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HomeMy WebLinkAboutMiscellaneous - 90 CROSSBOW LANE 4/30/2018 (2)r -t CD 71 FD- 0 h ME n (D Ln Ln I A, 'c r "--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 142old LOCATION: Assessor's Map Number SUBDIVISION STREET Gyp -S5&60 - PHONE PARCEL C20 LOT (S) ST. NUMBER '/ D USE ONLY********************* LRE COMMENDATIONS OF TOWN AGENTS: y X a ,�/ V- � Al CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS l�y0 Lv�I� TOWN. PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSP OR -HEALTH DATE APPROVED DATE REJECTED PT ! INSPgS R -HEALTH COMMENTS DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS_ ��A-,4- G4 DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTO Revised 9197 jm DATE Board of Health BEPTIC SZSTEK North An ver Has / INSTALUTICK CHECK LIST LOT UA 15 ul Lrirrtcuv ru uslr� eaRES 1. Distance Tot a. Wetlands b. Drains c. Well 2. Water Line Location 3. No PPC Pipe it. Septic Tank - a. -Tees -_Length & To Clean flat Covers. b. Cement Pipe to Tank On Both Sides of Tank 5. Distribution Box a. Covers & Box - No Cracks b. All Lines Flowing Bqual Amounts c. No Back Flow 6.- Leach Field or Trench a. Dimensions b. Stone Depth c. Capped Eads d. Clean Double Washed Stone 7. Leach Pity§ a. Dims;�sions b. Stobie Depth c. lash Pads d. Tees Cement 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 b. Dimensions of System c. Location with Regard -to Perc Test d. Elevations e. Water Table '!J rr ,ird of Health North. ndovergMass SUBgIJFiFACE DISPOSAL DESIGN CHECK LIST APPRMED DATE, Provided:_,i / 77/�3 1, C9. WN/7 ,eev. DISAPPROM DAT Reasons: LOT # AL GeEr�F Title V FAILCK . Reg 2.5 a submitted plan must show as a minim=! the lot to be served-area,dimensions lot #..abutters location and log deep observation holes -distance to ties location and results percolation tests -distance iOs design calculations & calculations showing requito leaching area location and dimensions of system -including reserve area existing and proposed contours location any wet areas Athim 100' of se -wage disposal system or disclaimer -check wetlands napping (h) surface and subsurface drains `,*ithin 100' of sewage disposal system or disclaimer (i) location any drainage easements sxithin 100' of stege disposal system or disclaizr—er-Planning Board files (3) kno= sources of -..ester sImply within 2001 of stege disposal 8 system or disclaimer location of -any proposed X11 to serve lot -1001 from leaching facili location of wster linea on property -101 from leashing facility m) location of benchmark (n) drive -ways i r) garbage disposals iP no PVC to be used in construction l i e s tic tank q) profile of system-ele�vatione of basem°nt, p , P P , gP distribution box inlets and outlets, distribution field piping and OtDer elevations () maximum ground water elevation in area se -wage disposal system s) plan mast be prepared by a Professional Engineer or other professional authorized by lax to prepare such plans Reg 6 Septic Tanks (a) capacit es -150% of flog, water table, tees, depth of tees, access, purping i (b) cleanout c) 10, from cellar km.l or inground sing POO (d) 251 from subsurface grains Reg 10.2 Distribution Boxes (a) slope greater than 0.08 Reg 10.4 b) st`'rp ��.+ O©� r, e- L J 1 vi «ti lace Desig FAIL Check List Lm I Page 2 Leaching Pits Leaching pits are prefes~red vhere the installation is possible reg 11.2 a) calculations of leaching area -minimum 500 eq ft 11.4 b) spacing 11.10 c) surface a 2% 11.11 d) cover erial e) splash pad f) at elbow g) bends in pipe from d -box to pipe Leaching Fields '.eg 15.1 no greater than 20 minutes/inch area -minimum 900 sq ft 15.4 construction of field 15.8 surface drainage 2 % 3.7 e) 201 from cellar wall or inground s-wimning pool Leaching Trenches eg 14.1 a) c c ons of -Teaching area-nin 500 sq ft 14.3 b) spacing -4 ft min 6 ft with reserve betiaeen 14.4 c) dim mgi6ns 14.6 Id) const+-Lction 14.7 e) stdne 11; .10 f.)V surface drainage 2% _ Doll Sloe _ a) s! ro5ee -7 1be sho�m� b) y/x X 150 = (to be shown) _ Pu, -,z s eg 9.1 a) approval 9.6 b) stand-by power -North Andover, Mass. Street No C,�?As-S Lot No' Loc/Subdiv. Pland - Owner InvestigatorObserver PROFILE DATES 1.'El.ev 2� ev e l'V 3.Elev 4.Elev lip `V 0 p �, f , (0 p L p - Ties Pits est 2 V 2 2 2 3 3 3 3 I-AcD 4 5 5 6 6 7 7 S1p�7 - 1 3 8 9 i0 10 Benchmark Elevation DM T Pit Number G� i �� 2 v Start Saturation Z �'� Z •1� Soak -Minutes 2 : 3 V � V Start, a -Z .. 3 -� • � 0 i Drop of 3" -Time Drop of 6" -Time Mmms.lst 3" drop (� Mins.2nd " Drop Percolation TO: FROM: NORTH ANDOVER, MASS BOARD OF HEALTH DESIGN ENGINEER SE7-" l S 19 L3 Re: Soil Absorption Sewage System Inspection This is to certify that I have inspected the construction of the said disposal system at C' OSSZO "--' North Andover, Mass. SITE LOCATION The grades and construction are as specified in wf�6 plans and specifications dated ,�u.NE 27 19-3_. t y A,)E 1/E !q ssc C " /45- /Iv C,QouN'6 !'�/y s 1,,V h ;_/V a •• � �'r��D�C�,�_.�Yl.� s_S � - �E,D.e":�. cis �� �ih�,� S. r�7ac.lc_ ��Y _ t.NL) �lN� ��p•4S. i�c•ecr,-/fie •47 r Lot'/G Lo- I - EN U SIN ia©•rs- 13a--�,io.�i V a has P(Qv,lded jN4 form to be aubn,l�lod (Q the local ana( A, Faclllry o n cord' AUG — 4 2008 lB}W o �, 9 QVI 1. 5yv,am LQUUon: 96 SYVem Owner vni ACdretJ ALA Of OVICIM ffom l4(;4LJQn) N. SACH Tno SX3:em . , fc1. pumping Rekord p Dais Of Pum In 2 a n a c Type 9f �y�(6m: CD Z��$QPOC Tank T19N Tanx 0 Ch (d EHum Too Flit' nr? L-7 Yu 7 qZ 1, If Y05- w85 k cleanoo? Y 5 ;5, " M. 061. n. where'�Q 1i 11 7�0, zf� a0l 7 ;0Cri Commonwealth of Massachusetts �" I� "4" 1, W City/Town of North Andover " System Pumping Record EON � 1 2012 Form 4 roe OF" )'RTHA OOVER 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 within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. v �I reran System Location: qc) CV6 Lbow Address North Andover City/Town 2. System Owner: Name Ma State 01845 Zip Code Address (if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping ` / 2. x6 C) p 9 Date Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) ,Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Ywr�No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6.tem Pumped B V(ye Name Stewart's Septic Service Company 7. Location where contents were disposed: Stewart's Pre-treatment Plant, 20 So. Mill Sighature of Haul r <_ Signature of Receiving Facility Vehicle License Number Ma 01835 Date Date t5form4.doc- 03/06 System Pumping Record - Page 1 of 1