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Home My WebLink AboutMiscellaneous - 115 VEST WAY 4/30/2018 (3)I L7']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 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. rt ream A. Project Information 1. This Certificate of Compliance is issued to: Shawn Gliklich rvame 115 Vest Way Mailing Address North Andover Gity/Town MA. State DEP File Number: P60 C 7d7_QG �w�ucu uy v"r 01845 Zip Code 2. This Certificate of Compliance is issued for work regulated by a final Order of Conditions issued to: North Andover Associates Name 3/4/1981 242-95 Dated 3. The project site is located at: 115 Vest Way Street Address Map 104B Assessors Map/Plat Number DEP File Number North Andover City/Town Parcel 159 Parcel/Lot Number the final Order of Condition was recorded at the Registry of Deeds for: Property Uwner (if different) Essex North County Certificate 1492 Book 4. A site inspection was made in the presence of the applicant, or the applicant's agent, on: 7/21/06 uate B. Certification 228 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 Lot 34A only 115 Vest Way. 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 PC `'c Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 242-95 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 The Order of Conditions has lapsed and is therefore no longer valid.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: 26 U. Authorization Issued by: North Andover Conservation Commission This Certificate must be signed by a majority of the Conservation Commission and applicant and appropriate DEP Regional Office (See Attachment). / -/ /.9 4 Af , �' Dat of Iss nce sent to the wpaform 8b.doc • rev. 7/13/04 Page 2 of 4 LlMassachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands DEP File Number: WPA Form 8B — Certificate of Compliance P60c, Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 242-95 Provided by DEP C. Authorization (cont.) Notary Acknowledgement Commonwealth of Massachusetts County of '2 a r4 On this Day Essex North Of IL dcti . Month Year before me, the undersigned Notary Public, personally appeared 540t-4- M4SSC 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 to me that he/she signed it voluntarily for its stated purpose. As member of North Andover Cityrrown Place notary seal and/or any stamp above Conservation Commission Signature of Notary Public 10I Printed Name of Notary Public My Commission pires (Date) CL � � `ju' rte' Sig ure of Notary Public wpaform 8b.doc • rev. 7/13/04 Page 3 of 4 T` �? yid+„' DONNA M. WEDGE NOTARY PUBLIC CO!!',!ON-WEALTH OF 6'.ASS1 CL'.T:[TTS wiy Comm. Expires AU}j . L'JJ� North Andover Cityrrown Place notary seal and/or any stamp above Conservation Commission Signature of Notary Public 10I Printed Name of Notary Public My Commission pires (Date) CL � � `ju' rte' Sig ure of Notary Public wpaform 8b.doc • rev. 7/13/04 Page 3 of 4 i Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 8B — Certificate of Compliance L7(� ]Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 DEP File Number: Pc0G 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: 242-95 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 App scant wpaform 8b.doc • rev. 7/13/04 Page 4 of 4 L7,1 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 Rutland Tisbury Dwight Street Agawam Conway Hancock Montague Pittsfield Plainfield g ham436 402 Amherst Cummington Dalton Hatfield Monterey Richmond WalesAlford WareSuite Springfield, MA 01103 Ashfield Deerfield Hawley Heath Montgomery Rowe Warwick Phone: 413-784-1100 Becket Easthampton Hinsdale Monson Mount Washington Russell Sandisiield Washington Fax: 413-784-1149 Belchertown Bemardston East Longmeadow Holland New Ashford Savoy Wendell Westfield Blandford Egremonl Erving Holyoke Huntington New Marlborough Sheffield Westhampton Brimfield Florida Lanesborough New Salem North Adams Shelburne Shutesbu rt West Springfield Buckland Charlemont Gill Goshen Lee Northampton Southampton p West Stockbridge Whatel y Cheshire Granby Lenox Leverett Northfield Orange South Hadley Wilbraham Chester Granville Leyden Otis Southwick Williamsburg Chesterfield Great Barrington Longmeadow Palmer Springfield Stockbridge Williamstown Chicopee Clarksburg Greenfield Hadley Ludlow Pelham Sunderland Windsor Worthington Middlefield Peru Tolland DEP Central Region Acton Charlton Hopkinton P Millbury Rutland Tisbury 627 Main Street Ashbumham Clinton Hubbardston Millville Shirley Uxbridge Warren Worcester, MA 01608 Ashb Atholby las Dudley Hudson New Braintree Shrewsbury Webster Phone: 508-792-7650 Auburn y Dunstable Holliston Lancaster Northborough Southborough Westborough Fax: 508-792-7621 A Ayer y East Brookfield Leicester Northbridge North Brookfield Southbridge Spencer West Boylston TDD: 508-767-2788 Barre Bellingham Fitchburg Leominster Oakham Sterling West Brookfield Westford Berlin Gardner Grafton Littleton Lunenburg Oxford Paxton Stow Westminster Blackstone Groton Marlborough g Pepperell Sturbridge Sutton Wo cester Bolton Harvard Maynard Petersham Templeton Worcester Boxborough Boylston Hardwick Holden Medway Phillipston Townsend Wilmington Brookfield Hopedale Mendon Milford Princeton Royalston Tyngsborough Upton Winchester DEP Southeast Region g Abington Dartmouth Freetown Mattapoisett Provincetown Tisbury 20 Riverside Drive Acushnel Attleboro Dennis Gay Head Middleborough Raynham Truro Lakeville, MA 02347 Avon Dighton g Duxbury Halifax Halifax Nantucket Rehoboth Wareham Phone: 508-946-2700 Barnstable Eastham Hanover New Bedford North Attleborough Rochester Rockland Wellfleet Fax: 508-947-6557 Berkle East Bridgewater Hanson Norton Sandwich West Bridgewater Westport TDD: 508-946-2795 Bourne Brewster Easton Edgartown Harwich Kingston Norwell Scituate West Tisbury Bridgewater Fairhaven Lakeville Oak Bluffs Orleans Seekonk Sharon Whitman Brockton Carver Fall River Mansfield Pembroke Somerset Wrentham Yarmouth Chatham Falmouth Foxborough Marion Marshfield Plainville Plymouth Stoughton Weymouth Chilmark Franklin Mashpee Plympton Swansea Taunton Wilmington DEP Northeast Region Amesbury Chelmsford Hingham Merrimac Quincy Wakefield 1 Winter Street Andover Arlington Chelsea Holbrook Methuen Randolph Walpole Boston, MA 02108 Ashland Cohasset Hull Middleton Reading P Waltham Phone: 617-654-6500 Bedford Concord Danvers Ipswich Lawrence Millis Milton Revere Watertown Fax: 617-556-1049 Belmont Dedham Lexington Nahant Rockport Rowley Wayland Wellesley TDD: 617-574-6868 Beverly Billerica Dover Lincoln Natick Salem Wenham Boston Dracut Essex Lowell Lynn L Needham Newbury Salisbury West Newbury Boxford Everett y Lynnfield Newburyport Saugus Sherborn Weston Westwood Braintree Brookline Framingham Malden Newton Somerville Weymouth Burlington Georgetown Manchester -By -The -Sea Norfolk Stoneham Wilmington Cambridge Gloucester Groveland Marblehead Medfield North Andover Sudbury Winchester Canton Hamilton Medford North Reading Norwood Swampscott Tewksbury Winthrop Woburn Carlisle Haverhill Melrose Peabody Topsfield wpaformBb.doc - DEP Addresses - rev. 7/19/06 Page 1 of 1 a Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Q rensn 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: Shawn Gliklich Name 115 Vest Way Mailing Address North Andover City/Town MA. State DEP File Number: p6c)c:. 7A24 QA rivviucu uy ucr 01845 Zip Code 2. This Certificate of Compliance is issued for work regulated by a final Order of Conditions issued to: Etal Realty Trust Name 3/18/1983 Dated 3. The project site is located at: 115 Vest Way Street Address Map 104B Assessors Map/Plat Number 242-184 DEP File Number North Andover City/Town Parcel 159 Parcel/Lot Number the final Order of Condition was recorded at the Registry of Deeds for: Property Owner (if different) Essex North County Certificate 1508 Book 4. A site inspection was made in the presence of the applicant, or the applicant's agent, on: 7/21/06 Date B. Certification 289 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 Lot 34A only 115 Vest Way. wpaform Bb_doc • rev. 7/13/04 Page t of 4 qk Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands DEP File Number: WPA Form 8B -- Certificate of Compliance wOC°C Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 24 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: 26 C. Authorization Issued by: North Andover 7Lof 6 Conservation Commission Date Is ante This Certificate must be signed by a majority of the Conservation Commission a py sent to the applicant and appropriate DEP Reg' nal Office (See Attachment). Signatures��Z wpaform 8b.doc - rev. 7/13/04 Page 2 of 4 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 C. Authorization (cont.) Notary Acknowledgement Commonwealth of Massachusetts County of Essex North On this '2'4+h - -T') K Day Of Month before me, the undersigned Notary Public, personally appeared 5 ( d t+- /11,g' Name of Document Signer proved to me through satisfactory evidence of identification, which was/were Massachusetts License Description of evidence of identification DEP File Number: InG (t (S' 242-184 Provided by DEP '? do Year 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 DONNA K WEDGE _ All jr P WTARV PUBuc COMMOINIMTH of MASSACHUSETTS \moi My Comm. Expires Aug. 7.2009 North Andover CitylTown Place notary seal and/or any stamp above Conservation Commission S nature of Notary Public IJ e v7 n A i� Printed Name of Notary Public SJ . 7 /0,00 q My Co mission pires (Date) 1AIII --L %%4. Signature of Notary Public wpaform 8b,doc - rev. 7/13/04 Page 3 of 4 ,v LlMassachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands DEP File Number: WPA Form 8B — Certificate of Compliance iocv C Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 242-184 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: 242-184 Project Location DEP File Number Has been recorded at the Registry of Deeds of: for: county Property Owner and has been i i Toted iii the chaii i� of title of the affected property on: uate Book 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 Page wpaform 8b.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 Egremonl 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 Ashburnham 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 Sherborn Westwood Braintree Framingham Malden Newton Somerville Weymouth Brookline Georgetown Manchester -By -The -Sea Norfolk Stoneham Wilmington Burlington Gloucester Marblehead North Andover Sudbury Winchester Cambridge Groveland Medfield North Reading Swampscott Winthrop Canton Hamilton Medford Norwood Tewksbury Woburn Carlisle Haverhill Melrose Peabody Topsfield wpaform8b.doc • DEP Addresses • rev. 7/19/06 Page 1 of 1 R' w Ll'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 DEP File Number: PCOC 9A9_1An rIVV1UVU Uy 11Cr- 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 Lot 34A only 115 Vest wpaform 8b.doc • rev. 7/13/04 Page 1 of 4 A. Project Information Important: When filling out 1. This Certificate of Compliance is issued to: forms on the Shawn Gliklich computer, use Name only the tab key to move 115 Vest Way your cursor - Mailing Address do not use the North Andover MA. 01845 return key. Cityrrown State Zip Code ,01� V4D I I "" 2. This Certificate of Compliance is issued for work regulated by a final Order of Conditions issued to: ��il Etal Real�Trust Name 1/6/1982 242-140 Dated DEP File Number 3. The project site is located at: 115 Vest Way North Andover Street Address Cityrrown Map 104B Parcel 159 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 1508 289 County Book Page Certificate 4. A site inspection was made in the presence of the applicant, or the applicant's agent, on: 7/21/06 Date B. Certification Check all that apply: ❑ Complete Certification: It is hereby certified that the work regulated by the above -referenced Order of Conditions has been satisfactorily completed. ® Partial Certification: It is hereby certified that only the following portions of work regulated by the above -referenced Order of Conditions have been satisfactorily completed. The project areas or work subject to this partial certification that have been completed and are released from this Order are: PCOC for Lot 34A only 115 Vest wpaform 8b.doc • rev. 7/13/04 Page 1 of 4 �1 e L1Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands DEP File Number: WPA Form 8B — Certificate of Compliance PCOG Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 242-140 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: 26 C. Authorization Issued by: North Andover Conservation Commission ? Q0 A � Da of IssLiance This Certificate must be signed by a majority of the Conservation Commission and a applicant and appropriate DEP Regional Office (See Attachment). Signatures: sent to the 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 Massachusetts Wetlands Protection Act M140 ��i.G.L. c. 131, §40 Provided by DEP C. Authorization (cont.) Notary Acknowledgement Commonwealth of Massachusetts County of Essex North a 6 4-tio� 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 to me that he/she signed it voluntarily for its stated purpose. As member of DONNA M. WEDGE ' - COMMOHYNWTYOF 10MCHMEM My Comm Expires Aug. 7, 2009 North Andover City/Town Place notary seal and/or any stamp above Conservation Commission Si ature of Notary Public D6P)iI 4 M Printed Name of Notary, Public My Co fission xpires (Date) Ml &1?� 71-r. Gy Signature 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: WPA Form 8B — Certificate of Compliance P606 242-140 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: 242-140 Project Location DEP File Number Has been recorded at the Registry of Deeds of: County for: Property Owner and has been noted in the chain of title of the affected property on: Date Book Page If recorded land, the instrument number which identifies this transaction is: If registered land, the document number which identifies this transaction is: Document Number Signature of Applicant wpaform 8b.doc • rev. 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 9 Agawam Conway Hancock Montague Plainfield Wales Suite 402 Alford Amherst Cummington Dalton Haffield Hawley Monterey Montgomery Richmond Rowe Ware Warwick Springfield, MA 01103 Ashfield Deerfield Heath Monson Russell Washington Phone: 413-784-1100 Becket Easthampton Hinsdale Mount Washington Sandisfield Wendell Fax: 617-556-1049 Belchertown East Longmeadow Holland New Ashford Savoy Westfield Fax: 413-784-1149 Bernardston Egremont Holyoke New Marlborough Sheffield Westhampton TDD: 617-574-6868 Blandford Erving Huntington New Salem Shelburne West Springfield Brimfield Florida Lanesborough North Adams Shutesbury West Stockbridge Buckland Gill Lee Northampton Southampton Whately Charlemonl 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 Sherborn Westwood Braintree Framingham Malden Newton Somerville Weymouth Brookline Georgetown Manchester -By -The -Sea Norfolk Stoneham Wilmington Burlington Gloucester Marblehead North Andover Sudbury Winchester Cambridge Groveland Medfield North Reading Swampscott Winthrop Canton Hamilton Medford Norwood Tewksbury Woburn Carlisle Haverhill Melrose Peabody Topsfield wpaform8b.doc • DEP Addresses • rev. 7/19/06 Page 1 of 1