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HomeMy WebLinkAboutMiscellaneous - 70 JOHNNY CAKE STREET 4/30/2018 (2) v r7 r Location_/ 'r'"r No. J tl Date TOWN OF NORTH ANDOVER F 9 + Certificate of Occupancy $ �' �°'••° '<�' Building/Frame Permit Fee $ cNust Foundation Permit Fee $ Other Permit Fee $ r� TOTAL $ � � Check # 189 2 7 - Building Inspector` TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVATk OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: y DATE ISSUED: SIGNATURE: Buildin mmlsslo /I u11 Date Z SECTION 1-SITE INFORMATIONI IO 1.1 Property Address: `, - 1.2 Assessors Map and Parcel Number: 176 3-66 n1 Ca16,7 f U 'f 1' 1 W N,1`. Cid M v 2�z� Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Fronto ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 30 v' c 1.7 Wata Supply M.G.L.C.40. 54) 1.5. blood Zone Information: 1.8 Sewerage Disposal System: Public ❑ private ❑ Zone Outside Flood Zone 0 Municipal 0 on Site Disposal System SECTION 2-PROPERTY OWNERSIIIP/AUTHORIZED AGENT Historic District: Yes No rn 2.1 Owner of Record foi%A, C0V-'1I0"r0 70 �t Name(Print) Address for Service: Signature Telephone Z2 Owner of Record: Wifine Print Address for Service: O Z rn Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable Licensed Construction Supervisor: O License Number on Address Expiration Date r Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ' Q Company Name rn Registration Number r Address r Z Expiration Date G) Signature Telephone r SECTION 4-WORKERS COMPENSATION(XG.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building it. Signed affidavit Attached Yes.......❑ No......X SECTION 5 Descrl tion of Proposed Work check all applicable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ 6 Accessory Bldg. ❑ Demolition ❑ Other , Specify c c ek Brief Description of Proposed Work: 1 r _9 I W 1�1 bu c� S�Rdt SCQ"J r•c 1 ,, 1 .A r?�d� IY4�e� �s L �/tAs lY i�(� �t d. � �a.,�'a •�• b. ��'1� ly,aV-- ;n. �> t"I-�c N lKt s t�cL eIC. -)�y�Nt c;j i�Ut.b(1�� ••i�,�c� SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(r)X(b) 4 Mechanical HVAC 6�f 5 Fire Protection 6 Total 1+2+3+4+5 4' '4,000 ra *1,500 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT - T 1, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. r Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, aswne Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief ram, �A'Vc1�'01'(0 Print Na}x� p � Si a"gent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION / THICKNESS SIZE OF FOOTING X MATERIAL OF CH VINEY IS BUILDING ON SOLID OR FILLED LAND 'C411T.. W�1� t 1V`. IS BUILDING CONNECTED TO NATURAL GAS LINE tit o rVKm U - LU i KCLC^Or- rvr%m F 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 �°'`^\ 'y`1 PHONE LOCATION: Assessors Map Number. PARCEL_ SUBDIVISION LOT(S) STREET ` r -- ST. NUMBER OFFICIAL USE ONL R E TI F TOW GENTS: SERVATION ADMINISTRATOR DATE APPROVED Z CO DATE REJECTED COMMENTS OWN P R DATE APPROVED DATE REJECTED COMMENTS L& siifvr,rsi FOOD INSPECTOR-H TH DA'(E APPR VED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT .7ECEIVED BY BUILDING INSPECTOR DATE Revised 9197 I I � � ' l � J OLO [:�ltl tA41c .37 '= rTT '4- I NNVG , i .:tHTiFY THAT THIS LOT IS NOT IN THE F.i.A. CERTIFIED PLOT PLAN F.