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BOARD VOF HEALTH
. 120 MAIN STREET TEL 6821-6483
NORTH ANDOVER, MASS. 01845 Exc�,3
APPLICATION FOR ABA.NOONMENT
OF SUBSURFACE DISPOSAL SYSTEM
(SEPTIC SYSTEM)
PURSUANT TO SECTION 310. CM�R 15.354
OF THE STATE ENVIRONMENTAL..CODE, TITLE V
y,
This form must be submitted to the Board of Health no less than
five (5) days crior to date of abandonment and be accompanied with
a coDy of the sewer connection De tit.
Name Phone
Address J? L 2 �� ✓
O Contractor hired for work:
r.
Name —� r,;7.
Address
Date for scheduled abandcnmen
Phone
Method of septic tank abandonment (check one).
( ) removal _ ( ) sandfill ( ) crush
Other
( ) other (describe
below)
PLEASE DO NOT WRITE IN THE SPACE BELOW
FOR HEALTH AGENT'S USE ONLY
Inspecting Agent
Comments
C
Date
N0- 1140
APPLICATION FOR SEWER SERVICE CONNECTION
i
North Andover, Mass. 1Z 19 C
Application by the undersigned is hereby made to connect with the town sewer main in G� �����"'/� "�—� Street,
subject to the rules and regulations of the Division of Public, Works
The premises are known as No. 'z 4 ����4s Street
or subdivision lot no. /
Owner Address
Contractor i Address
A icant's Si ature
l 4LTA�
�Z�0
�V/- 7-/ Aj
PERMIT TO CONNECT WITH SEWER MAIN
The Division of Public Works hereby grants permission to
to make a connection with the sewer main at
subject to the rules and regulations of the Division of Public Works..
By
Inspected by
Date
See back for rules and regulations
161
Street
Division of Public Works
f M. � I Z D OI, III r I
146 N fA I N STR f.'_ 1]; F
_VE I- E 1) f -I 0 N Eg (5 0 8) 6 8 8 - 95) 4
JF .SIiRk I I i /,S,' J-).,
(SEPTICSYSITL"Alf)
Pursuant to Section 3/0 3j4
o) the State Environmenlicil Co1,2. Tillc I,`
Address
Contractor hired for work:
?hone Name Z( elk7
I
Addresses
r TOWN OF NORTH AM -7
BOARD OF HEA'_TH
-7 1996
Date for scheduled abandonment
The septic system at the above address has been abandoned according to
Title V specifications. I w Q
Si(_) -nature of Contractor
T
Method of septic tank abandonment (check one;. O removal O sandfill
X� 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 HEATTH
REPRESENTATIVE'S USE ONLY.
rj zle
Inspecting Agent Date
Raymond MacLean
89 Marbleridge Rd.
APPLICATION FOR SEWAGE DISPOSAL INSTALIATION
HEALTH DEPARTNENT - NORTH ANDOVER, MASS.
I hereby make application for a permit for a sewage disposal installation at
Marbleridge Rd. . I will install this system in ac-
cordance with all the laws of 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 750 gal. in size. A manhole (s) permitting easy cleaning
will be provided with removable 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 160 lineal (L%mm) 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
tile Zine 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 -2
Signature of Applicant
I hereby issue the above permit for the Board of Health of the Town of North
Andover, Massachusetts.
DATE_
Si tune of Health Agent
I have inspected the uncovered system indicated above and find everything done
as described. j
DATE_
hUY-A
Signature of Inspelqjinrofficer
Percolation Test 6 min. Soil: -clay
Garbage Grinder No
� - J
April 15, 1961
Miss Mary Sheridan R. N.
Health Agent
Board of Health
North Andover, Mass.
Dear Miss Sheridan:
An examination was made as requested in order to determine the
suitability of the soil for the subsurface disposal of sewage on the
proposed Marbleridge Road building site of Raymond D. MacLean.
The land in general is high.
The subsoil in the area was of clay content and a 6 -minute
percolation test was conducted.
It is recommended that a 750 gallon concrete septic tank be
installed together with 160 lineal feet of drain pipe.
WJD:hd
Very truly yours,
INV,
am J. i co
2 BOARD OF HEALTH
TCHN OF NORTH ANDOVER, MASS.
130 _
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!.l Ivt�,j i�! L�
1.
NAPMi.1 .}:`�I.r.°; . DATE
2.
ADDRESS / Nfl.
TEL.%fi—
. .LOT
c
3.
N0, OF 13EDROOI-6 DEN YES . . . . . NO.. ► :�
. ..
4.
GARBAGE GRIItiTDER YES . . . . .. NO.. X .
5.
SHOW DIIENSIONS OF HOUSE
6.
SH099 DISTANCES OF HOUSE TO ALL PROPERTY LINES,
. 7.
SHOW DI ENISIONS OF LOT
$.
SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL
q,
NOTE LOCATION AND DISTAD?CE OF WELL FRom SE6�J�,RAGE SYSTEM
10.
SHOW LOCATION OF BROOKS, STREA16, DITCHES, LEDGE OUTCROP, ETC.
11.
SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE
NOTE: LOCAL REGULATIONS SHOULD HE READ CAREFUILY.
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