HomeMy WebLinkAbout83-345 - COC request & planE Massachusetts Department of Envi ronmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 8A - Request for Certificate of Compliance
Massachusetts Wetlands Protection Act M.G.L. c. 131 , $40
Town of Yarmouth Wetland B law, Cha r 143
DEP File Number:
YEgb-9-tS
Provided by DEP
A. Project lnformation omm ssron
lmportant:
When filling out
forms on the
computer, use
only the tab
key to move
your cursor -
do not use the
retum key.
uest is being made bt\,,v AU6 2 e 20181 . This
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Mailing Address
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State Zip Codes0, _3G 7 /trs "
Ya rmo ulh Conservation
Phone Number
2. This request is in reference to work
0
\,) \t-'Dated
3. The project site is located at:
,*t^bon
ulated by a final Order of Conditions issued to
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S
DEP File Number
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Upon completion
of the work
authorized in
an Order of
Conditions, the
property owner
must request a
Certiflcate of
Compliance
from the issuing
authority stating
that the work or
portion of the
work has been
satisfactorily
completed.
str;tAddrG .r
-8r-Assesso6 Map/Plal lvumber )
City/Town9A
Parcel/Lot Number
4. The final Order of Conditions was recorded at the Registry of Deeds for:
Property Owner (if ditferent) t (
Brp'r n:{ z,-b\r (J c10
County B Page
f,f the work regulated by the above-referenced Order of Conditions has been satisfactorily completed
n the following portions of the work regulated by the above-referenced Order of Conditions have
been satisfactorily completed (use additional paper if necessary).
E the above-referenced Order of Conditions has lapsed and is therefore no longer valid, and the
work regulated by it was never started.
wpatorm8a d@ - rev 5/29114
Applicant
\l
)\
Certificate (if registered land)
5. This request is for certification that (check one):
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 8A - Request for Certificate of Compliance
Massachusetts Wetlands Protection Act M.G.L. c. 131, $40
Town of Yarmouth Wetland By-law, Chapter 143
DEP File Number:
Provided by DEP
A. Project Information (cont.)
B. Submittal Requirements
Requests for Certificates of Compliance should be directed to the issuing authority that issued the final
Order of Conditions (OOC). lf the project received an OOC from the Conservation Commission, submit
this request to that Commission. lf the project was issued a Superseding Order of Conditions or was the
subject of an Adjudicatory Hearing Final Decision, submit this request to the appropriate DEP Regional
Office (see htto://www. mass.qov/eea/aqencies/massdep/about/contacts/find-the-massdeD-reqional-office-
wpaformSa.doc - rev. 529/14
6. Did the Order of Conditions for this project, or the portion of the project subject to this request, contain
an approval of any plans stamped by a registered professional engineer, architect, landscape
architect, or land surveyor?
I Ves lf yes, attach a written statement by such a professional certifying substantial
compliance with the plans and describing what deviation, if any, exists from the plans
approved in the Order.
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SHOI|N ON THIS, PLA'{ IS LOCATED OTI THE OROUIIDAS SHOWN HEREO'{ .
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