HomeMy WebLinkAboutMiscellaneous - 193 FOSTER STREET 9/29/2015 (2) Town of North Andover, Massachusetts Form No.3
NORTM BOARD OF HEALTH
O`t,tea° •"qH0 /
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*�'°°�,r.o •'°�* DISPOSAL WORKS CONSTRUCTION PERMIT
95SACHUSe
Applicant_ L=-1 L-1�-r
NAME ADDRESS TELEPHONE
Site Location 3 �—C-i clz
Permission is hereby granted to Construct ( ) or Repair V) an Individual Soil Absorption
Sewage Disposal System as shown on the Design Approval S.S. No.
CHAIRMAN, BOARD OF HEALTH
Fe I IS-1 l D.W.C. No. 1ORD
i
Town of North Andover, Massachusetts Form No.z
f AORTH BOARD OF HEALTH
o? 19
DESIGN APPROVAL FOR
ssACHU E` SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
Applicant ��/� I, sly - Test No.
Site Location J -
Reference Plans and Specs. �✓ %`!/ ,�;%
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
d� y A)
Fee—j-,2,3. Site System Permit No.
i
CHRISTIANSEN & SERGI, INC.
PROFESSIONAL ENGINEERS AND LAND SURVEYORS
160 SUMMER STREET HAVERHILL, MASSACHUSETTS 01830-6318 (978) 373-0310 FAX: (978) 372-3960
DOVE ,
6 140no
December 4, 1998
Ms. Sandra Starr
North Andover Board of Health Administrator
Office of Community Development Services
Charles St.
North Andover, MA. 01845
1z,113
Re: k39-Foster St. map 104D lot 42 septic system design
Dear Sandra,
Please find attached two copies of the revised design for the above referenced lot. Port
Engineering's comment was to add a 24" riser/manhole to the septic tank. We propose
to cut the existing grade so that the cover will be 6" from finished grade.
We also request that you schedule us for an appearance at the board's next meeting.
The purpose for this meeting is to request a variance from the Town of North
Andover's Minimum Requirements for the Subsurface Disposal of Sanitary Sewage for
the above lot. The variance requested is:
1. to allow the system to be built 50' from the wetlands per Title 5 as opposed
to North Andover regulation Section 5.02.
Sincerely,
1p .XChristiansen P.E,
PGC/epw
enclosures
Town of or Andover RTN
OFT-ICE OF '4 '4"
0
COMMUNITY DEVELOPMENT AND SERVICES s
L
4
30 School Street
WILLLAM J. SCOTT North Andover, Massachusetts 01845
sACH St
Director
OUTSIDE CONSULTANT ESCROW AGREEMENT
NORTH ANDOVER BOARD OF HEALTH
Agreement is made this—'"3) �-1-11CJY between the
Town of North Andover and
of
for Soil Tests, Q(a.n Review /a 44 Sle
KNOW ALL men by these present that the Applicant hereby
provides the Town of North Andover with a check in the sum
of $ I 0-�, to be deposited in an escrow account for the
Town of North Andover and has deposited in an interest-
bearing account as designated by the Town Treasurer to be
expended by the North Andover Board of Health to insure
payment to any outside consultant (s) for Soil Tests, Plan
Review for the above referenced project ,
This agreement shall remain in full force and effect
until the specified project has reached completion ,
—2 77724.rk;r,77
Board of Health Chairman Applicant
or Agent
Date Date,
FAMILY MUTUAL BANK
CHRISTIANSEN and SEIRGI,.INC. HAVERHILL,MA 19451
160 SUMMER STREET
HAVERHILL, MA 01830-6318
53-7054/2113
CHECK NO. 19451
PAY
ONE HUNDRED TWENTY-FIVE DOLLARS
DATE AMOUNT
10/30/98 *******$125 . 00
TO THE
ORDER TOWN OF NORTH ANDOVER
OF 120 MAIN STREET
NO ANDOVER. MA 01845
:may
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DATE:
LOCA ION:
ENGINES:;: - -
BOF, WIT
NESS. (�
FERCOL"\TION TEST
BOTTOM DEPTH OF PLRC TEST-.
� e.d
TIME OF SOAK.: : (At lest 5 minutes Icrc)
TIME AT 1 ��
TIME AT 9"
TIME AT C
CV'=F.NIGH.T SOAK
TIME STARTED
NEB T DA" S O r',K: �,t ens; 1 ,�inu:esi
I iME r', T 12
Tii��lE AT ..
TIME AT —
r
DATE:
LOCATION:
ENGINES.
