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HomeMy WebLinkAboutMiscellaneous - 2125 TURNPIKE STREET 4/30/2018 (3)le C2, Li 5, 3 ` 1k,11 -5�-,�S vr; � C Commonwealth of Massachusetts W City/Town of No Andover System Pumping Record Form 4 M M - ;. MAY -14 2013 t TOWN OF NORTH ANDOVER CcPARTM T 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. 6. System Pumped By: MCA M . a�"— Stewart's Septic Service Company 7. Location where contents were disposed: Vehicle License Number Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 ure of Hauler Date �= - nature of Receiving acility Date t5form4.doc• 03/06 System Pumping Record • Page 1 of 1 A. Facility Information Important: When filling out forms 1. System Location: on the computer, use only the tab 2125 Turnpike St key to move your Address cursor - do not use the return No Andover Ma key. City/Town State Zip Code 2. System Owner: Watters Name Address (if different from location) City/Town State Zip Code Telephone Number B. Pumping Record a A 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) �eptic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? \ ❑ Yes ❑ No 5. Condition of System: ()!aA 6. System Pumped By: MCA M . a�"— Stewart's Septic Service Company 7. Location where contents were disposed: Vehicle License Number Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 ure of Hauler Date �= - nature of Receiving acility Date t5form4.doc• 03/06 System Pumping Record • Page 1 of 1 0 a �•°; ��lti�1i51 �' f ry _hr!r' h ! ri l{ �Flr `F - r � a t t i i ,Common ' lth of Massachusetts aEP t� t Q1Q City f ORTH ANDOVER MASSA ®Avg /Town.:o ' 'y sfemPu Y., . mping Record H �+ Form�4 ` > *x DEP has provided this form for use by local Boards of Health. The System Pumping Record mu:'� be submitted to the local Board of Health or other approving authority. .A.. Facility Information � t . 1. Svstem Location: Add .. i...' r i—CL— Oty/Town State qZJPCde 2. System Owner game Address (If different from location) Clty/Town State ZIP Code Telephone Number B. Pumping Record ' J/ l i. 1. Date of Pumping ' ost� 2. Quantity Pumped: G 3... Type of system:. , ❑ Cesspool(s) Septic Tank ❑ Tight Tank Other (describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No if ye`s; •was It cleaned? ❑ Yes ❑No S. Condition of System: 8.. a Pumped �By: Me . Vehicle License Number Company.; 11ce- 7. '. Lo do where contents were disposed: tr ,k In S gns o aular .. Date http�' s.govldep/water/approvalsA5forms.htm#Inspect • `+' t5fc• 3 f ';. System Pumping RecoW Page 1 of i h' TOWN OF NORTH ANDOVER SYSTEM PLWING RECORD DATE SYSTEM OWNER & ADDRESS Waft i -s (=� 1,9,5 -- IUD . (QIVi66 vete, Ma. SYSTEM LOCATION 8a c � 0 -C Ao vx DATE OF PUMPING I L QUANTITY PUMPED 6 Km CESSPOOL NO__)4 YES ROUTINE EMERGENCY NATURE OF SERVICE: OBSERVATIONS: SEPTIC TANK NO GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES 14LACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLID CARRYOVER OTHER EXPLAIN SYSTEM PUMPED BY COMMENTS: r., CONTENTS TRANSFERRED TO YES4 TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: SYSTEM OWNER & ADDRESS SYSTEM LOCATION (example: left Lfront of house) DATE OF PUMPING: � "Z2'�- QUANTITY PUMPED%5� GALLONS Cf.SSPOOL: NO YES SEPTIC TANK: NO YES bl 'MATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION L1 HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER S"i"STE'N" PU",:PED BY: CONI M ENTS: CONTENT'S TRANSFERRED TO: FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) *'•V1 I ' i TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: D— ( +cl_z� l .'v\ cCj+AceS4 (example: left front of house) Imo+ S� c-- A- P %ems' Aoj13< DATE OF PUMPING: a-16 rGNMA QUANTITY PUMPED GALLONS CESSPOOL: NO "YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE � EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER SYSTEM - BY: FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) 6. L. s. D CONTENTS TRANSFERRED TO: TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: SYSEZ,A NER & ADDRESS SYSTEM LOCATION C(example: left front of house) DATE OF PUMPING: D' ( 6-3vI QUANTITY PUMPED ( gw GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) SYSTEM PUMPED BY: COMMENTS: c../,w,3N c CIO - C -e -,v k c ',-J cc�d(q �e,4�-OA a0> -,4P- Y)0�-VtAdj CONTENTS TRANSFERRED TO: t ' z4qtj gCaF �. BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: OF Nv c O � p4 �4 .95 RAlai SACH TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New BuildingOne family AddiPion wo or more family Industrial Alter No. of units: Commercial Others: Repair, replacement Assessory Bldg � 'tion Other ti Well Floodplain Wetlands'.Watersh, ed District Water/Severer .. . .- • •- f/_ P71- AAIICOSA� MA A ARCHITECT/ENGINEER Phone:#Y2-,�$� ��Q/ Y�p Address: VI IUPuLd W_Reg. No. FEE SCHEDULE: BOLDING PERMIT. $12.00 PER $1000.00 OF THEt4TAL ESTIMATED COST BASED ON $125.00 PER S. F. Total Project Cost: $ W 06 FEE: $ --� Check No.: NOTE: Persons contracting wi; Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/MassageBody Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private (septic tank, etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS DATE REJECTED DATE APPROVED low s 000000000�- DATE REJECTED DATE APPROVED HEALTH 7�1 COMMEkTS `� ^ Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments_ Conservation Decision: Comments Water & Sewer Connection/Signature & Date DrivewayPermit Located at 384 Osgood Street Ckls,r GIr- cCn+ca,--rr-- aRIvFwAy - pool IJrt 1�Q,Vu' � Fr - -�� a,zW" #2125 EX/sr HSE FND. COICP,-TE 7�R � uuv�17 50.00' o rE 85 TO Sj5PT�G J 5 PRO, 7:J rIi c)...J w , Ivor FA "It y N Ro4M F; c)It, .� �iSrr 16, t. fXisriW4 /�aP G�Llcyu Scr n c LOT 4 ? PLA 41607A LANDCOUR'T CONFIRMATION 20 - L f EXi SnWG C CAcr4we, FIC4�b ScAt-6 = a® L011 D k�� vch, ,• 3 o rE 85 TO Sj5PT�G J 5 PRO, 7:J rIi c)...J w , Ivor FA "It y N Ro4M F; c)It, .� �iSrr 16, t. fXisriW4 /�aP G�Llcyu Scr n c LOT 4 ? PLA 41607A LANDCOUR'T CONFIRMATION 20 - L f EXi SnWG C CAcr4we, FIC4�b ScAt-6 = a® L011 Town of North Andover Community Development and Services Division 0.3 Office of the Health Department 1600 OSGOOD STREET North Andover, Massachusetts 01845 Michele E. Grant (978) 688-9540 - Phone Public Health Inspector (978) 688-8476 -Fax Date: July 19, 2007 Address: 2125 Turnpike Street, North Andover, MA 01845 Re: Application for: Addition Dear: Mr. Watters Your application for an addition at 2125 Turnpike Street has been reviewed by the Health Department. The application was denied on, July 19, 2007 for the following reasons 1. x Missing information 2. % Passing Title 5 inspection of septic system required 3. ❑ Location of structure not acceptable 4. ❑ Undersized septic system To address the problem(s): If #1 is checked, please supply: a. Floor plan of existing and proposed addition — all rooms b. Certified plot plan showing house, septic system and proposed project in scale p`4t4ao If #2 is checked: a. Have the septic system inspected by a certified Title 5 inspector to determine the size of the system and whether it is operating properly: OR b. Tie-in to municipal sewer If #3 is checked: a. Relocate the project If #4 is checked: a. Provide additional information proving that the existing septic system meets current capacity requirements. Please consult an engineer to determine the flow capacity of the septic system. Please feel free to call the Health Office at 978-688-9540 with any questions you may have. Sincerety, fr f7 Kele E. Grant / Cc: Building Department A%� File BOARD OF APPEALS 688-9541 BUILDING 688-954.5 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 Permit NO: BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received 13 C% �gATID TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition wo or more family Industrial Altera fion No. of units: Commercial Repair, replacement Assessory Bldg Others: tion Other ���1oodlar� Wpih'ya W ' 'th$#1Ji:x ' er/Se11 u y q.. ;ew .DESCRIPTION F