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HomeMy WebLinkAboutMiscellaneous - 99 PHEASANT BROOK ROAD 4/30/2018 (2)O m - MAP '# 16(9� PARCEL # %� STREET O.NSTRUCTION—APP At., HAS PLAN REVIEW FEE BET PAID? YES \' NO PLAN APPROVAL: DATE - aY_ DESIGNER: �/r�1S //3 - PLAN DATE CONDITIONS WATER SUPPLY: WELL PERMIT_, WELL TESTS: COMMENTS: TOWN WELL MICAL DAIE AP)PFIUVED.-.--___-.-_-- BACTERIA DATE flPPRUVED .... _ BACTERIA II 'E (.IPPF2UVED_._.-,_-_ FORM U APPROVAL: 5515-14;;6 --7 Z a DATE ISSUED CONDITIONS: FINAL APPROVAL: /i R` ALL PERMITS PAID WELL CONSTRUCTION APPROVAL SEPTIC SYSTEM CONSTRUCTION APPROVAL OTHER ANY VARIANCE NEEDED FINAL BOARD OF HEALTH APPROVAL: YES NO NU YES NO YES NU CN YES DATE: _._..... BY t { ��PT�SYSCM_�NSI8L.1,R8TQ�I ,.. _. a NO ,.! rJ • t! i :� f ` , y> _.: "'•'`•. •`* , }''. ' •��' 'tii YES - 'nr �� INSTALLER LICENSED? IS�THE REPAIR' ' x `NEW ' TYPE OF CONSTRUCTION: - :,.NEW CONSTRUCTION: CERTIFIED NO PUTT 'PLAN REVIEW YES NO 1 CONDITIONS OF: APPROVAL �. j ' 4 (FROM FORM U)'; NO ISSUANCEOF `DWC PERMIT ,' r INSTALLER: DWC PERM 'BEGIN INSPECTION YES N0- :._ t :. 'INSPECTION: NEEDED • t . EXCAVAT I ON A , r : .` BY PASSED ~ NEEDED: CONSTRUCTION INSPECTIONS Nj AS BUILT PLAN SATISFACTORY. i DATE•BY APPROVAL. TO BACKFILL: ` .GRADING APPROVAL: DATE BY .:..FINAL DATE: BY FINAL CONSTRUCTION APPROVAL: AS -BUILT CHECKLIST LOT NUMBER, STREET NAME ASSESSORS MAP & PARCEL NUMBER LOT LINES & LOCATION OF DWELLINGS LOCATIONS & DIMENSIONS OF SYSTEM, INCLUDING RESERVE TIES TO LOT LINES & DWELLING, WELLS a. FROM SEPTIC TANK b. FROM LEACH AREA LOCATIONS OF DEEP HOLES & PERC TESTS ELEVATIONS OF DISPOSAL SYSTEM TOP OF FDN ELEVATION LOCATIONS OF WELLS, DRAINS, WATERCOURSES WITHIN 150' OF SYSTEM LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK & D -BOX ORIGINAL STAMP & SIGNATURE IMPERVIOUS AREAS - DRIVEWAYS, ETC. NORTH ARROW LOCATION & ELEVATIONS OF BENCHMARK USED TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System'i) constructed; ( ) repaired; located at�/ was installed in conformance with the North Andover Board of Health approved plan, System Design Permit # , dated , with an approved design flow of gallons per day. The materials used were in conformance with those specified on the approved 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 substantially with the approved plan. All work is accurately represented on the As -built which has been submitted to the Board of Health. Bed inspection date: Final inspection date: Engineer Representative Engineer Representative Date: /O —o?Y Date: 101la6 1 CHRISTIANSEN & SERGI INC 160 SUMMER STREET HAVERHILL, MA 01830 978-373-0310 FAX 978-372-3960 BILL TO NICK VERGADOS 8 DOUGLAS ROAD CHELMSFORD, MA 01824 Invoice DATE INVOICE # 10/25/2000 MMI014 DESCRIPTION AMOUNT FINAL SSDS AB 500.00 Y 1� Total $500.00 No................ ......... rw ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Tbu'�.........._ OF..../l� .f�'Tr.- ......11.1`L.D..t�.1/.E:: - Q Atitiliratillit fir R1111twal j nrlig C9ntli"trurti it 1 Application is hereby made for a Permit to Construct (x) or Repair ( ) an livid ewage Disposal System at: ..................................................................•---•-•--•---..._............-------•------------ P1JZ:R5Ak)-10,ftk R6191 Location • Address A....I,�UCznP-.x'1.1=%UI......�' X -D...-•-- y .. l� l�-._.Aewl)...X,.......'� ........... Owner Address ..................................................•--•---....................._._.................--•---..._...-------•----..._..........---.............-•----................................_... Installer Address Type of Building l..O f}G e5 Stze Lot--------------------------•-Sq—&et Dwelling— No. of Bedrooms.--.__-_ - �k..............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of pe' -sons .......................... ( ) —Cafeteria ( ) g ............. 5ltowers Otherfixtures ...............................:....... ....=......:.._........_........... Design Flow ...................... .........•-----••_---.gallons per person per day. Total daily flow..-_......�.h.�)---...---•-------....gallons. i V r / i A/ Septic 7 -auk — I_iquicl capacity.�.��......gallons Lengtl✓.Q..�'..__.._.. �� idth.r.O.....�.�.�....... Di;tnreter. ................ Disposal F -- * ' ........... Width....12..._....._ Total 1_ertgth... 6-w-.......... Total leaching area. ..%t•��...... sq. ft. Seepage Pit No ..................... Diameter.................... Depth below inlet .................... Total leaching -area .................. sq. ft. Other Distribution box ( l -f Dosis -tank ( ) ) �._ y Percolation Test Results Performed by.C'il/7_%9, G�2l��✓t�l.,j ....---•.... Date..../d F�.......................... Test Pit No. 1 ...... it minutes perinch Depth of Test Pi . lig._ Depth to ground water.-6-...�5..H... f Z Test Pit No. 2 .... S. ...... nlinutes per inch. -Depth of Test, P41-2-.............. L)epth to ground water..,. /'. -05NM/'l / ...................................... ............... ............................................... ................................................. Description of Soil ...... :!5k . ..... S?! Nay..--.LQA. 1/1 ....-•---•-------------•--•--•------••--------....-•---....---......--------..............................------.................-=-•-•-----•-----------.... •----------•--...--•-----------------------------------------•----------..................................-----.............-•-------....._.._......--------••-•.... Nature of Repairs or Alterations — Answer when applicable........................................................ ------•--------------•-------•--......._..----•-..............................................------•-••--•------•---------•------••----..........--••-----....... 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...................................... ---------• ................................. Application Approved 13y .................................................. nate Application Disapproved for the following rmsotns::...............................................nate ------------------------------------------------------•-....--•......--•--•------•-------...-----.......................................... Date PermitNo ......................................................... Issued_. Date THE COMMONWEALTH OF MASSACHUSETTS t30ARD OF HEALTH .......................................... OF .......................................................... Tafiflattg of (lrntttf1liFtttrh THIS I.S TO CERTIFY, That the Individual Sewage Disposal Systenn constructed ( ) or Repaired ( ) by......... Installer at.................................... ...................................... ......------...------.......---------...---......._.....---.............-------------------------------------------------- has been installed in accordance Willi the prop isiom of TITLE 5 of The State Sanitary Code as described in the application- for Disposal Works Construction Permit No ......................................... dated ... ..................... .............__....._--- THE ISSUANCE OF TiIIS 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-: ..................... joil<lp>lauttl IV,11dal (9ntt11trudiutt irrtttit Permission is hereby granted ........................ :---•--...------•-•--....---r------ to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo ................................... Strcct as shown on the application for Disposal \fortes Construction Permit No ..................... Dated..........................._._............ ----------------•------......-----...._............------•....