HomeMy WebLinkAboutMiscellaneous - 120 WOODCREST DRIVE 4/30/2018 (2)r
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SEPTIC SYSTEM INSPECTION FORM
ADDRESS
DATE INSPECTED
PROPERLY FliNCTIONING? Y) N
WEATHER CONDITIONS
COMMENTS:
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WATERSHED RESIDENTS QUESTIONNAIRE
1. Name --� ��l� �- .�L .�.� N�� cam.--
' 2. Street Address \ '�)-� Oen C�A r`5K k -moo
3. How many members are in your household?
4. What type of sewage disposal system do you have?
❑ cesspool
'49: 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 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 sewage disposal system been rebuilt or repaired?
❑ yes '1< 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
oil
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 sewage disposal system?
? washing machines dishwasher x 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. Does your property have a lawn? yes ❑ no
If yes, approximately what size?
less 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?
No. of applications per yeare�-�-
OSeason(s) of the year
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
z6�` Check here. if your lawn is maintained by a professional landscape contractor.
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APPLICATION FOR SEWAGE DISPOSAL INSTALLATION
HEALTH DEPARTMENT - N01M ANDOVER, MASS.
I hereby make application for permit for a sewage disposal installation at
y� sl Z�1 �1���� �� . 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 oft-i—d in size. A manhole (s) permitting easy cleaning
will be provided with remo'vabbl 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 0 - - V 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 / /� 9 �L S
Signature of A licant
I hereby issue the above permit for the Board of Health of the Town of North
Andover, /Mas/sacc usetts.
DATE
Signature of Health Agent
I have inspected the uncovered system indicated above and find everything done
as described.
DATE / ( / L— `�
Percolation Test
Garbage Grinder
N M
Signature olt Inspecting Offi
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4 _♦
7
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.�! BOARD OF HEALTH
TOWN OF NORTH ANDOVER, MASS.
4 (?o}
1. NAME OA h lwc ofl 7 oClt DATE Jac 9 A 719 ` 9
2. ADDRESS or! d e . LOT NO. J'/ TEL.
3. NO. OF BEDROOMS 3 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 .
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.
VV
apd ` Odd & 012
A Nance of Service Since 1897
CONTRACTORS AND BUILDERS
147 Washington Street
Methuen, Massachusetts
682-7901
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Jahn . /-?f� Alc Clrn,`-ock --
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10
NAME OF
BOARD OF HEALTH OF NORTH ANDOVER, MASSACHUSETTS
SEWAGE DISPOSAL
DATE 2
Ez)'_ APPLICANT C'LOCATION
Address of lot no,
BUILDING: Dwelling Other
SYSTEM: New X Repair
f
GENERAL DESCRIPTION OF LAND
SUBSOIL: Clay►��tavel Sand
PERCOLATION TEST (o
minutes per inch,
MINIMUM INSTALLATION RECOMMENDATIONS
CONCRETE SEPTIC TANK. lQ-_gallon capacity,
LEACH FIELD ` lineal feet of drain pipe,
William J. Dr's of , Engineer
Board of Healt
Date:
/ E-qq
Town of North Andover, MA
Watershed Septic System
Servicing Report
Homeowner:
�`�� Pumper %S ��2�
Street 2 O G��3- Address : 1 �� �'� V2�
Phone ( ( Phone?
Nature of Service: Routine
Emergency
Observations: Good Condition
Full to CoverBaffles in Place
` Leachf field Runback 1acp
Excessive Solids��
Heavy Grease
Roots
Other (Explain)
Description of Work:
Comments:
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