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Notice of Intent 2009
D A R T MOUT H �"��0•�1•, , , MASSACHUSETTS dA_ t�`ril•� Jr;e:lk Y II CONSERVATION COMMISSION z 3 - — 6,, MICHAEL O'REILLY =1� 400 SLOCUM ROAD•P. O. Box 79399 ��• 5�" ENVIRONMENTAL AFFAIRS COORDINATOR DARTMOUTH, MA 02747-0985 — TEL: (508) 910-1822 • FAX: (508) 910-1897 http://www.town.dartmouth.ma.us June 1, 2009 TO: Building Department Department of Public Works Planning Board Board of Health FROM: Dartmouth Conservation Commission SUBJECT: Request for review and written comments on the accompanying Notice of Intent and plan(s)from David Melancon re: Map 79,Lot 48-28 at 22 Sundance Road . Please review the attached Notice of Intent and plan(s). If you have any comments,please submit them to the Conservation Commission office by June 15,2009 . Thank you for your cooperation and assistance in this matter. DF:df David Melancon 22 Sundance Road Dartmouth,MA 02747 DARTMOUTH »�N.; � MASSACHUSETTS A' o l y-,.1 =i CONSERVATION COMMISSION MICHAEL O'REILLY 400 SLOCUM ROAD •P. O. Box 79399 N. . 5yy'{ ENVIRONMENTAL AFFAIRS COORDINATOR DARTMOUTH, MA 02747-0985 '" TEL: (508) 910-1822 • FAX: (508) 910-1897 http://www.town.dartmouth.ma.us June 1, 2009 The Chronicle P.O. Box 80268 Dartmouth, MA 02748 news@chroniclenewsonline.com LEGAL AD: Please run the following legal ad once in your issue of June 10, 2009 Advertiser#300329 PRE-PAYMENT CHECK TO FOLLOW DARTMOUTH CONSERVATION COMMISSION NOTICE OF PUBLIC HEARING Notice is hereby given in accordance with the provisions of the Dartmouth Wetlands Protection Bylaw and M.G.L., Ch. 131, §40,the Wetlands Protection Act,that a hearing will be held on the Notice of Intent of David Melancon who wishes to construct a garage addition on land located at Map 79, Lot 48-28 on Sundance Road in Dartmouth. The hearing will be held on Tuesday, June 16, 2009 at 7:00 p.m., in Room 103 at the Dartmouth Town Hall,400 Slocum Road in Dartmouth and all interested parties should be present at that time. Jacquelyn McDonald, Chair CC: Chronicle D.E.P. Dartmouth Board of Health Dartmouth Building Dept. Dartmouth Planning Board Dartmouth D.P.W. Owner Applicant Applicant's representative(s) I ' NOW)SEb ategAct‘ AbOtTtorJ I \ f2 .1f.,igisi-41..0.„ go. \ \ .71., , .', . 11,1c711.E.._f_All. :011.- ./ Si_ 1 : ..' 1 • C:::::1 F, • ,/". A _` ./1 "-- ‘VE-1, 1.-A-WP IV, Lii,.119.6pi ,•/.471_611 1,0/X11,i,k;, W , 1 ,.•' ! .• - c.r., .., f. ,•1 I ,,-y-,:•_.:- ED ,,, ,. • ‘ • ,- .. . ).1-12-6- se) fii> ‘ ..,..._ _..\:. 1. _ : 0 -. „- : •,--- ---- \ ILO , \ 7-:;..--- ..._., 7,-, \..zR: -----z c. , , , v iqfl L.L.f . , , •' ' / i ..-'.`,-,)1 1 • .1%7. •• k f,--.)-- t ' , --i------ -- - /.. , ....,- , r - :ca2i____ ____ - -- IIIIIIIIIIIrs ,. -- - _rrc:elit.4,A .,... 11-- r-t • F: a jC • .7%. ,.-,,. .N.`..`: I CO . 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',...;VO ,.._,' .--.'-„' .....--- • . • .,. . 3 t '1 ' (..,' ,••• , . : I • I . / , . i . • ' A i 1 '• . . 1 / k •-• V-...._,_ i I , .. ---^ ..._<WI re.--1.174 V e..\\/...-1-‹ t - . 1 _1- \ I 1 ..., ,...-.)--------- — -- • --,_„....,, t ...-- — • - -- ' '''' R . . . --..... . .. . . , . . . „. .......A., .-, . .,..__....2--' • Lis pp,c, F PMIAPQIVEST. ° oI I I4120 ft 't.i. 3 �4i �°.• o - x$ a P , `'. _ _ Pine Nand`Rd a V�.' a a d ti • O R v 3:- s� �uooln9 - ca .o cam. `Z ' ��' v 3 APR, . ti°Q 3 :7Qp l 7 ,, a • v..: o : u:: • gym, • 0 2009 MapQuest Inc. <'_Map Data 0 2009 NAVTEQ or TeleAtlas All rights reserved.Use subject to License/Copyright Map Legend Directions and maps are informational only.We make no warranties on the accuracy of their content,road conditions or route usability or expeditiousness.You assume all risk of use.MapQuest and its suppliers shall not be liable to you for any loss or delay resulting from your use of MapQuest.Your use of MapQuest means you agree to our Terms of Use • http://www.mapquest.com/maps?city=N.+Dartmouth&state=MA&address=22+Sundance+... 5/26/2009 -» ., - -*,tea._ _ 1 ,:,_-;:.-11--"....--..--1„:11-1.7:7.--'1.'r • , tea„ i t = : ,� .- • - - important Legend The Wetland Site Inspection procedure S is a service available pursuant to the i Approx.Wetland Boundary Dartmouth Wetlands Protection Bylaw. Any and all wetland flag locations and Buffer Zone depicted on the above j 1 100-foot Buffer Zone graphic are approximate only.Approximate Please refer to the attached Wetland 1l)o-foot Buffer Zone drawn only from points f 0 Wetland Fag Locations saeInspecionfarm�roimA-a). shown.Altwrtsandtiaagtoratiansand i for address,location and purpose Buffer Zone are for general reference i u oses and shall not be considered Parcel Boundaries recommendations the site inspection Inspector cononrrrb, p rP i i1 reeommendatians and/or requirements a final delineation for regulatory purpomf are shown on the reverse side of the form A submittal of the above flag locations 1 Aerial Photograph Taken tame Dartmouth conse��cnmmisne p utilizing State of Massachusetts procedures Spring 2005 a N f�;:-_�.,.. . is required for compliance with the Massachusetts Wetlands Protection Act s All Wetland delineation flags OtherResource Area delineation • CS Cam' requirements may appear on rear of form. are pink and are II ldr ltect W •Y • 1 DCC wet#through DCC wet# Town of Dartmouth No work within Buffer Zone,1RQ year g Geographic Flood Plain orotiferwetland see form for actual flag numbers) S InfonnatlonuSystem Resource Areas can begin until a permit 3 from the Conservation Commission is granted_ 1 VY51 A-I gfladunent 12-0307 Rev.MJOIDF Massachusetts Department of Environmental Protection Provided try l+Aass°>�'' ' --- Bureau of Resource Protection -Wetlands pEp F Number 1NPi� P4 rm _ Notice of tent Massachusetts Wetlands Protection Act M..G.L. c. 131, §40 '' "t Tran< con Number And Dartmouth Wetlands Protection Bylaw Cityrrown Important. A. General Information When filling out forms on the con'P -"ss 1. Project Location-(Note:electronic-filers will-click on-button to locate project site): onlymove tab your ey to OZ1Ll1 cursor do not ZZ SUNDANGE iD • - D,tat"thtlUTr� use the ra#urrr a Sheet Address b.City/Town c.Zip Code key. -Latitude andLengitttde:" d.Latitude e.Longitude �9 lioffi ras ` ICI �8 -Z� f.AssessorsiMtap/Plaf Number g.Parcel/Lot Number ICI 2. Applicant: a.First Name b.Last Name Note Before c.Organization completing this ZZ. SMlabANGE CoAb form consult your-local d.Street Address Conservation_ N.�AQT bOb17Cl-� - MA- o2 7± reiminK4lon -e City/Town f State g.Zip Code r municipal mucip bylaw Ste-995--191,1 508-6;19-Co-195- Sl1NIsAt4CEWvJe VECvLoN .NET or ordinance. h.Phone Number 1.Fax Number j.Email Address 3. Property owner(required if different from applicant): ❑ Check if'more than one owner a First Name b.Last Name c.Organization ----d.Street Address e.City/Town f.State g.Zip Code — — h.Phone Number i.Fax Number j.Email address 4. Representative(if any): a First Name b.Last Name c.Company — d.Street Address e.City/Town f.State g.Zip Code h.Phone Number i.Fax Number j.Email address 5. Total WPA Fee Paid (from NOl Wetland Fee Transmittal Form): L-17 , CO L2 . 5Q l35 .or _ a.Total Fee Paid b.State Fee Paid c.City/Town Fee Paid wnafnrm2 rine.raw t17t71 MR Pans 1 nt R • Massachusetts Department of Environmental Protection P ea 0' DEP 1 L Bureau of Resource Protection - Wetlands -.-:: .DEP File Number WPA o - Notice of Documen Transacts t Number Massachusetts Wetlands Protection Act M G.L. c. 131, §40 And Dartmouth Wetlands Protection Bylaw Cityrrown A -G r-al-- flrmation (continued) 6. General Project Description: 130126 A GAgAGe AbbtTION1 C 2'-1'-0" x 3o-o. 7a. Project Type Checklist: 1. IN Single Family Home 2. ❑ Residential Subdivision 3. Cl Limited Project Driveway Crossing 4. ❑ Commercial/Industrial 5. ❑ Dock/Pier 6. ❑ Utilities 7. Cl Coastal Engineering Structure 8. ❑ Agriculture(e.g., cranberries, forestry) 9. Cl Transportation 10. 0 Other 7b. is any portion of the proposed activity eligible to be treated as a limited project subject to 310 CMR 1.024 nrmstal)or 310.CMR 10 53(inland)? 1_ ❑ Yes i$ No If yes,describe which limited project applies to this project: 2.Limited Project 8. Property recorded at the Registry of Deeds for. -Q1.STp►— a.County b.Certificate#(if registered land) .2)i oA 341 c.Book d.Page Number B. Buffer Zonei& Resource Area inapaCtS (temporary & permanent) 1. !R( Buffer Zone Only—Check if the project is located only in the Buffer Zone of a Bordering Vegetated Wetland, Inland Bank, or Coastal Resource Area. 2. ❑ Inland Resource Areas(see 310 CMR 10.54-10:58 if not applicable, go to Section B.3, Coastal Resource Areas). 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 altematiye project design-or location. For all projects Ong other Resource-Area Size of Proposed AlterationProposed Replacement(if any) Resource Areas, please attach a narrative a El Bank 1.linear feet 2.-linear feet evlaining ha,v the resource b. El Bot rivr ing Vegetated area was Wetland 1.square-feet 2.square feet delineated_ c. ❑ Land Under 1.linear feet 2.linear feet Waterbodies and Waterways 3.cubic yards dredged unafr rm4 rind•.mu, f 9f 4 frig Pan.9 of R Massachusetts Department of Environmental Protection PtowdeaYrMassp>"P Bureau of Resource Protection - Wetlands tUlassDEPFe flurc r ,i . .:PA Form 3 - Notice of Intent Massachusetts VVetlands Protection. - (3.L. c. 131, §40 And Dartmouth Wetlands Protection Bylaw City/Town own -B.-Buffer Zone&Resource Area - permanent) (cont'd) {#sllnpo�ary ( ) Resource Area Size of Proposed Alteration Proposed Replacement(if any) d. ❑ Bordering Land Subject to Flooding 1.square feet 2.square feet 3.cubic feet of flood storage lost 4.cubic feet replaced e. ❑ Isolated Land Subject to Flooding 1.square feet 2.cubic feet of flood storage lost 3.cubic feet replaced f. Er Riverfront Area 1.Name-of Wate rway(if available) 2. Width of Riverfront Area(check one): ❑ 25 ft. -Designated Densely Developed Areas only ❑ 100 ft. -New agricultural projects only 0 200 ft. -All other projects 3.Total area of Riverfront Area on-the site of the proposed project: square feet a Proposed alteration of,the Riverfront Area: a total square feet b.square feet within 100 ft c.square feet between 100 It and 200 ft. 5. Has an alternatives analysis been done and is it attached to this NQI? ❑ Yes❑ No 6.Was the lot where the activity is proposed created prior to August 1, 1996? ❑ Yes El No 3. ❑ Coastal Resource Areas: (See 3-1Q CMR 10.25-10.35) Check all that apply below. Attach narrative and supporting documentation describing how the project will meet all performance.standardsfor.each of the resource areas altered, including standards requiring consideration of alternative project design or location. Online Users: Include r Resource Area Size of ProposedAfteration Proposed Replacement(if any) document transaction a. El Designated Port-Areas h rctivaie sire-underland Under the Ocean, below rnrmber (provided on. your receipt b. ❑ Land Under the ocean page),with all t square feet supplementary information you 2.cubic yards dredged submit to the g Department. c. ❑ Barrier Beach Indicate size under Coastal Beaches and/or Coastal Dunes below d. ❑ Coastal-Beaches 1_square feet 2.cubic yards beach nourishment Q Coastal-Dunes 1..square feet s9 2.cubic yards dune nourishment +�+nfe+ der..ro., rrsrsf rik Pzrds Massachusetts Department of Environmental ProtectionrtbyT,tassa !_ . . _,. .,.....„,. ,.._, , , ,, ..,.., .. ,, P u � . Bureau of Resource Protection- Wetlands r WPAForm Notice ..._ , . _. of Intent ,:,,..:,..,.._....::,..„ ,,2„.,...:,_,,. .....,,,,:.::... ,!... ....;.:, :,..,.....„iwassphitfie_Nt.itob .„,...,...4.,,,..,, Massachusetts Wetlands.Protection Act M.G.L. c. 131, §40 And Dartmouth Wetlands Protection Bylaw City/Town B. Buffer Zone& Resource Area impacts (temporary& permanent) (cont'd) Size of Proposed Alteration Proposed Replacement(if any) f. El Coastal Banks -1.linear feet g. 0 Rocky Intertidal Shores 1.square feet h.ID Salt Marshes 1.square feet 2_scgft-restoration,rehab.,creation i. D. Land Under Salt Ponds 1.square feet 2.cubic yards dredged i. ❑ Land Containing Shellfish 1.square feet k. ❑ Fish Runs Indicate size under Coastal Banks, inland Bank, Land Under the Ucean,.andfor inland Land Under Waterbodies and Waterways, above 1.cubic yards dredged I. ❑ Land Subject to Coastal Storm Flowage 1.square feet 4. [l RestorationlEnhanc meet If the project is for the purpose of restoring or enhancing a wetland resource area in addition to the square footage that has been entered in Section B.2.b or B.3.h above, please enter the additional amount here. a.square feet of BVW b.square feet of Salt Marsh C. Other Applicable Standards and Requirements Streamlined Massachusetts Endangered Species Act/Wetlands Protection Act Review 1. Is any portion of the proposed project located in Estimated Habitat of Rare Wildlife as indicated on the-most to d blind et!_ii tdl:Mafxof-State=tested-Ram-W anctWifdfifepublished°by the-Natural Heritage and Endangered Species Program(NHESP)?To view habitat maps,see the Massachusetts Natural Heritage Atlas or--go-to htto://w^tv .mass.q,vidfweleitlfwinhesp,nhreQmap.htrn. a. El Yes ❑ 140 If yes, include proof of mailing Qr hand delivery of NOI to: Natural Heritage and Endangered Species Program Division of Fisheries and Wildlife JO I a bb(D Route 135, North Drive b.Date of map Westborough,MA 01581 If yes, the project is also subject to Massachusetts Endangered Species Act(MESA) review(321 CMR-10.18). To.qualify for a-streamlined, 36-day, MESA/Wetfands Protection Act review, please complete Section C.1.C, and include requested materials with this Notice of Intent(NOI); OR complete Section.0 Ld,-if applicable.If MESA irppl"mental information js not included with the NOI, by completing Section 1 of this form, the NHESP will require a separate MESA filing which may take up to gg days to review(unless noted exceptions in Section 2 apply, see below). urnafrvmR`irv,.raw 117/71 MR Paned nfR Massachusetts Department of Environmental Protection #?rovidea by tu °F Bureau of Resource Protection-Wetlands 1 t±r a QG ,� ut� a MA Form 3 - Notice of Intent Massachusetts Wetlands Protection Act M 6.L. c. 131, §40 And Dartmouth Wetlands Protection Bylaw City/Town C. Other Applicable Standards andRequirements (contrd) 1. c. Submit Supplemental.Information for Endangered Species Review* 1. 0 Percentage/acreage of property to be altered: (a)within_wetland Resource Area- p 0 (b)outside Resource Area perci 00 2. ❑ Assessor's Map or right-of-way plan of site 3. Cr Project plans for entire project site, including wetland resource areas and areas outside of wetlands jurisdiction, showing existing and proposed conditions, existing and proposed tree/vegetation-clearing line,and clearly demarcatted limits of work** (a)❑ Project description(including description of impacts outside of wetland resource area& buffer zone) (b)❑ Photographs representative of the site (c)[O/MESA_filing fee(fee information available at: http://www.mass.qovicifweteidfwinhespirthenvmesa.htm) Make check payable to"Natural Heritage&Endangered Species Fund"and mail to NHESP at above address Projects altering 10 or more acres of land, also submit: (d)E Vegetation cover type map of site (e)❑ Project plans showing Priority& Estimated Habitat boundaries d. OR Check One of the Following 1._❑ Project is-exempt from MESA review. Attach applicant letter indicating which MESA exemption applies. (See 321 CMR 10.14, http://vw w.mass.govidt'wele/dfw/i hesprnhenvexerrfptions. tm;the NOI must still be sent to NHESP if the project is within estimated habitat pursuant to 310 CMR 10.37 and t0.59.) 2.❑ Separate.MESA review ongoing. a NHESP Tracking Number b.Date submitted to NHESP 3.D Separate MESA review completed. Include copy of NHESP"no Take"determination or valid Conservation& Management Permit with approved plan. * Some projects not in Estimated Habitat may be located in Priority Habitat, and require NHESP review-(see www.nhesp.org regulatory review tab). Priority Habitat includes habitat for state- listed plants and strictly upland species not protected by the Wetlands Protection Act. ** MESA_projectsmay not be segmented(321 CMR 10.16).The applicant must fiisdose full development plans even if such plans are not required as part of the Notice of Intent process. umafnrm i'Inr..rate 07/ 1/flR Aana c of • Massachusetts.Department of Environmental Protection � x r, r,E Bureau of Resource Protection- Wetlands T f WPA Form 3 - Notice-o-Intent Massachusetts Wetlands Protection.Act KG.L. c. 131, §40 " 'gum r And Dartmouth Wetlands Protection Bylaw City/Town C. AppIi ita ar Requirements (cont'd) 2. For coastal-projects.-only,-is any portion-the proposed project located below the mean high water line or in a fish run? a Er Not applicable—project is in inland resource area only b.❑ Yes ❑ No If yes, include proof of mailing or hand delivery of NOI to either: South Shore-Cohasset to Rhode North Shore-Hull to New Hampshire: island,and the Cape&Islands: Division of Marine Fisheries- Division of Marine Fisheries- North Shore Office Southeast Marine Fisheries-Station Attn: Environmental Reviewer Attn: Environmental Reviewer 30 Emerson Avenue 838 South Rodney French Blvd. Gloucester, MA 01930 New Bedford, MA 02744 Also if yes, the project may require a Chapter 91 license. For coastal towns in the Northeast Region, please contact MassDEP's Boston Office. For coastal towns in the Southeast Region, please contact MassDEP's Southeast Regional Office. 