HomeMy WebLinkAboutMiscellaneous - 131 CRICKET LANE 4/30/2018 (2) � � '�,
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Lot & Street .SOT`" 6,e/GCT C Map/Parcel
CONSTRUCTION APPROVAL
Has plan review fee been paid: CaNO Permit',
Plan Approval: Dat ��/�*A�pproved by:_
J
Designer:
l C/�1Plan Date: D?�
Conditions:
Water Supply- Town _._-__ Well.
Well Permit: Driller:
Well Tests: Chemic Date Approved -
Bacteria I Date-Approved
Bacteria II Date Approved
Plumbing,Sian-Off: i'irzng Sign-Off:
Comments: V \
Form "U" Approval: Approval to-Issue: rYES- NO
Date Issued Bv:
Conditions:
Final Approval:
All Permits Paid? NO
Well Construction Approval? YES NO
Septic System Construction Approval? NO
Certification? YES Nd
Other S No
Any Variance Needed? YES NO
FINAL BOARD OF HEALTH APPROVAL:
DATE:
APPROVED BY:
AP
SEPTIC SYSTEM INSTALLATION
CONDITIONS:
Is the installer licensed? E NO
Type of Construction: REPAIR
New Construction: Certified Plot Plan Review E NO
Floor Plan Review NO
Conditions of Approval from Form U Y ES, NO
Issuance of DWC permit: NO
DWC Permit Paid? YE NO
DWC Permit# _ Installer:
Begin. Inspection: YES NO
Excavation Inspection:
Needed:
Passed: -By:-
Construction Inspection:
Needed:
A rB�i�'It.Plan Satisfactory:.
ES: -
, F
Approval of Backfill: Date: /l1 b By: Z66��'
Final Grading Approval: Date:
Final Construction Approval: Date:_ By:
Certificate of Compliance: Approval: Date:
Commonwealth of Massachusetts
City/Town of OCT 082013
System Pumping Record NORTH ANDOVER U1,
h
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 within 14 days from the pumping date in
accordance with 310 CMR 15.351.
A. Facility Information
Important:
When filling out 1. System Location:
forms on the
computer,use —� — — — — -- - — -
only the tab key Address
to move your e-' �i�fov�'✓ ___ - 7/� ___-
cursor-do not City/Town- ——" State Zip Code
use the return
key. 2. System Owner:
IG�I 9
Name �—
Address(if different from location) ------ — --
Cityfrown State Zip Code
-----
Telephone Number
B. Pumping Record
GG
1. Date of Pumping Da02�/7 2. Quantity Pumped. Gallons
3. Type of system: ❑ Cesspool(s) [Septic Tank ❑ Tight Tank ❑ Grease Trap
❑ Other(describe): ---- — -- - --
4. Effluent Tee Filter present? ❑ Yes Wit o If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System:
6. System Pumped By:
100�h /� tt sj 8'71, / ----
Name j -vv i License Number
40 S porter St
Company Bradford, Ma 0183
7. Location where contents were di
3742382
Signature of Hauler Date
Signature of Receiving Facility Date
t5form4.doc•03/06 System Pumping Record•Page 1 of 1
Commonwealth of Massachusetts
City/Town of NORTH ANDOVER, MASSACHUSETTS
System Pumping Record
iY Form 4
DEP has provided this form for use by local Boards of Health. The System Pumping Record must
be submitted to the local Board of Health or other approving aut
RECEIVED
A. Facility Information
Important: JAN 10 2008
When filling out 1. System Location:
forms on the / �/ TH
computer, use 1- a TI L". 70WN OF N�EpARTMENT R
only the tab key Address -
to move your ✓y, A i,�yyu �tl 0 f C �
cursor-do not /7 e
use the return City/Town State Zip Code
key. 2 System Owner:
Name
Rehm `'
Address(if different from location)
City/Town State Zip ode
Telephone Number
B. Pumping Record
v ,3-
1. Date of Pumping [Date—/� 2. Quantity Pumped: Gallons Ud
3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank
❑ Other(describe): ---
4. Effluent Tee Filter present? Yes EP No If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System:
6. System Pumped By:
fy);ke willsot,- ?5a
Name Vehicle License Number
Wt�^� —ILtie-r rar-,rAer_A4a-1—
Company
7. Location where contents were disposed:
Signature Date
http://www.mass.gov/dep/water/approvals/t5forms.htm#inspect
t5form4.doc•06/03 System Pumping Record•Page 1 of 1
Commonwealth of Massachusetts
City/Town of NORTH ANDOVER, MASSACHUSETTS
System Pumping RecordEIVED
Form 4
TRE
DEP has provided this form for use by local Boards of Health[The %r �umoptng Re ord must
be submitted to the local Board of Health or other approving
HEALTH DEPARTMENORTH �NTER
A. Facility Information
Important:
When filling out 1. System Location:
forms the 1 � [ ��
computer,use LA .
only the tab key Addr ss
to move your
cursor-do not
DO 11)
use the return City/Tow State Zip Code
key.
2. Syste Owner:
Name
Address(if different from location)
City/Town State Zip Code _
Telephone Number
B. Pumping Record
1. Date of Pumping Date �G V�4 2. Quantity Pumped: Gallons
-p C)
3. Type of system: ❑ Cesspool(s) [Septic Tank ❑ Tight Tank
❑ Other (describe):
4. Effluent Tee Filter present? ❑ Yes 2"No If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System:
6. Systemumped
6&'
NaM11JPIIIIIII�
e Vehicle License Number
Company
7. Location where contents were disposed:
Signature of Hauler Date
http://www.mass.gov/dep/water/approvals/t5forms.htm#inspect
t5form4.doc•06/03 System Pumping Record•Page 1 of 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 or requirements.
