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Home My WebLink AboutMiscellaneous - 18 SUMMER STREET 4/30/2018i b "i North Andover Health Department Community Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: IS Summer Street INSTALLER: William Sawyer DESIGNER: PLAN DATE: BOH APPROVAL DATE ON PLAN: MAP: LOT: INSPECTIONS ABANDONED TANK INSPECTION: 5/13/15 DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS Comments: ICS L W&O SEPTIC TANK Contractor reports any changes to design plan Existing septic tank properly abandoned Internal plumbing all to one building sewer ❑ Topography not appreciably altered ❑ Building sewer in continuous grade, on compacted firm base ❑ Cleanouts per plan ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon tank has been installed H-10 loading ❑ Monolithic tank construction ❑ Water tightness of tank has been achieved by visual testing ❑ Inlet tee installed, centered under access port ❑ Outlet tee installed, centered under access port (gas baffle/effluent filter) ❑ inch cover to within 6" of finish grade installed over one access port ❑ Hydraulic cement around inlet & outlet Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon Pump Chamber installed ❑ H-10 loading ❑ Monolithic tank construction ❑ Inlet tee installed, centered under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off floats working ❑ Separate on/off floats ❑ Drain hole in pressure line ❑ cover at final grade installed over pump access port ❑ Water tightness of tank has been achieved by testing ❑ Hydraulic cement around inlet & outlet Comments: CONTROLPANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: basement ❑ Alarm signal located inside: basement Comments: DISTRIBUTION -BOX ❑ Installed on stable stone base ❑ H-20 D -Box ❑ Inlet tee (if pumped or >0.08'/foot) ❑ Hydraulic cement around inlet & outlets ❑ Observed even distribution ❑ Speed levelers provided (not required) ❑ Schedule 40 PVC Pipe Comments: Commonwealth of Massachusetts City/Town of System Pumping- Record Form 4 DEP has provided this form for use -by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using.this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility. Information 1. System Location: Left / 1htg front ofhouse ft / Right rear of house, Left /right side of house, Left / Right side of building, Left / Right front of building, Left / Right rear of building, Under deck Cityrrown 2. System Owner. Name Address (if different from location) 1 Cityfrown r GAS T s 1. Date of Pumping 3. Type of system: ❑ State PO-A� L-vo Zip Code State Zip Code Telephone Number �< Date 2. Quantity Pumped: Cesspool(s) eptic Tank Gallons ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes o If yes, was it cleaned? ❑ Yes ❑ No: 5. Condition of.sC%� 6. System Pumped By: 7. t5fbrm4.doc• 06103 Neil. Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company contents were disposed: 15-= r L( System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts RECEIVED City/Town of JUS 31 2014 System Pumping Record TOLVNOFNORTHANDOVER Foirm 4 NEAT TH DEPARTMENT DEP has provided this form for use -by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using.this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Le R' t of house Left / Right rear of house, Left / right side of house, Left / Right side of building, Left / Right fron of building, Left / Right rear of building, Under deck Address City/Town 2. System Owner. �UkikAVV\,e-< Address (if different from location) Citylrown ' B. Pumping Record Date of Pumping 3. Type of system: ❑ Date Cesspool(s) State IWA Trp Code State � � � Zoo r-0 Telephone Number' — 2. Quantity Pumped eptic Tank Gallons —� ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yep No If yes, was it cleaned? ❑ Yes ❑ No: 5. Condition o_ f system: \' 6. System Pumped By.- Nell y: Neil Bateson Name Bateson Enterprises Inc Company 7. Locaatioa eke contents were disposed: Waste Water F5821 Vehicle License Number 17 Date t5form4.doc- 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 DEP has provided this form for us&by local Boards of Health. C RECEIVE® JUS. 2 9 2013 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Cher forms may be used_ the information must be substantially the same as that provided here. Before using.this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left / I ht ront of hous Left / Right rear of house, Left /right side of house, Left / Right side of building, LeftRight front of building, Left / Right rear of building, Under deck Address t 'z-5 S --t— I� City/Town State 2. System Owner. Name Address (if different from location) Cityrrown B. Pumping Record 1. Date of Pumping 3. Type of system. ❑ ❑ Other (describe): Zip Code State f/ Zip Code Telephone Number �7 k3 Date 2. Quantity Pumped. Cesspool(s) Septic Tank Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes 01140 If yes, was it cleaned? ❑ Yes ❑ No 5. Condi bn 0yste� 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. 7MS �-� contents were disposed: _ Lowell Waste Water Date t5form4.doc• 06/03 System Pumping Recons • Page 1 of 1 TOWN OF SYSTEM PUMPING RECORD:. A� DATE: SYSTEM OWNER & ADDRESS ��l�g6iV�a SYSTEM LOCATION `" (example: left front of house) (1 DATE OF PUMPING: " O QUANTITY PUMPED: GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Commonwealth of Massachusetts RECEIVED City/Town of System Pumping Record AUG 1 3 2008 Form 4 TOWN OF NORTH ANDOVER DEP has provided this form for use by local Boards of Health. Other form ALTh�aRT NT information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. Syst m Location: Address zi City/rowm State 2. System Owner. ", �,r\ Address (if different from location) Cityrrown Code State C Telephone um er B. Pumping Record 1. Date of Pumping Date Z. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes Q-196--- o� If yes, was it cleaned? ❑ Yes ❑ No 5. Conditio� tem: � � / 7� 6. Syst Purn" By: Name ehicle License Number 1 Company 7. Location re contents were osed: .S Date t5fonn4.doc^ 06/03 System Pumping Record ^ Page 1 of 1 TO: NORTH ANDOVER, MASS -• -1,0 ?' 2z 19 7-7 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 a 'T t'� -SLc 114 1;4 C=A S % North Andover, Mass. 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