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Strong 384 North Farms Road.pdfwpaform1.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: Kenneth and Linda Strong Name klstrong@comcast.net E-Mail Address 384 North Farms Road Mailing Address Florence City/Town MA State 01062 Zip Code 413-320-8090 Phone Number Fax Number (if applicable) 2. Representative (if any): Hiltown Environmental Consulting Firm Mark Thompson Contact Name hilltownenvironmental@gmail.com E-Mail Address P.O. Box 314 Mailing Address Chesterfield City/Town MA State 01012 Zip Code 413-296-4499 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): 384 North Farms Road Street Address Florence City/Town # 7 Assessors Map/Plat Number # 52 Parcel/Lot Number b. Area Description (use additional paper, if necessary): 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): replacement of an existing septic system with all work to be performed outside the 100' riverfront buffer but within the 200' buffer Previously submitted on plan sheet 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). 310CMR10.03(3), Presumption concerning 310CMR15.00:Subsurface Disposal of Sanitarty Sewage (Title 5). 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: Kenneth and Linda Strong Name 384 North Farms Road 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 9/4/2023 Date Signature of Representative (if any) Date CONSTRUCTION NOTES 1. CONTACT THE SYSTEM DESIGNER AND HEALTH DEPARTMENT PRIOR TO STARTING THE INSTALLATION SO THAT INSPECTION ARRANGEMENTS MAY BE MADE FOR THE SUBGRADE AND FINISHED SYSTEM. 2. DWELLING IS SUPPLIED BY MUNICIPAL WATER. NO KNOWN WELLS WITHIN 200’ OF PROPOSED SYSTEM. 3. CONFIRM ELEVATION OF BUILDING EXIT PIPE PRIOR TO INSTALLING SYSTEM. BUILDING EXIT PIPE TO BE 4” DIAMETER SCH. 40 PVC OR ABS WITH A MINIMUM SLOPE OF 2% AND NO BENDS IN EXCESS OF 22 DEGREES. 4. PIPE FROM SEPTIC TANK TO D-BOX TO BE 4” DIA. SDR 35 WITH A MINIMUM 1% SLOPE. 5. LOCATION AND ELEVATION OF SEPTIC TANK MAY BE ADJUSTED AT CONTACTOR’S DISCRETION IF SETBACK AND MINIMUM SLOPE REQUIREMENTS ARE MAINTAINED. 6. EXISTING SEPTIC TANK AND DRYWELLS ARE TO BE PUMPED, CRUSHED AND BACKFILLED. 7. SEPTIC TANK AND D-BOX ARE TO BE PLACED ON A SIX-INCH BED OF STONE TO PREVENT SETTLING AND ARE TO INCLUDE SPECIFIED TEES AND EFFLUENT FILTER (POLYLOK PL-68 OR SIMILAR) AS SHOWN IN PROFILE DETAIL. 8. SET LEACH GALLERY AT ELEVATION NOTED IN PROFILE, BACKFILL TO PROVIDE A MINIMUM 12” OF COVER AND CREATE A 2% CROWN OR SLOPE TO DIVERT SURFACE RUNOFF AND PREVENT PONDING. 9. A RISER OVER ONE OF THE GALLEYS EXTENDING TO WITHIN 6” OF GRADE SHALL BE USED AS AN INSPECTION PORT. 10. ALL SYSTEM COMPONENTS TO BE MARKED WITH MAGNETIC TAPE PRIOR TO BACKFILLING. 11. ALL DISTURBED AREAS INCLUDING THE SOIL ABSORPTION SYSTEM TO BE LOAMED AND SEEDED (HAY MULCH MAY BE NEEDED ON SLOPES AND DURING WET TIMES OF YEAR). 12. SYSTEM IS NOT DESIGNED TO ACCOMMODATE A GARBAGE DISPOSAL. 13. AVOID DRIVING OVER THE SOIL ABSORPTION SYSTEM ONCE INSTALLED. 14. FIELD VERIFY DISTANCES TO PROPERTY LINES PRIOR TO ALL CONSTRUCTION AND OBSERVE LOCAL SETBACK REQUIREMENTS (SEE ACCOMPANYING PLOT PLAN FOR DIMENSIONS OF ENTIRE LOT). 15. NOTIFY SYSTEM DESIGNER IMMEDIATELY OF ANY SITE CONDITIONS THAT ARE NOT NOTED OR INCONSISTENT WITH THOSE SHOWN ON PLAN. 16. CONSTRUCTION MAY BE SUBJECT TO A WETLAND FILING WITH THE LOCAL CONSERVATION COMMISSION. CONTRACTOR TO OBEY ALL ORDERS OF CONDITIONS CREATED BY THE COMMISSION. 17. CONTRACTOR IS RESPONSIBLE FOR ALL HORIZONTAL AND VERTICAL CONTROL. 18. ALL CONSTRUCTION TO BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL CODE.