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BARNSTABLE LAND COURT REGISTRY
Massachusetts Department of Environmental Protection
LIBureau of Resource Protection - Wetlands
WPA Form 5 - Order of Conditions
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
Town of Yarmouth Wetland By-law, Chapter 143
Please note:
this form has
been modified
with added
space to
accommodate
the Registry
of Deeds
Requirements
Important:
When filling
out forms on
the
computer,
use only the
tab key to
move your
cursor . do
note the
return�key.
v�
A. General Information
tF
Yarmouth
rOm. Conservation Commissior
2. This issuance is for
(check one):
s. To: Applicant:
Lisa
a. First Name
c. Organization
10 Woodland Avenue
d. Mailing Address
Medford
e. CityTfown
Provided by MassDEP:
SE83-2191
MassDEP File #
eDEP Transaction #
Yarmouth
City/Town
a. ®Order of Conditions b. ❑ Amended Order of Conditions
4. Property Owner (if different from applicant):
Lisa Warren & Piers Hughes
a. First Name
c. Organization
10 Woodland Avenue
d. Mailing Address
Medford
e. CItyrrown
5. Project Location:
18 Crab Creek Lane
a. Street Address
126
c. Assessors Map/Plat Number
Latitude and Longitude, if known:
Warren
b. Last Name
MA
t. State
b. Last Name
MA
f. State
Yarmouth Port
b. City/Town
20
rv11U.1
W. —F ...,..o
02155
g. Zip Code
d. Parcel/Lot Number
41 d42m16.0992s -70d11 m50.787s
d. Latitude e. Longitude
wpaform5.doc • rev. 11/1212014 Page 1 of 12
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 5 — Order of Conditions
!' Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
Town of Yarmouth Wetland By-law, Chapter 143
G. Recording Information
Provided by MassDEP:
SE83-2191
MassDEP File #
eDEP Transaction #
Yarmouth
CityFrown
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.
Yarmrn ith
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:
18 Crab Creek Lane
Project Location
Has been recorded at the Registry of Deeds of:
Barnstable
County
for: Property Owner
SE83-2191
MassDEP File Number
Book
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
Page
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BARNSTAP-LE I_ANI?—��STRY
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