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CONSERVATION DEPARTMENT
Community Development Division
NEGATIVE DETERMINATION OF APPLICABILITY
SPECIAL CONDITIONS
224 Carlton Lane, North Andover
At the July 24, 2013 public hearing, the North Andover Conservation Commission (NACC) voted to issue
a Negative Determination of Applicability for the construction of a 22' x 21.8' deck with associated stairs r`
within the buffer zone to Bordering Vegetated Wetland (BVW). The new deck is 57-feet from BVW at its
closest point.
Applicant: McNeil Builders General Contractors,LLC
69 Olde Bridge Lane
Epping, NH 03042
Owner: Gregory and Amy Hughes
224 Carlton Lane
North Andover,MA 01845
Record Documents: Request for Determination of Applicability and Associated Maps and Plans
Submitted:July 8, 2013
Plan Titled: Plan of Land (with proposed deck hand drawn in)
North Andover,Massachusetts
Date: Original plan date May 5, 2005
SPECIAL CONDITIONS:
Prior to the start of construction the applicant shall ensure that the site contractor has reviewed the
small project petinit and is aware of the wetland resource area and the limits of the proposed work.
❖ The applicant/contractor shall place erosion controls in the form of a staked silt sock (or other erosion
controls as approved by the Conservation Department) between all work areas and the BVW.
Once erosion controls are installed, and prior to work commencing on the site, the applicant shall
contact the Conservation Department for a pre-construction meeting with the contractor.
1600 Osgood Street,Building 20,Suite 2-36,North Andover,Massachusetts 01845
Phone 978.688.9530 Fax 978.688.9542
Web:http://www.townofnorthandover.com/Pages/NAndoverMA_Conservation/index
+ Three (3) wetland markers (2 round and 1 square) shall be placed at the existing tree line near the
wetland. Markers shall incorporate the following text: "Protected Wetland Resource Area" and the
associated rules. This will designate the sensitivity of the area and assure no further inadvertent
encroachment into the wetland. These permanent markers are subject to review and approval by the
NACC. The applicant shall instruct all agents to explain these markers to buyers/lessees/landscapers
and all persons taking over the property from the applicant. These markers shall remain posted and be
replaced as necessary in perpetuity. Markers are available from the Conservation Department ($2
round/$3 square).
During Construction
❖ Accepted engineering and construction standards and procedures shall be followed in the completion
of the project.
❖ Excess material and construction debris shall be properly disposed of off site and stockpiled material
shall be stored within the erosion controls.
Post Construction
❖ Immediately following completion of the work,any disturbed areas shall be permanently stabilized 3`
against erosion (loam and seed or other stabilization as approved by Conservation Department).
• Upon completion of all requirements, the Conservation Department shall be contacted to conduct a
final site inspection.
1600 Osgood Street,Building 20,Suite 2-36,North Andover,Massachusetts 01845
Phone 978.688.9530 Fax 978.688.9542
Web:http://www.townofnorthandover.com/Pages/NAndoverMA_Conservation/index
LMassachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands
WPA Form 2 — Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
A. General Information
Important:
When filling out From:
forms on the North Andover
computer, use
only the tab Conservation Commission
key to move To: Applicant Property Owner(if different from applicant):
your cursor-
do not use the McNeil Bldrs Gen Contrs, LLC Gregory &Amy Hughes
return key. Name Name
69 Old Bridge Lane 224 Carlton Lane
-V Mailing Address Mailing Address
Epping NH 03042 North Andover MA 01845
�� City/Town State Zip Code City/Town State Zip Code
/♦ 1. Title and Date (or Revised Date if applicable) of Final Plans and Other Documents:
Plan of Land May 5, 2005
Title Date
Proposed Deck April 19, 2013
Title Date
Title Date
2. Date Request Filed:
7/8/13
B. Determination
Pursuant to the authority of M.G.L. c. 131, §40, the Conservation Commission considered your
Request for Determination of Applicability, with its supporting documentation, and made the following
Determination.
Project Description (if applicable):
Construction of a deck within the Buffer Zone to Bordering Vegetated Wetland.
Project Location:
224 Carlton Lane North Andover
Street Address City/Town
Map 107A Parcel 203
Assessors Map/Plat Number Parcel/Lot Number
wpaform2.doc•Determination of Applicability•rev.10/6/04 Page 1 of 5
F
Massachusetts Department of Environmental Protection
LBureau of Resource Protection - Wetlands
1
WPA Form 2 — Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Determination (cont.)
The following Determination(s) is/are applicable to the proposed site and/or project relative to the Wetlands
Protection Act and regulations:
Positive Determination
Note: No work within the jurisdiction of the Wetlands Protection Act may proceed until a final Order of
Conditions(issued following submittal of a Notice of Intent or Abbreviated Notice of Intent) or Order of
Resource Area Delineation (issued following submittal of Simplified Review ANRAD) has been received
from the issuing authority(i.e., Conservation Commission or the Department of Environmental Protection).
❑ 1. The area described on the referenced plan(s) is an area subject to protection under the Act.
Removing,filling, dredging, or altering of the area requires the filing of a Notice of Intent.
❑ 2a. The boundary delineations of the following resource areas described on the referenced plan(s) are
confirmed as accurate. Therefore, the resource area boundaries confirmed in this Determination are
binding as to all decisions rendered pursuant to the Wetlands Protection Act and its regulations regarding
such boundaries for as long as this Determination is valid.
i
(
❑ 2b. The boundaries of resource areas listed below are not confirmed by this Determination,
regardless of whether such boundaries are contained on the plans attached to this Determination or il
to the Request for Determination.
❑ 3. The work described on referenced plan(s) and document(s) is within an area subject to i
protection under the Act and will remove, fill, dredge, or alter that area. Therefore, said work
requires the filing of a Notice of Intent.
❑ 4. The work described on referenced plan(s) and document(s) is within the Buffer Zone and will
alter an Area subject to protection under the Act. Therefore, said work requires the filing of a
Notice of Intent or ANRAD Simplified Review(if work is limited to the Buffer Zone).
f
❑ 5. The area and/or work described on referenced plan(s) and document(s) is subject to review
and approval by:
Name of Municipality
Pursuant to the following municipal wetland ordinance or bylaw:
Name Ordinance or Bylaw Citation
wpaform2.doc•Determination of Applicability•rev.10/6/04 Page 2 of 5
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands
r WPA Form 2 — Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Determination (cont.)
❑ 6. The following area and/or work, if any, is subject to a municipal ordinance or bylaw but not
subject to the Massachusetts Wetlands Protection Act:
❑ 7. If a Notice of Intent is filed for the work in the Riverfront Area described on referenced plan(s)
and document(s), which includes all or part of the work described in the Request, the applicant
must consider the following alternatives. (Refer to the wetland regulations at 10.58(4)c. for more
information about the scope of alternatives requirements):
❑ Alternatives limited to the lot on which the project is located.
❑ Alternatives limited to the lot on which the project is located, the subdivided lots, and any
adjacent lots formerly or presently owned by the same owner.
❑ Alternatives limited to the original parcel on which the project is located, the subdivided
parcels, any adjacent parcels, and any other land which can reasonably be obtained within
the municipality.
❑ Alternatives extend to any sites which can reasonably be obtained within the appropriate
region of the state.
Negative Determination
Note: No further action under the Wetlands Protection Act is required by.the applicant. However, if the
Department is requested to issue a Superseding Determination of Applicability, work may not proceed
on this project unless the Department fails to act on such request within 35 days of the date the
request is post-marked for certified mail or hand delivered to the Department. Work may then proceed
at the owner's risk only upon notice to the Department and to the Conservation Commission.
Requirements for requests for Superseding Determinations are listed at the end of this document.
❑ 1. The area described in the Request is not an area subject to protection under the Act or the
Buffer Zone.
❑ 2. The work described in the Request is within an area subject to protection under the Act, but will
not remove, fill, dredge, or alter that area. Therefore, said work does not require the filing of a
Notice of Intent.
® 3. The work described in the Request is within the Buffer Zone, as defined in the regulations, but
will not alter an Area subject to protection under the Act. Therefore, said work does not require
the filing of a Notice of Intent, subject to the following conditions (if any).
See attached conditions
❑ 4. The work described in the Request is not within an Area subject to protection under the Act
(including the Buffer Zone). Therefore, said work does not require the filing of a Notice of Intent,
unless and until said work alters an Area subject to protection under the Act.
wpaform2.doc•Determination of Applicability•rev.10/6/04 Page 3 of 5
LMassachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 2 — Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Determination (cont.)
