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HomeMy WebLinkAboutMiscellaneous - 314 BOSTON STREET 4/30/2018 (2) r 314 BOSTON -� f - 210/107.6-0030-0000.-0000.0 z - F w MAP Pq CEL PL l 4 !^7CRw�✓1 ..iKR�-. HAS PLAN CONSTRUCT STREET.` _ REVIEW FEE B ION-OPPRO 54- APPROVAL EEN PAID PLAN ? DESIGNER. DATE YES NU CONDITIONS / APP' BY PLAN DA-rE WA TER SUPPLY: WELL ERM I T W --- WELL TES TS=� . DRILLER CHEM Z CAL rERI DA 1 E COMMENTS: BACTERIA F?UV- - -- Dq.1-E AP+pF?UVEL FORM U APPROVAL: DATE ISSUED f APPROVAL CONDITIONS= 8Y Z� L YES Je NU FINAL ApPR � - ALL OVAL- WELL PERNZ TS PAID TRU OTHER CONS SEPTICON SYSTEM TCONS ES ApPRO VAL Y ANY VARIAN RUCTION AppRUVgL YES NU CE NEEDED YES NU FINAL Fc)ARD OF HE ALYES NU NU 7H APPROVAL. YES NU DA rE: - -'._..._..._...- ....FAY; ' IS THE Ep� x�-Z �r 4 T1'P :1-;STA LER Ll CENSE ? CoNSTRUCTION, ,l z - N EW ES rs CONSTRUCTION• Y No . l t CONDIT IED PLOT .PLA NCW REAgI IONS .OF..APpROV REVIEW R rSSUgNCE O� D {FROM FORM U) AL. YES NO WC .pERMI , l �. YES NO pERMI T NO• F YES. N0. BEG = (\ IN ;ZNSPECTIpN rINSTALLER; _ _EXCAVATION N0. INSPECTIO N. ' PASSED -, .��;' :;• - :.. " -CONS• �:. . i � : -' . , .. ,_ `, :. . TRUCTION INSPECT < BY ON: NEEDED .j . . AS BUILT.PLA .. i. r N SATISFACTORY• - ;, - ' YESTo = QPP Rovq BACKFILL• - FINAL. . - RODATE: GRADING ' ' 'AP P Dq7 YAL: E �' BY :TINA „l. L CON STRUCTIO BY N APPROVq `' . . DATz• /� B OCT 0 7 2005 . ('C)1�'N OF NUK1 t-t NCh..)F . TO J Y S'T'ET N 1 P O M P!N U RF C�O KHEALTH��"`� �f FORTH ANDOVER Un � k LTH DEPARTMENT DATA OF p NQ7 --• _.. ... Q O A N TI T Y .�.. ...._. P�:r MPec- tssPOUL; Np 14A rUK6 Op sbRVlCs: KVU'rINc _ trIrtiKUh,h� ,. !`IUNJ. GOOD CUN-vJTIQN OM 01 5 . dr13'Y1.85 !N Pl n�: Rpp't's � _... OrNER EXPLAIN �'UMMhNT�. uh' I CN I'� l'K.�Nyt l✓KK:�U r� f NORTH F Town O OL dover NO. 0 9 rt dover, Mass., COCHICHEWICK ADRATED PPPF` 5 BOARD OF HEALTH PERMIT TFood/Kitchen J Septic System <x- BUILDING INSPECTOR THIS CERTIFIES THAT................ .�.�, 1JZ�. .................. ... ... .. .. . .. .................................................. .................... tR.has permission to erect...... C?tTC' ............ buildings on . ,y...... .. .. ....... . ....................... to be occupied as.......... .. ...... ............... . ... .................. Chimney .. ................ ............................................ ............... provided that the person accepting is permit shall in every respeconform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating.to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSP �TLOR� VIOLATION of the Zoning or Building Regulations Voids this Permit. o t�r/�Y� Z��� / PERMIT EXPIRES IN 6 MONTHS in UNLESS CONSTRUCTION STARTS ELECTRICAL SPECTO U �! ........................... .................. ............ .. .... ...... .... er ( BUILD G INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on,the Premises — Do Not Remove F nagh No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. Smoke Det D 22 17 Address &5T4/1_. _ ;-7— Title of File Page of Date File Open: Date file closed: Doc Document/Action Title Date of Refer to other Purpose of Document/Action and notes action Document/ document/ Num. Action Department Board of Appeals - Board of Health - Planning Board - Conservation Commission - Building Department FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: 2,n Phone QCL- LOCATION: Assessor's Map Number Parcel Subdivision (Q Lot(s) 1 Street ��jb5 St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Date Approved Food Inspector ---Health Date Rejected __ . Date Approved 'iL �/7, Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections 1-TL, /( -72-q5- - ( -ZZ-q5- - driveway permit TTk) r f-ZZ Fire DeDaxtntllfiy4l-,�v- `Received by Building Inspector Date r FORM U - LOT R L SE FORM INSTRUCTIONS: This form is used to veri tha all necessary approvals/permits from Boards and Departments having jurisdiction ave een obtained. This does not relieve the applicant and/or landowner from'complia ce ith any applicable or requirements. � * APPLICANT FILLS, HIS SECTION `! APPLICANT /Irc ►'() l cSh� PHONE`6 e6— 61 o 6 LOCATION: Assessor's Map Number I PARCEL -SUBDIVISION �� 1 0 `� Glc v � LOT (S) novdn �S> ST. NUMBER STREET j OFFICIAL USE ONLY" COMMENDATIONS OF TOWN AGENTS: CON ERVATION ADMINISTRATOR DATE APPROVED 3 DATE.REJECTED COMMENTS p 0 _T TOWN PLANNER ` DATE APPROVED 1 DATE REJECTED COMMENTS FOOD INSP OR-HEALTH DATE APPROVED DATE REJECTED 'STIC I SPE DATE APPROVED DATE REJECTED COMMENTS i err D � � . PUBLIC WORKS - SEWER/WATER CONNECTIONS DR VEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR � �� P '� �" � :t u. ,`^. ,ti. '*..,oaf- ,,;,.���. s;'+.«�+' ��•y„Fz a�� Y+..wt�"A�"�`ri€� *�'`^'. _ '. _ C 1 Y c r` ` ` ` • \ '9� �tiv I ' `- -�2os�':\ ..--• "� ,�loµ ,pQA�►1 t5oOG�o� G app �C TWC. 97, � 2. 3 :3 t \\B OSTON STREET 150' r , �I • f J T•O3 7:: T 08,26 l NORT�o Y q� F �1 S.—, HmracT SEP 191996 TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE: 10/30/97 This is to certify that the individual subsurface disposal system constructed (X) or repaired ( ) by Donald Johnston at 296 Boston Street has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations as described in the Design Approval Site System Permit # 784 dated 01/02/96. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Board of Health Inspector NORTIy Tov of .1 L Over � �o ��_��- � � dower, '.�' Mass., 1916 2COCMICKEWICK �t 'gyp ADRATED pP��-`� 7 rJ BOARD OF HEALTH Food/Kitchen PERM .IT T Septic System � n�� •� BUILDING INSPECTOR THIS CERTIFIES THAT.................. C_x.l ,.........,,.,•,••• . ........ . ... ........................ q� Foundation has permission to erect........ buildings on ...c,�-.�� Gh .. . ...... ..!� �.�...�. �o _ �gh to be occupied as • • • •• •• • • • • •• • Chimney provided that the person accepting this rmit shall in every respec conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. 7 PERMIT EXPIRES IN 6 MONTHS n UNLESS CONSTRUCTION START ELE /Ic INSP CT ug /' ....................... ........:,......... ............................................ Service LDING INSPECTOR 1, Final Occupancy Permit Required ccupy Building GAS INSPECTOR Display in a Cons picuous Place on the Premis' es' — Do. Not Remove Rough No Lathing or Dry Wall To BeFina Done FIRE D Until Inspected and Approved by the Building Inspector. DEPARTMENT Burner i Street No. I Smoke Det. G �� Town of North Andover, Massachusetts Form No. 1 ONORTFI • .16 BOARD OF HEALTH � 19� o C _ h APPLICATION FOR SITE TESTING/INSPECTION p°RATED P" �5 SSA US Applicant— NAME � ADDRESSI J1 � TELEPHONE II Site Location WT &Sjk-� i C=, � EngineerC�4 AME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,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 I. BOARD OF HEALTH. ((�J 19 APPLICATION FOR SITE TESTING/INSPECTION LjgSSAC HUSE�,�h Applicant NAME ADDRESS TELEPHONE Site Location ` ' C � r Engineer 's NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,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.3 • Ot &ORTN BOARD OF HEALTH 1 • t �au Ye 'Y CMUDISPOSAL WORKS CONSTRUCTION PERMIT SASE Applicant r�_A-A- rv� Nfl\ l C NAME ADDRESS TELEPHONE Site Location ,T ( . (� Permission is hereby granted to Constructor 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. �S APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: CURRENT INSTALLER'S LICENSE# LOCATION: a 2:5 _ r LICENSED INSTALLER: �� to MCf' SIGNATURE: ` ELEPHONE# 6//7" ell CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Administrat' a Use Only $75.00 Fee Attached? Yes No Foundation As-Built? Yes No Approval Date: ADDRESS PLAN REVIEW CHECKLIST ,p-� � ENGINEER_ GENERAL 3 COPIES �� STAMP L/ LOCUS NORTH ARROW � SCALE CONTOURS PROFILE _/ SECTION BENCHMARK SOIL & PERCS --- ELEVATIONS WETS. DISCLAIMER WEL S & WETS WATERSHED? DRIVEWAY Elev) WATER LINES FDN DRAIN SCH40 VTESTS CURRENT? '✓ SOIL EVAL SEPTIC TANK/ MIN 1500G J , 17 INVERT DROP / GARB. GRINDER�(2 comps +200) 10 ' TO FDN r� �NHOLE � l L ELEV GW # COMPS. GB D'BOX SIZE ## LINES'-3 FIRST 2 ' LEVEL STATEMENT INLET ,&.Q7 - OUTLET _ ' 1 7 (2" OR . 17 FT) TEE REQ'D?,ea LEACHING MIN 440 GPD?-z RESERVE AREA ✓ / 4 FROM PRIMARy?6/ 20 SLOPE 100 ' TO WETLANDS ` ---- U TO WELLS ' 4 ' TO S.H°.GW cam-- (51 >2M/IN) 20 ' TO FND & NTRCPTR DRAIN� �/ 400 ' TO SURFACE H2O SUPP 4 ' PERM. SOIL BELOW FACILITY 4h MIN 12" COVER FILL? x BREAKOUT MET? L--.. (15 ' ) TREES MIN 440 gpdL SLOPE (min .005 or 611/100 , ) SIDEWALL DIST. 3X EFF. W OR D (MIN 61 RESERVE BETWEEN TRENCHES? e--' BE 10MIN. IN FILL? MUST 4" PEA STONE?� VENT? BOT 7� —L,-- (>3 ' COVER; LINES >501 ) + SIDE X LDNG 0 . (L x W x #) 3 x##) � - TOT 7� � (DxLx2_ (G/ft2) Copyright © 1996 by S.L. Starr / Town of North Andover, Massachusetts Form No.2 NOR11y BOARD OF HEALTH F w A ����-"'—���--►►►*** DESIGN APPROVAL FOR ss^CN°5`` SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant _'-� V�n S tZ�'Vl _ Test No. Site Location G — ( 1 4 S l - Reference Plans and Specs—SA � Uy'so A 96 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. CTi --�y—,� AI AN,BOARD OF HEALTH d% Fee Site System Permit No. 1�7 0 _ NORTH ANDOVER BOARD OF HEALTH DESIGN REVIEW REPORT FEE: PERMIT ## DATE RECEIVED 16A 4/9 APPLICANT a/pAJ -f r)14NS7Z)A) MAP PARCEL ADDRESS LOT ## c� ENG. S jU�Sc� STREET p6.P"Od ADDRESS PLAN DATE REV. DATE CONDITIONS OF APPROVAL APPROVED DISAPPROVED REASONS FOR DISAPPROVAL: Z5/>e7 �c ,1� CSCE ald 0112 /vS Z7AC/,1 �s s 1A)6 /()o a' TOS g0�F'j'OR OF y�iAjO _ y�LTy�FR� e SEPTIC PLAN SUBMITTALSI LOCATION: C NEW PLANS: YES $60.00/Plan REVISED PLAN YES $25.00/Plan DATE: ( w DESIGN ENGINEER: When the submission is all in place, route to the Health Secretary 1*\No. FEE THE COMMONWEALTH OF MASSACHUSETTS 71LOeT/� y��Jd✓�— MASSACHUSETTS Xiration for is osaX stem Gnstrurttori! .grmti#�h'`"' ` �` ,�©� � Application is hereby made for a Permit to Construct (91) or Repair( ) an On-site Sewage",Disposa' System at: Location Address or Lot No. Owner's Name,Address and T I.No. W4, odd /yr�t4 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �7 403 W(Ak� 4lro ?"X-Lg6v Type of Building: Dwelling No. of Bedrooms Garbage Grinder( ) Other Type of Building No. per Persons Showers( ) Cafeteria( ) Other Fixtures CfflL Design Flow 1/6 gallons per day. Calculated daily flow / � gallons. Plan Date d d_ 7, 650 Number of she is Revision Date Title1-M e-6V0-4 Description of Soil 7� k n Yxi%Io y 600,77 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: 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 Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS MASSACHUSETTS 01.1ertifirate of Clomplianre THIS IS TO CERTIFY, that the On-site Sewage Disposal System installed ( ) or repaired/replaced( ) on 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: The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. This Certificate expires on DATE Inspector THE COMMONWEALTH OF MASSACHUSETTS No. , MASSACHUSETTS FEE �ts osttl 4gstem Tonstrurtton 1ermit 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 Approved by FORM 1255 Rev.3/95 A.M.SULKIN CO.-BOSTON,MA CERTIFIED PLOT PLAN LOCATED IN NORTH ANDOVER, MA. SCALE:1"=40' DATE: 6/29/96 Scott L. Giles R.P.L.S. Frank S. Giles 50 Deer Meadow Road Andover, Mass. 1 � � p � \a0� LOT 6 po 66,995 S.F LOT 5 CO w FO j G T o DA TION 208.26 r r h 92.97, o 'TOWN OF NORTH END ER/ ` BOARD OF H P-LTH 64,93' SEP 1919% I CERTIFY THAT OFFSETS SHOWN ARE FOR THE USE THE OFFSETS OF THE BUILDING INSPECTOR ONLY SHOWN COMPLY AND SUCH USE IS FOR THE WITH THE ZONING DETERMINATION OF ZONING BY LAWS OF CONFORMITY OR NON-CONFORM!T Y NORTH ANDOVER WHEN CONSTRUCTED. WHEN BUILT 8129196 CERTIFIED PLOT PLAN LOCATED IN NORTH ANDOVER, MA. SCALE:1"=40' DATE: 6/29/96 Scott L. Giles R.P.L.S. Frank S. Giles 50 Deer Meadow Road North Andover, Mass. BUF STREET 150' �o a� LOT 6 66,995 S.F LOT 5 CO �o Fxis6 MO w ,�T o��AT W.::z208.26_2p8 2 O r 1 I - 92.97F o 'TOWN OF NORTH 414 4 TR/ BOARD OF HEALTH 64.93, SEP 1919% I CERTIFY THAT OFFSETS SHOWN ARE FOR THE USE THE OFFSETS OF THE BUILDING INSPECTOR ONLY SHOWN COMPLY AND SUCH USE IS FOR THE WITH THE ZONING DETERMINATION OF ZONING BY LAWS OF CONFORMITY OR NON-CONFORMITY NORTH ANDOVER WHEN CONSTRUCTED. WHEN BUILT 8/29/96 i FORM II LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: Y1ri`.(Q �-- ���� Phone Ln?a -1 Ld LOCATION: Assessor's Map Number I Parcel Subdivision (? Lot(s) � Street ��OS�Crn V-Jo P-7 St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation, Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected Date Approved Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections 7—IF0 /(-Z z - driveway permit (T: l,J Fire De artment o -'"`` eR ceived by Building Inspector Date No................-....... FEs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ro ...............O F..........................,P�/.0.. �� N� Appliration for Uiopoottl Works Timitrur#inn Permit Application is hereby made for a Permit to Construct ()C) or Repair ( ) an Individual Sewage Disposal System at e'_ o SrO A) �j_ Lor 0 ---------------------------------------------------------------------------------------'••.._..... ............................................... Location-Address o Lot No. --- /_�f__ z'o _..................................................o-- .... io ... a AL.5-:o . W Owner Address ...... . Installer � Address / � U Type of Building Size Lot-___0�kl S.Sq. feet .-t Dwelling—No. of Bedrooms................. ....................... Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures . W Design Flow................ I Be ------gallons per person per-daq. Total dally flow..__.__..__ ..P-P.... ga pns. 11 WSeptic Tank—Liquid capacity/W2.gallons Itength___ _-_ Width---ro......... Diameter................ Depth...,5..ZQ x Disposal Trench—No. ___.3._..__.___.. Width..---�----._--__ Total Length__zg-&-•-.. Total leaching area... ----sq. ft. Seepage Pit No..................... Diameter----------.--------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing t k,^') a Percolation Test Results Performed by------- - rLlS !S ZZt Date- -�---5 _7 I' Test Pit No. I.....q-.--minutes per inch Depth of Test Pit._.____ �_4__. Depth to ground water_.__..�D_`.._.._. GL, Test Pit No. 2.._.Z __....minutes per inch Depth of Test Pit------ ....... Depth to ground water.......Z-Q,-y._.. P4 ---------------------------•-.......----•-•-•----------•'-•-•---•••--•-••--•-•--...-------'-.-••------•--•-••-•---•--.........•-----•....•---._....._....._. 0 Description of Soil-------------•••--••-•---------------------.....•... x ---------------------•---------------- -----------•------------------------------. � -�1 •-• -------------------------------------------------------------------------- w VNature of Repairs or Alterations—Answer when applicable............................................................................................... •-•'----------•-----•-•-----•-•-•---------•••--------------•----•--•--•-•------•---'-•------.....••••--•------........---•---•--•-•'--•---••••--...----•-•-------...'-•••-•---•--••-•--•.....•-•----•-•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance h y p pace a been issued b the oar Zf he th. Y Signed .. ..... ...................... Date ApplicationApproved By ---------------------- ------------------------------------------------------------------------------------------------------------------------- Date Application Disapproved for the following reasons: ------ ------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------=-------------------------------------------------------------------------------------------------------------------------- ........................................ Date PermitNo. .................. . . ................. .. . .. Issued --------------------------------................................... Date ___, _ ---____-_,___._ — ___—_._.—. ._._.___,---_, __.._. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................ --.. OF ... ..... ..__.........._.......... ........... 01-Prtifi ate of TomplianrE THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ................... . .. . .. Insteller at ......................................... has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ------------------------------------------------ dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.... .................. .. ...... .............. . . .......................... Inspector .... .. ........................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... No......................... FEE........................ RsVoottl- orko Tomitrnrtion rrrmit Permissionis hereby granted.............................................................................................................................................. to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo............................................................................................................................................................................................... Street as shown on the application for Disposal Works Construction Permit No--------------------- Dated.......................................... ..............•-•--...•..--•'--••------------•--•-----------•---•---•-----"-•'•-----------•--•----...... Board of Health DATE..................................... .......................................... Form 1255 H&W HOBBS&WARREN TM Publishers t No................_....... FEa.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _77- 01111t�. OF .................. " . . ............... . Appliration for Uiopoottl Mirkii Tonotrurtiort ramit Application is hereby made for a Permit to Construct (�K) or Repair ( ) an' Individual Sewage Disposal System at: ...— . ....------••...'•---•-•---- . ..........•--_...•-•••••-----•---•...................... ............................................ .......... Location Address of Lot No. Owner `Address w Installer Addressr 1 � d Type of Building Size Lot---- feet U � Dwelling Po. of Bedrooms..................: _______________-____Expansion Attic Garbage Grinder Other—Tye of Building :__._._ ( ) No. of persons____________________________ Showers- ( ) — Cafeteria ( ) p' fixtures ______________________________________________________ �� .............................................w Destgn Flow---------------------_s°,.._ ........gallons per person per day. Total dail� flow-_:_._._.._ _ ..................gallpns. WSeptic Tank—Liquid capacityZ,_� gallons 4ength___ `_Q___:_. Width___e—_______: I)iamefer----------- Depth___�___fQ x Disposal Trench—No.-3............ Width____________________ Total Length_._�� _ _...... Total leaching area_._ .Ss.sq. ft. Seepage Pit No------------.......... Diameter____________________ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank & ) Percolation Test Results Performed by.- :_�`.� _......� ......... AA ........ 16 Date__ ...._ ___. �'A_- minutes per inch Depth of Test Pit___.... _.__. f p g Test Pit No. 1..._. __-__-. Q,:__.. Depth to round water-------- ?....... ._. 44.f0rZ4 Test Pit No. 2.....!;i.;!----minutes per inch Depth of Test Pit------ ._._.. Depth to ground water.......Z44.." 04 4 --------------------------------------------------------------- ......................................................... ODescription of Soil.................... •----------•••--•••••••-•-•••••• -_ ----• -------------........................................................... U w ___ _______________ ___________.............................................................. Nature of Repairs or Alterations—Answer when a licable... Agreement: I The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed �--------------------------------------------------------------- --------------------------------------------------------- ----------------------------------- -------------------------------------- Dare Application Approved By ..-------------------................__.....------'------------- ----------------------------------- .-....-------- — ...-......---- -' Dare Application Disapproved for the following reasons: ................................ ................. . . . ....................................... .. ................ . . . - ....--...-.....-...............-...-......-.... -------- - - ................................................................................. ................................. Daze PermitNo- ----------------------------------------------------------------- t Issued Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............................................. OF :._.................................................................. ---------------------- Q-Ter#ifirate of 19ontpliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by------------------------------------------------------------------------------------------------------------------------------------------ Insraller , at ......................................................... .... ....................... . --- ...... -- . . - ......... ..... ..... .-- ......... -- .. ....... has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No- -----:.......................................... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE---- ------------------------------------------------------------------------ Inspector ..............................................-------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF................................................................_......-------...... No......................... FEE........................ Disposal Workii Tonotruction "rrmit Permission is hereby granted------------------------------------------•----•-•-•-•••'-•--------•-•--••--•----•••••-•-••••-------•--•--•-••-..__........._.........--_... to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo................................................................................................................................................................................................ Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... '-------------'•-----•--._....---------•----------------------------------•-••••-•-•--._....--'•-•••--•'. Board of Health DATE............................................................................... Form 1255 H HOBBS 8 WARREN TM Publishers STEVEN J. D'URSO LIE'T E Environmental Designs 22 Lilly Pond Road W. Boxford, MA 01921 DATE71 t, S,i (508) 352-987 ATTENTION /] /'T TO > WE ARE SENDING YOU X Attached ❑ Under separate cover via the following items: ❑ Shop drawings X Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. C/ DESCRIPTION Ae -� THESE ARE TRANSMITTED as checked below: /16 For 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 ❑ ❑ FOR BIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS COPY TO SIGNED: - If enclosures ars not as noted, kindly notify us at once. Town of North Andover °RT" OFFICE OF 32°yt1�0 L COMMUNITY DEVELOPMENT AND SERVICES ° h A 146 Main Street ` ° North Andover,Massachusetts 01845 9SSACHUS*- (508) 688-9533 December 7, 1995 Steve D'Urso 22 Lilly Pond Street Boxford, MA 01921 Re: Lot #6 Boston Street Dear Steve: This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: 1) No benchmark on site plan (see 310 CMR 15.2209) . 2) Water line missing. 3) Gas baffle needed on tank outlet. 4) No map & parcel number. P.S. I think the locus is wrong. If you have any questions, please do not hesitate to call the Board of Health Office. Sincerer 7 6,'z Sandra Starr, R.S. Health Administrator BOARD OF APPEALS 688-9541 BMDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Julie Parrino D.Robert Nioetta Michael Howard Sandra Starr Kathleen Bradley Colwell I 3 f�J J� r .,w r s�'M'�4rs ri f f v4 t °, �✓ q, w' �ioWZYj'1' r !" °i_TS � ; . • l i Y r � T- s► IIIIIIIIIIIIII�Ii�il:�!♦ IA'1llls 1111111111111®IMEN 121-13111 �� :1111111111®1111MEN 111111 ►1i1�z9111111®1111111111111111 ; IIGI; !IEi?� �ICA��11111111111 .. 111n a 11:1 ! I :Iiliii127�111111 iil��-EIII�AA17A11►��711i11 II �IIA1111 II�I��Illlll!'�C�! 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Cyt�. ,� a� Te. ��. �� ��4`j� 1a°� `lat�+Z'fr'`, fi�,Thi � .h ;Y ♦ , ♦ 'fF et 1 Yi'♦ t \ t r! � VI },Y" t\f `r�.• T', jt l`` ,� 4T? _ '1,;ti�f" •�'�•S',�;'clt'`' 1'i`4`ok 1 , t ,Lt{l S4tr,� ,\[[.�'i�a^ \ . .i .+�h5J1i µyt':Y +'• . .4-k tIh \s.C,)f.tn..i X 1 r ti t�fl..1�1 .'�.,.,lc {1.1. ..+1a\ i\♦♦I igti f�5 \ti t�r. 7j$1 y.\t`'�\�!��n�\t \1` 1' \, �-' i �i rk'47 ... ,.ti'. ...,A1a.\a.L\, .+i'y:• r .'1`.•' e„ : :tt i. .:>. .....E•ti',. ,u.: ,.\.,. .t,.a �.a,.Lig♦, ��t1 yy`,'°v" r, r 4. :C4.. ♦ +b a. .;.. L' t ]'rl Sl,':.....J _ 1aa.\4_.'�:� •s' �. '.�iia`i�a..'xn A�Fr^=14-99 10: 26A Christopher M. Marshall 978-686-8284 P.05 FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify tfia-Tarnecessa a rf rom Boards and Departments having jurisdiction have been obtained. This does not relie e the applicant andlor landowner from compliance with any applicable or requirements. APPLICANT FILLS OUT THIS SECTION i APPLICANT L: l Vt/J PNoNE_ -���` 610 LOCATION: A&w=rs Map Number1 0--M PARCEL.___,_____ � ) i 'SUBDIVISION�Q�L �•�1 1 LOT(g) STREET ASTc'a►? .STrtre.f ST. NUMBER OFFICIAL USE ONLY � /3x30 14Bo�� (anN.l� �� RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER GATE APPROVEO r� DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED c DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WA7ER CONNECTIONS DRIVEWAY PERMIT FIRE OEPARTMEN; RSC IVEO BY EUILOING INSPECTOR DATE rt= MAR 3 Q 2CQ ':'llJ / / - / •�,- s� } y � :, � a -t � A ;�, • � p � ^+.+.. 4 - F .4 Lr �.+.c=?dA-1°7"a.-+.. � ,� 'yam �,, "J� ` ��:.. ��" _�• -�. ,1 ,o� so Dy 1 1� �� . �• � Qp1K �� TAS Q - t • 97, • 7 »yp'1. •��'fl�Sl!agy(�1�t�',•�4+`+i ��li+ ,��i�'y�M�l"rdt z•' J ''j.a .•• Si A ..t '} • � ;, A' •�+M3�r z�''�.�i'ft ri.q�'Ail r41'[,e�4.�»y,y�l *����,�. t 1 :,t ^ ,•(f� - �r i J � �# �r �y� `�f.+rt�'4a� + �ri•,}t�)_-14 i's�S.t. ( at �. .. k. � � 1 • p'�ft frNaJ,.1� r'Tal1-+ e.�'N+ r^ r 1 '+ t irt7� n a + I ti }r,. Y•A,+'�,?+;H' �W- �' '{•IYb'S r -1.: \f ''�i'gif11��a� .. .'1' J. 7� S<Y 1+•�� al� ,�at �•J �fl t.;:t,.1'!.h•J4. 1, It.,��M , ' `At ,# TOWN OF NORTH ANDOVER �. n� !tt'.0 i Fx i f+S •t � . SYSTEM PUMPING RECORD ( • ' ' Wig ap +E A k i„ �.�..y1! ;5+ :>•''�.+ `/r. '�A�#kY.�y�,l,�t•+1 ti ,. w•., .. + .. t � "a1 it+ ,•Kt .,E•?!t `' ` { KiaT'1'�'Nf+?1 `+! +�'ft;>:' t. - t`.• qtr k ARM@= �.f. �a. t..M..•f'.ri t"dT.. „ES t �°^S iSXSTF.M OWNER 40WDRESS 4 SYS�EM'LpCATION. I �+ 4P�e;irt ifi�o 0 use)CY i _ of f h0 � 14 �•+..? w�^4r,C f'�bet t ',i p e} r,.j.Sst..