HomeMy WebLinkAbout33 Azalea RdFor Registry of Deeds Use Only
RECE1�lE:D _
T0AII,I (',I_FRi.`� OFFICE
-3 AIt' u2
Massachusetts Department of Environmental Prot ction 1 l)
Bureau of Resource Protection - Wetlands ,I �' ; �I;. DEPFil� Number:
WPA Form 8B — Certificate of Compliurice 211-1019
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provide -by DEP
A. Project Information
Important:
When filling out 1. This Certificate of Compliance is issued to:
forms on the
computer, use David Oberlander, BDO Engineering
only the tab key Name
to move your 47 Wilson Place
cursor - do not use the return Mailing Address
key. Mansfield MA 02048
City/Town Stale Zip Code
2. This Certificate of Compliance is issued for work regulated by a final Order of
Conditions or Order of Resource Area Delineation issued to:
Kyle Pernock, Keller Williams Elite
Name
5/5/25 211-1019
Dated DEP File Number
3. The project site is located at:
0 Azalea Road (now number 33)
Mansfield
Street Address
Cityffown
Map 36
Lots 109,110, 113, 21 (Combined to 109)
Assessors Map/Plat Number
Parcel/Lot Number
The final Order of Conditions or Order of
Resource Area Delineation was recorded at
the Registry of Deeds for:
Sherman Cox
Property Owner (If different)
Bristol County North Registry of Deeds
29334 10
County
Book Page
4. A site inspection was made in the presence of the applicant, or the applicant's agent,
on:
11/20/25
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.
wpafrm8b.doc • rev. M12021 WPA Form go, Cedificate of Compliance • Page 1 of 4
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 8B — Certificate of Compliance 211-1019
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 pfovidedby DEP
B. Certification (cont.)
❑ 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Conditions has lapsed and is therefore no longer valid.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:
❑ Order of Resource Area Delineation: It is hereby certified that the wetland
resource area delineation for the above -referenced Order of Conditions has been
satisfactorily completed
C. Authorization
Issued by:
Mansfield 11/24/25
Conservation Commission Date of Issuance
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
httos //www mass gov/service-details/massdep-regional-offices-by-community).
wpagm8b.doc. rev. 7/112MI WPA Fern 8B, Certificate of Compliance . Page 2 of 4
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
' WPA Form 8B — Certificate of Compliance SE211-1019
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
C. Authorization (cont.)
Slgnatures:
Signature
Signalur
Signature
Michael Healey
Printed Name
Aaron Roth
Printed Name
Aaron Gallagher
Printed Name
Ryan O'Hara
Printed Name
Laura Konick
Printed Name
Robert MacDonald
Printed Name
Jonathan Hedlund
Printed Name
Printed Name
wpafrm0b.doe• rev. 7/112021 WPAForm ee, Cedirmte ofCompllar •Page 3 of
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 8B — Certificate of Compliance 211-1019
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 provide -by DEP
D. Recording Confirmation
The applicant is responsible for ensuring that this Certificate of Compliance is recorded in
the Registry of Deeds or the Land Court for the district in which the land is located.
Detach on dotted line and submit to the Conservation Commission.
Conservation Commission
Please be advised that the Certificate of Compliance for the project at:
Project Location DEP File Number
Has been recorded at the Registry of Deeds of:
for:
Owner
and has been noted in the chain of title of the affected property on:
If recorded land. the instrument number which identifies this transaction is:
If registered land, the document number which identifies this transaction is:
Document
Signature
wpafm8b.doc • rev. 7/1/202/ WPA Form an, Certrhoate of Compliance - Page 4 of 4
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