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HomeMy WebLinkAboutMiscellaneous - 1075 SALEM STREET 4/30/2018 (3) 1075 SALEM STREET t 210/106.A-0259-0000.0 1 1 !i 1 .r. fi i • MAP # Ts PARCEL # STREET� � '`-.�_........ CONSTRUCT I QN__APPRO_._. HAS PLAN REVIEW FEEBEEN PAID? YES NO PLAN APPROVAL: DATE Z APP. BY_.._ ISN DESIGNER: �i1��?/y✓l��lC�� PLAN DA TE: _fc31� —_ n�5 �1 CONDITIONS ' WATER SURREY: TOWN WELL WELL PERMIT _ DRILLER._...._.._._._.__._.__.__._....._............... ...... ....__._._... ._................ WELL TESTS: CHE L DA E BACTERIA I UA I E (IPPRUVEU BACTERIA II D COMMENTS: FORM U APPROVAL': ARPROVAL 10 ISS YES NO DATE ISSUED ��z�/9� _BY -Li/ CONDITIONS: FINAL APPROVAL: . ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NU SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NO ANY VARIANCE NEEDED YES NO • p FINAL BOARD OF HEALTH APPROVAL: DATE:.4 .6... � �E�3 G �C.SZEM�NSI841,� Q�t : _� y.i`t •r y, ,.:a• +., - ,,_,_ ;,4 \ } i i�� J 1. r - _ +'xIS THE INSTALLER LICENSED? YES NO f TYPE. OF. CONSTRUCTION: ? - NEW REPAIR ; NEW CONSTRUCTION. CERTIFIED PLOT PLAN REVIEW E5 NO :E CONDITIONS OF:.APPROVAL. ` :l YES NO (FROM FORM U) (::` ISSUANCE OF DWC PERMIT c ` YES, NO DWC' PERMIT N0. k INSTALLER: G�Jt/' ��2 ' BEGIN INSPECTION YES 0: EXCAVATION . INSPECTION: : NEEDED: PASSED ` BY <=;CONSTRUCTION INSPECTION: NEEDED: AS BUILT PLAN SATISFACTORY: 8 t f(� BY APPROVAL TO BACKFILL. DATE. J FINAL •GRADING APPROVAL: DATE ! BY V CONSTRUCTION APPROVAL: DATE: Ala� HY� '.• , FINAL CONSTRU — , Form No.4 l-own of North Andover, Massachusetts BOARD OF HEALTH 19-96 CERTIFICATE 6CERTIFICATE OF COMPLIANCE This is to certify that the Individual Soil Absorption Sewage Disposal System constructed ( X) or repaired ( ) by Kenneth Rea INSTALLER at 1075 Salem Street, North Andover, MA 01845 SITE LOCATION has been installed in accordance with Board of Health Regulations as described in the Design Approval Site System Permit No.- 719 dated A ri 1 6 _19__9.5___. The issuance of this certificate shall not be construed as a guarantee that the system will " function satisfactorily. - BOARD OF HEALTH . S 4 TOWN OF NORTH AND► VER/! ELEVA TIONS 160/�RD OF HFALTH DESIGN AS-BUILT INV. OF PIPE OUT OF HOUSE 101.32 101.51 INV. OF PIPE AT SEPTIC TANK INLET 100.80 100.91 INV. OF PIPE AT SEPTIC TANK OUTLET 100.55 100.59 INV. OF PIPE AT D-BOX INLET 100.00 100.30 INV. OF PIPE AT D-BOX OUTLET 99.83 100. 11 INV. AT END OF DISTRIBUTION PIPE 1 99.50 99.47 INV. AT END OF DISTRIBUTION PIPE 2 99.50 99.43 -9.8 +� INV. AT END OF DISTRIBUTION PIPE 3 99.50 99.40 .o, 16-39 26,2' INV. AT END OF DISTRIBUTION PIPE 4 99.50 99.47 Fr8lON L E�6 11s.9' NEW ENGLAND POWER COMPANY EASEMENT LOT B L=98•$ A = 54, 198 S.F. Q O-4 NOTE. THIS PLAN IS NOT A WARRANTY OF THE SYSTEM. IT IS A RECORD OF THE LOCATIONS OF THE EXISTING STRUCTURES. P-3 ____- -----"""-_===-�04• TP 7 AS BUILT PLAN _-- OF SUBSURFACE DISPOSAL SYSTEM EX/STING FOUNDATION �� 8 P-a TOP FND. ELEV. = 104.36 AT `�'-- soa -BOX 1075 SALEM STREET V 30.8' 1500 GALLON i IN SEPTIC TANK _ ,2,.s' L 39'' NORTH ANDOVER, MASS. PREPARED FOR: WE DEVELOPMENT CORP. SCALE. 1" = .40' DATE: 9/7/96 ENG CHRIS TIA NSEN ;j` SERCI PROLAND/ONAL SURVEYORSEERS 160 SUMMER ST. HAVERHILL, MA 01830 TEL. 508-373-0310 Qc 1996 BY CHRISTIANSEN & SERGI INC. DRA WING NO. 95013003 To No. 7h = fth driver) Mass.,- PERMIT T 0 Nz E BOARD OF HEALTH - Food/Kitchen .0 Septic System . - D THIS CERTIFIES THATCIO BUIL I1VG.INSPECTOR. # .... buildings on - oun at oii ti_s _ 1.. ':7 K aa o:niwawn w �:e� ............ ...................... .�,,.............�•.......�.�r--rcr..,..... ,..............u.:�......., .. - ough to be occupied as � `f .......... .1/.. �'2�ti-.��' ........ ..:<..... .�"T .(. 2application .chimney provided khat the person accepting' 1his.permit shall in every respect conform to the terms of t' on file in `, Final this office, and to the provisions of the Codes and $y-Laws relating to the Ins pecti ttw Construction of y Buildings in the Town of North Andover: • - �11 ►U�NQATION ONLY REGULATED 0Y PARA.� 114.8-S: B;, PLUMBING INSPECTOR VIOLATION of the Zoning_or Building Regulations Voids this Permit.. �•�•. • . - c � �...' r, ' DATE_ FEE PAID y jAL _ T ELE IC IN)SPECT �. ... .. ................................... Service _- ' : . .. B ING INSPECTOR Final ' .'.. OCcupanol Pe?'wlit Required to GAS INSPECTOR Display in,a Conspicuous Place on the PremisesOki =�� Do Not Remove zfi 1 ' No Lathing or- Dry Wall To Be Done ILD 4 000' � � until inspected and Approved by the Building:anspector. FIRE EPARTMENT ii Burner tcl Street No. Smoke Det. .. _ �' Y 'S ARJUNA L CONSTRUCTION CO.INC. COMMERCiAI • INdUSTRiAl • RESidENIIAI 160 Pleasant Street—North Andover,MA 01845 Gene Willis, Pres./Treas.—Tel:(508)683 9127 Fax:(508)794-8363 Town of North Andover, Massachusetts Form No.2 f MORTq BOARD OF HEALTH I° w A • * s i DESIGN APPROVAL FOR ss'C""SES SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM • Applicant �Q tJ VS Gln ' �C��$1�- Test No. Site Locations SA"\ Reference Plans and Specs.Cil &AfQ-AA SIf cn. -t- ENGINEER DESIGN U DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. • C IRMA ,BOARD OF HEALTH Fee �� Site System Permit No. APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: 7 CURRENT INSTALLER'S LICENSE* �►� LOCATION: 64 LICENSED INSTALLER: SIGNATURE: TELEPHONE#_,�R CHECK ONE: TOWN OF NORTH ANDOVER/ / BOARD OF FtiFALTH REPAIR: NEW CONSTRUCTION: V SEP I 1996 IF NEW CONST UCTION, PLEASE ATTACH FOUNDATION AS-BU T Administrative Use Only $75.00 Fee Attached? Yes No Foundation_ As-Built? Yes No Approval Date: c/)//,7/F1,// 116.3 26.2 82 7' o0• �. �- — w - LOT w 118.9' �pWN OF NORTH ANDOVER/ �. N.E.P.CO. -0- BOARD OF HEALTH EASEMENT A=54, 198 S.F. ` ��- 1996 F1J0., 92.0' A EL.104.36' rn v 30.8' � L= 124.3' — 1 SALEM S T. FOUNDA TION LOCA TION PLAN I CERTIFY THAT THE PRIMARY STRUCTURE SHOWN CONFORMS TO THE HORIZONTAL SETBACK REOUIREMEN7S OF THE LOCAL APPLICABLE ZONING BY-LAWS IN EFFECT WHEN CONSIRUC7ED. S Nor CONSIDER ANY 07HER RESTRIC77ONSCSATION E SUCH SCOVENANTS,WEIlANDS,EASEME/yTS. CLIENT. WE DEV.CORP. ORDERS OF CONDITIONS,ETC.) THIS DRAWING SHALL NOT BE USED BY THE CUENT FOR ANY THIS CERTIFICATION IS MADE AND UMITED PURPOSE OTHER THAN 7HAT OUTLINED ABOVE,EXCEPT WITH THE TO THE ABOVE CLIENT. WRITTEN PERMISSION OF CHRISTIANSEN & SERGI INC, FURTHERMORE THIS DRAWING IS THE COPYRIGHTED PROPERTY OF Cl/RIS77ANSEN k SERGI INC. AND ANY UNAUTHORIZED USE IS PROHINITED.CHRISTIANSEN & SERGI TAKES NO RESPONSIB/UIY FOR THE UNAUTHORIZED USE OF THIS DRAWING OR ANY INFOR- MA770N CONTAINED HEREON. LOCATION:1075 SALEM ST.,NO.ANDOVER,MA. BOUNDARIES ARE BASED ON A PLAN BY SCOTT L.GILES DATED 1/24/94. OF SCALE.•1"=50, DATE:5/21/96ROf ��� �H�EL ✓` � d Na CHRI S TIA NSEN &SERGI PROLNDI SUAL RVEYORSEERS 160 SUMMER Sr. HAVERHILLMA. 01850 TEL 508-375-0310 ©1996 BY CHRISTUNSEN & SERGI INC. ` DWG.NO.:95013001 ^ , 'Town of North Andover, Massachusetts Form No.3 Of NORaTM BOARD OF HEALTH o 19A CHUSE DISPOSAL WORKS CONSTRUCTION PERMIT S�CNJ Applicant �n � NAME ADDRESS TELEPHONE Site Location -I Permission is hereby granted to Construct (`�or Repair ( ) an Individual Soil Absorption .Sewage Disposal System as shown.on the Design Approval S.S. No. C H A I R M A 9, B O L �db Fee �� D.W.C..No. &0.3 i i 4 T G4 q i r 1 ✓ �. :': - - •XHM -FORM U - VERIFICATION 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 local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: 1�r 1 (A V & a, �Tr. ?- �- PhoneO*-/P LOCATION: Assessor's Map Number /D Parcel Subdivision I Lot(s) Street /r�sl St. Number 116 ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments YA Lt LL� Date Approved _ Q Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected / PP Date Approved —.� Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Department I Received by Building Inspector Date Of HORTh 3? °141's 0 ` � too. BOARD OF HEALTH O A t • t i a ` 9 120 MAIN STREET TEL. 682-6483 ;C`HUSO' NORTH ANDOVER, MASS. 01845 Ext23 June 22, 1995 Mr. Phil Christiansen Christiansen & Sergi 160 Summer Street Haverhill, Ma 01830 Re: 1075 Salem Street Dear Phil: This is to inform you that the proposed plans for the site referenced above dated June 13, 1995 have been approved. If you have any questions, please do not hesitate to call me at 688-9540. Sincerely, Sandra Starr, R.S. Health Administrator SS/cjp DATE Co �JSheet of BOARD OF HEALTH TOWN OF NORTH ANDOVER SUBSURFACE DISPOSAL DESIGN REVIEW FEE D PERMIT # 7/ DATE RECEIVED�/'� /G�' A-=?EIC:LiIT ASSESSOR' S MAP ALD:ESS PARCEL # LOT tt M 7(5- STREET (5- STREET -519�66M Z51-7— A:,D R TALDR Ss ?_ DA ' okCM. REVISION DATE �_-- CD: ,.�__G:;S OF APPROVAL: 'I A:_�OVEJ DISAPPOVED i idWs �o 7-9 a G G Z5,0 /G✓ T�S,T� /�I UJ j �� �f��W�tJ � IV Q V RT HO M BOARD OF HEALTH 04%. MAIN STREET TEL. 682-6483 NORTH ANDOVER, MASS. 01845 9SS�cHus�t Ext23 June 8, 1995 Christiansen & Sergi 160 Summer Street Haverhill, MA 01830 Re: 1075 Salem Street To Whom it May Concern: This is to inform you that the proposed plans for site referenced above have been disapproved for the following reasons: 1) What are the elevations of the perc tests? 2) Note that test pit dates are incorrect. 3) Note that under design parameters, the trench is four (4) feet wide but cross section states two (2) feet wide. 4) All soils tests must be shown. 5) May need an additional perc. If you have any questions, . please do not hesitate to call the Board of Health Office at the number above. Sincerely, �7LI2 Sandra Starr, R.S. Health Administrator SS/cjp Jtle Draft Printed September 20, 1993 Appendix 4 Page i No. Date 13 9S Commonwealth of Massachusetts , oRTN f�l�DpU Massachusetts 3 � ' Site Suitability Assessment for On-site Sewage Disposal ` .................. Certification Number: . ._.--....._.... .. Performed By: ......�l�Al.11✓.�....-...Q...�-^..!-N..�G..C--.................. Witnessed By: ...........SIGN+�Y..--STcotZ.i�,... .- �2Tn-:-../ .n[nU.V.k 2...--H-f .................................................. Location Address or Lot No. Owner's Name.Address and Tel. A 1075 SAI.i?M PE 6E VEtopMf AIr r.1r1-A KOa.TN Arv►�oV�12 r 60 /V0a71 yr An/boV"//$ * 01164-�:- New. Construction Repair ❑ Office Review Published Soil Survey A vailable: No ❑ Yes Year Published ...J` 6I.- Publication Scale 1.51.840 Soil Map Unit -. .. .-... DrainageClass ...N..IA...-. Soil Limitations ....A/I11......................................................................:....................................... Surficial Geologic Report Available: No Yes ❑ Year Published Publication Scale Geologic Material (Map Unit) ................ ......... .. Landform . Flood Insurance Rate Map: Above 500 year flood boundary No �•❑ Yes Within 500 year flood boundary No U Yes ❑ Within 100 year flood boundary No Ej� Yes ❑. Wetland Area: National Wetland Inventory Map (map unit) .. ... .................................................. . ........................................... Wetlands Conservancy Program Map ,map unit) Current Water Resource Conditions (USGS): Month Range : Above Normal ❑ Normal ❑ Below Normal ❑ Other References Reviewed: -- ........... ....... _. ...... ..... .. . ........................... . _ . .............. Title S: Draft Printed September 20, 1993 Appendix 4 Page 2 On-site Review { Deep Hgle Number... ....... Daie:...3' �1 Time:......Z.' 30 p� Weather'. SuN�1 po Location (identify on site plan) ........................_............ .................... .... .. ......... ......... Land Use Slope m Q--- e.... Surface Stones ...bIS1�AgU- Sib4A<J 1b "I. Vegetation NONE Landform pRNMUAJ (At Xlao) Position on landscape (sketch on the back) .......--.........................................--.... : _ ..._........... Distances from: Open Water Body .>.-. bO feet Drainageway ................ feet Possible Wet Area ...ZO.0 feet Property Line .....ZS.I.. feet Drinking Water Well — feet Other DEEP OBSERVATION HOLE LOG Depth from.Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other (Inches) (USDA) (Munsell',. (Structure.Stones. Boulders, Consistency, % Gravel) � l Nny Io YR r,/f3 , fOR�� 4$ SA UM M q!✓vsic q 6'– 1321 L i �M'f IU YK 5/7 5Y 613 MAA/Y PRUMWL4 rl 3�Gvw sj�n _ CRELIC 1 MQTTLC ? Parent Material (geologic) .. ....... ......... - - Depth to Bedrock: IvIlt Depth to Groundwater: . Standing Water in the Hole: . Weeping from Pit Face: /06 Estimated Seasonal High Ground Water: 108 Tale S: Draft-Printed September 20,:1993 Appendix 4 Page 3 Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole inches Depth weeping from side of observation hole 103 inches ❑ Depth to soil mottles ................... inches ❑ Ground water adjustment feet Index Well Number ................ Reading Date ................... Index well level ... 'Adjustment factor ................... Adjusted ground water level .... Percolation Test Date: .. ..! . Z?. 4 Time: .......3. .Od..fm- Observation Hole # Pf-ru TEST3 Depth of:Perc 59 Start Pre-soak 3 04 , End Pre-soak 3 y 2,o Time at 12" 3 s Time 'at 9" 3 , 3� Time at 6" 5 314" 4 .03 Time (9"-6") Rate Min./Inch g MSN I IN Site Suitability Assessment: Site Passed LJ Site Failed ❑ Additional Testing Needed: Performed By: LAvlft O'GoNMf-u Certification Number: Witnessed By.......SANQ.Y. ...S74tiX.... ,..NO2 t.../1N 9�tc+2 1� ftCT1l.AGfi✓T. Comments: _ . . . ... Mde 5: Draft Printed September 20, 1993 Appendix 4 Page 2 On-site Review j Deep Hole Number... ..- - ? 3�(3.�9� Time:...... 3� V2 Weather S�f�l/M'1 60 Date:...... Location (identify on site pian) ID..Ut?t N t !!T..Ft '!..._ow. w-ILi(-�- _ 0 1S,LS Land Usey.Aly^':f."..-.�.W--.��uNSC..S(i?c Slope (/o) ..��-���----- Surface Stones -.nio'V. ..... .-. . .. 1 Vegetation GMSS f Landform . I h'IM LIN Position on landscape (sketch on the back) ................................................._...._.... - Distances from: Open Water Body 2.. ° feet Drainageway --.. -'------- feet Possible Wet Area --. feet Property Line ... .------ feet `N 5rarrr) Drinking Water Well — feet Other 4 DEEP OBSERVATION HOLE LOG Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other (inches) (USDA) (Munsell), (structure. Stones.Boulders. Consistency, % Gravel) ,t ,I – ZI Ab 5PAbY 79 fe 3)3 — M�sSIv� F�rA�SI FOAM ,, �( S7 S YR 41& W,1� " 3 S �'w �-ru L u�aM ��ss Ivy, �6 Lf 56 i f C I SNVv f 10 ya Sly — wAi4 MgSSty� F=ruptu Zd1"u 5 iLti�.S ib 1 t5'� 50 " 131 " GZ, SAA,/ny W K S�� ncwr, wnaq MRSSBVI, i,�QN1 E6�� t-YTYb6tiilyLy1K� 7F"�v S IZ1N�j Tb l Parent Material (geologic) ..........._. .. _ .. Depth to Bedrock: n//A Depth to Groundwater: Standing Water in the Hole: . 72 Weeping from Pit Face: 66 Estimated Seasonal High Ground Water: 66 ' 7�'1fe S: Dr Appendix 4 Page 3 ft Printed September Z0, 1993 Determination for Seasonal High Water Table Method Used: �. Eepth observed standing in observation hole inches Depth weeping from side of observation hole . G6 inches ❑ Depth to soil mottles ................... inches ❑ Ground water adjustment feet Index Well Number .............. Reading Date ............. Index well level ... ... 'Adjustment factor ................... Adjusted ground water level ......... ...... Percolation Test Date; .. .3 1.31 5......... Time: .........z..'....S.._./om Observation Hole.# g Depth of Perc �S ; Start Pre-soak 2 47 End Pre-soak Z ; 36 Time at 12" Z 13& Time at 9" Z: sq Time at 6" Time (9"-6") 3°I Rate Min./Inch Site Suitability Assessment: Site Passed Site Failed ❑ Additional Testing Needed: Performed By: DWNIft U'C�V�✓�LL Certification Number: Witnessed By:.......5A.NdY ....... .. .......... . Comments: - - i IV V. V .� �o ppL ouP 1 jV� 4 V SALEM STREET • � I d SE ' • x owdv PLAN REVIEW CHECKLIST ADDRESS_ � 3 8,14L. / ENGINEER GENERAL / 3 COPIES STAMP LOCUS L--- NORTH ARROWy SCALE CONTOURSI/ PROFILE L--- SECTION ti— BENCHMARK Z,--- SOIL & PERC INFO 'S _.GSA ELEVATIONS WETS. DISCLAIMER �� WELLS & WETLANDS WATERSHED? DRIVEWAY (Eley) WATER LINE FDN DRAIN L/ SCH40 L---- TESTS CURRENT? yl�5 SEPTIC TANK / MIN 1500G � . 17 INVERT DROPy GARB. GRINDER(+200% EDF) 25 ' TO CELLAR MANHOLE TO GRADE ELEV GW D-BOX SIZE # LINES 4 FIRST 2 ' LEVEL STATEMENT INLET IW,8 - OUTLET/t)0.6'6 = •49J (2" OR . 17 FT) TEE REQ'D? LEACHING MIN 660 GPD? RESERVE AREA� 4 ' FROM PRIMARY? 2% SLOPE 100 ' TO WETLANDS 100 ' TO WELLS `� 4 ' TO S.H.GW 35 ' TO FND & INTRCPTR DRAINS L,-;" 325 ' TO SURFACE H2O SUPP z- 4 ' PERM. SOIL BELOW FACILITY/ MIN 12" COVER ILL? (25 ' if above natural elev; 101if below) BREAKOUT MET? TRENCHES MIN 660 gpd SLOPE (min . 005 or 6"/1001 ) L-,,�>3 'COVER?-VENT '— SIDEWALL DIST. 2X EFF. W OR D (MIN 61 ) IS RESERVE BETWEEN TRENCHES? IN FILL? '�I MUST BE 10 ' MIN. 4" PEA STONE? BOT 400 X LDNG + SIDE X LDNG C.-Z,?= TOT 7 5 W A 10'i (L x W x #) (G/ft2) (DxLx2x#) (G/ft2) Copyright© 1993 by S.L.Starr REVIEW CON`1'INUED SHEET OF 1. -:t-ti v &-p T-,-s Fob TAr 5L- � s X — C�.oitJC�.eti/tiG EX�ST� 'v6' ��C-� /Uo i1o� 3 , ()A)D &-4 1 nJ C hft'-s IA-)7-0 \ ON ty�ilt� $4 3��i a x ,T��< t ,y '� �,�."'\ p,;t..,J�X,a� asr ! > \.y ii f �e i e ,��^ { • ' 9-`!'� {T3y.iN.ta�il `:F`• { f ,"J l, t� r)y.:;i•��Cit -,! r +`.,�ae� >• .}ttl-t �' \ r\>`, a ) `i \ia 1r'd' r ,..s•FIS. 1. �,\ { r _.ir F .I,I �4 ,•. a rF ft \'1. �y� t 1 l.;e } ` � -! $ t: ;,S .t\A.,,�•`,d.�it 5a�, !�yt$,� •rt'.{'1 ��f. Y �'i�� •`�,y .�_ 4[ s' +�s�F�. » $' �''�' I� S, \.,)r .� �T �' 'V . 1 \ t �,•� / 4 I�f +�t1 �..,. 