HomeMy WebLinkAbout- Miscellaneous - 23 TANGLEWOOD LANE 5/29/2020 }
f
MAP # LOT # a � ____�_.__,____._.__
PARCEL # STREETQZ2�;.. �v�
CONSTRUCTION APPRO......._:. �/„
HAS PLAN REVIEW FEE BE PAID YES NO
PLAN APPROVAL: D C APP. BY.___
DESIGNER: G}f/r'//S //�Q/S /�9 PLAN DA'IE:_ � 7- /` --
CONDITIONS
WATER SUPPLY: TOWN WELL
WELLPERMIT DRILLER._...___._..._--.._..._..._.___...__............._...__.___..___........ .
WELL TESTS: CHEMICAL DATE APPRUVEU_._..___..___..___.__-.
BACTERIA I DA T E f1PPRUVED
BACTERIA II DATE APPROVED.-___,.._.______
COMMENTS
FORM U APPROVAL: APPROVAL TO ISSUE" NO
DATE ISSUED BY
CONDITIONS:
FINAL APPROVAL: . ---"1
ALL PERMITS PAID ---�- y=� NO
WELL CONSTRUCTION APPROVAL -- --___._.}yU__.______
SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO
OTHER _.._ NU
ANY VARIANCE NEEDED YES NU
C� ...IIY:
FINAL BOARD OF HEALTH APPROVAL: DATE:/jr.�fj
/_ 7
ETHE INSTALLER LICENSED? F Y✓ ESQ NO
E OF CONSTRUCTION. - - ! NE REPAIR ' ` •
NEW CONSTRUCTION. . . CERTIFIED PLOT PLAN REVIEW YES NO
" c CONDITIONS OF..APPROVAL YES NO
(FROM FORM U)
1''�' '�. ``� M1 t• ` , r ��.. ' . ., .• A± ` YES . .NO -
ISSUANCE OF DWC PERMIT
DWC PERMIT N0. ��� ' INSTALLER: C�• ,���J �
BEGIN INSPECTION ":: Y S,--NO:
` EXCAVATION .•INSPECTION: : NEEDED:
ill , i �-, � �i. - .1 _.y z .._ .�~-1 • •. , .` ._
PASSED i
--• CONSTRUCTION INSPECTION: NEEDED:
AS BUILT PLAN' SATISFACTORY: -
APPROVAL TO BACKFILL: DATE: BY
FINAL . GRADING APPROVAL: DATE BY
FINAL CONSTRUCTION APPROVAL: DATE: ' 4 BY '-�
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/Righ f ont of house Left/Right rear of house, Left/right side of house, Left/
Right side of buil g, Left/Right front of building, Left/Right rear of building, Under deck
Address
Cityrrown State Zip Code
2. System Owner:
Name
Address(if different from location)
Cityrrown Sta J rZip Co e
Telephone Number
B. Pumping Record
1. Date of Pumping Date 2. Qu ntity 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? ❑ Yes ❑ No
5. Condi ion of Syste�^�
6. System Pumped By:
Neil Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7. Loca' pHaule
.ontents were disposed: rove
1'r�V �5 2013
G. S. Lowell Waste Wateror
Sign a Date
t5form4.doc•06/03
System Pumping Record•Page 1 of 1
AS-BUILT CHECK LIST
and
FINAL INSPECTION
Proposed Elevations As-Built Elevation
House
Tank IN
Tank OUT
D-box IN
D-box OUT
Trench Inverts
Line 1 �¢9�' l 9�•d
Line 2
Line 3 l94,0_3
Line 4
Bottom of Exc.
Stone OK? _ D-box checked?+ (/ Pipes cemented?
L Q�
Form No.3
Town of North Andover, Massachusetts
BOARD OF HEALTH
NORTH (' T1 1 9
'7
L �c
O "
F A
�'-°,,,,,..•`.� DISPOSAL WORKS CONSTRUCTION PERMIT
,SSACMUSEt
Applicant > / G Eo/?c� /�E/(/DE/•.=��
NAME ADDRESS TELEPHONE
Site Location
Permission is hereby granted to Construct,,(. or Repair ( ) an Individual Soil Absorption
Sewage Disposal System as shown on the Design Approval S.S. No.
CHAIRMAN, BOARD OF HEALTH
Fee
D.W.C. No. ' S -
VAT
Y
4-4,4WWO4
Nip,ANN
�2 P,
,A Om"m,
tx
m IV Azov-
"Own
�10
Mut
U,
MINI"'
Jk
S. Z RrM,
I Im,
WAS ! J
,%ulm,
NiA
Iowa
PER
e.
few
...........
AIDik
LP
woo
FORM U - LOT RFLZASyr FORM
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Depaztme.+ts 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: ` t Phone
LOCATION: Assessor' s Map Number Parcel
subdivision kA ) I K.� K 17( S Lot(s) r �S
Street 6:Lr Woo r v St. Number Z�
************************Official Use only************************
RECOMMENDATIONS OF TOWN AGENTS:
Date Approved
Conservation Administrator Date Rejected
• Comments
Date Approved
Town Planner Date Rejected
Comments
Date Approved
Health Agent Date Rejected
Comments ��sT 0��'��/O/� 7-0
---wee-►-
Public Works `water connections - Y - � . j � ✓'-,� /�_)/,� \ ,,�,
i
driveway permit l/ l ZD 3
Fire Department
Received by Building Inspector Date
' 1
Sheet of
L
BOARD OF HEALTH
TOWN OF NORTH ANDOVER
SUBSURFACE DISPOSAL, DESIGN REVIEW
FEE PERMIT # A-lDATE RECEIVED
APPLICANT �yA�C►.+��JIS��. ASSESSOR' S MAP
ADDRESS PARCEL #
LOT # 461.
STREET ��4t�_ Epp�„
ENGINEER N 1`x\IA0
ADDRESS 1G0 SU kH6e "2Ir 11( 1'!A
PLAN DATE REVISION DATE
CONDITIONS OF APPROVAL:
APPROVED
DISAPPROVED
tuv�T �k, tr '�
1�o�T w Lor 2'i �T?G SyS pPr
4 o -P1 PI an- `l
A 1�i o- �Q l I 40DEo 'Tv Tkr'- -PtAO 'r TI o-q "-
�>
l�
1
i
I
i
i
I
Q.
j t i44
s
J
� ,s S S t Z--------------
-912-
o
r ) t 40. C;1} 1
' 3 r? C,`,S,
Li Z
7 I
_ 1
I I Z
Y
77
Io 1
�i
jo
i' �1•
aln'in7
�,T 1 _ � \1 ily �ti �S f��q rt fi�r"..�rC..��5 ��'/"�+�1 J ��R`i S^ 4' J�EfJlll i ' � J � • �� �I '1'. .
i
ll11'1'E L v, �1 Sheet of
BOARD OF HEALTH
TOWN OF NORTH ANDOVER
SUBSURFACE DISPOSAL DESIGN REVIEW
FEE PERMIT # DATE RECEIVED
APPLICANT E\JA,►J ASSESSOR'S MAP
ADDRESS PARCEL # 0 Cr or
I_ LOT # -
ENGINEER Cl�czl 2T AtA41 0 STREET
ADDRESS jf.D 5V uur�0 e,,7
PLAN DATE REVISION DATE
CONDITIONS OF APPROVAL:
APPROVED
DISAPPROVED
�7 C�x'7�.-a •
�v'� of `.�rc�►a� �e(cx..� c u v�-r
Z� �-�.� wQy E.IEvatt�s �� L�s�•cyr ��I��
►,-� nor w/ tot- 2"I ao�Tc Sys; � Now �`fPp
�,L$=ate, Wa, ��up,,u� -
A 1-i a- 3 �4 l BC IDEA —tt� pjAQ DTI
C.) wfllt,-A� laic. (�� a
PLAN REVIEW CHECKLIST
ADDRESS 7/� 7;;2N6L,:-5�06y, ENGINEER
GENERAL
3 COPIES STAMP v' LOCUS Z / NORTH ARROW SCALE L�
CONTOURS ✓ PROFILE SECTION - BENCHMARK <— SOIL &
PERC INFO ' ELEVATIONS ,, WETS. DISCLAIMER 11 WELLS &
WETLANDS WATERSHED? /VL` DRIVEWAY t-� (Elev) WATER LINE
FDN DRAIN_ SCH40 TESTS CURRENT?
SEPTIC TANK /
MIN 1500G. t, . 17 INVERT DROP GARB. GRINDER(+200% EDF)
25' TO CELLAR ! MANHOLE TO GRADE ELEV GW
D-BOX
SIZE # LINES FIRST 2 ' LEVEL STATEMENT
INLET - OUTLET /g4.49 _ ' 7_ (2" OR . 17 FT) TEE REQ'D? AV()
LEACHING
RESERVE AREA V/ 4 ' FROM PRIMARY?IZ 100' TO WETLANDS ✓ 2% SLOPE
1001 TO WELLS -- 351 TO FND & INTRCPTR DRAINS �-''A 4' TO S.H.GW z---�'
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 SLOPE (min . 005 or 611/1001 ) -- >3 ' COVER? - VENT
SIDEWALL DIST. 2X EFF. W OR D (MIN 6' ) L ,•. IS RESERVE BETWEEN
TRENCHES? IN FILL? MUST BE 10' MIN. 4" PEA STONE?
BOT X LDNG + SIDE q L X LDNG = TOT 6,57L 0
(L x W x #) (G/ft2) (DxLx2x#) 0/C
l
Commonwealth of Massachusetts
Massachusetts RECEIVED
OCT 1 9 2004
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
System Pumping Record
System Owner I f System Location
C I ^f--( ,-fi 4& C �
� 1
Date of Pumping: O - d' t✓`� Quantity Pumped: ( 500gallons
Cesspool: No [• Yes [] Septic Tank: No [] Yes n/
System Pumped by: 4&4,00 License#
Contents transferred to: Greater Lawrence Sanitary District
Date: k o— I � - d Inspector:
F 1
J�'��
�!k,
�V +�
1�� . ,
y,...;,:
` _
tt'
w� #�
,;
�� �� �' � ,
�`'
��'n
+-
j. ., z.
t,�,�.`
k
~'�
_ 7 y=.
� }µ, r�<�
�' � t`,�
L
s.. �k��:
�. d �.
,;
. 'i�.
IM��
_ �'., _.
s
J ' ��'IV Ae^C
~ ~~ MASSACHUSETTS MASSACHUSETl3
FIRE INCIDENT REPORT STATE FIRE MARSHAL
A }
| situation found I 1 ,action taken | I mutual aid |
B | Co FRD 48
i fixed property | | igni+ inn factor | |
C | _1-FAY4 'fi.U' 1{06}!
| correct address | zip code | ceOus (
D } I
I ( ocxcup. name last, first , mi | telephone | room or Wi
E | _______}
| | owner name last, first, mi ! address | telephone |
F | __-1
( | method of alarm | i district ! shift | no. alarms |
G | _ �_ ____|
\ ( #fire service | #tankers \ #engines ( #aerial app | # other vehicles |
H I Ji
| hazardous material | substance | special equip used |
| ..........___i____________________ |
| numbers of injuries | number of fatalities | rescues |
___�__-_|
1 mobile property | | vehicle stolen ? | estimated total dollar I
J |
| insurance company | total insurance | claim paid |
| | year I make | model Icolor | lie no | vin# |
|
| | if equip involved | year | make | model | serial no |
| in ignition
l complex | | area of origin | equip inv in ignition |
K | |
| form of heat ignition | material ignited | fnrm i type � |
L I ...FORM OF E T IGN \
! method of extinguishment ! | level of fire origin | (
M | |
| numbers of stories | | construction type ! |
| |
| extent of flame damage | | extent of smoke damage | |
N | |
| detector performance { | sprinkler performance | |
P | |
| if smoke spread | material generating | form | \ type | |
| beyond room | most smoke : | 1001 | 001
RMJYN�D_1JR_N|
R | wqather conditions i
\ -------------------- | entries contained in this report are intended for |
| CLEAR & COLD 32 | The sole use of the state fire marshal. Fstiwat- |
| | ions & evaluations made herin represent "MOST |
| | LIKELY" & "MOST PROBABLE" cause & effect. Any . |
| representation as to the conditions outside the |
| | State Fire Marshals Office is neither intended nor !
\ member making report I implied |
| y e s
CHECKLIST FOR CAIZ13ON MONOXIDI+,
Location of Incident: L3 Date of incident
QUICK CHECKLIST OF OCCUPANTS
Ileadache yes no Fatigue yes no 1�
Nausea yes no Dizziness yes no�
Confusion yes nol
Are any members of the household feeling ill? yes no
Do the residents Feel better away from the house? yes no--Z
Since the detector's alarm went off, what have you done?
Shut- off carbon monoxide sources yes no-A/—
If yes which sources
Let in fresh air? yes no
If yes how did you let the air in PWCO or`%(Y)L J 2r" FLOOK
3% y
I low long did you let the air in 1 b M1 t\JU T C:.1-,
PPM reading ambient outside the dwelling 006
I Iighest PPM reading in the dwelling
Carbon monoxide detector present? yes no
If yes list the number of detetors locations and make, and serial number of each below.
A LC2 t 2-rib E toof2 (A A LL
2.
3.
4.
Which detector(s) by number above activated? I
SOURCE CHECKLIST LOCATION PPM READING
Chimney clogged flue, blocked opening co(5
Fireplace(s) Natural gas, LPG, Wood(indicate type for each fireplace)
coo
Gas Appliance (if Gas Company on Scene they can perform this check)
(IF MORE THAN I OF THE FOLLOWING APPLIANCES LIST EACH ADDITIONAL
ON THE COMMENTS PAGE WITH ITS LOCATION, AND PPM READING)
refrigerator 000
stove
vent over stove
clothes dryer
water heater r 12 &;CA jqa
GiAS furnace
� O 12 tJ co)26ea c FIG�
car garage 61,8
Entranceway from garage to house 1 `6
Name of individual operating the CO monitor L•}, —1-, CAS6CE
Person completing the Checklist Lt , 7 , CA&A L6
5EPT1 G 5`(STEI�[ AS-emu►t_.-�
CERTIFIED FOUNDA T/ON PLAN
LOCATED IN No: Aotv\jeV-- MA.
SCALE / = 43� DATE 5(26(93
Scott L. Gi/es R.L.S.
50 Deer Meadow Rood
North Andover, Moss.
del
Lur 3
E:msT. t�v►1�.
-rr,.F.° .
ourr -rA+.A- - A4Euf?1
IN bc>y- - 144/.a
ar gam< a a-.S3 /q
t.v-r Z7•P� ��o FiF�= tq4-.a�
-
'
17-s ZW L ar Z
I
W sPu—'TEV lve, c��15c�(�C-r�ot�l of
-ruts (�sPcySAL 5L 44ur> TKas i
Cot.i s-SR�KT�ot�l Amy ;:: wA - GFWA >iW,
NAS f,i I►.l AC,--nRDAW--e- w rI34 -T.,Ae
Dc xc c�Z's I W 7t:t.-r A►.tD T4Xr -rNf-
MAR t ASS u SEA, <�t.tfcxz} To lvtt RAf j
loJzp�33
-rAt`lGL�kloor> LIE �'"�
/ CERTIFY THAT OFF-SE TS SHO WN A RE FOR THE USE
THE OFFSETS OF THE BUIL DING IIVSPEC TOR ONLY
SHOWN COMPL Y AND SUCH USE/S FOR THEt
WITH THE ZONING DETERMINATION OF ZONING w
BY LAWS OF CONFORM/T Y OR NON-CONFORMITY
WHEN CONSTRUCTED. 4r
WHEN BUIL T. 5 q 3
,o I7�g3