The URL can be used to link to this page

Home My WebLink AboutMiscellaneous - 716 FOREST STREET 4/30/2018C .I rt 0 0 H cu tLl i z�v v 0 n _ o a � D O O' cn I (p coD O Q O = avv p o a, c� I � rt 33 m=� I 'r D -: 3 n D � C 'u O j 3 N m j O � v rt 7 n L O 7 01 7 1 S 7 I N C .I rt 0 0 H cu tLl i Board of Health nmc SISTEH bf(,\ / "kms D/ North r Andver 41�MiBso INSTALLkTICK CMK LIST LOT' -APPROM Rea )nst OK a ^WXLV XL LA. %JLV vto.0 MCI 1. Distance Tot a. Wetlands b. Drains c.. Well 2. Water Line Location 3- No PVC Pipe 4. Septic Tank a. -Tees !..-Length & To Clean Out Covers b. Cement Pipe to Tank .-' On Both Sides of Tank. 5. Distribution Box a. Covers & Box - No Cracks b. Ali Lines Flowing Equal Amounts c. No Back. Flow 6. Leach Field or Trench a. Dimensions b. Stone Depth c- Capped 'Ends d: Clean Double�Washed Stone, 7. Leach Pits a. Dimensions b. Stone Depth c. Splash Pads d. Tees 8. Cer ,Amt pipe to pit Both Sides f. Clean Double Washed Stone No Garbage Disposal 9. Final Grading Inspection 10. Barricading Covered System 11. As Built Submitted a. Lot Location b. Dimensions of System c. Location with Regard -to Pere Test d. 'Elevations e.* Water Table 61 FoP-es.T' 7-11--3 SOIL PROFILE & PERCOLATION TEST DATA North Andover, Mass. Street No Cop-, F-oeayr Lot No Loc/Subdiv. Pland Owner Investigator Gam• Cot4*-0UT'h+ rS Observer MTS SOIL PROFILE DATES l Alev 2. Elev 3. Elev 4. Elev t53 'Tc S 7JD1.acy 4bb. _ 11Z.C�v s.sl� 0 -nil 5 6 7 vow sa.�. 8 N o we.TE+2. 9 10 0 1 2 3 4, 5 6 7 8 9 10 Benchmark Location Elevation Datum PERCO"TION TESTS DATES !?l)"fJeg 1711d /f3 0 1 2 3 4 5 6 7 8 9 10 Ties Pits est Pit Number 1 2 3 4 Start Saturation Soak -Minutes Start Test --T=/ Drop of 3" -Time Drop of 6" -Time M6ms-lst 3" drop Z Mins.2nd " Drop f 3 Percolation 3 Town of Yorth Andover.Mass. Permit rr Date APPLICATION FOR WELL & PUMP PERMIT Application ft hereby made for permit to drill a well Application - i s made to instdl (-) a pump system-. Location: fess ...Lot # Owner Adcfi"'ess Tel.------- - Well Contradbrez2z_�' Address -- l✓ . Pump ContracMr Address Tel.'----- - WELL CONTRA (To be completed at time of pump test) Type of Well Well used for /_-��' -E7 -- - - - - Diameter of K-11 -Size of Casing .. ...... Depth of BeMck. -7 Was Seal Ted -rd? Yes( L4 Depth of WeV I , -Z-c Depth to Walm, No U Depth casing into Bed Rock -Z Date -of- Testing V7%61 . . Well Ended in What Delivers- Cals.Per Min. for 4 h --urs Drawdownfeetafter pumping hours at GPM Date of Com*Eion. onature-1-.1ell. Cohtractor ---- PUMP INSTAIMJTo be fille-d-in-bef-ore-.installation) --- Size & Na-me-Hitp Pump Type Used Water Pum R-Vers:GPM - Pump MSize of -Tank Pipe MateriiKT-sed in Well: -Cast Iron J-) Galvanized- (-) Plastic _(-) Well Pit ( 1w,2Pitles_s- Adapter (-) Was sleeve- ;to protect Pipe? --Yes NO{:--) Type or Name ',-,'ell Seal Date r e z�'s t a 1. 1. A- If IT iy If W IT Date Water aaksis report submitted to --Board of Health Date'releaselEven to owner of record & Bldg. Insp- _h Inspector -4- e Town of North Andover,Mass. , Permit # �� Date- 19 APPLICATION FOR WELL & PUMP PERMIT Application is heteby made for permit to drill a well ('). Application is made to install (_) a pump system. Location: Address _ - -__- - Lot ##-7�-__ - Owner i �Address ��9, �/d �`}P/ Tel . 