HomeMy WebLinkAboutMiscellaneous - 132 CRICKET LANE 4/30/2018 / _132 Cricket Lane .
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Lot & Street 7- �,�'/ ,�-�- IZA Map/Parcel
CONSTRUCTION APPROVAL
Has plan review fee been paid: YES ItNO Permit-9
Plan Approval: Date: f zI Approved by:� z,
Designer: Plan Date:
Conditions:
Water Supply- __Town, _ ___ Well. -
Well Permit: _.Driller:
Well Tests: Chemical Date Approved
Bacteria I Date-Approved
Bacteria II Date Approved
Plumbing Sign-Off: Wiring sign-off.-
Comments:
ign-Off:Comments:
Form"U" Approval: Approval to-Issue: NO
Date Issued /d�,zs �1�'�j Bv:
Conditions:
Final Approval:
All Permits Paid? YES NO
Well Construction Approval? YES NO
Septic System Construction Approval? <�ff) NO
Certification? YES NO
Other YES NO
Any Variance Needed? YES NO
FINAL BOARD OF HEALTH APPROVAL:
DATE:
APPROVED BY:
i
SEPTIC SYSTEM INSTALLATION
Is the installer licensed? YE NO
Type of Construction: REPAIR
New Construction: -..-Certified Plot Plan Review NO
-Floor Plan Review NO
_ Conditions of Approval from Form U NO
-Issuance of DWC permit: - NO
_DWC Permit Paid? NO .
--DWC-Permit-9 Installer: W, I p Lt) P/-
-- Begin_Inspection:_ NO -
a
Excavation Inspection:
-Needed:
- Passed: 131/D (J By: 17
-.-Construction Inspection:
--Needed:
As- an Satisfactory:
S:
- Approval of Backfill: Date: By: G��/�,
---Final Grading Approval: Date: Y 9!,6 0 By:
c
Final Construction Approval: Dater � By: LJ7C�j
Date:
Certificate of Compliance: Approval: �(� /t�.
Commonwealth of Massachusetts RECEIVED
u,pCity/Town of AUG 13 2008
System Pumping Record TOWN OF NORTH ANDOVER
Form 4 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
Important: G
When filling out 1. System Location:
forms on the
computer,use
only the tab key Address
to move your
cursor-do not CitylTown State Zip Code
use the return
key- 2. System Owner.dL
"ISI Name
ISI Address(if different from location) -
l
SEPTIC PLAN SUBMITTAL FORM y
LOCATION: Lak q -1 Cts AeB LN.
NEW PLANS: YES $125.00/Plan
REVISED PLANS: YES $ 60.00/Plan
SITE EVALUATION FORMS INCLUDED: NO
DATE: I - n i)
DESIGN ENGINEER: Neer r, P n�Freer nc
DATE TO CONSULTANT: /a� z-�--•$ — o l�
JAN Z 0 ' when the submission is all in place, route to the Health Secretary.
avi VlnR.4l/Ci•u6103`— - System Pumping Record•Page 1 of 1
Commonwealth of Massachusetts
City/Town of
System Pumping Record `
Form 4
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
Important: -
When filling out 1. System Locatio Left f n eft rear, left side of house. Right front, right rear, right side of house.
forms the 1 a J l•L
computer,use
only the tab key
to move your. Jv
cursor-do not Cityrrown State Zip Code
use the return
key. 2. System Owner:
Name
Address(if different from location)
City/Town State Zip Code
S ' 1 ( 3(-P
Telephone Number
B. Pumping Record �^
1. Date of Pumping !� ✓ - 2. Quantity Pumped:
Date Gallons
3. Type of system: 8 Cesspool(s) V"Septic Tank 0 Tight Tank
p Other(describe):
4. Effluent Tee Filter present? El YesNo If yes,was it cleaned? p Yes No
5. Condition of System: a-ej oo w• ac Ppl
6. System Pumped By:
Neil Bateson F 5821
Name vehicle License Number
Bateson Enterprises Inc
Company
7. Location where contents were disposed:
L.S.D Lowell Waste Water
mo�—3 S-
igna ure of H"r Date
t5form4.doc•06103 System Pumping Record•Page 1 of 1
Commonwealth of Massachusetts
F City/Town of 1417RECEIVED
W° System Pumping Recor
Form.4 `' 4 [UII
DEP has provided this form for use by local Boards of Hea hr�`� f d, but the
information must be substantially the same as that provide lee- ttag rm, 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 : Left fr�ouse.,
right front of house,.left side of house, right side of house, Left
rear of house, rig ft side of building, right rear of building, under deck.
'I G�-C2 - Lowes tc�-O'
A.A-��
City/Town State Zip Code
2. System Owner:
Name
Address(if different from location)
City/Town State / Zip Code
to SZ
Telephone Number
B. Pumping Record
1. Date of PumpingDate 2. Quantity Pumped: Gallons J
3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes ❑- 1To If yes, was it cleaned? ❑ Yes ❑ No
5. ConditiV�W
(-a� � 1/\
& System Pumped By:
Neil J. Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc.
Company
7. Location where contents were disposed:
S. owell steWpter
Signa u of auler Date
t5form4.doc•06/03 System Pumping Record•Page 1 of 1
Commonwealth of Massachusetts i� l ��
City/Town of ��,
System Pumping Record
FOrtY11 4 TOWN Of NORTH ANDOVER
HEALM 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 Location/Righ nt of hous , Left/Right rear of house, Left/right side of house, Left/
Right side of building, Left/Right front of building, Left/Right rear of building, Under deck
Address
Citylrown Com, State Zip Code
2. System Owner.
Name
Address(if different from location)
CitylrownState (--6q 6 Zip de
Telephone Number "a
i
r'
B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped: Gallons
3. Type of system. ❑ Cesspool(s) D—Septic Tank ElTight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No.
5. ConditipnfS�'ystem:
6. System Pumped By.-
Neil
y:Neil Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7. Location contents were disposed:
GLLS-Q Lowell Waste Water
SignAtufe qt Haule Date
t5form4.doc•06/03 System Pumping Record•Page 1 of 1
Town of North Andover F NORTH ,
OFFICE OF ��°t'"•' e•do0
COMMUNITY DEVELOPMENT AND SERVICES ° . p
t
27 Charles Street :�9 _ ,.�°;
WILLIAM J. SCOTT North Andover, Massachusetts 01845 �9SsgcHus�`�y
Director
(978)688-9531 Fax(978)688-9542
March 25, 1999
Les Godin
Merrimack Engineering
66 Park Street
Andover, MA 01810
Re: Lots 1-10 Cricket Lane, North Andover
Dear Sir:
This letter will serve as your notification that the proposed septic plans for
the lots specified above have been approved for dwellings with a maximum of
nine (9) rooms.
If you have any questions, please do not hesitate to contact this office.
Very truly yours,
Sandra Starr,
Administrator
SS/gb
cc: Copley Development
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
R
Z
INVERT ELEVATIONS
BUILDING TIES 4" PIPE ® FDTN. = 198.37
BUILDING CORNER A B SEPTIC TANK IN = 1.97.96
SEPTIC TANK 20' 16' SEPTIC TANK OUT _ 197.69
PUMP TANK IN 197.UU--
PUMP TANK 31.5 14.2 PUMP TANK OUT — 2 FORCEMAIN
DIST. BOX 43.5' 30.4' DIST, BOX IN _ " FQRCEMAIN
CORN. LEACH FIELD #1 62.0 54.2 DIST. BOX OUT = 201.33
CORN. LEACH FIELD #2 54.2' 63.2' END LEACH U E Al = 201.07
CORN. LEACH FIELD #3 30.7' 44.5' END LEACH LINE j2 = 201.07
ND LEACH UNE #3 201.06
/ r
ROOF DRAIN
\ / N
/
-Al
LOT 7A
GAR.
-!
70,357 S.F. CONSTRUCTION) BIT.
(UNDER
4 13DRM. yy F•D• CONC.
TF=201. 76 C DRIVEWAY
SEPTIC A B f
TANK ;
11 3,
O ° i
00
N PUMP FORCE
CHAMBER MAIN c'
R•#1ii
1 VENT _ 15
Li TR-#2
1
Lp 41 (TyP•)� � �
3
0 R # LEACHING P
TRENCH (TY )
51.24' cv
5.55, _
L = 57.10' WATER
SERVICE
CR/C
SET NE
�A
AS- BUILT
OF
SUBSURFACE DISPOSAL SYSTEM
LOCATED IN
NORTH ANDOVER, MA.
m AS PREPARED FOR MAR 2 0
COPLEY DEVELOPMENT ��,SNOFMgto
9p
50 COPLEY DRIVE g DANIEL y�N
U H METHUEN, MA. 01844 0 . KORAVOS U
CIVILCL
f!1
jSCALE: 1"=Z4O' 9�0.377520
m DATE: MARCH 15, 2000
ui
rn SUBDIVISION LOT #7A CRICKET LAN
MERRIMACK EN LEERING SSS
PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS
66 PARK STREET 9 MW ER, WASSAOM En S 01810 • TEL (978) 475-3555• FAX (978) 475-14Q
�3V11" �'f'I 99 �*��bns otiy�
561219 Q�laO
.�®.000 86D0�'� 7►�lyJ�'f�{,jiyni✓w0 Y/✓J�y�/yMgf„j�
lo�✓si swins�szv1lh+rs .w.cs�J� y �s.
W.Vvrn In/S WS we iOWAO"V..XW
SA»1r�M�V' oA��A'172 c'�3�OOi✓d 1Y Ib JP&d N1/•K
OAw Ar.Mi w$*107 JWJ
N/ Or1�►jtw9$lyi J7z/-z err 4L "w'.4 sul Avsstwyy s,
0
'y.
Il
i 1
CY �-
0
1
's
N
N -
s �sR Oz-
�� -elll ���
INVERT ELEVATIONS
BUILDING TIES 4" PIPE ® FDTN. = 198.37
BUILDING CORNER A B SEPTIC TANK IN = 197.96
SEPTIC TANK 20' 16' SEPTIC TANK OUT = 197.69
PUMP TANK IN 197.66
PUMP TANK 31.5 14.2
PUMP TANK OUT
DIST. BOX 43.5' 30.4' DIST, BOX IN - 2 FORCEIvIAIN
"
FORCEMAIN
CORN. LEACH FIELD #1 62.0 54.2 DIST. BOX OUT = 201.33
CORN. LEACH FIELD #2 54.2' 63.2' END LEACH UNE fil201-OZ
CORN. LEACH FIELD #3 1 30.7' 1 44.5' END LEACH UNE #2 = 201.07
IEND LEACH LINE #3201.06
oRA1N
NOON• /� �N P / / J
DRAIN P ENS ooF D
R v,
\ / N
LOT 7A
S.F. ONSTRDC�ON) GAR. IT.
70,357 R C B
E
�DND 4 BDRM• ► F.D.
CONC.
TF-201. 76 C DRIVEWAY
SEPTIC A B
TAN
° ° ° °
^� N PUMP FORCE
CH AMBER MAIN
�R.#1 D BOX
1
1 VENT _ 15
(�►� w
.#2 n
N_
41' (TYP•)
3 �
2O R # LEACHING P
TRENCH
TY )
51.24' N
�1
's
5.55' _
L = 57.103- WATER
tCE
SE
CR/CK
ET NE
LA
AS— BUILT
OF
SUBSURFACE DISPOSAL SYSTEM
LOCATED IN
3
NORTH ANDOVER, MA. MAR 20
0
C6 AS PREPARED FOR
aH OF M
COPLEY DEVELOPMENTCD
� q
50 COPLEY DRIVE g°� DANIEL y�N
METHUEN, MA. 01844 KORAVOSCIVIL y
CL
LLI
SCALE: 1"=Z40' 9�0.377520
m DATE: MARCH 15, 2000
rn SUBDIVISION LOT 97A CRICKET LAN
SACK ENGINEERING SERBS
PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS
66 PARK STREET • ANDOVER, MASSACHUSETTS 01810 • TEL (978) 475-3555• FAX (978) 475-1448
!-address D (z/21G1)F� Title of File
Page of
Date File Open:
------ Date file closed:_
Doc Document/Action Title Date of __
action Refer to other Purpose of�ocume"t/Act of nand n-utes
Num. Document/ document/ --
Action mei artment
Board of Appeals — Board of Heal>h = Planmm�g.Board - Ca
nseruatiion �ommtf$Sion — Building Departnle6.t --
Town of North Andover f AORTN ,
OFFICE OF 3?0•,`�.o °0
COMMUNITY DEVELOPMENT AND SERVICES °
27 Charles Street
North Andover, Massachusetts 01845
WILLIAM J.SCOTT SSACH 5�
Director
.(978)688-953.1 Fax(978)688-9542
January 20, 2000
Les Godin
Merrimack Engineering
66 Park Street
Andover,MA 01810
Re: Lot 7 Cricket Lane
Dear Les:
This is to inform you that the revised septic system plan dated 1/4/00 for the site
referenced above has been approved for a house with a maximum of nine(9) rooms.
If you have any questions, please do not hesitate to call the Board of Health Office at
978-688-9540.
Sincerely,
V
Sandra Starr,R.S.
Health Administrator
SS/smc
cc: Copley Development
File
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance with any applicable or requirements.
***APPLICANT FILLS OUT THIS SECTION*****
APPLICANT WG_ /NSG� / V 40ZV- � � PHONE- -6;2S7
LOCATION: Assessor's Map Number 3 PARCEL 4
SUBDIVISION /iy LOT (S)
STREET C...YC j e_ 11 d 11261e, ST. NUMBER �Z
****** *****OFFICIAL USE ONLY************
RECOMMENDATIONS OF TOWN AGENTS:
CONSERVATION ADMINISTRATOR DATE APPROVED
DATE REJECTED
COMMENTS
TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS
FOOD INSPECTOR-HEALTH DATE APPROVED
DATE REJECTED
__,.% IC SPECTOR-HEALTH DATE APPROVED
DATE REJECTED
COMMENTS
PUBLIC WORKS -SEWER/WATER CONNECTIONS rr ..\\ 9a
DRIVEWAY PERMIT �w [o ` ,5 / 1
FIRE DEPARTMENTGV
RECEIVED BY BUILDING INSPECTOR DATE
Revised 9\97 jm
Town of North Andover, Massachusetts Form No.2
MORT1y BOARD OF HEALTH
f w
_ F
• ,rg;, DESIGN APPROVAL FOR
SS'CHU SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
•
Applicant� Tr Test No.
: Site Location 1,19.
Reference Plans and Specs. P96/ �/11 �_
• ENGINEER DESIGN DATE
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. ���
�.
� �v��.
i a��
APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT
DATE:.marc, CURRENT INSTALLER'S LICENSE#
LOCATION:
LICENSED I STALLER: ` PLC_j � d-00 \-Z=-kC�✓�Z o� L
SIGNATURE: TELEPHONE
CHECK ONE:
REP. : NEW CONSTRUCTION: 1/
IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT.
Administrative Use Only
575.00 Fee Attached? Yes No
Foundation As-Built? Yes No
Floor Plans? Yes No
Approval Date:`�Z4�5)6
r—
r AJ
Town of North Andover, Massachusetts Form No.3
• t NORTH BOARD OF HEALTH
. p ttau 'I,yO -
3? 3 moa u
• o
• iFi �p
'',S•^=.o•='t� DISPOSAL WORKS CONSTRUCTION PERMIT
SICHUSE
Applicant ! )
NAME ARESS n TELEPHONE
Site Location J J
Permission is hereby granted to Construct ( or Repair ( ) an Individual Soil Absorption
Sewage Disposal System as shown on the Design Approval S.S. No.
CHAIRMAN,BOARD OF HEALTH
• Fee p'
D.W.C. No. / �'f
TOWN OF NORTH ANDOVER
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
DATE OF COMPLIANCE:
4/20/00
This is to certify that
the individual subsurface disposal system
constructed (X) or repaired ()
by
Tom Sawyer
at
Lot 7 Cricket Lane
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.
The Issuance of this certificate shall not be construed as a guarantee that the system will
function satisfactorily.
O' Board of Health Inspector
T
INVERT ELEVATIONS
BUILDING TIES 4" PIPE 0 FDTN. = 198.37
BUILDING CORNER A B SEPTIC TANK IN = 197.96
SEPTIC TANK 20' 16' SEPTIC TANK OUT _ 197.69
PUMP TANK 31.5 14.2 PUMP TANK IN 197.66
PUMP TANK OUT - 2 FORCEMAIN
DIST. BOX 43.5' 30.4' DIST, BOX IN _ »
CORN. LEACH FIELD 1 62.0 54.2 DIST. BOX OUT = 201.33
CORN. LEACH FIELD #2 54.2' 63.2' END LEACH LINE = 201.07
CORN. LEACH FIELD #3 30.7' 44.5 END LEACH LINE #2 = 201.07
ND LEACH LINE #3 = 201.06
�N
P ESA
ROOF DRAT R o�
/ rn
/
J
LOT 7A
GAR.
(U
-1 70,357 S.F. NOER CONSTRUCTION) BIT.
4 gORM. W F•O•
CONC.
TF-201. 76 C pRIVEWAY
SEPTIA B
TANKi
11 3'
C a . ° i
N PUMP FORCE
CHAMBER MAIN C'
p-BOX �
1 QTR.#1
VE15'
NT _
w W TR.#2 n
N
v! Z)
R #3
41' (TYP )
LEACHING O 2
• i
ING
TRENCH TYP.)
51.24' N
�
5.5 -
= 57.10' WATER
SERVICE
I
CRICKET T p,NE
AS- BUILT
OF
SUBSURFACE DISPOSAL SYSTEM .
LOCATED IN NEAR 2 0
a
o NORTH ANDOVER MA.
m AS PREPARED FOR
COPLEY DEVELOPMENT -tNOFMq
50 COPLEY DRIVE g°�� DANIEL cy�'cn
METHUEN, MA. 01844 coy KORAVOS
CIVIL ca
SCALE: 1"=L0' 90.377520
m DATE: MARCH 15, 2000
ui
SUBDIVISION LOT #7A CRICKET LAN
SACK 04GWER114G SERYICES
PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS
ry
66 PARK STREET • ANDOVER, WASSACHUSETTS 01810 • TEL (978) 475-3555• FAX (978) 475-1448
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
DATE: 1, —Qc" z I
SYSTEM OWNER &ADDRESS SYSTEM LOCATION
(example: left front of house)
DATE OF PUMPING: UANTITY PUMPED (—GALLONS
CESSPOOL: NO S SEPTIC TANK: NO YES
fH
NATURE OF SERVICE: ROUTINE ---EMERGENCY
NOV 3 G ?nni
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:
CONTENTS TRANSFERRED TO:
TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM
INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System ( constructed;
( ) repaired:
by I d�,I !7A
located at LpT -7 L,A0E
was installed in conformance with the North Andover Board of Health approved plan,
System Design Permit # dated_ with an approved design
flow of Z140 gallons per day. The materials used were in conformance with those
specified on the approved plan; the system was installed in accordance with the provisions
of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees
substantially with the approved plan. All work is accurately represented on the As-built
which has been submitted to the Board of Health.
Bed inspection date:
Engineer Representative
Final inspection date:
Engineer Re resentative
Installer: Lic.#: Date: !-1-12--?OGS
Design Engineer: Date: . !7—6"
q
Town of North Andover NORTN ,q
Building Department 3a'og ` t,ttieo �° 6
E 1 M O
27 Charles Street o
North Andover, Massachusetts 01845 *
(978) 688-9545 Fax (978) 688-9542
T O Cp[wl[IIwKI[ 1\
Arto
��SSACHUs���y
APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION
ADDRESS
LOT NUMBERS SUBDIVISIO4_w_���..
DATE REQUEST FILED '°� ` L o
DATE READY FOR INSPECTION C_ 0 C)
FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED
ALL WORK AND SIGN-OFFS MUST BE COMPLETED WITHIN THIS TIME
FRAME. A RE-INSPECTION FEE OF TWENTY-FIVE ($25.)DOLLARS WILL BE
CHARGED IF THE STRUC DOES NOT MEET ALL APPLICABLE CODES.
SIGNATURE <
OFFICIAL USE ONLY
ROUTING
CONSERVATION
PLANNING 4PIDATE
D.P.W. -WATER METER_::j; - DATE ef-2,)
D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED
PRIOR TO THE INSCTION REQUEST DATE.
xne(,0/-- 7
IGNATURE/DP A THORIZATION
o G U u Lr Date...... ... 1�...............
NORTH
°f ;•�"� TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
�,SSACHUSE�
This certifies that
has permission to perform ...... .....(IS�.J�..............................
wiring in the building of....... ..1�...l.I!� �.�``.�,—....:F e C t7 t C
ur �3.. � L Nat......... ... .... .... . ........ .. ...C.�.......... North Andover,.Masg:r
Fee. ��.� �. Lic.No....l.. , ............ �,•�, `�rt/'.
C /ELECTRICAL INSPECTOR
w
WHITE: Applicant CANARY: Building Dept. PINK:Treasurer
Office Use Only
Permit Na
res eo axa� .�r
07 X4ss er4us5ts
Occupancy&Fee Checked
a ��adlti Sa6itq
ulp
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WODRK
AA wak to be perfarmed in accordance with Me Massachusetts Electrical Cade 527 CMR 12:00� ��
(Plefte Print in ink or type all trtfonn�ion) pate Z-5 65z u
To the Inspector of Wires:
Town of North Andover
The undersigned applies for a pn mit to perform the electrical work described below.
Location(Street&Number C 0- -7 /,3 2 C I
Owner or Tenant UV/�G�
Owners Address 3 i"� rFx NIT
is this permit in conjunction with a building permit Yes No 0 (Check Appropriate Banc)
Purpose of Build �/1 % // Utility Authorization No. 0 0 0 7
E>asting s Service-Amps-
� Amps Voits Overhead 0 Undgmd 0 No.of Meters
New Jer,, c—�D Amps Z4 ZK J volts Overhead ❑ Undgmd No.of Meters
Number of Feeders and Ampacily
Location and Nature of Proposed Electrical work )
Total
No.of USMM Outlets No.of Hot fuse No.of Transformers KVA
Above 0 In ❑
No.of Ughtinng Firm es Swimming Pool gnid ❑ grnd ❑ Genets KVA
No.of Emergency Lighting
No.of Receptacles Outlets No.of Oil Bumers Salfery Units
No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zane
TOW No.of Detection and
No.of Ranges No of Air Cond Tons Initiating Devices
Meat Total Total
010OW No. Pumps Tons KW No.of Sounding Devices
Noi of Self Contained
No.of Dishwashers SoacefArea HeatiM KW Detection/Sounding Devices
❑ Municipal ❑ Other
No.of Dryers Heating Devices KW Local Connection
No.of No.of Low Voltage
No.of Water Heaters KW sqns Bailases Whin
No.Hydro MasWe Tuds NO.of Motors Total HP
OTHER:
INSURANCE COVERAGE Pursuant to the requiremen6ts of Massachusetts General Laws �
I have a current Liability Insurance Policy i plated Operations Coverage Or its substantial equivalent NO
�Hted valid Proof of same to the NO = K you have checked YES Please indicate the cavetage by checking the appropriate rix
fLE = BOND = OTHER = (PleaseSpecify) ( pination )
�-FS—U---� Fir
Estimated Value of Electrical Vft // ��
Work to start Inspection Data Resquested Rough GiJ c /�. Final
Signed under the Pegalttes of penury: q
FIRM NAME (-.6t ti,J M AJ LIC.NO.
Licenses a&i [ O _ t,-o A n c Slgnatuffl. 44
UC.NO.
Bus.Tel No.
Addreas�� ��'��v,¢-f "rl�a-N Alt Tet.No.
OWNER'S INSURANCE W : I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Maesacllusetts
General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one)
PERMIT FEE S r
y�
PERMIT NO. � `� APPLICATION FOR PERMIT TO BUILD********NOIZTII ANDOVr,.
&IAP NO. 3 - Llll'NO. 2_ Rt:<(1R1�Or(1N�)Nt:Ntilnlll• `/-------- / /- /•DATE HOOK 1 ,..
ZONE Sl 10 ul\•_ L( F NO. yyy��� W� //lJ i✓! /\��[ G De✓ {w i�`(�
IAIVATION -!// riikrOSt.OfII11TLDING [ ` �pjo�?c- -- ------'.
OX%NFR'SNAME ,_ /a f� QB�- L` G NO.OF STORIES V2 y SIZF 3--47,6 .
OAA-,%ER'S ADDRESS y_j 7&-&.V,0:11 ! L /S t/�1� R.ASUIENT OR SIAR46
------------
e
AR('itf17:('r'SNAAIF: 92�GPi -r-r- �o2- �lll Sl%F OFFI.00RTTAIRERS j l� X ( �A/ ZNU t( 3 (2~ ala
Iil'1I1)F.R'S►:AAIF: /f��LL /II' - SPAN /6 At 1-f �A•w /���- -
DIS IANCETONFAR F.STIMILDING DIAIENSIONSOFS11.IS lia/J x
DISTANCE FROM STREET DIMENSIONS OF POS-1'S •��%,K
DISI ANCF.FROM LOT I.INFS-SIDES REAR DIMENSIONS OF GIRDERS
:AREA OF 1.01 /70 ����( FROM AGF; nE N:IIT OF FOUNDATION � THICKNESS
IS BUILDING NEAP '/e C SIZE OF FOOTING '%o ", x F2
IS 111111.DING:ADDII ION rw/a AL►TERIAL OF CHIMNEY
IS BUILDING AI:rERA)ION �w/`�O IS BUILDING ON SOLID OR FILLED LANA 1 J
AA'11.1,111111DING CONMUNI TO RF01111RF.MENI:S OF C011t: - IS BUILDING CONNECTED 10 1 OWN WATER
HOARD OF APPEM S A('TION,IF ANY IS DOII.DING CONNECUD TO TOWN SE1\'Fk
IS H111LDING CONNECIED"1-0 NAI URAL GAS LINE e�
INS I14'1IONS 3. V1401'1-RI\ NI-0101AIIOIV IANII((lsf La dOa, OG'
ESI. DIDG. UOSI 00
1 \c.t 1 I ILI il! I,F.( ncl*,s 1-3ES 1'.i1Llu;-(Ott r1.R sc�-F1.
Esr. ni.D2:.1 osi rt:n uoom
Fltrlak MIIit',%WslutoNolvi:tiDIEof. 111,11.111-m. ` sFrrl('rl:unnlNo . -- --- `--_ - - --
:AIT:A(Tlrll(:.11L1Gt:SAlI!SIIYINFilkntl(ISt'AIt:Fntt.REGliI..\ff<1NS 1. ,11'l'R11\1-I)ul': //
1'I ANS Alrsi M.111.FDAN DAI'rROA'EII BY PU11,111\(:INSI'E('1OIt `�^ 11111LO1\(:i�'S1'F:<-1mt ---
ILA 11-FII I'D - ----- -- - - OWNERS I filli -
-
'-- Co,"Y11.1 r 1-�
C(1NTR.1.1( N - ---
Sn:NAiFut (IF (1\FNI R Olt At:IIIORI/.I D M.1 N l ___---_-_-- -- ------ /] 3 `3 J U/'/J fJ: Le. Sr-
Pl.k\111 D
Revised 5/' .111(
SEPTIC PLAN SUBMITTAL FORM
LOCATION: L6)'-r 7
NEW PLANS: YES $125.00/Plan
REVISED PLANS: YES $ 60.00/Plan TOWN OF NORTH ANDOVER/
BOARD OF HEALTH
SITE EVALUATION FORMS INCLUDED: YES NO E
DATE: a��-- �� Ig99
DESIGN ENGINEER: M60,71 S iE—U Vt4q5 S '
DATE TO CONSULTANT: oZ// h
*If.you want your plans expedited, please submit four plans and included a stamped
envelope with the correct amount of postage to mail plans to Port Engineering.
When the submission is all in place, route to the Health Secretary.
i
SEPTIC PLAN SUBMITTAL FORM a
LOCATION:ILDT
NEW PLANS: YES $125.00/Plan
REVISED PLANS: YES $ 60.00/Plan
SITE EVALUATION FORMS INCLUDED: YES LNO :)
DATE:
DESIGN ENGINEER: Hf? M MA G k—"
DATE TO CONSULTANT:
*If you want your plans expedited, please submit four plans and included a stamped
envelope with the correct amount of postage to mail plans to Port Engineering.
When the submission is all in place, route to the Health Secretary.
FORM 11 - SOIL EVALUATOR FORNI
Page 1
Pro A DOVER/,
No. ...................................... BOARD OF HEALTH
Commonwealth of Massachusetts
Nom.{ AWDovER , Massachusetts V 2 6 � 4
•l� AssessmentO - e
t
ed B ....W.I..LLi^M. ....... W--Fr..P1 �i�i►1=................
Perform Y� �����
Witnessed By: .:..:�H.�I:I�.1w.A..::::STP..�.�R.:::::::::....:....:::_..v�...:::..u..,..::...:::::::::. .:.: :::.:::::.:::,..:..:: :.:..
1, o�s rte. �a�C'1.>~�( Div P1-+�`—►-�"f_
L=dw Aftcs,a
Lal �/ G..ejd W— { LAS n Tk*K Sd �P�4 D1ZIV�
C.0 Hf-TIKuf-ti , A .
New construction Repair -❑
Of 'ce Review
Published Soil Survey Available: No. Yes
❑
Year Published ...1.Q.8...�.. Publication Scale .1.I:.15�a Soil Map Unit
Ye ..............�CAtyTo.>
• .. o D�E&RTS ...............:.............
Drainage Class ....�....... Soil Limitations ....*1-H....................................
Surf icial Geologic Report Available: No ❑
Yes El
Published Publication Scale
.........................................................
Geologic Material (Map' Unit) ................................ ... �.
— .....................................,...................
Landform .......................................................................
................................................... .
itFlood Insurance Rate Map: 2
Sb?��tg q�Co G
Yes❑
I Above 500 year flood boundary No � ❑
Within 500 year flood boundary No
Yes
� ❑
Within 100 year flood boundary ' No Yes
Wetland Area:
National Wetland inventory Map (Map
unitl ..........
Wetlands Conservancy Program Map (map unit).........................................................................................
y..�au..�
Current Water Resource Conditions (USGS): Month A-V-6
Normal ❑
Range : Above Normal ❑ ormal
(hssut SD
Other References Reviewed:
FORM 12 - PERCOLATION TEST
COMMONWEALTH OF MASSACHUSETTS
WoM AUWVMZ , Massachusetts
Percolation Test
Date: y.'..`. . .. Time: .....P.-.1:1...................
Observation Hole #
Depth of Perc "-t-2 S7 '. -3 8 + F)
Start Pre-soak Z ; Ll
EndPre-soak
r�
Time at 12"
Time at 9" -Z c)
---------------
Time at 6" -S Z U ; q ell
Time (9"-6")
Rate Min./Inch
ice. I lC) t-1 ��.i ,
Site Passed LTJ Site Failed ❑
...................
Performed By:
Witnessed By: 'L) Sr'1
Comments:
LoT 7
T,D.
LE4o=SERIES TECHNICAL SPECIFICATIONS
TOWN ^"?RTH ANDOVER/
';EALTH
PUMP IMPELLER I
The pump(s) shall be model The pump shall have a VORTEX sq(91 2 6
as manufactured by Liberty Pumps, Bergen, NY, impeller capable of passing a minimum
or equal. 2" spherical solid.
The pump(s)shall have a capacity of GPM at SEAL
a total dynamic head of feet. Motor size shall
be 4/10 horsepower, single phase, 60 hz. and 115 The shaft seal shall be of the carbon/ceramic
volt operation. unitized design, with BUNA N elastomers and
MOTOR stainless housings.
The pump motor shall be of the submersible EXTERNAL CONSTRUCTION
type, oil filled, hermetically sealed and shall be The pump volute, legs and motor housing
thermally protected.The overload element shall shall be heavy gray iron castings, class 25 or
automatically reset when motor cools. better. All castings shall be enamel coated before
Motor windings shall be of the class B insulation assembly.All fasteners shall be of 300-series
rating. The rotor shaft shall be made of 416 stain- stainless steel or brass.
less steel and shall be supported by lower bronze LEVEL CONTROL
and upper sleeve bearings. The pump shall be controlled by an adjustable,
The power cord shall be of the quick-disconnect mercury-free, wide angle float switch. Float cord
design allowing replacement of the cord without shall be equipped with a series plug for manual
breaking seals to the motor and/or oil chamber. by-pass operation.
MODELS HP VOLTS PHASE AMPS DISCHARGE AUTOMATIC IMPELLER
LE41 M 4/10 115 1 13 2" FNPT NO VORTEX
LE41 A 4/10 115 1 13 2" FNPT YES VORTEX
10'cord standard on above models.
For 20'option,add a"-2"suffix to model number. Example:LE41 A-2
DIMENSIONAL DATA; PERFORMANCE CURVE 1550 RPM
Weight: LE41 M: 39 LBS.
24
Height:13.25" s 20
Major Width:10.75" (manual models) t c 1s
4
Maximum fluid temperature 140 degrees F. m Cd
12
= L p
Y 8
SPFe, 356,P I1 , 6 l2 ' T.D,14 . 2 9
� 4
PNIA °
10 20 30 40 50 60 70 80
U.S.Gallons Per Minute
CH-Certified
a MF
City of LA certification available terser 0 1.4 2.8 4.2 5.6Liters Per Second
Liberty Pumps• 7307 Lake Rd •Bergen,New York 14416•Phone(716)494-1817 Fax(716)494-1839 7291-2/93
TOWN OF
SYSTEM PUMPING RECORD
DATE:
..�, 12
SYSTEM OWNER & ADDRESS SYSTEM LOCATION
(example:left front of house)
Dawn),
II
l
l-
Cf ,,cyJ Lo
DATE OF PUMPING: 6 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: Bateson Enterprises, Inc.
