HomeMy WebLinkAboutMiscellaneous - 257 BOXFORD STREET 4/30/2018 (2)r
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MAP # �o�i4
- LOT
PARCEL # `� STREETx
QQRr5-LRtQT_- QN._APPRQV-PI
HAS PLAN REVIEW FEE BEEN PAID? YE Imo''" NO
U�
PLAN APPROVAL: DATE �% /� ARP. By
DESIGNER: J'� �SSC'L PLAN DATE.,
CONDITIONS
WATER SUPPLY:
TOWN
WELL PERMIT �J� DRILLER,__.,_ ..__..`S
WELL TESTS: CHEMICAL DATE APPROVED,
BACTERIA I DATE APPROVED
BACTERIA II DATE APPROVED
COMMENTS.:
1y .
FORM U APPROVAL: APPROVAL TO IS' Y 0
DATE ISSUED %I BY
CONDITIONS:
FINAL APPROVAL:
ALL PERMITS PAID NO
WELL CONSTRUCTION APPROVAL YE NO
SEPTIC SYSTEM CONSTRUCTION APPROVAL NO
.OTHER YES NO
ANY VARIANCE NEEDED
FINAL BOARD OF HEALTH APPROVALS
YES NO
r
DATES _. �....�' - �l -_B Y :
I
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5
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NEEDED:
YES:
APPROVAL TO BACKFILL: DATE: BY
,•!',+f,,;.';' ,;rt:..�
_.FINAL. GRADING APPROVAL: DATE BY
-
`PASSED
f, t • FINAL
CONSTRUCTION APPROVAL:
1
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IS THE
INSTALLER LICENSED?
ES
NO
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CONSTRUCTION:
W
REPAIR
PERMIT
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(iEs140
;NEW CONSTRUCTION:
CERTIFIED PLOT PLAN REVIEW
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CONDITIONS Of= APPROVAL
'n'a i-
NO
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(FROM FORM U)
5
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NEEDED:
YES:
APPROVAL TO BACKFILL: DATE: BY
,•!',+f,,;.';' ,;rt:..�
_.FINAL. GRADING APPROVAL: DATE BY
-
`PASSED
f, t • FINAL
CONSTRUCTION APPROVAL:
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"', ISSUANCE OF
DWC PERMIT
YES NO
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1166 /A/ ✓
PERMIT
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INSTALLER:_i
SAS
BUILT PLAN SATISFACTORY:
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(,BEGIN
.INSPECTION
;'EXCAVATION
I NSPECT I ON : NEEDED:
_
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5
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NEEDED:
YES:
APPROVAL TO BACKFILL: DATE: BY
,•!',+f,,;.';' ,;rt:..�
_.FINAL. GRADING APPROVAL: DATE BY
`PASSED
f, t • FINAL
CONSTRUCTION APPROVAL:
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NSU CTION INSPECTION:
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BUILT PLAN SATISFACTORY:
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NEEDED:
YES:
APPROVAL TO BACKFILL: DATE: BY
,•!',+f,,;.';' ,;rt:..�
_.FINAL. GRADING APPROVAL: DATE BY
DATE:
0
Y
f, t • FINAL
CONSTRUCTION APPROVAL:
1
1
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1
DATE:
0
Y
Commonwealth of Massachusetts
Massachusetts
System Pumping Record
System Owner
Date of Pumping: _ C11— — q
Cesspool: No Yes ❑
System Location
S �j V� �,�CA
ti.
�Y'r
Quantity Pumped: S4—Jgallons
Septic Tank: No ❑ Yes
System Pumped by: Mw&w 454&"'4a License #
Contents transferrred to : Greater Lawrence Sanitary District
Date: Inspector:
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Commonwealtrl of Massachusetts
Executive Office of Environmental Affairs
Department of
Environmental Protectio
William F. Weld
Govemor
Argeo Paul Celluccl
U. Goremor
"s'
`(p(6 �,Irudlly
Coxe
Secetary
(� Davtd B�fruhs
1J� ommruioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM✓
PART A
[� �CEJ�RTIFIC/�� ,,� �
Property Address 5 ��1oX� �• 1 " ` I pddtess of Owner.
Date of Inspection: q�,f-- Iy r-J�1 J''�v (If different)
Name of Inspector. ►V � � 1 J_
Company Name, Address and Telephone ,''umber. ATESON ENTERPRISES, INC. TEL: ,308)
6_06-
`0 6— 405 t4tl� Encavating - Water & Sewer Lines . ;eptic ;vstems & Pumping Service FAX: i 3081 -4-i-.i-131
�����VJJJJJ V 1
CERTIFICATION STATEMENT I I 1 Argilla Road . Andover, Mass. 01810
I certifv 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 Further Evaluation By the Local Approving Authority
F'
Inspector's Signature: ate: < l�--C�/ _
The System Inspector shall sub 't a cop this inspection report to the Approving Authority 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.
INSPECTION SUMMARY:
Check A. B, C, or D.
A) SYS ASSES:
I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
Any failure criteria not evaluated are indicated below.
B) SYSTEM CONDITIONALLY PASSES:
One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes
inspection.
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, 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 conforming septic tank as approved
by the Board of Health.
(revised 11/03/95)
One Winter Street a Boston, Massachusetts 02108 a FAX (617) 556-1049 a Telephone (617) 292.5500
0A0 Pnmed on Recyded Papa
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (con inued) n
Property Address: ' �x� . ��1
Owner. t— ` /� / � �,� V
Date of Inspection: 1 � " ` W
9-1 L -17b
BI SYSTEM CONDITIONALLY PASSES (continued)
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 '.f (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
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 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 a 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 APPROPRIATE)
DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or. tributary to a
surface water supply.
The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
_ The system has a septic tank and soil absorption system and 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 compounds indicates that the well is free
from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm.
3) OTHER
(revised 11/03/95)
y
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:
Owner.
Date of Inspection: ` �
Dl SYSTEM FAILS: 9 (Q�
— `f
I have determined that the system violates one or more of the following failure criteria as defined 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.
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 leas than 1/2 day flow,
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(a).
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.
Any portion of a cesspool or privy is within a Zone I of a public well.
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.
El LARGE SYSTEM FAILS:
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 gpd or greater (Large System) and the system is a significant threat to public
health and safety and the environment because one or more of the following conditions exist:
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 11 of a public
water supply well)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 11/03/95)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:
Owner.
Date of Inspection.
Check if the folio ve been done
um
ormation was requested of the owner, occupant, and Board of Health.
one of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates
I d in t period. Large volumes of water have not been introduced into the system recently or as part of this inspection.
2
As/buil have been obtained and examined. Note if they are not available with N/A.
�he
er dwelling was inspected for signs of sewage back-up. does not receive non -sanitary or industrial waste flow inspected for signs of breakout.
components, excluding the Soil Absorption System, have been located on the site.
_ po 6 rP Ye tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or
tees of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
_�Th s and location of the Soil Absorption System on the site has been determined based on existing information or
ximated by non -intrusive methods.
_ The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub -
Surface Disposal System.
(revised 11/03/95)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
' SYSTEM INFORM14TION
Property Address: as sA- N i 4QAf`
Off ,, ''
VN
Date -� te of Inspection: ��- , W �
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 0 ons f
Number of bedroo
Number of current residents:
Garbage grinder (,yea or no): O
Laundry connected to sy (yes or no):�Qs
Seasonal use (yea or no): �" �
Water meter readings, if available:
Lest date of occupancy:—4s,s, '�TeAA `
COMME C -INDUSTRIAL
Type of establishment:
Design flow:_gallona/day
Grease trap present: (yes or no)_
Industrial Waste Holding Tank present: Ives or no)_
Non -sanitary waste discharged to the Title 5 system: (yea or no)_
Water meter readings, if available:
Last date of occupancy:
OTHER (Describe)
Last date of occupancy:
PUMPING RECORDS and source of information:
GENERAL INFORMATION
PQ'oex'
System pumped as part of ins ion: (yes or no)�lQ
If yes, volume pumped: _gall ns�- ,A/
Reason for pumping: k �A, � Y Vv e("
TYPE 9 F 5S X8 1100-M4
eptic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system (yes or no) (if yes, attach previous inspection records, if any)
Other (explain)
APPRO41XATE ( of al�components, date installed (if known) and source of information: E Q�Q
Sewage odors detected when arriving at the site: (yes or no) NO
(revised 11/03/95)
S
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION ( ntin�ue�d1),�
Property Address: �v�C/�
Owner. � 1 • �"�- 6&aml "" YN
Date of Inspection.Q r 4
SEPTIC TANK:_
(locate on site plan) f Q� 11
hl -4 fl C�vor�S- �3� ��
Depth below grade4 deef -
: �
Material of construction: _concrete _metal _FRP —other(explain)
Sludge depth:— tf\.J
Distance from top f sludge to bottom of outlet tee or baffle:aO
Scum thickness: it (I
;)WrWPce from top of scum to top of outlet tee or baffle:_ T )(
Distance from bottom of scum to bottom of outlet tee or baffle:
Comments:
(recommendation for pumpconditi of ' t and outlet or s, depth o ligtu'Alevel ' relation to
evidence of leakatze, etc.L UW'P- �P�—r 'T6G 1 � I A _
Depth below grade:
Material of construction: _concrete _metal _FRP —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 biffle:
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 11/03/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
n SYSTEM INFORMATION (continued)
Property Address: a1^11
Owner.`-�
Date of Inspection: ��'
Lf
TIGHT OR HOLDING TANK:_
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _FRP _other(explain)
Dimensions
Capacity: gallons
Design flow:gallons/day
Alarm level:
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 level pnd di"uttiory is equal, evidence of solids carryover,
0
PUMP CHAMBER. S `('� – CA ����a�^
(locate on site plan) v
Pumps in working order:(yes or no)
of leal;age into or out of box, etc.) D— 8 0
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
(revised 11/03/95) 7
FA
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Addreaa:��
Owner.
Date of Inspection:
L4- 9k
SOIL ABSORPTION SYSTEM
(beets on site plan, it po"ibli; excavation not required, but may be approximated by non -intrusive meth)
If not determined to be present, explain:
M.
leaching pits, number:_
leaching chambers, number:_
leaching galleries, number: r" i
leaching trenches, number,length:�_ �JCJ
leaching fields, number, dimensions:
overflow cesspool, number;_ r
note co clition ail, signs oh ure, leve f\�
!_ ,� �_ � � 4 f3T� f _ hydraulic � �..Q porid±+g, Condition of veRetation.etc.)
CESSPOOLSAUW
(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.)
PRR1fVY:VVy1e__
(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 11/03/95)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:s7
Owner.
I
Date of Inspection: � Q � .� �/� � ( It V\
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
DEPTH TO GROUNDWATE�R�� }
Depth to groundwater: V � � � t� M )v / �� � ( /,J`U'�-'"�
method of determination or approximation: t (�J�- �,
(revised 11/03/95) 9
FURY U
TOWN OF NURT11 ANDOVER
LUT RELEASE FURL!
SUBDIVISION
ASSESSORS MAP
SUBDIVISION LOT(S)
PERMANENT ADDRESS
STREET
ASSIGNED BY D.P.W.
APPLICANTd-
DATE OF APPLICATION
PLANNING BOARD
TOWN PLANNER
CONSERVATION COMMISSION
CONSERVATION ADMIN.
TOWN USE BELOW '1111S L1111"
DAPI: APPROVED
DATE REIJECTEU
BOARD OF HEALTH
DEPARTMENT OF PUBLIC WORKS
DRIVEWAY PERMIT
SEWER/WATER CONNECTIONS
FIRE DEPT.
RECEIVED BY BUILDING INSPECTION
DATE
DAI:E A1'1'ROVED
DATE REJECTED
DA'I I: Af PROVED
DATE 11,EJECTED
This form shall be signed by the agents of the 11;inning ani] llc:�lth Il�,nrcls,
the Conservation Commission prior to the issuance of any building; perml.ts
for the subject lot. This form s1ial_1. not rel.el.%,e the applicant from the
compliance of any applicable Town requirement or Bylaw.
