Loading...
HomeMy WebLinkAboutMiscellaneous - 51 COLONIAL AVENUE 4/30/2018 (2) 51 COLONIAL AVENUE r. 210/107.6-0125-0000.0 r y MAP # LOT # !__._ PARCEL # STREET1�r ._t ONSTRUCTI.•ON�APPRO L HAS PLAN REVIEW FEE .BEEN PAID? YES NO PLAN APPROVAL: DATE c l� L APP. BY o _ DESIGNER: /� ��/ PLAN DATE. CONDITIONS WATER SUPPLY: TOWN WELL WELL PERMIT _ DRILLER._...._._._._.__...._....__.._....._.__..._.......... _._._._._. WELL TESTS: EMICAL DATE AI�`hRUVED SACT A I UA I E flPPRUVED BACTERIA I DATE APPROVED COMMENTS: FORM U APPROVAL: APPROVAL TU I 'SUE" � �NO DATE ISSUED , 'Z3 Iq 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: yllY�+-i •`• \ r: ..:" ti'��ra..' :'".y- ...i,:;.r»�,;s�y?'r,.-rat j.�, {n; � �3 (ti.. Ae��..r t� � '" 5 7 - f. •`'• t r ;'�`' ISTHE' INSTALLER LICENSED? YES NO *' TYPEOF CONSTRUCTION: - a• - REPAIR . t' :,NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW NO CONDITIONS OF..APPROVAL .' YES NO (FROM FORM U) Y ' ISSUANCEOF DWC PERMIT ( YES NO 14 DWC PERMIT N0. 'r - INSTALLER: _ BEGIN INSPECTION 0: " EXCAVATION ,INSPECTION: ; NEEDED: PASSED HY `.:CONSTRUCTION INSPECTION: NEEDED: -r1 AS BUILT PLAN SATISFACTORY: APPROVAL. TO BACKFILL: DATE: '9b A BY ' FINAL . GRADING APPROVAL: DATE a BY FINAL CONSTRUCTION APPROVAL: DATE:`-)/G/ /?l BY • :- : , . .: . - •- - . • ' � . � � • - • ,moo• -��ti�• , , r11C.. :tom of 0" 1EAL1 TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD 1)A I F: �1 STEM OWNER & ADDRESS SYSTEM LOCATION (example: left front of house) Volsic�u i U:\1'E OF PUMPING: 1 dX/ QUANTITY PUMPED (j(% CALLON C. i:'S.-Si OUL: NO YES SEPTIC TANK: NO YES 'ATURE OF SERVICE: ROUTINE EMERGENCY tJ li>[:R Y:kTI ONS: GOOD CONDITION. FULL TO COVER HEAVY CREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER ;01�HER (EXPLAIN) S) �"I'LM PUMPED BY. c u1,1�I 2NTS: l UN"1 ENT' TRANSf ERRED "T'0: 4 1 IQ The Commonwealth of Massachusetts " u'l' / S UM1•rr-It <n. U Department of Public Sofcty Occupanc% S fee Cheeked BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 12'00 3/90 tleave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed In accordance with the Massachusetts E)ectrical Code. 521 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORHATION) Date 7-14.-97 City or Town of NagTW 4MDD✓6� To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) :5'/ t?OL ON/AL At/EN!/E Owner or Tenant G?EG ooe y RASO Owner's Address SAME (S-6 1f) 725- 6 770 Is this permit in conjunction with a building permit: Yes ❑ No ® (Check Appropriate Box) Purpose of Building Utility Authorization 170. Existing Service Amps / Vol re Overhead ❑ Undgrd[❑ )?o. of mete_rz _ New Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Installation of Alarm System No. of Lighting Outlets No. of Hot Tubs ' No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above In- grnd. ❑grnd. ❑ Generators KVA No. of Receptacle Outlets No. of Oil Burners , Batter Emergency Lighting No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges Total No. of Detection and 8 No. of Air Cond. tons Initiating Devices eat No. of Disposals No. of Pumps Total Total No. of Sounding Devices Tons KW g No. of Dishwashers Space/Area Heating KW No. of Self Contained Detection/Sounding Devices No. of Dryers Heating Devices KW Local❑ Municipal ❑Other Connection No. of No. of Water Heaters KW Signs Ballasts wintag Vol H No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES❑ NO ❑ I have submitted valid proof of same to this office. YES❑ NO ❑ you have checked YES, please indicate the type of coverage by checking the appropriate box. $URANCE ❑ BOND ❑ OTHER ❑ (Please Specify) 1 .0 pimated Value of Electrical Work S 4�S O Expiration Date) C== t F to Start 7-J8-97 Inspection Date Requested: Rough Final 7-.23-97 ned under the penalties of perjury: NAME A.D.T. SF_CURITV SYSTEMS NORTHEAST INC. LIC. No. 1231C %ensee DONALD A BROOKS Signat e NO. 1231C E7 S" cess 60 William Street, Wellesley, 8 s. el. No. 413-732-4400 Alt. Tel. No. 617-431-5831 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE S Signature of Owner or Agent Date..... .. ... ...... ,40 T 4, TOWN OF NORTH ANDOVER 22' 0 PERMIT FOR WIRING 41 A US r- This certifies that ........ ......... has permission to perform ..... ........... . . ..... ..................... wiring in the building of...... ...................................................I............. . at...... ............................ ... .................. .North Andover,Mass. Fee...JLic.No. .O.A.(............................................................... ELECTRICAL INSPECTOR C y WHITE: Applicant CANARY: Building Dept. PINK:Treasurer Addressf'Z Ga L.D��J��} !4-U� Title of File Page of Date f=ile Open: Date file closed: — Doc Document/Action Title rA Date of action Refer to other purpose of Documoent/ tion and noates —' Num. Document/ document/Action De artment Board of Appeads — Board of Health — Plannin� Board 9. Conservatiion Commission - Building Departm, Town of North Andover of 40 DT"-ti OFFICE OF 3a y4' '� °0 COMMUNITY DEVELOPMENT AND SERVICES ° . p 146 Main Street KENNETH R.MAHONY North Andover, Massachusetts 01845 "SSACHUSE< Director (508)688-9533 August 14, 1995 Hayes Engineering,Inc. 603 Salem Street Wakefield, MA 01880 Re: Lot #5 Colonial Ave. To Whom it May Concern: This is to inform you that the proposed plans for site referenced above have been disapproved for the following reasons: 1) Perc test data missing - elevations. 2) Tank not 25 feet from foundation. 3) Leach area not 35 feet from foundation. 4) Foundation drain missing. 5) 4 inch pea stone required. If you have any questions, please do not hesitate to call the Board of Health Office at the number above. Sincerely, "Z- J �L" Sandra Starr, R.S. Health Administrator SS/cjp BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Julie Parrino D.Robert Nicetta Michael Howard Sandra Starr Kathleen Bradley Colwell Form N0.4 Town of North Andover, Massachusetts BOARD OF HEALTH May 21 , 19 97 CERTIFICATE OF COMPLIANCE This is to certify that the Individual Soil Absorption Sewage Disposal System constructed ( X) or repaired ( ) by Charles Zaher INS-rALLCR at Lot #5 Colonial Drive, North Andover,MA 01845 has been installed in accordance with Board of Health Regulations as described in the Design Approval Site System Permit No. 745 dated June 22, 19 95 The issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. ARD OF H ALTH r_: Town of North Andover, Massachusetts Form No.3 BOARD OF HEALTH NORTN . O R F p GNDISPOSAL WORKS CONSTRUCTION PERMIT ' ,SSAUSEt Applicant NAME ADDRESS TELEPHONE Site Location �4 Permission is hereby granted to Construct (�r Repair ( ) an Individual Soil Absorption Town of North Andover, Massachusetts Form No.s f NOIITq BOARD OF HEALTH Q - 3?0,��.° 41 ti w (f •i i _ `•• •-��-- ,,� ' DESIGN APPROVAL FOR sAcMust�� SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant C' _Q Test No. Site Location „nT 4 S 0-6 10 Y-\"L 0.1— ►r- Reference Plans and Specs. ENGIN E DESIGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. C AIR AN,BOARD OF HEALTH Fee Site System Permit No. T40RT�y ® _ over o m * z19 * z dover, Mass., LAKE i�1•t '9 ACOCHICHEWICKoq� TED D�PP`y S E BOARD OF HEALTH Food/KitchenPERMIT T — Septic System 'I BUILDING INSPECTOR A THIS CERTIFIES THAT...................................... ...C'_..,.���'�t.. . ,.. . .�...... ................... ............... .......... Fou tion ll J has permission to erect...................�.................... buildings on .......J................�G...�.�v....��..!...........U .. .. tobe occupied as................................................... f./u. .l ................ ! .. .../. .................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of tfie 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. PLUM G(IN PECT VIOLATION of the Zoningor Building Regulations Voids this Permit. ou 6A,9 g � _ PERMIT EXPIRES IN 6 MONTHS 004_4 btL_2�_ UNLESS CONSTRUCTION START ELECTRICAL INSPECTOR Rough ................................................ ...:........ ................... ce LJILDING INSPECTOR in 'All Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final (� No Lathing or Dry Wall To BeDone Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. 4/'� Smoke Det. i TOWN, JUN - 6 199; PLAN OF LAND IN NO* DO VERMA 55, SCALE.• I" = 80' JUNE 5, 1996 HAVES ENG/NEER/NG, /NC. �J4 60.j SALEM STREET CIVIL ENG/NEERS & WAKEFIELD, MASS. 01880 LAND SURW YORS TEL. (617) 246-2800 / CERTIFY THAT THIS FOUNLZAT/ON /S LOC47ED ON THE GROUND AS SHOWN, AND THAT IT CONFORMS TO THE ZONING BY-LAWS OF THE TOWN OF NORTH / FURTHER CERTIFY THAT TH/S PROPERTY DOES NOT LIE WITHIN A FL000 84ZARD AREA (ZONE A OR V) AS SHOWN ON FLOOD INSURANCE RATE MAP COMMUNITY PANEL NUMBER 250098 0010 B. EFFECT/VE DATE.• ✓UNE 15, 198J OF Q4 DATEUhIC __-- SIDNEY a PROfLESSIONAY LAND SURVEYOR C. FIELD, JR. #15320 Pv SS% 54.0 r� EXISTING F ELEDA 158 57 rn !0 TOP OF FND, 0 2.0 2.0 ti ti�12.B,o 012.0/„ 12.8.0.12.4 � DETAIL SCALE 1 =20' D� "E � 7,3.12'44 3.1 10.631.,j5'20'E N83',3g'36' N8 95.63 " 24.2 • EX/ST/NG FOUND. SEE DETAIL -� F v 74-5 LOT 5 S.F. S'1 30, 130 ly/DE OR/VE 148 S8,3*0828•E- �,� 0 00 v00 F` O ZONE. P.R.D. (R-2) V R. O J MIN/MUM SETBACKS.' C, P FRONT = 20' SIDE = 20' REAR = 20' v N,) 0o TOP o � 0 E 63 ' pE 0. N8 35 2 "E g5 63 . 8.3'38 3 .. 4.24 2 II po EX/ST/NG FOUND. (. 1 Qp SEE DETAIL LOT 5 Oil �.� 3p 130 S. F. SIDE DRYVE 148. 39 S83°O8 0 SNE. P R. D. (R-2) U R• FORM 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 fill's( out this section***************** Lidt(5APPLICANT: A • C, Inc, Phone 05-83ec LOCATION: Assessor's Map Number Parcel Subdivision wood 10AJ E5tutt5 Lots) Street Co to n i U I ha St. Number ********.****************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments Date. Approved Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected Date Approved Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date DATE AF Sheet of BOARD OF HEALTH TOWN OF NORTH ANDOVER / SUBSURFACE DISPOSAL DESIGN REVIEW FEE /- PERMIT # 7j�3� DATE RECEIVED "-7-.Q.�� APPLICANT ASSESSOR'S MAP ADDRESS PARCEL # LOT # ENGINEER STREET C�UCo,(�i�3L AvG ��G J ADDRESS S 7- PLAN PLAN DATE REVISION DATE CONDITIONS OF APPROVAL: APPROVED DISAPPROVED �� ADUND,9 TioN PLAN REVIEW CHECKLIST�1 ADDRESS 1 c eo, QO xoe h�v� ENGINEER 114 Y&5 GENERAL / / 3 COPIESy STAMP Z� LOCUS L""" NORTH ARROW v SCALE CONTOURS PROFILE C---' SECTION L/ BENCHMARK 4>'." SOIL & PERCS Z ELEVATIONS WETS. DISCLAIMER WELLS & WETS WATERSHED? /t/6 DRIVEWAY t/ (Elev) WATER LINE FDN DRAIN SCH40y TESTS CURRENT? SOIL EVAL SEPTIC TANK MIN 150OG ✓ . 17 INVERT DROP ",/ GARB. GRINDER / (+200o EDF) 25 ' TO CELLAR MANHOLE ELEV GW # COMPS. D-BOX // SIZE # LINES FIRST 2 ' LEVEL STATEMENT L11� INLET- OUTLET C7.2�= i/(p (2" OR . 17 FT) TEE REQ'D? LEACHING / MIN 660 GPD? RESERVE AREA `� 4 ' FROM PRIMARY? &1 20 SLOPE 100 ' TO WETLANDS 6-- 100 ' TO WELLS 4 ' TO S . H.GW 5 ' >2M/IN) 35 ' TO FND & INTRCPTR DRAINS 325 ' TO SURFACE H2O SUPP 4 ' PERM. SOIL BELOW FACILITY 7 MIN 12" COVER FILL? if above natural elev; 101if below) BREAKOUT MET?_�� TRENCHES / MIN 660 gpd v SLOPE (min . 005 or 6"/1001 ) 7/ SIDEWALL DIST. 3X EFF. W OR D (MIN 6 ' ) 'RESERVE BETWEEN TRENCHES? FILL? t----MUST BE 10 ' MIN. L,,--4" PEA STONE?z VENT? (>3 ' COVER; LINES >501 ) BOT J6r+ SIDE �73 X LDNG TOT (L x W x #) (DxLx2x#) (G/ft2) Copyright 0 1995 by SA.. Suirr RmE.............................. THE COMMONWEALTH orMASSACHUSETTS Application is hereby made for a Permit to Construct K) or Re r Wa Disposal Location-Add Owner Address .------'----------'-----------_'------'----'_--',-- ------_..------'----'_---------------------_--_-- ��, a�� I�mc� Bo�d8- S�� �oL'��'�����'���-'Sg. feet Dwelling--No. of 8el,00/oa---'................................Expansion Attic ( ) Garbage Grinder Other--Type of Building ............................ No. ofpersons............................ 56o,mecx ( > -- Cafeteria ( ) (Jt6or fixtures .--_--.----'--..-.--.-----'--_--.._.-_.. Design Flow.............5'��--.- 'gdloouycrporoouyccduv. Total daily flow............................................gallons. Septic Tank—Liquid I �ocz ' ��- � � Diameter . . �_ �'. � - Disposal Trench- No. - ----- �kl��-- �_'-.- TotalIcooUz ' Totalb�c6iugure�llb ��sq. � �. Seepage Pit Nu----'--. Diameter............. Depth below inlet.................... Total area..................sq. f t. Z Other Distribution box Ioo� ~~ - � �� ' .. �Percolation Test RcxcJtu Performed bv .. ~� ° -- -' D�� ' ---u�-~-i'. ----' Test P6 No. l................minutes per inch Depth of Test Pit.................... Depth toground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground wuter-----..--- � � � � � - � R-------------------------------------------------- 0 D ofSo�------� g�..-- ��=----���� � �--..-- � ... ---_------_------------ -------------------------------- ----------------------- ------------------------- ------------'----------'----'--'-----------'---'- ------'''---_--- ---'--''--.-----_--_-__-.-_---.--.-'-__'-_--_------_'—'____._ U Nature of Repairs orAlterations--Answer when --------.-_.-_.--'._----_-_...----_- -----''---------'----`—`----------`-----------'``------`----`--`--`----`-`--------'- '�g -_-__. The undersigned agrees to install the afore6mcribe6 Individual Sewage Disposal System in accordance with the provisions ofTI TU�, 5 of the State Sanitary C toplace the system in operation until a Certificate of C ~ �isby ' ��.���u �� �- ......... - ~� ApplicationApproved By.................................................................................................. ........................................ Date Application Disapproved for the following reasons:................................................................................................................ -------------------------------------------------''---------------------'---''---------''----- Date PeroitNo.___------'_-'--'-'-'_-'-'---- .----.------'----'-- Date r*c cowwowvvEALrH or MxsSAo*ussrrs BOARD OF HEALTH ..........................................OF..................................................................................... Trrtffir*u4r of To44�pliautrr THIS lyTO (E8T{F}/' That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) -'----------..-------------_-----------.------------_--------_-------------------------------------' znstaller at...................................................................................................................................... been installed in accordance with He provisions of 5 o The State Sanitary Cmlc as described in the application for Disposal Works Construction pccm6 No----------------------------------------- dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT 0ECONSTRUED AS AGUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.------------------------_-------._-----' Inspector................................................................................... THE ooMMowvxsALr* or mAssAo*uscrre BOARD OF HEALTH --------------��F------______________________. �u--_--_-_- FEE........................ Bisposa� Work.5 Tomitrad0on pamit Permission is hereby --_-'--.-._.-'--___--_'-_.-_'-'-----_-------------------- U» Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo........................................................... Street as shown on the uoo6ca6no for Disposal Works Construction Pecozd 2Jo.