HomeMy WebLinkAboutFARNUM JR, BENJAMIN (2) T T
Massachusetts Department of Environmental Protection
DEP File Numbs
-- Bureau of Resource Protection - Wetlands
WPA Form 5 Order of Conditions 242-1224
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DE!
A. General Information
Important:
When filling From:
out forms on North Andover
the computer, Conservation Commission
use only the
tab key to This issuance if for(check one):
move your
cursor-do Z Order of Conditions
not use the
return key. Q Amended Order of Conditions
kTo: Applicant: Property Owner(if different from applicant):
Benjamin Farnum, Jr. John C. Farnum Farnum Estate Farnum Sr.
Name Name
rerun
397 Farnum Street 426 Franum Street
Mailing Address Mailing Address
North Andover MA. 01845 North Andover MA. 018,4:
City/Town State Zip Code City/Town State Zip Goc
1. Project Location: It
0 Brook Street/397 Farnum Street North Andovgk
Street Address City/Town
Map 107A Parcels 41 &246ti
Assessors Map/Plat Number Parcel/Lot Number
2: Property recorded at the Registry of Deeds for:
Essex North 642 579
County Book Page
Certificate(if registered land)
3. Dates:
10/17/03 1>7 _? _/� 'GeJ
Date Notice of Intent Filed Date Pdblic Hearing Closed Date of lssuance.
4. Final Approved Plans and Other Documents(attach additional plan references as needed):
NOI 10/17/03
Title Date
Plan of Land 10/6/03
Title Date
Title Date
5. Final Plans and Documents Signed and Stamped by:
John M. Morin P. E.
Name
6. Total Fee:
$575.00
(from Appendix B:Wetland Fee Transmittal Form)
Wpaform5.doc•rev.12/15/00- Page 1 of
y
Massachusetts Department of Environmental Protection
DEP File Nun
Bureau of Resource Protection -Wetlands
WRA Form 5 - order of Conditions 242-1224
1 Provided by E
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Findings
Findings pursuant to the Massachusetts Wetlands Protection Act:
Following the review of the above-referenced Notice of Intent and based on the information provided it
this application and presented at the public hearing, this Commission finds that the areas in which worl
proposed is significant to the following interests of the Wetlands Protection Act. Check all that apply:
Z Public Water Supply ❑ Land Containing Shellfish ® Prevention of Pollution
Z Private Water Supply ❑ Fisheries ® Protection of Wildlife Hab
Groundwater Supply ® Storm Damage Prevention Flood Control
Furthermore, this Commission hereby finds the project,as proposed, is: (check one of the following boxes)
Approved subject to:
Z the following conditions which are necessary, in accordance with the performance standards set%
in the wetlands regulations, to protect those interests checked above. This Commission orders tha
work shall be performed in accordance with the Notice of Intent referenced above, the following
General Conditions, and any other special conditions attached to this Order. To the extent that the
following conditions modify or differ from the plans, specifications, or other proposals submitted wit
the Notice of Intent, these conditions shall control.
Denied because:
❑ the proposed work cannot be conditioned to meet the performance standards set forth in the wetla
regulations to protect those interests checked above.Therefore,work on this project may not go
forward unless and until a new Notice of Intent is submitted which provides measures which are
adequate to protect these interests, and a final Order of Conditions is issued.
❑ the information submitted by the applicant is not sufficient to describe the site, the work, or the elle
of the work on the interests identified in the Wetlands Protection Act. Therefore, work on this projef
may not go forward unless and until a revised Notice of Intent is submitted which provides sufficier
information and includes measures which are adequate to protect the Act's interests, and a final
Order of Conditions is issued.A description of the specific information which is lacking and why it is
necessary is attached to this Order as per 310 CMR 10.05(6)(c).
General Conditions (only applicable to approved projects)
1. Failure to comply with all conditions stated herein, and with all related statutes and other regulator)
measures, shall be deemed.cause to revoke or modify this Order.
2. The Order does not grant any property rights or any exclusive privileges;it does not authorize any
injury to private property or invasion of private rights.
3. This Order does not relieve the permittee or any other person of the necessity of complying with al
other applicable federal, state, or local statutes, ordinances, bylaws, or regulations.
Wpaform5.doc•rev.12/15/00 Page,
T
Massachusetts Department of Environmental Protection
DEP File Numbe
Bureau of Resource Protection - Wetlands
WPA Farm 5 - Order of Conditions Provided by DEF
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Findings (cont.)
4. The work authorized hereunder shall be completed within three years from the date of this Order
unless either of the following apply:
a. the work is a maintenance dredging project as provided for in the Act; or
b. the time for completion has been extended to a specified date more than three years, but less
than five years, from the date of issuance. If this Order is intended to be valid for more than three
years,the extension date and the special circumstances warranting the extended time period are
set forth as a special condition in this Order.
5. This Order may be extended by the issuing authority for one or more periods of up to three years each
upon application to the issuing authority at least 30 days prior to the expiration date of the Order.
6. Any fill used in connection with this project shall be clean fill. Any fill shall contain no trash, refuse,
rubbish, or debris, including but not limited to lumber, bricks, plaster, wire, lath, paper, cardboard,
pipe, tires, ashes, refrigerators, motor vehicles, or parts of any of the foregoing.
7. This Order is not final until all administrative appeal periods from this Order have elapsed, or if such
an appeal has been taken,until all proceedings before the Department have been completed.
8. No work shall be undertaken until the Order has become final and then has been recorded in the
Registry of Deeds or the Land Court for the district in which the land is located,within the chain of titl
of the affected property. In the case of recorded land, the Final Order shall also be noted in the
Registry's Grantor Index under the name of the owner of the land upon which the proposed work is
be done. In the case of the registered land,the Final Order shall also be noted on the Land Court
Certificate of Title of the owner of the land upon which the proposed work is done. The recording
information shall be submitted to this Conservation Commission on the form at the end of this Order,
which form must be stamped by the Registry of Deeds, prior to the commencement of work.
9. A sign shall be displayed at the site not less then two square feet or more than three square feet in
size bearing the words,
"Massachusetts Department of Environmental Protection"[or, "MA DEP"]
"File Number 242-1224 "
10. Where the Department of Environmental Protection is requested to issue a Superseding Order, the
Conservation Commission shall be a party to all agency proceedings and hearings before DEP.
11. Upon completion of the work described herein, the applicant shall submit a Request for Certificate of
Compliance(WPA Form 8A)to the Conservation Commission.
12. The work shall conform to the plans and special conditions referenced in this order.
13. Any change to the plans identified in Condition#12 above shall require the applicant to inquire of the
Conservation Commission in writing whether the change is significant enough to require the filing of
new Notice of Intent.
14. The Agent or members of the Conservation Commission and the Department of Environmental
Protection shall have the right to enter and inspect the area subject to this Order at reasonable hour:
to evaluate compliance with the conditions stated in this Order, and may require the submittal of any
data deemed necessary by the Conservation Commission or Department for that evaluation.
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' Z
Massachusetts Department of Environmental Protection
DEP File Numk
Bureau of Resource Protection -Wetlands
WPA Form 5 - Order of Conditions 242-1224 -
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DE
B. Findings (cont.)
15. This Order of Conditions shall apply to any successor in interest or successor in control of the
property subject to this Order and to any contractor or other person performing work conditioned by
this Order.
16. Prior to the start of work, and if the project involves work adjacent to a Bordering Vegetated Wetlan;
the boundary of the wetland in the vicinity of the proposed work area shall be marked by wooden
stakes or flagging. Once in place, the wetland boundary markers shall be maintained until a
Certificate of Compliance has been issued by the Conservation Commission.
17. All sedimentation barriers shall be maintained in good repair until all disturbed areas have been full!
stabilized with vegetation or other means. At no time shall sediments be deposited in a wetland or
water body. During construction, the applicant or his/her.designee shall inspect the erosion controls
on a daily basis and shall remove accumulated sediments as needed. The applicant shall immediat,
control any erosion problems that occur at the site and shall also immediately notify the Conservab(
Commission, which reserves the right to require additional erosion and/or damage prevention conte
it may deem necessary. Sedimentation barriers shall serve as the limit of work unless another limit
work line has been approved by this Order.
Findings as to municipal bylaw or ordinance
Furthermore, the North Andover hereby finds(check one that applies):
Conservation Commission
❑ that the proposed work cannot be conditioned to meet the standards set forth in a municipal
ordinance or bylaw specifically:
Municipal Ordinance or Bylaw Citation
Therefore, work on this project may not go forward unless and until a revised Notice of Intent is
submitted which provides measures which are adequate to meet these standards, and a final Ordet
Conditions is issued.
® that the following additional conditions are necessary to comply with a municipal ordinance or byla\A
specifically:
North Andover Wetland Protection Bylaw Chapter 178
Municipal Ordinance or Bylaw Citation
The Commission orders that all work shall be performed in accordance with the said additional
conditions and with the Notice of Intent referenced above. To the extent that the following condition:
modify or differ from the plans, specifications, or other proposals submitted with the Notice of Intent
the conditions shall control:
Wpaform5.doc•rev.12/15/00 Page 4
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DEP FILE#242 - 1224
FINDINGS
The applicant filed a Notice of Intent with the Conservation Commission to
permit the construction of a new water supply pond located on active
agricultural farmland. The pond was created within bordering vegetated
wetland, located within Riverfront Area to Mosquito Brook. The pond was
constructed in August of 2002 under an emergency certification provision, which
requires the applicant to file a Notice of Intent within 60 days of the creation of
the new water supply.
The applicant failed to file a Notice of Intent within the required 60 day filing
period and was issued an Enforcement Order on February 27, 2003 and July 15,
2003. The Enforcement Orders mandated the filing of a Notice of Intent in
addition to removal of the excavated soils that had been deposited within the
wetland resource areas.
The Notice of Intent application filed on October 6,2003 addressed the
requirements of the Enforcement Order. The Order of Conditions issued for this
project permits the construction of the new water supply that has already been
completed. Several of the conditions outlined in the Order may not be relevant
as work has already been completed and the site stabilized.
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C 11/21/03
DEP FILE# 242 - 1224
Therefore, the North Andover Conservation Commission (hereafter the
"NACC") hereby finds that the following conditions are necessary, in accordance
with the Performance Standards set forth in the State Regulations, the local
ByLaw and Regulations, to protect those interests noted above. The NACC
orders that all work shall be performed in accordance with said conditions and
with the Notice of Intent referenced below. To the extent that the following
conditions modify or differ from the plans, specifications or other proposals
submitted with the Notice of Intent,the conditions shall control.
GENERAL CONDITIONS.
18. Failure to comply with all conditions stated herein, and with all related
statutes and other regulatory measures, shall be deemed cause to revoke or
modify this Order.
19. This Order does not grant any property rights or any exclusive privileges; it ,
does not authorize any injury to private property or invasion of property
rights. However, the NACC, agent of the NACC or the Department of
Environmental Protection (DEP) reserves the right to enter and inspect the
property at all reasonable times until a Certificate of Compliance is issued, to
evaluate compliance with this Order of Conditions,the Act(310 CMR 10.00),
the North Andover Wetland ByLaw and Regulations,and may require any
information, measurements, photographs, observations, and/or materials, or
may require the submittal of any data or information deemed necessary by
the NACC for that evaluation. Further, work shall be halted on the site if the
NACC, agent or DEP determines that any of the work is not in compliance
with this Order of Conditions. Work shall not resume until the NACC is
satisfied that the work will comply and has so notified the applicant in
writing.
20. This Order does not relieve the permittee or any other person of the necessity
of complying with all other applicable federal,state or local statutes,
ordinances,by-laws or regulations.
21. The work authorized hereunder shall be completed within three years from
the date of this order.
22. This Order may be extended by the issuing authority for one or more periods
of up to one year each upon application to the issuing authority at least thirty
days (30) prior to the expiration date of the Order (Refer to Section 8.3 of the
North Andover Wetland Regulations),.
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DEP FILE #242 - 1224
23. The NACC reserves the right to amend this Order of Conditions after a
legally advertised public hearing if plans or circumstances are changed or if
new conditions or information so warrant.
24.Where the Department of Environmental Protection (DEP) is requested to
make a determination and to issue a Superseding Order, the Conservation
Commission shall be a party to all agency proceedings and hearings before
the Department.
25.The conditions of this decision shall apply to, and be binding upon,the
applicant, owner, its employees and all successors and assigns in interest or
control. These obligations shall be expressed in covenants in all deeds to
succeeding owners of portions of the property.
26. The term "Applicant" as used in this Order of Conditions shall refer to the
owner, any successor in interest or successor in control of the property
referenced in the Notice of Intent, supporting documents and this Order of
Conditions. The NACC shall be notified in writing within 30 days of all
transfers of title of any portion of property that takes place prior to the
issuance of a Certificate of Compliance.
27. The proposed work includes: The construction of an agricultural water
supply pond located within bordering vegetated wetland and Riverfront
Area associated with Boston Brook.The pond has been constructed under
an Emergency Certification status.
28. The work shall conform to the following (except as noted in the remainder of
this document where revisions may be required):
Notice of Intent filed by: Benjamin Farnum,Jr.
0 Brook Street/397 Farnum Street
North Andover, MA 01845
Bated 10/17/03
Site Plans prepared by: Thomas E.Neve Associates, Inc.
447 Old Boston Road
Topsfield, Massachusetts,01983
Entitled: Plan of Land, in North Andover, Mass.
Showing "Existing Site Conditions"
For Emergency Water Supply Pond at
Boston Hill Farm, Prepared for
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DEP FILE #242 1224
Benjamin Farnum, dated October 6,
2003;
Letters: Prepared by Thomas E. Neve
Associates, Inc. dated October 6,2003;
Prepared by Thomas E. Neve
Associates, Inc., dated August 6, 2003;
Prepared by Julie Parrino,
Conservation Administrator, dated
April 3, 2003;
Enforcement Orders: Issued by North Andover Conservation
Department dated February 27, 2003
and July 15,2003;
29. The following wetland resource areas are affected by the proposed work:
Bordering Vegetated Wetland, Riverfront Area and Buffer Zone to
Bordering Vegetated Wetland. These resource areas are significant to the
interests of the Act and Town ByLaw as noted above and therein. The
applicant has not attempted to overcome the presumption of significance of
these resource areas to the identified interests.
30. The NACC agrees with the applicant's delineation of the wetland resource
areas on the site as shown on the plans dated referenced herein.
31.This document shall be included in all construction contracts,subcontracts,
and specifications dealing with the work proposed and shall supersede any
conflicting contract requirements. The applicant shall assure that all
contractors, subcontractors, and other personnel performing the permitting
work are fully aware of the permits terms and conditions. Thereafter, the
contractor will be held jointly liable for any violation of this Order resulting
from failure to comply with its conditions.
32. The owners of the project and their successors in title,in the event they
proceed to alter areas subject to the Commission. 's jurisdiction under the
order, agree that the Order does not in itself impose upon the Town any
responsibility to maintain the proposed drainage system: and that said Town
shall not be liable for any damage in the event of failure. By acceptance of
this Order, the owners agree to indemnify and hold harmless to the Town
and its residents for any damage attributable to alterations undertaken on
this property pursuant to the Order. Issuance of these Conditions does not in
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DEP FILE #242 - 1224
any way imply or certify that the site or downstream areas will not be subject
to flooding, storm damage or any other form of water damage. Maintenance
of the drainage system, if accepted by the Town as part of a public way,
becomes the responsibility of the Town.
33. Issuance of these Conditions does not in any way imply or certify that the site
or downstream areas will not be subject to flooding, storm damage or any
other form of water damage.
PRIOR TO CONSTRUCTION
34. No work shall be undertaken until all administrative appeal periods from this
Order have elapsed or, if such an appeal has been filed,until all proceedings
before the Department or Court have been completed.
35. This Order shall be recorded by the applicant at the Registry of Deeds
immediately after the expiration of all appeal periods. No work shall be ,
undertaken until the Final,Order has been recorded in the Registry of Deeds
or the Land Court for the district in which the land is located,within the
chain of title of the affected property. In the case of recorded land, the Final
Order shall also be noted in the Registry's Grantor Index under the name of
the owner of the land upon which the proposed work is to be done. In the
case of registered land, the Final Order shall also be noted on the Land Court
Certificate of Title of the owner of the land upon which the proposed work is
to be done. The recording information shall be submitted to the North
Andover Conservation Commission on the form at the end of this Order
prior to commencement of the work. Any Order not recorded by the
applicant before work commences may be recorded by the NACC at the
applicant's expense.
36.A sign shall be displayed at the site not less than two square feet or more than
three square feet in size bearing the words "Massachusetts DEP, File
Number 242-1224.
37. Any changes in the submitted plans caused by the applicant, another
Board's decision or resulting from this Order of Conditions must be
submitted to the NACC for approval prior to implementation. If the NACC
finds said changes to be significant, the NACC will call for another public
hearing (at the expense of the applicant). Within 21 days of the close of said
public hearing the NACC will issue an amended or new Order of Conditions.
Any errors found in the plans or information submitted by the applicant shall
be considered as changes. The proposed project may be still under review by
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DEP FILE #242 - 1224
other local or state boards or agencies. This may result in changes to the
projectplans lans or wetland impacts. If any such changes occur a revised plan
and an explanation of the revisions shall be submitted to the NACC for
review and approval prior to the start of construction. No work shall begin
on a project until written approval has been granted by the NACC.
38. It is the responsibility of the applicant, owner, and/or successor(s) to ensure
that all conditions of this Order of Conditions are complied with. The project
engineer and contractors are to be provided with a copy of this Order of
Conditions and referenced documents before commencement of construction.
39. The applicant and/or the legal owner of that portion of land upon which
these Orders of Conditions have been placed shall provide to the NACC prior
to transferring, or assigning any portion of said land to another party,
subject to said Orders of Conditions, the "Compliance Certification Form
Affidavit" attached via "Appendix A" signed under the pains and penalties
of perjury,stating that said applicant and/or owner has read these Orders of
Conditions and is in compliance with each and every condition. This
document shall apply to each of the conditions referenced herein and shall
be provided to the Conservation Department at least five (5)business days
prior to the closing of said land transaction.
40. Any fill used in connection with this project shall be clean fill, containing no
trash, refuse, rubbish or debris,including but not limited to lumber,bricks,
plaster, wire,lath,paper,cardboard,pipe, tires, ashes,refrigerators, motor
vehicles or parts on any of the foregoing.
41. No exposed area shall remain unfinished for more than thirty (30) days,
unless approved by the NACC_
42.No re-grading in the buffer zone shall have a slope steeper than 2-1
(horizontal: vertical). Slopes of steeper grade shall be rip-rapped to provide
permanent stabilization.
43. There shall be no stockpiling of soil or other materials within twenty-five (25)
feet of any resource area.
44.Washings from concrete trucks,or surplus concrete, shall not be directed to,
any drainage system,or wetland resource area.
45. All waste generated by,or associated with, the construction activity shall be
contained within the construction area, and away from any wetland resource
area. There shall be no burying of spent construction materials or disposal of
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DEP FILE #242 - 1224
waste on the site by any other means. The applicant shall maintain
dumpsters (or other suitable means) at the site for the storage and removal of
such spent construction materials off-site. However,no trash dumpsters will
be allowed within 50' of areas subject to protection under the Act or local
Bylaw.
46. Accepted engineering and construction standards and procedures shall be
followed in the completion of the project.
47. During and after work on this project,there shall be no discharge or spillage
of fuel, or other pollutants into any wetland resource area. If there is a spill
or discharge of any pollutant during any phase of construction the NACC
shall be notified by the applicant within one (1)business day. No
construction vehicles are to be stored within 100 feet of wetland resource
areas, and no vehicle refueling, equipment lubrication, or maintenance is to
be done within 100 feet of a resource area.
L I-- 1
AFTER CONSTRUCTION
48. No underground storage of fuel oils shall be allowed on any lot within one-
hundred (100) feet of any wetland resource area. This condition shall survive
this Order of Conditions and shall run with the title of the property. This
condition is issued under the authority of the Town's Wetland protection
Bylaw. '
49. Upon completion of construction and grading, all disturbed areas located
outside resource areas shall be stabilized permanently against erosion. This
shall be done either by foaming and seeding according to SCS standards. If
the latter course is chosen, stabilization will be considered complete once
vegetative cover has been achieved.
50. Upon complete stabilization of the site,erosion controls shall be removed and
disposed off properly. All unstabiiized areas under the erosion controls shall
be seeded immediately.
51.Upon completion of the project the applicant shall submit the following to the
Conservation Commission as part of a request for a Certificate of Compliance.
a. WPA Form 8A-"Request for a Certificate of Compliance."
b. A letter from the applicant requesting a Certificate of Compliance.
e. The name and address of the current landowner.
d. Signed statements from the individual property
owners shall be
submitted with the request for a Certificate of Compliance indicating
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DEP FILE # 242 - 1224
that they read and understood the recorded Order of Conditions prior
to purchasing their property.
e. The name and address of the individual/trust or corporation to whom
the compliance is to be granted.
f. The street address and assessor's map/parcel number for the project.
g. The DEP file number.
h. A written statement from a Registered Professional Civil Engineer
(and/or Registered Professional Land Surveyor) of the
Commonwealth certifying that the work has been conducted as shown
on the plan(s) and documents referenced above, and as conditioned by
the Commission.
i. A letter from a qualified wetland specialist stating all areas have
been stabilized and disturbed resource areas have been restored.
CAWinword\00C\242-1224.doc 8 NACC 11/21/03
c x
Massachusetts Department of Environmental Protection
DEP File Num
-- Bureau of Resource Protection - Wetlands
V1/PA Form 5 -- Order of ConditionsProvided by DI 242-1224
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Findings (cont.)
Additional conditions relating to municipal ordinance or bylaw:
See attached
This Order is valid for three years, unless otherwise specified as a special condition pursuant to Gener
Conditions#4, from the ate of issuance.
2!
Date ?
This Order must be signed by a majority of the Conservation Commission. The Order must be mailed b
certified mail (return receipt requested)or hand delivered to the applicant. A copy also must be mailed c
hand delivered at the same time to th appropriate Department of Environmental Pr n Regional
Office(see Appendix A) and the pro rty owner(if different from applicant). -
Signatu -
�! 'K4
t
On `1 Of 11 J
Day Month anti Year
before me personally appeared
1
to me known to be the person described in and who executed the foregoing instrument and
acknowledged that he/she executed the same as his/her free act and deed.
1 b 610.9
N tary Public My Co mis n Expires
This Order is issued to the applicant as follows:
❑ by hand delivery on [Z/by certified mail, return receipt requested,c
Date Date
Wpaform5.doc-rev.12/15/00 Page 5.
1 i
Massachusetts Department of Environmental Protection
DEP File Numb(
Bureau of Resource Protection - Wetlands
WPA Form 5 - Order of Conditions 242-1224
1
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEI
C. Appeals
The applicant, the owner,any person aggrieved by this Order, any owner of land abutting the land subjef
to this Order, or any ten residents of the city or town in which such land is located, are hereby notified of
their right to request the appropriate DEP Regional Office to issue a Superseding Order of Conditions.
The request must be made by certified mail or hand delivery to the Department,with the appropriate filing
fee and a completed Appendix E: Request of Departmental Action Fee Transmittal Form, as provided in
310 CMR 10.03(7)within ten business days from the date of issuance of this Order. A copy of the reque:
shall at the same time be sent by certified mail or hand delivery to the Conservation Commission and to
the applicant, if he/she is not the appellant.
The request shall state clearly and concisely the objections to the Order which is being appealed and ha
the Order does not contribute to the protection of the interests identified in the Massachusetts Wetlands
Protection Act, (M.G.L. c. 131, §40)and is inconsistent with the wetlands regulations(310 CMR 10.00).
To the extent that the Order is based on a municipal ordinance or bylaw, and not on the Massachusetts
Wetlands Protection Act or regulations, the Department has no appellate jurisdiction.
D. Recording Information
This Order of Conditions must be recorded in the Registry of Deeds or the Land Court for the district in
which the land is located, within the chain of title of the affected property. In the case of recorded land, th
Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land
subject to the Order. In the case of registered land, this Order shall also be noted on the Land Court
Certificate of Title of the owner of the land subject to the Order of Conditions.The recording information
on Page 7 of Form 5 shall be submitted to the Conservation Commission listed below.
North Andover
Conservation Commission
Wpaform5.doc•rev.12/15/00 Page 6 cf
x
Massachusetts Department of Environmental Protection
DEP File Numb(
Bureau of Resource Protection - Wetlands
WPA Form 5 - order of Conditions 242-1224
1
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEI
D. Recording Information (cont.)
Detach on dotted line, have stamped by the Registry of Deeds and submit to the Conservation Commissior
-----------------------------------------------------------------------------------------------------------------------
To:
North Andover
Conservation Commission
Please be advised that the Order of Conditions for the Project at:
242-1224
Project Location DEP File Number
Has been recorded at the Registry of Deeds of
County Book Page
s
for:
Property Owner
and has been noted in the chain of title of the affected property in:
Book Page
In accordance with the Order of Conditions issued on:
Date
If recorded land, the instrument number identifying this transaction is:
Instrument Number
If registered land, the document number identifying this transaction is:
Document Number
Signature of Applicant
Wpaform5.doc•rev.12/15/00 - Page 7 of
DEP FILE #242 - 1224
APPENDIX A-AFFIDAVIT
1, on oath do hereby depose and state:
(authorized agent applicant and/or current owner)
(PLEASE CBECK AT LEAST ONE BLOCK)
1. I am the of
(position with applicant) (applicant name or company name)
the applicant upon whom Order of Conditions
have been placed upon by (DEP or NACC number)
the North Andover Conservation Commission.
&/or
2. I am the of
(position with owner) (owner name)
the owner upon whose land Order of Conditions
have been placed up by (DEP or NACC number)
the North Andover Conservation Commission.
3. 1 hereby affirm and acknowledge that I have received said Order of Conditions
and have read the same and understand each
(DEP File#j and every condition which has been set forth
in said Order of Conditions.
4. I hereby affirm and acknowledge that on this day of 19
1 inspected said property together with any and all improvements which have
been made to the same and hereby certify that each and every condition set
forth in Order of Conditions are presently in compliance.
(DEP File#)
5. 1 hereby affirm and acknowledge that this document will be relied upon by the
North Andover Conservation Commission as well as any potential buyers of
said property which is subject to said Order of Conditions
(DEP File#)
Signed under the pains and penalties of perjury this day of 19
(Signature-authorized agent of applicant or owner)
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1/03
r ,
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Appendix E — Request for Departmental Action Fee Transmittal Form
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
A. Request Information
Important: 1. Person or a making request(If appropriate, name the citizen group's representative):
When filling
out forms on
the computer, Name
use only the
tab key to Mailing Address
move your
cursor-do City/Town State Zip Code
not use the
return key. Phone Number Fax Number(if applicable)
,a Project Location
Mailing Address
rertrn
City/Town State Zip Code
2. Applicant(as shown on Notice of Intent(Form 3),Abbreviated Notice of Resource Area Delineation
(Form 4A); or Request for Determination of Applicability(Form 1)):
Name
Mailing Address
City/rown State Zip Code
Phone Number Fax.Number(if applicable)
3. DEP File Number
B. Instructions
1. When the Departmental action request is for(check one):
❑ Superseding,Order of Conditions
❑ Superseding Determination of Applicability
❑ Superseding Order of Resource Area Delineation
Send this form and check or money order for$50.00, payable to the Commonwealth of Massachusetts to:
Department of Environmental Protection
Box 4062
Boston, MA 02211
wpaform5.doc•Appendix E•rev.11/3/03 Page 1 of
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Appendix E Request for Departmental Action fee Transmittal Form
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Instructions (cont.)
2. On a separate sheet attached to this farm, state clearly and concisely the objections to the
Determination or Order which is being appealed. To the extent that the Determination or Order is
based on a municipal bylaw, and not on the Massachusetts Wetlands Protection Act or regulations,
the Department has no appellate jurisdiction.
3. Send a copy of this form and a copy of the check or money order with the Request for a Supersedin
Determination or Order by certified mail or hand delivery to the appropriate DEP Regional Office(seE
Appendix A).
4. A copy of the request shall at the same time be sent by certified mail or hand delivery to the
Conservation Commission and to the applicant, if he/she is not the appellant.
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