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Home My WebLink AboutMiscellaneous - 483 JOHNSON STREET 4/30/2018 A !l. r /� I A483 JOHNSON STREET _ 210/098.A-0018-0000.0 't �5 Commonwealth of Massachusetts City/Town of North Andover S�;, 25 �uiZ n System Pumping Record TOWN OF NORTH ANDOVER HEALTH DEPARTMENT � H SJB 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. A. Facility Information Important:When filling out forms 1. System Location: \(� on the computer, use only the tab key to move your Address cursor-do not North Andover Ma use the return key. City/Town State Zip Code t�� 2. System Owner: Lek-h , Name ienm Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record A�A /—G 1. Date of Pumping ate 2. Quantity Pumped: 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: a Uri 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 Sig tureo�J�a11Pr — Date ig ture of Receiving Facility Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 July 9, 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 Johnson Street building site (Lot #24) of Sherwood Homes, Inc. The land in general is high. The subsoil in the area was of clay- content and a 7-minute percolation test was conducted. It is recommended that a 1,000 gallon concrete septic tank be installed together with 200 lineal feet of drain pipe. Very truly yours, amDr toll WJD:hd 1 - BOARD OF HEALTH TOWN OF NOfUH ANDOVER, MASS. :k•- tai _ toy tn'M�N. N �sf 13n►c J M 5'v SIP- 1. NAM .��' / ----- DATE s 3 Q u K S r RP<1�1�hy r 1 S f Re Z 3 2. ADDRESS . . .. . LOT NO. . . . . . TEL 3. NO. OF BEDROOPIB :?. . . . DEN YES . . . . NO. :C'>* . . . !�. GARBAGE GRINDER YES NO* ::. . . 5. SHOW DIlhENSIONS OF HOUSE b. SHOW DISTAICES OF HOUSE TO ALL PROPERTY LINES 7. SHOW DIIvENSIOM OF LOT 8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL 9. NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM 1 10. SHGW LOCATION OF BROOKS, STREAMS DITCHES, LEDGE OUTCROP, ETC. 11, SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULAT IOVIS SHOULD BE READ CAREFULLY. APPLICATION FOR SEWAGE DISPOSAL INSTALIATION HEALTH DEPARTMENT - NORTH ANDOVER, MSS. fI hereby make app ' ation for permit for a sewage disposal installation at I will install this system in ac- cordance with all fhe 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 tank of in size. A manhole (s) permitting easy cleaning will be provided with remova le 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 D lineal ( Te� 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 may be attached to the permit. Plot Plans n#st be submitted with application.A DATE Si na a of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DA TE // 4o Siphature of Health Agent I have inspected the uncovered system indicated above and find everything done as described. DATE Signature of Ifibpecting Officer Percolation Tes ty `hum Garbage Grinder 22 CUR.RIER FORM 4 - SYSTEM PUMPING RECORD SEPTIC & DRAIN SERVICE 107 FOREST STREET; MIDDLETON, MA 01949 (978) 774-2772 COMMONWEALTH OF MASSACHUSETTS MASSACHUSETTS SYSTEM PUMPING RECORD SYSTEM OWNER: SYSTEM LOCATION: L/;573 ::3ak A Sc,✓1 5-1 DATE OF PUMPING: /v-/Z - QUANTITY PUMPED: cloo GALLONS CESSPOOL: NO r7 YES F] SEPTIC TANK: NO F--] YES SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SERVICE CONTENTS TRANSFERRED TO: DATE: /U - (Z-y'8 INSPECTOR: