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HomeMy WebLinkAboutMiscellaneous - 673 GREAT POND ROAD 4/30/2018 (4) � 7,3 CieeAT y NORTH q 3+ g�'' ° 0 o m p CHU5�� CONSERVATION DEPARTMENT Community Development Division NEGATIVE DETERMINATION OF APPLICABILITY SPECIAL CONDITIONS 673 Great Pond Road, North Andover At the October 13,2010 public hearing, the North Andover Conservation Commission (NACC) voted to issue a Negative Determination of Applicability for the excavation and removal of an existing gas line and the installation of a new, slightly larger gas line in the Buffer Zone to Isolated Vegetated Wetland (IVW). The closest point of work to the IVW is approximately 20-feet. Erosion control is proposed between the adjacent wetland resource area and the gas line installation. The resource area delineation was confirmed by an Order of Resource Area Delineation issued under DEP File #242-1424 in April of 2008. Applicant: Robert H. Farnham,Jr. ICB Realty Trust 673 Great Pond Road North Andover,MA 01845 Record Documents: Request for Determination of Applicability 673 Great Pond Road, North Andover, Massachusetts Date: October 1,2010 Prepared by:Wetlands Preservation, Inc. 47 Newton Road Plaistow,NH 03865 Record Plans: Existing Conditions Site Plan Date: September 5, 2008 New Gas Line Date: Sep 21, 2010 Prepared by: Morgan Wheelock Inc. Stamped by: Christopher J. Dindal,Registered Landscape Architect Pre-Construction ❖ Erosion controls shall be installed per the approved plan. 1600 Osgood Street,Building 20,Suite 2-36,North Andover,Massachusetts 01845 Phone 978.688.9530 Fax 978.688.9542 Web:http://www.townofnordiandover.com/Pages/NAndoverMA_Conservadon/index Y , ❖ The applicant shall contact the Conservation Department prior to the start of work to inspect the installed erosion controls. During Construction ❖ Excess material and construction debris shall be properly disposed of off site and stockpiled material shall be stored between the trench and the driveway. Post Construction ❖ Immediately following completion of the work, any disturbed areas shall be permanently stabilized against erosion (loam and seed or sodded as seasonally appropriate). Upon completion of all requirements, the Conservation Department shall be contacted to conduct a final site inspection. 1600 Osgood Street,Building 20,Suite 2-36,North Andover,Massachusetts 01845 Phone 978.688.9530 Fax 978.688.9542 Web:http://www.townofnordiandover.com/Pages/NAndoverMA_Conservation/index Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 A. General Information Important: When filling out From: forms on the North Andover computer, use Conservation Commission only the tab key to move To: Applicant Property Owner(if different from applicant): your cursor- do not use the ICB Realty Trust return key. Name Name 673 Great Pond Road Mailing Address Mailing Address North Andover MA 01845 City/Town State Zip Code City/Town State Zip Code 1. Title and Date(or Revised Date if applicable)of Final Plans and Other Documents: Existing Conditions Plan Sept. 5, 2008 Title Date New Gas Line Sept. 21, 2010 Title Date Title Date 2. Date Request Filed: 10/1/10 B. Determination Pursuant to the authority of M.G.L. c. 131, §40, the Conservation Commission considered your Request for Determination of Applicability, with its supporting documentation, and made the following Determination. Project Description (if applicable): Removal of existing gas line and installation of new, slightly larger gas line within the 100' Buffer Zone to wetland resource areas (as established by the ORAD issued under DEP File#242-1424). Trench will be 1.5 feet wide and approximately 3 feet deep. Erosion control is proposed between all excavation and downgradient resource areas. Project Location: 673 Great Pond Road North Andover Street Address City/Town Map 63 Parcel 27 Assessors Map/Plat Number Parcel/Lot Number wpaform2.doc•Determination of Applicability•rev.10/6/04 Page 1 of 5 ' t ) ILIMassachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Determination (cont.) The following Determination(s) is/are applicable to the proposed site and/or project relative to the Wetlands Protection Act and regulations: Positive Determination Note: No work within the jurisdiction of the Wetlands Protection Act may proceed until a final Order of Conditions(issued following submittal of a Notice of Intent or Abbreviated Notice of Intent)or Order of Resource Area Delineation (issued following submittal of Simplified Review ANRAD) has been received from the issuing authority(i.e., Conservation Commission or the Department of Environmental Protection). ❑ 1. The area described on the referenced plan(s)is an area subject to protection under the Act. Removing,filling,dredging, or altering of the area requires the filing of a Notice of Intent. ❑ 2a.The boundary delineations of the following resource areas described on the referenced plan(s)are confirmed as accurate.Therefore,the resource area boundaries confirmed in this Determination are binding as to all decisions rendered pursuant to the Wetlands Protection Act and its regulations regarding such boundaries for as long as this Determination is valid. ❑ 2b. The boundaries of resource areas listed below are not confirmed by this Determination, regardless of whether such boundaries are contained on the plans attached to this Determination or to the Request for Determination. ❑ 3. The work described on referenced plan(s)and document(s) is within an area subject to protection under the Act and will remove, fill, dredge, or alter that area. Therefore, said work requires the filing of a Notice of Intent. ❑ 4. The work described on referenced plan(s)and document(s) is within the Buffer Zone and will alter an Area subject to protection under the Act. Therefore, said work requires the filing of a Notice of Intent or ANRAD Simplified Review(if work is limited to the Buffer Zone). ❑ 5. The area and/or work described on referenced plan(s) and document(s) is subject to review and approval by: Name of Municipality Pursuant to the following municipal wetland ordinance or bylaw: Name Ordinance or Bylaw Citation wpaform2.doc•Determination of Applicability•rev.1016/04 Page 2 of 5 ILIMassachusetts Department of Environmenta0 Protection Bureau of Resource Protection -Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Determination (cont.) ❑ 6. The following area and/or work, if any, is subject to a municipal ordinance or bylaw but not subject to the Massachusetts Wetlands Protection Act: ❑ 7. If a Notice of Intent is filed for the work in the Riverfront Area described on referenced plan(s) and document(s), which includes all or part of the work described in the Request, the applicant must consider the following alternatives. (Refer to the wetland regulations at 10.58(4)c. for more information about the scope of alternatives requirements): ❑ Alternatives limited to the lot on which the project is located. ❑ Alternatives limited to the lot on which the project is located, the