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Miscellaneous - 405 BOXFORD STREET 4/30/2018
405 60XFORD STREET ;t J/ r 21011050000`0 - i I I F I ` l � �I 1 I 1 I �� l t�F 'y MAP # LOT #��--..__.�__�—_-" PARCEL # STREET- �T-�C)x_ QY�...�T _....___........ CONSTRUCTI.O.N APPROVAL HAS PLAN REVIEW FEE BEEN PAID? LYES) NO PLAN APPROVAL: DATE APP. BY--- DESIGNER: MMe'9;11zW,,0-- A D5drl PLAN Dn-fE:_8/159h.�---- CONDITIONS WATER SUPPLY: • TOWN WELL WELL PERMIT DRILLER,._�._.__._l �/v._C ._....................... WELL TESTS: CHEMICAL DATE APPRUVED_jD�---- 3 BACTERIA I DATE F11"hRUVEU /0/0- �3... BACTERIA II DATE APPROVED 7 ¢�S COMMENTS FORM U APPROVAL: APPROVAL 1'0ISSUE (�YESNU DATE ISSUED J? BY CONDITIONS: FINAL APPROVAL: . ALL PERMITS PAID Y NO WELL CONSTRUCTION APPROVAL NO SEPTIC SYSTEM CONSTRUCTION APPROVAL --Y-E-S NO OTHER - NO ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: DATE:...._._._...__..._ -..._DY: .._.. . a �E �SYSNM_ .UB-44K N IS THE INSTALLER LICENSED? NO f :TYPE OF CONSTRUCTION. W REPAIR NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW NO y , 71 CONDITIONS OF..APPROVAL YES NO (FROM FORM U) ' ISSUANCE OF DWC PERMIT . _ YES NO DWC PERMITS N0. ,� 7/ INSTALLER:- �S�OIJh, ` —�— BEGIN INSPECTION 0: ' ;+ EXCAVATION . INSPECTION: : NEEDED: HY PASSED NSTRUCTION INSPECTION: NEEDED: AS BUILT PLAN SATISFACTORY: Y` ESs Ji APPROVAL. TO BACKFILL: DATE: BY " FINAL .GRADING APPROVAL: DATE BY FINAL CONSTRUCTION APPROVAL: DATE: BY T� j bZ Box-(� � `vi- . 66 LITTLETON ROAD WESTFORD, MA 01886 (508) 692.8395 FAX (508) 692.0023 1.000.649•TEST Report Numbers C-wps-10247 Report Dater October 25, 1993 client: Sample Taken At: Wilmington Pump supply Inc. Flintlock P.O. Box 517 Lot 4 Boxford St. Wilmington, MA 01887 N. Andover,Mass. Sample Taken Syr WPS staff on: October 21 1993 CERTIFICATE of ANALYSIS TEST PARAMETER: EPA Max RE6ULTS UNITS Total Coliform (P) 0 0 Per 100m1 Calcium No Limit 20.6 mg/L Copper (S) 1.3 <0.02 mg/L Iron (s) 0.3 0.1 mg/I• Magnesium No Limit 1.9 mg/L Manganese (a) 0.05 <0.01 mg/L Sodium " 20 5.1 Mg/L Potassium (s) No Limit 1.5 mg/L Alkalinity (s) No Limit 38.1 mg/L Ammonia No Limit <0.03 mg/L Chloride (S) 250 5.8 m8/L Chlorine (total) 0.7 <0.02 mg/L Color (8) 15 5 CPU conductivity No Limit 150 umhosi/cm Hardness No Limit 59 mg/L Nitrates(as N) (P) 10 0.22 mg/L Nitrites(ae N) 1 <0.01 mg/L pH (8) 6.5-8.5 6.7 SU odor (0) 3 0 TON sulphatoo (a) 250 12.1 mg/L Turbidity 5 1.2 NTU Sediment pos/neq neg NT=Not Tested, #4Value Exceeds EPA STD, TNTC-Too Numerous to Count *Background Bacteria Noted, '-EPA Advisory Limit '-Exceeds EPA Advisory Limit (P)-Primary EPA Standard, (S)-secondary EPA standard (may atfeot aesthetics of drinking water i.e. taste, color, etc.) This water sample, as tested, meets or exceeds EPA health standardo for the parameters listed above. The quality of this water is accepted as POTABLE according to EPA standards. . Massachusetts State Certified M1146/1-19P arlson, for Touting Laboratory #MA048 Thorstensen Laboratory Inc. II '$e Town of over 0 �tIY. ."� �: VIA if M' .. r, -,-Nord dower, Mass., A10 y COC MIC ME WICK �� �ADRATED '9vc !-{ BOARD OF HEALTH Food/Kitchen Septic System J. PERMIT T D 1� 4/v BUILDI G INS COR Aki*TTHIS CERTIFIES THAT....... .. ......................................................................... Fo a7 tio. has permission to erect.&.../.I�#1f buildings on ..04,400NNISAF.. V.. Rough'-t,&)C. - `I—A z 11 to be occupied as..I.1090.Af.. �.�.�...�. . tChimney -; provided that the person accepting this permit shall Wevery respect conform to the terms of the applicati n Final this office, and to the provisions of the Codes and By-Laws relating to the InspNIWjjftRf Buildings in the Town of North Andover. REGULATED BY PARA. 114.$-S. B.C. PLUM I G INSPEC R VIOLATION of the Zoning or Building Regulations Voids this Permit. ou 1`� L Q DATE FEE PAID ��,CJ �> &ICA 4; � • PERMIT EXPIRES IN 6 MONTHS ��`�p, �� (j UNLESS CONSTRUCTION STARTS ELECTRAL I SPECTOR / _--- PERMIT FOR FRAME/BUILDlwG Rough ...�� .... ........................... Service DATE: FEE PAIDla�c) U BUILDI G INSPECTOR Final C Occupancy Permit .Required to Occupy Building GAS INS CTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. 1 Burner ,/`v LXiN I N GKU. 021914NAL CONSERVATIO 7 y1j1'1 Street No. Smoke Det., SEWER/WATER irk FINAL DRIVEWAY ENTRY PERMIT �I iy A • i • �0 �► ' "h BOARD OF HEALTH �SSACIN4, NORTH ANDOVER, MASS. APPLICATION FOR WELL AND PUMP PERMIT Permit # 3 - Date 1'�Z�I93 A permit is requested to: drill a well; install a pump LOCATION:— �X/-�D.�D S./ Lot # Owner _T__G //(/7GDGAt- Address Tel We.'-'- Contrct.r Addo i Tel Pump Contrctr Add. , WELLS (To be completed at time of pump test. ) Type of well /ieT 511941 Use —Do"6-5,7-1 G, Diameter of well ( Size of casing To ' Depth 4or bed rock 30 Depth casing into bedrock Seal been tested? Yes (�) No (_) Date of test_ Depth of well Water-bearing rock �2.19iy/TC Depth to water /ur/ Delivers `R GPM for (how long?) Drawdown �700 feet after pumping hours at GPM Date of completion ig ture well tractor PUMPS (To be filled in before installation. ) Name & size of pump tx-,'e_�b+nnl 1o2S c,415 Type ,r Size of tanks,k_ �.c., Pump delivers 1 e_ GPM Pipe used in well: Cast iron (—) Galvanized (_) Plastic Sleeve used to protect pipe? Yes (_) No ( Type well seal Date Signa u e of pump insta j.ZQ *********************************************************** ********** Dat water analysis report submitted to Board of Health ' I I�)�,� P1 i.ng inspe t r ing i6#ector B and of Health yJlie�ate�aer� ,C'a�ozatoz�, 9w c. 66 LITTLETON ROAD WESTFORD, MA 01886 (508) 692-8395 FAX (508) 692-0023 1-800-649-TEST Report Number: C-wps-10246 Report Date: October 25, 1993 Client: Sample Taken At: Wilmington Pump Supply Inc. Flintlock P.O. Box 517 Lot 3 Boxford St. Wilmington, MA 01887 N. Andover,Mass. Sample Taken By: WPS Staff on: October 21 1993 CERTIFICATE OF ANALYSIS TEST PARAMETER: EPA Max RESULTS UNITS Total Coliform (P) 0 0 Per 100ml Calcium No Limit 25.3 mg/L Copper (S) 1.3 <0.02 mg/L Iron (S) 0.3 0.08 mg/L Magnesium No Limit 3.2 mg/L Manganese (S) 0.05 0.01 mg/L sodium " 20 11 mg/L Potassium (S) No Limit 2.0 mg/L Alkalinity (S) No Limit 67.3 mg/L Ammonia No Limit <0.03 mg/L Chloride (S) 250 17 mg/L Chlorine (total) 0.7 <0.02 mg/L Color (S) 15 7.5 CPU Conductivity No Limit 211 umhos/cm Hardness No Limit 76 mg/L Nitrates(as N) (P) 10 0.1 mg/L Nitrites(as N) 1 <0.01 mg/L PH (S) 6.5-8.5 6.9 SU Odor (S) 3 0 TON Sulphates (S) 250 19 mg/L Turbidity 5 1.7 NTU Sediment pos/neg neg NT=Not Tested, #=Value Exceeds EPA STD, TNTC=Too Numerous to Count *=Background Bacteria Noted, "=EPA Advisory Limit Exceeds EPA Advisory Limit (P)=Primary EPA Standard, (s)=Secondary EPA Standard (may affect aesthetics of drinking water i.e. taste, color, etc.) This water sample, as tested, meets or exceeds EPA health standards for the parameters listed above. The quality of this water is accepted as POTABLE according to EPA Standards. Massachusetts state certified Michael P. Carlson, for Testing Laboratory #MA048 Thorstensen Laboratory Inc. :j&cszate&je& oeadazatazy, 9.vc. 66 LITTLETON ROAD WESTFORD, MA 01886 (508) 692.8395 FAX (508) 692-0023 1-800-649-TEST Report Number: W- 12430B Report Date: June 24, 1994 Client: Sample Taken At: David Kindred Lot 4 sample Taken By:Client On: June 23, 1994 CERTIFICATE OF ANALYSIS ----------------------- Test Parameter: EPA Max Results Units Coliform Bacteria 0 0 per 100ml Method of Analysis: SM 9222E The quality of this water sample SATISFIES all State, Federal (EPA) and local requirements for coliform bacteria. /? 6&Z-A"';W"r Massachusetts State Certified Michael P. Carlson, for Testing Laboratory #MA048 Thorstensen Laboratory, Inc. i NORTIi R Of 4 ,�'''••.., "hi BOARD OF HEALTH ,SS4GMUSEt NORTH ANDOVER, MASS. APPLICATION FOR WELL AND PUMP PERMIT Permit # - Date_ A permit is requested to: drill a well; install a pump LOCATION: /-�G.'D SJ Lot # `r' Owner �--� i/G'TGOG.0 Address Tel Well Contrctr SlYL1,0141165 Add. Tel Pump Contrctr Add. Tel ********************************************************************** WELLS (To be completed at time of pump test. ) Type of well �'T=5/���/ Use —DD/1 ear/ C_ Diameter of well ( Size of casing Depth of bed rock Depth casing into bedrock Seal been tested? Yes (_) No (_) Date of test Depth of well BOG Water-bearing rock 0'e1-?N1 Depth to water /�� Delivers GPM for (how long?) Drawdown ';nLC0 feet after pumping hours at /�i GPM Date of completion 1alxrh3 Signature of well contractor ********************************************************************** PUMPS (To be filled in before installation. ) Name & size of pump Type Size of tank Pump delivers GPM Pipe used in well: Cast iron (_) Galvanized (_) Plastic (_) Sleeve used to protect pipe? Yes (_) No (_) Type well seal Date Signature of pump installer ****************** ********************************************** Date water analysis report submitted to Board of Health Plumbing inspector Wiring inspector Board of Health OCT 27 '93 06'40 • department of Environmental Mariagemant/Division of Water Resources P.2/3 WELL COMPLETION REPORT WELL. LO�jATIZN L GEOGRAPHIC DESCRIPTION Address `�G fr �, (� W of r1r M t.�Lr -el�L rreerl�I 1 fc;.crel City(Town 1 t'�'}1f f7l/ r Jro�.n Well owner f Adrlress •�).:[/!xx { //d NW Of jos!' L� t f_l.IC.,.-��ti•�' � .! ('14.In tnnrna) 1CJrctsJ lutersect. w/ a u QST Board of Health permit obtained, yes no C3 (raeJJ WELL USE WELL DATA Domestic Public❑ Industrial Q Total well tlepth. M� ft. Monitoring[D Other depth to bedruck r � ft, Water-bearing roc trtconsolidaled material; Method drilled Descripttoie Date drilled Water-beating zones; CASING 1! From To Type__�LL— 21 from To Length��ft. DiaLI.D.} in. gl From To Length into bedrock (t. Gravel pack well: dia.- -Protective wcli seal: Screw: dia. Gruut_❑ Ulher h/O V2 GC _ Slog w Icnyth from to STATIC WATER LEVEL(all wells) Static water level beiow land surface ILS it. Date WELL TEST(production wells} Druwdowi it, alter fxdmping hr. min. at 9Di11 How measured,•r� Recovery. ft. aftur„hr, min. LOG o FORMATIONSOM/MENTS M�lerialt From TO_ - ( La Av d4e. Driller t �e- .J12h�.Y- -� Firms + n s r, G Address City/Towns (� -- Supervising Driller Reg.# 5�ul r rep re-;drercd tiger Plaese Prig lirmly R I L L E R C 0 P Y I NUMBER FEE SGS THE COMMONWEALTH OF.MASSACHUSETTS $25 . 00 y� T-0Tt 1 ....... of .........hlQRTH-.ANIIL2V R----------------I------------- Skillings & Sons This is to Certify that -------------------•. ............... NAME 269 Proctor Hill Road, Hollis, N.H. 03049 . -------•-------------------- . . . . . • -------••-------•-.....••--•••-•-•-----------•----••-......--•----------_.. ADDRESS IS HEREBY GRANTED A LICENSE For Mei1..Aillnq. eft...f4 LQt. 4 Boxford-..Street ...............•----•----------•-•---•--•-----------------------•--•-••----------•-----...•-----•------------•------------------•-----•-----•-•-------------••------•------ ----•---•----------•---••----•••-•------•-------------•--------•--•-------•--•-----•--•----•-----•------•-•-------•---••-------•----------••-----••---•-------•---•--••-... ------------------------------------------------------------------------------------------=---------•--------------------•--------------------------------------------•--. This license is granted in conformity with the Statutes and ordinances relating thereto, and December 31, 1993 expires--------- .................................................... ess sooners n� ,3ev IFN � -------------- J - .- -- •--- ••-----Ocf ober 6.......................19---93 ----------••--------- �` -•• . . ••--------•------- FORM 433 HOBBS & WARREN, INC. a r DepmtaliMaagemt/Division ekoihrces +, WELL COMPLETION REP t ; i WELL LO ATI N G N O Ij Q Address I^© BOX Ord tr-e� � N S W .of (leery (circle) Git,.y/Town A)OY '-R f1 h or c Well owner +"(1V� )(J froadl .Address.. fit?x 1 ,T,3 1 r+'/a N W of r i-N jowl Y , Old t 4j'F (nd.in tenths) ( ' - drelel Board of Health permit obtained: yes no❑ //t rersecf. w/ K rST •Yroadl WELL USE. WELL DATA Domestic`(Public❑ Industrial ❑ Total well depth.