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Home My WebLink AboutMiscellaneous - 15 SANDRA LANE 4/30/2018 (2) `� i WATERSHED RESIDENTS QUESTIONNAIRE 1. Name 2. Street Address 3. How many members are in your household? 4. What type of sewage disposal system do you have? ❑ cesspool ❑ septic tank and leaching area �K 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? i?� 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 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��G' ` 9. Have you had any problems with your sewage disposal system? ❑ yes RJ 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 machine — dishwasher X garbage disposal dehumidifier drain sump pump toilet 4<_ roof/pavement drains shower/bathtub �C_ 11. Please state the brand and type (liquid or powder) of detergent you use for: dishwasher fid -— 5,775�,< clotheswasher Ti n E 12. Does your property have a lawn? yes ❑ no yam, If yes, yes, approximately what size? less than '/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 year oSeason(s) of the year 14. Please state the brand and type (liquid or granular) of lawn fertilizer you use: 4,46 ❑ Checkhere if your lawn is maintained by a professional landscape contractor. 1 NaTne 2. Street Address c 3. many members are in your household? r2 4. 'VVhf;1- type of sewage disposal system do you have? ❑ Cesspool ,,--,Ptic tank- and leaching area connection to municipal sewer other (describe) I i 4.o not know 5. Eire the plans (drawings) for your sewage disposal,system on file with the Board of Health? yes EJ no F do not know 6. Ho-w old is your sewage disposal system? X 0-5 years El 6-10 years El 11-20 years El over 20 years D do not know 7. H;-,.s your sewage disposal system been rebuilt or repaired? El yes no ❑ do not know yec', approximately how long ago? years. What was done? S. 141-ow frequently is your sewage disposal system pumped out? ❑ annually D every 2-4 years El every 5-10 years El over 10 years El -never R. E,;ave you had any problems with your sewage disposal system? El yes no 1: yes, what problems? El repeated pump-outs needed D system clogs, backs up, or drains slowly R odors ❑ sewage surfaces through ground 10. 1 v,, many of each appliance are connected to your sewage disposal system? Wa_,__,'_ng machine �_ dishwasher garbage disposal d0hvy-nidifier drain - sump pump toilet r0of/pavement drains - shower/bathtub R. 11. Please state the brand and type (liquid or powder) of detergent you use for: disc%,vashen cJotheswasher 12. Do(,. your property have a lawn? l yes D no • If N approximately what size? Jess than 114 acre El 1/4 acre El 1/z acre EY 3/4 acre El 1 acre ❑ more than 1 acre (Specify) - acres 13. Ho-.-. often do you fertilize your lawn? N,o. ,if applications per year Sea,, -n(s) of the year 14. P;-'e; state the brand and type (liquid or granular) of lawn fertilizer you use: IZS' ML /-lz�6' — Y s,-;r--r"5' - Check here if your lawn is maintained by a professional landscape contractor. ^"�r J. J. Segadelli, Inc. Lot #13, Sandra Lane APPLICATION FOR SEWAGE DISPOSAL INSTALLATION HEALTH DEPARTMENT - NORTH ANDOVER, MASS. # /5 I hereby make application for a permit for a sewage disposal installation at Lot # 13, Sandra Lane . 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 of 1000 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 180 lineal (fie) 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 1/41, (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 the 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. , 2, Z 57 1,,,J UZ- y Sigri f r� f Applicant I hereby issue the above permit for the Board of Healt�/f the Town of North Andover, Massachusetts. S EP 2 7 1 �}} DATE ignature of Health Agent I have inspected the uncovered system indicated aboveaand find everything done as describ d. DATE OLD Signature of ins cting Office Percolation Test 4 min, Soils Clay Garbage Grinder No I BOARD OF HEALTH TOWN OF NORTH ANDOVER, MASS. -2 Sox, r49 o o_o Q r i ono CAa�. cmic, I _-- ----- V 7 I a- / 7�- 33 I s-b o o + �- Nv 1. NAME ,T✓`eJ�e e o�io/�' 2„ DATE 2. ADDRESS I Z-2 e LOT NO. '�/.y TEL. c,FZ 3. NO. OF BEDROOMS f� 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 + o �- 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. I BOARD OF HEALTH OF NORTH ANDOVER, MASSACHUSETTS SEWAGE DISPOSAL DATE Seatember .l8. .1965 NAME OF APPLICANT J. J. Segedelli, Inc. LOCATION Sandra Lane, Lot #13 Address of lot no. BUILDING: Dwelling X Other SYSTEM: New X Repair GENERAL DESCRIPTION OF LAND high SUBSOIL: Clay X Gravel Sand PERCOLATION TEST 4 minutes per inch. - - - - - - - - - - - - - - - - - MINIMUM INSTALLATION RECOMMENDATIONS CONCRETE SEPTIC TANK 12000 gallon capacity. LEACH FIELD 180 lineal feet of drain pipe. A 1� 3 William J. Dr coll , Engineer Board of Heal ' -r.