3. Is any portion of the proposed project within an Area of Critical Environmental Concern (ACEC)? °Mine Users: a_❑ Yes NI No Ifyes, provide name of ACED(see-instructions to WPA Form 3 or MassDEP inekide yet* Websitefor ACEC-locafionsy. Notm electronic filers click on Website. document transaction b.ACEC number (provided.on 4_ Is any portion of the proposed project within an area designated as an Outstanding Resource Water your receipt (ORW)as designated in the Massachusetts Surface Water Quality-Standards, 314 GMR 4.00? pager with all supplementary a. ❑ Yes [r No information you submit to the 5. is any portion of the site subject to a Wetlands Restriction Order under the Inland Wetlands Department. Restriction Act(M.G.L. c. 131, §40A)or the Coastal Wetlands Restriction Act(M.G.L. c. 130, § 105)? a ❑ Yes ['No 6. Is this project subject to provisions of the MassDEP Stormwater Management Standards? a ® Yes. Attach a copy of the Stormwater Report as required by the Stormwater Management Standards per 310 CMR 10.05(61(k)-(q)and check if: ..❑ Applying for Low Impact Development(LID)site design credits(as described in Stormwater Management tlandbook Vol. 2, Chapter 3) 2.® A portion of the site constitutes redevelopment 3.❑ Proprietary BMPs are included in the Stormwater Management System. b.gs No. Check why the project is exempt: 1. 0 Single-family house 2.® Emergency road repair a❑ Small Residential Subdivision (less than or equal to 4 single-family houses or less than or equal to 4 units in multi-family housing project)with no discharge to Critical Areas. wn,f,mil Ant,.nav 09P)1/r1R Pan.. of R Massachusetts Department_of Environmental Protection Bureau of Resource Protection Wetlands r DBP x� W orm Notice cif.Intent - Massachusetts:Wetlands Protection Act 114rG.L. c. 131, §40 .01414 . And Dartmouth Wetlands Protection Bylaw City/Town -D. Additional Information Applicants must include the following with this Notice of Intent(NO!). 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. 1. 174 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.) 2. E 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. 0 Identify the rriethod for••BViAt and other-teso rce area boundary delineations(MassDEP BVW Field Data Form(s), Determination of Applicability, Order of Resource Area Delineation, etc.), andattach documentation of the methodology. 4. Q List the titles and dates for all plans and other materials submitted with this NOI. a.Plan Title b.Prepared By c.Signed and Stamped by d.Final Revision Date e.Scale f.Additional Plan or Document Title g.Date 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. ay. Q Attach NOI Wetland Fee Transmittal-Form s. ❑ Attach Stormwater Report, if needed. E. Fees 1. Q Fee Exempt No fling 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 TransmittalF^orm)to-confirm fee payment: 45i -. (. /i )aoo9 2.Municipal Ctqck Number 3.Check date ` 515 ► ID-cool 4_State Check Number 5.Check� 1DAV►>> 1) M 1E MLA-M cap] 6.Payor name on check:First Name 7.Payor name on check:Last Name wnarnnn'Teinr.emu rr7PiImk Piw 7 of A Massachusetts.Department of Environmental Protection Rrenfxted t?y fu�ssDE P Bureau of Resource Protection -Wetlands , A Form 3 - Notice of Intent r �-mw-ii Massachusetts.Wetlands Protection Act M.G.Q. c. 131, §40 Tran - - irnt t.,;; And Dartmouth Wetlands Protection Bylaw cityrrown f.Sitgnaturesand---Submittal Requirements I hereby certify under the Renalties-of perjury that the foregoing Notice ofIntent 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 alocal 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 by Certificate of Mailing or in wilting by hand delivery or certified mail (return receipt requested)to all abutters within 100 feet of the property line of the project locatio ,0.9 (/j1r;)DM 1.Signature of Applicant 2.Date 3.Signature of Property Owner(if different) 4.Date 5.Signature of Representative(if any) 6.Date For Conservation Commission: Two copies of the completed Notice of Intent(Form 3), including supporting plans and documents, two copies of the NOI Wetland Fee Transmittal Form, and the city/town fee