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HomeMy WebLinkAboutMiscellaneous - 228 Forest Street (2) 228 forest Street r 1 4 �,, �} f 1 (I� 4 ;t,IT � t kms.-C J A• i.r ,1 . a, 1„ �l,�Y ,T.�, �, 'ori 'V � -, r / r •,.}>Kt��L .Y'��� A# � 7��r:1Lt,ti���w-v� t . MAP # ' LOT •# PARCEL # STREET CONSTRUCTI O.N_APPROVAL, HAS PLAN REVIEW FEE .DEEN PAID? YES NU -�, PLAN APPROVAL: DATE /Z�/��9 5- APP. BY�� DESIGNER: PLAN DATE. /Z G- CONDITIONS /111brLy Tt-�.57- WATER SUPPLY: TOWN WELL WELL PERMIT �v� _Qu/ -�'- DRILLER.__.-.:_ WELL TESTS: CHEMICAL DALE APPROVED._. BACTERIA I UA 1 E (IPPRUVED BACTERIA II DATE APPROVED COMMENTS: FORM U APPROVAL: APPROVAL TO ISSUE YES NO DATE ISSUED (t/d 1�b BY CONDITIONS: FINAL APPROVAL: . ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NO SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NO ANY VARIANCE NEEDED YES NO ll� FINAL BOARD OF HEALTH APPROVAL: A • 4�� M_�NSIa4la QN -.L :�r?.1i 'i.. � ' Y _. .•11.JI y.-..-, j- 3... .'t'� . = t A f� �t1 1 ," J. 1. �'_ - - ISTHE INSTALLER LICENSED? 1 +: •art - NO • ', } • . NEW REPAIR TYPE. OF- CONSTRUCTION: i NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW YES NO .11 2 1 CONDITIONS OF:.APPROVAL YES NO (FROM .FORM U) _ES NO -ISSUANCE OF DWC PERMIT DWC PERMIT- ND. r .� INSTALLER: i­BEG INJ INSPECTION EXCAVATION , INSPECTION: : NEEDED: Fl PASSED :. . .. CONSTRUCTION INSPECTION= NEEDED: .1 •- S _ ' ' )* " AS BUILT PLAN SATISFACTORY: YES: - APPROVAL TO BACKFILL: DATE: 4. HY_._ " FINAL . GRADING APPROVAL: DATE ! BY FINAL CONSTRUCTION APPROVAL: DATE: C/ BY Address 5— Title of File Page of Date File Open: Date file closed: Doc Document/Action Title Date of Refer to other Purpose of Document/Action and notes. action Document/ document/ Num. Action Department Board of Appeals — Board of Health — Planning Board — Conservation Commission — Building Department CERTIFIED PLOT PLAN LOCATED IN NORTH ANDOVER, MASS. SCALE:1"=60' DATE:7/1/96 Scott L. Giles R.P.L.S. 50 Deer Meadow Road North Andover, Mass. NOTE;:LOCATION IS#228 FOREST STREET ao. a� w 126.Sq LOT 1 37,384 S.F. o k� 0 164.13, p0 ro, (P OF I CERTIFY THAT THE OFFSETS OFFSETS SHOWN ARE FOR THE USE SHOWN COMPLY OF THE BUILDING INSPECTOR ONLY WITH THE ZONING AND SUCH USE IS FOR THE BY LAWS OF DETERMINATION OF ZONING 13072 NORTH ANDOVER CONFORMITY OR NON-CONFORMITY F� aEa WHEN BUILT WHEN CONSTRUCTED. 7/i/9ro r . CERTIFIED PLOT PLAN LOCATED IN NORTH ANDOVER, MASS. SCALE:1"=60' DATE:7/1/96 L Scott L. Giles R.P.L.S. 50 Deer Meadow Road North Andover, Mass. I NOTE; LOCATION IS#228 FOREST STREET I R w i 128.54, e a LOT 1 37,384 S.F. 0 164.13, 00 60' O� PN f s Or I CERTIFY THAT THE OFFSETS OFFSETS SHOWN ARE FOR THE USE soy� SHOWN COMPLY OF THE BUILDING INSPECTOR ONLY WITH THE ZONING AND SUCH USE IS FOR THE H BY LAWS OF DETERMINATION OF ZONING •13M NORTH ANDOVER CONFORMITY OR NON-CONFORMITY 'elm. WHEN BUILT WHEN CONSTRUCTED. IL U►IIDs //x CERTIFIED PLOT PLAN LOCATED IN NORTH ANDOVER, MASS. SCALE:1"=60' DATE:7/1/96 Scott L. Giles R.P.L.S. 50 Deer Meadow Road North Andover, Mass. NOTE; LOCATION IS#228 FOREST STREET c`�o N �Q W 126.x, y. LOT 1 h 37,384 S.F. ti C �4 0 164.13, pp 6p' O (P I CERTIFY THAT OF M THE OFFSETS OFFSETS SHOWN ARE FOR THE USE oe� yG SHOWN COMPLY OF THE BUILDING INSPECTOR ONLY WITH THE ZONING AND SUCH USE IS FOR THE 3 y BY LAWS OF DETERMINATION OF ZONING 13972 NORTH ANDOVER CONFORMITY OR NON-CONFORMITY CIaE� WHEN BUILT WHEN CONSTRUCTED. ,u 7 10 r -- ' t FORM U - IAT RELEASE FORM d INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicnt fills out -this section***************** APPLICANT: Phone LOCATION: Assessor's Map Number %�v A_ Parcel Subdivision Lot(s) Street ��-�! ('� �'�. ��l' � St. Number ************************Of icial Use Only************************ RECOMMENDATIONS OF T WN GENTS: 6 Date Approved Conservati Administ ator Date Rejected Comments Date Approved Town Planner Date Rejected Comments --Date Approved . �. Food` Inspector-Health -ate Rejected Date Approved l FAA Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections ��J - driveway permit Fire D&PIpaptment L( f�"/ �'Ca*�' 1, rte%�;�:�.t�,� �, ��s-r =_; Received by Building Inspector Date 'h SS -- r l V �Arr fjovGM CHRISTIANSEN & SERGI, INC. PROFESSIONAL ENGINEERS AND LAND SURVEYORS 160 SUMMER STREET HAVERHILL, MASSACHUSETTS 01830 (508)373-0310 FAX: (508)372-3960 October 23, 1995 North Andover Board of Health 120 Main Street North Andover, MA 01845 Re: 228 Forest Street Septic System Repair Dear Board of Health Members: On behalf of my client, Mrs. Rima Brickus, I would like to appear before the Board at your scheduled November meeting to request variances from the Town of North Andover's Minimum Requirements for the Subsurface Disposal of Sanitary Sewage for a proposed repair system at the above referenced address. The variances requested are as follows: 1. North Andover Regulation 2.14.4 Minimum Cacity The variance