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智詰m。n,a-Design, LLC
Phone: (508) 829-7222 Elllail: needlic(禿)hotmail.com
母P.O. Box 376. Rし両a11d. MA Oは43
TOWN OF PAXTON
CONSERVATION COMMIS SION
PAXTON TOWN HALL
697 PLEASANT STREET
PAXTON, MA O1612
ENCLOSED PLEASE FIND THE NOTICE OF INTENT FOR:
GARY LEDERER
190 WEST STREET
PAXTON, MA O1612
PROJECT LOCATION: 190 WEST STREET
PAXTON, MA
JOB#1 766-21
BELOW IS A LIST OF ALL PLANS & OTHER MATERIALS SUBMITTED WITH THE
GARY LEDERER / 190 WEST STREET NOTICE OF INTENT:
- REPAIR SUBSURFACE SEWAGE DISPOSAL SYSTEM PLAN
- NOTICE OF INTENT FEE TRANSMITTAL FORM
- COPY OF CHECKS FOR STATEAND TOWN FEE PAYMENT
_ AFFIDAVITOF SERVICE
- COPY OF NOTIFICATION TO ABUTTERS
- CERTIFIED LIST OF ABUTTERS
- MAGISLOCUSMAP
- OLIVERZONEAMAP
_ DCR WATERSHED PROTECTION ACT MAP
- MASS DEP PRIORITY RESOURCE MAP
_ MASS DEPTITLE5 SETBACKAREASMAP
_ MASS DEP WATER SUPPLY PROTECTION AREAS MAP
_ MASS DEP WETLAND AND WETLAND CHANGE AREAS MAP
_ NHESP PRIORITY AND ESTIMATED HABITATS MAP
- FEMAMAP
- MASSDEPBVWFORIM
Ifyou have any questions or need any further infomation, Please feel free to contact me at (508)
829-7222.
諾易しan P. Votr燈 四国England Envirormental Design, LLC
闘Important:
When輔ng out
fo「ms on the
COmPute「, uSe
Only the tab key
to move you「
Cu「SO「 - do not
use the 「etu「n
固、二三]_」
Note:
Befo re
COmPleting this
form consult
you=ocalConservation
Commission
「egardjng any
municipaI byIaw
O「 0「d活ance.
WPA Form 3 - Notice oflntentMassachusetts wet-ands Protection Act M・G"L・ C" 131, §40
Massachusetts Depa巾ent of EnvironmentaI Protection P「ovjded by MassDEP:
Bu「eau of Resou「ce p「otection - WetIands
A。 Generai Information
1 90 West st「eet
1 PrQJeCt LocatIOn (Note: eIectro剛e「s w川cIICk on button to Iocate p「QJeCt SIte)
イl“ヽl"ヽ l A′臆 臆 ′ (.
Latitude and Longitude:
12
f. Assesso「s
2. App=cant:
C. O「ganization
West St「eet
e. City什own
Paxton
b. City什own
42.30736
d. Latitude
53
Lede「er
01612
C. Zip Code
-71 ,94401
3. P「operty owne「 (「equi「ed ifdiffe「ent f「om app-jcant)‥ □ check ifmo「e than one owne「
e. CityITown
4" Rep「esentatjve (ifany):
Ju=an P.
a. Fi「st Name
New Enala
C. Compa=y
P.0. Box 376
e. City什own
508-829-7222
$110.00
Envi「onmentaI
Vo書「u ba
5" TotaI WPA Fee Paid (from NOI Wedand Fee Transmitfa- Fo「m):
$42. 50
b. State Fee$67.50C. City几own Fee
Bu「eau of Resource p「otection - Wetiands‾‾ ‾. ‾““〇°‥‾〇°〇〇〇ヽラ〇〇〇`○○ 「1U葛きじ暮lq
WPA Fo「m 3葛Notice oflntentMassachusetts wet-ands P「otection Act M"G.L. c. 131, §40
Massachusetts Department of Environmentai Protection P「ov-ded by MassDEP:
口ii「合へ‥ (f ○○___.___臆 。、 . _.
