HomeMy WebLinkAbout- Permits #242-1389 - 870 GREAT POND ROAD 7/24/2008 ILIMassachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 8B — Certificate of Compliance 242-1389
Massachusetts Wetlands Protection Act M.G.L. c. '131, §40 Provided by DEV
A. Project Information
Important:
When filling out 1. This Certificate of Compliance is issued to:
forms on the Ronald & Karen McClu!skey
computer, use Name
only the tab
key to move 870 Great Pond Road
your cursor- Mailing Address
do not use the North Andover MA 01845
return key. CityfTown —State Zip Code
Ire
Z This Certificate of Compliance is issued for work regulated by a final Order of Conditions issued to,
z Ronald & Karen McCluskey
Name
April 13, 2007 242-1389
Dated DEP File Number
3. The project site is located at:
870 Great Pond Road North Andover
street Address CityTrown
Map 103 Parcel 112
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 108 397
County Book Page
13813
Certificate
4. A site inspection was made in the presence of the applicant, or the applicant's agent, on:
7/7/08
Date
B. Certification
Check all that apply:
Z 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:
%Ypaform ftdoc rev,V13104 Page I of 4
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 8B — Certificate of Compliance 242-1389
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
B. Certification (cont.)
E] 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 The Order of Conditions has lapsed and is therefore no
longer valid.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:
72
C. Authorization
issued by:
North Andover 714
conservation Commission late lssukce
14OR-
This Certificate must be signed by a majority of the Conservation Commission and a-eary"-Te'nt to the
applicant and appropriate DEP Regional Office (See Attachment),
Signatures-,
wpaform 8b.doc•rev.7/13104 Page 2 of 4
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 8B — Certificate of Compliance 242-1389
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DPP
C. Authorization (cont.)
Notary Acknowledgement
Commonwealth of Massachusetts County of Essex North
/ Year
On this Day Of 7 J'
Month
before me, the undersigned Notary Public, personally appeared
Name of Document Signer
proved to me through satisfactory evidence of identification, which was/were
Massachusetts License
Description of evidence of identification
to be the person whose name is signed on the preceding or attached document, and acknowledged
to me that he/she signed it voluntarily for its stated purpose.
As member of North Andover Cityfrown Conservation Commission
%nature of Notary Public
DONNA M.WEDGE bevaa
NOTARY PUBUC Printed Na-mie''of Notary Public
COMMOO
:: MTH OF MUSACHUSEM
?4 Comni.Explms Aq,7,M
V.
111map" jP
My ConImiss&Expires(Cate)
Place notary seal and/or any stamp above �47wx--1911 -
Signature of Notary Public
wpeform 8b.doc-rev,7/13/04 Page 3 of 4
LeiMassachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 8B — Certificate of Compliance 242-1389
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:
870 Great Pond Road 242-138,9
-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
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