HomeMy WebLinkAboutMiscellaneous - 48 WINDSOR LANE 4/30/2018 (2)31
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Town of North Andover p*N
Office of the Health Department g ^ �<
Community Development and Services Division
27 Charles Street +, =�• ^'tee
North Andover, Massachusetts 01845 �Ss�cwus%
Susan Y. Sawyer, REHS/RS
Public Health Director
978.688.9540 - Phone
978.688.9542 - Fax
CE127I�FICA7E Off' C01I11'LI09VCE
As of:
September 17, 2004
This is to cert that
the individuafsubsurface disposal system hada
r,r, 0NX - replaced (X' or repaired � o
by
George Yfenderson
at
48 Windsor Lane
North Andover, WA 01845
has been installed in accordance with the provisions of Title v of the State Sanitary Code and
with the North Andover Ooard of Yfealth regulations.
'The Issuance of this certifi'cate shall not 6e construed as a guarantee that the system will
function satisfactorily.
usan Sawyer, j3fS1j,5
TW blic Ifealth !Director
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTI-1 688-9540 PLANNING 688-9535
Gj ` 1
RECEIVED
AUG 2 3 1.004
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
TOWN'OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM
INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System ( ) constructed;
(X) repaired;
by & eo t- &e; N Dt;"�. S oN
located at W tKDr a R LAdjrr
was installed in conformance with the North Andover Board of Health approved plan,
System Design Permit.# , plan dated with a design now
of gallons per day. The materials used werein conformance with those specified
on the approved plan; the system was installed in accordance with the provisions of 310
CMR.15.000, Title 5 and local regulations, and the final grading ages .substantially with
the approved plan. All work is. accurately represented on the As -built which has been
submitted to the Board of Health..
Bed inspection date: y
Final inspection dateV7
: 0 --
Installer:
Engineer:
Lie.#:
,4114,
Engineer Representative
Engineer Representative
Date: 9' 12,— G y
r
vl
Town of North Andov r D
Health Department `�Date.
Location: Vg
(Indicate Address, if Residential, or Name of Business)
Check #: '1497/
1""id
Two of Permit or License: (Circle)
➢ Animal
$
➢ Dumpster
$
➢ Food Service - Type.
$
➢ Funeral Directors
$
➢ Massage Establishment
$
➢ Massage Practice
$
➢ Offal (Septic) Hauler
$
➢ Recreational Camp
$
➢ SEPTIC PERMITS:
❑ Septic - Soil Testing
$
❑ Septic - Design Approval
$
LW—Septic Disposal Works Construction (DWO
❑ Septic Disposal Works Installers (DWI)
➢ Sun tanning
$
➢ Swimming Pool
$
➢ Tobacco
$
➢ TrashIsolid Waste Hauler
$
➢ Well Construction
$
➢ OTHER (Indicate)
1 ' 4 Health Agent Initials
White - Applicant Yellow - Health Pink - Treasurer
0 h
TOWN OF NORTH ANDOVER of NORTH q
Office of COMMUNITY DEVELOPMENT AND SERVICES
1 bt:M•ib O
HEALTH DEPARTMENT
}
27 CHARLES STREET c r
pORAnp ^.ry,t�j
NORTH ANDOVER, MASSACHUSETTS 01.845 9SSqCHUS�S
Susan Y. Sawyer, REHS/RS 97 8.68 8.9540 — Phone
Public Health Director 978.688.9542 — FAX
healthdept@townofnorthandover.com
www.townofnorthandover.com
APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT
DATE: L - 2 `l —0 `l
LOCATION: Y 8 w
LICENSED INSTALLER NAME: � �y e- 77 �" cl e- rs o-1
PLEASE PRINT
SIGNATURE: TELEPHONE#
� CHECK ONE:
FULL SYSTEM REPAIR:
COMPONENT REPAIR (indicate what parts): YI e w S -e a-! c __T/
* NEW CONSTRUCTION:
* If NEW CONSTRUCTION, please attach the Foundation As -Built Plan.
$ ;00 Fee Attached? jfm D 6r -
Project Manager Obligation From Attached?
Foundation As -Built?
Floor Plans?
Approval of Health
F
2 3^^
L- -----.
Yes Y
Yes
Yes
Yes
D
No /
No
No�
No�
Da
I
FORM U -LOT RELEASE FORM Aad
b-CJ=
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 or requirements.
�* ********k****"*********APPLICANT FILLS OUT THIS SECTION*******************"**
APPLICANT 1 ANl&Z
LOCATION: Assessor's Map Number.
