Loading...
HomeMy WebLinkAboutMiscellaneous - 12 BONNY LANE 4/30/2018 JOONNY LANE 2101062.0-0041-OWO.o Date.. . �. .�".. �.f� ... .. H°RTM °f 3= TOWN OF NORT MOVER i ° ...; F • - PERMIT F�R AS INSTALLATION o h 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 ❑ x w � a w ° U O w d F a z z O z w � � G7 F z E; x w W A F x 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 NACC#29 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. C:\Winword\OOC\ImonnyLane.doc 1 NACC 5/4/2007 Bk 10794 Pg 141 #18269 NACC#29 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" CAWinword\00C\12BonnyLane.doc 2 NACC 5/4/2007 Bk 10794 Pg 142 #18269 NACC#29 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. CAWinword\00C\1MonnyLane.doc 3 NACC 5/4/2007 Bk 10794 Pg 143 #18269 NACC#29 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. C:\Winword\ooC\1monnyLane.doc 4 NACC 5/4/2007 Bk 10794 Pg 144 #18269 NACC#29 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 C:Mnword\00C\12BonnyLane.doc 5 NACC 5/4/2007 Bk 10794 Pg 145 #18269 NACC#29 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. C:\Winword\00C\1monnyLanc.doc 6 NACC 5/4/2007 Bk 10794 Pq 146 #18269 NACC#29 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. CAWinword\OOC\ImonnyLane.doc 7 NACC 5/4/2007 Bk 10794 Pg 147 #18269 NACC#29 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. C:\Winword\OOC\IMonnyLane.doc 8 NACC 5/4/2007 Bk 10794 Pg 148 #18269 NACC#29 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. CAWinword\00C\1MonnyLane.doc 9 NACC 5/4/2007 Bk 10794 Pq 149 #18269 NACC #29 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). CAWinword\OOC\1MonnyLane.doc 10 NACC 5/4/2007 Bk 10794 Pg 150 #18269 NACC#29 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) CAWinword\00C\12BonnyLane.doc 1 1 NACC 5/4/2007