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HomeMy WebLinkAboutMiscellaneous - 20 COLONIAL AVENUE 4/30/2018 20 COLONIAL AVENUE .� 210/107.6-0121-0000.0 1 V '.l • r • MAP # LOT # PARCEL # STREET_ CONSTRUCTION APPROVAL�� HAS PLAN REVIEW FEE .BEEN PAID? YES NO PLAN APPROVAL: DATE A� P. BY._-- - ..__._..... DESIGNER: 171172 Y&�5 PLAN DA-1-E._I��3�/ CONDITIONS WATER SUPPLY: M TO WELL WE L ERMIT _ DRILLER._..._.._._._.__......-.- .-- -._............... ...... . WELL TESTS: CHEMICAL DALE APPROVED C-TERIA I DA IE f1PPRUVED BACTERIA I DATE A1=PRUVEll COMMENTS: FORM U APPROVAL: APPROVAL TO ISSUE YES NO DATE ISSUED CONDITIONS: FINAL APPROVAL: . ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NO SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NO ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: DA1"E: BY: E �SY�I�M�NSI94L.ELTI4N , '�r,t ,�+.t.{ -� •f .. 'ti'i,a Y� ;-.+. '. .,•""•,:^i a. .,[_-, :•,� #1'' \ •Y'i i..iJ•£,� t-. y1 � : .. _ ,ISTHE INSTALLER LICENSED? ' . `+ n �r YES NO P 'TYPE. OF CONSTRUCTION: •? .` � NE REPAIR- NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW YE NO CONDITIONS OF..APPROVAL YES NO € f (FROM FORM U) ; r ._ISS UANCE OF DWC PERMIT `(� NO INSTALLER: 2G- �WC PERMIT N0. to.. .. .. BEGIN INSPECTION0: EXCAVATION , INSRECTION: * NEEDED: PASSED q� BY CONSTRUCTION INSPECTION: NEEDED: AS BUILT PLAN SATISFACTORY: YES: APPROVAL TO BACKFILL: DATE: "—'� BY FINAL . GRADING APPROVAL: DATE BY t FINAL CONSTRUCTION APPROVAL: DATE: BY Commonwealth of Massachusetts ;.� "v,:D = City/Town of System Pumping-Record ► OCT 27 2014 Form 4 TOWN OF NORTH ANDOVER ' _HEALTH DEPARTMENT 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. A. Facility. Information 1. System Locationig �ht�hous Left 1 Right rear of house, Left/right side of house, LeftRight side of bui gLeft/Riilding, Left/Right rear of building, Under deck Address City/Town L/v ,-'C �� State Zp Code 2. System Owner. Name Address('d different from location) Cityfrown S^tate/�,g Zjo Code Telephone Number a: B. Pumping Record 1. Date of Pumping `2. Quantity Pumped: Date Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes o if yes, was it cleaned? ❑ Yes ❑ No, 5. Condition of System: 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location ere contents were disposed: S. Lowell Waste Water a�3 sign 9t Haule Data t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts City/Town of .-= =:v-Ei.� System Pumping Record Form 4 SEP - 6 2006 �y TOWN CF NORTH ANDOVER DEP has provided this form for use by local Boards of Health. T e System Pmrn !nq-Reco d must be submitted to the local Board of Health or other approving authority. . A. Facility Information Important: When fining out 1. System L ation: forms on the .�..�] computer,use only the tab key Address to move your (/ cursor-do not s _ use the-return City/Town State Zip Code .key. 2. System Owner: CA" m Name Address(if different from location) City/Town State Zip^`de Telephone Number .B. Pumping Record 1. _Date of i� Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) C] S atfdTan.k ❑ Tight.Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes L-NT0 if yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. SystePumpe"y: - 7� :Nam ehicle License Number Company -- 7. locz!' here contendere ied: ail A�? Signat a of er Date http://www.mass.gov/dep/wat r/a provals/t5forms.htm#inspect t5form4.doc•06103 System Pumping Record•Page 1 of 1 r OMIn Use Only u4e �umutunurettl h of �� PUMIt No. lepartmcttt of Public $afetg Occupancy A Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 521 CMR 12:00 1 at90 net1°blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK { . All work to be performed in accordance with the Massacnusetts Electrical Code, 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Q* or Town of NORTH ANDOVER To the Inspector of Wiree: ^+; The udersigned applies for a permit to perform the electrical work described below. . �v Location (Street 8 Number) � �� / Aum s I; I. Owner or Tenant /9-c, /Su/e std S yi. Owner's Address i IS this permit in conjunction with a building permit: Yes cel No ❑ (Check Appropriate Box) Purpose of Building -P1' Utility Authorization No. y, Existing Service Amps —J Volts Overhead '! Und rnd ' g � No. of Meters • �, New Service Amps _J Volts Overhead _ Undgrno [ No. of Meters Number of Feeders and Ampacity // is Location and Nature of Proposed Electrical 'Mork C/Y/�f� l/—,q No. of Lignting Outlets I No. of Hct '%_-sI No. of Transformers Total 'n KVA 4 No. of Lighting Fixtures i Swimming Pcot Above— in- grna. _ grno. '_ Generators KVA No. of Emergency Lighting, No. of Receotacis Outlets I No. of Oil Eurnef"S I Battery Units , i:• No. of Switch Outlets I No. of Gas _urr.ers FIRE ALARMS No. of Zones ,. Total No. of Detection and No. of Ranges I No. cf Air Cor,c. s• :cnS Initiating Devices Heat Twat Totai No. of Disposals I No.of r.. !r Pucs :ons KW No. of Sounding DevicestiC ces :`•.- No. of Ssd Contained No. of Dishwashers I SoacefArea Heating KV/ Detection/Sounding Devices ' No. of Dryers ( Heating Cevices KW Local Municioai r—()the, f "w — Connection • No. of yo. of Low voltage No. of Water Heaters KW I Signs ea lasts Wiring No. Hyaro Massage Tubs ( No. of Motcrs Total HP OTHER: � „�✓I /2�G r� i INSURANCE COVERAGE. Pursuant :o ine reau,rements at 'Aassacni,seas ;eneral Laws I have a current Liability Insurance Policy inclubfng Cpm^:efec Ocerations Coverage or its substantial equivalent. YES '=ANO — 1 have suomined valid proof of same to the Otfice. YES C_77�'NO = If you nave checked YES. please indicate the checking the appro nate box, type of coverage oy INSURANCE SONO = OTHER = (Please Scec:'y) Estimated Value of E!sctncal Work S / lEnoirauon Deist : Work to Stan J / Insoec:con Date Racues:ec: Rough Final 1 4tr Signed unser:he Penalties of penury: FIRM NAME UC. NO. Licensee Sigra:ure Lam_ UC. NO. 1 `� //n L / Z f ��1jo ('T Bus. Tel. No. ,Toe Address / J Alt. Tel. No, OWNER'S INSURANCE WAIVER: I am aware that the Licensee toes not nave the insurance coverage or its suostanuat egtuvalenif as re- quirea by Massacnusetts General Laws. and that my signature an :^.is cermit application waives this requirement. Owner Agent (Please check one). :eieonone No. PERMIT FELE S (Signature at Owner or Agenti r a•bS8t3 Date . . .Z� pORTI{ °`,"`°:•'"° TOWN OF NORTH ANDOVER PERMIT FOR WIRING EE ,SSACMUS� oo O This certifies that has permission to perform.r........................................................................... wiring in the building of a....�J.......� i�lCU ............................... .North Andover,Mass. r-- Fee Fee ..�........ Lic.No. Fd ............... .......... .......................... r� f ELECTRICAL INSPECTOR p WHITE:Applicant CANARY: Building Dept. PINK:Treasurer �� a �T `1 a S . � �} �y� ��; �y��� ,�-tin, � � ,�� T. "IF 7�� r i ^� � t." vc, a ♦N� ,` � .v ,�' � i, ;, .� « � \�a t &. • s\ • �� \ T . « !