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HomeMy WebLinkAboutMiscellaneous - 72 SUNSET ROCK ROAD 4/30/2018 (2)1 Z e Iq MAP #LOT # ^_ PARCEL # STREET . CONSTRUCTION_APP __ . VA- . HAS PLAN REVIEW FEE BEEN PAID? /� YES NO PLAN APPROVAL: DATE / APP. BY.__ DESIGNER: /�/ �� PLAN DnTEJ-4n �� '/` CONDITIONS (S-&OPb/,uG Z:�:�3Zr/l gpxll 0A) 725g�� WATER SUPPLY: TOWN WELL WELL PERMIT DRILLER._..._- _........... ..... .......... WELL TESTS: CHEM I CAL DA 1 E APP RUVED_.._.____.___ ..__.. @ TERIA I 1)A F E (1F'hF2UVEU , 'BACTER74Q I I DATE APPROVED—. COMMENTS: FORM U APPROVAL: APPROVAL TO ISSUE YE5 P /� l 7�� @Y DATE ISSUED—7/z, _ ..__...__..... _...___.. CONDITIONS: FINAL APPROVAL:. ALL PERMITS PAID YE WELL CONSTRUCTION APPROVAL YES SEPTIC SYSTEM CONSTRUCTION APPROVAL C�� OTHER YES ANY VARIANCE NEEDED FINAL BOARD OF HEALTH APPROVAL: NO NU NO NU YES NO DATE: Iz..._ ....F3Y: Commonwealth of Massachusetts w City/Town of No Andover LHEALTH n� 2013 System Pumping RecordJQ,�THANDOVER DEPARTMENT Form 4 M Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. ieIIm 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 Purnping 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 1. System Location: 72 Sun set rock rd Address No Andover - City/Town 2. System Owner: Twomey Name Address (if different from location) City/Town MA State Zip Code State Telephone Number Zip Code B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: 1500 al ons 3. Type of system: ❑ Cesspool(s) OSeptic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No 5. Condition of System: If yes, was it cleaned? ❑ Yes ❑ No 6. System 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 Bradford, Ma 01835 Signature Date Si re of Receivin Date t5form4.doc• 03/06 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 return key} Commonwealth of Massachusetts \ "City/Town of, NORTH ANDOVER MASS CH` TTIV System Pumping Record S Form 4 FEB 0 2006 DEP has provided this form for use by local Boards of Health. be submitted to the local Board of Health or other approving a t!l��"� A. Facility Information 1. System Location: must Address City/Town S ate Zip Code 2. System Owner: Name (if different from location) City/Town 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): IF --3 State Zip Code Telephone Number Date/ 2. Quantity Pumped: /onO Gallons Cesspool(s) Septic Tank ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes ❑ No 5. Condition of System: P, If yes, was it cleaned? ❑ Yes ❑ No 6. Sy em Pumped By: Name Vehicle License Number Company 7. Location where contents were disposed: C5�-O 7r) . M,4. ;",N47. Signature of Hauler http://www.mass.gov/dep/water/approvals/t5forms.htm#inspect Date a t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 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 or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT _JAC Y - [a(ne, t V36rA PHONE 6Sy— y F 1- S' LOCATION: Assessor's Map NumberPARCEL(4�o!� SUBDIVISION LOT (S) _ y STREET %a ST. NUMBER OFFICIAL USE ONLY �y RECOMMENDATIONS OF TOWN AGENTS: ) `f `l—� fi/ w CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED_ DATE REJECTED COMMENTS ! MAR 3 1 2000 PUBLIC WORKS - SEWER/WATER CONNECTIONS 7-1 DRIVEWAY PERMIT t• 1_ _ FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm SEPTIC SYSTEM AS BUILT CERTIFIED PLOT PLAN LOCATED IN NO.ANDOVER, MA. W. SCALER"=50' DATE:10/26/95 REV. 11120/95 Scott L. Giles R.P.L.S. 50 Deer Meadow Road North Andover, Mass. L SUNSET ROCK ROAD 71 LOT 15 I CERTIFY THAT THE OFFSETS SHOWN COMPLY WITH THE ZONING BY LAWS OF NO.ANDOVER. MA. WHEN BUILT R=60.0� 28.71 LOT 13 lb 10'x• 51' vent .n TABLE OF ELEVATIONS 1a� INV. OUT OF HSE.=148.70 IN TANK =148.12 40,00 Q §t=_ OUT TANK=147.97 T f IN D. BOX=147.86 OUT D.BOX =147.70 /2 END;.PIPE =147.39 r =147.35 2 'l OFFSETS SHOWN ARE FOR THE USE OF THE BUILDING INSPECTOR ONLY AND SUCH USE IS FOR THE DETERMINATION OF ZONING CONFORMITY OR NON -CONFORMITY WHEN CONSTRUCTED. 13872 LANA TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: 0— t —aez i SYSTEM ocr 2 6 2001 (example: left front of house) o� OA-"OLSF DATE OF PUMPING: "� 1 �`"'l� QUANTITY PUMPED [� GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER vt� SYSTEM PUMPED BY: COMMENTS: CONTENTS TRANSFERRED TO: 6, FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) 1 Q� aN O r •®c O � O w o p C6 : Ey t5 " CIO mv• z 0 a x H =CJ 01 a W 0 w U� 1 C W a v� z O u o a v c w° ° �o co •®c O � O w o p C6 : Ey t5 " CIO mv• z 0 a x H GD O C �+ L 0 o 5 Z o CL O y � C CO c CD E mm CD o CJ C2oCA a n- C1 Q c o � c CCC v J� ca C Z O 0 CL C..7 CA C C }, � C cv � V) LM J z CD z z Z =CJ a u m C N cm �o m 3?C. HZ p V S.ca� CD y C .O / w C N o:5r = 7 a y'v' y m a R H 'E 'dt —C Q LJ a, Z o m CL = C per.- O� h M �oH•� o y r -L.- � 3 GD O C �+ L 0 o 5 Z o CL O y � C CO c CD E mm CD o CJ C2oCA a n- C1 Q c o � c CCC v J� ca C Z O 0 CL C..7 CA C C }, � C cv � V) LM J z CD z z Z GD rA L- w CL N Z N O CO) CD cmm C: tm c z O U IFA r r O cm m W LAJ Ll- LL - cc cc W Lij �+C D O 0 cr- L O cj O O Z 0- 0 y v � ca � c c TO m m CD O O CD O O G O ci 0- O CL cm Q y C O O V J 'fl AL1. O y0,, c Z CD CL V y t� O C CL _O) i5 I `� Q Z J � z CC W Q z z cc: LU .7 W CL U) r. 4 Avolol o v OO m a O O x , C 00 Ul w w W x O z w A E w � x � Q O o aai G1 uj U �0 Q w 0.4 r ¢ A w y f o a g p' ;� U w C7 "4 w v v z O w v O O C C U) O C rrte,� G G N A E m O C ��^C ca m cn cn L- w CL N Z N O CO) CD cmm C: tm c z O U IFA r r O cm m W LAJ Ll- LL - cc cc W Lij �+C D O 0 cr- L O cj O O Z 0- 0 y v � ca � c c TO m m CD O O CD O O G O ci 0- O CL cm Q y C O O V J 'fl AL1. O y0,, c Z CD CL V y t� O C CL _O) i5 I `� Q Z J � z CC W Q z z cc: LU .7 W CL U) r. 4 Avolol o v m O , C 00 O � A E anan o aai G1 uj �0 y f O m w C4*�o N N A m O C ��^C ca m m C.) I.: CD C Q y mom F-CDa' N C = CD "� CTJ. C1 yam, C CA) _U u' O �N m C y-. D A � u N .® A •qL C o .. U W v Em o.0= c N C' 61'5 O'O _ cp .a Om F- C y O. � m L- w CL N Z N O CO) CD cmm C: tm c z O U IFA r r O cm m W LAJ Ll- LL - cc cc W Lij �+C D O 0 cr- L O cj O O Z 0- 0 y v � ca � c c TO m m CD O O CD O O G O ci 0- O CL cm Q y C O O V J 'fl AL1. O y0,, c Z CD CL V y t� O C CL _O) i5 I `� Q Z J � z CC W Q z z cc: LU .7 W CL U) r. 4 SIGNED I TOPS V FORM 4003 J (PHONE CALL ffhh �'{- .M L FOR_�� DATE, y TIME [U M. M ft a c PHONED OF a , AL—TURNED PHONE Y°URCALL AREA CODE r4uMBER EXTENSION EASE CALL MESSAGE e--N A. _ ,. _ _ — A WILL GALL SIGNED I TOPS V FORM 4003 J NOTES 1 M w c ` O 2 O E a Q LL w J O M of O iz- uLU �Z CL t ZQj t/) u O N ce ` v V a > u J U) Q w d > 2 V c O Q U w N u ce Y Q L Z O 00 3 c c o 4- O U Jc c Q O � 3 3 N o �° O d kA N I ro O °`o E a� w ) to a N Z y — •�* c - N O °�Ea tA r C ° : , a NO hM01 r Y'� Q N d N LL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a . . . . . . . . . CERTIFIED PLOT PLAN LOCATED IN NO.ANDOVER, MA. SCALE:1 "=50' DATE:10/26/95 Scott L. Giles R.P.L.S. 50 Deer Meadow Road North Andover, Mass. SUNSET ROCK ROAD D = 95°29'35" A =100.00 R = 60.0 1& tig LOT 13 LOT 15 LO 40,000 S.F. I CERTIFY THAT OFFSETS SHOWN ARE FOR THE USE THE OFFSETS OF THE BUILDING INSPECTOR ONLY SHOWN COMPLY AND SUCH USE IS FOR THE WITH THE ZONING DETERMINATION OF ZONING BY LAWS OF NO.A f�VER. 0_MA. CONFORMITY OR NON -CONFORMITY WHEN BUILT WHEN CONSTRUCTED. '0 Ac:r- LAp0 N FORM U - IAT 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***************** APPLICANT: Phone LOCATION: Assessor's Map Number Parcel Subdivision Lots) Street ��b St. Number Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Conservation Administrator Date Approved Date Rejected Comments Town Planner Date Approved Date Rejected Comments r Food Inspector -Health Date.Approved Date Rejected / Date Approved %ZZ,l)l Septic Inspector -Health Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date SEPTIC SYSTEM AS BUILT CERTIFIED PLOT PLAN LOCATED IN NO.ANDOVER, MA. SCALE:1 "=50' DATE:10/26/95 REV. 11/20195 Scott L. Giles R.P.L.S. 50 Deer Meadow Road North Andover, Mass. SUNSET ROCK ROAD 95°2936' A =100.00, P, = 60.00 0.1, 90� Tg. LOT 13 _ o 15.21 �p • �\y�\�G � � 'e. LOT 15 — 2$•71 vent. cO TABLE OF ELEVATIONS LOT 14 , INV. OUT OF HSE.=148.70 , 40,000 S.F. IN TANK =148.12, 15 OUT TANK=147.97 IN D. BOX=147.86 OUT D.BOX =147.70 /2 " END PIPE =147.39 if f =147.35 2 I CERTIFY THAT OFFSETS SHOWN ARE FOR THE USE THE OFFSETS OF THE BUILDING INSPECTOR ONLY SHOWN COMPLY AND SUCH USE IS FOR THE WITH THE ZONING DETERMINATION OF ZONING BY LAWS OF NO.ANDOVER. MA. CONFORMITY OR NON -CONFORMITY WHEN BUILT WHEN CONSTRUCTED. TO STEVEN J. D'URSO Environmental Designs 22 Lilly Pond Road W. Boxford, MA 01921 (508) 352-9872 e _aQ z WE ARE SENDING YOU I/Attached ❑ Under separate cover via [LIEUVEEIM 01F M6106ONTUIL the following items: ❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION Of D 4 / THESE ARE TRANSMITTED as checked below: ❑ For approval 1 , For your use !❑ As requested ❑ For review and comment ❑ FOR BIDS DUE REMARKS ❑ Approved as submitted ❑ Approved as noted ❑ Returned for corrections ❑ 19 ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US COPY TO t"% SIGNED: 51 r Iii ( ; �; � i ! f � � PLAN REVIEW CHECKLIST ADDRESS I hT /-;f- ENGINEER GENERAL 3 COPIES G� STAMP LOCUS (/ NORTH ARROW `'� SCALE L� CONTOURS PROFILE SECTION 1,�. BENCHMARK SOIL & PERC INFO ELEVATIONS WETS. DISCLAIMER WELLS & WETLANDSI--'- WATERSHED?_k6 DRIVEWAY Elev) WATER LINE FDN DRAIN -"� SCH40 -� TESTS CURRENT? SEPTIC TANK MIN 150OG f/ .17 INVERT DROP GARB. GRINDER.A (+200% EDF) 25' TO CELLAR L/ MANHOLE TO GRADE ELEV 4- - GW z- -- D-BOX SIZE # LINES A FIRST 2' LEVEL STATEMENT INLET147, �g - OUTLET�97� y = �ZU (2 " OR . 17 FT) TEE REQ' D?A�l 14-7-71 LEACHING MIN 660 GPD? v RESERVE AREA �4' FROM PRIMARY? 2% SLOPE 100' TO WETLANDS C,--" 100' TO WELLS ✓ 4' TO S.H.GW 35' TO FND & INTRCPTR DRAINS ✓� 325' TO SURFACE H2O SUPP' 4' PERM. SOIL BELOW FACILITY ✓ MIN 12" COVER (� FILL? (25' if above natural elev; 101if below) BREAKOUT MET? TRENCHES y MIN 660 gpd SLOPE (min .005 or 6"/1001) l� >31COVER?-VENT SIDEWALL DIST. 2X EFF. W OR D (MIN 61) t/ IS RESERVE BETWEEN TRENCHES?L-,� IN FILL? MUST BE 10' MIN. L-"'�4" PEA STONE? '-� BOT n06 © X LDNGAkk + SIDE ��� X LDNG / = TOT (LxW�x #) (G/ft2) ( �z�#) (G/ft2) / I �� 63 Copyright m 1993 by S.L. Startj, JC/... CJ �����/�� /l/ ✓ 1,-3 O '"°• N�vvlaea ala ►orm for uae by local Boards of � be aubmll�ed fo the local Board of Health r o other app H ARTMENT" ° A; Facility .lnforltatlon 1,T wry,11 9Qvi 1...:1. <: SySWM to-uUm'' Q"�' �e � koy Address 00 PQ1 U-4LMn6Um`:i; t; c. Cky/Tgwn tl. i�v.i1 r 1. 11t i 2. r.Vy3l6m Oker ..` ..,1�L .t�^�L ��}�.:.t,. l�. Cllr, ,11 �Iwb•��11 Y�!'' .. :rr Addie�t (If MI(IM rQM louuon) C kq/Town L — Tolapnone NumDor '-Rump1t1(j�� Record,./ --- . ;� � i .dSf�v.'`I �� �%;41(�,�;,lJ•�'l�'{r��i. 6.11. �/�/� t Dah'olPumpin 1 9 pole 2. QuanUry Pumped: �; .3,. TYPe P�.ayalern, , ❑ . CO3spool(3) Septic T ,:;.' , ' .,l' ;}•� :�., ank ❑ Tlghl Tank 4 v iEmuerl.l T66 Fllla ry.,' •r. . es r�sant7 ❑ Ya9❑ No If Y Was Il Cleaned? ❑Yes �'�'.; ;tier y,:?�:•g�! • :oridl�Jon f�8y,��'m;;:•��'-�' I VehIde UCBn e N �'r !.j'r!-'1'r.,�,';!,Y".��}�;• IYf� .�l!1'• ;l' J� ' /?__, i umDef , -.,.,•.� ,{ ,.l�.r: �., '"`• Lova on'• ll !v•�y�f•;:', :t, .: .wher@ cor�lenls w/ere dlQ� c { �,. �., �. :: •. �. �:;•, 'd',�1. •.;;:, ,l�f `•N..v11,(1� :;, ;,.. •I.1, ,. �f✓osed; VY hr.pl/www,mass�,8ov/dep�irela�/a pprovaJs/Ibform 3,hlm#Inspect 0./Q .. . Sy116m Pumping Ret ; Town of North Andover, Massachusetts Form No. 2 BOARD OF HEALTH ° � w 9 • s DESIGN APPROVAL FOR ss�cow SEK SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant Test No. Site Location �� 1 e -p-, cam, ►2—e -K Reference Plans and Specs— 'Y, --� 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. 4 A' Fee LW D I CHAIRMAN, BOARD OF HEALTH Site System Permit No. 96 j