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Home My WebLink AboutMiscellaneous - 120 SALEM STREET 4/30/2018 (6) 121 SALEM STREET 210/097.0-0001-0000.0 FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT ��i' L�5 PHONE ASSESSORS MAP NUMBER LOT NUMBER SUBDIVISION LOT NUMBER STREET ZVYP c? STREET NUMBER �r r r r r r r r r r r r r r r r r r r r r r r r■ ■r r r r r r r r r r■ ■r r r r r r r r r r r r r r r r r■ ■r r r r r r r r r r r r r■ OFFICIAL USE ONLY = ............................................................................ RECONfNMNDATIONS OF TOWN AGENTS tr■■rrrrrrrrr�rrrrrrrrrrrrrrrrrrrrrr■■rrrrrrrrrrrrrrrrrrrrrerrrrr■■rrrrrrrr■ DATE APPROVED CONSERVATION ADMINISTRATOR DATE REJECTED COMMENTS DATE APPROVED TOWN PLANNER DATE REJECTED COMMENTS DATE APPROVED FOOD INSPECTS DATE REJECTED DATE APPROVED o 0 S PE R-HEALTH n r ' ) DATE REJECTED ll CON*RENTS ,/L.4-4%-,,.a 7 PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUU DING INSPECTOR DATE :� . ,� r� 1. �Z 1 r � ,gip I 'NIr f i•• �� + .' i �. - .. ;r A g,, �� 3 - , ,` -. ' Z'j. 0.t, \, - •opl� . � 3 ! /',/. ry r. �' !. f ; . - i. . �. . 4` ` � ;` '`'' -i . 11�.. / h O _f,` ! •��0� - Fats.` c�o� `��(p t. . . -` O Q� \ �f `'1 . "'per./- `� �„' �' lry i , `fir4. I. 'j` �' , �t, ,rf!. � 1 . . 4: _ . .F ter. ,: , r,.. :�c7 , / ,� �.. a �... - `y - -„i r� "ted '� . v' Co - /.. ' ' - �. r. . r .. ': - :/ _ 1. _ .. _ 1. ! r '! y -: .� '.. G iG. . _ l h �' ..: -� , . 0i i l . 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O - j / , / '� 0' , . . . .. j.. 1. - f: 1. 1. �! // . tfQi F �}. _n - 1. Oc . . xn . o*-% �. Y9, MAR28 i D n I SEWER SERVICE INC. DATEnICE COMPLETE SEWER-SEPTIC DATE SERVICE '""°'c CUSTOMER NAME '-- n kw 508 683-5709 ( ) (508)470-14 Methuen,MA Andover,MA BILLING ADDRES Q^^ _� (508) 937-9889 (508)851- /�'\ J\ Dracut, CITY STATE ZIP PHONE: 603 898-9339 MA Tewksbury,MA �� ^ ( Salem,NH (5 s8�ssa MA33 JOB ADDRESS IF DIFFERENT THAN BILLING ADDRESS ADDRESS STATE ZIP (508) 658-7700 Wilmington,MA DESCRIPTION OF WORK Ci t� m ACUUM PUMP PTIC TANK GALS. ❑ CESSPOOL C, OVERALL SYSTEM ❑ DRYWELL ❑ BASEMENT 0 FAILED SYSTEM DRAIN LINES CLEANED ❑ MAIN LINE: FT ❑ BATHTUB: FT. ❑ KITCHEN SINK: FT. ❑ TOILET BOWL: FT. ❑ FLOOR DRAIN: FT U VANITY: FT ❑ OTHER LINE: FT. WORK ORDER AUTHORIZATION USE ONLY ON CHARGES GUARANTEES INVOICE AMOUNTS I hereby authorize you to perform the above described services and I agree to pay the amounts indicated to the right. I hereby certify PARTS $ that I am duly authorized to order and approve the work requested. Interest® 1.5 per month 18%per annum on past due balances. LABOR SIGNATURE TITLE OTHER OTHER TERMS OF PAYMENT TYPE OF SERVICE TAX EXEMPT CASH IF] r RES/COMM a fAX INDUSTRIAL ❑ CHEC CHARGE E, PLUMBING C TOTAL $ �V JOB COMPLETION T is its two acknowledge completion of the above described work which has been done to my complete satisfaction. DATE CUSTOMER SIGNATURE SERVICEMAN'S NAME WATER-SHED RESIDEN, TS QUESTIONNAIRE 1. Name x/ JILI f 4 2. Street Address lc)— /—a V1 �- 0 3. How many members are in your household? 4. What-type of sewage disposal system do you have? ❑cesspool ❑ septic tank and leaching area ❑ connection to municipal sewer ❑ other (describe) ❑ do not know. 5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health? ❑ yes ❑ no do not know " 6. How old is your sewage disposal system? ❑ . 0-5 years ❑ 6-10 years ❑ 11-20 years C�over 20 years ❑ do not know 7. Has your sewage disposal system been rebuilt or repaired? ❑_ yes ❑ no �do not know If yes, approximately how long ago? years. What was done? S. Ho frequently is your sewage disposal system pumped out? El annually every 2-4 years ❑ every 5-10.years ❑ over 10 years ❑ never O 9. Have you had any problems with your sewage disposal system? ❑ yes 9--no - If yes, what problems? ❑ repeated pump-outs needed ❑ system clogs, backs.up, or drains slowly ❑ odors ❑ sewage surfaces through ground 10. How many of each appliance are connected to your sewage disposal system? C/ washing machiney dishwasher garbage disposal dehumidifier drain sump pump toilet �- roof/pavement drains shower/bathtub 11. Please state the brand and hype (liquid or powder) of detergent you use for: dishwasher C A-SC d e- clotheswasher C',L j 1p, r.J P 2 12. Does your property have a lawn? Lel' yes ❑ no If yes, approximately what size? ❑ less than 1/4 acre . ❑ 1/4 acrk— ❑ 1/2 acre ❑ 3/4 acre ❑ 1 acre ❑ more than 1 acre (Specify) 13 acres 13. How often do you fertilize your lawn? No. of applications per year Season(s) of the year 14. Pleas state the brandrff_type,(Ii uid or granul r) of law fertilizer you use: heck here if your lawn is maintained by a pr ssional landscape contractor. Ca 77 f Please forward us as much of the following informxation that is possible; 1. Type of system f A ` 2 . A e 3 Location, k-2v A11-_, t3 4 - Maintenance records and date of last pumping out 15. Documentation of repairs and reconstruction 6. Site conditions 7. Builder of system t 8. Engineer who approved% -- Site 0 -- System � I ar 2J m 9 . Installation Procedure 10. Problems SEPTIC SYSTEM INSPECTION FORM ADDRESS c _ DATE INSPECTED • �p PROPERLY FUNCTIONING? N WEATHER CONDITIONS COMMENTS: . I WATER OUALi i Y TESTEb. ? Re!&ULTS? DYE TEST PERFORMED? Y N .DATE? SKETCH: 2 ST)ul� LF- S 0 � 'ToNiPl of BOF �-�G��°r'�=_, February 25, 1997 Mr. Paul E. Donahue, General Manager By Facsimile (508) 664-1734 International Properties 11 Brassie Way North Reading, MA 01864 Re: Heritage Estates Subdivision Subject: Septic Soils Testing Dear Mr. Donahue, This is your authorization to proceed with an application to the North Andover Board of Health on our behalf for the performance of soils testing for a future septic system which may be required on our property. It is our understanding that Merrimack Engineering Services will make such application and perform such testing on our behalf and at our expense. pthAndover, y rs, property em Street MA 01845 cc/ Michael Hart by Fax (508) 521-5569 James Senior by Fax (508) 663-9502 Town of North Andover, Massachusetts Form No. 1 4ORT11 BOARD OF HEALTH 3�o ss`Eo `rr�tioL 13-�- 19� QC'•"G+U 4� A APPLICATION FOR SITE TESTING/INSPECTION ��SSACHus��y Applicant + NAME ADDRESS TELEPHONE Site Location Engineer e.'o NAME ADDRESS TELEPHONE Test/Inspection Date and Time Y — N CHAIRMAN,BOARD OF HEALTH Fee —IS Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No. , INORTH A BOARD OF HEALTH l � ,ES IED '6'6 �? y 0� r 19 m APPLICATION FOR SITE TESTING/INSPECTION 79 ADQFTED SSACHUS� ti Applicant NAME ADDRESS TELEPHONE Site Location Engineer NAME w ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee Test No. T ` S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. �� __. M �M BOARD OF HEALTH 146 M&N STREET T'EL, 688.R540 ' ;'►►„� '`b NORTH ANDOVM MASS. 01845 APPLICI&TiOON EORSO,..,�TUTS DATE: LOCATION OF SOIL TESTS: _t 2( 6__M__ r Assessor's map & parcel number: OWNER: TEL. NO.: rJ - kA3, ! r ADDRESS: 1 z.l �it`i�._ S ENGINEER: .tM TEL. NO.:_:"J�3 CERTIFIED SOIL EVALUATOR: �,i6tA _Il bQ=L c ; Intod use of land: residential subdivision, single family home, commercial t 6L f I d-ALIbF THE FOLLOWING MUSt BE INCLUDED WITH THIS FORM: 1, Proof of land ownerahlp (Tac bill, deed, or letter from owner permitting tests) 2. Plot plan S. Fee of$175,00 per lot for new construction. This covers the two deep holes and two percolation tests required for each lot. Fee of$75.00 per lot for repairs or upgrades. G,•ENOL INFORMATiM 1, Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Masa, Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the EtOH representative, 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a sealed plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forme shell be submitted. 0 a H.x.UOW NVHVn 4� i^Ia T Z E 0 _) 6 S 2 � February 25, 1997 Mr. Paul E. Donahue, General Manager By Facsimile (508) 664-1734 International Properties 11 Brassie Way North Reading, MA 01864 Re: Heritage Estates Subdivision Subject: Septic Soils Testing Dear Mr. Donahue, This is your authorization to proceed with an application to the North Andover Board of Health on our behalf for the performance of soils testing for a future septic system which may be required on our property. It is our understanding that Merrimack Engineering Services will make such application and perform such testing on our behalf and at our expense. Very truly yours, Owners of property at 121 Salem Street North Andover, MA 01845 cc/ Michael Hart by Fax (508.) 521-5569 James Senior by Fax (508) 663-9502 BOARD OF HEALTH 27 CHARLES STREET NORTH ANDOVER, MA 01845 TELEPHONE# (978) 688-9540 APPLICATION FOR ABANDONMENT OF SUBSURFACE DISPOSAL SYSTEM (SEPTIC SYSTEM r , Pursuant to Section 310 CMR 15.354 of the State Environmental Code, Title V Name {L a Phone Address Contractor hired for work: Name Phone d Address e t Date for scheduled abandonment The septic system at the above addr s as been a andoned according to Title V specifications. ature of Co ac MetW of septic tank abandonment (check one). ( ) removal ( ) sandfill (sf crush ( ) other Name of Offal Hauer 3A"j This form must be returned to the North Andover Board of Health. PLEASE DO NOT WRITE IN THE SPACE BELOW FOR HEALTH REPRESENTATIVE'S USE ONLY. Inspecting Agent Date