Loading...
HomeMy WebLinkAboutMiscellaneous - 335 BERRY STREET 4/30/2018 (2)_N O n ob W O O O O O Date ....J./� v 7 yORTry 'O`tt��o rb'ir% ...r ..,..•. o TOWN OF NORTH ANDOVER PERMIT FOR WRING This certifies that has'Permission toperform _ ..................... (' wiring in the buil ding of ...... ........... ............... . h Fee.. Lic. Mall U �v�er�ass. Check # �EIECfRICAL INSPECTOR .............. � �.a 5i;$ 02 The Commonwealth of Massachusett Department of Public Safety BOARD OF FIRE PREVENTION REGULATIONS S271CMR 1z-00 Office Use Only Permit No. Occupancy & Fee Checked L/Aheave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed In accordance with'the Ma4achuserts Electrical Code. S27 CMR 12:00 (PLE.ASE PRINT IN INK OR TYPE ALL INFORMATION) Date_qSJ�y City or Town of /Vo,L'7�N <wp0yLP_ To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number)_ 3IN5 BF—gMy. 5T Owner or Tenant jOCc 11-fLO RAME,S Curne—'s Address SAP{f_ Is this permit in conjunction with a building permit: Yes Rr No ❑ (Check Appropriate Box) Purpose of Building &Vf_LLf N C_ Utility Authorization NO. Existing Service i00 Amps_j 10 /2a0 Volts Overhead Undgrd ❑ No. of Meters__ 1 New Ser -rice `mPs / Volts Overhead ❑ Undgrd ❑ No, of Meters N=ter of Feeders and Acpacity Location and Nature of Proposed Electrical Work _Q CA L C A iCAirrt w No. of Lighting Outlets No. of Lighting Fixtures No. of Receptacle Outlets e I No. of Switch Outlets No. of Ranges J No. of Disposals No. of Dishwashers I No. of Dryers No. of Water Heaters KW No. Hydro Massage Tubs OTHER: No. of Hot Tubs Swimming Pool AboveIn- grnd. ❑ grnd No. of Oil Burners No. of Gas Burners No. of Air Cond. Total tons No. of HeaPumt Total Total Total Tons KW Space/Area Heating KW Heating Devices KW No, of No. or Sins Ballasts No. of Motors Total HP INo. of Transformers 'tea ❑ Generators KVA �No. of Emergency Lighting Battery Units (FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices @_ No. of Self Contained Detection/Sounding Devices Local[] Municipal ❑ Other Connection Low Voltage 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 C] NO ❑ I have submitted valid proof of same to this office. YES ❑ NO C] If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE OBOND ❑ OTHER ❑ (Please Specify) Estimated Value of Electrical Work S (0 7 trC Work to StartJ/plu Inspection Date Requested: Rough Signed under the penalties of perjury: FIRM NAMEPALeL rr ,- Expiration Date) Final C�ftl LIC. NO..A%4r95C Licensee Pnlrc CrEMME 1 Signatur LIC. NO.A/(09cO Address? jjt1v4r5 ,"-wo t.A/yr /q i116�t;f�1 itgp o�351 Bus. Tel. No.791-757-013ZL Alt. Tel. No. 7Q{,.5S7 - /0'f(v OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Signature of Owner or Agent Telephone No. PERMIT FEE S '%O e)0 X u 0 ♦ o `f+ ° Date ..5 ' (,-. - G. "/ TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ..�.� �. rV.4 �.4 ... �...°. .- :.................. . has permission to perform ..... C %Z.14 �'..'. . . . . . . . . . . . . . . . . plumbing in the buildings of ... 1 ...................... at ... )........ h ........ ........... . North Andover, Mass. Fee.. Lic. No.. I (J.-.( . ............. / PLUMBING INSPECTOR Check # I 5"c- 6 " 6 3 t,. MASSACHUSETTS UNIFUHM iRVVLIUAI IUN FOR PER, TU IJU.NLUMBING (Print or Type) f N. Andover , Mass. Building Location 335 Berry Street N. Andover. MA. O/AK New ❑ Renovation FIXTURES )% Permit # 0) s Name Ramos. Type of Occupancy Residence Plans Submitted: Yes ® No ❑. installing Company'Name E. Puopolo & Son Check one: Cenfficate- Address_ 24 Beek Road, ArlingLon, ' A. ❑ Corporation Estimated Cost of Plumbing ❑ partnership Business" Telephone 781-674-2600 • ® Firm/Co. Yes Name: of Licensed Plumber Stephen L. Puopo10 INSURANCE. COVERAGE:. I have a cu Yes ® liability Insurance. policy or Its- substantial equivalent. which meets the :. requirements cf MGL Ch.. 142 If you have checked yes, please indicate the type coverage by checking the appropriate box A liability Insurance policy IN 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 ❑ I hereby certify that all of the details and information I have su fitted (ore ) in above application are true and accurate to the best. of my knowledge and that all plumbing work and installations perf ' ed and r e rma issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing e d to 42 of the General Laws. �7 " � v /J Signature ol Ucensed Plumber True City/'Town Type of License: Pilaster ® Journeyman ❑ APPFONED OFFICE USE (DNLY) license Number 11836 Z N' N N V7 O 2: f•' j C7 W Y J W V V) O Q UJ Ul _ Q s x < W O x m a a V z Q m fn N z. W d W N x .^ O s O ti r It d. o Q' a.. +. Q W J" a c Q N a Z M c a x a .0 .4 a. ac tuu > H O CL z: _ y }. Z. a 0 o 0 N z ,� x d W W u.. O x c W 2. d F- �c .4c* d =— y rn Q d 0 d. a� Q M Q 0 Q h- v a< 3 e m o Sign—SS MT: BASEMENT IST- FLOOR 1 1 1 1 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 8TH FLOOR 7TH FLOOR STH FLOOR installing Company'Name E. Puopolo & Son Check one: Cenfficate- Address_ 24 Beek Road, ArlingLon, ' A. ❑ Corporation Estimated Cost of Plumbing ❑ partnership Business" Telephone 781-674-2600 • ® Firm/Co. Yes Name: of Licensed Plumber Stephen L. Puopo10 INSURANCE. COVERAGE:. I have a cu Yes ® liability Insurance. policy or Its- substantial equivalent. which meets the :. requirements cf MGL Ch.. 142 If you have checked yes, please indicate the type coverage by checking the appropriate box A liability Insurance policy IN 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 ❑ I hereby certify that all of the details and information I have su fitted (ore ) in above application are true and accurate to the best. of my knowledge and that all plumbing work and installations perf ' ed and r e rma issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing e d to 42 of the General Laws. �7 " � v /J Signature ol Ucensed Plumber True City/'Town Type of License: Pilaster ® Journeyman ❑ APPFONED OFFICE USE (DNLY) license Number 11836 I& Location w No. �1�1 Date TOWN OF NORTH ANDOVER o °1 . 0 Certificate of Occupancy $ NUEta Building/Frame Permit Fee $ 105 Foundation Permit Fee $ Other Permit Fee $ to TOTAL Check # i,Ign& r6`/ rl'1 �" Building Inspecto TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING "for OEfI if t3>al BUILDING PERMIT NUMBER: DATE ISSUED: /a 9-a o 03 SIGNATURE:CC-�— Building Commissioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 3-35 13FIZP2y ST,. 1.2 Assessors Map and Parcel Number: /Ose- 65 Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: t53, Y14% 71t z 170-03 Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide. Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zane Information: Public 0 Private R--- .Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: / Municipal 0 On Site Disposal System B� ,�S ECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Soy k" /1'1 , �2A-,nti1� 33S b i 57`"• k0, �Vl�©y�2 r,� Name Print) Address for Service Signature Telephone 2.2 Owner of Record: 7/1te671,W-4 1-4, G�"J 3 36- � �y �T. AJ A),0014*t 1-4 Name Print Address for Service: -Si natu a Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: ,�z 71MIJa 17117 0 S o� Licensed Construction Supervisor:' / 7 — -77q (f O � /Y D .[/o J Address V�/ Signature elephone Not Applicable 11 cs C95-0 9Q67 License Number OFD F MM Expirati n Date 3.2 Registered Home Improvement Co ctor Not Applicable ❑ / 3 V c�7, 3 7 Company Nam / ✓���.Sa�? �/ D/r Registration Number _q rJ D Address Expiratioon, ateJ Si nature Telephone SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildi permit. Signed affidavit Attached Yes ....... V No ....... ❑ SECTION 5 Description of Proposed Work check alfapplicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: Go rK D %� �Tro � / h ✓ 2 W c r r G w w -1 'at"'11Z7 pet) l'- 1-191rD I22 "i 2r? /r vV C!q j6e 714-1 c°P A-7 C/''q �v�r q ce FJtict t4'• �� Qd JO✓1 D �� a r SEC ON 6 . ESTTMATF.D CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building l qld 0 o (a) Building Permit Fee Multi Tier 2 Electrical (b) Estimated Total Cost of Construction /�/ ` 63 .61 �" / 0 3 Plumbing 13,000 Building Permit fee (a) X (b) '- 4 Mechanical HVAC 5 Fire Protection Z o O 6 Total 1+2+3+4+5 / (o E/ 000, 1 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR %APPLIES FOR BUILDING PERMIT / %*aw-Kner/Authorized Agent of subject property Hereby authorize �(%iL �iQ'ly( P7� /IC%� STa/C% to act on M ehal 11 Matter relative to w rl ionized by thi building t ap lic on�/'/O /l,( wy `bCAt If ,A�gnature of Owner L17 Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION t" I, ViIlavy0/01!9;dAuthonzed Agent of subject property ✓ / Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief I Print N of V NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1ST2 ND3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE P V .11 s NEW ENGLAND ENGINEERING SERVICES INC October 1, 2002 Socorru Ramos 334 berry Street North Andover, MA 01845 RE: Title 5 inspection 334 Berry Street, North Andover Enclosed is a copy of the Title 5 Report for the above referenced property. The system Passed our inspection. If you have any questions please call. Sincerely, Ben�ari C. Osgoodr. d ,A I8 31LpVIA- e o 0 16 � a� •2 � ` ,� O o 1 � X s� oa i r J 'UQ� '� g a- c �c lLk 4 Z �Z 60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 M or 0. NEW ENGLAND ENGINEERING SERVICES INC October 1, 2002 Socorru Ramos 334 berry Street North Andover, MA 01845 RE: Title 5 inspection 334 Berry Street, North Andover Enclosed is a copy of the Title 5 Report for the above referenced property. The system Passed our inspection. If you have any questions please call. Sincerely, Benham C.Osgoo r. 60 BEECHWOOD DRIVE — NORTH ANDOVER, MA 01845 - (978) 686-1768 — (888) 359-7645 — FAX (978) 685-1099 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: _ 33S— dc,z,2y s,12.c&-7 iV I,%A Owner's Name: So C l OP -0 QRA D S Owner's Address: Date of Inspection: !Z/ -3p/ - z Name of Inspector: (please print) _ be-4;r4-,A,,v L' ids 60,00 n� Company Name: rtJEyjN Mailing Address: /Jv/Li�� `?vva bvGYL ..�fl Telephone Number: q 7Eq .- y $ 6Y 7h CERTIFICATION STATEMENT 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 the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15340 of Title 5 (310 CMR 15.000 The system: asses Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: _, CIZ, Date: -30 1,3 The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If 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 the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of useat that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 2 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 13t 9t!j �s%/�Ce ,00 2lly 4A O Owner: 5;- ( c 0 e ,) 24t a s Date of Inspection: —13 g/, 7 Inspection Summary: Check A,B,C,D or E I ALWAYS complete all of Section D A �m Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the "Conditional Pass" section need to be replaced or r8pai ed. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, n not determined (Y,N,ND) in the for the following stater a s. If "not determined" please explain.' The septic tank is m and over 20 years old* or the septic t whether metal or not) is structurally unsound, exhibits substantial in tration or exfiltration or tank fail3p is imminent. System will pass inspection if the existing tank is replaced with a co g septic tank as approved by the Board of Health. *A metal septic tank will pass inspecti it is structurally found, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years is available ND explain: Observation of sewage backup or bt`eak out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, ed or uneven distributi h box. System will pass inspection if (with approval of Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is leveled or replaced -�-� ND explain: � The system required pumping more than 4 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 ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: -33S- '4 C -12-4'y Nv,2�t ItyV.>DJj ,-t 14 Owner:. occ>Q2c: 2r4�t flS Rate of Inspection: C. Farther Evaluation is Required by the Board of Health: Coli,ditions exist which require further evaluation by the Board of Health in order to, determine if the system is failing to tett public health, safety or the environment. f I. System ass unless Board of Health determines in accordance with 3.10 CMR 15.303(1)(b) that the system is not ctioning in a manner which will protect public health; safety and the environment: — Cesspool or pri is within 50 feet of a surface water _ Cesspool or privy within 50 feet of a bordering vegetated hand or a salt marsh r 2. System will fail unless the Board of He h (and Public Water Supplier, if any) determines that the system is functioning in a manner that protec .the p4lic health, safety and environment: _ The system has a septic tank and soil abso ti h,system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface ater supply. The system has a septic tank and S and the SAS is within a Zone 1 of a public water supply. — The system has a septic tank SAS and the SAS is within 50 feet,of a private water supply well. The system has a septic 9A and SAS and the SAS is less than 100 feet but -50 feet or more from a private water supply well**/I&lethod used to determine distance "This system passesdthe well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volati 'organic compounds indicates that the well is free from pollution from that facility and, the presence of affimonia, nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Page 4 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 33 /34f/L/1-y S,aee kUO&DI Ary,D eJ� �44A Owner: Date of Inspection: 3 Z D. System Failure Criteria applicable to all systems: You must indicate `yes" or "no" to each of the following for all inspections: Yes No _ _✓ Backup of sewage into facility or system component due to 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 an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow _✓Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the SAS, cesspool or privy is below high ground water elevation. r/ Any portion of 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. 'Any portion of a cesspool or privy is within 50 feet of a private water supply well. y 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. [This system passes if the well water analysis, performed at a DEP certified laboratory, 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, provided that no other failure criteria are triggered A copy of the analysis must be attached to this form.] (Yes/No) The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd 15,000 gpd. You must indicate either "yes" or `no" to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ the system is wi ' 400 feet of a surface drinking water su the system is within 20\0 feet of a ' tary to asurfa`ce drinking water supply _ the system is located in a nitrog sitive azeam` Wellhead Protection Area — IWPA) or a mapped Zone II of a publi�anyquestion well If you have answer in Section E the system is considered a sigmfi eat, or answered `yes" in Section D above the large system has failed. The owner or operator of any large system co—ftidered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 3.3Ls 9z574/2y , S7,-2eei A)0JLyz0 A-ANp DJc/l 44,4 Owner: S 4-1 R - AAA c pit AA C 5 Date of Inspection: _ W ;g V'A 2. Check if the following have been done. You must indicate "yes" or "no" as to each of the following: IY /No Pumping information was provided by the owner, occupant, or Board of Health /"Were any of the system components pumped out in the previous two weeks ? ✓ _ Has the system received normal flows in the previous two week period ? Have large volumes of water been introduced to the system recently or as part of this inspection ? Were as built plans of the system obtained and examined? (If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up ? Was the site inspected for signs of break out ? ;,L ` Were all system components, excluding the SAS, located on site ? jz_ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum ? L_ Was the facility owner (and occupants if different from owner) provided with information on the proper iiimaintenance of subsurface sewage disposal systems ? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: Yep. no ✓ Existing information. For example, a plan at the Board of Health. Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [3 10 CMR 15.302(3)(6)] Page b of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner: Date of Inspection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): 3 Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 'LIS -0 Number of current residents: 3 Does residence have a garbage grinder (yes or no): /4'0 Is laundry on a separate sewage system (yes or no):Z [if yes separate inspection required] Laundry system inspected (yes or no): — Seasonal use: (yes or no): Water meter readings, if available (last 2 years usage (gpd)): t,j t: L Sump pump (yes or no): N0 Last date of occupancy: C. o 1,,r j, i COMMERCIAL/INDUSTRIAL Type of establishment: Design flow (based on 310 CMR 15.203): gnd Basis of design flow (seats/persons/sgft,etc.): Grease trap present (yes or no): _ Industrial waste holding tank present (yes or no): _ Non -sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER (describe): GENERAL INFORMATION Pumping Records Source of information: !4 cc, S2 5 Was system pumped as part of the inspection (yes or no): �t___p If yes, volume pumped: gallons -- How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ( Septic tank, distribution box, soil absorption system _ Single cesspool _ Overflow cesspool _ Privy _ Shared system (yes or no) (if yes, attach previous inspection records, if any) _ Innovative/Altemative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) Tight tank _ Attach a copy of the DEP approval _ Other (describe): Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site (yes or no): X0 Page 7 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 3,3 S e7 NG /!,77/ Ani 7 oJEd. n- ,,4 Owner: F_s4A4C S Date of Inspection: 3 u BUILDING SEWER (locate on site plan) Depth below grade: Materials of construction: ,,,cast iron _40 PVC _other (explain): Distance from private water supply well or suction line: Z lb Comments (on condition of joints, venting, evidence of leakage, etc.): { ►" I f C LC) b /4S &C> c) 9 ) 1 *� .R s /! Aj F` 1J-7 SEPTIC TANK: _ (locate on site plan) Depth below grade: / z ` Material of construction: concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: _ Is age confirmed by a Certificate of Compliance (yes or no): _ (attach a copy of certificate) Dimensions: j 5 y o G -Az -k. rvs: Sludge depth: Z`' Distance from top of sludge to bottom of outlet tee or baffle: Z,9 Scum thickness: Z " / Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: :zs How were dimensions determined: 46F,A Cu fLC 5;- � r /( Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): /'UA30 1/)A1,1. GREASE TRAP: �ocate on site plan) Depth below grade: _ Material of construction: _concrete _metal _fiberglass___polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Page 8 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 33.- //L sine e7, /11 f1 fLA il ig 4"elt ,, di Owner: 5 r ->c cJ22 / MvS Date of Inspection: =-e— TIGHT z TIGHT or HOLDING TANK: /l& (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass _polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present (yes or no): Alarm level: Alarm in working order (yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Q Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): G -ox ,.1 nK rk 0 O 4 sz, Le,4KA-6-C 1N o'2 c��S1 i7��ir,�3��v•'l PUMP CHAMBER: (locate on site plan) Pumps in working order (yes or no): Alarms in working order (yes or no): Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Page 9 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 33-§- 66 -IM -1 sire r ; Owner: Date of Inspection: WD aZ SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, excavation not required) If SAS not located explain why: Type leaching pits, number: _ leaching chambers, number: leaching galleries, number: leaching tranches, number, length: I Y.2' leaching fields, number, dimensions: overflow cesspool, number: innovativetalternative system Typetname of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): ,57 -&nn .c/4� 4IM4L CESSPOOLS:,'!