-.---.---' Dated.......................................... -----'----'----------'''------'--------''--`--`------- DAo=� � a�� 7`II--_--------.---.___________________ ponM 1255 xoaosmWARREN, INC., punuo*snS HAYES ENGINEERING, INC. 603 SALEM STREET WAKEFIELD, MA 01880 (617) 246-2800 REFER TO FILE# NOA-0042 FAX (617) 246-7596 October 3, 1995 Mr. Richard A. Colantuoni Building Inspector Town Hall 146 Main Street North Andover, MA 01845 RE: Woodland Estates -Test Hole Information Dear Mr. Colantuoni: In accordance with our discussions back a couple of months ago, I have conducted the required test holes and inspected the soils on Lots 1, 2, 4, 5 and 6 Colonial Avenue in the Woodland Estates subdivision in North Andover. The procedure used was to excavate a test hole at each end of the proposed dwelling, determine the type of soil, and also estimate the seasonal high groundwater based on soil mottling. In addition, a comparison was made to the highest groundwater elevation of any nearby test hole conducted for the purposes of septic system design. Based on the highest groundwater encountered in the area, I recommended a cellar floor elevation at least two feet above the highest elevation. My conclusion is that underdrains are not necessary under the Mass. Building Code on Lots 1, 2, 4, 5 and 6 Colonial Avenue. I trust this information is suitable for.your purpose, and, by means of this letter, am requesting you to notify Sandy Starr, Health Agent for the Town of North Andover, so that permits may issue on these lots. Ve truly yours, 11 Of 0 V, (-I C - - r//K=I WREN 04 Peter J. Ogren, P.E., *33604 V148 President su:eo'�'o� °`SAL E PJO/dab 'T Enclosure cc: A.C. Builders, Inc. TEST HOLE INFORMATION WOODLAND ESTATES NORTH ANDOVER, MASSACHUSETTS October 2, 1995 Elev.Top Elev. Bottom ESHWT 2 Highest GW 3 Minimum Proposed Underdrain Lot# Hole#' Soil Type of Hole of Hole or (mottling) at nearby Recommended Elev. Required Water Elev. Title 5 Elev. Test Hole 1 1A(LE) Silty gravel 141.7 130.7 136.3 135.6 138.3 142.5 No 113 (RE) Silty gravel 145.3 132.3 None 2 2A(LE) Silty gravel 143.5 129.5/water 139.5 135.1 141.5 143.0 No 2B (RE) Gravel 142.7 132.7 139.2 3 NOT DONE 4 4A(RE) Silty gravel 144.0 134.0 138.5 140 142 145.5 No 4B (LE) Silty gravel 146.5 137.5 None 5 5A(RE) Gravel 146.5 136.5 138.5 143.9 145.9 151.0 No 5B (LE) Gravel 147.5 132.0 142.0 6 6A(LE) Gravel 154.0 145.0 None 148.8 150.8 154.5 No 6B (RE) Gravel 150.5 142.5 None ' End of House Facing Proposed Dwelling. LE = Left End RE = Right End 2 Estimated Seasonal High Water Table. 3 Actual or Estimated Groundwater Used in Septic Design. 's n--- s i T 7IAZ l k t �lS - Sl C T -s `t1hc►J ��+-� S� Cc7�-c _3 �, Commonwealth of Massachusetts City/Town of No.Andover 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: Co forms on the I computer,use Or aL AV(? only the tab key Address to move your No.Andover Ma 01845 cursor-do not City/Town State Zip Code use the return ....Y.a key. RECEIVED � 2. System Owner: K)O—,hn0. Name J I ` aw Address(if different from location) HEALTH DEPARTMENT City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date 1 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. Sy ste By: Na Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 G-) 2- Signature of Haul Date Signature of Re eivi Fa ity Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH 111" 16,,4/0 -19 APPLICATION FOR SITE TESTING/INSPECTION SSncHus���y Applicant Pf C &-ki I /� NAME ADDRESS f� TELEPHONE Site Location Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time 17 CHAIRMAN,BOARD OF HEALTH Fee Test No. 4 q -L- 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 F qA� Q �SIED b 'VD °6 0� 19 APPLICATION FOR SITE TESTING/INSPECTION 7 ADAA 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.