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Home My WebLink AboutRDA 10.23.2025 O�YRR DEPARTMENT OF � � CONSERVATION O; ` MATTA M [SE Site acc& 6 autfunkation, 5 c tm enexat Sitf o inlation If the applicant is not the property owner, please submit this form with your application. The owner must be sent a copy of the application on the same day it is filed with this office. Property Address: ' Aep-c.e- Assessors Map/Lot: I(we)hereby authorize the individual members of the Yarmouth Conservation Commission and its agents to enter upon the referenced property for the purpose of gathering information regarding the application filed with the Commission pursuant to the Wetlands Protection Act(M.G.L. Ch. 131, s. 40) and/or the Yarmouth Wetlands Protection Bylaw (Chapter 143). Authorized Signature: Date: f e/7 3/7..5— Please Print Name: '- If other than owner, please state whether tenant, agent, or other: /a.cj Mailing Address: EC) C rd46.efy /24 `dfic 2J cv—S/is- GLi• //f Phone: (S0 e) 2-2l a7�� Cell: fa- Email: rCPP cak Q yoke,c o vti Fax: NA Yarmouth Conservation Commission• 1146 Route 28 • South Yarmouth, MA 02664-4492 Tel. (508)-398-2231 Ext. 1288 • Fax(508)-398-0836 • TTD# (508) 398-2231 �i �� r t'tatiu t CONSERVATION (///�)■��[�� OFFICE �; M*OACM .°f, 1. �/WV c( aPPeicabilitil Sn.wunation: 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 appeicatuan.• Hardcopy filing dropped off or mailed to the Conservation Office including: v,. 1 RDA Administrative Checklist 1 complete RDA application WPA form 1 with original signatures (double sided). Detailed narrative of the project with sufficient information to enable the Commission to determine whether the proposed work will alter an area subject to protection. If BVW or vegetated wetlands are present, delineation sheet(s), coastal bank calculation and other ilevant material if applicable (not applicable for flood zone only projects). armouth Assessor's locator map highlighting parcel(s) where work is proposed, including map and parcel numbers 1 current abutters list identifying the property owners who are to be notified and abutter notification form. All abutters to be notified via certified mail, Certified Mail Receipts (PS Form 3800) must be �z provided. 1 original and 6 photocopies of the plan/sketch, folded separately, right side out with title and address visible. All plans shall reference NAVD1988 unless otherwise noted. Landscape plans shall be fietailed to show proposed and existing conditions, native species, quantity, size and spacing. t/ y-law filing fee: Separate check made payable to "Town of Yarmouth" —)-0 .4A Legal ad fee: Separate check made payable to `Town of Yarmouth" - Please list project property's street address on checks. Refer to Fee Schedule. Digital and DEP filing A pdf of the entire application emailed to bdirienzo(varmouth.ma.us and DEP Southeast Region at SERO NOI @..mass.gov in the same email. Subject line shall be "YARMOUTH - RDA—Street Address - Applicant Name" Please list project property's street address in the pdf file name. I itial 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. * If thyapplicant is NOT the property owner: r/ 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 it 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 bdirienzoyarmouth.ma.us Yarmouth Conservation Commission• 1146 Route 28 •South Yarmouth,MA 02664-4492 Tel. (508)-398-2231 Ext. 1288 •Fax(508)-398-0836•TTD#(508)398-2231 •bdirienzo@yarmouth.ma.us Rev.12/2023 1 LMassachusetts Department of Environmental Protection Bureau of Water Resources - Wetlands WPA Form 1 - Request for Determination of Applic, Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 armocourt tw yah, A. General Information OCT 23 2025 Important: 1. Applicant: When filling out �e� forms on thej4 R E C E I V E D computer,use only First Name Last Name the tab key to move eo Can`/ your cursor-do not �� 44e use the return key. Address ill vr MINN M. mat/ s- �,/fr �� a�� City/Town State Zip Code �S~� 1 — ��ag rep? etc 4c y Ave. e0�, Ph a Num r Email Add s MD N 2. Property Owner(if different from Applicant):Harry fivvd First Names Oast Name G„rhde,Apre_ G ()ni Address yar,nw f i/Tow n ! c{/ mA 6 ?3 (5/7) 3ia 47 ci? stat a-74A . 5.1revf:' 911Q 1aC'p Phone Number Email Addte (if known) 3. Representative (if any) First Name Last Name Company Name Address 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): I c„'ndeinerc bua, o t it (-E rmcvA pr/ Street Address CT own How to find Latitude and Longitude Latitude(Decimal Degrees Format with 5 digits after decimal Longitude(Decimal Degrees Format with 5 digits after e.g.XX.)XXXX) decimal e.g.-XX.XXXXX) and how to convert to decimal degrees 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 Date vi afmml.doc•rev.4J28E2023 WPA Form 1—Request for Delermnsdon of Applicability•Page I of 3 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 B. Project Description (cont.) 2. a. Actiiv ity/Work Description/ GYM I`Y,( c ( (use additional paper and/or provide plan(s) of Activity, if necessary): A.4 I "/ (C\QLA�( , - pai(d t't �Q�( , 7. ex lek, f �`� I �� rim �,� 6 �o �,�/2 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. El Single family house on a lot recorded on or before 8/1/96 El Single family house on a lot recorded after 8/1/96 El 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 El 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.) wpatormt.doc•rev.d7213t2023 WPA Form 1—Request for Dddmiation of AppNcabity•Page 2 of 3 Massachusetts Department of Environmental Protection Bureau of Water Resources - Wetlands WPA Form 1 - Request for Determination of Applicability L I Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Municipality C. Determinations 1. I request the make the following determination(s). Check any that apply: Conservation Commission Od 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 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. Signatures: I also understand that notification of this Request will be placed in a local newspaper at my expense in accord nce with Section 10.05(3)(b)(1)of the Wetlands Protection Act regulations. Si ture of Applicant Date Signature of Representative(if any) Date wpaforml.doc•rev.4282023 WPA Form 1—Request for Determination of Applicabiity•Page 3 of 3