-address -�Dm'0,Lo.,•trr�c. V — � � TitFe of File Page of Daae File Open: --, Date file closed: _ Doc Document/Action Title Date of _ action 6tefEr to other Purpose of Document/Act nand notes Document/ document/ Num. --- Action Department —_--_ Board of Appeals — Board of—Health — Planning Board _ Cons eruaflon Commission — Building Departrnen;fi : Town of North Andover, Massachusetts Form No.z f MORT#, BOARD OF HEALTH (p] O`� � o P ����"-��--•rrr++4" DESIGN APPROVAL FOR • ;�sAcNus� SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant - i 1 •¢.� �0 � Test No. Site Location �n-r .� �"_ _A-vim 0..m CkAj-� • Reference Plans and Specs. ENGIN DESIGIT DATE : Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. , C CHAIRMAN,BOARD OF HEALTTr— Fee Site System Permit No. 73 o 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 landowner from compliance with any applicable local or state law, regulations or requirements. **************e**/A�ppl/i�cant fills out this section***************** APPLICANT: APPLICANT: Phone LOCATION: Assesso r's Map Number Parcel / Subdivision F5kt415 Lo s) Street C04al "' ` St. Number ************************Official Use Only************************ RECOMMMATIO S O AGENTS: ,<. Date Approved Conservation Ad inistraDate Rejected omments K �, ,,Z/ 4s ccnntcky Date Approved Town Planner Date Rejected _l Comments Jan z-?�,Q f'CL-LJ!Y� OL�, wy5I:_/Vo Cn at aLsza�. Date Approved Food Inspector-Health Date Rejected L-,A,/ 2� Date Approved Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Department �- � ( � �r •�✓ Received by Building Inspector Date Town of North Andover, Massachusetts Form No.3 BOARD OF HEALTH • o< MORT/{ 19 a 10- 9 �'-°.,,,;.•�"� DISPOSAL WORKS CONSTRUCTION PERMIT • ,SS/1CNUSEt Applicant NAME TELEPHONE � �Q,r�A.Q jl Site Location Permission is hereby granted to Construct ( or Repair ( ) an Indivi (�Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. ` � N ��, O F HEA Fee D.W.C. No. g � r !4D/ PZ- AN Of SANZ) ° IN , NO , A ND 0 VER MA SCALE' 1" ! 40 ' DATE.• MAY 9 1996 HA YES ENGINEERING, INC. 603 SALEM STREET CIVIL' ENGINEERS 6 MAKEF.M0 MASS. 01880 LAND SURVEYORS TEL. 617-246-2800 I CERTIFY THAT THIS FOUNDATION IS LOCATED ON THE GROUND AS SHOWN ANO THAT IT CONFORMS TO ThE ZONING BY-LA#S OF THE TOl✓N OF NO. ANDOVER. I FURTHER CERTIFY THAT THIS PROPERTY DOES NOT LIE WITHIN THE FLOOD HAZARD AREA (ZONE A OR V) AS smomN ON FLOOD INSURANCE RATE MAP COMMUNITY PANEL NUMBER 250098 0010 B EFFECTIVE DATE. ✓UNE 15 1983. � DATE Ma►Y1996 -----------------�-----------.- ----------4/-l •� �, PROFESSION LAND SURVEY s $i��C. 015320 $t0�� aua �°� •�O C04 -Aq 9�f 2S �� op 140. 49 VE. �QO�6s pp L '196.68 =55.91 cn' / " w 0.01.0Z.0 TDP of FND.,f s4 o ry0 El.= 149.62 ti W ZONE. PRD (9 o MINIMUM SETBACKS. I FRONT = 20 " SIDE = 20 ` L O/T 2 C%. REAR = 20 ` 28, 865 S. F. I� TOP FOUNDA TION EL EVA TION = 149.8 \ --=s. - --- 109.67 ' ;�, aE .--- -• 55.01 N69'59'26"E 164.68 PITS MIN 660 LEACHING MIN 1 (131x16 ' ) PIT MANHOLE/PIT GW MIN 4 ' BELOW BOTTOM EXC 2x EFF W OR D 12"-48" STONE BOT + SIDE x LOAD = TOTAL (L x W x #) (2x(L+W) xD x #) (G/ft2) CHAMBERS MIN 660 LEACHING GW MIN 4" BELOW COVER >3 FT - VENT MANHOLES 12"-48" STONE SPLASH PADS SLOPE . 005 BED/TRENCH (Bed max. 60 ' X 601 ) MIN 13 ' X 16 ' PIT BOT + SIDE X LOAD = TOTAL (L x W x #) (2 x (L+W) xD x #) (G/ft2) FIELDS MIN 660 GPD 900 ft2 SEDC/ GW MIN 4 ' BELOW BOTTOM OF FIELD PIPE ENDS JOINED? 4" PEA STONE? L/ DIST LINE SLOPE . 005? >31COVER-VENT SCH 40C/ MIN 12" COVER 6-----7 RATE LDG , 74- X 660 = � z6 = TOTAL ft2/G REQ - D (ft2) LXW 6 DOSING TANKS AND PUMPS 4n L,^C 667 DIMENSIONS X X = PUMP CAPACITY gpm L W D Vol. DISCHARGE SIZE DISCHARGE RATE DISCHARGE TIME gpm MANHOLES TO GRADE ALARM SEP. CIRC. GW (Min. 1 ' below inlet) HWL LWL CHECK VALVE BLEEDER HOLE MANUAL OP. SWITCH Copyright© 1995 by S.L. Suer d- HAYES ENGINEERING, INC. 603 SALEM STREET WAKEFIELD, MA 01880 NOA-0042 (617) 246-2800 REFER TO FILE# FAX (617) 246-7596 October 3, 1995 Mr. Richard A. Colantuoni Building Inspector Town Hall 146 Main Street North Andover, MA 01845 RE: Woodland Estates -Test Hole Information Dear Mr. Colantuoni: In accordance with our discussions back a couple of months ago, I have conducted the required test holes and inspected the soils on Lots 1, 2, 4, 5 and 6 Colonial Avenue in the Woodland Estates subdivision in North Andover. The procedure used was to excavate a test hole at each end of the proposed dwelling, determine the type of soil, and also estimate the seasonal high groundwater based on soil mottling. In addition, a comparison was made to the highest groundwater elevation of any nearby test hole conducted for the purposes of septic system design. Based on the highest groundwater encountered in the area, I recommended a cellar floor elevation at least two feet above the highest elevation. My conclusion is that underdrains are not necessary under the Mass. Building Code on Lots 1, 2, 4, 5 and 6 Colonial Avenue. I trust this information is suitable for.your purpose, and, by means of this letter, am requesting you to notify Sandy Starr, Health Agent for the Town of North Andover, so that permits may issue on these lots. Ve truly yours, JJ N OF MAs�'cy tM c �l WRENH Peter J. Ogren, P.E., (336033604 President SUR lileNAl E PJO/dab Enclosure cc: A.C. Builders, Inc. f TEST HOLE INFORMATION WOODLAND ESTATES NORTH ANDOVER, MASSACHUSETTS October 2, 1995 Elev. Top Elev. Bottom ESHWT 2 Highest GW 3 Minimum Proposed Underdrain Lot# Hole#' Soil Type of Hole of Hole or (mottling) at nearby Recommended Elev. Required Water Elev. Title 5 Elev. Test Hole 1 1A(LE) Silty gravel 141.7 130.7 136.3 135.6 138.3 142.5 No 1B (RE) Silty gravel 145.3 132.3 None 2 2A(LE) Silty gravel 143.5 129.5/water 139.5 135.1 141.5 143.0 No 2B (RE) Gravel 142.7 132.7 139.2 3 NOT DONE 4 4A(RE) Silty gravel 144.0 134.0 138.5 140 142 145.5 No 4B (LE) Silty gravel 146.5 137.5 None 5 5A(RE) Gravel 146.5 136.5 138.5 143.9 145.9 151.0 No 5B (LE) Gravel 147.5 132.0 142.0 6 6A(LE) Gravel 154.0 145.0 None 148.8 150.8 154.5 No 6B (RE) Gravel 150.5 142.5 None ' End of House Facing Proposed Dwelling. LE = Left End RE = Right End 2 Estimated Seasonal High Water Table. 3 Actual or Estimated Groundwater Used in Septic Design. DATE 7 �-5 Sheet of BOARD OF HEALTH TOWN OF NORTH ANDOVER SUBSURFACE DISPOSAL DESIGN REVIEW A_ b FEE � PERMIT # 73CD DATE RECEIVED� APPLICANT A1C BU/GpS �,Uc, ASSESSOR'S MAP ADDRESS /VA PARCEL # LOT # J� STREET C-6 40N r14L U t7 � ENGINEER -}��Y�S ��(JG, ADDRESS PLAN DATE /��/ � REVISION DATE CONDITIONS OF APPROVAL: APPROVED DISAPPROVED V0 5016 17-(567-�5 IA,) 3 . 7-l9,v,� A)6-r R(l--" ,�,eo M �,��� A)07- C)�`f d� / PLAN REVIEW CHECKLISTTAgy,ADDRESS L pr 2 Q��/ ( J (J� ENGINEER •S GENERAL 3 COPIES// STAMP LOCUST NORTH ARROW C-- SCALE C� CONTOURS_[,:,,' PROFILE !/ SECTION c_- BENCHMARK SOIL & PERCS ELEVATIONS WETS. DISCLAIMERy/ WELLS & WETS WATERSHED? /t/6) DRIVEWAY (Eley) WATER LINE FDN DRAINx SCH40 L--*-- TESTS CURRENT? SOIL EVAL SEPTIC TANK MIN 1500G ✓ . 17 INVERT DROP �� GARB. GRINDER(+200% EDF) 25 ' TO CELLAR MANHOLE (/ ELEV GW # COMPS. D-BOX SIZE # LINES f) FIRST 2 ' LEVEL STATEMENT INLET A/o-/ 7 - OUTLET 1-4&y 0 _ (2" OR . 17 FT) TEE REQ'D? V0 LEACHING +i� q�;14 , MIN 660 GPD? RESERVE AREA FROM PRIMARY? 2% SLOPE 100 ' TO WETLANDS G-*'-- 100' TO OC .� � 4 ' TO S.H.GW 5 '>2M/IN 35 ' TO FND & INTRCPTR DRAINS JC 325 ' TO SURFACE H2O SUPP �- 4 ' PERM. SOIL BELOW FACILITY MIN 12" COVER FILL? (25 ' if above natural elev; 101if below) BREAKOUT MET? TRENCHES MIN 660 gpd SLOPE (min .005 or 6"/1001 ) SIDEWALL DIST. 3X EFF. W OR D (MIN 61 ) RESERVE BETWEEN TRENCHES? IN FILL? MUST BE 10 ' MIN. 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 J , Vi ♦ tt _ /`/ , '' '�lti.f{, ��I'l+itY���r���TI SM`1 �.y �•'�� I ' �!-\ � � p+t ,' - °:i`t ' �� tt r, e�• �ho� + fr$Li #yy ` yi` ) HORTN c� ,/p BOARD OF HEALTH ' 120 MAIN STREET TEL. 682-6483 �9SSA"HUS NORTH ANDOVER, MASS. 01845 Ext23 July 6, 1995 Hayes Engineering 603 Salem Street Wakefield, MA 01880 Re: Lot #2 Colonial Ave. To Whom it May Concern: This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: 1) No soils tests in reserve area. 2) No foundation drain shown (required in North Andover) . 3) Tank not 25 feet from foundation; leach area not 35 feet from foundation. 4) Three 20 inch access manholes required for tank (15.228) . Also specify gas baffle at outlet. 5) What are perc test elevations? If you have any questions, please do not hesitate to call the Board of Health Office at the number above. Sincerely, Sandra Starr, R.S. Health Administrator SS/cjp 3 wry v . ht. : T , _ I - ------- ----- -- - c cy ItC - 4�dl T-1A .. ltt �t iii Ce � I -— -------- I -�T � I � i ; _ r � , ✓off'' Q - �-�� T04V,� �'t", I ANDOVER/ Q D OF HEAMN No......................... Fins.............................. THE COMMONWEALTH OF MASSACHUSETTS MAY 2 5 sZ + BOARD OF HEALTH W:%J . r ....14..........OF..... ...0....A.14..POVIFIZ. ......... --------------- ApVtiration for Uhipoiittl orkii Totwundinn Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ........................ W�: 14.1 �J . t'._z- -.........-- .. Locat' n dress / Zr Lot No. --•------ .� ,... �U..i-- C � . ........-�................ 3_->.._..-l�v..A�•: E.�?.. !2 �o •��1.1�1??i.1..�.(� Owner Address W Installer Address V. ?.S � Type of Building Size Lot... feet _.._. q. �--� Dwelling—No. of Bedrooms........�....................................Expansion Attic ( ) Garbage Grinder ( ) '4d Other—TYPe of Building --------------------•------• No. of persons............................ Showers Cafeteria a Other ( ) xtures -•---••-•--•-------•---•----•---••-•----••-•••-------...-••-••--------------•----•---•-- -------------- xW -•-•-- Desi n Flow..............10....... gallons per person per day. Total dailyflow__ ��/ j , .J,�. •••gallons. 1:4SepticTaquid capacity .gallons Length................ Width.....__........_ Diameter..._.__...._.__. Depth................ Disposal�i—No. .................... Width....._��_..... Total Length...4--S......... Total leaching area... ft. Seepage Pit No--_----------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing t nk ( && , I I u ,/ ~" Percolation Test Result Performed by.._.. 1�. '' ._.�!�P._.l ...................... Date....._ .-I...9_4........... W ZA-Test Pit No. I...< minutes per inch Depth of Test Pit......0__....... Depth to ground water..... 0.....-.-.-. tX, Z'9 Test Pit No. 2_.. inutes per inch Depth of Test Pit....ea........ Depth to ground water----- .......... .... ................................................................... O - Description of Soil----••---• ..................... ------------------G U ------------------------ •-•---------------------- .-------------------------------- ----------------------- •-•------------------------------- •------------ •-------------------------•--------••----------- W VNature 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 iITTIE 5 of the State Sanitary Co Zhedersi d further agrees not to place the system in operation until a Certificate of Compliance has be edb r f healthy _ e� Signed _ S/ /� ApplicationApproved By.................................................................................................. ..........-............................. Date Application Disapproved for the following reasons-----------------------•----------...--------•-----------------•••--------------•----------------........._...... .......................................-----------•-------•-----•------•--------•------•--•--------------•----•-••--•-••--•-------•------•-•---••••-------------••-•••---------•-----------•----•-•---- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Tntifirate of Tomplianrr 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 T-r^;E 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No______________________________________ _ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.....------•-•----•------------------------------------•-•-•------•---••-••------•- THE COMMONWEALTH1. OF MASSACHUSETTS BOARD OF HEALTH .........................................OF.................................................................................... No.............•--......... FEE........................ IliouoottlWork-n 011.1ono#rnrtion "Permit Permissionis hereby granted.........-.................................................................................................................................... to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo........................................................................................................ Street as shown on the application for Disposal Works Construction Permit No--------------------- Dated.......................................... ....................•-•--------------•-------------------------------------...---••-•--•.......•••-•-_.._ DATE -_ ... Board of Health FORM 1255 HOBBS & WARREN, INC., PUBLISHERS Town of North Andover, Massachusetts Form No. 1 01NORTH BOARD OF HEALTH 1D � �<,,E �6,6h * c APPLICATION FOR SITE TESTING/INSPECTION aDRA TED WPy,�y �SSACHU5E� Applicant_ C &A� & A_A NAME ADDRESS TELEPHONE _ � �-Site Location �� liiazn , . .(Afn Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time 4 CHAIRMAN,BOARD OF HEALTH Fee (. Test No. q�3 9 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 Q ,SLE° ib tiO 3a y� 46 0� 19 FO A * �. 'rte APPLICATION FOR SITE TESTING/INSPECTION SSACHl15E��h Applicant NAME ADDRESS TELEPHONE Site Location Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. "MIA" Z� 7 i I�. � Ii � II Ili V4 -71 ��'� 111 I "� � --t t 1 , DO 4 rig"YLJ rg ; /3z- F� - - /j/ �/G)`- S�� 1 if cxp r3 COAotst4` 1 Z`�,. - f. ., �o ` i ZA�'/ �� �Z' e p1i !i ?8 ,1 � K - Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 M 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. A. Facility Information 1. System Location:. e J-Right ro� of hou eft/Right rear of house, Left/right side of house, Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under deck Address Cityrrown �' State RK V - Code 2. System Owner. dry QUO 14 2012 Name TOWN OP NORTH ANDOVER HEALTH DEPARTMENT Address(if different from location) City/Town StateZip Code (01e-1 Telephone Number B. Pumping Record 1. Date of Pumping Date _ 2ntity Pumped: Gallons l �C) O ;/Qu3 3. Type of system: El Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Locati ere contents were disposed: G.L Lowell Waste Water 7 ' 1 ' I � SignAtufe Haule Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1