requested is to allow for the minimum capacity of the disposal system to be reduced from the required 660 gallons per day to the design flow of 330 gallons per day. 2. North Andover Regulation 2.14 Sewage Flow Estimates The variance requested is to allow for the estimated daily flow per bedroom to be reduced from the North Andover requirement of 165 gallons per day to the Title V requirement of 110 gallons per day. Please notify me when you have scheduled a meeting to ;icy -his request for variances. ;'� ours i ip . C ristiansen Town of North Andover, Massachusetts Form No.z �10RTh BOARD OF HEALTH OC':fnLCA LG 19 cis N M 9 X �nar • ''���-"'--������-rrrrr-�� DESIGN APPROVAL FOR SSACHUSEt SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant- YYNa- Test No. Site Location Reference Plans and Specs-�`- -- Z,A--�a_IUA t �� ENGINEER DESIGN rN 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. 7 g�� No................_....... TOM OF NO ANDOVER/ THE COMMONWEALTH OF MASSACHUSETTS. 1 BOARDO � Al BOARD OF HEALTH ..... .o.1vt ................or....N..o�elN..��IU.IJ�✓ rC....................:.. ........ . OCT 2 41995 � �riirM#iott for �Aio��oFtiorlt C�ott' #rxtr i tt rruti# Application is hereby made for a.Permit to Construct ( ) or Repair (>O an Individual Sewage Disposal System at: 22 F�►�" `....s..r! :�f ...................................... ..................................................................•............................•.. Location.Address or Lot No. .................................. 74_x..:G�aN �v..!4v f. %4 r?1 1� 4,7 Owner Address W Installer Address Type of Building - Size Lot...... ot..... 37.�. `�? .....Sq. feet �. Dwelling—No. of Bedrooms.............3..........................E.-Zpansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ................................................•----..............----•---....................................----..........._....---....--•••••..... W Design Flow................... ......_. .......gallons per person per day. Total daily flow.................��Q....................gallons y� 0 Septic Tank—Liquid'ca.paclty..ISP! .gallons Length...lQ....f?._ Width.::b.'.4.`.`. Diameter._._....._..... Depth...'r...... Disposal Tarn ft— .9 ..Fh6..(r/3-... Width.....3(?......... Total Length.....��.�...:. Total leaching area....ZZ7-.O....sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet..................... Total leaching area..................sq. ft. Z Other Distribution box ()() Dosing tank ( ) a Percolation Test Results Performed by.... ............... Date..4jyjq.3}.§f Zzln-... a Test Pit No. I....40.....minutes per inch DeptlAof Test Pit......lit_.......... Depth to ground Li. Test Pit No. 2..... ......minutes per inch Depth of Test Pit...J.37e..'....._.. Depth to ground water...."..........`....... W ..................•---•----•-••----••--...----.......••-• -•--............:.._.................*........._--••...... ...._........_............. O Description of Soil...Z,.5..YA .4..... t�2! .Y...! I?.Nf'Kl ! .t.S!9ti!J�l...1.a!OM........V IZY..F.J6Z4!1...J"Z? U .................•••--....................................••---......------..............................---------..............._....-•----.........-•-••---....---............---................._... W x ... •--••--------------------•---........_..._............-----•-----......_........---••-•-----...------•......------•----....._...•------••--•-•----------........-•-••--------•-•-••---------•----_.. U Nature of Repairs or Alterations—Answer when applicable...7.??TAL... .. r .-jY.-+!`�5R?!v__ yS/�%h. ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE, 5 of the State Sanitary Code — The undersigned further agrees not to place th.e system in operation until a Certificate of Compliance has been issued by the board of health. Signed................................••---...........................•--................... ................................ Date Application Approved By......................................... I ........................................ Date Application Disapproved for the following reasons:............................:................................................................................... ..................................................................•--...........----....---...................................--•.................••----•--..........._-•----•--...............-••--•--•. Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............................I..........OF..................................................................................... ( pr#if irM#r of Toutlifitturr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by....................•--...........................-••.........._.................---.....---......:.......--•...........•---•-•-•--...--•-------------...._..............•---•---..........--_....._ Installer at..............................:_.