HomeMy WebLinkAboutMiscellaneous - 20 MILL ROAD 4/30/2018 (2)Commonwealth of Massachusetts'O� C�'VIEp
Ij City/Town of No Andover r I ,
System Pumping Record"' 41
Form 4 l`;lWN OF NORTH ANDOVER
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, I �'
use only the tab
key to move your Address
cursor- do not No Andover
use the return
key. City/Town
2. System Owner:
MU02N
Name
ieaan
Address (if different from location)
C
Ma
State
State
Telephone Number
B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped:
3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank
❑ Other (describe): '
Zip Code
Zip Code
15616
Gallons
❑ Grease Trap
4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System: _
6. System P y:
Name
Vehicle License Number
Stewart's Se tic Se ce
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
LETTER OF TRANSMITTAL
North Andover Health Department of N0 oTM q�
400 6sgood Street 3: b•` d _ .,`+, �oL
North Andover, MA 01845 IN. w ,�
978.688.9540 - Phone
978.688.8476 - Fax
healthdentna,townofnorthandover.com - E-mail �''7 +�'`�*•o ��"`�l`J
www.townofnorthandover.com - Website Page of CH
TO:
TO:
2
DATE:
COMPANY:
FROM: Pamela DelleChiaie, Health Dept. Assistant
Phone:
9'/ D LP / • Dlp (�
r
Fax:
G
L -
We are
U: OCopy of Letter . OPlans OOther (fill in below
I. nese are transmitted as Cliecked below:
OApproved as Noted Requested OAs Required OResubmit
OFor approval OFor Review and comment OFor, Your Use OSubmit
copies for approval
copies for dist.
REMARKS:
COPY TO:
COPY TO:
SIGNED:
COPY TO:
N` N
O O
N N
e4�XMU
a) �
m ui N
U
U c UU
L cu CL
U) a) o w
c2wUS
O T- 0
O CDF•N�
0
Y
U
JO ciiri�Q
CO O (a a c
OUE M
m N O O
d
01
0
OI
O
a
J_
in
n
J
00
E
E
O
U
—,
\I 0
o
o
Z
O
00
C
.o
�
Ln
O
O
c
O U_
D
-C w
asU 3
Q
m m
M
LL
O
J
J2 W
J
a >
NM
D
N
M N
-�
O
0 0
N
U
O
D
cc
U�
ooccooa) a
���-aNZ
maU _J
oWLO
0 Q
�wCL
a
I\
N"T0
O 0
a) <
0
� �'L u
2 a
-
d
m o
U
c c
aoHj a
O
U) U) ED u
O
J
O T- 0
O CDF•N�
0
Y
U
JO ciiri�Q
CO O (a a c
OUE M
m N O O
d
01
0
OI
O
a
J_
in
n
J
00
E
E
O
U
—,
\I 0
o
o
Z
O
00
O
O
�
Ln
O
O
Ln
co
�
0
O
M
LL
O
J
W
J2 W
c00o coo
a >
NM
D
02 oZ
J�
a
Q
xQ �x
U
(D 200
Q
���-aNZ
CL
cc
0 Q
fA
00
y
�
O �
rn
_
U
c00o coo
U
0
cc
I\
N"T0
O 0
LO
�OD
>O
Q �
W
O O
0 0
Q
d
Z
c0D
�a
c
Zco
O
Z
N w
O pN�
0� �
LLUorn
Q -o-6
cEZW
c c
O
�oZoJ
10
ON Q�
VQQ
LL
V
It LO
Z ori ri
•
Q� LL(00
0
0 NN
LO
Nm
gU)�
Q
J
0
W rnrn
xWrnrn
-oma
jmm
GM
U
d
m � fn
HN
W
00
00
Z
d
m
I; I;i
vv
o
V�
Ln
H T co
C.0 04
CL
O
U a
c
F- H
p
�(n o
c o
x
LM
_
'=
a
O
=
(w
Z W
co 0iJ
U
a
� o
0 0
N
le
r �
t�
r N N
Q 5 �
cc C6 f6
> 2 > >
Q E(9`0-000
w
- -oe
Ci za
m
LL
E00 E �in��0
wcrn L) o0""0
m
000LL_00 W2(nc)¢¢
coN
Z
I-. ti 0 ao co
s
O
a�-� N °��C9Q
O
y
IL
''M
m
Q�
m ai LU
a)�N�N
M eo
N
Lr
++.. (1) LL
O
ZcLi
cQQ `�¢ m o E a
�".
ma�`000
C
a'° c'" X 0 2 c�0
Ln
vc
��
s
V
M) w�C9Uiio
;,,-i
e
Z
0
ufir
W
D
L` v N r F• F• cn
(/�
Q ..
