Loading...
HomeMy WebLinkAboutMiscellaneous - 43 VEST WAY 4/30/2018 (2)F� F T N � O i �P w G o m ` L o n � o j i� Commonwealth of Massachusetts _ City/Town of North Andover System Pumping Record ;wM •,•„ Form 4 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. RECEIVED JL 07 2014 TOWN OF NORTH ANDOVER'. HEALTH DGPARTM !;4 A. Facility Information Important: When filling out forms 1 on the computer, use only the tab System Location: key to move your Address cursor - do not North Andover use the return key. City/Town ©1, 2. System Owner. Name Address (if different from location) Ma State 01886 Zip Code City/Town State Code7.-jTelephone Number /f B. Pumping Record 1. Date of Pumping Date ` f 2. Quantity Pumped: 3. Type of system: ❑ Cesspool(s) a Septic Tank ❑ Tight Tank Gallons ❑ Grease Trap ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes 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 7. Location where contents were disposed: Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 Si ler V Date (Sicyfature of Receiving Facility Date t5form4.doc• 03/06 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts City/Town of North Andover System Pumping Record Form 4 M 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 p _rrjrr pindate i accordance with 310 CMR 15.351. RECEOVEB Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. rab rehun A. Facility Information 1. System Location: 43 Vest way Address North Andover City/Town 2. System Owner: Smith Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 5/17/11 Date Ma State State Telephone Number 2. Quantity Pumped: 3. Type of system: ❑ Cesspool(s) ® Septic Tank ❑ Tight Tank JUN -7 1U11 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No 5. Condition of System: Good Condition 6. System Pumped By: Mike Snow 01845 Zip Code Zip Code 1500 Gallons ❑ Grease Trap If yes, was it cleaned? ❑ Yes ❑ No Name Vehicle License Number Stewart's Septic Service Company 7. Location here contents were disposed: St= -treatment PAnt. 20 So. Mill Bradford. Ma 01835 i ature ofer Date F-7, . l , Signature of ing Facility Date t5form4.doc• 03/06 System Pumping Record • Page 1 of 1 FORM U - IAT RELEASE FORK INSTRUCTIONS: This form is used to verify approvals/pe�,it9 from Boards and De �t all have been obtained, patents hav nec�nary landowner from compliance with a y relieve the a � Jur',iction regulations or re any applicable 1app"caut and/or requirements. or rotate law, ****************Applicant fills out this section*************** u'PLICANT: ** IACATION: Assessor's Map Numberphone 11 Subdivision parcel Street Lot(s) St. Number ** *********************Official Use Only******* �O D_TIONS OF TOWN AG • ENTS: Conservation OF Date A C� PProved Comments Date Rejected 11,4 0 � Town Planner Comments Food Inspector -Health Septic Inspector -Health Comments Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected Public Works - sewer/water connections driveway permit Fire Department Received by Building Inspector • Date 1b I �� �— ���` o, - `� � ��y ��� -�� � �� �� � �.'�� ��% LL7-�-54:5!- CITY/ TOWN: STREET. g 3 l/e3 T w/4 i 7-7-4 X SUBONISION: - SCALE; LOT No.: Now AdASSACHUSEM L NEW HAMPSHIRE 1508)154•$874 AJ S ff 7-J .s , TPaop�s�o .00 tTion+ � AT N (r c P�4 EM A� I W MOT VA4L10 WAFD 4 SHERBURNE ACA HUDSON, N.tt 0 051 (GOV 635-27" 11 r 4 c'l c'J LEACHING L' -C' —VAREA cl-4 3 . 4 7 4' I EXISTING . 'ST IN 6 FOUNDATION 150600 ,VEST. WAY ELEVATION S - 'TOP FOUNDATION 156.93 NOTE& CERtIFY,THAT'THE'SEPTIC SYSTEM WAS INSTALLED AS SHOWN.THIS PLL 41S -NOT rla INTENDED AS A.WARRANTY OF TH.t SYSTEM I I OVI'E 0 HOUSE OUTLET 15 3*60 S.T.JNLET 153,42 PUN SHOV�NG SOBSURIFACE SEWERAGE UT S.1 OUT, LET. D -BOX INLET I5 3 DISPOSAL SYSTEM AS—BUtLT -BOX OUTLET D BOX O� LOCATI ON' LOT 40 VEST WAY, OWN ER�JAYSON, ,15 REALTY CORp DATE I-3-83' --4 SCALEol 0' PREPARED BY= NOTLIP900ERTY-DESCRIPTiON FROM NERD'PLAN' 8012 FL/v�� A � / SSOC� P SSbS DESIGN BY F.'GEU.NAS AND ASSOC MARCH 16 P " 0 00X-5 - PLA ISTOW N.H. 7865 ��-1 ��� .� S�� �� � �7 d y : } r ry�D W f i -�-- 3i LEACHING AREA 34' q 1 EXISTING s 1 FOUNDATION f 34= --- 74' i -� 74'-L---->! r NOTElPROPERTY DESCRIPTION FROM NERD PLAN 8.012 SSDS DESIGN BY F. GELINAS AND ASSOC.DATED MARCH 16, 19610 i 1 7INOTE� CERTIFY THATZHE SEPTIC SYSTEM WAS NStALLED AS SHOWN -THIS PLANFI5 NOT NTENDED AS A WARRANTY OF THE SYSTEM. PLAN SHOWING SUBSURFACE SEWERAGE DISPOSAL SYSTEM;AS-BUILT LOCATIONQLOTAO VEST WAY J OWNER JAYSON REALTY G lx DAT 1, 3-$3 SCA LEal —4 PREPARED BY— FLt/VN ASSOCR ca POO/ P�A ISTO.W I 1 3 + YO O n_�865 1 s jell i , VEST -WAY ELEVATIONS rlT0P FOUNDATION 15603 yOUSE-OUTLET 153.60 S.T. INLET k534 S.T= GUTLET 15323 B"BOX INLET 15`11 85 d'BOX OUTLET 11,75 SND OF FIELD .. 151456'. x� r NOTElPROPERTY DESCRIPTION FROM NERD PLAN 8.012 SSDS DESIGN BY F. GELINAS AND ASSOC.DATED MARCH 16, 19610 i 1 7INOTE� CERTIFY THATZHE SEPTIC SYSTEM WAS NStALLED AS SHOWN -THIS PLANFI5 NOT NTENDED AS A WARRANTY OF THE SYSTEM. PLAN SHOWING SUBSURFACE SEWERAGE DISPOSAL SYSTEM;AS-BUILT LOCATIONQLOTAO VEST WAY J OWNER JAYSON REALTY G lx DAT 1, 3-$3 SCA LEal —4 PREPARED BY— FLt/VN ASSOCR ca POO/ P�A ISTO.W I 1 3 + YO O n_�865 1 s jell i , NORTH ANDOVER, MASS.�,_((�cL T0: M. BOARG"',S-F HEALTH RRUffl• � A S�a600 DESIGN EI461WEER Re: Soil Absorption t �SSoG �C Sewage Disposal ok System n O. 6 569 038(05 z�s+aw NH This tis to certify that I'have inspected the construction materials of said La} 4v d'sposal system atwM—_�— — Site Location Borth Andover, Class. The grades and construction materials are as specified in plans and 9Q3 19 and As—Built specifications datedr_• �L Reg. ppof. Engineer Rv-j. ,n— O of Ecalt: BUnC SM1Z NortU-i Anicyq�-,XaBs- -4 o UNMALLATICK CHME LIST LOT ra ME199 FAIL I P I. Distance Tot a. Wetlands b. Drains 0. 'Wen 'I-- 2- Water Line Location y_-3- No PM, Pipe Septic Tank ... .... 7 a. -Tees s. -Length & To Clean Out covers. b. Cement Pipe to Tank -- On Both. Sides of Unk Distribittion Box a. Covers & Box - No Cracks b. _X11 -Lines -M -owing -Equal- Amounts C. No Back Flow Leach Field or Trench a* Dimensions b. Stone Depth a*, -Capped Ends Clean e: ed Stone, 7. MLeach Pits ' a. Dimens a b. Ston epth ce ash Pads d. eas * Cement Pipe to Pit Both Sides. f. Clean Doub 'le Washed Stone No Garbage Disposal 9. Final Grading Inspection 3.0. Barricading Covered System .3.1. As Built Submitted a. Lot Location b. Dimensions of System c Location with Regard_to Pere Test . Elevations e.' Water Table Board '3f Health NoV% Andover,Xass APPROVED DATE Provide: 6 Title V Reg 2., SUPSt i FACE DISPOSAL Da --16 CHWK LIST LOT # 10 DISAPPROVED DATE Reasons: The- submitted plan mxwt shay, as a : e lot to be served-area.,dimensions lot ,abutters ocation and log deep obsn,,vation 0esadistance to ties ocation and rets percolation tests-distanee to ties Adesign calculations & calcUati.ons shoving reVdred leaching area cation € nd di menaions of stearx-including E ese area erlstin9 and proposed contours .9 cation areas uit1da 100 9 of sewage disposal system or disclaimer -check wetlands mapping surface and subsurface drains -rAthin IMI of see disposal system or disclaimer P' location any drainage easements k4tbln 1001 of lege disposal system or disclaimer - g Board files PIwom sources of vmtcr sLvply vit&in 2001 of stege dispoeAl - �system or disclaimer P) ocation of proposed vmll to serve lot -leas from leaching facility location of .tee° lines on p�p�'tY-1®" f��m leaching facility 4 -location of bchk Ndrivevrays arbage di o sal s PT no PVC to be used in construction q) prof le of € y8tem-e l vations of baserment., plumb, pipe, septic tea, disteLbution box iu.ets and outlets, distribution field piping and Other elevations r)--imaximam ground water elevation in area sewage disposal system S) plan mst be prepared by a Frofessiorml Mmglnoer or other professional authorized by lana to pm -pare h plans Reg 6 S tic Tanks / a c ac t cs-T50% of flow.. water table.. tees, depth of tees, access., Ping cleanout, :::;�W101 from cellar ual.l or inground mimlng pool. (d) 259 Atom subs face drams Reg 10.2 Distribution Boxes a) slope greater than 0.08 Reg 10.4 (b) s^ i Subs x;face Peg 11.2 11.1 11.10 11.11. Reg 15.1 1.5.E 15.8 3•7 Reg l 14.3 3.4.4 14.6 ILI.7if) Reg 9.1 9.6 Desi ' Check FAIL OK List Pa, e 2 ; ILeaci � Pits Leaching pits are preferred where the installation is possible a) calculations of leaching area -minim= 500 eel ft b) spacing c) surface drainage 2% d) corer material e) V x2' A" splash pad f) tee at elbow g) DO bends is pipe from d -box to pipe Leaching Fields a) no greater 20 lutes/inch a- aq ft construction of field surface drainage 2 % e) 201 from cellar wn or inground mdmdng pool Leaching Tweaches a) c c one -o eachi.ng area-rdn 500 sq ft b) spacing®4 ft win 6 ft with reserve bete c) di sl ons d) contraction e) stone surface drains -go 2% IIoia i 7.1 Slop a ja) a Ope��to be s wva) b) y/x Z 150 = (to be shown) a) al b) stand -bar poorer . 9 4 i i r ORDER OF CONDITIONS FILE #242-177 LOT 40 VEST WAY Pursuant to the.authority granted to us under Massachusetts General Laws, Chapter 1319 Section 40, and the Town of North Andover's Wetland Protection by -Laws, Chapters 3.5 A & B, the North Andover Conservation Commission hereby determines that the work proposed under filing 242-177 is insignificant to the interests of the Massachusetts Wetlands Protection By -Law, and hereby impose no conditions to govern this work. This determination of insignificance applies only to that work proposed under file 242-177. i_401RDER OF CONDITIONS CONTINUED - 3 FTLE NO. 241- It The Applicant, any person aggrieved by this order, any owner of land abutting .the land upon which the proposed -work is to be done, or any.ten residents of the city or town in which such land is located, are hereby notified of their right to appeal this order of the Department of -Environ- mental Quality Engineering. provided the request is made in writing and by certified mail to the Department within ten (10) days from the issuance of this order.. A1 17 ISSUED BY unuTu AmnnVF.R CONSERVATION COMMISSION On this 5th day of November 19 82, before me personally appeared Anthony Galvagna to me known to'Fe—the person described in, and w o -execute , the fore going instrument and acknowledged that he executed the same as his free act and deed. cJ My Commission expires On DETACH ON DOTTED LINE AND SUBMIT TO THE ISSUER OF THIS ORDER PRIOR TO' COMMENCEMENT OF WORK. To NORTH ANDOVER CONSERVATION COMMISSION (Issuing Authority) PLEASE BE ADVISED THAT THE ORDER OF CONDITIONS FOR THE PROJECT AT FILE NUMBER 242- 11 7, , HAS BEEN RECORDED AT THE REGISTRY OF ON (DATE) If recorded land, the instrument number which identifies is If registered land, the document number which identifies is this transaction this transaction Signed App scant --jc c. CONSERVA T 10N,COMVISSION TELEPHONE 683-7105 o Pursuant to the authority of the Wetlands Protection Act, Massachusetts General Laws Chapter 131, Section 40, as amended, and the Town of North Andover's Wetland Protection By Law, the North Andover Conservation Commission will hold a Public Hearing on . November 3, 1982 at 8:00 P.M. at the Town Building Meeting Room, 120 Main Street, North Andover, MA on the Notice of Intent of Jayson Realty Trust to alter land at Lot 40 Test Way for purposes of constructing a single family dwelling and realted site development. Plans are available at the Conservation Commission Office, Town Building, .120 Main Street North Andover, MA, on Tuesday from 12:00 noon to"2:00 p.m. and by appointment. run once in the N•A. Citizen Copies sent to: Planning Board Board of Health Public Works Highway Dept. Applicant Engineer DEQE By: A. Galvagna Chairman on October 28, 1982. SOIL PROFILE & PERCOLATION TEST DATA. 1.t�ort� Andover,l;pss. No.&Street Lot No.l ._ Loc./Subdiv. Plan Owner ------------- Invest-gator Observer_ � f SOIL PROFILES -DATE 1-2• Elev. 3. Elev.' 4'Elev. Elev. _ - 0 _ U 0 0 . 1 1 1 1 Benchmark Elevation Ties to Test Pits 2 2 2 ' 3 3 3 - — 4 4 _ 4 S S 5 6 6 6 7 7 7 8 - g 8 9 _ 9 _ 9 - 10 10 10 Location Datum Percolation Tests -Date �3t3S 1� LAM uqw__ 1 2 3 4 S Pit Number Start Saturation Soak -Mins. -----:--.._1_- ---- - Start -. Test -Time _-__- Dro-�) of 3" -Time - Drop of 6" -Time I•;ins.lst.3"Dro - /� Mins _ 2nd 3"Dro /� 1 C.� DA I TOWN OF ORTH ANDOVL-,�, SYSTEM UMPINQ UCORI) SYSTEM ()VvNF ADDRESS M LVt- A I ION m), lo io L cl* C DATE OF PUMPING; - _QUANTITY PUMPED: j YES Saptic Tank: NO_ YES ,,,A rURb OF SERVICE: ROUTINE---- EMER(jEN(,), -0-YED OBSERVATIONS. GOOD CONDI'rIQN FULL'r,() COVER DEC 0 7 2004 HEAVY ()),tjvME ROOTS EIAMES IN PLACE,TOe^.(7'- -H ANE-C"i BXCUSIVE SOLIDS LEACFMELD RUNBACK SOLID CARRYOVER_ 071fER EXPLAIN System PUMPCJ k)y ............... L'UNItN"S r'KAN8ktKR6D 11) CD T -7 Mo, 7 pt WOO w AUG 6 2009 0 1 Q LA 0 IOC 1 6 Q a t Q a, ;1&&` TOF�4bRtWN%OVER I —1y1 —nf (ion —W9ALT1iZE—PARTMENT $), on: rim wnqr, A441 ►4 4 (11 CQ^Ow 7 Z-7 V79'-tlo u.mp1nq.Ro'?ord, ------ 2- Z�L : 0.8 9.1 Pvmpin9. 0111 ? Ty CD Oc Ten. Etr��anl Too 109 No Ir o n r? L Y03. -,0) M::, 0)1 q. SY PvMp 7�n Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. K__5 Commonwealth of Massachusetts City/Town of North Andover RECEIVED System Pumping Record SEP 25 Zw Form 4 [,TOWhl1OF NnRTH ANDOVERDEP has provided this form for use by local Boards of Health. Other forms may e=1�sedt�6flthe;TMENT information must be substantially the same as that provided here. Before using this form, ch- ec withryouf 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. System Location: Address V north andover City/Town 2. System Owner: Name Address (if different from location) north andover City/Town Ma State State Telephone Number Zip Code Zip Code B. Pumping Record 1. Date of Pumping Dater �7 Z�� 2. Quantity Pumped: Gall Sod 3. Type of system: ❑ Cesspool(s) RR Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other (describe): - 6;;Ot7 4. Effluent Tee Filter present? ❑ Yes ❑ No 5. Condition of System: 6�i� 6. System Pumped By LgVe_ Nam— e I Stewart's Septic Service Company If yes, was it cleaned? ❑ Yes ❑ No Vehicle License Number 7. Location where contents were disposed: Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 Signature of Hauler Signature of Receiving Facility Date Date t5form4.doc• 03/06 System Pumping Record • Page 1 of 1