30B-084 20 Ladd Ave- Request for Certificate of Complaince
wpaform8a.doc •• rev. 5/29/14 Page 1 of 2
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 8A – Request for Certificate of Compliance
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
DEP File Number:
Provided by DEP
A. Project Information
Important:
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1. This request is being made by:
Name
Mailing Address
City/Town
State
Zip Code
Phone Number
2. This request is in reference to work regulated by a final Order of Conditions issued to:
Applicant
Dated
DEP File Number
Upon completion
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
work has been
satisfactorily
completed.
3. The project site is located at:
Street Address
City/Town
Assessors Map/Plat Number
Parcel/Lot Number
4. The final Order of Conditions was recorded at the Registry of Deeds for:
Property Owner (if different)
County
Book
Page
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the above-referenced Order of Conditions has lapsed and is therefore no longer valid, and the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 2 of 2
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 8A – Request for Certificate of Compliance
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
DEP File Number:
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-your-city-or-town.html).