HomeMy WebLinkAbout10-8 - 25-44P Wetlands Reporting Form
rev. 1/2024e
79 Elm Street • Hartford, CT 06106-5127 www.ct.gov/deep Affirmative Action/Equal Opportunity Employer
Statewide Inland Wetlands & Watercourses Activity Reporting Form
Please complete and mail this form in accordance with the instructions.
If completing by hand - please print and use the pdf version.
Incomplete or incomprehensible forms will be mailed back to the municipal inland wetlands agency.
PART I: Must Be Completed By The Inland Wetlands Agency
1. DATE ACTION WAS TAKEN: year: Click Here for Year month: Click Here for Month
2. CHOOSE ACTION TAKEN (see instructions for code): Click Here to Choose a Code
3. WAS A PUBLIC HEARING HELD (check one)? yes no
4. NAME OF AGENCY OFFICIAL VERIFYING AND COMPLETING THIS FORM:
(type name) (signature) ______________________________________
PART II: To Be Completed By The Inland Wetlands Agency Or The Applicant
5. TOWN IN WHICH THE ACTIVITY IS OCCURRING (type name): South Windsor
does this project cross municipal boundaries (check one)? yes no
if yes, list the other town(s) in which the activity is occurring (type name(s)): ,
6. LOCATION (click on hyperlinks for information): USGS quad map name: Manchester or quad number: 38
subregional drainage basin number: 4000 & 4004
7. NAME OF APPLICANT, VIOLATOR OR PETITIONER (type name): 648 Sullivan Avenue, LLC
8. NAME & ADDRESS OF ACTIVITY / PROJECT SITE (type information): P.O. Box 504, South Glastonbury, CT 06073
briefly describe the action/project/activity (check and type information): temporary permanent description:
Proposed construction of 15,600 SF + Gravel storage area and associated stormwater improvemetns.
9. ACTIVITY PURPOSE CODE (see instructions for code): D
10. ACTIVITY TYPE CODE(S) (see instructions for codes): 2, 3, 10, 14
11. WETLAND / WATERCOURSE AREA ALTERED (see instructions for explanation, type acres or linear feet as indicated):
wetlands: 0.00 acres open water body: 0.00 acres stream: 0 linear feet
12. UPLAND AREA ALTERED (type acres as indicated): 0.01 acres
13. AREA OF WETLANDS / WATERCOURSES RESTORED, ENHANCED OR CREATED (type acres as indicated): 0.00 acres
DATE RECEIVED: PART III: To Be Completed By The DEEP DATE RETURNED TO DEEP:
FORM COMPLETED: YES NO FORM CORRECTED / COMPLETED: YES NO
GIS CODE #: ____ ____ ____ ____ ____ ____ ____ ____ ____
For DEEP Use Only