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• Massachusetts Department of Environmental Protection
Bureau of Resource Protection T Wetlands DEP File Number:
WPA Form 8B —• Certificate of Compliance 242-1271
!Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
A. Project Information
Important: 1 This Certificate of Compliance is issued to:
When filling out
forms on the Litchfield Company — —
computer, use Name
only the tab Ra venue
26
key to move y A -- -- ---
your cursor- Mailing Address
do not use the _Burlington _ _ _._ _ MA. 01803
return key. City/Town State Zip Code
2. This Certificate of Compliance is issued for work regulated by a final Order of Conditions issued to:
Litchfield Comps
Name
10/26!04 242-1271
Dated DEP File Number
3. The project site is.located at:
236 Gray Street(Lot 8) _ _ North Andover _
Street Address City/Town
_Map 107D __— __— Parcel 122 _
Assessors Map/Plat Number Parcel/Lot Number
the final Order of Condition was recorded at the Registry of Deeds for:
Property Owner(if different)
Essex North _ 9286 _ 269
County Book Page
Certificate ----- -- - — --
4. A site inspection was made in the presence of the applicant, or the applicant's agent, on:
2/22/07
Date _. ----- --
B. Certification/
Check all that apply:
® Complete Certification: It is hereby certified that the work regulated by the above-referenced
Order of Conditions has been satisfactorily completed.
❑ partial Certification: It is hereby certified that only the following portions of work regulated by the
above-referenced Order of Conditions have been satisfactorily completed.The project areas or work
subject to this partial certification that have been completed and are released from this Order are:
wpaform 8b,d0c•rev.7/13/04
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Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands DEP File Number:
WPA Form $B — Certificate of Compliance 242-1271
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
BA Certification (coat.)
❑ Invalid Order of Conditions: It is hereby certified that the work regulated by the above-referenced
Order of Conditions never commenced. The Order of Conditions has lapsed and is therefore no
longer valid. No future work subject to regulation under the Wetlands Protection Act may
commence without filing a new Notice of Intent and receiving a new Order of Conditions.
® ongoing Conditions: The following conditions of the Order shall continue: (Include any
conditions contained in the Final Order, such as maintenance or monitoring, that should continue
for a longer period).
Condition Numbers:
65
C. Authorization
Issued by:
North Andover _ _ 3//Xq
Conservation Commission — Date fsuanYt; ce
This Certificate must be signed by a majority of the Conservation Commission and a c to the
applicant and appropriate DEP Regional Office(See Attachment).
Signatures:
wpafo-8b.doc•rev.7/13/04
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�L
Massachusetts Department of Environmental Protection DEP File Number:
Bureau of Resource Protection -Wetlands
WPA Form 8B — Certificate of Compliance 242-1271
(Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
C. Authorization (cont.)
(Votary Acknowledgement
Essex North
Commonwealth of Massachusetts County of — 1
Fe
On this pay
---- Of Month Year
before me, the undersigned Notary Public, personally appeared
Name of Document Signer
proved to me through satisfactory evidence of identification, which was/were
_Massachusetts License
Description of evidence of identification
to be the person whose name is signed on the preceding or attached document, and acknowledged
to me that he/she signed it voluntarily for its stated purpose.
North Andover Conservation Commission
As member of cityrrown
'P/ "z�
Signature of Notary Public
tel» f aEJnel !�
DONNA K VIII"DGE ----
i=_. Printed Name of Notary Public
UC
COMMONWEAL MASSACHUSETTS
Comm.Ex
Y pires Aura.7.2009
42 1p
My Commission xpires(Date)
Place nota seal and/or an s
notary y tamp above
Signature of Notary Public
wpafonn Wdoe•rev.7/13/04
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Massachusetts Department of Environmental Protection DEP File Number:
Bureau of Resource Protection - Wetlands
to ®f Compliance 242-1271
WPA Form 8� ® Cert�f'ca P
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
D. Recording Confirmation
The applicant is responsible for ensuring that this Certificate of Compliance is recorded in the Registry of
Deeds or the Land Court for the district in which the land is located.
Detach on dotted line and submit to the Conservation Commission.
To:
North Andover
Conservation Commission
Please be advised that the Certificate of Compliance for the project at:
242-1271
Project Location DEP File Number
Has been recorded at the Registry of Deeds of:
County
for:
Property Owner
and has been noted in the chain of title of the affected property on:
Date Book Page
If recorded land, the instrument number which identifies this transaction is:
If registered land, the document number which identifies this transaction is:
Document Number -
Signature of Applicant —" —
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[LEIMassachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands
DEE Regional Addresses
Massachusetts Wetlands Protection Act M.G.L. c 131, §40
Mail transmittal forms and DEF'payments,payable to:
commonwealth of Massachusetts
Department of Environmental Protection
Box 4062
Boston, MA 02211
DEP Western Region Adams Colrain Hampden Monroe Pittsfield Tyringham
Dwight Street Agawam Conway Hancock Montague Plainfield Wales
436 DWI
9 Alford Cummington Hatfield Monterey Richmond Ware
Suite 402 Amherst Dalton Hawley Montgomery Rowe Warwick
Springfield,MA 01103 Ashfield Deerfield Heath Monson Russell Washington
Backet Easthampton Hinsdale Mount Washington Sandisfield
Phone:413-784-1100 Wendell
Belchertown East Longmeadow Holland New Ashford Savoy Westfield
Fax:413-784-1149 Bemardston Egremont Holyoke New Marlborough Sheffield Westhampton
Blandford Erving Huntington New Salem Shelburne West Springfield
Brimfield Florida Lanesborough North Adams Shutesbury West Stockbridge
Buckland bill Lee Northampton Southampton Whately
Charlemont Goshen Lenox Northfield South Hadley Wilbraham
Cheshire Granby Leverett Orange Southwick Williamsburg
Chester Granville Leyden Otis Springfield Williamstown
Chesterfield Great Barrington Longmeadow Palmer Stockbridge Windsor
Chicopee Greenfield Ludlow Pelham Sunderland Worthington
Clarksburg Hadley Middlefield Peru Tolland
DEP Central Region Acton Charlton Hopkinton Millbury Rutland Uxbridge
627 Main Street Ashburnham Clinton Hubbardston Millville Shirley Warren
Ashby Douglas Hudson New Braintree Shrewsbury Webster
Worcester,MA 01608 Athol Dudley Holliston Northborough Southborough Westborough
Phone:508-792-7650 Auburn Dunstable Lancaster Northbridge Southbridge West Boylston
Fax:508-792-7621 Ayer Fast Brookfield Leicester North Brookfield Spencer West Brookfield
Barre Fitchburg Leominster Oakham Sterling Westford
TDD:508-767-2788 Bellingham Gardner Littleton Oxford Stow Westminster
Berlin Grafton Lunenburg Paxton Sturbridge Winchendon
Blackstone Groton Marlborough Pepperell Sutton Worcester
Bolton Harvard Maynard Petersham Templeton
Boxborough Hardwick Medway Phillipston Townsend
Boylston Holden Mendon Princeton Tyngsborough
Brookfield Hopedale Milford Royalston Upton
DEP Southeast Region Abington Dartmouth Freetown Mattapoiselt Provincetown Tisbury
20 Riverside Drive Acushnet Dennis Gay Head Middleborough Raynham Truro
Attleboro Dighton Gosnold Nantucket Rehoboth Wareham
Lakeville,MA 02347 Avon Duxbury Halifax New Bedford Rochester Wellfleet
Phone:508-946-2700 Barnstable Eastham Hanover North Attleborough Rockland West Bridgewater
Fax:508-947-6557 Berkley East Bridgewater Hanson Norton Sandwich Westport
Bourne Easton Harwich Norwell Scituate West Tisbury
TDD:508-946-2795 Brewster Edgartown Kingston Oak Bluffs Seekonk Whitman
Bridgewater Fairhaven Lakeville Orleans Sharon Wrentham
Brockton Fall River Mansfield Pembroke Somerset Yarmouth
Carver Falmouth Marion Plainville Stoughton
Chatham Foxborough Marshfield Plymouth Swansea
Chilmark Franklin Mashpee Plympton Taunton
DEP Northeast Region Amesbury Chelmsford Hingham Merrimac Quincy Wakefield
1 Winter Street Andover Chelsea Holbrook Methuen Randolph Walpole
Arlington Cohasset Hull Middleton Reading Waltham
Boston,MA 02108 Ashland Concord Ipswich Millis Revere Watertown
Phone:617-654-6500 Bedford Danvers Lawrence Milton Rockport Wayland
Belmont Dedham Lexington Nahant Wellesley
Fax: 617-556-1049 Rowley nha
Beverly Dover Lincoln Natick Salem Wenham
TDD:617-574-6868 Billerica Dracut Lowell Needham Salisbury West Newbury
Boston Essex
Lynn Newbury Saugus Weston
Boxford Everett Lynnfield Newburyport Sherborn Westwood
tweed
Framingham min�ham Malden Newton Somerville Weymouth
Brookline Georgetown Manchester-By-The-Sea Norfolk Stoneham Wilmington
Burlington Gloucester Marblehead North Andover Sudbury Winchester
Cambridge Groveland Medfield North Reading Swampscott Winthrop
Canton Hamilton Medford Norwood Tewksb
ury
Carlisle Haverhill Melrose Peabody Topsfield Woburn
wpaf0rm8b.doc•DEP Addresses•rev.2/23/07
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