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HomeMy WebLinkAboutMiscellaneous - 99 WOODCREST DRIVE 4/30/2018 (2)1 Charles lnr stgate / 48 Wood.crest Drive APPLICATION FOR SEWAGE DISPOSAL INSTALLATION +'� -- HEALTH DEPARTMENT - NORTH ANDOVER, MASS. I hereby make application for a permit for a sewage disposal installation at bA W,^ndgrAgt Drive 0 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 1_nm 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 pGO 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 (dial.) 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 1/4a' (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 anydwelling 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 .T,a g 1O. '1967 mo, Js Signature of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DATE July l(3_ 1967 Oignature of Health Agentk_,-),,14,d I have inspected the uncovered system indicated above and find everything done as described. DATE' Signatur' bf Inspecting Of icer Percolation Test 7-in„},es . Garbage Grinder no ._ i BOARD OF HEALTH TOWN OF NORTH ANDOVER, MASS. 0 MtrU.�i 5 a _ _ e �1_ 2,o nhr®J: boa 1. NAME dr%..r���s� � � ar Lt � �� 16� � �t�t DATE 6 // ADDRESS _ 1F �d it v-'4 4 �' " Q �j c���cv �i LOT NO. �.r3o o.� i VATEL . 3. NO. OF BEDROOMS U DEN YES NO 4. GARBAGE GRINDER YES 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 0o d 9. NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM 10,+Q 10. SHOW LOCATION OF BROOKS, STREAMS, DITCHES, LEDGE OUTCROP, ETC. NdtP 11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY. BOARD OF HEALTH OF NORTH ANDOVER, MASSACHUSETTS SEWAGE DISPOSAL DATE Jul;% 1, 1967 NAME OF APPLICANT Charles Westgate, Jr. LOCATION Lot 48, Woodcrest Dr. Address of lot no. BUILDING: Dwelling X Other SYSTEM: New Y Repair_____ GENERAL DESCRIPTION OF LAND High SUBSOIL: Clay X Gravel Sand PERCOLATION TEST 7 minutes per inch. MINIMUM INSTALLATION RECOMMENDATIONS CONCRETE SEPTIC TANK 1,000 gallon capacity. LEACH FIELD 200 _—lineal feet -of drain pipe. a William J. D scoll, Engi eer Board of Hea h BOARD OF HEALTH 146 MAIN STREET TELEPHONE# (508) 688-9540 APPLICA TION FOR ABANDON V!EVT OF SUBS (-'RFACE DISPOSAL SYSTEM (SEPTIC SYSTEM) Pursuant to Section 310 CMR 1..354 of the State Environmental Code, Title V Name Phone Address rive Contractor hired for work: Name Address ti ti;3 9 . 1 Date for scheduled abandonment /0-0-99 The septic system at the above address has been abandoned according to Title V specifications. S p"' ature of Contractor Method of septic tank abandonment (check one). ( )removal (X,) sandfill ( ) crush ( ) other Name of Offal Hauler �4"— A4:�7'z This form must be returned to the North Andover Board of Health. PLEASE DO NOT WRITE IN THE SPACE BELOW FOR HEALTH REPRESENTATIVE'S USE ONLY. 910 Inspecting Agent Date TOWN OFJORTH ANDOVIE —i. -75' –1 R Vqbu OF NO A - , SYSTEM PIMPING RECO ""464RD'O"FALT" DATE -.0 SYSTEM OWNER & ADDRESS lr"'z 917 SYSTEM LOCATION I 1 -1 �3 a, DATE OF PUMPING: 157-13-0,Y -_QUANTITY PUMPED: CESSPOOL: NO .,-/ YES NATURE OF SERVICE: ROUTINE OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLID CARRYOVER Septic Tank: NO YES 61"'EMERGENCY FULL 'TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER EXPLAIN System Pumped by ­aw-'/9_v e.I'S , COMMENTS: CONTENTS TRANSFERRED TO --,2-6-,f Nature of Service ` Reg ASP M /� Reg. Maint. ❑ N/C ❑mergency ANDOVER SEPTIC PUMPERS � Day ❑ Night = ,� _- ' PAY FROM THIS SILL.. Customer Name: % Box 4173 B Station Service Location: Of o 1 Andover, MA 01810 Phone: to, %f (508) 475-2593 Contact: Professional Septic & Drain Billing Address: Locally Owned and Operated City: zip: Emergency 24 Hr. Svc. — 7 Days Special Instructions /Completed i Incomplete Reason: Per: AM/PM Services Rendered V um Pumping Observations Drain Cleaning Septic Tank ElGood Condition El Main Line ❑ Drywell ❑ Leechfield Runback ❑ Toilet Bowl ❑ Leech Pit/ Overflow ❑ Riding High ❑ Kitchen Sink ❑ D -Box (liquid levet) ❑ Bathtub / Shower ❑ Pump Chamber ❑ Full to Cover ❑ Vanity ❑ Grease Trap ❑ Excessive Solids ❑ Floor Drain ❑ Catch Basin / 40 Top / Bottom ❑ Yard Drain /� 7 ❑ Portable Toilet ❑ Use No Powdered Soap ❑ Vent ❑ Other Heavy Grease ❑ Sewer Jet % Qty: (JJ ❑ Roots ❑ Other Size: j/ ❑ Suggest Electric Footage: El Under 1000 gallons 1000 gallons ❑ 1500 gallons Rootering g ❑ 2000 gallons ❑ 30 1 gallons ❑ 4000 gallons ❑ Van Called ❑ 5000 gallons ❑ other ❑ Other Misc ❑ Digging Charge ED Backhoe Un. ❑ Location firs. ❑ Consultation ❑ Service Call ❑ Estimate ❑ Labor ❑ Portable Toilet Rental ❑ Waiting Time ❑ Baffle ' Digging Charge Is Per Driver Discretion Description of Work Drain Month Yr. T & Conditions I ❑ Cash /rt. tit responsible for damage beyond curb line. 2//i11 complaints shall be reported within 48 hours. 