HomeMy WebLinkAboutMiscellaneous - 18 LACY STREET 4/30/2018 (2)VP`
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DelleChiaie, Pamela
From: DelleChiaie, Pamela
Sent: Wednesday, September 02, 2009 10:20 AM
To: 'mckinneywellco@aol.com'
Subject: Information Request - 18 Lacy Street, North Andover
Attachments: I.R. -18 Lacy Street - Mortgage Plot Plan - 10/9/1992; I.R. - 18 Lacy Street - Septic Plan -
9/19/1997 - 3 pages; I.R. -18 Lacy Street - Septic As Built Plan and Pumping Record
Hello John,
Here is the information you needed for the well application at 18 Lacy Street. Please call me if you have any
further questions.
Pamela DelleChiaie
Health Department Assistant
TOWN OF NORTH ANDOVER
Health Department
1600 Osgood Street
Building 20; Suite 2-36
North Andover, MA 01845
978.688.9540 - Phone
978.688.8476 - Fax
pdellechiaie@townofnorthandover.com - E-mail
http://www.townofnorthandover.com - Website
Notes:
If copied to BOH Members -Reference Copy Only -no response requested at this time
DelleChiaie, Pamela
From: noreply@townofnorthandover.com
Sent: Wednesday, September 02, 2009 10:49 AM
To: DelleChiaie, Pamela
Subject: I. R. - 18 Lacy Street - Mortgage Plot Plan - 10/9/1992
Attachments: SKM BT_60009090209482. pdf
TO: NORTH ANDOVER, MASS _,�ryt,�-l� °� 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
G 7— / L- /1 e % 57— - North Andover, Mass.
SITE LOCATION
The grades and construction are as specified in my plans and specifications dated
19 .
DelleChiaie, Pamela
From: noreply@townofnorthandover.com
Sent: Wednesday, September 02, 2009 10:46 AM
To: DelleChiaie, Pamela
Subject: I. R. - 18 Lacy Street - Septic As Built Plan and Pumping Record
Attachments: SKM BT_60009090209450. pdf
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APPRO� DISIPPROVED EXCAVATION OK
Date:. Date
Reason: /
As Biz t Submitted 7e
lr� location, dimensions, of system, location in regard to
percolation tests, depth of system, i - rater table
2. Distance V,etland Areas, Drains, Street & House, Drainage Easement and Wells.
3. Water LLocation
4. No PVG ipe OK
r �Joints
--
5. Septic Tank - �e Cement -Pip o ^lanon e of Tank.
6. Distribution Box - No cracks in bo cover, all lines flow e __ y from boy.
t
7. Leach Fields - Dimen ons, Stone D s, Capped nds, Clean doubl ;;-ashed stone
8. Leach Pits - Dimensions, Depth of Store, Splash pact tees, Cement -pipe to tank -
joints on both sides of tank, Clean double-uaashed stone
9. No GarbageXsposal
10C Final Grading f�parricading of11
sub surface system
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Commonwealth of Massachusetts RCS_ ,D
City/Town of NORTH ANDOVER MASSACH SETTS
System Pumping Record APR 0 6 2nm
Form 4 TO'N\ Ur iNUrlCH ANDOVER
HEALTH DEPARTMENT
DEP has provided this form for use by local Boards of Health. The System Pumping ecor ust
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
only the tab key
to move your
cursor - do not
Address
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O ��
use the return
City/Town'
State
Zip Code
key.
VQ
2.
System Owner:
Name
Address (if different from location)
City/Town
State
Zip Code
Telephone Number
B.
Pumping, Record
1.
Date of Pumping (
2. Quantity Pumped:
Date
Gallons
3.
Type of system: ❑ Cesspool(s)
Septic Tank ❑ Tight Tank
❑ Other (describe):
4.
Effluent Tee Filter present? 2 Yes ❑ No
If yes, was it cleaned?
❑ Yes ❑ No
5.
Condition of System:.
6. System Pumped By:
Name Vehicle License Number
Company --
7. Location contents were disposed:
Signature of Hauler
http://www. mass. gov/dep/water/approva is/t5forms, htm#inspect
t5form4.doc• 06/03
Dat
System Pumping Record • Page 1 of 1
Q --un RIRT A Z FORK
INSTRUCTIONS: This fora 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 lav,
�
regulations or r23sten
mss-
a
out .this section*****************
�rPPLSCA.*JT: ,� &A O'M Pr L l p::on, e
LOCATION: assessor's :dam Number Parcel
Subdivision Lot(s)
Street I G Re -y S i , st. Number
RiCOMU-7NDATIONS OF TCF7,%T AGENTS:
,-===en--.7
;w ?'_anne-
Data ALcroved
Tia -a
-.... -.- J
Dc to Approved
Da:.a Re] ec:.ed
Date Approved
Food ecto
I_^.s^ ._
sr--ea'_�� Data Rejected /
Date approved Co
Data Rejected
Public Works - sewer/water c=nnections
drivewav me^i--
== a Dena= =me_nt,
Received by Building L^^.spec-== Date
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Reg. 2.5
31 NORTH ANDOVER
SUBSURFACE DISPOSAL SYSTEM CHECK LIS
I. General Information
The submitted plan must show
as a minimum:
. (a)6t-the lot to be served
w
(b)OC,location and dimensions of the system (including
reserve area)
(c)CZ4esign calculations
WY -calculations showing required leaching area
e) existing and proposed contours
(f)I location and log of deep observation holes -
distance to ties
( ocation and results of percolation tests -
distance to ties
( ) location of any wet areas within 100' of the
sewage disposal system or disclaimer
(i % surface and subsurface drains within 100' of
the sewage disposal system or disclaimer
(j) location of any drainage easementswith'
100' of the sewage disposal system or disclaim
(k)W known sources of water supply within of
the sewage disposal system or disclaimer
1)oC ocation of any proposed well to serve the lot
(m)Atlocation of water lines on the property
aximum ground water elevation in the area of
44�
the sewage disposal system
o)e a profile of the system
to PVC is to be used in construction
( )QLlocation of benchmark
(r)04plan must be prepared by a Professional Engineer
or other professional authorized by law to prepare
such plans.
II. Garbage Disposers
Reg. 9.1 (a) Approval
Reg. 9.6 (b) Stand-by power
III.
Septic Tanks
Reg.
6.1
(a)O(-Capacities - 1.50% of flow
Reg.
6.7
(b)pLWater table
Re
6.8
(c)6XTees
Reg.
6.9
(d )Depth of tees
Reg.
6.12
(e)XAccess
Reg.
6.18
( f) X Pumping
(g) X Cleanout
IV.
Pumps
Reg. 9.1 (a) Approval
Reg. 9.6 (b) Stand-by power
V.
Reg. 10.2
Reg. 10.4
VI.
Reg. 11.2
Reg. 11.4
Reg. 11.10
Reg. 11.11
Distribution Boxes
(a) Slope greater than 0.08
(b) Sump
Leaching Pits
Leaching pits are preferred where the installation is
possible.
(a) Calculations of leaching area (minimum 500 S.F.)
(b) Spacing
(c) Surface drainage 2%
(d) Cover material
IX. Downhill Slope
(a) Slope y/x = (to be shown) d k�-
(b) y/x X 150 = (to be shown)
VII.
Leaching Fields
Reg.
15.1
(a)
Greater than 20 minutes/inch
Reg.
15.1
(b)
Area (minimum 900 S.F.) D
Reg.
15.4
(c)
Construction of field
Reg.
15.8
(d)
Surface drainage 2%
IX. Downhill Slope
(a) Slope y/x = (to be shown) d k�-
(b) y/x X 150 = (to be shown)
SOIL PROFILE & PERCOLATION TEST DATA
Town/City No.&Street Lot No. i
Loc . / Subdiv . Plan Owner-5,_7��/G''
Investigator Observer
Benchmark
0
1
2
3 .
3 4
5
6
7
8
9
10
SOIL PROFILES -DATE
Ele . 3. Elev.
1
.2
3
4
5
6
7
8
9
10
Location
Elevation Datum
Percolajion Tests -Date
1
2
3
4
S
6
7
8
9
10
4'Elev.
Pit Number
�1 2 3 4 5
Start Saturation
Soak -Mins.
Start Test -Time
Drop of 3" -Time
Dro of 6 "-Time
Mins.lst 3"Drop
�4p
Mins.2nd 3"Dro
..� ��_ 1.)
& Sketches on Back Fra C. Geli as Associates North And. �W
f�ee�o/LV `}Gt,vG j C�fi�/G 4� A �
WELL DATABASE
ADDRESS: L
AGE OF WE DRILLER.- -?
WELL FE R YCI T .T: ?` WELL LOCAT ON:
— -ViE?.L PER.Nf 7 DATE: DE?iri OF W I L:
T�FOFWELL_ a. DRILLED ? 'o. DIG c. SOWN
TYPEOFWA=BEkRING ROCS
WA=ANALYSIS• DAT" - -
E IGHIRON. Y N O'
WE--= DAT_ EIII=.
.MANGANESE- Y N
ANTS. it N
ADDRESS: O
AGE OF WELL: ? +� v rr r. DRILL�
WELL PERILYE7 T. WE LOCATiO i. l \
r
WELL; PERLtiLTD4T'E: ? DEPiT; F WELL:
TYPE OF WELL: a . DRILLED b. DIG" c. L`NKNOWN
TYPE OF WATER BEARING ROCK: `
WATER _ANALYSIS DATE: ? HIGTI -2lyIANGAN-ESE.: Y N
HIGH IRON: Y N OT= CONTA.�124ANTS: Y N
M 0 R T 6 A 6 E INSPECTION PLAN
Citylldwn: N_A�JDove 2 State: MA
---------------- ---------------------
Date: SGT ''� ! I "� °� Z Scale: �i = 5� 1
---------- ------------------------------------
Owner: C-
---------------------------
Deed Ret. 2 3 47
-----------------------
Buyer:-421MALf11:y
Plan No. X535
-------------------
Drawn per City/Town of------!`i��-------- Tax Assessors Map.
LDT' A
LAC --y sTRE r -,T
CLACey-DEEO)
Z
To: Ad A D O YiE 2 f3A!V K
--------------------------------------------------------------------------I-------------------
I hereby certify that the above Mortgage Inspection Plan was prepared for use in connection with a new Mortgage and is not
intended or represented to be a property line or land survey, It cannot be used for establishing fence, hedge , walls or building
lines. No responsibility is extended herein to the land owner or occupant. The location of the original building(s) as shown
herein was in compliance with the local applicable zoning bylaws in effect when constructed, with respect to horizontal
dimensional requirements, to lot lines or is exempt from violation enforcement action under Mass G.L. Title VII, Chap. 40A, Sec.
7, unless otherwise shown herein. Subject uilding(s) lies in a flood zone designated Ione: G
FIRM ma Communit -Panel t � 500fl 8 OGS 1 C E'
- g and shown on
P y --------------- ------------------------ Dated: SU N .-I rj�- I q b ------ Job No. _a12 = 2q-3_2____
JCO, INCORPORATED, LAND USE & DEVELOPMENT CONSULTANTS 4 AUTUMN LANE, METHUEN, MA 01844 508-683-9932