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Home My WebLink AboutMiscellaneous - 62 LISA LANE 4/30/2018 l - ------62tiSAtANE - 210/098.A-0039-0000.0 SEPTIC SYSTEM INSPECTION FORM ADDRESS 62 L DATE INSPECTED � 'V G PROPERLY FUNCTIONING? YQ N WEATHER CONDITIONS COMMENTS : WATER aVALiT'Y TES t Eb ? RESULTs' DYE TEST PERFORMED? Y N DATE? SKETCH: WATERSHED RESIDENTS QUESTIONNAIRE 1. Name Aepkl en T 2. Street Address 3. How many members are in your household? 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. Ar the plans (drawings) for your sewage disposal system on file with the Board of Health? Ar ❑ no ❑ do not know._ 6. How old is your sewage disposal system? ❑ 0-5 years [R/6-10 years ❑ 11-20 years ❑ over 20 years ❑ do not know __ 7. Has your sewage disposal system been rebuilt or repaired? ❑ yes QV no ❑ do not know If yes, approximately how long ago? years. What was done? 8. Ho frequently is your sewage disposal system pumped out? El annually Z7every 2-4 years ❑ every 5-10 years ❑ over 10 years ❑ never 9. Have you had any problems with your sewage disposal system? ❑ yes �o 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 appliance are connected to your sewage disposal system? washing machine )_v_1" dishwasher ✓ garbage disposal .'dehumidifier drain sump pump toilet roof/pavement drains shower/bathtub ,2 +/ 11. Please state the brand and type (liquid or powder) of detergent you use for: dishwasher .4 L L /L+r�u;n JPf G fea&LM Pager clotheswasher L,ct�,d /Svc 12. Does your property have a lawn? Oyes ❑ no If yes, approximately what size? ❑ less than 1/4 acre ❑ 1/4 acre ❑ 1/2 acrerJ 3/4 acre ❑ 1 acre ❑ more than 1 acre (Specify) acres 13. How often do you fertilize your 1 wn? No. of applications per year Season(s) of the year EAQ.L�j Z.tif 6- LATE-tSA2j UC, 4--AeLy FO LL Lf-Tv F,4LL- 14. Please state the brand and type (liquid or granular) of lawn fertilizer you use: IL Check here if your lawn is maintained by a profession f �dse ontr actor. ��L/ Lot #5, Lisa Lane APPLICATION FOR SEWAGE DISPOSAL INSTALLATION✓_ HEALTH DEPARTMENT - NORTH ANDOVER, MASS. ,y ,7 I hereby make application for a permit for a sewage disposal installation at Lot 5, Lisa 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 100 aal. 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 200 linear feet of effective absorption area. The pipes will be laid on a 9--In-ch 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 QGL- S . ature of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DATE r Sign tune of Health Agent I have inspected the uncovered system indicated above and find everything done as described. / DATE 4 !� Signature of Iris cting Officer Percolation Test 6 min. Soil: C#y Garbage Grinder Yes ♦- ayyl 196 BOARD OF HEALTH p TOWN OF NORTH ANDOVER, MASS. C. so r I �7 f 6inUT', � �t 1. NAME 61.) #_Au He, k 17 0 DATE 2. ADDRESS LOT NO. c 5 TEL. 3. NO. OF BEDROOMS t4 DEN YES ► NO 4. GARBAGE GRINDER YES t/f 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. BOARD OF HEALTH OF NORTH ANDOVER, MASSACHUSETTS SEWAGE DISPOSAL DATEAu,,x ,, . '^ , j c)�6 NAME OF APPLICANT william Herman LOCATION Lot #5, Lisa Lane Address of lot no. BUILDING: Dwelling X Other SYSTEM: New X Repair GENERAL DESCRIPTION OF LAND Hi3h SUBSOIL: Clay__L_ GravelSand PERCOLATION TEST 6 minutes per inch. - - - - - - - - - - - - - - - - - MINIMUM INSTALLATION RECOMMENDATIONS CONCRETE SEPTIC TANK 1,000 gallon capacity. LEACH FIELD 200 lineal feet of drain pipe. 'kUz' -- t'J1 William J. iscoll , En neer Board of Hea th Of HORT1� 1 41 ?�`' �� °0 BOARD OF HEALTH 9 ` 120 MAIN STREET TEL. 682-6483 �9SSACHUSNORTH ANDOVER, MASS. 01845 Ext 23 APPLICATION FOR ABANDONMENT OF SUBSURFACE DISPOSAL SYSTEM (SEPTIC SYSTEM) PURSUANT TO SECTION 310 CMR 15. 354 OF THE STATE ENVIRONMENTAL CODE, TITLE V This form must be submitted to the Board of Health no less than five (5) days prior to date of abandonment and be accompanied with a copy of the sewer connection permit. Name i'e�tx�h;,-«ter Phone 681pOC) t� ` - Address �� Uscc L,Qc.,Q— Contra�C�Wteyt�- ctor hired for work: Q Name 1� Phone 6G 6 7 1746— Address Date for scheduled abandonment�Maq /1,19C16 Method of septic tank abandonment (chec one) . ( ) removal ( ) sandfill ( j crush ( ) other (describe below) Other PLEASE DO NOT WRITE IN THE SPACE BELOW FOR HEALTH AGENT'S USE ONLY Insp-fit ' g Kgent Date Comments r Lgication • Date NORTM TOWN OF NORTH ANDOVER p Certificate of Occupancy $ Building/Frame Permit Fee $ o, « Foundation Permit Fee $ s�CMUSE o Other Permit Fee $ IL Sewer Connection Fee $ �11 w- Water Connection Fee $ TOTAL $ B I fi insp or 1 V° 8985 Div. Public Works N° 1001 APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass. i/('�1��NL'�'1' J 19 r -' Application by the undersigned is hereby made to connect with the town sewer main in '"'�S� `—*��`�- s, subject to the rules and regulations of the Division of Public Works. (� The premises are known as No. or subdivision lot no. � Owner Address &A—) Contractor Addr ./Applic is Sign re PERMIT TO CONNECT ITH SEWER A The Division of Public Warks hereby grants permission t'o l/ to make a connection with the sewer main at I/n C-7, Ll -'t ;W D `'freer subject to the rules and regulations of the Division of Public Works.. / ivisi n of ublic Works gy IvL4 Inspected by Date See back for rules and regulations TH AND----------- TOWN Town of North Andover, MAF HEALTH, Watorshed Septic System servicing Report Date: Homeowner: Pumper Street CD'a Address:_ Phone Phone Nature of Service: Routine Emerg-;�rcy Observations: Good Condition Full to Cover Baffles in Place �d Leachfield Runback N<'�) Excessive Solids Heavy Grease 1V� Roots Other (Explain) Descr=_pt.i_On of Work , ly�, Comments;