HomeMy WebLinkAboutMiscellaneous - 97 COTUIT STREET Town of North Andover koRTH
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Office of the Conservation Department
Community Development and Services Division
27 Charles Street y��gcNus¢`
North Andover,Massachusetts 01845 Telephone(978)688-9530
Alisan E. McKay
Conservation Administrator Fax(978)688-9542
Modification to Order of Conditions
The NORTH ANDOVER CONSERVATION COMMISSION agreed to accept
Applicant: 7_c�n �Bur Ke.
71 St,�,+-6,, h.'11 -Ra m A
U0,kh &n ova , M A ®►gY5
AA Q i-4 le-A "Ca,s,,jo kon As J.f 4 95-- 9 7
Mew {a )C)05 Dre .0 L1 bit Ne ; tWo-,d a"a inZ-Zf-Aa Se-VV e3 T„c ,
as a Modification to the Order of Conditions issued in File 242- 1 iv 9 dated Z and
recorded in TPa c.:4 7 9 63 f
Issued by the NORTH ANDOVEF,CONSERVATION COMMISSION•
V //V/ 'A A
On this 5 fih of Ma �OaS before me personally appeared Scott Masse to me
day i onth/yr
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.
WJNA K WEDGE
Notary Public Ft-7--_
nears
A receipt from the Lawrence Registry of Deeds must be submitted to this office showing
that this Modification has been recorded and referenced to the book and page numbers.
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
L 1
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands DEP File Number:
WPA Form 8B — Certificate of Compliance
242-1149
Massachusetts Wetlands 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 Greenland Construction
computer, use Name
only the tab
key to move p 0. Box 737
your cursor- Mailing Address
do not use the Rye Beech NH. 03871
return key. City/Town State Zip Code
r� 2. This Certificate of Compliance is issued for work regulated by a final Order of Conditions issued to:
John Burke
Name
7/25/02 242-1149
Dated DEP Fite Number
3. The project site is located at:
95-97 Cotuit Street North Andover
Street Address City/Town
Map 23 Parcel 17
Assessors Map/Plat Number Parcel/Lot Number
the final Order of Condition was recorded at the Registry of Deeds for:
John Burke
Property Owner(if different)
Essex North Document#9863 3/11/04
County Book Page
Certificate
4. A site inspection was made in the presence of the applicant, or the applicant's agent, on:
5/23/05
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.
II
❑ 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:
wpaform 8b.doc•rev.7/13/04 Page 1 of 4
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands DEP File Number:
WPA Form 8B — Certificate of Compliance
242-1149
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:
60
C. Authorization
Issued by:
North Andover5-
Conservation Commission Date 9f issuafice
This Certificate must be signed by a majority of the Conservation Commissi n a copy sent to the
applicant and appropriate DEP Regional Office(See Attachment).
Signat res:
it
wpaform 8b.doc•rev.7/13/04 Page 2 of 4
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 8B — Certificate of Compliance
� 242-1149
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
C. Authorization (cont.)
Notary Acknowledgement
Commonwealth of Massachusetts County of Essex North
a� ' M a aoo
On this Day Of Month Year
before me, the undersigned Notary Public, personally appeared
Name of Document Signer
proved to me through satisfactory evidence of identification,which was/were
Massachusetts License
Description of evidence of identification
to be the person whose name is signed on the preceding or attached document, and acknowledged
tome that he/she signed it voluntarily for its stated purpose.
As member of North Andover Conservation Commission
Cityrrown
B��M/Mr•
Signature of Notary Public
L�i�
DONNA M.WEDGE
NOTARY PUBUC
COMMONWEALTH OF MASSACMUS M Printed Name of Notary Public
My Comm.Exom Aug.7.2=
17
My C mis ion Ijkpires(Date)
Place nota seal and/or an stamp above e.—
notary Y P
S nature of Notary Public
wpaform 8b.doc•rev.7/13/04 Page 3 of 4
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
L11 WPA Form 8B — Certificate of Compliance
242-1149
Massachusetts Wetlands Protection Act M.G.L. c. 131, §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 Conservation Commission.
