HomeMy WebLinkAbout2-AOOC 20250325 Mierzwa 251 Green Dunes Drive 2-DEP Form _ wpaform3-pages 1-4
wpaform3.doc • rev. 12/4/2023 Page 1 of 9
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Massachusetts Department 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 MassDEP:
MassDEP File Number
Document Transaction Number
City/Town
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
Note:
Before
completing this
form consult
your local
Conservation
Commission
regarding any
municipal bylaw
or ordinance.
A. General Information
1. Project Location (Note: electronic filers will click on button to locate project site):
a. Street Address
b. City/Town
c. Zip Code
Latitude and Longitude:
d. Latitude
e. Longitude
f. Assessors Map/Plat Number
g. Parcel /Lot Number
2. Applicant:
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
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 NOI Wetland Fee Transmittal Form):
a. Total Fee Paid
b. State Fee Paid
c. City/Town Fee Paid
wpaform3.doc • rev. 12/4/2023 Page 2 of 9
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Massachusetts Department 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 MassDEP:
MassDEP File Number
Document Transaction Number
City/Town
A. General Information (continued)
6.General Project Description:
7a. Project Type Checklist: (Limited Project Types see Section A. 7b.)
1. Single Family Home 2. Residential Subdivision
3. Commercial/Industrial 4. Dock/Pier
5. Utilities 6. Coastal engineering Structure
7. Agriculture (e.g., cranberries, forestry) 8. Transportation
9. Other
7b. Is any portion of the proposed activity eligible to be treated as a limited project (including Ecological
Restoration Limited Project) subject to 310 CMR 10.24 (coastal) or 310 CMR 10.53 (inland)?
1. Yes No If yes, describe which limited project applies to this project. (See 310 CMR
10.24 and 10.53 for a complete list and description of limited project types)
2. Limited Project Type
If the proposed activity is eligible to be treated as an Ecological Restoration Limited Project (310
CMR10.24(8), 310 CMR 10.53(4)), complete and attach Appendix A: Ecological Restoration Limited
Project Checklist and Signed Certification.
8.Property recorded at the Registry of Deeds for:
a. County b. Certificate # (if registered land)
c. Book d. Page Number
B. Buffer Zone & Resource Area Impacts (temporary & permanent)
1. 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 alternative project design or location.
wpaform3.doc • rev. 12/4/2023 Page 3 of 9
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Massachusetts Department 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 MassDEP:
MassDEP File Number
Document Transaction Number
City/Town
B. Buffer Zone & Resource Area Impacts (temporary & permanent) (cont’d)
For all projects
affecting other
Resource Areas,
please attach a
narrative
explaining how
the resource
area was
delineated.
Resource Area Size of Proposed Alteration Proposed Replacement (if any)
a. Bank
1. linear feet
2. linear feet
b. Bordering Vegetated
Wetland
1. square feet
2. square feet
c. Land Under
Waterbodies and
Waterways
1. square feet
2. square feet
3. cubic yards dredged
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. Riverfront Area
1. Name of Waterway (if available) - specify coastal or inland
2. Width of Riverfront Area (check one):
25 ft. - Designated Densely Developed Areas only
100 ft. - New agricultural projects only
200 ft. - All other projects
3. Total area of Riverfront Area on the site of the proposed project:
square feet
4. Proposed alteration of the Riverfront Area:
a. total square feet
b. square feet within 100 ft.
c. square feet between 100 ft. and 200 ft.
5. Has an alternatives analysis been done and is it attached to this NOI? Yes No
6. Was the lot where the activity is proposed created prior to August 1, 1996? Yes No
3. Coastal Resource Areas: (See 310 CMR 10.25-10.35)
Note: for coastal riverfront areas, please complete Section B.2.f. above.
wpaform3.doc • rev. 12/4/2023 Page 4 of 9
4
Massachusetts Department 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 MassDEP:
MassDEP File Number
Document Transaction Number
City/Town
B.Buffer Zone & Resource Area Impacts (temporary & permanent) (cont’d)
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
document
transaction
number
(provided on
your receipt
page) with all
supplementary
information you
submit to the
Department.
Resource Area Size of Proposed Alteration Proposed Replacement (if any)
a. Designated Port Areas Indicate size under Land Under the Ocean, below
b.Land Under the Ocean 1. square feet
2. cubic yards dredged
c.Barrier Beach Indicate size under Coastal Beaches and/or Coastal Dunes below
d.Coastal Beaches 1. square feet 2. cubic yards beach nourishment
e.Coastal Dunes 1. square feet 2. cubic yards dune nourishment
Size of Proposed Alteration Proposed Replacement (if any)
f.Coastal Banks 1. linear feet
g.Rocky Intertidal
Shores 1. square feet
h. Salt Marshes 1. square feet 2. sq ft restoration, rehab., creation
i.Land Under Salt
Ponds 1. square feet
2. cubic yards dredged
j. Land Containing
Shellfish 1. square feet
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
l.Land Subject to
Coastal Storm Flowage 1. square feet
4. Restoration/Enhancement
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
5. Project Involves Stream Crossings
a. number of new stream crossings b. number of replacement stream crossings