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Home My WebLink AboutRDA 9.12.2025n Important: When filling out forms on the oomputer, use only the tab key to move your cursor - do not uthe return key. --se 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. f 31, §40 Municipality A. General Information t. Applicant ff ON RiSr2t�t First Name Last Marne --- - A _ Cityfrown 30E— -27(-c?G(.0 Phone Number 2. Property Owner (if different from Applicant). r} o "I (Ic Y state Zip Code S IIEA 43 eahcrsV_ T. /U r- T- Email Address First Name Last Name Address Citylrown State Zip Cade Phone Number Email Address (if known) 3. Representative (if any) First Name Last Narne Company Name Address Cityrfcwn state Zip Code Phone Num r 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): J F 's F et+.+ S. Y�qtet7oc�t Street Add ress 04rTdWn fi d tit 4 1.y 1 '2- tY qY ON Uu2itiAg Latitude (Decimal Degrees Format with 5 digits after decimal Longitude {Dedmal Degrees Format with 5 digits after e.g. XX-XXX X) decimal e.g.-YX.XXXXX) and hour to convert %9 813, d T / ,s- to d mal dg9rees Assessors' Map Number Assessors' Lot1Po cel Number - b. Area Description (use additional paper, if necessary): �l�f� �rpr�t�� c. Plan and/or Map Reference(s): (use additional paper if necessary) 04V<? i 9st p J A'F-9( LyaTF,.P-6r/)43 hC ![ I►5 E-m 010 a s Title T Date Title Date —r—1 A— — '4r2PJW 7 MPL G— 1 - Cary f wl % C Massachusetts Department of Environmental Protection Bureau of Water Resources - Wetlands WPA Form 1- Request for Determination of Applicability l Massachusetts Wetlands Protection Act M.G, L. c. 131, §40 Munrc�pality B. Project Description (cont.) 2. a. Activity/Work Description (use additional paper and/or provide plan(s) of Activity, if necessary), TO C0/'Js4Jz'CT//1A,-,,AA,ej ei Eyl-doll FICJAT quo i ev A � s o P�31t 1,� F a ram. A--f- P�- =s f r- Dry , w�, . O IL'L , o u t : /`I A S S 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). P-1 1999 3. a. If this application is a Request for Determination of Scope of Alternatives for work in the River font Area, indicate the one classification below that best describes the project. M11-s-ingle family house on a lot recorded on or before 811196 ❑ Single family house on a lot recorded after 811198 ❑ Expansion of an existing structure on a lot recorded after 811196 ❑ Project, other than a single-family house or public project, where the applicant owned the lot before 8f7196 ❑ New agriculture or aquaculture project ❑ Public project where funds were appropriated prior to 81V96 ❑ 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 govemment project ❑ Project required to evaluate off -site alternatives in more than one municipality in an Environmentai Impact Report under MEPA or in are 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.) ..+.�+rn.I A— — Aawm rl9 MOM r— i - -0 •�r. 6w'i . % Massachusetts Department of Environmental Protection 4 Bureau of Water Resources - Wetlands WPA Form I - bequest for Determination of Applicability Li Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 MunidpaRy C. Determinations 1. 1 request the make the following determination(s). Check any that apply; Conservat*n Commission ❑ a. whether the areas depicted on plan(s) and/or map(s) referenced above is an area subject to }uhsdiction of the Wetlands Protection Act. ❑ b_ whether the boundaries of resource areas) depicted on plans) and/or maps) referenced above are accurately delineated. ❑ c. whether the Activities depicter! on plans) referenced above is subject to the Wetlands Protection Act and its regulations. ❑ d. whether the area and/ar Activities depicted on plans) referenced above is subject to the jurisdiction of any municipal wetlands' ordinance or bylaw of. name of Municlpaiity Ej e. whether the following scope of alternativas 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 D E P 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. c Signatureoff Appl"nt — Date Signature of RepresentatNe (if any) Late u-.d.. I IL— .. rrmFr M,s %w A g:_ Y a...,b..-.b.9— o- 1.,e ti C C X . r CD a-4 0 m Z Q Z M o 0 c_ m QI034�, M01 N) rA z t[ M1 5 CAV xr - x ky 3 191 871 r 1 KOMBOURAS EFFIE D TR 11 TREVINO CIRCLE ANDOVER, MA 01810 191 41.1.1/ 1 1 MUSCOLINO ANGELO MUSCOLINO KATHLEEN 4301 POINT CT PORT CHARLOTTE, FL 33948 251 101 1 1 PALMA ROBERT T SR TRS PALMA NANCY A TRS 10 GROVE 5T PLYMPTON, MA 02367 251 91 1 1 DUNBAR JAMES M 3 SWORDFISH DR SOUTH YARMOUTH. MA 02664 191E 881 1 1 ERICKSON CHRIS A 2 CAPE ISLE DR SOUTH YARMOUTH, MA 02664 191 891 1 1 TOOE<SCO DAVID A TODESCO KIMBERLY L 9 PARK AVE MANSFIELD, MA 02048-2235 F