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HomeMy WebLinkAboutMiscellaneous - 203 GRANVILLE LANE 4/30/2018Commonwealth of Massachusetts _ R CitylTown of North Andover Sys terra Pumping Record Form 4 ws DEP has provided this form for use by local Boards of Health. Other forms may be used, but the ng this information must be substantially the same as that provided here. Before rReusico d must be submitted , check with Your local Board of Health to determine the form they use. The System Pumping 9 p um in date in the local Board of Health or other approving authority within 14 days from the p , accordance with 310 CMR 15.351. A. Facility Information Important: When Suing out forms 1. System Location' on the computer, I I j1 use only the tab key to move your Address Ma 01886 cursor - do not North Andover State Zip Code use the return City/Town key. 2. System Owner:&� fnc-�n . , chin dR Name �;L Address (if different from location) State CitylTown Telephone Number B. Pumping.Record l f 2_ Quantity Pumped: Gallons 1. Date of Pumping Date r 1 3. Type of system: ❑ Cesspool(s) [�S tic Tank Tight Tank El Grease Trap ❑ Other (describe): If. es, was it cleaned? ❑Yes ❑ No 4. Effluent Tee Filter present? ❑ Yes o y 5. Condition of System: / +(,�� 4n K�',il % rnN t7 6. Syste 'Pumped By' Name Stewart's Septic Service Company 7. Location where contents were disposed: re of Receiving Facility t5form4.doc• 03106 20 So. Mill Bradford i -_ r 7 __� Vehicle License Number JIB 01835 Date System Pumping Record • Page Commonwealth of Massachusetts F u City/Town of No andover System Pumping Record 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 on the computer, use only the tab key to move your cursor - do not use the return key. City/Town 2. System Owner: tab tenrn Name Address (if different from location) City/Town State ry Zip Code 'o �rOV � 2 X013 n HEALTH DEPART State Zip Code !3,7?- ( 06 �3 Telephone Number B. Pumping Record I. Date of Pumping %0/I I 2. Quantity Pumped: �5_0y Date Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yeso� No 5. Con on of System MitiA l >ai)f If yes, was it cleaned? ❑ Yes ❑ No 6. System Pumped By: 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 k66, O'n Date Signatu)s44ReBW* ac'itX,------- Date t5form4.doc• 03/06 System Pumping Record • Page 1 of 1 mmonwealthof Massachusetts 4 m City/Town of NORTH ANDOVER MASSACHUSETTS - System Pumping Record ,Form 4 DEP has provided this form for use by local Boards of Health. T e SystemPump ng Recoi d mu: be submitted to the local Board of Health or other approving autl iority. )EC JIML_ A. Facility Information Important: TOWN OF NORTH ANDOVER When filling out 1. System Location: HEALTH DEPARTMENT forms on the �7 computer, use only the tab key Address to move your cursor - do not use the return City/Town , • ~- State- key. Zip Code 04----h 2. System Owner: Name-—._..__..__—._.—�_T.--__ Address (if different from location) ty own StateQ Zip Code Telephone Number B. Pumping Record 1, Date.of Pumping 1f�q 2 Date -- • Quantity Pumped: ��% �'%gam C.% ---- - allons �3. Type of system: ❑ Cesspool(s) "IleSeptic'Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Ye�No If yes, was it cleaned? ❑ Yes ❑ No r 5. Condition of System: 6. Sy of -Pumped By: Name - - ---- _._...._ Vehicle License Apae t. Company 7. Location where contents were disposed: f Si atureofliau ~-- Date - - -- __.y___ ___-- _-•_-. http://www.mass.govi/dep/water/ provals/t5forms.htm#inspect t5form4.doc- 06/03 System Pumping Record - Page 1 of 1 PIN ov, im RECEIVED ... .. .. I I I 'f'()WN ()�. NOR -I'll IkNL>k,.I ', I JAN 0 6 2005 UA lit 5YST_E�" POMPINQ RJ_1C(-)8-LTOWN OF NORTH ANDOVER R AA 04� LT N JAN DEPARTMENT C>20 8 1 coM 44 QoA �al Ty NA rvKu ON 5L,,gyjcg: AC•WTIHo Qu 4 dA YA,nom. ► OOOD Qouvrrlo PvLL 1,YJ vo MmBa I?q WIoltLo LK VN6 �LroI A "yqnxZv, Q'INER-EXPLAIN r. 1. C .-<. l1/) 6 v of v I .. .. I I I I ......W I. . , Akv I'M )IV rMtWow r, cD Q CD a (D V) V) C r r uI m h CO LC CD Z� v G rt O I � o A v 0 A O (p N � Q � o D D � C 3 1 W O sy d O o m nD rt A rt o r- 3 0, 1 cD CL m C rt y O Z 3 D � 3 C 3 H S m i oft } D a c I 1� (D I � rt 1 7 _ _ o o l I 1 l cD Q CD a (D V) V) C r r uI m h CO LC CD North Andover Board of Health 120 Main St. North Andover Ma.01845 Haul Lic. #151 -OOH Install Llc. # 128-0 Date Address 11/1/2000 303 Chester St 11/1/2000 50 Willow Rd 11/1/2000 160 Carelton Ln 11/1/2000 165 Bridal Path 11/4/2000 174 Ingals St 11/4/2000 1062 Salem St 11/6/2000 373 Raligh Tavern Ln 11/6/2000 252 Boxford St 11/6/2000 150 Liberty St 11/6/2000 149 Osgood St 11/7/2000 255 Haymeadow 11/7/2000 850 Winter St 11/8/2000 25 Windsor Ln 11/9/2000 249 Carlton Ln 11/9/2000 767 Johnson St 11/10/2000 56 Academy Rd 11/14/2000 Sugar Cane Ln 11/14/2000 250 Abbott St 11/15/2000 195 Winter St 11/15/2000 187 Winter St 11/16/2000 85 Laconia Cir 11/16/2000 86 Willow Ridge 11/17/2000 2135 Turnpike St 11/20/2000 203 Grandville Ln 11/20/2000 391 Pleasant St 11/20/2000 124 Tucker Farm Rd 11/22/2000 394 Boston Rd 11/22/2000 728 Forest St 11/22/2000 18 Johnney Cake St 11/24/2000 106 Rockey Brook Rd 11/24/2000 258 Rea St 11/28/2000 1815 Great Pond Rd 11/28/2000 1420 Great Pond Rd 11/29/2000 266 Lacy St 11/29/2000 155 Laconia Cir Andover Septic 47 Railroad St. Bradford Ma. 01835 Gallons Comments 1000 1000 1500 1500 1000 1250 1000 1000 Leachfield Run Back/ Ex. Solids 1500 1000 1500 1250 1500 1500 1500 1500 1500 1000 Extra Solids 1500 1500 1500 1000 1500 1000 Flooded 1500 1500 1500 1500 1500 1500 1000 1000 1500 1000 1500 1-03 NORTH AN -O v ER IO RD OF HF-ALiH t A` INSTALLATION CHECK LIST��/L x `r APPROVED DATE DISAPPROVED DATE EXCAVATION OK / Rr1ASONS: _ FAIL -OK 1. Distance To: Wetlands Drains Well 2. Water Line Location dc4� 3. No PVC Pipe 4. Septic Tank - �c _ `' - Tees - Length & To Clean Out Covers Cement.Pipe to Tank - On Both Sides of Tank 5. Distribution Box r Cover & Box - No Cracks All Lines Flowing Equal Amounts No Back Flow h. Leach Field or Trench ' Dimensions St -one Depth 6�' i Z .� Capped Ends' Clean Double Washed Stone � 7. Leach Pits imensions St e Depth Splas ads Tees Cement Pipe 't - Both Sides Clean Double Washed Stone . No Gar' -,age Disposal 9. Final Grading Inspection 10. Barrac-1ding Covered System 11. As - Built Submitted Lot Location Dimensions of System Location with Regard '-o Perc Test Elevations Water Table / 3) /7w.'4d ". " " J Uop._y o f+upiic worxs SUBSURFACE DISPOSAL SYSTEM CHECK LIST s .. NORTH ANDOVER BOARD OF HEALTH APPROVED DATE PROVIDED DI APPROVED DATE TIME REASON. v Title 5 Reg. 2.5 Reg. 6 The submitted plan must show as a minumum: Ea-y—the lot to be served (area,dimensions,lot #,abutters) (Planning Board files) ebt-location and log of deep observation holes -distance to ties location and results of percolation tests -distance to ties (-d' esign calculations & calculations showing required leaching area (e ---location and dimensions of system (including reserve ea) Zexisting and proposed contours location of any wet areas within 100' of the sewage j disposal system ot- disclaimer (check wetlands mapping) (hamsurface and' subsurface drains within 100' of sewage disposal system or disclaimer f (-3�- location of any drainage easements within 100' of sewage disposal system or disclaimer (planning board files) known sources of water supply within 200' of sewage ! disposal system or disclaimer -location of any proposed well to serve the lot (100' from leaching facility) (1) location of water lines on property (10' from leaching facilities) location of benchmark (n) driveways gFarbage disposers --ngo-PVC is to be used in construction I profile of the system (elevations of basement, plumbers, pipe septic tank, distribution box inlets and outlets, distribution field piping and any other elevations) (_-} ximum ground water elevation in area of sewage disposal .system L,-,)_-Vlan must be prepared by a Professional Engineer or other professional authorized by law to prepare such plans Septic Tanks (a) apacities - 1509 of flow, water table, tees, depth of tees, access, pumping, b Cleanout c 10' from cellar wall or inground swimming pool d 25' from subsurface drains I� Vorth.Andpver Subsurface disposal system check list — Page 2' a it Reg.10.2 Reg.10.4 Reg.11.2 Reg.11.4 Reg.11.10 Reg.11.11 Reg.15.1 Reg. 15.1 Reg. 15.4 Reg. 15.8 Reg. 3.7 Reg.14.1 Reg.14.3 Reg.14.4 14.5 Reg.14.6 Reg.14.7 Reg.14.1( Reg. 9.1 Reg. 9.6 Distribution Boxes Slope greater than 0.08 (b Sump Leaching Pits Leaching pits are preferred where the installation is possible (a) Calculations of leaching area (minimum 500 S.F.) (b Spacing (c Surface drainage 2% d Covermaterial e 2 'c2 f ,r p(aask P.,d flee or e;� VO W ( � in o �� w, � d- �f t Leaching Fl�s 3 (LV_ (a) NoG,x4ater than 20 minutes/inch (b rea (minimum 900 S.F.) Construction of field Md Surface drainage 2% (e 20l.from,cellar wall or inground swimming pool Leaching Trenches (a Calculations of leaching area (min. 500 S.F.) Spacing (4 ft. min. 6 ft. with reserve between) Rb Dimensions (d Construction (e Stone (f) Surface drainage 2% Downhill Slope Slope y/x = to be shown y/x X 150 = to be shown o:a (a Approval (b Stand-by power i 0 ` SOIL PROFILE & PERCOLATION TEST DATA Board of Health -North Andover, Mass. Street Lot No. Subdivision Owner Investigator ,� ,�j Observer. SOIL PROFILES 1. Date Elev. Feet Inches 1 0 j 61 2. Date 3. Date Elev. Elev. 4. Date Elev. Ties to Test Pits 1. 2. 3. 4. 5. Tote: Top & subsoil depth; depths of other soil types; -depth of water table; depth of refusal. PERCOLATION TESTS T1a+-.PX-)2-TPngi-a TlaTlata -nn +-. P Pit Number 1 2 3 4 5 Start Saturation ;2$ Soak -Mins. Start Test -Time Drop of 3"—Time SA-- - Drop of "-Time Mins. I st• 3" Drop Mins. 2nd 3" Drop _ Rate Min. in. TOWN"OFA NORTH ANDOVER 0. AL, - NORTH ANDOVER BOARD OF HEALTH REPORT OF PERC TEST ADDRESS OF SYSTEM �'�7^Q,n (2; ham E' NAME OF PROFESSIONAL ENGINEER CR SANITARIAN CONDUCTING TESTS DATE*cdl��?7cl, NAME OF LOT OWNER L„ T ADDRESS v ; /77c, SHOW APPROXIMATE LOCATION OF PITS CN SKETCH ON REAR OF THIS SHEET Soil Loe: Topsoil : Subsoil Depths & Types Total Water Level Pit Death f 0J 7,8/71 Time to Time to Perc T sts Depth Saturation Time Drop 1211 - 911 Drop 911 - 611 Other Considerations: /✓ �1W Recommendations: fid? C_i�i 7 C cmc Signature I 90° o/ J/e4-/. .2sf50 pis' ��.E 0 tt i r_,,: R N � 0 1) o� � t u Ar' \ 0 _ O 1� ■ K I • w 9 J Z 3WJQ�Q � vi 0 Q�V�aOh`J�! LbOU '^ �0�0 J v��Ql?4• �7 a m V m �7 a I I , DO on r F ♦h yV. 8 �i <'P k � JAI kA in�,� 8 �i <'P k � JAI 8 /fie ��s E 'e 6*. 9 4 • Sl AM . // /'? 0 A • / G 7- -#/ 4 ©AcRES _„LOO U C—�/• S,�PTi.�_� // 1/ %L a "9NE 1 PPP-P'PP- TO: FROM: NORTH ANDOVER, MASS 19 7(? BOARD OF HEALTH DESIGN ENGINEER Re: Soil Absorption Sewage System Inspection This is to certify that I have inspected the construction of the said disposal system at % 1(9 G P 14/V V /�L L4 l 4/1/E North Andover, Mass. SITE LOCATION The grades and construction are as specified in my plans and specifications dated (seer/Reg. S�/tari vv !STEL` z�iVA,L TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE //- aU 63 SYSTEM OWNER & ADDRESS A)/q/9 aim% a� 6.- "Ile X,V DATE OF PUMPING �� ✓' v CESSPOOL NO L/ YES NATURE OF SERVICE: ROUTINE OBSERVATIONS: GOOD CONDITION HEAVY GREASE _ ROOTS EXCESSIVE SOLIDS SOLID CARRYOVER SYSTEM LOCATION QUANTITY PUMPED ,3 / SEPTIC TANK NO YES " ._ EMERGENCY FULL TO COVER BAFFLES IN LACE LEACHFIELD RUNBACK FLOODED OTHER EXPLAIN SYSTEM PUMPED BY �� . L-, COMMENTS: CONTENTS TRANSFERRED TO -- N RSH AN T� ,1 .4 "ID OF �ttiA�- TOWN QFNO$TH ANDOVER, SYSTEM PUMPING} RECORD DATE SYSTEM OWNER & ADDRESS �to3 rdnylrraeL Lalve- SYSTEM LOCATION DATE OF PUMPING QUANTITY PUMPED 1500 CESSPOOL NO PIES- SEPTIC TANK 0YES NATURE OF SERVICE;;,RQVTINE.' � 'EMERGENCY OBSERVATIONS; GOOD CONDITION ; ` FULL TO COVER 4AV GREASE' BAFFLES IN LACE ROOTS ,. �, LEACHFIELD RUNBACK V` EXCESSIVE SOLIDS • FLOODED SOLID CARRYOVER OTHER EXPLAIN SYSTEM PUMPED BY _ he ­JV IV j,_ SV 0 (� COMMENTS; ToI OFNORTH ANDOVEP, U A 11 Clal Sy'M PUMPINQ "COKU YSTSM OWN_#kj--A-D`­D-Rp---7 SS moo. �� DATE OF P(*fN—Q,. -M _l(.k'AJl0N Fr6r►f l�f side _QUANTITY PljhfpeD: sopcjc l'AAk: Nu IWUK$OFSERVICE: KGu'rtNe,v"%mf�R(jt,,,,). YES.,'.,/ RECEIVED OOOD CONDITION FULL'm COVER JUN 0 3 2005 tf luyy olitws BAFYLBS IN PLACE, ROOTS WN OF NORTH ANDOVER JO LT P TM T� LEACKPIELD KLN13ACK BXCB$SIVB SOLIDS FLOODED �­HEALTH DEPARTMENT SOLID CAKRYOVBR—" OTHER EXPLAIN )iy ILOM PUM43,44 by .. '6_ 177a. �-:vN vtwrs rmNsyexuo rt, SM. PUM�INC, SCO^ >> ICM U.:WN�R & hU01tCS5 SY;TC M LOC'aT;O U 'rI C SJgF,MY1N)q9, QUANTITY Pimp i:>>I'VUI. 'n0:' Y('S SE('TIC'TarcK: r,0 ':drlli TUKC.OF SERYICC'' R 0 U 7 1 N EMERCEhC� ;.4',UUO.',C,4��1'U17;LQN•, f'UI L:TU CUvCI{ ---- ' � CX•CESSI,YF �QI,IOS '' F1,0.0DED' --- f 's 5.4�IUB C`�pp;RI�YOt YAR T (J� HF M F U m (' C O - , ' i ''I JY.1 J�' IIS `lir��lr l! ulf•, � .. ----- t � t'!.1 ?t'i. � ;1,, 1!,Y� ! ( `�•ti.,;1)i'at'�l't�( �i`i�,1, J �.'• •'.1 fVYJ, 1 'V G -9i Y>r.t Ifel,.i Cl'htll`o;,,C, , �.;�,7 �l,P;,,`irit�lti(�4(Sl•--- lI , SM. PUM�INC, SCO^ >> ICM U.:WN�R & hU01tCS5 SY;TC M LOC'aT;O U 'rI C SJgF,MY1N)q9, QUANTITY Pimp i:>>I'VUI. 'n0:' Y('S SE('TIC'TarcK: r,0 ':drlli TUKC.OF SERYICC'' R 0 U 7 1 N EMERCEhC� ;.4',UUO.',C,4��1'U17;LQN•, f'UI L:TU CUvCI{ ---- ' � CX•CESSI,YF �QI,IOS '' F1,0.0DED' --- f 's 5.4�IUB C`�pp;RI�YOt YAR T (J� HF M F U m (' C O - , ' i ''I JY.1 J�' IIS `lir��lr l! ulf•, � .. ----- t � t'!.1 ?t'i. � ;1,, 1!,Y� ! ( `�•ti.,;1)i'at'�l't�( �i`i�,1, J �.'• Nil �•� ItI 1 / rIP �I �1.4�ir!, � b � 1r\ � t ; r {I OE hal 1• ..y1doo loc 11 r , A. Faclllty Informlon JAN 0 8 2009 1 of �0„1,ry70VER HEALTH DEF VENT • , ° ,: ! `'% � �� i%dam// i`'' -cam[./ -_ . a� t� n1 -'M. wn e r �a � .� ��' �QIN�'•., ;.,'�” •.,i.; .��', �' )/'7�/moi - Of OVfllrnl /cm lo(;4Uon) Cq^o,n ,..um Inord PmcpIng 3, :Type pl ays�am; c999�001(9) Q ' 0�'Jtar (dascrlba a, Ehl�eni Tea Fllla(,P�p•wr? [' r09 n'o 7:4.' On.whare Go�lanla'wera vlyposeo Sl11itwl olh'rV4�y�\X,<.,. maga.goYN6pl yei9r/epMYaJa/Ib/orm9.n:main9�ec . 1 1. v 0 P 0 c Ten,, '-7 TSS^, Te-' ify69 a11;C.-9anaoi Ya; a-419ROM