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Miscellaneous - 2009 SALEM STREET 4/30/2018
N Libertv Mutual 1- 01�r March 10, 2015 Town of North Andover Attn: Building Inspector 120 Main Street North Andover, MA 01845 Re: Property Address: 2009 Salem St, North Andover, Ma 01845 Policy Number: H3S21864145240 Underwriting Company: LM General Insurance Company Claim Number: 031428328-0001 Date of Loss: 2/10/2015 Attn: Town/City Official Liberty Mutual Insurance New England Region Central Property Unit 75 Sylvan Street Danvers, MA 01923 Tel: (800)566-0323 Pursuant to M.G.L. c. 139, § 3B, please be aware that a homeowners insurance claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or causes the condition of a building or other structure to render Mass. General Laws, Ch. 143, § 6 applicable. You are required to notify Liberty Mutual by certified mail in accordance with Mass. General Laws Ch. 175, §99, if you intend to initiate proceedings designed to perfect a lien pursuant to Mass. General Laws, Ch. 139, § 3A & B, or Mass. General Laws, Ch. 143, 5 9, or Mass. General Laws, Ch. 111, § 127B. This letter should not be construed as a waiver or estoppel of any of the terms, conditions or defenses afforded by the policy or applicable law. Please direct your notice to the attention of the undersigned and include a reference to the above captioned property address, policy number, claim number, and date of loss. Sincerely, Liberty Mutual Support Liberty Mutual Insurance New England Region Central Property Unit 1-800-566-0323 PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division Cenificate of Compliance As of.- December fIDecember 20, 2011 This is to cert that a S.APIISFAC2ORTE SISECTION Was completed for the: f air/ facement of an On-site SN ago a=Qgs�m (By: IWI am 2: Sawyer at: 2009 Safem Street Map-108.,X-1'arcef/Got 2 9Vorth Andover, WA 01845 The Issuance of this certificate shad not be construed as a guarantee that. the On Site Sewage DisposaCSystem wiCCfunction satisfactorily. Suian T Sa r, IREY1 (Puffic YfeaCth Director 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Date .... v � ,aORTI TOWN OF NORTH ANDOVER PERMIT FOR WIRING.- This IRING.- This certifies that .........j fl ....................... ............................ has permission to perform . .......................... .......... .......................... y wiring In the building of ........ / ............................. r�> ................................. .... _ at � s;--� ©.........:................................................. .. . North Andover, Mass. 3f Fee ..1 Z-75.... Lic. No. ` i ELECTRICAL INSPECT;( Check it [ p 10,504 3 C®mmonweafth of Massachusetts Official Use Only " z Permit No. } Department ®f Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL. WORK 1 All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 MR 12.00 (PLEASE PRINT IN OR TYPE ALL INFORMATION Date:__j/ City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her inte/tion t/o perfoim the electrical work described below. T.nratinn N reet Bz Number) /� n� /r'//%/1 577/�<iT f Owner or Tenant Owner's Address Is this permit in conjunction with a building permit? Purpose of Buil( Existing Service Amps /,-20/a Volts New Service Amps / Volts Number of Feeders and.Ampacity '5� `! Location and Nature of Proposed Electrical rk: (Check Appropriate Box) Utility Authorization No Overhead Undgrd ❑ Overhead ❑ Undgrd ❑ 4R 4,ol_ �C�O No. of Meters Comnletinn of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaireses 6 -- V dle) Fans No. of Ceil: Susy. (Paddle)Fans No. of total ' Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑'In- ❑ nd, grnd. No. of Emergency Lighting Batter Units No. of Receptacle Outlets 30 No. of Oil Burners FIFX ALARMS No. of ?ones No. of Switches ia- No. of Gas Burn_ NO..of DeteD and InitiatingDers evices No. of Ranges No. of Air Cond. 3T'oonsl �I No. of Alerting Devices ' Heat Pump Number Tons KW No. of,Self-Contained No. of Waste Disposers P Totals: -...... ....................... ..............._..... Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW g P '� Local ❑ Municipal Other Connection No. of Dryers ry Healing Appliances Imo' Security Systems:* No. of Devices or Equivalent No. of Water KW No. of Pio. of Data Wiring: Heaters Signs Ballasts . No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: i Attach additional detail if desired, or as required by the Inspector of wires. Estimated Value of lectric 1 Work: �o.�� (When required by municipal policy.) Work to Start: e Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: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" co'veiage 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 X BOND ❑ OTHER ❑ (Specify:) I certify, under the sins and penalties o peri ry, that the information on this application is true and complete. -1 FIItli�! NAME: (/ GI t°G r C 1-:/dG LIC. NO.: Licensee: �/�i �61l�/j tJ�/)roy Signature LIC. NO.: 1- _ (If applicable, enter "exempt" in the lice se number h e.) `N fes/ Bus. Tel. No.- 6C 3d —aaS$ Address: _T��-1 �i!5 �S ► �7Alt. Tel. No. 7 2 ' C1 *Per M.G.L c. 147, s. 57-61, security work requires DepaKment of Public Safety "S" License: Lie. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ Lc.�...4_._.. Tolonhnno Na t (l�21 < tie Conimanwealth of ifh'Ssachusetts ! Department ofIndustrial Accidents M VIS Office of Investigations 600 Washington Street H. Boston, MA 02111 www.hwss.gov/dia . Workers' Compensation Insurance Affidavit.- Builders/Contractors/Electricians/Plumbers A o."ll..---- a T- ,C — __ _ __ LIEt J 0 1r) C Name (Business/organization/Individtta) :�j LAG Address: City/State/Zip: Phone#:� D _3 ) . �; 0 Are you an employer? Checkthe appropriate -box: I°am a employer with 3� 4, ❑ 1 am a general contractor and I employees (frill and/or part-time),*have 2. ❑ I am .asole proprietor. or hired the sub -contractors listed $ partner- ship and. have no employees on. the attached sheet. These sub -contractors have working for mein any capacity, workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] 3. ❑ I am a homeowner doing all work officers have exercised their right of exemption per MGL myself. [No•workers' comp. c. 1.52, § I (4),'and we have no insurance required.] t employees. [No workers' comp, insurance required.] P___5 2fa 7 _O ,�> 5� 12;— Type of prgject (required): 6. ❑ New construction 7.❑Remodeling 8. [j Demolition 9. ❑ Building addition 10. ❑ .Electrical repairs or additions ` "I I.Q Plumbing repairs or additions 12-E] Roof repairs 13.❑:Other - -��� 7 muse also nu out the section below showing their workers' compensation policy information, t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. #Contractors that check this box muststtaehed an additional shegtshowing the name of the subcontractor. and their wor.Uers' comp. pt lick inforat'on. I am a.R employer that Is pvroviding workers' C&Apevrsadoat ia2suravace for rosy employees: Below is the policy and job site inforrrlatiom Insurance Company Name:_' Policy # or Self -ins. Lie, #: Expiration Date: o) I 1 Job Site Address: 20 0 Cl !�,A City/State/Zip:_ Attach a copy of the workers', compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can Iead 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 certify der he 5oYpenalfies of perjury that the information provided above is true'an correct official use only. Do not verde %� ikls Area, tm be c,�,;,pl�t�d by city or t�ulit. ofjiciaL 1 City or Town: Permit/License # i Issuing Authority (circle one): L Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical In 6.Other spector 5. Plumbing Inspector Contact Person: Phone Date. Ahok......... . r � - � Z -L TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .... e. W.. . .................... has permission for gas installation in the buildings of ... ... . .................. at ... ............. North Andover, Mass. Fee. Lic. No.. . ..... GASINSPECTOR Check 7892 �„��l'Y aotFl G MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) N ANDOVER ,Mass. Date 11/17 Building Location 2009 SALEM ST 2011 Permit # Owner's Name GEORGE HASETLTINE Owner Tel# 603)65-8768 Type of Occupancy RESIDENTIAL New Renovation Replacement F] Plan Submitted: Yes[�-] No[:] FIXTURES Installing Company Name Eastern Propane & Oil, Inc Address 131 Water Street Danvers, MA 01923 Business Telephone # 800-322-6628 Name of Licensed Plumber or Gas Fitter JACK COOMBS Check one: Certificate ZCorporation Partnership Firm/Co. INSURANCE COVERAGE: I have aCurren; liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yesll ✓ No ❑ If you have c ecked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy F( Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I herebv certifv that all of the details and information I have submitted (or entered) in above aoDlication are true and accurate to the best knowledge and that all p bing work and installations performed under the permit issued for this application will be in compliance with all pertinent pr,dyisions of a i�ilasAchusetts State Gas Code and Chapter 142 of the General Laws. By Type of License: •abber G Title as fitter • -Master City/Town • -Journeyman APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber or Gas Fitter License Number -.Z %el J Installing Company Name Eastern Propane & Oil, Inc Address 131 Water Street Danvers, MA 01923 Business Telephone # 800-322-6628 Name of Licensed Plumber or Gas Fitter JACK COOMBS Check one: Certificate ZCorporation Partnership Firm/Co. INSURANCE COVERAGE: I have aCurren; liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yesll ✓ No ❑ If you have c ecked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy F( Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I herebv certifv that all of the details and information I have submitted (or entered) in above aoDlication are true and accurate to the best knowledge and that all p bing work and installations performed under the permit issued for this application will be in compliance with all pertinent pr,dyisions of a i�ilasAchusetts State Gas Code and Chapter 142 of the General Laws. By Type of License: •abber G Title as fitter • -Master City/Town • -Journeyman APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber or Gas Fitter License Number -.Z %el Aug. 12. 2010 9:360 No. 3096 P. 2 The Commonwealth ofMassachusetts Department of Industrial Accidents Office ofInvestigations 600 Washington ,Street Boston, M41 02111 Workers' Compensation Insurance Affidavit: Builde.s/ContractorsMe--tncians/Plmmbers Aplicant Information Please Print Leobly Name (BusinesaJQrganiza iordlndivi&4' Address: City/StatelZip;���/'�JS%��� Are you an employer? Check the appropriate. boa: Type ofproject.(required): I • I am. a employer with J . 4• [] 1 am z general . contractor and I 6. ❑ New construction employees (fu11 and/orpml-time)." 2. ❑ I am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet '$ ❑ Remodeling ship and have no employees These sub -contractors have 8. ❑ Demolition workinE for mein any capacity' a actty workers' .comp. insurance. g, Ruildin addition {No workcrs' camp. insurance [ We are a corporation and its ME] repairs ar addrtions zequvred.j 3.0 1 am a homeowner doing all w - ork officers have exercised their right.of exemption per MGL 11.E] Piumbing.regairs or additions myself. (No workers' comp: 1 c. .152, §1(4),.and we have no elnployees. [No.workers' 12.{] Roof repairs insurance ] re uired. q 13. Other- GaS i s. ,rn� comp. msurance required_] •::Aay nppHcaactbat cbecia bat #1:M= also •fill M the ss=2i0a below shawing d!cir watt=' mon policy taftmLadtm t H=emm= who submit ibis affidavu mditadng theyata dour alt work and thea hire amffide camun== mast mbmtt a ww affidavit ba=ti ag spa 1Ccn= a m that check this box moat strshed. additi=r1 ah=t showiag the, mme of the sab-conhzm= and that: zvaiess' comp- Policy idvMuliaa I act an employer that is providing workers' compensation kzyw a mejbr_my empioyees Below is tate policy and job site . . 