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HomeMy WebLinkAboutMiscellaneous - 215 GRANVILLE LANE 4/30/2018 (2) a � Commonwealth of Massachusetts City/Town of RECEIVED System Pumping Record dForm 4 AUG 18 2008 TOWN OF NORTH AND ER DEP has provided this form for use by local Boards of Health.Other fo s-mayrbe�osed,Tbu��t�he information must be substantially the same as that provided here. Bef fe using tfiisform ec tenth 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 n : computer,use only the tab key Address to move your ( ✓/�'� � cursor-do not Cityfrown p State Zi Code use the return key. 2. System Owner. Name rim Address(if different from location) City/Town Statn��— Telephone "�Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes JPO If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. Systerg P meed By: Name Vehicle License Number Company 7. Locati ere comets disposed: Signatu of ler Date t5form4.doc^06/03 System Pumping Record^Page 1 of 1 TON" OF / SYSTEM PUMPING REC ECEIVED DATE: DEC 0 2 2005 TOHEALTH DEPART LATER SYSTEM OWNER& ADDRESS SYSTEM LOCATION (example:left front of hon /6`2k-� DATE OF PUMPING: QUANTITY PUMPED : GALLONS CESSPOOL: NO "YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER(EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: G.L.S.D Lowell Waste TOWN OF //V SYSTEM PUMPING RECORDS< DATE. 4 9 SYSTEM OWNER& ADDRESS SYSTEM LOCATION'S / (example:left front of house) LIA- DATE OF PUMPING: QUANTITY rUM?ED : (/S Z;�GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER(EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: G.L.S.D - -- Lowell Waste Commonwealth of Massachusetts �— City/Town of x System Pumping Recordo�� Form 4 J ,OVi� M Sus `,ic' OF NORTH� AND©VE R DEP has provided this form for use by local Boards of Health. Other forms mby-be f the information must be substantially the same as that provided here. Before using this form, ch�ec with your local Boar&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 1. System Location: LeftRi ht fr s Left/Right rear of house, Left/right side of house, Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under deck Address Cityrrown V� State Zip Code 2. System Owner. Name Address(if different from location) City/Town State Zip C� Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Q/uantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) D-Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: ` , l l-C/�s � 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location ywhe,,�contents were disposed: L SQ Lowell Waste Water Sign t e I-HaulerU Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 I� Address I�.- �P V'tc:I-c kH Title of File Page of Date File Open: Date file closed: Doc Document/Action Title Date of Refer to other Purpose of DocumeEnt/Action and notes action Document/ document/ Num. Action Department Board of Appeals — Board of Health ——Planning Board — Conservation Commission — Building Department TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: SYSTEM OWNER &ADDRESS SYSTEM LOCATION j (example: left front of house) DATE OF PUMPING: QUANTITY PUMPED GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: COMMENTS: CONTENTS TRANSFERRED TO: r . �.r���cio Forest St. FORM��� FOR1114 - SYSTEM Pni DI_'�G RECORD P ;i 4.! .._.Co.auuonNvealth of Massachusetts Massachusetts TflWNOFN jgTAANDOVE.R/ k3Jr+.RID OF W,-ALT i 1 MAY 3 0 1996 System. wrrRecord .. t �--- S;,s,em ��ner ystem ocati'on 1 C TZ CUvc9---) Dat, of Pumping; j Quantity Pumped;f� ()O gallons Cesspool: No ❑ Yes ❑ Septic Tank: No ❑ Yes Sys'_° n Pumped by: License # trans?erred to: D`t` Inspector it + � f/ 't ublic Works SUBSURFACE DISPOSAL SYSTEM CHECK LIST o G00 NORTH ANDOVER BOARD OF HEALTH ,��AD DATE PROVIDED DISAPPROVED DATE TIME REASON. -*A jt#7r `RA a,,�0.� ° Z �, _ V �� 7 Title 5 Reg. 2.5 Fail OK The submitted plan must show as a minumum: {a}'" the lot to be served (area,dimensions,l.ot //,' abutters) (Planning Board files) location and log of deep observation holes-distance to ties ; e4 location and results of percolation tests-distance to ties (d) design calculations & calculations showing required leaching area location and dimensions of system (including reserve area) f) existing and proposed contours i location of any wet areas within 100' of the sewage disposal system or- disclaimer (check wetlands mapping) 40,o- -If) surface and subsurface drains within 100' of sewage disposal system or disclaimer location of any drainage easements within 100' of t 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) t._m location of benchmark driveways ,, ..off garbage disposers p), -fto PVC is to be used in construction ('q) a profile of the system (elevations of basement, plumbers' pipe septic tank, distribution box inlets and outlets, distribution field piping and any other elevations) �rCoo;j ('r maximum ground water elevation in area of sewage disposal system A (s) plan must be prepared by a Professional Engineer or other professional authorized by law to prepare such plans . Septic Tanks Reg. 6tea,) --Capacities - 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 . AOV� adover Subsurface disposal system check list = Page 2 ail OK Distribution Boxes Reg.10.2 (a Slope greater than 0.08 Reg.10.4 (b� Sump Leaching Pits Leaching pits are preferred where the installation is possible Reg.11 .2 (a) Calculations of leaching area (minimum 500 S.F. ) Reg.11 .4 (b) Spacing Reg.11 .1 c Surface drainage 2% Reg.11 .11 d Cgver material , e� )_ ,42",4" ptasl� Leaching Fields Reg.15.1 -" a� RoGreater than 20 minutes/inch Reg.15.1 (b Area (minimum 900 S.F.) Reg.15.4 (c� Construction of fiel , Reg.15.8 �d) Surface drainage 2% Reg. 3.7 3�e) 20' from- cellar wall or inground swimming pool Leaching Trenches Reg.14.1 �Y (a Calculations of leaching area (min. 500 S.F.) Reg.14.3 �� b Spacing (4 ft. min. 6 ft. with reserve between) Reg.14.4 �ci Dimensions 14.5 Reg.14.6 (d Construction Reg.14.7 (e Stone Reg.14.1 (f) Surface drainage 2% Downhill Slope (a Slope y/x = to be shown C (b� y/x X 150 = (to be shown Pum Reg. 9.1 (a) Approval Reg. 9.6 (b Stand-by power SOIL PROFILE & PERCOLATION TEST DATA Board of Health-North Andover, Mass. .Street_ Lot No. f 1 Subdivision Owner Investigator_ Observer SOIL PROFILES 1 . Date Z� 2. Date _.._. � _ 3. Date 4. Date Elev. Elev. Elev. Elev. 'eet Inches 0 Ties to Test Pits 2 2. r 24 3. 36 4. 48 5• 60 ']2 84 96 108 C '120 ote Top & subsoil depth; depths of other soil types; depth of water table; depth of refusal. .PERCOLATION TESTS Date &-Iz-f Date Date Date Date Pit Number 1 2 3 4 5 Start Saturation Soak4Mins. Start Test-Time Drop of 3"-Time 72 Drop of 6"-Time o Mins. 'I st 3" Drop 3a Mins. 2nd 3" Drop Rate Min. In. t6 77 0� �- - 3 I AAAA •TOWN`OF'NORTH ANDOVER NORTH ANDOVER BOARD OF HEALTH REPORT OF PERC TEST _ ADDRESS OF SYSTEM d`',n t>r ��' &L-r') Z DA'T'E r NAME OF PROFESSIONAL ENGINEER /CSR SANITARIAN CONDUCTING TESTS , CSC �-�/10 NAME OF LOT OWNER ��. 1� /"r.. . ADDRESS j�Ze oj DY ,V,, 0 r,0/0 v e r SHOW APPRO)MiATE LOCATION OF PITS ON SKETCH ON REAR OF n1IS SHEET Total Soil Log: Topsoil Subsoil _ Depths & 8 Water Level Pit D th 01/ Qom • SCA Time to Time to Perc Tests Depth Saturation Time Drop 12" - 9+' Drop 9" - 6" Other Considerations: �plct� 1`/ (�1✓�'' G� �r �' J . ifs',/✓ � � G - F r Recommendations: Cr) t2�Ez ��. ,A:i / Signature __ d 9.4" �' 3 z 4' 3v 41 'o �s Commonwealth of Massachusetts City/Town of RECEIVED a System Pumping Record JAN 10 2007 Form 4 SV0 TOWN OF NORTH ANDOVER DEP has provided this form for use by local Boards of Health. Other f s-rt_tayi bwasedTbutAhe information must be substantially the same as that provided here. Before using this orm, chec 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 ther-Ij —�� (�vs computer,use only the tab key Address Q� to move your &- I '!�— 6 if Lo cursor-do not City/Town statv Zip Code use the return key. 2. System Owner: Uz,j �\ Name r�cr, Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 2. Quantity Pumped: canons P 9 Date 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes D No If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: V�0-4-��� ( 6. System u pedrBy: Vehicle License Number Company 7. Locati ere conte s isposed: Signature a er Date t5form4.doc-06/03 System Pumping Record•Page 1 of 1 �L\ Commonwealth of Massachusetts City/Town of JAN .. 3 �t011 a System Pumping Record F Form 4 TOWN OF NORTH ANDOVER `�M 5••y`.t 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 1. System Location: Left front of hous Ight front of sP Wt side of house, right side of house, Left rear of house, right rear of house, le-ftVd-e-6f building, right rear of building, under deck. CS- ��G � V(:�__ tic�� Cityfrown State Zip Code 2. System Owner: Name Address(if different from location) City/Town State Zip Cod Telephone Number B. Pumping Record ta 4440 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 o If yes, was it cleaned? ❑ Yes ❑ No 5. Conditionf Sy tem: 6. System Pumped By: Neil J. Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc. Company 7. LLocatLQni wbere contents were disposed: L.S. LqvdWaste VY4epj Signatur of Aaur Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 i