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HomeMy WebLinkAboutMiscellaneous - 121 CAMPBELL ROAD 4/30/2018 121 CAMPBELL ROAD , 210/106.6-0036-0000.0 i __ ISI 9 I i �, Commonwealth of Massachuse s RECS, VED --- City/Town of Noah Andover OCT ; 014 a System Pumping Record TC7WNOFNORTHAN©OVER Form'4 HEALTH DEPARTMENT w~ 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, i,-� i �¢ (/�! use only the tab '1LJ_ key to move your Address' Ma 01886 cursor-do not North Andover State Zip Code use the return City/Town i key. 2. System Owner: K rim a Name Address(if different from location) State / yZip Code / City/Town l 4 Telephone Number B. Pumping Record P � m ed: 1. Date of Pumping Date 2. Quantity Pu p Gallons - Se tic Tank ❑ Tight Tank ❑ Grease Trap 3. Type of system: ❑ Cesspool(s) p ❑ Other(describe): - 4. Effluent Tee Filter present? ❑ Yes - o If.yes, was it cleaned? E] Yes ❑ No 5. Condition of System: 1 6. Syst Pumped By: '2 ' Vehicle License umber Name Stewart's Septic Service Company 7. Location where contents were disposed: Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01.835 S(nature of aule Date Sof Receiving Facility Date System Pumping Record•Page 1 o t5form4.doc•03/06 I Commonwealth of Massachusetts �1ip City/Town of NORTH ANDOVER IInASS S€-T - System Pumping Record Form 4 JUL 1 9 2006 DEP has provided this form for use by local Boards of Health. The System Pumpin Rec rd mu,, be submitted to the local Board of Health or other approving au r�8`r"rty;-;= ''' ""`� ',w VER BENT A. Facility Information - --- I Important: When filling out 1. System Location: forms the /c>2-/ �j computer, use - only the tab key Address - -- — - -- ----- to move your cursor-do not use the return City/Town — -- ------ , key. 2. System Owner: tate Zip Code Name -- -- - - ----- -- -- Address(if different from— location---)-- ity/Town --------------------- State Zip Code — ------—----------- ------------------ Telephone Number i B. Pumping Record •�i — -- - -- -- 1. Date of Pumping Dm_;v p g Date 2. Quantity Pumped: -G-----------------_. Gallons 3 Type of system: ❑ Cesspool(s) E?Se tic Tank P El Tight Tank ❑ Other(describe): ------- 4. Effluent Tee Filter present? ❑ Yes U No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. Sy em Pumped By: Name Vehicle License Number Company 7. Location where contents were disposed: .C�_D_ �? _ ---- - - -- - -- �a. Si ature of Haul y _-_-- ---- Date -- _-- - --- http://www.mass.gov/dep/water/ "provals/t5forms.htm#inspect t t5form4.doc•06/03 System Pumping Record• Page 1 of 1 h � t •. I I I r , dop r DOWHOE, John ` APPLICATION FOR SEWAGE DISPOSAL INSTALLATION Lot 61 Campbell Rd. ?" HEALTH DEPARTMENT - NORTH ANDOVER, MASS. I .hereby make application for a permit for a sewage disposal installation at -- Lot # 6. Campbell Rd. I will install this system in ac- cordance with all the laws of the Commonwealth of Massachusetts and regulations of the Board of Health of the Town of North Andover. Further, I will construct the house sewer of bell and spigot pipe, the minimum diameter being 4 inches, and will maintain a minimum rade of 1% until 10 feet re- g p ceding the septic tank, where the grade shall not exceed 2%. I will install a con- crete septic tank of 1000 gal_& in size. A manhole (s) permitting easy cleaning will be provided with removable cover (s) of iron or concrete within 12 inches of the ground surface. I will provide subsurface disposal field with 4 inch perforated or open jointed pipe and laid in a series of trenches, the bottom of which will pro- vide a minimum of __200 linealfeet of effective absorption area. The pipes will be laid on a '6 inch layer o washed gravel or crushed stone ranging in size from 3/4 to 1-1/2 inches (dia.) and the pipes will be surrounded by similar material to a height of 2 inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench, 2 inches of gravel or stone 1/8" to 1/4" (dia.) will be placed over the course gravel or stone. The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single tile line will exceed 100 feet in length and in any case, two lines of tile will be installed. A minimum of 6 feet will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the installation will be less than 100 feet from any private water supply, 25 feet from any stream, 26 feet from any dwelling or 10 feet from any property line. I further agree not to cover any portion of this installation until approved by the inspection officer, as provided below, and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application. *�-k N-ell to--be in front of lot. 100 ft. from duain field. DATE I Signature of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DATE G __ Signature of Health Agent I have inspected the uncovered system indicated above and find everything done as described. DATE Signature of ItIpeciing Officer -v Percolation Test 4 min. Soil: Sandy-clay Garbage Grinder No C y„y. ,� !7 r/' ,!• ` �4.4'LLi.r' 4�_E r_'�. -. _ —sem ----p BOARD OF HEALTH TOWN OF NORTH ANDOVER, MASS. LIZ o r • �v �-� r 3 Oro 30 .l- 1. NAME_ D cyv f3 t)1 DATE \ f0 v2 ! �v 2. ADDRESS O/lq m 4k_1/ Cd- LOT NO. TEL. Zy�2� 3. _NO. OF BEDROOMS DEN YES NO_ 4. GARBAGE GRINDER YES N0�_ 5. SHOW DIMENSIONS OF HOUSE 6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES 7. SHOW DIMENSIONS OF LOT 8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL 9. NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM 10. SHOW LOCATION OF BROOKS, STREAMS, DITCHES, LEDGE OUTCROP, ETC. 11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY. ., � T t• � "�w� ,t ��_ BOARD OF HEALTH OF NORTH ANDOVER, MASSACHUSETTS SEWAGE DISPOSAL DATE October 24, 1964 NAME OF APPLICANT John Donohoe LOCATION Lot #6, Campbell Road. Address of lot no. BUILDING: Dwelling Other SYSTEM: New X Repair GENERAL DESCRIPTION OF LAND High SUBSOIL: Clay GravelSandy Clay PERCOLATION TEST 4 minutes per inch. MINIMUM INSTALLATION RECOMMENDATIONS CONCRETE SEPTIC TANK 1,000 gallon capacity. LEACH FIELD 200 lineal feet of drain pipe. William J. Dx1scoll , Engineer Board of Health ` ,, .. .. . .. I \�� DOZHOE, John i,.. Lot # 6, Campbell Rd.. APPLICATION FOR SEWAGE DISPOSAL INSTALLATION HEALTH DEPARTMENT - NORTH ANDOVER, MASS. I hereby make application for a permit for a sewage disposal installation at Lot # 6. Campbell Hcy.