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Home My WebLink AboutMiscellaneous - 43 SCOTT CIRCLE 4/30/2018 (2) 43 SCOTT CIRCLE 210/105.D-0070-0000.0 i �. 4 r • z MAP # LOT # PARCEL # ---- STREET ..._.......... i4 CONSTRUQ.TI_QN._,APPROVAL. HAS PLAN REVIEW FEE BEEN PAID? ES NO PLAN APPROVAL: DATE �1� .. APP. BY..._ ..... . .. .. . DESIGNER: 0% _�- -- - -�---- PLAN DAf-E._.__� C1......._f.�. 1 _r7I //;; ?� CONDITIONS_—�1eit._- __.._.. _......... _. ---- ___ ---- ----.._..._...................................._............................_...... ............_... WATER SUPPLY: TOWN WELL WELL PERMIT URILLEF2 WELL TESTS: CHEMICAL DAIE APPROVED BACTERIA I D(11 E f1l'PRUVED BACTERIA I I DA 1 E APPROVEll.... COMMENTS: r AD FORM U APPROVAL: �(, APPROVAL TO ISSUE YES DATE ISSUED_JT 93�/C1c13_ BY-1-44-111_. .....Gz/...... ........- _ ...- CONDITIONS: FINAL APPROVAL: ALL PERMITS PAID —CD NO WELL CONSTRUCTION APPROVAL YESNuNU SEPTIC SYSTEM CONSTRUCTION APPROVAL I NU OTHER YES NU ANY VARIANCE NEEDED YES FINAL BOARD OF HEALTH APPROVAL: DATE: DY: • r • SEPTIC SYSTEM__ N$j_j,-.LA.t. _QN - •'' IS THE INSTALLER LICENSED? C�Z_S NO 11,4 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. INSTALLER: a_/1&ND6P50,4) . i'i'i• �: i' Yil '�'' BEGIN .INSPECTION ES N0: I i'� _�i•• EXCAVATION . INSPECTION: NEEDED: . z�14,141 ' ' t'{i? ' � / f7/✓� 'v�/ Z`J /-/L��l Com'�G/��_.-_..Y._...____-._.. PASSED f�// BY-_ ' CONSTRUCTION INSPECTION: NEEDEUs _........_______.._.......___ —_._ I.,'4 i. _ 1 > I 1 •J p 1 • �e . •hl 1P.. 1 ' 3:•;11?.�, ,'. ;, AS BUILT PLAN SATISFACTORY: APPROVAL TO BACKFILL: DATE: FINAL . GRADING APPROVAL: DATE-y�-1 --BY'-- ' FINAL CONSTRUCTION APPROVAL: DATE: L3Y . �1,,•3 SI• •Wil. _ 1, Town of North Andover, Massachusetts Form No.3 t AORT#y �-� BOARD OF HEALT�1.. �19 oL # c `�'i """`�* DISPOSAL WORKS CONSTRUCTION PERMIT .�' �,SSACHUs�t Applicant NAME ADDRESS TELEPHONE Site Location Permission is hereby granted to Construct kor Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. CHAIRMAN,BOARD OF HEALTH '6 i Fee D.W.C. No. MORTGAGE SURVEY PLAN LOCATED IN LlcQ--r-•F+ SCALE I"_ 4- DATE: 4 (23 L4 3 Scott L. Gi/es R.L.S 50 Deer Meadow Rood North Andover, Moss. - �Yaa 1 � I SZ, (' C., SF i U 0 TO Y� t i AND ITS TITLE INSURER Q, THIS L 0TIS_k.�=IN A FLOOD HAZARD ZONE I CERTIFY THAT OFFSETS SHOWN ARE FOR THE USE 10 Of THE OFFSETS OF THE BUILDING INSPECTOR ONLY SHOWN COMPLY AND SUCH USE IS FOR THE w .. WITH THEZONING DETERMINATION OF ZONING 1. 13972 BY LAWS OF CONFORMITY OR NON-CONFORM/TY , �nEQ u a.jOrSVPDr WHEN CONSTRUCTED. l LAAO WHEN BUILT. q (23(43 FORM U - LOT R=ASE 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: C/LaZq L /de-t ,wPhone - o/Dg LOCATION: Assessor's Map Number Parcel Subdivision Lot(s) Street L(;T" lI'2 (� St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: ' Date Approved Conservation Administrator Date Rejected • Comments Date Approved Town Planner Date Rejected Comments Date Approvedl�,3 -3 Health Agent Date Rejected Comments Public Works sewer/water connections - driveway permit Fire Department Received by Building Inspector Date THOMAS E. NEVE ASSOCIATES, INC. �� (01F Engineers - Land Surveyors - Land Use Planners 447 Boston Street US Route #1 TOPSFIELD, MASSACHUSETTS 01983 DATE I I / I JOB NO. FAX 88p7-8586 FAX (508) 887-3480 ATTENTION "I KF_ ROSA-T I RE: TO M I KE ROSA'T 1 RF—C=Fk t>IlvC-r 1-10TG ADOS0 IJGIRTH AIV0oN1F_R t30ARD OF HEAL-TH TO EPT►G p N Fo DIC.iCERSON 5 L.O�'Z - �GO'r TOWN HALL_ rJ. ANDOvER C.iRc..,`C > WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via the following items: ❑ Shop drawings R Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION i i/1 /91 938 SEPT 1 L DESIGN LOT Z — SGOTr GIRGI.C THESE ARE TRANSMITTED as checked below: 59 For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution > ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FOR BIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS MIKE = THE n3o"rE YOO RE.QuESTEc> MAS ADDED TO THE AMOVE PLAN. WE RCQuEST THAT You 15150E THE PERMIT AF-TF—P. `(00 gF_\ttE_W THE r->t—AN AS VME HAD 015L0S5E0 OVER -T)-IF— P1A0"F— THUS, AFTEp►.IOON ANY QUESTIONS PL-EASF GALL THA NX 'JOHN MORIN COPY TO SIGNED: PRODUCT 240.2 In,Gmtw,Mm 01471. If enclosures are not as noted, kindly notify us at once. `f�l� \ �q - we F,��, � s SOIL PROFILE & PERCOL,.�_11'ION TE"'S"T DATA Town/City 400Y 40 eNo.&Street scorl- CeC145 Lot No. Loc. .—M-mer Invest-igator_ __-Observer SOIL PROFILE',"-DATE Of 2 4 Vl,ev. Elev. -Elev . 0 — 54 0 0 0 ITS— 2 2 2 3P . cv.4 4 4 4 4 Anf6- 7�C . 5- %5 r 5 5 13S rxAl"I 6 6 6 000 7 7 7 7111 12E r 8. 8 r 8 8 r. too A./ 31 Iq 9 9 10 10 10 &A Benchi-.iarkLocation 7-,i5 ',,Elevation Datum CVL Qjt7 Percolc .0 Te; -s-Date n VAA Pit Number3 4 5 -1 ZD ,.. Start .)aturatinri _0a-k,f"l J-n S Start Test--Time 1Drop )f 3"-Time Dro (2f 611-lilimc- _!4r__p M a- s - ]_,,j—t- 3 " 'Mins . 2j7d_3Drop_ ..Notes R, Sketches on Back FILE NUMBER f THE COMMONWEALTH OF MASSACHUSETTS FEE --•-T•OWN----- of ......NQRTH---ANaQV..E.R---•--.....---•-- .... $25. 00 This is to Certify that Viera Well Comp an- - --- ...-----•--•--.....--•---.. --•---•--•�-$-�---Andover---Street xAME .............•----••--•--•-•-•---- • - - ._,..-_Georgetown�._•Mp,.__ ADDRESS ............................................................ IS HEREBY GRANTED A LICENSE For .........YleLl.__I�rill ... This license is granted in conformity -- onformitywith the expires..--..December 1993 Statutes and ordinances relating thereto, and •--- ess sooner su l revoked. ''_ ' 19_93 _ - •------ FORM 439 -'--- R BBS WARREN, INC. '............... . '..........- --••-. •7:x. -- _.