PARCEL
SUBDIVISION LOT (S)
STREET kJ/AJb5Q/L -.ST. NUMBER Irk
v \ **'�"**��'"� *OFFICIAL USE ONLY
RECS PMENDATIONS QF TOWN AGENTS:
EO
CONSERVATION ADM INIST OR
DATE APPROVED a
DATE REJECTED
COMMENTS
TOWN PLANNER
DATE APPROVED
DATE REJECTED
COMMENTS
z
M
FOOD INSPECT R -HEALTH
DATE APPROVED
J
DATE REJECTED
C
T ECTOR EALTH
DATE APPROVED
DATE REJECTED
'
COMMENTS
PUBLIC WORKS - SEWERIWATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR
DATE
Revised 9197 jm
WAS -Sm
T4
ox
S'S
�J
4o/
0
/SD o Gzv,
3 Zd EN
Sun of
N OI�TH Ani IPOV E►-� , MA,
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t,or 3 2LtiOr R RD
wQTER SL)PPL-t wE14- .1-TY-VAJ APPRNED CIyE5 QMC7
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2(46 APPRovvJ6 /3L)i Hogi �/
Page 1 of 1
Sawyer, Susan
From: DelleChiaie, Pamela
Sent: Thursday, April 29, 2004 11:46 AM
To: Sawyer, Susan
Subject: FW: 48 Windsor Lane - Dan Weeder
4/29/2004
Here is an old e-mail from Brian regarding this subject....
P
-----Original Message -----
From: Lagrasse, Brian
Sent: Friday, April 09, 2004 12:33 PM
To: DelleChiaie, Pamela
Cc: Sawyer, Susan
Subject: RE: 48 Windsor Lane - Dan Weeder
I spoke to Dan and he is ok with what i told him. he is planning an addition right now and wanted to find out
about what he needs to do. his septic tank is 16' from his current house and wants to add on in that area. i
told him he would have to relocate his septic tank to meet the required setbacks. he asked about a variance
to the 10' setback but i explained to him that the varience was not appropriate for this situation and that there
is enough room to relocate the tank, meet the setbacks and be in compliance. he is also required to have a
title 5 inspection done for additional living area and is aware of the number of rooms allowed under his
current system. he is (i believe) only adding one room/office and expanding existing rooms, ie. kitchen, etc to
maintain the current design flow. he is looking into getting a new tank because he has been advised by his
septic pumper that septic tanks sometimes dont move well depending on their age, integrity etc. any
questions just let me know.
-----Original Message -----
From: DelleChiaie, Pamela
Sent: Thursday, April 08, 2004 3:59 PM
To: Lagrasse, Brian
Cc: Sawyer, Susan
Subject: 48 Windsor Lane - Dan Weeder
Hi Brian,
The homeowner, Dan Weeder of 48 Windsor Lane called regarding a building project that Pat Healey
spoke with you about this morning. Please call him at 781.953.4539. He was rather forward about
speaking with you, and expects a call asap. He must not be pleased with something that his builder told
him about your conversation.
Thanks.
Pamela DelleChiaie, Health Dept. Assistant
Town of North Andover
Community Development & Services
27 Charles Street
North Andover, MA 01845
pdWiechiaie@townofnorthandover.com
Tel. 978-688-9540
Fax 978-688-9542
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
ISI
Commonwealth of Massachusetts RECEIVED
City/Town of
System Pumping Record JUL 2 2 2009
Form 4
TOWN OF NORTH ANDOVER
DEP has provided this form for use by local Boards of Health. Other for HE H T
information must be substantially the same as that provided here. Before using this form, check wit 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.
A. Facility Information
1. System Location: Left front of house, Right front of house, Left rear of hou< Right�house
Address
City/Town
2. System Owner:
Name
Address (if different from location)
Cityrrown
B. Pumping Record
1. Date of Pumping
3. Type of system. ❑
State Zip Code
M
State Zip Code
3VY3T
Telephone Number
l —(5'
Date Quantity Pumped
Cesspool(s) Septic Tank
❑ Other (describe):
4. Effluent Tee Filter present? ❑ Yes No
5. Conditi n of System:
l) u_�
6. System Pumped By:
Neil Bateson
Name
Bateson Enterprises Inc
Company
71
Gallons
❑ Tight Tank
If yes, was it cleaned? ❑ Yes ❑ No
J
Vehicle License Number F5821
7. Location where contents were disposed. -
L. q
isposed:L.S Lowell Waste Water
�J �C
Signature of Hauler Date
t5form4.doc- 06/03 System Pumping Record - Page 1 of 1
TOWN OF N" 4"�
SYSTEM PUMPING RECORD
DATE: r3ao--05
SYSTEM OWNER & ADDRESS
�r� W-Q��
q's `K
SYSTEM LOCATION
(example: left front of house)
l 4 K)3
DATE OF PUMPING: QUANTITY PUMPED: (-5'� GALLONS
CESSPOOL: NO S SEPTIC TANK: NO YES �-
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION
HEAVY GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
FULL TO COVER
BAFFLES IN PLACE
LEACHFIELD RUNBACK
FLOODED
OTHER (EXPLAIN)
SYSTEM PUMPED BY: Bateson Enterprises, Inc.
COMMENTS:
CONTENTS TRANSFERRED TO: