HomeMy WebLinkAboutMiscellaneous - Exception (722)BOARD OF
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Town of North Andover, ass
Permit # Date 199'
APPLICATION FOR WELL & PUMP PERMIT
Application is hereby made for permit to drill a well (x). Application is
made to install (_) a pump system'. /
Location: Address c�Sc� Lot #� C4o1
,CAU e A 606 r _ E r�,a ZZU:5 �e1� c/
Own ert)o kj Address2?,80ok1dF,el.
Well Contractor ����,�,� r-L� Address j�qlVTe1.
Pump Contractor Address Tel.
WELL CONTRACTOR .(To be completed at time of pump test)
Type of Well
Well
used for PF_SVdclyI
Diameter of Well'"
contractor
Size
of. Casing
Depth of Bed Rock
�.....r. J. ,�. J. J..b : .
J i. .. .♦ •. n .. n /• /. i� :� i. i. is i. is ii � ii �. i�
Depth
casing into Bed Rock
.
Was Seal Tested?
Yes N) No (—)
Date.of
Testing
Depth..o_ Well
—adv ..
Well
Ended in W.ha.t. Material
Depth to Water-
Delivers
Gals.Per Min. for 4 hours
Drawdown Z�e>c, feet after pumping Y hours t SCPr1
Date of* Completion Z /i
P
nature well
contractor
/C .. i'C i. .. n ..
n n
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•. ..
J, i•. ... J.:r...l�y.
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�.....r. J. ,�. J. J..b : .
J i. .. .♦ •. n .. n /• /. i� :� i. i. is i. is ii � ii �. i�
I� i� �i� i. it i� ii .^ n n it i. �n �
�� �n�i. �n �n �ri iC� n ���
.
..
UMP INSTALLER (To be•' fi..11ed i..n• before installation)
Size & Name Pump -- _-_- _-_ Pump Type Used
Water Pump Delivers GPM Size of Tank
Pipe Material Used in Well: Cast Iron (_) G:�l.v.�ni.zed ( ) Plastic
Well Pit (_) or Pitless.Adapter ( )
Was sleeve used to protect pipe? Yes (�) NO(—) Type or Name Well Seal
nate
Date Water analysi's repdr--t 'submitted to Board of }•real*th
Date release given tD owner of record & Bldg.. Insp
Health Inspector
a Al7 Department of Environmental Management/Division of Water Resources
w WATER WELL COMPLETION REPORT
1 .I1µ nY.`•�?
WELL LOCATION
GEOGRAPHIC DESCRIPTION
Address lnT/Ac� 42 : njn^&5p'='R•47'A(/A/c
/ 5V N S� C O W o f
(feet) (circle)
n
sc//1/ /7// t�
City/Town. �
�/'/.it°)Q ��XCX� raC�i r1�1rUi�r✓c
(road)
Well owned n/ �f rr
Address A#116E S A0
N (D E W of
(mi. in tenths) (circle)
Board of Health permit: yes no ❑
intersect. w/ (road)
WELL USE
WELL DATA
Domestic ® Public ❑ Industrial ❑
Total well depth • _Q6 ft.
Monitoring ❑ Other
Depth to bedrock 2S ft.
Water -bearing rock/unconsolidated material:
Method drilled <ODW ✓
Date drilled <4
CASING
Type-,:SZFI / 5
Lengthft. Diai.I.D.) 6 in.
Length into bedrock 1,5- ft.
Description
Water bearing zones:
1) From 5_6 To
2) From ? Jr To x.30
3) From220' To ?Xs
Gravel pack well: din.
Protective well seal:
Screen: dia.
Grout_9 Other Slot length from_ to
STATIC WATER LEVEL
Static water level below land surface Q ft. Date
WELL TEST
Drawdown—,?—oat. after pumping_ // hr. min. at_57 gpm
How measured Recovery420 ft. afterI hr. ?0 min.
0
LOG of FORMATIONS COMMENTS 2
Driller !) E,I/.F'e'7
Mass. Regiisstration# l
Firm 11iLci <9/-Jca
Address A444;tMj 4' l 4_3
City/Town
ovmnY wr r7CA.L 0 e1 bVr 1
15083528586 VIERA WELL CO. 02/11/92 08: Pei =
BOARD ON 111: AL'1-P1 Q ,
Town of North hndovcr,Mas s .
Permit # Da e 199
APPi,ICATION FOR WEILL & PUMP PERMIT
Application is hereby made for permit to drill a well (Ac). Application is
made to install (y) a pump system'. /
Location: Address u�A W,,s •c+�S;C�f �� ,�, � _ Lot % &01
Owner C 5 Address �s� ?iW.�'.•� 1tJ� % tel.
Well Contractor /t:�aA�r �, A c I d r e s s A/ i`Q ,Tel.
Pump Contractor Address V,0G`•"s1� Te are
(riZ�wl� m�P��u.p-`�--`� Ave 1.4 In bueK
Lc.� c Ir+ n �i�•r► �� o tf� � �.
WELL. CONTRACTOR (To be completed at time of pump test)
Type of 14ell Well used for Cvr
Diamdrer of Well G —� `—Size of. Casing 6„
Depth of Bed Rock�
c?.S Depth casing into Bed Rock /s
Was Seal Tested? Yes (N) No (W) Date -of Testing 2
p t h ..o -f- We -11 — --. --Well Ended in Wha.t. Material
Depth to Water- gip' Delivers S 'Gals -Per Min. -for 4 hours
Drawdown feet after pumping, j/ hours , t S, GPM
Date of Completion c /i 9t
ig aCure.leContractor
:t :i:: i!..w':C'�'.t;tnit��':::C•%i,%�::i�'f'if'.':aaS...n....................a:C`:Cit:'tS'tit�t:':.'t5:'''9d'S'CnaS'tStS�i�'i!'7:1�'�`�71'S�'�'it�.�' .
PUIIP INSTALLER (To be,- fi.lXed in- before i.ns(:al).ation)
Size & Name Pump `
__.Pump Type Used,
Water Pump Delivers- GPM Size 'o
...�_ f Tank
Pipe Material Useri in Well: Cast Iron ( ) n:7ect ( ) r plastic- t
yr
1Je11 Pit {_} or Pitless Adapter (�'^��� ~���'
Was sleeve used to protect ripe? Yes (^) NO(,,'Type or Name Well Seal
Date
�k�i•tit�t�44��r����4tV4�4'r�4►4�'r�tii'r�Y�Y�4�r�IrtYti4�4�'t�4�'r�r�4s4�44�'r�'r�Vti'r�'r�'r�'r�'r�'r�'titrS�;�i�`�►��'�S�.�S'i��:tti:7i;�i�ti��r ,��P�4f4�4�4Vr .
Date Water analysis r'ep6r-t submitted to hoard of i•ical'th
Date release given tD owner of record & Il l.clg.. Insp
Health Inspector
j
c
BOARD OF III"ALTH
Town ok-Poruh Andovcr,Mass.
Permit # Date&,a
199.e
APPLICATION FOR WELL & PUMP PERMIT
Application is hereby made for permit to drill a well (k).
Application is
made to install (—) a pump system'.
-Luot
6d)
Location: Address c/,.- ZV_A
Lot s 9
Owner Address ?g 18AEy
2_-t94WVb416PQ s7-
Well Contractor Address /),4
:3k,
Tell.
Pump Contractor Address
:4�Z
-Tel.
WELL CONTRACTOR .(To be completed at time of pump, test)
Type of Well Well used for
-Diameter of Well Size of. Casing
Depth of Bed Ro.cle, Depth casing into Bed
Rock
Was Seal Tested? Yes No U Dar-e.of Testing
Depth 0_&_W, e_Well Ended in Wha.t. Material
Depth to Water Delivers Gals.Per
Min. for 4 hours
Drawdown feet aftq*r pumping hou rs at GPM
Date of*Completion
Signature Well Contractor
PUMP INSTALLER (To be''filled in- before installation)
Size & Name Pump Pump, Type Used
Water Pump Delivers GPMSize 'of Tank
Pipe Material Used in Well: Cast Iron 0'.-11.vqnj.zcd Plastic
Well Pit J—) or Pitless Adapt6r
Was sleeve..used to protect Pipe? Yes NO(—) Type or Name Well Seal
Da t e
NY NY * NY* NY NY ** NY ly * NY Ve *Y( Ye NY sle ? 11.,§ Re 1, ow
Date Water analysis r'ep6r-t. submitted to 1,1oird of I-rcal't1-1
Date release given tD owner of record & Bldg.. Insp
Health Inspector
N-•�.. may., I I `en •ti' . .��r
•.� .�J�b':v � .� Oct f � � � N fi ri
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ERY 1I�lJ0.7 AV)R9jZ1lMyll .�lNisi yy
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I c ed f3q- ; O i 7,6/q—O/'Z(s '0:) "I DA V831 A NIS�'ZSSIOS T a
NQMBpR
THE COMMONWEALTH ormAssAC*usErrs FEE
--zuw0--w{-4��0D
--.----' _�& -
This is to Certify that -- vie
Comgany_--__-----__—''---.--_--
NAME
253-An,dover������
'' r'^Ge.mucgGtQvmn-*--- 88A ..................................
ADDRESS
IS HEREBY GRANTED A LICENSE
For ............. ___WelI I)rill�r'o Permit
- �-----'----.--_---__--__----_-----.----
9 94
____________________.___—'--~~_----
--_--''-'------_'—'--.�-- _-�'---'---.—_—'.---..---'----'--'--'
�6�G000mo�*�ronto6iu000��o,��yv,id�du��mu '---'---'--'----'------
u�uumumdon7iuuncoe
expires-----er'.3l+—]'���2 ..............xoloo sooner »uuoo�r�«r«t»^und
_ ry... 6 .............. ------- D9 ..' 92
FORM 433 HOBBS & WARREN. INC.
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7hoedewea oCalocatory, Avc.
66 LITTLETON ROAD WESTFORD, MA 01886 (508) 692-11395 FAX (508) 692-0023
1 1 -800 -649 -TEST
Report Number: C-wps�5070
Cli6ont:
A7TNE"'tr��n
Wilmington Pump Su��lY
b39 W���rn �t.
Wi1mington, MA 0i81-37
Samp]e 1mken Uy: WP5 Staff
o
R��ort Dat�:Fe6ruary 1��199�
8amplce Taker 0�u /
Mr. J(.:) Gi
Lot #9- W"'A1kinW�"-ky
N"Andc: �YtaI a.
On:February 11,1992
/
CErrT1FIQF ANAL. YSIS
..... .... .... ..... . .... .... ....���
~
Test parameter:
EPA Ma
ults
Units `
'
CoIinrm r �
f Racte i (P)
0
�
100cc
pe r `
Acidity Va1ue(pH>(1-i:1.)
6.Tj_8.5
7^3
/
Cm]or (8)
1Ir
Mdness
No L1mit
1.4
mg/L
Manq
0.02
frig /L
Nitrate lz(as hl >
10
0.01
Od�r(S)
'3
0
TON ` �
Nitrit�N>
1
{0.01
mg/L
'Turbidity (P>
5
4.9
_
NTL]
Alkalinity
Not Specifid
IZ9.0
/
IT) g/L
Ammpni�
Not ified
{8~03,
mg�L '
Copper. (S>
'
1"0
`d�u�
'"
._
A
[a1cium'
Nc] LiNi�
.'
4.8
' In L
Ma ne�ium
No Limit0
" 59 '
'
frig /�
Potass�um (S>
4"0
^1.1
' mg/L ' ` ' �
Ch1�r1d� <S>
250
3.4
mg/'
Su1fat�� (S>
250
9.3
�hlorin�
0.�
�.09
Condu�tivity
No Ljmtt
umhp19/rm '
SediFri r) t.
^po�/ne*�
' nog
'
(P>- Prim�ry EPA P�r�meter (��-�econdar
� FPAP�r�mc-t
r (ftay :-1f|ect
a�sthet1� qua1ities
e.g. color,pdor
�nd |aste
) ` ` ' `
' NT = NtTeed
#� Exceeds
EPA Meximum
'
standard" J
"=EP� a�visory limit,no form11m1t
to
~ �
7h� qk..i y o[ this
wmtc�r �ample
cepted
mri e Tn Drink
according to EPA stand�rd�. Hom�v��,on�
or mew.
-m of the results
exdary
par amete�r as indi,cate6
b�
e (#) sign. �
�
�1assa�hus�tts �t t C
tifi e d
Micha�l P. C�r]�nn � fmr'
Testing Leborat ory #MA04� Thorsten�en Laboratory, %nc"
~ �
. �
' /� �
ikon At',
ATTN: 'Tnm Dr ren
01 i. l mi ngton Pump StIPP l y Lot #9-- wal ki ns WAY
h:55' Woburn St. N. Andova,-. Me.
Wi lmingtur), MA 01807 O c - On i Ferbl"eery 11#1992
&ami, f e Taken 8v,. WSta4f
.�
crAT I F I CATF OF ANALYSIS
•Te";t flarailtC.te t EPA Max Results Units
coo l lorm Bacteria (P) 0 4) por irJ()CC✓
Acidity Valuta (pH) (S) �•,.°i-8.5 7.3 SU ✓
ro) or (8) 1V) 10 Cull ✓
Hardness No Limit 14 mg /L
Iran (C) .3 1.2 # ma/L
Mangarlose (S) .050 b. 62 mq/L j
Ni t,rzres (as N) W 10 0101 mg /L
Ori car (5) ''_� 0 TON
Ni tri t a%� (as N) i {p. 01 mg /L
•lurt,i dity (r) 5 4.9 NTU
Alkalinity Not Specified 129.0 mg/L
Llmmnn Y E1 _ Nett �� .R { t 1. U3 my /L T ,�
Al kaki ni ty Not Specif iRd 129.0 mg/L
Amman`i. x Not Sped f i R� rU.,U3 mg . Q
crippvr, <$) 1.0 <0.01 mg -/L
r-Od i Ltm 20" ,''9 ' mg �L
Ca) r:i;tiru No Li mi t. 4.8 ma/L
Mavjne 'ium No Limit: 0.59 my/L.
Potas!:-ium (S) 4.0 1.1 mg/L
Chloride (S) 25n 3.4 mg/L
SUlfat_es (S) 250 9.3 Mg /L*
Chlni-I no 0.7 0.09 mg/L
Crnrlurti.vity No l_fknit 344 umha6/r.,�
Sediment Ro�'/rjeq nog
(P)- Primary EPA Par-ametar (91-9econdary'fPA-*0 riii►fiirftrir i ;'ilii ,-:;, ''=';;�'
A—esthetic quekl i ti es e.g. col er' odar%t,:.,rv,'
N7 = Not--Te5t:ed #a Exceeds EPA Maximum stbnd#r'q:�.,'• ''i�' ,
=EPA advisory i t mi t, no formal limit TNTC=To Numeraiis: ti `-" C�1�ar�t'
the quality of f. -his water sample is accepted as Safe 'Ca. -brink
according to CPA standar,ds.
Hnwevtrr lJn4 0 ....• ,• raE,..°'.:,:
e-elce-rd:7 .e% secondary pdi-ameter ws• inditesttea9: "�'���W+ •`.
_ ' K~f! "• :j, X qty►,`ft"Y:
Mar-S0chusPt:ts State Certified-
• Mid aai P. Gx0'atatl:R •�:• ;�',,;�'•:.�';
Tek t i n,g t,xtivratory #MAtr4E) Thorst.ensen LAbc'ratat^y� "fine:
Wf INTION REPORT
PHONE I(l."BER DATE t TIME DURATION TX/RX MODE PAGE RESLXTS ' : ;
FEB 12 15:03 00140 RX G3 01 OK '
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a LOT 1
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FLAGGED BY
THE THOM }SON CO,
XAIV
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�-` -" �. _� � .�.r � �...•� •lam -^� �� � � � ,_
1-6/19 WATK 1 NS WAY
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BOARD OF HEALTH
120 MAIN STREET TEL. 682-6483
NORTH ANDOVER, MASS. 01845 Ext. 32 or 52
January 23, 1992
Helene Driesen
Mortgage Acquisition Trust III
74 Atlantic Avenue
Marblehead, MA
RE: Lot 9 Lura Woodside Watkins Way
Dear Helene:
Thank you for submitting a copy of the proposed septic
design for "Lot 9 Lura Woodside Watkins Way". It is my
understanding that a building permit will be needed from the Town
of North Andover for the proposed house construction. If this is
the case, I feel that the North andover'Board of Health should
have some jurisdiction in this matter. The State Environmental
Code, Title V 310 CMR 15.02 (7) states that no building permit
shall be issued unless the Board of Health determines that the
disposal system is adequate. I do agree all inspections relative
to the septic system construction shall be conducted by the
Middleton Board of health. However, in order for this department
to consider the disposal system adequate, the proposed design
must also meet the North Andover Board of Health Regulations. I
offer the following:
1) Prior to the application for a building permit, a well
permit to be issued by the North Andover Board of
Health shall be obtained and evidence of a suitable
water supply shall be submitted to the North Andover
Board of Health (as outlined in the North Andover Board
of Health well regulations) for review. A list of
testing parameters & acceptable volumes of water are
available at the North Andover Board of Health Office.
2) Prior to the application for a building permit,
proposed construction plans of the proposed dwelling
shall be submitted to the North Andover Board of Health
for review.
a
Page 2
Lot 9 Lura Woodside
January 22, 1992
3) The disposal system plan should be revised to meet the
current Board of Health regulations where possible.
Specifically,
A) The proposed septic system should be raised
to provide for a four foot separation between
the ground water encountered on April 18,
1989.
B) The cellar floor shall be raised to comply
with North Andover Board of Health regulation
4.20.
C) The septic system shall be a t least 50 feet
from any subsurface drain in the street.
D) The North Andover Building Department
requires a footing drain around all
dwellings. The location and out fall of such
drain shall be shown on the drawings. The
septic tank and septic system shall be
separated from the drain as outlined in North
Andover Board of Health regulation 4.18.
E) The proposed D -Box should be sized and
located so that the reserve area can be
easily connected.
Please have your engineer address these concerns to the
satisfaction of the North Andover Board of Health. Please be
advised that a well permit will not be issued until all the
concerns expressed in item #3 have been addressed to the
satisfaction of the North Andover Board of Health and until
approval is granted by the Town of Middleton. Should you or your
engineer have any questions, please do not hesitate to call.
Sincerel ,
Michael J. Rosati
Health Agent
MJR/cjp
cc: Leo Comier, Middleton BOH
Les Godin, Merrimack Engineering
Karen H.P. Nelson, Director, Planning & Dev.
January 9, 1992
Mr. Leo Cormier, Health Agent
Board of Health
Town of Middleton
195 North Main Street
Middleton, MA 01949
Dear Leo:
Thank you for you support at the Board of Health meeting last night.
applaud you rational approach to testing for septic systems out of season
when the conditions indicate that it is a reasonable and rational thing to do.
Please find enclosed a septic plan and application for permit together
with my check for $150.
Very truly yours,
Edward T. Moore
ETM:hmd
Enclosures
CC; Mr. Mike Rosati;
January 9, 1992
Mr. Leo Cormier, Health Agent
Board of Health
Town of Middleton
195 North Main Street
Middleton, MA 01949
Dear Leo:
Thank you for you support at the Board of Health meeting last right. I
applaud you rational approach to testing for septic systems out of season
when the conditions indicate that it is a reasonable and rational thing to do.
Please find enclosed a septic plan and application for permit together
with my check for $150.
Very truly yours,
Edward T. Moore
ETM:hmd
Enclosures
TOWN OF MIDDLETON
Board of �ea&
Application for Permit for Sewage Disposal Works
Owner!�'lg�fi�9_�e Ac- ui for 74 4r-t41N1-rc 4vc
-
..............
Contractor ----------------------- --------- -- - _ __..__..__..Address
Location w0e aS106
._wA_:tn!.�_gy Dwelling _3K ----- Other Type Building
No. Bedrooms _._�_. Auto. Washer _2L_ Garbage Disposal _._ x_•-- Size Lot _•- .7�_.�:� Z .s ......
Tank Capacity .� 5�_�_ Gals. Design Flow _._1��!-Total Gals. Per Day �'
---------...----
Leach Trench No. ------- 3_------ Total Length `-`f---- Width --- --__-------------
Leach
I C - F ;-
�' Total Leach Area .__ _._ , __
Leach Bed No. Lines — ----------------- Length _:-- --- Width ----------- Total Leach Area ------:------
Leach Tank Capacity
-_ ------ Gals. Depth to
Ground Water
--
---------
Pecolation Test Results
M�KK�r)ACK E,JcJE:zTL��1b
Performed By_5 �����E_�� ! N-�
-------------- ---- ----
Date �"_ le-
._
Test�
Pit #1.. G--�__�Min. Per Inch
Depth Test Pit
_.-.._._Z�t ---.
Test Pit #2 --_ c _Z_-
Min• Per Inch
Depth Test Pit
/ . f
Description of Soil ........... -....... _- -�_-Scc._ DEEB, sf f �,( —
Date --- -------------- ------- ---- - Applicant Signature
------------- - ---------- - ---
Permission is hereby granted ______-------- -. refused ------- ---------- for the construction of the sewage
disposal works as described above and in the accompanying plot plan. Construction or repair
of any disposal works inust conform to the standards set forth in Article XI of the State
Sanitary Code.
Reason For Refusal
Building Inspector ___..__._ Health Inspector
Inspected and approved as required under Article XI of the State Sanitary Code. The approval
of this installation shall not be construed as a guarantee that the system will -w(;rk satis-
factorily.
Date .............. Health Inspector
------------------------_---
(over)
APPLICATION FORM
MIDDLETON, MASSACHUSETTS
Date
Application is hereby made for a permit for inspection to Construct (�%)
ar Repair (-) an individual wastewater disposal system at
Location-Addresss �u8a ��eE�rr H�Lcs 72-tJ000sid15 WArX145 WA Y or Lot No. 0. `i
Owner Kd&T'6&6c Ac4ul--IT O •�RvsT gi Address � ArL"^'Ttc �vF.
A_KF3LEHEaC' MA
Contractor Address
Type of Building ftloon FR.cM� ' Dwelling -No. of Bedrooms_
Other Type of Building No. of Persons --
Cafeteria
(X ) Other Fixtures fa 1A
Estimated Design Flow /00 gal./person/day
Total Daily Flow 00 6A I-tid,VS
PERCOLATION "TEST RESULTS
performed by_ M EjCltrj"A ck, Et"G"EtR!'16 S-eRV 4cfs
'Test
1 AJC Date 4--18 - g 9
Pit No.. 1:
Soak Time
minutes
@ 12 -inch
level o`'
Time dater Level:
_
Drops from 12 -inches
to 9 -inches
2 1(
s. minutes
134��
Time of Drop:
9 -inches to 8 -inches.
minutes
8 -inches to 7 -inches
minutes
PERC RATE s3 -Db -- S4"
7 -inches to 6 -inches
minutes
Total Time:
Total Time to Drop:
9 -inches to 6-inches/3 =
9 -inches to 6 -inches
2' os<<
minutes
6656Q
'" minutes/ir.
Test Pit No. 2:
Performed by_Mjie?kjMACK
ENbt►,n�ee��c
SE.l2VtCis jam,
Date_
Soak Time
minutes
@ 12 -inch level. P�.
Time Water Level:
Qe►
--
Drops from 12 -inches
to 9 -inches
/'0'
Time of Drop:
minutes,
9 -inches to 8-inchesmi
nutes
c
.�No C.auEL_
3()
8 -inches to 7 -inches
minutes
PERC nATE �•
7 -inches to 6 -inches
minutes
Total Time53"� � s'
:
Total Time to Drop:
9 -inches to 6-inches/3 =
9 -inches to 6 -inches
minutes
2�MI/cu" U minutes/ir
A dditional sheets to be
attached of
Test Pit Logs -and other
necessary r)at,-
No...................... .F$$..lr..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
vW til...................0 F......../. r.{. f> U•(..E]'.r-...................................
Appliratiuu for Diipnsal lVarkii Touti#.rurtinu Vrrutit
Application is hereby made for a Permit to Construct (k'�or Repair ( ) an Individual Sewage Disposal
System at: L^ L3 G K r Y H 14— L S
..... G6/IZA......ojoikC125a4.�-�`..... I.�j t Z.hLS:...li!A. ......._... _ - �= �' 7
Location •Address - ..."'
//' /t / �( �]/( // // C "/Jy , or LLot`No. ( {.
..i...:.1 /� i �F1GG ... � ��1�. �.Y.:.]:1.../--K....L(.L. i_......
Owner Address
................................•--...........---••--•---.............••--------..............---.............................................
Installer Address
Type of Building Size Lot.._.7.1.._ ....Sq. feet
Dwelling — No. of Bedrooms................":......................Expansion Attic ( )() Garbage Grinder (x )
Other — Type of Building ......................... No. of persons ............... 5!z5z........ Showers (—) — Cafeteria ( )
Other fixtures ..............................................
J
Design Flow.................... .�.0........... gallons per person per day. Total daily flow...................F--_C.�� :'.........gallons.
Septic Tank — Liquid capacity. (J�.f1 LgalIons Length .... .fU�...._. Width....!?........ Diameter__.._.-.._.... Depth...
Disposal Trench — No. ...... 3........ Width..... 3......... Total Length-...'?. ...... Total leaching area....:./ ?....sq. ft.
Seepage Pit No........... .----..... Diameter ...........-...... Depth below inlet .................... Total leaching area .......... ...... sq. ft.
Other Distribution box (✓S Dosing tank (X)
Percolation Test Results Performed by--- 1r16KXRA?MK•_. �V. ' ...5€K�!i �,l.!�L Date ........ : ............
Test Pit No. 1... 4.'Z_-.minutes per inch Depth of Test Pit --------- _. Depth to ground water....... i,_ ........_..
Test Pit No. 2...... �r..Z.minutes per inch Depth of Test Pit...... Depth to ground water......c : �,."._.....
------------------------------
---------------------------------------------
---.----------------------------
-.---- •.....
Description of Soil -------------- .......�.e—:......-U .T:I Ezh.l....... ��.r't!�.�......_._.._...._......._....._..........
......_•---•..............•---•-........---••--------•--•--•-•.........---................----•••-•.......---•------•-•........................_.._.............................-•---.......-•• -• ••......
-------•--------•-•--••-•---•-•---....-•...............•-•-•------......---•--........................_....--•--•---••-------••-•----•--...-•-•--•••--••--••---.......................................
Nature of Repairs or Alterations — Answer when applicable.................................... r-.... ?Sl.•/i-A............................._._.._..
------------------------------------•--••--------...---•••••------•-•-•-•--.....----•••--•----..................---------•------•---..............-----........................•-• • • •----------•••-••-•-
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............................................
Date
Application Approved By..........................
Application Disapproved for the following reasons: .... ..........
............................ ----•---••-•••...----..................
Date
....-•---•----•--•--••-•-•--•---•------•...................• •----••-••• •--•••-•-----
.•-----...••..............••.•.........
Date
Permit No .............................. _.. ___.....___..._ Issued ........................
Date
January 9, 1992
Mr. Mike Rosati, Health Agent
Town of N. Andover
Board of Health
120 Main Street
N. Andover, MA 01845
Dear Mr. Rosati
I attended the Middleton Board of Health meeting of last night so that
might understand who had jurisdiction over a house to be built on Lot # 9 on
Liberty Hills II off Sharpners Road.
enclosed a plan for your reference. You will note on said plan that
the sewage disposal system is located in the Town of Middleton but the
house will be built in the Town of North Andover.
The Middleton Board of Health informed me that since the septic
disposal system is located in Middleton they would be the appropriate party
having jurisdiction. Consequently, you will see from the attached
enclosures that I have submitted a complete application to the Middleton
Board of Health. However, since I feel that you would want to converse with
Leo Cormier, it would be advantageous for you to have the convenience of
all the data and information relating to this matter.
Moreover, if there is something that needs to be submitted to the
Town of North Andover, please so inform me, as I will be happy as to send
you what you might need.
Very truly yours,
Helene M. Driesen
hmd
Enclosures
SUBDIVISION
ASSESSORS MAP
FOIUI U
TOWN OF NORTH ANDOVER
LOT RELEASE FORM
414v,g4 wood ,d� ��rkN
2a- 46' 90 -
SUBDIVISION LOT(S) L -o % OF
PERMANENT ADDRESS (ASSIGNED BY D.P.W.
STREET
APPLICANTPRONE ,'9V- a 7a
DATE OF APPLICATION
TOWN USE BELOW THIS LINE
PLANNING BOARD
DATE APPROVED
TOWN PLANNER DATE REJECTED
CONSERVATION COMMISSION
llAT- APPROVED
CONSERVATION ADMIN. _ ., REJECTED
BOARD OF HEALTH
DEPARTMENT OF PUBLIC WORKS
DRIVEWAY, PERMIT
SEWER/WATER CONNECTIONS
FIRE DEPT.
DATE APPROVED 2 fZ Z
DATE REJECTED
RECEIVED BY BUILDING INSPECTION
DATE
This form shall be signed by the agents of the Planning and Health Boards,
the Conservation Commission prior to the issuance of any building permits
for the subject lot. This form shall not releive the applicant from the
compliance of any applicable Town requirement or Bylaw.