HomeMy WebLinkAboutMiscellaneous - 85 WINDKIST FARM ROAD 4/30/2018 (2)r 4
MAP # 16 9
PARCEL # 39
LOT # �p
STREET ��ruWVW�
CONSTRUCTION APPROVA
HAS PLAN REVIEW FEE BEEN PAID? YES NO
PLAN APPROVAL: DATE APP. BY
DESIGNER: �,�?/5 j//�—,{J�� PLAN DATE
CONDITIONS
COMMENTS:
FORM U APPROVAL: APPROVAL TO SUE YES NO
DATE ISSUED 7 BY
CONDITIONS:
FINAL APPROVAL:
ALL PERMITS PAID NO
WELL CONSTRUCTION APPROVAL YES NO
SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO
OTHER YES NO
ANY VARIANCE NEEDED YES NO
FINAL BOARD OF HEALTH APPROVAL: DATE: 3D BY:_
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W29ER SUPPLY:WN
WELL
WELL PERMIT
K
DRILLER
WELL TESTS:
CHEMICAL
DATE APPROVED
BACTERIA
I
DATE APPROVED
K
BACTERIA
II
DATE APPROVED
PLUMBING SIGNOFF b
WIRING
SIGNOFF
COMMENTS:
FORM U APPROVAL: APPROVAL TO SUE YES NO
DATE ISSUED 7 BY
CONDITIONS:
FINAL APPROVAL:
ALL PERMITS PAID NO
WELL CONSTRUCTION APPROVAL YES NO
SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO
OTHER YES NO
ANY VARIANCE NEEDED YES NO
FINAL BOARD OF HEALTH APPROVAL: DATE: 3D BY:_
N
SEPTI_C SYSTEM INSTALLATION
IS THE INSTALLER LICENSED? .(=ES NO
TYPE OF CONSTRUCTION: REPAIR
NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW C= NO
CONDITIONS OF APPROVAL YES
(FROM FORM U)
ISSUANCE OF DWC PERMIT ES NO
DWC PERMIT PAID?%�6
DWC PERMIT N0.
NO
INSTALLER. e r
BEGIN INSPECTION YES 0: avl(/ rivays�/
EXCAVATION INSPECTION: NEEDED:
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PASSED /9g BY
CONSTRUCTION INSPECTION: NEEDED:
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AS BUILT PLAN SATISFACTORY: YES,/ /7
APPROVAL TO BACKFILL: DATE: 1,-1- BY -
,-
FINAL GRADING APPROVAL: DATE 712,r BY
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FINAL CONSTRUCTION APPROVAL: DATE: 7 3Y
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Date: July 30, 1998
Town of North Andover, Massachusetts
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
E
This is to certify that
the Individual Soil Absorption Sewage Disposal System constructed ( X ) or repaired ( )
by Dave Maynard, at Lot #6 Windkist Farm Road, North Andover, MA 01845 has been
installed in accordance with Board of Health Regulations as described in the Design
Approval Site System Permit # 902 dated May 24, 1998.
The issuance of this certificate shall not be construed as a guarantee that the system will
function satisfactorily.
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Revised: 7/20/98
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SYSTEM , TT is A E:E�orc OF r�F&
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AS BUILT PLAN
OF
SUBSURFACE DISPOSAL SYSTEM
LOCATED IN
AS PREPARED FOR
6VL-0Q IA L. I L;ACA
DATE:
SCALE: � n 1, U
MERRIMACK ENGINEERING SERVICES, INC.
PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS
66 PARK STREET 0 ANDOVER. MASSACHUSETTS 01810 or TEL (617) 473-3533, 973-5721
"7 /7 /-1 �
TOWN OF NORTH ANDOVER
SEWAGE DISPOSAL SYSTEM
INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System ( V cC'G=Mraed; ( ) repaired,
by
located at (.Of (o k-) i ND kaS"i" �+` ►ZM 1�I�Q
was h%stalled in conformance witht N rth Andover Board of Health approved plan, System
Design Peruout # y0 , dated �/ �� with an.approved design flow of,!�W
,gallons per day. The materials used were in conformance with those specified on the approval
plan; the system was.installed in accordance with the provisions of 310 CMR 15:000, Title 5 and
local regulations, and the final grading agrees subMi tialty with the approved plan: All work is
-accurately represented on the As -built which has been submitted to the Board of Health.
Lia 41%�� Date: la -,5T
Design Engineer: 1. Date: 2- 7-11
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Applicant_
Site Location
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Town of North Andover, Massachusetts Form No. 3
BOARD OF HEALTH
7J Z' c1. G L 9
DISPOSAL WORKS CONSTRUCTION PERMIT
a—
ADD SS TELEPHONE
Permission is hereby granted to Construct ("or Repa_ (�) an Individual Soil Absorption
_; — _
Sewage. Disposal System -as shown on thei"I ign Approva F .S. No._
05
CHAIRMAN, BOARD OF HEALTH
51/
Fee D.W.C. No.
'�, - T` �" > �tl� -. «• v is
' as � �'S •C � . .
Town of North Andover, Massachusetts Form No. 2
IAORTh BOARD OF HEALTH 1
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DESIGN APPROVAL FOR
HUS Et SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
Applicant Test No.
Site Location (.X -)T to UU\ Y-
Reference Plans and Specs._ (' 'k
ENGINEER DESIGN DATE
Permission is granted for an individual soil absorption sewage disposal system to be installed
in accordance with regulations of Board of Health.
Fee ,
�4� 1
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CHAIRMAN, BOARD OF HEALTH
Site System Permit No. 9 6 C
Town of North Andover, Massachusetts Form No. 3
NORTH BOARD OF HEALTH
o 19
DISPOSAL WORKS CONSTRUCTION PERMIT
9SS�CHU5Et
Applicant j // S� L--; v e,—
NAME ADDRESS TELEPHONE
Site Location L�-7`
Permission is hereby granted to Construct �q- or Repair ( ) an Individual Soil Absorption
Sewage Disposal System as shown on the Design Approval S.S. No.
99CHAIR MAN, BOARD OF HEALTH
N
Fee D.W.C. No. �3
t
APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT
DATE: 6 -01,0 — 9r CURRENT INSTALLER'S LICENSE# /'/ �
LOCATION: 10116 v�rS T
LICENSED INSTALLER: z/,1��c'�1n-�2c✓
SIGNATURE: ,/�/—�� '�� "Gj TELEPHONE#
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CHECK ONE:
REPAIR: NEW CONSTRUCTION:
IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT.
Administrative Use Only
$75.00 Fee Attached? Yes V/ No
Foundation As -Built? Yes I/ No
Floor Plans? Yes No
Approval G. Date:
Q•�
1
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SEPTIC PLAN SUBMITTALS
LOCATION:
NEW PLANS: ( YES $60.00/Plan
REVISED PLANS: YES $25.00/Plan
DATE: c9 l
DESIGN ENGINEER: 0 A -777:s
When the submission is all in place, route to the Health Secretary