Loading...
HomeMy WebLinkAboutMiscellaneous - 712 SHARPNERS POND ROAD 4/30/2018.F- Liebe Mutual. INSURANCE September 12, 2014 Town of North Andover Attn: Building Inspector 120 Main Street North Andover, MA 01845 Liberty Mutual Insurance New England Region Central Property Unit 75 Sylvan Street Danvers, MA 01923 Tel: (800)566-0323 Re: Property Address: 712 Sharpners Pond Rd, North Andover, Ma 01845 Policy Number: H3221808344570 Underwriting Company: Liberty Mutual Fire Insurance Company Claim Number: 030525326-0001 Date of Loss: 9/2/2014 Attn: Town/City Official Pursuant to M.G.L. c. 139, § 3B, please be aware that a homeowners insurance claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or causes the condition of a building or other structure to render Mass. General Laws, Ch. 143, § 6 applicable. You are required to notify Liberty Mutual by certified mail in accordance with Mass. General Laws Ch. 175, §99, if you intend to initiate proceedings designed to perfect alien pursuant to Mass. General Laws, Ch. 139, § 3A & B, or Mass. General Laws, Ch. 143, � 9, or Mass. General Laws, Ch. 111, 5 127B. This letter should not be construed as a waiver or estoppel of any of the terms, conditions or defenses afforded by the policy or applicable law. Please direct your notice to the attention of the undersigned and include a reference to the above captioned property address, policy number, claim number, and date of loss. Sincerely, Liberty Mutual Support Liberty Mutual Insurance New England Region Central Property Unit 1-800-566-0323 {This certifies that. 1. has permission for gas installation . 'S� P-rjA,-:zl , in the buildings of .. ���. 7_„ Z.0 ... .. , , , at ....... 7�. ,,,�� S , , P�-. rj 4orth Andover, Mass. Fee. Lic. No. Z.`i GAS INSPECTOR Check 8592 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY MA DATE - Si PERMIT # JOBSITE ADDRESS OWNER'S NAME FW GOWNER _ ADDRESS , ] I T _ c TEL-- ` jFAX ..---�— TYPE OR OCCUPANCY TYPE COMMERCIAL i EDUCATIONALRESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: i PLANS SUBMITTED: YESF-11 NO Q APPLIANCES Z FLOORS, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE��?_ .- GENERATOR_J ,_,_I, _�. _l _.� ! L r�! _ _.I. (LTi,! __ —^�1 I _ :! _ _1 -.-! L__ .__ I GRILLE INFRARED HEATER _ . _ ..-C I--! ---P-__�_,_T-_ -->- . _. LABORATORY COCKS %I -I ! - I , _ �_ I _.-1 L__ MAKEUP AIR UNIT OVEN POOL HEATER JI -�_ _ )�_ .1L J ROOM I SPACE HEATER -[-1- ROOF TOP UNIT- ..�-1 :.— = __.. _�. =T.. :-- ._ - -_. ---1 �.._ ( TEST UNIT HEATER uNVENTED ROOM HEATER !.. , I,.._J!!!- WATER HEATER OTHER 1-_______ _ !r ._ti1. I_ I I__ . I--�! • -�.. I �-I� - .. I INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES/ NO 0 1 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ( OTHER TYPE INDEMNITY ©. IE BOND El OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER F-11 AGENT 0 SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent pr ' ion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER-GASFITTER NAME LICENSE # 73 NATURE MP MGF JP JGF F-1 LPGI 0 CORPORATIONF- =PARTNERSHIP , ..l #�___._.-n._..II LLC [�# COMPANY NAME:._ __. n ADDRESS CITY STATE 1ZIP 6 . U]TEL „663=�5`(- FAX CELL[ EMAIL ____ __ __ _ _ _1. ON y ❑ W CL ,V, The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers l Name (Business/Organization/Individual): -q-4 Address: L City/State/Zip: `'A&f-s�— ,4% 4 3 3 Phone #: (lo O '3 '-5— -�1`" Zf Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* have hired the sub -contractors listed on the attached sheet. E] Remodeling 2. I am a sole proprietor or partner- ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9• ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] 3. ❑ I am a homeowner doing all work officers have exercised their right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12,0Roofrepairs insurance required.] r employees. [No workers' 11 ❑ 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 ate 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 thepolicy and job site information. Insurance Company N Policy # or Self -ins. Lic. Job Site Address: Expiration Date:. 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 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. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. 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 #: Information and Instruction's - Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract ofhire, 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 of the foregoing engaged in a j oint 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, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall 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, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic 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 certificate(s) 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 maybe 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 city or town that the application for the permit or license is being requested, not the 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 number listed 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 permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license 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. Where 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 burn 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 Mossachmetts Department of industrial Accidents Office of Investigations 600 Washington. Street Boston, M.A. 0.2111 Tel, # 617-727-4900 ext. 406 or 1-877,7MASSAFE Revised 5-26-05 Fax ## 617-727-7749 www.mass.gov/dia a Division of Professional Licensure: License Search The Official Website of the Office of Consumer Affairs and Business Regulation (OCABR) Division of Professional Licensure Mass.Gov Home State Agencies A -Z Topics Home > Division of Professional Licensure > Check A Professional License By the Division of Professional Licensure SEARCH CRITERIA Profession: Plumber 3 Last Name: beginning with teonard First Name: beginning with john City: amherst State: nh Zip Code: 03031 LIC. BOARD LIC. TYPE LIC. NUMBER LIC. STATUS NAME CITY/STATE Plumbers & I Master Plumber 1132 JOHN A. AMHERST, l Current Gasfitters i �L ON R 1 NH Plumbers Et Journeyman 25690 JOHN A. AMHERST, Current Gasfitters Plumber LEONARD NH Your search has resulted in 2 licenses Note: If the licensee cannot be found by name and the name typically has apostrophes, spaces, hyphens or periods try doing the search again without these characters. Examples: If the last name is "O'Donnell", try searching for "ODonnetl" or "O Donnell" If the last name is "McDonald", try searching for "Mc Donald" If the last name is "St. Helens", try searching for "StHelens" or "St Hetens" If the last name is "Jones -Doe'. try searching for "JonesDoe" or "Jones Doe" The page above has been generated by the Division of Professional Licensure web server on Wednesday, January 30, 2013 at 10:03:39 PM. © 2007-2011 Commonwealth of Massachusetts Page 1 of 1 Mass.Gov ONLINE SERVICES Check a I-.icense Locate a Licensed Professional Online Address Change Contact the Agency More... REFERENCES & RELATED INFO Disclaimer Regarding Website License Searches Enforcement Process Glossary Glossary of License Status Codes fAwe... Site Policies Contact Us http://license.reg. state.ma.uslpubliclpubLicRange_asp?profession=Plumber&lName=leonar... 