Loading...
HomeMy WebLinkAboutBuilding Permit #156-15 - 412 SALEM STREET 5/1/2018 4i BUILDING PERMIT o`"°RT 6 TOWN OF NORTH ANDOVER - APPLICATION FOR PLAN EXAMINATION Permit No#: J j ✓ Date ReceivedrED ��SsgCHUS Date Issued: IMPORTANT: Applicant must complete all items on this page =PR PERWTY OWNER Pt - - - - w z not 100}YeargStruc ure Lyes PARCEL ZONING.�'DISTRICTHisto'ricpDistnctr Ayesn _ I yes, TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building )(One family ❑Addition ❑Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ARepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic ❑1Nell1 ❑hFloodplan ptUVetlands° ❑ WatershedDistrictr { ❑!Water"/Sewe.r _.i . -- - - L - -.- DESCRIPTIO O WORK TO BEP RF RMED: Identification- ease Type or Print Clearly OWNER: Name:, Phones Address Contract©r4Nae: _,_ _ �._ W— P - - 'AdcJress Supervisors, Constructions License / �_ _ _ Exgf, IDate::� _.__ _ Home lin r©vement�' E J p License: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ FEE: $_ Check No.: Receipt No.: NOTE: Persons contracting with unre ' .tered contractors do not-have access to the guaranty fund SignaturesofrAgent/Owner_ __ Signatureof contractor.__ _- _ - ! 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS 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 Ri _ � _ — tFIRE�iDE}PARTMENT" Temp ®umpsteron�site 1Locatedj 124Q'J'K' treet ,F.ire1Departme1*1011 nature/date - - - -�� n 4n 5�K D�� • • ♦y 1, Q RATED A� North Andover Health Department Community Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 412 Salem St. MAP: 037.13 LOT: 0051 INSTALLER: Chad Japlonski DESIGNER: PLAN DATE: BOH APPROVAL DATE ON PLAN: INSPECTIONS TANK INSPECTION: 10/3/13 (D-box and baffle) DATE OF BED BOTTO SPEC N: / DATE OF FINAL CO TRU CTI INSPECTION: DATE OF FINA DE IN CTION: SITE CONDITIONS ❑ Contractor ports any changes to design plan ❑ Existing ptic tank properly abandoned ❑ Intern plumbing all to one building sewer ❑ Top graphy not appreciably altered Comments: SEPTIC TANK Building sewer in continuous grade, on -5 compacted firm base ( ❑ Cleanouts per pl n ❑ Bottom of tank h le has 6" stone base ❑ Weep hole plug ed El 1500 gallon tan has been installed H-10 loading hic ❑ Monolittan construction ❑ Water tightne s of tank has been achieved by visual testing ❑ Inlet tee inst Iled, centered under access port Outlet tee installed, centered under access port ❑ inch cover to within 6" of finish grade installed over one access port ❑ Hydraulic cement around inlet & outlet Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ eep hole plugged ❑ 150 allon Pump Chamber installed ❑ H-10loa . g ❑ Monolithic to construction ❑ Inlet tee installe centered under access port ❑ Pump(s) installed o stable base ❑ Alarm float working ❑ Pump On/Off floats works ❑ Separate on/off floats ❑ Drain hole in pressure line ❑ cover at final grade installed over pump access port ❑ Water tightness of tank has been achieved by testing ❑ Hydraulic cement around inlet & outlet Comments: CONTROL PANEL ❑ Alarm & Pump/aon separate circuits ❑ Alarm sounds float is tripped ❑ Location of coanel: basement ❑ Alarm signal located inside: basement Comments: DISTRIBUTION-BOX Installed on stable stone base H-20 D-Box Inlet tee (if pumped or >0.08'/foot) ❑ Hydraulic cement around inlet & outlets Observed even distribution Speed levelers provided (not required) Comments: i . . � Commonwealth of Massachusetts Map-Block-Lot •• 037.B0051 BOARD OF HEALTH Permit No BHP-2013-0919 North Andover BHP-2013-0919 -------------- � . P.I. FEE F.I. $125.00 DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted Chad-Jablonski - - - - - - --------------kiqtz --- ---------------------------------------------- atNo(Repair)an Individual Sewage Disposal System.-ba� �1- at No 412 SALEM STREET T)V---- ---- as shown on the application for Disposal Works Construction Permit No. BHP�- ted O ober 03,2013 ---- ------------- --------------------------------------------------- Issued On: Oct-03-2013 BOARD OF HEALTH d6GOf NO eT�1y . 0 9 • Town of North Andover ` s A HEALTH DEPARTMENT SACHUSt � CHECK#: «J j DATE: LOCATION: 4'I .. T— H/O NAME: CONTRACTOR NAME:C L;& d Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ { ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ^� Septic Disposal Works Construction(DWC) $ 2 �j ❑ Septic Disposal Works Installers(DWI) $ r ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other:(Indicate) '3 >ry Z�$eal�toCgent Initials;§ White-Applicant Yellow-Health Pink-Treasurer Map-Block-Lot of Massachusetts .., a+ • 037.60051 BOARD OF HEALT ----------------------- H Permit No = " North Andover BHP-2013-0919 -- ------- ------- ..tt. w FEE A* $125.00 ----------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted Chad Jablonski ----------------------------------------------------------------------------------------------------- to(Repair)an Individual Sewage Disposal System. -buy. 14 bdf L at No 412 SALEM STREET as shown on the application for Disposal Works Construction Permit No. BHP-2013-091 Da ober 03,2013 - ----------------------- - Issued On:On: Oct-03-2013 BOARD OF HEALTH l �rn I + � J J °RTh _Application for Septic Disposal System (0 z3; ( � � TODAY'S DATE Construction Permit — TOWN OF ORTH ANDOVER, MA 01845 $250.00-Full Repair 4SSACMusk; $125.00-Component Important: Application is hereby made for a permit to: When filling out ❑ Construct a new on-site sewage disposal system* forms on the computer,use ❑ Repair or replace an existing on-site sewage disposal system* only the tab key ^ to move your [Repair or replace an existing system component—What? u cursor-do not use the return key. A. Facility Information "IAV Address or Lot# City/Town 2.-*TYPE OFJSEPTIC SYSTEM*: El Pump Gravity (choose one) ��T 0 `' `�'� ***If pump system,attach copy of electrical permit to application*** TOWN OFNOR-ftpA TH VER [9 ConHEALDE ZARTMENT ventional System (pipe and stone system) - ❑ Infiltrator or Biodiffuser(Gravel-Less)(Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D-Box) (Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D-Box Present)S.A.S. 2. Owner Information ro VA vv�C t-e.sc 0- Name SSb m t- Address(if different from above) .City/Town State Zip Code Telephone Number 3. Installer Information , `I r So.�S� 1,uG, Name Name of Company Address City/Town State Zip Code Telephone Number(Cell Phone#if possible please). 4. Designer Information Name Name of Company Address City/Town State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit-Page 1 of 2 ! OfpOR�TN 9ry Application for Septic Disposal System TODAY'S DATE Construction Permit - TOWN OF ORTH ANDOVER, MA 01845 $ 250.00-Full Repair •.�.* $125.00-Component 4SSACIN PAGE 2 OF 2 A. Facility Information continued.... 5. Type of Building: esidential Dwelling or❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the system in operation until a Certificate of Compliance has bee "ssued is oard of Health. Date Application Approved By: (Board of Health Representative) Name Date Application Disapproved for the following reasons: For Office Use Only: 1. Fee Attached. Yes No 2. Project Manager Obligation Form Attached. Yes_ No 3. Pump Sys tem? Ifso,Attach copy ofElecttical Permit Yes_ No 4. Foundation As-Built?(new construction ronly): Yes No (Same scale as approved plan) 5. Floor Plans?(new construction only): Yes No i ! Application for Disposal System Construction Permit•Page 2 of 2 i i I Commonwealth of Massachusetts N W City/Town of No Andover RECEIVED W° System Pumping Record Form 4 SSEP1 2 2013 DEP has provided this form for use by local Boards of fMjh,,�ther�.''S�a�ta�r b used, but the information must be substantially the same as that pro id ng tf is form, check with your local Board of Health to determine the form they use. he ys em umping Record must be submitted to the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important:When. filling out forms 1. System Location: Ila ron the computer, use only the tab �� key to move your Address cursor-do not No Andover Ma use the return key. City/Town State Zip Code 2. System Owner VT"191 Name renen i Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Ga1lons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of tem: 6. Syste ey: Name Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 I Hauler Date Signa e o iving Facility Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 t Commonwealth of Massachusetts RE���I E� W City/Town of NO ANDOVER a 4 2013 System Pumping Record ;", Form 4 �� N � �M HEAK�iH't�t?A;?s7ftdl:C DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantial) the same as that provided here. Before using this form check with our Y P 9 Y local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important:When filling out forms 1. System Location: on the computer, use only the tab 412 SALEM ST key 16 move your . , Address-- cursor Address -cursor-do not NO ANDOVER Ma use the return City/Town State Zip Code key. 2. System Owner: MACLEAN Name ieMn Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record Lj 3 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) ❑ Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: r� Name - Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: Stewart's Pre-treatment nt, 2,0 So. Mill Bradford, Ma 01835 Signature of Hauler Date Signature of Receiving Facility Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 M, �S�Iryh'd 7•� ti�I,f/ a+ijii v 'rs �. $:14 � � I xv.v ,. \\\ 1.4 Co`mmonwalth of Massachusetts sr�x. ity/TownQ �NORTH ANDOVER MASS f o .System Pumping Record NOV 13 2006 DEP has provided this form for use by local Boards of Health. 4gftslermpii� rd must be submitted to the local Board of Health or other approving au hoH LTH DEPA k Facility Information Important: ,. ,. : When filling out 1 System Location f fonn3.on the computer,use only the tab key Address to move your /0 • cursor-do not Citylrown : State Zip Code use the return 2.'` System Owner tA Name p Address(if different from location) City/Town - State Z' Cod Telephone Number B. Pumping Record ;;, • 1. Date of Pumping Date 2. Quantity Pumped: Gallons Type of system: . ❑ Cesspool(s) eptic Tank ❑ Tight Tank [I.Other(describe)' 4. Effluent Tee Filter present? El Ye i1J-IQo If yes, was it cleaned? ❑ Yes [] .No 5 Condition of.System �C YL 6 Sy e h Pumped By, � . Name. Vehicle License Number Company Location where contents were disposed: MaSignature of H .uler Date http://www.mass.gov/dep/water/approvals/t5forms.htm#inspect t5fom-A.doc•06103 System Pumping Record•Page 1 of 1 I n Conuuonw alth of Massachusetts Massachusetts System Pumping Record System Owner System Location Lost �C Date of Pumping: I O''�� �9 Quantity Pumped: l gallons Cesspool: No Yes LJ Septic Tank: No Yes System Pumped by: Slad4rt git 1aej License# Contents transferrred to : Greater Lawrence Sanitary District Date: Inspector: 1'GiA/ C t�l --q/ BOARD OF HEALTH JUL 02 1999 I/ Mr. De Fusco L/C.. Salem. St. APPLICATION FOR SEWAGE DISPOSAL IASTALLAT ION HEALTH DEPARTIWT--NORTH AiMOVER, MASS. I hereby make application.for a permit for a sewage disposal installation at Salem St. _. I will install this system in accordance with all the lays of the Commonwealth of Massachusetts and regulations of-the Board of Health of the Town of North Andover. Furtherf I will construct the house sewer of bell and spigot pipe, the minimum diameter being 4 inches, and will maintain a minimum grade of lig until 10 feet preceding the septic tank where the grade shall not exceed 2f. I will install a concrete septic tank of Gal.- in size. A manhole (s) permitting easy cleaning will be provided with removable cover (s) of iron or concrete within 12 inches of the ground surface. I will provide subsurface disposal field with open jointed bell and spigot Ackron pipe at least /+ inches in diameter and laid in a series of trenches, the bottom of which will provide a minimum of .200 lineal (dqJIU4 feet of effective absorption area. The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging in size from 3A to 1-1/2 inches (dia.) and the pipes will be surrounded by similar material to a height of 2 inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench, 2 inches of gravel or stone 1/811 to lAlt (dia.) will be placed over the course gravel or stone. The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single the line will exceed 100 feet in length and in any case, two lines of tile will be installed.. A minimum of 6 feet will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the in— stallation will be less than 100 feet from any private water supply, 25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line. II further. asrpe noA„to cover any portion of this installation until_,Mroved by the inspection officer, as 'provided below, and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application. DATE - 441IZ58 Signature of Kpplica. 4 I hereby issue the above permit for the Board of Health of the Town of North Andover, T&ssachusetts. DATE 1/17/58 gnature of Health Agent I have .inspected the uncovered system indicated above and find everything done as described. DATE00 S -=.-- S tune of Inspecting Officer Pbreolati.on Test 10 min. Garbage Grinder BOARD OF HEALTH TOWN OF NORTH ANDOVERI AMASS. � ei 4411 I q 1. NAME ., • • • . . . . DATE . . . . . . 2. ADDR��. �� ; ."rte: . LOT No TEL 3. N0, OF EEDROOM . . . DEN YES . . . . . NO.. �!� 4. GARBAGE GRINDER YES NO.. . 5. SHOW DIP11 NSIONS OF HOUSE b, SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES 7, SHOW DIPIIENSIONS OF LOT 8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL 9. NOTE LOCATION AND DISTAAtCE OF WELL FROM SEWERAGE SYSTEM 10, SHOW LOCATION OF BROOKS STREAIJS? DITCHES, LEDGE OUTCROP, ETC. 11, SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULATIONS SHOULD EE READ CAREFULLY, r . April 12, 1958 Miss Mary Sheridan R. N. Health Agent Board of Health North Andover, Mass, Dear Miss Sheridan: An examination was made as requested in order to determine the suitability of the soil for the subsurface disposal of sewage on the proposed .Salem Street building site of Joseph DeF m co. The subsoil in the area was of a sandy clay content and a 10-minute percolation test was conducted. The land in general is high. It is recommended that a 750 gallon concrete septic tank be installed together with 200 lineal feet of drain pipe. The drain pipe must be installed in a 2 foot wide trench. Very truly yours, r: ` JO William J. iscoll 1 U +� + • r�r{ ,r� � :�+ter , .. : ' s. y _ _ 2 2.003 YMO.FNORTH -,4,M OV�R.: - SYSTEM PUM'PI.NG \' c -- - 0WNFK & ADDRESS „ SYSTEM LOCATION .-- 1I"J� 1e�s h (mmple; Icf•l front or'housr) i U:� I C OF PUM1'1NC; (QUANTITY P U M P Q D 'loo C',� L Lc�.� , 5 ;. l »I'UW'NO .YES SEPTIC TANK; N0 YES aTURE OF SERVICE, ROUTINE. , EMERGEN"CY C0OD CONU.ITION. ,. PULL TU COYCk H.R.AYY OREASG:,�:! BAFFLES IN PLACE r KUOTS LEACCHFICLD RUNBACK.,, CXCESSIYE:SO.l�1DS FLOODED' SOLIUM'-::CA.RRYOYER HRtR (EX%A.IN . ;,'fJ fit ) .�' �•u.,I�ICNTs r5`TRANSrCRRBD TQ • r J,r��• !' r ,K}r` . ;M�,• t ,, off, 4p. Yyr ",� 1: I 4+.�. �S,S��CIIUSG'ttS f/��? ORTH.AIC�OVER MA SA�GHUI"S ;Sys em PuTpjpg Record J JUL U ',,n,�r {,�� '�o�rr�"4•,l�,�i � �,1 r, ;,,I�.JNI ( I 5 2007 , Tt- v� )�t`TH ANDOVER DEP has provldad thls form for use by local Boards of Hea the The�Syste' T Record must be submitted to the local Board of Health or other approvi u ority. A Facility Information Important. F,,,yNtien filling out 1 .:: System,Location foims:on the ; computer,use r" ,e�yJ • only the tab key Address to move your-; curaoc do not CI /Town use the return City/Town Zip Code. key , ` 2 System Owner Address(If different from location .: 'Clty/Town State, n r Zi C e 7'- Telephone � Telephone Number roping Record .Date of Pumping oa 2. Quantity Pumped; Gallons 3. p9 of system ❑ Cesspool(s) a tic Tank P ❑ Tight Tank ❑ Other(describe), uent Tee Filter present?.❑ Yes Cd Ivo If yes, was If cleaned? C] Ye ❑ No S Condition of Systgm r' r 33102 m Pumped By, -Jt '� 4rJI+—Name `I ,!Cyt /- Vehicle Ucen$e Number i VN( / COmpanY 7 LOcatign.where contents Were d( posed; Date http//www mass gov/dep/wafer/apprpvals/t5forms,htm#inspect t5form4 docs 06!03 System Pumping Record•Page 1 of 1 0 � • OV E ' R r A i ra 1 y' I OfP.hoI Pt Ylded ;hliyrplrn l*)r ,.IOJUL 0 8 2009 QOaICI Q np , ! Illod Io vie IOCII 6^IIC (Ip n J Sl7:dn, a . , , .•,a ., .... : .. o01fn rCu7or ip?.(IQ ri 1 .. A �aCIII`I Inf0(1 qCSWty^BPRORTHANDOVER HEALTH DEPARTMENT S ' ,"m .. > Locet,on: lM n gym'':'; CIt74>rn /?6�-f v;l,'';, ;i J..r '' $1111 -- �!f�,;� Owner S; . •i, l I` �dlri� (II OUflrrnl t= buVcn) v 1 . umpl . . ,�9. �. rYpo 01 ryslem;'.: �Q-Other (doscribe EmYon► Too Flllo(.P(g3enR [' Ya N ' 9 n' _ ••'`"�,��;:�:1:�•����1��:�Sr:f,��;jj1)�ii�l.�ll��l;��.••� 1 II y09. x'99 1; C'9ana07 � YF .. . ' .:�.rl� �� • :.l;Co�dl�iori'Q(;9yt,�m,'.�.,:•, . �� .•ir.� I,r!�1 'Y,.fir• 'l '�1'.��'f. ®�"'�•� p , pod • . ' ��' I ,,;a ' r•'i'I'i� 'G ; 'Jcenl r, ''��l� ';�%,`v nT:�l� 17'11�1�,ry��-0111' y1�,�j i�Il Vi'�I�l�l�• on.�rrtiar� co IenU' � � -- .'�.•:, (1 ,wane dl'posev: t• :,:%•,�:, :.',' S�nllwl vlh'rv4(yf,y,<.f. �60/� xW.maSJ. OYl �l1r . 9 do�llrelerlepprDYeJylblorm�.r:"naln9�acl