7l7fOTOfa?1172 "' .. - - Insurance Company Name: Policy -#.or Self :ins, Uc, E=iration Datc r% �i% �/�� 6 Oar/ Job Site Add -ss: aran4 �S I S} • - .CitylStateJZip:d, A,% e� alit � MS , O I S If S ; Attach.$ copy of the workers': compewmtiov policy, declaation P�e�(sho €-the policy number-;nd �kVlon data. 3 �=- Failure, to secure coverage w requimd under Section 25A ofMGL.c. 1S2: can lead -to the imposinon-of criminal, penalties .of a fine up to. S 1,500.00 andlair ane -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fne _ . of up to S250 -Ma day against. the -violator. -Be advised that a copy. of this statement may be forwarded to the Ofncc of ,' Investigations of the DIA for insurance coverage verifieatim I. I do hereby.cerriff under -the pains and p perjtg e-inyonnadon provided obavc. is.rru.e and correct t/ Phone # _ OU -X al use only. ho not write in this area; to be completed by .city or lown nffj--fal City or Town: Pe* m1tlLleense Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Tow-in Clerk 6. Other Contact Person: 4. Electrical Inspector 5, Plumbing. Inspector Phone #: Date.1��1 ........ Of ,ORT1y 1ti TOWN OF NORTH ANDOVER ry P PERMIT FOR GAS, INSTALLATION This certifies that .41 1118 ..................... t has permission for gas installation..AP104.47 .5........ . / r in the buildings of .............. at .... ZP5��.... 7............ NorthAndover., Mass. Fee ..Lic. No. GAS INSPECTOR Check # 7927 CN- MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING -IV City/Town: fl p �i� , MA. Date: �y- I Permit# Building Location: d©©� S �-1p Owners Name: r G. Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential [I� New: ❑ Alteration: ❑ Renovation: Replacement: ❑ Plans Submitted: Yes ❑ No ❑ FIXTURES W W rn � Z Q co CO U = W W m= O W W L) (q I_�- O= W W Z Z F— g O W ? O co W W � co V Z W 0 Im O Wa Q W � W X W I- W Q W W W Z 9 W = CO H W I- p = Li ZU W Z O J Q Q o0 W O Z O I- Z W W W W J I.., til I- W W V O t=i (Q'i 2= O d W F>>> O~ SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 FLOOR 4 FLOOR 6 FLOOR 6 FLOOR 7 FLOOR 8 FLOOR Installing Company Name: //D We, i'°T'�-� L. Check One Only Certificate # _ t�C+✓ Address: •®. y _K---7 L��,�j El corporation City/Town: �(((9,iM V`��State: �f ❑ Partnership Business Tel: _ 6.03 ` Jc� 5-Igj �S Fax: Name of Licensed Plumber/Gas Fitter: t 0,4, e— El Firm/Company INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ❑ No ❑ If you have checked Yes, please indi a the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANC AIVE : I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massarus s ene Laws, nd t t my signature on this permit application waives this requirement. Che�One Only Owner [�]/ Agent ❑ Si natuwner or wner's A ent By checking this box (]; I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 14 of the General Laws. By Type of License: ❑ Plumber ❑ Gas Fitter Title t3 L ❑ter Sign ure of Licensed Plumber/Ga Fitter Ci y/Town oumeyman License Number: 313 TD APPROVED (OFFICE UsE ONLY) 0 LP Installer The Commonwealth ofMassachusetts Department of Industrial.Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Sr www,mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors[Electricians/PIumbers )plicant Information p�� .. T-_ �L T •w � Name (Business/Organization/Individual): Address: f - 0 2 City/State/Zip:_ryLeyz o < ;, tA- G �__ P. 1• - Phone #: (e QA — 36 9- /913 Are you an employer? Check the appropriate box: . 1. ❑ I am a employer with 4. ❑ I am a general contractor and I 2. e?wployees (full and/or part-time).* have hired the sub -contractors I am a sole proprietor or partner- listed on the attached sheget t ship and have no employees These sub -contractors have working for mein any capacity. [No workers' comp, insurance workers' comp, insurance. 5. ❑ We are a corporation and its required.] 3. ❑ I am a homeowner doing .officers have exercised their all work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] t employees. [No workers' COMP, insurance required j Type of project (required): 6. ❑ N9,w construction 7. gRemodeliug 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.0 Roof repairs 13.❑ Other *Any applicant that checks box #1 Homeowners who submmust also fill out the section below showing their workers' compensation policy information. I it this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp, policy information. lam an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. Insurance Company Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: , City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required Wider Section 25A ofMGL 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 civilpenalties 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 ofthis statement maybe forwarded to the Office of Investigations of the DIA, for insurance coverage verification. Ido hereby certnder thepains 0ndpe � Itles ofperjury that the informationprovided above is true and correct. r/ o / 5-1P,3S— ""'caal use only. Do not write in this area, to be completed by city or town offcial. City or Town: Permit/License Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 6 Other /-dl1- // 4. Electrical Inspector 5. Plumbing Inspector Contact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shallnot because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shallWithhold the issuance'or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants PIease fill out the workers', compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificates) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy; please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/licexise applications in any given year, need only submit one affidavit indicating current Policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)" A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year. Where a homeowner or citizen is obtaining a license or permit not related tor any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOTrequired to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: xhae Co -t 7.�.1.loAA1'1Fealt ofyassacl usetts Department of 7adustnial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 TO. # 61.7.727•-4900 ext 4406 ox 1-877-MA.SSAFE Revised 5-26-05 Fax # 617--727;7744 Wwvu.mass.l;ov"a. 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O II FY m m ,fl bGC? y SET Z M 3 \ • 00 t4F p` c "° �'raF '�✓J oo yC;;"JW m� cn 3� Ln ------ o -- 3; N �+ a5 0 HN < W F 6 0 acon w En Oq I O n M o£ Z \7� ( & °C� e § ) )& \ : . \R/ /R\ j§ $)/ ()y 2 3) \ / \ � ■ § \ \ / ( (\ ( ( \k/ ~ \)§ \ : . � ( . / \ \ }� @ PCI z X00 \uw � ( (\ ( ( \k/ ~ \)§ cn G) }� @ PCI z X00 \uw � LAN WAS SALEM WOODS zVrsroN, AND NORTH ANDOVER, MA RULES AND DEVELOPER: DEEDS. 2009 SALEM . STREET REALTY TRUST HE TECHNICAL 66 GILCREST ROAD LONDONDERRY, NH 030 53. 'S OF THE OWNER: AND MAPPING," 2009 SALEM STREET REALTY TRUST 66 GILCREST ROAD -LONDONDERRY, NH 03053 2 SCALE: AS NOTED 0 1 DATE: JULY 13, 2011 L. S. MERRIMACK ENGINEERING SERVICES 66 PARK STREET ANDOVER MASSACHUSETTS 01810 <-HEET 1 OF 6 DefieChiaie. Pamela From: Isaac Rowe [irowe@miliriverconsulting.com] / Sent: Thursday, June 16, 2011 12:10 PM (� To: 'Susan Sawyer (ssawyer@townofnorthandover.com)' Cc: DelleChiaie, Pamela; 'Dan Ottenheimer'; 'Randy Burley'; 'Marianne Peters' Subject: 2009 Salem Street Attachments: 2009 Salem Street - Soil Logs 6-15-11.pdf Susan, Attached are the soil logs for the above referenced property. This was for new construction for 2 lots. As indicated in my notes Bill will survey locate the test pits and reschedule to conduct the perc tests. The soil was nice glacial till with some pockets of ledge but overall very