HomeMy WebLinkAboutMiscellaneous - 311 DALE STREET 4/30/2018 311 DALE STREET
210/064.0-000840000.0
F
-� RECEIVED
Commonwealth of Massachusetts
_
City/Town of North Andover Sc►P U 2 2094
System Punt In Record TOW"OF NOR TIiANDOVER
�
Form
HEALTH DEPARTMENT
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 CMR 15.351.
A. Facility Information
Important:When
filling out forms 1. System Location:
on the computer, 3 i l � ( '0_ 3
use only the tab 1
key to move your Address
cursor-do not North Andover Ma 01886
use the return City/Town State Zip Code
key.
2. Syste�j Owner:
b _
>Y'14n,
4
Name
emm
Address(if different from location)
City/Town State Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping 7 2. Quantity Pumped:
Date Gallons
3. Type of system: ❑ Cesspool(s) [ ' Septic Tank ❑ Tight Tank ❑ Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes ❑ .No if.yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System:
6. System, umped By:
Name Vehicle License Number
Stewart's Septic Service
Company
7. Location where contents were disposed:
Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835
Signature of Hauler Date
Signature of Receiving Facility Date
t5form4.doc-03/06 System Pumping Record-Page 1 of 1
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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 Facill. In '....... :..... ' ��R n 6 2007
ty . formation .
��knkprtsnt:, ..:. :" ., ....:. ': TOWN OF NORJH ANDOVER
s, ,yVtien fillihiout System Location''' HEALTH UEPARTi�:�)JT
°..: star : 611
only the tab key Address
to move your:,'.
curior-do not i:. �C���
;; use the:ietum ` _
'City State Zip Code
key.`: 2 S stem Owner.
t •tJame• ,- £ ;
Aj_a�j
Address(if different from location)
City/1 own; State Zip Code .
9 6Ra
Telephone Number
r 1` Pumping Record: N'
a r Date of Pumping Date 2. Quantity Pumped:
y } :.;.�:.~ ,.' ;, :• Gallons
Typo of system:; ❑ Cesspo'ol(s) M-Septic Tank ❑ Tight Tank'
'Other(describe): -
4 Effluent Tee Filter present?.❑ Yes [ Vo If yes, was it cleaned? ❑ Yes ❑ No
tr
' S" .Conditlon of System r
•.f _ 4, r -
. ,• ''I,' '.,• -U..t i .•..?•�..;r.'..': 1.1.1'• .
6., BY em Pumped By:
MhCI
ti
Namex = Vehicle Ucen�e Number
Company, • ti , J
Location where contents were dipposed:
. ry
LAo`, i u•,,v r'n;r •r. r is ;I �. � /�//�/�qlJ•/ . '•
Date
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System Pumping Record-Page 1 of 1
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INS TRUCTIONS.- This form is used to verify that allnecessary approval/permits from '-
4 . Boards,and Departments having jurisdiction have been obtained. This,does not relieve the
applicant and'or landowner from compliance with any applicable requirements.
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ASSESSORS MAP NUMBER LOT NUMBER
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SUBDIVISION LOT NUMBER
STREETr � STREET NUMBER 3/1
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RECONPAENDATIONS OF TOWN AGENTS
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DATE APPROVED
CONSERVATION ADMINISTRATOR
DATE REJECTED
COIvNffiwTS
I
DATE APPROVED
TOWN PLANNER
DATE REJECTED
CONS ENTS
DATE APPROVED
FOOD INSPECTOR-HEALTH DATE REJECTED
DATE APPROVED. tl
SEPTIC INSPECTOR-HEALTH
DATE REJECTED
C01,9vIENIS 'f� I�� lZ/lam ' /1/C I� 7-/a
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PUBLIC WORKS—SEWER/WATER CONNECTIONS I
DRIVEWAY PERMIT
DATE APPROVED
FIRE DEPARTMENT
DATE REJECTED
COMMENTS
RECENED BY BUILDING INSPECTOR DATE
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This plan was not prepared from an instrument MORTGAGE LOAN INSPECTION
survey. Offsets and distances shown should not LOCATION: 31') DALE ST"
be used to establish property lines. NO ANDOVER MA
This plan is intended for mortgage purposes
only. SCALE: I � = 60 DATE:
I certify that the structure shown on this REGISTRY: NO ESSEX
Plan WA S in conformance with the zoning TITLE REFERENCE: BK 1726 PG 121.
setbacks in effect at the time of construction.
PLAN REFERENCE.: PL-4'- 9067
I certify that the parcel shown is NOT
located within a'flood hazard area as depicted COREY & DONAHUE, INC.
on FEMA Flood Insurance Rate Maps for Engineers&Surveyors
Community No: 250098 198 Cambridge Road,Woburn, NIA'01801
Address , Title of File
C-;0/C
Page of
Date File Open:
--_ Date Me closed:
Doc Document/Action Title
action Date of Refer to other Pur
Document/ pose of 6ocumEnnt/Act of and n�
Num. / tes ---
Action documentDe artment
Ze
grIY)
---------------
------------
Board of Appeals - Board of
Health '- Planning Board ;Cons Commission - buil-ding Departnlent —
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD ':; � bp- QF
e op
DATE
--T- rk BAR
SYSTEM OWNER&ADDRESS SYSTEM LOCATION
Ile
DATE OF PUMPING_ /6 -9 QUANTITY PUMPED
CESSPOOL NO�YES SEPTIC TANK NO YES
NATURE OF SERVICE: ROUTINE 4, EMERGENCY
OBSERVATIONS:
GOOD CONDITION FULL TO COVER
HEAVY GREASE BAFFLES IN LACE
ROOTS LEACHFIELD RUNBACK
EXCESSIVE SOLIDS FLOODED
SOLID CARRYOVER OTHER EXPLAIN
SYSTEM PUMPED BY
02,1
COMMENTS:
F..
CONTENTS TRANSFERRED TO-,),D S, 1
t
ev
r,k "7 7
Commonwealth of Massachusetts
Executive Office of Environmental Affairs
Department of
• i Environmental Protection
William F.Weld
Governor Trudy Coxe
ArQoo Paul Ceilucci LL 1310womor David B.Stru sh
CornmWwrw
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address 31' 0,2(e St"14, V- tq4o.,tt, Irl A Address o[Owner.
Date of Inspection Q 7 (If different)
Name of Inspector. Benjamin C. Osgood Jr.
Company Name,Address and Telephone Number, New England Engineering Services, Inc.
33 Walker Road, North Andover, Ma 01845
CERTIFICATION STATEMENT Tel. 508-686-1768 Fax. 508-685-1099
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
V Passes
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
_ Fails
Inspector's Signature: /4 Date: � 47
The System yio Inspector shall a shared
a copy m this ins on report to the Approving Authority within thirty(30)days of completing this
inspection. If the system is a shared system or has a design flow of 10,000 or m8
report to the a gpd greater,the inspector and the system owner shall submit the
po PPmP��regional office of the Department of Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority.
INSPECTION SUMMARY:
Check A, B, C,or D:
Al SYSTEM PASSES:
I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.30
Any failure criteria not evaluated aindicated below. 3
re
Bl SYSTEM CONDITIONALLY PASSES:
One or more system components need to be replaced or re
paired• The
�pection system,upon completion of the replacement or repair,passes
Indicate yes, no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why sot)
imminent. The system will
The septic tank is metal,cracked, structurally unsound,shows substantial infiltration or exMtration,.or tank failure is
ins
pe ion if the existing septic tank is
by the Board of Health. P replaced with a Fonforming septic tank as approved
(revised 11/03/95)
1
One Winter Street a Boston,Massachusetts 02108 a FAX(617)556-1049 a Telephone(617)292-5500
A
��?Primed on Recycled Paper
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
I I
Property Addr-= 311 Dale Strxtf,, N.
Owner. Patel
Date of Inspection:
17
B]SYSTEM CONDITIONALLY PASSES(continued)
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipes)
or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of
Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is levelled or replaced
— The system required Pumping more than four times a year due to broken or obstructed pipe(s). The system will pass
inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
C1 FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the
public health,safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A
MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT.
— Cesspool or privy is within 50 feet of a surface water
— Cesspool or privy it within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER, IF APPROPRIATE)
DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a
surface water supply.
The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water
-PPIY well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free
from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm.
9) OTHER
(revised 11/03/95) 2
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
I
CERTIFICATION(continued)
Property Addrem 3)1 talc sf,eef- , N- A'00"t'?
Owner. PQ'k K o �ans�t
Date of Inspection: -1 23 97
D) SYSTEM FAILS:
I have determined that the system violates one or more of the following failure criteria as defined is 310 CMR 15.303. The basis for
this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the
failure.
Backupf
osewage into facility or system component due to an overloaded or clogged SAS or cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to as overloaded or clogged SAS or
cesspool.
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation.
_ Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone I of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen.
El LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public
health and safety and the environment because one or more of the following conditions exist:
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located is a nitrogen sensitive area(Interim We Protection Area(IWPA)or a mapped Zone lI of a public
water supply well)
The owner or operator of any such system shall bring the system and facility into full compliance with the d
p groundwater treatment program
�
requirements of 314 CMR 5.00 and 6.00. Please consult
the local regional gl nal office of the Department for further information.
(revised 11/03/95) 3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Addreex 311 O ctl c S j r c e i A/-
Owner. f 4-1
Date of Inspection:
-112 3tQ7
Check if the following have been done: `
V Pumping information was requested of the owner,occupant,and Board of Health.
1_None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates
during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection.
As built plans have been obtained and examined. Note if they are not available with N/A.
✓The facility or dwelling was inspected for signs of sewage back-up.
The system does not receive non-sanitary or industrial waste flow
The site was inspected for signs of breakout.
1/1 All system components,excluding the Soil Absorption System, have been located on the site.
The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baMes or
tees,material of construction, dimensions, depth of.li d,depth of sludge,i
P � P depth of scum.
f The size and location of the Soil Absorption System on the site has been determined based on existing information or
approximated by non-intrusive methods.
✓The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-
Surface Disposal System.
cT ,L-17Dx
(revised 11/03/95) 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address:
Owner. t Strcc�; AI. f�nYo.r+,
Date of Inspection:
I
FLOW CONDITIONS
RESIDENTIAL.
Design clow canons
Number of bedrooms:_
Number of current residents. 2
Garbage grinder(yes or no)-_i4_
Laundry connected to system(yes or no) `
Seasonal use(yea or no): 4(
Water meter readings,if available: 7o w Al t v ATE/L
Last date of occupancy:
COMMERCIALANDUSTRIA - -
Type of establishment:
Design Ilow:_pllons/day
Grease trap present: (yes or no)_
Industrial Waste Holding Tank present: (yes or no)_
Non-sanitary waste discharged to the Title 5 system: (yes or no)_
Water meterreadings, if available:
Last date of occupancy:
OTHER(Describe)
Last date of occupancy-.
GENERAL INFORMATION
PUMPING RECORDS and source of information:
992 Pei- c.—n t/—
System pumped as part of inspection: (yes or no)--dr 5
If yes,volume pumped: /.Sa ' ons,
Reason for pumping: 7'z:,
j TYPE OF SYSTEM
_ Septic tanWdistribution box/soil absorption system
Single cesspool
Over low cesspool
Privy
Shared system(yes or no) (if yes,attach previous inspection records,if any)
Other(explain)
APPROXIMATE AGE of all components,date installed(if known)and source of information:
Sewage odors detected when arriving at the site: (yes or no)Lv
(revised 11/03/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 31( o+<< S�at e C; AJ. f�.•9�veR
Owner.
P"-1Date of Inspection: Ko c�sr�s In
SEPTIC TANK_
(locate on site plan)
Depth below grede:�
Material of construction:Zwncrete metal_FRP—other(explain)
Dimensions. a �GON S
Sludge depth: 2
Distance from top of sludge to bottom of outlet tee or baffle: Z1
Scum thickness: < 1 "
Distance from top of scum to top of outlet tee or baffle:_7
Distance from bottom of scum to bottom of outlet tee or baffle: 2S
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage,etc.) 719n!K 15 1 A/ L:-co O c o...,!>i T74)N S NOvi- H 41 o E 21S 1x✓C S
v+�1NIN h�` ai�l�f�tJrSF/ [-r/LItOC' D.'t elf 7��te op�i,�nas
GREASE TRAP:_
(locate on site plan)
Depth below grade:
Material of construction: concrete_metal_F1tP_other(ezplam)
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage,etc.)
(revised 11/03/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 311 Dede N• 6.1000ek
Owner. Ra.t K.A'P.,X'
Date of Inspection:
�I t3lri7
TIGHT OR HOLDING TANK_
(locate on site plan)
Depth below grade:
Material of construction:_concrete_metal_FRP—other(explain)
Dimensions:
Capacity: gallons
Design flow: gallons/day
Alarm level:
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
DISTRIBUTION BOX:_
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of bo:,etc.)
Lion N w1 /-T
^� 0 4_
PUMP CHAMBER:_
(locate on site plan)
Pumps in working order:(yes or no)
Comments:
(note condition of pump chamber,condition of pumps and appurtenances,etc.)
(revised 11/03/95) 7
• f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address; 3 it Dole
Owner. ?.-A vl+
Date of Inspection: 41 L 3 1 y 7
SOIL ABSORPTION SYSTEM(SAS):_
(locate on site plan, if possible;excavation not required,but may be approximated by non-intrusive methods)
If not determined to be present,explain:
Type:
leaching pits,number:_
leaching chambers, number:_
leaching galleries,number-
leaching
umberleaching trenches, number,length:
leaching fields, number,dimensions:__/ IGI L LU SS X Z n
overflow cesspool, number:
Comments:(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetatiometc.)
lc 71 e & ✓,*T .9 K IV A/?,-A 1.1,o a e'A"- 7?> d s -,&f
ny& I n.t Tv c.ib a E cJ N-0 . �- lam✓AS CLi%/9•y cxyr !�
CESSPOOLS:_
(locate on site plan)
Number and configuration:
Depth-top of liquid to inlet invert:
Depth of solids layer.
Depth of scum layer-
Dimensions
ayerDimensions of cesspool:
Materials of construction:
Indication of groundwater:
inflow(cesspool must be pumped as part of inspection)
Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
PRIVY•_
(locate on site plan)
Materials of construction: Dimensions:
Depth of solids:
Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
(revised 11/03/95) 8
F
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: _3)1 NJ- Sties+ N.
Owner.
Date of Inspection:
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references Landmarks or benchmarks
locate all wells within 100'
pt
f �
156- GALw.- ,TRyI�
N 37
zoc O _ �Uc 1Mu n t= QOK ?E2
Aro,N
P #, F}s- a� LT Hs- �i.' LT. H c L t w&15, O v G..
k,:TK l� P�dcKkaL
SQ—1 A.b
Sac w R5 F�JND.
99-" .
{
srREt-T-
DEPTH TO GROUNDWATER
Depth to groundwater. 8 feet / r
method of determination or approximation: ekl-
B4s e LL
...
