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ILIMassachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands DEP File Number:
WPA Form 86 — Certificate of Compliance 242-1392
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
A. Project Information
Important:
When filling out 1. This Certificate of Compliance is issued to:
forms on the
computer,use Kartcher LLC c/o John Carroll, Manager
only the tab key Name
to move your 1501 Main Street, Suite 15
cursor-do not
use the return Mailing Address
key. Tewksbury MA 01876
City/Town State Zip Code
VQ 2. This Certificate of Compliance is issued for work regulated by a final Order of
Conditions issued to:
Kartcher LLC c/o John Carroll, Manager
Name
July 2, 2007 242-1392
Dated DEP File Number
3. The project site is located at:
810 Salem Street&409 Blueridge Road North Andover
Street Address City/Town
Map 65 Parcel 15
Assessors Map/Plat Number Parcel/Lot Number
the final Order of Condition was recorded at the Registry of Deeds for:
Helen St. Cyr
Property Owner(if different)
Essex North 10856 180
County Book Page
Certificate
4. A site inspecti n was made in the presence of the applicant, or the applicant's agent,
on: / �)
Date C/
wpafrm8b.doc•rev.12/23/09 WPA Form 813,Certificate of Compliance•Page 1 of 3
ILIMassachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 8B — Certificate of Compliance 242-1392
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
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:
❑ 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Conditions has lapsed and is therefore no longer valid.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:
80
C. Authorization
Issued by:
North Andover
Conservation Commission Datd of Issuance
This Certificate must be signed by a majority of the Conservation Commission and a
copy sent to the applicant and appropriate DEP Region Office(See
hftp://www.mass.gov/dep/about/region/findvour.htm).
Signatures:
wpafrm8b.doc•rev,12/23/09 WPA Form 813,Certificate of Compliance•Page 2 of 3
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands DEP File Number:
WPA Form 8B — Certificate of Compliance ILI
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 242-1392
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:
810 Salem Street&409 Bluerid a Road 242-1392
Project Location DEP File Number
Has been recorded at the Registry of Deeds of:
Essex North
County
for:
Kartcher LLC c/o John Carroll, Manager
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
wpafrm8b.doc•rev.12/23/09 wPA Form 8B,Certificate of Compliance•Page 3 of 3