1/3012013 fx s GENERATOR APPLICATION DATE: I'- Z -1 -3 LOCATION: ILS river -�crcl kd t Igor" 1' ndrvler OWNERS NAME: Miaae i GENERATOR kw 2Q k -Lk) NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* j) CONTRACTOR: PHONE NUMBER: N- - -155 - g wo } ELECTRICAL GAS RESIDENTIAL COMMERCIAL TEMPORARY j LOCATION OF GENERATOR: *ZONING DISTRICT: l0 *CONSERVATION APPROVAL 5c4f-_rl 1 `7-01 iz_ Emergen%y s sfi lbw Er and Cheirrtist`t�r�,1V���82�#,, 47' SO -8800 Conservation Department, �Ve have a property p y t hat is installing a generator, there is conservation land on this property and we would like to see if we can get approval with the enclosed plot pictures. I If there is a site visit needed to confirm location, please call us at 978-458-8800. 712 Sharpners Pond Rd North Andover MA 01845 Thank you, Denise Lloyd/Office Manager Emergency Power Generators of New England Coleman Light & Power r i. SAndover MIMAP 56 105.D-0057 #1041 I _ Meters Data Sources: The data for this map was produced by Merrimack 105.D,-0180: Valley Planning Commission (MVPC) using data provided by the Town of North Andover. Additional data provided by the Executive Office of Environmental Affairs/MasaGIS. The information depicted on this map is It be for legal boundary L p for planning purposes only. may not adequate definition or regulatory interpretation. THE TOWN OF NORTH ANDOVER • � ' alb:cJ� �- - " :,ali: - - ,lu .:':,Ile THE ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY i .^ ♦ OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION •:=:_ • wits ii.'..; •::' J��..:: 105.D-0183 Iii if�� �k i�•. 105.D-0181 `J ..... 105.D-0184 #700 IT ,Uu #684 105,D-0185 105.D-0004 #672 • 105.D-0186 #6fi0 Rail Line rstates Interstate Major Roads Roads Easements MVPC Boundary Municipal Boundary Trails Parcels Hydrographic Features Streams Wetlands Exempt Lands 1" = 148 ft L05.D-0177 1fl5.D-0178 193 #1055 #724 November 20, 2012 105.D-0179 105.D-0003 #740 105.D-0182 0 Ge IAPI P-404— of 6.1 #7 , J� .'�; it ::iii' •ykl✓ :�. :3�1�?� . ��,� - •Jg�y:: �<i:'i�lOS.D=U164 090:B'0009 c :=r: \ 105,D-0166 Horizontal Datum: MA Stateplane Coordinate System, Datum NAD83, Meters Data Sources: The data for this map was produced by Merrimack pORTI� Valley Planning Commission (MVPC) using data provided by the Town of North Andover. Additional data provided by the Executive Office of Environmental Affairs/MasaGIS. The information depicted on this map is It be for legal boundary L p for planning purposes only. may not adequate definition or regulatory interpretation. THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING * THE ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY i .^ ♦ OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION Date .1 - D... . TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . C� I...P � �N� l ... '.... ``k . ........... has permission to perform . .................... wiring in the building of ..... L, 2-2-o . ............... at..'. .�. ., ... ?t�I.c� c� p. I) — P�, North Andover, Mass. Fee.. "17.. Lic. No.26! * (-).. Mt.... . ELECTRICAL INSPECTOR Check # 11340 use ody 0ccvpuW=djWCbmAmd BOARD OF Fitt PREVENTION REGULATIONS ptev. M APPUCATM FOR Parr TO PERFOPA QCT C WORK (JPLfetWpAaVr MjNKURTPPLALLAWORAW t;. To 9*9 -- =-Wd*doscrbwbdow.Sho Y. iZ OOZY; lle :� :..::...uww_ cr1 r2c! c �.:.: li 5 - } rtes. No 0 iC2m'xApp r ofFeedm sag Am"ft .oma Vafm-ot a wod # 7- {atm steed �r ►? %im usi +ediwftmmnw €orft Iis inane; I— WIDOW dovelmit isoft offim afdec�icat�ad��l�saeuoies's the �i0C8o0ep:0�de.4p�oofo�'Tmwcadoam'�e�PR�llsw3o � cmm 2» 9th Rolm ❑ t Q Of a IasdnedGamprefF�+Y,�aat s�a�rsstds�opeaisAand p1rr4.. air" �►�Nod- am C4 Ira -&f Alt.'Pd.anb No'.. LCTJ.G i4'l ss -lb A.S7�i1 •se►lop �,7�...._ ..ar.�. ___._...� . . OZ'S il��AKCE WAlvM- I a�a awaoe �e 1�oa�oe dons sot lima ire ire eoe�pc :vge�ed by isw . By air b � i �y "i - pi mom' i mm �e Ecbect aoc) ❑ a ComessamL � W - 7, ��l ,,,g � - 1, �, , ofCdL4MSp6 ;Ki►7AA GflWTWx .. otOstleto ottces 0 otB,eoetsde oto FALk crowd - stAircm& De�rloes . otWas�eH�sas � nudog lcWAin' BCW paw _ ofor."=, Boman JcW Bates #ec�erioessr .oma Vafm-ot a wod # 7- {atm steed �r ►? %im usi +ediwftmmnw €orft Iis inane; I— WIDOW dovelmit isoft offim afdec�icat�ad��l�saeuoies's the �i0C8o0ep:0�de.4p�oofo�'Tmwcadoam'�e�PR�llsw3o � cmm 2» 9th Rolm ❑ t Q Of a IasdnedGamprefF�+Y,�aat s�a�rsstds�opeaisAand p1rr4.. air" �►�Nod- am C4 Ira -&f Alt.'Pd.anb No'.. LCTJ.G i4'l ss -lb A.S7�i1 •se►lop �,7�...._ ..ar.�. ___._...� . . OZ'S il��AKCE WAlvM- I a�a awaoe �e 1�oa�oe dons sot lima ire ire eoe�pc :vge�ed by isw . By air b � i �y "i - pi mom' i mm �e Ecbect aoc) ❑ a ComessamL � W - 7, ��l ,,,g � - 1, �, , i 1�6 &k- '-4 - 7- ('� P144 The Commonwealth of Massachusetts Department of Industrial Accidents Office of InveWgadons ' 600 Washington Street Boston, MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): dQle to al) L4 % A,zqj Address:f�-�- City/State/Zip: Are ypu an employer? heck the as 1. I am a employer employees (full and/o 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t d/WPhone #: riate box: 4. E] I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.: 5. F1 We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comm insurance required.] Type of project (required): 6. ❑ New construction 7. Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11.0 Plumbing repairs or additions 12.0 Roof repairs 13.0 Other *Any applicant that checks box #I 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 state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. 2-1 , I , n / Insurance Company Name: Policy # or Self -ins. Lic. #: �,�(, d I/V (. Expiration Job Site 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 a dcr Section 25A of ML 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 hereby certify under Jhj(pains and of perjury that the information provided above is true and correct 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 #: i GENERATOR APPLICATION DATE: 1Z12711L LOCATION: �Q-.Skefp N,2-,6 OWNERS NAME: ��l+c��+�I LUZ-Z-0 GENERATOR kw NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR: Lf PHONE NUMBER: qlb- LI �J �6bro ELECTRICAL RESIDENTIAL 5,e e— a N E RA R • I-� � � -� w�S-e LOCATION OF GE TO 44 , GAS ^ eap � �s— COMMERCIAL TEMPORARY *ZONING DISTRICT: PAV�� eXlh�j `CONSERVATION APPROVAL `� Ila o tY6 (,,�4 Vat^\ ' 6r7(""4" c�A-A\,a w0Q�� c�l� 1�21IIZ slxlu � Q EMl1 Q�tn�Q>,tr�) -4 �t ILA,,- 5Q,,, !qv �15d 1 B DATE: LOCATION: 11Z !Sbrirpner=s'Tcrd LC rl) fljy1rAie� OWNERS NAME: I'Y1�C,hr��l LuG GENERATOR I 'ZQ V L,J NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR: PHONE NUMBER: AIS- - -155 - 9900 ELECTRICAL RESIDENTIAL GAS COMMERCIAL TEMPORARY LOCATION OF GENERATOR:. 16R off HoLi5e-tth�r\d E()c&'-fcwa bcL-f,\4a,4 *ZONING DISTRICT: (05 *CONSERVATION APPROVAL Wbrl. �k � s in � I II jz- Conservation Department, Emergency Power Generators of New England 10 Jean Ave, Unit 8 Chelmsford, MA 01824 978-458-8800 cr%�l.n�.J `� 13 2 0 i 2 NORTH ANDOVER CONSERVATION COMMISSION We have a property that is installing a generator, there is conservation land on this property and we would like to see if we can get approval with the enclosed plot pictures. If there is a site visit needed to confirm location, please call us at 978-458-8800. 712 Sharpners Pond Rd North Andover MA 01845 Thank you, Denise Lloyd/Office Manager Emergency Power Generators of New England Coleman Light & Power ., N rth Andover MIMAP November 20, 2012 WIC et 7T 41A 1 SEW Ilk it Interstate Major Roads Horizontal Datum: MA Stateplane Coordinate System, Datum NAD83, Roads Maters Data Sources: The data for (his map was produced by Merrimack Ci Easements Valley Planning Cornmission (MVPC) using data provided by the Town of ,,,So North Andwer. Additional data provided by the Executive Office of MVPC Boundary en'honmental Affairs/MassGIS. The information depicted on this map is I Parcels r planning purposes only. It may not be adequate for legal boundary AK!tio orregulatoryinterpretation. THE TOWN OF NORTH ANDOVER ES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING 41 THE ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY 4t OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF o.- TH S INFORMATION 1^=148n A North' Andover MIMAP November 20, 2012 105.D-0056 105.D-0057 #1041 105.D-0181 105.D-0177 105.D-017 193' #1055 3-M 105.D-0182 Hon—tal Datum: MA Staleplane Coordinate System, Datum NAD83, �7 `4 140RT#4 Valley Planning Commission (MVPC) using data provided by the Town of 0 —.A 2 6 0 Environmental AffiarsiMassGIS. The information depicted on this map is j AMAKES 8 105.D-0179 090.B-0011 105.D-0003 #740 105.D -012E #7 Cc C., 105.D-0005 105.D-0004 #672 — Rail Line Interstates Interstate Major Roads Roads if'= Easements 0 MVPC Boundary CJ Municipal Boundary — Trails 11 Parcels Hydrographic Features Streams Wetlands Exempt Lands #660 1" = 148 ft 4, 105.D-0186 Hon—tal Datum: MA Staleplane Coordinate System, Datum NAD83, Meters Data Sources: The data for this map was produced by Merrimack 140RT#4 Valley Planning Commission (MVPC) using data provided by the Town of North Andover. Additional data provided by the Executive Office of 6 0 Environmental AffiarsiMassGIS. The information depicted on this map is for planning purposes only. It may not be adequate for legal boundary AMAKES definition or regulatory interpretation. THE TOWN OF NORTH ANDOVER NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING Is Y THE ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION `SSACNIJI a 95610 Date..... . .. ........ ....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..................... r .. /Z. jo .. . .............................. has permission to perform....... ...... wiring in the building of.............. Z_ at .... 511ARPAf 72S '.d W&6North Andover, Mass. Lic. Nogf�.'f.74� ....... . �t/l ­ ' ' _-�Z .......... /_ E ECr IC L INSPECTO Check # (0 VLZ�_ Commonwealth o Official Use Only cc� Permit No. S a1JeParEmenf o� ire �ervices UV Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] 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 TY�PEI ALL INFORMATION) Date: 7-(2-7-10, City or Town of: // U d r?Vj f70(dd e4 F 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) �1 A q rr;f o-,!3 ioA d X c-/ Owner or Tenant Telephone No. Owner's Address �Q�a_P Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building t = es / - 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 ' Cmmnletinn of the fnllnwinv table may he waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: SusP (Paddle) Fans rans Total sformers KVA Trans Tr No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ g rnd. rnd. o. oUnits Emergency Lighting Bette Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas B rners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Tonsl �Y No. of Alerting Devices No. of Waste Disposers P Hea ump Totals: Number .... ....... Tons ......... KW J........................ No. of Self -Contained Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW P g Loral ❑ Municipal ❑ Other Connection No. of D ers Y Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KWNo. Heaters of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attaen aaauional aetatt aV aesirea, or as requirea oy fine tnsyeceur q/ rr fires. Estimated Value o lectric I ork: (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 co rage is in force, and has exhibited proof of same to the ermit ii§5j jng office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) -Z -(%r 1 CA f I certify, under the pains and ena 'es of perjury, that the information on 40 application is true and complete. FIRM NAME: �S' eo LIC. NO.: Licensee: Signature LIC. NO.: (If applicable, ent . exeml j , in the lic a umber�f' �/ Bus. Tel. No.:�7- Address: ) 1/ d'�l /' "/ �� / � o�� / 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 a ent. Owner/Agent Signature _ Telephone No. I PERMIT FEE. $ M O O Y U O J m w 0 d Q O 156- 4 MIN j. O:O N'N r r V I.L V ca w` y. CO N dN 0. f6'a).a Imo. � U a m 6:4) fn N iC O,U' i ; $ C3 dj O S p T=� f. C O U aUiE m m O^w N 0 CD S o U_ 0 0� ), �. O CU � ,< o " . ad,Im, 01 �O U.1 ;00 0` D cn-co Z. N o m 7c cc U O_ca :�� d>'.q m m "'m a): 76 m m m' -roe 0):(1)UUU, 0 N'O'' O o co �'—NIN ct$ a�QO O (z O Cn "4 C.)VLL.� N X——i '. U m'O O Z O Q O LL, Z J W U Q M 0 O O J_ m _ c - m E E O U O O \I a H O W H J Z J pMj Q > N U J Lu M Q G J aQ aw _W cZ W W N cW OQ'LLQ> U `m a 00 00 N N t C • L ! t )1 ? 3 � x• � 0 N l �:CM M CD 0 Q W J J� C Z G s 2 ,f'r't O ,, a? ON Q LL 0 0 Z o� x;' t 3. a W p Z Z M - t0'w FO O N cox G LL(O QN'mv -[tco Q Z O J V :01 m CD D 4) > m ' m Ua o� rZW z ���' ��� oo � 1�00to (14 Fes- Fes- O C 0 x �� O Z U) U 0�'. C CD . rn 0 C4: ^ CM IN l - ' (0,0) cu'm } 0 - 0=" >-0 > QON.�' J�-Om�..�,` •, -Q m .U.., E m E Z 7 fn cnC U: UL- d M =LL MI, Q' UU'QQr- 3 C7 Z ) M O v� uN�� >_. o cn Oc Q d mm 00 2 m [6- m +O LLI m (D N _ N LL N ci O cQ m'm O•:ov m 00 HiQ T N Z C LL C ,LL - -0 'O IU O W U ov-moo �:mm0<0 IQ"�:F- W}C�Uda a � INcn Z to' RN LL W a0 v ,N! a D Q Le)n a { "�i.U U y :LL m:mUa NE OO — . 0wL« 'W m. 000 8'mCY—w t_ E EU U f— m ;LL 2 'W m :Y W m co Q UCLA LL C: LL Or} E rn H 0 ui -� U _ Q m = :� T m. v : _ m CI— 1- U m N U DL m4L) aif)Dw�L3: U `m a -to 777= a % '. vtwl [41 P, �p oP A 0 z ICU r. E :2 u —cz R 44 � —cu .5 �J. 1 � uu 0 1:4 � 0 1:4 —co -W 6 7- (U 0 E V) cc d CD C#? g BZW . Q q:r o < U - C.3 L LU CO CD LA - LL. cc LU co CL cc,* CC 3 Ea LLA CD CF 11- uj CO LAJ Lu Q ai COD 0 CL Ca CD u)L.Li Co > U t;cm ti CD c E co go C* .0 cm 0 . s :2 :s �& 0 0 i CL cc 0 CL ti m -0 CMCX CO2 AM JAr E75 cm --i ci Cl) Cc Cc < me C/) CJ -J- CM =0 CL CA ts < co ;z CL. x g) m 0 u CO2 cc C=M 0 CL CD CD 1 ;1. 