HomeMy WebLinkAboutMiscellaneous - 80 CAMPBELL ROAD 4/30/2018_�__
1E
�.
_N
O �
^ o
�j A
� d
m
m
V �
ob �
O 0
� o v
I
.�.�. i
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 or requirements.
*****************************APPLICANT FILLS OUT THIS SECTION***********************
APPLICANT A ��� R po-t ► _�_ PHONE .7'ty, " 3 f3 in'4
LOCATION: Assessor's Map Number Jr L6T I PARCEL
SUBDIVISION LOT (S) 1 7
STREET ST. NUMBER
*********************************OFFICIAL USE ONLY*******************************
.3L}Xy0 arn)
RECOMMENDATIONS OF TOWN AGENTS:
CON RVATION ADMINISTRATOR DATE APPROVED
DATE REJECTED—
COMMENTS—
TOWN
EJECTEDCOMMENTS
TOWN PLANNER
COMMENTS
FOOD INSPECTOR -HEALTH
COMMENTS
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE REJECTED
-�.
MAY
i
PUBLIC WORKS - SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT --
FIRE DEPARTMENT !10 � c�v,2 2(2Q1 -h
RECEIVED BY BUILDING INSPECTOR
Revised 9197 jm
DATE
' • '1Ci1 JI. _
Middleton Mq 01949 P1N
,508) 774-2772 rr�Q�SU CE
TITLE
0. OF C BEDROOMS: N0. •
GARBAGE�IDTS;
GRINDER:
LAUNDRY CONN.: .
SEASONAL USE:
WTR READiN - ._
PRIV•
N•
LAST
Pte' Y/N:
SOURCE: GALS
TYPE OF SYSTEM:
AGE OF SYSTEM
SOURCE:..
SEWAGE ODOR v v ,
•V.
FILE
-r
ADDRESS:
e /
ADDRESS OF OWN& IF
PASSES:
C PASS
F EVAL3--'�""-
FAILS: --- -_
DEPTH BELOW R.�: TXPE OF•;
��•G SLUDG DEP.: D __DIHENTIONS: !!, Dom$:
/ SCUM TOP IST. SLUR TO BOT. Ag CAPACITY:
7 C BAF... - _GALS:
S: S CUM THICK:
CUM TO BOT BAF.:. S -
4,�-�,
i, -2D -Boz:
0�';5ho D IME�TS NS :
i
D -BOX STRUCTU$
COMMENTS:
i�
`N
24wowe_
S.A.S.;
TYPE OF
COMt�TS
a
000 'r �-
�ELOW DEP ABOVE
DEP OF Ste, - _ OUTLET:
` :."-
�ID YIN -D-BOz LEV YIN:
SPEED LEVELS YIN
—46 VZ
S.A.S.:_BOTTQM OF S.A.S.:
-. DnSF.ETSION OF S.A. SA ;; --STONE OR PIT
CESSPOOL;
DEPTH TO -"-DEPTH BELOW GRADE; G / v
DIMENSIONS�T•'�*-------._DEPm:.,SOL IDS; :CONFIG.:
GROUNDWATER?: '�---DEPTS SCUM: -
VOLUME AT ----_.:TOTAL r VOLUME S OF CONST::
THIS Trig: GALS:
COMETS : - ----=---_GALS ;
GALS:
DEPTH- 0 • • "'"":
COMMENTS:BSm=T: SOURCE:
m; PiJMp YIN DRY YIN OTHER.
PUMP CHER
PA'S WOKING: DF,pT B
COtQNiDITS: 9404.9R -ADE:
PIM IONS G Y N..
alb. .. _
9 � i
4 `�T' • �_ ` (/CSL//�(/I(J. / -.
a s z• ;x.
4 f
f �oPCJL66 i C_`S
5 J r 4 t
13 , } { Ala E'%ray
f.
oll
�/ 7;//.. I � � } � : k � �L -f ., a •
X'/
�� �� ._.". •�� k .;xti ,.� .{. �.iL, � ,4th^ s S - '- � >.: hi y -�%`� -
�j37
50
s ria t t
a� i'cv4�dr
ya '
FORM 4 - SYSTEM P G RECORD
CURRIER
.'.Y -
SEPTIC & DRAIN; SERVICE? R
107 FOREST STREET; MIDDLETOM MA 01949
(978)''>774-2772
COMM WEALTH OF MASSACHUSETTS
a.. MASSACHUSETTS "
`SUTEMPUMFIIYG RECORD
SYSTEM OWNER: SYSTEM LOCATION:pi
Aj
DATE OF/lo ,- /?
4kms , QUANTITY ?UMPED • :t GALLONS
fY$ � �1 "SF �T�as'�� • ��N �Y� 1'� ..' '{ � �� f��� 'P. ...�i�
CESSPOOL NO a YES` .' SEPTIC TANK: NO' YES
jx • SYSTEM POMPED BY. CURRIER SEPTIC & DRAIN SERVICE=
CONTENTS {TRANSFERRE 3
r DATEINSPECTOR•
`>. � ��{ ^-•"i Jdk � '� �� t � .�J' E 4 PVI ItX�I['cE'�Y�r�9yi�y�y^ �'+y p',.� j'•i^^ � t[�#�'.�,w»� ��i *� ... ..
Vi, ITH 11 '•E
°fir r j,�>h•p � r! •� � � „( " :�b�j ssyr
wim
sfi x3;
�r s 's >-�� ' '�� � j� � e. � �.�,•aJ
a 4 �, H�' � 4 � w, t"'v Y.,r ° ii1't.A•.ks �s �P � 6�-�r� �9'� �..v7' ^u.'• a#� it se'-�".�, � � M+` r+, P� a' ".: a.n w .
♦ ,$.es ,y.. ffd � � - x iijci.a ,� +-"- �arPdF '; � a .. /» a. A w� a.!,l°J rt' 2,°k� ,+ t-, ,
V. Distribution Boxes
Reg. 10.2 S]] pe greater than 0.08
Reg. 10.4 ( ) egump
VI. Leaching Pits
Leaching pits are preferred where the installation is
possible.
Reg.
11.2
(a) Calculations of
f.
f
11.4.
(b) Spacing
�
Reg.
D
(c) Surface drainage
V. Distribution Boxes
Reg. 10.2 S]] pe greater than 0.08
Reg. 10.4 ( ) egump
VI. Leaching Pits
Leaching pits are preferred where the installation is
possible.
Reg.
11.2
(a) Calculations of
leaching area (minimum 500 S.F.)
Reg.
11.4.
(b) Spacing
Reg.
11.10 .
(c) Surface drainage
2%
Reg.
11.11
(d) Cover material
VII.
Leaching Fields';
Reg.
15.1
(a)/ !ater than 20
minutes/inch
Reg.
15.1
(b) ea (minimum 900
S.F.)
Reg.
15.4
(c) Construction of
field
Reg.
15.8
(d) urface drainage
2%
IX.
Downhill Slope__
a) Slope y/x = (to
be shown)
(b) y/x X 150 = (to
be shown)
th
SOIL PROFILE & PERCOLATION TEST DATA
Town/CityL�� WUUe_,-No.&Street �Gs�r�-���j'�� �� Lot No.
Loc . / Subdiv . Plan Owner jh � � zz
Investigator,% C /G Observer
y�a „ SOIL PROFILES -DATE
Elev. ?' Elev. 3' Elev. 4'Elev.
.gin n n 0
2
\�\ 3
4
O 5
6
7
8
9
1
2
3
0
� 4
5
6
7
8
9
1
2
3
4
5
6
7
8
9
11
21
1 31
FA
5
6
7
8
9
10 10 10 10
Benchmark Location
Elevation Datum
Percolation Tests -Date
n�
11
Pit Number
1 2 3 4 5
Start Saturation
',363
Soak -Mins.
/S
Start Test -Time
Drop of 3" -Time
Drop of 6" -Time
Mins.lst 3"Dro
/
Minse2nd 3"Dro
/
Notes & Sketches on Back Frank C. Gelinas & Associates, North And.
Lf0K_
PTQAE'I''0VED LD_a Ti -,,
Y
Well
';d a t e r L2_, ---.e Loca.tion
T`Yo P, C Pipe
Septic Tank
Tees - Length & To Clean Out Covers
Ce��ent Pipe to Tank - On Both Sides of Tank
�. Distribution Box
Cover & ?fox - No Cracl"s
All Lines rlot•.ing Dual Amounts
Teach Field or Trench
D5me„s.ons
Slc e Depth
Canned Ends
Clean Double Washed S',.o,le
7. Leach Pits
Dimensi ns
Stone epth
1) 10
Pads
Tem,
C _ ;en t Pi ; -pe to Pit - X o',h Sides
�•
e =n Double a.s'�.ed_ Si' -one
R. to Ga- e,fe Disposal
10. '>ar _ ac __.3;_ng Co,,�o_,ed System
11. As - Built. Submit ,ed
Lot Loca't,ion
D_L-mensionS of Sys -Gem
Locatj on ,,dith regard to er"c 'est
E] eva`ions
`r'ater Table
NORTH ANDOVER
SUBSURFACE DISPOSAL SYSTEM CHECK LIST
I. General Information
Reg. 2.5 The submitted plan must show as a minimum:
3.
(a)/ lot to be served
(b)location and dimensions of the system (including
reserve area )
( c ) /d ign calculations �(K
(d) ca lations showing required leaching area
(e) xisting and proposed contours �•"'-h"O
( location and log of deep observation holes
distance to ties
( location and results of percolation tests
d' tance to ties zu
(h) location of any. wet areas within 100' of the
sewage disposal system or disclaimer
(i) face and subsurface drains within 100' of
the sewage disposal system or disclaimers W
(jam location of / any drainage easements within t r
Know
of the sewage disposal system or disclaimer 79
n sources of water supply within 200' of
the sewage disposal system or disclaimer
(1) location of any proposed well to serve the lot
? (m) /Vocation of water lines on the property
maximum ground water elevation in the area of
t sewage disposal system
(o) rofile of the system,
(p) . -,"n PVC is to be used in construction
(q) tion of benchmark
(r)/lo lan must be prepared by a Professional Engineer
or other professional authorized by law to prepare
such plans.
II.rba e _Dis
III. Septic Tanks
Reg. 6.1 (a) C-i5acities - 150% of flow
Reg. 6.7 (b) er table
Re . 6.8 (c)s
Reg 6.9 (d)th of tees
g� (e)�cess
Reg. 6.12
Reg. 6.18 (f) Pumping
(g) Cleanout
IV. Pumps
Reg. 9.1 (a) Approval`
Reg. 9.6 (b) Stand-by,power
9 _Z�-� �
. � �C'�..�a-- ��,P.��P
� oma,
�. ,� ,