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HomeMy WebLinkAboutMiscellaneous - 2 HAY MEADOW ROAD 4/30/2018 (---2 HAY-MEADOW ROAD - � I210/104.8-0„2.0000.0 1 E IVED � Commonwealth of Massachusetts City/Town of NORTH ANDOVER �U�! '1 `1014 System Pumping Record TOWNHEAONORTH � ARTMENTR w 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 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 �J key to move your Address cursor-do not NORTH ANDOVER Ma use the return City/Town State Zip Code key. 0"--11 2. System Owner: h . Name redan Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 6b� /000 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) [Septic Tank ElTight Tank ElGrease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: f�!.—. System-Pu'm d B� _ Name 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 kta r Date Signature of Receiving Facility Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 i Commonwealth of Massachusetts rRE-CEIVED City/Town of System Pumping Record UN 16 2008 Form 4 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT DEP has provided this form for use by local Boards of Health. Oth -forms-may- ;b e 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 Important: When filling out 1. System Location: (� forms on the 1 computer,use only the tab key Address U� to move your cursor-do not Cityrrown State Zip Code use the return key. 2 System Owner: Name Address(if different from location) Citylrown State -�Cae Codg Telephone Number '� I B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes,was it cleaned? ❑ Yes ❑ No 5. Condition g System: tce�� 6. Syste P4 ped By: to Name ^ Vehicle License Number Company V 7. Location renten r dis sed: SignalUrrr auler Date t5forrn4.doc-06/03 System Pumping Record•Page 1 of 1 bATIE— TO FROM ARFr�CCC Pdl'�43ER (/C7� y�J OF r S�2 is T€R6S • W � V J CAI o W SIGN ❑ HSTC➢r�1GCD CALF ❑ WILL CALF O pilp/L3Q C `. �JTS TO❑ WAS UM7EM CALL @ACK AGAIN ,G�rO3 6!t AMPAD NO.23-176-400 SETS NO.23-376-200 SETS TO: NORTH ANDOVER, MASS �L e Z 19 711 BOARD OF HEALTH FROM: DESIGN ENGINEER Re: Soil Absorption Sewage System I nspection This is to certify that I have inspected the construction of the said disposal system at '/'I/ —S-S North Andover, Mass. SITE LOCATION The grades and construction are as specified in my plans and specifications dated Ili 19- 0 9 . R�' n''ineer . Sanitarian : g 6 3S0 � j([5`m Commercial Union Insurance Comoanies 401 Edgewater Drive, Suite 530 Insumnce Wakefield, Massachusetts 01880-1289 Building Commissioner or Board of Health or Inspector of Buildings Board of Selectmen �j 4z/, RE: INSURED: PROPERTY ADDRESS: POLICY NUMBER: ���-� � 77 f' l C LOSS OF CLAIM FILE NO: OBG Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1, 000 . 