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HomeMy WebLinkAboutMiscellaneous - 63 BRADFORD STREET 4/30/2018 (2) r BRADFORD STREET t 210!0/069.0-0032-0000:0 r -•Y MAP # LOT #------/_............................................................................... PARCEL # STREET._(p_3 ..........�(C'_/ D w..... CONSTRUCTION._._APPROVAL HAS PLAN REVIEW FEE BEEN PAID? YES NO PLAN APPROVAL: DATE , 5 _-- APP. BY_.,. ._ 1 /l _.......... DESIGNER: l J /"/ I'le 11 CSQ C. PLAN CONDITIONS WATER SUPPLY: ��. TOWN WELL WELL PERMIT ` ILLER._.............._.._._._..............._.............. .._..._._..._........._.._.............__..... WELL TESTS: E ICAL DATE APPROVED.......__.......__........... .__. SACT IA I DW E (IPPRUVEU BACTERIA II DATE APPROVED............___.._..___._....__ COMMENTS: FORM U APPROVAL: APPROVAL 1"0 ISSUE ES NO DATE ISSUED CONDITIONS: FINAL APPROVAL: ALL PERMITS PAID YES NU WELL CONSTRUCTION APPROVAL -y-E5 NU SEPTIC SYSTEM CONSTRUCTION APPROVALYES NO OTHER YC NO ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: IS THEN INSTALLER LICENSED? YES NO TYPE. OF CONSTRUCTION: NLW REPAII NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW CONDITIONS OF APPROVAL YES 140 (FROM FORM U) ISSUANCE OF DWC PERMIT YES NO •DWC PERMIT NO. <5 INSTALLER: BEGIN .INSPECTION YE NO: EXCAVATION . INSPECTION: NEEDED: PASSED. L Y.oZ BY-- _ _-1 CONSTRUCTION INSPECTION: NEEDED: - i3plC - ©< AS BUILT PLAN SATISFACTORY: APPROVAL TO BACKFILL: DATE: BY _ -- a. FINAL GRADING APPROVAL: DATE �•/� BY I FINAL CONSTRUCTION APPROVAL: DATE: BY Commonwealth of Massachusetts 7RECEIVEDCity/Town of System Pumping Record 0 2 ?013 Form 4 TOWN OF NORTH ANDOVER b .'~ HEALTH;DEPARTMENT DEP has provided this form for us&by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using.this form, check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left/Right front of house Rig rear of , Left/right side of house, Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under deck Address City/Town State Zip Code 2. System Owner: Name Address(if different from location) cityrrown Stat Telephone Number `e - i B. Pumping Record 1. Date of Pumping ✓��^C� p g Date 2. Quantity Pumped: Gallons 3. Type of system. ❑ Cesspool(s) eptic Tank El Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes to If yes, was it cleaned? ❑ Yes ❑ No. ' 5. Conditio�ofstem- 6. System Pumped By: Neil.Bateson . F5821 Name Vehicle License Number Bateson Enterprises Inc Company i 7. Location whare contents were disposed: pHaulVe Lowell Waste Water Sign Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts City/Town of NORTH ANDOVER MASSACH SIVA System Pumping Record Form 4 JUN - 5 2006 ''GSH TOWN OF NORTH ANGOVER DEP has provided this form for use by local Boards of Health. The S ist be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. System Location: forms the computer, use a only the tab key Address to move your cursor-do not ' use the return City/Towntate Zip Code key. 2. System Owner: Name Address(if different from location) Citylrown State Zip Code Telephone Number R. Pumping Record 1. Date of Pumping oat 2. Quantity Pumped: Ga ns Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee.Filter present? ❑ Yes to If yes, was it cleaned? ElYes El No 5. Condition of System: 6. System Pumped By: Name Vehicle License Number