Document
Paxton
A. General lnformation(COntinued)
C jty什own
6. Gene「aI P「。ject Desc「iption二
Construct-On Of a 「epal「 Subsurface sewage d-SPOSa- system and assoc-ated grad一=g
7a. Pr垂ct Type check-ist: (Limited Pr垂ct Types see section A. 7b.)
1. □ singleFam時Home
3. □ comme「ciaIIIndust「iaI
5.口 Utjlities
7.口Ag「icu-tu「e (e.g.’C「anbe「「ies, fo「estry)
9.図〇the「
2.口Residential Subdjvision
4, □ Dock/Pje「
6.口Coasta- enginee「jng St「uctu「e
8.口T「ansportation
7b Is a=y POrtien ofthe p「oposed act一∨岬g-b-e to be t「eated as a剛ed p「QJeCt (一nC-ud-ng EcoIogICal
Restorat-O= L-mIted P「QJeCt) su匝to 310 CMR lO.24 (COaSta一) o「 310 CMR lO 53 (一=land)?
1口Yes図No #語豊豊霊詰襟謹霊藍忠聖l竺COmPIete Iist a=d description諒mited pr垂ct types)
ifthe p「oposed act'VIty IS ellgib-e to be t「eated as an EcoIog-Ca- RestoratiOn Lim-ted P「QjeCt (310
CMRlO.24(8)・ 310 CMR lO.53(4)), COmPIete and attach Appendix A‥ EcoIogicai Resto「ation Limited
PrQject Checkiist and Signed Certifieation.
8. P「operty 「eco「ded at the Regjst「y of Deeds for:
Wb「ceste「
a. County
35056
B。 Bu情erZone & Resource
(if regiStered
Area impacts
1図BufferZo=e O=一y- Check -fthe prQrect ′S -ocated on′y一= the BufferZo=e Ofa Bordenng
Vegetated WetIa=d同and Bank' Or CoastaI Resou「ce A「ea.
2 □ inia=d Resou「ceA「eas (See 310 CMR lO 54-10 58両otappliCab-e) gOtO SectIOn B 3,
Check aIl that apply be-ow Attach na「rat-Ve and any supportmg documentatIOn descrlb'ng how the
PrQJeCt W川meet al- performance standa「ds fo「 each of the resou「ce areas a-te「ed, l=CIud'ng
Standa「ds 「equi「jng consjde「ation of a-te「native project design o「 iocation,
(temporary & permanent)
Bu「eau of Resou「ce p「otection - WetIands‾ ‾‾‾ ‾‾ ‾““▼“““′○○〃〇〇〇ラ○○績貫i 「lU葛CC暮○○
WPA Form 3 - Notice ofIntentMassachusetts wetlands P「otection Act M"G.L. c. 131, §40
Massachusetts Depa巾ent of Environmenfal Protection P「ov-ded by MassDEP:
口I〃「合き‥〈軍D《__‥一_臆。、 〇 一.
Docu ment
Paxto n
B。 Bu怖er Zone & Resource
B壁理工些A[鍾
a.口 Bank
b.口 Bo「de「ing Vegetat。d
WetIan d
c.□ LandUnder
Waterbodies andWaterways
壁些A[塑
d.□ Bo「de「ingLand
SuPject to Fiooding
e.□ IsoIatedLand
Su申ject to Fiooding
f.口 Rive面ontArea
Area impacts(temporary & pe「manent月COnt’d)
SPeCify coastaI or
2 Wdth ofRiverfrontArea (Check one):
口25 ft+ Designated Dense-y Deve-oped Areas onIy
□ 100 ft+ New ag「icuItu「al pr垂cts onIy
□ 200 ft+ A一一other p「qiects
3. Totai area of Rive面ont A「ea on the site ofthe proposed p「Qject:
4. P「oposed alte「atjon of the Rive巾ont A「ea:
5 Hasa=aite「natlVeSanalysisbeendonea=d-SItattachedtoth-SNOl? 口Yes□ No
6 VVIsthe Iotwhe「etheact一∨一ty -S P「OPOSed c「eated p「IO「tOAugust l’1996?口Yes□ No
3.口Coastal Resou「ce A「eas‥ (See 310 CMR lO.25-10.35)
Note‥ fo「 coasta- rjve面ont a「eas’P-ease compIete Section B.2.f. above.
