HomeMy WebLinkAboutMiscellaneous - 149 SUMMER STREET 4/30/2018 �. 149 SUMMER STREET _{
'
210/0,38.0- 175-0000.0 �
J
_ RECEIVED
TOWN OF WIN ANDOVER
D SYSTEM P, MPINQ RECORD SEP - 7 2004
TOWN or-
TN DEPARTMENT ANDOVER
SYSTEM OWNER.& ;i 3RESS SYSTEM LOCATION
z,
DATE OF PUMPING:
_._..._._F__7-=.-G..Y__.._...-,QErANTITY pt}M.AEp:
07
s
CLSSPOOL: NO YES Septic !'ark: NU YES
NA rURL Or SERVICE,: KOU TINE !✓ EMk�RCU�N�'Y
013SERVA rIONS:
GOOD CONDITION FULL "TU COVER
HEAVY GREASE BAFFLES IN PLACE:
ROOTS LEACKPIELD RUNBACK __..
EXC s'SIVE SOLIDS FLOODED
SOLID CARRYOVER OTHER EXPLAIN
SYntcm Pumped by
_
COMMENTS,
CON I'EN I'S FKANSI-EF(tiEt) I_()
�» ,§,Pcnu efts ,, ' , 7
AIVDOVER9 MASSACHUSETT
x ti
Setu�mping Record
DEP
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r1d, lry:.j. pt:.,?.,,+.Ir'.fi.,.,:'.j:'C,;f:•u•,n�;,t'.:1'^,S � .; ,
prov(ded thh form for use by Ioc!4- e
be submitted to the.local'Board of Health or oth @ stem Pumping Record m;,s!
r•: :,:r, ;;;,,;i:.Jc%....,, P' thori
A. Facility Inforrh,4tion DEC 0 7 2007 -
lrnortanG
�,TWner,'fna out 1 System Location,
.i(p pn r TL'• u yr ;vuFt I N ANDOVER
^Y tsr
�N' ai TH uEPARTMENT
U", . . "ma /
I
04the tab key Address
to move your:; . ` .
:.;.cursor,•do�Qt
U34 therotum •%'' Clty/Town Stat
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_ ''�; Yt,•{41'w t'i:{t�;ry:, r�•.::. .,'�.i..j':iY,'gr.i'. �,. ;'►•i•:,i' � �� 8 pri ode
}'• ':art. �1;;'r:::a'+ Sys em Ow
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r.
•,,
Yti
Address(If different from beatJon)
y, Ct41(TOWR State'
/�- _ �P Code
Telephone Number
• ."'�' _ '�::.: : �'' � ping . ,.
um Record;
r•� ; ,� 1 Date of Ptimpin9 " `
oate 2, Quantity Pumped;
` all
11'yp,9 pf.systerh:; ❑ Cesspools) ~Septic Tank ons
: ❑ Tight Tank
l :jOther(describe);
4 .Effitaent Tee Filter prQsent?.❑ Ye No' If yes, was It cleaned? ❑ Yes ❑ No
i i 5 .'^�.u.l'i'.'.i1 �•n^l,r 1 AtJ 1•{•�.,..f.,1
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1 '
T Pumped By,
G
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';''' :vtr�1 'j.,i'y r ST. //��Vehlcla Ucen#e Number
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F,...; {.
•�
r
ocafl n Where* '
Fier•
r;,.' •'•,;;> ;: a contents,yvere.dlpposed; •
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-lei
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.w:{i i.�•t: i�'J rr'fi„•n:'/Ji•d•��:...i i�i'' +�• •..;r; "l.l; ;'S:i�� /
b Of Ha Date
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t OMA.doa08/Q3
Sy:tem Pumping Record Page i or 1
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RECEIVE
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DO n (10d 10 1111 rOCll 8^ar+: •1 nOJiln 08t JUN :4
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C .InO lry
A' Faclllty In(orm��lon
HEALTH DEPARTMENT
S � loc�Uon;
IT
.;; ,,•.�L,•', ,y, m Own or,� • �'' , . ,
L90r + (II OVf+r'Ini rpm buUcn) ���
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Pumping.Rs'gord ,
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No o'PumPlnp.'' o+:,4
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6000'10f 1Qf.Mass h
DOVER MASS CH T S
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to gy$t�M ,. P,.,n Record;
FOrnt 4 TOWN OF NORTH ANDOVER
TIMMDEP has provided this form for use by local Boards of Health ord must
be submitted to the local Board of Health or other approving authority.
A: Facility information
important; out 1. System L on:
wt,en ttllam
forms on the
computer,tut --7T— Lnuff IMU
only tht tsb kty Address I
to mow your , � L n/ - r— Zip Code
cu[sor•do not �yRwn State
use tfte rectum
key...., 2. System Owner
Nam
Address(If different from location)
CftyfTown State Zip Code
Telephone Number
S. Pumping Record 1
1. Date of Pumping Quantity Pumped: /canons
Date
3. Type of system: [jGesspool(s) Septic Tank ❑ Tight Tank
,` ❑ Other(describe):
4. Effluent Too Filter present? [j Yes C3 No
If yes,was it cleaned? Yes ❑ No
5. Condition of System: CSS Ilk
6. Sy Pumped
Vehicle Uoense Number
7. Locatlo re contents were disposed: CA
T
3lprtatt of Date
httpJtwww.mass.govldep/w terlapprovals/t5forms.htm#inspect
t5form4.41w 060 system Pumping Record•Page t of f
Commonwe4ith of Massachusetts RECEIVED
City/Town of No Andover JUN 10 2013
System Pumping Record TOWN OFNORTHANDOVER
y
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
Important:When
filling out forms 1. System Location:
on the computer, �L
use only the tab I LSo/3r) e �J
key to move your Address
cursor-do not No andover Ma
use the return Cit frown
key. y State Zip Code
2. System Owner:&� ;
-fa ri
Name
rim
Address(if different from location)
r
City/Town State Zip Code
Telephone Number
B. Pumping Record _
1, Date of Pumping 2. 0`
p g Date Quantity Pumped: Gallons
3. Type of system: ❑ Cesspool(s) eseptic 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:
ame Vehicle License Number
Stewart's Septic Service
Company
7. Location where contents were disposed:
Ste"rt's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835
Si a r Date
Signature of Receiving Facility Date
t5form4.docr 03/06 System Pumping Record r Page 1 of 1
NOV — S 2005
('��wN OF AUK 111 ;lNlh,.�
,)OVER
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ars /� �� � i
/ 9 Sum/Werc) QLI;�.
i
/vD' ��r�c� ver2 ; ma ,
c
.._. ...Qo ANTITY
1 X /
R �'f'1UNJ.
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D CONOITIVN
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KQCT3
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UN ItN rtJl�lNyj XK.6U 11
11V
T 0 CJ o 1-�'
S Y ST E 1'11' C)
U V1 p I
oo--
U R & D DR C S S
S
u'm Ina, ('s �A,-us
PUM11 1 N C
No YES S C PT I c -I ANI<
0 ; SIERVICP
1) U fl, U I T 10
R U c"7,S L E A C 1-1 F I E-' S
�XCESSIVE SOLIDS FLOODED
--
SOL DS 'CARRYOVER 04i-
BY
Y
Board of Health = TW(t)
North An0_overz111aa8. SEPTIC SISTEK
INSTALLATICK. CHEC$ LIST
10xam DUE DISUPROM IRTA MAVATIM Or, FAIL
r
i
`i n OK
f-�u
' 1. Dis .ance Tot oIr
-2t
i' 2q�5 a. letlands - -
b. )rains
2. Water Line Location
No PPC Pipe ---
! Septic Tank
a. _Tees -_Length & To Clean Out Covers ;
' b. Cement Pipe to Tank On Both Sides of Tank
5. Distribution Box
a. Covers & Box - No•Cracks
b. All Lines Flowing.Equal ,Amounts
c. No Back Flow
l/ 6. • Le. ^h -leld or Trench I_2747 V07-e
a.
Din.onsions
1f' b. atone.DepthwQc, �l�q�� I N5R,
c. upped Eads , �EC�J�ST 1 /JO -45 ' UI
d. :lean Double Washed Stone /
/TED
7. Lech Pits
a. Dimensions
• . b. Stone Depth
E c. Splash 'Pads,
d.- 'Tees
e. Cement Pipe to Pit - Both Sides
f. Clean Double Washed Stone
8. No Garbage Disposal
1 � 9. Anal Grafi Inspection
10. Barricading Covered System ".
11. As Built Submitted
a. Lot Location
Dimensions of System
c. Lor,.tion, with Regard-to Perc Test
d. XL ,7ations
e. Water Table
Board of Wealth' V0 72
=.�.Jartt: :�dover�Basa -
w. SUBSURFACE DISPOSAL DESIGN CHCS LIST _IC
LOT # SUS-M
r
APPROM DATE Lz 3-3� DISAPPROVED DATE_
Piovideds Reasonss
�. go 6NX4A6eUr0 qOO
2. NO 64 36r UNlEi� t
Title V FAIL OK
The submitted plan must show as a m n�muni
�N d tE i to be served-area,dimensions lot # abutters
and log deep observation hoes-distance to ties
and results percolation tests-distance to ties
;alculations & calculations showing required leaching area
T��CKLS i and dimensions of system-including reserve area
and proposed contours
i any vet areas Athin 100' of sewage disposal system or
6er-check wetlands mapping
land subsurface drains within 1001. of sewage disposal
_ )r disclaimer
i any drainage easements within 1001 of sewage disposal
;r disclaimer-Planning Board files
3� No perces of water supply Within 2001 of sewage disposal e
—_
or disclaimer
n of any proposed well to serve lot-1001 from leaching facilil
a of water lines on property-101 from leaching facility
6---of benchmark---
to -be used in construction = a
-- -of system-elevations -of.basement, plumb., pipe; septic tank,
r iution-•box inlets and outlets,, distribution field piping and
:levations --
-_ �at_i�on d�=area��ewage-�3spo�$l �tc�m.----- _-
Lst be prepared _ -a Professional Engineer or other `--
donal authorized by law to prepare such plans
Tanks -
bfe—s-- '50% of flog:, kater table, tees, depth of;,.tees,.,- .
acceuss piw:.:.?ing
c
(b) c1rout
(c) 10' from cellar wall or ingroun.d simmm.ng pool
(a) 251 from subsurface drains
Reg 10.2 Distribution Boxes -_
Re _ - - - - -'-
(a) slope greater 0.08
- - g
10.?� b _ � --
f
Board of Health 7,tl- '
;.�Tarth :ind�ver�Hass -
SUBSURFACE DISPOSAL DESIGN CHECK LIST ? TANGLE S
-LOT
APPROM DATE DISAPPROVED DATE 7
Provideds Reasonss -7- 1�4
�. 80 Fti�AG� ro
. r
No G�J►�GF vN ��
12,0-EN 150 d
Title V FAIL Cg i
Reg 2.5 The submitted plan must show as a m;in4 rmimi
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
d design calculations & calculations showing required leaching area
e) location and dimensions of system-including reserve area
f) existing and proposed contours
(g) location any wet areas within 100' of sewage disposal system or
disclaimer-check wetlands mapping
J(h) surface and subsurface drains- within 1001, of sewage disposal
system or disclaimer
1(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 disclair►er
(k) location of arq proposed well to serve lot-1001 from leaching facilii
(1) location of water lines -on property-101 from leaching facility
(m) location-of:_benchmark—
` (n)' :driveways
'..
(P). no PVC to _be used in construction~ -
--- (q) profile-of system-elevations of basement,-plumb' pipe; sptic-sank,
- distribution-=box inlets and outlets, distribution field piping and
�llde�c-�elesations
- swage--d spo.sa3
(r)-insxda� aro ad a =�e3 anon dn:_area= s
- ` (s) -plan mast be prepared by a Professional Eagineer or other
professional authorized by law to prepare such plans
Reg 6 __ Sept 1c Tanks -
-- (a) capacities-150$ of flow, kater. table, tees, depthof-,tees,.-
accec:, per-?ing
1(b) cleanout _
(c) 101 from cellar wall or iuground s-.d.mni.ng pool
(d) 251 from subsurface drains
Reg 10.2 Distribution Boxes
(a) slope greater than 0.08
- Reg 10.4
_ _ _ _ _..._____.,__._____ ..... _
�Iubsurface Desi Check List Page 2
FAIL OK
- " Leaching Pits
.eg 11.2 a) calculations of leaching area-rdmiimm 500 sq_ft
11.1 b)._ spacing,
11-10 c) surface drainage 2%
'!1.11 d) cover material -
e) $'x2'x4n splash pad
f) tee .at elbow -
g) no bends in pipe frcn d-`c to pipe
-
Leaching Yields - - -
.eg 15.1 a no greater than 20 minutes/inch
b area-minimum 900 s4 ft
15.4 c construction of field ,
-15.8 - --- -- d)_snrfaee;drainage=:2 _ -
3.7_ e) 20C from- collar.vall or-ingrown&.swimming pool = _
-- — eaEhches - - —
_
(a) c s o ea g-.areM_ _500�sq Pt
(b) spacing-4 ft min 6 ft with reserve between
c} -
11�:6 d) construction
_- s
,?-_ -_-'- - - - e) stone _--_
1.4.14 f) surface drainage 2%
A .
Dow hill S1 e
--�m a) - slope y x - be shown)
:r
_ - b)-y/x-X-150 (to be shown) ...
PMPS
ag 9.1 a) approval. _
9.6 b) stand-by power
3
y
4 ..
t
e
i
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a{'"'4 rh e. .. _.� :,. r- �. ....•...... .. ":. -.,_ ..... ,aY.. y. '.lA - ,qY if ',.d�, y�'Y"''f6'w°�'.z'�+'+: G�, �"4.e!s� .4 •t 1*�,�4 r[r
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ry
ti t
SOIL PROFILE & PERCOLATION TEST DATA
North >Andover, Mass: Street No �F-� � Lot,No
Loc/Subdiv.
Pland Owner ( AiV 4L, S
Iinvestigator Observer µ� R-
�,� SOIL PROFILE DATES_
l:tel eve
�
2.El ev3,EI ev 4.El ev
IO �- O O
0
Ties to Test
Pits
2 2 . 2 2-
3 3 3 3
-- 5Ai,-o
s _
8 _8 =� _ g
9 --- _ 9 . - 9 __ 9
10 10 - 10 — - 10
Benchmark _ Location
Elevation — Datum
PEROO,.�T I0N TP:�TS
DATES
Pit Number =_ - 1_; ---2 = 3 - -.
- --
Start_Saturation-
Soak-Minutes
Saturation-Soak--Minutes
Drop of 3"--Time
Drop of 6"--Time --
M�r:s.3 s�drop
Mins.2nd " _Drop _
Percolation
le