HomeMy WebLinkAboutMiscellaneous - 39 HAY MEADOW ROAD 4/30/2018I
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�LN Commonwealth of Massachusetts
City/Town of N.Andover
System Pumping Record
Form 4 S�p
DEP has provided this form for use by local Boards of Health. Other forms a but�.914
information must be substantially the same as that provided here. Before si jL% with ur
, __%A
local Board of Health to determine the form they use. The System Pumpin Recor , 7' to
the local Board of Health or other approving authority within 14 days from the pum ing date I.
accordance with 310 CIVIR 15.351.
1. Date of Pumping n /� /I � 2. Quantity Pumped: , qb
D -ate' Gallons
3. Type of system: Cesspool(s) P/Septic Tank Ej Tight Tank Grease Trap
El Other (describe):
4. Effluent Tee Filter present? 0 Yes Fj No If yes, was it cleaned? El Yes El No
5. Condition of System: x sud I
6. System Pumpe By:
QabmePDO Vehicle License Number
Stewart's Septic Service
Company
7. Location where contents were disposed:
Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835
Signature Date
of Receiving Facility Date
t5form4.doc- 03/06 System Pumping Record - Page I of 1
A. Facility Information
Important: When
filling out forms
1 . System Location:
on the computer,
use only the tab
39 Hay meadow Rd
key to move your
Address
cursor - do not
N.Andover
MA
use the return
key.
City/Town
State Zip Code
2. System Owner:
Risdel
Name
Address (if different from location)
Cityrrown
State Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping n /� /I � 2. Quantity Pumped: , qb
D -ate' Gallons
3. Type of system: Cesspool(s) P/Septic Tank Ej Tight Tank Grease Trap
El Other (describe):
4. Effluent Tee Filter present? 0 Yes Fj No If yes, was it cleaned? El Yes El No
5. Condition of System: x sud I
6. System Pumpe By:
QabmePDO Vehicle License Number
Stewart's Septic Service
Company
7. Location where contents were disposed:
Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835
Signature Date
of Receiving Facility Date
t5form4.doc- 03/06 System Pumping Record - Page I of 1
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BOARD OF HEALTH
120 MAIN STREET
NORTH ANDOVER, MASS. 01845
COMPLAINT FORM
DATE: /a 12. 1 C41 - -. CASE# &&
Up.
ADDRESS: 3p Am" nLw-"'4' PHONE#&
COMPLAINT:
OWNER:
ADDRESS: PHONE#
ACTIONS: HT 2-
N
TEL: 682-6483
Ext. 32 or 33
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TO: NORTH ANDOVER, MASS. May 23 19 83
BOARD OF HEALTH
FROM: DESIGN ENGINEER Re: Soil Absorption
Sewage Disposal
System
This is to certify that I have inspected the construction materials of
said disposal system at lot 57 Haymeadow Road
Site Location
North Andover, Mass.
The grades and construction materials are as specified in my plans and
specif ications dated Julz 29 19 80 and As -Built May 19 19 83
(Rev. 3/lb/6.3)
Reg �4�ro -ineer/Reg.Sanitarian
William Place
1. WiLLIAM
PLA(CE
CIVI
H2
No. S101.2
'p
az -d 0 f
�orth An42V_e_r,%Fa_15q
5-.99
VA -
K r/M..
Z. -
BEMC SIKID".
INSTALLATICE1 CEZC-E LIST
1� -
LOT
[EXCAVATIM OK DJ L
OK
1. Distance Tot IZ&7
a. Wetlands
b. DraimLs
wen
_W
2. Water Line Location
-CX/
3. No PVC Pipe
Septic Tank
a* --Tess �__Length To Glean Out Covers
b. Cemeat Pipe to Tank Oa Both Sides of TanY
Distribution Box
a Covers & Box - No Cracks
b. All Lines Flo-Ang Bqual AmolInts
c .. No Back Flow
6. - Leachlield or Trench
Diman-sm-'ons
b.
Stone Depth
a
'tapped -Ends
d.'
_Cleaa Double Washed Stone
7. Leach Pits
a.
Dimensions
b.
Stone Depth
c.
Splash Pads
d.
Tees
e.
Cemmt pipe to Pit Both Sides
f.
Clean Double Washed Stone
8. No Garbage.Disposal,
9. Final Grading Inspection
L
10. Barricading Covered System
11. ks Built Submitted
a. Tot Location
b. Dim�ensions of System
c. Location vith Regard -to Perc Test
d. Flev tions
es' Water Table
iYur-un anclo",r.MaBB
LPPRuV DATE
'rovided:
itle V
ag 2.5
cUBSURFACE DISP
OsAL DEsm cag Lisr
LOT
DIS"PRMM UTZ
Reasons:
4
�If
V
e e submitted plan must show as a minimumt
lolot to be served-areasdimensions lot #sabutteris
location and log deep observation 008 -distance to ties
location and results Percolation tests -distance to ties
sign calculations & calculations showih
re -cation and dimensions of system 9 require,& leachinj area
e sting and proposed contours including reservearea
f S
9) ation any wSt areas Vithin loot
- loc of sewage disposal system or
,-"disclaizer-check wetlands mapping
P
face and subsurface drains within 1001 of,
Be-.mge disposal
system or disclaimer
"i) -cation any drainage ea'
sy sements vithin loot of 88mge disposal
sYstE= or disclairier-PLmning Board files
J) �knO= sou�ces Of v-ater slipply -within 200t of selage
system or disclaimer disposal
vfl�cation Of a1W. Proposed well to serve lot -I'
I)- :Location of water lines on property -101 fro 001 from leaching facility
wy-10c-ation of benchmark m leaching facility
X) driveways
�garbage. disposals
_nO PVC to be used in construction
1) profile of system-Olevations of basements plumb
- distribution box inlets.and outlets u s Pipes 86Ptic tank
bther elevati - - s distrib tiOU field piping ands
one
maxim'= ground-vater elevation in area se,'6-age disposal system -
plan rmst be prepared by a profe
profe ssiOnal EaginOGr or other
ssiOnal �uthorized by law to prepare such Plane
Septic Tanks
(a) _CaPacFtTe_8__-T50% of f3.ow te'
access., Purping .9 water table., esi &Pth Of teeB,,
cleanout
10 1 from c ellar
al
c)
or inground swimmifigpool
(d) 25, from subsurface drains
Distribution BoxeB
0.08
b)
e veal
Check Ll t
Pa
FAIL
e 2-
OK
L��hing Pita
Reg
Leaching pits are preferre d where the installation is Possible
3.1.2
11-4
calculations of leaching area" ninimm 500 aq ft
BPaC ing
3-1.10
3-1. ll
c Burface drainage 2%
cover material
21x2l.Am 6PI-ash Pad
f -tee at elbow
g no bends in pipe from d -box to pipe
Reg 15.1
Leaching 716
t
no gr ter 20'V'inutes/inch
b
1�-4
areaR 900 aq ft
3.5 8
cj . .
cons c On - Of field
'c
3:7
surfac e 2 %
e) 201 jFPdF
m cellar uIll or inim und swinxing pooI,
teg 1h.1
L hin
ea��chmn&
14-3
114-4
a) c"O _CM 8 01
c 8 0 eaching
b� spacing- r4- sq ft
ft min 6 area-m'n 5�*
ft with
14.6
c dirensl na reserve betueem
14.7
d) cons ction
3-h.10
ston.
f
Smu ace drainage 2%
Do Slo
e
a 8 ope to be shown
b ylx 1 (to be
shown)
Ig 9.1
a) Val
9.6
b) d -by- po,,er
SYSTEM OWNER &�DR�ESS�
,3.
/vo. C�W'060rle
-----------------
SYSTEM LOCATION" -
J.
671 .
DATE OF PUMPINQ QUANTITY?UMPEI)
CESSPOOL NO Ins
BPTIC TANK NO YES
NATURE OF SERVICE;;,RQy
KB ENORCENCY
OBSERVATIONS:
GOOD CONDITION FULL To COVER
BAFFLES IN'LACE
ROOTS LEACHFIELD RUNBACK
EXCESS * WE SOLIDS., FLOODED
SOLIP.CARRYOVER OTHER EXPLAIN
SYS7Zivl PU?vfP D BY
COMMENTS,-
DEPI.hai p*rQVIded 'for
M for uoe by local Soards of Health, Th
�be a u b�nl�6d to t�Q local BQard of Health or other apprQYln 0 System Pumping
9 authority,
k..FaC111t
y'.1 n o In
14 MQY0 XQW .
Ll`V4 Iry tum -Tl�/Tqwn
LLW
TP—C —we
)Addtf�" (If0fortnil from iQc4UQn)
191W CCU Z�p C
Wo.
b\�'6TIclop One NlIf
A
A
M.P1n�:R6'qord1':. 0_
0
:of Pump n
0 anUty Purnpeci:
2. Qu
Yp.Q
optic Tank Tight Tank
or
to r 3ent?..C] Y
Effly!'e' t 6Ao' If yes, was it
cleaned? C] yes
5W` on
7"
----------
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Z.
44 Y
posed:
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AN ")"V"!�- 91 MWo'.". ko,
ma
htlp
90
'IV
If
Date
SY116M PUMPIN Ro C�Qm P