The URL can be used to link to this page

Home My WebLink AboutMiscellaneous - 901 JOHNSON STREET 9/18/2015 VtORTIN aW � 0 Y x GO< GnG w.tN yon PUBLIC HEALTH DEPARTMENT Community Development Division C As e ` bveni6er 19, 2007" 7his is to cent y that the individuaCsu6su face disposaQYstem receiveda 54'1I,Sl£4(;7QRTINS(1.ECWowof the: Complete Septic System Re airf e facement B e s Todd Bateson ® 901 Yofinson Street 107-A c 5 NorthAndover, 91.4 01845 The Issuance of this cent! i'cate shaCC not 6e construed as a guarantee that the system wiff function satasfactofi y. ° e-e, ,Susan T Sawyer 1'u6fic_lfeafth(Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fox 478.688.8476 Web www.townofnortliandover.com a wanrN� $Ovvi,vu + pow .. •' s'S^\ow PUBLIC HEALTH DEPARTMENT RECEIVED ; Community Development Division TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION TMN(OF NORTH ANDOVER 44EX!,TH DEPARTMENT The undersigned hereby certify that the Sewage Disposal System( )constructed;(.,'frepaired; By: N–rt-r- ll� (Print Name) Located at: `�� l% tl r_--w r � (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan,originally dated and last revised on �� 1 --xi'_ ,with a 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 31.0.CMR 15.000,Title 5 and local regulations,and the final grading agrees substantially with the approved plan.All work is accurately represented on v the As-built which has been submitted to the Board of Health! Bottom of Bed Inspection Date: Y/" Z_7 I f c r ,r Engineer Representative(Signature) And–Print Name Final Construction Inspection Date: �t-Zi �'� ,•�,,, -----�-� Engineer Representative(Signature) rQ�A ad ems' And–Print Name Installer: G✓�Z1( - (Signature) Date. Y c" ! – 1 4 Vt AD1,�EFi R. NEMC.Iff!iVf7i< ', And—Print Name Enginer•�, r,'fi")U ,�� (Signature) Date And–Print Name 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com t4ORTII 4 Po y � C% coca+c"Kiuwea« ,q• � Arm t+�� C US PUBLIC HEALTH DEPARTMENT Community Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 901 Johnson Street MAP: 107A LOT: 156 INSTALLER: Todd Bateson DESIGNER: Merrimack Engineering Services PLAN DATE: April 10, 2007 � BOH APPROVAL DATE ON PLAN: INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM IN PECTION:? 17,1 DATE OF FINAL CONSTRUCTION INSPECTION: August 30, 2007 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS Existing septic tank properly abandoned Internal plumbing all to one building sewer Topography not appreciably altered Comments: SEPTIC TANK ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ® 1500 gallon tank has been installed H-10 loading Monolithic construction ® Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ® Inlet tee installed, centered under access port ® Outlet tee (gas baffle or effluent filter) installed, centered under access port 1600 Osgood Street,North Andover,Mossochaseits 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofoorthandover.com i tAORTe 0 b*;�S cac.iriwiwra gyp' PUBLIC HEALTH DEPARTMENT Community Development Division ® 24" inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present ® Hydraulic cement around inlet & outlet Comments: One (1) compartment, Monolithic i PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ Combo Tank installed. Size: ® 1000 gallon Pump Chamber installed H-10 loading Monolithic construction) ❑ Inlet tee installed, centered under access port ® Pump(s) installed on stable base ® Alarm float working ® Pump On/Off floats working ® Separate on/off floats ® Drain hole in pressure line ® 24" inch cover to within 6" of final grade installed over pump access port ® Watertightness of tank has been achieved Visual testing ® Hydraulic cement around inlet & outlet Comments: Hydromatic pump DISTRIBUTION-BOX ❑ Installed on stable stone base ® Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ❑ Speed levelers provided (not required) Comments: 1600 Osgood Street,North Andover,Mossochusetts 01845 Phone 978.688.9540 Fox 978.688,8476 Web www,townofnorthandover.coni %AORT 0 KpCeL MHUV2M K' Avrac 5 WIU � PUBLIC WEALTH DEPARTMENT Community Development Division SOIL ABSORPTION SYSTEM (General) ❑ Bottom of SAS excavated down to 6 in into C soil layer, as provided on plan ® Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan ❑ 40 Mil HDPE barrier installed ❑ Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: i SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ® Brand and Model of Chamber Infiltrator Quick 4 Stnd ® Number of chambers per row 10 ® Number of rows (trenches) 4 ® Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan Comments: CONTROL PANEL ® Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ❑ Location of control panel: ❑ Rated for exterior if placed outside ® Alarm signal located inside Comments: 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688,9540 fax 978.688.8476 Web www.townofnortliandover.coni 1 %AORTH 0 b � 'T Q SQC+A16 n�vuKw,yp�,",Cy f To 11` CHU' �' I PUBLIC HEALTH DEPARTMENT Community Development Division SYSTEM ELEVATIONS INVERT IN FIELD PLAN INVERT ELEV. Benchmark 104.25 Building Sewer OUT 97.72 97.80 Septic Tank IN 97.60 97.50 Septic Tank OUT 97.27 97.25 Pump Chamber IN 97.16 97.20 Pump Chamber OUT 97.39 N/A Pressure Distribution Box IN 98.35 N/A Pressure Distribution Box OUT 98.21 98.20 Lateral 1 INV 98.17 98.17 Lateral 1 TOP Lateral 2 INV 98.18 98.17 Lateral 2 TOP Lateral 3 INV 98.17 98.17 Lateral 3 TOP Lateral 4 INV 98.18 98.17 Lateral 4 TOP Bed Bottom at 4" Port 97.47 97.50 Top of Chmbr#4 Mid 98.54 98.50 1600 Osgood Street,North Andover,Mossarhusetts 01845 Phone 478.688.9540 Fax 978,688,8476 Web www.townofnorthandover.com i tkORTH q0 ~ R� 4Gd M9f YA�p�VRN w�� I AraCY SAC U i PUBLIC WEALTH DEPARTMENT I Community Development Division CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ❑ Property line 10 10 -- ® Cellar wall 10 20 -- ❑ Inground pool 10 20 -- ❑ Slab foundation 10 10 -- ❑ Deck, on footings, etc 5 10 -- ® Waterline 10 10 101 ❑ Private drinking well 75 1001 50 ❑ Irrigation well 75 100 ❑ Surface Water 25 50 ❑ Bordering Vegetated Wetland , Salt Marsh, Inland/Coastal Bank 75 100 ❑ Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ❑ Trib. to surface water supply 325 325 ❑ Public well 400 400 ❑ Interim Wellhead Prot. Area ❑ Reservoirs 400 400 ❑ Drains (wat. supply/trib.) 50 100 ❑ Drains (intercept g.w.) 25 50 ❑ Drains (Other)Foundation 10(5) 20(10) ❑ Drywells 20 25 ' Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance(NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54,and 10.30,respectively,pursuant to 15.211(3),also by NA wetland bylaws 1600 Osgood Street,North Andover,Mossochusetis 01845 Phone 978.688,9540 Fax 978.688.8476 Web www.lownofoorthandover.com i i 1 r 1 Commonwealth of Massachusetts Map-Block-Lot 107.A-0156- Board of Health Permit No 4 North Andover BHP-2007-0235 m' P.I. .� FEE C F.I. $250.00 Disposal Works Construction Permit Permission is hereby granted Todd Bateson t to(Repair)an Individual Sewage Disposal System. at No 901 JOHNSON STREET as shown on the application for Disposal Works Construction Permit No. BHP-2007-023 Dated July 05,2007 MAC mum Issued On: Jul-05-2007 — Boar of Health i Commonwealth of Massachusetts Map-Block-Lot 107.A-0156- w Board of Health North Andover ACV Certificate of Compliance THIS IS TO CERTIFY,That the Individual Sewage Disposal System (Repair) by Todd Bateson Installer at No 901 JOHNSON STREET has been installed in accordance with the provisions of TITLE 5 of the State Environmental Code as described in the application for Disposal Works Construction Permit No. BHP-2007-023 Dated July 05,2007 Printed On: Jial-05-2007 Board of Health Application for Septic Dis I System _- - r n, onsti Llctlon Permit — TOWN VF TODAY'S DATE 4, 1 .6 . . ti.....,... �,' . $ 250.00— Full Repair A $125,00 -Component R`5�AG v{Ufrkt Important: Application is hereby made for a permit to: When filling out ❑ Construct a new on-site sewage disposal system* forms on the j computer, use MRepair or replace an existing on-site sewage disposal system* only the tab key to move your ❑ Repair or replace an existing system component cursor-do not use the return A. Facility Information key. r� Address or Lot# een City/Town x tf� ❑�.,f , 2.