------••----------.........._ DATEBeard of Itealtt+ --•------•------ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS •8. N LOT 10 o ` T.O.F. =lsl.r i .oy ,q 4 *0 FOUNDA TION LOCATION PLAN CLIENT: Nick & Connie Vergados THIS CER77nC47/ON IS MADE AND LIMITED TO THE ABOVE CLIENT. LOCATION. -LOT 10 "EVERGREEN ESTATES" NORTH ANDOVER,MA. SCALE. l!=80' DATE: 6/28/99 Xb 11 4 ti C9��� �"�•' I I CERTIFY ""T THE PRIMARY SARUCTURE SHOWN COIVmon TO THE HOMONTAL SETBACK REOWREYEMS OF THE LOCAL APPLICABLE ZONING BY-LAWS IN FFTECT WHEN CONS/RI/CTED. (THIS CEIMFK:ATION DOES NOT CONSIDER ANY DIM RESIRLCTLOWS SUCH AS COVENAMMWETLANDS.EASEWE M ORDERS of CONOIIIONS.EIC) THIS DRAWING SHALL NOT BE USED BY THE CLIENT FOR ANY PURPOSE OTHER THAN THAT OUTUMM ABOVE~E7LCEPT WITH TME WRITTEN PERIASSION OF CH/ILS7UMMV R SERC/ INC. FURTHERMORE THIS DRAWING IS IME COPYRKRITFD PROPERTY OF CHRa uAwN R SERGI INC. AND ANY UNAUTNORQED USE IS PROIRB/IMCHRS/IAIIRSEN d SERB TAKES NO RESPONSIBILITY FOR THE UMUMOROM USE OF TMM DRAWING OR ANY lMFM- MATXW CONTA/MED HEREON. CHRISTIANSEN R SRRGI PMOFI �''`SURMEQ EYORS ILIO SUMMER Sr NAMPOLL.M. 01830 TEL 978-373-0310 a IM BY CHRUTWJSEN R Sam INC. Em sl N N Ay} 1 VIM- �ts4r":k �rrats. . r CIO C2 O > o v 6s. cn 0 I > o .c o o G Ls. (� Ls. �.ICr a � � ►.a W � C �; -`' Chi v o �p LC rI1 �(/•� Ay} 1 VIM- �ts4r":k �rrats. . 4 0 co CL Cl � ca -0 CD AE CD 0 w CD 0 ca 0 ca cmC CD CA CL r C2 ai% J •, CC2 C.) lj 'ate c cc Z o � V o m Ea D C C� CD S a Ec m ,o :ES v cm m c ca c o c4 :� tw rn ctu.• c� to 0 009 CD so _y 12 CS 0CL _ c V o 7 • o0 ge.C, y 01 �q ® w/ 4 0 co CL Cl � ca -0 CD AE CD 0 w CD 0 ca 0 ca cmC CD CA CL ci LU c Z/ z O E = d w fl L 0 O LL Ol J � N Q � O -� � b �'•i w = O O Z j > %0 U �c tA c Q 3 LU Zcu ` ¢ Ln Z O L a j U ro V o JLn V) a _Q > w o o Q O LIP) o c LL O ¢ b4 C: O O QO ce � Ln C }' z 3 o v 0 Q 0 4i N 2 N �! I b w >� N N — x** c •� Q l OOJER �MO1 * x Q cn 4. to li SEPTIC PLAN SUBMITTALS LOCATION: �1� L-�v 10 t NEW PLANS: YES $60.00/Plan REVISED PLANS: YES . $25.00/Plan DATE: DESIGN ENGINEER: When the submission is all in place, route to the Health Secretary SEPTIC PLAN SUBMITTALS LOCATION: NEW PLANS: YES REVISED PLANS: YES / DATE: 4 l t g E DESIGN ENGINEER:�,.,J, � $60.00/Plan $25.00/Plan ✓ When the submission is all in place, route to the Health Secret: APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: La — :,2 % — 22 CURRENT INSTALLER'S LICENSE# LOCATION: 46 / " U -P�-e Y -.C,> LICENSED INSTALLER: o4e Z4 603-9a F— Y V 3G SIGNATURE: TELEPHONE#c-r// 2RF 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 'Z/9 Floor Plans? Yes. No Approval �~ HcALTH VEd JUN 2 Date: 7ZiA, The ( ottom of bed; ( ) septic system located at 7 /0 0,&6j- , has been inspected and approved on L�/��%p by Board of Healthersonnel, and P the Health Department has no objection to a construction permit being issued for this lot. Inspector Date r, OA )A) FOR ATE TIME �' f M. M OF PHONED RETURNED PHONE YOUR CALL R A CODE C NUMBER EXTENSION M E� E JG V PLEASE CALL ])� WILL CALL f/1U� AGAIN n s PO�C� cv l�bo�/e i�f /'f f.Jt CAME SEE YOU �cA.%+i/r {ourv�� d t£ WANTS R LYO9S�1 rocn SEE U SEb -'o TG' i O«h (UjnIV@ISaI. 48003 N OTES,� TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE 11/8/00 This is to certify that the individual subsurface disposal system constructed (X ) or repaired ( ) by Dave Maynard at 99 (Lot 10) Pheasant Brook has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. T Board of Health Inspector PLAN REVIEW CHECKLIST ADDRESSI d%/D 6xe-E,c)ENGINEER �5 GENERAL 3 COPIES L,� STAMPy LOCUS �/ NORTH ARROW - SCALE L� CONTOURS L/ PROFILE(/ (Sc) SECTION BENCHMARK SOIL & PERCS ELEVATIONS WETS. DISCLAIMER WELLS & WETS WATERSHED? DRIVEWAY ` WATER LINE t/ FDN DRAIN �� M&P SCH40 TESTS CURRENT? SOIL EVAL SEPTIC TANK MIN 1500G 10' TO FDN D -BOX SIZE INLET LEACHING .17 INVERT DROP GARB. GRINDER (2 comps +200) MANHOLE ELEV GW # COMPS. GB # LINES - OUTLET = MIN 440 GPD? RESERVE AREA 100' TO WETLANDS 100' TO WELLS 20' TO FND & INTRCPTR DRAINS 4' PERM. SOIL BELOW FACILITY BREAKOUT MET? TRENCHES FIRST 2' LEVEL STATEMENT (2" OR .17 FT) TEE REQ'D? 4' FROM PRIMARY? 2s SLOPE 4' TO S.H.GW (5'>2M/IN) 400' TO SURFACE H2O SUPP MIN 12" COVER FILL? (15') MIN 440 gpd SLOPE (min .005 or 6'/1001)' SIDEWALL DIST. 3X EFF, W OR D (MIN 6'RESERVE BETWEEN TRENCHES? ✓''IN FILL? L---�­MUST BE 10' MIN. 4" PEA STONE?---,,� VENT? (>3' COVER; LINES >50') BOT aVF + SIDE X LDNG 1 2� = TOT 614,4o (L x W x #) (DxLx2x#) (G/ft2) 170� . SL 6; .5 //o Q) L Copyright' m 1996 by S.L. Starr 17, WILLIAM J. SCOTT Director Town of North Andover of,",° oT "'ti OFFICE OF 3a ,• COMMUNITY DEVELOPMENT AND SERVICES 30 School Street : ^° North Andover Massachusetts 018452•1'0`'x` I/We understand that if the area set aside for the septic leaching area on Lot 10 Pheasant Brook Road, Evergreen Estates, is found to have significant bedrock/ledge outcrops in the area, the septic system may not be able to be installed in that area and that additional soil tests may have to be performed on the lot. I/We also understand that if there is no appropriate location found elsewhere on the lot for the installation of the septic system, that the lot may be found unsuitable for the installation of a septic system and not be buildable until a sewer system is constructed in the subdivision, or unless a shared system with another owner can be approved. Signed this day of December, 1997. CONSERVATION - (978) 688 9530 • HEALTH - (978) 688-9540 • PLANNING - (978) 688-9535 *BUILDINGOFFICE - (978) 688-9545 0 *ZONING BOARD OF APPEALS - (978) 688-9541 0 *146 MAIN STREET APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: CURRENT INSTALLER'S LICENSE# LOCATION: LICENSED INSTALLER: SIGNATURE: TELEPHONE# 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 Floor Plans? Yes No Approval Date: Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES WILLIAM J. SCOTT Director November 20, 1997 Nick & Connie Vergados 8 Douglas Road Chelmsford, MA 01824 30 School Street North Andover, Massachusetts 01845 RE: Lot 10 Pheasant Brook Dear Mr. & Mrs. Vergados: At a recent meeting, the North Andover Board of Health unanimously agreed to the mandatory inspection of septic bed bottoms on the Evergreen Estates subdivision before any construction permit can be issued by the Building Department. The reason for this mandate arises from the numerous problems already encountered on this subdivision. The purpose of this letter is to inform you of this fact and to detail the process that you must follow in order to begin construction. 1. Hire a septic installer licensed to work in North Andover to apply for a permit for the septic bed bottom. He must apply to the Health Department. Usually there is no' fee for this permit; it is a short-term permit. 2. After the bed bottom is excavated, the Board of Health must make an inspection to determine whether the area is appropriate for the installation of a septic system; the bottom will either pass or fail. 3. If the area passes, approved septic sand is brought in to protect the area until the entire septic system is installed. 4. When it is time to install the septic system, your licensed installer must come to the Health Department, apply, and pay for the permit to install the system. The sand already put into the system will be cleaned up and, if necessary, additional sand will be brought in according to the approved design. The work will then continue normally. , I must assure you that this procedure is being followed to protect the homeowner and will be done by this department as expeditiously as possible. Please call the office if you have any questions. Sincerely, Sandra Starr, R.S. Health Administrator CONSERVATION - (978) 688 9530 - HEALTH - (978) 688-9540 - PLANNING - (978) 688-9535 *BUILDING OFFICE.