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Home My WebLink AboutMiscellaneous - 185 DALE STREET 4/30/2018N O 0 W o0 V cn W D O r o m {v M m m o � 0 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 R bmitted to the local Board of Health or other approving authority. C v NED A. Facility Information MAYLDEPAR 2008 Important: When filling out 1. System Location: TOS/� OFH NDO TER forms on the HEAT computer, use only the tab key Address to move your cursor- do not Citylrown State Zip Code use the return key. 2. System Owner: Name ISI Address (if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping bate 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Ic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condi' of System: , � � Pe� �cL4, 1 6. Syste777tz : 1� Name L Vehicle License Number 8- p4AP�� Company 7. t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 TOWN C)F NORTH ANDOVEY UA Ft � � ��-- SYSTEM pur�Pirl� �COKLJ 0 \ECEY V _'_ D JUL - 6 2005 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT SYSTEM O"nA a At LKESS _ SYSTEM LOC'ATTf}N Ald. anzl4,v_l� DATE OF i'i1MpqNq.� QuAN71TY PUMPED: Sopuc 1'ank: NU YDS NA rVK4 OF SBRYtef!: KUU'tlNB ^ _... ��t1rRCd�NC'r" UkMAVA,num; 00OD CONVITIUNPU!_l. ,i`tJ C Ovti x Fa4YY ORWB .. _.._ BAFFLES ITS PLAC L. ROM_. LgACHAIUD KUN5AC K OXCB$SIVB SOLIDS ...._.. FLOODED t,ii?CAR1�4'QYE QTKER EXPLAIN )7,�.trt PwR d br f IZI Ina. VVMMkNTS. I:VN 1'"*1'3 fKANSYtrKRbL) 1.0 AL Town of North Andover, Watershed Septic Syste Servicing Report Date: v I L)— c S— Homeowner : Co raLe S` Street 5 Picone Nature of Service: observations: Description of Work: Comments: Routine Emergency Pumper : Address: 1,41 Phone Good Condition Full to Cover Baffles in Place Leachfield Runback Excessive Solids Heavy Grease Roots Other (Explain) SEPTIC SYSTEM INSPECTION FORM ADDRESS I J DATE INSPECTED PROPERLY FUNCTIONING? (�) N WEATHER CONDITIONS COMMENTS: WATER QUALITY TES I to `_' IZESOLTS?. DYE TEST PERFORMED? Y N DATE? SKETCH: a WATERSHED RESIDENTS QUESTIONNAIRE 1. Name Ay (y U .s T'�nl 6' !,' SA L - y' e T7" / ' 2. Street Address f VfJ 94 LE s -T2 c�r � 7-- 0 3. How many members are in your household? 4. 4. What type of sewage disposal system do you have? EV cesspool 9 septic tank and leaching area ❑ connection to municipal sewer ❑ other (describe) ❑ do not know -2- 5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health? CJS yes ❑ no ❑ do not know 6. How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years ❑ 11-20 years Tr over 20 years ❑ do not know C S po s L 5` y/'J 7. Has your sewage disposal system been rebuilt or repaired? yes ❑ no ❑ do not know i`�SP� aL If yes, approximately how long ago? years. What was done? 8. How frequently is your sewage disposal system pumped out? ❑ annually ❑ every 2-4 years ❑ every 5-10 years ❑ over 10 years CP/ never J 9. Have you had any problems with your sewage disposal system? ❑ yes EB no If yes, what problems? ❑ repeated pump -outs needed ❑ system clogs, backs up, or drains slowly ❑ odors ❑ sewage surfaces through ground 10. How many of each appliance are connected to your sewage disposal system? washing machine dishwasher garbage disposal dehumidifier drain sump pump toilet t� roof/pavement drains shower/bathtub 11. Please state the brand and type (liquid or powder) of detergent you use for: dishwasher clotheswasher� / 12. Does your property have a lawn? 9 yes ❑ no If yes, approximately what size? may/ El less than 1/4 acre El1/4 acre E 1/2 acre ❑ 3/4 acre ❑ 1 acre ❑ more than 1 acre (Specify) acres 13. How often do you fertilize your lawn? No. of applications per year _ Season(s) of the year � ea i A✓c.-_ LL 14. Please state the brand and type (liquid or granular) of lawn fertilizer you use: S C.oTT '0AZ 041t_01MC= ❑ Check here if your lawn is maintained by a professional landscape contractor. /� h� 4 �- APPLICATION FOR SEWAGE DISPOSAL INSTALLATION HEALTH DEPARTMENT --NORTH AIMOVER, MASS. I hereby makeapplication for a permit for a sewage disposal installation at .,,_,. �jPs��.�.d��F,.�e.� I will install this system in accordance with all the laws of the Coiwonwealth 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 preceding the septic tank where the grade shall not exceed 2%. I will install a concrete septic tank of in size. A manhole (s) permitting easy cleaning will be provide witIf/ removable cover (s) of iron or concrete within 3.2 inches of the ground surface. I will provide subsurface disposal field with open jointed bell and spigot Ackron pipe at least 4 inches in diameter and laid in a series of trenches: the bottom of which will provide a minimum of —4z%�) lineal () feet of effective absorption area. The pipes will be laid on a 6 inch sayer 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 1/8't to 1/4" (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 wi3l 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 in— stallation 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 officer.. as provided belowq and to incorporate any additional requirements that ,L, may be attached o the permit. Plot Plans must be submitted with application. A. Signature of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andovert Massachusetts. DATE _ � Lz. ) S-) / • 1WV`-- - 'Signature of Health Agent I have inspected the uncovered system indicated above and find everything done as dei Vrid. DATE-� Signature of pe` ing Officer Percolation— Test Garbage Grinder w' b August 15, 1957 Miss Mary Sheridan R. N. Health Agent Board of Health North Andover, Mass. Dear Miss Sheridan: An examination was made as requested in order to determine the suitability of the soil for the subsurface disposal of sewage on the proposed Dale Street building site of James P. O'Connell. The subsoil in the area was of a clay content and a 5 minute percolation test was conducted. The land in general is high. It is recommended that a 750 gallon concrete septic tank be installed together with 210 lineal feet of drain pipe in order to take care of an automatic washer. Very truly yours, Will am �T. r sco I BOARD OF HEALTH TOWN OF NORTH ANDOVER, MASS. t�F Tcl� 1 rl Vic-; Ent vl. NAME 4.V` X.) DATE . . . . . . . . . . "2. ADDRESS : AV, . . . LOP NO. . /. . . . . . TEL. . . . . . '13. N0. OF BEDROO?Z j DEN YES V-.. . NO. . . . . . 4. GARBAGE GRINDER YES N0. . 15. SHOW DIIUZENSIONS OF HOUSE 6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES ,47. SHOW DIIENSIONS OF LOT $. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL 9, NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM 6v� 10. SHOW LOCATION OF BROOKS, STREA 5, DITCHES, LEDGE OUTCROP, ETC. 11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY. Il i Please forward us as much of the follow.ng information that is possible; 1. Type of system '1%.44't 4ZIAIaeom, /Im iLcr' a. 7t° .v�,tic.. ,�%�y�c•�C , � ��..,ca�,. �''l ,t-,c� .fie tial 2. Age 3. Location 4. Maintenance records and date of last pumping out po*�� el 61 iPirr�iu�a� an.0 .� ,at�GvuC �ciD�` � G�a�a.a•�`- �? 5. Documentation of repairs and reconstruction ?Axe 6. Site conditions 4- 7. Builder of system iat� 8. Engineer who approved'. /xW4"*Mv! — Site — System 9- Installation Procedure p - 2 s ,,o� 4- I)m - 10, Problems- Yj,Ou At m- �. h .4 mom, FORM 4 - SYSTEM PLA Commonwealth of Massachusetts , Massachusetts System Pumping Record vstem Owner sq, Date of Pumping: 0 ——�� W -A ystem Location ICA 5 Z�� Quantity Pumped: �!J gallons Cesspool: No � Yes ❑ Septic Tank: No ❑ System Pumped by: Contents transferred to: Yes & =.�� — License #: 57esy U. Date Inspector Town of North Andover, _MA Watershed Septic System Servicing Report Date: L4 - 6-q L( i Homeowner: G (-a, LQ CL Street t dis- -e &�- Phone C0C&q-"- Dee 1� Nature of Service: Routine Emergency Pumper: eJ4�n� �;� Address: HCl �4 Phoneme Observations: Good Condition Full to Cover Baffles in Place Leachfield Runback Excessive Solids Heavy Grease Roots Other (Explain) M Description of Work: Comments: ��V�f