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Home My WebLink AboutMiscellaneous - 39 DEER MEADOW ROAD 4/30/2018s ILI Commonwealth of Massachusetts City/Town of No.Andover. System Pumping Record y` Form 4 Important: When filling out forms on the computer, use only the tab key to move you: cursor - do not use the return key. -Q rzrtm I DEP has provided this form for use by local Boards of Health. Othe f6Wj 'A t'#r e information must be substantially the same as that provided here. B 1sa 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 within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information 1. / %Au1Oo.7 No Andover " City/Town 2. System Owner:�- Name Address (if different from location) City/Town Ma State State Telephone Number Zip Code Zip Code B. Pumping Record 1. Date of Pumpingate 2. Quantity Pumped: Ions 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other (describe): 7'. 4. Effluent Tee Filter present? [I Yes�No 5. Condition of S sm:�em�:� 6. System Pur"7 Name Stewart's Septic bervice Company 7. Location where contents were disposed: Stewart's Pre-treatment Plant, 20 So. Mill Bradford Signature Signature of Re4ei�ing Facility t5forrn4.doca 03/06 N. If yes, was it cleaned? ❑ Yes ❑ .No Vehicle License Number Ma 01835 Date ZI Date System Pumping Record • Page 1 of 1 M Important When filling out forms on the computer, use only the tab key to move your cursor - do not use the return keys.. . ISI law Commonwealth of Massachusetts City/Town of DEC 18 2010 System Pumping Record TOWN OF NORTH ANDOVER Form 4 1 HEALTH DEPARTMENT 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 within 14 days from the pumping date in accordance with 310 CMR 15.351, A. Facility Information 1. Ruaress North Andover ma 01886 City/Town State Zip Code 2. System Owner: Name Address (if different from location) City/Town State Telephone Number Zip Code B. Pumping Record 1. Date of Pum in 2. Quantity Pumped: 4�6 Pumping Date Gallons 3. Type of system: ❑ Cesspool(s) VjqeStic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6.st m P ed . Name , on Stewart Septic Service Company 7. where contentA were disposed: Vehicle License Number Plant 20 So. Mill St. Bradford Ma 01835 Signature of Receiving Facility Date t5form4.doca 03/06 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts �Y City/Town"of NORTH ANDOVER MASS EU.S System pumping Redord Important: When filling out forms on the . computer, use only the tab key to move your cursor - do not use the return key. DEC 6 2006 DEP has provided this form for use by local Boards of Health. The System Pumping Re Ord mw be submitted to the local Board of Health or other approving a jUWAWF NORTH ANDOVER HEALTH DEPARTMENT A. Facility Information 1. System Location: (X� Address -- - _ - - - - - - Clty wn State Zip Code 2. System Owner: Name Address (if different from location) _ City/Town rumping Kecord Y'i Date.of Pumping Type of system: ❑ ❑ Other (describe): State 6? Zip J /Zip�o e ----- --. Telephone Num6e-r-- Zh Date 2• Quantity Pumped: �� GaAons Cesspool(s) Peptic Tank ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yeslo C, 5. Condition of Syste V / 6, Sy Pumped By: Zia Company -A- 7. Location where contents were disposed: Si ature of Hau -�- -- hftp://www.m6'ss,govi/'dep/water/ provals/t5forms.htm#inspect If yes, was it cleaned? ❑ Yes ❑ No Vehicle License Number — - - - t5form4.doc- 06/03 . System Pumping Record • Page 1 of t .I—........ n TOWN OF NORTH ANDOVE UA 11 d �� J SYS76M1 PUMPINQ REC4RL SYST$M t?WTl€R r At?€�RESS / ��As SYSTEM LOCK RECEIVED JUL - 6 2005 `,, TOGS/N OF NORTH ANDOVER HEALTH DEPARTMENT DATE OF FNQ;�--' QUANTITY PUMPED: k tWOOL: too__..._. lis„ c Tank: NU, YDS NA rUK4 OF Sexvtee: Ub SbA V A'nom: ooaD 0ONVI 1.0N ty c o Rom RAVY d 8 13AMBS IN PLAUL, RQt7i'$ + ._ LBACKKUD RUNBACK OXCUSSIVE SOLIDS --FLOODED S0LrD CAKAYoYn_ Q'�{aR �XPLA IN �7,►qm Pw„Pcd by -- VVMMENTS. l.'vNt' m,3 r�nN�r KRiit? ►�1 a 4- O cn CL LL 4- O N 4-1 El 7 L O � a0+ 'V O ig vo 12 � I C O O E c �+ U '0 m O 7 13 4 I 1 1 1 f L' i.r H O L G 4- Q � n C U O C , m Z 'r - a) . E a✓ as rs. a� 0 cn c m r c 0 .N E E O u c O ra 5 L Q) cn C O U f ru O C c fp l I Q v 3 u I LOT Su P. fcs po 15YA5-T P.M �,� c- c) 5 CA, LP- 0 15 cl( bb 4 A t 1 ovia -741' SOIL PROFILE & PERCOLATION TEST DATA. North Andover) l ass. No.&Street - Lot No.0)%6 � ,r Loc./Subdiv. Plan"'Owner Investi-gator `.aba Observer SOIL PROFILES -DATE 1. Elev._ 2. 3. 3• 4'Elev. Elev. 0 0 0 0 1 1 1 1 Ties to Test Fits 2 3 4 5 6 7 8 9 10 2 2 3 4 5 6 7 8' 9 10 4 2 3 4 5 6 7 8 9 10 Start Saturation 2 3 4 5 6 7 8 9 10 Soak -Mins. - Start Test -Time -_ - Drop of 311 -Time - "-Time-Dro Drop of 6" -Time 2,1k Dins. lst. 3"Dro — __ Mins . 2nd 3"Dro G Benchmark Elevation Location Datum Percolation Tests -Date - I 1 I Pit Number 1 2 3 4 5 Start Saturation Soak -Mins. - Start Test -Time -_ - Drop of 311 -Time - "-Time-Dro Drop of 6" -Time 2,1k Dins. lst. 3"Dro Mins . 2nd 3"Dro G Percolation Rate a Notes & Sketches on Back Board of Health BEPTIC SISTEM p�-�✓ � North AnooverXH"so � INSTALLATICK CHECK LIST LOT 1. Distance To: a. Wetlands b. Brains c. Well 2. Water Line Location 3- No PPC Pipe %. septic Tank - a. Tess _Length & To Clean Oat 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 69. Leach Field or Trench a. Dimensions b. Stone Depth c. Capped Inds . d. Clean Double Washed Stone 7. /jeas as bth cds dpe to Pit - Both Sides. fble Washed Stone 8. No Garbage Disposal 9. -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 OK FAIL ,,hoard of Health k7orth Andover,Mass SUBSURFACE DISPOSAL DESIGN CHECK LIST LOT APPROVED DATE DISAPPROVED DATE______ Provideds Reasanssf Title , FAIL CK Reg 2.5 a submitted plan must show as a mdnimums the lot to be served-area,dimensions lot #,abutters location and log deep observation hoes -distance to ties b location and results percolation tests -distance to ties design calculations & calculations showing required leaching area location and dimensions of system -including reserve area existing and proposed contours g), location any vet areas within 100' of sewage disposal system or disclaimer -check wetlands mapping (h) surface and subsurface drains within 1001 of sewage disposal system or disclaimer (i) location any drainage easements within Loot of sewage disposal system or disclaimer -Planning Board files (j) known sources of water supply within 2001 of sewage disposal system or disclaimer location of any proposed well to serve lot -1001 Brom leaching facility (x) location of water lines on property -10, from leaching facility (a) location of benchmark driveways garbage disposals l no PDC to be used in construction V (q) profile of system -elevations of basement, plumb, pipe, septic tank, distribution box inlets and outlets, distribution field piping and "cher elevations 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 Septic Tanks (a) capacities -15D% of flow, water table, tees, depth of tees, �access, pwaping c) cleanout 101 from cellar wall or inground suLnmimg pool (d) 251 from subsurface drains Reg 10.2 Distribution Boxes a) slope greater than 0.08 Reg 10.E4(6) sump Ad -/j��• . I .: 5.. l 1rx 1,{•. Y/I {�. C. �L i+ i A f 1 .1 r `,QUANTITY PUMPED GALLONS 41, - �'�ESSFOOL: YNO YES -. SEPTIC TANK: NO YES ��+ �fQ��j NATURE�OF S ..'. .,. }. ' + ERVICE, ROUTINE EMERGENCY �r'}'r� . r. VATIONS•• r 1 OOD COND ITION: FULL ' HEAVY GREASE $ TO COVER AFFLES IN PLACE ROOTS -� LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED rf i r: ` ;SOLIDS CARRYOVER OTHER (EXPLAIN) I , `I1�.yy4 y tti «r s, o e , �.. s. / !�# I�fi�t s r , y 77. y (�. / YX r .. TOWN,OF NORTH ANDOVER SYSTEM PUMPING RECORD Ad -/j��• . I .: 5.. l 1rx 1,{•. Y/I {�. C. �L i+ i A f 1 .1 r `,QUANTITY PUMPED GALLONS 41, - �'�ESSFOOL: YNO YES -. SEPTIC TANK: NO YES ��+ �fQ��j NATURE�OF S ..'. .,. }. ' + ERVICE, ROUTINE EMERGENCY �r'}'r� . r. VATIONS•• r 1 OOD COND ITION: FULL ' HEAVY GREASE $ TO COVER AFFLES IN PLACE ROOTS -� LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED rf i r: ` ;SOLIDS CARRYOVER OTHER (EXPLAIN) I , `I1�.yy4 y tti «r s, o e , �.. s. / !�# I�fi�t s r , y 77. y (�. / � I I TOWN OF NORTH ANDOVER SYSTEM PUMPING P-ECO,U pr �l r- 'yl UWNER & AUDRESS SYSTEM LOCATION -- ��,(�G�C��J (ex'ample: Icf( from of hou�r) ,39 z►m /pa A' r. OF PUMPINC: (QUANTITY PUM?CD ,�SIIOOL: NO YES SEPTICTANK: NO YES ,, A URE OF SERVICE: ROUTINE EMERCENCY �!i>Fftv��TIONS: C COD CONDITION HFAVY CREASE ROOTS CXCESSIVE SOLIDS SOLIDS CARRYOVER I LM PUMPED BY: u,l '�•l FNTS: U-� I ':'NTS TRANSFERRER) TO: [FULL TO COvC'I� BAFFLLS IN i'I.ACI: LEACHFIELD IZUNN ACK.. FLOODED w, O. HFR (EXPLAIN.) TOWN Pf'NO'UH ANDOVER SYSTEM PLWING RECORD DATE op SYSTEM OWNER & Abb-R—ESS— N ve /r, SYS M LOCATION DATE OF PumPIN3/:)q 16UMPED e, -Z 6 _QUANTITYP CESSPOOL NO ✓ YES— SEPTIC TANK NO NATURE OF SERVICE;:,RQVT-_EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER 4AVY GREASE BAFFLES IN LACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS -FLOODED SOLID CARRYOVER„ OTHER EXPLAIN SYSTEM PUMPED BY COMMENTS: CONTENTS TRANSFERRED TO YES D)VER- MASSACHUSETTS DEP ho& Provldad ,hl4"fc �e + - DM I{od ;o the lo:a: A, Faculty InforrTl� H� V M •nom , 1 -' i '1 h'uno �,.ti r .r, i '✓,.. ( dVforonl f= bCaUon) B ,Pum I R d v or ayalam; Q Co9spool(9) 4, Etfluon! Toa FMo( prpsenl? 7, Yo9 rv'o �;C.oridlPgn 9y,jtl' Pvmpad 8y; _ •1 � .� r/("��,�;� I'��nti�'la� : �,•: :•� .:, ,',�.( •.,,.,..:,:<,• � .Ware c,, posaa. ,�:.;!n�w.mass.8ov/dapNralar/epprovaJa/lblorm9,h.m� nsvec! N Toltl�nono Iv,moe( 2.1 Sapllc Tang r7 "3N Tan,, I( y69, n89 i; c'6anad? Y89,/ p/OYI010 Jh,1 prrn lgr r o1 1- 1) 11c0 (o ver I 1, 19., or r 1 o CII aQW: C'1 n00 In p/ A. Facility In(.o(M� ftn i'•IG'. -44 lh' l� j �' •! i ! I �J / / ;+ v� n um''.' C17 l .';;;I ;qtr '��8r�lem Owner",?.;•;,., :� , `—�"1.i�'��.l.�r�i'y',1,4i'tl'yl,'�'I��'' �larr✓•,;Ir,. r • �%6 'Pu � mA ' ►, Oal�,� Ir; `,,Ill,,•,,,, . ��• e of P�mDln9 •�' rYD1�411yi10111,„LlC+3>>�oor(fJ ,• ' ''l;',,;�,'I ', 1'i";,;ra;' $Opus len, , r ,�Q O/her � '• � Ise' � a CM ' (deycriDa '• ' , '•rlil,� ry��l � 1�1 �I I •, t'9., I r � ' ''.1'r/•••,;,�,�6,1'•OQ�idi pn'p 'ay � I„r,r,' . I� �r ; . r'•Il,��;'I�V1"��%,��eY��l �l�l�„��/r��,� �,�i%��"'Si��lr11�'l� .. � .... '�. ;','•:`;, '';l,yrrl�',�,1v,rwneal,o� 011n1a;y�aio dhpo N; v Wf '•'r.m(•poY1dep�ieilippJpYij�141orm,,r;�nain�ooc( Y O a 0r10 Ir reg. „el c vaneo7 7 Tel IMM No Andover J&S Development dba 1600 Osgood St Stewart's Septic Building 20 Suite 2-36 Andover Septic No. Andover, Ma 01845 58 South Kimball Street Bradford, MA 01835 Date Name & Address Gallons Comments 5 -Apr Andriolo 37 Birch Lane 1500 Good Sullivan 47 Boxford St 750 Good 6 -Apr Sapienza 40 Sterling Ave 1500 Heavy bottom 9 -Apr Disalvo 400 Winter St 1500 Good 10 -Apr Sarano 265 Hay meadow Rd 1500 Xxxsolids 12 -Apr Lind 575 Wintery Ste. 1500 Good 16 -Apr Distefano aS& Raleigh Tavern Lane 1000 HG Walsh 58 Paddock Lane 1500 Good 18 -Apr Schrader 35 Woodberry Lane 1000 Good Ahlhdm 48 Hawkins Lane 1000 Good 19 -Apr Barrett 235 Candel Stick Rd 1500 Good 20 -Apr Harold 453 Forest St 1500 Good Duffy 67 Shirwood Dr 1500 Good Zoll 333 raeligh Tavern Lane 1500 Good 23 -Apr Haffeners Car wash 564 Chickering Rd 2000 red tank 25 -Apr Valle 58 Evergreen Dr / 1000 Good - 27 -Apr Lucas 39 deer meadow R 1500 Good 30 -Apr Meaney 745 Foster St 1000 Good RECEIV HAY 1 8-2012 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT