HomeMy WebLinkAboutMiscellaneous - 333 FOREST STREET 4/30/2018I
4
MAP # LOT
PARCEL # STREET
CONSTRUCTION APPROVAL
HAS PLAN REVIEW FEE BEEN PAID? YES NO
PLAN APPROVAL: DATE 9/.g APP. BY
DESIGNER: PLAN DATE:__ 7//
CONDITIONS
WATER SUPPLY:
WELL PERMIT 302 -
TOWN
WELL
DRILLER._..........Vl... .....--4P
.... . .. ......... ...... .........
WELL TESTS: CHEMICAL DALE APPROVED
BACTERIA I DATE (11 -l -)ROVED
BACTERIA II DATE APPROVED
C7 0A:'
-pp,6844-7A45 CeJ1rv4,-Bit>lTy 6,0e6e
J)AIC-,4,,Ve:s 6 / _CRU
IV :50 UAA
FORM U APPROVAL': APPROVAL TO ISSUE fES
NO
DATE ISSUED �a l /�a ___BY___
CONDITIONS:
. ..... ............... . .. ...... . ... ...... .. . .....
FINAL APPROVAL:.
ALL PERMITS PAIDNU
WYES Y E'�
ELL CONSTRUCTION APPROVAL C�NO
SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO
OTHER YES NO
ANY VARIANCE NEEDED YES NO
FINAL BOARD OF HEALTH APPROVAL: DATE: I BY A
AS BUILT PLAN SATISFACTORY:
APPROVAL TO BACKFILL:
FINAL GRADING APPROVAL:
DATE:
DATE -BY
DATE: �l
.DY_
FINAL CONSTRUCTION APPROVAL:
14
IE M -IN U13 L, LR--T-I.QN
'THEIINSTALLER
;.;,
IS LICENSED?
NO
7 ...,.,TYPE.
OF CONSTRUCTION:
NLW REPn 113
NEW CONSTRUCTION: CERTIFIED
PLOT PLnN REVIEW
YF s NO
CONDITIONS
OF APPROVAL
YLS lqu
(FROM FORM
U)
ISSUANCE OF'DWC PERMIT
YES NO
DWC PERMIT NO.
INSTALLER:
BEGIN.INSPECTION(:5D NO:
EXCAVATION ._INSPECTION
NEEDED: M 007
77,0,A4
PASSED
BY -
CONSTRUCTION INSPECTION:
NEEDED:
96r 1121510e�
C61///CEc7ZE
AS BUILT PLAN SATISFACTORY:
APPROVAL TO BACKFILL:
FINAL GRADING APPROVAL:
DATE:
DATE -BY
DATE: �l
.DY_
FINAL CONSTRUCTION APPROVAL:
Commonwealth of Massachusetts RECEI
4 City/Town of
W° System Pumping Record NOV 3 01011
Form 4 TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
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.
A. Facility Information
1. System Location: Le tight �aL
, Left / Right rear of house, Left / right side of house, Left /
Right side of building, Left / ilding, Left / Right rear of building, Under deck
Address
City/Town State ry Zip Code
2. System Owner:
ft1�
Name
Address (if different from location)
CitylTown State, :3 Zip
l de
Telephone Number
B. Pumping Record
1. Date of Pumping _ 2. Quantity Pumped:
Date Gallons
3. Type of system: ❑ Cesspool(s)eptic Tank ❑ Tight Tank
❑ Other (describe):
4. Effluent Tee Filter present? ❑ Yes 1:4 O If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of S st m:�-�
6. System Pumped By:
Neil Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7. Locati a contents were disposed: J
G.L S. Lowell Waste Water
t( f r? l�
Sign toe Haule Date
t5form4.doc• 06/03 System Pumping Recons • Page 1 of 1
Commonwealth of Massachusetts
City/Town of I RF(71EIVE®
System Pumping Record
w� Form 4 JUN 1 2 2006
DEP has provided this form for use by local Boards of Health.. Th yp em- rP,uM—,—in R@ must
be submitted to the local Board of Health or other approving auth
A. Facility Information
Important:
When filling out 1. SyStef� Location:
forms on the ,�
computer, use
only the tab key
to move your
Address
,
%tr
cursor - do not
t
use the return
Gi !Town
ty
i "'
Stat Zip Code
key.
2. System Owner:
Name
Address (if different
from location)
Cityfrown .
Stat Zip Code
Telephone Number
B. Pumping. Record
1. Date of Pumping �
P g Date 2. Quantity` Pumped: Gallons
3. Type of system: ❑ Cesspool(s) eptic Tank- ❑ Tight Tank
❑ Other (describe):
4. Effluent Tee Filter present? ❑ Yes ❑ o If yes, was it cleaned? ❑Yes ❑ No
5. Condition of System:
6. Syst m Pumped By'�1
Name Vehicle License Number
Company --
7. Locatii where contents w disposed:
of hteuler
http
t5form4.doc• 06103
rm#inspect
System Pumping Record •Page 1 of 1
-A
T (J -KI '1 - U L V 1 rc r,LL' Y -10m, F 1J1 IV-V
INSTRUCTIONS' This form is used to verify that all necessary approval /permits from `1
Boards and Departments having jurisdiction have been obtained. This. does not relieve the
applicant and or landowner from compliance with any applicable requirements.
■..........■.r��........■rr............■..■......u....r.r..........�....
APPLICANT PHONE( 5 �2 C}
ASSESSORS MAP NUi13ER
LOT NUMBER
\STREET ORM �3� —STREET NUMBER
■r.r oganwasawassms
FFICTAT• USE ONLY ...........................
Imousses .....■........-0....r...' .................. r.... r...■.....■...........■.
RECONLNffiNDATIONS OF TOWN AGENTS
Mass
/Now MOON .......■■■..........r............Museum ■......■r..'..............
7/ DATE APPROVED
LeONSER VATION ADMINISTRATOR
DATE REJECTED
DATE APPROVED
TOWN PLANNER
DATE REJECTED
CONIMEN'lS
DATE APPROVED
COD RN4SPECT6QR TH DATE REJECTED
r
DATE APPROVED .
SEPTIC P OR - HEAL
DATE REJECTED
PUBLIC WORKS — SEWER / WATER CONNECTIONS
DRIVEWAY PERMIT
DATE APPROVED
FIRE DEPARTMENT
DATE REJECTED
COMMENTS
RECEIVED BY BUILDING INSPECTOR
FINE
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�- 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 -1L"� PHONE
LOCATION: Assessors Map Number 1 d(o k PARCEL a—
OFFICIAL USE ONLY
RECOMMENDATIONS OF TOWN AGENTS:
/X x CONSERVATION ADMINISTRATOR DATE APPROVED
DATE REJECTED ((I U
COMMENTS
TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS
FOOD INSIDE R -HEALTH DATE APPROVED
DATE REJECTED
!I SF,PTI INS CTOR-HEALTH DATE APPROVED Z v
/X f ' DATE REJECTED
COMMENTS r r IZJ raL'1 /.G
-7Z,) _
PUBLIC WORKS - SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR DATE
Revised 9197 jm
SUBDIVISION
LOT (S)
STREET �vS�
�
ST. NUMBER 3 3 3
OFFICIAL USE ONLY
RECOMMENDATIONS OF TOWN AGENTS:
/X x CONSERVATION ADMINISTRATOR DATE APPROVED
DATE REJECTED ((I U
COMMENTS
TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS
FOOD INSIDE R -HEALTH DATE APPROVED
DATE REJECTED
!I SF,PTI INS CTOR-HEALTH DATE APPROVED Z v
/X f ' DATE REJECTED
COMMENTS r r IZJ raL'1 /.G
-7Z,) _
PUBLIC WORKS - SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR DATE
Revised 9197 jm
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7"/9ti,�
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PROPoS
DL-qa N•
(zo 8i ksmoo1W9)
Ex\st\tA&
'TANK EX15,TlN& •
REPtAe EMENT
TANK(z,oco Im.
SHR -A coNc.
orR,.)
I hereby certify that I have
inspected the construction
df 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
15.00.
N
00
F-YxSTIN6 `CANk-%8Eves
QU'ct�QEO e CRuSXp AND
soP 2eQvi2�ENT 6AcK�w�EO w/ sANO.
(/50 Y = /50 -- _ ......:.................... AO- MAS MSN. k0' To) DESrGN aEVdT/ON ,4r.........(rOP OF STONE) _ . , .. , .. , ..
EX/5T/NC� ELEV�IrroN QT......... �2E'QU/QED FILL a ............................ .
5/-eyo 1T/ON.S
A//p
je0A 7V-
/NV PIPE OUT OF /DOUSE
/' $ , 0
/�S• Zf-
X,
660-,�'U�F,4CL D/Sf•'O .l4
/NV P/PE /NTO T.4/VK
/3 #-/
/NV P/PE OUr OF TANK
J 3 7., Z5
j 3 7, 2'3
C
/ 3 7. / q 51/5
/NV PIPE /NTO 0 BOX
/ 4-1,
//VV P/PE OUT OF 0,30X
/-1+.0,4
� � �, g�
-- �N� p i/��
/NV END OF P/PE
log• O
/`��• �l
'INV. P 1Q E TN'CO RFPI.AC. T K,
G7.5
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,4 VE2,40E STONE
5C,4L E : / `ASO � D•4 TE: IVO✓, /7 M2
DEPT,/ ,4T P�eOBE
ReV(seD ; ` %-Q\y \\, iag6
C�IRI STIQ NSEN SEf3 C71, INC,
NOTE. r�//5 PL,4N is NOT
,a WAee.4NrY
OF TY4/E SYSTEM
BUT 14 l (Po WMMER STREET HAVERHILL , MASS.
OF Tf/E LOC.4T/ON OF MMC-
EX/ST/NU PROPOSED -c�lomAs �.�uF���.��,�.
sreucr�2Es.
.
R�v\s�oN 6y P,Obox 12y , � horn. NN
6
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V-- Y10MACT
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• ��CNWmB�R O
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I hereby certify that I have �I
inspected the construction
Cf 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
15.00.
EMUS -T G TANK TO SE
UI/2'�E�t�1�1`lr QWnQEO E CRus\1£9 AND
SLOPE 2 Q BAc.K��u.EO w J S AND. •
/50 y = /50 — _ ..:.................... ALS TANks M1N. to' To
x ANY STRU\CmAk e.
DES/GN E'CEI/,4T/ON AT.........(r0P of STONE> • .......... �"' ..
EX/ST/NC. ELEI/GT/ON dT ......... REQU/leED F/LL a
DES/�N Qs eamr Revlso
/NV P/PE OUr OF POO LI
/NV P/PE /NTD UM'
/NV PIPE OUT OF Tt1NK
/NV P/PE WITO .D. BOX
//VV P/PE OUr OF D. Box
/NV END OF PIPE
'INV. ?WE MIAV6 RFPI.PC. "CK.
INS• ?WE OUT REP�A�c.'TX.
4 VE244E STONE
DEPTH QT P,eOBE
37 23 / 3 7. /q
AS
-SU,eF,OCE
SYSTEM
/ 1+0ft 143-9 /VOR71f
A
5 SllNlt.Y;; : ti
9 No. SfS,
D
JOX�
F02
137.5
D4 r- /7,,
ReVtseD : T\.%\y \\, RRG
NOTE.- rA/rs P1 -,4N /5 /VDT .4 !�/,4,ee.4NTY C�•lRISTIQ NSEIV � SER Gl ,INC,
OF THE SYSTEM BUT A M6-01F/C,4r/ON /�4 SUMMER STREET NAVERH/LL , MAss.
OF Tf/E 10C.4T/ON OF T//E EX/ST/NCE PROPOSED --rKomAs A.DuT-FLSLQAS
S7',eUC7U2E5. ?zV\S16N 6Y Q,O. Box 12y ,Thorh'�o� NN
. \
APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT
DATE: �' l} -� CURRENT INSTALLER'S LICENSE#��
LOCATION: 3 3 7 i 5--,r-
LICENSED
:T
LICENSED INSTALLER: l�/1 I�,L ✓��
SIGNATURE: �� TELEPHONE# b c� 5":_ a O26"�
CHECK ON
REPAIR: X NEW CONSTRUCTION:
IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT.
Administrative Use Only
$75.00 Fee Attached? Yes ✓ No
Foundation As -Built? Yes No
Approval �� ��_ Date: r /
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66 UTTLETON ROAD
MA 01886
Report; Number: C w1,& -6t103
Cti.ent:
Wilmington Pump Supply Inc.
11.0. Box 517
Wilmington, MA 03.887
Sample Taken By: Wl'S Staff
Ares
(508) 692.8395 PAX (508) 692.0023
1•800.649 -TEST
Report Date: September 16,1992
Sample Taken At:
Richard Jackson
228 Forest St.
N. Andover NLA
On: September 17,1992
CERTIFICATE OF ANALYSIS
TESD' PARAMETER:
FPA Max
RESULTS
UNITS
Total Coliform (P)
0
0
Per 100tn1
Calcium
No Limit:
32.7
mg/L
Capper (S)
1.3
0.07
mg/L
Iron (S)
0.3
�#7- 3 7 -`
mg/L
Magnesium
No Li.ju.it
2.5
mg/L
Manganese (5)
0.05
Sodium
" 20
mgfL
Potauslum (S)
No Limit:
2.0
mg/1,
Alkal.inity (S)
No i,i.mit
64
rad;/L
Ammonia
No Limit
0.04
mg/1'
Chloride (S)
250
27.1
mg/L
Chlorine (total)
Not Spec
0.04
mg/L
Color (S)
15
CPU
Conductivity
No Limit
447
umbos/cm
Hardness
No Limit
92
mg/L
N,itrates(as N)(P)
10
0.05
mg/L
Ni.trites(as N)
1
<0.01
mg/L
PH (S)
6.5-8.5
7.3
SU
Odor. (S)
3
3
TON
Sulphates (S)
250
30.1.
mg/L
Turbi.di ty
5=_=I9
5
NTU
Sediment
f,o�/ncg.
pps
NT=Not Tested, #=Value Exceeds EPA STD,
TNTC -Too Numerous
to Cotxnt
*=Background Bacteria Noted,
"=-EPA Advisory Limit.
'..Exceeds EPA Advisory Limit
(P)=Primary LPA Standard, (S)zSecordary
EPA Standard (may
affect
vost.ltetics of drinking water.
i.e. tast,v,
(:olor, etc.)
This water ,ample, as tested, iS COTI idered SANE, to drink according
to RPA guidelines. llawever, one or more of. 0li-, yaraweLers exceeds
IPPA secondary standards as indicated by the (#) hign.
Massachusett-s State Certified Michael P. Carlson, for
Testing Laboratury #MA048 Thorbtensen Laboratory Inc.
Department of Environmental Management/Division of Water Resources
a �
' WATER WELL COMPLETION REPORT
WELL LOCATION
�r►
S�
GEOGRAPHIC DESCRIPTION
Address ,(07_%x .s/
S/Q9 N S E(0 of
WELL TEST
(leer! (circle)
City/Town- '�
/'17, ,$ 7' S T
/
Well owner PICA,
!/
C/G�1/
(road)
Address A®e,4-S7- .� �'
inn . 0 S E of
w/ LtW/ /Q41lele
(mt. in tenths! (circlet
intersect.( >4
Board of Health permit: yes 1K]
no ❑
WELL USE
WELL DATA
Domestic a Public ❑ Industrial ❑
Total well depth ft.
Monitoring ❑ Other
Depth to bedrock ft.
Method drilled �O�i4Q,�
Water -bearing rock/unconsolidated material:
o
_
Description MEW (12,
Date drilled
CASING
Water -bearing zones:
1) From 3� To •33'y
Type �7 �< ��_
2) From11,6716
Length yo ft. Dia�.I.D.) 6 in.
�To
3) From To
Length into bedrock 2� ft.
Gravel pack well: dia.
Protective well seal:
Grout -El 0ther�.��U s%%J.E
Screen: dia.
Slott/ length from_to
STATIC WATER LEVEL
Static water level below land surface ft. Date 9-i5/' 3'e''
WELL TEST
Drawdown__�?_,160_ft, after pumping hr. min. at �• gpm
How measured Recovery ft. after4? hr. min.
LOG of FORMATIONS 1 COMMENTS
c
A
0
Driller t:.>ri (./S+W s0�✓
Mass. ;)"C"
'stration # 6
Firm &"Ze`
Address Awdoyce ST
City/T,gwn b
ROARn✓OF HEALTH COPY
BOARD OF t-1EALTH Ah AhISNA%
Town of North Andover,Mass.
Permit Date- 19
APPLICATION FOR WELL & PUMP PERMIT
Application is hereby made for permit to drill a well ( Application is
made to install (_) a pump system'.
Location: Address r0,��g7— Lot �f
Owner �cAc1 �� t/�` Address es-� �- �iflt�ZEi�. "rel
Well Contractor Ufa r4 � � Address Tel.
Pump Contractor/nr�'�—"4//u 1:�Address � � j�'r%I Tel.
WELL CONTRACTOR (To be completed at time of purnp test)
Type of Well_ / Well used for
Diameter of Well (6, Size of. Casing Al
Depth of Bed Rock /,- Depth casing into Bed Rock �f r.� 4!d 7_2 �y_A .
Was Seal Tested? Yes (,M No (—) Date. of Testing 5)
Depth ••o -f Ue — 0 _. Well Ended in W.ha.t. Material
Depth to Water ,gyp Delivers
Gals .Per Min. for 4 hours
Drawdown feet after pumpingiours, at _ GPM
Date of* Completion
Si8natu e Wrell Contractor
PUMP INSTALLER (To be-- filled in- before installation)
Size & Name Pump Goo'-fr c _Pump Type Used
Water Pump Delivers GPM' Size of Tank_Y_7e0415 (p Q
Pipe Material Used in Well: Cast Iron ( ) 0,11.vrini.zed (_) Plastic ( i
Well Pit (—) or Pitless .Adapter ( ) 'D)U
Was sleeve used to protect pipe? Yes.(—) NO(—) T pe or Name Well Seal
Date q-, 9C3,
P1.. P P, l w,,K ' , c 7
Date Water analyst's repdr-t 'submitted to Board of H`cal'th
Date release given W owner of record & Bldg.. Insp
Health Inspector
C3
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DATE 8 g
Sheet of
BOARD OF HEALTH
TOWN OF NORTH ANDOVER
SUBSURFACE DISPOSAL DESIGN REVIEW %
FEE �o� PERMIT # DATE RECEIVED 71A'�2 A�
APPLICANTlcho,,,lock5�1't--
ADDRESS —'PC ��'�' :_. /
ENGINEER NK15,114175 ea? 54 S Pr,�/
ADDRESS /60
PLAN DATE
CONDITIONS OF APPROVAL:
APPROVED / / 9/ '7 -L
ASSESSOR'S MAP
PARCEL #
LOT # 3
STREET # �DY� 5 SLl
REVISION DATE
DISAPPROVED
b/ � '�,D � isTANc�s OF sYs r�� �or�1,�a�V�N7'� T� ,��Usr CN,q. x•03 a-�
(/ •040-1
1--ouNb,47'1o/L' vR191N Liv 111-09V)
UVIP 610-92)
L(J&/-,c- ,-O c 1q T/o A/ (o /s' u -)A reR z iNc:)
/,,0 LUtr ,,9Nb5 /SC��/M��' IVOT� CM / l
/.
- - 3&bl ooM.5 (A1,17. A,14
/
,/ t %N 5 u C /-E
0<7) 7J 5.E of D Dd -G A x- =5�� f'Ti c T/��Y K C/V /� - 4 : O
VENT ro Bc .-GCAreb /3r ,-NO oG C'N�MBEiPs C3/v CSR
NOr
Q /1) Al rN 1�9&c J `d" 413u7ieieS MI5 51W6 IV
iD 5 i rE- PZ AW
16-,13 (3),
R4i=Z,!!Fc7-- ;-lef�0 _6/-_._9
d,444 ANOUTS'?
DATE 92�h
BOARD OF HEALTH
TOWN OF NORTH ANDOVER
SUBSURFACE DISPOSAL DESIGN REVIEW
Sheet of
FEE�PERMIT # Ssy DATE RECEIVED
APPLICANT---k'/C/24,,-,d TIPC%5- ASSESSOR' S MAP
ADDRESS
ENGINEER
ADDRESS _
PLAN DATE
CONDITIONS OF APPROVAL:
APPROVED
DISAPPROVED
PARCEL #
LOT #
STREET #
REVISION DATE _�91SIIV71
BOARD OF HEALTH
120 MAIN STREET
NORTH ANDOVER, MASS. 01845
TO: Chrisitnesen & Sergi
160 Summer Street
Haverhill, MA 01830
FROM: Sandra Starr
RE: Plans Lot 3 Forest Street
t
1
1
TEL. 682-6483
Ext. 32
DATE: August 31.1992
Dear Phil:.
This is to inform you that the proposed septic design plans
for the above site dated July 14, 1992 have been
APPROVED.
If you have any questions about the next step in the
process, please call the Board of Health office.
APPROVED WITH THE FOLLOWING CONDITIONS:
DISAPPROVED FOR THE FOLLOWING REASONS:
Please see attached sheet.
DATE 8 8 gat Sheet of
BOARD OF HEALTH
TOWN OF NORTH ANDOVER
SUBSURFACE DISPOSAL DESIGN REVIEW %%
FEE (X�0� PERMIT # (J7Lly DATE RECEIVED 7*2ho,2
APPLICANT�lChOt-SCG ASSESSOR'S MAP
ADDRESS -W - Aorf�74- /i'. i`7. PARCEL #
ENGINEER NL151/6i� s en
ADDRESS 160
PLAN DATE
CONDITIONS OF APPROVAL:
APPROVED
DISAPPROVED X
LOT # 3
STREET
REVISION DATE
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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: ,'�C� IC r; r< i) �[.f�fOn Phone1413
LOCATION: Assessor's Map Number Parcel
Subdivision NhA Lot(s)
Street �y� St. Number
************************Official Use Only************************
RECOOMMEENDATIONS OF TOWN AGENTS: !� /
Date Approved G l q
Conservation Administrator Date Rejected
Comments
V.b64
Town Planner
Date Approved
Date Rejected
I
• 42LOE.�
-- -t4--, Date Approved /� C
Health Agent Date Rejected
Comments
Public Works - sewer/water connections
- driveway permit
Fire Department) =E -L
Receiv,ed by Building Inspector
Date
WELLS
ARTESIAN
EXPLORATORY
REHABILITATION
TEST WELLS
GRAVEL DEVELOPER
GRAVEL PACKED
Wilmington Pump Supply, Inc.
Est. 1936
Water Supply Contractors
MUNICIPAL - INDUSTRIAL
639 Woburn Street - P.O. Box 517 - Wilmington, MA 01887-0717
Tel. Area Code (508) 658-9111
Mr. Richard Jackson
Ref: Lot 3 288 Forest St. No. Andover
PUMPS
SALES & SERVICE
TURBINE
CENTRIFUGAL
SUBMERSIBLE
SEWAGE
CHEMICAL
September 21, 1992
Item #1 To correct turbidity, sediment, color, manganese
and iron We recommend installing One Lancaster DAIM
Unit. Samples to be taken after unit has been
.installed.
Note..If Sodium needs to be removed We recommend
One Lancaster Reverse Osmosis drinking water
system.
If you have any further questions pleas call me.
Robert Duggan
Wilmington Pump Supply Inc.
DATE f 9 6 90`�
Sheet of
BOARD OF HEALTH
TOWN OF NORTH ANDOVER
SUBSURFACE DISPOSAL DESIGN REVIEW
DVPMTT $ 7 DATE RECEIVED 71A'2 yj
APPLICANT��(CLLLZ J06A--<,l!2't' ASSESSOR'S MAP
ADDRESS �'r* <. :�.'� ' ,�' '• PARCEL #
ENGINEER C�/7i'lST/4�r5 ell
ADDRESS /60
PLAN DATE
CONDITIONS OF APPROVAL:
APPROVED
DISAPPROVED X
LOT # 3
STREET
REVISION DATE
�) Nc'�IJ IST.9N��5 OF sYs T��1 �o�U�tI�NT� 7Td 15166)ss CNA 03 c;
a) NEEb ��Nc/�,�'JAR,� //V u�CrPK/N6 /3.PEA ��/ � G •o4Q�
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41 l Ni O 60&41- I -a C A r/o AI (Op( u l9 reR L iivc') CN , A G v
5�No cuc r.4.9ND s ais c,�.19//w&le /vor� CA/
(N,A. A, 14)
7) Use aDDG 6Y,9,Z /< �N� /� 9 : o�)
g) VENT TO Be- .-oc:Are-b /3r ,6lv0 op C!N/gi'+BERS (3/4f) EMIZ /cS;l3(Iq�>
9) 5 Ptif�SN �A�S t3Ec�u BRED• (. 3ib e.y� /5S l3 (3j,
16) -pump �r��e��NGy G2APN oc 5 NoT C/ ,
/i) NoRIT/N /906cO cv� 1�13u;7-6,Ws Mr55//VG (N./9 4 19NY ccJ,LGS
1a) U04 vME o h pump C f�/�Mt3F�
io
BOARD OF HEALTH
120 MAIN STREET
NORTH ANDOVER, MASS. 01845
TO: Chrisitnesen & Sera;
160 Summer Street
Haverhill, MA 01830
FROM: Sandra Starr
RE: Plans Lot 3 Forest Street
TEL. 682-6483
Ext. 32
DATE: August 31. -1992
Dear Phil:.
This is to inform you that the proposed septic design plans
for the above site dated July 14, 1992 have been
APPROVED.
If you have any questions about the next step in the
process, please call the Board of Health office.
APPROVED WITH THE FOLLOWING CONDITIONS:
DISAPPROVED FOR THE FOLLOWING REASONS:
Please see attached sheet.
C
Form No. 3
: Town of North Andover, Massachusetts
BOARD OF HEALTH (�J
• HORTM I V
• pt t� �� o V ° 1'ti'p
O
F p
�,�•°,,,,;,,••� DISPOSAL WORKS CONSTRUCTION PERMIT
• SACMUSES
Applicant NAME ADDRESS
• 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
D.W.C. No.
Fee +
s
66 LITTLETON ROAD WESTFORD, MA 01886 (508) 692.8395 FAX (508) 692-0023 1.800 -649 -TEST
Report Number: C -WPB -8382
Client:
Wilmington Pump supply Inc.
P.O. pox 517
Wilmington, MA 01687
sample Taken ay:Client
TEST PARAMETER:
Report Date: April 14, 1993
Sample Taken At:
R. Jackson
228 Forest St.
N.Andover,Mass.
On: April 13, 1993
CERTIFICATE OF ANALYSIS
EPA Max RESULTS UNITS
calcium
No Limit
0.38
mg/L
copper (S)
1.3
<0.02
mg/L
Iron (S)
0.3
0.13
mg/L
Magnesium
No Limit
<0.01
mg/L
manganese (S)
0.05
<0.01
mg/L
Wardness
No Limit
<2
mg/L
pH (S)
6.5-8.5
7.5
SU
Turbidity (P)
5
0.72
NTU
#-Value exceeds EPA Standard
--=EPA Advisory Limit
—Exceeds EPA Advisory Limit
Massachusetts state certified
Testing Laboratory #MA048
Michael P. Carlson, for
Thorstensen Laboratory Inc.
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I hereby certify that I have
inspected the construction"
of 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
15.00.
(/50) X = /50 . _ ........................... eg.....o
DES/GN E�EI/4T/ON ,4T.........(TOP OFSTD/VE) _ .....,..., ...... .
EX15T1NG aEWTION .4r ......... 2EQU12E49 F/LL = ............................ .
z�L�I��IT/ON.S
/NV PIPE OUT OF!-/OU,5E
/NV P/PE INTO TANK
INV. P/FE OUT OF T<1NK
INV !'/PE • INTO D. BOX
INV P/PE OUT OF D. BOX
INV ENO OF. PIPE
GV,4TE2 EL Lc -k1,4 T/ON
,4 VE1?.4 E 5 TONE
DEPTH ,4T PeOBE
N/r-
.0ie A- T/ --
DE51(!�N ,4s BUIL - ofS BU/L T
NOTE .- TN/S PL ,4N /S NOT ,4 91,,4ele,4NT Y
OF T,4/E SYSTEM BUT A IV6�?IF/C,I7-10N
OF TIVE LOCATION OF 7W- E EX/STING
ST�UCTU2ES.
- SUKF,4CE D/.
SYSTEM
�Vo,�Tf/
//V
/4A41-
F02
� j i4 cKSoti/
D4 TE: n/o✓r. /7, 992
CUR/5TIAN5EN SERGI , INC.
/&0 SUMMER STREET HAVERRILL , MASS.
.� ,�-370
/37./1
/ 3-7.2-5
X37,23
/74-.04
/ 3.
/4-33. 95
144-0
1�3.qI
NOTE .- TN/S PL ,4N /S NOT ,4 91,,4ele,4NT Y
OF T,4/E SYSTEM BUT A IV6�?IF/C,I7-10N
OF TIVE LOCATION OF 7W- E EX/STING
ST�UCTU2ES.
- SUKF,4CE D/.
SYSTEM
�Vo,�Tf/
//V
/4A41-
F02
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D4 TE: n/o✓r. /7, 992
CUR/5TIAN5EN SERGI , INC.
/&0 SUMMER STREET HAVERRILL , MASS.
.� ,�-370
FORM U - VERIFICATION FORM '
INSTRUCTIONS: This form is used to verify that all nece sary
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 st�te law,
regulations or requirements.
****************Applicant fills out this section********** *****
APPLICANT: ��%b C _L , 1 luy ,� Phone 4� S s 7 �
LOCATION: Assessor's Map Number
Subdivision
Parcel
Lot (s)
Street L ..
St. Number �? S
Use Only*******************
RECOMMF�NDATIONS, TOWN AGENTS:
Con�ry an dministrator
Comments
Town Planner
Comments
Food. Inspector -Health
L/Septic Inspector -Health
Date Approved
Date Rejected
Date Approved
Date Rejected
Date Approved
Date Rejected
Date Approved Flo C
Date Rejected
Comments SEPT/G Ti9�U� j✓��/$T �� /ti ���CT�j BCi�Q,��=
Public Works - sewer/water connections
- driveway permit
Fire Department
Received by Building Inspector Date
Town of North Andover, Massachusetts Form No. 3
BOARD OF HEALTH
NoRTH19
F A
DISPOSAL WORKS CONSTRUCTION PERMIT
4SSACMU`oE�
Applicant /MVIA-"
TELEPHONE
NAME ADDRESS
Site Location—
Permission is hereby granted to Construct ( ) or Repair (t—Y-A-n Individual Soil Absorption
Sewage Disposal System as shown on the Design Approval S.S. No.
Fee 071- 00
CHAIRMAN, BOARD OF HEALTH
D.W.C. No. �S
N% os�
G U A, -r/S
Al
a'
PROPOSE
D M.1m,
('co BE A6ANDo�SRD�
Ex�s��Nf,
SANK £X15'�1N6 ®,
�. A�"P CHAtnBER o
AA
RSPtAe WENT
" TANK(2,oeb 6R1.
S%P-k' CONC.
I hereby certify that I have
inspected the construction
df this disposal system and that
the construction and final grading
has been in accordance with the
designer's intent and that the-
materials
he materials used conform to the .
plan specifications and 310 CMR
15.00.
MM
E1(.1sC 1N b TSN\� �o �E. P
QU`tmQEO e CRusll£p ANO
2eQ
UIfec"ENT BNMrR\j-Eo W/ salvo.
ASL wa s M\t�. to` To
(/50) y = /50 — = ........... I ............... P.NY s-rRu,�TuRE �.
TOP OF STONES.
DES/CN EC EVA AT..... (2EQ�1/QED F/LL - ...................
EX/5T/NG ELEVd7-1O1V ,1T .........
N1F
,6 lt-- A �T-l�
C7L
oEs/�N 14s 3LIlt Rey tSED ,4.5 45111.7
A aiPC' n1/T Of N(JU.) c
inw P/PC INTO /A/VK
in/1/ P/PC OIJT Ur I!-UVA
/A/I/ �/D� IN71) U. ZIUX
A ,cVAc n7/T OF O. f� Ux
560
/V VM P / f7,
ouFFir��.a P
o SAH..
r
3i5�1..-� Q1 6
ST Pr 4
. - A /%
STEM
/N
/NV END OF PIPE ��7' v i T =�' ± FOR
-INV. P \Q v TK.�yAR D � cK—S'o N
Nil Pie )-UT M� LNC, -M. I i. 5 �� r DATE: off, / /9%
4 VE2/l0i E STONE ReYtseD ; `5`v.\��
DEPTH 4T P,eOaE CWRISTIANSEN SEf�GI ,INC.
NOTE.• T111,5 f'L<1N /S NOT .4 WQ161e'4NTY ��0 SUMMER STREET HAVERN/LL ,MASS.
OF THE
OF CQOE/
TI -IE / FT/E E/SN RoPoSE� TKAs1�L0,
OT N O�.
iZEV\S1�N 6y
sreucTU2Es. Q.o. Box 12y 7 horh�rof� N
E�
TO
DAT
T ,iE t
v
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FRO
AhEA COLE
NUMBER
W
.
OF
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/
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URGED CJ cxLinnEo � BACK
AGAIti ALL Q rHorr .D (YC�NYOUC
{HAS
AMPAD NO.23-176-400`oETS NO. 23-376-200 SETS
PLAN REVIEW CHECKLIST
ADDRESS ! ENGINEER
GENERAL /
3 COPIESy STAMP L,-' LOCUS ✓✓ SCALE CONTOURS
PROFILE C/ SECTION BENCHMARK /Y ELEVATIONS SOIL
& PERC INFO WETS. DISCLAIMER ,�- WELLS & WETLANDS
WATERSHED? DRIVEWAY (Elevations) WATER LINE
DRAINS � SCH40 SLOPE TESTS CURRENT?
SEPTIC TANK
a 60b
MIN 1500G. .17 INVERT DROPy GARB. GRINDER Fol) (+2OOo EDF)
25' TO CELLAR pl5u,�e. MANHOLE TO GRADE ELEV GW
D -BOX
SIZE -% # LINES 3 FIRST 2' LEVEL STATEMENT
INLET OUTLET j� y.0 = •/�j (2" OR .17 FT) '3
LEACHING
/ ,-7
RESERVE AREA (/ 4' FROM PRIMARY? 100' TO WETLANDS 2% SLOPE
100' TO WELLS 325' TO SURFACE H2O SUPPA/)q 35' TO FND & INTRCPTR
DRAINS 4' TO S.H.GW 4' PERM. SOIL BELOW FACILITY MIN
12" COVER ✓ FILL? (25' if above natural elevation; 101if below)
TRENCHES
MIN 660 gpd SLOPE (min .005 or 6"/1001) >3' COVER? - VENT_
SIDEWALL DIST. 2X EFF. W OR D (MIN 61) IS RESERVE BETWEEN
TRENCHES? IN FILL? MUST BE 10' MIN. 4" PEA STONE?
BOT X LDNG + SIDE X LDNG = TOT
(L x W x #) (G/ft2) (DxLx2x#)
f�.
PITS
MIN -6-60 LEACHING GW MIN 4' BELOW BOTTOM c/ MANHOLE/PIT
EXCAV 2x EFF W OR D D/ 12"-48" STONE SURROUNDING
BOT + SIDE x LOAD = TOTAL
(L x W x #) (2 x (L+W) x D x #)
CHAMBERS NB - 6 B- f. = 9c1a G Pb
COVER >3 FT - VENT L'--' g'pl-' 5# pats p1PE 5CI440 veer
SND oA -'-INC
S Lfi PE •ci-
FIELDS
MIN 900 ft LEACHING PERC RATE FASTER THAN 20M/IN GW MIN
4' BELOW BOTTOM OF FIELD PIPE ENDS JOINED W/NON-PERF. PIPE?
4" PEA STONE? DIST LINE SLOPE .005? >3' COVER - VENT
SCH 40 MIN 12" COVER L x W = T x LDNG > DESIGN FLOW?
DOSING TANKS AND PUMPS
DIMENSIONS C� X 9 X V� v� _ /DdD PUMP CAPACITY C> gpm
L W— Vol.
DISCHARGE SIZE DISCHARGE RATE
MANHOLES TO GRADE ALARM SEP. CIRC.
inlet) HWL %33.,20 LWL 13a,76 CHECK VALVE
OP. SWITCH
&'I-ep) 0 Q 133.70
C, bv7'l T Q-) 0
�N.
-"�_ Box,IN- Q /4'�•Z0 7jab
DISCHARGE TIME
gpm
GW r/ (Min. 1' below
BLEEDER HOLE L---' MANUAL
t
014r Lfommunwr# of ttos#uoetts
Beva'tairIIt of Pu�111L ufPtg
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
Office Use Only�.__:: �
Permit No. l
Occupancy & Fee Checked
3/90 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
(X* or Town of NORTH ANDOVER To the Inspector of Wires:
The udersigned applies for a permit to perform the electrical work described below.
Location (Street & Number) 333 rOR'��` Si/2
Owner or Tenant �!cY/¢�% �AG/C -S34-2)
Owner's Address $�
1 h t n coniunction with a building permit: Yes C No ❑ (Check Appropriate Box)
S tIls permI )
Purpose of Building S!/1i6� �jU7lC Utility Authorization No
Existing Service Amps _J Volts Overhead ❑ Undgrnd ❑
New Service Amps _J Volts Overhead ❑ Undgrnd ❑
No. of Meters
No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrigal Work'��GO��r `✓�fl ��G -�ll?lfl�
U�
Total
No. of Lighting Outlets No. of Hot Tubs
No. of Transformers KVA
No. o` LighUr.y Fix;ores j I Swimming Pool grnd. Above ❑ In-
grnd. F-11Generators
U
KVA
No. of Emergency Lighting
No. of Receptacle Outlets No. of Oil Burners
Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS No. of Zones
No. of Oatection and
Total
Ranges No. of ; ranges
No. of Air Cond.
tons
Initiating Devices
Heat Total Total
No. of Disposals
No'of Pumps Tons KW
No. of Sounding Devices
No. of Self Contained
No -)f Dishwashers
I Space/Area Heating KW
Detection/:sounding Devices
I ,nnal J� Municipal r— Oth,r
Cun!:ecticn
l
No. of Dryers
He. -ting Devices KW
I 9
_�
No. of No of "'
Low Voltage,
ateeaters KW,__ .
Nc. of Wr H
[,No.
Ballasts _
Wiring
No. Hydro Massage Tubs
No. of Motors Total HP
OTHER: + '
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws
1 have a cujjent Liability Insurance Policy including Comprel ed Operations Coverage or its substantial equivalent. YES ��NO 1
have submitted valid proof of same to the Office. YES t/ NO _ If you have checked YES, please indicate the type of coverage by
checking the appropriate box.
INSU:-PANCE 'BOND ` OTHER (Please Specify)
(Expiration Date)
Estimated Value of Electrical Work S Li���• Q e,r /
Work to Start �%/7 "G f' Inspection Date Requested: Rough T Final vK
SI)Rned under the Penalties of pee'rjjuryy:D�0
/i�/Z �/TiLl/i(��L _,y /A)(f.
FIRM NAME /7� /// —1 n LIC. NO. s �(
Licensee
LIC. NO.0�`-�f!L
� Bus. Tel. Nostitiwi v
Address v6—Alt. Tel. Nor.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re-
quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent
(Please check one) / �d�
Telephone No. PERMIT FEE 3
r ,�
ffW
atute of Owner or Agent)
x-6565
328
Of NORTH 14,
0
'0 9
,SSACMUSE�
Date ...... 7..../...4 12�
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ..... A.5?'rC. e I C C)
.......
/ .......................................................................
has permission to perform .....rr.e..Y1:l.c�.�.. t ...........................................
wiring in the building of .........T r, C : Vt/L
...................................................................
1 P
at ........ �i...�r...?/............L.. C.)..k�.... ��........ �...:.............. .North Andover, Mass.
Fee .... /3..:.�.. Lic. No.�ll:l............................................................
ELECTRICAL INSPECTOR
07/19/% 13:oo
WHITE: Applicant CANARY: BuildijN%t. PAID
PINK: Treasurer
Important:
When filling out
forms on the
computer, use
only the tab key
to move your.
cursor - do not
use the return
key.
Commonwealth of Massachusetts RECEIVE
City/Town of MAY 0 6 2009
System Pumping Record
Form 4 TOWN 'OF NORTH ANJ:DOVER '
HEALTH DEPARTMENT
DEP has provided this form for use by local Boards of Health. Other forms may be used, but t e
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use. The System Pumping Record must be submitted to
the local Board of Health or other approving authority.
A. Facility Information
1. System Location: Left front, left rear, left side of hous ight frong right rear, right a of ouse
Address
City/Town State
2. System Owner:
Name
Address (if different from location)
City/Town
Zip .Code
State �Code
Telephone NumberC7�i
B. Pumping Record t Q��
`L �
1. Date of Pumping Date 2. Quantity Pumped: Gallons
3. Type of system: 0 Cesspool(s) _ eptic Tank Tight Tank
jj Other (describe):
4. Effluent Tee Filter present? 0 Yes 0 No
5. Condition of System:
6. System Pumped By:
Neil Bateson
Name
Bateson Enterprises Inc
Company
7. Loc ere contents were disposed:
Q.L.S.D Lowell Waste Water
Of
If yes, was it cleaned? [ Yes [j No
F 5821
Vehicle License Number
Date
S�(�,r-ks
t5form4.doc• 06/03 System Pumping Record • Page 1 of 1
Commonwealth of Massachusetts
City/Town of
System Pumping Record
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.
A. Facility Information
1. System Location: Left i h front of ho,,- , Left / Right rear of house, Left /right side of house, Left /
Right side of building, Left / Right front of building, Left / Right rear of building, Under deck
Address
Cityrrown state Zip Code
2. System Owner.
Name
Address (if different m l6cf3"L=0 `ff U
City/Town NOV .19 2313 State
d
TOWN OF NORTH Telephone Number
HEALTH DEP ANDOVEq
ARTIi1ENT
B. Pumping Record tt�
1. Date of Pumping V �I
p g Date 2. Quantity Pumped:
Gallons
3. Type of system- ❑ Cesspool(s) eptic Tank ❑ Tight Tank
❑ Other (describe):
4. Effluent Tee Filter present? ❑Yesa<o If yes, was it cleaned? [3 Yes E] No
5. Conditi n o System:r
6. System Pumped By:
Neil Bateson
Name
Bateson Enterprises Inc-
Company
nc
Company
7. Loca . e contents were disposed:
G.� S. Lowell Waste Water
60opt
t5form4.doc• 06/03
F5821
Vehicle License Number
Date
System Pumping Record • Page 1 of 1