25A-14 -16 -17 -168-400 Damon Road-Ct River Greenway-NOI-2012.pdf
A.General Information 1. Project Location: a. Street Address 400 DAMON ROAD b. City/Town NORTHAMPTON c. Zip Code 01060 d. Latitude 42.33499N e. Longitude 72.62147W f. Map/Plat # 25A
g.Parcel/Lot # 14,16,17, 168 2. Applicant: cdefgIndividual bcdefgOrganization a. First Name ALBERT b.Last Name STEGEMANN, P.E. c. Organization MASSDOT d. Mailing Address 811 NORTH KING
STREET e. City/Town NORTHAMPTON f. State MA g. Zip Code 01060 h. Phone Number 413-582-0599 i. Fax 413-582-0596 j. Email 3.Property Owner: cdefgmore than one owner a. First Name b. Last
Name c. Organization DCR d. Mailing Address 446 DAMON ROAD e. City/Town NORTHAMPTON f.State MA g. Zip Code 01060 h. Phone Number 413-586-8706 i. Fax j.Email 4.Representative: a. First
Name TIMOTHY b. Last Name MEYER c. Organization MASSDOT d. Mailing Address 811 NORTH KING STREET e. City/Town NORTHAMPTON f. State MA g. Zip Code 01060 h.Phone Number 413-582-0543 i.Fax
413-582-0596 j.Email timothy.meyer@state.ma.us 5.Total WPA Fee Paid (Automatically inserted from NOI NOI Wetland Fee Transmittal Form): a.Total Fee Paid 750.00 b.State Fee Paid 362.50
c.City/Town Fee Paid 387.50 6.General Project Description: THE NORTHAMPTON PORTION OF THE NORWOTTUCK RAIL TRAIL REHABILITATION PROJECT CONSISTS MAINLY OF THE RE-DESIGN OF THE DAMON ROAD
PARKING LOT. 7a.Project Type: 1. cdefg Single Family Home 2. cdefg Residential Subdivision 3. cdefgLimited Project Driveway Crossing 4. cdefgCommercial/Industrial 5. cdefgDock/Pier 6.
cdefgUtilities 7. cdefgCoastal Engineering Structure 8. cdefgAgriculture (eg., cranberries, forestry) 9. bcdefgTransportation 10. cdefgOther 7b.Is any portion of the proposed activity
eligible to be treated as a limited project subject to 310 CMR 10.24 (coastal) or 310 CMR 10.53 (inland)? 1. cdefgYes bcdefgNo If yes, describe which limited project applies to this
project: 2. Limited Project 8.Property recorded at the Registry of Deeds for: a.County: b.Certificate: c.Book: d.Page: HAMPSHIRE 2546 132 B. Buffer Zone & Resource Area Impacts (temporary
& permanent) 1.Buffer Zone & Resource Area Impacts (temporary & permanent): Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands WPA Form 3 -Notice
of Intent Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by MassDEP: MassDEP File #: eDEP Transaction #:496041 City/Town:NORTHAMPTON Page 1 of 8 * ELECTRONIC COPY
6.General Project Description: THE NORTHAMPTON PORTION OF THE NORWOTTUCK RAIL TRAIL REHABILITATION PROJECT CONSISTS MAINLY OF THE RE-DESIGN OF THE DAMON ROAD PARKING LOT. 7a.Project
Type: 1. cdefg Single Family Home 2. cdefg Residential Subdivision 3. cdefgLimited Project Driveway Crossing 4. cdefgCommercial/Industrial 5. cdefgDock/Pier 6. cdefgUtilities 7. cdefgCoastal
Engineering Structure 8. cdefgAgriculture (eg., cranberries, forestry) 9. bcdefgTransportation 10. cdefgOther 7b.Is any portion of the proposed activity eligible to be treated as a limited
project subject to 310 CMR 10.24 (coastal) or 310 CMR 10.53 (inland)? 1. cdefgYes bcdefgNo If yes, describe which limited project applies to this project: 2. Limited Project 8.Property
recorded at the Registry of Deeds for: a.County: b.Certificate: c.Book: d.Page: HAMPSHIRE 2546 132 B. Buffer Zone & Resource Area Impacts (temporary & permanent) 1.Buffer Zone & Resource
Area Impacts (temporary & permanent): This is a Buffer Zone only project -Check if the project is located only in the Buffer Zone of a Bordering Vegetated Wetland, Inland Bank, or Coastal
Resource Area. gfedc 2.Inland Resource Areas: (See 310 CMR 10.54 -10.58, if not applicable, go to Section B.3. Coastal Resource Areas) Resource Area Size of Proposed Alteration Proposed
Replacement (if any) a. cdefgBank 1. linear feet 2. linear feet b. cdefgBordering Vegetated Wetland 1. square feet 2. square feet c. cdefgLand under Waterbodies and Waterways 1. square
feet 2. square feet 3. cubic yards dredged d. cdefgBordering Land Subject to Flooding 1. square feet 2. square feet 3. cubic feet of flood storage lost 4. cubic feet replaced e. cdefgIsolated
Land Subject to Flooding 1. square feet 2. cubic feet of flood storage lost 3. cubic feet replaced f. bcdefgRiverfront Area 1. Name of Waterway (if any) 2. Width of Riverfront Area (check
one) 25 ft. -Designated Densely Developed Areas only 100 ft. -New agricultural projects only 200 ft. -All other projects gfedcgfedcgfedcb 3. Total area of Riverfront Area on the site
of the proposed project 162552 square feet 4. Proposed Alteration of the Riverfront Area: 23375 a. total square feet 1209 b. square feet within 100 ft. 24166 c. square feet between 100
ft. and 200 ft. 5. Has an alternatives analysis been done and is it attached to this NOI? cdefgYes bcdefgNo 6. Was the lot where the activity is proposed created prior to August 1, 1996?
bcdefgYes cdefgNo 3.Coastal Resource Areas: (See 310 CMR 10.25 -10.35) Resource Area Size of Proposed Alteration Proposed Replacement (if any) a. cdefgDesignated Port Areas Indicate
size under Land under the ocean below, b. cdefgLand Under the Ocean 1. square feet 2. cubic yards dredged Massachusetts Department of Environmental Protection Bureau of Resource Protection
-Wetlands WPA Form 3 -Notice of Intent Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by MassDEP: MassDEP File #: eDEP Transaction #:496041 City/Town:NORTHAMPTON Page
2 of 8 * ELECTRONIC COPY
100 ft. -New agricultural projects only 200 ft. -All other projects gfedcgfedcb 3. Total area of Riverfront Area on the site of the proposed project 162552 square feet 4. Proposed Alteration
of the Riverfront Area: 23375 a. total square feet 1209 b. square feet within 100 ft. 24166 c. square feet between 100 ft. and 200 ft. 5. Has an alternatives analysis been done and is
it attached to this NOI? cdefgYes bcdefgNo 6. Was the lot where the activity is proposed created prior to August 1, 1996? bcdefgYes cdefgNo 3.Coastal Resource Areas: (See 310 CMR 10.25
-10.35) Resource Area Size of Proposed Alteration Proposed Replacement (if any) a. cdefgDesignated Port Areas Indicate size under Land under the ocean below, b. cdefgLand Under the Ocean
1. square feet 2. cubic yards dredged c. cdefgBarrier Beaches Indicate size under Coastal Beaches and/or Coatstal Dunes, below d. cdefgCoastal Beaches 1. square feet 2. cubic yards beach
nourishment e. cdefgCoastal Dunes 1. square feet 2. cubic yards dune nourishment f. cdefgCoastal Banks 1. linear feet g. cdefgRocky Intertidal Shores 1. square feet h. cdefgSalt Marshes
1. square feet 2. sq ft restoration, rehab, crea. i. cdefgLand Under Salt Ponds 1. square feet 2. cubic yards dredged j. cdefgLand Containing Shellfish 1. square feet k. cdefgFish Runs
Indicate size under Coastal Banks, Inland Bank, Land Under the Ocean, and/or inland Land Under Waterbodies and Waterways, above 1. cubic yards dredged l. Land Subject to Coastal Storm
Flowage gfedc 1. square feet 4.Restoration/Enhancement cdefg Restoration/Replacement If the project is for the purpose of restoring or enhancing a wetland resource area in addition to
the square footage that has been entered in Section B.2.b or B.3.h above, please entered the additional amount here. a. square feet of BVW b. square feet of Salt Marsh 5.Projects Involves
Stream Crossings cdefg Project Involves Streams Crossings If the project involves Stream Crossings, please enter the number of new stream crossings/number of replacement stream crossings.
a. number of new stream crossings b. number of replacement stream crossings C. Other Applicable Standards and Requirements Streamlined Massachusetts Endangered Species Act/Wetlands Protection
Act Review 1. Is any portion of the proposed project located in Estimated Habitat of Rare Wildlife as indicated on the most recent Estimated Habitat Map of State-Listed Rare Wetland
Wildlife published by the Natural Heritage of Endangered Species program (NHESP)? a. bcdefgYes cdefgNo If yes, include proof of mailing or hand delivery of NOI to: Natural Heritage and
Endangered Species Program Division of Fisheries and Wildlife Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands WPA Form 3 -Notice of Intent
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by MassDEP: MassDEP File #: eDEP Transaction #:496041 City/Town:NORTHAMPTON Page 3 of 8 * ELECTRONIC COPY
4.Restoration/Enhancement cdefg Restoration/Replacement If the project is for the purpose of restoring or enhancing a wetland resource area in addition to the square footage that has
been entered in Section B.2.b or B.3.h above, please entered the additional amount here. a. square feet of BVW b. square feet of Salt Marsh 5.Projects Involves Stream Crossings cdefg
Project Involves Streams Crossings If the project involves Stream Crossings, please enter the number of new stream crossings/number of replacement stream crossings. a. number of new
stream crossings b. number of replacement stream crossings C. Other Applicable Standards and Requirements Streamlined Massachusetts Endangered Species Act/Wetlands Protection Act Review
1. Is any portion of the proposed project located in Estimated Habitat of Rare Wildlife as indicated on the most recent Estimated Habitat Map of State-Listed Rare Wetland Wildlife published
by the Natural Heritage of Endangered Species program (NHESP)? a. bcdefgYes cdefgNo If yes, include proof of mailing or hand delivery of NOI to: Natural Heritage and Endangered Species
Program Division of Fisheries and Wildlife Route 135, North Drive Westborough, MA 01581 b. Date of map:OCTOBER 2008 If yes, the project is also subject to Massachusetts Endangered Species
Act (MESA) review (321 CMR 10.18).... c. Submit Supplemental Information for Endangered Species Review * (Check boxes as they apply) 1. cdefg Percentage/acreage of property to be altered:
(a) within Wetland Resource Area percentage/acreage (b) outside Resource Area percentage/acreage 2. cdefg Assessor's Map or right-of-way plan of site 3. Project plans for entire project
site, including wetland resource areas and areas outside of wetland jurisdiction, showing existing and proposed conditions, existing and proposed tree/vegetation clearing line, and clearly
demarcated limits of work ** gfedc a. cdefgProject description (including description of impacts outside of wetland resource area & buffer zone) b. cdefg Photographs representative of
the site c. MESA filing fee (fee information available at: http://www.mass.gov/dfwele/dfw/nhesp/regulatory_review/mesa/mesa_home.htm) Make check payable to "Natural Heritage & Endangered
Species Fund" and mail to NHESP at above address gfedc Projects altering 10 or more acres of land, also submit: d. cdefgVegetation cover type map of site e. cdefgProject plans showing
Priority & Estimated Habitat boundaries d. OR Check One of the following 1. Project is exempt from MESA review. Attach applicant letter indicating which MESA exemption applies. (See
321 CMR 10.14, http://www.mass.gov/dfwele/dfw/nhesp/regulatory_review/mesa/mesa_exemptions.htm; the NOI must still be sent to NHESP if the project is within estimated habitat pursuant
to 310 CMR 10.37 and 10.59.) gfedc 2. bcdefg Separate MESA review ongoing. a. NHESP Tracking Number 08-24582 b. Date submitted to NHESP 2009 & 2012 3. Separate MESA review completed.
