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HomeMy WebLinkAboutMiscellaneous - 85 COLONIAL AVENUE 4/30/2018 (2)N OO C. 13L" O 0 V O W r- 0 O z N r- Z4 O Z C o m q (D r MAP # : r .a PARCEL # :....:..,.:: STREET s ' �ONSTRUCTIO.N A.P ___ . HAS PLAN REVIEW FEE .BEEN PAID? YES NO PLAN APPROVAL: DATE Z/9 �Gl�6 APP. HY DESIGNER: PLAN DATE. CONDITIONS WATER SUPPLY: TOWN WELL WELL PERMI DRILLER WELL TESTS: EMICAL DALE APPROVED BAC"TERIA I DA I E flPPRUVED BACTERIA II DAT •PPRUVED COMMENTS: FORM U APPROVAL: APPROVAL TO ISSUE �YESNU DATE ISSUED r% � BY CONDITIONS: FINAL APPROVAL: ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL Y NU SEPTIC SYSTEM CONSTRUCTION APPRUVAL NO OTHER YES NU ANY VARIANCE NEEDED YES NO FItdAL BOARD OF HEALTH APPROVAL: DATE:�Zzq% BY:.�Q./G(/ EP -C5MaL L$T� 4N . .y XYr 1i. i. � f � .'• \ 1.. a'T;. .. J ... r•'—moi::'i •.1 f 'A. .j•^ it \ 1 y �, 1 %., 7 . sx' ISTHE INSTALLER LICENSED? + _�� YE NO +t `TYPE. OF CONSTRUCTION: NEW REPAIR' • - NEW CONSTRUCTION: , ..: CERTIFIED PLOT - PLAN REVIEW NO :� : • 1 = f ` _ ' CONDITIONS OF.. APPROVAL YES NO (FROM .FORM U) :. OF DWC PERMIT s— ` NO ,,..,ISSUANCE DWC PERMIT N0. - - _. INSTALLER: C .•. HEGIN INSPECTION YE 0. EXCAVATION INSPECTION: ;NEEDED: PASSED _ =.:CONSTRUCTION INSPECTION: NEEDED: AS BUILT PLAN SATISFACTORY: :_YES s - '• ;;' APPROVAL TO BACKFILL: DATE: BY " FINAL.GRADING APPROVAL: DATE VA ? BY DATE:�/ 'FINAL CONSTRUCTION APPROVAL: North Andover Board of Assessors Public Access sl Parcel ID: 210/107.11-0127-0000.0 SKETCH Click on Sketch to Enlarge Community: North Andover PHOTO No Picture Available Location: 85L -7A COLONIAL AVENUE Owner Name: CASTALDO, JEFFREY CAROLINE CASTALDO Owner Address: 85 COLONIAL AVENUE City: NORTH ANDOVER State: MA ZIP: 01845 Neighborhood: 8 - 8 Land Area: 0.52 acres Use Code: 101- SNGL-FAM-RES Total Finished Area: 2460 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 530,400 507,700 Building Value: 345,800 331,900 Land Value: 184,600 175,800 Market Land Value: 184,600 Chapter Land Value: LATEST SALE Sale Price: 369,900 Sale Date: 05/22/1997 Arms Length Sale Code: Y -YES -VALID Grantor: A C BUILDERS Cert Doc: Book: 04760 Page: 0193 ::s;. 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Othe t t '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 Location: Left / Right front of house, Lefti ht rear of how' , Left / right side of house, Left / Right side of building, Left / Right front of building, Left / Right rear of building, Under deck - _ A Address ` Co City/Town 2. System Owner. Name Address (if different from location) City/Town pj �e— JU(2XOVLA�, N State Zip Code VSs V'\ State Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Other (describe): / 4. Effluent Tee Filter present? ❑ Yes ❑�laO 5. Conditiono� f �jre�mul�� `S-25;r� Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location a contents were disposed: G L S. Lowell Waste Water lult:11 I Date ���AS �� t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts City/Town of OCT 08 2013 : i System Pumping Record ��"'c'Fn:r_•,n�� ---- - NORTH ANDOVER>i„ =��-:: Form 4 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 within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important: When filling out 1. System Location: forms on the�� computer. use —__?k Co1antai ��� -------._...------ only the tab key Address to move your cursor - do not City/Town State Zip Code use the return key.. — 2. SysteOwner —� a do-- — — Name Address (if different from location) ------ - ---- CityfFown State Zip Code Telep no eh Number B. Pumping Record 3 /' SooDate of Pumping Dat— e 1 f 2. Quantity Pumped: Gallons � 3. Type of system: ❑ Cesspool(s) V --Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes M—No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of Svstem: 6. System Pumped By: Wind River Environmenta. Name—16WestemAve; — Gloucester, MA 01930 Company Vehicle License Number 7. Location where contents were disposed: G.L.S.D. Signature of Hauler Signature of Receiving Facility ll Date I Date t5form4.doc• 03/06 System Pumping Record • Page 1 of 1 &F I..5" OffE/�R KNOCKOUTS INLET f" __j )ow /N —4!' P.V.C. son. 40 — 30` l 201 B` 8"15` PLAN KfW TIC SYSTEM /N �; DE z NO. Av E R IWAS S. SCALES- AS NOTED DATE.- r A ov. 14, 199 S REWSED.- HAYES ENG/NEER/NG, /NC. 603 SALEM STREET CIVIL ENGINFERS &n�45 WAKEFIELD, AIASS 01880 LAND SURVEYORS TEL: 617-246-2800 Hayes Engineering, Inc. has been system design plan to the client \Q`� construct or supervise constructid ��qq In view of same, no guarantee a is mode to the c/lent or to the . system installed pursuant to the Hayes does represent that the pl the State Code, Title 5, except if Contractor to notify Engineer of , from those indicated. All work and materials shall conf sections of Title 5 of the State /- EGzSND LOT 7 24, 147 S. F. 125x2 EXISTING SPOT ELEVAT/ONS 3o" --120-- EXISTING CONTOURS TZ-Lf15'_ c5x� PROPOSED SPOT VATIONS 1 s` O -- �2---: PROPOSED CONTOURS 2` ---W---: WATER SUPPLY LINE PRECAST TEST HOLES 8Y HAVES ENG. INC. D1STROUT/ON BOX FERC TEST SY HAVES ENG. INC. SENCHMARK.•�5pY, 42Up ZW P1aE 1 l*45 ,4b of PETER J. OGREN `� CML .i No. 27145 W poi sT�R��� AL� mllv�% V..a 1S4o91 PRESENT AT TESTS.• ZONE- PRD �R-2J VR V z -Z, X lWj Wjzl/ 4-A Lc' X ktA/ As's 3CAV o7rAmolDsaa 01IL i = Z X `fib �D o9c) I -AWdOL 91 N l �' S 08L 7 Z = P9,VV ` IVYIN/`Y S6 -L\ -Q0 S6-jQ;6-St -S'Zb1b-Sb3 yM1ON/JOb'O Ol = SO/SJN/ ON -7 S-7.(b'HNM Oz S3• H -= 1NDb�� ON 1 ON -7 S7,l vy •NOSy7ooy NO(7 g�o9 �. 64,1 (-1d,p-57 PLAN OF LAND /N NO. ANDOVER, MASS. SCALE- I" = 40' MAY 21, 1996 HA YES ENG/NEER/NG, /NC. 9�5 603 SALEM STREET CIVIL ENGINEERS & WAKEF/ELD, MASS. 01880 LAND SURVEYORS TEL. (617) 246-2800 / CERT/FY THAT THIS FOUNDAT/ON /S Locom ON THE GROUND AS SHOWN, AND THAT /T CONFORMS TO THE ZONING BY-LAWS OF THE TOWN OF NORTH ANDOVER. / FURTHER CERRFY THAT 77-1/S PROPERTY DOES NOT L/E W/TH/N A FLOOD HAZ4RD AREA (ZONE A OR V) AS SHOWN ON FLOOD /NSURANCE RATE MAP COMMUN/TY PANEL NUMBER 250098 OOIOB. EFFECT/VE DATE- ✓UNE 15, 1983 , kkA 'J DA 7F- Noy 4g} I= - PROFESSIONAL S85 jl 'O6'E .43 )54ow G0LON1AL R. R. D. (R-2) V R. MIN/MUM SETBACKS. FRONT = 20' SIDE = 20' REAR = 20' Q� I 1• FORM 4 - SYSTEM PUMPING RECORD CURRIER SEPTIC & DRAIN SERVICE 107 FOREST STREET; MIDDLETON, MA 01949 (978)774-2772 COMMON EALTH OF MASSACHUSETTS MASSACHUSETTS SYSTEM PUMPING RECORD SYSTEM OWNER: Ca.S I �) SYSTEM LOCATION: F- ,? 3-S CC��U� ��'�I �Ue, V Ou /S , e d Le, II ` 1-1 e"I DATE OF PUMPING: - �/" 9 9 QUANTITY PUMPED: /S T)C) GALLONS CESSPOOL: NO 0 YES 0 SEPTIC TANK: SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SERVICE CONTENTS TRANSFERRED TO: S D DATE: JU►`� 101999 NO F-1 YES [:!�---- INSPECTOR: c'a-( < m m d O w W w ✓i 3.. W` ,z r -,J 4\` d" Qr Z N � ` W � az Q L•%ct Q H C7 a v o o? aj o rL cn ii u, W U)U) O F=04 LU zCL i •i ✓i 3.. ,z O F=04 LU zCL co o o? _ � Ooq W ^-� v : � p / R Z rn O QL3 o -: if �m �, A C=> cm u • r yam, tJJco - d c co fin: �om LA C, _ mm O O CD ts CL C CD CD (1n o�3 = �- >. Co CO)e� __ O i a o�7, C, o a r CO) r' _ cc O O. y CCL QiQ _ < O + 0 O ..•� J c �Df m LaCD G i J cm �C. O CD y Z V co ;mom pyo o•�Z o : cia .— _` V y �c�o c L•' O C +: v �o a Q m z 3 0 ao`- C2 N4d coo y m ev !C LLI s as LL.07 H 'CL C! CO) w E .s Z C1 o D LD c CD R m o O 2 F- L S C,, m �! a o z � 0 LL L a� N � L O Lr) �y r N N 00 9 '...I L O U r N r U !r b W V) LLJ n Z �I O - ao w ° r U = Z -ell — o u b ci � V)Q 0 'A i ao °m L L1 Z ` rz O Lr) OLL LL :...� � 0 w 4J �. c.) p O Q O Q 0 �- z ° L) Q Q w �— LI) 0 J Z w +~ a� L- Q U V1 V1 ° Z m m o 3 Quj o U ° U1 �r L Q —I UO � p u a L � m U E _ °1 Qi N L J ° U 4t::ami w u O `ro > 4J N c/) Oo V o � Town of North Andover, Massachusetts• F°"" "°• a NORTH BOARD OF HEALTH 19t O t�ao ;a 1ti F 9 �'�•,,,o��' DISPOSAL WORKS CONSTRUCTION PERMIT ,SSACHUS�� Applicant C 2 aj--L -- NAMr ADDRESS TELEPHONE Site Location � 0 T- Permission is hereby granted to Construct ( -j"'or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. Town of North Andover, Massachusetts Form No. s f MORTM BOARD OF HEALTH(''�r_, ti w r°r` DESIGN APPROVAL FOR SSACHUSEt SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant -A (I &,-� � (I Jl%o 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 l0 v CHAIRMAN, BOARD OF HEALTH Site System Permit No. go I no HAYES ENGINEERING, INC. 603 SALEM STREET WAKEFIELD, MA 01880 (617) 246-2800 FAX (617) 246-7596 January 4, 1996 Board of Health Town Hall 120 Main Street North Andover, MA 01845 RE: Variance - Lots 7 & 8 Woodland Estates, North Andover, MA Dear Members: REFER TO FILE # NOA-0042 Please accept this letter as an application for a variance from the North Andover Board of Health Regulations for the above-mentioned lots. We are requesting a variance from Section 4.18, which requires a distance of 100 feet between wetlands and the leaching facility or reserve area. We also are requesting a variance on Lot 8 for the distance between the street drain and the leaching facility or reserve area. Please allow time on the agenda at your next available meeting to discuss these issues. Very truly yours, Edward E. Stearns, P.L.S. Project Coordinator EES/dab Enclosures FORM U - LOT RELEASE FORK 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: A - G, 6ul I t r —Vic Phone 0 5- 8 3 50 LOCATION: Assessor's Map Number Parcel Subdivision -WA land F_5 attS Lots Street Co (o n i U I ha St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Conservation Administrator Date Approved Date Rejected Comments Town Planner Date Approved Date Rejected Comments Food Inspector -Health Septic Inspector -Health Comments Public Works - sewer/water connections - driveway permit Date Approved Date Rejected Date Approved 6P, Date Rejected Fire Department Received by Building Inspector Date no HAYES ENGINEERING, INC. 603 SALEM STREET WAKEFIELD, MA 01880 (617) 246-2800 FAX (617) 246-7596 January 4, 1996 Board of Health Town Hall 120 Main Street North Andover, MA 01845 RE: Variance - Lots 7 & 8 Woodland Estates, North Andover, MA Dear Members: REFER TO FILE #. NOA-0042 N% ot, iN-QF F1trL' B001D JW i2t� Please accept this letter as an application for a variance from the North Andover Board of Health Regulations for the above-mentioned lots. We are requesting a variance from Section 4.18, which requires a distance of 100 feet between wetlands and the leaching facility or reserve area. We also are requesting a variance on Lot 8 for the distance between the street drain and the leaching facility or reserve area. Please allow time on the agenda at your next available meeting to discuss these issues. Very truly yours, Edward E. Stearns, P.L.S. Project Coordinator EES/dab Enclosures Town of North Andover f NORTH , OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES ° . 146 Main Street North Andover, Massachusetts 01845 SAC US (508) 688-9533 January 5, 1996 Hayes Engineering 603 Salem Street Wakefield, MA 01880 Re: Lot #7 Colonial Drive To Whom it May Concern: This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: 1) Distance of leach area to wetlands 90 feet. (variance required) 2) Only 2 copies of plan - 3 are required. 3) No map & parcel number. If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Sincerely, 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 DATE G� v Sheet of BOARD OF HEALTH TOWN OF NORTH ANDOVER SUBSURFACE DISPOSAL DESIGN REVIEW FEE $60 PERMIT - # _o'O/ DATE RECEIVED P 0" APPLICANT ASSESSOR'S MAP ADDRESS _83 �U/1G/C�� L� /U A ; PARCEL # LOT # ENGINEER 99)167-5 )1ES STREET 0-6 G -DSU 112 ADDRESS ©3 1SAe-6-5-M PLAN DATE _// / /�L�Sr REVISION DATE CONDITIONS OF APPROVAL: APPROVED DISAPPROVED PLAN REVIEW CHECKLIST ADDRESS � � Cdr d t// AL ENGINEER GENERAL 3 COPIES% STAMP LOCUS NORTH ARROWy SCALE CONTOURS PROFILE �� SECTION BENCHMARK L% SOIL & PERCS ELEVATIONS WETS. DISCLAIMER �( WELLS & WETS WATERSHED?k DRIVEWAY ✓ (Elev) WATER TLIINNE FDN DRAIN O SCH40_Z TESTS CURRENT? ✓/ SOIL EVAL Q_206,se56,0 SEPTIC TANK MIN 150OG c// .17 INVERT DROP GARB. GRINDER (+200% EDF) 25' TO CELLAR t'7 C— MANHOLE (,� ELEV GW `'' # COMPS. D -BOX SIZE # LINES FIRST 2' LEVEL STATEMENT INLET OUTLET /,� _ ( 2" OR .17 FT) TEE REQ'D? LEACHING MIN 660 GPD? t,, -'---RESERVE AREA 4' FROM PRIMARY? 2% SLOPE 100' TO WETLANDS -'>( 100' TO WELLSy 4' TO S.H.GW 5'>2M 35' TO FND & INTRCPTR DRAINS /325' TO SURFACE H2O SUPP 4' PERM. SOIL BELOW FACILITY ✓ MIN 12" COVERC-�FILL? (25' if above natural elev; 101if below) BREAKOUT MET? TRENCHES MIN 660 gpd SLOPE (min .005 or 6"/100') L,---"SIDEWALL DIST. 3X EFF. W OR D (MIN 6' ) L/ RESERVE BETWEEN TRENCHES? --- IN FILL? /j---- MUST BE 10' MIN._arU 4" PEA STONE? VENT? -f"(>3' COVER; LINES >501) BOT ,5_�p + SIDE 4�6 X LDNG , 74 = TOT 660 (L x W x #) (DxLx2x#) (G/ft2) Copyright © 1995 by S.L. Swrr No. FEE L 1 THE COMMONWEALTH OF MASSACHUSETTS `yBA d I "V90UGQ— , MASSACHUSETTS �jjpliration for Construction ]Jrrntit Application is hereby made for a Permit to Construct 0) or Repair ( ) an On-site Sewage Disposal System at: Location Address or Lot No. &o T 7 Co Lo Owner's Name Address and Tel. No. A , C-% 8 u i tr D E i? 1 iU C io14-Lif E IL KV ® L)c pXA Installer's Name, Address, and Tel.No. Designer's Name, Address andTel. No. "iai�r / 5 Cacgi [AC, fo3 She -C-0- S WAX C-7 _Q � m 6 (TZd,6-mo Type of Building: ^ Dwelling No. of Bedrooms ` — Garbage Grinder (VA)b Other Type of Building No. per Persons Showers ( ) Cafeteria ( ) Other Fixtures Design Flow G®Q gallons per day. Calculated daily flow 62 6t, d gallons. Plan Date L S Nurr� er of sheets Revision Date Title !360Tic1 7` 1 ca i�lf�✓Oay i? mHs S Description of Soil 5L-,a,_.::-�lot L- o fid Pc -4t4 Nature of Repairs or Alterations (Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site sewage disposal system in accordance with the prov s of Ti 5 of the ironmental Code and not to place the system in until a Certificate of Compliance has =d is B=Health. _..amu AN — B Signed Application Approved b Application Disapproved for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS , MASSACHUSETTS C�ertifirate of Cgompltanre THIS IS TO CERTIFY, that the On-site Sewage Disposal System installed by for at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated . Use of this system is conditioned on compliance with the provisions set forth below: ) or repaired/ replaced ( ) on The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. This Certificate expires on DATE Inspector THE COMMONWEALTH OF MASSACHUSETTS No. , MASSACHUSETTS FEE �ts osttl S $tem 10-11anstrurtion jermit Permission is hereby granted to to construct ( ) or repair ( ) an On-site Sewage System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction must be completed within three years of the date below. DATE FORM 1255 Rev. 3/95 A.M. SULKIN CO. - BOSTON, MA Approved by r r HAY a ENGINEERING, INC. -:; FORM 11 - SOIL EVALUATOR FORM ftn2 880Page 1 (66 X800 : FAX (617) 246-7596 No........ ....................... Date... Commonwealth of Massachusetts K�, �) "N.,oA/ , Massachusetts Soil Suitability Assessment , for On-site Sewage Disposal, 1 (1 .......... ...... _...._............. Performed By: ?...................... . Witnessed By .._ _. w _...... ............. ................................................. .............. .............................................................................................................................................. L.o=ion Address or ow=es Wane. C o e h.. e r L« i CCAOIN % w\ 1N` Tekphars� ANDQVEFt/1 -ru Lc+'t -7 New construction ® Repair ❑ OT -66e Aeview :: _ luv"" .• FtD of titr W.- n _ Published Soil Survey Available: No ❑ Yes L=7 Year Published ...% $. Publication Scale %'�5�`4 Soil Map Unit .:................. DrainageClass.. ....... Soil Limitations ....._ _........... .................................. ................................ Surficial Geologic Report Available: No ❑ Yes ❑ Year Published . ... Publication Scale GeologicMaterial (Map Unit) .... ... ........ ....._.. ...... ...................................... ....................................................... Landform...... ...................................................._............... _ .._...... .......... .................. :................ ............. _........ ....... Flood Insurance Rate Map: / Above 500 year flood boundary No ❑ Yes ©/ Within 500 year flood boundary No ❑ Yes ❑ Within 100 year flood boundary No ❑ Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) _......... _ ... __........_._ ............................ Wetlands Conservancy Program Map (map unit)................................................................................................. Current Water Resource Conditions (USGS): Month ...Oc r-. Range : Above Normal ❑ Normal ❑ . Below Normal ❑ Other References Reviewed: FORM 11 - SOIL EVALUATORFORM- On-site Review Deep Hole Number ................... Date:. .-l-'1.I9T Time:...�.�2' ` 5 Location (identify on site plan) .............. _...........-_---------......-:.......--------........................................... Land Use "` ....�'�� 4s�':4 ��N! �� Slope (%) ..-.. :.. b... SurfaceStones ...... Vegetation.... �J..P,,t,............................................................... Landform-IDA-1.................................................................. ........................................................... ...................... Position on landscape (sketch on the back)........................................................................... Distances from: Open Water Body 1.5�P+... feet Drainage way ................... feet Possible Wet Area -bofeet Property Line ...I ------ feet I� Drinking Water Well ..._. feet Other.. --------- .................... Weather D= OBSERVATION-HOLK LOG Depth from Surface (Inches)' -�- Soil Horizon , . Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other .(Structure, Stones, Boulders, -Consistences. --1 `51 i'�S�r 5IG MgS»vt_ . N� NOS" �z.d Parent Material (geologic)... ........................._ ... Depth to Bedrock: No^.. Depth to Groundwater: Standing Wale- in the Hole: 0.. Weeping from Pit Face: Nd . Estimated Seasonal High Ground Water: I4A5 f l'S7.S IfAT. 1 ,M,4s HAY,ES ENGINEERING, INC. 603 SALEM'SMEET WAKEFIELD, MA 01880 (617) 246-2800 ` FAX (617) 246-7596 FORM 11 - Son, EVALUATOR FORM Page 3 Determination for Seasonal Hity1i Water Table Method Used: Y-)19' ❑ Depth observed standing in observation hole ................... inches ivlY El Depth weeping from side of observation hole ................... inches ❑ Depth to soil mottles .................. inches ❑ Ground water adjustment ................. feet Index Well Number ................... Reading Date ................... Index well level .... Adjustment factor .................. Adjusted ground water level ........ Depth of Naturally Occurring Pervious Material -Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If- not, what is the depth of naturally occurring pervious material? Certification I certify that on (date) I have passed the examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature Date Nal.1(,.