HomeMy WebLinkAboutMiscellaneous - 71 WINTERGREEN DRIVE 4/30/2018 (4)r
Commonwealth of Massachusetts RECEIVED
City/Town of OCT � 2 2013
System Pumping Record
TOWN OF NORTH ANDOVER
s •
Form 4 1 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.
A. Facility Information
1. System LocationLe Rig fr nt o Left / Right rear of house, Left/ right side of house, Left /
Right side of buil g, Left / Right front of building, Left / Right rear of building, Under deck
Address
Ui
City/Town State Zip Code
2. System Owner.
Name
Address (if different from location)
City/rown stat
Telephone Number _q
B. Pumping Record
1. Date of Pumping pate 2. Quantity Pumped:
Gallons
3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank
❑ Other (describe):
4. Effluent Tee Filter present? ❑ Yes aNo If yes, was it cleaned? ❑ Yes ❑ No.
5. Condition of System-
6.
y{step m1 :
6. System Pumped By:
- Neil Bateson
Name
Bateson Entemrises Inc
Company
7. Location mdwre contents were disposed:
G.l. S. Lowell Waste Wc,
F5821
Vehicle License Number
C -- C(,z:;, -- Ls
Date
t5fomi4.doc• 06/03 System Pumping Record • Page 1 of 1
0
LUT ►-!D
�- c --)-C 1 1
N T E R Cx- S E E 11 �_ ,14,
vE
.SLOPS 2�QU//��it./EIVT
DE.S/�N E -L EI/,4T/ON AT..... , .. STOP OF 57ONE) _
EX/5T/NCS i! EZDORON 47 ......... 2EQ61/2E0
z�LE!/.�1T/ONS
................
n, C5 v Qs C3U/LT
INV PIPE OUT OF yOUSE
INV P/PE INTO TgNK
INV PIPE OUT OF T44NiY
INV PIPE INTO D. BOX
INV P/PE OUT OF D. BOX
INV END OF PIPE
Gt/.4TE2 EL Lc -k 4TION NONE 47-11N,S
.4 VE1e,46E STONE
DEPTI-/ 4T f3C'O8E
NOTE.' T11/S P1 -,4N /S NOT ,4 G .41e1eg1/TY
OF T11E SYSTEM BUT 4 PE2/F/C,4T/ON
OF TXIE LOC,4TION OF TWE EXI.57/NG
S7-1PUC762E5.
1- oT 1 l
s
.4J OU/L/
S B-SU,PF4CE O/S
SYST�'M .
/N
N o R -T \A k Nk V -')ca \1 F— Qz
FOR
wIC.LI /JM Fri LLU�1
5C.4L E 1 �_ 40° DATE.- 14 IS 18 -7
CAl,C1,57 4NSE/�/ ENq//V�MIN61 INC
1/4 XENOZ,4 .4 VE., 11.4YEe11/1- L, /Y14.
114%.'10
I Z 9.69
l3i.00
Z8.7Z13v.GB
-)Z5,77-
IS C),G
12, S. 6 ,
12-200
13avSo
IL$.1/
3 �z9.so -
17,8,09
14 l z 9 .s o
Q18110
Gt/.4TE2 EL Lc -k 4TION NONE 47-11N,S
.4 VE1e,46E STONE
DEPTI-/ 4T f3C'O8E
NOTE.' T11/S P1 -,4N /S NOT ,4 G .41e1eg1/TY
OF T11E SYSTEM BUT 4 PE2/F/C,4T/ON
OF TXIE LOC,4TION OF TWE EXI.57/NG
S7-1PUC762E5.
1- oT 1 l
s
.4J OU/L/
S B-SU,PF4CE O/S
SYST�'M .
/N
N o R -T \A k Nk V -')ca \1 F— Qz
FOR
wIC.LI /JM Fri LLU�1
5C.4L E 1 �_ 40° DATE.- 14 IS 18 -7
CAl,C1,57 4NSE/�/ ENq//V�MIN61 INC
1/4 XENOZ,4 .4 VE., 11.4YEe11/1- L, /Y14.
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
kkey.
Commonwealth of Massachusetts -
City/Town of RE IVED
System Pumping Record
NOV 13 2008 ._
Form 4
TOWN OF NORTH ANDOVER
DEP has provided this form for use by local Boards of Health. Oth fotita94ii e
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 Locatio . Left fro left rear, left sidd6&s Right front, right rear, right side of house.
Address 1-7
City/Town
2. System Owner:
Name
Address (if different from location)
City/rown
B. Pumping Record
1. Date of Pumping
3. Type of system: El
[I Other (describe):
State
Zip Code
State 3 .--� '7 q
Telephone Number
I C t--5-
Date Date 2. Quantity Pumped
Cesspool(s) - Septic Tank
V/A
Gallons
Tight Tank
4. Effluent Tee Filter present? 0 Yes P!'No If yes, was it cleaned? E] Yes Ej No
5. Condition of System: tv
6. System Pumped By:
Neil Bateson F 5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7. Location where contents were disposed:
D Lowell Waste Water
re of
Date
t5form4.doc• 06/03 System Pumping Record • Page 1 of 1
--6-NN Commonwealth of Massachusetts
City/Town of
System Pumping Record
Form 4
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
requn
RECEIVED
OCT - 2 2007
VN OF NORTH ANDOVER
ACNIT
DEP has provided this form for use by local Boards of Health Oth'�i"fo_fzxis majr tis�dI 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. SysteV Locat�
Address `7 W1
City/Town
2. System Owner:
Address (if different from location)
City/Town
B. Pumping Record
1. Date of Pumping
3. Type of system: ❑
❑ Other (describe):
State
Zip Code
TelepC)
hone Number
Date 2. Quantity Pumped: Gallons
Cesspool(s) ff Septic Tank ❑ Tight Tank
4. Effluent Tee Filter present? ❑ Yes 9-90- If yes, was it cleaned? ❑ Yes ❑ No
5. ConditioV, Syst or�A� � �A-
6. System Pumped By: � B�� 3-1
Name -1 —r—::> Vehicle License Number
7. Location/where conte r"posed:
Sinnat a Date
t5form4.doc• 06/03 System Pumping Record • Page 1 of 1
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the:retum
key.
Commonwealth of Massachusetts
City/Town of 1
RECEIV
E
System Pumping Record
Form 4 SEP 29°
DEP has provided this form for use by local Boards of HealthjjTh%$ystiem Pumping Record must
be submitted to the local Board of Health or other appr`oj vng`auth'b1y4M _-
A. Facility Information
1. System ocation- �-
AddressVIA
C
J�-Svc\ V
�t
City/Town tate
2. System Owner:
Zip Code
Name
- Address (if different from location)
City/Town State ode
Tele ne 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? El Yes
0 If yes, was it cleaned? ❑Yes ❑ No
5. Condition of S stem: l
http://www.mass.
t5form4.doc• 06/03
ration ire contents were
-�
wrovals/t5forms.htmAnspect
Ia\UI UI d—
p/ at `/a
Date
System Pumping Record • Page 1 of 1
FORM U — LOT RELEASE FORA
INSTRUCTIONS: This form is used to verify that all nec::ssary approvals/permits from -
Boards and Departments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliancy with any applic=ble ar requirements.
t«*~�'<<`*AFFL1CA.haT FILLS OUT THIS
APFLICIANT �/�/�� v/ �' ��;� PHONE r7 °
LOCATION: ,Ass2sS&s Mz.p Nurmber
SUEDIVISION
goy
PARCEL g � OI
LOT (S)
STRE.Tyy'"^'�'i`j /P P✓ �j, .� ST. NUMEERc�
* .:. OFFICIAL USE
RECOMMENDATIONS OF TOWN AGENTS: Nis ,3,4s£ m £ N?"
CONSERVATION ADMINISTRATOR DATE APPROVED
DATE REJECTED
COMMENTS
TOWN PLANNER
COMMENTS
FOOD INSUCTO
?Tl I r
COMMENTS
TH
0R-HEALTH
A-1
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED-
OR-HEALTH
EJECTED
DATE APPROVED
DATE REJECTED4
PUELIC WORKS - SEVER/WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
REC'EiVED EY EUILDiNG iNSPECTCR
Revised 4',97 im
DATE
SO
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Vt
D CL
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(0)
(D
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vstem Owner
FORM 4 - SYSTEM PL1IPL�G RECORD
5
Commonwealth of Massachusetts
, Massachusett
System Pumping Record
Date of Pumping: D "— �J Quantity Pumped: �� gallons
Cesspool: No
System Pumped by:
Contents transferred to
Yes ❑ Septic Tank:
CLV\,
421
No ❑ Yes
License #:
Lot 12 Wintergreen Dr}ve PAge 2
(herefore, the
NACC hereby finds that the following conditions are
r necessary, in accordance•with the Performance Standards set forth in the regulations, to protect those inter-
ests checked above. The N C orders that all work shall be performed
in accordance with said conditions and with the Notice of Intent referenced above. To the extent that the fof,
lowing conditions modify or differ from the plans, specificalions'or other proposals submitted with the Notice
of Intent, the conditions shall control.
'f:encral C.ondillons
1. Failure to comply with ali'condilions staled herein, and with all related statutes and other regulatory meas-
ure, shall be deemed cause to revoke or -modify thin Order.
2. This Order does not grant any property rights or any excluslvc privileges it docs not authorize any injury
to private property or invasion of privale rights.
3. This. Order docs not relieve the permiltee or any other person of the necessity of complying with all
other ,�pplicabie feddral, state or local slntules, ordinances, by-laws or regulations.
4. The work authorized hereunder shrill be compleled within three years from the date of this Order unless
rather of the following apply:
(a) the work is a maintenance dredging project as provided for in the Act; or
(b) the lime for completion has been extended to a specified date more than three years, but less thar
live years, from the date of issuance and both that date and the special circumstances warranting
the extended time period are set forth in this Order.
,9:' This Order inrny be extended by the issuing authority for one or more periods of up trithree years each
upon application to the issuing authority al least 30 day.s.prior to the expiration dale of the Order.
6. Any fill used in connection with this project. shall be clean fill, containing no trash, refuse rubbish or de-
bris, including but not limited to lumber, bricks, plaster, wire, lath, paper, cardboard, .pipe, tires, ashes,
refrigerators, motor vehicles or parts of any of the foregoing.
V
7, • No work shall be undertaken until all administrative appeal periods.f corn Jilis Order have elapsed or, if
such an appeal has been filed, until all proceedings before the Department have been completed.
8. No work shall be undertaken until the Final Order has been recorded in the Registry of Deeds or the Land
Court for the district in which the land is located, within the chain of title of the affected property. In the
case of recorded land, the Final Order shall also be noted in the Registry's Grantor Index under the name
of the owner of the land upon which the proposed work is to be done. In the case of registered land, the
Final Order shall also be noted on the land Court Certificate of Title of the owner of the land upon which
the proposed work is to be done. The recording information shall be submitted to the NACC
on the form at the end of this Order prior to commencement of the work.
9. A sign shall be displayed at the site not less than two square feet or more than three square fect-in size
bearing the words, "Massachusetts Department of Environmental Quality Engineering,
File Number -2.4-2--, � o
10. where the Department of Environmental Quality Engineering is requested to make a determination and
to issue a Superseding Order, the Conservation Corn mission shall be a party to all, agency proceedings
and hearings before the Department.
11. Upon completion of the work described Mercia, the applicant shall forthwith request in writing that a
Certificate of Compliance be issued stating that the work has been satistactorily completed.
12. The work shall conform to the following ptnns and special conditions:
J
ORDER OF CONDITIONS
Page 3
Lot 12 Wintergreen Drive
.DEQE #242-410
12. a. Notice of intnet submitted by Bill Fallon, 537 Wellman Ave.,
Chelmsford, MA, prepared by Christiansen Engineering, Haverhill
MA., dated Marsch 4, 1987 and received by the NACC - March 4, 1987.
b. Plan entitled "Subsurface Disposal System", Lot 1.2, dated
Sept. 9,, 1986 and prepared,by Christiansen Engineering.
13. In advance of any work on this project, the applicant shall notify the
NACC and shall arrange an on-site conference among the.NACC, the
Contractor and the Applicant to ensure that all of the Conditions of
this Order of Conditions are understood. This Order also shall be
made a part of the contractor's written contract.
14. The Applicant, or its successors, shall notify the NACC in .writing
of.the identity of the on-site construction supervisor hired to
coordinate construction during the work on.the site and to ensure
compliance with this Order.
15. Prior to any construction on the site, a double row of staked hay bales
shall be placed as shown on the plan referenced in Condition 12b.
This barrier shall be inspected and approved by the NACC prior to the
start of construction. This row of hay bales shall remain intact.
V
until all disturbed areas have been mulched, seeded, and stabilized
to prevent erosion.
16. The Applicant shall.have on hand at the start of any soil disturbance,
removal or stockpiling, a minimum of twenty-five (25) hay bales and
sufficient stakes for staking these bales. Said bales shall be used
only for the control of emergency.erosion problems, and shall not be
used for the normal control of erosion, as described in Condition #16.
17. Upon completion of construction and grading, all disturbed areas
located outside resource areas shall be stabilized permanently against
erosion. This shall be done either by sodding, or by loaming, seeding,
and mulching according to Soil Conservation Service standards. If .the
latter course is chosen, stabilization will be considered once the
surface shows complete vegetative cover has been achieved.
18. After proper grading, all disturbed areas located within a resource
area, except those areas designated as compensatory wetlands, shall
be loamed and seeded with not less than four (4) inches of good
quality loam. Before seeding, ground limestone shall be applied at
a rate sufficient to bring the soil test to pH 6.5. In addition,
10-6-4 fertilizer, or its equivalent, shall be applied at a rate of
fifteen (15) pounds per one thousand (1000 square feet, in accordance
with SOil Consdervation Service Guidelines.
Page 4
ORDER OF CONDITIONS Lot 12 Wintergreen Drive DEQE #242=410
19. No earthen embankment in the buffer zone shall have a slope steeper
than 2:1.
20. All erosion prevention and sedimentation protection measures found
necessary during construction by the NACC will be implemented at
the direction of the NACC.
21. There shall be no stockpiling of soil or other materials within
twenty-f.ive (25) feet of any resource area.
22. During and after work on this project, there shall be no discharge
or spillage of fuel, oil, or other pollutants into any resource area.
23. Any changes in the submitted plans, Notice of Intent, or resulting
from the aforementioned Conditions must be submitted to the NACC
for approval prior to implementation. If the NACC finds, by ,majority
vote, said -changes to be'significant and/or deviate from the original
plans, Notice of Intent or this Order of Conditions to such an extent
that the interests of the Wetlands Protection Act and Bylaw cannot be
protected by this Order of Conditions, then the NACC will call for
another public hearing within 21 days, at the expense of the applicant,
in order to take testimony from all interested parties. Within 21 days
of the close of said pubic hearing, the NACC will issue an amended or
new -Order of Conditions.
24. Any errors found in the plans or information.submitted by the applicant
shall be considered as changes, and procedures outlined above for changes
shall be followed.
25. In conjunction with the possible sale of this lot, the applicant shall X
submit to the NACC a signed statement by the buyer that he is aware
of an outstanding Order of Conditions on the development and has received
notice under Condition X128 below.
26. Members of the NACC shall have the right to enter upon and inspect the
premises to evaluate compliance with this Order of Conditions.
27. Accepted engineering and construction standards and procedures shall be .
followed in the completion of the project.
28. The provisions of the Order.shall apply to and be binding upon the
applicant, its employees, and all.successors and assigns in interest
or control.
29. Issuance of these conditions does not in any way imply or certify
that the site or downstream areas will not be subject to flooding,
storm damage, or any other form of damage due to wetness.
- Page 5
ORDER OF CONDITIONS LOT 12,WINTERGREEN DRIVE DEQE X1242-410
30. A surety performance bond or letter of credit running to the Town
of North Andover shall be provided in the amount'of $2,000.00 which
shall be in all respects satisfactory to Town Counsel and the NACC,
and shall -be posted with the Treasurer of the. Town of North Andover
before commencement of work. Said bond or letter of credit shall be
signed by a party or parties satisfactory to the NACC and Town Counsel,
and shall be released after completion of the project, provided that
provision, satisfactory to the NACC, has been made for performance of any
Conditions which are of a continuing nature. This Condition is issued
under the authority of the Town of North Andover Wetlands Protection Law.
31. In addition to the requirements of Condition 411, the applicant shall
submit a letter to the NACC from a registered professional civil
engineer certifying compliance with this Order of Conditions. Said
letter will certify, but not be limited to the following:
a.' "As -Built" elevations of all drainage ways
constructed within 100 fett of any wetland
resource area.
N
b. "As -Built" elevations and grades of all filled or
altered wetland resource areas..
c. Distances to all structures.and alterations within 100
feet of any wetland resource area.
An "As -Built" topographic plan of all areas.within the jurisdiciton
of the Wetlands Protection Act and Bylaw shall be submitted when a
Certificate of Compliance is requested.
32. No underground storage of fuel oils shall be allowed within 100 feet
of a resource area. This Condition shall survive this Order of
Conditions, and shall run with the title of the property.
33. Fertilizers utilized for landscaping and.lawn care shall be of the
low nitrogen content variety, and,shall be used ±n moderation.
Pesticides andherbicides shall not be used on any lot in the sub-
division within one hundred (100) feet of a wetland resource area.
F-IuRb0F' HEa:�j
NoTrh 4k)pnUEi-�I MA,
SS 21
➢I SAPPRoVED
R�(JSoNS =
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DIS1vPRovE) DA T C
AP12MOOIAZ AurHor?rry
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"r' = GHr��STc,4 ,E,�f W-0 AM QC 4 2' 0�13v1; Gti
BENCH M4r�K ,1 r c.✓/�S NoTicE04Fr,E9 TH(5 4VP 56 6-f /lk o rbvK
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Commonwealth of Massachusetts
fvo �Y)dvye , , Massachusetts
System Owner
vcUIa 5 �(A(P
System Pumying Record
System Location
`7I 601
Date of Pumping: 9100d Quantity Pumped: )SOP gallons
Cesspool: No Yes L._ Se ptic Tank: No Yes
System Pumped by: Fettredea 46104,7pew License #
Contents transferrred to : Greater Lawrence Sanitary District
llate:
Inspector -
la
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
DATE: Z -
SYSTEM LOCATION
(example: left front of house)
l -e4 4ok aT kowsc
DATE OF PUMPING: -O QUANTITY PUMPED—tfja� GALLONS
CESSPOOL: NO YYES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION
HEAVY GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
SYSTEM PUMPED BY:
COMMENTS:
FULL TO COVER
BAFFLES IN PLACE
LEACHFIELD RUNBACK
FLOODED
OTHER (EXPLAIN)
CONTENTS TRANSFERRED ��
TOWN OF AAJJcj2fL=
SYSTEM PUMPING RECORD
nr •
DATE:` o3 MAY " 2 l003
SYSTEM OWNER & ADDRESS
DATE OF PUMPING: 5403
CESSPOOL: NO X YES
SYSTEM LOCATION
(example: left front of house)
i,er+ FtoAj4 Or S�
QUANTITY PUMPED: ( S (20 GALLONS
SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION
HEAVY GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
FULL TO COVER
BAFFLES IN PLACE
LEACHFIELD RUNBACK
FLOODED
OTHER (EXPLAIN)
SYSTEM PUMPED BY: Bateson Enterprises, Inc.
COMMENTS:
i
CONTENTS TRANSFERRED TO: 5 j
TOWN OF
SYSTEM PUMPING RECORD7SEP
ECEIVED
1 6
DATE: ` 2005
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
SYSTEM OWNER & ADDRESS
SYSTEM LOCATION
(example: left front of house
DATE OF PUMPING: q-13-69-5'-QUANT1TY PUMPED:
�S�ALLONS
CESSPOOL: NO YES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION
HEAVY GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
FULL TO COVER
BAFFLES IN PLACE
LEACHFIELD RUNBACK
FLOODED
OTHER (EXPLAIN)
SYSTEM PUMPED BY: Bateson Enterprises, Inc.
COMMENTS:
CONTENTS TRANSFERRED TO: G.L.S.D Lowell Waste