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HomeMy WebLinkAboutMiscellaneous - 35 PENNI LANE 4/30/2018 (2)r SEPTIC SYSTEM INSTALLATION IS THE INSTALLER LICENSED? TYPE OF CONSTRUCTION: NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW CONDITIONS OF APPROVAL (FROM FORM U) YES NO NEW REPAIR YES NO YES NO ISSUANCE OF DWC PERMIT YES NO DWC PERMIT PAID? DWC PERMIT NO. `r7,;?, BEGIN INSPECTION YES 0: EXCAVATION INSPECTION: NEEDED: PASSED L--� BY CONSTRUCTION INSPECTION: NEEDED: AS BUILT PLAN SATISFACTORY: SD NO INSTALLER: "�� 7T�;rllC? APPROVAL TO BACKFILL: DATE: fd/9s BY FINAL GRADING APPROVAL: DATE � /v BY FINAL CONSTRUCTION APPROVAL: DATE: BY RECEIVED OCTO0 CT 0 7 2005 I -OWN N U�..) TOWN OF N TH ANDOVrR SYS'TT-"l POMPINQ HEALTH D S YS TE -Iiav DATI OP p ...Q0AN'nTy puwpcc, 100L; y t 3 oe utl'jdA 000 KQQT3 P L 8XQU$NS SOL rDCAKAYQyUX'--' ONER -EXPL,� IN UN 21�r Town of North Andoyez , M3! Watershed Septic System servicing Report Date:� Homeowner: "A Street Phone Nature of Service: Observations: Routine x Emergency � \ 0 �gg5 �G Pumper V I — Address: CII -4t Phone (rwAle4') (o Good Condition Full to Cover, Baffles in Place Leachfield Runback -e Excessive Solids ILb Heavy Grease Roots Other (Explain) Description of Work: j Comments: Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 146 Main Street North Andover, Massachusetts 01845 TOWN OF NORTH ANDOVER BOARD OF HEALTH November 17, 1995 CERTIFICATE OF COMPLIANCE This is to certify that the individual subsurface disposal system constructed ( ) or repaired (X) by North Andover licensed installer, Kenneth Rea at 35 Penni Lane, North Andover has been installed in accordance with the provisions of TITLE 5 of the State Sanitary Code and with Board of Health regulations as described in the Design Approval Permit #782, dated October 24, 1995. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY. JivAA) Board of Health Inspector BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 UHrlA ZY 00 WV CH12 Lids-ol !9(g 17 c .0 A4 elf i -2-r. mewr. (i Ocw 44a,.) oaftm rric, TA-4f- po�—tdAcAr— Q) Mi - bu ALT SUBSURFACE DISPO-S�AL SYSTEM LOCATED IN N470�*N AwCOVDIZ.,, AS PREPARED FOR "HA .HAIqd DATE: Op SCALE: f MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS 0 LAND SURVEYORS 0 'PLANNERS ".PARK STREET • ANDOVER, MASSACHUSETTS 01610 TEL (617) 473.3SS3. 373.5721 Town of North Andover, Massachusetts Form No. 3 e p0R7M BOARD OF HEALTH F A 19 �— � Off' cx.irin.w�' 1' '► "°""�;��� DISPOSAL WORKS CONSTRUCTION PERMIT ,SSACMUSEt Applicant %tel C7—A-) r & AME ADDRESS TELEPHONE > Site Location �� - E/ x)l '/� Permission is hereby granted to Construct ( ) or Repair ( n Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. CHAIRMAN, BOARD OF HEALTH Fee S�Q — D.W.C. No. 4 i PLAN REVIEW CHECKLIST ADDRESS L l" �{/,(f/ �} ENGINEER GENERAL 3 COPIES [/ STAMP &--' LOCUS -X--' NORTH ARROW SCALE L-' CONTOURS al PROFILE (-/ SECTIONL--- BENCHMARK - SOIL & PERCS ELEVATIONS WATERSHED?IV6) DRIVEWAY SCH40,,�, TESTS CURRENT? WETS. DISCLAIMER WELLS & WETS (Elev) WATER LINE 1,1� FDN DRAIN !� SOIL EVAL T)4 le I� SEPTIC TANK MIN 1500G CD .17 INVERT DROP GARB. GRINDER(+200% EDF) 25' -T -O --CE M 0 EV--G-W----- #_COMPS. D -BOX SIZE # LINES FIRST 2' LEVEL STATEMENT T� INLET % ,,,;� 8 - OUTLET ( 2" OR .17 FT) TEE REQ' D? LEACHING MINAADGPD? O , ESERVE AREA 4' FROM PRIMARY? ` 2% SLOPE 100' TO WETLANDS a 100' TO WELLS 4"" 4' TO S.H.GW �(5'>2M/IN) 35' TO FND & INTRCPTR DRAINS 325' TO SURFACE H2O SUPP ----- 4' PERM. SOIL BELOW FACILITY ✓ MIN 12" COVER ,✓ FILL? (25' if above natural elev; 101if below) BREAKOUT MET? v TRENCHES MIN 660 gpd SLOPE (min .005 or 6"/1001) SIDEWALL DIST. 3X EFF. W OR D (MIN 6') BE 10' MIN. RESERVE BETWEEN TRENCHES? 4" PEA STONE? BOT + SIDE (L x W x #) Copyright © 1995 by S.L. Starr (DxLx2x#) IN FILL? MUST VENT? (>3' COVER; LINES >50') X LDNG = TOT (G/ft2) PITS MIN 660 LEACHING MIN 1 (131x16') PIT MANHOLE/PIT GW MIN 4' BELOW BOTTOM EXC 2x EFF W OR D 12"-48" STONE BOT + SIDE x LOAD = TOTAL (L x W x #) (2x(L+W)xD x #) (G/ft2) CHAMBERS MIN 660 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 ie - GPD /900 ft2 BED GW MIN 4' BELOW BOTTOM OF FIELD 'k PIPE ENDS JOINED? 1% 4" PEA STONE? DIST LINE SLOPE .005? >3'COVER-VENT SCH 40_1- MIN 12" COVER RATE LDG X 660 J3 X 1 3¢= TOTAL G/ft2 REQ'D (ft2) LXW DOSING TANKS AND PUMPS DIMENSIONS X X = L W D Vol. DISCHARGE SIZE DISCHARGE RATE MANHOLES TO GRADE inlet) HWL OP. SWITCH Copyright® 1995 by S.L. Starr ALARM SEP. CIRC. LWL CHECK VALVE PUMP CAPACITY qpm qpm DISCHARGE TIME GW (Min. 1' below BLEEDER HOLE MANUAL TO: NORTH ANDOVER, MASS Set G 3 19 75 BOARD OF HEALTH FROM: DESIGN ENGINEER Re: Soil Absorption Sewage System Inspection This is to certify that I have inspected the construction of the said disposal system at L• « Ps"N/ L /4 /VE North Andover, Mass. SITE LOCATION The grades and construction are as specified in my plans and specifications dated 19 -, lb �ESIG-NEIZ .fa SCpl-/ 7 `JA RQA6,4/-L a 1 \n/E StVl1/+RD CIP C' -F IVO. AN 14o/j\1G- j /ti 4 S. h/l oPMATi Su PPLI.Eb iy ,8c I NST/4L4,FR S Cc - �7' PR0P't R'rIrs 1�ESIGNC�Z .fa SL--p 7 13/1 R 134 GA L No A/l //.lFoR/vIA rlw G/�l StA PPLI,ED iy BuiL lit R INSr/3LLER Lc I'll S CoT 3S. C emrER ,sr $ v R L / /U G ro/V MASS. OS � f � F= �i til ► L/4 � 1 �. 8 y � •Y� Y i �Fx4 �}„ 1 I 'si;�NS4�r•"A�tii_"3t'��t.. _ t'�'}., �r.� - %*f > r Y r€; x: ��f I I B k'i �S L:E.. �,- Fr •1 .� h,fY y' i'.. if '. T ! 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'. . .4/.P,o.c dc.X. /*.�� mac. ec // "OP7 "OV /16/ a 64J e g V.P f ` G --C r t •� � C o ;C � 0�0 y " I Vj �yyy�y� Al r } NEP _ vP _ • _ .yx YI R F •.� 1111��! +�► W V` �1 � 1 i1i � - '� ,tip - � s... �.rt �{ �.•En VW ` - '` rl R.._.'r C� 3 i j a, f' 4 �♦� ` t � { ♦ ��c, �i 11" Y 1T{►. - Y •F �- .,(•�.• s f' ,� r '' V r { � Yom! a C.y ..• '/ i .. � � �. ♦ E r � Plot Wr..: } � T Y'. T z ;� •Y 1 .s .� �.4i�3�,� Y i' - - •i - I 4 4q nlE•►7c N LET = t4'6 MST. WL -sr W35TM44i LATt*ALS,.:,� 00 Loo It v 10 It �J D 49 , S Ito rail 1 ' i 4 D • �J D 49 , 4 t r 1 or�V ta; i.URT►i ASC G W;✓R/ ' OF HEALTH TOWN OF NORTH ANDOVER NOV _4 2` SYSTEM PUMPING I-ECOU _ 1'ENl U NER & ADDRESS SYSTEM LOCATION (example: left frons of house) i v� A/)W/ U \,!,E OF PUMPINC: /9071-0- QUANTITY PUMPCD boll ; )SPOOL: NO YES SCPTIC'TANK: NO YES � ATURE OF SERVICE: ROUTINE SEMERCEN CY Ali>FRV.:\TIONS: GOOD CONDITION HEAVY CREASC ROOTS CXCESSIVE SOLIDS SOLIDS CARRYOVER -�l > I LM PUMPED BY .u�I�,IFNTS U'� I f:'�' I'S TRANSFEIMED TO \j Zf"ULLTUCOVE;� BAFFLES IN PLAC!: _ LEACHFICLD IZUN�AC'K.. FLOODED � O�HFR (EXPLAIN) Commonwealth of Massachusetts City/Town of NORTH AND®VER, System Pumping Record Form 4 kCHUSET7T 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. 1. Date of Pumping Date I a "0' f L � 2. Quantity Pumped: Gallons I. 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. System Pumped By: f me ttl Vehicle License Number Company 7. 6' 7. Location where contents were disposed: Signatuia of Hauler ° http://www.mass.gov/dep/water/approvals/t5forms.htm#inspect Date t5form4.doc° 06/03 System Pumping Record ° Page 1 of 1 A. Facility Information V r-Lj KtUZJUL Important: 1. S stem L cation: 2008 When filling out forms on the x ND'OVER computer, use only the tab key AI dre ARTMEI f to move your cursor - do not �" t� City/Town State Zip Code use the return key. 2. System / g�Owner: f^ �, �✓�(� (p ✓j Name Address (if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date I a "0' f L � 2. Quantity Pumped: Gallons I. 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. System Pumped By: f me ttl Vehicle License Number Company 7. 6' 7. Location where contents were disposed: Signatuia of Hauler ° http://www.mass.gov/dep/water/approvals/t5forms.htm#inspect Date t5form4.doc° 06/03 System Pumping Record ° Page 1 of 1