HomeMy WebLinkAboutMiscellaneous - 524 FOREST STREET 4/30/2018 524 FOREST STREET 1
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MAP # LOT # --..__._
PARCEL # STREET n
CONSTRUCTI.OfV APPRO ....,.•
HAS PLAN REVIEW FEE BEEN PAID? YES NO
Z//`� APP. BY- -
PLAN APPROVAL:
p - DATE �._...� _ _..__._.....
DESIGNER: J •f'��G'�� PLAN DATE:
CONDITIONS
WATER BURBLY: TOWN EL
y
WELL PERMIT �O� DRLLLER._... .._�._._G// _.._.....__....... ....
WELL TESTS: CHEMICAL DA I E AI-'faRUVED,._..7/a�'�93__
BACTERIA I Ufa TE (1(=PRUVCD 71,9943
BACTERIA II DA I E APPROVED.__.___..___..__
COMMENTS
FORM U APPROVAL': . APPROVAL TO ISSUE <Jio NO
DATE ISSUED 7 BY �� ._.__.._.._.__...__..._._-
CONDITIONS:
FINAL APPROVAL: .
ALL PERMITS PAID NO
WELL CONSTRUCTION APPROVAL ___E5_; NO
SEPTIC SYSTEM CONSTRUCTION APPROVAL YES N(_l
OTHER YES NO
ANY VARIANCE NEEDED YES NO
BY:
FINAL BOARD OF HEALTH APPROVAL: l'E:l/Lj
Commonwealth of Massachusetts
N City/Town of North andover
a
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 forms 1. System Location: ,^
on the computer,
use only the tab
key to move your Address
cursor-do not N. Andover Ma
use the return
key. City/Town State Zip Code
2. System Owner:
�I Name
lawn
Address(if different from location) ,
O 1 V/5—
City/Town State Zip Code
Cw?
Telephone Number
B. Pumping Record f
1. Date of Pumping `�° 2. Quantity Pumped:
Date Gallons
la 3. Type of system: ❑ Cesspool(s) 'Septic Tank ❑ Tight Tank ❑ Grease Trap
i
❑ Other(describe): �/
4. Effluent Tee Filter present? ❑ Yes O No If yes, was it cleaned? E] Yes ❑ No
5. Condition of System: _
6. System Pumped By:
Name Vehicle License Number
Stewart's Septic Service
Company
7. Location where contents were disposed:
Stews Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 t� POT—
Si atof Ha er Date
S ature of R Date
t5form4.doc•03/06 System Pumping Record•Page 1 of 1
Address �^� �o
2s�) Title of File Page of
Date File Open: Date file closed:
Doc Document/Action Title Date of Refer to other Purpose of Document Action and notes
action Document/ document/
Num. Action Department
_ _ Board of Appeals - Board of Health Plannung Board - Conservation Commission Building Department
R
9.
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1 ° TOW1v OF NORTH
SYSTEM PUMPING RECORD
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YSTEM OWNER&ADDRESS
SYSTEM LOCATION
(example.ieft-front of house
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rhprt a•. � H a , A�
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AT OF PUMPING: QUANTITY P
--�--_ UMPED
GALLONS
P Ipt}�,�. .f✓��f V i rn 1 r 11
tl l v� ��i S�Ir'`"TT�' 1 r,9 7 Eh ..l •R`i ' .f' .. f ..
1 , r YES SEPTIC TANK: NO YES
3 _
s f,
r, MATURE OF SERVICE: ROUTINE EMERGENCY
' i'1ii 1,1Lgi 6y 7lrlpv'�} 1 '
, Of
11`t4.q
�t..� VA�'IONS•
GOOD'COND
jYe * ITION FULL TO COVER
HEAVY GREASE
�i BAFFLES IN PLACE
ROOTS
LEACHFIELD RUNBACK
EXCESSIVE SOLIDS FLOODED
OTHER i
k.� (EY�
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FORM - U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary approval/permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve the
applicant and or landowner from compliance with any applicable requirements.
APPLICANT PHONE C:Z-7- f
ASSESSORS MAP NUMBEROT NUMBER
SUBDIVISION LOT NUMBER
STREET 1 �'• S STREET NUMBER
........................... OFFICIAL USE ONLY..............y....<..�...
RECOMMENDATIONS OF TOWN AGENTS
DATE APPROVED
CONSERVATION ADMINISTRATOR
DATE REJECTED
COMMENTS
TOWN PLANNER DATE APPROVED
DATE REJECTED
CON MIF'NTS
DATE APPROVED
FOOD INSPECT -HEALTH DATE REJECTED
__._. DATE APPROVED
SEPTI S TOR- LTH
ry. DATE REJECTED
PUBLIC WORKS-SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
DATE APPROVED
FIRE DEPARTMENT
DATE REJECTED
COMMENTS
RECEIVED BY BUILDING INSPECTOR PE TOR DATE
Hj
.,:...�. .aid....
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AS-BUILT CHECK LIST
and
FINAL INSPECTION
Proposed Elevations As-Built Elevation
House
Tank IN 60 9 ��
Tank OUT q8- 3S 19 �j
D-box IN q8-la gg.024
D-box OUT ��-D� ��,D 7
/ 7
Trench Inverts 17
Line 1 q7, 94 C1 7-
Line
Line 2
Line 3
Line 4
Bottom of Exc.
Stone OK? D-box checked? Pipes cemented?
III
i
GRANITE STATE ANALYTICAL
61 EAST BROADWAY
DERRY, NEW HAMPSHIRE 03038
(603) 432-3044
C�.ex#tfiratje of ;knalpis for Prinking Water
SENT TO: Joe Barbasallo TEST NO. : 10610
TEST
LOCATION: Lot 1 Forest St.
DATE: July 23, 1993 No. Andover, MA
PARAMETER RESULT RECOMMENDED LOWER DETECTION
MAX.LEVEL(PPM) LIMIT (PPM)
--------- ------ -------------- ---------------
2 PH 8.77 UNITS 6.5 - 8.5
HARDNESS 50.18 150 4
CHLORIDE 250 0.1
NITRATE 0.7 10.0 0.5
NITRITE 0.05 1.0 0.05
SODIUM 49.6 250 0.002
IRON 0.16 0.3 0.03
MANGANESE 0.01 0.05 0.01
COLIFORM ABSENCE /100 ML ABSENCE 0
OTHER BACTERIA /100, ML 200 0
COPPER 1.3 0.02
ARSENIC 0.05 0.001
LEAD 0.015 0.001
CHROMIUM 0.1 0.001
CALCIUM 20.1 NONE SET 0.01
SULFATE 25.2 250 10.0
COLOR 1 CPU 15 1
ODOR TON 3 0
TURBIDITY 2.0 NTU 5 0.5
T.D.S. PPM 500 0.001
THE TESTED PARAMETERS MEET CURRENT STANDARDS FOR DRINKING WATER.
X THE TESTED PARAMETERS MEET CURRENT PRIMARY STANDARDS FOR DRINKING WATER,
BUT SOME SECONDARY PARAMETERS EXCEED STANDARDS.
THE TESTED PARAMETERS FAIL CURRENT STANDARDS FOR DRINKING WATER,
DUE TO PRIMARY STANDARDS OUTSIDE OF LIMITS.
--------------------------------------------------------------------------------------
COMMENTS: ALKALINITY = 90.2 PPM RECOMMENDED MCL = NONE SET
MAGNESIUM = 0.001 PPM RECOMMENDED MCL = NONE SET
j SPECIFIC CONDUCTANCE = 286 UHOMS RECOMMENDED MCL = NONE SET
---------------------
TNTC DENOTES T00 NUMEROUS TO COUNT.
1 DENOTES PARAMETERS THAT EXCEED PRIMARY STANDARDS; CAUSES TEST. FAILURE.
2 DENOTES PARAMETERS THAT EXCEED SECONDARY STANDARDS; DOES NOT, .FAIL TEST.
NOTE: SUBSEQUENT SAMPLES FROM THE SAME WATER SOURCE MAY VARY.
Authorized by—
IVIE: cIIE-,ll`c'h11, b1.'brcc EU01-I �UIE BTU AVIEIS ^C bCE WY 'v9A
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bf32E'A UP 0,00J
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01HEH rBV(,.EBTV `;T02 WF 500 0
C01'if•.Oi!i `:'B2E%CE 1100 Wr VHEW1 E 0
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2EPI 1,0 �)oE, g�1[ '3291 1( IE2d N' : TOMO
HvilliE ?IVIE V%Vf'3TIC1'1' �
North Andover
Town of
Massachusetts
Board of Health
7-23-93
Permit No. Date
APPLICATION FOR WELL AND PUMP PERMIT
-Application is hereby made for a permit to drill ( or repair O a well. Application
is also made to install ( ) major renovation ( ) or major repair ( ) of pump system.
Location: Address 524 Forest Street, North Andover, Mlot Number
Owner Joseph Barbagallo Address 120 Duncan Drive, North Andover, MA
Well Contractor C.M.Rollins Co. ,Inc. Address 129 Depot Road, Boxford, MA
_ Pump .Contractor Address F
WELL CONTRACTOR (To be filled in at time of pump test)
Type of Well Drilled Well Used For Domestic
Diameter of Well 6" Size of Casing 6"
Depth of Bed Rock 1016" Depth of Casing into Bed Rock 37'
r--� Was Seal Tested? Yes ( ) No ( ) Date of Testing
Depth of Wel13-10' Well Ended in What Material Rock
Depth to Water Fc 7 Delivers 12 Gallons/per/Minute
Drawdown feet after pumping _ours at GPM. Sketch map of well
I
location with tie down lines on reverse side of this form.
Date of ComplyJgrj93 >?Z
Well Contractor's Signa�ure
PUMP INSTALLER (To be filled in before installation)
Size and Name of Pump Type of Pump Used
Water Pump Delivers GPM Size. of Tank
Pipe material used in Well: Cast Iron ( ) Galvanized ( ) Plastic ( ) If plastic,
test strength
Well pit ( ) or Pitless adapter ( )
Was sleeve used to protect pipe? Yes ( ) No ( ) Type or Name of- Well Seal
Date
Pump Installer's Signature
I
Date water analysis report submitted to Board of Health
Date release was given to owner of record and Building Inspector 71W /f
Health Inspector
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 fills out this section*****************
APPLICANT: Jar Phone
LOCATION: Assessor's Map Number Parcel
Subdivision Lot(s) -;5z`
Street St. Number 2
************************Official Use Only************************
RECOMMENDATIONS OF TOWN AGENTS:
f Date Approved 7 Z,�
Conservation Administrator Date Rejected
Comments
Date Approved
Town Planne Date Rejected
Comments
Date Approved
Food I spector-Health Date Rejected
Date Approved
Septic Inspector-Health Date Rejected
Comments
Public Works - sewer/water connections . �J'� - -
- driveway permi ��
Fire Department
Received by Building Inspector Date
NORTH
Town of "E
over
FiA irk, 1*
No.
�"
` �./��J' � ',� ,.J_- ppb•`
Q t L A
o lover, Mass.,
�� l / j 19
�A cocriI .�r, �\� >
RATED PP ��
H BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT......... 7.0... I ..4................................................:.
"' Foundation
has permission to erect. .1® uildings on .��.. �/ 1 .fr� .�.... Rough/,, � t• 8-3 / -� ,3
to be occupied as � .�t.. ® , �1�•�di1/ �6himn y
C e
he person accepting this permit shall in e respect conform to the terms of the application on file in
provided that t p p g p Y p Final
this office, and to the provisions of the Codes and By-Laws relating to the Inspectr � �c ��pf (' P— 3 .
Buildings in the Town of North Andover. a#- j6 ape jee PL7 INSPE TOR
RaUIJITEO BY PARA. 114.8-S. B.C. 'T2
VIOLATION of the Zoning or Building Regulations Voids this Permit. Ro 3
PERMIT EXPIRES IN 6 MO a"��.�PAID_ O1) e 0
PERMIT FOR
FRAME/BU1�MCSS CONSTRUCTION STARTS ° � ELEC PECTOR
Rough
MA
10
14lmJ�iA e
Service
DATE:_._. ._FEE PAID:...,..__........ BUILDING INSPECTOR ��
Final CJ ��•
X
Occupancy Permit Required to Occupy Building GAS INSPECTOR
z
Rough '
Display in a . Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DE ARTMENT
Until Inspected and Approved by the Building Inspector.
Burner
Q � Street No. �
PLANNING FINAL CONSERVATION-2-KS) FI �� ;
. �
�S Smoke Det.
SEWER/WATER 2rw 9-2743 FINAL �� � F' Cu! Q�RIVEWAY ENTRY PERMIT VVV
VG�I
FORM U - IAT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessa��J�
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: Jnr �J/'�'/_� /�o Phone
LOCATION: Assessor' s Map Number Parcel
Subdivision Lot(s) `,�_
Street rD� .�1 ' St. Number
************************Official Use Only************************
RECOMMENDATIONS OF TOWN AGENTS:
Date Approved -7 Z,li/
Conservation Administrator Date Rejected
Comments
Date Approved .a ,1 -a_
Town Planne Date Refected
Comments
Date Approved
Food ISpector-Health Date Rejected
A-?. Date Approved
Septic Inspector-Health Date Rejected
Comments
Public Works - sewer/water connections � ' -7-
- driveway permif- 7-
Fire Department �' �`�P ✓
Received by Building Inspector V Date
?, Town of North Andover, Massachusetts F°m+Na z
N°R'h BOARD OF HEALTH
t c
r a i
�
s DESIGN APPROVAL FOR
� �sSgCNUSEt�
'v
SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
Applicant
V Test No.
Site Location
Reference Plans and Specs.
(NEER
13° DESIG�J � DATE
Permission is granted for an individual soil absorption sewage disposal system to be installed
in accordance with regulations of Board of Health.
f -
C AIRMAN,t$UAKUUF HEALTH
Fee Site System P //
� y Permit No. (O
Town of North Andover, Massachusetts Form No.3
f NORTH BOARD OF HEALTH
o . lJG c 3 19 —
A
DISPOSAL WORKS CONSTRUCTION PERMIT
�SSAONUSEt
Applicant_ A V AIA
NAME ADDRESS
. TELEPHONE
Site Location /—/
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, 1300 1)OF HEALTH
Fee ` �� D.W.C. No.
NUMBER FEE
? Q THE COMMONWEALTH OF MASSACHUSETTS $25 . 00
U--�— TOWN-------- of ........
NORTH-.ANDOVER
This is to Certify that ----------Chax1ES... _--. lollins--_Co.-......Inc................................
NAME
129 Depot Road, Boxford, MA 01921
- • - ----••---••-------•-•-•.................................•---•---...--•-••--•-----••---.•..--•••-
ADDRESS
IS HEREBY GRANTED A LICENSE
For ..............Well Drilling Permit - 524 Forest Street
----••------------------------------•----•--._.....-•---•------------------------•-•-•--------•---•--------••-------------------------------------•--------•--------------'
This license is granted in conformity with the Statutes an
gnces relating thereto,,and
expires------ ecember----3.7.......1'9-9-3....... unless soone pende
- .......... • - ------
---- -- ------------
FORM asa HOBBS 8 WARREN. INC.
--------------•----••--- ----•-•-•---••-•--•-•-•-••••-••-•--•----
S
_ _ l
I
PLAN REVIEW CHECKLIST
ADDRESS / �/���J- c�✓ ENGINEER
GENERAL f`e S
3 COPIESSTAMP LOCUS lcz:::-- NORTH ARROW "/ SCALENG�
/
A107- /V
aa
CONTOURS PROFILE ` '' SECTIONy BENCHMARK ,b --- baa
PERC INFO ✓ ELEVATIONS WETS. DISCLAIMER WELLS &
WETLANDS WATERSHED?410 DRIVEWAY (Eley) WATER LINE
FDN DRAIN 4.4 SCH40 TESTS CURRENT? Y�S
SEPTIC TANK
MIN 1500G. . 17 INVERT DROP Z/ GARB. GRINDER(+200% EDF)
25' TO CELLAR L, MANHOLE TO GRADE ELEV GW
D-BOX
SIZE # LINES FIRST 2' LEVEL STATEMENT X
INLET - OUTLET9797 = ' 17 (2" OR . 17 FT) TEE REQ'D?�
LEACHING
RESERVE AREA/ 4' FROM PRIMARY? ""
100' TO WETLANDS/ 2% SLOPE
100' TO WELLS ;/ 35' TO FND & INTRCPTR DRAINS ,-- 4' TO S.H.GW l
325' TO SURFACE H2O SUPP `� 4' PERM. SOIL BELOW FACILITY
MIN 12" COVERFILL? ✓ (25' if above natural elev; 101if below)
BREAKOUT MET?
TRENCHES O ,
MIN 660 gpd SLOPE (min . 005 or 6"/1001 ) >3 ' COVER? - VENTely
SIDEWALL DIST. 2X EFF. W OR/D (MIN 61 ) ,-/ IS RESERVE BETWEEN
TRENCHES? IN FILL?C/_ MUST BE 10' MIN.ZO" 4�1 PEA STONE?
BOT X LDNG + SIDE X LDN��= TOTS° C�+
(L x W x #) (G/ft2) (DxLx2x#)
� Dd �
DATE Sheet of
BOARD OF HEALTH
TOWN OF NORTH ANDOVER
SUBSURFACE DISPOSAL DESIGN REVIEW
FEE �`'L PERMIT # _ lOd3 DATE RECEIVED 7//64Z
APPLICANT ASSESSOR'S MAP
ADDRESS PARCEL #
LOT #
STREET
ENGINEER J , d
ADDRESS
PLAN DATE IIJ�/� /J` 199-3' REVISION DATE
CONDITIONS OF APPROVAL:
APPROVED
DISAPPROVED
U
WELL DATABASE
ADDRESS: eS �u`�.�✓I S,/
AGE OF WELL: L WELL DRILLER: ✓� `
WELL PERMIT': 3 ;Q/ WELL LOCATION: LaULi
_WELL PERMIT DATE: DEPTH OF WEA L:
TYPE OF WELL: D D b. DUG c. UNKNOWN
TYPE OF WATER BEARING ROCK.
WATER ANALYSIS DATE: 7"2 '� IIIGH MANGANESE: Y N
HIGH IRON: Y N ) OTHER CONTAMINANTS. Y N
WELL DATABASE
ADDRESS: 5
AGE OF WELL: WELL DR /ER:
WELL PERMIT#: WELL LOCATION:
WELL PERMIT DATE: DEPTH OF WELL:
TYPE OF WELL: a.. DRILLED b. DUG c. UNKNO WN
TYPE OF WATER BEARING ROCK:
WATER ANALYSIS DATE: HIGH MANGANESE: Y N
HIGH IRON: Y N OTHER CONTAMINANTS: Y N
l/
}S.P�
i-,h
Commonwealth of Massachusetts
7Qcity/Town off.NORTH ANDOVER MASSAC
r ..
YSystem Pumping Rec®rd RECEIVED..
<tM Form 4'
NOV .1 3 2006
DEP.has provided this form for use by local Boards of Health. Th System Pumping Recor must
be submitted to the local Board of Health or other approving auth x-10 of NORTH ANDOVER
HEALTH DEPARTMENT
A. Facility Information
-�-important:
:-,When filling out 1. System Location:
fortes on the
computer,use cO only the tab key Address
to move your , /0W
cursor-do not
use the return City/Town State Zip Code
2 ;System,Owner
\J�
Name
AQ7° Address(if different from location)
City/Town State //Zip Code
Telephone Number
g3.
mping Record
;. e of Pumping 2. Quantity Pumped:
t, Date Gallons
1e of system: . ❑ Cesspool(s) SepticTank ❑ Tight Tank
`.Other(describe)
4. Effluent Tee Filter present? ❑ YeNo If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System
-
6.
'S em Pumped By:.:
p' Name. Vehicle License Number
7 S�: rubcc:�Q, �f. ac�l�ard J Iva-
Company . .
7. Location where contents were disposed:
man
Signature of Hauler Date a/
htV://www,mass.gov/dep/water/approvals/t5forms.htm#inspect
t5forrn4,:doc-06/03 System Pumping Record•Page 1 of 1