6p �3,5r Well Contractor Address 1.�Z3� Pump Contractor -611 Address Tel WELL CONTRACTOR. (To be completed at time of pump test) Type of Well. Well - _Well used for Diameter of Well '� Size of Casing o i Depth ftfr Bed Rock-5*"r Depth casing into Bed Rock_ _ Was Seal Tested? Yes (V No (-) Date _of Testing Depth of of Well-___, --- Uell Ended in What Materia Depth to Water Delivers- Gals.Per Min. for 4 h:Durs Drawdown- / C0r feet after pumping __hours at - GPM Date. of Completion Si -nater t',el l Contractor-— .��`^!_.4n_r_y!.�_!__..>_.f_�__�_t_._w_e._y e,.r-_•_^'4..+..f.0 :: .: '.�, `. :. :: _'- ___ --,L. ::' :L `.�. :: :: PUMP INSTALLER - (To be filled -_in before instaIIafion) Size & Name Pump-- ----------------- _p,,;,;p Type Used Eater Pump Delivers-- GPM - Size of Tank Pipe Material Used in Well: -Cast Iron ( ) Galvanized ( ) Plastic( ) Well Pit (_) or Pitless--Adapter ( ) Was sleeve used to protect pipe? Yes ( ) -NO( ) Type or Nal -,ie 'Fell Seal Date---. ii rt 5'r i� N r� 3i �� i • �l ��. pit t r r: -r; iT :�(i � iT 'rT )a: '. i � 3, ,; `i: ;:.:c :� ;. ,... „ .. ;, :: z C 1 .71 Date Water analysis report submitted to Board of Health .Date 'release . given to owner of record & Bldg. Insp -- ----- Health Inspector ---------- - ---- - Board of Eealth uort}:: I FAIL Check List M1; 2 Leaching Pits Leaching pits are preferred where the installation is possible Re) calculations of leaching area-rdnimt m 500 sq ft spacing surface drainage 2% d) cover material e) VxVAII splash pad t f) tee at elbow - g) no bends in pipe from d -box to pipe Leaching Fields 4da) no greater than 20 minutes/inch } area -minim= 900 sq ft c) construction of field ) surface drainage 2 % e} 201 from cellar wall or inground skimming pool Leaching Trenches - teg 14.1 a.) c Gula—ti ss of leaching area -zein 500 sq ft 14.3 b) spacing -4 ft rdn 6 ft with reserve between 14.4_ - c) dimensions - 14.6 d) constriction - 14.7 - - e) stone 14.10: f) surface drainage 2% Ibuahill S122e - _ 'a) s ope. y x . _ to_ be = shom)- -- = ti) y/x 1 150:==. (to==be "shot) --= s a) , app.rOval >_ - - star,a-by-pawer.� - - - - WELL & PUMP CO ° RT. 28 WINDHAM, N.H. 03087 B&R CONST 277 ANDOVER ST NO ANDOVER MA 01845 [603]898-4232°[617]887-5888 LOT NUMBER OR SAMPLE LOCATION: LOT #7 TEL. NO. 686--6385 WATER TEST RESULTS 17 MAY 84 *************************************************** HARDNESS 68.4 (0-50 REC STANDARD) IRON 5 (0—.3 REC STANDARD) MANGANESE 0 (0—.05 REC STANDARD) HYDROGEN SULFIDE 0 (0—.01 REC STANDARD) Ph(ACIDITY) 8 (6.5-7.5 REC STANDARD) TURBIDITY 4 (0-20 REC STANDARD) CHLORIDES 40 (0-150 REC STANDARD) COLIFORM BACTERIA 0 (0 REQUIRED STANDARD) **************************************************** CHARGE FOR CHEMICAL & BACTERIA TEST ** $25.00 **************************************************** ABOVE TESTS MEET REQUIRED STANDARDS AND BASED ON THESE, WATER IS SAFE FOR HOUSEHOLD USE AND HUMAN CONSUMPTION. THERE ARE OTHER LESS COMMON MINERALS WHICH CAN AFFECT QUALITY OF WATER. Pumps *Submemib|o *]et *Contrifuga| *CeUar w Sewage Tanks Filters *5oftener * |nnn *Charcoa| *Neutra|izer � * Cartridge Water Testing Pump Parts � Motor Cnntnm|u � Water Softener Salt Resin Cleaner Rust & Stain Remover� Pwtuoaiunn Permanganate Plastic Pipe & Fittings� � Lawn Watering Systems Water Heaters * Solar � * Heat Pump * Electric * Energy Saving Wells * Drilled *Drivwn =Oug *Gravel Chemical Feeders Tank Alarms & Controls Hoist Service Portable Pump Puller Emergency Service Goulds Aerrnotnr jacuzzi Red jacket Fairbanks Morse Wayne /\quutron •IiN• x1 ltttt1 1. rYr �Y 4 -_. r � • 1 r , .F•/F� •�t•d?'t� r�. � !1J' ,t { ( �ri• 1 y�l F 1 ( � r .. . . 'N�.i ! I�h�. ,r i aK �� .` ref i4'y r•�`y,P a��b� xt�;!j!1 Y}. e y� u".��tt'.r r N ,; tt ..1 , _. 1 .. ... , tt �� I p 'r Yt t15� � `J,.,��1 r 4{ ^ 1 ` !r' •t { r i • 1 �„ 1{uf .ow ral 2tij jel�t5 la I. . q 1 4 ` it'r C ��F J ' .yrM• t,,�wl� 4 •tt;,4,.��,J. u ,r 1 . _ rt r f , _q T`•+se. A' l D o - To �• �' ! �'r> 1**tf/'In . t f (j`�'� t: t 'r �• . ' ' ' ,tt3 ' " .. ;>` 1.{'j"�•t7iJ t •fi/ . i t , f '4 � yw t!^I f � ra'•:s1 7 . ��;� � r ,�1� v C :::r k;r j �r "Jy'I'�f�,` �P1, .{1t • ! :S � �: t�... f t.t � -.. _.. ! 15x } - t TQWIv OFNaRT OV PR OCT - 3 Sy PUp 2p6�! ' a ING RECORD �r I •, J lrh��grrj♦�•Cp['I S ` x4yt (yi: '. .• �,..,( .1 y1 .A�r .1«�� f�� f• "4'ah r t�'{r•(��•ii }��*1'C��}til%_. '�.. /. .. :1 i � !pl 'i5 � ,T 1"1h ♦yv� li �iL r .4 ,t �t r t r tFl, 4 r rJ ry-�.'OC 7 . t4 a , ' Ems ADDIS SYSTEM LOIII CATION (+ uaples %fhfrqut of h//��.�m� ) . 2h •i r . �i � h' }• t lV1,p'#Ilit i '" i 1•.91 r. par -t, x' .�m.�, w,i, r. .. + 1j1Cfa'•rx�viilTlrr!}hj !►� `{ '-- �1. 'y �.+; r. �i i,, i `" r I"';��•�1 a�}(,�u r r. ...rr .. PUMPED.GALLONS I.Lt�,�f,h 1 1 -EMC TANK YES 't• 7 �•.. � r .n1ki � r:IjYi S .Yl -1 Y: .. 12 �1�, t ' @ 1 �. � .0 1 � oA �E� .'•/(�� 'r' �O�T� ':.FI'• l �µ,� 4 . .. - •. .AAA p .CONDWON .�i 5 ,HEAVY' FULL' T OVER REQ!►$ ROOTS 0. E-� BUFIrLES IN PLACE LEA CES,SIVE SOLIDS CBFIELD RUNBACK "�'�'`► SOT�IDS FLOODED VER } 'iJ p'y , 47��Tf low �rLl r, 1 <r 1' Sy "��"i�itAI9�jj .�n��jl1��'x st'�j i yr,ifi`� rr� �� i ' •� � t x•� . • , !fly f � i� :. J •n1 fi;i f t t'. - • •1� y1�' 119 j, RM 1, l'1'iv%!•N�iMf ti• ' ►i ,f''�'♦�! �' �1' � r.5 .f - , t 11 Y 1 } 1•. x r 7:77 JI1 x l..'�r? to '�51l 7• •�' .J. NI. a f A 1•( 1 ' f a 1 ,}� �1,�� 1�(3i�� w • *1��.�1�, J � . S , i c 9'7. •, �1. � , r' r 'aFyPr Ip111�!!r •l.M}�il.`1�,�,,'�I.^1 4 .1;� i r� �,�• s r .. . MI t 1 u* i q 11f i ,.Its Mr}Y•,1 f l.lv Ave-- < , •1 .141 �iryS•.tri vi ..,.. • I r:. '. i. i $ � h + 1 J , t f - � y + 'y� P il�� r � , r• , s �. Commonwealth of Massachusetts City/Town of NORTH ANDOVER, MASSACHUSETTS System Pumping Record Form 4 5. Condition of Svstem: 6. Sste i Pumped By: qj came I Vele ic�ense7NNur ber Company 7. Location where contents were disposed: U 1 1 ak�' (� Signature of Hauler Date http://www.mass.gov/dep/water/approvals/t5forms,htm#inspect t5form4.doc• 06/03 . System Pumping Record • Page 1 of 1 DEP has provided this form for use by local Boards of Healttext-P ecord must be submitted to the local Board of Health or other approvin authR EIVE A. Facility Information NQV - 3 2006 Important: When filling out forms on the 1. System Location: —�/ 6 (�()f TOWN OF NORTH ANDOVER HEALTH DEPARTMENT computer, use � only the tab key to move your Address /� I &kv—c cursor - do not use the return Cit /Town y State Zip Code key. 2. System Owner: n IL If Name ,( _ �✓ Address (if different from location) City/Town State Zip Code Telephone Number B. Pumping. Record 1. Date ��— of PumpingDat 2. Quantity Pumped: GallonsJ0 3. Type of system: ❑ Cesspool(s) Weptic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? Yes ❑ No If yes, was it cleaned? 3Yes ❑ No 5. Condition of Svstem: 6. Sste i Pumped By: qj came I Vele ic�ense7NNur ber Company 7. Location where contents were disposed: U 1 1 ak�' (� Signature of Hauler Date http://www.mass.gov/dep/water/approvals/t5forms,htm#inspect t5form4.doc• 06/03 . System Pumping Record • Page 1 of 1 f Commonwealth of Massachusetts City/Town of NORTH ANDOVER, MASSACHUSETTS System Pumping Record M r` Form 4 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 forms on the computer, use only the tab key to move your cursor - do not use the return key. Q IL If �;A' � 1. System Location: Ad7)" City/Town 2. System Owner: ci Wks State Zip Code Name � „ , •� -- Address (if different from location) City/Town State Zip Code Telephone Number B. Pumping. Record 1. Date of Pumping2� Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) [Septic Tank ❑ Tight Tank ❑ 'Other (describe): 4. Effluent Tee Filter present. Yes ❑ No If yes, was it cleaned? Yes ❑ No 5. Condition of System:, 6. 30hn m Pumped By: D i( holm Naln/ V'�M U� 'Do, /i2' Company 7. Location where contents were disposed: X41-13g� Vehicle License Number r CC,r- laWTMCL Signature of Hauler Date http://www. mass.gov/dep/water/approvals/t5forms, htm#inspect t5form4.doc• 06/03 Dv System Pumping Record • Page 1 of 1 . <�\ Commonwealth of Massachusetts _ v City/Town of North Andover System Pumping Record ,M Form 4 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. 1 �a A. Facility Information Important: When filling out 1. System Location: forms on the computer, use ss only the tab key AddreR to move your cursor - do not use the return key. 'Rn r� ietmn TOWN OF NORTH ANDOVER U� - -- Ma 01845 — 6. S stem Pumped By: 1 � ia�1 Rm,ne Stewart's Septic Service Company 7. Location where contents were disposed: Stewart's Pre-treatment P -cant, 20 So. Mill B v 1� Signature of Receivilw1mcility Vehicle License Number Ma 01835 Date Date t5form4.doc• 03106 System Pumping Record • Page 1 of 1 No.Andover City/Town State Zip Code 2. System Owner: Name Address (if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: II Ga o n s 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: nffil G��. 6. S stem Pumped By: 1 � ia�1 Rm,ne Stewart's Septic Service Company 7. Location where contents were disposed: Stewart's Pre-treatment P -cant, 20 So. Mill B v 1� Signature of Receivilw1mcility Vehicle License Number Ma 01835 Date Date t5form4.doc• 03106 System Pumping Record • Page 1 of 1