HomeMy WebLinkAboutHealth Permit # 7/12/1993 Town of North Andover, Massachusetts Form NO.3
Ot ,AORTH BOARD OF HEALTH
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19 q3
s •.� 't� DISPOSAL WORKS CONSTRUCTION PERMIT
"SA US
Applicant
NAME ADDRESS TELEPHONE
Site Location
Permission is hereby granted to Construct K or Repair ( ) an Individual Soil Absorption
Sewage Disposal System as shown on the Design Approval S.S. No.
CHAIRMAN, BOARD OF HEALTH
Fee
D.W.C. No.
AS-BUILT CHECK LIST
and
FINAL INSPECTION
Proposed Elevations As®Built Elevation
House x
Tank IN ..w
Tank OUT
D-box IN
D-box OUT �'®°° :a , �"o" � �r A 9,,/-
Trench Inverts
Line 1 >
Line 2 3rd'' /139 ele,
Line 3
Line 4
Bottom of Exc. u �,e
Stone OK? $w-" D®box checked? Pipes cemented?
a
PLAN REVIEW CHECKLIST
ADDRESS f`. ? ' ' i ; r'f R<' � ENGINEER
,F
GENERAL,
3 COPIES STAMP / LOCUS .. NORTH ARROW SCALE
CONTOURS '"" PROFILE .- " SECTION "" BENCHMARK °" SOIL &
PERC INFO ELEVATIONS WETS. DISCLAIMER WELLS &
WETLANDS WATERSHED. ,,L,, DRIVEWAY (Elev) WATER LINE
FDN DRAIN SCH4 0 TESTS CURRENT? " °-
SEPTIC TANK
'
MIN 1500G. . 17 INVERT DROP / GARB. GRINDER ,1 (+200% EDF)
'
25' TO CELLAR "" MANHOLE TO GRADE ELEV GW
D-BOX
SIZE 11, # LINES FIRST 2' LEVEL STATEMENT
INLET OUTLET " /�° _ (2" OR . 17 FT) TEE REQ'D? L)
LEACHING
RESERVE AREAL''= 4 ' FROM PRIMARY?� 100' TO WETLANDS ..� 2% SLOPE
1001 TO WELLS z, 35' TO FND & INTRCPTR DRAINS ._.. ... 4 ' TO S.H.GW
325' TO SURFACE H2O SUPP 4 ' PERM. SOIL BELOW FACILITY P.....
MIN 12" COVER -,,,..... FILL? (25' if above natural elev; 10' if below)
BREAKOUT MET?
TRENCHES
"k.
MIN 660 gpd ` SLOPE (min . 005 or 6"/100' ) >3 ' COVER? ® VENT,,""
SIDEWALL DIST. 2X EFF. W OR D JMIN 6' ) a,µ'" IS RESERVE BETWEEN
TRENCHES? �,,,,'. IN FILL? MUST BE 101 MIN. X; 4" PEA STONE?
BOT X LDNG + SIDE X LDNG = TOT
(L x W x #) (G/ft2) (DxLx2x#)
PLAN REVIEW CHECKLIST
ADDRESS ( �'�'�` .� (° „� ENGINEER
GENERAL
3 COPIES--. ,— STAMP LOCUS SCALE CONTOURS
PROFILE , `” SECTION a..,µ,.°'° BENCHMARK -°° ""` ELEVATIONS SOIL
& PERC INFO WETS. DISCLAIMER "°" WELLS & WETLANDS
WATERSHED? (',) DRIVEWAY ","-"(Elevations) WATER LINE .
DRAINS
" SCH40 e�.�"„�"""� . SLOPE L, TESTS CURRENT?
"
SEPTIC TANK
MIN 15000 "° . 17 INVERT DROP - ”" GARB. GRINDER `) (+200% EDF)
25' TO CELLAR ," MANHOLE TO GRADE ELEV GW
D-BOX
SIZE 5 # LINES FIRST 2 ' LEVEL STATEMENT
INLET � , j - OUTLET14 ,. 71 _ �� (2" OR . 17 FT)
LEACHING
RESERVE AREA w,w„ A 4' FROM PRIMARY? ® 100' TO WETLANDS `-” 2% SLOPE
100' TO WELLS 325' TO SURFACE H2O SUPPA 35' TO FND & INTRCPTR
DRAINS 4 ' TO S.H.GW 41 PERM. SOIL BELOW FACILITY MIN
12" COVER FILL? 25' if above natural elevation; 10' i ' below)
TRENCHES
MIN 660 gpd SLOPE (min . 005 or 6 11/1001 ) >3' COVER? ® VENT
SIDEWALL DIST. 2X EFF. W OR D (MIN 61 ) -L IS RESERVE BETWEEN
TRENCHES? ( " ""` IN FILL,? MUST BE 10' MIN. 4" PEA STONE?
ro ,(" + SIDE c x' ' X LDN " = TOT
(L x W x , > (G/ft2) (DxLx2x#)
w
PLAN REVIEW CHECKLIST
ADDRESS �,, � . ". ENGINEER „
GENERAL,
3 COPIES " STAMP l.�r"°�� LOCUS ." SCALE L" - CONTOURS
6'
PROFILE . "" SECTION BENCHMARK ELEVATIONS SOIL
& PERC INFO WETS. DISCLAIMER" WELLS` & WETLANDS
WATERSHED? ? DRIVEWAY -"'"` WATER LINE ' DRAINS
SCH40 ' . SLOPE
SEPTIC TANK
MIN 1500G. „,' . 17 INVERT DROP ,., GARB. GRINDERS / (+200° EDF)
25' TO CELLAR MANHOLE TO GRADE ELEV GW
D-BOAC
SIZE # LINES 'a FIRST 2 ' LEVEL STATEMENT .""
INLET �' �°aa , " OUTLET (2 11 OR . 17 FT)
LEACHING
RESERVE AREA ""° 4 ' FROM PRIMARY? 100' TO WETLANDS """"" 2% SLOPE r.--
100' TO WELLS 325' TO SURFACE H2O SUPP 35' TO FND & INTRCPTR
DRAINS 4' TO S.H.GW "- 4 ' PERM. SOIL BELOW FACILITY MIN
12" COVER (.,,, , (25' if above natural elevation; 10'if below)
TRENCHES
o'
MIN 660 gpd L SLOPE (min . 005 or 6 11/1001 ) >3 ' COVER? - VENT
SIDEWALL DIST. 2X EFF. W OR D (MIN 61 ) IS RESERVE BETWEEN
TRENCHES? C, IN FILL? MUST BE 10' MIN. 41' PEA STONE?
BOT X LDNG + SIDE X LDNG TOT
(L x W x #) (G/ft ) (DxLx2x#)