-- � j7 _ '�(' ' � y' •.' .. - �.f! i y�j"r4"[[r7��R'(%�� 1 .•,,� f ,y`+ a.. - 4 J .. - ,, , - 1.. YT� ` •< � �.. •� Krdlr+Vie ..l��X tp,,,.'.. 1' ',y�i, • _ ... ..Y^, . .. .. t PING; ' ,QUANTITY PUMPED GALLONS tjt .h:: 190.�ti•�'a�f , M"�1tGj r ff. tom, r +t j'1 �' ftk ;r' . , Itf' +�iP, QIP; NO .XES`.••,�,, . SEPTIC TANK: NO_ YES s. r 41 �'OF SERVIGE: ROUT�IEM'1 4� YXERGENCY +'' .•tK}•CRT i. + .M.1•.,�?op,ItC-i �'��to , rro +fter ro » .... ..... .,.. . .�. VATioNs•� 1. T, J�1 Y. •Tta ,. sGOOD CONDITION "' �`FULL1TO COVER . "JHEAVY GREASE BAFFLES IN PLACE h�N�Y��r}.f��`��M`I�,�tef'� •'�00•Y � � LEACHFIELD RUNBACK —EXCESSIVE SOLIDS FLOODED + €3� , } , SOT.IDS CARRYOVER OTSER(EXPLAIN2 Wi. � t + �I�IPIYJ♦1� ,'�a,! � � , ,�Sttfi�q�l�i�'��`L�S�''?�,�k`�7�xt��y Mt`q�-��• � ���dl�St�,(j°�''�f :N,. ;.� . y� ���F�y�°ai iM"}Mn1S'sw ti� •�r,Jt fr Y r t+•• l - aft *K.rp"' ,.1 RvJ1 "�•,,'i'lf;A t i r .1 i , 'n _� .. .. _ Y *K t .t��`�+v rnYr w J�v�'•fJi- - " s+� , :1,' Z+w- . . ... .� e x 1 �a5'� .. �r� 5 �.}�i t.[ i.l ��.«+Is 5 !r^� .G 1.�Ry�R t t i, {•.. -._ .•'y'N�1•�i 5•➢�' tlN.(�'.jf�4��ftl,�.>+"`d ft�"1� 1�;t x' Y�r y f � ' -{{},�t}�'�H r•+�1otr+.^6"'At }nr.j of ' .. - `* I �+�Y 1 }y• s•f,, w ! r + `�. a 1.; ,1{va,%.! J!►.v ,Y"..t r fr r , y .i. iA.fq?stc..~1,.�t;V" ;f.. _•l�tRr, 1 !. A/W. .. •H; Srfi'u;S„•y+t c ! 14 IF:,.J afi ball{A'yi+ t i p.- p � i I �1 N�::�'i t�;w ti'{ Y � J • •I >• a y� , •�'}, �.'. + ! 1 1r, 'fit * �t 'If�+J A t r p'•p 7 Y } w .a''. r V y t � ,k,�l♦ ,(�t f r ,f Y {, y t N, �ti7` +.. 7, � �` ��,,Y �I I L•� �r, I r , NORTH AtOOVER. . . R, S 'STEM PUKPI.NG COQ _ ,� • � .. �- 2003 UWNER &::A l?DRESSSYSTCM LOC'A'�T,1ON GrSh�'� (ezam�le; Icf7 from of t r r • � � + '-r (� I it �1i y , ++�_�_ J �VANTITY PUMP D )6 nyu llu j.., C. ►.»i'VUI. 'NOES • SE('TI - / ---- , C TANK : N 0 Y V NUKE 0 ER:YICE,. ROUTINE, EMERGENCY ('(iY;�iTIONSc ; 4'.�.V.Q CU,NU11'hON / h'ULL:TU CUYGI�. 'Fl f? `14�Y CFt rISC''' ' "l3AFFLLS' IN 1)L,ACI? LFA CH FI CLD 1ZUN0AC'x., _T CXCESSIYC SO1�1DS F1.0:0.DEDl . _-- 5'OIyIUI�' /CAyRCiYOy R „' Q RR (EXPLA.IN) syr{ +/1 Y 1'ttn.! l.YriT I'lr i fry*•1(� t ��l f f� rt p. 4 1� e , ` . A+�+(rrlft7ti>yl�rft��>`��r,,�rs'I�( �Jt ri1J�Yr y. t •.1 ru.��I JAI �NTs�; r 1, ✓ y }��,{`{• cs J'[414th.,fr.��l't'.,�1�11i�I�t�7,Y. . _1�`/ IF�y t�'YW1 v y 1,7 r. iv+;,:y,;.,.• ., it� r l Jr• -.i C r � ;,Y rtq 7,,%/.� ���s,l?' tlJ YI�1Y1 �f ti. s I 'r i'�,- .• ONIT I",N.!I'S' 1lANN .�Cltl��'D 'I'U; Commonwealth of Massachusetts City/Town of Nath Reading R LISM .0 a System Pumpilig Record Form 4 OO? NDOVER DEP has provided this fm for use by local Boards of He e u ed, but the information must be sultantially the same as that providing this form, check with your local Board of Health teetermine the form they use. The System Pumping Record must be submitted to the local Board of Healor other approving authority within 14 days from the pumping date in accordance with 310 GR 15.351. A. Facility Infoiation Important: 1. System Location When filling out forms on the 314 Boston Stre computer,use Address only the tab key to move your North Andover MA 01845 cursor-do not City(rown State use the return Zip Code key.�---� 2. System Owner Christopher Mall Name ream Addres m location) Citynown State Zip Code 1 978-686-6106 Telephone Number B. Pumpinecord 9/18/07 1500 1. Date of Pul Date 2. Quantity Pumped: Gallons 3. Type of sy ❑ Cesspool(s) ® Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Otheribe): 4. Effluent ler present? ❑ Yes ® No If yes, was it cleaned? ❑ Yes ❑ No 5. ConditioPtem: Very Gn 6. Systerrr'd By: Jason i L90-471 Name Vehicle License Number Jasoneptic Pumping Compal 7. Locate contents were disposed: GLS ign. Date — Sig Facility Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 I