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HomeMy WebLinkAboutMiscellaneous - 186 BRADFORD STREET 4/30/20180� �W v 0 lP o o c„ o --I o m o m W rt Vivint Solar 29 Draper St Woburn, MA 01801. Phone: (781) 305-3065 North Andover Building Department Donald Belanger Dear Mr. Belanger, This letter is to inform you that the following account(s) have been canceled, and therefore will not be installed: 175 Carter Field Rd PN#: 135-2017 186 Bradford St PN: 121-2017 Please cancel the associated permits and close them out in your system. Are there any additional steps to complete a refund? If so please reach out to my office adminstrator katelin, her contact information is katelin.brown0vivintsolar.com and we will be happy to complete any steps needed. Thank you. 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E O U fA �1 3 L Town of North Andover, MA 4 search... - 2'1046 -Electrical Permit - IN Conjunction with a Building Permit (Commercial or Residential) 77MUME Submission received Your request Is in progress Aug 5, 2016 at9:04am We'll I et you know of any updates via email. Feel free to check the ------------------- status at any time by coming back to this page. GElectrical Review In Prog— 0 Permit Fee - - --- - -- 4zy¢nent k E oPeimitissuante 42 Apptc t t.ocm-tion Vivint Solar, LLC Philip F 186 BRADFORD STREET, NORTH Zampitella jR ANDOVER MA o.- GHIKAS, PATRICIAA Attachments Friday, Aug 05, 2016 09:04 AM No Flies... L UW'm dPie A `� l.ommoneueaGth o� ///aasac�ueetfe Official Use Only cc�� cc77 Permit No. .1JePartinenf o�..tire �ervicee Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS Rev. 1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (NEq, 527 CW 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) I� Date: Q0 City or Town of: 0 • f � r )A O \ ��( To the Inspector of Wires: By this application the undersigned gives notic of his or her int ntion to perform the electrical work described below. Location (Street & Number) 12!5Q:> Telephone No. q�x 6(61 Vqx,)- Owner or Tenant Owner's Address Is this permit in conjunction with a building permit? Yes e Purpose of BuildingI .. I _ I j l ,l ft7C`(1,-2 No ❑ (Check Appropriate Boz) Utility Authorization No. Existing Service -LCQ Amps VcAO /,34() Volts Overhead ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Undgrd ❑ No. of Meters No. of Meters Completion ofthelollowini table may be waived by the.Inspector of Wires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans NO. Of TranOormers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool grud.e ❑ d ❑ Ba� e U tangy g ry No. of Receptacle Outlets No. of Oil Burners FM ALARMS No. of Zones No. of Switches No. of Gas Burners o. Oetection and fDatin Dances No. of Ranges No. of Air Cond. Ton No. of Alerting Devices No. of Waste Disposers eat ump Totals............ um �. I.etection/AlerEin _onsKW--..-o. .._.._.,....b o- onta Devices No. of Dishwashers Space/Area Heating KW Local ❑ Cona"Pal El No. of Dryers Heating Appliances KW see Nu o pf j or Equivalent No. of Water , Heaters o. o o. o Si Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP e ecomm cations - g No. of Devices or wtva7ent OTHER: 3C) Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of lec cal Work:'_ (When required by municipal policy.) Work to Start: a1 S (o Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE CO RAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties ofpedury, that the information on this application is d conWlete. FIRM NAME: ` .