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HomeMy WebLinkAboutBuilding Permit #Exception - 165 CARLTON LANE 5/1/2018 r NORTk BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION • T b � Permit N0: Date Received �gssgcHuse��5 Date Issued IMPORTANT Applicant must complete all items on this page } *.. 9 .s -9:Y -�— r� ..,Sr„=•,'6# '4- ry, o` "4Y ��`€J�1l, t t. .�� {-.r 5 ?r t'�4 10 h *3� t�, �f v , y' ,.!�"zj • 7_Kr' `�' y.i� ax�' a ' F �R,�o , + th�l idLJr; ir63 N. -��'-3 . . r ij "."�,� �{ aV. PERTYOWNERI.� .� _ _x «..,.��.�.. .p` -Fes..-+.fie.,. row,i•r'+` '-r°' .!:+"�-7Fr c ..,y.. _ :}t ti ]TO M MAP N®� Z0 4 'PARCELa tial 1Z©NING ©ISTRICTr°f `Histofic-District] eyes ono .�. '` ��� '? Shop�Villa ;,t4�¢ k�I(�`�t rr p 7 �`r + y�t�lvyt,�• r,.p �$ !'��iC+� ,r. it. :' .rr ly -" - TYPE OF IMPROVEMENT PROPOSED USE --Re- esidential Non-Residential ❑ New Building ❑ One family [I Addition 11 Two or more family 11 Industrial ❑Alteration No. of units: ❑Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ©Flood`1ain ? ��V1letlands"� , f i DUVafershed'Dtstrlct .�'' ' RR•�,❑Se tics-_ Well . ,j r, } p .;� . >R ��. tit .� t ; , F. .,.i DESCRIPTION OF WORK TO BE PREFORMED: SAect gx « Identification Please Type or Print Clearly) OWNER: Name: Phone: Address C0-N--, .d+,,.v-..i.: kik.-•.. „�.-,Jr�~y}:1° i .;x '�"� 3 ♦ � y'�t'�'r^p, �i -g J,, �.�,w h y Address J,Exp� ate} SupeivisoC�s Constructionl,License ��'1 �X R � tom.* Mrd> '�.�r _•kdty r7�'.> y' '` 15 � 4 f� -� �L �*��w���i Homelmprovement, icense, N„ ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $_ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature ofrAgent/0wne , °` __ rignatureofcontractor- i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS /k��—' HEALTH Reviewed on / Z Signature COMMENTS Z< Z V/ 40 Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: _ Located 384 Osgood Street E iFIRE pEPARTMENT-', Temp Dumpster` on siteF'yesx ;'no J, � '• '12ocated,�att124 Mair%Street , COMMENTS ¢. : it �Co 1.0-ACRE RECEIVED COmM®nwealth of Massachusetts MAY 12 2009 C itY/TOwn of C) 0�� f TOWS O H N'0'RTH )""TMENTER System Pumping ecord " Facility Inf®Dation: System Location: address wJ6v State Zip Code System owner: Name: 1�dress of different from location of pump) City/ 'own State Zip Code bK- qq3 Telephone Number NMping Record Date of Pumpirb 0 � t Quantity Pumped 1 -500, gallons Tye of System Septic Tank Grease Tra other P (what) System Pumped by: _�t)a (j._ *-� f �(J COmpany ROOTER-MAN 12 East Dracut Rd., Methuen, MA 01844 Location where contents were disposed: Signature of Mauler Q Date Commonwealth of Massachusetts City/Town of System Pumpin Record Facility Information: MAY 2 2 2008 +� i' System Location: Towry of NokTr,�wv'd.V li HEALTH DEPAti rin-h t(rn La io e, Address Allkwi, of 9 q5 City/Town State Zip Code System Owner: U Name: Address (if different from location) City/Town State Zip Code Telephone Number Pumping Record Date of Pumping y () Quantity Pumped VV LJ Type of System: Septic Tank —Grease Trap System Pumped by: I U n eA_1 Company: Rooter-Man 12 East Dracut Road, Methuen, MA 01844 Location where contents were disposed: Signature of Maulern Date: q1j& o 16: 12 HEALTH Commonwealth Ot l Aassach sets RECEIVED �0 City/Town of P Y JUL 0 9 2007 System Pumpin Form 4 TOWN OF NORTH ANDOVER [_ HEALTH DEPARTMENT DEF has Provided this form for use by local Boards of Health. The System Pumping Record must be submitted to the local Board of Health or other approving authority, A. Facility 1nfor'M_at_ion'----`--- Important: When filling out Systurn Location: forM8 on the computer;we only the talo key :0 move you( "UrSQ).-do n � Qt --- awe the return Clty/Tov'7r,_ (ey. 2. System Owner: State zip Code vtu NaMe Address Z= o ity/f_WnState'__ ip cod Telephone NwMb4( Pumping Record Date ofPumping / 5Z 2. Quantity Pumped. Gallons 3. Type of system- 11 ceqspool(t) 2/septic Tank ❑ Tight Tank El Other(describe),- 4_ EfflUent'Tee Filterpre's�etjt? ❑ yes 0 No Ifi yes, was i I t Cleined? ❑ yes ❑ No 5, Condition of System: -------———--------------- 6, System Pumped By: T� Name ROOTER-MAN Ve—hicli_Ljcar�s�e -CO—inpani— 12 EAST DRACUT ROAD Mufter METHUEN,MA Ole" 7. Location where Contents were disposed: Signalu of uter P://WwW.rnaS$.gl e'n/ 't". ovldep/ . ovildep/ 'Ater/aPPr`valjS/t,5f0rMS.htm#inspect fb=44oc08/ 3 - y Y$tem PuMP1,19 Record-page 1 of 1 Commonwealth o RECEIVED �`� Cit 1T � �lassachusetfi Y own ofU6 ,�,I '/JUL 12 2006 j - SYstem Pumping �' �" Record «� FOMI Q TOWN OF NORTH ANDOVER FIEALTH DEPARTMENT DEP has provided this form for use by Io l information must be substantially the same as that provided here. Before usin p Boards of Health. Other forms may be used but the this form, local Board of Health to determine the form the the local Board of Health or other approving autyho�ity The System Pumping Record must be subm trtCheQkMth d to A. Facility Information Important_ k�fl�en fi�Un�out 'i. System Location: --�_ forms the co I r computer,use ly the to key Address too move your cu=[-do not use the r�Yurn CitylTown kcy_ 2. System Owner: state v U`t_J__ i Zip Code Name rl 2 i a r Address(if different from location) _— CitylTown state (�_-_"'---- Tetephona Numb V "' E3• Pumping Record 9. Date of Pumping � �D Date 2. uantity Pum 3. Type of system: ped: ❑ Cesspool(s) Gauons Septic Tank❑ ❑ Tight Tank Other(describe): -4- Effluent Tee Filut r'present? [] Yes ❑ No 5. Condition of System; lf.ylm was it Cleaned? ❑ Yes ❑ No 6, Syst Ru ed By: t Company 1� Ve-hiide u Number cam- �` 7. Locatio Where contents were disposed: i Signature of Hautes / /iS t5form4.doa t)f03 Date ll((// ^— sYa-tem Pumping Record•pUgo 1 of 1 Address `6.5`.cA-Ii 4A( Title of File Page of Date File open: Date foie closed: Doc Document/Action Tifile Date of Refer to other Purpose of©ocumecnt/Action and nofies action Document/ document/ _ Num. Action Department Board of Appeals — Board of Health — Planning.Board _ Conservation Commis — Building Department Ol p TOWN OFMANDOVER SEPTIC SYSTEM SERVICING Date: REPORT 1//,��� Homeowner: Street : Pumper Phone � Ov Address: — Phone Nature of S.'-rvice: Routine Emergency Observation;;: Good Condition Full to Cover Baffles in Place Leachfield Runback Excessive Solids Heavy Grease Roots Other (Explain) Descriptio.. Of Work: Comments : Town of North Andover. MA Watershed Septic S stem Servicing ReRort Date: 3T�� Homeowner. Pumper : Street ✓� ,� j'�a/ Phone 1 Phonu Nature of Service: Routine D� Emergency Observations: Good Condition Ful]. to Cover Baffles in Place Leachfield Runback _ Excessive Solids Heavy Grease _ Roots Other (Explain) Description of Work- A, Say � Comments: LOT /o ACRE zcz. sz� a i3q CA RLTON LANE p� VES T ELE'yfiT►o>,r S OrE Z i FouNPAT701V WALL --� TANK l�fLE"ir 6/. 7-ANK 0010r- / o,9a hlsr Sox I�1LEi _ _ � l5 .So Dfsr Sox ouri.Er /x9.30 PI PL' AT PIT. FNTR Y -�' L5g•9s ,Pi T a07TOM �rr""" 4•` U. . Board of Health SEPTIC STSTEK North AndovarZHaaa. . INSTAI ATICK CHRCK LIST LOTai�i�rtJ4v , PPiCNED DATL �. DIWPR�7Ei X AVA1'ICSi OK FAIL — earns, 1 M FM OK lc4 I. Distance Tot ` a. Wetlands ES b. Drains CI(�C�tC C� wV c.. well S� �V►`T 2. Water Line Location S�i STG m G 3. No PVC Pipe t 4. Septic Tank a. Tees -_Length & To Clean Oat Covers b. Cement Pipe to Tank - On Both Sides of Tank 5. Di Ar_;oution Boa a. Covers & Box - No Cracks b. All Lines Flowing Equal Amounts c. No Back Flox 6. Le Bch Field or Trench a. Dimensions b. Stone Depth c. Capped Inds d. Clean Double Washed Stone 7. Leach Pits 12-f�f a. Dimensions b. Stone Depth c. Splash Pads d. Tees e. Cert Pipe to Pit - Both Sides f. Clean Double Washed Stone 8. No Garbage Disposal 9. Final Grading Inspection • 10. B, rr; -ading Covered System 11. k, Built Submitted a. Lot Location b. Dimensions of System c. Location with Regard-to Pere Test ' d. Elevations ' e; Water Table 'r 1 Board of Health Nvr t :,ndoverl Mass SUBSURFACE DISPOSAL DESIGN CHECK LIST LOT -Yo �l�l.�bVV pi'MOVED DATE DISAPPROVED DATE Provided: Reasonss Title V FAIL CK Reg 2.5 The submitted plan must show as a mi.nimumt the lot to be served-area,dimensions lot #,abutters location and log deep observation hoes-distance to ties � ' lcpdj do location and results percolation tests-distance to ties design calculations calculations showing required leaching area 4location and dimensions of system-including reserve area � existing and proposed contours g) location any wet areas within 100' of sewage disposal system or disclaimer-check wetlands mapping surface and subsurface drains within 100' of sewage disposal system or disclaimer i) location any drainage easements within 1D0' of sewage disposal system or disclaimer-Planning Board files tltj) known sources of water supply within 2001 of sewage disposal d system or disclaimer (k) location of atqq, proposed well to serve lot-1001 from leaching .facility 1) location of water lines on property-100 from leaching facility m) location of benchmark n) driveways I) garbage disposals p) no PVC to be used in construction profile of system-elevations of basement, plumb, pipe, septic tank, distribution box inlets and outlets, distribution field piping and Other elevations r) maadmum ground water elevation in area sewage disposal system s) plan mast be prepared by a Professional Engineer or other professional authorized by law to prepare such plans Reg 6 Septic Tanks a) capacities-�I50% of flog, water table, tees, depth of tees, access, pumping A(b) cleanout W(c 10, from cellar wall or inground swimid.ng pool ) 251 from subsurface drains Reg 10.2 Distribution Boxes (a) slope greater 0.08 Reg 10.4 b) mmp 1 , I&V Subsurface Design Check List Page 2 - - FAIL OK Leaching Pits • Leaching pits are preferred where the installation is possible Reg 11.2 a) calculations of leaching area-minimum 500 sq ft 11.4 b) spacing 11,10 c surface drainage 2% ?1.11 d� cover material e) V xV a4" splash pad P) tee at elbow g) no bends in pipe from d-box to pipe LeachinFields Reg 15.1 a no greater than 