HomeMy WebLinkAboutMiscellaneous - 324 WINTER STREET 4/30/2018- 01 4r Tommoumalo of f assar4usdo
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BOARD OF FIRE PREVENTION REGULATIONS 521 CMR 12:00
Office Use Only
Permit No.
Occupancy & Fee Checked
3/90 (leave blank)
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 5--/9-77
(M* or Town of NORTH ANDOVER To the Inspector of Wires:
The udersigned applies for a permit to perform the electrical work described below.
Location (Street & Number) 3 a q W/'/Ll /C-C/P 5 T
Owner or Tenant W J L L I /f
Owner's Address .S /9 ✓yi t
I Sul-Li'i
ru
Is this permit in conjunction with a building permit: Yes ❑ No � (Check
Purpose of Building 1?E S J Z),5 i✓?`, L Utility Authorization
Existing Service /02 Amps A201 ay° Volts Overhead L Undgrnd ❑
New Service 900 Amps iao/ aqo Volts Overhead 5i Undgrnd ❑
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
iropriate Box)
dna ivy
No. of Meters
N6.,of Meters
OTHER: % WDLL SW! 7"C,9ES FlrJQ kCPLAcJ!!�A �=2 h// r c11Cry 0U7_LE7Z5
7"o/G/'S ouTETS.
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws /
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES NO Y I
have submitted valid proof of same to the Office. YES = NO ._ If you have checked YES, please indicate the type of coverage by
checking the appropriate box.
INSURANCE BOND —_ OTHER (Please Specify)
(Expiration Date)
Estimated Value of Electrical Work S Jl 5-00, GO
Work to Start S l N - Y7 Inspection Date Requested: Rough
Signed under the Penalties of perjury:
FIRM NAME
Final WILL C4C-1-
LIC. NO.
Licensee fl(rwwry Rv •. .,.i pynawc -- (19117- 7300-1200
Bus. Tel. No.
Address 9 LEX%4TOOIJ DR• AWAI0S're" D, /VI" _ Alt. Tel. No. 1903- -
SWU
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 4General L ws, and that my signature on this permit application waives this requirement. Owner Agent
(PI ase check one) o
�!'_L�/ Telephone No. �a�'� PERMIT FEE S
P5�ner or Agent) �� x-5565
�J V
Total
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers KVA
No. of Lighting Fixtures
Swimming Pool Above
grnd. ❑
In-
grnd. ❑
LGenerators KVA
No. of Emergency Lighting
No. of Receptacle Outlets
f s I
No. of Oil Burners
° I
Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS No. of Zones
No. of Detection and
Total
No. of, Ranges
No. of Air Cond. tons
Initiating Devices
No. of Sounding Devices
No. of Self Contained
No. of Disposals Dis
p
No.of Heat Total Total
Pumps Tons KW
No. of Dishwashers
I Space/Area Heating
KW
Detection/Sounding Devices
Municipal
Local ❑ Connection ❑Other
I
No. of Dryers
Heating Devices KW
No. of No. of
Low Voltage
No. of Water Heaters
KW
I Signs Ballasts
Wiring
No. Hydro Massage Tubs
No. of Motors Total HP
OTHER: % WDLL SW! 7"C,9ES FlrJQ kCPLAcJ!!�A �=2 h// r c11Cry 0U7_LE7Z5
7"o/G/'S ouTETS.
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws /
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES NO Y I
have submitted valid proof of same to the Office. YES = NO ._ If you have checked YES, please indicate the type of coverage by
checking the appropriate box.
INSURANCE BOND —_ OTHER (Please Specify)
(Expiration Date)
Estimated Value of Electrical Work S Jl 5-00, GO
Work to Start S l N - Y7 Inspection Date Requested: Rough
Signed under the Penalties of perjury:
FIRM NAME
Final WILL C4C-1-
LIC. NO.
Licensee fl(rwwry Rv •. .,.i pynawc -- (19117- 7300-1200
Bus. Tel. No.
Address 9 LEX%4TOOIJ DR• AWAI0S're" D, /VI" _ Alt. Tel. No. 1903- -
SWU
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 4General L ws, and that my signature on this permit application waives this requirement. Owner Agent
(PI ase check one) o
�!'_L�/ Telephone No. �a�'� PERMIT FEE S
P5�ner or Agent) �� x-5565
�J V
930
HORTM
Qf t.ao .e 1�0
O A
S
Date ....... ..... r. a....�.!.. 7
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
s^cMus 1
This certifies that %hr!n....:...
has permission to perfor........... ...... ....._......... :/�.....
L
wiring in the building of ...... .. m .:..... ... .. ............................
6at.... a... N ..................... .North Andover, Mass.
e.��...-.... Lic. No.ll'I?..........................................................
