Request for Determination of Applicability 2004 DARTMOUTH 1:H�� .. ,�. �\ MASSACHUSETTS
ab`'_ _ ?2►` \
CONSERVATION COMMISSION z = - 1 MICHAEL O'REILLY
400 SLOCUM ROAD• P. O. Box 79399 ENVIRONMENTAL AFFAIRS COORDINATOR
DARTMOUTH, MA 02747-0985 '' TEL: (508) 910-1822 • FAX: (508) 910-1897
http//www.town dartmouth.ma.us
March 16, 2004
r-...,7
TO: Building Department -
Department of Public Works
Planning Board
Board of Health
FROM: Dartmouth Conservation Commission r
SUBJECT: Request for technical review and written report on the accompanying Request for
Determination and plans from Jane&Robbi Staples re: Map 80,Lot 6 at 27 Pine
Island Road.
Please review the attached Request for Determination and plan(s). If you have any comments
regarding the proposal and/or plans, please submit them to the Conservation office by April 5,
2004.
Thank you for your cooperation and assistance in this matter.
!fit e� ' -
RC:re (74/6L/
0
DARTMOUTH 46n0•is l.r�y MASSACHUSETTS
0 l
• ' G
CONSERVATION COMMISSION i3 . r= �r MICHAEL O'REILLY
400 SLOCUM ROAD• P. O. Box 79399 �. 166 i/ ENVIRONMENTAL AFFAIRS COORDINATOR
DARTMOUTH. MA 02747-0985 "' TEL: (508) 910-1822 • FAX: (508) 910-1897
http://www.town.dartmouth.ma.us
DARTMOUTH CONSERVATION COMMISSION
NOTICE OF PUBLIC MEETING
Notice is hereby given that a meeting will be held in accordance with the provisions of the
Dartmouth Wetlands Protection Bylaw and M.G.L., Ch 131, §40, the Wetlands Protection Act,
on the Request for Determination of Applicability from Jane&Robbi Staples regarding land
located at Map 80, Lot 6, Pine Island Road in Dartmouth. The meeting will begin at 7:00 p.m.,
Tuesday, April 6, 2004 in Room 103 at the Dartmouth Town Hall, 400 Slocum Road in
Dartmouth, and all interested parties should be present at that time.
Gerald Franklin
Chairman
CC: D.E.P.
Dartmouth Board of Health
Dartmouth Building Department
Dartmouth D.P.W.
Owner
Applicant
Engineering Firm
THE CHRONICLE:
LEGAL AD: Please run once in your issue of March 31, 2004.
PRE-PAYMENT CHECK ENCLOSED ($43.00)
Massachusetts Department of Environmental Protection �M„_Hfy,
Bureau of Resource Protection -Wetlands o o;�
WPA Form 1- Request for Determination of Applicability r i�
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 •`° Sy '
The Dartmouth Wetlands
t ands Protection Bylaw
Dartmouth
City/Town
A. General Information
Important:
When filling out 1• Applicant:
forms on the ,f�'l»r` °t h j R°�b; s/,, %S
computer, use V
only the tab key Name E-Mail Address
to move your ,A 7 A l l e ishie i l be c.i'
cursor-do not Mailing Address
use the return L J a V'1' ✓n 0,t t Yl M A c7,,2 7 y 7
key. City/Town State Zip Code
S 0 y 9 �-s / 9 y/
4, • Phone Number
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 Dartmouth make the following determination(s). Check any that apply:
Conservation Commission
0 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:
Dartmouth
Name of Municipality -,
❑ e. whether the following scope of alternatives is adequate for work in the Riverfront Area as
depicted on referenced plan(s).
wpaforml.doc•rev.02/00.
Page 1 of 4
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands o''.�t'''�w.
WPA Form 1- Request for Determination of Applicability :
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 .,
YI
166.'
•
The Dartmouth Wetlands Protection Bylaw
Dartmouth
City/Town
C. Project Description
1. a. Project Location (use maps and plans to identify the location of the area subject to this request):
2. 7 19 n e Dartmouth
Street Address City/Town
go Lei
Assessors Map/Plat Number Parcel/Lot Number
b. Area Description(use additional paper, if necessary):
c. Plan and/or Map Reference(s):
ciA
e
Title
Title Date
Title
Date
2. a. Work Description(use additional paper and/or provide plan(s) of work, if necessary):
j 5 k'of!� oi,tw1
/3/ C 1„.1y;0 JZif9 c-•,n k) 4 .T, / w:,11
i
G� Y C Li✓�t� k I c?C? / . 14� ► v1 v r ►-E' r�l t✓ts /C) be
// a
4111 P_ c 1�r c="e / S / ri 5 lei//Cvff
. ;`' Ise vecA�✓��
s j/$ Te•� v • r e PT, C The l43 Ye ,,11
wpafomi 1.doc•rev.02/00. 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
The Dartmouth Wetlands Protection Bylaw
Dartmouth
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).
/2)
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.)
wpaform 1.doc•rev.02/00.
Page 3 of 4
Massachusetts Department of Environmental Protection
c�''"Bureau of Resource Protection -Wetlands
•
4 WPA Form 1- Request for Determination of Applicability :1)
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 4.166,•Sj
The Dartmouth Wetlands Protection Bylaw
Dartmouth
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(see Appendix A)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: /
Name nt. \�n n 7'
,2 / fine e . 2 c/A,ii kG'(
Mailing Address
�a-v') m Q ,u/1
City/Town
mA 0.2
State Zip Code
Signatures:
I also understand that notification of this Request will be placed in a local newspaper at my expense
in accordance h S ection 10.05(3)(b)(1)of the Wetlands Protection Act regulations.
,141' di4ifigP10
Signature • Applicant Date
Signature of Representative(if any) Date
wpafor ml.tloc•rev.02/00.
Page 4 of 4
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