X N ll
U(n
=
W y
IPS
�,
E �' N=� �_ LL
Er 3L � �U)
O00O
N
o w 0
(7 C9
oof
IL
2mmm0C'!Y
~ w U E E0
Ln
F-MLL.x W in UJ IM 00
N
NC9m
UU x0z
o � H p ui U
a)
=
m - ?,= 0. CL
_c0
F•
U
F-�mm
o
W
OL
(nlnrw2L2LLLL0
d W d
cn
orf w/,
� Q f ly s f1 7-46 .
P -URD of HE L -1-H
. tia�TH A�vlbvEi�,, N1,4,
�r Z /"alt.(.. 5T
,� QPM Cq�J D_ -1 S 7 -
ss 5tPToc Sys IEM VES1r-A
�PPf{ovt-D D,�rt' 1JPRWN6Aurhol,�)-ry
(fO/ JPiTi oNS =
DI5AFob v5D
RQsoms
DSC
C- x4V4Tto1J Jtic p�6-po &j
FINAL W SPFGrIonJ
APPRdvED
'5 Prc c Sy5TOM t." s IA L ATioAJ
Arc
7,,-,�5s
Ej F4 iL-
Q4TC
&P TIoPAL, J AJSF6 , joNS Ali k jy)
DIS/ MovFD I DAT -C"
RE✓j5o tis ,
FML APPPpvAL D,o�E
Additions- and Septic
systems
Why do 1 need this approval? The Health
Department must approve all applications for
additions to houses served by a septic system
before the Building Department will issue any
permit. This is because there are several things
that the Health Department must check, namely:
• Does the addition meet setback
requirements?
• Is the septic system working now?
• Where exactly is the septic system?
• Will there be more flow to the system?
• Does the system currently comply with
relevant regulations?
• Is the system large enough to handle any
extra flow?
• Is there room enough on the lot for a new
system and a reserve?
All these questions address the problem of
whether the septic system is or can be made
large enough for the maximum number of
people the house could hold. An addition of any
kind when there is a septic system on the site is
considered "new construction".
What do I need?: You will need to submit floor
plans for the proposed addition along with a
complete floor plan of all floors of the house as it
currently exists. The two plans should be in the
same scale. You will also need a certified plot
plan showing the outline of the existing house,
the proposed addition, the location of the septic
system, and any wells or pools on the site. These
should all be to scale. It is also recommended
that you have your septic system inspected by a
certified Septic System Inspector. It is important
that your inspector checks on the size of your
septic system as well as how well it is working.
Who do I see? See the Health Department if
you cannot locate the septic system; there may
be a plan on file. See the Zoning Officer to find
out if your lot and the proposed addition meet
# HD -03
Zoning requirements. Check with the
Conservation Department to discover whether
wetlands will be a factor in your project. Then
submit your entire package to the Health
Department for a decision on your septic
system's fate. A Civil Engineer could help you
with this process.
How do I do this?: To start the process you must
first go to the Building Department and apply for
a permit for an addition. You will pay a fee and
receive some paperwork. You will probably have
to go through the Conservation Commission
process if there are any wetlands anywhere near
your project site. If your site is located in the Itake
Cochiewick watershed, then you should check
with the Planning Department to see if you need
a special permit. If you have submitted your
application to the Board of Health, staff can be
reviewing it while you are going through other
departmental processes. A final approval and
permission for a building permit will depend on
the approval of all pertinent departments.
Other References:
• 310 CMR 15.000 Title 5 (You can
download a copy of Title 5 at
v+.iww.state.ma. us/dep/brp/wwm/t5pubs
tm)
• Town of North Andover Requirements for
the Subsurface Disposal of Sewage
• List of properties in the Watershed (in the
Community Development and Services
office at 27 Charles Street)
Town of North Andover Health Department - Community Development & Services Division
This brochure is intended for educations/purposes only. It does not cover al/jurisdictions or scenarios thatyour
permit application maybe subject to. Permit applications are site specific.
Decks & Septic Systems # HD -0 1
Why do I need this approval? This approval is
necessary for two reasons. 1) A Building Permit
cannot be issued unless the Board of Health
approves the application and; 2) The Health
Department must make sure that the septic
system will not be adversely affected and result
in a threat to the environment or to the public
health. When a deck is added to a house that is
served by an individual septic system, the Health
Department must review the application to make
sure -that the deck isn't located over the septic
tank and the deck supports aren't on the tank or
in the leach area. Any one of these conditions
could jeopardize the proper functioning of the
septic system and/or cause a system failure.
What do I need? For the Health Department
review you will need the following documents:
• Scaled plot plan with house and septic
system accurately located;
• Plan location of your proposed deck at
the correct scale added to the plot plan
If you do not have this information in your own
files, the Board of Health may be able to help you
by providing a copy of your septic As -Built plan.
Who do I see? To obtain a copy of your As -Built
(the plan that shows ,your .lot, house and septic
system as it was buil4, you may request a copy to
be made at the Health Department if one is on
file. If you cannot obtain a scaled copy, you may
want to request that your septic tank pumper
come out and locate the septic system
components. A Civil Engineer may also. locate
the system and can then prepare a certified plot
plan. Once you have the plot plan and are ready
to site the deck, there are a few rules you need to
keep in mind. They are:
• Decks cannot be placed over septic
tanks.
• Deck supports cannot be placed on a
septic tank nor within 5 feet of the tank
or line to the tank.
• The deck must be at least 10 feet from
the leaching area.
How do I do this? To start the process you
must first go to the Building Department and
apply for a permit to build a deck. You will pay a
fee and receive some paperwork. If you are in
the Lake Cochiewick Watershed you should
check with the Planning Department about a
Watershed Permit. You may also have to go
through the Conservation Commission if you
have wetlands on or near your property. At the
same time you are talking with Planning and
Conservation, you may submit your paperwork
to the Health Department for review and
approval. If there is a problem with the
application, such as information being missing,
you will be contacted by a staff member of the
Health Department. A final approval and the
issuance of a building permit will depend on tine
approval of all pertinent departments.
Other References:
• 310 CMR 15.000 State Environmental
Code Title 5 (Download a copy online
at
www.state.ma.us/dep/brp/wwm/tSp
ubs.htm)
• Town of North Andover Minimum
Requirements for the Subsurface
Disposal of Sanitary Sewage
• List of properties in the Watershed
(on the counter)
Town of North Andover Health Department - Community Development & Services Division
This brochure is intended as education of the local permitting process only. It does not cover al1jurisdictions, -or
scenarios thatyour permit application maybe subject to. Permit applications are site specific.
Pools.& Septic Systems
Why do I need this approval? Unless the
Board of Health approves the location of the
proposed pool, the Building Department will not
issue a building permit. The Board of Health
reviews all applications for residential pools that
are proposed for sites with septic systems to
make sure that the pool is not being placed on
top of the septic system components, on or in
the leach area or on or in the reserve area. In
addition there are certain setbacks to the septic
system and any well on site that must be
maintained.
What do I need? For the Health Department
review you will need the following documents:
• Scaled plot plan with house and septic
system accurately located;
• Plan location of your proposed pool at
the correct scale added to the plot plan
If you do not have this information in your own
files, the Board of Health may be able to help you
by providing a copy of your septic As -Built plan.
Who do I see? To obtain a copy of your As -Built
(the plan that shows your lot, house and septic
system as it was built), you may request a copy to
be made at the Health Department if one is on
file. If you cannot obtain a scaled copy, you may
want to request that your septic tank pumper
come out and locate the septic system
components. A Civil Engineer may also locate
the system and can then prepare a certified plot
plan.. Once you have the plot plan and are ready
to site the pool, there are a few rules you need to
keep in mind. They are:
In -ground pools must be at least 20 feet
from the septic system leach area and at
least 10 feet from the septic tank.
Aboveground pools must be at least 10
feet from both the leach area and the
septic tank.
If there is a well on the property, regardless of
the well's use, then:
Both types of pools must be at least 15
feet from the well.
# HD -02
These setbacks include all parts of the pool, such
as fences, decks, cement walkways and grading.
How do I do this? To start the process you
must first go to the Building Department and
apply for a permit to install a pool. You will pay
a fee and receive some paperwork. You will
have to go through the Conservation
Commission if you have wetlands on or near
your property. It is always wise to check with
the Conservation Department whenever you
are planning an outside project that will result
in excavation of soil or removal of trees. You
can; at the same time you are working with
Conservation, submit your paperwork to the
Health Department for review and approval. If
there is a problem with the application or if
information is missing, you will be contacted
and asked to supply additional paperwork or
clarify something on your application. A final
approval and issuance of a building permit will
depend on the approval of all pertinent
departments.
Other References:
• 310 CMR 15.000 of the State
Environmental Code, Title 5
(Download a copy online at
www.state.ma.u5/depZbrp/wwMLt
5pubs.htm)
• Town of North Andover Minimum
Requirements for the Subsurface
Disposal of Sanitary Sewage
• #CD- 01 Notice of Intent (NOI)
brochure
• #PD -01 Watershed Permit brochure
Town of North Andover Health Department - Community Development & Services Division
This brochure is intended as education of the local permitting process only. It does not cover al1jurisdictions or
scenarios that your permit application maybe subject to. Permit applications are site specific.
IeChiaie, Pamela
From:
DelleChiaie, Pamela
Sent:
Thursday, August 04, 2005 11:15 AM
To:
Sawyer, Susan
Cc:
Grant, Michele
Subject:
30 Mill Road - Septic Breakout Issues
Hi Susan,
Mr. Dan Murphy of 20 Mill Road called and stated that Alan Jordan of 30 Mill Road came onto his property today and
stated: "Just so you know, everything is all set and checked out fine -- no problems (referring to septic/water issues)". Mr.
Murphy prefers not to interact with this neighbor, as he is difficult to deal with.
Mr. Murphy, therefore is calling to find out what the status is of 30 Mill Road. He has the copy of the June letter, but would
like to know what the final word is. Thank you.
Michele - FYI
Aosf Regw.ds,
'p4#10-414 D¢-00040 410
Health Department Assistant
Town of North Andover
400 Osgood Street
North Andover, MA 01845
978.688.9540 - Phone
978.688.8476 - Fax
http://www.townofnorthandover.com
healthdept@townofnorthandover.com
m�
+o
1.
T
Lk -
rh
In
0
00
+
a
���
H
$70
t>
�
o00
3:�
r
A ^, g4
w
4
0
(��
VI
�z\ao
%cv
s
wIN
PAS0I
\
j
o I
I
� o
I
I4r N �~ N
ii
ON
� o p
nN
Commonwealth of Massachusettslveo
City/Town of N'u'b 3 0 2011
System Pumping Record
Y [HEALTH
WN OF NORTH ANDOVER
Form 4 DEPARTMENT
�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 tct determine the form they use. The System Pumping Record must be submitted to
the local Board of Health ouotlaer approving authority.
A. Facility Information
1. System Lo ion: Left side of house, Right side of house, Left front of house, Right front of house,
,,t -6 r -ear of h!ouJP, Right rear of house. Left rear of building. Right rear of building.
Address
Cityrrown State Zip Code
2. System Owner:
Name
Address (if different from location)
City/Town
Statijq ` � Code
Telephone Number
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 If yes, was it cleaned? ❑ Yes ❑ No
5. Condition o System:�
6. System Pumped By:
Neil Bateson
Name
Bateson Enterprises Inc
Company
7. Loc *e contents were disposed:
G.LA7zj ,Lowell Waste Water
Signatu
F5821
Vehicle License Number
( ( 2J � (
Date
t5form4.doc• 06/03 System Pumping Recons • Page 1 of 1