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-RRIER
SEPTIC & DRAIN SERVICE
FOREST STREET; MIDDLETON, MA 01949
(978) 774-2772
SYSTEM OWNER:
"1 4 - SYSTEM PUMPING RECORD
f
CO ONWE TH OF MASSACHUSETTS
MASSACHUSETTS
SYSTEM PUMPING RECORD
a5/✓�11r
SYSTEM LOCATION:
4 -
DATE OF PUMPING: l QUANTITY PUMPED: �� GALLONS
'CESSPOOL: NO 4 YES F-] SEPTIC TANK: NO E:] YES
SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SERVICE
CONTENTS TRANSFERRED TO:
DATE:
--�� /`�IINSPECTOR:
10
FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify
approvals/permits from Boards and Departments that all necessary
have been obtained. This does not relihaving jurisdiction
landowner from compliance with any applicable o�s and/or
regulations or requirements, tate law,
****************Applicant fills out this section*****,►*******
#**
VAP�PLICANT:
Phone 41
Ll
LOCATION: Assessor's Map Number
Parcel
Subdivision
Lot(s)
---------------
" h St. NuMber —2c.
Official Use Only******************
RRCO
DATIONS OF TOWN AGENT :
Copse ation Admi Date Approved PProved
Date Rejected
► Comments I
VSA14, SQ �
Town Planne Date Approved'"
Date Rejected
! Comments
I
Food Inspector -Health Date Approved
Date Rejected
i Inspector -Health Date Approved
Date Rejected
Comments
� S
Public Works
sewer/water connections 'tea b
- driveway permit
Fire Department
Received by BuildingInspector
nspector
Date
I , OWN OF NORTH A.NeOVER
UA 11 SYSTEM C
Pump'N7 coRD
'""Z"OWNER AVE)RESS Isy
o We r
cz�
A. 4 AV
LOC-AltION
DATE OF PUMKNG:_6-a
—QUAWITY PUMPED.
Cl� SSPOOL: NO v yES
SOPtic -rank: NO
NAFURS OF SERVICE: KOUTINE
WROENCY-_
,lis
013SERVA'rIONS:
CJWD CONDITIONFULL
TO COVERnAVY
GREAS-L
BAFFLEs IN PLACE
ROOTS
EXCESSIVE SOLIDS..
LEACHF
� IELD RUNBACK
FL£OpiE.1
SOLID CARRY0VER'_____
OTHER EXPLAIN
SYStom Pomp.d by
COMMENTS,
CUNTJ�NCS I'KANSFERRIJ) I'()
LOT 26A
53,142 S.F.
M
100
i
lKand(over
n$ultants. 213 BROADWAY
' METHUEN, MASSACHUSETTS 01844
inc. (617) 687-3828
�1�ta�edJconaG Unp'� DATE
TO : NORTH ANDOVER HEALTH DEPARTMENT
TOWN HALL , NO. ANDOVER , MASS
RE : SUBSURFACE SEVIAGE DISPOSAL SYSTEM
NO. ANDOVER , MASS.
I hereby certify that I have inspected the construction of the
disposal system at Cai 26.9 Lf�E North Andover, Mass.
and that the location and elevations are as shown on the As -Built
Drawing dated %- B -I .
ANDOVER JZONSULTANTS C.
William S. Mac eod
Registered Sanitarian
This certification is notto be construed as a guarantee of the system.
7117,,
�Sfs.
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Bo;rd of-
ge,11kh
�/ZJ
ror th Andovzr,ML-;s
(� �`Z —91(LV
SUBSURFACE DISMS1 DF 1t('.:? CF, I LIST
LOT
APPROVED
DATE
DISAMOM DATE
Provided:
Reasons: #
Title V
F= 09
01
Reg 2.5
The submitted plan gust show as a minorum:
' a)
the lot to be seared-area,dimensions lot #,abutters -
served
to ties
b
location and log deep observation -distance
f d
location and results percolation testa -distance to ties
design calculations & calculations showing required leaching area
e)
location and dimensions of system -including seserve area
f)
existing and proposed contours
(g)
location any wet areas vithin 100' of sewage disposal system or —
disclai.r-sr-check wetlands mapping
'(h)
surface and subsurface drains within 100' of sewage disposal
system or disclaimer
- (i)
location any drainage vIthin 1001 of serge dieposal
/
system or disclairmr-M=wing Board files
" (j)-
knova sources of Bator sir,.ply within 2001 of semge disposal
'
system or disclaimer
(k)
location of any proposed well to serve lot -1001 from leaching facility
(1)
location of water lines on proporty-10' from leaching facility
(m)
location of benchmark
(n)
driveways
(o)
garbage disposals
(p)
no PVC to be used in construction
(q)
profile of system -elevations of basement, plumb, pipe, septic tank,
distribution box inlets and outlets, distribution field piping and
Other elevations
f
maximum ground water elevation in area sewage disposal system
s)
plan must be prepared by a Professional Ragtnver or other
professional authorized by law to prepare such plans
Reg 6
otic Tanks
(a)
capacities -150,% of flow, water table, teas, depth of tees,
access, punping
,, t)
cleanout
(c)
101 from cellar wall or inground svlamming pool
-"(d)
25+ from subsurface drains
Reg 10.2
7
Distribution Boxes
/ a)
s ope greater th 0.08
Reg 10.41
/ b)
suap
FAIL
Reg 15.1
15.4
15.8
3.7
Reg 14.1
14.4
14.6
14.7
14.10
Reg 9.1
9.6
Chuck List
IM
Leat Pits
Leaching pits are preferred where the installation is possible
a) calculations of` leaching area-rdmimm 5oo sq ft
b) spacing
c surface,diainage 2%
d cover,tiiaterial
'e) i t x2 t x4p splash pad
f) tea at elbow
g) no beds in pipe from d -lox to pipe
Leaching Fields -
a no greater than 20 ainutes/inch
b area-rdni=%m 900 sq ft
cconstruction of field
d) face drainage 2 %
e) 241 from cellar vaIl or inground mdm dng pool
L!!2h!Bg Tvenches
a) calculations ofleaching area -min 500 sq ft
., b) spacing -4 ft min 6 ft with reserve between
c) elisions
construction
.e') stone
y f) surface drainage 2%
Do=hill Slop e
slope y x - to be shown)
b) y/x X 150 - (to be shown)
Dag
a) approval
b) stand-by power
l•'r1�£
310 CMR 10. 99
Form 3 ....._._._
Ez( 6 <Commonwealth SSIQA! r
ofAdassachusetts t
D13p File No
(To be provided by DEP)
C(ty/'Town:
Applicant:
Department of
Defense
United Stales
ofAmerica
Notice of Intent
Under the
Massachusetts Wetlands Protection Act, G.I.. c. 431 s40
and
Application for a Department of Army Permit
Part I: General information
1. Location: Street Address
Lot Number:
2. Project: Type_ CATEGORY 1 Description QQNSTR 1 .T ADDITION WITHIN
THE 100' BUFFER ZONE
3. Registry: County: X N D Current Book: 4211 - & Pages 62
Certificate (if Registered Land)
4. Applicant CARL E. MELANDER Tel. _508-6839644
Address 25 GIl MAN I ANF NORTH ANr)r)VGR� mACS
S. Property Owrter DQE Tel.
Addr=
6. Representative: SCOTT L. GILES R p 14 Tel. 508-6833924
'Address 50 DEER MEADOW RD NORTH AND- 01&45-
7. a. Have the Conservation Commission and the Department's Regional Office each been sent, by certified mail or
hand delivered, 2 copies of completed Notice of Intent, with supporting plans and documents?
Yes M No ❑
b. Has the fee been submitted? Yes No ❑
c. Total Filing Fee Submitted
d. City/To-Am Shatz of Filing Fee 90.00 State Share of Filing Fee 1500
(giant to Ciryi7*vm) 40.00 +, tFxW LOCAL (+z of fee in e=M of 825, Mato DEP)
e. Is a brief statement attached indicating ho the applicant calculated the fee? Yes Q No ❑
3-1