APPLICANT FILLS OUT THIS SECTION
APPLICANT i J:� w G—yc j� J G i-} PHONEO 7<1')
LOCATION: Assessor's Map Number zoo .c �S' C�-f.`�25-c?.'r'D.�' PARCEL
SUBDIVISION vac. y.,�{ {� G�� LOT(S)
STREET 12 16 Ku-T L./1>v`ru ST. NUMBER I
OFFICIAL USE ONLY
RECOMMENDATIONS OF TOWN AGENTS:
CONSERVATION ADMINISTRATOR DATE APPROVED
DATE REJECTED
COMMENTS
TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS
FOO SPECT,OR-HE T DATE APPROVED
\\ DATE REJECTED
f
SEP C INSPECTO -HEAL H DATE APPROVED ' 00
DATE REJECTED d• /�r
COMMENTS l r i
PUBLIC WORKS -SEWERIWATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR DATE
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT WAM RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING .,
a •
BUILDING PERMIT NUMBER: DATE ISSUED:
SIGNATURE:
Building Commissioner/Inspector of Buildinp Date
SECTION 1-SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map and Pari!Number:
r
�`.0
Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area Front- ft 6
1.6 BUILDING SETBACKS tl
Front Yard Side Yard Rear Yard
Reqttired Provide red Provided Reqttired Provided
1.7 Water Supply M.GL.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ J
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No M
2.1 Owner of Record
Name(Print) Address for Service
/\ Signature Telephone
2.2 Owner of Record:
OV
Name Print _ Address for Service: O
i
40
Si ature Telephone
SECTION 3-CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable ❑
Licensed Construction Supervisor: �- c3%,� i,:�j
License Number
Address ASL -6 0-,13
l Expiration bate .a..
Signature Telephone
3.2 Registered Home Improvement Contractor Not Applicable ❑
1 � .:.;�',�✓� ���,��l����,,�%� i,mac : _/
Company Name r r7 ✓' n 9
Registration Number
Address
Expiration Nte ^^
i nature Telephone N♦
SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes.......❑ No.......❑
SECTION 5 Description of Proposed Work check au applicable)
New Construction ❑ Existing Building ❑ Repair's) 11Alterations(s) ❑ Addition 11Accessory Bldg. ❑ Demolition 11 Other ' Specify
Brief Description of Proposed Work:
e
f�y�/s r�✓t ;i'��s�ivP�s:� c .
SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY
Completed by permit applicant
1. Building 'i/<' ��.� .� (a) Building Permit Fee
Multiplier
2 Electrical (b) Estimated Total Cost of
Construction
3 Plumbing ,�. Building Permit fee(a)X (b)
4 Mechanical(HVAC)
5 Fire Protection
6 Total 1+2+3+4+5 rpt Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner/Authorized Agent of subject property
Hereby authorize to act on
My.pehalt',it all matteerss relative to work authorized by this building penin application.
t'y c'-,-��r -�-�- ,��-t..i �-'.�;�-mac c����-� ..-C��-�'•,yti�r•{�'
Signature of Owner /` Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
as ONvner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief
Print[lame
Signature of Owner/A ent Date
FMk w
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TBERS I` 2'
IM3RD
SPAM
DIMENSIONS OF SILLS
DIIv1ENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGI-LT OF FOUNDATION THICKNESS
SI7_E OF FOOTING X
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE,
K" � '
�' )
rown �A Noirdi 'Aj
Do,k.' �)pnent and
Office 4)fk'-.h,e .H.e-afth E
1%J0 05c"00)) STR
ID
Date:
Address: 1-3 I C C -1,'1t1Y th'.Andover,MA 6 1 a43
Re: Application for:
Dear:
Your application for at has been reviewed by the Health
Department. The application was denied on, 2004 for the following reasons:
1. Missing information
2. C/ Passing Title 5 inspection of septic system required (D
3. 0 Location of structure not acceptable
4. 0 Undersized septic system
To address the problem(s):
If#1 Is c
,4r,eked, please supply:
�a
Floor plan of existing and proposed addition—all rooms
Certified plot plan showing house,septic system and proposed project in scale
If#2 Is checked:
a. Have the septic system inspected by a certified Title 5 inspector to determine the size of the system and
whether it is operating properly: OR
b. Tie-in to municipal sewer
If#3 is checked:
a. , Relocate the project
If#4 is checked:
a. Provide additional information proving that the existing septic system meets current capacity
requirements. Please consult an engineer to determine the flow capacity of the septic system.
Please feel free to call the Health Office at 978-688-9540 with any questions you may have.
Sincerely,
Reviewer
Cc: Building Department
File
-:5,6o q D
Town of North Ai
V
Community Development and
Office of the Health I
400 OSGOOD STR
�Jorth :lnclover,tilassachu I Uj' 1
Susan Y. 5a,, ,er,RENS/RS
Public Health Director
Date: etc,c, ) P
Address: 1-3 I C (' C k ��' pg&h'Andover,MA bia4a
Re: Application for:
Dear:
Your application for at has been reviewed by the Health
Department. The application was denied on, 2004 for the following reasons:
1. Nil' Missing information
2. V Passing Title 5 inspection of septic system required �--
3. ❑ Location of structure not acceptable
4. ❑ Undersized septic system
To address the problem(s):
If#1 is c cked, please supply:
a. Floor plan of existing and proposed addition—all rooms
Certified plot plan showing house,septic system and proposed project in scale
If#2 is checked:
a. Have the septic system inspected by a certified Title 5 inspector to determine the size of the system and
whether it is operating properly: OR
b. Tie-in to municipal sewer
If#3 is checked:
a. Relocate the project
If#4 is checked:
a. Provide additional information proving that the existing septic system meets current capacity
requirements. Please consult an engineer to determine the flow capacity of the septic system.
Please feel free to call the Health Office at 978-688-9540 with any questions you may have.
Sincerely,
Reviewer
Cc: Building Department
File
40-6 a, -j�w ��e roppsem
1� C' 1,.'' R`;
CO Giik-tn-r)
RECEIVED
2
JAN 0 3 2005
2 TOWN Ot-rq,•-z iH ANDOVER
4 o HEALTH DEPARTMENT
I
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Residential Property Record Card
PARCEL_ID:210/038.0.0325.0000.0 MAP:038.0 BLOCK:0325 LOT:0000.0 PARCEL ADDRESS:131 CRICKET LANE
PARCEL INFORMATION Use-Code: 101 Sale Price: 748,500 Book: 05945 Road Type: T Inspect Date: 08/21/2002
Owner: Tax Class: T Sale Date: 12/06/2000 Page: 0178 Rd Condition: P Meas Date: 08/21/2002
PAJELA, REX Tot Fin Area: 5156 Sale Type: P Cert/Doc: Traffic: M Entrance: X
EVE PAJELA Tot Land Area: 1.05 Sale Valid: Y Water: Collect Id: SGC
Address: Grantor: WALNUT RIDGE Sewer: Inspect Reas: M
131 CRICKET LANE Exempt-B/L% / Resid-B/L% 100/100 Comm-B/L880 Indust-B/L% 0/0 Open Sp-B/L% 010
NORTH ANDOVER MA 01845
RESIDENCE INFORMATION LAND INFORMATION
Style: CL Tot Rooms: 9 Main Fn Area: 2884 Attic: NBHD CODE: 7 NBHD CLASS: 7 ZONE: R2
Story Height: 2.5 Bedrooms: 4 Up Fn Area: 2272 Bsmt Area: 2876 Seg Type Code Method Sq-Ft Acres Influ Y/N Value Class
Roof: G Full Baths: 4 Add Fn Area: Fn Bsmt Area: 1 P 101 S 43560 1 199,069
Ext Wali: FB Half Baths: 1 Unfin Area: Bsmt Grade: 2 R 130 A 0.05 235
Masonry Trim: Ext Bath Fix: Tot Fin Area: 5156 DETACHED STRUCTURE INFORMATION
Foundation: CN Bath Qual: L RCNLD: 702523 Str Unit Mar-1 Mer-2 E-YR-Blt Grade Cond%Good PIF/E/R Cost Class
Kitch Qual: L Eff Yr Built: 2000 Mkt Adj: 1.1 PG S 800 2002 G G /50//50 16,800
Heat Type: FA Ext Kitch: Year Built: 2000 Sound Value:
Fuel Type: G Grade: VE Cost Bldg: 772,800 VALUATION INFORMATION
Fireplace: 3 Bsmt Gar Cap:3 Condition: VE Aft Str Vall: Current Total: 875,000 Bldg: 685,300 Land: 189,700 Mktlnd: 189,700
Central AC: Y Bsmt Gar SF: Pct Complete: 100 Aft Str Va12: Prior Total: 947,400 Bldg: 757,700 Land: 189,700 MktLnd: 189,700
Aft Gar SF: %Good P/F/E/R: 1001//100
Porch Tvne Porch Area Porch Grade Factor
P 270
W 286
SKETCH PHOTO
274 Sq. 2e 6 Sq.R.
13 1322 Ask,
72 N P I"' C t U rfak
I
FU90euj5�qWM k
B, R4�/�a R.
lri q.R. 44 44 I
Av/ a
1
41
36 I
� I
r7 ===127 Sq.R. 11
Parcel ID:210/038.0-0325-0000.0 as of 12/28/05 Page 1 of 1
Town of North Andover, Massachusetts Form No.2
f NORT" BOARD OF HEALTHZ. W.4 OUZZZ
DESIGN APPROVAL FOR
SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
• Applicant Test No.
: Site Location
Reference Plans and Specs. A/ rx- '
e)AIACAI�
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 �o'iJ`- Site System Permit No. /���
Form 4 -- System Pumping Record
Commonwealth of Massachusetss /
Massachusetts
System Pumping Record 24 �,-
System Owner System Location
Type: Emergency Routine
Cesspool: No Yes Septic tank: No =Yes
Date of Pumping: Q d Quantity Pumped: /SVf' Gallons
System Pumped By: Wind Neer Environ mal, LLC Permit#:
Contents transferred to:
Contents Disposed at:
J
Date: Pumper Signature:
Condition of System/Other Comments
Dep Approved from - 1 Z/07/95
APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT 9
DATE: '211-74900 CURRENT P{'STALLER'S LICENSE,#_&V-0
LOCATION: Lir,c 4e r-
LICENSED INSTALLER: A11,11,47�
SIGNATURE: ~' TELEPHONET lags--5%/3
CHECK ONE:
REPAIR: NEW CONSTRUCTION:
IF :YEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT.
Administrative Use Only
a.., �/
.,.GU Fee Attached?. Yes No
F :undation As-Built? Yes / No
Floor Plans? Yes No
Approval �/,� � Date:
i
Town of North Andover, Massachusetts Form No.3
BOARD OF HEALTH ��
. Of NpRTM 1 _ �
G
040 ^
cD
h+ DISPOSAL WORKS CONSTRUCTION PERMIT
SS us
Applicant TELEPHONE
NAME ADDRESS
Site Location GcL
Permission is hereby granted to Construct ( • or Repair ( ) an Individual Soil Absorption
Sewage Disposal System as shown on the Design Approval S.S. NO.
CHAIRMAN,BOARD OF HEALTH
Fee -7 D.W.C. No.
1 G
BUILDING TIES INVERT ELEVATIONS
BUILDING CORNER A B 4" PIPE @ FDTN, = 193.99
SEPTIC TANK 33' 31.4' SEPTIC TANK IN = 192.62
PUMP TANK SEPTIC TANK OUT = 192.35
DIST. BOX 32' 38.7' DIST, X IN =
192.33
CORN. LEACH FIELD 1 20.7 52.8 DIST . BOX OUT = 192.17
CORN. LEACH FIELD 2 49.3' 72.2' EN LEACH IN 1 = 1 .10
END LEACH LINE #2 = 191.97
CORN. LEACH FIELD 3 74.5' 54.0' 9
EN LEACH IN = 189.70,
CORN. LEACH FIELD #4 60.0 25.5' END LEACH LINE #4 = 189.80
�S 0 EOGE 0
F
� °D wET�gN ED
> J
--� W o _
m r- �� LOTclo� 4- N N
...m cn = 45,5 74 S.F. ^� D
1,05ACAC. �o-p D
; rn r n
�.•z m N
me w
o X59 3
BOULDER
I RETAINING WALL <V
DECK �
N C) ')(IS TING 1
Q TWO STORY
: I
R _
M. 1.0.
ET.
WALLEL=
79,50500
1 D PORCH O
N D PKC I
0 N00 0
(<BRIKy r. I U7
Jf- JK
I
z 1
0 \ �, m1 tZt t I I t 1 t I I I
p ! ! I ! 1tt l I [
o ��S�'�`tiy �, � I I It ! I� i�{ 1 !I !«It I 1� I� I I� : • I
�j. C�O c 115 J L
®® Q L — 87-62 I N 4'W X 2 D x 8E`VCHES
cn
I —14°20'38 ' o� T
= 176.83' °� L=89.20' 1 °
L 3,
1 f1�4�0 4 3
05,
350.00 4
R AS—BUILT ': : s i7o
Q of CR /CSE T 1
. 8o �.
SUBSURFACE DISPOSAL SYSTEMzzz
LOCATED IN
NORTH ANDOVER, MA. � s
M AS PREPARED FOR ,^ NOTE: THIS PLAN & CERTIFICATION IS NOT
COPLEY DEVELOPMENTe�.E _ 4' •''• A WARRANTY OF THE SUBSURFACE DISPOSAL
SYSTEM. IT IS A RECORD OF THE LOCATION
0 50 COPLEY DRIVE :F =;• AND ELEVATION OF THE EXISTING
SYSTEM COMPONENTS.
METHUEN, MA. 01844v
fff CLE: -20 MERRIMACK ENGINEERING SERVICES
. _-�`� - - `�,
DATE: NOVEMBER 16, 2000 PROFESSIONAL ENGINEERS * LAND SURVEYORS * PLANNERS
} SUBDIVISION LOT4 CRICKET LANE
# 66 PARK STREET ANDOVER, MASSACHUSETTS 01810
TM 38, PARC. #38,44,45,46; TM 107A, PARC. #217 11TEL (978) 475-3555 FAX (978) 475-1448
CK
INSPECTION CHECKLIST FOR SEPTIC SYSTEMS
Yes NO Initial,
A. Bottom of Bed
1. Excavation to proper depth
2. With trenches,sides of excavation are beneath B horizon
3. Edge of excavation specified distance from foundation,etc.
Comments:
j
B. Retaining Wall
1. Wall height and-width as specified
2. Waterproofed
3. Wall minimum 10'to leachings '
4. Wall meets specificatio an
Comments:
C. Building Sewer
1. Pipe diameter minimum 4"
2. Schedule 40 pipe
3. Watertight joints
4. Inlet to tank cemented
5. Slope minimum 0.01 or 1/8"per foot minimum
6. Pipe properly set on compact firm base
7. Pipe laid on continuous grade in straight line
8. Cleanouts precede all change in alignment and grade
9. Manholes at any 90°change
10. 10'minimum offset to water line
Comments:
D. Septic Tank
1. Level
2. 1,500 gal minimum AJ
3. Gas baffle present on outlet
4. Manhole to grade
5. Manholes over center and each tee _
6. 3-20"manholes 1/
7. Inlet tee minimum 12"under invert
8. Outlet tee minimum 14"under invert
9. Outlet line cemented
10. Air space 3"above tees
11. 2"-3"drop from inlet to outlet
12. Pipe set
13. Compact base with 6"of V crushed stone under tank
14. Tank is watertight
Comments:
Yes NO
E. Pump Ch
1. If separate fro ..tank,compact base with 6"of/4"stone underneath
2. Minimum 2"pipe to x if gravity system
3. 20"access manhole
4. Tank level
5. Watertight
6. Tank size agrees with plan specification
7. Manhole to grade
8. Check valve and bleeder hole present
9. Alarm in building on separate circuit -
10. Alarm functions
11. Manual operating switch
12. Pump delivers liquid to d-box
Comments:
F. Distribution Box
1. D-box level
2. Minimum 0.17'(2")drop from inlet to outlet
3. Minimum 6"sump
4. Outlet pipes show equal distribution
5. Compact base with 6"of stone beneath box
6. Box is watertight
7. All lines cemented with hydraulic cement
8. Schedule 40 pipe C/
Comments:
G. Soil Absorption system
1. . All stone double-washed-3/4"- 1 ''/i"
-pea stone !/
Bucket test done?
2. Minimum 27of pea stone above distribution lines
3. Minimum 6"stone beneath pipe
4. Distribution lines capped or connected together
5. Grading meets 3:1 slope
6. Minimum of 9"of fill graded over system
7. Toe of slope stops minimum 5' from edge of property; if not,then Swale.
Comments:
H. Leach Trenches
1. Minimum 2 trenches
2. Length of trenches agree with plan. (Max. length 100')
3. Width of trenches agree with plan-Minimum 2';maximum-4'.
4. Vent present if<50 feet or specified
5. Distance between trenches minimum 4' and maximum of 6'
6. Minimum distance between trenches 10'
7. Pipe slope minimum 0.005 or 6"per 100'
8. Depth of trenches below outlet invert minimum of 6".
Yes NO
9. Pipes set on stable base. t/
Comments:
1. Leach Field
1. Maximum length of fiel 00'
2. Pipe slope minimum 0.005 \6"per 100'
3. Separation between pipe 6'maxi mum `
4. Pipes connected at end
5. Separation between adjacent fields 10'minim
6. Pipes set on stable base
7. Maximum 4' separation from edge of field to first line
8. Minimum two distribution lines
9. Maximum perc rate 20 mpi
Comments:
J. Leaching Pits
1. Minimum inlet pipe 4"
2. Pits of concrete
3. Sidewall between 12"and 48"wide
4. Access manholes on each pit
5. Pipes cemented with hydraulic cement
Comments:
K. Final Grade
1. Slope over soil absorption system minimum 0.02
2. All system components covered by at least 9"soil
3. Cover soil free of stones larger than 6"
4. Grading slopes away from dwelling
5. No areas over system that may pond
AS-BUILT CHECKLIST
LOT NUMBER, STREET NAME
ASSESSORS MAP &PARCEL NUMBER
LOT LINES & LOCATION OF DWELLINGS
LOCATIONS & DIMENSIONS OF SYSTEM,
INCLUDING RESERVE
TIES TO LOT LINES & DWELLING, WELLS
1. FROM SEPTIC TANK
b. FROM LEACH AREA
LOCATIONS OF DEEP HOLES & PERC
TESTS
✓� ELEVATIONS OF DISPOSAL SYSTEM
TOP OF FDN ELEVATION
LOCATIONS OF WELLS, DRAINS, WATERCOURSES
WITHIN 150' OF SYSTEM
_ LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE
t---''� DISTANCES FROM CORNERS OF HOUSE TO CENTER OF
TANK& D-BOX
ORIGINAL STAMP & SIGNATURE
IMPERVIOUS AREAS - DRIVEWAYS, ETC.
NORTH ARROW
�` LOCATION & ELEVATIONS OF BENCHMARK USED
TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM
INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System ) constructed;
( ) repaired:
by /'CyJ r XCaJr.�?�rC Lr/%� �. �c�� �/ �--
located at i # A
was installed in conformance th the North Andover Board of Health approved plan,
System Design Permit# dated 0-r) with an approved design
flow of 550 gallons per day. The mate�ed were in conformance with those
specified on the approved plan; the system was installed in accordance with the provisions
of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees
substantially with the approved plan. All work is accurately represented on the As-built
which has been submitted to the Board of Health.
Bed inspection date:
Engineer R esentativ
f
Final inspection date: 1011116f
Engineer presentative
4 Installer: G"' Lic.#: Date:
Design Engineer: Date: . f
TOWN OF NORTH ANDOVER
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
DATE OF COMPLIANCE
11/21/00
This is to certify that
the individual subsurface disposal system
constructed (X) or repaired ( )
by
Tom Sawyer
at
Lot 4 Cricket Lane
has been installed in accordance with the provisions of Title V of the State Sanitary Code
and with the North Andover Board of Health regulations.
The Issuance of this certificate shall not be construed as a guarantee that the system will
function satisfactorily.
Board of Health Inspector
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 or requirements.
** **** APPLICANT FILLS OUT THIS SECTION******''`*********�
APPLICANT W6d lVA,. _ /'U6G 0,9V PHONE 97J-42j0- P2 S7
LOCATION: Assessors Map Number L? PARCEL 4,4
SUBDIVISION kA IAIA f lei 2, LOT (S) _
STREET Cl,-')e/� ti �a f✓ e- ST. NUMBER
*** ** ****
********OFFICIAL USE ONLY*** ***************** ***
RECOMMENDATIONS OF TOWN AGENTS: /y/3
CONSERVATION ADMINISTRATOR DATE APPROVED
DATE REJECTED
COMMENTS
TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS
FOOD INSPECTOR-HEALTH DATE APPROVED
DATE REJECTED
SEPTIC INSPECTOR-HEALTH DATE APPROVED
DATE REJECTED
COMMENTS
PUBLIC WORKS -SEWERIWATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR DATE
Revised 9197 im
INSTALLER PROJECT MANAGEMENT OBLIGATIONS
As the North Andover licensed installer for the construction of the septic system for the property
atrelative to the application of 144 //loam
dated K--2Y-0010 for plans by IV e,'r,'1nac4 and dated /-/Y-9 9 with
revisions dated -S -
I understand and agree to the following obligations for management of this project:
1. As the installer I am obligated to call for any and all inspections. If homeowner, contractor,
project manger,or any other person not associated with my company schedules an inspection
and the system is not ready then item two shall be applicable .
2. As the installer I am required to have the necessary work completed prior to the applicable
inspections as indicated below. I understand that requesting an inspection, without completion
of the items in accordance with Title 5 and the Board of Health Regulations may result in a
$50.00 fine being levied against my company.
a) Bottom of Bed—generally first inspection unless there is a retaining wall which should be done first. Installer
must request the inspection but does not have to be present.
b) Final Inspection—Engineer must first do their inspection for elevations,ties,etc. As-built or verbal OK from
engineer must be submitted to BOH,after which installer calls for inspection time. Installer must be present
for this inspection. With pump system all electrical work must be ready and able to cause pump to work and
alarm to function.
c) Final Grade—Installer must request inspection when all grading is complete. Does not have to be on site.
4.
3. As the installer I understand that persons or companies not associated with my company may
not perform the work required by my company to complete the installation of the system
identified in the attached application for installation. I further understand that work by others
unlicensed to install septic systems in North Andover can constitute reasons for denial of the
systern, and/or revocation or suspension of my license in the Town of North Andover plus
significant fines to all persons involved.
4. As the Installer I understand that I must be on site during the performance of the following
construction steps:
a) Determination that the proper elevation of the excavation has been reached
b) Inspection of the sand and stone to be used.
c) Final inspection by Board of Health staff.
d) Installation of tank,D-box,pipes,stone,vent,pump chamber,retaining wall and other components.
5. As the installer I understand that I am solely responsible for the installation of the system as per
the approved plans. No instructions by the homeowner, general contractor, or any other persons
shall absolve me of this obligation.
Undersigns I.icens d Septic Installer
Date:
Town of North Andover NORTN
OFFICE OF 1O L
COMMUNITY DEVELOPMENT AND SERVICES ° . p
27 Charles Street
North Andover, Massachusetts 01845 9 -
WILLIAM J. SCOTT SSACHU50-
Director
(978)688-9531 Fax(978)688-9542
February 28, 2000
Les Godin
Merrimack Engineering
66 Park Street
Andover, MA 01810
RE: Lot 4 Cricket Lane North Andover
Dear Mr. Godin:
This is to inform you that the proposed plans for the septic system located
at Lot 4 Cricket Lane,North Andover, dated January 28, 2000 have been approved for a
house with a maximum of eleven rooms.
If you have any questions, feel free to contact the Health Department at 978-688-
9540.
Sincerely,
Sandra Starr,R.S., C.H.O.
Health Director
Cc: Copley Development
File
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
Town of North Andover I AORTN ,
o
OFFICE OF 3a ,•' °•e
COMMUNITY DEVELOPMENT AND SERVICES p
27 Charles Street :�9 •^;
North Andover, Massachusetts 01845 �9ss�cHusEttS
WILLIAM J.SCOTT
Director
(978)688-9531 Fax(978)688-9542
January 26, 2000
John Soucy
Merrimack Engineering
66 Park Street
Andover, MA 01810
RE: Lot 4 Cricket Lane North Andover
Dear Mr. Soucy:
This is to inform you that the proposed plans for the septic system located at Lot 4
Cricket Lane,North Andover, have deficiencies which must be addressed before plans
can be approved. These deficiencies are as follows:
1. Specifications of the proposed concrete wall are missing. (See 310 CMR
15.255(2)a-g).
2. The wall placement violates 310 CMR 15.255(2)g—distance from the wall to the
edge of the leaching area should be at least 10 feet.
3. Note#6 should read"Cover material over the system shall be free of large stones
greater than 6 inches, masonry..... .
4. Please note that grading easements given by Lot 5 and given to Lot 3 will be
required to be on file with the Board of Health before a Certificate of Compliance
will be issued.
Please be advised that all plan resubmittals require a$60.00 fee. If you have any
questions, feel free to contact the Health Department at 978-688-9540.
Sincerely,
_'Ij "� -
Sandra Starr, R.S., C.H.O.
Health Director
Cc: Copley Development
File
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
Feb-11-00 09:39A Paul D. Turbide, PE/PLS 978-465-0313 P.02
February 11, 2000
Sandra Starr
North Andover Board of Health Administrator
Office of Community Development and Services
30 School St.
North Andover, MA 01845
RE: Title V third review for Lot 4 Cricket Lane
Dear Sandra,
I find that the revision dated 28 January 2000 adequately addresses the concerns
outlined in my report dated 24 January 2000.
