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Home My WebLink AboutMiscellaneous - 29 WINTERGREEN DRIVE 4/30/2018 (3)i f' H txi tai H : Commonwealth of Massachusetts RECEIVED City/Town of . System Pumping -Record Auc, 'L 9 201 Form 4TOWN OF NORTH ANDOVER HEALTH DEPARTMENT DE'P 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. A. Facility Information 1. System Location: Left / Right front of house, Left / Right rear of house, Left ht si�hous6LeftRight side of building, Left / Right front of building, Left / Right rear of building,Unde . Address I� W � � f��s-✓V V C,dyfrown State Zip Code 2. System Owner. Name Address (if different from location) Cityirown State � � � l p Code t Telephone Number B. Pumping M 1. Date of Pumping 3. Type -of system: ❑ Date 2. Quantity Pumped: Cesspool(s) ' - ptic Tank Gallons ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes 01, O If yes, was it cleaned? ❑ Yes ❑ Na 5. Condition of System:k',&Vk,,,� 6. System Pumped By.- Nell. y: Neil. Bateson ' Name Bateson Enterprises Inc Company 7. Lo_c:abgp."e contents -were disposed: Waste Water F5821 Vehicle License Number Date ,[a `JjL t5form4.doc 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts City/Town of System Pumping Record Form 4700 DEP has provided this form for use by local Boards of Health. Other d MO information must be substantially the same as that provided here. B with your local Board of Health tQ determine the form they use. The System Pumping Record must be submitted to the local Board of Health of other approving authority. A. Facility Information 1. System Location: Left side of hous , Right side of ho eft front of house, Right front of house, Left rear of house, Right rear of house. Left rear of building. Right rear of building. ✓i Address ` 1 / / Cityrrown O` � V:rlState Zip Code System Owner: Name Address (if different from location) Cityrrown B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): Date Cesspool(s) State ?_3 — 1� Code 3 Telephone Number — 2. Quantity Pumped Septic Tank Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes [ff r No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition, f System: LCA_)_0j I �eauu 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Locatio re contents were disposed: G.L.S II Wase Water N . _ _ - F5821 _20 c.1 <::� Vehicle License Number Date t5form4.doc• 06/03 System Pumping Record . Page 1 of 1 DATE: Z ► S.6`( SYSTEM OWNER & ADDRESS vI c)1 0�— .7 reffilromh SYSTEM LOCATION (example: left front of house) ,i 'J�+Sar � k'oust DATE OF PUMPING: - i � j �`t QUANTITY PUMPED: GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES 7 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: Bateson Enterprises, Inc. COMMENTS: coNwNTs TRANsFmRm To: G.L.S.D -Lowell Waste t I\ DATE: Z ► S.6`( SYSTEM OWNER & ADDRESS vI c)1 0�— .7 reffilromh SYSTEM LOCATION (example: left front of house) ,i 'J�+Sar � k'oust DATE OF PUMPING: - i � j �`t QUANTITY PUMPED: GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES 7 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: Bateson Enterprises, Inc. COMMENTS: coNwNTs TRANsFmRm To: G.L.S.D -Lowell Waste t System Owner �C/oma nwe Ith of Massachusetts �'' `/ , Massachusetts Svstem Pumping Record System Location ()\,t �-(-O� q I "-w (cc Date of Pumping: �''� a a - a,-2� Quairiity Pumped: /� allons Cesspool: No f'J Yes U Septic Tank: No U Yes System Pumped by: Fare -dart 'For''v taw License # Contents transfertred to : Greater Lawrence Sanitary District Date: Inspector: 10 R a' :rmit N0: ate Issued: TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received4/AZL� IMPORTANT: Applicant must complete all items on this ',OCATIbN � � �� L4.� 1 �l � ✓ t`-[�F✓t`J t I �"� Print raRnpF.RTY OWNER l� ►��1ct-� C MAP NO.: 10 9 16 PARCEL: TYPE AND USE OF BUILDING TYPE OF IMPROVEMENT ❑ New Building ❑ Addition ❑ Alteration ❑ Repair, replacement ❑ Demolition F-1 Moving (relocation) ❑ Foundation only Print ZONING DISTRICT:_ j4 , o A � t a ca e* HISTORIC DISTRICT YES ❑ PROPOSED USE Residential Non- Residential ne family ❑ Two or more family [I Industrial No. of units: [I Assessory Bldg ❑Commercial ❑ Other ❑ Others: DESCRIPTION 99F WORK TO BE PREF K� 1,11/VA Identification Please Type or Print Clearly) OWNER: Name: M t C tiCAtj ) 1 Tpo iG— Phone: TW' Address: , • CONTRACTOR Name: % q F"Z,.---�- flI/ e" �=-I .., i Address: �� Supervisor's Construction License: e % Exp. Date: i / 1i Home Improvement License: Exp. Date: of /�49 ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL EST/MATED COST BASED ON $125.00 PER S.F. �� (�� Total Project Cost :$ FEE:$ Check No Page 144 Receipt No.: TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Well [J/ Private (septic tank, etc. F� Tanning/Massage/Body Art ❑ Swimming Pools f Tobacco Sales [ Food Packaging/Sales CI Permanent Dumpster on Site ❑ Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owr. Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS ATE REJECTEDDATE APPROVED CONSERVATI COMMENTS r , -tAM A I V Q) s CZ DATE REJECTED DATE APPROVED HEALTH ❑ COMMENTS Z' , FIRE DEPARTMENT - Temp Dumpster on site yes no Fire Department signature/date 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 r Y TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Well [J/ Private (septic tank, etc. F� Tanning/Massage/Body Art ❑ Swimming Pools f Tobacco Sales [ Food Packaging/Sales CI Permanent Dumpster on Site ❑ Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owr. Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS ATE REJECTEDDATE APPROVED CONSERVATI COMMENTS r , -tAM A I V Q) s CZ DATE REJECTED DATE APPROVED HEALTH ❑ COMMENTS Z' , FIRE DEPARTMENT - Temp Dumpster on site yes no Fire Department signature/date 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 I ,j 7. CERTIFIED PLOT PLAN :LOCATED IN NORTH ANDOVER, MASS. SCALE. I"=40' DATE.912212006 Scott L. Giles R. P. L S. Frank. S. Giles R. P. L. S. 50 Deer Meadow Road North Andover, Mass. 1, A�A \ IST - HSE. FN[?• �X #29 _, LOT 8AA 43,624 S.F. PLAN #10583 N.E.R.D. 99.28' WINTERGREEN GRADING EASEMENT I CERTIFY THAT OFFSETS SHOWN ARE FOR THE USE THE OFFSETS OF THE BUILDING INSPECTOR ONLY SHOWN COMPLY AND SUCH USE IS FOR THE WITH THE ZONING DETERMINATION OF ZONING BY LAWS OF NORTH ANDOVER CONFORMITY OR NON -CONFORMITY WHEN BUILT WHEN CONSTRUCTED. J,3 is tii IJ N % I I I I it Q 'A4 %19 ez 0 7 T L7 , i ) �! FORM U - LOT 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: I �I L-?•' �l �6'Q (City vti,.,,,e �li-7�7� LOCATION: Assesso r's Map Number �O913 Parcel Subdivision W iyi, (A �a Lot (s) Street St. Number : y ************************Official Use only************************ RECOMMENDATIONS OF TOWN AGENTS: c' Date Approved �6 L - Conservation Administrator Date Rejected Comments Town Planner Comments th Comments Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date Approved Date Rejected Date Approved Date Rejected Date a i p T rn Lc;,j CEET/FIED PLOT PL,4N LOCArED .SC.JLE� CI4RI5TIAN5EN e 5ERGI , INC. /60 WMMER STREET - HAVERRILL , MA. SE yrr. _T -, z4•4 -.S\ __7 A, P. MICHAEL cuENT:....................................... . / CERAFY T?gdT TWE O,-`F5ET5 51/OWN Aff FOR LOT BU/LD/N� 511OWN ON 7/1/5 ZON/N� DETERM/N,4T/ON /5 NpT /N PL 4N CONF01eM5 TO 711E ONLY .dND ,GAPE NOT -TO BE 4 FLOOD ZONING BY -L.4W5 OF 7_11E 05ED TO E5T,4BL/511 RPO- 114Zd eD T w�{...... OF PERTY L /NES. ZONE. WHEN CON5TWCTED. &.•Ik6A (-a4Rp OF, HE4L -1 N°l�TH Ati�UEI�� 'lA. �4PP�� CAIS �_ Gi245� W G-i� SopFy AT ... _b(A)n1 D wEc.,c_ AP�ouCDDOT'C SS SEPr)c sy s i�M vr✓-s►<-�J ,�Pf'+�ovED DArt� .�_�.�(o /��'�-�UwG /urhor�►ry � 6PAJPlTVJ5 = D1�QPPR�VEp Q� I E R�4SoNS SYSTEM ► ,J S 1;0 U AT I OA J L X4V4T(O,J )A-)cPEc IOU U/JrG S -L -1i15S ❑ FAIL- �1N�OL I �ISp�rlon� QPPROOEP Puc- � -OV AP121�001AvG Aur�oRmx OGOWA16O 4�DIT�o�AL. ►�s�'z., ��S �� may) , - DISAPP)�OvEp DArC J Qso NS FwAL APPROVAL 016T' APPRO\lt&)6