subdivided lots, and any adjacent lots formerly or presently owned by the same owner. ❑ Alternatives limited to the original parcel on which the project is located, the subdivided parcels, any adjacent parcels, and any other land which can reasonably be obtained within the municipality. ❑ Alternatives extend to any sites which can reasonably be obtained within the appropriate region of the state. Negative Determination Note: No further action under the Wetlands Protection Act is required by the applicant. However, if the Department is requested to issue a Superseding Determination of Applicability, work may not proceed on this project unless the Department fails to act on such request within 35 days of the date the request is post-marked for certified mail or hand delivered to the Department. Work may then proceed at the owner's risk only upon notice to the Department and to the Conservation Commission. Requirements for requests for Superseding Determinations are listed at the end of this document. ❑ 1. The area described in the Request is not an area subject to protection under the Act or the Buffer Zone. ❑ 2. The work described in the Request is within an area subject to protection under the Act, but will not remove, fill, dredge, or alter that area. Therefore, said work does not require the filing of a Notice of Intent. ® 3. The work described in the Request is within the Buffer Zone, as defined in the regulations, but will not alter an Area subject to protection under the Act. Therefore, said work does not require the filing of a Notice of Intent, subject to the following conditions (if any). See attached conditions ❑ 4. The work described in the Request is not within an Area subject to protection under the Act (including the Buffer Zone). Therefore, said work does not require the filing of a Notice of Intent, unless and until said work alters an Area subject to protection under the Act. wpaform2.doc•Determination of Applicability•rev.10/6/04 Page 3 of 5 f. 1 Massachusetts Department of Environmenta0 Protection ILIBureau of Resource Protection -Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Determination (cont.) ❑ 5. The area described in the Request is subject to protection under the Act. Since the work described therein meets the requirements for the following exemption, as specified in the Act and the regulations, no Notice of Intent is required: Exempt Activity(site applicable statuatory/regulatory provisions) ❑ 6. The area and/or work described in the Request is not subject to review and approval by: Name of Municipality Pursuant to a municipal wetlands ordinance or bylaw. North Andover Wetlands Protection Bylaw Chapter 178 Name Ordinance or Bylaw Citation C. Authorization This Determination is issued to the applicant and delivered as follows: ❑ by hand delivery on [2/by certified mail, return receipt requested on Date Date This Determination is valid for three years from the date of issuance (except Determinations for Vegetation Management Plans which are valid for the duration of the Plan). This Determination does not relieve the applicant from complying with all other applicable federal, state, or local statutes, ordinances, bylaws, or regulations. This Determination must be signed by a majority of the Conservation Commission. A copy must be sent to the appropriate DEP Regional Office (see http://www.mass.gov/deP/about/region.findvour.htm)and the property owner(if different from the applicant). Sig ures t ------------- 1011gbo Date wpaform2.doc•Determination of Applicability•rev.10/6/04 Page 4 of 5 t Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 D. Appeals The applicant, owner, any person aggrieved by this Determination, any owner of land abutting the land upon which the proposed work is to be done, 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 Department of Environmental Protection Regional Office(see http://www.mass.gov/dep/about/region.findyour.htm)to issue a Superseding Determination of Applicability. The request must be made by certified mail or hand delivery to the Department, with the appropriate filing fee and Fee Transmittal Form (see Request for Departmental Action Fee Transmittal Form)as provided in 310 CMR 10.03(7)within ten business days from the date of issuance of this Determination. 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. The request shall state clearly and concisely the objections to the Determination which is being appealed. To the extent that the Determination is based on a municipal ordinance or bylaw and not on the Massachusetts Wetlands Protection Act or regulations, the Department of Environmental Protection has no appellate jurisdiction. wpaform2.doc•Determination of Applicability•rev.10/6/04 Page 5 of 5 ,t Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands Request for Departmental Action Fee Transmittal Form Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 A. Request Information Important: When filling out 1. Person or party making request(if appropriate, name the citizen group's representative): forms on the computer, use Name only the tab key to move your cursor- Mailing Address do not use the return key. City/Town State Zip Code Phone Number Fax Number(if applicable) Project Location Mailing Address City/Town State Zip Code 2. Applicant(as shown on Notice of Intent(Form 3), Abbreviated Notice of Resource Area Delineation (Form 4A); or Request for Determination of Applicability(Form 1)): Name Mailing Address City/Town State Zip Code Phone Number Fax Number(if applicable) 3. DEP File Number: B. Instructions 1. When the Departmental action request is for(check one): ❑ Superseding Order of Conditions ($100 for individual single family homes with associated structures; $200 for all other projects) ❑ Superseding Determination of Applicability($100) ❑ Superseding Order of Resource Area Delineation ($100) Send this form and check or money order for the appropriate amount, payable to the Commonwealth of Massachusetts to: Department of Environmental Protection Box 4062 Boston, MA 02211 wpaform2.doc•Request for Departmental Action Fee Transmittal Form•rev.10/6/04 Page 1 of 2 Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands Request for r Departmental Action Fee Transmittal Form Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Instructions (cont.) 2. On a separate sheet attached to this form, state clearly and concisely the objections to the Determination or Order which is being appealed. To the extent that the Determination or Order is based on a municipal bylaw, and not on the Massachusetts Wetlands Protection Actor regulations, the Department has no appellate jurisdiction. 3. Send a copy of this form and a copy of the check or money order with the Request for a Superseding Determination or Order by certified mail or hand delivery to the appropriate DEP Regional Office(see http://www.mass.gov/der)/about/region/findyour.htm). 4. 