HomeMy WebLinkAboutMiscellaneous - 54 SUMMER STREET 4/30/2018 (2) 54 SUMMER STREET
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DATE Sheet of
BOARD OF HEALTH
TOWN OF NORTH ANDOVER
SUBSURFACE DISPOSAL DESIGN REVIEW
FEE PERMIT # DATE RECEIVED
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APPLICANT ASSESSOR'S MAP k
ADDRESS PARCEL #
LOT #
STREET #
ENGINEER
ADDRESS
PLAN DATE REVISION DATE
CONDITIONS OF APPROVAL:
APPROVED
DISAPPROVED
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�p APPLICATION FOR SEWAGE DISPOSAL INSTALLATION
HEALTH DEPARTMENT - NORTH ANDOVER, MASS.
I h9reby make application or a permit for a sewage disposal installation at
O / 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 1916 until 10 feet pre-
ceding the septic tank, where the grade shall not exceed 2%. I will install a con-
crete septic tank of / e-o- rJ 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 1id in a series of trenches, the bottom of which will pro-
vide a minimum of /.kQ lineal (square) 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 �'6 h
Signature of Applicant
I hereby issue the above permit for the Board of Health of the Town of North
Andover, Massachusetts.
DATE1
Signature/of Health Agent
I have inspected the uncovered system indicated above and find everything done
as describe .
DATEescr "{ 1"
P
Signature of I s cting Officer
Percolation Test
Garbage Grinder
1-7
BOARD OF HEALTH
TOWN OF NORTH ANDOVER, MASS.
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971 . 'IV
1. NAME DATE
2. ADDRESS_ ,� ,,,, �,,p,( �j� �j,,,lj �,/,y�� LOT NO.� TEL.
3. NO. OF BEDROOMS DEN YES NO
4. GARBAGE GRINDER YES NO /�
5. SHOW DIMENSIONS OF HOUSE
6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES
7. SHOW DIMENSIONS 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, STREAMS, DITCHES, LEDGE OUTCROP, ETC.
11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE
NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY.
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BOARD OF HEALTH OF NORTH ANDOVER, MASSACHUSETTS
SEWAGE DISPOSAL
DATE 6/24/172
NAME OF APPLICANT Paul F. Ellard
LOCATION Lot #1 S&lzmmer St„
Address of lot no.
BUILDING: Dwelling X Other
SYSTEM: New X Repair
GENERAL DESCRIPTION OF LAND high
SUBSOIL: Clay Gravel Sand
PERCOLATION TEST 6 minutes per inch.
MINIMUM INSTALLATION RECOMMENDATIONS
CONCRETE SEPTIC TANK-1,000 gallon capacity.
LEACH FIELD X80 lineal feet of drain pipe.
{
William J. Dr' oll, Engineer
Board of Healt
t.
FORM 4-SYSTEM PUMPING RECORD
CURRIER
SEPTIC & IDRAIN SERVICE
107 FOREST STREET; MIDDLETON, MA 01949
(978) 774-2772
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COMMONWEALTH OF MASSACHUSETTS
V C , MASSACHUSETTS rye.
SYSTEM PUMPING RECORD
SYSTEM OWNER: I IjSYSTEM LOCATION:
70
Fra,. -
`Y b e'
1075
, .
DATE OF PUMPING: // 3 0' 917QUANTITY PUMPED: SV C) GALLONS
x;
CESSPOOL: NO 0 YES SEPTIC TANK: NO YES
L�
SYSTEM PUMPED BY: CTRRIER SEP'T'IC 8c I3R4111'1 SERVICE
CONTENTS TRANSFERRED TO: L-
DATE: i/- .30- 9 S'
INSPECTOR:
1.5 _
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Form 4 -- System Pumping Record
Commonwealth of Massachusetss
: Massachusetts
System Pumping Record
System Owner System Location
P,.UL FLU.PD F; IL
D: t-ni A1ZxjVhR. MA 111845- 815 000TH At:L3UVPR M 01145
( )781 ..t+6 1079 J978) 686-1079
Type: Emergency Routine
Cesspool: No Yes Septic tank: No Yes
Date of Pumping: Z— Quantity Pumped: IT Gallons
System Pumped By: Wind River Environmental, LLC Permit#:
Contents transferred to:
Contents Disposed at:
.�Y
Date: Pumper Signature:
Condition of System/Other Comments
Dep Approved from - 12/07/95
Form 4 -- System Pumping Record
i
Commonwealth of Massachusetss
Massachusetts P.
System Pumping Record I;
6 2003
System Owner System Location
d p r Lm i r F,-irr-
NA, 014 4, lioc 0, AndO—tn 14;. 1 u 4 .
Type: Emergency Routine
Cesspool: No Yes EJ Septic tank: No =Yes
Date of Pumping; Quantity Pumped: Scy7 i/Gallons
System Pumped By. Wind Rinser Envinonmentoi, LLC Permit#: \
Contents transferred to:
Contents Disposed at:
2-3
Date: Pumper Signature:
Condition of System/Other Comments
Dep Approved Form - 12/07/95
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Services U4
16 Wo�ZyrnAre, --- �_,11 l[
k-.t�1ZTCllii ttarlSlGi'l';:i1 2t6p,3r41�31Q — _._ ---- —MA
Dace
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Ouldil1OR Of S� S'f�t11iOThCr COMA(AY
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FSR: STRONG
Soptic System Sarvi� � '•��"��` -�' ilkMYs
1'33 4vp�tarn Atin. c l
4VRg5t9f, MAp�0193�1 '
JAN �'i.
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Town of North Andover, Massachusetts Form No.a
of NODrhq tiBOARD OF HEALTH
o 4.
* 19 i .
DISPOSAL WORKS CONSTRUCTION PERMIT
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ant
M
E
ADDRESS
Site Location ELE_PkigNE
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Permission mi
ssi
on is hereby granted to Construct ( ) or Repair
Sewage Disposal System as shown on the D an Individual Soil Absorption
Design Approval S.S. No.
A
C7� c�fAl Jv1AN,BOARD�OF HEALTH
v
Fee
L a
D.W.C. No. �
-- --- - - --- -- - - -
CIL
cil
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10 x 4S
QAno 5�u6 - _-Q�-17,5 \OA5 tD�J
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Town of North Andover, MA
Watershed Septic System
Servicinq Report
Date:)
�rHomeowner: 1 Pumper
Street dry s' Address: r—
Phone Phone 27 4-2 "7 7
Nature of Service: Routine
Emergency
A�DTM ER/
TO OF NOOrr 14
BO
/ ARD 0
Observations: Good Condition r/
Full to Cover ptG 1 1 1995
Baffles in Place
Leachfield Runback
Excessive Solids
Heavy Grease
Roots
Other (Explain)
Description of Work:
Comments :
SYSTEM PL1iPrG RECORD
Forest St.
MA 01949
774.2772 S�Q 6��v\G
0000
A&MMOnI,,allh of Massachusetts
, .Massachusetts
System Pumnin Record
ystem ��ner •stem ocation
Date of Pumping: Quantity Pumped
allons
Cesspool: No ..V Yes ❑ septic Tank: No ❑
Yes Lam'
S�stem Pumped by: ame---f
�
Contents transferred to: License #:
Date
.Inspector
Form 4 System Pumping Record
Commonwealth of Massachusetss
I Massachusetts
System Pumping Record
System Owner System Location
In
PIA, 0irjui7 �,A, 0 L
(Vltll Vdi, LIL104 X
Type: EmergencyRoutine
Cesspool: No Yes Septic tank: w 0Y.s
Cate of Pumping: P/ -0 6,1. Quantity Pumped: /000 Gallon.
System Pumped By: Wind River Enwmmmtal, LLC Permit
Contents transferred to:
Contents Disposed at:
(� E
of
Date:
Pumper Signature:
Condition of System/Other Comments
RECEIVED
AUG 0 4 2004
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT -i
Dep Approved Form, - 12/07/95
05f01l2000
Commonwealth of Massachusetts Form 4--System Pumping Record
Massachusetts RECEIVE®
System Pumping Record
JUL 0 5 2007
TOWN OF NIC)RTW 4WP)(W
System Owner System Location HEALTH DEPARTMENT
Ellard Paul Pr_iunary Home
54 Summer Street 54 Summor St
North Andover., MA, 01845 North Andover, MA, 01845
(978)-686-1079 (978)-686-1079 x
Ellard
Type: Emergent Routine
Cesspool: No Yes Septic Tank: No = Yes®
Date of Pumping: ����'--� �- Quantity Pumped: /g,900 Gallons
System Pumped By: Wind River Environmental,LLC Permit#:
Contents Transferred to:
Contents Disposed at: _
Date: Pumper Signature:
Condition of System/Other Comments
Dep Approved Form-12/07/95
Commonwealth of Massachusetts
City/Town of NORTH ANDOVER, MASSACHUSETTS
System Pumping Record
'Y Form 4
DEP has provided this form for use by local Boards of Health. The System Pumping Record must
be submitted to the local Board of Health or other approving au ori ECEIVED
A. Facility Information
Important: JUN - S 2006
When filling out 1. System Location:
forms on the TOWN OF NORTH ANDOVER
f a. ti C- HEALTH DEPARTMENT
computer,use
only the tab key Address
to move your
cursor-do not
use the return City/Town State Zip Code
key. 2. System Owner:
Q
Name --- --- -
Address(if different from location)
City/Town State Zip Code
Telephone Number
B. Pumping Record
4(//
1. Date of Pumping 2. Quantity Pumped:
Date Gallbns
3. Type of system: ❑ Cesspool(s) D-'!§eptic Tank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes �No If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System:
6. System P ped By:
-- Wu=04 --)
Name Vehicle License Number
Company
7. Location where contents were disposed:
— 1 �
Signatu of Hauler Cate
http://www.mass.gov/dep/water/approvals/t5forms.htm#inspect
I
t5form4.doc•06/03 System Pumping Record•Page 1 of 1
Commonwealth of Massachusetts
City/Town of NORTH ANDOVER, MASSACHUSETTS
System Pumping Record
�,,,, o•�� Form 4 0 9 Ttt b&ir=: p4w'w'.
DEP has provided this form for use by local Boards of He Record must
be submitted to the local Board of Health or other approvi g au1 MV
A. Facility Information JUN - 4 2009
Important:
When filling out 1. System Location: TOWN OF NORTH ANDOVER
forms on theHEALTH DEPARTMENT
computer, useonly the tab key Address n
to move your C��•�-� f'`�l, (0 61-6
cursor-do not Cit /Town /"(�"'�' L.JI
use the return City/Town Zip Code
key.
2. System Owner:
;� _ F=/r/4.� Pak
• Name
Address(if different from location)
City/Town State Zip Code
Telephone Number
B. Pumping Record
�} -A -64
1. Date of Pumping Date 2. Quantity Pumped: Gallons
3. Type of system: ❑ Cesspool(s) [] 'S-eptic Tank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes ['lo If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System:
6. System Pumped By:
U �� X68 7
Name \
;VI ��— Vehicle License Number
z — IWl A --���.—
Company
7. Location where contents were disposed:
_ G.L.S.D.
renCe, MA-.--
Signature
—Signature ofuler A Date
http://www.mass.9ov/dep/water pp als/t5forms.htm#inspect
t5form4.doc-06/03 System Pumping Record•Page 1 of 1
Commonwealth of Massachusetts
City/Town of NORTH ANDOVER MASSACHUSE S
System Pumping Record
o Form 4
DEP has provided this form for use by local Boards of Health. The System Pumping Record must
be submitted to the local Board of Health or other approving a ECEIVED
A. Facility Information
Important: JUL 10 2008
When filling out 1. System Location:
forms on the TOWN OF NORTH ANDOVER
computer,use S S U U`-� w- v^ HEALTH DEPARTMENT
only the tab key Address
to move your �C) V
cursor-do not —
use the return City/Town State Zip Code
key.
2. System Owner:
Name —
Address(if different from location)
City/Town State Zip Code
el 7 jr
Telephone Number
B. Pumping Record
1. Date of Pumping Da� -� 2. Quantity Pumped:
Gallons
3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes ( No If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System:
_— S ,-4
6. System Pumped By:
7 _
Name Vehicle License Number
Company
7. Location where contents were disposed:
_ 1
--��-��"
Signatdre of Hauler Date
http://www.mass.govldep/water/approvals/t5forms.htm#inspect
t5form4.doc•06/03 System Pumping Record•Page 1 of 1
Commonwealth of Massachusetts
. City/Town of
System Pumping Record NORTH ANDOVER
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 14d
accordance with 310 CMR 15.351. RECEED
IV
A. Facility Information Jul -7 2010
Important:
When filling out 1. System Location: TOWN OF NORTH ANDOVER
forms on the 1 HEALTH DEPARTMENT
computer,use _ J� --' 1_• -- ------- — —...-- --- — ---only the tab key Address
to move your
cursor-do not ,V State Zip Code
use the return City/Town
key. 2. System Owner:
jpqu l -- � - r-- .---- - ---------- -
Name
Address(if different from location)
City/Town
Sta Zip ode
Telephone Number
B. Pumping Record
2. Quantity Pumped: -----
1. Date of Pumping Date Gallons
3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Grease Trap
❑ Other(describe): - ---- -- -- -- . .-- ..—---- -
4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of Symm:
q(yotel`/ ..
6. System Pumped By:
j Name Vehicle License Number
Company
7. Location where contents were disposed:
Signature of Hauler Date
Signature of Receiving Facility Date
t5form4.doc•03/06 System Pumping Record•Page 1 of 1
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