wpaform1_RDA

Conservation Commission RDA form for submission

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- Step 1 of 4

Applicant *

Person or entity who's property is affected

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone

Representative

Company or consultant if any.

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

B. Determinations I request the Otis Conservation Commission make the following determination(s). Check all that apply

a. Whether the area depicted on plans and or maps referenced below is an area subject to jurisdiction of the Wetlands Protection Act.
b. Whether the boundaries of resource areas depicted on plans and or maps referenced below are accurately delineated
c. Whether the work depicted on plans referenced below is subject to the Wetlands Protection Act.
d. Whether the area and or work depicted on plans referenced below is subject to the jurisdiction of any wetlands ordinance or bylaw of the Town of Otis.
e. Whether the following scope of alternatives is adequate for work in the Riverfront Area as depicted on referenced plans

a. Project Location (use maps and plans to identify the location of the area subject to this request):

Street Address

City/Town

Assessor Map ID

b. Area Description.

Use the upload boxes at the end of this application to provide additional data and documents.

Title / Date

use or provide additional documents as needed.

Work description

Identify provisions of the Wetlands Protection Act or regulations which may exempt the applicant from having to file a Notice of Intent for all or part of the described work. (Provide additional documents as needed.)

Project Description

If this application is a request for Determination of Scope of Alternatives for work in the Riverfront Area, indicate the one classification below that best describes the project.

Multiple Choice

Single family house on a lot recorded on or before 8/1/96
Single family house on a lot recorded after 8/1/96
Expansion of an existing structure on a lot recorded after 8/1/96
Project other than a single family house or public project, where the applicant owned the lot before 8/7/96
New agriculture or aquaculture project
Public project where funds were appropriated prior to 8/7/96
Project on a lot shown on an approved, definitive subdivision plan where there is a recorded red restriction limiting total alteration of the Riverfront Area for the entire subdivision
Residential subdivision; institutional, industrial, or commercial project
Municipal project
District, county, state, or federal project
Project required to evaluate off-site alternatives in more that one municipality in an Environmental Impact Report under MEPA or in an alternatives analysis pursuant to an application for a 404 permit from the U.S. Army Corps of Engineers or 401 Water Quality Certification from the Department of Environmental Protection.

I herby certify under penalties of perjury that the foregoing Request for Determination of Applicability and accompanying plans, documents, and supporting data are true and complete to the best of my knowledge. O further certify that the property owner if different from the applicant, and the appropriate DEP Regional Office were sent a complete copy of this Request 9including all appropriate documentation) simultaneously with the submittal of this Request to the Conservation Commission. Failure by the applicant to send copies in a timely way may result in dismissal of the Request for Determination of Applicability.

Name and address of the property owner *

Address Line 1

Address Line 2

City

State

Zip Code

I also understand that notification of this Request will be placed in a local newspaper at my expense in accordance with Section 10.05(3)(b)(1) of the Wetlands Protection Act regulations.

Signature and date of Applicant *

Signature of Representative and date ( if any)

Use the area below to upload additional documents to accompany this application. please label each page with the name, location, email and contact phone number.

File Upload

Click or drag files to this area to upload. You can upload up to 3 files.

File Upload

Click or drag files to this area to upload. You can upload up to 3 files.

Email *

Please enable JavaScript in your browser to complete this form.

- Step 1 of 4

Applicant *

Person or entity who's property is affected

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone

Representative

Company or consultant if any.

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

B. Determinations I request the Otis Conservation Commission make the following determination(s). Check all that apply

a. Whether the area depicted on plans and or maps referenced below is an area subject to jurisdiction of the Wetlands Protection Act.
b. Whether the boundaries of resource areas depicted on plans and or maps referenced below are accurately delineated
c. Whether the work depicted on plans referenced below is subject to the Wetlands Protection Act.
d. Whether the area and or work depicted on plans referenced below is subject to the jurisdiction of any wetlands ordinance or bylaw of the Town of Otis.
e. Whether the following scope of alternatives is adequate for work in the Riverfront Area as depicted on referenced plans

a. Project Location (use maps and plans to identify the location of the area subject to this request):

Street Address

City/Town

Assessor Map ID

b. Area Description.

Use the upload boxes at the end of this application to provide additional data and documents.

Title / Date

use or provide additional documents as needed.

Work description

Project Description

If this application is a request for Determination of Scope of Alternatives for work in the Riverfront Area, indicate the one classification below that best describes the project.

Multiple Choice

Single family house on a lot recorded on or before 8/1/96
Single family house on a lot recorded after 8/1/96
Expansion of an existing structure on a lot recorded after 8/1/96
Project other than a single family house or public project, where the applicant owned the lot before 8/7/96
New agriculture or aquaculture project
Public project where funds were appropriated prior to 8/7/96
Project on a lot shown on an approved, definitive subdivision plan where there is a recorded red restriction limiting total alteration of the Riverfront Area for the entire subdivision
Residential subdivision; institutional, industrial, or commercial project
Municipal project
District, county, state, or federal project
Project required to evaluate off-site alternatives in more that one municipality in an Environmental Impact Report under MEPA or in an alternatives analysis pursuant to an application for a 404 permit from the U.S. Army Corps of Engineers or 401 Water Quality Certification from the Department of Environmental Protection.

Name and address of the property owner *

Address Line 1

Address Line 2

City

State

Zip Code

I also understand that notification of this Request will be placed in a local newspaper at my expense in accordance with Section 10.05(3)(b)(1) of the Wetlands Protection Act regulations.

Signature and date of Applicant *

Signature of Representative and date ( if any)

Use the area below to upload additional documents to accompany this application. please label each page with the name, location, email and contact phone number.

File Upload

Click or drag files to this area to upload. You can upload up to 3 files.

File Upload

Click or drag files to this area to upload. You can upload up to 3 files.

Email *