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38C-003 194 Grove Street Addition-Request for Determination-8-15-2014Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. 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. 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