HomeMy WebLinkAboutMiscellaneous - 759 GREAT POND ROAD 4/30/2018 (2)N.
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BOARD OF HEALTH
120 MAIN STREET
NORTH ANDOVER, MASS. 01845
APPLICATION FOR ABANDONMENT
OF SUBSURFACE DISPOSAL SYSTEM
(SEPTIC SYSTEM)
PURSUANT Mn SECTION 310 CMR 15.354
OF THE STATE ENVIRONMENTAL CODE, TITLE
TEL. 682-6483
Ext23
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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 �4 L�Q/ �Git�efS Phone
Address
Contractor hired for work:
Name ��� Phone 1a86-- ZaO
Address
Date for scheduled abandonment 1 �� `olaT� �Z N
Method of septic tank abandonment (check one).
( ) removal ( ) sandfill crush ( ) other (describe
b -Tow"
Other
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PLEASE DO NOT WRITE IN THE SPACE BELOW
FOR HEALTH AGENT'S USE ONLY
Inspecting Age -n# Date
Comments
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A]AhAPPLI'.CATION�f-ORe�EWER-$E.RAM.0 -CJJ
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the town �, PO�Ji
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regulations mrl) no.2:201 (no-,
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F"ERMIT40i CON N ECTIMITHSEWERMAI Nil,,;. ;oil--)�--
The Division of Public Works hereby grants permission to
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subject to the rules and regulations of.the 'Division of Public Works.
Inspected by
Date
Div' ion f Public Works
By
See back for rules and regulations
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ri inilgqu2) srli,ln noi2iv19q:r. <�rli 1PERMITfTOICONNEOPWITH SEWERiMAINi; tx� nuii �f:lrfl� bnf nf)ii_; , 'r;i
9'Viifiin ?7Ci')7 i?n iu t t :E:)
The Division of Public Works hereby grants permission to
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`to iriake�aijniiefarlitli tll�'fsevderm'aiiiat 219t701C
Street
subject to. the rules and regulations of the Division of Public Works. (r1sJ�)S) ani of yioioc7't2iisz.lsnnf>rn u tti i, i7Ut"�'i1
D�iwion f Public Works
By' LSC/
Inspected by
Date
See back for. -rules and regulations
SEPTIC SYSTEM INSPECTION FORM
ADDRESS -1s-9 P6✓ti
DATE INSPECTED ` �p
PROPERLY FUNCTIONING? g N
WEATHER CONDITIONS
COMMENTS:
WATER QUALITY TESTED? RESULTS?
DYE TEST PERFORMED? Y .N
DATE?
SKETCH:
WATERSHED RESIDENTS QUESTIONNAIRE
1. Name VV14L--j"E-�lL.
2. Street Address -7 5-1 G 1ZC-4-7- fo N D /2-P •
3. How many members are in your household? A 1- 4 5 / f% Lt f 7-
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 E�-'do not know.
6. How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years ❑ 11-20 years.
E�1- over 20 years ❑ do not know
1 g6;'
7. Has your sewage disposal system been rebuilt or repaired?
❑ yes Cl'' no ❑ do not know
If yes, approximately how long ago?
years. What was done?
8. How freuently is your sewage disposal system pumped out? El annually
[Y very 4 years ❑ every 5-10 years ❑ over 10 years ❑ never
O9. Have you had any problems with your sewage disposal system? ❑ yes E- 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
dehumidifier drain sump pump toilet
roof/pavement drains shower/bathtub
11. Please state the brand and type (liquid or powder) of detergent you use for:
dishwasher c R-Z-,O�o A-1 poW'P CA_
1-/clotheswasher � o &r -c .Q v D
12. Does your property have a lawn? C�- yes ❑ no
If yes, approximately what size? -�/
❑ less than 1/4 acre El1/4 acre CCS 1/z acre ❑ 3/4 acre ❑ 1 acre
❑ more than 1 acre (Specify) acres
13. How often do you fertilize your lawn? 77
No. of applications per year 3
OSeason(s) of the year _-1)2 /2 / iy G - � u rr� ns 6 -IL-
14..
'n14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
G/fEM Lq-WAI Co. ,DyGS "T
Ek"'Check here if your lawn is maintained by a professional landscape contractor.
Demers, Walter Jr.
` L
16 q Great Pond Rd.
APPLICATION FOR SEWAGE DISPOSAL INSTALIATION
HEALTH DEPARTMENT - NORTH ANDOVER, MASS.
I hereby make application for a permit for a sewage disposal installation at
Great Pond Rd. . 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 1Jo until 10 feet pre-
ceding the septic tank, where the grade shall not exceed 21o. 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 oflineal ( 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
the 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'UT-C 9,3
Signature of Applicant
I hereby issue the above permit for the Board of Health of the Town of North
Andover, Massachusetts.
DA TE+
ignature of Health Agent
I have inspected the uncovered system indicated above and find everything done
as described.
DATA
Signature of Ins ecting Officer
Percolation Test 5 min. Soil: clay -gravel
Garbage Grinder _Nc�--e_ S
rot
�� n, -Z� �-'� � , �hn —acct
d �l
September 2, 1961
Miss Mary Sheridan R. N.
Health Agent
Board of Health
North Andover, Mass.
Dear Miss Sheridan:
An examination.was made as requested in order to determine the
suitability of the soil for the subsurface disposal of sewage on the
proposed Great Pond Road building site of Walter V. Demers, Jr.
The land in general is high., and ori the water shed.
The subsoil in the area is of clay and gravel content and a
5 -minute percolation test was conducted.
If approved by the State, it is recommended that a 1,000 gallon
concrete septic tank be installed together with 2400 lineal feet of
drain pipe.
Very truly yburs,
4),j
William J. i `oll
WJD:hd
C
BOARD OF HEALTH
OWN OF ANDO'VERS MASS. Z�® '`-•
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` 20 MlA3, C�A�w NG, ScP7eG '444
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1. NA ME UY . . . . . . . . . DATE
2. ADDRESS 612.eh r. D N� j2o A D. .LOT NO. . . .TEL is / 1 S'
(kt wt NTE2 S%�
3. N0. OF BEDROOMSDEN YES NO. .
4, GARBAGE GRINDER YES- • :L* 0 . N0. . . ,
5. `SHOW DIhERSIONTS OF HOUSE
b. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES
7, SHOW DIivENSIODS 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, STREAPMq DITCHESS LEDGE OUTCROPS ETC.
11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE Z�f 4-
NOPE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY.