HomeMy WebLinkAboutMiscellaneous - 432 SALEM STREET 4/30/2018 432 SALEM STREET
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` DEP,.has provided thl�form for use by local Boards of Health.
The Sys"tem4Pumping Record mus:
be submitted to the local'Soard of Health or other approving'-authoriry;— --.�
A:• Facill Inform'4tion
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.1.. System hocatlon
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as ❑ Yes ❑ No
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Form of Notice of Casualty Loss to Building
Under MASS. GEN. LAWS, Ch. 139, Sec. 3B
TO: Building Commissioner or Board of Health or
Inspector of Buildings Board of Selectmen
Town of N. Andover ) ( Town of N. Andover
(
N. Andover, MA 01845 ) addresses ( N. Andover, MA 01845
) (
RE: Insured: Robert F. & Sharon Broussard
Property address: X432 Salem-Street�-=—
N. Andover, MA 01845
Policy No. HVN 0295357
Loss of September 6, 19 87
File or Claim No. W 5859 (fire)
Claim has been made involving loss, damage or destruction of the above-captioned
property, which may either exceed $1,000.00 or cause MASS. GEN. LAWS, CHAPTER 143,
SECTION 6, to be applicable. If any notice under MASS. GEN. LAWS, CH. 139, SEC. 3B
is appropriate please direct it to the attention of the writer and include a reference to the
captioned 'insured, location, policy number, date of loss and claim or file number.
T. R. Pescuma, General Adjuster
Title:
On this date, I caused copies of this notice to be sent to the persons named above
at the addresses indicated above by first class mail.
PATRICK J. DONO'JAN ASSOC. 11/13/87
P. 0. Box A 39 Signature and date
Wakefield. MA MR30
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,r� 4 o t �p�frNORT hAVDOVER; MASSACHUSETTS
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DEP.has'provided this form for use by local Boards of Health. The S . Pu�t
be submitted to the local Board of Health or other approving aut�tority � �p2007 Record must
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A: Faclllty Information . �T«E• )vt,'RTyAN
�7 ALTy DEPARr DOVER
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Effluent Tee Filter Or ❑ Yes No If yes, was it cleaned? ❑ Yes
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Condition of System
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t5fonn4 docs 08/03 System Pumping Record•Page 1 of 1
APPLICATION FOR SEWAGE DZSPCSAL INSTALIATION
HEALTH DEPARTMENT - NORTH ANDOVER MASS.
�I reby make applicat' n for a pgrmit for a sewage disposal installation at
�t ��. I will install this system in ac-
cordance with all t 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 tants of 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 /F 6 lineal ( ) 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 line 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 maybeattached to the permit. Plot Plans must be submitted with application.
DATE
Signature of Applicant
I hereby issue the above permit for the Board of Health of the Town of North
Andover Massachusetts.
DATE
S' nature of Health Agent
I have inspected the uncovered system indicated above and find everything done
as des ibed.
QQ Signature oInspecting Officsr-
Percolation Test
Garbage Grinder::::�&
1 '
October 29, 1960
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 Salem Street (Lot #17) building site of Thomas Bunker.
The land in general is high.
The subsoil in the area was of clap content and a 6-minute
percolation test was conducted.
It is recommended that a 1,000 gallon concrete septic tank be
installed together with 180 lineal feet of drain pipe.
Very,.truly yours,
William J. V#scoll
WJD:hd
ICA
BOARD OF HEALTH
TOWN OF NORTH ANDO"VER, VPASS.
A _
� i+ IAA• OA0G*'L-6o AJC.SEPrOC /RtJIG
4-36 1-------
Alls� i
Y
1. NATaIE . . . . . . . . . DATE
2. ADDRESS . lf � � . . eTl . . . . . . . . LOT NO. l.7. TEL
3. - NO. OF BEDROOMS DEN YES . 4o NO.. . . . .
Q. GARBAGE GRINDER YES . NO.
5. SHOW DIT.ENSIONS OF HOUSE
6,, SHO.7 DISTANCES OF HOUSE TO ALL PROPERTY LINES
7, SHOW DIPIONSIONS OF LOT
8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL
9. NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM
10. SHOW LOCATION OF BROOKS,, STREAbBs, DITICHES, LEDGE OUTCROP, ETC.
11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE
NONE: LOCAL REGULATIONS SHOULD HE READ CAREFULLY.
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