20 minutes/inch b area-minim== 900 aq ft 15.4 c construction of field 15.8 d) surface drainage 2 % 3.7 e) 201 from cellar mall or inground swimming, pool Leaehia6 ftenches Reg 14.1 a) calculations-or Leaching area-min 500 eq ft 14.3 b spacing-4 ft min 6 ft with reserve between 1 4.4. c) dimensions 14.6 Id) construction 14.7 a stone 14.10 f surface drainage 2% Downhill Slone a) slope y x = Tto be shown) b) y/x X 150 - (to be shown) DMB Reg 9.1 a) approval 9.6 b) stand-by power TOWN OF NORTH ANDOVER _ SYSTEM PUMPING RECORD `� " 'BOP " 'L�'���t/ DATE: SYSTEM OWNER& ADDRESS SYSTEM LOCATION (example: left front of house) DATE OF PUMPING: ,-t)//.)�- QUANTITY PUMPED GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE X, EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: CFTC Y YYIG� COMMENTS: CONTENTS TRANSFERRED TO: LS D I Commonwealth of Massachusetts City/Town of System Pumping Recor JUN 2 0 2005 Form 4 TOWN OF NORTH ArNUOVER HEALTH DEPARTMENT DEP has provided this form for/the cal Boards of Health. Other forms may be used, but the information must be substantiallme as that provided here. Before using this form, check with your local Board of Health to determirm they use.The System Pumping Record must be submitted to the local Board of Healt or othing authority. A. Facility Infor !,iln Important: When filling out 1. System Location: forms on the S- C _ computer,use [Q z only the tab key Addr ss to move your /\J() vt cursor-donot use the return City/Town State Zip Code key. 2. Sy tem Owner: Name Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of PumpingDate Gallons 2. Quantity Pumped: s G s 3. Type of system: ❑ Cesspool(s) 0-Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: 620b 6. System Pumped By: 1 NVehicle License Number ar C mpany 7. Location where contents were disposed: Si atu f auler Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Watershed Seotic System • Servicincx Report wV, Date: A Homecwner: r r Street Pumper :-�F -►` �� Address: Phone Phone 49 �l Nature of Service: Routine (� N�plER! Em,argency �o���G Observations: G1 oy�d Condition Fu: 1 to Cover Baffles in Place Ida Leachfield Runback 10 Excessive Solids Heavy Grease Roots Oth-ar (Explain) ------------- Description of Work: ' ►-vim IN i Comments : TOWN OF NORTH ANDOVER °' SYSTEM PUMPING RECORD 3 DATE: SYSTEM OWNER & ADDRESS SYSTEM LOCATION -4-z- 0 (example: left front of house) �J , P DATE OF PUMPING:--] QUANTITY PUMPED �( GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: p (� ,� COMMENTS: CONTENTS TRANSFERRED TO: �� RECEDE® Commonwealth of Massachusetts MAY Cit, /T�wn ®� V �� TOWN OF NORTH ANDOVER HEALTH System Pumping Record OARTMENT @p Facility Information: System Location: o Address City/Town.. �jn State Zic C-.,ue System Owner: N�ame: Adress Iif diff�erent frown location-of City Town State 4q,5.� Telephone Number Pumping Record Date of Pumping 4 S U Quantity Pumped gao-s Type of System eptic 'Tank Grease Trap Other (what.) System Pumped by- U �� Company: ROOTER-MAN 12 East Dracut Rd-, Methuen, MA 01 844 Location where contents were disposed: Signature of Hauler u Date U s sai.,11 S 0 1 Mac �j irnpin.g Record RECEIVED a c_i 1 .Pi I J OFM all on: TOWN OF NORTH ANDOVER HEALTH DEPARTMENT V-V . 6 j(lct, State cob--S--_ yq2( L1 Si 7-- c o r al a ntft y Po— T��-ap ire A�o d574,r e Ie