HomeMy WebLinkAboutMiscellaneous - 110 FULLER ROAD 4/30/2018 (2) 110 FULLER ROAD
29D/065.0 00].6-0000.0 _
MAP # LOTit
......... ........................ ...........
PARCEL # _ STREET � [ L�..�/ ......_.. .
CONSTRUCTION APPROVAL
HAS PLAN REVIEW FEE BEEN PAID? YES NO
PLAN APPROVAL: DATE APP. / ...... ....... '..........
DESIGNER: PLAN DI-ITE._.__��?�_f�L.�__..__.
CONDITIONS
WATER SUPPLY: T04JN.� WELL
i
WELL PERMIT ,�` DRILLEf2.-........._... ...... _.... .. ........_..... ... __
WELL TESTS: 'CHEMICAL DAIE APPROVED_
BAC"F`ERIA I Df-l1 E AF-"PROVED
BACTERIA II A I E flf�'PFtUVEll
.............__....._...........
COMMENTS:
FORM U APPROVAL: APPROVAL TO ISSUEYES') NO
DATE ISSUED_ z ____.__BY_____�
CONDITIONS:
FINAL APPROVAL:
ALL PERMITS PAIDY�5� 1`1110
WELL CONSTRUCTION APPROVAL Y-.-S.- NO
SEPTIC SYSTEM CONSTRUCTION APPROVAL NO
OTHER YES NU
ANY VARIANCE NEEDED YES N�
FINAL BOARD OF HEALTH APPROVAL: DAZE:. /Z7/lf� BY : /"�
n
SEPT I.G._EY_SIEM__x NS..T..8.4L.AT _QN.
IS THE INSTALLER LICENSED? YES NU
TYPE. OF CONSTRUCTION: N=W REPAIR
NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW Y1=s 110
CONDITIONS OF APPROVAL YES NO
(FROM FORM U)
ISSUANCE OF 'DWC PERMIT YES NO
DWC PERMIT NO. 664 INSTALLER:_ N'REP
BEG I N INSPECTION Y S NO:
EXCAVATION . INSPECTION: NEEDED:
. • . - PASSED ' HY�_�^--�----__._----'_---------
CONSTRUCTION INSPECTION: NEEDED:
AS BUILT PLAN SATISFACTORY: YES
APPROVAL- TO BACKFILL: DATE: q � /�Zi�HY_
FINAL GRADING APPROVAL: DATE �IZZZe!i_-Y
FINAL CONSTRUCTION APPROVAL: DATE:_, L7 .HY_-�! =- -
4 Commonwealth of Massachusetts
City/Town of
System Pumping Record
Form 4
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.
A. Facility Information
1. System Location: Left/Right front of house, Left/( i rear of h , Left/right side of house, Left/
Right side of building, Left/Right front of building, Left/ Ight rear of building, Under deck
Address
Giity/Town State
2. System Owner. RECEIVED
E)p 14
Name MIA
nF NORTH ANDOVER
Address(if different from location) HEALTH DEPART
City/Town State/-) ��� •
r Zip Code
Telephone Number
�•1
B. Pumping Record
- (0"-T
1. Date of Pumping Date 2. Quantity Pumped: Gallons
3. Type of system: ❑ Cesspool(s) ErSeptim Tank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes a1go If yes, was it cleaned? ❑ Yes ❑ No:
" 5. Condition of stem
6. System Pumped By:
Neil Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7. Locatio here contents were disposed:
!-S. Lowell Waste Water
Sign HauleV Date
t5form4.doo•06103 System Pumping Record•Page 1 of 1
Commonwealth of Massachusetts
City/Town of RECEIVED
System Pumping Record APR ?4 2012
Form 4
TOWN OF NORTH ANDOVER
DEP has provided this form'for use by local Boards of Health. Othel T t4e
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.
A. Facility Information
1. System Location: Left/Right front of house, Left�r of �. Left/right side of house, Left/
Right side of building, Left/Right front of building, Left/Right rear of building, Under deck
Address
City/Town State Zip Code
2. System Owner.
Name
Address(if different from location)
City/Town State i Zipjode
Telephone Number
B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped:
Gallons
3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes D-lC0 If yes,was it cleaned? ❑ Yes ❑ No
5. Conditi n of System: U �e
6. System Pumped By:
Neil Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7. Location h contents were disposed:
L S. Lowell Waste Water
Sig t e Haule Date
t5form4.doc•06/03 System Pumping Recons•Page 1 of 1
:l:;. :yY: 'ifl:.'rf•^;.tit��1'r. � fvfJ!'�'r•�;j'�`' •r,•'. •'
RECEIVED
MMS�
EC 0 6 2005
TOWN OF NORTH ANDOVER
lJ^ I!t ��� SYST'E'M PIJMPINQ R_pOOK'l-I HEALTH DEPARTMENT
SYM
Ae�
7T, QOAN71TY
h� rvK6 01' s�RYlc.�e: ><ou'rIN� _�! �h,tn�,►.�
�,v oUAsa" . . . Yvu. Iv c��vrx
K O,p.r,3 : LaAcK
g�C�.98iY$ 301,1p$ � PLOOD p D Rvlvgn�'�.
$OLrDCAWSYOYZ��._....01' XPI.,�IN
t'uMM�NTJ.
� lJN I'�N I'y t�1Nyl�XKbU I't
�I
i
J.,
• y
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
SYSTEM OWNER & ADDRESS SYSTEM LOCATION
(example: left front of house)
loew
DATE OF PUMPING: C� �$ QUANTITY PUMPED/6-c'/-2 GALLONS
CESS1 00L: NO YES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS: t/
GOOD CONDITION FULL TO COVER
HEAVY GREASE BAFFLES IN PLACE
ROOTS LEACHFIELD RUNBACK
EXCESSIVE SOLIDS FLOODED
SOLIDS CARRYOVER OTHER (EXPLAIN)
SYSTEM PUMPED BY:
CU IMENTS:
CONTENTS TRANSFERRED T0:
CUNSLRVATION EWE MATER -1juP5
NAL
03�;
-LANNINGFINAL
0
oNvn of njover
No.
DRIVEWAY ENTRY PERMID Ou fi od6. er,, Mass,, elm - o? d -19 P.1
0"?A qkl
BOARD OF HEALTH
PERMIT T IWO?
THIS CERTIFIES THAT.J11.84-Afl....e04-0. .......I........ .........
0 0 BUILDING INSPECTOR
has permission to erect M.ruildings on �Ur&AfA.... Rough �'W-
Chimney
to be occupied asAV.4/4.4-f
W#ArOP Final
provided that the person accepting this permit shall in every respect conform to the terms of the application?file in
PLUMPING INS CTOR
this office,and to the provisions of the Codes and By-Laws relating to the Inspection,.Al tion and Construction of 9
i .
Buildings in the Town of North Andover. PERMIT FOR FOUNDATION ONLY Cgh
VIOLATION of the Zoning or Building Regulations Voids this Permit. REGIfLATED BY PAPA 114.8-5. B.C.
;;�E
Pl---I\'Ml'l' L_X11IRES IN 6 MONTHS ELE&RICAL PECTOR
Rough
•
QW**--&-FE PAID:&U,
LJNR- CONSTRUCTION S Service
Apr: 4) 1 0 0 Final cv -
.... ......................
PERMIT FOR FRAME/BUILDING BUILDING INSPECTOR GAS INSPECTOR
"'quired to Occupy Building Rough
DATE:3-Ai2; FEE
Display in a Con Place on the Premises T
Do emove Burner FIRE7EP
No Lathing to Be Done Jntil Inspected and Approved by Smoke Det.
IS- Building Inspector
Address lzb _tomy��t2 � Title of File Page of
Date File Open: Date fele closed:
Doc Document/Action Title Date of Refer to other Purpose of Document/Action and nates.
action Document/ document/
Num. Action Department
Board of Appeals - Board of Health - Planning Board - Conservation Commission - Building. Department
�lCommonwealth of Massachusetts
Massachusetts
System Pumping Record
System Owner System Location
f��"�CAA- 1t, T" 44- .mo.
Date of Pumping: Quantity Pumped: �j / gallons
Cesspool: No Yes L) Septic Tank: No Yes «—
System Pumped by: vaeedea License#
Contents transferrred to : Greater Lawrence Sanitary District
Date: Inspector.
y4ly
Town of North Andover, Massachusetts Form No. 1
NORTH BOARD OF HEALTH
OFSLED ib q�O � r 1
0
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A 4 o �Ew,,� APPLICATION FOR SITE TESTING/INSPECTION
7 ADAATED PPP
�SSACHUS��
Applicant r
NAME ADDRESS TELEPHONE
1 ,
Site Location
Engineer '
NAME ADDRESS TELEPHONE
Test/Inspection Date and Time
CHAIRMAN,BOARD OF HEALTH
Fee Test No.
S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No.
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No................--....... FEs..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
o .�[
...................OF.....%.QltIA.....
Appliratiun for Diopm al Workii Tows rnrtiun "eruiit
Application is hereby made for a Permit to Construct (-,o) or Repair ( ) an Individual Sewage Disposal
System at:
.......... ......-- --• •- - - ------ ---- ---------- ---------- ....... ....-- -
Location-Address or Lot No •-.•-••
LC�3�..4.�,......_ s -••----.-• 2Q-!z �A�v_JL-S---�(X�D . .rn
---•-�F- c'`^-�•...........................•--. .__....... _ ?...................
Owner .Address
'� r....-----•-•---•------------------------- ---.3..03..........•••-••••--...----
Installer Address QQ i1C
Type of Building Size Lot.._..�_._____.._l..........Sgc fM–
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures ------------------------------•. .
W Design Flow...........8K.5...................gallons per person per day. Total daily flow.__....C..cv.Q.......................gallons.
WSeptic Tan6—, iquid capacity.1159!..gallons Length-_!A!...... Width.._(a`__..... Diameter................ Depth... ,_..__-
x Disposal T•Feach—No. ......1.._......_.. Width._�5'_...... Total Length_'3�-......... Total leaching area__"5.19 d......sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box (✓) Dosing tank ( )
Percolation Test Results Performed by--- __'F'.___yXAY �?....__... P'C ............... Date._.S.-' _.-Q1 .........
aTest Pit No. I........____minutes per inch Depth of Test Pit....... .'_..._... Depth to ground water..3_q...............
Test Pit No. 2..... Z _._minutes per inch Depth of Test Pit.....!�'i_....... Depth to ground water.--'23...
..................................... ........................................................................................................................
0 Description of Soil.-S.I.Q....... K'`�..... ' l -------------------•------------------------------....................
U •---------------•-------------------------•----•----•---------------------------------......------------•-------------------------------•---------------•---------------•----------•--•-----------------
UW ------------------------- -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Nature of Repairs or Alterations—Answer when applicable...............................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been issued by the board of health.
Signed ......... ... . ... ........................................................ .... ....... .......................................
Date
ApplicationApproved By ------------------------------------------------------------------------------------------------------------------------------------------------------ -- - -------- --------------------
Date
Application Disapproved for the following reasons- ------- - ------- - ------ ---------------------------- ---- - ------------------- - ----------------------
. ............... . ... . --- --................ . .. ---- --- --.. ---- . .......------------....-----------......................----..................----.... . ........................................
Date
PermitNo. ............................................................. Issued -. ..-......---------------------------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
---------------------------------------------- OF -----------------------------------------------_........_............---------------------------
Cextiftcate of Complianoe
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by-------------
Installer
at ------------------------------------------------I----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ------------------------------------------------ dated ---------------------------------------------_
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE---- ....................................................------------------------------- Inspector ...--....... ... .. _...------.........---............--- . --.---------- --------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF.....................................................................................
No......................... FEE........................
lRiupuuitl Worko Tungiriun rrniit
Permission is hereby granted--------------------------------.............................................................................................................
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System
atNo...............................................................................................................................................................................................
Street
as shown on the application for Disposal Works Construction Permit No..................... Dated..........................................
•---------------•-------•--...--------•------•----------•------..•--•--------------------•-•-------.•-•--
Board of Health
DATE................................................................................
FORM 1255 HOBBS IN WARREN. INC., PUBLISHERS
�g�2(DTW land L Mnw D09(Nhbl hso
Professional Land Surveyors & Civil Engineers
ESSEX SURVEY SERVICE. 1958 - 1986
OSBORN PALMER 1911 - 1970
BRADFORD & WEED 1885 - 1972
September 21, 1992
Ms. Sandy Starr, Agent
North Andover Board of Health
120 Main Street
North Andover, MA 01845
RE: F 9436
Lot 71 Fuller Road
North Andover, MA
Dear Sandy:
In accordance with your telephone conversation of September 18,
1992, with Chris Mello, the required revisions have been made to
the subsurface sewage disposal system for the referenced lot.
Any questions regarding this matter, may be directed to the
undersigned.
Very truly yours,
r
\J
James H. MacDow 11
enc.
40 LOWELL STREET
PEABODY, MASS. 01960
(508)531-8121
FAX:(508) 531-5920
G T l I-UJI pr
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PITS
MIN 660 LEACHING GW MIN 4' BELOW BOTTOM MANHOLE/PIT
EXCAV 2x EFF W OR D 12"-48" STONE SURROUNDING
BOT + SIDE x LOAD = TOTAL
(L x W x #) (2 x (L+W) x D x #)
CHAMBERS
COVER >3 FT - VENT
FIELDS
MIN 900 ft2 LEACHING 1/ PERC RATE FASTER THAN 20M/INy GW MIN
4' BELOW BOTTOM OFF FIELD 1/ PIPE ENDS JOINED W/NON-PERF. PIPE? �b
4" PEA STONE? 1/ DIST LINE SLOPE .005? >3' COVER - VENT
SCH 40� MIN 12" COVER c/ L x W = T x LDNG > DESIGN FLOW? 7Z
DOSING TANKS AND PUMPS
DIMENSIONS X X = PUMP CAPACITY gpm
L W W Vol.
DISCHARGE SIZE DISCHARGE RATE DISCHARGE TIME
gpm
MANHOLES TO GRADE ALARM SEP. CIRC. GW (Min. 1' below
inlet) HWL LWL CHECK VALVE BLEEDER HOLE MANUAL
I
OP. SWITCH
i
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e 6
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1172-"
6 V5-
PLAN REVIEW CHECKLIST
7i
ADDRESS :'; I/ate ENGINEER (
GENERAL
3 COPIES STAMP t/ LOCUS l�-' NORTH ARROW SCALE
CONTOURS V PROFILE �� SECTION BENCHMARK 2/� SOIL &
PERC INFO ELEVATIONS WETS. DISCLAAIMER WELLS &
WETLANDS WATERSHED?-.,-L— DRIVEWAY �T (E1eW WATER LINE (/
FDN DRAIN ✓ SCH40 � TESTS CURRENT?
SEPTIC TANK /
MIN 1500G. (// . 17 INVERT DROP 1/ GARB. GRINDER_f (+200% EDF)
25' TO CELLAR ✓ MANHOLE TO GRADE_ ELEV GW
D-BOX
SIZE bb -7 # LINES J— FIRST 2' LEVEL STATEMENT
INLET OUTLET (2" OR . 17 FT) TEE REQ'D? ?
LEACHING
RESERVE AREA t,-' 4' FROM PRIMARY? L,--" 1001 TO WETLANDS ' --"�2% SLOPE
100' TO WELLS 35' TO FND & INTRCPTR DRAINS 4' TO S.H.GW -L -'
325' TO SURFACE H2O SUPP 4' PERM. SOIL BELOW FACILITY`
MIN 12" COVER r/ FILL? (25' i above natural elev; 101if below)
BREAKOUT MET?—,L,---'-
TRENCHES
ET? 2//TRENCHES
MIN 660 gpd SLOPE (min . 005 or 6"/1001 ) >3' COVER? - VENT
SIDEWALL DIST. 2X EFF. W OR D , (MIN 61 ) IS RESERVE BETWEEN
TRENCHES? IN FILL? MUST BE 10' MIN. 4" PEA STONE?
BOT X LDNG + SIDE X LDNG = TOT
(L x W x #) (G/ft2) (DxLx2x#)
1
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 local or state law,
regulations or requirements.
****************Ap li ant fills out this section*****************
e
APPLICANT' APhone ? l- 3F•? Z
LOCATION: Assessor's Map Number Parcel
Subdivision Lot(s)
Street �Gf. i2-;F FQI If kA . �, i4 �� St. Number
************************Official Use Only************************
RECOMMENDATIONS OF TOWN AGENTS:
Date Approved
gonservation Administrator Date Rejected
0.
Comments
1! L ri,
Date Approved
To lanner Date Rejected
Comments
Date Approved /;;�Yh
Health Agent Date Rejected
Comments
Public Works - aMwEr7water connection -*
, 125 %
driveway pe it ,t inn /z/sz ,E/�C
Fire Department Com• c�-
Received by 'Building Inspector Date
Town of North Andover, Massachusetts
' MORT ForT No.• �o;,,.•e BOARD OF HEALTH
w
• o i 19�
• ;��',^�•�t� DESIGN APPROVAL FOR
SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
Applicant
Test No.
Site Location
Reference Plans and Specs..S�i"�� �i ,
ENGINEER Zs'
rile sem•
D IGN
Permission is granted for an individualsoil absorption sew DAT T
in accordance with regulations of Board of Health, age disposal system to be installed
CHAIRMAN,BOARD OF HEALTH
Feely Q, 00
Site System Permit No.
Town of North Andover, Massachusetts Form No.3
HpRTM
BOARD OF HEALTH
of ,stip 19 �3
; F 9
3 '°•�.,o.%^"� DISPOSAL WORKS CONSTRUCTION PERMIT
• �SSACNUSES
Applicant V "In 010.
NAME L ADDRESS TELEPHONE
Site Location I ,,)— Id.-LIA 11 A �. .
Permission is hereby granted to Construct Y)-
) or Repair ( ) an Individual Soil Absorption
Sewage Disposal System as shown on the Design`Approval S.S. No.
CHAIRMAN,BOARD OF HEALTH
Fee Lo D.W.C. No.
cvl
FRO�;
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