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Home My WebLink AboutBuilding Permit #Exception - 115 CRICKET LANE 5/1/2018 BUILDING PERMIT °f No DTH TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION v Permit NO: Date Received �SSgcHuSEt Date Issued: IMPORTANT Applicant must complete all items on this page 41 �— tdr �� . J .T f R - � b a k Sm WE- 11 IA F/tF OEI� ON1,,,4Q- TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ I)lew Building rf One family Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ,�°ate�� t � W - } DESCRIPTION OF WORK TO BE PREFORMED: C I ase or Print clearly) OWNER: Name: IYY�`O t� Phone: 978-GS b Address: � ��c�fl� �2 �Yl q- O 1 S►� ru t a ce ', p�rso�san Via+ I»��15@ {{ p v ��"T " ARCHITECT/ENGINEERPhone: Address: oo' � ,e/l AI e J S Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $_ / F� d o d FEE: $ Check No.: Receipt No.: NOTE: Persons contracts ith unregistered.contractors do not have access to th aranty fu d igr ature i fp r tl 3 finer t Sinature:afi contjrip Ir Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS TE REJECTED DATE APPROVED CONSERVATI s COMMENTS WUft DATE REJECTED DAT OVE HEALTH ❑ COMMEN/T�S CV 4 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature&Date Driveway Permit Located at 384 Osgood Street � 'ART1 = et ,p Qum ' 3Ste1"ion Si#� jtS777777, locr1�# 24IiSfret� 7 _ Ieaaam, tga#urs/tlae' , ,0 xry d x .. � COMMENTS .. : t Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use �e 9 c P, -� i ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 J Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit. Addition Or Decks tea—Building Permit Application Certified Surveyed Plot Plan . Workers Comp Affidavit E'veL C ,,P, Photo Copy of H.I.C. And C.S.L. Licenses ,a Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE; All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 T - ,OS 93' 6� LOT #2 �2 0 0 JS "jh ►� �+.� II Z PROPOSED a, •�0� Q irk ADDITION o bb-�j9 J N 16'x22' a, co 11¢,8T %K ' A) F- 11 Y o U 40 V h�W v LOT 93 1 AREA=47 782 S.F. m y i i =1.0969 AC. �J � 55.o _ Mh• LOT #4 1 6� •�cS. PLAN OF LAND SHOWING PROPOSED HOUSE ADDITION LOT #3 CRICKET LANE r IN NORTH ANDOVER, MASSACHUSETTS N DRAWN FOR O'BRIEN CONSTRUCTION 0 1�� 203 NORTH STREET o STONEHAM, MASS. 02180 d 40 020 40 d M n SCALE: 1"=40' DATE: JULY 24, 2007 3 MEP"ACK ENGINEERING SERVICES d 7/24/07 II66 PARK STREET i STEPHEN E. STAP SKI, R.L.S. DATE ANDOVER MASSACHUSETTS 01810 r Town of North Andover NORTH , OFFICE OF 3�° s„�o �� COMMUNITY DEVELOPMENT AND SERVICES 0 9 x s 27 Charles Street WILLIAM J. SCOTT North Andover, Massachusetts 01845 sACNus��y Director (978)688-9531 Fax (978)688-9542 i i I March 25, 1999 i Les Godin Merrimack Engineering 66 Park Street Andover, MA 01810 Re: Lots 1-10 Cricket Lane, North Andover Dear Sir: This letter will serve as your notification that the proposed septic plans for the lots specified above have been approved for dwellings with a maximum of nine (9) rooms. If you have any questions, please do not hesitate to contact this office. Very truly yours, 44C Sandra Starr, Administrator SS/gb cc: Copley Development BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Mar-23-99 10:25A Paul D_ Turbide, PE/PLS 508-465-0313 P_02 March 22, 1999 Sandra Starr North Andover Board of Health Administrator Office of Community Development and Services 30 School St. North Andover,MA 01845 RE: Title V review for Lot 3 Cricket Lane Dear Sandra, I find that all the concerns outlined in my report of February 9, 1999 have been addressed except the following: • 310 CMR 247(2)states that for a minimum of 2"of 1/8 to 112.inch stone is to be placed on the top of the leaching bed. The plan design calls for a layer of filter fabric to be laid on top this stone. There is no regulation that I could find that allows filter fabric to be laid over the peastone, and therefore I would recommend that the filter fabric be removed from the design. If you have any questions or comments please feel free to contact me. Sincerely Carlton rown,PE/PLS PORT INGINFIRIE Civil Engineers& Land Surveyors One Harris Slreel Newburyporl,AIA 01950 (978)465-8594 Feb-09-99 1O: 15A Paul D. Turbide, PE/PLS 508-465-0313 P.O6 February 9, 1999 Sandra Stir North Andover Board of Health A- rninistrator Office of Cor—n-nunity Development and Se:rices 30 .School St. Noruh Andover,?YYA 0184.57 RE_ Title V review for Lot 3 Cricket Lane Dear Sandra, Enclosed find the"Checklist for North Andover Septic System Plans" for the above- mentioned site. The following is a list of all the `Problem' areas and deficiencies Port Enginee^ng has fo,-and. t Cl 2 l that f - - m E' » t 8 1/2 2 L t- �► i �,tvie�cw7(2�:dates hist ac7� a rilitlii[ur� i 2 of i��iii i2 irtGti SiCti��i�tli placed on the top of the leaching bed. The plan design tails for a layer of filter fabric to be laid on top this stone. There is no regulation that i could fund that allows filter fabric to be laid over the peastone, and therefore I would recommend that the filter fabric be removed from the design. • The septic tank detail should show that the inlet tee is to extend a minimum of 10 inches below the flaw line(227(6)), and that there is to be a 3-inch air space above the inlet and outlet tees(22701). • Note 13 states that bench narks are to be placed aced within 75 feet of the disposal area Before col su- ction. A condition Cif approval of this design should be ihat the benchunark will be set as noted. • The high water alarm for the pump chamber must be located in the house. 231(9) • The fill required around the system encroaches onto the abutting lot(Lot 4). There should be a slope easement around this encroaching fill. (255(2)). • The trenches are proposed to be stepped, The slope of the pipe connecting the d- box and the two lower trenches will be more than 11%. Note that'310 CIS 15.232(lXa) states that if the slope of the pipe leading to the d-box is snore than 8% then there should be a baffle to dissi ate the velocity oaf the effluent running into the p y -1L___ 1!_____P---:___t _ _ _ at_....1_-�_ _L IA L_ _ __1__:._ U- A. my pruiraibruna.upiiuuil is butt uttie b—houiu ue a Velmity-l-educei ,fi`;aed at the high end of the two lower trenches(i ne velocity-reducer could be another d-box and baffle, one d-box for each of the lower two trenches). DOPYT If you have any questions or comments please feel free to contact me. INGI 11811/11 Sincerely iy[[n Carlton A. Brown, PE/PLS Civil Eni;ir.rzrs$: Land Surveyors i Newburyport,MA 01950 (978)465-85914 eS .P.M 1013`+ 1,3 ( i �� ' T,1),H. 30 6-R, 1.= 10,3'.} 1,0' 12. i i .T'.p:l-f. 14o 6-P.M. = 10,3'+-3. i ` = 13.x{' r.p. l.{ - LE40-SERIES TECHNICAL SPECIFICATIONS PUMP IMPELLER The pump(s) shall be model The pump shall have a VORTEX style as manufactured by Liberty Pumps, Bergen, NY, impeller capable of passing a minimum or equal. 2" spherical solid. The pump(s)shall have a capacity of GPM at SEAL a total dynamic head of feet. Motor size shall be 4/10 horsepower, single phase, 60 hz. and 115 The shaft seal shall be of the carbon/ceramic volt operation. unitized design, with BUNA N elastomers and MOTOR stainless housings.The pump motor shall be of the submersible VERNAL CONSTRUCTION type,oil filled, hermetically sealed and shall be The pump volute, legs and motor housing thermally protected.The overload element shall shall be heavy gray iron castings, class 25 or automatically reset when motor cools. better.All castings shall be enamel coated before Motor windings shall be of the class B insulation assembly.All fasteners shall be of 300-series rating.The rotor shaft shall be made of 416 stain- stainless steel or brass. less steel and shall be supported by lower bronze LEVEL CONTROL and upper sleeve bearings. The pump shall be controlled by an adjustable, The power cord shall be of the quick-disconnect mercury-free, wide angle float switch. Float cord design allowing replacement of the cord without shall be equipped with a series plug for manual breaking seals to the motor and/or oil chamber. by-pass operation. MODELS HP VOLTS PHASE AMPS DISCHARGE AUTOMATIC IMPELLER LE41 M 4/10 115 1 13 2" FNPT NO VORTEX LE41A 4/10 115 1 13 2" FNPT YES VORTEX 10'cord standard on above models. For 20'option,add a"-2"suffix to model number.Example:LE41 A-2 DIMENSIONAL DATA: PERFORMANCE CURVE 1550 RPM Weight:LE41 M:39 LBS. 24 Height:13.25" s 20 Major Width:10.75"(manual models) CDc 16 ca a :o Maximum fluid temperature 140 degrees F. (D 12 = L r --. 8 >p 6-P, T.A.N ~ 2 z 4 PMA ° 10 20 30 40 50 60 70 80 OCertified U.S.Gallons Per Minute i i I I _.� City of LA certification available r�wesn 0 1.4 2!8 4.2 5.6 ri Liters Per Second Liberty Pumps• 7307 Lake Rd a Bergen,New York 14416•Phone(716)49.4-1817 Fax(716)494-1839 7291-2/93 l Town of North Andover E NORTN OFFICE OF o�t °oma COMMUNITY DEVELOPMENT AND SERVICES p At • 27 Charles Street North Andover, Massachusetts 01845 -is 4°^,rE° "1 t WILLIAM J. SCOTT ScU Director (978)688-9531 Fax(978)688-9542 February 25, 1999 Les Godin Merrimack Engineering 66 Park Street Andover, MA 01810 RE: Lots 1-10 Cricket Lane Dear Mr. Godin: This is to inform you that the plans for the septic systems proposed for the subdivision of Walnut Ridge have been disapproved for the following reasons: • The septic tank detail does not show the inlet tee extending a minimum of 10 inches below the flow line, nor that there needs to be a 3 inch space above the tees. (3 10 CMR 15.227(6)and 15.227(4)). • There are no benchmarks shown within 75 feet of the septic systems. (3 10 CMR 15.220(q)). In addition, for Lot 1: • Abutters' names are not shown. (NA 8.02j) • Design specifications for the proposed retaining wall are missing. (310 CMR 15.255(2)). For Lot 3: • The high water alarm for the pump chamber is not specified as to be located in the house. (310 CMR 15.231(9)) • Slope easement is required from Lot 4. (310 CMR 15.255(2)) • The slope of the two lower trenches will be in excess of 8% and at minimum a baffle is required to decrease the velocity. (3 10 CMR 15.232(3)(a)) Please consider a velocity reducer at the high end of the two lower trenches. i BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 A!50 Lot 4: • Please note that the septic tank is drafted incorrectly. Lot 5 and Lot 6: • Scale of the Plan view is not shown. Lot 7: • The scale of the Plan view is not shown. • Pump Note#4 neglects to state that the high water alarm is to be located in the house. (310 CMR 15.231(9)). Lot 8: • The estimated seasonal high water elevation-has not been adjusted to the highest existing grade. This results in the leaching area being less than 4 feet to groundwater. (3 10 CMR 15.212 a&b). Lot 9: • Slope easement required from Lot 10. (310 CMR 15.255(2)) • Slope to d-box exceeds 8%, therefore, at minimum, a baffle is required. (310 CMR 15.232(3)(a)) Lot 10: • Fill around system runs to property line of abutter. Toe of slope required to be 5 feet off the lot line. (310 CMR 15.255(2)) • Trenches #1 and#1 do not show 4 foot separation to groundwater. (3 10 CMR 15.212 a& b). Please feel free to call the Health Office with any questions you may have. Sincerely, /` Sandra Starr, R.S. Health Administrator Cc: W. Scott File FORM 11 - SOIL EVALUATOR FORM Page 1 No. ...................................... j0 Commonwealth of Massachusetts BOA�-' F Fi�ALTH I•I OTH AwwvER , Massachusettsok Usessmen2 619 _..--_- . . t o - i e e Performed By: ....lhl.. :LL.,iAm.......Du.mms!. �................ Witnessed By: .:::. H.11:�. .A:.:::..STS. R ......................................................................................................... tomtwn Addrcal or Ova m's t Ou'a Name. eOrLre'( L&I CFS LsF�T LA uE A&d M.and 3 Tekobm Sb C'oF'C '-( D -!I� t�ErNv�ti , MA . o��+.ly New Construction Repair ❑ Office Review Published Soil Survey Available: No ❑ Yes Year Published ...1.Q.8-)- Publication Scale .1.`:.1570�...i0 Soil Map Unit C'.b.c—A Drainage Class .....�....... Soil Limitations ......M.o.. PRT ....................................................... . Surficial Geologic Report Available: No ❑ Yes ❑ Year Published ....... Publication Scale Geologic Material (Map Unit) 777777 ............................................................................................. .. Landform _. ....................................................................................................................._...................... ... ............................................ 1 Flood Insurance Rate Map: 2Sbvet6 06-V60L 'k A Y Above 500 year flood boundary No ElYes E�( Within 500 year flood boundary No Yes ❑ With Y Within 100 year flood boundary No Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) ........�J11.1......5.►.7�.....D�!uE Tio.t ,1................ Wetlands Conservancy Program Map (map unit).................................................................................................... Current Water Resource Conditions (USGS): Month Au-6u Range : Above Normal ❑ plormal I Below Normal ❑ aSSU MEp . Other References Reviewed: V.5,. 6,,.< ; MAPS FORM It - SOIL EVALUATOR FORM Page 2 On-site- Review Deep Hole Number 10.o-U-0 Date:9:4-L-113 Time:.P#.M...., Weather Location (identify on site plan) . ........ ...... ................................................ Land Use Slope M ... a.. Surface Stones ....H.A.1-1-Y. ....................................................... Vegetation ....W-0 D.9.FZ.................................................................................................................................................................................................. LandformNO-VA1.14e............................................................................................................................................................................................... Positionon landscape (sketch.on the back) .......:........................................................................................................................................ Distances from: Open Water Body .......10 -fleet Drainage way I-00.± feet Possible Wet Area 106t feet Property Una .....1.Q..+. feet Drinking Water Well .1-0.0-t feet Other ......................................... DEEP OBSERVATION HOLE LOG Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other (inches) (USDA) IMunsell) (Structure,Stones,Boulders,Consistency, %Gravel) L Lill- F, I IN V-0 6, A i0q ZZ 10 ("ftw' met r (aLci it, %;) & 4 F, I b.�q P.SIZ 6-1q 7.5*\4(1&-1 4V Ll e" Parent Material (geologic) ... ......rj..4...L....................................................... Depth to Bedrock: .... ........... penth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: 411..... Estimated Seasonal High Ground Water: FORM 11 - SOIL EVALUATOR FORM Page 3 Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole _inches ❑ D pth weeping from side of observation hole inches Depth to soil mottlesinches ❑ Ground water adjustment feet Index Well Number . Reading Date ................... Index well level ................... Adjustment factor - Adjusted ground water level .............—............................. Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? A If not, what is the depth of naturally occurring pervious material? Certification I certify that on f` �—`� (date) I have passed the examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature t;L? Date l`'�$ FORM 12 - PERCOLATION TEST COMMONWEALTH OF MASSACHUSETTS WoiZTFt AUWVa. , Massachusetts Percolation Test Date: ... -..1.G..-`3.`7... Time: ..... .................. Observation Hole # Depth of Perc r� Liv Start Pre-soak ' : T7 j ' 30 End Pre-soak y S I ' LI 14 �E Time at 12" �1 Time at 9" t ; Time at 6" Time (9"-6") 22r)1A. H i Rate Min./inch 0 r?I>`r Site Passed Failed ❑ ........ .......... . ......................................................................................................................... Performed By: U� Ca 11`1 Witnessed By: SU S R 1�1 G iZD Comments: ................................................................................. FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. ***** ***APPLICANT FILLS OUT THIS SECTION****-*-****-***-****** APPLICANT k/aAvc, LL C PHONE972,--r1,7,�1'6'ZS7 LOCATION: Assessor's Map Number PARCEL _ SUBDIVISION WGa �N a �� LOT (S) STREET i c ke, L a/, e ST. NUMBER ********** ********OFFICIAL USE ONLY**********************� RECOMMENDATIONS OF-TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER - DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED S IN. OR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS -SEWER/WATER CONNECTIONS off' l� 1 -2�- DRIVEWAY PERMIT FIRE DEPARTMENT G n-� c'1 'D' RECEIVED BY BUILDING INSPECTOR DATE VA TH '9 Town of Q I' Yc 6 over No. log' . o. do ver Mass. O LA COCMICME WICK ORATEDpP� 5 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System W �IN v "� 91.4're �K BUILDING INSPECTOR THIS CERTIFIES THAT... ........................................... .............. ��'� Foundation,/" SIChAef as permission to erect...........