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Te--- /n(12„.. ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department 1146 Route 28,South Yarmouth,MA 02664-4492 ii"d' ;t 508-398-2231 ext. 1261 Fax 508-398-0836 �`' i Massachusetts State Building Code,780 CMR Building Permit Application To Construct,Repair, Renovate Or Demolish a One-or Two-Family Dwelling . . This Section For Official Use •. Building Permit Number: .Date Applied. !_ fS Cly ;' )Z Building Official(Print Name) �goaturer, :' _ _ • . Date SECTION 1:SITE INFORMATION •- 1.1 Prop ddn: 1.2 Asses ors Map&Parcel Numbe POta(A.,5t n/ �'� 1.1a Is this an accepted street?yes_ no Map Number Parcel Number 1.3 Zq>)in2I5fetlnation: �, 1.4 ;o�erty0D Dimensions: / /a - Zoning District Proposed Use Lot Arca(sq ft) 66 Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 30 ....)-6 /s' V7 t3v ,..6y 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood ne Information: 1.8 Sewage Disposal System: Public Fit Private❑ Zone: Outside Flood Zone? Municipal❑ On site disposal system�, Check if yes❑ SECTION 2: PROPERT�Y^OIVNERSIIIP' ry, 2.1 Oin1/4erl of Record: n I bid 414 Names(PPrint)��-r��t,��� n City,State,ZIP / 7 ,n7,�L No.and Street � K t Ga 0lephone�27 ,f M unad'Mddres#- - SECTION 3:DESCRIPTION OF PROPOSED WORK;.(Check all that apply), : , , New Construction❑ Existing Building❑ Owner-Occupied 0 Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition A Accessory Bldg.0 Number of Units_ Other ❑ Specify: Brief Description of ProposedIt2: .•e rs�js� • .. SECTION41ESTIMATEDCONSTRUCTIO}s4COSTS., ;. ; :;;• ;: w,. ;µt•,;:':,:: Item Estimated Costs: Official Use Onf " (Labor and Materials) y 1.Building $ ,1: Building Permit Fee:$ :, .7:Indicate how fee is determined 2.Electrical $ 0 Standard:Cityfrown:Appficatioti gee,.:,, .:,r 1.:i'7':„.1.:. ....5!:.! r,'` ❑,Tota'1 Project Costt,(Item 6)x multiplier i. 3.Plumbing $ 2 Other Fees $ Lisa ' • k `. � , "' 4.Mechanical (HVAC) $ , , '' 5.Mechanical (Fire Suppression) $ Total A11 Fees:$-, Check NO.'''. ;�._ CheekAmounir_- _CashAmount:' 6.Total Project Cost: $ g a Paid in Full r :.. , , b Outstanding Balance Due: r • SECTION 5: CONSTRUCTION SERVICES ` 5.1 Construction, Supervisor License(CsSL) DR/43 99--(4^/9/✓/l CMV/4-1,14-1,1 /1/jr/MDntL) License Number Expiration Date Name of CSL Holder n S nq/l /Zb irk � A List CSL Type(see below) (1_ No.and Sv'/tree! y� 1 Type _ Description 5. Awl. NM- 'ZIP/ U Unrestricted(Buildings up to 35,000 cu.ft.) //" b R Restricted l&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding /� �y //' / T SF Solid Fuel Burning Appliances `7(J / �/ 07 4/K/& N✓NAcneeo1 I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) »C6g7 , '9 . MT,V��II,,��GQ11 C 7 HIC C Nam;of tRta,- jt Name HIC Registration umber ff�� Expiration Date f 12'17/ .94'71/ Inti/V(01,1 //#,twalcefi11 No. C an S t mail address ' t,�i¢l�jy�1. 614--614-- 1714 77/�s'z7 50t- e 3I- G S ar t/ el City/Town,State,ZIP Telephone 53* SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit Signed Affidavit Attached? YesketNo ❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDINGYPERMIT I,as Gwn- . e subject property,hereby authorize Al/,j/LG' /r/ / eDo to act•n m b .n• -rs relative to work authorized by this building permit application. .te. amass" / c.omc Signature) Date ECTION 7b:OWNER'.OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. ef Print Owner's Authorized Agent's Name(Electronic Signature) Date • • - NOTES: - I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial walk is planned,provide the information below. Total floor area(sq.ft.) 3g (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) 3 3 Habitable room count Number of fireplaces / Number of bedrooms S Number of bathrooms Z{ Number of half/baths Type of heating system bliS 9rA-C. Number of decks/porches • Type of cooling system (IA-S /frA-C Enclosed 6 Open „? 3. "Total Project Square Footage"may be substituted for"Total Project Cost" . The Commonwealth of Massachusetts • _• vim=gtl Department oflndustrialAccidents _t:101_ 1 Congress Street,Suite 100 e =?i F Boston,MA 02114-2017 ...--� www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): N. -s-mitodylit tbri't pad ty CLC Address: 0299 while] 2 ," City/State/Zip: 5, AtrAyl , 6266c( Phone#: "77/ 9g7_7 Are you an employer?Cheek the appropriate box: rA Type of project(required): 1.. I am a employer with employees(full and/or part-time).* 'J, 0 New construction 2 I am a sole proprietor or partnership and have no employees working for me in capacity. S. ❑Remodeling any p ry,[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. .Demolition 4.0 1 am a homeowner and will be hiring contractors to conduct all work on m Yproperty. I will 10 El Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet These sub-contractors have employees and have workers'comp.insurance.t 13.❑Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.D Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. =Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: A//n me/toy/ Policy#or Self-ins.Lie.#: ewe W67O3y/70220)6 4 Expiration Date: 3`I i"iq Job Site Address: 02.5.- jVdtt/t7L5 LAi City/State/Zip: Wed, Y'Wh /Wl/- C12623 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under thee`pains and penalties of perjury that the information provided above is true and correct Signature: kVA- Illomiota Date: c-21— /7 Phone#: .ADCs' / — 1412-7 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: cft• TOWN OF YARMOUTH yi� ' s ! o BUILDING DEPARTMENT o - 'i g'y 1146 Route 28,South Yarmouth,MA 02664 508-398-2231 ext. 1261 Fax 508-398-0836 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at r.,25 �p' trflz4 Work Address Is to be disposed of at the following location: MOnta 7a4e-0 �.c Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. air S1: lure of Application Date Permit No. Uommonweann Or massacnuseus rt Division of Professional Licensure • • Board of Building Regulations and Standards Construct?brf Supervisor 'i CS-081139 Expires: 09/16/2019 `q f i /•+rte, MICHAEL J NARDONE •' 299 WHITES PATH _r} SOUTH YARMOUTH MA 02664 1 . ,S lli Commissioner CA • (Me 1(Omntonevea/tA r`ajjacAuief1 • Office Affairs HOME IMPROVEMENT CONTRACTOR iOn TYPE:LLC Registration EXPiriliSE 135887 08/14/2020 M J NARDONE CARPENTRY LLC. MICHAEL J.NARDONE &Ca' 299 WHITES PATH u SOUTH YARMOUTH,MA 02664 Undersecretary • Registration valid for individual use only before the expiration date. If found return to: • Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston,MA 02118 • of va d without signature . . 5 • A bR® • CERTIFICATE OF LIABILITY INSURANCE DATE (MM D YYY) 'THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT LIB inda Sullivan DOWLING & O'NEIL INSURANCE AGENCY Arc NE No. (508)775-1620 i"c,NO): EMAIL Iullivan@dof ns.com 973 IYANNOUGH RD INSURER(S)AFFORDING COVERAGE NAICN HYANNIS MA 02601 INSURER A: AIM MUTUAL INS CO 33758 INSURED INSURER B: M J NARDONE CARPENTRY LLC INSURER C: INSURER D: 299 WHITES PATH INSURER E: SOUTH YARMOUTH MA 02664 INSURER F: COVERAGES CERTIFICATE NUMBER: 245269 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSO WVD POLICY NUMBER (MMIDD/YYVY) (MMIDD/YYYY) COMMERCIAL GENERAL LIABIUTY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE n OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONALS ADV INJURY $ _ GE 'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ _ POLICY PRO- JECT RO PRODUCTS-COMP/OP AGG $ OTHER' 5 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ' ANY AUTO BODILY INJURY(Par person) $ ALL OWNED SCHEDULED AUTOS _ AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) UMBRELLA LIAR _ OCCUR EACH OCCURRENCE _ $ EXCESS UAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ X $ WORKERS COMPENSATION STATUTE ER AND EMPLOYERS'LIABILITY A OFFEL.EACHACCIDENT $ 500,000 CER/MEMBER EXCLUDED?ECUTIVE YI�I NIA WA AWC4007034172201 BA 03/122018 03/12/2018 (Mandatory In NH) I I E L.DISEASE•EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the Insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwd/workers-compensationfinvestigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Yarmouth ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Route 28 AUTHORIZED REPRESENTATIVE • South MA 02664 YarmouthDaniel Cr n�ei y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD • TOWN OF YARMOUTH BUILDING DEPARTMENT • 1146 Route 28, South Yarmouth, MA 02664 Ph.: 508-398-2231 ext. 261 BUILDING DEPARTMENT TOTAL DEMOLITION SIGN-OFF FORM State Building Code (780 CMR) Chapter 1, Section 112.1 —Service Connections "Before a building or structure is demolished or removed, the owner or agent shall notify all utilities having service connections within the structure, such as water, electric, gas, sewer and other connections. A permit to demolish or remove a building or structure shall not be issued until a release is obtained from the utilities, stating their respective service connections and appurtenant equipment, such as meter and regulators, have been removed or sealed and plugged in a safe manner." "All debris shall be disposed of in accordance with 780CMR 111.5." / Building or Structure Location: /O'5 4.) MAP:AP111 LOT: (p ao Owner's Name: -Srp- 4b/nSQY)Address: 67h't r ISE e/C phonC�$� /3 69 Contractor's NamW�Ke )74eint�►t.2.�ddress: Phone: 4.53 NSTAR: DABY: n s ' BY: TITLE: KEYSPAN: DATE: BY: TITLE: WATER DEPARTMENT: DATE: yt3//o BY: TITLE: /..J;2 aim c i/t r BOARD OF HEALTH DATE: BY: ,,,, '. /,, O TITLE: c,`n'`-4 G''�f'���e_Ae.. �. CONDITION: FIRE DEPARTMENT DATE: 'j( )I g BY: nf"G2 TITLE: Gk 'rinser— HISTORIC ^Sf tfl..HISTORIC COMMISSION: DATE: BY: TITLE: VERIZON: DATE: BY: TITLE: . i/997- YARMOUTH WATER DIVISION 99 BUCK ISLAND ROAD • WEST YARMOUTH, MA 02673 PH.: 508.771.7921 FAX: 508-771-7998 BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET Bldg. Site Location o?S / Proposed Improvement: reA . ./)o :� r 2e- a.. ;Go Applicant: -_-7427ACC c -2 -- Address I' /Orc�+ LA •.