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Home My WebLink AboutMiscellaneous - 80 LOST POND LANE 4/30/2018 (2)77 ::COMMENTS J. Y FORM 'U APPROVAL: r APPR AL TO "ISSUE 3 F OV YE NU. Ya DATES ISSUED P t b w 'tk 4 `4y *CON' D ITI ONS s 114 64, t FINAL` APP;ROYAL r— � ¢= L`L `4ERS ID APMITPAYES, NO ✓ s ,- CONSTRUCTI0 APPROVALv YE 5 b { NU 'SEPT IC�fSYSTEM' CONSTRUCTION "APP RU VAL YES � sr OTHER' YCSt�NU � ANY`NARIANCE NEEDED YES NO ^rFINALPOARD''OF HEALTH APPROVAL DATE BY - ..F/ Ir 4 v as ss+ �t > 3 x �my� rs Sry �y 1 a ash 4 n.•�f q�� 9. -IT§"z�7 #+ k r A r 'r 3 "'! ''� '{ yf .E:f Y ' y � E le,.� r d l^gyp $ s }z'�, `:. 't'' y" I � f `tts '.��-r r si d +,y. -' J + ' `'• h '• � s �' , `^}' [n '" 5 ^� ' .y.,." Fk, i y. � , s.� : ;" � M1 i �'ti r C.;: d t �111L `� .�s„s. ; T-'.tyYaa 4 f -i .•,4, , , , i#, t�'y rc .t -� k �y to , :.' . 7 3, 5-a r i sK'" 4'^t''°''" < 'T k :.' 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A 1s `` � � � NEW CONSTRUCTION CERTjF—IED PLOT IPC.'AN 'REVIEW -ES k'a ANO-` b , 4 S e ¢' yIC: CONDITIONS- OF' APPi, ., � YES 4 NO r< ( I , 4 Y , (FROM FORM U) b� *v f r r ,` s ,, N , y a. r :.r T.�1,\ x `. 1 f` r� Y 1 i c, �'.� r :,r s� - .+ i �`>t tom. yr ° � d ISSUANCE OF DWC PERMI+T k 1.Y4ES �.,�<N0 ; ��r{ e e ' l ` =DWC PERMITS N0. 4 '•. ` r INSTALLER. �'�i eA . .:�, '4` �. • .: s _ 'R s T a _ ;':.r pt{,^ ' t �e 1 a g I. 2 a A e i ti' \v r y' -`4 "�, a ��i��`' r HEG I N r I NSPECT.�I ON �.Y�ES 4 0 4 -� €t �' ,ga� A➢ 77 8 i e } f �; l ,t .'n -F I y `- _F. St +1 i"'St,Bvif"r3iz 1a� S� '1� sSo- �'� tly 1 £ �`'� _" EXCAVATION AINSPECTION �! =4r s NEEDED � �' ° ' �' ! I _ , t _ s J �'t y'' Y ,�'t' 3 i. + -_ a�' `r,. .c -_ ' "a ,�$ , y` a�. ', ``Fa r kV w '�:, X y y .t 'a '� a, - - -r '. v '+„ , ,7'1 f !L 't a.' 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UL (�0 O LO 0 o`ammco N vY E 0 O.N 7L6X L6 �'�C Nrn t1 w I—mLL2'wmYLLI mmQ ^' 0 UNLiLL' U LL OT� ai y a� W wS�;a� oXM:' d�.�a� U(n5 W LL _LLLLC O a Y co O N ca CL Owner information is required for every page. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. — I --- 1�1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Asses, 80 Lost Pond Lane Property Address Erica Fagan Owner's Name North Andover Cityrrown MA 01845 State Zip Code APR -0 o &DEPMENIT ER rH 2/10/10 G ,/ Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: Benjamin C. Osgood Jr. Name of Inspector none -Company 16 Hillside Avenue, Unit 3 Company Address Amesbury Cityrrown 508-328-4633 Telephone Number B. Certification MA 01913 State Zip Code 870 License Number I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 9, Lnt—' '/�— 2/10/10 Inspector's ignature Date The system inspector shall it 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. ****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. Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Lost Pond Lane Property Address Erica Fagan Owner's Name North Andover Cityrrown B. Certification (cont.) MA 01845 State Zip Code 2/10/10 Date of Inspection Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System Passes: ® 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. Check the box for "yes", "no" or "not determined" (Y, N, ND) 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. ❑ Y ❑ N ❑ ND (Explain below): Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Lost Pond Lane Property Address Erica Fagan Owners Name North Andover City/Town B. Certification (cont.) B) System Conditionally Passes (cont.): MA 01845 2/10/10 State Zip Code Date of Inspection ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Lost Pond Lane Property Address Erica Fagan Owner's Name North Andover Cityrrown B. Certification (cont.) MA 01845 State Zip Code 2/10/10 Date of Inspection 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 indicates absent 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: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Lost Pond Lane Property Address Erica Fagan Owner's Name North Andover City/Town B. Certification (cont.) MA 01845 State Zip Code 2/10/10 Date of Inspection ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® 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. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. 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. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Lost Pond Lane Property Address Erica Fagan Owner Owner's Name information is required for North Andover MA 01845 2/10/10 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No ® ❑ El 0 ® ❑ El Z ® ❑ ® ❑ z ❑ ® ❑ ® ❑ Pumping information was provided by the owner, occupant, or Board of Health Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined? (If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? Were all system components, excluding the SAS, located on site? Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: Existing information. For example, a plan at the Board of Health. Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 660 V Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Lost Pond Lane Owner information is required for every page. Property Address Yes ❑ No ❑ Erica Fagan ❑ No ❑ Yes Owner's Name No North Andover MA 01845 2/10/10 Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? Last date of occupancy: Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tank present? Non -sanitary waste discharged to the Title 5 system? Water meter readings, if available: Gallons per day (gpd) ❑ Yes ® No current Date ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Lost Pond Lane Property Address Erica Fagan Owner's Name North Andover Cityrrown D. System Information (cont.) Last date of occupancy/use: Other (describe below): MA 01845 2/10/10 State Zip Code Date of Inspection General Information Pumping Records: Source of information: Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: gallons Date Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Yes ® No ❑ 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) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Lost Pond Lane Property Address Erica Fagan Owner Owner's Name information is reuired for North Andover MA 01845 2/10/10 q every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Installed 1997 per BOH records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer (locate on site plan): Depth below grade: ee Material of construction: ❑ cast iron ® 40 PVC ❑ other (explain): Distance from private water supply well or suction line: N/A feet Comments (on condition of joints, venting, evidence of leakage, etc.): Pipe under floor in basement Septic Tank (locate on site plan): Depth below grade: Material of construction: ® concrete ❑ metal 2.5 feet ❑ fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) Dimensions: 1500 Gallons Sludge depth: 2" ❑ Yes ❑ No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Lost Pond Lane Septic Tank (cont.) MA 01845 2/10/10 State Zip Code Date of Inspection Distance from top of sludge to bottom of outlet tee or baffle 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 33" V- 6" 14" How were dimensions determined? Measure Stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank in good condition Sch 40 PVC Tees in good condition. Grease Trap (locate on site plan): Depth below grade: feet 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: Date Property Address Erica Fagan Owner Owner's Name information is North Andover required for every page. Cityrrown D. System Information (cont.) Septic Tank (cont.) MA 01845 2/10/10 State Zip Code Date of Inspection Distance from top of sludge to bottom of outlet tee or baffle 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 33" V- 6" 14" How were dimensions determined? Measure Stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank in good condition Sch 40 PVC Tees in good condition. Grease Trap (locate on site plan): Depth below grade: feet 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: Date Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Lost Pond Lane Property Address Erica Fagan Owner owner's Name information is required for North Andover MA 01845 2/10/10 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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 per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): * Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Lost Pond Lane Property Address Erica Fagan Owner's Name North Andover MA 01845 2/10/10 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): 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.): D Box OK. Distribution equal. No evidence of leakage or solids carryover Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Lost Pond Lane Property Address Erica Fagan Owner Owner's Name information is North Andover MA 01845 2/10/10 required for every page. Citylrown D. System Information (cont.) Type: State Zip Code Date of Inspection ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 2 Trenches 55'long 4' wide 12" ❑ leaching fields number, dimensions: Deep ❑ 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.): Area of leach field looks normal. No evidence of ponding, damp soil, or unusual vegetation. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth — top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments • s 80 Lost Pond Lane Owner information is required for every page. Property Address Erica Fagan Owner's Name North Andover MA 01845 2/10/10 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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.): Owner information is required for every page. Commonwealth Of Massachusetts Title 5 Official Inspection Fry Subsurface Sewage Disposal System For - Not for Voluntary mems 80 Lost Pond Lane Property Address Owner's Name North Andover City/Town D. System Information (cont.) MA 01845 2/10/10 state Zip Code Date of Inspection Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ® hand -sketch in the area below ❑ drawing attached seoarateiv Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Lost Pond Lane Property Address Erica Fagan Owner's Name North Andover MA 01845 2/10/10 City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells 5 Estimated depth to hlgh ground water. feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® 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: usgs maps You must describe how you established the high ground water elevation: System designed V above water table. Plans by Neve Associates Before filing this Inspection Report, please see Report Completeness Checklist on next page. -Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Lost Pond Lane Property Address Erica Fagan Owner Owner's Name information is North Andover MA 01845 2/10/10 required for every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, 6, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information — Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file f = OV 7019 ate. -0S Amo of I aoin.ras ,. � a i �gti —ice .9Z'.r*j =-uoi4onaj3 uoi;opuno•� �o do1 b� J +� zk; ;0;7 t to Ae- r Ae- A p' 0� % 11991 94 Lot` -4 'c'1 -est. warn ft.¢9 ched ule of A nVeTts ert ® Foundation = 134.16' p tic Tank /n = 133.58' ptic Tank- Out = 133.34' Box /n = 133.02' Box Out = 132.84' 'ench /n = 132.841, 132.67' ench Out = 132-19', 132.36' Pule of Tie Distances AE = 50.9' AG = 76.0' BE = 67.6' BG = 58.4-' 5' AF = 66.9' AH = 64.6' 1' BF = 79.5' BH = 43.1' U 0 Pon Of L and /n North Andover, Mass. Showing "A s Built " Sanitary Disposal Sys tem Lot 3 Lost Pond' Lane Prepared For Flintlock Inc - Scale: 1 " = 40' Date: April 11, 1997 Zoning District:. R-1 (Residence 1) (Planned Residential Development) l hereby certify that / have inspected the- construction of this disposal system and that- the construction and final grading has been in accordance with the designer's intent and that the materials used conform to the plan specifications and 310 CMR 15.0. This plan has been prepared for- the purpose of showing the "As—Built" conditions of the sanitary disposal system installed on the premises All work was doneas substantial oto k�Owas conformance with the design plans as Pref done within the construction limitations expected for a job of this type Thomas E Neve Associates, Inc Engineers — Surveyors. — Land Use Planners 447 old Boston Road US. Route 1 Topsfield, Massachusetts 01983 887-858E 4 7PYa—q N NGLAND ENGINEERING SERVICES INC AUG 2 6 2004 TOWN OF Nutt i n ANUOVER HEALTH DEPART MENT` August 24, 2004 North Andover Board of Health Town Hall Annex 27 Charles Street North Andover, MA 01845 RE: TITLE V REPORT: RE: 80 Lost Pond Lane, North Andover, MA Dear Sir or Madam: Enclosed is a copy of the Title V report for the above referenced property. The system PASSED our inspection. If there are any questions please call me at my office, 686-1768. Sincerely 6-",7 C O v�- Benjamm C. Osgood, Certified Title 5 inspector 60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 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: —60. L_ osT Pn N n L-Ak;F Ii/ O L224 Acv n o of -q- Owner's Name: 661" Aly TA -rokif ,2REDEdVED Owner's Address: _ Ro (--o i_AA) 0 2.i-FfnJ f1— Date of Inspection: S z: oy AUG 2 6 2004 Name of Inspector. (please print) _Beni amin C. Osgood, Jr. TfOFN NORTH ANDOVER CompanyName:New England Engineering Services Inc. EALTHDEPARTMENT Mailing Address:60 Beechwood Drive, North Andover, ILA 01845 Telephone Number. 978-686-1768 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: z, O 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. e Page 2 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: o 1—os i ?NJa L►4NL= "o 2-1.-P, A&2 �> 0'., e_"? �4 Owner: v5 Alm Iq a i Tom} 7'0 2 E YZ Date of Inspection: C y Inspection Summary: Check A B C,D or E / ALWAYS complete all of Section D A.. System Passes: Ira— 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 b~ckup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is leveled or replaced ND explain: the system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed ND explain: Page 3 .of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: A� O A) 0 R 13-j j Q n�c'12 4.4 Owner: 144AJ ?"V 2N Er - Date. of Inspection•alle'aloq C. Further Evaluation is Required by the Board of Health: NO v 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)(6) 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 fee_ t of a surface water supply or tn'butary 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 org-we oompounds 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. Page 4 of 11 OFFICIAL INSPECTION FORM -- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address, 60 1_os; PU .,J D L_A K)c AVo21W /ADD Ce "A Owner: 5 Rnn C R Date of Inspection: g 2 OL/ D. System Failure Criteria applicable to all systems: You must indicate W or -no?' to each of the following for all inspections: Yes No . _ _L/ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool — ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool — ✓' Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool „Liquid depth in cesspool is less than 6" below invert or available volume is less than'. day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped — _LZ Any portion of the SAS, cesspool or privy is below high ground water elevation. _ __,Z Any portion of cesspool or privy is within 100 feed of a surface water supply or tributary to a surface water supply. V Any portion of a cesspool or privy is within a Zone 1 of a public well. _Z Any portion of a cesspool or privy is within 50 fed of a private water supply well. . �/ Any portion of a cesspool or privy is less than 100 fect but greater than 50 fed 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.] v v (Yes/No) The system faits. 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 m ' dicate either "yes" or `no" to each of the following: (The folio criteria apply to large systems in addition to the criteria above) yes no — _ the system is wi 400 feet of a surface drinking supply the system is within 200 of a tri to a surface drinking water supply — the system is located in ogee itive area (Interim Wellhead Protection Area - IWPA) or a mapped Zone R of a pub ' ter supply well If you ha wered "yes" to any question in Section E th em is considered a significant threat, or answered in Section D above the large system has failed. The own r operator of any large system considered a significant threat under Section E or failed under Section D shallup de the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office the Department. Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: SO t._ o,, Po t, D N o z -o- k,jdv(:/2 Owner: C,)+M AAJ-r 4 TUIZrLCr- Date of Inspection: - F3' 2.?, -a 1/ Check if the following have been done. You must indicate `des" or "no" as to each of the following: Yes No ' 7/ umping information was providedby the owner, occupant, or Board of Health — _ Were any of the system components pumped out in the previous two weeks ? Has the system received normal flows in the previous two week period ? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection ? Were as built plans of the system obtained and examined? (If they were not available note as NIA) 1� Was the facility or dwelling inspected for signs of sewage back up 7 Was the site inspected for signs of break out ? _ Were all system components, excluding the SAS, located on site ? Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum ?. Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems ? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: Y no information.For example, a plan at the Board of Health. 2/E)dsting Determined im the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: (60 L_a51 ?D,i N'o t2Td-/ A,0 O _ Q� / vt t4 Owner: -SA/vi "— (Z VX c 2 Date of Inspection: , o�— FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): Number of cement residents: Does residence have a garbage grinder (yes or no): _ Is laundry on a separate sewage system (yes or no): _Q [if yes separate inspection required] Laundry system inspected (yes or no): — Seasonal use: (yes or no): IVO Water meter readings, if available (last 2 years usage (gpd)): Sump pump (yes or no): /0 Last date of o9t�aa— cj+: G LP r r -c v�� - -- ----------- i --- COMMERCIAIJINDUSTRIAL Type of establishment: Design flow (based on 310 CMR 15.203): gnd Basis of design flow (seats/persons/sgketc.): 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): Pumping Records GENERAL INFORMATION Source of information: Was system pumped as part of the hupec tion (yes or no): If yes, volume pumped: _gallons — How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank., distribution box, soil absorption system _ Single cesspool Overflow cesspool —Privy Shared system (yes or no) Of yes, attach previous inspection records, if any) _ InnovativelAlternative technology. Attach a copy of the cament 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: %�,(L S t De%iS fly iii Were sewage odors detected when arriving at the site (yes or no): A10 Page 7 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: L.oST Poeur, �-VqNc o 9 R -f A.,Q n Du2-v- -tA Owner: ;'7awl'9 07-A- TvQCI e 2 Date of Inspection: 8 ( 2 -4 L -)'J 13UIIAING SEWER (locate on site plan) Depth below grade: -3, 5 Materials of construction: cast iron PVCother (explain): Distance from private water supply well or suction line: ivA - Comments (on condition of joints, venting, evidence of leakage, etc.): P, Pc - N v C5 -(Z- spa --9-;' >,� e, P -'s SEPTIC TANK: _ (locate on site plan) Depth below grade: 2,_C,-' Material of construction: 1,elconcrcte 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: /522 0 &-{a- " o S Sludge depth - Distance from top of sludge to bottom of outlet tee or baffle: 33 Scam thickness, 1 " Distance from top of scum to top of outlet tee or baffle: 6 Distance from bottom of scam to bottom of outlet tee or baffle: How were dimensions determined: _ -t-s c�-+ 6,j a, s :,2 c i< Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): TA4N!A, 6-00 GvN ✓\ 5c.H C sC76D cc9. •1-z' n.rr T ;�2 Pi CfdEP t3RC/{ fns 71D 'J-AnJK. a2ccDIK crvP >0 -LS i k e 2e co nitc(o r,> /,v U P,15 E (?sOwl ALC. OP-'W(til &i- Tt)w i i�{(n N 6 O f'�- G-2" e - GREA R TRAP:. (locate on site plan) Depth below grade: _ Material of construction: concrete metal fiberglass _polyethylene other (explain): Dimensions: Scum thickness: Distance from top of scam 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: -) O t o5T PyN p 0 v (�-f "Iq Owner. S4e-oqc 7?9- Tc�2�lC2 Date of Ingrection: TIGHT or HOLDING TANK: iv r7 (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: CaIacrtY• gallons Design Flow: gallonslday Alarm present (yes or no): Alarm level: Alarm in working order (yes or no): Date of last pumping- Comments umpingComments (condition of alarm and float switches, etc.): DISTRIBUTION BOX: (if present must be openWocate on site plan) Depth of liquid level above outlet invert _ Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Rex D 17 t7/j, V V DGNCC !— �ol�/ O S Ci92 oc/Pr y c77-� C O PUMP CHAMBER:/(locate on site plan) . Pumps in working order (yes or no): Alarms in working order (yes or no): Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Page 9 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address - Owner: Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, excavation not required) If SAS not located explain why. Type leaching pits, number: _ leaching chambers, number: leading galleries, number: ✓leading trenches, number, length: z--)- t 2e N c KC- s 5-5 leading fields, number, dimensions: overflow cesspool, number: innovativelalteinative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, levet of uondina. damn soil. condition of veaetation. CESSPOOLS*-A� (cesspool must be pumped as part of inspectionXlocate on site plan) Number and configuration: Depth – top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow (yes or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIVY: J/—ftocate 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 (continued) Property Address: C30 4 A:> A ---77e AA-) Owner: 7-V" c/L Date of Inspection: F i j z - 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. tJ-0 Page 11 of 11 OFFICIAL INSPECTION FORM _ NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: So t-001— FO a i �2 P,D 42 0 Z tt A jj zL �� Owner: Date of Inspection: 2 0 SM EXAM Slope Surfacewater Check cellar Shallow wells Estimated depth to ground water feet Please indicate (check) all mediods used to determine the high ground water elevation: t,,- Staked from syam design plans on record - If checked, date of design plan reviewed: Observed site (abetting propertylobservation hole within 150 feet of SAS) Checked with local Board of Health -explain: Checked with local excavators, installers,- (attach documentation) Accessed USGS databaso-explain: You must describe how you established the high ground water elevation: A6c�,e t-tcG t-( -y2 Form No. 4 Town of North Andover, Massachusetts BOARD OF HEALTH ?nna ?'r 19- 97 - CERTIFICATE 'OF COMPLIANCE This is to certify that the Individual Soil Absorption Sewage Disposal System constructed (X) or repaired ( ) by- Peter Breen INSTALLER at—Lot 43 rnSt- Pnnd T,an (#301 SI rE LOCATION has been installed in accordance with Board of Health Regulations as described in the Design Approval Site System Permit No. lap " dated -Nov. 3, 19 95 The issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. /�' N(OARDOF HEALTH X —� i rte\ u :ae CL :ate :Cc t 0 cc C) V / o O O ee+ O O p. O t; cm :co= E m O rd o cm O N c 2 N y O m CC L O Of 1 C O a dCt m p . :up `o Z w a a y $ - o4D _W Z -t C .e.. Z W 1 v'O v O C.D AD . p :IE .0 CL ..: CD m Uw MA co � O co C. �O Beni eeeee. C cm COD -0 co•� M� W CD - CL. CD CD .� ®` ®. ca Cc AD �CO2 z co CL 6/2 ccC o C •ever w cc I t MOR7q 3? a ,r. °• ° O ,SSACMUSEt Applicant_ Site Location Town of North Andover, Massachusetts Form No. 3 BOARD OF HEALTH 19 9 DISPOSAL WORKS CONSTRUCTION PERMIT E DT Permission is hereby granted to Construct (-/or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. CHAIRMAN, BOARD OF HEALTH Fee D.W.C. No. APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: LOCATION: LD ! 3 CURRENT INSTALLER'S LICENSE# 7— LICENSED INSTALLER: �� ?�� ' ''e e -f✓ SIGNATURE:TELEPHONE# CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT. Administrative Use Only $75.00 Fee Attached? Yes No Foundation As -Built? Yes No Approval Date: /�7 .i THU ASS( April 15, 1996 Sandra Starr, R.S. North Andover Board of Health 146 Main Street North Andover, MA 01845 Re: Lot #3, Lost Pond Lane Dear Sandy: INC. >VVN OF NORTH ANDOVE BOARD OF HEALTH APR !_I 6 We are in receipt of your disapproval letter for Lot #3, Lost Pond Lane, dated April 3, 1996. Please find enclosed 3 copies of the revised plan reflecting the changes per your requests in the above -referenced letter. Please note, however, that your first request has not been met. Please remember that on our January 30, 1996 meeting we discussed the redox issue extensively and concluded that a ground water gradient would more than likely be found as you examine the subsurface profile from the lower system area to the upper part of the knoll. Please see the sketch, in the profile area, on the plan dated 12/15/95 that was made during our meeting. We concluded that in order to utilize the redox elevation, the system would have to move upslope to obtain the needed area down slope to grade the system without the use of a breakout wall (Please see enclosed sketch A). We realized that if we moved the system not only would we require further testing but, most importantly, since a gradient was apparent, moving the system upslope would prove to provide the same separation distance that we now have. At this time we feel that the system area, as designed, is appropriate. For your records, please find enclosed plans and correspondence pertaining to these issues. We hope that we have resolved everything and that an approval of this design will be granted. • ENGINEERS • • LAND SURVEYORS • • LAND USE PLANNERS • 447 Old Boston Road U.S. Route #1 Topsfield, MA 01983 (508) 887-8586 FAX (508) 887-3480 Sandra Starr April 15, 1996 Page 2 Thank you for your time in reviewing these matters. If we can be of further assistance, please call. Sincerely, THOMAS E. NEVE ASSOCIATES, INC. Steven Saraceno, EIT Engineer in Training Enclosures S S\ec steve\1276.doc Town of North Andover E AORTH OFFICE OF f �� Jhtt '� OL COMMUNITY DEVELOPMENT AND SERVICE k C n 146 Main Street a North Andover, Massachusetts 0184 WILLIAM J. SCOTT SsgcFs,US Director October 24, 1996 Sandra Starr, R.S. North Andover Board of Health 146 Main Street North Andover, MA 01845 Re: Lot #3 Lost Pond Lane Dear Sandra: We are in receipt of your recent disapproval letter for Lot 3 Lost Pond Lane dated October 1, 1996. We have not revised the plan to comply with your requests. We feel confident that the design water at 127.3' is appropriate for the system design. For further argument please see the letter and information sent to your attention, dated April 15, 1996. Please find enclosed copies of the system plans for the abutting lots 2 and 4. These designs, as revised, were sent to your attention and approved. You will note that the design water for lot 2 was 123.83' and that the design water for lot 4 was 125.6'. Both of these design waters used are lower than the design water proposed for lot 3 at 127.3'. This elevation is 1.7' higher than that used on lot 4 and approximately 3.5' higher than that used on lot 2. Again, we are very confident that the design water of 127.3' being used for the proposed system on lot 3 is accurate, if not conservative. • ENGINEERS • • LAND SURVEYORS • • LAND USE PLANNERS • 447 Old Boston Road U.S. Route #1 Topsfield, MA 01983 (508) 887-8586 FAX (508) 887-3480 Sandra Starr October 24, 1996 Page 2 We trust that you will see our decisions make sense and share in our interests by approving the plan as previously submitted on April 11, 1996. If you should have any questions, please do not hesitate to contact our office. Sincerely, THOMAS E. NEVE ASSOCIATES, INC. Steven Saraceno, EIT Engineer in Training SS/ec Enclosures cc: Dave Kindred Steve\1276.doe Town of North Andover F „ORT{-0i ORT{- , OFFICE OF 3� O COMMUNITY DEVELOPMENT AND SERVICES ° 146 Main Street � 09 North Andover, Massachusetts 01845 April 3, 1996 Mr. Tom Neve Neve Associates 447 Old Boston Road Topsfield, MA 01983 Re: Lot #3 Lost Pond Road Dear Tom: This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: 1. GW in pit 94-5A indicated at 131.5. System not 4 feet above. Perhaps we may want to check GW with additional deep hole. 2. Under 78 code 25 feet of fill is required if leach area is out of ground. Can we pull this back a tad? 3. Perc elevations not present. 4. Map & parcel missing. If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Sincerely, Sandra Starr, R.S., Health Administrator SS/cjp BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 146 Main Street North Andover, Massachusetts 01845 (508) 688-9533 Thomas Neve Neve Associates 447 Old Boston Road Topsfield, MA Re: Lot #3 Lost Pond Lane Dear Tom: This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: 1) Only one perc done - Minimum is two per lot. (N. A. 4.09) 2) Please show minimum distance between leach lines and house. 3) Please re -design using one code only. (loading - 178 code; breakout - 195 code) If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Sincerely, Sandra Starr, R.S. Health Administrator SS/cjp BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Julie Parrino D. Robert Nicetta Michael Howard Sandra Starr Kathleen Bradley Colwell THOMAS E. NEVE ASSOCIATES, INC. Engineers • Land Surveyors • Land Use Planners 447 Boston Street US #1 TOPSFIELD, MASSACHUSETTS 01983 (508) 887-8586 FAX (508) 887-3480 TO GjAl�1FV p,�j'fA>? r 2.5. $oPAZc> c>F c>H tom. A L --r t} WE ARE SENDING YOU Attached ❑ Under separate cover via ❑ Shop drawings 'R� Prints ❑ Plans P ❑ Copy of letter ❑ Change order ❑ DAT E 1 7 ' I& JOB NO. ATTENTION �jAti-1�P. STArccz RE: ❑ For your use ❑ Approved as noted ❑ Submit �v►s�p t2l(o -3 F�t_-! 'its ptz�Pc�sEp SA+-�1-CA+'L`� its frbsq-C_ 17EStC v-� V64 c_x5T ❑ For review and comment ❑ ❑ Samples the following items: ❑ Specifications COPIES DATE NO. DESCRIPTION ❑ For your use ❑ Approved as noted ❑ Submit �v►s�p t2l(o -3 F�t_-! 'its ptz�Pc�sEp SA+-�1-CA+'L`� its frbsq-C_ 17EStC v-� V64 c_x5T ❑ For review and comment ❑ ❑ FORBIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US �*JC I-c�St Y� —T}� REMARKS T�-Af-A�)�� +4`"'�(f ��V L f�F��'�t� GPet"N C-xe_5 VIA Pr - F<5 -t— `-�� e- Q.LAAeS-c S t11v L2 -- -� 5 L &A LA ta 063'L—--- - w'E►Z-,C- f- 1 LES E;,(--> QN-av jiC=i n s� -::,-VJ6\,AL-Ap �}A�E P�*-�`� QLr1�S-C�a,�� t��t✓ cf�u-� -- '��- `�cx.-t 'Fc�2_ "Ccs�e.� Tt rv�tt✓. _ THESE ARE'TRANSMITTED as checked below: ❑ For approval ❑• Approved as submitted Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FORBIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US �*JC I-c�St Y� —T}� REMARKS T�-Af-A�)�� +4`"'�(f ��V L f�F��'�t� GPet"N C-xe_5 VIA Pr - F<5 -t— `-�� e- Q.LAAeS-c S t11v L2 -- -� 5 L &A LA ta 063'L—--- - w'E►Z-,C- f- 1 LES E;,(--> QN-av jiC=i n s� -::,-VJ6\,AL-Ap �}A�E P�*-�`� QLr1�S-C�a,�� t��t✓ cf�u-� -- '��- `�cx.-t 'Fc�2_ "Ccs�e.� Tt rv�tt✓. _ COPY TO RECYCLED PAPER: 7 Contents: 4096 Pre.Consumer - 10% Post -Consumer SIGNED- t� d n - �L�• If enclosures are not as noted, kindly notify us at once. FORM U - VERIFICATION 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: _ r •�' I G C L ti' Phone,; LOCATION: Assessor's Map Number _ G/t Parcel/ Subdivision ~' I l a'v� Lot (s) Street -_ �-___-_-_ St. Number ************************OffiC.ial Use Only************************ RECOMMENDATIqNq OF TOWN AGENTS: Cq serva n Administrator Comments Date Approved Date Rejected _ Town Planner Comments Food Inspector -Health Septic Inspector-Health— Comments Public Works - sewer/water connections - driveway permi Fire Department Received by Building Inspector e_ Date Approved Date Rejected Date Apprcved Date Rejected Date Approved Date Rejected �` _ Date NORTH ANDOVER BOARD OF HEALTH DESIGN REVIEW REPORT FEE: lO PERMIT ## 790 DATE RECEIVED 4 1 /vr APPLICANT MAP PARCEL ADDRESS ENG. LOT # �J STREET 44 ADDRESS / PLAN DATE �1 JA- 1/ 3lJAI REV. DATE CONDITIONS OF APPROVAL APPROVED REASONS FOR DISAPPROVAL: l (,V, A • 17) DISAPPROVED /"7»1Ji )A-1 15 Z5 /Al aye` �.CD/�DiN6 - Zf� cvDE� 0 ObZ5- Lyn 4 PLAN REVIEW CHECKLIST ADDRESS `. 40,5J ENGINEER GENERAL 3 COPIES STAMP �' LOCUS c-'_-_ SCALE 6/6ONTOURS PROFILE SECTION BENCHMARK ELEVATIONS_ SOIL & PERC INFO WETS. DISCLAIMER WELLS & WETLANDS L/ WATERSHED DISTRICTJ/Q DRIVEWAY_j.,,:�jj- WATER LINE/ DRAINS f� RESERVE AREA �� SCH40 (/� SLOPE SEPTIC TANK MIN 1500G. .17 INVERT DROP GARB. GRINDER(+200% EDF) 25' TO CELLAR MANHOLE TO GRADE C/ ELEV GW D -BOX # OUTLETS FIRST 2' LEVEL STATEMENT INLET /33, - OUTLET Z Q ( 2 " OR . 17 FT) LEACHING 100' TO WETLANDS ` 100' TO WELLS' 325' TO SURFACE H2O SUPP 35' TO FND & INTRCPTR DRAINS(/ 4' TO S.H.GW_-�/_ 2% SLOPE 4' PERM. SOIL BELOW FACILITY MIN 12" COVER (,�' FILL?� (25' if above natural elevation; 101if below) TRENCHES MIN 660 FT2 SLOPE (min .005 or 6"/1001) V >3' COVER? - VENT AL SIDEWALL DIST.2X EFF. W OR D (MIN 61) �" IS RESERVE BETWEEN TRENCHES? C/.2IN FILL? ✓MUST BE 10' MIN.C---' BOT +0 X LDNG SIZ"'2+ SIDE �,t X LDNG � = TOT Cp %% 76G� (L x W x #) (G/ft ) (DxLx2x#) (:�01 44-'s /_ PLAN REVIEW CHECKLIST ADDRESS .C� v� Z,0,5 �DVh ENGINEER—,j/—&L/65 GENERAL 3 COPIES (.""' STAMP L-'� LOCUS Z,1� NORTH ARROWy SCALE CONTOURS_L�' PROFILE ✓ SECTION BENCHMARK --Y SOIL & PERCSc�1P�2 ELEVATIONS WETS. DISCLAIMER WELLS & WETS WATERSHED?/t//9 DRIVEWAY(Elev) WATER LINE lid FDN DRAINj,---- SCH401Z' TESTS CURRENT? ✓ SOIL EVAL 7 SEPTIC TANK MIN 150OG `-/ .17 INVERT DROP GARB. GRINDER(+200% EDF) 25' TO CELLARI� MANHOLE_ ELEV GW # COMPS. — D-BOX SIZE # LINES FIRST 2' LEVEL STATEMENT INLET 13 OUTLET 13a-93 ( 2 " OR .17 FT) TEE REQ' D?/u' LEACHING / MIN 660 GPD? L RESERVE AREA 100' TO WETLANDS 100' TO WELLS 35' TO FND & INTRCPTR DRAINS_L,,,t-- 4' PERM. SOIL BELOW FACILITY 4' FROM PRIMARY? 20 SLOPE L� 4' TO S.H.GW (5'>2M/IN) 325' TO SURFACE H2O SUPP C ---- MIN 12" COVER Z,-' FILL? 112D if above natural elev; 101if below) BREAKOUT MET? TRENCHES MIN 660 gpd cl/ SLOPE (min .005 or 6"/100')y SIDEWALL DIST. 3X EFF. W OR D (MIN 6') RESERVE BETWEEN TRENCHES? SIN FILL? —_ MUST BE 10' MIN. `�4" PEA STONE?y VENT?_ � (>3' COVER; LINES >501) BOT4� _3 +Z SIDE A90 3� X DNG = TOT 110 77 (L x W x #) (DxLx2x#) (G/ft2) Copyright 0 1995 by S.L. Starr NORTH ANDOVER BOARD OF HEALTH DESIGN REVIEW REPORT FEE: 46d PERMIT # 7'74) DATE RECEIVED APPLICANT D/QV� Kr n�bP-c.D MAP PARCEL ADDRESS LOT # 3 ENG. /(/CUA STREET 445 7` ADDRESS PLAN DATE REV. DATE CONDITIONS OF APPROVAL APPROVED DISAPPROVED REASONS FOR DISAPPROVAL: 19:t3,0 //I� . CJ)9 N T id O NDEk 78 G' o 77/GL /5 0 7 UJB j-�U� L '*/5 mpp -i- A21175 -5 1,U6 , f -- 0.65 A cres 12 -� ' ti 128 � E 130 ---------- --- ---�'------ --- 128 Yl� \\\ , 13 0 \ \ . P94-5 ` 136 _------- 9 5A _ 1 \ I 1 I � O \ \ N - - o 1 \ \ 1 I 1 CD Proposed Four \ I \ 1 1 I1 Bedroom Dwelling \ T.O.F. = 143.0' ` \ BSMT = 135.5' \\ \\ Gar. = 135.5' ON co 1 1 \ \ \ I \ 1 W O 1 I \ I 1 1 I Ow Sanitary Svstem Design Data Sheet Lot 3 Job - 121 Name: Y1►,aDQ.r=o Toy of Foundation Eiev. = 143.0 t. Basement Elev. = 115= -50 Garage Elev. _ ( �.5a fr. Invert at Foundation Drain ft. System Tvpe: Chambers Trenches Bed Invert at Foundation= 17�125- -oO ft. 13�� Zcj it at Z % Invert at Septic Tank in. = 1 5.1 O ft. (1-�>j .3> Invert at Septic Tank out._ ft. ere. n ft at % a� Rate i i� Invest at D -Box in. = 1� ^i $ ft. Invert at D -Box out. = ft. 1-7 ft at 1 % Invert at System in = 1,34,4r ft. z u Invert at System end = 1�q ,Iq-, ft. Bottom of System Elev. = 1�,aO.1L(• ft. in. 0 f L (hjCo • c�� Breakout Elev.--- out = ft. . � � • g Groundwater/Design water at Elev. = _ 129. fL Pit # Depth Pit ate I Elev. I GW Elev. @ ere. n Perc. at a� Rate i i� Top & Sub Observed by Town of North Andover, Massachusetts Form No. 2 MoRrh BOARD OF HEALTH o � � w x DESIGN APPROVAL FOR 7ss,C"OSft� SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant Test No. Site Location T �� Reference Plans and Specs. Tt`Yy-V-x ENGINEER DESIGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. t 0 Fee `d CHAIRMAN, BOARD OF HEALTH Site System Permit No. a a Q is `4�.i •gyp 4� N 6 O a~ 03 O co N morn °oo aiQ V` ro b o q> wv� 0 ^O o m p CM J Oi O � C � � V I •O p o � .ow °� o c~ � � �� _ y hyo EA ] O4N r.. CpOc v � 'Y � � � �y •ti � �� '� ° o Z o c sof Q� � �o c q) roc oq) COQ CCJ�. p p,N m O II N�`°�q�C, Oc�y a N �i o°mo foo° a�o ° zaoa ,xx� ,•'� Q � ti N 1.•. W jl WN C WOv ti 0 ry iz °\As ; cy� s'9. ...49.00'. 0 3 U vi 6LO `n p Qi �o.o� c h ryas• Cry lb �• �r r� y 1 �6n oo�v til�� Off• � a z �LZW^ Q� J a Q is `4�.i •gyp 4� N 6 O a~ 03 O co N morn °oo aiQ V` ro b o q> wv� 0 ^O o m p CM J Oi O � C � � V I •O p o � .ow °� o c~ � � �� _ y hyo EA ] O4N r.. CpOc v � 'Y � � � �y •ti � �� '� ° o Z o c sof Q� � �o c q) roc oq) COQ CCJ�. p p,N m O II N�`°�q�C, Oc�y a N �i o°mo foo° a�o ° zaoa ,xx� ,•'� Q � ti N 1.•. W jl WN C WOv ti 0 ry iz °\As ; cy� s'9. ...49.00'. 0 3 U vi 6LO `n p Qi �o.o� c h ryas• Cry lb �• �r r� y 1 �6n oo�v til�� Off• � a z �LZW^ Q� 4, 4[ Alm t/ V U (6 v ►Iz Lo Lf)I� o N O .n N 49.001.. �o C 0cri Q) 0 O - alb yJ yam, Or) � m O II b Q � cj 4, 4[ Alm t/ V U (6 v ►Iz Lo Lf)I� o N O .n N 49.001.. �o iiiiiiii iiiii ii ii ilii V Date.. L. ..-. ; N2 2328 ............... .......... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that........ I . ...... ...................................... i .................... ............. has permission to perform ............................................................... . . -- '6— Ir .......... 1w wiring in the building of ................................................................................... - at . Ej ....... ........ . North Andover, Mass. ........................ ........................ Fee.. ..... . .... Lic. No:, ELECTRICAL INSPECTOR C/1 Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 77W COMMONWEAL7710FM4SF64QYUSETIS Office Use only DER4RTAffiNT0FPUBL1C&4F= Permit No. BOARO OFFMPREVEMONRE6ZL4 MAS 527CDfR 121-09 Occupancy & Fees Checked--- S i APFLICA TTONFOR PERNET TO FERFORMEI�'=(TAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 �", �` (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date /0 ___ V Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. PARCEL Location (Street & Number) 3 %%,11 Owner or Tenant Owner's Address °�- Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building �J /):g)OF rcxo9) /y Utility Authorization No. Existing Service Amps / Volts Overhead Underground No. of Meters New Service Amps / Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work .S (-i-1 ay) oo,,n j', dai a/J No. of Lighting OutletsNo. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool AboveBelow Generators KVA ground and No. of Receptacle Outlets C J No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Davices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local MunicipalOther No. of Dryers Heating Devices KW Conncctions .lo. of Water Heaters KW No. of No. of Sims Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER - 61,1 AN F, iPbV1F;d_Z1.V-f@1'WI:QI1_q -go' C670-1ZIt, Ito �. rmn- •a I FIR 11 , ".1111001 WolktoSlatt �O `� ice, -►:a •. R:r- C c•. •ci:_• •- � ` �� ` , �� 311 i' y� Esftm&dVakEdElecbcal Wdk $ J Rotlgti L� ` — 0 Final 9f,1/` Lioa>seNa //) q6 L>oamillb BlnmtesTelNa OU —t�Q� �� IV /2/ 031/ > y A1tTe1Na �OWIT2'SEiSURANCEWANER Iamawa dmt theL wdoesmthamtheitmsameeoteragecritsslks=ialegrivalatasrcgmedbyM-madnsett Cxmc ilaNNs �tha2mysigr>ahaernthspamitapp}icadcnwai�es this tt�anart 'lease check one) Owner Agent a Telephone No. PERMIT FEE Signature ot Owner or Agent Date. l .. . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .... c 5.....��E9 �! ! f .! ..................... . has permission to perform .... I..... . plumbing in the buildings of ..1-;7/ d. .................. at ...:3... . !'s. ..� , North Andover, Mass. PLUMBING INSPECTOR Check # 6f')53 ),([ASSACHL;SFM LNIFORM APPLICATON FOR PERM TO DO GAS FTITING (Type or print) Date 0 ,6 NORTH ANDOVER, `MASSACHUSETTS / Building Locations A5 ,112�� Permit # C r Amount 111-2,o 0 /tJ Owner's Name New ❑ Renovation Replacement ❑ Plans Submitted 0 (Print or type) Name .address r'" Name of Licensed Plumber or Gas Fitter C e one: Certificate Installing Company IJ Corp. ❑ Partner. ❑ Firm/Co. LNSURAINCE COVERAGE- Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes [:3No❑ . If h ve checked es please indicatp the type coverage by checking the appropriate box.. you a y_, Liability insurance policy Other type of indemnity 13Bond ❑ 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: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ t hereby certify that all of the details and information f nave sunmittea (or enterea) in aoove application are we ana accurate to the best of my knowledge and that all plumbing .cork and installations rmed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts Sta Gas kde and f hJjtetr 2 of the General Laws. sy: Title CitylTown APPROVED cFFtCE USE (NLY) Sign re of Licensed Plumber Or Gas Fitter u ber �'� 4 /, 5 / / as itterick, Number aster Journeyman 15-1111 (Print or type) Name .address r'" Name of Licensed Plumber or Gas Fitter C e one: Certificate Installing Company IJ Corp. ❑ Partner. ❑ Firm/Co. LNSURAINCE COVERAGE- Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes [:3No❑ . If h ve checked es please indicatp the type coverage by checking the appropriate box.. you a y_, Liability insurance policy Other type of indemnity 13Bond ❑ 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: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ t hereby certify that all of the details and information f nave sunmittea (or enterea) in aoove application are we ana accurate to the best of my knowledge and that all plumbing .cork and installations rmed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts Sta Gas kde and f hJjtetr 2 of the General Laws. sy: Title CitylTown APPROVED cFFtCE USE (NLY) Sign re of Licensed Plumber Or Gas Fitter u ber �'� 4 /, 5 / / as itterick, Number aster Journeyman 5, Location ^��7 > No. / // Date �oRTM TOWN OF NORTH ANDOVER f � 3?o�tt`•o "M� F R 9 Certificate of Occupancy $ . s � cHu� Building/Frame (Frame Permit Fee $ s�st 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # . /,/- 7 '13 7 Building Inspector Q; C •I - •_ 1 11) 0■ mo C :n Z c c W U z_ � Z c: 1� =.1 N G c c � c V z C c�-s4 Li U 1 C N c ^Q Q r -?c � C C � Z Z W O O C U Z O C c JC, c O o U c U C Ow O C z U Z Q - Z �• '� Q hi W Ju -L W �:. i o O Q U i^i O LL, X V o Q o 0 c < aO C) z W uj Ula < _ Z V — c — O Z z i% T, 0■ mo C :n Z c c W U z_ � Z c: 1� C N G c c � c V Z C c�-s4 Li :n Z c c W U z_ � Z C N G c c � c Z C Li FORM U - LOT RELEASE FORM INSTRUCTIONS: This farm is used to verify that all nec=essary 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. *** *-'APFL]CANT FILLS OUT THIS SECTION*''"*�"` APPLICANT w /a !aur/d% vt PHONE v LOCATION: Assessors Map Number AVJy5 PARCEL SUBDIVISION 10STr LOT (S) Z! STRE=T �� f-C3S% iGY�llV�'V ST. NUMEER b3 OFFICIAL USE OfVLY` RECOMMENDATIONS OF TOWN AGENTS: & `X ( I ' ' 1�cx zy,(_-� CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS N+'� S 1D l^��``l� e/D31o� (A^Ii TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH DATE. APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS 4AJ-5 PUELIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED EY EUILDING ii ISPECTO Revised 9197 im DATE --" FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approva s/permits fromt Boards and Departments having jurisdiction have ,been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or; equirements. *****:F***—******************AP P L I C ANT FILLS OUT THIS SECT APPLICANT �/®i�ka� e�d��e.�-i PHONE LOCATION: Assessors Map Number Oi 0 PARCEL SUBDIVISION LOT (S) STREET e�OS/ f��il/i%f/�� ST. NUMBER ****************************** -***********O F F IC IAL USE I RECOMMENDATIONS OF TOWN AGENTS: �orcb �*- X CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS N� 1 w'�-�Y '`lu �V11 -PLANNER- COMMENTS LANNERCOMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED_ DATE APPROVED DATE REJECTED PUBLIC WORKS - SELVER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING iNSPECTO Revised 919; j DATE 4 CERTIFIED PLOT PLAN LOCATED IN NORTH ANDOVER, MASS. SCALE:1 "=40' DATE: 8/24/99 Scott L. Giles R. P. L. S. Frank. S. Giles 50 Deer Meadow Road North Andover, Mass. I CERTIFY THAT OFFSETS SHOWN ARE FOR THE USE �,�IH Of THE OFFSETS OF THE BUILDING INSPECTOR ONLY�� y SHOWN COMPLY AND SUCH USE IS FOR THE WITH THE ZONING DETERMINATION OF ZONING ; S • 13972 H BYLAWS OF iERE� � �o��l CONFORMITY OR NON -CONFORMITY �� NORTH ANDOVER WHEN CONSTRUCTED. WHEN BUILT A �.� a4 Name: Location: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print City Phone am a homeowner performing all work myself. 01 am a sole proprietor and have no one working in any capacity ® I am an employer`` providing workers' compensation for my employees working on this job. Comganv name: se/J /moi �o i��.� �L�o / sw1]re City: No ft,aoor/GP W4 o/BH.f Phone #: 9?1 Z W- 5 Policy # 4A) W('— 9'/( S 2 2- " 7 "/ Address Z& 4 X1;s /r/P City: 4z A041161- & Phone* AO C o Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify un ains and penalties ifp[ry that the information provided above is true and correct. Signature Date i Print name O Phone #��Z Official use only do not write in this area to be completed'by city or town official' ❑ Building Dept ❑Check if immediate response is required Building Dept ❑ Lincensing Board ❑ Selectman's Office Contact person: Phone #. ❑ Health Department ❑ Other 11/18/1998 15:43 978-975-3987 LA14DMARK INSIRANCE ;> .. . , : DATE f►'M .:�.. ...:::. _:..-.. r :a r.• w::w J`�'^► few,;?:;:: ee:::' .. - PAGE E2 CORD C...E IfiAT . aZ P3fJ.i:. 11 18 Y fs THIS CER IFI CA E IS ISSUED ASA TTE OF INFORMATION NO RIGHTS UPON THE CERTIFICATE ONLY AND CC'NFERS CERTIFICATE DOES NOT AMEND. EXTEND OR Landmark Insurance Agency, In'-( NCLDER. THIS ALTER TINE COVERAGE AFFOROEC BY THE POLICIES BELOW. 19S Xasr.s.ahTtsetts Avenue COMPANIES AFFORDING COVERAGE North Andawr MA 01845-4190 Charles S. Randone ' COb;P?w A Maryland/Zurich Phos" 978 688 8829 Fa Nc 978-975-3987 1 - `j INSUFED j o*MP&NY 8 Safety Insurance Co. Angelo C. DiDic Building i COMPANY C Guard Insurance Group Realty, Inc. 242 Johnson Street i COMPANY North Andover MA 01845 D THIS IS TO CERTIFY THAT TFIE POLICIES Of INSURANCE LISTED 6ELCrN NAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD OR OTHER DOCUMENT WITH RESPECTWCH THIS INDICATED, NOTWITtSrTANO1Nd ANY REQUREMENT. TERN. OF GONDTT ON Cf ANY GOHITRACT MAY THE INSCRApr E AFFORDED BY THc POLCIES DESCRIBED HEREIN IS SJSJECT TO ALL ERMS. CER-tFICATE MAY BE ISSUED Ni PERTAIN, EXCL'USIDNS AND CONDITIONS OFSLIGH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED EY PAID CLAMS. I POLICY EFFECTIVE PCLK:Y EXPIRATION 1 LIMITS GJ oOL�CY NUVB£F TYPE Of NSURANc£ L.M DATE YAMIOCWr) ' DATE (NMVDQ'Y'f? I I ' I Gj:VERALAGGREOATE js2000000 OEI:ERALL"ILTIY A �x'cOMME LCENEk/1LUAtIILTTY SCP330B6d72 s 04/30/98 1 04%30/99 PRoovcts-COMP(OpAGo 2000000 I -00 O O O GIAMdS MADE � CCCUR � PER90NAL t RN "JURY 110 I O OW"E l CON: NFR'S RACTOR'S PROT EACH OCCURREN f 1 0 0 0 O 0 1 FIRE OAMAOE(AAyOft* tln) s 50000 MECEXP0,1,t- P..0) 1110000 AUTOMoavx UAUIUTY 1 ; `CONGM0 04130/99 1 SINGLE LMAIT 1500000 $ ANYAUTO 1500704 04/30/98 ALL OWNED AUTOS I GOCI&Y NARY (P -F---9 f X L I SCHeVk&EO AUTOS I I 1 X HIRED AUTOS ! , ! C000.r MJURY roe;8*00np i x NON -OWNED AUMS I PROPERTY DAMA-7E ' S I i1-G-A-RACC UAbWTY t i AVTO ONLY • EA ACCIOENT ! t OTHER THAN AUTO ONLY: I AW AUtO i ( Er.; H #Cc:oEur ; s L-- { I ' AGGREGATE ' f EXCESS UA IUTY ! EACH OCCURREKGE I A•C.GREOATE f A UMMELLAFCRM 1 SCP33086472 04/30/98 1 04/30/99 >; I I OTHER THAN UMBRELLA FOAM I WORKERS COMPENSATION.AnD Wv Tp ' EMPLOYERT UAB UTY i I EL EACH ACaOENT 11500000 C ;ThePROPRIrTON MXL PARTH;RZJp*CunYG ' AWC916392 04/30/98 04/30/99 IELDISEASE .POUCYUMIT 1500000 EL OISEA6E-EAENPLOYeE16500000 OFFICERS ARG - OTHER ` ' I DESCRIPT OF OPERATIONS.LOCATIONWEHiQES#ZPE0AL ffXW General Contractor GERFIFaGl .E HOL{3E3.....: ::.: . . .::.. :, CAhtCEt L1t710N .r ,E SHOIKO ANY OF THE ADOVE OEWMEO POLICIES BE CANCELLED BEFORE THE EXFRATION SATE THCAF". tM tLS.IXNO COMPANY WILL ENDEAVOR TO MAIL Town Of Amesbury. Dept. of 10 DAYS WMr. EN NOTICE TO THE CERTIFICATE MOLDER NAMED TO nHc LEFT. Commune ty i Dove lopmsen t 62 rriend Street VJT FALtW TO MAL SUCH NOTICE SHAD. WOSE IND OOUGATION OR LWMAY Amesbury HA 01913 OF AM IWO LIPCN THE COMPANY, ITS AGENTS OR REPRESENTATIVES ALRHORMEDFTFPRESENTATNE Charles S. Pandone 6A4,11, ACORO 25-S ... - ACOAt COOORfL`f1s3N UM / � ~ � \ . ' !DEPARTMENT OF PUBLIC SAFETY ' CONSTRUCTION SUPERVISOR LICENSE Expires: Birthdate: CS Z3,647 .0412712000 04/27/1953 Restripiidflo: 00 .� ANTHONY,_ JL HANDUVEk, UA 0045 ^� W-zi DEPARTMENT OF PUBLIC SAFETY License: HOISTING ENGINEER LICENSE Numbee,:HE 052529 Ebpiwk 04t27J2001 Tr. no: 18720 "Aesirided To: 18,2A,313 549 WINTER ST N ANDOVER, MA 01846 Acting Commissioner -----r—`— �°,---`==�� `---'-- ------^ - - —` -- - HOME INPR0V[MENT CONTRACTOR i 8oAiun'utinn 10760/ � � Type — YR/vwuxvn '' � ' =^p^'p�~" ~~~~~^ � ^ >AMG[L0 C. HI0lO BLDG & REALTY 00in Box 395/5 ST, '----'— 8 N Andover HA�O18�. ' r` . � ` ` Town of North Andover f NORTH OFFICE OF ,? °` 00 COMMUNITY DEVELOPMENT AND SERVICES 0 . 27 Charles Street North Andover. Massachusetts 01846 .Is WILLIAM J. SCOTT SAc"us` Director (978) 688-9531 Fax (978) 688-95412 In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. The debris will be disposed of in: /, Gw�P�/�� elewzl�r 1Z4&zzr&2 Sianature of Permit Applicant NOTE: Demolition permit from the Town of North Andover must be obtained for this project thrauab the Office of the Building Inspector BO,AD OF APPEALS 688-9541 BLUDING 688-9545 CONSERVr'_TiON 688-9530 HEALTH 688-9540 PLaVN!NG 683-)535 t y 3 S %AN 12v Q. XV,\`I kill ! I i ! i q� N? I i i ! i q� � (aJ {I I i i � 4 �N N J I v v I x N I ! i �N {I I �N N I x N r 2 9 p ®l A �\ ®l x o a d Q G u u 'O ° V. v a u a ci) O z z A Cc: cz C z w° m � a°' T v G U w Cd O �b0 ' _ `� w a O w u U w w iOO P4 U '� cn c w a o CLI d SUO z c w w w A w a w 4J r� z i cit v o Y ° cn 0 0, Gir Ico c ca Q CD — �E W co L O CD � ~ � 3� 0 CO CM Q CDL M CD CL CL CMQ CO2 c c O O .