❑ 5. The area described in the Request is subject to protection under the Act. Since the work
described therein meets the requirements for the following exemption, as specified in the Act and
the regulations, no Notice of Intent is required:
Exempt Activity(site applicable statuatory/regulatory provisions)
❑ 6. The area and/or work described in the Request is not subject to review and approval by:
Name of Municipality
Pursuant to a municipal wetlands ordinance or bylaw.
North Andover Wetlands Protection Bylaw Chapter 178
Name Ordinance or Bylaw Citation
C. Authorization
This Determination is issued to the applicant and delivered as follows:
❑ by hand delivery on [ by certified mail, return receipt requested on r
'
�/9 JL
Date Date
This Determination is valid for three years from the date of issuance (except Determinations for
Vegetation Management Plans which are valid for the duration of the Plan). This Determination does not
relieve the applicant from complying with all other applicable federal, state, or local statutes, ordinances,
bylaws, or regulations.
This Determination must be signed by a majority of the Conservation Commission. A copy must be sent to
the appropriate DEP Regional Office (see http://www.mass.gov/dep/about/region.findyour.htm) and the
property owner(if different from the applicant).
Signatu
If '. ' (..._-------""--‘"--- ‘..4.. ,.
do?" ......., .
7 f'c J,3
Date
wpaform2.doc•Determination of Applicability•rev.10/6/04 Page 4 of 5
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
Li,
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WPA Form 2 — Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
D. Appeals
The applicant, owner, any person aggrieved by this Determination, any owner of land abutting the land
upon which the proposed work is to be done, or any ten residents of the city or town in which such land is
located, are hereby notified of their right to request the appropriate Department of Environmental
Protection Regional Office (see http://www.mass.gov/dep/about/region.findyour.htm) to issue a
Superseding Determination of Applicability. The request must be made by certified mail or hand delivery
to the Department, with the appropriate filing fee and Fee Transmittal Form (see Request for
Departmental Action Fee Transmittal Form) as provided in 310 CMR 10.03(7)within ten business days
from the date of issuance of this Determination. A copy of the request shall at the same time be sent by
certified mail or hand delivery to the Conservation Commission and to the applicant if he/she is not the I
appellant. The request shall state clearly and concisely the objections to the Determination which is being
appealed. To the extent that the Determination is based on a municipal ordinance or bylaw and not on the
Massachusetts Wetlands Protection Act or regulations, the Department of Environmental Protection has
no appellate jurisdiction.
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wpaform2.doc•Determination of Applicability•rev.10/6/04 Page 5 of 5
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
Request for Departmental Action Fee Transmittal Form
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
A. Request Information
Important:
When filling out 1. Person or party making request(if appropriate, name the citizen group's representative):
forms on the
computer, use Name
only the tab
key to move
your cursor Mailing Address
do not use the "h
return key. City/Town State Zip Code
V a Phone Number Fax Number(if applicable)
:=X Project Location
Mailing Address
City/Town State Zip Code
2. Applicant(as shown on Notice of Intent(Form 3), Abbreviated Notice of Resource Area Delineation
(Form 4A); or Request for Determination of Applicability (Form 1)):
Name
Mailing Address
City/Town State Zip Code
Phone Number Fax Number(if applicable)
3. DEP File Number:
1
B. Instructions
1. When the Departmental action request is for(check one):
❑ Superseding Order of Conditions ($100 for individual single family homes with associated
structures; $200 for all other projects)
❑ Superseding Determination of Applicability ($100)
❑ Superseding Order of Resource Area Delineation ($100)
Send this form and check or money order for the appropriate amount, payable to the Commonwealth of
Massachusetts to:
Department of Environmental Protection
Box 4062
Boston, MA 02211
wpaform2.doc•Request for Departmental Action Fee Transmittal Form•rev.10/6/04 Page 1 of 2
•
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands i
Request for Departmental Action Fee Transmittal Form
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Instructions (cont.)
2. On a separate sheet attached to this form, state clearly and concisely the objections to the
Determination or Order which is being appealed. To the extent that the Determination or Order is
based on a municipal bylaw, and not on the Massachusetts Wetlands Protection Act or regulations,
the Department has no appellate jurisdiction.
3. Send a copy of this form and a copy of the check or money order with the Request for a Superseding
Determination or Order by certified mail or hand delivery to the appropriate DEP Regional Office (see
http://www.mass.gov/dep/about/region/findyour.htm).
4. A copy of the request shall at the same time be sent by certified mail or hand delivery to the
Conservation Commission and to the applicant, if he/she is not the appellant.
•
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wpaform2.doc•Request for Departmental Action Fee Transmittal Form•rev.10/6/04 Page 2 of 2
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44, SACHUS t
CONSERVATION DEPARTMENT
Community Development Division
NEGATIVE DETERMINATION OF APPLICABILITY
SPECIAL CONDITIONS
224 Carlton Lane, North Andover
At the September 11, 2013 public hearing, the North Andover Conservation Commission (NACC) voted
to issue a Negative Determination of Applicability for the construction of a paver patio, fire pit and
kneewall within the buffer zone to Bordering Vegetated Wetland (BVW). The new patio is more than 80
feet from BVW at its closest point. 4'
Applicant: Amy Hughes
224 Carlton Lane
North Andover, MA 01845
Owner: Gregory and Amy Hughes
224 Carlton Lane
North Andover, MA 01845
Record Documents: Request for Determination of Applicability and Associated Maps and Plans
Dated 8/29/13
Plan Titled: Plan of Land (with sketch of proposed patio)
North Andover,Massachusetts
Date: Original plan date May 5, 2005 Edits 8/29/13
SPECIAL CONDITIONS:
• Prior to the start of construction the applicant shall ensure that the site contractor has reviewed the
determination and is aware of the wetland resource area and the limits of the proposed work.
+ Erosion controls installed for the deck installation will remain in place during patio construction.
❖ Prior to work commencing on the site, the applicant shall contact the Conservation Department for a
pre-construction meeting with the contractor.
During Construction
1600 Osgood Street,Building 20,Suite 2-36,North Andover,Massachusetts 01845
Phone 978.688.9530 Fax 978.688.9542
Web:http://www.townofnorthandover.com/Pages/NAndoverMA_Conservation/index
+ Accepted engineering and construction standards and procedures shall be followed in the completion
of the project.
❖ Excess material and construction debris shall be properly disposed of off site and stockpiled material
shall be stored within the erosion controls.
Post Construction
❖ Immediately following completion of the work, any disturbed areas shall be permanently stabilized
against erosion (loam and seed or other stabilisation as approved by Conservation Department).
Upon completion of all requirements, the Conservation Department shall be contacted to conduct a
final site inspection.
gg�
1600 Osgood Street,Building 20,Suite 2-36,North Andover,Massachusetts 01845
Phone 978.688.9530 Fax 978.688.9542
Web:http://www.townofnorthandover.com/Pages/NAndoverMA_Conservation/index
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l
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 2 — Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
A. General Information
1
Important:
When filling out From:
forms on the North Andover
computer, use Conservation Commission
only the tab
key to move To: Applicant Property Owner(if different from applicant): (<
your cursor-
do not use the Amy Hughes
return key. yame Name
224 Carlton Lane '1
_V t , Mailing Address Mailing Address
North Andover MA 01845 g
Y\ City/Town State Zip Code City/Town State Zip Code
1. Title and Date (or Revised Date if applicable) of Final Plans and Other Documents: I
t:
Plan of Land w/sketch of patio (8/29/13) May 5, 2005 (
Title Date
t
Title Date
Title Date
r
2. Date Request Filed:
8/29/13
i
B. Determination
I
Pursuant to the authority of M.G.L. c. 131, § 40, the Conservation Commission considered your
Request for Determination of Applicability, with its supporting documentation, and made the following
Determination.
i.
Project Description (if applicable):
Construction of a patio within the Buffer Zone to Bordering Vegetated Wetland. 4`
Y,.
s,
i
s
Project Location:
224 Carlton Lane North Andover
Street Address City/Town
Map 107A Parcel 203 1
Assessors Map/Plat Number Parcel/Lot Number
t
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wpaform2.doc•Determination of Applicability•rev.10/6/04 Page 1 of 5
l
z
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 2 - Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Determination (cont.)
The following Determination(s) is/are applicable to the proposed site and/or project relative to the Wetlands
Protection Act and regulations:
Positive Determination ='
Note: No work within the jurisdiction of the Wetlands Protection Act may proceed until a final Order of
Conditions (issued following submittal of a Notice of Intent or Abbreviated Notice of Intent) or Order of k;
Resource Area Delineation (issued following submittal of Simplified Review ANRAD) has been received
from the issuing authority(i.e., Conservation Commission or the Department of Environmental Protection).
