HomeMy WebLinkAboutMiscellaneous - 12 BONNY LANE 4/30/2018 JOONNY LANE
2101062.0-0041-OWO.o
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3= TOWN OF NORT MOVER
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• - PERMIT F�R AS INSTALLATION
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y,SSACMUSEt�
This certifies that . . . . . . . . . . . . . . . . . . . . . . . . .
has permission for gas
in the buildings of .'. .. ... `. ..`:�4-��. . . . . . . /. . . . . . . . . . . . . . . . . .
at ./. . _ : . . . . �. �-r� . . .r ., North Andover, Mass.
Fee:? '. .`. Lic. No.., . ... .`.yLP .`�: '_ .� 'r moi:. . . . . . . .
A GAS INSPECTOR•
Check#
703
r
MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING
(Type or print) Date X0
NORTH ANDOVER,{MASSACHUSETTS/
Building Locations [ Z 1✓�h�'1 L /I I Permit# w3
Amount$ _30Owner's Nametr-
/ a7 j Y �as'�`Q
New Renovation ❑ placement ❑ Plans Submitted ❑
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a w ° U
O w d F a z z O z w
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W
w > w z Q a Q o °o w° o w F
x o x w a 3 0 a v x > o w F o
SUB -BASEM ENT
B A S E M ENT
1ST. FLOOR
2ND . FLOOR
3RD . FLOOR
4TH . FLOOR
5TH . FLOOR
6TH . FLOOR
7TH . F L O O R
8 T H . F L O O R
(Print or type Check one: Certificate Installing Company
Name ElCorp.
Address _� ?� A�/��Q ly" a Y ❑ Partner.
t -Oig Pn GE' �Nl /2 JA
Business�fe ep one 7 — g 3 r Z 7-57 Finn/Co.
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes FT No❑
If you have checked yes,please indicate the type coverage by checking the appropriate box.
Liability insurance policy Ca Other type of indemnity ❑ Bond ❑
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass.General Laws,and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner ❑ Agent ❑
I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the MassachlksVtts State Gas Code and C pter 142 of the General Laws.
Signature of Licensed�Pllumber Or Gas Fitter
By: C f 30 '7 Z"/
Title ❑ Plumber � L—
City/Town Gas Fitter License Number
Master
APPROVED(OFFICE USE ONLY) ❑ Journeyman
The Commonwealth of Massachusetts
ru Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, A"-02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print LeLyibly
Name (Business/Organization/Individual):
Address:
City/State/Zip: Phone#:
Are you an employer? Check the appropriate bog: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have 8. Demolition
working for in any capacity. workers' comp. insurance. 9. ❑ Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
required.] officers have exercised their
3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions
myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs
insurance required.] t employees. [No workers' 13.❑ Other
comp. insurance required.]
•; y applicant that checks box#1 must also fill out the section below showing their workers'compensationpolicy inforn atioa
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins. Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct
Signature: Date:
Phone#:
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone#:
t.
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined as "...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as"an individual,partnership, association, corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartrnents and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability.Partnerships(LLP)with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permittlicense number which will be used as a reference number. In addition, an applicant
that must submit multiple permittlicense applications in any given year,need only submit one affidavit indicating current .
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in .(city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington.Street
Bnoston,MA 02111.
Tel. # 617-7274900 ext 406 or 1-877 MAS.SAFE
Fax 4 617-72.7-7749
Revised 5-26-05
.mass.Dov/dia
Town of North Andover
ttORTI{
�O6St�eo »n q.yo
10- A
�9SSACHtJ5ES�9
August 6,2010
Donald F.Borenstein,Esq.
Johnson&Borenstein,LLC
12 Chestnut Street
Andover,MA 01810-3706
RE: REQUEST FOR ZONING ENFORCEMENT OFFICER FINDING
NORTH ANDOVER ZONING BYLAW,SECTION 9.3.a
PROPERTIES: 10 BONNY LANE AND 12 BONNY LANE
Dear Attorney Borenstein:
I have received your letter dated August 5,2010. The section of the bylaw to which you refer
states"structure",not"lot" so how can I make a finding as to a lot? Are you suggesting that the word
"lot" should be read into the bylaw where"lot"does not appear? If so,please provide authority for me
to read"lot"into the bylaw.
Very truly yours,
Gerald Brown,
Building Inspector
f - 1 leo /131
LlMassachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands DEP File Number:
WPA Form 5 -- Order of Conditions NACC#29
A. General Information
Important: North Andover
When filling From: 1.Conservation Commission
out forms on
the computer, 2.This issuance is for(check one): ® Order of Conditions ❑ Amended Order of Conditions
use only the
tab key to 3.To: Applicant:
move your
cursor-do not Amy Constantino, Trustee Bonny Realty Trust c/o Johnson&
use the return a.First Name b.Last Name Borenstien,LLC
key. c.Company
12 Chestnut Street —
d.Mailing Address
IL AV Andover MA. 01810
e.City/Town f.State g.Zip Code
4. Property Owner(if different from applicant):
a.First Name b.Last Name I--c.Z&—X7774 P
d.Mailing Address
e.City/rown f.State g.Zip Code
5. Project Location:
12 Bonny Lane North Andover
a.Street Address b.City/Town
Map 62 Parcel 41
c.Assessors Map/Plat Number d.Parcel/Lot Number
Latitude and Longitude, if known(note:
electronic filers will click for GIS locator): e.Latitude f.Longitude
s. 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)
2483 243
c.Book d.Pe
'q-/97V7
3/30/07 _
7. Dates: a.Date Notice of Intent Filed b.Date Pul5lic Ylearing Closed c.Date bf Istfuance
a. Final Approved Plans and Other Documents (attach additional plan or document references as
needed):
.. Site Plan to Accompany Notice of Intent and Existing Conditions Plan to Accompany Notice of Intent
a.Plan Title
U3 Cammett Engineering Fred V. Ford, P. E.
b�.,P pared By c.Signed and Stamped by
CO) Y/I&/07 1"=20'
fm d1 Final Revision Date e.Scale
C
O Nf•Additional Plan or Document Title g.Date
4 V- O $500.00 $500.00
9. Total WPA Fee Paid: a.Total Fee Paid b.State Fee Paid c.City/Town Fee Paid
wpaform5.doc•rev.317105u Page 1 of 0
r
Bk 10794 Pg 132 #18269
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands DEP File Number:
WPA Form 5 - Order of Conditions NACC#29
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 Acts interests,and a final Order of Conditions
is issued.A description of the speck 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)
❑ Buffer Zone Impacts: Shortest distance between limit of project disturbance and
wetland boundary(if available) linear feet
Resource Area Proposed Permitted Proposed Permitted
Alteration Alteration Replacement Replacement
3. ❑ Bank a.linear feet b.linear feet c.linear feet d.linear feet
4. ❑ Bordering Vegetated
Wetland a.square feet b.square feet c.square feet d.square feet
5. ❑ Land Under a.square feet b.square feet c.square feet d.square feet
Waterbodies and
Waterways e.cu.yd dredged f.cu.yd dredged
wpaform5Aw- rev.3/1/05 Page 2 of 9
1 �
Bk 10794 Pg 133 #18269
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands DEP File Number:
WPA Form 5 -- Order of Conditions NACC#29
B. Findings (cont.)
i
Resource Area Proposed Permitted Proposed Permitted
Alteration Alteration Replacement Replacement
6. ❑ Bordering Land
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
a. ❑ Riverfront area a.total sq.feet b.total sq.feet
Sq ft within 100 ft c.square feet d.square feet e.square feet f.square feet
Sq ft between 100-200 ft e.square feet f.square feet 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.Gy nourishmt. d.c!y nounshmt.
13. ❑ Coastal Dunes a.square feet b.square feet G.cty nourishmt. d.ray noudshmt
14. ❑ Coastal Banks a.11nearfeet 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. ❑ 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
wpatorm5.doc• rev.31V05
Page 3 of 9
Bk 10794 Pg 134 #18269
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands DEP File Number:
WPA Form 5 - Order of Cnlnrlitions NACC#29
C. General Conditions Under Massachusetts Wetlands Protection Act
(only applicable to approved projects)
1. Failure to comply with all conditions stated herein, and with all related statutes and other regulatory
measures, shall be deemed cause to revoke or modify this Order.
2. The Order does not grant any property rights or any exclusive privileges; it does not authorize any
injury to private property or invasion of private rights.
3. This Order does not relieve the permittee or any other person of the necessity of complying with all
other applicable federal, state, or local statutes,ordinances, bylaws, or regulations.
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 NACC#29 "
wpafoan5.doc• rev.3/1105
Page 4 of 9
A
Bk 10794 Pg 135 #18269
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 5 -- Order of Conditions NACC#29
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 to all agency proceedings and hearings before DEP.
11. Upon completion of the work described herein,the applicant shall submit a Request for Certificate of
Compliance(WPA Form 8A)to the Conservation Commission.
12. The work shall conform to the plans and special conditions referenced in this order.
13. Any change to the plans identified in Condition#12 above shall require the applicant to inquire of the
Conservation Commission in writing whether the change is significant enough to require the filing of a
new Notice of Intent.
14. The Agent or members of the Conservation Commission and the Department of Environmental
Protection shall have the right to enter and inspect the area subject to this Order at reasonable hours
to evaluate compliance with the conditions stated in this 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.
18. All work associated with this Order is required to comply with the Massachusetts Stormwater Policy
Standards.
Special Conditions:
If you need more See attached
space for
additional
conditions,
select box to
attach a text
document ED
wpaformS.doo•rev.3/1105 Page 5 of 9
Bk 10794 Pg 136 #18269
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 5 — Order of Conditions NACC#29
D. Findings Under Municipal Wetlands Bylaw or Ordinance
t. Is a municipal wetlands bylaw or ordinance applicable? ® Yes ❑ No
2. The North Andover hereby finds(check one that applies):
Conservation Commission
3. ❑ 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.
4. ® 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
space for C. The special conditions relating to municipal ordinance or bylaw are as follows:
additional See attached
conditions,
select box to
attach a text
document
wpafomS.doc•rev.3/1105 Page 6 of 9
Bk 10794 Pg 137 #18269
LJMassachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 5 -- Order of Conditions NACC#29
I "Q. r"I ULCL.LIUI I I1LiL
E. Issuance
This Order is valid for three years, unless otherwise specified as a special S /0 0
condition pursuant to General Conditions#4, from the date of issuance. 1.Date of Issuance
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 at the same time to the appropriate Department of
Environmental Protection Regio ffice, if not filing electronically, and the property owner, if different
from applicant.
Signatures: C/
6J
Notary Acknowledgement
Commonwealth of Massachusetts County of Essex North
�h
On this Day of Month Year
Before me, the undersigned Notary Public, Scc- + Hs-'S's e_
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 North Andover Conservation Commission
City/rown
DONNA M.WEDGE
NOTARY SI nature of Notary Public
;� '.'."oHWEALTHOFMASSACHUSETTS
\ Co:rn,Ezpira AUg.? -,09
Printed Name of otary Public
Place notary seal and/or any stamp above cg�7�0�00 9
My ComHssiofi Expires(Date)
This Order is issued to the applicant as follows:
❑ by hand delivery on LIQ by certified mail, return receipt requested,on
Date Date
WPafWM6.d0C•rov.311(05 Page 7 of 9
Bk 10794 Pg 138 #18269
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 5 — Order of Conditions NACC#29
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.Any appellants seeking to appeal the Department's Superseding
Order associated with this appeal will be required to demonstrate prior participation in the review of this project.
Previous participation in the permit proceeding means the submission of written information to the
Conservation Commission prior to the close of the public hearing, requesting a Superseding Order or
Determination, or providing written information to the Department prior to issuance of a Superseding Order
or Determination.
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.
wpaform5.doc•rev.311 M5 Page 6 of 9
e Bk 10794 Pg 139 #18269
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 5 - Order of Conditions NACC#29
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:
NACC#29
Project location DEP He 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
Bk 10794 Pg 140 #18269
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Therefore,the North Andover Conservation Commission(hereafter the"NACU) hereby
finds that the following conditions are necessary in accordance with the Performance
Standards set forth in 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 plansecifications or other proposals submitted with the Notice
of Intent, the conditions shall control.
GENERAL CONDMONS
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 or agent of the NACC 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 or agent 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
public hearing if plans or circumstances are changed or if new conditions or information
so warrant.
24.This Order of Conditions is issued under NACC #29.
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25. 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.
26. 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.
27. The proposed work includes: the construction of a single-family dwelling,deck,
driveway,retaining wall,installation of utilities,stormwater features (water quality
swale/roof infiltration trench),removal of an existing paved area for restoration,the
installation of a boulder wall and associated grading within the buffer zone to an
Isolated Vegetated Wetland (1VV). The site is also located in the Watershed Protection
District.
Note: The Utility Easement to the rear of the property is not a Town owned easement
as determined from a property deed referenced herein.
28. 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: Bonny Realty Trust(Applicant)
C/o Johnson&Borenstein,LLC
12 Chestnut Street
Andover,MA 01810
Received March 30,2007
The Neve-Morin Group,Inc (Representative)
C/o Greg Hochmuth
447 Boston Street,Route 1,Suite 12
Topsfield,MA 01983
Bonny Realty Trust (Owner)
Amy F. Constantino,Trustee
70 Pine Ridge Road
North Andover, MA 01845
Site Plans prepared by: W.C.Cammett Engineering,Inc.
297 Elm Street
Amesbury,MA 01913
Dated 3/20/07,revised 4/18/07
Stamped &Signed by Fred V. Ford,P.E.
Entitled "Site Plan to Accompany Notice of Intent"
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Other Record Documents: Stormwater Analysis
Bonny Lane
North Andover, MA
Received date March 30,2007
Prepared by W.C. Cammett Engineering, Inc.
Stamped &Signed by Fred V.Ford,P.E.
Deed -Book 1478 Page 273-274 referencing the Utility
Easement
29.The following wetland resource areas are affected by the proposed work: Buffer Zone to
ifi ant to the interests
Isolated Vegetated Wetland (IV4V). These resource c areas are significant gn
of the Town BY Law as noted above and therein. The applicant has not attempted to
overcome theP P significance tion of si ificance of these resource areas to the identified
interests.
30. The NACC agrees with the applicant's delineation of the wetland resource areas on the
site as shown on the plans dated referenced herein and as approved under an ORAD
issued 1/30/07(File 3 242-1380).
31. 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). Further the
applicant shall cease maintenance of the 25' no-disturbance zone as noted on the
approved plans referenced herein.
32. 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 be held jointly liable for any violation of this
Order resulting from failure to comply with its conditions.
33. The owners of the project and their successors in title,in the event they proceed to alter
areas subject to the Commission's 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
and its residents for any damage attributable to alterations undertaken on this property
pursuant to the Order. Maintenance of the drainage system, if accepted by the Town as
part of a public way,becomes the responsibility of the Town.
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34. Issuance of these Conditions does not in any way imply or certify that the site or
downstream areas will not be subject to flooding,storm damage or any other form of
water damage.
PRIOR TO CONSTRUCTION
35. 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.
36.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.
37. 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"NACC #29."
plans caused b the applicant, another Board's decision or
38. Any changes in the submittedp y pp ,
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.
39. 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.
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40. Prior to any work commencing on site, the applicant shall submit to the NACC for
approval, a detailed construction sequence,including a dated timetable of construction,
the construction of compensation and retention areas, installation of
sedimentation/erosion control devices, phasing associated with the development and the
construction of the associated stormwater management structures. This timetable must
continue to be updated throughout the project.
41. 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.
42. 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 and referenced herein and shall be inspected
and approved by the NACC prior to the start of construction and shall remain intact until
all disturbed areas have beenP Y ermanentl stabilized to prevent erosion. All erosion
prevention and sedimentation protection measures found necessary during construction
shall be implemented at the direction of the NACC. 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
Commission's request.
43.The applicant shall have on hand at the start of any soil disturbance,removal or
stockpiling,a minimum of 10 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.
44.A check payable to the Town of North Andover shall be provided in the amount of
$3,000,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
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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.
45. Prior to the commencement of any work,the foundation corners of the single-family
home shall be staked in the field by a Registered Land Surveyor (R.L.S.).
Measurements shall be taken and verified by the Conservation Department during the
Pre-Construction meeting.
46. The applicant shall designate a Wetland Scientist as an"Erosion Control Monitor" 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. Proof
of the retained monitor must be submitted to the Conservation Department on
letterhead by the retained consulting firm. This person shall be given the authority to
stop construction for erosion control purposes.The erosion control monitor 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.
47. ON EVERY MONDAY of each week, or otherwise arranged by the NACC,in which
construction activities occurs on-site and for as long thereafter as ground remains
unstable,it is the applicant's responsibility that the Environmental/Erosion Control
Monitor(EMC) monitor the site and submit written reports to the NACC.The EMC
shall certify 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. The reports shall also include current condition of erosion and
sedimentation controls; describe any erosion or sedimentation repair and / or
replacement;and describe any erosion or sedimentation problems and mitigation
measures implemented.Such reports shall continue until the applicant requests a less
frequent reporting schedule or an end to repoxts. This request must be submitted in
writing and is subject to approval by the Conservation Administrator,
48.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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49. 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,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 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 for each pre-
construction meeting(e.g. 72 hours).
DURING CONSTRUCTION
50.IMPORTANT: Immediately upon completion of the dwelling foundation,and prior to
further construction activities associated with the site,the applicant shall complete a plan
prepared by a Registered Professional Land Surveyor of the Commonwealth(R.P.L.S.)which
accurately depicts the foundation location and it's proximity to wetland resource areas as
approved under this Order of Conditions. Said plan shall be submitted to the Conservation
Administrator for approval.
51. Accepted engineering and Best Management Practices (BMPs) for construction standards
shall be followed in the conduct of all work.
52.Erosion control devices shall be re inspected regularly;any entrapped silt shall be removed
P � Y
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.
53. Upon beginning work,the applicant shall submit written progress reports every month
detailing what work has been done in or near resource areas,and what work is anticipated to
be done over the next period. This will update the construction sequence.
54.The sewer lines on the site,where they cross wetland resource areas, shall be tested for
water tightness in accordance with North Andover DPW standards.
55.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.
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56.Approved de-watering activities anticipated shall be supervised and witnessed by the
designated erosion control monitor. This designee must be on-site while any dewatering
is occurrin&. De-watering activities shall be conducted as shown on the approved plans and
shall be monitored daily by the erosion control monitor 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 of the Wetlands Protection Act
and/or the North Andover Wetland 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 basin, to reduce turbidity prior to
discharge into a resource area.
57. A permanent boulder wall shall be constructed and installed immediately upslope of
Disturbance Zone as shown on the the 25 No D approved plan referenced herein.
58. Any fill used in connection with this project shall be clean fill,containing no trash,refuse,
I 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.
59. 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.
60. No re-grading in the buffer zone shall have a slope steeper than 2:1 (horizontal:vertical).
Slopes of steeper grade shall be rip-rapped to provide permanent stabilization.
61. Construction equipment/vehicles shall not be staged overnight within 100 feet of a
wetland resource area.
62.There shall be no stockpiling of soil or other materials within twenty-five (25)feet of any
resource area.
63.Washings from concrete trucks, or surplus concrete,shall not be directed to,any drainage
system,or wetland resource area.
64. 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.
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65. 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.
AFTER CONSTRUCTION
66. 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
Town's Wetland protection Bylaw.
67. 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. 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.
68. 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.
69.Upon approved site stabilization by Conservation staff,the erosion controls shall be
removed and properly disposed of and all exposed unvegetated areas shall be seeded.
70. 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.
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h. A written statement from a Registered Professional Civil Engineer (and/or
Registered Professional Land Surveyor) 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.
i. An"As-Built" plan prepared and signed and stamped by a Registered Professional
Civil Engineer(and/or 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. NOTE: If portions of the stormwater systems exist partially within the
Buffer Zone than the entire structure must be depicted to accurately verify
compliance.
➢ "As-Built" post-development elevations and grades of all filled or altered
wetland resource areas including the encompassing buffer zone,which is
regulated as a resource area under the local Wetland Protection Bylaw.
➢ Distances from structures to wetland resource areas. Structures include(but
are not limited to)septic systems, additions,fences,sheds,stone walls,
pools,retaining walls,subsurface utilities and decks.
➢ A line showing the limit of work and the extent of existing erosion control
devices. "Work" includes a�disturbance of soils or vegetation.
➢ Location of all subsurface utilities entering the property.
71.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#31);
➢ Discharge or spillage of pollutants (Condition#65);
➢ Prohibition of underground fuels (Condition #66);
➢ Limitations on the use of fertilizers,herbicides,and pesticides (Condition#67).
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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) I 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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