��s- HAYESENCANEERINd INc.. 603 -SP Enn Si EEr PORI 12 - PERCOLATION TFST WAKEFIELD. MA 01880 U� ts17? z4s-2aoo • � FAX. (617) 246-7596 COMMONWEALTH OF MASSACHUSETTS , Massachusetts Percolation Test Date: --- ------ --- _---------------- - Time: ..................................... Observation Hole # Depth of Perc Start Pre-soak End Pre-soak Time at 12" Time at 9" Time at 6" Time W-6") Rate Min./Inch Site Passed ❑ Site Failed ❑ L Commonwealth of Massachusetss Type: Emergency Routine Cesspool: w ✓ Yes Date of Pumping: /Z In I y ZuQ� System Pumped By: Wind River Environmental, LLC Contents transferred to: Contents Disposed at: Date: of System/Other Comments Pumper Signature: : Massachusetts System Pumping Record G/ Location Dep Approved Form - 12/07/95 Form 4 -- Septic tank: w Yes E3 Quantity Pumped: _L�_Gallons Permit #: EIVED JUN 13 2005 TOHEN OF NOR ALLTH DEPARTMENT rl ER ARTMENT ! Ijjl I I I i 76 d I� I i I I'II� I� illy, � 11 V � Ill ii /0,/'Lr v I i ! ..00001 Lao, �44%1 Town of North Andover, Massachusetts Form No. 1 trH BOARD OF HEALTH 19 0 APPLICATION FOR SITE TESTING/INSPECTION Applicant r" Site Location ) W d. `0 -' Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time o'D CHAIRMAN, BOARD OF HEALTH Fee 1,5b- Test No. Liq* ..o.ggq S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No. 1 oRrM BOARD OF HEALTH 19 a APPLICATION FOR SITE TESTING/INSPECTION \RATED O'Pp\.•�5 Applicant -- �-' -'- NAME ADDRESS TELEPHONE Site Location Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time Fee CHAIRMAN, BOARD OF HEALTH Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Form 4 -- System Pumping Record Commonwealth of Mossachusetss Massachusetts System Pumping Record vu I / 72001 Location Type: Emergency Routine Cesspool: w Yes Septic tank: w =Yes Date of Pumping: 9 - 'ale, _b 1 Quantity Pumped: J EO -b Gallons System Pumped By: Wind Nwer Environmental, LLC Permit #: Contents transferred to: Contents Disposed at: Date: Condition of System/Other Comments Dep Approved from - 12107195 nlo'ltln 1+`t: nn Commonwealth of Massachusetts Massachusetts System Pumping Record System Owner Gln .i.,; t i' t "n i .� t i i � A'.•. . r+ .+rrac: r, ' AI lJ, Type: Em Cesspool: No Date of Pumping_ System Pumped By: Contents Transferred to: Routine Yes WILIffo Wind River Environmental, LLC Contents Disposed at: Date: Pumper. Signature: Condition of System/Other Comments System Location Dep Approved Form - 12/07/95 Form 4 -- System Pumping Record RECEIVEED JUL 0 5 2007 TOWN OF NORTH ANDOVER Septic Tank: No = Yes Quantity Pumped: �,� Gallons Permit #: Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. serum •, Commonwealth of Massachusetts Cit /Town of NORTH ANDOVER, A TT' City/Town R, M SSACHUSE System Pumping Record Form 4 DEP has provided this form for use by local Boards of Health..-te n P�tmni�a, be submitted to the local Board of Health or other approving au horit;y'ECEiVED A. Facility Information IEC 0 4 2009 1. System Location: n -- PS- Ccslrr o�tc.� Aue TOWN OF NORTH ANDOVER HEALTH DEPARTMENT rd must Addrss A Ilk �,� air". City/Tow State Zip Code 2. System Owner. _ (2G Ste. l Name Address (if different from location) City/Town State2(9_ C82- Zip Code S�oS B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): Telephone Number Date 2. Quantity Pumped: Gallons Cesspool(s) R Septic Tank ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes �o 5. Condition of System: If yes, was it cleaned? ❑ Yes ❑ No 6. System Pum d By: Na e Vehicle License Number Company IPSWIch Water 7. Location where contents were disposed: Treatment Fant -- Ipswich''�8— Signature of Hauler Date http://www.mass.gov/dep/water/approvals/t5forms.htm#inspect 15form4.doc• 06/03 System Pumping Record • Page 1 of 1