HomeMy WebLinkAboutMiscellaneous - 711 DALE STREET 4/30/2018nn
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MAP # LOT it _-....? .....L.__}.. D.. ..__&".
PARCEL # - STREET.__.-.)._.LJ.........C,-iZ.�......5... ..
CpNSTRU.CT I.ON..,._APPROVAL
HAS PLAN REVIEW FEE BEEN PAID? / YES NU
PLAN APPROVAL: DATE �Cldl�oL APP. BY....
........... ......... ..
DESIGNER: _ PLAN Dfl fE:--7�7/,?Z__...._
CONDITIONS
WATER SUPPLY:
WELL PERMIT
WELL TESTS:
COMMENTS:
TOWN WELL �G ./y, yto Ui'1
DRILLER
_., let[ ..0 ,
CHEMICAL DA I E f)Pl-'RUVEU..f/074 /%21
BACTERIA I Df-l1E (W"PROVED/�2
BACTERIA II DALE APPRUVEU
FORM U APPROVAL: APPROVAL I'D ISSUE YE NU
DATE ISSUED 8Y_�/
CONDITIONS:
FINAL APPROVAL:
ALL PERMITS PAID rdU
WELL CONSTRUCTION Ar-'PROVAL YES NU
SEPTIC SYSTEM CONSTRUCTION APPROVAL, NO
OTHER YES-- NU
ANY VARIANCE NEEDED YESN_U .i
FINAL BOARD OF HEALTH APPROVAL: DA l E : 211()193 E y : /,%
SEPTI.G.__.Y_SZ.M__ZNS..T._9.4.Lr3LL.QM
"IS THE INSTALLER LICENSED?
TYPE. OF CONSTRUCTION:
NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW
CONDITIONS OF APPROVAL
(FROM FORM U)
Y rp
YES
NO
REPnIR
YI=S
1\J(]
YES
NO
ISSUANCE OF'DWC PERMIT YES NO
DWC PERMIT NO. l INSTALLER:_Tlm ,/� /�wle.___
11
r
AS BUILT PLAN SATISFACTORY :YE5�
APPROVAL• TO BACKFILL: DATE:
FINAL GRADING APPROVAL: DATE o� Ile / BY ��1/ G
FINAL CONSTRUCTION APPROVAL: DATE: 211 /11 -.BY-
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 or requirements.
*****************************APPLICANT FILLS OUT THIS SECTION***********************
APPLICANT J0�i/ �,va >/ %GPHONE '28' 6 S' 3 T3 c-/4/
LOCATION: Assessor's Map Number.
SUBDIVISION
PARCEL
LOT (S)
�O STREET "T. NUMBER 7 IJ
( ************************************OFFICIAL USE ONLY***********************************
RECOMMENDATIONS OF TOWN AGENTS:
CONSERVATION ADMINISTRATOR DATE APPROVED
DATE REJECTED
J�
COMMENTS
TOWN PLANNER
COMMENTS
FOOD INSPECTOR -HEALTH
SEPTIC INSPECTOR -HEALTH
COMMENTS
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
PUBLIC WORKS - SEWERANATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR DATE
Revised 9\97 jm
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INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Department's having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state lav,
regulations or requirements.
****************Applicant fills o this
Phone
✓6 CATION: Assessor's Map Number Parcel
Subdivision Lat(s)
Street J St.* Number
use Only***************** *** **
RECOI*=ATIONS OF TOWN AGMTS :
/ Data Approved
Conservation Administrator Data Rejected
Comments
Town Planner
Comments
Date Antroved
Date Raj ec ted
se?�c� �+411oti
V q
/C Data Apprcved / ,�2 4,
Healt:: agent Data Resected
Comments
Public Wcr';s - sewer; water ccnne=-ions
- driveway pe=it
Fire Denar en -m
Recaived by Building Inspector Date
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Depar-tments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state lav,
regulations or requirements.
****************Applicant fills o this
✓PLICANT: 2 lam. Phone
✓IACAT20N: Assessor's Map Number Parcel
Subdivision / Lot(s)
Street // St. Number__
************************Official Use Only************************
RECOMw=ATIONS OF TOWN AG=S:
/
Data Approved
Conservation Administrator Data Resected
Comae_nts
Town Planner
Comments
Data Arrroved
Date Rejected
/ stere. �+4Ttoti
3/ 1I'D Date Approved
Healt:: Agent Date Rei ected
Public Works - sewer; water connections
- dr-ve*nay pe=it
Fire Denar en -
Received by Buildina T_:7S:.e==r Date
r
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Depa*'f'R++ents 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 o this section*****************
I✓PLICANT: �� Phone l,
,,LOCATION: Assessor's Map Number Parcel
Subdivision Lot(s)
Street /i St. Number_
************************Official Use Only*************** ********
RECOM CMATIONS OF TOWN AGZ ITS :
/ Date Approved
Conservation Administrator Data Rejected
• Comaents
Data Antroved
Town Planner Date Rejected
Comments
sc�[c �4i7o�
�J9
Date Ar -rover;
7/Z-
Healtt Agent Data Rejected
Ccmments
Public Wcrks - sewer water ccnne=tions
- driveway per--i--
Received
eryit
Received by Building Inspectzr Data
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Tank IN
Tank OUT
D -box IN
D -box OUT
Trench Inverts
AS -BUILT CHECK LIST
and
FINAL INSPECTION
Proposed Elevations
!� 9 78
%
26
Line 1
/G 4, 26. -
.-Line
Line 2
- // z, ,0O
Line 3
Line 4
Bottom of Exc.
Stone OK? ✓ D -box checked?
As -Built Elevation
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16v'` /�_I_
Pipes cemented?
Town of North Andover, Massachusetts Form No. 2
NORTq BOARD OF HEALTH
a� • �` ' °�_ 19-1—
F w
A
i ���•' i DESIGN APPROVAL FOR
^aw r SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
(4Applicant Test No.
Site Location 3 1 o—kA S
Reference Plans and Specs
iei
Permission is granted for an individual soil absorption sewage disposal system to be installed
in accordance with regulations of Board of Health.
CL
Fee
.. CHAIRMAN, BOARD OF HEALTH
Site System Permit No. JSLq �
Town of North Andover, Massachusetts Form No. 3
f ,&ORTII BOARD OF HEALTH
i�
..4. ° 19t
� 9
•°.,.,o.•"� DISPOSAL WORKS CONSTRUCTION PERMIT
,SSACNUS��
Applicant / /Mi11/1V
NAME ADDRESS TELEPHONE
Site Location
Permission is hereby granted to Construct (L--ur Repair ( ) an Individual Soil Absorption
Sewage Disposal System as shown on the Design Approval S.S. No.
Fee ��U'
-CHAIRMAN, BOARD OF HEALTH
D.W.C. No. (: ���Z
� rv�, °-�
�r ���
a
NEW ENGLAND RADON LTD.
N E R 45 Stiles Road, Suite 206
Salem, New Hampshire 03079
WATER ANALYSIS RESULTS
NAME: YOUNG BROS. PUMP CO. DATE: 20 -Aug -92
36 PELHAM ROAD
SALEM, NH 03079
SAMPLE LOCATION: a 711 DALE STREET LAB.# 5540
NORTH ANDOVER, MA
603-893-4260
WATER MEETS Tested by:
FHA REQUIREMENTS -------- - -- ------------
(Note) 5 NTU is acceptable for non -surface waters.
NOTE: FHA has no maximum std. for Hardness. FHA recommends 50 mg/l
FHA MINIMUM
TEST
RESULT
REQUIREMENTS
STANDARD
MIN.
MAX UNITS
HARDNESS .............
103.8
0
75 mg/l
EPA Soft
IRON .................
0.01
0
0.3 mg/l
Secondary
MANGANESE............
0.013
0
0.05 mg/l
Secondary
pH ...................
6.70
6.5
8.5
Secondary
TURBIDITY.....(Note)
0.12
0
1 NTU
PRIMARY
CHLORIDES....:.......
40
0
250 mg/1
Secondary
NITRATES .............
0.3
0
10 mg/1
PRIMARY
NITRITES .............
0.001
0
1 mg/l
PRIMARY
COPPER ...............
0.01
0
1 mg/1
Secondary
SODIUM ...............
24.0
0
250 mg/1
Secondary
TOTAL DISOLVED SOLIDS
168
0
500 mg/1
Secondary
COLIFORM BACTERIA....
0
<1 Colony/100 ml
PRIMARY
NON -COLIFORM BACTERIA
2
<200 Col./100 ml
PRIMARY
COLOR
0
0
15 C.U.
Secondary
ODOR
ND
0
3 T.O.N.
Secondary
WATER MEETS Tested by:
FHA REQUIREMENTS -------- - -- ------------
(Note) 5 NTU is acceptable for non -surface waters.
NOTE: FHA has no maximum std. for Hardness. FHA recommends 50 mg/l
EM. YOUNG
o ARTESIAN WELL
CO.
36 PE.LHAM ROA I)
SALEM, NH 03079
(603) 898-2504
Mr. Thomas Zahoriiiko
185 Hickory Hill Road
North Andover, Mass
TERMS: PAYABLE UPON RECEIPT OF INVOICE. All invoices subject to 2%
Interest charge per month on the unpaid balance after 30 days.
JOB INVOICE
PHONE
DATE OF ER
8-� -92
ORDER TAKEN BY
XX)DAY WORK XX2CONTRACT O EXTRA
JOB NAME & NUMBER
Lot 31A
JOB LOCATION 711 Dale Street North
JOB�yQA{E 2 6 3 5
STARTING DATE Andover
gallons per minute - 60
static water level - 10'
QTY.
MATERIAL
PRICE
AMOUNT DESCRIPTION OF WORK
drilling of a 6" water well
305'
depth of well @ $7.00
2135.00
'
casing depth @ $6.50
_
1-6-9.-00
�!6 t9 -
1
drive shoe seal
65.00
1
steel well cap
20.00
_
- OTHER CHARGES
1
town permit fee
50.0
3/4 HP submersible pump
m -t
c ante -r-,—
trench work to take water
,
TOTAL OTHER
I clual-ity test
900'_U LABOR
HRS
RATE
AMOUNT
ump -s
installation to be billed
upon ompletiQn of work
tank and all electrical
controls
W a. CC '7 e,st-
total amount due
3'. TOTAL
LABOR
TOTAL MATERIALS
TOTAL MATERIALS
Signature
TOTAL OTHER
TAX
TOTAL
NUMBER FEE
,551 THE COMMONWEALTH OF MASSACHUSETTS $25.00
........T_0-wN-_ of --------- NORT-Ii.-ANDOVZR---------------- -------------
This is to Certify that ........... -.-M-.-!----- I .......................................
NAME
36 Pelham..Road, dl.. --Salem..... N . H .... 0 09.....................
.-_.
ADDRESS
IS HEREBY GRANTED A LICENSE
For--------------------------------------We Well Drilling --- Permit-----------------------------------------------------------------
..---------•-----7.1.1---- Dale Stye -e -t ---- Lot#3-1-A) ---- North . Andove-r-r---MA---41-8-4.5---------------
---------------------•----•-----------...---------------------------------...---•-•--------•---------------...--.....-----•--------------....--------.....................
This license is granted in conformity with the Statutes and ordinances relating thereto, and
December 31, 1992 _--4uless nsoon or
expires -- e . ....... .... .
August 12,92 ..... ............
-------- 19 ... ----------- . ---- -----.................
------ ---•----------•. , --- - ---------------- -----
��,tic- -----------------------�
FORM 433 HOBBS a WARREN, INC.
FORM U
TOWN OF NORTH ANDOVER
LOT RELEASE FOIUI
SUBDIVISION FORM A
ASSESSORS MAP ��p loq e- Ll 31
SUBDIVISION LOT(S) Lo -1 3 A
PERMANENT ADDRFSS (ASSIGNED BY D P.W.
STREET I f4 --z1 a 1n a C4,. aL. 0- A— 0 � ,
APPLICANT Sr0o 10,K Momai ZaL'tkp) PHONE -373-0(o?
DATE OF APPLICATION 16/3b�� 2
DEPARTMENT OF PUBLIC WORKS
DRIVEWAY PERMIT oD1��ilIAJnZ/�
i
SEWER/WATER CONNECTIONS Iyp U-1 !tet' 1y q ,
FIRE. DEPT. �" .(-
RECEIVED BY BUILDING INSPECTION
DATE
This form shall be signed by the agents of the Planning and health Boards,
the Conservation Commission prior to the issuance of any building permits
for the subject lot. This form shall not releive the applicant from the
compliance of any applicable Town requirement or Bylaw.
TOWN USE BELOW THIS LINE
PLA NING BO
LA
DATE
APPROVED
'7. •��
TOW PL NER
DATE
REJECTED
CONSERVATION COMMISSION
DATE
APPROVED
CO SERVATION ADMIN.
DATE
REJECTED
BOARD OF HEALTH
�
DATE
APPROVED
��`�A�
HEALTH SANITARIAN
DATE
REJECTED
DEPARTMENT OF PUBLIC WORKS
DRIVEWAY PERMIT oD1��ilIAJnZ/�
i
SEWER/WATER CONNECTIONS Iyp U-1 !tet' 1y q ,
FIRE. DEPT. �" .(-
RECEIVED BY BUILDING INSPECTION
DATE
This form shall be signed by the agents of the Planning and health Boards,
the Conservation Commission prior to the issuance of any building permits
for the subject lot. This form shall not releive the applicant from the
compliance of any applicable Town requirement or Bylaw.
��ojpa
DATE %/3/ /9
Sheet of
BOARD OF HEALTH
TOWN OF NORTH ANDOVER
SUBSURFACE DISPOSAL DESIGN REVIEW
FEE PERMIT # y-5~ DATE RECEIVED2z
APPLICANT �(}/K, �m211 /�. ASSESSOR'S MAP
ADDRESS
ENGINEER Ilowe 5uryey/�A
ADDRESS 73 '�'rl,'cefyn - Che%sfd.
PLAN DATE 171f Z
CONDITIONS OF APPROVAL:
APPROVED
DISAPPROVED
PARCEL #
LOT # 3/
STREET # 7//
gl7lq Z
REVISION DATE -
1, M 155/N6
�ooSgST To �aUst .
,�� ���v�cv�-y �--�ouND�-T�o� �I�.9�N (/U.,19• � •bad ,�v�
,1oZes CN A. (, o,� J )
�, NEED /5%9/Ue�s of 51,57—eM COAPolU�t-)UTS T-6
/Veeb D DiTioNA-, TEST 116 L,— /YV V/C/1v/7y 0l%
# ,� Ti�'�/VC 14
� . lV EED DV D R7 -H ARRO U-) O Al' 5 /TE 7>z (N. k 6, 09 0-
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to. S1160J 5. r4YK IMIW161--E TO
AUDTE T-/fAT ZXCAVi4T/o1y sN.9l<EXT�/YD Ar �e/�57' /NT -0
CN.A. a,/8) �,.
PLAN REVIEW CHECKLIST
ADDRESS Zale ACL./ (/- '31a' ENGINEER
GENERAL
3 COPIES f/ STAMP (/ LOCUS /j SCALE L/ CONTOURS --
PROFILE_SECTION_L,,::�- BENCHMARK ✓ ELEVATIONS %� SOIL
& PERC INFO WETS. DISCLAIMER — WELLS & WETLANDS
WATERSHED? DRIVEWAY (Elevations) WATER LINE—z--
DRAINS
INEz-DRAINS k n SCH4 0 ,'!� SLOPE v TESTS CURRENT?
SEPTIC TANK
MIN 1500G. t/ .17 INVERT DROPy' GARB. GRINDER(+200% EDF)
25' TO CELLAR MANHOLE TO GRADE -- ELEV GW
D -BOX
SIZE i33los- �ig # LINES FIRST 2' LEVEL STATEMENT ✓
INLET /6 y. y3 - OUTLET -/7 ( 2 " OR .17 FT)
LEACHING
RESERVE AREA fi/ 4' FROM PRIMARY? 100' TO WETLANDS 2% SLOPE(f
100' TO WELLS(/ 325' TO SURFACE H2O SUPP 35' TO FND & INTRCPTR
DRAINS 4' TO S.H.GW 4' PERM. SOIL BELOW FACILITY MIN
12" COVER ✓ FILL? (25' f above natural elevation; 101if below)
TRENCHES
MIN 660 gpd SLOPE (min .005 or 6"/1001) --*� >3' COVER? - VENT
SIDEWALL DIST. 2X EFF. W OR D (MIN 6') ✓ IS RESERVE BETWEEN
TRENCHES?(,--' IN FILL? MUST BE 10' MIN. L"' 4" PEA STONE?
BOT g00 X LDNG + SIDE 400 X LDNG = TOT
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Town of North Andover, Massachusetts Form No. 1
AORTH BOARD OF HEALTH
3�, oy ss`eo ba6+0� -19
O v A
co m
APPLICATION FOR SITE TESTING/INSPECTION
Applicant in n. �► Y� C��c.� �J ] 1 �_ L
NAME ADDRESS 'TELEPHONE
Site Location �f b I V �
Engineer
Test/Inspection Date and Time
<< CHAIRMAN, BOARD OF HEALTH
Test No. r , " I
S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No.