Town of North Andover, Massachusetts Form No. 1
NORTH BOARD OF HEALTH r
32Oy�s`ED L .�A / rri% 19
O
H Win• A
m ll� I Q
" APPLICATION FOR SITE TESTING/INSPECTION
7 p�R4TED PPP`y.�y 2
�SSACHUS��
Applicant -!x?cZ,.�-s r
NAME S ADDRESS TELEPHONE
Site Location Zy7—
Engineer
NAME ADDRESS TELEPHONE
Test/Inspection Date and Time 3115-A�'
CHAIRMAN, BOARD OF HEALTH
Fee Test No.
S.S. Pe rM it No /4 2 D.W.C. No. C.C. Date Ptbg-Rer+pit No• �ty
Department of Environmental Management/Division of Water Resources
3 WATER WELL COMPLETION REPORT
WELL LO N'
GEOGRAPHIC DESCRIPTION
Ad ess
r
q�—
Ol'JD ?S E W of
fleet) (circle)
City own
.
Well owner
(road)
Address •d�
3
(� Ir,? S E W of
(mi. in tenths) (circle)
Board,of Health permit: yes ��''no E]
intersect. w/
(road)
WELL USE
Domestic Public C] Industrial C]
WELL DATA /
Total well depth 111140
a
Monitoring [I Other
Depth to bedrock ft.
Water-bearing roc/ unconsollidat d material:
Method drille
Q�...—
Date drilled �� pi7' `!
Description
CASING ,
Water -bearing z sem-../
4T0
2)
1) From To
Typ
From To
Lengthft. Dial.l•� l�--in•
ft.
3) From To
Length into bedrock
Gravel pack well: dia.
Protective well seal:
Screen: dia.
Grout -El Othe
Slot* length—from—to—
ength from_toPUMP
PUMPTEST
I
/0 ft. Date a _ 9d
Static water level ]below land surface
y� j ``
Drawdown ����ft. after pumping_—thr. �� Lmin. atgpm
How measured19-4-A Recovery �ft. after -04-6 hr. min.
LOG of FORMATIONS COMMENTS g
NUWF-R FEE
OMMONWEALTH OF MASSACHUSETTS
of.................................. �
. --.... -------•----.........
This is to (.:ertify that..../2.-''`r.. ..:............ .......................................
F.
// i J�
.SG..g. `�'�"�114
ADDRESS
IS HEREBY GRANTED A LICENSE
I+or- .... .. -•------•------------•- •----•----------
.---------
......................
--e..-...{....-//....�......_---........._..
.......... ................. ....................... ..... .................
...
...........
....--------------- ----.
....-----•...................*-----•--------- *-------------.....--------------
.................------------ ---
This license is granted in conformity with the Statutes and ordinances rclatin;, thereto, and
cepires ...... .................. ......... ....................:...Unless sooner sm3pended or revoked.
_............./j ../1........_..1.9.9..v
FORM 43.3 HOARS & WARREN, INC.
wl q
t BOARD OF HEAL'I'I1
flown of North Andovcr,1-lass .
civ
Date �. � 19 /
APPLICATION FOR WELL & PUMP PERIII'f
ation.is hereby made for permit to drill a well
11 ( ) a ump sys tem'.
Application i„s
o insta _ p
•Lot ## • U . .
ontractor
'rel.
ontractor
:ONTRACTOR (To be completed at tine o`L pump test:)
.f Well Jell used for
:er of Well Size of Casing;
of Bed Rock /0 l Depth casing; into Bed Rock /
!a'1 Tested? Yes (_� No (_) Date of 'I'esting VT=' / 1 r
,af (dell — Well Ended in WI- t1aterial'Z
15'�rt At
C Delivers _GaIs•Per tiin. for
to Water V
IAI at
Dwn /-/ < feet after pumping _
Df Completionr''-~
il;natur le L ► actor
-� - ,. ,.:': •� :: ;, a �k � � � � �-
INSTALLER (To be' filled in be ore in:St<�J.l. r})'
c w Typ Used
Name Pump _.--- -- -
GPM i ze Tan
Pump Delivers —
Material Used in Well: Cast Iron (_) Gnlv;�niZecJ (_) ('lastic (_)
Pit (_) or Pitless ,Adapt6r
lee
ve used to protect pipe? Yes (_) NO(_) Type or Dame Well Seal
L)
'c�F���M��i4��►'t�41��4�k�'rti4lktM144t�4�'t14►'�t4�Y�cr4�4i4���'rti'rti'��'rti'r,':5;�;1L�','t)'�:DG
ti`r
Water analysi's repor-t •submitted to 13"rd of He"alth—
release given tD owner of record & Bldg. Insp
1lealth Lnshector
Board of Health
North Andover, Mass
1"004
3-
��
Applicant
Water Supply Town Well !/ Approved Date
S.S.Z Septic System Design
Approved Date A n
CONDITIONS+
Disapproved
Reasons=
DWC
Date
Approving Authority
na't a'g �y
SCIS RtS
Septic System Installation
Excavation Inspection Date
Final Inspection
Approved Date
Additional Inspections (if any)
Disapproved
Reasons
Date
Pass Fail
Approving Authority
Final Approval Dai e Approving Authority
M
LOT 1 i A
THIS PLAN IS INTENDED FOR ZONING
PURPOSES ONLY. IT WAS COMPILED
FROM EXISTING PLANS AND RECORDS
WITH BUILDING LOCATIONS CONFIRMED
IN THE FIELD. IT SHOULD NOT BE
USED FOR PROPERTY LINE-DETERMIN—
ATION.
THE BUILDING IS NOT LOCATED IN AN
ESTABLISHED FLOOD HAZARD AREA.
ZONING: jz1
REQUIRED SETBACKS:
FRONT:
SIDE:
REAR: 30"
CERTIFIED PLOT PLAN
Nkir-T o 44>iwaz
AS PREPARED FOR
f:bNTurcK, lKic-,
M & A FILE No.: 151- I
WE HEREBY CERTIFY THAT WE HAVE EXAMINED
THE PREMISES AND THAT ALL EASEMENTS,
ENCROACHMENTS AND BUILDINGS ARE LOCATED
AS SHOWN. ALL BUILDINGS SHOWN CONFORM
TO THE ZONING LAWS OF THE MUNICIPALITY
WHEN COU&tkt*W..
LtL N5�`
HONDA
1M1ff ; n VJ
"/ Ylcalf/
, P. E. D AT E
MARCHIONDA & ASSOC., INC.
ENGINEERING AND PLANNING CONSULTANTS
80 MAPLE STREET
STONEHAM, MA. 02180
(617) 438-6121
SCALE: 1" --
�q( DATE: 'S-&• qj
11
s
1.
2.
P/0 0 (=r-� W.
11kQ1441
CHECKLIST FOR
PLAN REGUIREME:NIS
FOR
SUBSURFACE SEWAGE DISPOSAL SYSTEMS
TOWN OF NO. ANDOVER BOARD OF HEAL'I H
MARCH, 1990
L c_us_..,,M4p._. (Suggested Scale: 1" = 2000' )
__......__��A. Locus identified.
B. Streets and names within 1/2 mile.
":�,,C. North arrow and scale
S_t_e.._Flan. (Suggested Scale: 1" = 20' )
... ___.._�A. Lot to be served, its dimensions and area.
B. Fronting street.
C. North arrow and scale.
D. Assessor's designation.
_._._E. Abutters names and lot numbers.
F. Easements.
G. Property lines.
._...._....,,_�.H. Footprint of proposed hokime to be served showing
garage (attached or detached).
_.._._
"--I. Where applicable setbacks to house.
J. Number of proposed bedrooms.
_....... _/__K. Location and type of materiel (if known) of
driveway.
_..__,.._L. Water service line from we 1 1.
e'�.._M. Locationproposed well.
_._ __N. Location of deep observation holes and percolation
tests.
Existing and proposed contourn.
............sP. Bench marks (2) and ties to proposed system
leaching facility from bench rnu�rks or other
permanent physical features, (storievoa11s, etc. )
Location and d i mens i oris, of f-,yst em ( septic tank,
pipes and leaching facility) including the reserve
area.
Profile and section arrows.
Location of any streams, water bodies, surface and
subsurface drains, known sources of water supply
within 200 -feat, arid wetlands within 100 -feet
(locate wetlands, specify type of resource and show
// 100 -foot buffer zone line if' applicable).
T. Erosion control devices as req ll i red by Con. Comm. ,
Board of Health or Planning Board with detail arid
description of device proposed.
| ^ .
/
3.
A. Percolation rate used for design.
Soil log results - designate various strata depths
and deescription» depth to ledge and/or groundwater
if encountered.
/
�_/_C" Date of percolation and deep hole tests.
,`P. Number of bedrooms.
,-_1E. Calculations for leaching area requirements.
4~ Prof le of Svst
�� (Suggested Scale: 1" = 41)
. Finished floor of house.
__/-�_B" Invert elevations at house, septic tank (inlrt &
«»ut8et)v and distribution box. If applicable for
pump systemsv inlet and outlet of pump chamber and
pump bloat switch settings with supporting
calculations.
___~�_C. Length, type and grade of pipe and length of
leaching facility.
,'-.D. Elevation of ledge and/or groundwater. g. Elevation of bottom of leaching facility.
F. Existing and proposed gi`ades.
Slope (breakout) requirement and calculations.
P. Scale.
5. (Suggested Scale: 1" = 41>
. Elevations of various components.
B. Existing and proposed grades.
C. Type, dimensions and stone and system components
specifications.
/'_.0. Elevation of ledge and/or groundwater.
//E° Elevation of bottom leaching facility.
1A. Dimensions.
-A- Slope (breakout) requirements and calculations.
Scale.
�
.
Owner's name, address and phone number.
'
B. Applicant's name, address and phone number.
InC. Engineer's name, address and phone number.
l[�ey designer should indicate any notes or special
conditions peculiar to the site of interest to the
Boardv Installer or Owner.
y E. Plans shouldbe dated. Any revised plans after the
initial submission should show a revision dote and
abbreviated explanation of the revision.
If a pump sYstem, type, make, model, operation head
and pump rates should be provided. All required
alarm, power and float switch data should be
provided for review and approval.
_____G. System components (septic tankv D-bo)(, etc.)
details should be provided if other than standard
as required from local supplie,`s. Component spec
should be indicated somewhere on the plans for
standard items.
Reviewed and recommended by:
Date
s.
REVIEW FORM
FOR
REVIEW FORM
FOR
SUBSURFACE SEWAGE uisrusnL SYST-EM
PLONS
TOWN OF NORTH ANDOVER BOARD
OF IlEflLill
OWNER NAME: .. ..... . ....
.....
ADDRESS:(")f........... ... . .. _........-........L ........ ........ ..
... . . .. .... ..... ............ ... . . ..... ... ..
. ............. . ...... ... . ...... .. ..........
PHONE:
APPLICANT
NAME:
ADDRESS: . ...............
PHONE:
ENG I.N.E.E.R.
NAME:
ADDRESS:
. ....... ..
PHONE: If 3 9? 2_
............... .................. ...........
PRD.P.E-RT-Y-..-R.LA..N.--..D.A.TA.
.
ASSESSOR' S . . ....
STREET LOCATION__ . .... ........... ..
.......... ... ...... ..... ....PLn11 DA E
.R.- E. Y J- - Ew_ QQ M. m _. E_ _. N_ T... 5
CHECKLIST DEFICIENCIES..
. .. . ............ . . ................ . .... .. .. . . ......... .. . .. .. .. .............
.. ............ .. ... ....... .....
.. .... . ........... .. . ...... . ...... ......... - .... ........ ......... . ........ ......
OTHER
. .................. ........... ....... .
... . ...... .... . .. . ........ .. . . .......... . .. ..... ...... .. .. . ... ...... ...... .............
RECOMMENDED DENIAL__
... .............. ......... ....... . ......... . ....... ... .... ..... ........... ............. ..... ............ .... .. .........
REASONS (CONT.)
RECOMMENDED APPROVAL
CONDITIONS/COMMENTS
Tewksbury Water Treatment Plant Laboratory
Massachusetts State Laboratory Certification # MA 126
Lewis W. Zediana Plant Chemist
Tewksbury Water Treatment Plant
71 Merrimac Drive
Tewksbury, MA. 01876
February 7, 1991
Wilmington Pump Supply
639 Woburn Street
Box 517
Wilmington, MA. 01887
Dear Sirs,
The results of the analysis of the water samples submitted on January 31, 1991
from Flintlock Inc. Lot #10 North Andover, MA. may be found below:
Test & Result.
State
Limit MCL
Type
Total Coliform: Absent
Absent
Primary
Color: 5.4 Hazen Units
15
Secondary
Turbidity: 1.20 NTU
1
- 5
Primary
pH: 8.08
6.5
- 8.5
Secondary
Alkalinity: 107 mg/L as CaCO3
No
Limit
Hardness: 162 mg/L as CaCO3
No
Limit
Sodium: 19.8 mg/L
20
mg/L
Primary
Iron: 0.64 mg/L
0.3
mg/L
Secondary
Manganese: 0.13 mg/L
0.05
mg/L
Secondary
Conductivity: 413 umho/cm
No
Limit
Analyst: r -'F� //V
Lewis W. Zediana
Lewis W. Zediana Plant Chemist
Tewksbury Water Treatment Plant
71 Merrimac Drive
Tewksbury, MA. 01876
April 18, 1990
Wilmington Pump Supply
639 Woburn Street
Box 517
Wilmington, MA. 01887
Dear
Sirs,
The results of the analysis of the
water samples submitted
on April 17,
1990
from Lot #1 Boxford Road North Andover
may be found below:
Test
& Result
State Limit MCL
Type
Total
Coliform: 0 colonies/ 100 mis.
1
Primary
Color: 3.6 Hazen Units
'r,
Secondary
Turbidity: 0.55 NTU
pH: 7.99
Alkalinity: 143 mg/L as Ca
Hardness: 112 mg/L as CaC(
Sodium: 24.6 mg/L
Iron: 0.08 mg/L
Manganese: 0.03 mg/L
Conductivity: 268 umho
Primary
Secondary
Secondary
Secondary
Secondary
* n-..__ ideline 20.0 mg/L
Laboratory Mass. Certification # MA 126 Analyst:
d�-�✓aQ `GC/ .
Lewis W. Zediana
Plant Chemist
Tewksbury WTP
z
' 2e12attment 6/ enviionmen&l 2uaUy (fnyineeany
9?aw1wnce ex12e2iment Aa1( do
37 Aalluch Yzuel, Yamience, c,*aylacl ",(& 0784y
CERTIFICATION FOR ENVIRONMENTAL ANALYSIS
LABORATORY: MA126 DATE: 04/15/90
'Pewksbury Water Treatment Plant
71 Merrimac Dr. EXPIRATION DATE: 12/31/90
Tewksbury, MA 01876
DIRECTOR: Lewis 'Lediana
508-858-0346
PRIMARY CATEGORIES (DRINKING WATERS)
FULL CERTIFICATION: Nitrate, Fluoride, Corrosivity Series, Sodium, Chlorine, Turbidity,
Total Coliform (MF)
PROVISIONAL CERTIFICATION: Trace Metals, Cyanide
SECONDARY CATEGORIES (OTHER MATRICES)
FULL CERTIFICATION: Fecal Coliform (MF), Standard Plate Count
PROVISIONAL CERTIFICATION: None at Present
This certificate supersedes all previous certificates issued to this laboratory.
Reporting of analyses other than those authorized above shall be cause for revocation of
certification.
Original Certificate, not copies, must be displayed in a prominent place at all times.
Certification subject to approval by OGC.
J seph E. O'Brien, Ph.D.
Director, Laboratory Certification
For the Commissioner
Town of North Andover, Massachusetts Form No. 1
NORTH BOARD OF HEALTH
"e- "
O 19
0 ? av F A
* Q0(O
APPLICATION FOR SITE TESTING/INSPECTION(P c�L 3
TM
SSncHUS���y
Applicant
NAME ADDRESS TELEPHONE
Site Location Loi
Engineer
NAME ADDRESS TELEPHONE
Test/Inspection Date and Time
Fee
S.S. Perm
CHAIRMAN, BOARD OF HEALTH
Test No.
.W.C. No.40-10 C.C. Date P+b%-ReAit No
DoT llq
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126. 93'
STREET
ELEVATIONS TAKEN AT TOP OF PIPE THIS IS TO CONFIRM THAT I HAVE
INSPECTED THE CONSTRUCTION OF THE
DWELLING ELEV.: 139.46 SAID DISPOSAL SYSTEM LOCATED ON
TANK IN: /3b.eo LOT UoT io A -IF-' --y- ST
TANK OUT: 13(,.sL THE GRADES ARE AS SPECIFIED IN THE
D -BOX IN: PLANS pivhli CATIONS DATED
D -BOX OUT: Itfi a -Fs; �rt p
B Y Md1A �8c '"ASS OC. , INC.
END OF DISTRIBUTION '}/ PAA � �'� � MICHAEL
MAJ. �4
LINE A:`i`" F. i, t. ROSATI
P40.
B:
I C H A DATE
D:,1_ �M
1 ''L —
AS -BUILT SEWAGE DISPOSAL
SYSTEM PLAN
MARCHIONDA & ASSOC., INC.
ENGINEERING AND PLANNING CONSULTANTS
IPJ 62 MONTVALE AVE., SUITE I
STONEHAM, MA. 02180
/V, niyDo1O - L,OT 100, I'loVaPD sl. (617) 438-6121
AS PREPARED FOR SCALE: 1 40 DATE:
% LI N rLOGk� �n10•
M & A FILE No.: 3E) -01
L oT 114
O
N
0
0
�X IST----------
D-130A
v,
A�
A3.4 - - -
rX
6, A
Sq.Tyq EXIS!
VErvr
48.0 7' -
BoXFOk' Cj
ELEVATIONS TAKEN AT TOP
OF PIPE
DWELLING ELEV.:
138,46
TANK IN:
136.80
TANK OUT:
136.5(l
D -BOX IN:
0S.78
D -BOX OUT:
/35•(51L�t;
END OF DISTRIBUTION
e
LINE A:
/3s,zq
`i`" �•
B:
I3s.zq
D:
W
oo,
G0 % /0A
�_711 a O 0 sr -
:2.00 At.
126. 43'
S-reErr
1-071A
THIS IS TO CONFIRM THAT I HAVE
INSPECTED THE CONSTRUCTION OF THE
SAID DISPOSAL SYSTEM LOCATED ON
LOT UoT to A
THE GRADES ARE AS SPECIFIED IN THE
PLANSfk�ICATIONS DATED
BY M. & �ASSOC., INC.
AEL
DATE
AS—BUILT SEWAGE DISPOSAL MARCHIONDA & ASSOC., INC.
SYSTEM PLAN I
ENGINEERING AND PLANNING CONSULTANTS
IN
/V, YI1vDovg2 - La'r IM, 12,OXFcWD 37,
AS PREPARED FOR
. FbNrL.06k, ln)G.
62 MONTVALE AVE., SUITE I
STONEHAM, MA. 02180
(617) 438-6121
SCALE: I'=�4 DATE: 7 -g' -q►
M & A FILE No.: 3E) -01
North Andover Conservation Commission
2011 Meeting Schedule
Meetings are held the 2nd & 4th Wednesday of the month at 7 p.m. unless otherwise changed by the
NACC. Known changes/conflicts in dates are asterisked below.
Meetings are held at:
Mtg Date
The Town Offices
120 Main Street
2nd Floor Meeting Room
Filing Deadline Legal Notice
(before noon) Published
.
_Feh_-------
*04 -Ma
22 -Apr
26 -Apr
*18 -Ma
06 -May
10 -May
08 -June
27 -May'
31 -Ma
22 -June
10 -June
14 -June
13 -Jul
01 -Jul
05 -Jul
27 -Jul
15 -Jul
19 -Jul
10 -Au
29 -Jul
02 -Au
24 -Au
12 -Au
16 -Au
14 -Set
02 -Set
06 -Sept
28 -Set
16 -Set
20 -Sept
12 -Oct
30 -Set
04 -Oct
26 -Oct
14 -Oct
18 -Oct
*02 -Nov
21 -Oct
25 -Oct
x'16 -Nov
04 -Nov
08 -Nov
*7 -Dec
25 -Nov
29 -Nov
*21 -Dec
09 -Dec
13 -Dec