HomeMy WebLinkAboutMiscellaneous - 206 FOREST STREET 4/30/2018 (4)�
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Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 5 - Order of Conditions
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
DEP File Number.
242-1155
Provided by DEP
Property Owner (if different from applicant):
Name
Mailing Address
uIty/Town
North Andover
City/Town
107
Parcel/Lot Number
2. Property recorded at the Registry of Deeds for:
North Essex 1397
County Book
Certificate (if registered land)
3. Dates:
6/26/02 7/24/02
Date Notice of Intent Filed Date Public Hearing Closed
State
Date dfifisuande
253
Page
Zip Code
4. Final Approved Plans and Other Documents (attach additional plan references as needed):
Sewage Disposal System Site Plan -and Profile 206 Forest Street rev. 6/28/02
Title Date
Notice of Intent 6/27/02
Title Date
Title
5. Final Plans and Documents Signed and Stamped by:
Joseph Serwatka, P.E.
Name
6. Total Fee:
110.00
(from Appendix B: Wetland Fee Transmittal Form)
Date
Wpaform5.doc • rev. 12/15/00 Page 1 of 7
A. General Information
Important:
When filling
From:
out forms on
North Andover Conservation Commission
the computer,
Conservation Commission
use only the
tab key to
This issuance if for (check one):
move your
cursor - do
®Order of Conditions
not use the
return key.
❑ Amended Order of Conditions
rQ
To: Applicant:
it AP
Douglas Beach
Name
206 Forest Street
Mailing Address
North Andover MA 01845
City/Town State Zip Code
1. Project Location:
206 Forest Street
Street Address
106A _
Assessors Map/Plat Number
DEP File Number.
242-1155
Provided by DEP
Property Owner (if different from applicant):
Name
Mailing Address
uIty/Town
North Andover
City/Town
107
Parcel/Lot Number
2. Property recorded at the Registry of Deeds for:
North Essex 1397
County Book
Certificate (if registered land)
3. Dates:
6/26/02 7/24/02
Date Notice of Intent Filed Date Public Hearing Closed
State
Date dfifisuande
253
Page
Zip Code
4. Final Approved Plans and Other Documents (attach additional plan references as needed):
Sewage Disposal System Site Plan -and Profile 206 Forest Street rev. 6/28/02
Title Date
Notice of Intent 6/27/02
Title Date
Title
5. Final Plans and Documents Signed and Stamped by:
Joseph Serwatka, P.E.
Name
6. Total Fee:
110.00
(from Appendix B: Wetland Fee Transmittal Form)
Date
Wpaform5.doc • rev. 12/15/00 Page 1 of 7