HomeMy WebLinkAboutMiscellaneous - 317 HILLSIDE ROAD 4/30/2018 j - 317 HILLSIDE ROAD D -
J/ 210/025.0-0030-0000.0
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INVOICE Bateson Enterprises Inc. Tel.(617)475-1474
formerly Ray Fortuna
111 Argilla Road • Andover, Mass. 01810
Sold to
SIZE DqSCRIPTION UNIT TOTAL
500
1000
1500
2000 C-1
2500 Q/C
AMOUNT DUE
Received by
o
Tp
BOARD OF HEAL I-Ff 5199
3
146 ','v1A1iN STREET
TELEPRONE9 (508) 688-9540
.4 i'PLICA [ION 11 OR A 8A
OF SUBSURIA CE DISPO').-IL <?-941
(SEPTICSYSTEV)
Pursuant to Section 310 CVI,-' !' .354
of the State EnVil-01Y77el7tal Code, Title V
c.
Address---.
_ 3
Contractor hired for work:
P
7
Name Alone 61�?AW, -l'o
Address V
Date for scheduled abandonment // //,5
The septic system at the above address has been abandoned accor, 'ng to
Title V specifications.
SimattiYe of Co act
Method of septic tank abandoninent (check one). removal sandfill
crush ) other
Name of Offal Hauler
-This form must be returned to the North Andover Board of Health.
PLEASE DO NOT WRITE IN THE SPACE BELOW FOR HEALTH
REPRESENTATIVE'S USE ONLY.
Insp�ctingAgent Dat�
INSTAjTXfIGN C:T1",K LISP LOT
�it(N`� DATE Di SA YitiGy�:D DA XCAVA2'YC1:1 l?K FAT.L M`
easonst
f
dV o'?
MAIL OK
I. Distance To:
a. Wetlands
b. Drains
C. Well
2. Water Line Location
3• Na PPC Pipe_ _
--- _ 4. -.Septic Tank-
a.
ank a. Tees --Length k To Clean Out Covers
b. Cement Pipe to Tank - On Both Sides of Tank
5. Distribution Box n Q
a. Covers &_ Box - No Cracks
b. All Lines FlaAmg Fqual Amounts
c. No Back Flow
6. Leach Field or Trench-
a. Dimensions
b. Stone Depth
c. Capped Ends '
-, ClearyDau e WashedSto eQ
?• L ch Fits ' n
a. Dir- rasions
b. Stone D
c. Saila ads
d. s
Ce.-�t Pipe to Pit - Both Sides
/ /f. Clean Doable Washed Stone
8. No Garbage Disposal
9. Final Grading Inspection
10. Barricading Covered System
11. As Built Subnd.tted
a. Lot Location
b. Dimensions of System
c. Location Stith Regard-to Pere Test
d. Elevations
e: Water Table
Bo&rd kf Health
North' Andov4r,Mass
WBMFACE DISPOSAL DFSIM CHECK LIST
LOT
APPROVED DATE ;24 DISAPPROVED DATE_____„
Provided: Reasons:
Title V FAIL jej
Reg 2.5 submitted plan must show as a minimums
he lot to be served-area,dimensions lot #,abutters
ocation and log deep observation hoes-distance to ties
ocation and results percolation tests-distance to ties
esign calculations & calculations showing required leaching area
ocation and dimensions of system-including reserve area
�dating andproposed contours
ocation any wet areas within 100' of sewage disposal system or
disclaimer-check wetlands mapping
N�,�- ation
face and subsurface drains within IWO of sewage disposal
tem or disclaimer
ation any drainage easements within LOO, of sewage disposal
tem or disclaimer-Planning Board files
sn sources of water supply within 2001 of sewage disposal
tem or disclaimer
of any proposed well to serve lot-1001 from leaching facility
location of water lines on property-101 from leaching facility
location of benchmark
driveways
garbage disposals
no PVC to be used in construction
(q) profile of system-elevations of basement, plumb, pipe, septic tank,
,Anstribution box inlets and outlets, distribution field piping and
then elevations
maximum ground water 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 Sep tic Tanks
(a capacities-150% of flow, water table, tees, depth of tees,
access, pumping
cleanout
]�
K
101 Brom cellar wall or inground ss�Imming pool
(d) 251 from subsurface drains
Reg 10.2 Distribution Boxes
a) slope greater ME 0.08
Reg 10.4 b) sung
SOIL PROFILE & PERCOLATION TEST DATA `
North Andover,Mass. No.&Street Ui g ni= Lot No.
Loc./Subdiv. I&MOLM, Plan Owner 113�1
T
Investigator Observer t, Pr4l u,1Y S'
SOIL PROFILES-DATE
1'
Elev. 6 'Z �' Elev.� 3' Elev. 4'Elev.
y � 3 �
0 0 0 0
2 2 2 2 Ties to Test Pits
3 3 3 3
4 4 4 4
S 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
Percolation Tests-Date
Pit Number 1 2 3 4 S
Start Saturation
Soak-Mins.
Start Test-Time
Drop of 311-Time -
Drop
"-Time -Dro of 611-Time
Mins. lst 3"Dro
Mins. 2nd 3"Dro s
Notes &. Sketches on Back
i
1�
i
SOIL PROFILE & PERCOLATION TEST DATA
North Andov &Stree 4No.
Loc./Subdiv. Plan Owne`
Investigator Observer
SOIL PROFILES-DATE
1' Elev. 2. Elev. 3' Elev. 4-E1ev.
0 �-/.2- 0 0 0
1 1 1 1
Ties to Test .Pits
2 2 2 2
3 /1� 3 3 3 ------
a
4 4 4 4
5 5 5 5
v
6 6 6 6
7 7 7 7
8 8' 8 8
9 9 9 9
10 10 10 10
Benchmark Location
Elevation Datum
Percolation Tests-Date
Date-----
Pit Number 1 2 3 4 5
Start Saturation
Soak-Mins. _
Start Test-Time _
Drop of 3"-Time
Drop of 6"-Time
bins . 1st . 3"Dro
Mins .-.2nd 3"D op
Percolation Rate
Dotes do Sketches on Back
0-6 71r-
'9T� 0Z1-)A,
/leo ,e1-1
00*0
00,0
00*0
00*0
00,0
00,0
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