HomeMy WebLinkAboutCOC requestMassachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands
WPA Form BA -Request for Certificate of Compliance
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
Town of Yarmouth Wetland By-law, Chapter 143
A.Project Information
Important: When filling out 1.
forms on the computer, use
This request is being made by:
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Phone Number
2.This request is in reference to work regulated by a final Order of Conditions issued to:
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The project site is located at:
DEP File Number
DEP File Number:
se83-2196 Provided by DEP
02&�1 Zip Cod
Upon completion 3 of the work authorized in an Order of Conditions, the property owner must request a Certificate of Compliance from the issuing authority stating that the work or portion of the
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work has been satisfactorily completed.
Assessors Map/Plat Number 70 Parcel/Lot Number
4.The final Order of Conditions was recorded at the Registry of Deeds for:
�ame.-)Property Owner (if different)
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Certificate (if registered land)
5.This request is for certification that (check one):
3/C/71 Book °336 Page
M the work regulated by the above-referenced Order of Conditions has been satisfactorily completed.
D the following portions of the work regulated by the above-referenced Order of Conditions have
been satisfactorily completed (use additional paper if necessary).
D the above-referenced Order of Conditions has lapsed and is therefore no longer valid, and the
work regulated by it was never started.
wpaform8a.doc •• rev. 5/29/14 Page 1 of2
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands
WPA Form BA -Request for Certificate of Compliance
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
Town of Yarmouth Wetland By-law, Chapter 143
A.Project Information (cont.)
DEP File Number:
se83-2196
Provided by DEP
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?
Q(Yes
D No
If 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.
8.Submittal Requirements
Requests for Certificates of Compliance should be directed to the issuing authority that issued the final
Order of Conditions (OOC). If the project received an OOC from the Conservation Commission, submit
this request to that Commission. If 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 http://www.mass.gov/eea/agencies/massdep/about/contacts/find-the-massdep-regional-office
for-you r-city-or-town. html).
wpaform8a.doc .. rev. 5/29/14 Page 2 of 2