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HomeMy WebLinkAboutMiscellaneous - 101 SUTTON HILL ROAD 4/30/2018 (2)Name f KZ L Address 14) 1 BOARD OF HEALTH 400 OSGOOD STREET NORTH ANDOVER, MA 01845 TELEPHONE# (978) 688-9540 APPLICATION FOR ABANDONMENT OF SUBSURFACE DISPOSAL SYSTEM (SEPTIC SYSTEM) Pursuant to Section 310 CMR 15.354 of the State Environmental Code, Title V Phone C4 7,g ` Ds -z- Llw X11 Rod N. Contractor hired for work: Name 90 t � �j GkS k4 (M Phone 5 Address Date for scheduled abandonment f The septic system at the above address has been abandoned accord' g o Title V specifications. 11A 41- Signa ure of Contractor Method of septic tank abandonment (check one). () removal () sandfill �4 crush ( ) other Name of Offal Hauler J LO)J This form must be returned to the North Andover oard of Health. PLEASE DO NOT WRITE IN THE SPACE BELOW FOR HEALTH REPRESENTATIVE'S USE ONLY. n ectin A ent Date APPLICATION FOR SEWAGE DISPOSAL INSTALLATION HEALTH DEPARTMENT - NORTH ANDOVER, MASS. Barrows>j, Frances 101 Sutton Hill Rd. I hereby make application for a permit for a sewage disposal installation at 101 Sutton Hill Rd, . I will install this system in ac- cordancewith all the laws of the Commonwealth of Massachusetts and regulations of the Board of Health of the Town of North Andover. Further, I will construct the house sewer of bell and spigot pipe, the minimum diameter being 4 inches, and will maintain a minimum grade of 1% until 10 feet pre- ceding the septic tank, where the grade shall not exceed 2%. I will install a con- crete septic tank of 1250 gal, in size. A manhole (s) permitting easy cleaning will be provided with removable cover (s) of iron or concrete within 12 inches of the ground surface. I will provide subsurface disposal field with 4 inch perforated or open jointed pipe and laid in a series of trenches, the bottom of which will pro- vide a minimum of 240 lineal (3Q) feet of effective absorption area. The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging in size from 3/4 to 1-1/2 inches (dia.) and the pipes will be surrounded by similar material to a height of 2 inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench, 2 inches of gravel or stone 1/8" to 1/4" (dia.) will be placed over the course gravel or stone. The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single tile line will exceed 100 feet in length and in any case, two lines of tile will be installed. A minimum of 6 feet will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the installation will be less than 100 feet from any private water supply, 25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line. I further agree not to cover any portion of this installation until approved by the inspection officer, as provided below, and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application. DATE_ Signature ,bf Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DATE ignature of Health Agent I have inspected the uncovered system indicated above and find everything done as described. DATE�-� e�ir� /417(77 lr �� Signature of Inspecting Officer Percolation Test No�done (replace old system) Garbage Grinder 6,, .. ✓ 's -3-105 HEBOARD OF ALTH TOWN OF NORTH ANDOVER, MASS. �� 1. NAQ DATE 2. ADDRESS /0/ S"��'� ff` rfG% LOT NO. TEL. 3. NO. OF BEDROOMS DEN YES NO 4. GARBAGE GRINDER YES NO 5. SHOW DIMENSIONS OF HOUSE 6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES 7. SHOW DIMENSIONS OF LOT 8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL g. NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM 10. SHOW LOCATION OF BROOKS, STREAMS, DITCHES, LEDGE OUTCROP, ETC. 11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE; LOCAL REGULATIONS SHOULD BE READ CAREFULLY. V-11, r'4 APPLICATION FOR SEWAGE DISPOSAL INSTALLATION HEALTH DEPARTMENT - NORTH ANDOVER, MASS. I hereby make application for a permit for a sewage disposal installation at I will install this system in ac- cordance with all the laws of the Commonwealth of Massachusetts and regulations of the Board of Health of the Town of North Andover. Further, I will construct the house sewer of bell and spigot pipe, the minimum diameter being 4 inches, and will maintain a minimum grade of 1% until 10 feet pre- ceding the septic tank, where the grade shall not exceed 2%. I will install a con- crete septic tank of in size. A manhole (s) permitting easy cleaning will be provided with removable cover (s) of iron or concrete within 12 inches of the ground surface. I will provide subsurface disposal field with 4 inch perforated or open jointed pipe and laid in a series of trenches, the bottom of which will pro- vide a minimum of lineal (square) feet of effective absorption area. The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging in size from 3/4 to 1-1/2 inches (dia.) and the pipes will be surrounded by similar material to a height of 2 inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench, 2 inches of gravel or stone 1/$" to 1/4" (dia.) will be placed over the course gravel or stone. The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single tile line will exceed 100 feet in length and in any case, two lines of tile will be installed. A minimum of 6 feet will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the installation will be less than 100 feet from any private water supply, 25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line. I further agree not to cover any portion of this installation until approved by the inspection officer, as provided below, and to incorporate any additional requirements That may be attached to the permit. Plot Plans must be submitted with application. DATE Signature (¢f Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DATE Signature of Health Agent I have inspected the uncovered system indicated above and find everything done as described. �. DATE U L�- \eoT Signature bf nspecting Officer Percolation Test Garbage Grinder 4'� a o ��r�'�-S r �'� BOARD OF HEALTH , EK-- -- �r ' -'- —' �r e � TOWN OF NORTH ANDOVER, MASS. '�re.tSer� N2. C�, , ', i 9 c-, 7 '� c, C('--1 V c�1 At ap 1. 2. DATE _ /Z/l LOT NO. At- jo' TEL. 3. NO. OF BEDROOMS DEN YES N0__ 4. GARBAGE GRINDER YES N0_ 5. SHOW DIMENSIONS OF HOUSE 6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES 7. SHOW DIMENSIONS OF LOT 8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL 9. NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM 10. SHOW LOCATION OF BROOKS, STREAMS, DITCHES, LEDGE OUTCROP, ETC. 11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY. 9 a BOARD OF HEALTH OF NORTH ANDOVER, MASSACHUSETTS SEWAGE DISPOSAL DATE April 3, 1965 NAME OF APPLICANT Mr• Francis Barrows by John Valois LOCATION Sutton Hill Road Address of lot no. BUILDING: Dwelling_ X Other SYSTEM: New X Repair GENERAL DESCRIPTION OF LAND high SUBSOIL: Clay X Gravel_ Sand PERCOLATION TEST minutes per inch. To put in 2'-0" gravel bed. MINIMUM INSTALLATION RECOMMENDATIONS CONCRETE SEPTIC TANK 11250 gallon capacity. LEACH FIELD240 __lineal feet of drain pipe. William J. scoll, Enginee Board of Health SEPTIC SYSTEM INSPECTION FORM ADDRESS (b i [I-)- DATE I1DATE INSPECTED - '9 `V0 PROPERLY FliNCTIONING? ( N WEATHER CONDITIONS COMMENTS: wA i E:R az;ALl i Y T ES TIF N DYE TEST PERFORMED? Y N DATE? SKETCH: WATERSHED RESIDENTS QUESTIONNAIRE 1. Name /" �?/ii✓K l Y11i4{ ��C;t� 2. Street Address /D / S4 W-04 ly, 3. How many members are in your household? 07 4. What type of sewage disposal system do you have? ❑cesspool I� 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 Cedo not know 6. How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years ❑ 11-20 years C'_ 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? ❑ annually ❑ every 2-4 years ❑ every 5-10 years ❑ over 10 years ®/never 9. Have you had any problems with your sewage disposal system? ❑ yes 3;/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 sump pump toilet -3— roof/pavement drains shower/bathtub �?- 11. Please state the brand and ty e (liquid or powder) of detergent you use for: dishwasher �4sc-a clotheswasher 36 12. Does your property have a lawn? ltd yes ❑ no If yes, approximately what size? ; F-1lessthan 1/4 acre F-11/4 acre CRJy '/z 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 zi mG// oac4 f- / c yelar O 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. 0 2. Street Adc re,, ss 3. How many mcnibers are in your household? 9 tvve of sewage disposal system do you have? n,,-loi L p7tic tank and leaching area `:jnnpactian to municipal sewer I 1ne3- (elescr.:be) "} C not know 5. A rc "he plans (drawings) for your sewage disposal system on file with the Board of Health? Yes ❑ no Evk'�"do not know 6. ;-;€o� � old is your sewage disposal system? El0-5years ❑ 6-10 years ❑ 11-20 years [ over 20 years ❑ do not know I ; s your sewage disposal system been rebuilt or repaired? y,. NXno ❑ do not know ,e:, approximately how long ago? years. What was done? ov: frequently is your sewage disposal system pumped out? ❑ annually every 2-4 years ❑ every 5-10 years ❑ over 10 years EU.. -'never ave you had any problems with your sewage disposal system? ❑ yes Nno , SI what problems? ❑ repeated pump -outs needed ❑ system clogs, backs up, or drains slowly ❑ odors ❑ sew -age surfaces through ground z a many of each appliance are connected to your sewage disposal system? �sing€achine d dishwasher I garbage disposal hurnidifier drain sump pump toilet — I-Wpavement drains shower/bathtub -,2- 3, se state the brand and type (liquid or powder) of detergent you use for: �aa.sl-�er �f't�Gr' Feswasher your property have a lawn? 1"1' yes ❑ no s, approximately what size? � ess than 1/4 acre. El 1/4 ' acre L� y 1/Z acre O 3/4 acre ❑ 1 acre +ore than 1 acre (Specify) acres often do you fertilize your lawn? f applications per year 5 f n(s) of the year —$ state the brand and type (liquid or granular) of lawn fertilizer you use: Check here if your ;awn is maintained by a professional landscape contractor.