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HomeMy WebLinkAboutMiscellaneous - 246 RALEIGH TAVERN LANE 4/30/2018 (2)r w m ..�,• •.:�}:'.., fry+},h��C.r���i!� hi'����� �j�+�'�„�i Ilryf��'� ,:`r',•-.• ' •••ti ••• �•ia'Iq • �'1• �� :�'";4�iV.",�''y�l� 4iY�•l��Y�� �; Y� ' ;' . RECEIV DEC 0 6 2005 ��)wN Uf' NUK I'1y Lh,.) TOWN OF NORTH ANDOVER J Y S 'B m P k) M P► N u FZp C O lI L. HEALTH DEP . .,, ..., ARTMENT „.. . ou gmck ylv PU t ��roo�„ NOf •••�/... YNR.. CD N� rvx6 OF' 58,gy,re; xwrlrr��_ . cn,rKui.h� r OOODOOi~or IoTYVIs I'Vvovr,x HllAYY OlXAsB • g�POT3.: � �8 .-,..- ��•4Cf#I�LO Kl/Ndn�.'�. • C�98rY6.801 FLOOp�p Wn • �ocroc��Y9Y��,�•...omeR•�XP��IN .:.... 1• �o,y.�., �'uMM�NTs, �vNI'�N1'y tX�1NyrXKbU ft' 4 �L\ Commonwealth of Massachusetts roSEP 25 City/Town of North Andover "�ACTHp°RrHAn, System Pumping Record gRTM�Nr�� Form 4 M 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. System Location:�F777Q �, j-_ I � �� on the computer, vfcn use only the tab key to move your Address cursor - do not North Andover Ma use the return City/Town State Zip Code key. 2. System Owner: 0( Name ietren Address (if different from location) City/Town State Telephone Number Zip Code B. Pumping Record 1 . Date of Pumping ate 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) —Z( 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: 6. System Pumped By: 7 Name Vehicle License Number Stewart's Septic Service Company Location where contents were disposed: Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 SignQ,turejbf Hauler Date SkjolftureNof Receiving Facility Date t5form4.doc• 03/06 System Pumping Record • Page 1 of 1 'a F Commonwealth of Massachusetts _ City/Town,of NORTH ANDOVER, MASAG-HUSETS System pumping Record Form 4 DEC 6 2006 I DEP: has provided thIs form for use by local Boards of He ItfaW �?e F' A ovEa ; Record mu,. pp 5; „r�rptng be submitted to the local Board of Health or other a rovi, ft A. Facility Information Important: When ruing out : 1.System Location: forms on the .: computer, use only the tab key Address -----------._._.-..- to move your cursor - do not use the return City/Town ti State'--'-- -` key. Zip Code 2. System Owner- -Wim Address (if different from location) -- "—....... ' — -- — City/Town ---------- State .(.--7--/----- Zi Code - Telephone Number B. Pumping.Record 1. Date. of Pumpin' in . Date 2• Quantity Pumped: B -----.--_-__ Gallons Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ other (describe):_.—. ----__._-- 4. Effluent Tee Filter present? ❑ Yes o If yes, was it cleaned? ❑ Yes ❑ No V. - 5. Condition of System: 6. Sy em Pumped By: !Name- /� Vehicle License Number AjoCompany 7.% Location where contents were disposed: /I _ __ --- ---�� �' _ - ---- - - Si ature fH u -- o a Date http://www.mass gov/dep/water/ provals/t5forms.htm#inspect t5form4.doc, 06/03 1� System Pumping Record • Page 1 of 1 TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD er , , �' 1 ani ; iER/' �,.._ HEAALT NO'v - 4 20 1 �l Elul OWNER & ADDRESS SYSTEM LOCATION (example: Ief( frons of house) 611,1 61 7 U i E OF PUMPINC:Id `l % w e2. QUANTITY PUMPED )SIlOOL: NO L.,- YES SCPTICTANK: NO YES > ATURE OF SERVICE; ROUTINEEM ERGENCY FRV.\TIONS: CUOD CONDITION FULL TU CUVL:� HFAVY CREASE 13AFFLL;S IN PLAC1: ROOTS LEACHFIELD RLNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER O�jHER (EXPLAIN) i >1 > 1 LM PUMPED BY� �A' r :71 FNTS: U-0 (:'N I'S TIZANSFEIZIZED TO TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: SYSTEM OWNER & ADDRESS CSC t�, cXAl I I� SYSTEM LOCATION (example: left front of house) DATE OF PUMPING: l�' 3fl"'d / QUANTITY PUMPED J500 CESSPOOL: NO YES SEPTIC TANK: NO YES v NATURE OF SERVICE: ROUTINE OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER SYSTEM PUMPED BY: COMMENTS: CONTENTS TRANSFERRED TO: EMERGENCY FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) 00000 t SOIL PROFILE & PERCOLATION TEST DATA. . North Andover, ss. No•&Street �1�,,-e�'�t Lot No. 4f Loc./Subdiv. Plan Owner Lp Investigator - Observer._ ` SOIL PROFILES. -DATE 1_ Elev. Eley, 3. Elev. 4'Elev. 0 0 0 0 Ties to Test Pits 2 2 2 2 3 3 3 3 - — 4 4 4 4 S 5 5 .5 6 6 6 6 7 7 7 7 8 :. s 8 - g g g 9 - 9 _ -.9 - 10 10 10 - 10 Benchmark -Location Elevation Datum .Percolation Tess -Date , Lazo----- Pit Number 1 F 3 4 S Start Saturation Soak -Mins Start - Test-Time----- Dro " of 3" -Time - Drop of G" -Time Mins. lst. 3"Dro Mins_2nd 3"Dro p- Pe=-colaticn Rate - _ - Board cHealth •- h'ar�,.h A6:1 SEPTIC STSTEM INSTALLATION CHECK LIST APPA—CIVr D DATE M W11ROVED UAttS s eaamnss 3 FAIL r LOT X AVA`I`I ON OK FAI L 1. Distance TO!- a. Wetlands 0 b. Drains c. Well 2. Water Line Location 3 • No PPC Pipe h. 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 Crackq b. All Lines Flowing Equal Amounts c. No Back Flow 6. Leach Field or Trench a. Dimensions b. Stone Depth c. Capped Ends d. Clean Double Washed Stone 7. Leach Pits _. a. Dimensions b. Stone Depth. c. SplasK Pads d. T e. C t Pipe to Pit - Both Sides f. lean 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 vi.th Regard -to Pere Test d. Elevations e: Water Table - Iloatd of Health north Andover,M ss h WDSURFACE DEPOSAL DFM(Rt CH K ;LI LOT # APPROVED DATB Provideds ` DISAPPROVID DATE Reasons: Title V FAIL Reg 2.5 submitted plan -wt Ohoi7 as a �.Dimom: e lot to be served-arca,dimensions lot #,abutters cation and log &iep obscrrvation lloias-distance to ties jIb cation and results pei�.olation tests -di dtannce to ties sign calcUat�ions & erl,etlations shDvdI tg raged. leaching area cation and edmenniens of t r„-i� ,cl45ding veserve area isting and propos ed eonWurs cation any wt areas iii -.un IGO, of 8Qwage M-sposal system or disclaimer -check wetlands mapping (h) surface and subsurface drains within 1001 of seen dissal ` system or divelai.mer .. (J) Location arq drainage easements v.thin 1001 of ass ge CA*Posal system or disclaimer -Planning Board files (J) laiom Lources of -ester supply within 2001 of sevage disporAl system or disclaimer location of mW proposed vrel.l to serve lot -1001 from leaching facility 1 ovation of nater lines on property 101 from leaching facility ocatioan of benchmark drive' .. ys o gart�age disposals Bio PVC to be u -ed in consk.mcUon Q) profile of of ba;serixnt, plumb, pipe, septic talc, dts bu-Uon box inlot.a fn.A Gatl.ets, distribution field piping and Outer F 1 °r ti.e-dgs MAP"1 &XVtInd -':- tr,.Y' ?.i tri 4i in ::' a a ;,s. ;e di.-Posal system plan ir.,tst be prapau-d by a r7vofcsti:IoiWC. Pas oor or other professionn.l G"utYiS?riz :d by lair to prcpar e such plans Reg 6 e stic 'Tanks a) ca pacilt 50% of flow, hater table, toes, dapth of tees, access, puping cle.nout 101 from coo lar til or inground mom ging pool rd) 251 from subs'urf'ace drains _ Reg 10.2 Reg l0.4 21", tion Doxes 0.08 i mmurrace Lesign unem 3 ` FAIL I OK Reg 15.1 15.4 15.8 3.7 Reg 14,1 14.3 14.4 14.6 14 .7 14.10 Reg 9.1 9.6 List .2 LeachLg Pits Leaching pits,t�e preferred where the installation is possible a) /ee2aof leaching area-r4ninm 500 sq ft b) c) nage 2% d) iale)ash pad f)g) pipe from d -bore to pipe /""Leachin Fields o gr€►aer than 20 Mates/inch a -Minim= 900 aq ft onstructi®n of field surfac® drainage 2 e) 20, from cellar tel. or inground siAmndng pool a)-� one —Teaching ares: -min 5 DO aq ft b) spacing -4 f 6 ft with reserve betwen c) dasi.on d) etr�a on e) stone f) surfa a drainage 2% s ope y� to be shown) b) y/x % 150 (to be shown) PUMS/ a) Tsd-by val b} power TOS `Oo. ALiCoyc-g-' 'FROM: V--eAQV- A,,) r -Assoc_ . Tm c_ . NORTH ANDOVER, MASS. Aj V UST b .198 1 BOARD OF HEALTH DESIGN ENGINEER Re: Soil Absorption Sewage Disposal System This is to certify that I have inspected the construction materials of said disposal system at L - L -4r-- LA Taves e -N Site Location North Andover, MA. The grades and construction materials are as specified in my plans and specifications dated Z -AN - 19 e-1 and Aucau.S"T 18 19031 v Reg. Prof. Engineer/Reg. Sanitarian a, 4-4 cypli LblV. PIPS DU7 F-jd5E LOOT ItAu OEM l nl�`c� o��»c��,ILto apt, t.i �. �' � �! 1 `�► �t�' ` �.. lyra PIP c� .�vx d ►Y ""T' W-V P, FT-. rte. b, i3c OS :3- • „ . _ 4"� ���'�� ��'� ��; - � D Com,,,' '% ` • > CJCA LE �' • � Q,41�t {,� �, �7 Et,.1 u 1 41 E 1,4 G V r F—e 0. ti riS �.a+ITJ�T• - .' . - l = � Fes' L.F. 1I A -r I i 91PE` NC-s17i.�' L- � 4 N Ioo C' 1 WTP r 1.11v+t� L� '! � �l. � + --� '+' � �-- ,��'� iia., � f �� �► �''w�`"`"..� • � .. :.�z�t-lar `` ► }Sji'`tC.srl',tE12 - f SFAPIFOI :i�•Q . +,d:jS�i,l(.f�i;fil•: L'•1S�JIli:yt�:. .. : � � .. ' � .: J'W.� 'Tity ,�ft•��: It�i' J."f.r.�,...: .:.•:.'.. _ - ^_..._..._ - I4. i �'�4tf ;fih'•it�.�'!,�i�"•�''/'r'1'i. s),'�l:'�\ • 1('. .� `i'' .:.;:5 r:�,InF • Vi;'\ R RT SySTNM. pUMnfh( R�„�'., V.. 3 10 u! I , 0"/., c'69 Q. Imp .'�.L. , .', 'Iv,4 f.•,r is J. ,I. 1f �1•.•1' ,t.. " �!'l Yrs seri , 7 ,\ N N,•tTVKf;'O.F;SERY.I.CE`':R0VTIKE. En^ERCc�C'r " '�,.';,.;,;;;U,U.U.O.'C..V.�a'.U•11'hq.N.�.:: h'Ul,I,:T� CU'!". fiU.C;Tsf��iY, LEnCf?. ;cX-C EssiYI"1'0 c;$g: F�oo.oeo 4,410.y'iN:A TY. 9 Y MR 7777 D , ,IZr. � � �• • i.�r'' YY�11' (., Jif � ��i � {{ 1' V 'r!//%�i'r :f )'• 1 tVlf�, i i �r ""'„:iti'.1'�,i,Y,:jI:T�:S����1.'.1:,1%ti�r� j{tY?i,)'�j� �r .. (j'/,• i�, ,' i 1,vM'PVM P CO':0 Y...; / / >Yr.`'; �,( �, /* :�.. l..f:; j!„ ^i;•f;�. 17uf •; 1, %.vi �•'y .. '•.. .. . VVNIlN,i .r�T�''�' 1•,f• ,,. l yr,.��rfi;tf,,a",;.��,fla�'; { {;,fN'�'�L-krr,,,; . �; .. .... • ' .. '�•.r'i. ;I � � Z,�� ' ,�' 1):1;/`.1,1 f'..1'.; j1Y'.. � �•�j,:l�,,:'' .� _. IV i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM t► ,r f* 5 J,4 M Address of property r -fir �►r` t - t�+e Owner's -name Date of Inspection,,(_ PART A CHECKLIST Chec .if the following have been done: Pumping information was requested of the owner, occupant, and Board of /''Health. "` None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. /The facility or dwelling was inspected for signs of sewage back-up. The site was inspected for signs of breakout. All system components, excluding the SAS, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the SAS on the site has been determined based on existing information or approximated by non -intrusive methods. The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of SSDS. t� .....�....-_ _,..,,��,„.t.r`-. ."�, r+-.,r-,--y.,+'a. M ,. .., ,. .. - nw ...,y..�is.r--- - 4x11"�Y,..,-.���,-'Y�-.�"'�l�h V�.. -•i n'.--y.-Y. � SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C - FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not) 00 Backup of sewage into facility? �1Q Discharge or ponding of effluent to the surface of the ground or surface waters? A/6 Static liquid level in the distribution box above outlet invert? Liquid depth in cesspool <6" below invert or available volume< 1/2 day flow? Required pumping 4 times or more in the last year. number of times pumped P6 Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? Is any portion of the SAS, cesspool or privy: below the high groundwater elevation? 10 within 50 feet of a surface water? //Q within 100 feet of a surface water supply or tributary to a surface water supply? V -d within a Zone I of a public well? within 50 feet of a bordering vegetated wetland or salt marsh (cesspools and privies only, not the SAS)? °U within 50 feet of a private water supply well? 0V less than 100 feet butreater than 50 feet from a g private water supply well with no acceptable water quality analysis? If the well has been analyzed to be acceptable, attach copy of well water analys for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. r.. wy.�t•-r.,. "" .y `" .,.r,rt.r.,-. y.�.? ' :�.y-Yr....,r.rii. �__RT`✓, Tom. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SEPTIC TANK: (locate on site plan) er depth below grade -, material of constructiontconcrete metal FRP other(explain) dimensions • _ sludge depth 3., distance from top of sludge to bottom of outlet tee or baffle scum thickness distance from top of scum to top of outlet tee or baffle ,4' distance from bottom of scum to bottom of outlet tee or baffle Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, recommendations for repairs, etc.) DISTRIBUTION BOX: (locate on site plan) /vH f depth of liquid level above outlet invert Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, recommendation for repairs, etc.) PUMP CHAMBER: (locate on site plan) pumps in working order, yes or no Comments: (note condition of pump chamber, condition of pumps and appurtenances, recommendations for maintenance or repairs,etc.) • •...- x r M , -.y xr r Y..I..r�'Y r r...nr...�..*,.-Ty... ._i.t^N+rR,.x+r-wZ+.^`^^r T- -t ... �,...M1,, eN1.w✓ .,. x. t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS If residential number of bedrooms number of current residents _v garbage grinder, yes or no S laundry connected to system, yes or no . seasonal use, yes or no If nonresidential, calculated flow: Water meter readings, if available: 41vt<<L IN Last date of occupancy GENERAL INFORMATION Pumping records and source of information: Alo0 f d qsr 7 ye # -T S System pumped as part of inspection, yes or no if yes, volume pumped Reason for pumping: iI% r ro 1i i'f=l� 5 )"`4 /I le, I -/f Al /- Type f system Septic tank/distribution box/soil absorption system Single cesspool overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other (explain) Approximate age of all components. Date installed, if known -'Source of information: Sewage odors detected when arriving at the site, yes or no .......k_.' I._....111 ., i i. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excavation not required, but may be approximated by non -intrusive methods) If not determined to be present, explain: Type leaching pits and number leaching chambers and number leaching galleries and number leaching trenches, number, length Lu 1.d A - leaching fields, number, dimensions overflow cesspool, number Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc.) CESSPOOLS (locate on site plan): number and configuration depth -top of liquid to inlet invert depth of solids layer depth of scum layer dimensions of cesspool materials of construction indication of groundwater inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc.) PRIVY: (locate on site plan) materials of construction dimensions depth of solids Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc.) 'wr.:ry'Yr'+`ea"^�.`Y-r ... -o ti.+R'b" ..s ♦ ��.. Y^ "+1^"'+Kc .r^<ir'1"'^'� s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' DEPTH TO GROUNDWATER 1 depth to groundwater method of determination or approximation: )'A yr 4'e SUBSURFACE SEWAGE DISPOSAL SYSTEN INSPECTION FORM PART D CERTIFICATION Name of Inspector ,j dpl 13 a S o' Company Name let ti A,Company Address Certification Statement I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accukaate and complete as of the time of inspection. The inspection was performed and any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function and manitenance of on-site sewage disposal systems. Chec one: toO I have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15.303. Any failure criteria not evaluated are as stated in/ the FAILURE CRITERIA section of this form. I have determined that the system fails to protect public health and the environment as defined in 310 CMR 15.303. The basis for this determination is provided in the FAILURE CRITERIA section of this form. Inspector's Signature Date t,1-/ y ► Original to system owner Copies to: Buyer (if applicable) Approving authority I G ,rowN OFNORTHDIOVER DA 1,h SYSTEM PUMPIN PRLF- C 0 R. L) SYSTEM OWNFR-j �ADDRESS A ��� LATE OF PUMPINO: T a I r -M LWAT-10N _QUANTITY PUMPED: CLSSPOOL: NO>- .. YES.- S00c Tank: NO NA SURE OF SERVICE: Rou-rINE,,.4.--- �EMEROENC,y L)bSF-RVA'rioNs:. GOOD CONDITION POLI LL'TYJ COVER HEAVY ()"-ASE BAFFLES IN PLACL ROOTS Y Es DEC 0 7 2004 TO' )rZTH ANDOVER 'AR rtviLNT OXCUSIVE SOLIDS —__ FLOODED LoAl-K UDRUNBIACK...— ..— SOLID CARRYOVER,_..'_. . OTHER EXPLAIN SYstom Pumpod by 0 Q%. 4- (-'UMMENTS. cuN vtm's f im T7^ Grorlof0lril�rlpirn c� r'.�bmlllod.lo Vff Iocrl Bclrcr c'r�',o�,��'�r 8 a+ v� Cit�(� In Ly Y( Iil,.l'r'rl 1,ir'lii�,�,�1 r�,!',, ,. '%i'•���,'� 1 c. s ---- .. 1 r't� r 's' t. r rh���;�,1,� ,'�Yll;r�l'�r ;• frfnl 91 mpinp rr ' Jr' 1 rrYD141 1 ,t ,, Y�iem� : co>>�o01(� .I �rj•,rl N,. )��19npn1 n,mp„ — IIp ey,c e�, • �' a`i. jey,'�I''I,/r�ii'i':Ylfi'�,�ttrrr��'i Yo) C3 n'o .... ,;; r IIt;,�Q�ie1JU9n:o 'SY%("m';.',t•!,, , '•' r'i('ri ��' YV `/Irir lrf,'/r !r' w � "/r ('{'t • �r,l•nlrljlr�IHlVtr�r'rlli,nli4�'i\ p;Ii'1 ' MIN `a • ' •.:. ' r'�' 1111x' III(( �i� l l Y ') V 1 I ')'I (,1';'!r , / r ' •'�'/ I '�� �1��! � �i�lr/l,I ' !'�Z�(,i',�,yjJ I ' � 'I'yV % 1, 1Ir ! .. '• ;;':��; '':I,,I,;r,,�,�,Yf,1�,�e�f,¢� Oli�ca,�Q�o dhposav, r�e.! r , , 1 •qY//f ) , • . � %��;'1'r'4'I'�1'i%/li�.'r I'dl�' lY l,,l.ifr "•' • ,,, , ,. PP�4Y1Ja�l�iorrna,r;maln��ocl 1 � Yl�luf'Jcanll /17