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Home My WebLink AboutRDA 9.25.2026Ow 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 A. General Information Important: 1, Applicant: When filling out forms on the Robert Neale computer, use only First Name the tab key to move your cursor - do not use the return key. tab 6x 2 8 Holly Lane Address Yarmouth uay/ i own 617-513-7561 Phone Number Property Owner (if different from Applicant): First Name Address Last Name MA State montane97@aol.com Email Address Last Name 02664 Zip Code City/Town State Zip Code Phone Number Email Address (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): 8 Holly Lane Yarmouth Street Address Clty/Town How to find Latitude 41.64792-70.21048 and Longitude Latitude (Decimal Degrees Format with 5 digits after decimal Longitude (Decimal Degrees Format with 5 digits after e.g. XX.XXXXX) decimal e.g.-XX.XXXXX) and how to convert 33/185 21 / F062 to decimal degrees Assessors' Map Number Assessors' Lot/Parcel Number b. Area Description (use additional paper, if necessary): Single family home in residential neighborhood. R25 Residential Zoning District. c. Plan and/or Map Reference(s): (use additional paper if necessary) Attachment A 9/23/26 Title Date Title Date wpaform1.doc • rev. 4/28/2023 WPA Form 1 — Request for Determination of Applicability • Page 1 of 3 zwv Massachusetts Department of Environmental Protection Bureau of Water Resources - Wetlands 1 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. Activity/Work Description (use additional paper and/or provide plan(s) of Activity, if necessary). - Replaced non-functioning deck. 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). Applicant asserts the project is not jurisdictional. 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.) wpaforml.doc • rev. 4/28/2023 WPA Form 1 — Request for Determination of Applicability • Page 2 of 3 Massachusetts Department of Environmental Protection Bureau of Water Resources - Wetlands (�1 WPA Form 1- Request for Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Municipality C. Determinations 1. I request the Yarmouth make the following determination(s). Check any that apply: Conservation Commission ❑■ 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: ❑ 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 accordanc it c o 0.05 3)(b)(1) of the Wetlands Protection Act regulations. Sig re of Applicant Date z�.Ignature of Representative (if any) Date wpaforml.doc • rev. 4/28/2023 WPA Form 1 — Request for Determination of Applicability • Page 3 of 3 ce— /D, 41�000, Robert Neale Attachment A 8 Holly Lane WPA - 1 9/24/26 21 I 2'\ 23 I'. 127, i � 196A 8 i26@ f. ti i� 27 'j 2* 34 36 &38 - ! - -V FPS ®G` DEPARTMENT OF CONSERVATION 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: Assessors Map/Lot: 53 t-�' f %I y W 'WV,"—%t '0/� Alk e, it 4 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: Please Print Name: 4-� �V If other than owner, please state whether tenant, agent, or other: Mailing Address: Phone: Email: Cell: 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 7. 0 Ll I u PINE GROVE ROAD 110 r-t m M lik 1-1 HOLLY LANE 0 i F- o C) C) w 'D 'I 2 LU < Lf) Q. uj -j o Cc, co 0 . 6 " > If —1 > g > - N 0 o 0 "1 n CN C) Lei C be ON oj U) co L" - 00 C', uj UJ L'u a 0 C'i r'j Ln co C) < co _7 U*" C� F ui LU cc CC LU Z) z u V) N 0 u cu E cu E CU w -a E 0 .0 m > V) m m O :5 m .1 o In a c: a a 0 V) CL HOLLY LANE .......... ....... o Xo < z(h Z c wo vo) wj ID torj -j ko J_- -C Lw —i N wi 0 N u 00 0 0 uj co = < < g >< Qj 00 X te (jr) V) 1 00 CL ;9 bl PINE GROVE ROAD 11 HC)l I Y LANE Abutting Properties for 8 HOLLY LN SOUTH YARMOUTH, MA 02664 33/ 185/ (1 Feet) Location: 33/ 185/ 8 HOLLY LN Owner: ROBERTS SANDRA B TR FITZHENRY NEALE ELIZABETH 205 CUMBERLAND RD WRENTHAM, MA 02093 Location: 14 HOLLY LN Owner: RUBEGA ROBERT W RUBEGA PATRICIA A 81 OCEAN AVE SOUTH YARMOUTH, MA 02664 Location: 33/ 186/ 8A &8B JOHNS PATH Owner: AVERBUKH EYNSHTEYN TR 136 MORSE ST SHARON, MA 02067 Postal _ ) O CERTIFIED MAILP . ■ [` Domestic Mau Owy C`- 17"' _ � 4`h n;rtWyrt xEi Mw 1171 id;? a ,` 'SJ t'. 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