COMMENTS:
CONTENTS TRANSFERRED TO: G.L.S.D Lowell Waste
Town of North Andover E NORTH ,
OFFICE OF 3�0`"'10 '6.41
COMMUNITY DEVELOPMENT AND SERVICES ° .
A
27 Charles Street :^9
North Andover, Massachusetts 01845
WILLIAM J. SCOTT 9SSACMUS�t
Director
(978)688-9531 Fax (978)688-9542
February 25, 1999
Les Godin
Merrimack Engineering
66 Park Street
Andover, MA 01810
RE: Lots 1-10 Cricket Lane
Dear Mr. Godin:
This is to inform you that the plans for the septic systems proposed for the
subdivision of Walnut Ridge have been disapproved for the following reasons:
• The septic tank detail does not show the inlet tee extending a minimum of 10 inches
below the flow line, nor that there needs to be a 3 inch space above the tees. (3 10
CMR 15.227(6) and 15.227(4)).
• There are no benchmarks shown within 75 feet of the septic systems. (310 CMR
15.220(q)).
In addition, for Lot 1:
• Abutters' names are not shown. (NA 8.02j)
• Design specifications for the proposed retaining wall are missing. (310 CMR
15.255(2)).
For Lot 3:
• The high water alarm for the pump chamber is not specified as to be located in the
house. (3 10 CMR 15.231(9))
• Slope easement is required from Lot 4. (3 10 CMR 15.255(2))
• The slope of the two lower trenches will be in excess of 8% and at minimum a baffle
is required to decrease the velocity. (3 10 CMR 15.232(3)(a)) Please consider a
velocity reducer at the high end of the two lower trenches.
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
Lot 4:
• Please note that the septic tank is drafted incorrectly.
Lot 5 and Lot 6:
• Scale of the Plan view is not shown.
Lot 7:
• The scale of the Plan view is not shown.
• Pump Note #4 neglects to state that the high water alarm is to be located in the house.
(3 10 CMR 15.231(9)).
Lot 8:
• The estimated seasonal high water elevation has not been adjusted to the highest
existing grade. This results in the leaching area being less than 4 feet to groundwater.
(3 10 CMR 15.212 a&b).
Lot 9:
• Slope easement required from Lot 10. (310 CMR 15.255(2))
• Slope to d-box exceeds 8%, therefore, at minimum, a baffle is required. (3 10 CMR
15.232(3)(a))
Lot 10:
• Fill around system runs to property line of abutter. Toe of slope required to be 5 feet
off the lot line. (3 10 CMR 15.255(2))
• Trenches #1 and#1 do not show 4 foot separation to groundwater. (3 10 CMR 15.212
a& b).
Please feel free to call the Health Office with any questions you may have.
Sincerely,
Sandra Starr, R.S.
Health Administrator
Cc: W. Scott
File
INSTALLER PROJECT MANAGEMENT OBLIGATIONS
As the North Andover licensed installer for the construction of the septic system for the property
at lative to the application of ,
dated SLS for plans by d //-24 with
revisions dated
I understand and agree to the following obligations for management of this project:
1. As the installer I am obligated to call for any and all inspections. If homeowner, contractor,
project manger, or any other person not associated with my company schedules an inspection
and the system is not ready then item two shall be applicable .
2. As the installer I am required to have the necessary work completed prior to the applicable
inspections as indicated below. I understand that requesting an inspection, without completion
of the items in accordance with Title 5 and the Board of Health Regulations may result in a
$50.00 fine being levied against my company.
a) Bottom of Bed—generally first inspection unless there is a retaining wall which should be done first. Installer
must request the inspection but does not have to be present.
b) Final Inspection—Engineer must first do their inspection for elevations,ties,etc. As-built or verbal OK from
engineer must be submitted to BOH,after which installer calls for inspection time. Installer must be present
for this inspection. With pump system all electrical work must be ready and able to cause pump to work and
alarm to function.
c) Final Grade—Installer must request inspection when all grading is complete. Does not have to be on site.
'i
3. As the installer I understand that persons or companies not associated with my company may
not perform the work required by my company to complete the installation of the system
identified in the attached application for installation. I further understand that work by others
unlicensed to install septic systems in North Andover can constitute reasons for denial of the
system, and/or revocation or suspension of my license in the Town of North Andover plus
significant fines to all persons involved.
4. As the Installer I understand that I must be on site during the performance of the following
construction steps:
a) Determination that the proper elevation of the excavation has been reached
b) Inspection of the sand and stone to be used.
c) Final inspection by Board of Health staff.
d) Installation of tank,D-box,pipes,stone,vent,pump chamber,retaining wall and other components.
5. As the installer I understand that I am solely responsible for the installation of the system as per
the approved plans. No instructions by the homeowner, general contractor, or any other persons
shall absolve me of this obligation.
Undersign Licensed Septi Installer
-7, Date:
f Y-Gn1