HomeMy WebLinkAboutCorrespondence - 171 FOREST STREET 10/16/1992 Town of North Andover, Massachusetts Form No..3
f tORTH BOARD OF HEALTH
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,SSACHUSEt� DISPOSAL WORKS CONSTRUCTION PERMIT .
Applicant �rl ilJ
NAME /� ADDRESS TELEPHONE
Site Location 4�� )q
Permission is hereby granted to Construct X1 or Repair ( ) an Individual Soil Absorption
Sewage Disposal System as shown on the Design Approval S.S. No.
CHAIRMAN,BOARD OF HEALTH
Fe PC D.W.C. No d
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m PLAN REVIEW CHECKLIST
ADDRESS �; ', ? ,^ � > ? .:�% ENGINEER
GENERAL
3 COPIES STAMP " LOCUS ,.,m '°' SCALE CONTOURS °
PROFILE SECTION BENCHMARK , ELEVATIONS '° ' SOIL
& PERC INFO Cw-°` WETS. DISCLAIMER " WELLS & WET DS
WATERSHED DISTRICT DRIVEWAY . -°"°.M WATER LINE µ DRAINS
RESERVE AREA t...., SCH40 °°°"". SLOPE
SEPTIC TANK{
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MIN 1500G. t�°"" . 17 INVERT DROP ,-, GARB. GRINDER ,) (+200% EDF)
251 TO CELLAR .�'' � MANHOLE TO GRADE ELEV - GW
D-BOX
# OUTLE'T'S ,.a FIRST 21 LEVEL STATEMENT INLET/ � '�!..."�.rv�
OUTLET// �,f(')= (2 r, OR . 17 FT)
LEACHING
1001 TO WETLANDS '�- ", ' 100' TO WELLS 325' TO SURFACE H2O SUPP""" -'
351 TO FND & INTRCPTR DRAINS °°°,rF' 4' TO S.H.GW a .°°°' 2% SLOPE
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41 PERM. SOIL BELOW FACILITY � ( �
MIN 12" COVER �- -' FILL. (251 if
above natural elevation; 101if below)
TRENCHES
MIN 660 2 SLOPE (min . 005 or 611/10011 )4,Z >3 ' COVER? VENT
SIDEWALL DIST. 2X EFF. W OR D (MIN 61 ) x,, 1111' IS RESERVE BETWEEN
TRENCHES? IN FILLS MUST BE 10' MIN.
BOT ��",;; ��� X LDNG + SIDE X LDNG '�
= TOT
(L x W' x #) (G/ft ) (DxLx2x#) ��!`
DATE �( `�' `� Z .
Sheet of
BOARD OF HEALTH
TOWN OF NORTH ANDOVER
// SUBSURFACE DISPOSAL DESIGN REVIEW
,,
FEE `C0 PERMIT # DATE RECEIVED
APPLICANT " ASSESSOR'S MAP
ADDRESS PARCEL #
LOT # - 4 �7- -
ENGINEER STREET
ADDRESS
PLAN DATE REVISION DATE
CONDITIONS OF APPROVAL:
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DATE'` r ' =, r Sheet
Of
BOARD OF' 11EALTI1
TOWN]' OF NORTH ANDOVER
SUBSURFACE DISPOSAL DESIGN REVIEW
PERMIT
DATE RECEIVED
APPLICANTS )P ,� ASSESSOR'S MAP
ADDRESS PARCEL $�
LOT
ENGINEER
STREET
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ADDRESS
PLAN DATE
REVISION DATE
CONDITIONS OF APPROVAL:
APPROVED
DISAPPROVED
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FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance with any applicable or requirements.
*******,^*********************APPLICA-IT fILLS OUT THIS SECTION'"**********************
APPLICANT k I () A r r" PHONE „
LOCATION: Assessor's Map Number
(� L Iq PARCEL (� '
SUBDIVISION LOT (S)
STREET f`V ��,5-� ST. NUMBER I y
* ********* ******* ******************OFFICIAL USE
RECOMMENDATIONS OF TOWN AGENTS:
CONSERVATION ADMINISTRATOR DATE APPROVED
DATE REJECTED
COMMENTS
TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS
FOOD INS P TOR-HEALTH DATE APPROVED
DATE REJECTED
T
CJ PECTOR-HEALTH DATE APPROVED =� 7
DATE REJECTED
COMMENTS — _L —
PUBLIC WORKS - SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING 4NSPECTOR DATE
Revised 9197 jm
FORM U
TOWN OF NORTH ANDOVER
LOT RELEASE FORM
SUBDIVISION
ASSESSORS MAP
SUBDIVISION LOT(S) �f}
PERMANENT ADDRESS (ASSIGNED BY D.P.W. )
STREET
APPLICANT 11111`1//frr7 IL rp 2 2 2� PHONE f,Z
DATE OF APPLICATION 30 /f 7 Z
TOWN USE BELOW THIS LINE
PLAN IN BOARD
�Aa:�� -C� -A=== uniE APPROVED 47
TOWN-PLANNER DATE REJECTED
CONSERVAT ON COMMIS ION
DA'T'E APPROVED
CONS ER ATION M DATE REJECTED
BOARD OF HEALTH
DnTF nPPRUVBI)
HEALTH SANITARlA DATE REJECTED
DEPARTMENT OF PUBLIC WORKS
DRIVEWAY PERMIT C.2 C�- ���`fz
SEWER/WATER CONNECTIONS ;UQ i-6-e-mzr/ 9t 4 n (D ,J l� z.9hi
FIRE DEPT.
RECEIVED BY BUILDING INSPECTION
DATE
This form shall be signed by the agents of the Planning and Ilealtl► Itoards,
the Conservation Commission prior to the issuance of any bulldiiig pernnits
for the subject lot. This form sl►all not releive the applicant from the
compliance of any applicable Town requirement or Bylaw.
NUMIXER FEE
a THE COMMONWEALTH OF MASSACHUSETTS —$-25 -0-0
.......TOWN.. of .. NORTH-.-ANDOVER................................
This is to Certify that :...... ...........Lc3ROcque...Vile.11.s..........................................................
NAME
244A Haven Stree.t, Reading, MA 01867 ...........................
...... ......
ADDRESS
IS HEREBY GRANTED_A LICENSE
For
Well Drilling Permit 25A Forest Street .....
This license is granted in conformity.with the Statutes and o� i aplees relating thereto, an(]
expires---Decemher...31-,:...1.9-92 ....... ess sooner st nded ed.
........
.. ...........
{ ................JULY..R.,..............<......19.....92 n.ria�: � ........ .
............... .......................................
FORM 433 HOBBS 8 WARREN, INC.
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DATE Sheet of
BOARD OF HEALTH
TOWN OF NORTH ANDOVER
SUBSURFACE DISPOSAL DESIGN REVIEW
FEE PERMIT # DATE RECEIVED
APPLICANT ASSESSOR'S MAP
ADDRESS PARCEL #
LOT #
( STREET
ENGINEER
ADDRESS
PLAN DATE REVISION DATE A;- `Z.
CONDITIONS OF APPROVAL:
APPROVED
DISAPPROVED X
To
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l/ l✓ �� BOARD OF III�ALTH
Town of .North Andover ,Mass .
Permit ## Date :'?19
APPLICATION FOR WELL & PUMP PERMIT
Application is hereby made for permit to drill a well (il) . Application is
made to install (—) a pump system'. —
Location : Address j Lot #f
Owner �>L ' Q 7Z Address��� f t�.�r 3T J— Tel .
Well Contractor S,�!�/- _� z�� n Address Tel . �
Pump Contractor Address /Yli9 Tel . •
WELL CONTRACTOR ,(To be completed at Lime of purnp test )
�P/LC Ecd.
Type of Well i r46 Well used for
-Diameter of Well Size of. Casing '
Depth of Bed Rock Depth casing into Bed Rock
Was Seal Tested? Yes (—) No (—) Date. of Testing
Depth ••of )ell — Well Ended in W.ha.C. Material
Depth to Water_ Delivers Gals . Per Min . for 4 hour,
Drawdown feet after pumping hour, at P�
Date of Completion
Signature We Contractor
PUMP INSTALLER (To be'• filled in, before i.nst<�1).ation ) r
Size & Name Pump Type Used
Water Pump Delivers GPM Size of Tank
Pipe Material Used in Well : Cast Iron (—) Cn ).vnni.7.ed (—) Plastic ( j
(Jell Pit (_) or Pitless .Adapter ( )
Was sleeve used Co protect pipe? Yes (—) NO(_) 'Type or Name Well Seal
Date '
�4i'r�1>1iF�4 �Yi4�4i4t4iM�rririlri4ir���'r�Yi4�'rt4�'rtYi';try'ri4lri'r�ri4irri4i�ri'r ti4i'r�';i'r�'ri'rY454)'; ntiC
Date Water analysis r'epdr-t• submitted to I'�onrd of i>cal't:h
Date release given tD owner of record & Bj.dg . Insp
Health Inspector
WELL DATABASE
ADDRESS: / �� �� 7"" — 2 6"'A"
AGE OF WELL: S t .�t� WELL DRILLER.
WELL PERMT 9: WELL LOCATION: ,
WELL PERMIT DATE: 5 �° DEPTH OF WELL- t l'1 a �,�,,,/i�•,�
TYPE OF WELL: a.. DRILLED b. DUG c. UNK'r1OWN
TYPE OF WATER BEARING,ROCKI.,
WATER ANALYSIS DATE: �' ` `� HIGH MANGANESE: Y N
HIGH IRON: Y N OTTER.CONTANIITiANTS: N
WELL DATABASE"
ADDRESS: / c ', �'"c v'� _.�-•,'� ✓
AGE OF WELL: WELL DRILLER:
WELL PERMIT#: WELL L4CATION: .y ,,� 1 S '•� Gl4c `�^ "Z 2f,
WELL PERMIT DATE: DEPTH OF WELL:
TYPE OF WELL: a.. DRILL'FD b. DIJG c. UNKNO WN
TYPE OF WATER BEARING ROw :
WATER ANALYSIS DATE: HIGH MANGANESE: Y N
HIGH IRON: Y N OTHER CONTAMINANTS: !Y N
Biomarine
16 EAST MAIN STREET, P,O. BOX 1153, GLOUCESTER, MASS,01930
TELEPHONE: (508)281.0222 FAX: (508)283.3374
0 Certificate i
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La Rocque Well Report No.: 28301
244 Haven Street July 28, 1992
Reading, MA 01867
Re: Well Water Analysis
Sample Description: Samples of water identified as Barletta, Lot 25,Andover.
Sampling: Samples delivered by Steve Murray of Northeast Environmental on
July 22, 1992.
Findings:
Results Guideline
Total Coliform Bacterial Count per 100 mL . . . . . . 0 0
pH Value . . . . . 6.39 Slightly Acidic
Hardness (as CaCO3, mg/L) . . . . . . . . . . . 93.2 Moderate
Sodium Content (mg/L) . . . . . 29.1 20
Chloride Content (mg/L) . . . . . . . . . . . . . 55.5 250
Iron Content (mg/L) . . . . . . . . . . . . . 0.10 0.3
Manganese Content (mg/L) . . . . . . . . . . . . 0.02 0.05
Nitrate Nitrogen Content (mg/L) . . . . . . . . . . 2.5 10
Nitrite Nitrogen Content (mg/L) . . . . . . . . . . <0.02 1.0
Copper Content (mg/L) . . . . . . . . . . . . . . <0.02 1.3
Methods: Standard Methods for the Examination of Water & Wastewater, 17th
Edition, 1989. *Guidelines are based on the recommended maximum levels of the Mass
Department of Environmental Protection Agency's 310 CMR 22.00, "Drinking Water
Regulations".
Remarks: Although the Sodium content detected exceeds the recommended level, 20-50
mg/L is considered tolerable for people who are not on strict salt-restricted diets.
Filtration is available to correct this level.
LaL
Jahn Marlet#a
Lab Director
J M/d n
Mass. Certified Labs MA026 and MA123
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MO SENDER: I also wish' to receive the
°w • Complete items 1 and/or 2 for additional services.
W ® Complete items 3,and 4a&b, following sere/Ices (for an extra
u) • Print your name and address on the reverse of this form so that we can fee):
® return this card to you.
> t
gt d Attach this form to the front of the mailpiece,or on the back if space 1. El Address u
does not permit:
® write'Return Receipt Requested"on the mailpiece below the article number. 2. ❑ Restricted Delivery
The Return Receipt will show to whom the article was delivered and the date
delivered. Consult postmaster for fee.
3. Article Addressed to: 4a. Article Number
P 371 830 462
1 e
Nir.. Willi-am Boil r e Ct 4b. Service Type
El Registered El Insured
0 171 Wereot Street
0 M Certified ❑ COD
0 North Andover, i�3A 01-345 Return Receipt for
W ❑ Express Mail ❑ p
tm Merchandise
7. Date of De 1v ry
5. Signature;(Addressee) 8. Addressee's Address(Only if requested
and fee is paid)
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6. Si natures( eni
> PS Form-3811, December 1991 irU.S.GP0:1®®3-352-714 DOMESTIC RETURN RECEIPT