HomeMy WebLinkAboutMiscellaneous - 4 LACY STREET 4/30/2018 4 LACY STREET
I 210/105.D-0073-0000.0
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MAP #. T _ _ LOT #_.._...._...._Q.................
PARCEL # STREET.---- hA-&-. .,...__.. _
CO.N.STR.UC—TIO..N..-.AP.PRQVAL.
Ft)o
HAS PLAN REVIEW FEE BEEN PAID? YES NO
PLAN APPROVAL: DATE_._ 3ZAPR. DY.... ...._ .....
DESIGNER:
PLAN Dfl TE:...__ .... ...:2......_
CONDITIONS_ _...._.._..--
,_
__..._------- --- .._..._._.._...._........_..._............................-................................................_.._
WATER SUPPLY: TOWN
CED
WELL PERMIT 3DRILLER
WELL TESTS: CHEMICAL DA t E (a!-PROVED
BACTERIA I DA f E (1F IPROVE
BACTERIA II DATE APPROVED
COMMENTS:
A?wo rz)
FORM U APPROVAL: APPROVAL TO IS'SUE NU
DATE ISSUED_ ^__..._.BY _.
CONDITIONS:
FINAL APPROVAL:
ALL PERMITS PAID YES NO
WELL CONSTRUCTION APPROVAL YES NO
SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO
OTHER YES NO
ANY VARIANCE NEEDED YES NO
FINAL BOARD OF HEALTH APPROVAL: DAVE: T3Y:
! BERT L ._SYS.ZE.M_JN_S..T..9.4.LA.Z ..QN.
IS THE INSTALLER LICENSED? ES NO
TYPE OF CONSTRUCTION: EW REPAIR
NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW S NO
CONDITIONS OF..APPROVAL YES NO
(FROM FORM U)
ISSUANCE OF DWC PERMIT YES NO
DWC PERMIT-. NO. INSTALLER:_ 0esAJ__
BEGIN INSPECTION 0: �•_ _�_�; _
EXCAVATION I NSPECT I ON: NEEDED:
d0t �'7 G'/. `S yeay
Q
-�
PASSED v`YI�// 4vZ BY__A�Ln, '
CONSTRUCTION INSPECTION: NEEDEDs�__,__ ______._.._.____._._..__w___._.._.__.� _._._......._._�.___._._
AS BUILT PLAN SATISFACTORY:
APPROVAL TO BACKFILL: DATE: HY�__^�`�lG� ._--
FINAL . GRADING APPROVAL: DATE BY
FINAL CONSTRUCTION APPROVAL: DATE:__�_______HY
Commonwealth of Massachusetts'
City/Town of No Andover
System Pumping Record
Form 4
i
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, � (.> ?C V
use only the tab
key to move your Address
carsor-do not No Andover Ma
use the return
key. City/Town State Zip Code
2. System Owner:
M r-et
Name
ieacn
Address(if different from location)
City/Town State Zip Code
Telephone Number
B. Pumping Record
i
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:
RECEIVES
6. System Pumped By: �� ('5 2013,
T1WN OF NURI H AND
Name VehicleLicebserNum`be�'tI-A"' 1"�k=M*
Stewart's Se tic Service .�
Company
7. Location where contents were disposed.-
Stewart's Pre-treatment Plant
20 So. Mill Bradford, Ma 01835
Signature of Hauler
Date
Signature of Receiving Facility Date `
t5form4.doc•03/06
System Pumping Record•Page 1 of 1
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.,,� Commonwealth of Massachusetts
RECEIVED
Eity/Town"of NORTH ANDOVER MASSP CHUSETTS
,,System Pumping Record NOV 13 2006
Form 4'
TOWN OF NORTH ANDOVER
H ALTH DEPARTMENT
DEP.has provided this form for use by local Boards of Health. rd must
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 City/Town State Zip Code
use the return
key_ 2. System Owner:
Name
Address(if different rom locatio
CityrTown. State Zip Code
Telephone Number
B. Pumping Record
1. 2. Quantity Pumped:
Date of Pumping
Date Gallons
3. Type of system: ❑ Cesspool(s) aSeptic Tank ❑ Tight Tank
❑' Other(describe):
4. Effluent Tee Filter present? ❑ Yes- E3"No If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System:
6. liern Pumped By:
Name Vehicle License Number
5�. a t!Q, f. aaftd Ina.
