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HomeMy WebLinkAboutMiscellaneous - 125 COLONIAL AVENUE 4/30/2018 �d- 125 COLONIAL AVENUE / 210/107.6-0130-M.0 .� \ YA ='•s . 'V _ r . ' ' z���� .L'§ t���t+� � �w' � �+'!ttle 1'r�r����rkyrjrti��+. • ,. . .• �� . MAP # � ` ` LOT # - ; PARCEL # STREET _... .. CONS�RUCTION_AP HAS PLAN REVIEW FEE .BEEN PAID? / YES NO PLAN APPROVAL: DATE- ��/� <� APP. BY ��� DESIGNER: I`fi /7" Y�i�S PLAN DA,1'E. // 02hS CONDITIONS WPTER SUPPLY: TOWN WELL WELL PERM.I4T DRILLER WELL TESTS: CHEMICAL DALE APPROVED FXtGTERIA I UA I E f1PPRUVED BACTERIA I DATE AF='PROVED COMMENTS: FORM U APPROVAL: APPROVAL 1'0 ISSUE `YE NU DATE ISSUED ll��9� BY CONDITIONS: FINAL APPROVAL: . ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NU SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NU ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: BY: ":, r ,, �E���SY�Z�M�.N S2$41.1�T�T Q.LI • M• "ne •moi- -i'. \. r. _" , i•'r: .r •.,•.y':•�;.'•+.'.:r•..,; :. t , t _ rt_ �� 1 ' IS THE• INSTALLER LICENSED? YES NO r TYPE. OF- CONSTRUCTION: INEW REPAIR NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW_ YES NO s y` CONDITIONS OF..APPROVAL YES NO (FROM FORM U) _ l _ISSUANCE •OF DWC PERMIT _ • ' - + ` ' ' t YES NO DWC PERMIT_ N0. INSTALLER: > /V •� .. Vii'. .... .. - �: - . - : :` • .: _ - .. • ,•, ' BEGIN INSPECTION - YES 0. EXCAVATION , INSPECTION: _ ; NEEDED: ' 'N /..¢yt� t .. y�jv%f{:J �s(P� �')•!/%/[�t I•• y��'s-i. ��'�.'� (an'�� ' :` - PASSED �✓ . ABY .. D ,' . . .0ONSTRUCTION INSPECTIONS NEEDE : .. AS BUILT PLAN SATISFACTORY: YES:. APPROVAL TO BACKFILL: DATE: LZ . BY - Ao " FINAL . GRADING APPROVAL: DATE BY u� '(�? DATE.6Aq BY CONSTRUCTION APPROVAL: :•1•'4111 F' — •• • , .. • • Commonwealth of Massachusetts _ City/Town of . System Pumping-Record Form 4 DEP has provided this form for usez by local Boards of Health. Other forms may be'used, but the information must be substantially the same as that provided here. Before using.this form, check with your 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. A. Facility. Information 1. System Locatio . Le igh ont of house Left/Right rear of house, Left/right side of house, Left/ Right side of bui g, Left/Rig ron o uildirig, Left/Right rear of building, Under deck Address Cityrrown state Zip Code 2. System Owner. Name Address(if different from location) t�FCEeVE citylTown • .,uN 3 O 20� state zip CO �OW�OF NC�TH ANppVER Telephone Number N�ALTN D���TtaF�T 3 B. Pumping Record _ 1. Date of Pumping � —�. p g 2- Quantity Pumped: Date Gallons 3. Type of system: ❑ Cesspool(s) ep Ic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes 0-wo, if yes, was it cleaned? ❑ Yes ❑ No; . 5. Condition of System: 6. System Pumped By: Neil.Batesbn F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location where contents-were disposed: S: Lowell Waste Water Sign a Haul Date t5form4.doc-06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts RECBIVEa City/Town of SUN 0 3 2013 System Pumping Record TOWN OF NORTH ANDOVER Form 4 1 HEALTH DEPARTMENT DEP has provided this form for use-by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using.this form, check with your 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. A. Facility Information 1. System Locatiod' Righ t of hous a Left/Right rear of house, Left/right side of house, Left/ Right side of bui Ing, Left/Right fron of building, Left/Right rear of building, Under deck Address � ^ � A� � �J City/Town State Zip Code 2. System Owner. Name Address(if different from location) Citylrown Stat Zip e, Telephone Number B. Pumping Record Gu 1. Date of Pumping Date 2• Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) alSeptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition ofSystem: 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location wheLe contents were disposed: tl G S. Lowell Waste Water Sign t e Haule Date i t5form4.doc•06/03 System Pumping Record.Page 1 of 1 FORM U - LOT RELEASE FORM ( /7 INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from ards 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 C..h rI s I-D hei,' cE✓ g s �` � f0( PHONE �7�-' '11-5 � `k �, LOCATION: Assessor's Map Number ` PARCEL / -3() SUBDIVISION � LOT(S) t; \" STREET Z j L�l-- c�0/[� L ttrV `G— ST. NUMBER,? USE ONLY*******************,+******* +►+t*,,� N TIO OF TOWN NTS: CIO ADMINISTRATOR DATE APPROVED DATE REJECTED_Zg, �— COMMENTS / l • TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD N P CTOR- LTH PPROVED D REJ TED E TIC ECTOR-HEALTH DATE APPROVED f DATE REJECTED COMMENTS. ti. '. /• J PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT ,. RECEIVED BY BUILDING INSPECTOR DATE_ Revised 8197 im �•�s'":'dl i!r mita: `€1 ,�rrG§:'t?'t`f • '\, November 28, 2005 Mr. & Mrs. Christopher Towler 125 Colonial Avenue North Andover, MA 01845 RE: REJECTED BUILDING PERMIT-125 Colonial Avenue,North Andover Dear Mr. Towler, This letter has been prepared as a follow up to my phone conversation with you and Kathleen regarding your building permit for the above-referenced property. As you may know, the North Andover Conservation Department REJECTED your building permit application for the conversion of a deck to a 3-season living space and construction of a new deck. During my site inspection on November 28,2005, I observed a jurisdictional wetland resource area that traverses along the eastern portion of your property,just beyond the stone retaining wall. This resource area was measured to be approximately 75-feet to the proposed deck. As such,you will be required to file a Request of Determination of Applicability (RDA)with the North Andover Conservation Commission(NACC) prior to the commencement of any construction activities, per MA Wetlands Protection Act-M.G.L. c.131, §40 and the North Andover Wetlands Bylaw (C.178 of the Code of North Andover). This will require you to hire a Professional Wetland Scientist to delineation all jurisdictional wetland resources within 100-feet of the proposed project. In addition, a Professional Civil Engineer or Registered Professional Land Surveyor would need to prepared a plan showing all proposed activities; the wetland boundary and its associated buffer zone (25' No Disturbance Zone, 50' No Build Zone, and 100' Buffer Zone). Enclosed please find the Request of Determination of Applicability (RDA) application and instructions, as well as other pertinent forms to be filled out. I have also included a copy of the as-built plan of your house lot prepared by Hayes Engineering, Inc., dated January 19, 1998 for reference. Please be aware that the Building Department cannot issue a building permit until all necessary permit are obtained. Should you have any questions regarding the filing process or need assistance with the application, please do not hesitate to contact the undersigned at your earliest convenience. Thanking you in advance for your anticipated cooperation with this matter. Respectfully, NORTH ANDOVER CONSERVATION DEPARTMENT Pamela A. Merrill Conservation Associate Enc. Request of Determination of Applicability (RDA) application Cc: Jerry Brown, Inspector of Buildings TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO OONSTRUM BELAM RENOV.AriT 2E��ORR-y�DEEMOUSH��AssONE TOR TWO FAMILY DWELLING tta BUILDING PERMIT NUMBER: DATE ISSUED X SIGNATURE: Building Commissiom/I r of BuiWins Date z SECTION I-SITE INFORMATION I0 1.1 Prgmty Addraw 1.2 A Map and Parcel Number: Z `i ��-•c/Jt��r`. t��l� r /�'�tea MT Number Parcel Xumber 13 Zanitglnfarmatian: 1.4 Pop Dimensions: 0 2 SUn;4rcM �}D171t. 4 . /// Zonis DPrislria oacd use [A Arm ��fy I- 1.6 BUILDING SETBACKS M Front Yard Sidc Yard Rear Yard Required Provide Required I Provided Requimd Provided t.�wmr_Sim-`n3vM.QLC.10. >n I.S. fl kdmmaoa� i.a oDirpoaal5ysrZ Public K Private 0 Zone 0,aida na d Zees 0 hlwk pd Oe Si.Di p.1 S,..g —! SECTION 2-PROPERTY OWNtRSHIPIAUTHORMED AGENT M 2.1 Owner of Retard 'l�Ii�isty der Towle. I2.1�" Nam t) Address for Service -gas-ss�-► Signature Telephone 22 Owner of Record: � ( .1 Cpi;��S j CU�drrtc( f{ to of Address for Servlet Si nature tele SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor. Not App[icabk 0 i�w�. x f--5 %-T. a/16 4/7 9 Licensed Construction Supervisor Vk , .5/. _���/1 Allld * LiccuseNumbcr ;61 ,U ` Gn`� Q_b F. iratidan ])ale S' ature Telephone r y3..22 RegisteredHorneImptavvement Contractor Not Applicable p fT C4` !tJ i lL��f.T/rLf�i CO y/1� /� � 7 m Company Name / 3 i L ��-- ^l{/J S 1 fr C Registration Number r p css W"/ U `} S -7l ,^s C:� fan� UFC" J K1 tf L3 J J 312— Fxpi n Date YI S n lure Vrckvb SECTION 4-WORKERS COMPENSATION(KG.L C 152 § 2-q6 Workers Compensation Insurance affidmit must be com*kd and submitted with this application. Failure to provide this affidavit will resuh in the denial of the issaance of the bufldi26 permit. Si ned affidavit Attached Yuz.......- Nu......D SECTION 5 Description of Frovosetl Wort; c"wvC4k tOpIkoble New Construction 0 Existing Building 0 Repair(s) 0 Alterations(s) 0 T Addition Accessory Bldg. fl Demolition 0 Other 0 Specify Brief Description of Imposed Work- J - .. fi - SECTION 6-ESTIMATED CONSTRUCTION COSTS hem Estimated Cost(Dollar)to be •i OFI YCuL ftE ONLY.r Completed M'permit applicant I. Building4 r� Z J C�1 (a) Building Permit Fee • I Multiplier 2 Electrical " _e0 �y (b) Estimated Total Cost of 1 Construction 3 Plumbing Building Permit fee f•)x for 4 Mechanical 1VAC p tJ CM, 5 Fire Protection 6 Total 1+2+3+4+5. -L3 tf ft 0 I_ eek Number — SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WIZEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUIId)ING PERMIT as ownerfAuthoraed Agent of sttbjw property Hereby audwikc CO AiC to act on My If,in all ma rs ret live to wxwl authorized be this building permit application. .r. 0—C— 11/t 3 l O J Si ntrc of Owner ]late SECTION 7b OWNERIAUTHORIZED AGENT DECLARATION Owner{Auth0ti7Ad Agent of subject propertS' Hereby declare that the statements and inforimbon on the foregoing application are true and amaate,to the best of my knowledge and belief —Ckt-(5{b()hC,1 'Ia .1le/ Pnn c J,/,— l l Si a ure of 0milertAgen, Date �— NO.OF STORIES Spy; ( i HASEWWY OR SLAB N C SIZE OF FLOOR TMERS Z p 1' 2ND3RD SPAN /1 DIMENSIONS OF SILLS Z X DMC -NSIONS OF POSTS DL1Cl1:NSIONS OF GIRDERS HEIGHT OF FOUNDATION wtl7i t 'D THICKNESS S17F.OF FOOTING ",-1-ea X Gr ../ . 'T(3Ea•a.� MATERIAL OF CHIMNEY- IS BUILDING ON SOLID OR FILLED LAND r t IS BUILDING CONNt:C'll;D 1.0 NAIURAI.GAS LINT: hf U NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: i-;Z5 C�zc.CQ=rrq-L .A-vE . is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section I OA. The debris will be disposed of in: � ,� ��- •� � ,���v c'r..�--�r•.J �U rn(�S �;� _ �'-e,.i �il r'!t,; �i��'��� (Location of Facility) Sig ature of Permit Applicant 44 Fire Department Sign off: —betaiL Dumpster Permit Da e j 4'i =.