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Home My WebLink AboutMiscellaneous - 650 FOREST STREET E Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands DEP File Number: WPA Form 8B — Certificate of Compliance 1 Massachusetts Wetlands 24vided b e .ands Protection Act M.G.L. c. 131 40 Provided by DEP A. Project Information Important: When filling out 1. This Certificate of Compliance is issued to: forms on the Robert& Patricia Gohn computer, use only the tab Name key to move 650 Forest Street your cursor- Mailing Address do not use the North Andover MA. 01845 return key. City/Town State Zip Code Q 2. This Certificate of Compliance is issued for work regulated by a final Order of Conditions issued to: James Wilhelm Name ,ems, 4/16/02 242-1130 Dated DEP File Number 3. The project site is located at: 650 Forest Street -North Andover Street Address City/Town Map 105D Parcel 24 Assessors Map/Plat Number Parcel/Lot Number the final Order of Condition was recorded at the Registry of Deeds for: Robert& Patricia Gohn Property Owner(if different) Essex North 6797 290 County Book Page N/A Certificate 4. A site inspection was made in the presence of the applicant, or the applicant's agent, on: 5/10/04 Date B. Certification Check all that apply: ® Complete Certification: It is hereby certified that the work regulated by the above-referenced Order of Conditions has been satisfactorily completed. ❑ Partial Certification: It is hereby certified that only the following portions of work regulated by the above-referenced Order of Conditions have been satisfactorily completed. The project areas or work subject to this partial certification that have been completed and are released from this Order are: wpatorm 8b.doc•rev.12/15/00 Page 1 of 3 A Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands DEP File Number. WPA Form 8B — Certificate of Compliance 242-1130 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP B. Certification (cont.) ❑ Invalid Order of Conditions: It is hereby certified that the work regulated by the above- referenced Order of Conditions never commenced. The Order of Conditions has lapsed and is therefore no longer valid. No future work subject to regulation under the Wetlands Protection Act may commence without filing a new Notice of Intent and receiving a new Order of Conditions. ® Ongoing Conditions: The following conditions of the Order shall continue: (Include any conditions contained in the Final Order, such as maintenance or monitoring, that should continue for a longer period). Condition Numbers: 62 C. Authorization Issued by: North Andover Conservation Commission Date 6f Iss ance This Certificate must be signed by a majority of the Conservation Commission a cop sent to the applicant and appropriate DEP Regional Office(See Appendix A). Signatures: On I Of Mcc �a Day Month an Year before me personally appeared 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. N ry Pubic My com MM�� K� NOTARYK%C SCGI #TNGFST v✓paform Sb.doc-rev.12/15/00 age 2 of 3 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands DEP File Number. WPA Form 8B - Certificate of Compliance 242-1130 Massachusetts Wetlands Protection Act M.G.L. c. 13.1, §40 Provided by DEP D. Recording Confirmation The applicant is responsible for ensuring that this Certificate of Compliance is recorded in the Registry of Deeds or the Land Court for the district in which the land is located. Detach on dotted line and submit to the issi Conservation Commission. t C m on To: North Andover Conservation Commission Please be advised that the Certificate of Compliance for the project at: 242-1130 Project Location DEP File Number,' Has been recorded at the Registry of Deeds of: County for: Property Owner and has been noted in the chain of title of the affected property on: Date Book Page If recorded land, the instrument number which identifies this transaction is: If registered land, the document number which identifies this transaction is: Document Number Signature of Applicant wpaform 8b.doc•rev.12/15/00 