Loading...
HomeMy WebLinkAboutMiscellaneous - 201 HAY MEADOW ROAD 4/30/2018�\ Commonwealth of Massachusetts RECEIVED \ City/Town of JL 2 8 Zoos System Pumping Record Form 4 TOWN OF NORTH ANDOVER HEALTH 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 Important: When filling out 1. System Location<G;ft front of hous 3 Right front of house, Left rear of house, Right rear of house forms on the computer, use Mee IJ6 k.&) only the tab key Address to move your , L.Ae-4we( cursor - do not ` use the return City/Town State Zip Code key. 2. System Owner J bZ.l `�OI�sC.tn- Name ILEI Address (if different from location) City/Town State q , Zip Code Telephone Number B. Pumping Record Q 1. Date of Pumping 7 — `� Date �� ` 2/Septic Quantity Pumped 3. Type of system: ElCesspool(s) Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes [j No 5. Condition of System: 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Location where contents were disposed: Lowell Waste Water Signature of Hauler Gallon ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No Vehicle License Number F5821 Date I a 3, a 9 t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 5. r vcr,nel Provlded Ihlr'lorrn lo, 5.10 ,y 10; llod.19 or eoa oe Ivvmlc1 Vli Io 18 00 In A. Faclllty Infnrz-i l,,,, 11!19noni n,mp„ yy/�;� A•»•; rP,' �'�j 011 � n':d�','� r 6 .5,;,,• j ,�y',,,:c,,; 7 7 $0900 ion, Q r QlhOf '•; , •r 1, , ; .Y ,�'; i{'i��{/,�I''��i, ',ur _ 4' ' �hlile/I) r00 FIIIO(+p 0„JO t? Yoh �`�'h;;�',;j'�!•��J,l'rY;1�,1/r41J%�)"�,%rltil'''• •�' CD 110 ' i.�Q�ir I"' �'S11'S5r•;'.,b, I55i,1/�'1,1' Pvmpfo 8Y,' r Ilyor. �elr,cvaneo� ''� res .. ••. ",,�;'• 1. rl�'r ��IJ'sr lir , ;,,' ,: . .' Ir�`,�,� fi i ✓i�i�j, ' y 11c;'( 110 ' ...� •.�'�'• : 'ra,5,oca onrwher� ooglbny,�Qro dl1 lei • ..'�. • J,�',l'rIN '�r•„tJrl v'S IW {y” � p0390; � _''^•,�, �:'1.;1ti .',r', sVnl„FYI Of NI'r,,,r, D dep�4releilipp�oYa�allb/orrn�,n:maln��ocl `•.:> : •; 'r I r►tti'y, ,'�•,��Y�Iem OWnar,'�i�-,•,; , ' ' .� , f'17'I''o-11I'''r' ' �QI µJ Q Illnl IQT1 bUVon) V' Oa4e of Pumf)in i'7 11!19noni n,mp„ yy/�;� A•»•; rP,' �'�j 011 � n':d�','� r 6 .5,;,,• j ,�y',,,:c,,; 7 7 $0900 ion, Q r QlhOf '•; , •r 1, , ; .Y ,�'; i{'i��{/,�I''��i, ',ur _ 4' ' �hlile/I) r00 FIIIO(+p 0„JO t? Yoh �`�'h;;�',;j'�!•��J,l'rY;1�,1/r41J%�)"�,%rltil'''• •�' CD 110 ' i.�Q�ir I"' �'S11'S5r•;'.,b, I55i,1/�'1,1' Pvmpfo 8Y,' r Ilyor. �elr,cvaneo� ''� res .. ••. ",,�;'• 1. rl�'r ��IJ'sr lir , ;,,' ,: . .' Ir�`,�,� fi i ✓i�i�j, ' y 11c;'( 110 ' ...� •.�'�'• : 'ra,5,oca onrwher� ooglbny,�Qro dl1 lei • ..'�. • J,�',l'rIN '�r•„tJrl v'S IW {y” � p0390; � _''^•,�, �:'1.;1ti .',r', sVnl„FYI Of NI'r,,,r, D dep�4releilipp�oYa�allb/orrn�,n:maln��ocl TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: SYSTEM OWNER & ADDRESS svD-0 � t4�nham, SYSTEM LOCATION (example: left front of house) DATE OF PUMPING: QUANTITY PUMPED l,'S"GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE �MERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER SYSTEM PUMPED BY: COMMENTS: FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) CONTENTS TRANSFERRED TO:. 1PN,^ O Commonwealth of Massachusetts Massachusetts System Pumping Record Date of Pumping: '7—lo— T 6 Cess: No M Yes ❑ System Location 201 HAY Mtrir�,ow NozTr-f ANC)01&c Quantity Pumped: l -SfO 0 ----gallons Septic Tank: No ❑ Yes IX System Pumped by: 644WM 5fAM1WW License # Contents transferrred to : Greater Lawrence Sanitary District Date: Inspector: C 361 0 2 o w0c M 137.63r HAYMEADOW NOTE: 1hls mortgogs Inspeetlon voo pimM sI i ft My -for mortgogs pur}ow and N not to be retied, upon as oqwM no responsibility for rmgthq f m mold rrtkrroe by onyaw other than the raid martgogse OW he aedP* In oorswctisn wft Its proposed mortgage 1hwr+el- Ao maid marlagogor. CERTWWION TO PRUDENTIAL HOME MORT. CO. ihls martgoos tnapestion was prrpared in ooaordonse WM ttw T Standards for Mortgage Loon Inspection* as lsdP W by the MeeusproseMe� w*ett* Association of Land Surv*yar* Chd 25-00' ROAD LOT 13 tAOF11�o_ UNU I FURTHER STALE THAT IN MY PROFIMONAL PA OOPIMON the prind s structure/s and we wavy Za CON FOR M ySURY� .Ito, the setback rmaphsments of the loud zoning ardinaroes. and that there am no encroachments of nwJor hnprovamenb sMor tray octose property thee. except rn. t " sho Al if • ftoperty Is not Am a Flood Hazard Are& 2 Is In a Flood Hazard Arco. 3. In Y ImAdIkient to detwmh+o Flood Hato . Flood *um latest Federd Flood InmAwwas �ddetwrnhwd FORM u . TOWN OF NORTH ANDOVER ,•,t: LOT RELEASE FORM SUBDIVISION } ASSESSORS MAP t SUBDIVISION LOT(S)` PERMANENT ADDRESS,(ASSIGNED BY'D.P.W. STREET APPLICANT ��� S r i��ciS c.c/ PHONE .DATE OF APPLICATION TOWN USE BELOW THIS LINE PLANNING BOARD TOWN PLANNER CONSERVATION COMMISSION CONSERVATION ADMIN. )EPARTMENT OF PUBLIC WORKS )RIVEWAY PERMIT ;EWER/WATER CONNECTIONS SIRE DEPT. :ECEIVED BY BUILDING INSPECTION DATE DA'T'E APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED ;U y DATE REJECTED Y-!� 'his form shall be signed by the agents of the Planning and Health Boards, he Conservation Commission prior to the issuance of any building permits 'or the subject lot. This form shall not releive the applicant from the :ompliance of any applicable Town requirement or Bylaw. :® 0 a i r L o -r 15 E L..F-VA-r L O Nk la • ��� DtZe�ta�t,0.q� EgSt<n^ 1(1 �^ r of �j L4Z e,500 00 (-qat- fwK n ►.0© h r NIV _ M 0 l- o -r V?) As &UILT cJ Ute- S V R.�"AG.E D 15 PO�A1�-. �jYST EM . I F�1 A\nJ DO V e R r AAA. O` Ff?'tot, SCAN. L.>= i•` _ i DgT�j 7'!) ! RD V� ���'��'• ��. t='RA1�itiC GC>E.�-irtAS � ASsc�tATES �'�a'.`•,�' �N�1N�.E1`ZS� A'RG.�-l[TEGTS 4 St �d.F.J Dc�/� FZ ST Irl a. AN W�IE f.� ` N O 0 �0p 1(1 �^ r of �j L4Z e,500 00 (-qat- fwK n ►.0© h r NIV _ M 0 l- o -r V?) As &UILT cJ Ute- S V R.�"AG.E D 15 PO�A1�-. �jYST EM . I F�1 A\nJ DO V e R r AAA. O` Ff?'tot, SCAN. L.>= i•` _ i DgT�j 7'!) ! RD V� ���'��'• ��. t='RA1�itiC GC>E.�-irtAS � ASsc�tATES �'�a'.`•,�' �N�1N�.E1`ZS� A'RG.�-l[TEGTS 4 St �d.F.J Dc�/� FZ ST Irl a. AN W�IE f.� Loi-' � t f v ---m ny����C�� I Board of Haalth '. North An49YVerJMBIIa. BEPTIC SISTEH INSMLAT�ICK CHECK LIST OK 1. Distance Tot V a. Wetlands b. Drains C. Well / 2. Water Line Location 3, No PVC Pipe %. Septic Tank / a.. _Tess -_Length & To Clean Ont Cowers. 4 b. Cement Pipe to Tank oa Both Sides of Tank 5. Distribution Box g. Covers & Box - No Cracks b. All Lines Flowing Equal AMOUnts c. No Back Flow 6,- Leach Fie' or Trench a. rC:;ed_Ends ons b. Depth c: d. Clean ouble Washed Stone` 7. Leach Pits a. Dimensions b. Stone Depth c. Splash Pads d. Tees e. Coment Pipe to Pit - Both Sides. f. Clean Double Washed Stone 8. No Garbage Disposal 9. -Final Grading Inspection 10. Barricading. Covered System .11. As Built Submitted-..: a. Lot Location b. Dimensions of System c. Location with Regard -to Perc Test d. Flervations a. Water Table North Anc;, r..2 19 (, 6 APPRU ID D.ATS_�/ Provided: Sf MMrACE DI,'�'OSAL IIESI'M CCK T 1,RT DISAPP' OVED DATE Reasons: Title V FAIL CK _ The Reg 2.5 submitted plan must show as a mini=: the lot to be sewed-area,dimensions lot #,sbutters ovation and log deep observation Mes-distance to ties location and results percolation tests -distance to ties sign calculations & calculations showing required leaching area location and dimensions of system -including reserve area: eylsting and proposed contours = - ( cation any wet ares vithin 1001 of sewage dib?os�al system or g) dx.scl.aimer-chick t;etlands r%pping (h) face and subswfaco drains iIthin 3001 of ser;�.ge disposal system or di.s9claimer (i) I ation any drainage eassr€'.:its 14' thin 100, of Nee nge disposal syrst€tet or disclaimer.-M_=ii _ng %ard files J).,%i sources of vmter supply within 2001 of sewage disposal system or disclaimer location of any proposed well to serve lot -10301 from leaching facility ocatd on of -water lines on property -101 -from leaching facility - location of benchmark ( driveways bage disposals - -no PSCC to be used in construction of system -elevations of basement, plumb, pipe, septic t=k, stribution box inlets and out -lets, distribution field piping and z,Aatzer elevations maA ground water elevation in area sewage disposal system (s) play tmFst be prepared by a Professional Eag:L,.eer or other professional authorized by law to prep -are such plans Reg 6Se tp is ,Tanks (a) c acit e' s�50% of flog, water table, tees, depth of tees, access, pumping cleanout 101 from cellar vmll or i,nground swimyzing pool (d) 250 from subsurface drains Reg 10.2 Reg 10.4 Distribution Boxes s .ape greater fa! 0.08 SUMP Reg 15.1 15.4 15.8 3.7 -Reg 14.1 - 14.3 14.4 14.6 14.7 14.10 Reg 9.1 - 9.6 i NAIL I Ox 1 LeacUM Pits Leaching pits ara preferred where the installation is possible a) cal.cu3 atians of h g area -mini a�am 500 sq ft b) spacing c) surface a 2% d) cover tenial e) 2 E 4" W ash pad P) a at elbow no bends in pipe From d -box to pipe �LeaachingFields L__I,&-qj-n_o greater than 20 minutes/inch area -minimum 900 sq ft onstruction of field surface drainage 2 % e) 201 from cellar will or itnground s imirdng pool Tranches--_- _ A). calculations of l - g `area-ndn 500 sq Pt-- b) spacing -4 ft 6 ft with_ reserve betwen - - C) em dimsio f) sl�face drainage 2% Oo<mhill o e a) spa� x = to be down) b) 7/x 50 = (to be shl own)- s a) app cal. b) sZ d -by pager SOIL PROFILE & PERCOLATION TEST DATA 2,ro%h .�nd�ver,J.ass. No.&Scree}_ �ot No. _17 Loc./Subdiv. H� h,ee,�w p Plan OwnerL1 zi,.r0&5 _ Invest gator '7U[ 4oy% c f,116 Observer s-1 vi �r SOIL PROFILES -DATE 1. Elev. 2. Elev. 3. Elev. 4'E1ev. 0 0 0 0 Ties to Test fits 2 3 4 S 6 1 2 3 4 5 6 3 2 3 4 S 6 S 2 3 4 S 6 Z; G - Soak -Mins. _ Start Test -Time ; Drop of 3" -Time N 8 9 -0 Benchmark Elevation. 7 8 9 10 7 8 9 10 7 8 9 10 Location Datum Percolation Tests -Date 7�/z17 Pit Number 1 2 3 4 S Start Saturation Z; G Soak -Mins. Start Test -Time ; Drop of 3" -Time 2',37 Dr o of 6" -Time; I.9ins.1st 3"Dro h, Nti ns . 2nd 3"Dro - Percolation Rate rn •" J � n • Notes & Sketehes on Back r 1 2 5 4 5 5 SOIL PROFILE & PERCOLZ,TION TEST - DATA 6 6 6 icortb Andover ,l.3ss. No. Street --)4 ( k/ _ __Lot No. JJ:7 # Loc./Subdiv. Plan Owner( Drop of 6" -Time 7 Investigator i Observer,( 7 7 SOIL PROFILES -DATE 1'?' Elev. Elev. 3' Elev. A--Elev. i o II—XI-717. 0 0 8- 0 O p O O 7- i 10 Ties to Test Pits 2 10 2 10 2 2 Location i - Datum f Percolation Tests -Date s 3 3 3 3 _ 4 %W4 �. , 4 -- 4 5 1 2 5 4 5 5 5 - 6 6 6 6 Drop Drop of 3" -Time" Drop of 6" -Time 7 7 7 7 i _ 8- O p O O 10 10 10 10 Benchmark Location i Elevation Datum f Percolation Tests -Date Pit Number 1 2 3 4 5 Start Saturation Soak -Mins. Start Test -Time Drop Drop of 3" -Time" Drop of 6" -Time h, i ns . 1st . 3"Drop t7ilns.2nd 3"Drop Notes & Sketches on Back