HomeMy WebLinkAboutCOC request L11Massachusetts Department of Environmental Protection DEP File Number:
Bureau of Resource Protection - Wetlands
WPA Form 8A - Request for Certificate of Compliance SE-83-38
Massachusetts Wetlands Protection Act M.G.L. C. 131, §40 Provided by DEP
A. Project Information
Important:
When filling out 1. This request is being made by:
forms on the BLH Environmental Consulting
computer, use _
Name
only the tab 47 Old Church Street
key to move
your cursor Mailing Address
do not use the Yarmouth Port MA 02675
return key. City/Town State Zip Code
1.
508-362-3397
411111111111111
' I Phone Number
2. This request is in reference to work regulated by a final Order of Conditions issued to:
KJEarle S. Davidson
Applicant
Oct 22, 1975 SE-83-38
Dated DEP File Number
Upon completion
of the work 3. The project site is located at:
authorized in 15 Davidson Lane Yarmouth Port
an Order of Street Address City/Town
Conditions,the
property owner MA
must request a Assessors Map/Plat Number Parcel/Lot Number
Certificate of 4. The final Order of Conditions was recorded at the Registry of Deeds for:
Compliance
from the issuing
authoritystating 9 Property Owner(if different)
that the work or Barnstable 30963 27
portion of the
work has been County Book Page
satisfactorily
completed. Certificate(if registered land)
5. This request is for certification that (check one):
® the work regulated by the above-referenced Order of Conditions has been satisfactorily completed.
❑ the following portions of the work regulated by the above-referenced Order of Conditions have
been satisfactorily completed (use additional paper if necessary).
❑ the above-referenced Order of Conditions has lapsed and is therefore no longer valid, and the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 of 2
Massachusetts Department of Environmental Protection
DEP File Number:
Bureau of Resource Protection - Wetlands
WPA Form 8A — Request for Certificate of Compliance SE-83-38
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
A. Project Information (cont.)
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?
® Yes 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.
❑ No
B. 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-tow n.html).
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