• < , *• _lie-Ftj . rb'� — / Te'' • A9 y �� Date I'�IPld• �/ �O RESIDENTIAL AND / OR COMMERCIAL BUILDING Eng reenca De^a. ery 2a . Dcte-m -es Compsance F Far ng and p a n=a eon; r, r, Comrs; D3 -n^es Co—pi a-ira 1,, Viet'2..♦s Arts e I' Lr` S e--J4- T > C,'.p a---• r. • PLEASE NOTE: COOMMENTS. f CO/l/O/! /o j Two, Mve es?•� AiLbewrie� R ar ed •y: Water Digion / f ate --- • r e NSTAR Way EVERS=URGE W stwood,Ma ssachusetts 02090 ENERGY August 15, 2018 'Jeffrey Robinson 5 Cedar Ridge Lane Manfield MA 02048 RE: 25 Powers Ln W Yarmouth MA Dear Jeffrey Robinson: At Eversource, we're committed to delivering great service. This letter serves as confirmation that, as of 08/14/18 -w/o#2290814, the electric service to 25 Powers Ln W Yarmouth MA, has been removed. Based on this information, there is no electric power at this address and you may proceed with the demolition. If you have any questions, please contact me at (888) 633-3797. Sincerely, Ms Hebshie New Customer Connects • • . • di_Yak TOWN OF YARMOUTH ;i% HEALTH DEPARTMENT oz _ f':4 '4•••! PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: 07-5- "PO w-O.5 / Proposed Improvement: O S //lam r Applicant: /(f` /Gf mac- Tel. No.: S' € S�-77( 9 ? Address: 02 (,45 7,74/ Date Filed: 5--)41-le **Ifyou would like e-mail notification sign off please provide e-mail address: Owner Name: G °` O (1-t Owner Address: -Z C I/.!.ve t.tA �w Owner Tel. No.: - 77/ 952? RESIDENTIAL AND/OR COMMERCIAL BUILDING HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. Please submit three (3) copies of plans, to include: (1.) Site Plan showing existing buildings, water line location, and septic system location; (2.) Floor plan labeling ALL rooms within building (all existing and proposed) - Note:Floor plans not required for decks,sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. ¢¢� / REVIEWED BY: DATE: t/��' ! PLEASE NOTE COMMENTS/CONDITIONS: • r1• ij• Dor_ : 1 .341 . 311 03-01-2013 1 :06 BARNSTABLE LAND COURT REGISTRY • • • Massachusetts Department of Environmental Protection Provided by MassDEP: Bureau of Resource Protection - Wetlands 2139 WA F — OCPFile# MassachusettsPorm W 5etlands Protectionrderof Act M.Gonditif M.G.L. 13ns 3E83-1, §40 3E83-eDEP Transaction# Town of Yarmouth Wetland By-law, Chapter 143 Yarmouth City/Town A. General Information Please note: Yarmouth this form has f.From: been modified Conservation Commission with added z.This issuance is for space to a.®Order of Conditions b.0 Amended Order of Conditions accommodate (check one): the Registry of Deeds 3.To: Applicant: Requirements Jeffrey and Nancy Robinson a.First Name b.Last Name Important: When filling out forms on c.Organization the 5 Cedar Ridge Lane computer, d.Mailing Address use only the tab key to Mansfield MA 02048 move your e.Cltyfrown f.State g.Zip Code cursor-do not use the 4. Property Owner(if different from applicant): return key. V rm ` a.First Name b.Last Name c.Organization ' ,win d.Mailing Address e.City/Town f.State g.Zip Code 5. Project Location: 25 Powers Lane West Yarmouth a.Street Address b.City/Town 14 66 c.Assessors Map/Plat Number d.Parcel/Lot Number Latitude and Longitude, if known: 41d38m01.00s 70d13m54.38s d.Latitude e. Longitude wpaform5.doc• rev.11/12/2014 Page 1 of 12 ' • rMassachusetts Department of Environmental Protection Provided by MassDEP: Bureau of Resource Protection -Wetlands SE83-2139 MassDEP File# / WPA Form 5 — Order of Conditions i.. -wall Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 eDEP Transaction Town of Yarmouth Wetland By-law, Chapter 143 Yarmouth • City/Town A. General Information (cont.) 6. Property recorded at the Registry of Deeds for(attach additional information if more than one parcel): Barnstable 214103 LCP 11781-B Sht 2 Lots 4 and 5 a.County b.Certificate Number(If registered land) c.Book d.Page 7. Dates: 1/18/2018 2/15/2018 3/1/2018 a.Date Notice of Intent Filed b.Date Public Hearing Closed c.Date of Issuance a. Final Approved Plans and Other Documents (attach additional plan or document references as needed): Title 5 Site Plan of 25 Powers Lane,West Yarmouth, MA prepared for Jeffrey and Nancy Robinson Down Cape Engineering Inc Daniel Ojala PE b.Prepared By c.Signed and Stamped by 2/28/2018 1"=20' d.Final Revision Date e.Scale • f.Additional Plan or Document Title g.Date . ' B. Findings 1. 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(the Act). Check all that apply: a. ® Public Water Supply b. ® Land Containing Shellfish c. ® Prevention of Pollution d. ® Private Water Supply e. f. ® Protection of pp y ® Fisheries Wildlife Habitat g. ® Groundwater Supply h. ® 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. epalorm5.doc• rev.11/12/2014 Page 2 0112 . Massachusetts Department of Environmental Protection Provided byMassDEP: \ - Bureau of Resource Protection - Wetlands SE83-2139 MassDEP File# itWPA Form 5 — Order of Conditions Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 eDEP Transaction# Town of Yarmouth Wetland By-law, Chapter 143 Yarmouth City/Town B. Findings (cont.) Denied because: b. 0 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 the interests of the Act, 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). 3. 0 Buffer Zone Impacts: Shortest distance between limit of project disturbance and the wetland resource area specified in 310 CMR 10.02(1)(a) a. linear feet • Inland Resource Area Impacts: Check all that apply below. (For Approvals Only) Resource Area Proposed Permitted Proposed Permitted Alteration Alteration Replacement Replacement • 4. 0 Bank a.linear feet b.linear feet c.linear feet d.linear feet 5. 0 Bordering Vegetated Wetland a.square feet b.square feet c.square feet d.square feet 6. 0 Land Under Waterbodies and a.square feet b.square feet c.square feet d.square feet Waterways e.c/y dredged f.dy dredged T. 0 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. 9 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 e. • ❑ 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 wpaform5.doe•rev.11/12/2014 Page 3 of 12 Massachusetts Department of Environmental Protection Provided by MassDEP: \ rBureau of Resource Protection -Wetlands SE83-2139 MassDEP File# 1WPA Form 5 — Order of Conditions Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 eDEP Transaction# Town of Yarmouth Wetland By-law, Chapter 143 Yarmouth City/Town B. Findings (cont.) • Coastal Resource Area Impacts: Check all that apply below. (For Approvals Only) . Proposed Permitted Proposed Permitted Alteration Alteration Replacement Replacement 10. 0 Designated Port Indicate size under Land Under the Ocean, below Areas 11. 0 Land Under the Ocean a.square feet b.square feet c.dy dredged d.c/y dredged 12. ❑ Barrier Beaches Indicate size under Coastal Beaches and/or Coastal Dunes below • huyd hu yd 13. 0 Coastal Beaches a.square feet b.square feet c.nourishment d.nourishment 14. ® Coastal Dunes 6400 6400 cu yd cu yd a.square feet b.square feet c.nourishment d.nourishment 15. 0 Coastal Banks a.linear feet b.linear feet 16. 0 Rocky Intertidal Shores a.square feet b.square feet 17. 0 Salt Marshes a.square feet b.square feet c.square feet d.square feet 18. 0 Land Under Salt Ponds a.square feet b.square feet c.dy dredged d.dy dredged 19. 0 Land Containing Shellfish a.square feet , b.square feet c.square feet d.square feet 20. 0 Fish Runs Indicate size under Coastal Banks, Inland Bank, Land Under the Ocean, and/or inland Land Under Waterbodies and Waterways, above a.dy dredged b.dy dredged 21. ® Land Subject to 2000 2000 Coastal Storm a.square feet b.square feet Flowage wpaform5.tloc• rev.11/122014 Page 4 of 12 Massachusetts Department of Environmental Protection Provided by MassDEP: ilBureau of Resource Protection -Wetlands SE83-2139 jt^ MassDEP File# / 1/wt1` WPA Form 5 — Order of Conditions ril Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 eDEP Transaction k Town of Yarmouth Wetland By-law, Chapter 143 Yarmouth City/Town B. Findings (cont.) po)ectllafor • 22. 0 Restoration/Enhancement': • the purpose of restoring or a.square feet of BVW b.square feet of salt marsh enhancing a wetland resource area 23. 0 Stream Crossing(s): In addition to the square footage that a.number of new stream crossings b.number of replacement stream crossings has been C. General Conditions Under Massachusetts Wetlands Protection Act entered In Section B.5.c , (BVw)or The following conditions are only applicable to Approved projects. B.17.c(Salt Marsh)above, 1. Failure to comply with all conditions stated herein, and with all related statutes and other please enter regulatory measures, shall be deemed cause to revoke or modifythis Order. • the additional 9 Y amount here. 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. c. If the work is for a Test Project, this Order of Conditions shall be valid for no more than one year. . 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. An Order of Conditions for a Test Project may be extended for one additional year only upon written application by the applicant, subject to the provisions of 310 CMR 10.05(11)(f). 6. If this Order constitutes an Amended Order of Conditions, this Amended Order of Conditions does not extend the issuance date of the original Final Order of Conditions and the Order will expire on 3/1/2021 unless extended in writing by the Department. 7. 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. wparorm5 doe• rev.11/122014 Page 5 of 12 • Massachusetts Department of Environmental Protection Provided by MassDEP: �" `s, Bureau of Resource Protection - Wetlands MassDEP File# isia WPA Form 5 - Order of Conditions Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 SE83-2139 eDEP Transaction# Town of Yarmouth Wetland By-law, Chapter 143 Yarmouth City/Town C. General Conditions Under Massachusetts Wetlands Protection Act 8. 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. 9. 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 the 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. 10. 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 SE83-2139 " 11. 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. • 12. Upon completion of the work described herein, the applicant shall submit a Request for Certificate of Compliance(WPA Form 8A)to the Conservation Commission. • 13. The work shall conform to the plans and special conditions referenced in this order. 14. Any change to the plans identified in Condition#13 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. 15. 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. 16. This Order of Conditions shall apply to 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. wpaform5.doc• rev.11/12/2014 . Page 6 of 12 Massachusetts Department of Environmental Protection Provided by MassDEP: I Bureau of Resource Protection -Wetlands SE83-2139 MassDEP File# WPA Form 5 — Order of Conditions Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 eDEP Transaction# Town of Yarmouth Wetland By-law, Chapter 143 Yarmouth city/rown C. General Conditions Under Massachusetts Wetlands Protection Act (cont.) 17. 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. 18. 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. 19. The work associated with this Order(the"Project") (1)❑ is subject to the Massachusetts Stormwater Standards . (2) 0 is NOT subject to the Massachusetts Stormwater Standards If the work is subject to the Stormwater Standards, then the project Is subject to the following conditions: a) All work, including site preparation, land disturbance, construction and redevelopment, shall be implemented in accordance with the construction period pollution prevention and erosion and sedimentation control plan and, if applicable, the Stormwater Pollution Prevention Plan required by the National Pollution Discharge Elimination System Construction General Permit as required by Stormwater Condition 8. Construction period erosion, sedimentation and pollution control measures and best management practices (BMPs)shall remain in place until the site is fully stabilized. b) No stormwater runoff may be discharged to the post-construction stormwater BMPs unless and until a Registered Professional Engineer provides a Certification that: L all construction period BMPs have been removed or will be removed by a date certain specified in the Certification. For any construction period BMPs Intended to be converted to post construction operation for stormwater attenuation, recharge, and/or treatment, the conversion is allowed by the MassDEP Stormwater Handbook BMP specifications and that the BMP has been properly cleaned or prepared for post construction operation, including removal of all construction period sediment trapped in inlet and outlet control structures; ii, as-built final construction BMP plans are included, signed and stamped by a Registered Professional Engineer, certifying the site is fully stabilized; iii. any illicit discharges to the stormwater management system have been removed, as per the requirements of Stormwater Standard 10; wpeform5.doc• rev.11/1212 01 4 Page 7of12 • Massachusetts Department of Environmental Protection I / Provided by MassDEP: \ Bureau of Resource Protection -Wetlands SE83-2139 MassDEP File# WPA Form 5 — Order of Conditions Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 eDEP Transaction# Town of Yarmouth Wetland By-law, Chapter 143 Yarmouth City/Town • C. General Conditions Under Massachusetts Wetlands Protection Act (cont.) iv. all post-construction stormwater BMPs are installed in accordance with the plans (including all planting plans) approved by the issuing authority, and have been inspected to ensure that they are not damaged and that they are in proper working condition; v. any vegetation associated with post-construction BMPs is suitably established to withstand erosion. c) The landowner is responsible for BMP maintenance until the issuing authority is notified that another party has legally assumed responsibility for BMP maintenance. Prior to requesting a Certificate of Compliance, or Partial Certificate of Compliance, the responsible party(defined in General Condition 18(e))shall execute and submit to the issuing authority an Operation and Maintenance Compliance Statement("O&M Statement)for the Stormwater BMPs identifying the party responsible for implementing the stormwater BMP Operation and Maintenance Plan ("O&M Plan") and certifying the following; I.) the O&M Plan is complete and will be implemented upon receipt of the Certificate of Compliance, and il.)the future responsible parties shall be notified in writing of their ongoing legal responsibility to operate and maintain the stormwater management BMPs and Implement the Stormwater Pollution Prevention Plan. 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 Pollution Discharge Elimination System Multi-Sector General Permit. e) Unless and until another party accepts responsibility, the landowner, or owner of any drainage easement, assumes responsibility for maintaining each BMP. To overcome this presumption, the landowner of the property must submit to the issuing authority a legally . binding agreement of record, acceptable 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 O&M Plan, and the requirements of the Massachusetts Stormwater Handbook. wpaform5.doe• rev.11/12/2014 Page 8 of 12 • Massachusetts Department of Environmental Protection Provided by MassDEP: Lik. Bureau of Resource Protection -Wetlands SE83-2139 jam' MassDEP File# \k\ WPA Form 5 — Order of Conditions Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 eDEP Transaction# Town of Yarmouth Wetland By-law, Chapter 143 Yarmouth city/Town C. General Conditions Under Massachusetts Wetlands Protection Act (cont.) ' g) The responsible party shall: 1. Maintain an operation and maintenance log for the last three (3)consecutive calendar years of inspections, repairs, maintenance and/or replacement of the stormwater management system or any part thereof, and disposal (for disposal the log shall indicate the type of material and the disposal location); 2. Make the maintenance log available to MassDEP and the Conservation Commission("Commission")upon request; and 3. Allow members and agents of the MassDEP and the Commission to enter and inspect the site to evaluate and ensure that the responsible party is in compliance with the requirements for each BMP established in the O&M Plan approved by the issuing authority. h) All sediment 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 inanagement system as defined in 310 CMR 10.04 are prohibited. j) The stormwater management system approved in the Order of Conditions shall not be changed without the prior written approval of the issuing authority. k) Areas designated as qualifying pervious areas for the purpose of the Low Impact Site Design Credit(as defined in the MassDEP Stormwater Handbook,Volume 3, Chapter 1, • Low Impact Development Site Design Credits)shall not be altered without the prior written approval of the issuing authority. I) Access for maintenance, repair, and/or replacement of BMPs shall not be withheld. Any fencing constructed around stormwater BMPs shall include access gates and 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): 20. For Test Projects subject to 310 CMR 10.05(11), the applicant shall also implement the monitoring plan and the restoration plan submitted with the Notice of Intent. If the conservation commission or Department determines that the Test Project threatens the public health, safety or the environment, the applicant shall implement the removal plan submitted with the Notice of Intent or modify the project as directed by the conservation commission or the Department. vryeform5.doc• rev.11/12/2014 Page 9 of 12 4 / Massachusetts Department of Environmental Protection Provided by MassDEP: • Bureau of Resource Protection - Wetlands SE83-2139 MassDEP File# / WPA m OC MassachusettsForWetlands5 — Protectionrderof Act M.G.L.onditions c. 131, §40 eDEP Transaction# Town of Yarmouth Wetland By-law, Chapter 143 Yarmouth City/Town D. Findings Under Municipal Wetlands Bylaw or Ordinance 1. Is a municipal wetlands bylaw or ordinance applicable? ® Yes 0 No 2. The Yarmouth hereby finds (check one that applies): Conservation Commission a. 0 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: Yarmouth Wetland By-Law, Chapter 143 • 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 text page(s) 10A and 10B of 12 wpaform5 tloc• rev.11/12/2014 Page 10 of 12 , Y f WPA FORM 5-ORDER OF CONDITIONS SPECIAL CONDITIONS-PAGE 10AOF 12 SE83-2139, Jeffrey and Nancy Robinson • 25 Powers Lane, Yarmouth, MA 1. The applicant/owner shall be responsible for having a copy of the"Order of Conditions"on the job site at all times and shall be responsible for insuring that all persons performing the permitted activity are fully aware of its terms and conditions. Failure to do so may result in the revocation of these "Orders", a fine or both. 2. The Conservation Commission, its agent(s)or assigned(s)shall have the express right of entry upon the job site at all reasonable times for the purposes of establishing compliance with the"Order of Conditions", "By-Laws"and "Regulations". Commission members and the Conservation Administrator may acquire any information, measurements, photographs, observations and/or materials or may require the submittal of any data/information deemed necessary by this Commission for that evaluation. 3. A preconstruction review shall be arranged by the contractor with the Conservation Administrator and shall occur prior to the commencement of any work. • 4. Any change in the approved plan(s)shall require the Applicant to file, in writing, a notice of project change with this Commission.The Commission will determine the significance of the change and determine whether administrative approval or an "Amended Order of Conditions"Is required. Should the project be changed without permission, or found by the Yarmouth Conservation Commission to be altered in any way from the approved plan(s), all work will immediately cease until the project is reapproved by the Commission. 5. The "Order of Conditions" is valid for three years from the date of Issuance unless otherwise specifically noted in the"Orders". Extension Permit requests must be applied for at least 30 calendar days prior to the expiration date of the original Orders". Failure to do so will result In a new"Notice of Intent"filing. 6. Noncompliance with these conditions shall constitute grounds for an Enforcement Order and possible fines. Fines shall not exceed $300.00 per day/per violation. 7. A"work limit" line shall be established with Erosion Controls(i.e sand fence, straw bales, staked filter fabric, bark mulch, "silt sacks," products made with rice straw, and other weed-free products or approved by the Commission.) Hay bales are not allowed. It is the applicant's responsibility to implement and maintain appropriate and adequate erosion controls measures throughout the • construction process. 8. No work of any kind shall occur on the Resource Area side of the work limit line. This line shall be established prior to any construction or work. 9. Debris, including litter, shall be picked up immediately. Any excess material that Is excavated from the job site shall be disposed of at a location approved by the Conservation Administrator or in a covered • dumpster. No debris shall be allowed in a Wetland or Waterway. 10. Washing of equipment/tools shall be done OFF-SITE or handled In a manner appropriate by the Conservation Administrator. 11. No equipment shall be refueled, nor shall fuel be stored within 100 feet of a resource area. 12. The driveway shall be constructed of pervious and unconsolidated materials such as crushed stone, gravel, seashells, or other similar materials.This is an on-going condition that does not expire with the issuance of a Certificate of Compliance. . . 13. Gutters and downspouts directed into adequately sized drywells shall be provided for roof drainage. The Commission may also allow"drip trenches" instead of gutter systems.At no time shall roof run off be directed to a wetland resource area or abutting properties. WPA FORM 5-ORDER OF CONDITIONS SPECIAL CONDITIONS-PAGE 10B OF 12 SE83-2139, Jeffrey and Nancy Robinson . 25 Powers Lane, Yarmouth, MA 14. Any dune area that is disturbed during construction shall be rebuilt to the preconstruction size and shape and revegetated Immediately or as soon after as the growing season commences,with appropriate native plantings. Permanent stabilization shall be carried out in order to minimize erosion. • 15. 18. 310 CMR 10.30(3) promulgated under MGL c. 131, s. 40, requires that no coastal structure, such as a bulkhead, revetments or seawall shall be permitted on an eroding bank at any time in the future to protect the project allowed by this Order of Conditions. This condition shall be an ongoing In perpetuity and does not expire with the issuance of the Certificate of Compliance. 16. Lawn area is limited to the area between the existing vegetation line and the relocated gravel driveway. This Is an on-going condition, in-perpetuity, that does not expire with the issuance of a Certificate of Compliance. 17. Landscape Debris, including leaves, grass clippings, brush, or other shall not be allowed within the resource area. This is an on-going condition that does not expire with the issuance of a Certificate of Compliance. 18. To enable the unrestricted movement of the dune under the structure,the pilings shall not be enclosed. Lattice work and breakaway panels are prohibited due to shading impacts, hindrance of natural movement of sediment and potential to become projectiles. This is an on-going condition, in- perpetuity, that does not expire with the issuance of a Certificate of Compliance. 19. Rerouted utilities shall be installed by horizontal bore under the dune, no open cut is allowed. 20. The work line limit shall be reduced to no more than 5 feet off the structure footprint to reduce dune impacts. Demolition and construction shall occur from within the existing footprint. 21. A stamped"As Built Plan"shall be certified by the Design Engineer(Massachusetts registered Professional Engineer or land Surveyor)and will certify that this project has been completed In accordance with the "Order of Conditions" before a Certificate of Compliance will be issued.The as- built plan shall indicate the structure location, gradients, distances to the resource areas, and other pertinent information described In the application and approved plans.Any deviation from the approved plan shall be identified. 22. Upon completion of the project, a "Request for a "Certificate of Compliance"shall be submitted by the applicant to the Conservation Commission for review. The"Order of Conditions"shall be considered incomplete until the "Certificate of Compliance" is issued by the Conservation Commission and recorded at the Registry of Deeds: • l L �I Massachusetts Department of Environmental Protection Provided by MassDEP: Bureau of Resource Protection - Wetlands SE83-2139 MassDEP File# r WPA Form 5 — Order of Conditions Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 eDEP Transaction# • Town of Yarmouth Wetland By-law, Chapter 143 Yarmouth City/Town E. Signatures This Order is valid for three years,unless otherwise specified as a special 3 /i/201e 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. 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 Departmeg t of r Environmental Protection Regional Office, if not filing electron'cailyy,and the property own'r if dtf-rent from applicant. Signatures. �`a• • El by hand de ❑ by certified mail, return receipt requested, on 3/f /2oi0 Date Date 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 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 providing written information to the Department prior to issuance of a Superseding Order. The request shall stale 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. wpaform5.doc• rev.11/12/2014 Page 11 of 12 • ., , , I I . t . . . . • i t ► Massachusetts Department of Environmental Protection Provided by MassDEP: LBureau of Resource Protection -Wetlands 8E83-2139 MassDEP File# WPA Form 5 — Order of Conditions Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 eDEP Transaction# Town of Yarmouth Wetland By-law, Chapter 143 Yarmouth City/Town G. Recording Information Prior to commencement of work, 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. • Yarmouth . Conservation Commission Detach on dotted line, have stamped by the Registry of Deeds and submit to the Conservation Commission. To: Yarmouth Conservation Commission Please be advised that the Order of Conditions for the Project at: 25 Powers Lane SE83-2139 Project Location MassDEP File Number Has been recorded at the Registry of Deeds of: Barnstable 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.11/12/2014 Page 12 of 12 4 I P df 4 : o Town of Yarmouth �\ V Conservation Commission "" �� Building Permit Sign-off Application TO BE FILLED OUT BYAPPLICANT: Building Site Location: 2s Powers torte Map # y //fr Haw /Q f4 Lot(s) # 66 Property OOwnerJ€fand c b//75�l7 Applicant i Mike- A et-one, Applicant Address: LSJteeple g_/ inarl9p. CQwriwoliiS Telephone: co& 7 7/ 9' /27 Date Filed Proposed Project Description: ��/ o oaw/,/T.ofl ,/ S-t h. Plans: /f//l SS'k- ea'? of 2, Ibr- e/s LQ-nQ TO BE FILLED OUT BY CONSERVATION ADMINISTRATOR: 4or//2 2C4fr Does the Proposed Project Require a Permit? Ye'f Comments from Conserve ' n Commission: Approved Conditionally Ap ed Rejected All work related debris shall be taken offsite or disposed in a legal upland location At the end of each day,the area shall be clean and no debris shall be in the Resource Area Refer to: SE83-2 inor DOA permit Conservation Commission Sign-ofSignature: 1:54-Q...neyAL. Date: tcIfaa,, Yarmouth Conservation Commission ---Pre-Construction_Meetin DEP File Number SE83-2139 Applicant Jeffrey& Nancy Robinson • Address 25 Powers Lane, West Yarmouth 02673 Company date ,ardor . Contact info: 1ff Na ro&on.t SD£ 77199022 Signature of Acknowledgement: My signature acknowledges that I read and understand the Order of Conditions, including the special conditions per the Yarmouth o servation Commission. A copy of the Order of Conditons will remain onsite. Pc' 1 Order of Conditions Recorded? • VJFile Number Sign Up? PJ Erosion Control: Your sediment and erosion control has been properly installed in the appropriate location(s) Y u MAY MAY NOT begin work. Other Comments: 2 /3912o /8. n/low up S/ vfl i t to , . . nationalgrid September 4, 108 James Nolan 25 Powers Lane West Yarmouth,MA 02673 • To Whom It May Concern: RE: 25 Powers Lane,West Yarmouth,MA 02671 This letter is to confirm that there is no live gas service to the above property. I can be reached directly at 508-760-7439 should there be any further questions. Sincerely, Ellen Whelan Gas Connections Rep National Grid 127 Whites Path S. Yarmouth,MA 02664 (T) 508-760-7439