Loading...
HomeMy WebLinkAboutMiscellaneous - 218 Forest Street Board of Health SEPTIC SISTER North AnciaverIJHaaa. _ INSTAILATICK CHBCg LIST OVER DATE DI SAPPRUVID AVAI0 `ATL Reaxons t MDOVE lorVI C - 1 U AL OK y 1. Distance Tos / a. Wetlands b. Drains c.. Well 2. Water Line Location 3. No PVC Pipe 4. Septic Tank a. Tees -_Length do To Clean out Covers. b. Cement Pipe to Tank On Both Sides of Tank 1 .5. Distribution Box a.' Covers & Box - No Cracks b. A11 Lines Flo-4mg Equal Amounts c. No Back Flog 6. Leach Field or Trench a. Dimensions b. Stone Depth c. Capped ids w d. Clean Double Washed Stone 7. Leach Pits ai Dimausions b. Stone Depth c. - Splash Pads d. Tess e. Ca-aant Pipe to Pit - Both. Sides f. Clean Double Washed Stone 8. No Garbage Disposal 2� 9. Final Grading Inspection M 100 Basri-cading'Covered System 11. As Built Submitted,' a.. Lot Location b. Dimensions of ;Spste?n c. Location'witth Regarkto Perc Test A. Elevations ' e.•. Water Table i 3 ' MASS LICENSE # flog Town of 0Vep M.G.L. CH 21, SEC 16- Massachusetts FEE - $25.00 Board of Health Permit No. Date APPLICATION FOR WELL AND PUMP PERMIT Application is hereby made for a permit to drill or repair ( ) a well. Application is also made to install ( ) major renovation (a) or major repair ( ) of pump system. Location: Address :P/-3 �o rL Ps fi ST- /v- A In - Lot Number .Owner �9 r� e� � 0-e Addressl= s q� �.�,� rRa�s a N , i'l�• ,�� Well Contractor c Address (�i ry X A n. Pump Contractor P,1� c �a �/i Address N d WILL CONTRACTOR (To be filled in at time of pump test) Type of Well Or 1 Well Used For _ P o A-, Diameter of Well _ �� Size of Casing � Depth of Bed Rock �r Depth of Casing into Bed Rock b Was Seal Tested! Yes (tf No ,O Date of Testing / O Depth of Well l __ c�O(7 p Well Ended in Khat Material c Depth to Water q D , Delivers Gallons/per/Minute Drawdown feet after pumping ,. - ours at GPM. Sketch map of well location with tie down lines on reverse side of this fo Date of Completion O ` PUMP INSTALLER (To be filled in before in allatiWell Contractor's Signature Size and Name of Pump _� /� V-cs S Type of Pump Used Water Pump Delivers GPM Size of Tank g Pipe material used in Well: Cast Iron ( ) Galvanized ( ) Plastic p<) Iflastic test strength po—o Well pit O or Pitless adapter Was sleeve used to protect pipe! Yes ( ) No (�;f Type or Name of Well Seal a ,tel Date _ C) " PJmp Installer's Signature Date water analysis report submitted to Board of Health Date release was given to owner of record and. Building Inspector `- Health Inspector i Pumps Submersible WELL & PUMP CO. " Jet 9� RT.28 WINDHAM, N.H.03087 a Cellar ifugal V R SE� [603]898-4232 a[617]887-5888 a Sewage Tanks Filters e Softener e Iron JIM MILLER TEL. NO. 362 5509 e Charcoal Al K I NSON, NH a Neutralizer e Cartridge Water Testing LOT NUMBER OR SAMPLE LOCATION: FOREST ST Pump Parts Motor Controls WATER TEST RESULTS 10/15/84 Water Softener Salt Resin Cleaner HARDNESS 68. 4 (0-50 REC STANDARD) Rust & Stain Remov, IRON . 2 (0—. :� REC STANDARD) Potassium MANGANESE 0 (0—. 05 REC STANDARD) Permanganate FlYDROGEN SULFIDE i y (0—. 01 REC STANDARD) Ph (ACIDITY) 7.5 (6. 5-7. 5 REC STANDARD) Plastic Pipe & Fittings TURBIDITY 0 (0-20 0 REC STANDARD) Lawn Watering CHLORIDES 10 (0-150 REC STANDARD) Systems COLIFORM BACTERIA 0 (0 REQUIRED STANDARD) Water Heaters NITRATES 0 (0-10 REC STANDARD) a Solar N I'f R I TES 0 (0-10 REG STANDARD) a Heat Pump SODIUM 7 (0-150 REC STANDARD) a Electric a Energy Saving Wells e Drilled ALCOVE 'PESTS MEET REQUIRED STANDARDS AND EASED ON THESE , e Driven WATER IS SAFE FOR HOUSEHOLD USE AND HUMAN CONSUMPTION aDug FHERE ARE OTHER LESS COMMON MINERALS WHICH CAN AFFECT o Gravel QUALITY OF WATER. Chemical Feeders Tank Alarms & Controls Hoist Service Portable Pump Puller Emergency Service Goulds Aermotor Jacuzzi Red Jacket Fairbanks Morse Wayne Aquatron Well-X-Trot Board of Health Nee..1: :,ndoverpMasfs c SUBSURFACE DISPOSAL DESIGN CHBCK LIST 4tbR-PT LOT APPROVED DATEDISAPPROPED DATE7-14l 4'I SS S' . Provided: Reasons: "� t0-t© i Cnn.V►�l I Title V FAIL, CK Reg 2.5 The submitted plan mist show as a minimum: a) the lot to be served-areaedimension lot #sabatters b location and log deep observation hoes-distance to ties c location and results percolation tests-distance to ties d design calculations & calculations showing required leaching area sit e) location and dimensions of system-including reserve area f) existing and proposed contours (g) location any wet areas within 100' of sewage disposal system or disclaimer-check -wetlands mapping (h) surface and subsurface drains within 100' of sewage disposal system or disclaimer (i) location any drainage easements within 1001 of sewage disposal system or dieclalmer-Planning Board files (3) known sources of water supply within 2001 of sewage disposal 6 system or disclaimer (k) location of amr. proposed well to serve lot-1001 Brom leaching facilit; (1) location of Water lines on property-101 from leaching facility (m) location of benchmark (n) driveways (o) gage disposals (p) no PVC to be used in construction (q) profile'bf system'' elevations of basement, plumb, pipe, septic tank, distribution box inlets and outlets, distribution field piping and otter elevations (r) maaimam ground Water elevation in area sewage disposal system (s) plan must be prepared by a Professional Engineer or other professional authorized by law to prepare such-plans Reg 6 Septic Tanks (a) capacities-15076 of flow., water table, tees depth of tees, access, pumping (b) cleanout (c) 101 from cellar wall or inground swimming pool (d) 251 from subsurface drains Reg 10.2 Distribution Boxes (a) slope greater 0.08 Reg 10.4 b) sump w ' Z1 G' A List ?_ IL OK Leaching Pits Leaching pits are the installation is possible g _ a) calculations of I,- ' ' � � r- 500 eq ft ► '� 1 �) ' b) spacing 3 ( c) surface dxa3nage 2% !• { ___{ - d) cover matey 5 al { ( e) I'x2'x4" r?l ash pad f) tee at elbow g) no bends in pipe f. to 1 e Leaching 11 r-lds a) no greater 01 "pan 20 Inch I b area-mini.z,,.: , 5x00 sqft •,c� constrtictio-i of filgI d d) surface cis w ^age 2 n° _ • t { _J e) 20' from ccIIAr --��, ot :Li , ; ring pool L__e__acch�hi_nng�gp T~, fiches i_ a) calculations of-Te, Ib0 eq ft 1),'31 1 b) spacing-4 ft min 6 . , :ca,-3r;, between c) dimensions d) construction ►-� • l ( e) stone . l f� "f) surface dra-i rage 2% Dotabill S?r e a) s ope y x = '(to be } 1 - _ b) y/x_t-150 = (to'be . } PUAPS 9.1 _ a) approval- 9�6 1 b)-stand-by powar - o yA - Su-__bsurf ce Design Check List -Page 2 �..Y..._,__.... _ FAIL OX Leaching Pits Leaching pits are preferred mhere the installation is possible Reg 3-1.2 a) calculations of leaching ,area-minimum 500 sq ft 11.1 b) spacing 1110 c) surface drainage 2% - -11.11 d) cover material le) V xV,x4" splash pad f) teO at elbow g) ago bends i� pipe �''x�ctm d-box to pips Leaching Fields, Reg 15.1 a) no gree er t ian 20 minutes/inch, Ile) ) area-minimum 900 sq,ft 15.4 c) constraction' of field 15.8 d) surface drainage 2 % 3.7 201 from cellar wall or ingroumd swiwadng pool L eachin Tumches " Reg 14.1 :a)—calculationssoo "-leaching area-min 500 sq ft 14.3 b) spacing-4 ft min 6 ft with reserve between 14.4 c) dimensions 14.6 d) construction 14.7 e) stone lh.10 f) surface drainage 2% Downhill Slo e a) s ope y x�to be shown) b) y/x X 150 = (to be shown) EMS Reg 9.1 a) approval 9.6 b) stand-by power