HomeMy WebLinkAboutMiscellaneous - 171 BRENTWOOD CIRCLE 4/30/2018 171 BRENTWOOD CIRCLE C le
2101064.D-0042-0000.0
tSEWER
J .
NOR�r,
Of
BOARD OF HEALTH
X77
•,; ;,, y' 120 MAIN STREET -6483
CHO NORTH ANDOVER, MASS. 01845 NOR�µH�P�oN� Xt2
��+eoA�o pF
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 Phone
Address 1 �•P�l `�� w" C
101
Contractor hired for work:
Name o �u Phone (OW'S —S-'-70(?
Address
Date for scheduled abandonment G �a
Method of septic tank abandonment (ch ck one) .
( ) removal ( ) sandfill crush ( ) other (describe
below)
Other
PLEASE DO NOT WRITE IN THE SPACE BELOW
FOR HEALTH' AGENT'S USE ONLY
r
Inspcti g gent �---- Date
Comments
N° 966
APPLICATION FOR SEWER SERVICE CONNECTION
North Andover, Mass. ��• 19
Application by the undersigned is hereby made to connect with the town sewer main in l�lP.�l�� C'�`�
—T— Street,
subject to the rules and regulations of the Division of Public Works, / /
The premises are known as No._ 71R?tz�t•����1 �f�'GE'_ Street
or subdivision lot no.
Owner Address
ant
Contractor Address
Applicant's Signature
ce
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
7Cc2.c.?
4
APPLICATION FOR SEWAGE DISPOSAL INSTALLATION
HEALTH DEPARTMENT - NORTH ANDOVER, MASS,
hereby make application for a permit for a sewage disposal installation at
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 4et� el 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 lineal (square) feet of effective absorption area.
The pipes will be laid on a 6inch 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 1/811 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
tile 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 �. < C
Signature of Appficant
I hereby issue the above permit for the Board of Health of the Town of North
Andover, Massachusetts.
DATE �- �• �
.. , ' g ature of'Health Agent
I have inspected the uncovered system indicated above and find everything done
as described.
DATE L
Signatur f Inspecting Of-Acer
Percolation Test '-
Garbage Grinder
BOARD OF HEALUE
TOWN OF NORTH ANDOVER, MASS.
t? \
1. NAME / DATE
2. ADDRESS LOT N0. I I TEL.
3. NO. OF BEDROOMS DEN YES V NO
4. GARBAGE GRINDER YES V NO
5. SHOW DIMENSIONS OF HOUSE
b. 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
10. SHO« 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.
L J HOLxl I I v r�-cyyJ-1,Vk—ivI
ORM - U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve the
applicant and or landowner from compliance with any applicable requirements.
i..........■e. ............................■.......a...........-.....Oman...■
APPLICANT 0ck Ferro n f c )fkONE
ASSESSORS MAP NUMBER iOT NUMBER L4 a
i
SUBDIVISION LOT NUMBER
STREET e✓)+woo u Ci rC l 6TREET NUMBER 1 -7 /
OFFICIAL USE ONLY
loommmanO mnmmmamam as mam.OmmOm momm OOnnn..naan.■■aaO.On..Manaus an an am cmmmmm ones
RECOMMENDATIONS OF TOWN AGENTS
'o"4= DATE APPROVED
CONSERVATION ADMINISTRATOR
DATE REJECTED
COMMENT'S
- r--,OL- `e.✓" W arV, I-N to t
A& DATE APPROVED S
TO/AW P ' R 4
DATE REJECTED V
COMMENTS �61rj 4 1,4,n (,)r I L6161m aLz Al-l la-k- aLe o
DATE APPROVED S
FOOD INSPECTOR-HEALTH DATE REJECTED R
DATE APPROVED
SEPTIC INSPECTOR-HEALTH 1
DATE REJECTED
COMMENTS
PUBLIC WORKS-SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
DATE APPROVED
FIRE DEPARTMENT
DATE REJECTED
COM]V[E 1S 9
9
RECEIVED BY BUILDING INSPECTOR DATE 3#)
i
j
F