HomeMy WebLinkAboutMiscellaneous - 55 BRADFORD STREET 4/30/2018 (2) 55 BRADFORD STREET SI
210/061.0-00240000.0
I
Commonwealth of Massachusetts
City/Town of
System Pumping Record
Form 4 APR 214
TOWN Or-WR H ANDOVER
DEP has provided this form for use-by local oards-of°F1Mth!0fher fo &:e u�"dit-
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
1. System Location: Left/Right front of house 'e Righ aro house Left/right side of house, Left/
Right side of building, Left/Right front of building, Left/Right rear o building, Under deck
Address
City/Town o State Zip Code
2. System Owner.
Name
Address(if different from location)
Citylrown stat e(C � Zip Code = .
- �� e
t
.21
Telephone Number
B. Pumping Record
1. Date of Pumping 2. Quan' Pumped:
Date ty p
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.
' S. Condition qt System
6. System Pumped By:
Neil.Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc'
Company
7. Location where contents were disposed:
L S. Lowell Waste Water
-- 1,
S77
ig Haule Date
t5fom4.doc-06/03 System Pumping Record•Page 1 of 1
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FORM U - LOT RELEASE FORM
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royals! ermits from
INSTRUCTIONS: This form is used to verify that all necessary app p Neve
Boards and Departments having jurisdiction have been obtained. This does not re
thea licant and/or landowner from compliance with any applicable or requirements.
pp
+ **** APPLICANT FILLS OUT THIS SECTION
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APPLICANT /JIackdo �' ' �a 11 PHONE
LOCATION: Assessor's Map Number 0U�C 0
PARCEL d
so
SUBDIVISION LOT (S)
STREET "i� 4�vf r i M19, ST. NUMBER SS
OFFICIAL USE ON..
R CO OF T AGENTS: '
L,, NSERVATI ADMINISTRAT R DATE APPROVED :.
DATE REJECTED
COMMENTS I
TOWN PLANNER DATE APPROVED
:I
DATE REJECTED
COMMENTS
J,
FOOD I CTOR-HEAL DATE APPROVED
!II DATE REJECTED
IC I INSPECTODATE APPROVED
P R- LT
DATE REJECTED
COMMENTS
} PUBLIC WORKS -SEWERMATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
—DATE
ZOOS
RECEIVED BY BUILDING INSPECTOR
Revlsea 9197Im BUILDI`�G DEPT.
MORTGAGE PLOT PLAN
EK SURVEY
17 ROYAL STREET, LAWRENCE, M-A. 01841
TELEPHONE 508-975-1413 '
MORTGAGOR HALL DEED REF. BOK. PG.
ADDRESS OF PRINCIPLE BUILDING PLAN REF. PmAl +V0
- 55 C' nwP sTrzEE-r' DATE OF INSPECTION. �+ x•93
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SCALE 1" _ 60" OPAD`PWO SWEET
I FURTHER STATE THAT IN MY: PROFESSIONAL
NOTE: THIS MORTGAGE INSPECTION WAS PREPARED I OPINION THE PRINCIPLE STRUCTURE/S: AND ACCESSORY'
SPECIFICALLY FOR MORTGAGE PURPOSES AND IS.NOTTP OUTBUILDINGS - co^1�oray.C4: I.aH6&') ZUIL*r
BE.RELIED UPON AS A SURVEY. EK SURVEY ACCEPTS;
WITH` THE SETBACK REQUIREMENTS 017 THE LOCAL
NO RESPONSIBILITY FOR DAMAGES T0.ANYONE OTHER THAN ZONING ORDINANCES,-AND:THAT NO.ENCHROACHMWM
THE SAID MORTGAGEE AND ITS ASSIGNS IN CONNECTION WITH OF MAJOR.IMPROVEMENTS.-EITHER WAY ACROSS
ITS PROPOSED MORTGAGE FINANCING TO SAID MORTGAGOR. PROPERTY LINES:EXCEPT AS SHOWN.
rRTIFICATION TO aaaE!� QiA�- L P ALSO
IVIS CERTIFICATION IS'BASED ON 711E LOCATION'OF SURVEY MARKERS 1111PROPERTY 1S NOT"IN THE 100 YR .FLOOD HAZARD AREA
o 2.
