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Miscellaneous - 69 SALEM STREET 4/30/2018
69 SALEM STREET 210/096.0-0059-0000.0 V 0 \ r� Date . TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . �r �/�.r.T.�y wiring in the building of . . . . .-�!� !yL . . . . . . . . . . . . . . . . . . . . . dat . . Z. . ` . . . .tea-..-.. . . . . . . . . . .No h Andover, Mass. Pee . �---'- Lic. No. '.�. 7Z. . . . . . . . . . . ELE TRICAL INSPECTOR! Check 11314 ;U 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with theprovislons of M.G.L.c.143,§.3L,the p permit application form to provide notice of installation of wiring shall be.uniforin throughout the Commonwealth,and applications shall be filed bn the prescribed form.After a pen-nit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an electrical permit shall be issued to the person,firm or corporation stated on the permit application.Such entity shall be responsible for the notification of completion of the work as required in M.G.L.a 143,§3L. Permits shalLbe limited as to the time of ongoing construction activity,and may'be.deemed by-the.Jnspector-of_Wires abandoned-and-invalid ifbe--. or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Secdons.74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job;growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain-permits-and licenses concerning the.use or development of real property.With limited exceptions,the Act automatically dxtends,for four years beyond its otherwis a applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008.and extendingthrough August 15,2012. A,16ie 8—Permit/Date Closed: % **Note:Reapply for new permi ❑Permit Extension Act—Per t/Date Closed: i Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. I BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked {Please add zip codes & electrician's cell#• [Rev. 1/07] (leave blank) a contract��bid permit#if applicable) APPLICAV®N FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: IA--/L-/'x City or Town of: /U To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) f Owner or Tenant Tele pho i No.GPF'3 J Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters 'i - Number of Feeders and Am acts t Location and Nature of Proposed Electrical Work: �� `\, �t � art�u S q s—le n0 Coin lesion of the followin table niay be waived by the Inspector of Wires. ! No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No. of Total Transformers KVA No. of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o inergency ig 1 ng rnd. rnd. Batter Units No. of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No. of Switches No.of Gas Burners No.of Detection and Initiatin Devices - No.of Ranges No.of Air Cond. Total No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained 1 Totals: "'"""".... �Lo tection/Alertin Devices No.of Dishwashers Space/Area Heating KW cal Municipal ❑ Connection El Other No. of Dryers Heating AppliancesTCW Security Systems:* No.of Devices or Equivalent No. of Water KW No.of No. of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Fal ival OTHER: ent C r Attach additional detail if desired., or as required by the Inspector of ldires. Estimated Value of Electrical Work: 379- (When required by municipal policy.) Work to Start: ��a-10 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The force,and has exhibited proof of same to the permit issuing office. undersigned certifies that such coverage is in CHECK ONE: INSURANCE ❑ BOND ❑ OTHER X (Specify:) Self Insured I certify,under the pains and penalties ofperjury,that the inforariratioZ oaa this application is true and complete. FIRM NAME: ADT LLC DBA ADT Security 42 LIC.NO.: C-172 Licensee: Thomas J.Lee ignature ,,! LIC.NO.: C-172 (If applicably.enter "exempt"in the l' ease number lin.e.) Bus.Tel.No.-� Address: < s (V Lin 1 em 'f��r �� \Vs, t�\F 0,SS04� Alt.Tel.No.:*Security System Contractor License required for this work;if applicable enter the license number here: 001779 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage norinally required bylaw. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. 'ERIMIT P'E'E'. $ � COE�IIP'�`It'�I'�°�lU'F�f-'t.l.."u H OF()BAS s% i��$4��E 1'i ELECTRICIANS ,�Al REGISTERED SYSTEM CONTRACTO .'IJSUEJ THE ABOVE LICENSE tO: ' j L)L.C. DBA ADT SECURITY: \ W; THOMAS 'J LEE. (j�K 41D` UNIVERSITY -AVE WESTWODD MA 02090—*2311 172 :C 07/31/13 201934,1 Fold Th n Detach H eng All Fe of tions - i 1. 1 t 7 Y s Iii Date.../,......r�................ koRT" °_ ``°-j°�"°o TOWN OF NORTH ANDOVER , F m « PERMIT FOR WIRING fi SACHUS This certifies that has permission to perform ........................................................ '��=' wiring in the-building of. �^z .....................:............................... at.. .. ..:.....::. ........... `j:.:. .............. , rth Andover,Mass. d Fee.R`� ........... Lic.No.hV.2,14..................... . ELE ICA SPECTOR +� Check # 1� 8400 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked 2-5-o% BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT INK OR TYPE ALL INFORMATION) Date: %f 9- Qe City or Tolwn of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) f s)p�ay Sf Owner or Tenant 1?1111C`j e e L _P,q Telephone No.g7?6 k?,044tr Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building AAfje 7 A&W A ,f , Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity .x Location and Nature of Proposed Electrical Work: Completion of thefollowing table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o Emergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil BurnersFIRE ALARMS No.of Zones No.of Switches S No.of Gas Burners No.of Detection and Initiating Dievices No.of Ranges No.of Air Cond. TonTots No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW........ No.of Self-Contained Totals: . Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW SecN of Devices or E uivalent No.of Water KW No.of No.of Data Wirin Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent `OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: /��, (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [PBOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee:�at%t L/ E. �5 SignatWC LIC.NO.: f037 1�1rC (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:d,43 fr�sf 1.16 8 Address: —g-71-11 2W. A;U:rh u!9 Ag l.{ + Alt.Tel.No.: *Per M.G.L c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) ❑owner ❑owner's agent. Owner/Agento� Signature Telephone No. PERMIT FEE: $ ��— � I r f' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 UV www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: S;:� //l City/State/Zip: /2Az-C ;o , A2 Al Phone #:—z4; Are you an employer?Check the appropriate b(ox: Type of project(required): 1.