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LOT #
PARCEL # STREET
HAS KLAN REVIEW FEE.DEEN PAID?� Ii%9 YES NO
PLAN APPROVAL: DATE PP, BY
DESIGNER:_ en,/w /5 PLAN DA,fE. ^`
CONDITIONS g7
WATER SUPPLY: TOWN WELL
PERMIT
WELL TLSS_S :
COMMENTS:
D R Z LLER._-
CHEMICAL
BACTERIA I
BACTERIA II
DA I E APPROVED,-.__ — _--
DA I E (IPPRUVED
DATE APPROVED
FORM U APPROVAL: APPROVAL TU ISSU<�;—L
NU
DATE ISSUED
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
YES NO
FINAL BOARD OF HEALTH APPROVAL: DATE: BY:
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1-A IS THE• INSTALLER LICENSED? +
syr YES
NO
`TYPE. OF CONSTRUCTION:
NEW
REPAIR,",
NEW CONSTRUCTION: , .. CERTIFIED PLOT PLAN REVIEW YE,S
NO
CONDITIONS OF. APPROVAL YES
T •
NO
E (FROM .FORM U)
_
`..ISSUANCE,
(
NO
OF DWC PERMIT
• 1 DWC ;PERMIT N0. ��' -
: ` INSTALLER:1�� J13L�y�
" BEGIN INSPECTION YES N0:
-'
EXCAVATION. INSPECTION: ;NEEDED:
PASSED _ BY
<'__:CONSTRUCTION INSPECTION: NEEDED:
AS BUILT PLAN SATISFACTORY: YESt
-
APPROVAL TO BACKFILL: DATE:
•1.
BY
FINAL.GRADING APPROVAL: DATE
BY
DATE: Q=�/-
'` `.FINAL CONSTRUCTION APPROVAL:
_BY
Commonwealth of Massachusetts
City/Town of RECEIVED
System Pumping- Record AUG 0 3 2015
Form 4
>• V TOWN 0F NORTH ANDOVER
HATH DEPARTMENT
DEP has provided this form for usezby 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 Location: Leftnt of Nous Left /Right rear of house, Left /right side of house, Left /
Right side of building, Left / Right front o uildirig, Left / Right rear of building, Under deck
Address '�AX G0-1'\4 L \ IiC
City/rown State Q/ Zip Code
2. System Owner.
Name'
Address (if different from location)
Cityirown ' State Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped: Gallons T
3. Type -of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank
4.
❑ Other (describe):
Effluent Tee Filter present? ❑ Ye. No If yes, was it cleaned?
5. Condition of System:
v
6: System Pumped By:
Neil. Bateson
Name
Bateson Enterprises Inc-
Company
ncCompany
7. Locatio ere contents were disposed:
Ca.L�S Lowell Waste W.
F5821
Vehicle License Number
Data
❑ Yes ❑ No:
06=4.doc• 06/03 System Pumping Record • Page 1 of 1
Commonwealth of Massachusetts
_ City/Town of
System Pumping Record Jl1N
Form 4 0 9 2014
TOWN OF NORTH AN OVER
DEP has provided this form for use=by local Boards of Health. Other forms sedDbc�tk T
information must be substantially the same as that provided here. Before using.this form, c ec I our
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 h front of house Left /Right near of house, Left./ right side of house, Left/
Right side of building, Left / Rig t rant of building, Left / Right rear of building, Under deck
Address rl�J l SCJ
City/Town State Zip Code
2. System Owner.
Name
Address (if different from location)
City/Town
B. Pumping Record
1. Date of Pumping
3. Type of system: ❑
State _ �^�, v r� CZipCode
Telephone Number
��epficaTanik
Pum
Date per' Gallons
Cesspool(s) ❑ Tight Tank
❑ Other (describe):
4. Effluent Tee Filter present? ❑ Yeas 0160
5. Condition o System:
6. System Pumped By.
Neil. Bateson
Name
Bateson Enterprises Inc
Company
7. Location where contents were disposed:
If, yes, was it cleaned? ❑ Yes ❑ No;
Waste Water
F5821
Vehicle License Number
Date
t5form4.doc• 06/03 System Pumping Record • Page 1 of 1
Commonwealth of Massachusetts
City/Town of
W° System Pumping Record
Form 4
DEP has provided this form for uset 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 Location: Left R ont of h , Left / Right rear of .house, Left / right side of house, Left /
Right side of building, Left / Right front of building, Left / Right rear of building, Under deck
Address
City/Town State
2. System Owner. C
V v�
Name
Address (if different from location)
City/Town
B. Pumping Record
1. Date of Pumping
3. Type of system. ❑
❑ Other (describe):
'_l -R— I3
— 2. Quantity Pumped
eptic Tank
Date
Cesspool(s)
Zip Code
State Zip Code
Telephone Number
Gallons
❑ Tight Tank
4. Effluent Tee Filter present? ❑ Yes 040 If yes, was it cleaned? ❑ Yes ❑ No
5. Condition� of LSy�stem-
Ulm •�J,ILJL� �/�.,
6. System Pumped By:
7.
Neil Bateson F5821
Name Vehicle
Bateson Enterprises Inc
Company
contents were disposed:
I nwall 1N�cic lA/�ic�
RECEIVED
:nse Number
APR 16 2013
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
t5fomu4.doc• 06/03 System Pumping Record • Page 1 of 1
L\ commonwealth of Massachusetts
City/Town of I RECEIVED
System Pumping Record
Form 4 JUN - 5 2006
DEP has provided this form for use by local Boards of Health.. Tt eTiSystelffi f d must
be submitted to the local Board of -Health or other approving aut _ _.psi.4LA i-1 °�' r
A. Facility Information
.Important:
When filling out
forms on the
1.
System Location: \ _
C% �—
computer, use
ona tab key
to move your
mo
cursor - do not
Addres
-
use tfie return
/T
Gityown
State Zip Code
key. .
2..
System Owner
Name
Address (if different from location).
City/Town
StateZip Code
L+
Telephone Number
B. Pu'rnping Record
'1.
Date. of Pumping Date
2. Quantity Pumped:
Gallons
3.
Type of system: ❑ Cesspool(s)
eptic Tank ❑ Tight Tank
❑ Other (d'escribe)..
4.
Effluent Tee Filter present? ❑ Yes Q'No
If yes, was it cleaned? ❑ Yes ❑ No
5.
Condition of System: .
6:
System Pumped B
Name
Vehicle License Number
Company --
7.
Location where co ents. ere disposed:
N
signature or mauler
http://www.mass.gov/dep/water/approva
t5form4.doc• 06/03
Date
System:Pumping Record • Page 1 of 1
1
TOWN OF NORTH ANDOVER ��b g
?ooi
SYSTEM PUMPING RECORD = _�
DATE: 1 Irl.
SYSTEM LOCATION
(example: left front of house)
I o— -�(OV4— 04 kou
DATE OF PUMPING: bl QUANTITY PUMPED r C GALLONS
CESSPOOL: NO YES SEP IC TANK: NO YES
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION
HEAVY GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
SYSTEM PUMPED BY:
COMMENTS:
CONTENTS TRANSFERRED TO: �- L
FULL TO COVER
BAFFLES IN PLACE
LEACHFIELD RUNBACK
FLOODED
OTHER (EXPLAIN)
ti
INSTRUCTIONS: This form is used to verify that all necessary approval /permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve the
applicant and or landowner from compliance with any applicable requirements.
r r.r.r..........0............................■■....rr...r...rr.r..rr.......,.
APPLICANT l kA is PHONE
i
ASSESSORS MAP NUMBER f^ f' LOT NUMBER Q`_
SUBDIVISION LOT NUMBER
. CZ; �_�,Q-�(,.��' �-- � STREET NUMBER _
STREET -
.r.r■.r.rr....rrr.r.r■■...r.........■■rrr.■■.■.....rrr...r..r.rarrr......r..
OFFICIAL USE ONLY
I.■r■r..■r.r■■rwas ..■.■■■■■.■'■■.■■.rrr.r.■■r..•■r...r.r..r.r..rrr..r.-.....r..
RE ,CON>N1ENDATIONS OF TOWN AGENTS.
DATE APPROVED
C.ONSERVATTON ADMII9IISTRAT0R
DATE REJECTED
CO
DATE APPROVED
TOWN PLANNER
DATE REJECTED _
C s
FOOFf INSPECTOR -HEALTH -
SEPTIC INSPECTOR - HEALTH
COIvAIENTS
PUBLIC WORKS — SEWER / WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
COMMENTS
RECENED BY BUILDING INSPECTOR
DATE APPROVED
DATE REJECTED
DATE APPROVED I
DATE REJECTED
DATE APPROVED
DATE REJECTED
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
w l_
BUILDING PERMIT NUMBER: DATE ISSUED:
SIGNATURE:
Building Commissioner/InsWtor of Buildin Date
SECTION 1- SITE INFORMATION
1.1((,'Property
Address: 0 1.2 Assessors Map and Parcel Number:
tMap Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
Required Provide Required Provided Rapired Provided
1.7 Water Supply AG.L.C.40. § 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑
SECTION 2 - PROPERTY OWNERS11MAUTHORIZED AGENT
2-1 Owner of Record
Name (Print) (Print) Address for Servic
IS 7q V
Signature Telephone
2.2 Owner of Record:
Name Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable ❑
"
Licensed Construct io Supervisor:
b7 O 5 �� License Number
Address
Expiration Date
Signature Telephone
3.2 Registered Home Improvement Contractor Not Applicable ❑
Company Name
Registration Number
Address
Expiration Date
Signature Telephone
W.
AJC UNITS
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Town of North Andover
Office of the Health Department
Community Development and Services Division
William J. Scott, Division Director
27 Charles Street
North Andover, Massachusetts 01845
Sandra Starr
Health Director
January 3, 2001
Chris and Lisa Hanson
84 Sugarcane Lane
North Andover, MA 01845
Dear Mr. and Mrs. Hanson:
Telephone (978) 688-9540
Fax (978) 688-9542
This correspondence is in regards to a recent application by you, to screen in your
existing deck at the above address. The Health Department signed off on that project on
November 6, 2000, and there remains no problem with that application. However, the
concern that this letter brings to you today came out of this office's research for that
project.
The object of this letter is your septic system. The application process required a review
of the floor plans of your home and its relation to the existing septic system. Apparently
it was discovered that your home has more rooms than the dwelling that was originally
planned for. The capacity of your septic system was based on a design of a four (4)
bedroom or a maximum nine (9) -room house. The recent floor plan review found that the
number of existing room in your home exceeds this number.
The Health Department wants you to be aware of this fact and be sure that you also
understand that you can not increase the number of rooms in your home unless either the
septic system is upgraded or tied into sewer if municipal sewer ever becomes available.
In addition, upon a future sale of your home, a Title V inspector may deem it necessary to
upgrade the capacity of your system to allow a passing Title V to be issued on your
property.
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535
f'
It is common that during the building application process observations such as this one is
identified. I hope that you find this letter only as it was intended, an informative
communication from the No. Andover Health Department. This correspondence requires
no immediate action on your part. However, if you have any questions feel free to
contact the Health office at 688-9540.
Sincereby,
Susan Ford, R.S.
Health Inspector
Cc: Sandra Starr
File
October 30, 2000
Dear Town of North Andover:
We have hired Dave Reitan to construct a screen porch on our,
already existing deck. It is our full intent to use this room only as a
screen porch. We have lived in North Andover "for a little over 3
years and have not been able to use our deck in the summer
months due to the overwhelming number of mosquitos. We have a
lovely backyard setting and by adding a screen porch we feel we
can sit outside without being attacked by insects.
If you have any questions or concerns, please feel free to contact
us at 794-2121.
Sincerely,
Chris and Lisa Hanson
84 Sugarcane Lane
North Andover, MA O1845
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FORM - U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all -necessary approval / permits f~ om
Boards and Departments having jurisdiction have been obtained. This does not relieve the
applicant and or landowner from compliance with any applicable requirements.
�.r.. r.. r..... Y.... r.■■■.....�............'rrrarryyr..rrrrrrrrrrrrrrrrrrr■...■
APPLICANTO_ - . �. �� ` —. r PHONE jz4 i{
�ASSESSORS MAP NUMBER A ffOT NUMBER
SUBDIVISION LOT NUMBER
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STREET ��' �� Y ET NUMBER
. ............. ............Room r..rr.......r.rrrrrrrrr.r.rr....r....r..r.r
OFFICIAL USE ONLY
...........................................................................
RECONaffiNDATIONS OF TOWN AGENTS
DATE APPROVED _
CONSERVATION ADMINISTRATOR
DATE REJECTED
CONQAENTS
DATE APPROVED
TOWN PLANNER
DATE REJECTED
CONDAENTS
FOOD INSPECTOR - I}FALTH
/��-`���
SEPTIC INSPECTOR - HEALTH
CONMIENTs
PUBLIC WORKS - SEWER / WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
COMMENTS
RECEIVED BY BUILDING INSPECTOR
DATE APPROVED
DATE REJECTED
DATE APPROVED a Zi
DATE REJECTED
DATE APPROVED
DATE -REJECTED
ME
..-........ .. . ..