=4 0'7 4- yi COLO /V 25'00 1- �DI 9 j 21, 6.3.3 S.F j I I 9 CD r)6 V\�% CJ`�j<• moi- moi; L — . TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: SYSTEM OWNER &ADDRESS SYSTEM LOCATION (example: left front of house) DATE OF PUMPING: (QUANTITY PUMPED C 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. COMMENTS: Flu. 14 2001 CONTENTS TRANSFERRED TO: D ' �".NOR�n tvr. °� I -pow ,Ro�:4i-r� PLAN OF LA NDti /NNO* AND 0 VER ` IWASS. NOVEMBER 8, 1996 MYES ENG/NEER/NG, INC. 603 SALEM SIMEET CML ENGINEERS & WAKEFJELD, MASS. 01880 LAND SURVEYORS TFL. (617) 246-2800 / CERTIFY THAT THIS FOUNa477ON /S LOC47ED ON THE GROUND AS SHOWN, AND THAT /T CONFORMS TO THE ZONING BY-LAWS OF THE TOWN OF NOR7N ANDOVER. / FURINER CERTIFY THAT TH/S PROPERTY DOES NOT L/E W/TH/N A FLOOD HAZARD AREA (ZONE A OR V) AS SHOWN ON FLOOD INSURANCE RATE MAP COMMUN/7Y PANEL NUMBER 250098 0010 B. EFFECTIVE DATE.• JUNE 15, 198J io`� OF SSS DATE.• NOVEMBER 8, 1996 1 �� �� SIDNEY 9cy --------------------- ��LAJVD __ C. PROFESS/OSURVEYO n LD, JR. � #15320 ��FSS SS>- 1 I L OT 10 N 22,880 S.F. sem, a TOP OF bhp FOUNDATION fy ELEV.=164.58 �, o0 ZONE.• P.R.D. (R-2 V R. G� � MIN/MUM SETBACKS.- FRONT = 20' S/DE = 20' (SEE SEC. 8.5.6.D. 1) REAR = 20' 9 dover, Mass., M - C - L A K E ti CHI CHEW ICK C-ED P _ J BOARD OF HEAL PH PERMIT T D Food/Kitchen — "" Septic System THIS CERTIFIES THAT....................................... ....... .................................................... ........... BUILDING INSPECTOR - r 4s Foundation y �' -� has permission to erect................:....................... buildings on ...: .. ............... ............ . Rough _ ,• to be occupied as..................................................... ...........................................................:........................................................ chimney ZZ provided that the person accepting this permit shall in every respect conform to the terms of the application on fife in Final this office, and to the provisions of the Codes and By-Laws,relating to the inspection, Alteration and Construction o. — -- Y Buildings in the Town of Nortel Andover. PLUMBING INSPECTOF. -`� VIOLATION of the Zoning or Building Regulations Voids this Permit. ��� - i +. r Final =S LN OSI c . ELECTRICAL INSPECTORSTARTS J�C - -- - `- - ..................................................................................................... S�rvic .. `_ e BUILDING INSPEC'T'OR Final f� _�.� moi•--, r•-'"4 �.� � �7.P'.�I f•-./O^'.e'T'T^ ^P!"� 7^^O �_ (, � I T �~+•.��.�-� — � coiz ..c. i _. .t.� ? ..�1..�r C zQ O.Cu Building i GAS INSPECTOR Display in a ConspiCUOUS Place on the Premises — Do Not Remove i Rough -- �.,"" aminal - r No Lathing or Dry Wall To Be Done FIRE DEPARTMENT lentil Inspected and Approved by the Building Inspector. �- x E Burner -Z Street No. P �3 r= Smoke Det. _ .+r.. -a. .r;.-s•. �..�•Y.-rc. ., .-a ..`.�a.iY�.may''_f., -..s.s^..r.i.-r""-a�":v}v�yl_'.,�'......^!I-':_-T_qa.-_:4_--_., _..''L..x:+-;ht.�_Ae._x.w_''-i>`. x,,'.-_-,. .:i'::a:-....;.�-",,-.�.-+�."�..•-��°'..._.�.��._[.,•.:.�.;.:...�:,s-.�,--.�.,._._•-.., --.,...L..�,_4-•arg'�i`-r�i...'..-..:_.•X•s.-_y'_�f.?�ri1`!...:T.�.:.,':..✓:..-,^r�+=..�..�.✓...e._�..�-'!::`.'�.*,S.•rarte. ^±._„'�--_^...•_-.-.. --.'..s._.. .-.,=�.-raw ,y-- - - �a.'4A-.f•!:._- �VR .. , 77 a - _ •. 'i4w.�, •�_ T __ - - ..,�. - .•;- ,.cam. •a. ,r -�.,� - Y ft . ,x,r -�"-;: .. - -». -.<+�a�,-5,..�- ..,_ +,.., '.-... .�_... _ - , ..,.,... - - - - - ''cry 'T;v'c•- z. .-_.._ --.- ..-...3" ...--. -- .. _ ,c< .. ., _ .. :<r. .�.._._ «, ....�:.` -=fie,�.• - - .:.. �... -e......_-c.' .-.�_,.. .-: • ..._'. a., - -- -... _ .-. � _.� -.. __ ._ —. ,_--..,. .�,:�-. -_ - - 7_} --his s,.