Company
T.. Location where contents were disposed:
add
Si nature of Hauler Date
http://www.mass.gov/dep/Water/approva.Is/t5forms.htm#inspect
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t5fomi4.doc•06/03 System Pumping Record•Page 1 of 1
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da n'Irrod Io the local Soarc: cr goo cn o, S farce or
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PQ�I/VlA Lo'F£'"� n cy
A. Facility Irl`d110(1 HEALTH DEP
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Y89. rv89 II c aanev7 Yes
Condl�lon P(:9y
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Cn. CoOlenU'Ware dl�posev:
'1....' •�.�••�' :.1: ;)til,'; ` � -
' ss.gov/depiwaier/epprOYaJs/f6lorms.h�maln9wct
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Commonwealth of Massachusetts
PSETTS
...:.. :u
City/Town of NORTH ANDOVER MASSACH
System Pumping Record j' - 5 Z
Form 4
'WDWN OR NORTH ANDOAR
DEP has provided this form for use by local Boards of Health. The S H� 7H D IAiTMEN� st
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 a
computer,use
only the tab key Address
to move your
cursor-do not Ci /Town
use the return State Zip Code
key. 2. System Owner:
Ua non
Name
WAI
Address(if different from location)
Citylrown State Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping 2. Quantityd:
P
Date Pumped:
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:
1 6. S stem Pumpe
Show
je Vehicle License Number
ILI-'.
Company
7. �io ghere contents were disposed: (�
ignature ofHauler Date
http://www.mass.gov/depANater/approvalstt5forms.htm#inspect
t5fonn4.doc•06/03 System Pumping Record•Page 1 of 1
FORM U - LOT RELEASE FORM
NSTRUCTIONS: 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 thisection*****************
APPLICANT: � .� / ����/�� / Phone
LOCATION: Assessor's Map Number Parcel
Subdivision
Lot(s)
Street �ZI St. Number _
************************Official Use Only************************
RECDATIONS OF TOWN AGENTS:
Conservation Administrator Date Approved 2
Date Rejected
Comments
i
I
Date Approved ..
wn P ner Date Rejected
Comments
Heal h Age Date Approved
Date Rejected
Comments Awsr 4£7- 4.1"/ /,vim
Public Works - sewer/water connections
- driveway permit
q�el/tiz
Fi De artme t /�Yn L�GD ✓
eceived by Buil ing Ins ector
Date
5'
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io
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I
I Andover, Massachusetts Form No.s
A'
-+ D OF HEALTH
N APPROVAL FOR
" SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
F'
Applicant
Test No
Site Location
v
. I
Ref •.z.. ,
er
e
nc
eP
tans and Specs.
ENGINEER 2
DESIGN DATE
Permission Is granted for an individual soil absor 'i 1
in accordance with regulation`of Board of Healthption sewage disposal system to a ins d
r11 � X � �I I
o,
CHAIRMA ,B F ALTH
Fee T ,
V
°t
Site System Permit No. ��
NUMIRER FEE
THE COMMONWEALTH OF MASSACHUSETTS Zy
'ter..--
.....5`7,0.4. of .....................................
This is to Certify that .........\jv",�Ov, (, . oc,�/,Ipwey
.................................................................
.......................................
NAME
..........................\.,or...i......L-Pe-', sr-....
. ......... .. ... ....... ---- ......7------------------------- --------- .......*.......**-------
ADDRESS
IS HEREBY GRANTED A LICENSE
For .......
.................................................................................................................
............................................................................I...............................................................................................
....................................................................................................................... ....................................................
...................................................................................................................... .....................................................
This license is Vranled in conformity with the Statutes and ordinances relating thereto, and
expires................ .... .............................nless sooner suspended or revoked.
......................................................................... ..................
............................................................................................
.............. ...f1f ')Z......._...........19.._.... ............................................................................................
-------------
............................................................................................
............................................................................................
FORM 433 HOBBS WARREN. INC.
PUAn�I�G __
TOWN OF NORTH ANDOVER
MASSACHUSETTS
J
Of
o
D
Any appeal shall be filed is ,
within (20) days after the
date of filing of this Notice 'Ss+c"USEt o
in the Office of the Town
Cleric. NOTICE OF DECISION
Date. . January.2; .1992 . . , . . . . . . . . ,
Date of Hear' December 19, 1991
Petition of . . Gregory.Follansbee
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Premises affected . . Lots1�&.2, known as, . .10LacyStreet
. , • • • • • . . . • .
Referring to the above petition for a special permit from the requirements
of the . .�JQrth ,A,11dover. Zoping.Bylaws Section.2: .Para 2.3Q.1
. . . . . . . . . . . . . . . . . . . . . .
so as to permit . .the construction of a common, driveway for the purpose of
. . . . . . . . . . . . . . . . . . . . . . .
gaining. . . . . . .access . .to Lots 1 & 2 (10 Lacy Street)
... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
After a public hearing given on the above date, the Planning Board voted
CONDITIONALLY
to -AP.PJA.V.E. . . . . . . . .the . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
cc: Director of Public works based upon the following conditions:
Highway Surveyor
Building Inspector
Conservation Commission
Board of Health
Assessors
Signed
Police Chief
Fire Chief George D. Perna, Jr. , Chairman
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Applicant .
Engineer John L. Simons. Clerk . _ . . , , . . . . .
File .
Interested Parties John Draper
Joseph Mahoney
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Richard Nardella
r-
Mr. Gregory Follansbee
Conditional Special Permit Approval,
Lacy Street
Common drive. lots 1 & 2.
The Planning Board makes the following findings regarding the
Special Permit Application cited above:
FINDINGS OF FACT:
1. The application adheres to the bylaw restriction that no more
than two (2) lots be serviced by this common drive.
2 . The specific location of the common driveway is appropriate
due to its location.
3 . The design and location will not adversely affect the
neighborhood.
4 . Adequate standards have been placed on the design which will
meet public health and safety concerns.
5. The purpose and intent of the regulations contained in the
Zoning Bylaw are met with the Special Permit Application
before us.
Upon reaching the above findings, the Planning Board approves
this Special Permit based upon the following conditions which
shall be submitted to the Board prior to signing the documents to
be filed with the North Essex Registry of Deeds
g ry
SPECIAL CONDITIONS:
1. The Applicant shall place a stone bollard at the entry to
the common drive off Lacy Street. This stone bollard shall
have the street numbers of all houses engraved on all four
sides of the stone. The dimensions of the stone shall be as
follows: 8" x 8" x 72". The stone shall have 48" exposed and
24" buried, and all numbering on the stone shall be 4" in
height. This condition is placed upon the applicant for the
purpose of public safety.
2 . Easements pertaining to the rights of access for driveways
between the lots involved shall be filed with the Registry
of Deeds Office prior to the issuance of the building permit
for any lot served by the common drive.
3 . Prior to a Certificate of Occupancy being issued for the
proposed dwelling, the access drive shall be paved for its
entire length. This shall include any turnoff for the
existing house.
4.
The driveway shall be constructed with a turnoff at the
i
halfway point. The dimensions of this turnoff shall be 20'
r
r
in width (including the drive) , and 40' in length.
I
5. Prior to a Certificate of Occupancy being issued, the
proposed dwelling shall
have a
residential fire sprinkler
system installed in accordance with the provisions of
Standard 13D, N.F.P.A. .
6. In no instance shall the Applicant's proposed construction
be allowed to further impact the site than as proposed on
the
plan p referenced above in condition # of this approval.
7. The Order of Conditions issued by the North Andover
Conservation Commission, File Number 242-562, shall be
considered as part of this decision.
i
8. The contractor shall contact Dig Safe at least 72 hours
prior to commencing any excavation.
9. Gas, Telephone, Cable and Electric utilities shall be
installed as specified by the respective utility companies.
10. All catch basins shall be protected and maintained with hay
bales to prevent siltation into the drain lines during
construction.
11. No open burning shall be done except as isermitted during
g
burning season under the Fire Department regulations.
12 . No underground fuel storage shall be installed except as
may be allowed by Town Regulations.
13 . Prior to a Certificate of Occupancy being issued for any
structures, this site shall have received all necessary
permits and
P approvals from the North Andover Board of
Health.
14 . Prior to the Building Permit being issued for the structure
and again prior to occupancy of the structure, the
applicant shall receive a written determination from the
Conservation Administrator that all work being done under
the jurisdiction of the Conservation Commission is being
satisfactorily performed and maintained. Further, all
disturbed soil shall be finish
edrade
prior to Occupancy.
g loamed and seeded
15. The provisions of this conditional approval shall apply to
and be binding upon the applicant, it's employees and all
successors and assigns in interest or control.
16. The following Plans shall be deemed as part of this
decision:
Plans Entitled: Sanitary Disposal System
Prepared By: Thomas E. Neve Associates, Inc.
Prepared For: Mr. Gre o Follansb
Dated: 10/25/91 ee
Scale: 1" = 40 '
cc: Director of Public Works
Board of Public Works
Highway Surveyor
Building Inspector
Board of Health
Assessors
Conservation Commission
Police Chief
Fire Chief
Applicant
Engineer
File
Ct -- — -
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_ 1 1,41 _._.._ .
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DATE �qz Sheet �` of �-
BOARD OF HEALTH
TOWN OF NORTH ANDOVER
SUBSURFACE DISPOSAL DESIGN REVIEW
FEE ��
PERMIT # DATE RECEIVEDQZ-
APPLICANT -FOI AQ5?,er, ASSESSOR'S MAP
ADDRESS \O ���/ S( 1.5�. ANp PARCEL #
LOT #
ENGINEER NdJE STREET
ADDRESS 4"4-1 R-2 K
PLAN DATE SOI`Z:�;l j I REVISION DATE
CONDITIONS IONS OF APPROVAL.
APPROVED
DISAPPROVED X
u 6X t�� ivy Or
sk L>
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To
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'vlassach.t.setts Certified #i 18651
!-Hampshire Certified #` 198707
Wafer Treatment CoTsultmits
NorrhftcHd Road - Route 63 Miners Falls, MA 01,349 413.659-3732
Ja;r 3260
F : 5/92
E . & P . 5uilders , Inc .
nclaiLj ; e Che analytical res:ilts from the sample receive=, . ;fay:
any questions concerning the results p '. ease do not
ca+r we .,s at your convenience .
Builders; tnc. - Turbidity: 1 Tirbidity uri 'L5
cdress - i' .0. 3ox 398
n.ndov r, MA-01845
`'. r jx4 b38-6$3-1490
ocµ:;onc
Addrass: 4 lacy Street
North Andov2r, MA 018n5
1i-lyzed.- ,lune 12, 1992
920342
5 w w ;,. ,,, by;
i4A Co• i�nt5 :
-lie puramete , gid meet .� Primary and/or secondary )r ' niti ng
-gin 5 '_and6rd5r
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a r ^!liars :ii
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r,.r V pr I I T9 -a ttr T y,lcilans 1 4 i I'J.,,l 1
Ar t,-p I c- 0.04 q 11 Marc rr 0.002
Bariti.-
1.0 SV.L I TM 1 0.01
Cad,ijr- 0.01 0.03
Chrqn I u— 9.03 Radi J, 29.0 -oil
L:--d- 0.05 �glt N1 trats- 10.0 40/1 of i
1,4 to 2.4 1911
14�,Pdin0 On 439- 4411Y air to-rpreturp.
(It 9±ni- Chsnl cAl Virioqr, lev,!lt for variout pq5tigidet, h�rblcldes and other or;-.nit
ch,*A r Al I. For A listing of tb- -exams,, contalthont levels for drinking water, p
laasc
r ;.jtj t a copy.
1 1- ;1rre,li0lagic41 COPD`nlOts- J 4 a Lib(lf-tOrY UL:4 tt L- ML-Mbr 3flO F i I t tr {HFI, Iithu�
for COlj;t'-- , ihit Conti ets 01 filtering your water 5121PID and than gro,.jill
confer.- ro:q'fes an pt4par2d noilig, from the filter.
5r;; "aL't ten EPA primary Drinking WAter standard for colif6rn bActeriit n a ly
tfi xn I colony / 100 111, All other results will exceed EPA ttind!rd-
'"'Ordary Drinking Water MalIMUIR taritAIRInant Liveils are as foljq%%:
t
230 19/1 Il;nqanest- 0,05 ng/1
Chi or 1 6 ?IQ 9/1 Odor- 3 Throahold Odor Nul)49r (TON)
Calor- iS Color JnIts pm- e,p to 5.8
rp,d Ztr- 1.0 0/1 out f ato- 250 aq/1
cqrea.L Vi ty^ Non-Corrosive Tctal Discolved Solids- 300 moll
Feat „;tints- 0.3 moll Turbidity 8 Turbidity Units
0.3 P911 zinc• 54 1911
4
Nartnest in N&tLr it caused by the pre%anrq of "Icig' and M119miltivI fon s. Mgrdne.i S:
41 nultsiqeq. the level of hardnqsi Is neAtofed in 41thar rilligra.is per liltt
g or to 91I1fir. pRr ;allan.
left Uatgr 0 - 1 0
Slightly Hard .11t;Ir 17 - 40 1 - 3 1/2
moderately Hard fiat-.& 60 120 3 1/2 - 7
Hard Water 120 Izo 7 - 10 1/2
Vory Hard Wiltot over 160 over 10 1/2
Pri:lry Standards are for the Prt"'"10M Of the 00blit health while the 5,1conjaer
ltsadgrds arc Considered '10Metle' standards. This is breAuts jovels in *,cess of
iQcond!ry slindird% will I.
of PradJog cUlAt in sinks of other fixtueso, cause problais 41th
QIWC: and/or trill c"Se tAStb Or 06OF PrObtRMS.
�T
HEXIR Z �
Cz i
9jO
O•
LOT 2
r10 ry
'UTILITY EASEMENT
O
O•'
30 X 30
ING CONCRETE TOP OF FOUNDATION 9
NDATION------,�r = 131.98 9
LOT 1
220,570 S.F.
O9 5.06 ACRES
1� UPLAND IN EXCESS
OF 1 ACRE \� ' a•a3,
O
OP
ISOLATED LAND SUBJECT lANO\'�
i TO FLOODING \! �\ -
N N
Op •1/�
t �
DAVID & CHERYL
DICK ERSON
SEW
CONSERVA 6/ a�W A,L � I OR'T►yJ I'I �I�� � G �L PLA�� ��OGV _�� ��'�G
own o :a ,. ,.6 0�
ndover
4`
jRIVEWAY ENTRY PERMIT =�K0
er• Mass. 19
O
C H EWICK J
AR
SS
BOARD OF HEALTH
. PERMIT. T, LD
V'
� O
THIS CERTIFIES THAT vrc...... ..... ... .. &V. .* .................
g .. BUI
has permission to .... � uildin son .... .... ..... ......JIN.a..I6.......�� ,.L. ....... .+R�r. Chimneyto be occupied as.... � ••••• '• '• •• Final
provided that the person accepting this permit shall in every respect conform to the terms of the application on file in
M NG NS CTO
this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of ugh \%
Buildings in the Town of North Andover. PERMIT FOR FOUNDATION ONLY Fin C4 G
VIOLATION of the Zoning or Building Regulations Voids this REGULATED BY PARA: 112.7 S.B.C.
• PERMIT EXPIRES 6 M NT H S DATE: E PAID: ELECTRICAL INSPECTOR
-- Rough
_ UNLESS CONS LIC I O Ty Service
PERMIT FOR FRAME/BUILDINGdo Final
DATE:
�� BUILDING INSPECTOR GAS INSPECTOR
.! FEE PAID: .--.
Occupancy Permit Required to Occupy Building Rough
Final
Display in a Conspicuous Place on the PrsT FEE s,
!E� �� FES 6-O 61-0
FIR DEPT
Do Not Remove Burner
DYE FRAME PER IT X7.5
No Lathing to Be Done Until Inspected and Approved by Smoke Det.
Building Inspector
. lSVHt�I! vi •-••
Town of North Andover ,Mass . �'� 197-
Date
' 'ermi.t. '
• APPLICATION FOIL WELL & PUMPL'1:1tMIT
�ppL.i.cation .is hereby made for p
ermit to drilla
well ) • Application i,.S
' e to Install ('4) a pump system
nadll '.