- . I will install this system in ac- cordance with all the laws of the Commonwealth of Massachusetts and regulations of the Board of Health of the Town of North Andover. Further, I will construct the house sewer of bell and spigot pipe, the minimum diameter being 4 inches, and will maintain a minimum grade of 1% until 10 feet pre- ceding the septic tank, where the grade shall not exceed 2%. I will install a con- crete septic tank of 1000 gal in size. A manhole (s) permitting easy cleaning will be provided with removable cover (s) of iron or concrete within 12 inches of the ground surface. I will provide subsurface disposal field with 4 inch perforated or open jointed pipe and laid in a series of trenches, the bottom of which will pro- vide a minimum of 200 linealfeet of effective absorption area. The pipes will be laid on a 6 inch layer "owaslied gravel or crushed stone ranging in size from 3/4 to 1-1/2 inches (dia.) and the pipes will be surrounded by similar material to a height of 2 inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench, 2 inches of gravel or stone 1/81' to 1/4" (dia.) will be placed over the course gravel or stone. The di b installed disposal field will p e ns alled at a grade of 4 to 6 inches/100 feet. No single tile line will exceed 100 feet in length and in any case, two lines of tile will be installed. A minimum of 6 feet will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the installation will be less than 100 feet from any private water supply, 25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line. I further agree not to cover any portion of this installation until approved by the inspection officer, as provided below, and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be .submitted with application. Jellt e in front of lot. 100 ft. from deain field. DATE--_����� Signature of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DATE G J4 tnature of Health Agent I have inspected the uncovered system indicated above and find everything done as described.'' DATE Wga -?_,d- i' Signature of I s cting Officer Percolation Test 4 min. Soil: Sandy-clay Garbage Grinder No f r. '� e t �--�`� r BOARD OF HEALTH �-c yv TOWN OF NORTH ANDOVER MASS A O B r R i Oro 2� 1. NAME (Q /Iyv DDATE 104- 111f, f 2. ADDRESS Cj jVI /-/�L��/ �C LOT NO. TEL. 3. NO. OF BEDROOMS DEN YES NO_ 4. GARBAGE GRINDER YES NO_� 5. SHOW DIMENSIONS OF HOUSE 6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES 7. SHOW DIMENSIONS OF LOT 8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL 9. NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM 10. SHOW LOCATION OF BROOKS,STREAMS, DITCHES, LEDGE OUTCROP, ETC. 11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY. hake , I BOARD OF HEALTH OF NORTH ANDOVER, MASSACHUSETTS SEWAGE DISPOSAL DATE October 24, 1964 NAME OF APPLICANT John Donohoe LOCATION Lot #6, Campbell Road Address of lot no. BUILDING: Dwelling Other SYSTEM: New X Repair GENERAL DESCRIPTION OF LAND High SUBSOIL: Clay Gravel SandY Clay PERCOLATION TEST 4 minutes per inch. - - - - - - - - - - - - - - - - - MINIMUM INSTALLATION RECOMMENDATIONS CONCRETE SEPTIC TANK 1,000 gallon capacity. LEACH FIELD 200 lineal feet of drain pipe. h)JL William J. Dr scoll , Engineer Board of Health i �yti S..J �� .. � .r '. . f .'. Y. 1. A r _.. .. � t '\ \ —— 2J12/9a0o FARMER PAGE 02 7,6' " O.F NORTH'APJ'DOVER ' SYSTEM PUM•pi-NO 4CORD ,VTEM OWNER & ADDRESS SYSTEMI.00'ATION (ezMP.1c 10 front of house) ruv de-A' i ./6acA 0�rh 0 145 U:\'i'E UR PUM1'INC;- '� (QUANTITY f'UMPCDJO C',� L Lu 1 , :. i'..SSVOUL"NO YES SEPTIC TANK, N0 YES MATURE OFSERYICE:' ROUTIN4 EM ERCEN'CY uIISrRYAT10NSc ":.QO D CUNUITION,. — FULL70 CUYCII HRAYY CKI";ASC :13AFFLLS IN 1'LAC11' L EA C H F I C! Q f Z U N 13 A C K. CXCESSIYE SOLIDS FLOO-DED SOLIUS'''CAR'RYOYER' jpJ Hgfl (EX%A.1N) • C U)l M RNTs: fir- rr. T S � , -__. ..:�---•»+.-....av-., ..._..��. -.-� r P., _, �� a.-....mom--........ .. i � .. '. i ` ���-' 4' lddressGC Title of File Page of Date f=ile Open: Gate fle closed: Doc action Documelnt/Action Title Date of Refer to other Purpose of Document/Action and note Document/ document/ s fWum• Action Department Board of Appeals — Board of Health Planning Board — Conser aatiion Commission — Building Department �— UW 11/-Xuu 1J:J r DUd,,)/jbbli 51 LwAK.I/AN1JUVtK PAGE ui _ I Jq o In St, &ISO.R'r's SEPTIC lipm SEMCO Ne f1l, A 47mulp,= g!pj= BRADPM, MA 01835 WINV l L ►6/-cam µ 978-372-7471 ►n S'�� Lie- ?� /�� mom or MOM I Y REPOEV F . 2C�i OF ADERESS sheruloop c!� Jr y ES 4� Iola SS/a,,� ��oa /Oct 197 !�✓llr-101 v /4,7e !� �5d S� �Qm S iSad /9., l 1 HAUL LIC # 777 $100 1996 STEWART'S SEPTIC TANK SERVICE INST LIC # 659 $200 1996 47 RAILROAD STREET BRADFORD, MA 01835 508-372-7471 May 3, 1996 j,A= NO ANDOVER BOH TOWN HALL ANNEX „`+ �'- 120 MAIN STREET 16 ,. NO ANDOVER, MA 01845 PH# 508-682-6483~ 508-688-9540 ** FAX 508-688-9556 Dear SIRS: The following is a list of properties that we pumped in your town. In accordance with TITLE V regulations, we are complying by sending you the following on a monthly basis, if need be. If we didn't pump, you will not be notified. PUMP DATE ADDRESS GALLONS 04-01-96 197 ABBOTT STREET 1,500 105 WINTERGREEN DRIVE 11000 04-02-96 A 42 OLYMPIC LANE 11000 04-04-96 A 71 PENNI LANE 11000 04-06-96 492 SHARPNER'S POND ROAD 11000 A 39 HAYMEADOW ROAD 1,500 04-08-96 498 WINTER STREET 11000 187 SOUTH BRADFORD 11000 04-09-96 A 495 REA STREET 11000 04-10-96 A 706 FOSTER STREEET 11000 04-11-96 A 83 CAMPBELL ROAD 11000 04-11-96 A 43 CHRISTIAN LANE(?) 1,500 04-12-96 7 HAYMEADOW ROAD 11000 1577 SALEM STREET. 11000 04-13-96 278 BARKER STREET 1,000 HEAVY 04-16-96 A 30 BRENTWOOD CIRCLE 11000 04-17-96 A 27 COACHMAN'S LANE 11000 04-18-96 369 HIGH PLAIN ROAD 11000 28 CEDAR LANE 11000 A ;.121 CAMPBELL ROAD 11000 04-19-96 A 160 BRIDALPATH LANE 2,200 04-20-96 A 200 RALEIGH TAVERN LANE 1,500 A 1 GARFIELD LANE 1,800 i i I MASSACHUSETTS UNIFORM APPL ATION FOR PERMIT TO DO PLUMBIN( (Type or print) NORTH ANDOVER,MASSACHUSETTS _ �v /f ,� Date U Building Location %Z C /�EI�6lhers Name : _V"V e G A '✓ Permit# d Amount ?n Type of Occu anc New Renovation Replacement Plans Submitted Yes No ❑ — .FIXT1TR-F.0 , F Date. . . . . . . . . . . . W AH 04 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SA US r This certifies that . .�. �. . . .l�?1. �. .`'. . . . . . . . . . . . . . . . . . . has permission to perform . . P : .�.'.�-.`.t. ,`.`. - . . . . . . . . . . . . . . . . plumbing in the buildings of . .F: Ii . . f` , . . . . . . . . . . . . . at. .r t. ! . . .<. .��.: �'. �. �. . . . . . . . . . . . . . . . . North Andover, Mass. Fee. . : . . .Lic. No.. . -H- I Eli . . ..t. . . . . . . . .��. . 1. . . . -t�� . . . . . . PLUMBING INSPECTOR Check # �/ l Check one: Certificate Corp. 6 0 1 0 Partner. Business Telephone �, �(, tJ $ L C) IaFirm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner D Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installa'ons perfo ed unde Permit Issu d for this a plication will be in compliance with all pertinent provisions of the Massachu State bing Co a and Chapt 142 of e General Laws. By: Signarure of Eicenseuum 0e of Plumbing License 4 (.1 Title City/Town License 114umoer Master Journeyman ❑ APPROVED(OFFICE USE ONLY C f r �i Date. HORTIy TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING .5, moo• o.A�`qh t.3 ,SSAGMUSE� y This certifies that . . .�. . . . .�'�.! �.'.�_. .�. . . . . . . . . . . . . . . . . . . has permission to perform . . : .t -.`.�. � ' `:" plumbing in the buildings of . .Fu ... _ . . . , . at . .11. ! . . .�. .��. :���. �.�. . . . . . . . . . . . . . . . . North Andover, Mass. r Fee. . Lic. No.. . . . . . . . . . . . . .t..< . . c r,-. . . . . . . PLUMBING INSPECTOR Check # 6 0 `c 0 i I MASSACHUSETTS UNIFORM APPLI,6ATION FOR PERMIT TO DO PLUMBIN( (Type or print) a NORTH ANDOVER,MASSACHUSETTS Date Building Location ers Name v A✓d e G Al ��A-�✓ Permit# 60(d t Amount Type of Occin anc"} New Renovation ReplacementO Plans Submitted Yes No ❑ FIXTURES F cc Cr Ln C �. a W A SLRHM R4SEMENr ]ST HOUR 2NQ FIDOR J A J U I 2M FID(R 4M FLOOIIt 5M FLOOR 6M HDOR 7M FLOOR 9M FIDOR (Print or type) c Check one: Certificate Installing Company Name S / /� " e �� Corp. Address 1 1361- rt- Partner. Business Telephone (, p �, ti $ L.J O—Fimvc6. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy E Other type of indemnity ❑ Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above i three insurance i Signature Owner ❑. Agent 1 I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installs'ons perfo ed unde Permit Issued for this a plication will be in compliance with all pertinent provisions of the Massachus� State bing Co e and Chapt 142 of e General Laws. By Signature o icense um y T e of Plumbing License Title 4 (11 City/Town ice se NumDer Master Journeyman ❑ APPROVED(OFFICE USE ONLY F VnIn V - `V I 1'%L-L.Vr1V0- 1 NO 1'%1V6 INS R CTIONS: This form is used to verify that all necessary approvals/permit from Boilrd! and Departments having jurisdiction have been obtained. This does not relieve the;ap licant and/or landowner from compliance with any applicable or requirements. APPLICANT FILLS OUT THIS SECTION APPLICANT ��r't�(,I�C 't�ASr11: 1� PHONE LOCATION: Assessors Map Number PARCEL SUBDIVISION LOT (S) STREET Z1 s �i &L ST. NUMBER � v OFFICIAL USE ONL RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS F INSPECTOR- T DATE APPROVED r DATE REJECTED f SE TIC INSPECT -H TH DATE APPROVED -c,) DATE REJECTED .� " n . COMMENTS . — - J�-- v ,z o — all - PUBLIC YVWORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT 'ECEIVED BY BUILDING INSPECTOR DATE EU RwiNd 947 IM NORTH ANDOVER COMMUNITY DEVELOPMENT&SVCS Commonwealth of Massachusetts 7REECE1!! ®City/Town of No.Andover System Pumping Record V 1 U 2011 Form 4 UTOWN O��tORr>�r At�r�ovER DEP has provided this form for use by local Boards of Health. OthEArr"nay-DEPART 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 1. Syste Location: forms on the computer, use I obe I only the tab key Address to move your No.Andover Ma 01845 cursor-do not ---- — use the return City,—,own State Zip(ode key. 2 System Owner: , e teb L� n /1. /��1 f� Name i 0 Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping — 2. Quantity Pumped: Date Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes L2 No If yes, was it cleaned? ❑ YesiQo 5. Condition of System: \ \ 6. : System Pumped B FY P Y_ rr�,►�cL E, Name Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 Signature of Haul Date / 0 <2 I 1 Signature of Recei i g Itacility Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 i