Include copy of NHESP "no Take" determination or valid Conservation & Management Permit with approved plan. gfedc * Some projects not in Estimated Habitat may be located in Priority
Habitat, and require NHESP review... 2. For coastal projects only, is any portion of the proposed project located below the mean high waterline or in a fish run? a. bcdefg Not applicable
-project is in inland resource area only b. cdefgYes cdefgNo If yes, include proof of mailing or hand delivery of NOI to either: South Shore -Cohasset to RhodebIsland, and the Cape &
Islands: Division of Marine Fisheries -Southeast Marine Fisheries Station Attn: Environmental Reviewer 12143 Purchase street -3rd floor North Shore -Hull to New Hampshire: Division of
Marine Fisheries -North Shore Office Attn: Environmental Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands WPA Form 3 -Notice of Intent Massachusetts
Wetlands Protection Act M.G.L. c. 131, §40 Provided by MassDEP: MassDEP File #: eDEP Transaction #:496041 City/Town:NORTHAMPTON Page 4 of 8 * ELECTRONIC COPY
1. Project is exempt from MESA review. Attach applicant letter indicating which MESA exemption applies. (See 321 CMR 10.14, http://www.mass.gov/dfwele/dfw/nhesp/regulatory_review/mesa/mesa_exemptions
.htm; the NOI must still be sent to NHESP if the project is within estimated habitat pursuant to 310 CMR 10.37 and 10.59.) gfedc 2. bcdefg Separate MESA review ongoing. a. NHESP Tracking
Number 08-24582 b. Date submitted to NHESP 2009 & 2012 3. Separate MESA review completed. Include copy of NHESP "no Take" determination or valid Conservation & Management Permit with
approved plan. gfedc * Some projects not in Estimated Habitat may be located in Priority Habitat, and require NHESP review... 2. For coastal projects only, is any portion of the proposed
project located below the mean high waterline or in a fish run? a. bcdefg Not applicable -project is in inland resource area only b. cdefgYes cdefgNo If yes, include proof of mailing
or hand delivery of NOI to either: South Shore -Cohasset to RhodebIsland, and the Cape & Islands: Division of Marine Fisheries -Southeast Marine Fisheries Station Attn: Environmental
Reviewer 12143 Purchase street -3rd floor New Bedford, MA 02740-6694 North Shore -Hull to New Hampshire: Division of Marine Fisheries -North Shore Office Attn: Environmental Reviewer
30 Emerson Avenue Gloucester, MA 01930 If yes, it may require a Chapter 91 license. For coastal towns in the Northeast Region, please contact MassDEP's Boston Office. For coastal towns
in the Southeast Region, please contact MassDEP's Southeast Regional office. 3. Is any portion of the proposed project within an Area of Critical Environmental Concern (ACEC)? a. cdefgYes
bcdefgNo If yes, provide name of ACEC (see instructions to WPA Form 3 or DEP Website for ACEC locations). Note: electronic filers click on Website. b. ACEC Name 4. Is any portion of
the proposed project within an area designated as an Outstanding Resource Water (ORW) as designated in the Massachusetts Surface Water Quality Standards, 314 CMR 4.00? a. cdefgYes bcdefgNo
5. Is any portion of the site subject to a Wetlands Restriction Order under the Inland Wetlands Restriction Act (M.G.L.c. 131, § 40A) or the Coastal Wetlands Restriction Act (M.G.L.c.
