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HomeMy WebLinkAboutMiscellaneous - 5 Cherise Circle t 5 Cherise Circle MAP # LOT # PARCEL # STREET CONSTRUCTI.ON_APPROVAL HAS PLAN REVIEW FEE BEEN PAID? E5 NO PLAN APPROVAL: DATE a'Z l� APP. BY DESIGNER: df//Z1,5T/�4N_� its PLAN DATE:_? CONDITIONS WATER SU �WN WELL WELL PERMITDRILLER�_•�_____._._ WELL TESTS: MICAL DAZE APP RUVED BACTER I DA I E (IPPRUVED BACTERIA II DATE APPROVED COMMENTS FORM U APPROVAL: APPROVAL TO ISSUE DATE ISSUED BY CONDITIONS: FINAL APPROVAL: . ALL PERMITS PAID NO WELL CONSTRUCTION APPROVAL YES NU SEPTIC SYSTEM CONSTRUCTION APPROVAL ( NO OTHER YES NO ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: DH 1•E:�//Av. DY: ✓ls���,4 �'� �EG�SY$.ZEM_Lr1SIfl4l �tT_QLl , •a �, 'vi- • . 1;•�Y .1 •+'- ... .. s ,A t r n _t�u ! aJ•� 1 .� '�• �, ...•' - .. t� IS THE INSTALLER LICENSED?... + � YES NO `r. ` TYPE OF- CONSTRUCTIONe ; _ �' NEW` REPAIR* _ NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW YES NO CONDITIONS OF..APPROVAL .• � YES NO (FROM FORM U) ; .. . . ,ISSUANCE OF DWC PERMIT ES NO • •.11`x- :�'• is �., .:' . .. :•' '_ • -DWC PERMIT N0. i +INSTALLER:7TM /ISG V1,f_) BEGIN .INSPECTION YES N0: EXCAVATION , INSPECTION: : NEEDED: i• .,J , � 1Y .f 'li.. 1 •i.• - a\ .rw ii�{ • j. •�1. �t l - PASSED HY CONSTRUCTION INSPECTIONS NEEDED: .. ••4 n AS BUILT PLAN SATISFACTORY: YES \ _ - ' APPROVAL TO BACKFILL: DATE: � a{J/�3' BY 1 Cd :FINAL . GRADING APPROVAL: DATE �� BY ZJ FINAL CONSTRUCTION APPROVAL: D ATE e 11 -� BY 1 w Office Use OnlyG} 4e &MMVUiuettl Permit No. Elepartmint of Puhlit -aufail Occupancy& Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WO K All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date City or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a,,permit to perform the electrical work described below. Location (Street & Number)L/2T y �' !-ICRC S� Cl2cce fiWA07e 611 eA( Owner or Tenant 1) 1) P De-41e4 OP/h-Al7`-- IIJCCed H Owner's Address & 13 o x"I- F3 93 r-2k - 3-9 1— V V6 P Is this permit in conjunction with a building permit: Yes l- No ❑ (Check Appropriate Box) Purpose of Building S llV e�L; p Int-, Utility Authorization No. 5_02 12 " Existing Service Amps _/ Volts Overhead ❑ Undgrnd ❑ No. of Meters New Service 00 Amps Q0 Volts Overhead ❑ Undgrnd P No. of Meters 1_ Number of Feeders and Ampacity 4 r Location and Nature of Proposed Electrical Work 5 h No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total No. of Lighting Fixtures Swimming Pool AboveI In n grnd. ❑ grnd. Generators KVA No. of Emergency Lighting 1 No. of Receptacle Outlets D No. of Oil Burners f Battery Units No. of Switch Outlets Ej No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total No. of Detection and tons Initiating Devices No. of Disposals No of Heat Total Total Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices No. of Dryers Heating Devices KW LocalMunicipal ❑ []Other Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: 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 E] NO 11 1 have submitted valid proof of same to the Office. YES - NO C If you have checked YES, please indicate the type of coverage by checking the appropriate box. / q INSURANCE W BOND Q OTHER Q (Please Specify) 7`y (Expiration Date) Estimated Value of Elect ical Work S 5—,0 Work to Start Inspection Date Requested: Rough Sv 30 9� Final Signed under the Penalties of perjury: FIRM NAME ` LIC. NO. Licensee ��et�ALD l GAiZO c���r� .a LIC. NO. 9fP9/3- ^ / Bus. Tel. No. 9,P9-7h'fa Address ?D o[OGUr'G/ Alt. Tel. No. 0 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE S (Signature of Owner or Agent) x-6565 2 Date....