• Lot # •�_
:'.ocation: Address z, T >17
` Address
)caner
c: " 'Te 1 . 3rq '''3
'
AddressG�
Gell Contractor Tel . •
• Address
.Dump Contractor
`DELL CONTRACTOR (To be completed at time of Pum1) test )
Well used for.
Type .of Well
Size of Casing;
Diameter of Well '
of Bed Rock Depth casing; into Bed
Depth stock
Was Seal Tested? Yes (_) No (_) Date. of
Testing;
�a.t. Material
Well Ended in Wl
Depth ••o•f c,—..e?� —
' G
Deliv�`rs a1s . Per Min . for 4 ho,
Depth to Water-
feet after Pumping.,—
hours• at CPM
Drawdown
Date. of' Completion — Signature lel Contractor
I Ir
To be f'illcd i.n' before insta].l.ation)
PUMP INSTALLER ( , hemp TYpe Used
Size &. Name Pump_-----------* _--
GPM Size of
Water. PuMp Delivers
"I•.�nlc_—
n We•11 ' Cast Iron ( _) Galvanized (_) Plastic (_1
Pipe Mi
Material Used
Well Pit (_) or Pitless •Adapter (_)
rotect pipe? Yes (_) NO(_ m
) rype or Nae Well
Was sleeve used top Seal
Date nc
tir�c tt
.
of liealt:Water analysis . repor--t 'submitted to Board
Date
Do-e .release given tD owner of record & i31c16 . Insp
-
Ileal Inspector
+ ..n.•..- .."n,�,--`.--...•. „„..r :+- .._... •, n^ >.r�-.......:.s. .?: .nmu?-;`..e':�:r.csri..=�,r.."`-: - "" .-a".._v�, ..�e.-�.....ti..f...�s�."~`
s
� �� `�'
BOARD Or III"ALTH
R Town of North Andover ,t ss
'� .......... 9
Date
�� >. .
. �
'ermit �# `
APPLICATION FOR WELL & PUMP LERMIT
;1pp' xcation .is hereby made for permit to drill a wiell ) . Applications
'nade to install (X) a pump system'.
i .
• • • Lot # • . .
..location: Address
4�Address Tcl . ��`� �C7
)wner. �o
C. � Address � Tel 3�� ~�3�_ 3
Jcll Contractor Z-
Address "Tel .
Dump Contractor
'aELL CONTRACTOR (To be completed at time of pulnp (:est )
Type of Well G am' Well used for 2n `e
1 Sif size oCasing 6 � � � •
'Diameter of Well 6 ! 1
Depth of Bed Rock Depth casing into Bed Rock
No ( ) Date. of Testing 4t'Ao '��
Was Seal Tested . Yes (7�) _
.Depth o —:1e�J — -���
Well Ended in Wha-t. Material
F
De th Co Water /S ,,fie Delivers Gals - Per Min
P . for 4 ho
. _
Drawdown b0 feet after pumping _hours' aC
CPM
Date ' of Completion q'. ' U�� _ c"14 �'�-
ignature k•1eI Con rac' or
X
PUMP INSTALLER (To be&• f-illcd i.n- before instal.J.ation )
Size & Name Pump
Pump Type Used
Water Pump Deli-vers GPM Size of 1'anJc
Pi e Material Used in Well : Cast Iron ( _) Ga ) vrinizcd (_) Plastic
P
Well Pit (_) or Pitless Adapter (_)
Was sleeve used to protect pipe? Yes (_) 140(_) 1'ype or Name Well Seal
Date
>k�k�t��Y��M��t�4�t�4>k�E��C�'r�4�'���C�4�M�4�4><ri'ttk*��r�►4*�'r�4�'t��r�r�4�4�Y�4i'rti'rt'c�'r�'r�'t,':;•;:c:.:,c,r,: c,,,r,:,:,::;::�t;::;, ,
Date eater analysi"s . repor--t 'submitted to Board of Ileal'th
Do -e .release given ID owner of record & illdg . Insp
1{ h Inspector
t
Department of Environmental Management/Division of Water Resources
#4 WATER WELL COMPLETION REPORT
WELL 1_00J19N / GEOGRAPHIC DES RIPTION
Address LL+•U I/q�
L�4 C>f 7` !f N S W of
,�/t 'Pd//r,
(feet) Iclrclel
City/Town rlrV/TA (/�r"..�� � L z 74/4 G y �I�
1
Well owner C. Y lf G (road)
Address 3 3 A L 1< �— G N S E of
(mi.in tenths) (circle
Board of Health permit: gest no ❑ intersect. w/
(road)
WELL USE WELL DATA p
Domestic, Public C3 Industrial C] Total well depth—Dad ft.
Monitoring❑ Other Depth to bedrock `aS ft.
A
Method drilled Water-bearing rock/unconsolidated ma erial:
Date drilled �a Q 9. Description
CASING
Water 1bearing From To
zo�gs: � f1
� F �' V
Type ) b D
LengthS&I ft. Dia(.I.D.) in.. 2) From To
3) From To
Length into bedrock ft.
Gravel pack well: dia.
Protective well seal:
Screen: dia.
GroutA Other � Slot* length from_to
PUMP TEST _
Static water level below land surface ft. Date
Drawdown3D� ft, after pumping_y__hr, min.at ""� gpm
How measured Recovery -300 ft. after hr. - min.
� o
LOG of FORMATIONS COMENTSk,q S �/�� a
/T c
Materials From To
0 3S
j b C gad Driller
Mass. Registration*
Firm
?2�c/<
City/Town/VL'Ats? J q--j
Signature of su ervisin re istered well driller
Please Print firmly -
BOARD ,OF HEALTH COPY
l s// �'�. ' - r{r � ��������r �- -�� / _ � . r•..����x �'. �f.--�S�.�H�:�L-�\�l^ f--\�"��.<'�= a� j,T
THE COMMONWEALTH OF MASSACHUSETTS
THE COMMONWEALTH OF MASSACHUSETTS
DEPARTMENT OF ENYIRONMENTAI:PROTECTION :�' I DEPARTMENT OF ENVIRONMENTAL PROTECTION ��-
Certifies .;I�t Certifiest�`
S _ Granite state Analytical, Inc. ,��
Granite state Analytical, Inc, r°
i 61 East Broadway - - - 61 East Broadway
I Derry, NH 03038 - I Derry, NH ..03038 '
+ I r for the Chemical Analysis of Potable and Non-Potable Water for the Microbiological Analysis of Water
\Ipursuant to 310 CMR 4200 ` ` pursuant to 310 CCR 4200
Philip H. West 04/01/92 • I Laboratory
Laboratory Director Director. Philip n. west Issued 04/01/92
• I r. issued.
_ II�
12/31/92 NH003 - !' _ d' Laboratory
' Laboratory ID #: Expires:
<. aboratory ID #: NH003 Expires: 12/31/92 '
771is certificate supercedes all previous Massachusetts certificates This certificate supen:edes all previous Massachusetts cerrificates `
-.issued to this laboratory. T7ie laboratory issued to this laboratory. The laboratory is regulated by and � rY• is regulated by and
shall be responsible for being in compliance with Massac/iusetts shall be responsible for being in compliance with Massaclutsetts �
1
regulations at 310 CMR 4200. I I� regulations at 310 CMR 4200.
This certificate is valid only when accompanied by r1:e latest T7iis certificate is valid only when accompanied by the latest !
I dated Certified Parameter List as issued by Massachusetts D.E.P. i, dated Certified Parameter List as issued by Massachusetts D-E.P.
t l` Certi cation is no f validity f Certification is no guarantee of the validity of the data Thus
•fi guarantee o the validi o the data. T7iis �
I certification it subject to unannounced laboratory inspections certification is subject to unannounced laboratory inspections T
i� <
fi' C� /�.,�..,.. ��- ,,.,F, � �Q � C�r�a iPs�,1>-est •'',
Acting Director, Division of Environmental Analysis < Division of Environmental Anaiysis� Actuig Du'ector, D' '
Jill
i
y
1
GRANITE STATE ANALYTICAL, INC.
61 EAST BROADWAY
DERRY, NEW HAMPSHIRE 03038
(603)432-3044
LABORATORY RESULTS
------------------
DATE: April 20, 1992 TEST NO. 7267
TEST SENT
LOCATION: Lot 1 Lacy St. TO: McKinney Artesian Well
N. Andover, MA & Pump Supply Co. , Inc.
Lacy St. Realty Trust
AGENT:
PARAMETER RESULT RECOMMENDED LOWER DETECTION
(PPM) MAX.LEVEL(PPM) LIMIT (PPM)
--------- ------ -------------- ---------------
PH 7.60 6.5 - 8.5
HARDNESS 40.00 150 0.1
CHLORIDE 250 0.1
NITRATE 0.68 10.0 0.5
NITRITE 0 1.0 0.05
SODIUM 20.00 250 1.0
2 IRON 4.30 0.3 0.01
2 MANGANESE 0.055 0.05 0.001
COLIFORM 0 %100 ML 0 0
OTHER BACTERIA 0 /100 ML 200 0
COPPER 1.0 0.001
ARSENIC 0.05 0.0001
LEAD 0.05 0.0001
CHROMIUM 0.05 0.001
CADMIUM 0.01 0.0001
SULFATE 10.00 250 10.0b,
COLOR 20.00 CPU 15
ODOR SIJXHT
TURBIDITY 28.50 NTll 5 0.1
T.D.S. PPM 500 .001
THE TESTED PARAMETERS MEET CURRENT STANDARDS FOR DRINKING WATER.
X THE TESTED PARAMETERS MEET CURRENT PRIMARY STANDARDS FOR DRINKING WATER,
BUT SOME SECONDARY PARAMETERS EXCEED STANDARDS.
THE TESTED PARAMETER(S) FAIL CURRENT STANDARDS FOR DRINKING WATER,
DUE TO PRIMARY STANDARDS OUTSIDE OF LIMITS.
---------------------------------------------------------------------------
COMMENTS: Alkalinity = 45.20 mg/l
Calcium = 3.18 mg/1
Specific Conductivity = 189.00 meg/ohm
----------------------------------------------------------------------------------
TNTC DENOTES TOO NUMEROUS TO COUNT.
1 DENOTES PARAMETERS THAT EXCEED PRIMARY STANDARDS; CAUSES TEST FAILURE.
2 DENOTES PARAMETERS THAT EXCEED SECONDARY STANDARDS; DOES NOT FAIL TEST.
NOTE: SUBSEQUENT SAMPLES FROM THE SAME WATER SOURCE MAY VARY.
i
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W MORTGAGE INSPECTION PLAN
To WE Assurance Mortgage Corp. of America
o 'AND ITS TITLE WSUR &
w N n D T u A TT „ n rr T N
M777777,77- 77 A"477777 '71
77
PLAN OF LAMLj SCH ,
A
V%, AmASSmA
NORTH ANUUVER
A
SHOWING "AS BUILT" SANITARY DISPOSAL SYSTEM A
LO. T # I LACY STREET A
PREPARED FOR. : GREGORY FC LLANSBEE A
A
SCALE 1 5W, DATE .JUNE 31 )ODID2
:EACH TRENCHES
LEO MURPHY HEIRS
C110 MR-So THOMAS REID
SEPTIC TANK
r_ TOP OF FOUNDAT"
EXIST. CONC.
Founs-noil.
NEW ENGLAND POWER COf.
' Hil, PLAN HAS BEFN PREPARF0 FOP THE,
PURPOSE -OF SHOWING THE A(-, BUILT CONDITION OF
rHE SANITARY DISPOSAL SYSTEM INSTALLED ON THE
PREMISES ALL WORK WAS DONE IN SUBSTAIMAL
NFORMANCt- WITH 1-HE, OF'SIGN PLANS AS PREPARED
ALt WORK WAS DOVE WITH 4-HE GONSIRUCA-10N
-IMITATIONS EXPECTED FOR A JOB OF THIS TYPE IcVID
ISOLATED I
a FLOODING
10
DAVID & CHERI
DICE' ER
o vo-ma FE
tmaww
Junc IMAM
DESIGN E? a DATE
THOMAS E NEVE . ASSOCIATES INC
ENGINEERS SURVEYORS-LAND USE PLANNERS
447 OLD BOSTON ROAD U S ROUTE # I
TOPSFEW, MASSACHUSETTS
Ll