HomeMy WebLinkAboutMiscellaneous - 38 GILMAN LANE 4/30/2018I--
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TOWN NO$.TH ANDOVER,
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SYS PUI��PINO REC -
DATE
SYSTEM OWNER & ADDRES SYSTEM LOCATION,-.•y� .'
a
DATE OF PUMPIN 3 _ QWMTY'PUMPED ` ' ^D(f:2
CESSPOOL NO
. • � $B
PTiC TANS NO
NATURE OF SERVTCBRQI
LL_WROENCY
OBSERVATIONS
' 0OOD CONDITIONFULL TO COVER
' HEAVY GREASE BAMBS IN LACE
ROOTS LEACHFiELD RUNBACK
EXCESSIVE SOLIDS,' FLOODED
SOLM CARRyOVEiz,_ OTHER EXPLAIN
�. SYSTEM PUMPED By
COMMENTS; r .•
CONTENTS TRANS '-,Z-
FERRED TO ��� �/ _
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�ltSr : r1NLYs1/1��' C$14 �,
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_ Commonwealth of Massachusetts
w W City/Town of NO ANDOVER
a
System Pumping Record - - ---
Form 4
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DEP has provided this form for use by local Boards of Health. Other form paly V'6r 1043but tfle
information must be substantially the same as that provided here. Before �s�`tj this form, check with your
local Board. of Health to determine the form they use. The System PumBing Recordlmtist 6e submitted to
the local Board of Health or other approving authority within 14 dayskfron;;.the-pump'ingdate'irr -
accordance with 310 CMR 15.351.
A. Facility Information
important: When
filling out forms 1. System Location:
on the computer,
use only the tab 38 GILMAN LANE
Ivey to move your Address
cursor - do not NORTH ANDOVER MA _
use the return�
ke Qity/Town State Zip Cod
2. System Owner:
BATES
Name
revm
Address (if different from location)
City/Town State Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping pat�6-23- 13 2. Quantity Pumped: �----�ov C
Gallons
3. Type of system: El Cesspool(s) IV' Septic Tank E) Tight Tank [ Groase Trap
Other (describe).-
4.
describe):4. Effluent Tee Filter present? Q Yes Ej No If yes, was it cleaned? Yes ( No
5. Condition of System;
6. System Pumped By:
Name Vehicle license Number
Stewart's Septic Service
Company.--�--�:.�.,.,,__,.T.�,_
7, Location where contents were disposed:
Stewart's Pre-treatment Plant, 20 So, Mill Bradford, Ma 01835
Signature of Hauler
Signature of Receiving f=acility
Date
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S3MC SYSTEM
INSTALLATIM CH K LIST
LOT L A
XC ASA' O3d r OK FAIL
1.
Distance Tot
a. Wetlands
b. Drains
c. Well
.2.
Water Line Location
3•
No PGC Pipe
4.
Septic Tank---
a. Tess -_Length & To Clean Out Covers _
b. Cement Pipe to Tank - Oa Both Sides of Tank
5.
Distribution Box
a. Covers do 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 Pits1
a. Dimensions
b. Stone, -Depth
c. SP14'sh Pads
d.ees
e./Cement Pipe to Pit - Both Sides
Clean Double Washed Stone
8.
No Garbage Disposal
f I
.
9•
Anal 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 -
a,ard of Health
North 1.ndaver,Yzss
SUBSURFACE DISPOSAL DFSICK CM LIST
J
,J r`
LOT i
APPROVED
DATE
DISAPPROM DATE
Provided:
Reasons:
Title V
(PftOKReg
2.5
a submitted plan must show as a min3mnm:
the lot to be served-area,dimensions lot #,abutters
location ties
b
and log deep observation holes -distance to
,� c.
location and results percolation tests -distance to ties
d
design calculations & calculations showing required leaching area
location and dimensions of system -including reserve area
f J
existing and proposed contours
(g)
location any wet areas within 1001 of sewage disposal system or
.
disclaimer -check wetlands mapping
h)
surface and subsurface drains within 100' of sewage disposal
system or disclaimer
(i)
location any d.-ainage e�:_svants Athi.n 1001 of se-t-ige disposal
system or disclaimer-P].aw:-ing Poard files
(j)
known sources of tnater supply wittin 2001 of sovmgs disposal
system or disclaimer
(k)
location of any proposed well to serve lot -1001 from leaching facility
(1)
location of water lines on property -101 from leaching facility
(m)
location of benchmark
(n)
driveways
(o)
garbage disposals
(p
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
(r)
maximum ground water elevation in area sewage disposal system
(s)
plan must be prepared by a Professional Engineer or other
professional authorized by law to prepare such plans
Reg 6
. -
'Seti�anks
(a)
0 of flow, water table, tees, depth of tees,
'capacities -150 t es -15
/
access, pumping
(b)
cleanout
(c)
101 from cellar wall or inground swimming pool -
i (d)
25+ from subsurface drains
Reg 10.2Ab)
'
Distribution Boxes
a)
s pe greater than 0.08
Reg 10.4
sump
J
Subsurface D3si�
I FAIL
Reg 15.1
15.4
15.8
3.7
Reg 14.1
14.3
14.4
14.6
14.7
1.4.10
Reg 9.1
9.6
2
Leeching Pits �
Leaching pI>s are proferred where the installation is possible
,a) cal ions of leaching area-minirxm 500 sq ft
b) sppeng
�c face drainage 2%
cover material
�) 21a21x4" splash pad
f) tee at elbow
g) no bands in pipe from d -box to pipe
1-1
Leac Fields
P, no grea er�an 20 minutes/inch
le
araa-minim m 900 sq ft
- construction of field
d) surface drainage 2 %
e) 201 from cellar wall or inground svinmdng pool
Leaching itenches
a) cilEMEtIons,bfleaching area -min 500 eq ft
b) spacing -4 min 6 ft with reserve between
C) dimansiena
e) stone/
f) surface drainage 2% _
DoTmhill Slope
a) slope y x = to be shown)
b) y/x Z 150 - (to be shown)
ysd!-b�y
a)b) poorer
h•
andover
consultants 1 213 BROADWAY
\•enc. METHUEN, MASSACHUSETTS 01844
(617) 687-3828
z?12 DATE &/
TO : NORTH ANDOVER HEALTH DEPARTMENT
TOWN HALL NO. ANDOVER , MASS
RE : SUBSURFACE SEVJAGE DISPOSAL SYSTEM
NO. ANDOVER , MASS.
I hereby certifythat I have inspected the construction of the
disposal system at Com/ 04-4 64j, North Andover, Nass.
and that the location and elevations are as shown on the As -Built
Drawing dated-SEl}T.
ANDOVER CONSULTANTS , INC.
William S. c eod
Registered Sanitarian
This certification is notto be construed as a guarantee of the system.