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Home My WebLink AboutMiscellaneous - 345 CANDLESTICK ROAD 4/30/2018 (3)W 04 �1 C, 0 Ll'Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 8B — Certificate of Compliance Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. tab A. Project Information 1. This Certificate of Compliance is issued to: John Miller Name 345 Candlestick Road Mailing Address North Andover City/Town MA. State DEP File Number: 7d7-1118 riwIucu uy ver 01845 Zip Code 2. This Certificate of Compliance is issued for work regulated by a final Order of Conditions issued to: John Miller Name 2/28/02 Dated 3. The project site is located at: 345 Candlestick Road Street Address Map 106A Assessors Map/Plat Number 242-1118 DEP File Number North Andover CitylTown Parcel 230 Parcel/Lot Number the final Order of Condition was recorded at the Registry of Deeds for: Property Owner (if different) Essex North County Book Page Certificate 4. A site inspection was made in the presence of the applicant, or the applicant's agent, on: 11/30/05 & 12/1/05 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.doc • rev. 7/13/04 Page 1 of 4 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands DEP File Number: WPA Form 8B — Certificate of Compliance 242-1118 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP B. Certification (cont.) ❑ Invalid Order of Conditions: It is hereby certified that the work regulated by the above -referenced Order of Conditions never commenced. The Order of Conditions has lapsed and is therefore no longer valid. No future work subject to regulation under the Wetlands Protection Act may commence without filing a new Notice of Intent and receiving a new Order of Conditions. ® Ongoing Conditions: The following conditions of the Order shall continue: (Include any conditions contained in the Final Order, such as maintenance or monitoring, that should continue for a longer period). Condition Numbers: 63 C. Authorization Issued by: North Andover ,$ _ Conservation Commission Date df Is ante This Certificate must be signed by a majority of the Conservation Commission and- opy sent to the applicant and appropriate DEP Regional Office (See Attachment). Signatures: 100, i wpaform 8b.doc • rev. 7113104 Page 2 of 4 Ll'Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands DEP File Number: WPA Form 8B — Certificate of Compliance 242-1118 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP C. Authorization (cont.) Notary Acknowledgement Commonwealth of Massachusetts County of trr`i On this Day Essex North Month Year before me, the undersigned Notary Public, personally appeared S Gc f' 1M -55e_ 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 .rsw � DONNA M. WEDGE T NOTARY PUBUCa COMMONVvEALTH Of MASSACHUSETTS ^c"r m. Expires Aa,i. 7, 2009 North Andover Cityfrown Place notary seal and/or any stamp above Conservation Commission -Wx /,////, I — , 46 Signature of Notary Public .7)KI,IJA� /;l Printed Name of Notary Public bLcl?,f1'97 My Co iss on Ex ares (Date) Sighature of Notary Public wpaform 8b.doc - rev. 7h 3/04 Page 3 of 4 L11Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands DEP File Number: WPA Form 8B — Certificate of Compliance 242-1118 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: 242-1118 Project Location DEP File Number Has been recorded at the Registry of Deeds of: County for: Property Owner and has been noted in the chain of title of the affected property on: Date Book Page If recorded land, the instrument number which identifies this transaction is: If registered land, the document number which identifies this transaction is: Document Number Signature of Applicant wpaform Bb.doc • rev. 7/13/04 Page 4 of 4 L1Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands 1 DEP Regional Addresses Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Mail transmittal forms and DEP payments, payable to: Amesbury Chelmsford Hingham Merrimac Commonwealth of Massachusetts 1 Winter Street Andover Chelsea Holbrook Methuen Department of Environmental Protection Boston, MA 02108 Arlington Cohasset Hull Box 4062 Reading Waltham Ashland Concord Ipswich Boston, MA 02211 Revere Watertown Phone: 617-654-6500 Bedford Danvers DEP Western Region Adams Colrain Hampden Monroe Pittsfield Tyringham 436 Dwight Street Agawam Conway Hancock Montague Plainfield Wales Lincoln Alford Cummington Hatfield Monterey Richmond Ware Suite 402 Amherst Dalton Hawley Montgomery Rowe Warwick Springfield, MA 01103 Ashfield Deerfield Heath Monson Russell Washington Phone: 413-784-1100 Becket Easthampton Hinsdale Mount Washington Sandisfield Wendell Fax: 413-784-1149 Belchertown East Longmeadow Holland New Ashford Savoy Westfield Manchester -By -The -Sea Bernardston Egremont Holyoke New Marlborough Sheffield Westhampton Marblehead Blandford Erving Huntington New Salem Shelburne West Springfield Medfield Brimfield Florida Lanesborough North Adams Shutesbury West Stockbridge Medford Buckland Gill Lee Northampton Southampton Whately Melrose 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 Ashbumham ClintonHubbardslon Millville Shirley Warren Worcester, MA 01608 Ashby Athol Douglas Hudson New Braintree Shrewsbury Webster Dudley Holliston Northborough Southborough Westborough Phone: 508-792-7650 Auburn Dunstable Lancaster Northbridge Southbridge West Boylston Fax: 508-792-7621 Ayer East Brookfield Leicester North Brookfield Spencer West Brookfield Barre Fitchburg Leominster Oakham Sterling Westford TDD: 508-767-2788 Bellingham Gardner Littleton Oxford Stow Westminster Berlin Grafton Lunenburg Paxton Sturbridge Winchendon Blackstone Groton Marlborough Pepperell Sutton Worcester Bolton Harvard Maynard Petersham Templeton Boxborough Hardwick Medway Phillipston Townsend Boylston Holden Mendon Princeton Tyngsborough Brookfield Hopedale Milford Royalston Upton DEP Southeast Region Abington Dartmouth Freetown Mattapoisetl Provincetown Tisbury 20 Riverside Drive Acushnel Dennis Gay Head Middleborough Raynham Truro Lakeville, MA Attleboro Dighton Gosnold Nantucket Rehoboth Wareham 02347 Avon Duxbury Halifax New Bedford Rochester Weltfleet Phone: 508-946-2700 Barnstable Eastham Hanover North Attleborough Rockland West Bridgewater Fax: 508-947-6557 Berkley East Bridgewater Hanson Norton Sandwich Westport TDD: 508-946-2795 Bourne Easton Harwich Norwell Scituate West Tisbury Brewster Edgartown Kingston Oak Bluffs Seekonk Whitman Bridgewater Fairhaven Lakeville Orleans Sharon Wrentham Brockton Fall River Mansfield Pembroke Somerset Yarmouth CarverFalmouth 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 Boston, MA 02108 Arlington Cohasset Hull Middleton Reading Waltham Ashland Concord Ipswich Millis Revere Watertown Phone: 617-654-6500 Bedford Danvers Lawrence Milton Rockport Wayland Fax: 617-5561049 Belmont Dedham Lexington Nahant Rowley Wellesley TDD: 617-574-6868 Beverly Dover Lincoln Natick Salem Wenham Billerica Dracut Lowell Needham Salisbury West Newbury Boston Essex Lynn Newbury Saugus Weston Boxford Everett Lynnfield Newburyport Sherborn Westwood Braintree Framingham Malden Newton Somerville Weymouth Brookline Georgetown Manchester -By -The -Sea Norfolk Stoneham Wilmington Burlington Gloucester Marblehead North Andover Sudbury Winchester Cambridge Groveland Medfield North Reading Swampscott Winthrop Canton Hamilton Medford Norwood Tewksbury Woburn Carlisle Haverhill Melrose Peabody Topsfield wpaformBb.doc • DEP Addresses • rev. 12/12/05 Page 1 of 1 �i Commonwealth of Massachusetts City/Town of JUN U 2010 System Pumping Record Form 4 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be, substantially the same as that provided here. Before using this form, check with your local Board of Health tQ determine the form they use. The System Pumping Record must be submitted to the local Board of Health oFother approving authority. A. Facility Information 1. System Location: Left side of house, Right side of house, Left front of hous , 4ig- Left t front of hous , rear of house, Right rear of house. Left rear of building. Right rear of buil Address City/Town State Zip Code 2. System Owner: � V� Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ Date Cesspool(s) ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes No ' 5. Condi ion pf System- 6. ystem 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Location where ntents were disposed: Lowell.WasteMater Stat � / Z' Code Telephone Number 2. Quantity Pumped eptic Tank S -2;?�- Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No F5821 Vehicle License Number 6 j- � --lG Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1