00 or cause Mass . General Laws, Chapter 143 , Section o to be applicable. If any notice under Mass. General Laws, Chapter 139 , Section 3B is appropriate please direct it to the attention of this writer and include a reference to to the captioned insured, location, policy number, date of loss and claim file number. On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail . SIGNATURE: TITLE: i DATE: �� y� qo ����� G� ��s ices ��,oD s �S���-.�y � �rc5���' Sys•� o �j�v,vp li.),c ,7 4.),45 X14: av tlT���iJ ,L .-/0 T 6164C/LU 7 3, /ti-/ 77 7k ��17�5 I�ly 4,0,0 1v7v.t,/ e-111 A e- % 4--C4oWLv4fZ5 Gv - def 6)1-)-D67z- 1-7k hl�5� -71A w 1 du4rtrZ —/a5;PAc ? R M SOIL PROFILE & PERCOLATION TEST DATA Towrf/Ci �OUe'' No.&Street ' , Y 1�� Gr- Lit N•. � Loc./Subdiv. f:::�o� z4,/1 Plan Owner/. / �✓.JOG. Investigator ,f�r'_ �w � Observer 0 SOIL PROFILES-DATE 3' Elev � �' Elev. 3' Elev. 4'Elev. 0 111-12z7,7e. 0 0 0 d 2 O 2 2 2 \3 3 3 3 A4 4 4 4 S 5 5 5 6 d � 6 6 6 �\7 7 7 7 b 8 8 8 8 a 9 M 9 9 9 ' r 10 10 10 10 v' Benchmark Location Elevation Datum 1 Percolati n Tests-Date fi a? E pt Number 1 2 3 4 5 j Start Saturation U . g Soak-Mins. Start Test-Time Drop of 3"-Time DroD of 6"-Time Mins.lst 3"Dro Mins. 2nd 3"Dro Notes & Sketches on Back Frank C. Gelinas & Associates, North And. �� _ at, f •�, _ 3 S 00-60 _ S U' o o'ojg Qi Fl LA -� oa 4Q " co 19 rn uoxovc; � - N - CO S uo 9 -elll 2169_l ,00Oy _ - ' o,_ 0 177 7-1 N IA� 7- vik e ' NORTH AIMVIR B0O_t.RD OF HFJ,`1'H . r /7, CN' CK LIST APPROVEDDISAPPROVER F- AVATION OK Date: Date: �• !?-71 • Reason: 1 4-6) Z AsSubmed Check: Lot location, dimensions of system, location in regard to percolation tests, depth of system, irater table 2. Distance to Wetland Areas, Drains, Street & House, Drainage Easement and Wells. 3. Water Lintocation 4. No PVC pe 5. Septic Tank - T s, Cement-Pipe to Tank- ints on both side of Tank. 6. Distribution Box - No cracks box or cov all l.uzes floor a ly from 7. Leach Fields - Dim Bions, s;- Capp ends, Clean do -crashed stone $. Leach Pits - Dimensi ons, Depth of Stone, Splash pads tees, Cemer_t-pipe to tank- joints ank-joints on both sides of tank, Clean double-washed stone 9 Garbage Disposals. , , 1 Final Gradin �'` _ rface system! l c . Z. � X177 `t PZA fc.1 L5W40WiA147 PROPOSE•b SUSSdR A,4 E S6wA4E h/sPaS& cY57EM AVIV P�pDPD.jED LDT CTRAD/NG SCALE M E 7'-- G R o tAp 2 1 8 LEVA/fs '4 VE - '71-84 ,-- 7o.00 - r3 car o fv ,, m 14 s s z S 4. LpT N© N +'Er�- , .00 Ar-ee SEpA 4 - S3 t Rb r4 G19//(,p I WEgtUl� R A A) RSH � �fvG1 fYlf�s� ' bE.S/f-AJ DA rA = -... T'YPE OF &114,01A147: /�� ''� `.'` � ; G ARAE E � CEl..L.AR f�L UMB/�c/C, F,4�G/G/T/ES= :�•D� 'E' SE6f/46E FLOW EST/MATE : .000U .-�• SEPT/G 74AIK /000G 141650.QP?"/0N AREA ;.a.'. • f. Al F U�' r4 ,,. A 4 �� Aj ,� b N '`�. � � l JJ \9 # �PEReo�ATioA/ TEs73 -0/ (10 DA roE -. H- 27-76 f , ^A \ TDP .47 i �-— __� �- � ,�$OTTOiy ELE✓A'Ti4ON ,g i \, Apt `� •e� ,' �Xob S,4TZIe-4 OA/ i / Mho/ M/N. 01A./. M/N. o ( /Z"ro 1" DROP iy/N. MiN. MIAI. M/A✓. 9'• ro !o" DROP / Z /yp/A/, AVAZ M/N. M/n/. Ile PE/?COLA r/oAl RArE /N. /V. - M/NMN Mie. /v Mini & ,'•/DTc: t4 Cl 7ES7- PITS V`J ��i,C' �►t' �:' cF = •Y� : s� yl`� 3 DATE _ ae- /8"r-00,7 //-27-76 MAS' &E /ivy 3C.GG� �1 e! 'r x TOP ELEf/AT/DA1 5. i V THE Pk '�S � �8"r-00< Sue �` --- '"„ Q ,► SO/L TYPES 7S Do`E'f "(o2 max 4Z-�.� WA7 ER- 7A6LE w wt W TQ F- .T 41 BorTOM ELEI/Ar/—n /gyp, S • -rE5TS coAl4 c TED BY y-ca s p L, cs'�4�b�►G'4/!G "S rESTs WIT-A1ESSED BY : TOWN/ OF' 4/0 4AS40V�4 RZ-4AY e D6s 16" eel rERIA c5' -16er / 0'- 2 in k ���Yh <SE-TED �/�vT, soy/D C//VA L6"T) p • - m�ett_ a _—.._� _ �.6 - e- age—• - �J'�). ---s� — CAPPED �itlDS - 1� L . Cot E67L/%l,A1_,i51vr) DIRT-'.a/ SED EVD SECTIO SCALE l2 _/ 42E-A- 900 Se 7—/oiV A7' LpWEER .2A T) �/DDO Q4c: •'.:'•'vC,�ETE SEPT/C T-�1NK `�5 ._,. _ i -VC .56.ALE_Z JOinlTS IL - iro`: ? y ABSOi2 PT/ON BEZ�l Pt.A AJ - -_. / t'?vfimN t?OX— �`4 A_X 7r TO CSCL AE .a f 25 —ter. CF. r .,�;�,�� 3E atL E� I ECT 57(o .�yo�^a '•"'�o + .�= o- Q �_ n- � ro C,2US NED SONE o • �'-a- - • o ti1.ti - •� •'�4d I i v � � EQc//v,•H�EnJT v -3 /�. WASHEDPs Q dl� Z <), c/BGE vvASNED r.^ MEET A.A.S N �. 1 V. ?' ' /q.B 4,550RP7-/0A,/ BED cS�ECT/D,y O„ r� - f .•e.�F/l.E BES PLAN Q�vv CT/o�v5 J�'H�Er o� 2 I 7v Al— -ZF-�y ��� � Gv�'✓E✓�Tocv►/�cat� QT -rO 1 V7 51r4 �Gp� � Gc�nC� ►���' T�� L�c.� �e.�C�. I �r 6>0-t TIS,--r �, � �� �o V'co -fo( (T nT �ni5 ��fJ S ►ie. ��� �v�c� w�1r ����► � Cf tt4e V"c4tec Ulp Y . af, _t" JUS.4h Allvwver as 4.- ).-JG M4in -C-f. ST19/ T S SEPTIC TANK SERVICE 47 RAILROAD STREET Nd/lh A nno a-,, ' BRADFORD, MA 01835 978-372-7471 ins'4-n, Moxre of ( b cf 4 ew MfJ�VW REPORT FOR TOWN OF ov� DATE ADDRFSS GALTZNS - - ��- 55 e6 763 UJ P3 1506 M�R ° 1 0-h en--,o 01 1 � boy 16 -5� 15"7IE= f q km lo oc -43 tsl i TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE:E: Q 1 5'I'E;YI OWNER & ADDRESS SYSTEM LOCATION `--� 1 (example: left front of house) donin fi �- _ T D.-%- TE OF PUMPING: QUANTITY PUMPED� GALLO\S CI;SSI OOL. NO YES SEPTIC TANK: NO YES \A"1'UIZE OF SERVICE: ROUTINE EMERGENCY Uf3SFIZ�'.1'I'I0NS: / V 1 LU011 CONDITION 1{l LL f0 COVER � 1-1I:AVY GREASE BAFFLES IN PLACE ROUTS LEACI-IFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) 1 t'E:M PUMPED BY: Uo1I:ti1ENTS: t-:ON E'N'I'S TRANSFERRED TO: h