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HomeMy WebLinkAboutSeptic System 1992 .�. .� SEPTI_ S1CS.IE.hI_ N .I9.4L.At�_4N. v, IS`yTHE INSTALLER LICENSED? AN NO TYPE OF CONSTRUCTION: REPAIR NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW YES NO CONDITIONS OF APPROVAL YES NO (FROM FORM U) ISSUANCE OF DWC PERMIT YES NO DWC PERMIT NO. o� INSTALLER: BEGIN .INSPECTION YE NO: EXCAVATION INSPECTION: - NEEDED: PASSED BY CONSTRUCTION INSPECTION: NEEDED: •III - . - ' - AS BUILT PLAN SATISFACTORY: APPROVAL TO BACKFILL: DATE: BY__� ! FINAL GRADING APPROVAL: DATE C� . �l �1� BY/j�/�i�=� _ FINAL CONSTRUCTION APPROVAL: DATE:fz'LLBY A f , 1 , 1 1 Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH 320�"Eo b 6 0 19 L O A APPLICATION FOR SITE TESTING/INSPECTION ��SSACHUS���� Applicant NAME ADDRESS TELEPHONE Site Location Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. S�PTtC C�ctTl�t�j� CERT/F/ED FOUNDA T/ON PLAN LOCATED IN kJ o 2-r--�-+ a,,_,o -::,„c-- e, SCALE /��_ tea' DATE Scott L. Gi/es R.L.S. 50 Deer Meadow Rood ftrM Andover,Mass. / 8� 9 / 3 1 1 f9/ _0 N -• 33'= � --- FtZ-oP. - Q.. 00 Z u�y cERTt�-{ -rl-taT Z NAME lt�1SPKT�p T1{E C�t�1ST. J�S-gV[1."r C-�E�//l-TIONS zue-Tiow of THIS DtSPCsxL_ 1"V.OuT N0.7SE = zasti Po SLtsvE-K M►D-ruaT 'TkE 6A 15T- crr- o I N Tay.tK = zsA za %-CTOW AW D KtNAl- 'fAKK - u 3 5 WWC- BeE+J t K ACO:::�RC�t.ICE I►1 Bo+- = zs s •s� t 3nu l.{E Vx~`SIGKee5 t�T ILo�7C Box = lkwt) NKr ( MI.tvma_:S C7 uz.32 GDIdFbKt�"Q��� R.4q Sk��- �• GND RPE; 222.E m t F tca.-noNs �►afl 3to cNtR ts�o ., � z�.t� I I — ISo.00 / CERTIFY THAT OFFSETS SHOWN ARE FOR THE USE `b THE OFFSETS OF THE SUIL DING I/VSPEC TOR ONLY SHOWN COMPLY AND SUCH USE/S FOR THE g� WITH THE ZONING DETERMINATION OF ZONING `�Eq 15 Q. M72 SY LAWS OF CONFORM/T Y OR NON-CONFORMITY srSt�Pta WHEN CONSTRUCTED. t u►�os WHEN BOIL T �l a 143 RELEA E FORM FORM - U - LO ,,// _ �---�- r t ' �• I �1STRUCTIONS: This form is used to verify that all-necessary approval/permits from • •urisdiction have been obtained.This does not relieve the Boards and Departments having J applicant and or landowner from Compliance w ith any applicable requirements. ............. ••• uch��- /)6entSbi?.................ONE•.978 •■79■..�..�1/b �'�RMes grid M.atiQ ST�,ot PH APPLICANT � R LOT NUMBER ASSESSORS MAP NUMBER LOT NUMBER SUBDIVISION STREET NUMBER STRE .............. ....ite K e! ................................................. OFFICIAL USE ONLY ,....................•OF TOWN AGENTS ................................... ----- RECOMMENDATIONS //f,/ DATE APPROVED 1.�� 1 / I" 4,•�} CONS RVATION AD _ TOR DATE REJECTED C_0WEN DATE APPROVED TOWN PLANNER DATE REJECTED COMMEN TS DATE APPROVED DATE REJECTED FOOD INSP TOR- TH DATE APPROVED PTIC PECTOR-MA LTH DATE REJECTED COMMENTS 't M PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT / • DATE APPROVED FIRE DEPARTMENT DATE REJECTED CO RECEMD BY BUILDING INSPECTOR MAP. # LOT #_ PARCEL # STREET IBC J1_ LA-'4— CQNSTR41K-T-1QN--P_. R _ 1 HAS PLAN REVIEW FEE BEEN PAID? YES NO PLAN APPROVAL: DATE h3 APP. BY DESIGNER: ClIX15 PLAN DATE. >a/ Al y— CONDITIONS PF.D �98 A]672�sD GN P4,9& 7R/0 7"fVgb' o�l�f-y! ✓7/qL Al 7'lf&iV6& I► U6 i t3E 5AN%, F/a WATER SUPPLY: TOWN WELL WELL PERMIT DRILLER, WELL TESTS: CHEMICAL DATE APPROVED_ \\ BACTERIA I DATE APPROVED...,_.__...___.___._._.._. CTERIA II DATE APPROVED _ COMMENTS: FORM U APPROVAL: APPROVAL TO ISSUE NO DATE ISSUED �7 A BY � CONDITIONS '��f� FINAL APPROVALS ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NO SEPTIC SYSTEM CONSTRUCTION APPROVAL �� NO OTHER YES NO ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: DATES_ _ PROPOSED ADDITION 0 0 � o BAH o HALL ail KITCHEN DINING ROOM ao N P FAMILY ROOM LIVING ROOM FOYER u 44' P. & R. BOUCHER BUILDERS, LTD. 978 /454-0196 DESIGNED FOR: MR.&MRS.JAMES STAUDT 112 TUCKER FARM ROAD NORTH ANDOVER,MA P EXISTING FIRST FLOOR DATE: 10-19-00 c 1 OF 2 E 0 0000 0 WALK-IN CLOSET O o T 0 BATH BA H OFFICE a N P MASTER BEDROOM BEDROOM BEDROOM I 44 P. & R. BOUCHER BUILDERS, LTD. 978 / 454-0196 DESIGNED FOR: MR.&MRS.JAMES STAUDT 112 TUCKER FARM ROAD NORTH ANDOVER,MA P EXISTING SECOND FLOOR DATE 10-19-00 � 2 OF 2 E NORTH ( E Town of � o� Andover f No. ®.t 1 0CH,CINQrt dower, Mass., . A DRATED PPS � S H S� f BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR` THIS CERTIFIES THAT.................. A Al .. ....... .. ... .. ............ l 0 7' I D ......................................................... Foundation has permission to erect.W.d.O.�I..f/t#J.Ilfbuildings on ..�.�.. .. �..�.. .!/. WOO...40 Rough 4 to be occupied as...a.I...�I.. l.. ..Fl� .' ...0. .1... .���.. � � Chimney provided that the person accepting this permit shall in every respect conform to the terms of the applicat7Tfile in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Fina ^� Buildings in the Town of North Andover. PERMIT FOR FOUNDATION ONLY PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. REGULATED BY PARR. 1142-S. B.C. Rough � � h,�J PERMIT EXPIRES IN 6 MC 1a�T �,_ FEE PAID z -o a 4 UNLESS CONSTRUCTION STARTS ELECT CAL INSPECTOR • Rough PERMIT FOR FRAME/BUILDING Service BUILDING INSPECTOR DATE: 1143 FEE P�19: i�)7, 'ermit Re 2lired to Occupy BuildingFinal q GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTM T Until Inspected and Approved by the Building Inspector. Burner PLANNING a CONSERVATION FINAL Street No. SEWER/WATERL__FIN 3 FINAL DRIVEWAY ENTRY PERMIT& Smoke Det.L�``! ��9 I COMMONWEALTH OF MASSACHUSETTS TOWN OF N. ANDOVER SYSTEM PUMPING'REPORT NAME OF PUMPING COMPANY �`7n .ir u'S Jta )er t� r 1�r P T REPORT FOR MONTH OF ' Y] CONTENTS CONDITION OWNERS GALLONS *H G TRANSFERRED OF ATE ADDRESS NAME PUMPED C D S TO SYSTEM n 1�a TtiGk�r' a rtvl c�. `Fcluc�� a5 op �f c cu�rence Sar,� � Tki.r �CW Q.fi o S 0 0 `J ar. LLU.Jr2nCe 2'1 Hat Ct i r 0 a �N I jr i cl�2 L�.n e_ . 1500 �! � 11-7y�u.rnpi —em . nl J �� l,ct;a,r�yt c e SOt,n�fQr�. q•� i ` _1.2 Zucker Farm Road Diane Mahalate North Andover, Ma 01845 Owner To B A N RTH ANDpVER/OF HEALTH =aZ7 � Subsurface Sewage Disposal System Inspection Report Title 5 Town of North Andover Board of Health Copy .Service Pumping & Drain Co. , Inc. (617) 245-7576 P. 0. Box 498 (800) 7 94-92 65 Wakefield, Ma 01880 Fax (617) 245-7590 ` William F. Weld Commonwealth of Massachusetts Governor Executive Office of Environmental Affairs Trudy Coxe Secretary Department of Environmental Protection David B. Struhs Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 112 Tucker Farm Rd. , N.Andover, Ma Address of Owner Date of Inspection: February 23, 1996 (if different) Name of Inspector: John B. Nicholas Company: Service Pumping & Drain Co. , Inc. P.O. Box 498 Wakefield Ma 01880 (617)245-7576 CERTIFICATION STATE4EW I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the roper function and maintenance of on-site sewage disposal systems. The system: X Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date: -g The system Inspector sh 1 submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of environmental Protection. The original should be sent to the system owner and copies sent to the buyer, If applicable and the approving authority. INSPECTOIN SUMMARY Check A, B C, or D: A] SYSTEM PASSES: X I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N or ND) Describe basis of determination in all instances. (If "not determined", explain why not) The septic tank is metal cracked, structurally unsound, shows substantial infiltration or exfiltriation, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 11/03/95) One Winter Street • Boston, Mass. 02108 • Fax (617)556-1049 • Phone (617)292-5500 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 112 Tucker Farm Rd. , N. Andover, Ma 01845 Owner: Diane Mahalate Date of Inspection: February 23, 1996 B] SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if (with approval of the Board of Health) : broken pipe(s) are replaced obstruction is removed distribution box is leveled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s) . The system will pass inspection if (with approval of the Board of Health) : C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing top protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL LNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFET AND THE NEVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. 3) OTHER (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 112 Tucker Farm Rd. , N. Andover, Ma 01845 Owner: Diane Mahalate Date of Inspection: February 23, 1996 D] SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static Liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid Depth in Cesspool is Less than 6" below invert or available volume is less than 'i day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s) . Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The following Criteria apply to large systems in addition to the criteria above: _ The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply. the system is within 200 feet of tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00 Please consult the local regional office of the Department for Further information. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART B CHECKLIST Property .Address: 112 Tucker Farm Rd. , N. Andover, Ma 01845 Owner: Diane Mahalate Date of Inspection: February 12, 1996 Check if the following have been done: X Pumping information was requested of the owner, occupant, and Board of Health. X None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined. Note if they are not available with N/A. X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout. X All system components, excluding the Soil Absorption System, have been located on the site. X The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. X The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. X The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Subsurface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 112 Tucker Farm Rd. , N. Andover, Ma 01845 Owner: Diane Mahalate Date of Inspection: February 23, 1996 FLOW CONDITIONS RESIDENTIAL: Design flow: --- gallons Number of Bedrooms: 4 Number of current residents: 3 Garbage grinder (yes or not) : N Laundry connected to system (yes or no) : Y Seasonal use (yes or no) : N Water meter readings, if available: Not available. Last date of occupancy: Occupied COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: gallons day Grease trap present: (yes or no) Industrial Waste Holding Tank present: (yes or no) Non-sanitary waste discharged to the Title 5 system: (yes or no) Water meter readings, if available: Last date of occupancy: OTFiER(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: Never pumped. System pumped as part of inspection: (yes or no) Y If yes, volume pumped: 1500 gallons Reason for pumping: Customer request TYPE OF SYSTEM X Septic tank/distribution box/soil absorption system Single Cesspool Overflow Cesspool Privy N Shared system (yes or no) (if yes, attached previous inspection records, if any) Other (explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: 3 years per plan. Sewage odors detected when arriving at the site: (yes or no) N (revised 11/03/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 112 Tucker Farm Rd. , N. Andover, Ma 01845 Owner: Diane Mahalate Date of Inspection: February 23, 1996 SEPTIC TANK: Y (locate on s e plan) Depth below grade: 4" Material of construction: X concrete metal FRP other (explain) Dimensions: 10' x 5' x 6' Sludqe depth: 2" Distance from to of sludge to bottom of outlet tee or baffle: 34" Scum thickness: Distance from top�um to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: 16" Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc. ) All okay. Recommend pumping every 2 years. GREASE TRAP: N (locate on site plan) Depth below grade: Material of construction: concrete metal FRP other (explain) Dimensions: Scum Thickness Distance from toptop—mecum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc. ) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 112 Tucker Farm Rd. , N. Andover, Ma 01845 Owner: Diane Mahalate Date of Inspection: February 23, 1996 TIGHT OR HOLDING TANK: N (locate on site plan) Depth below grade: Material of construction: concrete metal FRP other (explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc. ) DISTRIBUTION BOX: Y (locate on site plan) Depth of liquid level above outlet invert: 0 Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc. All okay. No visible signs of failure. PUMP CHAMBER: N (locate on site plan) Pumps in working order: (yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc. ) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 112 Tucker Farm Rd. , N. Andover, Ma 01845 Owner: Diane Mahalate Date of Inspection: February 23, 1996 SOIL ABSORPTION SYSTEM (SAS) : Y (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: leaching chambers, number: leaching galleries, number: leaching trenches, number, length: 2 @ 60' leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc. ) All okay. No visible signs of failure. CESSPOOLS: N (locate on s to plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: Inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc. ) PRIVY: N (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc. ) (revised 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIONF FORM PART C SYSTEM INFORMATION (continued) Property Address: 112 Tucker Farm Rd. , N. Andover, Ma 01845 Owner: Diane Mahalate Date of Inspection: February 23, 1996 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' D -n- AG PC. s3' AD 43' fl ?s,,„ _ DEPTH TO GROUNDWATER Depth to groundwater: 8 feet method of determination or approximation: _ Per plans. (revised 11/03/95) 9 SUBSURFACE SEWAGE DISOSAL SYSTEM INSPECTION FORM ADDENDUM 1 Property Address: 112 Tucker Farm Rd. , N. Andover, Ma 01845 Owner: Diane Mahalate Date of Inspection: February 23, 1996 (No Comments) Inittial Service Pumping & Drain Co. , Inc. has been retained by the owner to provide an inspection of the on site sewage disposal system as defined by 310 CMR 15.303. D.E.P. guidance instructs the inspector to make an evaluation of the systems performance on the day of the inspection. The Title 5 Inspection is not designed to provide information to demonstrate that the system will adequately serve the use to be placed upon it by the new over as stated in 15.302. This inspection is not a warranty or guarantee of the systems future performance, and does not either express or imply that. (revised 11/03/95) 10 7UCK«2 AS-BUILT CHECK LIST and FINAL INSPECTION Proposed Elevations As-Built Elevation House 0a• G7 r2�24,60 Tank IN Tank OUT �a,�a D-box INa/,G� aa �f D-box OUT Trench Inverts Line 1 32 — 2 2;� Line 2 Line 3 Line 4 Bottom of Exc. Stone OK? D-box checked? Pipes cemented? -4,7-4 .. - U .. x p.•r 3,fir. s .t �r .. LOT .: MAP STREET_ V PARCEL # L�ST�41_CT 7�QN A HAS PLAN REVIEW FEE BEEN PAID? AYES NO s: JII Jq.3 APP. BY PLAN' APPROVAL: . DATE / s .. PLAN DATE la Z' . „ DESIGNER: Ch�R1�T/.9N 5�� CONDITIONSS�,-Gl, jll � :P u�eP tp �s Al D aN .....—�.•�" � .*'----•,ram .. iy.4llr 'aZ/'f•� � -�/ iP i�Cf� ' /►I U67- R!a/SED-- U5� sAN' F/Cc •, r TOWN WELL WATER SUPPLY: WELL PERMIT DRILLER --_ -- ,' f DATE APPROVED___._ WELL TESTS: CHEMICAL BACTERIA I DATE APPROVED_-- CTERIA II DATE APPROVED } . `�.. .. COMMENTS FORM U. APPROVALS APPROVAL TO ISSUE NO r DATE ISSUED �A I7 5 BY CONDITIONS37ye; 'iP�O� CQ�sT. FINAL APPROVAL: YES NO ALL PERMITS PAID YES NO , ., WELL CONSTRUCTION APPROVAL SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NO ANY VARIANCE NEEDED NO YES DATE BY: FINAL BOARD OF HEALTH APPROVAL: : __ CERTIFIED FOUNDA T/ON PLAN LOCATED /N K J SCALE /"'_ mod' DATE 31q � Scott L. Gi/es R.L.S. 50 Deer Meadow Rood North Andover,Moss. / 8� 9 �00 I 1 P O N --- fl2oP. - � L o-T- I L (n o MAR 1 0 I I BALDING DEPARYi•JEi„ 1 - ISo.00 / CER T/FY THAT OFFSETS SHOWN ARE FOR THE USE y t THE OFFSETS OF THE BU/L DING /NSPEC TOR ONLY SHOWN COMPLY AND SUCH USE/S FOR THE WITH THE ZONING DE-TERM/NAT/ON OF ZONING / x SY LAWS OF CONFORMITY OR NON- CONFORMITY WHEN CONSTRUCTED. WHEN SOIL T l 9 43 Town of North Andover, Massachusetts Form No.3 r,ORTN BOARD OF HEALTH (� 1 C O 9 ' ".... DISPOSAL WORKS CONSTRUCTION PERMIT ,SSACIIUSEt Applicant— '1.(.,tAJL-), MT ADDRESS TELEPHONE Site Location Llo� : Permission is hereby granted to Construct (>Or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. n CHAIRMAN,BOARD OF HEALTH Fee `� �' D.W.C. No.�� HOR71� ?o .o '�°°p BOARD OF HEALTH ` o ' ' 120 MAIN STREET TEL. 682-6483 SACHUSEtt� NORTH ANDOVER, MASS. 01845 Ext. 32 M E M O R A N D U M TO: All Engineers Involved in Soils Testing for 1993 FROM: North Andover Board of Health Agent DATE: March 15, 1993 To aid in the record-keeping process and facilitate the permitting process I am requesting that within 30 days of performing soils tests in North Andover you forward to this office a scaled site plan (rough is acceptable) showing the location of all deep test holes and percolation tests including the results. Town of North Andover, Massachusetts Form No.s NOItTh BOARD OF HEALT f O L 12 DESIGN APPROVAL FOR ASS"C""5``� SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant �2 .� , \�--�+� Test No. Site Location ���y�- 0— Reference Plans and Specs. ots 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. CHAIRMAN,BOARD OF HEALTH Fee V Site System Permit No. 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: y N n r- 11 Phone �,92_- :?_,S�Ll LOCATION: Assessor' s Map Number !' 7C: . Parcel Subdivision uU JCL 7 Lot(s-) /O Street St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved 12A Conservation Administrator Date Rejected Comments "` 'f 12��" G� l`LSQP lYdc� g� Date Approved 7- �5 Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected - I '_'z z Date Approved Septic Inspector-Health Date Rejected Comments Public Works - setaor/water connections - driveway permit Fire Department �� --�-(� �---- Received by Building Inspector Date CHRISTIANSEN & SERGI, INC. MEMO Professional Engineers & Land Surveyors 160 Summer Street Haverhill, MA 01830 (508) 373-0310 FAX(508) 372-3960 / //9-3 TO: DATE ,1 SUBJECT SIGNED �il ❑Please reply ❑ No reply necessary DATE_/Z 19z Sheet of BOARD OF HEALTH TOWN OF NORTH ANDOVER //hh SUBSURFACE DISPOSAL DESIGN REVIEW FEE LOU PERMIT # ��1r DATE RECEIVED APPLICANT M/KE --kO.RE T.S ASSESSOR'S MAP ADDRESS PARCEL # LOT # /d ENGINEER STREET ADDRESS lloD 5'UM/.9 _// Sr: �f4V ,P,41/4L PLAN DATE // / Z REVISION DATE CONDITIONS OF APPROVAL: APPROVED DISAPPROVED 7�z,717- -7:31rS �v�r -�� ,�o��rEo ©1Y517-.6- 4A 2) 1>I37'; N9'* �'D SSD6 M155//VG (/V•�, � .63 a -c� c3) -5�Nc-#/YI.4R K MUST' W6- 6AI Zo7' (AI A 6 . 04 Q My.1r e,' Sc,y4o (A/A, /7 /7� I-e7- . 1e6Q -V- v,M Eiv 5,o.VS AM55//VG (/U;/? 4..0Z d) 6� Al,9,y,:--5 o,G ABurrE,ps /H/s.51N6 (I/.,9- W/. ioz7c) 7) WETLANDS -DISCGA/MeR ^1155/N6 8� Loc'971 �- ELri �N O� �OUNDg7"/DiV -DR191AI /`'!15S/NG � .DZ V 9,7 (N,A. /oJ Na r-E �'fr�.47' sego EX c�U l�rioq/ s.-j.9-Z c 4: NRy-v,P/�,c,�i-.9.P�rvT bG�G (N.,q. 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