130, § 105)? a. cdefgYes bcdefgNo 6. Is this project subject to provisions of the MassDEP Stormwater Management Standards? a. gfedcb Yes, Attach a copy of the Stormwater Report as required
by the Stormwater Management Standards per 310 CMR 10.05 (6)(k)-(q) and check if: 1. gfedc Applying for Low Impact Development (LID) site design credits (as described in Stormwater Management
Handbook Vol.2, Chapter 3) 2. gfedcb A portion of the site constitutes redevelopment 3. gfedc Proprietary BMPs are included in the Stormwater Management System b. gfedc No, Explain why
the project is exempt: 1. gfedc Single Family Home 2. gfedc Emergency Road Repair 3. gfedc Small Residential Subdivision (less than or equal to 4 single-family houses or less than or
equal to 4 units in multi-family housing project) with no discharge to Critical Areas. Areas. D. Additional Information Applicants must include the following with this Notice of Intent
(NOI). See instructions for details. Online Users: Attach the document transaction number (provided on your receipt page) for any of the following information you submit to the Department
by regular mail delivery. 1. gfedcb USGS or other map of the area (along with a narrative description, if necessary) containing sufficient information for the Conservation Commission
and the Department to locate the site. (Electronic filers may omit this item.) 2. gfedcb Plans identifying the location of proposed activities (including activities proposed to serve
as a Bordering Vegetated Wetland [BVW] replication area or other mitigating measure) relative to the boundaries of each affected resource area. 3. gfedcb Identify the method for BVW
and other resource area boundary delineations (MassDEP BVW Field Data Form(s). Determination of Applicability, Order of Resource Area Delineation, etc.), and attach documentation of
the methodology. 4. gfedcb List the titles and dates for all plans and other materials submitted with this NOI. a. Plan Title: b. Plan Prepared By: c. Plan Signed/Stamped By: c. Revised
Final Date: e. Scale: EDEP NOI PLAN NORTHAMPTON MASSDOT DISTRICT 2 Sept 7, 2012 50 Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands WPA Form
3 -Notice of Intent Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by MassDEP: MassDEP File #: eDEP Transaction #:496041 City/Town:NORTHAMPTON Page 5 of 8 * ELECTRONIC
COPY
b. gfedc No, Explain why the project is exempt: 1. gfedc Single Family Home 2. gfedc Emergency Road Repair 3. gfedc Small Residential Subdivision (less than or equal to 4 single-family
houses or less than or equal to 4 units in multi-family housing project) with no discharge to Critical Areas. D. Additional Information Applicants must include the following with this
Notice of Intent (NOI). See instructions for details. Online Users: Attach the document transaction number (provided on your receipt page) for any of the following information you submit
to the Department by regular mail delivery. 1. gfedcb USGS or other map of the area (along with a narrative description, if necessary) containing sufficient information for the Conservation
Commission and the Department to locate the site. (Electronic filers may omit this item.) 2. gfedcb Plans identifying the location of proposed activities (including activities proposed
to serve as a Bordering Vegetated Wetland [BVW] replication area or other mitigating measure) relative to the boundaries of each affected resource area. 3. gfedcb Identify the method
for BVW and other resource area boundary delineations (MassDEP BVW Field Data Form(s). Determination of Applicability, Order of Resource Area Delineation, etc.), and attach documentation
of the methodology. 4. gfedcb List the titles and dates for all plans and other materials submitted with this NOI. a. Plan Title: b. Plan Prepared By: c. Plan Signed/Stamped By: c. Revised
Final Date: e. Scale: EDEP NOI PLAN NORTHAMPTON MASSDOT DISTRICT 2 Sept 7, 2012 50 NOI ATTACHMENTS MASSDOT DISTRICT 2 Sept 7, 2012 VARIOUS 5. gfedc If there is more than one property
owner, please attach a list of these property owners not listed on this form. 6. gfedc Attach proof of mailing for Natural Heritage and Endangered Species Program, if needed. 7. gfedc
Attach proof of mailing for Massachusetts Division of Marine Fisheries, if needed. 8. gfedcb Attach NOI Wetland Fee Transmittal Form. 9. gfedcb Attach Stormwater Report, if needed. 1.
Fee Exempt: No filing fee shall be assessed for projects of any city, town, county, or district of the Commonwealth, federally recognized Indian tribe housing authority, municipal housing
authority, or the Massachusetts Bay Transportation Authority. Applicants must submit the following information (in addition to pages 1 and 2 of the NOI Wetland Fee Transmittal Form)
to confirm fee payment: I hereby certify under the penalties of perjury that the foregoing Notice of Intent and accompanying plans, documents, and supporting data are true and complete
to the best of my knowledge. I understand that the Conservation Commission will place notification of this Notice in a local newspaper at the expense of the applicant in accordance with
the wetlands regulations, 310 CMR 10.05(5)(a). I further certify under penalties of perjury that all abutters were notified of this application, pursuant to the requirements of M.G.L.
c. 131, § 40. Notice must be made by Certificate of Mailing or in writing by hand delivery or certified mail (return receipt requested) to all abutters within 100 feet of the property
line of the project location. For Conservation Commission: Two copies of the completed Notice of Intent (Form 3), including supporting plans and documents, two copies of the NOI Wetland
Fee Transmittal Form, and the city/town fee payment, to the Conservation Commission by certified mail or hand delivery. For MassDEP: One copy of the completed Notice of Intent (Form
3), including supporting plans and documents, one copy of the NOI Wetland Fee Transmittal Form, E.Fees 2. Municipal Check Number 3. Check date 4. State Check Number 5. Check date 6.
Payer name on check: First Name 7. Payer name on check: Last Name F.Signatures and Submittal Requirements Albert Stegemann P.E. 9/7/2012 1. Signature of Applicant 2. Date Jonathan Yeo
9/7/2012 3. Signature of Property Owner(if different) 4. Date Robert Natario 9/7/2012 5. Signature of Representative (if any) 6. Date Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands WPA Form 3 -Notice of Intent Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by MassDEP: MassDEP File #: eDEP Transaction #:496041
City/Town:NORTHAMPTON Page 6 of 8 * ELECTRONIC COPY
Determination of Applicability, Order of Resource Area Delineation, etc.), and attach documentation of the methodology. 4. gfedcb List the titles and dates for all plans and other materials
submitted with this NOI. a. Plan Title: b. Plan Prepared By: c. Plan Signed/Stamped By: c. Revised Final Date: e. Scale: EDEP NOI PLAN NORTHAMPTON MASSDOT DISTRICT 2 Sept 7, 2012 50
NOI ATTACHMENTS MASSDOT DISTRICT 2 Sept 7, 2012 VARIOUS 5. gfedc If there is more than one property owner, please attach a list of these property owners not listed on this form. 6. gfedc
Attach proof of mailing for Natural Heritage and Endangered Species Program, if needed. 7. gfedc Attach proof of mailing for Massachusetts Division of Marine Fisheries, if needed. 8.
