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Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 8B — Certificate of Compliance
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
A. Project Information
1. This Certificate of Compliance is issued to:
Brian Giuffride
2
3.
Name
104 Colonial Avenue
Mailing Address
North Andover
City/Town
MA
State
DEP File Number:
7A7 a) A
uy
01845
Zip Code
This Certificate of Compliance is issued for work regulated by a final Order of Conditions issued to
A. C. Builders, Inc
Name
January 6, 1993 242-634
Dated DEP File Number
The project site is located at:
104 Colonial Avenue (Lot 19) North Andover
Street Address City/Town
Map 107B Parcel 139
Assessors Map/Plat Number Parcel/Lot Number
the final Order of Condition was recorded at the Registry of Deeds for:
Property Owner (if different)
Essex North
County
Certificate
3662
Book
4. A site inspection was made in the presence of the applicant, or the applicant's agent, on:
8/10/09
Date
B. Certification
0177
Page
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:
PCOC for 104 Colonial Avenue (Lot 19) only
wpaform Bb. doe • rev. 7/13/04
Page 1 of 4
to Department of Environmental Protection
610's
r RXource Protection - Wetlands
�= 6u�eav h1 8B — Certificate of Compliance
)Npp% etts Wetlands Protection Act M.G.L. C. 131, §40
'etification (cont.)
DEP File Number:
PCCC
242-634
Provided by DEP
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 The Order of Conditions has lapsed and is therefore no
longer valid.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:
q s�
C. Authorization
Issued by:
North Andover
Conservation Commission
Date of Issuance
This Certificate must be signed by a majority of the Conservation Commission and a copy sent to the
applicant and appropriate DEP Regional Office (See Attachment).
Signatures:
r
wpaform 8b.doc • rev. 7/13/04
Page 2 of 4
LIMassachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 8B — Certificate of Compliance
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
G. Authorization (cont.)
Notary Acknowledgement
wpaform 8b.doc • rev. 7/13/04
Commonwealth of Massachusetts County of
On this Day/W
Essex North
Of Mont Year
before me, the undersigned Notary Public, personally appeared
John Mabon,
Name of Document Signer
proved to me through satisfactory evidence of identification, which was/were
Massachusetts License
uescnption or evidence of identification
DEP File Number:
jjG (.') C.
941) -F; -IAA
rroviaea oy utr
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
City/Town
Place notary seal and/or any stamp above
Conservation Commission
Signatur f otary Public or
/ A'e,�_ le'fem - --L-4;716719 -1-6
Printed Name 4Notary Publy v �
My Commission Expiresy(DDate)
Signature of Nottfy Public
o Mary Leary•lppolito
i� Notary Public
Commonwealth of Massachusetts
`y My Commission Expires
e May 16, 2014
MM�N
Page 3 of 4
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 8B — Certificate of Compliance Ll
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 24
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:
104 Colonial Avenue (Lot 19) 242-634
Project Location DEP File Number
Has been recorded at the Registry of Deeds of:
Essex North
County
for:
Brian Giuffrida
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
ILI Bureau of Resource Protection - Wetlands
DEP Regional Addresses
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
DEP Central Region
Acton
Charlton
Hopkinton
Mail transmittal forms and DEP payments, payable to:
Rutland
Uxbridge
627 Main Street
Commonwealth of Massachusetts
Clinton
Hubbardston
Millville
Department of Environmental Protection
Warren
Worcester, MA 01608
Ashby
Box 4062
Hudson
New Braintree
Shrewsbury
Boston, MA 02211
Athol
Dudley
DEP Western Region Adams Colrain Hampden
Monroe
Pittsfield
Tyringham
436 Dwight Street Agawam Conway Hancock
Montague
Plainfield
Wales
Alford Cummington Hatfield
Suite 402
Monterey
Richmond
Ware
Amherst Dalton Hawley
Springfield, MA 01103 Ashfield Deerfield Heath
Montgomery
Monson
Rowe
Russell
Warwick
Phone: 413-784-1100 Becket Easthampton Hinsdale
Mount Washington
Sandisfield
Washington
Wendell
Belchertown East Longmeadow Holland
Fax: 413-784-1149
New Ashford
Savoy
Westfield
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
Chademont 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
Mendon
DEP Central Region
Acton
Charlton
Hopkinton
Millbury
Rutland
Uxbridge
627 Main Street
Ashburnham
Clinton
Hubbardston
Millville
Shirley
Warren
Worcester, MA 01608
Ashby
Douglas
Hudson
New Braintree
Shrewsbury
Webster
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
TDD: 508-767-2788
Barre
Fitchburg
Leominster
Oakham
Sterling
Westford
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
Lakeville, MA 02347
Attleboro
Dighton
Gosnold
Nantucket
Rehoboth
Wareham
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
TDD: 508-946-2795
Bourne
Easton
Harwich
Norwell
Scituate
West Tisbury
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
Boston, MA 02108
Arlington
Cohasset
Hull
Middleton
Reading
Waltham
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
TDD: 617-574-6868
Beverly
Dover
Lincoln
Natick
Salem
Wenham
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. 7/23/09 Page 1 of 1