Online Users:
i=CIude you「
document
transaction
numbe「
(PrOVided on you「
「e∞ipt page)
Wjth a=
SuPPieme=tary
info「mation you
Submit to the
Department.
WPA Form 3葛Notice oflntentMassachusetts wet-ands Protectjon Act M.G・L" C. 131, §40
Massachusetts Depa巾ent of Envi「onmental Protection Prov'de翻assDE
Bureau of Resource protectjon - Wetlands
B。 Bu鯖e「 Zone & Resource A「ea lmpacts(temporary & Permanent) (COnt’
Check a冊app-y be′ow Attach =ar「at一Ve and supportng docume=tat-O= descr-blng how the
Pr坤w冊eet all performance standa「ds for each of the 「esou「ce a「eas alte「ed巾ud一ng
Standa「ds 「equi「i=g CO=Sjderatjon of a-te「natjve prQject design or iocation.
a.口 Desjg=ated PortAreas 冊cate sjze u=der Land U=de「the Ocean, below
b口 LandUndertheOcean
c.口 Bar「jerBeach
d.口 CoastaiBeaches
e.□ coasfaIDunes
f.口 CoastalBanks
g. □ Rocky inteI巾dal
Sho「es
h.□ saltMa「shes
i・ □ LandUnde「SaIt
j口 LandContaining
She=fish
k.口 FjshRuns
l.□ LandSu鴫ctt。
Coastal Sto「m FIowage
4.口Restoration/Enhan。。m。nt
lndicate size u=de「 Coasta- Beaches and/or Coastal Dunes beio
宣馳 早世坦9咄
Indjcate sjze u=de「 Coasta- Ba=ks・面and Ba=k, La=d Unde「 the
Ocean, a=d/o「 j=Ia=d Land Under Wate「bodjes a=d Waterways,
above
If the p「QJeC白S for the pu「pose of 「esto「-ng Or enhanc-ng a wet-and resource a「ea in additiOn to the
Squa「e footage that has been ente「ed -n Section B 2.b o「 B 3 h above' P-ease e=ter the addltionai
amOunt here.
a. Square feet of BVW
5・口P「Qject一口VO一VeS Stream crossings
St「eam crossjngs
WPA Form 3葛Notice oflntent
Massachusetts wetlands P「otection Act M.G.L" C. 131, §40
Massachusetts Depa巾ent of Environmental Protection P「ovided by MassDEP:
Bureau of Resou「ce protectjon - V¥letIands
Document
Paxton
C。 Other AppIicabie Standards and
□ Thjs js a proposa- for an EcoIogica- Restorat-On L両ed PrQjecL Skjp Section C and
COmPIete Appendix A Eco-ogica- Resto「ation Limited PrQJeCt Check-ists - Required Actio
(310CMR lO.11).
