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HomeMy WebLinkAboutMiscellaneous - 92 COLONIAL AVENUE 4/30/2018WN a N —O co N O f7 O W � 6 O O_ Z t5 Q n C) m o Z C: 0 m I le r S �, ,7i+, S�yi7 ""3V..� Yrf`�� y ✓ 4 'r r� "� .. -.., T '�-"L/'_y ,K.e, .\r.T -. T6 SFS �T.�{"�' �` •r . MAR # ',� , , 'LOT • # PARCEL # STREET -- --�-r ONSTRUCTI0IV_APP _._._.L NX HAS PLAN REVIEW FEE .DEEN PAID �9 /g7 YES NO PLAN APPROVAL: DATE ! PP. BY -` DESIGNER: PLAN DATE.. CONDITIONS WATER SUPPLY: f OWTN WELL WELL PERMIT WELL TESTS: COMMENTS: FORM U APPROVAL: DATE ISSUED CONDITIONS: DRI LLER.I,_._.- CHEMICAL ERIA I BACTERIA DA I E APPFIUVED,_._--__._._-_ DA I E (1PPRUVED DATE APPROVED i_ _- APPROVAL TO ISSUE ES NU BY FINAL APPROVAL:. YES NO ALL PERMITS PAID YES NU WELL CONSTRUCTION APPROVAL NO SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NU OTHER ANY VARIANCE NEEDED FINAL BOARD OF HEALTH APPROVAL: YES NO DATE: IIY • ._ . -�pS7����L�•LFL�xNSSflt�L$T.4Ll '•�' it t'--� •- "i. _ yai, .r -z. r ` ja+:\-t' ':+••�:F�••f 1 ),: y. •' - NO• ' S+z INSTALLER LICENSED? r x I S THE 1y ; t �' EW REPA I R ` `TYPE OF CONSTRUCTION: ?' - ,' ,.•;: PLOT PLAN REVIEW NO ;:,NEW CONSTRUCTION: CERTIFIED .. —Y. NO CONDITIONS OF:.APPROVAL. 1 s.. FORM U) l' (FROM ` YES NO `,ISSUANCE•OF DWC PERMIT INSTALLER: _ TDWC' PERMIT N0. :BEGIN INSPECTION YES EXCAVATION,, INSPECTION: -NEEDED: BY PASSED CONSTRUCTION INSPECTIONS NEEDEDs AS BUILT PLANr. SATISFACTORY. ' ESS APPROVAL TO BACKFILL: DATE: 7 BY, — • �� % BY " •+:�FINAL.GRADING APPROVAL: DATE i, DATE:�BY _Zj� ' `'.FINAL CONSTRUCTION APPROVAL: - 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: Dy 1 ' �E'r5 '-x-11 (` Phone (o 75 - i 3 J P LOCATION: Assessor's Map Number Subdivision VV (?G61Irld S�I�ieS Street 0- c) 1k U r� k\Q-\ e. Parcel Lot (s) '1� 0 St. Number ************************Official Use Only************************ RECOMMENDATIONOf/TOWN / GENTS: Conservation Administrator Comments r -P) kr- _ Town Planner Comments Food Inspector -Health Septic Inspector -Health Comments Public Works - sewer/water connections - driveway permit Fire Department Date Approved Date Rejected Date Approved�t-'-� Date Rejected Date Approved Date Rejected Date Approved Date Rejected Received by Building Inspector Date FORK U - IAT 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 fill's(' out this section***************** APPLICANT: A - C. 6ul I LtJ( 5 ! n G Phone 0 5_ 8 3 5 0 LOCATION: Ass essor's Map Number Parcel Subdivision land E5fatt5 Lot(s) O Street __coIDnli I AJC- St. Number l� ************************Official Use Only************************ RECOMMENDATION Zk;PIN;/FMC)6V97 ENTS: Date Approved 101YAL Conservation Administrator Date Rejected Comments cibu _0 Q _ Date Approved Town Planner Date Rejected Comments Date Approved Food In,s/pector-Health Date Rejected -�✓ �� Date Approved Septic Inspector -Health Date Rejected Comments Public Works - sewer/water connections - driveway permit T� 4 -,T -QG r-- Fire Department l�-*�C 'd— aC`/ t6lp�` Received b Building Inspector Date no, HAYES ENGINEERING, INC. 603 SALEM STREET WAKEFIELD, MA 01880 NOA-0042 (617) 246-2800 REFER TO FILE FAX (6171246-752.6 .._ .. _. June 17, 1996 Board of Health Town Hall 120 Main Street North Andover, MA 01845 RE: Variance - Lots 18, 19 & 20 Woodland Estates, North Andover, MA Dear Members: Please accept this letter as an applfcation 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 18 for the distance between a subsurface drain and the leaching facility or reserve area. ^lease 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 t kORT11 OFFICE OF COMMUNITY COMMUNITY DEVELOPMENT AND SERVICES ° 146 Main Street 11,90°.Argo North Andover, Massachusetts 01845 'Tz CHUS (508) 688-9533 March 1, 1996 Hayes Engineering 603 Salem Street Wakefield, MA 01880 Re: Lot #20 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) Soil evaluation sheets missing. 2) Soil tests out of date. 3) Leach area only 85 feet from wetlands, not 100 feet minimum. 4) No benchmark within 75 feet of system. 5) Will water line really go into garage? If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Sincerely, �...'- /2:�' Sandra Starr, R.S. Health Administrator SS/cj p BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Julie Parrino D. Robert Nicetta Nfichael Howard Sandra Starr Kathleen Bradley Colwell t ,10RTh 1,y 0 O ,SSICHUSE� Applicant N Town of North Andover, Massachusetts Form No. 3 BOARD OF HEALTH DISPOSAL WORKS CONSTRUCTION PERMIT ADDRESS I CL-tr"UNL Site Location LT art7 0 &—LAnA 1 Permission is hereby granted to Construct k(/,J- or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. AN, BOAR OF HEALTH 1� Fee D.W.C. No. I 117 o �� LU Z O w Z O Z CL i O1 J J L LL � w F- W F - � o x J Z ui x O E Z W Z O N O otb ce N fl u O LU O.. vUi Vi Z Q C Z � b Z x v � Q N w w p W W � a o ce o U O LULL C O Q Q U Q p N Q 0 Zm Z Z o O Q_ J -p Q Q p ODER *** O rra S Z Z Q O C rd i fl Ln ft •CL O O.L Q Q y a' i i bQ C Ln U U U v? w LU 0 iLLI 00 C� O O1 w J w J LL W W F- F- 2 O F- Z J Lij = O Z 0 Z a O N � N Q � m C_ W CL Z ce U N C7 a 2 y Q N w w ro L W W c LL W a a U c O Q 0 cn o a0 L - Z m Z Z o p o Q E I— U F D J -6 C_ c C.. m Q w w a> < < M0 Q Q *** Z Z ODER p O �p •C It W '•3 i a� _ L ClCL •�' 10 �N C hMpl '� * * •CQ !n Q v1 W I— LL- c/ i TV 1 i IL 1 floNq N MERRIMACK ENGINEERING SERVICES INC. Engineers • Surveyors • Planners 66 Park Street ANDOVER, MASSACHUSETTS 01810 (508) 475-3555 Fax (508) 475-1448 To BOA of RaAL-11! 13(j k ( OF l OZ74 fq �.o.Do u fL. WE ARE SENDING YOU ❑ Shop drawings ❑ Copy of letter 112UTE12 OLJ U o & MwnuuLJ- p. DATE 32- DATE JOB NO. ATTENTION f RE: LtT 0-0 Co COU i A vr-- v do -i� - e rr ❑ Attached ❑ Under separate cover via the following items: ❑ Prints ❑ Plans ❑ Samples, ❑ Specifications ❑ Change order ❑ COPIES DATE NO. DESCRIPTION f 3- ZL(-97 3 ice— cA aF Pr oSii5D oo-&E D2+ Lew/ THESE ARE TRANSMITTED as checked below: For approval For your use As requested For review and comment ❑ Approved as submitted ❑ Approved as noted ❑ Returned for corrections X ❑ Resubmit ❑ Submit ❑ Return copies for approval copies for distribution corrected prints ❑ FORBIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS S'A>u,��/ RV-44aTE. SOP -716 "0t)-kKn By j nZFW 77)45)-cc14r--� AS SHoi- CA ��.i►-�► �i� Aug/ �EL( �.c MEc-F� 4)% The, bt tLe— ',j AN- PLMS14-- IRIS rla tt= �(Oc) Nwue- A �js !/ 6�t"E,uTS- COPY TO SIGNED: if enclosures are not as noted, kindly notify us at once. Town of North Andover f NORT, OFFICE OF �? o H . p , 0 L COMMUNITY DEVELOPMENT AND SERVICES ° . A + Y 146 Main Street North Andover, Massachusetts 01845 WILLIAM J. SCOTT Director July 1, 1996 Hayes Engineering 603 Salem Street Wakefield, MA 01880 Re: Lot #18 Colonial Drive Lot #19 Colonial Drive Lot #20 Colonial Drive To Whom it May Concern: This is to confirm that the Board of Health, at their regularly scheduled meeting on June 27, 1996, voted unanimously to grant the following variances: • To allow 91 feet to wetlands and 25 feet to a catch basin on Lot #18 Colonial Drive. • To allow 90 feet to wetlands on Lot #19 Colonial Drive. • To allow 85 feet to wetlands on Lot #20 Colonial Drive. If you have any questions, please do not hesitate to call the office. Sincerely, Sandra Starr, R.S., Health Administrator SS/cjp cc: Kathleen Bradley Colwell, Town Planner Michael Howard, Conservation Administrator Files BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 DATE Z Z%/ �o Sheet of BOARD OF HEALTH TOWN OF NORTH ANDOVER / SUBSURFACE DISPOSAL DESIGN FEE D Sze PERMIT # REVIEW DATE RECEIVED Z APPLICANT 46 Ai)ll ASSESSOR'S MAP ADDRESS PARCEL # LOT # �D /1 ENGINEER STREET �p C 0 A , �j7 )`� .S ADDRESS PLAN DATE REVISION DATE CONDITIONS OF APPROVAL: APPROVED DISAPPROVED -� JO/ G Er//'9 L S .yE `� a-1 1SS 1A)-6 S o T� STS O U7_ o T 1J 4 fL ( l z4 M � Gv 17 j,)/GG No. FEE I THE COMMONWEALTH OF MASSACHUSETTS Lq ® It����� - e- , MASSACHUSETTS c kpyfira#tan for Pieposal *Vetem Tons#rurtinn jJermit Application is hereby made for a Permit to Construct V) or Repair ( ) an On-site Sewage Disposal System at: Location Address or Lot No. O ner's Name, Address and Tel. No. AVE- '3�c',_C� P -P Installer's Name, Address, and -ITel.No. Designer's Name, Address and Tel. No. NRYEN cls.. t Nc Ay_i;7 t6LU ON 6/7-0-Woc Type of Building: Dwelling Other Design Flow Plan Date Title Description of Soil No. of Bedrooms Type of Building Other Fixtures 6c.> gallons per day. -I-4t Garbage Grinder ( W O No. per Persons Showers ( ) Cafeteria ( ) Calculated daily flow lO L C-) gallons. of sheets 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 provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Application Approved by Application Disapproved for the following reasons Permit No. Date Date Date Issued THE COMMONWEALTH OF MASSACHUSETTS , MASSACHUSETTS Ger#tfi.ca#e of Gintylian e THIS IS TO CERTIFY, that the On-site Sewage Disposal System installed by for ) or repaired/replaced ( ) on 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: 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 MASSACHUSETTS FEE �ts�sIIsttl o S s#em (Iblnns#rixc#ton 19ermt# 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 APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: CURRENT T"' LICENSE# unrATION- LICENSED INSTALL SIGNATURE: CHECK ONE: REPAIR: IF NEW CONSTUCTION, PL. $75.00 Fee Attached? Foundation As -Built? Administrative Use Only Yes J No Yes No Approval - Date: -If. ,� � � o�� 1/��� Ute- TiD� �U� �� APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: C5 ( I: q CURRENT INSTALLER'S LICENSE# LOCATION: DC-) C'l LICENSED INSTALLER: S SIGNATURE: (?" TELEPHONE# CHECK ONE: P9 REPAIR: NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT. $75.00 Fee Attached? Foundation As -Built? Administrative Use Only Yes J No Yes Rne Approval Date: lBa,S� fir, -j-' Zo ZS, SYi3 s,� p E-:x►S77 1-4. F. T�'_ N` _ -15�1,�7 �A iza' vB - 3S' _ 3S' 6 Wo.c �6ocr ' 7o COLob ,ii A L- AY/ U� AS BUILT PLAN OF SUBSURFACE DISPOSAL ,LOCATED IN IQO R -1--H A NDOVER, 1 l A AS PREPARED FOR A.C. 8uiLDER S We . DATE: TuK,F— 30, lq�7 SCALE: I "= qo L O -r 20 COL.OKI.I AL AVa . MERRIMACK ENGINEERING 66 PARK STREET ANDOVER, MASSACHUSETTS 01810 SYSTEM SERVICES [ ;Ur S.77 ' I S7 Z�, Du -r 9,-r S.T 3Li Z' 17,5' D-13oX 241,0' li1,0' _.._. D T`2 % y . Z' '92.0' -- u� 37,Z' ea'6,8' — lBa,S� fir, -j-' Zo ZS, SYi3 s,� p E-:x►S77 1-4. F. T�'_ N` _ -15�1,�7 �A iza' vB - 3S' _ 3S' 6 Wo.c �6ocr ' 7o COLob ,ii A L- AY/ U� AS BUILT PLAN OF SUBSURFACE DISPOSAL ,LOCATED IN IQO R -1--H A NDOVER, 1 l A AS PREPARED FOR A.C. 8uiLDER S We . DATE: TuK,F— 30, lq�7 SCALE: I "= qo L O -r 20 COL.OKI.I AL AVa . MERRIMACK ENGINEERING 66 PARK STREET ANDOVER, MASSACHUSETTS 01810 SYSTEM SERVICES [ ;Ur S.77 ' I S7 Z�, Du -r 9,-r = 157.00 Iu .D-�3ox = 1s�r k5 O T",D-$aX = t S6, Z7 1,5-6,17 it = t,5-6.17 lBa,S� fir, -j-' Zo ZS, SYi3 s,� p E-:x►S77 1-4. F. T�'_ N` _ -15�1,�7 �A iza' vB - 3S' _ 3S' 6 Wo.c �6ocr ' 7o COLob ,ii A L- AY/ U� AS BUILT PLAN OF SUBSURFACE DISPOSAL ,LOCATED IN IQO R -1--H A NDOVER, 1 l A AS PREPARED FOR A.C. 8uiLDER S We . DATE: TuK,F— 30, lq�7 SCALE: I "= qo L O -r 20 COL.OKI.I AL AVa . MERRIMACK ENGINEERING 66 PARK STREET ANDOVER, MASSACHUSETTS 01810 SYSTEM SERVICES �•°.. w.... c:;�.::"S"'fd+1PRA!��°a r:...,r,�:.., .... ...�s, �..s%:Mrv,-Ml�hr�l*'p�Cr..."'; ,- .. ..t+v"=-1� .�. ` 0 o! I 0 Z E a� CL E (U a� M 3^ o E tA LL r%, a.+ E a� LU a Ln i `A un � J Q L b c ce o N = O O b ~ J J Ln O Q O > LU = > w " O a 0 o LL Q n c O n. 3 b = Q p Q N — c Z o 0 O Q O ro O04b m Lu D 4-- 0. 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I 0 Z E a� CL E (U a� M Commonwealth of Massachusetts (�l o r-�� Q n d o Vef , Massachusetts Sstem Pumping Record System Owner 2la) Date of Pumping: q/13/6 D System Location "I'la c 01-0 (11C, e Quantity Pumped: I pCi gallons No M Yes U Se tic Tank: No Ll Cesspool: p System Pumped by: Faredort SrteBow;da License # Contents transferrred to : Greater Lawrence Sanitary District Date: Inspector: Yes L3 MAP AND PARCEL ADDRESS !j �L s GL,,7� OWNER 4 >a , ) 3 ,-t,�JktA SIZE OF LOT IN SQUARE FEET 7 --) # BEDROOMS SEPTIC SYSTEM LOCATION (For example, FRONT YARD S FINAL GRADING DATE AS BUILT PLAN IN FILE? pp INSTALLER DWC PERMIT DATE CERTIFICATE OF COMPLIANCE DATE ENGINEER APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: ( CURRENT INSTALLER'S LICENSE# LOCATION: r < p LICENSED INSTALLER: SIGNATURE: TELEPHONE#r��� 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? r Yes No Approval Date: f Commonwealth of Massachusetts City/Town of `' 8 Z013 -- System Pumping Record NORTH ANDOVER Form 4 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. 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 1. System Location: y2 C�/ohs pl Address ,o,- 4!, /o City/Town 2. System Owner: 2,"e,41 State Zip Code Name -- ---._ — Address (if different from location) City/Town State Zip Code 078" ---- Telephone Number B. Pumping Record 1. Date of Pumping Da� 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) [ ptic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other (describe): ------ -- - 4. Effluent Tee Filter present? ❑ Yes B'*Ilo If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: d�c 6. System Pumped By Name Vehicle License Number Company 7. Location where contents were disposed: 1021 .413. Notch A_ ndwer_ MA _ Signature of Hauler Date Signature of Receiving Facility Date t5form4.doc• 03/06 System Pumping Record • Page 1 of 1 ww z dz 0 E0 a a O O1 w J LU J LL t-- W W I- F- O H Z J Q LU CC, O L T LL Z J2 O O Cie b U O o- UJ m CL V) Q Z 2 — oe U LA Q LA Z ro Ln w N U Q N W L UJ UJ > `o W a ¢ U c O Q o v7 c ce ` Q O O W Z m Z Z 0 0 U � J c CL G. cd Q 0LLI2 - m b Z C ° ..'a p =u ° = yr rd L fl. o� ..=aQ O C Z r r'Eo y U C t_ D_ LU 0 iLU O O � aLU a E O O1 J • '� uj J LL r- W W I- F- � � Z r J LU O E LL Z Z T O a. o. S i Z G N W ` Ln W Q Q Lw W U C O _ i ce C J O U Q Z m Z O 0 O Z C: ✓ r' � J Q r, VW \ill g —r y g Q Q 0 ER *** Z Z OJ S� C O O 20SSB , .' a6�y Z 0= a) W L 11 s ri, k., o p Q o aCL 00" •�' C •6b VI Gi Q in W F— u- cn C%- NERI-M Inom-lowl rri O rn U) CJ LL CD Lu JW �r as Cl) LU ir Ui fr- -Y 0 0 c) cl) Ir NERI-M Inom-lowl PLAN REVIEW CHECKLIST ADDRESS Z U �D GD.0//9G ENGINEER____�/7 �� 5 GENERAL f 3 COPIES STAMP LOCUS/ NORTH ARR SCALE CONTOURS C/� PROFILE C� SECTION v� BENCHMARK `�� SOIL & PERCS ELEVATIONS WETS. DISCLAIMER WELLS & WETS WATERSHED?S) DRIVEWAY /(Eley) WATER LIN/ate DN DRAINQA'-- SCH40i/ TESTS CURRENT? SOIL EVAL SEPTIC TANK MIN 1500G 1/ .17 INVERT DROPy GARB. GRINDER(+200% EDF) 25' TO CELLAROG MANHOLE t/ ELEV GW # COMPS. D -BOX SIZE # LINES 29 FIRST 2' LEVEL STATEMENT INLET /5�-A2 - OUTLET -17(2" OR .17 FT) TEE REQ' D? ltl-) lc3z , :s 117 LEACHING / MIN 660 GPD? RESERVE AREA ✓ 4' FROM PRIMARY?----"' 2% SLOPE 100' TO WETLANDS 100' TO WELLS 4' TO S.H.GW,l (5'>2M/IN) 35' TO FND & INTRCPTR DRAINS 325' TO SURFACE H2O SUPP 4' PERM. SOIL BELOW FACILITY MIN 12" COVER "' FILL?(/'"(25' if above natural elev; 101if below) BREAKOUT MET? TRENCHES MIN 660 gpd cl/ SLOPE (min .005 or 6"/1001) f SIDEWALL DIST. 3X EFF. W OR D (MIN 61) RESERVE BETWEEN TRENCHES?? L,,-� IN FILL? 6--�-- MUST BE 10' MIN. 4" PEA STONE? VENT? (>3' COVER; LINES >501) BOT Ca� + SIDE 5 CG'S X LDNG (o = TOT 7d (L x W x #) (DxLx2x#) (G/ft2) Copyright © 1995 by S.L. Starr ,be -1w o -a8 -TQI� 7 //INe 5iG7D� 5AA/ AS i� 6D 1,1:7-IN6 5167-1 sAN6 cy/ 7-6) 3c f-zv C/ds- b" - 93 o - �Z4 - S U �U �� C CO) C � O d CO)10 C3 CD n n Z y Er O n06� CL C O y aco -0 � o 0 v CD CDCL O cr CD CD O CD O CD y CD CZ O y �G CD S- CA O � Z CD .O -t 71 O CCD 0 CD C �?.0o d 2 d m C/) ma0 m a C2 .di m y T =r C.-► d O CD -4 O O y G y N o�m m 2 =moo; S: o zco W eco: ?y R: aCL a o = C/)m CD ►� C/) m a • c�� CD CD, .... 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O CO) o c CD Cm I o� y O O Co m co H0 CD CL -1-0 CD 3� O O _0 o a �Q O cc Cc O C Z O V y O C — C _cc d CO3 0 J O 0 F w H W •y a0 F z :+ C CJ C� a W N �p i E a ga o w o ° n w i co a t to a 0 W is w M is v o c cn aw rA cin cn VJ t y O N C O m cm CID 0 cm c �C N m Z O Z O 0 0 z 0 U CC% 6 CD O E c L O O v Z CD C. O CO) o c CD Cm I o� y O O Co m co H0 CD CL -1-0 CD 3� O O _0 o a �Q O cc Cc O C Z O V y O C — C _cc d CO3 0 J O N :+ C CJ C� W N �p i E a ga o sa �Ey . c m mcm C .. s N R �mm CT � m c� OM co CA CD E.. O La O Ca N p,Ct O 82'= LO,Z �. Q L y m C = o :ago W C O •N s R C •15 d p J •N� V C. 7 co, � CL VJ t y O N C O m cm CID 0 cm c �C N m Z O Z O 0 0 z 0 U CC% 6 CD O E c L O O v Z CD C. O CO) o c CD Cm I o� y O O Co m co H0 CD CL -1-0 CD 3� O O _0 o a �Q O cc Cc O C Z O V y O C — C _cc d CO3 0 Commonwealth of Massachusetts �u City/Town of NORTH ANDOVER, MASSACHUSETTS System Pumping Record Form 4 N 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 authtom- E(-�p °f' >� �,. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. ietrm A. Facility Information System Location: 9"� Address y.� f s A✓�Joy2 i City/Town 2. System Owner: ka o f- e, Name Address (if different from location) City/Town B. Pumping Record iq Pq State JAN 10 2008 (,ATH ANDOVER ILTH DEPARTMENT ol gy,5- Zip Code State Zip Code _ R-4�'-- 553-- �9UisF5 Telephone Number 1. Date of Pumping Dag- o2 �o�0- 2. Quantity Pumped: Gal 5620 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other (describe): — - 4. Effluent Tee Filter present? ❑ Yes Ef No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: Gor)A 6. System Pumped By: M; bgn N gv9, a. m t? Name � Vehicle License Number �, jZ�ye.r_ Fnyt rhenia j _.— Company 7. Location where contents were disposed: W✓ J.�0 Signature of Hauler Date http://www.mass.gov/dep/water/approvals/t5forms.htm#inspect t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of assac usetts City/Town of o System Pumping Recor 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. OCT 2 3 2008 I A. Facility Information Important: When filling out 1. System Location: t forms the computer, use q a Co 1 pn I cc I A\,/,C, only the tab key Address 1 to move your 1� 0 � h An j ore � I" t A /7. q 0) � cursor -do not City,Town State Zip Code use the return key. 2. System Owner: Name Address (if different from location) Citylrown State Zip Code l - S57 -g033 Telephone Number B. Pumping Record 1. Date of Pumping Date 0— 3_ O� 2. Quantity Pumped: Gallons500 3. Type of system: ❑ Cesspool(s) [✓Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes [ 'No If yes, was it cleaned? ❑ Yes ❑ No 5. ConditionofSystem: �b G 6. System Pumped By: Env; ron menial -7 6 (D-7 9 Name Vehicle License Number kyy-, Company 7. Location where contents were disposed: G.L.S.D. Signature of Hauler Lawrence, MA. Signature of Receiving Facility t5form4.doc• 03/06 1 Date Date System Pumping Record • Page 1 of 1 Location No. Date i NORTH TOWN OF NORTH ANDOVER O�<t�•O '•1�0 A Certificate of Occupancy $ o Building/Frame Permit Fee $ 160 Fu 10 i•�s',^°' Eta Foundation Permit Fee $ s�CHus $ Other Permit Fee $ Sewer Connection Fee $ Water Connectio TOTAL 9 3' I 4 n Fee $ _ �$ \ COU Building Inspector 8 Div. Public Works