HomeMy WebLinkAboutBURKE, ROBERT Massachusetts Department of Environmental Protection
Bureau of Resource Protection - WetlandsDEP Fi
c. 131, §40 le Number:
WPA Form 5 - Order of ConditionsL7_1 242-1
Massachusetts Wetlands Protection Act M.G.L. 261
A. General Information
Important: North Andover
When filling From:
out forms on 1.Conservation Commission
the computer, 2. This issuance is for(check one):
use only the ® Order of Conditions ❑ Amended Order of Conditions
tab key to 3. To: Applicant:
move your
cursor-do not John Burke
use the return a. First Name
key. b. Last Name o.Company
71 Sutton Hill Road
d. Mailing Address
North Andover
e. City/Town MA. 01845
f.State g.Zip Code
4. Property Owner(if different from applicant):
Robert Burke Estate of Robert J. Burke
a. First Name b. Last Name c.Company
14 Chickering Road
d.Mailing Address
North Andover MA. 01845
e.City/Town
f.State g.Zip Code
5. Project Location:
Cotuit& Leyden Street North Andover
a. Street Address b.City/Town
Map 47
c.Assessors Map/Plat Number Lot 26
Latitude and Longitude, if known (note: d.Parcel/Lot Number
electronic filers will click for GIS locator): e. Latitude
) f.Longitude
6. Property recorded at the Registry of Deeds for(attach additional information if more than one parcel):
Essex North
a. County b.Certificate(if registered land)
2597 235
c. Book
d.Page
7. Dates: 6/10/04 la p f
a.Date Notice of Intent Filed b.Date Public H aring Closed c.Date 6f Iss ante
s. Final Approved Plans and Other Documents (attach additional plan or document references as
needed):
Site Plan Lots 1-5 Cotuit Street
a. Plan Title
New England Engineering Services, Inc. Richard C. Tangard, P. E.
b. Prepared By c.Signed and Stamped by
6/9/04, revised 8/2/04, revised 10/12/04, revised 1"=20'
11/15/04
e.Scale
f.Additional Plan or Document Title
9. Total WPA Fee Paid: $ 1,000.00 g. Date
a.Total Fee Paid b.State Fee Paid c.City/Town Fee Paid
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Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 5 - Order of Conditions 242-1261
Massachusetts Wetlands Protection Act M.G.L. c. 131 §40
B. Findings.
1. 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 finds that the areas in which
work is proposed is significant to the following interests of the Wetlands Protection Act. Check all that
apply:
a. ® Public Water Supply b. ❑ Land Containing Shellfish c. ® Prevention of Pollution
d. ® Private Water Supply e. ❑ Fisheries f. ® Protection of Wildlife
Habitat
g. ® Groundwater Supply h. ® Storm Damage Prevention i. ® Flood Control
2. This Commission hereby finds the project,as proposed, is: (check one of the following boxes)
Approved subject to:
® the following conditions which are necessary in accordance with the performance standards set forth
in the wetlands regulations. 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
plans, specifications, or other proposals submitted with 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 wetland
regulations. 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. A description of the performance standards which the proposed work cannot
meet is attached to this Order.
❑ 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).
Inland Resource Area Impacts: Check all that apply below. (For Approvals Only)
Resource Area Proposed Permitted Proposed Permitted
Alteration Alteration Replacement Replacement
s. ❑ Bank
4. Bordering Vegetated
a. linear feet b.linear feet c.linear feet d. linear feet
❑
Wetland a.square feet b.square feet c.square feet d.square feet
5. ❑ Land Under
Waterbodies and a.square feet b.square feet c.square feet d.square feet
Waterways
e. cu.yd dredged f.cu.yd dredged
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Massachusetts Department of Environmental Protection
Bureau of Resource Protection Wetlands DEP File Number:
WPA Form 5 - Order of Conditions 242-1261
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Findings (cont.)
Resource Area Proposed Permitted Proposed Permitted
s. ❑ Bordering Land Alteration Alteration Replacement Replacement
Subject to Flooding a.square feet b.square feet c.square feet d.square feet
Cubic Feet Flood
Storage e.cubic feet f.cubic feet g.cubic feet h.cubic feet
7. ❑ Isolated Land Subject
to Flooding a.square feet b.square feet
Cubic Feet Flood
Storage c.cubic feet d.cubic feet e.cubic feet f.cubic feet
s. ❑ Riverfront area
a.total sq.feet b.total sq.feet
Sq ft within 100 ft
c.square feet d.square feet
Sq ft between 100-200 ft
e.square feet f.square feet
Coastal Resource Area Impacts: Check all that apply below. (For Approvals Only)
9. ❑ Designated Port Indicate size under Land Under the Ocean, below
Areas
10. ❑ Land Under the
Ocean a.square feet b.square feet
c.cu.yd dredged d.cu.yd dredged
11. ❑ Barrier Beaches Indicate size under Coastal Beaches and/or Coastal Dunes below
12. ❑ Coastal Beaches
a.square feet b.square feet c.c/y nourishmt. d.cty nourishmt.
13. ❑ Coastal Dunes
a.square feet b.square feet c.Gy nourishmt. d.c/y nourishmt
14. ❑ Coastal Banks
a. linear feet b. linear feet
15. ❑ Rocky Intertidal
Shores a.square feet b.square feet
16. ❑ Salt Marshes
a.square feet b.square feet c.square feet d.square feet
17. ❑ Land Under Salt
Ponds a.square feet b.square feet
c.cu.yd dredged d.cu.yd dredged
18. F-1 Land Containing
Shellfish a.square feet b.square feet c.square feet d.square feet
19. ❑ Fish Runs Indicate size under Coastal Banks, inland Bank, Land Under the
Ocean,and/or inland Land Under Waterbodies and Waterways,
above
a.cu.yd dredged b.cu.yd dredged
20. ❑ Land Subject to
Coastal Storm Flowage a.square feet b.square feet
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ILIMassachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
WPA Form 5 - Order of Conditions 242-1261
C. General Conditions Under Massachusetts Wetlands Protection Act
(only applicable to approved projects)
pp p leets)
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 properly 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.
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 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 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 242-1261 "
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ILI Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 5 -- Order of Conditions 242-1261
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
C. General Conditions Under Massachusetts Wetlands Protection Act
10. Where the Department of Environmental Protection is requested to issue a Superseding Order, the
Conservation Commission shall be a party tyto 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 Order, and may require the submittal of any
data deemed necessary by the Conservation Commission or Department for that evaluation.
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 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 Order.
Special Conditions:
If you need more See attached
space for
additional
conditions,
select box to
attach a text
document
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Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 5 - Order of Conditions 242-1261
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
D. Findings Under Municipal Wetlands Bylaw or Ordinance
1. Furthermore, the North Andover hereby finds (check one that applies):
Conservation Commission
2. ❑ that the proposed work cannot be conditioned to meet the standards set forth in a municipal
ordinance or bylaw specifically:
a.Municipal Ordinance or Bylaw b.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 Order of
Conditions is issued.
s. ® that the following additional conditions are necessary to comply with a municipal ordinance or
bylaw:
North Andover Wetland Protection Bylaw Chapter 178
a.Municipal Ordinance or Bylaw b.Citation
The Commission orders that all work shall be performed in accordance with the following 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.
If you need more c. The special conditions relating to municipal ordinance or law are as follows:
space for p 9 P Y
additional See Attached
conditions,
select box to
attach a text
document
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DEP FILE #242 - 1261
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 (p.37) of the North Andover Wetland
Regulations).
23. The NACC reserves the right to amend this Order of Conditions after a legally advertised
Pg P g
public hearing if plans or circumstances are changed or if new conditions or information
so warrant.
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DEP FILE #242 - 1261
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. This Order of Conditions is issued under File No.242-1261.
26. 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.
27. 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.
28. The proposed work includes: the construction of four (4) duplex townhouses with
associated appurtenances,stormwater drainage structures, and site clearing and
grading located within the Buffer Zone to a Bordering Vegetated Wetlands (BVW)
associated with an intermittent stream.
29. 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: John J. Burke (Applicant)
71 Sutton Hill Road
North Andover,MA 01845
No Date,Received June 11,2004.
Site Plans prepared by: New England Engineering Services,Inc.
Site plans entitled, "Site Plan: Lots 1 -5 Cotuit Street" Sheets
1 of 2, dated June 9,2004 with revisions made through
December 13,2004.
Sheet 2 entitled, "Site Plan Details: Lots 1 -5 Cotuit Street"
dated June 9,2004 with revisions made through December
13, 2004.
Stamped &signed by Benjamin C. Osgood,Jr.,P.E.
Operation &Maintenance
Plan prepared by: Erosion Control and Maintenance Plan prepared
by New England Engineering Services,Inc.
"Drainage Report:4 Lot Subdivision, Cotuit
Street and Leyden Street",prepared by New England
Engineering Services,Inc., dated October 12,2004 revised
November 15,2004.
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DEP FILE #242 - 1261
Other Documents: Review comment letter prepared by Lisa Eggleston,
Eggleston Environmental, dated November 3rd,and 30th,
2004.
Correspondence addressing Eggleston Environmental's
review comments prepared by Benjamin C. Osgood,Jr., P.E.,
New England Engineering Services, Inc., dated November
15,2004;and December 6 and 14,2004.
30. The following wetland resource areas are affected by the proposed work: Buffer Zone to
Bordering Vegetated Wetland (BVW). 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.
31. The NACC agrees with the applicant's delineation of the wetland resource areas on the
site as shown on the plans dated referenced herein.
32. The NACC finds that the intensive use of the upland areas and buffer zone proposed on
this site will cause further alteration of the wetland resource areas. In order to prevent
any alteration of wetland resource areas a twenty-five foot (25')No Disturbance Zone
and a fifty-foot (50') No Construction Zone shall be established from the edge of the
adjacent wetland resource area. The Conservation Administrator and/or other agents of
the NACC do not have the authority to waive these setbacks as established under the
local bylaw. No disturbance of existing grade, soils or vegetation is permitted in the No-
Disturbance zone. (See Section 3.4 &Appendix F of the local Regulations).
33. 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 beheld jointly liable for any violation of this
Order resulting from failure to comply with its conditions.
34. The owners of the project and their successors in title,in the event they proceed to alter
areas subject to the Commissions 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
P �
and its residents for any damage attributable to alterations undertaken on this property
pursuant to the Order.
35. Issuance of these Conditions does not in any way imply 1Y Y
or certify that the site or
downstream areas will not be subject to flooding, storm damage or any other form of
water damage
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DEP FILE #242 - 1261
PRIOR TO CONSTRUCTION
36. 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.
37. 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.
38. 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 242-1261."
39. 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 other local or
state boards or agencies. This may result in changes to the project plans 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.
40. 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.
41. Prior to any work commencing on site, the applicant shall submit to the NACC for
approval, a detailed sequence of construction, including,but not limited to, the
installation of temporary and permanent erosion control devices, installation of the
stormwater drainage structures to be completed before other work begins on site, and
housing development.
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DEP FILE #242 - 1261
42. Wetland flagging shall be checked prior to start of construction and shall be re-established
where missing. All wetland flagging shall remain visible and enumerated per the
approved plan(s) throughout the life of the project and until a Certificate of Compliance is
issued so that erosion control measures can be properly placed and wetland impacts can
be monitored. The proposed limit of work shall be shall be clearly marked with stakes or
flags and shall be confirmed by the NACC. Such markers shall be checked and replaced
as necessary and shall be maintained until all construction is complete. Workers should
be informed that no use of machinery, storage of machinery or materials, stockpiling of
soil, or construction activity is to occur beyond this line at any time. All flags used for the
above purposes shall be of a color different from other flagging used on the site.
43. A row of staked hay bales backed by trenched siltation fence shall be placed between all
construction areas and wetlands. The erosion control barrier will be properly installed
and placed as shown on the plans approved referenced herein. The erosion control barrier
shall be inspected and approved by the NACC prior to the start of construction, and shall
remain intact until all disturbed areas have been permanently stabilized to prevent
erosion. All erosion prevention and sedimentation protection measures found necessary
during construction shall be implemented at the direction of the NACC.
44. The NACC reserves the right to impose additional conditions on portions of this project
to mitigate any impacts which could result from site erosion, or any noticeable
degradation of surface water quality discharging from the site. For example, installation
of erosion control measures may be required in areas not shown on the plan(s) referenced
in this Order of Conditions. Should such installation be required by the NACC,they shall
be installed within 48 hours of the Commissions request.
45. The applicant shall have on hand at the start of any soil disturbance, removal or
stockpiling, a minimum of 50 hay bales and sufficient stakes for staking these bales (or an
equivalent amount of silt fence). Said bales shall be used only for the control of
emergency erosion problems and shall not be used for the normal control of erosion.
46. A check payable to the Town of North Andover shall be provided in the amount of
$20,000,which shall be in all respects satisfactory to Town Counsel,Town Treasurer,and
the NACC, and shall be posted with the North Andover Town Treasurer through the
NACC before commencement-of work. Said deposit of money shall be conditioned on the
completion of all conditions hereof, shall be signed by a party or parties satisfactory to the
NACC, and Town Counsel, and shall be released after completion of the project, provided
that provisions, satisfactory to the NACC,have been made for performance of any
conditions which are of continuing nature. The applicant may propose a monetary
release schedule keyed to completion of specific portions of the project for the NACC's
review and approval. This condition is issued under the authority of the local Bylaw.
47. The applicant shall be responsible for placing signs on each parcel designating the
applicable lot number as depicted on the plans approved and referenced herein.
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DEP FILE #242 - 1261
48. Prior to the commencement of any work on site,the corners of the foundations shall be
staked in the field by a Registered Land Surveyor(R.L.S.),which shall be verified by
Conservation Staff during the Pre-Construction meeting.
49. The applicant shall designate a Professional Wetland Scientist as the project's "Erosion
Control Monitor" (ECM) to oversee any emergency placement of controls and regular
inspection or replacement of sedimentation control devices. The name and phone
number of the erosion control monitor must be provided to the NACC in the event that
this person has to be contacted, due to an emergency at the site, during any 24-hour
period, including weekends. This professional must submit a letter to the Conservation
Department,on company letterhead stating they have been retained as the project's
Erosion Control Monitor. The designated Erosion Control Monitor is subject to
approval by the NACC. This person shall also be given the authority to stop construction
for erosion control purposes. The ECM will be required to inspect all such devices and
oversee cleaning and the proper disposal of waste products. Cleaning shall include
removal of any entrapped silt. At least ONCE during each week, in which construction
activities occurs on-site and for as long thereafter as ground remains unstabilized,the
applicant shall submit a written report from the EMC to the NACC certifying that,to
the best of his/her knowledge and belief based on a careful site inspection, all work is
being performed in compliance with this Order of Conditions and that approved
setbacks are being adhered to. The EMC must visually inspect all
sedimentation/erosion control measures and assume responsibility for their maintenance
on a weekly basis and that they are functioning as intended. In addition,all wetland
resource areas must be visually inspected for siltation, turbidity, and/or other water
quality impacts.
50. Prior to construction, the applicant shall permanently mark the edge of the "25' No-
Disturbance Zone" with twenty two (22) signs or markers spaced evenly every 40 feet
incorporating the following text: "Protected Wetland Resource Area". This will
designate their sensitivity and assure no further inadvertent encroachment into the
wetland. These permanent markers are subject to review and approval by the NACC.
The applicant shall instruct all agents to explain these markers to
buyers/lessees/landscapers and all persons taking over the property from the applicant.
51. 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 after to
the closing of said land transaction.
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DEP FILE #242 - 1261
52. Once these above mentioned pre-construction requirements are complete,the applicant
shall contact the Conservation Office prior to site preparation or construction and shall
arrange an on-site conference with an NACC representative,the contractor,the
engineer,wetland scientist and the applicant to ensure that all of the Conditions of this
Order are understood. This Order shall be included in all construction contracts,
subcontracts, andspecifications 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 permitted work are fully aware of the
permit's terms and conditions. Thereafter, the contractor will be held jointly liable for any
violation of this Order of Conditions resulting from failure to comply with its conditions.
The applicant or contractor shall notify the NACC in writing of the identity of the on-site
construction supervisor hired to coordinate construction and to ensure compliance with
this Order. A reasonable period of time shall be provided as notice of the pre-
construction meeting (e.g. 72 hours).
DURING CONSTRUCTION
53. Accepted engineering and Best Management Practices (BMPs) for construction standards
shall be followed in the conduct of all work.
54. A crushed stone construction entrance shall be designated for each lot to minimize
soil/material tracking onto Cotuit and Leydon Streets. This entrance shall be
reinforced as necessary.
55. Construction of the stormwater retention basins shall be constructed and functioning
as part of the initial project phase,immediately following clearing and rough grading
of the site to serve as siltation control during construction. Runoff from the site shall be
directed towards these basins.
56. Erosion control devices shall be inspected regularly; any entrapped silt shall be removed
to an area outside of the buffer zone and wetland resource areas; silt fence and hay bales
shall be replaced as necessary. The areas of construction shall remain in stable condition
at the close of each construction day. All erosion controls shall be in place throughout the
duration of any construction on site or unless authorized by the Conservation personnel.
57. Upon beginning work, the applicant shall submit written progress report every month
detailing what work has been done in or near resource areas, and anticipated work to be
completed over the next period. This will update the construction sequence.
58. The NACC shall be notified in writing of any lot line or number changes with a copy of a
plan showing these changes prior to any work on these lots.
59.The Erosion Control Monitor shall be on-site during the pouring of all dwelling
foundations.
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DEP FILE #242 - 1261
60. IMPORTANT: Immediately upon completion of each dwelling foundation, and prior to
further construction activities associated with each lot, the applicant shall submit an
interim as-built plan for each individual lot to the Conservation Department for review.
This As-built plan shall be prepared by a Registered Land Surveyor of the
Commonwealth (R.L.S.), showing at a minimum the foundation location, sub-grading,
drainage system(s), recharge area(s) with seasonal high groundwater elevations, limits of
work and it's proximity to wetland resource areas as approved under this Order of
Conditions.
61. The sewer lines on the site shall be tested for water tightness in accordance with North
Andover DPW standards.
62. All catch basins shall contain oil/gasoline traps, and it shall be a continuing condition of
this order, even after a Certificate of Compliance is issued, that the oil/gasoline traps in
the catch basins be maintained. All catch basins shall be free of all accumulated silt and
debris before a Certificate of Compliance is issued and the owner or his/her agent shall
so specify in the request for Compliance.
63. The Erosion Control Monitor shall be on site during and/or following a major storm
event of 1 inch of rain or greater to ensure that soils remain stable, erosion controls are
adequate and secure,and that all BMP's are adequately functioning.
64. De-watering activities anticipated shall be supervised and witnessed by the designated
Erosion Control Monitor (ECM). This designee must be on-site while work specific to de-
watering activities are occurring and until complete. Activities shall be monitored daily
by the ECM to ensure that sediment laden water is appropriately settled prior to
discharge toward the wetland resource areas. No discharge of water is allowed directly
into an area subject to jurisdiction under the MA Wetlands Protection Act and / or the
North Andover Wetlands Bylaw. If emergency de-watering requirements arise, the
applicant shall submit a contingency plan to the Commission for approval,which
provides for the pumped water to be contained in a settling tank or basin, to reduce
turbidity prior to discharge into a resource area.
65. 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.
66. There shall be no stockpiling of soil or other materials within twenty-five (25) feet of any
resource area.
67. At the close of each workday,hay bales or other means of erosion control shall be
installed along the construction entrances to prevent sediment-laden runoff from
migrating onto Cotuit and Leydon Streets.
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DEP FILE #242 - 1261
68. The adjacent roadways (Cotuit &Leydon Streets) shall be swept at least once per week
or as directed by the Erosion Control monitor,the Site Supervisor, Project Manager,or
the Conservation staff for as long as the site remains exposed and unstabilized.
69. A permanent fieldstone wall shall be constructed upslope of the 25' No Disturbance
Zone, as shown on the approved plan.lan. The wall shall be extended to the property line
in this same manner on Lot 2. In addition,the NACC finds that further protection to
the south of Lot 5 (i.e. plantings,wall,fence, etc.) is necessary to deter future
encroachment into the resource area. Therefore,the applicant shall submit to the
Conservation Department a plan detailing this area with the proposed added
protection to be approved by the Conservation Administrator. The erosion controls
shall be adjusted,if necessary,in these locations to accommodate any changes.
70. All exposed soil finish grade surfaces shall be immediately landscaped and stabilized,or
loamed, seeded and mulched,with a layer of mulch hay. All disturbed areas must be
graded,loamed and seeded prior to November 1St of each year.Outside of the growing
season, exposed soil finish grade surfaces shall be stabilized with a layer of mulch hay
until climate conditions allow for seeding. During construction, any area of exposed soils
that will be left idle for more than 30 days shall be stabilized with a layer of mulch hay or
other means approved by the NACC.
71. No re-grading in the buffer zone shall have a slope steeper than 2:1 (horizontal:vertical).
Slopes of steeper grade shall be permanently stabilized using clean, stone riprap or
biodegradable matting.
72. Equipment shall not be staged overnight within 50-feet of a wetland resource area.
73. Washings from concrete trucks, or surplus concrete, shall not be directed to, any drainage
system, or wetland resource area.
74. 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 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.
75. 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.
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DEP FILE#242 - 1261
STORMWATER MANAGEMENT CONDITIONS
76. All construction and post-construction stormwater management structures shall be
maintained and monitored in accordance with the approved Erosion&Sedimentation
Control Plan (Operation&Maintenance Plan) included as an attachment to this Order,
approved site plans, the MA Stormwater Management Policy, and as approved by the
NACC.
77. Prior to the placement of any impervious materials on site,all drainage structures shall
be properly installed and functional. During construction, all drainage structures shall
be maintained, as outlined in the Erosion Control and Maintenance Plan as referenced
and attached herein.
78. Basins being used for sedimentation and dewatering during construction shall be
cleaned of sediment when levels exceed six(6) inches.The basins shall be cleaned of
sediment prior to final grading and planting of the pond.
79. The grass Swale associated with the retention basin on lot 4 shall be mowed at least
once per year. The height of the grass shall be a minimum of four (4) inches,in order to
effectively reduce velocity and pollutants. Grass clippings and sediment shall be
removed. This swale shall be inspected semi-annually,and shall continue in
perpetuity.
80. A trash guard shall be installed around the perimeter of the retention pond on Lot 4, as
depicted on the approved site plans referenced herein.
81. All stormwater Best Management Practices (BMPs) shall be maintained as specified in the
above-mentioned Erosion Control and Maintenance Plan,and as incorporated in the
Order of Conditions. Evidence of maintenance of the stormwater management system
shall be provided to the NACC on an annual basis by a Registered Professional Civil
Engineer.The first report shall be submitted to the NACC one year after the first
stormwater structure goes on-line and annual reports must continue to be submitted
until a Certificate of Compliance is issued. Compliance with the designed stormwater
management system and associated stormwater management conditions shall be
satisfied prior to the issuance of a Certificate of Compliance.
82. There shall be no increase in the post development discharges from the storm drainage
system or any other changes in post development conditions that alter the post
development watershed boundaries as currently depicted in the Notice of Intent and
approved by this Order of Conditions, unless specifically approved in writing by the
Commission.
83.Water quality of the adjacent Bordering Vegetated Wetland (BVW) and intermittent
stream shall not differ significantly following completion of the project from the pre-
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DEP FILE #242 - 1261
development conditions. There shall be no sedimentation into wetlands or water bodies
from discharge pipes or surface runoff leaving the site.
84. Immediately upon the installation of the catch basins,silt sacks or equivalent to, shall
be installed under the grates to prevent/restrict sediment from entering the drainage
system or adjacent wetlands. Silt sacks shall be cleaned after any rainfall event of 1" or
greater or as directed by the Erosion Control Monitor,Site Supervisor,Project Manager,
or Conservation staff.
85. All catch basins shall contain oil/gasoline traps, and it shall be a continuing condition of
this order, even after a Certificate of Compliance is issued,that the oil/gasoline traps in
the catch basins be maintained. All catch basins shall be free of all accumulated silt and
debris before Compliance is issued and the owner or his/her agent shall so specify in the
request for Compliance. This condition will remain in perpetuity.
86. All roof runoff shall be directed to the infiltrators to provide groundwater recharge, as
shown on the approved plans referenced herein.
87. The applicants, owners, and their successors and assignees, shall maintain all culverts,
collections basins, traps, outlet structures, subsurface storage areas,and other elements of
the drainage system, unless put into an easement to the Town of North Andover, in order
to avoid blockages and siltation which might cause failure of the system and/or
detrimental impacts to on-site or off-site resource areas, and shall maintain the integrity of
vegetative cover on the site. This condition will remain in perpetuity.
88. As proposed by the applicant,a Condominium Association shall be established and be
responsible for the implementation of the Erosion Control & Maintenance Plan as
referenced and attached herein. This condition shall remain in perpetuity to this
Order. Written agreements of all conditions required in perpetuity of this Order,
inclusive of all stormwater maintenance agreements,shall be submitted to the NACC
upon completion of construction and prior to the issuance of a certificate of
compliance.
89. Prior to the issuance of the Certificate of Compliance, and the Condominium
Association assuming responsibility,the applicant shall be responsible for cleaning all
stormwater structures,in accordance with the "Erosion Control &Maintenance Plan"
and the associated stormwater management conditions referenced herein.
AFTER CONSTRUCTION
90. 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 Towns Wetland protection Bylaw.
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DEP FILE #242 - 1261
91. Fertilizers utilized for landscaping and lawn care shall be slow release, low-nitrogen types
(< 5%), and shall not be used within 25 feet of a resource area. Pesticides and herbicides
shall not be used within 100 feet of a wetland resource area. Only organic fertilizers may
be used. 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 and shall remain in perpetuity.
92. 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 loaming and seeding according to SCS standards. If the latter course is chosen,
stabilization will be considered complete once vegetative cover has been achieved.
93. Upon approved site stabilization by Conservation staff, the erosion controls shall be
removed and properly disposed of and all exposed areas shall be seeded.
94. 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.
c. 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 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 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.
This certification statement shall include verification that the stormwater
management system functions as designed.
i. An"As-Built" plan prepared and signed and stamped by a Registered
Professional Civil Engineer and Registered Professional Land Surveyor of the
Commonwealth, for the public record. This plan will include:
➢ "As-Built" post-development elevations of all drainage &stormwater
management structures constructed within 100 feet of any wetland resource
area. Plans shall also detail information sufficient to define the geometry
of the basins and systems,including the applicable seasonal high
groundwater elevations.The plans shall be accompanied by as-built
volumetric calculations (pre vs. post construction) NOTE: If portions of the
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DEP FILE#242 - 1261
stormwater systems exist partially within the Buffer Zone than the entire
structure must be depicted to accurately verify compliance.
➢ Distances from structures to wetland resource areas. Structures include (but
are not limited to) septic systems, additions,fences, sheds, stonewalls, pools,
retaining walls, subsurface utilities and decks.
➢ A line showing the limit of work and the extent of existing erosion control
devices. "Work" includes aanv disturbance of soils or vegetation.
➢ Location of all subsurface utilities entering the property.
95. The following special conditions shall survive the issuance of a Certificate of Compliance
(COC)for this project:
➢ 25' No-Disturbance Zone and a 50' No-Construction Zone shall be
established from the edge of adjacent wetland resource areas except in those
locations approved under this filing. Future work within 100' of existing
wetland resource areas will require a separate filing with the NACC. The
Conservation Administrator and/or other agents of the NACC do not have
the authority to waive these setbacks as established under the local Bylaw
(Condition#32);
➢ Discharge or spillage of pollutants (Condition #75);
➢ Maintenance of catch basins (Condition#62);
➢ Maintenance of the grass swale (Condition#79);
➢ Maintenance of all culverts, collections basins, traps, outlet structures,
subsurface storage areas, and other elements of the drainage system,unless
put into an easement to the Town of North Andover, in order to avoid
blockages and siltation,which might cause failure of the system and/or
detrimental impacts to on-site or off-site resource areas (Condition#87);
➢ The attached "Erosion Control and Maintenance Plan prepared by New
England Engineering Services, Inc.No additional filings will be required to
conduct maintenance of the above referenced system and plan.
➢ A Condominium Association shall be responsible for maintenance,
serviceability,capacity, and structural integrity of the drainage systems as
outlined in the Erosion Control &Maintenance Plan,prepared by New
England Engineering Services, Inc. (Condition #88);
➢ Prohibition of underground fuels (Condition#90);
➢ Limitations on the use of fertilizers, herbicides, and pesticides (Condition
#91).
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DEP FILE#242 - 1261
APPENDIX A—AFFIDAVIT
I, on oath do hereby depose and state:
(authorized agent of applicant and/ or owner)
(PLEASE CHECK AT LEAST ONE BLOCK)
1) I am the of
(position with applicant) (applicant's name)
the applicant upon whom the Order of Conditions have been
(DEP or NACC File#)
placed upon by the North Andover Conservation Commission(NACC).
and / or
2) 1 am the of
(position with owner) (owner)
the owner upon whose land Order of Conditions have been
(DEP or NACC File#)
placed upon by the NACC.
♦ I hereby affirm and acknowledge that I have received said Order of Conditions and
have read the same and understand each and every condition,which has been set
forth in said Order of Conditions.
♦ I hereby affirm and acknowledge that on this day of
20 I 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 the Order of Conditions are presently in
compliance.
♦ I hereby affirm and acknowledge that this document will be relied upon by the
NACC, as well as any potential buyers of said property, which is subject to the
Order of Conditions.
Signed under the pain and penalties of perjury this day of ,20
(Authorized agent of applicant or owner)
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COTUIT AND LEYDEN STREET
EROSION CONTROL AND MAINTINANCE PLAECEIVED
NOV 16 2004
NORTH ANDOVER
Erosion control during construction: CONSERVATION COMMISSION
Construction at the proposed Cotuit and Leyden Street subdivision is limited to the
wetland buffer zone resource area. The requirement of having it 25 foot no cut zone and a
50 foot no build zone is the first item in the erosion control plan.When construction is
located at a distance from the wetland that allows for a greater distance between the work
area and the resource area the chances of siltation in to the resource area or intrusion in to
the area by construction crews is decreased.
Prior to the start of construction a row of double staked haybales backed by siltation
fence will be installed between the work area and the wetland. This row of erosion
control will prevent any siltation of soil in to the wetlands as well as provide a barrier
preventing construction vehicles from entering the wetland. In case of an emergency
situation a stockpile of haybales, silt fence, and stakes will remain on site during
construction.
All areas will be loamed and seeded upon completion of grading.Erosion control will
remain in place until the site is stabilized. The site will be constructed in a manner that
will minimize the amount of un-stabilized land exposed at any one time. In the event of
construction being done during the winter months,the detention pond slopes would be
stabilized with an erosion control matting. The outlets of the detention ponds would be
fitted with erosion control fabric over a slotted riser to allow the ponds to be used as a
settling basin during construction.
Long term maintenance plan
Once the site is stabilized with grass and a certificate of compliance is issued the
maintenance of the site would become the responsibility of the homeowners.
Maintenance of the buffer zone areas and the side slopes of the pond would be
maintained by the owners of the lots.The drainage structures would be maintained by the
owners of the lots through a condominium association. Maintenance would include
cleaning the deep sump catch basins every spring and inspection the condition of the
forebays and wet ponds.
The inspection of the foreba sand the wet ponds shall be done b a qualified individual
P Y Im Y
who shall recommend what maintenance steps should be taken to keep the system
operating properly. Recommendations shall be made to the homeowners association as
well as the conservation commission.
Maintenance items that may need to be done on a regular basis would be cutting back any
woody vegetation growing on the banks of the pond and trimming the grass several times
per year. In the event the forebays contain a buildup of sediment they would have to be
cleaned. This is not expected to occur on a regular basis however they may need to be
cleaned every few years. In the event the wet ponds become chocked with vegetation and
dead matter they will have to be cleaned to restore the volume capacity to provide proper
sediment. This condition is not expected to occur more often than every ten years.
4
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 5 - Order of Conditions 242-1261
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
E. Issuance
This Order is valid for three years, unless otherwise specified as a special
condition pursuant to General Conditions#4, from the date of issuance. 1.Date of Issu6nce
Please indicate the number of members who will sign this form: S'
This Order must be signed by a majority of the Conservation Commission. 2.Number of signers
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 the same time to the appropriate Department of
Environmental Protection Regional Office, i not filing electronically, and the pro wrier, if different
from applicant.
Signatures:
f
r Ci
Notary Acknowledgement
Commonwealth of Massachusetts County of Essex North
I.14h -anwa v �1 a2 00,5On this Day of Month Year
Before me, the undersigned Notary Public, ;e..6 4* A1/c.Se-
personally appeared Name of Document Signer
proved
dttome through satisfactory evidence of identification, which was/were
Description of evidence of identification
to be the person whose name is signed on the preceding or attached document, and acknowledged to
me that he/she signed it voluntarily for its stated purpose.
As member of North Andover Conservation Commission
Citylrown
DONNA Pr WEDGE
NOT4-01 !19
HIC
COIuf 0NWEAL' , 'SS&401N= Si nature of Notary Oublic IV
My Comm.Exp ;s AuD.7, D6,14 d /A Meal cc r--
Printed Name of No ry Public
Place nota seal and/or an stamp above k)
notary y p My Commis ion xpires(Date)
This Order is issued to the applicant as follows:
❑ by hand delivery on ❑ by certified mail, return receipt requested,on
Date Date
wpaform5.doc• rev.12/1/04 Page 7 of 9
M [ i
Massachusetts Department of Environmental Protection DEP File Number:
Bureau of Resource Protection -Wetlands
WPA Form 5 - Order of Conditions 242-1261
1 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
F. 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 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.
Section G, Recording Information is available on the following page.
Page 8 of 9
wpaform5.doc• rev.12/1/04
Massachusetts Department of Environmental Protection DEP File Number:
-- Bureau of Resource Protection - Wetlands
WPA Form 5 - Order of Conditions 242-1261
1 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
G. 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 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 this form shall be submitted to the Conservation Commission listed below.
North Andover
Conservation Commission
Detach on dotted line, have stamped by the Registry of Deeds and submit to the Conservation Commission.
---------------------------------------------------------------------------------------------------------------------------
To:
North Andover
Conservation Commission
Please be advised that the Order of Conditions for the Project at:
242-1261
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.12/1/04 Page 9 of 9