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HomeMy WebLinkAboutMiscellaneous - 79 LACY STREET 4/30/2018� Sf �I ' MAP # PARCEL # LOT #-I-- -- CONSTRUCT I.ON_.APPROVAL HAS PLAN REVIEW FEE BEEN PAID? CS NO PLAN APPROVAL: DATE / APP. BY,__=/__._..... DESIGNER: l�V PLAN DATE._ ,--2h _q4: - CONDITIONS WATER SUPPLY: TOWN WELL � /� WELL PERMITDRILLER.) _ _....._._.. _..._... ......... _..... ..._....... CHEMICAL DA I E OPPRUVED WELL TESTS: .__._-J_ ._qS `1 BACTERIA I DOLE f PPHUVEUJ�/� 1- BACTERIA II DAIE APPRUVED.7/ /f J COMMENTS: FORM U APPROVAL: APPROVAL TO ISSUE YE5 NU� DATE ISSUED 2120 /l --- CONDITIONS: FINAL APPROVAL: ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NU SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NU ANY VARIANCE NEEDED FINAL BOARD OF HEALTH APPROVAL: YES NO DATE:. _.._......._..._ ...HY= ... t . 'h' ,rt. • .. (� TE.lMt-• T Tt �f 1iiL••a�•yTi.T �}�1 :•J: iiia .c'Z. ., .... ' ;;•' �1,:�::2-+rt. - -YES N .. . ISTHE INSTALLER LICENSED? .- � - . :.,;.• • REPAIR' . . .TYPE_ OF- CONSTRUCTION: ?� NEW :,NEW CONSTRUCTION: CERTIFIED PLOT.PLAN,REVIEW YES NO CONDITIONS OF.. APPROVAL. YES NO (FROM FORM U) ' t 74 `—ISSUANCE -OF DWC PERMIT = YES NO INSTALLER 'DWC PERMIT N0. BEGIN INSPECTION YES N0: i• . -- :: ;.- .. ; .: ::- .:..:,•...:,- •. ..... NEEDED: . ::EXCAVATION.INSPECTION: . PASSED ., BY CONSTRUCTION INSPECTION: NEEDED: -•. - AYES s . „.- • AS BUILT PLAN SATISFACTORY: � .., .: • ._:1. .. .. - • BY APPROVAL TO BACKFILL: DATE: " FINAL.GRADING APPROVAL: DATE Z BY DATE: BY FINAL CONSTRUCTION APPROVAL: . Commonwealth of Massachusetts RECEIVED City/Town of System Pumping Record CX" 0 7 20?3 Form 4 L N OF NORTH ANDOVER ALTH DEPARTMF_NT DEP has provided this form for us&by local Boards of Health. Other forms may=be=use , 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: Left/ Right front of hous/ Rig ear of hous Left/ right side of house, Left/ Right side of building, Left / Right front of bu-11ITifig, Left Ig rear of building, Under deck Address '7 q Lq� SY--,C 2. System Owner. Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): State Date Cesspool(s) 4. Effluent Tee Filter present? ❑ Yes 5. Condition of 6. System Pumped By. 7. Zip Code stat C Telephone Number — 2. Quantity Pumped eptic Tank Gallons -� ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No. L� Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc- Company ncCompany contents were disposed: I nwall Woe a wck+cr t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 f IAORTq o � F � A ,SSACMUSEtA Town of North Andover, Massachusetts BOARD OF HEALTH Form No. 2 DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant �J`I'� s �� Test No. Site Location Reference Pla Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. Fee CHAIRMAN, BOARD OF HEALTH Site System Permit No. 6 Gc) — M0,57— )j� 41012 7-6 Town of North Andover, Massachusetts Form No. 3 BOARD OF HEALTH t NORTH 1 O `� o �° •O Lam./\ 1` l 19 I J o ^ t Y • moo- .�° �''°•;,,o."� DISPOSAL WORKS CONSTRUCTION PERMIT 9SgAC11U5Et Applicant F -- NAME J t ADDRESS TELEPHONE Site Location - Permission is hereby granted to Construct M or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. -Y av Fee J p C' CHAIRMAN, BOARD OF HEALTH D.W.C. No. as rA Commonwe th of Massachusetts k/._Av._&a4IMassachusetts System Pumping Record System Owner PPCav�-A Date of Pumping: Cesspool: No,.PK Yes [I System Pumped by: V4&,&4t System Location r? q Lct 6 J_ S�L Quantity Pumped: 45?' gallons Septic Tank: No [ ] License # Contents transferred to: Greater Lawrence Sanitary District Date: Inspector: Yes' O/C -04 /iUF3•C- S 16ti 0/--,,,-- Ararat otatt Main offloe/LsboraUn zz MWWNNW Rd i RL 28 Derry, NN 03038 {603) 432044 211MIXtUL JIM At: Tramway jbrkeq)4" Route 16 & 25 Wap 20 trill 03890 (gertifirate of Anallasis for Prinking Pater SENT TO: Full Circle Construction/TEST NO.; 19525 PO Bog 398 4ta� No. Andover, MA O�pf o�N�P�°°� S PLE .�pNi9pPa LO TION: Lot 1 DATE & TIME SAMPLED: 07/17/95Lacy St. No. Andover, MA PARAMETER r; RESUL RECOMMENDED t.. 4' (PPM)- MA%.LEVEL(PPM) [�--------- __....- PH UNITS 6.5 8.5 UNITS `1 HARDNESS 150 CHLORIDE 250 NITRATE NITRITE 10.0 1.0 SODIUM 250 IRON 0.3 MANGANESE 0.05 COLIFORM ABSENCE /100 ML ABSENCE /100 ML OTHER BACTERIA /100 ML 200 /100 ML COPPER 1.3 ARSENIC 0.3 05 LEAD 0.415 CHROMIUM 0.1 CALCIUM NONE SET FLUORIDE 4.0 COLOR CPU 15 CPU ODOR TON 3 TON TURBIDITY NTU 5 NTU HYDROGEN SULFIDE NONE SET (XXX) THE TESTED PARAMETERS MEET CURRENT EPA STANDARDS FOR DRINKING WATER THE TESTED PARAMETERS MEET CURRENT EPA PRIMARY STANDARDS FOR DRINKING WATER, BUT SOME SECONDARY PARAMETERS EXCEED STANDARDS. { ) THE TESTED PARAMETERS FAIL CURRENT EPA STANDARDS FOR DRINKING WATER -DUE TO PRIMARY STANDARDS OUTSIDE OF LIMITS. --------------------------------------- COMMENTS: ------------------ 07-20-95 18:14 CFMD < LESS THAN OUR LOWEST CALIBRATION POINT > GREATER THAN OUR HIGHEST CALIBRATION POINT TNTC TOO NUMEROUS TO COUNT 1 FLAGS PARAMETERS THAT EXCEED PRIMARY STANDARDS; CAUSES TEST FAILURE. 2 FLAGS PARAMETERS THAT EXCEED SECONDARY STANDARDS: DOES NOT FAIL TEST NOTE: SUBSEQUENT SAMPLES FROM THE SAME WATER SOURCE 1A/ ��o_ Authorized by 74 11*y4lu& --�j ug ftz�.- ec-3 / / Oranitt otatt ffnalpt"'L jnc. Main Office/ Laboratory At: Tramway Marketplace At: Daniels Artesian Wells 22 Manchester Rd./ Rt. 28 Route 16 & 25 Route 3 Derry, NH 03038 West Ossipee, NH 03890 Sanbornton, NH 03269 (603) 432-3044 1-800-699-9920 1-800-699-9920 NL.eztifTirate of ;knalijois for Brining Water SENT TO: E & F Builders Inc. TEST NO.: 17731 PO Box 398 No. Andover, MA 01845 SAMPLE LOCATION: .__Lot 1 Lacy St. {#79 DATE & TIME SAMPLED: 03/13/95 5:50 PM (XXX) THE TESTED PARAMETERS MEET CURRENT EPA STANDARDS FOR DRINKING WATER. EPA PARAMETER RESULT RECOMMENDED { ) (PPM) ----------------------------------------------------------------------------------------- MAX.LEVEL{PP) PH 7.93 UNITS 6.5 - 8.5 UNI HARDNESS 43 < 150 CHLORIDE GREATER THAN OUR HIGHEST CALIBRATION POINT TNTC 250 NITRATE <0.5 2 10.0 NITRITE <0.05 1.0 SODIUM <10.0 250 IRON <0.20 0.3 MANGANESE <0.05 0.05 COLIFORM ABSENCE /100 ML ABSENCE /100 ML OTHER BACTERIA /100 ML 200 /100 ML COPPER 1.3 ARSENIC 0.05 LEAD 0.015 CHROMIUM 0,1 CALCIUM 14.2 NONE SET FLUORIDE 2.0 COLOR 1 CPU 15 CPU ODOR TON 3 TON TURBIDITY 1.0 NTU 5 NTU HYDROGEN SULFIDE NONE SET (XXX) THE TESTED PARAMETERS MEET CURRENT EPA STANDARDS FOR DRINKING WATER. ---------- { ) THE TESTED PARAMETERS MEET CURRENT EPA PRIMARY STANDARDS FOR DRINKING WATER, BUT SOME SECONDARY PARAMETERS