Massachusetts Department of Environmental Protection

<= !--[if gte mso 9]>	Massachusetts Department of Environmental Protection= Bureau of Resource Protection - Wetlands WPA Form 4 – Abbreviated Notice of Intent Massachusetts Wet= lands Protection Act M.G.L. c. 131, §40	DEP File Number: &nbs= p; &nbs= p; Note: Before completing this form, consult your local Conservation Commission regarding any municipal bylaw or ordinance.	1. Applicant:
= ^Name	= ^{E-Mail Address ⁼}
= ^{Street Address}
^City/Town	<= span style=3D'mso-bookmark:Text65'> ^{State <= o:p>}	<= span style=3D'mso-bookmark:Text66'> ^{Zip Code}
= ^{Phone Number}	= ^{Fax Number (if applicable)}
2. Representative (if any):
^Firm
^{Contact Name}	^{E-Mail Address ⁼}
^{Mailing Address}
^{City/Town =}	^State	&n= bsp; <= /span> ^{Zip Code}
&n= bsp; ^{Phone Number}	^{Fax Number (if applicable)}^<= o:p>
3. Property Owner (if different from applicant):
&n= bsp; ^Name
	&n= bsp; ^{Mailing Address}
	&nb= sp; = ^City/Town	&n= bsp; ^State	^{Zip Code}
	4. Total Fee:
	&n= bsp; ^{(from Appendix B: Wetland Fee Transmittal Form)<= /o:p>}
	5. Project Location:
	= ^{Street Address &= nbsp;}	^City/Town
	^{Assessors Map/Plat Number = ;}	^{Parcel /Lot Number}
	6. General Project Description:
	^&nb= sp;


	A. &nb= sp; General Information (cont.)
	7. Registry of Deeds:
	^{County &nb= sp;}	^Book	^Page
	^{Certificate (if Registered Land) &nbs= p; =}

	B. Site and Activities Subject to Regulation
	Complete any of the followi= ng sections that apply to the proposed work and project site.
	1. Com= plete for proposed activities located, in whole or in part, in Buffer Zone.
	&= nbsp; a. Check all the following borders to the Buffer Zone:
	Inland Resou= rce Areas	Coastal Resource Areas
	<= span style=3D'mso-bookmark:Check24'>= &nb= sp; Inland Bank	<= span style=3D'mso-bookmark:Check25'>= &nb= sp; Coastal Beach = = = Barrier Beach
	<= span style=3D'mso-bookmark:Check26'>= &nb= sp; Bordering Vegetated Wetland (BVW)	<= span style=3D'mso-bookmark:Check27'>= &nb= sp; Rocky Intertidal Shore = &nb= sp; Coastal Dune
		<= span style=3D'mso-bookmark:Check28'>= &nb= sp; Salt Marsh = &nb= sp; = &nb= sp; Coastal Bank

	b. Check all the methods used to delineate the Border= ing Vegetated Wetland boundary: <= span style=3D'mso-bookmark:Check82'>= = Final Order of Resource Area Delineation issued by Conservation Commission or D= EP (attached) &n= bsp; DEP BVW Field Data Form (attached= ) &n= bsp; <= span style=3D'mso-bookmark:Check81'>= &nb= sp; Final Determination of Applicability issued by Conservation Commission (attache= d) &n= bsp; = Other Method of Determining BVW boundary (attach documentation): &n= bsp; &n= bsp; = 50% or more wetland indicator plants &n= bsp; Saturated/inundated conditions ex= ist &n= bsp; Groundwater indicators Direct observation &nbs= p; &n= bsp; Hydric soil indicators &n= bsp; Credible evidence of conditions p= rior to disturbance.











	B. Site and Activ= ities Subject to Regulation (cont.)
	c. Describe, with reference to supporting plans and calculations where necessary, the size, type, and location of the proposed work and mitigating measures and designs to insure that the proposed work will not alter the resource area and Buffer Zone borders. Attach addition= al sheets, if necessary.

	&n= bsp; = ^&nb= sp;



	2. Complete for proposed activities located, in whole or in part, in Land Subject to Flooding.
	= ; a. Resource area description:
	Bordering Land Subject to Flooding:	Isolated Land Subject to Flooding:
	= ^{Volume of Flood Storage Lost (cubic feet)<= /span>} &n= bsp;	= ^{Volume of Flood Storage Lost (cubic feet)<= /span>} &n= bsp;
	&n= bsp; = ^{Volume of Flood Storage Compensation (cubic feet)}	&n= bsp; = ^{Volume of Flood Storage Compensation (cubic feet)}

	b. Describe, wi= th reference to supporting plans and calculations where necessary the size, shape, location, and type of work, mitigating measures, and designs proposed to meet the performance standards set forth in 310 CMR 10.57(4) and 10.60. Attach additional sheets, if necessary.

	= ^&nb= sp; ^&nb= sp;




	3. Com= plete for proposed activities located, in whole or in part, in the Riverfront A= rea.
	&n= bsp; a. Name of Waterway (if availa= ble):
	&n= bsp; = &n= bsp;
	&n= bsp; b. Width of Riverfront Area (c= heck one):
	&n= bsp; <= span style=3D'mso-bookmark:Check32'>= 25 ft. - Designated Densely Devel= oped Areas only &n= bsp; <= span style=3D'mso-bookmark:Check33'>= 100 ft. - New agricultural projec= ts only &n= bsp; <= span style=3D'mso-bookmark:Check34'>= 200 ft. - All other projects


	B. &nb= sp; Site and Activities Subject to Regulation (= cont.)
	c. Desc= ribe how the Mean Annual High-Water Line was determined:
	&n= bsp; = ^&nb= sp;


	d. Distance of proposed activity closest to the Mean Annual High-Water Line:
	= ; ^Feet<= /span>⁼
	e. Total area of Riverfront Ar= ea on the site of the proposed project:
	^{Square Feet &nbs= p;}
	f. Proposed alteration o= f the Riverfront Area: