HomeMy WebLinkAboutMiscellaneous - 122 UNION STREET 4/30/2018 (2)j1
N�
of
O N
in N
O' Z
O O
0 Z
(n
O0
O M
c�
77-77n. FORM U - LOT RELEASE FORM
I;.,-- tom...1T
,-]N
STRUCTIONS: This form is used to verify that all necessary approvals/pern*s from
Boards a %nd D�, p
artments having Jurisdiction have been obtained. This does not relieve
the applicant andior landowner from compliance with any applicable or requirements.
'"APPLICANT FILLS OUT THIS SECTION...
APPLICANT ceUi, 4,,i
.. I -7A-V77-f PLVLS -t-PWTL"
LOCATION: Assessor's Map Number
SUBDIVISION
STREET W A--je_'AYS
PHONE 91i--Xo-620-3
1,7117- 691-f,36?
PARCEL_Sj,Q
LOT (5) —a0l-3
ST. NUMBER_
------ ,","OFFICIAL USE ONLY����---------
MMENDATIONS OF TOWN AGENTS: POO,
CONSERVATION ADMINISTRATOR DATE APPROVED
PATE REJECTED
COMMENTS
TOWN PLANNER DATB APPROVED
DATE REJECTED
COMMENTS -
4 4,:
FOOD INSPECTOR -HEALTH
DATE APPROVED
DATE REJECTED
j---1S—A#Tj0NSPECTOR-HEALTH
DATE APPROVED
DATE REJECTED
COMM ;74 C-
ENT S
AW
Z:>
1-:2Z
PUBLIC WORKS - SEWERIWATER CONNECTIONS
DRIVEWAY PERMIT
'A
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR
DATE_,_____
4 4,:
f
I
VJ STLLQ o
FtA6 CTYP) f
r
J ,
x. \
Li
� 1 � � ` \ � � X04,7 ...� � �,. •_
F=C)SC OF
2
J.
t
No V,
It
�vu
C
b P {dos Q 1�' T �, \ �, : \ •� •� `.
Co04TRo`
S fA MU
Al
' 2 T
Sok C. bkRtN ��Sir�y cr
PROP
PROPO it PTr� T RCCA r
ROP -ala AHK %
sil 1n)ET �7k1dc,r,0N c're.erCK
4Ric
- � S
77
1 I
—3 -
W000-5
4 7-
[
TO 39Vd N013PQQIW d0 NMOi 8IL0t'
LL80S L6:6T 666i/S(-1/80
1-9
e2
0
�r
0
V
Z
I �
0
�
N
�
u
e'Z5.66
L-=41.85'
_ Noref - Fay.va+rio,v Loe� rio,v F.¢an .A.v /vrr.¢amevr
y�ooDS�DE WATk-IAIS �Y
�S //E.f'E�Y CE.cTiFY 7b T, Ie TirLE /.t/Saed.�.4N0
727 Ts/E B,4,V,r T.s/,47 T/+'EOa'E[G/.clC /S LOCATED O.c/
T//E taT.lS S.sGm%t/ A.vO T,�G4T�TOAs'S Got/FG=e'A!
!Y/Tip/ Ti�/E�»NS' Cf ,Do�Og ZON/.v6 ees4-,z,4rx% -v
IA, W -rd 71 ww r, eEETS tvT e%vE.t
CF..e'r/fY xV47-7we-f On► G[i.✓6 Ar NOT
ZOG4T60 /AI T•YE FEACAM..44 AZAA.O Af4Z4.C.O A.PEA.
,WdJV.v env C -e W f' 'a
2,5--0,094 aersi B a�/SB
c 983
Bovvo,�f �;
,9r/av rac�E,y
I
i
I�
E•usr'ur. E•'�SCMg4/T
TO T.VE /n.ttotETOV
n IllU,v/G•/PqL EGE'GT.eIC
A OEPARTgfBNT
RL or opz,4,ov
/N
it/a, �NOO vE2 f y%i.LaD� E•7'O.�//: !f'%A.SS,
O.P.9h�iV FO.P
/7%9 y /791-.
fA -
tf.9Gt' E.vG•u/EE,P/.�/6 SE.Pi�/lES
/c .cEz'o�os. 66 f'q•P,f� .ST.rEET
ANDOYE.� �1.4S.�4GfU/SETT.S O/g/O
1 �'�trrt`1 +`y t6 rr tf tJ t �
kNir� J }rr (a A r e /r 1 d u 1
C a
k•t{ .. �fl ak���{+ � jyy i r i x ,f �3 � ra , , . �.
L'u'L«tjy�r ,iY ' e :Fi +r Ir f ti A nits l�f t
. 't,
t T a i- { TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
3 ,+1 ��,�y 4t 11
i, h . a I r It JnKt1 ' !' G° e
rf�{' ) I+ �c ai h e rf {Taid•.r..�i ��'R,R y1ri
r(
�- t �� �^ 1��,� ��t�ja �� ,� �_. � jar `,N r a. . f1 •t+ t � it � ' � �' J �,r S. � - ... .. a.
r{ ,tr Kw iy SYSTEIK D�jA1► i
ADDRESS
SYSTEM'I�CATION
of house
i y��""'� f
�{
(a�ti4 F Ti,?� a *•`F t sit r r
r1'4 't1
PUMP
QUANTITY PUMPED
r j _CtALLONS
f
+sib x,ft^.,..: rI ♦ J ;:��ra ji t ;, jy p at'� 1, 1- - .
sry + '
OL.
NO was.,
� SEPTIC TANK
: NO YES
f r ���~ 0��lr• .1�i^FT���. � ar, { rets ' `' ..{ �.t r r y .. ,•,.� v a ..
Iry;. �,` K S! F5 �1 Y ��T O�� SEa1�-�C�• I p`� :.
ti,=at :� •:rs �, a ' .... EMERGENCY
!.r t i���%����' i 1�, i� � �.'4 1'�Ij�7r�' �R -,~ i' I i''' n�� a2w•� 1 ....
VA►1'IONS• '
CONDITION
HEAVY FULL TO
IN
' ,ki iii tr,rt GREASE
ROOTS " BAFFLESPLACE
EXCESSIVE SOLIDS FLOLD RUNBACK _---
SOLIDS CARRYOVER OTORDED
r a"Lr. f J rr ai ' %ExP
Y 'I
I'Y• ary
T',
tf
6s-";�f•t"y7_rM"1�_�`�1'R
t
ea.47 crhltf^14r� {i r ttifIIv it uof OLe t,'
-J A..,r) PEA I.e.._'
•..e •r 1 '1 . r� t r� 1 '1 1 r
!t, jt
47 AJ
b
T " b
.al1TO RO• ' 4
.{ x cti'tT i J I r • a
� ;'r .s ialt'tif'j �'P���'C� fry �,��'A���Sfy a ��`t�•rj�$�lMt ��'li tt�fn� �+qy�y,'}� riAa-f+.r s t � � - ' ' � � . - ..
� a �i�'ir :+ t ro 4i1r' I r jjp` N�•hJ ))) . �:5//'/J/� ///� � /���111/r`._, - u� .
E
, R
E
C
EIV
ED
TOWN OFNORTH ANDOVRANDOVER
SEP7 200
4
SYSTEMUMPINQ RECORD TOWN 0F NORTH AND 0
VE R
UA tl HEALTH DEPARTMENT
,�.._.
SYSTEM OWNER& ADDRESS— SYSTEW L
OCATTON5
A-lr% ", VF rumrfNu:-
QUANTITY
CESSPOOL: NO— .....YES,_.. SOPtic Tank, NO
. .... ... Yes
. . .......... .
NATURE OF SERVICE; ROUTINE_
OBSERVATIONS;
GOOD CONDITION �FUIIO COVER
HEAVY OPJASE BAFFLES IN PLACE
ROOTS MqELD
RUNBACK
6XCESSIVE SOLIDS ^ FLOODED
soLn) cARRYOVER'
OTHER EXPLAIN
Syal*M PUMpod by
VCS
21L
COMMENTS:
CONTENTS'rKANSFERUD TO
ed
�+ , :,t,:.:::'.,.,:DEC�Cm
'•''`'�v �{�:'.Yfl.ia.!:.�,:. D" 0 7 200/7
"
�.
roOded DEP,.has �.., r.
p this form for use by local Boards
`be:'ubmltted to the.10cal.'Board of Health or other a Nt ping Record mus;
;.A;. Facility inforiNtlon
f,rWhan (�Illn� out' .1: System Location.
.•�'cernputer, use•, .•r' 2�
only the tab key Address cJ
to move your
Oxw • do Pot
`use therofum':- Clty/TownState
t,, ; .. TP Cod
System Okerr , r ..',
A°" ;� Addreas (11 different from location)
Cltyrrovlm a; ' Slate Zip odel
Telephone Number
pumpip
g .Re(kord:
4y frit u,l Ii1(i a.;.d !. S/`` j,+r`•1 / r
1 Datq'of Pumpinq Date 2, Quantity Pumped:
Gallons
system; , ❑ Cesspools) S ptic Tank
❑ Tight Tank
- ❑ ,. Other (describe); r
4 Effluent Tae Flltar present? . ❑ Ye 0' If yes, was It gleaned? ❑ Yesf ❑ No
Condltlon of 8ystgm;"'
... :'i' ''7-' . rfl •.Y. YU:J ,i.p:•;.', A: � ta.�, ,1�.. 1., � ,
�' • � P.umped�By;'
�'!.` 'i \�'i�wy: �;i,r • ,,'1/',ilk l}�, :: 1. ••.t.• `., .J _ 1,.
•''; '.•,ti..+:'.�',`�'i'!1 ,%:r 11� 'iPi+'• ..411 �rlg i!c•�LtQ,�, ..f'1\\ Velli e N
Fide Ucen� umber
-:�i%�.t': SrM`�;3:fy�t•}:•y!r'. ;j7v'„'•>rk�l,�/
,: ��• . ....� . r.•.:0.: ,•71 :I U•1. ,;': '• y1�,ay .,lr�lj fb �[('•'' p t't .•!•1+`. � - ..
.''+^; .''!''��>.`Yr'�i�.. b•r,:�c1:;� (.i}., r r. �..,Jf• W.�fY.�:•r•.4/�;5.;liir�j..�.
1.r;>?; a:1'•;;;; :,:7;''t: Locaflon.wfiere'contents Were dlposed:
:�', :_, '1••iri'i).•;':: 1'.. ':'t.'.:i.: �F lel'! 0.. 5. : , , -
s'" '..Y,s �i.i�✓''.:.a�!.��' =•+•iii!' %.� i�',4:
. '.• 5�1 ,.r. :'1: ,.'�i:f�,tN.,, •. •.i(..�1.:' ,. ':1('i'•..�:� .•r: `��r� i•,::. ;r..
• •'�.��yrl:(('li'�•.��•Jli;d� "f'•'.'t.; i;,(�'' li �' � J � •i�' .. .
•.,�: ..: i'/..,?�• ,� `f•t.�a: .. W „ suler;,H/?,'wy•Y• , •4. .. ,. Date
: hUpJ/tivtivw.mass.qoJ/dap!wafer/apprGva)SA5form s,htm#Inspect
F.t5forrM.doa; 04IQ3 ' '
:r•.,. S stem P
Y umping Record Page i of t