�� d ft. eS .. Monitoring❑ ;Other Depth ao Uedrotk ft:. Wafer-bearing roc inconsolidaled mate�lal: { NI'ethod drilled[ UU ,r U scrl tion', Dat e drilled g P I CASING 1"Ier bearing zones. IType_ z l 11 From '?. To Type Length ft Dia(I D.) in I "li 2) From To Irl 3) From= To Length into bedrock ft r-. Gravel. ack well P dla: a'Ji Protective teed e.well seats. f - � - Scrt:en dia: ,1 C Grotrt.❑" Uthet l (1 ;Slot+' length from_to 3 STATICS WATER LEVEL(ail wells) � •` Static water level below land sur.•fare ft. Date S WELL TEST(production wells) l Drawdowt fY attar um in i P P 9 hr min at_�_gpin ,+ How measured r flecovery )iua'fler �; -- ''hr m)n LOG o FORMATIQNS OMMENTS I R `Materiels , Fionr= I b < _ Drill 2 La er � V"' Address ���``f { Cay/Town tf� . r Superoisln DPillerReg#`: ' l ,t. ! i r .Srr .r .re srered:w rgler ' a n rrml . i , I{ B0A OF HE LTH SOP, jI a' .h Department of Environmental Management/Divisio�t�f (te4 rces WELL COMPLETION REP WELL LO�ATIQN G ON Address O 41 70X Or� ►' PC't N CSS W .Ot ((��,,!feet)_ _l !,� � (circle) City/Town n-I (A h O�I do-y e r 1'It�X T(�YV�(' Well owner +"j lvH Ioe f< ! � -(road/ Address D,Pi- f D .7�` //d N 9OW Of I\I, Vl�_ou/7 i/ cn rl 0 1 3q J (nil.in tenthsl (circle) Board of Health permit obtained: 1/ yeesF no❑ infersect. w/Fu_$_r WELL USE WELL DATA Domestic Q/Public❑ Industrial ❑ Total well depth Monitoring❑ Other Depth to bedrock ,2)C-) ft. Method drilled Water bearing roc,Sinconsoliclated material:/�- Date drilled D -r Descnptlon CASING Water bearing zones: Type to 1) From ? To ? Length ft. Dia I.I.D.) (O in. 2) From To 3) From To Length into bedrock ft. Gravel pack well: dia. Protective well seal: Screen: dia. Grout-E] OtherD( I f-'470( Slot" length from_to STATIC WATER LEVEL(all wells) Static water level beiow land surface z ft. Date WELL TEST(production wells) Drawdowl ft. offor pumping o. hr. min,at gpm How measured Recovery ft. after—hr. min. 4r» o LOG o FORMATIONS COMMENTS �_Daf,� Fit a_ Materials From To / a1 b L31 c Driller, f i l l �e Firm 61<l G'r7 .,5 + )�n S' f Address �� ctor City/TownD (5 Supervisin Driller Reg.# 514 LA l r srr t A'registered wpl7 rJller Pleea print firmly BOA O F H E LTH C OP c r - - --/7 T / L- - ----- �__ 12 i • I I 1 _ J s i _ I l Jt, V I i t zv - h � Q --- ---------------------- 90 rC a�'\ ROSE RT ¢�� � MQRRIS ,�s Afa. 22150 •��� ISri�E���a' THIS PLAN IS INTENDED FOR ZONING WE HEREBY CERTIFY THAT WE HAVE EXAMINED PURPOSES ONLY, IT WAS COMPILED THE PREMISES AND THAT ALL EASEMENTS, FROM EYISTING PLANS AND RECORDS ENCROACHMENTS AND BUILDINGS ARE LOCATED WITH BUILDING LOCATIONS CONFIRMED AS SHOWN. ALL BUILDINGS SHOWN CONFORM IN THE FIELD. IT SHOULD NOT Q•E TO THE ZONING LAWS OF THE MUNICIPAL17Y USED FOR PROPERTY LINE DETERMIN- WHEN CONSTRUCTED. ATION, THE BUILDING IS NOT LOCATED IN AN ESTABLISHED FLOOD HAZARD AREA, I ZONING: REQUIRED STTSACKS: FRONT: 30 SIDE: SO ' REAR. 30 ' CERTIFIED BLOT FLAN MARCHIONDA & ASSOC., INC, �- -►�A�� � ENGINEERING AND PLANNING CONSULTANTS {`OWN & I 62 MONTVALE AVE., SUITE I AS PREPARED FOR STONEHAM, MA. 02180 (617) 438 -6121 SCALE; DATE:NIA, -I M & A FILE No,:. `.��� Town of North Andover, Massachusetts Form No 2 NORrh BOARD OF HEALTH Z 19 F w f s i i r, ";•b, �''' DESIGN APPROVAL FOR ,y4ACHUS SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM r ApplicantTest No. x Site Location�?T --A.- 4 Reference Plans and Specs._ ENGINEER DESIGN DATE s. n Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. x CHAIRMAN,BOARD OF HEALTH Y Fee E e g = Site System Permit No. "� a .. �.; k.`rte f^t,..s`• F ': _ .,.�:..�!;•rrtri�ca�.e+r.�v��..nk�r.w ...5.•5'..n+,y-..'w.ww',Mb'+1a,:1ti.,.F:-.a.,�.�'.w.,�.w«+..v,x.5r. wk4.• .__" __. - - .. TOWN OF NORTH ANDOVER MASSACHUSETTS `93 CT t NORTH e�n 3 s..' ,SOL !?+.�•. hd Any appeal shall be filed th days after p �(yar� 3 e t � - ' within (20) date of filing of this Notice $A us in the Office of the -bra:"`" Clerk. NOTICE OF DECISION Date. . . . . . . August 17, 1993, Date of Hearing August 311 .1993 & September 21, 1.993 Petition of , Flintlock,,, Inc... . . . . . . . . . . . . . . . . . Premises affected Lot ,3 ,& .4 Boxford .Street ,,. .South .side . .(Near Stonecleave Road) . . . . . . . . . . . . . . . . . . . . . . . . Referring to the above petition for a special permit from the requirements of the North, Andover, Zoning. Bylaw. Section_ 2,.:. Paragraph. 2..30..1. Driveway_ .(Common) . . . . . . . . . . . . . . . . . . so as to permit the ,construction of a common driveway .to .gain access to Lot .3 and Lot . Boxford, Street.•. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . After a public hearing given on the above date, the Planning Board voted CONDITIONALLY t0 APPROVE . . . . . . . . the . . .SPECIAL PERMIT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . based upon the following conditions: cc: Director of Public Works Building Inspector Signed Conservation Administrator �i - Richard Nardella, Chairman Health Agent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Assessors Police Chief . John. Simons,. Vice-Chairman. . . , . . . . . . . . . . . . . . . . . . . . . . . Fire Chief Applicant . John. Draper. . . . . . . . . . . . . . . . . . . . . . Engineer owen File . Richard. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Interested Parties John Daghlian.,. Associate Member • . . . . . • .planning B oard op NO.'0." KAREN H.P.NELSON o?' �m Director n Town of 120 Main Street, 01845 BUILDING NORTH ANDOVER (508) 682-6483 V •;'�0..:.°fir•19 CONSERVATION Ss°" a` DIVISION OF PLANNING PLANNING & COMMUNITY DEVELOPMENT October 4, 1993 Mr. Daniel Long, Town Clerk Town Building 120 Main Street North Andover, MA 01845 Re: Special Permit - Common Driveway Lot 3 & Lot 4 Boxford St. Dear Mr. Long: The North Andover Planning Board held a public hearing on August 17 , 1993 , upon the application of Flintlock Inc, requesting a special permit under Section 2 . 30. 1 of the North Andover Zoning Bylaw. The legal notice was properly advertised in the North Andover Citizen on July 28 and August 4, 1993 and all parties of interest were duly notified. The following members were present at that meeting: Richard Nardella, Chairman, Joseph Mahoney, Clerk and Richard Rowen. The petitioner was requesting a special permit for the construction of a common driveway to gain access to Lot 3 and Lot 4 Boxford Street. Mr. Mahoney read the legal notice to open the public hearing. The public hearing was opened with a brief discussion. No quorum - continued to the next meeting. Michael Rosati, Marchionda & Associates, presented the plan. Staff in support due to large area of wetlands. A 12 ' driveway is proposed. A turnaround for fire access is provided. Mr. Rowen asked if there were any future plans for the back lot. A question was raised as to whether any property would be donated to the Town as open space. The response was not at this time. Staff to check with the fire department as to size and location of the turnaround. Page 2: Lot 3 & 4 Boxford St. The driveways need to be an adequate distance apart. Requirements of stone bollard at fork of driveways will be added to the decision. Maintenance and snow plowing must be agreed upon as part of the easement. A resident of Stonecleave Road expressed concerns with traffic on the road and lack of site distance for driveway. Mr. Rosati needs to address the site distance issue and have it resolved by the next meeting. A larger radius may be provided at the driveway entrance. D.P.W. issues driveway opening permits, they will address these issues at that time. Mr. Robert Pouliot, abutter, asked if there were any restrictions on the number of homes on a common driveway. Mr. Nardella told him there was a limit of two homes per common driveway. On a motion by Mr. Mahoney, seconded by Mr. Rowen, the Board voted to continue the public hearing to August 31, 1993 . Mr. Nardella also voted. On August 31, 1993 the Planning Board held a regular meeting. The following members were present: Richard Nardella, Chairman, Richard Rowen, John Draper, John Simons and John Daghlian, Associate Member. The Board reviewed minutes from the previous meeting. Mr. Michael Rosati, Marchionda & Associates, was present. Issue of site distance and width of driveway at entrance was discussed at the last meeting. Information was provided to the Board stating that site distance is adequate with 18 ' wide at entrance tapered to 121 . A condition of no future access to Lot 3 from the driveway will be placed in the decision. The Board wants to review the vote to allow Planning Staff to sign Form A Plans to create new lots. Staff needs to review requirements of access with Town Counsel because Lot 3 has wetlands across the front. Lot 3 has a driveway, approximately 1, 000 feet long. Mr. Simons asked if all Conservation Commission and Board of Health requirements been met. Mr. Rosati answered "yes" . r Page 3 : Lot 3 & 4 Boxford Street On a motion by Mr. Rowen, seconded by Mr. Simons the Board voted to close the public hearing. A decision will be discussed at the next meeting.. On September 21, 1993 the Planning Board held a regular meeting. The following members were present: Richard Nardella, Chairman, John Simons, vice-Chairman, John Draper, Richard Rowen and John Daghlian, Associate Member. Mr. Nardella asked Mr. David Kindred about further development. Mr. Kindred would like to leave that option open. The Board reviewed the draft decision. Condition to be added: "No additional dwelling will be serviced by the common driveway. " Brush in the right-of-way on the east and west side to be cut back. On a motion by Mr. Rowen, seconded by Mr. Draper, the Board voted to approve the draft decision as amended. Attached are those conditions. Sincerely, North Andover Planning Board Richard A. Nardella, Chairman cc: Director of Public Works Building Inspector Conservation Administrator Health Agent Assessors Police Chief Fire Chief Applicant Engineer File I i i Boxford Street Lots 3 and 4 .Conditional Special Permit Approval _ Common Driveway The Planning Board makes the following findings regarding the application of Flintlock Inc. , P.O.Box 531, North Andover, MA, requesting a Special Permit under Section 2 . 30. 1 of the North Andover Zoning Bylaw for the construction of a common driveway to access lots 3 and 4 located on Boxford Street across from Stonecleave Road. 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 presence of wetlands on the site. 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. SPECIAL CONDITIONS: 1. No additional dwelling will be serviced by the common driveway. 2 . Prior to FORM U verification (Building Permit issuance) being for the proposed dwellings, a. Easements pertaining to the rights of access for driveways between the lots involved shall be filed with the Registry of Deeds Office. b. This site shall have received all necessary permits and approvals from the North Andover Board of Health, Conservation Commission, and the Department of Public Works. 3 . Prior to a Certificate of Occupancy being issued for either dwelling, a. The Applicant shall place a stone bollard at the entry to the common drive off of Boxford 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. b. the access drive shall be paved for its entire length. This shall include any turnoff for the existing house. C. the proposed dwelling shall have a residential fire sprinkler system installed in accordance with the provisions of Standard 13D, N.F.P.A. . 4 . The contractor shall contact Dig Safe at least 72 hours prior to commencing any excavation. 5. Gas, Telephone, Cable and Electric utilities shall be installed as specified by the respective utility companies. 6. All catch basins shall be protected and maintained with hay bales to prevent siltation into the drain lines during construction. 7 . No open burning shall be done except as is permitted during burning season under the Fire Department regulations. 8. No underground fuel storage shall be installed except as may be allowed by Town Regulations. 9. 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. 10. This permit shall be deemed to have lapsed after a two (2) year period from the date on which the Special Permit was granted unless substantial use or construction has commenced. Therefore the permit will lapse on October 4 , 1995. 11. The following Plans shall be deemed as part of this decision: Plans Entitled: Plan of Land, Boxford Street, North Andover, Mass. Drawn For: Flintlock Inc. P.O. Box 531 North Andover, Mass. Prepared By: Marchionda & Associates 62-I Montvale Avenue i I Stoneham, MA 01280 Scale: as shown Dated: 5/26/93 Plans Entitled: Site Plan Proposed Common Driveway in North Andover Drawn For: Flintlock Inc. P.O. Box 531 North Andover, MA Prepared By: Marchionda & Associates 62-I Montvale Avenue Stoneham, MA 01280 Scale: 1" = 40 ' Dated: 7/7/93 cc: Director of Public Works Building Inspector Health Agent Assessor Conservation Administrator Police Chief Fire Chief Applicant Engineer File FORM U - IDT RELEASE FORK INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Depa*-t=ents 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: Phone _ l ��-/SSS".%� LOCATION: Assessor' s Map Number /DS-r Parcel ili Subdivision Lot(s) Street ivc%- � St. Number SDS ************************Official Use only******** *************** RECOIMNDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected • Comments Date Approved Town Planner Date Rejected Comments -=�' Date Approved a Helth Agent Date Rejected Comments Public Worcs - sewer/water connections // % Y�l-�t � - driveway permit Fire Department j Received by Building Inspector Date • 'STI°�zl' North Andover Health Department Community and Economic Development Division 10/5/16 Address: 405 Boxford St. All North Andover Residents with Septic Systems and Garbage Disposals Please note that due to a recent review of a Title 5 Report, your property has been identified as maintaining a working garbage disposal that is being used in conjunction with a septic system. The Health Department is concerned for the longevity of your septic system. Garbage disposals are never recommended where septic systems are used, but if they are installed,the system must be specifically designed to handle the waste from them; your system can not handle the waste as designed. Please note that continued use of this disposal could quickly cause a pre-mature failure of your septic system, resulting in a large expenditure to replace it. The North Andover Health Department recommends that you remove it p p y from your home as soon as possible. Some information regarding regular maintenance of your septic system is attached. Please call the Health Department at 978.688.9540 if you have any questions, or e-mail your questions to: healthdept@northandoverma.gov. Thank you for taking the time to consider the impact that your current setup has on your septic system and the environment. v Sincerely, B an La rase, CEHT Director of Public Health 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.northandoverma.gov I i Commonwealth of Massachusetts 4—col n l � Title 5 Official Inspection Form RECEIVED 2 z ? Subsurface Sewage Disposal System Form Not for Voluntary Assessments _ 6 405 BOXFORD STREET TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Property Address DEBBIE GIBBS Owner Owner's Name information is required for every N ANDOVER MA 01845 09/09/16 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not John J. Soucy use the return Name of Inspector key. Soucy's Sewer S( r r Company Name Q Q S 1 e �- 78 North Broadw Company Address /Bran Salem "�'� ( � rW�,/ SL 03079 City/Town Zip Code 603-898-9339 Telephone Number 1T� �� t n� f,i, I it B. Certificatic I certify that I have at this address and that the information reporte, ime of the inspection. The inspection was performed based on my ua..��„y-,...____, inction and maintenance of on site sewage disposal systems. I am a DEP approved system"inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority A" An - on AP-�� 9/9/16 nspec sSignat Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. j ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. i i i t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Ii P � ����� 'JA\V� V � Qw��./ � Commonwealth of Massachusetts RECEIVED Title 5 Official Inspection Form SEP 2 2 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 2016 405 BOXFORD STREET TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Property Address "''`� '�`�`T— DEBBIE GIBBS Owner Owner's Name information is N ANDOVER MA 01845 09/09/16 required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not John J. Soucy use the return Name of Inspector key. Soucy's Sewer Service Inc. !� Company Name 78 North Broadway Company Address Salem NH 03079 City/Town State Zip Code 603-898-9339 13397 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 9/9/16 nspec s Signat Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 405 BOXFORD STREET Property Address DEBBIE GIBBS Owner Owner's Name information is required for every N ANDOVER MA 01845 09/09/16 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 405 BOXFORD STREET Property Address DEBBIE GIBBS Owner Owner's Name information is required for every N ANDOVER MA 01845 09/09/16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 i 1 Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 405 BOXFORD STREET Property Address DEBBIE GIBBS Owner Owner's Name information is required for every N ANDOVER MA 01845 09/09/16 page. CitylFown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 i Commonwealth of Massachusetts x 1iW Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 405 BOXFORD STREET Property Address DEBBIE GIBBS Owner Owner's Name information is required for every N ANDOVER MA 01845 09/09/16 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 405 BOXFORD STREET Property Address DEBBIE GIBBS Owner Owner's Name information is required for every N ANDOVER MA 01845 09/09/16 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of this inspection? ® El available as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 405 BOXFORD STREET Property Address DEBBIE GIBBS Owner Owners Name information is required for every N ANDOVER MA 01845 09/09/16 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: WELL ( SEE ATTACHED SKETCH ) Sump pump? ❑ Yes ® No Last date of occupancy: CURRENT Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 405 BOXFORD STREET Property Address DEBBIE GIBBS Owner Owner's Name information is required for every N ANDOVER MA 01845 09/09/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: current Date Other(describe below): General Information Pumping Records: Source of information: Soucy's Sewer Service Inc Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Gauge on truck Reason for pumping: Maintenance and Inspection Type of System: Y ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 405 BOXFORD STREET Property Address DEBBIE GIBBS Owner Owner's Name information is required for every N ANDOVER MA 01845 09/09/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1994 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 26"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): APPEARS TO BE WATERTIGHT Septic Tank(locate on site plan): 8" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 6'X 10.5' Sludge depth: 2" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 405 BOXFORD STREET Property Address DEBBIE GIBBS Owner Owner's Name information is required for every N ANDOVER MA 01845 09/09/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 40" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 7" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? TAPE & SLUDGE TOOL Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): PUMP TANK ANNUALLY. ALL TEES ARE IN PLACE. TANKS APPEARS TO BE WATER TIGHT AND STRUCTURALLY SOUND Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle I Date of last pumping: Date t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 405 BOXFORD STREET Property Address DEBBIE GIBBS Owner Owner's Name information is required for every N ANDOVER MA 01845 09/09/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: n ret metal fiberglasspolyethylene other(explain): ❑ co c e ❑ ❑ 9 ❑ ❑ Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): `Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 405 BOXFORD STREET Property Address DEBBIE GIBBS Owner Owner's Name information is required for every N ANDOVER MA 01845 09/09/16 page. CityTTown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): 0" Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids ca over, any evidence of leakage into or out of box, etc.): "D" BOX WAS REPLACED PRIOR TO INSPECTION, SEE ATTCHED PERMIT. i Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 405 BOXFORD STREET Property Address DEBBIE GIBBS Owner Owner's Name information is required for every N ANDOVER MA 01845 09/09/16 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: (2) 2'X 30r ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): NO SIGNS OF HYDRAULIC FAILURE Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 405 BOXFORD STREET Property Address DEBBIE GIBBS Owner Owner's Name information is required for every N ANDOVER MA 01845 09/09/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I i t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 405 BOXFORD STREET Property Address DEBBIE GIBBS Owner Owner's Name information is required for every N ANDOVER MA 01845 09/09/16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ❑ drawing attached separately wEE1 —--100,+ 62' SCREEN HOUSE CA, 42` 35' kGILTAN D OX t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 405 BOXFORD STREET Property Address DEBBIE GIBBS Owner Owner's Name information is required for every N ANDOVER MA 01845 09/09/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 6' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: DUG HOLE WITH AUGER APPROXIMATELY 50' DOWNSLOPE OF THE SYSTEM. NO WATER AT 3' (2' ELEVATION DIFFERENCE) Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 • i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments ° M 405 BOXFORD STREET Property Address DEBBIE GIBBS Owner Owner's Name information is required for every N ANDOVER MA 01845 09/09/16 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ❑ Inspection Summary: A, B, C, D, or E checked ❑ Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ❑ System Information—Estimated depth to high groundwater ❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 .s ..... .. __... . ....... . Commonwealth of Massachusetts Map-Block-Lot ,05.00056 BOARD OF HEALTH Peet No North Andover aHP-2o,s-o27a P.1. FEE I F.1. $175,00 f DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted JOSoucy . to(Repair)an Individual Sewage Disposal System. 1 j at No 4.05 $OXFORD STREE I' a as shown on the application for.Disposal Works Construction Permit No. BHP-2016-027 Dated Se Member 08,2016 Issued On:Sep-08-2016 BOARD OF HEALTH i I Commonwealth of-Massachusetts City/Town of No Andover MAY 4 2013 System Pumping Records =� FiEA�;Wi�J A 'P II4tYi>J T' 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, u -j n _ use only the tab 0-5 cUO�C key to move your Address cursor-do not No andover Ma use the return City/Town State Zip Code key. 2. System Owner: S t'bbs Name renin Address(if different from location) CitylTown State Zip Code Telephone Number B. Pumping Record 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: � © O n 6. System PumpedBy: �� • _ ' Z�k I Name Vehicle License Number `y Stewart's Septic Service Company 7. Location where contents were disposed: Stewart's Pr - eatme 4t,-2-0So. Mill Bradford, Ma Q1835 A0,Al— -14 Si of Hauler Date Signature of Receiving Facility Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts RECEIVED City/Town of No. Andover SAY a 1011 a System Pumping Record Form 4 TOWN OF NORTH ANDOVER M 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 within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important: When filling out 1. System Location: forms on the computer, use 405 Boxford Dr only the tab key Address to move your No. Andover Ma 01845 cursor-do not City/Town State Zip Code use the return key. 2. System Owner: Gibb Name " Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 4/26/11 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 ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: Riding High 6.:! emstPumped U_ C me Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: S rt's Pre-lireatoaent Plant, 20 So. Mill Bradford, Ma 01835 M nn�)l IR 12C� I1I a re o e a Date 00 Signature of R c vin acility Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts W City/Town of NORTH ANDOVER V �m , MASSACHUSETTS System Pumping Record Form 4 M DEP has provided this form for use by local Boards of Health. The System Pumping Record must be submitted to the local Board of Health or other approving authority. RECEIVED A. Facility Information Important: APR 0 5 2006 When filling out 1. System Location: forms on the N/ ` / TOWN OF NORTH ANDOVER computer, use / D GA HEALTH DEPARTMENT only the tab key Address ,�►� / to move your cursor-do not use the return City/TownState Zip Code key. 2. System Owner: Name Address(if different from location) e City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 3ty(o v 15Z)6p g Date 2. Quantity 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: 6. System Pumped By: Name Vehicle License Number Company aGG� Q 7. Location CCwherecontents were disposed: Si ature of Ha r /� Date http://www.mass.gov/dep/water pprovals/t5forms.htm#inspect t5form4.doc•06/03 System Pumping Record•Page 1 of 1 r 'rOWN OF NORT ANDOVER L)A t'h SYSTEM PUMPI 0 RECORD Y S7WN ER &ADDRESS YSTEM LOCATION ���� DATE OF PUMPTNO : TITY PUMPED: —7— CLSSPOOL: NO_-��- -SOPUC I'ank: NU YES e,� NA PURE OF SERVICE: Rou'rINE..V_�RUEN('1' OBSERVATIONS: (MD CONDUIONFUL..L 'ro COVER DEC 0 7 2004 HEAVYAVY 0"-ASE �-_._�AFFLES IN PLACE ' ROOTS LEACHMELD RUNBACK .... TOV,N1 OF OVER L-NT BXCBSSIVE SOLIDSFLOODED SOLID CARRYOVER,*-.....,...OTHER EXPLAIN systom Pump-W by m,.Z- . L57L,.. ira. CUMMENTS. ........... WN I'LN I'S MANSHAKED W TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: SYSTEM NER a ADDRESS SYSTEM LOCATION (example: left front of house) DATE OF PUMPING: QUANTITY PUMPED GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS _ LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) -- SYS EM P"tUMPED BY: lc- COMMENTS: I17 01/ 1' c%U lc-COMMENTS: CONTENTS TRANSFERRED TO: "'gra �, rte- _ _ --N->-,4.,�.,�.:�--_.-.--�- :..x-_._... .,.�-.,- .,t-.,,.-�.,.:_; .._ r _ --—...�---.�...F.,...,.-.._._.......,a 1 t �� ;� )95 �-- � 1V r: NOPT'H A RboV FPI � wt'i�; PR'EP..ARED v12 N7c vck 1>tt, NEW FN&LRNG EN:G!N.EER1NG 5ERVIc.E5 XivC; x 4 f G' 2Z.k9 DWELL , � •�; �. � fl tic.. �OiV s, F XI U15TRNC. E S h s r 1 T' F 3 3» � 2 T� F Sl• '7 i I To �1f.. • � VR.T1.0NS `1 9 f13 lei, so 41 < Lr-- _ ) 30, 91 2 �laE LsAeH f QFN�Fi WITH . : yi.. 5cH ... y� -'CNK 1'(\J I30, '9 ' DEEP ry �rt "T'sT 6 PrP of rN0. L ;z � pERc -1'�e, ! 1.116 Pl.f�rll '' 1S. Tai C I D]rFU At :;`o'STEM TH 4Fr e r < ';s ; T i o Nl»1 9 VV 1171-y t`i r" �r ��,sl4.N � vt: I <rfhiu. C-IVT '("V�1 Ar `�...i�y. M A:�'ti R:i fit.: :; �5.�D Co�j r=-c>;2ivl 4 Ito THE t t ' ,t/ �►'Ec t , ; ,'-, .�t ij lvs �,1,'m� If 3 /0 C-Ast I e JS, o r—)►V AL v ND i , 1 i { Rs 1301 LT A N NORTH ANDOYFA f )m R, PREPARE '.4,P&R F>w:1 wrlt oc:K fvc,. SAtF % GU'< 0RTF� SUN /•Y /94 •y NEW, Ft\t&40N p 6 N•Gt'iV E F,'P, Ncv- s.E9v 1 C 33 w RK R'o AD . ©. AN ra ov-F*R - - 72 �o e.' 9 ^^ �� �Xl 51ti X.r Q wEul D15TRNC ES 1 7U F 33.F F' I To 4 . Sox 1 Z. rl7 � �'/ •+' / o .3 9' 2q� SD ,' Bo CNK pv? 130- 51 4 WITri yn scH yJ l'j-NK I N 30'. 79 . . P6(zFOXWr.6; % Li7Me)-I 1 I PE ooS Fr.,� :iv"V, 13 I,,i7 °► s DEEt' wwrf-A YE,ST ';uP oF.. N►a. 13 3, 459 111 FfT 'P"I-1 l Awa T►-►�r 7i '� i'0.0,s 7.i2 v< r"F o N OPEN S n/ : /F c c v R,Yj p"w cEvv i T r v ;`" 1 (ai IG,NV-AS c3Qf Cot fV' :G„ A-TLpp �S, :si p . . e. :r---0 iN { To TME LP AV: ,$aec c Ano vs F�vr; 4f 3 l v c.vt ra:'. IV 6. 7`M L ►w,.,H,4 G.v2 fi 0; 1 N CG- W,1.a N o"r" Cann PG` " fF'r T"�-;i�. 1 .E Lo7VST�T,�'.cTrv.N . W ATF �U U N.�?. Tl�?iV C r ✓.1 ;r r:..)i< C- 1j.. FRvnn, j,, All r/0iNp13i ic • 4 _ .. �.»�� ,...r-w, • S�KTLEb'l�6. . PUBLIC HEALTH DEPARTMENT Town of North Andover Community and Economic Development Division CERTIFICATE OF. COMPLIANCE As of: 9/9/16 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Repair of D-Box By: John Soucy At: 405 Boxford Street Map 105.0 Lot 0056 North Andover, MA 01845 The Isl�suance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Br anGrasse Health Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com North Andover Health Department (ommunity and Economic Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 405 Boxford St. MAP: 105.0 LOT: 0056 INSTALLER: John Soucy DESIGNER: ;J p PLAN DATE: BOH APPROVAL DATE ON PLAN: INSPECTIONS D-Box INSPECTION: (� ( (D 4 e s+ek DATE OF BED BOTTOM IN PECTION: DATE OF FINAL CONSTRUCTION INSPECTION: I DATE OF FINAL GRADE INSPECTION: OIC- SITE CONDITIONS ❑ Contractor reports any changes to design plan ❑ Existing septic tank properly abandoned' N Q ❑ Internal plumbing all to one building sewer ❑ Topography not appreciably altered Comments: SEPTIC TANK ❑ Building sewer in continuous grade, on compacted firm base ❑ Cleanouts per plan ❑ Bottom of tank hole has 6" stone base nn ❑ Weep hole plugged (�M- ❑ 1500 gallon tank has been installed H-10 loading ❑ Monolithic tank construction ❑ Water tightness of tank has been achieved by visual testing ❑ Inlet tee installed, centered under access port i Y, I ❑ Outlet tee installed, centered under access port (gas baffle/effluent filter) ❑ inch cover to within 6" of finish grade installed over one access port ❑ Hydraulic cement around inlet & outlet Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon Pump Chamber installed ❑ H-10 loading ❑ Monolithic tank construction ❑ Inlet tee installed, centered under access port N ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off floats working ❑ Separate on/off floats ❑ Drain hole in pressure line ❑ cover at final grade installed over pump access port ❑ Water tightness of tank has been achieved by testing ❑ Hydraulic cement around inlet & outlet Comments: CONTROL PANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped (� ❑ Location of control panel: basement ❑ Alarm signal located inside: basement Comments: DISTRIBUTION-BOX Installed on stable stone base H-20 D-Box Inlet tee (if pumped or >0.08'/foot) Hydraulic cement around inlet & outlets [..� Observed even distribution [. Speed levelers provided (not required) Schedule 40 PVC Pipe Comments: \YAW/ , OVJWvZA . 1W� r Commonwealth of Massachusetts Map-Block-Lot - BOARD OF HEALTH PennitNo -- North Andover -BHP-2016-0274------------- --------- P.1. FEE F.1. $175.00 1W ----------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted John Soucy --------------------------------------------------------------------------------------------- to(Repair)an Individual Sewage Disposal System. at No 405 BOXFORD STREETb-bby-------------- -------------------------------------------------------------------------- as shown on the application for Disposal Works Construction Permit No. BHP-2016-027. Dated Se tember 08,2016 Issued On: Sep-08-2016 ` BOARD OF HEALTH f:; Application for Septic Disposal System Construction Permit - TOWN OF TODAY DTE Full Repair NORTH ANDOVER, MA 01845 r-00 Component Important: Application is hereby made for a permit to: When filling out ❑Construct a new on-site sewage disposal system* forms on the computer, use ❑ Repair or replace an existing on-site sewage disposal system* only the tab key H2O D BOX to move your ®Repair or replace an existing system component-What.? cursor-do not use the return A. Facility Information key. 405 BOXFORD ST � •�' Address or Lot# Arm n F �Q NyANDOVER �OFNORT R M D / oENT 2.- TYPE OF SEPTIC SYSTEM . Jb "�� ➢ ❑ Pu P Gravity(choose one) ***If pumps em, attach copy of electrical permit to application*** ➢ Conventional System (pipe and stone system) ➢ ❑ Infiltrator or Biodiffuser(Gravel-Less) (Attach a copy of your certification to install this type of system.) ➢ ❑ Pressure Distribution S.A.S. (No D-Box) ➢ ❑ Pressure Dosed(D-Box Present)S.A.S. ➢ ❑ Does the system require an effluent filter? Yes No__jf___ If yes, does plan specify make and model of filter? YES =(no further info. needed) NO =(installer must specify brand of filter before DWC issuance) What is the Make? What is the Model? 2. Owner Information DEBBIE GIBBS Name Address(if different from above) City/Town State Zip Code TAGIBBS1 @COMCAST.NET 978-239-3752 Email address Telephone Number 3. Installer Information JOHN SOUCY SOUCY SEPTIC SERVICE INC Name Name of Company 78 N. BROADWAY Address SALEM NH 03079 City/Town State Zip Code Telephone Number(Cell Phone#if possible please) 4. Designer Information r / Names/1 Name of Company Address City/Town State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 n-, Application for Septic Disposal System i hl TOD "S ATE Construction Permit - TOWN OF $350.00 -Full Repair NORTH ANDOVER, MA 01845 $175.00 -Component PAGE 2OF2 A. Facility Information continued.... 5. Type of Building: ®Residential Dwelling or❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental de, as well as the Local Subsurface Disposal Regulations for the Town of North Ando r. understand that until a final Certificate of Compliance has been issued by this Boa of alth, the in ed system is not approved. o- e Date Applica ppro B . (Board of Health Representative) I Na Date App cation Disapproved for the following reasons: For Office Use Only: L Fee Attached. Yes V No 2. Project Manager Obligation Form Attached. Yes No 3. Pump S sy tem? If so,Attach copy ofElectrical Permit s No Applicant received copy of "Electrical Inspection Notes for Septic Systems" Yes No Handout? 4. Revieu ed approval letter, all paperwork received? Yes No MISSIng: 5. Foundation As-Built?(new construction only): Yes \No (Same scale as approved plan) G. Floor Plans?(new construction only): Yes No Application for Disposal System Construction Permit•Page 2 of 2 ��r - ....t• \j�1 s?ry\§9hi'Z2�!►y"1� �,3.?1� tt � i' t�.t. '�I`Y �wt*'}yM a1.+\rC.i��+\ T{1> ��f��"' t t• .t �., `'at+ \, ,1�`i•1 k \,tN', 47 : �.j �\ll^ii�i�`;•�'l�`1i�(F�A�� �\`\.t ° \ � c i i�, ~� � v ' Town of North Andover, Massachusetts Form No.3 c� NoorM, BOARD OF HEALTH .� _ •.do • 3?a.?. -e O o 19 y s,s•,..o.•��� DISPOSAL WORKS CONSTRUCTION PERMIT SACMUSE Applicant NAMEADDRESS TELEPHONE Site Location �� C-Sk Permission is hereby granted to Construct 1kor 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. �� PLAN REVIEW CHECKLIST ADDRESS ,L/�7- X,Cb�211 ST. _ENGINEER GENERAL / 3 COPIES �� STAMPy LOCUS NORTH ARROWy� SCALE CONTOURS PROFILE L--- SECTION 1,-- BENCHMARK - SOIL & PERC INFO L-`� ELEVATIONS WETS. DISCLAIMER 4---- WELLS & WETLANDS_Lz:::��' WATERSHED? 10 DRIVEWAY�lev) WATER LINE �--� FDN DRAIN? SCH40 (/ TESTS CURRENT? SEPTIC TANK / MIN 1500G. C,� . 17 INVERT DROP GARB. GRINDER(+200% EDF) 25' TO CELLARy MANHOLE TO GRADE ELEV dA- GW 4< D-BOX SIZEj-,6 # LINES FIRST 2' LEVEL STATEMENTy` INLET/L30-6 - OUTLEToZ1 9.WSJ = • 17 (2" OR . 17 FT) TEE REQ'D?/V6 LEACHING RESERVE AREA 4' FROM PRIMARY? L" 100' TO WETLANDS L--- 2% SLOPE 100' TO WELLS t/ 35' TO FND & INTRCPTR DRAINS 4f TO S.H.GW L-- 3251 TO SURFACE H2O SUPPA1,4 4' PERM. SOIL BELOW FACILITY �---"� MIN 12" COVER FILL? �5' if above natural elev 10'i� below) BREAKOUT MET? I/ TRENCHES / / ,�/ MIN 660 gpd (/ SLOPE (min .005 or 6"/100' ) v >3' COVER? - VEN3' /17 SIDEWALL DIST. 2X EFF. W OR D (MIN 61 ) � IS RESERVE BETWEEN TRENCHES? O IN FILL? V MUST BE 10' MIN 4" PEA STONE? BOT X LDNG + SIDE 91q6 X LDNG,96 = TOT � 7al 71vL5 (L x W x #) (C/fLt2 (DxLx2x#) i DATE Iro ? Sheet of BOARD OF HEALTH TOWN OF NORTH ANDOVER SUBSURFACE DISPOSSAS�L DESIGN REVIEW FEE PERMIT # ( 6' DATE RECEIVED APPLICANT ASSESSOR'S MAP ADDRESS PARCEL # LOT # _ ENGINEER STREET �X/--1��2D �7`• �A2C/f/ON4�9 �iPC�s/,zT/ ADDRESS PLAN DATE REVISION DATE 6/ CONDITIONS OF APPROVAL: Q 6I)N AR,q/y dyTl'/jCG 01111A. APPROVED DISAPPROVED I