�L (cesspool must be pumped as part of inspectionxlocate 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 groundwater inflow (yes or no): 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 of hydraulic failure, level of ponding, condition of vegetation, etc.): Page 10 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: ,33.5 13c2r2y . Si ee j Owner: pc ,Cv /1.A" OS Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. W ELL. Page 11 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 2 25 13 C'2 a s r /y e -N 2T1 -f 44A Owner: oc0 � fZj4n4OS Date of Inspection: 1) SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water �2> feet Please indicate (check) all methods used to determine the high ground water elevation: Obtained from system design plans on record - If checked, date of design plan reviewed: Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health -explain: Checked with local excavators, installers- (attach documentation) Accessed USGS database -explain: You must describe how you established the high ground water elevation: LA C-5 VIA 012;E iNP1CA-r WA -►=/L } %-U' 06�zw &-e4 DF L)C-3i6 N �?L_aN3 I'Ji> ICA -RE t-- y, AFC3 S'' S FORM U - LOT RELEASE FORM '.l 1� --11- � 3 INSTRUCTIONS: This form is used to verify that all necessary approvals/permits frc Boards and Departments having jurisdiction have been obtained. This does not relies the applicant and/or landowner from compliance with any applicable or requirements. - "°`°`°`wwww °""APPLICANT FILLS OUT THIS SECTION********************* Pin APPLICANTSocary-c),kL pc'4nnasawHPr� LOCATION: Assessor's Map Number / D 8 Q— SUBDIVISION STREET *** * *** * **** *�_-------- "-7UFFICIAL USE ONLY** ;o 4 lc�T s of ,YJYVi9w igVJ + 9'78—7aS--665G PARCEL,—G 13 LOT (S) ST. NUMBER 3 CONSERVATION ADMIN z'}z-11 I& AGENTS: DATE APPROVED DATE REJECTED TOWN PLANNER COMMENTS j DATE -APPROVED DATE REJECTED FOOD_ INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS bD �� O PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE_ Revised 9197 jm --- ENERGY CONSERVATION APPLICATION FORM FOR LOW-RISE RESIDENTIAL NEW CONSTRUCTION and ADDITIONS 780 CMR AppenAix J (effective 3/1/98) Applicant Name: Applicant Address: Applicant Phone: W50�'-879_4g9Z (r_291-603—q? kko Compliance Path (check one): Site Address: 3 f3 e r(4 Cityrrown: o rpt A', ) v e Use Group: Date of Application:I 1 9_� 0 3 Applicant Signature:4 0 Prescriptive Package (Limited to I- or 2 -family wood frame buildings heated with fossil fuels only) Package (A through KK from Table J5.2.1 b): Heating Degree Days (HDDss) from Table J5.2.1a: (For items d. through i., fill in all values that apply from Table JS.2.lb:) a. Gross�l/a{{ At sq. n -value - b. Glazing Area' . sq.ft g. Floor R -value R_ c. Glazing %Q (too x b r a) % h. Basement wall R- d. Glazing U -value U- i. Slab Perimeter R- e. Ceiling R -value R, j. Heating AFUE 0 Component Performance: —Manual Trade -Of[" (Limited to wood or metal frtmed buildings only) Climate Zone (from Figure J6.2.2) Zone 12 [] Zone 13 Zone 14 Attach Trade -Off ITforksheet from Appendix J, land .HV4C Trade -Off Worksheet. if applicable) MAScheck Software .Attach Coniplimce Report and Inspection Checklist printouts. ❑ Systems Analysis OR [] Renewable Energy Sources Attach Mass Registered Architect or Engineer Analysis ALTERNATIVE FOR ADDITIONS ONLY: f a. Gro Wall +Ceiling Area q) 3 p sq.ft. b. Glazing Area'�_sq.ft. c. Glazing % ( loo x b = a) DITION with Glazing % (c.) up to 40% may use 780 CMR Table J1.1.2.3.1 below: MAXIMUM U-ralue MINIMUM 11 -Values Fenestration Ceiling Wall Floor Rasemerttwatl Slab Perimeter, Depth 039 R 37 R -l3 . R -i9 R-10 R-10, 4 ft "SUNTROO\I" addition (greater.than 40% lazing -to -wall and ceiling gross areal b b b Atta/ch "Consumer Info�ation Form" from 780 ChIR Appendix B. �1 -- 6re, 5S V CII -e Cee /yY __ 3-1�kZ i7.��., 7Jyv llr r.._ I i�ftz Official's fame: Official's Signature: Application Approved ❑ Denied EJ Date of ApprovaL'Denial: Reason(s) for Denial: (provide additional details as needed on back side) Glazing Area mai• tie either Rough Opening or Unit dimensions. MRS* 061121 THE MASSACHUSE7 T S STATE BUILDING CODE - ue . Manual Trade -Off Worksheet = UA 14 2 2s1 Pc mit }3uilder Name Basommwall (Tabki6231j Date --�_ Builder Addr= Unhe" Slab Checked By Site Address Zone1112 1113 ❑14 j a6k 162 k) Date Submitted By Phone PROPOSED REQUIRED Ceilings. SkAiehts, snd Fbors Over Outside Air .�. Insulation x Net Ara Required UNAK R Vslue U -Value — _ UA (Table J6?1h) z Ara t U4 eiliq (Tibic 16?2al -3 0 880 TOW JYapottd UA Onen be kta Tota( thaw K equal to Thad (orA4zau9 8equtired.UA Proposed UA Sntcmal of CQM0iM= lite proposed butldiag dcsip =V"CAted is Ebor 0w 0uW& Air AM docaws" it toerrittee(tvidn rhe 6tdWi,tP Pin* apa{jtcatiottc Md aha akuluions submitted vend, the uetmit aMI"f" ible 16?1al -- - _ R - . Taal Walls: VrIn&Ws and Doots Ara lCmdation x Net walls R-vQ&klc " Value Ara = UA UNAW x AM = UA trabk J6 +.n.cel ur"Mi a (?FERC arable 113 Sal _ - Di z ly TW iDooct (NFRC or Tabk 1133b) — Di 5O 7 6 Sliding Gust Doors — fe • ' . tNFRC orTabk 11,53a) —+• . !t- Taal Ana Fkners and Foundations _ lusulacioa kuutation R x Arca a R Value U Val Flo"OvaUaooaditioaod (Table - ue . Penaxus = UA 14 2 2s1 Basommwall (Tabki6231j Unhe" Slab a6k 162 k) Hated Slab abkf622 .�. TOW JYapottd UA Onen be kta Tota( thaw K equal to Thad (orA4zau9 8equtired.UA Proposed UA Sntcmal of CQM0iM= lite proposed butldiag dcsip =V"CAted is AM docaws" it toerrittee(tvidn rhe 6tdWi,tP Pin* apa{jtcatiottc Md aha akuluions submitted vend, the uetmit aMI"f" BuildcY.-&-signer Coatpartv Rome 760.12 780 CMR - Sixth Edition U -Value zAm I- VA 1 1 1 •--= Tact OR Required UA —� Adjusted Required UA Dare 220/98 (Effective 311/98). Name The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02911 Workers' Compensation Insurance Affidavit Please Print colt &LCW,,r2a-('-1c)A,71-S0C0rVo 0 V4 0 0 w n YY) 7 J am Location: Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity �am an employer providing workers' con Torg for my employees working on this job. _// 1_e k7 Lf -/,0- U C/ /� -'7 Address / A/gr ' / S O Al S� city, ✓' A-7 g 17 4, Y- IWJ4 iN 7OE2 Phone* � � ^ 9 7 7, VO e,�? // -4f.11 y -C ,' ,,ve7e-e-c, aZZ91CG0(no:�c4;Z Insurance. Co. •ev Policy # - G S Xf V S 9 ? aX Company name: Address Ctty Phone* Fallure to secure coverage as required: under Section 25A or MGL 152 can lead to the imposition cf criminal penalties ora fine up to $1.50( andfor one years' m prisonment �ntell�s coral Rena�ies ioshefnrm a�79P fiae�f (,i]�DD��r1aY�gai�tme. 1 understand that a cosy of this statement may be forwarded to the office of Investigabons of the DIA for coverage verification. f db hereby cWW xxter are Print Official use only do not write in this area to be completed by city or town ofriciar City or Town D Building Dept [ICheck Iimmediate response is required p licensing Board p Selectman's Office. Contact person: Phone # 0 Health Department 0 Other NL1V 1'1 2000 5:32PM HP LRSERJET 3200 PRODUCER .,.. ,. -... William J,O'Brien Insurance Agency,Inc 793 Washington Street P. 0. Box 13 Canton MA 02021- (781) 828-2300 INSURED WILLIAM PFINGSTON DBA CORAL CONSTRUCTION 19 HARRISON ST. F'RAMINGRAM MA 01702- (781) 1603-9740 P.3 GATE (MM/DD U 11 18/03 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION HOLDER. THIS ONLY AND OCEFITIFICATE DOES NOT NFERS NO RIGHTS OAMEND,N THE CEXTENDAOR ALTER THE COVERAGE AFFORDED BY THE POLICIES RFI nw COMPANY A COMMERCIAL CASUALTY INS. CO. OF NC COMPANY BONE BEACON INS CO. COMPANY C COMPANY D THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD] INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPEOFINSURANCE POUCYEFFECTIVI POLICYEXPIRATIONI LTR POLICY NUMBER DATE (MMlDD(YY) DATE (MM/DD/YY) UMTS A LGENERALLIABILITY MMERCIAL GENERAL LIA131UTY 12 2 8 CG 0 0 0 2 9 2 CLAMS MADE FY7 OCCUR OWNER'S &CONTRACTOR'S PROT AUTOMOBILE LIABILITY ANYAUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 09/04/03 09/04/04OMPIOPAhG $2,000,000 $1,000, 000 ADV INJURY Sl,000,000 WAGGREGATEGREGATE RENCE 5 1,000,000 {Any one fire) S 100,000 one penton) s5,000 / J I /I I COMBINED SINGLE LIMIT I S BODILYINJURY S (Plerperson) BODILY INJURY $ (Per Accident) DESCRIPTION OF OPERATIONS/LOCA TIONS(VEMCLES/SPECIAL ITEMS GENERAL COATTRACTOR 335 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ETOMRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 1_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDIR NAMED TO THE LEFT, TOWN OF NORTH ANDOVER BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBUGATIDN OR LIABILITY 335 BERRY ST. OF ANY KING UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. NORTH ANDOVER MA AUTHORIZED REPRESENTATIVE PRCPERTY DAMAGE S GARAGE LIABILITY AUTO ONLY - EAACCIDENT S ANY AUTO OTHER TFAN AUTO ONLY: ................. . EACHACCIDENT S AGGREGATE S O(CESS UA8IUTY EACH OCCURRENCE S UMBRELLA'FORM AGGREGATE OTHER THAN UMBRELLA FOMA $ B WORKERS COMPENSATION AND X S O S EMPLOYERS' LIABILITY 6S24UB972X659-5-02 11/27/03 11/27/04 ORY ILII ;....._.::...: THEPROPRIETOR/ EL EACH ACCIDENT 5100000 PARTNERBMECUTIVE INCL EL DISEASE - POLICY UMIT S_900000 OFFICERS AAE: X EXCL EL DISEASE - EA EMPLOYEE I 510 0 0 0 0 OTHER DESCRIPTION OF OPERATIONS/LOCA TIONS(VEMCLES/SPECIAL ITEMS GENERAL COATTRACTOR 335 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ETOMRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 1_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDIR NAMED TO THE LEFT, TOWN OF NORTH ANDOVER BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBUGATIDN OR LIABILITY 335 BERRY ST. OF ANY KING UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. NORTH ANDOVER MA AUTHORIZED REPRESENTATIVE / z \ \ < / / \ \ 2 a z s j E § ( \ z \ < 3 ± u = < / % % E \00 / ~ \j 2 =E k E §\ / hozCN \ \ \ \ CN LL u) \\ \ 2 j / § S 00 o .. { § ƒ j A \ \ w > ei \ ` }<0 �/z ��� \ \2/ North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: (Location of Facility) Signa ;7e97 Vpplicaht J NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 5 - Order of Conditions Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 City/Town State Zip Code 1. Project Location: 335 Berry Street Street Address Map 108C Assessors Map/Plat Number 2. Property recorded at the Registry of Deeds for: Northern Essex County Certificate (if registered land) 3. Dates: 3/28/03 DEP File Numher: 242-1192 Provided by DEP Property Owner (if different from applicant): Same Name Mailing Address City/Town State North Andover City/Town Parcel 65 Parcel/Lot Number 4512 _ 19 Book Page Zip Code j 0.3 5 c 3 Date Notice of Intent Filed Date Public Heari g Closed Date of ssuanc 4. Final Approved Plans and Other Documents (attach additional plan references as needed): NOI 3/28/03 Title Date Plan of Land 3/28/03 revised Title 4/30/03 Title 5. Final Plans and Documents Signed and Stamped by: Scott L. Giles, P. L. S Name- ----------- -------------------- --- 6. Total Fee: 90.00 (ByLaw) (from Appendix B: Wetland Fee Transmittal Form) Date ; rev. 12/15/00 Page , r 7 A. General Information Important: When filling From: out forms on North Andover the computer, Conservation Commission use only the tab key to This issuance if for (check one): move your cursor - do ® Order of Conditions not use the return key. ❑ Amended Order of Conditions QTo: Applicant: Socorro & Virginia Ramos i retran Name 335 Berry Street _ Mailing Address North Andover MA. 01845 City/Town State Zip Code 1. Project Location: 335 Berry Street Street Address Map 108C Assessors Map/Plat Number 2. Property recorded at the Registry of Deeds for: Northern Essex County Certificate (if registered land) 3. Dates: 3/28/03 DEP File Numher: 242-1192 Provided by DEP Property Owner (if different from applicant): Same Name Mailing Address City/Town State North Andover City/Town Parcel 65 Parcel/Lot Number 4512 _ 19 Book Page Zip Code j 0.3 5 c 3 Date Notice of Intent Filed Date Public Heari g Closed Date of ssuanc 4. Final Approved Plans and Other Documents (attach additional plan references as needed): NOI 3/28/03 Title Date Plan of Land 3/28/03 revised Title 4/30/03 Title 5. Final Plans and Documents Signed and Stamped by: Scott L. Giles, P. L. S Name- ----------- -------------------- --- 6. Total Fee: 90.00 (ByLaw) (from Appendix B: Wetland Fee Transmittal Form) Date ; rev. 12/15/00 Page , r 7 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands DEP File Number WPA Form 5 - Order of Conditions 242-1192 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DFP B. Findings -- Findings pursuant to the Massachusetts Wetlands Protection Act: Following the review of the above -referenced Notice of Intent and based on the information provided in this application and presented at the public hearing, this Commission finds that the areas in which work is proposed is significant to the following interests of the Wetlands Protection Act. Check all that apply: ® Public Water Supply ® Private Water Supply ® Groundwater Supply ❑ Land Containing Shellfish ❑ Fisheries ® Storm Damage Prevention ® Prevention of Pollution ® Protection of Wildlife Habitat ® Flood Control Furthermore, this Commission hereby finds the project, as proposed, is: (check one of the following boxes) Approved subject to: ® the following conditions which are necessary, in accordance with the performance standards set forth in the wetlands regulations, to protect those interests checked above. This Commission orders that all work shall be performed in accordance with the Notice of Intent referenced above, the following General Conditions, and any other special conditions attached to this Order. To the extent that the following conditions modify or differ from the plans, specifications, or other proposals submitted with the Notice of Intent, these conditions shall control. Denied because: ❑ the proposed'work cannot be conditioned to meet the performance standards set forth in the wetlare regulations to protect those interests checked above. Therefore, work on this project may not go forward unless and until a new Notice of Intent is submitted which provides measures which are adequate to protect these interests, and a final Order of Conditions is issued. ❑ the information submitted by the applicant is not sufficient to describe the site, the work, or the effect of the work on the interests identified in the Wetlands Protection Act. Therefore, work on this project may not go forward unless and until a revised Notice of Intent is submitted which provides sufficient information and includes measures which are adequate to protect the Act's interests, and a final Order of Conditions is issued. A description of the specific information which is lacking and why it is necessary is attached to this Order as per 310 CMR 10.05(6)(c). General Conditions (only applicable to approved projects) 1. Failure to comply with all conditions,. stated herein, and with all related statutes and other regulatory measures, shall be deemed cause to revoke or modify this Order. 2. The Order does not grant any property rights or any exclusive privileges; it does not authorize any injury to private property or invasion of private rights. 3. This Order does not relieve the permittee or any other person of the necessity of complying with all other applicable federal, state, or local statutes, ordinances, bylaws, or regulations. Wpaform5.doc -rev 12/15/00 Page 2 )f i Massachusetts Department of Environmental Protection i r Bureau of Resource Protection - Wetlands DEP File Numter WPA Form 5 - Order of Conditions 242-1192 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEF B. Findings (cont.) -- 4. The work authorized hereunder shall be completed within three years from the date of this Order unless either of the following apply: a. the work is a maintenance dredging project as provided for in the Act; or b. the time for completion has been extended to a specified date more than three years, but less than five years, from the date of issuance. If this Order is intended to be valid for more than three years, the extension date and the special circumstances warranting the extended time period are set forth as a special condition in this Order. 5. This Order may be extended by the issuing authority for one or more periods of up to three years each upon application to the issuing authority at least 30 days prior to the expiration date of the Order. 6. Any fill used in connection with this project shall be clean fill. Any fill shall contain no trash, refuse, rubbish, or debris, including but not limited to lumber, bricks, plaster, wire, lath, paper, cardboard, pipe, tires, ashes, refrigerators, motor vehicles, or parts of any of the foregoing. 7. This Order is not final until all administrative appeal periods from this Order have elapsed, or if such an appeal has been taken, until all proceedings before the Department have been completed. No work shall be undertaken until the Order has become final and then has been recorded in the Registry of Deeds or the Land Court for the district in which the land is located, within the chain of ti`le of the affected property. In the case of recorded land, the Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land upon which the proposed work is to be done. In the case of the registered land, the Final Order shall also be noted on the Land Court Certificate of Title of the owner of the land upon which the proposed work is done. The recording information shall be submitted to this Conservation Commission on the form at the end of this Order, which form must be stamped by the Registry of Deeds, prior to the commencement of work. 9. A sign shall be displayed at the site not less then two square feet or more than three square feet in size bearing the words, "Massachusetts Department of Environmental Protection" [or, "MA DEP"] "File Number 242-1192 10. Where the Department of Environmental Protection is requested to issue a Superseding Order, the Conservation Commission shall be a party to all agency proceedings and hearings before DEP. 11. Upon completion of the work described herein, the applicant shall submit a Request for Certificate cf Compliance (WPA Form 8A) to the Conservation Commission. 12. The work shall conform to the plans,and special conditions referenced in this order. 13. Any change to the plans identified in Condition #12 above shall require the applicant to inquire of the Conservation Commission in writing whether the change is significant enough to require the filing of a new Notice of Intent. 14. The Agent or members of the Conservation Commission and the Department of Environmental Protection shall have the right to enter and inspect the area subject to this Order at reasonable hours to evaluate compliance with the conditions stated in this Order, and may require the submittal of any data deemed necessary by the Conservation Commission or Department for that evaluation. Wpaform5.doc • rev. 12/15100 Page 3 of L 'Sam Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands DEP File Number: WPA Form 5 - Order of Conditions 242-1192 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEF A�l B. Findings (cont.) - - 15. This Order of Conditions shall apply to any successor in interest or successor in control of the property subject to this Order and to any contractor or other person performing work conditioned by this Order. 16. Prior to the start of work, and if the project involves work adjacent to a Bordering Vegetated Wetland, the boundary of the wetland in the vicinity of the proposed work area shall be marked by wooden stakes or flagging. Once in place, the wetland boundary markers shall be maintained until a Certificate of Compliance has been issued by the Conservation Commission. 17. All sedimentation barriers shall be maintained in good repair until all disturbed areas have been fully stabilized with vegetation or other means. At no time shall sediments be deposited in a wetland or water body. During construction, the applicant or his/her designee shall inspect the erosion controls on a daily basis and shall remove accumulated sediments as needed. The applicant shall immediate!y control any erosion problems that occur at the site and shall also immediately notify the Conservation Commission, which reserves the right to require additional erosion and/or damage prevention controls it may deem necessary. Sedimentation barriers shall serve as the limit of work unless another limit of work line has been approved by this Order. Findings as to municipal bylaw or ordinance Furthermore, the North Andover hereby finds (check one that applies): Conservation Commission ❑ that the proposed work cannot be conditioned to meet the standards set forth in a municipal ordinance or bylaw specifically: Municipal Ordinance or Bylaw Citation Therefore, work on this project may not go forward unless and until a revised Notice of Intent is submitted which provides measures which are adequate to meet these standards, and a final Order of Conditions is issued. ® that the following additional conditions are necessary to comply with a municipal ordinance or bylaw, specifically: North Andover Wetland Protection Bylaw Chapter 178 Municipal Ordinance or Bylaw Citation The Commission orders that all work shall be performed in accordance with the said additional conditions and with the Notice of Intent referenced above. To the extent that the following conditions modify or differ from the plans, specifications, or other proposals submitted with the Notice of Intent. the conditions shall control. '✓'Jpaform5.doc • rev. 12/15/00 Page 4 of DEP FILE # 242 -1192 Therefore, the North Andover Conservation Commission (hereafter the "NACC") hereby finds that the following conditions are necessary, in accordance with the Performance Standards set forth in the State Regulations, the local ByLaw and Regulations, to protect those interests noted above. The NACC orders that all work shall be performed in accordance with said conditions and with the Notice of Intent referenced below. To the extent that the following conditions modify or differ from the plans, specifications or other proposals submitted with the Notice of Intent, the conditions shall control. GENERAL CONDITIONS 18. Failure to comply with all conditions stated herein, and with all related statutes and other regulatory measures, shall be deemed cause to revoke or modify this Order. 19. This Order does not grant any property rights or any exclusive privileges; it does not authorize any injury to private property or invasion of property rights. However, the NACC, agent of the NACC or the Department of Environmental Protection (DEP) reserves the right to enter and inspect the property at all reasonable times until a Certificate of Compliance is issued, to evaluate compliance with this Order of Conditions, the Act (310 CMR 10.00), the North Andover Wetland ByLaw and Regulations, and may require any information, measurements, photographs, observations, and/or materials, or may require the submittal of any data or information deemed necessary by the NACC for that evaluation. Further, work shall be halted on the site if the NACC, agent or DEP determines that any of the work is not in compliance with this Order of Conditions. Work shall not resume until the NACC is satisfied that the work will comply and has so notified the applicant in writing. 20. This Order does not relieve the permittee or any other person of the necessity of complying with all other applicable federal, state or local statutes, ordinances, by- laws or regulations. 21. The work authorized hereunder shall be completed within three years from the date of this order. 22. This Order may be extended by the issuing authority for one or more periods of up to one year each upon application to the issuing authority at least thirty days (30) prior to the expiration date of the Order (Refer to Section VIII (B)(p.33) of the North Andover Wetland Regulations). s NACC 05/22/2003 DEP FILE # 242 -1192 23. The NACC reserves the right to amend this Order of Conditions after a legally advertised public hearing if plans or circumstances are changed or if new conditions or information so warrant. 24. Where the Department of Environmental Protection (DEP) is requested to make a determination and to issue a Superseding Order, the Conservation Commission shall be a party to all agency proceedings and hearings before the Department. 25. This Order of Conditions is issued under File No. 242-1192. 26. The conditions of this decision shall apply to, and be binding upon, the applicant, owner, its employees and all successors and assigns in interest or control. These obligations shall be expressed in covenants in all deeds to succeeding owners of portions of the property. 27. The term "Applicant" as used in this Order of Conditions shall refer to the owner, any successor in interest or successor in control of the property referenced in the Notice of Intent, supporting documents and this Order of Conditions. The NACC shall be notified in writing within 30 days of all transfers of title of any portion of property that takes place prior to the issuance of a Certificate of Compliance. 28. The proposed work includes: the construction of a 12'x 18' addition with an attached deck and stairs and an additional 24' x 42' addition and stairway to an existing dwelling located in the buffer zone of a bordering vegetated wetland and within the riverfront area of an unnamed stream. 29. The work shall conform to the following (except as noted in the remainder of this document where revisions may be required): Notice of Intent filed by: Site Plans prepared by: Socorro & Virginia Ramos 335 Berry Street North Andover, MA 01845 Scott & Frank Giles 50 Deermeadow Road North Andover, MA 01845 Entitled: Plan of Land, dated 3/30/03, revised and received by Conservation 4/30/03 Other documents: USGS Streamflow Statistics Fax from Basbanes Associates for 335 Berry Street 2 NACC 05/22/2003 DEP FILE # 242 -1192 30. The following wetland resource areas are affected by the proposed work: Bordering Vegetated Wetland (BVW) and associated Riverfront area. These resource areas are significant to the interests of the Act and Town ByLaw as noted above and therein. The applicant has not attempted to overcome the presumption of significance of these resource areas to the identified interests. 31. The NACC agrees with the applicant's delineation from wetland flags 3A —10A of the wetland resource areas on the site as shown on the plans dated referenced herein. 32. The NACC finds that the intensive use of the upland areas and buffer zone proposed on this site will cause further alteration of the wetland resource areas. In order to prevent any alteration of wetland resource areas a twenty five foot (251 No -Disturbance Zone and a fifty foot (501 No -Construction Zone shall be established from the edge of the adjacent wetland resource area. The Conservation Administrator and/or other agents of the NACC do not have the authority to waive these setbacks as established under the local bylaw. No disturbance of existing grade, soils or vegetation is permitted in the No -Disturbance zone. (See Section IIID) & Appendix G of the local Regulations). 33. There shall be no increase in the post development discharges from the storm drainage system or any other changes in post development conditions that alter the post development watershed boundaries as currently depicted in the Notice of Intent and approved by this Order of Conditions, unless specifically approved in writing by the Commission. 34. This document shall be included in all construction contracts, subcontracts, and specifications dealing with the work proposed and shall supersede any conflicting contract requirements. The applicant shall assure that all contractors, subcontractors, and other personnel performing the permitting work are fully aware of the permits terms and conditions. Thereafter, the contractor will be held jointly liable for any violation of this Order resulting from failure to comply with its conditions. 35. The owners of the project and their successors in title, in the event they proceed to alter areas subject to the Commissions jurisdiction under the order, agree that the Order does not in itself impose upon the Town any responsibility to maintain the proposed drainage system and that said Town shall not be liable for any damage in the event of failure. By acceptance of this Order, the owners agree to indemnify and hold harmless to the Town and its residents for any damage attributable to alterations undertaken on this property pursuant to the Order. Issuance of these Conditions does not in any way imply or certify that the site or downstream areas will not be subject to flooding, storm damage or any other form of water damage. NACC 05/22/2003 DEP FILE # 242 -1192 Maintenance of the drainage system, if accepted by the Town as part of a public way, becomes the responsibility of the Town. 36. Issuance of these Conditions does not in any way imply or certify that the site or downstream areas will not be subject to flooding, storm damage or any other form of water damage. PRIOR TO CONSTRUCTION 37. No work shall be undertaken until all administrative appeal periods from this Order have elapsed or, if such an appeal has been filed, until all proceedings before the Department or Court have been completed. 38. This Order shall be recorded by the applicant at the Registry of Deeds immediately after the expiration of all appeal periods. No work shall be undertaken until the Final Order has been recorded in the Registry of Deeds or the Land Court for the district in which the land is located, within the chain of title of the affected property. In the case of recorded land, the Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land upon which the proposed work is to be done. In the case of registered land, the Final Order shall also be noted on the Land Court Certificate of Title of the owner of the land upon which the proposed work is to be done. The recording information shall be submitted to the North Andover Conservation Commission on the form at the end of this Order prior to commencement of the work. Any Order not recorded by the applicant before work commences may be recorded by the NACC at the applicant's expense. 39. A sign shall be displayed, in a location at the site visible from the Street, not less than two square feet or more than three square feet in size bearing the words "Massachusetts DEP, File Number 242-1192." 40. Any changes in the submitted plans caused by the applicant, another Board's decision or resulting from this Order of Conditions must be submitted to the NACC for approval prior to implementation. If the NACC finds said changes to be significant, the NACC will call for,another public hearing (at the expense of the applicant). Within 21 days of the close of said public hearing the NACC will issue an amended or new Order of Conditions. Any errors found in the plans or information submitted by the applicant shall be considered as changes. The proposed project may be still under review by other local or state boards or agencies. This may result in changes to the project plans or wetland impacts. If any such changes occur a revised plan and an explanation of the revisions shall be submitted to the NACC for review and approval prior to the start of construction. No work shall begin on a project until written approval has been granted by the NACC. A NACC 05/22/2003 DEP FILE # 242 -1192 41. It is the responsibility of the applicant, owner, and/or successor(s) to ensure that all conditions of this Order of Conditions are complied with. The project engineer and contractors are to be provided with a copy of this Order of Conditions and referenced documents before commencement of construction. 42. Prior to any work commencing on-site, the applicant shall submit to the NACC for approval, a detailed sequence of construction, including the construction of compensation and retention areas, installation of sedimentation/ erosion control devices and re -vegetation to be completed before other work begins on-site. 43. Wetland flagging shall be checked prior to start of construction and shall be re- established where missing. All wetland flagging shall remain visible and enumerated per the approved plan(s) throughout the life of the project and until a Certificate of Compliance is issued so that erosion control measures can be properly placed and wetland impacts can be monitored. The proposed limit of work shall be shall be clearly marked with stakes or flags and shall be confirmed by the NACC. Such markers shall be checked and replaced as necessary and shall be maintained until all construction is complete. Workers should be informed that no use of machinery, storage of machinery or materials, stockpiling of soil, or construction activity is to occur beyond this line at any time. All flags used for the above purposes shall be of a color different from other flagging used on the site. 44. A row of staked hay bales backed by trenched siltation fence shall be placed between all construction areas and wetlands. The erosion control barrier will be properly installed and placed as shown on the plans approved and referenced herein and shall be inspected and approved by the NACC prior to the start of construction and shall remain intact until all disturbed areas have been permanently stabilized to prevent erosion. All erosion prevention and sedimentation protection measures found necessary during construction shall be implemented at the direction of the NACC. The NACC reserves the right to impose additional conditions on portions of this project to mitigate any impacts which could result from site erosion, or any noticeable degradation of surface water quality discharging from the site. For example, installation of erosion control measures may be required in areas not shown on the plan(s) referenced in this Order of Conditions. Should such installation be required by the NACC, they shall be installed within 48 hours of the Commission's request. 