-............................._....._........ has been inst:ulled in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...........:.......................................................•--•-....:... Inspector.................................... ............................................... • i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......................................OF..................................................................................... No......................... FEE........................ Noposttt Worlm Trian#rtzr#iott Permit Permissionis hereby granted...::................:.----•----........--------...----•• •--•--••--•-.....................-•---........................................-•-•- to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at No. ' Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... •-•-------•--•---•------•--•----••--•.--------- ........................................ ................. Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS i PITS MIN 660 LEACHING MIN 1 (131x16 ' ) PIT MANHOLE/PIT GW MIN 4 ' BELOW BOTTOM EXC 2x EFF W OR D 12"-48" STONE BOT + SIDE x LOAD = TOTAL (L x W x #) (2x(L+W)xD x #) (G/ft2) CHAMBERS MIN 660 LEACHING GW MIN 4" BELOW COVER >3 FT - VENT MANHOLES 12"-48" STONE SPLASH PADS SLOPE . 005 BED/TRENCH (Bed max. 60 ' X 601 ) MIN 13 ' X 16' PIT BOT + SIDE X LOAD = TOTAL (L x W x #) (2 x (L+W)xD x #) (G/ft2) FIELDS MIN 660 GPDy 900 ft2 BED L-------GW MIN 4 ' BELOW BOTTOM OF FIELD PIPE ENDS JOINED? f 4" PEA STONE? DIST LINE SLOPE . 005? �--� >3 'COVER-VENT t/ r SCH 40 L----' MIN 12" COVER RATE �/'�//d LDG X '&60 X A-3 = TOTAL��� - _�- �EQID (ft2) LXW 353 L�6� DOSING TANKS AND PUMPS DIMENSIONS X X = PUMP CAPACITY 9Pm L W D Vol. DISCHARGE SIZE DISCHARGE RATE DISCHARGE TIME 9Pm MANHOLES TO GRADE ALARM SEP. CIRC. GW (Min. 1' below inlet) HWL LWL CHECK VALVE BLEEDER HOLE MANUAL OP. SWITCH Copyright 0 1995 by S.L.Starr �, I t Publishers of h Mang 13 0 ° C009 DMM Scriptographic®Booklets CORPORATE HEADQUARTERS 200 State Road South Deerfield,MA 01373,USA Telephone:413-665-7611 Facsimile:413-665-2671 Show everyone that your department is doing its part to prevent food poisoning... When an incidence of food poisoning occurs, it's remarkable how rapidly citizens, employees, officials and reporters take an interest in how such a thing might have been prevented. Perhaps your environmental health department has even taken a call from the six o'clock news (at around ten of six?). As you know, if everyone who handled food took the right precautions, virtually every incidence of food poisoning could be prevented. And the time to teach those precautions is not when Channel 4 is on the line; the time is now. With the two booklets enclosed, you can show the people you serve how to prevent foodborne illness, and convince them to make appropriate precautions a habit. FOODSERVICE SANITATION(15800)A and PREVENTING FOODBORNE ILLNESS (37051)A show readers the importance of personal cleanliness, proper storage and preparation of food, and clean work areas. They discuss the causes of foodborne illness and show readers what they can do to keep the food they serve free from harmful germs. They stress cleanliness for kitchen and self. They're ideal for public education programs and sanitation seminars! Whether you choose one booklet or both, we'll give you a generous discount for your volume order. You can also combine these booklets with any other titles that have an item number ending in A. The unit price you'll find on the order form is based on your total order size. So give us a call at 1-800-628-7733. Let us know if you'd like your booklet covers personalized with your department's name, logo, or other information.We look forward to helping your department promote foodservice sanitation! Sincerely, Thomas K. Lund irs/Q276 Director, Educational Resources NAORTH F TO" OY dover No. zoL 11 : dover, Mass., 19- cac.lc�E ck ,4Z) RATE D PP�'IN NOUN& BOARD OF HEALTH Food/Kitchen Septic SystemPERMI � BUILDING INSPECTOR THIS CERTIFIES THAT...................... .. �15�. ......... �... ....................Q.................................................... Foundation has permission to erect... .. .... . ........ buildingt on ......... S........ .?.� .........�... .... Rough tobe occupied as.................................................... �6.1.0................ ../.... .. .................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of NSe application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PERMIT FOR FOUNDATION ONLY PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. REGULATED BY NAR?`,. 114.8-S. B.C. Final PERMIT EXPIRES IN 6 MOl\JiS PAID ` UNLESS CONSTRUCTION ST TS ELECTRICAL INSPECTOR Rough' ��`��t� ................................... Service LDING IN Final Occupancy Permit Required to Occupy wilding GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Foagh No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. Smoke Det. I I I I I SEPTIC SYSTEM AS-BUILT LOCATED IN NORTH ANDOVER,MASS. SCALE:1"=60' DATE:7/25/96 EY Scott L.Giles R.P.L.S. Frank S. Giles 50 Deer Meadow Road North Andover,Mass. J, NOTE; LOCATION IS#228 FOREST STREET C nl to W 12g•s4, .a a LOT 1 37,384 S.F. ti . 3•y'a cr 2 z ''' 4 WELL 30, b 3814 164.13, p0 . 6p' .C� TABLE OF ELEVATIONS O ���'' OUT OF HOUSE 135.51' IN TANK 134.86' �tp �a OUT TANK 134.63' IN D-BOX 134.17' OUT D-BOX g 5 133.99' �� END TRENCH 1 133.58' 2 133.57' r -—------- ------3--133,55' �,�V ' ' 5 133,61' HEREBY CERTIFY THAT I HAVE INSPECTED THE CONSTRUCTION OF THIS DISPOSAL SYSTEM AND A THAT-THE CONSTRUCTION AND FINAL GRADING HAS BEEN IN ACCORDANCE WITH THE DESIGNERS INTENT AND THAT THE MATERIALS USED CONFOR TO THE PLAN SPECIFICATIONS AND 310 CMR 15.00 7r25W Town of North Andover, Massachusetts Form No.3 '} E NOR71y BOARD OF HEALTH . L I 19 (� mss'„^''tom DISPOSAL WORKS CONSTRUCTION PERMIT SgCHUSE 4 Applicant NAME ADDRESS : Site Location — TELEPHONE Permission is hereby granted to Construct aor Repairan Individual own on the Design A ( Idual Soil Absorption Sewage Disposal System as sh • g Approval S.S. No. of 7t/ d'y/ CHAIRMAN,BO Fee D.W.C. No. r A ,;t TO 4AR�E�AC TI//' 03 PMF M /�� NO. (✓l/ ® °F EXT. E .�� S S r '� E O *ajdo 1t GNED PHONED 1:11 gACKOIR CALL RNED JWA�TSSEE YOU � AGAIN ALL � WA IN E] URGENT -(moo o KGt.c� - c u c:22, 1N3'JHt1 10 NISVM [:] IIVO ll M ElO1 SINVM 03NIMM8 ElllVO El03NOHd a3NEJIS vav" i 3 O 'eyFS e'L MQ2 ywv `b' W d rLg d s -n 3 W 1X3 8 ��-FQJ 'ON JO 3 V38V 8=1 H Nd d WVv 3iN11 31Va Ol ..............DAVE M �tis9�. Do DK SEPTIC SYSTEM AS-BUILT LOCATED IN NORTH ANDOVER,MASS. TOWN OF NORTH ANDOVER/ SCALE:1"=60' DATE:7/25/96 BOARD OF HEALTH Scott L. Giles R.P.L.S. J(n 55 1996 Frank S. Giles 50 Deer Meadow Road — North Andover,Mass. NOTE; LOCATION IS#228 FOREST STREET C cV W W� 128,54, LOT 1 37,384 S.F. o� Z ° z �' WELL 30' o M 3a�& 164.13, �0 .(\ TABLE OF ELEVATIONS " 60 O _ ���' OUT OF HOUSE 135.51' IN TANK 134.86' �(P r, OUT TANK 134.63' �A '�'� IN D-BOX 134.1 T OUT D-BOX X 5 133.99' END TRENCH 1 133.58' , 2 133.57' 3 133.55' s� � A 133.61' ;A �T 133.61' • I HEREBY CERTIFY THAT I HAVE INSPECTED THE 11 CONSTRUCTION OF THIS DISPOSAL SYSTEM AND THAT THE CONSTRUCTION AND FINAL GRADING. HAS BEEN IN ACCORDANCE WITH THE DESIGNERS INTENT AND THAT THE MATERIALS USED CONFORIV TO THE PLAN SPECIFICATIONS AND 310 CMR 15.00 7/25/96 . »V•= o j: 1 Rima E. Brickus 741 Canton Ave. Milton, MA 02186 (617) 698-1635 March 20, 1995 Ms. Sandra Starr Board of Health No. Andover, MA 01845 Dear Ms. Starr: I am witing to request an extension for one year of the Deep Hole test which was done on our property at 228 Forest Street. We need the exten- sion so that a Perk test can be done and engineering plans drawn up so that the disposal system could be upgraded for possible rental or sale of the house. Without an extension the Deep Hole test, which was done in May, 1993 (see enclosure) would expire before the next available time that a Perk test could be done. My husband and I had understood that both Deep Hole and Perk tests had been done in 1993. We did not find out until now that a Perk test had not been done. We are in a great predicament! Since we have a monthly mortgage to pay on the house, we cannot afford to wait another year for upgrading to be done. Yours truly, ima E. Brickus Enc. A-4 J SOILS DATA BRICKUS PROPERTY FOREST ST NORTH ANDOVER ENGINEER CHRISTIANSEN & SERGI INC. INSPECTOR SANDY STARR TEST PIT NO. 93-1 DATE 5\93rl/ cliRl i H Z�^ `csS�ONAL E�6\pc W CA�. DESCRIPTION 0 SURFACE TOPSOIL 24 SUBSOIL COMPACTED SAND WITH ROCKS NO GROUNDWATER 72 TEST PIT NO. 93-2 DATE 5\93 2. o .. DESCRIPTION 0 SURFACE TOPSOIL 18 SUBSOIL COMPACTED GREY SAND WITH STONES. COMPACT NO GROUNDWATER 72 %// I � �s P._9s_, / ci w � ftt stats 3nalpficaL Main Oftice/Laboratory At: Tramway Marketplace j i 22 Manchester Rd./Rt. 26 Route 18 &25 � I Derry, NH 03038 West Oaatpee, NH 03890 I (603) 432-3Q44 1.800-699-9920 Ii Crux r ftr.�xt of far i SENT T0: Messina Dev. Co. Inc. TEST NO. : 24381 i 44 Great Pond Dr. Boxford, MA 01921 SAMPLE LOCATION: 228 Forest St . + DATE TIME SAMPLED: 06/17/96 9:00 AM No. Andover, MA EPA PARAMETER ----_ RESULT RECOMMENDED (PPM) MAX.LEVFL(PPPL) � a ---- �I PH 7.99- UNITS 6. 5- -8. 5-UNITS 2 HARDNES , 220 150 ► CHLORIDE 250 I NITE2ATF. 2. 49 10.0 NITRITE 1110, 050 SODIUM 29,8 250 2 IRON 0.89 0.3 MANGANESE <0.05 COLIFORM 0.05 i E. COLI ABSENCE /100 ML ABSENCE /100 ML ABSENCE /100 NL„ ABSENCE /100 ML COPPER 1 . 3 i? ARSENIC 0.05 LEAD CHRO�[IUM 0 015 CALCIUM0. 1 FLUORIDE 78. 0 NONE SET 2 COLOR 4 .0 2D CPU 15 CPU ODOR TON . 3 TON j 2 TURBIDITY S.5 NTU 5 PJTU i HYDROGEN SULFIDE NONE SET I� { THETESTEDPARAMETERS MEET CURRENT EPA STANDARDS FOR DRINKING WATER. j (XXX) THE TESTED PAR*JE;TERS MEET CURRENT EPA PRIMARY STANDARDS FOR DRINKING WATER, BUT SORE SECONDARY PARAMETERS EXCEED STANDARDS. I j THE TESTED PARAMETERS FAIL CURRENT EPA STANDARDS FOR DRINKING WATER C DUE TO PRIMARY STANDARDS OUT51DE OF LIMITS. -- --------------------- - ---- '7------------------------------------------------- -- - -ITY = --- j $ .5 PPM SPECIFIC CONDUCTANCE - 558 uPIR03 ------SULFATE-^x20,6 PPM MAGNESIUM = 6. 1 PPM -------------------------------- __________ � LESS THAN OUR LOWEST CALIBRATION POINT --'-- w-- r GREATER THAN OUR HIGHEST CALIBRATION POINT 1 FLAGS `PARAPIETERS THAT EXCEED PRIMARY STANDARDS; CAUSES TEST FAILURE l FLAGS PARAMETERS THAT EXCEED SECONDARY STANDARDS; DOES NOT FAIL TEST. ! * NOTE: MICROBIOLOGICAL ANALYSIS RUN PAST 30 HOURS OLD PLAY NOT BE VALID SUBSEQUENT SAMPLES FROM THE SAME WATER SOURCE MAY VARY. Au thonzed by i i-stY.7. .T✓as: a' 'bcsc+h. �Fi:"1.SG�R➢" b.Sgz.Ssto.,T�G'v�aS7.7.S8G.4a.�.a. — 6tae 21nepttral Maln Office/Laboratory At: Tramway Marketplace ! 22 Manchester Rd.,Rt. 28 Route 16 & 25 � Derry, NH 03038 West Osslpael NH 03890 (603) 432-3044 f 1-600-699-9920 N' N� C.e.rtiftrate of xt rX for pritithing tez• SENT T0 : MESSINA DEV TEST N0 . : 4609-00009-J_ � 44 CREAT POND DR _ BOXFORD, MA 01921 � SAMPLE 228 FOREST ST LOCATION: NO ANDOVER, MA �f DATE k TIME S'1MPLED: 9/03/96 13 : 30 EPA y' PAPAPIEI'ER RESULT RECOMMENDED i 0-11y/1) MAX. LEVEL - - - - - - - - - -- - - - - rr - - - -- - - - - Coliform Bacteria y - -- - - ABSENT ABSENT /100 ml E . Coli r3actetj_a ABSENT ABSENT /100 mli - - - - - - - - - - - - - - - - - - - - - - - -- - -- - -- - - - - - - - --- - - -- - -- - - - - - - - < LESS THAI) OLJR. LOWEST CALI8R..ATIOT3 POINT I GREATER THAI OUR HIGHEST CALIBRATION POINT 1 FLAGS PARAMETERS THAT B'XCEED PRIMARY STDS : C-'AUSES TEST FAILURE . FLAGS PAP.A'4ETERS THAT EXCEED SECONDARY STDS ,; DOES .NOT FAIL TEST- MICROBIOLOGICAL ATd.ALYSIS RUN PAST 30 HOURS OLD MAY NOT BE VALID. MOTE : SUBSEQUENT SAMPLES FROM THE SAME WATER SOURCE KAY VARY. ' i i i i i i i I 1 �I I I i i II 11 �I i fry tats ZfRalptkalso Main Oftke i Laboratory At: Tramway Marketplace 22 Man0ester Rd./Rt.28 Route 18 &23 Derry,NH 03036 West Oselpee, NH 03890 (603) 432-3044 1.800-699-9920 Tie Trade ofAnal tf o for Brinking Pater SENT TO: Messina Rev. Co. Inc. TEST NO. : 24381 44 Great Pond Dr. Boxford, MA 01921 SAMPLE LOCATION: 228 Forest St. ' DATE & TIME SAMPLED: 06/17/96 9:00 AM No. Andover, MA i PARAMETEREPA RESULT RECOMMENDED - MAX.LEVEL(PPM) a ---TETT-- (PPM) � P1( 7.99 . UNITS ---_--__--T____ � 2 HARDNESS 220 150 6.5 - 8.5 UNITS CHLORIDE 250 NITRATE NITRITE2' 49 10.0 SODIUM <O.OSO 1 .0 2 IRON 29.8 250 0.89 0.3 MANGANESE 0.89 0,Q5 I SOLIFORM ABSENCE /100 ML ABSENCE 100 ML s E. COLI ABSENCE /100 141, ABSENCE /100 ML COPPER ARSENIC 1 .3 0. i, LEAD { CHROMIUM 0.015 [ E CALCIUM FLUORIDE 78.0 NONE SET I 2 COLOR 20 CP4•0 ODOR U i5 CPU 2 TURBIDITY TON 3 TON S• S NTU 5 14TU HYDROGEN SULFIDE NONE SET THEETEST-- j THE TESTED PARAMETERS MEET CURRENT EPA STANDARDS FOR DRINKING WATER. (XXX) THE TESTED PARAMETERS MEET CURRENT EPA PRIMARY STANDARDS FOR I DRINKING WATER, BUT SONE SECONDARY PARAMET - ------ ERS EXCEED STANDARDS. i THE TESTED PARAMETERS FAIL CURRENT EPA STANDARDS FOR DRINKING ',DATER ---_DUE-TO-PRIMARY STANDARDS OUTSIDE OF LIMITS. __-____--TETT-- � --- ------------- ------•---------------- ------ COMMENTS: ALKALINITY = 87,5 PPM SPECIFIC CONDUCTANCE - 558 uNHos ------- SULFATE --SULFATE = 20,6 PPM MAGNESIUM = 6, 1 PPM I -- ----------wTETT-- ; ,--- ----------_--------TETT-- ____ LESS THAN OUR LOWEST CALIBRATION POINT -------^r-_-"____--____-- GREATER THAN 1 OUR HIGHEST CALIBRATION POINT 2 FLAGS 'PARAMETERS THAT EXCEED PRIMARY STANDARDS; CAUSES FLAGS PARAMETERS THAT EXCEED SECONDARY STANDARDS; DOES NOT TFAIL LTEST . * MICROBIOLOGICAL ANALYSIS RUN PAST 30 HOURS OLQ IiAY NOT BE VALID NOTE' SUBSEQUENT SAMPLES FROM THE SAME WATER SOURCE MAY VARY. i Authorized by i granite *tats Z(natvtftaL Im. , Main Office/Laboratory At: Tramway Marketplace - 22 Manchester Rd./Rt. 28 Route 16 & 25 Derry, NH 03038 West Ossipee, NH 03190 (603) 432-3044 1-800-699-9920 Y %L�Iertif irafe of ;�nafijsis for Brirtking Water SENT TO: Messina Deva Co. Inca TEST NO. : 24381 44 Grea- rand Dr. Boxford, MA 01921 SAMPLE LOCATION: X28 Foxes St . No. Andover, MA DATE & TIME SAMPLED: 06/17/96 9:00 AM EPA PARAMETER RESULT RECOMMENDED (FPM) MAX.LEVEL(PPM) PH 7 . 99 UNITS 6 .5 - 8 . 5 UNITS 2 HARDNESS 220 150 CHLORIDE 250 NITRATE 2. 49 i0 .0 NITRITE "/0. 050 1 .0 SODIUM 29. 8 250 2 IRON 0.89 0 . 3 MANGANESE <0.05 0.05 COLIFORM ABSENCE /100 ML ABSENCE %100 ML E. COLI ABSENCE /100 ML ABSENCE ji00 ML COPPER 1 . 3 ARSENIC 0.05 LEAD 0 . 015 CHROMIUM 0. 1 CALCIUM 78.0 NONE SET FLUORIDE 4. 0 2 COLOR 20 CPU 15 CPU ODOR TON 3 TON 2 TURBIDITY 5 5 NTU 5 NTU HYDROGEN SULFIDE NONE SET i ( ) THE TESTED PARAMETERS MEET CURRENT EPA STANDARDS FOR DRINKING WATER. I (XXX) THE TESTED PARAMETERS MEET CURRENT EPA PRIMARY STANDARDS FOR DRINKING WATER, BUT SOME SECONDARY PARAMETERS EXCEED STANDARDS. ( ) THE TESTED PARAMETERS FAIL !CURRENT EPA STANDARDS FOR DRINKING WATER DUE TO PRIMARY STANDARDS OUTSIDE OF LIMITS. ----------------------------------------------------------------------------------------- COMMENTS: AL'r:ALiidITY = 81 . 5 PPM SPECIFIC CONDUCTANCE = 558 uMHOs SULFATE = 20. 6 PPM MAGNESIUM = 6. 1 PPM ------------------------------------------------------------------------------------------ LESS THAN OUR LOWEST CALIBRATION POINT i GREATER THAN OUR HIGHEST CALIBRATION POINT 1 FLAGS PARAMETER THA:' EXCEED PRIMARY STANDARDS; CAUSES TEST FAILURE. I 2 FLAGS PARAMETERS THAT EXCEED SECONDARY STANDARDS; DOES NOT FAIL TEST. * MIC.ROBIOLOGICAL ANALYSIS RUN PAST 30 HOURS OLD MAY NOT BE VALID NOTE: SUBSEQUENT SAMPLES FROM THE SAME WATER SOURCE MAY 'VARY. Authorized by 1' Orand' t Otate Snalpt kalt 3nt*- ' Main Office/Laboratory At: Tramway Marketplace., 22 Manchester Rd./Rt. 28 Route 16 & 25 1 Derry, NH 03038 West Ossipee, NH 03890 (603) 432-3044 1-800-699-9920 %Lertifiraxt.e of �knaljpis for Prinh.ing Water SENT TO : MESSINA DEV CORP TEST NO . : 9608-00305-1 44 GREAT POND DR BOXFORD, MA 01921 SAMPLE 228 FOREST ST LOCATION: NO ANDOVER, MA DATE & TIME SAMPLED : 8/26/96 10 : 30 EPA r' AMETER RELDJ :cE �.�i��:E.,4Ij (mg/1) MAX. LEVEL --- -- -- ------ - - ------ -- - -- - - pH 7 . 85 6 . 5 - 8 . 5 Units Calcium 55 . 8 None Set Magnesium 5 . 1 None Set 2 Hardness 160 150 mg/l Nitrates 1 . 80 10 . 0 mg/l Nitrites <0 . 050 1 . 0 mg/l Sodium 19 . 3 250 mg/l 2 Iron 0 . 48 0 . 3 mg/l 2 Manganese 0 . 06 0 . 05 mg/l Color 10 15 CPU Turbidity 4 . 5 5 NTU Alkalinity 92 . 3 None Set Specific Conductance 411 None Set/umhos Sulfate 18 . 2 250 mg/l 1 Coliform Bacteria PRESENT ABSENT /100 ml E. Coli Bacteria ABSENT ABSENT /100 ml ONE OR MORE OF THE ABOVE PARAMETERS HAVE EXCEEDED THE EPA DRINKING WATER PRIMARY STANDARD LIMITS AND FAILS POTABILITY. < LESS THAN OUR LOWEST CALIBRATION POINT > GREATER THAN OUR HIGHEST CALIBRATION POINT 1 FLAGS PARAMETERS THAT EXCEED PRIMARY STDS : CAUSES TEST FAILURE . 2 FLAGS PARAMETERS THAT EXCEED SECONDARY STDS : DOES NOT FAIL TEST. * MICROBIOLOGICAL ANALYSIS RUN PAST 30 HOURS OLD MAY NOT BE VALID. NOTE : SUBSEQUENT SAMPLES FROM THE SAME WATER SOURCE MAY VARY. Authorized by I L. . I { tats Salptical, htc# Main Ofdce/Laboratory At: Tramway Marketplace 22 Manchester Rd./Rt.28 Route 16&25 Derry,NH 03038 West Osstpee, NH 03890 (603)A32.3044 1.800-699-9920 Ted Tifirate of ;knalpts for BrTnking Water i SENT T0: Messina Dev. Co. Inc. TEST NO. : 24381 i 44 Great Pond Dr. Boxford, MA 01921 SAMPLE LOCATION: r�W Forest St. � e DATE & TIME SAMPLED: 06/1.7/96 9:00 AM °RnFHEALTH I PARAMETEREPA j 8IQ% RESULT R£COMMEN ED --------- (-PPM) MAX.LEV (PPM PH 7.99 UNITS 2 HARDNESS '220 6.5+-�8�5 UNITS �i CHLORIDE 150 NITRATE 2.49 250 250 NITRITE10.0 X0.050 I SGDIUM 0, 8 1 .0 2 IRON 250 0.89 0.3 MAi4GA1JE5E <0.05 0.05 E COLIFORM ABSENCE /100 ML ABSENCE /100 ML s E. COLI� ABSENCE /100 ML COPPER ABSENCE /100 HL Aj ARSENIC 1.3 LEAD 0.05 i CHROirfIUM 0.015 i CALCIUM 0.1 j FLUORIDE 78 0 NONE SET 2 COLOR 4.0 ODOR 20 CPU 15 CPU 2 TURBIDITY TON 3 TON i HYDROGEN SULFIDE 5. 5 NTU 5 14TU ( ) NONE SET t THE TESTED PARAMETERS MEET CURRENT EPA STANDARDS FOR DRINKING WATER. (XXX) THE TESTED PARAMETERS MEET CURRENT EPA PRIMARY STANDARDS FOR DRINKING WATER, BUT SOME SECONDARY PARAMETERS EXCEED STANDARDS. - ----- I II� THE TESTED PARAMETERS FAIL CURRENT EPA STANDARDS FOR DRINKING WATER I _ DUE- ..TO PRTNARY STANDARDS OUTSIDE OF LIMITS. i - ---_ __---,----------..__.,...._�_-------------------------------�-- ALKALINITY = 87,5 PPM SPECIFIC CONDUCTANCE - 558 uMFIOs -- � COMMENTS: SULFATE = 20.6 PPM MAGNESIUM = 6, 1 PPM -------------- --"--- i LESS THAN OUR LOWEST CALIBRATION POINT - -------- 7 GREATER THAN OUR HIGHEST CALIBRATION POINT ' 1 2 FLAGS `PARAMETERS THAT EXCEED PRIMARY STANDARDS; � i FLAGS PARAMETERS THAT EXCEED SECONDARY STANDARDS; DOES NOT TFAIL LTEST. I * MICROBIOLOGICAL ANALYSIS RUN PAST 30 HOURS OLD MAY NOT BE VALID NOTE; SUBSE4VENT SAMPLES FROM THE SAME WATER SOURCE MAY VARY. Authorized by �� WELL DATABASE ADDRESS: AGE OF WELL: �v,t WELL DRILLER: WELL PERMIT 4: WELL LOCATION: i( ._`1 G WELL PERMIT DATE: C�"� DEPTH OF WELL: TYPE OF WELL: D LED b. DUG C. UNKi WN TYPE OF WATER BEARING ROCK:. WATER ANALYSIS DATE: HIGH ANESE: Y N HIGH IRON: Y N OTHER CON ANT Y N WELL DATABASE ADDRESS: AGE OF WELL: I WELL DRILLER: R',� ' WELL PERMIT WELL LOCATION: ! a � � ��'C'',, • WELL PERMIT DATE: - 5 �1 DEPTH OF WELL: v ) TYPE OF WELL: a.. DRILLED b. DUG c. UNKNOWN TYPE OF WATER BEARING ROCK: WATER ANALYSIS DATE: G " �Z HIGH MANGANESE: Y N HIGH IRON: N OTHER CONTAMINANTS: Y N .. i 1r SEPTIC SYSTEM AS-BUILT TO�BO R o HE L LOCATED IN NORTH ANDOVER,MASS. SCALE:1"=60' DATE7/25/96 � 2 5 1996 , Scott L. Giles R.P.L.S. Frank S. Giles 50 Deer Meadow Road North Andover,Mass. NOTE;LOCATION IS#228 FOREST STREET N r W 126.,54, LOT 1 37,384 S.F. __�WELL 301 b 164.13, �0 T TABLE OF ELEVATIONS " 6� O ,\�y�' OUT OF HOUSE 135.51' �� IN TANK 134.86' OUT TANK 134.63' 1p ate ---- IN D-BOX 134.17' OUT D-BOX X 5 133.99' �� END TRENCH 1 133.58' 2 133.57' —--- 3 133.55' ------ 4 133,6V 5 133,61' I HEREBY CERTIFY THAT I HAVE INSPECTED THE t CONSTRUCTION OF THIS DISPOSAL SYSTEM AND THAT THE CONSTRUCTION AND FINAL GRADING HAS BEEN IN ACCORDANCE WITH THE DESIGNERS �L INTENT AND THAT THE MATERIALS USED CONFORIN TO THE PLAN SPECIFICATIONS AND 310 CMR 15.00 7/25/% - . � . . . `� i �;, &O*Tk 0� .♦e ,♦,MO R ♦ "s �, a Ss�C � .SACo <h BOARD OF HEALTH , MUSE� NORTH ANDOVER, MASS. APPLICATION FOR WELL AND PUMP PERMIT Permit # Date A permit is requested to: drill a well '� install a pump LOCATION: ���� Lot # Owner � �, � ddress Tel Well Contrctr�/ J' " Add. Pump Contrctr Add. Tel WELLS (To be completed at time of pump test. ) Type of well Use- Diameter of well Size of casing Depth of bed rock Depth casing into bedrock Seal been tested? Yes (_) No (_) Date of test Depth of well Water-bearing rock Depth to water Delivers GPM for (how long?) Drawdown feet after pumping hours at GPM Date of completion Signature of well contractor PUMPS (To be filled in before installatJon. ) Name & size of pump Type Size of tank Pump delivers GPM Pipe used in well: Cast iron (_) Galvanized (_) Plastic (_) Sleeve used to protect pipe? Yes (_) No (_) Type well seal Date Signature of pump installer Date water analysis report submitted to Board of Health Plumbing inspector Wiring inspector Board of Health NUMBER W �2—_ THE COMMONWEALTH OF MASSACHUSETTS FEE .TOWN........ of _....NQRTH..A .().V.F13............................... This is to Certify that ....._ C.M. Rollins Co. , Inc. •- _. _..----- NAM ._...._."12.9.."Depot .Road""Boxford, MA 01921 L"-s -------------- . .-" ..............••— i t IS HEREBY GRANTED A LICENSE For ._.Tniell..P_ermi t•-.-. 2,2$ l+qZQ.S Street, North Andover .... -"-................................"-...................•"-.......-•"""""-"••"• -----•••""--•-.-•... •-•••--•-•......... This license is granted in conformity with the Statutes and ordinances relating thereto, and. expires...December 31 :1996 """' unless sooner suspended or revoked. ........... Juni 5 , 13�`' -••-----•-•-----•--•-•- ....................................19:.9 6 -- ...... _ FORM as9HO .. .. . H&W BBS 8 WARREN TM .. •_._ .. i Al S ; ,�'X��T/A/G I,U�GG a N e,07- 17W6 G GAv� PlelV 9G W Z PLAN REVIEW CHECKLIST ADDRESS I-Cae--ST 67- ENGINEER GENERAL 3 COPIES STAMP • LOCUS i-,� NORTH ARROW �� SCALE CONTOURS PROFILE ✓ SECTION BENCHMARK SOIL & PERCS i. ELEVATIONS WETS . DISCLAIMER WELLS & WETS �— WATERSHED? IVO DRIVEWAY �lev) WATER LINE�16''v FDN DRAIN SCH40 TESTS CURRENT? SOIL EVAL -D, C) SEPTIC TANK MIN 150OGy . 17 INVERT DROPy/ GARB. GRINDER (+200% EDF) 25 ' TO CELLAR �-� MANHOLE ELEV GW # COMPS. I D-BOX SIZE # LINES FIRST 2 ' LEVEL STATEMENT INLET 3/ 4, OUTLET 133, �_ %7 (2 11 OR . 17 FT) TEE REQ' D?/VO i LEACHING MIN 660 GPD? ,Y, ESERVE AREA 4 FROM PRIMARY? 2% SLOPE 100 ' TO WETLANDS 100 ' TO WELLSy 4 ' TO S . H. GW �5 ' >2M/IN) 35 ' TO FND & INTRCPTR DRAINSc--- 325 ' TO SURFACE H2O SUPP 4 ' PERM. SOIL BELOW FACILITY d—'- MIN 12" COVERLf FILL? --- 25 ' if above natural elev; 101if below) BREAKOUT MET?,-- ' TRENCHES MIN 660 gpd SLOPE (min . 005 or 6"/1001 ) L-�"SIDEWALL DIST. 3X EFF. W OR D (MIN 6 ' ) RESERVE BETWEEN TRENCHES? IN FILL? MUST BE 10 ' MIN. 4" PEA STONE? VENT? (>3 ' COVER; LINES >501 ) BOT + SIDE X LDNG = TOT (L x W x #) (DxLx2x#) (G/ft2) Copyright 0 1995 by S.L. Starr Office use Only q 01 4r Liam tiIIlllU ulth If gustZ tits Permit No. !;k 13cpartment of Vuhlir OtufLtg Occupancy&Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 (leave blank) 3190 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:0j0 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date LLLL � QQxr or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit perform the electrical work describ9d below. Location (Street & Number) COO// S Fr"2 © k Owner or Tenant Owner's Address ` Is this permit in conjunction with a building permit: Yes �' Ncl C (Check Appropriate Boxj Puroose of Building_ p�l/'2 �^L Utility Authorization No. Existing Service Amos Volts Overhead I Undgrnd L—, No. of Meters New Service /tW� Amps 20 2-O Voits Overhead E---Uncgrne No. of Meters Number of Feeders and Amcacity Location and Nature of Preoosed Elect icai Werk rJ Totai No. of Llgntng Cutlets i No. of Hot -,;bs i No. of 7ranstormers KVA No. at Lighting Fixturesi Swimming Pool r.oe_ crnq. _ I Generators KVA iNo. at Emergency Lighting No. of Ott Burners No. of Receetac:e Cutlets I Battery Units No. of Switch Outlets I No. of Gas Burners I FIRE ALARMS No. of Zones Total No. of Detection and No. of Ranges No. of Air Conc. tons Inatatine Devices _-11 Heat Total Total No. of Disposals NO°f Pumcs Tons KW No. of Sounding Devices i No. of Sarf Contained