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HomeMy WebLinkAboutMiscellaneous - 220 SOUTH BRADFORD STREET 4/30/2018 (2) 220 SO BRADFORD STREET •d Street 210/104-C-0100-0000-0 E WEE, R" ` 1584 APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass. 19�' Application by the undersigned is hereby made to connect with the town sewer main in '� Street, subject to the rules and regulations of the Division of Public Works. The premises are known as No. Street or subdivisionlLo�� �^ l,, I nd)i yo Owner Address Contractor Address A plican ' ignature I I I V NZ-4Z-7W PERMIT TO CONNECT WITH SEWER MAIN The Division of Public Works hereby grants permission to to make a connection with the sewer main at Street subject to the rules and regulations of the Division of Public Works.. Division of Public Works By Inspected by Date See back for rules and regulations N I i i I BOARD OF HEALTH 27 CHARLES STREET NORTH ANDOVER, MA 01845 TELEPHONE# (978) 688-9540 APPLICATION FOR ABANDONMENT OF SUBSURFACE DISPOSAL SYSTEM (SEPTIC SYSTEM) Pursuant to Section 310 CMR 15.354 of the State Environmental Code, Title V S Name Phone Address 2 Z0 � - Contractor hired for work: Name k",/ PhoneZ-- Address Ct Date for scheduled abandonment 2�,-- p 4) The septic system at the above add .-ss has been abandoned according to Title V specifications. Signature of Contractor Method of septic tank abandonment (check one). ( ) removal ( ) sandfill crush ( ) other Name of Offal Hauler This form must be returned to the North Andover Board of Health. PLEASE DO NOT WRITE IN THE SPACE BELOW FOR HEALTH REPRESENTATIVE'S USE ONLY. Inspectingd1gent Date i Active Bab .9 N i SVTA 'rAWK cep Ex�S LOT 10 ra4,74-S 5.F, 1,QT i L UT 19 71 v X30 40 10 • 'V vJ E t-FvA-r i 4oN*S. N-A, E) u I L,00T ILlL P1P� RISA TA1�1►L ?0 3"91 - -- - - - - NV PiP �TQ P SOX 2o3 3.;k -- 1N V.Pi PF—011T 0-flax 20's IS No. ANPOVEP, MA. COME-Au Se, �'©� ' Nine- I Y), IM s S 1 ACTIVE &D :o N 15eo GwL. 23S „µ • SaPT�c TANK N LOT c I_O_ 1f�'7'j745 J.F LOT y_ r ' 43 O Oho 3 F E L-F-\/A -r i D N mss° . -Lhiv PIPE QQT OF.N�- _ A E5 V i L—r I I'A SL U I Q E TANV— -- ZDV.I z _ V U fl{ 5 O ,L•. ;�V-PIeF I nL p.,�a_ ___ �� L --- = _ -_ = 'x 45-1- am - IN V- PIPE OUT D.13[oX -_. 24>�- _- _ - �NNo. ANPOVEE , MA. J'OHN COMEAU -le, 177 1980 rr Boa--,-,,d of Health BF.PTIC SISTEK North An. ver Hass. 4 INSTALLATION CHECK LIST LOTAp OOTID DATE DT PRO ED AVATICH OK FAIL r-- eamnst Fin OK j 1. Distance Tot a. Wetlands b. Drains / c. Well 2. Water Line Location \ 3- No POC Pipe h. Septic Tank a. _Tees --Length & To Clean Oat Covers. b. Cement Pipe to Tank On Both Sides of Tank 5. Distribution Box a. Covers & Box - No Cracks b. All Lines Flowing Equal Amounts ✓ c. No Back Flow 6. - Leach Field or Trench a. Dimensions b. Stone Depth c: Capped Inds d. Clean Double Washed Stone 7. Leach Pits' a* dons b. Sto,e Depth c. ash Pads d. eas s. men Pipe to Pit - Both Sides. f. Clean Double Washed Stone S. No Garbage Disposal ✓ 9. Final Gradin; Inspection 10. Barricading Covered System 11. As Built Submitted- _ : - a. Lot 'Location _ b. Dimensions of System / c. Location vith Regard-to Perc Test ` d. Elevations ✓ e. Water Table Boarg of Health Norah Andover,Mass SUBSURFACE DISPOSAL DESIGN CHECK LIST LOT /D "' �Jii�/3 DFe/?10 APPROVED DATE DISAPPROVED DATE Provided: Reasons: 2U, I Title FAIL 4g) Reg 2.5 a submitted plan must show as a minimum: the lot to be served-area,dimensions lot #,abutters location and log deep observation hoes-distance to ties location and results percolation tests-distance to ties design calculations & calculations showing required leaching area location and dimensions of system-including reserve area existing and proposed contours location any wet areas within 1001 of sewage disposal system or LI-I( disclaimer-check wetlands mapping hj surface and subsurface drains within 1001 of sewage disposal system or disclaimer i) location any drainage easements within 1001 of sewage disposal system or disclaimer-planning Board files J) wn sources of water supply within 200+ of sewage disposal system or disclaimer (WIocation of a -7 proposed well to serve lot-1001 from leaching facility 1location of water lines on property-101 from leaching facility mylocation of benchmark n%, driveways garbage disposals no PVC to be used in construction q) profile of system-elevations of basement, plumb, pipe, septic tank, distribution box inlets and outlets, distribution field piping and Other elevations ►✓(r) maximum 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-150A of flow, water table, tees, depth of tees, access, pumping (b) cleanout ,,,'(c) 101 from cellar wall or inground swimming pool ✓(d) 25+ from subsurface drains Reg 10.2 Distribution Boxes -'�(a)'s ope greater then 0.08 Reg 10.4 b) sump IiOt't.il o & j c c - ----- - )j- ,!O• f.oc . /Sub(3:iv. _ __ —_ _ Plan Invest!-gator - Observer SOIL PROFILES-DATE ` 2. Elev. 3' Elev. 4'Elev. 0 __ 0 -- -- — - -- - Ties to Test Pits 2 2 2 3 3 3 - - 4 _ 4 _ —_ . 4 S ' S 6 - - " G 7 _ 7 7 — -- 8 - -- 8 8 9 9 -- 9 10 _ _ 7- _ - __ 10 _ Location- -- - - --- --- - - --- Elevation -- -- - __ Datum _ -------- Percolation Tests-Date -- -- - -__-- -- _ Date --_ --- - -- _.- --' --- - - - - -- Pit Numb( r -- 1 -- -2 3 - --4 - --5 - - Start Saturation _ _ --- - - -- - - - - Soak-_M�.ns_ - GI_oj5 of_ 31' -Time - 6"--Time "-Time - 6"--Time s - 1_st . 3"Drop - Hli-ns - 21-)d 3"Dr_-op �_ a