-UDO HA2AAD 2OtW-. THIS CERTWICATION IS BASED OF LAND IN �•tt THE SURVEY MARKERS Of OTHERS, AND IS NOT PROPERTY SURVEY, FOR MORTGAGE PURPOSES ONLY. CERTIFY THAT THE BUILDINGS ARE LOCATED AS SHOWN, AS DRAWN FOR ANO THAT THEY CONFORMED YO THE 2O(JOG BY-LAWS OF THE CITY/TOWN OF '/HEN CONSTRUCTED. - SCALE I' =Z/k) PAGE , -E.ED BOOK. /�� , C� �i' . REA _i Imo? op"�l ^'tli�' r J J $ 's A.SSESSOR MAP MO ) POJ. 12138 / A ,ALOCKR.A.M. ENGINEERING 160 MAIN STREET HAVERHILL, MA. 508-372-0449 00DPOSTWOODWORKING.COM • n 0 FW STORAGE SHEDS � • , . • • • = PW1 =SHED FREE ON-SITE CONSULTATION -= A Post Woodworking trained representative will - come to your home or business to help evaluate . your storage ' > . needs and site requirements. NEW FOR 2005 STRONGEST ROOF IN THE INDUSTRY • 2x6 Engineered Roof Trusses 16" on Center • Pressure Treated Floor-joists 12" on Center �? • Functional Aluminum Windows w Screen i T ---� ------------ Shown Shown in Pine n n " POST WOODWORKING, INC. 163 Kingston Road Danville, New Hampshire 03819 1-866-PWI-SHED w www. ostwoodorkin .com P 9 POST WOODWORKING , INC . 163 Kingston Road • Danville, NH 03819 ' 866-PWI-SHED • Fax: (603) 382-3087 .. www.postwoodworking.com / info@postwoodworking.com STANDARD WINDOW AND DOOR PLACEMENT PINE A B C D E SIZE VINYL & T-111 CEDAR $1,479 $1,339 ✓ 1 12' 2,099 $1,879 4' ✓ 1 1 ✓ 1 1 ' ✓ 1 7 1 ' ✓ 2 ' 10' X 10' $2,489 $2,309 $2,769 1 7 1 2 'B4.459 ✓ ✓ ✓ ✓ ✓ 12' x 20' $4,80 $4,589 $5,249 Applicable sales tax is not included.Delivery charges may apply to some areas.Prices,materials and specifications are subject to change without notice. Payment may be made by cash,check,credit card(mc/visa,disc)or through our financing. OPTIONAL DOOR PLACEMENTS MAFV , Double End Doors 5' Wide Roll-Up End Doors T Wide Roll-Up End Doors available in these models available in these models available in these s Colors Available: Gambrel Roof Shed Roof 8'x8'&UP 10'x10'&UP 10'x10'&UP 2'x12'&UP' 8'x8'&UP 8'x8'&UP - HARBOR STONE - ----- OPTIONS AVAILABLE PRICE Steel Roll-Up Door(End Wall Only) i i 5'wide ... .. . .... ... . . .. . ... . ... ... . .. . ... . .. . ... . .. ... . . . . .. . ... .. ..$309.00 VICTQRfAN SLATE. 7'wide .. . ... .... ... . . . $369.00 Additional 4-Panel Steel Single Door(29") .. .... . .. . ... ... . ... ... .... .. . ... .. . ..$100.00 Additional 4-Panel Steel Double Door(60') . . ... . .. . ... ... . ... ... .... .. .... . .. ...$150.00 4 Shelf Kit(customer installed) ... . .. .... . .. . ... ... . ... .. . .... .. .... ... .... .. ..$20.00 ADOBE CLAY Cupola . . .... ... . ... . .... .. . . ... .. . . ... ... .... .. . .... .. . ... . .. .... .. ....$150.00 Additional Aluminum Single Hung Window ... . ... ... .... .. . .... .. .... .. . ... .. . ..$65.00 (includes grills,screens,shutters and window box) One Ramp Included Pressure Treated Single Ramp ... .... . .. . . .. . .. . ... ... . .. . ... ... . .. ... . .. ... . ..$50.00 �II WARM SANDALWOOD Pressure Treated Double Ram (Fits 5' Roll-Up Door) $75.00 1 Pressure Treated Extra-Wide Ram (Fits 7' Roll-Up Door) $100.00 Storage Lofts 6'x4' .. . .. ..... ... . ... .... ... . . .. ... . ... . .. . ... ... ... ... ... . ... .. . .. .$60.00 SUNNY MAIZE 8'x4' . . ... ....... . . ... .... .... ... .... .. . ... . .. . ... .. .... . .. . ... .. . .. .$80.00 10'x4' . .... . .. . ... . ... . ... .... . .. . ... ... . ... ... .... . .. .... .. . .. . .. ..$100.00 12'x4' . .... . .. . .... ... . .... . .. . ... .... ... . .... . .. . ... ... ... . .. . ... ..$120.00 Solar Powered Light .. . .... .. . .... . ... . .. . ... . ... ... ... .... .. . ... ... .. ... . ..$119.00 CLASSIC SAND Pool Filter Hole . . ... . . .. . ... . ... ..... . .. ... . .. . ... . .. . ... ... ... . .. .. ... .. . ..$75.00 2'x8'Workbench(installed) .. .. .. .... . .. . ...... ....... ... . .. . ... .. . .. ... ... . ..$130.00 REQUIREMENTS FROST WHITE ♦Clearance of at least 2'front and rear ♦Access to site needs to be clear enough for the delivery crew to carry in shed panels ♦PERMITS are the sole responsibility of the customer,as some towns may require permits ♦Site should be no more than 12"from level under shed PROVIDENCE YELLOW Not sure if your site meets these requirements?Please call our office and schedule a free"on tno.tsrinclude ite consultation" -sa�ipl a upon request. 20-YEAR LIMITED WARRANTY Due to printing process,Colors may,vary slightly. Post Woodworking,Inc.building has a20-Year Limited Warranty for structural integrity.This warranty does Please ask about availability of custom color doors and windows(for obvious reasons).The roof shingles have a 20-Year Warranty against leakage. matching. Natural disasters,damage by accident or neglect are excluded.With proper maintenance we expect your building to last a full lifetime and more.We expect that when we have been gone a hundred years many of our buildings will still be standing all over the United States. Post Woodworking,Inc.,gives no other warranty expressed or implied,either oral or written. C.O.D. only.Payable to Post Woodworking, Inc. We accept Cash, Personal Check, VISA, MasterCard or Discover. POSTWOOuWORKING, NC. ImB66uPWImSHED NORTH ToVM Of Andover 0 * s = dower, Mass., O J`COCHICHEWICK y1. , �AD""ATE D PPS\ �CO �`s E BOARD OF HEALTH Food/Kitchen Septic System r� BUILDING INSPECTOR THISCERTIFIES THAT....... ......................................................: .... Foundation P T T has permission to erect...... ................................ buildings on ...... ......... ...................... Rough to be occupied as .........!........��� ... Chimney ?i. ... .................................................................... provided that the person ccepting this permit shall in every Arapect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ARTS Rough Service BUILD G R Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner 1 Street No. REVERSE SIDE smoke Det. 4 OF E V"q -21-16 N BAP�AGALLO No. 464 Q/STE���pQ\P r.LL� ��.�'�.._.... �U � ONAL S z L Lf O'n r=Z2 7t- A) A" u+.Qiana+•-rtiv+.r.w.e.ta.w..o.a.:w,+-..e+ro.iwcrttrv'rrro zswx. .r- ..•y.a.w.-a.+..+r.+ea.w5ruvw..cva•vrawsrv.r .irwraovanrarwwwvroa.waw.awne.r..xsivrraawewrr.. wwnow.+..w.w.rw+mnnrrrssma -�: - •- �Q I-C-tV o_��v_�!_ D rw1)►LS_ _v__�- W.��an/-���Y�f1�N i o_�� � .ter`-�� ---�� PLA AJ sNDcviwc 4 P4_6X __�-�_L_�^l_a�S �G��v-4_-t r__�.er C2- P•E'DPOSEO SLBSd eA4GE SEWAGE E b1.5PMs 6'YSTEM ar - PRO PctSED Zo r a--e-4A1NG SCALE - /"1= go LATE - s A 8 -,9,5- r?�✓�5 a� - •_ _ � � 11 D 3--`L --S Q I- J LOCAr/odv: / L f 4 9 1-0 U/ Cd-A-0 S I" • . DES/G A1ER d2UEPN cT BAR646AGL G , RS. �'`P�Z%\ Of Mq cy WE571WARA LCIRCL.E E°Vi J. G . ' Aldo. �AL�✓�tlh , IWW SS. BARBAGaEta rrr� • - / �'' �EG. G G '�-�983 'A J- 'p�G`STG������ { FSS�ONAL SP�� a / i\i /00" i bES/C A! pA rA / TYPE OF 4W.1/CL1/A/Ci: 4C3•R• Zw.t//iNa 1 / C34RAGE #f CEL"AC PLUMB/,VG SEWAGE- rWW EN;riMArE: LaaG-,o•p SEPTtG r4"A< /.Soo C-a-Z. 1 ( i4DlSGLePT/Gia/ AREA =�co = 047.= 89,9 S•F• L[S-& 5;aa S•Fa f OPE exxAnwAi yrs m/ Arz AW-4 -�►Q j 7G ELE/A.i47-100 J t 7 O !7 aS.1 rLI.eAT/O�l! � � ""' /I"r�. J'• DROP M/N- .Nig./. �btiv. •� !'-ra 4- DRG .y/N. Miu Mie/ M/N. / fW-feo A r/ON RA77E ', �l tic /✓ M. /� �lia. /�/ .tit. /,v, l \ \ Q 7 Sr PITS "olr 0z DArL� S-/ -95 S- L-83' TOP EZEYAT1 f go s /go•,S 14"toP � ��NtoP+ A�� �' SO/G TYPES Su 6 So,*L Sot 65°i L AA/0 Inc" So-,Y.Ay 7'5&.vAy ` WA rER rASi E f i L L / 40C.4 7-/40 Al BOT7-OM F1Ei/.4r 1-7;L. o 7/S 7'E--,7S CXW�i G TEn gy TOSEPN T- 54,e,6AG.4L L d , .P S. ....R MsTs WlrNES.SE� 8Y : /yJ.` Gr,q ,c - /N RasAt/• 13.M • by N.;V.r Cc S so e a 10"-OS ENS - PLAAl e DFSlaw GelrEiel.4 OF Z "'� �••� �SEAcED /icl7', �So�/o. Pile. e. P/PE Ole •' . L46 aE4'y��PCe?FICA7 PYC. /PE �O�e EQc//vALENT� p � a 4,eT/AL Z3ED EyD �S�ECT/D AJ _ h ALE �2 a=/��•! �2EA ` qo c 'cS 110 F0:2 PEC/F/C�!T/Oil/S — SEE sECT!OAI A7- rt! _ 1 DoTelsarl &x ' � �•SGtG/� ��/.C.,SEALED TO/NTS l �;�J /7y%1f 4FJ vZ�`� �B.SO.e PT/ON �ED !DL AE: !V �• � � � N �� ���' /CLOT TQ CSCALE IS' Aa- �TO IV Soe N � •t91 P/FLS - - , � r-+.. t 1 4 _vao ,t_ • . . G2US E� STO.vE • titi � • -178 - V - i'77 oCP eE� e e e EOc//vAc ©ENT V � � fit ~' r - i'75 ic7 O i7♦ -s�¢"TO / WASHED O ti d � G�!