� O CCD Z � V y cc cc CO2 C 0 LLJ V/ w w w U) Co 5 0 O a"= CLC co R� ' C O 0: 0 0, Gir Ico c ca Q CD — �E W co L O CD � ~ � 3� 0 CO CM Q CDL M CD CL CL CMQ CO2 c c O O .� O CCD Z � V y cc cc CO2 C 0 LLJ V/ w w w U) PO Box 55098 Boston, AAA 022055098 617-951-0600 Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectman City Hall City Hall NORTH ANDOVER, MA 02180 NORTH ANDOVER, MA 02180 RE: Insured: MELISSA HEGARTY and NEIL HEGARTY Property Address: 83 LOST POND LANE, NORTH ANDOVER, MA Policy Number: HMA 0352498 Claim Number: BOS00056076 Date of Loss: 3/8/2015 Company: Safety Indemnity Insurance Company Claim has been made involving loss, damage or destruction of the above -captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim number. Anne Dunphy Claim Examiner Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 Phone: (617) 951-0600 EXT 3061 Fax: (617) 531-6644 Email: annedunphy@safetyinsurance.com 3/17/2015 Location O S LI No. f yO Date �Zz TOWN OF NORTH ANDOVER Certificate of Occupancy $ M Building/Frame Permit Fee $ 776, 4 Foundation Permit Fee $ 5! Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ ZBuilding Inspector � 0 r1 n d r U Div. Public Works Location 3 o �oy��G`y e �'✓� No. NO Date /0-ZS-95 o NORTH Q TOWN OF NORTH ANDOVEa.R Certificate of Occupancy $ Building/Frame Permit Fee $ ° ; + ��b'<•°'''t�' Ss�C14 Foundation Permit Fee $ r Other Permit Fee $ Sewer Connection Fee $ �J 7 Water Connection Fee $ TOTAL $ In ector f `—.r„"Building �� F39 7 3 Di . PuKllic Works Location 7- ro A) No., U Date ZZ-7lo a ORTM TOWN OF NORTH ANDOVEFF C? •• + • OM Certificate of Occupancy $ • s + Building/Frame Permit Fee $ ,^°''(�' Foundation Permit Fee $ Dov ' ssACMUSE Other Permit Fee $ M Sewer Connection Fee $ Water Connection Fee $ TOTAL $� i `/(7 Building Inspector 9 7 3 fu Div. Public Works PER31ff NO. Q APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. V PAGE 1 MAP ri4O. JG q1- / LOT NO. aeTd r /zr f5'j 23 �` l7S 2 RECORD OF OWNERSHIP DATE PAGE ZONE, ISUB DIV. LOT NO. /Q �,�%`Q�K //V[ 6'�l IBOOK L�Z7I–Jv— LOCATIO N `',�� LosT �o � ��1�e PURPOSE OF BUILDING �� /C �ai•l . I� t2Je �� 5 � J OWNER'S NAME `�� LSC I/ p,V C�21 NO. OF STORIES a SIZE (/[t x Z � q L OWNER'S ADDRESS O QO xr �� f] jV QQ (f('� BASEMENT OR SLAB 6.45,-,17e N / ARCHITECT'S NAME 7AJD llEs.-'J' j� �`p(,/ SIZE OF FLOOR TIMBERS IST 'lk 2ND 0 3RD d BUILDER'S NAME E/IN 7C SPAN / I DISTANCE TO NEAREST BUILDING 301 DIMENSIONS OF SILLS DISTANCE FROM STREET //Of " POSTS DISTANCE FROM LOT LINES — SIDES Q ?� REAR J GIRDERS x 3 FRONTAGE JQQ j AREA OF LOT 31 ! S t s f HEIGHT OF FOUNDATION 7 • /O" THICKNESS /O IS BUILDING NEW le }[- SIZE OF FOOTING to % Z IS BUILDING ADDITION /vo MATERIAL OF CHIMNEY o",, F IS BUILDING ALTERATION No IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE 1 ` e 5 IS BUILDING CONNECTED TO TOWN WATER �� S BOARD OF APPEALS ACTION. IF ANY �' IS BUILDING CONNECTED TO TOWN SEWER / o IS BUILDING CONNECTED TO NATURAL GAS LINE Ili' 0 INSTRUCTIONS �'i qo t!j' ,SEE BOTH SIDES i y66 av PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED �11 11 ` SIGNATURE OF OWNER OR AUTHORIZED AGENT FEE PERMIT GRANTED �f 19 1 BLDG. PERMIT FEE . Vo LESS FDA FEF /O O DUE FRAME PERMIT 3 PROPERTY INFORMATION LAND COST Q� / C) O EST. BLDG. COST EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BUILDING INSP[CTOR OWNERTEL. # _6 S:�-V CONTR. TEL. # S CONTR. LIC. # H.I.C. A BUILDING RECORD ' 1 OCCUPANCY 12 SINGLE FAMILY y STORIE FFIS MULTI. FAMILY OCES APARTMENTS CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH 112 PINE HARDW D — PLASTER DRY WALL UNFIN. I3 _ _ CONCRETEB CONCRETE BL K. BRICK OR STONE PIERS _ 3 BASEMENT AREA FULL FIN. B M'T' AREA _ '/ 1/1 1/1 FIN. ATTIC AREA _ NO B M FIRE PLACES HEAD ROOM MODERN KITCHEN _ 4 WALLS 9 FLOORS CLAPBOARDS B _ 1 >c� 2 3 _ DROP SIDING CONCRETE EARTH HARDW D COMMCN ASPH. TILE WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING VERT. SIDING STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY BRICK ON FRAME ATTIC STRS. 6 FLOOR _ CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR POOR ADEQUATE i-� ONE 10 PLUMBING 5 ROOF GABLE HIP BATH 13BATH FIXE -Z GAMBREL MANSARD TOILET RM. 12TOILET RM. FIX) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST >< PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. 3 COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS GASOI 7 NO. OF ROOMS L B'M'T 2nd _ t.r 13rd ELECTRIC NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. x W4 m�� s cn p U z 0 � •° w° ao' v U W. O U 04 cJ � �' ao' co w W w � ao' °; cn cuo w H w � .c x w H W . w v w' 2 cn Q cn 0 r� rld v H H LLJ om m c o oqv O 0 ` Q N �f p y Z WGO :r� Fa ca V � ECJ o. Cc 0 0 r� LLJ N °A F/ \%O m LL E aCD e o O dC3 CD ` F 40 M C f c m C d CD CO) y_ y y Z r CA CD co c L : L C C CO2 cc O m Ci O rm ' =C.3 m - i y m 4>0 C: J ) rn d C L m :mor v y o cm c � o c_ a H m y C C m = m3p N d co w c tiD H 2 a t ca c Z ac E E'ocm_,y o U m p m C y L :9 c3z CIO p Co O_ Z A 0 i t CoO c co O co a.. O O v Z CD O y D � CD cm O C O•� H 0 � * O .O m m O i O O O d 0- o,Q c o CCc Cc C2 CD CD VCO) C cc .0 C cc H O FORM U - IAT 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***************** j APPLICANT: l ' l IN Phone dy- d ss LOCATION: Assessor's Map Number 7D Parcel ��T�F /2 /S,- 03'`�2S- Subdivision zOS�Nr� Lot(s) /0 Street g3 6057- Z-"V,Ale St. Number 83 ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: xv, Date Approved Conservation Administrator Date Rejected Comments �114_-9a 6 Lie- /)n J0 -�,5-' i� Town Planner Comments Food Ins a tor -Health ep c nspector-Health Comments Date Approved Date Rejected Date Approved Date Rejected Date Approved l Date Rejected Public Works - sewer/water connections LJ CU^- 2-5 -F5- Mr. Fire Department Received by Building Inspector Date _ _ _� _ ✓�e GG�)Y��ll17UIlCQlrit �� l Im"we6 DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE ,r Nueoer: Expires: Birthdate: CS 005693 01/13/1998 01/13/1954 Restricted To: 00 DAVID A KINDRED 40 NARBLERI06E RD POBOX531 M ANDOVER, NA 01845 Restricted To: 00 17650, 00 - None 14 - Nasonry oily 16 - 1 6 2 Faiily Holes j Failure to Possess a current edition of the Massachusetts State Buiildiny Code is cause for revocation of this license. � � I CERTIFICATE OF USE & OCCUPANCY Town ,Of North Andover Building Permit Number 140 THIS CERTIFIES THAT Date JULY 29,'.1996 THE BUILDING LOCATED ON 83 LOST POND LANE MAY BE OCCUPIED AS SINGLE FAMILY DWELLING IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO Flintlock, Inc. P.O. Box 53 , No. And r, ADDRESS ,�_T, ,�;� LU O z CU ` •zoo ; O g O a :H c :Cor+ z w :vz� e�0 C LL- Im N A :meg �� j •- cc cc CD E Q a W cm CD C :cf) tea N CD N 00 0 V ds co CD L v L N v J CD cc N Z \/ • = N 1��1 (may' N 0 N Um c.toj L m H--� Crronn L c ; vJ s L O cm _Cc oQ acr •� � :mor Co cv c a o c_ O C C = m m03 d t_ LJJ CO � �".� C yam••, •� O ac E c.) W N c LU m o -M= C/3 a m• o:5 49 :V a CD Z O D V) co cnCDL CL CD f� C O GD C3 _m M h O O C.2 y C O L3 O 0 v CD a_ CO) C U U ' is w w U .o " w z LQ cn ° co ° i � C ro w o� 7 cn U w ci�- wti cn cnw LU O z CU ` •zoo ; O g O a :H c :Cor+ z w :vz� e�0 C LL- Im N A :meg �� j •- cc cc CD E Q a W cm CD C :cf) tea N CD N 00 0 V ds co CD L v L N v J CD cc N Z \/ • = N 1��1 (may' N 0 N Um c.toj L m H--� Crronn L c ; vJ s L O cm _Cc oQ acr •� � :mor Co cv c a o c_ O C C = m m03 d t_ LJJ CO � �".� C yam••, •� O ac E c.) W N c LU m o -M= C/3 a m• o:5 49 :V a CD Z O D V) co cnCDL CL CD f� C O GD C3 _m M h O O C.2 y C O L3 O 0 v CD a_ CO) C is i IN IN IMIN II�� II E No Mm ii �o � D a �lj z 1 RDW MMVA*n0N rLINTLOM, INO. 5GALE: 1/4" = 1'-0" JOB NO: 1119_2 (AIG) CoCR f6TOR TO YMPY ALL Off-VOCINS MO STMrnW L t- b RS PRIOR TO STARTING DOW' Tftr,=K ALL WILDING N! TO MST OR O%CSD ALL 6TATZ AND LOCAL WILDING C-7. 0 014, 1<, 61 r> PAq �z rnulr11 C3rn� p,p ��.. tNttcrn rn rz- SO z lrnl�� rN z= N= � m dN Az 0 z ELEVAION5 FLINTLOCK <1 INC. SCALE: 1/6" = 1'-0" JOB NO: 1111-2 ol N r r N rn w r d CONTRACTOR TO Vemly ALL DIMCM9"AM 9TMXTV%AL MG 4m" MOR TO 6TAAVM COMMCTICK ALL MLD94 h TO ML4r OR M&W ALL 9TAT9 AW LOCAL DULDM6 COOLS. 1nl n■ SCALE: 1/4" = 1'-0" JOB NO: IIIQ_2 WWRAGTOR TO VCRIRY ALL OI -WH51 Ftl AM ow"TURAL M:!'t!l1t9 MOR TO OTNtrR CON mrlTw% ALL DJ LOTH! M TO MM OR MCW ALL, *TAT@ AW LOCAL MLVIN6 000M E N v 1N v vFrm FLOOR FLM MIN Lr C4<, IW-,. 5GALE: 1/4" = I' -O" JOB NO: lllq_2 GONTR/wGTOR TO VWrY ALL DIFBmo" AW STOlGT.RAL h-� rMOR TO STARnN6 OONSTRVOTIOK ALL EULDINS IS TO hC T OR MCED ALL STAT! AND LOCAL SULD046 DOOM %no b G ------------------------ - ------------- 1777-77 ------------ �- I r-------- — — — — — — — ------------=---� I i I � IN o i I 1 2x10 FLOOR JOISTS ® lb"0.0. W/ RII INSUL. �<� Nrn-o I rnz< DG�p L+J -< r" In OHM $z O0 N x C up ;K O 0 X U N �z d ��O �D 3rn (- + -I rnr NO i A 00 L J • N x Fy -I I I I I I I I I I I I I I I i I � I I rn➢ I I w I I ° L J mfjx - I 1 0 >-t X X -a I x I W z 1- r0rn tiff N 0>rj\ �Cv_ I rn� A�. 10 �Oz I O n �AO n-4Frt= horn rn0� �r 20 r- =d ��'� �r I Nrn-0� z 1 I 0 i5 � O L J `�� r rn q%:1 r 1 I e 1 �r 000 1000 z N I I N q �' I I I - - - - - - - - - - - - - - - - �- - - - - - - - - - - - - - - - -- 11—on -� 10 FLOOR JOIST'S ® Ib" O.G. M RII INSUL. ,- t nn > $z O0 U) �T I ni �z r11 ��O I o -n rn F> ? rn0 z I COCA ;I O Orn DA A I I o� I N 14'-O" .I1—On I P%XMA710N PLAN i�INT1Ar�i�, INC. 50ALE: 1/4" = I' -O" JOB NO: Iilq-2 CONTRACTOR TO v9M,v ALL DIMQ@IONS AM OTRXIVRAL msec" HtlOR TO OTARTIN6 &"TW44TIOK ALL DNLDM6 19 TO MMT OR OXC W ALL OTATR AND LOCAL IMO N6 COD!!. d I" I 1 I Z x d n XX A Q fff111�IIIpe 'TI 6 'O X O �� 9 r_ z O O 3 V-10' 14 EQUAL RISER e�-o• v z z O Q 3 b xx ►�,iuD1'N � x pz D1 z �Oto D 4� cn pwN=p �m-�a�n�wN— 0� Q1 XX A Q fff111�IIIpe 'TI 6 'O X O �� 9 Oi O A 0 r_ z O O 3 V-10' 14 EQUAL RISER e�-o• v z z O Q 3 b xx ►�,iuD1'N � x pz D1 z �Oto D 4� cn pwN=p �m-�a�n�wN— 3 to =G�-nrnv0N > 3 i A 0 l � 2 S� a O r rn v r rn Uiu�rn►�t�Nt�u� 0000�4`cp0 O ��N�N t��►aw �m�ma O ;a+* W rn A Cp Cp 0= cp (p (5, rn CANE-U-O-o�� NwwN� u��NN A O 70txi�t"n4a�JS.43 OrnDDDDzN - rrr-fr►iN O �` v r � vvvv�vz O may, rn N fACAQ�01D rrrrtprM.� rnN =zzzz3 N N �4�M� i C O� Oww MOTION PLINTLADVC� IW,. SCALE: 1/6" = 1'-0" JOB NO: Illq rn Z z X O X AWN W116 .4 mn— h o � C4NIRA4TOR TO V!RIP/ ALL CMR/CI" AM STMXTURAL ll� FRIOR to STARTINS CO"rI:iIrTnoK ALL EULLOM6 IS TO fl E OR !XO® ALL STAT! AW LOCAL MMO,HS COMS. f TO 2377 Date ... IT TOWN OF NORTH ANDOVER A. ..No, A�- A PERMIT FOR 9#9 'INSTALLATION -ec Ct This certifies that .. v.q.&-f .... tj—ln� !.�f -C .............. has permission < forrAinstallation All (t./. .#0 'ife . '........ in the buildings of ... h . '(P k-�e h . �n r ss. at JAf,,N9/1211W .... SPECTOR PAID 5 WHITE: Applicant CANARY: Building Dept, PINK: Treasurer GOLD: File Office Use Only (� u >: &ommonwratth of �fic'tt 1L�i>: 5 Permit No. p�16 Epartintra of Vubl[c 9—M&tJ Occupancy & Fee Checked ( ` 3190 (leave blank) BOARD OF FIRE PREVENTION REGULATIONS 527 CZAR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date �Z �L� (X)ii or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street 8 Owner or Tenant Owner's Address Is this permit in ccniunction wit a bui_ 'ng permit: Yes ✓ No I (Check Appropriate Box) Purocse of Buildina i�' «'� Utility Authorization No. 5- — 3,! �'2 Existing Service Amos _J Volts Overhead L --J Undgrnd 11 r No. of Meters New Service �UU Amps - �v��QVoits Overhead ; Uncgrna �� No. of Meters Number of Feeders and Amoacity Location and Nature of Prcoosed Electrical Work No. of L.gnnng Outlets Na. of Hct -:bs i Totai No. of -ransformers KVA No. of Lighting Fixtures I Abcve.— I Swimming Pool grr.a. — in - grnc. r Generators KVA No. of Ernergency Lighting No Re Cutlets 7� I No at Oil Burners Barery Units of ectaCe No of Switch Outlets I No. of Gas Burners I FIRE ALARMS No. of Zones Total No. of Detection anc No. of Ranges I No. of Air Cana. tens initiating Devices No. at Disoosals Heat Tota, I Noor Purncs Tors Total KW No. at Sounding Devices at Seif Contained iVo. ScaceiArea Heating KN^J Oetec,:oniSounetng Devices No. of Dishwashers No. of Dryers / Heating Devices KW — Mun:cmai Other Local _ Connec::on — No. of No. of Low Voltage No. of Water Heaters KW I Signs Sa iasts Wiring _ No. Hydro Massage Tubs I No. of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant :o the reau:rements at t.t-ssa 'users -.eneral Laws - I have a current Liae:iity Insurance Policy inciuc:ng C--,-"" co:e n m -aerations Coverage or its sucstanual eauivaient. YES O - have suom:ited valid proof of same to the Office. YES NC - If you nave checked YES. -lease inatcate the type of coverage cy checxtng the appropriate oax. INSURANCE s/evND = OTHER - (Please Scec:fy) (Exo:ration Datei Esumatea Value of Electrical Work 5 9: Work :o Start L LC Inspec::on Date nacuestec: Rough l��Gl✓ � � Final Signed under the P aittes of perjury: FIRM NAME L Z' `TZ t. LIC. NO. tij - C Slgnatcre LIC. NO. Licensee No. Bus. d gd�1( . ;e l. Sus Address Alt. :el. No. OWNERS INSURANCE WAIVER: I am aware that the Licensee toes not have the insurance coverage or its sucstanval eaurvalentt ente- qu,rea by Massachusetts General Laws. and that my signature on :r.is Lerma aop:'cat:on waives this reau:rement. 04fner g�� (Please check one) FSS 'eiecnone No. PERMIT FE Signature of Owner or Agent) Location No. `� 9 Date NORTM TOWN OF NORTH ANDOVER 3?� SOL f 9 s i a Certificate of Occupancy Z s"••°N ';<� Building/Frame Permit Fee $ ncus Foundation Permit Fee $ • Other Permit Fee $ TOTAL $ Check # Building Inspector ' TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING Ais sedin fOr QPi`a id t se BUILDING PERMIT NUMBER:�� Ta3-c7 DATE ISSUED: J3 Ow C SIGNATURE: Building Commissioner/IEEe2qor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: $ 3 tOgz � MapNumber Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private A -Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record � atU,'e d 4s,v rn,4 rz c r,*7,4 Jr7r Name (Print) Address for Service : R Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Tele hone SECTION 3 - CONSTRUCTION SERVICES 3. I..iFennsed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number t, 4114 i� t�/�Yt riti� Addres `t X (f a Expiration Date 'gnature Telephone 3. tstered Home Improvement Contractor Not Applicable ❑ 7, /�u 5 S �3� / Company Name Registration Number G _v Add /14 Expiration Date t nature Telephone 00 M X ic Z O i SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 2506) 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 permit. Signed affidavit Attached Yes .......9� No ....... ❑ SECTION 5 Description of Proposed Work check allapplicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ TAlterations(s) ❑ Addition LSL Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: v a ct-C r- e Y-4 a i N 3 S z s y pm A r�wls SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by pennit applicant OFFICIAL:IISE ONLY 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5) (2S- 41,31 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 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. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/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 Print Name Signature of Owner/Agent Date 11111ol lip 11111 1115=1011111 11111011111111111101011 NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST2 ND3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DD,4ENSIONS OF GIRDERS f[EIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE F"c�cfz,e u N cte r— e,,(tsA- 3 S-QaSOno ?OoV- e, FORM U - LOT RELEASE FORM �`"' �` �' �� 3tis�ft0- 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*********************** p APPLICANT �PHONE 79) - 691-� 776 LOCATION: Assessor's Map Number _q B PARCEL a O SUBDIVISION LOT (S) STREET__p �ST. NUMBER J> ************************************OFFICIAL USE WO MMENDATIONS Og TQ'1I" AGENTS: CONSERVATION ADMINISTRATOK DATE APPROVED /J DATE REJECTED_ COMMENTS �,e- Lnv��S "vt,L< rrn— M.4_&1� TOWN PLANNER r COMMENTS FOOD INSPECTOR -HEALTH SEP C INSPECTOR -HEALTH COMMENTS k� td 5 DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED_ PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT I RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm Zyz—ll')$ North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: h"Se4),sf4 � , (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector PETER K. COOK PETER COOK 36 GARDEN ST. ` �' _ G'G. . -•� HAVERHILL, MA 01830 Administrator BOARD OF BUILDING REGULATIONS " License: CONSTRUCTION SUPERVISOR Number. CS 077569 _ Birthdate: 06/1511968 Expires: 06/15/2004 Tr. no: 77569 f Restricted To: 00 t PETER K COOK SR t 35 GARDEN ST NAVERHILL, AAA 01830 Adrttirtts or i ✓/!G �4HL)X4)l[l�BCZGUt l�. �lldk3Cl!''LfIOP,� .+_'- \ ^� Board of Building Regulations and Standards rr HOME IMPROVEMENT CONTRACTOR Registration: 132816 Expiration: 0.4/06/2003 Type: Individual PETER K. COOK PETER COOK 36 GARDEN ST. ` �' _ G'G. . -•� HAVERHILL, MA 01830 Administrator BOARD OF BUILDING REGULATIONS " License: CONSTRUCTION SUPERVISOR Number. CS 077569 _ Birthdate: 06/1511968 Expires: 06/15/2004 Tr. no: 77569 f Restricted To: 00 t PETER K COOK SR t 35 GARDEN ST NAVERHILL, AAA 01830 Adrttirtts or i Uz/zo/UJ 13:46 MA 6036686831 INEANT�NE INS ACODTM CERTIFICATE OF LIABI -6631 Infantine Insurance, Tnc. P.O. Box S12S Manchester, NH 03108 Joyce McMann INSURED Blac dog Builders, Inc. 7 Red Hoof Lane Unit 1 SaTem, NH 03079 COVERAGES (0001/002 LITY INSURANCE DATE 02/29 200 oz/za/toos ans CfRTWATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER T+IE COVERAGE AFFORDED BY THE POLICIESBELOW. INSURERS AFFORDING COVERAGE INSURER A: Acadia Insurance Co. INSURER B: INSURER C: INSURER O: INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY WtHIUU INUIGA I tU. NU I VVI, ",ru'N" ANY REQUIREMENT. TERMOR CONDITION OF ANY CONTRACT OR OTI4ER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY SE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEK REDUCED BY PAID CLAIMS 30 DAYS W WTTEN NOTICE TO THE CERTIFICATE MOLDER NAMO TO THE LEFT, POL7CT EGTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER ATE MMVDD/YY T MM/DO/TY LIMBS OF ANY KIND UPON THECObI ITS AGENTS OR REPRESENTATIVES. GENERA. LIA&LITY CPA00692WIl 07/9I/2002 07/01/2003 EACH OCCURRENCE S 1,000.00 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any orte fire) f 250 CLAIMS MADE OCCUR MED EXP (Any one person) S 5,0001 A x CG2S03 CUS014 PERSONAL&ADVINJURY f 1,000,00 GENERAL AGGREGATE S - 2,000,000 GEN'L AGGREGATE UNIT APPLIES PER: PRODUCTS • COMP/OP AGG S 2:000, 0O 1-7 POLICrX PELT X LCC AUTOMOBILE UAWLITY 920311 07/01/2002 - 07/01/2003 COMBINED SINGLE LIMIT S (Ea accident) 1 000, DD X ANY AUTO BODILY INJURY 3 ALL OWNED AUTOS (Per yerson) A SCHEDULED AUTOS X HIRED AUTOS BODILY INJURY 5 I (Per 3ccleem) X YON -OWNED AUTOS PROPERTY DAMAGE S 11 (Per acedenr) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S OTHER THAN EA ACC S ANY AUTO AUTO ONLY: ACC S EXCESS LIABILITY UA006920511 07/01/2002 07/01/2003 EACH OCCURRENCE 5 11000,00 AGGREGATE S 1, 000 00 X OCCUR CLAIMS MADE A 5 DEDUCTIBLE RETENTION f WORKERS COMPENSATION AND .006920411 07/01/2002 07/01/2003 vvl_S X TORY LIMITS ERS E.L. EACH ACCIDENT S 1001 000 EMPLOYER$' LIABILITY A E.L. DISEASE - EA EMPLOYEE S 100,000 E L. DISEASE • POLICY LIMIT S 50,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIEXCLUSIONS ADDED RY ENDORSEMENTISPECIAL PROVISIONS i I - ra�Ir-F, 1 �iHifu AL:UKU L]v (IIVO SNOULO ANY or THE ABOVE DESCRIBED POLICIES BE CANCELLEO BEFORE THE EXPIRATIUN DATE YHEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS W WTTEN NOTICE TO THE CERTIFICATE MOLDER NAMO TO THE LEFT, W FAILURE TO MAIL SUCH MOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THECObI ITS AGENTS OR REPRESENTATIVES. AUTHORIZEDREPRESENTAT 11 !a...a.G'aa .G,^1111...... For Informational Purposes AL:UKU L]v (IIVO 5ubj: Madden headers Date: 3/5/200311:40:41 AM Eastern Standard Time iFrom: Danl elinas To: ctrulID-blackdoabuilders.com !File: L_236a_L_Madden.tif (441536 bytes) DL Time 2 ply 1 3/4" x 7 1/4" LVL required use at slider and window see letter attached Talk to you; 6elinag 5hvf)`uro1 Engineering LLG Daniel L. Gelinas. P.E. 579A North End Blvd. Salisbury, MA 01952.1738 phone 978.465.6436 fax 978.465.5160 email danigelinas@aol.com Page 1 of I i i i < 1 minute j N Wednesday. Mar' Cohna5 Structural �nqineernq LLC Daniel L. Gelinas, P.E. 579A North End Blvd. Salisbury, MA 01952-1738 March 5, 2003 Mr. Carl Trull Blackdog Builders, Inc. 7 Red Roof Lane, Unit 1 Salem, NH 03079 -2993 Phone 978.465.6436 Fax Line: 978.465.5160 email: danlgelinas@aol.com Letter L — 236a - L Phone 603.898.0868 Fax 603.898.0821 Cell 603.234.1422 SUBJECT: Madden Residence, N. Andover, MA Dear Mr. Trull: Per your request I have sized a header above the first floor 6'-8" slider and window based on the information you provided and enclosed. Please field verify this loading is correct; contact my office should you have any questions. Beam for slider and window: maximum span is 7 feet LVL, 2 ply I I/x 7 1/4" Clip LVL headers to wail framing studs with Simpson clip and lap wall sheathing to underside of LVL header LVL's to be Fb 2,900 psi and E 2,000,000 psi or better. I hope this information is useful to you, please call with any questions. Ve Truly Yo L40D e L. Gelmas, P. . 