HomeMy WebLinkAboutMiscellaneous - 328 SUMMER STREET 4/30/2018 (2)00
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Commonwealth of Massachusetts
CitylTown of V -
System Pumping Record
Form 4 jUL Z010
DEP has provided this form for use by local Boards of Heal T MPfdt�'iSTffi=1,
butthe
information must be, substantially the same as that provided check with your
local Board of Health tQ determine the form they use. The System Pumping Record must be submitted to
the local Board of Health or-otl r approving authority.
A. Facility Information _
1. System Location: Left side of house, Right side of hotLeft front of hous , fight front of house,
Left rear of house, Right rear,of house. Left rear of building. Right rear o ui ding.
Address 1-- a a
Cityrrown
2. System Owner.
Name
Address (if different from location)
City/Town
State
Zip Code
Stat
Telephone Number '
B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped: 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. Condi ion � rSys�em-
c.
6. System Pumped By:
Neil Bateson
Name
Bateson Enterprises Inc
Company
7. Location -where contents were disposed:
/G/.L.S.,Q�)4 4 L w aste Water
Signature
t5form4.doc• 06/03
F5821
Vehicle License Number
Date
System Pumping Record • Page 1 of 1
Commonwealth of Massachusetts
City/Town of RECEIVE®
System Pumping Record �QN to 2013
Form 4
PVf\ 9'f.Ylwv
DEP has provided this form for uselby local Boards of 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 / i o , Left/ Right rear of house, Left /right side of house, Left /
Right side of building, Left / Right front of building, Left / Right rear of building, Under deck
Address
�� C'Suw�v�- -
City/Town State
2. System Owner.
Name
Aaaress (it citterent from location)
Cityrrown
B. Pumping Record
1. Date of Pumping
3. Type of system: ❑
❑ Other (describe):
Zip Code
l Code
Telephone Number
a -76—c3
Date 2• Quantity Pumped;
eptic Tank
Cesspool(s)
/"-4:: �- e�
Gallons
❑ Tight Tank
4. Effluent Tee Filter present? ❑ Yes - No If yes, was it cleaned? ❑ Yes ❑ No.
5. Conditi&k- \
on of $ A `M p ek L, V�
6. System Pumped By:
Neil Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7. Locati n where contents were disposed:
Lowell Waste Water
-A3
iule4 j Date
t5form4.doc• 06/03 System Pumping Record • Page 1 of 1
Com tnonwealth of Massachusetts
l��_ Massachusetts
System Pumping Record
System Owner
At
I�
System Location
Date of i'umping: �� '��Lc.� Quantity Pumped: �� ' gallons
Cesspool: No Yes L._l Septic Tank: No Yes
System Pumped by: Fare -dart Srme7Alaed License #
Contents transferrred to : Greater Lawrence Sanitary District
Date:
Inspector:
Town of North Andover, Massachusetts Form No. 2
f NORTIy BOARD OF HEALTH j
c cJ 0,0 6
16.
w
°• °-�= ;r' DESIGN APPROVAL FOR
sSACHUSEt SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
Applicant 1A/e ',(�Lsr6x) Test No. 80�
Site Locationy`10`�� Cgu (/k?e-e'
Reference Plans and Specs. J� B - 44tA
ENGINEER DESIGN DATE
Permission is granted for an individual soil absorption sewage disposal system to be installed
in accordance with regulations of Board of Health. /
CHAT AN, BOARD OF HEALTH
Fee —..
Site System Permit No. yS
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Town of North Andover
OFFICE OF
COMMUNITY DEVELOPMENT AND SERVICES
30 School Street
North Andover, Massachusetts 01845
WILLIAM J. SCOTT
Director
September 5, 1997
J. B. Lanagan Engineering
433 Cross Road
North Dartmouth, MA 02747
RE: 328 Summer Street
Dear Jim:
This is to inform you that the proposed plans for the site referenced above have
been approved with the condition that maintenance requirements for the pump
be added to the plan and communicated to the homeowner.
If you have any questions, please do not hesitate to call the Board of Health
office at the number below.
Sincerely,
A A
Sandra Starr, R.S.
Health Administrator
Cc: Wm. Scott, Dir. PCD
Nancy Weston
File
C:C!A?SLeVATInN rFgg_9s3n TTPALTH 688-9540 PLANNINC 688-9535.. .
...........
O p
s i X
APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT
DATE: 9 , S 'q!] CURRENT INSTALLER'S LICENSE#
LICENSED INSTALLER:.F,IP—
SIGNATURE:0_, a. k4 TELEPHONE#
CHECK ONE: 0
REPAIR: NEW CONSTRUCTION:
IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS -BUILT.
U f 1 -p,
Ey, 5 i �-
$75.00 Fee Attached?
Foundation As -Built?
�Aocs5-a
Administrative Use Only
Yes No
Yes No
Approval Date:
NORTH ANDOVER BOARD OF HEALTH
DESIGN REVIEW REPORT
DATE 7/7IgI
FEE: S$loa� PERMIT ## 9S� DATE RECEIVED C� /" A97,
APPLICANT /VAJ46 y Z�JC57a/l MAP PARCEL
ADDRESS 3�� 5y/yiy ST LOT ## STREET ## 23,98
ENG. �A/V�GA/i� STREET '30ftlM6e 5-7-
ENGINEER'S
TENGINEER'S ADD. 4,31 1. eo,5s -7�a b AeT1y?0UT11 697,47'
PLAN DATE 4 18/97 REV. DATE
CONDITIONS OF APPROVAL
APPROVED DISAPPROVED X
REASONS FOR DISAPPROVAL:
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REVIEW CONTINUED
SHEET a2- OF
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�C.' Zt)M- 5CGTl
PLAN REVIEW CHECKLIST �,
0DRESS .399- -suppa S5 ENGINEER J! M Z,4t)A61 `/"N)
3ENERAL
3 COPIES STAMP V LOCUS NORTH ARROW SCALE
.ONTOURSPROFILES (Sc).. SECTION BENCHMARK SOIL &
?ERCS `� ELEVATIONS, WETS. DISCLAIMER WELLS & WETS
JATERSHED?A�Q DRIVEWAY WATER LINE X FDN DRAIN M&P —
�CH40 TESTS CURRENT? SOIL EVAL -J . 41 V/46,41J
SEPTIC TANK
'IIN 150OG .17 INVERT DROP ✓ GARB. GRINDERT(2 comps +200)
I' T F N :✓ NH '� f v
0 0 D MA OLE ELEV GW # COMPS. GB
D -BOX B�
SIZE # LINES FIRST 2' LEVEL STATEMENT "
INLET �DI I a� - OUTLET Ib A = 117 ( 2" OR .17 FT) TEE REQ' D? i�-5
LEACHING
MIN 440 GPD? RESERVE AREA --- 4' FROM PRIMARY?� 20 SLOPE
100' TO WETLANDS '� 100' TO WELLS ✓ 4' TO S.H.GW--�( (5'>2M/IN)
20' TO FND & INTRCPTR DRAINS'&--`- 400' TO SURFACE H2O SUPP 4--".
4 PERM. SOIL BELOW FACILITY C--' MIN 12" COVER 6--- FILL? (15')
BREAKOUT MET?
TRENCHES
MIN 440 gpd
W OR D (MIN 6')
BE 10' MIN.
SLOPE (min .005 or 611/1001)
RESERVE BETWEEN TRENCHES?
4" PEA STONE? VENT?
BOT + SIDE
(L x W x #)
:opyr 1 9 h t �) 1996 by S.L. Starr
(DxLx2x#)
SIDEWALL DIST. 3X EFF.
IN FILL? MUST
(>3' COVER; LINES >50')
X LDNG = TOT
(G/ft2)
PITS
MIN 440 LEACHING
GW MIN 4' BELOW BOTTOM
MIN 1 (13'x16') PIT
EXC 2x EFF W OR D
MANHOLE/PIT
12"-48" STONE
BOT + SIDE x LOAD = TOTAL
(L x W x ##) (2x(L+W)xD x #) (G/ft2)
CHAMBERS
MIN 440 LEACHING GW MIN 4" BELOW COVER >3 FT - VENT
MANHOLES 12"-48" STONE SPLASH PADS SLOPE .005
BED/TRENCH (Bed max. 60' X 601) MIN 13' X 16' PIT
BOT + SIDE X LOAD = TOTAL
(L x W x ##) (2 x (L+W)xD x ##) (G/ft2)
FIELDS
MIN 440 GPD L 900 ft2 BED GW MIN 4' BELOW BOTTOM OF FIELD
PIPE ENDS JOINED?_,�� 4" PEA STONE?� DIST LINE SLOPE .005?
>31COVER-VENT SCH 40 MIN 12" COVER f
RATE /" / ( 40_ X a.Q ) X S6 = TOTAL 446 r 4 ro 411 SC N
L W LDG
DOSING TANKS AND PUMPS
DIMENSIONS X X = PUMP CAPACITY <610gpm
L W D Vol.
DISCHARGE SIZE DISCHARGE RATE �6
\ gpm
MANHOLES TO GRADEALARM SEP. CIRC
inlet) HWL /b1.0 LWL 16166 CHECK VALVF�
OP. SWITCH ENUF STORAGE?7 &-TDH
t (�" 0 Jr
Copyright 0 1996 by S.L. Starr
DISCHARGE TIME
GW '(Min. 1' below
BLEEDER HOLE: MANUAL
WEIGHTED? C��—
No
FEE
COMMONWEALTH OF MASSAC14USETTS
Board of Health, 14. AtJDQgCV.- , MA.
APPLICATION FOP DISPOSAL SYSTEM STEM CONSTRUCTIO PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade{i Abandon( ) - ❑ Complete System ❑ Individual Components
Location 32,16 Sr. VAM£i2 37-
Owner'sName W hN C.Y I.A Xs [.cs ,- J
Map/Parcel# MAP LO 7,1 4Z7 160
Address CaA
Lot#
Telephone#
Designer's Name �,j e lVrAIW&2/f\/<i
Installer's Name
Address
Address U33 C12.Q SS (ZD• IJo (�h27 O(�Zi
Telephone#
Telephone# SVG 7841�-1666
Type of Building IZq 5 t Q LN "l tit— Lot Size
Dwelling - No. of Bedrooms q
Other - Type of Building
Other Fixtures
No. of persons
sq. ft.
Garbage grinder, M0
Showers ( ), Cafeteria ( )
Design Flow (min. required) 41 Ll(i gpd Calculated design flow 4l LiO Design flow provided 4 K t gpd
Plan: Date APip1 t. 2-b k M-7 Number of sheets Revision Date N IA
Title 5uC3su2r,4C.-,— SSW A -r,1- 1XSPeLSA-L SYSTEM RZ.Arl-IrL 637-v 5uNWEg- ST. N- AN&o '/L
Description of Soil(s) 0-12. A. t2.--3ez f3, C lfe u?-- `la" =lZ.e — 4.0Aehx J4N0 i Mo77ct5 47 3C"
Soil Evaluator Form No. ft Name of Soil Evaluator%TAMES L WA AO Date of Evaluation '3 -ZO--17
DESCRIPTION OF REPAIRS OR ALTERATIONS R EPL^&& F k -(L i K.l G SY$-T£ g t�j
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agre o not to lace the system in operation until a Certificate of Compliance has been issued by the Board of Health..
Signed Date
/ — I
Inspections
No. COMMONWEALTH Of MASSACHUSETTS FEE
Board of Health, �T MA.
CERTIFICATE Of COMPLIANCE
Description of Work: ❑ Individual Component(s) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded ( ), Abandoned ( )
by:
at
has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. dated Approved Design Flow (gpd)
Installer
Designer: Inspector: Date:
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
No.
COMMONWEALTH Of MASSACHUSETTS
Board of Health,
DISPOSAL SYSTEM STEM CONSTRUCTION PERMIT
FEE
Permission is hereby granted to; Construct( ) Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system
at
as described in the application for
Disposal System Construction Permit No. dated
Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Boston, MA Date Board of Health
No.
FEE
COMMONWEALTH Of MASSACHUSETTS
Board of Health, 14• AtJDQV£.V- , MA.
APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade {t Abandon() - ❑ Complete System ❑ Individual Components
Location 32,% &ww u- g-7�
Owner's Name U 44 CY W ES -1 0 n-)
Map/Parcel# MAP 10 7 L -a7 140
Address SSM
Lot#
pQ S87 cy
Telephone# Qy
Installer's Name
Designer's Name LA14A-64,,1 �-;Na w&eYPA
Address
Address 433 CO -0S.5 RD. N� QhP-? pd-r1f M4
Telephone#
Telephone# SG 78y-1,666
Type of Building &:51 Q� SA) 7 «t- Lot Size
Dwelling - No. of Bedrooms q
Other - Type of Building
Other Fixtures
No. of persons
sq. ft.
Garbage grinder` Me)
Showers ( ), Cafeteria ( )
Design Flow (min. required) 41 LlQ gpd Calculated design flow 1440 Design flow provided 41 C gpd
Plan: Date APPYL— 2-b ► M-7 Number of sheets ( Revision Date IV 1A
Title 5y8-5UP-r,4GZ. 9SWPk-Cn1- 71SPcLSA-L SYSTEM RUMP- 6326 5QikA4M 57IV AMOV�/L
Description of Soil (s) 0- 17- A t LL -3a 6, G-/ft�td Z - -6ci" =11.0 - !_aAyhh `( 54NO c mo -77(-t5 h? 349 �t
Soil Evaluator Form No. 1( Name of Soil Evaluator -,SAAm L4ot/A nO Date of Evaluation 3—ZC-1 %
DESCRIPTION OF REPAIRS OR ALTERATIONS R z PL Nc-L -FA-(L i Aj q
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agre o not to lace the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed Date .6'
/ — I F
Inspections
No. COMMONWEALTH OF MASSACHUSETTS FEE
Board of Health, , MA.
CERTIFICATE OF COMPLIANCE
Description of Work: ❑ Individual Component(s) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded ( ), Abandoned ( )
by:
at
has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. dated Approved Design Flow (gpd)
Installer
Designer: Inspector: Date:
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
No.
COMMONWEALTH OF MASSACHUSETTS
Board of Health,
MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
FEE
Permission is herebygranted to; Construct( ) Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system
at as described in the application for
Disposal System Construction Permit No. dated
Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Boston, MA Date _ _ Board of Health
Town of North Andover
OFFICE OF
COMMUNITY DEVELOPMENT AND SERVICES
30 School Street
North Andover, Massachusetts 01845
WILLIAM I SCOTT
Director
July 28, 1997
J. B. Lanagan Engineering
433 Cross Road
North Dartmouth, MA 02747
RE: 328 Summer Street
This is to inform your that the proposed plans for the site referenced above have
been disapproved for the reasons below. If new plans satisfactorily addressing
all these issues are submitted to the Health Department by August 12, 1997,
then approval for the plans should be given by August 19, 1997.
1. Profile is not to scale. (N.A. 6.02b2 & 6.02r)
2. Perc elevations are missing. (N.A. 6.02j)
3. Wetlands disclaimer missing. (N.A. 6.020)
4. Water line not shown. (N.A. 6.02q)
5. Bottom of system less than 4' to groundwater. (310 CMR 15.212)
6. Bed area less than required 900 square feet. (N.A. 2.14(1))
7. Ends of pipes to be joined, not capped as stated in note #10. (N.. 18.04)
8. Trenches are to be used whenever possible; please justify choice of field.
(310 CMR 15.240(6))
9. Four inches of pea stone OR 2" of stone AND filter paper required. (N.A.
18.05)
10. Alarm for pump to be on a separate circuit. (310 CMR 15.231(9))
11. Pump must have manual operating switch. (N.A. 6.02t)
12. Please calculate and add to plan emergency storage and number of dosing
cycles required per day. (310 CMR 15.231(2)(3), 15.254(d))
13. What is TDH, dimensions of chamber, pump capacity, and discharge rate?
14. Pump chamber missing manhole to within 6" of grade. (310 CMR 15.231(5))
15. No bleeder hole or check valve specified. (N.A. 6.02t)
16. If pump chamber is below groundwater table, buoyancy calculations shall be
submitted. (310 CMR 15.221(8))
CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
. '
Please be aware that all revision submittals must be accompanied with a $25.00
fee.
If you have any questions, please do not hesitate to call the Board of Health
office at the number below.
Sincerely,
Sandra Starr, R.S.
Health Administrator
cc: Wm. Scott, Dir. CD&S
Nancy Weston
c ---File
-i
S
FOP -M 11 - SOIL EVALUATOR FOR.l1
Page 1
r
No. Date
Commonwealth of Massachusetts
N• �N��— , Massachusetts
Soil Suitability Assessment for On-site Sewage Disposal
I
Performed By:.......�...............................
Witnessed By:
...............................................................................................................................
L=oon Addtcii or 3Z9 _,.-k3e-km z2 57 14,01cY ou- ..S «14
La r Mke 107 A, [_cs? J(-0 Ad°""''nd 3Z$ 5c)Mind _iL S7 � �ntDoJ�,t—
.•
rob 7- /g31
New construction ❑ Repair 0�
Office Review
Published 'Soil Survey. Available: No ❑ Yes
Year Publ-ished �.q.$�. Publication Scafe�..�..Z;
Soil Map Unit ...................
Drainage Class ... Soil Limitations ......................
......................................................................................
`
Surficial Geologic Report'�Available: No ❑ Yes
Year Published .. Publication Scale 1..'...Z.% dam
Geologic Material (Map Unit) ....., ....... ...........
.................................................................
Landform
Flood Insurance Rate Map:
Above 500 year flood boundary No ❑
Y.es
Within 500 year flood .boundary No
Yes '
❑
Within 100 year flood boundary No i'J
Yes
❑
Wetland Area:
National Wetland Inventory Map (map unit) ........
•
Wetlands Conservancy Program Map (map unit)................................
...................................................
Current Water Resource Conditions (USGS): Month ... O!l''✓ a
_Range : Above Normal ❑ Normal FT Below Normal ❑
Other References Reviewed:
�
FORM 11 . SOIL EVALUATOR FORM
.Pa�e 2
!
` .
On-site Review
'
Deep Hole Number 'y. ......... 1)atm������.�9 '. Time: �-C3 Weather '-..
Location (identify on site plan) ----'SS.2 - --_------_---_-__-----_-________.
Land Use (ZZ3-'_- Slope (Y6>Zz7;K' Surface Stones...................................................__
Vegetation ''—. LAw.hk.... 7 lk:�mii� -e? ---- --. ...... .................................................................................................... _... ...........
_� _
Landform ............ .��/7x��/�����-����(/��--'-------_--------'--------____________________.
Position onlandscape (sketch onthe back) .............................................................. .................................. .... .... ... —.................................
Distances from:
�^
(JponVVaterBody /Jc`���- feet Drainage feet
feet ,
*J��
PossPossibleWet Area .., .`�''hom� Property Lino '�K�—�� '~- feet
Drinking Water Well feet' Other ''...... N./A �
DEEP-OBSERVATION HOLE IEOGDepth
from Surface
Soil Hof Izon
Soil Texture
Soil Color
Soil Mortling
Other(Inches)
(USDA)
(Munsell)
(Structure, Stones, Boulders,Consistencv.
Gravel)CC
MMO/V
Parent Material (geologic)'LOAPICI.SIM14 ... ... ........... .... ........................... Depth to Bedrock: M/*
'
Depth
�
'to Groundwater:
~ -/� / ^
Standing VVaie: inthe Hole: .p���cn- Weeping homPuFace: /V]^�'
���u �
�°� k(Esdnnated SeasonalHig� Ground VVace,� ��y�
. __
FOPUNI 11 - SOIL EVALUATOR FORA
Page 3
Determination ,for Seasonal HighWaterTable
Method Used:
0 Depth observed standing in observation hole .............. inches
0 Depth weeping from side of observation',hole ................. inches
D�Depth to soil mottles........ 30e inches
El Ground water adjustment feet
Index Well Number Reading Date ................... Index well level ..................
Adjustment factor .......... Adjusted ground water level' ........................ ......
Depth of Naturally Occur -ring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas
observed throughout the area proposed for the soil absorption system?
If not, what is the depth of naturally occurring pervious material?
Certification
I certify that on 2L? 5 (date) I have passed the examination approved by the
Department of Environmental Protection and that the above analysis was
performed by me consistent with the required training, expertise and experience
described in 310 CMR 15.017.
Signature' surDate
0.
FORA 12 - PERCOLATION TEST -
COMMONWEALTH OF MASSACHUSETTS
Massachusetts
Percolation Test
Date: '3h!?&7 Time:
Observation Hole
Depth of Perc
Start Pre-soak
End Pre-soak
U.1<6
Time at 12"
Time at 9"
Time at.6"
Time (9%6")
.Rate Min./.Inch'
Site Passed E4""_Site Failed F-1
.. ...... .............. .......................... .......................... ... ... .. ....................... ................. . ...... .
Performed By: L17-xjA-6A—A_1
Witnessed By: SAAt o
Comments:
JAMES B. LANAGAN III
J. B. LANAGAN ENGINEERING CO.
433 Cross Rd. (508) 984-1668
N. Dartmouth, MA 02747 Fax (508) 992-4400
SEPTIC PLAN SUBMITTALS
LOCATION:
NEW PLANS: $60.00/Plan [/
REVISED PLANS: YES $25.00/Plan
DATE: 43
DESIGN ENGINEER. J i m �,d /t)P (V A
When the submission is all in place, route to the Health Secretary
sV
t Health ~ `.
�Adover,Mass.
SEPTIC SISTEM
INSTALLATION CHCK LISP
LOT
11A115 C�/� Q EXUAVATIM va L
OK
LIZ 1. Distance To:
a. Wetlands
b. Drains
o. Well
2. Water Line Location
3• No PDC Pipe
4. Septic -Tank
a. Tees - Length & To Clean -Out Covers
b. Cement Pipe =to Tank On Both -Sides of Tank
5. Distribution Box
a. Covers & Box - No Cracks
b. All Lines Flowing Equal Amounts
c. No Back Flow
6. Leach Field or Trench
a. Dimensions .
b. Stone Depth
c. Capped Ends
d. Clean Double Washed Stone
7. Leach Pits
a. Dimensions
b. Stone Depth
c. Splash Pads
d. Tees
e. Cement Pipe to Pit - Both Sides
f. Clean Double Washed Stone
8. No Garbage Disposal
q, Final Grading Inspection
'10. Barricading Covered System
11. As Built Submitted
a. Lot Location
b. Dimensions of System
c. Location with Regard -to Pere Test
d. Elevations
e: Water Table
0
and company
June 29, 1979
Mr. Thomas Murphy
Board of Health
Town Hall
120 Main Street
North Andover, Mass.
Dear Mr. Murphy:
The rocks that were over the system on Lot 12 Summer
Street were mixed in with loam for the site, and have
been removed.
No damage was done to the system as a result of their
being placed there.
BCO:hf
Yours truly,-,
,$ njamin C. Osgood
451 ANDOVER ST., NORTH ANDOVER, MASS. 01845 • 617 685-6331
The Real Estate People in Merrimack Valley
11
FORM U - IDT RELEM FORM
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state law,
regulations or requirements.
****************Applicant fills out this section*****************
APPLICANT: �L� �O�I�S�.(� Phone G��2�c�
LOCATION: Assessor's Map Number - Parcel
Subdivision 2 Lots)
Street ✓ Z �f E� 5/ St. Number
************************Official Use Only************************
RECOMMENDATIONS OF TOWN AGENTS:
Date Approved
Conservation Administrator Data Rejected
Comments
Date Approved
Town Planner Date Rejected
Comments
Date Approved-�
Health Agent Date Rejected
Commentsi/✓�S
Public Works - sewer/water connections
- driveway permit
L
Fire Deaartment
Received by Building Inspector Date
:V!
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SOIL PROFILE & PERCOLATION TEST'DXVA
i�r rr �� rr�r�iwrrrrir.� r
Town/Cit y_ No.&Street � 422 g,.Lot No.
Loc./Subdiv. Plan Owner
N Investigator_�� 'L&9 J Observer,
p�.�.,._
SOIL PROFILES -DATE
J 1. 2, 3. 4.Elev.
� J lev. Elev. Elev., _
0 77 p 0 ._....._
2
31
LA
5
6
7
8
i
E
3
4
5
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37
0
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4
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1.1
9
2
3
4
5
6
7
8'
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} 10 10 I_"_� 10 101
i Benchmark Location
Elevation Datum.
Perco at'on Tests -Date
-417177
Pit Number
1 2 3 4 5
Start Saturation
Soak -Mins--.
Start Test -Time
,
Drop of 3 "-Time
.Drop of 6" -Time
Mins.lst 3"Dro
Minse2nd 3"Dro
ivozes & sxetcnes on Back Frank C. Gelinas & Associates, North Ando
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NORTH ANDOVER .BOARD OF HEALTH
SUBSURFACE DISPOSAL SYSTEM CHECK LIST
4PP ROVED PROVIDED DISAPPROVED
(2-tq--??
Seg. 2.5
Reg. 6.1
Reg. 6.7
Reg. 6.$
Reg. 6.9
Reg. 6.122
Reg. 6.1E
leg 3.7
i
leg: 9:1
Reg. 9.6
General Information
The submitted plan must show as a minimum:
-the lot to be served (area,dimensions, lot #, abutters)
,location and dimensions of system (including reserve area)
design calculations
calculations showing reouired leaching area
.existing and proposed contours
location and log of deep observation holes -distance to ties
location and results of percolation tests -distance to ties
_Location of any wet areas within 100' of the sewage disposal
system or disclaimer
surface and subsurface drains within 1001 of sewage disposal
system or disclaimer
-location of any drainage easements within 1001 of sewage
disposal system or disclaimer
knoun sources of water supply within 2001 of sewage disposal
system or disclaimer ,.
location of any proposed well to serve the lot (1001 from leaching facilill!
location of water lines on property (101 from leaching facilities).
,maximum ground water elevation in area of sewage disposal system
-location of benchmark
Arlan must be prepared by a Professional Engineer or other
professional authorized by law to prepare such plans
driveways
garbage disposers
a profile of the system (elevations of basement, plumbers pipe
septic tank., distribution box inlets and outlets, distribution
field piping and any other elevations)
no PVC_is to be used in construction
tic Tanks
Capacities -
Water table
Tees
Depth of tees
Access
150% of,flow
—Cleanout
101 from cellar wall or inground swimming pool
51 from subsurface drains
�s
r_T`aT Approval
(b) Stand-by power
Worth Andover Subsurface disposal system check list -Page 2 �+
3eg.10.2
,-(a) Slope greater than 0.08
Reg.10.4
-_(b) Sump
Leaching Pits
Leaching pits are preferred where the installation is possible
ft eg.11.2
(a) Calculations of -leaching area (minimum 500 S.F.)
Reg.U.4
(b) Spacing
Reg.11.10
(c) ,Surface drainage 2%
Reg.11.11
(d) Cover material
Leaching F:i.elds
R eg.75.1
(a) Greater than 20 minutes/inch
Reg.] 5.1—Area
(minimum 900 S.F. )
FZeg.15.4
onstrue tion of field
Reg.�S 8
face drainage 2%
a 20� from
eg. .'(
cellar wall or inground swimming pool
Downhill Slope
(Fa)� Slope y/x = (to be shown)
(b) y/x X 150 = (to be shown)
Ur. parrs 4 &ood
Rjorth Andover OMcc Park
FarM ftdov=* .13"s' s.
Dear Sir:
J=e 28, 1979
Re: Lot !2 Srxror st.
i
On Arne Untli final appro- l wu given on: the
sm -1.1c ;s5mt cm on fihol above-MmUoned lot. 'ate: t-.,00-k-ond I
dx,Olm do -z S=zror Opt ,nd swu largo bomldezrs placed on the
rtj
cc azildlsk,, Insp
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V# erl $-,tdyj,,
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TIVIMW mrpb'
Rath`pm. for
N
J=e 28, 1979
Re: Lot !2 Srxror st.
i
On Arne Untli final appro- l wu given on: the
sm -1.1c ;s5mt cm on fihol above-MmUoned lot. 'ate: t-.,00-k-ond I
dx,Olm do -z S=zror Opt ,nd swu largo bomldezrs placed on the
rtj
cc azildlsk,, Insp
W
V# erl $-,tdyj,,
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TIVIMW mrpb'
Rath`pm. for
I.
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Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
man
Commonwealth of Massachusetts
t
City/Town of
System Pumping Record OCT 15 2007
Form 4 TOWN OF
FIEAL i I ; L j
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:
Address r:?-
��-2 P, 4A"—A0L'0
City/Town State' Zip Code
2. System Owner.
Name
Address (if different from location)
City/Town
B. Pumping Record
1. Date of Pumping
Date
State_ C? / l
Telephone Number
2. Quantity Pumped: Gallons
3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank
❑ Other (describe):
4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of�System: ` �,' �{ �� _ / )
/
V i'®V vt \ f�/l v�
A
System P m rd
'B� l � ,� J
Vehicle License Number
Company
7. Location w re contentrreftsed:
Date
t5form4.doc• 06/03 System Pumping Record • Page 1 of 1
Town of North Andover, Massachusetts Form No. 1
NORTII BOARD OF HEALTH
/b ��OL • J I • 19
��RAoe Ew P.^:y APPLICATION FOR SITE TESTING/INSPECTION
At
Applicant •; /,of
_ , +✓ .:1 J.
NAME ADDRESS TELEPHONE
Site Location - =� ^'tom
Engineer �� [ IV
NAME ADDRESS TELEPHONE
Test/Inspection Date and Time
Fee
CHAIRMAN, BOARD OF HEALTH
Test No.
S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No.