HomeMy WebLinkAboutMiscellaneous - 299 DALE STREET 4/30/2018gm
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BOARD OF HEALTH
1600 Osgood Street, Suite 2035
North Andover, MA 01845
978-688-9540
,4PPLIC,4 TION FOR,0,4NDONMENT
OF SUBSURF,4 CE DISPOS,4L SYSTEM
(SEPTIC SYSTEM)
Pursuant to Section 310 CMR 15.354
Of the State Environmental Code, Title V
Name K h, L hit� t (,L Phone qA:Z6)- A63
Address
Contractor hiredfor work:
Name Phone fva () - LO q 7
0�',Avte&-) -w-) 0181-+
Address
Date for scheduled abandonment
Se ptic system at the d =oess has been abandoned
Signature of Contractor
Method of septic tank abandonment (check one). ( ) removal
Name of Offal Hauler
to Tftle V specifications.
crush other
issandfill (/
Thisform must be returned to the North Andover Board of Health.
rLEANE JJU INU I WKIJ E UNTHE SFAUE BELOW
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-SANITARIAN
-A. No. 708
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TOWN OF NORTH AN -DOVER
S STEM PUMPING RECORD
DATE: C14-21
Q V Q -P P A A -;�� � � , -- - ,
-1 " ` ADDRESS
17
C�? 9�7
e��
/V I
SYSTENf-L-0-C-A-TI-ON
(example: left frOut Of house)
DATE OF PUMPING:..L,�-2-�,-o QUANTITY PUMpED��d GALLONS
CESSPOOL: NO SEPTIC TANK: NO � YES C'�
'NATURE OF SERVICE: ROUTINE
EMERGENCY
OBSERVATIONS:
GOOD CONDITION
HEAVY GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
-SN"STEM PUMPED BY:
-'O-NIMENTS:
().'N'TENTS TRANSFERRED TO:
FULL TO COVER
BAFFLES IN PLACE
LEACHFIELD RUNBACK
FLOODED -----
OTHER (EXPLAIN)
d or- N r,
il OAFM OF
-----------
JUN -21-99 MON 02:43 342N3.c-M784243.c- 508 -t -688-o..3348 P.02
Paul D. McCarthy
299 Dale Street
North Andover MA, 01845
June 21, 1999
Dear Sirs:
This letter is to request that I be allowed a board
review of the proposed variance for a septic system repair
(leach field) at 299 Dale Street, North Andover at the
upcoming Board of Health meeting on June 24, 1999.
Please relate all correspondence to Paul McCarthy
1060 Osgood Street, North Andover, MA. 01845 or, call at
1-978-975-4190
ly Your
Atty Paul D. McCarthy
Ju.- --I
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RESSA -p lvxbtJAZ OCONPIA�AZO ONS. SS.10,V
NO "IG IS 'r, D_pp;2,.t IN PrZASE
A.L T"tS
rn "-tl-"r.ED . tVOT X AND OIVPACSt CA'Lr- (9 7,q)
IS !,A 7. HtLe
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STAL S IV XAl',G Op
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Lot&Street Map/Parcel
CONSTRUCTION APPROVAL
Has plan review fee been paid: ED NO Permit#
Plan Approval: Date: 71161qZ Approved by:
Designer: 7,0-M /1()e_),ePh( Plan Date:- ZZ -Z z /q
Conditions:
Water Suppl-y- welt
Well Permit: -Driller:
Well Tests: Chemical Date Approved
Bacteria I "-Date-Approved
Bacteria H Date -Approved
Plumbing. Sign -Off: -Wiring Sign -Off:
Comments:
Form "U' Approval: pproval to- Issue: YES
NO
Date Issued By:
Conditions:
Final Approval:
All P ermits 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:
SEPTIC SYSTEM INSTALLATION
I - "- 4 .
Is the installer licensed?
NO
Type of Construction:
NEW
-�P AIR
New Construction- - Certified Plot Plan Review
YE S
N 0
--Floor Plan Review
YE S
IN 0
Conditions of Approval from Form U
Y -E S
NO
–Issuance of DWC permit:
NO
-DWC Permit Paid?
NO
---DWC,Permit Installer:-'��
Begin. Inspection:-
NO
Excavation Inspection:
'Needed: Com alek&-1 . Y, -e- (n g Li r- r e- rn ra n 4:5L4o
o do
S 15 0 L4 // 0 9 a-
4
Passed: 15 h2 By:_
-Construction Inspection:
Needed:
As -quilt -Plan Sat isfactory:
M-OAMA
Approval of Backfill: Date: 911(3 B y: 0
---Final Grading Approval: Da te: By:
V
Final Construction Approval: Date:
Certificate of Compliance: Approval:
By:.
— :0�. �.
Date:
TOWN OF NORTH ANDOVER
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
DATE OF COMPLIANCE:
09/16/99
This is to certify that
the individual subsurface disposal system
constructed ( ) or repaired (X )
by
William Hall
at
299 Dale Street
has been installed in accordance with the provisions of Title V of the State Sanitary Code
and with the North Andover Board of Health regulations as described in the Design
Approval Site System Permit # 1080 dated 7/12/99.
The Issuance of this certificate shall not be construed as a guarantee that the system will
ftinction satisfactorily.
Board of Health Inspector
TOWN OF NORTH ANDOVER
SEWAGE DISPOSAL SYSTEM
INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System (
by 0.)k
located at
bk1"-r_ -f.
) constructed; P4 repaired;
was installed in conformance with the North Andover Board of Health approved plan, System
Design Permit # dated with an approved design flow of
gallons erday.
-plan; e system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and
local regulations, and the final grading agrees substantially with the approved plan. All work is
accurately represented on the As -built which has been submitted to the Board of Health.
Installer:
Design E
Date:
Date:
ote: This certifi ation pertains only to those componen o the
disposal system which were replaced and not to the pre-existing
components or any other pre-existing subsurface drains, pipes,
lines, etc. which may or may not exist.
17 rOMITHMMOVER/
I'Mi''M 01: 1 1 -TH
Lz�OARD OF HEAL
2
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75
A,4,j 9 - 3 0-99 05:12P Paul D. Tut -bide, PE/PLS
PoiFT
INGINIFOING
August 30, 1999
Sandra Starr
North Andover Board of Health Administrator
Office of Community Development and Services
30 School St.
North Andover, MA 01845
508-465-0313 P.02
RE: Title V second review for 299 Date Street (pump mercury switches)
Dear Sandra,
The original approved design plans for the above-mentioned project dated June 1, 1999
called for three mercury switches to control the pumping of effluent ' One was for
64. pump off', another was for "pump on" and the third was for "alarm". As shown on the
two sheets of the manufacturer specifications (The Specs) that you faxed me, the
proposed revision to the plans is to replace two of the switches (the pump on and the
pump off switches) with one "Super Single(D" pump switch. My concerns about this
revision are as follows:
I - The design plans call for a "pumping range" (depth of effluent between the pump -
on and pump -off elevations) of 20 inches. Figure "A" of the Specs shows a
maximum pumping range of 13.5 inches. Therefore it is unknown whether this
switch will work for a pumping range of 20 inches.
1 The design plans call for a depth of effluent of 9 inches between the bottom of the
pump chamber and the "pump off' switch. Effluent pumps cannot pump right to the
bottom of the tank, but instead need a certain depth of effluent to feed the pump
impellers. If the depth between the bottom of tank and the "pump -off switch is too
small, then the pump will not shut off and will run until it bums itself out. Looking
at the Specs, it is not apparent to me how to place the Super SingleC switch so that
the 9 inch spacing between the pump bottom and "pump -off' switch is guaranteed,
If the spacing is less than 9 inches, the pump may not shut off If the spacing is
more than 9 inches, there may not be the required emergency storage of 440 gallons.
3. If the Super SingleC switch is used, there will still be need of a second switch as an
alarm- There is no mention in the Specs of how to use two switches, or how to add
an alarm switch. One possible concern is whether a second switch would hinder or
get in the way of the Super SingleC switch, which seems to need a substantial area
to swing on its tether.
v'r
4. The design plans must be revised to reflect any change to the switches. These
revised plans must be stamped and endorsed by the design engineer.
If you have any questions or comments please feel free to contact me.
Civil Engineers &
Land Surveyors Sincerely
One Harris Street 4��4
Newburyport, MA Carlton A. Brown, PE/PLS
0195U
(978) 465-14594 Dale299b.doc
Aug -30-99 05:12P Paul D. Tur�bide, PE/PLS 508-465-0313 P-01
Facsimile Cover Sheet
To: SANDRA STARR
Company: NORTH ANDOVER BOH
Phone: 978-688-9540
Fax: 978-688-9642
From: Carlton A. Brown
Company: Port Engineering Associates, Inc.
Phone: (978) 465-8594
Fax: (978) 465-0313
Date August 30,1999
Pages Including This
Cover Page: 2
Comments:
Enclosed is the report for the second reviews of 299 Dale (mercury switch review)
Thanks,
Carlton
AUG -27-99 FRI 00:57 342N3< -M784243<-
508-0-6884-3348 P. 01
Law Offices of
McCarthy and Molloy
1060 Oigood Street
North Andover, MA, 01845
(978) 975-4190
FAX: 688-3348
Pager(978) 209-6905
FACSIMILE ME'MORANDUM
DATE: TIME:
---------------
TO ICU FAX. -
FROM:
NUMBER OF PACES:INCLUDING THIS DOCUMENT:
COMMENTS: 4 IN V)
S
1�
Kim
&ALI xvu bELIEVE
PROBLEM, YOU ARE ENCOUNTERING A TRANSMISSION
975-4190. OR IF YOU HAVE ANY QUESTIONS, PLEASE CALL(978)
THE INFORMATION CONTAINED
PRIVILEGED AND CONFIDE IN THIS FACSIMILE MESSAGE IS
THE INDIVIDUAL OR ENTI NTIAL AND ONLY INTENDED FOR THE US" OF
MESSAGE TY NAMED ABOVE. IF THE READER OF THIS
NOTIFIED IS NOT THE INTENDED RECIPIENT
THAT ANY DISSEMINATION, YOU ARE HEREBY
DISTRiBUTION OR COPYING OF
THIS COMMUNICATION IS STRICTLY PROHIBITED. IF YOU HAVE
RECEIVED THIS COMMUNICATION IN ERROR,PLEASE NOTIFY US By
TELEPHONE AND RETURN THE ORIGINAL MESSAGE TO US AT THE ABOVE
ADDRESS VIA THE U.S. POSTAL SERVICE. THANK YOU.
LOCATIONS OF DEEP HOLES & PERC
TESTS
ELEVATIONS OF DISPOSA-L SYSTEM
TOP OF FDN ELEVATION
LOCATIONS OF WELLS, DRAINS, WATERCOURSES
W/IN 150'OF SYSTEM
LOCATION OF WATER,"GAS, ELECTRIC LINES, CABLE
DISTANCES FROM CORNERS OF HOUSE TO CENTER OF
TANK & D -BOX
AS -BUILT CHECKLIST
STAND & SIGNATURE
LOT NUMBER, STR.EET NAME
13VIPERVIOUS, AREAS -'DRIVEWAYS, ETC.
ASSESSORS MAP & PARCEL NUMBER
LOT LINES & LOCATION
vz'
OF DWELLINGS
FINAL CONTOURS
LOCATION & DETVMNSIONS OF SYSTENI,
INCLUDING RESERVE
vx
TIES TO LOT LINES & DWELLING, WELLS
a. FROM SEPTIC TANK
b. FROM LEACH AREA
LOCATIONS OF DEEP HOLES & PERC
TESTS
ELEVATIONS OF DISPOSA-L SYSTEM
TOP OF FDN ELEVATION
LOCATIONS OF WELLS, DRAINS, WATERCOURSES
W/IN 150'OF SYSTEM
LOCATION OF WATER,"GAS, ELECTRIC LINES, CABLE
DISTANCES FROM CORNERS OF HOUSE TO CENTER OF
TANK & D -BOX
LOCATION & ELEVATION OF BENCHMARK USED
LOCUSPLAN
STAND & SIGNATURE
13VIPERVIOUS, AREAS -'DRIVEWAYS, ETC.
NORTH ARROW
vz'
FINAL CONTOURS
LOCATION & ELEVATION OF BENCHMARK USED
LOCUSPLAN
AUG -27-99 FRI 00:58 342N3< -M784243< -
FROM : POLI
508-o-698-4-3349
Post -it" brand fax transmittal memo 7671
#of pages o -
C1.4 /9 //
5,T
C
PFTo
Co.
Dept.
Phone #
#
76 Aj
F1HU1,4tz—r,iu.— -;-- — - - -- — __
P. 02
27 1555 12*,37PM P1
MercuFV-aCt1vated,, wide-angle switch designed to
contirol pumps uP to I HP at 120 VAC and 2 HP at 230 VAC.
This mel"GurY-aCtivated. wide-angle PVMD Switch 0(ovidas OutOmatic control
Of pump3 in non�potable water and sewage applications.
This switch is not sensitive to rotation or turbulence. For certain pump
applications, one Super Singles May be wired in place of two control
switches to operate a relay control panel.
The Super SingleG pump switch i8; suitable for us@ with Intrinsically sate
circuits. Contact SJE-Fthombus regarding specific intrinsically safe
applications.
a -s -01Y U'ves Positive Pump on or
pump off
Controls pumps up to I Hp at 120 VAC and
2 HP a? 230 VAC
N Adjust8ible Pumping range of 6.6 to 13.5 inches
(17 to 34 CM)
9 IftludeS standard motintiriq strap and boxed packaging
ff UL Listed for use in non�l>Otable water and sewage
6 OSA Certified
Two-year limited warranty
ftOp DOWO / ON pftillon
COMM
dand I
9
LISTED
nN7
(EDO
1,P25W,145
"MP bm-n / OFF poshlen
This Switch is available:
&I for pump down or pump up applications
with a 120 VAC, or 23o VAC Piggy -back plug
contacts
inm
ff Without a plug for direct wiring in 120 VAO or 230 VAC applications
In -standard Cable length$ of 10. 15, 20, Or 30 feet and 1. 2, 3, 5, 6, or
10 meters (longer lengths available)
U.S. ftielA ft. 4.W2,4641
5PECIFICATIONS
Cable: flexibIF14 gaug;F-9 066ductor (UL,
CSA) SJOW, water-resistant (CPE)
NOW; 3.38 Inah diameter x 426 Inch long
(B-58 X 10-60 cm) high Impact, corrosl6n
resistant, PVC housing for use In sewage
and nQn-pctEtbIq water up to 140OF
(600C)
Mercury Switch: mercury -to -mercury
Contacts, hermetically sealed in a steel
oapsvle
Electrical-
1zQ3UW-J%M0 huftig- —phase:
Maximum Pump Running —curreht:
16 amps
Maximum Pump Starting Current.
55 amps
Recommended Pump Hp -
1 HP or less
2" �Q��n �ph
Maximum Pump Running Current:
15 arnpq
Maximum Pump Starting Current:
as amps
Recommended Pump 14P:
2 HP or less
Note: This switch must be used with
Pumps that provide integral therma)
overload proteotion.
AUG -27-99 FRI 00:59 342N3< -M784243-,1
F"_ POL I CY PHONE NO. :
Super Singl-, pump swilch
SCOMect Powerb,016re instalOngor.siervicing _7 �t
Product. A quAtified %(.vice person MinVipstall..,4
service this product accbrdlrg 10 applk-atlo 6lec*tr;CaI, 'A
a6dplumbing codes.
Falturitofol(OW[hesepreceLoNonscout�resuhins6riput�j��
"vared;& K6eP these InStmcfonswlth warranty Gtftqmh�*00i 4TI,
Codo,ANtYNEP_A.705Gas t0PrGYGM1 moisture fr enteAn'
MOUNTIN6 THIE S I � H
W YC'
I. Determine pumping range for
instailation (see Figures A and C).
Do not tether less than 3.5 inches
(9 cm) from pire,
2. Tighten strap around discharge
Pipe keeping switch cable between
strap and Pipe to Prevent Stiopage.
3. Space small ties at least i inch
(2,15 0M) apart (see Figure B). To
re-adju,st ties, press small tie tat)s
down.
4. To look (eleasable tab. run
remaining strao between
tab and head. Tuck Strap back
through head (see Figure 8).
H"re A
Determining Pumping Range
In Inches (I Inch = 2.5 cm)
her
9
13:13
F eth" — �
pumping 10i 2.5!t "
tl�!
ranp _.:C
use "as a quIde, Pumping range& are 0!jSgd
0A testing in non-lurbtilenl cond4ions. Range
May MY due to �VaMr temPorature ar4 cofd
shape. L�M: A: the tether l&tgth;,)Cr0aScG, A
'do" the vaftnO OF tht Pumping r4nge. .0
Figote n
secure 3,5 Inch (9 cm)
ftblo M1111murn
under
strop
strap
head
feleasabla!lab (2.6 P,�) eparz
In.g. Inaw, PR lcoiil4oir
08t. P299 PN 1006 1828
P* 03
Aug. 27 1999 12:38PM P2
Installation instruction
.-S
KAZ&RQ%
�M!q`thl$ Pfildu�t with flarneriable 1101dS, W not
i6siall In hazaMous Wations ag defin
adbyNationai
F-lectrIMI C66, ANSI/NFPA 70.
SiDgliPeproduotk""telyl(swildlItablODOMMer,diunabodoe'
Must bb fttaged in accordance with NaWrial EIqCtft
i2ot4i,lhinhnva.corvduitbocfles.fidin , ftat housing, ore&bl,. X
PIGGY -HACK Pititi INSTA L
L
Iff Elecuiew outlet mIjst not be
100aled in Pump charnber.
X Electrical outlet voltage, piggy-
back plug voltage, af)d pump
Voltage must maToh.
I - Follow Step$ I through 4 of
'Mounting The Switoll.t, 1
2. Insert switch's piggy -back plug
into outlet.
3. Plug Pump Into Piggy -back plug
(:see Figure 0).
4. Check ifigiallation. Allow systtrn
to cycle to insure proper
operation.
Figure c
M 111M M
1 - FOliOw steps I through 4 of Wount.
Ing The Switch."
2- Wire switch G -S shown below.
3. Check installation. Allow system to
cycle to insure proper operation.
junction
box 12OVr
p,,er
90ur
our
bj c
WIN to connector
z ri 126%A
PUM
junction _1
box 40V]
p6we
Ick
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life
w Ite can#
ri. I f
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SJ rLLIECTRO sysrems, INC.
P-0- Box 1708 ff County Rd 0 0 Detroit Lakes, Minnesota JS65o2 USA
11-88"11AL-SiE(342-S753�X Phone, 218-847-1317 0 Fax:
In 230 VAC PIAMP We sift
of 416 lh% going to the pump Is 4IW3YS
h0.X, This condition exJsts If ftswnth is
on o f off. install double Pde Wetonnect
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NUMBER FEE
THE COMMONWEALTH OF MASSACHUSETTS
of
Board of Health
This is to Certify that
NAME
ADDRESS
IS HEREBY GRANTED A "DISPOSAL WORKS INSTALLER -S PERMIT-- TO
CONSTRUCT, ALTER, INSTALL or REPAIR,
Individual Sewage Disposal Systems
This permit is granted in conformity with the State Environmental Code Title V, Regulation
2.2, and expires December 31, 19 - unless sooner supsended or revoked.
19
Copy Board
This Copy To Be Retained By Local of
Board of Health Health
FORM1256 (:�ii) HOBBS & WARREN TM
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DIV\�.j Q Fo f:,!- J.
PAUL MURPHY
I DA -T -e: 17 SANITARIAN
w N.. 700,0
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For
A.M.
Dat
-Time P.m.
WHILE YOU WERE OUT
LIZ
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Of
13 Phone
13 F
C3 Mobile
Area Code Number Extension
TELEPHONED
PLEASE CALL
CAME TO SEE YOU
WILL CALL AGAIN
WANTS TO SEE YOU
URGENT
RETURNED YOUR CALL
SPECIAL ATTENTION
Message
Signed
APPLICATION FOR DISPOSAL WORKS CONSTRUCTION
DATE: CURRENT INSTALLER'S LICENSE#_/q�� - 9
LOCATION:
LICENSED INSTALLER:
SIGNATURE: TELEPHONE#
CHECK ONE:
REPAIR: V_
NEW CONSTRUCTION:
IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT.
$75.00 Fee Attached?
Foundation As -Built?
Administrative Use Only
Yes I/ No
Yes No
Floor Plans? Yes No
Approval Date:
E JUL 2 0
L 20
V&ORTN
o
CHUS
Applicant
Site Location—
Town of North Andover, Massachusetts Form No. 2
BOARD OF HEALTH
DESIGN APPROVAL FOR
SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
Reference Plans and S
M
C
Test No. gc/)—//
70 12
Permission is granted for an individual soil absorption sewage disposal system to be installed
in accordance with regulations of Board of Health.
Fee- IaY�-- -
CHAIRMAN, BOARD OF HEALTH
Site System Permit No.
_9� /� wz�_
LE40mii:R ES TECHNICAL SPECIFICATiONS
PUMP
The pump(s) shall be model
as manufactured by Liberty Pumps, Bergen, NY,
orequal.
The pump(s) shall have a capacity of — GPM at
a total dynamic head of — feet. Motor size shall
be 4/10 horsepower, single phase, 60 hz. and 115
volt operation.
MOTOR
The pump motor shall be of the submersible
type, oil filled, hermetically sealed and shall be
thermally protected. The overload element shall
automatically reset when mptor cools.
Motor windings shall be of the class B insulation
rating. The rotor shaft shall be made of 416 stain-
less steel and shall be supported by lower bronze
and upper sleeve bearings. ,
The power cord shall be of the quick -disconnect
design allowing replacement of the cord without
breaking seals to the motor and/or oil chamber.
IMPELLER
The pump shall have a VORTEX style
impeller capable of passing a minimum
2" spherical solid.
SEAL
The shaft seal shall be of the carbon/ceramic
unitized design, with BUNA N elastomers and
stainless housings.
EXTERML CONSTRUCTION
The pump volute, legs and motor housing
shall be heavy gray iron castings, class 25 or
better. All castings shall be enamel coated before
assembly. All fasteners shall be of 300 -series
stainless steel or brass.
LEVEL CONTROL
The pump shall be controlled by an adjustable,
mercury -free, wide angle float switch. Float cord
shall be equipped with a series plug for manual
by-pass operation.
MODELS HP VOLTS PHASE AMPS DISCHARGE AUTOMATIC IMPELLER
LE41 M 4/10 115 1 13 2" FNPT NO VORTEX
LE41 A 4/10 115 1 13 2" FNPT YES VORTEX
10' cord standard on above models.
For 20' option, add a "-2" suffix to model number. Example: LE41A-2
DIMENSIONAL DATA:
Weight: LE41 M: 39 LBS.
Height: 13.25"
Major Width: 10.75" (manual models)
Maximum fluid temperature 1140 degrees F.
-IV 'P, f
(,1 - L' _9Z) 6 -A& q - S;
�nMd
co-Certifled
City of LA certification available
PERFORMANCE CURVE
1 24 , I I
20
16
Z
4
12
a !� '
21 9
0
1550 RPM
0 10 20 30 40 50 60 70 80
U.S. Gallons Per Minute
0 1.4 2.8 4.2 5.6
Liters Per Second
Liberty Pumps * 7307 Lake Rd * Bergen, New Yor* 14416 9 Phone (716) 494-1817 Fax (716) 494-1839 7291-2)93
Town of North Andover
OFFICE OF
COMMUNITY DEVELOPMENT AND SERVICES
27 Charles Street
North Andover, Massachusetts 0 1845
WILLIAM J. SCOTT
Director
(978) 688-9531
July 19, 1999
Thomas Murphy
37 Washington Avenue
Andover, MA 0 18 10
Re: 299 Dale Street
No. Andover, MA 0 1845
Dear Mr. Murphy:
This is to inform you that the proposed septic system repair plans for the site referenced
above have been approved. �
If you have any questions, please do not hesitate to call the Board of Health Office at
978-688-9540.
Sincerely,
- , �v 14q�
Sandra Starr, R.S.
Health Administrator
SS/Smc
cc: Paul McCarthy
File
BOARD OF APPEALS 688-9541
AL
Fax (978) 688-9542
BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
Me o
Trans i'ttal
TO: Sandy Starr
Front Tom Murphy
Paul McCarthy
Date: 07/12/99
Re: Upgrade Plan for #299 Dale Street
ErwJosed are plam revIsW as foRows:
0 6" stone base added beneath septic tank and d -box
0 Map and lot numbers added
0 Names and parcel numbers of abutters added
0 Locus map added
0 Water line shown
• Wetland disclaimer no longer missing
• Alarm for pump specified to be on separate electdcal circuit from pump power and to be located
inside the building
Feel free to call if you have any questions or comments.