__.. BOARD OF HEALTH Town of North Andover ,Mass . ~ � ........._. Date -�� 19 rmit PUMP PERMIT FOR WELL & b ade for permit to- drill a well (�) . Application is plication is here Y ms . de to install ( ) a pump system � l - _Lot # • . . . . cation : Address �/ .. Tel . ner ^p � o J Address 1 Address Tel �' '• �� .11 Contractor j 6 �� l� C� - G • Address Tela() Imp Contractor ;LL CONTRACTOR (To be completed at time of }��rrnp test: ) Well used for �� r - ,pe of Well �G�1(1'�� /f, . �ameter of Well �' Size of C'asi.ng �o i th of Bed Rock / Depth casing into Bed Rock rP /5 � 93 3s Seal Tested? Yes (�) No (-) Date of Testing 9- p1_h af Well Ended in What- Material e6�� j Delivers - -Gals . Per Hin . for 4 hours epth to Water- as hours nt -J . GI'M rawdown_.500 feet after pumping - - ate of' Completion 9-'A:�-93 _ Signature Well Contractor filled in- before installation ) UMP INSTALLER (To be' Pump 'Iype Used ize & Name Pump later Pump Delivers GPM , A Size o f Tank-- Material Used in Well : Cast Iron ( ) Ga ) vanized ( _) Plastic 'ipe (_1 _ lell Pit (_) or Pitless .Adapter (_) e? Ycs (_) NO( _) .l.ype or Name Well Seal- las sleeve used to - protect pip )ate �i P,I'latuIc.:.j'.',1�C T D 4*�t�M�'t�+riF��C�4�'��4�ri4�t�F�4�'t�Mi4t4�M�4�4�'ttk�'t��r4t�4�4�4�4�4�Y�4�'t�4�4�4�'r►'roti'rti'r�`ri:::S:�.:,':,c,c,c,;,:,r,:,. . : `� ort submitted to Iioarcl of 1lealth_ q/a3/q� )ate re Water analyses p Date release given tD owner of record & Bldg , Insp �---- Health Ins}�ector .. ...... }3° Department of Environmental Management/Division of Water Resources WELL COMPLETION REPORT WELL LOCAT}ON/ ,) ^/ GEOGRAPHIC DESCRIPTION Address (� ( J V�d S E W o �� r (leer) /circle) City/Town �Dl�� Scorrcl�eC� Well owner Cher(41 "'(v�'^ `'V e 1 (road) Address scoy i -CLE N S E W of (mi.in tenths) /circle) Board of Health permit obtained: yesno[] intersect. w/Lw`s��' (road) WELL USE WELL DATA Domestic M-Public❑ Industrial ❑ Total well depth Se—- ft. Monitoring❑ Other Depth to bedrock J 2' ft. Method drilled D�A/� Water-bearing tock/tinconsolidaled material: Date drilled 7 _AG Description �►'1�C/ CASING_ Water-bearing zorlu 11 From Type EG � 2) From Length�ft. Dia(.I.D.) in. 83 To y90 . 3) From To Length into bedrock Z,9 ft. Gravel pack well: dia. Protective well seal: �2R�EX�/oF Screen: dia. Grout-0 Other, Slot'' length from_to STATIC WATER LEVEL(all wells) Static water level below land surface ft. Date WELL TEST(production wells) Drawdown-- �� ft,/ after pumping Ilr. mll/n.at `3• gpm How measured�11e& rTRecovery °ft. after Lltr. min. 0 LOG of FORMATIONS COMMENTS ' c ffi Materials From To c p Z E �Z ZS Driller Firm /"co Address !Y Oa oe e S/ City/Town S ervi n rill r RegA '�•' - ft I i nature of supervising re istered well driller Please print firmly ARD OF HEALTH COPY ,rt ' P s 0 fa�"Qaml YA x. DATE Sheet of / BOARD OF HEALTH TOWN OF NORTH ANDOVER SUBSURFACE DISPOSA,�,,rL DESIGN REVIEW FEE &d PERMIT # 4Y 6 DATE RECEIVED APPLICANT _D cCk(ep-sc:;,4 ASSESSOR'S MAP ADDRESS �ai( G,Q,-J E PARCEL # LOT # 1,c3C Z ENGINEER STREET ADDRESS( IRV PLAN DATE _ 1 f1 `l' REVISION DATE CONDITIONS OF APPROVAL: APPROVED DISAPPROVED CoA Lo.-t- l s `cam TU c c v r-t cv pa E 1►� C�-(.tel�4 �j� �r E(,,v�?J�.�l t�ti-1 f ��.