If you have any questions or comments please feel free to contact me.
Sincerely
Carlton A. Brown, PE/PLS
Cricketlot4c.doc
i
PORTf
ENGINEERING
1
Civil Engineers&
Land Surveyors
One Harris Street
Newburypurt,MA
01950
(978)465-8594
MERRIMACK ENGINEERING SERVICES, INC.
PROFESSIONAL ENGINEERS 0 LAND SURVEYORS • PLANNERS
66 PARK STREET•ANDOVER,MASSACHUSETTS 01810•TEL(978)475-3555,373-5721 •FAX(978)475-1448•E-MAIL:merreng@aol.com
February 7, 2000
Ms. Sandra Starr
Town of North Andover
Board of Health
27 Charles Street
North Andover, MA 01845
RE: Lot 4 Cricket Lane
Dear Sandy:
Enclosed are plans which have been revised in response to your comments of January 26,
2000.
Please note the following:
1. By using stepped trenches a retaining wall is no longer necessary.
2. Note#6 has been revised.
3. Water service has been relocated.
4. Finish grading has been revised.
Please call me should you have any questions or comments.
Very truly yours,
MERRIMACK ENGINEERING SERVICES
Les Godin
Project Manager
cd i
cc: Copley Development
Jan-24-00 02:48P Paul D. Turbide, PE/PLS 508-465-0313 P.02
January 24, 2000
Sandra Starr
North Andover Board of Health Administrator
Office of Community Development and Services
30 School St.
North Andover, MA 01845
RE: Title V second review for Lot 4 Cricket Lane
Dear Sandra,
Enclosed find the "Checklist for North Andover Septic System Plans" for the above-
mentioned site. The revisions to this plan appear to be:
1. Change from 4 to 5 bedrooms
2. Change the footprint of the proposed house
3. Add one more trench to the leaching bed
4. Have a garage-under instead of an attached garage.
I find that the revisions adequately address the regulations except for the slope
requirements for construction in fill.
The garage-under will necessitate the installation of an impervious barrier (The critical
elevation of the top of the 1/8 to '/Z inch washed stone is 192.5'. The elevation of the
proposed driveway about 15 feet from the easterly end of the most southerly trench is
190'). Since it appears that the impervious barrier will be the wall marked on the plan
as "PROP. CEM. CONC. RETAINING WALL", then the requirements for a concrete
retaining wall outlined in 310 CMR 15.255 (2)must be met. Specifications must be
added and the appropriate reports or'statements must be submitted to conform to
subsections a,b, c, d, e, f and g of the said 310 CMR 15.255 (2).
(Also 1 do not know what the CEM. means in"PROP. CEM. CONC. RETAINING
WALL".)
If you have any questions or comments please feel free to contact me.
Sincerely
PORTCarlton A. Brown,PE/.PLS
ENGINEERING
Civil Engineers&
Land Surveyors
One Harris Street
Newburyport,MA
01950
(978)46S-8594
f
Jan-24-00 02:48P Paul b. Tut-bide, PE/PLS 508-465-0313 P.01
Facsimile Cover Sheet
To: SANDRA STARR
Company: NORTH ANDOVER BOH
Phone: 978-688-9540
Fax: 978-688-9542
From: Carlton A. Brown
Company: Port Engineering Associates, Inc.
Phone: (978) 465-8594
Fax: (978) 465-0313
Date Jan 24, 2000
Pages Including This
Cover Page: 2
Comments:
Sandy,
Here is the second review of Lot 4 Cricket Lane
Thanks,
Carlton
)AN 2 5 i,',nn
BUILDING TIES INVERT ELEVATIONS
BUILDING CORNER A B 4" PIPE @ FDTN. = 193.99
SEPTIC TANK 33' 31.4' SEPTIC TANK IN = 192.62
PUMP TANK SEPTIC TANK OUT = 192.35
DIST. BOX 32' 38.7' D15T. X IN192.33
CORN. LEACH FIELD #1 20.7 52.8 DIST. BOX OUT = 192.17
CORN. LEACH FIELD #2 49.3' 72.2' END LEACH LINE #1 = 192.10
CORN. LEACH FIELD #3 74.5' 54.0' END LEACH LINE #2 = 191.97
CORN. LEACH FIELD #4 6 END LEACH IN = 1 .7
.5' END LEACH LINE #4 = 189.80
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R = ``�) 20 I :��4. 05,3 30,,
350,pp ---_
I � —
m AS BUILT
OF
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8 2
a SUBSURFACE DISPOSAL SYSTEM t s K8,,
LOCATED IN
NORTH ANDOVER, MA.
M AS PREPARED FOR NOTE: THIS PLAN & CERTIFICATION IS NOT`S6. J9'
COPLEY DEVELOPMENT r``. , SYSTEM.WARRANTY
ISA RECORD OFFACE DISP SAL
THE LOCATION
0 50 COPLEY DRIVE .; AND ELEVATION OF THE EXISTING
" SYSTEM COMPONENTS.
METHUEN, MA. 01844
SCALE: 1"=20' " MERRIMACK ENGINEERING SERVICES
DATE: NOVEMBER 16, 2000 PROFESSIONAL ENGINEERS • LAND SURVEYORS * PLANNERS
SUBDIVISION LOT #4 CRICKET LANE 66 PARK STREET ANDOAER, MASSACHUSETTS 01810
TM 38, PARC. #38,44,45,46; TM 107A, PARC. #217 TEL (978) 475-3555 FAX (978) 475-1448
SEPTIC PLAN SUBMITTAL FORM
LOCATION: LdL� C��,ck I �r•�
NEW PLANS: YES $125.00/Plan
REVISED PLANS: )/ S"' $ 60.00/Plan
SITE EVALUATION FORMS INCLUDED: YES NO
DATE:::�
DESIGN ENGINEER:
DATE TO CONSULTANT:
*If you want your plans expedited, please submit three plans and included a
stamped envelope with the correct amount of postage to mail plans to Port
Engineering. - 'V
When the submission is all in place, route to the Health Secretary.
_ 4
74!6
a
S �e�✓Des+-�+S
SEPTIC PLAN SUBMITTAL FORM
LOCATION: Lok Jjq C K�clk8 L v
NEW PLANS: YES $125.00/Plan
REVISED PLANS: YES $ 60.00/Plan � /b
SITE EVALUATION FORMS INCLUDED: <Z�l NO
DATE: `- 'D o - 0 O
DESIGNENGINEER:
DATE TO CONSULTANT:
JAN 2 0
When the submission is all in place, route to the Health Secretary.
�—f Y
� � 5 i� , ee. _ �
LG
��/s
,ration c rd
documentatlon.requlred for every
record. They wi11 record what
ime of.�the company that_made the
dtitle of the person who gave the
the--document_'number arid`the:date
se:date the
VINI was given°ao you:
e Tint -
Birth date: Age: _
ice-number._:__:° - -
Town of North Andover NORTH
OFFICE OF 3aog
COMMUNITY DEVELOPMENT AND SERVICES ° .
A
k
27 Charles Street
WII LIAM J. SCOTT North Andover, Massachusetts 01845 �gSSgcEHUs��cS
Director
(978)688-9531 Fax (978)688-9542
March 25, 1999
Les Godin
Merrimack Engineering
66 Park Street
Andover, MA 01810
Re: Lots 1-10 Cricket Lane, North Andover
Dear Sir:
This letter will serve as your notification that the proposed septic plans for
the lots specified above have been approved for dwellings with a maximum of
nine (9) rooms.
If you have any questions, please do not hesitate to contact this office.
Very truly yours,
Sandra Starr,
Administrator
SS/gb
cc: Copley Development
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
'Feb-05-99 09:37A Paul D. Turbide, PE/PLS 508-465-0313 P.
February S, 1999
` Sandra Star-
North ndev
erloar= of T!P-Pth Ad-min i
st*aor
Dlce of Commnity Develcp:=ent a-
nd
S nicer
30 School St.
North Andover, MIA 019415 1
RE: Title V review for Lot 4 Cricket Lane
iDear Sandra,
Enclosed find the"Checklist for North Andover Septic System Pians"for the above-
mentioned site. The following is a list of all the`Problem' areas and deficiencies Port
Engineering has found.
i 310 OvM 247(2) states that for a ii3liijiT3um of 2"of 118 to i12 inch gLGme is to be
pias on the top of the leaching'reed. t ne plan design c:ails hor a lager of f lter
fabric to be laid on top this stone. There is no regulation that I could fired that alliuws
biter fabric to be iaid over the peastone, and therefore I would recommence that the
filter fabric be removed from the design.
• The septic tank detail should show that the inlet tee is to extend a minimum of 10
inches below the flow line(227(6)), and that there is to be a 3 inch air space above
the inlet and outlet tees(227(4)),
* Note 13 states that bench-marks are to be placed Nvlthi-n 75 feet of t_he di s-opal area
before construction. A condition of approval of this design should be that the
benchina►k;will be set as notes.
• The septic tank shown on the plan view is drafted incvrree ly Cilie outlet pipe is
incorrectly shown as coming out of one of the inlet ports).
If you have any Questions or comments please feel free to contact me.
- n
Sincerely -- vq;�,Gt
C triton A-Brown,PE!PLS
POIDTI
RA
ENGINFIRING
Civil Engineers&
Lased Surveyors
One Harris Street
Newbiiryport,MA
01950
(978)465-8594
Uj
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CA SEPTIC -PLAN SUBMITTAL VORM
NSEP / A�jr_—
CZAI
C3
C13 LOCAT'ON $125.001P1a'1------'
O Ca (ft YES
PLANS.
CO NEW $ 60.001PIan--`�
0 O gEVJSED PLANS YES
= 7.
-EVALUATION FORM INCLUDED:
SITE
...........
04 DATE:
E
con
SIGN EN
E DE.
0
included a stamped
TO CONSULTANT DATE submit four plans and
se to Port Engineering-
your plans expedited,plea mail Plans t
*If you Want ount of postage to
envelope with the correct am
e Health SecretarY-
all in place route to th
When the submission is
z
FORM 11 - SOIL EVALUATOR FORM
Page 2
On-site Review
Deep Hole Number .1.6�k1k,' Date: Weather
Location (identify on site plan) ......bZ51-M.I.T.1va........ ...... ................................................
Land Use Slope (%) ...tea.. Surface Stones ....H.A..w Y......................................................
Vegetation0 D.I FZ.....................................................................................................I............................................................I.............................
Landform ......NDZA-114f�........................................................I...............................................................................................................-....................
Positionon landscape (sketch.on the back) ........................................................................I................................................................................
Distances from:
Open Water Body .......1.004teet Drainage way-A.00-t feet
Possible Wet Area feet Property Line .....1.0 feet
Drinking Water Well -1.00.t feet Other .........................................
DEEP OBSERVATION HOLE LOG
Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other
(inches) (USDA) (Munsell) (Structure,Stones,Boulders,
Consistency, %Gravell
A
Lt
Off
311 Z'
PAV. t -2.SNt&IJ F
C�`,��75 jcF)
Parent Material (geologic) ...... ................................................... Depth to Bedrock: .40..........
Depth to Groundwater: Standing Water in the Hole: .644...... Weeping from Pit Face: P/).q.....
Estimated Seasonal High Ground Water:
�y � Ll
FORNI 11 - Son, EVALUATOR FORM
Page 3
Detpnd nation SWer Table
Method Used:
❑ Depth observed standing in observation hole.....'inches
❑ D pth weeping from side of observation hole inches
Depth to soil mottles 3.4.1q'I„inches
❑ Ground water adjustment... feet
Index Well Number Reading Date Index well level ...................
Adjustment factor ` Adjusted ground water level.......'— ...
Depth of NatuEally 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
I certify that on f7-1�6 (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 Ix Date �' 7
J- FORXI 12 - PERCOLATION TEST
i
COMMONWEALTH OF MASSACHUSETTS
WoIZ'tFt ALMOVF-Z , Massachusetts
Percolation Test
Time: ...k&i................
Date: ...g�..::.1.4-1.-1..... j
Observation Hole #
-------------
Depth of Pere 3S"-I-Z2 r' __7
Start Pre-soak
End Pre-soak--------------
Time at 12" ; D
Time at 9" : I I ' Z`7 1 ; 22
Time at 6" 11 ,
--------------
i + 3
Time (9"-6„) 7_ 1 HtoI
Rate Min./Inch 71,-,1 lei• (.fir I
Site Passed ET� Site Failed ❑ v ,
.. . AcA,
........................................................................
