16A-002 Look Park Restroom RDA.pdf
wpaform1.doc Page 1 of 4
Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 1- Request for Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
Northampton
City/Town
A. General Information
Important: When filling out forms on the computer, use only the tab key
to move your cursor - do not use the return
key.
1. Applicant:
Frank Newhall Look Memorial Park
Name
sporter@lookpark.prg
E-Mail Address
300 North Main St
Mailing Address
Florence
City/Town
MA
State
01062
Zip Code
413-584-5457
Phone Number
4135864324
Fax Number (if applicable)
2. Representative (if any):
Firm
Contact Name
E-Mail Address
Mailing Address
City/Town
State
Zip Code
Phone Number
Fax Number (if applicable)
B. Determinations
1. I request the Northampton
Conservation Commission
make the following determination(s). Check any that apply:
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).
wpaform1.doc Page 2 of 4
Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 1- Request for Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
Northampton
City/Town
C. Project Description
1. a. Project Location (use maps and plans to identify the location of the area subject to this request):
300 North Main St
Street Address
Florence
City/Town
16A
Assessors Map/Plat Number
002
Parcel/Lot Number
b. Area Description (use additional paper, if necessary):
The area is already used as a restroom and the goal is to replace the existing restroom with a new restroom located on the same footprint. Pictures of the current buidling and location are attached.
c. Plan and/or Map Reference(s):
Title
Date
Title
Date
Title
Date
2. a. Work Description (use additional paper and/or provide plan(s) of work, if necessary):
A copy of the plan for the new bathroom is attached. The current structure will be demolished. Silt fences and erosion controls will be used in order to ensure the project has no impact on surrounding
areas. Once the current restroom is removed the pits will be dug for the concrete chambers and a prefabricated buiding will be placed on the pad.
wpaform1.doc Page 3 of 4
Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 1- Request for Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
Northampton
City/Town
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).
n/a
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.)
wpaform1.doc Page 4 of 4
Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 1- Request for Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
Northampton
City/Town
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:
Frank Newhall Look Memorial Park
Name
300 North Main St
Mailing Address
Florence
City/Town
MA
State
01062
Zip Code
Signatures:
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.
Signature of Applicant
Date
Signature of Representative (if any)
Date
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COMP ROOFFASCIAGLULAM BEAM GABLE WINDOW125.48" x 16" CMU SPLIT
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Look Memorial Park Restroom Location