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Home My WebLink AboutMiscellaneous - 726 GREAT POND ROAD 4/30/2018 (2)1 DATE: Y TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD 0 z� G f-ra-� Pond (example: left front of house) DATE OF PUMPING: 2 -Oa---QUANTITY PUMPED ISS GALLONS CESSPOOL: NO YES 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 TO: 4` - L - !!E� - t` J - 2104RD of Ncou?i H NOI�TH AvI�VEI�, NIA, 33 -a—WP G �! PL( C4 &J TIG, 17aEA) 4 Wq�E� Sc�Ph'L7 Q UJEc - Appy 'oue s S WTI c S sT�, ves 6&) b PPjf�ovC5p DI SAPPROVEp RI�ASoNs COr"<�- PZXv DALt-ZZ-9 1ATE jv�= Trn�d y' s D� SrPrI c SY5TEN1 i�v SjA l.1_,Q"1'�o�,:J , YFx4v4T(o%1 )AicpeE�G—no,V F�N�4(_ I �15PF�i'lon� PP(�dVE1> P/J rE (� — — F'4 ►L- PI ISE FRO^-\ H0066- 1-0 T/J 0 K [,-]?A S5 -0 F�IL l5 � �6P�r�v�ti� A�T+toi�i� AV)I N5Ti�1,r.Gc� NE4� VI1j\)5fi3:Zi 10" t S ��= may) DISAPt'RdvF,D Fk)AL APPFOVAL D,arC D,oi l 5' i APPROVIA16 ;y A SUBDIVISION 1 FORM U TOWN OF NORTH ANDOVER LOT RELEASE FORM ASSESSORS MAP W / 0.p ce_L q6 SUBDIVISION LOT(S) STREET in 1 APPLICANT Ido c �T F. VU O rMi E A/ PHONE (fJ g () 4 DATE OF APPLICATION A 5- 1 qR R TOW K USE BELOW THIS LINE PLANNING BOARD Z e!�Z: rVIZM 1� DATE APPROVED TOWN AANNER 1116M rO Z B L DATE REJECTED CONSERVATION COMMI SION DATE APPROVED AT CONSER ION ADMI DATE REJECTED BOARD OF HEALTH -t1-q?J S WDATE APPROVED HEALTH SANlTARthN DATE REJECTED DEPARTMENT OF PUBLIC WORKS DRIVEWAY PERMIT SEWER/WATER FIRE DEPT. RECEIVED BY BUILDING INSPECTION DATE ,5(4.1 fi;�e This form shall be signed by the agents of the Planning and Health Boards, the Conservation Commission prior to the issuance of any buil.di,g permits for the subject lot. This form shall not releive the applicant from the compliance of any applicable Town requirement or Bylaw. N L VA N L HE --- 47, tA N L rk S` ',1 t1 _tjt -- - PiNt �l - --- '`f • 1 rk S` ',1 t1 .4 PiNt �l S '`f • 1 11D ACUS Applicant Site Location_ Engineer Town of North Andover, Massachusetts BOARD OF HEALTH Q�,iIED.I,�4.NQ f- W 7,9 gDAA APPLICATION FOR SITE TESTING/INSPECTION 19 Test/Inspection Date and Time Fee i . e --d . Form No. 1 1ga z CHAIRMAN, BOA OF HEALTH Test N o. /101 S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. E 3 i � � -�. 1 • � �% 'fit'; -r .� b' .. 5 � A "„� w 1 g. , 9 v\ AP x D o N ♦ 1 ! it,5' �y1 �1J v P � Ci � ' b is r• � � .!l � ' M ' Jq - � �' r � li. tr � � � ' r . „j. •.. h � `�'� 4 •� r '� � g 'fix UJ 01 ./ . � LSA -� t��"` �- �.� � � O �� ' t,=, v� •. ,1��,� +� „� `' , `` " .O [R 1 / i^� �,� ' ^ Wit' f �u ', rola ,A�. .� Kfj1,\f}a,• Y � � }ar. M�,yp�y F :: � 5��1 V • � �. �•. L'.i'' ''. fi�fl b'1J �z , r � �4: �,. t• �. 1i �{i � 1[' `�` �iYit\!:_-_3w�i +�{,3 iC t x � • V �''� ki 12 t tea' t: CS - It M el Ivf W '(�Y 4 .•- �' � J �� . p S P4 4) I1_ � �i ��IJI ----------- i1 andover Consultants 1 East River Place inc. Methuen, Massachusetts 01844 (508) 687-3828 July 12, 1989 Town of North Andover Health Department Town Hall North Andover, MA 01845 Re: Subsurface Sewage Disposal System for Mr. & Mrs. Robert Worthen Lot B, Great Pond Road, North Andover, Mass. I hereby certify that I have inspected the construction of the disposal system at Lot B, Great Pond Road, North Andover, Mass. The system was built within reasonable compliance with the approved plans and the location and elevations are as shown on the As -Built Drawing dated July 5, 1989. CK'A"A -�„.� ANDOVER CONSULTANTS INC. VV I LL I AM S. cs74�WiII iam S. MacLeod Grrr.*.fc�:� Registered Sanitarian This certification is not to be construed as a Guarantee of the syste. Civil Engineers o Land Surveyors o Land Planners SEPTIC SYSTEM INSPECTION FORM ADDRESS %2 DATE INSPECTED -7- PROPERLY FUNCTIONING? N WEATHER CONDITIONS COMMENTS: WATER QUALITY TESTED? RESULTS? DYE TEST PERFORMED? Y .N DATE? .SKETCH: WATERSHED RESIDENTS (,QUESTIONNAIRE 1. Name _ , rr/�,; 2. Street Address 7=26 Gr'� ` C O3. How many members are in your household? 4. What type of sewage disposal system do you have? ❑ cesspool [tom septic tank and leaching area ❑ connection to municipal sewer ❑ other (describe) ❑ do not know 5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health? ❑ yes ❑ no &do not know , 6. How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years ❑ 11-20 years_ -- R' over 20 years ❑ do not know 7. Has your sewage disposal system been rebuilt or repaired? ❑ yes Rr- no ❑ . do not know If yes, approximately how long ago? years. What was done? 8. How frequently is your sewage disposal system pumped out? ❑ annually ❑ every 2-4 years ❑ every 5-10 years ❑ over 10 years 9�i' never 9. Have you had any problems with your sewage disposal system? ❑ yes no If yes, what problems? ❑ repeated pump -outs needed ❑ system clogs, backs up, or drains slowly ❑ odors ❑ sewage surfaces through ground 10. How many of each appliance are connected to your sewage disposal system? washing machine I dishwasher garbage disposal dehumidifier drain sump pump toilet roof/pavement drains shower/bathtub I_ 11. Please state the brand an type (liquid or powder) of detergent you use for: dishwasher MOGO de-r-- clotheswasher 12. Does your property have a lawn? ❑ yes ❑ no If yes, approximately what size? ❑ less than 1/4 acre ❑ 1/4 acre acre ❑ 3/4 acre ❑ 1 acre ❑ more than 1 acre (Specify) acres _ 13. How often do you fertilize your lawn? No. of applications per year 3 Season(s) of the year c�- Qh4 - 14. Please state the brand and type (liquid or granular) of lawn fertilizer you use: H P K ❑ Check here if your lawn is maintained by a professional landscape contractor. Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH F qti� 19, E e L r � A 04 APPLICATION FOR SITE TESTING/INSPECTION AORATED �SSACHU5�� Applicant l_ VLx_'� l r t 't 4 NAME ADDRESS TELEF �f Site Locationc�- . Engineer 4, NAME Test/Inspection Date and Time ��ti GST rk CHAIRMAN, BOARD OF HEALTH Fee �-� c� ` Test No. S.S. Permit No ��33 W.C. No. C.C. Date Plbg. Permit No. PPi�ov C -D D►S,aPPr� vED kr: S Js : VA //l,� (A)A-f6Z s()PPL7 CJ Fc5w, U4 —1 L -o -r 8 rpl?orl A QPU C01-1 0 UJELL- D 1YJT'G — - - SCPri c SY sTE," VE7S, C� APNOUPJ613ur11OKiry Fav R4.1�� Dw� Std I Sy5TENt l j STA "Tin�J �x4v4T(cOIAJ j"SPE6 ► ro&J D/JrC WSP6,-DOn) F(PE FV<)AA t-�v APPROVED &P(TIDAJAL. 1, IJYbc.j IoN j (j may) DiSAPPj?ov%P D,arE" Iz o� Ads', Q 1/15S Q F41L- ry Ti/J 0 r Ll Fig S5 o R)L. /�Pl�izvvwG Aurhoj?�Ty I NS lIOU�& i A leek) lC�A-) FINAL APPIZVAL DATA W t5 01-Z16(Allo& F'/'-/AU47 5-6-� 4A,21) 5,-�-P IT— 4 BOARD OF HEALTH Town of North Andover,Mass. Permit # Date- 19 88 - APPLICATION FOR WELL.& PUMP PERMIT Application is hereby made for permit to drill a well (x): made to install (_) a pump system'. Location: Address Great_Pond Road, North Andover, Mass. Application is _Lot. # . B....... Owner Daniel A. Dineen Address 182 Washington St.Boxford.MNel. Well Contractor a-larlesM-Rollins ro. , Inc' Address 129 Depot road, Fcpcford, lass. T e 1 .887 2= Pump Contractor WELL CONTRACTOR Type of Well Diameter of Well Address Tel. (To be completed at time of pump test) Drilled Well used for Domestic 611 Depth of Bed Rock 25' Was Seal Tested? Yes (_) No (_) Depth ••o-f--W-ell_ Depth to Water_ 13` _ 305' Size of. Casing 6" Depth casing into Bed Rock 46' Date. of Testing Well Ended in W.ha-t. Material Rnr•k Delivers 28 Gals.Per Mtn. for 4 hours Drawdown feet after pumping hours -at __ GPM Date of Completion ll -'8=.88 Signature Wel Contractor PUMP INSTALLER (To be f•i.11'cd in before installation) Size & Name Pump ___.