HomeMy WebLinkAboutMiscellaneous - 178 BRIDGES LANE 4/30/2018N_
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INSTRUMONS: This form is used to verify that all necessary
approvals/permits from Boards and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state law,
regulations or requirements.
****************Aon.licant fills out- this sect -On***********,*****
APPLICANT: J I M OAAWy 06TP�( 2Z- Phone
LOCATION: As_asscr's Map Number ��Parcel
Su-d_vcn Lots; I L'—P`•
strait 1-78 ��IDC� "
S. Nu.:�er
Use
RECO.'!��ENCATIONS OF TOWN AGEITTS :
Date An=r .vee Z!y
Date Rei a=tom_
Date App-=ved
Tcwn Panner Date Re; ec-ad
CC:'7. e: __
Data Attrzved
Data Re; ect=__
Date Apt_.,:e-
Data Rei ec-=_
se'•" er «a =er ecnnect_ons
- dr_ve . a%- ce=i t
_ _re Demart-en-
Recti_•: ed �Y Bu-_dina Insrec-cr Da==
Town of North Andover,
Watershed Septic SysLm
Servicing Report
Date: /i - 17 -5,/
Homec,wner: Ptimper
Street Acidress:
Phone
Phone
Nature of Service: Routine
Emercency
ObservationS, Good Condition
Full to Cover
Baffle's in Place
Leachfield Runback
Excessive Solids
Heavy Grease
Roots
Other (Explain)
DescriptJ-6n of' W:)rk.
Comments:
Pit Number
SOIL
PROFILE & PERCOLATION TEST
DATA
Lot. No
North Andover
Nor t
Masi. Street No
` V� /
~
Loc/Subdiv.—
Soak -Minutes- -
Pland
Owner
Investigator
Observer
SOIL PROFILE DATES
Drop of 3" -Time
1 ev1ev
2 F.
�4
3 .Elev
4.Elev
-
Drop of 6", -Time
_
0
146ns.lst 3" drop
_
TY;ins.2nd-- "
1
-
l
_
1
_
1
�-
Ties to Test
Pits
' 2
-
2
2
3
3
3
3
5
5
5
5
01
-
—_-10- .. —
10 - _
10
Location:=:��:.--_.._
_.
Elevation
Datum
--- --
PERCOLATION TESTS
ri n mac
Pit Number
Start Saturation
Soak -Minutes- -
ar •yes lm-�
Drop of 3" -Time
_
-
Drop of 6", -Time
_
146ns.lst 3" drop
_
TY;ins.2nd-- "
-
_
Percolation
_
�-
Health
..,.dudover, Mass
APPROVED DATE - 6
Pi-ovided:
SUBSURFACE DISPOSAL DESIGN CHECK LI'T
DISAPPROVED
Reasons:
LOT # IH 131 I%`—_
DATE
Title V
Reg 2.5
f
Reg 6
--- --- -
Reg 10.2
Reg 10.1
FAIL
CK
The submitted plan must show as a minimums
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 shoving required leaching area
(e) location and dimensions of system -including veserve area
f) . existing. and proposed contours'
(g) location any wet areas within 1001 of swage disposal system or
disclaimer -check wetlands mapping
(h) surface and subsurface drains within lCXI of sewage disposal
system or disclaimer i
(i) location any drainage easements wt.thin 1)01 of 'sewage disposal
system or disclaimer -Planning Hoard fila a
(j) known sources of water supply within 20Ct of sewage disposal e
system or disclaimer
(k) location of any proposed well to sei.e �t-1001 from leaching facility
(1) location of water lines on property -101 u�m leaching facility
(m) location of benchmark,
(n) driveways
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) maximum groundwater elevation in area sewage disposal system
(s) plan mast be prepared by a Professional Engineer or other
professional authorized by law to prepare such plans
Septic Tanks
(a) capacities -150% of flow, water table, tees, depth of tees,
access, pumping
(b) cleanout
(c) 101 from cellar wall or inground swimmir, g pool
(d) 251 from subsurface drains
Distribution Boxes
(a) s . pe greater MZ'0.08
b) strap
'(o).
TOWN OF
SYSTEM
DATE: LI -L S7
SYSTEM OWNER & ADDRESS
�
PaY-Z
RECEIVED
G RECORD Nov 19 2004
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
SYSTEM LOCATION
(example: left front of house)
DATE OF PUMPING: S" QUANTITY PUMPED: GALLONS
CESSPOOL: NO YESEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE-7EMERGENCY,
OBSERVATIONS:
GOOD CONDITION
HEAVY GREASE
ROOTS
EXCESSIVE SOLID
SOLIDS CARRYOVER
FULL TO COVER
BAFFLES IN PLACE
LEACHFIELD RUNBACK
FLOODED
OTHER (EXPLAIN)
SYSTEM PUMPED BY: Bateson Enterprises, Inc.
COMMENTS:
CONTENTS TRANSFERRED TO: G.L.S.D, Lowell Waste
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Board of Health
North AndOVer_tmaae. SEPTIC SISTER
-. INSTA.ZATICK CHECK LIST
�P OVED DAs' DI SAPPRCVED
flea Bons t
LOT'S
X AVATICN OK RUL
1. Distance Tot
a. Wetlands
b. Drains
c.. Well
2, Water Line Location
3. No PVC Pipe
4. Septic Tank
a. ..Tees -_Length & To Clean Out Covers.
b. Cement Pipe to Tank Oa Both Sides of Tank
5. Distribution Boa
a. Covers & Box - No Cracks
b. All Lines - F10-.Ang Equal Amounts
c. No Back Flow
6. Leach Field or Trench
a. Dimensions
b. Stone Depth
co Capped Eads
d. Clean Double Washed Stone'
7. Leach Pits
a. Dimensions
b. Stone Depth
c. Splash Pads. ,.-
d. Tees
e. Cm, aat Pipe to Pit - Both Sides
f. Clean Double Washed Stone
8. No Garbage Disposal
9. Final Grading Inspection
10. Barricading Covered System
11. As Built Submitted
a. Lot Location
b. Dimensions of System
c. Location with Regard -to Perc Test
d. 'Elevations
e: Water Table