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HomeMy WebLinkAboutMiscellaneous - 43 FULLER ROAD 4/30/2018 (2) �a��r�� ��%r \� ' � � �,;f3 r-�n[le�r {!cry( �� I .\ COMMON'WEALTH OF MASSACHUSETTS C EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION <e� ONE WINTER STREET. BOSTON. NIA 02108 617-293-5$00 WILLI.AN±f.WELD TRUDY COXF Sectetan Governor ARGEO PAUL CELLUCCI DAVID B.STRUHS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner PART A CERTIFICATION Property Address:=�_j_ jV v`�� ' r' - '� Address of Owner: Date of Inspection: Q - �%. (if different) Name of Inspector. � CCS cs� 1 am a DE ppr ed system inspector ursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: Mailing Address: I i 4 -fi t ' ,-'CJ o t o Telephone Number. 6- CERTIFICATION STATEMENT 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: r.' asP ses J _ Conditionally Passes _ Needst Further Evaluation By the Local Approving Authority Falls// c f t-7- Inspector's Signature: i X�'�:" � Date: 1 The System Inspector shall ubmit a copy of this 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: AI SYSTEMPASSES: 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. COMMENTS: BI 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. 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, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. 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 04/25/97) Page 1 of 10 DEP on the World Wide Web: http:/Iwww.magnetstate.me.us/dep 0 Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A jJ CERTIFICATION (continued) Property Address: Owner: Date of Inspection: 6] 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). Describe observations: 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 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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. 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 PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The se system has a tic tank and soil absorption system (SAS)and the SAS is within 100 feet to a surface water supply or Y P tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone t of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption system and the SAS 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. Method used to determine distance (approximation.not valid). 3) OTHER (revised 04/25/97) Page 2 of 10 n SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A \ p� CERTIFICATION (continued) Property Address: ��� t Lt `t�� 4�& �� Owner: Date of Inspection: D) SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: 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. Yes No 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 cesspool. 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_. Any 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 cohiorm bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design floyy_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: 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) 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 Department for further information. (rwvised 04/25/97) P*g* 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner: Date of Inspection: ( `1--C_I0 Check if the following have been done: You must indicate either "Yes"or"No" as to each of the following: Yes /_o _ Pum ig information wasprovided by the owner, occupant, or Board of Health.h. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. large volumes of water have not been introduced into the system recently or --as part of this inspection. �/� -fCs built plans have been obtained and examined. Note if they are not available with N/A. i _ ---fhe facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. / The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of -- baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge,depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: LZ The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. _ Existing information. Ex. Plan at B.O.H. Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)] (revised 04/25/97) page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Cc- Owner: eDate of Inspection: t�- FLOW CONDITIONS RESIDENTIAL: Design flow: Q>V ¢.p.d./bedroom for S.A.S. Number of bedrooms: Number of current residents:•v� Garbage grinder (yes or no): 11701,j-1 Laundry connected to Sys myeyes or no): es Q(o ear 7Ck� x�' — V t: Seasonal use lyes or no). 4�� ,>�= t �r7"7 Water meter readings, if available (last two (2) year usage (gpd): 6 ` Sump Pump (yes or no): T`'0 Last date of occupancy: t!U�fa.A " arc_ �e ��� t�-,F.�( l,V\c_ �'Q k lc�c.�(- �•vD(`re- COMMERCI.AUINDUSTRIAL: 1 V Type of establishment: Design flow: Rallons/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: Last date of occupant),: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information v D� PC)V ns--- owV'�Q—,T— System pumped as part of ir�sp_ection: (yes or no)�. �S If yes, volume pumped: L,5M gallons SVT Reason for pumping: TYPE OF 5YSf—EM L�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) VA Technology etc. Copy of up to date contract? Other n APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no) � (revised 0{/25/97) Page S of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) [ ,�, Property Address: `t t `U 1 \ �' -`�"`'�� Owner, M Date of Inspection: t ( ^ BUILDING SEWER: "1�- 1 (Locate on site plan) 4 Depth below grade: 140 ' Material of construction: ' cast iron 40 PVCthey (exp)lin) � a ' (�<�� a�_ �v� �V©usQ- Distance from private water supply well or suction lir.c Diameter H 'I Commen (condition f joints, venting, evidence of leakage, etc.) lE'cx� S SEPTIC TANK:..- l (locate on site plan) 11 Depth below grade: ��� = � ' Material of construction: _ oncrete _,metal ,Fiberglass _Polyethylene _„other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: lo X .5 x y Sludge depth:_ Disiance from top of sludge to bottom of outlet tee or baffle: Scum thickness: a if u Distance from top of scum to top of outlet tee or baffle: <r Distance from bottom of scum to bottom �-�'�Y=coutlet tee or baffle: /e���g How dimensions were determined: Su t_�__S `Co"^'A lvc�c,. cV Comments: (recommendation for pumping, con iflisp of inlet an outlet tees or baffles, epth o liquifi le I in elat'oS n to out) igvv, s5r e I integri , eyidence of eakage;etc.) �' 9'�t v { J C. L C- S C- R WIN tip E��C lh r GREASE TRAPP,� (locate on site plan) Depth below grade: 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: Date of last pumping: 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 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: O�t(- Owner: Date of Inspection: QQ II tt (�- enol. TIGHT OR HOLDING TANK:VX)4- (Tank must be pumped prior to,or at time, of inspection) (locate on site plan) Depth below grade: Material of construction: _concrete metal _Fiberglass Polyethylene —other(explain) Dimensions: Capacity:_gallons Design flow: gallons/dav Alarm level: Alarm in working order Yes; _ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) R DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert: C� Comments: f box, etc.) ole if level and distribution is eqalJ � , evide a of solids carryover evidence f leakage into or ou C c 2 S' LA CkO-A AA PUMP CHAMBER: Q (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order (Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: SOIL ABSORPTION SYSTEM (SAS):_�� (locate on site plan, if possible; excavation trot required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number:_ leaching chambers, number:` leaching galleries, number: leaching trenches, number,length: t y �leaching fields, number, dimensions: �21l�',) jC overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of oil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) )1 - vt C �C CESSPOOLS:WV10 (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 pan of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:V\C)M-- (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: vegetation, (note condition of soil, signs of hydraulic failure, level of ponding, condition of etc.) (revised 04/25/97) Page a o1 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: ��j �'Q P,\ �J • Owner: U C, Date of Inspection: V LA— SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) i 46r Qjcu I ` r I 1q '4`-'l14 I Iv alL4 14 " (revived 04/25/97) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: �~ Date of Inspection: Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: (/Obtained from Design Plans on record bservation of Site (Abutting property, observation hole, basement sump etc.) L " Determine it from local conditions /J (/heck with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers L/ Use USGS Data Describe in your own words how you established the High Groundwater Elevation. Must be completed) (reviaad 04/25/97) Page 10 of 20 r;- I TEL: (508) 475-147/ FAX: (508) 475-545 ) T 4W UATESON ENTERPRISES, INC. Excavating - Witer & Sewer Lines - Septic Systems & Pumping Service I I I Argilla Road Andover, Mass. 0 18 10 Title 5 Inspection Report Property Address : u �1------------------ Owner : -- C;- "---------------- Date Of Inspection : -� ------------- My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system . Such report issued herewith is merely based upon my observations , and I hereby disclaim any further operation of your current septic system. r Neil J . Bateson Bateson Enterprises Inc . TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: , a-0aq- SYSTEM OWNER &ADDRESS SYSTEM LOCATION (example: left front of house) DATE OF PUMPING: - UANTITY PUMPED ( 50C> GALLONS CESSPOOL: N / YEsO SEPTIC-TANK: NO YES v/' 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) SYSTEM PUMPED BY: �`�ism/,,— COMMENTS: s /,,COMMENTS: CONTENTS TRANSFERRED TO: i Board of Health North AndovversMass, SUBSURFACE DISPOSAL DESIGN CHECK LIST /7� 1 �. Lar �-- ,PPROM DATE DISAPPROVED DATE 'rovideds Reasons., itle v F 09 _ eg 2.5 he submitted plan must show as a rdnimums the lot to be served-area.,dimensions lot i�sabutters Th e location and log deep observation Mes-distance to ties location and results percolation tests-distance to ties design calculations & calculations showing required leaching area location and dimensions of system-including reserve area existing and proposed contours location any wet areas -Athin 100' of sewage disposal system or disclaimer-check wetlands mapping (h) surface and subsurface drains within 100t of sewage disposal system or disclaimer i) location any drainage easements vithin 100' of sewage disposal system or disclaimer-Planning Board files (3) knolu sources of rater. supply within 200' of sewage disposal system or disclaimer location of saw proposed well to serve lot-1001 from leaching facility cation of water Lines on property-101 from leaching facility _-location of benchmark n} driveways Fq) garbage disposals no PVC to be used in construction profile of system-elevations of basements plumbs pipes septic tanks distribution box inlets and outlets, distribution field piping and other elevations (ra ma�dmam ground water elevation in area s"age disposal system s) plan must be prepared by a Professional weer or other professional authorized by law to prepare such plans eg 6Septic Tanks (a) capacities-150% of flows water table, tees., depth of tees, access., pumping , � ) cleanout 3.01 from cellar wall or inground swimming pool I d) 251 from subsurface drains j Qg 10.2. Distribution Boxes (a) slope greater iFa 0.08 eg 10.11 b) su rp • 1 I r--TOP FND. ( 2.6 ' � .00 F Ga 13 50 1 DVBD 6148 3G,83 ) FLAN ; D-BOX OUTLET SCALEao 1 -4d ♦ �► INV.136.38(136066) LOT _ 25 ` i ol WETLAND ` BOTo BED 13504(135A 5 S.T.OUTLET IN Vo 137.20( 137,13) HOUSE OUTLET S,1-1 NLET I - 'r .I.NV.- 137 °58) INV. 137,44(137,38) END'OFFIELD 0 N INV. ELE o 136604-036.45) ` - PROFILE _ 4 NOTE ( ) DENOTED DESIGN GRADES I SCALESo VERT: I. HORIZeI — 20' o-20' R.T C Fl LE S - Ck,, I !B 71 IRF'�; CE r tf_tf SEWERAGE D!C POgA L_ SYS � ��'if� S J_j: LT . ►Cr- v Q\/VNERo JAYSON REAL T Y T RUS T LOCATION-O N o LOT 25 ( 12) FULLER RD* i O DATE. 11- 19-81 I 1 �/. c -----,---� G P R E PARE D B Y o EXISTI � FN Ja' BCS �C9 -78L� �j.ST O�,I/ I �1�H1a 01D 65 5 NOTE BENCHMARK=TOP OF FND. LOT 15 ELEV= 144057 ULSjaS. 0 DATUM SEE PLAN BY GELINAS AND ASSOCO �� FULLER RDQ I DATEDA 3-23-81 r 'BoardF of Health North AndoverIMABSO BEImc SISTEM _ ` - ` INSTALLATICK GEMK LIST LOT j--� 4 Z••-�cr-v�� PN WED DATE DISAPPRO�ID APATI02d OK FAIL f t eaff?nst J OK 1. Distance Tot a. Wetlands •i b. Drains • - c. Well 4 2. Water Line Location r 3. No PPC Pipe f $: Septic Tank �= a.. -Tees--_Length & To Clean Unt Covers._ b. Cement Pipe to Tank — Oa Both Sides of Tank y �. Distribution Box a. Covers & Box - No Cracks b. I All Lines Floating Equal Amounts c. No Back Flow b. Leach Field or Trench ' ` l a. Dimensions Stone Depth c: Capped Rids -�•� d. Clean Double-Washed Stone' ?• Leach Pits :d. . Dimensions . Stone ' t� . Sp ' Pads s Cer ent Pipe to Pit - Both Sides. Clean Double Washed Stone 8. No Garbage Disposal /9. Final Grading Inspection 10. Barricading Covered System 11.- As Built Submitted_ a. Lot Location :.: b. Dimensions of System - - c. Location with Regard-to Pere Test d. Elevations e: Water Table TOWN OF SYSTEM PUMPING RECORD DATE: - + —A SYSTEM OWNER& ADDRESS SYSTEM LOCATION (example:left front of house) CkK --C Li� IF G� �d DATE OF PUMPING: QUANTITY PUMPED : [ S 0 C-) CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACIIFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER(EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED To: G.L.S.D Lowell Waste TOP ENDO.___ f I42,G4 ! F Ga35C? D-BOX INLET 00 INV, 136.49 136.63 PLAN - D-BOX OUTLET \\ _ SCALE. ! -40 � � �� INVQ136e38( 136066) i \ f. LOT 25 E# K WETLAND 'z ,CToBED 05D4035,5 _ r INV. 137 20( 137,13) HOUSE OUTLET �S.TdNLET ENDOF FIELD f � ' INV. '137.G7(137-58) INV. 1\37.44(137.,38) INV. ELE. 136e04-(136.45) N - PROFILE NOTE DENOTED DESIGN GRADES ro SCALED VERT: 1 - 4 , 4 ;?. HORIZa1 - 20 PSE\AfERAGE DfSPOSAL_ SYSTEM A.S— _1 'L-T arc Q C\�`°�1ERo JAS"SON PEAS RUST-< W !-OCP,T !,�N o LOT 25 ( 12) FULLER RD, 6 PREPARED BYO EXISTING 1� FNDOI -'soco Po Co U: OX. L-11, ; �) T`V? j NcHc, . O t I f Iz NO'E BENCH MAIRcK=TOP OF FND. LOT 15 ELE V= 144o57 ULS.G,S,� 150,00 DATUM SEE PLAN 13Y GELINAS AND ASSOC FULLER RD,,,, ; DATED..* 3-23-31 v WH(LG pIGGtN� A �Rywcic, Ft,R Tc�� �rr'�J� SSS` AT Cot L[, 1zazz PM" ,gNtD ce Pg'-I cyv. FORM Q - SYSTEM PUNHIL\G REC Off` Z0��0 2�09� Cotnmonivealth of Massachusetts Nva Massachusetts System Pumping Record S\-stem Owner System Location 4 Date of Pumping Quantity Pumped: Cesspool: No Yes ❑ Srntir Tant•- kl,, E Yes System Pumped by- � License #: Contents transferred to: Date Inspector I Address .�+ � � Title of File Page of Date File Open: Date tale closed: Doc Document/Action Title Date of Refer to other Purpose of Document/Action and notes action Document/ document/ Num. Action Department Board of Appeals - Board of Health - Planning Board - Conservation Commission - Building Department