Massachusetts Department of Environmental Protection

	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, &se= ct;40	Provided by DEP= : &= nbsp; ^{DEP File Number=} &= nbsp; ^{Document Transaction Numbe= r}
<= span style=3D'mso-bookmark:Text340'> &nbs= p; ^City/Town
&= nbsp;	A. General Information
	1. Project Location (Note: electronic filers will click on button for GIS locator):
	^{a. Street Address&nbs= p;}	^{b. City/Town}	= ^{c. Zip Code}
	Latitude and Longitude, if Known:	^{d. Latitude}	= ^{e. Longitude}
	^{f. Assessors Map/Plat Number &nbs= p; =}	^{g. Parcel /}^Lot<= /st1:place>^Number
Important:= When filling out for= ms on the computer, use only the tab key to move your cursor - do not use the return key. Note: Before completing this form consult your local Conservation Commission regarding any municipal bylaw or ordinance.	2. Applicant:
= ^{a. First Name}	= ^{b. Last Name}	= ^{c. Company}
= ^{d. Mailing Address}
= ^{e. City/Town}	&n= bsp; <= span style=3D'mso-bookmark:Text65'> ^{f. State} &nb= sp;	<= span style=3D'mso-bookmark:Text66'> ^{g. Zip Code}
&n= bsp; ^{h. Phone Number}	= ^{i. Fax Number}	&n= bsp; = ^{j. Email address}
3. Property owner (if differen= t from applicant):	FORMCHECKBOX Check if more than o= ne owner
^{a. First Name}	^{b. Last Name}	^{c. Company}
	^{d. Mailing Address}
Note: Before completing this form consult your local Conservati= on Commission regarding any municipal bylaw or ordinance.	^{e. City/Town}	&n= bsp; &n= bsp; ^{f. State} &nb= sp;	^{g. Zip Code}
&nb= sp; ^{h. Phone Number}	^{i. Fax Number}	&n= bsp; &n= bsp; ^{j. Email address}
4. Representative (if any):
^{a. Firm}
= ^{b. Contact Person First Name}<= /p>	= ^{c. Contact Person Last Name}
	^{d. Mailing Address}
	^{e. City/Town &nb= sp;}	^{f. State}	&n= bsp; <= /span> ^{g. Zip Code}
	&n= bsp; ^{h. Phone Number}	^{i. Fax Number}	^{j. Email address}
<= span style=3D'mso-bookmark:Check124'> &nb= sp; = ^{a. Total Fee Paid<= o:p>}	&n= bsp; ^{b. State Fee Paid}	^{c. City/Town Fee Paid}
6. General Project Description:
	= ^<= /span> ^<= /span>

	A. &nb= sp; General Information (continued)
	7. Project Type Checklist:
a. = &nb= sp; Single Family Home
b. = &nb= sp; Residential Subdivision
c. = &nb= sp; Commercial/Industrial
e. = &nb= sp; Dock/Pier
f. Coastal Engineering Structure
h. Agriculture – cranberries, forestry
i. Transportation
j. Other
	8. Property recorded at the Registry of Deeds for:
	= ^{a. County}
	= ^{b. Book}
	= ^{c. Page Number}
	= ^{d. Certificate # (if registered land)}
	9. Buffer Zone Only
	Is the pr= oject located only in the Buffer Zone of a bordering vegetated wetland, inland bank, or coastal = bank, coastal beach, coastal dune, or salt marsh?
	&n= bsp; a. <= span style=3D'mso-bookmark:Check71'>= &nb= sp; Yes	&n= bsp; If yes, skip to Section C.
	b. <= span style=3D'mso-bookmark:Check72'>= &nb= sp; No	If no, check the resource areas to be affected by this project, directly below.





B. Resource Area Effects
1. Inland Resource Areas
Check all that apply below. Attach narrative and any supporting documentation describing how the project will meet all perform= ance standards for each of the resource areas altered, including standards req= uiring consideration of alternative project design or location.
	Online Users: Include your document trans= action number (provided on your receipt page) with all supplementary information= you submit to the Department.	Resource Area	Size of Proposed Alteration	Proposed Replacement (if any)
a. <= span style=3D'mso-bookmark:Check92'>= Bank	= ^{1. linear feet}	^{2. linear feet}
b. Bordering Veget= ated = ; Wetland	^{1. square feet}	^{2. square feet}
c. Land Under Waterbodi= es and Wat= erways	^{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 of flood storage replaced}
e. Isolated Land S= ubject = ; to Flooding	^{1. square feet}
	^{2. cubic feet of flood storage lost=}	^{3. cubic feet of flood storage replaced}
	f. <= span style=3D'mso-bookmark:Check93'>=