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North Andover.,YAsa
APPROVED DATE
Providedi
Title V FA M f" OAK
Reg 2.5 1 1
�f
SUBSURME DISPOSAL DESIGN CHECK LIST
LOT
DISAPPROM DATE
Reasonst
Krhe submitted plan mat show as & minimuml
a) the lot to be served-area..dimensions lot # abutters
location and log deep observation Mes-dis$tance to ties
location and results percolation tests -di stance to ties
design calculations & calculations showing required leaching area
rlocation and dimensions of system -including reserve area
f existing and proposed contours
(9) location any wet areas within loo, of sewage disposal system or
- disclaimer -check wetlands mapping
�h),ffurface and subsurface drains within 100, Of sewage disposal
system or disclaimer
��'i) location any drainage easements within 100, of sewage disposal
system or disclaimer -Planning Board files
J) known sources of water supply within 200, Of sewage disposal
�� system or disclaimer
�k) location of any Proposed well to serve lot -loot from leacbing facility
location of water lines on proporty-10, from leaching facility
ation of benchmark
garbage disposals
P-) no PVC to be used in construction
q) profile of system -elevations of basement.. plumb.. pipe., septic tank,,
--,�idistribution box inlets and outletas distribution field Piping and
tier elevations
r)r maximam ground water elevation in area sevage disposal system
S) plan nust be prepared by a Professional Engineer or other
professional authorized by law to prepare such plans
Reg 6 gwtic Tanks
c ap-
acrt Os --150% of flow., water table., tees., depth of tees,,
access$ pumping
cleanout,
�7W-lot from cellar tall or inground swimming pool
7(d) 251 from subsurface drains
Reg 10.2 Distribution Boxes
W slo-pe greater UjZ 0.08
Reg 1o.4 (b) mmp
Reg 11.2
11-4
n.lo
ii.n
Reg 15.1
15.4
15.8
3.7
Reg 14.1
14.3
14.4
14.6
1h.7
14.10
Reg 9.1
9.6
1 2
Leachis Pits
Leaching pits are preferred where the installation is possible
a) calculations of leaching area-MAnimm 500 aq ft
b) spacing
c surface drainage 2%
d� cover material
e) klx2tx4s, splash pad
f) tee at elbow
g) no bends In pipe from d -box to pipe
;�eaching Fields
[a) no great -e -r -than 48;�tes/fnch
rb F9
area -minim= go -
/0 aq ft
,c� construction.-Af ield
'.d) surface d,)x,.,pLagef2 %
,e) 201 from van or inground a-Andng pool
Tr-.cpch
Leac=es
�a) calcul-ationd—,6T-leaching area-idn 5bO sq ft
,b) spacing-4ft min 6 ft, with reserve between
c) dizensionh
-!:age 2%
,d) constra
e
Znf a a
Do Slope
a� -s Topq7y-7x-----Fto be shomn)
b 79 150 = (to be shown)
. 6
a) app val
b) Tad -by power
Board of Health
North And_overj�lass-
A.MwED DATE
OK
MkIc '�MTEK
iNsTAMATICH CMrK LIST LOT
__]E_�MAVAP
nATf-
Reauonst
OK FAIL
1.
Distance Tot
a. Wetlands
b. Drains
c . a wen
2.
Water Line Location
3.
No PVC Pipe
4.
Septic Tank
a. -Tess r�_Length & To Clean Out Covers
b. Cement Pipe to Tank - On Both Sides of Tank
5.
Distribution Box
a. Covers & Box - No Cracks
b. All Lines Flowing Bqual AMOUntil
c. No Back now
Leach Field or Trench
a. Dimensions
b. Stone Depth
e - Capped Ends
d: Clean Double-washe d Stone
Leach Pitt
a* ions
b Sto e Depth
e
c: ash Pads
F:m�m:tt
d, ees
e. Pip e to Pit Both Sides
f. Clean Double Washed Stone
8.
No Garbage Disposal
V
9.
Final Gradi-ng Inspection
L,-'/--'10.
Barricading Covered System
3_1.
As Built Submitted.
a. Lot Lor-ation
b. Dimensions of System
c. -Location with Regard -to Pere Test
d. 'Elevations
e.' Water Table
OK FAIL
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Commonwealth of Massachusetss
: Massachusetts
System Pumping Record
System Owner System Location
Type: Emergency Routine
Cesspool: Klo Yes
Date of Pumping: �—) —
System Pumped By:
Contents transferred to:
Contents Disposed at:
Wind Nver Environwntal, LLC
Date:
Condition of System/Other Comments
I - L3 D
I
Form 4 -- System Pumping Record
Septic tank: N. =Yes r,7
Quantity Pumped: Gallons
Permit #:
Dep Approved From - 12107195
I
W,
EL -F -VA -r (40NI5.
-2qV
IK
qTC)
-2
uAv PIPE OLMOE T--AMV- ls-�, 1
IL 13 -Z -3
NIV, -P.LP-F- -OU T C?-eiO-X-
0 1 . -LZ9 -I - -.- --
Ilz -3-7
L -r
U;z
lf-,6, L- FEE I E---, /14- /ac)
G
:>
E�P_, A,
ard of H8alth
rth A4P_YEXM"B9
APPROVED DATE
FAIL OK
BUTIC. STSM
INSTAtLATICK CHECK LIST
LOT
–1fid—AVA
Reaffonst
V
r
1. Distance Tot
ae WetL-Mds
b. Drains
C. wen
2. Water Line Location
3- No PVC Pipe
Septic Tank
a, -Tees t --Length & To Clean Out Covers
b. Cement Pipe* to Tank – On Both Sides of UT&
5. Distribution Box
-a. Covers & Box - No Cracks
b. All Lines Flowing Equal Amounts
C. No Back Flow
6.- Leach Field or Trench
a. Dimensions
b. Stone Depth
ce- CappedEads
d. Clean Double Washed Stone
Lea�h Pits
a* Dimensions
b. Stone Depth
c. Splash Pads
d. Tees
6. Cement Pipe to Pit Both Sides.
f. Clean Double Washed Stone
8. No Garbage Disposal
9. -Final Grading Inspection
10. Barricading Covered System
32. As Built Submitted
a. Lot Location'. -
b. Dimensions of System
c. Location with Regard -to Perc Test
d. Elevations
e.' Water Table
OK FAIL
North Andover.,Mass
SUBSURFACE MOPNPAT. TV
nr GN CHMIK LIST
LOT
APPROM DATE DISAPPROVED WE
Providedt Reasonst
Title V kut CK
Reg 2.5 e submitted plan must show as minimum:
the lot to be Berved-areaj, dimensions lot # abutters
location and log deep observation Mes-ditRance to tiea
location and results percolation tests -distance to tieg
design calculations & calculations showing required leaching area
location and dimensions of system -including reserve area
existing and Proposed contours
location any wet areas within 100, of sewage disposal system or
disc3.aIvver_t%1k&,%u vs
Wo anus mapping
�W surface and subsurface drains within 100, of sewage disposal
system or disclaimer
�)-location any drainage easements within 100, of sewage disposa3
system or disclaimer -planning Board files
knOu'l sources Of water supply within 200, of sew&ge disposal
system or disclaimer
,K) location Of arW 10roposed vrell to serve lot -100, from leaching
P location Of vater lines on propGrty-10, from leaching facility
Ip
,M) location of benchmark
driveways
garbage disposals
no PVC to be used in construction
q) Profile Of Mtem-eleirationB of basement,, plumb,, pipe', septic
distribution box inlets and outlets$ distribution field piping
bther elevations
maximum ground water elevation in area sewage I disposal system
s) plan must be prepared by a Professional Engineer or other
- professional authorized by law to prepare such plans
Reg 6 / Septic Tanks -
C/ (a) capacities -150%
/ accemss punping
(b) cleanout
Of flowv vater table., tees., depth of tees.,
/ ke) 10 ' from cellar wall or inground. swimming pool
2:(d) 2251 from subsurface drains
Reg 10.2 /�' Distribution Boxes
(/a) slo—Pe gre_a_t_er__t_jjW_ 0.08
Reg 10.4 �7(b) sump
facility
tank,,
and
Reg U * 2
n 4
n:lo
n.n
Reg 15.1
15.4
15.8
3.7
Reg U.1
14.3
14.4
14.6
14.7
U. 10
Reg 9.1
9.6
FAIL I M
Leaching Pits
Leaching pite/,�re preferred vhere the installation is Possible
calculati s of leaching area-minimm 500 eq ft
spacing
Burfac drainage 2%
cover terial
21x/2" splash pad
A
te at elbow
bends in pipe from d -box to pipe
Leaching neel.
PI
:a) no greater an 20 minutes/inch
ea -
;b, ar [B;c 900 eq ft
c construc f
constru on of field
d) 'fac drainage 2 %
sur
m IL
e) 202 cellar mll or inground mdodng pool
Leac��im?cnches
a) calc tio-n—s—o-T-Teaching area -min 500 aq ft
b� spac g-4 ft, min 6 ft with reserve between
c sions
6
surface drainage 2%
ww"93-" D.Lop 8
a) sl6,,,K-7-7x-----rto be shown)
b) ;7xTx 15o = (to be showa)
�j
a) ro
b) WO power
ij�rigips. 2 7
L S�dl
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
Commonwealth of Massachusetts
City/Town of
System Pumping Record NORTH ANDOVER
Form 4
AUG - 5 2010
TOWN OF NORTH ANDOVER
DEP has provided th is form for u se by local Boards of Health. Other forms may belIJ-10; M Ir Trm�' " " - -'- -- -
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 CIVIR 15.351.
A. Facility Information
1 . System Location:
I
Address
No4y\ Anjoyc'(
-6-it—yr—roWn State Zip Code
2. System Owner.*
old I
Name
(If ij7
-�ddress Ifferent fr�m location)
Zip Code
-Cit—yrTown State 0 6 .5
9-7V fo&3
Telephone Number
B. Pumping Record tnl- 10 2. Quantity Pumped:
1. Date of Pumping Date Gallons
3. Type of system: n Cesspool(s) VSeptic Tank El Tight Tank E] Grease Trap
[-] Other (describe):
4. Effluent Tee Filter I present? 1X'Yes Ej No if yes, was it cleaned? vyes [] No
5, Condition of System:
6. System Pumped By:
, �' Yr Gctl I GY) -76
Name I — Vehicle License Number
Win ?iw'( EoviconmCY161
Company
7. Location where contents were disposed: IPSWich Water
- t lam
Signature of Hauler
Signature of Receiving Facility
Date
t5form4.doc- 03/06 System Pumping Record - Page 1 of 1
�_ L\ Commonwealth of Massachusetts
City/Town of NOM
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 Pumpir to
the local Board of Health or other approving authority within 14 days from 1he pKQEXWED
accordance with 310 CMR 15.351.
A. Facility Information dull 4 2009
TOWN OF NORTH ANDOVER
Important: HFALTH DEPARTMENT
When filling out 1 . System Location:
forms on the
computer, use a8b
only the tab key Ad re
to move your IaA
cursor - do not 411111
use the return ujty/ i own State Zip Code
key. 2. System Owner:
P
Name
2 0 G -
Address (if different from location)
kt 4 0 vc- e- /114 5-
City/Town State Zip Code
— 5
Telephone Number
B. Pumping Record
1. Date of Pumping 2. Quantity Pumped:
Date G�allons
3. Type of system: El Cesspool(s) 2"Septic Tank El Tight Tank El Grease Trap
Other (describe):
4. Effluent Tee Filter present? 01y -es n No If yes, was it cleaned? ET—Yes El No
5. Condition of System:
C' CIO
6. System Pumped By:
b4lqu-(c V 7?C?
Name Vehicle License Number
Ah piksaft
rMex
Coi�piny
7. Location where contents were disposed:
Treatment Plant
Signature o . . -- 4 1 3-
iogwic'', �"rA %j 1 38
Signature of Receiving Facility
Date
Date
t5form4.doc- 03/06 System Pumping Record - Page 1 of 1