- TYPE OF SEPTIC SYSTEM*: ®"Pump ❑ Gravity (choose one) ***If pump system, attach copy of electrical permit to application*** ❑ Conventional System (pipe and stone system) ❑ Infiltrator or Biodiff user(Gravel-Less) (Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D-Box) (Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D-Box Present) S.A.S. 2. Owner Information Name Address(if different from above) --------------------- - City/Town State Zip Code Telephone Number 3. Installer Information w . Name - —-- — 444 6 t (Muf rry � u „ Ar a ' -nom'q d ------- Address — — - Andover, MA 0 1810 City/Town State Zip Code Telephone Number(Cell Phone#if possible please) 4. Designer Information Name Name of Company / Address City/Town State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit Page 1 of 2 SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: clel (Address of septic system) For plans by 1 (Engineer) / Relative to the application of jd,` e6t -� 0✓ (Installer's name) And dated 1 d nguia ate Dated Z — -7'?—, o ay s ate With revisions dated (Last revised date) I understand the following obligations for management of this project: 1. As the installer, I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved ved plans and the permit on site when any work is being done. 2. As the installer, I must call for any and all inspections. If homeowner, contractor, project manager, or any other person not associated with my company schedules an inspection and the system is not ready, then item three shall be applicable. 3. As the installer, I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection,without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a $50.00 fine being levied against me and/or my company. a. Bottom of Bed—Generally, this is the first`(1'� inspection unless there is a retaining wall,which should be done first. The installer must request the inspection but does not have to be present. b. Final Construction Inspection—Engineer must first do their inspection for elevations, ties, etc. As-built of verbal OK (or e-mail to: healthdept @townofnorthandover.com) from the engineer must be submitted to the Board of Health, after which installer calls for an inspection time. Installer must be present for this inspection. With a pump system, all electrical work must be ready and able to cause pump to work and alarm to function. c. Final Grade—Installer must request inspection when all grading is complete. Installer does not have to be on-site. 4. As the installer, I understand that only I may perform the work (other than sinzp/e ex,-apatim)and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system and/or revocation or suspension of my license to operate in the Town of North Andover,significant fines to all persons involved are also possible. 5. As the installer, I understand that I must be on-site during the performance of the following construction steps: a. Determination that the proper elevation of the excavation has been reached. A Inspection of the sand and stone to he used c. Final inspection by Board ofHealth staff or consultant. d. Installation of tank, D-Box,pipes, stone, vent,pump chamber, retaining wall and other components. 6. As the installer, I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner,general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: � (Today's Date) (Name—Print) (Name—Signed) i Official-yUss��e�Only -� Permit No. !"/ ...� �,�d�ft"nZ0?2Zfl�s�.C'7>?f 6} S,Sr�G�l�a�`T�LS 7�O a..e 4 P-a,Sadi# Occupancy&Fee Checked „� •p�I }� BO;RD OF FIRE PREVENTION REGULATIONS.527 CMR 12:00 �P 1�1' ATION FOR PERMIT TO PERFORM ELECTRICAL WORK �� m u k� �,,g I rk to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 .au..,..M... . (Please Print in ink or type all information) Date To the Inspector of Wires: Town of North And The undersigned applies for a permit to perform`the electrical work described below. Location(Street&Number Owner or Tenant C✓ Owner's Address Is this permit in conjunction with a building permit Yes ❑ No 8-- (Check Appropriate Box) Purpose of Buildin Utility Authorization No. Bdsting Service Amps VOits Overhead ❑ Undgmd ❑ No.of Meters New Service Amps Volts Overhead ❑ Undgmd ❑ No.of Meters Date..... ...:....... ............... Total No.of Transformers KVA NORTH °',«`° •;'"o TOWN OF NORTH ANDOVER Generators INA No.of Emergency Lighting Aii�k p PERMIT FOR WIRING Battery Units +� + - FIREALARMS No.of Zone y +,ro',°• No.of Detection and iSSACHUS�h Initiating Devices NO.of�✓/ �? / c, NoJ Self ontained This certifies that netectioNSoundingDevlces . .k .. °( d f` ❑ Municipal ❑ Other has permission to perform . ... Local Connection ��y f� Low Voltage wiring in the building of.... .......... Wirin at......... ...: .....: �....�............. .North Andover,Maass. i•. Fee-/-Z ..` .. Lic.No. '............... - moo Apr...- q ELECTRICALINSPECTOR ` No Check # (_� ,� - -' - Average by checking the appropriate box 7497 Ddte) Work to Start Inspection Date Resqpested Rough Final Signed under a Pena ' of perjury: LIC.NO. FIRM NAME L '► -ts-`r `^C Lkensee ��'.® a.Jo 1 cx L,_Signature LIC.NO. Z-s� (� Bus,Tel No. / q 7 O f Address ZC�CJ rY't?'s:�Pj�d rh Alt Tel.No.-,�_2 y =—L2 OWNER'S INSURANCE WAIVER: I am aware that the Lice es does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that my signature on this permit application waives this requirement Owner Agent (Please Check one) Telephone No PERMITTEE S (Signature of Owner or Agent) NoRrH q 96 0 NO O t� F- 70 icy " y" � T CGCN`iC:WKK 'k.o �SSAC F1US PUBLIC HEALTH DEPARTMENT Community Development Division June 26, 2007 Eleanor Turke 901 Johnson Street North Andover, MA 01845 RE: Septic System Design, 901 Johnson Street,North Andover, Map 107A, Lot 156 Dear Ms Turke, The North Andover Board of Health has completed the review of the septic system design plans, for the above referenced property, submitted on your behalf by Merrimack Engineering Services, dated April 10, 2007, last revised June 12, 2007. This plan has been approved. As this is a replacement septic system, this plan is valid for two years from the date of this approval. The design has been approved for use in the construction of a replacement onsite septic system for a 4-bedroom house(maximum 9-room). During this time, a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover. In the event an imminent health problem such as sewage backup into the dwelling is occurring,the North Andover Board of Health may reduce the time period for which this plan is valid. This approval is subject to the following conditions: 1. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation, the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit. 2. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission, Zoning Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe or imply compliance with any of the aforementioned requirement. 3. The plan calls for a tee filter to be provided for the outlet of the septic tank. The Installer must provide the name and model number of the filter to the Health Department prior to issuance of the Disposal Works Construction Permit, 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www,townofnorthandover.com Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you may have. Sincerely i f Z Susan Y. r, H �AS�" Public Health Director Encl: list of licensed septic system installers Cc. Merrimack Engineering Services 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com I Jf X02 SA HIu PUBLIC HEALTH C, rarnrrnunit C:)evel pi nenf Division Jrwrne 12, 2007 Mr. Vladimir Nerrrch ncak Merrimack Engineering Services 66 Park Street Andover, ILIA 018,10 Re: Pr sed Waste t w o. ...w .o....��,.:'. du m., w t la 1 C'7A !=2t 0 �lcahn.�a�rr,. ��f' f�"�. 1 t � Dear Mr. N rrich rook: The ropose d wastewater treatment and dispersal sy stern April . office design n plan for the above referenced nc.ed site date d A ril 10, 2007 and receive d irr this n A pril 2 2007 l°ra been reviewed. Unfortunately, the l)ans cannot be approved a sub,n.tted. The following items are in need of attention prior to approval, with the section of' Title 5 10 MR 15,000 or North Andover Regnlaatie°an s (NA) rioted: 1. Please indicate the required tal ccw i,nerr it of magnetic rrraarkinrl tape or comparable means around the on-,site wastewater systerr'r (;310 CN/IR 15.221(12)) Please indicate the names of abutters from the rncast recent Assessor's rnaata (NA 8.02) 3. '`oLr.. have not chosorr to use trenches. Please (to scar or provide a plaLisible explanation as to why they carino[, be utilized within they rro[e section. (31.0 CMtt 15,240(6)) `T"reraches are to be used as the sail a bsorl:rtiorr systein ryiec;harrrisin where, possible. 4. Please clarify and provide Taercrya ncy calculations for both tanks used for this desip;rr (3 10 f"i4/tR 15.: 21) Please feel free to contact ttau office with airy qu stioris YOU may have, We look forward to working with you to obt irr an onsite wastewater syst rn which will be in cornpliance with all regulations and assure prcatuc,tion of public health and the rrvironrrre nt of North Andover. ;irrcerr ly, aw uhhc 11aaltla f�rreacatar cc: Elea rior,.t'rrrke;^ ........ .. _.__....... _...... _ ........ _ . _ ........_ -_..1600 Osgood Street, North Andover, N' u,sachu eft 01 Phone ne 711. 1 .9540 Fax 978.688.8476 Web www.townofnorthandover.com 1 1 1 i j MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS m LAND SURVEYORS PLANNERS 66 PARK STREET• ANDOVER,MA 01810• (978)475-3555,373-5721 • FAX(978)475-1448• E-MAIL Info @merrimackengineering.com i June 21, 2007 Susan Sawyer Public Health Director 1600 Osgood Street Bldg 20, Suite 2-36 North Andover,MA 01845 "' �� Re: 901 Johnson Street Dear Ms. Sawyer: We are in receipt of your review letter for the above referenced site. Enclosed please find 3 copies of the revised plans. We have addressed items 1-4 of your letter and respectfully request the plan be approved as re-submitted. Sincerely, MERRIMACK ENGINEERING SERVICES,INC. William Dufresne, Project Manager Cc: Eleanor Turke 0ORT►� q O RSLeo i6 ,Aq.. O A �o ° * o «N.wK. SSACHUS�� PUBLIC HEALTH DEPARTMENT Community Development Division June 12, 2007 Mr. Vladimir Nemchenok Merrimack Engineering Services 66 Park Street Andover, MA 01810 Re: Proposed Wastewater System Upgrade Design 901 Johnson Street, Map 107A Lot 156 Dear Mr. Nemchenok: The proposed wastewater treatment and dispersal system design plan for the above referenced site dated April 10, 2007 and received in this office on April 23, 2007 has been reviewed. Unfortunately, the plans cannot be approved as submitted. The following items are in need of attention prior to approval, with the section of Title 5 (310 CMR 15.000) or North Andover Regulations (NA) noted: 1. Please indicate the required placement of magnetic marking tape or comparable means around the on-site wastewater system (310 CMR 15.221(12)) 2. Please indicate the names of abutters from the most recent Assessor's map (NA 8.02) 3. You have not chosen to use trenches. Please do so or provide a plausible explanation as to why they cannot be utilized within the note section. (3 10 CMR 15.240(6)) Trenches are to be used as the soil absorption system mechanism where possible. 4. Please clarify and provide buoyancy calculations for both tanks used for this design (3 10 CMR 15.221) Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain an onsite wastewater system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincerel san Y. Sawyer, EHS/R ublic Health Director cc: Eleanor Turke 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com o 'r TOWN OF NORTH ANDOVER 0- ,,, j;-, I 01 0 Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 0 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 NORTH ANDOVER, MASSACHUSETTS 01845 SA US 978.688.9540-Phone Susan V.Sawyer,REHS/RS 978.688.8476-FAX Public Health Director E-MAIL: licalthdel)t@townofiioi-thandover.coi-n WEBSITE:http://www.townofnoi-tliandovei-.com SEPTIC PLAN SUBMITTAL FORM Date of Submission:- Site Location: q 0 1 J000 ':�olj Engineer: New Plans? Yes v/ $225/Plan Check# (includes I"s bmission and one re- review only) Revised Plans?Yes $75/Plan Check# M`k Site Evaluation Forms Included? Yes V/ No Al" Local Upgrade Form Included? VA Yes No - 70)Telephone#: —Fax#:- --, E-mail:_ 0" Homeowner Name: OFFICE USE ONLY When the submission is complete(including check): ➢ Date stamp plans and letter )> Complete and attach Receipt ➢ Copy File;Forward to Consultant Enter on Log Sheet and Database r t� .. i e { i I I , . t , { ` I i i i k } y a Val f Vol � r f 671 r vT� T�,p � j , 4 i , s ` W 1 I _ _ lI - j nit, JIM mig MEN Location Owner's Name: . MILP/Tamel: A, Address: Tel M. 6,V � --f--1- ew N PIML.Repidr Date: WCt11ndL-L1 M -n&MCI 12 -�on Cluj Soli LI-L Deep Observation Hole Logs' Elm,Rdan Depth Son H44ma Sol-I Ten= Soil bolor SORMOttlID9. % Gmvd,Stone4 etc za,:i k", yy i A- (\p • 7, ,147k GWLA�1;1 /c Date 'Pemalittion Tests Observation Hole# Depth of Pem Stift Pmqo Time sat 12-t Time Jar Time at 6" Time(.9 Rate Imunnch- 7- Performed ]a % L tuessed B%^....... TOWN OF NORTH ANDOVER HbR(�H Offir,e of COMMUNITY UNITY DEVELC PMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 '4.l T1Ir hTT,.(T? NORTH ANDOVER, MASSACHUSETTS 01845 Susan V.Sawyer,REHS,RS �"�� °,�:`��'u7 97 .688.9540—Phone Public health director 97 688.8476—FAX ,° �rJ he Ithde t a townofi1orp and.ver;com ! A wN w.townofnorthandov r.com t,,AA 2 AIPPLICATION FOR SOIL 8 DATE; 17 .. .. d;' MAP&PARCEL: eI LOCATION OF SOIL TESTS: 0 ,(J d OWNER.: r J�,fO�� ' 9 l� ' Contact#:-am,) APPLICANT: A O � � .. ,., Contact#:� "";7 ADDRESS: ENGINEER; c'" f�l t" ( ntact#; � � CERTIFIED SOIL EVALUATOR: " y, r ; y Intended Use of Land; Residential Subdivision Sin attu H e Commercial Is This. Repair Testing-- Undeveloped Lot Testing. Upgrade for Addition: In the Lake Cochichewick Watershed? 'Yes No THE FOLLOWING MUST RE INCLUDED WITH THIS FORM H ]Proof of land ownership(Tax bill,or letter from owner permitting test) A 8.S"x Xl". Plot plan&Location oP•Testin9(please indicate test pit sires On fire mart) > Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$360.00 per lot for repairs or ur►�rades. GENERAL INFORMATION A Only Certified Soil Evaluators may perform deep hole inspections. > Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. > At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. > Full payment will be required for all additional tests within two weeks of testing. D Within 45 days of testing,a scaled plan(no smaller than 1"-100')shall be submitted to the Board of Health showing the location of all tests(including aborted tests). > Within 60 days of testing soil evaluation forms shall be submitted, Please Do Not Write Below This Line N.A. Conservation Commission Approval Tate: .Signature Of Conservation Agerrt: c °° Date back to I-lealth Department.-(stamp in).- 1 -- - -- MORTGAGE - - INSPECTION CYR ENGINEERING SERVICES,INC. 234 ESSEX STREET LAWRENCE, MASSACHUSETTS MORTGAGOR: r� F a3y.zo F ADDRESS OF PRINCIPLE BUILDING o DEED REFERENCE:BK./�PG. i97 PLAN REFERENCE: tc�r37Y�>Q DATE OF INSPECTION: =9•�' e I i 1 NOTE:This Mortgage inspection was prepared spe- I cifically for mortgage purposes and is not to be relied upon as a survey.Cyr Engineering Services, p "9°r Inc,accepts no responsibility for damages result, 2-sro.e✓ - ing from said reliance by anyone other than the said mortgagee and its assigns in connection with � its proposed mortgage financing to sa(d mortgagor. r WN ye rear Z 6 CERTIFICATION TO: AL S v p V� This Mortgage inspection was prepared in accordance p O• with the Technical Standards for Mortgage Loan '.. Inspedions as adopted by the Massachusetts Associa- \1'l lion of Land Surveyors and Civil Engineers,Inc. m I FURTHER STATE THAT IN MY PROFESSIONAL c, OPINION the princjple structures and accessory outbuildings, G��7�L/ with the setback requirements of the local zoning or- dinances,and that there are no encroachments of major improvements either way across property lines except as shown. o, �o ALSO: t.Property is not In a Flood Hazard Area. O 2.Property is in a Flood Hazard Area. c C3 3.Information Is insufficient to determine Flood za - Hard. Scale: Dale of Plan: /7't'-,S9 Flood Hazard determined from latest Federal Flood Insurance Rate Map. i f TOWN OF SYS'T'EM PUMPiNG RECORD DATE: 1`4-110-1 SEP 14 2004 SYSTEM OWNER & ADDRESS SYSTEM LOCATION (example:left front of house) DATE OF PUMPING: � .�_ `( QUANTITY PUMPE D : � �` GALLONS CESSPOOL: NO YES SEP'T'IC T : NO YES t/ NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEAC +LD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTIHE R(EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMME NTS: CONTENTS TRANSFERRED TO: .L. Lowell Waste TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: =S-6 SYSTEM OWNER &ADDRESS SYSTEM LOCATION t, (example: left front of house) DATE OF PUMPING:"I" ' L QUANTITY PUMPED_ GALLONS CESSPOOL: NO /YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY. � COMMENTS: CONTENTS TRANSFERRED TO: A mow„ TOMN OF .� . , SYSTEM PUMPING REA CO REGLIVED DATE: ANDOVER SYSTEM OWNER& ADDRESS SYSTEM LOCATION (example: left front of house) t - S ' -� C DATE GE PUMPING: QUANTITY PUMPEID : GALLONS CESSPOOL,: NO L_�V_ES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE, EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EX CE SSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHJ R(EXPLAIN) SYSTEM PUMPE LD BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFEMED TO: .L. _ II Waste