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Home My WebLink AboutHealth Permit # 8/2/2004 xA � ,✓ y ,,. Map-Block-Lot Commonwealth of Nlassachosetts 107.A-0144 No Board Of Health Fern,�t f l ✓ BHP-2004-0553 i North Andover l 9FY ✓ DIY i✓'''"r , r'- f, .f FEE �r�. t'�n"t ✓ r ✓ ✓ Q��^��at� �,�� ✓Fy " $250.00 " ✓ `;1111®rks rmit . � h� �'' ✓ 1 r �� ✓ r' ' ✓ , ' Geor Henderson e -- ✓ ✓ P�rtnrssion t hereby g>Rx"a �T_ r, �'��;�to(G'onst>"uct)�ail`Tndi�dual SeWageDisposalSystem, ' ,,r✓ ::�- ate ✓'f r a - / -------------- -- - � � �ason ox►the;applicahono>��3isposalWorl,�s ConstructionPermttNo BHP -05 Dated August p2;2004 IV '. r Board Of Health ti •j• TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES 0 HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS 01.845 Susan Y. Sawyer,REHS/RS 978.688.9540-Phone Public Health Director 978.688.9542-FAX healtlidel)t@townofnortliaiidover.com www.townoffiordiandover.corn APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: 1 12 P LOCATION: 2 0 On, A-"I d LICENSED INSTALLER NAME: Lq-, ef e-, PLEASE PRINT SIGNATURE:,z� e'e-l'a TELEPHONE# xr CHECK ONE: FULL SYSTEM REPAIR: COMPONENT REPAIR (indicate what parts): NEW CONSTRUCTION: If NEW CONSTRUCTION, please attach the Foundation As-Built Plan. $250.00 Fee Attached? Yes No Project Manager Obligation From Attached? Yes No Foundation As-Built? Yes No Floor Plans? Yes No -7 Approval of Health Agent—/ Date:—, -..�., its 59' �FL W W _ --4 Q x H [x C►3 O r .r �� LO Z l+ + elf LO LL �V'�r p cl- U u co U t U; < C (j) ct� U110 U) ¢ U) �- Lo Lij cn r W co kO �\ LO rn co 11- TOWN OF NORTH ANDOVER pORTH q Q S4eo 46 ti Office of COMMUNITY DEVELOPMENT AND SERVICES �2 5 at fo HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS 01845 "SSACHU5E1 Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX SEPTIC SYSTEM CONSTRUCTION NOTES ADDRESS: 70 —s MAP%7AOT: INSTALLER: DESIGNER: ��k� � PLAN DATE: �n+/� z> BOH APPROVAL DATE ON PLAN: /-a / DATE OF BED BOTTOM INSPECTION: - X AZLE> �� f �'�°�' DATE OF FINAL CONSTRUCTION INSPECTION: ' `� DATE OF FINAL GRADE INSPECTION: SELECT SYSTEM TYPE GRAVITY DISTRIBUTION PRESSURE DISTRIBUTION PRESSURE DOSING HOLDING TANK ADVANCED TREATMENT OTHER COMPONENT SUMMARY FROM PLAN GALLON TANK = LOADING OF SEPTIC TANK GALLON PUMP CHAMBER = / LOADING OF PUMP CHAMBER = TYPE OF SAS = 7..- -F DIMENSIONS AND DETAILS OF SAS: SITE CONDITIONS Existing septic tank properly abandoned Internal plumbing all to one building sewer ❑ Topography not appreciably altered Comments: Page 1 of 4 TOWN OF NORTH ANDOVER of NoRrH q Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 0 '.. . 0 27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS 01845 ACHU5�S�9 Susan Y. Sawyer, REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX SEPTIC TANK ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ gallon tank has been installed (H-10 or H-20) (monolithic or 2 piece) ❑ Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ❑ Inlet tee installed, under access port ❑ Outlet tee (gas baffle or effluent filter) installed, under access port ❑ 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: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ gallon Pump Chamber installed (H-10 or H-20) (monolithic or 2 piece) ❑ Inlet tee installed, under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off float working ❑ Drain hole in pressure line ❑ inch cover to within 6" of final grade installed over one access port ❑ Water tightness of tank has been achieved Visual or Vacuum Test or Water held for 24 hrs ❑ Hydraulic cement around inlet & outlet Comments: Page 2 of 4 TOWN OF NORTH ANDOVER OF NWITH A Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT � p x 27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS 01845 �pSSgCHUS�S�� Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX D-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: SOIL ABSORPTION SYSTEM ❑ Bottom of SAS excavated down to soil layer, as provided on plan ❑ Size of SAS excavated as per plan ❑ Title 5 sand installed, if specified on plan ❑ 3/4-1 1/2" double washed stone installed ❑ 1/8-1/2" (peastone) double washed stone installed ❑ laterals installed and ends connected to header (and vented if impervious material above) ❑ Orifices @ 5 & 7 o'clock positions ❑ Gravelless disposal systems: type, number and location as per plan ❑ Elevations of laterals installed as on approved plan ❑ 40 Mil HDPE barrier installed ❑ Retaining wall (boulder/concrete /timber/ block) ❑ Final cover as per plan Comments: PRESSURE DISTRIBUTION ❑ inch manifold ❑ laterals installed with end sweeps size: material: ❑ Squirt test ft in height ❑ Equal distribution to all laterals ❑ orifice size inch as per plan Comments: Page 3 of 4 TOWN OF NORTH ANDOVER f tyOFTry Office of COMMUNITY DEVELOPMENT AND SERVICES o�o`tit�.o°°°41°m HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS 01845 �'"SSACH„sE�`y Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX CONTROLPANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: ❑ Rated for exterior if placed outside Comments: SYSTEM ELEVATIONS Benchmark: Rod at Benchmark: Height of Instrument: INVERT ON DESIGN PLAN ELEV @ TOP OP PIPE INVERT ELEVATION Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN D-Box OUT Manifold Lateral 1 HIGH Lateral 1 LOW Lateral 2 HIGH Lateral 2 LOW Lateral 3 HIGH Lateral 3 LOW Lateral 4 HIGH Lateral 4 LOW Lateral 5 HIGH Lateral 5 LOW Page 4 of 4 .,, ✓ - �� rl'J A J l i ✓/Il r � fl1�i ��/��ryit J �� i i I if".Jv�r ��d, r1 r ' v� r✓ 1..,,� J �j�ir,,yom� J ' �� b9 Ji 1 i r'";� r� 7 @ i flv J 4l'"'„J' � f`%� �. r 1��Z ��✓ i� / �J JJIf'�- � J ✓ �i Y �fi. 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D � � u ' r' ,,.,,� „t,;,f r., � r l��d,i,�Y�✓ ��V� � :,,„ �ii�� 1 '�„ Nr .,';r J �""',rY�,�� `ern N,� ”.,, /J JI r Jy� 'n � i P � J t✓r,` 9 r✓F �f�� r,��k �i✓�� l' a'< ,�� J� ,z, � /r r � i� �� , y',. �1�r�✓ �'� ✓�jl/� � ✓l�, �a Fviy� J J � � l w, t r J ,w � r r,�K� .g �I�'y -.� � is JF �, wr 1. ✓„ '� m r � ii� �9„ YoJ Wi !o%/ a✓ n �NJ, ��;�' ;iu�� %,ew/r,ti <i /rl1,J��>�� ✓; t � e � r/'�! � �a�?c;� HJ r, i J � a'' 4 �� IY J� '`tl j0,�i� „NYw,��. �S m��o; �,'�n, ir"/,{��,. a��.�fAJrm�r✓�r� ,. w r,;�"1r „�i,✓Ya �fi �,mr.J�� w1�Y x% .��,r0��r„ /��a /',,.(✓�%�G�1��%',( F�.(� ��,v �:.:1.J d%'Y ��)�� 70 Oakes Drive 8/5/04 George Henderson, installer n N% /1, �r r ✓i/�✓ �f kyi �� ,,,. lk� d� '�Y..� �, ,X" ' r!y r //�r�l/ � f +yr�A �f� 'ni'' �4G7�rr'�� l�uhmll�l I craWG� ,a, f� 1 � 1 a o n G t / a ME 70 Oakes Drive 8/5/04 George Henderson, installer