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HomeMy WebLinkAboutMiscellaneous - 59 PADDOCK LANE 4/30/2018 (2) 59 PADDOCK LANE J210/107.D-01040000.0 r SEPTIC SYSTEM INSTALLATION IS THE INSTALLER LICENSED? YES NO TYPE OF CONSTRUCTION: NEW EPAIR NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW YES NO CONDITIONS OF APPROVAL YES NO (FROM FORM U) ISSUANCE OF DWC PERMIT YES NO DWC PERMIT PAID? NO DWC PERMIT NO. 76 INSTALLER: -jGNh/ Soucy BEGIN INSPECTION YES NO: EXCAVATION INSPECTION: NEEDED: PASSED 5 /�T �oZ, l�/C/,r BY CONSTRUCTION INSPECTION: NEEDED: AS BUILT PLAN SATISFACTORY: YES.) APPROVAL TO BACKFILL: DATE: BY zd;Z -T FINAL GRADING APPROVAL: DATE BY FINAL CONSTRUCTION APPROVAL: DATE: BY IVOA /F DIN 0 /3-C = 47 " /4-D = 3;1161' /3-D= 5'8'' 4191vk OCA ± ' lom •L]. 13o x iyv /01 .20 Loo 9 L?Qx ouf /off--oma i5 o D GSL - S,�P fiC f�/Vf�t AIAIC a a I M r W CA q. Hwy ��0llIlYO'� Q 4a COMJAWI / o f N T T 9q�gN Sil'�S� w 0 0 r v •/o J v •t o1 o• o/ 6 fol r- rot o NO/-/{10/vHny -:�p/V/fS/x.7 ILY70 P lmll CYO J M �a COMAIO 0 9R�RN S1L�S�� 1 w 0 o r (L3E--I o .19 6v •I a157 *v,701 6f�7 nrof o rye,, f0a k? OY /V/f s 1 X.7 , » 0 AF brS Q7 -r r b, I'll, I'll, p .01 J M J c - ' Co a �1 t � e 9 m s o � a 'o. 3 . Z a � J 1 - �S�•y3 - l mV. MPE OUT OF HSE IL� E> U `„� 1 u LAI V_ Pi l nrr0-%u� I P�5• ©y 11,1i[ApEe rti—pF ." 1�Z`�°j5 �� U ! J UP. 1 p� INv v�P .uir .�ay . \stA.s� 5►Y'S►T �M It" r-klD oir PIPE B9 o A.NA t> r--z- \ \A. 41 1� 1 ti . - ,. - F2AN'�C C.�Ei1►.l4g � ASSVGI�.TES���1�Ci• .�,, Z'��� Ef�GiNEE2'S�, AC�L.arIITEC.T'3 Form No.4 Town of North Andover, Massachusetts BOARD OF HEALTH O.ctohpr .30-1995 CERTIFICATE OF COMPLIANCE This is to certify that the Individual Soil Absorption Sewage Disposal System constructed ( ) or repaired (X) by John Soucy INSTALLER at 59 Paddock Lane , North Andover, MA 01845 SITE LOCATION has been installed in accordance with Board of Health Regulations as described in the Design Approval Site System Permit No. 757'- dated August 17 19 95 The issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. BOARD OF HEALTH Form No.4 Town of North Andover, (Massachusetts BOARD OF HEALTH Q.ctahpr.3Q-19 q5 CERTIFICATE OF COMPLIANCE This is to certify that the Individual Soil Absorption Sewage Disposal System constructed ( ) or repaired (X) by John Soucy INSTALLER at 59 Paddock Lane , North Andover, MA 01845 SITE LOCATION has been installed in accordance with Board of Health Regulations as described in the Design Approval Site System Permit No. 757" dated August 17 19 95 The issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. BOARD OF HEAL H I Y ------� FORM II - VERIFICATION,FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section****** * * ** APPLICANT: /" � `jL"��G�f/�i�� Phone LOCATION: Assessor's Map Number Parcel Subdivision �^ n/ Lots) �(Q� Street �> 0- rT iD b d (z St. Number ************************Official Use Only************************ RECO NDATIO GENTS: Date Approved Co servati Administrator Date Rejected Comments ,Date Approved Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected 2�a� Date Approved is Inspector-Health Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date LJ r ivA1W KUA U /YtA/y Jt I t7AGt/ _ SIDE SETBACK = S89'56'47"E— S89'1 7'45-E S89'17'45"E -To.08, 110.00' - 51.34' MAP 1070 LOT 1 p5 N/F ROBERT & MARGEI L Q T 9 BRENNER N 49 PADDOCK LANE o AREA=44,431 S.F. ��p N un \i N LOT lo3 o N PROPOSED N: /F ADDITIONrn SALLY 0. 720 / INA \ �EXISrING a )CK LANE l ` 24' , EXISTING WELL. UA 36 19.5 pWELLING EXISTING _ co l cc °i L=190.39' _ R=150.00' 150.43 1` tAl 1� 57349 39 PRIVATE 126.45 5p� WIDE r-1PY 07 196 17. 25 OSGOi_D DEV. P. 01 MEN40 To: SA.NDI"STARR. FROM: BEN OS(MD .IR SANDY'- I HAVE RE VIE W'E.D TITLE 5 AS IT PERTAINS'I Ci !"t-jy,\T SEP.OF BEDROOMS?HAT A SYSTEM C.K L BE bl~SICYArED FOR AND i HA�'E COME UP WITH WHAT I Tllr.Nyy APPLIES TO 59 PADDOCk LANE. TTILE 5 STATES THAT A HOME WZTI?MOR.L:T'14ALN 8 BEDROOMS MUS? $E DESIGNED FOR THE NUMBER OF TOTAL ROOMS DIVIDED BY"! AIO. IF THE NUM3ER OF ROOMS DIVIDED BY TWO IS A NUMBER PLUS A FRACTION i IE- YOU SHALL ROUND DOWN To7TH NFXT LOWEST WHOLF Njj-,MBF.,R, AS FAR A5 59 PADDOCK LANL,IS CONCERNED YOU WOULD c.41LCULATE TIM DESIGN FLOW AS FOLLOVVS. I I TOTAL ROOMS/12=5,5 : T EINT ROIND DOWN TO 5 I HAVE ENCLOSED A COPY OF THE HOUSE PLAN ATH FII ROOMS NU1vik3I;REb AS WELL. AS A COPY OF THE SECTION OF TITLE 5 THAT PE.PTALN,TS TO TMS SITC'.A.TION. THE ONLY REASON I FAXED THIS TO YOL)IS i AM OUT OF TTTE OFFICE FOR MOST OF THE DAY TOMORROW. ,'IR'YOU HAVE ANY QUEST10\S PLEAS*.CALL BEN i k i` LJI c. TO Ick y` 0rt k.,.s A. bRr�.v.t � F• L^t /1 �.t-..._% .Ar - � � f 3 / { o,rt N►+r I �I (8f4t f7 ttocr(4 AKt } -- ---- -- :_- Z.;xZ v DR,,ir..y_ tea... t i tom„ t- '-_.. •_ 0.1 r.;t f✓' R - -" `— __ � �J ��FrHpf+t'�-}� E)trit '"°' ;. � _ r � �A}( Z.4,-r, [ E +tr:rrr ' E 5�+.. F !� irr+f4tS t�t:R:tbaSJRh+ .S Or fi rr ir'� b.tV :;TID.rb, 10':Al ( i By my signatoVe bel'ov, -hereby kit., to the VILUdILY Of th6 !IGar T LOSt plan of sy extsXtTg h— at 59 Pad-- )k Lan* CMCOSI&N. An—I COO -7--T T- Tf' Lf V-0 ST F/0 0 R , By my signature below, I hereby attest to the validity of the floor plan of To 7D ECK { M% existi home at 59 Paddock Lane. g 4 - -96 MI HALL GfkAGOSIAN 0a ` r } X ISTNG i 2 C h R --- Douai} OS 2 10 ��/\ `�V 1z L3 ATH I `r y 1 iE't,'CSWIRY. eta /`� bwzo FF Ct �-It1 ISG tZ�'t fir"0 53 P c{�d ocK t "t O N•A�dour2, a �ts � — _ � Rpt R P►Ant aooR T J4 a ' � ��xrs7�nlG ) By my signature below, I hereby at- test to the validity of the floor plan of my existing home at 59 Pad- . d ck Lan 5-7-96 CiXeT M cFMI GERAGOSI N �;Ccic�aoN t 4FNA`� i!as7tX ��'� C oSeT I - I - eroseT - 1 I cioseT oa � �CcJ Root 3 r atc�R M i \ � oNo.4 1A � TEWKSBURY. w MA y oy�Fgl rH Of MPSSP� • � i 1 i5� 1�Rddock 1.11 Ct-tAP RAFTerZ ,�cc7io^1 _ I 11 . ntd�u�2 of ifs f .00R PUhJ ��mv ��- � � G � ��C�-a-� � ') -� Zaalj Piz i , PO-,1 =,h1l Gibb$ 3,, (Yb)( °� �0 -9 2x°1 r 7 �tdd �51?j)v k+r�J Y�dd i7J 1�rc>> ^ass�%N jo Hob� Nw i Ma�v V��l 1J 11 tin ! - Ati 1&SJIl.1 v I111�ba (y)(n t Lx h z 1)(.z X41 I N woo p.��J fS1!!S o�L (stov97 0 la ZX C SJav�olX4 O 1 lO OP LY)in r,ol)1�1J (s�v9) zixZ1 HQ 5 br,s -59Alazle � }r L1ooZ1}�aQ /U3AOONb Hca(7U ON 30 NMO( cno�M M SSXBZ TO DATE TIME AM P o2"� (-.P=M - H FROP AREA CODE p O OF EXT. E nn N C, — - E � Mis kEis IM !kE O IS D NED❑ IRACK CALL RETURNED❑ WANTS TO ❑ WILL CALL ❑ WAS IN ❑ URGENT❑ iL- 'EL' RE JOYCE aRao�.!aaw Town of North Andover t NORTH TOWN CLERK OFFICE OF °.t"`° NORTCO WNITY DEVELOPMENT AND SERVICES A MA,315 ' 2 1�1 P� '96 146 Main Street North Andover, Massachusetts 01845 9SSACHUS�t Any appal shall be filed within, (20) c!a: s aft:r tl;e date of fi;!ng Cf this Notice BOARD OF APPEALS in the Office of the Tow; Clerk. NOTICE OF DECISION Property: 59 Paddock Lane Michael & Diane Geracosian Date: 3-25-96 59 Paddock Lane Petition: 08-96 North Andover MA 01845 Date of Hearing; 3-12-96 The Board of Appeals held a regular meeting on Tuesday evening, March. 12, 1996 upon the petition of Michael & Diane Geracosian requesting a variance from requirements of Section 7, Paragraph 7.3 and Table 2 of the Zoning By Laws as to provide relief of for sideline variance of 10'6"for the addition of car and second bedroom. Lot dimension area 43,560,existing setback 44,431,Street Frontage required are 150,existing are 150.34,front setback 30',existing area 87'+,right side setback 30',existing setback 34'6",left side set back 30,existing set back 44' relief requested 19'5". Rear setback 30',existing setback 175+. The left side variance was granted with the attached condition that 10' screening non disturbing of land of trees on the westerly side and that the garage enter from Paddock Lane front. The following members were present and voting: William Sullivan,Raymond Vivenzion, John Pallone, Ellen McIntyre, and Scott Karpinski. The hearing was advertised in the Eagle Tribune on 2.23.96& 3.1.96and all abutters were notified my regular mail. Upon a motion by Scott Karpinski and seconded by Ellen McIntyre, the Board voted unanimously to GRANT relief of 19'5"to 10'6"on the westerly or left side with the condition that 10' screening non disturbing of land of tries on the westerly side and that the garage entrance be on Paddock Lane. Voting in favor; William Sullivan,Ray Vivenzio,John Pallone, Ellen McIntyre and Scott Karpinski. The petitioner has satisfied the provisions of Section 10,Paragraph 10.4 of the Zoning Bylaw and that the granting of these variances will not adversely affect the neighborhood or derogate from the intent and purpose of the Zoning By law. Board of Appeals William Sullivan,Chairman ' BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Town of North Andover, Massachusetts Form No.2 NORTq BOARD OF HEALTH o.....° AL /4)6 7 o A °• �`' DESIGN APPROVAL FOR HU SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant ��6 O� J/Q Test No. Site Location Reference Plans and Specs. ENGINEER DESIGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. zi ��� CHAI A BOAR OF-HEALTH Fee Site System Permit No. _� �-�,�1��'c�s f � ( �'�,��yT Town of North Andover, Massachusetts Form No.3 t NORTH BOARD OF HEALTH Q oL I . p I 19- �.,S�,r;o•��� DISPOSAL WORKS CONSTRUCTION PERMIT swCHuse Applicant + N E ADDR SS TELEPHONE Site Location Permission is hereby granted to Construct ( ) or Repairan Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S. . No. ArEArWT�r—;;- Fee D.W.C. No. F z4d "vf, PLAN REVIEW CHECKLIST ADDRESS Q3-5? � ENGINEER GENERAL / 3 COPIES STAMP LOCUSy NORTH ARROW SCALE CONTOURS v PROFILE C/ SECTIONS BENCHMARK -L--' SOIL & PERCS k-'� ELEVATIONS WETS. DISCLAIMER WELLS & WETS- WATERSHED? /Vo ETSWATERSHED? /Vo DRIVEWAY L---(-Elev) WATER LINE FDN DRAIN SCH40t,�-' TESTS CURRENT? L../ SOIL EVAL SEPTIC TANK r � MIN 1500G 'v/ . 17 INVERT DROP — GARB. GRINDER V6 (+200% EDF) 25 ' TO CELLAR----- MANHOLE ELEV GW # COMPS. D-BOX SIZE # LINES---& FIRST 2 ' LEVEL STATEMENT INLET/ao- - OUTLET 160-66 = 17 (2" OR . 17 FT) TEE REQ 'D? AVO LEACHING MIN 660 GPD? RESERVE AREA[V 4 ' FROM PRIMARY? '— 2% SLOPE 100 ' TO WETLANDS ✓ 100 ' TO WELLS L—""' — 4 ' TO S .H.GW (5 ' >2M/IN) 35 ' TO FND & INTRCPTR DRAINS 325 ' TO SURFACE H2O SUPP 4 ' PERM. SOIL BELOW FACILITY MIN 12" COVER 4--�FILL? (25 ' if above natural elev; 101if below) BREAKOUT MET? TRENCHES MIN 660 gpd SLOPE (min . 005 or 6"/1001 ) SIDEWALL DIST. 3X EFF. W OR D (MIN 61 ) RESERVE BETWEEN TRENCHES? IN FILL? MUST BE 10 ' MIN. 4" PEA STONE? VENT? (>3 ' COVER; LINES >501 ) BOT + SIDE X LDNG = TOT (L x W x #) (DxLx2x#) (G/ft2) Copyright 0 1995 by SA.. Starr PITS MIN 660 LEACHING MIN 1 (131x16 ' ) PIT MANHOLE/PIT GW MIN 4 ' BELOW BOTTOM EXC 2x EFF W OR D 12"-48" STONE BOT + SIDE x LOAD = TOTAL (L x W x #) (2x(L+W)xD x #) (G/ft2) CHAMBERS MIN 660 LEACHING GW MIN 4" BELOW COVER >3 FT - VENT MANHOLES 12"-48" STONE SPLASH PADS SLOPE . 005 BED/TRENCH (Bed max. 60 ' X 601 ) MIN 13 ' X 16 ' PIT BOT + SIDE X LOAD = TOTAL (L x W x #) (2 x (L+W)xD x #) (G/ft2) FIELDS MIN 660 GPD v 900 ft2 BED 6-'� GW MIN 4 ' BELOW BOTTOM OF FIELD PIPE ENDS JOINED?_/4" PEA STONE? '- DIST LINE SLOPE .005? >31COVER-VENT —` SCH 40 MIN 12" COVER RATE LDG X 660 = X G/ft2 REQ'D (ft2) LXW DOSING TANKS AND PUMPS DIMENSIONS X X = PUMP CAPACITY gpm L W D 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 Copyright© 1995 by S.L.Starr TOWN OF BOARD OF t EAL17i H ww J MAS n {oQF FORM U - VERIFICATION FORM is 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: 6-�/C�G ,f Phone 4592_80Z8 LOCATION: Assessor's Map Number Parcel SubdivisionLot(s) ((�� Street d",4®h0(z St. Number ************************Official Use Only************************ RECO NDATIO OF TOWN AGENTS: Date Approved Co servatioln Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected Date Approved is Inspector-Health Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date SIDE SETBACK = S89'56'47"E-- S89'17'45£ S89'1 7'45"E 30.08' 110.00' _ 51.34' MAP 107D LOT 10. N/F ROBERT & MARGL L 0 T 9BRENNER N 49 PADDOCK LAM q AREA=44,431 S.F. W � W p 'gyp N W \ N O N Lor 103 ( PROPOSED N N- /F ADDITION SALLY D. EXISTING INA )CK LANE 5A,.6' 59, EXlSTlNG WELL. 36' 1 pWELLING \ 1 EXISTING \ \ L=190.39' R=150.00' 150- PRIVATE 50) WIDE 12645 0 ` S t �ir ;� `, ;� '�°`;} ^?t' i t - M. .i. # f'' •�' �ADo L j ♦,4 Y � !' s.r-•',i! i ,;S S A�f,3-y`t` i+ly.�".� ! , _ 1 � /�Q • .. x�tyr�'� 1 s, ', �' y # * +!",p.t.Y tr i!• f€,�k t s`it { f � ' QA— �a'�':�,+r ,�} E-, ��� r „� `4 _f� �t �, { E I � r '' • � f i � e + '`r }` ink i # ' _ ,� "T;,4.r ►,+. '� .r d..,:._: K�', \.t i tic�`r � `F ��r - 'l � � � +s �`� `'�fik",\, •� "S t �! •` 'f-` ''' • 4 41.�P F E 4 r e t� ,�,�}s. I�r 4 }1•t'�(�b••-1 �1'jt't i�.��� �� f N ��i Cr}� �r '�'rtr st, ;3�rstj #+`r� t'' ►} t ;i + rQ✓, 1►�.z}ry7,y`r'!`��fry���•!��•ly'�J" �•ja'Y#�j 111 } :�:� ''t�j�:�`��i 1 �L, .;1 ti'1,tt{;l;r r; 4;ir'�'. x1 t • l' "t'' ' C� ' `� r t " ( g-- o ,c / ',`M,� .�1ri�jMy°`}��Srr`��'i'+�.�����ti1.�`r,�i�/y��,�� �•� � •�`S�'���.# 4 1 i f� 7 r+� itr''i),�xr;��'q'�j�tf����t4'�tc#rK���*'�.�� .r�t<�w � �,'#.y# 1•� - i• �. t Y r• 4 ?;�} 3 da r �r tit � r�.� �g t.j� x,}�•YF ' V�f +i' il .�;�;1,` `{A "d��7; r s �IA#i t •�i�''!t'� j4'%f,r�,+i1 ` �,;;tt'/'•,�f}, t,�,�y 1,�`,�E�:, r �';{�„},y'S�, �'�1 �,�, {, `�s�j}°��'fX,`T; , •. •' "Ai iO' +{t.��,,t ,�tA;/•r+�t 1,..�Af'�.,kl{ i�l f� ��fJ.��i�f ,{rf,s'� t+•riSSSSS��}\�}tl;i;`�� '•i�•���tf�l +��,�'y:�,tt ��;r�f;; `�� •+r . I v j�i.#j;�'�ftl,�'�`a�rry�'} �t x�� tK -'�3Ji} `'� � '''�.�•t��`,�y - ! t r �: i•'r .t xr;'� t�{�t.�� ({ ,f c trd x���,(r,�i.`�I.`�k�;{fit '�$`.;S�,rr �fi k��.% ' � �lx �•rt,(d ss,�y � I - �.! � •'� ' ,~'•�E��,/rpf�t 'y�- r1}�' tF�'1� arw�''4.J '/r.�. •f)t��•f�"��x'r�f�{d��iK �Cf�/�i�{�� i'r,�F,�F LO',�"..�� � R �I'I{�� �^' YM y � 1';'•!�'` J''s'iy.�"S,¢'j .r' '-#f'�`s.' f�d'I•,�. '° � � {{rr i• V /.ir rS+S1r �{i 0 ��j xd��#� � x�f iX'�i Cxi+"` .•.�'. li,.Y�ff -7� .Lj��'� ,��� iY' u� F.- �j �'��y`r�;*.f i��9`'•�`� •j'( ,y.��{�`'i'�'1 �?}._'�' �i�, y,,''�a ��' 'i�Q���'.�a"a<' ��.ip. � .�4- �&��� y���'�y�4 41 V-4,t1 �'1T r.4 ¢� ile y' if f � " i+l.Y��'b�,r'�(,�1.� t?}€ y �" ��`3'r,y '`.:.��#�lt...,..jr,',S�<•FRt•ye,�,��,.. ��'.g�h��.,` f M ,ar@4p♦�3Y e f ,. !�` rtN-A 41, R �y P ' �.:;-r'��e t: �° rr�.. �..s.;.� .fid`. • .. d � _ - 3f Health Andover,Mass SUBS IRFACE DISPOSAL DESIGN CHECK LIST LOT ✓ ►� DISAPPROVED DATE„ dells Reasons: -,owe I 'itle V FAIL C[ Y•� � teg 2.5 'The submitted plan must show as a minimums the lot to be served-area,dimensions lot #,abetters b location and log deep observation hoes-distance to ties location and results percolation tests-distance leaching area design calculations & calculations showing required location and dimensions of system-including deserve area existing and proposed contours (g) location any wet areas within 3.001 of sewage disposal system or disclaimer-check wetlands mapping (h) surface and subsurface drains within 100' of aewage disposal system or disclaimer (i) location any drainage easements within 1001 of sewage disposal ��11 system or disclaimer-Planning Board files (3) known sources of water supply within 2001 of sewage disposal system or disclaimer (k) location of any proposed well to serve lot-1001 from leaching facility (1) location of water lines on property-101 from leaching facility (�a) location of benchmark n) driveways o garbage disposals no PVC to be used in construction septic tank (q profile of system-elevations of basement, plumb, Pipes eP , distribution box inlets and outlets, distribution field piping and Other elevations maxb= ground water elevation in area sewage disposal system S ) plan mast be prepared by a Professional Engineer or other professional authorized by lax to prepare such plans Reg 6 / SeDtic, Tanks (a) cepa- t es- 50% of flow, water table, tees, depth of tees, access, puMing b) cleanout 101 from cellar wall or inground swimming pool d) 251 from subsurface drains Reg 10.2S Distribution Boxes s o—ape ggrea�t 0.08 Reg 10.4 b) sump _ _� ivvtCl'n ANDOVER, MASS. L CT . DP 7 19,8/ LSdftifRD�OF BOARD OF HEALTH FROM: T7?1\K)Y C. /+� ING DESIGN ENGINEER Re: SewageSoil bDisposal sorption V System This is to certify that I have inspected the construction materials of said disposal system at I c; q ' PPDi>oC,IC LAN£ No . NO DOVVE - Site Location North Andover, Mass. The grades and construction materials are as specified in my plans and specifications dated 1 �J1Je 8 72_ and CT. &7 19 9 / e =_ Reg. Prof . Enginee /Reg. Sanitarian Board of Health North An.i,-Ir i ,ss. SEP`i'IC SYSTEM Iii iALLATTC N CHM$ LTSr • LOT #�` �. F C7VED� DATE 1)IS t'PdGv rD DlA~T-9— XCAVA'I`ZON OK L-- i V ran OK 1. Distance To: a. Wetlands b. Drains Well r i 2. Water Line Location i 3. No PPC Pipe Septic Tank=-- ,, a. Tees -_Length & To Clean Out Covers - b. Cement Pipe to Tank - On Both Sides of Tank .F 5. Distribution Box a. Covers & Box - No Cracks b. All Lines Flowing Equal Am ants c. No Back now 6. Leach Field or Trench a. Dimensions b. Stone Depth c. Capped Eads { d. Clean Double Washed Stone 7. Leach Pits, a. Dimnsions b. Stone Depth c. � sh Pads d. T s e. , lean t Pipe to Pit - Both Sides f. Double Washed Stone 8. No Garbage Disposal / 9. F'i.nal Grading Inspection 10. Barricading Covered System 11. As Built Submitted - a. Lot Location ! b. Dimensions of System c. Location with Regard-to Pere Test d. Elevations e: Water Table �j PHONm GALL) FOR "�'� DATE d TIME AJ HONED OF PHONE YOUR CALL AREA CO212 EXT NSION . � EASE CALL MESSAGE WILL CALL AGAIN CAME TO SEE YOU WANTS TO SEE YOU SIGNED TOPS FORM 4003 V VA > ad ,'t�•ooh �L 1n LL I- a ` }� _ - 0 dip JJ x " to cIr o a rt 7 CCa �t r tj -.fi..y� - � �� K ., ,j.• .-5�}`; `.t• 3ti .�� .'M, r �." .. il' $'y �,h � 5 $7# �. 4'3'x' ti y�,;.i r:'1 • y�.•r' } n� r '�`w ... :°'. J$' .� .3.. •. ..,^r.. „.. .^.t T'•.?I �R"°, + r .x fl.�z.. xic: ..�}' .y5 �#.. _ _. �__.. .. � _.._ .,. ,. . ."r �.: '.f•i"r�` � t .,. � .-::"�, a,,.i. '; wA#„, w.. ,r'S> aE'i�.4� n�5?.�” y, '-;r, TOWN OF NORTH ANDOVER. SYSTEM PUMPING RECORD DATE: lIIZ3 SYSTEMdWNER & ADDRESS SYSTEM LOCATION (example: left front of house) Aaly6c, , Z � DATE OF PUMPING: QUANTITY PUMPED /,1�00 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) SYcTEM nU]"APED BY: COMMENTS: <"g CONTENTS TRANSFERRED TO: L r � i i i i TOWN OF NORTH 'ANDOVER SYSTEM PUMPING RECORD 1 STEM OWNER & ADDRESS SYSTEM LOCATION (example: left front of house) 50, � D ► U:C'I'E OF PUMPING QUANTITY PUMPED0 LLU1.� C. 1.'SS1'00L: NO YES SEPTIC TANK: NO YES !/ MATURE OF SERVICE: ROUTINE EMERGENCY uli.>rRV:\TIONS. GOOD CONDITION, 1/ FULL TO COVER HEAVY CREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSI-VE SOLIDS FLOODED SOLIDS CARRYOVER O�jHER (EXPLAIN) >l F'I'LM P U M P C D BY: C.'U.M Yl FNTS: C.uN I I;N r5 tiZANSFEIZRED TO': Commonwealth of Massachusetts W City/Town of No.Andover System-Pumping Record Form 4 4M 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: # F� When filling out 1. System Ica tion: forms on the --, G - - i TOWN p�,�aYM�,��oVe OC r� computer, use 2 only the tab key Address to move your No.Andover t Ma ` -01845 cursor-do not use the return City/Town State Zip Code key. 2. System Owner: Name Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date( Z2. Quantity Pumped: Gall ons 3. Type of system: ❑ Cesspool(s) .eptic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes If yes, was it cleaned? ❑ Ye No 5. Condition of System: 6. Sy Pumped By: Name Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: Stewart's Pre-treatment Plant, 20 So. Mill Bra ford, Ma 01835 Signature of Hauler Date Signature of Receiving Facility Date - t5form4.doc•03/06 System Pumping Record•Page 1 of 1 t / 0 J 0 RT n Rec'o'rd a �C USE7 , �. I ,;,;. �?.t,q�,� . ,, ,.y.,.y,;: '.;` I :;• SEP 0 8 2008 CEP hay provldod ;nli�low, ',, ao av _on";4vC !0111910:8. ?;eJ ri4 ,'ANDO\fEA s: A rac!Iir y infor,�,;:: . �-�''--;•—;�I,I l.�I,r 2..� Sya;am Ownar A�Clsi� (IItlVf�r�nl rcm buucn; ,•Pumping Record (X� - - 11L11L t' � mplr� ' 1st Yre Cl ayslam; v ass, �' a . 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UOI1��lJlOJUI 1 ��d44��d314 u I, „ou©dNV 041 orl ! oIVl „pt,o o'po ll,,Do,,oi,'C'C; o16, ul,lo rr, 60OZ /1 „j.1 ir( 'l' ;t'�;i;fr41/1<�ht ld,'{I�y�/�r /�' 111t1i' fJy: Ile 7-7 �o4)L -a & 9 9, AJT-P, 5 Nps��Mp Form No.4 Town of North Andover, Massachusetts BOARD OF HEALTH QGtnhPr .3Q-1995 — CERTIFICATE OF COMPLIANCE This is to certify that the Individual Soil Absorption Sewage Disposal System constructed ( ) or repaired (g) by John Soucy INSTALLER at 59 Paddock Lane, North Andover, MA 01845 SITE LOCATION has been installed in accordance with Board of Health Regulations as described in the Design Approval Site System Permit No. 757" dated August 17 19 95 The issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. BOARD OF HEALTH