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HomeMy WebLinkAboutMiscellaneous - 26 WOODBERRY LANE 4/30/2018r' rr— IV -4 BVI uvv uy ivt,ar uvarU Tm�,�rn�1RAR7 NT U,m.P r- ; . .. be +ubml(jad to the local Board of Haal(h or other r A;. FacIIIty Jnfcrr)-qticn TY04n NIdi out 1..: Syswm LocaUon., • � liar, �' •, ' .. , . , , ��° � /G2-Ae.. oNy Ina ltb ko y Add(— :: n'Or0 y0G a;riA(.r 00 j1Ql , lM refum Y;'', CItY�7own (' ; Slob Up CcJoa ;;�;. ';�.�1.�• I,�r.;`,:� .� System .'.Y ' ;: �, ,'. •>ril \'`, if 4,t�vrrt' �,)% .t 1. , r ,;1. i i;,.,,,.,.'1!•�• %u.; .. ' .1. ;'�Lr .. .;J.' ,.� �.•�/,,.� Iry Ij.o'• �'j,l�•J7t J'..` .1'. �� .,• "r. Cl rr:(•ir.'.�i'J ''r.:'. :1; 1'.,.i'. � �(�i'f'1 : !i: MIJ1644 (It IWO(Inl ffOrn IouUOn) — C fq %r OvlT1 $1819 / �- — - fP.P d i ' ' ' '" Tol9phono NumCor 71�..; � ,V' ;•' '�• ,.fir:•,.' '• .Y. v. <:6�',RJumping.Rarlord. 1 ��(1,Ya'`'��fire',(/,1(w��r.1)•�I/��fIM.IJ``'I('„ � 4,1 ''' �' .;,'y ('i. ,', •.!'11,1:?� , •I t L" . �j � � � (CI Dah of Pumpinq` ` Dole 2. QuanUty Pumped: �`;, y Type Pf.ayatem; • [] Cesspools) Septic 'Tank CD Tight Tank }• jj ' ,❑ /Other (describe -- ,, r 1/,l k:`.1 t�. J°�, ', /-(i•i'•t;v'�Ir�Y •,1 ,r, : v .. 4 E�flut3nc T88 Flite( pr•q..wt? .❑ Ye9 No II yes, was Il cleaned? ❑ Ye `' f.' �''••1�.�i Il l�•. �, Ji'�y(,gllll lir 1'�' •J oondl�lon.Q.(8y%; m. 4(.v�6J'r'.'!i��J�J''�.I• v,.. .,i,.•;'.,>.tiJ'1!I',�j'f,�i',j('r;4��,..1'i1,r!;,"'(SrJ''�: ` 60 ab_ — Pvm ed ISX...,...:, -. .. •- ;� ,�1','�•.,'r'r %: ♦,. I ti }�i1tY r'I�j .ifi'�,°:�i'� v�. S � r,�,H•r �flY . �:' r •�'i v. 1\• Y;r.��'tu i r ��!A 4, i�,�•, �I r�i�'� v I';'ilil�i'��.', i, `+�""�'';,'ti��;' 1r,�J�'1,taA l;d,a .,,;� dr; YY��i{(/�1�,•;.Y.�,•r�, d. j;.�•;�r. :.,:Tr'. L�oCa on.wh@re co�lencs,Wara dl�posed. • .. 11.` .�..(,I�'.Ir'. (C, J. ''1,�,. %(�':•�V �" �''. l:J ,r'� II i•�:. �y,.� •I I.. ���iii %, n�.,.�h,r .!,`t'.l�.iG r. tl•, r,t •:�:�� �'''I r'� 1.4irr' ' ht+.�JNhvw,mass.9ov/dep�wefar/approvaJsJt6(orms,hlm#Inspect 7,4.coa'3 . �V,a,,h/icJe Ucan�e Nurrwor Sy(l9m Punpinp Rec n %, ; m;,q•tr.•;t.n;`�'sn+rr«;•r;JY:(••..... ` `DEP..has provided this form for use by local Boards of Health. ' s.ubm!>rted to the.local'Board of Health or other approving au :.A.; Facility Information , JUN -4 I tmRortant. TOWN OF i ,ANDOVER ,7,y1lhen filling out 1 System Location FSE?.(T ?TMENT * • Cotitpuoter U3e " only the tab key Address to move your cursor . do not use the r@tum Clty/Town State k,y , , ; ;, — p Code ,� , `"' S2 stem owner y r Name.. Address (If dii(eren from cuony. Clty/Tovm; State-. Zlp Code Telephone Number •;;>?BP,umping ord; •,.�' �� °;� • 1 Date of Pumping Date 2. Quantity Pumped; / Gallons pe of system' • ❑ . Cessj)ool(s) , S tic Tank ❑ Tight Tank ❑ other (describe); 4 Effluent Tee Filter present?. ❑ Yos If yes, was If cleaned? E]Yes to c' ` :Cop'dltlon of v`,/atm 6•;;Sy Qrf Pumped ,YG . Vehicle UCen/$1e Number.. S f^,'.'�rw•tl�li�,`1}�1. (ti ti),y1.{llr�i%�,,r f'. Pr,� 1 - 1 �+ P • ,y ,1. where contents were dipposed; t^/40. , r e - ti -+•' 11 �'I •�'I.�'. 1. .•�,� ?\ r J D'r..l 7 ,Illi ,Y.6 .• I !'1 ♦ � t.li. : ' r k` Slpnature of Hauler Date httpa/www, mass. gov/depJwafe�Mpprovais/t5forms. htm#(nspect Y r, , t5form4.doC A6J03 System Pumping Record • Page 1 of 1 RECEIVED JUL - 6 2005 WN OF NORTH ANDOVER HEALTH DEPARTMENT M U WNTR A kDID 71s -y FT Ala Nlol� DATE OF Pjq)qQ; Qt,"'A NMTY PLtkfpck_ %-SS POOL: No o 5 'wc p 1 F"qA t' Zib; A 'r A n 0 IN ,I. - 000 D Cvwq v � - r i 'ULL �MAY Y 0 V-" B A17Y KOM L85 t, N A�- MUMS FLOODEZ) $0LlTCAUYoYSY, '__ rff B p, EX P A) N j t:,f Cl, M t, 4T' i _ Commonwealth of Massachusetts 0 City/Town of NORTH ANDOVER MASSACHUSETTS System Pumping RecordRECEIVE ® Form 4 DEP has provided this form for use by local Boards of Health. T e System JUL d mu, be submitted to the local Board of Health or other approving aut o�r( J?! OF NORTH ANDOVER HEALTH DEPARTMENT A. Facility Information - Important: When filling out 1. System Location: forms on the computer, use , only the tab key Address to move your /� y cursor - do not use the return City/Town key. - - ... -- State -------- - --- ----- Zip Code 2. System Owner: Name -- - - ---- - - -- --- -- - - Address (ifdifferent from location) City/Town State ------------ ------.._. Zip Code ------------------- . --- - -- --- - --- -- Telephone Number B. Pumping Record 1. Date of Pumping -- 2 uantit Pumped: Date Y P ----------------- --- - allons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other (describe): ---- -- ----- — --- — --- -- --- ..__. -_. -- ----- 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. Sy em Pumped By: Name G C11-.-- ------ ... — -- -- ------ -- ------ - -- Vehicle License Number .61 kso 6f Company 7. Location where contents were disposed: Si ature of Haul-/- ------- - - ._ .__._-- _ Date -------�LJVJ.-------_ _--------------- --- http://www.mass.gov/dep/water/-provals/t5forms.htm#inspect t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Yet '' " • >~ '�,n r>z.ys TQWN 0011"NOZT'H ANDOVER -:^^ "-.-��• . . S'YSfiI UWrNO RECORD, -of ooGF b ► 4�- gQF? ;, DATE ! 4 ` 2r SYSTEM OWNER &ADDRESS SYSTEMLOGJATION-�~` No - Oivao veil i�'IGI. DATE OP Pl1$rIPIN }QUANTITY'PUMPEj) CESSPOOL� • N0 5-- ..' t UPTIC TANK No. yp � NATM OF SERVICE;;-RQv. r OENGY r, Y � ty �, :fir ^ ` ' • h , ., , f i .. - - ' "•`" `, TOVVN OF NORTH ANDOVERc ya+l�J Ur r SYSTEM PUMPING RECO RD .r• e PUS 1 2001 'r`Tr14;?0V,4RIJOS � r�{��4 '1,p� �{��• 7 / � 1 cl "A •gyp} I + � Y .. Yn y •� - .�vJAN xi I Il 1.r t�5'f t T. mi I IXM,ct , rid. = SY4TF O�N ' 8G ADI DRESS ! t SYSTEM 1�CATION LL(�/ m.U�1�C—• •9••S }'tl''r "5 r _ ! ! .1 0' }"A� 11. d (gu*pl_: _T• -front of house) . Y ' j. w .t •�I'Fk; ikt�ijinti�1 s.t1 r(� Aq RtiL K� 444W = Y Y i r }tIP'�ip"`.i�!»