HomeMy WebLinkAboutMiscellaneous - 337 SUMMER STREET 10/3/1995 FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state law,
regulations or requirements.
****************Applicant fills out this section*****************
APPLICANT: 'To QA),0,?A 9J,<SA LL Phone 1 ey-3 _, D
LOCATION: Assessor' s Map Number Parcel
Subdivision Lot(s)
Street 53 2 &,immLQ E-L St. Number
************************Official Use Only************************
RECOENDA O S O 7/GENTS:
Date Approved MQ Conservation Ad ini trator Date Rejected
Comments
Date Approved
Town Planner Date Rejected
Comments
Date Approved
Food Inspector-Health Date Rejected
Date Approved �S-
Septic Inspector-Health Date Rejected
Comments 1V6-"e(5C))Jb ,00,E
Public Works - sewer/water connections
- driveway permit
Fire Department
Received by Building Inspector Date
YT,t t 4 f.. -" -I
0%H.D.-O., H LTH
(,'ffT1',CK ljST
�"[Y[S.AJ-417?OVED 1)NIPE QCAV'ATIO,,N OIL
. ...................
01-11
F,4 1"L OK
Distance To:
Wetlands
Drains
Well
2. Water Line Location
>Ao PVC Pipe
4. SeptigyTanI,,-
is - Length & To Clean Out Covers
Cement Pipe to Tank - On Both Sides of Tank
DlstribuPQ Box
Ogvdf & Box - Sao Cracks
"All Lines Flowing Equal Amounts
No Back Flow
Leach R eld or Trench
DY onsions
Stone Depth
o-1
appe4 Ends
'I � ')
/,CAI(Tan Double Washed Stone
1,e,i c 1-i P i t,P,
Dimensions
Stone Depth
Splash Pads
Toes
Cement Pipe to Pit - Both Mes
Clean DoubTe Washed Stone
BarrarMing Covered System
114 As - Built Submitted
Lot Location
Dimensions of System
Location with Regard to Pere Test
Elevations .-
W
NORTH !MDOV111 BOARD OF HEALTH
M CHEr
1)jBsURFACE DISPOSAL SYSTE X LIST
'U'PROVED PROVID14M DISAPERWM)
00
40
-rD
i1v
91
General-Information
leg. 2.5 Fail OE ',the submitted plan must show as a minimum.o
the lot to be served (area.,dimensions, lot abutters)
location and dimensions of system (including reserve area)
wRc design calculations
�(. , calculations showing re(,ralred leaching area
(e) existing and proposed contours
(f) location and log of deep observation holes-distance tA tie's
(g) location and results of percolation tests-distance to ties
(h) location of any wet areas within 1001 of the sewage disposal
system or disclaimer
surface and subsurface drains within 1001 of sewage disposal
system or disclaimer
location of any drainage easements within 100, of sewage
disposal system or disclaimer
........ known sources of water supply within 2001 of s disposal
system or disclaimer
'(1) location of any proposed well to serve the lot(100 1 from leaching facjjj°
ua,, location of water lines on property (10t from leaching facilities)
(n) maximum ground water elevation in area of sewage disposal system
W"If—jo) location of benchmark
W plan must be prepared by a Professional Engineer or other
professional authorized by law to prepare such plans
,A, (q driveways
garbage disposers
.---,(s) -a profile of the system (elevations of basement,, plumbers pipe
septic tank, distribution box irlots and outlets., distribution
field piping and any other elevations)
W no PVC is to be used in construction
�Ttic Tants
Reg. 6.1 (a) Capacities - 150% of, flow
[leg. 6.7 e f"'(b) Water table
Reg. 6.0 --(c) T v.on
Reg. 6.9 --(,d) Depth of toes
Reg. 6.1 (,e) Acceso
Reg. 6.1f (f) P")ing
g) Cleanout
ieg 3.7 (h) 100 from cellar wall or inground swimming pool
""'M 251 from subsurface drains
leg. 9.1 a Approval
.leg. 9.61 (b) Stand-by power
North A.nrlovox� disposal system check list-Page 2
FnJ_ aion xes
OK,
Reg.10.2 -1:ja). Slope .greater than 0.08
Re .10-h (b) Shnp
Leaching pits are preferred where the installation is possible
Reg.11.2 (a) Calculations of leaching urea (aaainimam, 500 S.F.)
Reg.10.4 (b) Spacing
Rog.11.10 (c) surface drainage 2%
Reg.11.11 (d) Cover material
Reg.35.1 (a) Greater than 20 minutes/inch.
NOW (b) Area (Knimum 900 S.F.)
Reg,.'15-4 Construc Lion of field
Rest; Surface drpi age 2%
(ee)) 201 from cellar wall or inground swinning pool
Re .3 A
Doi,ni4ill Slop e
111 1, Slope Y/x = (• o be shoTm)
(b) YVX X 15D = (to be shown)
f� •
TO: NORTH ANDOVER, MASS 19
BOARD OF HEALTH
FROM: DESIGN ENGINEER Re: Soil Absorption Sewage
System Inspection
This is to certify that I have inspected the construction of the said disposal system at
, 5"`74- - North Andover, Mass.
SITE LOCATION
The grades and construction are as specified in my plans and specifications dated
19 S�dIwo s
e «PVa . E r'neer/ ": Sa nitarian
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