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986585
1/23/2018:12:14:00 PM
174.85K
COLDSPRING
WPA Form 3 - NOI
In Process
a.Yes, Attach a copy of the Stormwater Report as required by the Stormwater Management Standards per 310 CMR
10.05(6)(k)(q) and check if:
A.General Information
1. Project Location:
a. Street Address 142 RIVERBANK ROAD
b. City/Town NORTHAMPTON c. Zip Code 01060
d. Latitude 42.33250N e. Longitude 72.61468W
f. Map/Plat #25 g.Parcel/Lot #007001
2. Applicant:
Individual Organization
a. First Name HELEN b.Last Name HAYWARD
c. Organization
d. Mailing Address 71 FORT MEADOW DRIVE
e. City/Town HUDSON f. State MA g. Zip Code 01749
h. Phone Number i. Fax j. Email Helenhayward71@hotmail.com
3.Property Owner:
more than one owner
a. First Name HELEN b. Last Name HAYWARD
c. Organization
d. Mailing Address 71 FORT MEADOW DRIVE
e. City/Town HUDSON f.State MA g. Zip Code 01749
h. Phone Number i. Fax j.Email Helenhayward71@hotmail.com
4.Representative:
a. First Name ALAN b. Last Name WEISS
c. Organization COLD SPRING ENVIRONMENTAL CONSULTANTS INC.
d. Mailing Address 350 OLD ENFIELD ROAD
e. City/Town BELCHERTOWN f. State MA g. Zip Code 01007
h.Phone Number 4133235957 i.Fax 4133234916 j.Email aweiss@coldspringenvironmental.com
5.Total WPA Fee Paid (Automatically inserted from NOI Wetland Fee Transmittal Form):
a.Total Fee Paid 165.00 b.State Fee Paid 70.00 c.City/Town Fee Paid 95.00
6.General Project Description:
EXISTING DWELLING RENOVATION (BUILT, 1930 RENOVATED TO SELL INCLUDING EXTERIOR PAINTING OF
SIDING, PORCH REPAIRS AND NEW WINDOWS), DECK REPLACEMENT AND SEPTIC TANK ONLY
REPLACEMENT AS PART OF A TITLE 5 INSPECTION IN EXISTING GRASS YARD.
7a.Project Type:
1. Single Family Home 2. Residential Subdivision
3.Limited Project Driveway Crossing 4.Commercial/Industrial
5.Dock/Pier 6.Utilities
7.Coastal Engineering Structure 8.Agriculture (eg., cranberries, forestry)
9.Transportation 10.Other
7b.Is any portion of the proposed activity eligible to be treated as a 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:
2. Limited Project
8.Property recorded at the Registry of Deeds for:
a.County:b.Certificate:c.Book:d.Page:
HAMPSHIRE 4984 238
B. Buffer Zone & Resource Area Impacts (temporary & permanent)
1.Buffer Zone & Resource Area Impacts (temporary & permanent):
This is a Buffer Zone only project 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)
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
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 any)
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 2000
square feet
4. Proposed Alteration of the Riverfront Area:
0
a. total square feet
0
b. square feet within 100 ft.
0
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)
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 Beaches Indicate size under Coastal Beaches and/or Coatstal Dunes, below
d.Coastal Beaches
1. square feet 2. cubic yards beach nourishment
e.Coastal Dunes
1. square feet 2. cubic yards dune nourishment
f.Coastal Banks
1. linear feet
g.Rocky Intertidal Shores
1. square feet
h.Salt Marshes
1. square feet 2. sq ft restoration, rehab, crea.
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
Restoration/Replacement
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 entered the additional amount here.
a. square feet of BVW b. square feet of Salt Marsh
5.Projects Involves Stream Crossings
Project Involves Streams Crossings
If the project involves Stream Crossings, please enter the number of new stream crossings/number of replacement stream crossings.
a. number of new stream crossings b. number of replacement stream crossings
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 recent
Estimated Habitat Map of StateListed Rare Wetland Wildlife published by the Natural Heritage of Endangered Species program
(NHESP)?
a.Yes No
If yes, include proof of mailing or hand delivery of
NOI to:
Natural Heritage and Endangered Species
Program
Division of Fisheries and Wildlife
1 Rabbit Hill Road
Westborough, MA 01581
b. Date of map:FROM MAP VIEWER
If yes, the project is also subject to Massachusetts Endangered Species Act (MESA) review (321 CMR 10.18)....
c. Submit Supplemental Information for Endangered Species Review * (Check boxes as they apply)
1. Percentage/acreage of property to be altered:
(a) within Wetland Resource Area percentage/acreage
(b) outside Resource Area percentage/acreage
2. Assessor's Map or rightofway plan of site
3. Project plans for entire project site, including wetland resource areas and areas outside of wetland jurisdiction, showing
existing and proposed conditions, existing and proposed tree/vegetation clearing line, and clearly demarcated limits of work **
a.Project description (including description of impacts outside of wetland resource area & buffer zone)
b. Photographs representative of the site
c. MESA filing fee (fee information available at: http://www.mass.gov/eea/agencies/dfg/dfw/naturalheritage/regulatory
review/massendangeredspeciesactmesa/mesafeeschedule.html )
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.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://www.mass.gov/eea/agencies/dfg/dfw/lawsregulations/cmr/321cmr1000massachusettsendangered
speciesact.html#10.14; the NOI must still be sent to NHESP if the project is within estimated habitat pursuant to 310 CMR
10.37 and 10.59.)
2. Separate MESA review ongoing.
a. NHESP Tracking Number
b. Date submitted to NHESP
3.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...
2.For coastal projects only, is any portion of the proposed project located below the mean high waterline or in a fish run?
a. 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 Island,
and the Cape & Islands:
Division of Marine Fisheries
Southeast Marine Fisheries Station
Attn: Environmental Reviewer
1213 Purchase street 3rd floor
New Bedford, MA 027406694
North Shore Hull to
New Hampshire:
Division of Marine
Fisheries
North Shore Office
Attn: Environmental
Reviewer
30 Emerson Avenue
Gloucester, MA 01930
If yes, it 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)?
a.Yes No If yes, provide name of ACEC (see instructions to WPA Form 3 or
DEP Website for ACEC locations). Note: electronic filers click on
Website.
b. ACEC Name
4.Is any portion of the proposed project within an area designated as an Outstanding Resource Water (ORW) as designated in the
Massachusetts Surface Water Quality Standards, 314 CMR 4.00?
a.Yes No
5.Is any portion of the site subject to a Wetlands Restriction Order under the Inland Wetlands 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?
1.Applying for Low Impact Development (LID) site design credits (as described in Stormwater Management Handbook
Vol.2, Chapter 3)
2.A portion of the site constitutes redevelopment
3.Proprietary BMPs are included in the Stormwater Management System
b.No, Explain why the project is exempt:
1.Single Family Home
2.Emergency Road Repair
3.Small Residential Subdivision (less than or equal to 4 singlefamily houses or less than or equal to 4 units in multifamily
housing project) with no discharge to Critical Areas.
D. Additional Information
Applicants must include the following with this Notice of Intent (NOI). 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 by regular mail delivery.
1.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.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.Identify the method for BVW and other resource area boundary delineations (MassDEP BVW Field Data Form(s).
Determination of Applicability, Order of Resource Area Delineation, etc.), and attach documentation of the methodology.
4.List the titles and dates for all plans and other materials submitted with this NOI.
a. Plan Title:b. Plan Prepared By:c. Plan Signed/Stamped By:c. Revised Final Date:e. Scale:
OLIVER GIS AERIAL
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.
8.Attach NOI Wetland Fee Transmittal Form.
9.Attach Stormwater Report, if needed.
E. Fees
1.
Fee Exempt: No filing 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 Transmittal Form) to confirm fee payment:
2. Municipal Check Number 3. Check date
4. State Check Number 5. Check date
6. Payer name on check: First Name 7. Payer name on check: Last Name
F. Signatures and Submittal Requirements
I hereby certify under the penalties of perjury that the foregoing Notice of Intent 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 a local 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 writing by hand delivery or certified mail (return receipt requested) to all abutters within 100 feet
of the property line of the project location.
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 Section C, Items 13, 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.
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 #:
eDEP Transaction #:986585
City/Town:NORTHAMPTON
Page 1 of 7 * ELECTRONIC COPY
a.Yes, Attach a copy of the Stormwater Report as required by the Stormwater Management Standards per 310 CMR
10.05(6)(k)(q) and check if:
A.General Information1. Project Location:a. Street Address 142 RIVERBANK ROADb. City/Town NORTHAMPTON c. Zip Code 01060d. Latitude 42.33250N e. Longitude 72.61468Wf. Map/Plat #25 g.Parcel/Lot #0070012. Applicant:Individual Organizationa. First Name HELEN b.Last Name HAYWARDc. Organizationd. Mailing Address 71 FORT MEADOW DRIVEe. City/Town HUDSON f. State MA g. Zip Code 01749h. Phone Number i. Fax j. Email Helenhayward71@hotmail.com3.Property Owner:more than one ownera. First Name HELEN b. Last Name HAYWARDc. Organizationd. Mailing Address 71 FORT MEADOW DRIVEe. City/Town HUDSON f.State MA g. Zip Code 01749h. Phone Number i. Fax j.Email Helenhayward71@hotmail.com4.Representative:a. First Name ALAN b. Last Name WEISSc. Organization COLD SPRING ENVIRONMENTAL CONSULTANTS INC.d. Mailing Address 350 OLD ENFIELD ROADe. City/Town BELCHERTOWN f. State MA g. Zip Code 01007h.Phone Number 4133235957 i.Fax 4133234916 j.Email aweiss@coldspringenvironmental.com5.Total WPA Fee Paid (Automatically inserted from NOI Wetland Fee Transmittal Form):a.Total Fee Paid 165.00 b.State Fee Paid 70.00 c.City/Town Fee Paid 95.00
6.General Project Description:
EXISTING DWELLING RENOVATION (BUILT, 1930 RENOVATED TO SELL INCLUDING EXTERIOR PAINTING OF
SIDING, PORCH REPAIRS AND NEW WINDOWS), DECK REPLACEMENT AND SEPTIC TANK ONLY
REPLACEMENT AS PART OF A TITLE 5 INSPECTION IN EXISTING GRASS YARD.
7a.Project Type:
1. Single Family Home 2. Residential Subdivision
3.Limited Project Driveway Crossing 4.Commercial/Industrial
5.Dock/Pier 6.Utilities
7.Coastal Engineering Structure 8.Agriculture (eg., cranberries, forestry)
9.Transportation 10.Other
7b.Is any portion of the proposed activity eligible to be treated as a 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:
2. Limited Project
8.Property recorded at the Registry of Deeds for:
a.County:b.Certificate:c.Book:d.Page:
HAMPSHIRE 4984 238
B. Buffer Zone & Resource Area Impacts (temporary & permanent)
1.Buffer Zone & Resource Area Impacts (temporary & permanent):
This is a Buffer Zone only project 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)
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
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 any)
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 2000
square feet
4. Proposed Alteration of the Riverfront Area:
0
a. total square feet
0
b. square feet within 100 ft.
0
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)
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 Beaches Indicate size under Coastal Beaches and/or Coatstal Dunes, below
d.Coastal Beaches
1. square feet 2. cubic yards beach nourishment
e.Coastal Dunes
1. square feet 2. cubic yards dune nourishment
f.Coastal Banks
1. linear feet
g.Rocky Intertidal Shores
1. square feet
h.Salt Marshes
1. square feet 2. sq ft restoration, rehab, crea.
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
Restoration/Replacement
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 entered the additional amount here.
a. square feet of BVW b. square feet of Salt Marsh
5.Projects Involves Stream Crossings
Project Involves Streams Crossings
If the project involves Stream Crossings, please enter the number of new stream crossings/number of replacement stream crossings.
a. number of new stream crossings b. number of replacement stream crossings
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 recent
Estimated Habitat Map of StateListed Rare Wetland Wildlife published by the Natural Heritage of Endangered Species program
(NHESP)?
a.Yes No
If yes, include proof of mailing or hand delivery of
NOI to:
Natural Heritage and Endangered Species
Program
Division of Fisheries and Wildlife
1 Rabbit Hill Road
Westborough, MA 01581
b. Date of map:FROM MAP VIEWER
If yes, the project is also subject to Massachusetts Endangered Species Act (MESA) review (321 CMR 10.18)....
c. Submit Supplemental Information for Endangered Species Review * (Check boxes as they apply)
1. Percentage/acreage of property to be altered:
(a) within Wetland Resource Area percentage/acreage
(b) outside Resource Area percentage/acreage
2. Assessor's Map or rightofway plan of site
3. Project plans for entire project site, including wetland resource areas and areas outside of wetland jurisdiction, showing
existing and proposed conditions, existing and proposed tree/vegetation clearing line, and clearly demarcated limits of work **
a.Project description (including description of impacts outside of wetland resource area & buffer zone)
b. Photographs representative of the site
c. MESA filing fee (fee information available at: http://www.mass.gov/eea/agencies/dfg/dfw/naturalheritage/regulatory
review/massendangeredspeciesactmesa/mesafeeschedule.html )
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.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://www.mass.gov/eea/agencies/dfg/dfw/lawsregulations/cmr/321cmr1000massachusettsendangered
speciesact.html#10.14; the NOI must still be sent to NHESP if the project is within estimated habitat pursuant to 310 CMR
10.37 and 10.59.)
2. Separate MESA review ongoing.
a. NHESP Tracking Number
b. Date submitted to NHESP
3.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...
2.For coastal projects only, is any portion of the proposed project located below the mean high waterline or in a fish run?
a. 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 Island,
and the Cape & Islands:
Division of Marine Fisheries
Southeast Marine Fisheries Station
Attn: Environmental Reviewer
1213 Purchase street 3rd floor
New Bedford, MA 027406694
North Shore Hull to
New Hampshire:
Division of Marine
Fisheries
North Shore Office
Attn: Environmental
Reviewer
30 Emerson Avenue
Gloucester, MA 01930
If yes, it 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)?
a.Yes No If yes, provide name of ACEC (see instructions to WPA Form 3 or
DEP Website for ACEC locations). Note: electronic filers click on
Website.
b. ACEC Name
4.Is any portion of the proposed project within an area designated as an Outstanding Resource Water (ORW) as designated in the
Massachusetts Surface Water Quality Standards, 314 CMR 4.00?
a.Yes No
5.Is any portion of the site subject to a Wetlands Restriction Order under the Inland Wetlands 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?
1.Applying for Low Impact Development (LID) site design credits (as described in Stormwater Management Handbook
Vol.2, Chapter 3)
2.A portion of the site constitutes redevelopment
3.Proprietary BMPs are included in the Stormwater Management System
b.No, Explain why the project is exempt:
1.Single Family Home
2.Emergency Road Repair
3.Small Residential Subdivision (less than or equal to 4 singlefamily houses or less than or equal to 4 units in multifamily
housing project) with no discharge to Critical Areas.
D. Additional Information
Applicants must include the following with this Notice of Intent (NOI). 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 by regular mail delivery.
1.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.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.Identify the method for BVW and other resource area boundary delineations (MassDEP BVW Field Data Form(s).
Determination of Applicability, Order of Resource Area Delineation, etc.), and attach documentation of the methodology.
4.List the titles and dates for all plans and other materials submitted with this NOI.
a. Plan Title:b. Plan Prepared By:c. Plan Signed/Stamped By:c. Revised Final Date:e. Scale:
OLIVER GIS AERIAL
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.
8.Attach NOI Wetland Fee Transmittal Form.
9.Attach Stormwater Report, if needed.
E. Fees
1.
Fee Exempt: No filing 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 Transmittal Form) to confirm fee payment:
2. Municipal Check Number 3. Check date
4. State Check Number 5. Check date
6. Payer name on check: First Name 7. Payer name on check: Last Name
F. Signatures and Submittal Requirements
I hereby certify under the penalties of perjury that the foregoing Notice of Intent 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 a local 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 writing by hand delivery or certified mail (return receipt requested) to all abutters within 100 feet
of the property line of the project location.
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 Section C, Items 13, 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.
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 #:
eDEP Transaction #:986585
City/Town:NORTHAMPTON
Page 2 of 7 * ELECTRONIC COPY
a.Yes, Attach a copy of the Stormwater Report as required by the Stormwater Management Standards per 310 CMR
10.05(6)(k)(q) and check if:
A.General Information1. Project Location:a. Street Address 142 RIVERBANK ROADb. City/Town NORTHAMPTON c. Zip Code 01060d. Latitude 42.33250N e. Longitude 72.61468Wf. Map/Plat #25 g.Parcel/Lot #0070012. Applicant:Individual Organizationa. First Name HELEN b.Last Name HAYWARDc. Organizationd. Mailing Address 71 FORT MEADOW DRIVEe. City/Town HUDSON f. State MA g. Zip Code 01749h. Phone Number i. Fax j. Email Helenhayward71@hotmail.com3.Property Owner:more than one ownera. First Name HELEN b. Last Name HAYWARDc. Organizationd. Mailing Address 71 FORT MEADOW DRIVEe. City/Town HUDSON f.State MA g. Zip Code 01749h. Phone Number i. Fax j.Email Helenhayward71@hotmail.com4.Representative:a. First Name ALAN b. Last Name WEISSc. Organization COLD SPRING ENVIRONMENTAL CONSULTANTS INC.d. Mailing Address 350 OLD ENFIELD ROADe. City/Town BELCHERTOWN f. State MA g. Zip Code 01007h.Phone Number 4133235957 i.Fax 4133234916 j.Email aweiss@coldspringenvironmental.com5.Total WPA Fee Paid (Automatically inserted from NOI Wetland Fee Transmittal Form):a.Total Fee Paid 165.00 b.State Fee Paid 70.00 c.City/Town Fee Paid 95.006.General Project Description:EXISTING DWELLING RENOVATION (BUILT, 1930 RENOVATED TO SELL INCLUDING EXTERIOR PAINTING OFSIDING, PORCH REPAIRS AND NEW WINDOWS), DECK REPLACEMENT AND SEPTIC TANK ONLYREPLACEMENT AS PART OF A TITLE 5 INSPECTION IN EXISTING GRASS YARD.7a.Project Type:1. Single Family Home 2. Residential Subdivision3.Limited Project Driveway Crossing 4.Commercial/Industrial5.Dock/Pier 6.Utilities7.Coastal Engineering Structure 8.Agriculture (eg., cranberries, forestry)9.Transportation 10.Other7b.Is any portion of the proposed activity eligible to be treated as a limited project subject to 310 CMR 10.24 (coastal) or 310CMR 10.53 (inland)?1.Yes No If yes, describe which limited project applies to this project:2. Limited Project8.Property recorded at the Registry of Deeds for:a.County:b.Certificate:c.Book:d.Page:HAMPSHIRE 4984 238B. Buffer Zone & Resource Area Impacts (temporary & permanent)1.Buffer Zone & Resource Area Impacts (temporary & permanent):This is a Buffer Zone only project 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)Resource Area Size of Proposed Alteration Proposed Replacement (if any)a.Bank 1. linear feet 2. linear feetb.Bordering Vegetated Wetland 1. square feet 2. square feetc.Land under Waterbodies and Waterways 1. Square feet 2. square feet3. cubic yards dredgedd.Bordering Land Subject to Flooding 1. square feet 2. square feet3. cubic feet of flood storage lost 4. cubic feet replacede.Isolated Land Subject to Flooding 1. square feet2. cubic feet of flood storage lost 3. cubic feet replaced
f.Riverfront Area
1. Name of Waterway (if any)
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 2000
square feet
4. Proposed Alteration of the Riverfront Area:
0
a. total square feet
0
b. square feet within 100 ft.
0
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)
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 Beaches Indicate size under Coastal Beaches and/or Coatstal Dunes, below
d.Coastal Beaches
1. square feet 2. cubic yards beach nourishment
e.Coastal Dunes
1. square feet 2. cubic yards dune nourishment
f.Coastal Banks
1. linear feet
g.Rocky Intertidal Shores
1. square feet
h.Salt Marshes
1. square feet 2. sq ft restoration, rehab, crea.
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
Restoration/Replacement
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 entered the additional amount here.
a. square feet of BVW b. square feet of Salt Marsh
5.Projects Involves Stream Crossings
Project Involves Streams Crossings
If the project involves Stream Crossings, please enter the number of new stream crossings/number of replacement stream crossings.
a. number of new stream crossings b. number of replacement stream crossings
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 recent
Estimated Habitat Map of StateListed Rare Wetland Wildlife published by the Natural Heritage of Endangered Species program
(NHESP)?
a.Yes No
If yes, include proof of mailing or hand delivery of
NOI to:
Natural Heritage and Endangered Species
Program
Division of Fisheries and Wildlife
1 Rabbit Hill Road
Westborough, MA 01581
b. Date of map:FROM MAP VIEWER
If yes, the project is also subject to Massachusetts Endangered Species Act (MESA) review (321 CMR 10.18)....
c. Submit Supplemental Information for Endangered Species Review * (Check boxes as they apply)
1. Percentage/acreage of property to be altered:
(a) within Wetland Resource Area percentage/acreage
(b) outside Resource Area percentage/acreage
2. Assessor's Map or rightofway plan of site
3. Project plans for entire project site, including wetland resource areas and areas outside of wetland jurisdiction, showing
existing and proposed conditions, existing and proposed tree/vegetation clearing line, and clearly demarcated limits of work **
a.Project description (including description of impacts outside of wetland resource area & buffer zone)
b. Photographs representative of the site
c. MESA filing fee (fee information available at: http://www.mass.gov/eea/agencies/dfg/dfw/naturalheritage/regulatory
review/massendangeredspeciesactmesa/mesafeeschedule.html )
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.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://www.mass.gov/eea/agencies/dfg/dfw/lawsregulations/cmr/321cmr1000massachusettsendangered
speciesact.html#10.14; the NOI must still be sent to NHESP if the project is within estimated habitat pursuant to 310 CMR
10.37 and 10.59.)
2. Separate MESA review ongoing.
a. NHESP Tracking Number
b. Date submitted to NHESP
3.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...
2.For coastal projects only, is any portion of the proposed project located below the mean high waterline or in a fish run?
a. 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 Island,
and the Cape & Islands:
Division of Marine Fisheries
Southeast Marine Fisheries Station
Attn: Environmental Reviewer
1213 Purchase street 3rd floor
New Bedford, MA 027406694
North Shore Hull to
New Hampshire:
Division of Marine
Fisheries
North Shore Office
Attn: Environmental
Reviewer
30 Emerson Avenue
Gloucester, MA 01930
If yes, it 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)?
a.Yes No If yes, provide name of ACEC (see instructions to WPA Form 3 or
DEP Website for ACEC locations). Note: electronic filers click on
Website.
b. ACEC Name
4.Is any portion of the proposed project within an area designated as an Outstanding Resource Water (ORW) as designated in the
Massachusetts Surface Water Quality Standards, 314 CMR 4.00?
a.Yes No
5.Is any portion of the site subject to a Wetlands Restriction Order under the Inland Wetlands 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?
1.Applying for Low Impact Development (LID) site design credits (as described in Stormwater Management Handbook
Vol.2, Chapter 3)
2.A portion of the site constitutes redevelopment
3.Proprietary BMPs are included in the Stormwater Management System
b.No, Explain why the project is exempt:
1.Single Family Home
2.Emergency Road Repair
3.Small Residential Subdivision (less than or equal to 4 singlefamily houses or less than or equal to 4 units in multifamily
housing project) with no discharge to Critical Areas.
D. Additional Information
Applicants must include the following with this Notice of Intent (NOI). 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 by regular mail delivery.
1.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.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.Identify the method for BVW and other resource area boundary delineations (MassDEP BVW Field Data Form(s).
Determination of Applicability, Order of Resource Area Delineation, etc.), and attach documentation of the methodology.
4.List the titles and dates for all plans and other materials submitted with this NOI.
a. Plan Title:b. Plan Prepared By:c. Plan Signed/Stamped By:c. Revised Final Date:e. Scale:
OLIVER GIS AERIAL
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.
8.Attach NOI Wetland Fee Transmittal Form.
9.Attach Stormwater Report, if needed.
E. Fees
1.
Fee Exempt: No filing 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 Transmittal Form) to confirm fee payment:
2. Municipal Check Number 3. Check date
4. State Check Number 5. Check date
6. Payer name on check: First Name 7. Payer name on check: Last Name
F. Signatures and Submittal Requirements
I hereby certify under the penalties of perjury that the foregoing Notice of Intent 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 a local 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 writing by hand delivery or certified mail (return receipt requested) to all abutters within 100 feet
of the property line of the project location.
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 Section C, Items 13, 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.
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 #:
eDEP Transaction #:986585
City/Town:NORTHAMPTON
Page 3 of 7 * ELECTRONIC COPY
a.Yes, Attach a copy of the Stormwater Report as required by the Stormwater Management Standards per 310 CMR
10.05(6)(k)(q) and check if:
A.General Information1. Project Location:a. Street Address 142 RIVERBANK ROADb. City/Town NORTHAMPTON c. Zip Code 01060d. Latitude 42.33250N e. Longitude 72.61468Wf. Map/Plat #25 g.Parcel/Lot #0070012. Applicant:Individual Organizationa. First Name HELEN b.Last Name HAYWARDc. Organizationd. Mailing Address 71 FORT MEADOW DRIVEe. City/Town HUDSON f. State MA g. Zip Code 01749h. Phone Number i. Fax j. Email Helenhayward71@hotmail.com3.Property Owner:more than one ownera. First Name HELEN b. Last Name HAYWARDc. Organizationd. Mailing Address 71 FORT MEADOW DRIVEe. City/Town HUDSON f.State MA g. Zip Code 01749h. Phone Number i. Fax j.Email Helenhayward71@hotmail.com4.Representative:a. First Name ALAN b. Last Name WEISSc. Organization COLD SPRING ENVIRONMENTAL CONSULTANTS INC.d. Mailing Address 350 OLD ENFIELD ROADe. City/Town BELCHERTOWN f. State MA g. Zip Code 01007h.Phone Number 4133235957 i.Fax 4133234916 j.Email aweiss@coldspringenvironmental.com5.Total WPA Fee Paid (Automatically inserted from NOI Wetland Fee Transmittal Form):a.Total Fee Paid 165.00 b.State Fee Paid 70.00 c.City/Town Fee Paid 95.006.General Project Description:EXISTING DWELLING RENOVATION (BUILT, 1930 RENOVATED TO SELL INCLUDING EXTERIOR PAINTING OFSIDING, PORCH REPAIRS AND NEW WINDOWS), DECK REPLACEMENT AND SEPTIC TANK ONLYREPLACEMENT AS PART OF A TITLE 5 INSPECTION IN EXISTING GRASS YARD.7a.Project Type:1. Single Family Home 2. Residential Subdivision3.Limited Project Driveway Crossing 4.Commercial/Industrial5.Dock/Pier 6.Utilities7.Coastal Engineering Structure 8.Agriculture (eg., cranberries, forestry)9.Transportation 10.Other7b.Is any portion of the proposed activity eligible to be treated as a limited project subject to 310 CMR 10.24 (coastal) or 310CMR 10.53 (inland)?1.Yes No If yes, describe which limited project applies to this project:2. Limited Project8.Property recorded at the Registry of Deeds for:a.County:b.Certificate:c.Book:d.Page:HAMPSHIRE 4984 238B. Buffer Zone & Resource Area Impacts (temporary & permanent)1.Buffer Zone & Resource Area Impacts (temporary & permanent):This is a Buffer Zone only project 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)Resource Area Size of Proposed Alteration Proposed Replacement (if any)a.Bank 1. linear feet 2. linear feetb.Bordering Vegetated Wetland 1. square feet 2. square feetc.Land under Waterbodies and Waterways 1. Square feet 2. square feet3. cubic yards dredgedd.Bordering Land Subject to Flooding 1. square feet 2. square feet3. cubic feet of flood storage lost 4. cubic feet replacede.Isolated Land Subject to Flooding 1. square feet2. cubic feet of flood storage lost 3. cubic feet replacedf.Riverfront Area 1. Name of Waterway (if any)2. Width of Riverfront Area (check one)25 ft. Designated Densely Developed Areas only100 ft. New agricultural projects only200 ft. All other projects3. Total area of Riverfront Area on the site of the proposed project 2000square feet4. Proposed Alteration of the Riverfront Area:0a. total square feet 0b. square feet within 100 ft.0c. square feet between 100 ft.and 200 ft.5. Has an alternatives analysis been done and is it attached to this NOI?Yes No6. Was the lot where the activity is proposed created prior to August 1, 1996?Yes No3.Coastal Resource Areas: (See 310 CMR 10.25 10.35)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 feet2. cubic yards dredgedc.Barrier Beaches Indicate size under Coastal Beaches and/or Coatstal Dunes, belowd.Coastal Beaches 1. square feet 2. cubic yards beach nourishmente.Coastal Dunes 1. square feet 2. cubic yards dune nourishmentf.Coastal Banks 1. linear feetg.Rocky Intertidal Shores 1. square feeth.Salt Marshes 1. square feet 2. sq ft restoration, rehab, crea.i.Land Under Salt Ponds 1. square feet2. cubic yards dredgedj.Land Containing Shellfish 1. square feetk.Fish Runs Indicate size under Coastal Banks, Inland Bank, Land Under the Ocean, and/or inland LandUnder Waterbodies and Waterways, above
1. cubic yards dredged
l.Land Subject to Coastal
Storm Flowage 1. square feet
4.Restoration/Enhancement
Restoration/Replacement
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 entered the additional amount here.
a. square feet of BVW b. square feet of Salt Marsh
5.Projects Involves Stream Crossings
Project Involves Streams Crossings
If the project involves Stream Crossings, please enter the number of new stream crossings/number of replacement stream crossings.
a. number of new stream crossings b. number of replacement stream crossings
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 recent
Estimated Habitat Map of StateListed Rare Wetland Wildlife published by the Natural Heritage of Endangered Species program
(NHESP)?
a.Yes No
If yes, include proof of mailing or hand delivery of
NOI to:
Natural Heritage and Endangered Species
Program
Division of Fisheries and Wildlife
1 Rabbit Hill Road
Westborough, MA 01581
b. Date of map:FROM MAP VIEWER
If yes, the project is also subject to Massachusetts Endangered Species Act (MESA) review (321 CMR 10.18)....
c. Submit Supplemental Information for Endangered Species Review * (Check boxes as they apply)
1. Percentage/acreage of property to be altered:
(a) within Wetland Resource Area percentage/acreage
(b) outside Resource Area percentage/acreage
2. Assessor's Map or rightofway plan of site
3. Project plans for entire project site, including wetland resource areas and areas outside of wetland jurisdiction, showing
existing and proposed conditions, existing and proposed tree/vegetation clearing line, and clearly demarcated limits of work **
a.Project description (including description of impacts outside of wetland resource area & buffer zone)
b. Photographs representative of the site
c. MESA filing fee (fee information available at: http://www.mass.gov/eea/agencies/dfg/dfw/naturalheritage/regulatory
review/massendangeredspeciesactmesa/mesafeeschedule.html )
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.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://www.mass.gov/eea/agencies/dfg/dfw/lawsregulations/cmr/321cmr1000massachusettsendangered
speciesact.html#10.14; the NOI must still be sent to NHESP if the project is within estimated habitat pursuant to 310 CMR
10.37 and 10.59.)
2. Separate MESA review ongoing.
a. NHESP Tracking Number
b. Date submitted to NHESP
3.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...
2.For coastal projects only, is any portion of the proposed project located below the mean high waterline or in a fish run?
a. 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 Island,
and the Cape & Islands:
Division of Marine Fisheries
Southeast Marine Fisheries Station
Attn: Environmental Reviewer
1213 Purchase street 3rd floor
New Bedford, MA 027406694
North Shore Hull to
New Hampshire:
Division of Marine
Fisheries
North Shore Office
Attn: Environmental
Reviewer
30 Emerson Avenue
Gloucester, MA 01930
If yes, it 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)?
a.Yes No If yes, provide name of ACEC (see instructions to WPA Form 3 or
DEP Website for ACEC locations). Note: electronic filers click on
Website.
b. ACEC Name
4.Is any portion of the proposed project within an area designated as an Outstanding Resource Water (ORW) as designated in the
Massachusetts Surface Water Quality Standards, 314 CMR 4.00?
a.Yes No
5.Is any portion of the site subject to a Wetlands Restriction Order under the Inland Wetlands 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?
1.Applying for Low Impact Development (LID) site design credits (as described in Stormwater Management Handbook
Vol.2, Chapter 3)
2.A portion of the site constitutes redevelopment
3.Proprietary BMPs are included in the Stormwater Management System
b.No, Explain why the project is exempt:
1.Single Family Home
2.Emergency Road Repair
3.Small Residential Subdivision (less than or equal to 4 singlefamily houses or less than or equal to 4 units in multifamily
housing project) with no discharge to Critical Areas.
D. Additional Information
Applicants must include the following with this Notice of Intent (NOI). 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 by regular mail delivery.
1.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.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.Identify the method for BVW and other resource area boundary delineations (MassDEP BVW Field Data Form(s).
Determination of Applicability, Order of Resource Area Delineation, etc.), and attach documentation of the methodology.
4.List the titles and dates for all plans and other materials submitted with this NOI.
a. Plan Title:b. Plan Prepared By:c. Plan Signed/Stamped By:c. Revised Final Date:e. Scale:
OLIVER GIS AERIAL
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.
8.Attach NOI Wetland Fee Transmittal Form.
9.Attach Stormwater Report, if needed.
E. Fees
1.
Fee Exempt: No filing 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 Transmittal Form) to confirm fee payment:
2. Municipal Check Number 3. Check date
4. State Check Number 5. Check date
6. Payer name on check: First Name 7. Payer name on check: Last Name
F. Signatures and Submittal Requirements
I hereby certify under the penalties of perjury that the foregoing Notice of Intent 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 a local 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 writing by hand delivery or certified mail (return receipt requested) to all abutters within 100 feet
of the property line of the project location.
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 Section C, Items 13, 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.
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 #:
eDEP Transaction #:986585
City/Town:NORTHAMPTON
Page 4 of 7 * ELECTRONIC COPY
a.Yes, Attach a copy of the Stormwater Report as required by the Stormwater Management Standards per 310 CMR
10.05(6)(k)(q) and check if:
A.General Information1. Project Location:a. Street Address 142 RIVERBANK ROADb. City/Town NORTHAMPTON c. Zip Code 01060d. Latitude 42.33250N e. Longitude 72.61468Wf. Map/Plat #25 g.Parcel/Lot #0070012. Applicant:Individual Organizationa. First Name HELEN b.Last Name HAYWARDc. Organizationd. Mailing Address 71 FORT MEADOW DRIVEe. City/Town HUDSON f. State MA g. Zip Code 01749h. Phone Number i. Fax j. Email Helenhayward71@hotmail.com3.Property Owner:more than one ownera. First Name HELEN b. Last Name HAYWARDc. Organizationd. Mailing Address 71 FORT MEADOW DRIVEe. City/Town HUDSON f.State MA g. Zip Code 01749h. Phone Number i. Fax j.Email Helenhayward71@hotmail.com4.Representative:a. First Name ALAN b. Last Name WEISSc. Organization COLD SPRING ENVIRONMENTAL CONSULTANTS INC.d. Mailing Address 350 OLD ENFIELD ROADe. City/Town BELCHERTOWN f. State MA g. Zip Code 01007h.Phone Number 4133235957 i.Fax 4133234916 j.Email aweiss@coldspringenvironmental.com5.Total WPA Fee Paid (Automatically inserted from NOI Wetland Fee Transmittal Form):a.Total Fee Paid 165.00 b.State Fee Paid 70.00 c.City/Town Fee Paid 95.006.General Project Description:EXISTING DWELLING RENOVATION (BUILT, 1930 RENOVATED TO SELL INCLUDING EXTERIOR PAINTING OFSIDING, PORCH REPAIRS AND NEW WINDOWS), DECK REPLACEMENT AND SEPTIC TANK ONLYREPLACEMENT AS PART OF A TITLE 5 INSPECTION IN EXISTING GRASS YARD.7a.Project Type:1. Single Family Home 2. Residential Subdivision3.Limited Project Driveway Crossing 4.Commercial/Industrial5.Dock/Pier 6.Utilities7.Coastal Engineering Structure 8.Agriculture (eg., cranberries, forestry)9.Transportation 10.Other7b.Is any portion of the proposed activity eligible to be treated as a limited project subject to 310 CMR 10.24 (coastal) or 310CMR 10.53 (inland)?1.Yes No If yes, describe which limited project applies to this project:2. Limited Project8.Property recorded at the Registry of Deeds for:a.County:b.Certificate:c.Book:d.Page:HAMPSHIRE 4984 238B. Buffer Zone & Resource Area Impacts (temporary & permanent)1.Buffer Zone & Resource Area Impacts (temporary & permanent):This is a Buffer Zone only project 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)Resource Area Size of Proposed Alteration Proposed Replacement (if any)a.Bank 1. linear feet 2. linear feetb.Bordering Vegetated Wetland 1. square feet 2. square feetc.Land under Waterbodies and Waterways 1. Square feet 2. square feet3. cubic yards dredgedd.Bordering Land Subject to Flooding 1. square feet 2. square feet3. cubic feet of flood storage lost 4. cubic feet replacede.Isolated Land Subject to Flooding 1. square feet2. cubic feet of flood storage lost 3. cubic feet replacedf.Riverfront Area 1. Name of Waterway (if any)2. Width of Riverfront Area (check one)25 ft. Designated Densely Developed Areas only100 ft. New agricultural projects only200 ft. All other projects3. Total area of Riverfront Area on the site of the proposed project 2000square feet4. Proposed Alteration of the Riverfront Area:0a. total square feet 0b. square feet within 100 ft.0c. square feet between 100 ft.and 200 ft.5. Has an alternatives analysis been done and is it attached to this NOI?Yes No6. Was the lot where the activity is proposed created prior to August 1, 1996?Yes No3.Coastal Resource Areas: (See 310 CMR 10.25 10.35)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 feet2. cubic yards dredgedc.Barrier Beaches Indicate size under Coastal Beaches and/or Coatstal Dunes, belowd.Coastal Beaches 1. square feet 2. cubic yards beach nourishmente.Coastal Dunes 1. square feet 2. cubic yards dune nourishmentf.Coastal Banks 1. linear feetg.Rocky Intertidal Shores 1. square feeth.Salt Marshes 1. square feet 2. sq ft restoration, rehab, crea.i.Land Under Salt Ponds 1. square feet2. cubic yards dredgedj.Land Containing Shellfish 1. square feetk.Fish Runs Indicate size under Coastal Banks, Inland Bank, Land Under the Ocean, and/or inland LandUnder Waterbodies and Waterways, above1. cubic yards dredgedl.Land Subject to CoastalStorm Flowage 1. square feet4.Restoration/Enhancement Restoration/ReplacementIf the project is for the purpose of restoring or enhancing a wetland resource area in addition to the square footage that has beenentered in Section B.2.b or B.3.h above, please entered the additional amount here.a. square feet of BVW b. square feet of Salt Marsh5.Projects Involves Stream Crossings Project Involves Streams CrossingsIf the project involves Stream Crossings, please enter the number of new stream crossings/number of replacement stream crossings.a. number of new stream crossings b. number of replacement stream crossingsC. Other Applicable Standards and RequirementsStreamlined Massachusetts Endangered Species Act/Wetlands Protection Act Review1.Is any portion of the proposed project located in Estimated Habitat of Rare Wildlife as indicated on the most recentEstimated Habitat Map of StateListed Rare Wetland Wildlife published by the Natural Heritage of Endangered Species program(NHESP)?a.Yes NoIf yes, include proof of mailing or hand delivery ofNOI to:Natural Heritage and Endangered SpeciesProgramDivision of Fisheries and Wildlife1 Rabbit Hill RoadWestborough, MA 01581b. Date of map:FROM MAP VIEWERIf yes, the project is also subject to Massachusetts Endangered Species Act (MESA) review (321 CMR 10.18)....c. Submit Supplemental Information for Endangered Species Review * (Check boxes as they apply)1. Percentage/acreage of property to be altered:(a) within Wetland Resource Area percentage/acreage(b) outside Resource Area percentage/acreage2. Assessor's Map or rightofway plan of site3. Project plans for entire project site, including wetland resource areas and areas outside of wetland jurisdiction, showingexisting and proposed conditions, existing and proposed tree/vegetation clearing line, and clearly demarcated limits of work **a.Project description (including description of impacts outside of wetland resource area & buffer zone)b. Photographs representative of the sitec. MESA filing fee (fee information available at: http://www.mass.gov/eea/agencies/dfg/dfw/naturalheritage/regulatoryreview/massendangeredspeciesactmesa/mesafeeschedule.html )
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.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://www.mass.gov/eea/agencies/dfg/dfw/lawsregulations/cmr/321cmr1000massachusettsendangered
speciesact.html#10.14; the NOI must still be sent to NHESP if the project is within estimated habitat pursuant to 310 CMR
10.37 and 10.59.)
2. Separate MESA review ongoing.
a. NHESP Tracking Number
b. Date submitted to NHESP
3.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...
2.For coastal projects only, is any portion of the proposed project located below the mean high waterline or in a fish run?
a. 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 Island,
and the Cape & Islands:
Division of Marine Fisheries
Southeast Marine Fisheries Station
Attn: Environmental Reviewer
1213 Purchase street 3rd floor
New Bedford, MA 027406694
North Shore Hull to
New Hampshire:
Division of Marine
Fisheries
North Shore Office
Attn: Environmental
Reviewer
30 Emerson Avenue
Gloucester, MA 01930
If yes, it 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)?
a.Yes No If yes, provide name of ACEC (see instructions to WPA Form 3 or
DEP Website for ACEC locations). Note: electronic filers click on
Website.
b. ACEC Name
4.Is any portion of the proposed project within an area designated as an Outstanding Resource Water (ORW) as designated in the
Massachusetts Surface Water Quality Standards, 314 CMR 4.00?
a.Yes No
5.Is any portion of the site subject to a Wetlands Restriction Order under the Inland Wetlands 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?
1.Applying for Low Impact Development (LID) site design credits (as described in Stormwater Management Handbook
Vol.2, Chapter 3)
2.A portion of the site constitutes redevelopment
3.Proprietary BMPs are included in the Stormwater Management System
b.No, Explain why the project is exempt:
1.Single Family Home
2.Emergency Road Repair
3.Small Residential Subdivision (less than or equal to 4 singlefamily houses or less than or equal to 4 units in multifamily
housing project) with no discharge to Critical Areas.
D. Additional Information
Applicants must include the following with this Notice of Intent (NOI). 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 by regular mail delivery.
1.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.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.Identify the method for BVW and other resource area boundary delineations (MassDEP BVW Field Data Form(s).
Determination of Applicability, Order of Resource Area Delineation, etc.), and attach documentation of the methodology.
4.List the titles and dates for all plans and other materials submitted with this NOI.
a. Plan Title:b. Plan Prepared By:c. Plan Signed/Stamped By:c. Revised Final Date:e. Scale:
OLIVER GIS AERIAL
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.
8.Attach NOI Wetland Fee Transmittal Form.
9.Attach Stormwater Report, if needed.
E. Fees
1.
Fee Exempt: No filing 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 Transmittal Form) to confirm fee payment:
2. Municipal Check Number 3. Check date
4. State Check Number 5. Check date
6. Payer name on check: First Name 7. Payer name on check: Last Name
F. Signatures and Submittal Requirements
I hereby certify under the penalties of perjury that the foregoing Notice of Intent 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 a local 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 writing by hand delivery or certified mail (return receipt requested) to all abutters within 100 feet
of the property line of the project location.
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 Section C, Items 13, 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.
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 #:
eDEP Transaction #:986585
City/Town:NORTHAMPTON
Page 5 of 7 * ELECTRONIC COPY
a.Yes, Attach a copy of the Stormwater Report as required by the Stormwater Management Standards per 310 CMR
10.05(6)(k)(q) and check if:
A.General Information1. Project Location:a. Street Address 142 RIVERBANK ROADb. City/Town NORTHAMPTON c. Zip Code 01060d. Latitude 42.33250N e. Longitude 72.61468Wf. Map/Plat #25 g.Parcel/Lot #0070012. Applicant:Individual Organizationa. First Name HELEN b.Last Name HAYWARDc. Organizationd. Mailing Address 71 FORT MEADOW DRIVEe. City/Town HUDSON f. State MA g. Zip Code 01749h. Phone Number i. Fax j. Email Helenhayward71@hotmail.com3.Property Owner:more than one ownera. First Name HELEN b. Last Name HAYWARDc. Organizationd. Mailing Address 71 FORT MEADOW DRIVEe. City/Town HUDSON f.State MA g. Zip Code 01749h. Phone Number i. Fax j.Email Helenhayward71@hotmail.com4.Representative:a. First Name ALAN b. Last Name WEISSc. Organization COLD SPRING ENVIRONMENTAL CONSULTANTS INC.d. Mailing Address 350 OLD ENFIELD ROADe. City/Town BELCHERTOWN f. State MA g. Zip Code 01007h.Phone Number 4133235957 i.Fax 4133234916 j.Email aweiss@coldspringenvironmental.com5.Total WPA Fee Paid (Automatically inserted from NOI Wetland Fee Transmittal Form):a.Total Fee Paid 165.00 b.State Fee Paid 70.00 c.City/Town Fee Paid 95.006.General Project Description:EXISTING DWELLING RENOVATION (BUILT, 1930 RENOVATED TO SELL INCLUDING EXTERIOR PAINTING OFSIDING, PORCH REPAIRS AND NEW WINDOWS), DECK REPLACEMENT AND SEPTIC TANK ONLYREPLACEMENT AS PART OF A TITLE 5 INSPECTION IN EXISTING GRASS YARD.7a.Project Type:1. Single Family Home 2. Residential Subdivision3.Limited Project Driveway Crossing 4.Commercial/Industrial5.Dock/Pier 6.Utilities7.Coastal Engineering Structure 8.Agriculture (eg., cranberries, forestry)9.Transportation 10.Other7b.Is any portion of the proposed activity eligible to be treated as a limited project subject to 310 CMR 10.24 (coastal) or 310CMR 10.53 (inland)?1.Yes No If yes, describe which limited project applies to this project:2. Limited Project8.Property recorded at the Registry of Deeds for:a.County:b.Certificate:c.Book:d.Page:HAMPSHIRE 4984 238B. Buffer Zone & Resource Area Impacts (temporary & permanent)1.Buffer Zone & Resource Area Impacts (temporary & permanent):This is a Buffer Zone only project 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)Resource Area Size of Proposed Alteration Proposed Replacement (if any)a.Bank 1. linear feet 2. linear feetb.Bordering Vegetated Wetland 1. square feet 2. square feetc.Land under Waterbodies and Waterways 1. Square feet 2. square feet3. cubic yards dredgedd.Bordering Land Subject to Flooding 1. square feet 2. square feet3. cubic feet of flood storage lost 4. cubic feet replacede.Isolated Land Subject to Flooding 1. square feet2. cubic feet of flood storage lost 3. cubic feet replacedf.Riverfront Area 1. Name of Waterway (if any)2. Width of Riverfront Area (check one)25 ft. Designated Densely Developed Areas only100 ft. New agricultural projects only200 ft. All other projects3. Total area of Riverfront Area on the site of the proposed project 2000square feet4. Proposed Alteration of the Riverfront Area:0a. total square feet 0b. square feet within 100 ft.0c. square feet between 100 ft.and 200 ft.5. Has an alternatives analysis been done and is it attached to this NOI?Yes No6. Was the lot where the activity is proposed created prior to August 1, 1996?Yes No3.Coastal Resource Areas: (See 310 CMR 10.25 10.35)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 feet2. cubic yards dredgedc.Barrier Beaches Indicate size under Coastal Beaches and/or Coatstal Dunes, belowd.Coastal Beaches 1. square feet 2. cubic yards beach nourishmente.Coastal Dunes 1. square feet 2. cubic yards dune nourishmentf.Coastal Banks 1. linear feetg.Rocky Intertidal Shores 1. square feeth.Salt Marshes 1. square feet 2. sq ft restoration, rehab, crea.i.Land Under Salt Ponds 1. square feet2. cubic yards dredgedj.Land Containing Shellfish 1. square feetk.Fish Runs Indicate size under Coastal Banks, Inland Bank, Land Under the Ocean, and/or inland LandUnder Waterbodies and Waterways, above1. cubic yards dredgedl.Land Subject to CoastalStorm Flowage 1. square feet4.Restoration/Enhancement Restoration/ReplacementIf the project is for the purpose of restoring or enhancing a wetland resource area in addition to the square footage that has beenentered in Section B.2.b or B.3.h above, please entered the additional amount here.a. square feet of BVW b. square feet of Salt Marsh5.Projects Involves Stream Crossings Project Involves Streams CrossingsIf the project involves Stream Crossings, please enter the number of new stream crossings/number of replacement stream crossings.a. number of new stream crossings b. number of replacement stream crossingsC. Other Applicable Standards and RequirementsStreamlined Massachusetts Endangered Species Act/Wetlands Protection Act Review1.Is any portion of the proposed project located in Estimated Habitat of Rare Wildlife as indicated on the most recentEstimated Habitat Map of StateListed Rare Wetland Wildlife published by the Natural Heritage of Endangered Species program(NHESP)?a.Yes NoIf yes, include proof of mailing or hand delivery ofNOI to:Natural Heritage and Endangered SpeciesProgramDivision of Fisheries and Wildlife1 Rabbit Hill RoadWestborough, MA 01581b. Date of map:FROM MAP VIEWERIf yes, the project is also subject to Massachusetts Endangered Species Act (MESA) review (321 CMR 10.18)....c. Submit Supplemental Information for Endangered Species Review * (Check boxes as they apply)1. Percentage/acreage of property to be altered:(a) within Wetland Resource Area percentage/acreage(b) outside Resource Area percentage/acreage2. Assessor's Map or rightofway plan of site3. Project plans for entire project site, including wetland resource areas and areas outside of wetland jurisdiction, showingexisting and proposed conditions, existing and proposed tree/vegetation clearing line, and clearly demarcated limits of work **a.Project description (including description of impacts outside of wetland resource area & buffer zone)b. Photographs representative of the sitec. MESA filing fee (fee information available at: http://www.mass.gov/eea/agencies/dfg/dfw/naturalheritage/regulatoryreview/massendangeredspeciesactmesa/mesafeeschedule.html )Make check payable to "Natural Heritage & Endangered Species Fund" and mail to NHESP at above addressProjects altering 10 or more acres of land, also submit:d.Vegetation cover type map of sitee.Project plans showing Priority & Estimated Habitat boundariesd. OR Check One of the following1. Project is exempt from MESA review. Attach applicant letter indicating which MESA exemption applies. (See 321CMR 10.14, http://www.mass.gov/eea/agencies/dfg/dfw/lawsregulations/cmr/321cmr1000massachusettsendangeredspeciesact.html#10.14; the NOI must still be sent to NHESP if the project is within estimated habitat pursuant to 310 CMR10.37 and 10.59.)2. Separate MESA review ongoing.a. NHESP Tracking Numberb. Date submitted to NHESP3.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...2.For coastal projects only, is any portion of the proposed project located below the mean high waterline or in a fish run?a. Not applicable project is in inland resource area onlyb.Yes No If yes, include proof of mailing or hand delivery of NOI to either:South Shore Cohasset to Rhode Island,and the Cape & Islands:Division of Marine Fisheries Southeast Marine Fisheries StationAttn: Environmental Reviewer1213 Purchase street 3rd floorNew Bedford, MA 027406694 North Shore Hull toNew Hampshire:Division of MarineFisheries North Shore OfficeAttn: EnvironmentalReviewer30 Emerson AvenueGloucester, MA 01930If yes, it 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)?a.Yes No If yes, provide name of ACEC (see instructions to WPA Form 3 orDEP Website for ACEC locations). Note: electronic filers click onWebsite.b. ACEC Name4.Is any portion of the proposed project within an area designated as an Outstanding Resource Water (ORW) as designated in theMassachusetts Surface Water Quality Standards, 314 CMR 4.00?a.Yes No5.Is any portion of the site subject to a Wetlands Restriction Order under the Inland Wetlands 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?
1.Applying for Low Impact Development (LID) site design credits (as described in Stormwater Management Handbook
Vol.2, Chapter 3)
2.A portion of the site constitutes redevelopment
3.Proprietary BMPs are included in the Stormwater Management System
b.No, Explain why the project is exempt:
1.Single Family Home
2.Emergency Road Repair
3.Small Residential Subdivision (less than or equal to 4 singlefamily houses or less than or equal to 4 units in multifamily
housing project) with no discharge to Critical Areas.
D. Additional Information
Applicants must include the following with this Notice of Intent (NOI). 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 by regular mail delivery.
1.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.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.Identify the method for BVW and other resource area boundary delineations (MassDEP BVW Field Data Form(s).
Determination of Applicability, Order of Resource Area Delineation, etc.), and attach documentation of the methodology.
4.List the titles and dates for all plans and other materials submitted with this NOI.
a. Plan Title:b. Plan Prepared By:c. Plan Signed/Stamped By:c. Revised Final Date:e. Scale:
OLIVER GIS AERIAL
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.
8.Attach NOI Wetland Fee Transmittal Form.
9.Attach Stormwater Report, if needed.
E. Fees
1.
Fee Exempt: No filing 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 Transmittal Form) to confirm fee payment:
2. Municipal Check Number 3. Check date
4. State Check Number 5. Check date
6. Payer name on check: First Name 7. Payer name on check: Last Name
F. Signatures and Submittal Requirements
I hereby certify under the penalties of perjury that the foregoing Notice of Intent 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 a local 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 writing by hand delivery or certified mail (return receipt requested) to all abutters within 100 feet
of the property line of the project location.
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 Section C, Items 13, 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.
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 #:
eDEP Transaction #:986585
City/Town:NORTHAMPTON
Page 6 of 7 * ELECTRONIC COPY
a.Yes, Attach a copy of the Stormwater Report as required by the Stormwater Management Standards per 310 CMR10.05(6)(k)(q) and check if:A.General Information1. Project Location:a. Street Address 142 RIVERBANK ROADb. City/Town NORTHAMPTON c. Zip Code 01060d. Latitude 42.33250N e. Longitude 72.61468Wf. Map/Plat #25 g.Parcel/Lot #0070012. Applicant:Individual Organizationa. First Name HELEN b.Last Name HAYWARDc. Organizationd. Mailing Address 71 FORT MEADOW DRIVEe. City/Town HUDSON f. State MA g. Zip Code 01749h. Phone Number i. Fax j. Email Helenhayward71@hotmail.com3.Property Owner:more than one ownera. First Name HELEN b. Last Name HAYWARDc. Organizationd. Mailing Address 71 FORT MEADOW DRIVEe. City/Town HUDSON f.State MA g. Zip Code 01749h. Phone Number i. Fax j.Email Helenhayward71@hotmail.com4.Representative:a. First Name ALAN b. Last Name WEISSc. Organization COLD SPRING ENVIRONMENTAL CONSULTANTS INC.d. Mailing Address 350 OLD ENFIELD ROADe. City/Town BELCHERTOWN f. State MA g. Zip Code 01007h.Phone Number 4133235957 i.Fax 4133234916 j.Email aweiss@coldspringenvironmental.com5.Total WPA Fee Paid (Automatically inserted from NOI Wetland Fee Transmittal Form):a.Total Fee Paid 165.00 b.State Fee Paid 70.00 c.City/Town Fee Paid 95.006.General Project Description:EXISTING DWELLING RENOVATION (BUILT, 1930 RENOVATED TO SELL INCLUDING EXTERIOR PAINTING OFSIDING, PORCH REPAIRS AND NEW WINDOWS), DECK REPLACEMENT AND SEPTIC TANK ONLYREPLACEMENT AS PART OF A TITLE 5 INSPECTION IN EXISTING GRASS YARD.7a.Project Type:1. Single Family Home 2. Residential Subdivision3.Limited Project Driveway Crossing 4.Commercial/Industrial5.Dock/Pier 6.Utilities7.Coastal Engineering Structure 8.Agriculture (eg., cranberries, forestry)9.Transportation 10.Other7b.Is any portion of the proposed activity eligible to be treated as a limited project subject to 310 CMR 10.24 (coastal) or 310CMR 10.53 (inland)?1.Yes No If yes, describe which limited project applies to this project:2. Limited Project8.Property recorded at the Registry of Deeds for:a.County:b.Certificate:c.Book:d.Page:HAMPSHIRE 4984 238B. Buffer Zone & Resource Area Impacts (temporary & permanent)1.Buffer Zone & Resource Area Impacts (temporary & permanent):This is a Buffer Zone only project 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)Resource Area Size of Proposed Alteration Proposed Replacement (if any)a.Bank 1. linear feet 2. linear feetb.Bordering Vegetated Wetland 1. square feet 2. square feetc.Land under Waterbodies and Waterways 1. Square feet 2. square feet3. cubic yards dredgedd.Bordering Land Subject to Flooding 1. square feet 2. square feet3. cubic feet of flood storage lost 4. cubic feet replacede.Isolated Land Subject to Flooding 1. square feet2. cubic feet of flood storage lost 3. cubic feet replacedf.Riverfront Area 1. Name of Waterway (if any)2. Width of Riverfront Area (check one)25 ft. Designated Densely Developed Areas only100 ft. New agricultural projects only200 ft. All other projects3. Total area of Riverfront Area on the site of the proposed project 2000square feet4. Proposed Alteration of the Riverfront Area:0a. total square feet 0b. square feet within 100 ft.0c. square feet between 100 ft.and 200 ft.5. Has an alternatives analysis been done and is it attached to this NOI?Yes No6. Was the lot where the activity is proposed created prior to August 1, 1996?Yes No3.Coastal Resource Areas: (See 310 CMR 10.25 10.35)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 feet2. cubic yards dredgedc.Barrier Beaches Indicate size under Coastal Beaches and/or Coatstal Dunes, belowd.Coastal Beaches 1. square feet 2. cubic yards beach nourishmente.Coastal Dunes 1. square feet 2. cubic yards dune nourishmentf.Coastal Banks 1. linear feetg.Rocky Intertidal Shores 1. square feeth.Salt Marshes 1. square feet 2. sq ft restoration, rehab, crea.i.Land Under Salt Ponds 1. square feet2. cubic yards dredgedj.Land Containing Shellfish 1. square feetk.Fish Runs Indicate size under Coastal Banks, Inland Bank, Land Under the Ocean, and/or inland LandUnder Waterbodies and Waterways, above1. cubic yards dredgedl.Land Subject to CoastalStorm Flowage 1. square feet4.Restoration/Enhancement Restoration/ReplacementIf the project is for the purpose of restoring or enhancing a wetland resource area in addition to the square footage that has beenentered in Section B.2.b or B.3.h above, please entered the additional amount here.a. square feet of BVW b. square feet of Salt Marsh5.Projects Involves Stream Crossings Project Involves Streams CrossingsIf the project involves Stream Crossings, please enter the number of new stream crossings/number of replacement stream crossings.a. number of new stream crossings b. number of replacement stream crossingsC. Other Applicable Standards and RequirementsStreamlined Massachusetts Endangered Species Act/Wetlands Protection Act Review1.Is any portion of the proposed project located in Estimated Habitat of Rare Wildlife as indicated on the most recentEstimated Habitat Map of StateListed Rare Wetland Wildlife published by the Natural Heritage of Endangered Species program(NHESP)?a.Yes NoIf yes, include proof of mailing or hand delivery ofNOI to:Natural Heritage and Endangered SpeciesProgramDivision of Fisheries and Wildlife1 Rabbit Hill RoadWestborough, MA 01581b. Date of map:FROM MAP VIEWERIf yes, the project is also subject to Massachusetts Endangered Species Act (MESA) review (321 CMR 10.18)....c. Submit Supplemental Information for Endangered Species Review * (Check boxes as they apply)1. Percentage/acreage of property to be altered:(a) within Wetland Resource Area percentage/acreage(b) outside Resource Area percentage/acreage2. Assessor's Map or rightofway plan of site3. Project plans for entire project site, including wetland resource areas and areas outside of wetland jurisdiction, showingexisting and proposed conditions, existing and proposed tree/vegetation clearing line, and clearly demarcated limits of work **a.Project description (including description of impacts outside of wetland resource area & buffer zone)b. Photographs representative of the sitec. MESA filing fee (fee information available at: http://www.mass.gov/eea/agencies/dfg/dfw/naturalheritage/regulatoryreview/massendangeredspeciesactmesa/mesafeeschedule.html )Make check payable to "Natural Heritage & Endangered Species Fund" and mail to NHESP at above addressProjects altering 10 or more acres of land, also submit:d.Vegetation cover type map of sitee.Project plans showing Priority & Estimated Habitat boundariesd. OR Check One of the following1. Project is exempt from MESA review. Attach applicant letter indicating which MESA exemption applies. (See 321CMR 10.14, http://www.mass.gov/eea/agencies/dfg/dfw/lawsregulations/cmr/321cmr1000massachusettsendangeredspeciesact.html#10.14; the NOI must still be sent to NHESP if the project is within estimated habitat pursuant to 310 CMR10.37 and 10.59.)2. Separate MESA review ongoing.a. NHESP Tracking Numberb. Date submitted to NHESP3.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...2.For coastal projects only, is any portion of the proposed project located below the mean high waterline or in a fish run?a. Not applicable project is in inland resource area onlyb.Yes No If yes, include proof of mailing or hand delivery of NOI to either:South Shore Cohasset to Rhode Island,and the Cape & Islands:Division of Marine Fisheries Southeast Marine Fisheries StationAttn: Environmental Reviewer1213 Purchase street 3rd floorNew Bedford, MA 027406694 North Shore Hull toNew Hampshire:Division of MarineFisheries North Shore OfficeAttn: EnvironmentalReviewer30 Emerson AvenueGloucester, MA 01930If yes, it 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)?a.Yes No If yes, provide name of ACEC (see instructions to WPA Form 3 orDEP Website for ACEC locations). Note: electronic filers click onWebsite.b. ACEC Name4.Is any portion of the proposed project within an area designated as an Outstanding Resource Water (ORW) as designated in theMassachusetts Surface Water Quality Standards, 314 CMR 4.00?a.Yes No5.Is any portion of the site subject to a Wetlands Restriction Order under the Inland Wetlands Restriction Act (M.G.L.c. 131, §40A) or the Coastal Wetlands Restriction Act (M.G.L.c. 130, § 105)?a.Yes No6.Is this project subject to provisions of the MassDEP Stormwater Management Standards?1.Applying for Low Impact Development (LID) site design credits (as described in Stormwater Management HandbookVol.2, Chapter 3)2.A portion of the site constitutes redevelopment3.Proprietary BMPs are included in the Stormwater Management Systemb.No, Explain why the project is exempt:1.Single Family Home2.Emergency Road Repair3.Small Residential Subdivision (less than or equal to 4 singlefamily houses or less than or equal to 4 units in multifamilyhousing project) with no discharge to Critical Areas.D. Additional InformationApplicants must include the following with this Notice of Intent (NOI). See instructions for details.Online Users: Attach the document transaction number (provided on your receipt page) for any of the following information yousubmit to the Department by regular mail delivery.1.USGS or other map of the area (along with a narrative description, if necessary) containing sufficient information for theConservation Commission and the Department to locate the site. (Electronic filers may omit this item.)2.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.Identify the method for BVW and other resource area boundary delineations (MassDEP BVW Field Data Form(s).Determination of Applicability, Order of Resource Area Delineation, etc.), and attach documentation of the methodology.4.List the titles and dates for all plans and other materials submitted with this NOI.a. Plan Title:b. Plan Prepared By:c. Plan Signed/Stamped By:c. Revised Final Date:e. Scale:
OLIVER GIS AERIAL
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.
8.Attach NOI Wetland Fee Transmittal Form.
9.Attach Stormwater Report, if needed.
E. Fees
1.
Fee Exempt: No filing 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 Transmittal Form) to confirm fee payment:
2. Municipal Check Number 3. Check date
4. State Check Number 5. Check date
6. Payer name on check: First Name 7. Payer name on check: Last Name
F. Signatures and Submittal Requirements
I hereby certify under the penalties of perjury that the foregoing Notice of Intent 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 a local 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 writing by hand delivery or certified mail (return receipt requested) to all abutters within 100 feet
of the property line of the project location.
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 Section C, Items 13, 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.
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 #:
eDEP Transaction #:986585
City/Town:NORTHAMPTON
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