�i 'l� LIC. NO.; Ab441)Or Licensee: Z zayn ok Signator LIC. NO.: I')J t-1 I A - (if applicab! enter ' mpt" in the lkenfe number line) Bus. Tel. No.: 1W - ?x65' �.5 Address:Alt. Tei. No.:SQ1 1N�i Sit *Per M.G.L. c. 147, s. 57-61, security work requires Department of Publie. Safety "S" License: Lic. No. —4WNl±;R'S3NSCI ANC -E W:-I-am-aware-that-theLiewsm4oes-not-haw-me•liabmty irrsurance�overoge-normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ The Commonwealth of Massachusetts Department of Industrial Accidents Ogee of Investigations IV 1 Congress Stree4 Suite 100 Boston, MA 02114-2017 www. mass gov/d1a Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Liceibly Name (Business/Otgenization/Individuaq:y V SO � G V— I -T— Address: Address: ( e CD (�D W - 14,c S �11-<ZD V"`-% TQ� \/ 4 City/Statelzi : LQV-) i UT S14Q14 =-� Phone #: 80 Z-ZC�'] (O S Are you an employer? Check the appropriate box: 1. Lam'[ am a employer with 4• ❑ I am a general contractor and I Type of project (required): employees (full and/or Part-time).* have hired the sub -contractors 6. ❑ New construction2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub -contractors have g, ❑ Demolition workingfor me in an capacity. y p ry• employees and have workers' comp, insum"ce. t 9. ❑ Building addition (No workers' comp. insurance required.] S. ❑ We are a corporation and its (0. Electrical repairs ❑ pairs or additions 3. ❑ 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t C. 152, §1(4), and we have no t3.©�ther ICA— employees. (No workers` comp. insurance required.I *Any applicant that checks box 01 must also Cell out the section below showing their workers' compensation policy information. t Homeowners who submit this aiFidavit indicating they are doing all work and then hire outside contractors must submit a new atildavit Indicating such. =Contractors that check this box must attached a• additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub-conhacton have employees, they must provide their workers' comp, policy number. amt an employer that is providing workers' compensation Insurance for my empfeyee& Below Is the policy andJob site lnfornwtion. Insitrance Company Name: Z i C YYl e t CQ 1'-) Policy /1 or Self -ins. Lia #:Q � I Expiration Date: �_� (� O �4 M Pr Job Site Address. City/State/Zip:ft,/Aogln!�(i � Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failtue to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cern trndter the pghks and *naldes of perjury that the /nformatfon provided above k !rite and correct. Offlelat ase only. Do not write in this area, to be completed by city or town oJJi'cieL City or Town: Permit/License 0 Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone M Please visit our web site at http://www.mass.gov/dpi/boards/EL PHILIP F ZAMPITELLA JR VIVINT SOLAR DEVELOPER LLC (EL) 1850 W. ASHTON BLVD LEHI, UT 84043-4126 Fold, Then Detach Along All Perforations a. COMMONWEALTH OF MASSACHUSETTS • • • • • j - B .. N . ELECTRICIANS �'SSUES THE FOLLOWING LICENSE AS A REGISTERED MASTER ELECTRICIAN PHILIP F ZAMPITELLA JR o VIVINT SOLAR DEVELOPER LLC 1850 W. ASHTON BLVD o_EHI, UT 84043-0126 13141 07/3112019 69010 LICENSE NUMBER EXPIRATION DATE SERIAL NUMBER ti mac ZO a {5' Cn z COz z 0x OD OD z m =0 � W O mho 0xD 0T0 A neo TCD m T 0 -4 (n � 0 w 0 0 o m m N nOrn m n g un O N O 0 � O ----- 00 Q 0 a Cn , 0 > I ° a 0 m D CD TCrlo 00 00 c - 0 < z0 WZ 00 x `— - — - — - — - — - - — - — - — - — - — - - J O �cs0v m -� r < m r Z 0 ,n X {0�T D mmm0 m (n nAi X Z o r to m II m 0 0 Q m C)0-1 o Cl' �zZ m �0 zz0 z z m�- z�z �n< O=m 90 X m PV1.N' C = SITE Z N m INSTALLER: VIVINTSDIAR M•M• �1n'} q (ALJ j}{ �^�7 �� GhiMs Residence INSTALLER NUMBER: 1.8]].0064129 186 B.dford Sl MALICENSE: 1]6359 Na A over, MA 01865 m —1 PLAN IT m `� `� "� �` • `✓' 5095781 Desic—r.LW Last ModlOed: 7/182616 fi:13 PM Utility Are.#660883]00] i 0 1 0 0 0 T Z A C CD 50 f W O� W W � CD 0--1 O X r- Z m� rf D < m { N 2 m N �, m �I _ A Z Z iv m p 00 O m r- m D Z INSTALLER: VIVINT SOIAR Ghiq sResidence 6129 INSTALLERMA P\ � 2.0 POOHLAN �� (�n� x r• q� ii 1� t NICENSE:1]0359 North Antla�erroMA 01845 `/ 5095781 OeSinner LW Lest Maifed'. 7118120166:13 PM Uti6ry Afs.Y 6608837007 § § \\( mm` }k\ §� 5f moo 0 �k/ °C j®q r ` q oy e m m_ 0G) > 222 2 =z n>� -n ��� \ >> ��0 /\\ }M . D 2 k --i E $ DKom n& m SSEr- _ -0 - 0 0 < R C m> ® w 2 I� m Kom o >n �> z G) EE0 E c; /§ mI z + « ¥ ° m z % m m . \ a 0 z 6 u < / _ ; « m = H m � � O E z g . 2 0 O . m � e \ }; § k f )) 0QE _ - a I 2 r �10 « - /\\ \ Ip §Pm$2 \ f \k ck@�M 7 2P /§ ��IT F_ § k® -n§§ iq / ®20®®O m \§� : ; a k* PXm0 ; /0c ` 0 \Mk \\ \ CD M§ w PV ƒO)) }MA �� So|J[IEb LICENSE 1703 D D Nr tr : 3 I j I I I I WI I I I i � I I I ' o< nw 0 I I I it _ Av np<A c �E3 Dl Dy 0 OT P I 3 I a� � c n0 � 'vn _FLJ-- — — D o O F m 2 3An C: = D = INSTALLER: VIVINT SOLAR E. 1 K rH r 3 -Line Drawine 3 INSTALLER NUMBER: 1.87 MA LICENSE: 170359 2 Z n D D a K m m •c-• D D Patricia Ghikas Residence 186 Bradford St North Andover, MA 1845 Itility Account:6608837007 D D n� 3-0 n n< 300000 x : N333� n n n n 3 z x m e m x »- v n � z 3 c io' 3 0'o O ? n 3 z c�� x o o z n s w oA m � n o - K o � n � c m O � m N D w m H a z x N N m N o o� 3 p 0 � �Vi, \ D D D< = n o O D� D D<� a m N 3 3 3° a n l�0 O N c w 3 3° Z 3 w o a d N N oO n a C °o C n 3 o f a ri j m A a o v S s = - Z D r r m n N m m o m Z n ° m z o o i N oD 0 w p0 < . E s i � n o� 0 D o 3 N O x x O 3 m z W n v D a 3 c 3 n n a a p .o m n z a c- c o O 3 3 c m 3 s N W< P z n N -. o. o T W N C H o C ti d n o a „ o .D m '° m o o c 'moo x o m0 03 o3 3 < •�'• O h m m o 3 O m N w N D j w i N< m'» m< w 3 3 y 0 w n 0 0 - m 0 v .... a a D w F= y N ...3 Nv mDa'- m� o _ m O�Nv' N m z a D z oDmo _ v+ O m o n z m Z �^ Q? m O< N w w m po D D IW O N N W 01 ? A N Q0 3 Z N n t�ii D D O O NO z N m S A w ° 3 N 9 C 4 3 3 0 0 3 N a No u m m 3 o o c O O O O S o m o 3 o io m n ro p o 0 0 0 °o O1 in z c io D ,o„n �, 0, 3,0 c m n w ` C A c w w w= D � O w c c c a H O -6 ti 0 D f n .C -r' o N N fD 0 3• N C x < N � N N G Q O u a ^zo�Z a�wa o � n= ° °w ��°�' on O O m° N�vwo no 7 i) og° DDDDo a ^O CL N ox x .1 3 n X y3 y v< X xxxo. .c»=0iri O A 3 Ao A D Z X a M o o C c m i 3 C N n n N n d n 3< K- o m,, w Z 3 o O 3 N On a m O fN1 N n a N T o G N o Z -- o v N N N C N v v-- F,3 3 D io 3 _ o - y D p 0 'w m n v v m - 3 � 5, w m y -. O b 3 o JJ O _ p O C J D N d a ° � m O O z m D m INSTALLER: VIVINT SOLAR Patricia Ghikas Residence INSTALLER NUMBER: 1.877.404.4129 K y Notes m y 186 Bradford St E. 2 z page North Andover, MA 1845 MA LICENSE: 170359� 5095781 Created:?/18/16 Utility Account:6608837007 3v+onan� „ o p� n� 3-0 n n< 300000 x : N333� n n n n a 3 ° n x m e m x »- •• � 3 c io' 3 0'o O n 3 c�� x o o m � - o � n � c m w m o m N N m N o o� N in W a o 0 � �Vi, \ D D D< o D� D D<� a m N 3 3 3° c w 3 3° w� 3 a } \ . ƒ § / \ ) 7 o \«} Clo , .�. ,R< AP � , 0{6' / , K. / ^ )\ 11 Sm \ \ § . )om \\ 186 B.dbM St PV ¢0(,"LO / $/ VM[n Soil [ EcolibriumSolar Customer Info Name: Email: Phone: Project Info Identifier: 5095781 Street Address Line 1: Street Address Line 2: City: State: Zip: Country: System Info Module Manufacturer: Jinko Solar Module Model: JKM265P-60 Module Quantity: 18 Array Size (DC watts): 4770.0 Mounting System Manufacturer: Ecolibrium Solar Mounting System Product: EcoX Inverter Manufacturer: SolarEdge Technologies Inverter Model: v.SE3800A-US (240V) Project Design Variables Module Weight: 41.88778 lbs Module Length: 64.960665 in Module Width: 39.0551392 in Basic Wind Speed: 100.0 mph Ground Snow Load: 50.0 psf Seismic: 1.5 Exposure Category: B Importance Factor: I Exposure on Roof: Partially Exposed Topographic Factor: 1.0 Wind Directionality Factor: 0.85 Thermal Factor for Snow Load: 1.2 Lag Bolt Design Load - Upward: 820 Ibf Lag Bolt Design Load - Lateral: 288 Ibf Module Design Moment — Upward: 3655 in -Ib Module Design Moment — Downward: 3655 in -Ib Effective Wind Area: 20 ft2 Min Nominal Framing Depth: 2.5 in Min Top Chord Specific Gravity: 0.42 Plane Calculations (ASCE 7-10): South West Roof Roof Shape: Attachment Type: Average Roof Height: 25.0 ft Least Horizontal Dimension: 50.7355760151869 ft Roof Slope: 24.0 deg Truss Spacing: 16.0 in Snow Load Calculations EcolibriumSolar Edge and Corner Dimension: 5.073557601518691 ft Stagger Attachments: Yes Include Snow Guards: Yes Include North Row Extensions: No Description Interior Edge Corner Unit Flat Roof Snow Load 33.6 33.6 33.6 psf Slope Factor 1.0 1.0 1.0 psf Roof Snow Load 33.6 33.6 33.6 psf Wind Pressure Calculations Description Interior Edge Corner Unit Net Design Wind Pressure Uplift -19.4 -31.9 -47.9 psf Net Design Wind Pressure Downforce 11.4 11.4 11.4 psf Adjustment Factor for Height and Exposure Category 1.0 1.0 1.0 psf Design Wind Pressure Uplift -19.4 -31.9 -47.9 psf Design Wind Pressure Downforce 16.0 16.0 16.0 psf ASD Load Combinations Description Interior Edge Corner Unit Dead Load 2.4 2.4 2.4 psf Snow Load 33.6 33.6 33.6 psf Downslope: Load Combination 3 13.5 13.5 13.5 psf Down: Load Combination 3 30.2 30.2 30.2 psf Down: Load Combination 5 11.8 11.8 11.8 psf Down: Load Combination 6a 30.4 30.4 30.4 psf Up: Load Combination 7 -10.3 -17.8 -27.4 psf Down Max 30.4 30.4 30.4 psf Spacing Results (Landscape) Description Interior Edge Corner Unit Max Allowable Spacing Between Attachments 59.5 59.5 59.5 in Max Spacing Between Attachments With Rafter/Truss Spacing of 16.0 in 48.0 48.0 48.0 in Max Cantilever from Attachment to Perimeter of PV Array 19.8 19.8 19.8 in Spacing Results (Portrait) Description Interior Edge Corner Unit Max Allowable Spacing Between Attachments 46.2 46.2 46.2 in Max Spacing Between Attachments With Rafter/Truss Spacing of 16.0 in 32.0 32.0 32.0 in Max Cantilever from Attachment to Perimeter of PV Array 15.4 15.4 15.4 in EcolibriumSolar , Layout Skirt o Coupling End Coupling 0 Clamp © End Clamp ® North Row Extension Q Bonding Jumper Note: If the total width of a continuous array exceeds 35 ft, break array to allow for thermal expansion and contraction. See Installation Guide for details. Warning: PV Modules may need to be shifted with respect to roof trusses to comply with maximum allowable overhang. EcolibriumSolar Roof Weights In Conformance with Solar ABC's Expedited Permit Process Module Quantity: 18 Weight of Modules: 754 lbs Weight of Mounting System: 74 lbs Total Plane Weight: 828 lbs Total Plane Array Area: 317 ft2 Distributed Weight: 2.61 psf Number of Attachments: 37 Weight per Attachment Point: 22 lbs Roof Design Variables Design Load - Downward: 918 Ibf Design Load - Upward: 720 Ibf Design Load - Downslope: 460 Ibf Design Load - Lateral: 252 Ibf Bill Of Materials EcolibriumSolar Part Name Quantity ES10260 EcoX Row -to -Row Bonding Clip 3 ES10121 EcoX Coupling Assembly 14 ES10146 EcoX End Coupling 4 ES10103 EcoX Clamp Assembly 29 ES10136 EcoX End Clamp Assembly 8 ES10144 EcoX Junction Box Bracket 1 (Optional) ES10132 EcoX Power Accessory Bracket 18 ES10184 PV Cable Clip 90 ES10195 EcoX Base, Comp Shingle 37 ES10197 EcoX Flashing, Comp Shingle 37 Commonwealth of Massachusetts LY 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 1. System Location: Left / Right front of house, Left / , Left / right side of house, Left / Right side of building, Left / Right front of building, Left / Right rear of building, n r ec Address City/Town State Zip Code 2. System Owner. Name Address (if different from location) Citylrown ' Stat a Z Code a- �-� Telephone Number a ASR 2 1Q1�i ; B. Patowfa(Eard 1. Date of Pumping Date 2. Quantity Pumped: Gallons ;. 3. Type of system: ❑ Cesspool(s) ptic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes; No If yes, was it cleaned? ❑ Yes ❑ No: 5. Condition �sS w�, t C V �1" Gil, L 6. System Pumped By: Neil. Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Loc$6n.3vP\ere contents were disposed: Lowell Waste Water KIM t5form4.doc- 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts City/Town of RECD IVED System Pumping Record Form 4 APR, 2 2 2014 V DEP has provided this form for use, -by local Boards of Health. Other forms r ee�used;!but4hewvm _ information must be substantially the same as that provided here. Before usi gtif�ls�or riFecki,y r 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: Left/ Right front of house, Left tgiih t rear of hou j Left/ right side of house, Left/ Right side of building, Left / Right front of building, Left / Right rear of building, Under deck Address n Cityfrown State Trp Code 2. System Owner. � [A k s Name Address (if different from location) Citylrown State %� Zip Code T�+ K-� 1. C� { ice, i Telephone Number B. Pumping Record1 cob �{ > 1. Date of Pumping D `^ �~ 2 uantlty Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was .it cleaned? ❑ Yes ❑ No. 5. Condition of System: 6. System Pumped By: Neil. Bateson Name Bateson Enterprises Inc Company 7. Location where contents were disposed: Waste Water F5821 Vehicle License Number Date 1� , t5form4.doe- 06103 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 RECEIVED MAR 26 2013 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT DEP has provided this form for useiby 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: Left / Right front of house, Left rear of hous , Left / right side of house, Left / Right side of building, Left / Right front of building, Left / Right rear of building, Under deck —MM—NOMFlo City/Town State 2. System Owner. Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ Zip Code State,, Zip Code Telephone Number C J` 7-�—�'3—�-3 Date 2. Quantity Pumped Cesspool(s) L 'Septic Tank Gallons ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Con itio� of S�� 6. System Pumped By: Neil Bateson Name Bateson Entemrises Inc Company 7. Locatio here contents were disposed: "S. Lowell Waste Water c4y- O.c VA F5821 Vehicle License Number Date t5forrn4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts City/Town of . System Pumping Record Y p 9 Form 4 OR 7 providedDEP has iin ormati nmust be substantially local ally the sa easothat provided here. Befog �" �' your Tu� �r 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: Left / Right front of house, 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 ( &6 6p City/Town 2. System Owner. Name Address (if different from location) City/Town State Zip Code State Zip Code State Telephone Number B. Pumping Record 7- 1 1. Date of Pumping t ^, a 2. Quantity Pumped Date 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Other (describe): CDn---- Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condi 'on of System* 5 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location where contents were disposed: �lyS� _ Lowell Waste Water --16 -)a Date Me - t5fonn4.doc• 06/03 System Pumping Record • Page 1 of 1 UA i*t TOWN OF NORTH AN-DOVSP, SYSTEM PUMPING "CORI, 5 y 3 M Owwg--R—&—A—rD)—DD—RRE—OSq—Sc---- DATF, OF PVWNQ: SYSTEM LOCATION -.-.--,-QUAN'MTY PUMPED: ... k:tWOOL: NQ_ YES 5npcic rank: NU YES "Arvw� OF sB;tvjcj!: xov F ---RECEIVED ObShAVA'nom; JUN 0 3 2005 GOOD CONDITION FULL'Tyj (�oytrR MLAYY ORWB TOHEWN NORTH ANDO f T I , BA"LBS IN P1./1(:t.[ALTHOF DE BXCB$Slvs SOLIDS ,14 FLOODED RUNBACK -SOLID CAKKYOYBR,orr(ER EXPLA IN �yfkvm wN rtwi,3 rKANsymuo vu m Commonwealth of Massachusetts /U. AA� , Massachusetts System Pumping Record System Owner Date of Pumping: �Gv' , ? q Cesspool: No ['� Yes [ ] System Pumped by: Va&"W saavww System Location Quantity Pumped: 16�ggallons Septic Tank: No [ ] License # Contents transferred to: Greater Lawrence Sanitary District Date: Inspector: Yes [ PATRICK J. DONOVAN ASSOCIATES, INC. claim and Xoss .adjustments February 12, 1997 Building Commissioner City or Town Hall N. Andover, MA 01845 Insured Property Address Insurer Policy Number Type of Loss Date of Loss P. O. BOX 110 WAKEFIELD, MA 01880 (617) 245-5540 - FAX (617) 245-7016 : Patricia & David Ghikas : 186 Bradford Street N. Andover, MA 01845 : Hingham Mutual Ins. Co. : H09233745 : Boiler Damage : 2/7/97 F� ► � t99� 1 Claim has been made involving loss, damage or destruction of the above -captioned property, which may either exceed $1,000 or cause Mass. Gen. Laws, Chapter 143, Section 6, to be applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned Insured, location, policy number, date of loss and file number. On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. Signature Ic 4iASSOCIATION OF INDEPENDENT INSURANCE ADJUSTERS ASSOCIATgN ,, of Massachusetts "�""� M APPLICATION FOR SEWAGE DISPOSAL INSTALLATION r "` HEALTH DEPARTMENT - NORTH ANDOVER, MASS. c� I hereby make Cap for a permit for a sewage disposal installation at ' C ,L I will install this system in ac- cordance/with-all' c- cordance withall th laws of the Commonwealth of Massachusetts and regulations of the Board of Health of the Town of North Andover. Further, I will construct the house sewer of bell and spigot pipe, the minimum diameter being 4 inches, and will maintain a minimum grade of 196 until 10 feet pre- ceding the septic tank, where the grade shall not exceed 2%. I will install a con- crete septic tank of in size. A manhole (s) permitting easy cleaning will be provided with removable cover (s) of iron or concrete within 12 inches of the ground surface. I will provide subsurface disposal field with 4 inch perforated or open jointed pipe and laid in a series of trenches, the bottom of which will pro- vide a minimum of 2---e lineal (square) feet of effective absorption area. The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging in size from 3/4 to 1-1/2 inches (dia.) and the pipes will be surrounded by similar material to a height of 2 inches above the crown of the pipe, The joints of these pipes will be protected from clogging and before filling the trench, 2 inches of gravel or stone 1/8" to 1/4" (dia.) will be placed over the course gravel or stone. The disposal field will be installed at a grade of 4 to 6 inches/100 feet,. No single tile line will exceed 100 feet in length and in any case, two lines of tile will be installed. A minimum of 6 feet will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the installation will be less than 100 feet from any private water supply, 25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line. I further agree not to cover any portion of this installation until approved by the inspection officer, as provided below, and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application. DATE `r Y�/%/ Signature of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DATE 16 f 1-2 / Signature of Health Agent I have inspected the uncovered system indicated above and find everything done as describ Id. DATE 71 i T Percolation est / ,� L_. Garbage Grinder AQL C j_�) Signature of nspecting Officer "}00 BOARD OF HEALTH TOWN OF NORTH ANDOVER, MASS. t -D v 5-O' lTO� 3S � ,Pod 1. NAMEl ARCD Q RP DATE MAY � �j I�� 2. ADDRESS LOT NO. `j TEL. 3. NO. OF BEDROOMS 3 DEN YES L--- NO 4. GARBAGE GRINDER YES NO Z, 5. SHOW DIMENSIONS OF HOUSE t... 6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES �- 7. SHOW DIMENSIONS OF LOT 8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL t_ 9. NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM /j/a/1►4, 10. SHOW LOCATION OF BROOKS, STREAMS, DITCHES, LEDGE OUTCROP, ETC. 11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY. w . . r BOARD OF HEALTH OF NORTH ANDOVER, MASSACHUSETTS SEWAGE DISPOSAL DATE 5/2841 NAME OF APPLICANT , Barco Gcr 'poration LOCATION Lot #9 Bradford St. Address of lot no. BUILDING: Dwelling x Other SYSTEM: New x Repair GENERAL DESCRIPTION OF LAND high SUBSOIL: Clay__!_Gravel Sand PERCOLATION TEST 12 minutes per inch. MINIMUM INSTALLATION RECOMMENDATIONS CONCRETE SEPTIC TANK 1}000 gallon capacity. LEACH FIELD 200 lineal feet of drain pipes 4aA --VwxL� J1 illiam i. Dr's oll, Engineer Board of Healt N -stem Owner FORM 4 - SYSTEM PLN Commonwealth of Massachusetts , Massachusetts System Pumping Record system Location N BOARD OF "v— Sq Date of Pumping: ����' / Quantity Pumped: (gallons Cesspool: No Yes Septic Tank: No ❑ Yes System Pumped by- _ License 4: Contents transferred to: S Date Inspector Commonwealth of Massachusetts N, �c�s.�.uC Massachusetts 0 System Punning Record System Owner CO Date of Pumping: i ( — C O Cesspool: No Pl Yes L-1 System Location Quantity Pumped: le -t/ gallbns Septic Tank: No U Yes tai' System Pumped by: lee'don' 51.an, m a License Contents transferrted to : Greater Lawrence Sanitarit 019trid Date: lttspectbr: - Commonwealth of Massachusetts P, 4414—P� Massachusetts �stetn Putn_ping Record System Owner G " �.� S - Date of Pumping: �' �� qk Cesspool: No Yes L_l System Location Quantity Pumped: ja-U gallons Septic Tank: No U Yes �=1 System Pumped by: Varedert 5''rian"" e j License # Contents transferrred to : Greater Lawrence Sanitary District Date: Inspector: [e, a) 0) d 4- 0 m It I 6 f0 I G Q 0 0 m y 0 c. L a L Q� U C C CD .0 1- 0 Q U O O C r 0 Cl m Z is Commonwealth of Massachusetts City/Town of RE:forffTn. System Pumping RecordForm 4APR 8� ,RDEP has provided this form for use by local Boards of Health. Other fo FRO U3- T.�1�QWN � information must be substantially the same as that provided here. Befo mg is 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. B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped 3. Type of system: ❑ Cesspool(s)p Ic Tank ❑ Other (describe): e/oznzz� Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes 0- eo If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 0 '�-L ( V111- 6. System Pumped i3y: Name 7. Location /ehicle License Number Date :!�o IlC�� -E -31--0 t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 A. Facility Information Important: When filling out forms on the 1. System LoCa ion: computer, use only the tab key to Address move your cursor - do not use the return Zip Code State Cilyfrown key. VQ 2. System Owner: c^ Name Address (if different from location) 1 1 Zip Code State aS City/Town Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped 3. Type of system: ❑ Cesspool(s)p Ic Tank ❑ Other (describe): e/oznzz� Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes 0- eo If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 0 '�-L ( V111- 6. System Pumped i3y: Name 7. Location /ehicle License Number Date :!�o IlC�� -E -31--0 t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Important: When filling out forms on the computer, use only the tab key to move your. cursor - do not use the return key. Commonwealth of Massachusetts RECEIVED City/Town of MAR 2 7 2009 System Pumping Record Form 4 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT DEP has provided this form for use by local Boards of Health. Other orms 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: Left front, left re r, left side of house. Right front right rear right sid of hoias r l =t Address Cityrrown 2. System Owner: Name Address (if different from location) City(rown B. Pumping Record 1. Date of Pumping 3. Type of system: 8 State �0 �cas Zip Code Stat _ �c Q C ode Telephone Number 3- '-5 Date 2. Quantity Pumped Cesspool(s) a-S—eptic Tank Other (describe): 4. Effluent Tee Filter present? [] YesO 5. Condition of System: n, l 6. System Pumped By: Neil Bateson Gallons L] Tight Tank If yes, was it cleaned? p Yes Lj No F 5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Locat' ontents were disposed: S,.L.S.D Lowell Waste Water of Hduibr Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts City/Town of a System Pumping Record wM Form 4 RECEIVED HAR '19 2010 TOWN OF NORTH ANDOVER DEP has provided this form for use by local Boards of Health. Other fges 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: Left side of house, Right side of house, Left front of house, Right front of house, Left rear of hou Right r r o ous . Left reaj of building. Right rear 9f building. Address 19-6 6 Cityrrown 2. System Owner: Name Address (if different from location) Cityrrown S1 State Douv-', C� &�) �6 �'q S Zip Code State C a 7jQ Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes to Gallons ❑ Tight Tank If yes, was. it cleaned? ❑ Yes ❑ No 5. Condition of System: n C) C""� N V�- q-z;pt� 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Location where contents were disposed: Ln D Lowell Waste Water of F5821 Vehicle License Number Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 �L\ Commonwealth of Massachusetts W City/Town of Lusing �CEISystem Pumping RecordForm 4����of N074DEP has provided this form for use by local Boards of Health. Other forbre (WER information must be substantially the same as that provided here. Before h 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: Left front of house, right front of house, left side of house, right side of house, Left rear of house, right rear of house, left side of building, right rear of building, under deck. I S-6 e S�- Q0 r4t\� City/Town State Zip Code 2. System Owner: 6 k 11 �� Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): S' l)C2 - I f — 2. Quantity Pumped: Septic Tank Date Cesspool(s) State Zip Co � r ��- Telep one Number Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Conditi n of System: 6. System Pumped By: Neil J. Bateson Name Bateson Enterprises Inc. Company 7. , to where contents were disposed: G.L.S.D. F5821 Vehicle License Number Date W t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 :-C\- Commonwealth of Massachusetts City/Town of V Sstem Pumping- Record Form 4MEN s • pF tt� DEP has provided this form for use -by local Boards of Health. Othertrti '11'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: Left / Right front of house, Left(Rid t 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 i „ r44 / a Avja�,,f City/Town l — 1(<, State Zip Code 2. System Owner. Address (if different from location) CityTrown B. Pumping 1. Date of Pumping 3. Type -of system: ❑ ❑ Other (describe): S Date [ t 2. Cesspool(s) 4. Effluent Tee Filter present? ❑ Yes 5. Condition of System: 6: System Pumped By: Neil. Bateson Name Bateson Enterprises Inco Company State Zip Code Telephone Number Tank Pumped: 1 0(��;'; Gallons —? ❑ Tight Tank No If yes, was it cleaned? ❑ Yes ❑ No, 7. Lo re contents -were disposed: Lowell Waste Water F5821 Vehicle License Number Lf- 1!1-t� Date t5form4.doc 06/03 System Pumping Record • Page 1 of 1