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HomeMy WebLinkAboutMiscellaneous - 1327 SALEM STREET 4/30/2018 (4) 1327 SALEM STREET _ 210/106.A-0125-0000.0 v Y t' r '' .: C � r '@� lt? •..r+' 'tut,/r!a �.n'i •s•:':'_:"�7':. ''�•' �''. ?!; - .'r.y+ ti ��,� �•_�, 4~i " r < 4w i °r.. ,� J is J Yy,1 ]�. t� _ _ r..► - �t ; i 'lI t',•+Fr ('?r`r,.j�,:�^�,� - `! 1 r fir• y+�,�1 N?a�. ' - --� - ., , .5. t� f". t k�•`'��*`fi'� �a . ` tt .. .tlr r K �4fr:�.�is S�'�.��)f�r" � �4 • _ �' t s¢ y �t'�,1'J ��•�'4� t �• r r Y ,,�{, �.r f' .'4'♦,: it 4 r'f.:}"`i a }i�`��.•-,r.�'h,:.i.' • MAP # # tf:J c ' LOT PARCEL # STREET_' QO.NSTRUCTION_APPROV 1, HAS PLAN REVIEW FEE .DEEN PAID? YES NO PLAN APPROVAL: DATE / �P APP. BY DESIGNER: � PLAN DACE. _ CONDITIONS • WATER S _ URRLY. . OWN WELL WELL PERMIT DRILLER t WELL TESTS: CHEMICAL DAIE APPROVED RIAI DAIE OPPRUVEU BACTERIA JA I DA i'E in—PPR0VE1) COMMENTS: FORM U APPROVAL: APPROVAL TO ISSUE YES NU DATE ISSUED BY CONDITIONS: FINAL APPROVAL: . ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NU SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NU ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: BY: ,�EPTz_C�SY�IC��NSSfl4L..gQt4 "i� ry t ,. � r .''I�'tby Y': .I . - ._.• '-••e,.�i T..L t ? I' yi♦_\-1� ♦. J• ' 1. 1. 7• �- - rtx ;ISTHE' INSTALLER LICENSED? YES NO „ f t , , - .• ,� ': r 1'".'- :.. . `,;•"• r _• it ` .TYPE. OF CONSTRUCTION: ? NEW REPAIR NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW \YS NO .E 1 ; CONDITIONS OF..APPROVAL YES NO (FROM .FORM U) ­ E DWC PERMIT t YES' NO t DWC PERMIT N0. y _ INSTALLER: .-:.-BEGININSPECTION YES 0: EXCAVATION . INSPECTION: ' NEEDED: a ' • Iff / BY .-'"' '% PASSED �. CONSTRUCTION INSPECTIONS NEEDED: . .AS BUILT PLAN SATISFACTORY: (_Y:ESs APPROVAL TO BACKFILL: DATE: �6 A� BY ' ..,FINAL . GRADING APPROVAL: DATE Z BY DATE: BY . FINAL CONSTRUCTION APPROVAL: i ELEVA TIONS DESIGN AS—BUILT TOWN OF N( ---Vi ANDOVER/ INV. OF PIPE OUT OF HOUSE 95.65 95.57 BOARD OF 41ALT14 INV. OF PIPE AT SEPTIC TANK INLET 95. 15 95.09 7 l9 INV. OF PIPE AT SEPTIC TANK OUTLET 94.90 94.82 INV. OF PIPE AT D—BOX INLET 94.44 94.61 INV. OF PIPE AT D—BOX OUTLET 94.28 94.43 INV AT BEG. OF DISTRIBUTION PIPE 1 94.26 94.34 INV. AT BEG. OF DISTRIBUTION PIPE 2 94.26 94.34 INV. AT BEG. OF DISTRIBUTION PIPE 3 94.26 94.33 320.2 1500 GALLON D—BOX 2 SEPTIC TANK INV. AT END OF DISTRIBUTION PIPE 1 94.00 94.05 34' PT-Q2 TP3INV. AT END OF DISTRIBUTION PIPE 2 94.00 93.99 =35 TPI ��9 s� INV. AT END OF DISTRIBUTION PIPE 3 94.00 93.74 �� �y PT-3 25' PT_1 y0Z�' �. 32' N . EXISTING FOUNDATION ; Q ai �J , TOP OF FND. ELEV. = 97.74 i �\ ��/%/ ^• TP2 CJ Q VENT ('TYP.) kn LOT 20 c� °'- LOT AREA = LOT A S.T. - NOTE: THIS PLAN IS NOT A WARRANTY OF THE SYSTEM. IT IS cr A RECORD OF THE LOCATIONS OF THE EXISTING STRUCTURES. 56.10' m INTERIM AS BUILT PLAN OF 320-00p SUBSURFACE DISPOSAL SYSTEM AT LOT 20 SALEM STREET IN '= NORTH ANDOVER, MASS. `^ISTEP +y`� UNA` PREPARED FOR: S & S BUILDERS SCALE: I" = 40' ` DATE: 10/7/96 CHRIS TlA NSEN J ERV l PROFESSIONAL SURVEYORS EERS 160 SUMMER ST HAVERHILL, MA 01830 TEL. 508-373-0310 c0 1996 BY CHRISTIANSEN & SERGI INC. DRAWING NO. 9507400 �~�r NORTH ANDOVER BOARD OF HEALTH DESIGN REVIEW REPORT FEE: PERMIT # DATE RECEIVED q��Ax� APPLICANT c ' t5 -�5016AMAP PARCEL ADDRESS LOT # 13Z7> ENG. Cf�/21 ST!/�iUR� STREETGC� ADDRESS PLAN DATE / z ��� REV. DATE CONDITIONSOFAPPROVAL APPROVED DISAPPROVED REASONS FOR DISAPPROVAL: 5�1�>7C Tl9�1/� Z-,,=66 Tff/�� <S ` 7-0 /U O 2 6-5 6;;e OR 4/b O R o TN�� ( ,P,4 n>U�.9-e �f,9TE/Pj,7iGJ o,e j5)4ti 1C D Town of North Andover °t NORTH " OFFICE OF �? ,�'' COMMUNITY DEVELOPMENT AND SERVICES p 146 Main Street �, 404-;.o KENNETH R.MAHONY North Andover,Massachusetts 01845 9sSACHUS�� Director (508) 688-9533 October 11, 1995 Mr. Phil Christiansen Christiansen & Sergi 160 Summer Street Haverhill, MA 0.1830 Re: Lot #20 Salem Street Dear Phil: This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: 1) Septic tank less than 25 feet to foundation drain. 2) No apparent reserve area. 3) Vent required for trenches. 4) Breakout elevation 94. 66 - please check lower side of system. 5) Note #2 regarding fill should read: " . . .clean granular sand or other granular material, free from organic matter and other deleterious substances. Mixtures. . .used. The fill material shall have a percolation rate between 2 and 5 minutes per inch, before and after placement. " If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Sincerely, Sandra Starr, R.S. Health Administrator SS/cj p BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Julie Partin D.Robert Nioetta Michael Howard Sandra Starr Kathleen Bradley Colwell PLAN REVIEW CHECKLIST 63=27J ADDRESS L�jZD S LG ENGINEER �,�.�'�ST//��'✓�'�%� GENERAL 3 COPIES STAMP �� LOCUS NORTH ARROW SCALE CONTOURS PROFILE ----- SECTION c/ BENCHMARK A SOIL & PERCS ELEVATIONS WETS. DISCLAIMER WELLS & WETS WATERSHED? /�/6) DRIVEWAY C--'�'(Elev) WATER LINED FDN DRAIN SCH40 °1--", TESTS CURRENT? SOIL EVAL A.ST�.P� SEPTIC TANK / �� // MIN 1500G .17 INVERT DROP GARB. GRINDER/W (+200% EDF) zo/ 25 ' TO CELLAR/` MANHOLE ELEV GW # COMPS. D-BOX SIZE # LINES 3 FIRST 2 ' LEVEL STATEMENT INLET q � - OUTLET 9-/ -? _ (2" OR . 17 FT) TEE REQ-D? LEACHING l MIN 660 GPD?� RESERVE AREA 4 ' FROM PRIMARY? ' 20 SLOPE 100 ' TO WETLANDSL 100 ' TO WELLS 4 ' TO S.H.GWy (5 ' >2M/IN) 35 ' TO FND & INTRCPTR DRAINS L----325 ' TO SURFACE H2O SUPP `�— 4 ' PERM. SOIL BELOW FACILITY 1--- MIN 12" COVER (FILL? �(25 ' 1�1E056 if above natural elev; 10 ' if below) BREAKOUT MET? AJO #z Fes-F/CL, TRENCHES MIN 660 gpd A SLOPE (min .005 or 6"/100 ' ) ""'�SIDEWALL DIST. 3X EFF. W OR D (MIN 61 RESERVE BETWEEN TRENCHES? IN FILL? V MUST BE 10 ' MIN. t- ' 4" PEA STONE? VENT?�'� (>3 ' COVER; LINES >501 ) BOT + SIDE X LDNG TOT (L x W x #) (DxLx2x#) (G/ft2) Copyright 0 1995 by S.L. Starr 4 tAQRT" Tovm . � Of 0 over o K art dover, Mass.,_ 7 19 COC.ICMEwICK RATED PP �� S BOARD OF HEALTH RMI Food/Kitchen PE T T Septic System �O� c� -•, THIS CERTIFIES THAT................................ BUILDING INSPECTOR C !V.�............ d.�l;s ...... . .............................. Foundation has permission to erect..............�.A�F. buildingl,on ............1.. ..?...........�A.l r.�../:..4 ........S.'T:....... Rough to be occupied as................................................................ /../�l.�a.. .......... Chimney ................................... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final Buildings in the Town of North Andover. PERMIT FOR FOUNDATION ONLY PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. REGULATED BY PARA. 114.8 S. 13.G. g 1 PERMIT EXPIRES IN 6 MO W;H,`�V_-�FEE PAID �� (5k"h 9-2�0 UNLESS CONSTRUCTION STAR ELECTRICAL INSPECT oe ................................. . .... .... ....... ......... ................. i .. ... ervic BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Fifi� 1� a"(• p� �, No Lathing or Dry Wall To Be Done � �- Until Inspected and Approved by the Building Inspector. FBurner IRE DEPARTMENT OV- � Q'�223=5 o. Smoke Det. CHRISTIANSEN & SERGI, INC. PROFESSIONAL ENGINEERS AND LAND SURVEYORS 160 SUMMER STREET HAVERHILL, MASSACHUSETTS 01830 (508)373-0310 FAX: (508)372-3960 August 20, 1996 TOWN OF OF NORTH Ms. Sandra Starr North Andover Board of Health AUG 1 19% 120 Main Street North Andover, MA 01845 Re: Lot 20 Salem Street (S & S Builders) Dear Ms. Starr: At the request of my client, Fred Saracino, I have reviewed the the septic system design for the above referenced lot to determine what impact the lower as-built foundation elevation may have on the septic design. My findings are as follows: 1. The top of the existing foundation is at elevation 97.7 ft. 2. The proposed invert elevation of the building sewer at the foundation is at elevation 95.65 ft., therefore the top of the pipe will be at elevation 96.0 ft. +/-. 3. Assuming that the minimum cover amount of 12" will be placed over the top of the pipe, the finish grade at the foundation will be 97.0 ft. 4. The resulting 0.7 ft. +/- of exposed foundation wall is within Building Code allowances. 5. Although the driveway will be steeper due to the lower foundation elevation, the Title 5 slope requirements can be met at the driveway. In summation, the lower foundation elevation will not prevent the septic system from being constructed accord' to the approved plan. .:VcpiSH OF Rf� Ve r?�, p a � 'M 5083723960 P02 CHRIS"TIANSEN & SE'OGI, INC. PROFESSIONAL ENGINEERS AND LAND SURVEYUK5 (508) 373.0310 FAk (508) 372-3960 160 SUMMER STREET HAVFRHILL, MASSACHUSETTS 01$3(7 AN�O�Et� WN of 14 6f S� t3o�'R August 20, 1996 ? l tJOS Ms. Sandra Starr North Andover Board of health 12U Main Street North Andevcr, MA 01845 Re: l.ot 20 Salem Street (S & Builders) Dear Ms. Starr: At the request of 1ny client, Fred Saracino, I have reviewed the the septic system design for the above referenced lot to determine what injPaet the lower as-built inundation elevation may have on the septic design. My findings are aS ti)llows: I, rhe top of the existing foundation is at elevation 97.7 f1• 2. 'T'he proposed invert elevation of the building sewer at the foundation is at elevation 05.65 ft., therefore the top of the pipe will be at elevation 96.0 ft- +/-- 3. Assuming that the minimum cover amount of 12" will be placed over the top of the pipe, the finish grade at the 16undation will be 97.0 ft. +-/-• 4. Z he resulting0.7 t1. -4./- of exposed foundation wall is within Building Code allowances. due to the l 5. Although the driveway will be steepercower foundation elevation, thc'Title S ,lope requirements can be met at the driveway. In summation, the lower toundati�?n elevation will not prevent the septic syst,,-m from 1t bei9 constructed accord' , tO the approved plan. , p,LTH Up 4r,� Ver � ' a Phil' 08/20/96 14:22 TX RX NO.1017 P.002 $ 5083723960 Pill CHRISTIANSEN & SERGI, INC. PROFESSIONAL ENGINEERS AND LAND SURVEYORS FAX 160 SUMMER STREET HAVERHILL, MASSACHUSETTS 01830 (508) 313.0310 FAY,: (508) :172.3960 August '20, 1996 Ms. Sandra Starr North Andover Board of Health 2.0 Mala Street Nonh Andvvcr, IvL"L 0184.5 Re: Lot 20 Salern Street (S & S Buitders) Dear Ms. Start': At the request of my client, Fred Saracino, I have reviewed the the septic system design for she above referenced lett to determine what impact the lower as-built foundation elevation may have on thr. septic design. My findings are m follows: 1. The top of the existing foundation is at elevation 97.7 ft. 1. The proposed invert elevation o3 the bUding sewer at the foundation is at elevation 95.65 ft., therefore the top of the pipe will be at elevation 96.0 ft. 3. Assuming that the minimum cover mount of 12" will be placed over the top of the pipe, the finish grade at the foundation will be 97,0 tt. _ tion wall is within Btti.lding Code allowances. 4. The resulting 0.7 ft. / of exposed foundation 5. Although the driveway will be steeper due to the lower foundation elevation, the "i itle 5 slope requirements can be riot at the driveway, In summation,, the lower foundation elevation will not prevent the septic system from ir19 constructed accord' to the approved plan. Ve P ,� 310 CMR: DEPARTMEN-1' OF ENti-EtO,',4-i'vENTAL PROTECTION 15.255: continued (a) The retaining wall shall be constructed of reinforced concrete, shall have no weep holes. and shall be waterproof. (b) The retaining wall shall be designed by a Registered Professional Engineer, who shall certify that the above condition is met by the submitted design. (c) The upgradient side of the retaining wall shall be waterproofed. (d) Construction of the retaining wall shall be supervised by the design engineer. (e) An as-built plan shall be prepared and certified by the design engineer that the wall has been constructed in accordance with his approved design plan. (f) The elevation of the top of the retaining wall shall be no lower than the "breakout" elevation,which is the elevation of the top of the two inch layer of'/s inch to '/z inch washed stone aggregate cover. (g) The distance from the wall to the edge of the leaching area should be at least ten feet. (3) Fi11 material for systems constructed in fill shall consist of select on-site or imported soil material. The fill shall be comprised of clean granular sand, free from organic matter and deleterious substances. Mixtures and layers of different classes of soil shall not be used. The fill shall not contain any material larger than two inches. A sieve analysis,using a 44 sieve, shall be performed on a representative sample of the fill.Up to 45%by weight of the fill sample may be retained on the#4 sieve. Sieve analyses also shall be performed on the fraction of the fill sample passing the 94 sieve, such analyses must demonstrate that the material meets each of the following specifications: SIEVE SIZE EFFECTIVE %THAT MUST PARTICLE SIZE PASS SIEVE # 4 4.75 mm 100% 450 0.30 mm 10%_ 100% 9100 0.15 mm 0%- 20% 4200 0.075 mm 0%- 5% A plot of the sieve analyses of the portion of the sample passing the 94 sieve shall fall on or between the lines on the following graph: 1 PARTICLE SIZE DISTRIBUTION ' tG0 #200 t100 {SC `' AU ;-;�� �� �� f Sieve Sze 90 80 1 ! 1 I 70 ,f 03 c i W 50 ! I A Jj, z 40 0- 30 ! 1 20 t 10 0 Micron 60 200 600 2 6 110 mm 12/1/95 (Effective 11/3/95)-corrected 310 CNiR-531 1 SEP-07-199E 09. 11 FROM MILLER ENGINEE°Ihr,MNCSTF TO 150868732'77. 51 P-33 ✓J� TOWN BOARDOOF HEALTH Tue Sep C3 08:38:26 1996 EPagei C-$OTVCMICAL LASORATORT TEST DATA Project GALWWAY QC FSlensn,e 7,96743 Project No• 50376.01 Depth : NNA slovation N%A Soxing No. N\A Test Date : 9.3.96 Tested by DCN Ml 6aarple No. L96743 Test Method ; ASTM Checked by SC Location : GALL74AX PIT Sol! Description , SEPTIC SAND Remarks ; ASAP COARSE SIEVE SSI Sieve Sieve Openings Weight .a,xulative Pcroent Mesh Taches Millimeters Retained Weight Retained Fi.nex ilbY !lb) (}) 1" 1.000 25.40 ti-50 11,50 100 0.75" 0.752 29.10 11.5C 11.50 100 0.5" 0.500 12.7. 12.25 12,25 98 0.375" 0.375 9.52 12.65 13.40 96 44 0.287 4.75 15.10 17.00 s7 'Focal Weight of Sample . $4.6 Tare Weight - 11.5 FINE SIEVE 68T Sieve Sieve Openings Weight CVMulative Ptrcent Mesh InChee Millimeters Retained Wcigbt Retained Finer (gm) (gm) (3) 810 0,0;9 2.00 24.80 24.80 ---77 420 0.033 0.85 26.20 51.00 66 #40 0.017 0.43 76.00 127.00 35 pyo 0.010 0.25 60,50 187.50 9 4100 0.006 0.15 14.50 702.00 3 8200 01003 0.07 4.20 206.20 2 Pan 3.90 210.10 0 Total Weight of sanTle . 213.9 Tare Weight . 0 Moisture Cwtent 0 DAS 3.9356 MM D60 0.7440 an D50 0.5973 an D30 0.3864 nm DIS 0.281S :req DSO 0.2533 nen Soil Classification A8TM Group 8yrbol SP ASTM Group Name Poorly graded sand AASRTO Group 8ymbo2 A•1-b(0) AASXTO Group Name : Stone Fragments, Gravel and gand 51,�4 014 C4cv--A.,�, > ;lf/05hr TOTAL P.03 5- O Q�!//►fit/ 9� /�4'I�tSE i��'!� �IQ'l/// �'� v O 607 32- ;!-7 _GRAIN SIZE DISTRIBUTION - AGGREGATE GRADING Boring No. : N\A Project : GALLOWAY QC Somple No_ LR6743 Project No.. 50376.01 MILLER,..ENGINEERING do TESTING, INC- Tested by DC\BM Locotion: GALLOWAY PIT ----- — Filenorne L96743 Date Tue Sop 03 1996 J.S. STANDARD SIEVE SIZE 4" 2" 1' 0.5" 46 f10 ¢20 }4o 06o 4100 J200 4400 N 100 —},T, ( r 1-1Tn k-- , ° I F �--I 00 lis I Itl h ; I ! I ! I I i , III ' i I. i I ILII i {i 3 1:3111 i i Cr! 90 1° F- 80 -7 3sI!I�1Ij:-t� � ! i}l-�l�i •r� I' ; -- 20 70 r I-li-i—'--- 30 i i 60 i 1 -i---}�-� -y-I- -- i I ri�-+ s -- s. y 1--�- :. . I 1 —� -f-i— -- 40 F— Cn 4J i 50 � 4 1! Q 7 40 -i W U I 1 1 1 1 { r =fr ..e , i1 i i ° I 1• s I ; Q. w 30 j _ -a j T= ; -i ---�i j 1-±- ; -i- } f ,-i �i i; i i }- _ �,� �_I-+-i—±- 70 jj � ''hj ss iT''1 1 { w 20 11 I - -- j N -�—t-- I E I-1 F '-1— , i :[�'a !I j ° 1 80 J J I I I I i �iiii I g t I Itit i I I i �lii 1 F I i I £ ' I.1 ' � 10 ,€{-! I . I I I 1; IIs i l i i Ill ! rl l lrt � �� t 1 1100 Lif LL 1000 500 100 50 10 5 1 0.5 0 1 0.05 0.01 0.005 0.001 GRAIN SIZE IN MILLIMETERS U' CRAVEL SAND C013 .s — SILT OR CLAY CDARSE FINE CtamsF MEDIUM PINE D� rJti r1 Clossi{icotion Remorks (SP) Poorly groded Bond ASAP CL Visual Description >EPTIC SAND Figure I �4 V 5083723960 P()1 C RISTIAN EN & SEI: li, INC%, Professionai Engineers and Land Surveyors 150 SUMMER STREET HAVERHILL, MASSACHUSETTS 01830 pR�� TORN pF N pF NE 3-03 0 BppR1� • SEp _ g �g90 FROM FA 508-372 -' , RGI-ASC ULl- j VEP Tlii i 0LL0WING PAGC (S) TCI : NAME AN 1) FIRM: TOTAL NUMBER OF PAGES _ �- ( includinS cover pzac, ) DATE SENT �� , _ TIME SENT.-—— �� CLIENT- CI�WO I—O r ?u LEO ST-a _ OP S t "vi liomA l."Ims_ 4417 S 10 a , �C st LC ME 1 EV 0 L4 OlqA) IF THLRC IS A14Y PROHl.F1' RECCIVING THIS TRANSMISS1ON CALL 50$mm373-0310 ANU ASK r 0R:_ 00� V 5083723960 P02 VEMPUM79UPFW 10DOMEFF19LD" M o•P.O.VQX A775 4 MANGHUTER,NEW MAMP$HI%C31G0•TRL MM d08-W10•IAA:(W3)OW-x}41 139 LAT MAIN>fTF1EET•*,O BOX 11 •NORTMSOROLrOM.M+A63ACHU8ff TS 01*R•TES 008)393.2W' FAX(50a)303-0490 =F�-06-2 p9E 16 0� FROM M I L'LEF ENG I NEED'I tZ i MNCSTR TO 1�509-2^23660 F.02 tz� Atp 06 1513)115 lost pace 0120T& IWSC►s• LANMATMY MT UTA Project iLLdMAB Qt F�xenratw i L1i763 �rey�nt fro, t lbi7d.Ol Depth : N\A Slwatiaa i N\A got" NO. ; lP1A J%I Daof : L-3-96 Tooted by DC1SH 04th fro. ; Lf04) 'rest joeaod alrt>ti checked Ay 1rt LoCAtlOn ; dAU*WAY DIT Iv41 4N4Griptiaf+ , !brie 9AIM icea+arkr �sa� Fila sure NET _ Ole" Owe op4YSio4e 'Night cumulative peremnt ��r Meth ixa03xaa Mi1Xltiwt♦r� PA"L"d weight Retained 71PAr 1 � tptril fwi N.. ....-- -0.17 _...-4.ys.. _...0.00 M1Q 4,079 1.00 24.so si.ev ee 520 0,033 9.41, 26.20 s:.o4 76 N40 0.017 0.43 74.60 1:7.00 •0 � —�.� � �`LY Ni0 01010 0.25 40.s0 197.90 10(1 0.044 O.IS 14.30 202.08 K r 0.001 G.07 4.2C 2016:20 3.9C 270.10 Total %toot at tople • 31)'1 Tare weivkt - a 1MCa,.turt QpriE�Yit � o •��. 1756 .,65662 amja►.Aa1B� _—116 . ,,_ �,.�. .--� pea 0.40.6 bio 0.3256 am .�. ___. ' •- ---,-----_.�_T-�... Dao G.3sd6 ba, 9.479) 9341 Gxau�.xinasi.oe� AM GNOW &YwbDl , It Aft" dr-w Kati 96WIV frail" sma ! ARNKM QTVW BY093 i A-1-b(0) AiAV= fano i st-m rropeanLf. Mrs"I And #ulud APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT !1 DATE: CURRENT INSTALLER'S LICENSE# LOCATION: ' ® LICENSED INSTALLER: SIGNATURE: (wjA_)q,,,tTELEPHONE#6Z)9&6 Z�Z� CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only $75.00 Fee Attached? Yes ✓ No Foundation As-Built? Yes No Approval Date: Town of North Andover, Massachusetts Form r,°' a BOARD OF HEALTH .. Of NORTH 14, - 19 O DISPOSAL WORKS CONSTRUCTION PERMIT �9SSACHUSEt - Applicant Ltluf NAME I AD SS TELEPHONE Site Location Permission is hereby granted to Construct-�r Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. s/d 4 1 .:.„ ; Fee D.W.C. No. r�J TOWN OARt7 OF HAA HWER/ AUG 1996 LOT 19 320' m w ` ` J EXIS77NO FOUNDATION LOT 20 TOP OF FOUNDATION ELEV477ON=97.7 46,800 SQ.FT.t Ct LOT 21 REFERENCE PLANS: N.E.R.D. PLAN FILE#5702 & 6196 FOUNDATION LOCATION PLAN TMT S ,�OF V APKXAAE ZONBMG snAWS IN EFFECT WHEN CONS7IPII M Ma CERRm11oN DOES NOT COMB/ANr onMER RES7Rk7MM SUCH AS COVE71fMM CLIENT: SARACINO CONSTRUCTION INC. aom OF OONDf11GMVS.E7C) THIS OMWM SIMU NOT BE USED Br WE CIW FOR ANr THIS CERT/fICATION IS MADE AND UNITED PUS PM onfM "M Mr OUn.06o ABO►�E Wr *= INE W1WT/EN PEMAMSgM OF 06M/AMM & SM IMC TO THE ABOVE CLIENT. FURnMO M M "0 DRAWM/8 IS THE COIPrR/O M PWPgMY OF CHR5114MM 4 SM IMC AND ANY UNAUTHOMM UM IS PMM8IlEALhMl14NSEN & SEAIII MM NO RESPOMS/MUM FOR 7K UNAUii#MM USE OF THIS DRAWMIO OR ANr IWOR-- MAnom CONrAMIED HOM M LOCATION: LOT 20 SALEM STREET NORTH ANDOVER, MA. �H OF SCALE: 1" = 60' DATE: MAY 3, 1996 $� E.' yT U H o 191 CHRISTIANSEN &SERGI `k"° MMIO SUMMER Sr. NAYEFHU." 01Q.'Jo IEC 3Oh373"alo ®1986 Rr CIMWUNSE1V & SERA/ IMC. DRAWING No. 95074001 Town of North Andover, Massachusetts Form No.2 MORTNBOARD OF HEALTH 19 _ 9 DESIGN APPROVAL FOR 'ss4C"°5` SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant Test No. Site Location �•t�T a-U ��1.�--d_--���,..� A = Reference Plans and Specs. C-"-.S L-1'n m-- -<Ro A.4 ,( A21,�rl�' ENGINEER DESIGN 6— DATA 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 Site System Permit No. (0('e FORM U - IAT 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 II landowner from compliance with any applicable local' or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: Phones LOCATION: Assessor's Map Number Parcel Subdivision Lot(s) Street �" t-•i�-"' " ' ` � _ St. Number 132:1 ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Date Approved Food Inspector-��He—ealth Date Rejected Date Approved /� �•7 Septic Inspector-Health Date Rejected Comments ,-s-- ` Public .Works - sewer/water connections 1 '� W l 27- - driveway permit 2 7 Fire Department Received by Building Inspector Date i Town of North Andover 01 NORTH 1 OFFICE OF �? ye1eo ,6etiOL COMMUNITY DEVELOPMENT AND SERVICES ° . 146 Main Street , North Andover, Massachusetts 01845 WILLIAM J. SCOTT SAC US Director Memorandum To: Bill Scott, Dir:PCD From: Sandy Starr, Heak .' tr�ator� Date: September 23;.1996 Re: 1327 Salem Street In response to your memo of September 20, 1996 concerning 1327 Salem Street I have created a chronology of the history of the project:: 10/26/95 -.septic plan approved 8/20/96 application for septic construction permit 8/21/96 - approval of application 8/216/96 - bottom of bed inspection done and approved 9/3/96 - sieve analysis of proposed septic sand done and submitted 9/4/96 sieve analysis reviewed and disapproved 9/9/96 revised format of sieve analysis submitted, reviewed and approved 9/11/96 - discussion with septic installer on readying bottom of bed for inspection since it had rained since the last inspection 9/13/961 - Rain 9/16/96 - Rain 9/17/96 - Rain 9/18/96 Rain 1 BOARD OF APPEALS 688-9541 BUMDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 ti y September 23; 1996 9/20/96 - Call received from installer stating that side of excavation had caved in and asking for a time.when an inspection could be done immediately after the hole was excavated. Appointment set up for Wednesday, September 25th, around 11:00 A.M. 9/23/96 --Rain. Spoke to installer in attempt to find a time when inspection could be done. Inspection date originally set up for late morning on Wednesday, September 25th. However, rain is forecast for that date. He is to call back depending on backhoe availability. l hope this clarifies for you the process which has occurred concerning this site. Please.let me know if you have any questions. 2 TOWN 0 NQ�� No......................... BOF AtCDNOyR/ THE COMMONWEALTH OF MASSACHUSETTS j BOARD OF HEALTH SEP 19 1995 1.V. ........OF....... Q... .... :C.'\(..W.VE. ..... ......... Appliration for lliipo,ial Mirkii Tomitrurti Application is hereby made for a Permit to Construct (�) or Repair ( ) an Individual Sewage Disposal System at: .......:.... U ._.... ••-•-- --------•-----• •---••--•....o....L..o.t..,.Il.F.o... ...................----------.----_---••- Location Address � -- P ���5•--�3 .. - ------ ------------ -- .._ -�.,. W Owner Address i a ..........................................•-•................................................. ..................................................... Installer Size Address Lot...._.�°��0d......Sq. feet U Type of Building �-, Dwelling—No. of Bedrooms.........Y...............................Expansion Attic O Garbage Grinder ( ) `4 Other—Type of Building ............... No. of persons..........._.............__. Showers ( ) — Cafeteria04 ( ) d Other fixtures Design Flow............................................gallons per person per day. Total daily flow.............66?P....................gallons. W Septic Tank—Liquid capacity.15. .d..gallons Length.. 10��" l��idth._.�'`f`�'.: Diameter---------------- Depth..S . x Disposal Trench—No....�........... Width....41............. Total Length.645' ..._. Total leaching area.`-1.1/...sq. ft: Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) ►-' Percolation Test Results Performed by................................ ----------------- Date........................................ _ ,aa Test Pit No. T___. O minutes per inch Depth of Test Pit-----?!2.......... Depth to ground water....1/9"...C6#6I / fZ4 Test Pit No. 4.....t.__....nunutes per inch Depth of Test Pit.__/_t'A.._......... Depth to ground water..../.t_...eslva llTf 0 9 -•--•--•-•••---------------------------••--•---------•-••--•----•-•...-•--.......---...................--••-•-•--••--------••---•--••-••-.._......---...----- Description of Soil.......................................................................................................... ............................................................. j x W U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ....................--....................... ------------....---------------------••-----......---•----...--------------------------------••-------------------.....-•-------------..........--•------• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed --•-------•-•-------------------------•---•--•-••••......•- Date Application Approved B Date Application Disapproved for the following reasons-------------------------------------•------------------....-----------------•--•----•••--•----......_........--- .......•-••-•-----•-•-•-•------•------•-•--•••-----...---•-•-----...-•-----•--•-•--•---•--••-•--••-•......----•-----••••--•-••---•-•----•-•-------•---•--•-----•---•••----•----•....••-----••••••...-••-- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................:.................OF........................................................ (Intifirtt#p of Tomphaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by----------------------------------------------------------------------------------- --•------------------_-_-____--------__-__-.---•--•---•--•--------•----•--••--------•--••----••--••-•----_••-- Installer at---••••-••--•••-- ---------•---------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No...............................::........ dated................................................ i THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector..................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........................................OF..................................................................................... � No.--•-•.............•----- FEE......................... i �i,u�o�ul orko �oi�,u�r�r#ion �r.eruti� Permissionis hereby granted....................................................----------•---••-•----•••----••••-----••••......-•-•-......••--••........•----•.......... to Construct ( ) or Repair (, ) an Individual Sewage Disposal System at No 'i Street i as shown on the application for Disposal Works Construction;Permit No----------_.......... Dated.......................................... ..--•--•----......--•-----------------------------------------------.................................. Board of Health DATE............................................._.................................. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS No. ....... .................... THE COMMONWEALTH OF MASSACHUSETTS8p FNORrHq qRp OF DO WEVER/ BOARD OFF HEALTH gL .............. IV, ........OF....... o....T. .......... .... ..1 -/.E..T ............ -----• SEP 1 91995 Applirtttiott for Dhipnnttl Works ( omitrurtin er Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sew osal System at: ... Co ZO ..................................... .......•--............----••-----...-----•••--..... ----••-•.._...........-----...... ►7th!/ Location Address o Lot,Ijjo. W Owner Address a ....... ......•-............................._..........--•.......•............................._ ...........--•-......................------...••----•-----.........._.......•..................... �] Installer Address Type of Building / Size Lot.......�°.>A4.....Sq. feet U Dwelling— No. of Bedrooms.........`,/...............................Ex Expansion Attic p ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures . Design Flow......................... ..................gallons per person per day. Total daily flow..............��..(P. ....................gallons. Septic Tank—Liquid capacity.15W_gallons Length.__.Iof4." Width.._fc'' Diameter................ Depth.. x Disposal Trench—No. ...-J........... Width.._4............. Total Length.&r;��--...__ Total leaching area-4-IA/ ...sq. ft. Seepage Pit No..--_-----__----.._ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results Performed by-------------------------•------••-----•----............-----•--------... Date........................................ Test Pit No. I._.- U minutes per inch Depth of Test Pit-----Q�.....__.._ Depth to ground water........................ / fTq Test Pit No. �.....t-3__.-minutes per inch Depth of Test Pit...HAL.t....... Depth to ground water....lt�r,��'__.�5N6GvT ... ; -----••-------------------•--•-•--•-------------- •....... .... Descriptionof Soil........ .........................:........................................................................................................ U •--••----•------•-•-------------•------...-----•------•-----....---...---------------------•-•------..,_t.--•---•-••-------•------••----•-•-------••....... W x ----------------------------------------------------------------------------•-------••----------------------------------------- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... •-------•-•--------------------•---...---------------........------------......---••----....----••••--------•-•-•---------. ------------------------••-•--••---•--------•-••-•-•--••--......._......-•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed ---•••...............•----••••-----•-----•--•--•-------•-------•-- ................................ I Date Application, Approved By---••---•-•------••-----• --••• -------------•------...--•-----------•-•-----•-...-•---------•-- iApplication Disapproved for the following reasons:............................................................................................Date ----... -----------------•-----•--•-•------------------....-•--••.•-•---..--••-- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................:.................OF (9rrtifirttte of fgnotpliattre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by..................................................................................................................................................................................................... Installer at.. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Constructit5n Permit No-------_.................................. dated................................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............................•---........----...------••-••-----••......--...... Inspector.-- --------------------------------•----------------....--•-----••--.....-•-------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.......................---.......--------..................-- ......._..... No......................... FEE..........'.............. Binpn,iul Marko (Inttntrurtion Vantit Permissionis hereby granted------------------------------------•------•---•--••-•---••--...•------•----••--•.....---•.......--•--•----•----•---•--........--•••---.----- to Construct ( ) or Repair (, ) an Individual Sewage Disposal System at No. = Street as shown on the application for Disposal Works Construction Permit No-----------------_-- Dated.......................................... ••--•----•-•---•----••----....--•---•--••...............•-•---••--•--••-•-------•...----•-............... DATE................................................................................-•----••-•...........................................• Board of Health FORM 1255 HOBBS & WARREN. INC., PUBLISHERS .�...9,� ,s�„F� ,yF ,sas�'�e• �a ye.. a�" '§ "� � T.f� rr is$rr y���,.#�tfr �•,e�. � � ;�a� y ` 'u� .. i, �"�� , �a " �` �a i,.�C� ��, f sem"' ,at`�v }�,r.�.e" � .Y�` - '4 '• tl � � '•'.�`� r '; '� � $ r .,�'.� �:�f�j`"� l�s'��' .ori t"r �*` ? 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Date..................................... tom', Commonwealth of Massachusetts Massachusetts Soil Suitability Assessment for On-site Sewage Disposal PerformedBy: ................................................................................................................ ........,................... Witnessed By . ..................................................................../.�..............M............................................._.............................................................................................................................. Lmarion Address or )3a7 �A 'GC S• 1 37- Owner's Name, Loi p Address,and Telephone d New Construction Repair ❑ Office Review Published Soil Survey Available: No ❑ Yes Year Published ..19g/� Publication Scale .................. Soil Map Unit , ..... Drainage Class %A),D . Soil Limitations ..... �Cf'��,... Toi✓ ....l r'.................... ............... Surficial Geologic Report Available: No. ❑ Yes ❑ Year Published .......... .... Publication Scale ................ GeologicMaterial (Map Unit) .... ...... ..............................................................................................................................: . . .. Landform ..:. ....... ... ........... ......: Flood Insurance Rate Map: -Above 500 year flood boundary No ❑ Yes ❑ Within 500 year flood boundary No ❑ Yes ❑ Within 100 year flood boundary No ❑ Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) ............................................................................................................. Wetlands Conservancy Program Map (map unit).........................................................:...................................... Current Water Resource Conditions (USGS): Month ................. Range : Above Normal ❑ Normal ❑ Below Normal ❑ Other References Reviewed: i Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH o� oZ,tD 19 o `u.. APPLICATION FOR SITE TESTING/INSPECTION SaCHus���y Applicant -'- et NAME ADDRESS _ l_ TELEPHONE Site Location �-:�> Qla Q �nnn S�Y 0 Engineer—, NAME I�NAME ADDRESS TELEPHONE Test/Inspection Date and Time �i CHAIRMAN,BOARD OF HEALTH Fee f �� Test No.-b S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No. 1 NORTH q BOARD OF HEALTH °0 19 Gf 04 APPLICATION FOR SITE TESTING/INSPECTION SSaC USE��y Applicant A 1 ��l-, �, l' ;'�tsVl "1[T�' )�. �1..0 ;;�. P�, L�c NAME ADDRESS TELEPHONE l Site Location Engineer .� •: i\�►.,� I A�t_P 1 NAME ADDRESS TELEPHONE Test/Inspection Date and Time r. CHAIRMAN,BOARD OF HEALTH Fee TestNo I v � . S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. . - - -- �- `�� - ����v � � �V w� _��� I r THE COMMONWEALTH OF MASSACHUSETTS FISCAL YEAR 1995 REAL ESTATE TAX HILL T 4':I ! 4 F d i 11 d V E Based on assessments as of January 1, 1994 your REAL ESTATE TAX for the fiscal year beginning July 1, 1994 and ending June 30, 1995 on the parcel of REAL ESTATE described below is as follows: OFFICE OF THE COLLECTOR OF TAXES MAKE PAYMENTS TO TOWN OF _ -E !JT — DUE EE3 1,2199r, NORTH ANDOVER — ; ,t _• �5=i l" D OVEER — OFFICE HOURS : BILL NUMBER Ury TAX RATE REiLICE�TIAL Ur--DAA—FR1YAY 8•J0A1,1-4:3 PEA TOTTAX RATE i T 'f =T _L6AY &` PROPERTY IDENTIFICATION SPECIAL ASSESSMENTS TOT.TAX a SPEC.ASSESS.DUE ..� ' DESC. 1 CLa VAL c \.- - - - O Y LAND AND _94L7. A AND 1 46 1`0 PRELIMINARY TAX PRELIMINARY CREDITS — — AREA A P _ 106A PRELIMINARY OUTSTANDING - = �`t�,, EXEMPTION .4 n ` '� 000 ``I 3RD CTR.TAX PYMT.DUE FEB 1 �PAGE 01172 y 'b/TD 011011?l ZAL b •d l'AFUE [� U TOT.SP.ASSESSMENTS CURRENT CREDITS m �YE�S.1P. VALUATIONTICK _-_ - ¢ '' � �- •�- �- • TOT.REAL ESTATE TAX CURRENT OUTSTANDING _ Y < LOCATION _ - PAG!PINE Cj 7 PRELIMINARY TAX BALANCE DUE ^• _ p Il �'j A�T M T T:\p` 3RD QUARTER PAYMENT 3 z THIS FORM APPROVED BY THE COMMISSIONER OF REVENUE 4TH QUARTER PAYMENT 143-813 COLLECTOR OF TAXES INTEREST P�T-CKARDv KENNETH E KEVIN F - MA.HONEY RUTH $ P K�1 R Interest at the rate of 14% per annum will accrue on overdue .' sET TAXPA.Y E R E S J OP payments from the due dace until payment is made -?•`ti ti..� �':�s« R - .. A 16 4.S=' I o `p.'+•5.: +w'�y 4r §� :a4,. -?r'T s. a .r �s :}^. ..( � -ac.. :+5` �, !\ 2 `� :✓.'K.�3, -� r'."+""F.a_.t' 1�.:;ri. :X'.. -$.ea''�" �: +4:-w, c'v.,; gra "��, `�--t� 115 <95 13.09400-I 0' Q0QQ0-111361'.. nx a i COPYRIGHT 1994 ARLINGTON DATA CORP- .. �. - a ., ...a •,c .q �r t e - >.,�::" `'s mak; ^t ,"�, s 4 M' x . T d \ < } -_;'r .t..-.. -n. 1.h-'^c.. _J:....: n J. � :.. .s'-?1-' 'S;k.. ^+�.YM.. ,.,c,+lcna \ •'ry,. y.. �. �,7c a p -_ r... F. 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Q Y t LQa I.1r.,. t.le..- t•► Ol»(G ► Ztal ..✓ Ir�9 t0 7,..1 222 y y ' tr- j • n r.•, GP .a N +.1'.. �. a y L O \y /1 ,r •�- t rp 'r Y 7 `,. `tO fltT •� •�1. ,t,\,1 +t:r •••`y ,����f.(^i�•-/�!. sem• ^ J F 0 b2 DG x h W F- �" , [213 ' `, s• a /, ,r- \y W dl) l.ar a• a`r fie 11\ ✓ t I I ne n \ i •r Y Jryi 2... r w ^ 4µ tK a y - ItS 9� 1 c.e4 labs / !90 Zlf , Nt it AAa,V AA.LaI \ r �. i s. 1.41 I.ItK 1...x. I.f... I.rK ` i• r 6 " to \t�' set .S.,ti sL aa.Mas t•• re• cT♦ el♦ ` 1 i * L Z1 A Ita ✓° '. � °� � �s°f �t••` w t fr 11 1'J3 m lio t AD 4A l'7► .A J u la u �fis �.. �Ism t '� � `.• � 1A. r t1' a.y a' r • 4\ } :.s 100 IEIL o ..yam ,.. . ,,y• .�`••' `G}. \ \�, `�: SSR eve - l co k GG f .n •' 1.a s. .� 1 t•`a •.•a.c� i i A � aeD t„ta. LI4tr 1 tfj • \d1 J ► `tayr G4 a t lt1= Al �-"r M'7ZD t.•r ^' a toa 131 Milt tss 10 Nos"t VIA kG tS GA st bacAlt lt+d n... `'f y t� l tt`• ..\� \� _ Ittft.�.•. � � �.,, � 'S. F Mtn *r 68 `,cy, twr Acts. ..�..i A8 P,V�`M Ita t. •'�1 sa` ye. \ `�•° - ` lt5' S co •aar s.a,a .� 1... r-« .n N p rlli tfA w 41 '' Y �• -�-_ 6y i ` �6•� i'� I( �1� ^..`- Si,N41 cR,tett Lr • v ,l Co•.N.si MAIC. .3 AA 06 �' L9 CoA',y o,. _` r..1� f itb •O` ♦` r� .t' / J 1.aar �1`-4 A, 1 .af• 7 Yr a- v,e. � 1 S1•`L• Pt_A i I�G f..r... Le+r ' � / � F `�r T 9 0, 5 G,_( z w 5 ',/�'' Ail --- — ---- - ----- � - --- N TOWN OFNOJ .TH ANDOVER SYSTEM PUMPING RECORD DATE-No vI Q DD 3 ) s SYSTEM OWNER&ADDRESS SYSTEM LOCATION l�a JI �il Y DATE OF PUMPING _QUANTITY PUMPED CESSPOOL NO yflS SEPTIC TANK NO YE� NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION,. FULL TO COVER HEAVY GREASE BAFFLES IN LACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLID CARRYOVER . OTHER EXPLAIN SYSTEM PUNTED BY` 4 ✓ COMMENTS: CONTENTS TRANSFERRED TO' Commonwealth of Massachusetts l f City/Town of No.Andoverl m System Pumping Record F7 a Form 4 MOWN OF NORTH AN�OV�R h1EA-T DIIPARTMINT 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 SysiJrn 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 No.Andover Ma 01810 cursor-do not City/Town State Zip Code use the return key. 2 System Owner: Name Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping ate 2. Quantity Pumped: eons 3. Type of system: ❑ s Cess ool F1Ti ht Tank ❑ Grease Trap Yp Y p ( ) /[/Septic Tank p 9 p ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ENo If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of. otem: y 8- 6. Sys By: Name . Vehicle License Number Ste rt'Stic Service Company 7. Location where contents were disposed: e art's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 r _ Signatu of . r Date � � j Signatu e f Re eiving Facility Date / t5form4.doc•03/06 System Pumping Record•Page 1 of 1 }.. l�r{�.1A �li••'n�-r5f �.' :.pf �. .:t' f 1 °� R. 1, MAS SACfHUSETTS '.'' r m M . . ::1•:`,�' �. ty�, �0��;'�,^,r'1';',J�',•,���' 1�A''�j''�sJCi't!r:l.�f.::•' t'� 1. .d% 1 �,� J.1.)ir.J r.wY• ) ,,, .,r(lwn;IV�{�i:: rlkl'nn'7711)`T�'!r'l vl";4:,! ,l ,��l\fir r.•Y.,(',: .. EP.,has provided 01 form for use by local Boards of Health, The System Pumping Record be submitted to the.locai'Soard of Health or other app uthorl P g ° ° m s roving a authority, A Facility Infori;� tion fl;�NCOW .•J,•VY�aJI fI►!!n9 out• .1;. Systam Location;' ,• OA y the tab key : Address to move your:: �• � . ar:or,�do Pgt Clty/Town State 21p C •i.. ,�%.i>r,.(,l•,..r, .';:),t:.•;y.r' ;'';��.'� .v.' 1.F:;i• ...:'' ode ;� - 'l•""i. ystem SC)Wn8r; 1 t.UnAi .Jl •�)•':rit • J':�•.. 1 ,•t J• .Name,'.' >.t•. 1^.,•,�•,;i• ;;, .I::r.., � , a.... ;c/r Addraas(if different frombcation) , +' State ,7 Code r „' . ., 4r'• ,�' Telephoneber • '.lJ..' :f.� •',1+/Ii+• ' I.2A•' :1'1,1',•'i i1•' ! 5 VP�um.pjJnR,dq°;•Id:,: .y.. : ,..t.,,f:;,!.w•ct,r:+.y,:•,:::�'.Jti:):: T ,I,.':.�a�.', A D8tQ`of Pumpin9;;`7'. C )'•: Dale 2. Quantity Pumped: ' ,,3!: ;,Type pfaystem,`• ❑ Cesspool(s) 'S ptic Tank uons ❑ Tight Tank •, !'� Other(descrltie) �� •' . Tee Filter prosent?:.0 Ye " o If ,,;;,,;, fr,r;' "'�>, ;•%�:+:t ra' , yes, was it cleaned? ;,;,`.,„ '' ,,.: a'c,r•.1� .,': 5 4l.r CD Yes ❑ No .. .�tt','��•C�i:7�.:�'y,.� Y,, ., Q. 'P ••p�Li;Ji; }I,r!u rl,'.^�:. ,r. ',r�. ,i•';1 ."•r.:N;s.t O'/ l�lot>Q(,.8y ,r;�,.^•', .. ... �1,: i.+;,ti.... ;itg�`'�r,itr.�+'(J;ii:t�f}.JJ: 'Lr,iL5liap Jr'J:�.•� �'.`.' � :e:•.,� '•�•{•r�a�'.f�a:)�'i3(Slt�:.f•'j�il,,'t,l,'q��yltiw�,r�r•i.:.1':.."1� �. ' `��' i 1. 7� r-1 t..a•;;:+�i:',�,.;?ti�;;,'.. ::f.• • �''''• � ;r'A•!• fl'l T.•. rtr,J!�W.�;/1t1T.'(l''" Jt r7•�,', . r3,;r,:sy P.umpea ey;'�' ' :•,'L. at liir.•'' �, •'' 1 ' amsltl�!.i�l 1'i;v }:. �,�, .' . ';, jT. VehlcJe Ucen� e Nu ` ji�' ;k;'"���'�1 fi7;• r ;` .u:x . d ;cl ( t mber :: :'.J:'•1':•::J��,•I�3'1:}}'•:� 1• 1 , C•! `�•t: 'y'i•:�•i;'17,i'�:%�:• J `/'vl:p'•)tr:' If�i u':' �' / '+ .. +.', •'' `r"Y r: '' `F.�::r. 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