HomeMy WebLinkAboutMiscellaneous - 115 COLONIAL AVENUE 4/30/2018 115 COLONIAL AVENUE
210/107.6-0129-0000.0 \
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MAP # ., >+ ,+
LOT f,
PARCEL . # #
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STREET _ _ _ ...!� •
O.iVSTRUCTIO,IV A,PP
HAS PLAN REVIEW FEE .DEEN PAID? YES NO
PLAN APPROVAL: DATE PR. BY
DESIGNER: r�s PLAN DA-rE.
CONDITIONS
WATER--SUPPLY: TOWN WELL
WELL PERMIT DRILLER
WELL TESTS: CHEMICAL DAZE APPROVED
BACTERIA_ I lira I E. (IPPRUVED
BACTERIA II DAT"E APPROVED
COMMENTS:
FORM U APPROVAL: APPROVAL TO ISSUE , YES NU
DATE ISSUED bgl/h�-By
CONDITIONS:
FINAL APPROVAL: .
ALL PERMITS PAID YES NO
WELL CONSTRUCTION APPROVAL YES NO
SEPTIC SYSTEM CONSTRUCTION APPROVALY c NO
OTHER YES NU
ANY VARIANCE NEEDED YES NO
FINAL BOARD OF HEALTH APPROVAL: DATE: BY:
-[F,�WNSIfl4L,$ZI QLl
,i Rr ry.�/ -i \ { .:'• \ 1..yr-:.. : 1 1.. ..r:.:.•�?:i",=•. } .1. ; biz \ / J, - 1, 1-• -
tt ISTHE INSTALLER LICENSED? "„ + �� YES NO
!
` -TYPE OF CONSTRUCTION: ► 'REPAIR
-
. ; '..NEW CONSTRUCTION: CERTIFIED PLOT 'PLAN REVIEW NO
CONDITIONS OF:.APPROVAL YE NO
4 . \ (FROM FORM U)
`..ISSUANCEOF DWC PERMIT ? - �!E� NO
1DWC ;PERMIT N0. INSTALLER:
BEGIN) INSPECTION 0
EXCAVATION INSPECTION: ; NEEDED:
..•�'y is.lsJ•:'.2tt 1:�:;::.:_l-• ..M1t/
^14
BYzlz
_
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:..:CONSTRUCTION INSPECTION: NEEDED:
'
AS BUILT PLAN SATISFACTORY: Y � "
APPROVAL TO BACKFILL: DATE:
"
FINAL . GRADING APPROVAL: DATE 9 �� /Q�/ By_ �_ L�
FINAL CONSTRUCTION APPROVAL: DATEBY
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
'� DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET. BOSTON, NIA 02101 617--'92-53'00
TRL�OY COX
WILLIAM F WELD
Governor Secrets
4 �,^ 7
AltGEO PAUL CELLUCCI DA%1D B STRUF
Ll.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commission
PART A
,,II �CERTIFICATION J
Property Address: 116— ea 0 N i'A-� AV. �• � �o V-« Address of Owner:
Date of Inspection: ♦ o —?— (If different)
Name of Inspector: �. �- .� '
I am i DEP'spitroved system inspector p want to Section 15.340 of Title 3 (310 CMR 13.0001
Company Name. /Q k
Mailing Address: o
Telephone Number: S 7,E !0 C
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 Inspection. The inspection was performed based on my training and experience to the proper funCron and
maintenance of on-site sewage disposal systems The system:
_Passes
_ Conditionall% Passes
_ needs Further E%aluation 8% the Local approving Authority
Fads
Inspector's Signa Date:
The 5%,stem Inspector shall submit a copy of this ins ion report to the Approving Authority within thirty 1301 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
(he report to the appropriale'regional office of the Department of Environmental Protection. The original should be sent to the system ownr
!nd copies sent to the buyer, if applicable. and the approving authority.
INSPICTION SUMMARY: Check A, B, C, or D:
Al SYSTEM PASSES:
I have not found any informalloh which Indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303
Any failure criteria not evaluated are indicated below.
COMMENTS:
e1 SYSTEM CONDITIONALLY PASSES:
One or more system components as described in the 'Conditional Pass- section need to be replaced or repaired. The system, up
completion of the replacement or repair, as approved by the Board of Health, will pass.
Indicate Yes, no, or not determined (Y, N. or NDI. Describe basil$ 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 lattached) indicating that the tank was installed within twenty(201 yem prior to the date of the inspection:
the septic tank, whether or not metal, is cracked. structurally unsound, shows substantial infiltration or exfiltratton, or tar
failure is imminent. The system will pass inspection If the existing septic tank is replaced with a conforming septic tank
as approved by the Board of Health.
tte.faed 04/35/971 ane+ 1 of Is
011r as we wires V%ft V%W hM:IAVWW n00 6 sore W&tsafeae
A PrMM�A^�ItecycW paver
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: f 5 0-6 16
i� �✓L N
Owner: V Giti
Date of Inspection: KM '✓a t'�
D) SYSTEM FAILS:
You must indicate ether "Yes" or "No' as to each of the following:
I have determined that.the system violates one or more of the following failure criteria as defined in 31 CMR 15.303. The basis
for this determination is identified below. The Board of Health should be contacted to determine w will be necessary to correct
the failure.
Yes No
Backup,of sewageinto facility or system component due to an overloaded or clogg or cesspool.
Discharge or ponding of effluent to the surface of the ground of surface waters d to an overloaded or clogged SAS or
cesspool.
._ Stant liquid level in the distribution bot. above outlet invert due to an overt ed or clogged SAS or cesspool.
Liquid depth in cesspool is lest than 6' below invert or available volu is less than 1/2 day flow
Required pumping more than 4 times in the last year NOT due to d ed or obstructed pipe(s).
Numoer or Mmes pumped
Anv portion of the Soil Absorption Svstem, cesspool or privy is low the high groundwater elevation
Anv porton of a cesspool or privy ,s within 100 feet of a su ce water supply or tributary to a surface water suppl%•.
Any porton of a cesspool or privy is within a Zone I of public well.
Am portion of a cesspool or privy is within SO feet o a private water supply well.
Anv portion of a cesspool or privy is less than 1 feet but greater than 50 feet from a private water supply well w4h no
acceptable hater quality analysis. If the well h been analyzed to be acceptable. attach copy,of well water analysis for
colnorm bacteria, volatile organic compounds ammonia nitrogen and nitrate nitrogen.
E) URGE SYSTEM FAILS:
You must indicate either "Yes" or "No' as to each of the f lowing:
The following criteria apply to large systems + addition to the criteria above:
The system serves a facility with a design w of 10,000 gpd or greater (Large System) and the system is a significant threat to
public health and safety and the environ t because one or more of the following conditions exist:
Yes No
the system is within 400 eel of a surface drinking water supply
the system is within feet of a tributary to a surface drinking water supply
the system is I in a nitrogen sensitive area (Interim Wellhead Protection Area-IWPA) or a mapped Zone II of a
public water su y well)
The owner or operator of any h system shall bring the system and facility into full compliance with the groundwater treatmem program
requirements of 314 CMR S. and 6.00. Please consult the local regional office of the Department for flinher information.
(rar11,864 0 /13/17) rage 3 K 10
e .
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
/ SYSTEM INFORMATION
Al/
Propertv Address: / �O(on� /Ft- V - 4A�V t--
Owner-
Date
��
Date of Inspection: _ (�
REJIDENtIAI: FLOW CONDITIONS
Design flow Q.p.d.Amdroom for S.A.S
Number of bedrooms:
Number of current residents:.3
Garbage griller (yes or no!:
Laundry connected to system or no):
Seasonal use Lyes or no)
Water meter readings, ifava lable (last two (1) year usage (gpd):
Sump Pump Ives or no).
Last date of occupant\• c �new
COMMERCI 46UINDUSTRIAL:
Type of establishment:
Design flow_ itallonsidav
Grease trap present: Ives or nof_
Industrial Waste Holding Tank present: eves or nof_
Non•sanitan Naste discnarged to the Title 5 system lyes or no)_
Water meter readings. if available
Last date of oC:upanc\
OTHER: (Describe
Last date of occuoanc\
GENERAL INFORMATION
PUMPING RE O S and sou e i iniormauon
System pumped as part oi inspection: lyes or nof
If Yes, volume pumped: Z-V4-b gallons
Reason for pumping A-,vAA-A.I ( SC'sKVtC—
F SYSTEM
Septic tank/distribution box/soil absorptfnn system
Single cesspool
Overflow cesspool
Privy
T Shared system (yes or no) (if yes. attach previous inspection records, if any)
VA Technology etc. Copy of up to date contract
Other
C
APPROXIMATE AGE of all components, date installed (if known) and source of information:
Sewage odors detected when arriving at the site: (yes or no)
(revised 04/22/27) Pan 9 /L 111
1
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 1/ Ca 10 n.) t,7
Owner: ��m
Date of Inspection:
TIGHT OR HOLDING TANK: Tank must be pumped prior to. or at time, of inspection)
(locate on site plan)
Depth below Erode
Material of construction: _concrete _metal _Fiberglass ,_Polyethylene _otherlexplain)
Dimensions:
Capac ra,: gallons
Design flow galions/da%
Alarm level Alarm in working order_ Yes; _ No
Date of previous pumping:
Comments:
(condition of inlet tee. condition of alarm and float switches. etc.)
DISTRIBUTION BOX:_✓
(locate on site piano
Depth of liquid level above outlet imert: r 4
Comments:
(note 44&Xel and distribution is equal. evidence of solids carryo er, evidence of le kale into or outof 4�c.)
dA
PUMP CHAMBER:_
(locate on site plan)
Pumps in working order. (Yes or Nol
Alarms in working order(Yes or No)
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
Iswfew 00/32/991 P"e 7 e! to
a
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continu"
Property Address:
Owner-
Date of Inspection: 1
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100• (Locate where public water supply comes into housel
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Page 9 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSM:E.N TS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: �; ,lu i
Owner: L U
Date of Inspection:
SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required)
If SAS not 1pcated explain why:
Type
leaching pits,number:_
leaching chambers,number:
leaching galleries,number:
leaching trenches, number, length:_ �� /
leaching fields,number, dimensions:
overflow cesspool,number:
innovative alternative system Tvpeiname of technology:
Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of vegetation,
etc.):
I Lt
CESSPOOLS: (cesspool must be pumped as pan of inspection)(locate on site plan)
Number and confieuration:
Depth—top of liquid to inlet invert:
Depth of solids laver:
Depth of scum laver:
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.):
9
Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: / 1.
Owner: G
Date of Inspection: 5-
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 67 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 propertyiobservation 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 waox-elevation: I
C6 4� 1
4- 6723
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11
Form No.4
Town of North Andover, Massachusetts
BOARD OF HEALTH
May 29 , 19 97
CERTIFICATE OF COMPLIANCE
This is to certify that
the Individual Soil Absorption Sewage Disposal System constructed (x or repaired ( )
by ('h arl a-_ 7hnr
INSTALLER .
atLMVtC06W th Andover-, MA 0184=5
has been installed in accordance with Board of Health Regulations as described in the Design
Approval Site System Permit No. 802 - dated 11/28 19 95
The issuance of this certificate sliall not be construed as a guarantee that the system will
function satisfactorily.
-. BOARD OF HEALTH
3
�r
't
$1
Form No.3
Town of North Andover, Massachusetts
BOARD OF HEALTH
pt NOaoT"1"p 19 �.
_ L
♦�o •••f
DISPOSAL WORKS CONSTRUCTION PER
,SS^CHUSES
Applicant ADDRESS TELEPHONE
A M ;1
Site Location
Permission is hereby granted to Construct ( or Repair ( ) an Individual Soil Absorption
Sewage Disposal System as shown on the Design Approval S.S. No.
.B
D.W.C. No.
Fee
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}
i'.
.7
t
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R,.
Y�_
/address /6 Co 4-c>. ki lq-U Title of File
Page ! of
Date f=ile Open:
Date file closed:
Doc Document/Action Title Date of _
action Refer a other l''urpose of Docurne nt/Action and notes;
Document/ doc�n'uent/
IW u m.
Action Department
---------------
- --------------
Board of Appeals — Board of Health '— Plan mmnBoard ;
9. Conservation Commission — Building Departm,
en,t �---
Form No.4
Town of North Andover, Massachusetts
BOARD OF HEALTH
May 29, 19 97
CERTIFICATE OF COMPLIANCE
This is to certify that
the Individual Soil Absorption Sewage Disposal System constructed (X ) or repaired ( )
by Charles 7ahPY
INSTALLER
at L A
has been installed in accordance with Board of Health Regulations as described in the Design
Approval Site System Permit No. 802 dated 11/28 19 95
The issuance of this certificate shall not be construed as a guarantee that the system will
function satisfactorily.
BOARD OF HEALTH
i
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67
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HAYESXN GINEERING,INC.C. FORM 11 - SOIL EVALUATOR FORM
Pa 1
7)
FAX(617)246-7596 %A
TItE Of 11 � 9
N00'9E1 0 . .................. ..........�GA a 1995
Commonwealth-of Massachusetts
X/0. Massachuset
Soil Suitabilio Assessment -for On-site Sew ge ispo
Performed By: kocersotj,__* ..........................
................................... . ..............
Witnessed By
..�q ............................................................................................................................................
................................................................ .....................................
L=tim Addms or Owmes Nam.
Ad&css.and
Tdcowr r
New Construction Repair F1
0&
I& ".Rev-,ie-w..-
,1.
Pu.blished Soil Survey Available: No El Yes
Year Published ... Publication Scale Soil Map Unit
..............
DrainageClass...... Soil Limitations .... . ................. ................._._..................................................................
Surficial Geologic Report Available: No ❑ Yes ❑
Year Published ......... .... Publication Scale ........
GeologicMaterial (Map Unit) _ ....... ......................__...................................................................
Landform -----------__ ................................ .......................................... ..................;........................................ .... ...........................
Flood Insurance Rate Map.:
Above 500 year flood boundary No El Yes S/
Within 500 year flood boundary No El Yes F]
Within 100 year flood boundary No El Yes El
Wetland Area:
National Wetiand Inventory Map (map unit) ...............................................
Wetlands Conservancy Program Map (map unit)..................................................... ...................................
Current Water Resource Conditions (USGS): Month ............ ---
Range Above Normal ❑ Normal ❑ Below Normal El
Other References Reviewed:
HAYES ENGINEERING,INC.
603 SALEFORM 11 - SOIL EVALUATOR FORAM
WAKEFIELD,MA 01880 � Page 3
(617)246-2800 •
FAX(617)246-7596
,Detenninati'on for Seasonal Hival2 Water Table
Method Used:
k)
❑ Depth observed standing in observation hole................... inches
❑ Depth weeping from side of observation hole.N -.. inches
❑ Depxh to soil mottles ..1�16 inches
❑ Ground water adjustment ................ feet
Index Well Number ------------------- Reading Date ..............._.. Index well level ----........
Adjustment factor Adjusted ground water level .......................
Depth 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?
If not, what is the depth of naturally occurring pervious material?
Certification
certify that onGp-rL1 lit' (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 Date Wag, 14 .vv-,T-
s e
HAYS ENGINEERING,INC. .
603 SALEM srEEEr FORA1 12 - PERCOLATION TEST
WAKEFl, W A 01880 ,�A
(617)246.282800
FAX'(617)246-7596
COMMONWEALTH OF MASSACHUSETTS
Massachusetts
Percolation Test
Date: -----_----------------------•-•- Time: ......................................
Observation Hole #
Depth of Perc
Start Pre-soak
End Pre-soak
Time at 12
Time at 9"
Time at 6"
Time W-61
Rate Min./Inch
Site Passed ❑ Site Failed ❑
......................................................... _............... ....... _ _..........
_ .. .
Performed By:
Witnessed By:
Comments: .. ...... ........ ......................... ........................
No. FEE
THE COMMONWEALTH OF MASSACHUSETTS
�-01 A g a b g 2- —,MASSACHUSETTS
�Vylirativn for Pisposal ,*Votem (Hone#rurtion ]Jrrntit
Application is hereby made for a Permit to Construct( i or Repair( )an On-site Sewage Disposal System at:
Location Address or Lot No. Owner's Name,Address and Tel.]i0'
LC-7 c( QoLoisiA� Avc A-c, GuiL R5 1
Z3> AL�� O
Installer's Name,Address,and Tel.No. Designer's Name,Address and R
7-04-6-2866
Type of Building: 1gg�
Dwelling No. of Bedrooms �— \Psons
a Gfdh^8er( b
Other Type of Building No. per owers( afeteria( )
Other Fixtures
CD
Design Flow �& gallons per day. Calculat daily gallons.
Plan Date l�'lS Numb;Lof sheets Revtst n Date
Title '--fa�tC 'tST�W+ ye;s l6l•( l &L. a14#0006e I)I A'% 5
Description of Soil '5 O Lo G s ® w cr"
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site sewage disposal
system in accordance with the prov' ' sof
Title of the t mental ode and not to place the system in operation until a
Certificate of Compliance has n ' ued by is Bo ealth.
Signed Date
Application Approved by Date
Application Disapproved for the following reasons
Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
, MASSACHUSETTS
Q'Ier#tftrtt#E lof CZomylittnr>e
THIS IS TO CERTIFY, that the On-site Sewage Disposal System installed( ) or repaired/replaced( ) on
by for
at has been constructed in
accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
. Use of this system is conditioned on compliance with the provisions set forth below:
The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. This
Certificate expires on
DATE Inspector
THE COMMONWEALTH OF MASSACHUSETTS
No. , MASSACHUSETTS FEE
�ts ttsttl S s#em (fnns#rnr#ion jhrmi#
Permission is hereby granted to
to construct( ) or repair( )an On-site Sewage System located at
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her
duty to comply with Title 5 and the following local provisions or special conditions.
All construction must be completed within three years of the date below.
DATE Approved by
FORM 1255 Rev.3/95 A.M.SULKIN CO.-BOSTON,MA
J PLAN REVIEW CHECKLIST
�/
ADDRESS off- 9LD�tJ//�L �� ENGINEER
GENERAL
3 COPIES STAMP LOCUS NORTH ARROW SCALE
CONTOURS L-`� PROFILE SECTION BENCHMARK `� SOIL &
PERCS ELEVATIONS WETS. DISCLAIMER b� WELLS & WETS
WATERSHED? DRIVEWAY (Elev) WATER LINE '--' FDN DRAIN
SCH40_Z TESTS CURRENT? SOIL EVAL �'. �o��e5b� S° t5rA,e-
SEPTIC TANK
MIN 1500G� . 17 INVERT DROP GARB. GRINDER io(+200% EDF)
25 ' TO CELLARS MANHOLE b-' ELEV GW ## COMPS.
D-BOX /
SIZE ## LINES FIRST 2 ' LEVEL STATEMENT
INLET /5 7,41 - OUTLET J,6--7,3A _ 47 (2" OR . 17 FT) TEE REQ'D? IfIn
LEACHING
MIN 660 GPD? RESERVE AREA L,'� 4 ' FROM PRIMARY? � 2% SLOPE
100 ' TO WETLANDS 1--' 100 ' TO WELLS `— 4 ' TO S.H.GW L--"", (5 ' >2 )
35 ' TO FND & INTRCPTR DRAINS 325 ' TO SURFACE H2O SUPP �-
4 ' PERM. SOIL BELOW FACILITY -- MIN 12" COVER // FILL?- ,,--' (451
if above natural elev; 10 ' if below) BREAKOUT MET?
TRENCHES
MIN 660 gpd SLOPE (min .005 or 611/1001 ) y SIDEWALL DIST. 3X EFF.
