HomeMy WebLinkAboutMiscellaneous - 320 BOXFORD STREET 4/30/2018 (2) 320BOXFORD STREET 1
/ 210/104.8-0013-0000.0 \\
APPLICATION FOR SEWAGE DISPOSAL INSTALLATION
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HEALTH DEPARTMENT - NORTH ANDOVER, MASS.
I hereby maNp app1' tion fora parmit for a sewage disposal installation at
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I will install this system in ac-
cordance with all the laws f the Commonwealth of Massachusetts and regulations of
the Board of Health of the Town of North Andover.
Further, I will construct the house sewer of bell and spigot pipe, the minimum
diameter being 4 inches, and will maintain a minimum grade of 1/ until 10 feet pre-
ceding the septic tank, where the grade shall not exceed 2%. I will install a con-
crete septic tank of /tea -fl in size. A manhole (s) permitting easy cleaning
will be provided with emovable cover (s) of iron or concrete within 12 inches of
the ground surface. I will provide subsurface disposal field with 4 inch perforated
or open jointed pipe and laid in a series of trenches, the bottom of which will pro-
vide a minimum of _---c lineal (square) feet of effective absorption area.
The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging
in size from 3/4 to 1-1/2 inches (dia. ) and the pipes will be surrounded by similar
material to a height of 2 inches above the crown of the pipe. The joints of these
pipes will be protected from clogging and before filling the trench, 2 inches of
gravel or stone 1/8" to 1/4" (dia. ) will be placed over the course gravel or stone.
The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single
the line will exceed 100 feet in length and in any case, two lines of tile will be
installed. A minimum of 6 feet will be maintained between the center lines of the
disposal field trenches and the average depth of trench shall not exceed 36 inches.
No part of the installation will be less than 100 feet from any private water supply,
25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line.
I further agree not to cover any portion of this installation until approved by the
inspection officer, as provided below, and to incorporate any additional requirements
that may be attached to the permit. Plot Plans must be submitted with application.
DATE_ �/—/
I J' _e�a�
Signat, of Applicant
I hereby issue the above permit for the Board of Health of the Town of North
Andover, Massachusetts.
DATE
Signature of Health Agent
I have inspected the uncovered system indicated above and find everything done
as described.
DATE__ / _ �� of
IIJAR
Signature o nspecting Office
LPercolation Test ;
Garbage Grinder
BOARD OF HEALTH
TOWN OF NORTH ANDOVER, MASS.
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1. NAME TO HN S k VIC!j6 DATE
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2. ADDRESS d X"o'E s s/ / , 3 p2C`� TEL. 68-3. 90 5
3. NO. OF BEDROOMS DEN YES NO
4. GARBAGE GRINDER YES v" NO
5. SHOW DIMENSIONS OF HOUSE
6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES
7. SHOW DIMENSIONS OF LOT
8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL
9. NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM
10. SHOW LOCATION OF BROOKS, STREAMS, DITCHES, LEDGE OUTCROP, ETC.
11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE
NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY.
702 FA,e 4voO0 )9 t /lo- 9�srDa��-2
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BOARD OF HEALTH OF NORTH ANDOVER , MASSACHUSETTS
SEWAGE DISPOSAL
DATE
NAME OF APPLICANT
JA_4A-
LOCATION 2Zt�
Address of lot r
o,
BUILDING: Dwelling X Other
SYSTEM: New Repair
GENERAL DESCRIPTION OF LAND
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SUBSOIL: Clay ?� lavel Sand
PERCOLATION TEST 4 minutes per inch.
MINIMUM INSTALLATION RECOMMENDATIONS
CONCRETE SEPTIC TANK &-A- gallon capacity,
LEACH FIELD �_ lineal feet of drain pipe,
William J. Dr' s o , Engineer
Board of Heal
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7. Sy:tem Pumping Record Page 1 or t
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Date File Open: Date file closed:
Doc Document/Action Title Date of Refer to other Purpose of Docume�nt/Action and notes
action Document/ document/
Num. Action Department
Board of Appeals — Board of Health — Planning Board — Conservation Commission — Building Department
WELL OWNER RESPONSE CARD
My private drinking water well is within 100 feet of a right-of-
way and I request that my well location be incorporated in the
operating plan of herbicide applicators who maintain the corridor.
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TYPE OF RIGHT—OF—WAY: 'ecA
NAME of WELL OWNER:
LOCATION OF WELL
(Street Address )
SIGNED:
IF AVAILABLE PLEASE COMPLETE THE FOLLOWING INFORMATION: Is
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Well Depth: P?b feet
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Installation Date:
, G
Distance Between Well Head and Edge of Right-of-Way: S feet � E
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WELL. DATABASE
ADDRESS:
AGE OF W_L_r : __Ail-" WELL DRILLER: 7
�v�I.L PE.�tiFiT.T: Z; WELL LOCATION:
-- -VF.LL PERRMET DATE: E --- DEPTrI OF
-TYPE OF WE•i..L.: a_ DRILLED b. DAG c UNKNOWN -
TYPE OF WATT HE`4RIGr ROCK: _.
WAgR AHALYSIS DA1� IG'H of ANGANESE:. Y
- N —--
HIGET IRON:. Y N GTE=CO. A� ,AIT :- Y N
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WELL:DATABASE
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ADDRESS: '01
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AGE OF WELL: WALL DRILLER
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WELL PERMIT T: WELT, LOCATION:
WELL PEERZ�ET DATE: D,IPTH OF WE LL:
TYPE OF WELL: a-. DRELLE b. I uG c. UNFILNNWN
TYPE OF WATER BEARING ROCK�j
WATER ANALYSIS DATE: HIGH NIANGA�,MSE: Y N
HIGH IRON: Y N �/J OTHER CONTA v2 ANTS: Y N
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FRECEICommonwealth of Massachusetts �' 2010
City/Town of NORTH ANDOVER MASS E,ER
System Pumping Record
Form 4
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. Facility Information
Important;
When filling out 1. S"M_Lpaj,
tion:
forms on the
computer,use
only the tab key Ad
to move your
cursor-,do not /Town
use the return CI ty State p Code,
key.,. 2. Sycilkhm Owner
Name
Address(If different from location)
Cityrrown State Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumpingnor4
Date ro 2. Quantity Pumped: Gallons
3. Type of system: . ❑ Cesspool(s) EKseptic Tank ❑ Tight Tank
Other(describe):
4
4. Effluent Tee Filter present? ❑ Yes ❑ No If yes,was it cleaned? ❑ Yes ❑ No
5. Condition of System:
6. System Pumped By:
Fr
' ���-�„ �,•� y�__�"1 ,..��1 �ehl a License Number
CompanyyT-
7. o tlon wh o0 ten Were disposed:
<�� gri
gnature o Hauler Data
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