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. wpaform2.doc-Request for Departmental Action Fee Transmittal Form•rev.10/6/04 Page 2 of 2 Massachusetts Department of Environmenta0 Protection Bureau of Resource Protection -Wetlands DEP File Number: WPA Form 8B — Certificate of Compliance 242-1429 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 Curtis R Young, Wetlands Preservation Inc. only the tab key Name to move your 47 Newton Road cursor-do not Mailing Address use the return key. Plaistow NH 03865 City/Town State Zip Code rab 2. This Certificate of Compliance is issued for work regulated by a final Order of Conditions issued to: Robert H.Farnham, Jr. Name June 17, 2008 242-1429 Dated DEP File Number 3. The project site is located at: 673 Great Pond Road North Andover Street Address City/Town Map 63 Parcel 27 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 5563 152 County Book Page Certificate 4. A site inspection was made in the presence of the applicant, or the applicant's agent, on: 8/30/2011 Date wpafrm8b.doc•rev.12/23/09 WPA Form 8B,Certificate of Compliance•Page 1 of 3 Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands DEP File Number: WPA Form 8B — Certificate of Compliance 242-1429 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: 65 C. Authorization Issued by: North Andover Conservation Commission Date of I suance This Certificate must be signed by a majority of the Conservation Commission and a copy sent to the applicant and appropriate DEP Regional Office(See http://www.mass.gov/dep/about/region/findyour.htm). Signatures: i wpafrm8b.doc•rev.12/23/09 WPA Form 813,Certificate of Compliance•Page 2 of 3 LlMassachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands DEP File Number: WPA Form 8B ® Certificate of Compliance 242-1429 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: 673 Great Pond Road 242-1429 Project Location DEP File Number Has been recorded at the Registry of Deeds of: Essex North 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 wpafrm8b.doc•rev.12/23/09 WPA Form 86,Certificate of Compliance•Page 3 of 3 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands MassDEP File Number: WPA Form 5 - Order of Conditions 242-1429 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 A. General Information Important: North Andover When filling 1. From: Conservation Commission out forms on the computer, 2. This issuance is for(check one): a. Z-Order of Conditions b. ❑ Amended Order of Conditions use only the tab key to 3. To: Applicant: move your cursor-do not Robert H. Farnham, Jr. use the return a. First Name b.Last Name key. ICB Realty Trust c.Organization 673 Great Pond Road d. Mailing Address North Andover MA 01845 e.City/Town f.State g.Zip Code 4. Property Owner(if different from applicant): a. First Name b.Last Name c.Organization d.Mailing Address e.City/Town f.State g.Zip Code 5. Project Location: 673 Great Pond Road North Andover a.Street Address b.City/Town MAP 63 Parcel 27 c.Assessors Map/Plat Number d.Parcel/Lot Number Latitude and Longitude, if known: 42-41-39N 71-05-16W e.Latitude f. Longitude 6. Property recorded at the Registry of Deeds for(attach additional information if more than one parcel): Essex North a.County b.Certificate Number(if registered land) 5536 152 c. Book d.Pag 5/16/08 /a D e 7. Dates: Qk a. Date Notice of Intent Filed b. Date Public Hearing Closed c.Date of Is ance s. Final Approved Plans and Other Documents (attach additional plan or document references as needed): Existing Conditions Site Plan, Developed Conditions Site Plan a."Plan Title Morgan Wheelock, Inc Christopher J. Dindal, Registered Landscape b. Prepared By Architect 5/16/08 1" =20' d. Final Revision Date e.Scale f.Additional Plan or Document Title g. Date wpaform5.doc•.rev.2127/08 - Page 1 of 10 c � L71Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands MassDEP File Number: WPA Form 5 - Order of Conditions 242-1429 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Findings i. 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. Z. Protection of Wildlife Habitat g. Z,.Groundwater Supply h. Z 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: a. ® 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: b. ❑ 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. c. ❑ 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 Act's interests, and a final Order of Conditions is issued. A description of the specific 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) 3. ❑ Buffer Zone Impacts: Shortest distance between limit of project disturbance and wetland boundary(if available) a. linear feet Resource Area Proposed Permitted Proposed Permitted Alteration Alteration Replacement Replacement 4. ❑ Bank a. linear feet b. linear feet c. linear feet d. linear feet 5. ❑ Bordering Vegetated Wetland a.square feet b.square feet c.square feet d.square feet 6. ❑ Land Under Waterbodies a.square feet b.square feet c.square feet d.square feet and Waterways e.c/y dredgedf.Gy dredged wpaform5.doc• rev.2/27/08 Page 2 of 10 4 f Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands MassDEP File Number: WPA Form 5 - Order of Conditions 242-1429 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Findings (cont.) Resource Area Proposed Permitted Proposed Permitted Alteration Alteration Replacement Replacement 7. El 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 8. ❑ 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 g. ❑ 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 g.square feet h.square feet _ i.square feet j.square feet Coastal Resource Area Impacts: Check all that apply below. (For Approvals Only) 1o. ❑ Designated Port Areas Indicate size under Land Under the Ocean, below 11. ❑ Land Under the Ocean a.square feet b.square feet c.c/y dredged d.c/y dredged 12. ❑ Barrier Beaches Indicate size under Coastal Beaches and/or Coastal Dunes below 13. ❑ Coastal Beaches a.square feet b.square feet c.c/y nourishmt. d.c/y nourishmt. 14. ❑ Coastal Dunes a.square feet b.square feet c.Gy nourishmt. d.c/y nourishmt. 15. ❑ Coastal Banks a. linear feet b. linear feet 16. ❑ Rocky Intertidal Shores a.square feet b.square feet 17. ❑ Salt Marshes a.square feet b.square feet c.square feet d.square feet 18. ❑ Land Under Salt Ponds a.square feet b.square feet c.c/y dredged d.c/y dredged 19. ❑ Land Containing Shellfish a.square feet b.square feet c.square feet d.square feet 20.. ❑ Fish Runs Indicate size under Coastal Banks, inland Bank, Land Under the Ocean, and/or inland Land Under Waterbodies and Waterways, above a.c/y dredged b.c/y dredged 21. ❑ Land Subject to Coastal Storm Flowage a.square feet b.square feet wpaform5.doc• rev.2/27/08 Page 3 of 10 Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands MassDEP File Number: WPA Form 5 - Order of Conditions 242-1429 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 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, "MassDEP"] "File Number 242-1429 " wpaform5.doc• rev.2/27108 Page 4 of 10 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands MassDEP File Number: WPA Form 5 - Order of Conditions 242-1429 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 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 MassDEP. 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 applyto 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. The work associated with this Order is (1)® is not(2)❑ subject to the Massachusetts Stormwater Policy Standards. If the work is subject to the Stormwater Policy,the following conditions apply to this work and are incorporated into this Order: a) No work, including site preparation, land disturbance, construction and redevelopment, shall commence unless and until the construction period pollution prevention and erosion and sedimentation control plan required by Stormwater Standard 8 is approved in writing by the issuing authority. Until the site is fully stabilized, construction period erosion, sedimentation and pollution control measures and best management practices (BMPs) shall be implemented in accordance with the construction period pollution prevention and erosion and sedimentation control plan, and if applicable, the Stormwater Pollution Plan required by the National Discharge Elimination System Construction General Permit. wpaform5.doc• rev.2/27/08 Page 5 of 10 i Massachusetts Department of Environmental ,Protection Bureau of Resource Protection - Wetlands MassDEP File Number: WPA Form 5 - Order of Conditions 242-1429 Ll Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 C. General Conditions Under Massachusetts Wetlands Protection Act (cont.) b) No stormwater runoff may discharged to the post-construction stormwater BMPs until written approval is received from the issuing authority. To request written approval, the following must be submitted: illicit discharge compliance statement required by Stormwater Standard 10 and as-built plans signed and stamped by a registered professional engineer certifying the site is fully stabilized; all construction period stormwater BMPs and any illicit discharges to the stormwater management system have been removed;.and all post-construction stormwater BMPs were installed in accordance with the plans (including all planting plans) approved by the issuing authority, and have been inspected to ensure they are not damaged and will function properly. c) Prior to requesting a Certificate of Compliance, the responsible party (defined in General Condition 18(e)) shall submit to the issuing authority an Operation and Maintenance (O & M) Compliance Statement for the Stormwater BMPs. This Statement shall identify the responsible party for implementing the Operation and Maintenance Plan and also state that: 1. "Future responsible parties shall be notified in writing of their continuing legal responsibility to operate and maintain the stormwater management BMPs and implement the Pollution Prevention Plan; and 2. The Operation and Maintenance Plan for the stormwater BMPs is complete and will be implemented upon receipt of the Certificate." d) Post-construction pollution prevention and source control shall be implemented in accordance with the long-term pollution prevention plan section of the approved Stormwater Report and, if applicable, the Stormwater Pollution Prevention Plan required by the National Discharge Elimination . System Multi-Sector General Permit. e) Unless and until another party accepts responsibility, the issuing authority shall presume that the responsible party for maintaining each BMP is the landowner of the property on which the BMP is located. To overcome this presumption, the landowner of the property must submit to the issuing authority a legally binding agreement Bement acce table to the issuing authority evidencing that another entity has accepted responsibility for maintaining the BMP, and that the proposed responsible party shall be treated as a permittee for purposes of implementing the requirements of Conditions 18(f) through 18(k)with respect to that BMP. Any failure of the proposed responsible party to implement the requirements of Conditions 18(f)through 18(k)with respect to that BMP shall be a violation of the Order of Conditions or Certificate of Compliance. In the case of stormwater BMPs that are serving more than one lot, the legally binding agreement shall also identify the lots that will be serviced by the stormwater BMPs. A plan and easement deed that grants the responsible party access to perform the required operation and maintenance must be submitted along with the legally binding.agreement. f) The responsible party shall operate and maintain all stormwater BMPs in accordance with the design plans, the Operation and Maintenance Plan section of the approved Stormwater Report, and the Massachusetts Stormwater Handbook. g) The responsible party shall: 1. Maintain an operation and maintenance log for the last three years including inspections, repairs, replacement and disposal (for disposal the log shall indicate the type of material and the disposal location); 2. Make this log available to MassDEP and the Conservation Commission upon request; and 3. Allow members and agents of the MassDEP and the Conservation Commission to enter and inspect the premises to evaluate and ensure that the responsible party complies with the Operation and Maintenance requirements for each BMP set forth in the.Operations and Maintenance Plan approved by the issuing authority. h) All sediments or other contaminants removed from stormwater BMPs shall be disposed of in accordance with all applicable federal, state, and local laws and regulations. i) Illicit discharges to the stormwater management system as defined in 310 CMR 10.04 are prohibited. wpaformEdoc• rev.2/27/08 Page 6 of 10 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands MassDEP File Number: WPA Form 5 - Order of Conditions 242-1429 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 C. General Conditions Under Massachusetts Wetlands Protection Act (cont.) j) The stormwater management system approved in the Final Order of Conditions shall not be changed without the prior written approval of the issuing authority. Areas designated as qualifying pervious areas for purpose of the Low Impact Site Design Credit shall not be altered without the.prior written approval of the issuing authority. k) Access for maintenance of stormwater BMPs shall not be obstructed or blocked. Any fencing constructed around stormwater BMPs shall include access gates. Fence(s) shall be at least six inches above grade to allow for wildlife passage. Special Conditions (if you need more space for additional conditions, please attach a text document): D. Findings Under Municipal Wetlands Bylaw or Ordinance 1. Is a municipal wetlands bylaw or ordinance applicable? ® Yes ❑ No 2. The North Andover hereby finds (check one that applies): Conservation Commission a. ❑ that the proposed work cannot be conditioned to meet the standards set forth in a municipal ordinance or bylaw specifically: 1.Municipal Ordinance or Bylaw 2.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. b. ® that the following additional conditions are necessary to comply with a municipal ordinance or bylaw: North Andover Wetland Protection Bylaw Chapter 178 1. Municipal Ordinance or Bylaw 2.Citation 3. 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. The special conditions relating to municipal ordinance or bylaw are as follows (if you need more space for additional conditions, attach a text document): See attached wpaform5.doc• rev.2/27/08 Page 7 of 10 DEP FILE #242 - 1429 Therefore, the North Andover Conservation Commission (hereafter the "NACC") hereby finds that the following conditions are necessary, in accordance with the Performance Standards set forth in the State Regulations, 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 plans, specifications or other proposals submitted with the Notice of Intent, the conditions shall control. GENERAL CONDITIONS 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, agent of the NACC or the Department of Environmental Protection (DEP) 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, hoto ahs, observations, and/or materials P �' P / , 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, agent or DEP 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. ons. Y g 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 of the North Andover Wetland Regulations). CADocuments and Settings\dwedge\Local Settings\Temporary Internet Files\OLK35\242-1429 OOC.doc 1 NACC 6/10/20 DEP FILE #242 - 1429 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. Where the Department of Environmental Protection (DEP) is requested to make a determination and to issue a Superseding Order, the Conservation Commission shall be a party to all agency proceedings and hearings before the Department. 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: Construction of stone walls,walkways and landscaping within the buffer zone to a bordering vegetated wetland and isolated vegetated. 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: Robert H. Farnham Jr. ICS Realty Trust 673 Great Pond Road North Andover, MA 01845 Site Plans prepared by: Morgan Wheelock,Inc.. 625 Mount Auburn Street Cambridge, MA 02138 Entitled: Developed Conditions Site Plan Demoulas Residence North Andover, MA Dated May 16,2008 CADocuments and Settings\dwedge\Local SettingsUemporary Internet Files\OLK35\242-1429 OOC.doc 2 NACC 6/10/20 DEP FILE #242 - 1429 29. The following wetland resource areas are affected by the proposed work: Buffer Zone to Bordering Vegetated Wetland and Isolated Vegetated Wetland. These resource areas are significant to the interests of the Act and Town ByLaw as noted above and therein. The applicant has not attempted to overcome the presumption of significance 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. 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). 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 Commissions 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. 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. Maintenance of the drainage system,if Yaccepted by the Town as part of a public way, becomes the responsibility of the Town. CADocuments and Settings\dwedge\Local SettingsUemporary Internet Files\OLK35\242-1429 OOC.doc 3 NACC 6/10/20 DEP FILE # 242 - 1429 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 "Massachusetts DEP, File Number 242-1429. 38. Any changes in the submitted plans caused by the applicant, another Board's decision or 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. CADocuments and Settings\dwedge\Local SettingsUemporary Internet Files\OLK35\242-1429 OOC.doc 4 NACC 6/10/20 DEP FILE #242 - 1429 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. 40. Prior to any work commencing on-site, the applicant shall submit to the NACC for approval, a detailed sequence of construction, including the construction of compensation and retention areas, installation of sedimentation/erosion control devices and re-vegetation to be completed before other work begins on-site. 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 been permanently 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 C:\Documents and Settings\dwedge\Local Settings\Temporary Internet Files\OLK35\242-1429 OOC.doc 5 NACC 6/10/20 DEP FILE #242 - 1429 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 $1000 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 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. 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. At least once during each week in which construction activities occurs on-site and for as long thereafter as ground remains unstabilized, the applicant shall submit a written report from the "Erosion Control Monitor" to the NACC certifying 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 erosion control monitor 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. 46. 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 CADocuments and Settings\dwedge\Local SettingsUemporary Internet Files\OLK35\242-1429 OOC.doc 6 NACC 6/10/20 DEP FILE #242 - 1429 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 prior to the closing of said land transaction. 47. 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 of the pre-construction meeting (e.g. 72 hours). DURING CONSTRUCTION 48. Any fill used in connection with this project shall be clean fill, containing 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 on any of the .fore oin g g 49. No exposed area shall remain unfinished for more than thirty (30) days, unless approved by the NACC. 50. 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. 51. There shall be no stockpiling of soil or other materials within twenty-five (25) feet of any resource area. CADocuments and Settings\dwedge\Local Settings\Temporary Internet Files\OLK35\242-1429 OOC.doc 7 NACC 6/10/20 DEP FILE #242 - 1429 52. Washings from concrete trucks, or surplus concrete, shall not be directed to, any drainage system, or wetland resource area. 53. 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. 54. Accepted engineering and construction standards and procedures shall be followed in the completion of the project. 55. 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 56. 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. 57. 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. 58. 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 CADocuments and Settings\dwedge\Local SettingsUemporary Internet Files\OLK35\242-1429 OOC.doc 8 NACC 6/10/20 DEP FILE # 242 - 1429 the latter course is chosen, stabilization will be considered complete once vegetative cover has been achieved. 59. Upon complete stabilization of the site, erosion controls shall be removed and disposed off properly. All unstabilized areas under the erosion controls shall be seeded immediately. 60. 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. 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 plans) 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. CADocuments and Settings\dwedge\Local SettingMemporary Internet Files\OLK35\242-1429 OOC.doc 9 NACC 6/10/20 DEP FILE #242 - 1429 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 limitofwork and the extent of existing erosion control devices. "Work" includes a—U disturbance of soils or vegetation. 65. 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; ;- Discharge or spillage of pollutants (Condition#59); Prohibition of underground fuels (Condition#60); Limitations on the use of fertilizers, herbicides and pesticides (Conditions #61). CADocuments and Settings\dwedge\Local SettingsUemporary Internet Files\OLK35\242-1429 OOC.doc 10 NACC 6/10/20 DEP FILE #242 - 1429 APPENDIX A - AFFIDAVIT 1, on oath do hereby depose and state: (authorized agent applicant and/or current owner) (PLEASE CHECK AT LEAST ONE BLOCK) 1. I am the of (position with applicant) (applicant name or company name) the applicant upon whom Order of Conditions have been placed upon by (DEP or NACC number) the North Andover Conservation Commission. &/or 2. I am the of (position with owner) (owner name) the owner upon whose land Order of Conditions have been placed up by (DEP or NACC number) the North Andover Conservation.Commission. & 3. 1 hereby affirm and acknowledge that 1 have received said Order of Conditions and have read the same and understand each (DEP File#) and every condition which has been set forth in said Order of Conditions. 4. I hereby affirm and acknowledge that on this day of 19 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 Order of Conditions are presently in compliance. (DEP File#) 5. 1.hereby affirm and acknowledge that this document will be relied upon by the North Andover Conservation Commission as well as any potential buyers of said property which is subject to said Order of Conditions (DEP File#) Signed under the pains and penalties of perjury this day of 19 - (Signature-authorized agent of applicant or owner) C:\Documents and Settings\dwedge\Local SettingsUemporary Internet Files\OLK35\242-1429 OOC.doc I1 NACC 6/10/20 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands MassDEP File Number: WPA Form 5 - Order of Conditions 242-1429 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 E. Issuance This Order is valid for three years, unless otherwise specified as a special 0// 1aAP, 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: 7 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 Regional Office, if not filing electronically, and the property owner,.if different from applicant. > Signatures: / 7 �- �� l No ary Acknowfedgement Commonwealth of Massachusetts County of Essex North 44- T On this /� of C) r?OC IP Day Month `` Year, Before.me, the undersigned Notary Public, T/0 /9Z4 NOV,' 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/Town DONNA M.WEDGE - NOTARY PUBLIC Si nature of Notary Public COMAIOW"TH Of HAMCHUSETTS n _ hI11C rLEVk sAt07,2= I DDE?1�fl M Gr1e—M Printed Name of Notary Public Place notary seal and/or any stamp above - 'P �7 "�&`�F My Commission pires(Date) This Order is issued to the applicant as follows: ❑ by hand delivery on [�by certified mail, return receipt requested, on Date Date wpaform5.doc• rev.2/27/08 Page 8 of 10 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands MassDEP File Number: WPA Form 5 - Order of Conditions 242-1429 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 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 MassDEP 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.2/27/08 Page 9 of 10 LlMassachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands MassDEP File Number: WPA Form 5 - Order of Conditions 242-1429 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 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 this page 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: 673 Great Pond Road 242-1429 Project Location MassDEP File Number Has been recorded at the Registry of Deeds of: Essex North 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 If recorded land, the instrument number identifying this transaction is: Instrument Number If registered land, the document number identifying this transaction is: Document Number Signature of Applicant wpaform5.doc• rev.2/27/08 - Page 10 of 10 A: Massachusetts Department of Environmental Protection DEP File Number: Bureau of Resource Protection -Wetlands WPA Form 4B — Order of Resource Area Delineation 242-1424 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP A. General Information Important: North Andover When filling out From. 1.Conservation Commission forms on the computer, use 2. This Issuance is for(check one): only the tab key to move your cursor-do not a. ® Order of Resource Area Delineation Only use the return key. b. ❑ Order of Resource Area Delineation Subject to Simplified Review 1. ❑ Not Subject to Stormwater Policy 2. ❑ Subject to Stormwater Policy C. ❑ Amended Order of Resource Area Delineation Note: Before 3. To: Applicant: completing this form consult Robert H. Farnham, Jr. ICB Realty Trust your local a. First Name b. Last Name c.Company Conservation 673 Great Pond Road Commission regarding any d.Mailing Address municipal bylaw North Andover MA 01845 or ordinance. e.Cit /Town Y f.State g.Zip Code 4., Property Owner(if different from applicant): a. First Name b. Last Name c.Company d.Mailing Address e.City/Town f.State g.Zip Code 5. Project Location: 673 Great Pond Road North Andover a.Street Address b.City/Town Map 63 Parcel 27 c.Assessors Map/Plat Number d. Parcel/Lot Number Latitude and Longitude (note: electronic filers 42-41-39N 71-05-16W will click for GIS locator): e. Latitude f. Longitude 3/28/08 4/23/08 4/24/08 6. Dates: a. Date Notice of Intent filed b. Date Public Hearing Closed c. Date of Issuance 7. Title and Date (or Revised Date if applicable) of Final Plans and Other Documents: Topographic Survey Plan 4/10/08 M a.Title b. Date c.Title d. Date wpaform4b.doc•rev.01/07 Page 1 of 7 x Massachusetts Department of Environmental Protection DEP File Number: Bureau of Resource Protection - Wetlands WPA Form 4B — Order of Resource Area Delineation 242-1424 Ll Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP B. Order of Delineation 1. The Conservation Commission has determined the following (check whichever is applicable): a. ® Accurate: The boundaries described on the referenced plan(s) above and in the Abbreviated Notice of Resource Area Delineation are accurately drawn for the following resource area(s): �. ❑ Bordering Vegetated Wetlands 2. ® Other Resource Area(s), specifically: Two isolated vegetated wetland flags 1-26 and flags 27-46 b. ❑ Modified: The boundaries described on the plan(s) referenced above, as modified by the Conservation Commission from the plans contained in the Abbreviated Notice of Resource Area Delineation, are accurately drawn from the following resource area(s): 1. ❑ Bordering Vegetated Wetlands 2. ❑ Other Resource Area(s), specifically:, c. ❑ Inaccurate: The boundaries described on the referenced plan(s)and in the Abbreviated Notice of Resource Area Delineation were found to be inaccurate and cannot be confirmed for the following resource area(s): 1. ❑ Bordering Vegetated Wetlands 2. ❑ Other Resource Area(s), specifically: s. The boundaries were determined to be inaccurate because: wpaform4b.doc•rev.01/07 Page 2 of 7 Massachusetts Department of Environmental Protection DEP File Number: Bureau of Resource Protection -Wetlands WPA Form 4B — Order of Resource Area Delineation 242-1424 Provided by DEP Ll Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 C. Simplified Buffer Zone Review Work within the Buffer Zone pursuant to the Simplified Review(310 CMR 10.02) requires that you must comply with the following conditions. If your project does not meet these requirements, you are required to either file a Determination of Applicability or Notice of Intent or take other corrective measures as directed by the Conservation Commission. Simplified Review Conditions: Work conducted under Simplified Review requires the following: 1. No work of any kind shall occur within any wetland resource areas including Riverfront Area and Bordering Land Subject to Flooding. 2. The inner 0-to-50-foot wide area from the delineated wetland boundary that has a Buffer Zone shall not be disturbed by any work associated with this project, including placement of any stormwater management components. 3. No work shall occur in the Buffer Zone bordering an Outstanding Resource Water(e.g., certified vernal pool, public water supply reservoir or tributary), as defined in 314 CMR 4.00 or border coastal resource areas at 310 CMR 10.25-10.35. 4. No work shall occur in the Buffer Zone adjacent to wetland resources with estimated wildlife habitat(which is identified on the most recent Estimated Habitat Map of State-listed Rare Wetlands Wildlife). 5. Erosion and Sedimentation controls shall be installed and maintained at the 50-foot Buffer Zone line or limit of work (whichever is a greater distance from the resource area)to protect resource areas during construction. 6. If the project is subject to the Massachusetts Stormwater Policy, all work shall be conducted in conformance with an approved Stormwater Management Plan. 7. The Buffer Zone does not contain a slope greater than an average of 15% at its steepest gradient across the 100-foot Buffer Zone. 8. The amount of new impervious surface, in combination with existing impervious surfaces, shall not exceed 40% of the Buffer Zone between 50 and 100 feet. 9. No work is allowed, and no additional NOI or RDA shall be filed, for any work within the 0-to-50- foot Buffer Zone during the three-year term of an Order associated with this application. 10. Prior to any work being undertaken pursuant to this Order, the wetland resource boundary shall be flagged; all boundary delineation flagging should be maintained for the term of the Order. 11. If stormwater management structures are proposed in the Buffer Zone, the stormwater management structures shall be maintained as required in the Stormwater Plan. Such maintenance constitutes an ongoing condition and is not subject to further permitting requirements. 12. If this ORAD involves work as part of a Simplified Review, the ORAD shall be recorded at the Registry of Deeds prior to the commencement of work per the requirements of Section F. 13. Prior to proceeding with any work under Simplified Review, applicants are required to provide written notice to the Commission one week prior to commencing any work. 14. If work authorized under Simplified Review is commenced, no work is allowed, and no additional NOI or RDA may be filed,for any work within the 0-to-50-foot buffer zone during the term of an ORAD associated with this application. If work authorized under Simplified Review is not commenced, then future NOIs or RDAs may be filed for work within the 0-to-50-foot portion of the buffer zone. --End of Conditions— wpaform4b.doc•rev.01/07 Page 3 of 7 Massachusetts Department of Environmental Protection DEP File Number: Bureau of Resource Protection -Wetlands WPA Form 4B — Order of Resource Area Delineation 242-1424 Ll Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP C. Simplified Buffer Zone Review (cont.) Stormwater Applicability 1. ❑ The project is not subject to the Stormwater Policy. 2. ❑ The project is subject to the Stormwater Policy and the Stormwater Plan included for the project complies with all stormwater standards. Ineligibility Determinations Site Conditions: The applicant is not eligible for Simplified Buffer Zone review and must file a Request for Determination of Applicability or Notice of Intent prior to any work because: 3. ❑ Work is within the Buffer Zone of a Coastal Resource Area as defined at 310 CMR 10.25- 10.35. 4. ❑ The Buffer Zone contains existing slopes greater than an average of 15%. 5. ❑ Buffer Zone contains estimated rare wildlife habitat.' s. ❑ The site borders an Outstanding Resource Water.2 Stormwater 7. ❑ The project is subject to the Stormwater Policy and the applicant has not submitted sufficient information to demonstrate compliance with the Stormwater Management Policy. Prior to any work, the applicant must submit plans showing compliance with the standards in the_ Stormwater Policy, the location of the work, the amount of impervious surface, and the location of erosion controls, to the Commission for its concurrence. (See instructions to ANRAD Form 4A.) The following necessary stormwater information was not submitted by the applicant: a. s. ❑ The project is subject to the Stormwater Policy but the project does not comply with one or more of the stormwater standards (specify which standard(s) not met). a. Standard # b. Standard# s. ❑ Impervious surface exceeds 40% of the area of the Buffer Zone between 50 and 100 feet from the resource area. 1o. ❑ The applicant did not submit plans depicting adequate erosion and sedimentation controls located at the limit of work or at least 50 feet from any resource areas,whichever will be greater. 11. ❑ Work is proposed within 50 feet of a resource area. Notice to Commission Any applicant proposing to proceed under Simplified Buffer Zone Review, as specified in 310 CMR 10.02, must provide written notice to the Commission one week prior to any work. ' Identified on the most recent Estimated Habitat Map of State-listed Rare Wetlands Wildlife of the Natural Heritage and Endangered Species Program. 2 Certified Vernal Pools, public water supplies, or inland ACECs as identified in 314 CMR 4.00. wpaform4b.doc•rev.01/07 Page 4 of 7 Massachusetts Department of Environmental Protection p DEP File Number: Bureau of Resource Protection -Wetlands WPA Form 4B — Order of Resource Area Delineation 242-1424 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP D. Findings This Order of Resource Area Delineation determines that the Stormwater Plan, if applicable, and the boundaries of those resource areas noted above, have been delineated and approved by the Commission and are binding as to all decisions rendered pursuant to the Massachusetts Wetlands Protection Act (M.G.L. c.131, §40) and its regulations (310 CMR 10.00). This Order does not, however, determine the boundaries of any resource area or Buffer Zone to any resource area not specifically noted above, regardless of whether such boundaries are contained on the plans attached to this Order or to the Abbreviated Notice of Resource Area Delineation. 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. If the Abbreviated Notice of Resource Area Delineation was filed as Simplified Review for a Buffer Zone project, the applicant has certified that any work associated with the proposed project meets all eligibility requirements for Simplified Review listed in Section C of this Order. Any work that does not comply with the Simplified Review requirements will require a Notice of Intent or Request for Determination of Applicability. The applicant is responsible for promptly requesting a Certificate of Compliance following completion of any work allowed pursuant to a Simplified Review or no later than three years from the date of the Order of Resource Area Delineation unless the Order is extended. Failure to comply with the conditions of this Order is grounds for the Conservation Commission or the Department to take enforcement action. This Order must be signed by a majority of the Conservation Commission. The Order must be sent 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 DEP Regional Office (see http://www.mass.gov/dep/about/region/findvour.htm). E. 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 Resource Area Delineation.When requested to issue a Superseding Order of Resource Area Delineation,the Department's review is limited to the objections to the resource area delineation(s)stated in the appeal request.The request must be made by certified mail or hand delivery to the Department,with the appropriate filing fee and a completed Request for 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 bylaw or ordinance, and not on the Massachusetts Wetlands Protection Act or regulations,the Department of Environmental Protection has no appellate jurisdiction. wpaform4b.doc-rev.01/07 Page 5 of 7 Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands DEP File Number: WPA Form 4B — Order of Resource Area Delineation 242-1424 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP F. Signatures and Notary cknowledgement S- Please indicate 14e nuwho will sign this for 1. Number of Signers Signat of on a on mm' ion ember Si t re o Con at' C mission Member Sign tur of Conserv o mber Sign tur of Conserygtionttommission Member Signatu on Commission Member Signature of Conservation Commission Member Signature of Conservation Commission Member This Order is valid for three years from the date of issuance. This Order is issued to the applicant and the property owner(if different) as follows: ❑ by hand delivery on [f'by certified mail, return receipt requested on I/J.? � Date Date Notary Acknowledgement Commonwealth of Massachusetts County of Essex North On this °? of firleI Day Month Year Before me, the undersigned Notary Public, 13LAeer10 1V.4u21 ;J^R 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 CityfTown DONNA M.WEDGE NOTARY PUBLIC COMMONWEALTH OF MASSACHUSETTS 6666 Mt G=&ExplimAug.7,2009 Signature of Notary Public _ -ION- o GJ1) Printed Name of Notary Public Place notary seal and/or any stamp above rP 17 /RDS My ComrfiissioA Expires(Date) wpaform4b.doc•rev.01/07 Page 6 of 7 Massachusetts Department of Environmental Protection DEP File Number: Bureau of Resource Protection - Wetlands WPA Form 4B — Order of Resource Area Delineation 242-1424 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP G. Recording Information If this Order is issued for purposes of Resource Area Delineation only, this Order should NOT be recorded. If this Order of Resource Area Delineation is issued as part of a Simplified Review, this Order 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 6 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: 673 Great Pond Road 242-1424 Project Location DEP File 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 If recorded land, the instrument number identifying this transaction is: Instrument Number If registered land, the document number identifying this transaction is: Document Number Signature of Applicant wpaform4b.doc•rev.01107 Page 7 of 7 ILIMassachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands Request for Departmental Action Fee Transmittal Form Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 A. Request Information Important: When filling out 1. Person or party making request(if appropriate, name the citizen group's representative): . forms on the computer, use Name only the tab key to move your cursor- Mailing Address do not use the return key. City/Town State Zip Code QPhone Number Fax Number(if applicable) Project Location Mailing Address City/Town State Zip Code 2. Applicant(as shown on Notice of Intent(Form 3), Abbreviated Notice of Resource Area Delineation (Form 4A); or Request for Determination of Applicability (Form 1)): Name Mailing Address Cit /Town Y State Zip Code Phone Number Fax Number(if applicable) 3. DEP File Number: B. Instructions 1. When the Departmental action request is for(check one): ❑ Superseding Order of Conditions ❑ Superseding Determination of Applicability ❑ Superseding Order of Resource Area Delineation Send this form and check or money order for$100.00(single family house projects) or$200(all other projects), payable to the Commonwealth of Massachusetts to: Department of Environmental Protection Box 4062 Boston, MA 02211 wpaform4b.doc Page 1 of 2 LlMassachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands Request for Departmental Action Fee Transmittal Form Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Instructions (cont.) 2. On a separate sheet attached to this form, state clearly and concisely the objections to the Determination or Order which is being appealed. To the extent that the Determination or Order is based on a municipal bylaw, and not on the Massachusetts Wetlands Protection Act or regulations, the Department has no appellate jurisdiction. 3. Send a copy of this form and a copy of the check or money order with the Request for a Superseding Determination or Order by certified mail or hand delivery to the appropriate DEP Regional Office (see http://www.mass.gov/dep/about/region/findyour htm). 4. 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. wpaform4b.doc Page 2 of 2 COMMONWEALTH OF MASSACHUSETTS.--_ TOWN OF: NORTH ANDOVER _ SYSTEM PUMPING REPORT RECEIVED, _ _ .._.__.. ACTIOU KING ENTERPRISES,INC REPORT FOR THE MONTH.OF JANUARY 2010 Zulu TOWN OF NORTH ANDOVER CONTENTS CONDITION OF HEALTH DEPARTMENT DATE NAME ADDRESS GAL I• TYPE _TRANSFERRED TO SYSTEM 1/4/2010 BOB FARNHAM 673 GREAT POND ROAD 1,500 SEPTIC':LOWELL WWTP 1/5/2010 1BOB FARNHAM 673 GREAT POND ROAD 1,000 SEPTIC'LOWELL WWTP i I ---------- I� I