EXCEED STANDARDS. { ) THE TESTED PARAMETERS FAIL CURRENT EPA STANDARDS FOR DRINKING WATER ----------------------------------------------------------------------------------------- DUE TO PRIMARY STANDARDS OUTSIDE OF LIMITS. COMMENTS: MAGNESIUM = 1.9 PPM RECOMMENDED MAXIMUM LEVEL = NONE SET SPECIFIC CONDUCTANCE = 110 uMHOs MCL = NONE SET ALKALINITY = ----------------------------------------------------------------------------------------- 42.0 PPM MCL = NONE SET SULFATE = <10.0 PPM MCL = 250 PPM < LESS THAN OUR LOWEST CALIBRATION POINT GREATER THAN OUR HIGHEST CALIBRATION POINT TNTC TOO NUMEROUS TO COUNT 1 FLAGS PARAMETERS THAT EXCEED PRIMARY STANDARDS; CAUSES TEST FAILURE. 2 FLAGS PARAMETERS THAT EXCEED SECONDARY STANDARDS; DOES NOT FAIL TEST NOTE: SUBSEQUENT SAMPLES FROM THE SAME WATER SOURCE MAY VARY. SLS Authorized by AAM tate Snatpficat,Ora�nfte o Jnc* CONTAMINANTS PARAMETER: EFEE_CT_S PH _ Recommended range '0 A pH of 7.0 is considered neutral. Below 7.0 the vater is considered acidic, and above 7.0 the water is considered basic. At a pH of less than 6.5, corrosive effects may transpire and the leaching of toxic metals may.occur. Greater than 8.5 can cause mineral incrustations and bitter tasting water. HARDNESS Recommended range Is less than 150 ppm. Hardness 1s the results of segre3atior, of minerals such as calcium, magnesium and slllca. Excessive hardness can cause scale formation In heating systems and combine with soap to leave Insoluble particles. Hay also cause a foul odor. CHLORIDE Recommended range is less than 250 ppm. Can cause corrosion above 250 ppm concentration. Above 400 ppm concentration it causes an objectionable salty taste. NITRATE - N Maximum contaminant level 10 ppm. Major sources of nitrate -N are caused by fertilizer runoff, soil, organic matter, leachates from landfills, and municipal and Industrial wastewaters. Excessive concentrations can Indicate septic tank pollution. Under certain conditions nitrate -N can be' chemically reduced in the body to form nitrite -N NITRITE - H Ma, -!mum contaminant level is 1.0 rpm. Vater with high nitrite levels should not be used for Infants under 3 months of age due to the potential risk of methemoglobinemia (blue baby syndrome). Vater with high nitrite concetrations usually are heavily polluted and bacterloleglcally unacceptable. SOD!UM Recommended t1axlmum 250 ppm. Can cause Increased blood pressure through excessive sodium intake and may cause hypertension. For people on low sodium Intake the recommended Maximum level is 20 ppm. IRON Recommended level !s less than 0.3 ppm. Iron can cause discoloration in laundered goods and can cause a bitter or a astringent Last& In the water. may come from corroding Iron or steel piping, although It does occur naturally. Presently, there are no known health effects from high levels of iron in the water. MANGANESE Recommended level is less than 0.05 ppm. Can cause discoloration In laundered goods and impair taste In drinking water and beverages. At high concentrations may cause brown spots in laundry Items and leave unaesthetic black precipitates. COLIFORM Recommended level is 0 per 100 ml of sample. coliform bacteria are used as Indicator organisms to ascertain bacterial quality of potable water. The presence of excessive con form bacteria Indicates that disease -causing bacteria may be present. ( WATER SHOULD BE RETESTED IF ANY COLIFORM IS DETECTED ) Ira COPPER Recommended maximum levet is less than •i'T ppm. Can cause adverse taste affects or stain porcelain. Extremely high concentrations of copper may cause gastrointestinal tract irritation. ARSENIC Recommended maximum level is less than 0.05 ppm. Arsenic In water occurs naturally as well as from industrial activities. Excessive Ingestion of arsenic can cause severe poisoning. a•o1S LEAD Recommended maximum level Is less than Ov* ppm. Lead can occur due to corrosion of lead containing household plumbing and by Industrial poilutior,. Major toxic effects Include anemia, neurological dysfunction/damage and renal impairment. CHROMIUM Recommended maximum level Is 0.05 ppm. Chromium is found In the air, soil, and most biological systems. May cause growth retardation and sensitize the skin. CADMIUM Recommended maximum level is less than 0.01 ppm. May cause chronic kidney dtsease. High levels may Indicate industrial Pollution. SULFATE Recommended maximom level to 250 ppm. May cause detectable taste at concentrations above 300 ppm. High levels can cause scaiing in boilers and heat exchangers. At concentrations above 600 ppm a laxative effect may occur. FLOURIDE Recommended maximum level Is 2.4 ppm. A fluoride concentration of approxtmatei+s 1.0 ppm In drinking water effectively reduces dental caries without harmful effects on health. Fluoride may occur naturally In water. Some fluorosis may occur when the fluoride let,el exceeds the recommended limits. DEFINITIONS ppm signifies parts per million and/or milligrams per liter ew. e _ w eftno ,r,�•, BOARD OF HEALTH SAC NORTH ANDOVER, MASS. APPLICATION FOR WEL4L AND PUMP P�-1-T-- Date _ Permit # A permit is requested to: drill a well _ install a pump_„ ._. LOCATION' Lot # .yf� -S`78 Owner_ �'— Address Tel well Contrctr o -fl) p Add . Tel Pump Contrctr Add. Tel *dr dekde�lrk�i�3edki�r�r9ei�idr�ekk3e4rkieirk7k•kdrdc�*��r�ekdki�cie�ede#�e7kki�e�rde�jt*de�rY*ar�e�eieiF•k3e* WELLS (To be completed at time of pump test•) Type of well �� - use SCJ' Diameter of well Size of casing Depth of bed rock J/ Depth casing into bedrock Seal been tested? Yes ( No (_) Date of test Depth of well G7 Water -bearing rock Depth to water 4- f " Delivers GPM for (how long?) Drawdown_ feet after pumping _ hours at ,• GPM Date of completionLJD f Signature of well contractor • PUMPS (To be filled in before installation.) Name & size Of pump Type—• . Size of tank Pump delivers _ GPM pipe used in well: Cast iron (�) Galvanized () Plastic (�} Sleeve used to protect pipe? Yes (—) No (_) Type well seal Date --�' signature of pump installer Date water analysis report submitted to Board of Health Plumbing inspector Wiring inspector Board of Health A-! w. P, q NUMBER FEE THE COMMONWEALTH OF MASSACHUSETTS $25.00 ----- TOWN----- Of ......... U01:nj1.-AhM.0.VBR ................ ............. This is to Certify that ........ C-harl.e-s... M ...... R0.1.1.i-n.s --- Co Inc.................................... .. .......... .. .. ... .• . NAME ............. ................................................................................ ADDRESS IS HEREBY GRANTED A LICENSE For --------- WeIL-2eimit ... m. -.L.Q.t ... 4.1 ... Lacy ... S.trQ.Qt ............................................................ ............................................................ .............................................................................................................. ............................................................................................................................................................................ ........................ ....................................................................................................... ........................ .................. This license is granted in conformity with the Statutes and ordinances relating -t cto, and expires ...De c emb.e-r.. ....3.1 1995................ unless soe f 7 Pe�oke d. ................. ...... :4N ........ ......... .............. March 6 95 --------- - - ----- ......................... ............................. 19 ------ U .................... ................................. ............ 4-11 ---- .................................. .. ......... FORM 433 HOBBS & WARREN, INC. 77 V -: }�;l';'.'�+r e "t��'?ti �-� ; Ji; �� � �G. ,4,r.4k�'���;�."!=�a?`g<�jii� � t,,. ,�\; �r�a�'�kltx�r �•i3�'�<�t�'���.�����1�,.� • r:. •it4'` �,{ t.F'.•�,�. ,`Sl.•i�t. �1 t it't :. t 'Y �j�•�i . : i. ,.I ',,k�' ;r( Z 1 � ii r•.\ r �i< { � <-•��'��\ Yr�\ir.��'.�,.tGy,.,� '(l.,ti },.`•.1l':,`ti��)\ty'vry,.i'-A`,.�t :���:t�•w. s{(7:�'i:'•�.�''•,��j���;'� a•� }�(�:i:4i�,1�1.`1,�•(r.� �.•,.��i,�,•[ ��•��h4�R! i:�yr\t�+T�S��ti�`�'S-`�`���,1�X,•t�.�15�t��,i�8 �4`� 'k .t�'��y ; tr a '.a-;T,tt\.4 rw, ,l yyS,ti , �Y�' 1'a.� •i � �.�•\- ` :i .. -�, r � �. •`�� •Y ,�tr1 \, v. '�'\ ?,, a •`�.. :"`�`�A�, ,C;�r�i �"� J.•. +t r .r R � Parc-1 —_ RK a7 - i 3 -� 3 i - �� w PLAN REVIEW CHECKLIST ADDRESS �ljT ,��J�}/ ENGINEER GENERAL 3 COPIES L- STAMP ✓ LOCUS ✓ NORTH ARROW SCALE CONTOURS1L PROFILE (� D PERC INFO� ELEVATIONS_ WETLANDS LZ WATERSHED?A FDN DRAIN SCH40�� do f SECTION C-- BENCHMARK r-0455 SOIL &A;Lvg ,e Lo waR WETS. DISCLAIMER WELLS & v 2'10-41 DRIVEWAY (Eley) WATER LINE C/ TESTS CURRENT?AaA SEPTIC TANK MIN 1500G4-/ .17 INVERT DROP GARB. GRINDERJ4 (+200% EDF) 25' TO CELLAR D -BOX MANHOLE TO GRADE ELEV GW SIZE # LINES AL FIRST 2' LEVEL STATEMENT INLET 191�0�- - OUTLET (2 11 OR . 17 FT) TEE REQ' D?A6 LEACHING MIN 660 GPD? RESERVE AREA (� 4' FROM PRIMARY? v 2% SLOPE 4--**' 100' TO WETLANDS ✓ 100' TO WELLS (/ 4' TO S.H.GW L--- 35' TO FND & INTRCPTR DRAINS 325' TO SURFACE H2O SUPP 4' PERM. SOIL BELOW FACILITY MIN 12" COVER 6`� FILL?c (25' if above natural elev 10'if elow) BREAKOUT MET? ci TRENCHES MIN 660 gpd ✓ SLOPE (min .005 or 611/1001) l/ >3 -COVER? -VENT SIDEWALL DIST. 2X EFF. W OR D (MIN 61) 1'1� IS RESERVE BETWEEN TRENCHES? `�� IN FILL? 1/ MUST BE 10' MIN. L,--' 4" PEA STONE? +� BOT Q�06 X LDNG + SIDE aa(� X LDNGQ = TOT (L x W x #) (G/ft2) (DxLx2x#) (G/ft2) Copyright C 1993 by S.L. Starr 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 local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: ���n�s!�e' S� >>" Vii/ ate; ij Phone LOCATION: Assessor's Map Number Subdivision Street tAcv ************************Official �;TVDT ON OF WN AGENTS Conservation �lA\dmi strator Comments - Y l l� (�.A- 5f' ,w k Town Planner Comments /05" %-) Parcel '31 Lot (s) / St. Number Use Only************************ Date Approved 3 �� Date Rejected wr�4p,165 6A) -Sik Date Approved Date Rejected Date Approved Food Ins/p/ector-Health Date Rejected Date Approved Sept—Inspector-Health Date Rejected Comments �:f' %t<_ / /%' T -z5 Public Works - sewer/water connections /- CLQ =�- - l - driveway permit 61; Fire Department Received by Building Inspector Date THOMAS E. NEVE ASSOCIATES, INC. fnI 22 II�� I� n /� �V1 ISI /� �1 Engineers - Land Surveyors - Land Use Planners L�,LEUTEW OF VW1�,.1u SO � TUR L� 447 Boston Street US Route #1 TOPSFIELD, MASSACHUSETTS 01983 C,a (508) 887-8586 FAX (508) 887-3480 TO Sar+cly Stc�rr �B.O.H� 12 O M A I K.) S'T. Nor t.h Andc,jct- . MA O 10415 > WE ARE SENDING YOU X Attached ❑ Under separate cover via ❑ Shop drawings Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ DATE Z/3 �5 JOB NO. 3►1-! ATTENTION SA>avy STAtZtz RE: REVISE© SEPTIC C�ESlcsr� LoT 1 LAGy S -r Reil:2f3�195 31t-1 SEPTtG DE91CrrJ dor t.A>-r 1 LAcy ST. the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION 3 Reil:2f3�195 31t-1 SEPTtG DE91CrrJ dor t.A>-r 1 LAcy ST. THESE ARE TRANSMITTED as checked below: XFor approval ❑ For your use > ❑ As requested ❑ Approved as submitted ❑ Approved as noted ❑ Returned for corrections ❑ For review and comment ❑ ❑ FOR BIDS DUE ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS QeC'r Sand..i : Please Fina. enc.laSecl, re.vlSed arir,t_•S of +1•e "bove r,^,e.nt.;oned` Lot. A note h+aS t>een added, to ttie Plan �, Gpr,�irnninq d ep 1^o12, be dl,va in Season _ ;n tl,e Fresenc,e o'Fr One - 13.0.H• AQt A- prior +o Goi,S}ruc.}`on A no}e bee•, aoloLcd to 'F•�c l3tnc.>•.�.arK t -,-%A t, a bencJ-+ w; 1I be Set w/ in 50 of S'yS+M flrior to construction . A foul ckc,+ion bcee, gold d_ •iv t -he flan. AS -je d.'sc.ossedl on Z/3 +b+e well %es bttn r -o• ect ;ur+l,tr up SLooe row+ +1,c driytwov. A we+1ands d+sc.lair+%cr i,aS been rodded +o t?,c ole�n c►S vno+e *0 14. 7"F,anK vog Cor your +1,-t and effort seen'' ,,a/ rv�e, Z n 1-esol -J `r, � +l,ig ^-&-1'1�tr Any auest;on5 p1case. Gal l COPY TO Sinterly.) SIGNED:pe PRGDUCT24112 � Int, GmW, Mess 01471. If enclosures are not as noted, kindly notify us at once. DATE Sheet of BOARD OF HEALTH TOWN OF NORTH ANDOVER SUBSURFACE DISPOSALDESIGN REVIEW PERMIT # Co/ 7 0!�; DATE RECEIVEDZZA119,0 A P ��CT /nn�ZJJ 4,6ASSESSOR'S MAP rCC CSS �vl �1�j PARCEL LOT # % STREET -49c 5 7- A AC s 7 Oz -o 365I-O,u �� > /�s/���r�� 0/98,3 /�/q,o- REVISION DATE CC:;Ci:CC: S Or APPROVAL: Ar_ :.OVtD DIEAPPOVED X R 6"1- �9 U T Ol' 7? T� OIC Z -%3� NG f�/r'I � /�� A,1,07' //.) S1 -D W AUG G pOT�2�/V T v � D i= a� �= C a ivT�v•e� / i��s��vG o v�•e /�'/vG y o,c 5 (2 G /9 /1�12 6'Z f' l l 55 JlU G �Y Addressee: From: TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 120 MAIN STREET NORTH ANDOVER, MA 01845 Telefax Transmittal Form January 31, 1995 Date Name: Scott Follensbee Firm: E_& F Builders Street: P.O. Box 398 City, State, Zip: North',Andover, MA 01845 Telefax phone number: (508) 685-7362 Town of North Andover Health Department 120 Main Street North Andover, MA 01845 Telephone # (508) 682-6483 Ext. 32 Telefax # (508) 682-2996 Total number of pages, including transmittal form 2 If you do not receive all pages, notify sender immediately. Additional Comments: O-tt``D BOARD OF HEALTH 120 MAIN STREET TEL. 682-6483 NORTH ANDOVER, MASS. 01845 Ext23 January 31, 1995 Mr. Thomas Neve 447 Old Boston Road Topsfield, MA 01983 Re: Lot #1 Lacy Street Dear Tom: This is to inform you that the proposed plans for site referenced above have been disapproved for the following reasons: 1) Soil tests out of date. 2) Benchmark not in work area of septic system. 3) No foundation drain. 4) Please show full footprint of driveway. 5) Contours missing over much of the site. 6) Wetlands disclaimer missing. If you have any questions, please do not hesitate to call the Board of Health Office at the number above. SS/cjp Sincerely, Sandra Starr, R.S. Health Administrator CPA 9-4 W4 O z w 7-4 R.; W om mw Vf O m w S� � C; tc y CD 0 � C N \p O rm r cT 3m� a € 03 m d O y rn m� y a c � C, o coE co ev m O p m m 1 cm C pQ m a,ct c V O O C 3 y i 44 p.>Z O y rr C O O C CD C', O. C C a •, C.L O C Z ►+ cr- uj �E c=.��Ey O m 0-0c g CIO p- m '.5 O 2 OM O CL, C13 7 0 C/) o -j z E xGOy U CD G U F - z a `}'�t cav � UU z o Q w° c V C: w° ° U w a ° w w w ° v c ° u� w w z v ' ° w cn cn W om mw Vf O m w S� � C; tc y CD 0 � C N \p O rm r cT 3m� a € 03 m d O y rn m� y a c � C, o coE co ev m O p m m 1 cm C pQ m a,ct c V O O C 3 y i 44 p.>Z O y rr C O O C CD C', O. C C a •, C.L O C Z ►+ cr- uj �E c=.��Ey O m 0-0c g CIO p- m '.5 O 2 OM O CL, C13 7 0 C/) o -j z E CD F - z a � C z � � CD CM o w CO) Ocr- O Q M 'E O O m m Cw z W m C o O L O CDL tC O Off. a �a cn C O O O Q e J z .y Z v J O CD CL C.D cc ca •� ccCO) cx: W cn Q z z � Z W LLJ �� U) (WELL DATABASE A 7DRESS: AGE OF WE : 'WELL DRLLL R: �Fi'C PE Ylj T: WELL LOCATION: /11 —_-VEL.L. PERM711, DA---�TE��.2 3 -tet S� DEP it OF ? L: c� TYPH OF WELL. <LRIL::=:D b. DAG C. �Jro i i TYPE OE WAS BERING RO CK_- WA YA rYSIS DALE= EIGHNANLi T S Y FLG LELON: Y 0.1= CON77-AIrYi AMTS: Y N J r WTrT r DAT_�BA�E ADDRESS: ! . ��/ �o AGE OF W �: WELL L DRILLER - WE= P EP-WMIT DATE. 18 EP i H 04 WELL. TYPE OF WELL: a.. DRILLED b. DU Gr C. UNFKYO WN TYPE OF WA 1 ER BE AlR tG ROCK: WATER ANS YSIS DATE:... 2- I-EGH NANGANESE: Y N HIGH IRON: Y N OTIC CONTANML ,4NTS: Y N Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 RECEIVED \ , v NOV 2 5 2008 TOWN ODEPARTM OVER DEP has provided this form for use by local Boards of Hea&-er-far 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, ft rear eft sid of house Right front, right rear, right side of house. forms on the computer, use only the tab key Address to move your ry cursor - do not use the return City/Town State Zip Code key. 2 System Owner: - d Name Address (if different from location) City/Town State/t oar Zip Code Telephone Number X11 B. Pumping Record 1. Date of Pumping 3. Type of system: 0 El Other (describe): 2 Q f P d Date uan ty Umpe Gallons Cesspool(s) u Septic Tank [I Tight Tank 4. Effluent Tee Filter present? 0 Yes 9-<O 5. Condition of System: -r 6. System Pumped By: Neil Bateson If yes, was it cleaned? 0 Yes 0 No (1�-e 1 F 5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location ere contents were disposed: 111�L.S.:Q�� Lowell Waste Water re of Z(—C Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1