�........................ buildings on. .�............................c.....................,.......... Rough I � t0 be OCCU 18�' S .....Poe&" ...3tA &4** �....�..S��II..v........��........................ Chimney provided tha' tie person accepting this perk shall in everyrespect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. h �.S F' PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO STABWS .. 00 ugh 00 .................. .................................................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECT�O , Display in a Conspicuous Place on the Premises — Do Not Remove No Lathing or Dry Wall To Be Done FIRE EPARTMENT Until Inspected and Approved by the Building Inspector. Burner - Street No. SEE REVERSE SIDE smoke Det. SEPTIC PLAN SUBMITTAL FOR dr LOCATION: I-e6-F S 1-kAWa(_A4v i V-1b6F_ gva)) NEW PLANS: �� $125.00/Plan -REVISED PLANS: YES $ 60.00/Plan \\ I SITE EVALUATION FORMS INCLUDED: YES NO C09 Ficw-J DATE: DESIGN ENGINEER: DATE TO CONSULTANT: o� _q 'f� *If you want ourPI sex edited, please submit four Tans and included a stampeded , envelope with the correct amount of postage to mail plans to Port Engineering. When the submission is all in place, route to the Health Secretary. SEPTIC PLAN SUBMITTAL FORM LOCATION: NEW PLANS: YES $125.00/Plan REVISED PLANS: YES $ 60.00/Plan SITE EVALUATION FORMS INCLUDED: YES DATE: DESIGN ENGINEER: 9;,,:7JrZ) DATE TO CONSULTANT: *If you want your plans expedited, please submit four plans and included a stamped envelope with the correct amount of postage to mail plans to Port Engineering. When the submission is all in place, route to the Health Secretary. Town of North Andover, Massachusetts Form No.2 Of pOR7q, BOARD OF HEALTH 00 0 19P DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant___( L��'G.c'y �-TY T.P�/$% Test No. Site Location //) ecs. / /"lam Reference Plans and S 1�i'.�L'� p ENGINEER DESIGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. CHAIRMAN,BOARD OF HEALTH : Fee Site System Permit No. /� � - 24 INVERT .ELEVATIONS BUILDING TIES 4" PIPE @ FDTN. = 198.45 BUILDING CORNER ; A B SEPTIC TANK IN = 198.08 SEPTIC TANK 22.8' 30.8' SEPTIC TANK OUT = 197.99 PUMP TANK 33.0 21 .5' PUMP TANK IN = 197.95 DIST. BOX 63.5' 49.0' PUMP TANK OUT = 198.14 CORN. LEACH FIELD 1 47.3 67.3 DIST. BOX IN = 204.2 CORN. LEACH FIELD #2 60.0' 70.0' DIST. BOX OUT = 204.10 CORN. LEACH FIELD #3 74.2' 77.0' END LEACH LINE #1 = 200.94 END LEACH LINE #2 = 202.46 END LEACH LINE #3 = 203.94 BENCHMARK X—CUT BOLT@ TOP FLANGE HYDRANT U.S.G.S., M.S.L. I EL=200.60(N.G.V.D) `C15 N 80.793 Cls 9 08'' Z cn I �S ' N Ui 9 WDGE OF V �' ' "EiNEATED � cn (O WETLANDS c19 C20 >4 G o . ur:; J G W n VW O APPROX. WATER SERNCE DRAINAGE !L v N ti AN ACCESS 07D V rn J O EASEMENT ( '� 3 C21 c'O N m ' " -BOX O O L N 1 C22 ( J m o T ��•/� M 97. ` �r SS earn ---. ' -3 .,SS "� w,� Z0.S9 N �o AS—BUILT NOTE: THIS PLAN & CERTIFICATION IS NOT OF � A WARRANTY OF THE SUBSURFACE DISPOSAL SYST - IT IS AOF THE SUBSURFACE DISPOSAL SYSTEM AND ELEVATION OF THEDEXXISTING SYYSTEM LOCATION Q LOCATED IN COMPONENTS. r NORTH ANDOVER, MA. 4 , AS PREPARED FOR : 1:N Commonwealth of Massachusetts f City/Town of North Andover System Pumping Record Form 4 ' M DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important:When filling out forms 1. System Location: on the computer, it S cp�"�l(_ t+ t-`r� use only the tab � key to move your Address cursor-do not North Andover use the return key. City/Town State Zip Code 2. System Owner: fA Name eyen Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of PumpingD, ^sl t 2. Quantity Pumped: Gallons 3. Component: ❑ Cesspool(s) R Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Observed c-ndition of component pumped: 6. sem mped By: e Vehicle License Number Stewarts Septic 58 So Kimball St Bradford Ma Company 7. Location where contents were disposed: 20 so mill st bradford ma �A !_t Si re of Hauler Date Signature of Receiving Facility(or attach facility receipt) Date t5form4.doc•11/12 System Pumping Record•Page 1 of 1