HomeMy WebLinkAboutMiscellaneous - 21 SOUTH CROSS ROAD 4/30/2018 (3)vJ
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Form.5
!jl - Commonwealth
of Massachusetts
1,
South Cross Road
U J
DEOE t=ile hu. 242-494
(To be provided byEOE)
City/Town North Andover
Applicant Allen Cuscia & - Joseph Levis
Order of Conditions
Massachusetts Wetlands Protection Act
G.L. c.131, §40
land under the Town of North Andover's Town Bylaw, Chapter 3.5
From NORTH ANDOVER CONSERVATION COMMISSION
To- Allen Cuscia & Joseph Levis Same
(Name of Applicant) (Name of property owner)
Address P.O. Box 952, Lawrence, MA
Address Same
This Order is issued and delivered as follows:
2/by hand delivery to applicant or.representative on (date)
❑ by certified mail, return receipt requested on
This project is located at South Cross Road, North Andover, MA
The property is recorded at the Registry of Northern Essex
Book 2743 page 55
Certificate (if registered)
(date)
The Notice of Intent for this project was filed on February 2, 1989 (date)
The public hearing was closed on . April 12, 1989 (date)
Findings
The North Andover Conservation Commission has reviewed the above -referenced Notice of
Intent and plans and has held a public hearing on the project. Based on the Information available to the
NACC at this time, the NACC has determined that
the area on which the proposed work is to be done is significant to the following interests in accordance with
the Presumptions of Significance set forth in the regulations and precedent and practice under this
Town's ByLaw for each areasubject to protection under the Act and ByLaw:
LJ Public water supply ,/,/ Flood control El Land containing shellfish
Private water supply ,L1 Storm damage prevention ❑� Fisheries
"-^ilnd water supply Lid Prevention of pollution ❑ Protection of wildlife Habitat
5-1
11/1/87
Commonwealth of Massachusetts
City/Town of No.Andover
W° System Pumping Record
G^M SVS
Form 4
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
r�
rerun
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use. The System Pumping Record must be submitted to
the local Board of Health or other approving authority within 14 days from the pumping date in
accordance with 310 CMR 15.351.
A. Facility Information
1. Svstem Location:
C. ro
Haaress
No.Andover Ma �I r
CityTrown State Zip Code
2. System Owner:a f^n '� `�(� �c-j ��2U12
Name TOWN OF NORTH ANDOVE
HEALTH DEPARTMENT
Address (if different from location)
City/Town
State
Telephone Number
B. Pumping Record I
1. Date of Pumping� Date i l ( 2. Quantity Pumped:
3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank
❑ Other (describe):
4. Effluent Tee Filter present? ❑ Yes No
5. Condition of Sy m:
6. S m Pu ed By:
Name
Stewart's Septic Service
Company
7. Locationhere ontents were disposed:
Ste art' re-ttatment Plar-t,2-9-St ill Bradfoi
Sigkatuterof
Zip Code
/SCD
Gallons
❑ Grease Trap
If yes, was it cleaned? ❑ Yes ❑ No
Vehicle License Number
Ma 01835
Date
- 12./2-//
Date
t5form4.doc• 03/06 System Pumping Record • Page 1 of 1
A
Commonwealth of Massachusetts RECEIVED
W City/Town of North Andover FEB 14 2017
System Pumping Record TOWNOFNVRIHAWOVER
Form 4 HEALTH DEPARTMENT
Important: When
filling out forms
on the computer,
use only the tab
key to move your
cursor - do not
use the return
key.
— I—
WR17
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use. The System Pumping Record must be submitted to
the local Board of Health or other approving authority within 14 days from the pumping date in
accordance with 310 CMR 15.351.
A. Facility Information
1. System Location:
North Andover
City/Town
2. System Owner:
Name
Address (if different from location)
City/Town
B. Pumping Record
1. Date of Pumping
State
Zip Code
State QQ � � o, e
Telephone Number
Date / ` uantity Pumped: lS�
Gallons
3. Component: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Grease Trap
❑ Other (describe):
4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No
5. Observed condition of comp(o'ne t %pump( d:
6. Sys - Pumprry:
Name Vehicle License Number
Stewarts Septic 58 So Kimba)St Bradford Ma
Company
7. Location where contents were disposed:
26L so mill st bradford ma A
A , � � 1 -0 9 - /1K
Sign ure of Hauler Date
of Receiving Facility (or attach facility receipt) Date
t5form4.doc• 11/12 System Pumping Record • Page 1 of 1