❑ I am a employer with 4. ElI am a general contractor and I 6. F-1 New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. t 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ DemoIition working for me in any capacity. workers' comp. insurance. 9, ❑ Building addition [No workers' comp. insurance 5• ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per'MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12,❑ Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required quirel unler Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that.a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do her under the pains and penalties of perjur,that the information provided above is true and correct Si ature: Date- O� Phone#: Official use only. Do not write in this area,to.be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: /1 Date.................................. &ORTH ice" f TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING CHUS tt Thiscertifies ..................................................................... has permission to perform-rr7... ................................................. wiringin the building of.......... ...................................................................... ....... . ....................... ....... North Andover,Mass. Fee.................... Lic.No;'%�J-Y-I..)lf ........... ............... . ......... (ELECrRICAL INS . Check # 8242 Commonwealth of Massachusetts Official Use Only _ Department of Permit No. 02 p Fire Services Occupancy and Fee Checked o a `4, BOARD OF FIRE PREVENTION REGULATIONS ✓ [Rev. 1/07] Qeave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 rY (PLEASE PRINT IN INK OR TYPE ALL E&ORM4TION) Dater(, City or Town of. NORTH ANDOVER To the Inspector of Wires:, By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) Owner or Tenant /yf . � /7Auy� Telephone No. Owner's Address ,�,� Is this permit in conjunction with a building permit? Yes �y L1 No ❑ (Check Appropriate Bog) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead❑ Und d �' ❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Com letion of thefollowing table may be waived by the Insector o Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- o.o mergency ig nd. d. Batte Units No.of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No.of Switches No. of Gas Burners No,of Detection and Initis • Devices i No.of Ranges No. of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers eat �P Number Tons KW No,of S -Contained Totals: `� _` -`— _..--. e f Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Local❑ umcipal Connection 0 Other Its No.of Dryers Heating Appliances KW Security Systems:* No.of Water o.of No.of Devices or Equivalent KW No.of .Data Wiring: # Heaters SiEms Ballasts. No.of Devices or Equivalent No.Hydromassage Bathtubs No.of MotorsTotal gp Telecommunications firing: ' OTHER: No.of Devices or E uivalent Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: �Qa; (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cove a is in force,and has exhibited proof of same to the permit issuing office.. CHECK ONE: INSURANCE OND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury,that the information on this application is true and complete- IBM NAME: LIC.NO.: Licensee: _D At,�� t *j i Z� Signature 9 (If applicable, enter"exempt"in the license number line.) LIC.NO.: Address: Q J;1/ .ptQ X)n c{,_ �► r t^.��i�2?� Bus.Tel.No.:j:�ja j?jV *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt L cl.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage required �' era a no q by law. By my signature below,I hereby waive this reu' g anally q irement I am the(check one)ne owner Owner/Agent ) ❑ F-1 owner's agent.- Signature Telephone No. f PA 4 ti cc The Common wealth of Massachuseft k; ! Department of Industrial Accidents '1 t Knh!d Office of Investigations iiia} 600 Washington Street ` Boston, MA 02111 www nwss gov/dia Workers' Compensation Iaseu-ance Affidavit: Builders/Contractors/Eiectricians/Plumbers Applicant Information Please Print Legibiv Name(Business/Organization/Individual); Address: City/State/Zip: Phone#: . Are you an employer?Check the appropriate box: 1.0 i an a em to er with 4, Type of project'(required): P Y ❑ I am a general contractor and I ployees.(full and/or part-time).*. have hired the sub-contractors 6 []Now consbvction 2.! I am.8soie proprietor or partner_ Iisted on the attached sheet S 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition` working forme in any capacity, workers' comp.insurance.. [No workers comp.insurance 5. 9• ❑Building addition P ❑ We are a corporation and its required-] officers have exercised their 10•7 Electrical repairs or additions 3.[] I sin a homeowner doing all work right of exemption per MGL 1 I-[I Plumbing repairs or additions myself.[No•workers'comp. c..IS2, §I(4),'and we have no insurance required:]t + 12.❑Roof repairs -employees, [No workers I3:[] comp. insurance required.] Other *Any applicantthat checks ba#1 must also fill out the section below showing their workers'compensation policy infonnaiion r Homeowners who submit this affidavitindicating they are doing all work and then hire outside conuaeton:must submit a new affidavit indicating such. ;Contractors that check this box must attached an additional sheer showing the name of the sub-contmetors and their worker'imp.policy information. I am an employer that.is providing workerscompensation insurance for my.employees: Below is.the policy and job site information. Insurance Company Name: Policy#or Self--ins.Lic.#: Expiration Date: Job Site Address: City/swz2ip: Attach a copy of the.workers'compensation policy declaration page(showing the policy number and expiration date Failure to secure Coveraa as C required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500,00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido here cerci der the pains and pea •es of perjury that the information provided above is trse and correct Si a Date. �lr� Q� A Phone#: Of,j`rcra!use onl . Do ' not w y rite to this are to b a, a completed by city or town officraL City or Town• Permit/Lieease# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Othe'r Contact Person• Phone#: I Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. r� Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any,two or more ofthe'foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee-of an individual,partnership,association or other legal entity,employing employees. 'However the owner.of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,conshvction or repair work on such dwelling house or on the grounds or building appurtenant thereto shaU not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every,state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence.of compliance with the insurance coverage required." Additionally, MOL chapter 152,§25C(7)states"Neither the commonwealthnor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation.affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractors)name(s),address(es)and phone number(s)along with their certificates)of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. if an LLC.or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.. Also'be sure to sign.and date the affidavit. The affidavit should, be returned to the cityor town that the application for the permit or license is being requested,notthe Department of Industrial Accidents. Should you have any.questions regarding the law or if you are required to obtain a workers'. compensation policy,please call the Department at the numberlisted below. Self.-insured companies should enter their self insurance"license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permittlicense number which will be used as a reference number. in addition,an applicant that must submit multiple permitAicense applications in any given year,need only submit one affidavit indicating•current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of'the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.When a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call.. The Department's address,telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investiations 600 Washington Street Boston, MA 02111 Tel.# 617-7274900 ext 406 or 1-8.77-MA.SSAFE Revised 5-26-05 Fax#617-727-7744 www.mass.gov/dia Date...... ......C'2-3.....0.6 koRTH 0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING US 2. This certifies that ............il... .... ............. ....... ................... has permission to perform .........0.2 ... .4........................... wiring in the building of.................f�.yAl FF.............................................. 17 at...........69.....5� 01K-4711-1.......�57................... orth Andover,Mass. - Fee. ........... —111c.No.�4 ................ ELE ICAL INSPECTOR Check # 7974 Commonwealth of Massachusetts Official Use Only 41, Department of Fire Services Permit No. 7 MY Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/051 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC,527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:_1 a3 Ug City or Town of: �� �. C��YQ,l2 To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) LQ S a Owner or Tenant h-k(L Cu 9—m mu Telephone No. Owner's Address SCt - Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. yjq 1 q() 45 Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service bU Amps )ZO Volts Overhead❑ UndgrdEl No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: f- Q t�p, a UQ0.�Iu tLtr_V 1 C,1_ Completion of the followingtable may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- El o.o Emergency Lighting rad. rad. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: `� __ _ �� Detection/Alertine Devices r No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent J No.of Ater KW No.of No.of Data Wiring. Heaters Si ns Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under th"ains and penalties of perjury,that the information on this application is true and complete FIRM NAME: Cc-(a t Ob Cf2 (C. LIC.NO.: A,2LY-.moo Licensee: 1 Cip— R LCL+(Cl-� Signature LIC.NO.: C 99 Da (If applicable a ter "exempt"in he licens numA ber ne.) Bus.Tel.No.• aE 1 77 Address: L� C3 P,LL, YLJ_ GL ))Cw 4 LA_)J Alt.Tel.No.: SLI L *Security System Contractor License required for this work;if applicable,enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's a ent. Owner/Agent PERMIT FEE:$ Signature Telephone No. I I t i S�2U o a 13--0 ft � aw 1 r (PHONE CALL� FDR-S�S DATE TIME OC" P.M. O F Q / � HOHONED PNE "" �1 `/ 67 bl1R.CAL�L AREA GOO_ _ E NUMBER XT NSION t�T .r3E,t,A.tt.. MESSAGE �-��1 1!U#tl.GAtt '; AGAIN .AME TD 5E1+YGIU WANTS TfJ`; SEE YDt}. SIGNED TOPS I FORM 4003 NOTES au�i�i'� ���eAfL t��4w.. �w. ,I�Q�k►t �,:, FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from Boara� and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT_ iii U..� �.v��.rw PHONE �, 19 —1 3 5' ASSESSORS MAP NUMBER (�`i_ LOTNUMBER5 SUBDIVISION '3 �' LOT NUMBER ? STREET STREET NUMBER ................................................................... mama... OFFICIAL USE ONLY ............................................................................ RECONWENDATIONS OF TOWN AGENTS ..........fl...,,...........................................................mass 6 DATE APPROVED =� CONSERVATION ADMINISTRATOR DATE REJECTED .�Y Ai COMMENT'S DATE APPROVED TOWN PLANNER DATE REJECTED CG'v'Rv ENTS , DATE APPROVED FOOD INS_P�CTO HEALTH DATE REJECTED DATE APPROVED L)U fIC. PECTOR—HEALTH DATE REJECTED COMMENTS C'.:%y=•'� / �1'•'��dTw , .sem �//A l/ t 4� ��F ..J ' 1001, PUBLIC WORKS—SEWER 1 WATER CONNECTIONS DRIVEWAY PERMIT s i DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE I 27 I LOT 7 39, 310 ; IT . L•, �Ii I N �> f wF } .. I i `*1 f i • SBL�/`'I ST/2EET t S .NEREBY CE.cT//-y TO Tye 7?J Ts/E B.4AW TNigT T,VE O�rEGG/.cit/S LOCATED O.V TiyEGo7"AS.Sist9i►'NANO Tf/AT/TOG�ES GO,c/FGtP� /N JY/T// TINE 1owN OF NO. A/YA5ZVa 20N/�vG e�E6aLAT.G.vS .e�s�+.e0i i� sETe..c rs F.CO,,1 sreEErs!Lor G/.vEs /A/OR TH /9/\/Oo M/9 S-9, a s F/icr.Y� cE,rri.�sr �.s%pf T' or-EG�ivs /s,vor �Syaw,v oiV�f ,a.i /�'Y .ttrGG 'aZSap98 , �6 C /"/ s -;`�3 /'/Au2E'CN /VIeCfJFF2CY rr / =60 �iuLY� 1 Q9S a 7?//S PLAN Fo,P �fo.PT�4GE Pa,C�SES-�✓OT FO.P BOU.vO.PY L1�'•TE.Piff/N�4T/off! Boeu�o.oes�iu.�o.P�•s- �E.P.P/�s1.4Gf�E.vGit�EE.Pili6 SE.Pv/lES � AT/O.</ TAKES/ F,�o.YJ EX/STjNC .CE'Go,PpS• to la �q.P,� ST,r�cET r1_y 6 S(� A.t/ODYE.C, tiJ.4SSAG',fwSETTS O/8/O � II CP-HDNE CALL FOR 'SJ DATE l� TIME P.M. M PNnNED OF / RETURNED PHONE l2 YOUR CALL: AREA CODE NUMBER EX ENSION OF LEASE CALL MESSAGE WILL CALL _ CAME TO 5EE YCILi ': W Q^^ � WANTS TO SEE YDLi SIGNED 11 TOPS ISM FORM 4003 NOTES i �� �� �� ��C� � �/�� /ti ��q�' � f i I rMi amwey [Engineering a nc• CIVIL/SITE ENGINEERING July 5, 1995 SERI o ao Ms. Sandra Starr BOP 9� North Andover Board of Health Town Hall Annex- 146 Main Street North Andover, MA 01845 Re: Holloran Septic, North Andover,MA (IEI File no. 95021.00) Dear Sandy: Enclosed are two copies of the preliminary septic plans and a copy of the pump calculations for the repairs to the Holloran septic system on 69 Salem Street in North Andover, MA. The following is a list of variances that we would be requesting with the attached preliminary plan.: Section 2.14#4 -Design flow=440 GPD (110 GPD x 4 Bedrooms)vs 660 GPD. Section 17.02 - Offset to groundwater 3 feet vs 4 feet. Section 17.03 - 6 feet distance between trenches in fill vs 10 feet between trenches. Please review these variances and contact me regarding which variances.would be obtainable. We will submit a formal request for the variances with the final septic design plan. i Please contact me if you have any questions. Very truly yours, HAMWEY ENGINEERING,INC. <::�u 14(/ Fred A. Hamwey, Jr. PE / President 14 MANNING AVENUE,SUITE 308, LEOMINSTER,MA. 01453 (508)840-2964 H amwey I Engineering nC. CIVIL/SITE ENGINEERING 69 SALEM STREET,NORTH ANDOVER, MA Project No.: 95021.00 Date: July 5, 1995 SEWAGE PU_M_P CALCULATIONS - 2" PVC Discharge pipe - Sewage Flow Existing 4 bedroom house= 110 Gal/bedroom x 4 bedrooms =440 GPD - Distance to be pumped L=41' - Change in elevation from D-Box inlet to pump outlet H= 101.50 - 94.50 = 7.0' - Fittings 1 Check valve (18') 18' 1 Gate valve (3') 3' 7-45 elbows (2') 14' 2-90 elbows (3') 6' Equivalent Length = 41' 14 MANNING AVENUE,SUITE 308,LEOMINSTER,MA. 01453 (508) 840-2964 95021.00 July 5, 1995 - Total Equivalent Length L=41' Fittings=41' 82' - Pump Rate 440 GPD/ 16 hr/day/ 60 min/hr='0.46 GPM 0.46 GPM x(5 peak factor) =2.30 GPM Minimum Velocity Allowed = 3 ft/sec 2" PVC, V= 9.6 ft/sec Pump Rate= 100 GPM - Head Loss for Total Equivalent Length H.L. = 16.87100' H.L. in 82' = 13.8' - Size pump chamber 5'Diameter Chamber Dosing Volume Requirement: 1 Dose per day=440 gallons 440 gal/7.48 gal/CF = 58.8 CF zz (2.5) x h= 58.8 CF h=2.99' Use h= 3.0' Page - 2 95021.00 July 5, 1995 Chamber Bottom 0 Sump + 1.01 Pump Off 1.0' Holding Depth(h) +3.01 Pump On 4.0' + 0.5' Alarm On 4.5' Excess Storage (1 day) +3.0' Inlet to Bottom 7.5' - Depth of Chamber(Outlet to Bottom) Inlet Elevation= 98.36 - 7.50 Bottom Elevation= 90.86 Outlet Elevation= 94.50 Chamber Depth= 3.64' Use 3.6' - Total Head Loss (THL) H = 70 Equivalent Length= 13.8' Chamber Depth = 3.6' THL = 24.4' Page - 3 95021.00 July 5, 1995 - Determine Pump Size THL=24.4' Pump Rate= 100 GPM Use ABS SJS-15W Pump 1.5 HP, 1750 RPM, Single Phase 2" Discharge Capable of passing 2" solids @ 100 GPM, Vel. =9.6 ft/sec which exceeds the minimum of 3 f}/sec required @ 100 GPM, pump cycle will last for 4.4 minutes Page - 4 EQUIVALENT LENGTH (FEET) OF STRAIGHT PIPE FOR PIPE FITTINGS (BASED ON HYDRAULIC INSTITUTE PIPE FRICTION MANUAL)- PIPE DIAMETER PIPE FITTING �4 1 1'/4 1 V2 2 1 2lh F3 4 5 E SCREWED RETURN BEND OR (Z� REGULAR SCREWED ELBOW 4 6 6 7 9 9 11 14 - LONG RADIUS SCREWED ELBOW 2 3 3 3 4 4 4 5 - REGULAR SCREWED 45- ELBOW 1 1 2 2 3 3 4 5 - - SCREWED T-LINE FLOW 2 3 5 6 8 10 13 18 - - SCREWED T-BRANCH FLOW 5 7 1 8 10 12 14 17 22 - - SCREWED INCREASER (1 PIPE SIZE) 1 3 1 3 2 4 10 - - - SCREWED GATE VALVE 1 1 1 1 1 2 2 3 SCREWED GLOBE VALVE 27 32 41 45 60 66 84 112 - - <D'c@2 SCREWED COUPLINGS & UNIONS 1 1 1 1 1 1 1 - - - SCREWED SWING CHECK VALVE 9 11 13 15 19 23 28, 40 - - SCREWED ANGLE VALVE 16 16 18 18 18 18 20 20 - - +-i INWARD PROJECTING PIPE OR SUDDEN INCREASE 3 4 5 6 9 1 11 14 20 26 3:- REDUCERS 1 1 1 1 2 2 3 4 4 7 FOOT VALVE - 3 4 5 7 9 11 16 21 26 BELL MOUTHED INLET 0 0 0 0 0 1 1 1 1 2 ;- SQUARE EDGED INLET 1 2 3 3 4 5 7 10 13 16 REGULAR FLANGED RETURN BEND OR REGULAR FLANGED ELBOW - 2 2 3 3 , 4 5 6 8 9 LONG RADIUS FLANGED RETD. BEND OR LONG RADIUS FLANGED ELBOW - 2 2 2 3 3 4 4 5 6 LONG RADIUS FLANC.FD 45- ELBOW - 1 1 1 2 2 3 4 5 5 - FLANGED T-LINE FLOW - 1 1 1 2 2 3 3 4 - FLANGED T-BRANCH FLOW - 4 5 6 7 8 10 14 16 19 FLANGED INCREASER - - - 1 1 1 1 1 1 1 FLANGED GATE VALVE - - - - 3 3 3 3 3 3 FLANGED GLOBE VALVE - 45 57 63 74 p 98 120 156 192 FLANGED SWING CHECK VALVE - 7 10 13 18, 22 28 40 53 i 65 FLANGED ANGLE VALVE - 16 18 18 21 23 30 39 53 65 BASKET STRAINER - - 10 11 13 14 17 22 25 28 / 1 VELOCITY HEAD AND FRICTION LOSS IN FEET PER 100 FEET OF PIPE :l i 1 Y2" 2" i • IRON/STEEL PLASTIC COPPER IRON/STEEL PLASTIC T M Sch•dvle 40 Schedule 40 Type M Sc vie 40 Schedule 40 H• Hood H• He • US Y•l. Vel. Lou Vol. Vol. lou Vol. V.I. lois US V.I. V.I. lou Vel. Vol. lou VOL Vea Lou H./ Hd, ft./ ft./ Hd, ft./ Pt./ Hd. Fl./ ft./ Hd. ft./ Ft./ Hd. ft./ ry,/ Rd N/ GPM Sec. Ft. 100' Sec ft. 100, Sec. ft. 100' GPM Sec ft. 100' Sec. Ft. 100 Sec, ft. 1 10 1.6 - 0.8 1.6 - 0.7 1.8 0.1 1.2 20 1.9 0.1 0.9 1.9 0.1 0.9 2.0 0.1 1.1 12 1.9 0.1 1.2 1.9 0.1 0.9 2.1 0.1 1.6 22 2.1 0.1 1.0 2.1 0.1 1.1 2.2 0.1 1.3 14 2.2 0.1 1.5 2.2 0.1 1.3 2.5 0.1 2.2 24 2.3 0.1 1.2 2.3 0.1 1.2 2.4 0.1 1.5 16 2.5 0.1 2.0 2.5 0.1 1.6 2.8. 0.1 2.8 26 2.5 0.1 1.4 2.5 0.1 1.4 2.6 0.1 1.8 18 2.8 0.1 2.4 2.8 0.1 2.0 3.1 0.2 3.5 28 2.7 0.1 1.6 2.7 0.1 1.6 2.8 0.1 2,0 20 3.2 0.2 2.9 3.2 0.2 2.4 3.5 0.2 4.2 30 2.9 0.1 1.8 2.9 0.1 1.8 3.0 0.1 2.3 22 3.5 0.2 3.5 3.5 0.2 2.8 3.9 0.2 5.0 35 3.4 0.2 2.4 3.4 0.2 2.4 3.5 0.2 3.1 24 3.8 0.2 4.1 3.8 0.2 3.2 4.2 0.3 5.8 40 3.8 0.2 3.1 18 0.2 3.1 4.1 0.3 4,0 26 4.1 0.3 4.8 4.1 0.3 3.8 4.6 0.3 6.7 45 4.3 0.3 3.9 4.3 0.3 3.9 •4.6 0.3 5.0 28 4.4 •0.3 5.5 4.4 0.3 4.5 4.9 0.4 7.8 50 4.81 0.4 4.7 4.8 0.4 4.7• 5.1 0.4 6.0 30 4.7 0.3 6.3 4.7 0.4 5.2 5.3 0.4 8.8 55 5.31 0.4 5.6 5.3 0.4 5.6 5.6 0.5 7.1 32 5.0 0.4 7.1 5.0 0.4 5.8 5.6 0.5 10.0 60 5.71 0.5 6.6 5.7 0.5 6.5 6.1 0.6 8.4 34 5.4 0.4 7.9 5.4 0.5 6.6 6.0 0.6 11.2 65 6.2 0,6 7.7 6.2 0.6 7.6 6.6 0.7 9.7 36 5.7 .0.5 8.8 5.7 0.5 7.3 6.3 0.6 12.5 70 6.7 0.7 8.9 6.7 0.7 8.6-R7. 0.8 11.2 38 6.0 0.6 9.8 6.0 0.6 8.1 6.7 0.7 13.7 75 7.2 0.8 10.1 7.2 0.8 9.80.9 12.6 40 6.3 0.6 10.8 6.3 0.6 8.8 7.0 0.8 15.0 80 7.7 0.9 11.4 7.7 0.9 11.1 8.1 1.0 14.3 42 6.6 0.7 11.8 6.6 0.7 9.7 7.4 0.8 . 16.5 85 8.1 1.0 12.8 8.1 1.0 12.5 8.6 1.2 16.0 44 6.9 0.7 12.9 7.0 0.8 10.6 7.7 0.9 18.0 90 8.6 1.2 14.2 8.6 1.2 13.8 9.1 1.3 17.8 46 7.3 0.8 14.0 7.3 0.8 11.4 8.1 1.0 19.5 95 9.1 1.3 1.5.8 9.1 1.3 15.3 - 9.6 1.4 19.6 48 7.6 0.9 15.2 7.5. 0.9 12.4 8.4 1.1 21.1 100 9.6 1.4 17.4 9.6 1.4 16.8 • 10.1 1.6 21.6 50 7.9 1.0 16.4 7.9 1.0 13.3 8.8 1.2 22.7 110 10.5 1.7 20.9 10.5 1.7 20.2 11.1 1.9 25.8 55 8.7 1.2 „19.7 8.7 1.2 16.0 9.6 1.4 27.2 120 11.5 2.1 24.7 11.5 2.1 1 23.5 12.1 2.3 30.4 60 9.5 1.4 23.2 9.4 1.4 18.6 10.5 1.7 31.8 130 12.4 2.4 28.8 12.4 2.4 27.3 13.1 2.7 35.1 65 10.2 1.6 27.1 10.2 1.6 21.6 11.4 2.0 36.8 140 13.4 2.8 33.2 13.4 2.8 31.5 114.2 3.2 40.3 70 11.0 1.9 31.3 11.0 1.9 24.9 12.3 2.4 42.4 150 14.3 3.2 38.0 14.3 3.2 35.7 15.2 3.6 45.8 75 11.8 2.2 35.8 11.8 2.2 28.2 13.1 2.7 48.1 160 1S.3 3.6 43.0 11S.3 3.6 40.4 16.2 4.1 51.5 80 12.6 2.5 40.5 12.7 2.5 32.0 14.0 3.0 54.2 170 16.3 4.1 48.4 116.3 4.1 45.1 17.2 4.6 57.7 85 13.4 2.8 45.6 13.4 2.8 35.3 14.9 3.5 60.5 180 17.2 4:6 54.1 17.2 4.6 50.3 18.2 5.1 64.1 90 14.2 3.1 51.0 14.2 3.1 39.5 15.8 3.9 67.3 190 18.2 5.1 60.1 18.2 5.1 55.5 19.2 5.7 70.7 95 15.0 3.5 56.5 15.0 3.5 43.7 16.6 4.3 74.3 _200 19.1 5.7 66.3 19.1 5.7 60.6 20.2 6.3 77.9 100 15.8 3.9 62.2 15.7 3.9 47.9 17.5 4.8 82.0 220 21.0 6.9 80.0 21.0 6.9 