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HomeMy WebLinkAboutMiscellaneous - 1797 SALEM STREET 4/30/2018A. Facility Infc-"'r'tion �) location; "1 �a �: ��� QST �::-61► "^b -x ocool Aea_ _... wl� ��„ ',,;.,.:•� ;.System Owns..•, .:1,: TWO !r, `;= 1 T ��//'�'— .4 �� Lddrµ�•(II dVflrinl,•rVm buUcn) C4^o..•'l 97f T/�CpnOn/ N�m0/1 -- . ;E3 Pumping Record �. 0a14 o! Pping.um LOY �) 31' 'T P.QPf ayslem; .. �999p0o1(y) 50POC Tan, ;,' ----------------- Tang Effluent Tae FUIe(Pf0�enr? r' Yo 9 ;.�'• ,,:,��: \,;��:�; ,:rr.,..;,,�,.;,,1 � o Ir ye9. nasi; Baan o n — Yes n .Pon.QGsytm;'�" P4'mpad 111 4v9'Uc4n+o ,...' �• (, 'r� i...��.�1 �ti ' � ice. N',: Ot 1 VI (i( / , '/f o co�lenla'wON d1�po$ao: 141 91 o/�/ �:.;%nyww.mass,8ov/dap!waler/epprOYaJsJ(61orm9,r��n�ln9�ecl Commonwealth of .Massach is = ��.r City/Town.of NORTH ANDOVER S�CHUSETTS System Pumping Record OCT 1 uos �•, Form 4 • TOWN OF NORTH ANDOVER HEALTH DEPARTMENT DEP has provided this form for use by local Boards of Health. T -Me Pumping Record mw be submitted to the local Board of Health or other approving authority. A. Facility information - Important: When filling out 1. System Location: forms on the . computer, use ,y only the tab key Address to move your cursor • do not Clty/Town l� State Zip Code use the return --"---- - - key. 2. System Owner; Name Address (if different from location) - - - - ------ -- - ---- Clty/Town __...----------- State ----- �� � Zip Code Telephone Number Pumping Record ;. 1. Date of Pumping Type of system: ❑ ❑ Other (describe): 9s Date2• Quantity Pumped: - ---- -.- -. Gallons Cesspool(s) 4:*P$eptic Tank ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes 9:�<— If yes, was it cleaned? r 5. Condition of System; 6. Sy em Pumped By: Op Vehicle License Number. Company A 7. Location where contents were disposed: ❑ Yes. o Si ature of Hau DatV5- e_""'—'--- ---- — http://www•mas��gov/dep/water/ proyals/t5forms.htm#inspect t5form4.doc- 06/03 System Pumping Record • Page t of TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: ` SYSTEM OWNER & ADDRESS Z617�- 797 /V , 1&yXvAj SYSTEM LOCATION (example: left front of house) DATE OF PUMPING: fb `rte _C -f/ QUANTITY PUMPED 10p22 GALLONS CESSPOOL: NO Ll YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: , / GOOD CONDITION _ ` FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: .4n0dVe,(— COMMENTS: CONTENTS TRANSFERRED TO: Sq. rn l (� �'�' bjLQdf M� 5 /V� XE 7/-Z 7- 5,,4 m 5,,4m PS Co 77,i 14 A \ate 0/907 3 X17 etnk5 S . TO: NORTH ANDOVER, MASS P 19 BOARD OF HEALTH FROM: DESIGN ENGINEER Re: Soil Absorption Sewage System Inspection This is to certify that I have inspected the construction of the said disposal system at L© ! S41—ZF/N S r North Andover, Mass. SITE LOCATION The grades and construction are as specified in my plans and specifications dated 19 . !=� ALid A /b/io/78 *0 /V _wed ILo7- #¢2 r da/• comb,��� A y oD`N o T /-7o PRC, X 45x1S7iNG D+'►-&!/IIVG -'AVK 40 CA ` Fi OIL,D S'4 /-,E 114 S T• 7 -- SOIL PROFILE & PERCOL'ATION TEST DATA North Andover,Mass. No.&Street 5�� ro� Lot No. Loc./Subdiv. Plan Owner Investigator - Observer SOIL PROFILES -DATE 1.3. . Elev. `7-101 - ' Elev. Elev. !-*Elev. 0 0 0 0 1 1 1 1 Ties to Test Pits 2 2 2 2 3 3 3 3 4 4 4 5 5 5 6 6 6 7 �'� 7 7 8 8- 8 9 9 9 10 10 10 Benchmark Elevation Percolat 4 5 6 7 8 9 10 Location Datum Lon Tests -Date Pit Number 1 2 3 4 S Start Saturation Soak -Mins. Start Test -Time Drop of 311 -Time - Drop "-Time-Dro of 6" -Time Mins.lst 3"Dro Mins.2nd 3"Drop Notes &. Sketches on Back ! ; v;• r APPROVED PROVIDED leg. 2.5 Reg. Reg. Reg. Reg. Reg. Reg. IZ-t(•-11 6.1 6.7 6.$ 6.9 6.1,, 6. if leg 3.7 leg: 9.1 leg. 9:6� NOR`I ANDOVER,BOARD OF HEALTH SUBSURFACE DISPOSAL SYSTEM CHECK LIST The submitted plan must show as a minimum: DISAPPROVED 1 yz� - 4 - the lot to be served (area,dimensions, lot #, abutters) location and dimensions of system (including reserve area) design calculations -calculations showing reouired leaching area existing and proposed contours To -cation and log of deep observation holes -distance to ties location and results of percolation tests -distance to ties location of any wet areas within 100' of the sewage disposal _system or disclaimer surface and subsurface drains within 1001 of sewage disposal system or disclaimer location of any drainage easements within 100' of sewage disposal system or disclaimer 4mo-wn sources of water supply within 2001 of sewage disposal system or disclaimer 'location of any proposed well to serve the lot (1001 from leaching facility) 9:ocation of water lines on property (10' from leaching facilities) .maximum ground water elevation in area of sewage disposal system -location of benchmark pl=l` must be prepared by a Professional Engineer or other professional authorized by law to prepare such plans driveways garbage disposers 'a profile of the system (elevations of basement, plumbers pipe septic tank,,distribution box inlets and outlets, distribution field piping and any other elevations) no PVC * o be used in construction ' -Tanks (a) Capacities - 150% of flow (b) Water table (c) Tees (d) . Depth of tees (e) Access (f) Pumping (g) Cleanout (h) 101 from cellar wall or inground swimming pool (i) 251 from subsurface drains Pumps G) (b) Approval Stand-by power Vorth Andover Subsurface disposal system check list -Page 2 Reg.10.2Slope greater than 0.08 Reg.10.4 (b) Sump 40 Leaching Pits 'Leaching pits are preferred where the installation is possible Reg.11.2 (a) Calculations of leaching area (minimum 500 S.F.) Reg.11.4 (b) Spacing Reg.11.10 (c) Surface drainage 2% Reg.11.11 (d) Cover material eac= rYelc s Reg.75.1 Reg.] 5.1 Reg.15.4 geg.j5 8 eg. .'� (a)' Greater than 20 minutes/inch /(b) Area (minimum 900 S.F. ) (c) Construction of field () Surface drainage 2% �e) 2(V --from cellar wall or inground swimming pool Downhill Slope (a)' Slope y/x = (to be shown) /(b) y/x X 150 = (to be shown) TOWN OF N SYSTEM PU DATE SYSTEM OWNER & ADDRESS /,07 14 AK) [ANDOVER G RECORD SYSTEM LOCATION DATE OF PUMPING: ----6—' QUANTITY PUMPED: CESSPOOL: NO CII—ES— Septic Tank: NO YES NATURE OF SERVICE: ROUTINE-.- --'EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK. EXCESSIVE SOLIDS FLOODED SOLID CARRYOVER OTHER EXPLAIN System Pumped by COMMENTS: CONTENTS TRANSFERRED TO C52,0 i Commonwealth of Massachusetts City/Town of NORTH ANDOVER, MASSACHUSETTS System Pumping Record Form 4 , DEP has provided this form for use by local Boards of Health. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. System Location: forma the UCi 7 computer, use only the tab key Address M to move your ' use the ret t mCityrrown State Zip Code key... 2. System Owner Q e n Name Address (if different from location) City/Town State Zip Code Telephone Number B. Pumping Record (�� 1 1. Date of Pumping ( 2. Quantity Pumped: Gal/lonsQ 3. Type of system: ❑ Cesspool(s) �epfic Tank ❑ Tight Tank 4. ❑ Other (describe): Effluent Tee Filter present? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: ice N e Company 7. Location where ccgtents were disposed: Signature of Hauler http:/Aovww.mass.gov/deptwater/approvalstt5forms.htm#inspect t5form4.dw 06/03 I I t 4. � If yes, was it cleaned? ❑ Yes ❑ No Vehicle License Number Date System Pumping Record • Page 1 of 1 t -- A r 4 Nc to i It 3� zq�.zV 1W IZS Q 3 a � OR `S �� � oIq f c J rr ,' ii 14 0 -.} C\ 4 z !L ON*, f r r i l ep val ii -.} C\ 4 z !L r o iv rZ>1vt7'7.V/MO £a'wi-ovu lv lAanrA 40• b6 = o� � �4a 9., 001- lJim 0011 001=131lnv wxA 1514 Sb 401 2.131 tvl " 15b sq, oo1=L7J� n� �Lld3s ab' 0O1'1M'�11d'�5 oo• loi =1311tt;� 35iG�i W I . 1 .WJLl v 0 tA J•�Q��o�:�Oq�J KOLU RO J va0�Q1�Q ,a. o• ;e: ,gid. :d• a: m 4� V qj t, m CO ,a. o• ;e: ,gid. :d• a: m 4� V qj t, m ,a. o• ;e: ,gid. :d• a: ■ 1M t, ■ 1M pqj �- Ulm J -t yJ`jE'f