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HomeMy WebLinkAboutMiscellaneous - 420 WINTHROP AVENUE 4/30/2018 (2)Commonwealth of Massachusetts i City/Town of NORTH ANDOVER, MASSACHUSETTS P, System Pumping Record Form 4 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Brum 6 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. A. Facility Information 1. System Location: Add ress_-- City/Town State 2. System Owner: i Name Address (if different from location) City/Town Zip Code State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping -f=U—/ 2. Quantity Pumped: to ©� --- Date Gallons 3. Type of system. ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other (describe): -- -- - — - --- --- - 4. Effluent Tee Filter present? ❑ Yes [ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System ,�)K 6. System Pyfnped By: Name -- — ----- —� - ---- --- Company 7. Location where contents were disposed: Signature of Hauler http://www. mass. gov/dep/water/approvals/t5forms. htm#inspect Vehicle License Number --------- - Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts - City/Town of NORTH ANDOVER, MASSACHUSETTS >. -'U— System Pumping Record Form 4 DEP has provided this form for use by local Boards of�Health. The System.;P_umping Record mi. t be submitted to the local Board of Health or other approvtrr"auftj6VyD Important: When filing out forms on the computer. use only the tab key to move your cursor do not use the return <ey t� A. Facility Information . DEC 3 0 2013 1. System Location: TOWN OF NORTH ANDOVER 2, 0 c - J 0r0, 1 HEALTH )DEPARTMENT Address 1/U di;"` -ti fvtl,�r Cityr7own State 2. System Owner: Name � ) -- Address (if different from location) Cityffown State Telephone Number 019"'11 Z:p Code Zip Code B. Pumping Record �2� /3 1. Date of Pumping pa e—,------ ---- 2. Quantity Pumped IMC Gailons 3 Type of system: ❑ Cesspool(s) [j?"Septic Tank ❑ Tight Tank ❑ Other (describe): -- 4 Effluent Tee Filter present? ❑ Yes : NR 5 Condition of System. If yes, was it cleaned? [ Yes F--,,' Nc 6. System Pumped By: �"'L , `nr'� Zr4' Name Vehicle License Number Company 7 Location where contents were disposed. Signature of Hauler Date nttp //www mass gov/dep/water/approvals/t5fcrms.htm#inspect :5form4 doc• 06/03 System Pumping Recuid • Page '. �yY FORM U - IAT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and landowner from compliance with any applicable local or state law, regulations or requirements.' ****************Applicant fills out this section***************J** APPLICANT: ��/F%�/Ji'�� ( `1 `� '�°cL f Phone�_.�"�"i/ LOCATION: Assessor's Map Number Parcel Subdivision Lots) Street " �� GL `' �� %1'�;G' A//7 St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved on rvation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Food I pector-Health ec or -Health Comments Public Works - sewer/water connections - driveway permit Fire Department Date Approved Date Rejected Date Approved Date Rejected Received by Building Inspector Date o"A x lkVJ�I 0,-T- =� �' Vii. IM SFYTIC sis"MN Lj I Ji FH IV 5T JFSTAILALTM'%' CIEM LIM LOT DrI10.h2pIUJID XOAVATICN OK TAIL (09 1. Distance Tot a. Wetlands b. Drains C. well 2. Water Line Location 3. No PVC Pipe Septic Tank a. -Tess t. -length & To Clean Oat Covers. b. Cement Pipe to Tank - On Both Sides of Tank 5. Distrib-ation, Box a. Covers & Box - No Cracks b. --AU Lines -Flowing Equal Amounts e. No Back Flow 6. Leach Field or Trench a. Dimensions b. Stone Depth o" Capped 'Ends d. Clean Double Washed Stone 7. Leach Pits a. Dimensions b. Stone Depth e. Splashelads d T 7- t Pipe to Pit Both Sides e: f:,, -,C=lean Double Washed Stone 8. No Garbage Disposal 9. Final Grading Inspection 10. Barricading Covered System 3.1. As Built Submitted - a. lot Location 6,39 b. Dimensions of System c. Location with Regard -to Pere Test d. Elevations e.' 'Water Table SOIL PROFILE & PERCOLATION TEST DATA z"11117 I,, North An'---- �• T1n . �Jf T.nt No. j Loc./Subdiv._ Plan Owner CN7p-0 i Invest i.gator; JpAll-j 4,14,'! / Observers • $OIL QROFILES-DATE Elev3' 4Elev. E1ev. . Elev. 0 0 0 - 0 1 1 1 1 Ties to Test Pits 2 3 4 5 6 7 8 9 _0 3 4 5 2 3 4 5 6 7 8 9 10 2 3 _4 5 6 7 8 9 10 2 3 4 5 6 7 8 9 10 V S� � _ 0 Dins. 1 st - 3"Dro Mins.2nd 3"Dro - Fercolation Rate S �► L� p�V !�P V �© B h a k Location enc m r Elevation Datum Percolation Tests -Date Pit Number 1 2 3 4 5 Start Saturation I.I� Soak -Mins. ► ��� Start Test -Time Drop of 3" -Time - II Drop of 6" -Time Dins. 1 st - 3"Dro Mins.2nd 3"Dro - Fercolation Rate S �► Notes & Sketches on Back " u c M SUBSURFACE DISPOSAL DEMO CHECK LIST l LOT APPRO7M DATE DISAPPROVED DATE_ Provided: , Reasonss IJ6Sr1� �( Title V FAIL Reg 2.5 The submitted plan must show as a minimums a) the lot to be served-area,dimensions lot #,abutters location and log deep observation heies-distance to ties location and results percolation tests -distance to ties design calculations & calculations showing required leaching area location and dimensions of system -including reserve area f existing and proposed contours g location any vat areas vithin 100' of sewage disposal system or disclaimer -check wetlands mapping h) surface and subsurface drains within 1001 of sewage disposal ---system or disclaimer C.l�`� '[ ►r a ` rr�'P. i i) location any drainage easements within 100' of sewage disposal system or disclaimer -Planning Board files knokn sources of water supply within 2001 of sewage disposal e system or disclaimer .location of a y proposed well to serve lot -1001 from leaching facilit, cation of water lines on property -101 from leaching facility m _location of benchmark n driveways o garbage disposals 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 maximum. ground water elevation in area sewage disposal system s plan mast be prepared by a Professional Engineer or other professional authorized by law to prepare such plans Reg 6 Septic Tanks (a) capacities -150% of flow, water table, tees, depth of tees, access, pumping (b) cleanout (c) lot from cellar gall or ingromd. suLmming pool Ad) �5t from subsurface drains Reg 10.2 Distribution Boxes (a) slope greater than 0.08 Reg 10.4 b) suap D.. I Pte, Reg 15.1 15.4 15.8 3.7 Reg 11.1 14.3 14.4 14.6 14.7 1h.10 Reg 9.1 9.6 Chectk Lint I OK Leaching Pits Leaching pits are preferred where the installation is possible a) calculations of leacMj g area-rdni mum 500 eq ft b) spacing ,,� c) surface drainee 2% d) cover mat al e) 2 �x2 splash pad f) tee elbow g) ends in pipe from d -box to pipe Leachin Fields a o greater t 20 minutes/inch _area-minimumm 900 sq ft construction of field d)` face drainage 2 % i1*1201 from cellar vaU or inground swimming pool Leachin Tumches a) calculations o each ng area -min 500 eq ft b) spacing -4 ft min 6'ft with reserve between c) dimsnsions.,� d) cons on e) stqM f) face drainage 2% Downhill Slorie a) slope y x -_Ito be shown) b) y/x Z 150 - (to be shown) Purps a) appro - b) st� power Julius Kay, M.D., Chairman R. George Caron Edward J. Scanlon BOARD OF HEALTH NORTH ANDOVER MASSACHUSETTS 01845 COMPLAINT REPORT �yORTy1Yw�. %,� 1855 ,meq w ►� AcWj 4{ �rrrr*e TEL. 682-6400 Date Z - 7R Made by I N 0 I Address Tel Nature of complaint Location Ly W14VV U P Occupant Owner or Agent L- C /S,6c p //Z49k/ Address 4'rpo V -&W - DO NOT WRITE BELOW THIS LINE Referred to L �� Hlc C �� Date Investigated- Z i ` 7 Result of investigation P�DNL�� aF LEAt rev(- "(272C 7-,4A.)k J� vs Recommendations ePL+c,6" Al S C-9 77 c 7-0 ' 5CT-Je-P- LOVE dN r Action taken 4 Wyeth WYETH LABORATORIES Dr. aulius Kay M.D. Chairmen Board of Health No. Andover, Mass. Division of American Home Products Corporation April 9, 1978 Dear Dr. Kay, ,Sometime in Nov., 1977, I contacted the Health Office by telephone to request that the Health Dept. inspect the property next door to me at 420 Winthrop Ave. It is my understanding that such property is owned by the.contracting firm of Follensbee and Philbin of Andover. The nature of my complaint was concerned only with the horrendous odor which seemed to emanate from the area of the septic tank at rear of the house which was not properly covered at the time. Both secretaries, yours at the Health office, and at your Medical office were very gracious and co-operative, and recommended that I write a letter of complaint to you. Since I had also complained to the tenants, who weee also upset, it came as no special surprise that the tank was cleaned out within three days. Therefore, I did not write .to you at that time. There are different tenants there now. With the arrival of Spring, and much moisture in the ground, we are noticing the same unhealthy odor again, only now it seems much worse. It was quite overwhelming late this afternoon. Frankly, Doctor, I am not at all certain that the cause of the problem is that septic tank next door, but considering the usual prevailing wind and the apparent deteriorating condition around that property of late, it is my best judgement. I also know that when Mrs. K. Shea owned it there was never a problem, and I am also certain that it is NOT my own septic tank. Herve Croteau cleaned mine out only six months ago. I am sure you can understand how unhealthy this situation is, and will continue to be until it is rectified. W►yeth W Y E TH LABORATORIES Division of American Home Products Corporation I trust you will use your best judgement, for all parties concerned without offense to anyone. Certainly, we cannot look forward in this household to a very pleasant Spring and Summer under such germ - breeding conditions. Therefore, will you please advise me as to what you can and have been able to do regarding these circumstances, and be kind enough to notify me of any results. Many thanks for attffntion to this matter. Sincerely l f atv ohn J. Hog J 432 Winthrop Ave. No. Andover, Ma. 01845 n 3