The URL can be used to link to this page

Home My WebLink AboutMiscellaneous - 182 OLYMPIC LANE 9/29/2015 ? f"' 1 1 i f�! C ti w i f • !'NT qt 1 �t�;4y C� �h1S��j it ltV � t�.a ii it � �,! � . t � •. .� �omM ealth'®f Massachuse s DOVER !/Twn df ORTH AN DOVE TTY y� n� raping Record Form 4 7. DEP has provided this form for use by local Boards of Health. The System Pumping Record n' be submitted to the local Board of Health or other approving authority, .- A• Facility information t: ing out 1, S Locatlon l i the / r,use Lab key Ad your Jo not Aum Cl /Town State Zip Code 2, System Owner, Name Address(If different from location) City/rown State Zip Code Telephone Number B, Pumping Record 1, Date of Pumping 2, Quantity y Gallons 3, Type of system, ❑ Cesspool(s) Septic Tank ❑ Tight Tank w� Other(describe): 4, Effluent Tee Filter present? ❑ Yes ❑ No If yes°was it cleaned? ❑ Yes ❑ No 5, CondlUon of System: 6,• tem Pumped By; me Vehicle License Number Company 7 • tla where conten were disposed: e -�-�, C qna of Haul Da mass,gov .epAvater/approvalsA5forms,hUn#Inspect •`j' 08/03 • ^• System Pumping Record-Page 1 of • i d I Commonwealth of Massachusetts J North Andover, Massachusetts 1 System Pumping Record System Owner& address: Yangkil Kim 182 Olympic Lane North Andover, MA Location of system: Front U G 8 Date of Pumping: August 14, 2006 L/V FffDEad N fCrs ids r�r_ i Type of system: Septic tank a Gallons Pumped: 1000 Gallons System pumped by: Service Pumping &Drain Co., Inc. License #: BHP-2005-0649 Contents transferred to: Greater Lawrence Sanitary district Date ' August14, 2006 ump1ig�T,;ehnkian;>;CC This is PROPRIETARY and CONFIDENTIAL information that may be used only by the Board of Health for regulatory purposes TOWN OF NORTH'ANDOVER _ S=YSTEM PtlkPING RECO" _ 0WNER ADDRESS SYSTEM LOCATION (example: left front of house) . o a- DATE OF PUMPINC: QUANTITY PUMP CD GALLWNN �:a�NUUL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE; ROUTINE " EMERGENCY GOOD COl' DITtON FULL TO COVE12 HRAYY GREASE BAFFLES IN I'LACE ROOTS LEACHFIELD I?ViYBACK- CXCESStVI?S(JLfDS FLOODED SOLIDS CARRYOVER iP.Wfi R (EXPLA.lN) iYSTEM PUMPED L1Y. • � ' ,. , �. 1 .a (.'U'►I tii rNTS: c U.NTIsNTS" TRANSFEItRED TO: 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. `"*'A APPLICANT FILLS OUT THIS SECTION APPLICANT �[y/ ) K �� L 14 PHONE -------_ LOT (S) J.Uf c STREET_ U, 11,41,0/c ST. NUMBER OFFICIAL USE ONLY'*" �s 4 REC NQATIONS OF TOWN AGENTS: ' �.. ty CONSERVATION ADMINISTRATOR DATE APPROVED L "' DATE-REJECTED COMMENTS VU �� 0 TOWN PLANNER DATE APPROVED t DATE REJECTED COMMENTS FOOD INSPER-HEALTH DATE APPROVED DATE REJECTED S S CTOR-HEALTH DATE APPROVED 2 � S DATE REJECTED COMMENTS 4` PUBLIC WORKS -SEWERIWATER CONNECTIONS DRIVEWAY PERMIT / FIRE DEPARTMENT V RECEIVED BY BUILDING INSPECTOR DATE 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. eq ts. APPLICANT FILLS OUT THIS SECTIO APPLICANT 'rill 1/ Clrti � S `a'zw�S PHONE LOCATION: Assessors Map Number PARCELS I� SUBDMSIO N LOT (S) STREET_ l/cy � r'�l L! :�'l !71�l_ L/�'ty�> ST. NUMBER of --L-- OFFICIAL USE ONL R. MEN IPIOAF TO NTS: . CONSERVATION ADMINISTRATOR DATE APPROVED f, DATE REJECTED COMMENTS- TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD ECTOR-H DATE APPROVED DATE REJECTED TIC INSPECT R1 T DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS -SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE RGV WW 07 Jm Boa-rd of HOnIth BFMC MTEM North .Qn4gyer linano IN5TALI.ATZC1�1 CH] CS LZST LOT Dl PRCNFD X AVATLC�t OK FAILS (,Nm DATE - - easonst . 7 FM OK 1. Distance Tot a. Wetlands b. Drains c. Well 2. Water Line Location 3- No PVC Pipe ; 4. Septic Tank - a. _Tees--Length & To Clean Out Covers. ' b. Cement Pipe to Tank -- on Both Sides of Tank 5. Distribution Boa a. Covers & Box - No Cracks b. All Lines Flowing Equal Amo unts C. No Back Flow 6. - Leach Field or Trench Dimensions b. Stone Depth c; Capped Ends d. Clean Double-Washed Stone' I 7. Leach Pits a. Dimensio b. Stone epth c. SPl Pads d. T s e. ement Pipe to Pit - Both Sides. f, Clean Double Washed Stone �1", 8. No garbage Disposal 9. -Final. Grading Inspection 10. Barricading Covered System ll. As Built Submitted. __ - '' , a. Lot Location _ . b. Dimensions of System _ c. Location with R egard_to Pere Test d. Elevations ° e: Water Table f 11 j 1,1ORTH ANDOVER BOARD OF HEALTH ,/ APPROVED PROVIDED DISAPPROVED DATE TIME REASON _ ss ° mmu r Title 5 Reg. 2. 5 Fail OK The submitted plan must show as a minumum:" the lot to be served (area,dimensions ,lot //, abutters) „ (Planning Board files) (h) " location and lag of deep observation holes-distance to ties (c) location and results of percolation tests-distance to ties (d) design calculations & calculations showing required leaching area e, ~' location and dimensions sf system (including reserve area) t f existing and proposed contours location of any wet areas within 100' of the sewppe in g) disposal system ot disclaimer (check wetlands ma surface and subsurface drain's within 100 of sewage disposal system or disclaimer � l° ` (i) locat=ion of any drainage easements within '100 of sewage disposal system or disclaimer (planning board .. . files) - known sources= of--water supply- within- 2001 o sewage - disposal system or disclaimer location of any proposed well to serve the lot (100" from leaching Facility) (1) location of water lines on property (10' from. leachine facilities) (rri location of benchmark .n driveways o) garbage disposers p no PVC is to be used in construction a profile of the system (elevations of basement , plum pipe septic tank, distribution box inlets and outlet' distribution field piping and any other elevations) I (r) maximum ground water elevation in area of sewage dispe (rs) plan rofessional Engineer or anmust be prepared by a P "f other professional authorized by law to prepare such plans Septic Tanks Rem. 6 (a) Capacities - 150% of flow, water table , tees , depth CD of tees , access , pumping. Cleanout c 10' from cellar wall or inground swimming pool d 25' from subsurface drains I ?ail OK Distribution Boxes 10. 2 .� ( Slope greater than 0. 08 eg.10..4 ,., (b� Sump Leaching Pits Leaching pits are preferred where the installation �,s possible eg,11 , 2 (a) Calculations of leaching area (minimum 500 S.F. ) eg.11 .4 b),_,,,, Spacing eg,11 .1c Surface drainage 2% eg.11 .11 d Cover material �e e cr¢C 1 b0�1 S� i—' Leaching Fields eg.15,1 �-- . RiGreater than 20 minutes/inch eg,15.1 Area-(minimum-900 S.F. ) eg,15,4 / Construction of field eg.15. 8 Surface drainage 2% 3,7 L (e 20' from- cellar wall or inground swimming pool eg. • Leaching Trenches eg. 14.1 (a) Calculations of .leaching area (min. 500 S.F. ) eg.14. 3 (b) Spacing (4 ft. min. 6 ft. with reserve between) eg.14.4 (c Dimensions 14. 5 ego14.6 (d Construction- eg.14.7 (e� Stone eg.14.1 (f) Surface drainage 2% Downhill Slop e �a� Slope y/x to be shown b y/x X 150 = �to be shown Pumps eg. 9.1 (a Approval eg, 9, 6 . (b� Stand-by power �1 F , I