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P IIIIIIIIIIIIIIIIYIIIIIIIIIIIIIIII �j.�� 111111111111111111111111 �� - IIzEEE:! t x ' ''�J1111111�1111111111111111 �` r�" !ll3.,e1391111�d1�IG�1111111111111! } - li�llillli�.IGGIl�I�J�lll�llGIII/IIII � . 111111/�31�1191GIII��Z11/�Gl11111111 JT.,�.� ©1�1'AI!�d�11:�GilR;IIG�111 -�� 1111111111111111�1111111111111111 r= • Iilii�11:11111111�1111111111111111 . { Y � s5'J'P•"s r-s 1lLI ®11111111111111111111111111 �����` IG!! 71!lIL1�Il�Jl�':'��Jhl�llll�.�!"�lilll �� _ 1111 IIG��/in �LIIr11L�1�i11111 `����= nr 11111111111G1�11�13�11111111111111 a �: 1111111G11�JIIII�IIGl1�11®1111111 µ: ph Fnit............................. No......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - tJA/..... .......OF..... ../.LN':✓` ... .. .............................. Ijrjjtjlljj f 11r Tjjj171p11l3tjl jinr(t1a Tomitrurtiolj l?rlltt Application is hereby made for a Permit to Construct (t�or Repair ( ) an Individual Sewage Disposal System it: tl �/�/] 7 .......� .7�J� ..r�!7. '!...:•...:Sr.4................................... ...../`.....................................or LotndNo......(..,,.....pp........a..j.�.f.J....11.....�....�j. t� /��p,L�o/,ca�tfo�i \`JJ'rc:s 160...�.C1'.l?lJ�.:t�T NQ;,`���Y(Gr'Jk/•sl 1r.=•..vl�'•`—• . .....l.�p.�I.U�V.1[J:•.4.!101 ..i::� : .. ............................ LSC l.XCt'. n.. ndJroa. ' o„ncr .......................................................................................I.......... .................... .t.....................Addre.. �. .................... 11.,JIer ca Size Lot...54:�.1.1..��.......Sq. feet Q Type of Building U Dwelling— \'o. of T3crlrr,ums............ "'..........................)rxps�nsion Attic ( ) Garbage Grinder ( ) .� Other—'Pylic of liatiltlill(; No. of I�crsons............................ Sl a Showers ( ) — Cafeteria ( ) aOther fixttlre .................................................p..................................,................................................................ ......gallons per person er day. Total dail flow................. . .. ............. Y ..gallonsy WDesign Flow............. tyl ............. t' a Septic Tank - Liquid capacity/.:`� ..g;lllolls Length./.U...�..... Width.. ..:....... Diameter... llepth..�.... ..... 4 � W Disposal Trench ---- No. ........ Width...Zer.... Total Length....Z,.QQ.f�Total leaching area....J.Z..C1il...sq. ft. > Seepage Pit No..................... Diameter.................... Doth below inlet....................Total leaching area..................sq. ft. Depth Z Other Distribution box (x ) Dosing tank ( ) 10111, q4- Percolation Test Results Performed b ...CAUYIS�T.tllAlSfa41...i..: > .�a��..1,.V.�:..... Date 7.7.5 ..........., y... r f-� Test Pit No. I.. . . .....minute,per inch Depth of Test Pit.....Qk .. Depth to ground water....../. . .....1� el, w r-5 Test Pit No. 2....f{:.......nllnutes per Inch Depth of Test Pit..... :..... Depth to ground water....... ..... O Description of Soil.......1 ..' k.. 1. ... ^.I?`1. . !!!..t.r`.1 ► .t..f14TELY.F1A ................................................. v .u:1a.....51?l!U r., ...1.i?...!ke:.'............................................................................................................. UNature.of Repairs or Alterations—Answer when applicable .. .. •' ...................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the proN.isions of:ITLt. 