1 3: c :5 0 CD = LU COD L O CCP NJ 0 < "re MD% cc COD w 5 -.— = 4D W Cl LU •E ca .0 C3 CD .9 cm LLJ CO) CL 00:2 =0:=a OM= 0 a CLO.. cc :p 1 o a t a_ U) It 1 L W W cd v oOy 0 w0 t�Z� W Q� LL. z z o O m Q� c IL -s o Q CD : a CL Go ✓Q� E c o m C3 o eq: a o rem.- 3:�• cm m aA �c � c o A ycc zip o m � - tt o cm m.o Wwo.-o Z -c H c x mm� 3o N H =$ wmol m - W - CDa'..mr-oz LU V o -':p m:C c y^H CL 0 CO 'ae F=- t r Ems 19 do 0 co y co L- 12 - co co .c C O O C.3 Cc h O C C3 H C O C.3 !c MCC W ui ° w p A �A 0$ z = u t ��,� �� �\��� v� A ° ' ° !f v C A E c V U W c m a ° D W z G L2 cn ° ° U rL ° ° u: w ' as cn v) v oOy 0 w0 t�Z� W Q� LL. z z o O m Q� c IL -s o Q CD : a CL Go ✓Q� E c o m C3 o eq: a o rem.- 3:�• cm m aA �c � c o A ycc zip o m � - tt o cm m.o Wwo.-o Z -c H c x mm� 3o N H =$ wmol m - W - CDa'..mr-oz LU V o -':p m:C c y^H CL 0 CO 'ae F=- t r Ems 19 do 0 co y co L- 12 - co co .c C O O C.3 Cc h O C C3 H C O C.3 !c MCC W ui C 4• �A o o_ r ' r{. HAS PLAT REV I W � EEN E FEE B PAD c N� ��. s? , _., : ('?��, �S Y ��� ,-::;:� '���i.Sj � ziJ.�. '� 4�rq e� ,�I���.rwr'?'is�R�, a�t-' ry�r` v.•; �, PLAN APPROVAL: � ,s SATED/✓�.'APia DY �,. f �F DESIGNER:LAN Dn-rE. CONDITIONS WATER SUPPLY: TOWN WELL ,. WELL PERMIT_ DRILLER Al- _D_U_(l_� WELL TESTS: CHEMICAL DAZE APPRUVED.�% BACTERIA I DATE f1PPRUVED ��1 BACTERIA II DA'T'E APPROVED COMMENTS: FORM U APPROVAL: APPROVAL TO ISr*UE YES U DATE ISSUED CONDITIONS: FINAL APPROVAL: ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NO SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NU ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: - DATE :.. _..._ ........_ ..._ ...... DY :._... . .r1 v 1 Y'.c �+•r r• •�;s r 1 a+:.v:,a, ,tai?Yl+ fir Pll. \.i' -, Y' 4�+:1 'k''` Si �. r, fur ti "y.S -.fit tip e+ 4:"R^Y, ..'va y Yl'..,• rA. r.�+ yq'�. ��♦,� �2C'�tl.\ +*1q 1 1+� �y'M1�i�: 7,�;•;1:w /� !il:':'. ,s.� �t. .t' i ca\S. i •, 1.> .l'b1 [ l 1� , 1'+ \U, h + `'•F'', n ri <. , ♦ .,t� i. q+,` �" + l' 1 h' :.C�; _� " '? . �,_ -\,7 .,tr �1t d . + `1 �1�' ail 1 ti \L t �,t Li �.1., . h )r;` �t r! ,8. �•,'�..� \ +ii, �) tt tZ -:1 �.. ..tt 0.`i': ;.+� r♦ + , r•' t ! + %w`�. ! \ R •f lc A*-' �.�N 1 1 .��,Il; .� t t ..' �. lI v �' ht � !�. i 1{ e lT 1,1 li ;.+� �.\ ��,` a i�a1\� It � �+ +0•x,11 dF S ( i.l f'. • .) ` + ,e. � ,,' �01 > '\� it i.;; I'"� t_.t.(; �';) r i, t -� u1 .+. •. t .. _ r ' i P, (+ , . ` I j d I iia y Y � 4Y , ` . *r:•..+,uly-,yr'�''L-'E`� Failure to oopo'sa DEPARTMENT OF PUBLIC SAFETY _ ! Nlarsrsapa Stall a ONE ASHBORTON PLACE" et de ithis licenselicense`rr � ' BOSTON, MA 02108 I ,,,:_:._ I CAUTION EXPIRK FOR PROTECTION AGA EFFECTIVE DATE LIC -N0. THEFT, PUT RIGHT TH ' RESTRI' PRINT IN APPROPRIA _ 0`; BOX ON LICENSE. M T INCLU PH PHOTO (E NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY STAMPED - OR - SIGNATURE OF THE COMMISSIONER FjUN 1 1 1993 SIGN NAME Dj povGWSWRE LINE SIGNA RE OF LICENSEE R OTHERS z. LLJ,� CD CD a .J O CN t.I cf-) O XCIO 0 00 CD N I� � ,w--- �� o � 830N,,n 3oravo ave a HiiM ��co ,2.$�� �� � viNo�o� ov x sa � i imm s83mino n8nvvi �a M38ONV �r �o :1 u' I co :1 N � � 'L p, 0 0 � Ln ' O U� o� ta- E.�a) v Q) o • ooc O -0 m�•� >�W— _0 O E= L O t•�� '� 0 O` L N 0 N O 0 d O U a) N O d O p u � CL 'c8:- � _g•`- O 2 N0 Cl. U O — Q) O O a) Y O C O O O U 0 U +' > 4— - O E .O -.0, a> U <D Q) a) 3 N N p� 0 ?� •+� � O a> � c D L ,• c o U T E E c E o +� a❑ O — E � ID, &.- o T 0 U US o o 0 (D ` p -+- � O CD o L.. o O -0 O O-0 U_0 .V.N°-__-' L` EOsvi qo o p" V,° � �, L > N a[) t > Q) o V) p • o 01 vO •DC Q, C U Qoc L d CL). (UL)) N s N NN c a 'OU 0�LOp-p c p pN O N Q 0 a) 6. N O t _0 U -p `, Q o n cYpN . +, U O p E U S E 00 0 U (D _0 O U p p N a) +� .+- a) � +, 0 � O 0 N U �O o ��, :1 0 Cc: gC o o a c O E v +. ` ►-Use. o oa O Q, �,c -0 0 3 �' >, oa, o E `oma E+ o o �;v o o a) o -p N c aci II O Q I L U Q Q Oa E `� N Q +�+ -L Q Q Q • U U' c-1 ,.j �i co u' I co r 14'0" 710" 71011 28'0" load 14'0" C% • r � O C Z r c/r V+ Ln T • O - f _ OT ; ■ . \O C O Oo O _1 V CL 218" 7'10" 3'6" 0 � 5'0" 3'0' II_ w O n N W ------ -0 ------- OO 1 o = i � N a w As 1 - - � CO IF IF o pN 1 1 � O O co I 1 T T N x CPT I ;y of • i w � 1 1 W O �\ t J i C C=) • I 1� I W A\ 1 1 1 1 1 1 3,0" 1 � 21.8" 4'21/4" 3 9" 3'4/4" �. . ` (Q O —T1' O Z 00 o CIS O IF O [ 7o W C _ 0. W N _ rn _ .316" 219" 510" 1013' 6'6' 28'0" c!s W I W O Tt 01 00 ' � .as • w. wosZ o „i.0,6SIOIC L� .a r�L r Ln $ i � o qIY 00 O U) n r M y t e r 1 wO L It �OOL�OLQ900g N000 '9 m- DD7 Az LLJ HiV8.h h �Z a94ry i 9MWWOO'. W� . d . a 9Z RN R R 00 0HldB � L OOZ Ayg,Z G L o `no •w� 0o o n E� LL) aco o :Dj .MW6OOOO�Z,LJ II. N r- D C -If 4NwV-)O ' � N AL OL ALL w9,' wo,tL r ICD O O s 1'10" 9'0" 4'4" 910" 1'0" iZ I _1'10" Bottom of frostlwall footing: 4'0" I elow grade (min.) 6'3" 1 5'0" ---- C --------------------------- --------------------------------------- --------------------=-- w ONE-- Ci C 1 1 I , 1 1 1 1 ►► , � I I I T , I I 1 I ►, N N�ww I �0 > G7 1 i. I I o = ' 1 �' �• o rn ^' x I I 01)o `CD o D, i \ o =�� I I I o Cl. G7 D 1 , ► N . ,,,� r+ a• IV a L1 CIl fTl I , 1 1 M CD I CSD cn CD am Z ►► 1 1 o o o x .+ -► nID I I .0 Q� 1 � i 1 1 ,► ► I 0 d O W I 0V) CD D' I �• C CID I X a I 1 O 1 O O -CD y I I ICD CD p 1 I ►► I NCD CL I o CL n , D► ' � 1 L• LO 1 1 1 , � 'D , � I I I 1 ,►► ' ' 1 ►, i I I W 00 1 r � 1 I 1 � ►► 1 1 ► 1 3'0" 1 i 1 I i ►, .1 '1 I 1 I 00 s ►► � I I I � 1 I '► 1 1 I I I '', � ► , 1 Tt � C11 I I ' I � 1 1 ,► ► 1 ,I i•' tom• N N 1 ;�0 3'6" oo 1 1 I , 1 comer 1 vo z ' 1 ' dO n O0 ?as O QOfi ►► I m 1 p I ►► ► I(CDD 3 aa -x O— I 1 I I n 1 ''' 1 1 I X- i� I �� Z 1 '► ' ► 1 S x I ( 0 , I 1 M 2 C C 1 � 1 CD 1 ,► I � � 1 1 , 1 ► L----------------r------r----- --1--------- -------------------------J 1 , 1 v v v v v v v 1 r 1 1 F4 Ci 1 L} -------------+J 3'61" , 2�9" I I 10'9" 6l0" . . 6'3" 1 5'0" If- ► -- .I 28'0" 16'9" V O N Ln Qi • v C w If- ► -- .I 28'0" 16'9" V O N Ln Qi • ., 49,t 0 . O N rn Li � 0 LO 0 92O.m p > J O® co 3 C m R R Q -12.6. N x O N O N Q�N 0= >� -W o, O rn 0 O ! 1 , N N j M o rn v o . OR C�LL- OL EL ® c O N�N� v v to Q M CV R O CO O, ., 49,t 0 . O N rn Li � 0 LO 0 92O.m p > J O® co 3 C m R R Q -12.6. N x O N O N Q�N 0= >� -W 4 • rn 0 4 ! 1 , j M o .ate � • OL ' c v v to s R O CO O, 0C 1 UJ y Q U® ,pO Z pp Li e � T® O CL O x 4 O 0 0� 0 A O CD 0 - LA +, L) C - co CD cX <t \ c N v z O U .�R T E 3 3 CD2 - N O x U Q v-00 O CD 0 O Q o,' Z C x o CL LI' J c N 00 . j �, Ute U -,�,® 0 R R D O \ C a c 4 rn 0 4 j M o OL ' v v to - R O CO O, 0C UJ y Q U® ,pO Z pp Li � T® O CL O x 4 Wx�o U OJJ �X \� NW L� MN MM J � - sbuuado gbno.i coop Q o > 0 4 PUD MopuM }o dol Q 3 o C� ¢ 0 3 „8,9 c c 4 OL ' v v to - at Z7 X 4 Z +r +• O � C 'too N 0 U sbuuado gbno.i coop Q o > 0 4 PUD MopuM }o dol Q 3 o C� ¢ 0 3 „8,9 „ziB,L Z�LgL T u0g it OL l - „ziB,L Z�LgL T u0g it cQ _3 II CD 3 C:) CD C CD N x W G 57 O I _ZZI, D_ ws cl 3 II CD 3 IIs CD N CD s 3 Q' O CD a CD I Na cn O O Cl O (D n N x 0 rn O C7 _ZZI, D_ ws 3 II CD CD C CD s 0 CD Na X O Cl O n V 00 00 co 14 Of bo C C14 00 o LL- CD CD C-4 C4 1p 00 CL, CS 675 C14 C14 CN <. Do 0 Pe[ CN U- C-4 cn rn C14 04 u A��Cj Ln CDL LAJ C4 C14 LLJ t --- /71 Location No. / Date •q k � 12350 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $� Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $) Building Inspector M114/98 1.5127 112.m PAID Div. Public Works r;► Location No. 1t9;7 Date NORTN TOWN OF NORTH ANDOVER AL O9 " '} Certificate of Occupancy S $ Buildin /Frame Permit Fee 9 $ 'ss�cMus Et� Foundation Permit Fee $ " Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ ` TOTAL $ r r� t 3 •, '"_ ^ Building Inspector n a`-- Div Puhlic Wnrkc M I NIR 00 c Q f v N cf) L'l O LL: z U C d N in c-3 F- X Q z W X Q LQ w L n = o u y LWz_ rY a J �y t 1c y u u vA -r C U U W F J 3 -K Cij v a J N � F-0 = W c � Z cc h C C .j W O c y m ¢ C. L �, X C Q Z`_ L a LL; z z Z Z Z_ r IG U x W w z Gn C w �; `` Q C C C N iW^ r a y Z m h Q ti C ^ p ,,4 in Q 2 C9 ti 9 ;n N 1�1 �1 O o D J ` � W ! W W � y � , Lu w J W LU J W u z¢ ;j c z i 5 V Ln° z z p O o p NIR 5 C JJ W Q C 00 c Q f C,7 5 C JJ W Q C C,7 Z U X Q LQ w L n = o u y LWz_ rY a J u u vA -r C U U 5 C JJ W Q C 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*'k**'`****************** APPLICANT ���� Ie�('�,� l PHONE LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT (S) STREET `GtC ISS i �YV �� ST. NUMBER �c7 *************OFFICIAL USE ONLY******* DATIONS OF TOWN AGENTS: v CONSERVATION ADMINI§TRATdR DATE APPROVED DATE REJECTED TOWN PLANNER DATE /APPROVED ' DATE REJECTED COMMENTS EALTH DATE APPROVED DATE REJECTED TH DATE APPROVED DATE REJECTED COMMENTS�,�� 29 D PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT • FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE May -08-98 09 s O6A caffrey8as i t berst+e i n � E ' Lol EXHIBIT A 5084755662 P-02 Laselnent Sketch Shaded area shows location Of common driveway 3.eaw, 4o7- . 7',9 is L 22/h 0 oe, .�..•- ..�..-.,,_,.---t....._ _..,. CE_;tCElON" certify thot t:: faundaten shown , hereon is in compliance h tho gppllcobla Zoning L'_�lows of thD Town of�<-:�.y,r„u:a,�.�; � � rn 1 r=.;hunt to horizontal dime f t �+ S ��-'�f�=•�T ld�' LAND y►++�r.�. nasnot ro Town . ��rFT DAVia �r av SCALE: 9es (�,'m�_ !<i: p ,..1'E: �: _<wir� _✓ rte; : i.'. Tfg,t.eC.: yds F _- aa r `-•-'-sa�RY-�--.-�C�.i mcraa+aofx-.-,ate MVTI0Fur-NT SERVICE s"pMPAIHy 30 NCODLANn ROAD DATEtS:• L ?D. W. 01721 7- /.f: _. v os p llqlsl yE: / L✓/9 R 'j C/R r / F Z - !Y0 1 f G ❑! j30 '57 i30LA 7L ENS ��- /'AIe- l�9• A/C', — �/`4 il-t6C �0f/U, �? fa 1 45 /� -42 - CS" �F MASSq�y ) 1 vlr r "1 ` 8P Nt,. n5' �FESSIOWa' 4 � � I ID F 0 Ia t?sROO y- ❑! j30 '57 i30LA 7L ENS ��- /'AIe- l�9• A/C', — �/`4 il-t6C �0f/U, �? fa 1 45 /� -42 - CS" �F MASSq�y ) 1 vlr r "1 ` 8P Nt,. n5' �FESSIOWa' 05106/1998 15:55 6038981676 CYR LUMBER COMPANY MAY 6'98 14:09 PR MITEK INDUSTRIES INC 314 434 9110 TO 16038981676 944M [001 1cAtma0 4 19 11 1�u 601 47.0 W44 141 1317 4A= PAGE 01 P.0czi02 TEitOO Uft A rk6m Nmswe t ICeI 7.6 t.tmb.r kWmW 1-16 21eCo� 10:0 (su.nttm TCR CHWx 4 WF N&t =cam IX4WssW WA MOM2 OWW low 16tl /o s", 2;162!g?• s , to Tc 01 pm am maV" A13 0 x222 mc 14*125 vr2 $p -f14 V= •4.44 e-2 >476 Huf4lli 4-13 r� tat (•i: u. mW um s,{o 1A MW! 71 2, eRA m 9 411011411 ease" a 4.1.11 of arrpfaif41 ;9= a an mum I #d4 Idw�/inii7ttWr j3 i�2OW110• Rftt+raA i�w Crh♦ TOP C 1-2.{R, i-A�fOOs/ b•4..1afQ +f..tMO5•t1w10, &7.12/ eoT alfollp 1.40.-Ift 2.16.14137- 9-s.163a 7.e..1#2 MRsiB 3.2«.2741. 4-/.279, 5.t.-277, 6.5w-30/4, 2-t6.-162.6-/..232.7-16-•2064 �IDztFi[ tl This *AM ht f bW aivabad ix W dwwfd I - l- I OkUMs. i3 Ar Few we mm~ WAM ,'i - in bdlaalfd. 31 ilii 11m h -Mtn dm?#W lar s 6w Mad d 2o.6pef OR #W bates aiwr4 in d aow WNhh a 00 y lwtetr dun 2-" 6KWO * 1M boftm abfrd o d aw Q TWW wn h i1p w4h A 1-1M0 w%pV. U AD 0e/te1 StwAud May 9,19" Or91m- ~AMWi=vWFa ArA�a JWufMa 0 � db meow ,tw<w. .s�nsss.s rw 4600fi tical atw atw.Otaartt+Mr 9 d�[�w.4 Mit frhra tsnaaw0-0 1626 qui -m• WM.� weaioraMrn el.snfys�w M rrsts y� bti�� rsr4ar - nai Mas Y M IM wrclar. �W� o pwrMs"MMr.yWM tbatAbq wtM• Ad sr y�owy bw.ry M bfdnWa0PROUG m b *A=IMonrvik-wW * owe b MMHpafifM No bdep 41PPW. . IN,," MAWmMwao anlalbm ww taowts q�lfyt 2fl tl 2wry ttlYlad AIiM •aabfr psaalarws wK�oe danr,ttb sttt�sast f wy Mf.t� faaaatM mwq!!m avawar aw nvts 1%w wrwpM sM o pedtls oma., stA4Mw4 WI Ofrty.jar• *m TOTAL PAGE: WIT {cry c 13 c m IK m 1 1 1 i m IK m p it O F=04 LO o -z W W ct O pq u w ' ch O U a c ° w° p°G U C's w O Q. no czW w a � -ob O " G w" a H ' O LY, c° G IL w v ' CO z° cn C o cn C� W p t_O.tC�O G O m :A H �/ J ,Oma co aL o a o E V) z pj c� z 4 m H A H - u., o o:0 0 c U m .�, mIc m, 20 c w c C.'* mom m V H O C R � Z 000 cm O. c =1— m ym=3 •C o 0� N Wto +Z. O m •_.. •tyq dt O C Z .0 C .cab- Q O y CD a 5 S A moO H .c 0 CL > �41' Aa CD O CD O V Z o. O H O � CD C C CO)CD Q .y m m CL _CD �� 3� CD O � G O L m oa C Q o c ev .v H O,D C Z CD 0 CL V CO) O C C■� C ev CO) v cl- 411bA 44, oe� 40,�� i r a THIS PLAN IS NOT FOR RECORDING PRPOSES OFFSETS ARE NOT $'1) BE USED FOR THE REPRODUCTYJN OF PIiQPERTY LINES SPECIAL ]FLOOD HAZARD AREA -(FIA) IS Nod! APPLICABLE N 1-07 7 .077 ` t 0CxrsT wF� 1R elf N f `III Of DAVID PRESTON 38389 O o L "I certify that the l0uNr-Q'n04- shown hereon is in comptionce wits 44^ applicable Zoning Bylaw4t of the Town of No¢W A `,, ,cm tq t to horizontal dimensional requirements." .tea , VW MUM to P.L.S. DATE -11-iI� L "FOUNDATION• CFRTIF'ICAVON" PLOT PLAN fJF LANA IN SCALE: 1" = 810 FEET DATE: V AP- Z' /994 • L'G�/SED: !1 z5 D S C DEVELOPMENT Sil"VICE COMPANY 36 WOODLAND ROAD ASWAND, MA 0172.1 (508) 881-8776 Y FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: AyflRFw A4jgyruc,e 7, U/ t2LC :7 (1c Phone 79q'-35'1 1 LOCATION: Assessor's Map'Number Parcel Subdivision Foam A" LOTS Lot(s) � Street .S#,1 R uE-n S -al . St. Number 7/2 - ************************Official Use Only************************ RECO NDATIO OF'TOWN AGENTS: Coqervatioh Administrator Comments KP C� Town Planner Comments Food Inspector -He lth Septic Inspector -Health Comments Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspect Date Approved dah/ Date Rejected Date ApprovedIX Date Date Rejected Date Approved Date Rejected Date Approved Date Rejected r Date NOV - 9. 1994 w HO.N 1 f • 1 r KAREN H.P. NELSON?' ?$< Town of Di'`or NORTH ANDOVER BUILDING CONSERVATION @y,C""5` DIVISION OF HEALTH ' PLANNING & COMMUNITY DEVELOPMENT CHIMNEY APPLICATION AND PERMIT 120 Main Street, 01845 (508)682-6483 DATE OlhumavA S, )Q15 _ PERMIT # LOCATION _2 231,WWO OWNER'S NAME-ad2zw BUILDER'S NAME_M&,�-Wtet i MASON'S /. y /L MASON'S ADDRESS MASON'S TELEPHONE SOS - 74 y-3'5 7/ MATERIAL OF CHIMNEY e&4 INTERIOR CHIMNEY a EXTERIOR CHIMNEY .01 NUMBER AND SIZE OF FLUES 2- FA 6 THICKNESS OF HEARTH 90 Will chimney or fireplace conform to requirements of the code and have rules and regulations been received: DATE / �9 SIGNATURE OF MASONVES y �Q - _ — CONTR. LIC. EST. CONSTRUCTION COST/CONTRACT PRICE 304DO s PERMIT GRANTED 1 �S^ FEE 2 br ROBERT NICETTA, BUILDING INSPECTOR INSPECTED REMARKS SOLID BRICK REQUIRED THIS PERMIT MUST BE DISPLAYED ON THE PREMISES 1 Date ......... .... ... .... .. . 01 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION a o .Sh This certifies that .... /.`/ ".�......�................. .. . has permission for gas installation ..-��.-:'...r-?-.!S•:...: ?-�- in the buildings of ............................ at -�.....:..... f �.. t ..''.. , North Andover, Mass. Fee .. `s(�.. Lic. No.. .ti: ? ... ! --. ............ GAS INSPECTOR Check #c2y7 4' 70 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) Mass. Date J 20 z? 2 Permit #--'Id 10 Building Location ! Z Owner's Name_s�?//� r"/ Type of Occupancy G� New p Renovation 96 Replacement ❑ /Plans Submitted: Yesp No�i Installing. Company INSURANCE COVERAGE: I have acu ent_iiab�ility insurance policy or Its substantial equivalent which meets the requirements of MGL Ch 142. Yes If you have checked yes, please indicate the type coverage by checking the appropriate box A liability Insurance policy �K Other type of indemnity O Bond O OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement Check one: Owners] Agent O Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Geneerrall Laws. By T of License: Plumber §gnature of Uclensed Plumber or Gas Fittef Title Gasfitter Master. license Numbers City/Town Journeyman 0 I NL r, ^� Location '1 2' + doe ter t�nS� t"oN►��cj 'iV& S -q — �- Date t S S, NpRTM'1 TOWN OF NORTH ANDOVER 0 o 3a.!, Certificate of Occupancy $ t {� Building/Frame Permit Fee $ Q E Foundation Permit Fee s�cMs < $ -- u f Other Permit FeeNt $ e� -; Sewer Connection Fee $ M Water Connection Fee $ un TOTAL $ cxs &D 30SC� .� Building Inspector 'D ?836 Div. Public Works Location NG Date NORTH TOWN OF NORTH ANDOVER 9 7708 Certificate of Occupancy $ Building/Frame Permit Fee $ -- Ity� Foundation Permit Fee $ Othejjr Permit Fee $ Sewer Connection Fee $ Wafer Connection Fee $ TOTAL $� Building Inspector Div. Public Works Location 112- �t-�c12�t�tt�2� ?610 9-3 No.� S14 Date _l %, I ra _ I -7767 TOWN OF NORTH ANDOVER= Certificate of Occupancy $ S -Z 8 V Building/Frame Permit Fee $ Foundation Permit Fee $ 03 Other Permit Fee $ Sewer Connection Fee $ Wate Connection Fee $ LD T( $ Building Inspector Div. Public Works m w � o 7 O LU m � m tai �'��'\`��P Z a W o J f wo w 0 F a 0 Z m O U 0 a (L 0 p 7 N a w U Z J _Z w O 0 J _Z D J _Z D J J � W 0 O 0 tv) o 0 y Iv W y do VlE I -A W Z' a w w Z W i C x x 0 < y Z 0 0 z < U y y y W LLU W Ix a 0 Z O J 7 m IL 0 W y d rc 7 d 0 Z f.. 0 \SII y 0 W m m U) y F W_ C 0m w 0 0 O F J LL 4 w a 0 f 0 W W 0 < N Z m YI Ii > � o 7 O LU m Z a 4 m tai �'��'\`��P Z w Z ~ W o Z 0 < f wo w 0 F a 0 Z m O U 0 a i< ~0 0 0 p 7 N a w U Z J _Z w O 0 J _Z D J _Z D J J � W 0 O y Iv W y VlE a w Z W i C Z z < y Z 0 0 z < U y y y W LLU W Ix IxW Fa Q W W a z U 2..Z � O N N I6 < m o IV _ w 0 L I, w y � o 7 O LU m Z a 4 m tai �'��'\`��P Z w Z ~ W o Z 0 < f wo w 0 F a 0 F m O U 0 a i< ~0 0 0 i 0 Z p< a w U Z J _Z w O 0 J _Z D J _Z D J J 7 m W 0 O D < InT m I m m I ; m y m y z 0 f 0 z W IL 0 Ir IL n Qr 6 zz �. l i 9 \ m8 -0 mea d d 0 U U V F a 0 0 o d cc~ cJ m m m V W Z Z Z U W W W m a V J ad O C,6 ® $ V Z oq H W ui Q W 0.. �m jujw a.W O r G � W � J W Z Z w 0 p E Z J_ li C 7 W J f m 7 Z LL ~m w 0 y T 0 w 0m < O F 0 0 f W N N 0 w d ZO U < 0 y W < Z Z m N Z ¢ 0 O F-- fo UU 7 W J y y y w W 7 7 W C w O w a 0 0 F < m w f� W J j i 0 y 0 0 '�' ` i _C n, 4 IL U W 7 J - OmN I-- u m < W W W U < Z W Z W 0 0 w F < r F 0 w W i- IA d d W f< d O m IL 6 s L= c C. N D m 0 O y y n p p y y m D D* 0 n m Z- D v w n n D 3 N y O y 3 W O O z n n n c p m o O p D A DIp m W A n z N D c z m0D mm mmnx7cnn Ny 00 vw Ow D N7c nn A_IO pp Z^�Ozjp� Nn > w N3 ON;2 OOOzz ZAOOO y x xQO Z z Z Z Oy mW m D Nm D Z 3ovGN p C DD�Z ,NAZz ? �3DN�A: D p Z30Z m;< mD< O D { f m< ? Z 0 0 1111. z n p�o < om y ��OApO tD 0 z Z Z py D Zi OD C OTO N D oxDmmx OA n x3t7 n m " yam,,, A-�_ C S xm vDm Z`m� m Z C Z A A W D O y y p Z y 3 D A N N 3r tiA N rz0 Z O x m m T T n x m '° m I O Z DD I I Iwo x O ZOzl- A 111I► I II=_ m A N ?Ili I 1 1111111 II IIIIII` fm t f c � V p . yo O NZZ COC MM r m M D n 040 p3m — Z O m N 9^ C1 •y mW v0m 5�N N 00 0 �- M NCN v a s T ro0 -4c)r O n H O C1 O O D*D ?_Z rn A z O O p- v nz in mm D3 Z O'--DzDO'Om m p p c A D x N m o 0A -� y r N y ~ D m r m m JO m Z 0 ? F; O H D -D+n z D~Z �„ v_ ~ A 2 O C 0 O O A D T N~ 0 OHO Z m C, Z C. N D m 0 O y y n p p y y m D D* 0 n m Z- D v w n n D 3 N y O y 3 W O O z n n n c p m o O p D A DIp m W A n z N D c z m0D mm mmnx7cnn Ny 00 vw Ow D N7c nn A_IO pp Z^�Ozjp� Nn > w N3 ON;2 OOOzz ZAOOO y x xQO Z z Z Z Oy mW m D Nm D Z 3ovGN p C DD�Z ,NAZz ? �3DN�A: D p Z30Z m;< mD< O D { f m< ? Z 0 0 1111. z n p�o < om y ��OApO tD 0 z Z Z py D Zi OD C OTO N D oxDmmx OA n x3t7 n m " yam,,, A-�_ C S xm vDm Z`m� m Z C Z A A W D O y y p Z y 3 D A N N 3r tiA N rz0 Z O x m m T T n x m '° m I O Z DD I I Iwo x O ZOzl- A 111I► I II=_ m A N ?Ili I 1 1111111 II IIIIII` SON N t NC c � . yo NZZ COC MM M D n 040 SON N NC Zm MMO . yo NZZ COC MM M D n 040 p3m m _IN_n @0 -1_ �Z mW v0m 5�N � 00 0 �- M NCN v r ro0 -4c)r Z C1 rNo D*D ?_Z rn A xo O p- v nz in mm D3 .G z Date ........ f NORTH '1 q ff TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .............................. . has permission to perform ............................. ................................................. wiring in the building of...... at .... North Andover, Mass. FeeLic. No.........../................................................................. rR icAL EcrOR INsp ELEc 05/29/98 15:27 30-00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer '' �,�� ea�ta~•2w�r�rT� o; �ss�Gr�rsE775 9ya�r,+�rr � P�[e S�cry BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 / Office UseeOnly Permit No_ �J Occupancy & Fee Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 1200 (Please Print in ink or type all information) Date 5 _ '6T_ To the Ins ector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number 0? SL,aTPNw-S � � Owner or Tenant x- 5 q/U%::5)z-s Owner's Address Is this permit in conjunction with a building permit Yes No ❑ (Check Appropriate Box) Purpose of Existing Service Amps Voits New Service Amps voits Number of Feeders and Location and Nature of Proposed Electrical Overhead ❑ Overhead ❑ Authorization No. Undgmd ❑ Undgmd ❑ No. of Meters No. of Meters OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws 1 have a currem Liability insurance Policy incl d repleted Operations Coverage or its substantial equivalent YES = NO = have submitted valid proof of same to the OfB YES NO = If you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE = BOND = OTHER = (Please pecify) (Expiration Date) Estimated Value of &t cal