•->. ... .. -w .e TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE: August 31, 1998 This is to certify that the individual subsurface disposal system constructed (X) or repaired ( ) by Charles Zaher at Lot 10/125 Colonial Avenue has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations as described in the Design Approval Site System Permit# 800 dated 12/28/95 The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Board of Health Inspector v �- `J i I i �I TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE: August 31, 1998 This is to certify that the individual subsurface disposal system constructed (X) or repaired ( ) by Charles Zaher at Lot 10/125 Colonial Avenue has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations as described in the Design Approval Site System Permit# 800 dated 12/28/95 The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Board of Health Inspector Form No.4 Town of North Andover, Massachusetts BOARD OF HEALTH 19 ,E CERTIFICATE OF COMPLIANCE This is to certify that the Individual Soil Absorption Sewage Disposal System constructed (--<Or repaired ( ) INSTALLER at�'GGi /D / 1�v �UGO�J/��G /7G%.UUP SITE LOCATION has been installed in accordance with Board of Health Regulations as described in the Design Approval Site System Permit No. 9ne) dated / h�8 19 . The issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. BOARD OF HEALTH Form No.4 Town of North Andover, Massachusetts BOARD OF HEALTH 19 CERTIFICATE OF COMPLIANCE This is to certify that the Individual Soil Absorption Sewage Disposal System constructed (--<Or repaired ( ) INSTALLER SITE LOCATION has been installed in accordance with Board of Health Regulations as described in the ``__ Design Approval Site System Permit No. ono d < ated /�� 19 . The issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. BOARD OF HEALTH TOWN OF NORTH ANDOVER �' 1 BOARD OF HEALTH CERTIFICATE OF COMPLIANCE ] DATE OF COMPLIANCE: August 31, 1998 This is to certify that the individual subsurface disposal system constructed ( X ) or repaired ( ) by Charles Zaher at Lot 10/125 Colonial Avenue has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations as described in the Design Approval Site System Permit # 800 dated 12/28/95 The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Board of Health Inspector �� Q �. �� .p �'rT �r r jf .� �` f//`� tt'�� � -� z^ � s TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE: August 31, 1998 This is to certify that the individual subsurface disposal system constructed ( X ) or repaired ( ) by Charles Zaher at Lot 10/125 Colonial Avenue has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations as described in the Design Approval Site System Permit # 800 dated 12/28/95 The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Board of Health Inspector 1 Address 4f Title of File Pa9e of Date f=ile Open: Date file closed:— Doc Document/Action Title Date of Refer to other Purpose of Docume�nt Act action Document/ document/ / ion and nate& tWum. Action Des artment Board of Appeals — Board of Health Plannin-g Board _ Cons ervatiion C ommrssion — Building Departrr,-ien;t --� l TOWN OF SYSTEM PUMPING RECORD DATE: SYSTEM OWNER& ADDRESS SYSTEM LOCATION Coe;, �S (example:left front of hoose) l J�- 6�kvD�-�a �-"-'��--V f� DATE OF PUMPING: Q UANTITY PUMPED : t' "D�GALLONS CESSPOOL: NO `/ YES SEPTIC ANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACMULD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER(EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: G.L.S.D Lowell Waste APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE:�� Ic"(0 CURRENT INSTALLER'S LICENSE# LOCATION: - 4-Y (C) KC (v^"�f A LICENSED INSTALLER: 4r- C a4z.-c SIGNATURE: TELEPHONE# �f�—�YaS CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only $75.00 Fee Attached? Yes No Foundation_ As-Built? Yes No Approval tz,t Date: Form N°•3 An over)Massachusetts 9J- Town of North A l 1 � • BOARD OF HEALTH N°RTM , F • *� DISP OSAL WORKS CONSTRUCTION FERMI SAC US TELEPHONE ' � ADDRESS Applicant NAME 1 i Site Location an Individual Soil Ab or Repair ( ) ranted to Construct ("' royal S.S No Is hereby g on the Design App • Permission stem as shown Sewage Disposal Sy V� BOARD OF HEALTH ' CHAIRMAN, D.W.C. No. Fee I I, 1 i FORK U - LOT RELEASE FORK 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: A • C. 6ul 1(5 !A C, Phone LOCATION: Assessor's Map Number Parcel C Subdivision W000 I a Ad L5�(JL5 Lots) Street Co I D n i A I AJO_ St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected .f (�!A Date Approved / Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date RN5 LEUVEN OF 'r[RAH3M 7z%L HAYES ENGINEERING, INC. 603 SALEM STREET �+ WAKEFIELD, MA 01880 DATErf �oB TEL.: (617) 246-2800 ATTENT FAX : (617) 246-�7�5]9,6 RE. ) �(� TO GENTLEMEN: WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via the following items: ❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION THESE ARE TRANSMITTED as checked below: For approval ❑ Approved as submitted E] Resubmit—copies for approval ❑ Foryouruse ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FOR BIDS DUE 19 f / ❑ PRINTS�RETURNED AFTER LOAN /TO US REMARKS: O (i %/ ( )l J/"T- L_- V t l 0 �vy y41 9�S 6 i't�T 1 C_� ��iq"C' COPY TO: � �Lzz�SIGNED. t If enclosures are not as noted,kindly notify us at once. PLAN REVIEW CHECKLIST �J < ADDRESS Zlg9 eOZQ II-AA ENGINEER I GENERAL f 3 COPIES STAMPL-------' LOCUS y NORTH ARROW SCALEy CONTOURS_L PROFILE �� SECTION L/� BENCHMARK I-� SOIL & PERCS ELEVATIONS WETS:,--t�DI-SCLAIMER L,---- WELLS W& -E WATERSHED?__ D DRIVEWAY lev) WATER LINE-- FDN D1 N� SCH40 (— TESTS CURRENT? IL EVAL SEPTIC TANK MIN 150OGy/. 17 INVERT DROPy GARB. GRINDER(+200% EDF) 25 ' TO CELLARQ�r MANHOLEz/� ELEV GW # COMPS. — D-BOX SIZE # LINES FIRST 2 ' LEVEL STATEMENT " INLET - OUTLET /,37:�,3 7 = .146 (2" OR . 17 FT) TEE REQ'D? /yC) LEACHING / MIN 660 GPD? RESERVE AREAy 4 ' FROM PRIMARY? 2% SLOPE 100 ' TO WETLANDS � 100 ' TO WELLS L--' 4 ' TO S.H.GW (5.' >2M/IN) 35 ' TO FND & INTRCPTR DRAINS ' 325 ' TO SURFACE H2O SUPP 4 ' PERM. SOIL BELOW FACILITY ✓�J MIN 12" COVER,,-' FILL? (25 ' if above natural elev; 10 ' if below) BREAKOUT MET? y TRENCHES MIN 660 gpd SLOPE (min .005 or 611/100 ' ) SIDEWALL DIST. 3X EFF. W OR D (MIN 6 ' )_L,--' RESERVE BETWEEN TRENCHES? L/'IN FILL? `MUST BE 10 ' MIN. L-,"" 4 11 PEA STONE? VENT? (>3 ' COVER; LINES >501 ) BOT 39'6) + SIDE 5'20 X LDNG 17L = TOT (L x W x #) (DxLx2x#) (G/ft2) Copyright © 1995 by S.L. Starr No. FEE 4 THE COMMONWEALTH OF MASSACHUSETTS CD- AV-100V'l7 e- MASSACHUSETTS �yylirativn for Pisposal Vei#.em Gus#rurtion Permit Application is hereby made for a Permit to Cons or epair( )an On-site Sewage Disposal System at: Location Address or Lot No. DEt� ner's Name,Address and Tel.lo. id O c 9 Ie�lf �t� Q� Av Installer's Name,Address,and Tel. Desige is Na �d�pss aro Tel . Type of Building: Dwelling No. of Bedroom Garbage Grinderp Other Type of Building No. per Persons Showers( ) Cafeteria( ) Other Fixtures / Design Flow ` lD G© gallons per day. Calculated daily flow `� Q gallons. Plan Date `—�4 9 S Nuniker ofheet R ision Date — Title — TQC YST ck" E� C.� N 00 F(2 Description of Soil 5�2 !;�ZQ I L t'!� gr:) Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site sewage disposal system in accordance with the provisions of Tit11e,5 of the E mental Code and not to place the system in operation until a Certificate of Compliance has b sued b is Bov6KVealth. I/ Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS , MASSACHUSETTS Ter#ifi ate of (.9oxttylianre THIS IS TO CERTIFY, that the On-site Sewage Disposal System installed( )or repaired/replaced( ) on by for at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Use of this system is conditioned on compliance with the provisions set forth below: The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. This Certificate expires on DATE Inspector THE COMMONWEALTH OF MASSACHUSETTS No. , MASSACHUSETTS FEE �ts osttl kgs#eot (fons#rurttort fermi# Permission is hereby granted to to construct( ) or repair( )an On-site Sewage System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction must be completed within three years of the date below. DATE Approved by FORM 1255 Re,3/95 A.M.SULKIN CO.-BOSTON,MA Form No.4 Town of North Andover, Massachusetts BOARD OF HEALTH 19 - CERTIFICATE OF COMPLIANCE This is to certify that the Individual Soil Absorption Sewage Disposal System constructed (—J"'o"'r repaired ( ) by 2191145 e. INSTALLER n at �d r /b / /��" ��Ld.0 l/�•G /�UE�y U� SITE LOCATION has been installed in accordance with Board of Health Regulations as described in the Design Approval Site System Permit No. �6b dated A9 a8 19 . The issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. 12-j A' BOXRD OF HEALTH ' HAYES ENGINEERING,INC. 603 SALEM:STREET WAKEFIELD,MA 01880 FORM 11 - SOIL EVALUATOR FORM (617)246-2806. Page 1 FAX(617)246-7596;. q ...... Date..A....:/.....�/ JOB FILE Com onwealt I of Massachusetts NGS 6 ,�,vOOdE�'M-assachusetts Soil Suitability Assessment for On-site Sewage Disposal. ��� PerformedBy: 61. :....................................©� � --................. ............ .................... WitnessedBy: ... 1V.0y .: :..x..::.,.....:::..:....:::.::..:....::::::.:...:.. :.::.. ::. . . �..:..r�:...::M: .:...:.... ............................................................. d .....:.............................................................................................................................................................._...._............ Location Address or Owner's Name. / Q yKl t�ir La/ Address.and 1.1 rekplane r New Construction Repair-.-❑..._.,_-_. .__. _ Office Review - Published Soil Survey Available: No ❑ Yes D- d . Year Published :../.q� Publication Scale '�:/:��� Soil Map Unit .- . ... DrainageClass ... Soil Limitations .... ....................................................................................:................................ Surficial Geologic Report Available: 146 '❑ Yes ❑ Year Published ................ Publication Scale . GeologicMaterial (MapYUnit) . :.:-. ......................:................................................................................................................. Landform ...................................................................................... . ............................... Flood Insurance Rate Map: NORTH AND01 ER' TOW gOAROOF HEALTH F Above 500 year flood boundary No El Yes Within 500 year flood-boundary No ❑ Yes ❑ Within 100 year flood boundary No ❑ 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: FORM 11 -SOELEVALUATOR.FORM: Pa ' 2 P, On-site Review ................... D a ..................................... ................. Deep Hole Number to. Weather .. ........ Time:. n.."L�-....... I ) _. Location (id tif n it n ...... ....................................................................................................................... Land Use- ...................... ............... Slope:(%) ................. 'Surface Stones -_-_.-....-.-.._....-............_• ............................................ . .... Vegetation ...... ... ............................................................................................................................................................................................................ .... ..... . Landform`--...I!: . ..--............... ......................... I................. ........................................................................................................*......*­.'­*­*.............. Position on landscape (sketch on the back) ....................................................................................................... ............................................. Distances from: Open Water Body ................ feet Drairfage way................... feet Possible Wet Area .................. feet .,..Property Line ......—.... feet Drinking Water Well ................. feet.---Ofher ......................... ......... -E. LOG -DEEP OBSERVATI L Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other (Inches) (USDA) (Munsell) (Structure,Stones,Boulders, Consistency, %Gray.eq v P % I& 13�- Iql /6L Parent Material (geoloic O. WO-A g ....................... ................. Depth to Bedrock: Depth to Groundwater:. Standing Wate.- in the Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water: !l 1 AYES-ENGINEERING,INC. . 603 SALEM T11M JOB FILE FORA1 12 - PERCOLATION TEST WAKEFIELD,MA 01880 (617)246-2800 ` FAX(617)2465-7596 COMMONWEALTH OF MASSACHUSETTS Massachusetts Percolation Test Date: ..................................... Time: ..................................... Observation Hole # Depth of Perc Start Pre-soak End Pre-soak Time at 12 Time at 9" Time at 6" Time W-61 Rate Min./Inch Site Passed ❑ Site Failed ❑ ..................... ....... . ._ _........_ . ..... _.. . Performed By: Witnessed By: Comments: ..... . _. .............. ............... . HAYES ENGINEERING,INC. SOS FILE 11 - SOH, EVALUATOR FORM 603 SALEM STREET WAKEFIELD,MA 01880 Page 3 (617)246-2800 ` FAX(617)246-7596 Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole... ... inches ❑ Depth-weeping from side of observation hole.................. inches ❑ Depth to soil mottles .... 1..... inches ❑ Ground water adjustment --------------- feet Index Well Number Reading Date ................... Index well level .Adjustment factor .................. Adjusted ground water level ..._..................... Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed_throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious material? Certification certify that on �NL Vb-�S (date) I have passed the examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature �C�� Date .� ... . ;., �o � o ��� �, , � _ . � � � �, �. \ � � �: ' ( ` ` � i I I I L (b 1 A 117 ll II � IIi � r �.-`— _,._:_.�--__, .....�� .err -•----_ � ...,..._._ i . I i CFll��s i I _ Z4 7 O �' f2�ri t4 14 it r7l� yy rep O .VJ , Town of North Andover, Massachusetts Form No. 1 Q VAORTFI q BOARD OF HEALTH O ZlE° ti JK A° 0 ' OAAAPPLICATION FOR SITE TESTING/INSPECTION 7.9 TE PPp�•�y SSACHUS� Applicant 'fAL I bA 0 AME ADDRESS TELEPHONE Site Location j— lo A-6d� a.iU-'—� _ Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time iCHAIRMAN,BOARD OF HEALTH t FeeL� Test No. '-4 �I r S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH pF t�eo q1. �6 "6 °0 19 p APPLICATION FOR SITE TESTING/INSPECTION �9SSACHUSE��� Applicant t NAME ADDRESS TELEPHONE Site Location Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No.2 f pppTh BOARD OF HEALTH F � 9 DESIGN APPROVAL FOR °5` SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicants �.L� �� �--P Jl�� Test No. Site Location Reference Plans and Specs. /pAT 41-A Ve t ENGIN ER DESIGN Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. CHAIRMAN,BOARD OF HEALTH Fee Site System Permit No. 8