HomeMy WebLinkAboutMiscellaneous - 252 BOXFORD STREET 4/30/2018 (2)�..
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Commonwealth of Massachusetts
W City/Town of No Andover
System Pumping Record
Form 4
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.
on the computer,
System Location:
use only the tab
key to move your
Address
cursor - do not
No Andover
use the return
key.
City/Town
2.
System Owner;,_
u
Name
ietran
Address (if different from location)
City/Town
Ma
State
State
Telephone Number
B. Pumping Record
1. Date of Pumping (' 2. Quantity Pumped:
Dat
3. Type of system: ❑ Cesspool(s) '� Septic Tank ❑ Tight Tank
❑ Other (describe):
4. Effluent Tee Filter present? ❑ Yes
5. Condition of System:
Zip Code
Zip Code
IA -a
Gallons
❑ Grease Trap
t I
No If yes, was it cleaned? ❑ tes ❑ No
6. System Pu7?�
y:,%
Name Vehicle License Number -
Stewart's Septic Service
Company
7. Location where contents were disposed: .�
Stew rt's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 -96\Nll OF NCR"" "OVER
of Hauler .--._—._—•-----
of Receiving
t5form4.doc• 03/06
Date
System Pumping Record • Page 1 of 1
RECEIVED
OCT 0 7 2005
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,TT -4 PINQ UCOKj TOWN OF NORTH AN'DOVER
HEALTH DEP<aRT'.;'�.NT
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TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
DATE:
SYSTEM OWNER & ADDRESS
A
C;�5-a
�•
SYSTEM LOCATION
(example: left front of house)
DATE OF PUMPING: QUANTITY PUMPED GALLONS
CESSPOOL: NO YES SEPTIC TANK: NO YES
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NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION FULL TO COVER
HEAVY GREASE BAFFLES IN PLACE
ROOTS LEACHFIELD RUNBACK
EXCESSIVE SOLIDS FLOODED
SOLIDS CARRYOVER OTHER (EXPLAIN)
SYSTEM PUMPED BY: v � ����p✓� � '"`'L ,
COMMENTS:
CONTENTS TRANSFERRED TO:
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North Andover Board of Health
120 Main St.
North Andover Ma.01845
Haul Lic. #151 -OOH
Install Lic. # 128-0
Date Address
11/1/2000 303 Chester St
11/1/2000 50 Willow Rd
11/1/2000 160 Carelton Ln
11/1/2000 165 Bridal Path
11/4/2000 174 Ingals St
11/4/2000 1062 Salem St
11/6/2000 373 Raligh Tavern Ln
11/6/2000 252 Boxford.St
11/6/2000 150 Liberty St
11/6/2000 149 Osgood St
11/7/2000 255 Haymeadow
11/7/2000 850 Winter St
11/8/2000 25 Windsor Ln
11/9/2000 249 Carlton Ln
11/9/2000 767 Johnson St
11/10/2000 56 Academy Rd
11/14/2000 Sugar Cane Ln
11/14/2000 250 Abbott St
11/15/2000 195 Winter St
11/15/2000 187 Winter St
11/16/2000 85 Laconia Cir
11/16/2000 86 Willow Ridge
11/17/2000 2135 Turnpike St
11/20/2000 203 Grandville Ln
11/20/2000 391 Pleasant St
11/20/2000 124 Tucker Farm Rd
11/22/2000 394 Boston Rd
11/22/2000 728 Forest St
11/22/2000 18 Johnney Cake St
11/24/2000 106 Rockey Brook Rd
11/24/2000 258 Rea St
11/28/2000 1815 Great Pond Rd
11/28/2000 1420 Great Pond Rd
11/29/2000 266 Lacy St
11/29/2000 155 Laconia Cir
Andover Septic
47 Railroad St.
Bradford Ma. 01835
Gallons Comments
1000
1000
1500
1500
1000
1250
1000
1000 Leachfield Run Back/ Ex. Solids
1500
1000
1500
1250
1500
1500
1500
1500
1500
1000 Extra Solids
1500
1500
1500
1000
1500
1000 Flooded
1500
1500
1500
1500
1500
1500
1000
1000
1500
1000
1500
4
Norman Tardie
Boxford Street
APPLICATION FOR SEWAGE DISPOSAL INSTALLATION (E. Flanders)
HEALTH DEPARTMENT - NORTH ANDOVER, MASS.
I hereby make application for a permit for a sewage disposal installation at
Boxford Street . 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 1000 gal, 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 160 lineal (Squwm) 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
Signature of Applicant
I hereby issue the above permit for the Board of Health of the Town of North
Andover, Massachusetts.
DATE _592tember 18, 1967
Signature of Health Agerit
I have inspected the uncovered system indicated above and find everything done
as descr'bed.•
DATE `' 2
Signature Inspecting 0 ficer
Percolation Test 3 Min. Soil: Gravel
Garbage Grinder No
BOARD OF HEALTH
TOWN OF NORTH ANDOVER, MASS.
` 0 fig'
Iry u Ga (,:I,# tr
30® �
I
1,501
1. NAME ���V� Gt�r.� DATE/� �/ %
6pF-&5C35�
2. ADDRESS LOT NO. TEL. d PZ -
3. NO. OF BEDROOMS DEN YES NO
4. GARBAGE GRINDER YES NO X
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.
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BOARD OF HEALTH OF NORTH ANDOVER, MASSACHUSETTS
SEWAGE DISPOSAL
DATE Sept. 15, 1957
NAME OF APPLICANT Norman Tardie
LOCATION Boxford Street
Address of lot no.
BUILDING: Dwelling X Other
SYSTEM: New X Repair
GENERAL DESCRIPTION OF LAND High
SUBSOIL: Clay Gravel X Sand
PERCOLATION TEST 3 minutes per inch.
MINIMUM INSTALLATION RECOMMENDATIONS
CONCRETE SEPTIC TANK
11000
gallon
capacity.
LEACH FIELD 160 —lineal
feet of
drain pipe.
):d. - N - � e-od
& -
4lilliam J. iscoll, Engineer
Board of Hea th
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Faciiity Information ..
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