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Home My WebLink AboutMiscellaneous - 41 BRUIN HILL ROAD 4/30/2018 41 BRUIN HILL ROAD d / — 210/104.A-0032-0000.0 i d I ; d I k i F � e) MAR # (0'A' __ LOT #__..___-_._- ..----_....._..___..____..._____.....__.. PARCEL # 3Z' STREET, a.A.__._eP_.....-- CON$TRUCT_I ON__APPROVAL HAS PLAN REVIEW FEE BEEN PAID? YES NOZ.. - g -- - APP. BY" PLAN APPROVAL: DATE �7 DESIGNER: Alen � _ y� PLAN DATE____Z/ ._..�� CONDITIONS WATER SUPPLY: OWN WELL WELL PERMIT DRILLE R.__._--------__..__....._..__...._...._.—................ __._._ WELL TESTS: CHEMICAL DATE APPROVED._____.____.__.__^._. BACTERIA I DATE APPROVED,............................ ..... BACTERIA II DATE APPROVED_._._.__.___,-__._-_ COMMENTS: FORM U APPROVALa APPROVAL TO ISSUE ES NO DATE ISSUED_ � Z�� ____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: DATE: f � SEPT I_G._SY_STEM.__I_N.S..TA.I,LAT. ON. IS THE INSTALLER LICENSED? =YES NO TYPE OF CONSTRUCTION: NEW REPAIR NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW NO CONDITIONS OF APPROVAL YES NO (FROM FORM U) ISSUANCE OF DWC PERMIT YES NO DWC PERMIT NO. L�ZE� INSTALLER:._...._.� BEGIN INSPECTION YE5 O: .............___._..._._........__............ EXCAVATION INSPECTION: NEEDED:_._.-.__._._.-._....__._._.-_-............_.__....___.._..__....._._........_._._.................._.-. PASSED BY-. __._.. ._.___._.._.._.. ......._ .. _.. .__ ..._ _..__-. CONSTRUCTION INSPECTION NEEDED:_.__....._. _. ..._. ... ...... ._-._._.._- AS BUILT KLAN SATISFACTORY: Y S:__ .._ APPROVAL TO BACKFILL: DATE-.- _ ._ BY FINAL GRADING APPROVAL: DATE_ 2� BY_.--_ FINAL CONSTRUCTION APPROVAL: .... BY__.. _ ..-,.-, ,,,.._... . ... ........ I� , pa ® �oRTH r� BUILDING PERMIT oF�tyeo �g 6 TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION � = m Date Received �- A�RATEU Permit No#: �SSgcwus�R i Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION "7 �v`�1 Print TY OWNER �t>t'1/1 i' � �(�`i�1 S�2 ROPER oo Year Structure yes P � Print MAP__PARCEL:__ZONING DISTRICT:__ Historic District yesSn Machine Shop Village yes i li 7E] OF IMPROVEMENT PROPOSED USE Non- Residential Resid tial ew Building ne family ❑Two or more family ❑ Industrial ❑Addition ❑ Commercial ❑Alteration No. of units: ❑Assessory Bldg ❑ Others: ❑ Repair, replacement ❑ Demolition ❑ Other --- , W �t sh - - " - a4er ed IDistr`ict. �p _. ._, � Flood lain ❑UVetlancJs r Well ` ❑ Septic 0 � _ Y ❑WaterlSewer _ _-. __ _ _.� - ` DESCRIPTION OF WORK TO BE PERFORMED: l I Identification- Please Type or Print Clearly Phone: OWNER: Name: �n�i L �' � - i��`��c� Address: �'� [Contractor'Name: Phone: Email: 47I to I,` e1 v t�S N G[`1 � e Cdr Addres' '� !J i l � a Supervisor's Construction License: �� f Exp. Date: ( - 1 - i ce ::: Home Improvement License: v 7 Exp. Date: .> � ARCHITECT/ENGINEER �� Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ � �/ -2> 5 FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ----- --------- 1 1 stamped Plans 0 Ceyified PI°t plan Plans Waived� � � d❑ Sw�iagpools � pOSAk 0 g(Sate5 0 GEDXS ' ❑ ,f�gmassagelSody 0 Foodpacka� ' 0 'xobacco Sates 0 perm�entD�pstex on Site etc. ®1_LOW114G SE A®SIGMA ®FF F®R�' THS FO,®ePA�-�wir- IL�`��R Signature_ Reviewed On�— iG ®f-Vf-L Ts si nature ® N Reviewed on 1, 7 (� si natur Reviewed on WMENT s � in Decisionlreceipt submi�ed yes t zon 9 Variance petIt1on No: of Appeals: + tonin)Board � Comments plann'tn9 Board Decision: Comments permit privewa ILL50 it 20 . TDTALg ° RD/�/TAGE; , . s y7 S 72'38'3{)" E sl9g . 33 .38' rDT�L�F RDtVT,q / t7y, N 0 g3,70� SPS ` P A�: ARCA_ NOS- . 65 0 TOT OPAN OUS / OONTtOU 9E� 5.F g EX/SMVG O FOUNDA 770N ` p v'. N t3` �i cls`CP LAUtum . iS w O O, y 1 . 0 ap �� r. Ep 4 6 F M Lo = 87 4�0: 5 TpTA� ARES 65, �. UON� UPLAND sp � T1 00 � 9' e, ,x � n7 1 03 to i w 1 f 1\ ff I 3 � PLAN OF LAND ATLANTIC E'NGINE'ERING & N SURVEY CONSULTANTS INC: Mrd''JOHN B. P.0. BOX 776 — 30 PROSPECT ST. PAULS�N N " Tei ;Y:u ,c� '>U/ r< "4 \A RO WLEY, SIA 01969 N o, 31725 JDA NO: (y P� d O? - W DATE:• / 1 SCALE/91 SCAL1 "_ 0 ' "d SuR��`° THIS IS NOT A PROPERTY LINE DETERMINATION. ON THE BASIS OF MY KNOWLEDGE, THE SETBACK DISTANCES SHOWN HEREON ARE INFORMATION AND BELIEF, I CERTIFY TO INDICATE THE LOCATIONS OF PROPOSED OR THAT THE INDICATED STRUCTURES EXISTING STRUCTURES ONLY. ARE LOCATED AS SHOWN, AND THAT THESE SETBACKS ARE NOT TO BE USED BY THE SETBACK DISTANCES SHOWN Z THE CLIENT TO ESTABLISH LINES FOR FENCES, HEREON WERE THOSE RECORDED AT SHRUBS, ETC. THE SITE. G I i Commonwealth of Massach setts u W City/Town of IVO • Ari d o ve4 System Pumping Record Form 4 M 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. Sy t m Locatl on the computer, /� I use only the tab r to move your Addr cus cursor-do not n . A use the return —v) !)a key. City/Town State Zip Code 2. System Owner: Name rerttm 30— Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record I �lq— SOO 1. Date of Pumping Date 2. Quantity dumped: Gallons 3. Type of system: ❑ Cesspool(s) 4/ 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: 6. System Pumped By: '�)Q�Do�ft D� ame Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: Stews Pre-tre tment Plant, 20 So. Mill Bradford, Ma 01835 4 Signature o auler Date SGw�U� "D�pp,R NEA4SN Signature ofR n i ity Date t5form4.doc•03 System Pumping Record•Page 1 of 1 Town of North Andover, Massachusetts orm No. 1 NORTIM -4A BOARD OF HEALTH 19 5 46 APPLICATION FOR SITE TESTING/INSPECTION �9SSACHus��y Applicant NAME ADDR S TELEPHONE Site Location LOT ( /B/ZUI.c/ Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee Test No. S.S. Permit No 2 D.W.C. No. Z . .C. Date Plbg. Permit No. �'" � '� i �� SURD of N -j�-1 �T 1f BE UW— 111Q, l.Jl �TC12 S� NdI�TH, -4u MA, 1 QP�� CAIv C ?2MI 2 T Ur cyAtE�{ Sc�PP(.Y wf ► OUJEc,— AP ouCD1YJrC SS 5ET-IG Sy sTEAA vLSIe&) �Ppjf�ovt-v D,4r�' Z -z 1- /JPR�OUiNG yUrI-101�iTI' PLAIJ V654 &A�) FZWAv U14 j�: �(SAPPx�VEpCo�DIT��s DgiE R�ASoNS Dw� SrPTtC Sl�ST�M ��5�`A1.1.,QTro�J MT(ol") 1NSPE6T(OA J 94rG Q 045 CJ FAIL. �15pF�r�onJ P(PE �/,-A How T'v T K : I?A 55 `Cl Ro)L ,dPPI�dVED Q/JTC APHR)JI^iG AUTHORvF/ 1,A,5FbC foNS (1p any) DIS�iPt'�vv�D D,arC Ru4L APP DVAL DATA �( .;f ei § ".f`•aF�sxr A^3j'.177"u.t "•c4�iZ`C: . 'r�a v � ! I IP. lj� ,l :' � r{r 4,, tYt'. t�ww •i ... °45� :�. II I.,p,1 q V r .. LQttrt. .{r �vr,cfi rr ..- ii1 h' a> � ,.. -.`;•t�' .. i N 't .. r Sim C` •( �.� rll ffSV ;i ti,, (s �.. rl t,� t Y . ° r yA.• fG LI v � , ? lin i b v til r Fly _ 1 Avi NG: I FORM U — IAT CEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** ,/�'APPLICANT: Qow L) C)'JE Phone LOCATION: Assessor' s Map Number Parcel Subdivision Lots; ,/Street er �cUin �A << St. Nurd:er 41 Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Cons e--:anion Ad:-inistra zr Dame Re;ected C or=en Date Approved Town Planner Date Rejected Co=,, ..er.z- Daze Approved Foo:: =n=_Lec:= - ealtt Daze Rejec=ate �/ Date Apprcve�d Se' _ Inspecp.,.. :lea?t Daze Re;ec:__ Co=_.. Wcr%:s - sewer/wager connections _ - dr_vewa_• permit Fare Demar-ment Received by Building Inszector Dame u , NORSE ENVIRONMENTAL SERVICES, INC. 6h 3 Pondview Place ' TyngSboro,Mass. 01879 Tec.649-9932 CERTIFICATION OF SUBSURFACE SEWAGE DISPOSAL SYSTEM INSTALLATION I, STEVEN ERIKSEN A Registered Sanitarian duly licensed by the Commonwealth of Massachusetts , License Number 886 , and working as an employee for Norse Environmental Services , Inc . certify that I have visually inspected the construction of the individual subsurface sewage disposal system at the referenced location and hereby certify that to the best of my knowledge and belief all work has been performed and completed in general compliance with the terms of the permit and in general accordance with the plans approved by the local Board of Health. Furthermore, all construction appears to comply with the provisions of Title V r. of the Massachusetts Environmental Code (310 CMR 15 .00) and all r� applicable local regulations. LOT NUMBER: 8 STREET ADDRESS: Bruin Hill Road TOWN: No. Andover, Mass. DATE: 5-21-91 SIGNATURE. f •r'_ �t�__ / SEAL: NORSE ENVIRONMENTAL SERVICES, INC. 3 Pondvlew Place TyngSboro, Mass. 01879 TEL. 649-9932 7/12/90 Mr . Michael Rizotti North Andover Board of Health 120 Main St . No. Andover, Ma 01845 RE: Lots 7 and 8 Bruin Hill Road Dear Mr . Rizotti : Recently, copies of the above referenced plans dated 7/10/90 were hand delivered to you by Jeffrey Hannaford . Unfortunately, this was due to an error by our personnel, who believed that although the plans were designed years ago, the plans had never been submitted. A new owner 's name and new date was simply put onto the plan. We have since corrected this error . The original date ( 2/14/89 ) is now on the plans (which HAD been submitted ) , and they are being treated as REVISIONS dated 7/10/90 . Please destroy the copies that were sent to you in error . Enclosed are the revised copies, which are dated 7/10/90 and reflecting the current owner ' s name as John Cormier (previous owner : Mr . Tulley of Dunstable ) . Thank you for your consideration in this matter . We apologize for the inconvenience this error may have caused. Respectfu y submitted, NORSE ENVIRONMENTAL SERVICES, INC. 3 Pondv/ew Place ' Tyngsboro, Mass. 01879 TEL.649-9932 CERTIFICATION OF SUBSURFACE SEWAGE DISPOSAL SYSTEM INSTALLATION I � STEVEN ERIKSEN A Registered Sanitarian duly licensed by the Commonwealth of Massachusetts , License Number 886 , and working as an employee for Norse Environmental Services , Inc . certify that I have visually inspected the construction of the individual subsurface sewage disposal system at the referenced location and hereby certify that to the best of my knowledge and belief all work has been performed and completed in general compliance with the terms of the permit and in general accordance with the plans approved by the local Board of Health. Furthermore, all construction appears to comply with the provisions of Title V of the Massachusetts Environmental Code (310 CMR 15 . 00) and applicable local regulations. LOT NUMBER: 8 STREET ADDRESS: Bruin Hill Road TOWN: No. Andover, Mass. DATE. 5-21=91 SIGNATURE: f�'"- %==- — /fey �7 SEAL: .t F. 4 T `i AS-BUILT SURVEY 5-21-91 0 �y Lot 8 Bruin Hill Road f No. Andover, Massa Owner : John Cormier 54� } Scale : 1" = 20 ' Location Elevation Top Found . . . . .. . . . 159 . 01 Found . Outlet . . . . Tank Inlet . . . . . . . 162 . 90 A Tank Outlet . . . . . . 162 . 82 D-Box Inlet . . . . . . 162 . 55 D-Box Outlet . . . . . 162 . 45 Beg Tr . #1 . . . . . . . 162 . 38 it it #2 . . . . . . . 162 . 38 ( it of #3 . . . . . . . 162 . 39 it it #4 . . . . . . . 162 . 38 End Tr . #1 . . . . . . . 162 . 07 #2 . . . . . . . 162 . 07 #3 . . . . . . . 162 . 08 a A-38.5 105 r� n &- 34' A_ #4 . . . . . . . 162 . 08 5 - '1G Bottom Tr . #1. . . . 160 . 07 8 -13' A -=64 � " " #2 . . . . 160 . 07 #3 . . . . 160 . 08 #4 . . . . 160 . 08 ------ A- 111 rb P.� rz U I HI L L 4�to. . ccl� � Commonwealth of Massachusetts Executive Office of Environmental Affairs ®apartment of Environmental ProtectronR ��- William F.WoldG&oernis rg�� Trudy Coxe Argon,r 9 R t S t, ecretwy U.Go�emor rgeo Paul Ceilucct {i`t' "� vld B. Struhs Commissioner t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION-F RM PART A C JE�R� TIFICATION Property Address: h �\ �� 1 �o` Address of Owner. Datb t_1 of Inspection: 1 (If different) Name of Inspector. f�`�� Company Name,Address and Telephone Number. BATESON ENTERPRISES, INC. TEL:(508)475-1474 Excavating-Water&Sewer Lines-Septic Systems&Pumping Service FAX:(508)475-5451 CERTIFICATION STATEMENT 111 Argilla Road . Andover,Mass.01$10 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: _V Yasses Conditionallv Passes Needs Further Evaluation By the Local Approving Authority _ F Q Inspector's Signature: Date: / 97 The System Inspector shall subs it a copy o . inspection report to the Approving Authority within thirty(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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: AJ SYSTEM ASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. BJ SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair, passes inspection. Indicate yes, no,or not determined(Y, N, or ND). Describe basis of determination in all instances. If"not determined",explain why not) _ The septic tank is metal, cracked, structurally unsound,shows substantial infiltration or exfiltration,.or tank failure is urunment. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 i��Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION '/(continued) Property Address: g` l ` I I�l r`� `& 41LA Q Owner. Date of Inspection: B1 SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four 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 obstruction is removed C1 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MAN"It W111011 WIt.410 Pft4J'['ECT THE PUBLIC HEALTH AND SAFE AND THE ENVIRANMIa" 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. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption m and is within 100 feet to a surface water supply or tribe to a P rp �e PP y �9 surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. 3) OTHER (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) `- Property Address: L B V\� L ' I l o r-T °� Owner. 14V, VQ ` t6` ,S(2A-1 0,\- Date M` Date of Inspection: ` `3- 1 q_ c r1 D) SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an 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 <:esapool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Anv portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 I 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. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the �1 Bi Department for further information. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner. Date of Inspection: �vJ Check if thefolio have been done: P information was requested of the owner, occupant, and Board of Health. _ one of the system components Have boon VUm W. for at lalkAt two weeks and the Pygtom has been receiving flatus Aew rates dd ' that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As t plans have been obtained and examined. Note if they are not available with N/A. • -u _The,.racihty or dwelling was inspected for signs of sewage back-up. p Them does not receive non-sanitary or industrial waste flow 1,/The • was inspected for signs of breakout. AAU atem components, excluding the Soil Absorption System. have been located on the site. he septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. "XThe ' e and location of the Soil Absorption System on the site has been determined based on existing information or a rozimated by non-intrusive methods. _The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: q l a(� �Y 1I1A l' UOC Owner. ( • ��U�) 1 ��0 SZM Date of Inspection: FLOW CONDITIONS RESIDENTIAL. Design flow: ns Number of bedrooms: Ll Number of current residents: Garbage grinder(yes or no):-V-0 Laundry connected to system (yes or no):�S Seasonal use(yes no Water meter readings, ift available: nn'i tJ 300 70 109 +- q a = aaA / aC�� Last date of occupancy: CU d(AA-A,+ C `� COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow:_ gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: z,e,c sate or oommpasqy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: 4* 4 System pumped as part of inspection: (yes or no)V2 If yes, volume pumped: J Op ¢allons Reason for pumping: t 1i\SiOP�r TYPE OF SYSTEM 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) Other(explain) PRO MAGE f all components, date installed(if known)and source of information: 74V�OV-1- Sewage odors detected when arriving at the site: (yes or no) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property AddressOwu Vl ��C1� _1KC Qrz �� Vow � :.�a r.) \ V".Date of Inspection: VA `J SEPTIC TANK: ( (locate on site plan) It Depth below grade: Material of construction: _concrete_metal_FRP—other(explain) Dimensions: 0' >< H r,rl S - / 00 C ONS Sludge depth: C_ " 1 �� I)ie ao ftp►trop of slkdpa to bottom of outlet tee or baffle:z Scum thickness:_ Distance from top of scum to top of outlet tee or baffle: 4 r( 11 Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pump' condition o inlet d out1 t tees o baffles, of liq 'd 1 vel ' relation outlet inve ,afro integrity, evidence f leakage, tc.) �j P, • �— brf� GREASE TRAP:NjNbv�p (locate on site plan) Depth below grade: Material of construction: _concrete_metal_FRP—other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance fiom bottom of scum to bottom of outlet tee or baffle: e Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) (revised 11/03/95) 6 • I I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address ! C��U'1V\ to(R�• NorAkk Owner. �"`(-' , l ,� ��1/\ 1M Date of><I®Pf�f�iHi `q VOW TIGHT OR HOLDING TANK:hDVke- (locate on site plan) Depth below grader Material of construction:_concrete_metal_FRP_other(eaplain), Dimensions Capacity: gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee,condition of alarm and float switches, etc.) DISTRIBUTION BOX- (locate OX(locate on site plan) Depth of liquid level above outlet invert: Comments: � ( if leve and distbuti is equal, evide of sgl�ds carryover, evid ice of leaks into oA out of bap:,�tc.) O" � !, � ��'T�M C� ov�N\2. l�c� U'no VAM, CD Q . ti PUMP CHAMBERr e- 6W i (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C L] SYSTEM INFORMATION(oontin ed) U Property Addrew U t"I P& �"O C� & " UVI' - Owner. M Y, aat.@ XJ�w� hof Inspection: ` _,,,4►y SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible;excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number:_ leaching chambers, number:_ loschiog galleries, number: leaching trenches, number,length: -1G-�pg � lvv, leaching fields, number, dimensions: overflow cesspool, number: Comments: (note ndit' of 9 signsof hydraulic frure, vel of din conditigp o��ge t on�t�.) ��1 yE Pt�OVA CESSPOOLS: V\]O\P (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(cesspool must be pumped as part of inspection) Comments: (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:Y\QA- (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.) (revised 11/03/95) 9 AS-BUILT SURVEY 5-21-91 Lot 8 Bruin Hill Road No. Andover, Mass . Owner : John Cormier 54It Scale : 1" = 20 ' Location Elevation Exist G`' Top Found. . . . . . . . 159 . 01 Found. Outlet. . . . Tank Inlet . . . . . . . 162 . 90 A Tank Outlet . . . . . .162. 82 D-Box Inlet . . . . . . 162 . 55 D-Box Outlet. . . . .162. 45 Beg Tr . #1 . . . . . . . 162. 38 it if #2 . . . . . . . 162. 38 of 1 " #3 . . . . . . . 162 . 39 " it #4 . . . . . . . 162. 38 End Tr . #1 . . . . . . . 162 . 07 #2 . . . . . . .162. 07 �� rr #3 . . . . . . . 162. 08 o A-''8.5 A- X05 �� 8- 34' #4 . . . . . . .162 . 08 ' 5 - 'I`' Bottom Tr. #1. . . . 160 . 07 A -51 A-64.5� If it #2. . . . 160. 07 — " " #3. . 160 . 08 If #4 . . . . 160. 08 �3 A- 111 �j@ Uv'l HILL 9oA- i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ,1 SYSTEM INFORMA,TIIO,N (continued) Property Addresw q1 Bf U-(6 f l I v Q`T v` "Ow-f- Owner. �'\ SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' •r',v Q. �SQ_ (�es Ao a = 3gu It a lig` (04 DEPTH TO GROUNDWATER Depth to groundwater: 14 feet method of determination or approximation: 5 �� Q gaCAYN 0AA, (revised 11/03/95) 9 im..Y,r.: _ rxx _ :. .;: .- .`:=.•'t. ,:f'_ d y'• .e•':'• _ . .. .--'t"...'tiw'�%,w•++tiY."'� c:.t.. s .- 59 rep r +-rvR;q.,y x.,4.'. I FO1U1 U TOWN OF NORTH ANDOVER LOT RELEASE FORM SUBDIVISION ASSESSORS MAP SUBDIVISION LOT(S) PERMANENT ADDRESS ASSIGNED BY D.P.W. STREET APPLICANT Ca--(,� PIIONE DATE OF APPLICATION TOWN USE BELOW THIS LINE r� ' PLANNING BOARD DATE APPROVED TOWN PLANNER DATE REJECTED CONSERVATION COMMISSION I' DATE APPROVED CONSERVATION ADMIN. DATE REJECTED ' BOARD 0 EALTH 1Z ` DATE APPROVE /fo Z HEA NITARI �/ DA'Z'E REJECTED 7 <� DEPARTMENT OF PUBLIC WORKS DRIVEWAY PERMIT —6T- WATER CONNECTIONS _V-ML G "o FIRE DEPT. RECEIVED BY BUILDING INSPECTION DATE This form shall be signed by the agents of the Planning and Health Bo, rds, '' ..the Conservation Commission prior to the issuance of any bull.dfng pernnits for the subject lot. This form shall not releive the applicant from the compliance of any applicable Town requirement or Bylaw. �iaNJ h � gyp, W�,y;. .f. v�•�•; �n[f .;t,., ��{ • I �l ��,��IS til �1 A t S. I { chusettsal •� .Q. Y. ORTH ANDOVER i MAS A _UMP 0.0 Record 7 a t zl'' (n= �,iO,��'1't\v �J y'n+,J,,Y}T MC iR.�yS�r!f:•`Y.'i 7 1 ��C j '� 5 �0�1 ;� v •IJ 'G► �)�r)1,�/1v n t } �,i'�i�:T}''Y%;r t, t . r:.u•":1 Jt':,bar( NOR i H F.Wo TER DEP,.has provided thls'form'for use by local Boards of He alt .T� l� be submitted to the local'Board of Health or other a � ys;tanayiPrl1 cord must :A , Fadity lnforrOVIon ► ; : f, .W�n f�uri�out 1:. System Location.' only the tab key Address =R' to move your . cursor..do pot,. /Y�'d2�-k-1 �q. `uaa the�rotum•: -� .Clty/Town � .,: . Stale � ;.keY,t::,, w;::; t : a,i:' i. .. p Code. ..�� vt 1h. i t J t nt' .i.• : 'tti ` c i.•.t•.r• y HT00, . :r �•y NarrTe Address(If different from locauon) Clty/Tovm:',i; State' Zip Code Telephone Number • ��Z'� .,,:`ice �} '., �; ,�;:: i:' _ ,. Pumping Record; : Ni• rttt.l•p.+ '�+ 1tR;..,r9i,','g1�;�'1y1,J'�1� `'� Date•of Pumping ' .: Date (1f 2, Quant)ty Pumped: `�� Gallons Typ9 of system;, ❑ Cesspool(s) l. eptic Tank ❑ Tight Tank Other(describe'; ; N 4 Effluenit lea Filter present? ❑ Yes o If yes, was it cleaned? El Yes ❑ No .. .>: ` :1,5.?Lfh�:i+i l.;1'..fi r. �rS:tJ.l i{'J..q. .'�(• rr t ' +t 5/,,Co�ditlon Gf 3y$t mi -` yM )1:fil+J �•('y'.'t'.+:l�/'.,�%i/ b�l,Y �•.•,' �V G � /J 1 Pumped B ' :''• °^ �I`q.'ij. Fy�);ty't; , 1✓�t�•;t `.`€,I;r54Ucen4e Number 1•t4� -r�:a-,1Cr�'rr.�ri,,,f•r; 1.,,.1 i•, .+' :}.yt!•• .J,+ },":�•,".Y�wf�.�%v'•J:f.:f 1.'i' �''"1%lV�1lr.:P ,t,,�, - t✓:. .r! ,y..tr,:; ,'•"•N;��.�: !14• , a•a{�/ I Rj� ��. 4. litti'..,..... .. . ;��, ::,',y '%•,'{ .j;•',�.,��i'�A��7Lt:�ywi;t;e:[t�:�}'r{ tii�:'��•:'.oii"'.�.,r• ';:, r}�' 7. Locatlon.where:contorts yvere di;;posed; 3• .c 1 ' :'/','' f•rii.:,':•�t:a .,'v'.i~%ir•1,1W...i:J:, Hallo Date http://www.mass.gov/dep%wafer/approvals/t5forms,htm#Inspect t5f6rm4.doa'06/03 _ ;y: System Pumping Record Page 1 of T