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HomeMy WebLinkAboutMiscellaneous - 480 REA STREET 4/30/2018 480 REA STREET - 210/038.0-0062-0000.0 \ ` 1 1 � P L North Andover Board of Assessors Public Access Page 1 of 1 NORY►J Town of lqcwth AAJ l Ver ort,t`•o"cryo 111oard of t ssc,SS035 h b � K Property elms Return to the Home page click on logo Record Card Parcel ID:210/038.0-0062-0000.0 Community:North Andover New Search SKETCH PHOTO Click on Sketch to Enlarge Sales No Picture Summary Residence Available Detached Structure Condo Commercial Comparable Sales Location: 480 REA STREET Owner Name: ROMANO,RICHARD F JILL P ROMANO Owner Address: 480 REA STREET City:NORTH ANDOVER State: MA ZIP: 01845 Neighborhood: 6-6 Land Area: 1.21 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 2772 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 676,200 613,700 Building Value: 443,500 402,600 Land Value: 232,700 211,100 Market Land Value: 232,700 Chapter Land Value: LATEST SALE Sale Price: 1 Sale Date:09/17/2001 Arms Length Sale Code: F-NO-CONVNIENT Grantor:RICHARD ROMANO Cert Doc: Book: 06369 Page: 0275 http://csc-ma.us/NandoverPubAcc/jsp/Home.jsp?Page=3&Linkld=985478 12/19/2007 t MAP # 3V" LOT # ^n PARCEL # � -�- STREET M CONSTRUCTION APPROV L HAS PLAN REVIEW FEE BEEN PAID>� . YES NO PLAN APPROVAL: DAT 7 APP. BY R: r fNfA�K C>�2lUL PLAN DATE DESIGNER: CONDITIONS WATER SU ,PLY: TOWN WELL WELL PERMIT DRILLER WELL TESTS: CHEMICAL DATE APPROVED CTERIA I DATE APPROVED BACTER II DATE APPROVED PLUMBING SIGNOFF WIR SIGNOFF COMMENTS: FORM U APPROVAL: APPROVAL TO ISSUE YES NO DATE ISSUED BY CONDITIONS: FINAL APPROVAL: ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NO SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NO ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: BY: s 46 SEPTIC SYSTEM INSTALLATION IS THE INSTALLER LICENSED? YES NO TYPE OF CONSTRUCTION: NEW REPAIR NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW CESS NO CONDITIONS OF APPROVAL r S ----) NO (FROM FORM U) ISSUANCE OF DWC PERMIT YE NO DWC PERMIT PAID? =YES NO DWC PERMIT NO. qsl INSTALLER: /J 1 /1 BEGIN INSPECTION .AYES O: EXCAVATION INSPECTION: NEEDED: PASSED BY CONSTRUCTION INSPECTION: NEEDED: AS BUILT PLAN SATISFACTORY: YES: APPROVAL TO BACKFILL: DATE: bk q I BY /.j FINAL GRADING APPROVAL: DATE 11 BY AA FINAL CONSTRUCTION APPROVAL: DATE: Z/ %r BY /�G� Commonwealth of Massachusetts ®REC W City/Town of NORTH ANDOVER System Pumping RecordForm 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, use only the tab 480 REA STREET key to move your Address cursor-do not NORTH ANDOVER MA 01845 use the return City/Town State Zip Code key. X11 2. System Owner: V� JILL ROMANO Name eAm Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 8/28/14 2. Quantity Pumped: 1500 Date Gallons 3. Component: ❑ 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. Observed condition of component pumped: GOOD CONDITION 6. System Pumped By: JAMES H CURRIER II H79 406 Name Vehicle License Number J' SEPTIC & DRAIN Company 7. Location where contents were disposed: GLSD 8/28/14 Signature of Hauler Date Signature of Receiving Facility(or attach facility receipt) Date t5form4.doc•11/12 System Pumping Record•Page 1 of 1 480 REA STREET 038.0-0062 Complaint Detail Report Printed 0n:Wed Dec 19,2007 Complaint#: CT-2008-000027 Status: In discovery _ IGIS#_ 2045 Violator: ROMANO, RICHARD F t Nawx►r Address: 480 REA STREET Map 038.0 Address: 480 REA STREET - -- - - -- 3: ,• o� Date Recvd.: Dec-19-2007 Time Recvd.: 11:42 AM Block. 0062 NORTH ANDOVER,MA 018 a (Category: Odors Lot: Type: Residential 1' �+t (GeoTMS Module: Board of Health District: Trade: '983 ••`sc'? Recorded By: Pamela DelleChiaie Zoning_ Structure: �cwus� --- - - - - - - - -- - --. - - -- - - - - - - - — DescriptionI _ Complaint: Calls came in from Rich Ramano,508.243.2727,and Jill Romano,978.771.9513 regarding terrible septic type odors around their property For the last week or so, the smell has gotten progressively worse. The odor has now permeated into their home. It is not their septic system,but possibly a system on the comer of North Cross and Rea Street. This is the other Rea Street off of Salem Street. Please investigate odors and possible source,and let the caller know the findings.--p.d. [Comments: Callers Date Time Name Phone Best Time To lynch Reror-led By Response Dec-19-2007 11:42 AM Rich and Jill Ramano (508)243-2727 Q Pamela DelleChiaie Actions Taken GeoTMS Module Status Date Time Response Type Action Taken Comments Board of Health REFERRAL r ere-�` GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Page 1 of 1 uILC�I ES umt4A Y o ��a a A IS 6 2 -1 E ae -- i�r E 1 10.9 7 — it PnfiZWW 1-70,`l3 5.S 1'70, -5 6 O/ 39 55' 12 LIE Oft sm, 1-70,3-1 " 2 5`i' — Ido, II �� • Pfl 106 " I o, 13 .1770 , 10 3 O rrnn rof Ai tv I.J Cf L042 vc.rr �o� �• — — —-- A ISooE,A�. f c wr. I 46TIC,TAPv L r v !` Lj MIDI �5� 5. _ 5 19 3 t3.I !. I 1`1.7 - AS BUILT PLAN OF s u fc3o"U R HA C,`E D ISPOSAL. SYSTEM LOCATED IN AS PREPARED FOR G O 1.-O Ll Ga L V I Lo.UE D EV, C -P i . DATE: 10,& - q �H oF,�ss' SCALE: I 4-0 DANIEL �N KORA No.37752 ca1"r� 3v 9F o � • G/ST P� T L (�► ? �� MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS 66 PARK STREET • ANDOVER, MASSACHUSETTS 01810 4 TEL (617) 47-5-3553. 373-5721 1 . 1 � r f a c t s h e e t Responding to Local Noise, Odor and Dust Complaints Across Massachusetts, environmental and public health officials are seeing an M a s s a c h u s e t t s increase in the number of noise, odor and dust complaints they are called upon to D e p a r t m e n t Of handle. E N V IR O N M E N T A L P R O T E C T I O N The local board of health or public health department is usually the first line of defense against these and other nuisance conditions. Municipal officials can respond to nuisance complaints in an informed, effective and timely way. In some cases, the Department of Environmental Protection (DEP)can assist and support local officials in their response, or take the lead in responding. This fact sheet was developed to guide municipal officials as they follow up on nuisance complaints and to help them determine when it might be appropriate to request DEP assistance. Local Response Most noise, odor and dust complaints can be handled on the local level. Boards of health have broad authority under state law(M.G.L. Chapter 111, Sections 31C and 122)to investigate and control nuisance conditions. They and other local government agencies are empowered by DEP (310 CMR 7.52)to take enforcement action against violators of DEP's noise, odor and dust regulations (310 CMR 7.09-7.10). When investigating nuisance complaints, municipal officials should determine whether: • Nuisance conditions unreasonably interfere with the enjoyment of residential property and/or the operation of a business; and/or • The source of the nuisance, if a business, has the necessary licenses, permits and approvals to be operating and conforms to local zoning requirements; and/or • Offending activities constitute a violation of local nuisance by-laws or ordinances that may be more stringent than state regulations or statutes. In many cases, those responsible for nuisance conditions are unaware of the problems they are causing and, in the interest of being good neighbors, will willingly take the necessary steps to solve them. In these instances, local officials need only notify the offending parties. Other cases may require local officials to exercise their skills of diplomacy and mediation in helping the parties to a dispute reach an accommodation. For still others, local enforcement action can be an effective solution. When these efforts are unsuccessful, coordinating local actions with DEP follow-up may be necessary. Local officials should keep a log of all complaints they receive and clearly document their investigations and findings. Responding to Local Noise,Odor and Dust Complaints•Page 1 How DEP Can Help DEP can assist and support local officials in investigating noise, odor and dust complaints and taking appropriate enforcement actions by: • Providing policies, guidance and other forms of technical assistance; • Answering questions and offering regulatory expertise on request; and • Lending sound level meters and other equipment to boards of health or other local agencies on request. For details, contact the service center in the DEP regional office nearest you. Telephone numbers are provided below. Criteria for Direct DEP Involvement DEP may respond directly to local noise, odor and dust conditions at the request of local officials if: Massachusetts Department of . The identity of the complainant(s) is supplied to the agency*; and Environmental Protection One Winter Street • Nuisance conditions pose a potential imminent hazard to public health or the Boston,MA 02108-4746 environment, are causing significant impacts across municipal or state boundaries, or are symptomatic of a serious environmental compliance problem; or Commonwealth of Massachusetts • There have been numerous complaints about the facility that is the source of the Mitt Romney,Governor nuisance, there is a history of violations by the same party, or a state facility is causing the problem; or Executive Office of Environmental Affairs ' Local officials have pursued and exhausted all other avenues without successfully Ellen Roy Herzfelder,Secretary resolving the matter; or • The complaint is about a pure tone noise from a source that cannot readily be Department of identified. Environmental Protection Edward P. Kunce, *Complainant names and addresses must be known to DEP, but under the Fair Information and Acting Commissioner Practices Act(M.G.L. Chapter 644), the agency is required to keep all such information confidential while any investigation or enforcement action is ongoing. Produced by the For Additional Information Bureau of Waste Prevention, February 2003. To learn more about responding to noise, odor and dust complaints or to request state Printed on recycled paper. assistance or support, please contact the service center in the nearest DEP regional office. This information is available in alternate format by calling our . Central Region, Worcester: (508) 792-7683 ADA Coordinator at • Northeast Region, Wilmington: (978)661-7677 (617)574-6872. • Southeast Region, Lakeville: (508) 946-2714 • Western Region, Springfield: (413) 755-2214 Responding to Local Noise,Odor and Dust Complaints•Page 2 Mass DEP :: MA DEP Policy #BWP-94.092 Reuse and Disposal of Street Sweepings Page 1 of 4 Policy#BWP-94-092: Reuse &Disposal of Street Sweepings This Policy provides guidance on Massachusetts Department of Environmental Protection requirements, standards, and approvals for handling, reuse and disposal of street sweepings. By Carl F. Dierker, Assistant Commissioner Bureau of Waste Prevention [Signature on Original] 1. Policy Statement &Scope This Policy explains the Department of Environmental Protection's requirements for managing street sweepings. Street sweepings are solid waste subject to the Massachusetts solid waste regulations. The options for managing street sweepings are as follows. 1. Use the street sweepings in accordance with the preapproved uses described in Section 4 of this policy. 2. Use the street sweepings for a beneficial use after obtaining prior approval from the Department under the provisions of the solid waste regulations, 310 CMR 19.060, Beneficial Use of Solid Wastes. 3. Dispose of street sweepings at a permitted solid waste landfill. The provisions and requirements for managing street sweepings under these options are the subject of this policy. 2. Applicability This policy applies to the reuse or disposal of street sweepings that are generated in the ordinary and customary maintenance of roadways. The policy does not apply to catch basin cleanings or street sweepings mixed with catch basin cleanings or other wastes. The policy does not apply to the material generated as the result of the clean up of an oil or hazardous material spill. Street sweepings are not exempt from the Hazardous Waste Regulations, 310 CMR 30.000, and must be handled as hazardous waste when they exhibit any of the characteristics of a hazardous waste. If there is no evidence of unusual contamination, the Department does not require street sweepings to be routinely tested, but, as is the case with any waste, the generator has the ultimate responsibility for determining whether the waste is a hazardous waste. 3. Definitions Department or DEP means the Massachusetts Department of Environmental Protection. Public Way means the strip of land over and under a publicly owned, paved road or highway and includes the publicly owned land adjacent to the road or highway. Street Sweepings means materials consisting primarily of sand and soil generated during the routine cleaning of roadways but may also contain some leaves and other miscellaneous solid wastes collected during street sweeping. Street sweepings does not mean the material generated during the clean up of a spill or material from other structures associated with a roadway such as catch basins. Urban center roads means local roads in central commercial and retail business districts and industrial and manufacturing areas. 4. Pre-Approved Uses, Restrictions&Conditions This policy allows street sweepings to be used in several applications. No approval from the http://www.mass.gov/dep/recycle/laws/stsweep.htm 3/29/2006 Mass DEP :: MA DEP Policy #BWP-94.092 Reuse and Disposal of Street Sweepings Page 2 of 4 9 Department is required when the restrictions and conditions identified in this policy are adhered to. However, sweepings shall not be used unless prior approval is obtained from the owner of the location where the sweepings are to be used. 4.1. Use at Landfills Street sweepings may be used for daily cover at lined or unlined permitted solid waste landfills and need no prior DEP approval if the sweepings satisfy the requirements for daily cover material specified at 310 CMR 19.130(15). 4.2. Use as Fill in Public Ways Street sweepings shall be used for fill in public ways without prior approval from the Department only when the following restrictions and conditions are observed: The sweepings have not been collected from Urban Center Roads (see definition); The sweepings are used under the road surface or as fill along the side of the road within the public way; The sweepings are not used in residential areas; The sweepings are kept above the level of the groundwater; The sweepings are not used in designated "No Salt Areas"; The following definitions have been taken verbatim from the solid waste regulations and are repeated here for clarity in understanding this policy. The sweepings are not used within the 100 foot buffer zone of a wetland or within wetland resource areas including bordering vegetative wetlands and riverfront areas; The sweepings are not used within 500 feet of a ground or surface drinking water supply. 4.3. Use As an Additive to Restricted Use Compost Street sweepings shall be used as an additive to compost without prior approval from the Department only when the following restrictions and conditions are observed: The sweepings have not been collected from Urban Center Roads (see definition); The compost is used only in public ways; The compost is not used in residential areas; The compost is kept above the level of the groundwater; The compost is not used in designated "No Salt Areas"; The compost is not used within the 100 foot buffer zone of a wetland or within wetland resource areas including bordering vegetative wetlands and riverfront areas; The compost is not used within 500 feet of a ground or surface drinking water supply. 5. Other Uses Any use not pre-approved in the preceding section requires prior Department approval under the Beneficial Use provisions of the Solid Waste Management Facility Regulations at 310 CMR 19.060. A "Beneficial Use Determination" or BUD can be made only after the submission of an application characterizing the waste and describing the proposed beneficial use. http://www.mass.gov/dep/recycle/laws/stsweep.htm 3/29/2006 Mass DEP :: MA DEP Policy #BWP-94.092 Reuse and Disposal of Street Sweepings Page 3 of 4 6. Disposal While the beneficial use of street sweepings is strongly encouraged, the Department does not prohibit the disposal of street sweepings. Street sweepings may be disposed in either lined or unlined permitted solid waste landfills without prior approval from the Department. 7. Handling 7.1. Collection of Street Sweepings Although DEP does not regulate the collection of street sweepings, collection practices should be compatible with intended uses. For example, sweepings from Urban Center Roads are not approved for the uses allowed for sweepings from other areas. Keeping sweepings from Urban Center Roads separate from sweepings from other areas will make the full benefits of this policy available. This policy does not cover sweepings known to be contaminated by spills, and such sweepings should be collected separately and kept segregated. Depending on the contamination and circumstances, the handling of contaminated sweepings may be governed by the Massachusetts Contingency Plan, 310 CMR 40, the Massachusetts Hazardous Waste Regulations, 310 CMR 30, the Massachusetts Site Assignment Regulations for Solid Waste Facilities, 310 CMR 16 or the Massachusetts Solid Waste Management Facility Regulations, 310 CMR 19. 7.2. Storage Street sweepings shall be temporarily stored prior to use, only when the following conditions are satisfied: Storage must be at the site where the sweepings are generated (in the public way) or at a location, such as a DPW yard, that is under the control of the governmental entity which is doing the sweeping or has contracted for the sweeping; The sweepings shall be protected from wind and rain to the extent necessary to prevent dust, erosion and off-site migration; The sweepings shall not be stored within the 100 foot buffer zone of a wetland or within wetland resource areas including bordering vegetative wetlands and riverfront areas; The sweepings shall not be stored within 500 feet of a ground or surface drinking water supply; Storage shall incorporate good management practice and result in no public nuisance; Storage must be temporary. Street sweepings shall be used within one year of collection unless the DEP Regional Office in the region where the sweepings are stored grants a written extension. An extension may be granted when it is demonstrated that all storage conditions will continue to be satisfied and the stored sweepings will be put to a specific identified use prior to the expiration of the extension period. 7.3. Preparation Prior to Use Solid waste, such as paper, auto parts and other trash, shall be removed from the sweepings prior to use. Leaves, twigs and other organic matter should also be removed when good engineering practice indicates this is necessary to produce a material that is suitable for the intended use. 8. Background The Department has consistently classified street sweepings as solid waste subject to Massachusetts General Law Chapter 111, Section 150A and the Massachusetts Solid Waste Regulations (Site Assignment Regulations for Solid Waste Facilities, 310 CMR 16.00 and Solid Waste Management Facility Regulations, 310 CMR 19.000). There has been confusion among some in the regulated community about this classification. http://www.mass.gov/dep/recycle/laws/stsweep.htm 3/29/2006 Mass DEP :: MA DEP Policy #BWP-94.092 Reuse and Disposal of Street Sweepings Page 4 of 4 f v 1 Prior to the development of this policy, the options for handling street sweepings were limited to: 1. Disposal at a permitted solid waste landfill, 2. Use as cover at a permitted solid waste landfill or 3. Use in accordance with a Beneficial Use Determination (BUD). BUD decisions r ( ) are made on a case-by-case basis and require the submittal of a formal application to the Department containing data showing the chemical composition of the street sweepings. The simplest of these options was either to use the sweepings for landfill cover or to dispose of the sweepings at the local landfill. As many local landfills close, these options become less available to many communities. However, transporting sweepings to a distant landfill involves increased transportation costs and possibly payment of tipping fees. To clarify the requirements and to provide simpler and less expensive alternatives for handling street sweepings, the Department undertook the development of this policy. Because useful studies of the chemical composition of street sweepings could not be found in the literature, the Department solicited the help of municipalities and state agencies in conducting a study of the composition of street sweepings from various types of areas. The results showed that sweepings from all areas, except Urban Center Roads, were similar with the main constituents of concern being total petroleum hydrocarbons (TPH) and polynuclear aromatic hydrocarbons (PAHs). Very limited data from Urban Center Roads indicated that sweepings from these areas may be more contaminated than sweepings from other areas. The test results indicate that sweepings may contain levels of contamination that are unsuitable for unrestricted use. However, except for sweepings from Urban Center Roads, the levels of contamination were consistent and low enough to allow the use of sweepings in restricted applications without requiring testing or pre-approval as long as certain conditions were met. Sweepings from urban areas were excluded from some pre-approved uses. This situation could change when more data are available from Urban Center Roads. This policy makes it possible for municipalities, state agencies and other governmental entities to handle street sweepings in an environmentally sound manner with a minimum of paperwork and expense. 9. Additional Information For additional copies of this policy, permit application forms or other DEP documents (except regulations) call any DEP Regional Office and ask for the Service Center or call the DEP Infoline in Boston. The permit application number for a Beneficial Use Determination is BWP SW-13 (Major) and BWP SW-30 (Minor). Many DEP documents, including this policy, are available via modem from the DEP electronic bulletin board system, 617-292-5546. Information about the DEP and some documents are also available from the DEP's internet site at http://www.state.ma.us/dep/. Copies of all Massachusetts regulations, including the solid waste regulations, may be purchased from the State House Bookstore, 617-727-2834. The solid waste regulations are: 310 CMR 16.000, Site Assignment Regulations for Solid Waste Facilities 310 CMR 19.000, Solid Waste Management Facility Regulations Questions about the Provisions of the Policy http://www.mass.gov/dep/recycle/laws/stsweep.htm 3/29/2006 f i Form No.4 Town of North Andover, Massachusetts BOARD OF HEALTH i)ecember 1 619 97 CERTIFICATEOF COMPLIANCE -'h This is to certify that .8 the Individual Soil Absorption Sewage Disposal System constructed (x) or repaired ( ) by «ano INSTALLER at Lot A, Rea St. , North Andover . MA 01845 SITE LOCAT ON ; has been installed in accordance with Board of Health Regulations as described in the Design Approval Site System Permit No. 896 dated January• 30 19 97 The issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. —BOARD OF HEALTH s r10RT Town of t _ _ _9 _ Andover No. 3 "' * adover, Mass., 19 LAKE '9A COCMICHE ICK '9s °q�re o�a��. S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System /Z/ 9� ...... t 1 BUILDING INSPECTOR . .. .. THIS CERTIFIES THAT.............. .,...... ... ..l..C)►.IM............... ............[+orwe.s................. Foundation ................. buildin ' has permission to erect...... ............,. gs on ......�.. ................�.'�.G.......��................................ Rou �- tobe occupied as...................................................31..A.•.P. .�C........... `Q. ...1... ................................................... Chimney provided that the person accepting iihis permit shall in d"very respect'conform to the firms 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 INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough a Q 7 � _ PERMIT EXPIRES IN 6 MONTHS na � L-41 ELECIAL UNLESS CONSTRUCTION ST / UINSPE Ro `D 3�° ............................... .. .... .............................................. .. .. .... . .... LDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove R°ag ci o Q No Lathingor D Wall To Be Done 0 Until Inspected and roved b the BuildingInspector. FIR DEPARTMENT P Pp Y � Burner " 'Q �s � Street No.. &L Smoke Det. l`�3�� SEPTIC PLAN SUBMITTALS LOCATION: NEW PLANS: YES $60.00/Plan REVISED PLANS YES ~` $25.00/PlanG 73 4-6 DATE: ���C,/ 7 DESIGN ENGINEER: U When the submission is all in place, route to the Health Secretary Town of North Andover t NORTH OFFICE OF 3a°.<'``° +0 COMMUNITY DEVELOPMENT AND SERVICES ° . p 30 School Street North Andover,Massachusetts 01845 WILLIAM J.SCOTT 9SSAcNus�t Director July 28, 1997 Merrimack Engineering Services 66 Park Street Andover, MA 01810 RE: Rea Street Dear Bill: This letter is to inform you that the proposed septic plans for Lots A (3D- 1) and D (3A-1) Rea Street have been approved. If you have any questions, please do not hesitate to call the Board of Health office at the number below. Sincerely, Sandra Starr, R.S. Health Administrator cc: Wm. Scott, Dir. CD&S Bob Messina Colonial Village Dev Gina Armano File CONSER`.'ATTOW 6s??-951n HFAUM PT ArrTNT 688-9515- 1 1 FORM U - VERIFICATION 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: Lo�.�J �c� �.t.C_ _ Phone b17 G- �o2 6111, LOCATION: Assessor' s Map Number Q Parcel 4 G Subdivision = Lot(s) Street _ � e__ St. Number 4-8 Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments R.. wipo Date Approved Town Planner ! Date rl Rejected Comments _ Q�Q` Q (' ti( G� �„(�,in(4orl En&-'f o&,, Date Approved Food Inspector-Heeaalth Date Rejected -v� Date Approved Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections IJ 7 - driveway permit -2-9 7 Fire Department Received by Building Inspector Date Town of North Andover f NORTiy , OFFICE OF 3? 1 A �-0L COMMUNITY DEVELOPMENT AND SERVICES A 146 Main Street *, x North Andover,Massachusetts 01845 °.,r,° .• �y WILLIAM J.SCOTT SA US Director March 14, 1997 Gina Armano 24 Tyler Road North Andover, MA 01845 Dear Ms. Armano: This letter is to notify you that the proposed septic plans for Lot A Rea Street have been approved. Particular items on Lot B Rea Street are being addressed, and additional testing needs to be performed on Lots C and D. Sincerely, Sandra Starr, R.S. Health Administrator Cc: Bill Dufresne, Merrimack Eng. Wm. Scott, Dir. CD & S BOH File BOARD OF APPEALS 688-9541 BUn DING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Town of North Andover of No oT;1ti OFFICE OF 3a ,• °0 COMMUNITY DEVELOPMENT AND SERVICES A 146 Main Street North Andover,Massachusetts 01845 0,40.A.,, WILLIAM J.SCOTT 9SSACHUS�t Director February 13, 1997 Merrimack Engineering 66 Park Street Andover, MA 01845 Re: Lot A Rea Street Dear Bill: This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: 1. Profile not to scale. (N.A. 6.02 b2 & 6.02r) 2. Wetlands disclaimer missing. (N.A. 6.02 o) 3. Please show stepped trenches in cross section, including existing grade & water table relative to each trench. 4. No cellar floor shall be constructed less than one foot above the maximum ground water elevation. (N.A. 4.20) If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Sincerely, /,14 7-4'1C- Sandra Starr, R.S., Health Administrator SS/cjp cc: Gina Armano William Scott, Director, P&CD File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 February 13, 1997 Merrimack Engineering 66 Park Street Andover, MA 01845 Re: Lot A Rea Street Dear Bill: This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: 1. Profile not to scale. (N.A. 6.02 b2 & 6.02r) -T" Wetlands disclaimer missing. (N.A. 6.02 o) L,,3. Please show stepped trenches in cross section, including existing grade & water table relative to each trench. UK 4. No cellar floor shall be constructed less than one foot above the maximum ground water elevation. (N.A. 4.20) If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Sincerely, Sandra Starr, R.S., Health Administrator SS/cjp cc: Gina Armano William Scott, Director, P&CD File 'C\ Commonwealth of Massachusetts RECEIVED City/Town of NO. ANDOVER AUG 0 9 2006 �Y System Pumping Record Form 4 TOWN OF NORTH ANDOVER s•• HEALTH DEPARTFV?ENT 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. A. Facility Information Important: When filling out 1. System Location: forms the 480 REA RD. computer,use only the tab key Address to move your NO.ANDOVER MA 01845 cursor-do not City/Town State Zi Code use the return P key. 2 System Owner: rQ JILL ROMANO Name Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 7/20/06 2. Quantity Pumped: 150k0 Datens 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes J4-No If yes,was it Cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Benjamin Shute H79 406 Name Vehicle License Number J's Septic& Drain Company 7. Location where contents were disposed: GLSD 7/20/06 nature auler Date t5form4.doc•06/03 System Pumping Record.Page 1 of 1 I Commonwealth of Massachusetts FREIVE � City/Town of No. Andover m System Pumping Record $ �no5 a Form 4 ,SCK IT 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. A. Facility Information Important: When filling out 1. System Location: forms on the computer,use 480 Rea St. only the tab key Address to move your No. Andover MA 01845 cursor-do not City/Town State Zip Code use the return key. 2. System Owner: QJill Romano Name Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 6/2Dat/ o 05 2. Quantity Pumped: 1500ns 3. Type of system: ❑ Cesspool(s) R1 Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes [9 No If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Benjamin Shute H79 406 Name Vehicle License Number J's Septic& Drain Company 7. Location where contents were disposed: GLSD 6/2/05 gna a of Hauler Date t6form4.doc•06/03 System Pumping Record.Page 1 of 1 SN Commonwealth of Massachusetts W City/Town of No. Andover System Pumping Record M yV 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. A. Facility Information Important: When filling out 1. System Location: forms on the computer,use 1175 Turnpike St. only the tab key Address to move your No. Andover MA 01845 cursor-do not City/Town State Zi Code use the return p key. 2. System Owner: QB & C Realty Trust Name 14 Gates Rd. Address(if different from location) Middleton MA 01949 City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gal o3s 3. Type of system: ❑ Cesspool(s) F�5 Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes -No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Benjamin Shute H79 406 Name Vehicle License Number J's Septic& Drain Company 7. Location where contents were disposed: GLSD 6/7/05 gignatupf of Hauler Date t5form4.doc•06/03 System Pumping Record.Page 1 of 1 Commonwealth 'of Massachusetts = City/Town of No. Andover w° 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. A. Facility Information Important: When filling out 1. System Location: forms on the computer,use 158 Olympic Lane only the tab key Address to move your No. Andover MA 01845 cursor-do not use the return City/Town State Zip Code key. 2. System Owner: rea Thomas Throop Name Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 6/14/05 2. Quantity Pumped: 1200 Date Gallons 3. Type of system: ❑ Cesspool(s) ® Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ® No If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: Good Condition 6. System Pumped By: Benjamin Shute H79 406 Name Vehicle License Number J's Septic& Drain Company 7. Location where contents were disposed: GLSD 6/14/05 ignatur f Hauler Date t5form4.doc-06/03 System Pumping Record-Page 1 of 1 Commonwealth of Massachusetts City/Town of No. Andover °�� V� W� System Pumping Record Form 4 M DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. System Location: forms on the computer,use 2135 Turnpike St. only the tab key Address to move your No. Andover MA 01845 cursor-do not Ci fr use the return own State Zip Code key. 2. System Owner: t James Chleapas Name Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pum in 6/17/05 1500 p g Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ® No If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: Good Condition 6. System Pumped By: Benjamin Shute H79 406 Name Vehicle License Number J's Septic& Drain Company 7. Location where contents were disposed: GLSD ���67/05 Zue Hauler Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 FORM 4-SYSTEM PUMPING RECORD Commonwealth of lMassachusetts assac husetts System Puyho n Record L; System Owner System Location Type: Emergency ❑ Routine Cesspool: No Yes ❑ Septic Tank: No ❑ Yes Date of Pumping: 0 Quantity Pumped: f � gallons System Pumped by (Company): I n � �.7 Permit #: Contents transferred to: Contents disposed at: Date��,�� -Q Pumper Signatur e b Condition of system/other comments: DEP APPROVED FORM-12/07/95 �r OF� TR I-f A^,'CO OA TOWN OF NORTH ANDOVER ��oF �;�_ SYSTEM PUMPING RECORD' 1 STEM OWNER & ADDRESS SYSTEM LOCATION (example: left front of house) Kone(' igbov if �D 66 a' � /Ml �c C D:\TE OF PUMPINC: "� QUANTITY PUMPED I� G'ALLO'-.S Ci'S.S 1)0 0 L: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE I.// EMERGENCY Ul3.SFRVATIONS: GOOD CONDITION FULL TO COVER HEAVY CREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OAHER (EXPLAIN) i / 1 �l's"I'EM PU",SPED 3Y: CUIINIENTS: � UN'TENTS TRANSFERRED "T'0: Town of North Andover, Massachusetts Form No.z f NORT1y BOARD OF HEALTH 190 41 p °•�b°� '-- �r' DESIGN APPROVAL FOR "°SE` SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant_ �� �1��-t� Test No. Site LocationJP Reference Plans and Specs. It I 2� .!! • ENGINEER UU __ DESIGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. CHAIRMAN,BOARD OF HEALTH LFe �U ' Site System Permit No. NORTH ANDOVER BOARD OF HEALTH 15V DESIGN REVIEW REPORT DATE // 7 FEE: '40 PERMIT ## 996 DATE RECEIVED Z 14 IQ 7 APPLICANT 0, A, 111.41flO MAP M PARCEL �0'0Z ADDRESS EJB /y A LOT # 9 STREET # ENG._l''1G/Z,�I,G/AC �UF,e�sc1G STREET�2E�} ST ENGINEER'SDD. 6 6 PLAN DATE A/FAV REV. DATE CONDITIONSOFAPPROVAL 61966 `j,- APPROVED DISAPPROVED X REASONS FOR DISAPPROVAL: / --7-'126 c Ivor To �5 e/-2e c (N, ,9, 6, oa �. 6UC�T,c /9tiD5 "7D/se-.- /IV&Ee /y VSs/Al .CSS NATE 7-11197- ySTCM / 5 6017-/1/4) A001 D/,t- M o 6 Q U/ro -73406 Ci�c-- �, 6-,195 17A� 5 T �i�G,C1 Tiee/Uc/-IC.S 1A) G T/iV(:S 657-65 '7-1744t) c��v� ,�voT ��3©vc� T/��' �-/�lCir►�vti1 �,e��U� � C e : C tAJA �IGG� PLAN REVIEW CHECKLIST ADDRESS ..e -QL,Q / �'O� (30)ENGINEER U " ti� GENERAL 3 COPIES L/ STAMP c/ LOCUS t/ NORTH ARROW SCALE `— CONTOURS PROFILE-Q'-f SECTIO � BENCHMARK Ll--- SOIL & Zb0 PERCS i/ ELEVATIONS WETS. DISCLAIMER WELLS & WETS WATERSHED?4/0— DRIVEWAY &"�'(Elev) WATER LINE FDN DRAIN SCH40_Z' TESTS CURRENT? SOIL EVAL �j • �(JreG'S�G SEPTIC TANK ���✓✓ MIN 150OG . 17 INVERT DROP GARB. GRINDER /t/0(2 comps +200) 10 ' TO FDN✓ MANHOLEy ELEV GW ## COMPS . GB D-BOX SIZE ## LINES FIRST 2 ' LEVEL STATEMENT INLET 7f 0.4-7 - OUTLET /76-40 _ .17 (2" OR .17 FT) TEE REQ'D?-LL- LEACHING MIN 440 GPD? --- RESERVE AREA_jZ4 ' FROM PRIMARY? Z-------2% SLOPE 100 ' TO WETLANDS 100 ' TO WELLS a/ 4 ' TO S.H.GW / (5 ' >2M/IN) 20 ' TO FND & INTRCPTR DRAINS 6,--' 400 ' TO SURFACE H2O SUPP 4 ' PERM. SOIL BELOW FACILITY t, . MIN 12" COVER ` f'-FILL? -�(151 ) BREAKOUT MET? TRENCHES MIN 440 gpd `/ SLOPE (min .005 or 6"/1001 ) SIDEWALL DIST. 3X EFF. W OR D (MIN 6 ' ) RESERVE BETWEEN TRENCHES? C-' IN FILL? -' MUST BE 10 ' MIN. t,� 4" PEA STONE? 1,� VENT? L---- (>3 ' COVER; LINES >501 ) BOT + SIDE X36 X LDNG , 3-3 = TOT 7 446 (L x W x #) (DxLx2x##) (G/f t2) Copyright 0 1996 by S.L. Starr FORA 11 - SOEL EVALUATOR FORM Page 2 On-site Review �PDeep Hole Number .... ..... . Date: �ll`�� Time: lj-'l/d� Weather Location (identify on site plan) . .., .f/��Gc. ..... ........................ ...................................I............... Land Use ....... .. Slope (%) 0�`'v Surface Stones .....'' .. ...........I...................... Vegetation Landform ......... _... .... ......... ........ ... Position on landscape (sketch on the back) .............................................................. ................... ..... Distances from: Open Water Body7. 1 feet Drainage wayy.(401 feet Possible Wet Area >1�1 feet Property Line .,50._x.. feet Drinking Water Well>VWt feet Other . ........... .. .... OBSERVATIONDEEP Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other (Inches) (USDA) (Munsell) (Structure,Stones, Boulders, Consistencv, % Graved to y11, � — y,��-Ss. -v. �as� -sy" c SLS 2-s 161c, pxg5S 7,S'Yk90 7 Parent Material (geologic) i ... ................................... .... Depth to Bedrock: Death to Groundwater: Standing Water in the Hole: Weeping from Pit Face: . Estimated Seasonal Hign Ground Water: .L—fie, FORM 11 - SOIL EVALUATOR FORA Page 2 On-site Review �P2 9—� �'r4 grl�t Weather Deep Hole Number ......... ... Date: /� Time: � . Location (identify on site plan) . .. ..... ............ . . ...... .... ............................................................................ 6 Land Use ....f!N!? �............ .. Slope ft �'�l'' Surface Stones .. ..... Vegetation ......!L�f/... ................. Landform .......... . .......... .... _.. Position on landscape (sketch on the back) .................. .................. ...... Distances from: Open Water Body '-ILO feet Drainage way>kOOI feet Possible Wet Area )rIJ feet Property Line .`,Z`>`t. feet Drinking Water Well> feet Other . ............ .. DEEP OBSERVATION HOLE LOG Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other )Inches) (USDA) (Munsell) (Structure,Stones, Boulders, Consistencv. % Graved 'hh"tIY (d I L/ a 10 yk-* n 5,�8 I � -y Parent Material (geologic) /.<<i(/ ............. Depth to Bedrock: Depth to Groundwater: Standing Wate- in the Hole: ...... Weeping from Pit Face: Estimated Seasonal Hign Ground Water: �� FORl11 12 - PERCOLATION TEST COMMONWEALTH OF MASSACHUSETTS Massachusetts; Percolation Test : y Date: Time: ... ....`l� Observation Hole # Depth of Perc �. Start Pre-'soak i End Pre-soak Time at 12" Time at 9" � Time at 6" I �z� • Z , Sy Time (9"-6") . 