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Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 8B — Certificate of Compliance
242-1149
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
C. Authorization (cont.)
Notary Acknowledgement
wpaform Bb.doc • rev. 7/13/04
Commonwealth of Massachusetts County of Essex North
r�
� M+,a
Day a o�00
On this Of Month Year J
before mei, the undersigned Notary Public, personally appeared
J C.6 �+
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
MONWEALTH OF MASSACHUSM
rJy Comm. Expires Aug. 7,200
Place notary seal and/or any stamp above
gnature of Notary Public
_ D«n4 I
Printed Name of Notary Public
4? 0
My C mis ion pires (Date)
v
5 nature of Notary Public
Page 3 of 4
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 8B — Certificate of Compliance
'242-1149
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:
Project Location DEP File Number
Has been recorded at the Registry of Deeds of:
for:
County
Property Owner
and has been noted in the chain of title of the affected property on:
Date Book Page
If recorded land, the instrument number which identifies this transaction is:
If registered land, the document number which identifies this transaction is:
Document Number
Signature of Applicant
wpaform 8b.doc • rev. 7/13/04 Page 4 of 4
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
DEP Regional Addresses
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
Mail transmittal forms and DEP payments, payable to:
Amesbury
Chelmsford
Hingham
Merrimac
Commonwealth of
Massachusetts
1 Winter Street
Andover
Chelsea
Holbrook
Methuen
Department of Environmental
Protection
Arlington
Cohasset
Hull
Box 4062
Reading
Waltham
Boston, MA 02108
Ashland
Concord
Ipswich
Boston, MA 02211
Revere
Watertown
Phone: 617-654-6500
Bedford
Danvers
DEP Western Region
Adams
Colrain
Hampden
Monroe
Pittsfield
Tyringham
436 Dwight Street
Agawam
Conway
Hancock
Montague
Plainfield
Wales
Suite 402
Alford
Amherst
Cummington
Dalton
Hatfield
Hawley
Monterey
Montgomery
Richmond
Rowe
Ware
Warwick
Springfield, MA 01103
Ashfield
Deerfield
Heath
Monson
Russell
Washington
Phone: 413-784-1100
Becket
Easthampton
Hinsdale
Mount Washington
Sandisfield
Wendell
Lynnfield
Belchertown
East Longmeadow
Holland
New Ashford
Savoy
Westfield
Fax: 413-784-1149
Bemardston
Egremont
Holyoke
New Marlborough
Sheffield
Westhampton
Manchester -By -The -Sea
Blandford
Erving
Huntington
New Salem
Shelburne
West Springfield
Marblehead
Brimfield
Florida
Lanesborough
North Adams
Shutesbury
West Stockbridge
Medfield
Buckland
Gill
Lee
Northampton
Southampton
Whately
Medford
Charlemont
Goshen
Lenox
Northfield
South Hadley
Wilbraham
Melrose
Cheshire
Granby
Leverett
Orange
Southwick
Williamsburg
Chester
Granville
Leyden
Otis
Springfield
Williamstown
Chesterfield Chester
Great Barrington
Longmeadow
Palmer
Stockbridge
Windsor
Chicopee
Greenfield
Ludlow
Pelham
Sunderland
Worthington
Clarksburg
Hadley
Middlefield
Peru
Tolland
DEP Central Region
Acton
Charlton
Hopkinton
Millbury
Rutland
Uxbridge
627 Main Street
Ashbumham
Clinton
Hubbardston
Millville
Shirley
Warren
Ashby
Douglas
Hudson
New Braintree
Shrewsbury
Webster
Worcester, MA 01608
Athol
Dudley
Holliston
Northborough
Southborough
Westborough
Phone: 508-792-7650
Auburn
Dunstable
Lancaster
Northbridge
Southbridge
West Boylston
Fax: 508-792-7621
Ayer
East Brookfield
Leicester
North Brookfield
Spencer
West Brookfield
Barre
Fitchburg
Leominster
Oakham
Sterling
Westford
TDD: 508-767-2788
Bellingham
Gardner
Littleton
Oxford
Stow
Westminster
Berlin
Grafton
Lunenburg
Paxton
Sturbridge
Wmchendon
Blackstone
Groton
Marlborough
Pepperell
Sutton
Worcester
Bolton
Harvard
Maynard
Petersham
Templeton
Boxborough
Hardwick
Medway
Phillipston
Townsend
Boylston
Holden
Mendon
Princeton
Tyngsborough
Brookfield
Hopedale
Milford
Royalston
Upton
DEP Southeast Region
Abington
Dartmouth
Freetown
Matlapoisett
Provincetown
Tisbury
20 Riverside Drive
Acushnet
Dennis
Gay Head
Middleborough
Raynham
Truro
Attleboro
Dighton
Gosnold
Nantucket
Rehoboth
Wareham
Lakeville, MA 02347
Avon
Duxbury
Halifax
New Bedford
Rochester
Wellfleet
Phone: 508-946-2700
Barnstable
Eastham
Hanover
North Attleborough
Rockland
West Bridgewater
Fax: 508-947-6557
Berkley
East Bridgewater
Hanson
Norton
Sandwich
Westport
Bourne
Easton
Harwich
Norwell
Scituate
West Tisbury
TDD: 508-946-2795
Brewster
Edgartown
Kingston
Oak Bluffs
Seekonk
Whitman
Bridgewater
Fairhaven
Lakeville
Orleans
Sharon
Wrentham
Brockton
Fall River
Mansfield
Pembroke
Somerset
Yarmouth
Carver
Falmouth
Marion
Plainville
Stoughton
Chatham
Foxborough
Marshfield
Plymouth
Swansea
Chilmark
Franklin
Mashpee
Plympton
Taunton
DEP Northeast Region
Amesbury
Chelmsford
Hingham
Merrimac
Quincy
Wakefield
1 Winter Street
Andover
Chelsea
Holbrook
Methuen
Randolph
Walpole
Arlington
Cohasset
Hull
Middleton
Reading
Waltham
Boston, MA 02108
Ashland
Concord
Ipswich
Millis
Revere
Watertown
Phone: 617-654-6500
Bedford
Danvers
Lawrence
Millon
Rockport
Wayland
Fax: 617 556-1049
Belmont
Dedham
Lexington
Nahant
Rowley
Wellesley
Beverly
Dover
Lincoln
Natick
Salem
Wenham
TDD: 617-574-6868
Billerica
Dracut
Lowell
Needham
Salisbury
West Newbury
Boston
Essex
Lynn
Newbury
Saugus
Weston
Boxford
Everett
Lynnfield
Newburyport
Sherbom
Westwood
Braintree
Framingham
Malden
Newton
Somerville
Weymouth
Brookline
Georgetown
Manchester -By -The -Sea
Norfolk
Stoneham
Wilmington
Burlington
Gloucester
Marblehead
North Andover
Sudbury
Winchester
Cambridge
Groveland
Medfield
North Reading
Swampscott
Winthrop
Canton
Hamilton
Medford
Norwood
Tewksbury
Woburn
Carlisle
Haverhill
Melrose
Peabody
Topsfield
wpaform8b.doc • DEP Addresses • rev. 5/23/05 Page 1 of 1