`! ........�...... NORTI, " TOWN OF NORTH ANDOVER PERMIT FOR WIRING j SACH This This certifes that ..... . .......r ......:..... ..G..... .............................. has permission to perform �Cf ` /-/()�'�� ..................... ........................................ wiring in the building of �{ ......... .1 .. �. .. ........, ....... /c.:...... j at .. .�`.' ..(. ` i — 1 ,_1) '..: �.... . ,North Andover,Mass. Fee.,:� r. v... Lic.No. ..-. .............. ........... ........................... ELECTRICAL INSPECTOR ( V3/� /95 14:18 2I0.00 PAID WHITE: Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File d - \ Office Use Only 01 4P Liam I outuPalth, of MuS!caotmEftfi Permit No. i9epartmtnt of Vttblic —AafetV Occupancy A Fee Checked —sL_ w BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:000 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 15 t (l* or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. \ Location (Street & Number) OTY � " % Owner or Tenant Z •!� 7ez1ay10keit/T J Owner's Address PG 13 ox k39.3 GIJagp Is this permit in conjunction with a building permit: Yes _ No C (Check Appropriate Box) Purpose of Suiiding 1emlo Se-xy/C�-- Utility Authorization No.77 �� �7a3• Existina Service Amos _J Volts Overhead Undgrnd No. of Meters 77, New Service 100 Amps -Q21 0Voits Overhead ' Undarnd u No. of Meters Number of Feeders and Ampacity C Location, and Nature of Proposed Electrical Worx Te,Al P• ��eCTe;e- Segt&e,P Total No. of Ugninnc Cutlets i No. of Hct -ucs I No. of Transformers KVA No. of I Licntin Fixtures I SwimmingPool 'above`— n- g grr,c. Generators KVA No. of Emergency Lighting No. of Receotac!e Cutlets No. of Oil _.,niers Battery Units No. of Switch Outlets j No. of Gas Burners F!RE ALARMS No. of Zones j Totai No. of Cetection and No. of Ranges No. of Air Cone. tons Initiating Devices Noor Heat Total —,at No. of Disccsa!s Pumps Tons K'.V No. of Sounding Devices No. of Seif Contained No. of Disnwasners SoacelArea Heating KW DetectioniSounding Devices I Municipal Heating Devices Lcca: — !-Other No. of Drvers I Connection t i No. of No. of Low Voltage No. of Water Heaters KW S:cns Ba!!asts Wirinc No Hvcro Massage Tubs I No. of Motors Total HP I 1 OTHER: INSURANCE CCVERAGE: Pursuant to the reeu,rements of '.iassacnusens general Laws ! have a current Liacility Insurance Policy inducing Como:etee Cperaticns Coverage or its substantial equivalent. YES = NO = have suorm-ea valid proof of same to the Office. YES - NO = If you nave checxeci YES. please indicate the type of coverage by cnecking the approorlate box. /O ...JO 94r INSURANCE - BOND = OTHER = (PleaseScec:fy)d 0 0 (Expiration Date) Estimated Value of E!ectncal work S 1S0 �'' �f, Worx to Start ,�`_ �3 Insoectton I- - -,e Recuestec: J Final Signec unser the Penalties of perjury: =iR�1 NAh1E LIC. NO. Licensee Signature -!C. NO. Z2 Q 1_�1 ?�,,,, , 1 �i� AA r1� Bus. Tei. No. J)- 07 Address 1�-�l� J �,v Q {-+-�t16�el f /►l Int Alt. Tel. No. ��- OWNER'S INSURANCE WAIVED: I am aware that the Licensee coes not have the insurance coverage or its substantial egwvaient as re cuireci bV Massacnusetts General Laws. and :hat -v signature on :his permit application waives this requirement. Owner Agent :Please --hecx one) Teleonone No. PERMIT FEE S (Signature of Owner or Ageno x-5505 2235 I Date...../- �I f NOR1�y 9 ................. 0 IL TOWN OF NORTH40 ANDOVER A i o "•,;' PERMIT FOR WIRING 1 ,SSACMUSEt� Q Q Jii ! 1�1 J This certifies that .,,•,,���� ! �--/ perI has mission to perform G,6 wiring in the buildingof... �,.,,/ _ at. . P... . .. ... ... .. ..... .. _ ... / .. ' .�... .C_,- ..... z` �.. ... .. .... ..... G r✓ 3 ,North a ..... Lic. CTRAndover,Mass � ELEICALINSPECTpR WHITE:Applicant CANARY: Building Dept. - PINK:Treasurer � GOLD: File Address Title of Fiae Page of Date File Open: Date file closed: . Doc Document/Action Titl action e Date of Refer to other Purpose of Docu fW u m' mecnt/Actio Document/ document/ n and notes; Action Department Board of Appeals — Board of Health Planning Board - Conser+�atiion Comm' — tssion Building Departrnen,t -----_ _ _� G 4 ORT Town of � � � - � Andover VIA No. 126 art dover, Mass., &aIL. 14 19 �r Q �- LAKE COCHICHEWICK 7�ADRATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System V_,_ BUILDING INSPECTOR THIS CERTIFIES THAT.. .� .� ►....>� .JL4? Ml.1JC�............................................................................. """"' oundatio -A I7_4`qV- � ..... ou has permission to erect. .... lylf.... buildings on .... ...... to be occu ied as �'�+ �.l'� W +4'�'••••• Chimney provided that the person accepting this permit shall in every rpect onform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PERMIT FOR FOUNDATION ONLY PLUMBING INSPECTOR REGULATED BY PARA. 114.M B.C. oug ��s/��, ¢ VIOLATION of the Zoning or Building Regulations Voids this Permit. FEE PAID PERMIT EXP 6 MO so �- �� ELECTRI_eAL SPECT& UNLESS CONS T Rough , PERMIT FOR FRAME/BUILDING Servic fi�f �- 4r, BUILDING INSPECTOR DATE: FEE PAID:.,., Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE PART_MEN ;�+ Until Inspected and Approved by the Building Inspector. Burner ��// ,p t/k CONSERVATION F Street No. �if G '0 % PLANNING FINAL Smoke Det. \.J A- g, SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT It -1008 - 8 <o�"' LOT 6WHITE EL E VA TIONS " BIRCH DESIGN AS-BUILT WHl TE BIRCH ESTATES" INV. OF PIPE OUT OF HOUSE 130.45 133.39 LA NE- INV. OF PIPE AT SEPTIC TANK INLET 128.45 132.33 17 . 13' t 8 t j INV, OF PIPE AT SEPTIC TANK OUTLET 128.20 132.08 —• I INV. OF PIPE AT D-BOX INLET 127.41 130.30 e%�% INV. OF PIPE AT D-BOX OUTLET 127.24 130. 11 `Qo INV. AT END OF DISTRIBUTION PIPE 1 12Z OO 127.37 55' LOT 4 INV. AT END OF DISTRIBUTION PIPE Z 127.00 127.38 QQ �. 1 HEREBY CERTIFY THAT I HAVE INSPECTED THE CONSTRUCTION TP-94K AREA = Z , 70 O S. F. DISPOSALOF THIS AND THAT THE CONSTRUCTION FINAL GRADING HAS BEEN IN ACCORDANCE WITH THE DESIGNER'S INTENT AND THAT THE MATERIALS USED CONFORM TO THE PLAN QSPECIFICATIONS AND 310 CMR 15.00. N TP-94L 0 PERC-7 to NSEN / / g EXISTING No.28M FOUNDATION _ PERC-8 35' 23' A9p 9�Ql3TEP� / (TOP FND. = 140.3') *$'ONAL EN i � Z TP-94-7 Q l I� NOTE: THIS PLAN IS NOT A WARRANTY OF THE SYSTEM BUT A SEPTIC TANK VERIFICATION OF THE LOCATIONS OF THE EXISTING STRUCTURES. 1 � 169 14' (� A S BUILT PLAN 1, D-BOX 13' 189. 16' .,� � OF 38' SUBSURFACE DISPOSAL SYSTEM AT .� LOT 4 CHER/SE CIRCLE LOT 5 11 IN NORTH A ND O VER, MASS. EXISTING FOUNDATION PREPARED FOR: SCOTT CONSTRUCTION CO. SCALE: 1" = 20' DATE: JULY 17, 1995 CHRIS T/A NSEN ,, SERGI P�°LAURVE ENGINEERS 160 SUMMER ST. HAVERHILL,MA. 01830 TEL 508-373-0310 c 1995 BY CHR/STIANSEN & SERGI INC. DRAWING NO. 93067010 Ty` 1 '� } ?Q t 1 l .�� 1 K 't t �' y lT t `! :. t �t, g<.{ \ `�`. t1 �1 y it ' !i t�35't +y, ,•��1':��i ! y,« 't :, tkC 1 , i a�Y .i Y '1 {�frfai�+��i�,�y�` J R ra' �•\ �`-.t ti `-�:.� t >ti tis •1 „ l i� k ill 1. •1 :17 t T �1 t`1,t',.�`::.+..T'��� ,�'l.a*`}� t `4 �' .:4i� iL.r'..a�a•c '3 .,..++ !r ,,;..- �_�.`i',�? !. i} .\•• 1 1 ,tom ,.. 1- i ^a w y+.. t it t l7. t. l �F ♦ i \. ^; l. 4Y�c.{;,i�,. .1i�M �� Via• �..'f"t• ��•,-�MS' 41 r.. •� '"�^�. '`�:;T 1 t 1 .S�,nt, > �.\ � � Z��` X` s 4 h�fS�:, t :>.•lti � is i}'T'1� s^�. '�n •�,h- `1 �T',�l�y�. LtA� `;'.-1 t�r''��:.``..i'`-.«fin`'ttJ•?�-�Y� �.,1,� \c-''\�\,. .�y�'_'7��:�'�: ���;5,, � }'!` a l'2.:''; �� '�}T.(''t 'trr�St`•,li. ^}'?� +Tx .R..'x �,1Q.`/.,v90 >> ` "hz«`�h,S - £ �( ,+' T 'k '7 4r ,�'� -• ��.F\',alai`+`��`7 ���r"'�;'y.. v'4, }>\,, '.nit _�;.s.,?.j,Jt'..�,. ? r'�. :5'�.ta.;t:(t\t11s r,�,t',1.:'--• �1h lkl i'0 t. r , . •� ,��ti+. r �e> �lti { t:+4, \. tt��:, +t i..�ti 'ti taL.'1 �: J. 7\„� },,1����v') ,FjDlh .,TF'`P ,�”\���l ;Y\�• I .�i .a �t ,t li•rtF-j � i ) r + t_` .t- +•� i:�.:,l.^ +. \•,t ;t 4. 1 �0 t � S �' �° � � 1 `�t + l 1 ` i ` '1.', t.. ''�i1.)l, 1 l•l 1`` t1 �R\s t'.��� rY,l.; T `'•n v 3 t � �.>,. '+ rt ,.i �i ,.� s 11,. t�e-1^�..5:.�;Jt�n��� t�t t�.7i�;;.1'::.�'t 4 ^i '', '`-f.�.'1,t`..! �•"�.Z.s+ ` ,. To• ; Vit.. r'T t \ 41 1 t \�s1.,�11hr ,_.7VT i - i � ;,� 7J i� is �;Ft1\ti�a � v -•''l l t `1 1 t , t •; ,�\ ,ti ` ms`s, .l '1. ��• i �• ^ •\`�: 't l - Town of North Andover, Massachusetts Form No.3 t NORTH, BOARD OF HEALTH • O � � 19 DISPOSAL WORKS CONSTRUCTION PERMIT �SSACHUSft Applicant Yin• , LAJv✓—) —NAME ADDRESS TELEPHONE Site Location UD I— Permission is hereby granted to Construct or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. CHAIRMAN,BOAR60F HEALTH • Fee D.W.C. No. 3� WHITE BIRCH LANE n 177.1' o LOT 4 AREA=21,780 S.F. BUFFER ZONE v �o 23'0 (� in ao FCUNp � , TOP OF A')'10N FOUNDATION AO ELEV. _ ' 140.3' N Z. r•, 189.2 LOT 5 1 r FOLINDA TION LOCATION PLAN TrCE HTIFYZTHAT THETBACKE RIMARY STRUCTURE SHOWN OF THECONFORMS TO APPLICABLE ZONING BY-LAWS IN EFFECT WHEN CONSTRUCTED. (THIS CERTIFICATION DOES NOT CONSIDER ANY 07H£R RESTRIC77ONS SUCH AS CLIENT: JPD DEVELOPMENT ORDERS OF CONDITIONS,ETC.)NANTS,WETLANDS,EASEMENTS, THIS DRAWING-SHALL NOT BE USED BY THE CLIENT FOR ANY THIS CERtIFICATION IS-0,6E AND LIMITED PURPOSE OTHER THAN THAT OUTLINED ABOVE.EXC£PT WH HE WRITTEN,PERMSSION OF CHR & SERGI INC. TO THE ABOVE CLIENT, RTHERMORE I THIS DRAWING LIST I ANSEN HE COPYRIGHTED PROPERTY OF CHRISTIANSEN & SERGI INC. AND ANY UNAUHORIZED USE IS PROHIBITED.CHRISTIANSEN & SERGI TAKES NO RESPONSIBILITY FOR THE UNAUHORIZ£D USE OF HIS DRAWING OR ANY INFOR- r`' MATJON CONTAINED HEREON. A ONLY THE PRIMARY STRUCTURE SHOWN LOCA TION: NORTH ANDO VER,MA. IS NOT SED ON IN A T FLOOD HAZARD ZONE AS SHOWN ON FEMA FLOOD INSURANCE RATE. MAP. COMMUNITY NO.: 250098 0005C DAME.612193 ,y SCALE. 1" = 40' DATE: APRIL 25, ' 1995 ��``A LSH 0 gsfq MI EL �' I H 191 � ST/A NSEN Iu SERGI PROFESSIONAL ENGINEERS FC�STER�� .h LAND SURVEYORS T. 70Ng1 LAND ' HAVERHILL.MA. 01830 TEL 508-373-0310 /1995 BY CHRISTIANSEN B SERGI INC. DRAWING No. 9306701 FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section********r********* APPLICANT: fG 2-75' _ C0k1 J ' C Phone37Y- P 0? 1 LOCATION: Assess or's Map Number Parcel Subdivision Lot(s)" Street St. Number J� ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: -PIE Date Approved 1 Conservation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Date Approved Food Inns�pector-Health Date Rejected Date Approved Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Department 1 Received by Building Inspector Date Town of North Andover, Massachusetts Form No.2 f MORTp BOARD OF HEALTH 19 q-4— M i s + DESIGN APPROVAL FOR S�CHUS t� SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant--A- C-A�n Test No. Site Location LEE �`_ U Reference Plans and Specs._C� `�- 0.svl� -vim 1 R.� 7lZlel- ENGINEER DESIGN 4 DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. x CHAIRMAN,BOARD OF HEALTH _: Fee Site System Permit No. S(r PLAN REVIEW CHECKLIST ADDRESS JE (..f��.e%5 �j.�G'CC ENGINEER GENERAL 3 COPIES f/ STAMP Z- LOCUS L--"' NORTH ARROW �� SCALE CONTOURSy PROFILEy SECTION /� BENCHMARK (� SOIL & PERC INFO ELEVATIONS WETS. DISCLAIMER_LZ WELLS & WETLANDS c,// WATERSHED?,J/0' DRIVEWAY-Z(Elev) WATER LINE FDN DRAIN SCH40 1/' TESTS CURRENT? lgg3 4'99- SEPTIC TANK MIN 1500G_L/ . 17 INVERT DROPy/ GARB. GRINDER(+200% EDF) 25 ' TO CELLAR MANHOLE TO GRADE, ELEV Or- GW ©iC D-BOX SIZE D 6_g # LINES 2 FIRST 2 ' LEVEL STATEMENT INLET 7.,f - OUTLET Q 7. ), 47 (2" OR . 17 FT) TEE REQ'D? j LEACHING I / / / MIN 660 GPD? L-,0RESERVE AREA/ 4 ' FROM PRIMARY? � 2% o SLOPE 100 ' TO WETLANDS,-' 100 ' TO WELLS , G-' 4 ' TO S.H.GW 35 ' TO FND & INTRCPTR DRA9 O� 3251 TO SURFACE H2O SUPP 1--`- 41 PERM. SOIL BELOW FACILITY ✓ MIN 12" COVER '- FILL? (25 ' if above natural elev; 101if below) BREAKOUT MET?L__� TRENCHES / MIN 660 gpd�/ SLOPE (min . 005 or 6"/1001 ) Ll� >31COVER?-VENT SIDEWALL DIST. 2X EFF. W OR D (MIN 61 ) L/ IS RESERVE BETWEEN TRENCHES? V IN FILL? 10 MUST BE 10 ' MIN L,� 4" PEA STONE? ✓ BOT 169 X LDNG + SIDE ` ' X LDNG/,J = TOT IrS �j (L x W x #) (G/ft2) (DxLx2x#) (G/ft2) 40 Copyright 0 1993 by S.L.Stan Z `te � ----� � � �� .= ��8 i� � z 3 � 6 Z- S �j � � �7 � �- � -a ,kORTN 110 BOARD OF HEALTH � A ♦ 7 120 MAIN STREET TEL. 682-6483 9SS�CHUSE' NORTH ANDOVER, MASS. 01845 Ext23 May 11, 1994 Christiansen & Sergi 160 Summer Street Haverhill, MA Re: Lots #3-9 White Birch II Dear Phil : I have briefly looked at these plans and find that most of them do not have sufficient test holes in the system. In addition, there will be changes in light of the testing done today. Would you please review these plans keeping in mind the criteria I recently sent you, add the new tests and re-submit the designs. Sincerely, Sandra Starr, R.S. Health Administrator cc: Karen Nelson, Director, Planning & Comm. Dev. Jim Grifoni File No......................... FIs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN.........................OF....................NORTH ANDOVER .......................................................... . Appliration for Dio.pooal Works Toatotrurtiurc rrrutit Application is hereby made for a Permit to Construct ( x ) or Repair ( ) an Individual Sewuge Disposal System at CHERISE CIRCLE .................................................................................................. .................................................................................................. Location-Address or Lot No. .......... I.I.Q.I....JjIQ......................... 12 ROGERS RD..,....HAV-ER,HILL.2....MA.................. ................................... Owner Address ...................................I.............................................................. ............................................ ........................................... InstallerAddress Q Type of Building Size Lot....2..I...... .....Sq. feet U .Ex Expansion Attic Garbage Grinder ., Dwelling— No. of Bedrooms.............4......................--•-•• P ( ) g ( ) `4 Other—Type of Building No. of persons............................ Showers — Cafeteria P4 Other fixtures W Design Flow.............g.2.�.5....................gallons per person per da�. Total daily flow.............6.6.Q.......................gallons. W Septic Tank—Liquid capacity 500-.gallons Length 1,0,',-,6. Width.6.'.-8.��. Diameter................ Depth.5_..-6,". t � x Disposal Trench— No. ...2............... Width.....2............. Total Length.....8.4....... Total leaching area....4`..0l:.....sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( x ) Dosing tank ( ) Percolation Test Results Performed by.....C H R-I S T I A N$,HN,,,&„•S E R G 1..,,,I N CDate.../MY...I.?.?S............. Test Pit No, .....minutes per inch Depth of Test Pit....../.. ...... Depth to ground water.... ......... G� Test Pit No. 2...'–..2–....minutes per inch Depth of 'fest Pit.....td Z...... Depth to ground water...N.. .......... .. ................................................................................................................................................. D Description of Soil.......Q ..................................................................................I......I.......... ... v .......... .?S?...... ............................................................................................................ W ........................................................................................................................................................................................................ UNature of Repairs or Alterations—Answer when applicable.......;........................................................................................ ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLi: 5 of the State Sanitary Code — The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed...................................................................................... ................................ Date ApplicationApproved By.................................................................................................. ........................................ nate Application Disapproved for the following reasons:................................................................................................................ ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Tatifiratr of Toutpliatur THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by..........................................................................................Installer.............................................................................................. at...................................................................................................................................................................................................... has been installed in accordance with the provisions of TITLE, 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector..................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No......................... ..•.......•.....•...•..............'OF..........................................................................I.......... Fim........................ Biopoottt orku �olto#t'urtiortlerutit Permission is hereby granted................................................ to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo.................................................................................................... .................................................................................... Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... .................................................................................•----................... Board of Health DATE................................................................................ FORM 1255 A. M. SULKIN, BOSTON