HomeMy WebLinkAboutMiscellaneous - 79 JOHNNY CAKE STREET 4/30/2018 (2)ri
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
DATE: 7— Z—w,
YSTEM OWNER & ADDRES
Pn c1,
(example: left front of house)
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DATE OF PUMPING: '0o2QUANTITY PUMPED GALLONS
CESSPOOL: S OOL: NO /YES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE /EMERGENCY
OBSERVATIONS:
GOOD CONDITION
HEAVY GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
SYSTEM PUMPED BY:
COMMENTS:
FULL TO COVER
BAFFLES IN PLACE
LEACHFIELD RUNBACK
FLOODED
OTHER (EXPLAIN)
7)0�,W �.�y
CONTENTS TRANSFERRED TO: l L -,5, b -
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INSTRUCTIONS: This form is used to verify that all -necessary approval /permits from
Boards and Departments having jurisdiction have been obtained. This. does not relieve the
applicant and or landowner from compliance with any applicable requirements.
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' APPLICANT �c��/7 /� PHONE
ASSESSORS MAP NUMBER LOT NUMBER
SUBDIVISION LOT NUMBER
ST'REET4f
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OFFICIAL .USE ONLY
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RECOADAENDATIONS OF TOWN AGENTS
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DATE APPROVED
CONSERVATIONADNOgISTRATOR .
PUBLIC WORKS - SEWER / WATER CONNECTIONS
DRIVEWAY PERMIT
DATE APPROVED
FIRE DEPARTMENT
DATE REJECTED
CON4�vfENIs
RECEIVED BY BUILDING INSPECTOR -
MOO
DATE REJECTED
CONAIENIS
DATE APPROVED.
TOWNPLANNER
DATE REJECTED `-
CO1\IIvIENTS
DATE APPROVED
FOOD INSPECTOR -'HEALTH
DATE REJECTED
DATE APPROVED
SEPTIC INSPECTOR - HEALTH
DATE REJECTED
COM1VfENTS
PUBLIC WORKS - SEWER / WATER CONNECTIONS
DRIVEWAY PERMIT
DATE APPROVED
FIRE DEPARTMENT
DATE REJECTED
CON4�vfENIs
RECEIVED BY BUILDING INSPECTOR -
MOO
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Board of Health.• SEPTIC SZSTEH
North AndOveriN.aa.
INSTA?A-ATICK CHSC$ LIS'
�P OVID DATE I DI MPPRUM
SS
FAIZ OK
Gamont
1. Distance Tot
a. Wetlands
b. Drains
C.. Well
2. Water Line Location
LOT'.'
3. No PPC Pipe
4. Septic Tank
a. Tees -_Length & To Clean Out Ce-rer 1
b. Cement Pipe to Tank - On Both LdLi of Tank
5. Distribution Box
a. Covers & Box - No Cracks
b. All 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. Dimansions
b. Stone Depth
c. Splash Pads
d. Tees
e. Ce-,jant Pipe to Pit - Both Sales
f. Clean Double Washed Stone
8.
No
Garbage Disposal
9.
Final
Grading Inspection
10.
Barricading Covered System
]1..
As
Built . Submitted
a.
Lot Location
b.
Dimensions of System
e.
Location with Regard -to Pere Test
d.
Elevations
e.'
Water Table
..
' Health
,....,hdover, Mas s
APPROVED
Provided:
DATE '7 -?-
SUBSURFACE DISPOSAL DESIGN CHECK LIQ P
DISAPPROVED DATE!
Reasons:
LOT f -L6T 7
SS
Title V FAIL Ob
Reg 2.5 The submitted plan must show as a minimum:
a) the lot to be served-area,dimensions lot f abutters
b location and log deep observation holes -distance to ties
c location and results percolation tests -distance to ties
d design calculations & calculations showing required leaching area
(e) location and dimensions of system -including veserve area
f) existing and proposed contours
(g) location any wet areas within 100' of sewage disposal system or
disclaimer -check wetlands mapping
(h) surface and subsurface drains within 10(" of sewage disposal
system or disclaimer
(i) location any drainage easements within 1101 of sewage disposal
system or disclaimer -Planning Board filen
(j) know sources of water supply within 20(U, of sewage disposal o
system or disclaimer
(k) location of any proposed well to ser , L,t-1001 from leaching facility
(1) location of water lines on property -.01 _'rom leaching facility
(m) location of benchmark 06
(n) driveways
(o) garbage disposals
(p) no PVC to be used in construction
(q) profile of system -elevations of basement, plumb, pipe, septic tank,
distribution box inlets and outlets, distribution field piping and
other elevations
(r) maximum ground water elevation in area sewage disposal system
(s) plan must be prepared by a Professional Engineer or other
professional authorized by law to prepare such plans
Reg 6 Septic Tanks
(a) capacities -150% of flow, water table, tees, depth of tees,
access, pumping
(b) cleanout
(c) 101 from cellar wall or inground suimn r Z pool
(d) 251 from subsurface drains
Reg 10.2 I 7 Distribution Boxes
1(a) slope greater 0.08
Reg -10.4 b) suzop '
Commonwealth of Massachusetts
Massachusetts
System Pumping Record
System Owner
A/0
v l�
Date of Pumping: 3
Cesspool: No [er'-_ Yes [ ]
System Pumped by: 64&44W saaqww
System Location
79
T6) (Avvy.�Vcaiae
Quantity Pumped: I gallons
Septic Tank: No [ ]
License #
Contents transferred to: Greater Lawrence Sanitary District
Date: Inspector:
L�N ti
7
Yes [-t--
TOWN OF
SYSTEM PUMPING RECORD°..,
DATE:
SYSTEM OWNER & ADDRESS
Pmac.' lI
'*-? q -)� �A"
SYSTEM LOCATION
(example: left front of house)
e4+ P��
�V'oj%<�
DATE OF PUMPING: q"--a-..q-0L(Q`UANTITYP`UMPED: C GALLONS
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
y OTHER (EXPLAIN)
SYSTEM PUMPED.BY: Bateson Enterprises, Inc.
COMMENTS:
CONTENTS TRANSFERRED TO: G.L.S.D Lowell Waste
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
DATE:5 Z3-01
(example: left front of house)
I)Ivncave J
DATE OF PUMPING: QUANTITY PUMPED ? 506 GALLONS
CESSPOOL: NO J YES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION
HEAVY GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
SYSTEM PUMPED BY:
COMMENTS:
CONTENTS TRANSFERRED TO.• L
FULL TO COVER
BAFFLES IN PLACE
LEACHFIELD RUNBACK
FLOODED
OTHER (EXPLAIN)