- (978) 688-9545 - *ZONING BOARD OF APPEALS - (978) 688-9541 - *146 MAIN STREET TO DATETIMME AM 0-5 PM H FROM , • AREFA CODE ONO. OF EXT. M E s S G E S GN PHONED BACK CALL RNED SEE YOUO AGAIN ALL WAS IN EIJURGENT UNITED STATES POSTAL SERVICE J • Print your name, adc}rdss�and 7-1P Code in fFi sbox North Andover Board of nth Town Hall Anne% 146 Main strept 01645 North Andover, MA u � 11�1l4l1411/13l1�1l11�l1l1l1li'!�1144!'�fll�!!!t�!lIll�41�1�!!� SENDER: ■Complete items 1 and/or 2 for additional services. I also wish to receive the P 205 969 518 ■Complete items 3; 4a, and 4b. following services (for an ■ Print your name and address on the reverse of this form so that we can return this extra fee): ❑ Express Mail ❑ Insured card to you. ■Attach this form to the front of the mailpiece, or on the back if space does not 1. ❑ Addressee's Address m permit. ■ Write'Return Receipt Requested' on the mailpiece below the article number. 2. ❑ Restricted Delivery d' to ■The Return Receipt will show to whom the article was delivered and the date T a delivered. Consult postmaster for fee. 8. Addressee's Address (Only if requested Nick & Connie 8 Douglas Road Chelmsford, MA 5. 6. Veraados PS Fofm 3811. December 1994 01824 4a. Article Number m. P 205 969 518 L' 4b. Service Type ❑ Registered KI Certified °C ❑ Express Mail ❑ Insured ❑ Return Receipt for Merchandise ❑ COD w 7. Date of Delive J11 '7 T 8. Addressee's Address (Only if requested and fee is paid) t NORTH ANDOVER BOARD OF HEALTH DESIGN REVIEW REPORT DATE FEE: PERMIT ## 97 DATE RECEIVED APPLICANT �C V��� MAP PARCEL ADDRESS 9'-D0(xc,95-TD C'1166N-5 LOT ## G6) STREET ## ENG. ��� S��A.USlV STREET -)�W6/9,5,4�e�D,- ENGINEER'S ADD. PLAN DATE q J, CONDITIONS OF APPROVAL APPROVED REASONS FOR DISAPPROVAL: REV. DATE D N�1"4�F - a' 19,-`-7z:-,e D �oiC DISAPPROVED �- `Goo'e z /� A25 6 (9-V (9-L PLAN REVIEW CHECKLIST ADDRESS Z id 71��1'9 WIUr A6X ENGINEER 561-j GENERAL 3 COPIES STAMP LOCUS NORTH ARROW SCALE — , 4 t/ CONTOURS PROFILEL---SECTION BENCHMARK SOIL & r✓ �j�" ,lr-- PERCS t/ ELEVATIONS WETS. DISCLAIMER/ WELLS & WETS WATERSHED?/)/O DRIVEWAY f(Elev) WATER LINE FDN DRAIN SCH40 TESTS CURRENT? SOIL EVAL SEPTIC TANK. Z---- MIN /MIN 150OG .17 INVERT DROPy GARB. GRINDER(+200% EDF) 25' TO CELLAR (/ MANHOLE--- ELEV ✓ GW_&-, ## COMPS. D -BOX SIZE ## LINES FIRST 2',LEVEL STATEMENT INLET k36, 36" - OUTLETl3� _ /7 (2" OR .17 FT) TEE REQ' D?Ab— i%,,57 /36r 90 r/7 LEACHING -- MIN GPD? RESERVE AREAL 4' FROM PRIMARY? 2% SLOPE �� L--- 100' TO WETLANDS x-100' TO WELLSC-----4' TO S.H.GW &/ (5'>2M/IN) 35' TO FND & INTRCPTR DRAINSL--' 325' TO SURFACE H2O SUPP 4' PERM. SOIL BELOW FACILITY f/ MIN 12" COVER (/ FILL? 4—�5' if above natural elev; 10'if below) BREAKOUT MET? Ql� ' TRENCHES MIN 660 gpd_ SLOPE (min .005 or 6"/1001) SIDEWALL DIST. 3X EFF. W OR D (MIN 6') RESERVE BETWEEN TRENCHES? IN FILL? MUST BE 10' MIN. 4" PEA STONE? VENT? (>3' COVER; LINES >501) BOT + SIDE X LDNG = TOT (L x W x ##) (DxLx2x##) (G/ft2) Copyright © 1995 by S.L. Starr r PITS MIN 660 LEACHING MIN 1 (13'x16') PIT MANHOLE/PIT GW MIN 4' BELOW BOTTOM EXC 2x EFF W OR D 12"-48" STONE BOT (L x W x ##) CHAMBERS MIN 660 LEACHING + SIDE x LOAD = TOTAL (2x(L+W)xD x #) (G/ft2) GW MIN 4" BELOW COVER >3 FT - VENT MANHOLES 12"-48" STONE SPLASH PADS SLOPE .005 BED/TRENCH (Bed max. 60' X 60') MIN 13' X 16' PIT BOT + SIDE X LOAD = TOTAL (L x W x ##) (2 x (L+W)xD x ##) (G/ft2) FIELDS v PD�900 ft2 BED GW MIN 4' BELOW BOTTOM OF FIELD PIPE ENDS JOINED? 1,--4" PEA STONE? -/ DIST LINE SLOPE .005? >31COVER-VENT SCH 40J MIN 12" COVERL------ RATE C%/V% LDG� J X 660 = 16 � X=(�= TOTAL G/ft2 REQ'D (ft2) LXW qnc X, 4 _ � 4o 7446 DOSING TANKS AND PUMPS DIMENSIONS X X = PUMP CAPACITY 9Pm L W D Vol. DISCHARGE SIZE DISCHARGE RATE DISCHARGE TIME 9Pm MANHOLES TO GRADE ALARM SEP. CIRC. inlet) HWL LWL CHECK VALVE OP. SWITCH Copyright 0 1995 by S.L. Starr GW (Min. 1' below BLEEDER HOLE MANUAL SEPTIC PLAN SUBMITTALS LOCATION: NEW PLANS: YES $60.00/Plan REVISED PLANS: YES $25.00/Plan DATE: q-30 -q-1- DESIGN ENGINEER: r When the submission is all in place, route to the Health Secretary rVv'1 C.' ! v2�t u d es lG) j'l - Q �- t� 1 Y? GLA (t]QS GPP� D U C!'iOL� 1C,20J / �7ar,, 66D 40 y � Q 0 No. COMMONWEALTH OF MASSACHUSETTS J SLP 3 0 1997 Board of Health, flX)M &iJllOVt: fZ , MA. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT' Application for a Permit to Construct JRepair ( ) Upgrade ( ) Abandon ( ) - ❑ Complete System ❑Indvidual Components Location LOT IU EVERG2EN ESTATES Owner's Name WXCrh +CONN IE VEF, GA00S Map/Parcel! tAA%P V06 anas Address O bOUC AS -PP. C 4RMiSR Qd NA 01 Lot# to Telephone# (Crjg) �S c 3 Installer's Name Designer's Name MILIP MILLG C4 %%TW&)5 C f� Address ®1 Telephone# Telephone# (a'7g) z'i-5--O-6tQ Type of Building:�C% � �• --, ..l•y � -- 9�-••n�,.p. YA.r '�s: .l+ ;1.. i.• .-h't;.r�'r�`'r'r'. ...•v. - -.:.r.- -..�.�y • r.�-"M'""..:...6'r++F4t;.,•..�w.::a.. -.. ,N.�:y.� V _ _ .,? i . No. COMMONWEALTH OF MASSACHUSETTS Board of Health, QOM A&XV6k , MA. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct (JRepair O Upgrade O Abandon O - ❑ Complete System ❑Indvidual Components Location LOT t U EVERGk E' N ESTATES Owner's Name X110) +(ON N I E \IEP; CAbcs y Map/Parcelk CA as Address bGA)CLA'S A 046tMS 7fit i, MA 018 Lot# 10 Telephones Installer's Name Designer's Name ffAILW G,CH( 45rlA &Z E M Address AddressWa)W4US� .^UAiLLIPA 61 Telephone# Telephone# (CA -7?) 3"T -5— G31® Type of Building: 4-)Mp Lot Size F`(4#. %Dwelling - No. of Bedrooms H Garbage grinder ( ) Other - Type of Building No.of persons Showers( ), Cafeteria( Other Fixtures w Design Flow(min. required)L4() pd, Calculated design flow Design flow provideq gpd Plan: Date sheets —L— of sheet_ Revision Date' of C Title rj° p L G Description of Soil(s) INS SAC N L, CA M Soil Evaluator Form No. t lZZ Name of Soil EvaluatoC(.{fj_t � 1 4Qb1 Date of Evaluationtl /� • (� DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal: System in accordance with the -provisions of TITLE 5 and further agrees to not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed, DEP APPROVED FORM 5/96 No. Fee COMMONWEALTH OF MASSACHUSETTS Board of Health, CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) ❑ Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded ( )• Abandoned ( ) by: at tltrt- tj-r %, ,'Ir r,rfE,\ --, j�+4, w has been installed itt ags ordanceowith the -provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans`relaung to application No. dated Approved Design Flow _ (gpd) x Installer Designer: Inspector Date p4 ,�3Q The issuance of this permit shall not be construed as a guarantee that the system will function as designed. DEP APPROVED FORM- 5/96. t.- . r t • {., ----------------------- --- Fee ___e>____ _•____.__ :_ __, COMMONWEALTH OF MASSACHUSETTS' ,, . r Board of Health, / 1 l f f k ` ' I` DISPOSAL SYSTEM CONSTRUCTION`PERMIT ~ s,.,hereby granted, to; .Construct( ) Repair(..,.) Upgrade( ) Abandon( ) an individual sewage . disposal system Permission yi at ' ,~ e t ! ` `as described in the application for Disposal System Construction Permit No.: dated ' Provided: Construction shall be'compl4eted within three years of the date of this permit. All local conditions must be met. DEP APPROVED FROM 5/96 Date ` Board of Health R FORM 11 - SOIL EVALUATOR e lOaf 3 Date: � _ C 7 No. Commonwealth of Massachusetts Massachusetts Soil Suitability Assessment or ©n -site- Sewa e Dis osal e F L G Da Zl ��Gti -Ut . Date: ' F 1 �1 v Performed By C.. N ._...._ ..... _. .. .. Witnessed By : Alf-....5Ai�lZ..�,�...... =. J1 ! ................................ .. r'1C� TCcNftiIC_ \j CrtLLJ _ �C/�i 1, f TLS Owner's Namc. _ L- ­ ova Addfus -LOT L7 ►o ' G 1Z.,6 ..r; AddMS2. Ind �� 6 �. A 5 r� G ,c �.:.r�i5 20►'O'`� �%� Z44 Loc t Telephone IC(`.Zp� ew Construction !�Repair LJ I office Review Published Soil Survey Available: No Si Yes M'i ,1.... Publication Scale I z ls.. Soil Map Unit � i'C .. . Year Published Drainage Class UEiv.L-D Soil Liim-ittati Surficial Geologic Report Available: No lam' Yes ❑ Year Published Publication Scale - - Geologic Material (Map Unit).............................................................................................. ....... Landform.................................................................................... ......... Flood Insurance Rate Map: Above 500 year flood boundary No '_Yes No ❑Yeso Yes '❑ Within 500 year flood boundary - N ❑ Within 100 year flood boundary - Wetland Area: (map unit .................................................................... National Wetland Inventory Map ( ) .. . ..................................................... .............. Wetlands Conservancy Program Map (map unit ) Current Water Resource Conditions (USGS):. Month Range :Above Normal ❑Normal 1JBelc,.v Normal ❑ Other References Reviewed: SEP 3 0! 199 DU pppROVM FORM - 12107195 FORM 11 - SOIL EVALUATOR FORM Page ? of Location Address or Lot iJo. IC. L VIrL 4 LEti as On-site Review 1 % 7 Date: � C � Oj� Time: Weather Deep Hole Number � � . Location (identify on site plan) Land Use _ Slope Surface Stones Vegetation Landform - Position on landscape (sketch on the back) Distances from: Open Water Body feet Drainage way feet Possible Wet Area feet Property Line feet Drinking Water Well feet Other DEEP OBSERVATION HOLE :OG* Depth from Soil Horizon I Soil Texture I Soil Color I Soil Other Surface (Inches) I j (USDA) (Munsell) Mottling (Structure, Stones. Boulleers,Grav Consistency, 4% FS* (=S L`� Sf �. +11. ice -'T. I ` uv5 I L Or t HUL=t t t A [.� Parent Material (geologic) , L DepthtoSedrock: � � `� Depth to Groundwater' Standing Water in the Hole:- Weeping from Pit Face: Estimated Seasonal High Ground Water: iiDEP APPROVED FORM - 12107/95 FORIM 11 - SOIL EVALUATOR FOR;\1 Page 2 of 3 Location Address or Lot Ivo. 10 E\2 iv QZ LLZ &- t2-2- r✓ .S - On-site Review Deep Hole dumber! Z- Date: y j6 / 95 Time: Weather Location (identify on site plan) ... ...... - - Land Use _ Slope (°!o) Surface Stones Vegetation Landform Position on landscape (sketch on the back) Distances from: Open Water Body feet Drainage way feet Possible Wet Area feet Property Line feet Drinking Water Well feet Other Parent Material (geologic) ���. OepthtoBedrock: Depth to Groundwater:_ Standing Water in the Hole: Weeping from Pit Face: _ � 61 Estimated Seasonal High Ground Water: iiDEP APPROVED FORM - 12/07/95 FOR�ti1 I1 - SOIL EVALUATOR FORM Page 3 of 3 Location address or Lot No. 1.y7 IC EJErLL-�' Z Determination dor Seasonal Isiah Yater 'Tabie Method Used: Q Depth observed standing in observation hole ................ inches Depth weeping from side of observation hole _.... inches il-d.Qetl i -�- 3c: 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 atleast four feet of naturally occurring pervious material- exist in all areas observed throughout the area proposed for the soil absorption system? y 9s If not, what is the depth of naturally occurring pervious material? Certification I certify that on f`t (date) I have passed the soli evaluator 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 Js Date 3/Z DEP APPROVED FORM - 12107/95 FORM 12 - PERCOLATION TEST Location Address or Lot No. iC COMMONWEALTH OF MASSACHUSETTS Massachusetts Percolation Test* Date: _ -; ICcj Time:, Observation Hole # Depth of Perc iLj ' j Start Pre-soak End Pre-soak Time at 12" 3 �; Time at 9" � °fib 3'SI Time at 6" L4.� cC- Time (9"-6") Rate Min./Inch * Minimum of 1 percolation test must be perfcr„mad in both the primary area AND reserve rea. Site Passed Site Failed ❑ ......................................................................................................................................_._..............._. Performed By: C�-+IZkSTlsll;Si.r1;c' 5 2C� I VIII: C S1 E _2' Witnessed By: SA O' -A STA Comments: iiDEP APPROVED FORM - 12/07/95 FORM U - LOT RELEASE FORM INSTROCTIONS: This form is used to verify approvals/permits from Boards and De a that all necessary have been obtained. This does not relieve thehvin landowner from compliance with anapplicant Jurisdiction regulations or re Y applicable localoand/or quirements. state law, ****************Applicant fills out this CANT�s APPLI ` rli� - l C. � LOCATION: Assessor's Map Number Subdivision�G�'r Street L c+--4 I o Official RE'COM CNDATIONS OF TOWN AGENTS: Conservation Administrator Comments Town Planner Comments Food In pector-Health Septic Inspector -Health Comments Phone ..--•-)C)O, Parcel Lots) -41 1L St. Number Use Only*******************#*** , 38 os oo4 . P lic Worl�� - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date Approved Date Rejected Date Approved'" Date Rejected Date Approved Date Rejected Date.Approved Date Rejected Date FORM U - VERIFICATION 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: Phone — LOCATION: Assessor's Map Number Parcel Subdivision Lot(s) ---t--= Street St. Number **********************Official Use RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator .Date Rejected Comments .Date Approved Town Planner Date Rejected Comments _ Date Approved Food Inspector --Health Date Rejected /a- 'Date Approved �' S 9.L Septic Inspector -Health Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date FORM U - VERIFICATION 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: AA C -5S (t�;= �(� J CO '-f-�'��c_ Phone LOCATION: Assessor's Map Number Subdivision ��- ���'��/�! StreetT Parcel Lots) k) St. Number ***********;*************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Conservation Administrator Comments Town Planner Comments Food Inspector -Health Septi � Inspector -Health Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected Date Approved -3 Date Rejected Comments Public Works — sewer/water connections driveway permit Fire Department Received by Building Inspector Date f gORTN OL A ♦CHUi Town of North Andover, Massachusetts BOARD OF HEALTH Form No. 2 DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant , Test No. Site Location L ODI— � 1 (� Reference Plans and Specs. ENGINEER 4 -- GN 0 Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. Fag �--- RMAN, BOARD OF HEALTH Fee�D ' Site System Permit No. 92-2— Commonwealth of Massachusetts City/Town of System Pumping Record 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. A. Facility Information 1. System Location: Left / Right front of house, Left / Right rear of house, Left / i ht side of;ho:uus, Left/ Right side of building, Left / Right front of building, Left / Right rear of building, n er ec Address Cityrrown State Zip Code 2. System Owner-. R Name ►V Address (if different from loi ation) RECEIVED City/Town State J - >v r ZJp� de � NOV �'� 9.103 `'C_.7/ �,(y TOWN OF NORTH ANDOVER Telephone Number ANDOVER HEALTH DEPARTMENT B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other (describe): i 4. Effluent Tee Filter present? ❑Yep o If yes, was it cleaned? ❑ Yes ❑ No. 5. Condit' n of System: 6. System Pumped By. Neil Bateson Name Bateson Enterprises Inc Company 7. t5form4.doc• 06/03 were disposed: F5821 Vehicle License Number System Pumping Record • Page 1 of 1