25-068 67 Riverbank Road-Certificate of Compliance-246-301--10-28-2010 chimney
Massachusetts Department of Environmental Protection
DEP File Number:
Bureau of Resource Protection - Wetlands
WPA Form 8A –
Request for Certificate of Compliance
246-301
Provided by DEP
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
A. Project Information
Important:
1. This request is being made by:
When filling out
forms on the
Jesse Lang
computer, use
Name
only the tab
67 Riverbank Road
key to move
Mailing Address
your cursor -
Northampton MA01060
do not use the
return key.
City/Town StateZip Code
(413) 585-9417
Phone Number
2. This request is in reference to work regulated by a final Order of Conditions issued to:
Heyl Associates
Applicant
October 21, 1991 246-301
Dated DEP File Number
Upon completion
3. The project site is located at:
of the work
authorized in
67 Riverbank Road Northampton
an Order of
Street Address City/Town
Conditions, the
Map 25 Lot 68
property owner
Assessors Map/Plat Number Parcel/Lot Number
must request a
Certificate of
4. The final Order of Conditions was recorded at the Registry of Deeds for:
Compliance
from the issuing
authority stating
Property Owner (if different)
that the work or
Apparently not recorded
portion of the
County BookPage
work has been
satisfactorily
Certificate (if registered land)
completed.
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the above-referenced Order of Conditions has lapsed and is therefore no longer valid, and the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. 7/13/04 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
246-301
Provided by DEP
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
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/dep/about/region/findyour.htm).
wpaform8a.doc •• rev. 7/13/04 Page 2 of 2