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HomeMy WebLinkAboutMiscellaneous - 140 BRADFORD STREET 4/30/2018 (2) �I f 140 BRADFORD STREET et — 210/061.0-0004-0000.0 J / Ot NORTH{ p TOWN OF NORTH ANDOVER °? APPLICATION FOR PLAN EXAMINATION y,SSACNII`�E�9 Permit NO: Date Received: Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION \`A o --Ex-gAYo K- A Print �` PROPERTY OWNER C- Vt V /� Print NIAP NO.: ' PARCEL: A/ ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES 0 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential -,New Building One family 0 Addition ❑ Two or more family 1--1 Industrial Alteration No. of units: ><Repair, replacement E Assessory Bldg Commercial U Demolition C Moving(relocation) Ei Other 0 Others: 0 Foundation only DESCRIPTION OF WORK TO BE PREFORMED c1 cam. 1la.X`'.Sa C"NZ)ov q�� a \LQ X a LA Identification Please Type or Print Clearly) OWNER: Name 7 C) C- GV Phone-1��'�S5%-9 Address: �y � i�0.G' t�'Z�T G' `�� �\r C�0\1 CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. O ' FEE SCHEDULE:BULD/NG PERMIT.•, 10.00 PER S1000.00 OF THE TOTAL ESTIMATED C STBA ED S ON�b/25.00 PER S.F. Total Project Cost S \ a. OO o x10.00=FEE:$ /0>0•00 Check No.: Receipt No.: Pa.ze i„rpt i TYPE OF SEWARGE DISPOSAL Tanning,'Massage/Body Art Swimming Pools .w Public Sewer Tobacco Sales Well ❑ Food Packaging/Sales _ Permanent Dumpster on Site Private(septic tank, etc. Ig�C Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of Contractor Plans Submitted ❑ Plans WainCertttt- h cd Plot Plan ,J Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM I DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ COMMENTS Other DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ` ��� ,� t.t� ❑ C MMENT S Z.o g Board of Appea . Variance, Petition No: Zoning Decision/receipt submitted yes_ Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer connection signatu &date Temp Dempster on Site ye no. Fire Department signature/date �/ V D ti Building Permit Approved and Issued by: Page 2 of 4 C:>J V} 1 I Cir 1 cn, j G;{ \LI, QjI vi : Io SuNt�, M jI—vil, Ca) I Q I o -. To LL sl MORTGAGE PLOT PLAN E K SURVEY INC 0 HAVERHILL,MA 4 Phone 978-4Wl GW Fog 076-0.7048 tJt7RTGA00R2WIiLN . Gil s j . 4m i DEED REF. AM PG. �0 AOORE38 OF PRINCIPLE BUILDING PLAN REF. 0/0 146 W424" x. DATE OF INSPECTION mAau/ 30, Zsoto A) Ako SCALE;1'w(fip' d la' 13A 13A 8 qql o=7¢t BoYiOR� , Vogt 1^I '- AkiKK--- _ AN Loft IL ` i T. CERTWCATION TO: Ak RUDEL This Morlpap Pbt PLW'sgr praparsd s IceUy fa No 36eaf T ►ocatlorc a aie ort,apla aruccur�a morlpsps DaD artd R Is nottAwidw or npreented In— to he a propartr!rr a Mnd arv�p.Thla plan M rot b bs uasd q CI314 MIRt1!M bal xaii�p ~Mian OWdh stied wlt to aalww ary d the prdp"Klee for arty puryosa.No �1t W► et N'Cr r am*tram YiTRW V .Chap. 40A aotlan urtdsr Marrs B,L T9ia VII.Chr+p.4t1A,list.T. rsapatsibRV Is Oundad to tlts land"w or oeaupa t 8+�1K+L buidfnp Is nol In a Ftoaf Hazard Arae. his owWb Wn Is basad a+be boation of rawy mallow Q&lCW L> kkV b h s F bod haat d Anr, d others. FLOW Hiurd d4mnined from ft FIRM wM* OBI uif(�1. Dded V8-475-a925 Kurt L. Kefferstan . Title V Inspector Lic.Drain Layer,Septic Installer Drinking Water Facility Operator Andover,MA Lic.#DW7093DC COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (61 )-292=5 'COVED SEP 14 2005 TRUDY Com Secretary ARGEO PAUL CELLUCCI TOWN of NORTH ANDOVER AVID B STRUHS Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTI N+ORNI TL DEPARTMENT Commissioner PART A CERTIFICATION f Property address: Name of Owner t G(1-j 2 1e Address of Owner: 14V (32Ada�4r�2 S �O,'T n AN OG�3 G2 Date of Inspection: q—jq Name of Inspector:(Please Print) % G A!U 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: Maing Address: 6 f 4 Ay c2 b i Q S VI)t]©v c(Z: f1 A Telephone Number: !9-7 6 '4-7& `350-1C CERTIFICATION STATEMENT , I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: _/Passes Conditionally Passes _ Needs Fu her Evaluation By the Local Approving Authority _ Fails Inspectors Signature: 'z Date: �' _o The System Inspector shall submit a copy of t#spection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS revised 9/2/98 Pagel or 11 '1 Printed on Recycled Paper i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: W 0 6 R A D Ude-0 51, c�p c"('1q Oa,.Tre(L- Owner: 4 e,114 Z C- Date of Inspection: -� — P4 INSPECTION SUMMARY: Check A, B, C, of D: A. SY TEM PASSES: I have not found any information which indicates that an of the failure conditions y rt�ons described in 310 CMR 15:303 exist.. Any failure criteria not evaluated are indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health, will pass. Indicate yes, no, or not determined(Y, N,or ND). Describe basis of determination in all instances. If "not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass. inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed revised 9/2/98 Page 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: "1 d R R,ORO Cor, O S7 �JO PTV R►NAO-4Ce— Owner:. C I►� , Date of Inspectkm: C 4l C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further,evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES 1N ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil,absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _, The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic com ounds indicates cates that the well is free from pollution from that facility and the presence of ammonia nitrogen 9en and nitrate nitrogen is equal to or less than 5,ppm. Method used to determine distance (approximation not valid). 3) OTHER revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: tz (���i Q 4 c►Q o S 1v is rTK Owner:. Ple) ivze, Dace of Inspection: D. SYSTEM FAILS: You indicate either "Yes" or "No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No/ Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. _ " Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. vl Any portion of a cesspool or privy is within a Zone I of a public well. V Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ - Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds,ammonia nitrogen and nitrate nitrogen. . E. LARGE SYSTEM FAILS: You must indicate either"Yes" or "No" to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 d or greater(Large System)and the system is a significant threat to public Y Y 9 9P 9 9 Y Y 9 � health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area=IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further inforjnation. revised 9!2/98 Page 4of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: L4 0 ICZ A f a-o a A -A N b O J C Q, Owner: 1�c.i w r ic— Date of Inspection: r Check if the following have been done:You must indicate either"Yes" or "No" as to each of the following: Yes No Pumping information was provided by the owner,occupant,or Board of Health. - _ None of the system components have been pumped for at least two weeks and the system has been,receiving rmrmat flow rates during that period. Large volumes of water have not been introduced intothe system recently or as part of this inspection. Y _ As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow.. _ The site was inspected for signs of breakout. _ All system components,excluding the Soil Absorption System,have been located on the site. _ The septic tank manholes were uncovered,opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: _ Existing information.,For example, Plan at B.O.H. _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) (15.302(3)(b)) The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Subsurface Disposal Systems. revised 9/2/98 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: W R 0 �2 P 5 b 5` �'► A pj oa�j c-9— Owner: RCI Ni;L Date of Inspection: l FLOW CONDITIONS RESIDENTIAL: Design flow: g.p.d./bedroom. Number of bedrooms(design): Number of bedrooms(actual): Total DESIGN flow 200 Number of current residents: Garbage grinder(yes or no): Laundry(separate system) (yes or no)- NO If yes,separate.inspection required Laundry system inspected (yes ore Seasonal use(yes or no):-L6 Water meter readings;if available(last two year's usage(gpd): See RTi-14 1,ep Sump Pump(yes or no): Psi —-— Last Last date of occupancy: C u(`r-rej COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: Qpd ( Based on 15.203) Basis of design flow Grease trap present: (yes or no)_ Industrial Waste Holding Tank present:(yes or no)_ Non-sanitary waste discharged to the Title 5 system:(yes or no)_ Water meter readings,if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of info mation: S Ten-. V �`D Gi�L rVlfgl.e I System pumpe6 as part of inspection: (yes or no)_L40 If yes, volume pumped: 1000 gallons Reason for pumping: )Baer JT c"(-e TYPE YSTEM Septic tank/distribution box/soil absorption.system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous inspection records,if any). I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components,date installed(if known)and source of information: Sewage odors detected when arriving at the site: (yes or no)Aly revised 9/2/95 Page 6ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM r PART C SYSTEM INFORMATION(continued) Property Address: 1(4 0 a(Z P-0) 1z t, ST pw c-t . A r-o 6'j c tt_ Owner: µe t N Z Date of Inspection: BUILDING SEWER: (Locate on site plan) Depth below grader Material of construction: cast iron_40 PVC_other(explain) . Distance from private water supply well or suction line Diameter Comments:(condition of joints,venting, evidence of leakage�etc.) ci e�av� v'(' i ps co"Cc,e� IND c r SEPTIC TANK:— (locate on site plan) Depth below grader Material of construction: concrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal,list age_ Is age confirmed by Certificate of Compliance_(Yes/No) Dimensions:_ D® 4 A L Sludge depth: 43 fJ Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: IWAJ 114 i NJ Distance from bottom of scum to bottom of ou t tee or baffle: How dimensions were determined: J Comments: (recommendation for pumping, co dition of inlet and o et s or baffles, dep h of liquid level i9 relation to outlet invert, structural integrity, evidence of 1 akage,etc.) OP-1 C.(`LT ,,,W# A � S S n0(.✓!w �d`P`oS Ito C1 j t 1 A C GREASE TRAP: (locate on site plan) Depth below grade: . Material of construction:_concrete_metal_Fiberglass _Polyethylene_other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION IcontirWed) Property Address: 146 Q ZAf)�®e A ST Nof-Tk iA N OOQ eF— �1►� Owner: Kit— Date of Inspection: STIGH9 r ILI os- TIGHT T OR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_Fiberglass_Polyethylene_other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm present Alarm level: Alarm in working order:Yes No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches,etc.) DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if leveland distribution is equal,evidence ofsolids carryover evidence of leakage into or out of box,etc.) Il {3tayf _ (S C IS -f- ,$ OL,; + J AT L 0 kyT P1 ALL Z•, ever 0 PUMP CHAMBER:_ (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) revised 9/2/98 Pages of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C p (� SYSTEM INFORMATION(continued) Property Address: f� 1�P.AO vo zo Owner: mejlJCe— Date of Inspection: SOIL ABSORPTION SYSTEM(SAS):_ (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: Type: leaching pits, number:_ leaching chambers,number:_ leaching galleries,number:_ leaching trenches,number,length: (� 3 60 rT tj Lk-e S leaching fields,number,dimensions: overflow cesspool,number:_ Alternative system: Name of Technology: Comments: (note condition of soil,signs of hydraulic failure,level of ponding, damp soil, condition of vegetation, etc.) CESSPOOLS: (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow(cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) PRIVY:_ (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.) revised 9/2/98 Page 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Iq4 QQAnVOeo sT {moorTk A"OGUt Owner: Dace of Inspection: q-)y --osr SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) v (� ----------- T6 �-o revised 9/2/,98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(wed) Property Address: y 0 S-1 po('Th {a W Do:Y<V... Owner: I+el ZL Date of Inspection: _G NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater�eet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site(Abutting property, observation hole,basement sump etc.) rDetermined from local conditions n _i Checked with local Board of health PIANS D S+ 1' BR 0 O��ftD S 7 Checked FEMA Maps 5 COT)L, U�'STS ti'1 R��(?6�T Checked pumping records o Checked local excavators,installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) revised 9/2/98 Page 11 of 11 Address ��Title of File Page of Date File Open: Date file closed: Doc Document/Action Title Date.of Refer to other Purpose of Document/Action and notes. action Document/ document/ Num. Action Department i Board of Appeals — Board of Health — Plan nFing Board _ Conservation Commission — Building Department — G HP Fax K1220xi Log for NORTH ANDOVER 9786889542 Sep 12 2005 3:1lpm Last Transaction Dae Time Twe Identification Duration Pages Result Sep 12 3:lOpm Fax Sent 819786238392 1:05 OK ell, . APPLICATION FOR SEWAGE DISPOSAL INSTALLATION HEALTH DEPARTMENT - NORTH ANDOVER, MASS. V0 eek I hereby make amplication fora permit for a sewage disposal installation at . I will install this system in ac- cordance with all the law of the Commonwealth of Massachusetts and regulations of the Board of Health of the Town of North Andover. Further, I will construct the house sewer of bell and spigot pipe, the minimum diameter being 4 inches, and will maintain a minimum grade of 1% until 10 feet pre- ceding the septic tank, where the grade shall not exceed 2%. I will install a con- crete septic tank of /c>� in size. A manhole (s) permitting easy cleaning will be provided with removable cover (s) of iron or concrete within 12 inches of the ground surface. I will provide subsurface disposal field with 4 inch perforated or open jointed pipe and laid in a series of trenches, the bottom of which will pro- vide a minimum of '9- cr--F) lineal (square) feet of effective absorption area. The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging in size from 3/4 to 1-1/2 inches (dia.) and the pipes will be surrounded by similar material to a height of 2 inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench, 2 inches of gravel or stone 1/8" to 1/41' (dia,) will be placed over the course gravel or stone. The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single tile line will exceed 100 feet in length and in any case, two lines of tile will be installed. A minimum of 6 feet will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the installation will be less than 100 feet from any private water supply, 25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line. I further agree not to cover any portion of this installation until approved by the inspection officer, as provided below, and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application, DATE -7 7 Signature of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DATE 7' Signa ure of Realth Agent I have inspected the uncovered system indicated above and find everything done as described. 4 DATE (�/(/ d" '' 17o h),411, 1 AAa Signat f nspecting Of r F Percolation Test A2 ��t.0.� Garbage Grinder BOARD OF HEALTH TOWN OF NORTH ANDOVER, MASS. d N 1. NAME Sc G T/ -- DATE / 1� 2. ADDRESS !� &1}4,0 fol f D Y T LOT NO. TEL.�eJ 3. NO. OF BEDROOMS DEN YES NO 4. GARBAGE GRINDER YES NO 5. SHOW DIMENSIONS OF HOUSE 6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES 7. SHOW DIMENSIONS OF LOT 8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL q. NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM 10. SHOW LOCATION OF BROOKS, STREAMS, DITCHES, LEDGE OUTCROP, ETC. 11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULATIONS. SHOULD BE READ CAREFULLY. BOARD OF HEALTH OF NORTH ANDOVER , MASSACHUSETTS SEWAGE DISPOSAL DATE �/?-7/7j> NAME OF APPLICANT LOCATION 3 h Addres of lot no. BUILDING: Dwelling Other SYSTEM: New Repair GENERAL DESCRIPTION OF LAND SUBSOIL: Clay__ G vel Sand PERCOLATION TEST 10 minutes per inch. MINIMUM INSTALLATION RECOMMENDATIONS CONCRETE SEPTIC TANK ! a:= gallon capacity. LEACH FIELD `Z-QZ? lineal feet of drain pipe. William J. Dr' s oll, Engineer Board of HeaIt