0 Page I
FA 1 1519 99
Town of North Andover
OFFICE OF
COMMUNITY DEVELOPMENT AND SERVICES
27 Charles Street
North Andover, Massachusetts 0 1845
WILLIAM J. SCOTr
Director
(978) 688-9531
June 25, 1999
Thomas J. Murphy, R.S.
37 Washington Avenue
Andover, MA 01810
RE: 299 Dale Street
Dear Mr. Murphy:
This letter is to inform you that the proposed septic plan for the repair at 299
Dale Street, North Andover has been disapproved for the following reasons:
• The d -box (and septic tank, if replaced) requires a 6" stone base. (310 CMR
221(2) and 998(1). 1
• Map and lot number are missing from the plan. (310 CMR 15.220(4)(u))
• Names of abutters missing. (NA 8.02j)
• Locus plan missing. ((310 CMR 220(4)(t))
• Existing water line or well missing from plan. (310 CMR 990(4)(m))
• Wetland disclaimer missing. (NA 8.02S)
• Alarm not specified as being on separate electrical circuit from pump. Also,
alarm for pump must be inside the building. ((310 CMR213(9))
16
'0
Fax (978) 688-9542
Please do not hesitate to call the office at the 978-688-9540 if you have any questions.
Sincerely,
Sandra Starr, R.S.
Health Administrator
Cc: Paul McCarthy
File
'APPEALS 688-9541 BL9LDING 688-9545
CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
Town of North Andover, Massachusetts
BOARD OF HEALTH
Form No. 1
'/-/5,-lg 579
APPLICATION FOR SITE TEST[ NG/I NSPECTION
Applicant--pa'4�L
Site Location .12
Engineer
Test/I nspection Date and Time
Fee 75-,0-4�
CHAIRMAN, BOARD OF HEALTH
TestNo. qe�z
S.S. Permit No.-D.W.C. No.-C.C. Date-Plbg. Permit No.
Town of North Andover, Massachusetts Form No.1
,�kORTH BOARD OF HEALTH
694,
, 6 ,, � — / -r� -Y
6 0
APPLICATION FOR SITE TEST[ NG/I NSPECTION
Applicant U -',15t I LL/
NAME �IADDRESS TELEPHONE
Site Location 4iN— '144 ICAe' A -I,(_
Engineer
NAME ADDRESS TELEPHONE
Test/inspection Date and Time
7'-6— "4:
Fee . L/
CHAI RMAN, BOARD OF HEALTH
Test No. C.7" % �r.
S.S. Permit No.-D.W.C. No.-C.C. Date-Plbg. Permit No
SEPTIC PLAN SUBMITTAL FORM
LOCATION-:'-O'N 1*e— C-1
NEW PLANS: YES
REVISED PLANS: (��:S)
$125.00/Plan
$ 60.00/Plan t-�
SITE EVALUATION FORMS INCLUDED: YES
DESIGN ENGINEER: --CRqt-1A5- k(,'94!q�/7
DATE TO CONSULTANT:
( �NOD
*If you want your plans expedited, please submit four plans and included a stamped
envelope with the correct amount of postage to mail plans to Port Engineering.
To N OF RTH A
Bo't'� r HEAQ H
When the submission is all in place, route to the Health Secretary.
JUL 151999
L
Town of North Andover
OFFICE OF
COMMUNITY DEVELOPMENT AND SERVICES
27 Charles Street
North Andover, Massachusetts 0 1845
WILLIAM J. SCOTT
Director
(978) 688-953 1
June 25, 1999
Thomas Murphy
37 Washington Avenue
Andover, MA 0 18 10
Re: 299 Dale Street
Dear Tom:
0
Fax (978) 688-9542
This is to confirm that on 06/24/99, at their regularly scheduled meeting, the North
Andover Board of Health considered variances requested for the repair of a septic system
at 299 Dale Street, North Andover, MA. The following variances were granted by a vote
of the Board.
1. NA Section 6.Oi requirement for alternative technology was waived.
Please feel free to call the Health Department at 978-688-9540 if you have any questions
concerning this action.
Sincerely,
Sandra Starr, R.S.
Health Administrator
cc: Paul McCarthy
File
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
Jun -23-99 09:04A Paul D_ Tur-bide, PE/PLS
P011T
ENGINFIRIE
Civil Engineers &
Land Surveyors
One Harris Street
Newburyport, MA
idqso
(978) 465-8594
June 23, 1999
Sandra Staff
North Andover Board of Health Administrator
Office of Community Development and Services
30 School St.
North Andover, MAO 184 5
RE: Title V review for 299 Dale Street
Dear Sandra,
508-465-0313 P.02
Enclosed find the "Checklist for North Andover Septic System Plans" for the above-
mentioned site. The following is a list of all the 'Problem' areas and deficiencies Port
Engineering has found.
• A 6" stone base must be placed beneath the d -box and beneath the Septic tank (if the
septic tank is replaced). 3 10 CMR 221(2) and 228(l)
• Map and lot number must be on plan. 3 CMR 220 (4) (u)
• Names of abutters must be on plan. NA 8.02J
• Locus plan must be on plan 3 10 CMR 220 (4) (t)
• Location of existing waterline or well must be on plan 3 10 CMR 220 (4) (in)
• Wetland disclaimer must be on plan NA 8.02S
ci Alarm for pump must be in building and alarm must be on separate electrical circuit
fromthepump. 3]OCMR2]3(9)
u 3 10 CMR 247(2) states that a minimum of 2" of 118 to 1/2inch stone is to be placed
on the top of the leaching bed. The plan design calls for a layer of filter fabric to be
laid on top this stone. There is no regulation that I could find that allows filter fabric
to be laid over the peastone, and therefore I would recommend that the filter fabric
be removed from the design.
If you have any questions or comments please feel free to contact me.
Sincerely
Carlton A. Brown, PE/PLS
Dale299.doc
Al?
6D
Hours of Cperations:
SS* or Federal ID#:
Fee: �50.00 Payab
SEPTIC PLAN SUBMITTAL FORM
LOCATION:
NEW PLANS: $125.00/Plan__)�s_
REVISED PLANS: YES $ 60.00/Plan
SITE EVALUATION FORMS INCLUDED: (DS NO
DATE:—
DESIGN ENGINEER:
DATE TO CONSULTANT:
*If you want your plans expedited, please submit three plans and included a
stamped envelope with the correct amount of postage to mail plans to Port
Engineering.
When the submission is all in place, route to the Health Secretary.
DATE. -
LOCATION.
LE N G I N E IR. -7
BOH VVITNESS�
p E 4F. C 0 LA\ T 10 N T E S T
BOTT OM DEIPTH OF PE:RC TEST -
TIME OF SOAK: minui-es 1cric)
, ?'. 01
TIME AT i -
TIME AT 9" 3
T I M E AT E5 to
C V E =i,,N I G H S 0 1-11 K
TIMIE. ST'-2.RTED
N�—:"'KT D,L"Y SOr"X
—1;mE '-"�T '12"
TiME, ,�.T
TIME AT '5z"
" --%L le-;: Ai r
I - '
DATE-
LOCATION�
Vm
LE: N G I N _71---7
BOH, VVTNESS�
p (C 0 LA T 10 N T Ec_ S T -r#
50TTOM DEIPTIH, OF PILE -RC TEST-
TIMLE OF SO,"X. I e s _5 t s .1 c rt c-)
TIME AT 12"
TIME AT 9"
TIME AT,-':'-"
CVE=;NIG��T _`-Ol-�X
TIME SzTr�-.RTHED
NEX\7 D,L'-,Y SO' -"\K.
N I E '-"IT 12
TIMEL
T 5"
TlNILc-: r%
e E s
Location Address or Lot No.* -Z q
FORM 11 - SOIL EVALUATOR FORM
On-site Review
I
Deep Hole Number Date:- 4.-7,1-. q q
Location (identify on site plan)
Land Use SIJ44, -FAM.... ki SE- SIOP6 M
Vegetation.. 61ZA 9 -9, 1,AQ-Q
Landform
Position on landscape (sketch on the back)
Distances from:
Time: Weather
Surface Stones KIDAA—�::'
Open Water Body 16C) -r feet Drainage way ICO -t- feet
Possible Wet Area ICO+ feet Property Line Z�� feet
Drinking Water Well )00t- feet Other —
DEEP OBSERVATION HOLE LOG*
Depth from
Surface (inches)
Soil Horizon
Soil Texture
JUSOA)
Soil Color
(Munsell)
Soil
Mottling
Other
(Structure, Stones, SwIders, Consistency, %
Gravel)
Af>
9 r FIAUy F-1 "E_
S2"-
6ZAV,
IoNesk'
9 1 Kf4' 6 V
A ij D
CA ?A\,I,
7-5,93J44
Flljcvaa�: TO Lj("'
-%Ub
f4AAi6AUC-q—::r
-7, 5- 111Z
.
HA39tve,Fj?t-j AW4�
��05
IF19MUM WU 46 "%JU&,a n&%AW§nr.W^ I U.V&n I rnWrW�&W
Pool. Mat" (98ndagor) &.1 -FL -A ��./ -ri a DepdvtD8@drcx*: q Z
DepM to Groundwater: StwadkV Watw in the Hole: Weapvtg from Pit Few:
Esthna Seasonal Kqh Ground Water:
laDW ArMO,VZD FORM - L2M/"
FORM 11 - SOIL EVALUATOR FORM
Location Address or Lot No. *Z-19 t) jq (I —�--
On-site Review
Z.
Deep Hole Number Date:. �72�17- 1?q
Location (identify on site plan)
Land Use
_6� SlopeM
Vegetation
Landform
Position on landscape (sketch on the back)
Distances from:
Open Water Body )COt feet Drainage way 1CC-+ feet
Possible Wet Area 100 t feet Property Line (0 -t– feet
Drinking Water Well 1W 1- feet Other —
DEEP OBSERVATION HOLE LOG*
Depth from
Surface (inches)
Soil Horizon
Soil Texture
JUSDA)
Soil Color
IMunsell)
Soil
Mottling
Other
fStructure, Stones, Boulders, Consistency, %
Gravel)
MINIMUM wixa n&%jwsn&w P% P r v &n i rnvr-wa,-w ws-arwa^u �Q�
Pool. Materw (9001,ogic) DepthoBedrock'
Death to Onninghwer Standing Watw in the Hole: Weeping from Pit Few:
Esth w Seasonal High Ciround Wow: I
iiD1W ArrRO-VED F09M - 1IM19S
No. ................................. ....
ow 1" 0, 1- flr-�
FORM 11 - SOIL EVALUATOR F)ORr%1
Page 1
Date. 7T...
Commonwealth of MasSaChusetts
, Massachusetts
New Construction El Repair
office ReView
Published Soil Survey Available: No El Yes
Year Published I.M. Publication Scale
Drainage Class ..... .. ....... . Soil Limitations .................................................
Surficial Geologic Report Available: No El Yes
Year Published . ..... .. ..... Publication Scale . ..................
Geologic Material (Map Unit)
Soil Map Unit ...................
Landform.......... ........ ............... PA. ........................................................................................
Flood Insurance Rate Map:
Above 500 year flood boundary No El Yes El
Within 500 year flood boundary No El Yes
Within . 100 year flood boundary No El Yes
Wetland Area:
National Wetland inventory Map (map unit) .....................................................................
Wetlands Conservancy Program Map (map unit) .......................................................
Current Water Resource Conditions (USGS): Month ..................
Range : Above Normal El Normal 0 Below Normal El
Other References Reviewed:
Location Address or Lot No.
FORM 11 - SOIL EVALUATOR FORM
On-site Review
Deep Hole Number3 Date: 470.-q9
Location (identify on site plan)
Land Use F&M - H S ff , Slope M
Vegetation
Landform
Position on landscape (sketch on the back)
Distances from:
Time: A..7M. Weather
Surface Stones
Open Water Body 100+ feet Drainage way 100+ feet
Possible Wet Area W -t- feet Property Line H -01L feet
Drinking Water Well ICO -t-- feet Other
DEEP OBSERVATION HOLE LOG*
Depth from
Soil Horizon
Soil Texture
Soil Color
Soil
Other
Surface (inches)
(USDA)
(Munsell)
Mortfing
(Structure, Stones, &w1ders, Consistency, %
Gravel)
41
A
ZO'—' 37
P3�
M11111MUM WU a r1%d4.&.j n&%AW5n&L# ^I & V &n V CnWVW'ar-L# W10r%0%PP%4. ru�&^
PO4M. Mawrial W
pepM to Groung1woter: StandkV Watar in the Hole: Wsepinql from Pit Face: 67
F d Saaeorml K0 Ground Water:
iiD6F AFMO*V= F04M - 12MI"
FORNI 11 - SOEL EVALUATOR FORM
Page 3
Determination - f Water Table
or SeaLoifflL—ft—h
Method Used:
El Depth observed standing in observation hole ................... inches
El epth weeping from side of observation hole ................... inches
eDepth to soil mottles .................. inches
El Ground water adjustment .... .............. f eat
index Well Number ................. . Reading Date ................... Index well level ...................
Adjustment factor .................. Adjusted ground water level ........................................................
Degth of Naturally curring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas
observed throughout the area proposed for the soil absorption system?
If not, what is the depth of naturally occurring pervious material?
Certif -ication
I certify that on J10� ITT
Adate) I have passed the examination approved by the
Department of Environmental Protection and that the above analysis was
performed by me consistent with the
described in 310 CMR 15.017.
Signature
training, expertise and experience
t'11-4 - - I& , r -
N
FORNI 12 - PERCOLATION TEST
COMMONWEALTH OF MASSACHUSETTS
WOOT-4 -AXJDC)\4,5fZ- , Massachusetts
Date:
Observation Hole #
Depth of Perc
lb f 0/,j
percolation Test
4r
T4wff W'.1 .............
Start Pre-soak
End Pre-soak
-----------
Time at 12"
Time at 9"
_k'31
Time at 6"
Time (9"-6".)
J1r
11YV _j
Rate Min./inch
ell'
Site Passed Site Failed 1:1
.....................................................................
Performed By* /� ovh�
Witnessed By: t(d 0
Comments: ..... ................... ...... ..................... . ...................... ..... .................. .................... .. ** .... *'*"** ...... . ..
-7: -7
BOARD OF HEALTH TEL. 688-954o
NORTH ANDOVER, MASS. 01845
APPLICATION FOR SOIL TESTS
DATE: Z
LOCATIdN OF 8OiL TESTS:
Assessor's map & parcel number:
0 W N E R:
TEL. NO.:
ADDRESS:
ENGINEER: TEL. NO.:
CERTIFIED SOIL EVALUATOR:
Intended use of land- residential subdivision, single family home, commercial
Repair testing Undeveloped lot testing
N. A. Conservation Commission Approval:
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM:
1. Proof of land ownership (Tax bill, deed, or letter from owner permitting
tests)
2. Plot plan
3. Fee of $275.00 per lot for new construction. This covers the minimum two deep holes
and two percolation tests required for each disposal area. Fee of $75.00 per lot for
repairs or upgrades.
GENERAL INFORMATION
1 . Only Certified Soil Evaluators may perform deep hole inspections.
2. Only Mass. Registered Sanitarians and Professional Engineers can design septic
plans.
3. At least two deep holes and two percolation tests are required for each septic system
disposal area.
4. Repairs require at least two deep holes and at least one percolation test, at the
discretion of the BOH representative.
5. Full payment will be required for all additional tests within two weeks of testing.
6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to
the Board of Health showing the location of all tests (including aborted tests).
7. Within 60 days of testing soil evaluation forms shall be submitted.
BOARD OF HEALTH TEL. 688-9540
NORTH ANDOVER, MASS. 01845
APPLICATION FOR SOIL TESTS
DATE:
LOCATIdN OF 801L TESTS:
Assessor's map & parcel number:
0 W N E f R. � X�TZ A/ TEL. NO. -.--.,z
ADDRESS:
ZZ TEL
ENGINEER: NO.:.
CERTIFIED SOIL EVALUATOR:
Intended use of land: residential subdivision, single family home, commercial
Repair testing Undeveloped lot testing
N. A. Conservation Commission Approval:
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM:
1 . Proof of land ownership (Tax bill, deed, or letter from owner permitting
tests)
2. Plot plan
3. Fee of $275.00 per lot for new construction. This covers the minimum two deep holes
and two percolation tests required for each disposal area. Fee of $75.00 per lot for
repairs or upgrades.
GENERAL INFORMATION
i . Only Certified Soil Evaluators may perform deep hole inspections.
2. Only Mass. Registered Sanitarians and Professional Engineers can design septic
plans.
3. At least two deep holes and two percolation tests are required for each septic system
disposal area.
4. Repairs require at least two deep holes and at least one percolation test, at the
discretion of the BOH representative.
5. Full payment will be required for all additional tests within two weeks of testing.
6. Within 45 days of testing, a scaled plan (no smaller than V-1 00') shall be submitted to
the Board of Health showing the location of all tests (including aborted tests).
7. Within 60 days of testing soil evaluation forms shall be submitted.
� X
p- j
-1Y
Dec. 10 82
_R Re
--,I s oo �'E
s s o c e r a a E, i- n e ru c t i On ls of
Z5
-aid disposal syst-em, a ---L6-t--aB---.Dz.1.e—S-tr-eet
Site Loca-Lion
North Andover, Mass.
The grades and construction materials
specificati-ons clEted Oct. 27 _, 1 9_
ed in my plans and
L , Dec. 10 _�, 1 9,f_iq2
P'720. r'rof
Richai
T (; C
APPROM DATE
Provided: -7
, W�4/
SUBSURFACE DI��:,OSAL DESl�t-' CTLZK L15A"
I
DIWPRUVED DATE_
Reasons:
LOT
Title V nn 09
Reg 2.5 e submitted plan must show as a miMiMuM:
the lot to be served-areasdimensions lot #.,abutters
location and log deep observation Mes-distance to ties
location and results percolation tests -distance to ties
design calculations & calculations showing required leaching area
e location and dimensions of system -including VeBerve area
existing and proposed contours
g) location any wet areas within 1001 of sewage disposal system or
. disclaimer -check wetlands mapping
hl)�esurface and subsurface drains within 1001 of sewage disposal
76,", system or disclaimer
J) location any drainage easements within 1001 of sewage disposal
system or disclaimer -Planning Board files
vI(j) known sources of vater supply within 2001 of sewage disposal
system or disclaimer t-1001 from leaching facilit
location of amy. proposed well to serve lo,
=cation of water lines on property -101 from leaching facility
cation of benchmark
V0' arbage disposals
.no PVC to be used in construction
q) profile of system- elevations of basement., plumb., pipe.. septic tank,,
distribution box inlets and outletsj, distribution field piping and
other elevations
5r),maxlnum ground vater elevation in area sewage disposal system
s) plan mast be prepared by a Professional Engineer or other
professional authorized by law to prepare such.plans
Reg 6 Septic Tanks
ka)) capacities -150% of flow., water table., tees., depth of tees.,
access$ pumpine
cleanout
from cellar wall or inground sudmming pool
25f from subsurface drains
Reg 10.2 6 Distribution Boxes
1 -74 slope greater than 0.08
Reg 10.4 1 --X b) sump
Cho c,,k TI iA, Pace 2
FAI L I ( Z, I
Leaching Pits
Lp,mr-Inins, nits are nref ere the installation is possible
:a) calculations of 1 area-wd ni im, 500 oq ft
al lations of 1 ar,,,a-,,I,
'b) spacing
ce e 2%
0 swface e 2%
r
'd) _O� r mat a3l
cove
21
e) 21x2t splash pad
sp
:L
�f) tee elbow
in pip e fro ox to P.
g) bends in pipe from d -box to Pipe
Leaching Fields
:tin nnh
no greater than 20 n=Utes/in--
a area-rdnimum 900 Bq ft
c onstruction, of field
e ej surface drainage 2 %
) 201 from cellar vall or inground sminxiing pool
Leac 9 Mches
a) c—alc-Uitions of , ching area -min 500 oq ft,
b) spacing -44 f 6 ft with reserve between
c) dimensi,
d) con ction
e) ne
surface drainage 2%
Downhill Slope
a) -sTo—p a -y7x = rto be shown)
b) y/x X 150 = (to be shown)
I PUPPS
a) approval
b) stand-by power
01, he
SL?7IC S13M
T
IN SM11-ITION CHECK Li r, LOT e
DISAPPRUM EX Amja4- —OK FAIL
ReaffDnst
Y -All
1.
Distance Toi
a. Wetlands
b. Drains
0. wen —
2.
Water Line Location
No PVC P.,Lpe
Septic Tank
a. -Tees t.. -Length & To Clean "Out CoVers.
b. Cement Pipe to Tank .- Oa Both Sides of Tank
5.
Distribution Box
a. Covers & Box - No CrackO
b. All Lines Flowing Equal AnOlmts
c. No Back Flow
6o-
Leach Field or Trench
a. Dimensions
b. Stone Depth
c ' Capped 7nds
d: Clean Double Washed Stone
7.
Pit8
Lea:ch Pits!
a. Dimen one
b. Ston Depth
7ssh
)h Pads
c. Spi
T 8
d T s
ment pipe to Pit Both Sides
f. clean Double Washed Stone
8.
No Garbage Disposal_
9.
-71nal Grading Inspection Vz-
10.
BarricacUng Covered System
As Built Subndtted
a. lot Location
b. Dimensions of System
c. Location with Regard -to Pem Test
/11-,
d. Elevations
e,* Water Table
107 Forest St.
Middleton, MA 01949
FORM 4 - SYSTEM PUNIPING RECORD
.-Cmmon.wealth of Massachusetts
.Massachusetts
TOWN ------
?'—''R7HAAIDOVj:Rj
Svstem Pumping Record MIAY 3 0
System U\\mer System Location
I 4ir
GAV
Date of Pumpin.- Quantity Purnpej-l� gallons
Cesspool: N Yes Septic Tank: . No El Ye
SystemPumped by: . .. .. .......... I...... . . .. ...... ...... .................................... License 4: ................................................ ........ ...........
Contents transferred to:
SEPTIC SYSTEM INSPECTION FORM
ADDRESS 11Z 911) La
DATE INSPECTED
PROPERLY FUNCTIONING? (t N
WEATHER CONDITIONS
COMMENTS:
WA—iE:IZ CXALITY TESTIF-ts-Z REsi)L-Ts�
DYE TEST PERFORMED? Y V
DATE?
SKETCH:
WATERSHED RESIDENTS QUESTIONNAIRE
1. Name
2. Street Address
3. How many members are in your household?
What type of sewage disposal system do you have?
D cesspool
0 septic tank and leaching area
El connection to municipal sewer
0 other (describe)
F-1 do not know
5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health?
F -I es El no XJ do not know
El 11-20 years
6. How old is your sewage disposal system? ;K 0-5 years
El over 20 years F� do not know
7. Has your sewage disposal system been rebuilt or repaired?
El yes SL no F do not know
If yes, approximately how long ago?
El 6-10 years
years. What was done?
8. How frequently is your sewage disposal system pumped out? El annually
every 2-4 years 0 every 5-10 years 0 over 10 years EI never
no
9. Have you had any problems with your sewage disposal system? El yes
If yes, what problems?
0 repeated pump -outs needed
El system clogs, backs up, or drains slowly
F� odors
El sewage surfaces through ground
10. How many of each appliance are connected to your sewage disposal system?
washing machine dishwasher garbage disposal
dehumidifier drain sump pump toilet
roof/pavement drains shower/bathtub !�I_
11. Please state the brand and type (liquid or powder) of detergent you use for:
dishwasher 0-a-s't
clotheswasher
12. Does your property have a lawn? yes no
If yes, approximately what size?
F� less than 1/4acre El 1/4 acre El 1/2acre V1 3/4 acre El 1 acre
F more than 1 acre (Specify) - acres
13. How often do you fertilize your lawn?
No. of applications per year
Season(s) of the yea r
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
Ej Check here if your lawn is maintained by a professional landscape contractor.
C11) IE) !V7
UIXXXI R
SEPTIC & DRAIN SERVICE
107 FOREST STREET; MIDDLETON, MA 01949
(978) 774-2772
�-N -1-4
F)RM 4 - SYSTEM PUMPING RECORD
MAR 8 L999
COMMONWEALTH OF MASSACHUSETTLI�
AI -4VD()Ve-v( MASSACH-USETTS
SYSTEM PUMPING RECORT)
SYSTEM OWNER:
e�-qcc'�V(v\
D211� S7,
SYSTEM LOCAl ION:
C) o
/yo
DATE OF PUMPING:-..- QUANTITY PUMF ED: GALLONS
CESSPOOL: NO F--] YES SEPTIC TANK NO YES
SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SERI ICE
CONTENTS TRANSFERRED TO: --
DATE:- INSPECTOR:-