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HomeMy WebLinkAboutMiscellaneous - 650 FOREST STREET 4/30/2018 650 FOREST STREET 1 -21-0/105-D-0024-0000-0 \ APPLICANT: 4 i � d � � � � s � � � � � � 06S6-699-L19 V3Sl3H0 0911-SLS-Ll9 NOlNVO OSS£-l£E-L19 H1f10WA3M ll18-899-905 H3AOONV HIIJON� _o m o o m A, w W O ` 2 L � : ® 1p w N J W_ U r � C r 0 C� Z co C5 z ® 3 � lie3 o ® � 0 } w CANTON 617-575-1150 CHELSEA 617-889-4590 LAWRENCE 508-686-8108 NORTH ANDOVER 508-688-8211 7RECEIVEDT]� Commonwealth of Massachusetts 013 = City/1-own of 6ffEALT;4DEPARTIMENT N OF NORTH P14DOVER System Pumping Record NORTH ANDOV Form 4 DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before.using this form, check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information r Important: When filling out 1. System Location: forms on the f �� computer,use �Q - _.`vS^h�_ only the tab key Address _ to move your cursor-do not use the return City/Town State Zip Code key. 2. Syst m 0 ner: Name Address(if different from location) ---- —. �.--- City/Town State Zip Code Cy7a- -:7: -25- 8' VV! Telephone Number B. Pumping Record -.? -a,;L - i' 3 1. Date of Pumping 0 2. Quantity Pumped: ��aU Date Gallons 3. Type of system: ❑ Cesspool(s) KSeptic 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: &.0 � 6. System Pumped By: Name /� Vehicle License Number i f� Company 7. Location where contents were disposed: M.S.D. North Andover MA. -77 atWe of H er Date Signature of Receiving Facility — Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts City/Town of NORTH ANDOVER, MASSACHUSETTS System Pumping Record Form 4 DEP has provided this form for use by local Boards of Health. The yste Qord ust be submitted to the local Board of Health or other approving autho ity. A. Facility Information AUG 6 200T Important: TOWN OF NORTH ANDOVER When filling out 1. System Location: HEALTH DEPARTMENT forms on the '„j, computer, use �J 6 �C�C'c5-4 1 only the tab key Addr ss to move your s cursor- not use the return City/Tow State Zip Code key. ' 2. System Owner: r �Arr s_ Name Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 2. Quantity Pumped: Date Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes 2--N-o If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: &Cx-, 6. System Pumpe Na e Vehicle License Number Company 7. Location where contents were disposed: G.L.S.®• ., — --- r'e s -- Signature of Hauler Date http://www.mass.gov/dep/water/approvals/t5forms.htm#inspect t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealthof assac usetts �CBIVB® City/Town of System Pumping Recor UG 1 3 2008 Form 4 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 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 1. System Location: forms on the y9 S i computer,use 650 rO�-es V ? only the tab key Address to move your ol<? LfS cursor-do not 'I use the return City/Town State Zip Code key. 2. System Owner: Name Address(if different from location) — City/Town State Zip Code 01 Telephone Number B. Pumping Record 0 1. Date of PumpingDa�-16 O 2. Quantity Pumped: 1�� Gallons 3. Type of system: ❑ Cesspool(s) [?"Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes L/ No If yes, was it cleaned? ❑ Yes [�No 5. Condition of System: Goo J 6. System Pumped By: �im GcOIQT) 6-) g3 Nme 1 Vehicle License Number (%�d \�V _,( P-ndi�roY)men�a I Company 7. Location where contents were disposed: Ipswich Water Signature of Hauler Treatment Plant Date Signature of Recei h , MA Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 Form 4 -- System Pumping Record Commonwealth of Massachusetss Massachusetts System Pumping Record System Owner System Location Gohn Robort/ atricld Gohn Pobarti atrir_.ta P p (so Fornat St. 650 Foro-t St. North Andaver, HA. 018 North Andover. MT, 016:5 978 +)56445 9789758445 Gohn Boburtspatricia Type: Emergency Routine Cesspool: W Yes Septic tank: W �Yes � Date of Pumping: Quantity Pumped: Gallons System Pumped By. Wind River Environmental, LLC Permit Contents transferred to: Contents Disposed at: Date: Pumper Signature: G�u Ru �L Condition of System/Other Comments Dep Approved from - 12/07/95 1 r, 4.5 • Vu L� 07 2 _ 3, 561 S- b /soo CAL-•-S-COM fi.4uK w to A' /9. -,. vo cry b �.A 20,94 / ra PSS/aN As eyuEcr ��� t twv P1Pt 42PT Orr HsE. 99.1 imy, PIP.E_wr21-rt.kE 98.7? r rt,�PcP� O�f N 98.S4 _96.73 _ fNy P►Pk rrvTo to ox� 98.34 98.3 ,� 9 e.os� 98. io �15 P v S.� i..... AVERAGE 57b►-1� •f�� j � DPPTHPR4 Norrr+i A NPOV E.' R, MA. 14orgZ : /s Ve9'A WAkFiANTY of TNS F d R. 9Ysrrm IIvrA VCR 1,0'-1C-A'r10,V or THS LocA-rlc v ,/ /'� ? �j�' Off' THE EX/.g7'1NG STF UC.TURF:S- t... U e (� ,E�V�L-C����/Y CH.e/3T/ANSGN iENG/'N�E'R/N4 //4 KENOZA Ava. HY4VE'R#4u-i./ /YA, Board of ealth smxac SnTEM / North 'An ver Haan. INSTALLATIcK CHECK LIST LOT``j B DISAPFitC1PID AVAT;rP4 �' OK FAlL I/It FAIL OK 1. Distance Tot a. Wetlands b. Drains c.. Well 2. Mater Line Location F 3. No PPC Pipe /rf �- 4. Septic Tank a. _Tees --Length & To Clean flat Covers. b. Cement Pipe to Tank On Both Sides of Tank 5. Distribution Box a. Covers & Box - No Cracks b. A11 Lines Flowing Equal- Amounts c. No Back Flow 6. LeachField or Trench a. Dimensions b. Stone-Depth- c. Capped Ends d: Clean Double,Washed S e' 7. Leach Pits a. Dimensi IeSton epth ash. Pads- ees Cement Pipe to Pit - Both Sides f. Clean Double Washed Stone 8. No Garbage Disposal 9. Final Grading Inspection 10. Barricading Covered System 11. As Built Submitted. �✓ _ Fn`� ' a. - Lot Location . b.- Dimensions of System c. Location -.4th Regard-to, Perc Test d. Elevations e: Water Table j 1 y 1 •1 Board of Health ^� A� Nart3: :�nc�.over,?Sasa (� n' / •.p� SUBSURFACE DISPOSAL DESIGN CHECK LIST K M LOT # �' Fd�sT APPRM-ID DATE DISAPPRQPED TE � PraQi.ded• Reasonss� `��<'l� �CNa � � 3 Ve r4 Tie � � , s vG /Ss li�D Title V FAIL . Reg 2.5 a submitted plan must show as a nini==1 W'b ) the lot to be served-area,dimensions lot #,abutters location and log deep observation hoes-distance to ties ies location and results per�eolation tests-distanceui red leaching area design calculations & calculatio�ns�egg reserve area ) location and dimensions of sysexisting and proposed contoursystem or ) location any wet areas .thin 100 of sewage disposal disclaimer-check wetlands mapping (h) surface and subsurface drains Vithin 100' of sewage disposal system or disclaimer (i) location any drainage easements within loo' of serge disposal system or disclaiYr—er-Planning Board files �(j) ku sources of cater supply within 200' of Selage disposal e stem or disclaimer ---- ---- ( location of-ar prqposed—vrn to lo serve t�lOJ, from leaching facili' location of water lines on property-10' flrom leaching acilil� m} location of benchmark ✓ dr ivelMys ' } garbage disiibsals . (p) no PVC to be used in construction plumb., pipe., septic tank ✓(q) profile of system-elevations of basem.�t, p , P P distribution box inlets and outlets, distribution field piping and 0-fter elevations (r) maximum ground later elevation in area sewage disposal system (s) plan mast be prepared by a Professional Ragineer or other professional authorized by lax to prepare such plans Reg 6S tic Tanks {�a) capacities-150 of flog, water table, tees, depth of tees, access, pumping `f'(b) cleanout and sing P001/ (,6) l0i from cellar wall or ingro d) �5' from subsurface drains Reg 10.2 Distribution Boxes a) sjope greater than 0.08 Reg 10.4 ( / b} SUIMP �� V,{�-g ot, ppm,t•�g v.,� -- loo . Le IUamrse— V IL Lbsurface Design Check List Page 2 FAIL Og Leaching Pits Leaching pits are preferred where the installation is possible eg 11.2 a) calculations of leas g area-minimum 500 eq ft 11.4 b) spacing 11.10 c) surface drainage 12.11 d) cover materi e) 2 l x2 t x4v sp,1 sh pad f) teeat bow g) nob sin pipe om d-box to pipe Leachin Fiel eg 15.1 a) no greater an 20 minutes/inch b) area-mini 900 sq ft 15.4 c) constion of field 15.8 d} ourf e drainage 2 % 3.7 e) 201 from cellar X11 or inground svimming pool Leachin Trenches - eg 1.4.1 } c� cula�f leaching area-idn 500 aq ft 14.3 i/ b�spacing-4 ft min 6 ft with reserve between 14.4 dimensions 14.6 construction 14.7 e� stone 24.10 f) surface drainage 2% Doun}ti l l Slope- aTs opo y x = to be oho=) ✓ b) y/x.X 1500 = (to be shown)PUPP _ r s -eg 9.1 a) approval 9.6 b) stand-by power Sly v c= Ke&T' 1ITL SOIL PROFILE & PERCOLATION TEST DATA North Andover, Mass. Street No V7. F-of.EST Lot No Z- Loc/Subdiv. Pland Owner ':xc i i �lr Investigator Cp&1STlp►N 5c oy Observer h5 SOIL PROFILE DATES '971 l.'Flev 2.Elev 3.Elev 4.Elev p 1. 1 0 1' Z p 0 1 ► S 1 -Z-c S 1 "T C 1 Timms Pto Test 2 2 2 2 3 3 3 3 4 4 4 4 v C- 6 6 6 6 6 4 ��t�E S S�c�si+•� --e-er-0a E �w L 7 t 7 7 7 X vE-p � flE� 8 8 8 8 9 9 9 9 10 10 ; 10 10 Benchmark Location Elevation Datum PERCO;,ATION TESTS DATES Pit Number 1 2 3 4 Start Saturation Soak-Minutes - Start Test=TlMe Drop of 3"-Time Drop of 6"-Time Moms-lst 3" drop _ Mins.2nd 311 Drop Percolation �j t -z. 6D Z 3 v Le:-..,g. too' Z-10(00 Posy g puG-� Q 52 i �WE4L 1-4.54 ao` Za � W A"' LI VF. r-'X 1gl'1NG W 5 E IL( r`i r � fp ��\ ^' .15'00 GAL.sgpoc TANK 2 41 43,560 sr i1-• 2?' A ALI o f o � 64 qq (Z 5� 3 ,94 / r DE�rC3nr a 5 OvFer .I my, G.Ior Qur or H 5E. 99/.5, i my P lP- ltq�T!O_TAlqlz 1 n1 Y. POPE O UT N 98.54 INV, P!-PivTo a_P�oX _ .-•- 98.34 _9$.30. �+ EWIL -F 98./7 9a./9 - r�,v C e1 5 P► 98•oO 98�/0 1 S Po SA }-- Ute`cJ V E5: E w L_ 93:vD _ `13•� A\,/E RA 6 E S p�P r tr 0 P lz NO AM—i /4 N Do u E' R, MA. 7H/s ol.<i,> is N!'! A WAk>tiANYY of �'h� / F OP, a r:TFM L�v`rA VTICN op TKE LOGA7'10// C.. l✓` �/ �. 0 P/ fi j O� 7HE EXl.