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Home My WebLink AboutMiscellaneous - 58 RUSSETT LANE 4/30/2018 (2) �,� .� -, �� "' f Winic, Samuel Lob 5A, Russet Lane APPLICATION FOR SEWAGE DISPOSAL INSTALLATION HEALTH DEPARTMENT - NORTH ANDOVER, MASS. I hereby makeFFA plication for a permit for a sewage disposal installation at Lot . ALRusset Lane . 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 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 (squave) 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 ,4a,� Signature of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DATE 6 Signature of Health Agent I have inspected the uncovered system indicated above and find everything done as described. DATE 2 7 Signature bA Inspecting Officer Percolation Test 4 min. Soil: gravel Garbage Grinder et BOARD OF HEALTH TOWN OF NORTH ANDOVER, MASS. r t tb- 614 L �a3 15� � f 1. NAME t (%! P t f �..� DATE 2. ADDRESS ?VSgel�o' C J e- LOT NO. J79 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 ��;rra WJ r- 10. 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. BOARD OF HEALTH OF NORTH ANDOVER, MASSACHUSETTS SEWAGE DISPOSAL DATE December 2�, t966 NAME OF APPLICANT Samuel Winic LOCATION Lot #5A. Rus set LaLe Address of lot no. BUILDING: Dwelling X . 'Other SYSTEM: New x Repair GENERAL DESCRIPTION OF LAND High SUBSOIL: Clay Gravel_ X _ Sand PERCOLATION TEST 4 minutes per inch. MINIMUM INSTALLATION RECOMMENDATIONS CONCRETE SEPTIC TANK 1,000 gallon capacity. LEACH FIELD 180 lineal feet of drain pipe. s e, William J. D scoll , Eng ine r Board of Health 6 Please forward us as much of the following information that is possible; 1. Type of system 14700 2 . Age C 2l 3.. Location 4 - Maintenance records and date of last pumping out 5. Documentation of repairs and reconstruction 6. Site conditions 7. Btiilder of system 8. Engineer who approved; — Site -- System �� r � • g , Installation Procedure 10. Probl ems �wc SEPTIC SYSTEM INSPECTION FORM ADDRESS S S,.P,-f DATE INSPECTED g-g(A PROPERLY FUNCTIONING? N WEATHER CONDITIONS COMMENTS : WATEP, QUALIFY TESTEt, ? ReSUL-'S? DYE TEST PERFORMED? Y N DATE? SKETCH: \may 1 WATERSHED RESIDENTS QUESTIONNAIRE 1. Name od mi p_j 0 ,10 , - 2. Street Address sR Asst-4: 1,,-*e 3. How many members are in your household? 2 4. What type of sewage disposal system do you have? ❑ cesspool septic tank and leaching area ❑ connection to municipal sewer ❑ other (describe) ❑ do not know 5. Are the plans (drawings) for y r sewage disposal system on file with the Board of Health? ❑ yes ❑ no D? do not know 6. How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years 11-20 years:-"` ❑ over 20 years ❑ do not know 7. Has your sewage poral system been rebuilt or repaired? ❑ yes no ❑ do not know If yes, approximately how long ago? years. What was done? 8. How frequently is your seewaa e disposal system pumped out? El annually El every 2-4 years L�' every 5-10 years ❑ over 10 years ❑ never 9. Have you had any problems with your sewage disposal system? ❑ yes L`J' no _ - If yes, what problems? ❑ repeated pump-outs needed ❑ system clogs, backs up, or drains slowly ❑ odors ❑ sewage surfaces through ground 10. How many of each appli are connected to your sewage disposal system? washing machine V dishwasher '/ garbage disposal dehumidifier drain sump pump toilet roof/pavement drains shower/bathtub 11. Please state the rand and type (liquid or powder) of detergent you use for: dishwasher � �� v�� W n c2 clotheswasherd��Y' 12. Does your property have a lawn? [g' yes ❑ no If mss, approximately what size? [�' less than 1/4 acre ❑ 1/4 acre ❑ 1/2 acre ❑ 3/4 acre ❑ 1 acre ❑ more than 1 acre (Specify) acres 13. How often do you fertilize your lawn? No. of applications per year !qVq_"/ S Season(s) of the year ,FA-4-4 14. Please state the brand and type (liquid or granular) of lawn fertilizer you use: ❑ Check here if your lawn is maintained by a professional landscape contractor. bii{� 'i•''-, "�i�•ti 7i' + : °:'. ; f.\: :�`i5.��k:.•...-S'jk.15. ti47'.l�• `e�;�.`.'{.i _.T.� �a: ;�� +::• ,�t• '��•:%J.. :i'Y:':^�`' t,��=�� 1� 4,'�,l,.iYe'ri�<�''T`�y,1' _`' '`ti'.:.. ia:.`�• .•f ,Z' ,7 j i...J..,•\.i: J `,- 1.ti? •,. 11F:,�\ � ,.�"'r': -�r•.i?� \.i .P.• ;W. •'G. "l `t• ,:\`: `f. •', f;�ti 4r•nl`i> 4i'.Vi, t\, _t n1'.:.• ..l'1�..�^:1' .�� : �.i''�� ,r' r^ ,'.L: .�, 1• '�i"� .1�, ilk: '�1� �atl :L.ti` .t�\ •t` .,��^'1,^,1.��y.�,)y `i?•� is •,',;•, ,'.'• ~;� ,,,' .,\ �,t, �;�, ,�a •�•,,:; ,la'•+• 1. t�, ;:,. "i a .'.� ,I ', '')` ^,�,t-! .;,, is �0^:• ,t'c}):,a,;,,, .�\i` yi �s..�� ,. �\t s..•;S"�_ /(' \ STATEMENT 0\ VV DANIEL A. GIARD 130A Appleton Street NORTH ANDOVER, MA 01845 DATE Phone 686-7653 i TERMS: QQ PLEASE DETACH AND RETURN WITH YOUR REMITTANCE $ DATE I INVOICE NUMBER/DESCRIPTION I CHARGES I CREDITS - BALANCE BALANCE FORWARD -- - ___ ---- -- L 09Iyow PAY LAST AMOUNT DANIEL A. GIARD � IN THIS COLUMN PRODUCT 100,2�.0 lne..Groton,Mut 01171.Yo OIEer PHONE TOLL FREE I800715GI80 BOARD OF HEALTH '146 MAIN STREET TO-a��M H raa AND. VER� TELEPHONE# (508) 688-9540 �oRr��rH _.T�,__ APPLICA TION FOR ABANDONMENT EC L 3 OF SUBSURFACE DISPOSAL SYSTEM - (SEPTIC SYSTEM) Pursuant to Section 310 CMR 15.354 of the State Environmental Code, Title V Name wi k(`C Phone Address Le-we, Contractor hired for work: NamefG�� x d� +`o rS Phone Address Date for scheduled abandonment 12-- zzr Q� The septic system at the above address has be nof ccording to Title V specifications. Signactor Method ofseptic tank abandonment (check one). ( ) removal ( ) sandfill V) crush ( ) other Name of Offal Hauler This form must be returned to the North Andover Board of Health. PLEASE DO NOT WRITE IN THE SPACE BELOW FOR HEALTH REPRESENTATIVE'S USE ONLY. rO'ce Inspecting Agent Date