-�E�.1 st 0�..?S ��F �t1G AS-BUILT CHECK LIST and FINAL INSPECTION Proposed Elevations As-Built Elevation House `s " 44 Tank IN � " Tank OUT f�� D-box IN D-box OUT fay 9� Trench Inverts Line 1 Line 2 Line 3 Line 4 Bottom of Exc. a1- Stone OK? D-box checked? L--� Pipes cemented? �-- ~"rw oo 00) 692-8396 FAX (604) B9y.0023 1 ^80064�tEST 'part Humbert C.Wpg-9875 Ilentt Elepart pater Sept, 21, 1993 (sample Taken At, ilmingtan Pump Supply Inc. 4, 0 .of BOX 517 Choryl"DIcksraon ilningtOtl, MA 01887 Lot 2 Acott Circle a`3 N. AndoVsr VA ntple Takon By, Wrq Staff Ont Sept. 20, 1993 caRT=PrchTH or j1NALYSI0 PSE T BT PllRA!(kTEltl SPA Max REBULTa ��' UNITS T tal ColifoM (F) 0 ***Of per 100tg1 lcium No Limit 40.6 mg/L C par (s) 1.3 0.02 mg/L Z n (8) 0.3 6 0.64 mg/L M gnasium No Limit 4.6 mg/L rt 4anese (a) 4.05 0.03 mg/L, s ium " 20 5.2 mq/L p 6aaiuffi (8) Wo Limit. 0.7 s(gIL A 'alinity (S) No W.mit 04.5 mg/L A onin No Limit -c0.03 mg1L C oride (0) 250 17.B mg/L C urine (total) 0.7 r-0.02 lhg/L C or (a) is 25 CPU C dufttivity NO Limit 268 umhas/cal H d"600 No Limit 120 Mg/L N .rntes(aft N)(e) LO 1.95 mp/L N 1 V.0.01 Mg/L p l8) 6.5-8.5 7.2 su o r (8) 3 0 TON S phatee (0) 250 28A mg/L T bidity 5 1 7.1 NxU S imant Poe/flog neg !? Not Tented, 4-Va3-ue Zxvgods EPA STD, TNTC-TOO NUMOrUUP to COUnt ackground Bacteria Noted, "-EPA Advisory Limit xaaeds EPn Advisory Y.imlt ( )=Primary EFA atandard, (8) secondary EPA standard (maty affect utlietios of dr(,eking water i .e. taste, volar, etc.) T is water aampla, as tested, In u9naidered sArA to drink according t. EFA guidelines. However, one or mare of the pArametera exceeda n eacotedary ntandarda as indicated by the (4) sign, 19 snachueetta etaLet Certified Ah l P. catlson, for T sting Laboratory 04aD48 'ThOrsteneen Laboratory Inc. SEP-22-1993 13:30 5886583557 P.01 ----_ C� /��1�� G�'1 �� THOMAS E. NEVE ASSOCIATES, INC. n n �/� MM ��,,vv,,�� /�nn Engineers - Land Surveyors - Land Use Planners UETTEW Oo F Ulll1U°,�LIVSLI1/1.10TTU,_1L� 447 Boston Street US Route #1 TOPSFIELD, MASSACHUSETTS 01983 DATE / JOB NO. 93 6 (5os) ss7-$sss FAX (508) 887-3480 ENTION RE: TO 4�I e o or LXo1 o The y # Z Twp 4fj6_ Sccrr C/ece� > WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via the following items: ❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION s SAL S-ra ,.De c,A,1 - Lar� Z S'Co rr �i�e�� .rJie>e�sG.v L.1II�.o THESE ARE TRANSMITTED as checked below: X, For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution > ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FOR BIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS ie' /A/.CZ 7/NGS S�Gil e 12VxE� CGh7/) te,,12A— //z 7D r � GSC qnn) 2 Gam. SVG 0�7sE/2iej r Is gr 6 u/ey-D ,'euj r COPY TO -s/`� ��/cK�y rcf � SIGNED: l v(!7 PRODUCT 2402 1rc,Groton,Maa.01471. If enclosures are not as noted, kindly notify us at once. .Y. ' DATEL8 / �,- SheetI � of F. •Y BOARD OF HEALTH TOWN OF NORTH ANDOVER SUBSURFACE DISPOSAL DESIGN REVIEW u FEE PERMIT # -479 DATE RECEIVED APPLICANT — ASSESSOR'S MAP >. ADDRESS : PARCEL # Ka LOT # l,cn- vt Z ENGINEER S TRE E TIZC- 'l��.9G � j�cs�,� er ADDRESS _4441 PLAN DATE — �r f 1 REVISION DATE CONDITIONS OF APPROVAL: APPROVED DISAPPROVED X f T� 4A i fid, c oA Z0 z) 7RZ O Q –to-4c- 1 SSJ A►-j C-E l LOT k --ro ccs f-t v aoTE 1t� cv- vk&J t `Z . r t c Lv ea., 1 c,4 t�,�-�r-�E,15 c oo.