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed........::.........................:.................................................. Da1e.............. - Application Approved By.................................................................................................. .................. .Date.............. Application Disapproved for the following reasons:.........................................................................................................:...... .................................................................................................................................................................................. .Date ............ PermitNo......................................................... Issued................ .....................................Date Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........................................OF..................................................................................... &)rfif irate of Gout IiMnrr THIS IS TO CERTIFY, That the Individual SeWage'Disposal System constructed ( ) or Repaired ( ) ............................................................................ y........................................... installer at.................. ............................................................................................................. has been installed in i acco"(1: nce with the prnvttiings of TITLE. 5 of The State Snnitary Code as described in the application for Disposal Works Construction rennit No..7 ..........I......................... dated....................................,........... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE'................................................................................ Inspector................................................................................... THE COMMONWEALTH'OF MASSACHUSETTS BOARD OF HEALTH ............................ ........ OF........... ........................................................................ FEF........................ 1\10......................... li,gp.0jj o�•Itu C�ujtufrixrfinn 1'ruti# Permissionis hereby granted.............................................................................................................................................. to Construct ( ) or Repair ( ) :ala Indivirhral SVwagc IDisposnl System atNo................................................................... ....................................41...I, ............................................................................. ns Shown un the application for Uispo..;;II Works Construction Permit No..................... Dated.......................................... ....................................................................................... Board of Health DATE................................................................................ FORM 1255 H0913S & WAnnEN. INC..'PUBLISHERS TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD OCT 2 5 2001 s DATE• 1� � R-Q� SYSTEM OWNER &ADDRESS SYSTEM LOCATION (example: left front of house) r ` /ode 6 Vtoc,�5� DATE OF PUMPING:_ QUANTITY PUMPED--t � GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE YEMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: % : 'Lew �v� COMMENTS: CONTENTS TRANSFERRED TO: Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH (� 32Oz, Eo b�ti°Ll� 19—L� FO W a •' A Egj � ON APPLICATION FOR SITE TESTING/INSPECTION 7,95 RATED PP '(y SUSE ACH ti Applicant NAME ADDRESS TELEPHONE Site Location l I= Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time 6U CHAIRMAN,BOARD OF HEALTH I � � Fee Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No. 1 NORTH AA BOARD OF HEALTH � /� Q��SLED b q.YO W^"` ��. 3� y� 0� �.. 19 f 0 * r APPLICATION FOR SITE TESTING/INSPECTION ��SSACHU$���y Applicant . r1.L NAME ADDRESS TELEPHONE Site Location Engineer NAME ADDRESS TELEPHONE 'J Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee Test No. (-"4 / S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Date.. ...... ..�z 373 TOWN OF NORTH ANDOVER PERMIT FOR WIRING WOO ,SSACMUS� This certifies that ..... .. .. .... .,Y..?.'L.� ....t�.E:6 ..:.........has permission to perform .............. .... �T G4c-a wiring in the building of... . ! .. 1/J�'� '..... at .:...�F. .�................. ,North Andover,Mass. . Fee./Ja?... L. Lic.N .a...... ... ............ . ..... E RICAL INSPECT R d WHITE:Applicant CANARY: Building Dept. PINK:Treasurer � -� 1 The commonwealth of Massachusetts ' Dcpartmrnt of Public SoJcry BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 1200oee.,.�eT a ass 3/90 ties—.ala-11) e Fiq7�7 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL-WORK All work to be petiormed 1n accordance with the Maeaachwttru EltetRUl Code.S27 CMR 12.-00 (PLEASE PRINT IN nm OR TYPE ALI. INFORMATION) Date — 6 City or Town of To the Inspector of Wires: The %mCvrsigned applies for a permit to perform the electrical work described below. Location (Street 6 Number) 06-ner or Tenant— Owner's Address_ Is this permit in conjunction with a building permit: Yes ' No ❑ (Check Appropriate Box) A rpose of Building ,g ,-e �4/ Gv�iL�/ � Utility Authorization NO. Existing Ser.ice Amps / Volts Ovenccad ❑ Undgrd❑ No. of ::ct:ts —=— New Serrice av APs 12 Volts Ovcrbtad Lngrd❑ No, of Meters____,_ Number of Feeders and /lmpacity Location and Nature of proposed Electrical Work No, of Lighting Outlets No. of Hot Iubstotal No. of Transformers LYA 9%'o. of Lighting Fixtures Swimming Fool Above❑ In- grnd. grnd. ❑ Generators VA No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Batte Unita No, of Switch OutletsNo. of Cas Burners FIRE ALlIRISS No. of Zones No. of Ranges No, of Air Conde Total g tons No. of Detection and Heat -17t-a-1. Total Initiating Devices Na of Disposals No. ofPu=ps Tons W No. of Sounding Devices ,•o. of Dishwashers S ace/Area Heating iBNo of Self Contained Detection/Sounding Devices No. of Dryers Heating Devices KWtLniei al Local❑Conneetfon00ther No. of Water Seaters KW noof o. o Lav Voltage Si s Ballasts Wiring No. Hydro Kassage Tubs No. of Motors Total HP CAR: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Law I have a current Li t Insurance Policy including Coepleted Operations Coverage or its stantial equivalent, YES �0 I have submitted valid proof of same to this office. YES NO❑ If you have checked YE$; please indicate the type of coverage by checking the appropriate box* INSURANCEOhDf] MMM[:] (please Specify) �/ Estimated Value of Electrical Work S cpiration DateJ Work to Star to ��6 Inspection Date Requested: Rougher-�� inal Signed under the penalties of perjury: FIRM NAISE 0E, LIC..N0. Licensee e Signature a_ 3� LIC. N0. Address tS Bus. el. No.Alta OWNL7%'S INSURANCE WAIVER: I am aware that the License does eat have the�feueurance coverage or is sub- stantial equivalent as( reytiired by Massachusetts General wsTa a and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No, PERH12 FEE S Signature of Owner or Agent