To:
North Andover
Conservation Commission
Please be advised that the Certificate of Compliance for the project at:
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 6b.doc•rev.7/13/04 Page 4 of 4
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands
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 02211
DEP Western Region Adams Colrain Hampden Monroe Pittsfield Tyringham
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 Charlton Hopkinton Millbury Rutland Uxbridge
627 Main Street Ashbumham Clinton Hubbardston Millville Shirley Warren
Ashby Douglas Hudson 'New Braintree Shrewsbury Webster
Worcester,MA 01608 Athol Dudley Holliston Northborough Southborough Westborough
Phone: 508-792-7650 Auburn Dunstable Lancaster Northbridge Southbridge West Boylston
Fax:508-792-7621 Ayer East Brookfield Leicester North Brookfield Spencer West Brookfield
Barre Fitchburg 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 New Bedford 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
1 Winter Street Andover Chelsea Holbrook Methuen Randolph Walpole
Arlington Cohasset Hull Middleton Reading Waltham
Boston,MA 02108 Ashland Concord Ipswich Millis Revere Watertown
Phone:617-654-6500 Bedford Danvers Lawrence Milton Rockport Wayland
Fax: 617-556-1049 Belmont Dedham Lexington Nahant Rowley Wellesley
Beverly Dover Lincoln Natick Salem Wenham
TDD:617-574-6868 Billerica Dracut Lowell Needham Salisbury West Newbury
Boston Essex Lynn Newbury Saugus Weston
Boxford Everett Lynnfield Newburyport Sherbom 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•DEP Addresses-rev.5/23/05 Page 1 of 1
Massachusetts Department of Environmental Protection DEP File Number
Bureau of Resource Protection -Wetlands Anen
WPA Form 5 Order of Conditions 242-1149
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
A. General Information
Important: From:
When filling
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 ❑ Order of Conditions
not use the
return key. ® Amended Order of Conditions
To: Applicant: Property Owner(f different from applicant):
John Burke
Nam Name
71 Sutton Hill Road
Mailing Address Mailing Address
North Andover MA 01845 •
City/Town State Zip Code Cdy/Town State Zip Code
1. Project Location:
Cotuit Street North Andover
Street Address Cky/fown
23 17
Assessors Map/Plat Number Parce"Number
2, Property recorded at the Registry of Deeds for.
Essex North 1373 797
County Book Page
Certificate(if registered land)
3. Dates:
5/31/02 7/24/02 7/25/02
Date Notice of Intent Filed Date Public Hearing Closed Date of issuance
4. Final Approved Plans and Other Documents(attach additional plan references as needed):
Site Plan, Cotuit Street, N.Andover, MA 5/31/02,final
Title revised 2117/04
Notice of Intent 5/31/02
Title Date
Title Date
5. Final Plans and Documents Signed and Stamped by:
Richard C. Tangarrl, P. E.
Name
6. Total Fee:
$250
(from Appendix B:Wetland Fee Transmittal Form)
Wpaform5.doc•rev.2126/04 Page 1 of 7
Massachusetts Department of Environmental Prot 'on DEP File Number:
Bureau of Resource Protection -Wetlands AMe�j
WPA Form 5 order of Conditions 242-1149
l
Massachusetts Wetlands Protection Act M.G.L. e. 131, §40 Provided by DEP
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 in
this application and presented at the public hearing,this Commission firms that the areas in which work is
proposed is significant to the following interests of the Wetlands Protection Ad. Check all that apply:
® Public Water Supply [] Land Containing Shellfish ® Prevention of Pollution
® Private Water Supply ® Fisheries ® Protection of Wildlife Habitat
® Groundwater Supply ® Storm Damage Prevention Flood Control
Furthermore,this Commission hereby finds the project,as proposed,is:(c)eck one of the Hollowing boxes)
Approved subject to:
® the following conditions which are necessary, in accordance with the performance standards set forth
in the wetlands regulations,to protect those interests checked above.This Commission orders that all
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 pians,specifications, or other proposals submitted with
the Notice of Intenf 'these conditions shall control.
Denied because:
❑ the proposed work cannot be conditioned to meet the performance standards set forth in the wetland
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 effect
of the work on the interests identified in the Wetlands Protection Act.Therefore,work on this project
may not go forward unless and until a revised Notice of Intent is submitted which provides sufficient
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 regulatory
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 all
other applicable federal,state,or local statutes,ordinances, bylaws, or regulations.
Wpaform5.doc.rev.2/26/04 Page 2 of 7
Massachusetts Department of Environmental Protection DEP File Number:
Bureau of Resource Protection -Wetlands
_ '�� 242-1149
WPA Form 5 Order of Go critions 242-1149
Lilt Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Pmvkled by Obi
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 Omer 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 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 ca$e of the registered lard,the Final Order shalt 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'for, `MA DEP']
"File Number242-1149
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 a
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 hours
to evaluate compliance with the conditions stated in this Omer, and may require the submittal of any
data deemed necessary by the Conservation Commission or Department for that evaluation.
Wpaform5.doc•rev.2/26/00 Page 3 of 7
Massachusetts Department of Environmental Protection DEP File Number:
(t Bureau of Resource Protection -WetlandsA" 242-1149
WPA Form 5 - Order of Conditions Provided byDEP
1 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
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 Omer 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 Wetland,
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 fully
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 immediately
control any erosion problems that occur at the site and shall also immediately notify the Conservation
Commission,which reserves the right to require additional erosion and/or damage prevention controls
it may deem necessary. Sedimentation barriers shall serve as the limit of work unless another limit of
work line has been approved by this Omer.
Findings as to municipal bylaw or ordinance
Furthermore,the North Andover hereby finds(check one that applies):
Conse►mrw Com r on
❑ that the proposed work cannot be conditioned to meet the standards set forth in a municipal
ordinance or bylaw specifically:
Municipal Ordinance or Bylaw cin
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 Order of
Conditions is issued.
® that the following additional conditions are necessary to comply with a municipal ordinance or bylaw,
specifically:
Chapter 178 of the Code of North Andover
Municipal Ordinance or Bylaw cvafion
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 conditions
modify or differ from the plans,specifications, or other proposals submitted with the Notice of Intent,
the conditions shall control.
Wpaform5.doc•rev.2/26!04 Page 4 of 7
AMENDMENT-LOT 17 COTUIT STREET-242-1149
At their meeting of February 25, 2004, The North Andover Conservation Commission(NACC)
voted unanimously to amend the Order of Conditions for Lot 17 Cotuit Street (242-1149). The
applicant had requested a modification for the construction of a duplex dwelling and associated
changes in place of the previously approved single-family dwelling. The proposed changes were
minor. However, upon review of the original Order of Conditions by the Interim Administrator,
several "boiler plate" conditions were omitted from the original Order,of which should be
incorporated into the Order. Therefore an amended Order was more appropriate to incorporate
these additional conditions.
Amendments to Lot 17 Cotuit Street include the construction of a duplex dwelling,in
replacement of the previously approved single family dwelling,an additional garage stall,
driveway extension, an additional deck and associated stairway,an extension of the front
walkway,a wooden guardrail,and a 4' tall stockade fence.
Condition#28 of the Order of Conditions shall be amended to include the following record
documents associated with the approval:
Site Plans prepared by: New England Engineering Services,Inc. •
60 Beechwood Drive
North Andover,Massachusetts
Entitled: Siie Plan
Cotuit Street
N.Andover,MA
Dated May 31,2002; Last Revised 2/17/04
All conditions in the original Order must be complied with,in addition to the following additional
conditions:
1. The Amended Order of Conditions shall be recorded in accordance with condition #36.
2. Prior to construction,the applicant shall stake the dwelling foundation and
decks/stairs corners by survey.
3. Immediately upon completion of the dwelling foundation,and prior to further
construction activities associated with the site,the applicant shag complete a plan
prepared by a Registered Professional Land Surveyor of the Commonwealth
(R.P.L.S.),which accurately depicts the foundation location and its proximity to the
wetland resource areas as approved under this Order of Conditions. Said plan shall be
submitted to the Conservation Administrator for approval.
4. The NACC agrees with the applicant's delineation of the wetland resource areas on the
site as shown on the plans date referenced herein,with the exception of flags B-17 to
f 7 4 04 but not referenced in the .original inal Order
B-22(as noted m the minutes o /Z i � )
Massachusetts Department of'Environmennnta��l__Protection DEP File Number:
Bureau of Resource Protection -Wetlands
/rn x%rXX°�f3
LI WPA Form 5 - Order of Conditions 242-
Provided by DEP
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 General
Conditions 44,from the date of issua ce.
-71,151U. it �S
Date
This Order must be signed by a majority of the Conservation Commission.The Order must be mailed by
certified mail (return receipt requested)or hand delivered to the applicant.A copy also must be mailed or
hand delivered at the same time to the appropriate Department of Environmental ection Regional
Office(see Appendix A) and the prope caner(if different from applicant).
Signatures:
On � Oft7tuor o�b0
Day Morrth and Year
before me personally appeared
to me known to be the person described in and who executed the foreg "
acknowledged that he/she executed the same as his/her free act and d DONNA V GIG
f t;01MOMMf11l1HdFMASSAt� �B
ARY
Notary Public My comm ssi E `
This Order is issued to the applicant as follows:
b hand delivery on (�b certified mail,return receipt requested, on
❑ Y
Y rY
Date Date
Wpaform5.doc•rev.12/15/00 Page 5 of 7
Massachusetts Department of Environmental Protec 'on DEP File Number:
Bureau of Resource Protection -Wetlands 1�� A. M
242-1149
WPA Form 5 - Order of Conitions
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
C. Appeals
The applicant,the owner, any person aggrieved by this Order, any owner of land abutting the land subject
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 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.
The request shall state clearly and concisely the objections to the Order which is being appealed and how
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,the
Final Order shall also be nOed 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
Wpaform&doc•rev.2126104 Page 6 of 7
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands DEP File Number
WPA Form 5 - Order of Conditions Provided 24 by DEP
L LMassachusetts Wetlands Protection Act M.G.L. c. 131, §40
D. Recording Information (cont.)
Detach on dotted line,have stamped by the Registry of Deeds and submit to the Conservation Commission.
-------------------------------------------------------------------------------------------------------------------------
To:
North Andover
Conservation Commission
QM2n[�
Please be advised that the Order of Conditions for the Project at:
Lot 17 Cotuit Street 242-1149
Project Location DEP File.Number
Has been recorded at the Registry of Deeds of:
County Book Page
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.2/26/04 Page 7 of 7
Massachusetts Department of Environmental Protection
L7 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 party 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)
Project Location
Mailing Address
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/Town 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 mon order for$50.00, able to the Commonwealth of Massachusetts to:
money Pay
Department of Environmental Protection
Box 4062
Boston, MA 02211
wpaform5.doc.Appendix E.rev.2126104 Page 1 of 2
Massachusetts Department of Environmental Protection
Bureau of Resource Protection-Wetlands
't 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 form,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 fora Superseding
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.
wpaform5.doc•Appendix E•rev.2/26/04 Page 2 of 2