___ ___Pump Type Used Water Pump Delivers GPM Size of Tank Pipe Material Used in Well:.Cast Iron (_) Well Pit ( ) or Pitless.Adapte'r (_) o,ilvani.zcd ( ) Plastic •(_i Was sleeve used to protect pipe?.Yes (_) NO(_) 'Type or Name Well Seal 0 Date _ �r�r►1r�tri!r�'r+'r�M�'c�'r�4�Fi4ti��Mi4�Y�M�'r��r�M�'c�4�'c�k�Mti4�'rt4�4ti4�4�4�Yvk�4ti'rtiN54i'r.'rti4�'r►';�'r,':SipnaCure,;ps;[?E STD ,c ,b , �r'skdh�tl�td Datb Water analysi's r'epor--t 'submitted to Board of lieal'th Date release given tD owner of record & Bldg. Insp Health Inspector FEE NUMBER THE COMMONWEALTH OF MASSACHUSETTS �10 of .2�� ......AA1 .......... ................................. This is to Certify that ............... ....... ...................... NAME ADDRESS IS HEREBY GRANTED A LICENSE For .... ....... ....................... ........ ------------------------ .................. ................ I ....... ............................................................................................................................ ...................................................................................... .................................................................................... ........................................................................................................................................................................... This license is granted in conformity with the Statutes and ordinances relating thereto, and expires -------------------------------------------------------------------- unless sooner suspended or revoked. . E"? .. .... ...................... ;17.. 1 ------- * -- ---- ....................... . ......... ......................................... 1941 ................... ................................................ ........................... ................................................................... . ....................... FORM 433 HOBBS at WARREN. INC- � andover ��consultants inc. 1 East River Place Methuen, Massachusetts 01844 (508) 687-3828 0 July 12, 1989 Town of North Andover Health Department Town Hall North Andover, MA 01845 Re: Subsurface Sewage Disposal System for Mr. & Mrs. Robert Worthen Lot B, Great Pond Road, North Andover, Mass. I hereby certify that I have inspected the construction of the disposal system at Lot B, Great Pond Road, North Andover, Mass. The system was built within reasonable compliance with the approved plans and the location and elevations are as shown on the As -Built Drawing dated July 5, 1989. 1.. ANDOVER CONSULTANTS INC. William S. MacLeod Registered Sanitarian This certification is not to be construed as a guarantee of the syste. Civil Engineers ® Land Surveyors o Land Planners Commonwealth of IlyIassachusetts Massachusetts System Pumping Record System Owner Vc)CA- V System Location �7a � -, ( 'e�' eo - Date of Pumping: ✓ —� Quantity Pumped Cesspool: No Yes Ll Septic Tank: No L System Pumped by: t; areQO.-t.11&7 tjjeJ License # Contents transferrred to : Greater Lawrence Sanitary District Date: Inspector: Yes gallons Commonwealth of Massachusetts City/Town of System Pumping RecordL-P 29 Z010 wAi S ey`�v Form 4 TOWN OF NORTH ANDOVER ONT DEP has provided this form for use by local Boards of Heal T , but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health tq determine the form they use. The System Pumping Record must be submitted to the local Board of Health a ottteIrapproving authority. A. Facility Information 1. System Location: Le de'vf fit Left rear of hou Right rearof Address I __� r) e) 6 1 City/Town 2. System Owner. Name Address (if different from location) Cityrrown side of house, Left front of house, Right front of house, t rear of building.. Right rear of building. State Zip Code State 1-6 ( Zin Code Telephone Number - ` � �3 T B. Pumping Record Q L -_� -( 1. Date of Pumping Date 2. Quantity Pumped 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Other (describe): Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes JA'No If yes, was it cleaned? ❑ Yes ❑ No 5. Cond' ' n of System: 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Lo wher contents were disposed: G.L.S. AoweAWaste Water '777_7_'�('� cx_� Signature a F5821 Vehicle License Number Date t5form4.doa 06/03 System Pumping Recons • Page 1 of 1