deep well drained soil. Please let me know if you have any questions. Thanks, Isaac M. Rowe, R.S. Project Manager Mill River Consulting 6 Sargent Street 1 Gloucester, MA 01930-2719 Phone:(978)282-0014 Fax: (978) 282-1318 irowe o.miIIriverconsulting.com www.millriverconsulting.com Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. SLS I�sl.1�---20ocl S,Inl."S A lz L3 —.5ye.f I-a-- Az- 12 Lo 11--oo I A-� Cf ,NOR71+.,hQ U 1 V 0 a • Town of North Andover s R r ♦ •' r iir • i mii TTT / TTIL•fT. ATT ,s'SACMUSt� CHECK #: LOCATION: H/O NAME: CONTRACTOR N 'H ANDOVER F �,OR7y ,OPMENT AND SERVICES ARTMENT p JILDING 20; SUITE 2-36 ;SACHUSETTS 01845 'SSAC14USFS 978.688.9540 — Phone 978.688.8476 — FAX 3 www.townomortnanaver.com ON 4011 Type of Permit or License: (Check box) TOWN 0F N3 tt o AaN;J4'ER 0 Animal $ P & PARCEL: �Q {� N t-rH DEF TMEN'r ❑ Body Art EstablishmentA LE $ ❑ Body Art Practitioner t. $ $ Contact #: ❑ Dumpster ❑ Food Service - Type: $ - Contact #:�/i ����i �9?(, 0 ❑ Funeral Directors $ d o Y�0 ❑ Massage Establishment $ Contact #: 7 S - . ❑ Massage Practice $ ; ❑ Offal (Septic) Hauler ❑ Recreational Camp $ ingle Family Home Commercial ❑ Sun tanninU pg ag $ �fing Upgrade for Addit' n: $ ❑ Swimming Pool No ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ S FORM ❑ Well Construction $ er permitting test) dicate test Pit sites on theplan) SEPTIC Systems: x vers the minimum two deep holes and wee of $360.00 per lot for repairs or upgrades. Septic -Soil Testing $ j % ORMATION ❑ Septic - Design Approval $, inspections =gineers can design septic plans. ❑ Septic Disposal Works Construction (DWC) $ r quired for each septic system disposal area. ❑ Septic Disposal Works Installers (DWI) $ percolation test, at the discretion of the BOH ❑ Title 5 Inspector $ `ithin two weeks of testing. ❑ Title 5 Report $ .:n 1"-100') shall be submitted to the Board of Health aS). p1 be submitted. ❑ Other: (Indicate) $ Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer Below This Line DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Tuesday, June 14, 2011 1:29 PM To: 'Daniel O nheimer-'Fsaae-Rew '• eters, Marianne; 'Randy Burley' Cc: �-Se'pltic yer, Susan Subject: - 2009 Salem Street - Conservation Co ments Received - see below Importance: -"- Follow Up Flag: Follow up Flag Status: Flagged Here are the comments from Heidi Gaffney in Conservation: ,`.`.Test Pits Only ... access to sites by driveway only. " Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover, MA o1845 9 Office - 978-688-9540 Fax - 978-688-8476 Email - pdellechiaiePtownofnorthandover com Website http://www.townofnorthandover.com/Pages/index "We can never see the path of our life if we are too busy focusing.on the pebbles under_ our feet_. "—Anonyinous From: Isaac Rowe [ma ilto: irowe@m ill riverconsulting.com] Sent: Tuesday, June 14, 2011 12:21 PM To: DelleChiaie, Pamela Subject: RE: 2009 Salem Street - soil testing Has Bill been notified that this is tentative? If not, he should be ASAP because I am sure he has a contractor already scheduled for tomorrow morning. A determination from the Town (to schedule or not) should be made probably by 3pm at the latest. I have no problem calling Bill if you need me to. Let me know, thanks. Isaac M. Rowe, R.S. Project Manager Mill River Consulting 6 Sargent Street LGloucester, MA 01930-2719 Phone: (978) 282-0014 Fax: (978) 282-1318 irowe(c�millriverconsulting.com www.millriverconsulting.com From: DelleChiaie, Pamela [mailto:pdellech@townofnorthandover.com] Sent: Tuesday, June 14, 201111:58 AM To: 'Isaac Rowe' Subject: RE: 2009 Salem Street - soil testing Please mark as tentative on your schedule until I receive the comments back from Conservation. Thanks. Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover, MA o1845 2 Office - 978-688-9540 Fax -978-688-8476 D Email - pdellechiaie@townofnorthandover.com Website http://www.townofnorthandover.com/Pages/index "We can never see the path of our life if we are too bcrsy focusin on tl:e ebbles under our eel. "— Anon utous From: Isaac Rowe [mailto:irowe@millriverconsulting.com] Sent: Tuesday, June 14, 201111:54 AM To: DelleChiaie, Pamela Subject: RE: 2009 Salem Street - soil testing Is there any site plan or sketch that can be emailed over? Did Marianne let you know about this being scheduled? It was on my calendar so I assumed NA was notified. Isaac M. Rowe, R.S. Project Manager Mill River Consulting 6 Sargent Street Gloucester, MA 01930-2719 Phone: (978) 282-0014 Fax: (978) 282-1318 irowe(a)millriverconsulting.com www.millriverconsulting.com From: DelleChiaie, Pamela[mailto:pdellech@townofnorthandover.com] Sent: Tuesday, June 14, 201111:43 AM To: 'Daniel Ottenheimer'; 'Isaac Rowe'; Peters, Marianne; 'Randy Burley' Cc: 'Bill Dufresne (wrdufresne@comcast.net)' Subject: FW: 2009 Salem Street - soil testing Importance: High Hello Isaac, Just waiting until Conservation can view the site. Will let you know when I receive the feedback. Thank you. &eat Rg41 a, Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover, MA 01845 2 Office - 978-688-9540 Fax - 978-688-8476 [] Email - pdellechiaiegtownofnorthandover.com Website http_//wwwtownofnorthandover.com/Pages/index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet. "-- :Anonyinous From: Gaffney, Heidi Sent: Tuesday, June 14, 2011 11:40 AM To: DelleChiaie, Pamela Cc: Hughes, Jennifer Subject: RE: 2009 Salem Street - soil testing will go today... Heidi Gaffney Conservation Field Inspector Town of Nordi Andover 1600 Osgood Street North Andover, MA 01845 978-688-9530 phone 978-688-9542 fax From: DelleChiaie, Pamela Sent: Tuesday, June 14, 2011 11:39 AM To: Hughes, Jennifer; Gaffney, Heidi Subject: FW: 2009 Salem Street - soil testing Hi, Any updates on this one yet? Consultant was asking, as he is going to seethe soil evaluator tomorrow. This one is a large area, so if you have not gotten to it yet, don't worry about it. SW Refa%4, Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover, MA 01845 2 Office - 978-688-9540 2 Fax - 978-688-8476 l] Email - ndellechiaiePtownofnorthandover.com `16 Website httl2:/hvww.townofnorthandover.com/Pages/index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet. "—Anonymous From: Isaac Rowe [mailto:irowe@millriverconsulting.com] Sent: Tuesday, June 14, 201111:25 AM To: DelleChiaie, Pamela Cc: 'Susan Sawyer(ssawyer@townofnorthandover.com)' Subject: 2009 Salem Street - soil testing Pam, Do you have the soil testing application for the above referenced property? I am testing with Bill Dufresne tomorrow and did not see the application in our emails. It is for new construction. Thanks, Isaac M. Rowe, R.S. Project Manager Mill River Consulting 6 Sargent Street 4 TOWN OF NORTH ANDOVER of ,,OATH Office of COMMUNITY DEVELOPMENT AND SERVICES o HEALTH DEPARTMENT $ 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 NORTH ANDOVER, MASSACHUSETTS 01845 9SSACHUS, Susan Y. Sawyer, REBS, RS 978.688.9540 — Phone Public Health Director 978.688.8476 — FAX www. APPLICATION FOR SOIL TESTS DATE: (!� — ?i- i I MAP & PARCEL: LOCATION OF SOIL TESTS: __—QQ �A LZ LA .comJON 11 O 11 TOWN OF NORTH ANDOVER DEPARTNIENT OWNER: C,rl UV� Contact #: APPLICANT: Chi ^ ' _ Contact #:41,1h) :7 ADDRESS:. Cod ��! L�,m.i �L6�. --PtO rJo Ylajo� D wzo ENGINEER: &� }N' � Contact #: (�l 7P CERTIFIED SOIL EVALUATOR: r�,j�/ ' aFfyF G&) 6� 17b) Intended Use of Lan : esidentiaa Subdivisio Single Family Home Commercial Is This: Repair Testing. redeveloped Lot Testing[—V7Upgrade for Addit' n:� ` I E�►f, In the Lake Cochichewick Watershed? Yes No THE FOLLOWING M 9T BE E ICLUDED WITH THIS FORM 9 Proof of land ownership (Tax bill, or letter from owner permitting test) 8.5"x 11" Plot plan & Location of Testink (please indicate test nit sites on the plan) ➢ Fee of $425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of $360.00 per lot for repairs or upgrades. GENERAL INFORMATION ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. ➢ Full payment will be required for -all additional tests within two weeks of testing. ➢ Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Comm. Signature of Conservation Date back to Health Depan ,� F1 54 {E SEE PLAN BY CLINTON GOODWIN, SURVEYOR, DATED JULY 1975 FOR PROPERTY LINES OF THIS SITE. TOPOGRAPHY FROM AN ACTUAL FIELD SURVEY, DATUM BASE U.S.G.S M.S.L. (N.G.V.D.). WETLANDS FIELD DELINEATED BY WEST ENVIRONMENTAL CO. IN 2004, 122 MAST RD. -SUITE #6 LEE, NH, 03824 FIELD SURVEYED BY MERRIMACK ENGINEERING SERVICES INC. THIS SITE IS NOT LOCATED IN THE ESTABLISHED 100 YEAR FLOOD PLAIN PER FEMA COMMUNITY PANEL #250098 0012 C DA TED JUNE 2, 1993. INSTALLATION PLANS FOR UNDERGROUND GAS, ELECTRICITY, TELEPHONE, AND CABLE TELEVISION UTIL177ES SHALL BE PREPARED BY THE APPROPRIATE UTILITY COMPANY AND SUBMITTED TO THE NORTH ANDOVER DEPARTMENT OF PUBLIC WORKS PRIOR TO INSTALLATION. TOTAL PARCEL AREA=441,261 S.F. =10.129 AC. RIGHT-OF-WAY AREA =36,661 S.F. =0.842 AC. TOTAL LOT AREA 404,600 S.F. =9.288 AC. DEEDS FROM THE OWNER OF THE SUBDIVISION SHALL RESERVE THE FEE IN ALL STREETS OR WAYS SHOWN ON THE SUBDIVISION PLAN, SUCH FEE TO BE RETAINED BY THE DEVELOPER UNTIL CONVEYED TO THE TOWN. NO SOILS ARE INTENDED TO BE EXPORTED FROM SITE. APPROXIMATELY 2000 YDS. OF SOILS SHALL BE IMPORTED AND USED FOR BACKFILL AROUND THE PROPOSED DWELLINGS, THE.SEP77C SYSTEMS AND FOR THE DRIVEWAY SUBGRADE R.FCEV�D JJ. 2 N11 TOilVd OF NORTH ANOC ER HEAD!"H D.EPAR hfiEff PRELIMINARY PREPARED FOR GEORG 66 GILCREA,S'T LONDONDERRY, DATE: APRIL 7 REV.: MAY 11, E HASELTINE ROAD, N H 03053 2011 2011, SCALE.- 17--4.0' , ' 20' 40' 80' 120' MERRIMACK`' E`;` GINEERING SERVICES 66 PARK STREET, ANO0VER MASS, CH, USE 01810 ,.. .PHONR• (976)475 355'_5, ` FAX: (978) 475-1448 EMAIL: MERRENG-0. ZZOM ----y,X126.0324.::8 ZA '_78 WE .12 A -0io 6. 3 5\ i, X 107.05 iAn ,-80{— x I X I 9's k�o 4-1 y V, . 99 N� r27-' 16' COMMON 0,24 .111'24 "y X ) 0 -W PW X WN WU iR 5 .75 .1W72 'It p 2142 T 4i }i0.5? . ...... .... 16 A, ; WWe -1, Tim C() 3-0"7 .. . . ...... v 11 2z 7 2 -2, 130.55 gR c.j 1,5.71 X 497 1 rrj 100 Y. wo Q M&NfL 4, M N 4. (P ;AWxr-5 . . . . . . . . . . . Irrl x m _g iw. tels.38/ x y3,61 12-51 447 127, 0 1z I ol LOT #3 X\1112. i I ' c: X t4l.31' a) AREA!5:�S4,9:�2 S.F. an, ) 1/26C8 AC. 0 X § g!y. 2. x 121.01 1 . ,, I W, EW-oi, Tp C) X 127.55 Y. l n 120. z 12' I 40". Z Z %x I a-6 x 120.63 to aa "'OPME'R 1011you'r ozF 'OLYMPIC LANE. BENCH CENTEI CATCH Rlm=9� -c ,-,APPROX. 100 YEA1 (ELEVATI BENCHMARK k 1� BOTTOM WEST CORNER (a OF STEP ELEVATON 127.94 �I �ti Qr..TzK_:,.�•?`t.�/"i'i:�ni.0Ih5ir�f' '.a11/$��I 4 }s[a..i-'/.�I l{ms... �sy/ /t (!j�t-5..-3-+�^�,--�i y 3-_'//�J"�. " / ; `.(.""4,�� . (,�t-�'` iG.`5,%�ii t.Ij �� .9'sxj�:r9 ,f1�t �y\ � i/�.�/} t�.^ms%A/Xi�. / ,1,V.rSt 1t , ;'.,a-x-r��.rz.r ,-.y i `\— �t\ `-'_�_ti_ d/ -ti �j.1\_��w.':.Z ._..3�/ �., 3 � \ �Y�.i ` --`,�—� < �/ — {t\. 1—.�:/\,J.�-t`r '\� .i s,yti:SJ/'i'�j.�r`( ;/':. i•*��:`�,\/ (�S'.,Ir��st4k(t (1sr'.j_�i{b�stfc�=. ax .a,` 1(t� `t�'s' �!~��1 ? st.H `'.s,t{�2J.,t..: ,7�, yl6imac\xs �l`Z� ;!,i;'a/2_f.,-�s i�l ;'�T'+�-�'i-"�,-,2""_�;�/�`lxdc.-.=i.vf��:�.�D�?c'f�'{[a�-„sa�,.�:3�-Ws.tar$;�.3.tiViafa5.2%t-'tl9�t/z�!.llk)., 3t.ii;�,;s�,.?/. .���tr.', b.=y3��ms.:/\zss,ff `.�s��+s`=1'~•w,�'""`,Q-�'*` ` `;.'�1�.•'�yt3v '.`�l,: �•r�'`�•:-n,��yk'`3.'it` '`633+l�•n,i!.�;t,1�-1�,� '";3�t �•�t 3 /3q o �3 : ' _ , �j ,�fts.r�i. .: .2 .8 135 X 149.5 Zf 10 x 150.21 (,A2?X 1 n3 1 x.52 fi 15Q�J 141.131 '111 --MIN 140.50/ a'/ �����j1e1 3.E4 r Ey3!55t --N o -04 / zROP 140 WELL 5.82 PROP. 12' WIDE 7.1BT. CONC. p 63 NA 0- DRIVEWAYgo r yJw TYP 14, X 14A.42 RPTION 14S.01 iw4.`8 i -e P f PRO SOIL -ABSORPTION :�r� SYSTEM 1}235x 14 ` Yi4F.5 TP SY�Y 11133.:f� 14$.5 1a,aAj.F.tb[?l{ .+ ' • •- t ., :47,•x:; / � srdA � '�a '� � j i � 1 1 � � '� � 39.44\`�'. :i -- `ff X148.64 5 •{ � f L 1t77gg t o 1