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TOWN OF BREWSTER
NATURAL RESOURCES DEPARTMENT
1657 MAIN STREET BREWSTER, MA 02631
PHONE: (508) 896-4546
FAX: (508) 896-8089
CONSERVATION@BREWSTER-MA.GOV
OFFICE OF
CONSERVATION COMMISSION
Brewster Wetlands Protection By-law
REQUEST FOR DETERMINATION OF APPLICABILITY (RDA)
The state form, “Request for Determination of Applicability” is available online at:
http://www.mass.gov/eea/agencies/massdep/service/approvals/wpa-form-1.html
If you would like a print copy of the form, please telephone the Conservation Commission at
(508) 896-4546.
Brewster Wetlands Protection By-law Section - Please complete each applicable form in this package
along with the above referenced state form application. Submit all completed forms, materials, plans, and
a check, made payable to the Town of Brewster, to the Conservation Department so that your filing,
under the MA Wetlands Protection Act and the Brewster Wetlands Protection By-law, will be complete.
Contents: Brewster Wetlands Protection By-law Request for Determination of Applicability (RDA)
1. Policy for Plans used for Wetlands Permitting
2. RDA Filing Checklist
3. Brewster Wetlands Protection By-law Notice to Abutters
4. Site Access Authorization Form
TOWN OF BREWSTER
NATURAL RESOURCES DEPARTMENT
1657 MAIN STREET
BREWSTER, MA 02631
PHONE: (508) 896-4546
FAX: (508) 896-8089
CONSERVATION@BREWSTER-MA.GOV
OFFICE OF
CONSERVATION COMMISSION
Policy for Plans Used for Wetlands Permitting
Adopted 11/26/02, Amended 7/6/11
Plans shall be submitted at a scale of 1 inch equals 20 feet, unless prior approval is given by the
Conservation Commission and/or the Conservation Administrator. Plans shall provide a proper and
clear identification of resources and any details necessary to adequately describe the proposed
activity.
The Following plans shall be submitted with the proper certifications as listed below:
Construction Documents:
Engineering Design Professional Engineer (PE)
Site Plans including all new home construction PE and Professional Land
Surveyor (PLS)
Plot Plans with no engineering PLS
Subsurface Sewer Design over 2000 gpd PE
Subsurface Sewer Design under 2000 gpd PE or Registered Sanitarian
Docks, Stairways, or retaining walls over 3 feet in height PE
Landscape / Planting Plans Conservation Commission Discretion
TOWN OF BREWSTER
NATURAL RESOURCES DEPARTMENT
1657 MAIN STREET
BREWSTER, MA 02631
PHONE: (508) 896-4546
FAX: (508) 896-8089
CONSERVATION@BREWSTER-MA.GOV
OFFICE OF
CONSERVATION COMMISSION
Request for Determination of Applicability Filing Checklist
Before you submit your Request for Determination of Applicability to the Conservation
Commission and other applicable agencies, please complete and sign this checklist, showing that
you understand and have completed all of the forms and procedures required for a Request for
Determination of Applicability filing. The Conservation Commission will not open the hearing if the
filing is not complete.
The Conservation Commission requires one (1) complete electronic copy and three (3)
complete paper copies of the Request for Determination and attached plan(s) for each
filing. Include each item of the application, with pages numbered consecutively and in the
order designated on this checklist. Staple these pages together, and attach the plan(s) with a
paper clip. Collectively, each item of the application and the plan(s) represent one complete
copy. In addition, the Conservation Commission members require a copy of the plan(s) and a
copy of the narrative/variance request rather than full copies of the Request for Determination
of Applicability. Please include ten (10) copies of the plan(s) with a copy of the
narrative/variance request stapled to each.
Unless a digital application was submitted to the Massachusetts Department of
Environmental Protection, one complete paper copy of the NOI should be sent by US
Certified, Return Receipt Mail, to the DEP Southeast Regional Office, 20 Riverside Drive,
Lakeville, MA, 02347. Submit the Certified Receipt Postal Service Form 3800 to the
Conservation Commission.
Submit only ONE copy of this checklist.
Components of the Application
□ 1. Obtain a certified abutters’ list from the Brewster Assessors’ Office and a photocopy of the
appropriate section of the Town of Brewster Assessors’ map, showing the property of the project and
all abutting properties required for a legal wetland filing under the BWP By-law. This list will provide the
names of all direct abutters to the property (first abutters), all that abut the first abutters (second
abutters) if they are within 300 feet of the lot lines of the property, and lot(s) directly across the street
from your lot. The street is the first abutter and lots directly across, second abutters.
If abutters are in another town, obtain a certified list of the abutters from the assessors’ office in
that town, and submit it and the appropriate assessors’ map in the application also.
Submit the certified abutters’ list and the Assessors’ map, as part of the application
□ 2. Notify all abutters on the list of your proposed project on the RDA “Notice to Abutters” form
letter, by Certified, Return Receipt mail or hand delivery before or on the day of filing, and
submit the Certified Mail receipts (Form 3800) as part of the filing. Submit the US Postal
Service Form 3811 at the hearing.
□ 3. Complete and include the state RDA application (WPA Form 1).
□ 4. If applicable, include DEP Appendix G. Field Data Forms for bordering vegetated wetlands.
Submit one form for each area tested; one form for the wetland area and one for the upland.
□ 5. Include a photocopy of an 8” by 10” section of the appropriate United States Geological
Survey (USGS) Quadrangle Map clearly showing the location of the project.
□ 6. Include a clear narrative, describing all aspects of the project.
□ 7. Include a professional site plan in accordance with the enclosed Brewster Conservation
Commission “Policy for Plans Used for Wetland Permitting”. Designate buffer zones and
wetlands in color (blue line = 100 feet, red line = 50 feet, green line = wetland).
□ 8. Include a copy of the RDA “Notice to Abutters” form letter.
□ 9. If the lot is an undeveloped, secluded, or otherwise unidentifiable area, identify the lot on the plan
by the number of the nearest telephone pole or the nearest road intersection. If there is no pole on
the lot, describe the lot’s proximity to the nearest; for example, “The lot is twelve feet
east of telephone pole no.167”.
□ 10. The town filing fee for a Request for Determination of Applicability is $75.00, with an
advertising
fee of $15.00 and a $20.00 fee for processing and mailing. Include this as one check for $110.00
payable to the Town of Brewster, with the application. The state does not assess a fee for an RDA.
□ 11. Fold each plan separately, right side out with the title visible, and paper clip it to each copy of
the application.
□ 12. Include a signed Site Access Authorization Form.
□ 13. Properly stake and flag the project site to identify all portions of the project, prior to the day of
filing. • Clearly stake all boundaries and limits of work.
• Clearly identify all stakes and flags in the field, showing the 100 foot and 50 foot
buffer zones and wetland areas. • Designate each wetland type on the flag as “BVW” (bordering vegetated wetland),
“TOB” (top of bank), “LSF” (land subject to flooding), etc.
Department staff and Conservation Commissioners will inspect the site.
Unless a holiday interferes, the filing deadline for applications is noon on the Thursday at least ten (10)
business days before the hearing. The hearing must be advertised in a local newspaper (at the time, the
Cape Codder newspaper) no less than five business days before a hearing.
I, _____________________________________ , confirm that this application is
complete. Environmental consultant/engineer/surveyor/applicant
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
Massachusetts Wetlands Protection Act (M.G.L. C.131 S. 40)
Brewster Conservation Commission
Brewster Wetlands Protection By-law Chapter 172
Notice to Abutters
Date: ___________________
To: Abutters of property located at: ________________________________________
Assessors' Map_______, Parcel_______, Formerly Map_________, Parcel________
From: _____________________________________________________________ , Applicant
Owner of Property: _______________________________________________
In accordance with the requirements of G.L c. 131, §40, Massachusetts Wetlands Protection
Act and Section 5, the Town of Brewster Wetlands Protection By-law, this is notification to you
that a filing has been submitted to the Brewster Conservation Commission on behalf of the
applicant for a proposed project at the above captioned location.
The Project includes the following:
The proposed work will occur within __________ feet of:
Inland Wetlands Coastal Wetlands
The project will occur within an Inland Wetland. The project will occur within a Coastal Wetland.
The information and plans for the project may be reviewed between 8:30 AM and 4:00 PM, Monday through Thursday, at the Conservation Department, Brewster Town Offices, 1657 Main S
treet. Electronic copies may be requested as an alternative.
A public hearing will be held Tuesday,_____________________________, 20_________.
Until further notice, due to the Covid pandemic, meetings will be held by remote participation.
Hearings begin at 6:00 PM. The hearing notice will be publicized in the Cape Codder Newspaper
no less than five (5) days prior to the hearing. If you have any questions, please call the Brewster
Conservation Department at 896-4546, between the hours of 8:30 AM and 4:00 PM.
Sincerely,
_____________________________________________Representative for Applicant
TOWN OF BREWSTER
CONSERVATION COMMISSION
SITE ACCESS AUTHORIZATION FORM
Date:__________________________________________________________________
Project:________________________________________________________________
Location:______________________________________________________________
Property Owner:________________________________________________________
I (we) hereby authorize the individual members of the Brewster Conservation
Commission and its agents to enter upon the referenced property for the purpose of
gathering information regarding the application filed with the Commission pursuant
to the Wetlands Protection Act (M.G.L. Ch 131, s. 40) and/or the Brewster Wetlands
Protection Bylaw (Chapter 172).
Additionally, if a permit is issued for the project, I (we) grant permission for
Commission members and the Commission’s agents to enter the above referenced
property for the purpose of inspecting for compliance with the permit. This site
access authorization is valid until a Statement of Compliance is issued by the
Conservation Commission.
Authorized Signature:_________________________________ Date:_____________________
Please Print Name:___________________________________
If other than owner, please state whether tenant, agent, or other:__________________________
Mailing Address: _____________________________________________________
_____________________________________________________
_____________________________________________________
Phone:______________________________ Email:____________________________________
Cell:________________________________ Fax:______________________________________
wpaform1.doc • rev. 7/27/2020 WPA Form 1 – Request for Determination of Applicability • Page 1 of 4
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 1- Request for Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
Brewster
City/Town
A. General Information
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
1. Applicant:
Name E-Mail Address
Mailing Address
City/Town State Zip Code
Phone Number Fax Number (if applicable)
2. Representative (if any):
Firm
Contact Name E-Mail Address
Mailing Address
City/Town State Zip Code
Phone Number Fax Number (if applicable)
B. Determinations
1. I request the Brewster
Conservation Commission
make the following determination(s). Check any that apply:
a. whether the area depicted on plan(s) and/or map(s) referenced below is an area subject to
jurisdiction of the Wetlands Protection Act.
b. whether the boundaries of resource area(s) depicted on plan(s) and/or map(s) referenced
below are accurately delineated.
c. whether the work depicted on plan(s) referenced below is subject to the Wetlands Protection Act.
d. whether the area and/or work depicted on plan(s) referenced below is subject to the jurisdiction
of any municipal wetlands ordinance or bylaw of:
Brewster
Name of Municipality
e. whether the following scope of alternatives is adequate for work in the Riverfront Area as
depicted on referenced plan(s).
wpaform1.doc • rev. 7/27/2020 WPA Form 1 – Request for Determination of Applicability • Page 2 of 4
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 1- Request for Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
Brewster
City/Town
C. Project Description
1. a. Project Location (use maps and plans to identify the location of the area subject to this request):
Street Address
Brewster
City/Town
Assessors Map/Plat Number Parcel/Lot Number
b. Area Description (use additional paper, if necessary):
c. Plan and/or Map Reference(s):
Title Date
Title Date
Title Date
2. a. Work Description (use additional paper and/or provide plan(s) of work, if necessary):
wpaform1.doc • rev. 7/27/2020 WPA Form 1 – Request for Determination of Applicability • Page 3 of 4
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 1- Request for Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
Brewster
City/Town
C. Project Description (cont.)
b. 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 (use additional paper, if
necessary).
3. a. 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.
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 deed
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 government project
Project required to evaluate off-site alternatives in more than 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.
b. Provide evidence (e.g., record of date subdivision lot was recorded) supporting the classification
above (use additional paper and/or attach appropriate documents, if necessary.)
wpaform1.doc • rev. 7/27/2020 WPA Form 1 – Request for Determination of Applicability • Page 4 of 4
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 1- Request for Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
Brewster
City/Town
D. Signatures and Submittal Requirements
I hereby certify under the 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.
I 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 (including all appropriate documentation)
simultaneously with the submittal of this Request to the Conservation Commission.
Failure by the applicant to send copies in a timely manner may result in dismissal of the Request for
Determination of Applicability.
Name and address of the property owner:
Name
Mailing Address
City/Town
State Zip Code
Signatures:
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 of Applicant Date
Signature of Representative (if any) Date