Company 7. Location where contents were disposed: gnature of H er Date hftp://www.mass.gov/dep/water/approvals/t5forms.htm#inspect t5form4.doc•06/03 System Pumping Record•Page 1 of 1 TOWN OF NORTH -AN'IJ.OVER SYSTEM PUMPING RFCOR.D pQ3 /oma r _ z2 � 1 CM OWNER & ADDRESS SYSTEM LOCATI-O'N (example: lef( front of house) U:\,I'C OF PUMPINC: -jo QUANTITY PUMPCDrSC 0,� LLu�� CA:SSPOOL: NO YES SEPTIC' TANK: NO YES VATUKE OF SERVICE: ROUTINE EMERCENCY OII.SrRY:\TI0NS: GOOD CONDITION. FULL TO COYER HEAVY CREASE BAFFLES IN PLACE UCS ROOTS LEACHFlCLD RUNl3AC K.. CXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER Al-1 R (ExPLA.)N) PUM ('CD BY; �, �., �,Y�," : �Z C U .'y] P NTS: � � ���TC-� /7,7 �DLe i UTI-.'-NTS TItaNSFCItRE"D. TO: _„ _ �.,..w`.:..-.a.w•.a<,.,: .,,,.p+,:- '1..,.,,,�.i,.5¢tiaaN:,a+y;:a^t./• _ .._ Y ,..,.i,c..,,.- ; + COMMONWEALTH OF MASSACHUSETTS p' EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS r DEPARTMENT OF ENVIRONMENTAL PROTECTION qq- ♦t V �y TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: (—n Owner's Name Owner's Address: Date of Inspection: L4—��� 4— Name of Inspector:( lease.print) Company Name:, Mailing Address: - , . �e,`('Y ► Ge. Telephone Number: [. 7 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 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: AWA Date: 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 use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) 1JRProperty Address: 6 r s" 0e r Owner: 6 Date of Inspection: -L4— Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: N/5 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: *' ` yx`4 '�• r 8 B. System Conditionally Passes: One or more systefivcomponents as,described in-the"Conditional Pass"section need to be replaced or repaired:The system,upon completion of the repla cement ox rej;ii as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution 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: 2 s , Page 3 of 1 l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:� (� S IA Owner: G 2 Date of Inspection: ��� C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance "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. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner: T Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No C,-*"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 logged 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 1/2 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. 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. -" Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [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.] 'a (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 to 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 within 400 feet of a surface drinking water supply _ — the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone.II of a public water supply well , If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered 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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B }}�� CHECKLIST Property Address: Gcl1 '--7"C� d 54 fy 0 Owner: �C�� Date of Inspection: `-4b—,C)3 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes 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? 