OF OTHERS; AND DOES'NOT REPRESENT A PROPOERTY SURVEY; THEREFORE . PROPERTY S FLOOD HAZARD'AREA=.
OFFSETS SHOWN. ARE NOT TO. BE USED FOR THE ESTABLISNMENI OF �3• INFORMATIONN IS-IUFFTCIENT I0 DETERMINE FLOOD.::HA7JIRD.
PROPERTY LINES. FLOOD HAZARD DETERMINATION FROM`'HE LATEST FEDERAI:.FL'OOD
INCIIRAN(V RATC'It-AD DAKIM AK
Grant, Michele
From: DelleChiaie, Pamela
Sent: Friday, September 09, 2005 4:54 PM
To: Grant, Michele
Subject: 55 Bradford Street- Form U
Michele,
Joyce from BlackDog Inspections statedc that the septic is in the front yard. Please call her at 603.898.0868 if any further
questions.
Skst Ragwd8,
Pwwia�a Da��aG�lflwla
Health Department Assistant
Town of North Andover
400 Osgood Street
North Andover,MA o1845
978.688.9540-Phone
978.688.8476-Fax
http://www.townofnorthandover.com
healthdept@townofnorthandover.com
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MORTGAGE. PLOT PLAN
EK SURVEY
17 ROYAL STREET, LAWRENCE, MA. 01841
TELEPHONE 508-975--141'3
MORTGAGOR IIALL DEED REF. B'K. (18Z PG. '
ADDRESS OF PRINCIPLE BUILDING PLAN REF. PMN 4170
--
5S- IYADF:iogf) 57Tr EE`r- `DATE OF INSPECTION. 111.15
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MOVE& MA _ 1+2.4"Z –
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r o Mo. 388 9 ;• "
A � y
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14,4-5B .^ -. ..
SCALE I" = $Q' C3"D rO RO STV67
NOTE: THIS MORTGAGE INSPECTION WAS PREPAREDI I FURTHER` STATE THAT IN MY PROFESSIONAL
OPINION THE PRINCIPLE STRUCTURE/S AND ACCESSORY
SPECIFICALLY FOR MORTGAGE PURPOSES AND IS NOT TlD OUTBUILDINGS CoNEQ_QYv.t=4 WHGY, ti Ic.T
BE RELIED UPON AS A SURVEY. EK SURVEY ACCEPTS WITH THE SETBACK REQUIREMENTS OF THE LOCAL
NO RESPONSIBILITY FOR DAMAGES TO ANYONE OTHER THAN ZONING ORDINANCES;. AND THAT NO ENCHROACHMENTS
THE SAID MORTGAGEE AND ITS ASSIGNS IN CONNECTION WITH OF MAJOR IMPROVEMENTS.EITHER WAY ACROSS
ZITS PROPOSED MORTGAGE FINANCING TO SAID MORTGAGOR: PROPERTY LINES EXCEPT AS SHOWN.
RTIFICATION T0: ARjz�y 12&j4Al4jdLiWep! ALSO:
iN15 CERT1FiCATION IS BASED ON THE LOCATION OF SURVEY MARKERS X;. PROPERTY IS;NOT"IN.THE.100' YR FLOOD HAZARD AREA
OF OTHERS, ANb DOES NOT REPRESENT A PROPOERTY SURVEY, THEREFORE 0 2. PROPERTY IS IN A FLOOD HAZARD AREA`
❑3. INFORMATION IS (SUFFICIENT TO DETERMINE FLOOD. HAZARD.
OFFSETS SHOWN ARE NOT TO BE USED FOR THE ESTABLISHMENT OF
PROPERTY LINES: FLOOD HAZARD DETERMINATION FROM THE LATEST FEDERAL FLOOD
tt�ctraeur•r° DAW aeno oAMM a
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
DATE: 30/ voL....
SYSTEM OWNER &ADDRESS SYSTEM LOCATION
l (example: left front of house)
Lact n -f
DATE OF PUMPING:_S*-3_o-0a QUANTITY PUMPED a 06�) GALLONS
CESSPOOL: NO YES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION FULL TO COVER
HEAVY GREASE BAFFLES IN PLACE
ROOTS LEACHFIELD RUNBACK
EXCESSIVE SOLIDS FLOODED
SOLIDS CARRYOVER OTHER (EXPLAIN)
SYSTEM PUMPED BY:
COMMENTS:
CONTENTS TRANSFERRED TO: Com, •S
Address u �'���� �� 2 U 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 — Planning Board _ Conservation Commission — Building Department
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Comm "we hh of Massachusetts
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P """'Massachusetts
System Pumping Record
Systent Owner System Location
Date of Pumping: / '� Quantity Pumped: gallons
Cesspool: No 19- Yes L_) Septic Tank: No Yes `
W
System Pumped by: Fctreo0a 5114MI"ej License #
Contents iransferrred to : Greater Lawrence Sanitary District
n to
Dale: 1 s c,tor:
OWN OF NOR114 ANDOVER/
BOARD OFA 6 H
APR 2 6 in
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31
Dear Health 'Officer:
Please- find *enclosed a copy of the DEP notification
that 'is .verification of an asbestos :reinoval.being perormed
in you r,.district;. If .you require- any further information,
or .have 'any questions; please contact Asbestos ,Free Inc
At .(617) 245-4403
Tank you
A Thank
y
Frank Arsenault
supervisor'.
FA:lc,
Enclosure
'
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t
13 New_Salem St., .Woke field;' /VIA'01880 617-245-4403
Massachusetts Department of EnvironmPntat Protection 32,
�...... .01..'!
Bureau of Waste Prevention—Air Quality "`'' Transmittal
BWP AQ 04 Asbestos Removal Notification
i................................!
I BWP AQ 06 Notification Prior to Construction or Demolition Facility lD(if known)
Permits for Asbestos
.................
Applicability
r"NrpfPUasonry '"• `
i PermA No.........................
neteived Dale................... Uemolilion/lienovation operations invvlding asbestos renovation operations and demolition/renovation operations
10
neviewer....... ..........
PermA OAppr.07enled curtaining material(ACM)and general Demolition?Itnnovation Involving ACM is required under 310 CMR 7.09(2)and 3
Decision Dale„•................. i operations are regulated by the Department of Environmental CMR 7,15(1)(b)twenty(20)days prior to any work being
Protection(DEP),Bureau of Waste Prevention—Air duality performed.The following information Is required pursuant to
Division,under Regulations 310 CMR 7.00,7.09 and 715. 310 CMR 7.15.
Notification to the REGIONAL OFFICE of general demolition/
General Projecl Description
1. Facility
Joseph.:,Killash 3, On-Site Manager.
Name:............................:.. ,,. - .. .................
55 Bradstreet Road
.......................................................................................... ...........Name
Address .................
N•...Andoveri,:..MA...01845.....................................I , ....ansa.. ve`..i.................................................... .
ciry508-975-81,00.................................................................. Cjryo .................
Telephone
•.,. telephone ,
Size 21400 �
. .................................................
..................... .
syuareleei A. General Contractor
2 ..........t........................................................................
Nombe�d hodrs �,i -
Name
Was the Facility built prior to 1980? IN Yes U No Adores +,
Residential
....... ............................................
Current or Prior use of Facility CI yAown
Is the Facility occupied?. [N Yes U No --- —------ --~ --
is this Facility owner-Occupied Residential with A units or less? Telephone,
Yes U No
Does this project involve the removal and/or alteration of
2. Facility Owner any Asbestos Containing Material(ACM)as defined and
SAME applied In 310 CMR 7.00 and 7.157;
Marr .....................................................................'............................ O Yes O No
............................................................................................................ If Yes,complete Sections C and D.
Address
If No,complete Sections D and E.
it I`Town
...........................•..........................................................................;
Telephone
Asbestos.Removal Description
Wakefield, MA
1. Asbestos Contractor clVown +'r
Asbestos Free, Inc. 617245-4403
............ --Name -
Telephone 4 Railroad Avenue AC000133 - ----
Department of LAM and Industries License/
Address
Page 11011,
i' 'r
Massachuse.. is Department of Environmental Protection . r i I! j
.
. ............................... .
Bureau of Waste Prevention-Air Ouality Trensm tt-91OF
BWP AQ 04 Asbestos Removal Notification
t BWP AQ 06 Notification Prior to Construction or Demolition �aot�itrrpt�knaiwl�
Permits for Asbestos p
7. Description q
io of techniques used for estimation
2. On-Site Supervisor
Frank Arsenault Tape Measure _ --
Sf06284
Cnparbnent of(ab01 and IndoshleS CEr1lllgdOn '
3. Hygienist Testwell Craig
4. Specific Worksite Locations(s)(i.e.Building name, 8. Asbestos Removal
number,wing,floor,room,tunnel.) ��� '%_
Februar�....10,.. : ..;..
start Date IN T.__
February. .... ...........................................................
.
EndWe
Hours of Operation
5, Is the job being conducted indoors or outdoors? d daytime '" O evening O night
indoors _ _ — --- Days of Operation
ff Mon.—Fri. ❑ Sat.—Sun..
___ __•__-_._._...____._.__-__-._.._....- (Note:Any changes In these dates must be reported to the
appropriate regional office. If a removal is postponed for
6. Estimated amount of Each type of ACM to be handled more than thirty(30)calendar days separate notification will
be required.)
Linear/Square Feet
boiler,breeching,duct, 9. Describe the asbestos removal procedures to be used.
tank surface coatings . /............ l4 glove bag ❑ enclosure CEJ full containment
❑ cleanup ❑ encapsulation ❑ disposal only
thermal,solid core pipe insulation / 145 ❑ other-please describe
............................................................................................4...................
corrugated or layered
paper pipe insulation, •... 10. Transporter of asbestos•containingwasfe material from site
�
...........
to temporary storage site(ii necessary)to final disposal.site
insulating cement: it. �.............. A .beszns...�.raey...•I e ..................................................
��� :,;,•.•, Nara .+..
spray-on fireprooling .............. 4 Railroad Avenue
........................................................................................................
Address
trowel/sprayer coatings ............ .............. Wakefidld, MA 01880
cloths,woven fabric .......................... 617-245-4403, ......... ............................................ .
telephone ,
transits board,wall board
other—please describe .........../..............
Total in Linear Feet ............!.1..45.....
} ,
Total in Square Feet ............................
,
Rev.1/91 ,,Page 2 of 4
..;.
et �
,. .,a e 32011
Massachusetts Department of Environmental Protection s w.a
.� ................................4
Bureau of Waste Prevention—Air Oualiicl
tY ��'�''�� Tranamittal,�
BWP AQ 04 Asbestos Removal Notification
t BWP AQ 06 Notification Prior to Construction or Demolition
..........................
facility ID(!1 kno.wn)
° Permits for Asbestos ; . ,:, ,
11. Transporter of asbestos-containing waste material from 13. Final Disposal Site
removalAomporary storage site to final disposal site .;,•,r
Mead ..
............................ .................
;Recovery' Ekpress, Inc. Name .
NameRt2..»Box 68..:..................... .............................................
197 Portland Street Address
saeelAddress Brid ,eport.x..»W. VA.........................
..... »
Boston, MA 02114 Ciy/rown
Cly/Ton 304-842-24M.....................................................................
_6177523-774Q - Telephow
telephone .»................................................................................
. ..........
Owner's Name
12. Refuse transfer station facility and owner(ii applicable) (Note:Disposal of ACM must comply with the Solid Waste
Divisions regulations 310 CMR 19.00.)
............................................................................................................
Name 14. Emergency Asbestos Removal Operations
DEP official who evaluated the emergency:
Address • ' '
C!ry/rown...................................................................................... Name................ ...:.,...........................................................................
..
............ ......................... ...........................................
.
Telephone............................... ........................................................... tale
:......:.,+..............................................................................
AmersName........................................................................................ AuMdr ,
(Note:Transfer Stations must comply with the SolidpafeoiAulirorttttion� �.. .........•..............................••••.•............. ... ...
r}
t Waste Division,regulations 310 CMR 18.00.)
General Demolition/Renovation Description
1. Demolition/Renovation Contractor 4. Was the facility surveyed for the presence of asbestos
containing material(ACM)?
0 Yes 0 No
Name
If yes,who.Conducted the Survey?
..... ......... ................................ ..................
_ Depaftenl o/Labor and lndusrdes Ceriilialion/
Telephone
5. If yes,who conducted the survey?
2. On-Site Supervisor
....................................................................................................... Name...._.................................................................................
.
Name
Dep&ftenl of LaborarMlnduslrks Cerfilra6on/
3. Identify the specific Worksite Location(s):
6. Demolition/Renovation Asbestos Removal
............................................................................................................
........................ .. ................................. .............
..................................................................... Sbrl Date. End Dale
y`'
............................................................................................................
Rev.1/91 Pan. 3ot4
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention—Air Duality TranamlttatL , s'
BWP AQ 04 Asbestos Removal Notification
BWP AQ 06 Notification Prior to Construction or Demolition
facility 0'(/1'60
Permits for Asbestos
7. Describe the demolition/renoval ion procedures to be 8. Emergency Oemolilion/Renovallon Asbestos Removal
used: Operations
State or local official who evaluated the emergency:
...........................................................
AWN
tale
............................................................................................................
Auarodty ,.. .
(Note.Demolition/Renovatlon Operations must comply
with 310 CMR 7.09 to control emissions to prevent a We ofAufnodraf/on,,,..
condition of air pollution.) ``'`
(General Statement: If asbestos-containing material is unexpectedly found or damaged during a Demolition/Renovation
operation,all responsible parties must comply with 310 CMR 7.00,7.09,7.15 and Chapter 21 E of the General Laws of the
Commonwealth.This would include but would not be limited to filing an asbestos removal notification with the Department +'
and/or a notice of a releaseAhreat of release of a hazardous substance to the Department If applicable.) " µl
Certification,
certify that I have examined the above and that to the
best of my knowledge It Is true and complete.The
signature below subjects the signer to the general statutes
regarding a false and misleading statement(s).
Asbestos...Free,...Inc:................................ ����.............
Pdnl Name Auarodred Slpnafunl
Asbestos Free, Inc.
Supervisor ........................................ ......................................... .........................................................................» �.
Represenanp
January..........r...199 .........................................
Date
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'Y
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Mt
Page 4 of 4
Rev.1/91 f , �.`.
� 7-
APPLICATION FOR SEWAGE D13PCSAL IhSTALIATION
HEA LTH DEPARTMENT - NORTH ANDOVER, MSS, f
I hereby make application for a permit for a sewage disposal installation at
Bradford St. . I will install this system in ac-
cordance with all the laws of the Commonwealth of Mkssachusetts and regulations of
the Board of Health of the Town of North Andover.
Further, I will construct the house sewer of bell and spigot pipe, the minimum
diameter being 4 inches, and will maintain a minimum grade of 1% until 10 feet pre-
ceding the septic tank, where the grade shall not exceed 2%. I will install a con-
crete septic tank of 0 gal. in size. A manhole (s) permitting easy cleaning
will be provided with removable cover (s) of iron or concrete within 12 inches of
the ground surface. I will provide subsurface disposal field with 4 inch perforated
or open jointed pipe and laid in a series of trenches, the bottom of which will pro-
vide a minimum of 160 lineal ( Ij feet of effective absorption area.
The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging
in size from 3/4 to 1-1/2 inches (dia.) and the pipes will be surrounded by similar
material to a height of 2 inches above the crown of the pipe. The joints of these
pipes will be protected from clogging and before filling the trench, 2 inches of
gravel or stone 1/8" to 1/4« (dia. ) will be placed over the course gravel or stone.
The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single
the line will exceed 100 feet in length and in any case, two lines of the will be
installed. A minimum of 6 feet will be maintained between the center lines of the
disposal field trenches and the average depth of trench shall not exceed 36 inches.
No part of the installation will be less than 100 feet from any private water supply,
25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line.
I further agree not to cover any portion of this installation until approved by the
inspection officer, as provided below, and to incorporate any additional requirements
that may be attached to the permit. Plot Plans must be submitted with application.
DATE 10/2/61
Signature of ApY-1,,can
I hereby issue the above permit for the Board of Health of the Town of North
Andover, Massachusetts.
DA TE 10/3/61
gnature of Health Agent
I have inspected the uncovered system indicated above and find everything done
as described.
Ilk TE 2,
Signature of I14ecting Officer
Percolation Test !t min, Soil: Sand
Garbage Grinder No
September 30, 1961
Miss Mary Sheridan R. N.
Health Agent
Board of Health
North Andover, Mass.
Dear Miss Sheridan:
An examination was made as requested in order to determine the
suitability of the soil for the subsurface disposal of sewage on the
proposed Bradford Street building site of Robert Rowe.
The land in general is high.
The subsoil in the area was of sand content and a 4-minute
percolation test was conducted.
It is recommended that a 750 gallon concrete septic tank be
installed together with 160 lineal feet of drain pipe.
Very truly yours,
a
A
W' am4%cok
WJD:hd
r
BOARD OF HEALTH
TOWN OF NORTH ANDOVER MASS.
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40`
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Uisr.Box
'soCA L.C'oNc.��+�r«7��� 20�
! � F
1. NAME .� . 4 �-t/. DATE
/ //
2. ADDRESS . .C2 ,�l J A.. '. LOT N0.
3. NO. OF BEDROOMS . . . DEN YES NO.
4. GARBAGE GRINDER YES NO. . .:�. .
5. SHOW DIhEKSIONS OF HOUSE
b. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES
7. SHOW DII:ENSIOIZ OF LOT
8, SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL
9, NOTE LOCATION AIM DISTANCE OF WELL FROM SEWERAGE SYSTEM
10, SHOW LOCATION OF BROOKSp STR.EAfSp DITCHES.. LEDGE OUTCROP0 ETC.
11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE
NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY.
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Standard Construction Co.
` �' B radford St.
APPLICATION FOR SEWAGE DISPOSAL IIS ULLATION
HEALTH DEPARTEENT»-NORTH ANDOVER2 MASS.
I,hereby a application for a permit for a sewage disposal installation at
I will install this system in
accordance with all the laws of the Commonwealth of Pltassachueetts and regulations
of the Board of Health of the Town of North Andover.
Furthers I will construct the house sewer of bell and spigot pipe, the minimum
diameter being 4 inches., and will maintain a minimum grade of 1% until 10 feet
preceding the septic tank# where the grade shall not exceed 2%. I will install a
concrete septic tank of , in size. A manhole (s) permitting easy
cleaning will be provided With removable cover (s) of iron or concrete within 72
inches of the ground surface. I will provide subsurface disposal field with open
jointed bell and spigot Ackron pipe at least 4 inches in diameter and laid in a
series of trenches, the bottom of which will provide a minimum of , ��$" lineal
(sure) feet of effective absorption area. The pipes will be laid on a 6 inch
layer of washed gravel or crushed stone ranging in size from 3A to 1-1/2 inches
(dia.) and the pipes will be surrounded by similar material to a height of 2 inches
above the crown of the pipe. The joints of these pipes will be protected from
clogging and before filling the trench, 2 inches of gravel or stone 1/8" to 1/4"
(dia.) will be placed over the course gravel or stone, The disposal field will be
installed at a grade of 4 to 6 inches/l00 feet, No single tile line will exceed
100 feet in length and in any case# two lines of tile will be installed. A minimum
of 6 feet will be maintained between the center Zings of the disposal field trenches
and the average depth of trench shall not exceed 36 inches. No peat of the in-
stallation will be less than 100 feet from any private water supply, 25 feet from
any stream! 20 feet from any dwelling or 10 feet from any,property line. I fuer
ggree not to cover any_portion of thi iMtallation until apRl:oved by th2 insg cg tion
officer, as provided below,, and to incorporate any additional requirements that
may be attached to the permit. Plot Plans must be/ submitted with application.
DATE
Signature of Applicant
I.hereby issue the above permit for the Board of Health of the Town of North
Andover$ Massachusetts.
DATE
e.Ignature of H tent
I have inspected the uncovered system indicated above and find everything cons
as described.
DATE
Signature of Inspecting Officer
Percolation Test i t!►�'o Sc�vv�.c{'
Garbage Grinder
r I
+ J l ,
BOARD OF HEALTH ! 10 y C
TOWN OF. NORTH ANDOVERV MASS.
book
Yvl'
3
E�,' .- C �_ A;v`-fir -
1, NAPS. . DATE 3
2. ADDRESS LOT NO. . . . . . . TEL.
:f
�. N0. OF BEDROOPIS ., a DEN YESNO. .
4. GARBAGE GRINDER YES NO.. .
5. SHOW DIP,ENSIOTJS OF HOUSE
b. SH04 DISTANCES OF HOUSE TO ALL PROPERTY LINES
7, SHOW DIPJENSIONS OF LOP
8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL
9, NOPE LOCATION AND DISTAl\TCE OF WELL FROT4 SEVVERAGE SYSTEM
20. SHOW LOCATION OF DROOKSO STREA10., DITCHE89 LEDGE OUTCROP, ETC.
11, SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE
NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY.
September 5,1956
Miss Mary Sheridan R. N.
Health Agent
Board of Health
North Antlover, Massachusetts
Dear Miss Sheridan:
An examination has been made relative to
the suitability of the soil for the sub-surface
disposal of selga,ge on the proposed Bradford Street
building site of the Standard Construction Company.
The soil in the area consisted of sand
and a 1 minute percolation test was conducted.
It is recommended that a. 600 gallon tank
be installed together with 150 lineal feet of drain
pipe.
Very truly yours,
Ernest F. Romano
Sanitarian
TOWN OF veL
SYSTEM PUMPING RECORD
Ctrifn�i��-�rcr r� }
DATE:
MAY fi �;
SYSTEM OWNER& ADDRESS SYSTEM LOCATION
(example:left front of house)
alp uS�
I�
DATE OF PUMPING: _ 6 QUANTITY PUMPED : _� Ob GALLONS
CESSPOOL: NO YES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION FULL TO COVER
HEAVY GREASE BAFFLES IN PLACE
ROOTS LEACHFIELD RUNBACK
EXCESSIVE SOLIDS FLOODED
SOLIDS CARRYOVER OTHER(EXPLAIN)
SYSTEM PUMPED BY: Bateson Enterprises, Inc.
COMMENTS:
CONTENTS TRANSFERRED TO: G.L.S.D Lowell Waste
FOR'114 - SYSTEM Pt71Pr\G RECORD
Commonwealth of MassachusettsM ¢&pOF H�NDOVER
BARD EAt.TH
Massachusetts
X 2I
3
System Pumping Record °
'stem Uvvner ystem Location
�2 --
Date of Pumping: C C Quantity Pumped: - gallons
Cesspool: No Yes ❑ Septic Tank: No ❑ Yes
P9-
Systern Pumped b,,-: _ License
Contents transferred to:
ector
Ins
Date p
A r. 94
i
10Fy'�r�-rrt�s'�
Commonwealth of Massachusetts
a
Massachusetts 's
System Pumping Record
System Owner System Location
-C`
I"
Date of Pumping: Quantity Pumped: �52"" gallons
Cesspool: No Yes L.� Septic Tank: No U Yes
System Pumped by: Farejea 51&nA e4 License#
Contents transferrred to : Greater Lawrence Sanitary District
Date: Inspector:
Commonwealth of Massachusetts
City/Town of RICEIVED
a
Y° System Pumping Record
Form 4 DEC 0 4 2008
DEP has provided this form for use by local Boards of Health. Oth rrfoay, re ivaeilbetzt ie
information must be substantially the same as that provided here. efd*°us k 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: Left fro , 1 rea , left si of hous . Right front, right rear, right side of house.
forms on the
computer, use
only the tab key Address ��(
to move your J
U.-
cursor-do not City/Town State Zip Code
use the return
key. 2 System Owner:
Name
ISI Address(if different from location)
City/Town Statpn � i Code
Telephone Number
B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped: Gallons
3. Type of system: F1 Cesspool(s) ` eptic Tank Tight Tank
Other(describe):
4. Effluent Tee Filter present? 0 Yes No If yes, was it cleaned? p Yes No
5. Condition o System:
6. System Pumped By:
Neil Bateson F 5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7. Lo ca w e contents were disposed:
Pureof
Lowell Waste Water
ignau r Date l
t5form4.doc°06/03 System Pumping Record°Page 1 of 1
&\ Commonwealth of Massachusetts
City/Town of
System Pumping Record
Form 4
APR 27 2010
DEP has provided this form for use by local Boards of Health. her forms may be used, t the
information must be substantially the same as that provided her . eck with your
local Board of Health to determine the form they use. The Syste submitted to
the local Board of Health or other approving authority.
A. Facility Information
1. System Location: Left side of house, Right side of house, Left front of house, Right front of house,
eft rear of hous" Right rear of house. Left rear of building. Right rear•of building.
Address /,—
City/Town State Zip Code
2. System Owner:
Name
Address(if different from location)
City/Town State —. Zi de
Telephone Number
B. Pumping Record
1. Date of PumpingDate 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 Sstem:
Ub"� l
6. System Pumped By:
Neil Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7. Location where contents were disposed:
L Lowell Waste Water
g to a of Haul r Date
t5form4.doc•06/03 System Pumping Record•Page 1 of 1