}-9f1Fr i't. �4"`j45f •F,.�r:��...�,:. c'j��".''(r�.':ti• - td^ p :. .yl{, ,� . „'S?''+r• t t ... 1. ti` e 4r'`,H:, �'rt r. • _. - • - .....r' µ{}'"��►a'+ .OF PUMP r v QUANTITy PUMPED - - Ira 1. .. • a GALLONS ,��� �T�t �',� '� S�'OOL• ANO 'YES t �` � , � . . ,; � ... _ • SEPTIC TANK YES —V �+ (. r��jir(1 - r 'J. n5TM rl I. � t= .� rr �j,.. w•. ' r Y r YY rf► OF .SERVICE► ROUTINE , J . , XMERGENCY tIftAl, a'tK:GOOD CONDITION FULL TO COVER ;r xtre t HEAVY GREASE . , R00 1- BAFFLES IN PLACE TS EXCESSIVE SOLIDS . LEACHFIEI,D RACK " N ; ` SOLIDS CARRYO 5 ` FLOODED ; 1 �' OTHER (EXPLAIN) ■` M' ` �/i ♦ IN [ }�1 �°f fir+• ! r �.. • �j��J■ • � `+ «��j�f�'1 "�`rr1,:K`'}� }ti��j''.�4 k crf�+ s,�yss ry. l ..�� ! :�� t{` .� '' , t y IN SSI 1-1 3 1 l�,j�.k'rjtA ,I �4•S!/ �/lA �lA -{l 4'•� .. J1,64 AV46ver 2.6.4. 1JD Moon V. h/e flPi A nba l*e, sow MOO CT's SEPTIC TAM SMMCE 47 RAIJ;M grr WNNM,, 1"W 01835 978-372-7471 st s�'- sow MOO ✓ l7� D/y.»�ic, /qn� Vlzg / 90 -7 /d. 7vl Ile - Iia t-v� �1e/4L,� ��- 103 -Dd&cr9vm, (� ! 155o by/7 C 16�6�0A l6Gjp ENE Dr Name: Location: ir Contact: Billing Address: fity: .Special Instructions Per: r AM/PM :Services Rendered A§PNature of Service ) 7 eg. Maint. VEmergency ANDOVER SEPTIC PUMPER QXay 0 Night PAY FROM THIS BILL P.O. B X 4173 B Station kiover, MA 01810 ll (508) 475-2593 6_ (508) 664-0640 Professional Septic & Drain Locally Owned and Operated zip:- Emergency 24 Hr. Svc. — 7 Days Completed Incomplete Reason: um Pumping ervations V Septic Tank Good Condition Septic �l Wi A teechfield Runback Leech Ph/ Overflow 0 Riding High D -Box .(liquid level Pump Chamber 0- over Grease Trap sive Solids Catch Basin op / ttom Portable Toilet �owden O Other Heavy Grease :Oty: El Roots Size: F-1 Suggest Electric ID Under 1000 gallons C1 1000 gallons 0 1500 gallons Rootering 2000 gallons 0 3000 gallons 0 4000 gallons 0 Van Called 5000 gallons .0 -other 0,Other %sc. il Digging Charge _0 Backhoe ftji Location n. 0 Consultation 1 t 4 Service Call 0 Estimate (h 'labor 11 Portable Toilet Rental :1 Waiting Time El Baffle 'wigging Charge Is Per Driver 1Discretion .S)/( E3Aghch r X ❑ f I6/ ower V0,414-ir f El Flo6r Main 0 Yard Drain 11 Vent El Sewer Jet 0 Other Footage: .0 Inspection ❑ Certification: ,P/F -Reason: 0 Pump Repair 0 Repair El -Chemical Treatment 0 Other Upscription of Work Recommendations Terms of P/Yment Va9yum Drain Cleaning Parts Month - Yr. Month NET 30 DAYS Tax Tomsk Conditions0 Cash 1:1 Check redit Disco llv" N bt responsible for damage beyond curb line. 3. 1 % per month will be charged to accounts past due. Tor complaints shall betepred within 48 hours. 4. e purchaser agrees to pay all cost of collection. IA72 r 4 tomer Signature Serviceman r I) 1- - M0r-ZTGAC-xE PUPtPosc-:s CNK VSE ©ul_�C (BAS E D UP04 PU5U C RECORDS AND Edf DZ),ICE UPS 7Mm GAN t� AP D RE 5'S Z-� �l% c�b'FS E 2.1Z`( Ld. IU E, N 0 eT (-i & kl T> civ E Q., 0P-rGAG0 :—��>-�a�-�T �., r(2µ1!SYL l.. LLL T(K)CYE�, Soup -CE : ,s��;,,t,• {3342 Ii 12P_ A, It,3A4M EA,sF t -AS Qr� L4 S 0 V , N 00 v4 q SCAL r410 OWNERS) •; fhi, REGISTRY: ESS�C-Q2?rT� DEED: BK. kSoap- -ro-1 - CERT. OF TITLE: NOTE: ROBERT G. GOODW7 R.L. S. 62 CENTR.i.L ST:tET;T AN DOVER, 1(A�Sy . CERTIFICATE • I CERTIFY that the Lot shown hereon &QD that the -DwE. LL l QCY shown W(T(-{ 114Z present Zokiing' of the of QC-) The premises do not lie within a designated ;4. _ _ I; ,�',`tH'�t •ir,�c Flood Hazard Lone. o F?OJc�T Z5oo�B-00(0 - 8, I%,` ��lLzTl' J00, vs 163 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. ****************Applicant fills out this section***************** APPLICANT: 1e0QQ�T �eT//y /z Phone �Oyf",-7R,30 LOCATION: Assessor's Map Number Parcel Subdivision Lot(s) Street a1U1P,�,�y L,51A/e- St. Number a6 ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments Town Planner Comments Date Approved Date Rejected Date Approved Food Inspec�t-/or-Health Date Rejected / Ai Date Approved 41g4( Septic Inspector -Health Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date l�trjl t�tl�t���\�} G fi•.1 U N 115%j Ajl� SS'I."Pre, .y t 1i m1' I � � t ' � `� 7'��YN `4.�' NORTH :..• �������� SIYSTEM pljmipr.Nc R CORS ...... . _ ADDRESS„� SYSTEM LOC'aTION 10 (ez�mPle; fron( of hour) SEPTIC SYSTEM INSPECTION FORM ADDRESS 'Z l C,,6 be-,fr DATE INSPECTED 9.0 PROPERLY FUNCTIONING? lJ N WEATHER CONDITIONS COMMENTS: 1_i d "' `. 7 A I- A, L -n Please forward us as much of the following information that is possible; 1. Type of system 5�P-ri� 2. Age Cg Yes /�'R S 3. Locat ion; 4- Maintenance records and date of last pumping out 'Documentation of repairs and reconstruction b. Site conditions %. Builder of system Oare NOW A) 8. Engineer who approved, — Site t l r,) /, /V o — S-pstem m 9 . Installation Procedure Viv A! N tv &V PQ 10. Problems ',j M® .0v 6 E WATERSHED RESIDENTS QUESTIONNAIRE tAR. & MRS R. R. KETTiNGER 1. Name _ N. ANDOVER, MASS. 01845 2. Street Address 3. How many members are in your household? 4. What type of sewage disposal system do you have? ❑ cesspool 1 septic tank and leaching area ❑ connection to municipal sewer ❑ other (describe) ❑ do not know 5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health? ❑ yes ❑ no 9�-do not know- . -6. How old is your sewage disposal system? ❑ 0-5 years W--510 years ❑ 11-20 years =-f4 ❑ over 20 years ❑ do not know 7. Has your sewage disposal system been rebuilt or repaired? ❑ yes no ❑ do not know If yes, approximately how long ago? years. What was done? 8. How_trequently is your sewage disposal system pumped out? ❑ annually every 2-4 years ❑ every 5-10 years ❑ over 10 years ❑ never 9. Have you had any problems with your sewage disposal system? ❑ yes ©ono If yes, what problems? -__ ❑ repeated pump -outs needed ❑ system clogs, backs up, or drains slowly ❑ odors ❑ sewage surfaces through ground 10. How many of each appliance are connected to your sewage disposal system? washing machine dishwasher garbage disposal dehumidifier drain sump pump Atoilet roof/pavement drains showerlbathtub 11. Please state the brand and type (liquid or powder) of detergent you use for: dishwasher VAR 10 0 $ clotheswasher L/ R 10V S 12. Does your property have a lawn? P"'Y-es ❑ no If yes, approximately what size? ❑ less than 1/4 acre 1/4 acre ❑ % acre ❑ % acre ❑ 1 acre ❑ more than 1 acre (Specify) acres 13. How often do you fertilize your law ? No. of applications per year Season(s) of the year SPR 1 W G Sah 0te1rjtLI 14. Please state the brand and type (liquid or granular) of lawn fertilizer you use: (� iEM L AUVA.1 M- heck here if your lawn is maintained by a professional landscape contractor. TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD s10?h;0, �vSTEM OWNER & ADDRESS /�_ v2 6 f� Ole alolm a-10�2a°4x&12./ DATE OF PUMPING: cii,.sSI'OOL: NO V YES SYSTEM LOCATION (example: left front of house) ��.c % C) r� �C � 3 kic O3N QUANTITY PUMPED GALLONS SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE 4z, EMERGENCY 013SERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER SYSTEM PUMPED BY: UUIINIENTS: -Z FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) C0NTE' NTS TRANSFERRED T0: It Q �WIz �Q0 ` Nj W 4o W 1. 1. o IQ;W 0 J � y� 141 lj 0 N i tv NI f i• � may; -e � t i V c- y t� N i\ V c- y t� J i � q .`! � 0 q N � f� Q i ku __ gi�L6 =ino LL = h'i koFa J i � q � 0 q N � f� Q i ku J OR � 0 f� J 0 f� i __ gi�L6 =ino LL = h'i koFa J J �. "T � 1p/ioq M0 N;E'IL TO: NORTH ANDOVER, MASS BOARD OF HEALTH FROM: DESIGN ENGINEER 0C t .1G 19 76 Re: Soil Absorption Sewage System Inspection This is to certify that I have inspected the construction of the said disposal system at L 0 "r 3 WC 0 .lb 6 Lk R Y L19IV E North Andover, Mass. SITE LOCATION The grades and construction are as specified in my plans and specifications dated S',E P 7" 3 19 %� ." i SOIL PROFILE & PERCOLATION TEST DATA Town City, _ No.&StreetiRJ /je e- % - Lot No. 3 Loc./Subdiv.� c,r-� e �C�Plan Ownerr�r- Investigator l/V . Observer /1 7/75 SOIL PROFILES -DATE 1 12 Elev. 2* Elev. 3° Elev. 4'Elev. 0 ..� 0 0 . Benchmark Elevation 1 2 3 LA 5 6 7 8 N 10 2 3 4 5 M 7 ED 0 10 Location Datum Peer-ccollatt n Tests -Date 4//7/7_, Ii 2! 3' 4' 5 6 7 9 10 Pit Number 1 2 3 4 5 Start Saturation Soak -Mins. Start Test -Time Drop of 3" -Time Dro of 6" -Time Mins.lst 3"Dro ,.. Mins.2nd 3"Dro ,-1 Notes & Sketches on Back Frank C. Gelinas & Associates, North Ane' L A'rAQ T23i '.IOIT.' M23q g 3jlloRq sIoz