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HomeMy WebLinkAboutMiscellaneous - 39 SPRING HILL ROAD 4/30/2018 (2) -_ -- - --- _ -- - - -. _ J _ v v _ ------ / �- I f� RECEIVED -Commonwealth of Massachusetts MAY 1 1 2015 CityITown of North Andover TOWN OF NORTH ANDOVER System Pumping Record l.is,LTH DEPARTMENT Form 4• w` DEP has rovided this form for use by local Boards of Health. Other forms may be used, but the p information must be substantially the same as that Provided here. Before usiRecordmust-be submitted o local Board of Health to determine the form they use.The System Pumping um in date in the local Board of Health or other approving authority within 14 days from the p p 9 , accordance with 310 CMR 15.351. A. Facility information important When ming out forms 1. System Location: . +� on the computer, use only the tab key to move your Address Ma 01886 cursor-do not North Andover State Zip Code use the return City/Town key. VQ 2. System Owner: a Name rman Address(if different from location) State Zip Code Cityrown Telephone Number B. pumping Record j W 2. Quantity Pumped: Gallons 1. Date of Pumping Date Tight Tank Grease Trap 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ 9 ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If.yes,was it cleaned? E] Yes ❑ No 5. Condition of System: Pumped By: Vehicle License Number ame Stewart's Septic Service Company 7. Location where contents were disposed: Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 Date Signature of Hauler Signature of Receiving Facility Date System Pumping Record-Page t5form4.doc-03106 �EiitED \ Commonwealth of,Massachusetts .� 4 2��3 City/Town of No Andover E Gr�l System Pumping Record Y KEX T E4f 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, �� A ).) use only the tab �J key to move your Address cursor-do not No andover Ma use the return City/Town State Zip Code key. 2. System Owner: ,05(-o Name renin Address(if different from location) City/Town ' State Zip Code Telephone.dumber B. Pumping Record 1. Date of PumpingDate 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Ti ght Tank ❑ Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: K Name Vehicle Licerise Number Stewart's Septic Service Company 7. Location where contents were disposed: Stewart's Pre-treatme4 PLarjj, 20 So. Mill Bradford, Ma Q1835 Si n ure of Hauler Date Si r of Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 r Y TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Z AltA"r Date Issued: IMPORTANT:A licant must complete all items on this page LOCATION kqnM �nc� ��( �� AMJ V�. 444 Pr t PROPERTY OWNER l- -rS0 Al t1. Unit# Prin MAP N0: I V A PARcp-L:o,)-qq ZONING DISTRICT: Historic District yes Machine Shop Village yes d? 100 year-old structure yes "% TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential -New Building 0-One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑Repair, replacement ❑Assessory Bldg ❑ Others: ❑Demolition ❑ Other rau✓t�_ Spfi` all o�odp ain0 ,�tland�sF" 0 Waged; istn'ct 'I ,. . .. -'int DESCRIPTION OF WORK TO BE PERFO D: 7 n. C A, �20) ,M,Evl;i J (Identification Please Type or Print Clearly) •� �� - 3 3?� OWNER: Name: Phone: S'3.5-2- Address: A .A,-1ACNPfP 0-� T p CONTRACTOR Name: m r ��S Phone: 7 6 EL-93<D-? Address: Supervisor's Construction License: (0(n 3 c� )3xp. Date: Home Improvement License: —,I 192-aq Exp. Date: (o2--- (3- (3 ARCHITECT/ENGINEER Phone: ' Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ �r ©CD FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund mature" f?A ent/ t iiiiner Signature:of confractor ' Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑' Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS / CONSERVATION Reviewed on Signature COMMENTS UD C oActAL— w Akw ` o v/ HEALTH Reviewed on r: Signature COMMENTS '4 Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS PLOT PLAN LOT 18-A LOT SHOWING PROPOSED POOL LOCATION S49° 49' 34" E IN 77.29' NORTH ANDOVER, MA 39 SPRING HILL ROAD 0 30' 60' 90' SCALE: 1" = 30'-0" o MARCH 1 , 2012 D & A SURVEY ASSOCIATES, INC. o L" - P.O. BOX 621 MEDFORD MA 02155 _ Aci LOT 21 `nA = 43,560 S.F. ` (781) 324 - 9566 (781) 321 - 2501 (FAX) &yj 6) co v to 0 cd 1 .00 AC. 0 co Z POOL LOT 5 DECK - - - - ± POOL TO 47'+ POOL rO I a a LOT LINE LOT 20-A LOT LINE I I PLAN NO. POOL 88 � 4' 40'x 20' 10388 I y v I 10, I0 PROPOSED 6' I I FENCE TO SURROUND p POOL p w - 56.9' Q I SCR. 6 r POR.Icso 1 SEPTIC TANK TO POOL p pp, DISTANCE=78'± 2 STY. LOT 4 NO.39 45.3 Wg[:K�W-A Y� cn In SEPTIC p CIO do TANK \ ZC� \ N vi ul o Q r LOT 3 00. 1 mss, '0 SB/DH SB/DH 1 1 FND FND 320.00' 80.00' R —i – 595.10' N 490 32' 38n E N 490 32' 38" E L = 145.41' = 140 00' 00„ SPRING HILL (PUBLIC - 50.0' WIDE) ROAD JA 04 .� No RECORD OWNER: MARK AND SANDRA BOSCO f DEED RECORDED IN BOOK 12724 PG. 189 L LOAD,�. PLAN REFERENCE: PLAN NO. 10388 a . ppM M Q/y "Z/ 7 l'U,... ._»,.. FAI LOT mc H sY57,'E t A �� t7-80X.."'► �/ . Y � FILL REQaJIREIt FACICITY� _ THAN2 MIN�JTI --� f 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 'F-CCI L' e. sec� l PHONE LOCATION: Assessor's Map Number_ f1T_ PARCEL6 ?_4 SUBDIVISION LOT(S) STREET_'�4 Spr•nrr k U sPd ST. NUMBER *****************************************OFFICIAL USE i _J RNS OWN AGENTS: CONS RVAT ADMINISTRATOR DATE APPROVED Z DATE REJECTED { COMMENTS RO (t�c111W , TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS { FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED ZI Z 4o G DATE REJECTED i COMMENTS_ �U ' i PUBLIC WORKS - SEWER/WATER CONNECTIONS I DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE__ Revised 9\97 jm � E { .-- w KPT a d X —149 r fir' FORM U - IDT RELEBSE FORK 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 lav, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: RCt44 (�Gi M J(t-7 Phone LOCATION: Assessor' s Map Number /0-? R Parcel a(f 4 Subdivision Lot(s) Street 391 5� � 14-rz Q . St. Number 3c� ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments v Date Approved Town Planner Data Rejected Comments /? , Date Approved Health Agent Date Rejected Comments Public Works - sewer/water connections - driveway permit l '/Fire Department Received by Building Inspector Date F-Iwb of NOS Th AtilbvEl�,`Nl,d, y APPLt COi I j ILLP-T (,yA�'Ef{ Sc0 PNl7 �J TbWnl ❑ WEA AP�oyr"D 1)OT"C 56HIC SY STF-M VES6 ,�PP-{ovt� Dart' APNOviN6 Aunyoi?,ry l COMPITO/J5_ _ Nk/5 CW1,166-9 (q5 r FZ N) R�4SONS = D SrPrf c SYSTErvt I J STA Q-ATI OA J eX4V4T(o,'�j )NSPi�-c POAJ PArC Q PASS F4ir_ FrNA� 1�15pF�Tlo� i QPPRovEP QUC l r -3-S(a ApPi�)vrNG Aur+to/�t-y AVDIT10,L)A , 1-�J5Ib.,jotj5 (ii A►�y) 3 �o' oN�S DISAPI'J?ovF,D DarC FVj4L APPR)VAL �,orE 0 h2o-Y6I,,� - APP)3ov 6 i Hogi t \ s BOARD OF HEALTH < No.Andover, 'Mass . , SUBSORFACE DISPOSAL DESIGN CIMK LIST LOT111Q APPROVED DATE`_ DISAPPROVED DATE _ Provided: Reasons: � ( Title V FAIL 0K Reg 2.5 The submitted plan must show as a minimum: a) the lot to be served-area,di.mensions 1<t # abutters b location and log deep observation hoes-distance. to ties c location and results percolation tests-distance to ties d design calculations do calculations showing required leaching area (e) location and dimensions of system-including reserve area f) existing and proposed contours (g) location any wet areas within 1001 of sewage disposal system or disclaimer-check weilands mapping (h) surface and subsurface drains within 1001 of sewage disposal system or disclaimer. (i) location any drainage easements within 1001 of sewage disposal system or disclaimer-Planning Board files (3) known sources .of water supply within 2001 of sewage disposal e system or disclaimer (k) location of any proposed well to serve lot-1001 from leaching facility (1) location of water lines on property-1G ' from leaching facility (m) location of benchmark (n) driveways (o) garbage disposals (p) no PVC to be used in construction (q) profile of system-elevations of basoAw^ t, plumb, pipe, septic tank, distribution box inlets and outlet,, d'stribution field piping and Otter elevations (r) maximmm ground water elevation in area sewage disposal system (s) plan must be prepared by a Professional Engineer or other professional authorized by law to prepare such plans Reg 6 Septic Tanks (a) capacities-150,% of flow, water table, tees, depth of tees, access, pumping (b) cleanout (c) 101 from cellar wall or inground swimming pool (d) 251 from subsurface drains Reg 10.2 Distribution Boxes (a) s pe greater than 0.08 Reg 3.0.4 b) ,sump Y �pMMO/yw C' -- �� � j I'1t1 n1111nt �a1111 tlf htAl�4a41111�1aIe • �}'11�111�11YIIFIT - _�_.____---------__..____ -�Y#1�It1I•t,cA11ut1~ --___-_....- -___------- - o �'fAt�punl: fJt► I�f 1•F9 I I Hp�,1ic �IAnk: N+t �.) �'�9 (�� . ��r�l�ul I"1ulq,etl I,y: �Ati��Ari �NlICt� 1-'11111aI11R 1lnpal�lltod 111 � 1�1 --- . LIAIp: _._--.....-----------.......... ... _..___------------------ 111spe1aul: _------------------ __---- n � 4 1. � v Form 4 -- System Pumping Record Commonwealth of Massachusetss Massachusetts r LF System Pumping Record ZUP System Owner system Location a tt,i) Krf P-10! -hur.t n l*•. a-ju l r 1 ry Ki I, r c n• I 1' Gr•7d :"rt,) A�do,.,r 1A 01d; hur-n ,kit i'.,u k Type: Emergency Routine Cesspool: Ido Yes Septic tank: No Yes Date of Pumping: Cp Quantity Pumped: Gallons System Pumped By: Wind River Environmental, LLC Permit 7t: Contents transferred to: Contents Disposed at: S Date: Pumper signature: Condition of System/Other Comments ,Dep Approved from - 12/07/95 s Commonwealth of assac usetts City/Town of System Pumping ecolr4ap 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 d, ays:from the pumpindate in accordance with 310 CMR 15.351. a I A. Facility Information ULI2 3 Lund Important: TOWN OF NOF + When filling out 1. System Location: HEALTH DC forms the computer, use 3°I pr�� �Hill only the tab key Address 1 to move your No-Th And oyc✓ MQ D II7l'5- cursor-do not use the return City/Town State Zip Code key. 2. System Owner: 'C(U� CI1UC►h'S1�C�� Name Address(if different from location) City/Town State Zip Code COIR - bT9 - g8S8 Telephone Number B. Pumping Record 1. Date of Pumping C)- a g 2. Quantity Pumped: 1500 Date Gallons 3. Type of system: ❑ Cesspool(s) [Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes R No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: Oo cel 6. System Pumped By: )irn Gollad Name 11 -- Vehicle License Number W nd kiye-� EnYironmcnlal Company 7. Location where contents were disposed: Ipswich Water Tr®a �°�'��— Signature of Hauler Date ` Ipswich, MA 01938 Signature of Receiving Facility Date t5form4.doc•03/06' System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts El ED City/Town ofa�� System Pumping Record NORTH AND VE Form 4 TOWN OF NORTH ANDOVER PA MENT DEP has provided this form for use by local Boards of Health. Other fo , 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 1 System Location: y .. forms on the q C-0C� computer,use -! A-- _J— only the tab key Address �t ` /� n n to move your _I VOC �(1 �`\Yl�OUC -- — -- -�v` -- — -- --- cursor-do not ity(fown - State Zip Code C use the return key. 2. System Owner: Name • Address(if different from location) --- --- -- ----- ---- — — -- ------- ..— .---------- ity/Town to Zip Code C TeM!"phond Number B. Pumping Record 10 0 2. Quantity Pumped: Gan 1. Date of Pumping Date �/ ns 3. Type of system: F1Cesspool(s) Lad Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): 4. Effluent Tee Filter p ---- '---- resent? F1Yes EO/No If yes, was it cleaned? ElYes MINo 5. Condition of System: 6. Syst`em`)Pumped By: Vehicle License Number Name Company 7. Location where contents were disposed: Signature of Hauler Laurence, Date Signature of Receiving Facility Date System Pumping Record•Page 1 of 1 t5form4.doc•03/06