Streamlined Massachusetts Endangered Species ActAVet-ands Protection Act Review
=s a=y PO巾on of the p「oposed p「QJeCt located 'n Estimated Habitat of Ra「e Wildlife as IndICated
the most recent Est-mated Habitat Map of State-L-Sted Ra「e ¥焼=d W剛fe pub一一Shed by the
Natu「a川e「一tage a=d Endange「ed Species Program (NHESP)? To v'eW habItat maps, See the
鑑箋霊箋塾a.口Yes因No lfyes, incIudeproofofma軸gorhandde-iveryofNOIto:
Natura川erjtage and Endange「ed Species Program
8′2。 1 7 指藍措畿es and Wi-dIifeWestborough, MA O1581
Ifyes' the p「QJeCt -S a-so s喧to Massachusetts Endangered SpecIeS Act (MESA) 「evIeW (321
CMR l O 18).丁o quaitfy fo「 a st「eamlmed' 30-day, MESA/Wdia=ds Protect-On Act rev-eW, PIease
COmPlete Sect-O= C I c’and inc-ude 「equested mate「-als w-th thlS Not-Ce Of -ntent (NOi), OR
COmPiete Sect'O= C 2 f’lf app一一Cab-e /fMESA s仰/emenfa廟o仰afron /S nOt /nC妬d剛e NO/
dy coa胸g Sec研o刷s fo仰, the MESP w〃 requre a separafe惟SA勅ng w胸may fake
叫0 90 days fo review Wess ”Ofed excapto”S wh Sec勅2軸y see be勅
C Submit Supp-ementa冊o「matjon for Endange「ed Species Review・
1.ロPercentage′ac「eage of p「operty to be alte「ed:
(a) Withjn wetia=d Resou「ce A「ea
(b) OutSide Resou「ce Area
2.口Assessor’s Map o「 「jghトoトway plan ofsite
2.口P「qect p-ans fo「 ent一「e P「QJeCt S-te巾udIng wet-and 「esou「ce a「eas a=d a「eas outside of
WetIands ju「jsdictjon, Showjng exjsting and p「oposed conditjo=S・ eXistjng a=d p「oposed
t「ee/vegetatjon cIea「jng lj=e’and clea「-y dema「cated冊s of wo「k軍事
(a) □ p「。ect desc「lPtio= (一nCludIng descrIPt-On Of impacts outs-de ofwetla=d 「esou「ce a「ea &
buffe「zone)
(b) □ photog「aphs 「epresentative of the site
繚d認諾詳説蒜。晒s,。。.,ants唖SA prtyects may not be segmented (321 CMR lO.16) The appllcant must dISCIose fu一一deve-opme岬s even if such plans are
nOt 「equj「ed as part of the Notice of 'nten申OCeSS.
WPafo「m3.doc. rev. 2I812018
Page5of9
‾‾ 葛‾ ‾““〇°““′〇°○〃○ヽラ〇〇〇く○○ 「IU葛きじ暮い〇
Bureau of Resou「ce p「otection - WetIands
WPA Form 3 - Notice oflntentMassachuse請S VvetIands P「otection Act M"G"L. c. 131, §40
Massachusetts Depa巾ent of Environmenta! Protection P「ovided by MassDEP:
口-Ir∠ゝ{‥ (f回____一__臆。、 ○ ○.
Document
Paxton
C. Other AppIicabie Standards and(COnt’d)
整謀議蒜護憲薄諾詣課atabove add「ess
Prtyects a/femg ,O or mo′℃ aCres offa旬atso sub励
(d)口 Vegetatio= COVertype map ofsite
(e)口P「時t plans showing Prio「ity & Estimated Habitat bounda「ies
(f) OR Check One ofthe Fo-1owing
l. □ p「Qject is exemptf「om MESA 「eview.
鑑藷紫鴇器謀議認諾310CMR lO"37a=d lO.59.)
2. □ sepa「ate MESA reviewongoing.
3. □ sepa「ate MESA review completed.
incIude copy of NHESP ``no Take,一dete「mination o「 va-jd Conservatjon & Management
3 Fo「 coastal p「QJeCtS O=一y’lS any函On Ofthe p「oposed p「QJeCt -ocated below the mean high water
a.口Notapp-icab-e-P「Qjectis刷and「esou「ceareaonIy b □ Yes □ No
ifyes’jncIude p「oofof ma冊g・ hand delivery, O「 e-ectronic de-ivery of NOI to either:
South Shore - Cohasset to Rhode Isiand bo「der, and
the Cape & isIands:
Djvisjon of Ma「jne Fjsherjes -
Southeast Marine Fisheries Station
Attn‥ Enviro=mentai Reviewer
836 South Rodney French BIvd.
New Bedfo「d, MA O2744
Ema帖旦吐馳
North Sho「e - Hu旧o New Hampshire bo「der:
Djvjsjon of Marine Fjsherjes -
North Shore Office
Attn‥ Environmental Reviewer
30 Eme「son Avenue
GIoucester, MA O1930
EmaiI‥ !辺土旦軸
AIso If yes) the prQJeCt may requ-re a Chapte「 9川cense For coastaはowns 'n the No軸east Reg-On,
PIease contact MassDEP’s Bosto= O簡ce. Fo「 coasta- tow=S in the Southeast Regjon, PIease contact
MassDEP’s southeast RegjonaI Office,
Oniine Users:
lncIude your
document
transaction
numbe「
(P「0Vided on you「
receipt page)
With a=
SuPPIementa「y
informatio= yOu
Submit to the
Department.
WPA Form 3葛Notice oflntent
Massachusetts wet`ands P「otection Act M.G.L" C" 131, §40
Massachusetts Department of Environmental Protection P「ov-ded by MassDEP
Bureau of Resou「ce protectjon - Wetiands
C. Other AppIicable Standards and(COnt’d)
4 Is any po巾On Ofthe proposed prQ,eCt W-th-n an Area of C「it-Cal Env-rOnmenta- Conce「n (ACEC)?
a.口Yes 図No 早yeS,P「OVjdenameofACEC/se。inc血.ti.n。.∩,^,D^.《輸工一。 .Ifyes, P「OVjde =ame ofACEC (See jnst「uctjons to wpA Fo「m 3 o「 MassD
Websjte for ACEC -ocatjo=S). Note: electro=jc filers c′jck o…lebsite.
〉● ’O a’’y HUluU「1 0Ttne PrOPOSed pr句ectwithin an a「ea desjgnated as an outsta=ding Resou「ce wat
(ORV囲s des-g=ated一n the Massachusetts surface Wate「 Quatry standa「ds, 314 CMR 4 00?
6 1s any po巾On ofthe site sudyect to a wetIa=ds RestrICtIOn O「de「 u=de「 the -nIand Wetlands
Rest「一CtlOn Act (M.G L c 131’§ 40A) o「the Coastal Wctfands Rest「ict-On Act (M G L c 130, § 10
7 1s thIS P「Q,eCt Su匝to p「ov-S-OnS Of the MassDEP Sto「mwate「 Management standa「ds?
a口Yes Attach a copy ofthe Sto「mwate「 Reportas requ一「ed by the Stormwater Management
Sta=dards pe「 310 CMR lO.05(6)(k)-(q) and check jf:
1口ApplyIng for Low -mpact Deve-opment (L`D) site desIgn Cred-tS (as desc「ibed in
Sto「mwate「 Ma=agement Ha=dbook Vo′・ 2' Chapte「 3)
2.口 A portion of the sjte constitutes 「edeveiopment
3口 Prop「一etary BMPs a「e InC-uded -n the Stormwater Management system
b.図 No. Checkwhythe prQjectis exempt二
1.図 Single-famtry hous。
2. □ Eme「gency road 「epai「
Single-famjiy houses o「 Iess than
5. Isa=yPOrtionofthe
3.口 Smal- Reside=tjal Subdjvisio= (一ess than o「equai to 4
0「 equa=o 4 unjts in mu描_famjI、, hn一,e;n,, ,,.《;《_ふ、.∴⊥,臆
D。 Additional lnformationWith no to C「jticaI A「eas.
口Thjs -S a p「OPOSa′ for a= Eco′og-Ca′ Restorat-On L両ed Pr。ect sk,P Sect,On D a=d compIete
Appe=dlX A EcoIog-Cal Resto「at-On Notice of一=te=t - M-n-mum Requi「ed Documents (310 CMR
AppI-CantS must -nClude the foltow-ng W冊s Not-Ce Of lntent (NO一) See -nStruct-OnS fordetaIis
O輔ne Users: Attach the document transact-On number (P「OVIded on you「 「eceiPt Page) for any of
the fo”owing irIfo「mation you submjt to the Department.
1図USGS o「other map ofthe area (a-ong with a =a「「at一Ve desc「IPt-On, lfnecessary) conta-ning
Su簡c-ent -nformat-On f軸e Conservation Comm-SSIOn a=d the Department to Iocate the site
2図Plans ldentftylng the -ocat-O= Of p「oposed act'∨'t-eS (一nC′ud肌g act-V't-eS P「OPOSed to serve as
a Bo「de「一ng Vegetated Vvet'a叫BWVI 「epI`Cat-O= a「ea or othe「 mIt-gating measu「e) 「eIatIVe
tO the bounda「jes of each affected 「esou「ce a「ea.
