HomeMy WebLinkAboutMiscellaneous - 167 HAY MEADOW ROAD 4/30/2018 (2) 167 HAY MEADOW ROAU d
210/104.B-0091-0000.0
Board of Health BEC SZSTEH
North An ver�Masa.
— INSULLATICK CHECK LIST LOTAPN ' 3 `'�, r
(NID DATE DI PROM AVATICN OK FAIL
easnnst
OK
1. Distance Tot
a. Wetlands
b. Drains
`
C. Well
/ 2. Water Line Location
✓✓✓ 3. No PVC Pipe .
4. Septic Tank -
a. _Tess
-• _Length &
To Clean
Out Covers
_
b. Cement Pipe to Tank - Oa Both Sides of Tank
5. Distribution Box
a. Covers & Box - No Cracks
b. All Lines Flowing Equal Amounts
c. No Back Float
/
6. - Leach Field or Trench
a. Dimensions
b. Stone Depth
Ce Capped 'Eads
d. Clem Double'Washed Stone
7. Leach Pits
a. Bions
b. � a Depth
c. ash Pads
d. ees
e. CMMt Pipe to Pit - Both Sides.
f Clean Double Washed Stone
8. No Garbage Disposal
-Final Grading Inspection
10. Barricading Covered System
11. As Built Submitted_
Lot Location .
b. Dimensions of System -
c. Location -Ath Regard-to Perc Test
d. Elevations
Water Table
t
ti
} 1NJ1AJAAk'111.dY litlt9 L JALU LV1 Jr
4S A
OVED DATE , , DQ PRUM EXCAVATIONOb FAII
t —
Fin OK
_ easDnsi
- 1. Distance Tot
a. Wetlands
` b. Drains
>° c. Well
s. 2. Water Line Location
3. No PPC Pipe
�. Septic Tank - -
a. . -Tess--_Length Ec To Clean-Out Cowers- - -
b. Cement Pipe-to Tank ._ On Both Sides of Tank
5. Distribution Box
.101
a. Covers k Box - No Cracks
b. All Lines Flowing Equal Amounts
c. No Back Flow
A6. ' Leach Field or Trench
a. Dimensions
b. Stone Depth
a - Capped Ends
4, 'f d. Clean Double Washed Stone
?. Leach Pit
a. ons
_ b. Sto Depth
C. Sp ash Pads
d. T s
e. ement Pipe to Pit - Both Sides. -
f. Clean Double Washed Stone
fr
x: d'
8. No Garbage Disposal
-Final Grading Inspection
' 10. Barricading Covered System
11. As Built Submitted..
F - a. Lo t Lo cation
b. Dimensions of System
c. Location -with Regard`to Pere Test
d. . ELevations
Water Table j
F
if
:ard�of Health .
3rth Andover,tass .
SUBSURFACE DISPOSAL DFSICN CFWK LIST
LOT �3
A PP.C1VED DATE DISAPPROVED DATE�__�,__
R ov£aeds Reasons:
Title V VFill 09
Reg 2.5 Athe submitted plan must show as a minimum'.
3f)a) the lot to be served-area dimensions lot ,#,abutters
location and log deep observation hoes-distance to ties
c location and results percolation tests-distance to ties
design calculations & calculations showing required leaching area
location and dimensions of system-including reserve area
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 within 100' of sewage disposal
system or disclaimer
location any drainage easements vithin 1001 of serge disposal
system or disclaimer-Planning Board files
(J) known sources of water supply within 2001 of sewage disposal
system or disclaimer
location of any proposed well to serve lot-1001 from-leaching facility
location of waiter lines on property-101 from leaching facility
F) location of benchmark
) 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
tither elevations
r) maAwam ground water elevation in area sewage disposal system
(s) plan must be prepared by a Professional Feer or other
professional authorized by law to prepare such plans
Reg 6 Septic Tanks
(a) capac t es 150 of flow, water table, tees, depth of tees,
access, pumping
(b) cleanout
(c) 101 from cellar wall or inground sig pool
(d) 251 from subsurface drains
Reg 10.2 Distribution Boxes
(a) slope greater 0.08
Reg 10.4 b) sump
Bo, ' of Health
Ni;r,,.. &ndover,Mas s
SUBSURFACE DISPOSAL DESIGN CHECK LIST �
LOT #0?3
APPRMED DATE__ �7
1 � DISAPPROVED DATE____
Provided: Reasons:
1�7
Title V FAIL OK
Reg 2.5 The submitted plan must show as a minimum:
a) the lot to be served-area,dimensions lot #,abutters
b location and log deep observation Mes-distance to ties
c location and results percolation tests-distance to ties
v- d design calculations & calculations showing required leaching area
e) location and dimensions of system-including reserve area
I
) existing and proposed contours
I
) location any tet areas within 100' of sewage disposal system or
disclaimer-check wetlands mapping
(h) surface and subsurface drains within 100' of sewage disposal
system or disclaimer
(i) location any drainage easeaents within 1001 of sewage disposal
system or disclaimer-Planning Board files
3) known sources of water supply within 2001 of sewage disposal
system or disclaimer
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
n) 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) marlmum ground water elevation in area sewage disposal system
s) plan must be prepared by a Professional Engineer or other
professional authorized by law to prepare such plans
Reg 6 Septic Tanks
(a) capacities-150% of flow, water table, tees, depth of tees,
ccess., pumping
leanout
101 from cellar wall or inground swimming pool
(d) 251 from subsurface drains
Reg 10.2 Distribution Boxes
(a) slope greater than 0.08
Reg 10.4 v'" b) sump
I
SOIL t=ROFILE & PERCOLATION TEST DATA
Idorch .vndsver;I.-ss. No.&Street A.cj ,�, Lot No.a 3
Lor_./Subdiv, Plan Ownerze _
Investigator Observer
-7-1--77
SOIL PROFILES-DATE
3.
Elev. ?' Elev. Elev. 4'Elev.
0 0 0
1 Ties to Test Pits
2 2 2 2
F
3 3 3 -----
{ 4 4 4 4
5 5 5 5 -
6 6 6 _ 6
t 7 7 7
p 8 8 8 8
t
9 9 9 9
I
10 10 10 10
Benchmark Location
Elevation Datum
Percolation Tests-Date
Pit Number 1 2 3 4 5
Start Saturation
Soak-Mins. /
Start Test-Time_ 3�
Drop of 3"-Tip,e
Drop of 6"-Tine 6 J
Pains . 2nd 3"Drop S -
Notes & Sketches on Back
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