............... .....
Performed BY: � ��)
Witnessed By: S/11•i�'�� !3-M F_2-
Comments:
o• o ��
coo
`A o
n
J SEPTIC PLAN SUBMITTAL FO N
LOCATION: O , RM v.
21
o ! NEW PLANS: �L,t�v ;�G
QLS—) ,
REVISED PLANS: YES $125.00/plan
°
$ 60.00/plan v�1
SITE EVALUATION F °
ORMS INCLUDED:00 .� .•C
DATE: J Z _ YES NO rown,of Nc�R s
r
DESIGN ENGINE
ER C"
m FJA � � �
5 DATE TO CONSULTAN �'lt »�vi� �/ N b%o Cs
*If you want '— "4
'van' a
envelopeYour plans expedited,
with the correct amount of lease submit four o C
postage to mail plans to p and included a
stamped
Port Engineering.
When the submission is all in
�l place, route to the Ifealth Secretary,
I �
t�
N
TOWN
(D O O in
CID
. 0�0 �' �• N 00 �Fl•9',, O2
00 {y O°
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- -
--------------
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N
Lot 4:
• Please note that the septic tank is drafted incorrectly.
Lot 5 and Lot 6:
• Scale of the Plan view is not shown.
Lot 7:
• The scale of the Plan view is not shown.
• Pump Note#4 neglects to state that the high water alarm is to be located in the house.
(3 10 CMR 15.231(9).),
Lot 8:
• The estimated seasonal high water elevation-has not been adjusted to the highest
existing grade. This results in the leaching area being less than 4 feet to groundwater.
(3 10 CMR 15.?? _$&b).
Lot 9:
• Slope easement required from Lot 10. (310 CMR 15.255(2))
• Slope to d-box exceeds 8%, therefore, at minimum, a baffle is required. (310 CMR
15.232(3)(a))
Lot 10:
• Fill around system runs to property line of abutter. Toe of slope required to be 5 feet
off the lot line. (3 10 CMR 15.255(2))
• Trenches #1 and#1 do not show 4 foot separation to groundwater. (3 10 CMR 15.212
a& b).
Please feel free to call the Health Office with any questions you may have.
Sincerely,
Sandra Starr, R.S.
Health Administrator
Cc: W. Scott
File
Form 4 -- Syste eeord
Commonwealth of Massachusetts
Massachusetts y' " of
System Pumcing Record (J
System Owner System Location
4yps: Emergency Routine
Cesspool: w L Yes Septic tank: w =Yes
Daft of Pumping: O) Quantity Pumped: /Co- salons
System Pumped By: Wind Rirrr EnviAN~t41, LLC Permit#: —�--+_—
Contents transferred to: /
v r
Contents Disposed at:
6
Rmw
sigr4tL—:
Condition of System/Other Comments
Dep Approved Form - 12/07/95
Commonwealth of assac usetts
City/Town of
I
System Pumping Recor 407T - 7 2008
Form 4 I
TC,, .
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 1. System Location:
forms on the
computer,use C
only the tab key Address _
to move your Nor k�) An�Ovt,� M Q O1 IK4 G
cursor-do not CitylTown State Zip Code
use the return
key. 2. System Owner:
�t ex i a_�el q
Name
1�J Address(if different from location)
City/Town State Zip Code
9TH - 613S - aS95
Telephone Number
B. Pumping Record
1. Date of Pumping
Date og >�oo
2. Quantity Pumped: Gallons
3. Type of system: ❑ Cesspool(s) [Septic Tank ❑ Tight Tank ❑ Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes 2 No If yes, was it cleaned? ❑ Yes ❑ No
5. Conditionof System:
QooJ
6. System Pumped By:
J;m ValiAn 7b6-7 9
Name Vehicle License Number
Viv)J -Rive Eryironmcnial
Company
7. Location where contents were disposed:
Signature of Hauler G. .3.D. Date
` Lawrence, MA.
Signature of Receiving Facility Date
t5form4.doc•03/06 System Pumping Record•Page 1 of 1
Commonwealth of Massachusetts
City/Town of
System Pumping Record NORTH ANDOVERMCT
Form 4 �'�
DEP has provided this form for use by local Boards of Health.Other forms may be used,bit TOWN OF NORTH ANDOVER
information must be substantially the same as that provided here.Before using this form,Cfeck to°F 1 DEPARTMENT
local Board of Health to determine the form they use.The System Pumping Record must
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 fining out 1. System Location-
forms on the1{�`
computer,use til^�_
only thefab key Address
to move your
cursor-do not GlyrTown Stale Zip Code
use the return
ked--�h 2 System Owner
Name
Address(d different from location)
GityrTown State Ii -
Telephone Number
B. Pumping Record
1. Date of Pumpingpate 2. Quantity Pumped- Gskonv
3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Grease Trap
❑ Other(describe). -
4 Effluent Tee Filter present? ❑ Yes ( No If yes,was it cleaned? ❑ Yes j,No
5. Condition of S�^stem
6. System Pumped By.
Name VehiUe License Nvmoe,
Company
7. Location where contents were disposed:
Signature Di Hauler North Andover,Mk- Date - - — — --
Signature of Receiving Facility Date
15fom-A.doc•07106 System Pumping Record•Page I or I
Commonwealth of Massachusetts , 21Z
City/Town of
NORTH
System Pumping Record NORTH ANDD �,� 9LDTHDEP RTMENTR
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 within 14 days from the pumping date in
accordance with 310 CMR 15.351.
A. Facility information
Important:
1 S
When filling out stem Location:Y
forms on the
computer,use _.__._13// -
only the tab key Address
to move yourcur
-- _ -� _ 0 . _ _. -
use the
- et not City/Town State Zip lode
use the return
key. 2. System Owner:
V� �
_
----aux-- _ _ ��� -----_.-_—----
Name
Address(if different from location)
City/Town
- State Zip Code
— 921-_
Telephone Number
B. Pumping Record
1. Date of Pumping Date — 2. Quantity Pumped: Gallons
3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System:
6. System Pumped By.
t �
Name Vehicle License Number
Company
7. Location where contents were disposed:
----------------- -... . Date
Signature of Hauler North AmdCV
im_ — -. ..._._..—_..... .--------- ---- -
Sign_ature of Receiving f=acility Date
t5form4.doc•03/06 System Pumping Record•Page 1 of 1