WPafom3.doc. rev. 2/8I201 8
Page7of9
WPA Form 3 - Notice ofIntentMassachusetts wetIands Protection Act M.G・L" C. 131, §40
Massachusetts Department of Environmental Protection Provjded by MassDEP:
Bureau of Resou「ce p「otection - Wetiands
Document
Paxton
D。 Additional 1nformation(COnt’d)
3図ide=trty the method for BVWand othe「 「esou「ce a「ea pou中矧i=eatIOnS (MassDEP B
FieId Data Fo「m(S). Dete「min茄nn nf △nr品《」出し, 〈臆,‾ - ‾ ‾… 〉、‥レ’’9OUu’しt=‖因Jea DOunaary deiineations (MassDEF
FIeId Data Fo「m(S)’Dete「m'nat-On Of App-1Cab時O「de「 of Resou「ce A「ea De一'neatiOn,
and attach documentation of the methodoIogy.
4図Ljstthe tit′es and dates foralI p-a=S and othe「 mate「-a-s submltted wlth thlS NOI
D《._,〃:_ ( i
Subsurface
b. P「epa「ed
8I31/2 1
T. Mann
et
‾ ‾葛-“‾’“ 〉‥‾ rUrC"y UWiiel上PieaSe attacn a Iist ofthese p「operty owne「s not
Attach p「oof of ma冊g for NaturaI He「jtage and Enda=gered Specjes P「og「am, if needed.
Attach p「oof of ma冊g fo「 Massachusetts Division of Ma「ine Fishe「jes巾eeded,
Attach NOI Wetland Fee T「a=SmjttaI Form
Attach Stormwater Repo直言f needed.
5.口ifthe「e js mo「e tha= One p「operty ow=e「, PIease attach
iio書A′J (〇、∴●」:_重__臆_臆
E。 Fees
1口Fee Exempt No f帖g fee shal- be assessed fo「 p「QJeCtS Ofany c-tytown, COunfyrmdISt「ICt
Of the Commonwea-th, federal-y 「ecogn-Zed -nd-an t「lbe hous一口g autho「rtyrmu…C印OuS-ng
authorjty’O「 the Massachusetts Bay T「ansportation Autho「ity.
Appl-Ca=tS muSt Subm-t the fo”owlng一=fo「mat-On (一n addItlO= tO PageS l and 2 of the NOI Wedand
Fee T「ansmjttal Fo「m) to confirm fee payment:
1355913/2 1
4. State Check
WPaform3.doc. rev. 2/8/2O1 8
5. Check date
Lede「e「
口 口 図 □
6
7
8
.
9
.
Massachuse筒S Depa巾ment of Environmentai Protection
Bu「eau of Resou「ce Protection - WetIands
WPA Fo「m 3 _ Notice of lntent
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40Pocument T昭nsadion Number
Paxton
F. Signatures and Subm田al Requi「ements
I he「eby certify unde「 the penalties of pe申ry that the fo「egoing Notice of lntent and accompanying
PIans, documents, and suppo巾ng data are true and compiete to the best of my knowledge. I unde「Stand
that the Conservation Commission wi= place notification ofthis Notice in a locaI newspape「 at the
expense ofthe appiicant in acco「dance with the wetiands 「eguIations, 310 CMR lO,05(5)(a).
1 fu軸e「 certify unde「 penaities of pe申ry that a= abutte「S We「e nO師ed ofthis appiication, Pu「Suant tO
the 「equi「ements of M.G.L. c. 131, § 40. Notice must be made by Ce輔Cate Of Ma冊g o「 in w「iting by
hand delivery o「 cer輔ed maii (「etum 「eceipt 「equested) to a= abutters within lOO feet of the property line
Of the p「Qject Iocation.
For ConsenIation Commission:
Two copies of the compIeted Notice of intent (Fo「m 3)言ncIuding suppo面ng pians and documents,
two copies ofthe NOi Wetiand Fee T「ansmittaI Fo「m, and the city/town fee payment, tO the
Conservation Commission by ce輔ed maii o「 hand deiive「y.
For MassDEP:
One copy of the completed Notice of Intent (Fo「m 3)言nciuding suppo巾ng plans and documents, One
copy of the NOI Wetland Fee T「ansmittai Fo「m’and a copy of the state fee payment to the
MassDEP Regional O怖ce (See inst「uctions) by ce輔ed maiI o「 hand de=very.
Other:
ifthe appiicant has checked the “yes” box in any part ofSection C, ltem 3’above’「eferto that
section and the lnst「uctions fo「 additional submittal 「equi「ements.
The o「-gIna- and copies must be sent simuitaneousiy. Fa冊「e by the appIicant to send copies in a
timeiy manne「 may 「esuIt in dismissal of the Notice of intent.
隔Massachusetts Department of EnvironmentaI Protection
Bu「eau of Resource protectjon - Wetlands
NOI Wetiand Fee丁ransmjttal Form
Massachusetts wetIands Protection Act M.G.L・ C. 131 , §40
Importan書: When A" Applicant
霊需器富1" LocatjonofPrQj。。t:
黒岩嵩…∴些use the retu「n
窪])
⊇⊆
To calcuIate
捕ng fees, 「efe「
to the catego「y
fee list and
examples in the
jnst「uctjons for
帥ng out wpA
F°「m 3 (Noti∞ Of
Intent).
West streeta. St「eet Ad(
State1 356 しocaI1355
2. AppIica=t Ma冊g Add「ess:
West st「eet
d・ Ma冊g
Paxton
e. City什own
3. Property owne「 (if diffe「e時
B。 Fees
Paxton
C時什own
State $42,50
Lede「e「
」ocaI $67.50
Fee shouid be ca-culated us-ng the falIowIng P「OCeSS & worksheet Pfease see whstwcfrons before
Step l什ype ofActivjtyroescrIbe each type of act'VIty that w川occu「 -n Wet-and resource a「ea and buffe「 zone
Step 2/Number of Activities:一denttry the number of each type of activity.
Step 3thdividua- Activify Fee: Identrty each actIVrty fee from the s一× P「QjeCt Catego「'eS l-Sted 'n the InSt「uctlOnS
Step 41Subtotal Activfty Fee: MultlPly the numbe「 of actlVit-eS (一dentrfed ln Step 2) tlmeS the fee pe「 category
(identified -n Step 3) to 「each a subtota- fee amount Note -fany ofthese activit-eS are葛n a R-Ve面ont A「ea ln
addIt-O= tO anOthe「 Resou「ce A「ea o「 the Buffdr Zone・ the feaper act-Vrty shou-d be muItlPlled by 1 5 and then
Step 5Thi P「Qject Fee‥ Dete「m-ne the total p「QJeCt fee by addlng the subtotaI amounts什om Step 4.
Step 6/Fee Payments: To calcu-ate the state share ofthe f軸vIde the total fee m haIf a=d subtract $12 50 To
Catoulate the crtyftow= Share ofthe fee’divjde the tota- fee jn haIfand add $12.50.
Massachusetts Department of Environmenfal Protection
Bu「eau of Resource protection - WetIands
NOi Wetland Fee TransmittaI FormMassachusetts wetiands Protection Act M.G・L. c. 131, §40
B〃 Fees (COntinued)
Step l什ype ofActivfty s繍器豊3,ln譜u。,
Activity Fee
1e.)workon septicsystemsepa「ate l
f「om house
C。 Subm配ai Requirements
$110.00
Step 4/Subtotal Activi
戸ee
$110.00
Step5什otai PrqjectFee: $110.00
Step 6IFee Payments:
Total P亘yect Fee二
State sha「e of f冊g Fee:
City什own share of f冊g Fee:
$110.00a. TotaI Fee f「om Step
$42.50b. 1I2 Totai Fee Iess
$67.50
a.) CompIete pages l and 2 and send with a check or money orderfo「 the state share ofthe fee, Payabie to
the Commonweaith of Massachusetts.
Department of Envi「onmental Protection
Box4062
b") To the Conservation Commission: Send the Notice of l=tent O「 Abbreviated Notice of `nte=t; a CoPy Of
this form; a=d the cjty伽wn fee payment.
To MassDEP Regiona- O簡ce (See Instructions)‥ Send a copy ofthe Notice of lntent o「 Abb「eviated Notice of
冊ent; a COPy Of this form; a=d a copy ofthe state fee payment. (E輔s of Notices of lntent may submjt these
eIect「onica=y.)
譲醇 醜,2′地霊
国語竪琵琶畳語悪童…碧豊吉豊里㊨
$ルタ‾篇
D側a誌固蓮㌔
AFFIDAVIT OF SERViCEUh(ねr the Mdssachuset応Wetlands' Protection Act
(Tb be submitted to /he Mdssachuse鵜Department QfEnvironmental Protection, the
Conservation Commission, Whenfling a Notice Qfhte砂
尋蒜帯a’hereby ce正fy under the pains and penalties ofpe車ury that on
2021 I gave notification to abutters in compliance with the
SeCOnd paragraph ofthe Massachusetts General Laws Chapter 13 1 , Section 40, and the
DEP Guide to Abutter Notification dated Apri1 8, 1994, in comection with the following
ma請er:
A Notice of Intent filed under the Massachusetts Wetlands Protection Act
by Gary Lederer with the Town of Paxton Conservation Commission for 190 West Street
located in the Town ofPaxton.
The form ofthe notification, and a list ofthe abutters to whom it was
glVen and their addresses, are attaChed to the A綿davit of Service.
図星聖
NOTIIuCATION TO ABUTTERS UNDER THE
MASSACHUSETTS WETLANDS PROTECTION ACT
In accordance with the second paragraph of Massachusetts General Laws Chapter 1 3 1 , Section 40,
you are hereby notified ofthe following:
A. The nane ofthe applicant is: Gary Lederer.
B. The applicant has filed a Notice ofIntent with the Conservation Commission for the Town ofPaxton
Seeking pemission to remove, fill, dredge or融e′ an area Suqiect to protection under the
Massachusetts Wetlands Protection Act (General Laws Chapter 1 3 1 , Section 40).
C. The address where the activity is proposed is: 190 West Street, Paxton.
D. Copies ofthe Notice ofIntent may be examined at the Town ofPaxton Town Clerks or Conservation
Commission O飾ce during regular o綿ce hours. For more infomation, Ca= the Town ofPaxton
Conservation Commission.
E. The meeting will be held on date and time to be determined by the Town ofPaxton,s
Conservation Commission.
NOTE: Notice ofthe public hearing, including its time, date, and place will be published at least five days
in advance in the /ocal "eW岬即er.
NOTE: You may contact the Department of Envirormental Protection (DEP) Central Regional O飾ce for
more infomation about this application for the Wetlands Protection Act. To contact DEP, Call the Central
Regional O飾ce at (508) 792-7650.
Town of Paxton
Board of Assessors
697 Pleasant Street
Paxton, MA O1612
(508) 799-723l - Phone
(508) 797-0966 -ぬⅩ
Certified Abutter List for 190 WEST STREET
map_Par_id �OWnerl �OWn addr �OWn_City �OWn State �OWn_ZIP
12/70 �SANSOUCYROBERT&EMILY �5KEEPAVE �PAXTON �MA �01612
12/17 �EARしY」ODI&ANDREW �189WESTST �PAXTON �MA �01612
12/与2A �MAGNUSONDAViDM �3KEEPAVE �PAXTON �MA �01612
12/8戸 �GOODALL」EANM. �10SUOMiS丁 �PAXTON �MA �01612
12/与4 �O-HEARNWILLIAMR �24PROSPECT �RUTLAND �MA �01与43
」R&PHYLLISA �S丁
12/与2 �ESSEX」OSEPH �186WESTST �PAXTON �MA �01612
Ka†eri M. CIu†e
Principai Assessor, Town of Paxton
697 Pleasant St., Paxton, MA O1612
与08/799-7231 Ext 16, Fax 508/797-O966
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