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HomeMy WebLinkAboutMiscellaneous - 57 SOUTH CROSS ROAD 4/30/2018 (2) ad i V a i �i .f t i II r 4 MAP # LOT # PARCEL # STREET '5 '1_.. .._IOI CONSTRUCTLON_APPROVAL HAS PLAN REVIEW FEE BEEN PAID? YES NO 5L%°/`%�/ PLAN APPROVAL: DATE ha _ APP. BYA_ iiL/�,.__.._ DESIGNER: -�F?9/I PLAN DATE:_____; CONDITIONS /N WOe _. AM619� _•« --/z'1P/D.C' -PRIOR 716 CONST. 4-4 /9,-1 /9& ( sFc P iv� ^^ J. WATER SUPPLY: TOWN WELL WELL PERMkT• DRILLER._..._.. -.._.............._.._ ................. WELL TESTS: CHEMICAL DA I E APPROVED BA IA I DAI'E fIPPRUVED BACTERIA II DATE COMMENTS: FORM U APPROVAL: APPROVAL TO ISSUE NO _ G DATE ISSUED / X6 - BY _ .......... CONDITIONS: FINAL APPROVAL: . - ALL PERMITS PAID YES'- NO WELL CONSTRUCTION APPROVAL Y°ES NO SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER - NO ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: DA 1'E•.. l'.1._ .. DY. _.. '. r �EC�SYSIL ZEM-.NS16.41,flTQN ., ISTHE INSTALLER LICENSED? �� t �` YES NO r TYPE OF. CONSTRUCTION: ?. = NEW REPAIR NEW CONSTRUCTION: CERTIFIED PLOT -PLAN REVIEW YES NO CONDITIONS OF..APPROVAL YES NO t 1 (FROM FORM U) ':-ISSUANCE OF DWC PERMIT ` YES NO DWC PERMIT NO. NSTALLER: N /�: _ BEGIN INSPECTION YES 0: — EXCAVATION . INSPECTION: NEEDED: PASSEDBY :CONSTRUCTION INSPECTIONS NEEDED: ;-:.AS BUILT PLAN SATISFACTORY: YES_s APPROVAL TO BACKFILL: DATE: � BY - .• / � • " FINAL .GRADING APPROVAL: DATE ( �� BY : .FINAL CONSTRUCTION APPROVAL: DATE BY OF F oI rH rAE�LT H 80 TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE /.;2 -/- 0 SYSTEM OWNER&ADDRESS SYSTEM LOCATION GOSS DATE OF PUMPING /2-/-_6 3-QUANTITY PUMPED XV U CESSPOOL NO_4Z YES SEPTIC TANK NO YES NATURE OF SERVICE: RbUTINE L,4MERGENCY OBSERVATIONS: GOOD CONDITION FULL TO.COVER HEAVY GREASE BAFFLES IN LACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLID CARRYOVER OTHER EXPLAIN SYSTEM PUMPED BY 7 L COMMENTS: CONTENTS TRANSFERRED TO r r rpt sYi.! r id Lt`` htrt r I, r .srr r�r• ( < v ,iSr ±)}, Cr � u } 1 {�� i t,� � t n � t - rhfhtii}r' rk��",•'`4'7J'9- yrS�F,6sr'� �T,a��{{lrr+ .. t t Ta td ,zt� ir Std.Ar s ft r r�Y.Y, i. ! Y r9 r k� assachusetts RECEIVIRD r �4ranwlf . City/Town of A DOVER MASSAC USETTS 801,10tn_Pump ng Record. DSC 2010 Y FOrnt4 . TOWN OF NORTH ANDOVER EA H D A st DEP has provided this form for use by local Boards of Health. The WA be submitted to the local Board of Health or other approving authority. A: Facility Information , ro 1, System Location:. forms onc �� compuforr ttse Address only a,e tab key - to mow your , Cursor•do not , City/Town State Zip Code use the retum �Y 2, System Own@r. • Name •.a Address(if different from location) Q;I y own State Zip Code Telephone Number B. Pumping Record • / 2. Quantity Pumped: Gallons 1. Date of Pumping Date 3. Type of System: ❑ Cesspools) Septic Tank ❑ Tight Tank ,` ❑ Other(describe): 4, Effluent Tee Filter present? ❑ Yes ❑ No If yes,was it cleaned? ❑ Yes ❑ No 5. CondMon of System: e. System Pumped By: Vehicle Ucense Number y :\W. 7. Locationcontents ware disposed: . z n-im Date http://www.mass.gov/dep/water/approvW3ASforrns.htm#inspect t5fonn4.doa 060 : system Pumping Record•Page t of t : a: t REC D Commonwealth of Massachusetts 11'..-32013 I City/Town of North Andover.NC)R System Pumping Record H= ►DEPATILSW 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 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, 5 use only the tab G �` ��J key to move your Address cursor-do not North Andover Ma 01845 use the return key. City/Town State Zip Code 2. System Owner: Ac 1�ue e 0 Name remm Address(if different from location) CityFrown State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 11 Date/ b �� 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: w Name 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 Si a re of aul Date Signature o Receiving Facility Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 1 M0RTjj 1 ?�` � �°foBOAS OF HEALTH D Is 120 MAIN STREET TEL. 682-6483 'SSAcm„S't NORTH ANDOVER, MASS. 01845 Ext. 32 DATE: September 3, 1993 TO: R.A.M. Engineering Patrick Murphy 160 Main Street 800 Osgood Street Haverhill, MA 01830 No. Andover, MA 01845 FROM: Sandra Starr, Health Agent RE: Lot 4 South Cross Road Dear Mr. Masys: i i This is to inform you that the proposed septic plans for the site referenced above have been disapproved for the following reasons: Incomplete information on TP #102 . Please complete and locate all perc tests and deep holes and show elevations. (N.A. 6. 02j ) Please show existing grade on rjrofile. Please show distances from house and garage to septic tank and leach area. (N.A. 6. 03b) 1/4. Please show water line. (N.A. 6. 02q) c--'5,. Minimum distribution line slope is . 005. 6l. Benchmark missing. (N.A. 6. 04a) Show driveway elevation. (N.A. 6. 02p) --8. What size is D-box? Please specify. 9. Please check elevation of cellar floor with respect to existing grade. If you have any questions, please call the Board of Health office. i; , r�6 RT}-� To" 0 ' Andover y c. 4- o - - C0(111 CAI rth , dower, Mass., 19 put 11L 1,11 BOARD OF HEALTH Food/Kitchen . D Septic System �&,L,,. , „ • PERMIT 4a s w s • �� /BUILDIN INS T �c THIS CERTIFIES THAT... '.............................. ��--`���-! c�C �(� C/ ,j . "" F undation has permission to erect.1000.10.A# buildings on .170.JI..0104..�NW.�00-4I. ....#........ Rough ot�j to be occupied ...RAIVA�. 4� ..*$..l..r/.A.CSjA..I#A1r4.04 0, Chimney provided that the person accepting this permit shall iff every respect conform to the terms 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. PERMIT FOR FOUNDATION ONLY V SPEC R VIOLATION of the Zoning or Building Regulations Voids this Permit. REGULATED BY PARA. 1143& B.G. " a � E PERMIT EXPIRES IN 6 MONW&�- q PAID w„ Final ELECTRIC PEC OR UNLESS CONSTRUCTION STARTS ,(I Rough V PERMIT FOR FRAMI /171PI-PING ... ... ............ ....... ..... ............................ ...................... Service BUILDING INSPECTOR DATE:/ FEE P Ic� -�6 Final cc ), is Permit Required to Occupy Building GAS INWE T Display in a Conspicuous Place on the Premises — Do Not Remove r Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. BurneFIRE DEPARTMENT r PLANNING f 10 JAL CONSERVATION &04 Street No. Smoke Det. SEWER 11AIATER`Pikh-42-9FINAL DRIVEWAY ENTRY PERMIT No....................... FEB............._............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF E ILTI.I.V gyp ...NJ..... ........OF.... ..... ..... .... . . Appliration for Dhiposal Works Tonotrurtion ramit Application is hereby made for a Permit to Construct (K) or Repair an Individual Sewage Disposal System at: -k 41,- _1111A............................................ L 4.............. ............................. ............ I j�_ location Address or Lot No, T OJ4 Owner A dre ...........6 ............................ ..... Yy � .......................SV .................... Installer Address Type of Building Size Lot . U ,V? Ak ........Sq. feet Dwelling—No. of Bedrooms............... -------------_-------Expansion Attic Garbage Grinder �4 Pk Other—Type of Building ............................ No. of persons....._...................... Showers Cafeteria 04 Other fixtures ......................................................................................................... Design Flow.............. ................gallons per person per day. Total dail low............co W P—D.............gallon& 1:4 Septic Tank—Liquid capacityA.5_6_Pgallons Length/_Q_'.t%".. Width.,!U..... Diamet, 2F�........... Depth_.,'5.r.LV. Disposal Trench—No. .................... Width.....1.9...... Total Length....S.76...... Total leaching area.10-0.9 j..._0.9...sq. ft. Seepage Pit No..................... Diameter............___.._.. Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (X) Dosing-tank '_4 Percolation Test Results Performed by.. _-EA4 ... ............ Date...01:n..]... �-4 Test Pit No. 1..... .....minutes per inch Depth of Test 1?i epth to ground water . Test Pit No. 2..........1. ....minutes per inch Depth of Test Pit.................... Depth to ground water...... ............. ... . ..................41...................;_....-•.... ------- ... ........I.,... ................... ------------W�� ................JD-=r?!D......... ...... ...... k..,51:............. .Ak 0 Description 07?0't�-.4 ............ ............ . A.44....(3).... ....on. ...... ........ ................... ...US..4.5.? ...Ul-U. U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed...................................................................................... ................................ Date ApplicationApproved By.................................................................................................. ........................................ Date Application Disapproved for the following reasons:............................................................................................................... ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE LT ...... -�". .(.-64 OF...... ................. THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (,�) or Repaired by---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Installer at.....--•...............•------••-------•---•--.........------....---•--•--------•--••----------------....---------...................-•-•-----•------------....---•----.............-•----...----••••. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated_......._..............____._____............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE--•..............................••---...----•-........-•---------•-•---•-_..... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD 9F ALTH No......................... ....... .............OF..... ...... FEE........................ DispoodVorh,5 flan #riirti»lnfrrufit Permissionis hereby granted............................................................................................................................................. to Construct or Repair an Individual Sewage Disposal System atNo........ ...................................................................................................................................................................................... Street as shown on the application for Disposal Works Construction Permit No..................... Dated.._....................._.._._............ ........................................................................................................ Board of Health DATE------------------------- -•-•--•---•-•........................................ FORM 1255' A. M. SULKIN, BOSTON No......................... FES........................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF E LT ... .. ............OF..... .Q.�:::..... ................... ......�OV - -�.s:'.'......--- Appliration for Disposal Works Tontrnrtion rami# Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: ............ ............................. ................... Location-Address or Lot No. .............. — ... .................... ...... ...'' - .............. Owner Address W Installer Address � Type of Building Size Lot/40,2.1k.......Sq. feet aDwelling—No. of Bedrooms............... __________________.____Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures ...--------•------------------------•-----------•-•--............_._._..----------•-••-•---•--•---------- ------..._._.....---------•---•----__----- d W Design Flow............. .. gallons per person per day. Total dailow............._ .............gallo _ g W Septic Tank—Liquid capacity,ldallons Length/.(I'.4 Widt 1; Depth__ _ x Disposal Trench—No_ ____________________ Width...... _"`___.___ Total Length.._a....t_(..... Total leaching area_Q.0.0... ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( Dosi tank '-' Percolation Test Results Performed by... l _..._ .... .�.�C" + .. t_____ e th to ground water_.___. ,...� Test Pit No. 1_._._. .____minutes per Inch Depth of Test it._.__:�_____..____ p gr ._.__. (i Test Pit No. 2.._____A...minutes per inch Depth of Test Pit____________________ Depth to ground water....... ............ .... 0 Descri tion of` 't!1 A {? .}t7� .................�f`44c S �i'd_ A �1y a` 15, = - UNature of Repairs or Alterations—Answer when applicable............................................................................................... ----------------------------------------------------------------------------------------------•----------------------------------------------...--------------------._..__...._..__.....•--•••---•••__-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed....................•-------------------•-••-•-••--------------...........------_--_.. ..........__..............-•---- Date ApplicationApproved By.................................................................................................. ........................................ Date Application Disapproved for the following reasons:_.__•_________••_______•____-_-•_______________________________________________________________________________ ....................•------•---------.._......_......----------------------------._....----.....------._.._.........--------------------------------------------------•_...._....--------------•-•--••-•- Date PermitNo........................................ Issued--•------•--...--------............................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE LT ......----f �-!V!J.........OF...... fFJ:f. "el6c�4e 4.................. Trr#if iratr of Toutphanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (,q) or Repaired ( ) by.............••-••-•---....._---.......-••••••••-•--•----•••---••-••••••••...••••••••--.....------•------------......._.__..._••------....---••--................._....----•••--••••••-•--•-•-••_--- Installer at__----------•---------------------------------------------------•---•--------------•---------------•---------------------------------------------------------------------------------•-•---•--------- has been installed in accordance with the provisions of TITI3 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No_________________________________________ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOAR F H�EALTH - :.......L..�...1� ....................OF..... - .. . ._..::_.... 1 f, No......................... FEE........................ Disposal Works Ton#rnr#ion rrmit Permissionis hereby granted------------------------------------------------------•---•-•------------._...._..............-------•--..............__............._••----• to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo..............--•---•-•------------------........-•-----•-----------------•-••---•-••-•••-•--•.-------------------------•-------------------------•---•------.._...---------...--•-'•-••...... Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... ..._..------•-----------•------------------------------------------------------------------•--••---•--•- Board of Health DATE................................................................................ FORM 1255 A. M. SULKIN, BOSTON DATE o�Z / Sheet of BOARD OF HEALTH TOWN OF NORTH ANDOVER SUBSURFACE DISPOSAL DESIGN REVIEW FEEPERMIT # c>9q DATE RECEIVED�i1.3 APPLICANT PX)—PICA- IUP, P/T ASSESSOR'S MAP ADDRESS 96.0 66,so6p PARCEL # LOT # -- -4 STREET u %{ 6ROSs R D ENGINEER 2-fi. M ,,:�-AICI / q/�- ADDRESS C3,Y� /�,g y5 �,[ Y 114 &R14/6 er /`'In G'1e30 PLAN DATE /� J9s� REVISION DATE CONDITIONS OF APPROVAL: APPROVED DISAPPROVED [,GAs :5 Ho 1"j9/ejr-//v U-4ReA. (/j1,/9, 6 0 /(/OTE.' 54-7E G�O�/s�,eilAT�dN_ 5�m/55/O/t/ �C3acJT wETcA�I/DS - NOTA 7-11,-9r /9�� �i/�� r��s� �� c./ 40 , (A//9 l8, 11 - IRS` :7"m fo uN,b/9TiO/J DRAM. muST ��� �ou�v D/4T�GN b e,,N_ NOTA /b US /»/�7CiP//�L.s' S�A� EXTEgIQ �'O/�56/Gi 5UC3SO/G 4Y OT'i�Le /'E/zV 197 V �3� - ��E/�S� GOC�T� TEST ��aGG` �oda . C�/.�- � •OBJ � I ✓q Q) ra F • i 1' DATE Z•-I7 Sheet ' of BOARD OF HEALTH TOWN OF NORTH ANDOVER SUBSURFACE DISPOSAL DESIGN REVIEW FEE GS PERMIT # DATE RECEIVED _ ;or APPLICANT A-11W ASSESSOR'S MAP ADDRESS F`® Y- 11. PARCEL # 1�V4Z H4 LOT # STREET ENGINEER ADDRESS VAC) MN1%%1 'J'r PLAN DATE REVISION DATE CONDITIONS OF APPROVAL: APPROVED DISAPPROVED u *�- 'u�St4t't"'C�C�X11 iJ�►' p � Oro '11v�s 15&Ks Wsy W&A 5 tk S. Lolllio &,r LC,QST' 20 Pr' tAeLj 'DGUPL ``'moa atzo jo u, -rwy 'O !! �WE 1p o 46fi. H{w,,40�Lt C ?6CtN - or. SOIL PROFILE °. PERCOLATION TEST DATA Town/City Nc7.&St:reet 5� L� G,�j Lot: No.� Loc. /Subdiv : 4__----- -Play, � Ouner Investl.gator12#0 - Observer�_ 4 . f 1 SOIL PRO FILE-S-DATE 1 ' F.].•ev. ?' Elev. ' Elev. ' Elev . 0 10 O _ 0 `o 0� 0 2 _ 2 ell S2 . 2 •3 ' 3 3 3 t 4 T_ 4eA 4 9 t+ 5 5 (,�5 5 Ott 4!),,. 6CoAr. 6 G V G a. 9 / 9 9 9 10. _ 10 10 10 ., Benchmark Location Elevation Daturn P r_ olation Tests-Date i Pit Number �0� -1 "'02 10Ti 3 4 _ 5 Start :saturation Soak-1-1-ins. — Start '-['est-Time I�3 .Drop o:f 3"-Time d, _ Drop of 6"-Time - Mi.ns . lst 3"Drop 'Mins . 2nd 3"Dro Notes & Sketches on Back � Aisling Construction Co, Inc. 800 Osgood North Andover, Massachusetts 01845 Telephone (508) 689-9446 Fax (508) 687-0515 Sandra Starr 8/25/93 Board of Health Town of North Andover 120 Main St. North Andover, Ma. 01845 Re: Lot 4 South Cross Rd. Dear Ms. Starr. Attached,please find revised plans for above site incorprating the wetland line and driveway location approved by the Town (see Order of Conditions issued 8/16/93). Bob Masys of RAM Engineering is available at 372-0449 to discuss as needed. Sincerely, r( -- Patrick K. Murphy President PLAN REVIEW CHECKLIST I/6-6-b AI&40 ADDRESS ap , ��' �� ENGINEER� A M .. GENERAL / 3 COPIESy STAMP LOCUS NORTH ARROW SCALEy" CONTOURS PROFILE SECTION r/ BENCHMARK SOIL & PERC INFOELEVATIONS WETS. DISCLAIMER WELLS & WETLANDS WATERSHED? //0 DRIVEWAY i..- (Eley) WATER LINE FDN DRAIND� SCH40 �~ TESTS CURRENT? SEPTIC TANK MIN 1500G. L�b/ . 17 INVERT DROP GARB. GRINDER(+200% EDF) 25' TO CELLAR MANHOLE TO GRADE ELEV GW I D-BOX n SIZE J J -S^ # LINES FIRST 2' LEVEL STATEMENT INLET OUTLET jQa.YO (2" OR . 17 FT) TEE REQ'D? 4/6 LEACHING / RESERVE AREAy 4' FROM PRIMARY? � 100' TO WETLANDS 2% SLOPE— ox_I- LOPEoxC 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" COVER L,""' FILL? (25' if above natural elev; 101if below) BREAKOUT MET? TRENCHES MIN 660 gpd SLOPE (min . 005 or 6"/1001 ) >3 ' COVER? - VENT SIDEWALL DIST. 2X EFF. W OR D (MIN 61 ) IS RESERVE BETWEEN TRENCHES? IN FILL? MUST BE 10' MIN. 4" PEA STONE? BOT X LDNG 2+ SIDE X LDNG = TOT (L x W x #) (G/ft ) DxLx2x# �/�a c,v ,t./�QTS D� •�/G�. `i PITS MIN 660 LEACHING GW MIN 41 BELOW BOTTOM MANHOLE/PIT EXCAV 2x EFF W OR D 12"-48" STONE SURROUNDING BOT + SIDE x LOAD = TOTAL (L x W x #) (2 x (L+W) x D x #) CHAMBERS COVER >3 FT - VENT I FIELDS MIN 900 ft2 LEACHING PERC RATE FASTER THAN 20M/IN v GW MIN 41 BELOW BOTTOM OF F IELD C,-' PIPE ENDS JOINED W/NON-PERF. PIPE? -)�— 4" PEA STONE? DIST LINE SLOPE .005? >3' COVER - VENT SCH 40�v MIN 12" COVER L x W = T x LDNG > DESIGN FLOW? DOSING TANKS AND PUMPS DIMENSIONS X X = PUMP CAPACITY Spm L W W Vol. DISCHARGE SIZE DISCHARGE RATE DISCHARGE TIME gpm MANHOLES TO GRADE ALARM SEP. CIRC. GW (Min. 1' below inlet) HWL LWL CHECK VALVE BLEEDER HOLE MANUAL OP. SWITCH i Aisling Construction, Inc. Patrick K. Murphy - Builder I 800 Osgood street • No. Andover, MA 01845 4 i Tel. (508) 689-9446 Fax (508) 687-0515 R.A.M. ENGINEERING ROBERT A. MASYS, P.E. 160 MAIN STREET HAVERHILL, MA 01830 O PHONE: (508) 372-0449 M!L G�3 April 15 , 1993 Sandra Starr, Health Agent North Andover Board of Health 120 Main Street North Andover, MA 01845 RE: Lot - S uth Cross Road Dear Ms . S � Att ched, please find revised plans for the above site incorporating the changes requested in your letter dated March 29, 1993 . All items that you listed have been added to the plan. If I can provide any further information, please contact me . trul yours , �c Robert A. Masys, P.E. PL/7/I 5 O� 8/oma/Cj� PLAN REVIEW CHECKLIST ADDRESS_Z, , 4 Sd. C,eosS ENGINEER GENERAL / 3 COPIES STAMP_ LOCUS ✓ NORTH ARROW ✓ SCALE L� CONTOURS PROFILE ✓ SECTION BENCHMARK SOIL & FERC INFO,,v ELEVATIONS WETS. DISCLAIMER-"' WELLS & WETLANDS t/ WATERSHED? DRIVEWAY (Elev) WATER LINE �f FDN DRAIN6�C v SCH40TESTS CURRENT? Ak, /2q/ SEPTIC TANK MIN 1500G. V . 17 INVERT .DROP '� GARB. GRINDER(+200% EDF) 25' TO CELLAR; MANHOLE TO GRADE ELEV GW D-BOX SIZE # LINES �3 FIRST 21 LEVEL STATEMENT w I INLET IgZ. 7S - OUTLET IV.TL,> _ (2" OR . 17 FT) TEE REQ'D? A16 LEACHING / RESERVE AREA 4' FROM PRIMARY?/ 100' TO WETLANDS ✓ 2% SLOPE 100' TO WELLS ✓ 35' TO FND & INTRCPTR DRAINS 1 4' TO S.H.GW 325' TO SURFACE H2O SUPP -,---/ 4' PERM. SOIL BELOW FACILITY 7 MIN 12" COVER FILL? (25' if above natural elev; 101if below) BREAKOUT MET?2� 7 P /43 16 TRENCHES MIN 660 gpd SLOPE (min . 005 or 6"/1001 ) >3 ' COVER? - VENT SIDEWALL DIST. 2X EFF. W OR D MIN 61 )_ IS RESERVE BETWEEN TRENCHES? IN FILL? MUST BE 10' MIN. 4" PEA STONE? BOT X LDNG + SIDE X LDNG = TOT (L x W x #) (G/ft2) (DxLx2x#) .y PITS MIN 660 LEACHING GW MIN 4' BELOW BOTTOM MANHOLE/PIT EXCAV 2x EFF W OR D 12"-48" STONE SURROUNDING BOT + SIDE x LOAD = TOTAL (L x W x #) (2 x (L+W) x D x #) CHAMBERS COVER >3 FT - VENT FIELDS MIN 900 ft2 LEACHING t/ PERC RATE FASTER THAN 20M/IN GW MIN 4' BELOW BOTTOM OF FIELD ✓ PIPE ENDS JOINED W/NON-PERF. PIPE? �-- 4" PEA STONE? DIST LINE SLOPE .005?_,4 >3' COVER - VENT Alld SCH 40 f MIN 12" COVER ✓ L x W = T x LDNG > DESIGN FLOW? e36--� DOSING TANKS AND PUMPS DIMENSIONS X X = PUMP CAPACITY gpm L W W Vol. DISCHARGE SIZE DISCHARGE RATE DISCHARGE TIME gPm MANHOLES TO GRADE ALARM SEP. CIRC. GW (Min. 1' below inlet) HWL LWL CHECK VALVE BLEEDER HOLE MANUAL OP. SWITCH DATE_ 9/a /93 Sheet I of —�- BOARD OF HEALTH TOWN OF NORTH ANDOVER SUBSURFACE DISPOSAL DESIGN REVIEW FEE PERMIT # DATE RECEIVED 8 APPLICANT ASSESSOR'S MAP ADDRESS 86D QS6e5,5b ST PARCEL # LOT # ,¢ STREET 5'h„r�1 .eos5 �f 6A1� ENGINEER A M. ADDRESS PLAN8/ DATE �?6 // 3 l9 REVISION DATE CONDITIONS OF APPROVAL: APPROVED DISAPPROVED a DN 6 /qG /d o2, - AGE/ 5 Sod 1NCDMPGGsTE /N60. (DA/ TP �yp� EGEVAr1eA16 (,v•A. �•oa� �. �-- y" •A�EI� HOGS �G EF3 5 G" ,fib�J �'��/� D/sT/�'/vcGc6 03 7-a l 4. �GE/35 E �• M!/v- � /5T!?I.BUT/Old �-lN� Oov�. �o. -B�N�/�/►'IFI�� m/5 61A16 (/4/. /9 /9 5/-loc4-) tJ 2� VG'u��y EG�sv�T'roN• � �I/ /�. � -D�� J 8• /ze -D 7 sPEc/Fye cv/�EsPEGj- 76 6,1157//1/6 z ' �. DATE 9�a 193 Sheet % of BOARD OF HEALTH TOWN OF NORTH ANDOVER SUBSURFACE DISPOSAL DESIGN REVIEW FEE PERMIT # DATE RECEIVED 8 APPLICANT ASSESSOR'S MAP ADDRESS 0066 ST �/�. PARCEL # LOT # -4 STREET Sty,,rti (,eo55 —, 6!q/� ENGINEER �1 • /a• /y1 . ADDRESS %l61 /Y/A/iU 6 PLAN DATE s46 h 3 REVISION DATE CONDITIONS OF APPROVAL: APPROVED DISAPPROVED a DN /G�. - �GC-C/35� - /N60 m P�6 Tc /Nlc�. o iv TP 5 Ho�:v zc v,�>icn/s ssT S d/ ( /V.A � v`�`� c6-6 6 6 03 �J 7-0s .oTic J-. 5 7, Cc 6�v 7 /V. ` ;� /�. �/0 s1zc -BoX �PCci �y� s6 TU G�'i5T/NG G.P�DF. DATE 9�a �93 Sheet I of BOARD OF HEALTH TOWN OF NORTH ANDOVER SUBSURFACE DISPOSAL DESIGN REVIEW FEE PERMIT # DATE RECEIVED(f APPLICANT ASSESSOR'S MAP ADDRESS Sn& ST• �'. PARCEL # IAT # -¢ STREET ENGINEER A /V? . ADDRESS PLAN DATE REVISION DATE CONDITIONS OF APPROVAL: APPROVED DISAPPROVED a DN a_ %/�/GoM�L�=TC //VGc'. O/V TP �/DoZ. - C'�G11'��G T Gss� 5 dr //o a-) cv1a /v� 5 6 D AJ //o us E w 03 �J To INS (N e5-N K l 8 2 sPCc/Fy, uJ��L-S�Ec7-- 7D Town of North Andover, Massachusetts Form No.2 f �oRTM BOARD OF HEALTH F s '��"-'��"��•..++++' ' DESIGN APPROVAL FOR ss"C14 SOIL ABSORPTION.SEWAGE DISPOSAL SYSTEM Applicant Test No. Site Location_ �T y ..�OIJ�- 1 C1� Reference Plans and ENGINEER DESIGN DATE s Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. ,y CHAIRMAN,BOARD OF HEALTH } Fee ' !V1{/ Site System Permit No. l i i } 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 fills out this section***************** � �� 9 4 Ll APPLICANT: QatR GA< Phone LOCATION: Assessor's Map Number Parcel Subdivision Lot(s) Street tj{1lf_¢c,s.s St. Number ************************Official Use only************************ REC0MMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments 1A 22 A Date Approved Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected Date Approved116 Septic Inspector-Health Date Rejected Comments J��/� /,�� �EFo�� �Fi�'Tic I LL7%-'`1 C�n�' T�'yGTicN Public Works - sewer water connections driveway permit ' ` "�"%'2 Fire Department Received by Building Inspector Date Aisling Construction, Inc. Patrick K. Murphy - Builder i Al +, 800 Osgood Street No Andover, Fa o�508M687O10515 845 Tel. (508) 68 l ti , Aisling Construction Co. Inc. 800 Osgood North Andover, Massachusetts 01845 Telephone (508) 689-9446 Fax (508) 687-0515 o' 8 �3 Sandra Starr 9/7/93 Board of Health Town of North Andover 120 Main St. North Andover, Ma. 01845 Re: Lot 4 South Cross Rd. Dear Ms. Starr. Attached,please find revised plans per your letter RAM Engineering dated 9/3/93 for above site. The cellar floor grade that is above existing grade will necessitate raised footings,foundation walls. Bob Masys of RAM Engineering is available at 372-0449 to discuss as needed. Sincerely, Patrick K. Murphy President +r••-n Town of North Andover, Massachusetts Form No.3 BOARD OF HEALTH ,AOR Th Of t�ao ,a•�qO ���X ir� ►yt�t/�/V/ � �9 \� F p �'•�,,.;o.�`� DISPOSAL WORKS CONSTRUCTION PERMIT • ,SgACHUSEt Applicant NAME ADDRESS TELEPHONE Site Location : Permission is hereby granted to Construct 1X) or Repair ( ) an Individual Soil Absorption : Sewage Disposal System as shown on the Design Approval S.S. No. CHAIRMAN,BOARD OF HEALTH : � N Fee D.W.C. No. �� r GEOTECHNICAL SERVICES, INC. Geotechnical Engineering • C:ons[riIction N-10nitoring • Environnzcntal Studics • Matcrials Tcsiing November 24, 1993 Mr. Pat Murphy Aisling Construction 800 Osgood St. North Andover, MA RE: LOT 4 SOUTH CROSS ROAD NORTH ANDOVER, MA PROJECT NO. 93162 Dear Mr. Murphy: Presented herewith are the results .of the testing performed an a sample of crushed septic stone delivered to oux laboratory. The sample was designated as L198-931 and was subjected to grain size testing in accordance with ASTM D422 to determine the aggregate size distribution. Based on the results of this test the material is classified as a 3/4 to 1-1/2 inch crushed stone suitable for use in septic leachbed construction. The supporting test data is attached to this report. It is trusted that the contents of this report meets with your satisfaction. Should you have any questions or desire additional information, please do not hesitate to contact us. Very truly yours GEOTECHNICAL SERVICES, INC. Wendell T. Barry Staff Engineer Harry K. Wetherbee, P.E. Principal attach 12 Rogers ltd. • Haverhill, Ma.01835 • (508)374-7744 • Fax(508)373-6944 10 Governors Row • I3ox 4 • Weare,Nil 03281 • (603)529-7766 • Fax(603) 529-3232 TO'd STSOLL89 Oi '00 NOIi3naiSNOO ii00S W06-� WU6Z:6O 266T-6Z—TT 1 - f UNIYUD SOIL CLASSIFICATION COBBLES GRAVEL S"D SILT OR CLAY COARSE I FINE MEDIUM HNE IJ.9. =s IN Bic= U.S. OTAN®ARD MM No. HYDNOl�TER 5 3/4 3/9 4 10 20 40 00 140 200 100 0 I so 20 so A0 z ul r~ m w a a z 40 60 w � a w a a 20 80 01 100 10 s 10' is 1 10' 1f� 14 9 GRAIN SIZE IN MI1,IMTER SYMBOL BORING D ft UE3CREPTION 0 L198--93 Coarse GRAVEL. I Remark SEPTIC STONE Project Na. 93182 SOUTH CROSS ROAD (LOT 4) i GEOTECHNICAL GRAIN SIZE DISTRIBUTION ngure No. 1 —SERVICES, INC 20'd STSOL89 Ol '00 NOI1 nNiSN00 1100S WOdd WU02:60 €66i-67-` r TABLE 1 GRAIN SIZE ANALYSIS W MECHANICAL PROJECT: SOUTH CROSS RD. (LOT 4) PROJECT NO. : 93152 TESTED BY/DATE: W.S. 11124/93 SAMPLE DESCRIPTION: Coarse GRAVEL LAB NO. : L198-93 WT. OF TOTAL SAMPLE - WET: 4. 14 LBS TARE ZEROED SIEVE NO. CUM. WT. PERCENT PERCENT RETAINED RETAINED PASSING 3t' o.00 0.00 100.0 2+t 0.00 0.00 100.0 1. 511 0.00 0.00 100.0 1" 3. 30 79. 7 20.3 3/4" 4. 14 100.0 0.00 1/211 NO MATERIAL ON SIEVE 3/811 NO MATERIAL ON SIEVE NO. 4 NO MATERIAL ON SIEVE NOTE: NO MATERIAL PASSING THE 3/4" SIEVE P-URD OF Nit.i ( �r �l s X055 rvol�TH *)POVEI,�, MA. 4�11j5wtj ❑ UJEU 6PFRoUeDZff- %PP,�p t v VM DISAPP�vE� Co�pFr��S : � 7Z SY5 DgiE cYCAvAT(a,�J ),JS`t�--c►roti) vr�rG Q i,���S �} PAIL- t tiS�Ecrlo� P(PE F(:Z()Aj F jt) J5 i o TA Or Ll Pry SS `Q F=/0)L- �PPI�OVED G)/3TC APl'1�OU1^)G �J�r+tDl�iiy D1Sl�Pt'�ov�D D,arC FIti,QL APPf;�DvAL ---" D,oF� ,. APP)�ovV)6 /6v i-Hogi �`/ Town of North Andover, Massachusetts Form No.3 • t NORTH BOARD OF HEALTH L '-T 1 2-9 I , ' • O tt�eo e'�.�.0 1(�7 O) 3? e!sA.-... •a O F A yyss 5 icy DISPOSAL WORKS CONSTRUCTION PERMIT ACHU Applicant A 1Icy, 1.oc-x'AJ M 0 < jSok q6 I ��1d,1Yl,t NLf p NAME p ADDRESS TEL EP ONE Site Location 41o�4N�t'L-t-h C'k OSA 4L Permission is hereby granted to Construct ( ) or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. I• i CHAIRMAN,BOARD OF HEALTH Fee to D D.W.C. No. i ' | Fmc.............................. THE COMMONWEALTH orMASSACHUSETTS U���� ��K� �� ���~��" ~�� H -'��ak)...........�x�F'"������[W.'���^��K���0��K�. ........................ _ �.°�� ��� ���� = ����������K ������ K� �4�s Application is 6«rcbv made for u Permit to Construct (X or Ilcnuir ( \ an Individual 5emuQo Disposal System at � � .� _��� '�»�^ ��~ I ����� ���� ��a�mc��� ��m�� ��� ��� ��-- -'�°c�/ Aa - -' --' ----' -'-- ---- ------'------------------- � - ....... - '-'-' � u°"� ' Address � Installer Address � Type nfBuilding Size | Dwelling--Nu ofBedrooms................. ��_-___--Expansion Attic Garbage Grinder ( ) 114 Other--Type of Building ............................ No. ofycranuo---_--------- Showers ( ) -- Cafeteria ( ) .� Other '-__ ................................................................................................ - Des~ Flow - -_ gallons per ^ ^� gallons. Septic Tank--Liquid Disposal Treuch-- ............ Width.................... Total Length.................... Total area....................sq. fc U '-- Seepage Pit No........2-_.. ' ' De^tb below v Total leaching ' ~w Z Other Distribution box \a�/ Dosing tank \ ~~ Percolation Test Results Performed '�'.- Test Pit No. 10). perinch Depth of Test Pit Depth to ground water...... 1:F----------- Test Pd No. 101...0..minutes per inch Depth of Test Pit..... .......... Depth to rr0006 wucer--' .......... O ---------'---------------'-------------'-------'''--'---''-----'--------'-----'------- '-"'-_'_-'. The undersigned agrees to install the uforc6c»cribe6 Individual Sewage Disposal System in accordance with the provisions of TlITIE 5 of the State Sanitary Code—The undersigned 6urthorugreesoot toplace the system in operation notd u Certificate of Compliance has been issued bvthe board ofhealth. Signed..................................................................................... ................................ Date ApplicationApproved _'.................................................................................................. ........................................ Date Application Disapproved for the following reasons:................................................................................................................ »"te � Permit � Date THE COMMONWEALTH oF M^es*oHussrre BOARD OF HE LTH � | .........OF-A����........--� �����..... ............ Tntufira4r of To4utphauta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) bc--------------_--------------------_---------_-_...---------------------------------------'------ ' Installer � . at...................................................................................................................................................................................................... been iostqllfA in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated-_---------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Ioupectoc----------------------------------------_ THE ooMmomvvsALr* or mAsSAcxusErrs BOARD - ��� -4���������-----'��F-'^���A08�����-' ---- I�o------------ Fou.----'--'---- | DisposalTwOnstrudion ! Permissionis hereby '-_-''.............................................................................................................................. to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo............................................................................................................................................................................................... Street. � as shown on the application for Disposal Works Construction Permit No.................... Dated.......................................... ----------'----------------._-------------------.-- � Board of Health DATE.-----------_-------------------'--'_ ronw 1255 A. m. svLx/w. oosrow No......................... FEB............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H ALTH Ota/y).............of... . ..t`. ....` &A-ve-re-•._......................... Appliratiun for Disposal Murks Tonstrnr#ion Prrntit Application is hereby made for a Permit to Construct (,V or Repair ( ) an Individual Sewage Disposal System at: (' .. .:: I�1 .x.:: _.CA(is%...-�} -�- -�ll�----.. ... ......................................... / Location-Add*Yg�- f _ or Lot No. 1/c"IJ-•-f644-t-.c. ...... ......�.1_fl.�!�,�%r 1=bra-... .........;:� . -O .e1..� ... Owner Address W Installer Address U Type of Building Size Lot•z:.��.....C_Stf q, Dwelling—No. of Bedrooms....................!......................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria 04 Other fixtures ...... - ----------------------.---...........-----------------------------------•.-- W Design Flow...................�;,r� ...........gallons per person per � .ay. Total daily flow............ ..... ................gallons. WSeptic Tank—Liquid capacity-12.14allons Length.{S.)........ Width_ r' .'O.... Diameter_,4.'_`6'`. Depth...zf" x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........Z------- Diameter./7— f 4i... Depth below inlet........ G!:.`.�. Total leaching area,(,..`–�/....sq.f ►�a Z Other Distribution box (`; ) Dosing tank Percolation Test Results a Performed �� �� ---41�'241,�i �-.X--- Date----- ...... PTest Pit No. 101....4...minutes erinch Depth of Test it....._.lA Deto ground water....... Z .. f=, Test Pit No. ..minutes per inch Depth of Test Pit.......•-"........... Depth to ground water-------?./.......... a' --•-•-••---•--•�-------•---•-•-•--•..................: .................... ----�..... .....--- ------ Description of Soil./-/,1l.n ........1` ! �'��? �ry .�=.�v r��;. !:. �r'ry U ,r04.a w2 �� � < Vit' ' '�+ = `� rt,�. J_ 1. l.�rr�`�... 7 -�' f L srolltjl{!�• t1.ti. !�..fJt'fc�l�? _.�7 ,�G"� � U Nature of Repairs or Alteratioi —Answer when apolicable.................................................................../ILS..rtf..4�t�._.. ------------------------------------------------------------------------------------------------•.••-••---•--•--•--•-----•--••----•-----------•--•----•-•-•--•••---••--•--•--••---•-•-............-•---. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIS 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed................•------•-----......--------------------------------................--• ................................ Date ApplicationApproved By.................................................................................................. ........................................ Date Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------------------•- -------------------------------------------------------------------------------------------•------------•--•-•••-•---•......----•--••--•••-•••••-••-•-•-••-----••---•----------------•-•---••-••--••.--- Date PermitNo....................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' �..4r�.�,1Z,,. .........OF.... Trrtifiratr of Tompliattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by..................•-•-•••--•----•---...•--...........•--••-...._..........•-•--•--••••••••------•-•......•-•----•--...-•-•--••-•-•-••----•••-••------•-••••.........•••••-......-••-••......•--..... Installer at----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE....................•--...........------.......................•--••----••-----• Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD O� ,HEALTH .................OF... ..d'. i.....,/jllllf .............. No......................... FEE........................ Disposal Works Tonutrnrjtion Vprrutit Permissionis hereby granted.............................................................................................................................................. to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo............................................................................................................................................................................................... Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... ...-------••-•-•---------------------------------------------------------------------------------••....•- DATE................................................................................. Board of Health FORM 1255 A. M, SULKIN, BOSTON 2. r i� f h2,� yf �'� is �N•� '�yti 7 4 a F �5 n �ar.� -�'r�..,.:: ._...,�1.,._.«,�f�n.��.ti 'r��n,�� "�x? �wa.5:c..w„�.:,.3.tc d,.rari:���rL 5,,,�,.a„a.�:s �,.', - �f2,� v - �r't.• aft a,'' - _ i a �l T _ R.A.M. ENGINEERING ROBERT A. MASYS, P.E. ONE MASYS WAY HAVERHILL, MA 01 830 PHONE: (61 372-0449 08 September 2 , 1991 Mike Rizzotti North Andover Board of Health North Andover Town Hall North Andover , MA 01845 RE: South Cross Road - Lot #4 - Septic Design Dear Mike , Enclosed are three copies of the revised septic design for Lot #4 on South Cross Road . As you can see the leaching facility has been changed from seepage pits to leaching trenches . The trenches accommodate the topography and configuration of this particular lot . In response to a recent phone conversation with John Barrows of my office, we checked the actual topography as compared to the topography shown On the original definitive subdivision plan . As you can see we discovered some differences in the topography and have implimented them into the plan . If I can be of any assistance on this matter please feel free to contact me . Ver ru yours , Robert A . Masys . p .E F d' DATE- Sheet r of BOARD OF HEALTH TOWN OF NORTH ANDOVER SUBSURFACE DISPOSAL DESIGN REVIEW FEE_ PERMIT # DATE RECEIVED APPLICANT (�U sc-1& ASSESSOR'S MAP ADDRESS PARCEL # LOT # ENGINEER STREET < �p ADDRESS PLAN DATE REVISION DATE CONDITIONS OF APPROVAL: APPROVED DISAPPROVED 09, �Ct�c-(�-S `�cz..� t,���.. -tom � C�►�z-�v�S �s '�ca�.j 'nook, tic-; /•�•-t- 'i��--�s i t ir-c r� �c►•�c�'+1�W tyT�2�3'�43�� �-s "�+C�� '75) D Ad-7 0 Q —L�Q-4 -liSE A t Commonwealth of Massachus etts Cat /Town of NORTH ANDOVER, MASSACHUSETTS System Pumping Record . Form 4 C 1 2 2006 DEP has provided this form for use by local Boards of Health. The tem R;umping Record mu: be submitted to the Local Board of Health or other approvin j authority. \Rt'','ENT A. Facility Information - Important: When filling out 1. System Location: forms on the — computer, use only the tab key Address to move your -- cursor•do not Clt /Town use the return y Zip Code key. 2. System Owner: m - /- Name Address(i(different from location) . City/Town State ------ Zip Code - Telephone Number B. Pumping Record - -- 1. Date of Pumping Da -- 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) V;4eptic Tank Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes If yes, was it cleaned? ❑ Yes ❑ No r 5. Condition of System: �oode0 6. Sy em Pumped By: Name Vt Q Vehicle License Number Company 7. Location where contents were disposed: Si ature ofHau - Date -. ._._.. http://www,mas$,gov/dep/water/ provals/t5forms,htm#inspect t5form4.doc-06/03 System Pumping Record-Page 1 of rOWN U� pox t� SEP — 7 2005 5Y3'7EN-1 PUMPINU RFC l7 iTOWN OF iVORTH ANDOVER HEALTH D�-PARTMENT 4DDPS C/ 'sti sT' M •,c,, DATE OF pUkMNQ: tss�pp� ; Np y4� 00 tiA rUKt Gr spRviCe. Ue�irR Yh C'IUttJ. � 0000 KIAvY oV.BA38 KQ¢pn eht��� as ;N F�n� - � G�98iVE sOl.lp$ AjWLEitiCHpte.Q KVNBAA.4. SOL rD CA RR yo yey, rLpODED t urr ► trtr►•� rx.�M,�tGKr�v North Andover Board of Health Andover Septic 120 Main St. 47 Railroad St. North Andover Ma.01845 Bradford Ma. 01835 Haul Lic. #151-OOH December 2000 Install Lic. # 128-0 Date Name &Address Gallons Comments 12/1/2000 Murphy - 16 Crossbow Lane 1500 12/2/2000 Manzi -.72 Foster St 1000 - 12/4/2000 Grifin - 240 Candlestick Rd 1500 12/5/2000 Mcilvien - 57 So .Cross Rd 1 1500 Flooded 12/6/2000 Small - 440 Fosrer St 1000 12/6/2000 Orlando - 274 Foster St 1000 12/7/2000 Weger- 29 Barco lane 1000 12/8/2000 Walton - 161 Bridges Lane 1500 12/11/2000 Coflan - 73 Christian Way 1500 12/12/2000 Orlando - 7 Laconia Cir 1000 12/12/2000 Fitzgerald - Sharpner Pond Rd 1500 12/18/2000 Mangano - 324 Bradford St 1500 12/19/2000 Galea -= 1589 Salem St 1000 12/19/2000 Johnson - 91 Boston St 1000 12/22/2000 Senton - 1620 Turnpike St 1250 Flooded FOAM *hr CERTIFIED FOUNDATION PLAN ' . LOCATED /N No• ANDd�ER,MA• - ; SCALE: DATE: i� 23 33 Scott L. Gi/es R.L.S. 50 Deer Meadow Rood North Andover,-Moss. ' ume NV. ovr uScl-, iu-20 ,tem -(AMK 137.17 \ 1. 11 • '1`0) _ u� c Zt -(w�Z �IA1JE LOT 4- ��lSPt�G�D �w c r- -n�ts D�sR�sAt-5�{src-trl �scr►t�cr '546 IdD,818 S.F. c�.►s-tR�� AuD tax._C�Rf►Dit�G�. Hps Be04 tN Ac-amrvo wrnd lVe 07-11 n�stt�s tht�t�st' A►`tD TtdaT'ME ,Nl1Kfi�At•S tJyEt� Cd��oRNI•�o'1FIE pt,Aat - S t�tC S At t> 316 AAO 6+01-, j tdcRQSs �, / CERT/FY THAT OFFSETS SHOWN ARE FOR THE USE THE OFFSETS OF THE BUILDING/NSPEC TOR ONLY SHOWN COMPLY AND SUCH USE/S FOR THE WITH THE ZONING DETERMINATION OFZONING 061v LAWS OF CONFORMITY OR NON-CONFORMITY • {' , `T •A!im e R WHEN CONSTRUCTED. " ,%HEN BU/L T. 53