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r ;4, Department of Public Safety.
O,, oewp�ncy 8 rye OVICked yy BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3/90 (law bi*)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in W00fdOnCS with the Massachusetts ElectniCW Code, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION)
City or Town of /Ye w f%�o�� To the
The undersigned applies for a permit to perform the electrical WAW described below.
N
Location (Street S
Owner or Tenant .
Owner's Address
nspeC�tor •of 1Nlrea ,
Is this permit in conju ' n with s building permit: Yes ❑ No 19—(Check Appropriate Box)
Purpose of Buildings f�A���� :,t��� - Utility Authorization No
Existing Service rif»_ Amps ere-, VOI1111 Overhead B�Undgrd ❑ No of Meters
NOW S°^ft* Amps Volts Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity —
Location and Nature of Proposed Electrical Work ` ii�T% -S
OTHER: -
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
I have a current Liability Insurance Policy including Completedlona Coverage or its aubstandW equivalent. YES �NO 13I have submitted valid proof of sante to this office. YES 0— per❑.
If you have chocked YE,S; please indlaft the type Of coverage by checking the &WOWUM box.
INSURANCE 80ND ❑ OTHER ❑` (Please Specify)
Estimated Value of Electrical Work S / -0_ — (Exgimtion DARN
Worts to Start
Signed under the penalties of perjury:
FIRM NAME
Licensee
Address.
Signature
&a. Tel. Na
All. Tet. No.
OWNER'S INSURANCE WAIVER: 1 am aware that the Iiconsee do" not have the insurance coverage or its substardW equivalent as
required by Masaadweetts General Laws, and that my signature On this permit application wales this requirement.
Owner [] Agent ❑ (Please chedt one)
_ Telephone No. ___ __r__ - PERMIT FEE S
No. of Lighting Outlets
No. of Hot Tube
No. T►ansiorrners
of KVA
No. of � � Fixtures
Above In-
Swimmirhp Pbcil md. ❑ md. ❑
�--
GQnersto+b KVA
No. of Receptacle Outlets
No. of 00 surners
No. of Emergency LQWng
Battery Unite
NO. of Switch Outlets
No. of Gas burners
! FIRE ALARMS No. Of
No. of Ranges ��4No.
of Air Cond.oral
NO. d D0111111,01101, and
tons
intt�irhg DevicesNo.
NO. of Sounding Devices
of Disposals
No. of PUmt e T ns KW
NO. of DishwashersZA
Space/Area Heating KW
No. of Self Contained
Detection/Sounding Devices
❑ M130ther
No. of Dryers
Heating Devk es KWLoW
Na. Ot Water Heaters KW
No. of No. of
Signs Ballasts
Low VOltagp
Wiling
No, Hydro Massage Tubs
NO. of Motors Total HP
OTHER: -
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
I have a current Liability Insurance Policy including Completedlona Coverage or its aubstandW equivalent. YES �NO 13I have submitted valid proof of sante to this office. YES 0— per❑.
If you have chocked YE,S; please indlaft the type Of coverage by checking the &WOWUM box.
INSURANCE 80ND ❑ OTHER ❑` (Please Specify)
Estimated Value of Electrical Work S / -0_ — (Exgimtion DARN
Worts to Start
Signed under the penalties of perjury:
FIRM NAME
Licensee
Address.
Signature
&a. Tel. Na
All. Tet. No.
OWNER'S INSURANCE WAIVER: 1 am aware that the Iiconsee do" not have the insurance coverage or its substardW equivalent as
required by Masaadweetts General Laws, and that my signature On this permit application wales this requirement.
Owner [] Agent ❑ (Please chedt one)
_ Telephone No. ___ __r__ - PERMIT FEE S
M
Date....
TOWN OF NORTH ANDOVER
0
PERMIT FOR WIRING
4L
,SSA
C US
Thiscertifies that ................................................. ) ..........................................
has permission to perform ....... elor C, A -c" 0/P5
P5
...................................................................
wiring in the building of Ek........ .......................
at .............................................. vf*e ..... North Andover, Mass.
Fee Ar°,� Lic. NoAI2 � ,S ...... RM
Check # 94005-
5 b 6 '
The Commonwealth of Mas,
Urs only
;+ Department of Public Safety �.�- ---_
�y 0CM4 anoy fee Cho*&d _- _
F y. SOARD OF FIRE PREVENTION REGULATIONS 527 CMA 12:00 3/90 (M,,, y*,) �✓r'�
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in aCCOrdanee with the Maaaachusatts EbaatricM Code, 527 -CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Oat+--�'[%�/ .
City or Town of /�� / To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical wdescribed below.
Location (Street A NUTber) ��c v�f _ - -
Owner or Tenant _
Owner's Address
Is this permit In conjun nn with a building permit: Yes ElNO ❑' (Check Appropriate Box)
Purposs of Building szl±� n-A��« ���1 Utility Authorization No. i
Existing Service /� Amps ZZ -::2 f civ dolts Overhead �Undgrd ❑ No. of Meters '
•w Amps -- Volts Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and Arnpacity _
Location and Nature of Proposed Electrical Work
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
I have a current Liability Insurance Policy induolng ComPWtgd pprdratl0ng Coverage or Its substantial equivalent. YES E No ❑
1 have submitted valid proof of same to this office. YES ❑ NO ❑.
If you have chocckeddYY ;please indicate the type of coverage by checking the appropriate box.
INSURANCE I.J 80ND ❑ OTHER ❑ (Please Specify)
Estimated Value of E.tec3trlp4W Work S --/-- (Expiration Dale)
Work to Start
Signed under the penalties of perjury:
FIRM NAME /
LPC. NO.
No. of Lighting Outlets
No. vl Hot Tubs
No. of Transiormsrs KVA
No. of L h
ig lisp Fixtures
Above In-
Swimming PSI rnd. ® md. ®
^—
Ciwwnktors KVA
No. of Receptacle Outlets
No- of Oil Burners
B c � � b LiONinp
. .� _
An. Tet, No.
No. of Switch Outlets
No. of Gas burners
/
FIRE ALARMS No, of Zo/net
No, of detection and
initiating Devices (c
No. of Ranges
No. of Air Cond_/total
tons
No. of Disposals
No. of Heat Total Toast
Rumps
No. Sounding
no KW
of Devftxis
No. of Dishwashers
Space/Area Hewing KWNo.
1
of Self Contained
Deteabon/Sounding Devices
Local ®MQOther
No. of Dryers
Heating Devk es KW
No. of Water Heaters KW
No. of No. of
Ballasts
Low Voltage
wirina
No. Hydro Massage Tubs
No. o! MataraTotal HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
I have a current Liability Insurance Policy induolng ComPWtgd pprdratl0ng Coverage or Its substantial equivalent. YES E No ❑
1 have submitted valid proof of same to this office. YES ❑ NO ❑.
If you have chocckeddYY ;please indicate the type of coverage by checking the appropriate box.
INSURANCE I.J 80ND ❑ OTHER ❑ (Please Specify)
Estimated Value of E.tec3trlp4W Work S --/-- (Expiration Dale)
Work to Start
Signed under the penalties of perjury:
FIRM NAME /
LPC. NO.
� �
Lcenese tl� Signature
U NO
Address . D --- �, —
XC_ �� s�%�1.�1L� %/�
�. Tel. No,
- �.
. .� _
An. Tet, No.
OWNER'S INSURANCE WAIVER: I am aware that the licensee doh not hams the insurance
coverage or its substantial sayuivalent as
required by Massachusetts General Laws, and that my signature on this permit application waives this requirement.
Owner ❑ Agent ❑ (Please otteok ane)
_. _ Telephone No. _--
PERMIT FEE S
-
s�
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
s
METROPOLITAN BOSTON — NORTHEAST REGIONAL OFFICE
MITT ROMNEY
Governor
KERRY HEALEY
Lieutenant Governor
Diana Kiesel
1491 Turnpike Street
North Andover, MA 01845
RECEIVED
MAR - 7 2005
TOWN OF NORTH Aiv-�uVER
HEALTH DEPARTMENT
March 2, 2005
ELLEN ROY HERZFELDER
Secretary
ROBERT W. GOLLEDGE, Jr.
Commissioner
Re: Approval of Title 5 Variance (BRPWP59b) - Variance from Percolation Testing Requirement
1491 Turnpike Street, North Andover (17 -Ipswich)
"SEP Transmittal No.: W058413
Dear Ms. Kiesel:
Pursuant to Title 5 of the State Environmental Code, 310 CMR 15.412, the Northeast Regional Office
of the Department of Environmental Protection has completed its review of the above referenced
application for approval of a variance granted by the North Andover Board of Health.
The application contains a copy of the Board of Health's grant of a variance from the following
provision of Title 5, 310 CMR 15.000:
• 310 CMR 15.104, Percolation Testing
As part of the application, the Department received plans consisting of two (2) sheets, titled as
follows:
Title: Proposed Subsurface Sewage Disposal System
Location: 1491 Turnpike Street
Municipality: North Andover
Applicant: Diana Kiesel
Designer: Benjamin C. Osgood, Jr., P.E. No. 45891
Date: November 22, 2004
Based upon its review of the application, and in accordance with 310 CMR 15.410, the Department
has determined both of the following:
a) The applicant has established that enforcement of 310 CMR 15.104 would be manifestly unjust,
considering all of the relevant facts and circumstances of this case.
A percolation test could not be performed because of high groundwater. High groundwater was
encountered in the deep hole or holes excavated on site.
This information is available in alternate format by calling our ADA Coordinator at (617) 574-6872.
One Winter Street, Boston, MA 02108• Phone (617) 654-6500 • Fax (617) 556-1049 • TDD # (800) 298-2207
DEP on the World Wide Web: http://www.state.ma..us/dep
0 Printed on Recycled Paper
b) The applicant has established that a level of environmental protection that is at least equivalent to
that provided under 310 CMR 15.000 can be achieved without strict application of 310 CMR 15.104
and 15.105. The applicant has established equivalent environmental protection as follows:
A particle -size soil analysis in conformance with the Alternative Percolation Testing Policy,
BRP/DWM/PeP-P00-4, was performed and, along with an evaluation of soil compaction, was used to
determine soil classification, the effluent loading rate, and the design of the system. The soil was
found to be sandy loam and uncompacted in nature. The system is designed with a Long Term
Acceptance Rate of 0.33 gallons per day (gpd) per square foot in accordance with that policy.
The Department, therefore, approves the North Andover Board of Health's grant of a variance from
310 CMR 15.104.
Additionally, the Department imposes the following conditions as part of this approval:
• The Department has received a written concurrence from the North Andover Board of Health, dated
January 21, 2005, that the soils are uncompacted. In all future applications, the lack of written
confirmation from the Board of Health as to the compaction of the soil, in the initial submittal to the
Department, will be viewed in non-compliance with the Department's Alternative Percolation Testing
Policy and a technical deficiency will be issued.
• The applicant shall obtain a Disposal System Construction Permit (DSCP) from the North Andover.
Board of Health prior to commencement of construction of the system.
• The system is not designed to accommodate a garbage disposal. As such, one shall neither be used
nor installed at this facility.
• There shall be no increase in design flow to the upgraded subsurface sewage disposal system. The
design flow for the facility is 330 gpd. The facility consists of a three (3) -bedroom house.
• At the time of construction, if groundwater has receded to a point where percolation testing is feasible
in the opinion of the local approving authority, then confirmatory percolation testing must be
conducted and, if necessary, the system design revised based on the actual percolation rate.
• It is the responsibility of the applicant to assure that the approved plans are available at the site
during construction.
Should you have any questions regarding this matter, please contact George A. Kretas, of my staff, at
(617) 654-6602.
This variance determination is an action of the Department. If the applicant is aggrieved by this
determination, s/he may request an Adjudicatory Hearing in accordance with 310 CMR 1.00 and M.G.L.
C.30A. A request for an Adjudicatory Hearing must be made in writing and postmarked within 30 days of
the date of issuance of this determination. Pursuant to 310 CMR 1.01(6), the request must state clearly and.
concisely the facts that are grounds for the request and the relief sought.
The hearing request, along with a valid check payable to Commonwealth of Massachusetts in the
amount of one hundred dollars ($100.00), must be mailed to:
Commonwealth of Massachusetts
Department of Environmental Protection
P.O. Box 4062
Boston, MA 02211
The hearing request will be dismissed if the filing fee is not paid, unless the appellant is exempt or
granted a waiver, as described below. The filing fee is not required if the appellant is a city or town (or
municipal agency), county, or district of the Commonwealth of Massachusetts, or a municipal housing
authority. The Department may waive the adjudicatory hearing filing fee for a person who shows that paying
the fee will create an undue financial hardship. A person seeking a waiver must file, together with the
hearing request as provided above, an affidavit setting forth the facts in support of the claim of undue
financial hardship.
Very truly yours,
Madelyn Morris
Deputy Regional Director
Bureau of Resource Protection
cc: Benjamin C. Osgood, Jr., P.E., New England Engineering Services, Inc., 60 Beechwood Drive,
North Andover, MA 01845
Susan Y. Sawyer, Director, Health Department, 27 Charles Street, North Andover, MA 01945
DEP Watershed Permitting Program, Policy Section, Boston
Claire Golden, BRP/WM/NERD
Location 1 '1
No. ��yTyP �G�E�CO�.0 Date / 72G -i.
NORT1y TOWN QWRTH ANDOVER
MiNgli&c f Occupancy $
# Building/Frame Permit Fee $
Foundation Permit Fee/ $
s�CHust
Other Permit Fee �' $�
Sewer Connection Fee $
Water Connection Fee $
TOTAL `
. i
Building Inspector
Div. Public Works
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OFFICES OF:
APPEALS
131,11IX)ING
CUNSERVA110N
H EAL'I'H
PLANNING
0
Town of
NORTH ANDOVER
""" DIVISMN OI'
PLANNING & COMMUNITY DEVELOPMENT
KAREN H.P. NELSON, DIRECYOR
120 NWin Street
North Andover,
(61 i) 61-15-477!-)
In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit
Number is that the dcbris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL c 111, S
150A.
The debris will be disposed of in:
(Location of
LY)
Signature of Permit Applicant
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector.
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