HomeMy WebLinkAboutREVISED RDA 5.1.2025veget:ted Wetlands a
e present, delineation sheet coastal bank calculation and other
/ relevant material iT
.�_ Yarmouth Assess
applicable (not applicable for flood zone only projects).
r's
parcel numbers.
i current abutters list i
IP 4h
0catior map highlighting parcels} where work is proposed, including map and
dentify'ing the property owners who are to be notified and abutter notification form.
All abutters to be notified via certified mail. Certified Mail Receipts
1 original and 7 photocopies of the plan/sketch, folded separately
visible. All plans shall reference NAVD1 988 unless nthP_.rvv'ic;-P. nntF
9� ,u�tatian
All filings must be
IV
dw
Conservation
Office
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 AdministratlVely Incomplete Application and will not be advertised for a Public Hearing. Refer to the meeting
schedule. Contact the Conservation Office if
Su.(a�uff�a� an Q�pCicafiai�
Hardcopy filing dropped off or mailed to t
RDA Administrative Checklist
Rev. 21201"$
you need assistance.
he Conservation Office including:
complete RDA application WPA form 9 with original signatures (double sided).'
Detailed narrative o
WOMENEEMMM MENEMMNF
he project with sufficient information to enable the Commission to determine
whether the proposed work will alter an area subject to protection
If BVW or
ft
(PS Form-13800) must be provided.
r_#NW_MW_ P
right side out with title andaddress
Landscape plans shall be detailed to
show proposed and existing conditions, native species, quantity. size and spacing.
✓ By-law 'filing fee. Separate check made payable to "Town of Yarmouth"
LollLegal ad fee: Separate check made payable t) " Town of YarmouthI*
Please list project property's street address on checks,. Refer to Eye Schedule.
Digital and DEP filing
e7, A Pdf of the entire application emailed to bdirienzo6a.varmouth.ma.us and lierolirno@yarmouth.ma.us
and
DEP Southeast Region at SERO N01amass.gov in the same email. Subject line shall be "YARMOUTH -
RDA Street Address -Applicant Name"
Please list project property 'ssetret address in the pdf ale 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 Requlations, page 17.
understand that in person representation is required at the scheduled hear
ing to present to the
conservation commission.
` 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 i is filed with this
office. Please submit a copy of the Certified Mail receipt with application.
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
bdirienzoawarmouth.ma.us and iierolimo(a�varmouth.ma.us
YarniouOi
ConservaLion
Conunission -
1146 Route ?S - South Yannouth., MA O?664-4492
�rel. (,508)-_3`98-2231
Ext. 1288 -
Fax (508)-398-0836
. TTD?, (508)398-2W2MMWW31 • hdirico/_00)VC�rm��t�t1�.1����.�2s
wpaform1.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
ED
Ln
aaga
QPC JF
1=4 t
E:
T {
�y 7
t
MA V&O 3
F■ �
ti
7 -
ya
r*4mq Certified Mail Fee
Extra Services & Fees {check fox, add fee p,
� ❑ Retum Recent (hardcopy) $
Q I ❑ Retum Recent (electronic) $ i
�„ ❑ Certitiod Mail Restricted Delivery $ .�
rU ❑Adult Signature Requlred $
LR") ❑Adult Signature Restricted Delivery $
Postage SIM.� �.
r=1 $ IJ 6
T I P-Dstage and Fees
%J
0 1$-.
T hf FFAP I P Po-
r
2a9
fl :
zu /7)q pil-11117.
ir
-4 r L. 91 L. J.- III -
Sent To
CO Ilk
—i i�i■M 4! W ii--i��ii��!—ii
�tree !!i—li�i�l��Af ��
a t. N. x o,
Ln
Ir
+4
City,�ii l�,
A4
UA"101d I I IrL 1; '11 7--M: raTra`W�T doom
Postal SLmrvinr
omestic Mail C
# i T
n
1 e S t N'
1p�w
n
ri A.4 6 `. r
Certified Mail Fee
r
RIP f R + I
+ fy
Extra-:Serv--'1ces & Fees (checkboxadd fee,
:�
! etum Receipt(hardcopy)C3 �, ,.
Return Receipt electronic -: � C 1 114
El Certified flail Restricted Delivery $ 1.1m)
F'*- 14:0
4 [jAdult Signature Required $ .. "
ru U7)
d ult S'rg natu re Restricted Delwary
Postage
.T
I$
r=1 Ol Pp;stage and Fees
Sent To
Er Vyk
- . S tre�
and Apt. r fax No.
4
orate,I ?q,
R
ii
pro-
0
Ln
w
i
;)nstai Service
it
t _
V
te}
a
0
r
�s
4 PR P?styar2025
Here
eAc It
0
4Dsk ���#f iFi i' ! i i� r11Yi Yil##-I 7w
W 7 i
=1 =Cal =1 10
TT
limb
01
• 1
Certified Mail Fee
r%- L 0 J
__ ...
r Services Fees (check box+ add 1
turn Reca4lpt and op )
Retufn Re elpt (electrO
n1c)
C;ertifled Mail Restricted Dell e ,1
Adult Signature Required
nj E] nature Restricted D llver
Postage
r-j To I gage end Fees
prPOI
NI
i
rate)
f
postmark
PR 2 Y'e 7025
Ilip — ------
Sent T
Er 1 !
0 ■
i=0 8treet and is No., F
U1� � � � � � � � w ! f � i f � Y � ! ! i i i i — i — � ! � � i � yl■ ! — i r Pl ! �t �• ! ! r 7� i ! s ulF f 7r i ! — � ii +li i iR + � ! i � i l f � � i iF
- ' 6 'jj
t t�Am h e7% Ir Ll
rq
m
r`[
r�
rNew certified Ma*11 Fey
r * t
ON F
r�l Extra Services & Fees (check box, add fe'
❑ Return Receipt (hardcopy) $
Q Return Receipt (electronic) $ J
� Cer-tified Mail Restricted Delivery $
� Adult Signature Required
LO Adult Signature Restricted Delivery $�
Postage � ,_; .7; —:
r� A di
� Tctal PRsjage and Fees
$� IC•^•Lf
cps.
cam
�•.
viv
OAV
L
3p", 0 1
1 ai M
IF%
ate)
# Rt
P _
Ob
It, Iwo .
r
9 044
il
ere
202
'rf k,
--I jliiilillj� -
Sent To I&ID ,
�■■Y i i i i i � � i i �i # !■h i i■■i i i i i i # i � # � i' � i Yw � i i � � Y• iI � � � i iI � � � M E i i i # � i i i i � i' � i i i # � � Yh i �
CO
Street and , No,.,g( N.
f F
Ap- mmmom i i i E i i i mo i i i iE i i 1w i w w 402am 0*60imsev
ci4/0 ZIPS
r
raft
6
f � jr e
ru
O
Un
iift'M;r*Ti711Kf-i1I1MF.
JnSt2
0
U(Imagric lvicmr-
3ry 2U23 PSN 7530-02-000-9C
•
6111P
0 � i T
F• i
L, P h,
f�J. L� + 1 ■. +* 4i a+ P ,Ji '+Tam
t '� i
Certified Mail Fee
�- 1$ 4 2 Edw
Extra Services & Fees (check box, add Fe
� Return Receipt (hardcopy) $
Return Receipt (electronic) $
[7 � Certified Mail Restricted Delivery $
Adult Signature Required $�.
� Adult Signature Restricted Delivery $ -11.
Lr) Postage
C:3 $
r=q T� tal Pa�#age and Fees
MM4E
IL
I
0
+.
4W3q .+
&t3i
S11111woh,-vilimf
-tsee- Keve
0
bra
� U Fj
4L_ 4
O/V + i
� 7T
OM MEMO
no
Postmar�
` 1 #
i y
� r 4 k'
6
Sent To
-..._
COI
mend r• MEi r M i r■■r i 1� i w i Y< i m i i # i Mb� ON i i• i me IN M i# W W i W ME ONE i NOii
Street an No., or P,O-d ABox
tate
rtWX CM'* �W� r
cc
U1
Ir City,0.
For
5 PRIOR 11 11 IN
1. 11 51 rem mn=01 [low