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Home My WebLink About230306 MA DEP Executed WPA Form 1wpaform1.doc • rev. 7/27/2020 WPA Form 1 – Request for Determination of Applicability • Page 1 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 City/Town A. General Information Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. 1. Applicant: Name E-Mail Address Mailing Address City/Town State Zip Code 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 Conservation Commission make the following determination(s). Check any that apply: 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: Name of Municipality e. whether the following scope of alternatives is adequate for work in the Riverfront Area as depicted on referenced plan(s). Osterville Richard and Anne Segerson amullinsegs@yahoo.com 3910 N. Flagler Dr. #402 West Palm Beach FL 33407 203-912-6421 Barbara Conolly Gardens by Barbara Conolly barbara@gardensbybarbaraconolly.com 366 Carriage Shop Road MA 02536 East Falmouth Town of Barnstable 4 wpaform1.doc • rev. 7/27/2020 WPA Form 1 – Request for Determination of Applicability • 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 City/Town C. Project Description 1.a. Project Location (use maps and plans to identify the location of the area subject to this request): Street Address City/Town Assessors Map/Plat Number Parcel/Lot Number b.Area Description (use additional paper, if necessary): c.Plan and/or Map Reference(s): Title Date Title Date Title Date 2.a. Work Description (use additional paper and/or provide plan(s) of work, if necessary): This is a private residential lot with dwelling. on the corner of Cockachoisett Lane and Peaks Dr. The lot is .27 acres and measures approximately 130 feet by 93 feet. The lot is in a neighborhood with other single family dwellings and is abutted by a marina and other private residences. Certified Plot Plan 3/3/23 Landscape Design Plan 1/22/2023 The proposal is to install a 28' x 14' pool in the back southeast corner of the yard and to fence in the yard so as to provide safe entry to the pool area. The pool is to be a maximum of 6' deep in the deepenst end and 3.5 feet in the shallow end. The pool will be surrounded by a porcelain tile deck with bluestone coping around the pool. Pool equipment will sit on a slab in the corner of the lot. Fences will be a minimum of four feet high. One double gate and one single gate with be equipped with with pool locks at 54". A proposed pergola is situated to provide shade to owners and guests. A gas fired fire pit will augment the pool deck area. Stepping stones will be placed from the stairs off the house deck to the pool decking and from the left side gate to the pool area and to the basement access door. A small BBQ area will be placed at grade next to the house deck stairs. The proposed driveway will be peastone lined with granite cobble blocks set in cement with a granite apron to mitigate peastone from entering the street. Proposed is a 3' fence in the front yard with gate and a three foot high fence incorporated into the driveway entry gardens. A mix of native and non-invasive non-native trees, shrubs, and perennials will fill garden beds. Osterville 21 Cockachoisett Lane Osterville 116008 wpaform1.doc • rev. 7/27/2020 WPA Form 1 – Request for Determination of Applicability • Page 3 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 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). 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.) No grade changes are proposed. This new dwelling complies with the Wetlands Protection Act. Osterville wpaform1.doc • rev. 7/27/2020 WPA Form 1 – Request for Determination of Applicability • Page 4 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 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 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 Mailing Address City/Town State Zip Code Signatures: I also understand that notification of this Request will be placed in a local newspaper at my expense in accordance with Section 10.05(3)(b)(1) of the Wetlands Protection Act regulations. Signature of Applicant Date Signature of Representative (if any) Date Osterville Richard and Anne Segerson 3910 N. Flagler Dr. #402 West Palm Beach FL 33407 3/6/2023 Anne segerson (Mar 7, 2023 10:09 EST) wpaform1 Final Audit Report 2023-03-07 Created:2023-03-07 By:Barbara Conolly (barbara@gardensbybarbaraconolly.com) Status:Signed Transaction ID:CBJCHBCAABAAPIzL4X9h2rAsMRAUJ3FqEkE_CB97cPtL "wpaform1" History Document created by Barbara Conolly (barbara@gardensbybarbaraconolly.com) 2023-03-07 - 2:47:24 PM GMT- IP address: 73.61.72.11 Document emailed to amullinsegs@yahoo.com for signature 2023-03-07 - 2:48:22 PM GMT Email viewed by amullinsegs@yahoo.com 2023-03-07 - 3:07:42 PM GMT- IP address: 172.225.251.100 Signer amullinsegs@yahoo.com entered name at signing as Anne segerson 2023-03-07 - 3:09:17 PM GMT- IP address: 73.204.216.42 Document e-signed by Anne segerson (amullinsegs@yahoo.com) Signature Date: 2023-03-07 - 3:09:19 PM GMT - Time Source: server- IP address: 73.204.216.42 Agreement completed. 2023-03-07 - 3:09:19 PM GMT