HomeMy WebLinkAboutMiscellaneous - 315 SOUTH BRADFORD STREET 6/18/1986 SEPTIC SYSTEM INSPECTION FORM
ADDRESS
DATE INSPECTED
PROPERLY FUNCTIONING? N
WEATHER CONDITIONS
COt4MENTS
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DYE TEST PERFORMED? Y N
DATE?
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WATERSHED RESIDENTS TI
1. Name 15wLb(Cc.L ,
2. Street Address
3. How many members are in your household?
4. What type of sewage disposal system do you have?
❑ cesspool
septic tank and leaching area
❑ connection to municipal sewer
❑ other (describe)
❑ do not know
5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health?
❑ yes ❑ no [ J do not know`
6. How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years ❑ 11-20 years`
V over 20 years ❑ do not know
7. Has your sewage disposal system been rebuilt or repaired?
❑ yes ❑ no ❑ do not know
If yes, approximately how long ago? years. What was done?
8. How frequently is your sewage disposal system pumped out? [X annually
❑ every 2-4 years ❑ every 5-10 years ❑ over 10 years ❑ never
9. Have you had any problems with your sewage disposal system? 1 yes ❑ no
_ If yes, what problems?
❑ repeated pump-outs needed
X system clogs, backs up, or drains slowly
❑ odors
❑ sewage surfaces through ground
10. How many of each appliance are connected to your sewage disposal system?
washing machine dishwasher 12•— garbage disposal
dehumidifier drain to sump pump 0 toilet
roof/pavement drains 0 shower/bathtub
11. Please state the brand and type (liquid or powder) of detergent you use for:
dishwasher aj a e-
clotheswasher LA)hm k
12. Does your property have a lawn? yes ❑ no
If yes, approximately what size?
❑ less than 1/4 acre ❑ 1/4 acre 1/2 acre ❑ 3/4 acre ❑ 1 acre
❑ more than 1 acre (Specify) acres
13. How often do you fertilize your lawn?
No. of applications per year i
Season(s) of the year
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
❑ Check here if your lawn is maintained by a professional landscape contractor.
WATERSHED RESIDENTS QUESTIONNAIRE
1. Name ._- ec,k cc e wyt.t,(a.�C f
2. Street Address `!1;`:?!1 '!QLC_F-Ac.,eY!A_ _7Z
3. How many members are in your household?
4. What type of sewage disposal system do you have?
❑ cesspool
septic tank and leaching area
❑ connection to municipal sewer
❑ other (describe)
❑ do not know
S. Are the plans (drawings) for your sewage disposal system on file with the Board of Health?
❑ yes ❑ no do not know"
6. How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years ❑ 11-20 years46
9 over 20 years ❑ do not know
7. Has your sewage disposal system been rebuilt or repaired?
❑ yes ❑ no ❑ do not know
If yes, approximately how long ago? years. What was done?
• 8. How frequently is ycur sewage disposal system pumped out? annually
❑ every 2-4 years ❑ every 5-10 years ❑ over 10 years ❑ never
9. Have you had any problems with your sewage disposal system? IJ yes ❑ no
If yes, what problems?
❑ repeated pump-outs needed
system clogs, backs up, or drains slowly
❑ odors
❑ sewage surfaces through ground
10. How many of each appliance are connected to your sewage disposal system?
washing machine dishwasher -- garbage disposal
dehumidifier drain CO sump pump U toilet
roof/pavement drains showerlbathtub
11. Please state the brand and type (liquid or powder) of detergent you use for:
dishwasher _6haL&e_
clotheswasher LA)hjA k
12. Does your property have a lawn? yes ❑ no
If yes, approximately what size?
❑ less than 1/4 acre ❑ 1/4 acre 1/2 acre ❑ 3/4 acre ❑ 1 acre
❑ more than 1 acre (Specify) acres
13. How often do you fertilize your lawn?
No. of applications per year
' Season(s) of the year
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
❑ Check here if your lawn is maintained by a professional landscape contractor.
lie
Pleas forward us as much of the following Information that Is possible;
1. Type of system
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2 . Age
3. LocatioM 16W lot zw
4 - Maintenance records and date of last pumping out
Documentation of repairs and reconstruction
6. Site conditions
7. Builder of system
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Engineer who approved,
Site
System
9 . Installation Frocedi.ire
'10. Problems
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ORDER OF CONDITIONS: LOT P, TUCKER FARMS
242-M282
20, Upon completion of construction and grading, all areas shall be
s! .dpi l i_z& permanently against erosion. This shall be done
either by sodding, mulching according to Soil Conservation Service
nuan Ards , or by loaning and seeding. If the letter course is
chosen, sLab:i_llzakion will be considered once the surface shows
complete vegetative cover has been achieved.
21 . All erosion prevention and sedimentation protection. «asure
found necessary during construction by the North. Andover
Conservap:i_on. Commission will be implemented at the direction
o i the. NACC or Highway Surveyor. ,
22 . Any Ghauges in the submitted plans, Notice of Intent or resulting
from the aforementioned conditions , must be submitted to the NACC
for approval prior_ to implementation. If the NACC finds, by
majority vote, said changes to be significant and/or deviate
from the original plans, Notice of Intent or this Order of
Conditions to such an extent that the interests of the Wetlands
Protection Act cannot be protected by this Order_ of Conditions
,lnd would best be served by the issuance of additional conditions ,
then theNACC will call for another public hearing within 21 days ,
--- at the expense of the applicant, in order_ to take testimony from
all interested parties . Within 21 days of the close of said
public hearing, the NACC will issue an amended or new Order of
Conditions .
23. Any errors found in the plans or information submitted by the
applicant- shall be considred as changes and procedures outlined
for changes shall be followed.
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