�s o-c- Tk ALLIANCE TESTING & CONSULTING 13 Hersam Street Stoneham MA 02180 4/11/94 REPORT Cheryl Dickerson One Scott Circle North Andover MA 01845 Sample Date : 4/5/94 Sample Source: One Scott Circle Artesian Well - Lot #2 Reference: Standard Methods for the Examination of Water and Wastewater, 17th edition PARAMETERS CONCENTRATION Total Coliform 0 per 100 ml Chlorides 32 mg/L pH 6 .8 Iron 0 .72 mg/L Manganese 0.03 mg/L Sodium 15 . 8 mg/L Nitrates Less than 0 . 1 mg/L Nitrites Less than 0. 1 mg/L Lead Less than 2 .0 ppb Hardness 78 mg/L n Alan Stevens, Chemist The results of these analyses meet federal and state standards for drinking water. However, the iron exceeds the recommended standard. Although iron is not harmful to your health, it can affect the taste, color, and odor of the water. If desired, iron can be removed with filters sold by water treatment specialists. mg/L = parts per million ppb = parts per billion ALLIANCE TESTING & CONSULTING 13 HERSAM STREET STONEHAM MA 02180 Interpretation of Test Results TOTAL COLIFORM The coliform test is used to determine the possible presence of septage pollution and pathogenic organisms in water. The U.S. Public Health Service has established that the coliform concentration should not exceed 0 per 100 milli- liters in public water supplies. An absence of coliform bacteria eliminates the possibility that septage pollution and pathogenic organisms are present in water. HARDNESS Hord waters are aenerolly considered to be those waters that require considerable amounts of soap to produce a foam or lather and that also produce scale in hot water pipes, heaters and boilers. Specifically, hardness is a measure- ment of the calcium and magnesium concentration in water. These hardness minerals are responsible for ring and sediment buildup in bathtubs and sink bowls and many other domestic problems. From an economic standpoint, hard water can increase water heating costs due to the scale build up in boilers and also increase detergent con- sumption. Waters are commonly classified in terms of the degree of hardness as follows: 0-75 mg/1 Soft 75-100 mg/1 Moderately hard 150-300 mg/l Hord 300 up mg/l Very hard pH Water with a pH of less than 7.0 is considered acidic. Water with a pH above 7.0 is considered alkaline or basic. A pH of 6.0 to 6.6 is moderately acid and may eventually corrode plumbing fixtures and water using appliances. A pH of 4.0 to 5.9 is considered very acidic and corrosion could be even more extensive. CHLORIDES Chlorides in reasonable concentration are not harmful to humans. However, they can give a salty taste to water which is objectionable to many people. For this reason the U.S. Public Health Service recommends that chlorides be limited to 250 mg/1 in supplies intended for public use. Salting of nearby highways is often the cause of high chloride concentrations in water supplies. IRON AND MANGANESE Iron and Manganese can cause problems with staining during foundering operations, impart objectionable stains to plumbing fixtures, and cause difficulties In distribution systems by supporting growth of iron bacteria. Such waters when exposed to the air become turbid and highly unacceptable from the aesthetic viewpoint. Iron imparts a taste to water which is detectable at very low concentrations and con be very objectionable at higher concentrations. Iron can also change the taste and color of beverages and food. For these reasons the U.S. Public Health Service Standards recommend that public water supplies should not contain more than 0.3 mg it of iron or 0.05 mg/1 of manganese. SODIUM Sodium in high concentrations can promote hypertension or high blood pressure in humans. Some individuals are more susceptible to the effects of sodium than others. Th! U.S. Public Health Service recommends that sodium be limited to 20 milligrams per liter in public water supplies. Note: - ml = milliliters mg/L = milligrams per liter Town os r � F overNo. 430 - 0 7 � 20 77'- ;North;Andover, Mass., 19f.! � 0fQATE1) FP ,tom SR � BOARD OF HEALTH U L D Food/Kitchen Septic System -RMIT TO ' 1 PE BUILDING INSPECTOR THIS CERTIFIES THAT......4.. ....................................... ....................................... Foundation has permission to erect.1.0.4 . buildings jySQI � ld�I? to be occupied as I.Ir.�.�► f�i� l� �I IFL.L,�w! .�G'd�t-"**x^.. +!te Chimney If�ll in ever respect conforarto the terms of the application on file in provided that the person accepting this permits y p Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. rttiiv��+ ruR FOUNDATION ONLY PLUMBING PSPECTOR REGULATED BY PARD. 114JM BSG, VIOLATION of the Zoning or Building Regulations Voids this Permit. _ ina Gl �� PERI',11�1' EXPIP\,ES IN 6 MOS I I� '� " �FEE PAID a - ,�`%� ELECTR C PEC UNLESS CONS I I��UC`I�IO?�" STARTS •✓ Rough ME/BUILDING l PERMIT FOR FRA .. .. Service BUILD G INSPECTOR DATE: FEE PAID��0 Final Ochi-q'o-ii.(,y Perniit lr:3qutred to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: _ 1510 0 SYSTEM OWNER&ADDRESS SYSTEM LOCATION o*o (example: left front of house) W3 Scott C"Acle DATE OF PUMPING: 1 xG In QUANTITY PUMPED_5 p GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE"-,,""'. EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE -BAFFLES IN PLAUE _ ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED _ SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: • l i COMMENTS: CONTENTS TRANSFERRED TO: 4 Sr rl orn:,0ucy's Sewer Service Inc. Month: ` Om Date Address Owners Name Gallons um d 'H,G,C,D,S Contents tranferred to Condition of sS�ll�itu� 1�� m 2 hr\ 4Am,e,— °� $ � S 10 6 11 12 13 14 16 RECE 1 16 17 JUL 2 18 TOWN OF NORT i ANDOVER f EP RTrVIENT 19 20 r . w C= Cesspool, D= Drywell, S= G=G Septic, reasetra '~ p, H= Holding Tank i i Commonwealth of Massachusetts _ City/Town of NORTH ANDOVER MAS System Pumping Record Form 4 MAY 1 9 2008 DEP has provided this form for use by local Boards of Healt .TTKSy�,#erp-fPu gkF ecord must be submitted to the local Board of Health or other approving puthDtltyll DEPARTMENT A. Facility Information Important: When filling out 1. System Location: forms on thet` w y.,. computer,use 143 Yf:.c�t L., C'4 c only the tab key Addre 3 to move your '. �4 _L`ye-b�• cursor-do not City/Town State Zip ode use the return key. 2. S stem Owner: Name rte" Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 2. Quantity Pumped: ) Date Gallons 3. Type of system: ❑ Cesspool(s) dSeptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes Id No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 0(*'r;>/1I , 6. S stem Pumped By: r,I d ! Vehicle License Number Company 7. ''o ation where contents were disposed: c ' - ,� < � Signat re of Hauler Date http://Www.mass.gov/dep/water/approvals/t5forms.htm#inspect t5form4.doc•06/03 System y m PumpingRecord Page• g 1 of 1 Commonwealth of Massachusetts Town o� � ' % 'off From: Soucy's Sewer Service Inc. Month: Date Address Owners Name Gallons um d " H,G,C,D,S Contents tranfered to Condition of s em /3, 5-29 61 C-%0 42, 10 11 12 13 14 15 .:. RE 16 17 i . .._ 18 r TOWN OF NORTH NDOVER HEALTH UEPAR [VENT 19 1.201 C= Cesspool, D= Drywell, S= Septic, G= Greasetrap, H= Holding Tank - UUIIT MOR TGAGy SURVEY PLAN LOCATED /N t-lam-�-►� ��, oo..� A S, SCALE /"- d-- DATE: 4 (23 (4 a• Scott L. Gi/es R.L.S 50 Deer Meadow Rood North Andover, Moss. - �Y-aa I 0 0 x gc-Reaq CI✓RTI F 'THAT S WAVE: � W S Ep l4e MLr:na t oS= IW4I"f AND-CNaT ilk M16tRtaUS tocoprokm -T i 1"V.mir lose.,- 130,f+ Ll '*WK 12flA4 dtlT D.00)L •12.3 ESQ- 3 �N •tS IZ3,68 X �(U ; TO AND /TS TITLE INSURER Q, THIS L OT/SA.A=/N A FLOOD HAZARDZONE ' / CERT/FY THAT OFFSETS SHOWN ARE FOR THE USE �p��N �s THE OFFSETS OF THE SU/L DING INSPECTOR ONLYo� SHOWN COMPLY AND SUCH USE /S FOR THE WITH THE-ZONING DETERMINATION OF ZONING SY LAWS OF CONFORM/TY OR NON-_CONFORM/T YTEKc� ' WHEN CONSTRUCTED. .qy4�tags WHEN SU/LT. yI2- 2, q3 at (2-3�IIIg3 u� T MORTGAGE` SURVEY PLAN LOCATEDIN ►� A� oo�� s. SCALE I" DATE 4 123 (4 3 Scott L. Gi/es R.L.S it( I lg3 50 Deer Meadow Rood North Andover, Moss. 4- dv� Yea 12Z, g� —off 4 DoT- ZP,A g�, ►7�t S.F 1 0 0 ct;RTl r-`i -rNAT S NAVE Ik T4JT ANDTNS� � ^IV i 05'�-,V COP62*� To SIE RA16 / ti �i• _3'�4•�i IIJ p$o�c�1Z5.oZ � /,�j � c0 ►1� D.Fey. �t'1A..1t �} 3 N •ns = 17-95,68 TO _'� '`�A� �E- ,�AND ITS TITLE INSURER Q, TH/S L OT/St �=/N A FLOOD HAZARDZONE I CERT/FY THAT OFFSETS SHOWN ARE FOR THE USE Awl or ,• THE OFFSETS OF THE BU/LD/NG INSPECTOR ONLY y SHOWN COMPLY AND SUCH USE IS FOR THE $ WITH THEZON/NG DETERMINATION OF ZONING V rr? BYLAWS OF CONFORM/7Y OR NON-CONFORM/T Y '�FcrsrEKE° WHEN CONSTRUCTED. WHEN BUIL T. at (23(93 i7- 2 q3 a-11 X33