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HomeMy WebLinkAboutMiscellaneous - 450 Forest Street (2) T Address.—. �as-T _� Title of File Page of Date File Open: Date file closed: Doc Document/Action Title Date of Refer to other Purpose of Document/Action and notes action Document/ document/ Num. Action Department Board of Appeals — Board of Health — Planning Board — Conservation Commission — Building Department G_ NORTH ANDOVER BOARD OF HEALTH 1 i INSTALLATION CHECK LIST APPROVED DATE DISAPPROVED DATE hXCAVATION OK REASONS: FAIL OK 1 . Distance To: Wetlands //(/,Y� Dreams Gp� 2. Water Line Location I( No PVC Pipe 4. ptic Tank ` Tees - Length & To Clean Out Covers Cement Pipe to Tank - On Both Sides of Tank 5. Dis ibution Box Cover & Box - No Cracks All Lines Flowing Equal Amounts No Back Flow 1 6. Leac Field or Trench imensions Stone Depth Capped Ends Clean Double Mashed Stone 7. Leach Pits Dimensions Stone Depth Splash Pads Tees Cement Pipe to Pit - Both Sides Clean Double Washed Stone . No Garbage Disposal . Final Grading Inspection -Z Zg 10. ` Barrac a 1 _ stem ` 1 As - Built Submit ��� Lot Location Dimensions of System Location with Regard to Pere Test Elevations Water Table NOR iii Ax1DOVER .BOARD OF HEALTH SUBSURFACE DISPOSAL SYSTEM CHBOK LIST APP OVr. PR(ATIDED DISAPPROVED 72 amt General Information Reg. 2.5 Fail OE The submitted plan must show as a minimum: (a) the lot to be served (area,dimensions, lot #, abutters) (b) location and dimensions of system (including reserve area) design calculations calculations showing reouired leaching area ,---(-e) existing and proposed contours •(f) location and log of deep observation holes-distance to ties —location and results of percolation tests-distance to ties location,of any wet areas within 100' of the sewage disposal system or disclaimer surface and subsurface drains within 100' of sewage disposal system or disclaimer --(j) location of any drainage easements within 100' of sewage disposal system or disclaimer ---(k) kriovn sources of -water supply irithin 200' of sewage disposal system or disclaimer (1) location of any proposed well to serve the lot(100' from leaching facility (m) location of water lines on property (10' from leaching facilities) n} maximum ground water elevation in area of sewage disposal system )—location of benchmark lan must be prepared by a Professional Engineer or other professional authorized by law to prepare such plans (q) driveways __(r) garbage disposers __(s) a profile of the system (elevations of basement, plumbers pipe septic tank, distribution box inl.e,ts .and outlets, distribution field piping and any other elevations) (-t) no PVC is to be used in construction Se ptic T s Feg. 6.1 (a) C pacifies - 150c/O" of. flow Reg. 6.7 (b) iTater table Reg. 6.5 ( Tees Reg. 6.9 d) Depth of tees Reg. 6.1 (e) Access Reg. 6.1 (f) Pumping (g) Cleanout Reg 3.7 (h) 10' from cellar wall or inground swimming pool (i) 25' from subsurface drains Reg; 9:1 ; Approval Reg. 9.6 j (b) Stand-by power ���'c, i,cf.✓�5 �/b/��l'G,'�7G'.y.�5 �'�s''� `L'l'Grl c- � �S�-cy G! G�i��7/`� -low 6 roy� 47 5-3 Z.; Noi.th Andover Subsurface disposal system check list-Page 2. FaiL OKDistributAon Boxes Reg:l{D.2--_ _-- - (a) S?6pe greater than 0.08. . Reg.10.4 �, (b) Sump Leaching Pits -- '`R Leaching pits are preferred where the installation is possible Reg.11.2 (a) Calculations of-leaching area (minimum 500 S.F.) Reg.11.4 (b) Spacing Reg.11.10 (c) Surface drainage 2% Reg.11.1 (d) Cover material eachImo Fields Reg.15.1 (a) Greater than 20 minutes/inch Reg.7 5.1 /,(b) Area (minimum 900 S.F.) Reg.15.4 (c) Construction of field Reg.15 8 ( ) Surface drainage 2% Reg.3.1 �e) 201 from cellar wall or inground szrimming pool Tmhi ll Slope (a) Slope y/x = (to be shoUm) (b) y/x X 150 = (to be shown) SOIL PROFILE & PERCOLATION TEST DATA Town City 0/0&1 '— No.&StreetyrLot No. Loc./Subdiv. Plan OwnerUhe,Oae7,�J ea c./W, v Investigator AblaG'a; Observer SOIL PROFILES-DATE 1- Elev. 2. Elev. 3. Elev. 4'Elev. 0 7 0 0 0 1 1 1 2 2 2 2 3 3 3 3 4 4 4 4 1 5 �n5 5 5 1 .6 ( 6 6 �. 6 7 7 7 7 1 � 3 8 8 8 9 9 9 9 10 10 1 10 10 Benchmark Location Elevation Datum Percolation Tests-Date o?P/ Pit Number 01 1 2 3 4 5 Start Saturation 9 Soak-Mins. fi„-7• Start Test-Time • _�_j Drop of 3"-Time 03 Drop of 6"-1ime Mins.lst 3"Dro Mins.2nd 3"Dro Notes & Sketches on Back Frank C. Gelinas & Associates, North And. _'4(= "�/ g/1 r 1� -R 4 aoaG O c�p0 ot9 G7od�caG� oaO�poa� D�po CP Ile 924.11le M M r v c�0—A 7 �" ��r . f��ty ��5tr •� 'ra�ll,If� L� �K. a�s7�4 A • off " 14:44AN S 111-401 Cknr 1-49-lb �,, ��a7� G'�Y�iG� Y�AIz�hJ L�►1�16 �'�''� 6 I�IA►t�la►�r� 3T APT 20 - t..�►wr�NSE,r1�►. L. rrow Fvsirlwrt. ST � B •, 10 N O r' Sd3,vdCr ,�LGaM' ��ldT�s 45o f�r•P. 1.�. �:`���L x 45b6 /J4 - -- - -- --- 66077 TAA ic;r,., 440AI ¢GQu�e� -• - Z S-A'�E'./774V �+ e" 9c,c� •r 7" Pi �rv�► rp Ow 4S �AWA MW x_ r SATiJ�P..eT/o�T �, ._.�!S XIV' -- - 1�11A1 _ i+?►A _ IYraJ. t—` AN L/ /'11�, W Al. ; M�lA+ty lAk e.AP. A"4 ,o p�nyri�trtncw RQr'� y ,,�, ry tar r�r f __ !►�i�t -__ NAVIiAA loot / AO C*4046G PISAbMl- R4 Y'A 0 o7Ey°Y GLAivAI cW %o8.oe rN�4L40 IM 7%iT P�SEl� - __--_ ._ Zv._ Dls2�LUat/�• - � ,� �' ' { � � T?fi�"3 ' svRSoi�. N� ��;'.nf��.� :��'�✓�TL�4,�✓GS �is� , � � , �� � ' , '' , s©t�� ' T6"S.�vey � . �/. 106 - 1 %0 lG Kistf&,d A NAIL /f/ - 0 n/o ,��Ir% s J ;� To ,� ' ��ls�Lc >>. O�'�E� 7 T e naD O '. Tos�ry Ic- c7A"exo,;4av , �S 0104474- rASr- i✓ITMOSSAT AbY-t T, ic-L 4AI � VkS16AI �lrWM 5PE-Or ! or A 6s roo ,,bow wwr? 47 min X SAL �._ �. ^._.�.__ 3"- ,-q.-�rn� � �.." _- GAPf�En Ed.IDS � j•(C�/G 7"y�e�./,�', �' ' Z~Ca`. •<�! fc- � � y �„ �' j " Z.'-tc'�_ 4"0 /b/7. MPT OAC FIOUAL i rAF�-n 4L- V E,QP 6 TTCENl yzI ,l irk 1 � � AT KICHT) AA = oj0O �A ;ZQj'd . ` x "e>Tl 6L3Tto) IWY, SEE �a� -5N6Fr 2) i ►lWJnUTiopt FIFA _ ___ 4 Lo POO rvAA..GO 4w-sT6 Sapt1G TANK? - 4h `ic t i G FSPAIL2 S ozo N ¢ 4''� (,,A'S'�' iia, --•4.N�r,^�,�, �.;r r-'/�;-x°. s-,005 F�IJ'���VIV Giri�/ f (..�"br Ir"�,'�� sc,02a ! 1 • Ne i 4L. s ._,., �.e c�'t� 11 TD V8"lVA$H cl v —� 1' rl _ \/oo,S rim PC EqUAl- x s e o <�, GI�vS1W. IND Nowt ��vu� a o ° I }' k WA•Q4MC2 To MWO A.A. o Ik I 1 R — �f� (ioh! P. 'j10�.15 5N Z of - - 2 w, _ .. RECENED_.... . TOWN F NORTH ANDOVER UA Ck SYST M PUMPINQ RECORD SEP - 7 2004 TOWN SYSTEM OWNER�$ ADQRESS ✓ OF NORTH ANDOVER ��y •• SYSTEM LOCATI C�/9 DATE OF PUMPING: _ - _QUANTITY PUMPED:— s` � � _ t,ESSPOOL. NO YES­­ SOPUC Tank: NO ._..._.�.._.._. ._._... YES NATURE OF SERVICE; ROUTINE EMERGENCY OBSERVATIONS; GOOD CONDITIONPULL TO COVER HEAVY OEBASE BAFFLES IN PLACE; ROOTS _ LW,HFIELD RUNBACK BXCESSiVE SOLIDS FLOODED SOLID CARRYOVER_ O'V'ER, EXPLAIN System Pwnped by COMMENTS. CONTENTS rKANSFERKED TC) p?8 S Commonwealth of Massachusetts REE FIVER City/Town of North Andover 0 System Pumping Record AUG 15 2007 Form 4 TOWN%,ji iik-w,i/o%J0VER 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 Important: When filling out 1. System Location: forms on the computer,use 450 Foster Street only the tab key Address to move your North Andover MA 01845 cursor-do not City/Town State Zip Code use the return key. 2. System Owner: Lang Name IGfew S Address(if different from location) Cityrrown State Zip Code 978-685-8379 Telephone Number B. Pumping Record 1,000 1. Date of Pumping Date 2. Quantity Pumped: Ghon Date Gallons 3. Type of system: ❑ Cesspool(s) ® Septic 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: Good 6. System Pumped By:. Jason Elliott L90-471 Name Vehicle License Number Jason Elliott Septic Pumping Company 7. Location where contents were disposed: GLSD CN 9V 8/12/07 natur o Hauler Date Signature of Receiving Facility Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 I