Loading...
HomeMy WebLinkAboutMiscellaneous - 196 CARLTON LANE 4/30/2018 (2) 196 CARLTON LANE / M 107.A-0205-0000.0 r ,, ':• SEPTI_S.__F.Y_SZE�1__�.►� .TA4.Q..... 0I.. ,.; IS THE INSTALLER LICENSED? YES_ NU TYPE. OF CONSTRUCTION: NEW f2Lf�AIR NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW YLS NO CONDITIONS OF APPROVAL YES NU (FROM FORM U) ISSUANCE OF DWC PERMIT YES NO DWC PERMIT NO. 6c-Ct_'_3 INSTALLER:6. BEGIN INSPECTION `YES NO: EXCAVATION INSPECTION: NEEDED: OZ M PASSED By-- CONSTRUCTION INSPECTION: NEEDED: ._ AS BUILT PLAN SATISFACTORY:<YES: • APPROVAL- TO BACKFILL: DATE: FINAL GRADING APPROVAL: DATE __ BY FINAL CONSTRUCTION APPROVAL: DATE:__-___.___.-__DY 1 Commonwealth of Massachuse is �62Q vz City/Town of ✓�/� . /4 Uv' �� a m System Pumping Record Form 4 �M *.y. 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 within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important:When filling out forms 1. System o + on the computer, !/ use only the tab Com!_-- ! �–--- --— key to move your Add���r s /�) cursor-do not use the return - key. City/Town 2't;a0 rteZip Code 2. System Owner: vs��A -- e, S � tea, Name reiwn Address(if different from location) Cityrrown State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping lalv ��--/0272 Quantity Pumped: k�m Gallo 3. Type of system: ❑ Cesspool(s) [Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): -- -- 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: O 6. S tem Pumpe y: e Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 Signature of Hauler Date Signature of Receiving Facility Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 IL Commonwealth of Massachusetts City/Town of RECEIVED a`. System Pumping Record JUL 0 8 2009 Form 4 TOWN OF NORTH ANDOVER DEP has provided this form for use by local Boards of Health. Other forms 1mayidxL15tjMFtAR1M6NT information must be substantially the same as that provided here. Before using is 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 Important: When filling out 1. System Locatio . Lefr`front eft rear, left side of house. Right front, right rear, right side of house. forms the ���( ( computer,use only the tab key Address to move your ^ � cursor-do not use the return City/Town State Zip Code key. 2. System Owner: Name Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons S� 3. Type of system: Cesspool(s) �ptic Tank Tight Tank Ej Other(describe): 4. Effluent Tee Filter present? rl Yes [/No If yes, was it cleaned? Yes No 5. Condition of System: 6. System Pumped By: Neil Bateson F 5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location where contents were disposed: L.S.D Lowell Waste Water �"". A igna ure of H r Date ��—O u t5form4.doc•06/03 System Pumping Record•Page 1 of 1 �f��..'�,— � t� y �� � I�� �'� ,fir��_'.�":� f•,� C..<•-4 Of W ' C N J - 34 t � G Ics.G3 , � tc.5, `s.LIq i t � 1 e t k t i 3 { , i i 3 r I Address Af Title of File Page of Date File Open: Gate fie closed:_ Doc Document/Action—Title Date of action stefer to other Purpose of Document/Actio -- Document/ docurnent/ nand notes Num. Document/ Department ------------ Board of Appeals — Board o(—Health plann�ng.Board = Conseruatiion Commission — Building Department G ETT� DEP.hovldod Ihli loan for neo .y vocal Apt Q ZQO$ ov �'-�r1`I(lod (0 l)v 10C d/ 6carc: C'I nOdilnoarQ oal 0 Sy7 a.'TI P ._ Or 1110r °P;)10 111V 4:,tn0r1ry a c l l l ry l n(o r rT1 c i o n TOWN OF NORTH ANDOVER 77 OC-0Uon; ell: 14 ^.'61I �CQ u/\ .�v'\I•:''/ l.r'. 11..1�1,�ri.l .,'; 'r' , VIM Sys�am Own or, � �nl rpm l�uVcn) Cq^o..n umping Ro r d oai� o! Pump►npVI3C � � . X711 ? �':ar''•.1 r• �6r , 7h? 3' TYN GIeya►em,.. Ca99�oo1(9) SaP(!c Tangy r 1 IS ar' Emuan► Tee; Fllle(P(q)enr7 Yes — .. . 6." y PvMP un#,tw,, ��.;;�'^�y'.�',j)( k� ,Y.1�' �7,!• �(�� ';1,�J l.' : :' 3r l OC7kQ� r r•,'. •. n.�vh8l9 CQ0 enLJ Vote dlyposao: ^r✓ +.maSJ. oYlda �olr 9 �walal/apprpYaJa/Ib(orm9.n.mpiny�ac( :is;:'i�r J '.Yr"� . y! '.r •y* :y{•n:d� ytsr/y':i:f �tichusetts . ' G: ORTH A�1lOVER MAS .5` 7 t ,( ''y.J(i � .,IJ�• :'.r11�s,',L' .'1\d P IDIOM.umpylrn '`R ",1�,LSLIS�C. ` �Y h"' f✓u N 1'I lf' ["'A ... r nJ �DXII] w�rt+,` 'I fLti t14�;vt JUL 0 5 2007 DEP,.has provided this form for use by local Boards of Healt T�iha 6 L t� �l� v,,_, 9 ecord must be submltted to the.local'Board of Health or other approving auYH A Facility information j1,,Wrien r>lunfl out 1 : System Location ,,:w;forms on the.; � �J .•;: 'computer,use �p (�u only the tab key Address to move your curw•do not ` 'use the rotum Clty/Town ,: St to Zip Code Y'. key.': System ON ner,' M1''. � . "r•' Name , ,' wr„', ' '• Address(it different from location) CltylTovm, State Zip Code Co r3�7 ` Telephone Number Q ',1 ,Tump1ng Retcord r °>• Date'of Pumping Date 2. Quantity Pumped; /S" v Gallons Type of System,: ❑ Cesspool(s) Veptic Tank ❑ Tight Tank 9 ..Other(describe); ' 4 Effluent Tee Fliter present?.❑ Yes o If yes, was it cleaned? ❑ Yes ❑ No kJ L 1t .i� rI trf .r Condition of.3ystm;' 01( . 6 Sy. e�r1 Pumped By�• ' r - n4� { Nama:,'�::,�:;':,..;• ` €;,� V/eehhllcle Ucenae Number Lr {'4t j.r ri,/ff� ,.i� F', •�+}�it +, 'I 'V/ Company,{„",, fv Ir r, t Locatloh where contents,yvere di;3posed; E":S I { 4natws of Hauler, httpJ/www.mas's.g,0.V ep/wafe�/apprGvals/t5forms,htm#Inspect t5forrrr4.doa 08/03 System Pumping Record Page 1 of 1 . iM•• VA I`e� �� SY8'1'E1�1 PIJMPIN hlh.. � — L Z��J•. U RF_C.C)kl.. �Y5r8M WNKR (t ADOR285 -QUANTITY i �'_•__,._.. _...... _._.__�.,_ •_,�._ ..-- PUMNEc t.. �'tssPOUL; N Y�3 rVx6 UN s�Rvlca; x�u'r1Ne uti�ti7iY.1'('IUNJ. ► 0000 CoN01'1'IUN ' rvu. ►t� t'Ci� rr, IrM1YY 0U•38 j IN RQQT3:: .. L aACKFI eL D g C&9$IY$ SOLJW `,.... P1.00D�D $oLmcAJuYo K' ONER EXPL,tiIN own N4Y,4 . y TO WNwT QF 06RWTH ANDOVER SYSTEMP INCa RECORD ._�4 oL i•c�y�•�s,.L�N.� �. OATE ' 1 SYS"TEM+OWNER A.DD SR E SYSTEM LOCATION � ;� ���•/�� ,�,, Ba c') UA'TE OF PUMP' dO__ _QUANTITY PUMPED J'Q� CESSPOOL NO YES- SEPTIC TANK NO NA7 I RS OF SERVICE, ROUTINE EMERGENCY_______. OBSERVATIONS: GOOD CONDITION _ FULL TO COVER HEAVY GREASE _ BAFFLES IN LACE ROOTS LEACHI~IELD RUNBACK EXCESSIVE SOLIDSFLOODED SOLID CARRYOVER_____ OTHER EXPLAIN - SYSTEM PUMPED BY COMMENTS. CON'TEN` S TRANSFERRED TO o 's" Al �. TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: .SYSTEM OWNER & ADDRESS SYSTEM LOCATION ,S/ (example: left front of house) Z"c ii i DATE OF PUMPING: L� aH ��'Z QUANTITY PUMPED /5'00 GALLO'N'S CESSPOOL: NO YES SEPTIC TANK: NO YES .� NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVEIZ HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: Ai. C'OIIMENTS: CONTENTS TRANSFERRED TO: tJJ/ 11/ �tJt1kJ 1J:J r JtJ7j/jbbll 51 tWAh:i/ANVUVttC P96E kJl Nor �N�ver Q.a �+. o�n s f CT's �c �c SMICE 1 �� A nna/�r 47 RAIIaM grpj T MNXMMt Mh 01835 U.ul L �6l-ppb 978-372-7471 MOTH CF 7 YRFCR TUN Cpaml s 6oc� �- 310 93 SherL4jocn y� dry �s� kS� /odd I o el �a� l vao 6-v�� P -I /Poo lJ' /Yfi,Dic /Qi�� �G Ibdv R&A 7 6r.-,140. v /g,7e ti O? lao �_ PLAN REVIEW CHECKLIST `���� / � %►�/'f- ADDRESS / [�1y / / ENGINEER 0 GENERAL 3 COPIES D STAMP LOCUST'------ NORTH ARROW SCALE CONTOURS PROFILE SECTION BENCHMARK SOIL & PERC INFO �� ELEVATIONS WETS. DISCLAIMER WELLS & WETLANDS WATERSHED? DRIVEWAY (Elev) WATER LINE FDN DRAIN SCH40 TESTS CURRENT? SEPTIC TANK MIN 1500G. ----- . 17 INVERT DROP GARB. GRINDER (+200% EDF) 25' TO CELLAR MANHOLE TO GRADE ELEV GW D-BOX SIZE ��90 fu q# LINES FIRST 2' LEVEL STATEMENT/ INLET OUTLET 146. = + 7 (2" OR . 17 FT) TEE REQ'D? r /o LEACHING �/ RESERVE AREA �' 4' FROM PRIMARY? ,C 100' TO WETLANDS t-'-" 2% SLOPE 100' TO WELLS c.�' 35' TO FND & INTRCPTR DRAINS '—"- 4' TO S.H.GW 325' TO SURFACE H2O SUPP 4' PERM. SOIL BELOW FACILITY MIN 12" COVER ✓ FILL? (25' if above natural elev; 101if below) BREAKOUT MET? i/ TRENCHES MIN 660 gpd SLOPE (min . 005 or 6"/1001 ) >3 ' COVER? - VENT SIDEWALL DIST. 2X EFF. W OR D ,(MIN 61 ) IS RESERVE BETWEEN TRENCHES? IN FILL? MUST BE 10' MIN. 4" PEA STONE? BOT X LDNG + SIDE X LDNG = TOT (L x W x #) (G/ft2) (DxLx2x#) % T �'L PITS MIN 660 LEACHING ✓r GW MIN 4' BELOW BOTTOM MANHOLE/PIT EXCAV 2x EFF W OR D 12"-48" STONE SURROUNDING I-� BOT + SIDE x LOAD = TOTAL (L x W x #) (2 x (L+W) x D x #) CHAMBERS COVER >3 FT - VENT FIELDS MIN 900 ft2 LEACHING PERC RATE FASTER THAN 20M/IN GW MIN 41 BELOW BOTTOM OF FIELD PIPE ENDS JOINED W/NON-PERF. PIPE? 4" PEA STONE? DIST LINE SLOPE . 005? >3 ' COVER - VENT SCH 40 MIN 12" COVER L x W = T x LDNG > DESIGN FLOW? DOSING TANKS AND PUMPS DIMENSIONS X X = PUMP CAPACITY gpm L W W Vol. DISCHARGE SIZE DISCHARGE RATE DISCHARGE TIME gpm MANHOLES TO GRADE ALARM SEP. CIRC. GW (Min. 1' below inlet) HWL LWL CHECK VALVE BLEEDER HOLE MANUAL OP. SWITCH I I _ I ' ' f 1 I ---------------- 4 - 1 ------- - -------- ------------ ------------ ------------------ AT i I � � P r 1 � I Town of North Andover, Massachusetts Form No.3 f NORTIy BOARD OF HEALTH O? e,sr. •..'e O 7 G A 1910 � CNUSE CHUSt�' DISPOSAL WORKS CONSTRUCTION PERMIT SI Applicant 4NE ADDRESS Site Location_. CA ,A b TELEPHONE;�.� ^A � Permission is hereby granted to Construct ( ) or Repair-� an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. CHAIRMAN, BOAR4HEA�HH' ' Fee D.W.C. No. J IL Ve Any appeal be le CH Heal shall v►nv�•r+ 1 afit within er 'the TOWN OF NORTH ANDOVER date of fi. }L c c;-,is Notice MASSACHUSETTS in the Office of. the Town Clerk. BOARD OF APPEALS NOTICE OF DECISION Date . . . .April 24, ,1992. . . . . . . Petition No.. . .013-92. . . . . . . . . . . . . Date of Hearing. .April .14, . 1992 . Petition of . .Danie.l .and.Hallene. Sha.f.fer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Premises affected . .196 .Carltan.Lane. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Referring to the above petition for a variation from the requirements of the . . S e.c t ion. 7.,. . . . Paragraph 7.3 and Table 2 of the Zoning Bylaw . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . so as to permit , .relief. of. side.yard .setback.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . After a public hearing given on the above date, the Board of Appeals voted to . .GRANT. . . . . the variance . . . . . and hereby authorize the Building Inspector to issue a Permit to . .Danial .and. Hallene. Sha££er. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . for the construction of the above work, based upon the following conditions: Signed � � 5� • L� �� Frank Serio, Jr. , Chairman . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . William Sullivan, Vice-Chairman Walter Soule, Clerk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Anna O'Connor . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Board of Appeals NORT1{ 20etco ",q Any appeal shall be filed ,� q o p within (20) c',�s after the ; it L : �, of t its Notice date of fi 9p' .... in the Office of. the Town SSACHUSES Clerk. TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS Daniel L. & Hallene R. Shaffer * Petition #013-92 196 Carlton Lane North Andover, MA 01845 * DECISION * ******************************** The Board of Appeals held a public hearing on April 14, 1992 upon the application of Daniel . and Hallene Shaffer requesting a variance from the requirement of Section 7, Paragraph 7.3 and Table 2 of the Zoning Bylaw so as to permit relief of 2.2 feet for side yard setback at Easterly boundary located at 196 Carlton Lane. The following members were present and voting: Frank Serio, Jr. , Chairman, William Sullivan, Vice-Chairman, and Anna O'Connor The hearing was advertised in the North Andover Citizen on April 1 and 8, 1992 and all abutters were notified by regular mail. Upon a motion by Mr. Sullivan and second by Mrs. O'Connor, the Board voted unanimously to GRANT the variance as requested. The Board finds that the granting of this variance will not adversely affect the neighborhood or derogate from the intent and purpose of the Zoning Bylaw. Dated this 24th day of April 1992 . BOARD OF APPEALS F ank Serio, r., Chairman TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE: 6/26/00 This is to certify that the individual subsurface disposal system constructed () or repaired (X) by Dave Maynard at Lot 3 Sterling Lane has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Board of Health Inspector © r TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System( constructed; ( ) repaired; / located at 1#2 E was installed in conformance with the North Andover Board of Health approved plan, System Design Permit '%, dated Z�i,3��� , with an approved design flow of#q gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As-built which has been submitted to the Board of Health. Bed inspection date: Engineer Representative Final inspection date: Engineer Representative Installer.']� J a- v1 4 Y- Lic.#: t Date: � Design Engine Date: i. .J APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: l?4 CURRENT INSTALLER'S LICENSE# LOCATION: Q¢ LICENSED INSTALLER: Z��u-e SIGNATURE;1, TELEPHONEnt-e// 9,>F CHECK ONE: / REPAIR: NEW CONSTRUCTION: y IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only .575.00 Fee Attached? Yes ✓ No Foundation As-Built? Yes x�-' No Floor Plans? Yes ✓ No Approval / '' Date: are _ :q r INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at 2o© 2 S"j<<,tif relative to the application of,,,, x dated for plans by —D&gd'n and dated —60 with IF revisions dated a moi' I understand and agree to the following obligations for management of this project: 1. As the installer I am obligated to call for any and all inspections. If homeowner, contractor, project manger, or any other person not associated with my company schedules an inspection and the system is not ready then item two shall be applicable . 2. As the installer I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a $50.00 fine being levied against my company. a) Bottom of Bed—generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final Inspection—Engineer must first do their inspection for elevations,ties,etc. As-built or verbal OK from engineer must be submitted to BOH,after which installer calls for inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. c) Final Grade—Installer must request inspection when all grading is complete. Does not have to be on site. 3. As the installer I understand that persons or companies not associated with my company may not perform the work required by my company to complete the installation of the system identified in the attached application for installation. I fiu'ther understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system, and/or revocation or suspension of my license in the Town of North Andover plus significant fines to all persons involved. 4. As the Installer I understand that I must be on site during the performance of the following construction steps: a) Determination that the proper elevation of the excavation has been reached. b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff. d) Installation of tank,D-box,pipes,stone,vent,pump chamber,retaining wall and other components. 5. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer Date: Cid VAR - 9 AS-BUILT CHECKLIST LOT NUMBER, STREET NAME ASSESSORS MAP & PARCEL NUMBER I/ LOT LINES &LOCATION OF DWELLINGS (/ LOCATIONS & DIMENSIONS OF SYSTEM, I INCLUDING RESERVE l/ TIES TO LOT LINES & DWELLING, WELLS a. FROM SEPTIC TANK b. FROM LEACH AREA V LOCATIONS OF DEEP HOLES &PERC TESTS ELEVATIONS OF DISPOSAL SYSTEM TOP OF FDN ELEVATION LOCATIONS OF WELLS, DRAINS, WATERCOURSES WITHIN 150' OF SYSTEM LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE _ DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK&D-BOX ORIGINAL STAMP & SIGNATURE IMPERVIOUS AREAS - DRIVEWAYS, ETC. �\ NORTH ARROW lei LOCATION& ELEVATIONS OF BENCHMARK USED Commonwealth of Massachusetts City/Town of NORTH ANDOVER, MASSACHUSET System Pumping Record M yea 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 aim A. Facility Information Important: When filling out 1. System Location: forms on the � � R computer, use only the tab key Address to move your cursor-do not City/Town use the return State Zip Code key. 2. System Owner: rah Name Address(if different from location) City/Town Stat G / �y Zip Code Telephone Number B. Pumping Record Date of Pumping Da 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s)r7L5eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes 4pqu If yes, was it cleaned? ❑ Yee 5. Condition of System: 6. System Pumped B Name ( Vehicle License Number 37 (JO. �D Uf Company 7. Location where contents were disposed: 27�fO Signature9/Mauler Date http://www.mass.gov/dep/w ter/approvals/t5forms.htm#inspect t5form4.doc•06/03 System Pumping Record•Page 1 of 1 TOWN OF NORTH -ANDOVER SYSTEM PUMPINC RECORD J r f - 303 � 1 � 1'EM OWNER & ADDRESS SYSTEM LOCATION (example; Icf( from of house) (7doc�Ynar� o c p ®ut,5c, U.iTC OF PUMPINC:_ v�-03 ; QUANTITY 1'UM1'CD_K�J 0,� LLc�� � . . C. I:-).�I'OOL: NO YES SEPTIC TANK: NO YES ", ATURE OF SERYICE: ROUTINE EMERGENCY (Ml 17RVATIONS: COOD CONDITION. FULL TO COVED HFAYY CREASE BAFFLES IN Pl.,ACE ROOTS LEACHFIELD RUNBACK . EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER Q�HFR (EXPLAIN) UM.'yIrNTS: u1 PI:N r5 TItANSFEIZIZED TO: 1je, • ► �. �'L—'fir.:-�c_. t-'(�t•c,-•; .ct ��"�..� �4A Of 93 1 � it t t 6g,.4-d f jj N E «nr sm 6 f Town of North Andover, Massachusetts Form No.2 f OORT►I BOARD OF HEALTH o f M DESIGN APPROVAL FOR ass CHUSEt SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant /�� -t, Test No. Site Location 9 (-? C. Reference Plans and Specs ENGINEER DESIGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. CHAIRMAN,BOARD OF HEALTH .15 Fee 00 Site System Permit No. S�U IV: ioF FROM T � �'�_ �. C-1 3S ULU - - ei �Ni�! ............ I `= - S6GNED -- AMPAD NO.23-176 -' TS< 6 � - 1 . ��_..Z`"i�►//�L /� Cly : _ i .,.��1.�.�.�/_�.�'.�_��. :.' . _..�_:, � r i A COM4104�� i C-D, /> cc CJ N �� NVE R ELE 7-/0-V SSR a�c Y- /L�•ga ���•v���� c '��j/ f 1 e Gyp { I } I ri I a w..wmx.w.,rw+.rrnr,oMV.tneay..lnNMrMtAwK,NeYr.nroMeYrnaxMMwWqfo1.'alwMafaMt.wOUtl:wiM/JM1ore4:M nruNrnfwrow•0,11M'tRMMOKYIA'PN't/r'Mi4MifllU'kI1WM,1il10YLfs0IMLf,1MMN11MMh•9Mi,M•MrPItiMMmMUMIIr'f4I1MlItuMM1.a11NYliwPAKtltlIWRWONY!fIVGV.RNXfIfRMYff.WI3WY r • ��4P.O.SED SC/BSURFgGE S=WA4C= I)/sPms4e- SosrEM • ��U � _Lot SL --W /-t_�inr /a c '_c F. Sys.•�_�m_ ---- --- - -- --- ' PRo.000sEp Lor aTRA.b/.vG ., ._ --- _ ... . �'CA L E 0 = 4 v ' KATE 7-1- B 4 dao x �. • 7 .� 0� :' � ,�•• D6El.VEA2 Rei/sE '7- 4L 16 5' �i _ LOCAT/GIV i G �. �� -ti � Des/ N _ -- - , > •,,, ,,,` ,� � � O cT�SEPf•/ cT �A�2BA4ALC. D , RS. .���%;,��✓ 1 �� , �' � � TEc. �G � -�983 � "ar�A•.... /A;/� f QES/GAl pATA 1eaps'F• TYPE OF 81/!LD/A/4: 4 c,R 7> w ///A/ G a4RAGE $ CEZ"R P4UMB/A14v AAC/G/T/ES= A1,A ,o �� q SEK/AGE FLOW EST/MATE A G t S46RrIC T4NK / q c A °4BSG.�PT/�N AREA = S ¢ 'X 3 5 57 1 ` ePERroc.4T/oAJ 72�73 1 QA4 '+ 3 U• I ABOT'7 Af EYE✓d TAGAV dA, j .Sr1 rc%eA rioAV 1Y Af/AI. A49/N • [S � 9'" 1'b 6^ OROP �6 til/M. Af/!V. MiN ,M/nom S-q Af IA A ANI A/ All/A/. 4L--PGoeA 4f,, /,v. M // M/- /A,' tit ti /,v. D TEST PITS Mt l v" �*¢ DA rE TOP ECFX/AT/OA! I oc s L i �.' -top Sub .%O/C T YPES S 3'S<< y NAIL IN R WATER rA ec.E / A AV p y GocA ria, / -4z 3- t TESTS Ce_WD IGTELD By 11A yGeES _FRIG. ,c_z eoS ) 7LST.s W/TNESSEd BY : 7 CLO,u G�, E f_ Ae_4Al E' D�SIF�t! Gel rEie/A cS'HEET � OF ENND S C7 Q --- o ¢„PI PEzorae.4 rao P vC. PIPE �O� EQc//vALENT) PART/AZ- _BEz) EA./z) SECT/o/V ALE 4QEA -IG 10 S'-1 %.� t M (FOS SPEC/F/CA r,,oA/s — SEE <sccrIoA,/ .4T LOWED e/4jN7-) /,S'00 44C. CONG.QETE SEPr/C r"AwK S4 SEALED TOiN7' R 4BSOR PT/O404 A A/ AfoT TU c 5C.4LE 17o• i c 8 EA ED JEG EG T ' TO/NT, -- f•—ISS—� �c7 spG�o • �CKFILL _ - � _ ,- _ _ _ _ -._.._.._...••_... .,._`� t?, .. ��� P. YAG. - � � rc4 -s• _ _ //g". ry f/B' yvasHED w _ CF /42•S v.4L EN 7- 40 40rp J Q d O S•X• Iv , l G D�S O � IZw STovE � O O ti --- - �DOc/BGIri N/AS�i/E'D Td MEET A 4.S N O. Pct. T-//-GOJ _ _--.--.._ _-.- -- --• - ------ ,Q,BS::J�PT/O,t,/ BEIM c..�EC T/p AJ ,rc F/L E R�visE 7 ie�-�* ��A���c��. l�/_¢� I�E,ET' /`�' P,QOF/GE ANV f{BSd.�PT/O�v C3E� f'��AN ati/t� SEG T/OrvS �f•/�E' 4F www z Board of Health - SEPT'IC SISTER MQ I North AndoverZHaaa. ��QA IN STALLATI CtQ CHIC$ LI ST LOT'� �P OOVID DATE DISUPgt O7ED AVATION 0� FAIL ea sons t h FAM OK 1. Distance To s 1��Cr, a. Wetlands 1 o t b. Drains C.. Well 2. Water Line Location 3. No PVC Pipe 4 1 !t. Septic Tank a. Tees -:Length Ec To Clean Out Covers' b. Cement Pipe '.to Tank - Oa Both Sides of Tank 5. Distribution Box a. Covers & Box - No Cracks b;, All Lines Flowing Equal- Amounts c. No Back Flow 6. Leach Field or Trench a. Dimensions b. Stone Depth c. Capped Inds d. Clean Double Washed Stone 7. Leach Pits a. Dimensions b. Stone Depth c. Splash Pads d. Tess e. Cement Pipe to Pit - Both Sides f. Clean Double Washed Stone 8. No Garbage Disposal i 9• Final Grading Inspection 10. Barricading Covered System 11. As Built Submitted Tf3�19� a. Lot Location b. Dimensions of System c. Location -4th Regard-to Perc Test d. 'Elevations e: Water Table i i l 1 i TO: NORTH ANDOVER, MASS 0 CT l7 19 8� 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 Lo t S6 ed RZ tOAJ I-A&4 North Andover, Mass. SITE LOCATION The grades and construction are as specified in-my plans and specifications dated 19 -b''�e ora COMMp�, O A eg. n er/ye ni ian 7 9�/�N S t 11CSP�a . r . e, Board of Health r ` cre..Y. LndoveryMass J f SUBSURFACE DISPOSAL DESIGN CHECK LIST LOT APPROM DATE A-1 (0- DISAPPROPED DATE______ Provided: Reasons: V Title V FAIL Ob Reg 2.5 The submitted plan must show as a minimums ) the lot to be served-area dimensions lot #,abutters b location and log deep observation hoes-distance to ties v c location and results percolation tests-distance to ties d design calculations & calculations showing required leaching area e) location and dimensions of system-including reserve area f) existing and proposed contours (- ) location any wet areas within 1001 of sewage disposal system or disclaimer-check wetlands mapping (h) surface and subsurface drains within 100' of sewage disposal system or disclaimer 3,) location any drainage easements within 100' of sewage disposal system or disclaimer-Planning Board files (3) know sources of Water supply within 2001 of sewage disposal a system or disclaimer location of any proposed Well to serve lot-1001 from leaching facilii location of water lines on property-10' from leaching facility location of benchmark IX driveways ) :garbage-disposals 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 ground water elevation in area sewage disposal'system- (s) plan must be prepared by -a Professional Engineer--or other professional authorized by law to prepare such plans Reg 6 Septic .Tanks tZ(a) capacities-150% of flow, water table, tees, depth of tees, acceus, purin (/" (b) cleanout (c) 101 from cellar call or inground swimming pool (d) 251 from subsurface drains Reg 10.2 7 Distribution Boxes �j (a) slope greater than 0.08 Reg 10.4 ✓ b) sump 'l•` til fC••`y?i e•': ,�M�'��I�"fl(J+V, �117I� Ai•+Y T 4,Nt �l 4�T111 ' .. 4 r i I I 4 SL RECEI RECE1C• �i l�dl�a E� Jdb'': Jtf;)teri Ir,S+T .,til 1t., wi l 5r tti ¢ .r rtr .+itli 1.1 ii+ \j FSEP JZ�}(�y �1l.Ulo omonyvealth`of MassachusettsICifyrfown.;of:NORTH ANDOVER MASS �ovaa System' Pimping:Record "� Form"41 J DEP has provided this form for use by local Boards of Health. The System Pumping Record mu:, be submitted to the local Board of Health or other approving authority. I .A..Facility Information c 1, Syst Location, AdAa (� U4 l CI own State ZIp Code 1 2, S to Owner. , J • Name Address(If different from location) Mrrown State Zlp Code Telephone Number B. Pumping Record I. Date of Pumping pa ' 2. Quantity Pumped: Gallons 3, 1 Type of system: ❑ Cesspool(s) �eptic Tank ❑ Tight Tank y{] Other(describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If ye§'was it cleaned? ❑ Yes ❑ No � 5. Condition of System: I 6. tem Pumped By: zrI me. Vehicle License Number Company.,: Y111C2 7.: Locatio where contents were disposed: pnature soler . h gov/depm.ater/approvals/t5forms.htm#Inspect t5f y ^,.. System Pumping Record-Page 1 of 1 Commonwealth of Massachusetts w City/Town of North Andover 5 2013 System Pumping Record C,-; ., -;l ANDOVER 'ENT Form 4 M 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 within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important:When filling out forms 1. System Location: on the computer, use only the tab key to move your Address cursor-do not North Andover Ma 01845 use the return key. City/Town State Zip Code 2. System Owner: !� Name renin Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record Date of Pumping Date 2. Quantity Pumped: Orton 3. Type of system: ❑ Cesspool(s) ❑ Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. SyMern Pumped By: Name Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: Sjev.,Kts Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 Si of Hauler � � Date Signature of Re iving Facility Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1