72.4 22.2 7.7 93.1 110 17.3 4.7 74.5 17.3 4.7 57.3 19.3 5.8 97.5 240 22.9 8.2 95.0 22.9 8.2 85.5 24,3 9.2 110.0 120 18.9 5.6 88.3 18.9 5.5 67.2 21.0 6.9 115.0 260 24.9 9.6 111.0 24.9 9.6 99.2 26.3 10.7 127.0 130 20.5 6.5 103.0 20.5 6.5 78.0 22.8 8.1 133.0 280 26.8 11.1 128.0 28.3 12.4 145.0 140 22.1 7.6 119.0 22.0 7.5 89.3 300 28.7 12.8 146.0 30.4 14.4 165.0 150 23.6 8.7 137.0 320 30.6 14.5 166.0 160 25.2 9.9 156.0 340 32.5 16.4 187.0 170 26.8 11.2 175.0 360 34.4 18.4 209.0 180 28.4 12.5 196.0 380 36.3 20.5 233.0 190 29.9 13.9 218.0 400 38.2 22.7 258.0 Standard Sewage SECT. loo TAB Ejectors PG 101 DATE January 1, 1986 A Company in the Cardo Group MODEL SJV- 4W. SJS- 5W 10W. 15W 20W RATED HP o.4 0.5 1.0 1.5 2.o SOLID SIZE 2 BLADE 2 SPEED 7-750 RPM DISCHARGE SIZE 2or3� VOLTAGE * 60 Hz 1 PH 48 F_ W U_ Z 40 D Q w 2 3 J2 s✓S2 0 O S✓S rs �'1' 24 �L S✓S ro 16 � S✓`S .614 8NS g� 0 40 80 120 160 200 240 280 320 360 USGPM SJV-4W and SJS-5W: 115/230V SJS-10W and 15W: 230V only ABS Pumps Inc. 140 Pond View Drive Meriden nnnnartir.ut 0F450 - 1706 APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass. � r Application by the undersigned is hereby made to connect with the town sewer main in Street, subject to the rules and regulations of the Division of Public Works. The premises are known as No. l � Street or subdivision lot no. Q.wner Address Contractor A p icant's Signature 9 AJ uJ ; i PERMIT TO CONNECT WITH SEWER MAIN The Division of Public Works hereby grants permission to to make a connection with the sewer main at Street subject to the rules and regulations of the Division of Public Works.. Division of Public Works By i Inspected by f Date See back for rules and regulations c AL3 ri _. `FC v H� 6 I TONS OF NORTH ANDOVER DIVISION OF PUBLIC WORKS 384 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845-2909 J. WILLIAM HMURCIAK, DIRECTOR, P.E. Timothy J. Willett f Noery (Telephone 978 685-0950 Staff Engineer Fa°�;`•':"�"o�A P ) Fax(978) 688-9573 3�SS^CHU t .. November 1, 2000 TO RESIDENTS OF SALEM STREET: Please be advised that the recently installed sewer main on Salem Street has passed all required testing and inspections. Consequently, it is now ready for public use. This affects the following houses on Salem Street: #39, #40, #49, #58, #59, #69, #70, #79, #99, and#120. You may now begin the process of connecting to the sewer. A sewer connection permit must be taken out from this office. The fee for the permit is.$1,000.00. You must hire your own contractor to make the connection. A list of contractors is available at this office. Contractors not on the list may also be hired. The permit requires "sign-offs" from the Health Agent and Conservation Agent at 27 Charles Street. Once the permit has been paid, and has been signed by the Conservation and Health Agents, your contractor may proceed to connect your house to the sewer line. The Board of Health has a regulation in place stating that all homes that have access to town sewerage must connect within six months after a line becomes ready for connections. CC: Sandra Starr Susan Ford i �-r� �kyr k �� sG��� � ! Dl , �/ o�G��iS -�-ao�cS l (� d 6� /�IOTT�s. 685E,�UA-QGIs � Y _ DISPOSAL WORKS CONSTRUCTION PERMIT ; D.W.C. No. Fee Name Site S.S. No. 19 Form No. 3 Mamwey CIVIL/SITE ENGINEERING engineering Onc. (508)840-2964 FRED A. HAMWEY, JR., P.E. PRESIDENT 14 MANNING AVENUE,SUITE 308 LEOMINSTER,MA. 01453 J-0 U I %'L,E;h 5T _OT 7 ,)oe7V J. MRIWALLO R.S. ��T 7 -SIO RT N RW>t4.G -/AA44,. StALEt IV- 401 X41 LOQCH 4Re4 tiE4-1?, d w61. Ct�lkseP c,�s-r tiGr�r>SwAC�, bo�SN'i �l�Pi Zo . 4VC�FL�wtrvG 711006M . MlGhT 0XII 1 fro e(-4 lDf oe 1 t11Zcu ; 1157/7 ' Al A y Ic 4- u�.ToPs ou. tovev. o. roe •,•��• - i y•'Pc�oou►�eOC)ar►asEgE°a� %7 ASsoavrtov4 AVMA a 2.0 ABSORPTION BED END SECT N` k S 1000 - - VicC—ALLON . ++ , lO1,6 AdE N , ! SEPT 1G •9TAKK i i b DISPOSAL SYSTEM PROFILE' 40 AESMV .sor4 AREA ABSORPTION BED PLAN OBS.HOLE PERC. MOLL PERC RATE TEST DATE Tr�' I F O PERC TEST , /2 ��..�� � y�.�� Gbh«,�. � • 72 it .{ �• 1 71-7 AD 4r� �O ' OT t V PIPE ,5z-,c rl oAl A _A , a ! I A 1 i 7$ - c 8�f Gl I1� CKUS�l4.0 3� , 5 _ - g � �ocl�t7q•Tia�U �+��rll,�° ( ( �p ir1 SEcTcDA s 2c� C' � �fiL � �� r .: _ _ � PSA 4 Vt&W 8i �FX6 �- - - -- - I TIE 7-0 II � f�H®:N•E CALL FOR " ` }' -DATE--- M ATE M x Fii✓TUANEQ PHONE Y.1l1R GAL! AREA CODE NUMBER EXTENSION f�LEAS R MESSAGE `EE YCIU` WANTS TO- s>> i U. SIGNED frops FORM 4003 MOTES_ 't_U _,F 06/07/1995 20:48 508-452-4378 MARK GOODEN PAGE 84 .:� TIGER HOME INSPECTION INC.° _ HIRE THE EYE OF THE TIGER �r )O R/ 989 WASHINGTON STREET ''7 BRAINTREE, MA 02184 5 f 017-"9-0088 z .1 � suvou"ACm AENAOX DIsVOSAL XYSTRK XMPZCTION ?O TITLE 5 INSPECTION FORK Address of property -Y".� ���� e�"1' {�- Qrtw� j*_—F_ 1 �+- Owner'a namet_s:S,� 1 is. ."E10C Adh] Date of inspection 15"1. 611 - MAT !► CMCZLI/T Check if the following have been done: ✓ pumping information was requested of the owner, occupant, and Board of He lth. ✓ None of the system components have been P la ed for at least two vook s and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the sTystem recently or as part of this inspection. built plans have been obtained and examined. Note if they are not available with N/A. /The facility. or dwelling was inspected for signs of sewage back_up. ✓ he site was inspected for signs of breakout. All system components, excluding the SAS, have been located on the site, ✓/The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of ludge, depth of scum. N The size and location of the SAS on the site has been determined based on existing information or approximated by non-intrusive methods. The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of ssDs. 06/07/1995 20:46 508-452-4378 MARK GOODEN PAGE 05 TIGER HOME INSPECTION INC-c' HIRE THE EYE OF THE TIGER r 868 WASHINGTON STREET BRAINTREE, MA 02184 8 71, 817.849-0066 XUBOM ACE RZIMOa DXSVOBAL 8181=1 ZNBPEdTIOg PORN pass s �B�[ IDl�OEI�'1'IOM lLOW CONDITIONS it residential number of bedrocs number of current residents garbage grinder, yes or no laundry connected to system, yes or no seasonal use, yes or no if nonresidential, calculated flow: Water meter readings, if available: u',s APIA '}t CC> e r t o ct''i 6160 e I AA OrM rvl� S 4PPL r v Last date of occupancy t� GENZ"L INFORMATION Pumping records and source of information: „system pumped as part Of ins Gtion, yes or no if yes, volume pumped ,._. CrV T4-= Reason for pumping: prof system ✓ septic tank/distribution box/soil absorption system Single cesspool overflow cesspool Privy shared system (yes or no) (if yes, attach previous inspection records, it any) other (explain) Approximate age of all copponents. Date installed, if known. Source of ,information: sewage odors