HomeMy WebLinkAboutMiscellaneous - 920 JOHNSON STREET 4/30/2018N
O
Z
O �
z
m
LTJ
H
Commonwealth of Massachusetts
P- Massachusetts
System Pumping Record
System Owner
H,,-- HCL%.Vs
System Location
Date of Pumping: i '^ CDc7n
3—
Cesspool: No [� Yes [ ]
System Pumped by: 64&4"
`3D Uvv�,,c �
Quantity Pumped: gallons
Septic Tank: No [ ]
License #
Contents transferred to: Greater Lawrence Sanitary District
Date:
Inspector:
Yes [a -----
JAN i I ,
Date: a I
Town of North Andover, MA
Watershed Septic System
servicing Report
Homeowner: tcwe- VGU 0AW3 Pumper :
Street Address: l l l AA�cti
Phone Phone
Nature of Service:
Observations:
Description of Work:
Comments:
Routine
Emergency
Good Condition
Full to Cover
Baffles in Place
Leachfield Runback iG
Excessive Solids
Heavy Grease
Roots
Other (Explain)
no
TOWN OF / V- M/
SYSTEM PUMPING RECORD
DATE: t t -1
SYSTEM OWNER & ADDRESS
Rio
SYSTEM LOCATION
(example: left front of house)
DATE OF PUMPING: (('--C�� UANTITY PUMPED :
Q
t -�Z—Z�GALLONS
CESSPOOL: NO 'ES SEPTIC TANK: NO
L-1�
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION
HEAVY GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
FULL TO COVER
YES
BAFFLES IN PLACE
LEACHFIELD RUNBACK
FLOODED
OTHER (EXPLAIN)
SYSTEM PUMPED BY: Bateson Enterprises, Inc.
COMMENTS:
CONTENTS TRANSFERRED TO: G.L.S.D Lowell Waste
DATE:
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
( x-3_0(
Mc_H0AA_AJ_S' .
9 ar) A�e�- s--z+-
(example: left front of house)
DATE OF PUMPINGPI—S QUANTITY PUMPED 16"-l—GALLONS
CESSPOOL: NO YES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE
OBSERVATIONS:
GOOD CONDITION
HEAVY GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
SYSTEM PUMPED BY:
COMMENTS:
EMERGENCY
FULL TO COVER
BAFFLES IN PLACE
LEACHFIELD RUNBACK
FLOODED
OTHER (EXPLAIN)
CONTENTS TRANSFERRED TO:
Lot 920 Johnson St.
Geo.Farr
APPLICATION FOR SEWAGE DISPOSAL INSTALLATION
HEALTH DEPARTMENT - NORTH ANDOVER, MASS.
I'hereby make application for a permit for a sewage disposal installation at
Lot 920 Johnson St. . 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 1% until 10 feet pre-
ceding the septic tank, where the grade shall not exceed 2%. I will install a con-
crete septic tank of 1000 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 of 200 lineal (square) 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 1/41' (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
tile 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 / `/� le �/ '/
of
I hereby issue the above permit for the Board of Health of the Town of North
Andover, Massachusetts.
DATE ___./ e A
' Signat, a of H alth Agen
I have inspected the uncovered system indicated above and find everything done
as described.
DATE �� }
.�0J
Signature of 9specting Officer
Percolation Test 5 Min Soil: Clay
Garbage Grinder no
m
BOARD OF HEALTH
TOWN OF NORTH ANDOVER, MASS.
C C p vroli t5-----q-Z::-
T
5E
9
92L-9
7
2-32 2*�
1. NAME (<:: o DATE�if ,- 02 �ot1�
2. ADDRESS r1 (5-71 LOT NO. TEL.
3. NO. OF BEDROOMS y DEN YES 11 NO
4. GARBAGE GRINDER YES v NO
5. SHOW DIMENSIONS OF HOUSE
6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES
7. SHOW DIMENSIONS 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, STREAMS, DITCHES, LEDGE OUTCROP, ETC.
11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE ;22-6 /
NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY.
BOARD OF HEALTH OF NORTH ANDOVER, MASSACHUSETTS
SEWAGE DISPOSAL / p'
DAT ��6 0
NAME OF APPLICANT' �/
LOCATION Q
Addresd of lot no,
BUILDING: Dwelling % _Other
SYSTEM: New y _Repair
GENERAL DESCRIPTION OF LAND
SUBSOIL: Clay_ Gravel Sand
PERCOLATION TEST minutes per inch.
MINIMUM INSTALLATION RECOMMENDATIONS
CONCRETE SEPTIC TANKen", gallon capacity.
LEACH FIELD 2-45)0 lineal feet of drain pipe.
)� )illpj a __ tj
illiam J. D i coli, Engineer
Board of Heal
' t;,llullll,u�rr«11111,1 Alesrlhburrll! .
• 1 IVlassaal�ueatle � _ . _ _
r..R .� d� ;� F,;• �; OV.EFFt/
,4• r
. —5j•ilaiii`LucQtl"o --- `
• 53'ltelrrt�«ne , ,
b n�
VL
!V
`.. ! ► 1 Udlllll ' Ilullll,��ll � •.
D or Ilulnl►Ing lvq�
• fiNhlll' '1'dh1.1 ', ISM � ;.. + �t! �' •
tj
.es � LiCllls! N,
System Pumped
CulNelill.Ilmisie,lell 101
• Illsl,dtlot
I)n!e •
,, 0, "
('ommonwea ih of Massachusetts
"assachusetts
stem Pumping Record
System Owner
H, c � C,� vs
J`
Date of Pumping: l -,�- ( —
Cesspool: No H--- Yes LI
System Location
J�
61AA-S�'S4-
�
Quantity Pumped: gallons
Septic
Septic Tank: No U Yes Ftp
System Pumped by: �,Iredeje 6#� a License #
Contents transferrred to : Greater Lawrance 8anitary District
Date:
Inspector:
ft
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
ILS
Commonwealth of Massachusetts
City/Town of
System Pumping Record
Form 4
RECEIVED
FEB 10 2009
DEP has provided this form for use by local Boards of Heali�! ` ' ATOWYA MR6 , but the
information must be substantially the same as that provide = Is orm, 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.
A. Facility Information
1. System Location: Left front, left rear, left side of hou e. Ri h fron right rear, right W e of hous
Address qD0
City/Town State Zip Code
2. System Owner: T
G OL V1
Name
Address (if different from location)
City/rown
B. Pumping Record
1. Date of Pumping
3. Type of system: 0
Other (describe):
State Ziod
:��
Telep one Number
Date 2. Quantity Pumped: Gallons
Cesspool(s) eptic Tank Q Tight Tank
4. Effluent Tee Filter present? Yes If yes, was it cleaned? [I Yes L] No
5. Condition of System: n n I J -12—k
6. System Pumped By:
Neil Bateson
Name
Bateson Enterprises Inc
Company
7. Loc io
L.S. D
igna ure of H u r
t5form4.doc• 06/03
s were disposed:
Lowell Waste Water
F 5821
Vehicle License Number
Date
C - a - 0
System Pumping Record • Page 1 of 1