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BoLrd of Health s
-Nce..Y .indoversXass
SUBSURFACE DISPOSAL DESIGN CHECK LIQ.
^ LOT
APPROVED DATE_ DISAPPROVED DATE
Provided: Reasons:
Title V FAIL 0!C
Reg 2.5. The submitted plan must show as a minimum:
a) the lot to be served-area,dimensions got # abutters
b location and log deep observation hoiis-distance to ties
c location and results percolation testi-distance to ties
d design calculations &calculations sb ming required leaching area
(e) location and dimensions of system-ind uding reserve area
f) existing and proposed contours
(g) location any wet areas within 100' of sewage disposal system or
disclaimer-check wetlands mapping
(h) surface and subsurface drains with ,n 1101 of sewage disposal
system or disclaimer
(i) location any drainage easements within luo' of sewage disposal
system or disclaimer-Planning Board fi-es
(3) known sources of water supply within 200' of sewage disposal e .
system or disclaimer
(k) location of atq proposed well to serve lot-100' from leaching facilit.
(1) location of water lines on property-10' from leaching facility
(m) location of benchmark
(n) driveways
(o) garbage disposals
(p) no PVC to be used in construction
-- - --._.._ (q) profile of system-elevations of basement, plumbs pipe, septic tank,
distribution box inlets and outletss distribution field piping and
Other elevations
(r) maximum ground water elevation in arca sewage disposal system
(s) plan must be prepared by a Profession l Engineer or other
professional authorized by law to pre; are such plans
Reg 6 Septic Tanks
(a) capacities-1507, of flow, water table, tees, depth of tees,
access, pumping
(b) cleanout
(c) 10' from cellar wall or inground s tw ing pool
(d) 25' from subsurface drains
Reg 10.2 7 Distribution Boxes
(a) slope greater Um
0.08
Reg 10.1 b) sump
9n�pace Design Check List 2
• FAIL OK
Leaching Pits
Leaching pits are preferred where the installation is possible
Reg 11.2 a) calculations of leaching area-rdnimum 500 sq ft
11.4 b) spacing
n ao c) surface drainage 2%
?1.11 d) cover material
e) IW IAR splash pad
f) 'tee at elbow
g) no bends in pipe from d-box,to pipe
Leaching F eelds
Reg 15.1 a) no greater urian 20 minutes/inch
b) area-minimum 900 sq ft
15.4 c) construction of field
15.8 d) surface drainage 2 %
3.7 e) 201 from cellar wall,or inground M dmsdng,cool
Leachina Wenches
Reg 14.1 a) c�a. cul a ons or iLeaching area-min 500,sq ft
14.3 kb) spacing-4 ft min 6 ft with reserve between
14.4 kc) dimensions
14.6 d) construction
14.7 e) stone
14.10 f) surface drainage 2%
Downhill 6122 e
a) -slope y x S be shown)
b) y/x X 150 = (to,be shown)
s
Reg 9.1 a). approval
9.6 b) stand-by power
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kORTN
�0 °4,° BOARD OF HEALTH
O p
' s
c° 120 MAIN STREET TEL. 682-6483
X04.♦10'. �y
9SSACHUSEs NORTH ANDOVER, MASS. 01845 Ext23
APPLICATION FOR ABANDONMENT
OF SUBSURFACE DISPOSAL SYSTEM
(SEPTIC SYSTEM)
PURSUANT TO SECTION 310 CMR 15. 354
OF THE STATE ENVIRONMENTAL CODE, TITLE V
This form must be submitted to the Board of Health no less than
five (5) days prior to date of abandonment and be accompanied with
a copy of the sewer connection permit.
Name �< �, ff�. �S� Phone
Address �C Lia--G.A\f- ;c)o e '�A
Contractor hired for work:
Name p,\ 4P_���� �& (`< Phone
Address
Date for scheduled abandonment E� F�f� p
Method of septic tank abandonment (check one) .
( ) removal ( ) sandfill (rush ( ) other (describe
below)
Other
PLEASE DO NOT WRITE IN THE SPACE BELOW
FO HEALTH AGENT'S USE ONLY
Insi A nt Date
Comments
0
1045
APPLICATION FOR SEWER SERVICE CONNECTION
q
North Andover, Mass. I Aw, 19 L
Application by the undersigned is hereby made to connect with the town sewer main in Street,
subject to the rules and regulations of the Division of Public Works.
1
The premises are known as No. l / ✓I el Street
or subdivision lot no.
Owner Address
Contractor Address
Applicant's Signature
r
PERMIT TO CONNECT WITH SEWER MAIN
The Division of Public Works hereby grants permission to
to make a connection with the sewer main at Street
subject to the rules and regulations of the Division of Public Works..
Division of Public Works
By
Inspected by
Date
See back for rules and regulations