detected when arriving at the site, yes or no r 06/07/1995 22:00 508-452-4378 MARK GOODEN PAGE 03 TIGER HOME INSPECTION INC. HIRE THE EYE OF THE TIGER r 989 WASKIN©TON STREET BRAINTREE.MA 02164 9 817448-0088 pa►�rr a sisT= ZWOWMTZO r aomtiaued SEPTIC TANG: (locate on *Lt* plan) depth below grade: Z material of constructions concrete metal FRP cther(explaia) dimensions: LOQ L 6, 13, 0 sludge depth diast4noe from top of sludge to bottom of outlet tee or baffle A ' scum thiekn ass distance from top of scum to top of outlet tee or baffle distance from bottom of scum to bottom of outlet tee or baffle Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, recommendations for repairs, etc.) tAQ f4nvw% - au cE _ env a taLre'W-4- So>La 5 n3 JC t. t—t> X04- R-ex fK — CAP �+Ge Imo; ft ,�•e�s+►r+� DISTRIBUTION SOX: (locate on Site plan) ewl- 004P%1FLv j depth of liquid level above outlet invert Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, recommendation for repairs, etc. ) �•► a ac.. PUMP CHAMBRx: (locate on site plan) Pumps in working order, you or no Comments: (mote condition of pump Chamber, condition of pumps and appurtenances, recommendations for maintenance or repairs,etc.) 06/07/1995 20:48 508-452-4378 MARK GOODEN PAGE 06 TIGER HOME INSPECTION INC:9 141RE THE EYE OF THE TIGER r 969 WASHINGTON STREET 10 BRIJNTREE, MA 02184 ' 617449-0098 sussu"ACP slrM= D2dPOBAL ByBT= =NPXMION 70M vomer a sXs#1pi[ �s�a�u►�=o� aselixmea SOIL. AHSOP"ZON SYSTZK (BAS) s (locate on site plan, if possible; excavation not required, but may be opproximoted by non-intrusive methods) If not determined to be present, explain: Te leaching pits and number MeMw LoNrlk III leaching chambers and number leaching galleries and number ►J leaching tranches, number, length leaChi.ng fields, nU ber, dimensions overflow cesspool, number Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc. ) CESSPOOLS (locate on site plan) : number and configuration depth-top of liquid to inlet invert „ depth of solids layer depth of scum layer- dimensions of cesspool materials of construction indication of groundwater inflow (cesspool must be pumped as part of inspection) Commentss (note condition of soil, signs of hydraulic failure, level of ponding, ' condition of vegetation, recommendations for maintenance or repaire,etc.) N PRIVY: (locate on site plan) materials of construction 1U dimenseians depth of solids comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maiptenance or rep airs,etc.) r 06/07/1995 20:48 508-452-4378 MARK GOODEN PAGE 07 TIGER HOME INSPECTION INC.10 f HIRE THE EYE OF THE TIGER 989 WASHINGTON STREET 31 BRAINTREE, MA 02184 0 y�#8.00BB DQUOU Vacs 111111111MMI D18106AL 579T= i>1T nCTX()N 70M nXT e BUTEX XWON (TION continued sKETc I or 800= D16POUL 8YE'Ta'M: include ties to at least two permanent references landmarks or barks locate all Wells Within toot DEPTH TO CHICU D MM I /+ depth to groundwater method of determination or approximation: 06!071'1995 20:48 508-452-4378 MARK GOODEN PAGE 08 TIGER HOME INSPECTION INC.' r HIRE THE EYE OF THE TIGER r 969 WASHINGTON STREET T' BRAINTREE, MA 02184 12 s>r>�evRsaca sslraas DUPOSsa SYSTM I�IBP)cCTIo>I< ro>�t PART C FXXLU= CRITERM Indicate yes, no, or not determined (_, N, or XD) . Describe basis of determination in all instances. If "not determined", explaln why not) Backup of sewage into facility? NO Discharge or ponding of effluent to the surface of the ground or Je surface waters. static liquid level in the distribution box above outlet invert? Liquid depth in cesspool <6" below invert or available volume< 1/2 day flow? µat !"'PST' OP s yslLff--M N o Required pumping 4 times or more in the last year? number of times pumped NO Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? Is any portion of the SAS, cesspool or privy: 0 below the high groundwater elevation? 0 within 50 feet of a surface water? T- ' within 100 feet of a surface Mater supply or tributary to a surface water supply? _bL(L within a Zone I of a public well? _h!a within 50 feet of a bordering vegetated wetland or salt marsh (cesspools and privies only, not the SAS)? within 50 feet of a private water supply well? NU, less than 1.00 feet but greater than SO feat from a private hater supply well with no acceptable water quality analysis? If the well has been analyzed to be acceptable, attach copy of well water analx psi for coliform bacteria, volatile organic compounds, ammonite nitrogen and nitrate nitrogen. i 06/07/1995 20:48 508-452-4378 MARK GOODEN PAGE 09 TIGER HOME INSPECTION INC.° HIRE THE EYE OF THE TIGER 969 WASHINGTON STREET }r BRAINTREE. MA 02164 f= 617-849-0088 13 iOs/OA!l10E 8EM#421 DId OSDA 1513K zMarzartolt csnssrsC7�Tzor Name of Inspector Company Name E � Company Address Cart f cation tatemsn_ I certify that I have personally inspected the sewage disposal system a this address and that the information reported its true, accurate and complete as of the timse of inspection. The inspection air formed and any recommendations regarding upgrade, maince nrepair the proper fair are crud consistent with my training and expo manntenance of on-site sewage disposal systems. Check one: I have not found any informationwhich indicates that the system tails to adequately protect public health or the environment as defined in 310 CMR 15.303. Any section criteria terihisafnot evaluated are as stated in the VAILDA= CRIrgof nd have determined that the system fai15t303rot The basiscforubliathisltha the environment as defined in 310 CHR determination is provided in the FAILUZZ CRSTNRIA section of this farm. ` Inspector's signature "" Date original to system owner Copies to: Buyer cif applicable) Approving authority II 06/07/1995 20:48 50B-452-4378 MARK GOODEN PAGE 11 05706/1995 21:58 5889573 N.A. DPW PAGE 01 5MtUUV04tVC:Sf')4t1• :JA13 TOWN OF WORTH ANDOVER UA'fiErs Qi6 TL1401I M141.. NO.4 G1"<...: CONSUM5M M IFTE:R r/I.1 1,101E: 1a9 Acc C : 0'.--4,'980'40 W MARTIN HOLLORAN 69 �a'ALfWM hle3ta��' A1. • i R;.,� I�Iti^/Ali N bookArb 4: 16 i~'ager �+�:iZ31�.4!lQk�ih+ZEi�I i►lu!4 tea^ F 3.g s � DiRitRt 43 nim Cd: A3 Multilplieri i manF cd : jUni.tso Papw Size: 1 Lam,-.a :l Ty p: Req. I r:st a Gnct s Disc o di Wr`k CO 1 Mt Code: 7 Not LCC: In/a NoteYF: U/b " RI l_NG I 5vrial bi: veli i�lE. rEldll'� 1$41 A Preva 1818 A 2nd Pr•ev: 5797 H Fa: 04/26/95 Lurgi 3'vixt 0s Lro Mth all Uscar 9 ' ,.....,...._.___._..___...- -----------_. oTtsuroptiar� Iw�ft.t"matic�r� •--,-----._�..---_..__.-._......._,..,,. .. . Fir-it 1 Ni ,11 ' g Montle --- 12 Billing Mct»the _ 0f;/'75 !'e3$ A 1 i�L ise 13 A 0'3!9319 A 103/9a 21 A 1tJ'94 "—��li, L1 Q116/93 �lc F1 1 kra a94 A I ►:4r .:,t: IP 'fr,{:al 234 1 Lae:ti 12 Total : a4 4ESC? t._. F!"tu:r• Naw Motor Numbor, N)c+di fy+ tD)e l eta oi- ?N)ext yds nb 14 �I a kny appeal shell be filed MUM B P E,I E:,, �. within (20)days after that O W N OF N O R T x n N D tr ori i. :. �K gate of filing of this Notice H A S S A c x U S E T in the Office.of the Town °f NORTH,�ti JUL 1 f 42 �{�1 Clerk. 3 °c .. ,SSgGNUSEt , r r.. NOTICE OF DECISION Date. . July. 8-,. .19 8.6 . . . . . . . . . , _ . Date of Hearing 7 , 1986 Petitionof , , , , , , , ,Milltown, r Realty.Tust . Premises affected . . . . .. . . . Lots. 3A .& , 4A Foster .Street . . . . . . . . : . . . . . . . . . Referring to the .above petition for a special permit from the requirements of the , :NAKth, Andover ,Zoning, Bylaw.,. Section .2...3.0 . 1. . . . . . . . . . . . . . . . . . . so as to permit . . . . . , Construction ,of, a .Common. w Driveay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . After a public hearing given on the above date, the Planning Board voted conditionally to : .4PPrQYQ. . . . . .the . . . . . . . . . Special, ,Permit . . . . . . . . . . . . . . . . . . . . . . . . . . . . based upon the following conditions: Signed Erich W. Nitzsche, Chairman Michael P. Roberts, Vice-Chairman . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . John L- Simons, Clerk . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . Paul A. Hedstrom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Y John J. Burke ' " " " "plannirtg � Board� � � " � � � � A r, Zc�i 7 q �'l�f �Gw�2 wG5 COv�S�r�cTc� v v bcG,rd G{ i w. 1 t. � I '0 , i TIGER, HOME INSPECTION INC:° } > 4 HIRE THE EYE OF THE TIGER 969 WASHINGTON STREET 7 BRAINTREE, MA 02184 617-849-0088 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM I TITLE 5 INSPECTION FORM Address of property �p� �j�j,(_�`"Y� G?-fi' (�• pOt1�"'�2 pr Owner' s name LE.'SL, t i.- l�&I 1 ne ck J Date- of inspection: s ' S PART A CHECKLIST Check if the following have been done: .1---lumping information was requested of the owner, occupant, and Board' of Health. ✓ None of 'tYe system -com onents have been. um ed for at least two weeks P P P and,- system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into. the system recently or as -part of this inspection. ✓ As built plans have been obtained and "examined. Note if they are not available with N/A. " ✓ The facility or dwelling was inspected for signs of .sewage back-up. P ► he site was inspected, for signs .of breakout._,.. , I# All system components, excluding the SAS, have been located on the ite. ✓ The ma 'septic tank p Wholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of /sludge, depth of scum. V The size and location of the SAS on the site has been determined based on existing information or approximated by non-intrusive methods. The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of SSDS. j I 9 � ih I ,. TIGER HOME INSPECTION ING. s HIRE THE EYE OF THE TIGER 969 WASHINGTON STREET BRAINTREE, MA 02184 617-849-0088 j 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS If residential number of bedrooms number%of current residents �j garbage grinder, -yes or,,;, no . A�, e5 laundry connected to system, yes or no seasonal use, yes or no If nonresidential, calculated flow: Water meter readings, if available: 1 1 Co C r- l q� t"l `b C O0 G F A-s Q-e N Fol M 0MI D'-�1 S q PPS'I�� #. �,3�J -t'�Yv�N �� /�.!O�-t•Tn f�ri1 CD8 �P Last date of occupancy GENERAL INFORMATION ; Pumping records and source of information: L A-s r Qu l I- 11 9 / - ✓ System pumped as part of insp_ection, yes or no if yes, volume pumpedG.- Reason for pumping: ` Y 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) Other (explain) Approximate age of all components. . Date installed, if known. Source of information: I P�Pfnx a t vR5 �-S Pc-R. 0�)Je - - Sf D to - a 3 -7 7) IJ Sewage odors detected when arriving at the site, yes or no TIGER HOME INSPECTION INC.© A .,t:� . :r HIRE THE EYE OF THE TIGER 969 WASHINGTON STREET BRAINTREE, MA 02184 9 .. • . 617-849-0088 ` - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B { SYSTEM INFORMATION continued SEPTIC TANK: '! (locate on site plan) depth below grade: Z4 material of construction: concrete metal FRP other(explain) dimensions: I O i 4.. -D 1sludge depth , r -1 distance from ,top of ,sludge tet bottom of outlet tee or. baffle 611 scum thickness 1 distance from top of scum to top of outlet tee or baffle IS ► distance ' from bottom of scum to bottom of outlet tee or baffle Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert', structural integrity, 'j evidence of leakage, recommendations for repairs, etc. ) L,e+ b d fi 6ArrLgI rJ o'D NO I O/Q -- D e%/=-L SO Ho OF n u k Cot (t,)Ven? - 5-+12 tic-fy,rz Ac- 1 N+E-GR(t�, APp m s A s6'b - x.1--0 F V ICS J n F L�A K 8!0-& — E y'(4-enc a t,� f3 Uk l- c,4o A-- i N l e+ o N d eie t- SoL\O5 rtosisat kr C>Lk-kta-t oye12'1' gaa.�i.&g-o r3`/- ft"4L- DISTRIBUTION BOX: (locate on site plan) �+oX oUFwa► depth of liquid level above outlet invert Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or. out of box, recommendation for repairs, etc. ) , rz Pce*-'& 'P Z"SL-n 41 L: 1 N 5 L fir., !_ A-fzo�c n►"f� &tix n -( -2�`I/ - Fv I p-42*.e-e 1 4 �4 k►'�*1-C A fi i N r-Iy r� a/ euQL X PUMP CHAMBER: NIA- (locate on site plan) pumps in working order, yes or no Comments: (note condition of pump chamber, condition of pumps and appurtenances, . recommendations for maintenance or repairs,etc. ) GV Pr r ,. ,.-....r r .n.'a,rtrr 4.«-...Kan.,r;ri:.,7r«-.-.a:�M:.wyy.,A:.vow-...-r rr� _m.:...,.,,,,nnsw, - ..:. _ .,;,..a.n. •; -aHTt. '1til,rMx� mtit:11 �:•'�i- Y" b `M z TIGER HOME INSPECTION INC. f' HIRE THE EYE OF THE TIGER 969 WASHINGTON STREET 10 BRAINTREE, MA 02184 617-849-0088 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SOIL ABSORPTION SYSTEM (SAS) : (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type leaching pits and number , .,, COra�e Le:�4,c t-� G M7D w/ y Li wry leaching •,dhambdr!s j, and-*. number A Py2ox `:2�' x2o' l4S R.e rL. U.tSI leaching galleries and number c, a,�j S t-LonL i-V() � j ©vim rJe V-z- leaching trenches, number, length leaching fields, number, dimensions overflow cesspool, number Comments: (note condition of soil, signs of. hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc. ) . ;i `t CESSPOOLS (locate on site plan) : number and configuration depth-top of liquid to inlet invert depth of solids layer depth of scum layer dimensions of cesspool materials of construction indication of groundwater inflow (cesspool must be pumped as part of inspection) 3 Comments: y (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc. ) AJ 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, recommendations for mai tenance or repairs,etc. ) ,..r1Kt*+>+rK�'$ia.'Y.. .,w:r'-y-; .,.rr r "e -h+' M:t.. „.y r.A 3•. ay. tr.:y F,.ai ' . > - X t e. TIGER.HOME INSPECTION -INC. ): HIRE THE EYE OF THE TIGER 969 WASHINGTON STREET 11 BRAINTREE, MA 02184 ' 617-849-0088 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORK PART B SYSTE* INFORMATION continued i+ SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks orbenchmarks locate all wells within 100' Y S ` k• D-e►ox S� DEPTH TO TO GROUNDWATER J depth to groundwater method of determination or approximation: . ii. .. . .. ....\'1- .r ,... _.....pry M. Ib `.r. li '1 '"• !£Y'AT T\l'):'. - Y 1 n 1 _.t.. w-1 TIGER HOME INSPECTION. INC.IQ HIRE THE EYE OF THE TIGER 969 WASHINGTON.STREET t. BRAINTREE, MA 02184 12 617-849-0088 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of determination in all. instances. If _"not determined", explain why not) t110 Backup of sewage into facility? NO Discharge or ponding of effluent to the surface of the ground or surface waters? "v f- S, at`ic liqui,, level in the distribution box,?above outlet invert? A—D Liquid depth in cesspool <6" below invert or available volume< 1/2 day flow? Nit PPTz-r Or S t/S-"--nA N o Required: pumping 4 times or more in the last year? number of times pumped • i No Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial .exfiltration? tank failure imminent? 4 s„ ,r Is any portion of the SAS, cesspool or privy: NO below the high groundwater elevation? ti NO within 50 feet of a surface water? 10 within i0.0 feet of a surface water supply -or tributary to a surface , z( water supply?-- NO upply?LJO within a Zone I of a public well? a No within 50 feet of a bordering vegetated wetland or salt marsh (cesspools and privies only, not the SAS) ? NV within 50 feet of a private water supply well? NO less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis? If the well has been analyzed to be acceptable, attach copy of well water analysi for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. k • � �i' +�v.���s��+$avt.. � "`; "4." �'t dry� .�' d" , e � i. .... .+ , �,,;�:» .�. . .r� ,bw"• a Ar .... TIEq� R HOME INSPECTION INC. . HIRE THE EYE OF THE TIGER } 969 WASHINGTON STREET -.,:BRAINTREE, MA 02184 ;i r• 6.17-849-0088 13 SUBSURFACE SEWAGE DISPOSAL SYSTEM` INSPECTION FORM PART D CERTIFICATION Name of Inspecto im 1< Cb 7 �1 q t Company Name 17-1 C-7 E7- gin E Company ,Addressg1 Gel W OAQ5 41 n3!l-bf K At N-k2e:C- M Iq Certification Statement I certify that I have personally inspected the sewage disposal system at "., this address and that the information reported is true, accurate and }; complete as of the time of inspection. The inspection was performed and +" any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function and manitenance of on-siteesewage disposal systems.. s Check one: I have not found any information which indicates that the system fails to adequately protect public healtli or the environment as defined in 310 CMR 15.303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of ,this form. (have determined that the system fails to protect public health and _,. the environment as def,ine� in3,10 CMR 1;5. 3;Q3 The basis for "this i determination .is rd ed iri the: FAILIIRE CRITERIA section of this' form. p y 1 b Inspector' s Signature4. �v rDate - 1 Original to system owner Copies to: Y Buyer (if applicable) y Approving authority 4 06/06/1995 21:58 6889573 N.A. DPW PAGE 01 TOWN OF NOR-m ANDOVER I)ATEA 06 M-MISLAIER METER E t 08 f,-)C,C: 0 MARTIN HOL LORAN E79 SALEM 16 1:,CAqC-p.- N L L*o r i ri t 1:)irpts&: 43 I)irn CC:i'b Al MU.1tif:)Iier'-* I A b it ripe Size., :1 L L ri. .1 Ty p 1"I F C d -I Urt i t S: It Req : I rest Disc., Mt Code: J Met I-CIC: I Serial #: Note'n.; (PH I.Nc 1797 A Eq C'..I r 1841 A Plrotiv 1818 A 2nd Prey +4/-'r./"ala C, 2 Nex*k, lib L"r Ri Iz z:7I,Tl I carom urapt i ors I rif ormrt F:'irt IL Morithat i arc c'r' 12 Billing M-::ti , h 0 C." S)5 Ll /92 13 A 0: /91,31 X719 A 103/92 21 A 1 4 1) 4 0 03/93 7 A i 0 3 i".9 4 19 A I 234 1 La!E:t 12 Total : 34 <E-,SC,` [-':nt(4r No?w Meter Number (M)od i f yj M) elete or <N)ext -, ea/ la CA— nb74 P FOR111.4:-SI'ST E.'1q PL.%' U) d RECORD 107 Forest St. N Middleton,MA 01949 (508) 774-2772 �Q��w�rA .. 5 gE C on ealth of Asassachusetts ,.Massachusetts :�`vsfem Pum ing�ecord . yst m %Nmer LQ )'stem ocaza tion /n& �7_ 7 I (f' 60 0 41- Date of Pumping: ( p(Z)C;' Quantity Pumped; allons g Cesspool:. NO A. Yes ❑ • Septic Tan};; I�'o ❑ yes SN stem Pumped bN: -Contents transferred to: License #: Date Inspector n Town of North Andover, MA ij Watershed Septic System servicing Report Date: Homeowner: , Pumper : r' Street Address: Phone �j Phone Z Nature of Service: Routine Emergency Observations: Good Condition Full to Cover Baffles in Place Leachfield Runback Excessive Solids Heavy Grease Roots Other (Explain) Description of W I Comments : 1 `� r Town of North Andover E NORT►r p taw ,s'9,y j Office of the Health Department 3 1°- A Community Development and Services Division 4L �* 27 Charles Street '•,.,o��"<g North Andover, Massachusetts 01845 9SSAC14U`�Et Sandra Starr Telephone(978)688-9540 Health Director Fax(978)688-9542 May 15, 2001 Mr. &Mrs. Michael Payne 69 Salem Street No. Andover,MA 01845 Re: Sewer Tie-in Dear Mr. &Mrs. Payne: The Health Department has been supplied with a list of all residences, currently on septic, which have access to the municipal sewer system. Your property was listed as having access as of November 2000 due to the completion of the new sewer in your area. This office was notified that you were sent information from the Department of Public Works informing you of your status and the tie-in regulation. As previously published at a Public Hearing on March 17, 1994, the Board of Health has adopted regulations concerning the required sewer tie-in. The following timetable concerning your property status was adopted: 4.1 All establishments that currently do not have municipal sewer available to them must connect to the sewer as soon as it becomes available, with a maximum time limit of six months. i The purpose of these regulations is to safeguard North Andover's drinking water, surface waters, groundwater and surrounding environment. Sanitary sewer is believed to be the most effective form of wastewater treatment. A copy of the entire regulation can be obtained at our office. BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 i rr Any questions concerning this regulation should be directed to the Board of Health at (978) 688-9540. Additional inquiries regarding the physical tie-in and permitting process should be directed to the Department of Public Works at (978) 685-0950. Please be advised this Board intends to persevere in this regulation. Yours truly, I Ga)"Osgood, Chairman s Francis P. MacMillan, M.D., Member Jo ' za, D.M.D., , ember SF/sc