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Home My WebLink AboutMiscellaneous - 524 JOHNSON STREET 4/30/2018 + 524 JOHNSON STREET l I_ 210/03850000.0 \ Commonwealth of Massachusetts City/Town of No Andover System Pumping Record 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, i use only the tab � 4 �h n�n j key to move your Address cursor-do not No Andover Ma use the return key. City/Town State Zip Code 2. System Owner: Name mmn Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 2. Quantity Pumped: 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: 60'oadJad �♦y w60"So S 6. System Pumped By: _ Name p Vehicle License Number Stewart's Septic Service C~r, v �3 Company ,}Lv 7. Location where contents were disposed: -To, "P XR.TR'EA'T Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 ure oful Date Signatbre,6f Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 t _ John 4�illis -, Lot A, Johnson St. APPLICATION FOR SEWAGE DISPOSAL INSTALLATION HEALTH DEPARTMENT - NORTH ANDOVER, IHSS. I hereby make application for a permit for a sewage disposal installation at Lot A. Johnson St. . I will install this system in ac- cordance with all the 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 750 gal• 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 180 lineal (s)GpnW) 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 must be submitted with application. DATE JUL 17 196J w S. P�1.�� Signature of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DA TE JUL 1 7 19 61 ignature of Health Agent I have inspected the uncovered system indicated above and find everything done as described. DATE 4 ® c Signature of I ecting Officer Percolation Test u min. Soil Sandy-clay Garbage Grinder No L- June 24, 1961 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 A. of John Willis. The land in general is high. The subsoil in the area was of sandy clay content and a 4-minute percolation test was conducted. It is recommended that a 750 gallon concrete septic tank be installed together with 180 lineal feet of drain pipe. Very truly yours, loj�". William J.gni. o WJD:hd f, —Ado. LL BOARD OF HEALTH r,. TOWN OF NORTH ANDOVER, MASS. l 1 �Ne- 7 �t ,01 1. NAIVE � � .�u.XJ�XI • . DATE . 2. ADDRESS .. . .. LOT NO. i. TEL. . . 3. NO. OF BEDROOMS . . . DEN YES NO. GARBAGE GRINDER YES N0, 5, SHOW DIL'ENSIONS OF HOUSE b. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES 7, SHOW DIIFD)SIONS OF LOT 8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL q, NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM 10. SHOW LOCATION OF BROOKS, STREA16, DITCHES, LEDGE OUTCROP, ETC. 11, SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROTu4 HOUSE NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY. i A TOWN OF NORTH ANDOVER 6 SYSTEM PUMPING RECORD ��`� .•�`` DATE �rl�'lJ$-O �•^'' r r SYSTEM OWNER&ADDRESS SYSTEM LOC ON DATE OF PUMPING-� QUANTITY PUMPED d CESSPOOL NO �'/ YES SEPTIC TANK NO YES NATURE OF SERVICE: ROUTINE " EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN LACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLID CARRYOVER OTHER EXPLAIN SYSTEM PUMPED BY COMMENTS: CONTENTS TRANSFERRED TO 5�? 0 S /�� Vh use ':� � ;Q. ORTH A�IDJOVERry MASSACHUSETTS ,;1.• i.�.'ftanyy,.w1'1;1..r,:,�•�;.� l,J,}�l.>y��"i•n. y• ..rili.� 4•a,i:,t RECEIVED04 T1 P DEP,.has provlded thla form for use by local Boards o Health. The System Pu ping Record mus; esu bmitted to the.local'Board of Health or other a p rovin§j@h�rq�y2007 A . Facili InfordWion . TOWN OF NORTH ANDOVER ; lalortaflt:, •, ,';'.. ;'•;t:: HEALTH DEPARTMENT ..�;;,Wber,•f►Alri�out• .1:. System l.ocatlon•' � h^ cunputar oro the tab key Address t0 move your:;-do not use the roturn'%'. c4frown State • .. p Code. _ •.t�'J'k0y.`{a 111•}.{'`�l',: J' r•:••I',•',:..'.,'� ,J•.}�!�,••r.: �.`,.'1 r .1� .. .... - Y jfl�;: S stem ow. .'' J :.,.'a,,:. ,,''• ,';Fr-:.Name. wase: Address(Ir different Tfom IOCat10n) I: Clbrlrovm. :::`' State ^/Z�lyp/J}C C�yJ{♦� ` Telephone Number Pumping:•Re.pord; Oat of Pumpin �} 9' Date 2• QuantJty Pumped; " ' Type pf.system,. ❑ Cesspools) eptic Tank ❑ Tight Tank lar .•:'i.1`:•��;�!. "�: •• ',V rY4',": y uent TeB Fliter present?.❑ Yes.[ No If yes, was It cleaned? El Yes 5�,No •' ,�.,. .. :j": :r%; 1. ;::r':� `•,:. ,3;,rr. ":; ... . . QM •, .;.. .;.[i!'.;Y.".�+V:J'�i:4:`.h'i:7:'a�S;l�l�'l.1`',�•'�• -• y Pumped B is Vehicle'U .::.,.. ,. 4; =1gi`.;J' cense Number IAV 102 ::5;�. ..�;', •a+S,;N�'' ':a.} , .�.. • . � �V/N I �� (jam( ✓�..r�y,';'.r � �,+::, ,. .{„ r v'ti�ff I'. ft!L �.• ..4/r;1.,.►�j�,... .. . : i'•f;;;'.r .a:7;. .locaboh4h'ere contents Were.dl;3posed: ��}Vii: �l5•;r•`�•,{.:-.'. :.,,.1',,: ''� 1 � - _ 77 :r' •`Ki a:,:if.•f':' °.;;':ir''c%'V.�• }•.(•j' i',i' r'• :I ..�'� :•lam' -'4:+,�f'•` „ [,r�•�.'.' , r'111;1:•�.:•C,..,{.pry-. 'I, :,; ,;,;'•.,::;?ai• :�' r i�.�,..,a:Slpnature of Hauler,; ,•;�;,;. {'.. Date • •:httpJ/wtivw mass gov/deplwafe�/approvals/t5forms,htm#inspect • � t5fofrM.doa�OBJ03 ;�: System Pump ln9 Record•Pa9a 1 or �L\ Commonwealth of Massachusetts W City/Town of No.Andover System Pumping Record « � ,M Form 4 FTOWN OF NORTH ANPOVIFt HEALTH DEPARfiMENT 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 I— n computer, use L4 S50 n only the tab key Address to move your No.Andover P^? 01810 cursor-do not City/Town State Zip Code use the return key. 2. System Owner: rub Name feh Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: canons 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. Conditio of S dem: 6. Syste By: Name"— Vehicle L ci ense Number Stewart's,- eptic Service Companyx 7. Location where contents were disposed: Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 ! M Signatuf ler Date,/'q Signat Vo iving Facility Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1