4 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 — _ Were all system components,excluding the SAS,located on site? _ _ 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? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Ye3,,,,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)(b)] 5 Page 6 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: S� Owner:�`�CO Date of Inspection: LA Zka—Q FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):q Number of bedrooms(actual): DESIGN flow based on 310 CMA 15.203(for example: 110 gpd x#of bedrooms): Number of current residents: ' Does residence have a garbage grinder(yes or no): 0 Is laundry on a separate sewage system(yes or no):&a[if yes separate inspection required) Laundry system inspected(yes or no):_ Seasonal use:(yes or no): No Water meter readings,if avai ble(last 2 years usage(gpd)): Sump pump(yes or no):_ G Last date of occupancy: v COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): eDd 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: Zi Was system pumped as part of the inspection(yes or no): If yes,volume pumped: p ca gallons--How was quantity pumped determined? Reason for pumping: TYOF 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/Alternative 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):k� 6 Page 7 of 1 l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: (0s 12)1 ' sz:'� � Owner://1 \Q 5C h 2 n Date of Inspection: H—30-43 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: Comments(on condition QQf joints,venting,evidence of leakage,etc.): lG/t/ SEPTIC TANK.-D(locate on site plan) Depth below grade: Material of construction:�crete_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: /U G 5 f Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: --" <r Distance from top of scum to top of outlet tee or baffle:6 N Distance from bottom of scum to bottom of outlet tee or baffle./ Y How were dimensions determined: /J/-/ 5 / T c- Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): S �dc1 h C'a /10 / 2/oma GREASE TRAP:_(locate 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.): 7 Page 8 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: / ~ � e Owner: cr, Date of Inspection: kA— TIGHT or HOLDING TANK: (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:ViS (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: &-)/ 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.): �hU CSU t� CO)4 1/d ✓/ — ��} ?`trY U U t ,4-- PUMP L— PUMP CHAMBERNA(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.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: (n- Owner: [ h A-1+(-) Date of Inspection: u— 2Nn 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: r i ' leaching trenches,number,length: p 4 3 leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): E / eSsf�-Vij., 1-16fnn -z' CESSPOOLS:/ (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY:8 A(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.): 9 Page 10 of 11 F OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM'INFORMATION(continued) Property Address: -A 12�140ffior Owner: 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. Q � I 0 — _ 37 '$- v � 10 i Page l l of l l / F OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 2� 12)r n8n V Owner: -E-0 Date of Inspection: LzS d b SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 