4,tKie undersigned agree to all terms and conditions. Customer Signature ❑ Credit ❑ Inspection ❑ Certification: P/F Reason: ❑ Pump Repair ❑ Repair ❑ Chemical Treatment ❑ Other Terms of Payment Parts NET 15 DAYS Tax Discount A. 1.7% per month will be charged to accounts past due. 4. Tfie purchaser agrees to pay all cost of.collection. r Serviceman WATERSHED RESIDENTS QUESTIONNAIRE 1. Namek-- O2. 2. Street Address 3. How many members are in your household? 4. What type of sewage disposal system do you have? ❑ cesspool �geptic tank and leaching area ❑ connection to municipal sewer other (describe) ------- _ - _ -- . - do not know 5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health? yes ❑ no. ❑ do not know 6. How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years F 11-20 years ❑ over 20 years ❑ do not know 7. Has your sewage disposal system been rebuilt or repaired? ❑ yes CK no ❑ do not know If yes, approximately how long ago? years. What was done? 8. How frequently is your sewage disposal system pumped out? ❑ annually r4y� ❑ every 2-4 years IX every 5-70 years ❑ over 10 years ❑ never 9. Have you had any problems with your sewage disposal system? ❑ yes no If yes, what problems? ❑ repeated pump -outs needed ❑ system clogs, backs up, or drains slowly ❑ odors ❑ sewage surfaces through ground 10. How many of each appliance are connected to your sewage disposal system? washing machine_ dishwasher _1 garbage disposal 1 dehumidifier drain sump pump �_ toilet_ roof/pavement drains shower/bathtub 11. Please state t r brand and type (liquid or powder) of detergent you use for: dishwasher s _ clotheswasher 12. Does your property have a lawn? yes ❑ no If yes, approximately what /size? . ❑ less than '/, acre 1] 1/4 acre ❑ '/z acre ❑ 3/4 acre " 1 acre ❑ more than 1 acre (Specify) . acres 13. How often do you fertilize your 1 wn? O No. of applications per year Season(s) of the year S ruil t -t-- 14. Please state the brand and type (liquid or granular) of lawn fertilizer you use: XCheck here if your lawn is maintained by a professional landscape contractor. WATERSHED RESIDENTS QUESTIONNAIRE 1. Name '- J 2. Street Address—(A C CA XWestf ("Z O 3. How many members are in your household? — i 4. What type of sewage disposal system do you have? ❑ cesspool �eptic tank and leaching area ❑ connection to municipal sewer ❑ other (describe) ❑ do not know 5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health? j�k,J4vw_ss yes ❑ no ❑ do not know 6. ; How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years 54 11-20 years ❑ over 20 years ❑ do not know 7. Has your sewage disposal system been rebuilt or repaired? ❑ yes CX no ❑ do not know If yes, approximately how long ago? years. What was done? 8. How frequently is your sewage disposal system pumped out? ❑ annually ❑ every 2-4 years [ every 5-10.years, ❑ over 10 years ❑ never 9. Have you had any problems with your sewage disposal system? ❑ yes [ no If yes, what problems? _❑ repeated pump -outs needed ❑ system clogs,,backs up, or drains slowly ❑ odors ❑ sewage surfaces through ground 10. How many of each appliance are connected to your sewage disposal system? washing machine— dishwasher garbage disposal 1 dehumidifier drain sump pump toilet ,3— roof/pavement drains_ shower/bathtub - 11. Please state t brand and type (liquid or powder) of detergent you use for: dishwasher clotheswasher 12. Does your property have a lawn? X yes ❑ no If yes, approximately what ize? El less than 1/4 acre rJ 1/4 acre ❑ 1/2 acre ❑ 3/4 acre S" 1 acre ❑ more than 1 acre (Specify) acres 13. How often do you fertilize your 1 wn? . No. of applications per year O Season(s) of the year S r -1:7p) Lt_ 14. Please state the brand and type (liquid or granular) of lawn fertilizer you use: ri -; �, Check here i your lawn is maintained by a professional landscape contractor. JTOWN OF�ANDOVER SEPTIC SYSTEM SERVICING REPORT Date:. Homeowner: Pumper Street �' Address: Phone Phone Nature of Service: Observations: Description of Work Comments: Routine Emergency Good Condition Full to Cover Baffles in Place Leachfield Runback Excessive Solids Heavy drease Roots Other (Explain) #rte -, L cj�— 4Q,� SEPTIC SYSTEM INSPECTION FORM ADDRESS C // DATE INSPECTED PROPERLY FliNCTIONING?. Y WEATHER CONDITIONS w 2 -N COMMENTS• 7' N -' (Y\ I 5c ` d ra,v- i tN�6 4n i>v Sv3 0 -3 WAi'EP, aVALI 2 &�,L .S^? DYE TEST PERFORMED? Y N q DATE? SKETCH: t.., 10A � 7" 13' 7 W&, revii e� S T (f _ 5 c ' Le is D.. ��L Jhd -r,►4� - `► o I n�1, tv� ick �G,�• BOARD OF HEALTH TOWN OF NORTH'ANDOVER, MASS. 4=" 3 b ? 1. NAME 4 d- 9� ld i kA X r DATE 9. ADDRESS i, 1. JA Pcf LOT vd NO. cA TfL L ,y 4 M 3. NO. OF BEDROOMS, DEN YES 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 /V" 10. SHOW LOCATION OF BROOKS, STREAMS, DITCHES, LEDGE OUTCROP, ETC. Nc,,c 11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY.