HomeMy WebLinkAboutMiscellaneous - 30 SUGARCANE LANE 4/30/2018n e
1
t e
`�L.s& � .•,,;.}r r�yY+`��s�y�-moi �FyY"�:��#�- ��2�a .. Y - • F, ..
y .a' r .}, cla. .<,it^ �,.f;a t,.�L7k '} �>, 'kytT `,z•`r,�T+.p a � 3'� JSj,� i.Cs'y f�*� L+d,•,J1 1 r� tF �: r
I � i
r err ' '3"'c�r?'tee.t e; he7� 'stif`.y;! Yr si #r"Fha'4 - 4{ t't11'>- 1 t r
1 s�tf a� '#�xi��-''�{�•'r �aCr ! .w � t� k- ^"yra,� '-°""s " �� ,�` ,, i c'`r 'S.,,• y... ,F- r i ��R'�3 # ) : _.ti.,. � '.. - 4 .
, .�.��ar��-!, yit'c `y 1= � ,�_.y'�� ,i'f. � 3�"��"<` i �_Y�x 3-- t [.' � �tF 'L}. ri "" . - - ,.• .,
i
PARCEL`#�� f STREETwz
Y
t '. .• t 4 r� 'yT`(� fY Ko� s�t ; - n _ _.t-Stt.,'`':,a ;#•x+` '! ,
1 � 1 .y t?. 'FI Y;£X''i- ,5t`A �, t 3K. $t 1l.,1 ..s -� a. F ✓-. �. ', _
� s BIAS PLAN REVIEW . FEE BEEN PAID?., NO
e
a.?.
KLAN APPROVAL: DATE'ARP.l?l
G - ,
DESIGNER_ii PLAN DATE
CONDITIONS
rJl .j'p
73 -`:/
�.1
WATER SUPPLY:` TOWN WELL
:
WELL'PERMIT DRILLER
. -;,,WELL TESTS:,. ° CHEMICAL DATE APPROVED
t • ACTERIA I DATE APPROVED—___�_,_
BAlTERIA. II DATE APPROVED.
i
COMMENTS:
III
FORM U APPROVAL: APPROVAL TO ISSUE ES NO
DATE ISSUED BY
CONDLTIONS: I
FINAL APPROVAL:
ALL `PERMITS RAID NO
WELL.CONSTRUCTION APPROVAL YES NO
SEPTIC SYSTEM CONSTRUCTION APPROVAL ES NO
OTHER YES NO
ANY VARIANCE NEEDED YES NO
FINAL BOARD OF HEALTH APPROVAL: DATE: -BY:+
.I�' 1 >j 1I.I. Z. t.��,tg� YS t *. 1 . i{,i ' R f �'- JY i y Y 7 94 1 jf i y { .1w' R� i
i{ ! 4.. ';53 'di1 ". ,.� ..i
at,p A f t •}w t ,, ef" `rt 1
e 7
I
f
,-
pl tT `' ' }' i i f•. % - :Sk ', �9'G f'-, -Z '%^} ;.i .(- , -. a- v v 1C { > R � `' s*i M — k � ;m li�
iS 'X. § '�NS :. t i� i `q,.fFJ_ ri
Ji e
,
11�'` i Y
t s . k-`• J� .f� K�> { 7 b-.1 7.1 1h t i ar a ,
s _ F if r� 2 j'?. 1 C da'
�
Y
{ 5'a k•,ro c T c
;; 1.le•..r # ' r rf<'S 1_ t y ;. 4- }r:° V fti� XS .r c.y
t;� DATE: BY
t} „�,
55kEt t1 T'V i ".,s,: Zf L." ��,. a; 'i - y ,i _ i ' -.
r
} '-
fur `x �,5`� ' � F k� �EPTIG �1L I M NSI�l44F3%�QN �
;�
{} , ; R i_'
r er iii : t� C rk ti. h ,?,g t�. .+"^ S Ys j� Wyj � \'{ ¢�' , & v 1' ,, .r • t a":r" f '_,.
5i��.y7.�•.'�:F si
b
d-l,4'7�!*�o- �=T J :. .iL ti .: ii -di r,.; F,T�Y�ra fSEi�� i�yi•'"�ik f _- .
ix' f,•
.7a�
Fa z r 'j�t.': ryi YES
S THE INSTALLER LICENSED? ' J�� „�
�_-1 i,
NO ,
:y
fir, 1�`i, h <o� f Ilk .. + ��r'� ritr.' u,R'`co- ; `"i� � �I., /-€¢ N ,y, =..i
"" t_. >
�, R"' J kpl:y A''wvi�'R`P"y'.:-^b^afk tc-r":+ f..(�r.. �.. * a F t i q �...k 1.4 .LV• { '� �i',>ii >y y f',
'CONSTRUCTION �� ` ^1ti b 1 �' :�,£a'i"_ .m NEW
REPA I R
YRE OF :
L.(. Win l'r "' +F ,sr t ! : e,' ^4 u u.'Y ,� 5t..{y ai '
• -
A P2
,
1'4-
�
� Fos NO
EW CONSTRUCTION. CERTIFIED PLOT,•PLAN-REVIEW
x � 'if1 � a �a /is i ', CONDITIONS, OF 'APPROVAL v ; YES
NO
,t{J"4k,;' t€ ��;�r �1 £ ,�� E (FROM .FORM U) r'r';,� �r � j }`
`Ln i �' }>," +l 8.,e i ;J r'(,5• s 15 .1 f . , t 3 } ':+ x f,Ytlys£'"S' -
r _ t �. Gdti k `11F'5*_; "Y 'k: H"-ki. x.1.1 8'f 1\y =r'. l `kt 1 Y" 6 Tt}i. SY.f 1;-.� Zi .t M'hs --',ir 4 :�' " k
r 1• . Y �. ,t• < c., C ,.ea.,,,,i i ;,�. .. M1':. 4i . <:: v - _` `' I } S � t �,5.•k e�? 11.'r•a4 y ,t f; F ( ..
1.
f y}ISSUANCE OF DWC PERMIT ; ' ,— tea,,{= .- , ° NO
S ' � S k' s 11 �� 5 3 --.< i t - "t��.'"-t i' ` sf - F ' , - 3�'r d 1 +'f it c !'ta tf *sr; p! i A"' .7
Sr tt}S} 1� f +rzi s ,�y fy '• i ., e'$r {- l .
ro 4 i �G' A`" 1 1ylf/ l S
I ' �" `W�DWC 4PERMIT N0. � `' r ^ } + f +�`' k j :r YNSTALLER •
,. 9 .... i..,.i int i G�T.� Y,s:.:; �`t .3,k7. �;x rR-. ;�Mt t. _. _`.c• ...r;: �14s 'r'';.111.
: ✓:'.
i zt..
h, > 1. dttu�lyy t,:s.t . K �>k t :' b 1 rr,+,,, i ti k. \
r. Y,it '• F -.i xF S16 -
{r� BEGIN INSPECTION t�1-�NO:
i , -%� .i» ,' � ��-?,'.':.71,3•pF,4F.-;; .Hf �r .+, tit y.#r::'< zfz ° ..: i .rw �: :' L. ".,.,:�'
I - 4-, fit .. !•.r _i- ... . ti•.
EXCAVATION INSPECTION: NEEDED:1.
a r y
+' F ..y, �� r r3'+`? 1-1�a.a .�. , .° �. 7 u+�r ` $4a._r:. N F i-, 4S t = F.Y, i : r ;; } k c
,!%,ja Si jj= i i. br Si q§'�nig' - xt� t to � s .t i ? i ro 'i + a ar^ };^ .z •1 }
J' -< .4 r'. i iM1 - 4.-. 7W'i i if'i-AL. xk M .'"- S"w P._n• TAxF. Z•yS P ..-{
i r � Ij �?.,{ '" i. ,f.f�a -f; hr " s e , r..`vr S 5 p l..f;i r " .� 4 ♦ - ,: .� r
•i. V 'iiF- t i i1wl. liei } 1 y ..,. %/ to �, / �'1 i �. -C t• rY'
i x�c�r, Y # w';af+s' b x k 'Ki. � r ! ? v:. Rt i;.i .i �. r n� r ^ k ' z k i `
} r
'Jf.. �'�}.'' a'}i}�:?c �� ✓ e.�`xa ,� i il i�r y s. e q'+4# 1 isr;t'v r� i ' - -
w PASSEDv;vri �W.v BY
p G i.t a
f ,[ ,S{ I { 6 d..,b T . . �,� . t1, `: . "t - ', Y 4+ 'rY J '1 - , _ f
+ e '� is ix to .k's:C>'„ "s....i>i`+'S.x!•r :; .ti+ \rr ..
ty a .
1. i4�tx 7 t,CONSTRUCTION INSPECTION: NEEDED: _
q FtL 1, ,; i. }iht w�rr. :5`i "" 3:.. ' i- "�•: '.+ i -i. i ` V y 4
3 rf` t i , 1. Z " r 'S s
,17 ^1. 7 r, ri yx Vis« i}s r `§ f N k.�
.i a'_ip 1'di r'1 �, ,Ft, cT .:J. .... .., .y ,:' .. - - _ - '
�'. -
%
't.A - •j!' �, "% {: k i.., ' [:, f, - f ^ tY. �1 k hL 1 , i. Jed f f i'u
it .yrr.r cur, i;, t • gt, a+5k i �1 t
' 4 .. ! , Y t -' h.
+' r - - s .J., " 4 t >', 'L• Icy i Z.t. F' - r .t } �� 1 f 4 -'; 5 i
y4 y s.t l., �• a'i <. ' •'
! z . # r_ a `
_
i 7 , "+ t? 'ir•�dr s f �` --.. r r-`:-. .._ r?:. t �: .:.: -:� t ..-e.7e z:
`( �:ASABUILT PLAN SATISFACTORY:
'� 9i fi� 3 !.` 1 roti `:'S1 i u :
fr, i 7.. fi Y �1,^
' !ari. T c c .- .L
! Cyt { ?• : .a. f ,T r'. S - 1.. rc.; �' �• S t �� -.J Y• //�//J/A/j - 'I -
'µ`APPROVAL TO BACKFILL• DATE: BY
f• z n B:11
,, . ''' 'FINAL .GRADING APPROVAL: DATE ��
Y
�_ I a,.
;t. -.
f
J1'
1.
- 11
(--,'L,/
FINAL-CONSTRUCTION„APPROVAL:
t;� DATE: BY
,
s
'
'1/ l+
�ti ,'
i +' , i 1 a f t
x
/ z _�
,A
-
i 17
t _f
a t i >
•
4 t z' -.. s
f f t . 7
k -. .
`
_
1 Z i LN 4 , .r �/V •IY
t 4 i 333, 111///
7
s 2 ”. ��' 'v i, `. � � e s,r. `' r a'^ ' t + 3 %ti t' 4 ` 3
J1'
1.
- 11
(--,'L,/
14 4
6?
.Fi ?
k -
/ z _�
9
j
..
+ i 'i' f r{ ' i - !:y T f
> r
+
I r - L i t
5.: 4
..
s•.
M uml
z
1
Ac-aad
c LZ : U
C N
S2
•��ag z
�i Rcc A
0
y1 rn
Ea
o �
'3co�•
CL
N r�
�• o co O v J
COD
cm
d C
h a
N cc (D
40 CL
C `Q ` N co()
.tea
Qf ' CA •
N C C O
ID v C1) C �.
m
Q ui CL;
i `Noc •o M W
= m o N Q W
LA-
Ea
LEa C!
C o
co
LU
CM
C.3 c m CD CM g
CO2 '�
f— z sam S a. .
o
O
i
0
E
0
O
0
H
co
.E
co
L
O
Q
Q
co
ci
_Q
y
O
O
O
V
.y
c
O
cc
.0
cc
a
H
0
v
co
C.
W
C
0 co
Q
L '
Q
O 0'
Q
m<
c
0.c C
!C
J -0
O CO
zco
Q
ca
C
J
Q
z
C3
z
z
z
Q
W
W
K�
�' '
v
v
Z-
q
w
v .
""Qw
Z�
w
A
b N
v
C �➢0
MW
w
"� OD U
w o
v z
O v
w cn
p O C C
U w"
G
w
W a �� ca
cL � w
BOJ w
v O
cA ci) cn
M uml
z
1
Ac-aad
c LZ : U
C N
S2
•��ag z
�i Rcc A
0
y1 rn
Ea
o �
'3co�•
CL
N r�
�• o co O v J
COD
cm
d C
h a
N cc (D
40 CL
C `Q ` N co()
.tea
Qf ' CA •
N C C O
ID v C1) C �.
m
Q ui CL;
i `Noc •o M W
= m o N Q W
LA-
Ea
LEa C!
C o
co
LU
CM
C.3 c m CD CM g
CO2 '�
f— z sam S a. .
o
O
i
0
E
0
O
0
H
co
.E
co
L
O
Q
Q
co
ci
_Q
y
O
O
O
V
.y
c
O
cc
.0
cc
a
H
0
v
co
C.
W
C
0 co
Q
L '
Q
O 0'
Q
m<
c
0.c C
!C
J -0
O CO
zco
Q
ca
C
J
Q
z
C3
z
z
z
Q
Commonwealth of MassachusettsP.
City/Town ' own of CEI
System - Pumping- Record 014
> . ~ FOITn 4 T OWN OF NORTH ANDOVER
HEALd i-11
DEP has provided this form for use; by local Boards of Health. O ' orms may a"use ut 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: Le Ri t front of hou , Left/ Right rear of house, Left/ right side of house, Left/
Right side of building, Le g ron o building, Left / Right rear of building, Under deck
Address
City/Town
State
2. System Owner.
Name
Address (if different from location)
City/Town
B. Pumping Record
1. Date of Pumping
3. Type of system: ❑
❑ Other (describe):
Trp Code
State � � 7i Code
Telephone Number
AVI-p-(Y - �6�
Date 2. Quantity Pumped: Gallons
Cesspool(s). 9-Sieptic Tank ❑ Tight Tank
4. Effluent Tee Filter present? ❑ Yes [ _ifo_ If yes, was it cleaned? ❑ Yes ❑ No:
5. Condition of System -
6. System Pumped By.
Neil. Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7. Loca inhere contents were disposed:
tftrm4.doe- 06/03 System Pumping Record • Page 1 of 1
A-5
�
����l
er�~����
:57�_����_ ,
t NORTH
O °t��°c ,°,•r0
F
#
9SSACMUSEt
Applicant 4
N
Site Location
Town of North Andover, Massachusetts Form No. 3
BOARD OF HEALTH
40-���
DISPOSAL WORKS CONSTRUCTION PERMIT
Permission is hereby granted to Construct >�or Repair ( ) an Individual Soil Absorption
Sewage Disposal System as shown on the Design Approval S.S. No.
4HAIWMANB5oARDOMEA�LTH��
1"
Fee 6. D.W.C. No. 'L^L
AS -BUILT CHECK LIST
and
FINAL INSPECTION
Proposed Elevations
House 4,-5"
Tank IN % `2
Tank OUT / 0 3
D -box IN /0,77
D -box OUT 144,57
Trench Inverts
Line 1
Line 2
Line 3
Line 4
0
As -Built Elevation
/ 45,_�-�
J4 .3,:5-
/4g.y3
144-, 7`4
1411,4,�_ - 144,07
1 f4 "J-7 I 44, le
Bottom of Exc. f40,50
stone OK? � D -box checked? �� Pipes cemented?
FORM U — LOT RELEASE Pam[
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Depart'�,Pnt-n having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state lair,
regulations or requirements.
plica t fills out this section*****************
APPLICANT: _- " �%�Fj /h�//� &//i-" f ///c Phone SW q 7r .fit ?/
LOCATION: Assessor's Map Number Parcel 023
Subdivision riw&) P10s LLLot (s)
Street St. Number
************************Official Use Only************************
RECClq=ATIONS OF TOWN AGrE iTS :
_ Date Approved
Conservation Adminis`rator Date Rejected
Comments
�7 J:�ti1-9
Data Aearoved ?•-
Town Planner Date Rejected
Comments 1Ag--e
Date Arrrcved
HealtZ age_^.t Dare Rejected
Ccr..ments
Public WOr';s - sewer/WaLar c^.nne=tions
- drivewav pe=i t
F -re Department
Received nv Building Inspec==r 0ares
Town of North Andover, Massachusetts Form No. 2
N°RTh BOARD OF HEALTH C� >
nc-kD
'^°• • -meg4 DESIGN APPROVAL FOR
ss"C"p5`` SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
Applican
Site Loca
Reference Plans and Specs. I ®'YV-% Y UA- -A
ENGINEER DESIGN DATE
Permission is granted for an individual soil absorption sewage disposal system to be installed
in accordance with regulations of Board of Health.
Fee
inn
CHAIRMAN, BOARD OF HEALTH
Site System Permit No. �Z.
THOMAS E. NEVE ;AS�FuCIATES, INC.
Engineers - Land Surveyors - Land Use Planners
447 Boston Street US Route #1
TOPSFIELD, MASSACHUSETTS 01983
(508) 887-8586
FAX (508) 887-3480
TO E3o^ R o OF H p_A L. -r 1-1
'rov i N HAL -L.
NOR-rl-1 Aiv1DoVEER f`AASS.
L IEUTE ° (OF VIURSEDUUL
DATE
JA1J 115,
JOB NO.
ATTENTION
SAr-JDRA STARR
RE:
REv15ED SA.tzI,-rA2t>E51Cx,,Z5
LO -r i p tSEtZAD PLAcE RoA.a
Lo -r-5 Z5 Z7 CAooLESi'►ci< Ro^o
/SND 1 -OT Z A S�CrA2C_A� C-A�.)E
5A"I-17AVVY DISPOSAL SYSTEM DIES1CsN i -O -r 1(O' IZAD L.ALt=
RoA 3`1' 'TMOrMAS E. 1uGVE AS oc.lA-r-
> WE ARE SENDING YOU f�L Attached ❑ Under separate cover via the following items:
❑ Shop drawings it Prints ❑ Plans ❑ Samples ❑ Specifications
❑ Copy of letter ❑ Change order ❑
COPIES
DATE
NO.
DESCRIPTION
REQ (/I3jo�330Pj^Z-I
5A"I-17AVVY DISPOSAL SYSTEM DIES1CsN i -O -r 1(O' IZAD L.ALt=
RoA 3`1' 'TMOrMAS E. 1uGVE AS oc.lA-r-
REV. 1 1 ��
3d5 -Z -LS
SANITAZ-f DL. ISPOSA5YS-ra— De6lC,-N U6_17LoZ5 GAn1D�5T►:_l<
D I3Y. rIAB r � AS5 1 I"C,.
Z
REV, 1/18/g3
3C6 -Z -Z7
SAt.WrArZY 1>%69oSA�5Y5TGm DC51Crta t -o -r ZT C-Asal>L• ,STIC-RC
OA BY THor--%rA S. ev1:VE AS or -OA T E INC,.
Z
REV. I/I'3A3
3eS-2$A
5AwJIT,v1t,'/ D1SFOSAL 3Y5Ter•-% Dr.S1vtJ DoT Z,SA Sutsc4acaA��
LA,.,E. 13`f TA1oA.ra tE iv6v6 ASS o( -t AT 5
THESE ARE TRANSMITTED as checked below:
U9 For approval
❑ For your use
❑ Approved as submitted
❑ Approved as noted
> ❑ As requested ❑ Returned for corrections
❑ For review and comment ❑
❑ FOR BIDS DUE
❑ Resubmit copies for approval
❑ Submit copies for distribution
❑ Return corrected prints
19 ❑ PRINTS RETURNED AFTER LOAN TO US
REMARKS DEA1Z SAY -' PLEASE FI -JD E,JC_Lo51_D rIAL: Af3ov(:, REF-4512EA e -6D
M/XTE)Z1AL_ Loi IG NAS 5EE.ta RtSViSE17 To 31aow THE L.O`Ariao OF -c1aE FOurJOA-riots
DRA)1a AND THE ADG1TIoeJ OF" THE WETLAwp D15C_t.AtrinEf2 Lo -r5 ZS E Z%
WAvE r3ECN REy1 sCp -ro 514OW TIDE ED No-rE5 I-kAN/E SC-EtJ
ADDED TO I HE Pt, -Al -JS Fol LOTS ZS a 27 STA-rt,vC,- TL -IAT rKe Elj&i,,ll:infl.
IS -rO 5ET A BCIaL1Ar+A1Z1t tN THEy1G10IT-( OF -r RE LEALwIruC, ^rzGA
Plx%olx -ro c.o/a 5T rz.,L rr 1 Oro, A5 Post T 1-4E EXPI RAT tot..) of THE DEEP 1-1oLC
TES-rS FO2 t,.oTS Z5 c Z7.L SEL -It' -1C M2. r13(5VC. HAt> AIJ I--fTEI-1510IJ
CSRAO-r6Z> FrL00-t TWtg BOARD OF 14t✓AL_-rl-1 OA) AL(- Tr=S-r ira -rt-%C-
L_ Or
rtie_L,OT Ie) HA5 15L.E.J RG01>6D '7a SNOW T,+Le CNAnXrES R6Q06Sr(_5C>. QjaSYlOt.55
09- PMQP1-CsMS PL.eAiE OAU. i 1AAnNK '4bO FOM_ Yovti 4004-LRArlo" Ir.J TR'115 r+'Arrer
COPY TO
No—re'. LOT Z'7 - PR1MAfZ'1 L_E:Ac i4 BED = IS50 S•>- SIGNED:
RESER-,JE L9ACGH 5Si> : Z000 S.F.
PRODUCT 240-2 nrees Im, Groton, oras 01471. if enclosures are not as noted, kindly notify us at one .
BOARD OF HEALTH
Neve Associates
447 Old Boston Road
Topsfield, MA 01983
120 MAIN STREET .
NORTH ANDOVER, MASS. 01845
TEL. 682-6483
Ext. 32
January 11, 1993
RE: Lots 25 and 27 Candlestick, and Lot 28A Sugarcane Lane
Dear Tom:
This is to notify you that the proposed septic plans for the
above -referenced lots have been disapproved. Please see the
enclosed design review sheets for explanations.
If you have any questions, please do not hesitate to call me
any Monday, Wednesday or Friday.
Sincerely,
Sandra Starr
Health Agent
cc: Karen Nelson
BOH file
PLAN REVIEW CHECKLIST
ADDRESS ��-C/3.�'Ciq /VF ENGINEER
GENERAL
3 COPIES �� STAMP 4-� LOCUS L-'-'- NORTH ARROW �� SCALE
CONTOURS (-/ PROFILE c-�
PERC INFO ELEVATIONS,
WETLANDS WATERSHED?M6
FDN DRAIN ✓ SCH40.v
SEPTIC TANK
SECTION Z/ BENCHMARK `�� SOIL &
WETS. DISCLAIMER c:/ WELLS &
DRIVEWAY (Elev)
TESTS CURRENT?
MIN 1500G. .17 INVERT DROP,
25' TO CELLAR MANHOLE TO GRADE
D -BOX
WATER LINE L�
GARB. GRINDER(+200% EDF)
ELEV O/K_ GW_0]&,-
SIZE '_Df - 3 #
LINES
oZ
FIRST 2'
LEVEL STATEMENT
INLET /* 77 -OUTLET Iq¢,S7 =
ZU
(2"
OR .17 FT)
TEE REQ'D?/k/)
LEACHING /
RESERVE AREA c% 4' FROM PRIMARY?z 100' TO WETLANDS 6" 2% SLOPE
100' TO WELLS ✓ 35' TO FND & INTRCPTR DRAINS
✓-1-,- 4' TO S.H.GW
325' TO SURFACE H2O SUPP `� 4' PERM. SOIL BELOW FACILITY
MIN 12" COVER'S FILL? (25' if above natural elev; 10'' below)
BREAKOUT MET? -
TRENCHES
MIN 660 gpd SLOPE (min .005 or 6" i✓
/100') >3' COVER? - VENTo
SIDEWALL DIST. 2X EFF. W OR D (MIN 61) IS RESERVE BETWEEN
TRENCHES?/ l/ IN FILL?MUST BE 10MIN. V 4" PEA STONE?�
BOT �%�?' X LDNG��+ SIDE S2�o X LDNG /'y j TOT
(L x W x #) (G/ft2) (DxLx2x#)
,�� z
11F 2 Il�4�; " _ 83 (:�; <5
DATE
Sheet of
BOARD OF HEALTH
TOWN OF NORTH ANDOVER
SUBSURFACE DISPOSAL DESIGN REVIEW
`` Od
FEE C�� PERMIT # DATE RECEIVED
APPLICANT'EO.8y AIZUS'Z ASSESSOR'S MAP
ADDRESS
PARCEL #
LOT # c'�9
ENGINEER
ADDRESS%
PLAN DATE_ /D1%12- REVISION DATE
CONDITIONS OF APPROVAL:
APPROVED
DISAPPROVED
t c/
I'
6� 7d �5���awL3-1� - SEE /� o� • if'�G �f, /4•
/-Ro— A� ��'ie//�7l
DoT � r . �
b�
TOWN OF NORT ANDOVER
SYSTEM puMpl 0 RECORL)
L) A rt /C%3 1�...
SYSTEM OWNER FN
YZ's I tM LUCATION
REGI E
NOV - 3 2004
TOWN OF
LT NORTH ANDOVER
, I
"EA DEPARTMENT
NTE OF Pummo
QUANTITY PUMPED:
CLSSPOOL: NO-.- YES— SOPLIC Tank: NU, YES LZ
NA PUKE OF SERVICE: KOUTINE"MERCIEN(')'
ObSERVATIONS:
t�F JYJ COVER
ASE M
HEAVY OREASE AFnES IN PLACL
E
LM-CFWIF-LD RUNBACK
XCESSIVE SOLID OODED
VER OTKER EXPLAIN
SYstom Pwnp-.d by
L'()MMhNTS, S� 1 __
....... ............... . . ......
1'KANSktKRED I'L)
,
D:. MASS
I�OVERACNUSEI-?
vi 4
DEP.hai prpvldvCl {hl�y(orm tr iso ;;;• vocal soar
00 1' ��1`1{Iod to the loc°I scar(: cr noa,(n pr cu,vr
A. Faclllty In(ormaclon
location:
'611
-
G. 00 P*
as t�� n,�,m•.,; CIr7/i�rn � .
I �)�, ,�y�'1,;','�,,, �.�J..;.l�t•.:,,:�.; '�';..;' , 51111 1 _ -----
(IIdVf°rinl lownbuVcn)
P,umPing ReyvI
I oa,o oPum�lnp' �O
Typo. 91 #y)lQM:' L7Cos9�ool(9�
Q rOhar NOscrOO
EMVenl Too, Fl1l0(1P(��ont7 [' Yo9 n'o
9.; SY Q�T1 Ptim od 8
oca ,,•.
onrWho`� qQr onla'wers d,yposao:
• ;4 silly,.
., 1,.', ./•,��I� ,•'', Sl�nll,yl of h'Jv4(, � ,<.,... .., .
=.=.-��.masa,gov/dap!vralar/apprOYeJsJlblorm�.n'.malns�oc! ^
Sapl!C Tan,,
�,.,�,.� .,_.d.=.. ,_
Applicant
Site Location
Engineer
Town of North Andover, Massachusetts
BOARD OF HEALTH ,
Form No.1
WMt�l 13-19 9.3-,
APPLICATION FOR SITE TESTING/INSPECTION
Test/I nspection Date and Time
Fee
on
CHAIRMAN, BOARD OF HEALTH
Test No._q & 7
S.S. Permit No.------D.W.C. No.______C.C. Date-Plbg. Permit No
Ihiq