R=5Q? 58'
L=19.47'
I
TABLE OF ELEVATIONS
INV. OUT HSE. =
145.22
INV IN TANK =
145.02
INV. OUT TANK--
144.81
IN D. BOX =
143.93
" OUT D. BOX =
143.75 / 2
"END PIPE —143.44
/1
" END PIPE =
143.44 /2
57'
D.BOX
ch
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TANK
-- T.O.W .=147.0
EXISTING BUILDING
N TO THE PLAT
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System Owner
Conn ionwealth of Massachusetts
Ao . I - , Massachusetts
System Pumping Record
System Location
J
Date of Pumping: 5- _ tl- k a Quantity Pumped: 15 0-0 gallons
Cesspool: No "f' J Yes 1] Septic Tank: No Yes Lyl
System Pumped by: FerredOrt Srea t lida License #
Contents transt'errred to : Greater Lawrence Sanitary District
Date:
Inspector -
ED ,
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System Owliel-
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Quailtity
Date of Pumping: j, --
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�eptic Tank: No-, Yes,-
Cesspool- No Ll
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sysitill Ilumped by: 64&ddst License
Contents traitgrettred to Greater 6wtence-A a Its airld
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02-21-97 14:14 21 508 6832645 SCOTT L GILES s 001
OFFSETS SHOWN ARE FOR THE USEOF THE BUILDING
INSPECTOR ONLYAND SUCH USE IS FOR THE
CERTIFIED PLOT PLAN
DETERMINATION OF ZONING CONFORMITY OR
NON -CONFORMITY WHEN CONSTRUCTED.
IN
NORTH ANDOVER, MASS.
TO THE STONEHAM SAVINGS BANK:
DRAWN FOR
I HEREBY CERTIFY THAT THE
COLONIAL VILLAGE DEV. CORF
FOUNDATION SHOWN DOES NOT
FALL WITHIN A FLOOD HAZARD ZONE
SCALE: 1"= 7A' DATE: 1/2/97
f
AS PER FLOOD INSURANCE RATE FOR
SCOTT L. GILES, R.P.L.S.
THE TOWN OF NORTH ANDOVER
FRANKS. GILES
COMMUNITY PANEL 140: 250098 0008 C
NORTH ANDOVER, MA.
CERTIFY THAT THE OFFSETS SHOWN
�N�
COMPLYTH THE ZONING BY LAWS OF
AN
SUG PR�,F►N�
NORTH OVER, MA. WHEN BUILT
R=507.58' 102,
m
LOT 8
42,083 S.F. -=
LOT 7
---J-\-r
�T.O.W: 147.0
EXISTING BUILDING w
F_.1
WET,L:ANDS yy�
1 `I'l
APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT
DATE: �2 % % CURRENT INSTALLER'S LICENSE#
LOCATION: �6 r --O" g ,soae--� 90_L;
LICENSED INSTALLER: 1A "// i
SIGNATURE:
CHECK ONE:
REPAIR:
NEW CONSTRUCTION:
IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT.
Administrative Use Only
$75.00 Fee Attached? Yes No
Foundation As -Built? Yes �� No
Approval D;�/�1 Date: o�
0
CHRISTIANSEN & SERG1, INC.
PROFESSIONAL ENGINEERS AND LAND SURVEYORS
160 SUMMER STREET HAVERHILL, MASSACHUSETTS 01830
February 5, 1997
Ms. Sandra Starr
North Andover Board of Health
146 Main Street
North Andover, MA 01845
Re: Lot 8 Sugarcane Lane ("Seven Oaks" Subdivision)
Dear Ms. Starr:
(508) 373-0310 FAX: (508) 372-3960
r A
20P ?
On behalf of Colonial Village Development Corp., I submit to you the enclosed modified septic
system design for the above referenced lot. The modifications made to the plan were required due to
the fact that the house was constructed further back on the lot than what was shown on the previously
approved design. The modifications are limited to the locations and elevations of the foundation, septic
tank, and the piping between the foundation and the d -box. No changes have been made that effect the
d -box, leaching trenches, or reserve area.
Enclosed are 3 copies of the revised Septic System Design for Lot 8. Please contact me if you
have any questions regarding these modifications.
Verx Truly Yours,
&,I �-av -
Daniel J. O'Connell
C.C. William Barrett, Colonial Village Development Corp.
Town of North Andover I HORTil
OFFICE OF 3a °y '""
COMMUNITY DEVELOPMENT AND SERVICES °
146 Main Street + a'
North Andover, Massachusetts 01845..P,t�
WMLIAM J. SCOTT
Director
January 9, 1997
Mr. William Barrrett
Colonial Village Dev. Corp.
1049 Turnpike Street
North Andover, MA 01845
Re: Lot #8 Sugarcane Lane
Dear Bill:
I have received the sketch of the proposed changes for the house and septic tank locations
on the above referenced site. The elevations appear to be acceptable, however, I cannot
"approve" it as such because: 1) It is drawn by a R.L.S., and according to Title V, this
profession does not have the qualifications to design septic plans, or, at least, they are not
approved to do so. 2) As a plan, too much information is missing. An installer could not
construct a system using this document.
I suggest you give these proposed changes to the designer of record, in this case Phil
Christiansen, and have a revision plan drawn up and submitted to the Health Department
for review. There is no additional review fee levied by the Board of Health since the
changes are not extensive and this procedure occurs frequently. Changes like these,
however, should come in to the Board of Health as stamped, full plans so that all relevant
information for system construction is included on the plan we give to the installer.
Please call if you have any questions.
Sincerely, ,
Sandra Starr, R.S.,
Health Administrator
SS/cjp
cc: William Scott, Director, P&CD
BOH
File
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
FORK U - LOT PJK s?AGE 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: C.a�fln�� 9iG /�,/�,qj r Y%PdL . �oQ a Phone tf Z -Z 32 d
LOCATION: Assessor's Map Number l o 6 Parcel
subdivision dA1CS Lot(s)
Street 75U cA,yC_ L LYNX— St. Number
************************Official Use Only************************
RECO14KENDATIONS OF TOWN AGENTS:
Conservation Administrator
Comments
Town Planner
Comments
Food Inspectoorr-Health
Septic Inspector -Health
Comments
Public Works - sewer/water connections
- driveway permit
Date Approved
Date Rejected
Date Approved
Date Rejected
Date Approved
Date Rejected
Date Approved
Date Rejected
Fire Department
Received by Building Inspector Date
Town of North Andover, Massachusetts Form No. 2
O 14011Th BOARD OF HEALTH ��..�`'7y'�'
.... l� 00
0 19
ti w
� s
DESIGN APPROVAL FOR
NUS Et� SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
Applicant An -A A - Test No.
Site Location_�?1
Reference Plans and Specs. -NX J\ 1SA7-ia/YWQ h y �b /l,O►1 � %( AdA&
ENGINEER DE51 N DATE
Permission is granted for an individual soil absorption sewage disposal system to be installed
in accordance with regulations of Board of Health.
Fee V
CH IRMAN, BOARD OF HEALTH
Site System Permit No. r),(, _�
l
Town of North Andover NORTH
OFFICE OF 3� oy �«o '6
COMMUNITY DEVELOPMENT AND SERVICES °
i 9 e
146 Main Street ,, ^„x;'001
KENNETH R. MAHONY North Andover, Massachusetts 01845 9SSac►+us�`
Director (508) 688-9533
October 11, 1995
Mr. Phil Christiansen
Christiansen & Sergi
1'60 Summer Street
Haverhill, MA 01830
Re: Lot #8 Seven Oaks
Dear Phil:
This is to inform you that the proposed plans for the site
referenced above have been approved.
If you have any questions, please do not hesitate to call the Board
of Health Office at the number below:
Sincerely,
>U f��_ /t
Sandra Starr, R.S.
Health Administrator
SS/cjp
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
Julie Parrino D. Robert Nicetta Michael Howard Sandra Starr Kathleen Bradley Colwell
PLAN REVIEW CHECKLIST
ADDRESS S8V4F,0 k/_'_), -))C57 ENGINEER
GENERAL
3 COPIES . t ---"-'-'STAMP [--" LOCUS a� NORTH ARROW �� SCALE
CONTOURS PROFILE t.,-' SECTION BENCHMARK C---' SOIL &
PERC INFO �� ELEVATIONS WETS. DISCLAIMER WELLS &
WETLANDS L,---" WATERSHED?ia/ DRIVEWAY (Elev) WATER LINE t�
FDN DRAIN �� SCH40 2/ TESTS CURRENT?
SEPTIC TANK /
MIN 1500G � .17 INVERT DROPy GARB. GRINDER A6 (+200% EDF)
25' TO CELLARy MANHOLE TO GRADE ELEV GW
D -BOX
SIZE # LINES FIRST 2' LEVEL STATEMENT
INLET 143.'70 -OUTLET 1,0V.,19 = • 7i/ (2" OR .17 FT) TEE REQ' D?Y-
LEACHING
MIN 660 GPD?`f " RESERVE AREAy/ 4' FROM PRIMARY? e-__�2% SLOPE
100' TO WETLANDS L11__,_100' TO WELLS e/ 4' TO S.H.GW
35' TO FND & INTRCPTR DRAINS` 325' TO SURFACE H2O SUPP
4'
PERM.
SOIL BELOW FACILITY_Lz___MIN
12" COVER FILL?.,�Z (25'
if
above
natural elev; 101if below)
BREAKOUT MET?
TRENCHES % /
MIN 660 gpdSLOPE (min .005 or 6"/100') >3'COVER?-VENT v
SIDEWALL DIST. 2X EFF. W OR D (MIN 61) (/ IS RESERVE BETWEEN
TRENCHES?A0 IN FILL?h MUST BE 10' MIN. 4" PEA STONE?y
BOT :9098 X LDNG / SIDE ��� X LDNGL6_f "¢ TOT
(L x W x #) (G/ft2) (DxLx2x#) (G/ft2)
Copyright O 1993 by S.L. Starr
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Town of North Andover, Massachusetts Form No. 1
NORTH BOARD OF HEALTH `. -
O Il N /V
• 5. o� l/'.' I 19
luW
APPLICATION FOR SITE TESTING/INSPECTION
Applican
Site LocationLT 0
Engineer
SA,
Test/Inspection Date and Time
t
Fee 156 1
0
CHAIRMAN, BOARD OF HEALTH
Test No.
S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No.
Town of North Andover, Massachusetts Form No. 1
BOARD OF HEALTH
I C
19—
APPLICATION
APPLICATION FOR SITE TESTING/INSPECTION
n
Site LocationT
Engineer jtl�.t S �7,Qtry� X11
NAME ADDRESS v TELEPHONE
Test/Inspection Date and Time
Fee
CHAIRMAN, BOARD OF HEALTH
Test No. (�' G
S.S. Permit No.� D.W.C. No. C.C. Date Plbg. Permit No.
Tit
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40,
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No................ _.......
THE COMMONWEALTH OF MASSACI-;USETTS
BOARD OF HEALTH
................. N..!O. 490WEX.
' QZfFop7 ,�ppitrM#ion for Roitowd 'Blurlto ToAto#rurflots' tprttr>rt
Application is hereby made for a Permit to Construct (ter Repair ( ) an Individual Sewage Disposal
System at:
... �u �a c� �__LAK�.... �....8 .....--. s�vE�J o�S.
Location - Address or Lot No.
...................... .............................. .....o% ..... PtM4�.K!.!-�..1�
Owner Address
W
.:......................
............................................................................................................
Installer Addiess
Type of Building Size Lot ... 4Zi0S....... Sq. feet
t Dwelling — No. of Bedrooms.................�...................... E.-Zpansion Attic ( ) Garbage Grinder ( )
Other — Type of Building..... No. of persons ............. ( ) ( )
....................... __......._..... Showers —Cafeteria
a' Other fixtures ...................................
W Design Flow...............8 ,,.�................gallons per person per day. Total daily flow.........'......... r,.(,.)..............gallons.
:01 Septic Tank — Liquid capacity./SM..gallons Length./Q.' lZ.._.. Width.iL,6.' 1111 Diameter .... -.......... Depth.. _' S...
,x Disposal Trench No. ...L..7 Widih....... 3............ Total Length..Z..Y.3_&:. Total leaching area....,?. .... sq. ft.
Seepage Pit No ..................... Diameter.................... Depth below inlet..................... Total leaching area .................. sq. ft.
z Other Distribution box (,.,j Dosing tank ( ) / l
`-' Percolation Test Results' Performed by....eJll�lSt"IMatV..._ :.SJ 6!�:.(!v�:............... Date.0IZ/S3t.��Z/"�1_f..7r1J11fr
�_l a 9S /
,�P 95-( Test Pit No. I ..... 3 ....... _Minutes per inch DepthAof Test Pit ..... 16t0........ Depth to ground water..M�lf.............TP
L= P 9S'Z. Test Pit No. 2 ...... -r'.. ....... minutes per inch Depth of Test Pit .... ).Z&`"...... Depth to ground water..!Y ...........T° 9.t' -Z
'w......................•............................................................•-----...._......---..:------•--...-•--------.................--•-.....
O Description of Soil .... ll6M1... S�N-..Y.-•Sil^!py..44oM-J..Ve_tZ-f-..14V4! w.YK
xur''v...•••----•.........-••........J&.m.Y....lvwu(?t�wertS_...7b.__.4..M_T...-......................................
W
'U Nature of Repairs or Alterations — Answer when applicable..____........................................................................................
........................ IT ............................................................................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code — The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Signed.................................................................•--......
Date
ApplicationApproved BY............................................................. ---•--.------•-•--:...................................... ....................
Date
Application Disapproved for the following reasons::............................................................
Permit No .................................
•.................................•------------•--•......................-•-•••----•-•.
Date
Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.......................................... OF .....................................................................................
( rdifiratr of Totttphattrle
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by.................................... .•-------._....................................._._ ..-------------•---....----...._-----------.........---..................---...---••---..•-----
Installer
at............................................•---•---•-•-•---........................--- :_.__...
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No ......................................... dated ................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE........................................................................:... Inspector .................................... ...............................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
......................................... _OF .....................................................................................
No......................... FEE ........................
�9i��rrr�ttl onto (�ott�#r�tr#iott �lieruti#
Permissionis hereby granted._.'............................••--------••----•---•--•--._......_..._......................----......._....................................
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System
atNo ....................................
Street
as shown oil the application for Disposal Works Construction Permit No ..................... Dated ..........................................
-----------------•--•-----•-•-•-----------•--•-•--........--_.._.._...--•••-•-•••••--....................
Board of Health
DATE............................ .................................................
_._.
FORM 1255 M013139 & WARREN, INC.. PUBLISHERS
Town of North Andover
Office of the Health Department
Community Development and Services Division
William J. Scott, Division Director
27 Charles Street
North Andover, Massachusetts 01845
Sandra Starr
Health Director
January 3, 2001
Chris and Lisa Hanson
84 Sugarcane Lane
North Andover, MA 01845
Dear Mr. and Mrs. Hanson:
Telephone (978) 688-9540
Fax (978) 688-9542
This correspondence is in regards to a recent application by you, to screen in your
existing deck at the above address. The Health Department signed off on that project on
November 6, 2000, and there remains no problem with that application. However, the
concern that this letter brings to you today came out of this office's research for that
project.
The object of this letter is your septic system. The application process required a review
of the floor plans of your home and its relation to the existing septic system. Apparently
it was discovered that your home has more rooms than the dwelling that was originally
planned for. The capacity of your septic system . was based on a design of a four (4)
bedroom or a maximum nine (9) -room house. The recent floor plan review found that the
number of existing room in your home exceeds this number.
The Health Department wants you to be aware of this fact and be sure that you also
understand that you can not increase the number of rooms in your home unless either the
septic system is upgraded or tied into sewer if municipal sewer ever becomes available.
In addition, upon a future sale of your home, a Title V inspector may deem it necessary to
upgrade the capacity of your system to allow a passing Title V to be issued on your
property.
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535
It is common that during the building application process observations such as this one is
identified. I hope that you find this letter only as it was intended, an informative
communication from the No. Andover Health Department. This correspondence requires
no immediate action on your part. However, if you have any questions feel free to
contact the Health office at 688-9540.
Sincere ,
Susan Ford, R.S.
Health Inspector
Cc: Sandra Starr
File
TOWN OF, )\J • . AyAA
SYSTEM PUMPIN
DATE:
SYSTEM OWNER & ADDRESS
L1 � �So'�l
I'I1
MAY 2 5 2005
TOHEALTN OF HvDE ARTM TER
SYSTEM LOCATION
(example: left front of house)
f I' ) I 'ko-usc_
DATE OF PUMPING: 05 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
FULL TO COVER
BAFFLES IN PLACE
LEACHF'IELD RUNBACK
FLOODED
OTHER (EXPLAIN)
SYSTEM PUMPED BY: Bateson Enterprises, Inc.
COMMENTS:
CONTENTS TRANSFERRED TO: G.L.S.D N Lowell Waste
Commonwealth of Massachusetts
City/Town of
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
Important:
wnen tilling out 1. System Location: C
forms on the ` \w��� �l
computer, use \ ` v
only the tab key. ` Address ,
to move your�CO
cursor - do not
/Town
use the return Cit y tate Zip Code
.key..
2. System Owner.
Name
Address (f different from location)
CityfTown State Zip Code
4.-- c .�
Telephone Number
B. Pumping Record
1; Date.of PumpingDate 2. Quantity` Pumped:
Gallons
3. Type of system: ❑ Cesspool(s) Septic Tank- ❑ Tight.Tank-
❑ Other (describe)'
4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? El Yes ❑ No
5: Condittn of S stem:
6: System Pumped By
Name �-"--� Vehicle License Number
Company
7. Locatio where con #e is w�jq�' p�\disposed::
Sig ure uler Date
hftp://ww*.mass*.gov/dep/`water/approvals/t5forms.htm#inspect
t5form4.doc• 06103
System Pumping Record • Page 1 of 1
Commonwealth of Massachusetts
City/Town of.IV6�®
�,
System Pumping Record
Form 4 DEC
17 2008
_ ss
Nom.'COVERDEP has provided this form for use by local Boards of Health.n§[payy,,be,,,U0SA ut the
information must be substantially the same as that provided he slug Is orm, 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.
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
kkey.U--
�A_
A. Facility Information
1. System Locatio eft fron eft rear, left sid of house Right front, right rear, right side of house.
2
Address
qq S-0
City/Town State
System Owner:
Name
Address (if different from location)
City/rown
B. Pumping Record
1. Date of Pumping
3. Type of system: 8
E] Other (describe):
Zip Code
State' -7 Zi Code
(? L -f
Telephone Number
Date Quantity Pumped. Gallon
Cesspool(s) Septic Tank 0 Tight Tank
4. Effluent Tee Filter present? 0 Yes u No If yes, was it cleaned? Yes [j No
5. Condition of System:IQQ o�
jDCAti��-
6. System Pumped By:
7.
Neil Bateson F 5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
of
§Ve—re disposed:
Lowell Waste W;
Date
t5form4.doc• 06/03 System Pumping Record • Page 1 of 1
Commonwealth of Massachusetts
= City/Town of
a
System Pumping Record _.
w Form 4
Vi' - 10
H SVey`e f¢{'y IS,
DEP has provided this form for use by local Boards of H alth. Other forms may beused, but the
information must be substantially the same as that provi EOtwew BeforAwaylt-Rij form, check with your
local Board of Health to determine the form they use. T SI §t'dffi11PE- must be submitted to
the local Board of Health or other approving authority.
A. Facility Information
1. System Location: Left side of house, Right side of house, Left front of%e;5gai
front o� f h
Left rear of house, Right rear of house. Left rear of building. Right rear.
Address
City/Town
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
Zip Code
State Zip Code
a
Telephone Number
Date 2. Quantity Pumped: Gallons
Cesspool(s) E4 ptic Tank ❑ Tight Tank
4. Effluent Tee Filter present? ❑ Yes 2 --No — If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System:
C,_
6. System Pumped By:
Neil Bateson
F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7. Location v
&ere contents were disposed:
LAS. j Lowell Waste Water
of
Date
t5form4.doc• 06/03 System Pumping Record • Page 1 of 1
Commonwealth of Massachusetts
City/Town of ...
W° System Pumping Record '10
Form 4 r 304011
DEP has provided this form for use by local Boards of Health. Other for40. R
information must be substantially the same as that provided here. BeforN wi h your
local Board of Health to determine the form they use. The System Pum mi ed to
the local Board of Health or other approving authority.
A. Facility Information
1. System Location: Left front of hous , rtf ont of fou , left side of house, right side of house, Left
rear of house, right rear of house, le I e of buildinq, right rear of buildinq, under deck.
City/Town
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
Zip Code
State q ^ f Zip Code
Telephone Number l 1
Date 2. Quantity Pumped:
Cesspool(s) 0 -Septic Tank
1s�
Gallons
❑ Tight Tank
4. Effluent Tee Filter present? ❑ Yes [4-1To---
If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System: C�j
6. System Pumped By:
Neil J. Bateson
Name
Bateson Enterprises Inc.
Company
7. Locere contents were disposed:
G.L.S. D. off Waste W ter
Signature
F5821
Vehicle License Number
Date
t5form4.doc• 06/03 System Pumping Record • Page 1 of 1
Commonwealth of Massachusetts --- -- -
City/Town of
System Pumping Record APR 01Z
y Form 4 TOWN OF NORTH ANDOVER
HEALTH pt_
DEP has provided this form for use by local Boards of Health. Other form ,idT . NT
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: Le :��nt of hous eft / Right rear of house, Left / right side of house, Left /
Right side of building, ron o building, Left/ Right rear of building, Under deck
Address �L4
City/Town y " State Zip Code
2. System Owner.
Name
Address (if different from location)
City/Town
State Zip Code
Telephone 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? ❑ Yes LSO If yes, was it cleaned? ❑ Yes ❑ No
5. Condi ' nA ystev�' `avl
6. System Pumped By:
Neil Bateson
Name
Bateson Enterprises Inc
Company
7. Location
contents were disposed:
Lowell Waste Water
F5821
Vehicle License Number
`3 I 44 -
Date
t5form4.doc• 06/03
System Pumping Recons •Page 1 of 1