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HomeMy WebLinkAboutMiscellaneous - 119 DUNCAN DRIVE 4/30/2018 (2) 119 DUNCAN DRIVE + 210/104.B-0186-0000.0 1 i it RECEIVED Commonwealth of Massachusetts MAR C 7 2013 ugCity/Town of North Andover T©WN OF NORTH ANDOVER System Pumping Record HEALTHDEPARTA�cNT Form 4I� DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important:When filling out forms 1. System Location: ilq T on the computer, 11 use only the tab omie key to move your Address cursor-do not North Andover Ma use the return City/Town State Zip Code key. 2. System Owner: Name relran Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping� g ate 2� luantlty dumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. S stem Pumped By: r-- ame Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: to t Plant 20 So. Mill Bradford, Ma 01835 Signature of Date �- 0�;L h?' � Signat re o e Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 '.1;:(�.�::(i,;C�ii/y,^,4i}:)fi.'.`�.4.';'tii•��tiM�4't:»i��tty't..::;•. i_i _ ,'�`•I�f,YrnM'•'IrI,�::i,• I AL1 YYnr•'/X rr�,j�; ' .,'y„ •r.. � rtj t�t�r,'(br�Jl+may;',J. .. 4 � RECEIVED S YBTBht DEC0 6 2005 PIJMPINQ Rpc ' k 1.. $YsrsM C) 6R t �h 'S5 _ TOWN OF NORTH ANDOVER HEALTH DEPARTMENT NQ...,.,. . )vuuc I via ti; rvxb Or 3�Rvt GOOD , vy rvu. ['u Rom.. 0�- 438 IN 8XCUMS � �OLID(7AMYp PLOODeC) ONER•EXPLAIN l'UMM�NT�. • �N t•�Ni•� rx�iNyr�xx•�v t: y. Insurance Adjustment Service, Inc. 435 King St. Littleton, MA 01460 (978) 952-6966 Fax (978) 952-2459 UNDER MASSACHUSETTS GENERAL LAWS CHAPTER 139, SECTION 3B Date: February 8, 2005 TO: Board of Health/Building Inspector Town of N Andover N Andover, MA 01845 RE: Insured: Michael &Ann Bova RECEIVED Property Address: 119 Duncan Dr. FEB 1 1 2005 North Andover, MA 01845 TOW O HNORTH DEPARTMENTDOVER Date of Loss: 1/29/2005 Policy Number: HP2041174 Type of Loss: Burst pipe File or Claim Number: 20462 Claim has been made involving loss, damage or destruction of the above captioned property,which may either exceed$1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6,to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 38 is appropriate,please direct it to the attention of the writer and include a reference to the captioned insured, locations,policy number, date of loss and claim or file number. Thank ou f our cooperation. 1 urs, i Patr o Adju ter Ext. 1 FORM U - LOT RELEASE FORM q`03 INSTRUCTIONS: This form is used to verify that all necessary approvals/permits frog Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements_ ***************APPLICANT FILLS OUT THIS SECTION******,*-***-*,t********," /y1�c j APPLICANT e-L �(�> PHONE LOCATION: Assessor's Map Number I PARCEL SUBDIVISIO/N LOT(S) STREET /r-! ���tsC�l� `� ILIO. �( '� rC ST. NUMBER. 1 i *******`OFFICIAL USE RE MMENDATIONS OF TOWN AGENTS: C NSERVATION ADMINrRATOR DATE APPROVED DATE REJECTED o� s� COMMENT M 1c� �i�¢. IJ 6= t.n clear G�+� �n�'or-�e,�v.�+ r u✓nr K .ST Q d Cn�/dtL� o� �C�frhrT- does czol mcel SQA ho-bwld TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS i FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPE OR-HEALTH DATE APPROVED. d DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR —DATE— Revised - Revised 9\97 jm %F/ED 70. t Job No. g62.9C 20 7]' 95 'ZoT 3/� i 19,2 m o lo zs— 5-b mss' O �0 ' O ��p`tp OF Mass \ i G?O 0,6,411V,,,l�' cA5,AWFNT oy► HMF190N 9� // `�• A. v -404, This plan was not prepared from an instrument MORTGAGE LOAN INSPECTIOt survey. Offsets and distances shown should not LOCATION: 113 011AIr-4/V OR be used to establish property lines. This plan is intended for mortgage purposes �' 4A.00 YleE_4 �lq, only. SCALE: �s NOTED DATE: 7-16-� i I certify that the structure shown on this REGISTRY: /,Vo ESSL--X Plan �/,4S in conformance .with the zoning setbacks in effect at the time of construction. TITLE REFERENCE: ' /l30 PG PLAN REFERENCE: 11ZA1V I certify that the parcel shown is /VO 17- located located within a.flood hazard area as depicted on FEMA Flood Insurance Rate Maps for COREY & D'ONAHUE, INC. Community No: .25'60 98 Engineers&Surveyors 198 Cambridge Road,Woburn, MA 01801 Address _ uc" p Title of File Page 9 of Date File Open: Date file closed: Doc Document/Action Title Date of Refer to other Purpose of Document/Action and notes action Document/ document/ Num. Action Department Board of Appeals - Board of Health - Planniing Board - Conservation CommiSsion - Building u dingy Department � G~ t WELL DATABASE f ADDRESS: AGE OF WELL: WELL DRILLER: WELL PERMIT" WELL LOCATION: WELL PERMIT DATE: DEPTH OF WILL: TYPE OF WELL: a.. DRILLED b. DUG c. UIN NO WN TYPE OF WATER BEARING ROCK: ? WATER ANALYSIS DATE: HIGH MANGANESE: Y N HIGH IRON: Y N OTHER CONTAMINANTS: Y N M o �`"'' Yip Health `*.;, w SEPTIC SYSTEM INSTALLATI K ClftK LISP LOT DATE DI PROVED EXCAVATION OK FAIL 1i � � -�;,�-t' easonst 10 f= � I OK ZCo Z 1. Distance Tot a. Wetlands p f?oc_v,_ , b. Drainsr_ ,o�� ��� � Z- 'T Q.82. c. Well NiAoGCi� pw 2. Water Line Location 7r,� 36 No PPC Pipe fit. Septic Tank- a. Tess --Length & To Clem Ont Covers b. Cement Pipe to Tank - On Both Sides of Tank t 5. Distribution Box a. Covers & Box - No Cracks b. All Lines Flowing Equal Amounts c. No Back Flow i b. Leach Field or Trench a. Dimensions b. Stone Depth c. Capped 'Ends d. Clean Double Washed Stone 7. Leach Pit a. ons b. Sto Depth c. ash Pads. d. eas e Cement Pipe to Pit - Both Sides f. Clean Double Washed Stone S. No Garbage Disposal 9. Final Grading Inspection u 1,6 �4 10. Barricading Covered System 11. As Built Submitted a. Lot Location _ b. Dimensions of System c. Location with Regard-to Perc Test d. Elevations e. Water Table SUBSURFACE DISMOSAL DESICM, CHECK LIST Lar ` 413------------ -D�N C,4►J D�. APPROVED DATE DISAPPROVED DATE Provided: �` Reasons: q 7- ZC-C,J12cS 3" OF SIS,' BIZ G2JS1 Title V FAIL Reg 2.5 The submitted plan must show as a minimum: a) the lot to be served-area,dimensions lot #,abutters b location and log deep observation hoes-distance to ties c location and results percolation tests-distance to ties design calculations & calculations showing location and dimensions of required leaching area existing and system-including reserve area g proposed contours g) location any wet areas Within 1001 of sewage disclaimer-check wetlands mapping ewag disposal system or (h) surface and subsurface drains within loot of sewage disposal system or disclaimer i) location ani• drafnage easements vithin 1001 System or disclaimer-Planning Board Piles of sewage disposal ( ) know sources of -water system or disclaimer � within200 of sewage disposal e location of MY proposed well to serve lot-100j from leaching facility location of water lines on property-10, from leaching facility (m) location of benchmark - driveways driveways o garbage disposals no PVC to be used In construction (q) Profile of system-elevations of basementj, plumb distribution box inlets and outlets, distributionl field piping tank Other elevations P PSS and, s) Plan maximum ground P�Pad a le tion in area seg,-age disposal system ionalor Professional authorized by law to preps Engineerresuch plaann other �Pas Reg 6 � S tic Tanks(a) capacit es-150% of flow, imter table, tees depth of access, pumping P tees, b) cleanout c) 10 f from cellar wall or ingr ound swimming pool (d) �5, from subsurface drains Reg 10.2 / Distribution Boxes a) s Reg 110.4 ( ope greater an 0.08 b) sump Lih -^ - -4-A Cheek List P45ze 2 a- Sn FAIL CK Leaching-Pits Leaching pits are preferred mere the installation is possible Reg 11.2 a) calculations of 1 area-mLnimum 500 eq ft 32.x, b) spacing 11.10 c) surface 2% 11.11 d) cover mate e) k'x2+x4" lash pad f) tee at box g) nob ds in pipe from dg-box to pipe - Leaching Fields Reg 15.1 ) o greater t 20 minutes/inch area-minim 900 sq ft 15.4 construction of field 15.8 I ) surface drainage 2 % 3.7 e) 201sfrom cellar wall or inground auimming pool Leachinp, Temches Reg 1 .1 a) c Scup moons o thing area-min 500 sq ft 14.3 b) spacing-4 ft 6 ft with reserve between 14.4 c) dime sions 31.6 d) construc 14.7 e) stone 1lt.10 f) sur a drainage 2� Downhill Slop e slope —y7x - to be shown) b) y/x X 150 = (to be shown) s Reg 9.1 a) Wroval. 9.6 Abystand-by power t Boalrd o"Fr P_I th 27,orth And-­L ,K-,os , SUBSMACE DMIOSAL DEWRI CMK LIST LOT APPP07FD D..TS DIWP GnM DATE -- Provided: Reasons: 4 r s Title V FAIL 09 Reg 2.5 a submittedplan must show as a gym: the lot to be served-area,dimensions lot #,abutters location and log deep observation hoes-distance to ties location and results percolation tests-distance to ties f. design calculations & calculations showing required leaching area location and dimensions of system-including reserve area existing and proposed contours g) location any vat areas Within 1001 of sewage disposal system or fes,( disclaimer-check wetlands :sapping ) surface and subsurface drains within 100' of sewage disposal . system or disclaimer (i) location any drainage eassmants ;,.thin 1001 of sev;age disposal system or disclairmr-PL-mning Board files ,¢ J) knom sources of cuter supply within 200 se of s .ge disposal system or disclaimer location of axw proposed well to serve lot-1001 from leaching facility r ' 1) location of ester lines on property-101 from leaching facility location of benchmark ' ) driveways garbage disposals no PVC to be used in construction (q) profile of system-elevations of basement, plumb, pipe, septic trek, distribution box inlets and outlets, distribution field piping and 1 Other elevations maximum ground water elevation in area sewage disposal system 1,�` s) plan must be prepared by a Professional Engineer or other professional authorized by lax to prcgare such plans i Reg 6 S tic Tanks (a) capacities-�50� of flow, water table, tees, depth of tees, access, pumping (b) cleanout e) 101 from cellar wall or inground swimming pool (d) 25+ from subsurface drains Reg 10.2 Distribution Boxes (a) s pe greater 0.08 Reg 10.1 b) sump f r i Submsface Daaign Check List _Pan 2 FAIL OK LeachingPits Leaching pits Pre preferred sphere the installation is possible Reg 11.2 a) calculations of lcaching area-nd nim m 500 sq ft 1.1.4 b) spacing 11.10 c surface dra,isi"age 2% 11.11 d� cover M terial e) ' sp splash pad P) tde at elbow Z) no bends in pipe from d-box to pipe Leaching Fields Reg 15.1 ) no greater EW 20 minutes/inch 7. bb area-minimum 900 eq ft 15.4 7 construction of field 15.8 d) surface drainage 2 % 3.7 e) 201 from cellar xall or inground swimming pool Leaching famc�hei Reg 14.1 a) calcu eaching area-izdn 500 sq ft 14.3 b) spacing-lit min 6 ft with reserve betk-jen 14.4 c) dimesns ,. 14.6 d) con I ction 14.7 e) scene 14.10 f) surface drainage 2% DosmhM Slope a) slop9v"y xto be shown) b) y/r 150 = (to be shorn) Puma, Reg 9.1 a) jst� 9.6 b) power