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Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands Northampton
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WPA Form 1- Request for Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
A. General Information
1. Applicant:
Darlene Kellogg dadene J kelogg@yahoo.com
Name E-mas Address
1162 Westhampton Road
Mailing Address
Northampton
City/Town
413-586-4573
Phone Number
2. Representative(if any):
Cold Spring Environmental
Finn
Alan Weiss
Contact Name
350 Old Enfield Road
Mailing Address
Belchertown
City/Town
413-323-5957
MA
State
01062
Zip Code
Fax Number(ii applicable)
aeweiss @charter.net
E-Mail Address
Phone Number
MA
State
413-323-4916
01007
Zip Code
Fax Number(d applkebie)
B. Determinations
1. I request the Northampton make 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.
(21 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
❑ a whether the following scope of alternatives is adequate for work in the Riverfront Area as
depicted on referenced plan(s).
P .1 a.
G3
w+orr•1 doe
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands Northampton
grown
WPA Form 1- Request for Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
C. Project Description
I. a. Project Location(use maps and plans to identify the location of the area subject to this request):
1162 Westhampton Northampton
Street Address CilyRmm
41 -033 01
Assessors Map/Plat Number ParceVtot Number
b. Area Description(use additional paper, if necessary):
See Septic System Repair Plan Board of Health and Conservation concurrent.(New septic system
exceeds 50'from BV W and intermittent stream,bout work is within Buffer Zone).
c. Plan and/or Map Reference(s):
Site Plan 05.102018
Title Date
Title Date
Title Date
2. a. Work Description (use additional paper and/or provide plan(s)of work, N necessary):
Septic system repair on site as shown on plans. Siltation control noted, Limit of xoddgrading within
45-50 ft BV VV (rid system decommission at closest,45'). RDA filed as for area of work to Conservation.
Comm as required.
P.se x a/
.Morrn+.eoc
Massachusetts Department of Environmental Protection Northampton
of Resource Protection-Wetlands City/Tom
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).
See above
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 817/96
❑ 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.)
N/A
•eeuue^1 a:
Massachusetts Department of Environmental Protection Northampton
Bureau of Resource Protection -Wetlands N N ofroem
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
Darlene Kellogg
Name
1162 Westhampton Road
Melling Address
Northampton
City/Town
MA 01062
State 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
Alan Weiss
Signature of Representative(if any) Date
6- id-96
Date
05.10.2016
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