Loading...
HomeMy WebLinkAboutMiscellaneous - 65 SUGARCANE LANE 4/30/2018 (2) / -65 SUGARCANE LANE 7 21 b11 06.:;-0240-0000.() V V c V --��. ♦ yy :+ei"� . -� Lj, hilSo, ✓a L. *.� r 'rr f ick.-.r.. r {. - >t .F-. ' J a < _ MAP T� PARCEL STREET ��C/�/Y TL i HAS PLAN REVIEW FEE. BEEN PAID? NO PLAN APPROVAL: DATE r� �9 APP. BY µ DESIGNER: �'n � �� PLAN DATE CONDITIONS yYftiDit`C�1�/ ` 861/ �� WATER SUPPLY: , TOWN : WELL : - i. WELL PERMIT DRILLER ' WELL TESTS: CHEMICAL DATE APPROVED _ B TERIA I, DATE APPROVED.._---___._.-_-._-. ' .. BA TER II DATE APPROVED, COMMENTS.: FOR U APPROVAL: . , APPROVAL TO ISSUE ES NO . DATE ISSUED ��7 � BY CONDITIONS: _ FINAL APPROVALa ALL PERMITS PAID ES .`.' NO WELL. CONSTRUCTION APPROVAL YES_ NO SEPTIC SYSTEM CONSTRUCTION APPROVAL ES NO OTHER YES NO ANY VARIANCE NEEDED YESNQ FINAL BOARD OF HEALTH APPROVAL: DATE: Commonwealth of Massachusetts City/Town of System Pumping Record y Form 4 DEP has provided this form for use-by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using.this form, check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Le ' ht'front:pf::ho��, Left/Right rear of house, Left/right side of house, Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under deck Address Cityrrown State Zip Code 2. System Owner. � C2\r"-s Name Address(if different from location) Cityrrown RECEIVED State � p de 5 � � -3� ° Telephone Number 2,3 2013 -FLN1A/ 4 B. Pumping . .elto.',aw.... ........ , 1. Date of Pumping " I 2. Quantity Pumped: Date 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 5. Conditiory,of$ys�; 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location ere contents were disposed: SQ Lowell Waste Water Signitufe Haule Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth. of Massachusetts Rei, EM City/Town of System Pumping Record SEP 14 2006 Form 4 TOWN OF NORTH ANDOVER HEALTH DEPARTAENT DEP has provided this form for use by local Boards of Health.. The System-Pumping-Record- ust be submitted to the local Board of Health or other approving authority. . A. Facility Information Important: When filling out 1. System Location: forms the computeto r,.use V only the tab key Address � �` to move your � l/_l cursor-do not Qi /Town use the�return tY Statd Zip Code .key. 2.. System Owner: - 'Name ICI Address(if different from location). City/Town. Stat p Co Telephone Number B Plumping Record -7 �- i: .Dateof Pur. Date 2. QuantityE'umped- Gallons .3. Type of system: ❑ Cesspool(s) El Septic Tank- ❑ Tight.Tank. ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes e No If yes, was it cleaned? ❑ Yes`❑ No 5. Condition o System: 6: Syste Pu pp dd B Name Vehicle License Number Company -- 7. Location re contents were d* osed: Sign ure uler Date hftp://www.mass.goqvide ater/approvals/t5forms.htm#inspect t5form4.doc•06103 System Pumping Record•Page 1 of 1 TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: SYSTEM OWNER &ADDRESS SYSTEM LOCATION 0V�5 (example: left front of house) &s DATE OF PUMPING: `boQ-QUANTITY PUMPED 1.50-C:) GALLONS CESSPOOL: NO J 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: �A • L..GG AT�O 11..1 F) I/��'�'C��/ ` �J Of�T Fd A �...�flC?Y ErP� �M AS.S• :'� S NERE3`1 `� �t411E I►.�S4G'C�-� T41E C.00STt`a`! �� �I�SiR��eT1DN A►-��t►�T�(�t�U�N� , N�aS .1tJ AC1Ga►- w t'rvl TNtr �StGaJE2� lt �.Pa�D-CKi�T CNE SPS. tk5.700 ,PNo 3 to GMF" 1 zl-7 �3�561 S.F, � ��,�5-c, �11_D X83, •s o As-�tLT V ft ly, our U,_140,28 •• aJf TANK. � t383o `• ,� -iu P <3a,1S 2,14-11 F {, THE C F''FSiE.TtS l�a�.•.-c��."T�F�►fZ,, .'�y�,?14Qt�C�r;�u SF�T;s �vj ,1 t¢7u�:.N Al..�fl. 7►c.iC�M 4fi�li?✓' ,L�s!. r�'�.fC. o f SL.G o ; fir. S K a k1 1.1 C.o1.lF�l.. k1 TFi THEZ.oA11uG •! �P-Ar— � r r E l...A`c.!S o F C c�"��o2.M"T`�/ 40C, I.lo►..1 Cowl F'o Q-1-1 fTY w ►-t E.t..t C o ...1"' I..IS"rE'.uGTE�D. AS-BUILT CHECK LIST and FINAL INSPECTION Proposed Elevations As-Built Elevation House /v 9,� 7 Tank IN 139,17 Tank OUT13 L �a f 9, 'y D box IN 13dl D-box OUT V 3 3.� i3 g ,3� Trench Inverts Line 1 / 5 g, Line 2 Line 3 Line 4 Bottom of Exc. Stone OK? t''� D-box checked? Pipes cemented? �— V �� `tA VI'9 1 • /l l�lr/dw/�/Y f; i:A �L' YVIrYbAr tl 0 rri'"11w Town o ', 0 Anover RIVE1AY ENTRY PERVIA [A� - , - ~��An� ver Mass. 19g.� �i]Y . �. H E W i.K BOARD OF HEALTH PERMI L 0 THIS CERTIFIES THAT...��... ..... .. .......................................... g �•�•� �� BUILDING INSPECTOR has permission to erect!Y..K.d� � . ildin son` : �. � Rou Wr6 � l .�. � . .. .�a .�0At..�.lf�/�`j1►Rirft h�mney to be occupied as. •• � � 0inar provided that the person accepting this permit shall in every respect conform to the ternsr''II11aa�e �lp111 `g ONLY PLUMBING SP TOR this office,and to the provisions of the Codes and By-Laws relating to the InspectionRtttIt� aUbA$trddt9o8_& B.C. u Buildings in the Town of North Andover. DATE 11- 9� �`_.�.FEE PAIQ'/ted• © cr VIOLATION of the Zoning or Building Regulations Voids this Permit. 'Sd p J t_XF'IIZES IN 6 MONTHS �� ELECTRICAL INSPECTOR PERMIT FOR FRAME/BlR � i91._ESS CONSTRUCTION STARTS Ser icee • l 'lill Final 0 -77 DATE: d^� FEE PAi z LAZ� . . .. BUILDING INSPECTOR GAS.IF� f' T R Occa anc Pere it Required to OccupyBuilding �Final 3 Display in a Conspicuous Place on the Premises FIRE DEPT. Do Not Remove Burner No La hing to Be Done Until Inspected and Approved by STREET WLI, Smoke Det. Building Inspector � 5;�6 S7 9 1 Town of North Andover, Massachusetts Form No.3 O� jORTH BOARD OF HEALTH y^ tt`•o 'sem ti0 1 F 9 DISPOSAL WORKS CONSTRUCTION PERMIT SSACHUSE Applicant \�\ NAME U ADDRESS TELEPHONE Site Locations3 Permission is hereby granted to Construct) or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. CHAIRMAN,BOARD OF HEALTH Fee �� D.W.C. No.. �e( �- Form No.Z Town of North Andover, Massachusetts BOARD OF HEALTH 19� AORT#f "� DE F' SIGN APPROVAL FOR . • :'. « 'r1•b•.ne•A�'h Ustt SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM . Test No Applicant Site Location 33 DATE Reference Plans and Specs DESIGN , . . Permission is granted for an individual soil absorption sewage disposal,system to be installed in accordance with regulations of Board of Health /C..� CHAIRMAN,BOARD OF HEALTH Site System Permit No. Fee �`� # FORM U - LOT RF'LK SE 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: Phone LOCATION: Assessor's Map Number 106,4- Parcel -�klo Subdivision �/f4mD 41-1C£ _--/7— Lot(s) _ 3 3 Street -fU(r� F/g"/A�, !�/�� St. Number --pl-G5 ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved 341fL. Conservation Administrator Date Rejected Comments d Date Approved T n P1 er Date Rejected Comments Date Approved / Z2 Health Agent Date Rejected Comments Public Works --sew-or/water connectiont driveway permit D net up-I 0DID ro.ieel 9L/9t Fire Department Received by Building Inspector Date i h 112 i rz6 ell al M — O i e► 49i! JII d r'• t l jii: 4 t v 3 3 ' I r 1 d s Town of North Andover, Massachusetts Form No. 1 %ORTH ♦ BOARD OF HEALTH 11 2O1q �SLED ib 6 OL /_�•r� ' �1 13 19 Of APPLICATION FOR SITE TESTING/INSPECTION 7,p gDAATED PQP,�•�y SSACHUSO A licant U � pp ,NAN ADDRESS TELEPHONE Site Locationlt�I%C .t� a, CAA—L (.U-/u--, Engineer NAME ADD ESS I. TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee— aD Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH �/�� �2 Oy t e o e qti OL 19 E 6 O °� " APPLICATION FOR SITE TESTING/INSPECTION �q Q�RATED PPP,`.�y SSACHUS� Applicant �NAME y 1 V i ADDRESS TELEPHONE Site Location Engineers OlAn !" � , �C S 'r1 t � L(A `NAME ADDRESS ti TELEPHONE Test/Inspection Date and Time .43 J) CHAIRMAN,BOARD OF HEALTH Fee « Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. DATE %D 130 lU, Sheet of BOARD OF HEALTH TOWN OF NORTH ANDOVER SUBSURFACE DISPOSAL DESIGN REVIEW FEE, loD PERMIT # DATE RECEIVED APPLICANT ASSESSOR'S MAP ADDRESS PARCEL ## LOT # 33� STREET ENGINEER 6- M IVE VE ADDRESS PLAN DATE - /D���%� REVISION DATE CONDITIONS OF APPROVAL:-- APPROVED PPROVAL: _APPROVED DISAPPROVED #� BDT/OM 09 Ll - PLAN REVIEW CHECKLIST ADDRESS L 53,9 5 >PG�/% ENGINEER GENERAL 3 COPIES STAMP LOCUS C/' NORTH ARROW U SCALE L--- CONTOURS PROFILE__L� SECTION (/" BENCHMARK / SOIL & PERC INFO ELEVATIONS WETS. DISCLAIMER (_,� WELLS & WETLANDS WATERSHED? IVD DRIVEWAY le ; WATER LINE L--- FDN DRAIN �� SCH40 L,---' TESTS CURRENT? '25 SEPTIC TANK MIN 1500G. . 17 INVERT DROP �_� GARB. GRINDER,(+200% EDF) 25' TO CELLAR MANHOLE TO GRADE ELEV GW D-BOR SIZE # LINES FIRST 2' LEVEL STATEMENT INLET 138.6a - OUTLET /,3639 = ,;?0 (2" OR . 17 FT) TEE REQ'D?//O LEACHING RESERVE AREA L,�_ 4' FROM PRIMARY? LX 100' TO WETLANDS f2% SLOPES/' 100' TO WELLS ✓ 35' TO FND & INTRCPTR DRAINS ---'- 4' TO S.H.GWA--_'_'3,15' 325' TO SURFACE HH20 SUPP L_," 4' PERM. SOIL BELOW FACILITY MIN 12" COVER (/ FILL? t/'(25' if above natural elev;( 10'i 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 + SIDE X LDNG = TOT (L x W x #) (G/ft2) (DxLx2x#) PITS MIN 660! LEACHING GW MIN 4' BELOW BOTTOM MANHOLE/PIT EXCAV 2X EFF W ORfD 12"-48 STON SURROUNDING BOT 411.` , + SIDE x LOAD ,r` TOTAL ¢ (L x W x #) x (L+W) x D x #) CHAMBERS MIN 660 LEACHING l/ GW MIN 4" BELOW COVER >3 FT - VENT MANHOLES 12"-48" STONE v-. SPLASH PADS SLOPE .005 BED/TRENCH (Bed max. 60' X 601 ) BOT -41q �a + SIDE X LOAD S��' = TOTAL q,6/ (L x W x #) (2 x (L+W) x D x #) FIELDS MIN 900 ft2 LEACHING 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? >3 ' COVER - VENT SCH 40 MIN 12" COVER L x W = T x LDNG > DESIGN FLOW? 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 i rV � L to '' iv 9/11 GYM i� p 42 E ° •t*sig-• Fi }x: k tkst. 9 > i� t f,li i�iciiit nNiif11in � tl�u!�It� "� `1 . ~ �yal�fti �.�tVifCi__ � 3y+�[�IN�u�AiltiN � � 3 ' n�ry48xtiAdrin:n'. sh000at flowislo±: q— symmst foolopM by, witredolo 45Ntiowaga �.IC I�+J .•.� H� a parr c a ,a W r, t:ti�il��f�a tialialN od fit : Oroor 1AM11ed amtrMy i s I i III �jr �YSfM n y Alro f AVI Y R y 3.' 1? Jr 3-. •. i�3t 3gy5 Y p., TOWN OF RECEIVED SYSTEM P PING RECORD NOV 19 2004 OF NORTH DATE: lj -(.( -o T�HEAL H D PARTM NTE SYSTEM OWNER& ADDRESS SYSTEM LOCATION (example: left front of house) DATE OF PUMPING: QUANTITY PUMPED : 1 SOD 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 Commonwealth of Massachusetts (Y� yJ`a City/Town of OCT �- 9 2008 a System Pumping Record 'TC TH ANDOVER Form 4 - PARTMENT 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. A. Facility Information Important: When filling out 1. System Location: Left front, left rear, left side of hous . Right front, right rear, right sid of house forms on the computer,use only the tab key Address r— to move your 4-"� cursor-do not use the return City/Town State Zip Code key. 2. System Owner: �- , Name ieaen - Address(if different from location) City/Town State _ Zip Code Telephone Number B. Pumping Record 1. Date of PumpingDate 2. Quantity Pumped: Gallons 3. Type of system: Q Cesspool(s) __ Septic Tank 0 Tight Tank Other(describe): 4. Effluent Tee Filter present? Q Yes Quo If yes, was it cleaned? Q Yes No 5. Condition of System:� 6. System Pumped By: Neil Bateson F 5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location where contents were disposed: L.S.D Lowell Waste Water J-- tignalu-re of H u r Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts = City/Town of RE a System Pumping Record DEC -8"2011 yfM Syey`�w Form 4 TOWN OF NORTH AND VER DEP has provided this form for use by local Boards of Health. Othe MOW t e information must be substantially the same as that provided here. Before using Is orm, 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/ ght front of hous Left/Right rear of house, Left/right side of house, Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under deck Address (O' s S-'q"j- Cityrrown State Zip Code 2. System Owner: Name Address(if different from location) City/Town Stat Zip Code St Telephone Number B. Pumping Record 1. Date of Pumping Date 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. Condi ion of System: /U�� �V\- qvv� 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location where contents were disposed: G. S. Lowell Waste Water tC -l� Sign toe Haule Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1