7 / Rate Min./Inch Site Passed E- Site Failed ❑ .............................................................. .................. Performed By: Witnessed By: S• Comments: .:. ..................................... ........... . MERRIMACK ENGINEERING SERVICES INC. Engineers • Surveyors • Planners 66 Park Street ANDOVER, MASSACHUSETTS 01810 DATE '��— JOB NO. (508) 475-3555 ATTENTION Fax (508) 475.1448 TO E V_ RE: �.--(-- Y20A fg'o cc hff'A ill-IL2 ED 6 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 l� �zG lis G 7' G 77 C2 THESE ARE TRITTED as checked below: or 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 ❑ ❑ FORBIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS COPY TO SIGNED: if enclosures are not as noted,kindly notify us at once. Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH �t Q 32Oy�t`ED /646�O0 -19 g 0 APPLICATION FOR SITE TESTING/INSPECTION �9SSACHUS���h Applicant 1 C_.QnQ_J�fA_ o NAME ADDRESS TELEPHONE Site Location �) Ll S� ' Engineer C7'e- AME ADDRESS TELEPHONE Test/Inspection Date and Time i 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 L 19 o U•�F� m 4 APPLICATION FOR SITE TESTING/INSPECTION pDA4 TED �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. F NORTH A��VRR/ TOW BOARD OF HEA�TN AUG d 6199 Sandra Star Health Agent 146 Main Street August 16, 1996 Dear Mrs. Starr : Based on your recommendation we are proceeding with the Wetlands delineation of lot 4 of Rae Street. We are tentatively scheduled for a meeting with Conservation Commission for September 12th to establish the wetlands boundaries . Therefore after the wetlands are delineated we would request a perc test in the first week of October. I have filed the appropriate application and fee for the test. I would like to schedule the engineer and backhoe for the testing please contact me with a scheduled time or if you have any questions. Cicha y, rd Romano (508)794-4406 -Ph. r• r 'r i ��.�a� :.'�/�•4�'�I ! �i. _ -rte„ I I , tpxl0l .......r,?{tt Y I I ' % m6t w � trr i - ... +,r _-•=�„�`—'�.a •'��� 0^ 41. / I ------------ rt rr }•y���t,} ria 11at {�y �.4: �/ � .- ILl 1, � 1 i FNS 1+{l} Ise �F 4 t r: . 9. y+yr� .5tr�tr� �•4x i ,� ��.�.. �� � >. ISI _ :' x'c i Okbt ra u �.. w�C. Ir., t i i Or i I II y2 /Z� i i I j - - c I I t I � i � ll 7 i l i t L:j+et, �f r.M+'6.+►v 4w _ r f 1 .• '�. .. ~ tkfd.'S`rt �'I� t '.#fie...' � �� � .{�� r � «•.' y� �f(�,' r , ' `�^�l.���.f�'.I ,s 1��,ra 1�'a �,p'��r,`� ,,. '�,r �q ' �i'. , `ll� •'� � a X24 '��V 7F L.� +.�,i �' + 1 •. .eta. _+�"�:�•*�.t'h• `I!'1•. i. f. r4 y.'q� ?`lfhl'�v.1�'l.al�r!' i I i I j y I - I _ II / i+ r i i r I I Lp o if f � '• f it l � I i - , lig I � I I i - f i I { 1 I • 1. M-1-7-1 +( '.•, (. °r� r°-i r .. n tF;;re.`r 1 r.� a�� I�YI r4 � i X11)nr�� Ftl.�„ �.14117r�� .!lff,'�!�{\Y tiltel�.ly�� l��r � •`�•i' •.lt - � ' :��:>\' 1'.1 �2 y+4{�, � ♦f ;�'/�;1'�itr��`riC>��`��r#'�'��{j�• .�t•�}:��tVt�FJ� �� �,}t,�, 'l,� '•4'' " i {f t' :l ` � .,� '' r ' ',�- .Yti�,+�-. �• �`` ����Ir � 1't � l-iT.. { �^'"4 is�` 'llF•� t t �5).r �L,.Y r 1.l`e\ •••` ,'• ••. .'��', :Ir�'r•� •-\ \!�t`t\t!• �,���t'���.t`1 ,.i,��' •��t,;:���,1�•4.��� �``=?-2'nJ .1�y, � (�\���\y[. � ,{`, `, r•� ,I.. '�:hti;°i; `�`�tc��\)�''�?"f:��`;.��;��'���<r,T,""t; t\ Y '�l:� _ � �• �1'4a;a r..',.... { '1�,��. `��i �'� 1 _ `"� ':�' ��,7';� �.�f�3~I .,1`7'C 1�1,\\�j:'i"ti !•y.. �A ,,+}� � � '�'�1!�.l C •,• � .{ � `r� ! i �} f `CAJt � t•+r .r�.rR �•i� S � r I is { ., \l� � ** t t � •f=rlt !n �`tiPt1.w� � �`' 1 t,•� '°. r � ti ��- e ' .t ; IL-C.D.T1 LINES BE REMOVED S . 5 105.15' / 114 \ n 1'7> 7,e 112 119, los \ 0 4 � 108 ISN \ ; 46 r 105 v' 103 CLOT D / ' \ ^� %I I LA TOTAL AREA �b WETLAND LOT A �� �� TOTAL ARS F U! 6, =43, 733 S. F- FIELD FLAG / TOTAL AREA \� TOT,AL AREA /O �. —44, 7 O = 1 . 00 AC. ! =52, 754 S. F. \\ —45, 744 S. F. _ ' . 03 \AC. -- 1 . 05 AC. i C A 75, CBA �co 785� CBA CBA \ 16 9 ,moo \ / ���� ' 136.86 O „ 50 00' N 5 18'06 R 24 0 69 /,, rov Commonwealth of Massachusetts RECEIVED City/Town of NO. ANDOVER JUN System Pumping Record Form 4 T�WiV �NQR PH ANpgvER GSM HEALTH jBpARTMENT 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. A. Facility Information Important: When filling out 1. System Location: forms on the computer,use 480 REA ST. only the tab key Address to move your cursor-do not NO.ANDOVER MA 01845 i use the return City/Town State Zip Code key. 2. System Owner: JILL ROMANO Name Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 5/27/10 2 uantity Pumped: 1500 Date Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes /No If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: James H. Currier H79 406 Name Vehicle License Number J's Septic&Drain Company 7. Location where contents were disposed: GLSD 5/27/10 Signature of l4auler Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts = City/Town of NO. ANDOVER W� 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 Important: When filling out 1. System Location: forms on the computer,use 480 REA ST. only the tab key Address to move your NO. ANDOVER MA 01845 cursor-do not C /Town use the return State Zip Code key. 2. System Owner: JILL ROMANO Name few Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 7/24/12 1500 p g 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 Pumped By: JAMES H. CURRIER H79 406 Name Vehicle License Number J's SEPTIC & DRAIN Company 7. Location where contents were disposed: GLSD 7/24/12 ghature of Hauler Date Signature of Receiving Facility Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1