gfedcb Attach NOI Wetland Fee Transmittal Form. 9. gfedcb Attach Stormwater Report, if needed. 1. Fee Exempt: No filing fee shall be assessed for projects of any city, town, county,
or district of the Commonwealth, federally recognized Indian tribe housing authority, municipal housing authority, or the Massachusetts Bay Transportation Authority. Applicants must
submit the following information (in addition to pages 1 and 2 of the NOI Wetland Fee Transmittal Form) to confirm fee payment: I hereby certify under the penalties of perjury that the
foregoing Notice of Intent and accompanying plans, documents, and supporting data are true and complete to the best of my knowledge. I understand that the Conservation Commission will
place notification of this Notice in a local newspaper at the expense of the applicant in accordance with the wetlands regulations, 310 CMR 10.05(5)(a). I further certify under penalties
of perjury that all abutters were notified of this application, pursuant to the requirements of M.G.L. c. 131, § 40. Notice must be made by Certificate of Mailing or in writing by hand
delivery or certified mail (return receipt requested) to all abutters within 100 feet of the property line of the project location. For Conservation Commission: Two copies of the completed
Notice of of Intent (Form 3), including supporting plans and documents, two copies of the NOI Wetland Fee Transmittal Form, and the city/town fee payment, to the Conservation Commission
by certified mail or hand delivery. For MassDEP: One copy of the completed Notice of Intent (Form 3), including supporting plans and documents, one copy of the NOI Wetland Fee Transmittal
Form, and a copy of the state fee payment to the MassDEP Regional Office (see Instructions) by certified mail or hand delivery. Other: If the applicant has checked the "yes" box in Section
C, Items 1-3, above, refer to that section and the Instructions for additional submittal requirements. The original and copies must be sent simultaneously. Failure by the applicant to
send copies in a timely manner may result in dismissal of the Notice of Intent. E.Fees 2. Municipal Check Number 3. Check date 4. State Check Number 5. Check date 6. Payer name on check:
First Name 7. Payer name on check: Last Name F.Signatures and Submittal Requirements Albert Stegemann P.E. 9/7/2012 1. Signature of Applicant 2. Date Jonathan Yeo 9/7/2012 3. Signature
of Property Owner(if different) 4. Date Robert Natario 9/7/2012 5. Signature of Representative (if any) 6. Date Massachusetts Department of Environmental Protection Bureau of Resource
Protection -Wetlands WPA Form 3 -Notice of Intent Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by MassDEP: MassDEP File #: eDEP Transaction #:496041 City/Town:NORTHAMPTON
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Two copies of the completed Notice of Intent (Form 3), including supporting plans and documents, two copies of the NOI Wetland Fee Transmittal Form, and the city/town fee payment, to
the Conservation Commission by certified mail or hand delivery. For MassDEP: One copy of the completed Notice of Intent (Form 3), including supporting plans and documents, one copy of
the NOI Wetland Fee Transmittal Form, and a copy of the state fee payment to the MassDEP Regional Office (see Instructions) by certified mail or hand delivery. Other: If the applicant
has checked the "yes" box in Section C, Items 1-3, above, refer to that section and the Instructions for additional submittal requirements. The original and copies must be sent simultaneously.
Failure by the applicant to send copies in a timely manner may result in dismissal of the Notice of Intent. Massachusetts Department of Environmental Protection Bureau of Resource Protection
-Wetlands WPA Form 3 -Notice of Intent Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by MassDEP: MassDEP File #: eDEP Transaction #:496041 City/Town:NORTHAMPTON Page
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Are you exempted from Fee? gfedc (YOU HAVE SELECTED 'NO') Note: Fee will be exempted if you are one of the following: l City/Town/County/District l Municipal Housing Authority l Indian
Tribe Housing Authority l MBTA State agencies are only exempt if the fee is less than $100 Fees Activity Type Activity Number Activity Fee RF Multiplier Sub Total J.) ANY OTHER ACTIVITY
NOT IN CATEGORY 1,3,4,5 OR 6; 1 500.00 RFA MULTIPLIER 1.5 750.00 City/Town share of filling fee $387.50 State share of filing fee $362.50 Total Project Fee $750.00 Massachusetts Department
of Environmental Protection Bureau of Resource Protection -Wetlands WPA Form 3 -Notice of Wetland FeeTransmittal Form Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Page 1
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