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Home My WebLink AboutRDA 7.30.2026Massachusetts 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, S40 Municipality lmportant: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. A. General lnformation 1. Applica.nt: S'/ ll." LLrDov 3hui.e5 R r*1 Fi e }ame/p 'Be-irA tQ,6r- Last Name Addresslct ltrle.tr UA Cityffown \.tvQer U*-^ rl^- Phone tttuniOei I 2. Property Owner (if different from Applicant): First Name 3e g D-r'TrAe |€,.u*iL.. 0 V+t /'nr 0 1013 Zip Code EmailAddress Last Name ,*,4 Address City/Town State Zip Code Phone Number Email Address (if known) 3. Repqsentative (if any) S"( ,",.- '?r, f tA 7-3 rt,tA First Name Last Name Company Name S W e+r vltwn^ *, r,0,A^A o tbtz State Zip Code 6 € Bq-inA € t v.r ftlL . c o,v.- 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): Street Address own 6 3 f . Z5Z (Decimal Degrees Format with 5 digits after decimal @ 1 t 1- 'aa -.9 tot lua6r L6 How to find Latitude and Lonqitude and how to convert to decimaldeorees e.g. )fi)fi)fiX)*L Map Number b. Area Description (use additiona! paper, if necessary): Longitude (Decimal Degrees Format with 5 digits after decimale.g. -XX)fi)fiX) /o Assessors' LoUParcel Number c Plan and/or Map Reference(s): (use additional paper if necessary) Title Date Title wpaform 1.doc . rev. 412812023 Date WPA Form 1 - Request for Determination of Applicability . Page 1 of 3 I State t>J 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, S40 Municipalitv B. Project Description (cont.) 2. a. ActivityMork Description (use additional paper and/or provide plan(s) of Activity, if necessary): b. ldentify provisions of the Wetlands Protection Act or regulations which may exempt the applicant from having to file a Notice of lntent for all or part of the described work (use additional paper, if necessary). 3. a. lf 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. tr Single family house on a lot recorded on or before 811196 tr Single family house on a lot recorded after 8/1/96 tr Expansion of an existing structure on a lot recorded after 8/1/96 n Project, other than a single-family house or public project, where the applicant owned the Iot before 817196 tr New agriculture or aquaculture project tr Public project where funds were appropriated prior to 8/7/96 tr 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 tr Residentia! subdivision; institutional, industrial, or commercial project tr Municipal project tr District, county, state, or federal government project tr Project required to evaluate off-site alternatives in more than one municipality in an Environmental !mpact 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.9., record of date subdivision lot was recorded) supporting the classification above (use additional paper and/or attach appropriate documents, if necessary.) wpaforml.doc . rev. 412812023 WPA Form 'l - Request for Determination of Applicability . Page 2 of 3 WPA FOrm 1- Request for Determination of Applicability Massachusetts Wetlands Protection Act tvl.G.L. c. 131, S40 Municipality C. Determinations 1. I request the make the following determination(s). Check any that apply Conservation Commission tr 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. tr 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. tr 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 tr e. whether the fotlowing 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 notificatio Request will be pl in accordance Secti 5(3X (1)the Wetlands aced in a local newspaper at my expense Protection Act regulations. 1-z g .-ct, Applicant Date Date wpaforml .doc . rev. 412812023 Signature of Representative (if any) WPA Form 1 - Request for Determination of Applicability . Page 3 of 3 Massachusetts Department of Environmental Protection Bureau of Water Resources - Wetlands DEPARTMENT OF CONSERVATION Sitp Ancaso inn frum emusl lnl"azmstion: 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:Bs 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 Commissionpursuant to the Wetlands Protection Act (M.G.L. Ch. 131, s. 40) and/or the Yarmouth Wetlands Protection Bylaw (Chapter 143). Authorized Signature Please Print Name: Date: 7Ze- ta S ut^^ 'Bp lt-rr If other than owner, please state whether tenant, agent, or other: Mailing Address: Phone:Cell: Email:Fax: 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