HomeMy WebLinkAboutMiscellaneous - 108 WINDKIST FARM ROAD 4/30/2018 (2)MAP # J LOT # D/
PARCEL # STREET
CONSTRUCTION APPROVAL
HAS PLAN REVIEW FEE BEEN PAID l )cj� NO
PLAN APPROVAL: DATE APP. BY
DESIGNER: _%e!a"�1x�s PLAN DATE '- -
CONDITIONS 71z).q
WAFER SUPPLY TOWN WELL
I. \
WELL PERMIT_
WELL TESTS
It I
PLUMBING SIGNOFF
COMMENTS:
4.
f
DRILLER
CHE L DATE APPROVED
BACTERIA I DATE APPROVED
BACTERIA II DATE APPROVED
WIRING SIGNOFF
FORM U APPROVAL: APPROVAL TO SUE =YES NO
311 �s
DATE ISSUED gy
CONDITIONS:
FINAL APPROVAL:
ALL PERMITS PAID YES NO
WELL CONSTRUCTION APPROVAL YES NO
SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO
OTHER YES NO
ANY VARIANCE NEEDED YES NO
FINAL BOARD OF HEALTH APPROVAL: DATE: By:
SEPTIC SYSTEM INSTALLATION
IS THE INSTALLER LICENSED? YES NO
TYPE OF CONSTRUCTION: y NEW REPAIR
NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW NO
CONDITIONS OF APPROVAL YES NO
( FROM FORM U)
ISSUANCE OF DWC PERMIT YES NO
DWC PERMIT PAID? YES NO
DWC PERMIT NO. "7 INSTALLER: :Dpvc--141) g
BEGIN INSPECTION(
YES 0:
EXCAVATION INSPECTION: NEEDED:
PASSED BY
CTION INSPECTION: NEEDED:
AS BUILT PLAN SATISFACTORY:
\�._-
APPROVAL fiO BACKFILL:
FINAL GRADING APPROVAL:
DATE: jp,. j y qy BY
DATE �% 0� BY
FINAL CONSTRUCTION APPROVAL:
DATE: BY ,✓'�.
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SSACHUSEt
Town of North Andover, Massachusetts
BOARD OF HEALTH
r
DESIGN APPROVAL FOR
SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
Form No. 2
Applicant_
06 Ga
/i GG— Test No.
Site Location
_,�617'-
Il ly�iU�X/s/'
Reference Plans and Specs.
ENGINEER
Permission is granted for an individual soil absorption sewage disposal system to be installed
in accordance with regulations of Board of Health.
Fee A,/ 0
CHAIRMAN, BOARD OF HEALTH
Site System Permit No. 9 11
4
AS -BUILT O ECKLAST
TOWN OF NORTH
BOARD OF HEALi ; l
J Mas
J
a
LOT NUMBER, STREET NAME
•V/
`�
ASSESSORS MAP & PARCEL NUMBEf
LOT LINES & LOCATION OF DWELLINGS
I/
LOCATION & DEMENSIONS OF SYSTEM,
INCLUDING RESERVE
V/
TIES TO LAT LINES & DWELLING, WELLS
�a. FROM SEPTIC TANK
—b. FROM LEACH AREA '
PGAns Dsv�
�1�0
LOCATIONS OF DEEP HOLES & PERC
g y OPCS
TESTS
t/
ELEVATIONS OF DISPOSAL SYSTEM
V
TOP OF FDN ELEVATION
LOCATIONS OF WELLS, DRAINS, WATERCOURSES
WAN 1 S0' OF SYSTEM
/
✓.
LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE
✓
DISTANCES FROM CORNERS OF HOUSE TO CENTER OF
TANK & D -BOX
STAMP & SIGNATURE
IMPERVIOUS AREAS - DRIVEWAYS, ETC.
*�V lS�t�l� INSp
✓
l?vrca-,�i-eT�D ¢
NORTH ARROW
Ti14SiW,vF-'y
FINAL CONTOURS
I of FAN.
LOCATION & ELEVATION OF BENCHMARK USED
LlAt LOCUS PLAN
t`��1.4n��
a
APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT
DATE: CURRENT INSTALLER'S LICENSE#�
LOCATION: oC0 ,�lc �� •� ,/�i i,�
LICENSED INSTALLER:
SIGNATURE:1G _.--r ;
CHECK ONE:
REPAIR:
TELEPHONE# 1,05 r z2,f — V(--24
OF ^ 9s-y-'i�,075-
NEW CONSTRUCTION:y�
IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT.
$75.00 Fee Attached?
Foundation As -Built?
Administrative Use Only
Yes No
Yes L--' No
Floor Plans? Yes �' No
Approval ��� �/L, Date:
Town of North Andover, Massachusetts
BOARD OF HEALTH `�
19
-_DESIGN APPROVAL FOR
SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
Applicant Test No.
Site Location I I LUf ^ A V_t C
Reference Plans and Specs. I Ju., S �a./l&4gy- °i Q 7/
ENGINEER DESIGN DATE
Permission is granted for an individual soil absoprtion sewage disposal system to be installed in accordance
with regulations of the State and the Board of Health.
./'M T41�_�
BOARD OF HEALTH
Fee I ZS 0' Site System Permit No. '7 M_ q_
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No........................
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THE COMMONWEALTH OF MASS_ACI- L SETTS
BOARD OF HEALTH
O..W..✓......... Q .... .N.UR...jy...4N�a.U.V1.............................
Appli.rativit for Diupuutcl 10orltu Tumantruatt Frrutit
Application is hereby made for a Permit to Construct OQ or Repair ( ) an Individual Sewage Disposal
System at:
....................W l Nl7.... ...FI'i%1M__.l L?/ ...------......................-----------............. e-07—
.... ..................
Location - Addressor Lot No.
J0.1
.0 `.1. Itif'N..C'lK .ST.:.._ML.A./Y.1.U..VF.J ...........
Owner Address
.................................................................................................. .............. ••••............----................................................................
Installer Add""'
Type of Building Size Lot...6s%Q SLf._.Sq. feet
Dwelling — No. of Bedrooms.............4._.......... ................ ERpansion Attic ( ) Garbage Grinder ( )
Other — Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Otherfixtures ................................................•---...---..............................................................................._............••--
Design Flow..............5 ....................gallons per person per day. Total daily flow ......... _.......5-rSr................ gallons.
�
Septic Tank — Liquid capacity&W.galIons Length./D_-6.... Width..%. -q.... Diameter..._. .=.... Depth...5.-S5..
Disposal Trench —No. ...:�a . Width.......4........... Total Length..@3:�_:� Total leaching area ... 1,3 ..sq. ft.
Seepage Pit No ..................... Diameter.................... Depth below inlet..................... Total leaching area .................. sq. ft.
Other Distribution box (X) Dosing tank ( ) el , 6 �;Z3fj6
Percolation Test Results Performed by......SEtLG14... -A -�....... Date'.. ... 19 46......
Test Pit No. /q ..3Ominutes per inch Dept]Aof Test Pit �....f.Q.l..".. Depth to ground
Test Pit No. .. ....
37.•--, /?.minutes per inch Depth of Test Pit l,F r� Depth to ground water ....v?.7. .............
..................................................••-•---••-•-------•••••.................................-••-•--••......--•-•••••-••......................
Description of Soil......S Yt j 49.1.21 d................................................................................
.....................................................................................................••--•---••-•--••-•-•----•---...........•-•-----•--•.........-•••......_.............-----•-•--......
----•-•....................•-............-•••.......••••-•••--••••--:...............----•....---•-•---•--.......----------••••........................----------•------•-----------•----••••-••••••---.
Nature of Repairs or Alterations —Answer when applicable...............................................................................................
FORM 11 - SOIL EVALUATOR FORA
Page 2 of 3
Location Address or Lot No. `!V )161 1c{ st f--01vffl c — LAL / l
7C7 4- L On-site Review
Weather Z Z
Deep Hole Number Date: I �'� A1C^ Time:
Location (identify on site plan)
Land Use Slope (%? Surface Stones
Vegetation ,
Landform
Position on landscape (sketch on the back)
Distances from:
Open Water Body feet Drainage way feet
Possible Wet Area feet Property Line feet
Drinking Water Well feet Other
DEEP OBSERVATION HOLE _OG'
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface (Inches) (USDA) (Munsell) Mottling (Structure, Stones, Boulders, Consistency, %
Grave0_7
Parent Material (geologic) DepthtoBedrock:
Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face:
Estimated Seasonal High Ground Water:
iiDEP APPROVED FORM - 12/07/95
Location Address or Lot IJo. 'N � no �( St
On-site Review
' % "Z Weather �0 J �/i Z Z�.
Deep Hole NumberTr Date: f I(� "�(q� Time:
Location (identify on site plan)
Land' Use Slope (%) Surface Stones -
Vegetation
Landform
Position on landscape (sketch on the back) -
Distances from:
Open Water Body feet Drainage way feet
Possible Wet Area feet Property Line feet
Drinking Water Well feet Other,
DEEP OBSERVATION HOLELOG
Depth from
Soil Horizon
Soil Texture
(USDA)
Soil Color
(Munsell)
Soil
Mottling
Other
(Structure, Stones, Boulders, Consistency, %
Surface (Inches).
GraveV
s LMINIM11M75T-r=-
REQUIRED AT E ERY PROPOSED DISPOSAL ARE;V---
Parent Material (geologic) DepthtoBedrock:
Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face:
Estimated Seasonal High Ground Water:
iiDEP APPROVED FORM - 12/07195
TOWN OF NORTH ANDOVER
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
DATE OF COMPLIANCE:
1/14/99
This is to certify that
the individual subsurface disposal system
constructed ( X ) or repaired ( )
by Dave Maynard a North Andover Licensed Installer
at 108 Windkist Farm Road (Lot 11), North Andover, MA 01845
has been installed in accordance with the provisions of Title V of the State Sanitary Code
and with the North Andover Board of Health regulations as described in the Design
Approval Site System Permit #911 dated 4/4/97.
The Issuance of this certificate shall not be construed as a guarantee that the system will
function satisfactorily.
Board of Health Inspector
TOWN OF NORTH ANDOVER/
BOARD CO: *a, ,LTH
JAN - Q 1999
TOWN OF NORTH ANDOVER
SEWAGE DISPOSAL SYSTEM
INSTALLATION CERTIFICATION
The undersigasd busby certify that the Sewage Disposal Syatem )
(�ceoaoucted; t
c ,
wad balled in coaftnmft witb the N%wRh Andover Hoard of Health approved Plan, Sy*=
DesipPeatadt 01 , dated wilt as appmoved design flour of 4+7
gallams Im 40Y. 71141 mst ri01s used were M 00600 me with those speed an the approved
VIM; the system Was.iaM20d in accordance with the provisions of 310 CMR 13.000, Thk S and
10001 regukdOu , and rite 11a01 grading agrees 509000ally with the approvod per. All work is
accurately repmeaml on the As -built which has bm anbmined to the Board of Katt.
Lic.4: L g'
Date: I v' Z7— r
FORM U - VERIFICATION FORM
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state law,
regulations or requirements.
****************Applicant fills out this section*****************
APPLICANT: Z1LL G . Phoned -""Z ^,?���
LOCATION: Assessor's Map Number Parcel _ 55�,
Subdivision /�i//�/S �.�7�/� Lot(s) %1
Street �r�l��/,S �,42�I �� St. Number (0�3
************************of icial
RECOMMENDATION OF, WN ENTS:
Conservation Administrator
Comments
Town Planner
Comments
Food In Ctor-Health
c.
�5eli'ti Inspe tor -Health
Comments
Use only************************
Date Approved
Date Rejected
Date Approved
Date Rejected
Date Approved
Date Rejected
Date Approved 3 -
Date Rejected
Public Works - sewer/water connections SIL L�> f 3p Z 7
- driveway permit_6
re Department-,?to1f.,66d rwA(a,
eceived by Building Inspector Date
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AS BUILT PLAN
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LOCATED IN
NORTFt ANDOVER, MA.
AS PREPARED FOR cD�
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SCALE: 1"=20' _ � _. _ r,_...
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