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Home My WebLink AboutMiscellaneous - 754 FOREST STREET 4/30/2018CA T 1 M i TO: NORTH ANDOVER, MASS BOARD OF HEALTH FROM: DESIGN ENGINEER A R 19 %P Re: Soil Absorption Sewage System Inspection This is to certify that I have inspected the construction of the said disposal system at 1v- o 7- / /= ®f2 E5 T -137— North Andover, Mass. SITE LOCATION The grades and construction are as specified in my plans and specifications dated 19 Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 RECEIVED JUL 31 2014 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 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. .. A. Facility Information 1. System Location: Left / Right front of house, Left / Right rear of house, Left / ht side of—ho—use, of—ho—use,Left / Right side of building, Left / Right front of building, Left / Right rear of building, Under deck Address 1--7 �� City/Town 2. System Owner. Name Address (if different from location) State Trp Code City/Town ' State Co e Telephone Number B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): Date 2. Quantity Pumped: Gallons Cesspool(S) eptic Tank ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes " 5. Condition o Sy tem: 6. System Pumped By: If yes, was it cleaned? ❑ Yes ❑ No; Neil. Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location w e contents were disposed: S. Lowell Waste We Q—ff r0i W. or Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth C•tyRown °f Of Massachusetts ang Record System FUInp may but the be used, FprM 4this form, check with your for use -by local Boards ofov Health. h re.Befo e using as provided this form .all the same as that p The System Pumping Record must be submitted to DEP h p use. Boa of Health to determine the form they use information must be substantially roving local B the local Board of Health or other ap of house Left I A. Facility Information under deck Left I Right rear of house, Left Right front of house, deft 1 Right rear of building, i. System Location, Left Left 1 Right front of building, Right side of building, �� Code Zip Address State RECEIVED Aiu05Z013 TOWN Cq-- WOrTP, HEALTH MRO'�Tll' ...tff' City ofr `Nn 2. System owner. Name Address (if different from location) Citynown Telephone Number lS� ReCord t3 B• pumping V 2. Qua titY Pumped: Gallons . Date of Pumping Date Septic Tank [] Tight Tank ❑ Cesspool(s) 3. Type of system: _:�� If yes, was it cleaned? Yes ❑ NO. ❑ other (describe): Yes 4. Effluent Tee Filter present? ❑ ° v J 5 Condit'F5§rS n 6. System Pumped BY- Ne'1 Bateson Name Bateson Ente rises Inc Company ed' 7. t5form4.doc• 06103 contents Were d►spos Water Lowell F5821 Vehicle License Number Date System Pumping Record • Page of 1 Commonwealth of Massachusetts RECEIVE City/Town of System Pumping Record MAY 2 2 2006 Form 4 TOWN OF NORTH ANDOVER i HEALTH DEPART^, i=:NJ ., J DEP has provided this form for use by local Boards of Health.. The System Pumping Record must be submitted to the aocal Board of Health or other approving authority. A. Facility Information Important: When filling out 1. System Location: forms on the computer, use only the tab key Address to move your cursor - do not--7L- use oti (s' use the return City/Town State Zip Code key. 2. System Owner:_ Name Address (if different from ovation) Cdy/Town . Sta Zi erode Telephone Number B. Pumping Record I. .Date. of Pumping (� p g Date e. Quantity Pumped. Gallons 3. Type of system: ❑ Cesspool(s)ptic Tank _ ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter .resent? ❑ Yes p Q' No If yes, was it cleaned? El Yes ❑ No 5. Condition of System: v 6: Syste Pumpd y; "Name Z_ i Vehicle:License Number Company -- . 7. Loca where contents w disposed: Signa ure H er Date hftp://www.mass.gov/dep/water/approvalt./t5forrns.htm#inspect t5form4.doc•'0&03 System Pumping Record • Page 1 of 1 WTT V, ru a - in H 4- O (U h L 2 I 0 Q C id � I 1 1 to �� a � � o c � � H f E O :r= C. r L � a c L c J.2 CL v f_ Is CL c d o E c i Eu a ,a m o'i ro a� 004 = w 0 0 m a� V) c o fl fL a 0 a ra0 0 E m a V O O C P-4z nunonwealth or Massachusetts _ ,Massachusetts System Pumping Record System Owner F:j�S+:;e� Date or Pumping: 3-- !to —0 cc -c-.) Cesspool: No 1.� Yes 1_1 System Location Quantity Pumped: PS`J gallons Septic Tank: No Yes L System Pumped by: icit`edoa Eie&'tftew License # Contents transrertred to : Greater Lawrence Sanitary District Date: Inspector: t SUBDIVISION FORM U. TOWN OF NORTH ANDOVER LOT RELEASE FORM ASSESSORS MAP lQ -n SUBDIVISION LOT(S)-42- PERMANENT OTS)2,PERMANENT ADDRESS ASSIGNED BY D.P.W. V-'S"TREET -:X<'A (r, (:Z1 ,'-AGP ICANT Cka,,It-52. fs`?_'ri' -e-r` (GQ Co,-,JwaHONE 6/? -63968z -a ATE OF APPLICATION G %Zo 19 TOWN USE BELOW THIS LINE PLANNING BOARD TOWN PLANNER CONSERVATION.001 ISSION CONSERVATION ADMIN. BOARD OF HEALTH HEALTH" S -ANI DEPARTMENT OF PUBLIC WORKS DRIVEWAY PERMIT SEWER/WATER SCONNNECTIONS _ FIRE DEPT. /`� 10��ri I/f RECEIVED BY BUILDING INSPECTION DATE DATE APPROVED DATE REJECTED DATE APPROVEDh Zr% I: DATE REJECTED DA'T'E APPROVED LO ZO g DATE REJECTED This form shall be signed by the agents of the Planning and Health Boards, the Conservation Commission prior to the issuance of any building permits for the subject lot. This form shall not releive the applicant from the compliance of any applicable Town requirement or Bylaw. 41 '"Tlq--rx A A4" 771 -Al FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. *************.***Applicant fills out this section***************** APPLICANT: ViKc,waT��3��c' Phone 4 -78 -87 - LOCATION: Assessor's Map Number Parcel Subdivision Lot(s) Street ta' sT St. Number 7,6 - 4 - ************************Official Use Only************************ RECOM[ENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments ` Date Approvedy To Planner Date Rejected Comments Date Approved 61)1-1;Z ,,Z �--v, Health Agent 4 Date Rejected Comments Public,^, Works sewer/water connection 3 v -X9 - driveway permit Fire Department Received by Buildin Inspector Yk Date TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: q� (example: left front of house) r) 9'� 4�;� C�Le- DATE OF PUMPING: —w'a�e�bUANTITY PUMPED I<!%/GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER SYSTEM PUMPED BY: FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) COMMENTS: MAY 1 4 2001 CONTENTS TRANSFERRED TO: TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: :_2 YSTEM OWNER & ADDRESS SYSTEM LOCATION 1po (example: left front of house) DATE OF PUMPING: q--2-00-- QUANTITY PUMPED t 5�� GALLONS CESSPOOL: NO J YES SEPTIC TANK:N O YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER SYSTEM PUMPED BY: COMMENTS: CONTENTS TRANSFERRED TO: 0 FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) DATE: N OF A) , A�K 11nJr4 SYSTEM PUMPING RECORD SYSTEM OWNER & ADDRESS �®s WC�- SYSTEM LOCATION (example: left front of house) RECEIVED R 2 5 2005 TOWN f,)F NORTH ANDOVER HEALTH DEPARTMENT DATE OF PUMPING: q7-(� -65 QUANTITY PUMPED: V S -D t-) GAL NS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: G.L.S.D \/ Lowell Waste r +? ilr:, .� APPROVFM Y Pvte NORTH e.NDOVER BOARD OF lEkLTH 14_5 T ALLA ION CHECK LIST L DISAY "?,0VED Dater Reason: Z, EXCAVATION OK �T 1. As Built Submit trd—'' Check: Lot anon, dimensions of system, location in regard to per`olation tests, depth of system, water table 2. Dist ce to Wetland Areas, Drains, Street & House, Drainage Easement and wells. 3. hater ine Location 4. No P Pipe 5• Septic Tank - Te �,Cement,- pe to Tank -Joints on both side of Tank. 6. Distribution Box - No crac' r in box or cover, all line oar equally from box. 7. Leach Fields - Dimensions, Stone Depths, Capped ends, Clean double -trashed stone 8. Leach Pits - Dim Bions, Depth Stone, Splas ac3 tees, Cement,,�petotank- joints on both sides of tank, Clean do ub-mashed stone C9.No Garbage' Disposals �� itc.»u�,•✓ 4„' 1.0. Final Grading Y barricading of sub -surface system? 7- WAR L� Ati -ji- S�F' 17 ------- en 7-/ f q NOR'i4I ANDOVER .BOARD OF HEALTH r SUBSURFACE DISPOSAL SYSTEM CHECK LIST APPROVED PROVIDEDDISAPPROVED leg. 2.5 leg. 6.1 leg. 6.7 Reg. 6.$ :leg. 6.9 Reg. 6.1', Reg. 6.1E leg 3.7 leg: 9:1 leg. 9.6 neral Information 'The submitted plan must show as a minimum: 1 a) the lot to be served (area,dimensions, lot #, abutters) b) location and dimensions of system (including reserve area) c) design calculations d) calculations showing required leaching area e) existing and proposed contours f) location and log of deep observation holes -distance to ties g) location and results of percolation tests -distance to ties ih) location of any wet areas within 100' of the sewage disposal system or disclaimer .i) surface and subsurface drains within 1001 of sewage disposal system or disclaimer j) location of any drainage easements within 1001 of sewage . disposal system or disclaimer k) known sources of water supply within 2001 of sewage disposal system or disclaimer I) location of any proposed well to serve the lot (1001 from leaching facility) aft) location of water lines on property (10' from leaching facilities) D) maximum ground water elevation in area of sewage disposal system -e) location of benchmark plan must be prepared by a Professional Engineer or other professional authorized by law to prepare such plans .q)- driveways F)' garbage disposers ,q)--a-profile of the system (elevations of basement, plumbers pipe .septic tank, ;distribution box inle;ts.and outlets, distribution field piping and any other elevations) -0—no PVC is to be used in construction tic Tanks (a) Capacities - 150% of,flow (b) Water table (c) Tees (d) Depth of tees (e) Access (f) Pumping (g) cleanout (h) 101 from cellar wall or inground swimming pool (i) 251 from subsurface drains s •. Approval (b) Stand-by power m North Andover Subsurface disposal system checklist -Page 2 CKDi stribu ion Boxes Reg.10.2 a) Slope greater than 0.08 Reg.10.4 sum Reg. 3-1.2 Reg.11.lt Reg.11.10 Reg.11.l Reg.75.1 Reg -15i1 Reg.15.4 Ieg.35,E 8 eaching Pits . 'Leaching pits are preferred where the installation is possible '( T Calculations . of -leaching area (minimum 500 S.F.) Spacing 4CY Surface drainage 2% Cover material saching Fields (a) Greater than 20 minutes/inch (b) Area (minimum 900 S.F.) (c) Construction of field Y) Surface drainage 2% e) 201 from cellar wall or inground swimming pool :)wnhill Slope Via) Slope y/x = (to be shown) (b) y/x X 150 = (to be shown) e SOIL PROFILE & PERCOLATION TEST DATA t North Pzndover,Mass. No.&Street r-OIt-twyr S`r- Lot No. Loc./Subdiv. GD Plan Owner Investigator 8AJZ6*►*tG0 Observer L_CZ P 1 S• /�oGt�lVi/'S',gy SOIL PROFILES -DATE 11-1 - -71 1. Elev._ ?' Elev. 3. 4'Elev. "Eley. 0 0 0 0 1 1 1 1 QQNB v� Ties to Test Pits 2 V 2 2 2 3 3 3 3 4 4 4 4 5 5 -- S S Ili 6 6 6 6 12_ .G �` 9r4xv 7 7 7 7 8 8 8 8 10 10 10 10 Benchmark Location Elevation Datum • Percolation Tests -Date (L—?-? 7 Pit Number Start Saturation 1 2 3 4 5 Soak -Mins. 1 Start Test -Time :O Drop of 3" -Time- Dro of 6" -Time : p M&ns .1 t 311Dro L Mins.2nd 3"Dro 37 Notes &.Sketches on Back AW TOWN OF N SYSTEM PUMPING RECORD zi DATE•V cr F - SYSTEM OWNERn& ADDRESS 7.5ti( �tea� SYSTEM LOCATION "!— (example: left front of house) �kou DATE OF PUMPING: '_,; sc_)"� --V `( QUANTITY PUMPED : i GALLONS CESSPOOL: NO ES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER FULL TO COVER BAFFLES IN PLACE LEACI OIELD RUNBACK FLOODED OTBER (EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: G.L.S.D Lowell Waste Commonwealth of Massachusetts RECEIVE City/Town of APR 15 2009 System Pumping Record Form 4TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 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. A. Facility Information Important: When filling out 1. System Location: Left front, left rear, left side of house. Right front, right re , Ight si=ofhouse:) forms on the computer, use only the tab key Address 1—/ �.--9 �� n A K� r to move your �— J 4A& cursor - do not Cityrrown State Zip Code use the return key. 2. System Owner: Name Address (if different from location) City/Town State, i Zip Code Telephone Number v� B. Pumping Record 1. Date of Pumping Dae 2. Quantity Pumped: Gallons 3. Type of system: 8 Cesspool(s) eptic Tank [j Tight Tank Other (describe): 4. Effluent Tee Filter present? Yes lu— o If yes, was it cleaned? Yes No 5. Condition of System:�� 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Locationyhere contents were disposed: Lowell Waste Water Of F 5821 Vehicle License Number '3 Wil- o Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 PEC -C-\ Commonwealth of Massachusetts -N up City/Town of APR 2 S 2008 System Pumping Record Form 4 TCHEALTH D PARTM LATER Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. lb -Q 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. A. Facility Information 1. System Location: Address Cityrroum 2. System Owner. Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ State Zip Code State Trp Code Telephone Number Date 2. Quantity Pumped: Gallons Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes No 5. Conditsgn of System: If yes, was it cleaned? ❑ Yes ❑ No 6. SysterTAPu peciy: Name Company 7. Location R -FS€ai Vehide License Number IP151 Date ��JJ� v t5form4.doc- 06/03 System Pumping Record . Page 1 of 1 Commonwealth of Massachusetts W City/Town of System Pumping Record Form 4 �M DEP has provided this form for use by local Boards of Health. OteY�tthe information must be substantially the same as that provided here.0-Mck 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. A. Facility Information 1. System Location: Left front of house, right front of house, left side of hous lig t side of hous Left rear of house, right rear of house, left side of building, right rear of building, under deck. Citylrown State Zip Code 2. System Owner: 1 -4 -- Name Address (if different from location) City/Town B. Pumping Record <' ' ce f j( 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): Date Cesspool(s) 4. Effluent Tee Filter present? ❑ Yes ET No Stag Z' e phone Number — 2. Quantity Pumped: Septic Tank Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No 5. Condition pf -System: 6. System Pumped By: Neil J. Bateson Name Bateson Enterprises Inc. Company 7. L where contents were disposed: G.L.S.QLgVII Waste 16)1a�r F5821 Vehicle License Number Date f? /( t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts iD City/Town of System Pumping Record JUL 31 2012 Form 4 TOWN -OF NORTH ANDOVER HEALTH DEPARTMENT 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. A. Facility Information 1. System Location: Left / Right front of house, Left / Right rear of house, Left / ' ide of house eft / Right side of building, Left / Right front of building, Left / Right rear of building, Under deck Address Cityrrown State Zip Code 2. System Owner. 1 Name Address (if different from location) City/Town Stat( < -s Telephone Number B. Pumping Record 1. Date of Pumping Date 2• Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s)M--866-0-ticTank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes Lam" No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Location where contents were disposed: L S. Lowell Waste Water F5821 Vehicle License Number Date t5form4.doc• 06/03 System Pumping Record •Page 1 of 1 Commonwealth of Massachusetts City/Town of System Pumping- Record Form 4 TOWN o,= DEP has provided this form for useby local Boards of Health. Other forms maybeTIf 4,u �/? information must be substantially the same as that provided here. Before using.this form, cuk 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. A. Facility. Information 1. System Location: Left / Right front of house, Left / Right rear of house, Left / ht A.of Nous , LeftRight side of building, Left / Right front of building, Left / Right rear of building, n e c Address 1� 5.—Lf 54- e , City/rown 2. System Owner. Name Address Cd different from location) City/rown B. Pumping 1. Date of Pumping 3. Type -of system: A z State Zip Code Stat , q Telephone Number WFU Lf_ C Date 2. Quantity Pumped: Gallons ❑ Cesspool(s)[9-ft-VIE-Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑Ye s 3 No If yes, was it cleaned? ❑ Yes ❑ No; • 5. Condition of Syste�-AAC� 6: System Pumped By - Neil. Bateson Name Bateson Enterprises Inc Company 7. Loca i ere contents -were disposed: Waste Water F5821 Vehicle Uoense Number Date t5form4.doc- 06/03 System Pumping Record • Page 1 of 1 Zx, r sz R , 61 r M p Is _sa�-jo-i -qq