Page 3 of 3 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Appendix A - DEP Regional Addresses Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Mail transmittal forms and DEP payments,payable to Commonwealth of Massachusetts Department of Environmental Protection Box 4062 Boston, MA 0221 DEP Western Region Adams Colrain Hampden Monroe Pittsfield Tyringhem 436 Dwight Street Agawam Conway Hancock Montague Plainfield Wales Alford Cummington Hatfield Monterey Richmond Ware Suite 402 Amherst Dalton Hawley Montgomery Rowe Warwick Springfield,MA 01103 Ashfield Deerfield Heath Monson Russell Washington Phone:413-784-1100 Becket Easthampton Hinsdale Mount Washington Sandisfield Wendell Belchertown East Longmeadow Holland New Ashford Savoy Westfield Fax:413-784-1149 Bernardston Egremont Holyoke New Marlborough Sheffield Westhampton Blandford Erving Huntington New Salem Shelburne West Springfield Brimfield Florida Lanesborough North Adams Shutesbury West Stockbridge Buckland Gill Lee Northampton Southampton Whately Charlemont Goshen Lenox Northfield South Hadley Wilbraham Cheshire Granby Leverett Orange Southwick Williamsburg Chester Granville Leyden Otis Springfield Williamstown Chesterfield Great Barrington Longmeadow Palmer Stockbridge Windsor Chicopee Greenfield Ludlow Pelham Sunderland Worthington Clarksburg Hadley Middlefield Peru Tolland DEP Central Region Acton Chariton Hopkinton Millbury Rutland Uxbridge 627 Main Street Ashburnham Clinton Hubbardston Millville Shirley Warren Ashby Douglas Hudson New Braintree v Shrewsbury Webster Worcester,MA 01605 Athol Dudley Holliston Northborough Southborough Westborough Phone:508-792-7650 Auburn Dunstable Lancater Northbridge Southbridge West Boylston Fax:508-792-7621 Ayer East Brookfield Leicester North Brookfield Spencer West Brookfield Barre Fitchbbrg Leominster Oakham Sterling Westford TDD:508-767-2788 Bellingham Gardner Littleton Oxford Stow Westminster Berlin Grafton Lunenburg Paxton Sturbridge Winchendon Blackstone Groton Marlborough Pepperell Sutton Worcester Bolton Harvard Maynard Petersham Templeton Boxborough Hardwick Medway Phillipston Townsend Boylston Holden Mendon Princeton Tyngsborough Brookfield Hopedale Milford Royalston Upton DEP Southeast Region Abington Dartmouth Freetown Mattapoisett Provincetown Tisbury 20 Riverside Drive Acushnet Dennis Gay Head Middleborough Raynham Truro Attleboro Dighton Gosnold Nantucket Rehoboth Wareham Lakeville, MA 02347 Avon Duxbury Halifax NewBedford Rochester Wellfleet Phone:508-946-2700 Barnstable Eastham Hanover North Attleborough Rockland West Bridgewater Fax:508-947-6557 Berkley East Bridgewater Hanson Norton Sandwich Westport Bourne Easton Harwich Norwell Scituate West Tisbury TDD:508-946-2795 Brewster Edgartown Kingston Oak Bluffs Seekonk Whitman Bridgewater Fairhaven Lakeville Orleans Sharon Wrentham Brockton Fall River Mansfield Pembroke Somerset Yarmouth Carver Falmouth Marion Plainville Stoughton Chatham Foxborough Marshfield Plymouth Swansea Chilmark Franklin Mashpee Plympton Taunton DEP Northeast Region Amesbury Chelmsford Hingham Merrimac Quincy Wakefield 205 Lowell Street Andover Chelsea Holbrook Methuen Randolph Walpole Arlington Cohasset Hull Middleton Reading Waltham Wilmington,MA 01887 Ashland Concord Ipswich Millis Revere Watertown Phone: 978-661-7600 Bedford Danvers Lawrence Milton Rockport Wayland Fax: 978 661-7615 Belmont Dedham Lexington Nahant Rowley Wellesley Beverly Dover Lincoln Natick Salem Wenham TDD:978-661-7679 Billerica Dracut Lowell Needham Salisbury West Newbury Boston Essex Lynn Newbury Saugus Weston Boxford Everett Lyynnfield Newburyport Sherborn Westwood Braintree Framingham Malden Newton Somerville Weymouth Brookline Georgetown Manchester-By-The-Sea Norfolk Stoneham Wilmington Burlington Gloucester Marblehead North Andover Sudbury Winchester Cambridge Groveland Medfield North Reading Swampscott Winthrop Canton Hamilton Medford Norwood Tewksbury Woburn Carlisle Haverhill Melrose Peabody Topsfield wpaform8b.doc•Appendix A•rev.5/12/04 Page 1 of 1