HomeMy WebLinkAboutMiscellaneous - 125 CANDLESTICK ROAD 4/30/2018 125 CANDLESTICK ROAD bad
21011060000.0 I
Commonwealth of Massachusetts rRECEEIVED
Cityjownn of No Andover L 10 2013
System Pumping Record TOWN OF NORTH ANDOVER
Form 4 HEALTH DEPARTMENT
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
Importarn:When
filling out forms 1. System Location:
on the computer,
use only the tab
key to move your Address
cursor-do not
dover
use the return No anMa
key. City/Town State
Zip Code
2. System Owner.
Name
oras
Address(if different from location)
CtWTown State Zip Code
Telephone'Number
B. Pumping Record
1. Date of Pumping ate 2. Quantity Pumped:
Ilons
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
i 5. Condition of Systems_ �
S� rho �.' s
St
Name Vehicle License Number
Stewart's Septic Service
Company
7. Location where contents were disposed:
Stewhrt's Pre-treatment Plant 20 So. Mill Bradford Ma 01835
Signature of Hauler Date
Signature of Receiving Facility Date
t5forrn4.doc•03/06 System Pumping Record•Page f of 1
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12.E
Address �At,iio/:2z�q—g.r 12 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 — soildin� Depar t mment
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Board of Health
North Ancjn4eriHaaa. BEPT'IC SISTER
INSTAILKTICK CH3CK LIST LOT
CNID
DATE
IIISAPPdQtiTED AVATIC�J Og FAIL
r: easnnst
FAIL og
I. Distance Tot
i a. Wetlands
b. gains -
` C. Well
i
2. Water Line Location
!t. Septic Tank
..
a. -Tees -_Length & To Clean Out Covers. .
b. Cement Pipe to Tank On Both Sides of Tank
5. Distribution Box
f a. Covers & Box - No Cracks
b. All Lines Flowing Equal Amounts
c. No Back Flog
6. Leach Field or Trench
a. Dimensions
b. Stone Depth
c. Capped Ends
d. Clean Double Washed Stone'
7. Leach Pits
a. Dimensiofie
b. Stone- epth
C. 8p, 'sh Pads
' d. s •
e. Cement Pipe to Pit - Both Sides -
i f. Clean Double Washed Stone
8. No Garbage Disposal
9. -T nal Grading Inspection
10. Barricading Covered System
11. As Built Submitted
a. Lot Location - -- --_ -.
b. Dimensions of System
j! c. Location With Regard-to Perc Test
d. Elevations
I" e: Water Table
i
IS
ljy
t
Board- of Xeal.th
I rth Andov�.r,?' ss
S�JB RFACE DIOPOSAL DF.,SIGY CHECK LIST
LOT # /f
APPRQJID DATE DISAPPRCM UTZ
Provided: Reasons: .
�f
C) led
007
T tie �'t3,.IL 0� . � t4v?
b ~-
Re 2. submitted plan east sho as a Mininw
� g 5 P u 31
s the lot to be cern d-area,dimens`ionq lot #,abutters 417
b location atad log deep obeervation hoes-distance to ties
c location and results percolation tests-distance to ties
designcalculations & calculations choWin
g required leaching area.
location and dimensions of system-including seseIive area
existing and proposed contours
g) ation wet areas n tM 1001 of sewage disposal system or
d�scl.aima-cheek ii—atl.ands napping
fsce and sbstarface drainstSn lit of se �ga disposal
system or disclaimsr
^� L000(i) Xention any drainage ease—mt outs idthin 1.001 of set;-a-ge disposal
system or disclaimear-Plaa�g P3oard files
k is sources of in-ter supply v 4hin 2001 of oe age disposal -
stem or disclaimer
LooO location of a�W' proposed vel]- to sow lot-1001 from leaching facility
'.V. ovation of water Limes on property-101 A;= leaching facility
cation of benchmark
ivel7ays
bage disposals
no PVC to be used in construction -
�q) profile of systsr_—ca. Dens of base..mwevit, plumb, pipe, s piic tank,
a stribtatican b®x 3x lots and G.xtA€sts, cast , butien field .piping and
Mer elevations
wixlEam gromad nater elevation in -xea se-wige aispssal system
(s) Plan rmist be propm-cid by a Fxofes€ional Pb1z,5ar or other
r professional mathorized by law to prepare such plazas
I Rea 6 sc tic TM2ks
7-Fa_cit s-15D% of flaw, L=atex table, ties, dcptMh of tees.,
r ac ess, pum. ing
WMout
101 from cellar ,,-a1 or iW-oLmd m4aaing pool
d) 251 from'sabswfaee &-a-mss
Reg 10.2 Distribution Faxes
slppe greater tT 0.08
Reg 1.0.4 Kb)
f
t
i
I
j> Sabs-1rfac'e Bw^fix' Check Ust Page 2
FAIL OK
L. hLg Pits
Leaching pits ® preferred where the installation is possible
Reg 11.2 a) cal.culat s of leaching area-zLnim m 500 sq ft
11.4b) spac
11.10 .. c sur ce drainage 2%
11.11 dj c er material -
- e) Ix2 SAO splash pad
tee at elbow
g) no bends in pipe from d-box to pipe
Leaching Flelds
Reg 15.1 ) nogre er t-" an 20 mutes/ ch
area- mm 900 sq ft
15.4 construction of field
15.8 d) surface drainage 2 %
3.7 e) 201 from cellar or inground sang pal
Leaching T�,� es' --
Reg 3)4,1 a) cA co 0 o eaching area-min 500 eq ft
14.3 b) spaeing- ft r n 6 .ft with reserve better
' Vi.4 c) dim si s
14.6 d) cons otion
Ih.7 e) stow
111.10 f) surface dr -e 2%
a) s = to be shav:ri)
b) y/x = .(to be shoran)
Reg 9.1 a) app ogal
9.6 . b) s d-by power
t
i
r.• .
'r Board of Health
North Andover,Mass
SUBSURFACE DISPOSAL -DESIGN CHECK LIST
LOT
APPROVED Q� DATE DISAPPROVED DATE______
Pro Reasonss
Title V FAIL
Reg 2.5 The submitted plan must show as a minimums
a) the lot to be serged-area,dimensions loti ,abutters
b location and log deep observation holes-distance to ties
c location and results percolation tests-distance to ties
design calculations & calculations showing required leaching area
(e) location and dimmsions of system-including reserve area
f) existing and proposed contours
(g) location any wet areas within 1001 of sewage disposal system or
disclaimer-check wetlands mapping
,✓ (h) surface and subsurface drains within 100' of sewage disposal
system or disclaimer
,&-'I(i) location any drainage easements within 1001 of sewage disposal
system or disclaimer-Planning Board files
�(3) known sources of water supply within 2001 of sewage disposal a
system or disclaimer
(k) location of any proposed well to serve lot-1001 from leaching facility
1) location of water lines on property-101 from leaching facility
' (m) location of benchmark
a) driveways
(o) garbage disposals
(p) no PVC to be used in construction
✓(q) profile of system-elevations of basement, plumb, pipe, septic tank,
distribution box inlets and outlets, distribution field piping and
Other elevations
�/(r) maximum ground water elevation in area serge disposal system
(s) plan mast be prepared by a Professional Engineer or other
professional authorized by law to prepare such plans
Reg 6 Se tic Tanks
(a) capac t. es- 50% of flow, uater table, tees, -depth of tees,
access, pumping
(b) cleanout
(c) 10t from cellar wall or inground swing pool _
d) 251 from- subsurface drains
Reg 10.2 Distribution Boxes
✓ a} slope greater Uum 0.08
Reg 10.4 b} s�
)Sab_surface Design Check List Page 2
' FAIL 0$
Leaching Pits
Leaching pits are preferred where the installation is possible
Reg 11.2 a) calculations of leaching area-minimum 500 eq ft
11.1 b) spacing
11.10 o surface drainage 2%
11.11 d cover material
e) �'a2'x4" splash pad
P) tee at elbow
g) no bends in pipe from d-box to pipe
Leachin Fields
Reg 15.1 a) no greater thm 20 minutes/inch
b) area-minimum 900 sq ft
15.4 c) construction of field
15.8 d) surface drainage 2 %
3.7 e) 20' from cellar wall or inground mdn d.ng pool
L achin Tbenches
Reg 14.1 a) c .a ons o�Ieaching area-min 500 sq ft
md
14.3 spacing-4 ft n 6 ft with reserve between
14.4 c) dimensions
14.6 d) constriction
14.7 e) stone
31.10f) surface drainage 2%
Downhill Slop e
a) s ope y x -- to be shown)
b) y/x x 150 = (to be shown)
s
Reg 9.1 a approval
9.6 b) stand-by power
td
� �„� e% yrs. ��
.<, � � .--
�� �✓ � �_
Board of Health
T`orthh Azucjpvr: atsa. BKMC ST3T'Ef
INSTALLATICI GIS--WK LIST Lf7t .'
_Pfl 0_ DATEDSARWM AVATI CSOg �7aI L
FM 11.4 -
.. 1. Distance Tot
' a. Wetlands
b. Drains
c- Well
2- Nater Line Location
�..3. No PVC Pipe
Septic Tank
a. _Tees --Length & To Clean Oat Covers. :
b. Cement Pipe to Tank- Cn Both Sides of Tank
5. Distribution Box
a. Covers & Box - No Cracks
b. All Lines FloAmg Equal Amounts
{,
C. No Back Flow
' 6. Leach Field or Trench
1
a. Dimensions
` b. Stone Depth
c Capped Inds
` d. Clean Donble Washed Stone'
7. Leach Pits
f a. Dimensions
b. ne Depth
}' c. Sp Pads
' d. Tees
e. Cement Pipe to -w Both Sides.
f. Clean Double Washed Stone
8. No Garbage Ili spo sal
9• Anal Grading Inspection
` 10- Barricading Covered System
As Built Submitted
- a. Lot Location -
' b. Dimensions of System
c. Location with Regard-to Pere Test
d. Elevations
Y
e: Water Table
1
3
S
t
Joseph B. Cushing
30 Gray Street
North Andover, MA 01845
October 4, 1982
Dr. Julius Kay
Chairman
North Andover Board of Health
Town Hall
Main Street
North Andover, MA 01845
Re: Status of Subsurface Disposal System Construction,
Lot 15 Candlestick Drive, North Andover, .MA
Dear Dr. Kay:
As requested, I have reviewed my logs and notes in order to be
able to determine the status of the Board of Health inspection
relative to the construction of the subsurface disposal system
on lot 15 Candlestick Drive.
I first met with Mr. Budnick relative to this project on June 18,
1982. At that time, .I informed Mr. Budnick that we would be
unable to do any inspections of the construction on this lot
until the certification from the design engineer stated that the
existing construction was in conformance with Title V, the North
Andover Board of Health Rules and Regulations, and the approved
plans. Since that time, I met with Mr. Budnick on several
occasions. The last time was on July 26, 1982. Mr. Budnick was
told that the distribution box was out of level and had to be
reset and that the pipe from the house to the septic tank would
have to be a cast iron pipe. I was assured by Mr. Budnick that
this work would be done the following day and would I be able
to return on the 27th to reinspect it so that he could backfill.
On the afternoon of July 27, 1982, I made a site visit in order
to determine if the work agreed upon the previous day had been
done. There was no change in the status of construction at that
time. An examination of the notes on file at the Board of Health
office will verify this.
If it is the intention of all concerned parties to get on with
this project, I would recommend the following:
a
October 4, 1982
Dr. Julius Kay
Page 2
1. The distribution box be exposed and proved to be set level.
2. The pipe from the cellar wall to the septic tank be exposed
and proved to be cast iron.
3. The material backfilled over the bed be examined to prove
that there are no large stones which may have knocked the
pipe out of alignment.
If I .may be of further service to you in this matter, .I would be
pleased to meet with the Board of Health at their convenience. .
in order to resolve any outstanding misunderstandings.
Sincerely yours,
i
Joseph B. Cushing
JBC/j t