HomeMy WebLinkAboutMiscellaneous - 73 FARNUM STREET 9/29/2015 t10RT#j q
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PUBLIC HEALTH DEPARTMENT
Community Development Division
CERII FICA�I2 O F COM<'�I.ANE
As
of:
,duly 31, 2007
This is to certify that the individual subsurface disposal system received a
SATISFAC`7ORTINSITECTTO,Nof the:
Distribution Bo.V Only
RepairedBy:
ToddBateson
At:
73 Farnum Street
Map 10T.A, .Got SS
North Andover, M,4 01845
The Issuance of this certificate shall not 6e construed as a guarantee that the system will
function satisfactorily.
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Su do T Sawyer
Public Wealth Director
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
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PUBLIC HEALTH DEPARTMENT
Community Development Division
ONITE WASTEWATER SYSTEM CONSTRUCTION NOTES
LOCATION INFORMATI ❑
ADDRESS: MAP- LOT:
INSTALLER::' ; 14
DESIGNER:
PLAN DATE:
BOH APPROVAL DATE ON PLAN:
INSPECTIONS ❑ -
TANK INSPECTION: w --
DATE OF BED BOTTOM INSPECTION:
DATE OF FINAL CONSTRUCTION INSPECTION:
DATE OF FINAL GRADE INSPECTION:
SITE CONDITIONS
❑ Existing septic tank properly abandoned
❑ Internal plumbing all to one building sewer
❑ Topography not appreciably altered
Comments:
SEPTIC TANK
❑ Bottom of tank hole has 6" stone base
❑ Weep hole plugged
❑ 1500 gallon tank has been installed
H-10 loading Monolithic construction
❑ Water tightness of tank has been achieved
(Visual or Vacuum Test or Water held for 24hrs)
❑ Inlet tee installed, centered under access port
❑ Outlet tee (gas baffle or effluent filter) installed,
centered under access port
1
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688,8476 Web www.townofnorthandover.com
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PUBLIC HEALTH DEPARTMENT
Community Development Division
❑ 24" inch cover to within 6" of final grade installed over
one access port, must be over outlet of tank if effluent
filter is present
❑ Hydraulic cement around inlet & outlet
Comments:
PUMP CHAMBER
❑ Bottom of tank hole has 6" stone base
❑ Weep hole plugged
❑ Combo Tank installed. Size:
❑ 1000 gallon Pump Chamber installed
H-10 loading Monolithic construction)
❑ Inlet tee installed, centered under access port
❑ Pump(s) installed on stable base
❑ Alarm float working
❑ Pump On/Off floats working
❑ Separate on/off floats
❑ Drain hole in pressure line
❑ 24" inch cover to within 6" of final grade installed over
pump access port
❑ Water tightness of tank has been achieved
Visual testing
❑ Hydraulic cement around inlet & outlet
Comments:
DISTRIBUTION-BOX
Installed on stable stone base
Inlet tee (if pumped or >0.08'/foot)
Hydraulic cement around inlet & outlets
Observed even distribution
s Speed levelers provided (not required)
Comments:
2
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.town0northandoverarn
Commonwealth of Massachusetts Map-Block-Lot
So
Board of Health 107.A-0055-
Permit No
re North Andover BHP-2007-0246
P.I.
_ FEE
twt F.I.
- $125.00
Disposal Works Construction Permit
Permission is hereby granted Todd Bateson
to(Repair-D-BOX REPLACEMENT ONLY)an Individual Sewage Disposal System.
at No 73 FARNUM STREET
-
as shown on the application for Disposal Works Construction Permit No. BHP-2007 024, Jut�"27,2007
, or
- -------- --- -
Issued On Jul-27-2007 Board of Health
, .� , � Commonwealth of Massachusetts Map-Block-Lot
107.A-0055-
Board of Health --
North Andover
Certificate of Compliance
THIS IS TO CERTIFY,That the Individual Sewage Disposal System (Repair-D-BOX REPLACEME
by Todd Bates on
Installer
at No 73 FARNUM STREET
has been installed in accordance with the provisions of TITLE 5 of the State Environmental Code as described in the
application for Disposal Works Construction Permit No. BHP 2007-024 Dated July 27,2007
-
Printed On Jul-27-2007 Board of Health
,nkr„ Iii ti n Se tic Disnosal ,S tem
-f
TODAY'S 15A EE
° n1 struction Permit — TOVN OF
1 $ 250.00—Full Repair
NORTH ANDOVER MA 0845
$125.00 -Component
SA 5
Important: Application is hereby made for a permit to:
When filling out ❑ Construct a new on-site sewage disposal system*_
forms on the
computer,use ❑ Repair or replace an existing on-site sewage di osa
only the tab key
to move your P16'pair or replace an existing system componen
cursor-do not
use the return A. Facility Information
key.
"T3 F&O�Aov,
n ray Address Or Lot#
City/Town
2.-*TYPE OF Sf."C SYSTEW:
❑ Pump MWriavity (choose one)
***If num p system. attach copy of electrical permit to application'
2-`Conventional System (pipe and stone system)
❑ Infiltrator or Biodiffuser(Gravel-Less)(Attach a copy of your certification to install this type of system.
❑ Pressure Distribution S.A.S. (No D-Box)(Attach Draft Maintenance Agreement)
❑ Pressure Dosed (D-Box Present)S.A.S.
2. Owner Information
S'+ / �A-lo'r <2—,
Name
Address(if different from above)
City/Town State Zip Code
Telephone Number
3. Installer Information
Name Name g�ffrn�y)';q
r 114-
Address 17
Andover,
City/Town State Zip Code
V als'—al?113. - -
Telephone Number(Celt #if possible please)
4. Designer Informaj!en
Name Name of Company
Address--
City/Town State Zip Code
Telephone Number(Best#to Reach)
Application for Disposal System Construction Permit•Page 1 of 2
r c
°F ,,ON1}a 7y6 Application for Septic Disposal ystem ®d--3—" 7 -'
TODAY'S DATE
- pConstruction Permit ® T ®F
} ' * ORTH ANDOVER MA 01845 $250A0—Full Repair
.,,�-•4,,,: -;�.c + $125.00-Component
PAGE 2 OF 2
A. Facility Information continued....
5. Type of Building: esidential Dwelling or❑Commercial
B. Agreement
The undersigned agrees to ensure the construction and maintenance of the afore-described
on-site sewage disposal system in accordance with the provisions of Title 5 of the
Environmental C_ ode,as well as the Local Subsurface Disposal Regulations for the Town of
North Andove nd not to place the system in operation until a Certificate of Compliance has
been issue b this Board of Health.
Name Date
Application rov By: (Board of Health Representative)
/{ r
Name d for Date
App icatr' n Disappro r the following reasons:
r Office Use Only:
1. Fee Attached? Yes No
2. Project Manager Obligation Form Attached? Yes No
3. Pump S sy tem? If so,Attach cow f Electrical Permit Yes_ / . No
4. Foundation As-Built?(new construction ronly): Yes_ No
(Same scale as approved plan)
S. FloorPlans?(new construction only): Ye _ No
SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS
As the North Andover licensed installer for the construction for the septic system for the property at:
(.address of septic system) For plans by
(Engineer)
Relative to the application of to� _ s � ®�
(Installer's name) And dated r0�—-
ngvia ate)
Dated �— J 3_0 2
o ay'sscc`ate With revisions dated
(Last reN ised date)
I understand the following obligations for management of this project:
1. As the installer,I am obligated to obtain all permits and Board of Health approved plans prior to
performing any work on a site. I must have the api2ro ed plans and the permit on site when any work is
being done.
2. As the installer, I must call for any and all inspections. If homeowner,contractor,project manager,or any
other person not associated with my company schedules an inspection and the system is not ready, then
item three shall be applicable.
3. As the installer,I am required to have the necessary work completed prior to the applicable inspections as
indicated below. I understand that requesting an inspection,without completion of the items in accordance
with Title 5 and the Board of Health Regulations may result in a $50.00 fine being levied against me and/or
my company
a. Bottom of Bed—Generally,this is the first (1S) inspection unless there is a retaining wall,which
should be done first. The installer must request the inspection but does not have to be present.
b. Final Construction Inspection—Engineer must first do their inspection for elevations,ties, etc.
As-built of verbal OK(or e-mail to: healthdeptntownofnorthandover.com) from the engineer must
be submitted to the Board of Health,after which installer calls for an inspection time. Installer must
be present for this inspection. With a pump system, all electrical work must be ready and able to
cause pump to work and alarm to function.
c. Final Grade—Installer must request inspection when all grading is complete. Installer does not
have to be on-site.
4. As the installer,I understand that only I may perform the work(other than finple excavation)and I am required
to complete the installation of the system identified in the attached application for installation. I further
understand that work done by others unlicensed to install septic systems in North Andover can constitute
reasons for denial of the system and/or revocation or suspension of my license to operate in the Town of
North Andover, significant fines to all persons involved are also possible.
5. As the installer, I understand that I must be on-site during the performance of the following construction
steps:
a. Determination that the proper elevation of the excavation has been reached
A Inspection of the sand and stone to be used.
c. Final inspection by Board of Health staff or consultant.
d. Installation of tank,D-Box,pipes, stone, vent,pump chamber, retaining wall and other
components.
6. As the installer, I understand that I am solely responsible for the installation of the system as per the
approved 121ans No instructions by the homeowner, Qeneral contractor, or any other persons shall absolve
me of this obligation. �7
Undersigned Licensed Septic Installer: (Todat's Date) " —3 /
®
acne— Print) i e—Signed)-,
Salvatore Dimilla
3 Lot il 73 Farnham St.
APPLICATION FOR SEWAGE DISPOSAL IDETALIATION
HEALTH DEPARTMENT - NORTH ANDOVER, PASS.
I hereby make application for a permit for a sewage disposal installation at
-4 1 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 lJo until 10 feet pre-
ceding the septic tank, where the grade shall not exceed 2%. 1 will install a con-
crete septic tank of Z5_0 Gal. 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 (14=4) 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 1/81, to 1/01 (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
the 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 RpRroved 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.
D A Tg4 ley
Signature of Applicant
I hereby issue the above permit for the Board of Health of the Town of North
Andover, Massachusetts.
DATE e"✓
Sig�6tune of Health Agent
I have inspected the uncovered system indicated above and find everything done
as described.
DA TE
Signature of IfikrJecting Officer
Percolation Test 6 min. Soil: SanjXrclay
Garbage Grinder No
April 1, 1961
Miss Mary Sheridan R. No
Health Agent
Board of Health
North Andover., Masso
' Dear Miss Sheridan:
An examination was made as requested in order to determine the
suitability of the soil for the subsurface disposal of sewage on the
proposed Farnum, Street building site of Salvatore Jo Dimilla.
The land in general is higho
The subsoil in the area was of sandy clay content and a 6-minute
percolation test was conducted.
It is recommended that a 750 gallon concrete septic tank be
installed together with 200 lineal feet of drain pipe.
Very truly yours,
am
0,
WJD:hd
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BOARD OF HEALTH
TORN OF NORTH ANDUVER S.
It,
1, NAME DATE
20 ADDRESS . . . . . . . . . . . . . . o LOT NC;e"7,�o3 • . . . . . EL
3. NO* OF BEDROOMS 0:3. . . . DEN YES o o o NO.
GARBAGE GRINDER YES o 0 0 o o NOo o 0 0
SHOW DIMENSIONS OF HOUSE X PV
6o SHOW DISTANCES OF HOUSE TO ALL PRQPERTY LINES
7, SHOW DIMENSIONS OF LOT
8, SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL
9. NOTE LOCATION AND DISTANCE OF WELL PROM SEWERAGE SYSTEM
10. SHCW LOCATION OF BROOKS3 STREAMSt DITCHES, LEDGE OUTCROPp ETC.
11. SHUN DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE
N'OTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY.
Commonwealth t Massachusetts
x City/Town of
a System
.``
Form 4
D P has provided this form for us&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.
A. Facift Information
1. System Location: Left/Right front of hous Q'enggX, "/F r®f h , Left/right side of house, Left/
Right side of building, Left/Right front of b Left ight rear of building, Under deck
Address
City/Town State Zip Code
1
2. System Owner: r �
Name W wba, - ^na
It
Address(if different rom location),ti
�. ��..
Ci !Town r 4 u� State Zip Code
' ^"�
F Telephone Number
B. Pumping cr � .
1. Date of Pumping 2. Quantity Pumped:
Date Gallons
3. Type of system: ® Cesspool(s) Septic Tanks ® Tight Tank
Other(describe):
4. Effluent Tee Filter present? ® Yep w o If yes, was it cleaned? ® Yes No:
' 5. Condition of SysteS :���-/�-�,
6. System Pumped By:
Neil Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7. Locati here contents were disposed:
TN
,.L S: Lowell Waste Water
UY&9A
Sign t e gtHauleV Date
t5form4.doc-06/03 System Pumping Record®Page 1 of 1
Commonwealth of Massachusetts
City/Town of A R ?9 ?01
System Pumping Record TOWN IOF orzf H NDOVER
.�` Form 4 ,�
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.
A. Facility Information
1. System Location: Left/Right front of house, Left/4=ciga ear of house, Left/right side of house, Left/
Right side of building, Left/Right front of building, Left/Right rear of building, Under deck
Address
Cityrrown State Zip Code
2. System Owner: 1� ` Ar-l" LA
Name
Address(if different from location)
Cityrrown State y 70 Co e
Telephone Number
B. Pumping Record
1. Date of Pumping 2. Quantity Pumped:
Date Gallons
3. Type of system- ❑ Cesspool(s) eptic Tank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes No If yes,was it cleaned? ❑ Yes ❑ No
5. Condition of System:
6. System Pumped By:
Neil Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7. Location where contents were disposed:
Lowell Waste Water
Sign t e Haule Date
t5form4.doc•06103 System Pumping Record•Page 1 of 1
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DEP has provided this form for use by local Boards of Health. The y must
be submitted to the local Board of Health or other approving authority,
X Facility Information
Important: 1, System Location; " '
forms an thsgUt y
computer,use r ,
only the tab key Address f
to move your t�
ogw•do not yR n state Zip Code
use the return
key.._ 2, System Owner,
Name
Awr
Address(If different from location)
clty/Town state Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping Date
2. Quantity Pumped: Gallons
3. Type of system; [] cesspool($) Peptic Tank ❑ Tight Tank
❑ Other(describe);
4. Effluent Te®1. Filter present? ❑ Yes ❑ No if yes,was It cleaned? ❑ Yes ❑ No
5. Condition of System
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1 MP&ny® Vehicle Ucense Number
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7. Location wtAro contents were disposed; m
01 Fieuler .. Date
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Commonwealth of Massachusetts
City/Town of NORTH ANDOVER, MASSACHUSETTS
System Pumping Record
�Form
DEP has provided this form for use bx local Boards ofHealth. The System Pumping Record must |
be submitted tm the local Board mf Health or other approving authority.
�
A. Facility Information �
Important:
1 �oo�Uon� �
,~.~..~. . -/-.-. . �
forms on the
computer, use
only the tab key Address
to move your
cursor'donot �
use the return ^"''"-" oate Zip Code
hey.
_ System _Owner:
�
Name
�
— r RECEIVED
Cityfrown State 9,, Zip Code
MAY 2006 Telephone Number
11. Date of Pumping 2. Quantity Pumped:
DaI;4� Gallons
3. Type of system: El Cesspool(s) XSeptic Tank Tight Tank
Other(describe):
4. Effluent Tee Filter present? F� Yes DNo |f yes, was dcleaned? F� Yes Fl No
5. Condition ufSystem:
6. � Pumped
Narne Vehicle License Number
Company
7 Location where contents were disposed:
Signature Hauler Date
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