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Home My WebLink AboutMiscellaneous - 40 MARBLERIDGE ROAD 4/30/2018 (5) 40 Y' aa &f ! ,OPT" 1 3�0`a;tea° I•a tiO - n BOARD OF HEALTH 120 MAIN STREET TEL. 682-6483 SSAGHUSE� NORTH ANDOVER, MASS. 01845 Ext23 APPLICATION FOR ABANDONMENT OF SUBSURFACE DISPOSAL SYSTEM (SEPTIC SYSTEM) PURSUANT TO SECTION 310 CMR 15 . 354 OF THE STATE ENVIRONMENTAL CODE TITLE V This form must be submitted to the Board of Health no less than five (5) days prior to date of abandonment and be accompanied with a copy of the sewer connection permit. Name D2-ve- Phone Ld Address 1-tO Contractor hired for work: 9 Name �' Lire I s ,�P\�t'�c:: �� - Phone Address CAl� Date for scheduled abandonment Method of septic tank abandonment r(check.. one) ( } removal (�,�sandfill ( ) crush ( ) other (describe below) Other PLEASE DO NOT WRITE IN THE SPACE BELOW FOR HEALTH AGENT 'S USE ONLY Inspecting Agent Date Comments N-0 _1.124 APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass. 19 Application by the undersigned is hereby made to connect with the town sewer main in *,-er 1�e Street, subject to the rules and regulations of the Division of Public Works. The premises are known as No. �L' �!G'a � Street or subdivision lot no. Owner Address Contractor Address 'Applicant's Signature Z5 _ o t�rr�zr/ L PERMIT TO CONNECT WITH SEWER MAIN The Division of Public Works hereby grants permission to to make a connection with the sewer main at Street subject to the rules and regulations of the Division of Public Works.. Division of Public Works By Inspected by Date See back for rules and regulations -�u5 �• ? ;5+>��+qac`�fl!F'��rw+ra�u,�*nie�r•e'et6 �'�►"�' •'" "5' a Q Nature of Service Reg , ' ' ASP ► , f v Reg.Maint. ; C1mergency O C`UC ANDOVER SEPTIC-`PUMPERS lay Night f 3e i PAY FROM 'THIS BILL Customer Name P:O. B x 4173 B Station Service Location: ,' K/ dOV@r, MA 01810 (508) 475-2593 Phone .� Contact::.,.-...,, Professional Septic & Drain ,. Locally Owned and Operated Billing Address city Emergency 24 Hr. Svc . 7.Days. Spm~al Instruchens l Complat d ❑ Incomplete Reason. Per: -,A WPM Services Rendered N i V cuum Pumping ; Vt \ rvations. Drain Cleaning Septic Tank ;Good Condition ❑ Win,Line ,,f ,Drywall �. ; � � . ❑'Leech field Run o_ Toi a wl e ❑ .Leech Pit/tJv'rflow ❑ 'Riding Hig IGtchen ink (liquid level) O D Box ❑ Full er O Pump;Chamber Vani • ' sive Cor Drain ❑ Grease Trap ; op/.Bo m Yard DrainL4-111 E3 Catch Basin _lJse No P red -❑ Portable Toilet ❑ Vent Heavy Grease ❑ Sewer J t p Other Roots `' ary _ ❑Other ❑ pug ectric �; Footage lG 1T/d�L� ❑ Under.1000 gallons ❑ 1000 gallons 1500 gallons Roo ring ❑'2000 gallons 0 3000 gallons,O 4(�W gallons 1 y O Van Called 9 , 9 ❑ .Other ❑ 5000 gallons ❑ other F ' MI j i c D Digging Charge a ❑Backhoa ❑. InspechrL tion ❑ Certification: P/F ❑ Location ` ` " O Consultation Estimate Reason: , 14 '0: r `❑ Service Call _•' , , ❑ Labor• ❑ Portable Toilet Rental ❑:Pump Repair 0.. . aitin Time s ❑ Baffle ❑ Repair �>l L• 9 ❑ Chemical Treatment a Digging'Charge Is Per Driver -�- ❑...Other Discretion Description of Work t� t �/'/ o�K.�' p r „ ; Terms of ' Recommendations Y P Vacuum UT in s Drain Cleaning. V: NET t , �Cilonth Yr Month' <: F Discount z T s&londlUons ❑,Cash eck redit ! L t No responsible for damage beygnd.ix�rb line, 3 5 permonth will be charged to accounts past due agr "rte .w in;48.ho rs a purchaser ees to pay co all purchst of collection / 2 AI complaints shall a repo d y r e undersigned uagr a to all s d dill f i ^f - r Cstomer$ignatu�e., G ti eNICe u •1^�.��i w; tf ♦� �� SEPTIC SYSTEM INSPECTION FORM ADDRESS DATE INSPECTED ` t PROPERLY FUNCTIONING? � N WEATHER CONDITIONS COMMENTS : ,t psi WA i EaZ;ALl T Y 1 ES"1` , � R ES LiS? DYE TEST PERFORMED? Y N DATE? SKETCi:: y.4: j1 1 WATERSHED RESID,pENTS QUESTIONNAIRE 1. Name 0- 2. 2. Street Address 3. How many members are in your household? 4. What type of sewage disposal system do you have? ❑ cesspool septic tank and leaching area ❑ connection to municipal sewer ❑ other (describe) ❑ do not know S. Are the plans (drawings) for your sewage disposal system on file with the Board of Health? yes ❑ no ❑ do not know "- - 6. How old is your sewage disposal system? 0-5 years ❑ 6-10 years ❑ 11-20 years ❑ over 20 years ❑ 'do not know 7. Has your sewage disposal system been rebuilt or repaired? ❑ yes no ❑ do not know If yes, approximately how long ago? years. What was done? 8. How frequently is your sewage disposal system pumped out? ❑ annually every 2-4 years ❑ every 5-10 years ❑ over 10 years ❑ never ` 9. Have you had any problems with your sewage disposal system? ❑ yes no If yes, what problems? ❑ repeated pump-outs needed ❑ system clogs, backs up, or drains slowly ❑ odors ❑ sewage surfaces through ground 10. How many of each appliance are connected to your sewage disposal system. washing machine dishwasher garbage disposal dehumidifier drain sump pump toilet roof/pavement drains shower/bathtub _I 11. Please state the brand and type (liquid or powder) of detergent you use for: dishwasher COLA cxLCLL PO- clotheswasher VJ_C � 12. Does your property have a lawn? is� yes ❑ no 'es, approximately what size? (poo S .6 -4. I less than 1/4 acre ❑ 1/4 acre ❑ 1/2 acre ❑ % acre ❑ 1 acre ❑ more than 1 acre (Specify) acres 13. How often do you fertilize your lawn? No. of applications per year 1 0-7- Season(s) of the year � 14. Please state the brand and type (liquid or granular) of lawn fertilizer you use: EANJCC 0 Check here if your lawn is maintained by a professional landscape contractor. II COMMON DRIVEWAY, UTILITY AND CONSTRUCTION COVENANT - i Whereas, Flintlock, Inc. is the owner of two certain I parcels of land situated in No. Andover, County of Essex, I Commonwealth of Massachusetts, shown as Lots 5 and 6 on a plan j{ entitled "Plan of Land in North Andover, Mass. Prepared for WQJ Flintlock, Incorporated, P.O. Box 531, North Andover, Mass. 01845, showing 25' Common Driveway & Utility Easement & Construction Easements" dated February 2 , 1996, Thomas E. Neve Associates, Inc. , Engineers-Surveyors-Land Use Planners, which said plan is recorded with the Essex North District Registry of Deeds, herewith, and _ m i Whereas, the Planning Board of the Town of North Andover �. ' c IIhas issued a Special Permit dated April 10, 1995 and recorded in 'i said Registry of Deeds, Book 4274, Page 39 permitting the ►-' construction of a Common Driveway to service Lots 5 and 6, and 3 c.c Whereas, the Planning Board of the Town of North Andover rs has issued a Special Permit dated April 10, 1995 and recorded with said Registry of Deeds, Book 4274, Pare 64 permitting access i IIWhereas Flintlock, Inc. intends to install sub-surface I sewer disposal systems on Lots 5 and 6 in or adjacent to the f areas shown on the said plan as "Construction Easement for Lot #5" and "Construction Easement for Lot #611 , and I II _ 4 Whereas, Flintlock, Inc. intends by these presents to' establish the rights of present and future owners of Lots 5 and 6 with respect to the Common Driveway and Utility Easement and the II Construction Easements as shown on the aforesaid plan. ! Now, therefore, Flintlock, Inc. does hereby declare for i itself and its successors in title that said Lots 5 and 6 shall be subject to and have the benefit of the Covenanter hereinafter 11 set forth: 1. The owner of Lot 5 shall have the right to pass and repass by foot and motor vehicle over that portion of Lot 6 �i designated as 1125 foot wide Common Driveway and Utility Easement ! Area" shown on the aforesaid plan for ingress to and egress from I Lot 5 to Lost Pond Lane as shown on said plan, and for any other 'i j� purpose for which driveways are commonly used in the Town of North Andover. ii 2 . The owner of Lot 5 shall have the right to install, maintain and repair lines of utilities within said Easement Area Ito service the single family residence to be .constructed on said Lot 5. 3 . Neither the owner of Lot 5 nor .the owner of Lot 6 ji shall allow any obstruction co be placed or parked within -clie (� Easement Area which would inhibit or obstruct the. free passage o itvehicles over said Easement Area or which would obstruct the installation, maintenance or repair of utilities within said ' i i; Easement Area. I i it - Ij - 2 - I �i I 4 . The owners of Lot 5 and 6 shall each be responsible for 500 of the cost to maintain, repair and remove snow from the Common Driveway to be constructed with the Easement Area and each shall be responsible for 50% of the cost to maintain and repair the utilities to be installed within said Easement Area. i 5. The owner of Lot 6 shall have the right to maintain oni Lot 5 in that area designated "Construction Easement for Lot 6" ,I a grading, slope and construction easement as required by the jj owner of Lot 6 for the installation, maintenance and repair of a sub-surface sewage disposal system to b,: located on Lot 6 Ij southwesterly of said Construction Easement. If the owner of Lot 6 is required to enter upon Lot 5 within said Construction i E I asement in order to maintain or repair the sub-surface sewer disposal system to be located on Lot 6 then the owner of Lot 6 ±! shall re-loom and reseed any disturbed area on Lot 5 resulting .i from the entry. I� 6. The owner of Lot 5 shall have the right to maintain ori Lot 6 in that area designated "Construction Easement for Lot 511 a grading, slope and construction easement as required by the owner of Lot 5 for the installation, maintenance and repair of a �I sub-surface sewage disposal system to be located on Lot 5 it northeasterly of said Construction .Easement. If the owner of Lo �) 5 is required to enter upon Lot 6 within said Construction I` Easement in order to maintain or repair the sub-surface sewer +I disposal system to be located on Lot 5 then the owner of Lot 5 shall re-loom and reseed any disturbed area on Lot 6 resulting from the entry. i - 3 - \ j \ I 7. This Covenant shall run with the land and shall be binding on and be for the benefit of the Declarant, its successors and assigns. II In Witness Whereof, Flintlock, Inc.. has caused these 1 presents to be signed and sealed by David A. Kindred, its duly authorized President and Treasurer this 14th day of February, �i 1996. I j I FLINTLOCK, INC. By: D vi re , IIS President and Treasurer ii II COMMONWEALTH -OF MASSACHUSETTS �I ESSEX, SS February 14 , 1996 � Then personally appeared the .above named David A. Kindred �) and acknowledged the foregoing e e free act and deed of Flintlock, Inc. , before me, I. II Notary Public My commission expires: drIl- FLINT.MV/DMT �I i• I I i 4 - I I' s Registry of Deeds Northern District of Essex County Lawrence, MA 01840 02/10/96 \ I FLINTLOCK INC PL # 5; Recctime 1111 Type COVEN 10.0 lii5t B,J�' Postarae 0 "' ..]L Total 10 a,;i # 54 Payment Lash 4- CJr Lhry Ii�Y 10.03 j THANK YOU Thomas J. Parke j Register of Deeds f I t � l 1 r i i I ,�.A��bp tat.- • � �' `\`