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Home My WebLink AboutMiscellaneous - 625 GREAT POND ROAD 4/30/2018 (2) 625 GREAT POND ROAD )ad 210/063.0-0025-0000.0 H0RT1y �1� BOARD OF HEALTH O 9 Y s ° • 120 MAIN STREET TEL. 682-6483 SACH US.•S�5 NORTH ANDOVER, MASS. 01845 Ext23 S 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 )0")k ee'-'weti - Phone C.� )-c30�� Address (',Zs GA4e'- - Contractor hired for work: Name F- KV,15 t tri Phone 5tk--36e---coW Address -10 -e fiRu" y5 Date for scheduled abandonment Method of septic tank abandonment (check one) . ( ) removal ( ) sandfill ( crush ( ) other (describe below) Other PLEASE DO NOT WRITE IN THE SPACE BELOW FOR HEALTH AGENT' S USE ONLY Insti g ?Kent Date Comments r' A Na 1060 APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass. 61 19 Application by the undersigned is hereby made to connect with the town sewer main in�C�� I��az� / Street, subject to the rules and regulations of the Division of Public Works. The premises are known as No. �75 �i � �/ Street or subdivision lot no. 7 u! V . Owner Address Contractor Ad re / A A- pplicant's cant's Signature C0A)6&Z Y/9 ✓iORJ PERMIT TO CONNECT WITH SEWER MAIN The Division of Public Works hereby grants permission to to make a connection with the sewer main at Street subject to the rules and regulations of the Division of Public Works.. Division of Public Works By Inspected by Date See back for rules and regulations NORTH ANDOVER BOARD OF HEALTH - INSTALLATION CHECK LIST APPROVED DATE DISAPPROVED DATE �jl7/1* hXCAVATION OK ,9P 7 J-,,�4 ONS: FAIL OK Distance To: Wetlands .iDrains -�e11 2. Water Line Location o PVC Pipe 4. ptic Tank Tees - Length & To Clean Out Covers Cement Pipe to Tank - On Both Sides of Tank 5. Distrib ion Box er & Box - No Cracks _. es •F1-owing,.Equa1--'AMbd is ' Te Flow _. ._..� 6. Leach Field or Trench Dimensions Stone Depth Capped Ends Clean Double Washed Stone 7. Leach Pits pensions --_-St e Depth plash Pads ..-C e t it - oth Side �l=-tL Aas 8. No Garbage Disposal c 9. Final Grading Inspection 10. Barracading Covered System 11 . As - Built Submitted Dimensions of System Location with Regard to Pere Test Elevations Water Table - ---- -- --- — (�OT (7c1T pr t0(-_ �O_ SG i - __ -- �►e SviTe-�I I rTv-.O�- re_-5C 5 Te-+U. c --cam ..-� ver d� G( _Dccc��&vV �e._ ray �_Tf-�_ _ _er; wear - - .y - - t " 1 SEPTIC SYSTEM INSPECTION FORM i ADDRESS DATE INSPECTED -T 9- PROPERLY FUNCTIONING? N WEATHER CONDITIONS COMMENTS: - WATER QUALITY TESTED? RESULTS? DYE TEST PERFORMED? Y .N DATE? SKETCH: -./f "` { f �' I�v'�/�� 6 O� �W A G Y,57— E 1`!l i rr 2•/ � `ted v s of �, Ca (JI rye IN In Vj eG'r re pir s" pr7M� Sd` i !dr-z " 0 /Soo (SRI- z„ o T'k U,t pie � 3z 4or .L` w CHARLES R. YEATON _ 166 SUMMER STREET ANDUVFR, MASS. 11810 r i , 1 .. SOIL PROFILE & PERCOLATION TEST DATA TbWn%City No.&Street Lot No. Loc./Subdiv. -Plan Owner Investigator 6L/10 Observer. S0�L PROFILES-DATE 1 � \\``® lev. 2` E164. *747 3' Elev. 4' _. _ --�lev. 0 77 07 0 � b• 2 2 2 2 3 3 4 t 4 4 5 \ 5 \ 6J6 � 6 6 8 8 --- 8 9 9 . 9 9 10 10 10 10 Benchmark Location Elevation Datum Percolat' on Tes s-Date Pit Number 1 2 - 3 4 S Start Saturation Soak-Mins. Start Test-Time y� Drop of 3"-Time Drop of 6"-Time Mins.lst 3"Dro Mins.2nd .31IDro r Notes & Sketches on Back Frank C. Gelinas & Associates; North And. '7/711<2 a C� coc-le, 5��, c/Cc�-s.1 xG I O w C.. h 00 4/7/77IL At YE ATOM. 9 MAsS,, 1DENTI AL 2 . �5� ALL 2)1/1. APkO X . 73 / r �.oAD MDRT// .41V bOVE/Z O / /7,7 lop-vell�e/ , -4� Uc�^ 2.74/�cr�,� OD i ZOO.C:oo 167 .- k,654 <Ue f PERCTT.37 1 / .... RO•:ta p 1s i 7 0 NoS! -' �•+ " Z � 4 pl -- -.- --�s4 s f i 71 3.G . JH Fir 1 6 n CL (.57432, [. /-%7.50 � • 7-0 .9G � �:1.. _/�� • ��_ - ) VATEk � r i i i I I r i W,,-re P- I I I l ��IIN, 54<1rt Qn1 MAV li fir/r� 1 1 4 i I I �__!__..____._ - �1�(/; �__.7_.__i � �— — �ft*G vk •-9 ti� �'N rLf A ! f /.:.`i',t V A/a am r Vic. s. . -' l EC.t S�•r / 1 t r ti r 9 lS6�.o f OUT /s9. 2S" YT I c 'T'fi N X V 3 I r � U. /ELLEN TO � !��s"• �= �,�5 j,,g,sg r t./ 1_ x` 7"' f-4-f ; 14if -0 1 �►.04 ; t 10 J � r , # z i I , Pro rlZ H FL E I { L Ill � � � `� j' Rl • J L'` !,` i 8 f O �r TO: NORTH ANDOVER MASS %� I" 19 _ BOARD OF HEALTH FROM: DESIGN ENGINEER Re: Soil Absorption Sewage System Inspection This is to certify that I have inspected the construction of the said disposal system at North Andover, Mass. SITE LOCATION The grades and construction are as specified in my plans and specifications dated 19". Reg. Prof. Engineer/Reg. Sanitarian WATERSHED RESIDENTS QUESTIONNAIRE 1. Name 2. Street Address 3. How many members are in your household? .3 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 your sewage disposal system on file with the Board of Health? ® yes ❑ no ❑ do not know 6. How old is your sewage disposal system? [2 0-5 years ❑ 6-10 years ❑ 11-20 years ❑ over 20 years ❑ do not know 7. Has your sewage disposal system been rebuilt or repaired? ❑ yes 2 no ❑ do not know If yes, approximately how long ago? years. What was done? 8. How frequently is your sewage disposal system pumped out? ❑ annually Z every 2-4 years ❑ every 5-10 years ❑ over 10 years ❑ never 9. Have you had any problems with your sewage disposal system? ❑ yes 2 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 appliance are connected to your sewage disposal system? washing machine ✓ dishwasher garbage disposal ✓ drain sum um dehumidifier p pump toilet roof/pavement drains shower/bathtub 11. Please state the brand and type (liquid or powder) of detergent you use for: dishwasher fj clotheswasher 12. Does your property have a lawn? yes ❑ no If yes, approximately what size? ❑ less than 1/4 acre ❑ 1/4 acre 2 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 .L Season(s) of the year 2-7%at:j_- — --� -ee— tf 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.