10B-054 reservoir rd Wetlands-Notice of Intent�JW •
City of Northampton -- Wetlands Application
This form is required for all applications filed under the Northampton Wetlands Ordinance
File with the Office of Planning and Development, 210 Main Street, Northampton, MA 01060
We recommend applicants consult with the Land Use and Conservation Planner (587 -1263) before applying
1. Check what kind of permit you are requesting
'
❑, tequest for Determination of Applicability (WPA form 1)
Notice of Intent (WPA form 3 or 4)
❑ Abbreviated Notice of Resource Area Delineation (WPA form 4A)
2. Property Street Address: teeC6
3. Assessors' Map and Parcel: fUi�-05q Second lot (if any) Map and Parcel(s):
Additional property description: io tF. rJ ed_s J?04,rs4®�
4. Ct Ick the items enclosed. Your application will not be accepted if any items are missing.
he appropriate completed Massachusetts DEP application www. mass . (gov /dep /brp /ww /wwforms.Iitm
Completed versions of this Wetlands Application
Nine (9) copies of the fully completed and collated application packages (forms, plans and attachments)
y All plans folded (not rolled) and collated with each application packet
❑
FoPNotice of Intent applications only, the following:
Check to "City of Northampton" for the municipal share calculated from state Wetland Fee Transmittal
Form PLUS $105; and
M $75 check to "Commonwealth of Massachusetts" for the Registry of Deeds recording fee; and
M An abutters list of all property owners within at least 100 feet of the property line of your project.
Abutters lists may be generated at www.NorthamptonMA.g_ov /opdd (click on Database: Abutters,
Permits and Historic). Computers are available at City Hall, Forbes and Lilly Libraries.
❑ or Request for Determination and Notice of Resource Area Delineation applications, a check to the
"City of Northampton" for $85.
A #10 business envelope addressed to the applicant.
5. Provide an Existing Conditions Site Plan. Check the items shown on that plan. You may request a waiver
fro submittal requirements in the space provided, with a reason for the waiver request.
Boundary of entire lot and notation of lot area
` ❑ Context of adjacent lots, if necessary to show extent of wetland/riverfront resource area
❑ Numbered wetland flags
N , O❑ Existing and potential vernal pools
❑ 50' AND 100' wetland buffer
❑ Mean Annual High Water line, for Riverfront Area permits
❑ 100' inner riparian zone AND 200' outer riparian zone, for Riverfront Area permits
❑ Existing structures, impervious surfaces (ie: pavement, gravel) and lawn areas
❑ Edge of vegetation accurately measured or surveyed ,
Significant (8 "+ DBH) trees within the limit of work area that are also within the 200' Riverfront Area,
ordering Vegetated Wetland, or 100' wetland buffer
2' contours
•
❑ Elevations in feet (not meters), for projects within the floodplain
❑ Zoning setbacks
❑ 1:20 scale, if possible
6. If new work is proposed, provide a Proposed Site Plan. Check the items shown on that plan. You may
request a waiver from submittal requirements in the space provided, with a reason for the waiver request.
❑ Grading /proposed new contours
i
t. it
❑ ardscape (ie: footprint of house, driveway, walkways, terraces, etc... )
Any removal of vegetation and significant trees within the riverfront area, wetland and buffer
❑ Landscaping and plantings within the riverfront area, wetland and wetland buffer
' Location of erosion control barrier
Limit of work line
❑ Utility lines
❑ Stormwater management (use DEP form www. mass Rov /dep /brp /ww /wwforms htm ), if required
(� �❑ Wildlife assessment if the site is in a habitat resource area based on NHESP maps, Northampton Potential
and Certified Vernal Pools Map or otherwise required by the Act or Ordinance.
❑ At the same scale as the Existing Conditions Site Plan
❑ For new homes in the Riverfront Area only, documentation of the date the lot was recorded,
7 have provided and requested information and believe and understand that (initial each item below):
Application deadline is one calendar month prior to a public hearing. If the application is incomplete or
waivers are requested, however, the public hearing may be delayed;
We will check for the date and time of our public hearing at www.NorthamptonMA. ov or in the Daily
Hampshire Gazette Legal Ads section. Such notice is posted seven days prior to the public hearing;
The Conservation Commission may request an alternatives analysis for work proposed within the buffer
zone of a wetland;
The Conservation Commission and their representatives have permission to enter the property;
All documents and plans submitted are in the public domain and may be copied freely in any form; and
The City will record Orders of Conditions at the Hampshire County Registry of Deeds.