411�feet Please indicate(check)all methods used to determine the high ground water elevation: '_ btta'"ined from system design plans on record-if checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked.with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: 6& IjIY6# " 11 FORM U - LOT RELEASE FORM bu&) nom '"`' ��ui6 ' �ec,CL INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT PHONE_ LOCATION: Assessor's Map Number le PARCEL 3 SUBDIVISION CC' tt LOT(S) STREET n a °�- O-t— ST. NUMBER 4- 3 ********** ** ***** *** ***OFFtC1AL USE ONLY************ ►* * **** ***,� RE MEND ..ATION$ OFWN AGENTS: C NSERVATION ADMINIST OR DATE APPROVED ,i DATE REJECTED COMMENTS ef TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SE TIC INSPECTOR-HEALTH DATE APPROVED Q DATE-REJECTED COMMENTS l r - Zq 0 c PUBLIC WORKS-SEWER/WATER CONNECTIONS NS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 jm Town of North Andover O¢S�IID�b-s'I Office of the Health Department Community Development and Services Division 27 Charles Street 9 gDR�TtD North Andover,Massachusetts 01845 Sandra Starr Telephone(978)68&9540 Health Director Fax(978)688-9542 April 16,2003 Russell and Karis Moschetto 63 Bradford Street North Andover,MA 01845 Re: Application for an addition to an existing home at 63 Bradford.Street Dear Mr. and Mrs.Russell: Your application for an addition at 63 Bradford Street has been reviewed by the Health Department and denied for the following reasons: 1. ✓ Missing information 2. ✓ Passing Title 5 inspection of septic system may be required 3. ✓ Location of structure not acceptable To address the problem(s): If#1 is checked, please supply the bolded items: a. Floor plan of the existing dwelling(all floors)and a floor plan depicting the proposed addition. All rooms must be accurately named; b. Certified plot plan showing house,septic system and proposed project in scale,including any associate grading. If#2 is checked.- a. hecked:a. Have the septic system inspected by a certified Title 5 inspector to determine the size of the system and whether it is operating properly: OR b. Tie-in to municipal sewer. If#3 is checked: a. The proposed the project must meet all current Title 5 setbacks. Please feel free to call the Health Office at 978-688-9540 with any questions you may have. Sincer y, 1 , rian J.LaGrasse,Health Inspector Cc: Building Department File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 5,V oq X 1 cw� �� h� �d � aJO c d � f G -------------- V \o hb � G y L C ro,,-Od (,u oi b R � � 1 �Q `AG AH AJ A B C - D E -- p G .. ;-.H.-,., ..:.J K L M N P Q R' S T U V W X Y Z AA B AC AD AE AF _ 24% ` - - - - - - DWG 1 ISS 3 4 s 5 6 6 _ 7 7 _ i 6 B 6 9 V �'. \. 1 10 10 : i I rei 1 i oY 'y� 12 C 12 13 13 � 14 14 1 15 a 16 D D. 16 Q - 17 17 y y8 1s ` 19 20 E E .20 \ _ Q. 21 22 22 3 23 I 5-61 . \ _ 2 24 F'' F 24 !� \. 25 Cd I \ 26 26 (0✓'E ` 27 27 26 G PAO G 28 29 29 30 30 ✓ 31 `31 32 R H 32 33 _. 33 r �334 34 _ ^•~ 35 Oghmi� a TF i 35 -INCOR?ORATED ? - n o W A B C D E F G H_ J K L M N P Q R S T U V W X Y Z AA AB AC AD AE AF AG AH AJ " _ _. ' . 9 _ _ .. _. - REDUCE I.ENGTB(TO 17. -.- ,a ra 6 8 O INCHES--. h- a : I S -IOD L v E. LANNING FINAL L Town of 6 m ncfover C%No. o _ . ,,Yrp : ` r A'Ek MA�T, � � er, Mass.,U ViV E 2. 1 AC Y2 C ME IC q0R ?p\� SS BOARD OF HEALTH I it PERMI LD ra"A rI THIS CERTIFIES THAT � � lI � g �� ��:�� � BUILDING INSPECTOR fi 'l has permission to ere ........ .... .. .. . ildin s on ... ..... .... ... ...... ... Rough ,�-- ��jj � Chimney to be occupied as. MCP a.... ... ��.....��ir..f�r�eov&................. Fi al ,+ provided that the person accepting this permit shall in every respect conform to the terms of the application on file in ��� '' �'�`� Id w s PLUMBING INSPECTOR this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Rou � '7-, Buildings in the Town of North Andover. PERMIT FOR FRAMUBUILDING Final VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES l ONTY19E:L/a FEE PAID' UlELECTRI LI o� Rough a � �NLESS�, CONS UCT ST R S Service y_._.._ Final FDA FE-E.__ 100, 00 .. ..... WE RAJ` E i." `'` /Oy/, O0 .� BUILDING INSPECTO GAS INSPECTOR Occupancy Permit Required to Occupy BuildinPERMaff" ON ON though gREGULATFD BY PARA. 1142-& B.C. Final Display in a Conspicuous Place on the Pre s,A L PAID FIRE DEPT. Do Not Remove Burner G1'i� Y-1, No Lathingto Be Done Until Inspected and Approved b �` rz1 . Al P PP y Smoke Det. Building Inspector ector i G 3 r 60 CC1;� <`1 0 aL I . e T" ti `9 a� RQi3P�T P. 4� l,+IJRRiS rn , N 0. 2215`3 tc' o THIS PLAN IS 4TE14DE0 FOR ZONING YdE HERESY CERTIFY THAT `"lE HAVIE EXAMINED PURPOSES ONLY, IT WAS Co MPiLED I THE PREMISES AND THAT ALL EASEMENTS, FPGf" EYISTING PLANS AND RECORDS ENCROACHAEN TS AND U'UILDiNGS ARE L OCATED 'er'I T H BUILDING LOCATIONS CONF'IR'IED AS SHOWN, ALL BUILDINGS SHOWN CONFOR? j IN THE FIELD, IT SHOULO NOT ✓3E TO THE ZONING LAWNS OF THE k,AUNICIPAi.ITY USED FOR PROPERTY LINE nETE01 jlI — V11.EN CONSTRUCTED. ATION, THE B'JILDIN 15 NOT LOCATED IN AN ESTABLISHED FLOOD HAZARD AREA. ZONING: 7-1- REQUIRED SETBACKS: FRONT: ' SIDE: f REAR: a` CERTIFIED PLOT PLAN MARCHIOHDA ASSOC., INC, N EWG!NEERING AND PLANNINGi CONSULTANTS Lk'�t>CN6 ) t'41 SZ MCNTVA''.E AVE., SUITE 1 AS PREPARED FOR STGNEF�A'M, MA, 021St; (617) 41"18--51: 1 Cr t r,A'r�• c9� Hca Its 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***************** APPLICANT: ����1� Oroj J aid Phone LOCATION: Assessor's Map Number Parcel Subdivision Lots) Street 6 f��r�rJ S-f St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments i Date Approved Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected 1 A Date Approved Septic Inspector-Health Date Rejected Comments ✓.%��„. . �� �i Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date Town of North Andover, Massachusetts Form No.3 • tORT#1 BOARD OF HEALTH . Of t �ao .e,tiO 19 140 v2 DISPOSAL WORKS CONSTRUCTION PERMIT ,SgACHUSE� Applicant i NAMEADDRESS TELEPHONE Site Location t/,9/ ` J4 AD� 7�� � 4 - Permission is hereby granted to Construct ( ) or Repair (4-Jn Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. CHAIRMAN, BOARD OF HEALTH Fee Y �. D.W.C. No. S� Ile DATE Sheet of BOARD OF HEALTH TOWN OF NORTH ANDOVER (,•�_ J� SUBSURFACE DISPOSAL DESIGN REVIEW f F � // EE l/0 PERMIT # DATE RECEIVED APPLICANT ASSESSOR'S MAP ADDRESS PARCEL # LOT # ENGINEERSTREET ADDRESS PLAN DATE _ �A2A141, REVISION DATE CONDITIONS OF APPROVAL: T r , APPROVED DISAPPROVED — i PLAN REVIEW CHECKLIST ADDRESS �cJ Cl 7`p ENGINEER GENERAL 3 COPIES STAMP L�-' LOCUS SCALE CONTOURS PROFILE ��''� SECTION BENCHMARK `� ELEVATIONS L---'- SOIL & PERC INFO WETS. DISCLAIMER WELLS & WETLANDS WATERSHED DISTRICT DRIVEWAY WATER LINE DRAINS RESERVE AREA SCH40 SLOPE SEPTIC TANK p//) MIN 1500G. . 17 INVERT DROP GARB. GRINDER/v U (+200% EDF) 25' TO CELLAR MANHOLE TO GRADE �� ELEV U� GW 014� D40X # OUTLETS FIRST 2' LEVEL STATEMENT INLET ?K,47 - OUTLET 7" = , 17 (2" OR . 17 FT) LEACHING G1�gt� �`� �e� �5 100' TO WETLANDS &'6 100' TO WELLS 325' TO SURFACE H2O SUPP L-- 35' TO FND & INTRCPTR DRAINS / 4' TO S.H.GW 2% SLOPE 4' PERM. SOIL BELOW FACILITY ✓ MIN 12" COVER ✓ FILL? (25' if above natural elevation; 101if below) Al TRENCHES � I MIN 660f$,2 SLOPE (min . 005 or 611/100' ) L,'" >3' COVER? - VENT SIDEWALL DIST. 2X EFF. W OR D (MIN 61 ) L.IZ IS RESERVE BETWEEN TRENCHES? IN FILL? L,'� MUST BE 10' MIN. qj- BOT v!" U X LDNG a + SIDE U X LDNG = TOT low 7f-(�l0 (L x W x #) (G/ft2) (DxLx2x#) BUTTERWORTH & 01TOOLE, INC. P.O.BOX 8294 SALEM,MA 01971-8294 ADJUSTERS/APPRAISERS FOR INSURANCE COMPANIES ONLY TELEPHONE(978)741-5731 FAX 978 740-9109 February 16, 2007 FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B TO: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectmen City/Town Hall City/Town Hall ADDRESSES North Andover, MA 01845 North Andover, MA 01845 RE: Insured: Russell Moschetto Address : 63 Bradford Street RECEIVED North Andover, MA 01845 FEB 2 2 2007 Policy No. : F0108615 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Loss of : 02/14/07 File or. Claim No. : 073-0159 Claim has been made involving loss, damage or destruction of the above Captioned property. whi--h may -either excecd $1, 000 . 00 or cause Ziass. Geri. Lads, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. If no reply is received from your office within ten days, we will assume you have no liens of any type against this property and we will recommend to the insuring company that this claim is paid. Paul Trainor Adjuster v w'za> �'> Member of National Association of Independent Insurance Adjusters BUTTERWORTH & O'TOOLE, INC. P.O.BOX 8294 SALEM,MA 01971-8294 ADJUSTER SIA PPRA I SER S FOR INSURANCE COMPANIES ONLY TELEPHONE(978)741-5731 FAX(978)740-9109 February 16, 2007 FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B TO: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectmen City/Town, Hall City/Town-Hall ADDRESSES North Andover, MA 01845 North Andover, MA 01845 RE: Insured: Russell MoschettoCEIVED Address : 63 Bradford Street FEB 2 2 2007 TOWN OF NORTH ANDOVER_9 r.-TY IC'- North Andover, MA 01845 HEALTH DEPARTMENT Policy '-No. F0108615 Loss of : 02/14/07 File or Claim No. : 073-0159 Claim has been made involving loss, damage or destruction of the above Banti nno 7 pt'r-ept'e-�t'Y,r .L -ch mayz eJ theme , 001v . 00 or cause /nSS. nen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 3B is appropriate, please direct it to the attention of the writer and includea reference to the captioned insured, location, policy number, date of loss and claim.or file number. If no reply is received from your office within ten days, we will assume you have no liens of any type against this property and we will recommend to the insuring company that this claim is paid. Paul Trainor Adjuster y�r.2 Member of National Association of Independent Insurance Adjusters i 1 a 141•,. t,t ,,•. •;:;;. �t•{w, �t r7S7sL,�1;1,�I�7.V�V'��I.y,•„I;r�' �>� '• .�,.,. ORT A1D4VER MASSACHUS r r� p1n. record, •�.J:y.�•.•,, ' ,s. ��co,!<'!�:1:� 'Ja,h; ��,, ,�A'.��yy�,r�c',ki:1.1r.:::. .. j,i•'.M5' ,itV! 1: I ��>1a1r+1%r�gw4';,,i),r� n.li,r,�•�'r 4y�,: �' DEP,,has provided�4 form for use by local Boa ...:be :ubmi�ted to the.local'Board of Health or othe 8 em Pumping Record m,; A FaclIIty.]nforri �tlon DEC 0 7 2007 i'Ttm�ortanL � �,, ,` •, ;j; , `r+,�+wh4r1(uWl�QUSystem TOWN OF NORTH ANDOVER HE LDEPA TM T. only the tab key Address (� , to move your do pot . � - us+thr rotum %.' :,;: ;Clty/Town Stat key FP 0 `::System Ow 4I I, cod • `.�;. � i' !a;.,'T. r'• i ��:t,r a II:L• � �!�':`;'.''♦Name ''d:'b'�: i"'.,•'i.,,,jS;�,(rr:..;.,�.r.ti,.. ;i .j•,i..r , '„"� :,.„.r' ,.; �'• ,, •:.:'..,' c��91�� Addre€a(If different from locatlon) Clty/Toum:. State' �+ Coda ;.,1,•i' Telephone Number 696I'CI, �'t'rt�,1, • Date'of PUmpin9 ;. 5c0 2r QUantJty _ ; Dale Pumped: /�:�. ..3. .. :'•.-.',,''; :,.:' : ... 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Date htipJ/41Massrgov/dap%wafer/approvajs/t5 forms,htm#Ins t5forrM.doal0"3 System Ptlrnpinp Record Pa I Address (- � A f) A:zo n Title of File Page of Date File Open: Date fl e closed: Doc Document/Action Title Date.of Refer to other Purpose of Documernt/Action and notes action Document/ document/ Num. Action De artment Board of Appeals — Board of Health — Planning Board — Conservation Commission — Building Department D 15 - I 1 I 1 r �i li i �- 1_'1 SYSTEM L Cl 1' { +l�Lff.17: 1�. a 7ti�. JCC' �'�r c A;�.�:.1'E C J ri ` u. ...74�y8x �7) p�.�t�tiJ 'a .. .J,r `...K rF.�� ~ ✓i^•r .^.fir •.� 1s { —L;7 vX Cu is :7 c�" y~_ ; ti AS-BUILT SEWAGE DISPOSAL MARCHIONDA & ASSOC, , INC. SYS'F EM PLAN E;rC 'IEP,'' C A"�D PLANNING Colvsi�L7ati I'S 1 TVA; E AVE., 5`JITE I (617) 436--6121 AS PRLr'ARED FOR SCALE: 111= *0' GATE ' ,: � 1 •..i � 7 Y A FILE ^yo.: ��; - ��S.ti js.+` ;.-..^.s''ers-.. ,tiJ..r.:•,.-1-" •..`..,ea+.•.CTs+c.r._3-,..'u,.., tir`.. i �{J//Jr / •s.,. :. _. Date. ✓ 709 - HORTIy 9 ;hVN,fOF NORTH ANDOVER t-- O20tt•�eo f .. .. F p PERMIT FOR=GAS-:INSTALLATION teo lo m �q�1EO^PP y'(h (VVIIO�Ap �9SSACH ppUSEt C`/! / - - Q'teCE f This certifies that . !` . . �` -�. . . . . ... has permission for gas installation . -Mw. . . . . . in the buildings of . . _ 4 4. at .f '�?� / �' . : . , North Andover, Mass. r Fee.2,5 � Lic. No..�1,L . . GASINSPECTOR e WHITE:Applicant CANARY: Building Dept.- G PINK:Treasurer GOLD: File. BUILDING PERMIT NORTH TOWN OF NORTH ANDOVER Q O�1 1L7. 0 hb� O m APPLICATION FOR PLAN EXAMINATION Permit NO: �o Date Received _c -•-•-� pq `�. Date Issued: ACH615 I1VIPORTANT Applicant must complete all items on this page -,"' 'i is .+� e t �3. r� �e � �t 'a, f i z � �.r •a � -, � � it 5 `T f 3 ��p, �-� 4�� etc � t•' �F-.;, t° 011- E � � rz� -' , a,.. '�`„s•°—3r �"-" - `�- - E p. z=G a- -r�.z -'ar ate- ��s-�'"�a -: k•: s ..�.�^ ,� 4. '�k . fG R �{1R"t- P1� P EL � Q't�l �STtfIC7sot t ag ts.;3�,W- r `-, -., TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition _ Other f� {t7� t �r'Y��II-��� �r� i{c`'�r,i a� �F�L��p'.h���'E�•�"�r``i!Y�i��+�J��� �`�" -� x � �� L .. - r, ,sri sM.: tea ��`"� � .��� � ^ate s v-• --,�� ,�� �i„1�.# �"?: �` �,. �'�.,v� � w .�l��t>, „��. ... �.,..�,Y:i/�`ael�v7�we3",�'t ��C.._� 3 a �•'� �..Y�.^r�-��� �u�.,��!�, �' �` � � .��^' °� `�� r � y, � --�a'�'�-; �� ��+r,��.�- b�• DESCRIPTION OF WORK TO BE PREFORMED: Identification Please , ype Frim Cleanly) OWNER: Names S 3--0 Phone: G <<�' J Address: gg.... '�-qy f{ w,x:. t. �, - 'y,�-..�, rc d'r=^>,ne-s"••c?�, ',tat:&> '" .sem✓; "'�''` i '' a ,. WIN '' z z ,• r .w g„5 ' '�.,t"'>3- .-� p, v n-fr'• c r... �. 4, '' '•Y -- - ;ty P " Lr A ,01 6 ` mb 'x�" t w' -�r-"`�4 F�° ,.. -' �rx 3 f .r.'�']�{� ,: .'�` „t�.4 7t _- >J-` +NS' 1�1't1F11'�ir 43,E 'jai r ' 'h- M �:. �'�'' M ,�. .: i -sauc, a'3`• nix-. e,+-..ee "3"�s "r t ..-,��, t ri"mss, .- > t td`�A". • '... -„T-2..- °.� •r"{,✓.,�*"S, "''^-rc- - 'RAN, �'� S"d° -" 'c - - -^u, � -t, c:,, "` i ','-3 l.fpl '9w'r P .r:?-fi�t's +. .•"„_ -sy- .. c -,�art...a F a-i�y,• -_.utxP-_a "T�t�,�, t ,<.?,'�z�xr.- ..'R„ -�y.r_r•t„*,'•,rF -" M kc+,.:r^a'it�.'��.F” ::�,-+ "�,•'a- �'Z4. .: "�' z -�'� `�"� '� 'z��r *r� ��� �:-. ts,''cz.'^ �a ",�'Y �::, x ff � .,'_,.nom �,n`r ,a,�; S+r`3• -.,u,,.&` :-'"u7r'y, �� .-, -- '�z`"-"psi�" a �m+ ,� eiAvr�a�•��G �t� �r���L��e`r�sT��� s �F � �� :� � �_� wv�,. F^ p f.+•.cn �`R -d.0�, ! �` NO.k2"®•at' 4, t ti.�.,.,y-Yt..y: -s^ -+ �. � "���Y --:'�� '*t� � -4 �• � � .r,"R,C �`s � r „� - ..��,� a m�*�.f �* n - '. r� - ,�. a, 4 ..,r' ,k'r 4 t r.�..•S" ..-'+.. z*,^-c "4r ri' ail # -"-t',.., r".s y z'•°s�,„ 'pr's r `a a*,x..,f �:y. -�h ''� � t k4 ,cls x� �. +a_ � �� � x "�. * a t x f krfr � r '•r-. .�r�r.�,h..+�•.r =_:,,w�.� ,. ..,,. ,_a, } -� �f�,.,� ?aa....._-r�....v+::. ._+t.ta?a?...a;.�-"za?}.:€�:= < �".d ,,�.• 1�i - v.�..� �� N � ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $_ ' FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered con .actors ado not have access to the guaranty fund "Ignure ofAe 't/Oa�ur . - _. _.� ar ' ' ig ature of k H raetor Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic to c. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF e U FORA DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS a CONSERVATION Reviewed on / Signature I /x!\11 RA Rrrf Tn I :1 I � � I�VIVIIVICI�I IJ `JU �,� I �,�`f� `�� L4 k HEALTH Reviewed on .._._....Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW'Town Engineer: Signature: Located 384 Osgood Street FIF 'E ��#Ter�ateri � 1y��=r � , 'ea% LOGa 'C� a � 3nu� ree �2` "M'M'M zn x gra r, r err s "s *7 �,,.. sS°+', A�u�.,;f*�,r.r k��a�����•r'-� z.� a � -. �r���i 3 tirY s»a-.r f^•"q,..ra.'� l� z 1 �'y� t: �c- il.it w Dimension I Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Deter location, creast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use I ® Notified for pickup - Date Doc.Building Permit Revised 2008 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract ❑ Mass check Energy Compliance Report o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application i Doc:INSPECTIONAL SERVICES DEPARTMENTWITORM07 Revised 2.2008 r� • � ,�.f. 1f+ �pt t � t Z NE�'E3Y CECT/FY TO TyE T/TGE TD Tf/E B 4 N.t- 7,4 QT /S GOCATEO ON Tf/E 7-,4S T/d4TT4/E / OFvo q�oo��e ZpN/�vG PEG�LATfOvS /� r FU,C7HE,P cE.PT/Fs� THAT TH/S OsrELL/H6 /S�/OT �/ �/ !/ � LOG4TE0 //,/ TiYE FEOE.PAG �OOp yAZA.Pp A.PE.4, O�iq/r�y �Q� iSHGwn! O,(/ F�iao1:.CQa 1�ivNiTy P�CN�L '°r - ^ ':'c"'�l�.,e;'_ :• -;�,��+`:•.''- SO OGT/9iz T ,r •a i Bovvo,Py� o�-�.�e�;�r�v,v,���aso�,vo.v,es%iu,�o.QiN- �E.P.�/isl.9C.Y �.vGidEE,P�.(/G ,SE.PI�/lES Ario-(/ T,4.rE.c/�,�.�yyr•-�"�?��ic/G�ECoeoS. 6( f� .P