The URL can be used to link to this page

Home My WebLink AboutMiscellaneous - 23 GILMAN LANE 4/30/2018 23 GILMAN LANE ` / 210/107.A-0152-0000.0 I 1 � r i i } L Q1 i I h I f i Je4 Q0 � � �� i i I �� t �� s 1 � �,�.� i i ,�� s , � � � � Map of 30 Myrtle Ct Lawrence, MA by MapQuest Page 2 of 2 All rights reserved. Use subject to License/Copyright Map Legend w Directions and maps are informational only.We make no warranties on the accuracy of their content, road conditions or route usability or expeditiousness.You assume all risk of use. MapQuest and its suppliers shall not be liable to you for any loss or delay resulting from your use of MapQuest.Your use of MapQuest means you agree to our Terms of Use North Andover Board of Assessors Public Access f w Page 1 of 1 NORT/r Forth Andover Board of Assessors Ot ttrao.e 1ti S,CNose roperty Record Card Click Seal To Return Parcel ID:210/107.A-0152-0000.0 FY:2010 Community :North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlar e Search for Parcels Search for Sales Summary - Residence Detached Structure Condo 23 GILMAN LANE Commercial Location: 23 GILMAN LANE Owner Name: MC MAHON,RICHARD F LINDY K MC MAHON Owner Address: 23 GILMAN LANE City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 6-6 Land Area: 1.21 acres i Use Code: 101-SNGL-FAM-RES Total Finished Area: 2828 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 536,600 572,400 Building Value: 328,100 362,200 Land Value: 208,500 210,200 Market Land Value: 208,500 Chapter Land Value: LATEST SALE i Sale Price: 176,000 Sale Date: 08/24/1983 Arms Length Sale Code: Y-YES-VALID Grantor: STEPHENSONMICHAEL J Cert Doc: Book: 1712 Page: 232 i 1 http://csc-ma.us/PROPAPP/display.do?linkld=1519457&town=NandoverPubAcc 5/7/2010 NORTfi s fit►E O 16 O L O ILE SPY � O cocwi«ew«« 9 'P ��SSAC NUy S PUBLIC HEALTH DEPARTMENT fommunity Development Division ffA-.JRT1(F1C A-A-P 0 F C09V1(P f- T gYff As of: May 24, 2010 This is to cert that the individuaCsu6surface dzsposafsystem received a SA7IS FAC20RT 1NSTECT109V of the: Instalration of a new Yf-20 Distri6ution Box for an On Site Selvage (&Tosa[System By: ,john DiVincenzo At: 23 Gilman .Gane W ap"10T.A; Farrel—1 S2 %orthAndover, 9WA 01845 The Issuance of this certificate shaff not be construed as a guarantee that the system wid function'satisfactorily. S an 2'. Sawyer, 1� /�,S' lPu6fic I feafth Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com i I II i I� I e I i I i i t i no ------------ I r r I I I I i I I I I I t t + -- r-- I I I i i I I I I I I I i j I I I i I I I I I I I I I I I i I �- } I �-- I I I I I I I I I I I I I i i I i I I I I I I I I I I I I TOWN OF NORTH ANDOVER =' `A r i Office of COMMUNITY DEVELOPMENT AND SERVICES f NORTH i O HEALTH DEPARTMENT 1600 OSGOOD STREET;Building 2-36 NORTH ANDOVER,MASSACHUSETTS 01845 �9S"""°' <� ' S�cNus Susan Y. Sawyer,RENS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORIVATION ADDRESS: ;�3 C41 &(k MAP: LOT: INSTALLER: a 6L5 DESIGNER: PLAN DATE: BOH APPROVAL DATE ON PLAN: INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS []Existing septic tank properly abandoned []internal plumbing all to one building sewer []Topography not appreciably altered Comments: SEPTIC TANK ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon tank has been installed H-10 loading Monolithic construction ❑ Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ❑ Inlet tee installed, centered under access port ❑ Outlet tee (gas baffle or effluent filter) installed, centered under access port ❑ 24" inch cover to within 6" of final grade installed over one accessort, must be over outlet of tank if p effluent filter isP resent ❑ Hydraulic cement around inlet & outlet Wastewater System Documentation—Feb 2006 Page 1 of 6 TOWN OF NORTH ANDOVER NORTit Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; Building 2-36 `►^o r NORTH ANDOVER MASSACHUSETTS 01845 SACHUS Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ Combo Tank installed. Size: ❑ 1000 gallon Pump Chamber installed H-10 loading Monolithic construction) ❑ Inlet tee installed, centered under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off floats working ❑ Separate on/off floats ❑ Drain hole in pressure line ❑ 24" inch cover to within 6" of final grade installed over pump access port ❑ Water tightness of tank has been achieved Visual testing ❑ Hydraulic cement around inlet & outlet Comments: ADVANCED TREATMENT TECHNOLOGY ❑ Type of treatment device: ❑ Installed per manufacturers requirements ❑ All components working in accordance with manufacturer's requirements Comments: Wastewater System Documentation—Feb 2006 Page 2 of 6 TOWN OF NORTH ANDOVER NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES o?��`�`•�w'�"°off HEALTH DEPARTMENT 1600 OSGOOD STREET;Building 2-36 NORTH ANDOVER,MASSACHUSETTS 01845 �'9s°"'•' E<� SACHUS Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.68 8.8476—FAX D-BOX ❑ Installed on stable stone base ❑ Inlet tee (if pumped or >0.08'/foot) ❑ Hydraulic cement around inle & o tlets�` Observed even distribution KO- �-Q,e LL 0 jjj- Speed levelers rovidednot required) ( q ) Comments: J � SOIL ABSORPTION SYSTEM ❑ Bottom of SAS excavated down to soil layer, as provided on plan ❑ Size of SAS excavated as per plan ❑ Title 5 sand installed, if specified on plan ❑ 3/4-1 Y2" double washed stone installed ❑ 1/8-1/2" (peastone) double washed stone installed ❑ Laterals installed and ends connected to header ❑ Laterals vented if impervious material above ❑ Orifices @ 5 & 7 o'clock positions ❑ Gravel-less disposal systems: type, number and location as per plan ❑ Elevations of laterals installed as on approved plan ❑ 40 Mil HDPE barrier installed ❑ Retaining wall (boulder/ concrete /timber/block) ❑ Final cover as per plan Comments: Wastewater System Documentation—Feb 2006 Page 3 of 6 i TOWN OF NORTH ANDOVER Of„ORT„ A Office of COMMUNITY DEVELOPMENT AND SERVICES F HEALTH DEPARTMENT 1600 OSGOOD STREET;Building 2-36 NORTH ANDOVER MASSACHUSETTS 01845 S�cHus Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX PRESSURE DISTRIBUTION ❑ -- inch manifold ❑ laterals installed with end sweeps size: material: ❑ Squirt test ft in height ❑ Equal distribution to all laterals ❑ orifice size inch as per plan Comments: CONTROL PANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: ❑ Rated for exterior if placed outside Comments: Wastewater System Documentation—Feb 2006 Page 4 of 6 r I ' a TOWN OF NORTH ANDOVER Ot pORTp 4 Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET;Building 2-36 NORTH ANDOVER,MASSACHUSETTS 0184 �s'"•'° <� 5 sACMUSF Susan Y. Sawyer, REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback j Tank SAS Sewer ❑ Property line 10 10 -- ❑� Cellar wall 10 20 -- ❑ Inground pool 10 20 -- ❑ Slab foundation 10 10 -- ❑ Deck, on footings,etc 5 10 -- ❑ Waterline 10 10 101 ❑ Private drinking well 75 1002 50 ❑ Irrigation well 75 100 ❑ Surface Water 25 50 ❑ Bordering Vegetated Wetland , Salt Marsh, Inland/Coastal Banka 75 100 ❑ Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ❑ Trib.to surface water supply 325 325" ❑ Public well 400 400 ❑ Interim Wellhead Prot.Area ❑ Reservoirs 400 400 ❑ Drains(wat. supply/trib.) 50 100 ❑ Drains(intercept g.w.) 25 50 ❑ Drains (Other)Foundation 10(5) 20(10) ❑ D ells 20 D'�' 25 i 1 Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance(NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54,and 10.30,respectively,pursuant to 15.211(3),also by NA wetland bylaws Wastewater System Documentation—Feb 2006 Page 5 of 6 ` TOWN OF NORTH ANDOVER NORTN V Office of COMMUNITY DEVELOPMENT AND SERVICES ? o HEALTH DEPARTMENT 1600 OSGOOD STREET; Building 2-36 NORTH ANDOVER,MASSACHUSETTS 01845 �9S"4CHU S�caus Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX SYSTEM ELEVATIONS INVERT ON DESIGN PLAN FIELD INVERT ELEV. Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN Distribution Box OUT Lateral 1 HIGH Lateral 1 LOW Lateral 2 HIGH Lateral 2 LOW Lateral 3 HIGH Lateral 3 LOW Lateral 4 HIGH Lateral 4 LOW Lateral 5 HIGH Lateral 5 LOW i Wastewater System Documentation—Feb 2006 Page 6 of 6 i w4R1fy N Commonwealth of Massachusetts Map-Block-Lot N• • a� 107.A0152 Board of Health o Permit No � . North Andover BHP-2010-0567----------------------- g" 0 7 FEE HP-2010-0567'' FEE gwus�i $125.00 ---------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted John D1Vincenzo - - - - - - - --- ----- ------------------- ---------- to(Repair-H2O D-BOX)an Individual Sewage Disposal System. at No 23 GELMAN LANE as shown on the application for Disposal Works Construction Permit No. BHP-2010-056 1 ; 07,2010 ----------------------- ---------- -- Issued On.May-07-2010 'A----------- ------------ ---- - Board of Health t f �4R*� Commonwealth of Massachusetts Map-Block-Lot 107.A0152 Board of Health - ------------ ' �' •— � Permit NNo 4 BHP-2010-0567 j North Andover ------------------_--- T P.I. FEE �Ss, MuE� F.I. $125.00 _- ----------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted John DiVincenzo --------------------------------------------------------------------------------------- to(Repair-H20 D-BOX)an Individual Sewage Disposal System. at No 23 GILMAN LANE ------------------------------------------------------------------------------------------------------------------------------- as shown on the application for Disposal Works Construction Permit No. BHP-2010-056 Dated May-07-,-20-10 --------IF il CI O-��----------- ',Issued On:May-07-2010 040ard of Health ----------------------------------------------------- + AORTR Map-Block-Lot Commonwealth of Massachusetts *. o� 107.A0152 Board of Health � p North Andover CERTIFICATE OF COMPLIANCE �s3ACrn}`��i THIS IS TO CERTIFY,That the Individual Sewage Disposal System (Repair-H20 D-BOX) by John DiVincenzo ------------------------------------ ----------------------------------------------------------------------------------------------------------------- f� Installer at No 23 GILMAN LANE /� (/ has been installed in accordance with the provisions of TITLE 5 of the State Environmental Code as described in the application for Disposal Works Construction Permit No. -BHP-2010-056- - -- - Dated- -May-07,2010-------_ ------------ -- ---- -------------------------------------------- ---- Printed On:May-07-2010 Board of Health ------------------- ------------------------- � a NoRT4j ' 7 �i J O iy o i Town of North Andover HEALTH DEPARTMENT �Ss�cwust� CHECK#: �pD DATE: AD LOCATION: H/O NAME: CONTRACTOR NAME:I/ Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment J' $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler ) $ ❑ Recreational Camp f / $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco ' ❑ TrasWSolid Waste Hauler $ % iP' ❑ Well Construction $ SEPTIC Systems: ,r f ❑ Septic-Soil Testing j $ ❑ Septic-Design Approval $ �c Disposal Works C structio DWC) ❑ Septic Disposal Works l Aller � ❑ Title 5 Inspector ❑ Title 5 Report $ ❑ Other:(Indicate) $ Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer "ORt b,N Application for Septic Disposal System •'•`.' °oma TODAY'S DATE Construction Permit - TOWN OF ` 35 . —Full Repair ORTH ANDOVER MA 01845 s $125.00 Component SshcHust Important: Application is hereby made for a permit to: When filling out ❑ Construct a new on-site sewage disposal system* forms on the computer, use ❑ Repair or replace an existing on-site sewage disposal sstem* only the tab key to move your �epair or replace an existing system component—Wha sq 2 G cursor_do not use the return A. Facility Information _ key- M441 /C?G L G�/I A1C' W Address or Lot# City/Town 2.-*TYPE OF SEPTIC SYSTEM*: ❑ Pump Gravity(choose one) ***If pump system, attach copy of electrical permit to application*** ❑Conventional System (pipe and stone system) ❑ Infiltrator or Biodiffuser(Gravel-Less) (Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D-Box) (Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D-Box Present)S.A.S. 2. Owner Information Name a25 Gc t_m4Al 64tikA,_— Address if differen from above) City/Town Stat 7 — 7 2 3-5 C� 22 Telephone Number 3. Installer Information Name Name of Company /Ii� Co�eu�S/e �_& �A Address City/Town State Zi Cod •�� 7 X38'"r�� Telep o e Number(Cell Phone#if possible please) 4. Designer Information Name Name of Company Address City/Town State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit-Page 1 of 2 } "" Application for Septic Disposal System 3� •°.``�� e�yO°L TODAY'S DATE Construction Permit - TOWN OF ORTH ANDOVER, MA 01845 $250.00-Full Repair ,SSACNU^�`t $125.00-Component PAGE 2 OF 2 A. Facility Information continued.... 5. Type of Building: Residential Dwelling or❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code,as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the system in operation until a Certificate of Compliance has been issue by thi Boar of Health. �l a Nanf Date Applicati A roved By: (Board of Health Representative) Nam Date Application Disapproved for the following reasons: For Office Use Only: Z Fee Attached. YesJ No , rl Z. Project Manager Obligation Form Attached. Yes No 3. Pump System? If so.Attach copy ofElectrical Permit Yes No V�, 110 4. Foundation As-Built?(new construction ronly): Y s No (0 (Same scale as approved plan) 5. Floor Plans?(new construction only): Yes No Application for Disposal System Construction Permit•Page 2 of 2 'I 05/10/2010 13113 FAX 978 373 6611 J AND S DEVLOPMENT PAGE 001 WEALTH v �5118/201�. 1;3:38 9786888476 SEPTIC SYS'I'1 NI INS ALLE PRO ECT MANACxEN')� B .TiG,ATIONS a�eYl7 for.the property at: As the North Andover licensed installer for the cOnsmction for the septic sy, p ];or plans by firms) ��eer) ' (�,ddcosa of acl?t'c �t Relative to the applimion of ! f And dated n�staUez's fl.�e) �gtTaa arc Dat cd �� WITh revisions dated o - (Last revised elate) I understand the following obligatiosas for mama m.ent of this proiect: 1. As the,installer,I am obligared to obtain all pM= and Bo rd 0 �ffi approved plansto performing any work on a sate. T m,Yst have the h&&dong. ox 2. As the installer,I must can for a>,y alad all i0spec i dui If ahno peony and tl�c sy his not fie dy,9tl�ezt y otll,et pexsm not assoaated tRrirh zr�y cotx�p y item three shall be applicable. 3. As the j�5tallet:,I am required to stave the aecessary work completed phQqLCom totioi oppkcea t j m g rrnr Is indicated below. i 2i►de s d, ues ins 'th d 5 and file a eat tionq esul e ein evic ar o I I r I I' v Cairo. -B tt f B ,–Generally, I9 die first\1 pL inspection unless there tv5 a i;etain.i lg gall,which should be don ixst. ".Che installer roust xequesi the inspection but does z,,ot have to be pz�fin�tc. b, Final�Pr�8 I ect Sm_ E"*ncer xn�ast rust do rJrcu st�spectton foi elevations, , towriofn4 than vim) from the e:r�giueet musk As-built of verbal.OK(ox a-M4 to-,heal '�� .�— be submitted to,th e Board of NeAlth,after whA installer owls for an inspection titre. Iitstallex must be present fat this inspection. With,a pt=p sykern,av electrical work t�,ust be ready and able to cause pub to work and,alarin to fwnctitm„ c, itin iGrade–Installer must i^eclucst ittspectio when a]1 gradixtg is complete. li3staU does not )Ave to be on.-sii:r-., A perform le W rlt mbar than IiOle ex'cwVA'6n)and I Mn"U ted 4. As the installer.,I tutdoi acarid that only T m. p p to complete the}nstallatiou of the system ideal-ied in&attached applicatiop'.fot installation. dersta d h work o e the s t se o in 11 a 'c s st s ' ordi d e can con e r s s fpr deni M==—and/or Jon or n of awipense to the of Ines to ons ' v e ate al Ie. e follo consttuetio�n 5. T1s the instdier.,I understated that I roust be ori-site duttrig&C perfoa maucc of th steps: eleva a. Detr�itxadall t the proper tio�z a excRvatton has beet rieachcd b, Inspecizou of the sand and stone to be Wed- c. edc. Maid inspectior by,Board of Hegftfi staff 0),cons"Itattt d. ,�t�stailatian oftao(c, I7_Box,(pipes, stone, ve, pump�laXiet,rcrnxzutrg r atzd other eompvne.�xts. 6. s d e tall I un the ams l res 6 for h e'zst a ' the stem e c ---� µ+ +roved p Ars o ins tractio s ley th harncr�wner ries contra tax a env alher pcxsans sl all a of Tinelersigxted Licensed Septic Installer ��(1 �j (Today's date)20 � i TRANSMISSION VERIFICATION REPORT TIME 05110/2010 13:30 NAME HEALTH FAX 9786888476 TEL 9786888476 SER.# 000B4J120960 i I DATE DIME 05110 13:30 FAX NO./NAME 9783736611 DURATION 00:00:23 PAGE(S) 01 RESULT OK MODE STANDARD ECM I SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: I (Addins9 of 9cp6:s=rstC ) T"ar plans by � (Eagineex) Relative to the kation of Maa dr/ l` app kation name) end dated zxguza ate Dated l a YCLAM) With revisions dated & (LRSt revised date) I undefrstand the following obligations for managew.eot of this project: I. As the i+astaller,I am obligated to obtain all permits a.nd Board of Health approved plans prior to performing any work on.a site. i t' y1 lagLve the approved pl=s and the permit on gine wben arty work is < beuig_done. " 2. ,As the installer,I must can for any and all inspections. If homeowner,contractor,project manager, or,any oth,ex person not associated with my company schedules an inspection and the system is not ready,then item three shall be applicable. 3. As the installer, I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understaa that requesting an inmce tiQn,don, W a. hog`completion of the items in accordance with'Title 5 and tlae Iioat;d of Health Re ations mar icsul,t iso,. X50.00 fine beim levied against.1Yte, ndlor Mav_c_oinpany. a. Bottom of BeId-Generally,this is the first (l. inspection unless there is a xetai,ning wall,which should be done first, The installer must request the inspection but does not have to be present. b, Final Constructiorx_Inspection-Engineer tna st:first do their inspection for elevations,tics,etc. As-built of verbal.OIC (or e-mail to: healtl,.-,.ILLI�,townofnortl-Landova.coxn) from the engineer must be submitted to the Board of Health, after wLd'h installer, calls for an inspection time. Installer must be present for this inspection. With a piunp syfitem all electrical work must be ready and able to cause punip to wont anal.alarm to fiumcdon,. c. Figgl Grade-Install,ex must request inspectiol when All gviding,is complete. Installer does not 11,2ve to be onsite. 4. As the instauer, I lwdci�at tad.that only I may per le work (other than sale exca�atron)and I Atr�required to complete the installation of the system identified in the attached application for installation. rther =derstand that work done by others unliggmsed to inst.1111septic systcins in North Andover can con5ti to SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: 1,611rAlaw (Address of septic!system) For plans by al�'Vzd (Engineer) Relative to the application of (� / A nstaller's name) And dated ngma ate Dated �0//10 o ay ate With revisions dated �Z . (Last revised date) I understand the following obligations for management of this project: 1. As thell installer, I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. `--�2. As the installer, I must call for any and all inspections. If homeowner, contractor,project manager, or any other person not associated with my company schedules an inspection and the system is not ready, then item three shall be applicable. 3. As the installer, I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection,without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a $50.00 fine being levied against me and/or MY company a.i Bottom of Bed—Generally, this is the first (1'� inspection unless there is a retaining wall,which should be done first. The installer must request the inspection but does not have to be present. b: Final Construction Inspection—Engineer must first do their inspection for elevations, ties, etc. As-built of verbal OK (or e-mail to: healthdept@townofnorthandover.com) from the engineer must be submitted to the Board of Health,after which installer calls for an inspection time. Installer must be present for this inspection. With a pump system, all electrical work must be ready and able to cause pump to work and alarm to function. c. Final Grade—Installer must request inspection when all grading is complete. Installer does not have to be on-site. 4. As the installer, I understand that only I may perform the work (other than simple excavation)and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system and/or revocation or suspension of my license to operate in the Town of North.Andover, significant fines to all persons involved are also possible. 5. As the installer, I understand that I must be on-site during the performance of the following construction steps: a. Determination that the proper elevation of the excavation has been reached. b. Inspection of the sand and stone to be used. c. Final inspection by Board of Health staff or consultant. d. Installation of tank, D-Box,pipes, stone, vent,pump chamber, retaining wall and other components. 6. As the installer, I understand that I am solely responsible for the installation of the system as per the gV12 roved plans. No instructions by the homeowner,,general contractor,or any other persons shall absolve me of this obligation. ---�j Undersigned Licensed Septic Installer: 5_X6 //0 (Today's Date) I 00/1 a e—11 rint (Name—Signed) i Commonwealth of Massae usetts City/Town of ��• hdo— �� a System Pumping Record Form 4 GSM SV ey`• I , 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'. Sy atlon: on the computer, use only the tab key to move your Ad es --- cursor- not //'' use the return — �— -- ----(((- --------------------- - — key. City/Town State Zip Code 2! System Owner Name -- r.an i Address(if different from location) City/Town State Zip Code St Telephone Number B'. Pumping Record 1. 1 Date of Pumping m 2. Quantity Pumped: p Date Gallons 3. Type of system: ❑ Cesspool(s) ❑ Septic Tank ❑ 'Tight Tank ❑ Grease Trap ❑ Other(describe): ------ —— ------- -- 4. Effluent Tee Filter present? ❑ Yeso If yes, was it cleaned? ❑ Yes 5. Condition of Sy tern: 6. System Pumped By: .--- Name Vehicle License Number Stewart's Septic Service __ v Company 7. Location where contents were disposed: TON IStewart's Pre-treatment Plant, 20 So. Mill Bradford. Ma 01835 � Ilk� �' S, a IHauler Date gnature of Receiving Facility Date I t5form4.doc•03/06 System Pumping Record•Page 1 of 1 i Boarrd% of Rcalth North AndoreriHasa. SSMC SISTM iN S�AIS.ATItkI CEK LIST LOT P DATE DISAPPROVED X AV Odd ED Ob k I L W�tLO�-' l , s� FAIL OK +` I. Distance To: a. Wetlands P /V 2 3 6'ILA IrOA_.� r / b. Drains C. Well 2. Water Line Location �- 3. No PVC Pipe Septic Tank a. -Tees --Length do To Clean Out Covers b. Cement Pipe to Tank - Oa Both Sides of Tank 5. Distribution Box / a. Covers & Box - No Cracks b. All Lines Flowing Bgiial Amounts c. No Back Flow 6. , Leach Field or Trench a. I;imansions b. Stone Depth t ✓ c. Capped lads 'i d. Clean Double Washed Stone'✓ { e - 7. Le!5pth hs a. ns b. ---- _ c. ads d,e. ie to Pit - Both Sides Pf. lean Do le Washed Stone 8. Na 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 Pere Test / d. Elevations Water Table 6 11 Burd of R-alth "'or+.,h � 0 br,lfass, e — W r d wd E Sc;,'FACE DISPOSAL DrSIGN CHECK LIST ._.. � _-._. LOT APPROVED DATE DISC MUVED ]ATE Provided. d ry Reasons ' �-stib.=' r TitlV F Reg .5he ribmitted plan must show as a minim= 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 4(g) location any wet areas vithin 1001 of sewage disposal system or r disclaimer-check wetlands mapping (h wn-face and subsurface drains within 100' of sewage disposal system or disclaimer (i location any drainage easerxi:,nts (thin 1001 of sir.-wse disposal system or eieclaimsr-Plff.niag Foard files kala= sources of vntcr supply within 2001 of s�A .ge disposal system or disclaimer location of any proposed well to serve lot-1001 from leaching facility location of vater lines on property-101 from leachizg facility location of benchmark driveways (61 garbage disposals Icy no PVC to be used in construction 701(q) profile of system-elevations of basement, plumb, pipe, septic tank, } distribution box inlets and outlets, distribution field piping and Other elevations maxdr= ground grater elevation in area sewage disposal system ' (s) plan mast be prep---d by a Professional Engineer or other professional authorized by law to prepare such plans Reg 6 Septic Tanks a) capaciflea-150% of flow, water table, tees, dopth of tees, access, purging cleanout t __7 101 from cellar wall or inground sing pool (d) 251 from subsurface drains Reg 10.2 Distribution Boxes a) 'Slope greater than 0.08 Reg 10.4 b) sump Subsurface D3gie Check List page 2 vA1Z' Gk - jh Pits Leach r are zofaived uhcre the installation is possible Reg 11.2 a) calcul an of leaching area-uAx_b��= X10 aq ft 11.4 b) spacii 11.10 c •surfac` e 2% 11.11 d� cov material e) $' 'A" splash pad f) a at elbow g no bends in pipe from d-box to pipe i E Leach- Fields Reg 15.1 '�' no grea er zaa 20 rdnutes/inch area-minim m 900 gq ft 15.4 construction of field 15.8 surface drainage 2 % 3.7 e) 20t from cellar or inground and mdng pool L eac ft hes - Reg 14.1 a) cilculati s o eaching area-min 500 aq ft 14.3 b) spacing ft rdn 6 ft with reserve betty-en 14.4 c) dimes ons 14.6 d) c ction 14.7 e) s e 14.10 f) face dr ge 2% t S122e s ope x = be shown) b) y/ 150 = (to be shoran) s Reg 9.1 a) approval 9.6 b) stand-by poorer o ar dog=er consultants 213 BROADWAY inc. METHUEN, MASSACHUSETTS 01844 (617) 687-3828 (1�`ana� W DATE //3 (� TO : NO TH ANDOVER HEALTH DEPARTMENT T&n..,JHALL, NO. ANDOVER, TJASS . RE : SUBSURFACE SEVIAGE DISPOSAL SYSTEM Gaf ZS-4 G,*J, , NO. ANDOVER, MASS . I hereby certify, that I have inspected the construction of the disposal system at ZT`-ZS-q L ,y, North Andover, Klass . and that the location and elevations are shown on the As-Built Drawing dated -13 -e ANDOVER CQNSULTANTS , IN tiIilliam S . WiacLe - Registered Sanitarian This certification is not to be construed as a guarantee of the system.