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HomeMy WebLinkAboutMiscellaneous - 301 RALEIGH TAVERN LANE 4/30/2018 (2) ti - - - 301 RALEIGH TAVERN LANE ,Y'ri Lane --- 2101107 7-0000.0 IL Commonwealth of Massachusetts City/Town of a o System Pumping Record Form 4 14 1010 TQWN O!N6 DEP has provided this form for use by local Boards of Health. 0th r f TRU he information must be substantially the same as that provided here. Before u k 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. A. Facility Information 1. Sys�et on: Left front of house, right front of house, left side of house, right side of house, aright rear of house, left side of building, right rear of building, under deck. 3 Citylrown State Zip Code 2. System Owner: Name Address(if different from location) City/Town Stat n Clod Telephone Number '7 B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes [moo— If yes, was it cleaned? ❑ Yes ❑ No 5. Condition ^nof System: ystm: � 6. System Pumped By: Neil J. Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc. Company 7. Loca' re contents were disposed: 64fyar L.S..L.S. ell Wa e W r , 4�� f- — l a — a---- I Signature Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts = City/Town of System Pumping-Record Form 4 DEP has provided this forrri 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. A. Facility. Information 1. System Location: Left/Right front of house, Le(/Rlgh r , Left/right side of house, Left/ Right side of building, Left/Right front of building, eft/Right rear of building, Under deck Address 130 Cityrrown State Zip Code 2. System Owner. Name Address(if differe from-location) CitYrTown State /��� . D'cC 0 �� 2014 . ((� -�de jTelephone Number TOWN Vr Pr'�F'11- AflaL,.,+_R'•1 _ HEA r B. Pumping Record 1. Date of Pumpinggate 2. Q ntity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) ;Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes o If yes, was it cleaned? ❑ Yes ❑ No: 5. Condition ofs 4`Nx—( -&JZ1 6. System Pumped By. Nell.Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Locati re contents were disposed: LS-QLS-Q Lowell Waste Water Sig Haul Date ` t5fomu4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts =; ; City/Town of ��� 11 2012 System stem Record Form 4 TOWN OF NORTH ANDOVER EALTH DEPARTiv;ENT 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. A. Facility Information 1. System Location: Left/Right front of hous Right of hous. Left/right side of house, Left/ Right side of building, Left/Right front of building, Left/Right reobuilding, Under deck Address A Citylrown state Zip Code 2. System Owner. Name Address(if different from location) City/Town State Zip�� Telephone Number B. Pumping Record / 1. Date of Pumping ✓��a(� p g Date 2. Qua mped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By.- Neil y:Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location re contents were disposed: GLS. Lowell Waste Water lc -� � Sign te Haule Date t5form4.doc•06!03 System Pumping Record•Page 1 of 1 Commonwealth.of Massachusetts City/Town of \\j System Pumping Record DEC 8 2006 Form 4 TOft - iv.+ cTH ANDOVER DEP has provided this form for use by local Boards of A *i D:PARTME T Ing Record must be submitted to the local Board of Health or other approving authority. . A. Facility Information Important: When filling out 1. Syste Location- forms forms the computer,use only the tab key Address to move your Q �.. — �( cursor-do not , _ use the'retum Cityfrown State Zi Code key. 2. System Owner Name Address(if different from location). CityfrownStat (. Zip Code Telephone Number B. Pumping Record l - -off 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system ❑ Cesspool(s) eptic Tank- ❑ Tight Tank ❑ Other(describe)'. 4. Effluent Tee Filter present? ❑ Yes [moo If yes, was it cleaned? ❑ Yes:`❑ No 5. Condition o�f.S�ystem: 6. Sy m Pumped _eA Vehicle License Number Company 7. Locati where con ` wesposed: a -- Signatur of ul r Oate http://www.mass.gpv/dep/water/approvals/`t5forms.htm#inspect t5form4.doc•06/03 Sys temPumping Record•Page 1 of 1 ('0111onw Ith of Massachusetts �r (Massachusetts System Pumping Record System Owner System Location Date of lumping: 1�-� l � � Quantity Pumped: gallons Cesspool: No-' Yes I] Se rtic Tank: No L_J Y l l es «- System Pumped by: elredea gffa ,64a a License # Contents transferrred to : Greater Lawrence Sanitary District Date: Inspector- 1 FORM 4- SYSTEM PUN PL\G RECORD o�ND XV1 jOW�epp►R Commonwealth of Massachusetts , Massachusetts System Pumping Record -stem Uwner System Location Pon (30 ( Date of Pumping: (":2 �'- Quantity Pumped: gallons Cesspool: No Yes ❑ Septic Tank: No ❑ Yes ,® -U 4-j System Pumped by: _ License #: Contents transferred to: L' Date Inspector i� 5UR.T-A.C.P. Spo AL. TES afIGM of Lc.�T 4 S 1?.A1- tvi4 %7weat4 L,,wE PR EPAiZE_O F 07- ���,.�� ENC�1t�.IL�.R� AiVp ARC.NITi�CTS RA K z 4Vo2-rN Ar+oov�,..R•,MA..©t$4s ' t o /J �4 1 ,i _ i lot Qo 6MZ&66E 15Z%Q17'C2 S4AL.L 1LLI 1QS-TX3,1-C 1�)a KJo ':�'Jf2�-4C6 ,AJLa-rr-R. \,0-rL.hK4 100' r�„r N ��7�+Et�tT�� kt t�tl_ti PJ !v©' of S�lSTE3� . �[�•► � lJ��"�C� P}d��l.. 'Sy Ni Loi- 4b i tJvtZtt_.1 L�Nt�/"�2 , MAS JU KIE Sot 1`x'78 DESIGN DATA, CALCULAT IONS 4 SOIL OBSERVATIONS BY- 17- G• 6• L• �PwLwp,-J W4TNESS 1 •PEMOLAz ION TEST NO. ! 2 3 4 S DAT E Gv TOP-ELEVATION q(o,S T BOTToM- ELEVA7 ION SA—fURA'TIoN —MINS. 1,5 MIA --+.9" DROP- MINS. 28 9" DROP -MINS. SOIL PROFILE-DEEP PIT NO. 1 2 3 4- DAT 'SAT E ToP-ELE VATtt7N1 < -TOPSOILSUBSOIL PARE NT SOIL ` WATER TABLE 7L(o 'Tt L L WATER TABLE E LEVATION q0.615 BOT'rom ELEVATION GAL.{UNIT 45o GPD FLOW 460 GPD FLo� x ISO = �'? GIS USE GALS EPTIC `T'At1K LEA,CHINGr AREA gE TJ 4SOr G-PD FLOW x l . 9 SV:/G- -AL.= SSS SF 8En USE `oc) SF Pht-S TYPE1`iz Myvt. (-TYP. SIDEWALL A SFX GALS.l SP = GPD BO-TT AREA SF x GALs.1 SIP = GPD -T AL PIT LF-Ar-+H 1907 CAPACITY _ _ _ _ - _ _ _ G-P D /PIT GP D FLOW GPD/PIT= PI-5 RF-4D. USE.PIT5 7kF-NCHES SIDEWALL AR Poll SFf LFX GALS Is = GAL-JUN-FT. cI S©TTOM EA SF f LF x GALS/SP = GAL LI>s.FT f `IOTA ENCH LEACHING GAPAcITY _ _ _ _ _ _ GAL,/ LIN.PT. k GPD :Low -- obi LWYT.= I.T.-TRIENCgES REq'D. USS. LF NoT Es - - -- - _ -__ -- Pr-\GE 2 0f CSer�c� MA 4 PL.uMeeatx Pipe NOTE: ALL ELE V&T IO N b tZBPSV- TO 1507-rC)PA b SCvTie- -r&"v INL.&T Of% PIPE (INVEQT) G b 1E p-r i G. TAM K-t- Uva'L..r.T D DiO"C2. �o,. -ML*.'T Pit,-rm. 15&,c ov r►-BT F- E-rr v or- n>&alz. Rim r G Pini. Gs2A.oE (Zz) HouSF- �•a H Pt h►. GRA4vr a� Y _ ,mow V F N I �1 E- 4" PEa-;:a2aTED CitTUMINOVS Ftt3EIL PIPE (CLIPPED 1`NDL) woo M/N. r-we ovrAor &01.S>9-. 43ox � � — _ - - - - - - • N I I Nom- PFR;ro(LAlrF-D LF-AC-14 t N O, Otb 1 v LIMIT LINE PL © N OFF L EbG.w t mG I3e D ELEVA`z"tOt"►.t SCHEDLf �� "I't MARK' -row ,4 PLUMBERS PIPE DWEII. �►(p o— ALL �i_EY,�TtOhtS 1Q�t=E -R:> NVMT OP P%PE i Q SEPTI `TAN t{ INLET Glo . 075 S rPTIC TANK OUTLET RGO .is, N I3 1ST. BOX -IN LV-7 oto .1 19 E •DIST• 130X CUTLET '94o.. l o2 _F aND or, PE pm Pi P I~ 95 .1 ll q So`rToM of .1z'. 83 Sep GC-ESS MA-NNOLES -m WITHIN 4 " op FtmtSN cTRADF I R LAMER UNTRLATED BUILDING PAPER . _t' I 4 C.7.PIPE �.� `�'� �\ �� 12" KA%N. CovR E wr FL. t. ' . _�- _ _ _ DIST. • . . . , _ . 2" ,/g�-l2 I S"t�O N E N $ .d7L s S6 _ 0 + `� Oo o /Suc t 3 e a o oti e G 9 3�qI- ty2" STC Ng $ GAL --•;� u _ .. COARS M 5 AwiU E TIC TANK, t ALL STONE S7WALL 0E WASHEL7 . _._ 12t_ md �► -NPtCAL LEAcNtKG -MENct-i PPOFILE too S�AL.E . �oTf :�JcHEk1ATtC ONLY - r-oR SrrE LA.`/oUT s 5EE 'Pc:-• { r 4 :~lNiyll GQApt (�GQb.l,b�D �►e6i� dPE6LF02ATE0 f31"'t'. P1PE - i t---- • . . ..,. ,•,�. �, I tN. yv, STot4F- • •:�• '�� `�::+'"� ••. �' ;";+�•. ',�» 'i • • ; +3"1:: .,•� «•jP•;• l qw•l�' ,,. �.. 4- l V17 STONE N �4 Zvi 4 CROSS SECTION of .LE- A.Cw l m G 1'5E1) v NO sC�eLF-- o . NOTE-: M.L ST0%ra TO t"SE, w 6, SOIL PROFILE & PERCOLATION TEST DATA Board of Health-North Andover, Mass. Street �. `�,,,,,e,,,. Lot N o. 46 Subdivision' Owner Investigatory Observer L- SOIL PROFILES 1 . Date 2. Date 3. Date 4. Date Elev. Elev. Elev. _ Elev. ?eet Inches 0 Ties to Test Pits 1 • 1 2 2. 24 3- 36 4. 48 5. 60 72 84 3* 96 + 108 0 120 ote : Top & subsoil depth; depths of other soil types; depth of water table; depth of refusal. PERCOLATION TESTS Date -7,1 Date (o'X] Date Date Date Pit Number 1 2 3 4 5 Start Saturation 7;3D i Soak-' Mins. I ke Start Test-Time 9' � Drop of 3"-Time Drop of 6"-Time �Y,as-v Mins. 1st 3" Drop 2.`; Mins. 2nd 3" Drop Rate Min./In. b - iz Mph Vs SOL Z? LOT S r' oo ` S.M.`of> CONC e 1 U o, O I A� SOV.SE !SE �; Z) S ,T -Dj-�) tsr 13 o-< :rmzsT E)Dk sT, ao- . O vTL-ET oP 'Pt RES �aTrot v°� QED w� l? 1 f E tT 2 C� VT Lr� i 12 A F lSrG nN. L39 W . { 12 �7 14ORTH AIMMM BO_IRD OF HEALTH a _ 1r5i:4LLATION CH LIST _ ., — A 'PRO"VM DI S0PROVED -- EXCAVATION OK Dt:e:T~ Date: - - Reason. s Built Submitted °`„ Check: Lot location, dimensions of system, location in regard to percolation tests, depth of system, grater table 2. Distance to W land Areas, Drains, Street & House, Drainage Easement and Wells. 3. Water L' Location 4. No P Pipe 5. Septic Tank - T s Cement-Pipe to -Joints on both side of Tank. A�Q_0 !- 6. Distribution Box - No cracks i ox or cover, a limes flow erually from bo CR''`�Ive 7'. Leach Fields - Dimen ons, Stone ptbs, CL . ends, Clean do e-tshed stone 8. Le ac its - Dimensions, Depth of Stone, Splash pad tees, Cement-pipe to tank- joints on both sides of tank, Clean double-washed stone 9. No Garbage 'sposals r 10. Final Gradi fbarricading of sub-surface system, t h V Q {.J i; f i, i 1. L o T ¢-D ' �•{t•� 7b� sF. +j c { t r' r' ra ni' :•y 1 ¢3 c L A (r ¢sn► 1 1 le �',ay / JLf ' f y')rte:N cJ�'^,' /S,.• �, � A { 5 { f O / i �Z � 4 / jEIEGrI T•Ov. 44, i i I + i i 4 � l r 7►-�y{x 7 t 41 iL • F., �Y � , bra �l� �v I i •� ��',, s 1,� 'fir= � �'`� �� �k: i' i1,F�i �f tJ /�/Y✓ ��� r 3 • t2,I..rt r CA ;7R 1 _ • y f : 4W -- /g :Lek je es �'`'�...� -•,� _ _l,�7�:���II_ S,Q•�+r77j.QJ'3•mss 7-0 E 44 S Vb 4 Ff �r- c 3 7-1f,1 v r� , 1�TCyI`� OF 1 qR RP' N TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD '✓ 9 X00/ DATE: SYSTEM OWNER &ADDRESS SYSTEM LOCATION (example: left front of house) 3o i DATE OF PUMPING: ` (QUANTITY PUMPED 1C�-�GALLONS CESSPOOL: NO,=:� YES SEPTIC TANK: NO YES �— 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: COMMENTS: CONTENTS TRANSFERRED TO: y i TOWN OF SYSTEM PUMPING RECORD DATE: �`I" v SYSTEM OWNER& ADDRESS SYSTEM LOCATION (example:left front of house) ko K-(- k4— '0 cwtf V\- DATE OF PUMPING: r QUANTITY PUMPED : GALLO S CESSPOOL: NO YES SEPTIC TANK: NO YES 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) I SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: coNTENTS TRANSFERRED TO: G.L.S.D Lowell Waste Commonwealth of Massachusetts City/Town of RECEIVED System Pumping Record Form 4 NOV 2 5 2008 DEP has provided this form for use b local Boards of e N NO TMusing p y � � pused, but the information must be substantially the same as that pro a oform, 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. A. Facility Information Important: When filling out 1. System Location: Left front left re eft sick-of house ight front, right rear, right side of house. forms on the computer,use only the tab key Address O r to move your cursor-do not use the return City/Town State Zip Code key. 1 2. System Owner: Name Address(if different from location) City/Town State ipCode Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: canons 3. Type of system: Q Cesspool(s) u eptic Tank~ [j Tight Tank [] Other(describe): 4. Effluent Tee Filter present? Q Yes If yes,was it cleaned? Yes No 5. Condition of System: 6. System Pumped By: Neil Bateson F 5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Loca ' re contents were disposed: L.S. Lowell Waste Water ignaAol. r Date[( t5form4.doc•06/03 System Pumping Record•Page 1 of 1