 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH
MASS. ENVIRONMENTAL CODE TITLE
V. 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO
BE USED FOR LOT LINE
STAKING. B. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4"
PVC. 9 COMPONENTS NOT
TO INSPECTION
BY
BOARDBOFBACKFILLED OR CONCEALED
WITHOUT HEALTH AND PERMISSION
OBTAINED FROM BOARD OF
HEALTH. 10. WATER TEST D'BOX FOR
LEVELNESS. SITE AND SEWAGE
PLAN OF #86 CROWELL
ROAD IN THE TOWN OF: (WEST)
YARMOUTH PREPARED FOR: `MICHAEL
DENARO 30 n 30 60
90 SCALE: 1 - 30 DATE: SEPTEMBER 18,
1998 REV. 10/13/
98 REV. 10/20/98 (CONCOM COM'
S) REV. 11/3/9B (
PEASTONE) ARNE H. 9cyGs o
ARNE QJALA
2
CIVILyn No. 3 @L Q No.
63
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CERTIFIED PLOT PLAN NOTE: TO OF POINT FOUNDATION
0 THE ROAD ATAE V
FOR 12.9
86 CROWELL RD., WEST YARMOUTH, MA.
ASSESSORS MAP 17 PARCEL 88 I CERTIFY THATI THE FOUNDATION
SHOWN ON THIS PLAN IS LOCATED ON
PREPARED FOR THE GROUND AS SHOWN HEREON AND
THAT IT CONFORMS TO THE MINIMUM
BUILDING SETBACK REQUIREMENTS OF
GIULIO REALTY TRUST THE TOWN OF YARMOUTH.
SCALE: 1" = 60' SEPTEMBER 27,1999
Weller & Associates ;
1645 Falmouth Rd. — Suite 4C Centerville, Ma. 02632
(609) 775-0735
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South Yarmouth, MA
Scale: i' - 20' Dote: May 10. 2018
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Prepared by.
All Cape Septic and Survey
618 Route 28
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West Yarmouth, MA 02673
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NOTIFICATION TO ABUTTERS UNDER THE
TOWN OF YARMOUTH WETLAND BY-LAW, CHAPTER 143
In accordance with the Town of Yarmouth Wetland Regulations Section 2.03,you are hereby notified of
the following:
A. The name of the applicant is MIC. ci21 11e c R,rr
B. The applicant has filed a Request for Determination of Applicability with the Yarmouth
Conservation Commission, seeking knowledge of whether a project is subject to the Wetlands
Protection Act (MGL c. 131 s. 40) or Bylaw (Town of Yarmouth Wetland By-Law, Chapter 143).
C. The address of the lot where the activity is proposed is gb CroWell 2
D. Proposed work is Set-xi AA Flom itcidinakv Oiler Yisiy (J ifit 01 4
atiOISLOA0e vti1g1l tti, rt- Nit.) lArre'iz,
E. Copies of the Request for Determination of Applicability 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 Request for Determination of Applicability may be obtained from either the
applicant or applicant's representative. Applicant's phone number tell 15 7 G3co
Or Applicant's representatives phone number
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 ei Dekwo
Address /SFV c4 i /r& #f
Town /UCa tt1v State MG- Zip vzyt t'
Telephone (0/7 3C7 03/0
Note:
• 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 on the Town Website
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.