HomeMy WebLinkAboutMiscellaneous - 124 BOSTON STREET 4/30/2018 (2) `��
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Commonwealth..of Massachusetts I
City/Town of
System Pumping Record
Form 4
DEP has provided this form for use by local Boards of Health.. The System Pumping Record must
be submitted to the local Board of Health or other approving authority. .
A. Facility Information
Important:
When filling out 1. System Location:
forms the
computer.use
only the tab key Address ,
to move your f / � � • l.�-�✓
cursor-do not
use theretum Cityfrown State Zip Code
key.
2_. System Owner
Name
Address(if different from location)
Cityrrown. State
Zip Code"
Telephone Number
.B. Pumping Record
1: .Date.of Pumping Date 2. Quantity Pumped:
Gallons
3. Type of system: ❑ Cesspool(s) ET Septic Tank_ ❑ Tight:Tank
❑ Other(describe)`
4: Effluent Tee Filter present? 0 Yes 0 No . If yes, was it cleaned? ❑ Yes E] No
5. Condition of.System: .
6. System Pum�edlBY(� (\
�....e..-�, l °��,t✓���J+� ���cam'(
"Nam Vehicle License Number
Company
7. Locatwhere contents w disposed::
S nat Hauler Date
h,ftp://www.mass.9 at r/approvals/t5forms htm#inspect
t5form4.doc-06103
System Pumping Record-Page 1 of 1
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Wk. Campbell, Jr.
J hot 10 Boston St.
APPLICATION FOR SEWAGE DISPOSAL INSTALLATION
HEALTH DEPARTL4CNT--NORTH AIMOVER, MASS.
I hereby make application for a permit for a sewage disposal installation at
,. Lot 10 Boston St.- . I will instar, this system in
accordance 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
preceding the septic tankp where the grade shall not exceed 2%. I will install a
concrete septic tank of _ 750 gad_ 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 open
jointed bell and spigot Ackron pipe at least 4 inches in diameter and laid in a
series of trenches, the bottom of which will provide a minimum of ,152 Lineal
(MMankfeet 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 l/$" 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 in-
stallation 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. T further,
agree not to cover any portion of this installation until approved by the inspection
of_,ficer, as provided below., and to incorporate any additional requirements that
may be attached to the permit. Plot Plans must be submitted with application.
DATE _ 7/18/57
Signature of Applicant
I hereby issue the above permit for the Board of Health of the Town of North
Andoverjv Massachusetts.
DATE
Sidnature of Health Agent
T have inspected the uncovered system indicated above and find everything done
as described.
DATE
Signature 6fjInspeoting Officer
Percolation Test
Garbage Grinder
BOARD OF HEALTH
TOWN OF NMI H ANDOVERO MSS.
7S'a 0A1.baa Lbs
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1. NAP.'.E :Ci4�. rr,. . DATE
2. ADDRESSF . :Z': . . . . . . . LOT NO. TEL ---:2.
3. NO. OF BEDROOM DEN YES . . :* . NO..
4- GARBAGE GRIIv1DER YES NO.. J� .
5. SHOW DIi! PSIONTS OF HOUSE
6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES
7, SHOW DIP!lEiISIONS OF LOT
8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL
9. NOTE DATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM
10, SHOW VOCATION OF BROOKSO STREA169 DITCHES., LEDGE OUTCROP, ETC.
11, SHOW DISTMTCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE
NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY.
July 15, 1957
Miss Mary Sheridan R. N.
Health Agent
Board of Health
North Andover, Mass.
Dear Miss Sheridan:
An examination was made as requested in order to
determine the suitability of the soil for the subsurface
disposal of sewage on the proposed Boston St. Lot No. 10
building site of Mr. William F. Campbell.
The subsoil in the area was a mixture of gravel and
clay and a 2-minute percolation test was conducted.
The land in general is high and apparently dry.
It is recommended that a 750 gallon concrete septic
tank be installed together with 152 lineal feet of drain
pipe in order to take care of an automatic washer.
Very truly yours,
VV
William J. iscoll
0
Add ress� Q 5 7 6 W s� _ Title of File Page 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 - Planning Board - Conservation Commission - Building Department
L
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD .
DATE:
SYSTEM OWNER &ADDRESS SYSTEM LOCATION
(example: left front of house)
�a Gel"
DATE OF PUMPING: QUANTITY PUMPED �� GALLONS
CESSPOOL: NO YES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION FULL TO COVER
HEAVY GREASE BAFFLES IN PLACE
ROOTS LEACHFIELD RUNBACK
EXCESSIVE SOLIDS FLOODED
SOLIDS CARRYOVER OTHER(EXPLAIN)
SYSTEM PUMPED BY:
COMMENTS:
CONTENTS TRANSFERRED TO: