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HomeMy WebLinkAboutMiscellaneous - 235 RALEIGH TAVERN LANE 4/30/2018 (2) 235 RALEIGH TAVERN LANE 210/106.C-0044-0000.0 n Lane Commonwealth of Massachusetts = City/Town of = System Pumping Record NORTH ANDOVER CjUi `' 23 -- - Form 4 NEALT T. 1 .'OVEN ' _ H�'cPFP-, 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 1. System Location: forms on the c, V n Ln computer,use --- _----------._....—_.._-- only the tab key Address to move your _. cursor-do not --- Staje' '� Zip Code use the return Cite key. 2. System Owner: Name Address(if different from location) ---- —- — ----- CitylTon — -- St - Zip Code M 1%) 10 w Te phone Number B. Pumping Record f �/�(� 1. Date of Pumping 3 2. Quantity Pumped: Gallon— `-- Date 3. Type of system: ❑ Cesspool(s) ['Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): — -- --- ----_- — - -- 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 01004 — —._.. 6. System Pumped By: Name Vehicle License Number VSi3-- Company 7. Location where contents were disposed: G.L.S.D. North Andover, MA. - ---- re of Hauler Date Signature of Receiving Facility Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 107 Forest St. �3" FORM 4-SYSTEM PLAU NG RECORD Middleton,MA 01949 (508)774-2772 t z CommonwoWth of Massachusetts y `Massachusetts'' . ink or a T,0 }stem %mer ystem ocation ? 12 Date of Pumping: 7Q Quantity Pumped`_a�gallons Cesspool: No ❑ Yes ❑ Septic Tank: No ❑ Yes S1'Stem Pumped bv: l LT�/ License #: Contents transferred to: Date 11"of �- .�! (o Inspector 0 THE PROFESSIONAL EXPERTS IN THE SEPTIC AND DRAIN INDUSTRY• 0', APPLICATION FOR SEWAGE DISPOSAL INSTALLATION HEALTH DEPARTMENT - NORTH ANDOVER, MASS. I hereby ake application for a permit for a sewage disposal installation at z I will install this system in ac- cordance with all the laws of the Commonwealth of Massachusetts and regulations of the Board of Health of the Town of North Andover. Further, I will construct the house sewer of bell and spigot pipe, the minimum diameter being 4 inches, and will maintain a minimum grade of 1% until 10 feet pre- ceding the septic tank, where the grade shall not exceed 2%. I will install a con- crete septic tank of in size. A manhole (s) permitting easy cleaning will be provided with removable cover (s) of iron or concrete within 12 inches of the ground surface. I will provide subsurface disposal field with 4 inch perforated or open jointed pipe and laid in a series of trenches, the bottom of which will pro- vide a minimum of "_ 69-0 lineal (square) feet of effective absorption area. The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging in size from 3/4 to 1-1/2 inches (dia.) and the pipes will be surrounded by similar material to a height of 2 inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench, 2 inches of gravel or stone 1/8" to 1/4" (dia.) will be placed over the course gravel or stone. The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single tile line will exceed 100 feet in length and in any case, two lines of tile will be installed. A minimum of 6 feet will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the installation will be less than 100 feet from any private water supply, 25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line. I further agree not to cover any portion of this installation until approved by the inspection officer, as provided below, and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application. DATE �Y�7 G S nature. of Applicant I hereby issue the above permit for theLd' o Health of the Town of North Andover, Massachusetts. DATE —/� - ),e 17,1 Sig ature'of Health Agent I have inspected the uncovered system indicated above and find everything done as described. DATE �' _- �� - /71 Signature Inspecting Of 'cer Percolation Test 7 Garbage Grinder s s Fee_ a THE COMMONWEALTH OF MASSACHUSETTS y + / OF— i i BOARD OF HEALTH S' _19 7/ w T'4W is to Trrtify t4at-_ x 4 — is hereby granted permission to install CESSPOOL—SEPTIC TANK on the premises at _ / � I in accordance with an application on file at this office. Said work must be done in strict conformity with the requirements of the regulations of the Boqr,4 of Health relating thereto. i CHAIRMOF THE tOARD OF HEALTH I i Violation of any of the requirements or conditions will cause immediate revocation of this permit. ' I I _g"/ - - C APPLICATION FOR SEWAGE DISPOSAL INSTALLATION HEALTH DEPARTMENT - NORTH ANDOVER, MASS. hereby, a application for a permit for a sewage disposal installation at / __71;1_ � . I will install this system in ac- cordance with all tfle laws of the Commonwealth of Massachusetts and regulations of the Board of Health of the Town of North Andover. Further, I will construct the house sewer of bell and spigot pipe, the minimum diameter being 4 inches, and will maintain a minimum grade of 1% until 10 feet pre- ceding the septic tank, where the grade shall not exceed 2%. I will install a con- crete septic tank of / in size. A manhole (s) permitting easy cleaning will be provided with removable cover (s) of iron or concrete within 12 inches of the ground surface. I will provide subsurface disposal field with 4 inch perforated or open jointed pipe and laid in a series of trenches, the bottom-of which will pro- vide a minimum of >-o-z) lineal (square) feet of effective absorption area. The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging in size from 3/4 to 1-1/2 inches (dia. ) and the pipes will be surrounded by similar material to a height of 2 inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench, 2 inches of gravel or stone 1/8" to 1/4" (dia. ) will be placed over the course gravel or stone. The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single the line will exceed 100 feet in length and in any case, two lines of tile will be installed. A minimum of 6 feet will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the installation will be less than 100 feet from any private water supply, 25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line. I further agree not to cover any portion of this installation until approved by the inspection officer, as provided below, and to incorporate any additional requirements that may be attached to the ermit. Plot Plans must be su mitted with application. DATE 16-1 7/ Signature of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DATE /6 _4- -7/ Signature of Health Agent I have inspected the uncovered system indicated above and find everything done as described. DATE Signature of Inspecting Officer Percolation Test Garbage Grinder f i BOARD OF HEALTH TOWN OF NORTH ANDOVER, MASS. I 31 l 5 4 1. NAME46//0'�17 ` G DATE zpo/ � 2. ADDRESS feAW44,-1 LOT NO. �Vyll ] TEL. 015I-Sys-11 3. NO. OF BEDROOMS DEN YES` NO 4. GARBAGE GRINDER YES NO Y 5. SHOW DIMENSIONS OF HOUSE 6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES 7. SHOW DIMENSIONS OF LOT 8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL 9. NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM 10. SHOW LOCATION OF BROOKS, STREAMS, DITCHES, LEDGE OUTCROP, ETC. 11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY. BOARD OF HEALTH OF NORTH ANDOVER , MASSACHUSETTS SEWAGE DISPOSAL DATE $,,L2J70 NAME OF APPLICANT John J. Burke LOCATION Lot #21 Raleigh Tavern Lane Address of lot no. BUILDING: Dwelling x Other SYSTEM: New X" Repair GENERAL DESCRIPTION OF LAND high SUBSOIL: Clay_.A,,- Gravel Sand PERCOLATION TEST 7 minutes per inch. MINIMUM INSTALLATION RECOMMENDATIONS CONCRETE SEPTIC TANK 1000 gallon capacity. LEACH FIELD 2,00 lineal feet of drain pipe. i William J. riscoll, Engi eer Board of He lth I may. k)0E--rkA PI N V®O'C- NORTH Ai1DJL'�R, MASS. 7 � Z 19 BOARD OF HEALTH FROM: ' DESIGN ENGINEER Re: Soil Absorption Sewage Disposal System This is to certify that I have inspected the construction materials of said disposal system at 0 T 7, i S I<� �'Aj C-,- T<-1J Site Location North Andover, Mass. The grades and construction materials are as specified in my plans and specifications dated D17 19q3j_ and -7 /2 19 __ Reg. Prof. Engineer/Reg. Sanitarian f J / ' • �� �c:s•-lit► •� Per V w e- �� � . � �kir • r " I � ` r 2:. L1 • L.F.VAT t ONAS. 1NY. PIPE Os1T OF(SSE 4- L—r ��r Pity ou-r©F rcS&V ; 0'7 ' V k'y 'g UI.FE, D!SPO INN-V PtPE tWT4 D� � 1 ww�4y 4 Y ` tk FSP PA-ra Q4,K VC C.C7 E-t_►tit AS > A�Ssc�Gt�'TES r ' •.�'�- ,� � EIaC-s1t�(�.�12St� �t2G.#-ll'�"�GT`�3 • i AVS 4 Per E'.'.., b w� v _ Tya iL � Fkr I Y � 1 I f r �f �r 41 4;E� L.F.VA-roto. �. A F r"�.,1 �# 0'7' � � tJ�?y.l.'.rJ►IJ�'�.�"�,�. �15 f�t� �,t.l..,. INV PIPS 1hITO D P>OX l INILV �, t � � `-k -76 ~�", ;at. 4�.r• T Q��4 1t G V"EA,.1 W QT'S L /'•'� �7.g(. �T . '��"��-•��. �tai�11�1EE�g� �a.1�C,ti�-�1 tT'£G'y'"rte' �4 t .4►tJ /moi S`T o.,4n1 cxa t lz t Al f '\ f Jll� r•' 'Jif" '�, T 1 � + _ 1 A1�(....PI�F.._11�L'Tl��hl►�,.. � �7 �*ii - - w.��+ u ��in1�,.� D� rti r"y_�*+►� i hi V Dr DF 1 MTO D BDX 1 ~� G y4r G _J G PAIrl Soe-- ►CT'E�3 a e � t F X55 A qlel17 F r Board of :fTeAth t40rth �4ci;�c�r,l�ass SUBSURFACE DISPOM DFSTCRI CHWK LIST AIV LOT APPROVED DATE DISAPPROM DATE Prodded: Reasons: �X)/. llAi-AL. ial V W1 OK Reg 2.5 The submitted plan must show as a mini t a) the lot to be served-area,dimersions lot # ab-atters location and log deep observation hoes-distee to ties c location and rets percolation tests-distance to ties design calculations & calculations chowing requim,& leaching area location and dLmmaions of system-including reserve, area € ) existing and proposed contours i (g location eny vat areas td.tl-dn 1001 of sewage disposal system or d.iscl.airar-check wetlands mapping 3 (h) st rZzce end subsurface drains within 1001 of seimge disposal system or d isclaivisr (i . locatien any drage easeme-As vIthin 1001 of aevnzge cltcposal systct or di.sclaimtir-Planing Board files (3) Mo= sakes of -.-Lter simply within 2001 of sowago disposal - system or disclaimer location of agiy j)roposed invIl to seams lot-1601 from leaching facility location of water lines on property-1.01 fl--om leaching facility location of benohmark drive-ways o garbage disposals no PITC to be used in construction (q) profile of syst€macl. bties of taaset, plumb, pipe, septic tank, 6i.stri,bution box inlets md outlets,, d etribution- field piping and Mer elevations M gromad water elevation in arca sei,-age dicpo� system (s) plan rzast be prepared by a Frofcssi.onal �sieer or other professional authorized by law to pm-pare vu--h plans Reg 6 Sc ai.e Tis (a) eap$cit os-150% of flow, v ter table, tees, rlcp th of tees, access, pur-ting yojcI e--nout c) 101 from cellar or ian„groLmd swirmdmg pool - (d) 251 from sabface drains Reg 10.2 Distribution Faxes a) slope: greater than 0.08 Reg 10.4 (b) uump p Sgbstrfua'e nZ,,-ign Chock ListPape 2 FAIL 0K - Leachin� Pits Leaching pits are preferred where the installation is possible Reg 11.2 calculations of leaching area-mLnim m 500 sq ft 11*4 spacing 1 11.10 surface drainage 2% 11.11 cav®r material 2'x2Ix4" splash pad tee at elbow g) no bends in pipe from d-box to pipe Leaching F1 ds d. Reg 15.1 a) nogra er t an 20 mutes/inch Nb) area- 900 sq ft 15.4 c) con tra on of field 15.8 d) mikfaa &vAnage 2 % t 3.7 e) 201 m c, vaU or inground €udmdng pool Leachix� caches Reg 14.1 a) ns- o eaebing area-md.n 50 sq ft 14.3 b) spacing ft min 6 ft with reserve betuve 14.4 c) diram. ns Ia.6 d.) consetion 1h.7 e) sto Ee.10 :f Sma ace drainage 2% r Lo FmhiU ape a) slope y = to be &,oi..-a) b) y/x g 1 = (to be sho,an) PUM Rog 9.1 a) 5apprPval 9.6 b) s7-by pour s Boak o Aeatth r North An ; r�?�.aas. $gP'PZC SYSTEM . INSTALLATION CPMg LIST LOT APROWED DATE L1I2XCAVATIC �- OK FAJL- ea�onsi " PAIL V OK 1. Distance Tos- a. Wetlands b. Drains c. Well 2. Water Line Location 3• ,No PPC Pipe Septic Tank—'=- a. _Tees -_Length & To Clean Out Covers_ b. Cement Pipe to Tank = On Both Sides of Tank - 5. Distribution Box a. Covers & Box - No Crapks b. All Lines Flowing Equal Amounts c. No Back Flow 6. Leach Fi d or Trench a. 'ons b. Sto a Depth c. C ed Bads d. CV san Double Washed Stone 7. Leach Pits a. Dimensions b. Stone Depth --- c. Splash Pads d. Tees e. Cement Pipe to Pit - Both Sides f. Clean Double Washed Stone 8. No Garbage Disposal 9. -Final. Grading Inspection 10. Barricading Covered System _ 11. As Built Submitted a. Lot Location b. Dimensions of System c. Location -.4th Regard-to Pere Test d. Elevations e: Water Table Commonwealth of Massachusetts �x City/Town of NORTH ANDOVER MASSACHUS TTS System Pumping Record Form 4 , v , DEP has provided this form for use by local Boards of Health. The System Pumping..Record must be submitted to the local Board of Health or other approving �u o ty. A. Facility Information NOV 0 2 2007 Important: When filling out 1. System Location: TOWN Or;iCrt� 'ANDOVER forms on the w Liz �.EA_1 Fr�.:` +R ,.',ENT computer,use ��� �� � only the tab key Address to move your N,gr& A N W cursor-do not CityrTown State Zip Code use the return key. 2. System Owner: 'r�(sae — �,�V� �T.��-�'�✓ — — Name AA AA�n► Address(if different from location) City/Town State Zip Code �-75.-ggi 104)? Telephone Number B. Pumping Record -7/9 Lb-7U17061. 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 (i No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: - Name vehicle License Number t NCA � \ �N V CQ ONMIE Nt L-- Company 7. Location where contents were disposed: fq 07 Signature of Hauler Date http://www.mass.gov/dep/water/approvals/t5forms.htm#inspect t5form4.doc•06103 System Pumping Record•Page 1 of 1 Commonwealth of MassachusettsfiVE City/Town of System Pumping Record NORTH ANDOVEFHEALTH ����Form 4 NORTH ANDOVER DEP RTMENT DEP has provided this form for use by local Boards of Health. Other forms may a us , 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 ruing out 1. System Location: forms on the - � 1• �"4 -✓ computer,use -fr ------ — ..T--- -------- -__only the tab key Address /f to move your _ _ _ /` -✓�. - - —-_ ��7-�--- cursor-do not ---— State Zip Code use the return City/Town key.. 2. System Owner: Name Address(if different from location) --------- - --...--- ----- --- ----- City/Ton State Zip Code w Telephone Number B. Pumping Record 1. Date of Pumping —�— �-- 2. Quantity Pumped: aeons Date ------- 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): — ----- ----- — ---------- 4. -------4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Name Vehicle License Number a Company 7. Location where contents were disposed: Signature of Hauler Date Signature of Receiving Facility Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 I ,b Commonwealth of Massachusetts City/Town of system Pumping Record NORTH ANDOVER Form 4 [)r=P has provided this form for use by local Boards of Health, Other forms may be used,but the information must be substantially ft same as that provided here. Before using this form,cheek with your local 13oard 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 yithin 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important: # System Location: When filling out Y forms on the computer,use _�_ --.w._....._.... . . .... _ only the tab key Address to move your ��_...✓T'`� �/!, ,f .. . •. .. ... ... ......... State ZiR Colt use the return w cursor-do not GitylFan' key, 2. system owner: SO Name aY. Address(ii different from location) -- _ Zip � — — . CilylTown Sbte �Q Telephone Number B. Pumping Record date A .�._��. 2, Quantity Pumped: 1. Date of Pumping 1� Gallons 3. Type of system: ❑ Cesspool($) eptiC Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): -- 4. I ffluent Tee Filter present? ❑ yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5, Coadition of System: 6. system Pumped By: Name vett FeL nse Number rte/' ���"••� ---• •.., •--._... _.,.._ , Company 7. Location where contents were disposed: Signature of Hauler Dale Siftaiure of Receiving Facility Date 15formit.doc•030 System Pumping Record Page t of t