HomeMy WebLinkAboutMiscellaneous - 87 HAY MEADOW ROAD 4/30/2018FORM U - VERIFICATION 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: Dk<c �UF � �U ` SS Phone ks�-303,5'(4)
LOCATION: Assessor's Map Number /0 Parcel
Subdivision
' Lot (s)
Street / C7%� �/ !� `2� L` 1 St. Number
************************Official Use Only************************
RECOMMENDATIONS OF TOWN AGENTS:
L_-— Date Approved
Conservation Administrator Date Rejected
Comments
Town Planner
Comments
Food Inspector -Health
JAfiL
Septic Inspector -Health
Comments �✓J���C
Public Works - sewer/water connections
- driveway permit
Fire Department
Date Approved
Date Rejected
Date Approved
Date Rejected
Date Approved �/�
Date Rejected
Received by Building Inspector Date
Board of Health
North An4oveFjHa38.
sib' �: a���+� � •_
M
a
BEPTIC SMTEK
INSTALLATICK CH33 LIST
Reaffmit
LOT
AVATICN 0K FAIL
1.
Distance Tot
a. Wetlands
b. Drains
c. Well
/
2.
stater Line Location
30
No PVC Pipe
it.
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. All Lines Flouring R44al Amounts
c. No Back Flow
6.
Leach Field or Trench
a. Dimensions
b. Stone Depth
j'
c: Capped Inds
d. Clean Double -Washed Stone
7.
Leach Pits
a. Dimensi s
b. Stone epth
C. SP1 Pads
d. T s
e. t Pipe to Pit - Both Sides
f. Clean Double Washed Stone
8.
No Garbage Disposal
9.
Final Grading Inspection
10.
Barricading Covered System
11.
As Built Submitted
_
a. Lot Location
j
b. Dimensions of System
c. Location Xith Regard -to Pere Test
fj
d. Elevations
e: Water Table
Lo'r �5A
E LF-
yo.,- t
Lt�1V PIPE OUTOF H E 1 �(-) t--� 1
1 U V PIPE I NTO __ _i
a til V PIPE OUTOE LA V—
IN
1 N V_ PI PE I NTO _Q. E5oX
CNV. Et�D O� PI PE_.__j_.�
A 5 P-) u i L -r
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a
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F"2AN1< C �E�i►.1p�S � AssvclATE'S
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� �I AN nc�v�.c2 Ste' N o. Ary oa�EGZ .
�x
E L.E, vA-r 101 3. s
1I NV PIPE OUT OF HSE I_�o01
1 m V PIPE I NTO TAMIL I X00
it 1\/ P►PEOUTOFTANtL
IN -V PIPE INTO D.130X
LNV PIPE OUT D. FLIQX
INS/. i; ND OE PI DE:�
0
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♦.
TO: 1J D. A►.1® o v *--r-
boAtr-c> pF 149:AL-- r VA
FROM: J:�izAt.4 j:�. G . ��L.� MAS 4
Assoc.. •g•�c..
NORTH ANDOVER, MASS._ ZZ 19 25 1
BOARD OF HEALTIi
DESIGN ENGINEER Re: Soil Absorption
Sewage Disposal
System
This is to certify that I have inspected the construction materials of said
disposal system at L-0 -T �� A 14AY k r ---A L> Q IJ E:
SITE LOCATION
North Andover, Mass.
The grades and construction materials are as specified *-.4wx lidplans and
H OFM+,
specifications dated MA?-c.�-� �� 19 --:>
FRCNK
C—
Reg. Prof. Engi er/Reg . t7V0. 2273.3
G/ST6��U` �6
)NAL ENG\
Bo&M of 17--alth
North
M
8 S'
CH ;VK Li Sr LOT
DI SUPROV-0 VATI OK
Reasunst
1.
Distance Tot
a. Wetlands
b. Drains
0. Well
2*
Water Line Location
3.
No PVC Pipe
4.
Septic Tank
a. Tess a --Length & To Clean Out P,6vers
b. Cement Pipe to Tank - On Both Sides 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
a* Capped Ends
d. Clean Double Washed Stone
7.
Leach Pits/
a., Dime ons
9'
_0
b. Sto Depth
'I
ce ash Pads
/ees
d.
S. Cement pipe to Pit Both Sides
lean Double Washed Stone
CleanD
8.
No Garbage Disposal
9.
Final Grading Inspection
10.
Barricading Covered System
32.
As Built Submitted
a. Lot Location
b. Dimensions of System
c. Location with Regard -to Pere Test
d. Elevations
eo' Water Table
Poard of H(2�,2th
I;grthfindovor,Kass
Y `-
APPROVED DATE
Provided:
3/3,
SUBSURFACE DISPOS,41 DESIM CWK LIST
LOT
DISAPPRUVw DATE
Reasons t
Title V :je
Reg 2.5 submitted plan m�itst show as a r��Bt�4 im:
the lot to be sewed-areadimernsionq lot #,abutters
location and log deep observation holes -distance to ties
location and resalts percolation tests -distance to ties
design calculations & calculations showf ng ires3leaching area
el location and dimensions of item -including reserve area
er.sting and proposed contours
�disclaimar-check
Location any trot areas ulthAn 1001 of sewage disposal system or
watlsnds mapping
(h) surface and subsurface drams within 1001 of sewn�ge' disposal
systgta or disclaimsr
i) location any drai",Ze ease-ruzarits vlUiin 1001 of seyzige ditposal
systca or d3.sclaIg"-A-Pl=_ning Lard files
(j),kno-mi sourues of inter . ply vihim 2001 of sowago dippoGal _
system or disclaimer
Location of MY Proposed -,.vll to seams lot -1001 from leaebi-ng facility
oeation of water lines on pmperty-101 from Leaching facility
Location of benchmark
)' drivefrays
I—Vo) garbage disposals
4
no PVC to be used in construction
(q) rofile of systers-ol�bt.ons of base���nt, plums, pipe, septic tank,
6istribution box inlets and outlets, diatribution ff,eld piping and
Otter elevations
r) ma>lru n grouted -tater e14Ev�ation in area sewage disposal system
7",
)
(s) plan mast be prepared by a Professiom2 Fgglmoer or other
,profeSs~ional authorized by law to prepare succi plus
Reg 6 She Tanks
( ) capac:I_tTF�-1-1,K0% of flow, g meter table, tees., depth of tees,
access, pur'ping
} cl WMout
p mac) 101 from cellar tnall or iWound siArcdng pool.
(d) 251 from vabawface d-al-ne
Reg 10.2 Eyes
a) slope greater than 0.08
Reg 10.1 (b} gurp
Sixbaurfac'e D.wzign Chec!k List Page 2
FM I PK
Reg 3-1.2
li.4
11.10
11.3-1
Reg 15.1
15.8
3.7
Reg 14,1,
114.3
14.4
14.6
14.7
Reg 9.1
9.6
Leaching Pits
Leaching pils.,,dxe preferred where the installation is possible
'a) calculations of leaching area-vdnimum 500 sq ft
b) spacing.
c surface drainage 2%
dj cover -material
e) 2�1A" splash pad
f) at elbow
,0 b
g) tl
ba in pipe from d -box to pipe
Leaching-Aelds
a) no great an 20 suites/inch
b area-rd�ifm= 900 sq ft
c constx&tion of field
d) surf ce drainage 2 %
a) 201, from cellar vall or inground &jd=dng pool
elaaCIMAn Trunches
3
a 0 Monis o eaching area -min 50o jjq ft
§Yspacing-4 ft spin 6 ft with reserve betu--en
surface drainage 2%
Ibo, VS lop a
A)ope x = (to be shama)
b) y1x X 150 = (to be sho=)
a) approval
b) stand-by powar
k
Z
�19 eo
NORTH A27DOVER , MASS . MAY �I
y, i A�.►�ov�iz BOARD OF HEALTH
t�0A2A of HEAL-TH
DESIGN ENGITIEER Re: Soil Absorption
FROM:�gZ✓�.il� G C�EL� NAS Sewage Disposal
ASSVC_ . Z System
is
is
-1
This is to certify that I have inspected the construction materials of said
disposal system at L—o -r �� j� i -A U
SITE LOCATION
ON �D
North Andover, Mass.
The grades and construction materials are as specified in my plans and
specifications dated rjAP_c-- )4 •l5 19 I
Reg. Prof .. Engineer/- R&d. Sanitarian -•
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