�7'tn1� Sy�f,(J('.7UR/-.5 :30 ' QATei Pev, 9164, REV WCLL LoGA-riaiU �ye�sTSAu�Enr ENGrntCS'RrNo- 114 -MENoZA AvF_. HAveRH1L.l., MAr (53 ps"o \All-LL Z- oe A T1a 1c,,l 407-S /q s 2-,i 1:50,'e53— e I i i I Z4.5A 3 W d r I � �"x I gT't NG HSE � 'u�,,•`,. -� �, .� co b 1500 GAL• S—eF?'/G T4I✓K 43,s- 0 sr- 19• ^j Z� n 6 a 31194/ � � FC- o Q ELE �/A�` ► 0►� 5 . A S BUfLT INV, P/PF QuT Cr HSE. 9gI/5" INV. PIPS' INT_o TANK 1NV PPI€ QuTOFTANK 9� SQ 98.73 _ _TO _98._34 . .. INV�IP Int _D.-6OX G8.30� f.—'+ 5 �... ihly. PIPE oaf?" P. e5nx 98'/7_ 98. 9 u,t v C nI._oo F_ P I P� 9 8.co i _F-7 P- E L- 93,00 I 93.00 _PTH/„_ V PRoC's>r I _ �— No r? r'i-i 1 N r,>O V 5R, M A. No,-E: : %Nf9 P.,./ tl /9 N,-!”A WA--,A,AN7Y OF r h� bui-A Vim'RfF"/rstT/O/V of- THS L0C•,Toof/ F oR- o� rH� Ex/.^:'ffv� S�-i.✓�.7uR� s - �fL3G PEVE 0 PMS 5AT Rev 4 wcLL LOGAT/O A! SCA t_E = 30 DA7 E; ///,Z8/83 Rev, 1119184 CH.e/ST/ANSEN CNGINCERfN6 114 KENozA AVE- 1-14VERH1LL, MA, 83 a1:5"o y4• � i i L o T� 2 A �9 t 1yT ., i - IV . tSG4 0 1ST !Soo GAL.S6Pf tc TANK e 1 , v� r 1 I 54.Qg '( 3t.44� /- r o tz r� LE: V,A T I ON S . D� sr aN AS Duac7- iuv, ptp _ 99./5' 9�.?9 �• 99,E/ ANY PtP c1T�NK gg•S4 t N V..PIPg OUT Piv_T© D. ox - $8.34 9p.9 A 98 i T w � � T93.o4 q3•� ,d�/E k A G E 5 TONE �/�"� #I•�I � ! � QEPte— PRO IYQIerM ANU©V 5R1/� / 1A. E O F 7"N Nv r'E = 7Hi� Pi..,µri i s M&7'A WA�h.+NTY F d� 5>ar-M 007-A VeRIfY -A7"/oh/ o� TNS L©cA7'�onr C � C.� �i�1f��-0 PHgArr OF' THE EA/.S7-/NC-, . S-rpU!'TUR1.S- SGA La = 30 DATA ; ���g — CHR/s-rmA/'.!-'N ENGlNGEjewo. //4 P(ENOZA AAE. lyAa 1 IIS_ Address 65rd _ ?�s� Title of File Pae 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 — Buiiding Department Form 4 System Pumping Record Commonwealth of Massachusetss I Massachusetts System Pumping Record System Owrner System Location Ptril,.,!ary Home Vorth A,,dov,-,r, Y'A. ('11045 '°,Iorth Andover, 9A. u045 (9731 97 —64,15 Type: Emergency Routine Cesspool: No Yes Septic,tank: Yes Date of pumping. Quantity Pumped: 161()() 6allons System Pumped By. Wind River Ebvironmenftl, UC Permit#: Contents transferred to: Contents Disposed at: Date: Pumper Signature: Condition of System/Other Comments Dep Approved Form 12/07/95 Town of North Andover, MA Watershed Septic System TOWN OF NORTH ANDOVER/ BOARD OF HEALTH servicing Report Date: 1-1-9 hs-,--� JUN 28 1995 Homeowner Pumper fir' Street ddress: Phonehone �. d . Nature of Service: Routine Emergency Observations: Good Condition Full to Cover YI Baffles in Place Leachfield Runback Excessive Solids Heavy Grease Roots Other (Explain) Description of Work Comments: ;r FORM 4-SYSTEM PUMPING RECORD C U RRI SEPTIC & DRAIN SERVICE 107 FOREST STREET;MIDDLETON,MA 01949::.. (978)774-2772 r COMMONWEALTH OF MASSACHUSETTS 1U ' .✓Gly ,MASSACHUSETTS SYSTEM PUMPING RECORD SYSTEM OWNER: /0 h SYSTEM LOCATION: 6 s-o fvr�s� �- DATE OF PUMPING: -�g QUANTITY PUMPED: GALLONS CESSPOOL: NO YES SEPTIC TA NO YES F7 /C'4 c`? P i"� SYSTEM PUMPED.BY: CURRIER SEPTIC& DRAIN SERVICE ,�4., h > CONTENTS TRANSFERRED,TO.-', DATE { a INSPECTOR: Gz�rJJ��s� r J zr .our taw r,UK ^, al OF HEALTH 1999 FORM 4-SYSTEM PUMPING RECORD Cu- MER SEPTIC & DRAIN SERVICE 107 FOREST STREET;MIDDLETON,MA 01949 , (978) 774-2772 OMMO ALTH OF MASSACHUSETTS MASSACHUSETTS SYSTEM PUMPING RECORD SYSTEM OWNER: / SYSTEM LOCATION- . bra� f vs � off'. 97S-- e?yys DATE OF PUMPING: UANTITY PUMPED: Al � � Q GALLONS CESSPOOL: NO YES 0 SEPTIC TANK: NO 0 YES .E—. SYSTEM PUMPED BY: C RIF.R SEPTIC & DRAIN SERVICE CONTENTS TRANSFERRED TO: < JSID DATE: S= /,2-tel' r �..,... —INSPECTOR: BOARD OF HEA TH JUN 10 1999 s Middleton,107 Forest St. re�O�p\Ni.N FORA14- YSTE11'1 PU11g'INC'PEC MA 01949 '0 Rv\Ci Commonwealth of Massachusetts • r �i r Massachuse +T Vklli L 5 Symp ord E �F.stePumpin •Rc , 3 System %timer ��� ystem Location • 4 � Vt' 4.1 Date of Pumping: ( t � " P Quantit}, Pum ed. gallons . T Cesspool: No ❑ Yes ❑ Septic Tank: No ❑ Yes r r ei System Pumped br• ............. .. ...... .................................. Lice se #. Contents transferred to:, Date Inspector X 2, ' CURRIERFORM 4-SYSTEM PUMPING RECORD SEPTIC & DRAIN SERVICE 107 FOREST STREET; MIDDLETON,MA 01949 (978) 774-2772 CO ONWEALTH OF MASSACHUSETTS MASSACHUSETTS SYSTEM PUup jryG RECORD SYSTEM OWNER; SYSTEM LOCATION: 7T DATE OF PUMPING: QUANTITY PUMPED: CD GALLONS CESSPOOL: NO 0--YES . SEPTIC TANK: NO YES SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SERVICE CONTENTS TRANSFERRED TO: S DATE: �� �� IN �� v� Form 4 -- System Pumping Record Commonwealth of Massachusetss : Massachusetts System Punmpina Record System Owner System Location tOBERT/PATRICIA GCHN ROBERT/PATRICIA +50 FOREST STREET 550 PUREST STREET IORFIT ANDOVER, M 01845 NORHT ANDOVER, HA 01845 978) 975-8445 (978) 975-8445 Type: Emergency Routine Cesspool: W Yes Septic tank: No ayes .ED/ Date of Pumping: �{ 4/ Quantity Pumped: /LM(/ Gallons System Pumped By: Wind River Environmental, LLC Permit#: Contents transferred to: Contents Disposed at: Date: Pumper Signature: Condition of System/Other Comments Dep Appmved from - 12/07/95 ..` n Form 4 -- System Pumping Record Commonwealth of Massachusetss : Massachusetts System Pumping Retard OCT 1 7 2001 System owner system location �, I bll,, r AeEST ;!'PUT t' .. 0 ii_g N tl(1l') W:Rti1' ,VlI7CrfLV NA 01,A5 Type: Emergency Routine Cesspool: W Yes septic tank: W F]Yes Date of Pumping: Quantity Pumped: JS 0 J Gallons System Pumped By: Wind River Environnrentoi, LLC Permit#: Contents transferred to: Contents Disposed at: cam— l� t 1 f j I( ' 1 Date: Pumper signature: Condition of system/Other Comments Dep Approved from - 12/07/95 Commonwealth of Massachusetts City/Town of NORTH ANDOVER, MASSACHUSETTS System .Pumping Record ~� Form 4 DEP has provided this form for use by local Boards of Health. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information RECEIVED Important: When filling out 1. System Location: APR O 7 2008 forms on the computer, use only the tab key Address to move your HEALTH DEPARTMENT cursor-do not use the return CitylTown State Zip Code key. 2 System Owner: r f,•/ Name &-570 Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record t -Soo 1. Date of Pumping Date 2• Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) VSeptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes E�/No If yes, was it cleaned? Yes El No 5. Condition of System: 6. System Pumped By: Name Vehicle License Number Company 7. Location where contents were disposed: Signature of Hauler Dat http://www.mass.gov/dep/water/app.rovaIs/t5forms.htm#inspect t5form4.doc•06/03 System Pumping Record•Page 1 of 1