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Home My WebLink AboutMiscellaneous - 255 JOHNSON STREET 4/30/2018 (2)a C Lot & Street 46 Map/Parcel CONSTRUCTION APPROVAL Has plan review fee been paid: YES Plan Approval: Date: Designer: Conditions: Water Supply: Town Well Well Permit: Well Tests: Chemical Bacteria I Bacteria II Plumbing Sign -Off: Comments: NO Permit# Approved by: Plan Date: Driller: Date Approved Date Approved Date Approved Wiring Sign -off: Form "U" Approval: Approval to Issue: YES NO Date Issued By: ,Conditions:— Final onditions: Final Approval: All Permits Paid? YES NO Well Construction Approval? YES NO Septic System Construction Approval? YES NO Certification? YES NO Other? YES NO Any Variance Needed? YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: APPROVED BY: r 00� CONDITIONS: Is the installer licensed? Type of Construction: New Construction: Issuance of DWC permit: DWC Permit Paid? DWC Permit # Begin Inspection: Excavation Inspection: Needed: SEPTIC SYSTEM INSTALLATION Passed: By: Construction Inspection: Needed: As Built Plan Satisfactory: YES: Approval of Backfill: Date: By: Final Grading Approval: Date: By: Final Construction Approval: Date: By: Certificate of Compliance: Approval: Date: YES NO NEW REPAIR Certified Plot Plan Review YES NO Floor Plan Review YES NO Conditions of Approval from Form U YES NO YES NO YES NO Installer: YES NO Passed: By: Construction Inspection: Needed: As Built Plan Satisfactory: YES: Approval of Backfill: Date: By: Final Grading Approval: Date: By: Final Construction Approval: Date: By: Certificate of Compliance: Approval: Date: Town of North Andover, MA " Watershed Septic System if Servicing Report Date: e -sa - 9 y Homeowner: M" 2 "U Street Sd U Phone Nature of Service: Observations: Description of Work: Comments: 4 Routine ✓ Emergency Pumper r,', clic"l A:. GIARD Address: NO. ANDOVER, MA Phone (508) 686-7653 Good Condition ✓ Full to Cover / Baffles in Place ✓ Leachfield Runback Excessive Solids Heavy Grease Roots Other (Explain) •. ".1A:ia. \.•:.x=-:...,1.,._. .... ,. .. .. .. ..,. � ,t,. ....;SS,ra ali.e:Al.iyiL.a...^,........,....o'\'3u.�ha..._.�w.w-,}L :sal:w...:. ... �.. U4.t,e..(...SkL_�.»i STATEMENT DANIEL A. GIARD TERMS: (� i PLEASE DETACH AND RETURN WITH YOUR REMITTANCE $ DATE I INVOICE NUMBER / DESCRIPTION CHARGES I CREDITS I BALANCE BALANCE FORWARD 0 �`✓ w PAY LAST AMOUNT DANIEL A. GIARD IN THIS COLUMN PRODUCT 10D.2 r�r Inc.. Groton, Mass. 01471. To Order PHONE TOLL FREE 1-8*225-63M ELATE h Coy SEPTIC SYSTEM INSPECTION FORM � L ADDRESS Z DATE INSPECTED PROPERLY FliNCTIONING? Y N WEATHER CONDITIONS COMMENTS: clk 0-1 �-e l i� DYE TEST PERFORMED? Y N DATE? SKETCH: Com! "-&g A(43 bi sc 6 i 6 Ve I 7 WATERSHED RESIDENTS QUESTIONNAIRE 1. Name b l k 2. Street Address �5�5� 1 OIZAISC?/V SZ - 3. Z a � `f 3. How many members are in your household? 4. What type of sewage disposal system do you have? ❑ cesspool I septic tank and leaching area ❑ connection to municipal sewer ❑ other (describe) ❑ do not know 5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health? X yes ❑ no ❑ do not know. 6. How old is your sewage disposal system? X 0-5 years ❑ 6-10 years ❑ 11-20 years ._.�._ ❑ over 20 years ❑ do not know 7. Has your sewage disposal system been rebuilt or repaired? ❑ yes X no ❑ do not know If yes, approximately how long ago? years. What was done? 8. How frequently is your sewage disposal system pumped out? ❑ annually \ f ❑ every 2-4 years ❑ every 5-10 years ❑ over 10 years 9 never CA)E�) 9. Have you had any problems with your sewage disposal system? ❑ yes 5� no If yes, what problems? ❑ repeated pump -outs needed ❑ system clogs, backs up, or drains slowly ❑ odors ❑ sewage surfaces through ground 10. How many of each appliance are connected td -your sewage disposal system? washing machine dishwasher garbage disposal dehumidifier drain sump pump toilet roof/pavement drains shower/bathtub 11. Please state the brand and type (liqui 'or "14pe owder) of detergent you use for: dishwasher d clotheswasher b 12. Does your property have a lawn? [4 yes ❑ no If yes, approximately what size? ❑ less than 1/4 acre ❑ 1/4 acre 1/2 acre` ❑ 3/4 acre ❑ 1 acre ❑ more than 1 acre (Specify) acres 13. How often do you fertilize your lawn? No. of applications per year �I/ovE ` Season(s) of the year 14. Please state the brand and type (liquid or granular) of lawn fertilizer you use: ❑ Check here if your lawn is maintained by a professional landscape contractor. .ard of Health north AndaverzHaaa. ,S ID DATE �(1elSK?nC SISTEK INSTAILATICK CHECK LIST 01 DI SAPPRUM eaR-onst r Dlp�(J LOT' EXCAVA OK FAIL (09K'� CJS -3v� � 1. Distance Tot 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 Oa Both Sides of Tank 5. Distribution Box Covers & Box - No Cracks . All Lines Flowing Equal Amounts No Back Flow 6.- Leach Field or Trench a. Dimensions b. Stone Depth c. Capped Ends d. ,Clean Double Washed Stone 7. Leach Fits a. Dinansions b. Stone Depth c. Splash. Pads, d.. Tees e. C en, e.nt Pipe to Pit - Both Sides . f. Clean Double Washed Stone 8. No Garbage Disposal Final Grading':Inspection' •, r3,�1�', 10. Barricading Covered System 11. As Built Submitted a., Lot Location b. Dimensions of System c.Location 'with Regard -to Perc Test d. Ilervations e: Water Table 1 . `Board of Health North Andover,Mass SUBSURFACE DI!,TOSAL DESIGN COCK LIST �j. To *5U45' APPRaW DATE-/ - DIsAPPRom DATE '-224 Providdd: Reasons: W77rLlAu D CIOu as�' 1 x7 5 sr*11v la '46�5, lwywaiect011.1 --- TED LOT JOWSO" Title V Reg 2.5 !0 s�-IQ SAP /U -P �fo S�10 ��4 D = y � - ------- = - - Reg 6 Reg 10.2 - Reg 10.4L::4�b) FAIL Ob . �"''� 0' The submitted plan must show as a adnimums a) the lot to be served -area., dimensions lot # abutters b location and log deep observation hoes -distance to ties 'c location and results percolation tests -distance to ties d design ealculkXions & calculations showing required leaching area e) location and dimensions of system -including reserve area f) existing and proposed contours (g) location any wet areas Within 100' of sewage disposal system or disclaimer -check wetlands mapping (h) surface and subsurface drains Within 100' of sewage disposal system or disclaimer (i) location any drainage easements within 300' of sewage disposal systemFor disclaimer -Planning -Board files (j) known sources of water supply within 2001 of sewage disposal e _ system or disclaimer location of any proposed well to serve lot -1001 from leaching facilii 1) location of water lines on property -101 from leaching facility m) location -of -benchmark n)- drivevV-s (o) garbage-dlspersal=e no PVC -to be used in construction _ profile -of system -elevations. of basement, plumb, pipe, septic. task, distribi tion box inlets--and-outlets, distribution field piping and - - Otter -elevations -- = tem ma ground ter isvatiaa .n --arca =sewage.-,disposal__Us ---_ --plan mast be prepared by a Professional Engineer or other professional authorized by law to prepare such plans Septic Tanks (a) capacities -150% of flow, water table, tees, depth of -tees, acceGs, ping b) cleanout 101 from cellar im11 or ingroun.d sw.mnin g pool - - - - 251 from subsurface drains Distribution Boxes a) slope -greater 0.08 sump �_ _ -- - _- _ --(q) 4(d) - 7(d)