ELECTRICAL INSPECTOR
44
WHITE: pplicant CANARY: Building Dept. PINK: Treasurer
Date: 6-. 1-,' (1
Homeowner:
Stree-z _ 04k P- 54
Phone (p(6,; -
Nature of Service:
Observations:
Servicing Report
Routine U 2 <,
I—
Emergency
31990
Pumper
Address:
Phone
Good Condition UQ•i
Full to Cover A!9
-
Baffles in Place Ut
Leachfield Runback =j
Excessive Solids
Heavy Grease rVo
Roots N0
Other (Explain)
Descript:_on of Work Q
Comments:
William F. weld
T= Trudy S. Coxe
EoeA
David B. Struhs
Ca1f1 dation f
Commonwealth of Massachusetts
Executive Office of Environmental Affairs
Department of
Environmental Protection
Metro Boston/Northeast Regional Officeo��'�`Ny`'�
2 ro
t
• 1
' i 1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PAST A
CERTT ;TCATION
3 2 4 Winter St. Addreo of Owner.
Property Address N. Andover, MA
�B °� 10-24-96 of allerent)
NazaeOfI=gw*w-James Wright, JR.
Qu"My Name, Address and Telephone Number.
R.J. 'INspections,Ine•.
One Osgood Street, Methuen, MA 01844
CESTIFICATION STATEMENT (508)681-8759
I certify that I have Personally inspected the sewage disposal system at this address and that the information reported below is true, accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on -situ disposal kms, The system:
Passes
_ Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
Fails
Inspector's S) Date:
The System shall submit a copy of this inspection report to the Approving Authority within thirty. (30) days of completing this
inspection. /j�the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to appropriate regional office of the Department of Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority.
INSPECTION SUMMARY:
Check A B, C, or D-
A] SYST
EM PASSES:
I have not found any information which indicates that the system violates an of the failure
y criteria as defined in 310 C]lrIIt 15.303.
Any failure criteria not evaluated are indicated below.
B] SYSTEM CONDITIONALLY PASSES:
One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes
inspection.
Indicate yea, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If "not determined -,explain why not)
The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or dation, or tank fiulure is
imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved
by the Board of Health
(revised 8/15/95)
10 Commerce Way 9 Woburn, Massachusetts 01801 a FAX 0 Telephone
_ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)
or due to a broken,`setged or uneven distribution box. The system will pass inspection if (with approval of the
Board of Health):
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
s
(revised 8/15/95) 2
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (aontim ed)
Propeetyeddrsom 324 Winter Street, N. Andover, MA.
owe Frank Trombley
Data at 10-24-96
BI SYSTEM CONDITIONALLY PASSES (continued)
The system required pumping more than four times a year due to broken or obstructed pipe(s). The system
will pass inspection if (with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions east which require fiu Cher evfalnation by the Board of Health in order to determine if the system is failing to protect the
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETER OM THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER,
WffiCH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated.wetland or a salt marsh..
2) SYSTEM WILL PAM UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES
THAT TEE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
The system has a septic tank and soil absorption system and is within 100• feet to a surface water supply or tributary to a
surface water supply.
The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well
The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water
supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free
from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm.
DI SYSTEM FAIIA:
I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for
this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the
failure.
Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspooL
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool
Static liquid level in the distribution box above outlet invert due to aa.=Wloaded or clogged SAS or cesspooL
Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
(revised 8/15/95)
Number of times pumped
Any portion of the Soil Absorption System, cesspool or privy is below the .high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone I of a public well.
i
(revised 8/15/95) 4
Property Address:
Owner
Dose of Inspection:
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PAST A
CERTIFICATION (conned)
324 Winter Street, N. Andover, MA
Frank Trombley
1-24-96
Dl SYSTEM FAILS (continmeda:
Any portion of acesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from. a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrdgen.
El LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria above:
The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public
health and safety and the environment because one or more of the following conditions exist:
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area•(IWPA) or a mapped Zone II of a public
water supply well)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
PART B
CBECSLIST
Check if the following have been done:
v Pumping information was requested of the owner, occupant, and Board of Health.
LNone of the system components have been pumped for at least two weeks and the system has been receiving normal
flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this
inspection.
built plans have been obtained and examined. Note if they are not available with NIA.
The facility or dwelling was inspected for signs of sewage back-up.
The system does not receive non -sanitary or industrial waste flow
site was inspected for signs of breakout.
—All system components, excluding the Soil Absorption System, have been located on the site.
(revised 8/15/95)
V The septic yank manholes were uncovered, opened, and the interior of the septic tank was u=ected for
condition of babies or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on existing
information or approximated by non -intrusive methods-
1 fae ty owner (and owapants, if different from owner) were provided with information on the proper
maintenance of Sub-Sw ace Disposal System.
(revised 8/15/95)
SUBSURFACE SEWAGE DISPOSAL SYSTEM IldSPECi'ION FORM
PART C
SYSTEM INFORMATION
i 324 Winter Street, N.Andover, MA
C—Mm Frank Trombley
hof 10-24-96
FLOW CONDMONS
REMENTUI7
Design flow gallons
Number of bedrooms-
17
Number of current residents:
Garbage grinder (yes or no)W/
Laundry connected to system (yes or no):,&�;
Seasonal use (yes or no):,.�jf L' _
Water meter readings, if available'
Inst date of ce=pancy:
COM IERCLAIL NDUSTMAT-
Type of establishment:
Design flcw ¢allons(day
Grease trap present: (yes or no)_
Industrial Waste Holding Tankpy+nt: es ' o)_
Non -sanitary waste • discbarged A the Title iso -stem (yes or no)_ ,
Water meter readings,, if available I /
Last date of occl.,anc : /
OT>3E'Lc •' (DescrEbe) (J
Last date of occupancy:
GVV.NXRAL W- ORMATION
PUMPING RECORDS and source of information: _
System pumped as part of
inspection: (yes or no)
If yes, volume Pumped: gallons
Reason for Pumping:
TYPE O
Septic tankldistriicution bomisoml absorption system
3ingie cesspool
Overflow, cesspool
Privy
Shared system (yes or no) (if yes, attach Previous inspection records, if any)
Other (ezalain)
AtPPEOXINLA= AGE of ail components, date �t�led (if known) d source of information:
/ 114 -�� C% moi6i !
Sewage ode's detected when arriving at the site: (yes or no),!
(revised 8/5/95)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PAST C
SYSTEM INFORMATION (wed)
property Address: 324 Winter Street, N. Andover, MA
Owner. Frank Trombley
Date of Inspeetiom: 10 - 2 4 - 9 6
SEPTIC TANK-
(locate
AI(:(locate on site plan)
Depth below. grade:
Material of construction concrete metal FRP other(explain)
Sludge depth O ' /
Distance from top of sludge to bottom of outlet tee or baffie: ':Pe
Scum thickness:'
Distance from top of scum to top of outlet tee or Qde:6
Distance from bottom of scum to bottom of outlet tee or baffie: V-3
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffies, depth of liquid level in relation to outlet invert, stractural integrity,
evidence of leakage,
GREASE TRAP:—
(locate on site plan)
Depth below grade:
Material of construction: concrete metal FRP --other(explain)
scum thickness-
Distance from top of scum to of yet tee or baffie:
Distance from bottom of sc m of outlet tee or baffle:
—
Comments:
(recosaaendation for pumping, condition of inlet and outlet tees or baffies, depth of liquid level in relation to outlet invert, structural integrity,
evidence of leakage, etc.)
(revised 8/15/95) . g
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
yAddrees:324 Winter Street, N. Andover, MA
O"zwr Frank Trombley
OfI'si0n` .10-24-96
TIGHT OR HOLDING TANS:_
(locate on site plan)
Depth below grade:
Material of construction concrete metal _FRPcther(esplain)
CaPacitYder a
Design flow ns/day
Alarm level:-
Comments:
evel:Comments:
(condition of inlet tee, conditiaa of and float switches, etc.)
DISTRIBUTION BOX
(locate on site plan)
Depth of.liquid level above outlet invert:_ /
Comments:
(note if level and distribution is equal, evidence of solids carryover, evidence of le into 9zo4 of box, etc.)
PUMP CHAMBER:_
(locate on sits plan)
Pumps in worldng order (yes
Comments
(note condition of Pump fib,
of pumps and appurtenances, etc.)
(revised 8/15/95) 9
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (cmitinned)
P"ParLyAddrOm 324 Winter Street, N.Andover, MA
Owner Frank Trombley
Date of
°n' 10-24-96
SOII. ABSORPTION SYSTEM (SAS):_
(locate on site plan, if possible; excavation not required, but may be approximated by non -intrusive methods)
If not determined to be present, explain:
leaching pits, number
leaching chambers, number-
leaching
umberleaching galleries, number
leaching trenches, number,length: 3
leaching fields, number, dimensions:
overflow cesspool, number-
Comments:
umberComments: (note condition of soil, signs of hydranligfarlure, level yyf po condition of vegetation,etc.
7`J`/ /i
CESSPOOLS: _
(locate on site plan)
Number and configuration:
Depth -top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer.
Dimensions Of cesspool.•
Materials of construction:
Indication of groundwate
inflow ( 1 musiA pumped as part of inspection}
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, 'etc.)
PRIVY: _
(locate on site plan)
Materials of construction: Dimensions:
Depth of solids:
Comments: (note condition of soil, signs" , level of ponding, condition of vegetation, etc.)
(revised 8/15/95) 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSWM INFORMATION (coed)
ProportyAddmw- 324 Winter Street, N.Andover, MA
Owner Frank Trombley
Debe0f 10 2 4 9 6
sBETCH OF SEWAGE DISPOSAL. SYSTEM--
include
YSTEM_include ties to at least two. permanent references landmarks or benchmarks c
locate all wells within 100'
(revised 8/15/95) 11
� 1
DEPTH TO GROUNDWATER
Depth to giwndwater:. f 1___feet
method of determination or approximation: _
d
(revised 8/15/95) 12