❑ 1. The area described on the referenced plan(s) is an area subject to protection under the Act.
Removing, filling, dredging, or altering of the area requires the filing of a Notice of Intent.
❑ 2a. The boundary delineations of the following resource areas described on the referenced plan(s) are
confirmed as accurate. Therefore, the resource area boundaries confirmed in this Determination are
binding as to all decisions rendered pursuant to the Wetlands Protection Act and its regulations regarding 1.
such boundaries for as long as this Determination is valid.
t
❑ 2b. The boundaries of resource areas listed below are not confirmed by this Determination, j
regardless of whether such boundaries are contained on the plans attached to this Determination or
to the Request for Determination.
(
❑ 3. The work described on referenced plan(s) and document(s) is within an area subject to
protection under the Act and will remove, fill, dredge, or alter that area. Therefore, said work 4'
requires the filing of a Notice of Intent.
❑ 4. The work described on referenced plan(s) and document(s) is within the Buffer Zone and will
alter an Area subject to protection under the Act. Therefore, said work requires the filing of a
Notice of Intent or ANRAD Simplified Review (if work is limited to the Buffer Zone).
❑ 5. The area and/or work described on referenced plan(s) and document(s) is subject to review
and approval by:
Name of Municipality
Pursuant to the following municipal wetland ordinance or bylaw:
Name Ordinance or Bylaw Citation
i
wpaform2.doc•Determination of Applicability•rev.10/6/04 Page 2 of 5 ?_
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
l WPA Form 2 — Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Determination (cont.)
❑ 6. The following area and/or work, if any, is subject to a municipal ordinance or bylaw but not
subject to the Massachusetts Wetlands Protection Act:
❑ 7. If a Notice of Intent is filed for the work in the Riverfront Area described on referenced plan(s)
and document(s), which includes all or part of the work described in the Request, the applicant
must consider the following alternatives. (Refer to the wetland regulations at 10.58(4)c. for more
information about the scope of alternatives requirements):
ti
❑ Alternatives limited to the lot on which the project is located.
❑ Alternatives limited to the lot on which the project is located, the subdivided lots, and any
adjacent lots formerly or presently owned by the same owner.
❑ Alternatives limited to the original parcel on which the project is located, the subdivided
parcels, any adjacent parcels, and any other land which can reasonably be obtained within
the municipality.
❑ Alternatives extend to any sites which can reasonably be obtained within the appropriate
region of the state.
Negative Determination
Note: No further action under the Wetlands Protection Act is required by the applicant. However, if the
Department is requested to issue a Superseding Determination of Applicability, work may not proceed
on this project unless the Department fails to act on such request within 35 days of the date the
request is post-marked for certified mail or hand delivered to the Department. Work may then proceed
at the owner's risk only upon notice to the Department and to the Conservation Commission.
Requirements for requests for Superseding Determinations are listed at the end of this document.
p
❑ 1. The area described in the Request is not an area subject to protection under the Act or the
Buffer Zone.
❑ 2. The work described in the Request is within an area subject to protection under the Act, but will
not remove, fill, dredge, or alter that area. Therefore, said work does not require the filing of a
Notice of Intent.
® 3. The work described in the Request is within the Buffer Zone, as defined in the regulations, but
will not alter an Area subject to protection under the Act. Therefore, said work does not require 1`
the filing of a Notice of Intent, subject to the following conditions (if any).
See attached conditions
❑ 4. The work described in the Request is not within an Area subject to protection under the Act
(including the Buffer Zone). Therefore, said work does not require the filing of a Notice of Intent,
unless and until said work alters an Area subject to protection under the Act.
w aform2.doc•Determination of A pp licability•rev.10/6/04 Page 3 of 5
•
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 2 — Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Determination (cont.)
t
❑ 5. The area described in the Request is subject to protection under the Act. Since the work r
described therein meets the requirements for the following exemption, as specified in the Act and t"
the regulations, no Notice of Intent is required: 1
f
Exempt Activity(site applicable statuatory/regulatory provisions)
(
a
y.
F
f
❑ 6. The area and/or work described in the Request is not subject to review and approval by:
1
Name of Municipality
Pursuant to a municipal wetlands ordinance or bylaw.
a,
North Andover Wetlands Protection Bylaw Chapter 178
Name Ordinance or Bylaw Citation 1
t
C. Authorization
This Determination is issued to the applicant and delivered as follows: f
❑ by hand delivery on Er by certified mail, return receipt requested on
9,// 3 /J2
Date Date te'
This Determination is valid for three years from the date of issuance (except Determinations for
Vegetation Management Plans which are valid for the duration of the Plan). This Determination does not l>
relieve the applicant from complying with all other applicable federal, state, or local statutes, ordinances, !!'
bylaws, or regulations.
r'
This Determination must be signed by a majority of the Conservation Commission. A copy must be sent to ,
the appropriate DEP Regional Office (see http://www.mass.gov/dep/about/region.findyour.htm) and the
property owner f different fr•m he applicant).
,
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Signatures: /
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I Mar My //� z
,Az.
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V1/2 ) i'l? i
Date
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wpaform2.doc•Determination of Applicability-rev.10/6/04
Page 4 of 5 t
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Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 2 — Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
D. Appeals
The applicant, owner, any person aggrieved by this Determination, any owner of land abutting the land
upon which the proposed work is to be done, or any ten residents of the city or town in which such land is
located, are hereby notified of their right to request the appropriate Department of Environmental
Protection Regional Office (see http://www.mass.gov/dep/about/region.findvour.htm) to issue a
Superseding Determination of Applicability. The request must be made by certified mail or hand delivery
to the Department, with the appropriate filing fee and Fee Transmittal Form (see Request for
Departmental Action Fee Transmittal Form) as provided in 310 CMR 10.03(7)within ten business days
from the date of issuance of this Determination. A copy of the request shall at the same time be sent by fi
certified mail or hand delivery to the Conservation Commission and to the applicant if he/she is not the
appellant. The request shall state clearly and concisely the objections to the Determination which is being
appealed. To the extent that the Determination is based on a municipal ordinance or bylaw and not on the
Massachusetts Wetlands Protection Act or regulations, the Department of Environmental Protection has
no appellate jurisdiction.
xi.
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wpaform2.doc•Determination of Applicability•rev.10/6/04 Page 5 of 5
L UP11Massachusetts Department of Environmental Protection r
Bureau of Resource Protection - Wetlands
Request for Departmental Action Fee Transmittal Form
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
r
A. Request Information
Important:
When filling out 1. Person or party making request(if appropriate, name the citizen group's representative):
forms on the l;
computer, use Name f
only the tab
key to move
your cursor Mailing Address
do not use the
return key. City/Town State Zip Code
rb ` Phone Number Fax Number(if applicable)
..:=IK: Project Location
Mailing Address
City/Town State Zip Code
2. Applicant(as shown on Notice of Intent(Form 3), Abbreviated Notice of Resource Area Delineation
(Form 4A); or Request for Determination of Applicability(Form 1)):
Name
Mailing Address
(
City/Town State Zip Code e
Phone Number Fax Number(if applicable) {!
t
3. DEP File Number: ''
K
is
1
B. Instructions
1. When the Departmental action request is for(check one):
❑ Superseding Order of Conditions ($100 for individual single family homes with associated
structures; $200 for all other projects)
❑ Superseding Determination of Applicability ($100)
r
❑ Superseding Order of Resource Area Delineation ($100)
Send this form and check or money order for the appropriate amount, payable to the Commonwealth of
Massachusetts to:
Department of Environmental Protection
Box 4062 ,
Boston, MA 02211
f
2
,
wpaform2.doc•Request for Departmental Action Fee Transmittal Form•rev.10/6/04 Page 1 of 2
■1110 Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
Request for Departmental Action Fee Transmittal Form
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Instructions (cont.)
2. On a separate sheet attached to this form, state clearly and concisely the objections to the
Determination or Order which is being appealed. To the extent that the Determination or Order is
based on a municipal bylaw, and not on the Massachusetts Wetlands Protection Act or regulations,
the Department has no appellate jurisdiction.
3. Send a copy of this form and a copy of the check or money order with the Request for a Superseding
Determination or Order by certified mail or hand delivery to the appropriate DEP Regional Office (see
http://www.mass.gov/dep/about/region/findyour.htm).
4. A copy of the request shall at the same time be sent by certified mail or hand delivery to the
Conservation Commission and to the applicant, if he/she is not the appellant.
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wpaform2.doc•Request for Departmental Action Fee Transmittal Form•rev.10/6/04 Page 2 of 2