FWR 10.00 FALMOUTH CONSERVATION COMMISSION
FWR 10.99
Form C
File No.
Town of
Falmouth
Applicant
Permit Application
Under
Falmouth Wetlands Bylaw
Chapter 235 of the Code of Falmouth
Part I: General Information
1. Location: Street Address
Lot Number
2.
Project: Type
3.
Registry: Barnstable County
Description
Current Book
& Page
Certificate (if Registered Land)
4.
Applicant
Tel.
Address
5.
Property Owner
Tel.
Address
6.
Representative
Tel.
Address
7.
a.
Has the Conservation Commission been sent, by certified mail or hand deliver, 2 copies of completed
Permit Application, with supporting plans and documents?
Yes G
No G
b. Has the fee been submitted?
Yes G No G
c. Total Filing Fee Submitted
8.
Have the abutters been notified and proof of such notification included in this application?
Yes G
9.
No G
Is any portion of the site subject to a Wetlands Restriction Order pursuant to G.L. c. 131, '40A or G.L. c. 130,
'105?
Yes G
No G
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FWR 10.00 FALMOUTH CONSERVATION COMMISSION
FWR 10.99
Form C continued
10. List all plans and supporting documents submitted with this Permit Application.
Identifying
Number/Letter Title, Date
11. Check those resource areas within which work is proposed:
(a)
G 100 foot Buffer to
(b) Inland
G Bank
G Freshwater Wetland
G Land Under Waterbody
G Vernal Pool
(c)
Coastal
G Land Under the Ocean
G Coastal Beach
G Barrier Beach
G Rocky Intertidal Shore
G Land Under Salt Pond
G Fish Run
G Bank of a Salt Pond
G Land and Waters within the Black Beach/Great Sippewissett
Marsh District of Critical Planning Concern
G Land and Waters within the Waquoit Bay Area of Critical
Environmental Concern
12. (a)
G Land Subject to Flooding
G Bordering
G Isolated
G Land Under an Estuary
G Coastal Dune
G Coastal Bank
G Salt Marsh
G Land Containing Shellfish
G Bank of an Estuary
Land Subject to Coastal Storm
Flowage
G A-zone
G V-zone
Is the project within estimated habitat which is indicated on the most recent Estimated Habitat Map of
State-Listed Rare Species (if any) published by the Natural Heritage and Endangered Species Program?
YES [ ]
NO [ ] Date printed on the Estimated Habitat Map
NO MAP AVAILABLE [ ] (if any)
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FWR 10.00 FALMOUTH CONSERVATION COMMISSION
FWR 10.99
Form C continued
Part II: Site Description
Indicate which of the following information has been provided (on a plan, in narrative description or calculations) to
clearly and accurately describe existing site conditions.
Identifying
Number/Letter
(of plan, narrative
or calculations)
Natural Features:
Soils
Vegetation
Topography
Open water bodies (including ponds and lakes)
Flowing water bodies (including streams and rivers)
Public and private surface water and ground water supplies on or within
100 feet of site
Maximum annual ground water elevations with dates and location of test
Boundaries of resource areas checked under Part I, Item 11 above
Other
Man-made Features:
Structures (such as buildings, piers, towers and headwalls)
Drainage, flood control facilities, and stormwater management systems
at the site and immediately off the site, including culverts and open
channels (with inverts), dams and dikes
Subsurface sewage disposal systems
Underground utilities
Roadways and parking areas
Property boundaries, easements and rights-of-way
Other
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FWR 10.00 FALMOUTH CONSERVATION COMMISSION
FWR 10.99
Form C continued
Part III: Work Description
Indicate which of the following information has been provided (on a plan, in narrative description or calculations) to
clearly, completely and accurately describe work proposed within each of the resource areas checked in Part I, item 11
above.
Identifying
Number/Letter
(of plan, narrative
or calculations)
Plan view and Cross Section of:
Structures (such as buildings, piers, towers and headwalls)
Drainage and flood control facilities, including culverts and open
channels (with inverts), dams and dikes
Subsurface sewage disposal systems & underground utilities
Filling, dredging and excavating, indicating volume and composition of
material
Compensatory storage areas, where required in accordance with
10.38(4) of the regulations.
Wildlife habitat restoration or replication areas
Other
Part IV: Mitigating Measures
1. Clearly, completely and accurately describe, with reference to supporting plans and calculations where necessary:
(a) All measures and designs proposed to meet the performance standards set forth under each resource area
specified in the regulations; or
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FWR 10.00 FALMOUTH CONSERVATION COMMISSION
FWR 10.99
Form C continued
(b) why the presumptions set forth under each resource area specified in Part II or Part III of the regulations do not
apply.
G Coastal
G Inland
Resource Area Type:
Identifying number or letter of
support documents
G Coastal
G Inland
Resource Area Type:
Identifying number or letter of
support documents
FWR 10.99
Form C continued
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FWR 10.00 FALMOUTH CONSERVATION COMMISSION
G Coastal
G Inland
Resource Area Type:
Identifying number or letter of
support documents
2. Clearly, completely and accurately describe, with reference to supporting plans and calculations where necessary:
(a) all measures and designs to regulate work within the Resource Area Buffer so as to ensure that said work complies with
FWR 10.18; or
(b) if work in the area adjacent to a resource area will alter such an area, all measures and designs proposed to meet the
performance standards established for the adjacent resource area, specified in these regulations.
G Coastal
G Inland
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Resource Area Type Bordered
6
Identifying number or letter of
support documents
FWR 10.00 FALMOUTH CONSERVATION COMMISSION
FWR 10.99
Form C continued
G Coastal
G Inland
Resource Area Type Bordered
Identifying number or letter of
support documents
Information provided will be used in evaluating the application for a permit and is made a matter of public record through issuance
of a public notice. Disclosure of this information is voluntary; however, if necessary information is not provided, the application
cannot be processed nor can a permit be issued.
I hereby certify under the pains and penalties of perjury that the foregoing Permit Application and accompanying plans, documents
and supporting data are true and complete, to the best of my knowledge.
Signature of Applicant
Date
Signature of Applicant's Representative
gust 15, 1998
Date
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