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HomeMy WebLinkAboutMiscellaneous - 304 BOXFORD STREET 4/30/2018 304 BOXFORD STREET ...� 210/104.6-0049-0000.0 t { ti i A f � Lot & Street Map/Parcel CONSTRUCTION APPROVAL Has plan review fee been paid: YES NO Permit# --�, Plan Approval: Date: v' v1� Approved by: Designer: AeAye Plan Date: /,P, , Conditions- Post-It"'brand fax transmittal memo 7671 #of Pages Water TO m. J � - ©�/(/ �lel FromCo n Well F Dept. 19:5 5a Co. . D Phone# Fax# � 7- 3-�� Well , Fax# Bacteria lI a e Plumbing•Sign-Off: Wiring Sign-Off. Comments: Form"U" Approval: Approval to-Issue: YES NO Date Issued By: Conditions: - Final Approval: .All Permits Paid? YES NO Well Construction Approval? YES NO Septic System Construction Approval? YES NO Certification? YES NO Other YES NO Any Variance Needed? YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: APPROVED BY: r J i ' r SEPTIC SYSTEM INSTALLATION Y Is the installer licensed? NO Type of Construction: NEW AIR New Construction: -Certified Plot Plan Review YES NO -Floor Plan Review YES NO - - Conditions of Approval from Form U YES NO _Issuance of DWC permit: - NO _DWC Permit Paid? -- S NO . DWC Permit# f�/o? Installer: �� -y - _ =Begin_Inspection:_ YES NO -Excavation Inspection: -Needed: - —Passed: By: -Construction Inspection: Needed: ti A)6--C-r���°� //b 1"-1&- O O X &-XJT z_/X)CSS 7-6 Z) ~ ,80 As-Built-Plan Satisfactory: YES: Approval of Backfill: Date: �—^ __. PP �� �.: By: ---Final Grading Approval: Date: By: Final Construction Approval: Date: By: Certificate of Compliance: Approval: Date: .mmonwea th of Massachusetts ? y City/Town `of NORTH ANDOVER MASSAt!! - System Pumping Record,,Form 4RTH M TER DEP has provided this form for use by local Boards of Health. The System Pumping Record mu! be submitted to the local Board of Health or other approving authority. A. Facility information Important: -when filling out 1. System Location: ,forms on the computer,use only the tab key Address- ----------.�•--_-_..____...___._..._._.--.- to move your _ __�, cursor-do not _ use the return City/Town •- State -----'— Zip Code key. .. . . 2. System Owner- ent Name _...._.— _��� -•---------_._—__-------__--..—_--__..-----' aara Address(if differfrom locatio_n) - -- - - - - City/Town --------- __ _--------- --- State Zi Code " Telephone Number— -^-- B. Pumping Record 1. Date of Pumping - 2 —/op C) Date . Quantity Pumped: ---'-- - Gallons 3. Type of system: ❑ Cesspool(s) ptic Tank ❑ Tight Tank ❑ Other(describe): —_-•-.---.__.____.-__-__..__-----..._�_.-.._..__.___---.-.____...-- 4. Effluent Tee Filter present? ❑ Yes Flo If yes, was it cleaned? r ❑ Yes ❑ No . 5. Condition of System: C 6. ASyem Pumped By: 6r um Vehicle License Nbe --�- t A ---- Company � Q % . . 7., _ Location where contents were disposed: J Si ature ofHau r/ http://www,mass.govi/dep/water/ provals/t5forms.htm#inspect t5form4.doc-06/03 System Pumping Record-Page 1 of 1 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 or requirements. APPLICANT FILLS OUT THIS SECTION APPLICANT--Aa—.11D� PHONE 1 7 b LOCATION: Assessors Map Number SQL � PARCEL SUBDIVISION LOT (S) STREET 3c:�— G x I'n-D �� ST. NUMBER OFFICIAL USE ON 6.T OM Q TI OF TOW NTS: CO SERVATION OM1141STRATbR DATE APPROVED DATE REJECTED COMMENTS llyka TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH--- DATE APPROVED n "" DATE REJECTED -"A �. SEPTIC INSPECTOk-HgALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS -SEWERMATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT 'ECEIVED BY BUILDING INSPECTOR DATE Rw19W 91/7 JM I s � TOWN OF NORTH ANDOVER BUILDING DEPARTMENT .'ATION TO CONSPRUCr WAH RKNOVAT& OR DEMOLISH A ONE OR TWO FAMILY DWELLING ■ onk ,JMDING PERMIT NUMBER DATE ISSUED: SIGNATURE: Building CommisSi2ngjM2qLr of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 1) Zarin District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R aired Provided M 'G L.C.40. 54) 1.5. Flood Zone lnfom=on: 1.8 Sewerage Disposal System: 1.7 Weer Supply ❑ Zone outside Flood Zone ❑ Municipal ❑ On Site Disposal System Public ❑ 1?M.G.rwate ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No 2.1 O/w(ner of Record Name(Print) Address for Service: �?. Y r Li r Signature ` Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor- Not Applicable ❑ _K I r e-vl V\, V�' ., r' S C) S C) Licensed Construction Supervisor- L f� License Number Address 7-C)6 Expiration Date Si ature Telephone 3.2 Regi54ered Ho ImprovemeContractor Not Applicable ❑ t f Company Name Registration Number eW Addressr Cy L 7 1. Expiration Date rr a yn e Ma cNeil Scale: 1" = 20' Date. June 12 y Zoning District: R- 1 — Residence 1 Dis tric t i Schedule of In ver is ' Invert ® Foundation = 154.89' ' Septic Tank /n = 154. 19', Out D-Box /n = 153.46', Out = 153.30' Leach Bed /n = 15316', Out = 152.95' Schedule of Tie Distances AC = 54.2' AE = 63.3' AG = 57.2' BC = 38.7' BE = 76.2' BG = 88.3' AD = 60. 1' AF = 102.9' AH = 99.2' BD = 81.8' BF = 110.0' BH = 118.9' ' l hereby certify that / have inspected the construction of l� this disposal system and that the construction and final ! grading has been in accordance with the designer's intent and that the materials used conform to the plan specifications and 310 CMR 15.0. This plan has been prepared for the purpose of shown the "As-Built" conditions of the sanitary disposal sys, installed on the premises. All work was done in substai conformance with the design plans as prepared And Fn Changes Approved By The Design Engineer And The Bo Of Heo/th. All work was done within the construction Limitations Expected For A Job Of This Type. Desi ng r Dote w�o+s . �, aaul✓ lYV. '04B — Parcel 49 4L.o t :Area 44,600 S F. 1.0 A Cres F y Leach Bed System.• ; ~ (20' X 45') I r l r l I r r r r I r r r I r 1 I r --371---- � r r I r I 1 I I I I 1 I I I E G D 1500 Gallon \\ Septic Torek\ L c C `` r A / J Q Existing 3 Bedroom Garage Dwelling ` 1 Top ofAnd. 0 0 ` Approximate fit ur�i7 r'c �TiNLS ` Property ' Lines / ' f Existing 10 15.0' weu i / £xistir i I 130 wORflr , a BOARD OF HEALTH �: ' • 146 MAIN MTLEEr - NORTH ANDOVER, MASS. 01845 APPLICATION FOR SOIL TESTS DATE. March 24 , 1998 LOCATION OF SOIL.TESTS: 304 Boxford Street Assessor's map & parcel number. Map 104B, Parcel 49 OWNER: Wayne MacNeil TEL NO.: ( 978 ) 975-4365 ADORESS: 304 Boxford Street, North Andover ENGINEER: Thomas E. Neve Assoc. TEL. NO.: ( 978 ) 887-8586 CERTIFIED SOIL.EVALUATOR: Steven D' Urso Intended use of land: residential subdivision, single family home, commercial Single Family Home -- Septic Repair THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot pian 3. Fee of $175.00 per lot for new construction. This cove o deep holes and two percolation tests required for-each lot. ee of$75.00 per for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each sept.;- system. 4. Repairs require at least two deep holes and.at least one percolation test, at the discretion of the 80H representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted.. - '• , � .! •. _. .. it BARBARA J. MaCNE1L" ' - .`- 53-7047/2113 R. WAYNE MACNEILx5190164335: 304 SOXFORD ST. PH. 508-975-4365. _ NORTH ANDOVER;MA 04845-3226 PAY TO THE V$ r ORDER OF ~ • ' A= DOLLARS B "Andover Bank - f, Andover MA 01810 MEMO +4,24 L.3 7 0 4..7 7 r;:. 6 5 L 9 0 L-6Y4 3.3.5'110 0 L 3.5 ` =� MAR-24-98 09:14 TEL:9786873235 P:14 ca ; h I AA y CAR. 114,6G�0 c•.' :1 OWN wir li) Ol �� i Q� V rtI .r 0T Rl-,4A/ 4" krv7 rvE•a►srccn�i� �ue'.+r�,o pv TiS/E Cer,*s•�,y�.,�,�,vD r.Wr�r purrs Cav/�U!M /YiTN 7-N.� 7'C.w!v per•n',,, ,-�.<i:::'C r�GLVivef ��6�/G,�Y,ayJ ,, C. .mss strw�crs sxaw srtE s .,or Ups« NTT/4� n , fOs�.rrC.r cErr r ��corca/.v rv4 .. s o..•e-�s�,..s� is,vor , S/ldwN ON,c �ArO .I per.o, O,P.�WA y ti �'_. - -;>- 1�,�R�Y I�!F�F C3/!;IT'C3A/?r I -"Mop. AM L- 199 72'/.S PI.4N/'Ve A eC� i'�.t/r�JE,S-SOT,e,�► .inov r...r�.V fie'�as Ea:<rr�.�.G �drr alas. 446 F'n s1!• i:�T .INDOI�EE, A1�.f.��.�!/•�'t"r�' a/�i0 MAP,-24-1998 09:29 9786973235 92% P.14 t - --------�_ fc� ' � tr?acr //1 3 Ir:at as !�3'3• t t=,.9 0ti•rys 6.CLtP3•G11�V t • aa.n W �Tas• r♦t.tw!t.a.s 1;T k0 LAM !32 ► CS .. •+^t•• .. Romeo i '� .. tlr'� a." • LU in = O ga �OS NUJ "Wra V La.. ►o t't !S • �:t a a,. t 1r s ).t/0 - • _ :pet ►� It — Z •t Z . • ` _ SEE PLAT N0. 1040 1 SEE PLAT O'L 104 8 watt ar 0?' 12! tat dl to 1 C:a• `Ct ►' N E LA a » aT ' All ;, �a} ?1' 71 t3 t tM1� tt•>.� I.ilaw -heat _ d5 t to 'olt' ' t2t! , o• �/ /r w.d•a 3b 1 - SA- :1 // r- I /r r/ / / UJ/2496 ILIE 10_44 Fax 9786884679 001 it 250 2 _. 1 We, R. Wayne MacNeil and Barbara Classaan Brien, both a! I04 Boxford Street, Borth Andover, Esasx County, Massachusetts for $1.00 and other noaiaal consideration paid, do hereby grant to R. Wayne MacNeil and Barbara J. MacNeil, wife *as tenants by the entiretyand and of 304 )Andover, Essex county, Kaasacauastts, BaxLord ethuhusbsHorth With 40ITCIh X COVENANTS A certain parcel of land with the buildings thereon, situat North Andover, Worth Essex County, Massachusetts, ed in bsi;tg Showa on a � a plan entitled, •plea of a parcel of Land is North Andover, d Mss:, awned by Earl L. Poster dated March 3, 1961", recorded vita North EsaOX Registry of Beads as Plan NO. 6256, said n �j preaises being bounded and described as follows: SOUTMiESTMY by BOXford Street,. in two coursesa distance of one hundred fiftyAnd,00/100 total (/11� (150.00) feet; j NOR TIMSTERLY by land of Earl L. Foster, two hundred Sixty- I sight and 03/100 (268.02) lost: L Q, NORnmAS TERLY one hundred forty and 82/100 (140.82) lest o and x SOUTHEASTERLY in two courses, mostly by x stone wall, a (� V total distance of three hundred fittean and + ! 93/100 (315.93) feet, more or lees. I Said parcel Of land Contains 4+,600 square last o! land, t, according to said plan, mora or less. I . Af,J. l {! oqa MAP,-24-1998 89:51 9786884679 94% P.81 03/24/98 TUE 10:45 FAX 9786884679 pp2 s82so2 117 Said promises ars conveyed subject to and with the benefit of easaments, rights, restrictions, and agrsoesnts of record, it any, insofar as the saes are now in force and applicable. For title reference sea deed recorded with Essex North District Registry of Deeds Book 2226, Page 69. WITNESS our hands and seals tbis V-,O day of 1987. R. Wayne Machei �40oc.WZ ... 0-2 I Barbara Glassman Br on COMMONWEALTH OF MASSACNQSMS 6 i Essex, County, as. ,1967 Then personally appeared the above named R. Wayne MacNeil and Barbara Glassman Brien and acknowledged the foregoing instrument to be tbair free act and deed, before as 7 f I� OtarY Public':�`i •,rr r, j rl 8y Comeiasicitix�cg�re�..c: Recorded Ns, 22,1987 at 3:5FN #16054 3 r+uvr,w�.ass. _ h rtoL R7Rf � I�wrI/.�Oq.W1► '� l 27 it MAR-24-1998 09:572 9786884679 94% P.02 i i 140.87 �' CO rs, ire f en Assessors Map Nb. 104E — Parcel 0 ; ` Lot Area ; ' 44,600 S.F. 1.0 Arrrc ` Lepch Bed System .Ihti (2b' X 45') I i � t 55.0' � r , Fin Reqt • o0 r I, W ��' • , ; ; • r ,, ,•� N Al + : Fit&Abandon r—�� x_ 4.8 Exist' s tem: --�\- � �D Box 156 / New 1500 _ - // Gallon Septic Tank �> R ; Ez+sT. ANI( TO 8E En+o�Eta-r►. / ass•-%'__„_-_ \ / \ Existing 9 Bedroom / Dwelling \ / \ Exist Inv.0 Fnd. = 154.89' Y \� Top ofAnd. 158..34' / tOb To Approximate Property Lines _ ,o ff/�Existing I 15.0' Wei1 r I i I I B o x f Or d \ / S t r e e t Date fU//Y- io "oRT" TOWN OF NORTH ANDOVER ° p PERMIT FOR PLUMBING �,SSACHUS� This certifies that r./� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . .C . . � ,�.�,�,r- . . . . . . . . . . . . . . plumbing in the buildings of . . ��/>! . . . . . . . . . . . . . . . . . . . . . . . . at . . (7,� x A'c.b':.4. . . . . . . . .. . . . . . . . . . . . . .. North Andover, Mass. Fee. . .G . . .Lic. No. . . .tJ _. . . . . . . . . . f PLUMBING IN P CTOR Check # aJ�Qi r 6652 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date.,,�e Building Location e Owners Name Permit# Amount Type of Occupancy Pj -- tom New Renovation Replacement 0 Plans Submitted Yes No FIXTURES Cr BMMM »>l 4M Fl" sn�lz,oat s»>C 7M NJ" s>H HDM (Print or type) Check one: Certificate Installing Company N e l . ff ❑ Corp. Addresso ��'' �' 11 Partner. 4`^ usmess a ep one '��. — — / LSI Finn/Co. Name of Licensed Plumber. a , Insurance Coveraee: Indicate the pe of insu ance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity 0 Bond Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature er Agent I hereby certify that all of the details and info ation I haves bmitted(ore red)in ab a i 'on are true and accurate to the best of my knowledge and that all plumbing w rk and insta tions perfo d_u r e t s dor this application will be in compliance with all pertinent provisions of the IV Its State in ode d apt 42 of the General Laws. BY: 31gilatUrC 01 License ,p Flul Der Type of Plumb' g Licens Title /6,301 City/Town License lNumoer Master Journeyman ❑ APPROVED(OFFICE USE ONLY Address -0 f3 0 X X02 P S'7- Title of File Page of Date File Open: Date file closed: Doc Document/Action Title Date of Refer to other Purpose of Documeant/Action and notes action Document/ document/ Num. Action Department Board of Appeals — Board of Health --Planning Board _ Conserv-ation Commission — Bonding Departr erAt SEPTIC PLAN SUBMITTALS LOCATION: r� NEW PLAIN YES S60.00/Plan REVISED PLANS: YES S25.00/Plan DATE:�� DESIGN ENGE EER: %rry Ate'Sa al E <' When the submission is all in place, route to the Health Secretary TC MAY --8 ;98 N-81 3 12 U 0 U 0 0 0 0 0 Q 0 0 0 0 0 0 G 0 � PRODUCT 240 NEBS kr-GIMIM NA.01471•To Oft ROE MU.FREE 1.800.225-9660 THOMAS E. NEVE ASSOCIATES, INC. ��44�� 4 p n ����44Q� Engineers • Land Surveyors • Land Use Planners 447 Boston Street US #1 TOPSFIELD, MASSACHUSETTS 01983 DATE JOB NO. (508) 887-8586 5 1 S 93 1-7 44 FAX (508) 887-3480 - ATTENTION TO RE: 0.C-1 Ste�cr Mac.Ne.� 5 Bo ac-d�. of 30 4 50*c .r-at St. Ar,oko Ve p• 1 WE ARE SENDING YOU Attached Under sep a over v the following items: > f ❑ Shop drawings Prints ❑ ans Samples 31 Jfications ❑ Copy of letter ❑ Change order ❑ --� COPIES DATE NO. DESCRIPTION 3 5,i=v 9 1744 5A►.i�-rlar�y DfSpoSAL Sy STEM KAP 51 �! THESE ARE TRANSMITTED as checked below: XFor approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FORBIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS De_o.c P1ec.Sc nLloSed 3 oc`in"t S ort e re-./wised o,ey DfSOoso., SvS+c Tor tL.t abov{, -1'l,t Plan 1-,as 6 per yoyr Cor-�.e.."E5 o�1a-��dl S f I Sf ga- t alr"+ol VoJf C_c, eTSel.+e+ vJ'4+ 10rYm r on Prick,../ rt vaJ �Na-10- 0_n.q o.xS'i�on5 Gal 1 COPY TO Waynt fA&L IAJe,+ 5'.�cerclY) RECYCLED PAPER:g� SIGNED:Contents:40%Pre-Consumer•10%Post-Consumer if enclosures are not as noted,kindly notify us at once. �J C� t� � � � C� �J � t� � � C� U � C� • . . _. 3 ...� •�i .I. .. _ .. ,is i .moi• � ,� �, t� ,.. 1 �. • ; -� � � • l' • • y_,•I� � s �' • ~' X71 { ' ., f • � ' • l a '.�J . . !a Town of North Andover NORTH 1 OFFICE OF 3�°��'`" ^.a 10 L COMMUNITY DEVELOPMENT AND SERVICES ° 30 School Street WILLIAM J. SCOTT North Andover,Massachusetts 01845 �9ssgcHus�s�y Director May 15, 1998 Mr. Thomas Neve Neve Associates 447 Old Boston Road Topsfield, MA 01983 Re: 304 Boxford Street Dear Tom: This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons- 1. easons:1. Elevation of perc test missing. (N.A. 8.02n) 2. Missing septic tank manhole to within 6 inches of grade. (3 10 CMR 15.228(2)) 3. Incorrect BOH witness listed. 4. Trenches to be used whenever possible. (3 10 CMR 15.228(2)) 5. Where is the reserve area mentioned on the site plan? 6. Since garbage grinder is being considered, leach area must be increased by 50%. (3 10 CMR 15.240(4)) N.A. code requires minimum of 900 square feet for four bedrooms if leach bed used, this area must be enlarged. If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Sincerely, Sandra Starr, R.S. Health Administrator S S/cjp cc: Wayne MacNeil William Scott, P&CD, Director File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 PLAN REVIEW CHECKLIST�/ ADDRESS__ ENGINEER GENERAL / / 3 COPIES V STAMPy LOCUS Ll NORTH ARROW L--' SCALE CONTOURS PROFILE ' -(Sc) SECTION BENCHMARK `' SOIL & PERCS ELEVATIONS WETS . DISCLAIMER WELLS & WETS WATERSHED? NI) DRIVEWAY WATER LINE Of FDN DRAIN — M&P SCH40 L""� TESTS CURRENT? (/ SOIL EVAL ^Tpm SEPTIC TANK MIN 150OG . 17 INVERT DROP C� GARB. GRINDER ,✓( 2 comps +200 ) 10 ' TO FDN e/ MANHOLE ELEV i GW -� # COMPS . GBI /T- D-BOX SIZE ## LINESy FIRST 2 ' LEVEL STATEMENT INLET OUTLET./&2,U _ (2" OR . 17 FT) TEE REQ ' D? /ud LEACHING MIN 440 GPD? RESERVE AREA— 4 ' FROM PRIMARY? _ 2% SLOPE 100 ' TO WETLANDS 100 ' TO WELLS 4 ' TO S,.H.GW ✓ ( 5 ' >2M/IN) 20 ' TO FND & INTRCPTR DRAINS v 400 ' TO SURFACE H2O SUPP 4 ' PERM. SOIL BELOW FACILITY MIN 12" COVER L"" FILL?A)d ( 15 ' ) BREAKOUT MET? TRENCHES MIN 440 gpd SLOPE (min . 005 or 6"/1001 ) SIDEWALL DIST. 3X EFF . W OR D (MIN 61 ) RESERVE BETWEEN TRENCHES? IN FILL? MUST BE 10 ' MIN. 4" PEA STONE? VENT? ( >3 ' COVER; LINES >501 ) BOT + SIDE - X LDNG = TOT ( L x W x #) (DxLx2x##) (G/ft2 ) Copyright (0 1996 by S.L. Starr PITS MIN 440 LEACHING MIN 1 ( 13 'x16 ' ) PIT MANHOLE/PIT GW MIN 4 ' BELOW BOTTOM EXC 2x EFF W OR D 12"-48" STONE BOT + SIDE x LOAD = TOTAL (L x W x ##) (2x(L+W)xD x ##) (G/ft2) CHAMBERS MIN 440 LEACHING GW MIN 4" BELOW COVER >3 FT - VENT MANHOLES ' 12"-48" STONE SPLASH PADS SLOPE . 005 BED/TRENCH (Bed max. 60 ' X 601 ) MIN 13 ' X 16 ' PIT BOT + SIDE X LOAD = TOTAL ( L x W x ##) (2 x (L+W)xD x ##) (G/ft2) FIELDS / MIN 440 GPD ✓ 900 ft2 BED GW MIN 4 ' BELOW BOTTOM OF FIELD PIPE ENDS JOINED? L-4" PEA STONE? (-f DIST LINE SLOPE . 005? L� >31COVER-VENT SCH 40 cam— MIN 12" COVER Z- RATE ( X A 0 ) X ' 74 = TOTAL lalo�o G G L W LDG goo DOSING TANKS AND PUMPS DIMENSIONS X X = PUMP CAPACITY m 4P L W D Vol . DISCHARGE SIZE DISCHARGE RATE DISCHARGE TIME Spm MANHOLES TO GRADE ALARM SEP. CIRC. GW (Min. 1 ' below inlet) HWL LWL CHECK VALVE BLEEDER HOLE MANUAL OP. SWITCH ENUF STORAGE? TDH WEIGHTED? Copyright 0 1996 by S.L. Starr MAY-12-1998 09:25 THOMAS E. NEVE ASSOC. P.01 FAX Transmission o: Sandy Starr Pages: 6 (including this one) ompany: NABH ax: ate: May 12, 1998 From: Kathy Address: Thomas E. Neve Associates,Inc. 447 Boston Street-Route 1 Topsfield,MA 01983 PhouefFax: (978)887-8586 (978)887-3480 fax Message Sandy: Attached are the Soil Evaluator Forms for Mr. MacNeil, 304 Boxford Street. Please let us know if you need any additional information. - Kathy MAY 2 MAY-12-1998 09:25 THOMAS E. NEVE ASSOC. P.02 u FORM 11 -S%L-f-EVALUATOR FORM Page l of 3 No. Dare: r Commonwealth of Massachusetts Ac do oq-)r , Massachusetts Soil Suitability Assessme� for On-site Sewage Dis-osal Peri'otmed By: g n,?, Date: Witnessedsy: c,54'1 tJ , jAW LocationAddress or ownces Name 1&4yne 14 tp �`G Lot 5L.I,q- D Address ani 3 0`t BoX� S-r Tel # /�� /1J0� �, X75-1/365 New Construction ReP Office Published Soil Survey Available: No � Yes Year Published ��� Publication Scale _ Soil Map Unit �///�CkL!//�'JddO�. Drainage Class �(J�f� Soz7 Lit<dtations ^Q r! Surficial Geologic Report Available: No Q Yes Yva Published Publication Scale Geologic Material(Map Unit) Landform Flood ho rune Rage Map= Above 500 year flood boundary No JC Yes Within Soo yearflood boundary No Yes VtThWn loo year flood boundary No X iYes Wetland Area: National Wetland kvemOIY Map(=aP vn't) Wetlands Conservancy Propun Map(map Wit) i"a D n e— Current Water Resource Conditions(USGS): Month JI d Yl--- Range: Above Normal Normal �BeIOW Normal Other References Reviewed; DgpAppItOY®fOYM-17/09195 MAY 2 MAY-12-1998 09:26 THOMAS E. NEVE ASSOC. P.03 FORM I I - SOIL EVALUATOR FORM Page 2 of 3 Location Address orLot No_ 'r On - Site Review Deep Hole Number OP j Date Vl4 'rime 9-'300" weather S00r7Y Location(identify on site plan) 5 ee— S.4177 Atry 4t;k S f 74 4 Land Use 12e-j,'` Slope(%) / 3 °la Surface Stones n 4,0p7 G Vegetation ' `p Landform Position on landscape(sketch onthe back) Distances from: `jQ Open Wates Body feet Drainage way feet Possible Wet Area feet Property Lure feet Drhiking Water Well feet Other DEEP OBSERVATION HOLE LOG* Depth front Soil Horizon SoilTexture Soil Color Soil Othw Surface(Inches) (USDA) (Munsell) Mauling (Stas vxm,Stones,Bouldw, consistB '% travel) Z if SSL /oyn i 12+3611 gu, Z- 5 1ayxsl6 ,;6-16 3 4 C Cs s/Gy - 2•sy 6/4 Mo-d- scar/5 Flo /2 +MINIMUM 417 2 HOLES REQUIIM AT EVERY PROPOSED DISPOSAL AREA Parent Material(geologic) Q UT Z 410'/1 Depth to Bedrock: 4 G 4 g Depth to Groutldwacer: Standing Water in the Hole: �p/'Y� cPmofmm Pit Facc We ! /'f b/'!t.. Estimated Seasonal High Caound Water. t D>w'- DEA AresavfD Posai-tvmvs '°'t°'�"° - -, T' MAY 1 2 j MAY-12-1996 09:26 THOMAS E. NEVE ASSOC. P.04 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. (f .90XF04W ST- On-Site Review Deep Hole NumberaP- Date Time -'I Weather �U�'l�f�/ r-0 °I Location('identify on site plan) �,CS 194i4 R,J -g57/744 Land Use j _Slope(%) 3 % sm face Stones /f D n -G Vegetation 7f C4-01 Landform Z- -e � Position on landscape(sketch on the back) Distances from: f/f0 ",Yl /r`S Open Water Body Feet Drainage Way Feet Possible Wet Area Feet Property Line Feet Drinking Water Well Feet Other DEEP OBSERVATION HOLE LOG* Depth from Soil Horizon Soil Tcxra Soil Color Soil Other Surface(Inches) (USDA) (MnceolI) Mottling (Stractm,Swnes,Boulders.Consistency. %GMVQD 40 -1001 �P FSG. /O YRf7- fy •MNBffJM OF 2 HOLES REQUUMD AT ZvFAy PROPOSED DISPOSAL ARBA Parent Maternal(geologic) Q U rW JIsff Depth to Bedrock: /7 on IC Depth to GroundwaterStanding Water in the Hole: /JD n e— Weeping from Pit Face: no77t Estimated Seasonal.High Ground Water. /70 7?II10 DP4 APPROVED FORM-12/17(95 son.6v2SAM rf i MAY 12 r 1 _ MAY-12-1998 09:27 THOMAS E. NEJE ASSOC. P.06 FORM 12-PERCOLATION TEST Location Address or Lot No. COMMONWEALTH OF MASSACHUSETTS Massachusetts Percolation Test* Date: 4—/O- 9 e" Time: Observation Hole#: QP 0-/ Q pjotC Depth of Perc 3 2 y[I/'/ StartPre-soak /0 -, 4/0 End Pre-soak Time at 12" f p,• Time at 9" 1 I d D Time at 6" Time(9"-610) -6-r17 lei Rate Min./Inch < 2rrjjn /s1C cSZ 417e *Minimum of I percolation test must be performed in both the primary area AND reserve area. Site Passed Site Failed Performed By: h01'naj- '4 . e� Witnessed By: Comments: DEP APMOVM FORM•12107/93/93 F-f- MAY 1 2 TOTAL P.06 MAY-12-1998 09:26 THOMAS E. NEVE ASSOC. P.05 FORM 11 I- SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No. 04- 46340JC11-6d 3r, Deternrinatioa,for Seasonal High A�ater Table Method Used: F7Depth observed standing in observation hole 19,O)I IC inches F7Depth weeping from side of observation hole inches U Depth to soil mottles 4 D inches F7Ground water adjustment /X n-C feet Index Well Number Reading Date Index well level Adjustment factor Adjusted groundwater level Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Yom_ If not, what is the depth of naturally occurring pervious material? Certification I certify that on 1119 I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature Date DRPAPPROVMFORM-12MI95 nab/imm, NAY 12 FORM 11 - S EVALUATOR FORM Page 1 of 3 No. Date: Q /a 135T'A7E Commonwealth of Massachusetts Massachusetts Soil Suitability Assessment for On-site Sewage Disposal B Date: �/f Performed y f� �f ��� �� �� Witnessed By: 51)s4/lU r g0 Location Address or Owner's Name //��Jj7� C°lve1L Lot# 36,q- 80X�Pejeo `r Address and Telephone# /t/1 AltjLoOvlPlei (9 20) 97s-�3L�s New Construction � Repair Office Review Published Soil Survey Available: No �'� Year Published f�� Publication Scale Soil Mar Unit Drainage Class �(fQ/1 DYtd/IIL'd Soil Limitations Surficial Geologic Report Available: No © Yes Year Published Publication Scale Geologic Material(Map Unit) Landform Flood Insurance Rate Map: Above 500 year flood boundary No X Yes Within 500 year flood boundary No X Yes Within 100 year flood boundary No )c Yes Wetland Area: National Wetland Inventory Map(map unit) /170;1�. Wetlands Conservancy Program Map (map unit) /Z an C. Current Water Resource Conditions(USGS): Month 0 p Range: Above NormalNormalBelow Normal Other References Reviewed: DEP APPROVED FORM-12107/95 soAevlsun FORM 11 SOIL EVALUATOR FORM Page 2.of 3 Location Address or Lot No. S'7— On - Site Review Deep Hole Number Date /D Q8 Time (?230 P" Weather S041Yy -6-40,1-- Location 'pa/Location(identify on site plan) gem s',q�� ?L& � el?QjIG/l/ �74z/ Land Use Slope(%) / ,j "lp Surface Stones 1-7 ,0,4.7 G Vegetation tL/� LandformS/CE,�2.. Position on landscape(sketch on the back) Distances from: /2� Open Water Body feet Drainage way feet Possible Wet Area feet Property Line feet Drinking Water Well feet Other DEEP OBSERVATION HOLE LOG* Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(Inches) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, Consistency,% Gravel) 6- /Z AP �s�- /0YfZ¢/ 12-361, 23 w L- S soya 6 -14,3 C Cs s�G/2 �-sr�/� ho rf-�. �'��5'rrarrs yb *MINIMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA Parent Material(geologic) 6 U TL!l-Q►J•/7 Depth to Bedrock: Q Depth to Groundwater: Standing Water in the Hole: n p/7-iC- Weeping from Pit Face: Estimated Seasonal fligh Ground Water: "-0rw_ DEP APPROVED FORM-17!07/95 soilevlsam FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. X61- 1,96XO2d ST On-Site Review Deep Hole Number V— 2 Date Time `t7 A4-f Weather SU6'I�7�/ S�O of Location(identify on site plan) e" � '5S.0 "q["' 'j '-!57/g � 74-4- Land UseSlope(%) 1-3010 Surface Stones 17 0/7 ic:: Vegetation -7f Landform ���? Position on landscape(sketch on the back) Distances from: Open Water Body Feet Drainage Way Feet Possible Wet Area Feet Property Line Feet Drinking Water Well Feet Other DEEP OBSERVATION HOLE LOG* Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(Inches) (USDA) (Munsell) Mottling (Structure,Stones,Boulders,Consistency, %Gravel) /Q yr2 /i 21 ty *MINIMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA Parent Material(geologic) 4 U 7W/9-SH Depth to Bedrock: on-e— Depth to Groundwater: Standing Water in the Hole: On e— Weeping from Pit Face: no-n< Estimated Seasonal High Ground Water: j jp7�1� DEP APPROVED FORM-12/07/95 SOILEVISAM FORM 11 - sOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No. �� Determination for Seasonal High Water Table Method Used: F7Depth observed standing in observation hole 126n C inches F-1 Depth weeping from side of observation hole inches F-1 Depth to soil mottles /1,0 11-C- inches aGround water adjustment 1 feet Index Well Number Reading Date Index well level Adjustment factor Adjusted ground water level Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? y�J If not, what is the depth of naturally occurring pervious material? Certification 9� I certify that on 1114. I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature Date DEP APPROVED FORM-12/07/95 soilevlsam FORM 12 -PERCOLATION TEST Location Address or Lot No. � i� COMMONWEALTH OF MASSACHUSETTS Massachusetts Percolation Test* Date: 4--/0— 9Time: Observation Hole#: QP A`-/ ©P# Z �1®11G Depth of Perc 3 2 — -/V`/ Start Pre-soak 10 -' 410 End Pre-soak Time at 12" Time at 9" Time at 6" Time (9"-6") 5-m ir)' Rate Min./Inch < 2mn 1,wl *Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed Site FailedF7 Performed By: `alwQs ee . eul(f Witnessed By: SA—AJ _ v. Comments: DEP APPROVED FORM-12/07/95 pereform.sarn w`^wwr.waYs::. arysi:.L. 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Dev . 508 688 9542 P.02 r FI-O-V ,, i zf JUN 18 TOWN OF NORTH ANDOVER SEWAGE OtSPOSAL SYSTEM INSTALLATION CEWIFICATtO Tltt undersigned 6errb;y�cxmfs that the Sewage Dispasa!System i )constructed: ( repaired; located at _. _._ d tr� -• �` {e'er,� 7�_—._ T-- —___� ._was installed in confOrmance with the Worth Andover Board of Health approved plats,SVstetn Design Permit a/PA-0 dated S lens —' ! � .�._-,with an approved design flow of L 1. O l'� per day. The materials used were in conformance Plan' with those spcxified on the approvePlan'the system was installed ,accordance with the provisions of 3 tel CMR 1 S.Ooo, Title S and local regulations.and the Final gradin8 agrees substantially with the appy accurately represented on the As-built which has beer,stab plan All work is �t d orNeal Bed inspection dart. Final Inspection date: �Q Installer- ic.#: Date: Design Engineer: • ZO'd Zb56 899 ,305 -ns0 'WCO .AOAOPUV 44.AON dZZ=Z T 86-60-unr JUN-16-1998 13:41 508 688 9542 P,02 06/10/98 13:38 5087748148 TYKE ERASER. COMPAF4e GAGE 01 TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION Tl:e undersigned hereby certify that the Sewage Disposal.System t j by constructed; ( )repaired; �� --—---- r—z„ t S e located at i 3 Otr --- -- _ _ was installed in conformance with the North Andover Board of Health approved plan.System _ Design Permit#/ dated S y/ D gallons per day. The materials used were in conformance with those specan approved ified fled on the apsign flow of p e� plan; the system was installed in accordance with the provisions of;10 CMR 15.000, Tide 5e and local regulations.and the final grading agrees substantially with the proved Plan. All accurately represented on the As-built which has been submitted to the Board of Health.work is Bed inspection date. 7peerm e � j -----_—. Fatal inspection date: Installer:?!� Lic.4. Date: Design Engineer: Late: 20*d Zb56 689 905 -ABC •WOO -4eAOpuV 44-ION dZZ=Zt 86-60-unC APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: Lq8 CURRENT INSTALLER'S LICENSE# 13E-8 LOCATION: 304 BOYE'ORD S R66 LICENSED INSTALLER: Rtq 61V Q % FRI9503 .7L SIGNATURE: TELEPHONE# 978-774 8/4g 313 CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only $75.00 Fee Attached? Yes v No Foundation -Built? Yes No A s Floor Plans? Yes No �L�/ Approval a��jl/L� Date. <J Town of North Andover, Massachusetts Form No.3 NORTM BOARD OF HEALTH G�y/(� 3? ° �4 19 p P DISPOSAL WORKS CONSTRUCTION PERMIT 9SSACHUS�S .. Applicant —�M 0 ADDRESS TELEPHONE Site Location Permission is hereby granted to Construct ( ) or Repair ( an Individual Soil Absorption Sewage Disposal System as shown.on the Design Approval S.S. No. CHAIRMAN, BOARD OF HEALTH Fee D.W.C. No. Town of North Andover, Massachusetts Form No.2 f MORTh BOARD OF HEALTH OJ O ` / 19 �x w .—t-� D # i •. # DESIGN APPROVAL FOR �Ss,C"USE`� SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM r�Applicant (-�yt�-� Test No. Site Location,�J c)7 Reference Plans and Specs. 0� C g ENGINEER DESIGN ATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. C AIRMAN BOARD OF HEALTH Co Fee 2� Site System Permit No. ��� Town of North Andover, Massachusetts Form No. 1 01 NORTH ••�� BOARD OF HEALTH 3a y� b o� 3 19 ..> A ° " APPLICATION FOR SITE TESTING/INSPECTION 7�AOgATED PPp��S is CHUS� Applicant "0— / ' !a6ye NAME ADDRESS� TELEPHONE Site Location ,2c/ ��ok?'SSa✓o'1J Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time # 75CHAIRMAN,BOARD OF HEALTH Fee_ Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH F qti O0 _ t 9 T iL * n0LAKE APPLICATION FOR SITE TESTING/INSPECTION �9SSAcr+us���y Applicant NAME ADDRESS TELEPHONE Site Location Engineer •� NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH r' Fee Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. i r r Town of North Andover, Massachusetts Form No.2 f vko*Th BOARD OF HEALTH oO f • °•--- ~ ` ESIGN APPROVAL FOR ss'CHU SOIL A PEON SEWAGE DISPOSAL SYSTEM Applicant r Test No. Site Location o S ' Reference Plans and Specs ���— �In ENG NEER DE IU DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. I rn Z'r CHAI R M� RD OF HEALTH Fee to Site System Permit No. 1 I NORTH ANDOVER BOARD OF HEALTH DESIGN REVIEW REPORT DATE FEE: PERMIT # DATE RECEIVED— APPLICANT ECEIVEDAPPLICANT (�c//�Yi�1�/�IA�/1/C/G MAP PARCEL ADDRESSLOT # STREET # ?D� ENG._/�G�G cScSDG' . STREET �O)CF-6,tp 61 ENGINEER ' S ADD. PLAN DATE REV. DATE CONDITIONS OF APPROVAL APPROVED DISAPPROVED REASONS FOR DISAPPROVAL : %°K> 1i?iss;�u�. m l91U H04,!!�— 7-6 &J 17—.-`i ck 16 ,594,0 &)) �.�' �t>/�E�C= 15 rr�� ���E,eU� �-•e��- �c�TrD�v�D ' fid. 171 (4)) , 19- LC : CcJ /�y.v c; M,4c/V c i `/GL THOMAS E. NEVE ASSOCIATES, INC. Engineers a Land Surveyors a land Use Planners @[F CTUUMMOTTEL 447 Boston Street : US #1 ' TOPSFIELD, MASSACHUSM.S;-01983 't'y s, M _ ••• DATE. -5/1 JOB NO. I ^ ^ (508) 887.8586 I g 9 g '-F�}� FAX (508) 88773480 - ATTENTION - Sar, 5+Grr TO RE S O.ncJw S-t d'r r M a C N e. S - ,C. 8oac•d� O� 1•-t�.o�1 -1.1�.. 304 50YSrocd S+. "Andio.�er WEARESENDINGrYOU: Attachedx , :'ET"Under-separate_'covervia the following items: Q•Shop drawings,�,. �( Prints ❑' Plans, _ ❑. Samples ❑ Specifications M fY,. , y. pY *❑ Change°order p.` COPIES' DATE. NO .= DESCRIPTION. 1-744 SANITA2y DISPoSAt_. Sy STEM KF_PA72 PE-�ICa-N y._ } THESEARETRANSMITTED as-checkea below:; . For-approval" ❑':Approved,as;-submitted. ❑: Resubmit- [1. ❑:;.Fbryouruse _-0, Approved asnoted` ❑: Submit copies for.distribution. `❑ As.requested - = 0 Returned,for corrections ;.❑ Return- -corrected prints ❑;>For review and comment- 0- omment❑-FOR BIDSDUr' - _1.9 ❑" PRINTS RETURNED AFTER-LOAN TO US REMARKS` �ea� Sso P-d..r` _PI ea 5r `r -mal n<-loeee4 3 0t-, S 01� �},Q 're's/ Se�C' :. SGr;'.-� dr.i ' D•Sc>oSe 1 S..s+e ho ILL/1 �^GS .hQ�/^ �v•S�'Gl; ptir <OMM P r oPr y ti:-OL Jr �oi..leTS'c'.T car �j' +1� !Qey, Or., r r. o,.J•eS'�-.on5 c7lf�"�+P cU-; /10� 11 es "} --4-e COPY TO., Hilar B1�a R ' a �jt^cr«lY • ' T 4 a RE CIM PAPER Conterrts40%PreCo�umer 70°/uPostCorreumer .- ,, �� -'�'�-; If enc%sures are notasnofed,k/nd/y;notlfy:us•at'once � } ♦.�.7nC"�, 'e r t l.. _ kt1".`'� •rr yM .� .4 'a .*,,, 3 r* 2; Y } t 4 n . ."`i.-'""�; ._.. .• ;nwax.,st i.. vty,�,. -^..,yia.Yr.—sem...,.=w..v+fs-�•. r-r:.+-�w.or.Sw'•d'+c.•,-KYc...d.: .t_ .. _t. • �. - r.�. ..�'d .. --17-- 77-11, -- , r 7 7 , rx 1 3 "f,+`f�t a t'�P+ 7 r 4i*�•�'�`a S 7�4M 7=F��� x fib} �, a Z t tt ,�'ttris�4�_ t ✓a::1 rl ^[- ¢ s�Y_r�` =E�it7.' t#tt ��{fb`a St d'S' }�s" ^'S '' fi�^ � tt �f tr �. { n#`�yt,Y a� ,�r{ >x� �iy�,ri;pt}eV+i �.s t,-x§ �7�F+a�' �'. r1•, .. _ }t::ri s 7i � C� "r,'[�' 0.rt"�td x1^sr4 E L•[��':t f Ise yry � i r�'xl.y :i +�.,•r 2 �' r �`xa.�!�#tl �'S r � � y71 � .� i` rd 3�>` ist'�;,� •.rt s� •} { 3r!° � °eY r.. r =Fel Ft=.e t�1 1 f;,n �7x D� +' i � x;• eli ..fie.. . N° a / ......... NORT�y TOWN OF NORTH ANDOVER +? O p PERMIT FOR WIRING ,SSACHUSEt r r This certifies that ...... ...............................o............................................................ has permission to perform ' .................................' f-' _ wiring in the building of ` ` r .............. at-:0..'.:.�r....l�--�-� ! ' .. ,North Andover,Mass. Fee!��..�........ Lic.No.............. .............. :...... ......................... ELECTRICAL INSPECTOR Check # % L� WHITE: Applicant CANARY: Building Dept. PINK:Treasurer The Commonwealth of �asacJ)ur °`�1c< u'< Depamrnellt Of Public San jey """ ~' BOARD OF FIRE PREY-El-411N REGULATIONS S27 Chili 1-_1CJ3/90 i�ta�c ot.nh) APPLICATION FOR PERMIT -1-0 PERFORM ELECTRICAL WORK 4Jl work to b< periormtd In aicQldancc will, 111a "'A"'chwcru E4011"l Cock, 52) CMH 12:00 Gii y o k„Tos�u of. /vim, Tne undersigned applies for a p�rwic Co parforA the electrical Mork descrlCed 'oclov, LJ."cioR (Street S Number) !)7Xr:: //�,eA ��7” owner or T.eaant_ AV72VO IV Cl / �,-4A ?miner's Address Is chis permit in conjunction with a buildinb permit; les ❑ No (fleck Appropriate Box) Furse of Building UtiliLy Authorization NO. F__i ting Service imps / voles 0--c head El Undgrd ❑ No, of Kecers Ncw et�ice "mPs I `'ales Overhead ❑ Unda-rrd ❑ No, of lieters � ii=ber of Feeders and Ampacity l.oc.acion and Mature of Proposed Elcecri"l Mork No. of Lighting Outlets No. of floc Tubs No. of Transformers T Al No. of Lighting Fixtures Swimming Pool Abovej� ln- ❑ '. grad. l J grnd. Generators KVA No. 0i Receptacle Outlets No. of 011 Burners No. of Emergency Lighting Bacte Jnits No. of Swi.teh Outlets PIo. of Cas Burners Fin. ALARNS No, of Zones No. of Ranges No. of Air Concl, dotal No. of Detection and tons Initiating Devices No. of Disposalstlo. of Ileac Tocal local Pu s 'Lolls Pl1 Ho. of Sounding Devices No. of Dishwashers Space/Area Heating KW lloe of Seeion fSoundingeDevices ' i:o_ of Dryers Heating Devices KN Local ❑ Municipal ❑Other + Connection No, of Water Heaters K Ni nof Po °� Low Volcage s c Ballasts Wiring No. Hydro,Massage Tubs Q. of 1' Cors Tocal HP GrKER INSURANCE COVERAGE; Pursuant to the requirements of }Lassachusetts Ceneral Laws I have a current Liability insurance Policy including Completed Opera cions Coverage substantial equivalent. YES a NO U I have submittederage or its valid proof of same to this s Cove. YES❑ NO [� If you have checked ITS, please indicate the type of coverage by checking Che appropriate box. ItiSURANCE Z BOND ❑ OTHER ❑ (Please Specify)_ Expiration baceT Estimated Value of Electrical Work $'�� Work to Start inspection pace Requested; hough Final Signed -n..-er the penalties of per Jur; FIPu`1 NAME N y,� •C Fd LIC. NO. z r Licensee ignature_ , V(,J--� Np. Address, b. c it Bus, Tel. No, Alt, Tel, No. 05.'NSR 5 LNSUF2.1,NCE WAIVER; I aa aware that the Licensee does not have the insurance coverage or cs sub- atantial equivalent as required by Massachusetts Ceneral Laws, and chat my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone Mo. PERMIT FEE S (Signature of Owner or Agencj�'�� t_ t PRIVATE DISPOSAL . REPORT. . Fill Ct h F.J. STORCH BUILDING INSPECTION SERVICES 255 Whipple Street Fall River, Massachusetts 02721 Call (508) 675-8511 INSPECTOR: LICENSE#: CLIENT: I, SELLER,2" BUYER ❑ OTHER ❑ SITE: ��r()til �Xk=-(3C�.1� C� CITY/TOWN: IV A-'Jf)6.'1tF1z STATE: BUILDINGTYPE: ,�+TV��-�- APPROX.AGE: HOME OCCUPIED/ HOME VACANT ❑ (HOW LONG: ) DATE OF INSPECTION: )d _ WEATHER CONDITION: ❑ WET/DRY ❑ SNOW COVER © 1995 F.J.Storch Leasing&Business Management,Inc. t r COMMONWEALTH OF MASSACHUSETTS f EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS >� DEPARTMENT OF ENVIRONMENTAL PROTECTION ? ONE WINTER STREET. BOSTON. MA 02108 617-292-5500 WILLIAM F.WELD TRUDY CORE Govemor Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner PART A L h� CERTIFICATION Property Address: joy K.Rt 1~:� ,`^ 'V'�� � a Address of Owner: Date of Inspection: ,'.��►,1y$ (If different) Name of Inspector: l ,_/ILL143 j]�U=•1�(!~ I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: F.J. Storch Buildinq Inspection Service Mailing Address: 255 Whipple Street, Fall River, MA 0272.1 Telephone Number: 1508) 675—,9911 CERTIFICATION STATEMENT I certify 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 Fails Inspector's Signature: / Date: v. The System Inspector shall submit a copy of this inspe r 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] SYSTEM PASSES: 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. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. 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, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is 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 04/25/97) Page 1 of 10 DEP on the World Wide Web: httpJtwww.magnet.state.ma.us/dep j Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Ownerty Address: �OL; CD, ' y� �l? JqA Date of Inspection: B] 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 if(with approval of the Board of Health). Describe observations: 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 PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS 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 the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS 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. Method used to determine distance (approximation not valid). 3) OTHER (revised 04/25/97) Page 2 of 10 S S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: :(69 Owner: 1, l�`� � ]"►f}�:., i(��i;,,, Date of Inspection: .,l11 y7 DI SYSTEM FAILS: You must indicate ewer "Yes" or "No" as to each of the following: '401 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. Yes No _ 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. y _ 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 less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). 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. E] LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: 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: Yes No 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 II 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 04/25/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: .�(} fJ(�X�`'UY-l� ,�`� Al. P oJt z ✓44 Owner: Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. _ None of the system components have been pumped for,at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. JV As built plans have been obtained and examined. Note :f they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. _ The size and location of the Soil Absorption System on the site has been determined based on: S _ The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. Existing information. Ex. Plan at B.O.H. Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)] (revised 04/25/97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Owner: Property Address: q �..�tt T t 4P jWV/E�1 H11 Date of Inspection: � Oik'Al'o l - -4 t q g FLOW CONDITIONS RESIDENTIAL: Design flow: '3-3ng.p.d./bedroom for S.A.S. Number of bedrooms:- Number edrooms:Number of current residents:, o):-SGarbage grinder (yes or no): CvN►MtrJil kN�LA%— PQMfjNL,) Laundry connected to system (yes or no):-1— Seasonal easonal use (yes Water meter readings, if if bl' available (last two (2) year usage (gpd): f Sump Pump (yes or no):�Jo ' Last date of occupancy: COMMERCIAUINDUSTRIAL: Type of establishment: Design flow: gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: 0:61 0 System pumped as part of inspection: (yes or no) rf If yes, volume pumped: gallons Reason for pumping: TYPE OF,WSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: 317,1126. ��C�C�Jy�1�W� Vu�? Sewage odors detected when arriving at the site: (yes or no)-SID (revised 09/25/97) Hage 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM J t INFORMATION,(continued) Property Address: 3� x><Fi 3�-� �. . hy1JLvVe--e Yyy,\ Date of Inspection: 1: ar BUILDING SEWER: (Locate on site plan) t� Depth below grade: l, G' — — Material of construction: cast iron 40 PVC other (explain) Distance from plr�ivate water supply well or suction line +`, Diameter _ ` Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: (locate on site plan) I` Depth below grader Material of construction: concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age _y Is age/confirmed by Certificate of Compliance _(Yes/No) Dimensions: /9L.L61'J� Sludge depth: l.7` Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: 0%% ` A( —�', Distance from top of scum to top of outlet tee or baffle:+ble / 0 /2a - 1"�LC: 6-A/ Distance from bottom of scum to bottom of outlet tee o How dimensions were determined: ��#;z�JAL 0UrL =r pi e)1J 6 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.) GREASE TRAP: (locate on site plan!) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene —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 baffle: Date of last pumping: 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 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 3N 60>4F:Z--��.!`+. �y�, �-rJ j�rj�l rj`� HA Owner: Date of Inspection: , TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Capacity: gallons Design flow: gallons/clay Alarm level: Alarm in working order _ Yes; _ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:-� (locate on site plan) 7 Depth of liquid level above outlet invert: jeJT© �TL. .r � /�►�'j"' ..j3a� �ivTL C �r�.e:T Comments: ye/1�w T (note if level and distribution is equal evidencetof solids carryover, evidence of leaka a into or out of box, etc.) 1 _ f 1 ti•- •—do>f. t r r c Uig h � 0 fly AAJD _ r -. r _ ,, / — —130 ;, `Lt —qtr. :L. .. PUMP CHAMBER: (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order (Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 36L jt^ ;;=//» Al,� ;vp0/F� Owner: WI4y ^ r t.. f I Date of Inspection: it f'! A SOIL ABSORPTION SYSTEM (SAS): 1/ (locate on site plan, if possible, excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number:_ .- leaching chambers, number:_ f leaching galleries, number: ' leaching trenches, number,length: leaching fields, number, dimensions: Ox, j t )�1,- •^ overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) CESSPOOLS: (locate on sitep an) 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.) PRIVY: (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 04/25/97) Page 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) �} Property Address: �j04 (�C,j-�jij� "i', tJ1-(�dfr Owner: W)sq)V - N+ -4' •V/EIS. Date of Inspection: j � ;1r, q9 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) 1 � F�,�1:�^ray►�� � w��. �-�U�, �r+rryyr (revised 04/25/97) Page 9 of 10 c SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: ,��� %KG01r—t, " , 14('jV0Vwc^ Ilf-A Owner: Mofq HAL. �r L J Date of Inspection: Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. (Must be completed) S'T'N OF WATT*M I),J Wej_. (revised 04/25/97) Page 10 of 10 Robinson Barrett �v�Boxford St. APPLICATION FOR SEWAGE DISPOSAL INSTALIATION HEALTH DEPARTMENT - NORTH ANDOVER, MASS. I hereby make application for a permit for a sewage disposal installation at Boxford St. . I will install this system in ac- cordance with all the laws of the Commonwealth of Mhssachusetts and regulations of the Board of Health of the Town of North Andover. Further, I will construct the house sewer of bell and spigot pipe, the minimum diameter being 4 inches, and will maintain a minimum grade of 1% until 10 feet pre- ceding the septic tank, where the grade shall not exceed 2%. I will install a con- crete septic tank of 7q0 gg1 _ in size. A manhole (s) permitting easy cleaning will be provided with removable cover (s) of iron or concrete within 12 inches of the ground surface. I will provide subsurface disposal field with 4 inch perforated or open jointed pipe and laid in a series of trenches, the bottom of which will pro- vide a minimum of 180 lineal ( RkRRJ feet of effective absorption area. The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging in size from 3/4 to 1-1/2 inches (dia. ) and the pipes will be surrounded by similar material to a height of 2 inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench, 2 inches of gravel or stone 1/8" to 1/4" (dia. ) will be placed over the course gravel or stone. The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single tile line will exceed 100 feet in length and in any case, two lines of tile will be installed. A minimum of 6 feet will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the installation will be less than 100 feet from any private water supply _ 25 feet from any stream, 20 feet from any dwelling or 10 feet from any property lin'.. I further agree not to cover any portion of this installation until approved by the inspection officer, as provided below, and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application. DATE Signature of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DA TE, �Z G / 7° SiJAature of Health Agent I have inspected the uncovered system indicated above and find everything done as described. DATE . _� Signature of I p cting Officer Percolation Test 5 min. Soil: QXavel Garbage Grinder �.a^ `t1 � „ �. E1 :�.;. ...i . •T �I :'I f. March 4, 1961 Miss Mary Sheridan R. N. Health Agent Board of Health North Andover, Mass. Dear Miss Sheridan: An examination was made as requested in order to determine the suitability of the soil for the subsurface disposal of sewage on the proposed Boxford Street building site of Barrett F. Robinson. The land in general is high. The subsoil in the area was of gravel content and a 5-minute percolation test was conducted. It is recommended that a 750 gallon concrete septic tank be installed together with 180 lineal feet of drain pipe. Very truly yours, William J. Dri c 11 WJD:hd BOARD OF HEALTH TOWN OF NORTH ANDOVERO WS. 41 4Vi 459 __�. M•N, or::j t7 SOCA L, C;NC, ` pric-r u ! DATE . . . . . . . . . 2. ADDRESS . �� 7. �-�; .`: � : LOT NO. TEL 3. NO. OF BEDROOM . . . . . NO.. . . . 4. GARBAGE GRINDER YES 5. SHOVE DI;,ENSIONS OF HOUSE t/ 6. SH017 DISTANCES Or HOUSE TO ALL PROPERTY MIMS ✓ 7: SHOW DrJEI\VSIONB OF LOP S. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL t q. NOPE LOCATION AND DISTANCE OF WELL FROM SM-MERAGE SYSTEM /bd 10. SHOW LOCATION OF DROOKSo STRE145, DITCHES, LEDGE OUTGROP, ETC. 11. SHOW DISTAITCE OF SEPTIC TANK OR CESSPOOL FROM, HOUSE NOTE: LOCAL REGULATIONS SHOULD HE READ CAREFULLY. TOWN O NORTH ANDOVER SY I E PUMPING RECORD DATE�(��/� �, 4 SYSTEM OWNER_&A-D—D-RESS SYSTEM LOCATION laltlwF o�r () °A X30 ho. alwove-4 Ma. VA DATE OF PUMPING,_ QUANTITY PUMPED: CESSPOOL: NO V _YES Septic Tank: NO YES NATURE OF SERVICE: ROUTINE �EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE _ ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLID CARRYOVER OTHER EXPLAIN System 1� �� �j y tens umped b} _.. _ft. Ci.(�� 21-2 COMMENTS: CONTENTS TRANSFERRED TO �J ��/ ✓—� ' hJ1• 'u� "Jr 11 1 '� S trl '1141 ,ir!(t S,� 1N, Y � s f � -. .. (. �~ � `b •f�1# �>bbl'�Il,a!rx��,��k�`OI��yY����7�7.K6d fi•Ih�,,� _� �+ _1 . t{�Z�` T Y i••r Q�,1u. I h 1 N i/•1. '6 r t 1 � , 1 r• 1 tdt ,�, a' �1J•�,i+/�A�tf'/r'1'N;t�.'pS '�,tlr:!',�i ii , .i�,r�� r ' #. , it fel i�•i \r Ir •1 dMVr' C � ,3�a,,[ 14f,� ��tt7. lit �+!n 't', a 7`t tl 117. a ' • " of 3 r �'',1 Ctl 5•!� r ..KI#.��n r'dr 5�,r+,4+ ''1�W {�..1ti ;r � /a 'Y1f4°,d1 / ... .d.' (] `I�'� ..l�r }�, ,h!fh2Yt'�,rl l l},�li x tri«�I;aNXFh�y�f of�+,d^<+5 �,.,1•:,t�,� : ,+. ,.:I! +r' 'i+i! •.. . �f. • ' )�i 1 r l f L _ St i1 fr,it:i .. ar +t';�{„u�• t,�il Sir t. r `i+ it il.�# F4r.. , ANDO SYS VER j PIING RECORD , +j,'�il M•� ,1 X ♦ 'dY `' r � �: ' - j-� ,,4 rc'r'4rs,S�i 1�Q.4 4��st�r}t,�?+ � - • 1�. - t 11t' hsyS��'r a .fi Nat + r 1 r i ►�1;, 'i'lf [!l:,�f`�i �4 { rY6 rt{�.IIYP i�t af4.�Y;Yr. t �1 f.Y'{n�t�. .i � � r k •t• . • , �.,i! n'..�p�,. K ,1 1 M i d1 lJ I �fili t Cl yi.1 ty, ` iY�7`► R f 1 KiQQ t*,P iz ' S SYS�EA'I LOCATIO N. i �'C rad j p yr ..,•�,y.. ''l ,.. 7 .� pk. kft ♦• `of ho i7 +� ''it+� tn l is +�T—` T' �Lry ���y ►'�/l ' � ` !•�(yy7�A�1rf��.r,�,Jt�rt�" t � s"t+ M r .q� �r 4� 'i, �...•.' r •'' r. w r t` r1f� 5��1'. .r r � ,1 '�f t 6 4 ! p. AJ, r 1 '♦ ��< �1�f�1 f,A1' }.�t'�1'lyl 'r r•�VY�w �' ,yf 4 t _ �,'�I ,`� r�1 '+�•� R��le♦1i y of 4r rri A ,.,f I , y, I�tyt. d�,i I r ...,, .. J AIVTITy PUMPED ' ' 15D0.. _GALLONS yy {{ii NS + i H t 4� t- "'• _ ,7,.�)^i= W X}f k a .IN' �l�T;II IIYa[•,�� ` t j'1 •r 4 �1��' ' S ,. ! + T•O � h /i a 1 SEPTIC Tg1NK. A NO YES F �q r � ."Y�i' 1�•° 1 I���.O�S� 4 w.'f'. I 'r i.f!�',rN ,, • �• :r.ir�, CaRGEN Y��ONc� 1� 1.t> >i �r I til y ft"R1tti•r �•�, � .. . ... . , ,.. ' : , (}��r�w) .M• � le; r �' °.�til '.•, t �''e i� Y 5f� r� his`+XO�' /I 1 1•�1•.�� ° r .r• 'e I HEAVY GREASE ,^ FULL TO Cpm a 1 r tl r Itub y "S�:�i* �Ir � .�to•� t�' , r; ,,� TS� ---�. H �IN PLACE G }.+ ,rP�a CESSIVESOi,ZDS : •�. LEACgFLD RUNB , T3 ' , '. #• ° SOTS C --�� . FLOOD ACK 7r,•r t . �,, ,. ';,.: ; 3YO��R OIIIj��;TKED _ ----.. `�, t,yt.�YyS.Y�i� b •+ - fT [ y f ���,Ni� ',[, r tie�1 I r "r�. ,r. , i , ' S.a • ° f�r�,r,j"tt'�7�1 ♦,t A�..�� I Ptp�fia � ��...t>5 'h <.� , dip All F / , Will r. 1. / . ���'Aflp'�,�>,r �'�. t '��.I:r r';'t 3`t.h 4' ti�4 q i.-1..-. • ,I,�t''•�►yf f •'' '� �It�t`ts�;�. I� 1 hr f�!°1 �•�`a+�}�r! r .i:. ,_ .. .: lip•'+fid. _�t�i;«.+�%...9,.•'/ S' 'ir i+• . 1! I i31� �t� t �'tfl 'i`i.r o-al'-1�}'• .�� r .1,� d 4Y+A��1eil6 qit'�� q f � _. I ✓; -,.i 1 il.. 1ir I'll 11 111111 11 ) �,µ•. r 1 'it •i..f I��M#y, C1 V r0. 1r {.,p tIT13fi't•5M Y, • . t � I t�i I , T 's' r • ' q, 4,P �! }tj �i.r il, t �•I:F4. h lila•r., y rri' 4140 , �1 t 4F.�"y�.c �)pyflyyyy N�rp;rl�r �Ir4+ t �,ty,�.i �i � l ti t Y, �� t:r h + ♦��. ,,y >. �I •d,ya �i i7.• �'..^r4r`. 1���} �r�:i�R�l ^S// ".A 11 i• .1® Ao Commonwealth of Massachusetts City/Town of NORTH ANDOVER, MASSACHUSETTS System Pumping Record Form 4 , 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 other approving authority. A. Facility Information Unporwat whenwhen aling out 1. System Location: , formon the RA- computer, � ` compp uter,use ' only the tab key Address _ to move yourcursor-do )J . use the retumt City/Town State Zip Code key.,. 2. System Owner. Name Address(if different from location) Cftyrrown State Zip Code Telephone Number B. Pumping Record _ 1. Date of Pumping Date 2. Quantity Pumped: D Gallons 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: cjoed 6. ^gtern Pum d By: � I e Vehicle License Number Company &Etc 7. �ocatloNwhere contents were disposed, Signature of Hauler Date http:/twww.mass.gov/deptwater/approvalstt5forms.htm#inspect t5form4.docr 08/03 System Pumping Record•Page 1 of 1 RECEIVED Commonwealth of Massachusetts W City/Town of North Andover FEB "15 2013 System Pumping n Record TOWN OF NORTH ANDOVER ' Y P HEALTH DEPARTMENT iv M Form 4 DEP 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 within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important:When filling out forms 1. System Location: on the computer, I V � use only the tab key to move your Address cursor-do not North Andover Ma 01845 use the return City/Town State Zip Code key. 2. System Owner: raD Name Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record // 1. Date of Pumping Date 2• Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) [�Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: CAC 6. S st m Pumped Name Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: St wart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 S' n ure of Haule Date jLl r Signature of iving Facility Date I t5form4.doc•03/06 System Pumping Record•Page 1 of•1