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Home My WebLink AboutMiscellaneous - 57 JAY ROAD 4/30/2018 57 JAY ROAD y I _21.01098-0057-0000.0 ) Date... i, 1110 #, cF �o oT;1a TOWN OF NORTH ANDOVER 0 � PERMIT FOR GAS INSTALLATION SS CH This certifies that . . !.(Y . . . . / . . . � has permission for gas installation,.,,. ../' .e.�.�. . . .r:: . . l:.! in the buildings of . . . . . . . . . . at . . . . . . .'.:. . .... ..... . . . . . . . .. North Andover, Mass. Fee .-•:-�-.-. Lic. Ngo^.. . . . . . . . . . . . . . . . . . . . . . . ... . /',)1t_- �f 1 -7 � ` GAS INSPECTOR WHITE:Applicant CANARY-Building Dept. PINK:Treasurer GOLD:File �F MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) NORTH ANDOVER Mass. Date tuilding Location 5 ? G4 r CIPermit # /(OOL /V C) P Indo yer , 441 c Owners Name ` oncl l s _ New -7 Renovation Replacement Plans Submitted y FIY.TUP_ a Yw vi Z N cc N a w w a O U m F_ N w o drt w M H oaO at" Cr W W _ w " m V t4 N a cc o >Z La W qa o z wz, c� s t. FW- yW- to m z o ~ ul o u~i i z 4 W e a z a u > C w4 O O.4 w — O w ti c O U _ u. o O .a U > SUR-RSt.1T. i ! BASEMENT ISTFLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TK FLOOR 8TH FLOOR (Print or Type) � Check one: Certificate Installing Company Name hilhIl•e 12CJC/C �f �t'J!^� Corp. Address-60-6 726 Partner. /l1 CJ ndG i/CC, O �CJ4J� Firm/Co. Business Telephone: 875- 4-2 2' /0/2 / 1f Name of Licensed Plumber or Gas Fitter l-Chlfr! /� /�l4 C/7e e Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy X Other type of indemnity Q Bond Ej Insurance Waiver: I , the undersigned, have been made aware that the licensee of this application does nothave a y one of the above three insurance coverages. a��A 'q, Q, - l Signature of owner/agent of property Owner L Agent E I hcteby certify that all of the deuds and information I have submitted (or entered)in above application are true and accurate to the best of mY knowledge and tlat ill ptumbintl work and Installations petfomted undo: Permit iuued fo: this appCuation will be in compliance with all pertlnent provisions or tho Massachusetts State Cas Code and Chapter 142 of tho general Ltws. By TYPE LICENSE: Dj Plumber Title Gasfitter Signature of Licensed Master Plumber or Gasfitter City/Town: Journeyman APPROVED (OFFICE USE ONLY) License Numbet NEW ENGLAND ENGINEERING SERVICES INC TO'VVN OF NORTH Ah�130Vr Wi BOARD RF HEALTH 'AUG T 2001 E August 24, 2001 North Andover Board of Health Town Hall Annex 27 Charles Street North Andover, MA 01845 RE: TITLE V REPORT:57 Jay Road,North Andover Dear Sirs: . Enclosed is a copy of the Title V report for the above referenced property. The system PASSED our inspection. If there are any questions please call me at my office, 686-1768. Sincerely �7 B6�aAin C. Oso Jr. J g 60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 x COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION t ,s V TITLE 5 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: .5-7 J fiq RD ND R Ati .,cn, dF Owner's Name: Ofd l.0 �cr7� FHEALTH i' ARD OH EALTH. .,,/ Owner's Address:_ 5-7 L-FA ' V_3> ® _ No TL( Date of Inspection: _ Mof L 2001 Name of Inspector: (please print) Pe t),�A^4t.&; C. �S(To::p 1'L Company Name: Mew Eng(,t_1�ti7 CN(�1k:r�Rkti(7 Mailing Address: leof2n� ��2 AAk Telephone Number: -I-Z. 176 cit, CERTIFICATION STATEMENT I certify that I have personally:inspected the sewage disposal system at this address and that the information reported below is true,accurate and:complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15340 of Title 5(310 CMR 15.000). The system: asses Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: sjj & The system inspector shall submit a copy of this inspects report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 2 of i l OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A 3ROPERTY ADDRESS:57 JAY ROAD CERTIFICATION (continued) NORTH ANDOVER,MA OWNER DON SCOTT DATE OF INSPECTION: 8/10/01 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. S stem Passes: y7 1 have not found an information which indicates that an of the failure criteria Y y described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional.Pass"section need to be replaced or repaired.The system,upon completibn.of the replacement or repair,as approved by the Board of Health,will pass.. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration:or exfiltration or tank failure is imminent. System will pass inspectiom.if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or. obstructed pipe(s)or due to a broken;settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ROPERTY ADDRESS:57 JAY ROAD CERTIFICATION (continued) NORTH ANDOVER.MA OWNER DON SCOTT DATE OF INSPECTION: 8/10/01 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system i ailing to protect public health,safety or the environment. 1. stem will pass unless Board of Health determines in accordance with 310 CMR I 03(1)(b) that the sy em is not functioning in a manner which will protect public health,safety an a environment: Ces ool or privy is within 50 feet of a surface water _ Cesspo or privy is within 50 feet of a bordering vegetated wetland or a It marsh 2. System,will fail unless the Bo d of Health(and Public W er Supplier;if any)determines that the, system is;functioning in a manner th protects the public h Ith,safety and environment: _ The system has a septic tank and so absorption stem(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surfac ater upply. The system has a septic tank and SAS the S is within a Zone I of a public water supply. _ The system has a septic tank and S and the SAS i ithin 50 feet of a private water supply well. The system has a septic tank d SAS and the SAS is less 100 feet but 50 feet or more from a private water supply we ll**. od used to determine distance **This system passes if well water analysis, performed at a DEP cert laboratory, for coliform bacteria and volatile o anic compounds indicates that the well is free from p ution from that facility and the presence of am nia nitrogen and nitrate nitrogen is equal to or less than 5 p ,provided that no other failure criteria ar triggered.A copy of the analysis must be attached to this form. 3. 0 er: Page 4 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) 'ROPERTY ADDRESS:57 JAY ROAD NORTH ANDOVER,MA OWNER DON SCOTT DATE OF INSPECTION: 8/10/01 D. System Failure Criteria applicable to all systems: You must indicate`yes"or"no"to each of the following for all inspections: Yes No V Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped V Any portion of the SAS,cesspool or privy is below high ground water elevation. ±�. Any portion of cesspool or privy is within.100 feet of a surface water supply or tributary to a surface water supply. ✓.... Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, :,,z,,.t-�d:perfor?med„,at a DEP certified laboratory,for coliform bacteria and.volatile organic compounds , .s1."indicates that the well is free from pollution.from that facility and the presence of ammonia �; �.i:;'.nitrogen•:and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.l ! (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. I.arg stems: To be conside d a large system the system must serve a facility with a design flo f 10,000 gpd to 15,000 gpd. You must indicate eith es”or`no"to each of the following: (The following criteria app large systems in addition to the crit ' above) yes no the system is within 400 feet of face ar' ing water supply the system is within 200 feet of ibutary a surface drinking water supply _ the system is located i nitrogen sensitive area(Int ' Wellhead Protection Area—I WPA)or a mapped Zone l I of a pub ' water supply well If you have answ "yes"to any question in Section E the system is con sid a significant threat,or answered "yes" in S ' n D above the large system has failed.The owner or operator of.an ge system considered a signif t threat under Section E or failed under Section D shall upgrade the system in rdance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST 3ROPERTY ADDRESS:57 JAY ROAD NORTH ANDOVER,MA OWNER DON SCOTT DATE OF INSPECTION: 8/10/01 Check if the followinghave been done.You must indicate"yes"or"no"as to each of the following: g Yes No Pumping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks Has the system received normal flows in the previous two week period ? V1 Have large volumes of water been introduced to the system recently or as part of this inspection'? _ Were as built plans.ofthe system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? ✓ _ Was the site inspected for signs of break out'? Were all system components,excluding the SAS, located on site? _✓ _ Were the septic tank manholes uncovered,.opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum Was the facility owner{and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems'? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no ✓ _ Existing information. For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [3 10 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ROPERTY ADDRESS:57 JAY ROAD SYSTEM INFORMATION NORTH ANDOVER,MA OWNER DON SCOTT DATE OF INSPECTION: 8/10/01 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): — Number of current residents: Does residence have a garbage grinder(yes or no): �� Is laundry on a separate sewage system (yes or no): tjo [if yes separate inspection required] Laundry system inspected(yes or no):— Seasonal use: (yes or no): NC Water meter readings, if available(last 2 years usage(gpd)): Sump pump(yes or no):_,'ys Last date of occupancy: c.,,;^✓e�.i COMMERCLUANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,ete.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system (yes or no):— Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: :i ne_ a kqq1,, Was system pumped as part of the inspection(yes or no): ALo If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank,distribution box,soil absorption system _Single cesspool Overflow cesspool Privy _Shared system (yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: , 1 G` 2 pC gaN Were sewage odors detected when arriving at the site(yes or no): /Uv Page 7 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) ROPERTY ADDRESS:57 JAY ROAD NORTH ANDOVER,MA DWNER DON SCOTT DATE OF INSPECTION: 8/10/01 I BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: cast iron _40 PVC_other(explain): Distance from private water supply well or suction line: N/} Comments(on condition of joints,venting,evidence of leakage,etc.): Q,pe wU 1{,S (1-c2e n i K-: ?t2 A sc=na SEPTIC TANK:_(locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a.Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: foe;: < llo� Sludge depth: y Distance from top of sludge to bottom of outlet tee or baffle: 2 Scum thickness: 4 1" Distance from top of scum to top of outlet tee or baffle:—12 ` Distance from bottom of scum to bottom of outlet tee or baffle: � How were dimensions determined:_-4A 5.� ,�C STZ e Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): _-rA N 1k b%A,_ 9.17-w nn C N S 2 TO W -14 n: G" o k_ I - A-)1'4-L- L—Ar-V n E a L'ti:v C 2C IV g/r�c.C >IL GREASE TRAP:Al&(locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Page 8 of 1 I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) ttOPEK1•Y ADDRESS:57 JAY KUAll NORTH ANDOVER,MA DWNER DON SCOTT DATE OF INSPECTION: 8/10/01 TIGHT or HOLDING TANK: A v A(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): �n711 C 5 v c ►O s C R-CL ej+ n^ e_ v PUMP CHAMBER:(locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C PROPERTY ADDRESS:57 JAY ROAD "STEM INFORMATION(continued) NORTH ANDOVER,MA OWNER DON SCOTT DATE OF INSPECTION: 8/10/01 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type ✓leachin its,number: g p leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool, number: innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): Alct LX f-I-- 5 rt AA s ,,ab iZ r„A-t &11_L' 1; o F.- ct= 0 i_ un1c7 ,>C—, A— /t'i CE-A11r11CA.; CESSPOOLS:((cesspool must be pumped as part of inspectionxlocate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: i Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY:(locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): Page 10 of I 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 'ROPERTY ADDRESS:57 JAY ROAD NORTH ANDOVER,MA OWNER DON SCOTT DATE Of INSPECTION: 8/10/01 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. r 1b i gj"16 � 1 lip � 1 I � I , s 4 Page 1 I of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) PROPERTY ADDRESS:57 JAY ROAD NORTH ANDOVER,MA OWNER DON SCOTT DATE OF INSPECTION: 8/10/01 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record- If checked,date of design plan reviewed: 4 Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You roust describe how you established the high ground water elevation: F�ftl (t F PT.S 1 y t,r r rr (1',132>-'c c t; v Z) C,II- I> f-ILL C-,3Z)., c.� cc,c��N z i i aR� of M -TJ JAY (A ,Q�� S�PPLy ❑ l-6Wnl ❑ WE(.L 6pR�OUEDDIlT - SS �PPi�ovt�v D,Qr�' /JPRZOvING AUTIIOi�ITy PCAtJ D6'5f 6NCK 1R4soNs 1�5 r�L� �� fel V5 D SCPT"f C SY5TENt 1 J STA LLATI OA J cX/JU/JTO,IJ 1NSPEG 100&j D/JTE Q PASS F4it_ I tiSPEcT�on� PIPE FROAA HOLX Tv T/J 0 K C,1 PASS 1C7 FIX. APP OVEp �J/JTC APFJZOJJNG AUTH01��Ty +4WT10MAL 1�5�?z.j SNS C11=,0►-1y) DlS�C1Pt'�ov�D D,arC R�OSO NS' FVA L A PPI�pvAL � ' APPRw &IG /MiHoj;I i y CNA'Ove rL JOB s- GILBERT REA 44 Rea St. SHEET NO. OF NO. ANDOVER, MA 01845 Phone 682-9864 CALCULATED BY DATE CHECKED BY DATE SCALE ............. ...................... .............. ....... ...... ................... .... .......... ....................................................... .............. .......... ...............- ......................... ............................ ....................................... 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De-94� .................................. ..... ..... f . ..................... ............ .......................... ................ .................................................. ............................ .......... .............. ...........-............. .........I......... ......... - ............ ............. ............ zl �j( .............. .......... ............ ................ .......... .............. .......................... ............ 17) ............. ................ .......... ............ ............. ............ ............. -0111.1. .............. ............ ............ ..................... L41 .......................... ..... .............................. ................................................. ........ ..................... ................................................. ............................. ............... ........................................... ........................ .................. .......... .-F- ....................... .......... .............. PRODUCT 2041 Inc..Groton,Mass.01471. PvA� Lot 5-Jay Rd. ' j�_�s APPLICATION FOR SEWAGE DISPOSAL INSTALLATION HEALTH DEPARTMENT - NORTH ANDOVER, MASS. I hereby make application for a permit for a sewage disposal installation at Lot. 5♦ .T;, Rd. . 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 1000 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 _ 289 Lt 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 disposalfield 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 8/26/68 Signature of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DATE 26/68 Signature of Health Agent I have inspected the uncovered system indicated above and find everything done as described. 4;� DATE U1, Signature o Inspecting Offic Percolation Test 13 minutes-clay Garbage Grinder no 1" BOARD OF HEALTH TOWN OF NORTH ANDOVER, MASS. 441P 4 � --�- fp f 7,c) All , 1. NAME DATE -b 2. ADDRESS, LOT NO. TEL 3. NO. OF BEDROOMS DEN YES NO- 4. GARBAGE GRINDER YES NO fes' 5. SHOW DIMENSIONS OF HOUSE 6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES �. 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//4"--�/' 11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY. i BOARD OF HEALTH OF NORTH ANDOVER , MASSACHUSETTS SEWAGE DISPOSAL DATE NAME OF APPLICANT LOCATION u Address of 1 nj. BUILDING: Dwelling Other SYSTEM: New 9L Repair f GENERAL DESCRIPTION OF LAND SUBSOIL: Clay Aavel Sand PERCOLATION TEST I3 minutes per inch. MINIMUM INSTALLATION RECOMMENDATIONS CONCRETE SEPTIC TANK_&-&-0_gallon capacity. LEACH FIELD `Zf((� lineal feet of drain pipe, illiam J, D i co 1 , Engine. Board of Heal i VERS Town of North P.ndover, MA N00 i ®F DFHNEP��N � Watershed S� is s s.t�).. tOV�A N0 0 _ Servicing report 95 VCI Date: Q Homeowner: Pi:m er. Street _ 1 Ac dress:_ la Phone CD PI one Nature of Service: Routine Emergency Observations: Good Condition Full to Cover r ' Baffles in Placc (� Leachf field Runbe ck Excessive Solids Ar Heavy Grease Roots Other (Explain) Description of work: Comments: 107 Forest St. �N FORM 4- SYSTEM PLJN1 PLNG RECORD Middleton,MA 01949 (508) 774-2772 CO mmonwealth of Massachusetts Massachusetts Svstem Pum17 0, Ror'n 'stem \\mer ystem Location Itl ve Date of Pumping: Quantity Pumped: �' al eons Cesspool: 1\0 ❑ Yes .' ❑ Septic Tank: No ❑ Yes System Pumped by: f�iL Contents transferred to: License #: .: 1{. Date I 4 nspector j 0 THE PROFESSIONAL EXPERTS IN THE SEPTIC AND DRAIN INDUSTRY 0