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Massachusetts Department of Environmental Protection Provided by MassDEP:
Bureau of Resource Protection - Wetlands sE83-2210
' MassDEPFile #
WPA Form 5 - Order of Conditions
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 eDEP Transaction #
LM Town of Yarmouth Wetland By-law, Chapter 143 Yarmouth
_ City/Town
A. General Information
Please note: Yarmouth
this form has 1. From:
been modified Conservation Commission
with added 2. This issuance is for
space to a. ®Order of Conditions b. ❑ Amended Order of Conditions
accommodate (check one):
the Registry
of Deeds 3. To: Applicant:
Requirements
Important:
When filling
out forms on c. Organization
the
12 Windsor Road
computer,
use only the
d. Mailing Address
tab key to
East Walpole _
move your
e. City/Town
cursor - do
not use the
4. Property Owner (if different from applicant):
return key.
rep
a. First Name
c. Organization
d. Mailing Address
e. City/Town
5. Project Location:
10 Surfside Terrace
a. Street Address J
51
c. Assessors Map/Plat Number
Latitude and Longitude, if known:
wpaform5.doc • rev, 11/12/2014
b. Last Name
MA
f. State
b. Last Name
f. State
South Yarmouth
b. City/Town
68
d. Parcel/Lot Number
41 d39m44.5356s
d. Latitude
g. Zip Code
-70d11 m13.347s
e. Longitude
Page 1 of 12
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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:
SE83-2210
MassDEP File #
eDEP Transaction #
Yarmouth
City/Town
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:
10 Surfside Terrace
Project Location
Has been recorded at the Registry of Deeds of:
Barnstable
County
SE83-2210
MassDEP File Number
Book
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
Page
wpaform5 doc • rev 11/12/2014 Page 12 of 12
SARNSTABLE REGISTRY OF DEEDS
John F. Meade, Register