14-009 Kennedy Road Certificate of Compliance.pdf
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands WPA Form 8B – Certificate of Compliance
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
DEP File Number: 246-547
Provided by DEP
A. Project Information
Important: When filling out forms on the computer, use only the tab key to move your
cursor - do not use the return key.
1. This Certificate of Compliance is issued to:
Robert and Ann Borawski
Name
170 Audubon Road
Mailing Address
Northampton
City/Town
MA
State
01060
Zip Code
2. This Certificate of Compliance is issued for work regulated by a final Order of Conditions issued to: Thomas Borawski
Name
7/5/2005
Dated
246-547
DEP File Number
3. The project site is located at:
Kennedy Road
Street Address
Northampton (Leeds)
City/Town
14
Assessors Map/Plat Number
009
Parcel/Lot Number
the final Order of Condition was recorded at the Registry of Deeds for:
Robert and Ann Borawski
Property Owner (if different)
Hampshire
County
8390
Book
82
Page
Certificate
4. A site inspection was made in the presence of the applicant, or the applicant’s agent, on: January 10, 2022
Date
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands WPA Form 8B – Certificate of Compliance
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
DEP File Number: 246-547
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 The Order of Conditions has lapsed and is therefore no longer valid.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
Conservation Commission
January 13, 2022
Date of Issuance
Signatures are made in accordance with M.G.L. c.110G, and pursuant to the board’s
electronic signature authorization vote recorded on June 5, 2020 in Book 13653, page
165 at the Hampshire Registry of Deeds.
Kevin Lake
Jason Perry
Jen Smith
Randy Krotowski
C. Mason Maronn
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: 246-547
Provided by DEP
A. Project Information
Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key.
1. This request is being made by:
Robert and Ann Borawski
Name
170 Audubon Road
Mailing Address
Northampton
City/Town
MA
State
01060
Zip Code
413-237-1742
Phone Number
2. This request is in reference to work regulated by a final Order of Conditions issued to:
Thomas Borawski
Applicant
July 5, 2005
Dated
246-547
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:
Kennedy Road
Street Address
Leeds, (Northampton)
City/Town
14
Assessors Map/Plat Number
009
Parcel/Lot Number
4. The final Order of Conditions was recorded at the Registry of Deeds for:
same(Robert and Ann Borawski)
Property Owner (if different)
Hampshire
County
8390
Book
82
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: 246-547
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).