8. PL ASE COMPLETE ONLY IF APPLYING FOR A NOTICE OF INTENT or ABBREVIATED
—Ur 'ICE OF RESOURCE ARE DELINEATION:
/ We certify under the pains and penalties of perjury, that PRIOR to filing this application all abutters were
notified of this application pursuant to the requirements of M.G.L. c. 131 § 40. Notice must be made in
writing by hand delivery or certified mail (return receipt requested) to all abutters within 100 feet of the
property line of the project location.
Applicant (print or type): ao rt Applicant Signature: — )I —
Address: �r S I I ( &i!!f it RJ.� bo N' Applicant Phone: �{/3 ���' 7f725
Owner (print or type): _ oG.1 101 !' Owner Signature:
Address: K sq / 5/ Ar wC' rf' Lodi NA Owner Phone: y / 3 f 5 - 40" 1 f - 7 0 2 j
The Northampton Conservation Commission generally meets on the 2 nd and 4`" Thursdays of each month in Hearing
Room 18 located on the 2" floor of City Hall, 210 Main Street
Page 2 of 2
rN Ma ssachusettslepartment of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 3 — Notice of Intent
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
tab
fetwn
Note:
Before
completing this
form consult
your local
Conservation
Commission
regarding any
municipal bylaw
or ordinance.
A. General Information
1
Provided by DER
DEP File Number
Document Transaction Number
City/Town
Project Location (No ele filers will click on button for G `II� S locator):
/Y'&ISC.AJ —/� i % e" Zee'd5
a. Street Address b. City /T wn
Latitude and Longitude: —
d. Latitude e. Longitude
f. Assessors Map /Plat Number
2. Appl
P of
a. First Name b. Last Name
o X 3 ?�-?
d. Mailing Address
L-e-f 01
e. City /Town
q13 f.5v 7o
h. Phone Number i. Fax Number
3. Property owner (if different from applicant):
g. Parcel /Lot Number
c. Company
-' ()10,6,,3 f. State g. Zip Code
j. Email address
❑ Check if more than one owner
b. Last Name
c. Company
a. First Name
d. Mailing Address
e. City /Town
f. State
g. Zip Code
h. Phone Number i. Fax Number j. Email address
4. Representative (if any):
a. Firm
b. Contact Person First Name
d. Mailing Address
e. City /Town
c. Contact Person Last Name
f. State
g. Zip Code
h. Phone Number i. Fax Number j. Email address
5. Total WPA Fee Paid (from NOI Wetland Fee Transmittal Form):
a. Total Fee Paid b. State Fee Paid c. Cit Fee Paid
6. / _
General Project Description: =� P crP141 P / , ace old '��VkJd'�z - 6 '0
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Massachusetts p t of Environmental Protec
Bureau of Resource Protection - Wetlands
WPA Form 3 — Notice of Intent
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
A. General Information (continued)
7. Project Type Checklist:
a. ❑ Single Family Home
c. ❑ Limited Project Driveway Crossing
e. ❑ Dock/Pier
g. ❑ Coastal Engineering Structure
i. ❑ Transportation
8. Property recorded at the Registry of Deeds for:
a. County 103 7 1 60
c. Book
Provided by DER
pEP File Number
Document Transaction Number
City/Town
b. ❑ Residential Subdivision
d. ❑ Commercial /Industrial
f. [Utilities
h. ❑ griculture — cranberries, forestry
j. Other
i961 • I8 0 :
b. Page Number
d. Certificate # (if registered land)
9. Has work been performed on the property under an Order of Resource Area Delineation involving
Simplified Revi;/No ithin 3 years of the date of this application?
a. 171 Yes b.
If yes, no Notice of Intent or Request for Determination of Applicability may be filed for work within the
50- foot -wide area in the Buffer Zone along the resource area during the three -year term of an Order
of Resource Area Delineation, or any Extended Order, or until the applicant receives a Certificate of
Compliance, whichever is later.
10. Buffer Zone Only - Is the project located only in the Buffer Zone of a bordering vegetated wetland,
inland ank, or coastal resource area?
a. Yes - answer 11 below, then skip to Section C.
b. ❑ No - skip to Section B.
11. Buffer Zone Setback — For projects that involve work only in the buffer zone, select the applicable
adjacent resource area (check one):
a. �VW b. ❑ inland bank c. ❑ coastal resource area
The distance between the closest project disturbance and the associated resource area is:
d.li e
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L1 7 Massachusetts4partment of Environmental Protcc:tion
Bureau of Resource Protection - Wetlands
WPA Form 3 — Notice of Intent
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Resource Area Effects
1. Inland Resource Areas
Provided by DER
DEP File Number
Document Transaction Number
City/Town
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Check all that apply below. Attach narrative and any supporting documentation describing how the
project will meet all performance standards for each of the resource areas altered, including
standards requiring consideration of alternative project design or location.
Online Users:
Include your
Resource Area Size of Proposed Alteration Proposed Replacement (if any)
document
transaction
a. El Ba nk
number
1. linear feet 2. linear feet
b. ❑ Bordering Vegetated
(provided on
your receipt
Wetland 1. square feet 2. square feet
page) with all
supplementary
c. ❑ Land Under 1. sq uare feet 2. square feet
q
Waterbodies and
information you
Waterways
submit to the
3. cubic yards dredged
d 171 Bordering
Department.
Land
Subject to Flooding 1. sq uare feet
1 g q 2. square feet
3. cubic feet of flood storage lost 4. cubic feet of flood storage replaced
e. ❑ Isolated Land Subject
to Flooding 1. square feet
2. cubic feet of flood storage lost 3. cubic feet of flood storage replaced
❑ For
f. Riverfront area - TA 812uo1K-
projects
1. Name bf Waterway (if available)
impacted by
1. Width of Riverfront Area (check one):
the riverfront
area and a
❑ 25 ft. - Designated Densely Developed Areas only
buffer zone of
another
❑ 100 ft. - New agricultural projects only
resource
area, add
[� 200 ft. - All other projects
50% to the
total fee.
r�
2. Total area of Riverfront Area on the site of the proposed project:
Square Feet
3. Proposed alteration of the Riverfront Area:
,
' UO ' 7100
a. Total Square Feet b. Square Feet within 100 ft. c. Square Feet between 100 ft. and 200 ft.
4. Has an alternatives analysis been done and is it attached to this NOI? ❑ Yes M No
5. Was the lot where the activity is proposed created prior to August 1, 1996? [JJ Yes ❑ No
..m�fnrmQ rinn . rm. A /4 9 /!1R
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Massachusett*epartment of Environmental Protwction
Bureau of Resource Protection - Wetlands
WPA Form 3 — Notice of Intent
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
Provided by DEP:
DEP File Number
Document Transaction Number
3. Limited Project:
Is any portion of the proposed activity eligible to be treated as a limited project subject to 310 CMR
10.24 or 310 CMR 10.53?
a. ❑ Yes E� No If yes, describe which limited project applies to this project:
o. Urnaea rrotect
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City/Town
B. Resource Area Effects
2. Coastal Resource Areas:
Check all that apply below. Attach
narrative and supporting documentation describing how the
project will meet all performance standards
for each of the resource areas altered, including
standards requiring consideration of alternative project design or location.
Online Users:
Include your
Resource Area
Size of Proposed Alteration Proposed Replacement (if any
document
transaction
a. ❑ Designated Port Areas
Indicate size under Land Under the Ocean, below
number
(provided on
b. ❑ Land Under the Ocean
your receipt
1. Square feet
page) with all
supplementary
2. Cubic yards dredged
information you
c. ❑ Barrier Beach
Indicate size under Coastal Beaches and /or Coastal Dunes
submit to the
below
Department.
d. ❑ Coastal Beaches
1. Square feet 2. Cubic yards beach nourishment
e. ❑ Coastal Dunes
1. Square feet
q 2. Cubic yards dune nourishment
f. ❑ Coastal Banks
1. Linear feet
g. ❑ Rocky Intertidal Shores
1. Square feet
h. ❑ Salt Marshes
1. Square feet
q 2. Sq ft restoration, rehab., or creation
i. ❑ Land Under Salt Ponds
1. Square feet
2. Cubic yards dredged
j. ❑ Land Containing
Shellfish
1. Square feet 2. Square feet restoration, rehab.
k. ❑ Fish Runs
Indicate size under Coastal Banks, inland Bank, Land Under the
Ocean, and /or inland Land Under Waterbodies and Waterways,
above
1. Cubic yards dredged
I. ❑ Land Subject to Coastal
Storm Flowage
1. Square feet
3. Limited Project:
Is any portion of the proposed activity eligible to be treated as a limited project subject to 310 CMR
10.24 or 310 CMR 10.53?
a. ❑ Yes E� No If yes, describe which limited project applies to this project:
o. Urnaea rrotect
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D- A of 7
ILI� Massachusetts epartment of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 3 — Notice of Intent
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
Provided by DEP:
DEP File Number
Document Transaction Number
City /Town
C. Bordering Vegetated Wetland Delineation Methodology
Check all methods used to delineate the Bordering Vegetated Wetland (BVW) boundary:
1. ❑ Final Order of Resource Area Delineation issued by Conservation Commission or DEP
(attached)
2. ❑ DEP BVW Field Data Form (attached)
3. ❑ Final Determination of Applicability issued by Conservation Commission or DEP (attached)
4.0 Other Methods for Determining the BVW Boundary (attach documentation):
a. d 50% or more wetland indicator plants
b. EZ Saturated /inundated conditions exist
c. [21 Groundwater indicators
Online Users:
Include your
document
transaction
number
(provided on
your receipt
page) with all
supplementary
information you
submit to the
Department.
For all projects
affecting other
Resource
Areas, please
attach a
narrative
explaining how
the resource
area was
delineated.
d. P Direct observation
e. ❑" Hydric soil indicators
f. ❑ Credible evidence of conditions prior to disturbance
5. Other resource areas delineated:
D. Other Applicable Standards and Requirements
1. Is any portion of the proposed project located in estimated habitat as indicated on the most recent
Estimated Habitat Map of State - Listed Rare Wetland Wildlife published by the Natural Heritage and
Endangered Sp cies Program?
l
a. ❑ Yes No If yes, include proof of mailing or hand delivery of NOI to:
Natural Heritage and Endangered Species Program
Division of Fisheries and Wildlife
Route 135, North Drive
b. Date of Map Westborough, MA 01581
2. For coastal proje is only, is any portion of the proposed project located below the mean high water
line or in a fish un?
a. ❑ Yes No If yes, include proof of mailing or hand delivery of NOI to:
Division of Marine Fisheries - Southeast Marine Fisheries Station
50A Portside Drive
Pocasset, MA 02559
b. ❑ Not applicable — project is in inland resource area only
3. Is any portion e proposed project within an Area of Critical Environmental Concern (ACEC)?
a. ❑ Yes If yes, provide name of ACEC (see instructions to WPA Form 3 or DEP
Website for ACEC locations). Note: electronic filers click on Website.
b. ACEC
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Massachusettsqkpartment of Environmental Prot -,tion Provided by DEP:
ILI Bureau of Resource Protection - Wetlands DEP File Number
WPA Form 3 — Notice of Intent
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Document Transaction Number
City /Town
D. Other Applicable Standards and Requirements
Online Users:
Include your
document
transaction
number
(provided on
your receipt
page) with all
supplementary
information you
submit to the
Department.
4. Is any portion of the site subject to a Wetlands Restriction Order under the Inland Wetlands
Restriction Act (M.G.L. c. 131, § 40A) or the Coastal Wetlands Restriction Act (M.G.L. c. 130, § 105)?
a. ❑ Yes E2r No
5. Is any activity within any Resource Area or Buffer Zone exempt from performance standards of the
wetlands regulations, 310 CMR 10.00.
a. ❑ Yes [f No If yes, describe which exemption applies to this project:
b. Exemption
6. Is this project subject to the DEP Stormwater Policy? a. ❑ Yes e No
If yes, stormwater management measures are required. Applicants should complete the Stormwater
Management Form and submit it with this form.
b. If no, explain why the project is exempt:
E. Additional Information
Applicants must include the following with this Notice of Intent (NOI). See instructions for details.
Online Users: Attach the document transaction number (provided on your receipt page) for any of
the following information you submit to the Department.
�. USGS or other map of the area (along with a narrative description, if necessary) containing
sufficient information for the Conservation Commission and the Department to locate the site.
(Electronic filers may omit this item.)
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2. d
Plans identifying the location of proposed activities (including activities proposed to serve as
a Bordering Vegetated Wetland [BVW] replication area or other mitigating measure) relative
to the boundaries of each affected resource area.
3. [�
Other material identifying and explaining the determination of resource area boundaries
shown on plans (e.g., a DEP BVW Field Data Form).
4.6
List the titles and dates for all plans and other materials submitted with this NOI.
tJl�
5. ❑
If there is more than one property owner, please attach a list of these property owners not
listed on this form.
6. ❑
Attach proof of mailing for Natural Heritage and Endangered Species Program, if needed.
7. ❑
Attach proof of mailing for Massachusetts Division of Marine Fisheries, if needed.
d
a.
Attach NOI Wetland Fee Transmittal Form
�IPs
9. ❑
Attach Stormwater Management Form, if needed.
�....ofnrm7 rinn . —, A 119MR Donn 9 of 7
Massachusettstpartment of Environmental Protection Provided by DEP:
Bureau of Resource Protection - Wetlands DEP File Number
WPA Form 3 — Notice of Intent
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Document Transaction Number
City /Town
F. Fees
The fees for work proposed under each Notice of Intent must be calculated and submitted to the
Conservation Commission and the Department (see Instructions and NOI Wetland Fee Transmittal
Form).
No filing fee shall be assessed for projects of any city, town, county, or district of the Commonwealth,
federally recognized Indian tribe housing authority, municipal housing authority, or the Massachusetts
Bay Transportation Authority.
Applicants must submit the following information (in addition to pages 1 and 2 of the NOI Wetland
Fee Transmittal Form) to confirm fee payment:
1170
1. Municipal Check Number
(1
3. State Check Number
8 /2N/o G
2. Check d2fte
9 7y r 6
4. Check ate
5. Payor name on check: First Name
6. Payor name on check: Last Name
G. Signatures and Submittal Requirements
I hereby certify under the penalties of perjury that the foregoing Notice of Intent and accompanying
plans, documents, and supporting data are true and complete to the best of my knowledge. I understand
that the Conservation Commission will place notification of this Notice in a local newspaper at the
expense of the applicant in accordance with the wetlands regulations, 310 CMR 10.05(5)(a).
I further certify under penalties of perjury that all abutters were notified of this application, pursuant to the
requirements of M.G.L. c. 131, § 40. Notice must be made in writing by hand delivery or certified mail
(return receip �Izv I a butters within 100 feet of the property line of the project loc tion.
Signature pplican Date
Signature of Property Owner (if different)
Signature of Representative (if any)
Date
Date
For Conservation Commission:
Two copies of the completed Notice of Intent (Form 3), including supporting plans and documents; two copies
of pages 1 and 2 of the NOI Wetland Fee Transmittal Form; and the city /town fee payment must be sent to the
Conservation Commission by certified mail or hand delivery.
For DEP:
One copy of the completed Notice of Intent (Form 3), including supporting plans and documents; one copy of
pages 1 and 2 of the NOI Wetland Fee Transmittal Form; and a copy of the state fee payment must be sent to
the DEP Regional Office (see Instructions) by certified mail or hand delivery. (E- filers may submit these
electronically.)
Other:
If the applicant has checked the "yes" box in any part of Section D, Item 3, above, refer to that section and the
Instructions for additional submittal requirements.
The original and copies must be sent simultaneously. Failure by the applicant to send copies in a timely
manner may result in dismissal of the Notice of Intent.
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