HomeMy WebLinkAboutCorrespondence - 73 CARLTON LANE 8/9/2016 FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance with any applicable or requirements.
*************'�***************APPLICANT FILLS OUT THIS SECTION*****************'�***'"'``
APPLICANT L ,C; v f• /�/� PHONE," i L '
LOCATION: Assessor's Map Number (a PARCEL c); c '
SUBDIVISION LOT (S)
STREET (. /f L ro A,✓f ST. NUMBER-73
USE ONLY***************"********�*****y`**
[R:jE,4CPMME A OF TQ GENTS:
CON ERVATION XDMINISTRATOft DATE APPROVED
DATE REJECTED
COMMENTS !VD
TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS
F77, OR-HEALTH DATE APPROVED
DATE REJECTED 9
E IN PECTO EALTH DATE APPROVED
DATE REJECTED
COMMENTS AZV c � E
PUBLIC WORKS - SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR DATE
Revised 9197 jm
SOIL PROFILE & PERCOLATION TEST DATA
R 4-rosz-4- O. 1,nf~ No.
North l s.
u
r ,
S011i r�O:F'ILES-DATE
4
Elev. Elev. Elev. --=Ev
Q
Ties to Test Pits
2 2 2 _._.
4 `,, 4 ' 4
4
`-,� ,�„.;• � 'tea,�t �,,► .�.._..,�.
7 7 �_. _ 7 7 _ ---
g 8 8
9 _ .__ , _ 9 9
10 _ _.,._._.. .._.... 10 _. 10 .. ., _ 1 _. ..
Denc1)mar C ? rcation
Percolation Tests-Date
Pit Number 2 4-
Start Saturation
_ _.____, __.
311-Time 0(�
w
I�iir I t . 3"Dr2 .
Perco , tion Rates
Notes & mhs on Bwk
O¢H°xrM Y
OFFICES OF: p °� TOWn of 1 2()N-ItA[II street
APPEALS «; .`-' � NORTH ANDOVER N(fss dIuS tt�r,
BUILDING
iv1��55<(cllE(SC ttS(11t3�1
CONSI-,RVATION "usEt DIVISION OF ((i 1 7)68 i 477 i
I IFAIATI
PLANNING PLANNING & COMMUNITY DEVELOPMEN'1'
KAREN 1A.P. NELSON, 1_)[1-11 CTOR
May 17 1988
Mary Magl.iato
73 Carlton Lane
North Andover, Mass .
re= 73 Carlton Lane
Lot 28A
This office has no record of complaints about
the Septic System at this house.
Sincerely
—
Sanitarian 8o d of Health
; '� '� ✓ , .^�£' a"' '� 3 it r
SECTION 9-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failura to grotide this afFtdavit uv�ll result
in the denial of the issuance of the building permit.
Signed affidavit Attached'Yes.......❑ No... ..❑
SECTION 5 Descri tion of Proposed Work check ail aviDUcable
New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify
Brief Description of Proposed Work: /
i
f`71 A� r t ld '4d JUG1' J — L, d r E ,,.t
SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to be OF'F'ICIAL USE ONLY
Completed by ennit applicant
I. Building (a) Building Permit Fee
S •4�c�
Multiplier
2 Electrical (b) Estimated Total Cost of
Construction
3 Plumbing v Building Permit fee (b)
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5 Check Number
SECTION 7a OWNER AUTHOR IZA ION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner/Authorized Agent of subject property
Here ufhorize/''/�Yr!/l tiC.;�rt�i,,� to act on
My elu iin all matters relative to v,ork authorized by this building permit applicat�nn.
Si uahlre of Owuuer le, ` y
Date
SE ON 7b OWNER/AUTHORIZED AGENT DECLARATION
I, IF as Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief
PAC L�_
.1
P III aloe ,
�r
Su atuure of Owner/A ent Date '
N
NO, OF STORIES
SIZE
BASEMENT OR SLAB a
SIZE OF FLOOR TIMBERS 3
RD
SPAN
DMENSIONS OF SILLS "-
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS �X
HEIGHT OF FOUNDATION
THICKNESS
SIZE OF FOOTING X
MATERLAL OF CHM4NEY '
IS BUILDING ON SOLID OR FELLED LAND
1S BUILDING CONNECTED TO NATUIZAT,GAS_L1NE • �5 s ter?
d
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR,RENOVAT& OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER: DATE ISSUED:
SIGNATURE:
Building Commissioner/Ins tar of Building Date
SECTION i-SITE INFORMATION I 0
1.1 Property Address: 1.2 Assessors Map and Parcel Number:
F`( j C`��,2TnrJ _ �-R� bj Uni�lQvs��
la Jzko
ct Map Number arcel Number
1,3 Zoning Information: 1.4 Property Dimensions:
Zoning District Propos se Lot Areas Fronts ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
r R red Provide Required Provided Required Provided
l 1.5. Flood Information: 1.8 Sewerage Disposal System:
i.7 Water Supply M.G.L.C,40. S4) Zone ;N_ Outside Flood Zono 0 Municipal ❑ on Site Disposal Syste �j
Public Private a r
SEC ON 2--PROPERTY OWNERSHIPiAUTHORMED AGENT %i ft; i�'trict: m
2.1 Owner of Record
{Print) Address for Service:
4 ignature Telephone
2.2 Owner of Record:
Name Print Address for Service: z
M
Si nature Tele hone �Q
SECTION 3-CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable 17
49 401,eyd"o z
Licensed Construction Supervisor: '
License Number
Address
Expiration Date
tgnature Telephone rM
3.2 Registered Home Improvement Contractor Not Applicable Q
J
Company Name M
Registration Nmrtbor r
Address z mom
Expiration Date G)
Telephone
Si nature
a d oi" Healtlh BFP'T°IC ST3TEK
North A.no.oa„a�.����. INSTALLATIG t CH2VK SIFT LOT
M1,
CrV-ED DAT AI FtRCRED x AVATIM 0K , FAIL
lw„oye
FAIL OK
1. Mstance Tot
. Welds
b. Drains
c. Well
2. Water Line Location
3. No PVC Pipe
Septic Tank A
a* _Tees Length & To Gleam that Covers
b. Cement Pipe to Tank — on Both Sides of Tank
® Distribution Boat
a. Covers & Box - No Cracks
b. . All Lines Flowing Equal- Amounts
C. No Back Flog
6. - Leach Field or Trench
a. Dimen.sions
b. Stone Depth
e. Capped ads
d. Clean Double Washed Stone
7. _
Leach each isions
b. a Depth
c. h
Pads
d. ees
8 Cment Pipe to Pit _ Both Sides
. Clean Double Washed Stone
8. No Garb ag e Di spo sal.
9. 71nal. Grading Inspection
3-0. Barricading Covered. System
ll. As Built Sabnitted
a. Lot Location
b. Dimensions of Sy-stem
e. Location with Regard-to Pere Test
/ d. Elevations
e: Water Table
oT �
8A
PIPE,1H V A7 out/.Sr
TWK
5 7-
AID b,91, [3 oy
(74
D 1-)3 r�b m vr�
L C>-r
'30
Yo,<13
-45'
27
CARMN 01�1'-.
B. Health
Board of w
North I ndo ry,ii"is
MBSURFACE DISPOSAL DFMGN CMK LI57 w " 9/ "T"A,taf"."
"LOT O
' DISAPPFt.CTV"F�`3 DATE DATE
Provided:
mm oM" '55r
00 � l
0�5, �Aa iI /
('
�o� y y
V°
ANO rt(P6/rFf.�
Title V FAIL 09
'Reg 2.5 e submitted plan gust show as a x0inimu4t
the lot to be aerved-area,dimensions lot;#,,abetters
location and log deep observation, hO es-"di tance to ties
N.00 location and results percolation tests-distance to
d ties
ns shoving required lea'c
hing area
design calculations c, c alatio
location and dimensions of system-including neserve �e8
,f) existing and proposed+ contours
� ) location any Bret areas 4thin 1001 of sewage disposal system or
disclaimer-check "wetlands napping
surface and subsurface drains vi.thin lap of sus disposal
system or disclaimer
i) location any drainage easements vithin 1001 of serge disposal
system or disclaimer- g Board files
J) mow ' sources of "water supply vi,tkin 2001 of sewage disposal: a
system or disclaimer
M c location of a ' pmposed well to serve lot-100 from leaching facilit;
° 1)' location of water lines on property-101 from levzhing facility
°location of benchmark
driveways
��rc" /garbage disposals
joo p� PVC to be used in construction � t l i e septic tank.,
q) profile of system-elevations of base , P P p
distribution box inlets and outlets, di stri,bution f"i.eld piping and
a " aer elevation$
"} mam ,ground vater elevation, area sevage disposal system
plan mist be prepared by a Professional weer or other
professional authorized by law to prepare such plans
septic
Reg. 6 ic Tanks
a) capac t e�50% of flow,, rater tables tees, depth of tees,
� access$ punping
b) cl eanout
77( ,„ 101 from cellar u-all or i.p„ground sting Pool
d 25w from subsurface drains
Reg 10.2 Distribution Boxes
a) mope 'greater 0.08
Reg 10.4 b) omp
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