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Miscellaneous - 31 VEST WAY 4/30/2018 (2)
Commonwealth of Massachusetts C4' /Town of 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 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 Le ig A�ig hou,;16, Left/ right side of house, Left / Right side of building, Left / Right front of building, Left / of building, Under deck r+wress A Cityrrown State Zip Code 2. System Owner. RECEIVED Name Address (if different from location) NORTH ANDOVER HEALTH DEPARTM Citylrown B. Pumping 1. Date of Pumping . State - �ep.Code Telephone Number rd 3. Type of system: ❑ ❑ Other (describe): 5� - . Date 2. Quanti Pumped: Gallons Y Cesspool(s) Septic Tank ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes 5. Condition of stem: 6.- System Pumped By: Neil. Bateson Name i Bateson Enterprises Inc Company 7. LocatiqajMWe contents were disposed: 6S - _ Lowell Waste Water If yes, was it cleaned? F5821 Vehicle License Number ❑ Yes ❑ No, 41 Date t5form4.doc 06/03 System Pumping Record • Page 1 of 1 #n.,.",,...^YS, .Cipi :..n•. -....ice �'w......a 7rk�L..^a. '•Maw.-�+,..X•«ra"i,.4a .r..y ec'»'r.,..� ,Cry_^=•xis^-,+«+}y ;i r"77 a.`, �,•�' y v ` tit w r:,y. .,r �' � �}�'�, }.. fpr h- �" ��Y--'�� {{�`�1't�s�`�T���:�� ��,'#�.��� a` 3• w„~ �, �7, ,� }?� µa ?�, '� ? ' x �” «t� ,fry) �� t_� { i;� y 1 L * +�•,� "',7 ///����\'tls/J ( 1 A(5 ��..d-.�+e�'rr'?°# .'':z'%''`.' •: L eIR - Mr. Charles Pbster,`rBuilding Insp. Nort2iAndover Mass.' 5*rti' �a 'Dear tMr. - Septic tankpernuts ti Vr $a it *`r y^�y revoked. 'have been ,�_;� t_,P '`4 1 ' Lot 5i. -Vest :Way, ;t t i a .. f � X data -must be redone because the septic lana aubtted to this <�x��. at .nai5ir� F'• 4vi y xr �„-,+. -•,. y,aar,�. r.. f45}.'Fv,x r..?�. °office show percolation andz d eprvtest" hoifies� where none e .ist v } xAl$i' t'L.h on the lot ' e - �' q t c , �. irk ,gt�L #4 E`i •1 ''`� � a [ �t ?(++tY's i» �: t 3 't -�. r 3n y. . - a k i'a s. .•�}`�'a�.�1 kd.; t;;y,'-v. sa ' ,� rt ,, Yrj Lot 41' Vestt4Way, ,.theitaroposed�-system >. 8-0 y t a , r x .€.ia z}pr x - ¢ ,..a. �"7> s'sPsaw �r- tr • r a x } ' .r,F' }'s �,G . �,tr.'F �. r 'i'.�'f§i+"` ark - '•� .. a k - F :,F 'rS k ;'+ 5 r' a M2.' e ,k , 30 feet from reset lands, 'a factch�dad notes show onthe" plans 'ti r ..� r =g•.. z. r .y�,•"Pr' a.1'rrci }F• "kr°4'�•' Y1 ':r• �,a m.:. a roved b this "Board. ? _ , very truly 'yours t chael NOsati s r Inspector jt,- a g� A H } � '' ... .. • • - �. .� ! ��F,��-+� � � war . '-d of Health North An ver Maas. BEPTIC SZSTIIi x--' IN STAI.LATIC K CHBCg LIST LOT CHID DISAPFRCNID AQATICN OK FAIL eascns� -. 100 v O$ or 1. Distance Tos ' a. Wetlands b. Drains C. Well 4 2. Water Line Location 3. No PVC Pipe Septic Tank a. _Tess --Length & To Clean Ont Covers.. b. Cement Pipe to Tank - Gln Both Sides- of Tank 5. Distribution Box a. Covers & Box - No Cracks % b. All Lines Flowing Equal Amounts c. No Back Flow 6. Leach Field Trench a. Dimer 'ons b. S'])Vth c. C ed 'Endsd. Clean Double Washed Stone 7. Leach Pits a. Dimensions b. Stone Depth c. Splash Pads d. Tess e. Cement Pipe to Pit - Both Sides. / f. Clean Double Washed Stone 8. No Garbage Disposal 9. Final 4rading Inspection 10. Barricading Covered System 11. As Built Submitted------ EG& -v a. Lot Location . QTS 7G 419� b. Dimensions of SystemEof1 6W// 2' - rt c. Location with Regard -to PeTest A107 6k d. Elevationso.IG S e: Water Table k P>6ard of Health North AndoversHass LOT APPROVED DATE DISAPPROVED DATE Provided: Reasons: 4 T eV FAIL _ Reg 2.5 The submitted plan mst show as a) the lot to be seed-areasdimensions to #,a tters b location and log deep observation ho as -distance to ties c location and results percolation tests -distance to ties d design calculations & calculations showing requireei leaching area (e) location and dimensions of system -including seserrve area M existing and proposed contours (g) location any vat meas idthin 1001 of sewage disposal. system or disclaimer -check wetlands mapping (h) surface and subsurface drains within 1001 of sewage disposal system or disclaimer (i) location any drainage easements vithin 1001 of sev ge disposal system or disclairar-PlawAng Board files (j) knom sources of tater supply witkin 2001 of sevage disposal _ system or disclaimer (k) location of opy, proposed w1l to serve lot -1001 from leacbing facility (1) location of water lines on property -101 from leaching facility (m) location of benchmark (n) driveirays (o) garbage disposals (p) no PVC to be used in construction (q) profile of system -elevations of basement., plumbs pipes septic tanks distribution box inlets and outletss distribution field piping and Other elevations (r) maximum ground water elevation in area sewage disposal system (s) plan rust be prepared by a Professional Ragineer or other professional authorized by late to prepare such plans Reg 6 Septic Tanks (a) capacities- -T50% of flogs vater tables t6ess depth of tees,, access,, pining (b) cleanout (c) 101 from cellar til or inground swimming pool (d) 251 from subsurface drains Reg 10.2 Distribution Boxes 1(a) slope greater than 0.08 Reg 10.4 (b) Q COM MW PMAcncE 4 -t,091: -MO CoOFLICr W1 TITLE S. d Co&Xvurrs ae LE Fr of b w cg. <OWRE4-r- S�f4MP 5lef ADDFD. Reg 15.1 15.4 15.8 3.7 Reg 14.1 14.3 14.4 14.6 14.7 x;.10 Reg 9.1 Q.6 sriEa Check List FAIL I OK LeachIN Pits Leaching pits are preferred where the installation is possible a) calculations of leaching area-minimm 500 sq ft b) spacing c) surface drainage 2% d) cover material 'e) 2'x2'x4" splash pad f) tee at elbow g) no bends in pipe from d -box to pipe Leae-h jmg Fields a) no gra than 20 minutes/inch b) area- 900 aq ft c) construction of field d) surface drainage 2 % e) 20t from cellar van or i aground sdmming pool Leaching wenches a) calculations of area -min 500 sq ft b) spacing -4 ft min 6 ft with reserve betwen c) dimmsions d) construction e) stone f) Mace drainage 2% Do hill Slope a) s y x-- to be shown) b) y/x X 150 = (to be shown) E a) approval b) stand-by power 74 EUEVAtION:1D N lop OU D AT I J) t 114,9.9� E':1 -DWELLINGO"UTL 4a65 T I . SEPTIC,TANK INEt_ 'L0 46.1 s OUTLET;145.93 D'80X INLET 14x5 WtLET- 4 LEACHING PiTINL.jf L #',145,15, LOT 5 uf 44)7284, 2 ✓ 0���#2 NOT E. kir" Kl!:- i , AN nilu'l,c 0 OUND"'A-NIY,,DWELL-INi4,4otd*f`11--l- ..COMPANY E.A.E M ENT. a -"LOCAT1.64' FRROWCE'TIFI E PLAN BY AN INC - DATF-D fog I CERTIFY THAT r'ti=!S:S'&.WAIS N'TALLEDAS,15HOWN AND WITH AS SPECIFIFO THE QELATED PLAN - OF AS BU I LT... 30-t CONDITIONS 0 LOT 41 A VENT AWAY �L6; OWNER JAYCO 'ONSTRUI.1710 30, _ ':-77--.- / 'N ��ETI S�; I N D A.TF_ =6- I. 1- 6 3 tcAL-r_-. j DWELLIN3- PC 4' PREPARED. -3 FLYNN PC, BOX 569 __PLAlS7'0W, N.Hi. 03',365l VEST Wiv�Y r [,RAIN A3 EASEME,4` z4j D i _)_ 2 11 )( , '-Ll 30-,: 2 LOT 41 A ,d4)728 4� NEW ENGLAND NGLAND POWER COMPANY EASEMENT 30;f -c- EXISTING L)WEL-1 m" To 44' 38 it \N 190; 1,41Lo DRAIN EASEMENT VEST WAY 0 V,' -\T 10 0 V 0 L) NOATION', 149.9S DWELLINGOLJTLET:14Gk;'r' SEPTIC TANK INLET: ;46.15 -145.9. OUTLET 3 D BOX INLET: 145A5 OUTLET,- . 145,41 LEACHIN3 PIT INLETS � 1: 14 5.15 2.144.62, NOTE: 19OUNDARY AND DWELLING LOCAT10N FROM CERTIFIED PLAN BY ANDOVEf+ CONSUCTiANT IN C - DATE D '6 - I 1-, 83. I CERT IF� THAT THES.'SLS.WAS INSTALLED, AS SHOWN AND WITH CONSTRUCTION MATERIALS AS SPECIFIED !tq THE DELATED DESIGN. PLAN OF A' BUILT. CONDITIONS LOT 41 A. VES`:, 11/4 OWNER JAYC'_) _'0NSTRu,,: T I �D DATE: S C A LE '. 1'7'4 a'�' PREPAPED 9Y FLYNN A,550C. PC, PC), R"'X 569 ..PLAIST-C)W, N.,H. 03865 W; 9 Pit Number SOIL PROFILE & PERCOLATION TEST DATA. 3 4 V. Start Saturation Aorth Andover,llass. No.&Street Lot No. Loc./Subdiv. Soak -Mins_ Plan 'Owner Start : Test -Time Invest?.gator ` - Observer-._ .. Drop of 311 -Time - "-Time-Dro Drop of 6" -Time SOIL PROFILES-DATE 1. ev. El 3' . 2' Elev. Elev 4-Elev. 0 0 0 0 1 i 1 1 Ties to Test Pits 2 2 2 2 3 3 3 3 4 4 4 4 5 5 5 5 6 6 6 6 7 7 7 7 8 8 8 8 9 9 9 9 - '10 10 10 10 Benchmark Location Elevation Datum � YAZ2 Percolation Tests-Date .1 Pit Number 1 2 3 4 5 Start Saturation Soak -Mins_ Start : Test -Time --- Drop of 311 -Time - "-Time-Dro Drop of 6" -Time I.9ins . l st . 3"Dro " Mins. 2nd"- 3�,'Dro Percolation - Town of North Andover, Massachusetts Form No. 1 t,.H k BOARD OF HEALTH A&A w y CO 10 \Ao�° fwop,y APPLICATION FOR SITE TESTING/INSPECTION Applican Site Location bt 4 Engineer M V i r Oil -L�� NAME ADDRESS TELEPHONE Test/Inspection Date and Time k&n P'C'J'� 1 --) , L q� CHAIRMAN, BOARD OF HEALTH Fee Test No. 9 ? q S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. jLEO i646NC yE Town of North Andover, Massachusetts BOARD OF HEALTH Form No. 1 APPLICATION FOR SITE TESTING/INSPECTION Applicant ! 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CL Elf w in u ta TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: 23 _c I cko,5c (example: left front of house) �ctc,k, �4�C-Tr— kovse-- DATE OF PUMPING: QUANTITY PUMPED 156GALLONS YES CESSPOOL: NO YES SEPTIC TANK: NO NATURE OF SERVICE: ROUTINE YEMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER SYSTEM PUMPED BY - COMMENTS: FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) CONTENTS TRANSFERRED TO: r - / - t . L f NORT1y Oat,�ao �a'�q0 0 ^ . A • SSACHUSft Town of North Andover, Massachusetts BOARD OF HEALTH 01 1 DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant a I- 2dlALf}-j Test No. Site Location Reference Plans and Specs Form No. 2 Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. Fee '* CHAIRMAN, BOARD OF HEALTH Site System Permit No. of A�Aasnrl�usrll� Massachusetts .+� gam" j11e1f1"Utt1tL�—Sydei�i Gncelion - tme of i'umpinu ��� '� t?ue►�tili;� 1'ul�i���dt t Cesspool: N0 1 eS U System Pumped b.. a-ies License Cuntenis Untist'eited W: Dille inSfleClUr ..r-- r,p��a� � N &b� €N TOWN OF � SYSTEM PUMP q -�n Uk-( DATE: SYSTEM OWNER & ADDRESS lj�n DATE OF PUMPING: G RECO SYSTEM LOCATION (example: left front of house) QUANTITY PUMPED: CESSPOOL: NO YES SEPTIC TANK: NO NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: jjE ti'VED OCT 19 2004 7OHC ?T 0 PF�RTH RTNIEANIONT R C GALLONS YES /'- GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: i/ CONTENTS TRANSFERRED TO: G.L.S.D Lowell Waste Commonwealth. of Massachusetts . City/Town of . VSystem Pumping Record APR 2 3 'TH2007 Form 4 F No TGHEA TH DE AR M NT ,OiN or NORTH R DEP has provided this form for use by local Boards of Health.. a 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: forms the computer, use only the tab key Address to move your 'y cursor - do not Ci use thereturn h'!Town State Zip Code key. 2. System Owner: Name Address (if different from.location) City/Town State. 79Code r Telephone Number B. Pumping Record 1. Date of Pu m .i.n9 Date 2. Quantity Pumped: ed: L Gallons 3. Type of system ❑ Cesspool(s) eptic Tank- ❑ Tight Tank: ❑ Other (describe).. 4. Effluent Tee Filter present? ❑ Yes Q_Ko� If yes, was it cleaned? ❑ Yes ' ❑ No 5. Condition of.System: 6: System Pu. ped �� Name Vehicle License Number Company - 7. Locatio hese Conten ere posed:: Sign ure H u er Date http://www.mass.gov/dep/ovate approvals/t5folms htm inspect 4 t5fortn4.doc• 06103 System Pumping Reco(d • Page 1 of 1 Commonwealth of Massachusetts FTqkNO EIVED! City/Town of System Pumping Record 6 2009 Form 4 ,b TH Alvnnv DEP has provided this form for use by local Boards of Health. Other 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 Important: When filling out 1. System Location: Left frontoiKiDeft sidWb6f--h7u's-e--1tight front, right rear, right side of house. forms on the computer, use only the tab key Address< -3 to move your. cursor - do not use the return City/Town I State Zip Code key. 2. System Owner: Name Address (if different from location) Cityrrown Sta Z4kZode Telephone Number B. Pumping Record Cf1. Date of Pumping —�� 2: Quanti Pumped: P g Date ty p Gallons 3. Type of system: 8 Cesspool(s) Septic Tank El Tight Tank Ll Other (describe): 4. Effluent Tee Filter present? Yes �If yes, was it cleaned? 0 Yes No 5. Condition ste t\--u-c-k v\ - 4��� 6. System Pumped By: Neil Bateson F 5821 Name Bateson Enterprises Inc Company 7. Location wh .-e contents were disposed: 1.L.S.D . Lowell Waste Water Vehicle License Number Y -a �F" of Wutbr Date t5form4.doc• 06!03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts F City/Town of W° System Pumping Record Form .4 M 5v8 y`e DEP has provided this form for use by local Boards of Health. information must be substantially the same as that provided h local Board of Health to determine the form they use. The Sy: the local Board of Health or other approving authority. A. Facility Information M JUN 4 N11 ut the heck with your e submitted to 1. Syste cation: Left front of house, right front of house, left side of house, right side of hou eft ar of hni nhf roar of hni ma loft ciria of hi dirlinn rinhf roar of hi dirlinn i mrler rinrle q-3 � Ue-s+ V4� kbc�-Vk 4u-,A-� City/Town 2. System Owner: Name Address (if different from location) City/Town B. Pumping Record 6 1. Date of Pumping 3. Type of system: ❑ Date Cesspool(s) State Zip Code State � ! Zip Code Telephone Number — 2. Quantity Pumped eptic Tank Gallons ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes D190 If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of _Sy���- 6. System Pumped By: Neil J. Bateson Name Bateson Enterprises Inc. Company 7. Location where contents were disposed: L.S.Q. A Lowell AA(aste)Nater Of F5821 Vehicle Date Number t5form4.doc• 06/03 System Pumping Record • Page 1 of 1