Work$ 9p -00 ^ Work to Start Inspection Date Resquested S��y/ Y Final Signed under the Penalppes of p rju FIRM NAME %%e -M lr= L A h LIC. NO. LIC. NO. 0 -::�k 61s. Tel No. k to V.3 ) ZS,` ate ),=1 Address Alt Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE $� (Signature of Owner or Agent) Total No. of Light8ng Outlets No. of Hot fuse No. of Transformers KVA C� No. of Lighting Fixtures ` Above ❑ Swimminq Pool gmd G In ❑ gmd G Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond - Tons Initiating Devices Heat Total Total No. of Dioosal No. Pumos Tons KW No. of Sounding Devices No./ of Self Contained No. of Dishwashers Space/Area Healing KW DetectionrSounding Devices G Municipal ❑ Other No. of Dryers Heatinq Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiring No. Hydro Massage Tuds No. of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws 1 have a currem Liability insurance Policy incl d repleted Operations Coverage or its substantial equivalent YES = NO = have submitted valid proof of same to the OfB YES NO = If you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE = BOND = OTHER = (Please pecify) (Expiration Date) Estimated Value of &t cal Work$ 9p -00 ^ Work to Start Inspection Date Resquested S��y/ Y Final Signed under the Penalppes of p rju FIRM NAME %%e -M lr= L A h LIC. NO. LIC. NO. 0 -::�k 61s. Tel No. k to V.3 ) ZS,` ate ),=1 Address Alt Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE $� (Signature of Owner or Agent) 4"\ Commonwealth of Massachusetts k9l,City/Town of System Pumping Record Form 4 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. DEP has provided this form for use by local Boards of Healt information must be substantially the same as that provided local Board of Health to determine the form they use. The S the local Board of Health or other approving authority. A. Facility Information RECEIVED FEB 0 6 2008 er forms may be 1. Systeocation: Address I P City/Town 2. System Owner: Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): but the check with your be submitted to Tp Code Stat /<�od17 Telephone Number C Date 2. Quantity Pumped: Gallons Cesspool(s) Septic Tank ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes D40 If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: n ,� 6. Syste =Pped By: Name ide License Number Company 7. sereco tents re disposed- ,('-, Date t5form4.doc• 06/03 System Pumping Record . Page 1 of 1 W Jc 0 r w �= p � t i a � Oc d y C 3 0 a Z J J G o Jc � w O C7 w y 0 a LO W0 a0 y o E o o 0 V y M V d � o C `o Oc a d y c C 3 w Q y w Q O y c Q Q � m c p c � o m w y CLI w J Z z Z d x a 0 m a Y C w c H Q > O y z° z z ;_ 0 00 � y E `0 Co `O p d 13 c = N 04 o E o 0� 0 a w o �L o �L 3 i0 a cr O +r o co a a c = c v c c� (9 V O � I� y C7 ►`0i w y 0 a LO W0 a0 y o E o o 0 V y M V d � o C `o 3123 s aipliklfA w 9 Town of North Andover HEALTH DEPARTMENT SCMUSt CHECK #: lain "/� DATE: LOCATION: H/O NAME:._ CONTRACTOR NAME.( Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Sustems: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic D_ is/possal Works Installers (DWI) $ ❑ Ti��tle,61nspector $ a�Title 5 Report $ ❑ Other: (Indicate) $ Health Agent Initials'. White - Applicant Yellow - Health Pink - Treasurer COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: _712 Sharpners Pond Road_ _ North Andover_ Owner's Name: _Fernando Santo_ Owner's Address: _4438 Via Del Villetti _ Venice, FLA 34293_ Date of Inspection: _1/30/2008_ Name of Inspector: Neil J. Bateson_ Company Name: Bateson Enterprises Inc._ Mailing Address: _111 Argilla Road_ _Andover, MA 01810_ Telephone Number: _ (998) 475-4786 RECEIVED X58 d 6 2008 TOHEAOF NORTH LLTH D� ART ANDOVER T CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: _X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority 'ls Inspector's Signature: Date: _1/30/2008 _ The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments: ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. \V� OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 912 Sharpners Pond Road_ North Andover — Owner: _ Santo. _ Date of Inspection: _1/30/2008 _ Inspection Summary: Check A,B,C,D or E / ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y,N,ND) in the for the following statements. If "not determined" please explain. _ The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ND exnlain: broken pipe(s) are replaced obstruction is removed t Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 712 Sharpners Pond Road_ _ North Andover— Owner: _Santo. _ Date of inspection: _1/30/2008 _ C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: _ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance _ "This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: f Page 4 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: _712 Sharpners Pond Road- - North Andover— Owner: _Santo. _ Date of Inspection: _1/30/2008 _ D. System Failure Criteria applicable to all systems: You must indicate "yes" or "no" to each of the following for all inspections: _ No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _No_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool No_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _No_ Liquid depth in cesspool is less than 6" below invert or available volume is'/z day flow. _No_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the SAS, cesspool or privy is below high ground water elevation. _No_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. —No_ Any portion of a cesspool or privy is within a Zone 1 of a public well. _ _No_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ _No_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] _No_ (Yes/No) The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either "yes" or "no" to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply _ _ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Page 5 of 1,1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: _712 Sharpners Pond Road _ _ North Andover _ Owner: _Santo Date of Inspection: _1/30/2008 Check if the following have been done. You must indicate `yes" or "no" as to each of the following: Yes No Yes_ Pumping information was provided by the owner, occupant, or Board of Health No Were any of the system components pumped out in the previous two weeks ? No_ Has the system received normal flows in the previous two week period ? No Have large volumes of water been introduced to the system recently or as part of this inspection ? Yes_ _ Were as built plans of the system obtained and examined? Yes_ ___ Was the facility or dwelling inspected for signs of sewage back up ? _Yes_ _ Was the site inspected for signs of break out ? Yes _ Were all system components, excluding the SAS, located on site ? _Yes_ _ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum ? _Yes_ _ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems ? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: Yes No _Yes_ _ Existing information. _Yes_ _ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [3 10 CMR 15.302(3)(b)] A Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: _712 Sharpners Pond Road- - North Andover - Owner: _Santo. _ Date of Inspection: _1/30/2008 _ FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): _4_ Number of bedrooms (actual): _4_ DESIGN flow based on 310 CMR 15.203 _660_ Number of current residents: _0 Does residence have a garbage grinder (yes or no): _No Is laundry on a separate sewage system (yes or no): No _ Laundry system inspected (yes or no): Seasonal use: (yes or no): -No- Water o_Water meter reading: _On well water_ Sump pump (yes or no): -No- Last oLast date of occupancy: _ June 07_ COMMERCIAL/INDUSTRL4 L Type of establishment: Design flow (based on 310 CMR 15.203): gpd Basis of design flow (seats/persons/sgft,etc.): — Grease trap present (yes or no): _ Industrial waste holding tank present (yes or no): Non -sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: _ Last date of occupancy/use: OTHER (describe): GENERAL INFORMATION Pumping Records Source of information: Pumped 3 years ago _ Was system pumped as part of the inspection (yes or no): -Yes- If esIf yes, volume pumped: _1500 gallons -- How was quantity pumped determined? _Measured tank Reason for pumping: Inspect tank & tees_ TYPE OF SYSTEM X Septic tank, distribution box, soil absorption system _ Single cesspool _ Overflow cesspool _ Privy _ Shared system (yes or no) (if yes, attach previous inspection records, if any) _ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) Tight tank _ Attach a copy of the DEP approval Other (describe): Approximate age of all components, date installed (if known) and source of information _13 Years old, 6/19/1995, as built plan _ Were sewage odors detected when arriving at the site (yes or no): _No Page 7 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 712 Sharpners Pond Road_ North Andover _ Owner: _Santo. _ Date of Inspection: _1/30/2008 BUILDING SEWER _ X _ (locate on site plan) Depth below grade: _4'_ Materials of construction: cast iron _X_ 40 PVC _other Distance from private water supply well or suction line: Comments (on condition of joints, venting, evidence of leakage, etc.) _ 4" PVC thru floor, no leaks visible SEPTIC TANK: X Depth below grade: 3' _ Material of construction: X concrete _ metal _fiberglass _polyethylene _other(explain) If tank is metal list age: ____ Is age confirmed by a Certificate of Compliance (yes or no): — (attach a copy of certificate) Dimensions: 10' x 5' x 4' Sludge depth 8"_ Distance from top of sludge to bottom of outlet tee or baffle: _19" _ Scum thickness: _3" Distance from top of scum to top of outlet tee or baffle: - 8" -Distance from bottom of scum to bottom of outlet tee or baffle: 18" How were dimensions determined: _ Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc. _Pumped septic tank. Inlet tee ok. Outlet tee ok. Depth of liquid at outlet invert. No evidence of leakage. Center cover on tank has riser 8" deep. _ GREASE TRAP: _(locate on site plan) Depth below grade: _ Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Page 8 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _712 Sharpners Pond Road _ _ North Andover - Owner: _Santo _ Date of Inspection: _1/30/2008_ TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present (yes or no): Alarm level: Alarm in working order (yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): DISTRIBUTION BOX X Depth below grade 3'_ Depth of liquid level above outlet invert: _ 0 _ Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.) __P -box cover broken. Replaced it. No evidence of leakage. Evidence of carryover, pumped d -box to clean _ PUMP CHAMBER: _ (locate on site plan) Pump in working order (yes or no): Alarm in working order (yes or no): — Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Page 9 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 712 Sharpners Pond Road _ _ North Andover— Owner: _Santo Date of Inspection: _1/30/2008_ SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan, excavation not required) If SAS not located explain why: Type leaching pits, number: _ leaching chambers, number: _ leaching galleries, number: _X leaching trench, number, length: —2 Trenches 65' long_ leaching field, number, dimensions: overflow cesspool, number: innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Lawn covered in snow. No signs of ponding to surface.. _ CESSPOOLS: Number and configuration: _ Depth — top of liquid to inlet invert: — Depth of sludge layer: Depth of scum layer: _ Dimensions of cesspool: _ Materials of construction: _ Indication of groundwater inflow (yes or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: _712 Sharpners Pond Road _ _ North Andover— Owner: _Santo _ Date of Inspection: _1/30/200$_ SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building A to Tank = 30' A to D -Box = 51 B to Tank = 20' B to D -Box = 33 C to D -Box = 44 Page 11 of l OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _712 Sharpners Pond Road _ _ North Andover— Owner: _Santo Date of Inspection: _1/30/2008 _ SITE EXAM Slope _ Yes _ Surface water _ No _ Check cellar _ Dry _ Shallow wells _ No _ Estimated depth to ground water _>4'_ Please indicate (check) all methods used to determine the high ground water elevation: X Obtained from system design plans on record - If checked, date of design plan reviewed: _5/24/1993_ Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health -explain: _ _ Checked with local excavators, installers- (attach documentation) Accessed USGS database -explain: You must describe how you established the high ground water elevation: No water found 4' below system as per test pit data on design plan _ Tel: (978) 475-4786 Fax: (978) 475-5451 BATESON ENTERPRISES, INC. Excavating -Water& Sewer Lines -Septic Systems & Pumping Service 111 Argilla Road Andover, Mass. 01810 Title 5 Inspection Report Property Address: 712 Sharpners Pond Road, North Andover Owner: Santo Date of Inspection: 1/30/2008 My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic system. Nei J. Bateson Bateson Enterprises, Inc. V Y �r - Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 DEP has provided this form for use by local Boards of Health. Other fomes may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to detemvne the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. VQ til t5form4.doc• 06/03 1. Syster-4ocation: 1 ) pj V�A— ca City/Town 2. System Owner: Address (if different from location) Zip Code Cityr-ow, Telephone Number B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): l�—CJS D�e'�'�� 2• Quantity Pumped: Gallons Cesspool(s) Septic Tank ❑ Tight Tank 4. Effluent Tee Filter pmsent? ❑ Yes LSI If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. Systegj Pymped By: t1-0-v'QA t�k Name —? Vehicle Lcense Number Company , 7. Location ere cte.nts re disposed: T Date System Pumping Record • Page 1 of 1