W OR D (MIN 61 )��JRESERVE BETWEEN TRENCHES---"—IN FILL?Z MUST
BE 10 ' MIN. `S 4" PEA STONE? VENT? L"", (>3 ' COVER; LINES >501 )
BOT X370 + SIDE .32,0 X LDNG � 7¢ = TOT ( �3 �66d
(L x W x #) (DxLx2x##) (G/ft2)
Copyright 0 1995 by S.L. Starr
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.
****************AppllQO
****************Applicant fills out this section*****************
APPLICANT: A • C, DUI 111.5 Inc Phone �05-8350
LOCATION: Assessor's Map Number Parcel G�
Subdivision W00J I a AJ E5�ult-5 Lot(s) t
Street CO lO n i Q I ha St. Number
************************Official Use Only************************
RECON24ENDATIONS OF TOWN AGENTS:
Date Approved
Conservation Administrator Date Rejected
Comments
Date Approved
Town Planner Date Rejected
Comments
Date Approved
Food Inspector-Health Date Rejected
Date Approved
Septic Inspector-Health Date Rejected
Comments
i
Public Works - sewer/water connections
- driveway permit
Fire Department
Received by Building Inspector Date
TOWN OF NORTH A'
►.ill -
6199r'
PLAN Of- LAND
/N
NO, AND 0 VER
MA 55*
SCALE.• I" = 40' JUNE 4 1996
HAVES ENG/NEER/NG, INC. ► 60.E SALEM STREET
C/V/L ENGINEERS & WAKEFIELD, MASS. 01880
LAND SURVEYORS TSL. (617) 246-2800
/ CERTIFY THAT THIS FOUNDATION /S LOC47ED ON THE GROUND AS SHOWN, AND THAT /T
CONFORMS TD THE ZONING BY-LAWS OF THE TOWN OF NORTH ANDOVER. / FURTHER CERTIFY
THAT TH/S PROPERTY DOES NOT LIE WITHIN A FLOOD HAZARD AREA (ZONE A OR V) AS
SHOWN ON FLOOD INSURANCE RATE MAP COMMUN/TY PANEL NUMBER 250098 0010 B.
EFFEC77VE DAM JUNE 15, 1983
.o OF 4jIS
DATF•----J_v_NE 4 SIDNEY cyGN
---- ------- ----- -- ---- — C.
PROFESSIONAL ND SURVEYOR FIELD, JR.
#15320
P�
585 j1 06'E -ss
49.47
L OT 9
h l 21,835 S.F.
V TOP OF FND.
ELEV.=160.95
1
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R=175.00 \\
L=5.8.3
o ,
/�S
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9 �O
ZONE P.R.D. R-2 VR. � F
MIN/MUM SETBACKS:
FRONT = 20'
SIDE = 20' (SEE SEC. 8.5.6.D. 1)
REAR = 20'
Town of North Andover, Massachusetts Form No.2
T Mo*Tq BOARD OF HEALTH _
o L
19Ak �•�;�ry-=',..�,' DESIGN APPROVAL FOR
�sJ"C"°Stt SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
i�
t, iApplicant ,1.�... ,Q /l A Test No.
Site Location
( r)-y- 9 Co cs OaQ
f
Reference Plans and Specs. i6—IL,X---p Z ZO
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. � -Z�
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Town of North Andover, Massachusetts Form No. 1
NORTH BOARD OF HEALTH
3�O5�t`ED OL
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APPLICATION FOR SITE TESTING/INSPECTION
��SSACHUs���y
Applicant'" C rn-L , I �u o l
NAME ADDRESS
/ TELEPHONE
Site Location LbT -� q Lou, ?--<z"4' �"��--t—�
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.
Town of North Andover, Massachusetts Form No. 1
NORTH BOARD OF HEALTH
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32 h��tt 646 O L 1 9
APPLICATION FOR SITE TESTING/INSPECTION
TED
�9SSACHU5����
Applicant
NAME ADDRESS TELEPHONE
Site Location �" r
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.