No. of Dishwasners ScaceiArea Heating KVV Detect:oniSounaing Devices — Mumcioaiother No. of Dryers Heating Devices KW Local Connec::on No. of No. at I Law Voltage No of Water Heaters KW I Signs Sanas<s Wir ric No Hydro Massage -subs I No of Motors otal HP OTHER: INSURANCE COVERAGE. Pursuant ,a the requirements of massacr:useas general Laws _ _ I have a current Liaociity Insurance Policy inctucing Cam^:etec Ccerations Coverage or its supstantial equivalent. YES _ NO _ I have submitted vaiid proof of same to the Office. YES =!yU _ if you nave checxea YES. -!ease ingicate the type of coverage cy Chec King the apprg pox. INSURANCE = BOND = OTHER = (Please Scec:ty) (Exeiration Oatel Estimated Value of E!ectrical WorK S / WorK :o Start Inscecnon Date Recuestec: Rough ! Final Signea unser the Penalties f perjury -0 LIC. NO. -- FIRM NAME Licensee Bus. Signature -1 t UC. NO. ��L,`?� Bus. Tel. No. Y 6 Y 2 �� Address F� / f•r N' -� J ! °- Y /" Alt. -et. No. OWNER'S INSURANCE WAIVER: t am aware that the Licensee toes not have the insurance coverage or its suostantial equivalent as re auirea by Massachusetts General Laws. and that my signature an his permit application waives this requirement. Owner( � gent(Please cnecK ones /QJ✓�� / 'eieonone Na. PERMIT FEE 5 (Signature at Owner or Agent x-6565 .a^ro"+•T..s�+N-7t.'4:•a.�.-.:+yp:n.�.a.�r*,.a.--tet✓'.y_ ,�._ �T� ...�..- �..�...-.` °d5., n ...e"Y�'4�d•S:4.d'xIa["=.t'r—'�'--.r+..s�— s*'4. . 2665Date.. NOR,ti 1TOWN OF NORTH ANDOVER O Of` q, , to PERMIT FOR INSTALLATION F ,- y ;,o �9SSgCHUSEt This certifies that . f. . . . . 7 P,.$/. .. . . . . . . . . . . . . . . has permission foy S''fnstallation .. . . . . in the buildings of . . . .14.1rs5?� . . . . .!�eh'�.. . . . . . . . . . . . at O . . . !r$t`. . . . . . . ., North Andover, Mase: Fee,. •� . Lic. No.. . . . . . . . . . . . . . . tCr6/j, SPECTOR t .� `i WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD:FII Cs Office Use Only - - , uh� LjMMBnWeatth of faggar#gEttl Permit No. SV i3epartment Qf VUblic -'FIfPtU Occupancy& Fee Checked �77 BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3/90 (leave blank) Z? I APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527�CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date ! 2 6— S� (X)Q or Town of NORTH AHnQVFR To the Inspector of Wires: The udersigned applies for a permittoperform the electrical work described below. Location (Street & Number) 22-ddu A')Re-'S Owner or Tenant j e S S !W/T Owner's Address Is this permit in conjunction witIqi la building permit: Yes � No ❑ (Check Approoriate Box) Purpose of Building , ` Utility Authorization No. 0 2 YS Existing Service Amps Volts Overheadr❑i1�Undgrnd ❑ No. of Meters New Service � Amps l 2�� 2(10 Volts Overhead t� Undgrnd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electripal Work.-4&we,2- !,a"�_,,'6 Total No. of Lighting Outlets No. of Hot Tubs No. of Transformers KVA Above In No. of Lighting Fixtures I Swimming Pool grnd. gid. ❑ I Generators KVA Na. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units No. of Switch Outlets I No. of Gas Burners FIRE ALARMS No. of Zones Total No. of Detection and No. of Ranges — I No. of Air Cond. tons Initiating Devices No.of Heat Total Total No. of Sounding Devices No. of Disposals Pumps Tons KW g No. of Self Contained No. of Dishwashers Space/Area H,-..ting KW Detection/Sounding Devices - I Municipal Other No. of Dryers I Heating oevicesr;vv ! Local ❑ connection No. of No. of Low Voltage Nu. of Water Heaters )C N.. I SignsBallasts - Wiring _No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant ,a the requirements of Massachusetts general Laws - NO _ I I have a cu)!£nt Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES have submitted valid proof of same to the Office. YES �y0 = If you have checked YES. please indicate the type of coverage by checking the appropriate box. INSt1FtANCE C;�nNO _ OTHER = (Please Specify) (Expiration Date) t Estimated Value of Electical Work S Work to Start S Inspection Date Requested: Rough Final Signed under the Penalties ot.perjuryLI - Z z �- C. NO. FIRM NAME ti (y� 1f2/ S V Signature LIC. NO. Licensee h Z`?y 3 (/�� _ `, �- `^[/► /]/ Bus. Tel. No. Address �� o / J I I ��'e "" Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent tio (Please check one) _ Telephone No. PERMIT FEE 3 (Signature of Owner or Agent) X•8565 . <^ Date...... ...... 348 NORTI{ '14, q6 �' TOWN OF NORTH ANDOVER 3? •� °t p PERMIT FOR WIRING �,SSACMUSE� cl* f5� w Thiscertifies that ...... .. ...... . ................. ......... ....................................... has permission to perform . ........ ....... .. .......... . ........... wiring in the building of....... ..... .. .. .......................... at.. .. '.. .............................. .North Andover,Mass. ' keZ7.2! ' Lic.No.C. U......... EL Z� ECT �INSPE WHITE: Applicant CANARY: Building Dept. PINK:Treasurer 3/0