23B-011 Certificate of Compliance, Northampton Pediatrics 246-470ILIMassachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 86 - Certificate of Compliance
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the.return
key.
_ Q
A. Project Information.
1. This Certificate of Compliance is issued to:
Northampton Area Pediatrics
Name
193 Locust Street
DEP File Number:
7AC A7n
Mailing Address
Northampton MA 01060
City/Town State Zip Code
2. This Certificate of Compliance is issued for work regulated by a final Order of
Conditions issued to:
193 Locust Street Associates & Howard F. Kantor, et. al
Name
August 24, 2000 246-470
Dated DEP File Number
3. The project site is located at:
190 Locust Street Northampton
Street Address City/Town
23B 011
Assessors Map/Plat Number Parcel/Lot Number
the final Order of Condition was recorded at the Registry of Deeds for:
193 Locust Street Associates & Howard F. Kantor, et. al
Property Owner (if different)
Hampshire 6050 284
County Book Page
Certificate
4. A site inspection was made in the presence of the applicant, or the applicant's agent,
on:
December 6, 2010
Date
w0afrm8b.doc • rev. 12/23/09 WPA Form 813, Certificate of Compliance • Page 1 of 3
Massachusetts Department of Environmental Protection
Bureau of. Resource Protection -Wetlands DEP File Number:
L, i WPA Form 8B — Certificate of Compliance 246-470
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
B. Certification
Check all that apply:
® Complete Certification: It is hereby certified that the work regulated by the
above -referenced Order of Conditions has been satisfactorily completed.
❑ Partial Certification: It is hereby certified that only the following portions of work
regulated by the above -referenced Order of Conditions have been satisfactorily
completed. The project areas or work subject to this partial certification that have
been completed and are released from this Order are:
❑ Invalid Order of Conditions: It is hereby certified that the work regulated by the
above -referenced Order of Conditions never commenced. The Order of
Conditions has lapsed and is therefore no longer valid. No future work subject to
regulation under the Wetlands Protection Act may commence without filing a new
Notice of Intent and receiving a new Order of Conditions.
❑ Ongoing Conditions: The following conditions of the Order shall continue:
(Include any conditions contained in the Final Order, such as maintenance or
monitoring, that should continue for a longer period).
Condition Numbers:
C. Authorization
Issued by:
Northampton January 13,
Conservation Commission 2011
This Certificate must be signed by a majority of the Conservation Commission and a
copy sent to the applicant and appropriate DEP Regional Office (See
http://www.mass.gov/dep/about/region/findyour.htm).
E`
V.
wpafrm8b.doc • rev. 12/23/09 WPA Form 813, Certificate of Compliance • Page 2 of 3
nERIT GE SURVEYS, INC.
Professional Surveyors and Engineers
241 College Hwy & Clark St, P O Box 1
Southampton, Massachusetts 01073-0001
Bruce A. Coombs, President
Professional Surveyor, MA, CT & VT
E-mail: bruce@heritagesurveys.com
December 2, 2010
Conservation, Preservation and Land Use Planner
City of Northampton
Office of Planning and Development
c/o Sarah I. LaValley
210 Main Street, Room 11
Northampton MA, 01060
RE: Request for Certificate of Compliance
Northampton Area Pediatrics
193 Locust Street
Northampton, MA 01060
DEP File #246-470
HSI Job #3960-981113
Dear Commission Members:
Telephone (413) 527-3600
Facsimile (413) 527-8280
Website: heritagesurveys.com
At the request of Northampton Area Pediatrics and in compliance with the
Northampton Order of Condition - General Condition #11, please find enclosed a WPA
Form 8A - Request for Certificate of Compliance for the above reference site. The
Order of Conditions for the project was issued August 24, 2000 by the Northampton
Conservation Commission and recorded in the Hampshire County Registry of Deeds in
Book 6050 page 284.
The work performed at 193 Locust Street, Northampton, Massachusetts is in
compliance with the approved plans, entitled Northampton Area Pediatrics,
Northampton Massachusetts, Prepared for 193 Locust Street Associates, Sheets 1-4,
Topographical Plan, Site Plan, Enlarged Site Plan, Detail Plan, date November 28,
2000 prepared by Heritage Surveys, Inc.
Please contact this office if you should have any questions or comments relative
to the above.
Sincerely,
ruce A. Coombs
BRUCE
A.
COOMBS
No. 27814
cc: DEP - Western Regional Office (with enclosures)r°gsscis����Q
Northampton Area -Pediatrics -(with -enclosures) °Nay LO
LlMassachusetts 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
A. Project Information
Important: 1
When filling out
forms on the
computer, use
only the tab
key to move
your cursor -
do not use the
return key.
teb
2
Upon completion
of the work 3•
authorized in
an Order of
Conditions, the
property owner
must request a
Certificate of 4
Compliance
from the issuing
authority stating
that the work or
portion of the
work has been
satisfactorily
This request is being made by:
Northampton Area Pediatrics
DEP File Number:
Provided by DEP
Name
193 Locust Street
Mailing Address
Northampton MA 01060
City/Town State Zip Code
(413) 584-8708
Phone Number
This request is in reference to work regulated by a final Order of Conditions issued to:
193 Locust Street Associates c/o Northampton Area Pediatrics
Applicant
August 24, 2000 246-470
Dated DEP File Number
The project site is located at:
193 Locust Street
Street Address
23B
Assessors Map/Plat Number
Northam
City/Town
011
Parcel/Lot Number
The final Order of Conditions was recorded at the Registry of Deeds for:
193 Locust Street Associates & Howard F. Kantor, et al.
Property Owner (if different)
Hampshire 6050
County Book
completed. Certificate (if registered land)
5. This request is for certification that (check one):
')QA
-ti-
® 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
Bureau of Resource Protection - Wetlands DEP File Number:
WVPA Form 8A — Request for Certificate of Compliance ILI
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/dep/about/region/findyour.htm).
wpaform8a.doc -- rev. 7/13/04 Page 2 of 2