WORK TO _ _ PREF MED: Y-6( T),,A�rm v'2 t) t ve OCaC-Uwt, Identification Please Type or Print Clearly) OWNER: Name: fj�uD/ �Phone: A.4.4roc c - ARCHITECT/ENGINEER Phone: --291 JY2, 0/ l �O Address:CA-�Vl IGi Reg. No.Q ,(;:7 FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ ?S` FEE: $ 991 --'� n Check No.: NOTE: Persons contracting Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well _ Tobacco Sales Food Packaging/Sales Private (septic tank, etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS T15 REJECTED 4—cONSERVA COMMENTS �DATE REJECTED DATE APPROVED HEALTH COMME` S Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision:. -Comments Water $ Sewer Connection/Signature & Date Driveway Permit Located at 384 Osgood Street f TOWN OF NORTH ANDOVER AIPPLICATION FOR PLAN EXAMINATION Date Received 11-2:4L IMPORTANT: Applicant must complete all items on this page i Print OWNER— �// !_ iia I Print PARCEL: ZONING DISTRICT: 0 JSE OF BUILDING HISTORIC DISTRICT YES ❑ PROVEMENT PROPOSED USE Residential Non- Residential ling ne family ❑ Two or more family No. of units: E Industrial placement n ❑ Assessory Bldg 0 Commercial elocation) ❑ Other G Others: n only DN OF WORK TO BE PREFORMED. r Identification Please Type or Print Clearly) 6 'OR Name: 1 4q Lel 6)f Construction License: Exp. Date: vement License: / d 6%�P7 Exp. Date: 27Z-20Lm- zS-E-70Z0 PENGINEER G Name: Phone: Reg. No. E. BOLDING P R. 1T: $12 00 PER $1000.00 OF THE TOTAL EST/MATED COST BASED ON $125.00 PER S.F. t Cost :$ �-�� FEE:$ &Z12 Receipt No.: __r 4 TYPE OF SEWERAGE DISPOSALSwimming Tanning/Massage/Body Art ❑ Pools L Public Sewer � --� Tobacco Sales �7 Food Packaging/Sales El Well Private (septic tank, etc. Permanent Dumpster on Site 7, Electric Meter locatio to ' project 9 /1 NOTE: Persons contracting with unregistered contractors ao nor nave access to rile Signature of Agent/Owner Plans Submitted ❑ Plans Waived ❑ Signature of Certified Plot Plan C' THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM fund 'f �o VV Plans ❑ DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION COMMENTS 1, HEALTH COMMENTS ,/. _v DATE REJECTED DTPPRO q) � FIRE DEPARTMENT - Temp Dumpster on sit yes n no Fire Department signature/date e2 .4 COMMENTS Zoning Board of Appeals: Variance, Petition No: "Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer connection/Signature & Date Driveway Permit THE ZONING DIST. IS R2. 150' FRONTAGE 43,560 S.F. AREA 30' SETBACKS ALL AROUND. PLAN OF LAND IN NORTH ANDOVER, MASS. OWNED BY JOHN AND HEIDI WAITERS SCALE: 1"--40' DATE.101102006 10/232006 TURNPIKE 150.00' os 0 STREET 53' #2125 T. 16 EXIST HSE. PROP A FND. FAM/L y 51 ,3 Roots l �, 16, CO M LOT5 LbT4 PLAN 41607A LANDCOURT CbNFIRMATION 7 J� f Scott L. Giles R.P.L.S. Frank. S. Giles R.P.L.S. 50 Deer Meadow Road North Andover, Mass. LOT 3 '8s 1 CERTIFY THAT OFFSETS SHOWN ARE FOR THE USE 6 THE OFFSETS OF THE BUILDING INSPECTOR ONLY SHOWN COMPLY AND SUCH USE IS FOR THE WITH THE ZONING DETERMINATION OF ZONING BYLAWS OF CONFORMITY OR NON -CONFORMITY WHEN CONSTRUCTED. WHEN BUILT Scott L. Giles R.P.L.S. Frank. S. Giles R.P.L.S. 50 Deer Meadow Road North Andover, Mass. LOT 3 f�i9: 17812,955101 GPI STONEHAM PAGE 01/04 r N To: Michele Graft From; John Watters Company: North Andover - Roafrd of Health Time: 9:25 AM Phone: 978.688.9540 Date: ,July 19, 2007 Fax: 978,688,8476 Project Number. Project Hahne: Wages including cover: 4 o Urgent ❑ For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle 0 Ms, Grant Thank you for talking to me about my building permit this morning. As requested, here are three 8 , f by 11 sheets of paper showing the existing and proposed basement, first, and second floors. If I can be of any assistance in answering some questions for you about the house or the plans, please feel free to give me a call . Also, if these fax copies are not clean enough for you to read or use, please let me know and I can email PDF files for your use, Thank you John Watters 2125 Turnpike Street 781.279.5500 (ext 3917) work 978.258.7020 home The Informatlon contained in this facsimile message Is privileged and confidential information Intended only for the use of the individual or entity named above and other, who have been specifically authorized to receive it, If you have received this communication In error, please notify us 2 Immediately by telephone. Any dissemination, dls4 Wi on or copying of this communica4on is strictly prohibited. O'ER Greenman — Pedersen, Inc. 105 Gentral Strad, Sulfa 4100, Stoneham, MA 02180 Tel: (781) 279.5500 Fax: (781) 279-5501 VO/ZO 39VJ HVH3HOlS IdD TLISSE,L'ToLT :GCl LOOZ `6Ti'-'O WH,�wl�; TH�) TAqqG-!ZT@LT L 6 Cl LOFJ7 /6 T z .! bbl/t7A WHHANOIS Ids! 6 La IOW 6T,"41 ... .{� � �r � � { �t � . � •yl{�i � ,•`V r= � ^ d; � r .�Yv,. v�Vrn � rr,Ytji lir p1jy"'� NW, ' '`. �' ,i TTT t .d ) . r, c • �d� ,;� � ;sN' 1,R 1d 1. r ,",• , 4r� f� I } i. �N olasschusetts RTH A�11 ER`.MASSACHUS r+ y ys em umpn ' Recod' ,fit jt� fi ti :111.yr -ne t �1 4 ' Form 4 r+,� W,r 1 JAN 2 <� 2 2007 DEP has provided this form for use by local Boards of Healtri°1`lie? stem P.txtrtping Record must be submitted to the local Board of Health or other approvin""g autMor`ity; t "`� iTMEW H: rapity intormation �r1 {/1 I've• / • -- Amportant. -;- When filum out 1 : System Location computer, use') &Yjl2ga LR Ma only the tab key Address 14,15;,• to move your-' � ;.cursor • do not Date use the Tatum City/Town State Zip Code IM x ', d [ ";' 2 System Y m r { ' 0 'Name . ; • Address (if different from location) Citylrown State • Zip Code • Telephone Number x1B.4 Pumping Record: „w a • 1 Date of Pumping 2. Quantity Pumped: pate Gallons 3, Type of system, ❑ Cesspool(s) E" Septic Tank ❑Tight Tank 0's Other (describe); 4, Effluent Tee Filter present?. ❑ Yes. aNNo If yes, was it'cleaned? ❑ Yes ❑ No 4 5 Condition of System + . 3y em Pumped By AWN Name a . • . • ,. • Vehicle Uoen$e Number 1 �. rF i.iS ��r L�/w., I�r:. ///y //'D -`C} • d ay}` )' t _� :7 {,hrd .l :..V �!'fi� j'<C Il w ��WV, V� , .. i . •, .Company" C 4o- • 1 / 3 { f, 7 Location where contents were disposed: , Ma 14,15;,• • e !'• rix � �k1 S� ureo auler;x �. Date httpa/www.mass.gov/depJwafer/apprOvals/t5forms,htm#inspect • t5f0mA.dW-0&03 System Pumping Record • Page 1 of 1 NORTH L T 71 * - # ,SSAC14IJ Applicant_ Site Location Town of North Andover, Massachusetts F°"" No. a l BOARD OF HEALTH i DISPOSAL WORKS CONSTRUCTION PERMIT NAME ADDRESS '�/5 - 741.5 TELEPHONE Permission is hereby granted to Construct ( ) or Repair (i.') an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. I CHAIRMAN, BOARD OF HEALTH Px Fee /J D.W.C. No. Subsurface Disposal System Construction Inspection Availability Monday. 9:45 - 12:00 PM Tuesday 2:45 - 3:45 PM Wednesday 9:45 - 12:00 PM Thursday 2:00 - 3:30 PM Friday 9:45 - 12:00 PM All requests for septic inspections that are made before 9:30 AM, (schedules permitting) will be inspected on that day. All requests made after 9:30 AM will be inspected the following day at the available time as noted above. ALL scheduling will be Performed by the secretary. Please call the (978) 688-9540 for the required inspections listed below: Bottom of Bed Please have the entire bed bottom exposed as per plan and a sample of the septic sand on site for observation. Final Please have all of the system pipes bedded properly and the top of the pipes exposed for review, the d -box outlets flowing level, and all the pipe connections sealed properly. The pea stone may be covering parts of the system, but do not fully spread it out. For a pump system, please fill the tank with water and have access to the building to observe electrical connections. Final Grade Please have all of the system components covered, loomed and the finish grade completed per plan specifications. Please note that the licensed installer must be readily available to supervise the ongoing construction of the system and an approved plan stamped by the town must be on site at all times. Fines may be levied for premature requests for any inspections that result in additional visits to the site by the inspector. TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System ( ) constructed; ( ) repaired; by located at was installed in conformance with the North Andover Board of Health approved plan, System Design Permit # , dated , with an approved design flow of gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As -built which has been submitted to the Board of Health. Bed inspection date: Final inspection date: Installer: Engineer Representative Engineer Representative LicA Date: Design Engineer: Date: TNELL DATABASE ADDRESS: I ? 77 A o- �/�����i �C r; `-7 AGE OF ,vim? r� - -�' WELL DRILLER: W_I_t. P�R1tiE_ .T- y Lf TVELL LOCATIION. —=- ri.L PERiy=DATA: 7 — p D E? 711 OF WEELL: '- TYPE OF Wrr.:_L: DRILLF..D ; b. DUG TYFEOFIVATLEE`ARINGROCK- W-A=AYALY=DAT - - IICrE_ I�f AF CrAl`IE �y y E`LGHIRON Y N 02�Et CONLA�rITiYA1tiTS: y W L DAT. EA -SE ADDRESS: AGE OF W=L.: Wi ALL DRIL E -R- ..WELL PERI Vr= LO.CATiON: d _ wEI.L PER YET DATE: ? j c1 7 DEPT"r'�� QF WELL: TYPE OF Rr/ LL: a.. DFIELED b. DU TYPE OF WATER BEAR2G ROCK: WA �, A,`+AL'YSIS DATE: ISG MANGANESE: Y N FHGH IRON: Y N OTP�'tx CONTAM'ANTS: Y N v2�l�Gz-t� �. AMO `~ �����«~ MAPLOT #___________ � PARCEL uc_���- STHEE T t��� �j� CONSTRUCTION APPROVAL . HAS PLAN REVIEW FEE DEEN PAID? NO ` PLAN APPROVAL: DATE APP. BY. . ...... ' ^ .�"�� DESIGNER: ��o^� PLAN ./ CONDITIONS , . . ' '�A��� SUPPLY: TOWN ^ ' WELL PERMIT DRILLER___«~^�^«�«���«� WELL TESTS: CHEMICAL DAlE APPROVE ' 71L BACTERIA l DQ|E AP!�RUVE ' BACTERIA II DAlE APPRDVED COMMENTS: FORM UAPPROUAL: APPROVAL lO ISSUE YES NO � DATE ISSUED CONDITIONS: FINAL APPROVAL: ALL PERMITS PAID WELL CONSTRUCTION APPROVAL SEPTIC SYSTEM CONSTRUCTION APPROVAL OTHER ANY VARIANCE NEEDED FINAL BOARD OF HEALTH APPROVAL: YES NO YES NU YES NO YES NU YES NO DAlE: _BY �- �RdP�SF� 6.T Coca �bRrv6,1q M M 3, r r 150.001 FXiS�i.✓ 4 /snp,G�ll;y� Sciric C75 r7t OT4 IP LA 41607A LANDCOUR.T CONFIRMATION 60F,+ ---1- -- f�dirl 1 \ (;,JtL� EXI 57-7A/ 6: C Cgc�I/.J� FiEL,)5 S�AL6 1 ao LO Atar� Jho 7'E �cyjSIrl tj X157 Q/>' CGvC(ic/� 85 Y/ 7Z1 S'5:P71C igNK 'oL ftl �. C�' r✓,; DRfv6wAy WAIL rL 6 PRO?. #2125 Pr, or -,,oz ,t ..r , i�tl ' EXIS T SSE. 16 4 - - "-�=x, ,'• �� s - FND. �,,-•-• -•,— FA 411L y N -- _ --- - ROpM Ppzo,l-, DC;t s1r FXiS�i.✓ 4 /snp,G�ll;y� Sciric C75 r7t OT4 IP LA 41607A LANDCOUR.T CONFIRMATION 60F,+ ---1- -- f�dirl 1 \ (;,JtL� EXI 57-7A/ 6: C Cgc�I/.J� FiEL,)5 S�AL6 1 ao LO 4WW SERI ?.Y$TEM lNUALQ).T.I.QN.- IS THE INSTALLER LICENSED? YES NO TYPE OF CONSTRUCTION: NEW REPAIR NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW NO CONDITIONS OF APPROVAL YES NO (FROM FORM U) ISSUANCE OF DWC PERMIT YES NO .eta 17 DWC PERMIT NO. INSTALLER: BEGIN INSPECTION ��YeES: EXCAVATION INSPECTION: NEEDED: PASSED By TRUCTION INSPECTION: NEEDED:-,__.._._.__..._._._...___.._.....__._ ........................... . ... . ...... cL L,C flt06 Acm- TVif-w-k-7 Vltt-i co -T Or - AS BUILT PLAN SATISFACTORY: YES: APPROVAL TO BACKFILL: DATE: FINAL GRADING APPROVAL: DATE FINAL CONSTRUCTION APPROVAL: DATE: BY FORM U - IDT REUSE 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 lav, regulations or requirements. ****************Applicant fills out this section***************�** t APPLICANT:/� 'l �e`)(},� Phone —/ /� LOCATION: Assessor's Map Number Subdivision Street Parcel Lot (s) Z / ZS '?.-?.2&VII':�',5 �/- St. Number 2 ************************Official Use only************************ RECON MMATIONS OF TOWN AGENTS: Conservation Administrator Comments Town Planner Comments Health Aaent Comments Public Works - sewer/water connections Date Approved Date Rejected Date Approved Date Rejected Data ADmroved 7 / Date Rejected driveway permit Fre Depart -lent Received by Building Inspector Date ACTION NOTES I i PLANNING NOTES 2 3 20 22 2 s i 2 -ro %ft 44 fi ( 171 ^/(1- &7-Ee-T-OVL L7Z476& t 1 1 4 -AV LAY W. L. _ L ,9�� 3. BOARD OF HEALTH NORTH ANDOVER, MA 01845 978-688-9540 APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: -�L'I- O � CURRENT INSTALLER'S LICENSE# LOCATION: LICENSED INSTAL R: �A�2 sdi✓ SIGNATURE: TELEPHONE# CHECK ONE: REPAIR' : Ll--," NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT. Administrative Use Only $75.00 Fee Attached? Yes No Foundation As -Built? Yes No Floor Plans? Yes No Approval Date: ;iVN OF SOV AEOC�F 4- 0 21 = f8 c 0 a 0 E u 0 G w 0 m H O o. L a o�� o 0 C a� 0=o oc°a a� I— _ a i� 0 U O O _ C V �r p U O 21 FORM 4 - SYSTEM PUMPING IaGiM CURRIER SEPTIC & DN SERVICE 107 FOREST STREET; MIDDLETON, MA 01949 (978) 774-2772 m C07)0NWEALTH,QF MASSACHUSETTS MASSACHUSETTS SYSTEM PUMPING RECORD SYSTEM OWNER: ze" Flo lord /.iS/3 SYSTEM LOCATION: 01� ��"� r3A CL ' rJ��me DATE OF PUMPING:-,UANTITY PUMPED: GALLONS CESSPOOL: NO YES 0 SEPTIC TANK: NO F7 YES SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SERVICE CONTENTS TRANSFERRED TO: DATE:/ �• gPECTOR: INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property relative to the application of 0, so,� dated � — %�-/- 41 for plans by and dated revisions dated I understand and agree to the following obligations for management of this project: with 1. As the installer I am obligated to call for any and all inspections. If homeowner, contractor, project manger, or any other person not associated with my company schedules an inspection and the system is not ready then item two shall be applicable . 2. As the installer I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a $50.00 fine being levied against my company. a) Bottom of Bed — generally first inspection unless there is a retaining wall which should be done first Installer must request the inspection but does not have to be present b) Final Inspection — Engineer must first do their inspection for elevations, ties, etc. As -built or verbal OK from engineer must be submitted to BOH, after which installer calls for inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. c) Final Grade — Installer must request inspection when all grading is complete. Does not have to be on site. 3. As the installer I understand that persons or companies not associated with my company may not perform the work required by my company to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system, and/or revocation or suspension of my license in the Town of North Andover plus significant fines to all persons involved. 4. As the Installer I understand that I must be on site during the performance of the following construction steps: a) Determination that the proper elevation of the excavation has been reached b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff. , d) Installation of tank, D -box, pipes, stone, vent, pump chamber, retaining wall and other components. 5. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Under ' n d Licensed Septic Installer V Date: 3 - I L%o % Department of Environmental Management/Division of Water Resources WATER WELL C TION REPORT Me TI GEOGRAPHIC DESCRIPTION hite6pq N ©E W of (r I p�(circle) ,p City/lw ' �o—(� stil f1 N S OW of(mi. In tenths) (circle) Boarcof Heal permit: yes no ❑ _ (road/ WELLUSE WELL DATA Dometic Public ❑ Industrial ❑ Total well depth ft. Depth bedrock ft. Monitoring ❑ Other to Water -bearing rock/ c I'd led material: Method drille Date drilled �`r`� �` Description CASING Water -bearing zo �es/:j 1) From�To Type 2) From To Length ft. Dia(I.D.)�_in.. Length into bedrockft. 3) From To Gravel pack well: dia. Protective well seal: Screen: dia. Grout -[3 Other Slot* length from_to PUMP TEST 9 Static water level below land surface ft. Date " Drawdown' 00tft after pumping hr. min, at gpm How measured Recovery i S^ ft. after-b*Lhr. min. 0 LOG of FORMATIONS COMMENTS 113, / Am City/Tovv yy (17wo3o na%supervisingistered well dr' ef' _ nnnnn nr UrAI TI -.I rnDv ' (-'/; BOARD'OF HEALTH Town of North Andover,Mass.. • Date 3^ 19 rmi t X39 APPLICATION FOR WELL & PUMP PERMIT permit Co drill a well (��APP1icaCion plication .is hereby mesystemo de Co.insCall (_) a PumP f // — , c a t i o n: A ,dr s cl: �f7 dress ,ner .11 Contractor ddr ✓,�j� imp Contractor, �l Address,��M� r Tel. :Lb CONTRACTOR (To be completed at time of pump test) (� Well used for ✓ �- ipe of Well n J;, _ �� r( Z � — / Size of. Casing �ameter of Well C. Depth casing into Bed Rock epth of Bed Rock - / �,_ �� • as Seal Tested? Yes ( No (_) Date. of Testing ^ '? Well Ended in Wha.tw- Material epth --o-f �.,,—,-max-- — _ . . It t Delivers�Cals.Per Min. for 4 hours epth to Water_ rawdownfeet after pumping 8' _hours at ate of Completion �--�' S nature ,le Con actor UMP INSTALLER (To be' f.illcd in before > nt;ta].l.ati.on). Ize & Name Pump �,�c'rna ^� 3 — - � --- -- --_— Pump Type Used d Size of "Tank S, �• !ater Pump Delivers 0 _GPM 'i.pe Material Used in Well: Cast Iron (_) Galvanized (_)w` Plastic` dell pit (_) or PiCless Adapter (�) rotect ipe? Yes (_) NO(✓) ,ryPe or Name Well Seal -)as sleeve used to.protect P )ate . Tnrrrvrr �r��C�r�'r�'r�Ir4�YM4�M�'r�r�'r►'t�r�4�4�'ri4�4�4�4ti4�4'ri4�4ti'r►4�'rti'r�'t'r�'r�`t�`;S':Qiilc GS""1, :nG Date Wateranalysis report submitted to Board of Iiealth Date release given tD owner of record & Rldg. Insp Ilealth Inspector a ^ mDMoEo` FEE THE scow�nm����r '../�------------- of ....... /��/..�..�� ............................ This ..........__.-' ''''--.-------'---~------.------.-'__---------._-'_��'----_---ADDRESS IS HEREBY GRANTED /\ LICENSE For.............................. ------- '~7---===------ --------------------. 11 ........................ --'^-'^--+... ....... ^-'------- ------- ~........................... _........... ..................... � ................... ....................................................................................................................................................... This license is granted ioconformity with the Statutes and ordinances relating thereto, and ---- ---------' ../....... l0.-/!' ~nnm 433 *oaaoaWARREN. INC. -��---- . "' -_ 3 Department of Environmental Management/Division of Water Resources WATER WELL COMPLETION REPORT WELL LOCATION tof GEOGRAPHIC DESCRIPTION Address ) ra6441- �FDLTy' T/lytT ST(feet) (circle) RocITL� //f �L1n No E W of �N�oV`j/\ D�l4jS City/Tow /mmonfE fr. 4//4,' Well owner/F6E941, Poop' �iP�l i 3 (road) Address bs Fo0ji, f r eF i T �� N Sa2a) W of tVILH/Al 6770^' Mt�SS (mi.intenths) — Board of Health permit: yes 12 E]intersect. w/rte no0lu T(road) WELL USE WELL DATA 800 Domestic id Public ❑ Industrial ❑ Total well depth ft. Monitoring ❑ Other Depth to bedrock S ft. Method drilled 10-211-L oWater-bearing rock/unconsolidated material: J (�G�1,E Date drilled 't! 7. 9� Description J CASING Water -bearing zones: �TFFL 1),f rom O'D0 To &0 Type 2) From To Length2V ft. Dia(.I.D.) in.. 3) From To Length into bedrock /S Gravel pack well: dia. Protective well seal: Screen: dia. Grout -0 `Other�f�F 1A( Slot` length from_to PUMP TEST Static water level below land surface �'� ft. Date Q Drawdown'4/00� ft. after pumping hr, min. at gpm How measured Recovery ft. after Z" hr. min. r 0 LOG of FORMATIONS COMKoNTS�Pao l S ,D Materials From To 0"_10410 0 'pry d / �/ LLlN6J c 9A V�` / S Driller/V��1� fA(/ cv Mass. R�"egistration # (��� Firm Ala /y6S '� fovi -De-, Adclressh &(- e /v City/Town / 4L -IS f U30 t � SjgjAture o s ervising registered yell driller Please print firmly V DnAnn nE Ur7AI Tu rnD Department of Environmental Management/Division of Water Resources ti WATER WELL COMPLETION REPORT w (WELL LOCATJON �FOLT)- Zo/ lcrr T/ GEOGRAPHIC DESCRIPTION Address 1CCDE�G ST ouTf �/� / N�ci W of City/Town N d V �� �� IS r fleet) (circle) Well owner {'EPAL OCYITY � � � r. (road) 1// Address bs FEDfQd�.wA of N SVcIL)w ^fr&(-7 / l N S 5 (mi. in tenths) / intersect. w/ '� Board of Health permit: yes U no ❑ /road) WELL USE WELL DATA Q Domestic (Public ❑ Industrial ❑ Total well depth—ft. ft. Monitoring ❑ Other Depth to bedrock S ft. Method drilledpp�� A y J �I'J Water -bearing rock/unconsolidated material; Q Date drilled 71 %- /� Description 57,E CASING Water -bearing zones: 060 �p O Type 1) From To Length 20 ft. Dia(.I.D.) in. 2) From To. Length into bedrock /S ft. 3) From To Gravel pack well: dia. Protective well seal: (� Screen: dia. Grout -0 Other IV6 J NDS` Slog length—from—to— PUMP engthfrom_to PUMP TEST Static water level below land surface / s -,/ q ft. Date Z / o Drawdown �oCft. after pumping --I— hr. min. at _gpm � How measuredRecovery IS. ft. after 7 --hr, min, 0 LOG of FORMATIONS COMM 3 �O7-0 h Materials cL wN1 DFFpF� From To � YO /I d %< E� s Drillerl►r�%�1�ltJ VLA/1�LLl'y 6J G 4 6 E S tfcP Mass. Registration* �T�•6 _ Firm Ala /,V(.,(� �I dNf .1 Acidress W ,&c7T e ZY/GL City/Town LL/f 7t 090 DRILL`'�R COPY ^ . . � 66 LnTLETON ROAD W[STFORD WN 01886 O (500 692-8399 1-800-649-TE@T ~- - - xeporr mumoer: c-sks-1942 Report Date:August 17,1990 Client: q�mnl= T=�m, u+. __.~.`^.. .`. ATTN: Leroy E. Skillings Skilling and Sons 269 Proctor Hill Rd. Hollis , N. H. 03049 Sample Taken By: %..-illings Staff Federal Realty Trust Jack Warford Lot 4- Turnpike St. N. Andover, Mass. On:August 15,1990 CERTIFICATE OF ANALYSIS ________________________ Test Parameter EPA Max Results Units Coliform Bacteria 1 0 per 100kcc Nitrates 10 <0.1 mg/L Sodium 20" 12.0 mg/L Acidity Value 6.5-8.5 7.0 SU Cooper 1.0 0.01 mg/L Hardness No Limit 69 mg/L Iron .3 3.0 # mg/L Manganese .()50 0.06# mg/L Calcium Not set 25.0 mg/L Magnesium Not set 1.5 mg/L NT = Not Tested # = Exceeds EPA Maximum Standards TNTC = Too Numerous To Count "= EPA advisory limit,no formal limit '=Exceeds EPA advisory limit This water sample,as tested,does NOT comply with EPA health standards for all the parameters listed above. The quality of this water is accepted as SAFE TO DRINK according to EPA health standards. Massachusetts State Certified Testing Laboratory #MA048 Mi%ael P. rlson for Thorstensen Laboratory, Inc. •, .. BOARD ' OF HEALTH C U0:/W • t Tof NorCh Andover,mass. �........ Date 3- 2 `7 -- 19� . To. rmi t �9_y APPLICATION FOR WELL & PUMP PERMIT permit to drill a well (1�APPlicaCion i..s plication is hereby made sostm'. de to. install ( ) as Pump y Lot #• ' ca Cion: A0, dd�e s Te /.% Addres�u� °ner —8 9_�da •11 Contractor cldre �t Te1,LGo3 Tel. • �-��^•�' imp Contractor Address :LL CONTRACTOR (To be completed at time of pump test) Well used for ipe of Well C �/�•"y'' �(C �r /� J/0 J. • Size of. Casing � �.ameter of Well r �"''� Depth casing into Bed Rock ��• 2pth of Bed Rock � �� �,� ' --is Seal Tested? Yes ( No (_) Date. of Testing 0 Well Ended in Wha-t. Material epth Delivers' Ga1s.Per Min. for 4 hours epth to Water- hours' a C ...'GPM ` rawdown Lf ee t of ter pumping_ _ ate of' Completion -; S' na ure 'We Cont or cfo.rc i1-1,;ta1.1.ati_on). UMP INSTALLER (To be•f illcd in' b i ze & Name Pump Pump Type Used t', �„ ,{ { Tank later Pump Deliver_ sGPM Size of "�r�crs4-Cert 'ipe Material Used in Well: Cast Iron (_) Grilvnnized (_)` Plastic ]ell Pit (_) or Pitless .Adapter Jas sleeve used to protect pipe? Yes (_) NO(✓� TYPe or Name Well Seal"' 1 P. )ate _ S, Q,ilcIGWJC,C.:.�.;':. Dr�Ftktlydtilr�4tk' h9t��1��M*tM iM���r�+r�r�4�`��Mi4�'r,Y�4���M�4�4i'c�4�4�4�r�Y�4�4�Yti'r�Y�r�Y�4tiYti4►rtir�r�rtir4'r,:,c.:•.,uicticu:,,c,c,.,..c:;;7;c:c, . , , Date Water analysis repor-t• •submitted to board of }iealth Date release given to owner of record &Bldg.- Insp 1-lealth Inspector f 140RTq to o � 41 � w _ 9 ,► ro= i i ,SSACNUSEt Town of North Andover, Massachusetts BOARD OF HEALTH Form No. 2 FIIIIIIIIIIIIIIIIIIIIKMWOIORM' •1 DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant Patnaude Realty Trust Test No Site Location Lot 4 Turnpike St., No. Andover, MA Reference Plans and Specs. ENGINEER DESIGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. Fee $60.00 CHAIRMAN, BOARD OF HEALTH Site System Permit No. 443