/SNED STONE Q O � 173 �LbUBGE w4sNE1 ry MEET A.4.s'N.O. 5• Fl L5/• i 7.� o C A /.y .6.e a .e PL ccs /o/ .46.5oRp7-lOA/ 9ED cYEC T/O!v 7-yo lvS: R,a.Fi/L_leZ z to _I —ov,4 ye L 5:46E 0 •• •, --- ALE NO.e. ��/_¢D YE�2T. ~"¢ P"F/L E 4",o BEp PLA�v AAlAo SK T/ONS Sg4EE T 2 OF FORM - SYSTEM PL11PL\G RECORD gOF ND OF HEA LAVER/ Commonwealth of Massachusetts Massachusetts c�� "A`l I U �. System Pumping Record -stem Owner System Location 170 Date of Pumping: Quantity Pumped: gallons Cesspool: No Yes ❑ Septic Tank: No ❑ Yes ,2 System Pumped by. __ License #: Contents transferred to: ' Date Inspector SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 1111111111 }-1 ^� TOWN OF NORTH ANDOVER/ Address of property IO JOIAh»�J C0.�CBOARD OFhEA�7H owner's name ::Sei S Date of Inspection Y-,;9 r,��s spy 101995 "t PART A CHECKLIST Check the following have been done: Pu ping information was requested of the owner, occupant, and Board of ealth. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that Zyspeiod. Large volumes of water have not been introduced into the tem recently or as part of this inspection. Zeailable uilt plans have been obtained and examined. Note if they are not As with N/A. facility or dwelling was inspected for signs of sewage back-up. e site was inspected for signs of breakout. 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, m erial of construction, dimensions, depth of liquid, depth of Judge, depth of scum. T size and location of the SAS on the site has been determined based n 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. 8 II; SUBSURFACE SEWAGE DISPOSAL SYSTEM . INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS If residential number of bedrooms number of current residents _ garbage grinder, yes or no laundry connected to system, yes or no O seasonal use, yes or no If nonresidential, calculated flow: Water meter readings, if available: Last date of occupancy GENERAL INFORMATION Pumping ecord andource of information: ©C19,3LI .-0WVNeX- �S System pumped as part of inspection, yes or no if yes, volume pumped 1,5W cz.VVlloh-5 Reason for pumping 1�ns�ec,� Se P C- Type 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: �L}2CJl�"S Jam'' b Ui IA- 21Ctit-�. NQ- Sewage odors detected when arriving at the site, yes or no L 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B ✓ SYSTEM INFORMATION continued SEPTIC TANK: (locate on site plan) depth below grade:— 8 material of construction: concrete metal FRP other(explain) dimensions: �� x y'G X x "� '— 1 SO0 QJ61S sludge depth distance from top of sludge to bottom of outlet tee or baffle alr 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 Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, idencq of leakag , re ommend tion for :repairs, tc. ) *CKj le, NC) q h r 00-V C24- C-1 DISTRIBUTION BOX: (locate on site plan) depth of liquid level above outlet invert Comments: (note if level and distribution is equal, evidence of solids carryover, eV 'd nccceof leakage into of b �,b� commendati n for re al c. ) d 7C C C ` c> PUMP CHAMBER: Oh \P (locate on site plan) �1 pumps in working order, yes or no Comments: (note condition of pump chamber, condition of pumps and appurtenances, recommendations for maintenance or repairs,etc. ) 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' /AA \(\V)Se- A-- 71 $ .S - -o S3 is DEPTH TO GROUNDWATER 0 depth to groundwater method of determination or approximation: 1�,�- 12 SUBSURFACE SEWAGE DISPOSAL SYSTEM 'INSPECTION FORM PART C FAILURE CRITERIA Indichte yes, no, or not determined (Y, N, or ND) . Describe basis of determination in all instances. If "not determined", explain why not) NBackup of sewage into facility? Discharge or ponding of effluent to the surface of the ground or surface waters? Static liquid level in the distribution box above outlet invert? N Liquid depth in cesspool <6" below invert or available volume< 1/2 day flow? NRequired pumping 4 times or more in the last year? number of times pumped Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? i N Is any portion of the SAS, cesspool or privy: below the high groundwater elevation? Nwithin 50 feet of a surface water? 'v within 100 feet of a surface water supply or tributary to a surface water supply? within a Zone I of a public well? 'v within 50 feet of a bordering vegetated wetland or salt marsh (cesspools and privies only, not the SAS) ? Nwithin 50 feet of a private water supply well? ' 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. 13 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION Name of Inspector KOM Sck1 Company Name ! V� Company Address 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-site sewage disposal systems. Te one: I have not found any information which indicates that the system fails to adequately protect public health 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. I have determined that the system fails to protect public health and the environment as defined in 310 CMR 15. 303 . The basis for this determination is provided in the FAILURE CRITERIA section of this form. Inspector' s Signature Date Original to system owner AV, Copies to: Buyer (if applicable) Approving authority Town of North Andover, Massachusetts Form No.3 f NorerM BOARD OF HEALTH o 19 IL .7 CHU`�tf' DISPOSAL WORKS CONSTRUCTION PERMIT S^CMUSE Applicant — NAME E' x�J ADDRESS Site Location J TELEPHONE Permission is hereby granted to Construct ( ) or Repair an Individual Soil Absor tion Sewage Disposal System as shown on the Design A p g Approval S.S. No. CHAI MAN, BOARD-AF HEALTH Fee D.W.C. No. Q — r 4 .. Health ,... .4hdc-ver,?Sass ' SUBSURFACE DISPOSAL DESIGN CHECK LI'." LOT APPROVED DATE C DISAPPROVED DATE_„ Provided: Reasons: Nf7 IU l`JO�� Title V FAILI1� L(� Reg 2.5 The submitW VSE9 3o� S� Au C- &W-riolV5 . a) the lot U 'J b location I c location a � d design ca] l�� t� Fog Id 4t�N,P 0,c (e)jo cation i f) existing i (g) location i disclaimer - _ (h) surface at system or , (i) location i system or � (3) known sow -- ---- - system or disclaimer (k) location of any proposed well to serve 1 ii 1001 Brom leaching facility (1) location of water lines on property-101 'rom leaching facility (m) location of benchmark (n) driveways (o) garbage disposals (p) no PVC to be used in construction (q) profile of system-elevations of basement, plumb, pipe, septic tank, distribution box inlets and outlets, distribution field piping and Other elevations (r) maximum ground Water elevation in area sewage disposal system (s) plan mast be prepared by a Professional Engineer or other professional authorized by lax to prepare such plans Reg 6 Septic=Tanks capacities-150% (a) -a�p—a�-c�ities-150% of flog, water table, tees, depth of tees, access, pumping (b) cleanout (c) 101 from cellar wall or inground swimming pool (d) 251 from subsurface drains Reg 10.2 Distribution Boxes (a) s pe greater than 0.08 Reg 10.11 b) sump ` 0f HEvm t-o-r q j JowvtiW,4t�g;7 (�gtGf� S�Pf%(.7 bt,�nl D WEU- 6 Ec,c _ �PoyCDlYJTC— — SSy 5t�r1c SY s i ,� OcSI 6A Appl�ovl5v ' IJPR vO �v6 /3ouloi iry �I�QPPPo vEp DgiE R�45oNS �X4V4T(o,�J )"cn�-6-toti VA -t-r/ass E] F41L PINAL t�SpF�rlo� aSA '�Dv�i7 DarC FK AL APPi?DVAL D,o�� - D �"