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Commonwealth of Massachusetts RECEIVED
W City/Town of NORTH ANDOVER JUN 10 2014
System Pumping Record TO WN OF NORTH ANDOVER
Forth 4 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 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 Cityrrown State Zip Code
key.
2. System Owner:
Name
(earn
Address(if different from location)
Citylrown State Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping2. Quantity Pumped: I`
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: ka)` to
6. System Pump
me Vehicle License Number
Stewart's Septicervice
Company
7. Location where contents were disposed:
Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835
Signature of HauueT r-� Date
Signature of Receiving Faci i _., Date
t5form4.doc•03/06 System Pumping Record•Page 1 of 1
Form No.3
Town of North Andover, Massachusetts
BOARD OF HEALTH
NORTH
16
OG
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♦off_.««��.� �� a
DISPOSAL WORKS CONSTRUCTION PERMIT
' 7SgACMUSEt
Applicant "-'�� �'Il1YL.t1—> TELEPHONE
NAME ADDRESS
Fl �e
I :
Site Location
Permission is hereby granted to Construct (� or Repair ( ) an Individual Soil Absorption
: Sewage Disposal System as shown on the Design Approval S.S. No.
CHAIRMAN,BOARD OF HEALTH
Fee D.W.C. No. (1��
PLAN OF LAND
IN
NORTH ANDOVER, MA
SHOWING "AS BUILT" SANITARY DISPOSAL SYSTEM
LOT 30A-SUGARCANE LANE
PREPARED FOR : JARED PLACE II DEVELOPMENT CORP.
SCALE : 1 ' = 2O' DATE : JULY 15) 1993
SCHEDULE OF TIE DISTANCES..
BD = 3-8' GG= 55.o�
BE = 32.0' qH = 80.9'
G E= 39. B"
BF= 29.&1 c-H -
CF= 41, 8' BZ = 43.4'
THIS PLAN HAS BEEN PREPARED FOR THE
PURPOSE OF SHOWING THE 'AS BOLT" CONDITIONS OF
THE SAMTARY.DIS K)$.. SYSTEM INSTALLED ON THK
1 to Vim,
DOLE, -O-F N ERTS
CURRIER FORM 4-SYST;- PUMPING RECORD
SEPTIC & DRAIN SERVICE
107 FOREST STREET; MIDDLETON, MA 01949
(978) 774-2772
4
COMMONWEAL OF MASSACHUSETTS
MASSACHUSETTS
SYSTEM PUMPING RECORD
SYSTEM OWNER:
SYSTEM LOCATION:
SZ 2�
DATE OF PUMPING:
QUANTI Y PUM ED: ���� GALLONS
CESSPOOL: NO YES
D SEPTIC TANK: NO � YES
SYSTEM PUMPED BY: CURRIERSEPTIC & DRAIN SERVICE
CONTENTS TRANSFERRED TO: f/
DATE: :�/'7,
INSPECTOR:
PC CF.:: -
L•
411014-rrrr""
Nh .
Town of ®rti over
No. 0 �..
North ;Andover, Mass., 192S
5s- .
9 BOARD OF HEALTH
PER MIT TO BUILD Food/Kitchen
Septic System - lG S
BUILDING INSPECTOR !�4a3
THIS CERTIFIES THAT.... ....... .. ..........................
"""" Foundation
has permission to erect.&). .$17.AAWAOWbuildings on . � lZ,
Rough.4/��`v G Z
to be occupied as.rrm).4i.e.-Avloo �i. .,� r�'�.�� 40. Chimne9
y
provided that the person accepting this permit shall in every respect conform to the ternfis of the application on file in Fi 1
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration andCo struction of '
Buildings in the Town of North Andover. PERM ONLY UM G ID9P R
VIOLATION of the Zoningor Building Regulations Voids this Permit. REGULATED BY PJIRJL 114.8-5. B.C. gh �• •
9 9 -a�-V.Y
PE
al ..tg6 -'C`7
� C1'N41 !� E TIRE`S IN 6 �! O. JjJ .T - Fff PAID lno. v o
.111C nell ELECTRICAL INSPECTOR
PERMIT FOR FRAME/BUILDING Rougho/'�
....� ..... Service
��jj BUILDING INSPECTOR
DATE: 7 '� �3 FEE PAIO,•/ �� Final
RR eg1.Z1rcd to Occupy Bitildirig GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal °h q/f3
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector.
14 Burner
PLANNING FINALCONSERVATION Street No.
Smoke Det.
SEWER/WATER FINAL �W1,;7 01681 DRIVEWAY ENTRY PERMIT& 6) ��
Town of North Andover, Massachusetts F°'"'No.
BOARD OF HEALTH r ;
�`c k—o tom.► A _ 19
F a
4L
a •
�• �`g; DESIGN APPROVAL FOR
b'Ano•A`�
,ssACNUSEt SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
Applicant }'' Test No.
Site Location �� �� ` C.�C��
Reference Plans and Specs. -Tl % YU A)-�
ENGINEER DESIGN DATE ;
Permission is granted for an individual soil absorption sewage disposal system to be installed
in accordance with regulations of Board of Health.
C RA IR AIN,40�AR �AT
573
Fee Site System Permit No.
DATE lj q
Sheet of
BOARD OF HEALTH
TOWN OF NORTH ANDOVER
SUBSURFACE DISPOSAL DESIGN REVIEW
FEE_ 4Z n PERMIT # DATE RECEIVED
APPLICANT W• JAAIL,S ASSESSOR'S MAP
ADDRESS PARCEL #
LOT #
STREET S[1GA2c.�NE LJ�sVt7
ENGINEER 7
ADDRESS
PLAN DATE REVISION DATE
CONDITIONS OF APPROVAL: 7"d GTPA , ON 74- AIK
1411- - r -P/IL--S 141 C1119IL18ek
APPROVED
DISAPPROVED
i
PLAN REVIEW CHECKLIST
ADDRESS Z ,3/S/� �f/G/�2C�/U� ENGINEER ]-, /VcV,�-
GENERAL
3 COPIES Z/ STAMP ✓✓ LOCUS NORTH ARROW /'/ SCALE C 1
CONTOURS2-✓ PROFILE ✓ SECTIONy BENCHMARK ✓ SOIL &
PERC INFO ELEVATIONS WETS. DISCLAIMER WELLS &
WETLANDS rZ WATERSHED?_A/0 DRIVEWAY ✓ (Eley) WATER LINE r%
FDN DRAIN f SCH40 TESTS CURRENT? .�
SEPTIC TANK
MIN 1500G. . 17 INVERT DROP GARB. GRINDER(+200% EDF)
251 TO CELLAR L,--' MANHOLE TO GRADE ELEV O K GW O Y
D-BOX
SIZE z # LINES ,3 FIRST 2' LEVEL STATEMENT
INLET /Zf•6Z - OUTLET lZ4.4Z (2 11 OR . 17 FT) TEE REQ'D?
LEACHING
RESERVE AREA l"'I 4' FROM PRIMARY? L-"*' 100' TO WETLANDS '/ 2% SLOPE
100' TO WELLS ✓ 35' TO FND & INTRCPTR DRAINS 4' TO S.H.GW_4,,::I-
325' TO SURFACE H2O SUPP 4' PERM. SOIL BELOW FACILITY L
MIN 12" COVER t/ FILL? t✓ (25' if above natural elev; (12f below)
BREAKOUT MET?
TRENCHES
MIN 660 gpd SLOPE (min . 005 or 6"/1001 ) >3' COVER? - VENT
SIDEWALL DIST. 2X EFF. W OR D (MIN 61 ) IS RESERVE BETWEEN
TRENCHES? IN FILL? MUST BE 101 MIN. 4" PEA STONE?
BOT X LDNG + SIDE X LDNG = TOT
(L x W x #) (G/ft2) (DxLx2x#)
PITS
MIN 660 LEACHINGy GW MIN 4' BELOW BOTTOM MANHOLE/PIT
EXCAV 2x EFF W OR D _ 12"' "- STONE SURROUNDING
BOT z + S1D�E ZZ� 9�2 LOAD = TOTAL 80/
(L x W x #) `/� (2 x (L+W) x D x #)
CHAMBERS
MIN 660 LEACHING GW MIN 4" BELOW COVER >3 FT - VENT i
MANHOLES 12"-48" STONE L/ SPLASH PADS SLOPE .005 ,E
BED/TRENCH (Bed max. 60' X 601 )
BOT 441 - 3414f + SIDE Z Z - ¢�'Z X LOAD = TOTAL_926
(L x W x #) (2 x (L+W) x D x #)
FIELDS
MIN 900 ft2 LEACHING PERC RATE FASTER THAN 20M/IN GW MIN
4' BELOW BOTTOM OF FIELD PIPE ENDS JOINED W/NON-PERF. PIPE?
4" PEA STONE? DIST LINE SLOPE .005? >3' COVER - VENT
SCH 40 MIN 12" COVER L x W = T x LDNG > DESIGN FLOW?
DOSING TANKS AND PUMPS
DIMENSIONS X X = PUMP CAPACITY gpm
L W D Vol.
DISCHARGE SIZE DISCHARGE RATE DISCHARGE TIME
gpm
MANHOLES TO GRADE ALARM SEP,. CIRC. GW (Min. 1' below
inlet) HWL LWL CHECK VALVE BLEEDER HOLE MANUAL
OP. SWITCH
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Town of North Andover, Massachusetts Form No. 1
NORTH ••-� BOARD OF HEALTH //1 �/� Q/ /�/
��14ED i66'YOL IU f A 1 ) � 13 ism
:1L� 19
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APPLICATION FOR SITE TESTING/INSPECTION
SACHU5���y
Applicant
NAME ADDRESS-
L4
DDRES TELEPHONE
Site Locati onb-- +
Engineer \ \
NAME I A DRESS TELEPHONE
Test/Inspection Date and Time
CHAIRMAN,BOARD OF HEALTH
Fee Test No.
S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No.
Town of North Andover, Massachusetts Form No. 1
32oZNORTF1 ° BOARD OF HEALTH �R{ ■// //�� (/' 1/`.
S�LED ib�'YOL AJ !h� 4 l✓ 1 3 19
4
,J4 °��E= •.. APPLICATION FOR SITE TESTING/INSPECTION
9 QDAHTED PPp`��7
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{{ NAME E ADDRESS ( TELEPHONE
Site Location
Engineer �� Q.00—,
NAME i AIDDRESS TELEPHONE
v
Test/Inspection Date and Time
CHAIRMAN,BOARD OF HEALTH/
Fee `�� Test No. `7' ( ►
S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No.
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October 29, 1996
AI 01
Ms. Sandra Starr
Board of Health
Town of North Andover
146 Main Street
North Andover, MA 01845
Dear Ms. Starr:
My home at 56 Sugarcane Lane (Lot 30) abuts a new home development on Lot 29. I
have some special concerns about the septic system planned for the new house. My two
neighbors also brought the issue, and their similar concerns, to my attention.
The new septic system "catch box" is sitting on the edge of the two lots. The
construction of the septic system has not been completed and Bob Innis (builder)
informed me last Saturday that you will be reviewing it's progress late this week. The
concerns I have come from the elevation of the unit, related to the downward grade
toward my house, and the planned "mounding" Mr. Innis plans to make toward my lot in
burying the unit. Street rain water run off around my house regularly proves that the
grading between the two lots brings all water toward my residence. This repeated water
flow situation during the rains only confirms suspicions that there is extreme potential for
waste drainage problems.
Additionally, the mounding and grading planned by Mr. Innis creates an unnatural, and
unsightly, extended hill in the middle of a currently even and flat landscape on my side.
These issues need to be resolved before construction completes.
In leaving you a phone message today, I understand you are out of your office until
tomorrow. I will call back then. Please call me at your earliest convenience during the
day at (617)498-4067 or at night at (508)686-2664.
Sincerely,
C. Michael Staff
56 Sugarcane Lane
North Andover, MA 01845
PROGRAMART
C O R P O R A T I O N U.S. PCS FHGE
P 060 563 336
"H�pzsL_m"
An► .. �Hf'1LLIPiJV
VNIT[DST:.TES A
III j CO T SCRVf i.E
$2.52
L _ Ian
Ms. Sandra Starr
Board of Health
Town of North Andover
146 Main Street
North Andover, MA 01845
UNIVERSITY PLACE
124 MOUNT AUBURN STREET,CAMBRIDGE,MA 02138
TELEPHONE:617-661-3020 FAx:617-498-40.10 01 is4.'. 4�- '4 8i iii!IItI.IIII!
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Commonwealth of Massachusetts
City/Town of NORTH ANDOVER, MASSACHUSETTS
System Pumping Record
r` Form 4
V i
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 authority.
A. Facility Information
Important:
When filling out 1. System Location:
forms on the J C)computer,use
only the tab key Address
to move your v
cursor-do not City/Town use the return y state Zip Code
key. 2. System Owner:
Name — —
_--
Address(if different from location)
City/Town State Zip Code
Telephone Number
B. Pumping, Record
1. Date of PumpingDae f- 2. Quantity Pumped:
Gallons
3. Type of system: ❑ Cesspool(s) ( Septic Tank ❑ Tight Tank
t)
❑ 'Other(describe):
4. Effluent Tee Filter present?,,Yes__❑ No If yes, was it cleaned?7�0Yes ❑ No
5. Condition of System:.
6. System Pumped By:
ba LAJ LA'S Z71
Name Vehicle License Number
C pa
7. Location where contents were disposed:
_�dvvj— �
Signature of Hauler Date
hftp://www.mass.gov/dep/water/approvals/t5forms,htm#inspect
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