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Home My WebLink AboutMiscellaneous - 29 PADDOCK LANE 4/30/2018 (2)CD 0 p 0 F n' Ma 0 th Q IVED' RECE a it�1T0Wn"'6fN0RTH ANDOVER ACHUS MAS ETTS No' 13 2UUb stem'Pumping Rec"dir"d "�:'Foft 4� DOVER TOWN OF NORTH AN H T DEPARTMENT EALTH DF e , VSt( DER has provided this form for use by local Boards of Healt e ystem Pumping Record must be submitted to the local Board of Health or other approving authority. A., Facility Information ,..VVheri fiffing out Location: forms on the computer, use only the tab key to move your cursor - do not use the return key.*.; 2. ON Address Clty/Town Mate System.Owner: me Address (if different from location) Zip Code CityfTown State —7 a Zip Code 9)" - 7::�' - x - Telephone Number Pumping Record 52� 0 Da te- of Pumping Date 7 2. Quantity Pumped: Gallons 3. ype of system: Cesspool(s) 0-1§eptic Tank 0 Tight Tank Other (describe): k7 DJ Effluent Tee Filter present? Yes. No If yes, was it cleaned? E] Yes E]. No 5. Condition of System: -�6044o 6. S P d By Name /,Veh.icle License Number Oaftd, /M. Compan y 7* Location where contents were disposed: C57 0 Signature of Hauler http:/twww.mass.gov/dep/water/tipprovals/t5forms.htm#inspect t5fomA.doc-.06103 Date System Pumping Record - Page 1 of 1 Board of Health. North An42Y_e_r.2,Y,"3- APPROVED DATE FAIL U. - I � t sEFTIC SISTEH INSTALLATIM CMK LIST LoT"u_)2A_PAP_ 'EXCAVATICK OK FAIL 1UPPROVED hb 7- lo eamnst a. Lot Location b. Dimensions of System C. Location -4thRegard-to Pere Test d. Elevations e.* Water Table 114 1. Distance Tot a. Wetlands b. Drains Well 2, Water Line Location 3. No PVC Pipe 4. Septic Tank a. -Tees r. -Length To Clean Out Covers b. Cement Pipe to Tank — On Both Sides of Tink - 5. Distribution Box a. Covets & Box - No Cracks b. All Lines Flo -wing Bqual AmUnts c. No Back Flow 6. Leach Field or Trench a. Di -mens -ions b. Stone Depth a- Capped 'Eads d: Clem Double -Washed StOns'___ 7. Lea Pits tzsions a. b. no Depth e. Splash Pads d. Tees e. Cement Pipe to Pit Both Sides f. Clean Double Washed Stone 8. No Garbage Disposal 9. Final Grading InspectionO, 10. Barricading Covered SYstem 11 As Built Snbmitted a. Lot Location b. Dimensions of System C. Location -4thRegard-to Pere Test d. Elevations e.* Water Table 114 ij 90/ Permit V-RO!5 Town of North Andover.Mass. 9 Da t e - APPLICATION FOR WELL & PUMP PERMIT Application is hereby made for permit to drill a well Application is, made to install (-) a pump system-. Location: Address < ..-Lot #J Owner)e,&t77- 0�f OZ-Zl��Ok<�, Address 'Tel -------- - Well Contractor 11-7liAeA Address e 1 T Pump Contractor —Address WELL CONTRACTOR (To be completed at time of pump test) Tel.;-- - Type of Well ?e 0 Well used for Diameter of We'll Size of Casing ...... .... Depth of Bed Rock. 15- / Was Seal Tested? Yes (�') No U Depth of Well 260 -- Depth to Water Drawdown --41 feet after pumping q .Depth casing into Bed Rock Date -of Testing Well Ended in What Material Delivers- Cals.Per ',Iin. f hours at 3 GPM Date of Completion__, 'e I I Contractor Sionature 1. PU1,JP- INSTALLER- (To be -f ille-d-in before� inst-allaf ion). -- Size & Namie-Pump Pump Type Used 1'.1ater Pump Delivers -r- - GPM-�----' Size-of.Ta n k ---- Pipe Material Used in Wel-l:--Cast Iron -Calvanized.(-) Plastic Pit-( or P-itless- -AdapterJ-.). -le Was slee-ve- used to protect Pipe? --Yes NO( Type or Name It. ll --Seal Date- �c 0-1? ---------- It Wli)t lf), 'It )(1. Date V.1a ter analysis r e port-- submi t t ed--t-o -:Boa rA-- of--Alea 1-th Date 'release.given. tD ov.-,,ner of record &- Bldg. Insp Ilealth -Inspector 7houtemiew eakzatoz yo Ate. 66 LITTLETON RD. - WESTFORD, MA 01886 Report Number: C-081-7389 Client: B & H Drilling P.O. Box 307 Windham, NH 03087 Report Date: Sample Taken at: (617) 692-8395 May 24, 1984 S-13 Collamore Lot #13A Paddock Lane No. Andover, MA On: May 23, 1984 CERTIFICATE OF ANALYSIS ----------------------- Test Parameter: Results: UNITS Sample 1 Coliform Bacteria per 100cc 0 Sodium (Salt) mg/l NT Soap(MBAS) mg/l NT Benzene(Toluene) mg/l NT Lead mg/l NT Acidity Value SU NT Arsenic mg/l NT Barium mg/l NT Cadmium mg/l NT Chromium mg/l NT Color CPU NT Copper mg/l NT Cyanide mg/l NT Flouride mg/l NT Grease(Total) mg/l NT Hardness mg/l NT Iron mg/l 0.94 Manganese mg/l 0.043 Mercury mg/l NT Nitrates(as N) mg/l NT Odor TON NT Phenols(Total) mg/l NT Phosphates(as P) mg/l NT Selenium mg/l NT Sulfide mg/l NT Turbidity NTU NT NT = Not -Tested Massachusetts State Certified Microbiological Drinking Water Laboratory #33051 Pyter T. Thorstensen, for Thorstensen Laboratory, Inc. 1"-L " CHECK LT-br -SUBSURFACE M51?t ;J, DES" C, 7 DI SA.:- ITED 1) �- -,E— LOT I(j Imo.,,= &ources of v-, r within 2001 of b..-2ZC Byatem or disclairy -location-of any' E,.ed _ie:r�t_10 es on i CXty-10 I from 3, location of uster V (m) location of benchr, driveva� garbage disposals Wn &- I- �A consti,,-.'%,!on no _11(q) profile of - syster, E -,ation o 'L basem--qt., PluL',.; PI v,, 4 ts ane oatlets distribu'!�,- CIS U %J" OtLer elevations va' elzoo- maximum groimd ele, 1111vn in area se -wage - plan mast be prepa-, I by a rrol(essional Engine 7 or professional authe-. *��&d by I r,�T to prepare sep��Tan��s S p - - -- -1 S )i c cities -150% 0� c?.;., v::- table., tee dc -,(a) cap accerS3 P11 --ping (b) cleanout (c) 101 from cellar or i�, �g POO". 25t from subsurfal�-,- a -n L' Distribution BoxeF , 08 slope greater thar W;xv Th - e submitted plan rra_�,' 7hoW Z!T the lot to be- ser-% z- -,rea., eV �nqions lot abla! K;Ies-distal, to location and log 1��- obser , M, on I' _b) location and-reuul-', jejl) Perco tests-distanc. to design calculationz cal cv 7 - Lions aliowing re, - I - . -diment ocation -and -.8 of t� ,-imluding re.,_ r -v a :,te7 exi5ting and propo. g) location any% vet a- T conto. - .; s Wity., 100 of se -page If -wr --�a ng -disclaimer-aheck - . -nc'[B r surface and s-ubsur.'I', & dis-In., vi thin 10D 1 0 f 5 i �,�stem or disclair� : YI) location any drain- within 1001 Of o� -� — -- '44 sclaill, ja_-jr_,4 BDard files I(j Imo.,,= &ources of v-, r within 2001 of b..-2ZC Byatem or disclairy -location-of any' E,.ed _ie:r�t_10 es on i CXty-10 I from 3, location of uster V (m) location of benchr, driveva� garbage disposals Wn &- I- �A consti,,-.'%,!on no _11(q) profile of - syster, E -,ation o 'L basem--qt., PluL',.; PI v,, 4 ts ane oatlets distribu'!�,- CIS U %J" OtLer elevations va' elzoo- maximum groimd ele, 1111vn in area se -wage - plan mast be prepa-, I by a rrol(essional Engine 7 or professional authe-. *��&d by I r,�T to prepare sep��Tan��s S p - - -- -1 S )i c cities -150% 0� c?.;., v::- table., tee dc -,(a) cap accerS3 P11 --ping (b) cleanout (c) 101 from cellar or i�, �g POO". 25t from subsurfal�-,- a -n L' Distribution BoxeF , 08 slope greater thar W;xv SubstArface Reg 11. 2 u.4 11.10 11.11 Reg 15.1 15.4 15.8 3.7 leg lh.1 3-4.3 14.4 3-4.6 14.7 1h.10 FAIL Check List Page 2 1 1 C� I . LeachingPits Leaching pits are preferred where the installation is possible a) calculations of I g area-rdnirmin 500 eq ft b) spacing c disurface e 2% cover al ,e) I'x2' splash pad If) te at elbow m,g) bends in pipe from d -box to pipe Leaching Fields a) no grciater than 20,=Lnxites/inch b� area-rzinimm 900,--dq ft 0 cons truc,4on--of field d) surfac* dzainage 2 % le) 2051--,�m cellar v -a.0 or inground swimming pool Leachin� Trenches calculations of Teaching area-nin 5bO eq ft spacing -4 ft nin 6 ft with reserve betimen c) dirter-Aona d) cons tra c tion e stone ) f) f) surface drainage.2% ----Wii-Mhi3-1 Slop'e*-- -slope- be shlown)-�L� 61�YyA-X 150-= (to�be Shown)— ro �-id-b i4tand-by P.Over PQ a lu (14A r,oarif of Health ,qorth AndoversMass APPROVED DATE Providedi Title V I FAIL I CK Reg 2.5 Reg 6 Reg 10. 2 Reg 10 .4 SUBSURFACE DISPOSAL DESIGN CHECK LIST LOT #/ DISAPPROM DATE Reasons: The submitted plan must show as a "AMIMim: a) the lot to be served-area.,dimensions lot # abutters b) location and log deep observation Meo-die'tance to ties c) location and results percolation tests -distance to ties design calculations & calculations showing required leaching area location and dimensions of system -including reserve area existing and proposed contours location any wet areas within 1001 of sewage disposal system or disclaimer -check wetlands mapping h) smrface and subsurface drains within 1001 of sewage disposal , system or disclaimer i) location any drainage easements within U)01 of sewage disposal / system or disclaimer -Planning Board files J) known sources of water supply within 2001 of sewage disposal ,,, system or disclaimer location of amr proposed well to serve lot -1001 from leaching facility location of water lines on property -10, from leaching facility in) location of benchmark driveways b garbage disposals P, no PVC to be used In construction q) profile of system-elevationB of basement.. plumb., pipe., septic tank., distribution box inlets and outlets., distribution field piping and other elevations ,r) maximum ground water elevation in area sewage disposal system s) plan mast be prepared by a Professional Engineer or other professional authorized by lav to prepare such plans 1-0 Septic Tanks a) caPacities-150$ of flow., water table,, tees,, depth of tees., access., pupping cleanout 101 from ce3lq vall or inground. swimming pool d) 251 from subsurface drains Distribution Boxes a) slope greater than 0.08 b) suM absurfa e Desiga Check List Pan 2 FAIL Leaching -Pits Leaching pits are preferred where the installati is possible Reg 3.1.2 3-1.4 11.10 11.3-1 Reg 15.1 15.4 15.8 3.7 a) calculations f leaching area-mdnimm 500 eq ft, culations f Ing b) spac r 4 f .0 mwface e 2% d) cover terial 1 sh e) 2'x2 splash pad f) te a elbow �ow g) no bends in pipe from d -box to pipe Leaching FIeMs a) no greaterA 20 minutes/inch b area M 900 aq ft 0 cons on of field s"f e drainage 2 % 01 FIM e) 2 m collar vall or inground m4mmJng pool LeachinR Trenches Reg 14.1 a) calculations of leaching area -min 500 Bq ft 14.3 ) spacing -4 ft min 6 ft with reserve between 14.4 0 dimensions 14.6 construction 14.7 stone 3.4.:Lo Elf surface drainage 2% Dou3hill S122e �a) 71ope y/x (to be shown) V,'b) ylx X 150 : (to be shown) s Reg 9.1 a) 9.6 r___ W *d!� power SOIL PROFILE & PERCOLATION TEST DATA zal'I"I'g.? North Andover, Mass. Street No < � �i e Lot No_2ZZq Loc/Subdiv. Pland Owner Investigator Observer�_ SOIL PROFILE DATES— l.'Faev 2.Elev 3.Elev 4.Elev 0 0 po 0 1 A 1 �Dt!1iULU11ZL.L*A Elevation At� 2 1 3 9 10 DATES ,I 4 5 5 7 3 Location Datum PERCO�ATION TESTS 2 3 4 5 6 7 8 9 10 Ties A Test Plas Pit Number 1 2 3 4 Start Saturation Soak -Minutes Start TesV--TTMe Drop of 311 -Time Drop of 61' -Time Mms.lst 311 drop Mins.2nd 3" Drop Percolation T Benchmark Elevation 5 6 7 8' 9 10 5 6 7 M 5 6 7 8 9 9 I SA jry (3 A 10 10 1 Z -A, 1 ('13 Location 5 Datum 11 Percolation Tests -Date Pit- Number SOIL PROFILE & PERCOLATIOX TEST DATA 4 5 Start Saturation 01 M^ 994-raxn.4- I Cue, I i4 Tx1f Nn. North An - _W_ Loc./Subdiv.- CI _S 0 Plan Owner,::� Drop of 3" -Time to If 09 -'U Investi-gator. _LA Observer Y2k Mjins.lst 3"Drop \C1 S011, PROFILES -DATE Elev. 2. Elev. 3. Elev. -!--Elev. Percolation Rate 0 0 0 Ties to Test Pits 2 2 2 2 3 3 3 3 4 4 4 4 Benchmark Elevation 5 6 7 8' 9 10 5 6 7 M 5 6 7 8 9 9 I SA jry (3 A 10 10 1 Z -A, 1 ('13 Location 5 Datum 11 Percolation Tests -Date Pit- Number 1,d 2 3 4 5 Start Saturation 01 Soak -Mins. Start Test -Time CI _S 0 Drop of 3" -Time to If 09 Drop of 6" -Time Mjins.lst 3"Drop \C1 Mins.2nd 3"Drop Percolation Rate Notax & Sketches an Back TO: NORTH ANDOVER, MASS. BOARD OF HEALTH July 23 1984 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 Lot 12A Paddock Lane, North AndQver Site Location North Andover, Mass. The grades and construction materials are as specified in my plans and specifications datedMarch 27 1 19 84 and As -Built July 23 1 19 84. X7 -.1) Reg.Prof 1. WILLIAM PLACE CIVIL 00 No. 31012 ST ONAL .Sanitarian L07 1�10MAL E L- E \/A -r 5. As OF:7 HSE V E- LtqLT I.N V. V i P E 0 P, e> 0 Y, 0_20 at - - ------------- 1� kkt7voi LOT I Z A T --/4W .6a&-2a&k tA CD -P, a cl- 19 E-) u I I -T L) Eb u �z D 5A SY5T Er -1 0 QTH W L!s T E- (S I t -j E- E e- S j!!- c t -r E C- -r !L-> �,J c) V7- T 1-4 A �-j r -I C) C 0 P �: I C E- P,61. V-1 $I, - KI 0--T k4 F,> 0- 4 LOT \ I -B A/ - PLACF rlv,%� N U. 3 1 o L) E LS ",VA -r o pj 5. A )NY, rjpc- OUT OF7 Hse. /R7 WV INT!2 i INv ViPe OQT P E5oX..—, 118e - QX V C-tljr�' 40C- PIPE zr 60 zo 160 LOT ( 2 A T- - 4ro�� P, a / -'I A 9 . "Zo U &Z PAC, -F- D 5 P'0 L- �SY5T EM o fzTH A -r A Fl>.4,-r ff ') -.:T-u 4. c> A 5 -S 0 c I &. -V ��- �:-> T G I KI E- E 0- S c �-4 1 -r E C- -r �s P L W F- 0- t4 -r �-4 A �-J C7 0 ',� G- C 0 P �: I C E- F'.-tS� 0- k—' A �-j C7, C> \/ C-- 0- x", DATE: SYS WNER ADDRESS SYSTEM LOCATION jr% QUANTITY PUMPED k1r2Fd GAL ONS. CESSPOOL: NO YES SEPTIC TANK: NO _ YES y NATURE OF SERVICE: ROUTINE. jv EMERGENCY (example: left front of house) ;.49 RVATIONS:" ,,ASE, GOOD CONDITION* FULL TO COVER HEAVY GREASE f ?cJj loot ROOTS LEACHFIELD RUNBACK NO FLOODED SOLIDS cARRyOVER. OTHER (EXPLAIN) jr% QUANTITY PUMPED k1r2Fd GAL ONS. CESSPOOL: NO YES SEPTIC TANK: NO _ YES y NATURE OF SERVICE: ROUTINE. jv EMERGENCY ;.49 RVATIONS:" ,,ASE, GOOD CONDITION* FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS cARRyOVER. OTHER (EXPLAIN) 0/f Z41 L Jj 4v '6MMENTS: IT 1 :7 �T -N '�j,,'��..''�,,�!tCONTENTSTRANSFE D TO: 7�noe- C�J "a* k" 7,�, 111% Jh AM - Br " 0- AEAL. TOWN OF NORTH ANDOVER 4 2oT SYSTEM PUMPING RECOR-D L OWNER & ADDRESS SYSTEM LOCATION 4 � 5—/— lcr(�ron(of houst) "? c? /,Oro L) \,I*c OF PUMPINC: )01 OZ QUANTITY PUMPED 0,1 L �),) J'U 0 L: N 0 --LZY E S SEPTICTANK: NO YES URE OF SERVICE: ROUTINE "'--<E R C E N C Y A - E I r R Y:\Tl ONS: COOD CONDITION HFAVY CREASE ROOTS EXCESS] VE SOLIDS SOLIDS CARRYOVER -�.) )I LM PUMPED By� , i �) '\,,] FN T S � U ^\') E'N 1'� T) � A N S F C I Z I � LD TO: L---��ULL TO COY [:� BAFFLLS IN I)L,ACI" LEACHFIELD RLNIBACK...- FLOODED O�jHFR(EXPLAJN) Tow I OF I ANDOVER SYST EM INCT RECORD ,-. - .. 1,4 f tLovkv DATE V� IV, SYSTEM OWNER & ADDRESS JSV.�figl—m LOCATION A-3190 x- j- /L--.,. '42 DATE OF PUMPING_5 QUANTITY PU.MPF-j-) CESSPOOL NO— YES-- SEPTIC TANK NO,--- YES- VI"- NATIJIRE OF SERVICE: R6UFINE_-/—. EMERGENCY__ OBSERVATIONS: GOOD CONDITION / RJLL TO COVER HEAVY GREASE BAFFLES IN LACE ROOTS LEACHFIELD RUNBAcK EXCESSIVE SOLIDS FLOODED SOLID CAFRyov.,zk---- 0T -HE -R EXPLAIN SYSTEM PUMPED BY _411ld 11N. Aw COMNIENTS. CONTENTS TRANSFERRED TO TOWN OF SYSTEM DATE: I I - I � -0.4 SYSTEM OWNER & ADDRESS ao C G RECO SYSTEM LOCATION (example: left front of house) R: = C E'V tr-- I -D NOV 19 2004 TOWN OF NOR-rH ANPOVER HEALTH DEPARTMENT ri�+- �,+ ; 6 m -c - DATE OF PUMPING: 1 1,(t - 0 4 QUANTITY PUMPED: GALLONS CESSPOOL: NO YES NO YES ,SEPTIC TANK. NATURE OF SERVICE: ROUTINE J EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER FULL TO COVER BAFFLES IN PLACE LEACMULD RUNBACK FLOODED OTHER (EXPLAIN) SYSTEM PuwED BY: Bateson Enterprises, Inc. COAMENTS: coNwws TRANmmm To: G.L.S.1) V Lowell Waste L Qon: Q I Clry/7r, 117 - nor, 8"s sv� e --;W . Vflt4J Ul 90.11fril IIQ(n lQwUQn) T 9t oyll m: p 0 0 P(!c Ter),, Tan, CD ---------- -M�Qn( Too' Fil Y05 Q Y05. i: — - - - — - - - - - — — — Qn. w - ------------- .: -�—A ' ;k'-) :41�'N M rA I' ip, or Important Men filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. . aw Commonwealth of Massachusetts City/Town of NORTH ANDOVER, MASSACHUSETTS System Pumping Record Form 4 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 authority. A. Facility Information 1. System Location: Address Cityf roWn- 2. System Owner Address (if different from location) CityfTown r - State State Telephone Number Zip Code Zip Code B. Pumping Record 1. Date of Pumping Wk- k f 0 2. Quantity Pumped: 16-C-0 Date Gallons 3. Type of system: Cesspool(s) _12 -septic Tank El Tight Tank El Other (describe): 4. Effluent Tee Filter present? F] Yes El No 5. Condition of System: If yes, was it cleaned? F1 Yes [] No 6. System Pumped By: + L -F-1CAefa.qE— ,N4me Vehicle License Number -Q�- knrt� S r,--D4— Company 7. Aocatio"here contents were disposed: OC) ��' C1 An r)'� I I I Signature of Hauler http:/twww.mass.gov/depANater/approvalstt5forms.htrn#inspect t5form4.doc- 06/03 0 A Date System Pumping Record - Page 1 of 1 Commonwealth of Massachusetts C I ity/Town of North Andover System Pumping Record Form 4 I � E'�L J, 5 2 0 13 T0711-"07 NORTH k'-0'rmR HEALTH Impf.;�—" L 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 CIVIR 15.351, A. Facility Information Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. J0____h 2 vt�=A System Location: Address North Andover Ma City/Town State System Owner: Name Address (if different from location) 01845 Zip Code City/Town State Zip Code Telephone Number B. Pumping Record 1 . Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: F1 Cesspool(s) A Septic Tank El Tight Tank El Grease Trap F-1 Other (describe): 4. Effluent Tee Filter present? 0 Yes No If yes, was it cleaned? El Yes [:1 No 5. Condition of System: q0ed, 6. System Pum ped By: 'Finny-, �DderQce Name Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: St�w��-treatment Plant, 20 So. Mill Bradford, Ma 01835 Signature of Haule =7- 4 . Date 7__;i�f7777 Signature of ReAivi�g Facility - - // Date t5form4.doc- 03/06 System Pumping Record - Page 1 of 1