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HomeMy WebLinkAboutMiscellaneous - 46 OXBOW CIRCLE 4/30/2018 (2) I _ 46 oxbow Circle J - r Lot & Street OW- ZA Map/Parcel CONSTRUCTION APPROVAL Has plan review fee been paid: NO Permit Plan Approval: Date: Approved by:_��j—_ � L Designer: /bYE5 LAJ Plan Date: Conditions: Water St�ipply: Town _ Weli. Well Permit"--\ Driller: Well Tests: Chemical ate proved Bacteria I Date-Approved Bacteria H Date tApproved Plumbing.Sian-Off: -WiringOf .. Sian- Comments: Form "U' Approval: Approval to-Issue: NO Date Issued p/7 A By: Conditions-- Final Approval: All Permits Paid? YES NO Well Construction Approval? YES NO Septic System Construction Approval? YES NO Certification? YES NO Other YES NO Any Variance Needed? YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: APPROVED BY: SEPTIC SYSTEM INSTALLATION Is the installer licensed? NO Type of Construction: :_EW REPAIR New Construction: . .-Certified Plot Plan Review NO —Floor Plan Review NO _ Conditions of Approval from Form ti YES _Issuance of DWC permit: - NO _DWC Permit Paid? —. NO . DWC_Permit#j Installer: l', d - - Begin-Inspection:_ NO - -E. cavation Inspection: —Needed: —Passed: // By: -- .-Construction Inspection: Needed: -BuiltPlan Satisfactory: YES: '`Approval of Backfill: Date: /i Olq� By: --Final Grading Approval: Date: `�,' ��%�� By: Final Construction Approval: Date: y/>11177 By: Certificate of Compliance: Approval: `� Date: till lU T. ZiWN OF NORTH'ANDOVER' SYSTEM PUkPING RECORD -31�3 s al'sTFA9 OWNER & ADDRESS ,. SYSTEM LOCATION (example: left front of Douse) . VATF OF PUMPINC: 3 ,i7 QUANTITY PUMPEDL4{;ALL0 �, C:I:aS1'00L: NO ,;L7,�, YES SEPTIC TANK: NO YES ,�v NATURE OF SERVICE: ROUTINE -,z?_EMERGENCY ulliERVATIONS:- s. - GOOD CONDITIOM FULL TO COYE14 HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUMBACK- EXCESSIVE SOLIDS FLOODED- SOLIDS CARRYOVER R.WHFR (EXPLAJN) iyslllkM PUMPED BY: f•.-` ' ��. CONIN I F.NTS: UNTI"N'I'S '1'RANSP0RRED TO: s Y S,T-E?� m p I�?,4 Q KE C., SEP 7 2005 TOWN F NORTH ANDOVER I-455-RESS ,Q 'YS TE M 71MEA DA7 E OF pVMMNQ: DS t�SPOOL: No Y L, ,�OfXlc rU K eR V IC p ObZibA YA nUN3. 0,000 CONVI FUU F'.- KZAVY OUMB 8 AJT� ' 33 'N PLA�- $Oty, FtOODEV LrDCAKAyoy OTHep, EXPLAIN 7�1 Sep-02-98 10: 18A Paul D. Turbide, PE/PLS 508-465-0313 P.02 August 21, 1998 Sandra Starr North Andover Board of Health Administrator Office of Community Development and Services 120 Main Street North Andover,MA 01845 RE: Title V review for Lot 24 Oxbow Road Dear Sandra, Enclosed find the"Checklist for North Andover Septic System Plans" for the above- mentioned site. The following is a list of all the `Problem' areas and deficiencies Port Engineering has found. Distribution Box • No stone is specified beneath the distribution box_ 221(2) If you have any questions or comments please feel free to contact us. Sincerel Carlton A.A. Brown,PE/PLS P 0 DT ENGINEERING Civil Engineers& Land Surveyors One Harris Street Newburyport,MA 01950 (978)465-8594 TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE: 04/08/99 This is to certify that the individual subsurface disposal system constructed (X) or repaired ( ) by Charles Zaher at Lot #24 (46) Oxbow Circle has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations as described in the Design Approval Site System Permit #1058 dated November 12, 1998. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. / Board of Health Inspector F NORT Town of �_ 9Andover O L q3 ? LAKE dover, Mass., COCN19 9A_ 0 ; `yy;�A ICME WICK TED�PP\ BOARD OF HEALTH PERMIT T D Food/Kitchen 1 Septic System /d�� 1 BUILDING INSPECTOR THIS CERTIFIES THAT....... .♦.... ....�. 8.04. ......... ..................................... Foundation has permission to erect................./.................... buildings on ...�.Q.. .°�.. ...0#.41.0. ...a..& . ^' Rough 41,,q ; _ to be occupied as............... .1N l.�. . ! ......... .wl.�.I.. ........ Lbs I. ..N...C.!�.... e2.....ArI.......�u�rr� Chimney provided that the person accepting his permit shall in every fespect conform to the terms of the application on file in 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. PLUMBING SPEff VIOLATION of the Zoningor Building Regulations Voids this Permit. o ,4 y7s . I ` S� 9 g �� oqPERMIT EXPIRES IN 6 MONTHS ELECTRICAL SPEC UNLESS CONSTRUC N S T " C Rou ...... ..... . ..................... ................... BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough P Y P Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. Smoke Det. TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that thLSewaae Disvosal System(}_constructed; ( )repaired; by �����ar�rSw,�e � located at was installed in conformance-with the.North Andover Board of Health approved plan, System Design Permit#_�Dom'.dated E)bJ j:2� 1`I`I F , with an approved design flow of O goons per day. The were is conformance with those specified on the approved plan;the system was installed irraecordsaca with the provisions of 310 CMR 15.000,Title 5 and local regulations,and the final grading'agrees substantially with the approved plan. All work is accurately represented on the As-built which has been submitted to the Board of Health. Installer: . 1«�A., S 13 Date. I Design Engineer: - Z- I ms mw Date: 3,)-wa AS-BUILT CHECKLIST ✓ LOT NUMBER, STREET NAME ASSESSORS MAP & PARCEL NUMBER LOT LINES & LOCATION OF DWELLINGS / LOCATION & DEMENSIONS OF SYSTEM, INCLUDING RESERVE ✓ TIES TO LOT LINES & DWELLING, WELLS a. FROM SEPTIC TANK b. FROM LEACH AREA LOCATIONS OF DEEP HOLES & PERC TESTS ✓ ELEVATIONS OF DISPOSAL SYSTEM TOP OF FDN ELEVATION LOCATIONS OF WELLS, DRAINS, WATERCOURSES W/IN 150' OF SYSTEM ✓ LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK& D-BOX STAMP & SIGNATURE IMPERVIOUS AREAS - DRIVEWAYS, ETC. NORTH ARROW FINAL CONTOURS LOCATION & ELEVATION OF BENCHMARK USED LOCUS PLAN i i APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: CURRENT INSTALLER'S LICENSE# LOCATION: a4 0X jp(,,) lJrr_ e- LICENSED INSTALLER: aAV _-,, SIGNATURE:_(LQ2_�JTELEPHONE# 5_0 -?oo CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Ad inistrative Use Only $75.00 Fee Attached? Yes No Foundation As-Built? Yes No Floor Plans? Yes No Approval Date: i i . Town of North Andover, Massachusetts Form No.3 of 40RT#1 BOARD OF HEALTH _ °.eti0 3r oL 19 � p CHU DISPOSAL WORKS CONSTRUCTION PERMIT SACHUSE � .. Applicant /�- NAME ADDRESS (1 TELEPHONE Site Location_._ C>� Permission is hereby granted to Construct ( ) or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. - CHAIRMAN, BOARD OF HEALTH e FeeD.W.C. No. /off - -- ,' ..:,.,,..•r��,-.ori--�e-T. BUCHAN CONSTRUCTION 2-89 3055 CHARLES G. ZAHER I,1 40 GERTRUDE AVE. PH. 978-441-9429 LOWELL, MA 01851 i 53-7133/2113 ul p i PAY DATE ( ( �(� J l TOT E � \ `�- /� ORDER OF i IN) `J c t ` is (`-JVD r"ArzOWELL F/f/,E DOLLARS k' LOWELL,MASSACHUSETTS 01852 J I FOR l `` QA c "l(l c) � 11200 30 5 5O Town of North Andover,Massachusetts BOARD OF HEALTH c� 19 DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant k&t k,� Test No. Site Location 0—r X Reference Plans and Specs. ENGINEER DESIGN DAT E Permission is granted for an individual soil absoprtion sewage disposal system to be installed in accordance with regulations of the State and the Board of Health. BOARD OF HEALTH Fee ` 2� Site System Permit No. "� 00 — SEPTIC PLAN SUBMITTAL FORM LOCATION: L NEW PLANS: YES $125.00/Plan I REVISED PLANS: YES $ 60.00/Plan SITE EVALUATION FORMS INCLUDED: YES NO DATE: 9 � 0 DESIGN ENGINEER: LIS ZfC0Q- DATE TO CONSULTANT: When the submission is all in place, route to the Health Secretary. FORK U - LOT RELEASE 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: ,e AAOIICols__ _zc Phone la 5 n3 DO LOCATION: Assessor's Map �Number Parcel Subdivision `t,/OU 'J�c� ` ? S Lots) Street St. Number 4-4p � ************************Official Use Only************************ DATIONS OF TOWN AGENTS: Date Approved G' Conservation Administrator Date Rejected Comments r Date Approved g Town Planner Date Rejected Comments Date Approved Food Inspector -HHealth Date Rejected Date Approved Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections - driv-sway pe it Fire Department Received by Building Inspector Date September 16, 1998 Hayes Engineering 603 Salem Street Wakefield, MA 01880 Re: Lots 23 & 24 Oxbow Circle To Whom it May Concern: This is to inform you that the proposed plans for the sites referenced above have been approved. If you have any questions, please do not hesitate to call the Board of Health Office at (978) 688-9540. Sincerely, Sandra Starr, R.S. Health Administrator SS/cjp cc: William Scott, Director, P&CD Aurele Cormier File Town of North Andover of NORTN , OFFICE OF ;� ,`I"" tiooL COMMUNITY DEVELOPMENT AND SERVICES p 30 School Street North Andover,Massachusetts 01845 �,9"° ,,,,.�•'`t5 WILLIAM J. SCOTT SSACNUS�S Director " September 8, 1998 Hayes Engineering, Inc. 603 Salem Street Wakefield, MA 01880 RE: Lots 23 and 24 Oxbow Road This is to inform you that the proposed plans for the sites referenced above have been disapproved for the reasons below. 1. No stone is specified beneath the distribution box. 310 CMR 15.221(2) Please be aware that all revision submittals must be accompanied with a $45.00 fee. If you have any questions, please do not hesitate to call the Board of Health office at the number below. S Sincerely, Sandra Starr, R.S. Health Administrator cc: Wm. Scott, Dir. CD&S Aurele Cormier File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 i SEPTIC PLAN SUBMITTALS LOCATION: C ky C-1 e_ NEW PLANS: YES $125.00/Plan REVISED PLANS: YES $ 45.00/Plan SITE EVALUATION FORMS INCLUDED: NO DATE: J a lg 9S DESIGN ENGINEER: DATE TO CONSULTANT: When the submission is all in place, route to the Health Secretary - - — Town of North Andover f AORTN OFFICE OF °�'' ��o 3' L COMMUNITY DEVELOPMENT AND SERVICES 30 School Street s North Andover, Massachusetts 01845 WII LIAM J. SCOTT North �y Director a t OUTSIDE CONSULTANT ESCROW AGREEMENT bx NORTH ANDOVER BOARD OF HEALTH Agreement is made this a LTktm t , f�u(�-u_5-L between the Town of North Andover and QN- 9AL:Q iLLJ In L , for Soil Tests, Plan Review—L07 't 2�A CDx bow y-J--c– -------------- KNOW ALL men by these present that the Applicant hereby provides theown of North Andover with a check in the sum of $ lo5. , to be deposited in an escrow account for the Town of North Andover and has deposited in an interest- bearing account as designated by the Town Treasurer to be expended by the North Andover Board of Health to insure payment to any outside consultant (s) for Soil Tests, Plan Review for the above referenced project , This agreement shall remain in full force and effect until the specified project has reached completion . ' ,� Beard of Health Chairman Applicant or' Agent REMITTANCE ADVICE A. C. BUILDERS, INC. 33WALKER ROAD 53-307 NORTH ANDOVER,MA 01845-1910 1-13.._..... ... CHECK U le DOLLARS AMOUNT :..... PAY`Y DESCRI TION CHECK NO. DATE THE ORDER a� p , $ O $eGn1Y IeGlu,ae Deleile on Deck. WOBURN NATIONAL _ NP WOBURN,MASSACHUSETTS ---' AUTHORIZED SIGNATURE HAYES ENGINEERING,INC. DORM I 1 - SOIL EVALUATOR FORM. 5593 SALEM STREET WAKEFIELD,MA 01880 Page I of 3 (617)246.2800 ` g FAX(617)246-7596 No. %2 Date: JOB FILE 1�0G- Oe�'� Commonweal:I, Massachusetts /1o, A,i�iryMassachusetts Soil Suitability Assessment for On-site Sewage Disposal Performed By: ! PI'1. - - cl J-----•-------------------------• Date:.._ Witnessed By: ..... taatfon Addax:or oma• . �. :n„n<. //� /�j Ad&-as.ud �. C. IJ 0/c(/Gl�l� ew Construction RP Repair ❑ Ayupov%� Office Review Published Soil Survey Available: No ❑ Yes ❑ � Year Published ._.._•_.:._..__...___..: P ublication Scale.... :_. Soil Map Unit ....-----_-_. Drainage Class_._...� Limitations �..... . Soil ....... Surficial Geologic Report Available: No ❑ Yes ❑ -................. Year'-Published - - Publication Scale Geologic Material (Map Unit) ........................._--------.._.---:---_-_.- Flood Insurance Rate Map:.............. .. ........:.. ~ __.. Above 500 year flood boundary No ❑Yes ❑ Within 500 yeaPllood boundary No ❑Yes ❑ 4� Within 100 year flood boundary No ❑Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) ....................__ Wetlands Conservancy Program Map (map unit) Current Water Resource Conditions (USGS): Month Range :Above Normal ❑Normal ❑Belc.., Normal n Other References Reviewed: DEP APPROVE.)FOP-%I. 1:107ros FORM 11 - SOIL ENAIXATOR FOItl11 Page. 2 of 3 Location Address or Lot No. _ ��p GU � _ JOB FILE On-site Review Deep Hole Number..) 2`-tw.. Date:........... . Time:......: . . ...... Weather...-...-- - --•--- -- - - Location (identify on site plan) ..-......_• ..„ .............................................. Land Use ...... Slope (%).... Surface Stones. .. (Z :2 ) �,,- -.•Vegetation. -............. - Landform........__........................... .... Position on landscape (sketch on the back) Distances from: Open Water Body...........feet Drainage way.............feet Possible Wet Area. .. .-......feet Property Line.-. .. ... _.feet Drinking Water Well............feet Other . . . .. .. . .. . . ....._ DEEP OBSERVATION HOLE LOG* Depth from .. Soil Horizon Soil Texture Soil Color .Soil Other Surface(IncWs) (USDA) (Munsell) Mottling (Structure,Stones,Boulders,Consistency, % Gravel) 52 Parent Material(geologic) DepthtoSedrock:_ / / y Depth to Groundwater: Standing Water in the Hole: �_�� Weeping from Pit Face:_ ��a _ Estimated Seasonal High Ground Water: ut:P APPROVED 170"t- 1207195 HAYES ENGINEERING,INC. 603 SALEM STREET JOB FILE WAKEFIELD,MA 01880 FORM 11 - SOIL LVALUATOR DORM (617)246-2800 /1/d, L ooIYy FAX(617)246-7596 Page 3 of 3 DEP APPROVED FORM-12/07/95 Location Address or Lot No. _ 6X&UJ 2opo - R4 of oti Determination ,for Seasonal High. Water Table Observation Hole Number: Z �7 Method Used: ❑ Depth observed standing in observation hole......... . . inches ❑ Depth weeping from side of observation hole.......v inches ❑ Depth to soil mottles . .P�LI inches ❑ Ground water adjustment ................... feet Index Well Number .................. Reading Date. ................... Index well level ......... . .. Adjustment factor ................... Adjusted ground water level ........................................ Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material'exist in II areas observed throughout the area proposed.for the soil absorption system? If not, what is the depth of naturally occurring pervious material? Certification I certify that on Nov. 1994 (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature Date 7--9 DES017IPTI01V OF HORIZONS TExr4 :• pvwl —S "-.,Jr*81W Jowl --SSJ SrRUCrLw: wry svrw A&W --ww Jow J *w4ft blit fwy r. �yp� tAurve wrw —,cw pvwllr Jow --yl S&%VtwJSa —0 wrr ffne —rf /IStr —p1 Sw0 --r Sta v Jaw --_StJ wrest —1 fine —/ �rJSrrdC --pr rin..rw --fi alt —SJ wow,vt• –,e Ardj w "N Cola~ wry flee A" —.•f• alt low ---*JJ comw --# idew tarty saw —Jror elar Joer --ol wry toww -wc awl-Otoekr—rAY jaw sow —!s 8110 clot Jar --wic! JawRr flno Srw --lfi SMAY elor Jor —,rc! SaorpvJr trlocKIr-tieAt fim Jar --- Slit•tier I~ — /rwxilwr lttl fl/IS maw Jaw —fel SJltr elSr — Silvis VVIR ySlc AWMRM -•,S wry fine Sr�Or Jow --rfa clSr —,C MOTTLING. comrSTENCE., AAabwmR S�rR ewrtiwe AVt MJfi Mist Sall.• O•r Sall.• hr —f pnp fins —1 fart —/ mmtlekr --Mo Joe" --SJ low& --O! edwom -ti• k�b MOltr --P Alstimt 800"y Sticky —*W wrr IrlweJS —Wrfr Soft -tilr Seer --e X17-JGLW c�oryS -�/ pear nmt -� Stictr --M ft`labjv --err SlAotlr Mti --dM W17 Sticky -,r►v fen _*fJ h" -ti1i pow"tle -tion wry fen -9 f! wrr Aero —r►y► SiAwir 01"tic —+pe eravrlr Piro-.%Wfi ertewelr Aero--SIM /JSStic —10 wrr Plastic __WW HAYES ENGINEERING, INC. 603 Salem Street Wakefield, MA 01880 (617) 246-2800 FORM 12 - PERCOLATION TEST Fax (617) 246-7596 Location Address or Lot No. X tl Gc� COMMONWEALTH OF MASSACHUSETTS .AVB FILE 01 Z�- Massachusetts Percolation Test* Date: . ..._... —.1._. ........ Time: ......................... . Observation !-lcle # Depth of Perc •.���°! q G Start Pre-soak End Pre-soak Time at 12" /2. ov Time at 9" Time at 6" Time (9"-6") Rate Min./Inch Minimum of 1 percolation test must be performed in both the primary area ANU reservee area. Site Passed MX Site Failed ❑ Abandoned ❑ ...................................................................................:......................................._...................... Performed By: UYl (A,(_ Witnessed By: 2 u D R o Z"d l,y Comments: .:.:::..:::...::::::::::::::..::::::::.::::::::::..:::.:::::::::. DEP APPROVED FORM-12/07/9S HAYES ENGINEERING,INC. FORM 11 - So "' :�l.l : ()It FORM,603 SALEM STREET WAKEFIELD,MA 01880 page I of 3 (617)246.2800 ` FAX(617)246-7596 No. ¢ D . atc• JOB FILE �tot;i- _Ua Zy Commonwealth gf Massachusetts m Ar�aBo1 , . Massachusetts Soil Suitabilitv Assessment for On-site Sewag Disposal Performed By: !� 1�f/� � Witnessed By: L=tioo wamas or Owoer'a Name.If Tea«:.a /� ,' I .2 EV 5* ."Les'1 AJ 2-4—' T ���w /�� - Tckplanet �� New Construction Repair ❑ Office Review Published Soil Survey Available: No ❑ Yes Publication Scale-._- !_ -_ Soil MapUnit Drainage Class_ ,. .,.-_-• Limitations ........ . ... . ... . .. ..-,''T_ - .. Soil_. .._ . - c�._..__._.. surficial Geologic Report Available: No ❑ Yes ❑ -....._._..._.__.. Year`Published - - Publication Scale Geologic Material (Map Unit) ............. ..----•-_-----___.._.__.-_-_�-.-.-----•_-__-- Flood Insurance Rate Map:.....`.._. :.....-.........:......__.._._---- .. . ........._......._._ _.._.. ----- Above 500 year flood boundary No ❑Yes ❑ With-in 500 year#fYood boundary No ❑Yes ❑ Within 100 year flood boundary No ❑Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) ............_. Wetlands Conservancy Program Map (map unit)-,•- .•-• Current Water Resource Conditions (USGS): Month Range :Above Normal ❑Normal EJBe1c,.v Normal El Other References Reviewed: ner ArrKo«.n FOPW- 12107195 FORM 11 - SOI►. ENAIXATOR F0IZ,%I ►'age. 2 of 3 Location Address or Lot i4a. _ 6 ( (.�J l2�_ _ JOB FILE On-site Review Deep Hole Number I.. r.!.. Date:_.K.7.L.� --. Time:....... Weather.._....-- - -----. _. . . Location (identify orf,site plan) ........._. ..... ........... _..... . .. ... ... .. .... .... Land Use.... .'' Y......_........... ..... Slope (%)........._._. Surface Stones. .. .. Vegetation....-..-..._............. - Landform........-_........................ Position on landscape (sketch on the back) Distances from: Open Water Body ...........feet Drainage way.............feet Possible Wet Area. .. ........feet Property Line._. .. ..._.feet Drinking Water Well............feet Other . . . .. .. . .. . . ...._ DEEP OBSERVATION HOLE LOG* Depth from .Soil Horizon Soil Texture Soil Color Soil Other Surface(inche's) (USDA) (Munsell) Mottling (Structure,Stones,Boulders,Consistency, % Gravel) s MINIMUM OF REUUMTqXrrvEWPROPOSED DIS Parent Material(geologic) DepthtoBedrock: Depth to Groundwater: Standing Water in the Hole- Weeping from Pit Facer _ Estimated Seasonal High Ground Water: t7 r' DEP APPROVED FORA[• 12/07/95 HAYES ENGINEERING,INC. 603 SALEM STREET JOB PILE WAKEFIELD,MA 01880 NORM 11 - SOIL LVALUATOR FORM (617)246-2800 FAX(617)246-7596 'Z Page 3 of 3 DEP APPROVED FORM-12/07/95 Location Address or Lot No. 6X&Ui 2000 Determination Lor Seasonal ,high Water Table Observation Hole Number: 211A— Method Used: ❑ Depth observed standing in observation hole........... . inches ❑ Depth weeping from sideobservation hole ........ inches F] Depth to soil mottles .�d � inches ❑ Ground water adjustment ................... feet Index Well Number .................. Reading Date .................. Index well level .... Adjustment factor ................... Adjusted ground water level ..................................................... Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in ay areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally:occurring pervious material? Certification I certify that on Nov. 1994 (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature 4�44Date DESCRIPTION OF HORIZONS TEXTUS• . /ww! --gyp pvrNJy arWy Jar -yrJ STi9UCTU9E.' wry aDrw IoW -rcor Jow —J Ar+.ac die. fisc or OW aoww rrns --say "WHY!ow —o very fine --rr Piety -y,1 MSO -y stony Jar -OtJ MNIr -! fine -f p^lrartic -fir fine IrrW --ta slit ---*! Aaawvts -,p A*OlaW --a calla 9rr wry fine srW --rfi slit Jar --*JJ Itror10 corraa --c OJrary -fir Jaw comw IoW -Jew clay Jar --Ci wry coww --re. owl-OJaary-ON Jury sow -Ji slity Clay Jar --,rtcJ WAA Jost'• fine awd --Jfa srWp cJsy Jars -Iwj su pawla OJaary-Or "MY Joy ---*J atony usy Jaw --*tcJ Arw,rv.r -dr` fine arWy Joss —fa alit,cJsy ---*lc Amroer w,.ln -„° wry I!ne Irney Jar -rfiJ cloy -,e Awa�w -y MOTTLING. CGWSISTENCE.• AOo wUnm' Size.* centivaa AYt rlJ.' Ablet IOJJ.' AV"Ji.- few —f Apnw flne --! Mint —f Aawtlary -wa J*~ --*I Iowa --WJ cawao --c A%,W A*Olrw Alstlnct --s aijimly stlary --ass wry IhlroJ* -,wfr soft -dr Army -+ Av-104V caws -�f p�arinrnt -�o at-fay --.. t 1diftie --*A, also wir nww --aA wry scary -.rya fJf,. --.ff Arno Aww"tJc --apo ww flfr -,wfl wry AwW -�rl► sJAWJy rlsstic -cps axa,.rJy f&W-«fl Artr~Jy AAs--AYA pJwtls --AP parr/Jsatic --pro HAYES ENGINEERING, INC. 603 Salem Street Wakefield, MA 01880 (617) 246-2800 FORM 12 - PERCOLATION TEST Fax (617) 246-7596 Location Address or Lot No. k} .eye �IL� COMMONWEALTH OF MASSACHUSETTS , CoA py hi 0 � 0,q�lassachusetts Percolation Test* Date: ........ .."7^ Time:_-.............. Observation Hole # pgq# Depth of Perc Start Pre-soak �G Z End Pre-soak Time at 12" 11,'67 / .67 Time at 9" //,-/r Time at 6" Time (9"-6") 2 Rate Min./Inch * Minimum of 1 percolation test must be performed in both the primary area ANU reserve area Site Passed Site Failed ❑ AbandonedC � ........................................................................................................................................................ ❑ Performed By: --- Witnessed By: U p p O L0 Comments: DEP APPROVED FORM-12/0719S Town of North Andover t NORTN OFFICE OF �,?o't`•� ,,�o COMMUNITY DEVELOPMENT AND SERVICES F- A 30 School Street • _ > ; WII LIAM 1. SCOTT North Andover, Massachusetts 01845 �,I Director ss,�"uses (�-�v,..� � ism •� �a t OUTSIDE CONSULTANT ESCROW AGREEMENT Y-L-,,� NORTH ANDOVER BOARD OF HEALTH Agreement is made this ��,�'kia A (>uSt' between the Town of North Andover and o f N Q�-U` ► n ask (U, for Soil Tests, Plan review_ Lt] W �V- KNOW ALL men by these present that the Applicant hereby provides the Town of North Andover with a check in the sum Of $ Jo5, , to be deposited in an escrow account for the Town of North Andover and has deposited in an interest- bearing account as designated by the Town Treasurer to be expended by the North Andover Board of Health to insure payment to any outside consultant (s) for Soil Tests, Plan Review for the above referenced project . This agreement shall remain in full force and effect until the specified project has reached completion . Board of Health Chairman Applicant or Agent MREMITTANCEEu� � A. C. BUILDERS, INC. 2,569 33 WALKER ROAD NORTH ANDOVER,MA 01845-1910 53 307 113 e CHECK to DOLLARS AMOUNT PAY DATE THE ORDER D E S C R I TION CHECK NO. 8 � Serumy leaN/es nclWeG. Oetale on back. WOBURN NATIONAL WOBURN,MASSACHUSETTS NP —AUTHORIZED SIGNATURE nsnn ? c;P.9e 1:0113030711: 112506430911' i Commonwealth of Massachusetts CLEAVED City/Town of NORTH ANDOVER W° System Pumping Record JUN 10 2014 Form 4 TOWN OF NORTH ANDOVER w" 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 forms 1. System Location: on the computer, qG O Y b ( �� C��C 1P.n, use only the tab Jl ( �VIJ -t;" key to move your Address cursor-do not NORTH ANDOVER Ma use the return key. City/Town State Zip Code 2. System Owner: Name renrn Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record /-7 L11 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: 6. System P nV7 Nme ' Vehicle License Number Stewa �65�ticServV�iice Company 7. Location where contents were disposed: Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 Signat -oLhlau! ��___---- Date Signature of Receiving Facility Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 � 6 No. COMMONWEALTH OF MASSACHUSETTS Board of Health, NDoYE1z MA. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construe Repair O Upgrade O Abandon Complete System ❑Indvidual Components Location ON F O W cvv—c e Owner's Name C (pj,1 V E'eS `��L Map/Parcel# 10-19 l4-t- Address 33 ►V go, NjyovErL Lot# 7— Telephone# Installer's Name Designer's Name ky er, G�G, W 't._ Address Address 603 pp L S�T A{� EL ca Telephone# TC_4-�o .Welephone# Q (.> Type of Building: Lot Size 444--uq•ft. Dwelling- No. of Bedrooms Garbage grinder( d Other-Type of Building No.of persons Showers( ), Cafeteria( ) Other Fixtures Design Flow(min. requpi,r�e�d)�gpd, Calculated design flow Design flow provided gpd Plan: Date9N–ICJ 1� Number of sheets. �,� Revision D to Title S �1T�12-`� yxs f os L 'Yr.—1 : �^1 �L�►� Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator ER SO 14 Date of Evaluation S DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date Inspections DEP APPROVED FORM 5/96 No. Fee COMMONWEALTH OF MASSACHUSETTS Board of Health, MA. CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) ❑ Complete System The undersigned hereby certify that the Sewage Disposal System;Constructed(), Repaired(), Upgraded(), Abandoned() by: at has been installed in accordance with the provisions of 310 CMR 15.00(Title 5) and the approved design plans/as-built plans relating to application No. dated Approved Design Flow _(gpd) Installer Designer: Inspector Date The issuance of this permit shall not be construed as a guarantee that the system will function as designed. DEP APPROWD FORM 5/96 No. Fee COMMONWEALTH OF MASSACHUSETTS Board of Health, , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system at as described in the application for Disposal System Construction Permit No. dated Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met. DEP APPROVED FROM 5/96 Date Board of Health DATE: LOCATION: E:NCINEE~. ' BOH WITNESS: FE=,COLATI0N TEST „ BO i OM DEVTI; OF PE..RC TEST: S� TIME OF -C A K _ D,�S (A� least ,5 irutes Icrc) Tiiv1E A.T i 2" 11 : v TIME AT 1 TIME AT f �X i L r i iN1E ~, I TIME: AJ DATE.- LOCATION: ATE:LOCATION: ENGINEER. _ BOH WITNESS. FE;.COL^\T10N TEST tC <� l BO i I OM DEPTH; OF PERC TEST: / � �� TIME OF SOAK.: _ t < 7 (A legis; irut�s Icrc) TIME AT 12" l D O TIME AT 9" TIME AT C\,,E^NICrT SOA.F TIME S I r-.. I _D NEXTr,L-�s v I I Illi I EE"I iNIE AT Q HAYES ENGINEERING,INC. FORM 11 - SOIL EVALUATOR hOlt�i 603 SAt_EIkSMEET WAKEFIELD,INA 01880Page l of 3 (617)246-2800 FAX(617)246-7596 No. �� Date. JOB FILE /o 00 112-- CommXZ'7 Massachusetts '%, Massachusetts Soil Suitability Assessment for On-site Sewage Disposal Performed By: -�1/sat�l_. -- -...... - -- - Date:..__. " ... Witnessed By: ._......�.......-......... .... --------------- ----- „ ,or owl Name. { Cr. Adds:.ud ew Construction Repair ❑ Office Review Published Soil Survey Available: No ❑ Yes Year Published .-•----==--- - -��.�. e--/:/S�dO------ • Publication Sca __. t _.. Soil Ma Unit . r Drainage Class---..: �: ....... tions ........ _... . ... . Limitsa �` ._._.. Surficial Geologic Report Available: No ❑ Yes ❑ - - -- - - Year`Published Publication Scale Geologic Material (Map Unit) ----------------- ................_..._____.------._ .-- -------------------- -------------- -- --- Landform..... Flood Insurance Rate Map: .............. ...........:....... _..__.____........ . . Above 500 year flood boundary No ❑Yes ❑ Within 500 year'flood boundary No ❑Yes ❑ - Within 100 year flood boundary No ❑Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) ....................____._._____.. Wetlands Conservancy Program Map (map unit).. •_ ••--•••--•--••--•-.-- „ Current Water Resource Conditions (USGS): Month Range :Above Normal ❑Normal ❑Bek�. Normal n Other References Reviewed: DEP APPROVEr1 FO"I- 12/07/95 K FORM Il - SOII, F,VAIXATOR FOR,%, Page. 2 of 3 Location Address or Lot No. _ 6j (AJ �2�_ JOB FILE On-site Review Deep Hole Number 1 ..2¢ Date:_.o.'772_� --. Time:....... Location (identify osite plan) ..-......_. ...... _--.• Land Use .... . ....._........... ..... Slope (%)...........__ Surface Stones. .. .. - Vegetation... -......... - ...... . Landform........- Position andform........_Position on landscape (sketch on the back) Distances from: Open Water Body......._...feet Drainage way.............feet Possible Wet Area. .. ........feet Property Line._. .. ... _.feet Drinking Water Well............feet Other . . . .. .. . .. . . ...._ DEEP OBSERVATION HOLE LOG! Depth from _. Soil Horizon Soil Texture Soil Color .Soil Other Surface(Inches) (USDA) (Munsell) Mottling (Structure,Stones,Boulders,Consistency, % Gravel) M(NIMUM OF 2=REQUIR !JRY_PROF0SM_DTPZSAL_ARE.4V__ y Parent Material(geologic) QYWT _ Depthto8edrock: Death to Groundwater: Standing Water in the Hole: o Weeping from Pit Face: /Ja _ Estimated Seasonal High Ground Water: r' ueP APPROVED FORAt- 12/07/95 'K HAYES ENGINEERING,INC. 603 SALEM STREET JOB PILE WAKEFIELD,MA 01880 FORM 11 - SOIL EVALUATOR FORM (617)2464800no FAX(617)246-7596 Page 3 of 3 DEP APPROVED FORM-12!07/95 Location Address or Lot No. ui2-oplD 'V Determination for Seasonal High Water Table Observation Hole Number: Method Used: ❑ Depth observed standing in observation hole......... . inches ❑ Depth weeping from side observation hole....... inches El Depth to soil mottlesd inches ❑ Ground water adjustment ................... feet Index Well Number .................. Reading Date ................... Index well level ......... Adjustment factor ................... Adjusted ground water level .......................................... .. ..... Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in aW areas observed throughout the area proposed.for the soil absorption system? If not, what is the depth of naturally occurring pervious material? Certification I certify that on Nov. 1994 (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature Date DESCRIPTION OF HORIZONS TEXTGKaE• ' pvroilr sensy Joy ---psJ STHUCTU9E' wry car"sans —reos Jar —J I►vak Slrw• Fore alt 7rpR carve A~ -prom srvwlly Jar --VJ rmry /Ina -rf platy -pJ sand —m stony Joao --00 wwt -! fins --f prtr tic --yr tine srW --fs slit --mt Iodnvh -,P mOlus --r COJrnr• __W wry flim srW --rfe silt low. ---oil ot—W __J COW" -,c oJa rr -*t lory Corw sena —leas cloy Jar --CJ very cosres -rc wtpWr Woaky-dAt Jury A&W --Ji silty cloy lar —stet scOrApulr OJOC*),--ffAf' Jowq flits saw ---Jfi srWY Cloy Jove —scJ plawJwr, -"Pft "My Joy —sl stony Clsy Jor stcJ slnple pvin -w fins srWy lar —fol slitr CJsy ---*lc sryssw --r rw), fins srWy Joy —rfsl cloy ---o MOTTLING.• CWSISTENCE.• AbmaW ev Size., awt~v Met sol L• Ablst sol J.• ary soil.• felt -f to-Im fine -1 faint —f 00"t.Wy --wo loos• --iJ loos. —eJ carr, --c A%~ Cosh. -? /lstlnct --s sltOUy stic .V --esi wry nvable -,wfr soft __&V Amy -. AV-104V COW" -,f p�osJnsnt -V eua�rr --+. /rlwsle -,.fr sJlpntlr Aare -•,dm wry st ic*y --ltrs Iter --rf! nr,e --arn nrwl eue -apo far Ilio -,wft wry nwW -,syn 8"Oft"y P"Sttc -nw sxtre mly fli,.--rmfl mxtiwsJy th"-•"+n ilrtte --gyp wnr.7-04, --- HAYES ENGINEERING, INC. 603 Salem Street Wakefield, MA 01880 (617) 246-2800 . g FORM 12 - PERCOLATION TEST Fax (617) 246-7596 �} n Location Address or Lot No. O � 1� ►Ldp ,M FILE: COMMONWEALTH OF MASSACHUSETTS 19NDO,Jgrt-,Massachusetts Percolation Test* Date: ........ ..? Time:_........................... Observation Hole # n��n Depth of Perc �/& ', Start Pre-soak 2� End Pre-soak Time at 12" 11,'67 / .67 Time at 9" Time at 6" �/ • 3 Time (9"-6") 2 Rate Min./Inch * Minimum of 1 percolation test must be performed in both the primary area ANU reserve area Site Passed Site Failed ❑ Abandoned ❑ ......................................................................... Performed By: C ...... J✓ clm �o Witnessed By: Comments: ............... ..........:.......................... ... ................ ...... ..,........ DEP APPROVED FORM-12/07/95 HAYES ENGINEERING,INC. FORM I1 - SUIT, [?\`:�I.l :�"I'UK l:pltll 603 SALEM STREET WAKEFIELD.MA 01880 , l'a9 1 of (617)246-2800 FAX(617)246-7596 No. JOB FILE 1�rj Oa l(y Commomvealth of Massachusetts / 0, ��er', Massachusetts Soil Suitability Assessment for On-site Sewage Disp= osal Performed By: Y '1. - - J.... - - ---- - Date:.._ _Z�1`�.— . .. ..... �J Witnessed By:Loml -------------__ ----- or. r:w„r. L". KAddress.am t"'j Telepbont/ Newconstruction Repair ❑ icip�/%� Office Review Published Soil Survey Available: No ❑ Yes ❑ Year Published ._._._•__:._..___..__�.. Publication Scale...-..._.__..______._ Soil Map Unit _ Drainage Class-----=_>;�. --- Soil Limitations Surficial Geologic Report Available: No ❑ Yes ❑ - - -- - Year'Published - Publication Scale Geologic Material (Map Unit) ........................._.__.__.__.._.---:-------.-----•--------------------------- _-. . Landform.•----•-=-----��.��:._-----._-.w_..._----- Flood Insurance Rate Map:.............. .. .........:.......__.._.._---_......_. .. Above 500 year flood boundary No ❑Yes ❑ Within 500 yeaitood boundary No ❑Yes ❑ - Within 100 year flood boundary No ❑Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) ....................____._._____.. Wetlands Conservancy Program Map (map unit).. ,• ••••••••._•.•••••--- Current Water Resource Conditions (USGS): Month Range :Above Normal ❑Normal E]Belc�v Normal E Other References Reviewed: DEP APPROVED FowNt- 12107195 FORM 11 - SOIL EVALUATOR FUlt,%1 Page. 2 of 3 Location Address or Lot ,vU. _ O 6Q GCJ _ �iOB FILE On-site Review Deep Hole Number..) 2`'r�.. Date:_.? -7-�. Time:....... Weather....... -- - Location (identify on site plan) ........._. ..- Land Use ...... ......... ..... Slope (%)..-.�..... Surface Stones. .. C.1,)p�,:. ... ..... --_ -•.•- ..-. Vegetation.. �!�,r2 -........................... . ..................... Landform......-•---........................... .... Position on landscape (sketch on the back) Distances from: Open Water Body ...__.._._...feet Drainage way.............feet Possible Wet Area. -. ._ ...feet Property Line._. .. ...-.feet Drinking Water Well............feet Other . . . .. .. . .. . . ...._ DEEP OBSERVATION HOLE LOG* Depth from .Soil Horizon•: Soil Texture Soil Color .Soil Other Surface(inches) (USDA) (Munsell) Mottling (Structure,Stones,Boulders,Consistency, % Gravel) 5Z C 52 ry MINIMUM OF 2 LES REQUIRED ERY PROPOS Parent Material(geologic) 3_ d'9_ / DepthtoBedrock: Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face:_ � ')a _ Estimated Seasonal High Ground Water:--- DEP ater:__ueP APPR0%T.D FOPht. 12/07,95 ' r HAYES ENGINEERING,INC. 603 SALEM STREET JOB PILE WAKEFIELD,MA 01880 FORM II - SOIL LVALUATOR FORM (617)2464800 • FAX(617)246-7596 Page 3 of 3 DEP APPROVED FORM-t2l07I95 Location Address or Lot No. uj2oAf) Determination for Seasonal High Water Table Observation Hole Number: Method Used: ❑ Depth observed standing in observation hole inches ❑ Depth weeping from side of observation hole-....... inches ElDepth to soil mottles 1/77-7/.. inches ❑ Ground water adjustment ................... feet Index Well Number .................. Reading Date ................... Index well level ......... . ... Adjustment factor .................. Adjusted ground water level ..................................................... Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in II areas observed throughout the area proposed.for the soil absorption system? If not, what is the depth of naturally occurring pervious material? Certification I certify that on Nov. 1994 (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature Date DESCRIPTION OF HORIZONS TEXTlA4E.• plawJ --� plariJJr seer Jaw --O+l STi9UCTU4E.• rrrr tor&sane —row !or —J &leak dJtw firla ar 7yp¢ eaw as &&mwtwJ*es -0 /lily -pJ sow --a starer Jar ---stJ wwr -J fine _f prlowtic -•pr fine 8" —fs slit --,sl IoaWvto rely.& --I ealurar -,%W rrr floe ane --rfs slit Jaw --til ot—W earrlas --c Ll"I --At J"W ewrlas snd —leas cler Jowl --,cJ wry oawla/ -SPC amwlr"oe"-�At Jeaw amw --Ji slitr eJsr Jar --wici "Awl-OJodr--eat J"W fine srW --lfi savvy"My Jar ---WJ P,&Wjr -yr swwr Jar ---sJ stony cisy Jar ---stcJ "Wif plain --sp fine sndy Jar —fsJ siltr clay —sic wry floe saner Jaws —rf*J oJsy —,e MOTTLING. caysrsrENCE.• Aocnar►ca Alit cwunwa• at folk Mist soJJ.• 07 sof!• for —f A;.Im fine —1 faint --f nwwtlaar --ago Joss —+J Joos -_OJ cawww► —e 06MO ~.f&w --%P elstlnct --,d sJJp/tir stJC*y --•ass wrr MJssls —Wfr sort --at swrr --a AV-JOOV cw.ws ,f P-Ownnt —v sucky --.. nv.eJi -wfr s.1iparir 1WW —oar MY etla*r -ww fJM -Off 1MV -ali swpissue r"flir -•yrfl wry AwW —sone o"Aft Jr 0Jrtic --sops extrarsJr flea--"AJ srtnwJr nsro-yaw OJrue -••gyp of Ilsstfe --Mrp HAYES ENGINEERING, INC. 603 Salem Street Wakefield, MA 01880 (617) 246-2800 FORM 12 - PERCOLATION TEST no Fax (617) 246-7596 Location Address or Lot No. COMMONWEALTH OF MASSACHUSETTS .jOB 'PILE Massachusetts Percolation Test* Date: ......_..-��-.1... ........ Time:............................. V UsCI vativri Hole # Depth of Perc Start Pre-soak End Pre-soak Time at 12" 12.' ov Time at 9" /2 . 3 Time at 6" Time (9"-6") Rate Min./Inch * Minimum of 1 percolation test must be performed in both the primary area ANU reservee area. Site Passed EK"'Site Failed ❑ Abandoned ❑ .................:......................................._........ ............. Performed By: ('Jf1 G44_ Witnessed By: 2 U 0 o d l.C� Comments: :::::::::::::::::.:.::::::::::::::..:::: ,..:::..:::.::::::..::::.::::::::..:.:::.::. DEP APPROVED FORM-12/07/95 • �23 PZ36 T�34 Tz3R P�}a 4 Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH O� 19 p APPLICATION FOR SITE TESTING/INSPECTION 7 Aol, �SSAC HUS�� Applicant 'n NAME ADDRESS TELEPHONE Site Location Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee �\� Test No. 1, 1 S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No. 1 oF NORTH BOARD OF HEALTH 9 LED 1. /646 OG \ f 19 OS c 11 p 10 " APPLICATION FOR SITE TESTING/INSPECTION 79 Aw DR4TE DPPp�,Cy SS , Applicant - - + -A� NAME ADDRESS TELEPHONE Site Location ~~ Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH �] 32Oy�t`E� 6+6ti0OL -19 —I APPLICATION FOR SITE TESTING/INSPECTION SACHUS���y Applicant PC NAME ADDRESS TELEPHONE Site Location lX)T (l.J��`tQ Ok 610CUdA, Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time 04 CHAIRMAN,BOARD OF HEALTH Fee—] • Test N o. 13b S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Farm No. 1 NORTH BOARD OF HEALTH Q� ib�tiO 6 0- 19 o rO h APPLICATION FOR SITE TESTING/INSPECTION X1,9 AERATED SSACHUS� Applicant NAME ADDRESS TELEPHONE Site Location Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. I I ------------- - - -- - - -- —= Lel �;651 ^cam - - -- - - - - -- - - - -- -- / ----- --- i Z - = Am ZO �� —lei z- I7 71a 1i�O(� TOWN (-ldP NORTH ANDOVER SYSTEM PUMPING RECORD SYSTEM OWNER&ADDRESS SYSTEM LOCATION 49nt (example: left front of house) it x'14 ; .+'r�i�t'1�4ta, r!•1! , + i '�e 1.•,`, `/. T4s M-7 . ��'�i,�� ����R?a.��' .c,,yt�.:,4, ..;�.rrT t f ,..+.: ri �.=j..,} _.t., ;,t' � :e '!., ... s.e'• DATE OF PUMPING: �"�7-�� . lid `QUANTITY PUMPED GALLONS p1} T ,t+ � tit fi, S'. r `1 :• t d Ory CESSPOOL: 110. YES .SEPTIC TANK: NO YES . 1' 9►� JRE OF SERVICE: ROUTINE EMERGENCY tlr; 11 i!} 4' _.� • . :-GOOD CONDITION*: - `�;�.' �„•,.'.:,. :'� � � �,. '` FULL TO COVER. HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER(EXPLAIN) �. ro :S ,S7'EM PUMPED BY... ac 4',•?�Eta'F''�i ?��;, t' � n' ..: � .. '. - 4 Mb *' iw�`�:� .TRANSFRRE , .�.u1''. �1 X34/,�q n °,1. �1��.,.��,{,� ,: � , I a, ' ' •.,, ,... _ —�_�� � . �j, tt 2001 �'�9 1il ,fir+ ' I,j• •�•..' 6 1 V l 7 72- \ �7C)�C? C) svk Df-SIGN. REVISION DATES.• CCA- REG/STEREO PROFESS/OVAL ENG/NEER DRAWN• __-- S _ w 9No.2714 safoMN�E DATE, �� 1���,�N_ CHECKED. P, o _ ------------ SCALE.' AS NOTED HAVES ENG/NEER/NG INC. 60,3 SALEM STREET C/N ENGINEERS & � � WAKEFIELD, MASS. 01880 _ LAND SURi�EYORS DATE 8 1�-`i$_ SHEET OF TEL. (781 246-2800 Y* O O CP � o O r a� ` v - Q � � Q Q O ►1i('� oQ. ^'TE�cfi1J�Z5E �ctST S tntlT4���s► 10U�T. '` O � � Z Q � 33 v�l�LrtE jL. rLfl � Q 1,o A4009 EaZ k , ZONE• PRD (R-2) O M/N/MUM SETBACKS FRONT = 20' 5/DES = 20" SEE SEC. 8.5.6.D. 1 REAR = 20" s t-u o Ll S Fcc)o /L gP� °°VKJ ti(j��:a, ,,lll r Y1'1'��r(,�I�✓tti'I,;S,� T- _ W,Clll�,,,,y.,,,,, Mrd 1714,1i,r�'I�,r'V Q�P.hL1 p/OYldrd lhl/ Iplrrm 1pl91 i DEC Q g 01 r�b/lllllOd.10 tr r ,,' Vll 1011 apll(% A' F a c l l I ty I(1�.0 r OWN OF 1WOEPART NTT location,. num..p I;- CI7(> ,;,;',', U ,,,, Ydfl''ly,,;'r•r;,'1rRrl `'Y„ . „' , • I:; l'i''/�'1;1��'rY'�l.l,r,2,' p'” l�l(�wr�''' ; ,',r , $1111 '�--- 5 'S„,• r r,i1/�l'IrrrY411�r+iy ���' roll/� C(\'•�' 0+ ------------------- + 1 Irrnl rcrn buVon) C 4 r O+rT1 , umping: mord' ` . i'I ly'I ' � ,I ly+,�•`� if V(,+,•, � l� PVIII �y,lem; $OPft Ton, oil `;' y� r1� F•I�I 1'�(,0„a 0n�1 n Yo� �'o y�1 'y ��1,11(�f! Yrl,�{I I'. '; II Yo 1. n'9l ll c:eane07 • ., ':1 I/,��ird' 11,;'validl 9�.P U',g �((/"}�Igrt.t5,. ... �I S _ rrll'�II wwli,"1/rll I,III cn,oc� ' ''„lyl r�llil5u' 11 ' +''Q Sy py' • ' r + r 1, +� �l . , .....•:. ;r�;�'�r���./F'�;,�/r'y� �,{�l/J� � l.•��1,�,r'1�1� "� /^yi;'1�;, . ;`i;j�:i,,l��. ,.i1��y�Yr111 IIrI�JS����',lf� �'�Vf51�,���;'��I•'� � / �;.,.' ,.l r,�'I'..�o� vnr when oo�l�nu' e( • /• ri; rJAbrl,r'r/ '`I r dY rS i ' •.y��„y of ,��}'ll', •/,, ' ,/'r r ,I,�,'r',,,i,�,1 N1: 111 IY • . ,; '1' .'I'�1'r'�r/r 5.�'r•i.J r�lr,f l I�',,I • •����•!, ,•� 3l�nl�tYl 91 Nl Y4(��11�/f;fr;',nrrl , ;•, ,,.,r.ma4.gQY/der” 1 ✓IIr ,. f r,., . 1 , Commonwealth of Massachusetts City/Town of System Pumping Record 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 octant: m filling out 1. System Location:. puler,is on the use W D Cz C the tab key Address love your North Andover ma 01886 or-do not Cityrrown State the return �C D 2. System Owner. (,�;'�/ G 1' n _ Name AUG Address(if different from location) HEALTH DEPARTMENT City/town State Zip Code Telephone Number B. Pumping Record--7 Wo 1. Date of Pumping Dafe 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) E 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: :Wo 6. y tem Pu ped am e Vehicle License Number Stewart Septic Service Company 7. Location where contents were disposed: tewa treatment Plant 20 So. Mill St Bradford Ma 01835 ature ofW@011qr Date Signature ovIeceiving Facility Date wµ,doc.03106 System Pumping Recons•Page 1 of 1 .__V Commonwealth of Massachusetts ,- , ; .~, - W City/Town of North Andover System Pumping Record ' f`JV 21 2U12 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, G_Xbba �le . use only the tab �I key to move your Address cursor-do not North Andover Ma 01845 use the return City/Town State Zi Code key. P 2. System Owner: Name retran Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 45/1 A5C 0 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: 6. S stem Pumped By: mnww \Jerme, Name Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: Stewart's Pre-treatment Pla_n440 So. Mill Bradford, Ma 01835 Y V /'5— /;� Signature of auler Date Is Signatu of Receiving Facility Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1