1
(revised 11/03/95) 9
T WN F NORTH ANDOVER
S STJ PUMPING RECORD -
DATE 'aS r y ADT J'�09'' i A�
SYSTEM OWNER&ADDRESS SYSTEM LOCATION t
Al rle4s
311 pa-le
DACE OF P[IMPING:— aS:_O_�/___QUANTITY PUMPED:
CESSPOOL: NO
_--_-- -�.-_- Septic Tank: NO YES t�
NATURE OF SERVICE: ROUTINE /EMERGENCY
OBSERVATIONS:
GOOD CONDITION FULL TO COVER
HEAVY GREASE -- — BAFFLES IN PLACE. ^-
R.00TS LEACH.FIELD RUNBACK.-�
EXCESSIVE SOLIDS FLOODED
SOLID CARRYOVER �OTHER EXPLAIN
System Pumped by
COMMENTS:
CONTENTS TRANSFERRED TO
—S
observed elevations:
Ho. sill; 193-00
110, inv. out; 189.00
tank. inv. in, 188.87
tank inv. out; 188.48
-Y"ic Dbox inv. in: 184.91
perf. pipe (bed) :184.65
drive @ bed: 1811
Note; Benchmark used: rim, C.B.
C Lot #3B el. 181.81
t4..
"AS BUILT" PLAN OF SANITARY D7,SPOSAL
SYSTEM, LOT #2, DALE STREET
NORTH ANDOVER, MA.
OWNER: ZACHARY REALTY CORP.
-13 6-5-0 967 rV
27
0 PLAISTOW, N.H.PLAN REF. #9067, NORTH DISTICT REG.
by KAT1aNSKYj GELINASs & ASSOC.
NORTH ANDOVER, MA.
0 observations & measurements (this plan)
o by D.L. Roulston n.s.p.s. & J.Risdon
for
Engineering Research Services
20 Alfred Drive
Salem, N.H. 03079
o
scale: 111= 401
20 Sept. 1983
Fin
I do hereby certify that all elevations and
locations conform to the facts as, existing
in the field on the above date.
LZ
Z
{
✓ b�`
Board of Health BgpnC SISTEH
North Anooveriass.
INSTALLATICK CHBCK LIST LOT
OV-ED gT MUPPROVED DATE AVATION Og FAIL
!i Get G "i easonst
FAIL OK =
1. Distance Tot
a. Wetlands
b. Drains
c. Well
2. Water Line Location
3. No PVC Pipe
4. Septic Tank
a. _Tees --Length & To Clean Dut Covers. .
b. Cement Pipe to Tank On Both Sides of Tank
5. Distribution Box
a. Covers k Box - No Cracks
b. All Lines Flowing Bqual Amounts ,
c. No Back Flow
6. Leach Field or Trench
a. Dimensions
b. Stone Depth
c. Capped ids
d. Clean Double Washed Stone m
7. LYPi
a. s
b. th
c. ds
d.e. e to Pit - Both Sides.
f. Clean Double Washed Stone
8. No Garbage Disposal
9. Final Grading Inspection
10. Barricading Covered System
11. As Built Submdtted
a. hot Location
b. Dimensions of System
c. Location with Regard-to Pere Test
d. Elevations
e: Water Table
SUBMFACE DISPOSAL D-'.SIGZ Chz2l: LIE'
LOT
APPROM DATE__ DISAPPROVID DATE___.___
Provided: Reasons:
Title V FAIL Cb T�'T P/%T I OF �h�fi.7.=-WVc: SIzS'li'3
Reg 2.5 The submitted plan mist show as a minimum:
the lot to be served-area,dimensions lot #,abutters
location and log deep observation Mes-distance to ties
location and results percolation tests-distance to ties
d design calculations & calculations showing required leaching area
e location and dimensions of system-including reserve area
existing and proposed contours
g) location any suet areas within 100' of sewage disposal system or
disclaimer-check wetlands mapping
surface and subsurface drains within 100' of sewage disposal
system or disclaimer
(i) location any drainage easements within 100' of sewage disposal
system or disclaisrer-Planning Board files
3) known sources of water supply within 2001 of sewage disposal d
system or disclaimer
k location of any proposed well to serve lot-1001 from leaching facilit;
cation of water lines on property-10' from leaching facility
K
cation of benchmark
iv�eways
.t
age disposals
no PVC to be used in construction
(q) profile of system-elevations of basement, plumb, pipe, septic tank,
distribution box inlets and outlets, distribution field piping and
Other elevations
rs
) maximum ground water elevation in area sewage disposal system
) plan must be prepared by a Professional Engineer or other
professional authorized by law to prepare such plans
Reg 6 Septic.�Tanks
a) capacities-150% of flow, meter table, tees, depth of tees,
access, pumping
cleanout
c 10I from cellar wall or inground swimming pool
25+ from subsurface drains
Reg 10.2 Distribution Boxes
greater 0.08
Reg 10.4 �Yslope
) sump
f'e1c r' �rim Check Li c;t P, ,-e 2
�±-
F' CK
Leaching Pits
Leaching pits are preferred where the installation is possible
Reg 11.2 a) calculations of leas g area-rd nismzm 500 sq ft
11.4 b) spacing
11.10 c) surface 2i6�
11.11 d) cover mate
e) klx2tx n lash pad
f) tee a elbow
g) no ds in pipe from d-box to pipe
Leaching Fields
Reg 15.1 no greater than 2o mutes/inch
area-minimum 900 aq ft
15.4 c construction of field
15.8 surface drainage 2 %
3.7 e) 20 T Brom cellar van or inground s imting pool
Leachin $'LEne
Reg :L4.1 a) c cuons eaching area-min 500 sq ft
U.3 b) spacing-4 t min 6 ft with reserve between
1.14..4 c) dime
14.6 d) cons ction
3-4.7 1 e) s ne
1.4.10 f) surface drainage 2%
Downhill. Slop e
Lope y x = rto, be shown)
b) y/x Z 150 = (to be shown)
Reg 9.1 kbb),-MFtan�d-by
9.6 ower
i.
'-.
JI
Ul
A,v
- Itd) 1
'Zi 0
vi
Ol
SOIL PROFILE & PERCOLATION TEST DATA
North Andover, Mass. Street No ��<<-` S� Lot No
Loc/Subdiv. Pland Owner ZsK . WlA
Investigator G'✓.5/-1i.NGs Observer
SOIL PROFILE DATES
l.'El.ev 2.Elev 3.Elev 4.Elev
0 0 0 0
1 1 1 1
Ties tro 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 L 7
'2rcFc�Sd c_
8 Wo 8 8 8
9 9 9 9
10i. 10 10 10
Benchmark Location
Elevation Datum
PERCOWION TESTS
DATES
Pit Number 1 2 3 4
Start Saturation
Soak-Minutes
Start e
Drop of 3"-Time
Drop of 6"-Time
Mmms-lst 3" drop -
Mins.2nd " Drop
Percolation
RICHARD F. KAMINSKI AND ASSOCIATES, INC.
IENGINEERS•ARCHITECTS •LAND PLANNERS •SURVEYORS
451 ANDOVER STREET
NORTH ANDOVER,MASS.01845
TELEPHONE 687-1483
June 1, 1983
Mr. Michael Rosati
Inspector
North 'Andover Board of Health
Town Hall
Main Street
North Andover, MA 01845
Re: Soil Testing, Lot 2 Dale Street,
North Andover, MA
Dear Mr. Rosati :
As you requested, I am enclosing a copy of . the subsurface disposal
system plan for lot 2 Dale Street, which had been tentatively
approved by the North Andover Board of Health, along with a copy
of the soil log obtained as a result of the testing performed by
me and witnessed by you on May 25, 1983. As you will note from
the enclosed soil log, the spring high water table refusal,, as
measured April 25, 1983, is 7 feet, as was originally estimated.
Would you please inform me, at your earliest convenience, as to
the status of this lot relative to the Board of Health Rules and
Regulations.
Sincerely,
Richar F. Kaminski and Associates, Inc.
J eph B. Cushing
vironmental Biologist
Enclosure
cc: Zachary Alexanian
JBC/j t
=oh_.,/C�t.YJ ot ivo.
S'.3bgiviSion D1ar_
Own iZ-0 s'
Investigator I/hi Observer
i
SOIL PROFILES Date:
1. Elev. ; 2. Elev. 3 . Elev. 'e . Elev.
2 + 2 2
2 t
+ I
- i
i
5 5 5 5 •
8 i
I
10 --- — 10 10 -- - ,
I'er,ch7,arx Location 4, 10
levation Datum.
PERCOiITTON T .STS Date :
' uw,:oer 1 2 3 4 S
t Saturation ---
!4-i ns. 1
est - Ti,:+e l I ! I —
ff
f 3" -- Time
L C-I. -
3"
-3" Drop ! t
btf6-�- 7'v D-ICU
l�
Z
t
• �GAO
a �G\
�=c
I
WATERSHED RESIDENTS QUESTIONNAIRE
1. Name .1, - ' Z-ALa_seV,
�'
2. Street Address
&/// S/ G leh�o y-6 /',Z-
O3. How many members are in your household?
4. What type of sewage disposal system do you have?
❑ cesspool
Kseptic tank and leaching area
❑ connection to municipal sewer
❑ other (describe)
❑ do not know
5. Are the plans (drawings) f r our sewage disposal system on file with the Board of Health?
❑ yes ❑ no X.
do not know' -
6. How old is your sewage disposal system?X 0-5 years ❑ 6-10 years ❑ 11-20 years
❑ over 20 years ❑ do not know
7. Has your sewage disposal system been rebuilt or repaired?
❑ yes X no ❑ do not know
If yes, approximately how long ago? years. What was done?
1
8. How frequently is your sewage disposal system pumped out? ❑ annually
❑ every 2-4 years ❑ every 5-10 years ❑ over 10 years never
9. Have you had any problems with your sewage disposal system? ❑ yes )K/no
1 If yes, what problems?
❑ repeated pump-outs needed
❑ system clogs, backs up, or drains slowly
❑ odors
❑ sewage surfaces through ground
10. How many of each appli nce are connected to your sewage disposal system?
washing machine dishwasher X— garbage disposal
dehumidifier drain sump pump toilet
roof/pavement drains shower/bathtub
11. Please state the b and an ty (liquid or powder) of detergent you use for:
I dishwasher
clotheswasher C
f12. Does your property have a lawn? yes ❑ no
If yes, approximately what size?
❑ less than 1/4 acre ❑ 1/4 acre ❑ 1/2 acre ❑ 3/4 acre 1 acre
4 ❑ more than 1 acre (Specify) acres
I 13. How often do you fertilize your law ?
No. of applications per year,
i
Season(s) of the year f 1C
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
Check here if your lawn is maintained by a professional landscape contractor.
i
i
.SEPTIC SYSTEM INSPECTION FORM
ADDRESS � I �
,DATE INSPECTEDQ
PROPERLY FUNCTIONING? N
WEATHER CONDITIONS
COMMENTS :
r
14A i ER QUALITY TES r tb r.' l'ESOLTS? �
DYE TEST PERFORMED? Y N
DATE?
SKETCH:
r
lj ature of Service
( l 'ti,
ASP Reg.Maint.
❑ N/C
Emergency
ANDOVER SEPTIC PUMPERS ;^ay ❑ Night
/rof S:z
�-- PAY FROM THIS SILL
Customer Name'
P.O. Box 4173 B Station
Service Location: / Andover, MA 01810
1 1
Phone: L (508) 475-2593
Contact: Professional Septic & Drain
Billing Address: Locally Owned and Operated
City: zip: Emergency 24 Hr. Svc. — 7 Days
Special Instructions Completed u
❑. incomplete 'Rea ns.
Per: •• II
AM/PM YG'17/.�/N
Services Rendered ^ / \
Vacuum Pumping servation Drain Cleaning
Septic Tank / Good Condition ❑ Main Line
Drywellf-keechfield Runback/Q) ❑ Toilet Bowl
❑ Leech Pit/Overflow ❑ Riding El Kitchen Sink
❑ D-Box (liquid level ❑ Batht b/Shower
❑
❑ Full to Cover (77
Pump Chamber /Le�� #91t r
El Grease Trap r '` ❑ Excessive Solids�S �� J Floor Drain
O Catch Basin ` Top/Bottom-.Iqv ED Yard Drain
O Portable Toilet ❑ Use No P ;�rdered Soap ❑ Vent /
❑ Other t - t-Heavy,Grease
El Sewer Jet
Qt I'. i ir'_' =Roots
❑ Other
Qty:
Size: �,.,.. --'" � ❑ Suggest Electric Footage:
❑ Under 1000 gallons ❑ 1000 gallons 1500 gallons 'Rootedng
❑ 2000 gallons ❑ 3000 gallons ❑ 4000 gallons ❑ Van Called
❑ 5000 gallons ❑ other ❑ Other >,
Misc. yr
O Digging Charge ❑ Backhoe ❑ Inspection
El Location firs.
❑ Consultation El Certification: P/F
❑ Service Call ❑ Estimate Reason:
❑ Labor ❑ Portable Toilet Rental ❑ Pump Repair
❑ Waiting Time ❑ Baffle ❑ Repair
' Digging Charge Is Per Driver ❑ Chemical Treatment
Discretion
Description of Work 1, /
Recommendation
Vacuum Pum in i Er, Parts
9 Drain Cle Hing - 5 D��yS Tax
Month Yr. r�I
& Conditions E] Cash ck ❑Credit D" nt
1. No responsible for damage beyond curb line. 3. 1.15%per month will be charged to accounts past due.
2. A complaints shall be reported thin A$ urs.n 4. a purchaser agrees to pay all cost of-collection.
1116 undersigned agree to rrms ' "C '(t o
Customer Signature / !� ih,//�" /�� erviceman.
Commonwealth of Massachusetts .
City/Town of NORTH ANDOVER MASSAC USURPED �
System Pumping Record
Form 4
DEP has provided this form for use by local Boards of Health. The F�NO P1:H R st
be submitted to the local Board of Health or other approving auth— Y.
A. Facility Information
Important:
When filling out 1. System Location,
forms on the + .
computer,use 1
only the tab key Address (ICA
to move your yV/``'
cursor-do not City/Town State Zip Code
use the return
key. 2. System Owner:
Name
IGS Address(if different from location)
City/Town State Zip Code
Telephone Number
B. Pumping Record
1. Date of dumping Date 2• Quantity dumped: i50
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. S stem Pumped By,
me L� Vehicle License Number
Company
7. Location re contents were di posed: /�
QX
Si ature of Hauler Dat
http://www.mass.gov/dep/water/approvals/t5forms.htm#inspect
t5form4.docc 06/03 System Pumping Record•Page 1 of 1
s.
Commonwealth of Massachusetts
w City/Town of No.Andover
System Pumping Record
Form 4
4M
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 CMR 15.351.
A. Facility Information
IVL
Important:
When filling out 1. Loc bon:
System
forms on the y Y Nil
computer, use
only the tab key Address N Nq A
to move your No.Andover Ma HEALTH TMENT
cursor-do not
use the return City/Town State Zip Code
key. 2. System Owner:
Name a—n± ct, 0S
'efA7 Address(if different from location)
City/Town State Zip Code
Telephone Number
B. Pumping Record _
1. Date of PumpingDate ' 2. Quantity Pumped: gallons
3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System:
C"7—)cco(
6.([5 ystem Pum e1!-fy�
Name 1 Vehicle License Number
Stewart's Septic Service
Company
7. Location where contents were disposed:
Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835
Signature of Hau Date _ l
Signature of ec V ing Facility Date
t5form4.doc•03/06 System Pumping Record•Page 1 of 1