45. The applicant shall have on hand at the start of any soil disturbance, removal or stockpiling, a minimum of 15 hay bales and sufficient stakes for staking these bales (or an equivalent amount of silt fence). Said bales shall be used only for the control of emergency erosion problems and shall not be used for the normal control of erosion. 5 NACC 05/22/2003 DEP FILE # 242 -1192 46. A check payable to the Town of North Andover shall be provided in the amount of 2,000, which shall be in all respects satisfactory to Town Counsel, Town Treasurer, and the NACC, and shall be posted with the North Andover Town Treasurer through the NACC before commencement of work. Said deposit of money shall be conditioned on the completion of all conditions hereof, shall be signed by a party or parties satisfactory to the NACC, and Town Counsel, and shall be released after completion of the project, provided that provisions, satisfactory to the NACC, have been made for performance of any conditions which are of continuing nature. The applicant may propose a monetary release schedule keyed to completion of specific portions of the project for the NACC's review and approval. This condition is issued under the authority of the local ByLaw. 47. The applicant shall designate a Wetland Scientist as an "Erosion Control Monitor" to oversee any emergency placement of controls and regular inspection or replacement of sedimentation control devices. The name and phone number of the erosion control monitor must be provided to the NACC in the event that this person has to be contacted, due to an emergency at the site, during any 24-hour period, including weekends. This person shall be given the authority to stop construction for erosion control purposes. The erosion control monitor will be required to inspect all such devices and oversee cleaning and the proper disposal of waste products. Cleaning shall include removal of any entrapped silt. At least once during each week in which construction activities occurs on-site and for as long thereafter as ground remains unstabilized, the applicant shall submit a written report from the "Erosion Control Monitor" to the NACC certifying that, to the best of his/her knowledge and belief based on a careful site inspection, all work is being performed in compliance with this Order of Conditions and that approved setbacks are being adhered to. The erosion control monitor must visually inspect all sedimentation/erosion control measures and assume responsibility for their maintenance on a weekly basis and that they are functioning as intended. In addition, all wetland resource areas must be visually inspected for siltation, turbidity, and/or other water quality impacts. 48. Prior to construction, the applicant shall permanently mark the edge of the 25 foot no disturbance with signs or markers spaced evenly every 25 feet incorporating the following text: "Protected WetlAnd Resource Area" (available at the Conservation Office at a cost of $2.00 each). This will designate their sensitivity and assure no further inadvertent encroachment into the wetland. These permanent markers are subject to review and approval by the NACC. The applicant shall instruct all agents to explain these markers to buyers/lessees/landscapers and all persons taking over the property from the applicant. 6 NACC 05/22/2003 DEP FILE # 242 -1192 49. The applicant and/or the legal owner of that portion of land upon which these Orders of Conditions have been placed shall provide to the NACC prior to transferring, or assigning any portion of said land to another party, subject to said Orders of Conditions, the "Compliance Certification Form Affidavit" attached via "Appendix A" signed under the pains and penalties of perjury, stating that said applicant and/or owner has read these Orders of Conditions and is in compliance with each and every condition. This document shall apply to each of the conditions referenced herein and shall be provided to the Conservation Department at least five (5) business days prior to the closing of said land transaction. 50. Once these above mentioned pre -construction requirements are complete, the applicant shall contact the Conservation Office prior to site preparation or construction and shall arrange an on-site conference with an NACC representative, the contractor, the engineer, wetland scientist and the applicant to ensure that all of the Conditions of this Order are understood. This Order shall be included in all construction contracts, subcontracts, and specifications dealing with the work proposed and shall supersede any conflicting contract requirements. The applicant shall assure that all contractors, subcontractors and other personnel performing the permitted work are fully aware of the permit's terms and conditions. Thereafter, the contractor will be held jointly liable for any violation of this Order of Conditions resulting from failure to comply with its conditions. The applicant or contractor shall notify the NACC in writing of the identity of the on-site construction supervisor hired to coordinate construction and to ensure compliance with this Order. A reasonable period of time shall be provided as notice of the pre - construction meeting (e.g. 72 hours). DURING CONSTRUCTION 51. Upon beginning work, the applicant shall submit written progress reports every one (1) week detailing what work has been done in or near resource areas, and what work is anticipated to be done over the next period. This will update the construction sequence. 52. De -watering activities anticipated shall be supervised and witnessed by the designated erosion control monitof. This designee must be on-site while work specific to de -watering activities are occurring and until complete. De -watering activities shall be conducted in accordance with a de -watering plan to be submitted and approved by the Conservation Department. Activities shall be monitored daily by the erosion control monitor to ensure that sediment laden water is appropriately settled prior to discharge toward the wetland resource areas. No discharge of water is allowed directly into an area subject to jurisdiction of the Wetlands Protection Act and/or the North Andover Wetland ByLaw. If emergency NACC 0/22/2003 DEP FILE # 242 -1192 de -watering requirements arise, the applicant shall submit a contingency plan to the Commission for approval which provides for the pumped water to be contained in a settling basin, to reduce turbidity prior to discharge into a resource area. 53. Any fill used in connection with this project shall be clean fill, containing no trash, refuse, rubbish or debris, including but not limited to lumber, bricks, plaster, wire, lath, paper, cardboard, pipe, tires, ashes, refrigerators, motor vehicles or parts on any of the foregoing. 54. No exposed area shall remain unfinished for more than thirty (30) days, unless approved by the NACC. 55. No re -grading in the buffer zone shall have a slope steeper than 2:1 (horizontal: vertical). Slopes of steeper grade shall be rip -rapped to provide permanent stabilization. 56. There shall be no stockpiling of soil or other materials within twenty-five (25) feet of any resource area or beyond the limits of the erosion controls. 57. After proper grading, all disturbed areas located within a resource area which will not remain as wetland areas, shall be loamed (minimum of 4" of quality loam), and seeded. This shall all be done in accordance with SCS guidelines. All disturbed areas located within wetland resource areas which are to be only temporarily disturbed during construction, shall be restored to their original grade, soil profile and vegetative cover. Soil used for this purpose will either be wetlands topsoil or a minimum of 4" of quality loam. 58. Washings from concrete trucks, or surplus concrete, shall not be directed to, any drainage system, or wetland resource area. 59. All waste generated by, or associated with, the construction activity shall be contained within the construction area, and away from any wetland resource area. There shall be no burying of spent construction materials or disposal of waste on the site by any other means. The applicant shall maintain dumpsters (or other suitable means) at the site for the storage and removal of such spent construction materials off-site. However, no trash dumpste"rs will be allowed within 50' of areas subject to protection under the Act or local ByLaw. 60. Accepted engineering and construction standards and procedures shall be followed in the completion of the project. 61. During and after work on this project, there shall be no discharge or spillage of fuel, or other pollutants into any wetland resource area. If there is a spill or discharge of NACC 05/22/2003 DEP FILE # 242 -1192 any pollutant during any phase of construction the NACC shall be notified by the applicant within one (1) business day. No construction vehicles are to be stored within 100 feet of wetland resource areas, and no vehicle refueling, equipment lubrication, or maintenance is to be done within 100 feet of a resource area. AFTER CONSTRUCTION 62. No underground storage of fuel oils shall be allowed on any lot within one hundred (100) feet of any wetland resource area. This condition shall survive this Order of Conditions and shall run with the title of the property. This condition is issued under the authority of the Town's Wetland protection ByLaw. 63. Fertilizers utilized for landscaping and lawn care shall be slow release, low -nitrogen types (< 5%), and shall not be used within 25 feet of a resource area. Pesticides and herbicides shall not be used within 100 feet of a wetland resource area. This condition shall survive this Order of Conditions and shall run with the title of the property. This condition is issued under the authority of the Town's Wetland Protection ByLaw and shall remain in perpetuity. 64. No road salt, sodium chloride, or other de-icing chemicals shall be used on paved surfaces, and any arrangement for snow removal shall so stipulate due to the importance of the site and wetlands. 65. Upon completion of construction and grading, all disturbed areas located outside resource areas shall be stabilized permanently against erosion. This shall be done either by loaming and seeding according to SCS standards. If the latter course is chosen, stabilization will be considered complete once vegetative cover has been achieved. 66. Upon completion of the project the applicant shall submit the following to the Conservation Commission as part of a request for a Certificate of Compliance: a. WPA Form 8A — "Request for a Certificate of Compliance." b. A letter from the applicant requesting a Certificate of Compliance. c. The name and address of the current landowner. d. Signed statements from the individual property owners shall be submitted with the request for a Certificate of Compliance indicating that they read and understood the recorded Order of Conditions prior to purchasing their property. e. The name and address of the individual/ trust or corporation to whom the compliance is to be granted. f. The street address and assessor's map/parcel number for the project. g. The DEP file number. 9 NACC 05/22/2003 DEP FILE # 242 -1192 h. A written statement from a Registered Professional Civil Engineer (and/or Registered Professional Land Surveyor) of the Commonwealth certifying that the work has been conducted as shown on the plan(s) and documents referenced above, and as conditioned by the Commission. i. An "As -Built" plan prepared and signed and stamped by a Registered Professional Civil Engineer (and/or Registered Professional Land Surveyor) of the Commonwealth, for the public record. This plan will include: ➢ "As -Built" post -development elevations and grades of all filled or altered wetland resource areas including the encompassing buffer zone which is regulated as a resource area under the local Wetland Protection Bylaw. ➢ Distances from structures to wetland resource areas. Structures include (but are not limited to) septic systems, additions, fences, sheds, stone walls, pools, retaining walls, subsurface utilities and decks. ➢ A line showing the limit of work and the extent of existing erosion control devices. "Work" includes Any disturbance of soils or vegetation. ➢ Location of all subsurface utilities entering the property. 67. The following special conditions shall survive the issuance of a Certificate of Compliance (COC) for this project: ➢ 25' No -Disturbance Zone and a 50' No -Construction Zone shall be established from the edge of adjacent wetland resource areas. Future work within 100' of existing wetland resource areas will require a separate filing with the NACC (refer to Section XI (page 18) of the Regulations for performance standards within these zones) The Conservation Administrator and/or other agents of the NACC do not have the authority to waive these setbacks as established under the local ByLaw; ➢ Discharge or spillage of pollutants (Condition # 61); ➢ Prohibition of underground fuels (Condition #62); ➢ Limitations on the use of fertilizers, herbicides, road salts, de-icing compounds and pesticides (Conditions #63&64). 10 NACC 05/22/2003 Massachusetts Department of Environmental Protection �— Bureau of Resource Protection - Wetlands DEP File Nurn-er WPA Form 5 - Order of Conditions 242-1192 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP B. Findings (cont.) - - Additional conditions relating to municipal ordinance or bylaw: See attached This Order is valid for three years, unless otherwise specified as a special condition pursuant to General Condition A fr m the date of issuance. 'S7aa 3 Date - This Order must be signed by a majority of the Conservation Commission. The Order must be mailed b�/ certified mail (return receipt requested) or hand delivered to the applicant. A copy also must be mailed Cr hand delivered at the same time to the appropriate Department of Environm rotection Regional Office (see Appendix A) and the property owner (if different from app lica Signakres: _ _,-— -x _ / / /r On Day before me personally �appeared tS C_u-f+ l cuS Q_ Of M Glo c"3 Month and Near -- - to me known to be the person described in and who executed the foregoing instrument and acknowledged that he/she executed the same as his/her free act and deed. No ary Publica, My Cowissio pires This Order is issued to the applicant as follows: ❑ by hand delivery on Date E�J/by certified mail, return receipt requested, on Date /;1f�11c13 Wpaform5.doc • rev- 12/15/00 Page 5 ff , Massachusetts Department of Environmental Protection "�— Bureau of Resource Protection - Wetlands DEP File Numre WPA Form 5 - Order of Conditions 242-1192 Massachusetts Wetlands Protection Act M. G.L. c. 131, §40 Provided by DEF. C. Appeals - - The applicant, the owner, any person aggrieved by this Order, any owner of land abutting the land subjEct to this Order, or any ten residents of the city or town in which such land is located, are hereby notified o their right to request the appropriate DEP Regional Office to issue a Superseding Order of Conditions. The request must be made by certified mail or hand delivery to the Department, with the appropriate filirc fee and a completed Appendix E: Request of Departmental Action Fee Transmittal Form, as provided in 310 CMR 10.03(7) within ten business days from the date of issuance of this Order. A copy of the request shall at the same time be sent by certified mail or hand delivery to the Conservation Commission and to the applicant, if he/she is not the appellant. The request shall state clearly and concisely the objections to the Order which is being appealed and hov the Order does not contribute to the protection of the interests identified in the Massachusetts Wetlands Protection Act, (M.G.L. c. 131, § 40) and is inconsistent with the wetlands regulations (310 CMR 10.00). To the extent that the Order is based on a municipal ordinance or bylaw, and not on the Massachusetts Wetlands Protection Act or regulations, the Department has no appellate jurisdiction. u. Kecoraing Intormation This Order of Conditions must be recorded in the Registry of Deeds or the Land Court for the district in which the land is located, within the chain of title of the affected property. In the case of recorded land, t`ie Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land subject to the Order. In the case of registered land, this Order shall also be noted on the Land Court Certificate of Title of the owner of the land subject to the Order of Conditions. The recording information on Page 7 of Form 5 shall be submitted to the Conservation Commission listed below. North Andover �-,onservauon commission Wpa`orm5.doc • rev. 12115/00 Page 5 J "" Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands DEP File Number: WPA Form 5 - Order of Conditions 242-1192 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP D. Recording Information (cont.) Detach on dotted line, have stamped by the Registry of Deeds and submit to the Conservation Commission. --------------------------------------------------------------------------------------- To: North Andover Conservation Commission Please be advised that the Order of Conditions for the Project at: zIZ -11 Project Location DEP File Number Has been recorded at the Registry of Deeds of: for: County Book Page Property Owner f and has been noted in the chain of title of the affected property in: Book Page In accordance with the Order of Conditions issued on: 3 Date If recorded land, the instrument number identifying this transaction is: Number If registered land, the document number identifying this transaction is: uocument Numuef Ur mplill :dnt Wpaform5.doc • rev. 12/15/00 Page 7 of 7 m m m m y m CA m V CA �.e. 03 � d CA CM) CD 'v O c� Z y CLO � O CL = y n� -�v o n o v CD CD O CL cc � Cr c ? CD CCD O CD ww a. C� CD rA CD CL 0 CA co CD C c ?'o p I S cCA0CT H ao�o to CL o o C7 4 moCLC., m Z H o ' = C O y—I o� = M o H T ,_, CL o aOmd p y ti � N aSO 0 O N CC2 ^ C. N CL m n'0 d n3 , `0 co � C � o'er' �• E. o ` CL cn -� y CD 'm C, GH Q OLvCD �o O �oFa z y oCDcn� � � SR cn y : i CD Dq : dJX 953 m s �Z ^ Ir oCA c CD o o = O o CD GJDo�N D0, Z m ny � ms •p, x V 't�:t� cn o 0 n cn 0 py •rf w oGn e cn A m n �? w 7d � r MM z e n � D ,'v aGc 0 o ��.,y/ cn ^ C a x rD td COD y w 7d W O b I� O '� Ir O oNq 0 K- a O C Location_ No. Date MaRT� TOWN OF NORTH ANDOVER 0��,..o ,.�ti imago p Certificate of Occupancy $ �, ,�` Building/Frame Permit Fee $ s Foundatiou�Permit Fee $ Other Permit .Fee",- - $ Sewer Connection Fee $ `-'Water., Connection Fee $ 1. p, >a TOTAL . - c _ „, $ 6 Building Inspector Div. Public Works Location No. _ r !-J Date• 01t7" TOWN OF NORTH ANDOVER I Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee.,/-, F � .�3 ,§ewer Connection Fee $ •1 � � ager nl% ift Fee $ vGTOT'J 1 4 T r. r Building Inspector Div. Public Works Location C - `'y art► c'c ;" � 'f fc� No. Date ,&ORT" TOWN OF NORTH ANDOVER „ Certificate of Occupancy $ ` "� y Building/Frame Permit Fee $ s�CMus Foundation Permit Fee $ / Other Permit Fee $ $"w Ponnection Fee $ nn �� 1'Nater`Connection Fee $ �UN Z $ 19aTpTAL $ i �.- r 71 i`�*P Building Inspector Div. Public Works m r 0 L Q 1. N 0 z > c r m c r1 'C m a Q` r- 0 0 :3:3:3 r5 n r5 r > D (D H. o CC) m'cl 0 m -< -r- r ° J W `� NO v Zj I o .P Ul fa o N m = Z r r m c r1 'C m ED Q` r- > > v 0 r > D m H. o CC) m'cl 0 m -< -r- r c c NO > N fa -1 N m = Z r m Z m r _ 0 c O o o N n m n N 0m r r y > -+ 0 0 om r M iy z O r N m m N 0 -+ i 1 z Z �r 0 r o Oi A 3 O Z 0 3 y D m > A > O 0 m m { N Z Z m m D m m N N n n 9 Z Z -� . J r 0 N -4 D MA 3 m N N 0 c W 0) 0 Z j -i to N r A H v t Ln N A 0 m f< w M m . r W A. N Fl- rS N r C o z 3 N C 4 N F m c p o r o(D(D (ZD O rr W Z M z O N Z A 0 z sem. a (1 (D rs p Z Cl rqrn m c r1 'C m o O Q` r- ::Ioz v 0 N N m v v H. o CC) r, o -< -r- IT (D Ick M f m m m> of v_l o> o o r, N A r c c c > D D D r = Z Z O Z m 0 c O o o n m n N "� n m y L O 'nm D r z z z O r m m N 0 -+ > z Z N r o A 3 A 3 O Z Z 3 N z O A D m O W A > 0 m m m m D m n N 0 -� . J r 0 N -4 D MA 3 m N N to 0) Z j -i z N r m d t Ln i A p z f< w m --4 . r W A. N Fl- rS N r o z 3 N - p o(D(D (ZD '.t1 rr W 01 m A M O to z N m (1 (D rs p Z <A Nw~,proortr° <�o 3 o0 I-rR N 1 0 M w - - Q, Q, H �P z w N. (D rs Z Dy m 0 0 A rS m Z m Imo' i > D A K M ` U1 Ln O w N N N N A ( 9 > N ZO c N c c cZ 3 D N 0 A 0 rrr;m 0: Z N 0 r m N r 1' 0 0 , zl 0 m n 0 0 a o o Q N o 0 z 1 0 0 :i >� r1i A N N C_W O o N i> r~0 Ir m m s RWI'N0 M m �t N 0� g Z ad, m N C O m N N HN _ V (D N N y zD c \ N m N n x o ` * 6 /off 0 .0, z rt \ 77, Ul W P)rq v G1 ID (Ay ^Trmw mO A y A Op D C) 0 N zm n G p 0 v A lZ'DD O zmz r) mznnm n Nc pmAfn p p Azn�7 Dp m xn m AN y 00000 Z 00,- O O yD O Qy ; OO D QA p_ Am Z � A p O m Tti n �o ZA T Z Ginl,0 D DZDN Np D ZD D O ZO v or) O D D O QAmszD z Ty 0 „ N N p { j m N y z D ° Z l! '_ 0 z SII IIIIII ill IIIIIIIIIIIII LLQ ILu I�L _ _ D2� FOO O- A .� -��3yZA r�ODQ-DDOy T T n< :gym D� pm D P) Dn2 NOD 1� A DO 3 A n p Z (D �T_TT QmZz CpT 2v. TA D Y `� D A Z W .� c n�3m O N r pm°rvxymAy2 0A n1��j?S�2m p ATDm Z`m�T p p 2 y p Q? N C O w n m ti A N� - m z p y m n 3 ti D A p y _ 0 A �O OA 2 QAX`2zZ O m N< x v __ Q. ., nNmDF Z Q A Z D D z .'o ; �4" APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 na'AP 4"o108C/65 I LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK 'PAGE ZONE SUB DIV. LOT NO. ~�I iding Realty Trus — LO(tATION Berry Street 335 PURPOSE OF BUILDING OWNER'S NAME Riding Realty Trust NO. OF STORIES 2 SIZE 241 x 341.-/t.37- 41+/`3.2- OWNER'S OWNER'S ADDRESS 242 Neck Road, Haverhill, MA BASEMENT OR SLAB full basement w/4" concrete slab ARCHITECT'S NAME James Bourgeois SIZE OF FLOOR TIMBERS IST 2x10 2ND 2x10 3RD BUILDER'S NAME Channel Building Company, Inc. SPAN 121 max. DISTANCE TO NEAREST BUILDING 1401 + DIMENSIONS OF SILLS Dbl. 2x6 P.T. DISTANCE FROM STREET 1301 -I- POSTS 3-2" Lally DISTANCE FROM LOT LINES - SIDES 331 REAR 751 GIRDERS 8x8 built-up AREA OF LOT 1.23 AC FRONTAGE 170.331 HEIGHT OF FOUNDATION 81 THICKNESS 1011 IS BUILDING NEW Yes SIZE OF FOOTING 11 X 11 18 W 12 D IS BUILDING ADDITION No MATERIAL OF CHIMNEY Masonry IS BUILDING ALTERATION NO IS BUILDING ON SOLID OR FILLED LAND Solid WILL BUILDING CONFORM TO REQUIREMENTS OF CODE YeS IS BUILDING CONNECTED TO TOWN WATER No BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER No IS BUILDING CONNECTED TO NATURAL GAS LINE No INSTRUCTIONS 3 PROPERTY INFORMATION (� LAND COST $60,000.00 SEE BOTH SIDES PER!4'1 k !-UR FOUNDATION ONLY EST. BLDG. COST FT. D' - PAGE 1 FILL OUT SECTIONS 1 - 3 REGULATED BY PARA. 114.8-S. B.C. EST. BLDG. COST PER PAGE 2 FILL OUT SECTIONS i - 12 EST. BLDG. COST PER ROOM �y� E- 6 -i9-1/ i/m SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING DAT FEE PAID 4 APPROVED BY ATTACHED GAR AAGES M T CONFORM TO STATE FIRE REGULATIONS PLAI�15 MUS BE FIL D A APPROVED BY BUILDING INSPECTOR DATE FILw // /Jerry Diorio, Channel Bldg. Co BOAR? OFHEALTH SIGNATUR F O R OR AUTHORIZED AGENT Owner Tel.# 374-4511 14P U�Contr. Te - F E E Contr. Lic# 039770 PLANNING BOARD PERMIT GRANTED 19 PERMIT FOR FRAME/BUILDING DATE: �8 9� FEE PAID�3i � vw" FEZ LESS FDA -/ooh UE MME P41T8 310 o� Due 3�0 BOARD OF SELECTMEN . 1 •' 3 NV"id 1O1d S3OH'ld3tl S1Hl^a3S&jMM3dnS''�J.3 'S3E)vu -V9 'S3H721Od H11M 'SE)Nia11n8 d0 SNOISN3WIa lOVX3 aNV 'S9NM 10'1 WOLid 3ONV1SIa aNV lO1dOSNOISN3W1a'lOVX3 MOHS1SnW NO11Q3S SIHl zt AONvdn000 t 07lOD3b JNlalins R 'JNIiV3H ON DIN1�313 _I Q P' I isI PSL T• 1,W.9 110 SWOON 40 'ON L SVJ SN31V3H 11Nn 0.1.H 1NVIOVN CININOI110N00 alV NOdVA 210 b.1.M lOH WV31S 'NNnd NIV lOH 03JNOd 3JVNNnd SS313d1d S83JVN DOOM 510 B 'SW9 13315 Slob g 'Sw9 i139wll 1s10f OOOM 9NIlV3H ll I ONIWVNd 9 00V0 3111 Noold 3111 S3Nnlxld N63GOW JN1do0N nod 63MOHS llV1s 13AVdO T NVl ONI9Wnld ON 31VIS XNIS N3HDlIX S30NIHS DOOM ANOIVAV1 S310NIHS 1lVHdSV 13SOlD N31VM 03HS 1V1d I'Xid LI WN 131101 ONVSNVW � 13N9WVJ 'Xid E) H1V9 dIH 319yo ONWwnld of 4002 5 3NON 31Vn030V _ NOOd i NOlUcIns ONI21M _I Noold v sals �Illtl 3WVNd NO 3NO1S ANNOSVW NO 3NO1S 'X19 N30NI� 80 'JNOJ 9WVNd NO XDIN9 ANNOSVW No )IDIN9 _ C X l 9 _ T UTA 3111 'HdSV N0llW0D 3WV8d NO o»nls ANNOSVW NO ODDn1S ONMIS 'MA ONIOIS 10IS39SV 0.M0NVH rJI�IOIS llVHdSV HldV3 S310NIHS DOOM 313N�N0� ON0 SONV109dVID 520014 6 II SllVM b N3HD11X NN300W ` WOON 0V3H S3DVld 3NH 1.W 9 ON V3NV DI11V 'Nld % R/, '// V36V .LW.9 -N13 Lind V3NV 1N3W3SV9 £ E L X t _ E N13Nn 1lVM' AN0 SN31d N31SVld 0 MONVH 3NO1S NO XDIN9 3NId X119 313N0N00 313NDNOD HSINI4 201231NI 8K NOI1VONn04 z NOucinHISNOo 1 S1N3W1NVdV Allwtld ulnw 531N0!S X AIIWVd 3lcJN15 e, 4, 'FORM U • . TOWN OF NORTH ANDOVER LOT RELEASE FORM SUBDIVISION ASSESSORS MAP I gG SUBDIVISION LOT(S) PERMANENT ADDRESS (ASSIGNED BY D.P.W. STREET Berry Street APPLICANT Riding Realty Trust PHONE 508-373-3000 DATE OF APPLICATION 5/21/91 TOWN USE BELOW THIS LINE PLANNING OARD DATE APPROVED TOWN PLANNER DATE REJECTED CONSERVATION COMMISSION ll ` CONSERVATION DATE APPROVED DATE REJECTED BOARD OF :3Jl7�t"( DEPARTMENT OF PUBLIC WORKS DRIVEWAY PERMIT t:L466t Log SEWER/WATER CONNECTIONS ,Up � FIRE DEPT.(ire. W" �C IU�•� c iur� RECEIVED BY BUILDING INSPECTION DATE Vi aY DA'Z'E APPROVED 4,P1121)1F1_ DATE REJECTED z k" 64- L This form shall be signed by the agents of the Planning and Health Boards, the Conservation Commission prior to the issuance of any building permits for the subject lot. This form shall not releive the applicant from the compliance of any applicable Town requirement or Bylaw. 2Ua 1 z3 ,Uj t! J Zk ZAq ->/-va- �4 a?.+ i ^i .� vfz-i1 G7� -Z 1 1 Z c v -Zr C-4 --61 CI '"'tea cy a %-vu �F7 S C! --X4„1 c' CN /b/.:�S 1.,-A Zg'�A lv` ,w -j l7 EL t t". t • O z iL 2 J z 0 z :z K �q �a � 07 z O '.1, LL&O m W Q C) li W a - N wme � O O 0 O a i J O C Q u c W W O � o a V W W CL a a d. j.. O V z � •� H a o �- � Z Z Z G O a z a Z uj o z °z m m U W L C J °' t uj L .` L m Y :3 E �' m W �' m �' f o O L C O C O N c O C 7 N E ¢ U ii oC ii ¢ cn LL Qu. m 0) J z 0 z :z K �q �a � 07 z O '.1, LL&O m W Q C) li W a - N O z � O � a i C � c a� � o a V a O V z � •� a o �- � V 0 O z r►'3 n vQ z r"1 E iU 2 J Z O :a �z :z ir LUm ZD V) z O V) W J CD 0 O m W Q 0: LA0 i1.. 0= w a. 24 m c J Ir L 4) a cc ce cc cc o 0 0 Q O W W CW, C. F- H CL N W W Z Z Z LU C. 0 0 Z Z u ? �. W Z O — V r m 0 m V U W m t C ..d t J L L m Y rn 0 E .._ c C. rn c u+ rn 0 > 0 �' c ` N o o' c C E � U u. cc U. a°c ui U. cc U- m to J Z O :a �z :z ir LUm ZD V) z O V) W J CD 0 O m W Q 0: LA0 i1.. 0= w a. 24 m c J Ir L 4) a cc OF. HL 111.1 )IN6, ('UNII -.I ( VATI ON I'I.i\NNW(. ATE. )CATION Tt)w11 i IyURTAl ANDUVE 1'1,i1NN1N(; (;Ol�lf►!l!NI"1'ti' Ul:�'ls1,U1'I11l:N'1' VlsrV I:,•\I;I:14 1 I.P. NFLSO )N. I)Iltl:(; I ()It CHIMNEY APDL I CA I-1O1J ANO VE -13111, 54. 'NER' S NAME: G-G��i C� v►cL. e l i11. Cornet-� oQ . I LDER'S NAME: ' ' 'hYie If SON'S NAME: Iiuo SON'S ADDRESS: 015" it 111 'Ni II III\'I'I, hl;Ititi;l('IIIL';1'II':►1111.1!i . Ilii �flifi!i•I i �,'i PEKMiT # SON'S TELEPHONE:_ FERIAL OF CHIMNEY: FERIOR CHIMNEY: EXILRIOR CIIIMNEY: 6✓1CfC .�i3ER AND SIZE OF FLUES:u6 baiLu– /. x–Y, 4--k-e4la-c CKNESS OF fiEARTH: cel biney oa (,�)Lepeace con(jaAm to Vie �(e.c�u,t�(enle►I•t:5 uo .the cuc/e and have )u1Ce3 (11.1d lu,2ati.arv6 been necetved: ('��------------- -E:����4/ NATURE OF MASON: MIT GRANTED: A-L�cr. iS I g5'1 ERT NICETTA LOING INSPECTOR PECTEO: ARKS: I' E E SOLID FLOCK REQUIRED THIS PERMIT AILISF 13E OISI'LAYLO 014 111E I'UMISL:S 1 H n c a V m z c 3 N 00 W 2M u r I ClQ A C 0 c cr MOIL eD Flo IT 00 aq IT E� w co I=D JN c w 0 > L4 .0 -j z 41i . . . . . . N It: I'L ...... CN) J q CHANNEL Channel Building Company Inc. 242 Neck Road Haverhill, MA 01835 TO (508) 374-4511 GENTLEMEN: WE ARE SENDING YOU ❑ Drawings ❑ Copy of letter ttached ❑ Prints ❑ Change order h0h;ir 0� t1ranamn'tW DATE -2a, JOB NO ATTEN ION RE IF ❑ Under separate cover via— [L—Pi —an s ia_[dans ❑ Samples _the following items: ❑ Specifications COPIES DATE NUMBER DESCRIPTION ell Z2r Aed1 e/)" 1 rr THESE ARE TRANSMITTED as checked below: ❑ For approval Kor your use ❑ s requested ❑ Approved as submitted ❑ Approved as noted ❑ Returned for corrections ❑ Resubmit.—co pies for approval ❑ Submit copies for distribution ❑ Return corrected prints ❑ For review and comment ❑ For bids due 19 ❑ Prints returned after loan to us REMARKS SIGNED: IV& T/a►O Wei Department of Environmental Management/ Division of Water Resources WATER WELL COMPLETION REPORT < WELL LOCATIOV *Uk� Address City/'town ,G.S. Quadrangle Map Grid Location WELL USE Domestic ?r** Public ❑ Industrial ❑ Other Method Dril'ed Date Drilled (0- `1 ` CASING r Lengt iameter_ Type ���iY CONSOLIDATED WELL Type of Water -bearing Rock Water -bearing Zones 1) From To 2) From To 3) From To 4) From To Depth to Bedrock r0 UNCONSOLIDATED WELL STATIC WATER LEVEL / Water -bearing Materials Feet below •�;id surface Sand:. fine ❑ medium ❑ coarse ❑ Date measw Gravel:. fine ❑ medium ❑ Screen: coarse ❑ GRAVEL PACK WELL Slot# length from to Yes [7 No ❑ Split Screen (or 2nd screen) WATER QUALITY TESTS MADE Slog length from to Chemical 0 Biological E] Depth To Bedrock PUMP TEST ✓ ✓ Drawdown / feet after pumping days hours at IS 0 GPM. How measured _m 2 Recovery feet after �! m 1f55urs. LOG of F=ORMATIONS COMMENTS: (On well or water) Materials From To e - AL'` r7 IU `�'SIA, Cb DRILLER y Firm Address ' Registration No. CUSTOMER COPY dZ , s SiqnaMjre 15M.2 84.176471 11 ,1' � j� ,� - � � - 1 •�,I�1 �, '' ,� l �, '� �� ..� � " � �� �;: , r �' � y ��,�; rT &C5C3 CHANNEL Channel Building Company Inc. 242 Neck Road Haverhill, MA 01835 TO ( 08) 374-4511 l,E.lnJ � ri • ,✓ Lro GENTLEMEN: WE ARE SENDING YOU ❑ Att d ❑ Drawings ❑ Prints ❑ Copy of letter ❑ Change order DATE 08 NO ATTENTION �l►,/n/ DESCRIPTION ❑ Under separate cover via the following items: O P a ❑ Samples ❑ Specifications COPIES DATE NUMBER DESCRIPTION 1 nC3C AKC I KHrvZiMI 1 1 to as checked below: ❑ For approval ❑ For your use ❑ As requested ❑ Approved as submitted ❑ Approved as noted ❑ Returned for corrections ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints ❑ For review and comment ❑ For bids due 19 ❑ Prints returned after loan to us REMARK SIGNED: %1�t02[0 FORM U TOWN OF NORTH ANDOVER LOT RELEASE FORM SUBDIVISION ASSESSORS MAP SUBDIVISION LOT(S) PERMANENT ADDRESS (ASSIGNED BY D.P.W. STREET Berry Street APPLICANT Riding Realty Trust PHONE 508-373-3000 DA'Z'E OF APPLICATION 5/21/91 PLANNING ARD /, -1 TOWN PLANNER CONSERVATION 1) � Iw u CONSERVATION SSION N. TOWN USE BELOW THIS LINE DA'L'E APPROVED � DATE REJECTED DATE APPROVED DATE REJECTED BOARD OF DEPARTMENT OF PUBLIC WORKS DRIVEWAY PERMIT c,A SEWER/WATER CONNECTIONS �C�D FIRE DDEr1PT. l &14 RECEIVED BY BUILDING INSPECTION DATE Vi E>Y DA'Z'E APPROVED DATE REJECTED -7- ► Pj 6-r_•, 'f' 011i U This form shall be signed by the agents of the Planning and Health Boards$ the Conservation Commission prior to the issuance of any building permits for the subject lot. This form shall not releive the applicant from the compliance of any applicable Town requirement or Bylaw. z rt N O Ti h � n o' n z rt N O Ti h