payment, to the Conservation Commission by certified mail or hand delivery. For MassDEP: One copy of the completed Notice of Intent(Form 3),including supporting plans and documents, one copy of the NOI Wetland Fee Transmittal Form, and a copy of the state fee payment to the MassDEP Regional Office(see_Instructions),by certified mail or hand delivery. Other: If the applicant has checked the"yes"box in any part of Section C, 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. tsmafnrm'2 sins•.ruts 1-17M1 inn Pano R of R 1 Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands - NOi Wetland Fee-Transmittal-Form Massachusetts Wetlands.Protection Act M.G.L. c. 131, §40 Important A. Applicant Information When filling out forms on the 1. Applicant: computer,use only the tab key DAVI D A 'G � to move your a First Name J� �Y cursor- not b.Last Name -use=theireturrr c.Organization ll[trath o?.Q 8UNDA-NCE 12.E d.Mailing Address N PA-2T Mou r1-1 MA ag-7 —7 e.City/Town f.State g.Zip Code Orme X �8 OS -lga4 fig• (o1q•096 SUNpflNr WW@.doRI2oN1 .NET h.Phone Number i.Fax Number j.Email Address 2. Property Owner(if different): a.First Name b.Last Name c.Organization d.Mailing Address e.City/Town f.State g.Zip Code h.Phone Number i.Fax Number j.Email Address 3. Project Location: as &UNDA\3 cE N D, 2T Mourfl . MA a.Street Address b.City/Town To calculate B. Fees firing fees,refer to the category fee list and The fee should be calculated using the following-six-step-process_arrdworksheet. Please see examples in the Instructions before filling out worksheet. instructions for ftiltngoul_WPA Step IlType of Describe- h Form 3(Notice of Activity: each type of activityr that will-occur WI wetland resource area and Intent)-. buffer zone. Step 2/Number of Activities: Identify the number of each type of activity. Step 3/Individual Activity Fee: Identify each activity fee from the six project categories listed in the instructions. Step 4/Subtotal Activity Fee: Multiply the number of activities(identified in Step 2)times the fee per category(identified in Step 3)to reach a subtotal fee amount. Note: If any of these activities are in a Riverfront.Area in addition to another Resource Area or the Buffer Zone, the fee per activity should be multiplied by 1.5 and then added to the subtotal amount. Step 6rrotal Project Fee: Determine the total-project fee by adding the subtotal amounts from Step 4. Step 6/Fee Payments: To calculate the state share of the fee, divide the total fee in half and subtract $12.50. To calculate the city/town share of the fee, divide the total fee in half and add$12.50. Massachusetts Department of Environmental Protection Bureau of Pesotwce'Protection -Wetlands NOL.Wetland Fee Transmittal Form MassacE3usetts.Shetlands.Protection Act-M.G.L. c. 131, §40 B. Fees (continued) Step 1/Type:of Activity Step 2/Number Step Step 4/Subtotal Activity of Activities 3/Individual Fee Activity Fee GARA-GE AonlnoN 1 1io.o0 11o.00 r Step 5/Total Project Fee: Step 6/Fee Payments: cf Total-Project Fee: Il . CAD a.Total Fee from Step 5 SD State share of firing-"Feela, b.12 Total Fee Less$12.50 City/Town share of filling Fee: 7 c.112.Tatat Fee.plus.$19 So C. Submittal Requirements . a.) Complete pages t and 2 and send with a check or money order for the state share of the fee, payable to the Commonwealth of Massachusetts. Department of Environmental Protection Box 4062 Boston, MA 02211 b.) To the Conservation Commission: Send the Notice of Intent or Abbreviated Notice of Intent; a copy of this form; andt a city/town fee payment. 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