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Home My WebLink AboutMiscellaneous - 112 LISA LANE 4/30/2018 / 112 LISA LANE J210/098.A-0067-0000.0 WER i t pORTI{ , O BOARD OF HEALTI� I♦ i � a °9 120 MAIN STREET TEL. 682-6483 S„C„USEt`y NORTH ANDOVER, MASS. 01845Ex-t23 V�tN OF NORC�A TO BOARD OF HF,ALT APPLICATION FOR ABANDONMENT AUG 13 1996 � OF SUBSURFACE DISPOSAL SYSTEM (SEPTIC SYSTEM) PURSUANT TO SECTION 310 CMR 15.354 OF THE STATE ENVIRONMENTAL CODE, TITLE V This form must be submitted to the Board of Health no less than five (5) days prior to date of abandonment and be accompanied with a copy of the sewer connection permit. Name /1 50z-r t!: �l�i T-c �( Phone (50,5 �5 7- q q EZ, S Addres s l Z L F Nc, A-Nf'�-o vi F-r& Contractor hired for work: \ Name RF %br---A &A3&-K7E C--r1Qk2 _ Phone �SD�1 aSI --ZLT O Address q6o tkJb8Ltyz-Al S-T- .. --TE-wks au-.jQL44 'NXA 0 1 tWe Date for scheduled abandonment U41257 Z910 /9 OIZO' Method of septic tank abandonment (check one) . ( ) removal ( ) sandfill (xJ crush ( ) other (describe below) Other-DVZ" L IL- v►-� PLEASE DO NOT WRITE IN THE SPACE BELOW FOR HEALTH AGENT' S USE ONLY Inspecting Agent Date Comments 0 SEPTIC SYSTEM INSPECTION FORM ADDRESS 2 L isc, DATE INSPECTED g ' & PROPERLY FUNCTIONING? lJ N WEATHER CONDITIONS COMMENTS : WA t ER 4UALi T Y TES I E'b ? iZESULTS? DYE TEST PERFORMED? Y N DATE? SKETCH: `.'At oz Please forward us as much of the following? information that is possible; 1. Type of system 2 . Ade 3. Locat i onf 4 • Maintenance records and date of Last pumping; out >i 7�- 5. nocumentstion of .repairs and .reconstruction 6. Site conditions -�� 7. Builder of system C A/ JV 8, En?inee r who approved'. Site — S-y s t em I 9 Installation Procedure I.O. Problems r 1 r r 1 WATERSHED RESIDENTS QUESTIONNAIRE 1. Name 2. Street Address `�- O 3. How many members are in your household? 4. What type of sewage disposal system do you have? ❑ spool VK'septic tank and leaching area ❑ connection to municipal sewer ❑ other (describe) ❑ do not know 5. Are the plans (drawings) for yo r 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 years ' ❑ over 20 years ❑ do not know 7. Has your sewaage isposal system been rebuilt or repaired? ❑ yes Lei" no ❑ do not know If yes, approximately how long ago? years. What was done? S. How frequently is your sewage disposal system pumped out? ❑ annually C7every 2-4 years ❑ every 5-10 years ❑ over 10 years ❑ never 9. Have you had any problems with your sewage disposal system? ❑ 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 wage disposal system? washing machine dishwasher garbage disposal / dehumidifier drain sump pump toilet roof/pavement drains shower/bathtub 11. Please state the brand and type (liquid or powder) of detergent you use for: dishwasher clotheswasher 12. Rs our property have a lawn? �es El no approximately what size? 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? r` No. of applications per year 41 OSeason(s) of the year 4- 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. APPLICATION FOR SEWAGE DISPOSAL INSTALLATION HEALTH DEPARTMENT - NORTH ANDOVER, MASS. Ihereby 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 1966 until 10 feet pre- ceding the septic tank, where the grade shall not exceed 2q. 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 anlaid 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 1/8" 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 of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. ; DATE J i 'Z Z� Signat ,e o- fqlealth Agent I have inspected the uncovered system indicated above and find everything done • as described. DATE Signature of I s cting Officer �. Percolation Test Garbage Grinder 1�y //�� ` _ r� /•, J /F /�,/J �/� /,/, ,.o.� //y��++/p.�y .J1 '/ /J \\\J 177J.tt//P////_ _ , /t•'///G�' /7 lG .CiC�-�/[I `'T✓'4.si�� K ��L � CJ�".'�iC/„�� U/�/—✓ BOARD OF HEALTH TOWN OF NORTH ANDOVER, MASS. �� lv _s 1. NAME Cu��. ' �/L .�Gf%Y <j DATE Ci"�/y � / !252 2. ADDRESS iGpJl0 O�CL�2lJ IAT NO. TEL. 3. NO. OF BEDROOMS DEN YES NO 4. GARBAGE GRLNDER YES NO 5. SHOW DIMENSIONS OF HOUSE 6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES 7. SHOW DIMENSION:, 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 CF BROOKS, STREAMS, DITCHES, LEDGE OUTCROP, ETC. 11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY. t BOARD OF HEALTH OF NORTH ANDOVER, MASSACHUSETTS SEWAGE DISPOSAL DATE )I_2q_t7.p NAME OF APPLICANT Rosario L, Consol_i LOCATION T, t. 6 T,i isa Lane Address of lot no. BUILDING: Dwelling Other SYSTEM: New Repair GENERAL DESCRIPTION OF LAND high SUBSOIL: Clay_ Gravel Sand PERCOLATION TEST minutes per inch. I MINIMUM 'INSTALLATION RECOMMENDATIONS CONCRETE SEPTIC TANK 1000 gallon capacity. LEACH FIELD 200 lineal feet of drain pipe. William J. Dris o 1, Engineer Board of Health O t , - L Town of North Andover, MA Watershed Septic System �\ servicing Report Date: Homeowner: Pumper Street Address: S Phone / Phone ye ,Q I Nature of Service: Routine Emergency Observations: 'Good Condition Full to Cover Baffles in Place Leachfield Runback Excessive Solids Heavy Grease Roots Other (Explain) I Description of Work: I Comments: i WELL DATABASE ADDRESS: AGE OF 7iv=E WELL DR T LE? WELL LOCATION: ---WELT P ySi'_'DA rE: DEPTIE-1 OF W IE ; =E OF W LL a_ DRIL= b li L,I'�-V'0WI --- -= 1- 0FWA.T-FEARING ROCK—_- WA.TA.NALYSIS DAA--- FLGiitilANC�1�TESE_ Y N - ELCIRaN: Y N OZ CONTAMINANTS: y �'v'�T• DATA.�A�E . . _ ADDRESS: 3 S AY AGE OF Vy : Wt: DRILLER .WELL PERI T- 7f=lo-CATION: WELL;PERtiLT DATE: DEP7H OF WELL: r TYPE OF WELL a-. DRIi.LED b. DLG TYPE OF WATER BEARI iG ROCK: WATER ANNAi YSIS DATE: Y N I-ECH IRON: `! N OT FR CONTA ANTS: Y N �} 9 C-)