COH JVl T Nc.,... - -_
FE :C0LAT10N T`ST
EOT OM DEFTH of PERC TEST. 5
TiME OF SOAK: inc es Icnc
IINIEAI
TIME AT c
T WE E
C ,NJICH ! S0 K
^ iT=
T i iV i E S'I �.;.
NNE ,
TIME AT
TIME AT
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DATE:
LOCATION.
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ENGINEEP: ti
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50r VVI i NESS
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P EP.COL;I 10 I ES T -r#-
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-C TT OM DEPT'r, OF PERC TES)7
TIME OF SOAK: .�
TIME AT 1
TIME AT �w,.
TIME AT
Cv,TIGHT S-0AK
TiiViE S T r^.R T":--
TI viE AT
T'M ,2T
TIME AT
Commonwealth of Massachusetts
City/Town of No Andover
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a 'System Pumping Record
t
Form
''A, v rtrt a.¢vn var i, n¢r
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use. The System Pumping Record must be submitted to
the local Board of Health or other approving authority within 14 days from the pumping date in
accordance with 310 CMR 15.351.
A. Facility Information
Important:When
filling out forms 1. System Location:
on the computer, °( ❑ �� t ` 4
use only the tab
key to move your Address
cursor-do not No Andover Ma
use the return City/Town State Zip Code
key.
2. System Owner:
Name
retwn
Address(if different from location)
City/Town State Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping Dafe 2. Quantity Pumped: Ions
3. Type of system: ❑ Cesspool(s) �/Septic Tank ❑ Tight Tank El Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes I—A/ No If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System:
6. System Pump �Y~
Name Vehicle License Number
Stewart's Septic Service
Company
7. Location where contents were disposed:
Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835
Signature of Hauler Date
Signature of Receiving Facility Date
t5form4.doc•03/06 System Pumping Record•Page 1 of 1
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t,'ATE OF PUMPING: �� QUANTrTY PVMPED /J-0r.`) (;AtaL0°t ,
tii'U(Jl�: 1~tp YES SEPTIC `I'AhtIC: NO YES
NATURE OF SERVICE: ROUTINS —L, EMERGENCY
GOOD CONDITIOM FULL TO COVEk
HEAVY GREASE BAFFLES IN PLACE
ROOTS LEACHFIELD RUNBACIC...
EXCESSIVE SIDS FLOODED
SOLIDS CARRYOVER rq H1R (J?XPLA.lN)
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�-u��Itilrr�TS:
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TOWN OF NORTH ANDOVER.
SYSTEM PUMPING RECORD
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DATE; �;.._.. �I
SYSTEM OWNER& ADDRESS SYSTEM LOCATION
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DATE OF PUMPING: QUANTITY PUMPED .°a�� GALLONS
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YES SEPTIC TANK: NO YES
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HEAVY GREASE BAFFLES IN PLACE
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DEP..has provided this form for use by local Boards of Health, The Sys tem Pumping Record must
be submitted totha local Board of Health orother approving author( °:'�
X Facility lnforr t tion
rngrtant.: �:�.'` , ���,. �'. a/ 0
�,,,yvhen Nung out 1 System location
,,;for�nsontho �
computer,use
190
only the tab key Address
to move your
use the rotum City/Town e r State Zip Coda
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Name
Addre"(If different from location)
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Telephone Number
u►nplg Record
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1 Dat, t Pumping ' to 2, Quantity Pumped,
Gallons
Typq Qf system; ® Cesspool(s) ❑� Septic Tank ❑ Tight Tank
Other(descrlb®j
Effluent Tea Filter prey®nt? ❑ Yes Ho If yes, was if cleaned? ❑ Y No
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Commonwealth of Massachusetts
rtr,�ar�&Fw,d'„�u (�i���p�wor 1 � nun Jorm,City/T'own of � „°°��� �� °� `
System Pumping Record
Form 4 DEP has provided this form for use by local Boards of H 1iL” � sed, but the
information must be substantially the same as that provid ng 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 front of house, right front of house, left side of house, right side of house, Left
rear of house, right rear of hous<1eft`slde of bui In right rear of building, under deck.
Citylrown State Zip Code
2. System Owner:
Name
Address(if different from location)
City/Town State Zip C I de
Telephone Number
B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped: Gallons
3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes D--No If yes, was it cleaned? ❑ Yes ❑ No
5. Condition Pf System:
6. System Pumped By:
Neil J. Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc.
Company
7. Locati ere contents were disposed:
w t aste ter
SignatureoI/llull Date
t5form4.doc•06/03 System Pumping Record•Page 1 of 1