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Massachusetts Department of Environmental Protection Provided by MassDEP:
Bureau of Resource Protection - Wetlands SE83-2158
MassDEP File#
WPA Form 5 - Order of Conditions
L\ 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
Please note: Yarmouth
this form has 1. From: Conservation Commission
been modified
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
Errol Gaudette
a. First Name b. Last Name
Important:
When filling
out forms on c.Organization
the 83 Arrowwood Drive
computer, d. Mailing Address
use only the
tab key to Scituate MA 02066
move your e.City/Town f.State g.Zip Code
cursor-do
not use the 4. Property Owner(if different from applicant):
retum key.
r�5 ^ a. First Name b.Last Name
�s�VVVVVV \
c.Organization
/ X\
mrm
d.Mailing Address
e.City/Town f.State g.Zip Code
5. Project Location:
133 Mayflower Terrace South Yarmouth
a.Street Address b.City/Town
120 2
c.Assessors Map/Plat Number d.Parcel/Lot Number
Latitude and Longitude, if known: d _ m s d m s
d. Latitude e.Longitude
wpaform5.doc• rev.11/12/2014 Page 1 of 12
1<
Massachusetts Department of Environmental Protection Provided by MassDEP:
Bureau of Resource Protection - Wetlands SE83-2158
MassDEP File#
}� WPA Form 5 - Order of Conditions
1`\ 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:
133 Mayflower Terrace SE83-2158
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 BARNSTABLE REGISTRY OF DEEDS
Page 12 of 12
John F. Meade, Register