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HomeMy WebLinkAboutMiscellaneous - 89 DUNCAN DRIVE 4/30/2018Lot & Street I jD,mcvyJ 3)r Map/Parcel 144' CONSTRUCTION APPROVAL Has plan review fee been paid: QYE Plan Approval: Date: W I lAod�, Designer: WM Conditions: NO Permit# 00 Approved by: Plan Date: Water Supply: own Well Well Permit*1r, Driller: Well Tests: Che ical Date Approved Bacten Date Approved Bacteria II Date Approved Plumbing Sign -Off: Comments: Wiring Sign -off: Form "U" Approval: Approval to Issue: YES NO Date Issued By: Conditions.- Final onditions: Final Approval: All Permits Paid? YES NO Well Construction Approval? YES NO Septic System Construction Approval? YES NO Certification? YES NO Other? YES NO Any Variance Needed? YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: APPROVED BY: HORT►, 0 i �,SSAC14USE� This certifies that Date. .7/Z4L. . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING " '1. kamk II..Tr................ has permission to perform ... 4f�l?.. 2/�4................ plumbing in the buildin s of ..I/W, ".�J.�!�............... . at .. 1. '?.. / .............. Nortli dover, Mass. Fee. 71.e 5-0. Lie. No..&Z ?,0 PLUMBING INS ECTOR Check x 0e611,9 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY d ►' �}n a��_ MA DATE 7^d _ �•� PERMIT# rYiPE JOBSITE ADDRESS 4 A C.( n i%, OWNER'S NAME C ✓ ,i C OWNER ADDRESS g �" C `t ''+ � r`TEL (�, O �,j ' 07 ] FAX OCCUPANCY TYPE COMMERCIAL 0I EDUCATIONAL El RESIDENTIAL PRINT CLEARLY NEW: 0 RENOVATION: REPLACEMENT: ©I PLANS SUBMITTED: YES © NOD FIXTURES 7 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM I _.__.__-}.. _.I E { DEDICATED WATER RECYCLE SYSTEM (} . I 1 .._..� .-_.._._I 1 J I ..-._._.-( .__ __.I ._---_} DISHWASHER DRINKING FOUNTAIN __.i ..__.._ I f ( _I ..._.___( _-.--._I FOOD DISPOSER FLOOR / AREA DRAIN INTERCEPTOR (INTERIOR) _ I (-_.._.._.! } ( i _-.__-_1 .....___._} KITCHEN SINK LAVATORY _{ ....- ! (.. --1 - } --- -? - - I -- (__.-...-I __.J .._...._(. --_...I .. -- I[=j—IL__.... _J ROOF DRAIN SHOWER STALL SERVICE I MOP SINK �_.( _. _J _ _ _-_(. I . I _ _. _ ._I _._ ._...I _ J TOILET 1 ( -- --._. I _. � ._J .._.._I _.._.__.1 F-_? ._.__.-} _ .______! __ _._._.{ . _ -__I URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPESI- WATER PIPING _ OTHER -----! .___.__i ____.__i= INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES ...; NO ®1 IF YOU CHECKED YES, PLEASE INDICATE THE TY E OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY EI BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT J0 SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME [[T—LI CEN SE # n 7e SIGNATURE MP I JP CORPORATION P# PARTNERSHIP [2# #L�j LLC E COMPANY NAME,ADDRESS aS R rr e (d r ✓r CITY ���r r `'f ;STATE ZIP 03 of g TEL _ FAX _ ;CELL �� EMAIL _ _...._ . _._ ..... _.__ .....' . N H O z z U W a w iz❑ w � w o W w W 4 z o CO W 5 � V) a W w a p zo a � w a � U J a a � w x w F- w F °z 0 H � U N W a c7 as a c�7 °a The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information j j Please Print Leafty Name (Business/Organization/fndividual): 4 �-X 1 d— �� 1 �� e Tr F4- H Address: o 57 R D,-- rey fiCe- G City/State/Zip: Oe-rr Y A ff 030?'?' Phone #: Are y n employer? Check the appropriate box: 1. I am a employer with 0 4. ❑ 1 am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. # ship and' have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11. E] Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. 9: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one=year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the paint and penalties of perjury that the information provided above is true and correct. � 0:�--a.3W --gs Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - Contact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract ofhire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA, 02111 Tel, # 61.7-727_4900 ext 406 or 1-877rMASS.AFE Revised 5-26-05 Fax ## 617-727-7749 vvww mass.govfdia 10602, Date ....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........... .......... has permission to perform.. ..... .... .... .............. .......... wiring in the building of ...... ..<.:........ ... 14-1-m G..... at ............ ..................... . North Andoyer, M —< ..... - Fee ..... Y5 ......... Lic. No.4..�I.?.. c-rRICAL IN ECTOR Check# 3�1 t1l CammoniveaL(.r{. of Mla6aachecsel-b Of ficial Use Only N c'fifi Permit No. ! U 3 U 2- ' ..L:Jepartrnnnt o11Fre �ervi-cel Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leave blank) APPLIC TION FOR PERMIT TO PERFORM ELECTRICAL All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (� (PLEASE PRINT IN INK OR .TYPE ALL INFORMn4T•'ION) Date: /--\. (P City or Town of: 'K )611-/TNi�uu�U To the Inspector of Wires: By this application the undersigned givesnoticeof'is or her intention t perforin the electrical work described below. Location (Street &Number) 0 9 —J C4 rel C ct r) /W Owner'or Tenant �'a'C�C%CP r A-Nl G (s e �,C Telephone No. _�7s `%�� dd C LO 3 Owner's Address Is this permit in conjunction with a building.permit? Yes ❑ No FV --1 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Overhead ❑ Undgrd ❑ No. of Meters Overhead ❑ 'Undgrd ❑ No. of Meters N No. of Recessed Luminaires Jv..v - No. of Ceil: Susp. (Paddle) Fans --.guy Ue wuiveu I citeans—"'''v/ rrJres. No. of 'Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires S�Mmmlhg Pool Above ❑ In- "❑ o. oT E ni ergency ,ig . ing rnd. arnd. Battery Units No. of Receptacle Outlets No. of Oil Burner's FIRE ALARMS No. of Zones No. of'Switelies No. of Gas Burners E, of Detection and Initiating Devices No. of Ranges g Total No.. of Air Cond. `Pons _ No. of Alerting Devices No. of Waste Disposers Heat Pum Niimbe�. Tons._........K�N........ ""' ". 1Yo, of Self -Contained Tota1P Deiertion/Aiertintr Devices No. of Dishwashers Space/Area Beating KWLocal ❑ unicipal ❑Other tion No. of Dryers _ Heating Appliances KW Se lflityS stems: of • or Equivalent Data Wiring: 1`l0. of Water KW No. No. oflasts Si BalNo. Si ns Bal No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: — No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Valu f Electrical Work: _ / (When required by municipal policy.) Work to Start: inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [N BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties ofperjury, that the in ormation. on this application is true and complete. FIRM NAME: � Z� --se�� t LIC. NO.: L5f ,Icensee: h Signaiu LTC. NO.: G j (fy"applicable, enter "exem t" in the license number Bus. Tel. No.: Address: _ \ G� t u� b r. �-�o t,s, 6J 14 U a Alt. Tel. No.: `Per, M.G.L. c. 147, s. 57-61, securiy work requires Department of Public Safety "S" License: Lic. No. Do �5 3 OWNER'S INSURANCE WAIVER:. 1 am aware that the Licensee does not have the liability insurance. coverage norriiaily required by law. By my signature below, I hereby waive this requirement. I am the (check one) [] owner C] owner's anent. Ovrner/Agent Signature Telephone No.1'ERM; T FEE: --REGISTERED SYSTEM CON.TRACTbP,.:;:_.'., = :ISSUES THEABOVELICENSETCI: D,T•'SECUR1TY, S_ERVICE-S•.,:.I1JC:,: MA.PA :BR0P UNIVERSITY. -AVE :,`:; •: :'•:::}o: • . in ;GESTW.QOD MA••:.02.09,0-231.1.:';::..' rG ':.45 C' 07/31/13 -8'0.174 _ -��,� •�1 �• I'. � Jr.o tJl: •t rl• i 'x:11 �.c •'-:1 f-Iq� �..� .. ' .Fob• Tnon Dolan) along.AG Pzrorado Keep top for receipt and change of address notification- DPS-DAI v ?Sid-ieg9.7o162oo8LICENSEFORMt :./-�•C 'IG071b?l KJ'I'1.C!%CQ.GIJI. G�JI ,kip.Gf!liP.�i1 DEPARTMENT OF PUBLIC SAFETY h S - License Number:' SS CO 000953 �-• Expir-es:02107/2013 - Tr. no: 195.0 • S -License: ADT . MARKA BROPHY•SR• 410 UNIVERSITY AVE� WES-RNOOD, MA 02090 DIG SAFE'CALL CENTER: '(88(3) 344-7233, j Commissioner w D 4I Commonwealth of Massachusetts �1 W City/Town of NORTH ANDOVER MASSACHUS TS la - System Pumping Record J` Form 4 M sv. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. -JQ DEP has provided this form for use by local Boards of Health. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Aaoress City/Town 2. System Owner: State �L Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): State telephone Number Date 2. Quantity Pumped Cesspool(s) Septic Tank APR 0 5 2006 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Zip Code Zip Code 15z)D Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: M System Pumped By: n Name / Vehicle License Number Company 7. Location where contents were disposed: S' nature of Ha r Date hftp://www.mass.gov/dep/water/approvals/t5forms.htm#inspect t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Town of North Andover, Massachusetts Form No. 2 f NORTq BOARD OF HEALTHVJ j I� O � F ' A " °•+++���-"'���--++++++' DESIGN APPROVAL FOR CHUS SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant ���� lN� v (�// 1 V�� Test No. Site Location 0 q �U✓VC .�ii� _ Reference Plans and Specs.ZS��c,)6 ZDL)6°65/ 6_ ENGINEER DESIGN Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. CHAIRMAN, BOARD OF HEALTH Fee %/1� Site System Permit No. lf CIL) '- TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 Sandra Starr Public Health Director August 19, 2002 William Dufresne Merrimack Engineering 66 Park Street Andover, MA 01810 Re: 89 Duncan Drive Dear Mr. Dufresne: gORTN 4 A C"g Telephone (978) 688-9540 FAX (978) 688-9542 This is to notify you that the proposed plans dated May 23, 2002 and revised July 25, 2002 for the upgrade of the septic system at 89 Duncan Drive, North Andover have been approved. If you have any questions, please call the office at 978-688-9540. Sincerely, Sandra Starr, R.S., C.H.O. Public Health Director Cc: BOH Homeowner File TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD . AR 1'EM OWNER & ADDRESS SYSTEM LOCATION (example; left front- of house) To.,n L t' n 4t�� fc, U \"1 C OF PUMPINC:.` 7 � QUANTITY PUM PCD /.Z/) C,�LL c»� S1)00L: NO X- YES SEPTIC TANK: NO YES MATURE OF SERVICE: ROUTINE EMERGENCY OII�FRV;\T10NS: GOOD CONDITION, FULL TO COVER HEAVY CREASC BAFFLES IN PLACE: ROOTS LEACHFIELD RUNBACK.— EXCESSIVE UNBACK.EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER Oj�HFR (EXPLAIN) -)Y 'TL.m PUMPCD BY: �u,I�,yIrNTS: UN'l f:'N rS !'IzANSFCIZIZED TO: �.Y' �. VV SEPTIC PLAN SUBMITTAL FORM LOCATION: og 'Dv to C -Aro J NEW PLANS: YES $160.00/Plan REVISED PLANS: $ 60.00/Plan'T7rr�u SITE EVALUATION FORMS INCLUDED: YES DATE: DESIGN ENGINEER: DATE TO CONSULTANT: When the submission is all in place, route to the Health Secretary. t''BOA I �O�yrfE L N:.;/ ,��� 2622 North Andover Health Dept. 27 Charles Street North Andover, MA 01845 978-688-9540 Fax: 978-688-9542 facsimile trammittal To: Gretchen Papineau Fax: 470-2762 From: Sandra Starr Date: 10/22/99 Re: 89 Duncan Drive Pages: i CC: [Click here and type name] ❑ Urgent ❑ For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle The house at 89 Duncan Drive is already at its maximum allowed size. This means the no additional rooms can be added with the septic system at the size it is now. This includes finishing the attic. It looks as though, however, there is room on the lot for an increase in the septic system size. The procedure to do that is as follows: • Hire an engineer who will conduct soils tests with the Board of Health. Fees are associated with this. • The engineer will create a septic design and submit it for review to the Board of Health. Additional fees. • When the review is approved, a North Andover licensed septic installer must be hired to obtain a permit and install the system. More fees. • Once the system is installed, or even concurnentiy, the proposed addition can be built Hope this helps. . 0 . . 0 . . . . . . . . . . . . . . . . . . . . . 0 . OCA=.ION =COL i ION i i .= ^(rte. ! .c ,j Titv IE: It T iNlc . i 1 BOARD OF HEALTH NORTH ANDOVER, MA 01845 978-688-9540 j`^ 2 0 -,,-c. APPLICATION FOR SOIL TESTS` LOCATION OF SOIL TESTS: 1l� L1 N� �� (tea OWNER: L, i Lt i &C 1-f JCA I,UyOTEL. NO.: -7q q - ZIqq ADDRESS: [Awcao Qf21u ENGINEER: P CM f �Jefn-1 l� TEL. NO.: CERTIFIED SOIL EVALUATOR:i Intended Use of Land: Residential Subdivision S' e F y Horn Commercial Is This: Repair Testing: Undeveloped lot testing: In the Lake Cochichewick Watershed? Yes 60)-L--� THE FOLLOWING MUST BE INCLUDED WITH THIS FORM 1. Proof of land ownership (Tax bill, or letter from owner permitting test) 2. Plot plan & Location of Testing 3. Fee of $425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of $200.00 per lot for repairs or up rg ades. (If time is not critical, fee for repairs is $75.00) GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1 "-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line a N.A. Conservation Commission Approval: Date Received: AA Q Q Z Check Amount: 4iZ5— Check Date: ��o` =00 HIIAIAC. /9S //V G- 9 614ALD 101 A& 't— /41 —9 1.-- - — lye l`4"��'� ELtv&,U1Y.. rev O lye l`4"��'� ELtv&,U1Y.. rev LV ot r NEW ENGLAND ENG�I EERING SERVICES lk I August 15, 2002 North Andover Board of Health Town Hall Annex 27 Charles Street North Andover, MA 01845 RE: TITLE V REPORT: 89 Duncan Drive , North Andover, MA Dear Sirs: . 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 �� Benjamin C. 4sgoo r. 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: 9 9 L-) v u C A� N D iZ sue' 1P o gm:( A>`N Pb u E o - Owner's Name: G, N 150 tai v AN Owner's Address: D , i u c ren/ P 1Z%t ui- IJv (Lilt &,.,D CR- /} Date of Inspection: A` L-11 0 2 - Name of Inspector: (please print) c^`j�►4.ti �,�, SCs()Q i> J Company Name:(�- Mailing Address: Telephone Number: 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: _asses Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: r)., I Date: g 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. Page 2 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Property Address: _ Owner: Date of Inspection: _ PART A CERTIFICATION (continued) 89 BARCO LANE NORTH ANDOVEI , GNA SULLIVAN MA 8/19/02 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: On or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The tem, upon completion of the replacement or repair, as approved by the Board of lth, will pass. Answer yes, no or not d fined (Y,N,ND) in the for the following statements. not determined" please explain. The septic tank is metaland er 20 years old* or the septic tank ( ether metal or not) is structurally unsound, exhibits substantial infiltratio exfiltration or tank failure ' inent. System will pass inspection if the existing tank is replaced with a complying tic tank as approved the Board of Health. *A metal septic tank will pass inspection if it ins structurally so not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is availabl ND explain: Observation of sewage backup or br out or high stati ter level in the distribution box due to broken or obstructed pipe(s) or due to a broken, ed or uneven distributionx. 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 stem required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspdction 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: Owner: Date of Inspection: _ 89 BARCO LANE NORTH ANDOVER,MA GINA SULLIVAN 8/19/02 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 ISA ' g to protect public health, safety or the environment. 1. S tem will pass unless Board of Health determines in accordance with 310 CMR 15 3(l)(b) that the systN# is not functioning in a manner which will protect public health, safety andtfie environment: _ CessNol or privy is within 50 feet of a surface water / _ Cesspo or privy is within 50 feet of a bordering vegetated wetland ora It marsh 2. System will fail unless the Boa of Health (and Public ater Supplier, if any) determines that the system is functioning in a manner that'pTotects the publi we/ safety and environment: _ The system has a septic tank and soil aborpt' system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface er supply. _ The system has a septic tank and S and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank d SAS and the SAS is �� 50 feet of a private water supply well. The system has a s tic and SAS and the SAS is less than 00 feet but 50 feet or more from a ys eP private water supply well* . Method used to determine distance **This system pas -4 if the well water analysis, performed at a DEP certified Wratory, for coliform bacteria and vol9tfle organic compounds indicates that the well is free from polluften from that facility and the presenceX ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, ovided that no other failure cri is 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: _ Owner: Date of Inspection: 89 BARCO LANE NORTH ANDOVER,MA GINA SULLIVAN 8/19/02 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 %z day flow 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 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.] A) v (Yes/No) The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. U Systems: To be consider large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either `yes' o" to each of the following: (The following criteria apply to larges ems in addition to the criteria ve) yes no _ — the system is within 400 feet of a surface dr' �-ter supply _ the system is within 200 feet of utary to a surface drin i water supply — _ the system is located ' nitrogen sensitive area (Interim Wellhead Pro ion Area - IWPA) or a mapped Zone II of a pub water supply well If you have anred "yes" to any question in Section E the system is considered a significant -threat, or answered "yes" in ion D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: _ Owner: Date of Inspection: _ 89 BARCO LANE NORTH ANDOVER,MA GINA SULLIVAN 8/19/02 Check if the following have been done. You must indicate `yes" or "no" as to each of the following: Yes' No Y _ 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 ? V 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) v — 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 thh baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum ? y _ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems ? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: Yes no _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) [3 10 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Property Address: _ Owner: Date of Inspection: PART C SYSTEM INFORMATION 89 BARCO LANE NORTH ANDOVER,MA GINA SULLIVAN 8/19/02 FLOW COND TIONS 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 current residents: (_ Does residence have a garbage grinder (yes or no): NO Is laundry on a separate sewage system (yes or no): No [if yes separate inspection required] Laundry system inspected (yes or no): — Seasonal use: (yes or no): _At O Water meter readings, if available (last 2 years usage (gpd)): W G t- L Sump pump (yes or no): AO Last date of occupancy: C U �2 (L EN 7- COMMERCIAL/INDUSTRIAL Type of establishment: Design flow (based on 310 CMR 15.203): gpd Basis of design flow (seats/persons/sgft,etc.): Grease trap present (yes or no): _ Industrial waste holding tank present (yes or no): Non -sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER (describe): GENERAL INFORMATION Pumping Records Source of information: ►! j el Was system pumped as part of the inspection (yes or no): _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) (if yes, attach previous inspection records, if any) _ Innovative/Altemative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) _ Tight tank _ Attach a copy of the DEP approval — Other (describe): Approximate age of all components, date installed (if known) and source of information: 23 _+ PUL UIJA9EV- Were sewage odors detected when arriving at the site (yes or no): A O Page 7 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _ 89 BARCO LANE NORTH ANDOVER,MA Owner: GENA SULLIVAN Date of Inspection: 8/19/02 BUILDING SEWER (locate on site plan) Depth below grade: I O Materials of construction: Zcast iron _40 PVC other (explain):_ Distance from private water supply well or suction line: Z ,5" " Comments (on condition of joints, venting, evidence of leakage, etc.): SEPTIC TANK: _ (locate on site plan) Depth below grade: Material of construction: concrete _metal _fiberglass __polyethylene _other(explain) If tank is metal list age: _ Is age confirmed by a Certificate of Compliance (yes or no): _ (attach a copy of certificate) Dimensions: j o o o Cs- A L LO S Sludge depth: 3" N Distance from top of slule to bottom of outlet tee or baffle: Z.5 Scum thickness: 41 Distance from top of scum to top of outlet tee or baffle: 8 Distance from bottom of scum to bottom of outlet tee or baffle: t7 " How were dimensions determined: n1 FPr5j ae c nc r Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 7-AN� 1.AJ �VD e0/1D01on, SC) -t Zb lii 0, ) Lt / '(G LT / y .9 n o 1i1 o ll. GREASE TRAP: Vit'(locate on site plan) Depth below grade: _ Material of construction: _concrete _metal fiberglass --polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Page 8 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _ Owner: Date of Inspection: _ 89 BARCO LANE NORTH ANDOVER,MA GINA SULLIVAN 8/19/02 TIGHT or HOLDING TANK: A/ A (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass _polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present (yes or no): Alarm level: Alarm in working order (yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: D 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.): PUMP CHAMBER: Alt+ (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: _ 89 BARCO LANE NORTH ANDOVER,MA Owner: GINA SULLIVAN Date of Inspection: 8/19/02 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, excavation not required) If SAS not located explain why: Type leaching pits, number: _ leaching chambers, number: leaching galleries, number: leaching trenches, number, length: f leaching fields, number, dimensions: i >=i E L n X q.s�` 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.): --_ ^ReD 1= Tike M41 -- CESSPOOLS: (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: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Page 10 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Property Address: _ Owner: Date of Inspection: PART C SYSTEM INFORMATION (continued) 89 BARCO LANE NORTH ANDOVER,MA GINA SULUVAN 8/19/02 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. Page 11 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: (9q taA R1_a L HA/--- N o [2M -f Atj Doo &V— vxft Owner: Cs -1 AJ ih S o U-1 Q flN Date of Inspection: SITE EXAM Slope /70 Surface water .v o N 9 Check cellar /vo !,camp Shallow wells None Estimated depth to ground water S feet Please indicate (check) all methods used to determine the high ground water elevation: Obtained from system design plans on record - If checked, date of design plan reviewed: Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health -explain: Checked with local excavators, installers- (attach documentation) Accessed USGS database -explain: You must describe how you established the high ground water elevation: w S s N' .4-4. r42t t/.b(J�✓efl MAN S�j5Te %�J;ra rv� QF S�sZ=M Z � j?, 6 L6....� Li •^,,3.' A,'7 PAuL -,.T• N/L, A PR s: N� • R � Ali ��,� �, �?� s s /„r lay `r4— /41'B a �- 77 T r T 0 - -T-6 !LPC.. T / 2 Q_ �� •_ _ _ -_ �6ox our ►?cT r..i�c��7-int pr — l�t•8 -r eN,?Yf 1.1L..�.��.=.._ ='<o -/2(•(Z ../xC•C2 -I?4 Cp �'f' ,D iS acs S �j .G SySrE'�l LL O 12 V L a -J H Q L 7 a L G C � 49 4 Eft 'tf a� O E C O O .O m O - cca y i 1 1 1 L O t •F+ f C O � j Q C }, Z C tU n C 3 U O O C in fa Z OCT -21-99 THU 22:25 HUNNEMAN(MAIN) FAX NO. 7497075 P.01 To: Sandra Starr From: Gretchen Papineau, Hunneman Victor Coldwell Banker Subject: 89 Duncan Drive, North Andover Date: October 22, 1999 Sandra, Thank you for your reply regarding Candlestick in North Andover! 'My buyers were hoping for greater expansion possibilities and are now considering another property We have some questions on the Duncan Drive property that will sound strikingly similar. We would appreciate your input again. The current property is a nine room, 4 bedroom, 21/2 bath home. Tl►e existing system is the age of the house, with the modifications made during the recent Title 5 test. This home also has a heated sunroom, constructed on columns, off the kitchen. The buyers would like to bump out the back of the home to achieve the following: Heated sun room with concrete foundation (where existing heated sun room is) Current bath and laundry conversion to a study 1. Is there room in the back of the house based on the current septi., location? 2. Would the expansion of space in the back change the current room count? 3. Could they still consider finishing the attic at some future date? 4_ What is the maximum room count that could be added for this hame/location based on the septic design? 5. Could the septic design be enlarged in any way to increase expansion possibilities? We really appreciate your input on this. I can be reached at 978-475.2201, and my fax is 470-2762. Thank you again. COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONME14TAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE Wnr= STREET, BOSTON MA 02108 ($I7) 92.5500 i i ARGEO PAUL CELLUCCI Gove== SUBSURFACE SEWAGE DISPOSAL SYSTEM USPECT110 I FORM PART A CERTIFICATION piopeetYAddraas: 89 Duncan Drive Name ofOwner__Suzan n ,.C. McCabe North Andover, MA A`ress of.Ownw: ' 41s4a of insp.e9ioe. 9 >Altreia of 1pa�0or: W dame s jiJ . Wright J r . I ani a DFP approved syohm. knPGCW passtiiwd to Section 15.340 of Title 51310 CiVl 15.0001 CempoWN R_..T- T n s p c� 1- i cin a F T n c- --- TdePhww Ntim6w. 9 7 R - 81 8 r MA TRUDY CORE Secretary DAVID B. STRUHS Commissioner North Andover,MA ER a FICA_TIO1N1 STATEINE]HT I certify that l have personally inspected the sewage disposal system at this address and that this information reported below is true, accurate MW complete as of the time of inspection. The inspection was performed based on my training land experience in the proper function and ;maintenance of on-site se ge disposal systems. The system: Passes Conditionally Passes - Further Evaluation By the Local Approving Authority ails bvgwctor's Sigriatue: Date: The System Inspectt(hai4 mit a copy of this inspection report to the Approvin�Authaiity (ward re health or SpectDEP)wor an thirty system O of completing this in 'tion. !f the system is a shared system pr has a design flow of 10,000 gd or greater, lite inspector and the system owner shalt submit the report to the appropriate regional office of the Department of•Environmentai Prptection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS F COF NORTH At!D0V'C-R/ '_'T "RD OF HEALTH .r r revised 9/2,1'98 Page t or 11 i !1 Pnntm on R�I.d Pan.. i i. en~r10CAPC csternd= nzc9nC&1r C"IrM aueoer "nsi anau CERTIFICATION (contirated) peprrty Addrasa: 89 Duncan Drive, North Andover, MA Owner: Suzanne McCabe Ioata of Mpae111; 9/2/99 M18PECMU SUMMARY: Check A. 8, C, or A A. syg":.PASSES: 1 have not found any information which indicates that any of the failure conditions dPscrlbed in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMEM: s. SYSTiM CONVnIONALLY 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 63 approved by the Board of Health, will pass. Indicate yes, no, or not determined IY, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not. _ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance iettached) indicating that the tank was installed within twerrty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, stjows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection If the existing septic *k is replaced with a complying septic tank as approved by the Board of health. Sewage backup or breakout or high static water level observed in the dist lbution box Is due to broken or obstructed pipels) or due to a broken, settled or uneven distribution box. The system will pass inspection if (with approval of the Board of Health). broken pipels) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping incre than four times a year due to broken r obstructed pipe{s). The system will pass Inspection if (with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed revised 9/2/98 Page 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION! FORM PART A _. COMFICATION taandrxred) may :.. 89 Duncan Drive, North Andover, MA )WM Suzanne McCabe N�rok 9/2/99: C. PUATHEiR EYALtRATiON 11EQU� BY THE BOARD OF HEALTH: evaluation by the Bisard of Health in order to data rains if the system is failing to protect the Cdnfticns oxistvhich require further public.hashh. safety and tM enyironmerrt. 1) SYSTM WILL PASS UNLESS BOARD OF HEALTH DETERNIUM M ACCORDANCE fit+ 310 CUA 15.303 t1p) THAT THE SYSTEM IS. NOT FUNCTIONING N A MANNER WHICH WILL PROS THE PUBLIC HEALTH AIID SAFETY AND THE EMONMENT: _ Cesspoolor privy is within SO feet of surface water I Cesspool or privy Is within SO feet of a bordering vegetated wetland or a saltmarsh. 21 SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLI, IF AMY) DETERMINES THAT THE SYSTEM G FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE EIWIRONMENT: The system has a septic tank and sail absorption system (SAS) and the SASIis within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is'wit in a Zone I of a public water supply wail. The system has a septic tank and soil absorption system and the SAS is wit in 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is les! than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis 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. Method used to determine distance (approximatidln not valid). 3) OTHER revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTIEM RaPECY111D1 FORM PART A . . CERTIFICATION (aondnOwl >~w�r,Addwss 89 DUndan Drive, North Andover, : MA oen wI. Suzanne McCabe Daae ofi les paalioro 9/Z/99 D.: 8Y81LM;f/�.5. You must Indieste eifhsr 'Yes" or "No" to each of the following: I have determined that onoor more of the following failure conditions exist as `deaeritied in 310 CMR 15.303. The basis for this dstKert(nadon is identified below. The Board of health should be contacted to deter#+ine what will be necessary to correct the failure. Yea No Backup of sewage into iacllitrcr *I to component doe^to an overloaded �rcloggld-SAS orcesspool. Discharge or ponding of effluent to the surface of the ground or surface winters due to an overloaded or dogged SAS or cesspool. i Static liquid level in the des ;pinion box above outlet invert due to an overloaded or clogged SAS or cesspool. Uquid depth in cesspool is less than 6" below invert or available volume Is !less than 1l2 day flow. _ Required pumping more than 4 tines in the last year NOT due to clogged 4r obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the jhigh groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water sypply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water suplbly well. _._ Any portion of a cesspool or privy is less -then 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well 'water analysis for -coliform bacteria, volatile organic, compounds, ammonia nitrogen and nitrate nitrogen. •i I E LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: The following criteria. apply to large systems In addition to the criteria above: The system serves a faeifity.with a design low of 10,000 gpd or greater (Large Siatem) and the system is a significant threat to public health and safety and the environmerrt because one or more of the following condiiions exist: Yes No` the system Is within 400 feet of a surface drinking water supply the system is -within 200 feet of•e-bibutary to a surface drinking -water s ppiy ---» _ the system is located in a nitrogen sensitive orae (interim Wellhead Protection Area = IWPA) or a mapped Zone 11 of a public water supply weep The owner or operator of any such system shall upgrade the system in accordance with 390 CMR 15.304(2). Please consult the local regional office of the Deparunent for further infamwdon. revised .9/2/98 Page 4of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART 8 CHECKLIST Prwrereyf►aa!!}sa 89 Duncan. Drive, North Andover, MA O""rae's�uzanne McCabe Dsa. mt Irspaetianc 9/2/99.. Check if the following have been done: You must indicate either 'Yea' or "No" as to each of t�+a following: -Yes No li •Pumping information wee provided by the owns►, occupant, or Board of Heblth. None of the system composentii hawe:lseen pumpe"ratJeast two weskei and -aa -system hssJeserrsscsiving'arrrtel flow rates during that period. Large Wumes of water have not been introduced into the system recently or as part of this inspection. f _ As bulk plans have been obtained and examined. Note if they are not available with NIA. The facility or dwelling was Ir apected for signs of sewage back-up. / The system does not receive non•sankary or industrial waste flow. The site was inspected for signs of breakout. _ AN system components, excluding the Safi Absorption System, hAve been ;ocated on the site. _ The septic tank manholes were uncovered, opened, and the interior of the �eptic tank was inspected for condition of baffies or toes, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System orrthe site has been di termined based on:, Existing information. For example, Alan at B.o.H. _ Determined in the field (if any of the failure criteria related to Part C is at Isisue, approximation of distance is unacceptable} 175.30213?Ibis The facility owner (and occupants -If different from owaer),wsra.provided Vith information. on tha propm mairttersaoce.4f SubSurface Disposal Systema. I i I i I I i revised 9/2!98 ?a;esotit r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM — . PART C SYSTEM INFORMATION Pity .89 Duncan Drive, North Andover, MA Owner- Suzanne McCabe o.o.of 9/2/99. FLOW CONDITIONS Design flow. • a.p.d./bodroom. Number of bedrooms (desion):_ Number of bedrooms (actualh Total 096104,00w Number of',euprept residents• Garbage Vbtifeu (yes or no):, `V Laundry(soptriite system) (yrs ar no):,/4. if yes, separateinspection•requ:red Laundry system Inspected {y!� or not Seasonal: use (yes or noH /" L WsRor motor roadktgs, ff s �J�b1e (last two year's usage iopol: Sump Pune (Yes or no) -4% Last date of oca"Upancy: Type of eahtiiishment; Design flows- and ( Based on 15.203) Basis of design flow Grosse trap present: (yes or no) Industrial 'Wast* Holding Tank pre t: (yes or no)_,,. Non•sonitary waste coach thtie 5 system: (yes or no)` Water motor readings if Last date of occupane OTHER: (Describe) Last date of occup GENERAL INFORMATION PUMPING RECORDS and source of Information: System pumped as part of inspection: (yes or not if yes, volume pumped: gallons Reason for pumping. TYPE YSTEM Septic tenk/distribution box/sail absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology no. Attach copy of up to date operation and maintenance contract Tight To* Copy of DEP Approval Otter APPROIMMAN AGE of. &R components, d instagad{ff known) -and source *Nftfonnatloo: 3 !� s'�-1 L r Sswags odors -detected when arriving at the site: (yes or no)%j/a revised 9/2/98 Paq.dorlt SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTM FORM PART C - SYSTE#N MFORMATUM (continued! lroWty.Ad c 89 'Duncan. Drive, North Andover, MA Owrrer: . ;:Suzanne McCabe ova of .912/99 ,,.::r..•, . BUUO: .. {Locate on Nib pian) Depth be'loiv :'jrade: Mst "of consbtitctloii: cost iron 4t) PVC Distance framorivete water Sul D ISMA sr Colmdtrents: (condition of -joints. other (explain) Eno of leakage, -etc.) SEP`= TANK•_ (locate on sits flan) Depth below gre":,� Material of construction:. oncrete _metal Fiberglass _Polyethylene other(explain) If tank is metal, list pge ­,Is.age.coinM//nad by Certificate of Compliance _ (Yes/No) Dimensions:-- X. /67 Sh+dge depth: Distance from top of sludge to bottom of outlet tee orbaffle m Scuthickness: 1 r Distance from top of scum to top of outlet tee or baffle:% Distance from bottom of scum to bottom of outlet tee or baffle- Opo Now dimensions ware determined: g�UOT.f (recommendation for pumping, condition of Upt and outlet tees or baffles, depth of liquid lever In relation o outlet invert, structural -integrity, evidence of leakage, etc.) GREASETRAP: (locate on s e.plan) Depth below-grade:� !ling of construction: —concrete _Motal _Fiberglass —Polyethylene ,,,_other(expleln) Dimensions: Swm thieknese:,�_ Distance from top. of scum to top of tee r baffle: Diaartce from bottom of scum to �O�tbafn of baffle: Dots of iastpwnping: Corrrrrtants: for pumping, con n of nl t and outlet tees or baffles, depth of liquid level; in relation to outlet invert, structural integrity, etiidsnoe of laak� ' etc.) revised 9/2/98 rate7orli SUBSURFACE SEWAGE DISPOSAL SYSTEM NSPECTION FORM PART C SYSTEM NFoRiiilATUM (amwneed) Pro"tyAddress: 89 Duncan Drive, forth Andover, MA O'a". Suzanne McCabe D: 9/2/99 TOM OR'NDLDMIlf3 TANK: {Tank must be punwed prior to, or at time of, inspection) (lacom an alft plan) Dap* below gtede: Mateetal of eorilstrnation:Zeane"to ,metal _,,,_Fiborgiass _Polyethylene _othar(e:plain) DaeigN ttow•ppmg-r— Deft Y Alanw ��wtAlan orking order: Yes No„— c Connnanb: (condition at, Inlet tee, condition of alarm and float switches, etc.) DIS I IBUTION BOX, (locate on site plan) Depth of liquid level above outlet invert: Continents: (note if lqg PtXV CHAMBER-_ (locate on alta plan) Kowss in working order: (Yes or No) Aiarnis in working order (Yes or No) (noxa condition of pump chamber, cor t!3 revised 54/2/98 solids carryover, evidence pf leakage into_jor out of box, etc.) - — and appurtenances, etc.) . Page 8 of 11 w SUBSURFACE SEWAGE DISPOSAL SYSTEM SISPECMN FORM PART C SYSTEM WFORMATION toontimade view" 69 Duncan Drive, North Andover, MA f�srnsr Suzanne McCabe . Daen N! Mrraedon: 9 / 2 / 9 9 SM ANsoRrnoN. SYSTEM WAS) poomo an site pian, If possible. excavation not required, h=d6n may be approximated by non«nvusive methods) if not lcebawd, *Wain: 5 Type: leachingpits, number:,,, _ (caching. chambers, rwmbw*— leaching.gallofts, number: leading trenches, number, length: r' leaching fields, number, dimensions. overflow cesspool. number: Alternative system: Name of Technology: Comments: )note conrda�ttiion of $OR, si a of hydraulic failure, lev_tI of ponding, damp salt, condition of vegetation, etc.) CESSPOOLS: — (locate on Site plan) Humber and configuration: Depth -top of Rquld.to inlet invert: Depth of solids layer: Depth of scum layer:: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool rnusf be ed as part of inspection) Comments: (note gondhion of sob, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIVY: _ (locats, on site pian) Materials of construction: Depth of solids: Comments: (nen condition of soil signs of ydraugc f of ponding, condition of vegetation, etc.) ftV 9 of 22 Dimensions ... " V SUBSURFACE SEWAGE DISPOSAL SY37M nsp€C WM FORM PART C SYSTEM WFORMATpM (aonftiloo �p�tlrA4wis' 89 Duncan Drive, North Andover, MA Dow Suzanne ,McCabe 9/2/99 SKETCH OF SEWAGE DEPOSAL SYSTEM: Wg*aS ties to at leest two permarnent reference WWmerks or,benohmarks W*pt an wells within 100' (Locate where public water suppiy comes into honje) I_ 'je>0:X ,P,g "-� Q 6��- - �Ilk 31 MSURFACE SEWAGE DISPOSAL SYSTEM NSPECTION FORM PART C _ ..... SYSTEM NFORMATION fcondraredl PeopartYAftiiws: 89 Duncan Drive, North Andover, MA o.nnee: Suzanne McCabe Dna edr't on:9/2099 MRCS Report name $oil Types Typjeal depth to groundwater USGS Date •wabeite visited Obsvvttion Wepa checked / Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Caller Shanow wens Estimated Depth to Groundwater _ Feet Please indicate all the methods used to determine Mtigh Groundwater Elevation: 9btained from Design Plans on record OV rved.Site iAbutting property, observation hole, basement sump etc.} -//Determined from local conditions Checked with local Board of health Checked FEMA Maps Chacked pumping records ChecW local excavators. installers sed USGS Data Describe how. you established. the High Groundwater Elevation. IMM be completed) revised 9/2/98 INV 11Ofit 1 of4 9/23/99 7:45 AM ll�ltldl LLl6.,,uwl..::,�,u.yy.. •, ..,-•• _, - SUMMARY OF GROUND -WATER LEVELS AUGUST 1999 PROVISIONAL L START NET CHANGE DEPARTURE WATER LEVEL WELL T I YEAR IN MONTH INONE BELOACEAND- 0 T OF YEAR MFROM ONTHLY CE P H RECORD MEDIAN DATUM 0 0 (FEET) (FEET) (FEET) (FEET) DAY MASSACHUSETTS ACTON 158 TS 1965 ----- - 3.33 - 1.61 21.05 < 16.76 27 27 ANDOVER 462 VS 1968 - 0.34 0.33 - 1.56 - 1.27 -1.66 - 0.86 5.34 << 30 ATTLEBORO 83 230 VS 1964 FS 1957 - - 0.47 - 2.42 - 0.77 25.23 27 BARNSTABLE 13ARNSTABLE 247 FS 1962 - 0.54 - 3.38 - 0.69 25.26 27 BECKET 12 TS 1986 + 0.26 + 0.57 + -0`37 -3.65 24 DRY BILLERICA 363 HS 1962 VS 1986 ----- + 0.49 ----- + 0.85 - 0.19 3.13 24 BLANDFORD 9 BOURNE 198 FS 1962 - 0.42 - 2.47 - 34_07 BOYLSTON 87 VT 1995 FS 1962 ----- - 0.42 ----- - 3.24 ----- - 1.51 ----- 11.44 DRY 24 BREWSTER 21 BREWSTER 22 FS 1962 - 0.39 - 2.61 - 1.12 32,20 24 CHATHAM 138 FS 1962 - 0.49 - 2.29 - 1.40 25.60 24 CHELMSFORD 384 TS 1987 - 0.30 - 1.03 - 0.94 17.07 < 27 23 CHESHIRE 2 HT 1951 - 1.57 - 0.47 - 0.96 9.23 CHICOPEE 95 TS 1984 - 0.38 - 1.29 - 1.29 22.81 < 23 COLRAIN 8 VS 1965 - 0.70 - 0.78 - 0.42 20.99 23 CONCORD 165 TS 1965 - 0.45 - 3.77 -0.46 41.40 27 CONCORD 167 TS 1965 - 0.74 - 3.25 - 2.38 10.60 << 27 CUMMINGTON 13 VS 1986 - 0.18 - 0.07 - 0.44 6.26 23 DEDHAM 231 ST 1965 - 1.31 - 4.76 - 3.53 13.82 < 23 DEERFIELD 44 VS 1965 - 1.12 + 0.12 - 1.63 5.49 23 DOVER 10 TS 1965 - 0.57 - 1.98 - 0.83 34.72 30 DUXBURY 79 VS 1965 - 0.56 - 1.43 - 0.68 9.96 30 DUXBURY 80 VR 1965 - 0.61 - 1.56 - 0.74 23.56 30 EAST BRIDGEWATER 30 HT 1958 - 1.80 - 5.25 - 1.88 14.55 30 EDGARTOWN 52 VS 1976 - 0.47 - 3.99 - 0.54 18.01 27 FOXBOROUGH 3 TS 1965 - 0.73 - 1.80 - 0.76 20.68 31 FREETOWN 23 TS 1964 - 0.44 - 2.28 - 1.51 15.20 30 GEORGETOWN 168 VS 1965 - 0.66 - 0.75 - 0.73 6.35 27 GRANBY 68 VS 1954 - 0.92 - 1.42 - 1.42 10.53 < 23 GRANVILLE 5 TS 1965 - 0.60 ----- 1.32 34.25 24 GRANVILLE 6 SS 1965 + 0.21 + 0.41 - 0.64 7.49 24 GREAT BARRINGTON 2 VT 1951 - 0.38 - 0.01 + 0.38 12.24 23 HANSON 76 VS 1964 - 0.56 - 1.01 - 0.68 5.88 30 HARDWICK 1 TS 1965 - 0.43 - 0.65 - 0.10 16.05 23 HARDWICK 31 TS 1984 - 0.02 + 0.36 + 0.40 11.08 23 HAVERHILL 23 TS 1960 - 0.55 - 1.44 - 0.59 14.03 27 HAWLEY 8 ST 1986 - 0.96 - 0.51 - 1.19 5.79 < 23 HOLDEN 169 FT 1995 - 1.63 5.02 ----- 7.88 26 LAKEVILLE 14 TS 1964 - 1.61 - 4.40 - 1.52 18.35 30 LEXINGTON 104 VS 1965 - 0.23 - 0.65 - 0.22 3.54 27 MASHPEE 29 FS 1976 - 0.14 - 1.63 - 0.63 9.47 20 MIDDLEBOROUGH 82 VT 1965 - 1.33 - 3.83 - 2.05 16.62 < 30 MONTGOMERY 19 SS 1986 - 0.27 - 0.61 - 0.97 3.22 24 NANTUCKET 228 FS 1976 - 0.22 - 2.99 - 1.71 25.74 26 NEW BEDFORD 116 VS 1964 + 0.11 - 0.82 - 0.56 4.94 30 NEWBURY 27 VT 1965 - 1.21 - 1.80 - 0.99 11.13 27 SUMMARY OF GROUND -WATER LEVELS AUGUST 1999 PROVISIONAL WELL L START NET CHANGE DEPARTURE WATER LEVEL 1 of4 9/23/99 7:45 AM 3 E a m tm � Q L cQ • O Q �LL �^L' ^G'' L.CI r W -J w 1 ^ W w W Z `�• Z p = z Ll- iO Q 0 W a F—cew N OO w V^ zm c s am L L ` G N O N `j O c s LL I- Y �'I-nG`TED �fitle V Rag 2.5 R r,g 6 Rte; 10.2 Rcg 10.4 DATE SJFSLTct% h:CE DI: ?()Skt W -',-LGN Cb -4!K IAST LOT ## ✓� %� DISAPPROM DATE______ Reasons: a submittcd plan rust shop: as a Un3num: the lot to be served -area, dimensions lot #, abutters location and log deep observation holes -distance to ties location and results percolation tests -distance to ties design calculations & calculations showing required leaching area location and dimensions of system -including reserve area existing and prcposed contours location my vat areas *Athin 1001 of sewage disposal system or disclaimer -check wetlands mapping surface and subsurface drains vithin 7001 of sev,%ge disposal !,yAcm or disclaimer location �J zy &-aInage e= .:arts vAthin 1001 of ss tze Aisposal system or disclalMr-Pl=zIng Board files ImoT-a sourtes of tater supply within 2001 of sewage disposal b sybtam or disclaimer location of ajy proposed rall to serve lot -1001 from leaching facility location of water lines on pr-cpcwty.-10' from loaching facility location of benchmark drive,vmys garbage disposals no PVC to be used in consta action profile of systom-elevations of basezkmt, plu-b, pipe, septic t-nmk, diutribution box inlets and outlets, distribution field piping vnd UV'ier elz ations Linidi .:m ground hater elevation in area sownge disposal system plan cast be prapamd by a Professional Eagineer or other professional authorized by law to prepare such plans Szptic Tznks eapL:citf a--150;6 of flog, j atLr W31e, tc: s, el_p•ih of tees, access, purging cl canout 101 from cellar wall or in„Tvuad sv. -.ng pool 251 from subsurface drains Distribution Boxes ,slope greater 0.08 / / g3 r o�F s 7-I9,U � Reg 15.1 15.4 15.8 3.7 Reg 14.1 14.3 11.4 14.6 14.7 11x.10 Reg 9.1 9.6 A 2 J,AIL OK e Lc,ezb Pits Leaching pits ase, preferred where the installation is possible a) calculations of leaching area-rdnirwim 500 sq ft b) spacing c emrface drainage 2% dj cover material 'e) 2 t x2 � x4n aplash pad f) too at elbow g) no binds in pipe from d -box to pipe Loechin Fields a no gi�c3a�ar t� 20 iAnutes/inch r� area -minim 900 aq ft c construction of field d) surface drainage 2 % e) 201 from cellar ill or inground swimdng pool o `Maching area-rAn 500 sq ft min 6 ft with reserve betzion cY 0) E3' VA9 f ;, i -face drainage 2% Ib:iillSla e y x�to a) s ope be shoe) b) y/x % 150 - (to be shov.n) st a)p vel b) s d -by pourer _ u or 1;orth Anqz�ve :.Nass. ` &r..MC STw, INrIALLATIaT CN N LIST LOT�} c--Q� nm �5 T3 ui C.T o" 1. Distance Tot a. Wetlands b. Drains -� c. well C� AV. 414 \e> 2. Nater Line Location 3• No PPC Pipe Zt. Septic Tank a. -Tess -_L do To Clean Oat Covers b. Cement Pipe to Tank -- On Both Sides of Tank V 5. Distribution Box a. Covers & Box - ' No Cracks b. All Lines Flowing Equal Amounts / c. No Back Flow ' 6. Leach Field or Trench a. Dimensions b. Stone Depth / c. Capped maids d. Clean Double Washed Stone 7. Leach Pits a. Dimensions b. Depth c. lash Pads . Teas e. Cement Pipe to Pit - Both Sides f. Clean Double Washed Stone 8. No Garbage Disposal 9. Final Grading Inspection 10. Barricading Covered System 31. As Built Submitted a. Lot Location P` b. Dimensions of System c. Location with Regard -to Pere Test d. Elevations e: Water Table U` () 1 d t �G4Ru A(Ai. 6000c pa ojjAA - - 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance -with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall -be limited as to the time of ongoing construction activity, and may be_deemed-bythe -Inspector_of-Wires abandoned.and_ avalid,if_he— or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or.the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses conceming the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending -through August 15, 2012. 8 — Permit/Date Closed: — / V * k Note: Reapply for new p 0 Permit Extension Act — Permit/Date Closed: f- 0251 Date.................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that........ 141) T 41W .................................................................................... has permission to perform ......... T 5�,S ................ wiring in the building of ............. ...... ................... at .... 4-? . ...................... North Andover, Mass Fee Lic. No. .................. Z' Z'&. � Check # 7 4-11 irRIC LIN INSPECTOR Permit No. DGtNt�r7.l Q�✓ tet �J ervlCd 7 Occupancy and Fee Checked BOARD OF FIRE f'REvEiJ T ION REGULn,Ti�'`'.C, Rcv. 1t07) (;taut blank-) APPLICATION FOR. PERMIT -TO PERFORM L=LECTMi "Ai- WORK All wort to be performcd in accordance with chc Mmachuscns Elcct. iczl Codc (MEQ, 527 Cit 12.00 (PLEASE PRLYTJJV JXKOR TYPEAL IWORA69TION) Date: _ d ��..�� _ City or Town of: -0de __ to the Ir7specror o Wir es: Av this application the undersigned gives notice of his or her intention, to pct form the eiectricai work described below. Location (Street c Ovrner or Tenant Owner's Add ress itiumber) 1, � + Telephone No. - Is this permit in conjunction v+-ith a building permit" Purpose of Building Existing Service Amps ! molts New Servicc ,sumps ! Volts Number of Feeders and Ampacit-' Location and Nature of Proposed Electrical lVark: Yes ❑ No FA (Check Appropriatt Bo\) LttiiitjAuthorization No. Overhead ❑ Undgrd ❑ Nd. -,f deters Overhead ❑ Uridgrd ❑ No. of Mews Camphtinn crriu %flak'inA noble rna�• bt warvtd br.tlrt lnlvdcror of 1i`rres. No. of Recessed Lumin3irt s No. of Ccii.-Susp. (Paddle) Fans No. of TOL21 ,Transformers _ KVA INN. of I.,uminaire Outlets 10 -of Hat Tubs IGcntrators RVA \a. of Luminaires Swimming Pool ? ❑ !o. at mereencv Lighting - - -rnd.e rnd. 1Battery Units \a_ of Reccptacic Outlets 10- or Oil Burners FIitE ,ALARMS 1Na. of Zones tea. of et nand Na. of switchcs No. of Gas Burners IRrtiztinz � I�evICCS D No. of Ranges No. of Air Cond. Tons No. of Alerting Devices No. of lirasce Disposers P Flesr�urtlp f�ur ons mbe Torz1 —�_.-. , Kwe - ontaine o. oDetection/Alerting Devices No, of Dishyiashcrs S atel4rea Heat:na KiV P o Loc. ❑ Municipal Connection (D Othtr No- of D ers t7' _ Heating Apphances I<trV ecurity vstems:° No. of Nviccs or L uivalcnt No. of WatcriV' ' o. o o• a, Data Wiring- ftesters Sieus Ballasts No. of Devices or E u.vaient No. Hydromassage Bathtubs No- of Motors Total HP elecommunteationsWiring: No. of Devices or Equivalent OTHER: -. r,t•- ,;mach additaonv! delai! if deslred, ar arrrquued vy rare rnspecwr ul ••�, ��. Estimated Value of Electrical Work: � 19— (When icquircd by aturiieipal policy.) Work to Starr: Inspections to be requested in accordance with Nf-C Rule 10, and upon completion, INSURANCE COVERAGE: Unlcss waived by the owner, no permit for the performance of electrical work may issue unless the iicenscc provides proof of liabiliry insumice including "coinplcted operation" coverage or its substantial cquivale-nt. The undersigned ccrtifits that such coveraCc is in force, and has exhibited prenfof same to the permit issuing office. CHECK CVE: INSURANCE (A BOND ❑ OTHER ❑ (Specify:) SP -If Insured i cerlif under th e pains oral penalties of_vtrjur)', that fire in rm,&.,an air this application is true and complete. FIRM NAIVE: P_UT Securit,, Services _ _ LTC.h0.: � `�S Licensee: Mark A. Brophlr_ Sigltatart_4, (If aoplicoblt, enter "e.Ttrlpt " in rllt fitaut 11117nkr lint.) � Bus. Tel_ Cd -3 - $ 9 4 - S 9: Address: 1.8 r1in--to-ii Drive. Hoi l is, NR _ _ i ,-kIf. Tel. No.: 'Per M.G.L. e. 147, s. 57-61, security %Fork: requires Dcpaltmcnt ofRublic Safecy "S" License: Lie. No. 00953 O'WNER'S INSUPL- i4CI; WAIVER: I am a%•arc that the Licensee does not hovi' the liabilitY insurance coverage normally required by law. 'By my signature below, I hereby waive this rcquircmcni, f am the (check one) (D] owner ❑ owner's astnt. 0wncrll17eat FEfIT FEE: $ ��� 07iyyr�, Department of P bfic Safety One Ashburton Place, Rm 1301 Boston, Ma 02108-1618 License: S - License Number: SS CO OW95 3 Expires: 02.07140 i t Restricted To: 00 %IARK A 1114011I}' SR \t)►2:1'Cit)1), NIA 11111r,' � — •:•.P-�,i-Uft,LiC=+.^.ei �.:wel:C_Ot: 9 (lX trtt-1e�r. {.rf!'IY r!. !!.:✓nir:J.�ir ! DEPARTMENT OF PUHLIC SAFETY r: S UXIme •'>' Number. SS CO atl)_S:s Expires: v 'O1:2U1 I Tr. 110; 1 17, S -License: AUT -SECURITY SERVICE -,RK A tIROPHY SR I MORSE ST ;RV -,0'05. MA 0--%—: Curnmtastcvsa! n. Tr, no: 1 17 0 Keep tap for receipt and change at address notiflratiun DIG SAFE CALL CENTER: (888) 344-7233 FaV. Th= DSoc s Kong w: P-WIZWO i'ai--r[�7 orrr3-01�;;r[T� BOARD Z:�u:c: rr�1►�s .. PA A REGISTERED SYSTEM CONTRACTOR. SWES THE ABOVE UCENSE TM 1 1 TYPE •ADI.SECURITY SERVICES, INC. �P MARK :.A DROPNY SR i —C 410 UNIVERSITY AVE WESTWOOD 11A 82090-2311 1 849174 45 C 07/31/13 849174�y I r •Y�R`�-lamaR. �Vgfrfelil: lir l VM_�+2•i_R %r'. t i' - FC4 T" Dwath X=v U Pce-90- - -I 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance -with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall -be limited as to the time of.ongoing construction activity, and maybe_deemed-by-theJnspector_of-Wires abandoned.and_inYalid,if he—.. _ or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or.the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2Q128 and extending -through August 15, 2012. k-Rule—Permit/Date Closed: 6-2-3_% *** Note: Reapply for new per mAr 0 Permit Extension Act — Permit/Date Closed: This certifies that. . Cl- ............... has permission to perform .... .................... wiring in the building of �",r ...................... at. D"A. '. 0 ............ I N Andover, Mass Fee...... Lic. No. ... . .. ELECTRICAL INSPECTOR Check #- I Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. r1 g 7 p Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (NEC 527 CMR12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: `7 A 01 City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 01 'CG1 CC.n 11 �L4j i 1� Owner or Tenant Owner's Address Telephone No. Is this permit in conjunction with a building permit? Yes �4v No ❑ (Check Appropriate Box) Purpose of Building ci,�I ,E, rJ Utility Authorization No. - Existing Service s Amps iZv / 2.0 Volts Overhead ❑ Undgrd L,?r No. of Meters __L_ New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: K } n Gr Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans s Total of Trsformers KVA Tran No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires AboveIn- Swimming Pool rnd. [irnd. o. o mergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Tons Tot No. of Alerting Devices No. of Waste Dis osers P Heat Pump Totals: Number Tons I.KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers g S ace/Area Heating KW P Local ❑ Municipal ❑ Other Connection No. of Dryers y Heating Appliances KW Security Systems. No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring. No. of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: a� (When required by municipal policy.) Work to Start: % 1gO Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE (T BOND ❑ OTHER ❑ (Specify:) I certify, under thepains and penalties ofperjury, that the information on this application is true and complete. FIRM NAME,,:pp�� 1712`-(r (ec cd:., LIC. NO.: 71.5 ✓E Licensee: _ AY;b &k C_ 1 kfA i 5 Signature LIC. NO.: (If applicable, entt�"exempt" i�the1license r�ber lin( �Bus. Tel. No.: Address: i7 \j&5w� uo, U3 �ko( Alt. Tel. No.: 6034W, L *Per M.G.L cc.14 .57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. 4� r ._ JU�.ILttil.rl..ii.Jl�l�itiyi-lit �L-[.rL��tr.L�i--l�F-'�L1y1� d�1y���.�I � yy�t� /�,•�-� ��.U�S.f{!.®�SC�IJ�'1�®�1.: —.!'JJt-R[StI�,L,[�a.4,,�►J-1.g15�.�ei�.r�V.[6.•,^' .. r .. � + �. �'XN�L' �N�1'��•'3C'zON', . �'asse��-[ � •�i'aiSec�--r) � �t��ns�eciiox�.xec�uixe�(��0.00)-•[ � . �it�iectak-S' co7mm.ents: . (�'ns�iectoz's',�'igxtatuze..�.o�tiaTsj 37ate 'asset•—,� � �'aziec�--j � �te�inspeetZo�xequixet���50.UD)�[ � • aspetoxs' comaents: (lnspectozs',�ignatuxe��o?nifaTs) ]ateVAPECAT . !�pectoxs4 eomm.epfs: (fwpeetors',figgture-io jUlilals) Slate �"��'EC3C`Zm�7 •- Ute: ' 'epi---[ ��+°aila�f•-•� J_ 'ate �nspectzonreq�ed {��OAD) •-[ � eetors' Signature -.no InVdalls) Date R1.7'E 1'e'7 .6 A'Y CK A •r".'1'l ti:fl YlY'I 'iiYY Y •ilT. RYY7rrt � S3'hi M •r�r.�r.-r ,r.�vr rvrmr. •.-.-e mrrr+ t •.-.•.--r a r-ri r -a •r.rr �-,.o-rm�.-r.�..-�.�.-.-.-.....,.. �.. _.—. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): OR L ccAr (c, Address: �� (�,Y�e,S�ct� mac. City/State/Zip: ��„�� J)`�� , L�y5vN r1 Phone #: Cao S �FIF(� 7& f Z Are you an employer? Check the appropriate box: 1. I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2.am a sole proprietor or partner- F'ship listed on the attached sheet. t and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] i employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 1 ❑ Plumbing repairs or additions 12. ❑ Roof repairs 13.❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I ant an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Instyance Company Name: Policy # or Self -ins. Lic. #: Job Site Address: Expiration Date: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a dne up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under tains and penalties of perjury that the information provided above is trite and correct. Phone #: (U,; " 3 fl '. 761 Z Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License It Z Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be retumed to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia Any lien perfected pursuant to section three A, or to section nine of chapter one hundred and forty-three or section one hundred and twenty-seven B of chapter one hundred and eleven, shall extend to and may be enforced by the city or town against any casualty insurance policy or policies covering any loss, damage, or destruction pursuant to which the proceedings to perfect the lien were initiated. No insurer shall be liable to any insured owner, mortgagee, assignee, city or town, or other interested party for amounts disbursed to a city or town under the provisions of this section, or for amounts not disbursed to a city or town under the provisions of this section. On this date, I caused copies of this Notice to be sent to the persons named above at the addresses indicated above by First Class Mail. Cunningham Lindsey Catastrophe Department cicat@cl-na.com 800-867-3885 Cunningham Lindsey U.S., Inc. P.O. Box 703689 Dallas, TX 75370-3689 Telephone (888) 738-8714 Facsimile (214) 488-6766 CLCAT@)CL-NA.COM "**********************AUTO**3-DIGIT 018 760 T3 P1 95000058950 Building Commissioner or Inspector of Buildings 120 MAIN STREET N ANDOVER, MA 01845 Cunnin ham fA Lindsey Form of Notice of Casualty Loss to Building Claim has been made involving loss, damage, or destruction of the above captioned property, which may either exceed $1,000 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. If any notice under Massachusetts General Law, Chapter 139, Section 313 is appropriate, please direct it to the attention of the writer. Kindly include a reference to the captioned insured, location, date of loss and claim number. Section 36. No insurer shall pay any claims (1) covering the loss, damage, or destructions to a building or other structure, amounting to the one thousand dollars or more, or (2) covering any loss, damage or destruction of any amount, which causes the condition of a building or other structure to render section six of chapter one hundred and forty-three applicable, without having at least ten days previously given written notice to the building commissioner or inspector of buildings appointed pursuant to the state building code, to the fire department or arson squad of the city or town and to the board of health or board of selectmen of the city or town in which the same is located. If at any time prior to the payment the said city or town notifies the insurer by certified mail of its intent to initiate proceedings designed to perfect a lien pursuant to section three A, or to section nine of chapter one hundred and forty-three, or section one hundred and twenty-seven B of chapter one hundred and eleven, the said payment shall not be made while the said proceedings are pending; provided, however, that said proceedings are initiated within thirty days of receipt of such notification. Under MASS. GEN. LAWS Ch. 139, Sec 3B Claim Number: 2289473 Policy Number: 2289473 11 o Company Name: MERRIMACK MUTUAL FIRE INS 0) Cause of Loss: ICE DAM g Date of Loss: 2/19/2015 Insured: EDWARD & IRIS MCGETRICK C Property Location: 89 DUNCAN ST Claim has been made involving loss, damage, or destruction of the above captioned property, which may either exceed $1,000 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. If any notice under Massachusetts General Law, Chapter 139, Section 313 is appropriate, please direct it to the attention of the writer. Kindly include a reference to the captioned insured, location, date of loss and claim number. Section 36. No insurer shall pay any claims (1) covering the loss, damage, or destructions to a building or other structure, amounting to the one thousand dollars or more, or (2) covering any loss, damage or destruction of any amount, which causes the condition of a building or other structure to render section six of chapter one hundred and forty-three applicable, without having at least ten days previously given written notice to the building commissioner or inspector of buildings appointed pursuant to the state building code, to the fire department or arson squad of the city or town and to the board of health or board of selectmen of the city or town in which the same is located. If at any time prior to the payment the said city or town notifies the insurer by certified mail of its intent to initiate proceedings designed to perfect a lien pursuant to section three A, or to section nine of chapter one hundred and forty-three, or section one hundred and twenty-seven B of chapter one hundred and eleven, the said payment shall not be made while the said proceedings are pending; provided, however, that said proceedings are initiated within thirty days of receipt of such notification. NOONAN & Mc DOWELL, INC. 25 Bridge Street, Suite 6, Billerica, MA 01821-1023 Voice (978) 667-9736 Fax (978) 671-9565 Email: nmgconversent.net June 26, 2002 Town of North Andover Office of the Health Department Community Development and Services Division 27 Charles Street North Andover, MA 01845 RE: Subsurface Sewage Disposal System Plan Review, 1770/078 89 Duncan Drive Assessors Map 104B, Lot 188 Dear Members of the Board, 'D r7or-e C>e3 _&e Please be advised that Noonan & McDowell, Inc. has reviewed the plan dated: May 23, 2002, by: Merrimack Engineering Services. It is our opinion that the proposed design will meet the requirements of Title 5 and the North Andover Board of Health `By -Laws" if the following is addressed: p � 1) The log for test pit 1 does not match Board of Health log. 2) Identify water line as either pressure or suction. 3) Identify the presence of lack of surface water supplies within 400 -ft, public wells within 250 -ft, and private wells within 150 -ft. 220(4) 4) Identify wetlands within 150 -ft. NA 8.02r 5) Add to septic tank detail maximum distance from centerline wall to tee, 12 -inches. 6) Add to septic tank detail outlet tee length. 227(6) 4 7) Add detail for ends of distribution lines connected with elbow up to prevent cross flow. <` 8) NA 15.01 9) Top of fill slope stops at property line a local variance is necessary. 255(2) 10) The outlet tee in septic tank is 3 -in above inlet on detail. Respectfully, John L. Noonan, P.L.S.-P.E. P/Office/boh/ 1770078.doc Land Surveyors Civil Engineers Environmental Planners NOONAN & Mc DOWELL, INC. 25 Bridge Street, Suite 6, Billerica, MA 01821-1023 Voice (978) 667-9736 Fax (978) 671-9565 Email: nmgconversent.net June 26, 2002 Town of North Andover Office of the Health Department Community Development and Services Division 27 Charles Street North Andover, MA 01845 RE: Subsurface Sewage Disposal System Plan Review, 1770/078 89 Duncan Drive Assessors Map 104B, Lot 188 Dear Members of the Board, Please be advised that Noonan & McDowell, Inc. has reviewed the plan dated: May 23, 2002, by: Merrimack Engineering Services. It is our opinion that the proposed design will meet the requirements of Title 5 and the North Andover Board of Health `By -Laws" if the following is addressed: 0 � 1) The log for test pit 1 does not match Board of Health log. 2) Identify water line as either pressure or suction. 3) Identify the presence of lack of surface water supplies within 400 -ft, public wells within 250 -ft, and private wells within 150 -ft. 220(4) 4) Identify wetlands within 150 -ft. NA 8.02r 5) Add to septic tank detail maximum distance from centerline wall to tee, 12 -inches. 6) Add to septic tank detail outlet tee length. 227(6) 7) Add detail for ends of distribution lines connected with elbow up to prevent cross flow. ` 8) NA 1.5.01 9) Top of fill slope stops at property line a local variance is necessary. 255(2) 10) The outlet tee in septic tank is 3 -in above inlet on detail. Respectfully, John L. Noonan, P.L.S.-P.E. F: /O fii ce/boh/ 1770078. do c Land Surveyors Civil Engineers Environmental Planners NOONAN & Mc DOWELL, INC. 25 Bridge Street, Suite 6, 'Billerica; MA 01821-1023 Voice (978) 667-9736 Fax (978) 671-9565 Email: nm@netway.com DateZ G Q 'Z Town of North Andover Office of the Health Department Community Development and Services Division 27 Charles Street North Andover, MA 01845 RE: Subsurface Sewage Disposal System Plan Review, 1770/ Q % f5- 6,9 p/L Assessors Map B , Lot /6 9' Dear Members of the Board, Please be advised that Noonan & McDowell, Inc. has reviewed the plan datedi� by ef7 /�•¢ �-/c ry t: iry�-fix! y, SF U c It is our opinion that the proposed design will meet the requirements of Title 5 and the North Andover Board of Health `By -Laws" if the following is addressed: TJ� Gv e 1'x73- T ' J T / 40Q.,e-5- S' 3 % - l%E1 7/1 �'ili/f j�5 Sc /,� t r � 5 C� l?�fs •� .� Q o �- 7 ��J3'� � C w � � � S G v / %/�r-•� Z So '--Jr - > espectfully, O/s7.7'�-ticE-- � �-� �- 7--� �-�—fie_ ! � fin. � ,F�c� � '�? l�'�V ;'�s-r- e:✓� John L. Noonan, P.L.S.-P.E. G: office/forms/tonarev ©V CIl Land Surveyors Civil Engineers Environmental Plannersi_C` '`S� %l'�f. v �_ ��2 9 GOA,, . 1T cry /tT J'����. TY 2/i✓E V 47 3 "�' ' /� ��`� v � /�-' � � �'� �-�' T� 1' - i moi' � L ,v Noonan : McDowell,�;,, 101X1 ad1ill 1>vl File Edit Tools pata Maintain Process View Report Windows Help Microsoft Word ❑'2;&'ai ®N -A f 0 -'I 0, ®630 9 r; - - r '� x Project: 11770 1 office of Health Department 27 Charles Street, No. Andover, Billing Group ID: 078 J Billing Type: Fixed Fee Billing Fee: 150.00 Card ID: ToNA J Main I Billing Info contract info , ClassificatiQn I GLAccognts I Billing Messages 1 Alerts 1 Staffing I Actiyities I Assign To Proposal Number: _ Department: Contract Number: Contract Date: 6121102 Work Start Date: 6121102 Expected Finish Date: 7112102 r Use Government Invoice Style Description: Engineering services required for plan review. Engineer: Merrimack Eng. Serv. Assessors Map 1048, Lot 188 Applicant: Regina & William Sullivan 88 Duncan Drive J Save Close l[otes... Project Request Record Town of North Andover Date: Client Id: ToNA Card Id: ToNA Client/Company Name: Board of Health Card Type -Client Contact Name: Ms.. Sandra Starr Phone: 978-688-9540 Title:. Director Fax:. 978-688-9542' i Address: 27'Charles Street Email: sstarr@townofnorthandovencom 1' Notes: Town: North Andover State: MA Zip Code:. 01845- 1845Other: Othercontacts if applicable.: ie F,ingine Installer ,r ' Name:. Phone: Title: Fax: Address: Email Notes: Town: State: Zip Code: r'1r1` Pro iect: Project Id: 1770 Project Title: Town of North Andover. Board of Health (JOB NO) (PROJECT NAME & STREET ADDRESS) Manager: NOW Billing Group: Billing CA: Fixed Fee 15-0 Contract Info. Project Description for each billing group BG/ wic- c- o 0 oo'! Sra e. z - i 1/sy Assessors May /-I 9-B Lot S8" Street rr 9 A9vN e -rev vr> vdE7 a Type of. service 2 Officdfbnns/jbrqutona V I - P-V,FrA YNA a Y- P-V,FrA c.� I Location: A t\ l owner's Name: L11� !Z u Map/Parcel•_ 11.1 104 P) Address:-- is Installer. Tel:%dj �' 2'if New (stso) Repair 1/ t Date: -?,�-i 47, WetlandsZjg?t&ne II -- Soil Symbol Soil Ram Soil Class Deep Observation Hole Logs Elevation Depth Soil Horizon Soil Tem -re Soil Color Soil Mottling % Gravel, Stones, etc: T1 IvYO/0 n4"N -Fik Z�-04!' 2, 5 Y 5/4 O-24 �'uc i w�• F►r c Parent Material Depth to Bedrocl•_04�Standing Nater in the Hoic-4dt eepin.v from Pit Faee_q�LF$HG%V: ZI It Mki ►rpt' ,•-- �; � tt�iv� t.�rz-::.: Ww% Parent Material - w4 Depth to Bedrod;,�Standin; Water in the Holr._`� w Nreepin.- from Pit Face 3 Date q-zAf -lyl� . Percolation Tests Obsei Deptl Start Time Time Time Time Rate Performed By: Ou raga Oky Witnessed By: � yr/-; :, CHECKLIST FOR NORTH ANDOVER SEPTIC SYSTEM PLANS N & M Job 1770/ % The following is a checklist that incorporates all Title 5 and local regulations for septic plans. Name of Applicant: .5U L C- / C--' Name of Designer: ?- CA -- Plan APlan Date: Revision Date: — Date of Review: Z Property Address: �9 Map:/ate Lot: /a- Z BOH Reviewer:(c� ti aQ�/./%�� Type of Plan (new or u ade Number of Bedrooms in Assessor's Records: -- gpd) Garbage Disposal Allowed: ,"Ov P General Information: N.A. = North Andover Septic Regulations Other numbers refer to Title 5 OK P blem N/A Q/ Street number and map/lot - 220(4)(u) Maximum scale of 1 "=40' for plot plan - 220(4) Maximum scale of 1 "=20' for profile and component details - 220(4) _� Legal boundaries of the facility being served - 220(4)(a) Names of abutters from recent tax map - NA 8.02j Number of bedrooms, design calcs., - NA 8.02i �— Name & address of record owner & applicant - NA 8.02k Name & address of designer - NA 8.021 Holder and location of all easements - 220(4)(b) y� Date plan drawn & any revision date - NA 8.02m t/ All dwellings and buildings, existing and proposed - 220(4)(c) Location of all existing or proposed impervious areas - 220(4)(d) All distances on site plan – NA 8.03a -c . J Elevation of proposed driveway - NA 8.02t ^� Location and elevation of foundation drain - NA 8.02y Location and dimensions of the system incl. reserve (new const.) - 220(4)(e) Limits of excavation of leach area on site plan - NA 8.02z Locus plan - 220(4)(t) (Not to scale) y North arrow - 220(4)(g) Existing and proposed contours - 220(4)(g) Locations and logs of deep holes - 220(4)(h) Locations and logs of percolation tests - 220(4)(i) f Date(s) of soil testing - 220(4)(h) & (i) Existing grade elevation of each deep hole - 220(4)(h) Elevation of percolation tests – N.A. 8.02n Name of approving authority representative - 220(4)(h) & (i) Name of soil evaluator - 220(4)0) TP --- Soil logs and perc test logs match BOH records Locations of waterlines, drains, and subsurface utilities - 220(4)(m) tG Observed and adjusted g.w. elevation in the vicinity of the system - 220(4)(n) Complete profile of the system to scale - 220(4)(o), NA 8.02c +� Cross section of leaching facility - NA 8.02w (Not to scale) Location of benchmark(s) within 50-75 feet of facility - 220(4)(q) Note listing all variance requests with proper citations - 220(4)(p) '—' Local upgrade approval request form submitted - 403(1) Original R.S./P.E. stamp, signature & date - 220(1) & (2) If P.E., discipline specified within stamp. MGL C. 112 s. 81M sfc. supplies (w/in 400'), pub. wells (w/in 250'), pvt. wells (w/in 150') - 220(4)( Location of watercourses, wetlands, wells, etc. w/in 150' of system – NA 8.02r 1� Wetland disclaimer – NA 8.02s RLS plan reference & certification required (prop line setbacks) - 220(3) Use approvals / standards checked for UA system - DEP docs., r i Perc rate >30 MPI - not allowed for new, LUA for upgrade - 245(1)&('3) Perc rate > 60 MPI - must use modified tight tank or UA technology - 245(4) �--� Proposed system qualifies as "shared" system - 002 (definitions) Flow is over 2,000 gpd - No R.S. allowed - 220(1) Design flow was set in accordance with code - 203 Existing system location and note on proper abandonment - 354 Leaching facility at least 1' above Base Flood elevation — NA 9.05 All piping Sch 40 minimum — NA 10.01 Basement floor minimum 1' above groundwater elevation — NA 5.04 i Foundation drain present with elevation — NA 8.02y On-site Soil and Groundwater Review OK Problem N/A v ground elevation el. acceptable soil el. Leach facilitv invert el. ground water el. refusal el. bottom of leach facility el. Proper deep observation hole logs on plan - 220(4)(h) All deep holes and peres shown, including aborted tests — NA 8.02n Soil evaluation forms submitted within 60 days of field work - 018(2) Proper percolation test log - 220(4)(i) Ample deep observation holes in primary disposal area" (minimum 2) - 102(2) Ample deep observation holes in secondary disposal area (minimum 2) - 102(2) Ample perc testing (one in each disposal area, 3 in prim. > 2,000 gpd) - 104(4) Deep hole testing conducted within two years — NA 7.05 thickness of acceptable soil before & after soil R&R separation to groundwater separation to refusal soil class perc rate loading rate septic tank below g.w. table pump tank below g.w. table l.f in fill Hole Identification Numbers: —L� f i (yes or no) _ (yes or no) -255(l) Setback Distances (Given in feet) 15.21 1 YES NO Is the lot in the Lake Cochiewick Watershed? NA 6.00 & 5.02 OK Problem N/A Septic Tank Leach Facility / Property line 10 10 Cellar wall 10 20 2 2 w/o barrier Buildine Sewer OK Problem N/A Grease trap required for certain uses (check 230 for details) Pipe diameter listed (4" minimum) - 222(1) Pipe schedule listed - 222(3) i- Pipe cast iron or Sch 40 PVC - NA 11.02 Watertight joints specified - 222(3) & (4) �G Pipe laid on compact, fin base - 222(5) Pipe laid on continuous grade in straight line - 222(7)@ ,c Cleanouts precede all changes in alignment and grade - 222(8) Cleanout provided every 100 feet - 222(8) Manhole at any 90 degree alignment change - 222(8) Invert elevation at building: Invert elevation at septic tank: Length of run: Slope: (minimum of 0.01 - 0.02 desired) - 222(6) 10' offset to private well or suction line - 222(2) 3 3 Inground pool 10 20 �— Slab foundation 10 10 Deck, on footings, etc. 5 10 Waterline 10 10 Private drinking well 75 100 Irrigation well 75 100 Wetlands 75 100 Public well 400 400 Wetlands bordering surface 150 150 ( water Supply or trib. (in Watershed) Trib. To Surface Water supply 325 325 Reservoirs 400 400 "--� Tributaries to reservoirs 200 200 Drains (wat. supply/trib.) 50 100 Drains (intercept 25 g.w.) 50 72- Foundation drains 10 20 Drains (Other) 5 10 / Drywells 20 25 Downhill slope 15' to 3:1 slope w/o barrier Buildine Sewer OK Problem N/A Grease trap required for certain uses (check 230 for details) Pipe diameter listed (4" minimum) - 222(1) Pipe schedule listed - 222(3) i- Pipe cast iron or Sch 40 PVC - NA 11.02 Watertight joints specified - 222(3) & (4) �G Pipe laid on compact, fin base - 222(5) Pipe laid on continuous grade in straight line - 222(7)@ ,c Cleanouts precede all changes in alignment and grade - 222(8) Cleanout provided every 100 feet - 222(8) Manhole at any 90 degree alignment change - 222(8) Invert elevation at building: Invert elevation at septic tank: Length of run: Slope: (minimum of 0.01 - 0.02 desired) - 222(6) 10' offset to private well or suction line - 222(2) 3 3 Septic Tank t ( .5- e2 OK Problem N/A ' Tank is accessible - 228(3) No structures above tank — (228(3) c Tank can accommodate both primary & reserve — NA 9.04 200% of flow (required & provided given. 1500 min.) - 220(4)(f) & 223)(1)(a) 2-3" drop from inlet to outlet - 227(5) ^� Minimum of 4' liquid depth - 223(2) r , 3" air space above tees/baffles (minimum) - 227(4) �G 9"air space above flow line (minimum) - 227(4) _ Tees are not to be replaced by baffles - 227(1) Tees extend 6" above flow line - 227(1) Inlet tee extends 10" below flow line (minimum) - 227(6) Outlet tee extends 14" below flow line (more for deeper tanks) - 227(6) Gas baffle installed on outlet - 227(4) Access manhole cover above center of tank & each tee (except 2 compart) 228(2) 3-20" manholes - 228(2) 1 childproof, 24" riser/manhole Win 6" of final grade if <1000gpd- 228(2) Inlet and outlet tees on center line - 227(1) Soil compaction below tank specified (if soil is non-native) - 221(2) 6" of <=3/4"stone beneath tank specified - 221(2) & 22 8(1) If > 1,000 gpd AND not a single fam. dwell. must be 2 tks or 2 comp. - 223(1)(b) If plan specifies disposal must be 2 tanks in series or 2 compart. tank - 223(1)(c) Buoyancy calcs. required if tank at or below water table - 221(8) 1 Tank is watertight - 221 (1) 9" of cover over tank (minimum) - 228(1) H- 10 loading (min.) - H-20 if traffic - 226(3) Top of tank <=36" below grade - 221(7) ^� All pumping to tank (if applies) in accordance with - 229 Tank is set to keep old system in service during install if possible Distribution Box (Check here if not present: ) OK Problem N/A Pump Chamber (Check here if not present: ) OK Problem N/A --Volume specified: 220(4)(r) Pump on elevation- 220(4)(r)- Pump 20 4 )_Pump off elevation: 20(4)(r) Alarm on elev 220(4)(r) Nu cycles per day - 220(4)(r) (also 254(1)(d) if gravity from d -box) inimum 2" delivery line to d -box if gravity - 254(1)( c) 4 Inlet elevation: Outlet elevation: 0.17' drop from inlet to outlet (minimum) - 232(3)(b) 6" sump (minimum) - 232(3)(e) All outlets at same elevation - 232(3)(b) Outlet pipes laid level for first 2 ft. - 232(3)(c) Pipe Sch 40 - NA 10.01 Number of outlets: Number of laterals: -- Size of outlets: Inlet baffle/tee min. 1" over outlet invert for all d -boxes - 232(3)(a), �G Soil compaction below distribution box specified (if soil is non-native) - 221(2) 6" of stone beneath distribution box specified - 221(2) Box is watertight - 221 (1) Top of box <=36" below grade - 221(7) Buoyancy calculations required if box is at or below water table - 221(8) Pump Chamber (Check here if not present: ) OK Problem N/A --Volume specified: 220(4)(r) Pump on elevation- 220(4)(r)- Pump 20 4 )_Pump off elevation: 20(4)(r) Alarm on elev 220(4)(r) Nu cycles per day - 220(4)(r) (also 254(1)(d) if gravity from d -box) inimum 2" delivery line to d -box if gravity - 254(1)( c) 4 Pressure dosed 11. if flow >= 2,000 gpd - 254(1)(a) & 254(2)(a) Cycles per d onsistent with chamber volume - 23 1 Vol alculations include flowback volume - 2') 1(2) 2 our storage capacity above pump on elevation - 231(2) umber of pumps: 2 if system serves >2 dwelling units - 231(6) Capacity of pump(s) - gpm @ ' TDH - 220(4)(r) Pump can pass 1 1/4 "solids (minimum) - 231(7) Pump controls specified - 220(4)(r) Alarm equipment specified 31(2) im is in building and veered on separate circuit from pump - 2') 1(9) sequence corre (off -lead on -lag on-alan-n on) - 231(8) performanc curves included - 220(4)(r) l opera ' g switch - NA 12.01 valy , bleeder hole - NA 12.01 of, 24" riser/manhole to final grade - 2' mpaction beneath pump chamber sp ed (if soil is non-native) - 221(2) =3/4"stone beneath chin - speci - 221(2) & 228(1), cy calculations if chamber ' t or below water table - 221(8) @ over over chamber (mi ' um) -228(l) loading (min.) - H- if traffic - 226(')), amber is watertig - 221 (1) Top of chamber —36" below grade - 221(7) Leaching Facility (general - complete for all designs) OK Problem N/A 50% larger if garbage disposal - 240(4) Trenches to be used whenever possible - 240(6) No vehicle or imperv. area above 11 unless unavoidable - 240(7); NA 13.02 Vented if under impervious cover - 241 (1) Vented through same pipes as distribution system - 241 (1)(a) Vent protected from precipitation/animal entry - 241 (1)(b) Vent is placed beyond traffic or impervious area - 24 1 (1)(c) All lines connected to vent if bed or trenches - 241(1)(d) 9" cover over peastone - 240(9) Reserve area provided (new construction) - 248(1) Reserve 4' from primary leach area — NA 9.04 4'(5' if perc rate <=2 MPI) separation to g.w. - 212(a) & (b) 4' (down to 2' with variance or I/A - upgrades only) of natural soil under 11. GW separation is adjusted to highest existing grade if facility cuts into a hillside Pipe slope minimum of 0.005 - 251(9) Require 5' removal and replacement if in fill - 255(5) Top of leach facility <= 36" below grade - 221(7) Final grade over 11 minimum 0.02 ft/ft -240(10) Surface & subsurface draina a away from 11 - 240(1 1) & 245(5) Minimum design 44 'thout deed restriction -NA 13.01 3:1 slope where grading required - 255(2) Toe of fill slope stops 5' from property line or swale installed - 255(2) Impermeable barrier if < 3:1 slope or < 15 feet to-3:1slope - 255(2) Impermeable barrier/retaining wall poured concrete — NA 9.02 Retaining wall stamped by P.E. - 255(2)(b) Top of retaining wall >= top of peastone elevation - 255(2)(f) 10' offset from edge of leach facility to edge of ret. wall - 255(2)(g) Perc test(s) done in most restrictive layer - 104(2) Perc test 4' below leaching elevation — NA 7.06 Design flow listed and required/provided leach area given - 220(4)(f) Leach pipes SCH40 PVC — NA 10.01 Leach pipes minimum 4" diameter except for dosed system — NA 14.04 Leach lines capped, vented, or connected together - 251(9) Pressure dosing guidance followed if pressure distribution - 254(2)(c ), Pressure dosing required over 2,000 gpd or with I/A remedial use - 231(1) Leaching Trenches (Check here if not present: ) OK Problem N/A Nu r of trenches: mimum of 2 trenches - NA 9.01(2) Depth of trenches (max eff. 2'): -247(l) Width of trenches (2' min., 4' max.): - 251 (1)(b) Length of trenches (100' max.): - 25 1 (1)(a) Trenches are vented (when > Trenches follow contour ' s - 251(2) Trench spacing 3 ti effective width or depth minimum- 251 (1)(d) In fill or resery etween trenches, 10' min. - NA 14.01& 14.03 Available ch area given (Min. 500 s.f.) - NA 9.01(2) ttom=L x x# — Sidewall =_L x D x # Effective leach area given Loading factor: Effective area = total area s.f. x LTAR — Effective area is >= desi ow of facility being served 2"of 1/8"- 1/2" 2 shed peastone.- 247(2) Tren6 dW of 3/4" to 1 1/2" double washed stone - 247(l) Leach Fields (Check here if not present: ) s.f. s. f. g/day OK Problem N/A Number of fields: (need dosing chamber if > 1, 231 (1)) Length (100' max.): - 252 (2)(b) —� Width: Total area: L x W = s. f. Minimum 900 square feet - NA 9.01(1) Distribution lines connected with solid pipe — NA 15.01 Effective leach area given Loading factor: Effective area = total area s.f x LTAR = g/dav Effective area is >= design flow of facility being served Minimum of two distribution lines - 252(2)(a) 6' line separation (max.) - 252(2)(d) 4' maximum separation from edge of field to line - 252(2)(e) 10' minimum separation between adjacent leach fields - 252(2)(f) Between 6" and 12" of 3/4 - 1 1/2" stone beneath field - 252(2)(g) & 247(2) 2"of 1/8"-1/2" 2x washed peastone.- 247(2) Final Grading OK Problem N/A Slope over leach area minimum of 0.02 feet/foot — 240(10) �— Grading shall divert drainage away from leach area — 240(l 1) Grading slopes away from dwelling 5/24/01 f./office/forms/tonackltr.doc Location: P7'i V[14VO Owner's Name: LIIWIAt.t_s Map/ParceL•_ -rl't 7 Address: LCL.► +/�al � � 0 Installer. Tel R New (stso) Repair t/ Date: � t _ "dZ WetlandsZL0-lone II — Soil SvmboI__4�LSoil Ram Soil Class Deep Observation Hole Logs Elevation Depth Soil Horizon Soil Texture Soil Color Soil hiottling %Gravel, Stones, etc; r Pvovoa Ipo-vo --� Z-04 G n ' 2, 5 Y 5/4 e-24 WA" NF F►,,,,u�.e rs-41 0MO hY WW& � r� Parent Material "It61+V! Depth to Bedroc@-fi_Cj�St=ding Nater in the Hole:�tiVeepinge from Pit Faee_� r/F!g ,(`%V; ,WWW -e 2„ 5Y jc+ Ito'v e, -;W ktoA V g - U. �Y Parent h42teri214V// Depth to Bedmck Standing Nater in the Holci " jVespin� from Pit Face �FSgG%Y; Date L'i"'2.� �2, Percolation Tests Obsei Deptl Start Time Time Time Time Rate Performed Bv:- �i, ` �} Witnessed By: