HomeMy WebLinkAboutMiscellaneous - 142 REA STREET 4/30/2018 (2) { 142 REA STREET 1
1 210/098.A-0010-0000.0
Commonwealth of Massachusetts
R LIE 141"011 i;1VE0
City/Town of North Andover
J%j 07 2014
System Pumping Record
TOWN OF;JOR'i H ANDOVER
<cwM Form 4 LHEALTH 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
Important:When
filling out forms 1. System Location:
on the computer, �—`-
use only the tab � -R Q J
key to move your Address
cursor-do not North Andover Ma 01886
use the return
key. City/Town State Zip Code
2. System Owner:
Name
reran
Address(if different from location)
City/Town State Zip Code
1
Telephone Number
B. Pumping Record
1. Date of Pumping 2. Quantity Pumped: `
Date (5Ions
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
G/
5. Conditi yfs`tem:V(2
6. S umped By:
Name Vehicle License Number
Stewart's Septic Service
Company
7. Location where contents were disposed:
Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835
Signature of Hauler Date
Signature of Receiving Facility Date
t5form4.doc•03/06 System Pumping Record•Page 1 of 1
G Sherwood Homes
�4 Lot 16, Rea St.
APPLICATION FOR SEWAGE DISPOSAL IIBTALLATION
U HEALTH DEPARTMENT - NORTH ANDOVER, MS.
I hereby make application for a permit for a sewage disposal installation at
Lot 16 i Reg St. . 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,Lbeing 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 of _ L000 gal* 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 and laid in a series of trenches, the bottom of which will pro-
vide a minimum of 200 lineal (ire) 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 the 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.
D vel Fill _ _ 6 3
Sign "'f Applicant
I hereby issue the above permit for the Board of Health of the Town of North
Andover, Massachusetts.
DATE_
�J'/�t 1,..1 C? . `�-ZA?_-�- c�j•
Sig tore of Health Agent
I have inspected the uncovered system indicated above and find everything done
as described.
DAA412-
Signature of Insv- ting Officer
Percolation Test 4 min. Soil:
Garbage Grinder No
TOWN OF NORTH ANDOVER 3AN � 6 2005
SYSTEM PUMPING RECOR ) ;:;_a ,
UA ll
SY TEM OWNER. ADDRESS
SYSTEM LOCATION
DATE OF pUMPTNq; .—QUANTITY PUMPED:
C 0SPOOL: 140�'�a _ .... 500c 1'ank: NO. YES
NA rURE OF SERVICE: IkOU'rlNB_,.�ERUI:NC'Y
ObSF-RVA'rioNs:
GOOD CONDrrION PULL ,ro COVER �� �►,
HRAVY 0"-ASE BAP.FL,ES IN PLACE.
ROOT'S LWHRELD RUNBACK
BXCESSIVE SOLIDS_. FLOODED
SOLID CARRYOVER,_..._._-O't{ER EXPLAIN
Sy,tam Pumpcd by
�'uMMENTS.
�.'uN ItN'I'S -rKANSF'ERR.BD I.0