HomeMy WebLinkAboutMiscellaneous - 30 EAST PASTURE CIRCLE 4/30/2018HAS PLAN REVIEW FEE BEEN PAID?q/h�/"
PLAN APPROVAL: D ATE P -W -W! APP. BY
a U
DESIGNER: PLAN DI
CONDITIONS
WATER S PPLY: WELL
WELL PERMIT DRILLER
WELL TESTS: ------CHEMICAL DAIE APPROVED
---I_
BAc,rERIA.-.I
BACTERIA II
COMMENTS:
DIAIE flPPRUVED
__ DATE APPROVED
FORM U APPROVAL: APPROVAL 1*0 ISc'UE ES NO
DATE ISSUED
CONDITIONS:
FINAL APPROVAL:
ALL PERMITS PAID YES NO
WELL CONSTRUCTION APPROVAL YES NO
SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO
OTHER YES NU
ANY VARIANCE NEEDED
FINAL BOARD OF HEALTH APPROVAL:
YES NO
1-9
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MAP #
L
PARCEL
#
STREETI
HAS PLAN REVIEW FEE BEEN PAID?q/h�/"
PLAN APPROVAL: D ATE P -W -W! APP. BY
a U
DESIGNER: PLAN DI
CONDITIONS
WATER S PPLY: WELL
WELL PERMIT DRILLER
WELL TESTS: ------CHEMICAL DAIE APPROVED
---I_
BAc,rERIA.-.I
BACTERIA II
COMMENTS:
DIAIE flPPRUVED
__ DATE APPROVED
FORM U APPROVAL: APPROVAL 1*0 ISc'UE ES NO
DATE ISSUED
CONDITIONS:
FINAL APPROVAL:
ALL PERMITS PAID YES NO
WELL CONSTRUCTION APPROVAL YES NO
SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO
OTHER YES NU
ANY VARIANCE NEEDED
FINAL BOARD OF HEALTH APPROVAL:
YES NO
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"IS 'THE' INSTALLER LICENSED?.;'-':C:'�...�:,.-_
NO
NEW
REPAIR"
TYPE,OF-CONSTRUCTION:
:..,:.NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW
NO
CONDITIONS OF..APP ROVAL
YES
NO
'FROM FORM U)
JSSUANCE OF DWC PERMIT.
NO
INSTALLER:
;.'-DWC PERMIT-NOm_
`BEGIN..INSPECTION YE 0.
4S
EXCAVATION. INSPECTION: NEEDED:
PASSED By
-..:.CONSTRUCTION. INSPECTION: NEEDEDz
AS BUILT PLAN SATISFACTORY: E
,,A.PP.ROVAL TO. BACKFILL: DATE: BY
FINAL.GRADING APPROVAL: DATE By
FINAL CONSTRUCTION APPROVAL: DATE:
B y
,40RTH
0
CHU
Town of North Andover, Massachusetts
BOARD OF HEALTH
DISPOSAL WORKS CONSTRUCTION PERMIT
19
Form No. 3
Applicant
NAME ADDRESS TELEPHONE
Site Location Cn-�- a
Permission is hereby granted to Construct ( -j"or Repair an Individual Soil Absorption
Sewage Disposal System as shown on the Design Approval S.S. No.
CHAIRMAN,-BOA1C=F ffEArT?r-
Fee D.W.C. No. e6l,
4.) *A
APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT
DATE: k(a CURRENT INSTALLER'S LICENSE#
LOCATION: I _(� � 4 '�)- D,.x-o-
LICENSED INSTALLER:
SIGNATURE: TELEPHONE#
CHECK ONE:
REPAIR: NEW CONSTRUCTION:
IEF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUIELT.
AdM7 trative Use Only
$75.00 Fee Attached? Yes No
Foundation As -Built? Yes_j�_� No
Approval Date:
no
HAYES ENGINEERING, INC.
603 SALEM STREET
WAKEFIELD, MA 01880
TEL.: (617) 246-2800
FAX: (617) 246-7596
To S.'& " A��
ry)n a"� O -P ��_ 'H�
uc�' anIa --�r�
GENTLEMEN:
WE ARE SENDING YOU E] Attached 7 Under separate cover via
E] Shop drawings Ej Prints Ej Plans
Ej Copy of letter E] Change order F]
LETrER OF 7HANSOTTAL
ROOM,
DATE
NO.
IEW M-11,
cm
the following items:
Ej Samples E] Specifications
COPIES
DATE
NO.
DESCRIPTION
cm
+-,,3
THESE ARE TRANSMITTED as checked below:
E] For approval
2-ro-r-your-use
n As requested
n For review and comment.
n FOR BIDS DUE
REMARKS:
LIN
[:] Approved as submitted [-] Resubmit —copies for approval
E] Approved as noted E] Submit —copies for distribution
E] Returned for corrections F] Return —corrected prints
1-1
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NOW WE
19 E] PRINTS RETURNED AFTER LOAN TO US
A A (')
If enclosums am not as noted, kindly notify � at once,
FOM( 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
landovner from compliance vith any applicable local or state law,
regulations or requirements.
****************Applicant fills out this section*****************
APPLICANT: _-`�nyla �1 Phone
to;?1;i G)) 9
LOCATION: Assessor's Map Number C Parcel
subdivision (Ca,_S�- Lot (s)
Street PQ 4-0re- 4r LC St. Number
************************Official Use Only************************
T) t� �) 7;:.4,
RECON24=ATIONS OF TOWN AGENTS:
Conservation Administrator
Comments
L1__ Town Planner
Comments
Food Inspector -Health
Sep�E_ic Inspector -Health
Comments
Public Works - sewer/water connections
- driveway permit
Fire Department
Date Approved
Date Rejected
Date Approved
Date Rejected
Date Approved
Date Rejected
17
Date Approved
Date Rejected
Received by Building Inspector Date
-7
NORTH ANDOVER BOARD OF HEALTH
DESIGN REVIEW REPORT
I
FEE: PkRMIT # 609 DATE RECEIVED- IQA6191-
APPLICANT I)OJV)9Z-,b MAP PARCEL
ADDRESS --�50 5 7-6A-) LOT#
ENG. STREET ale6e:��
ADDRESS
PLAN DATE 3/ 1 / 9 9",5- REV. DATE
CONDITIONS OF APPROVAL
APPROVED
REASONS FOR DISAPPROVAL:
DISAPPROVED
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PLAN REVIEW CHECKLIST
ADDRESS -�3957 ENGINEER 11A y!
,g Z-�95,- / -Ve6- 01,e—
GENERAL
3 COPIES bl-� STAMPZ,"'-" LOCUS -L,---' NORTH ARROW SCALE
7
CONTOURS-L,,n� PROFILE SECTION BENCHMARK SOIL &
\\\.01- 6111.16,C14
PERCS-!!E< ELEVATIONS/ WETS. DISCLAIMER,--' WELLS & WETS
WATERSHED?-.A/—O- DRIVEWAY_��(EWev) WATER LINE FDN DRAIN
SCH40 L--- TESTS CURRENTIL /c/24V SOIL EVAL
SEPTIC TANK
MIN 150OG �--' .17 INVERT DROP 4--�
25' TO CELLAR4-� MANHOLE ELEV
D -BOX
siz
# LINES 5
INLET IqQ-9-1 - OUTLET /90,
LEACHING
9
GARB. GRINbER_J/a(+200% EDF)
GW # COMPS.
FIRST 2' LEVEL STATEMENT
,17 (2" OR .17 FT) TEE REQ'D? 4/0
MIN 660 GPD? RESERVE AREAL--- 4' FROM PRIMARY?L----- 2% SLOPE-::�
100- TO WETLANDS Z,-' 100' TO WELLS 4' TO S.H.GW` (51>2M/IN)
35' TO FND & INTRCPTR DRAINS 6-� 325' TO SURFACE H20 SUPP
-7
4' PERM. SOIL BELOW FACILITY' MIN 12" COVER4--' FILL? (25'
if above natural elev; 10'if below) BREAKOUT MET?
TRENCHES
MIN 660 gpd_ SLOPE (min .005 or 611/1001)t-�� SIDEWALL DIST. 3X EFF.
W OR D (MIN 61 RESERVE BETWEEN TRENCHES?A0 IN FILL? MUST
BE 10 1 MIN. bK- 4 11 PEA STONE? "'..""VENT? (>31 COVER; LINES >501)
BOT + SIDE X LDNG = TOT
(L x W x #) (DxLx2x#) (G/ft2)
Copyright 0 1995 by S.L. Starr
Town of North Andover 40RTH 11
OFFICE OF *0
COMMUNITY DEVELOPMENT AND SERVICES
146 Main Street
North Andover, Massachusetts 0 1845 ISSA HUS
(508) 688-9533
January 29, 1996
Hayes Engineering
603 Salem Street
Wakefield, MA 01880
Re: Lot 2 East Pasture Circle
To Whom it May Concern:
This is to inform you that the proposed plans for the site
referenced above have been disapproved for the following reasons:
1) No soil test in reserve area. (N.A. 4.09)
2) Soil tests out of date. (N.A. 4.06)
3) Benchmark not in Vicinity of leaching area. (N.A. 6.02m)
4) Elevations of perc tests missing.(N.A. 6.02)
5) Please change note regarding garbage grinder from "not
recommended" to "not allowed".
If you have any questions, please do not hesitate to call the Board
of Health Office at the number below.
S incerely,
-1-1'1����
Sandra Starr, R.S.
Health Administrator
SS/cjp
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
Julie Parrino D. Robert Nicetta 1fichael Howard Sandra Starr KaUeen Bradley Colwell
No.
THE COMMONWEALTH OF MASSACHUSETTS
North Andover
, MASSACHUSETTS
FEE $ 60.0
,�Vylirativn for Pispoeal Sgeitern Construrtion jJermit
Application is hereby made for a Permit to Construct (X) or Repair ( ) an On-site Sewage Disposal System at:
Location Address or Lot No.
Owner's Name, Address and Tel. No.
East Pasture Circle — Lot 2
Donald Johnston 1-508-682-1619
North Andover, MA 01845
114 Boston St., North Andover, MA
Installer's Name, Address, and Tel.No.
Designer's Name,* Address and Tel. No.
Hayes Engineering, Inc. 617-246-2800
603 Salem St., Wakefield, MA
Type of Building:
Dwelling
Other
Design Flow
No. of Bedrooms — 4 Garbage Grinder AA
Type of Building No. per Persons
Other Fixtures
165 _ gallons per day. Calculated daily flow
Showers ( ) Cafeteria ( )
Plan Date March 31, 1995 — Number of sheets one Revision Date
Title Sej)tic 5ystem Design in North Andover, Mass.
Description of Soil See soil log on T)lan.
Nature of Repairs or Alterations (Answer when applicable) -
Date last inspected:
gallons.
Agreement:
The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site sewage disposal
system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a
Certificate of Compliance has been issued by this Board of Health.
Signed
Application Approved by
Application Disapproved for the following reasons
Permit No.
Date
Date
Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
, MASSACHUSETTS
0:11-ertifirate of (gompliance
THIS IS TO CERTIFY that the On-site Sewage Disposal System installed
- by for —
at has been constructed in
accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
. Use of this system is conditioned on compliance with the provisions set forth below:
)or repaired/ replaced( )on
The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. This
Certificate expires on
DATE
No.
Inspector
THE COMMONWEALTH OF MASSACHUSETTS
, MASSACHUSETTS FEE
pisposal *Votem %Q 11anstrurtion jhrmit
Permission is hereby granted to
to construct ( ) or repair ( ) an On-site Sewage System located at
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her
duty to comply with Title 5 and the following local provisions or special conditions.
All construction must be completed within three years of the date below.
DATE
FORM 1255 Re, 3/95 A.M. SULKIN CO. - BOSTON, MA
Approved by
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TELEPHONE (781) 944-0149 P.O.BOX 4
FAX (978) 738-9801 READF,4G, MASS. 0 1867
JOHN ZANNI PUMPING CO.
r OF NOR7H �—ftjj)07
W
7 -OW D TH
VACUM PUMPING '7rj4�00AR F HE)
COMMERCIAL AND RESIDENTIAL
MAY 10 2002
May 7, 2002
Town of North Andover
Health Department
Town Hall
North Andover, Ma 0 1845
Gentlemen:
Enclosed please find System Pumping Record as follows:
Jacobs 30 East Pasture, North Andover 5/6/02
If you have any questions, please call this office.
Very truly yours,
John Zanni Pumping Co.
Debbie Mugford
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
DATE:
SYSTE—MO—WN—ER —&AD5R--ESS
J,1c OR 's -
DATE OF PUMPING: i. �-6
SYSTEM LO�CATi`ON
(example: left front of house)
0
QUANTITY 1111PED -Z.86-0 GALLONS
CESSPOOL: No 4��
YES SEPTIC TANK: No
, YES
NATURE OF SERVICE: ROUTINE 61-010, EMERGENCY
OBSERVATIONS:
GOOD CONDITION
HEAVY GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
SYSTEM PUMPED BY:
COMMENTS:
FULL TO COVER
BAFFLES IN PLACE
LEACHFIELD RUN -BACK
FLOODED
OTHER (EXPLAIN)
CONTENTS TRANSFERRED TO: ------------
GREATER LAWRENCE SANITARY DISTRICT
CHARLES STREET, NORTH ANDOVER, MASS. 01845
TRUCKED WASTEWATER DISCHARGE SLIP
N oo A 41e,4,o,V f -
TOWN
Company Name: A/
Hauler's Name:
Address: 0.
Telephone: 7 VY, 0/y
SOURCE#1 Date Pumped: jo*- 0/ - 0
Name: lb,
Address: Cov#jT,,,y 61,j13 XJV
Telephone: 7,P8- 4CV-7p0e�
Signature: *, I
SOURCE#2 Date Pumped: Jr -e - 'Dr.)
Name: ?e-,? Z e-11 0+
Address: 3.2 ctj 7--,
Telephone:p (f/
Signature: Z 'y " M A e,- / A'
SOURCE#3 Date Pumpedjo-,,�
Name: 7,1 e 0 /3 ;
Address: )0 e417,
Telephone: 1) 9 - .4 9
Signature: *ojfA I�W,0,gV,
t
Slip No. /vo/ /4/
Date: _r-4 , 0,2
Tank Size: -2 0 0
Tank Size: / 0 0 o
Tank Size:
To the best of my knowledge the above information is true and correct.
Hauler's Signature
1,7 0 0
Tank Size:
/ .,�,o 0 -
TON" OF
SYSTEM P
DATE: q-�O-oq
SYSTEM OWNER & ADDRESS
C. 0 Pt 4'.�o v'k
G RECO
SYSTEM LOCATION
(example: left front of house)
EIVED
OCT 19 2004
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
�-e -�- 6(c� 6 6 � f—
DATEOFPUMPING: QUANTrrY PUMPED: GALLONS
CESSPOOL: NO YES EPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION
HEAVY GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
FULL TO COVER
BAFFLES IN PLACE
LEACIIMLD RUNBACK
FLOODED
OTHER (EXPLAIN)
SYSTEM PUMPED BY: Bateson Enterprises, Inc.
COMMENTS:
CONTENTS TRANSFERRED To: G.L.S.D / Lowell Waste
lnflpOrtant:
When filling out
fOrMS on the
computer, Lire
0111Y the tab key
to move you(
Cursor - do lot
uILI the re(urn
key.
PAGE',,, 0
RIEd
rs JUN 1 9 2007
TOWN Ot
HEALTh_ -
DEP has provided this form for use by local Boards of Health- The System PUMPIng Record must
be submitted to the local Board of Health or othat approving authority,
A. Facility Information
I. SYstenm Location-
dd�_it_.j__'__'
A
�5�41/ToWtl
zip code
4. `�0 rn Owner:
aq—f-IL�_
Td d —re 5 Fif - i5 �";r_ '___
I Iffererit T ON location)
E3- PuMP109 Ptecord
I. Date of Pumping :s
.-I'L �A i000
3. Type of system: Dam 2- Qu8ntitY Pumped: Galf0mb
D ces.spool(s) 11, /Septic Tan� Tight Tan K
Other (describe):
4- EffluentTee Filter present? E] YeS 0 No
& Condition of Sqy$tem,
syst PUII)Ped By:
?T
ROOTER -MAN
12 EAST DRACUT ROAD
METHUEN, MA 01844
If yes, w8s it cleaned? 11 yes 0 No
7. Locati011 Where Contents wet"a disposed:
19 UrO Of Hauler
g
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ater�appro_valsltSfOrr)ls. htM#1r)spect
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16:12 9786888476 HEALTH
A,
CoMmonwealth of Massachusetts
City/Town of h!Q ANDOVER
SYSteM Pumping Record
Forrin 4
lnflpOrtant:
When filling out
fOrMS on the
computer, Lire
0111Y the tab key
to move you(
Cursor - do lot
uILI the re(urn
key.
PAGE',,, 0
RIEd
rs JUN 1 9 2007
TOWN Ot
HEALTh_ -
DEP has provided this form for use by local Boards of Health- The System PUMPIng Record must
be submitted to the local Board of Health or othat approving authority,
A. Facility Information
I. SYstenm Location-
dd�_it_.j__'__'
A
�5�41/ToWtl
zip code
4. `�0 rn Owner:
aq—f-IL�_
Td d —re 5 Fif - i5 �";r_ '___
I Iffererit T ON location)
E3- PuMP109 Ptecord
I. Date of Pumping :s
.-I'L �A i000
3. Type of system: Dam 2- Qu8ntitY Pumped: Galf0mb
D ces.spool(s) 11, /Septic Tan� Tight Tan K
Other (describe):
4- EffluentTee Filter present? E] YeS 0 No
& Condition of Sqy$tem,
syst PUII)Ped By:
?T
ROOTER -MAN
12 EAST DRACUT ROAD
METHUEN, MA 01844
If yes, w8s it cleaned? 11 yes 0 No
7. Locati011 Where Contents wet"a disposed:
19 UrO Of Hauler
g
http://vvww.mess-gu, idep/w.-qeriaPpj
ater�appro_valsltSfOrr)ls. htM#1r)spect
t-'IfO-4.doca oeju3
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