02236A L Blackdog_Carl ,AuWen.doc Feb 20 03 01:06p 8lackdog Builders 6038980821 p,1 Design/Build/Remodel 7 Red Roof Lane, Unit 1 Salem, NH 03079 (603) 898-0868 ■ Pax (603) 898-0821 www.blackdogbuilders.com F -Mail_ ctruIKa-)hlark doghuilders.cam To: Dan Gelinas Fax From: Carl T. Trull Fax (978)465-5160 # Pages: 3 Phone: Date: 7/20103 Re: Madden project M. ■ Comments: Ni Dan! Here is the floor pian and the elevation in question. We are looking at what appears to be support posts coming down betwe4an the windows on the first floor level on top of the slider and the basement window. The roof, from the sides looks like a steed roof with a gable built on the front. The ceiling is cathedral, so 1 assume that there is a toad bearing ridge that is postect clown to a bears over the half circle and then down between the windows. We need to know what to put for beams over the slider and the double hung. Thanks, Carl �.-- _ _ _ Grp �:_ ,cn ,•.:n �. nnn7 n icIII Feb 20 03 01:06p Blackdo6 Builders MAY!H SIVIN& . AND EXPOa RE 6038980821 P-3 5TP 5HC GLIA Feb 20 03 01s06p Blackdos Builders 6038980821 NNW 6-0° x 6._0' � PELL.A 43153 ry-r SLIDER I {2.0. 3'-1 9/4alX 4'-53/441 y I i ' i •' �FRNMIG TILE O� FA"LY ROOM 1DITION OIMENSIONS D,NS'MV PERE AIN GEILENG NEI64r 2X4 FURRED — E 50 TvtAT NEW MALLS n�. d" ./_) � 5ASFJ-fENT WALL / MAIN FLOOR WALLS G+F3Opte; ENtitJ e r�2 1 ice' - °Nr UR !ENT 4'-2' OIL TANK I I P.C. a - % Gel ina5 Structural �ngineerinq LLC Daniel L. Gelinas, P.E. 579A North End Blvd. Salisbury, MA 01952-1738 December 17, 2002 Mr. Carl Trull Blackdog Builders, Inc. 7 Red Roof Lane, Unit 1 Salem, NH 03079 Phone 978.465.6436 Fax Line 1: 978.465.5160 Fax Line 2: 978.465.6436 email: danlgelinas@aol.com Letter L — 236a - A Phone 603.898.0868 Fax 603.898.0821 Cell 603.234.1422 SUBJECT: Madden Residence, N. Andover, MA Dear Mr. Trull: Per your request I have sized a beam for the rear wall based on the information you provided, enclosed as Attachment A. Please field verify this loading is correct, contact my office should you have any questions. Beam: maximum span is 12'-6" Beam options are: Steel, W8x28 or W10x22 (A36 Fy 36 ksi or better) LVL, 4 ply 1 3/4 x 14" thru bolted per manufacturer's recommendations, LVL, 2 ply 1 3/4" x 18" All beams must be continuously/fully laterally supported. LVL's to be Fb 2,900 psi and E 2,000,000 psi or better. Posts: 3 1/2" diameter Lally column with %2"x 6"x 6" top cap plate and bottom bearing plate welded and anchored appropriately. Note a 3 1/2" diameter schedule 40 steel pipe column may be substituted. Foundations: beam/post can bear on an existing foundation wall/existing footing if field observations indicate such foundation wall/footing is in good structurally sound condition. If new footings are required, place a 24" x 24" x 12" thick footing. I hope this information is useful to you, please call with any questions. ,11' - -- _ VlWy Y ur Q�,,^.�-, D li E. e FiiR11D1iiR4� > desktop/02_LLC/L_236A_Blackdog_Cazl_Madden.doc �? F_ .d %: Dec 1.6 02 03:38p ::...:.: ..:... Blackdog Builders Deslv'/Build/Remodel 7 Red Roof Lane, Unit I Salem, NH 03079 (603) 898-0868 ■ Fax (603) 398-0821 www.blackdogbuilders.com E -Mail ctrLLIICMblackdo�ders.�� To: Dan Gelinas Fax: (978)465-643e- 6/ GD Phone: 6038980821 A&04ei �� Al Faux From: Carl T. Trull # Pages: 2 Dates 12/13/02 Re: Madden CQ ■ Comments: p.1 Eli Dan, Sounds like you didn't get the floor plan that 1 sent through so I'm resending it. The existing 15" floor addition is on posts and we are building a room on slab under it. We are taking out 1 I'6" of framed Goodall from the walk out basement. But we can use the post at the door of the oil tank to break the beam span down to 1213". The house span is 2$1, the space on the first floor is dining area, and the space above that is bedroom, then roof load from a 9 pitch roof. The existing 4 season addition has a shed roof off the house that has a gable built into the back. All of this space is c.,athedral. Call if you need more information, unfortunately the cople"s that you faxed are a little difficult to read. Thanks, Carl 'Dec -16 02 03:39p Blackdog Builders 6038980821 p.'2 +yME— IWW HU N T r m N ' e• fAGB 7 ' n�nnbt� VIVe,f X^lo vL �l a r 16 009 Z -d 128O868EO9 SiaPi6nH 2opMoeTH ez2:60 60 11 jeW J 0 F-0 0 Annl;4ij d 5 ��,k kyr�o rn Ell APR 16 2M I 0,7"a" ll i -%a A/0W Ia002 I'd 128O868C09 siapjtng 2opMoelg e22:6O Co 11 JeW v C � d 'O o Cl) Z CO) CCD O Z7 CL r �• ? O d �• CO) nC � o � O v CD CDCL o d CD CD 0 CD ww O CD y. � O y c v y O CD Z CD o 0 CD C CD O �• N V Q N E a_ 0 co :/1 � m p m Cl) C co C) G. A m Z co ? -O y �. =� to d p T m C O an d C N CO) N �mmCD c7d 4 a .0 ca : • O © y n W o m i CC �a o 'VJ m D m N �� VJ o o C d :� f _ ` J o \', o N O dN. �`f• 7 N C,- < t _ : C. �••�a NCD CO) cop) CD A#'Cm m CA SAWb CD OCD CD c , Cm, y t ,� � _d:dip ' o CDcm cu �t av _ t c o cl � eo (n Cn 0 p7 iG Cr7 71 0 � +n 71 w 77 S. DQ2 Ci7 �r O ny JJ � -P w n 7U •r1 rt 7 � cn c ro 91 x n rD r O d 4) rA C/1 I 00 O 0 60 y 0 0 c Date ... 4lr�.... /. 3�..d. 3. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that r ... 4P. .............. CPO �A-c- .. ............... has permission to perform -OAS5- N� � � `° 14, OcQ.. ........`...................................................................... 'wiring in the building of fYl�cPc� ................................................................................ 0.5.......?��P 1 bS ,North Apdover, Mass. Fee ...5(',rLic.No�3.....1......�t!�...Cv`^... ............. ...... 1 ELECTRICALINSP$CTOR Check 11 tt2cy 4.56,; Official Use O Permit No. j VeAw,&,ear 4 PaR& Sakrl Occupancy & F ecked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date U 3 D 3 To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number D �57- �/V�1 Owner or Tenant A l) G fY Owner's Address J':�c't Is this permit in conjunction with a building permit Yes No ❑ (Check Appropriate Box) Purpose of Building -5�V4i4E lr-�! Lfy Utility Authorization No. Existing Service Amps Voits Overhead ❑ Undgmd ❑ No. of Meters New Service Amps Voits Overhead ❑ Undgmd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy includin pleted Operations Coverage or its substantial equivalent= NO = have ed valid proof of same to the Officer NO = If u have checked YES please indi the of coverage by checking the appropriate box SURANC = BOND = OTHER = (Please Specify) p'n) Estimated Value of Electrical Workb ogs?9G Work to Start Inspection Date Resquested Rough Final Signed under thnphies of pe 'u FIRM NAME_ /L a bEX�itl7Wy.�TI� ` �LOt%�?L %per;! LIC. NO. 4--34P l(!i LIC. NO. -/ 19 /� /� s. Tel No. ©.s S J Address 14:wlkt� uai%zz �1 ,�i �Jlif � � 't 3 Tel. No.�vil f g 9'4" ''YOe OWNER'S INSURANCE WAIVER: I am aware that t6e 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. PERMITfEE $ (Signature of Owner or Agent) Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above ❑ In ❑ No. of Lighting Fixtures Swimming Pool gmd ❑ gmd ❑ Generators KVA No. of Emergency Lighting No. of Receptacles Outlets l / No. of Oil Burners BatteryUnits 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 Diposal No. Pumps Tons KW No. of Sounding Devices NoJ of Self Contained No. of Dishwashers Area Heating KW ung Devices ❑ Murbcipal ❑ Other No. of Dryers Healing 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 I have a current Liability Insurance Policy includin pleted Operations Coverage or its substantial equivalent= NO = have ed valid proof of same to the Officer NO = If u have checked YES please indi the of coverage by checking the appropriate box SURANC = BOND = OTHER = (Please Specify) p'n) Estimated Value of Electrical Workb ogs?9G Work to Start Inspection Date Resquested Rough Final Signed under thnphies of pe 'u FIRM NAME_ /L a bEX�itl7Wy.�TI� ` �LOt%�?L %per;! LIC. NO. 4--34P l(!i LIC. NO. -/ 19 /� /� s. Tel No. ©.s S J Address 14:wlkt� uai%zz �1 ,�i �Jlif � � 't 3 Tel. No.�vil f g 9'4" ''YOe OWNER'S INSURANCE WAIVER: I am aware that t6e 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. PERMITfEE $ (Signature of Owner or Agent) Name Name: Location: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print City Phone # QI am a homeowner performing all work myself. �I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address City: Phone # Insurance. Co. Policv # Company name: City: Phone * Failure to secure coverage as required. under Section 25A or MGL 152 can lead tathe imposition cfcriminal perraMies of,a fine up to $1,500 and/or one years' irnprisonnvwt_as v,ellas_c:od-penabesJoSheSam-cfaMDPYAORKDRf1ER,and afioe�f 1 )��aY�9�� m� I understand that a copy tlhs statement may be forwarded to the Office of Investigations of the IIIA for coverage verification. / do hereby ced* urxW-9�e IPS and pence ofp-lury that the Wove above is bye and c west Print name ' /�J 1J Official use only do not write in tt»s area to be completed by city or town official' #.V/ $-S-'�c� � I City or Town PewiULicer>sino Building Dept E] Check if immediate response is required Q Licensing Boars! E] Selectman's Office Contact person: Phone # E] Health Department Ei Other