38C-003 194 Grove Street Addition-Request for Determination-8-15-2014Important:
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wpaformi.doc
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
City/Town
WPA Form 1- Request for Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
A. General Information
1.
Applicant:
Douglas Benton and Katherine Geis
Name
194 Grove Street
Mailing Address
tvgeis@mac.com
E -Mail Address
Northampton MA 01060
City/Town State Zip Code
413-586-4989
Phone Number
2. Representative (if any):
Fax Number Of applicable)
Firm
Contact Name
E -Mail Addres
Mailing Address
City/Town
State Zip Code
Phone Number
Fax Number Of applicable)
B. Determinations
1, I request the -✓r� li✓L 'Vmake the following determination(s). Check any that apply:
Conservation Commission
a. whether the area depicted on plan(s) and /or map(s) referenced below 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
below are accurately delineated.
c. whether the work depicted on plan(s) referenced below is subject to the Wetlands Protection Act.
d. whether the area and /or work depicted on plan(s) referenced below is subject to the jurisdiction
of any municipal wetlands ordinance or bylaw of:
Northampton
Name of Municipality
e. whether the following scope of alternatives is adequate for work in the Riverfront Area as
depicted on referenced plan(s).
Page 1 of 4
�i
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
Clty/Town
WPA Form 1- Request for Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
C. Project Description
1. a. Project Location (use maps and plans to identify the location of the area subject to this request):
194 Grove Street
Street Address
Northampton
'*4/ 37 City/Town
Assessors Map /Plat Number
3
Parcel /Lot Number
b. Area Description (use additional paper, if necessary):
Single family_ home on Grove Street, home was built in 1900 next to wetlands,
c. Plan and /or Map Reference(s):
Title 47,10 age Date
Heritage Survey Map, 6926- 130107 Book 9728 ,_Page 100 /n7 no3 1-/7/2013_
Title Date
Registry of Deeds Book 8019 page 203
Title
Sept 10, 2004
Date
2. a. Work Description (use additional paper and /or provide plan(s) of work, if necessary):
Add dining area underneath overhang of existing home structure, remain in aerial footprint of house.
Work area is 65 ft and 72 ft from the top of the bank,
wpaforml.doc
Page 2 of 4
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
City/Town
WPA Form 1- Request for Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
C. Project Description (cont.)
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.
>vi
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.)
wpaformt.doc Page 3 of 4
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
City/Town
WPA Form 1- Request for Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
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.
Name and address of the property owner:
Douglas Benton & Katherine Geis
Narne
194 Grove Street
Mailing Address
Northampton
City/Town
MA
State
Signatures:
01060
Zlp Code
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.
'y
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r f✓b2. //4 `s7✓,2° 8/15/14
Signature of Applicant l! fd Date
Signature of Representative (If any) Date
wpaformi.tloc Page 4 of 4
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