HomeMy WebLinkAboutMiscellaneous - 284 BRADFORD STREET 10/13/2015 APPLICATION FOR SEWAGE DISPOSAL INSTALLATION
HEALTH DEPARTMENT - NORTH ANDOVER, MASS.
I h by make,, pplication fop-q permit for a sewage disposal installation at
1,1, "t 4 e7� '41. /
AM /"- 11/1-11, 0 1 will install this system in ac-
cordance with all the la 0s 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 1961 until 10 feet pre-
ceding the septic tank, where the grade shall not exceed 2%. 1 will install a con-
crete septic tank of / J_._`...._._..` 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 id in a series of trenches, the bottom of which will pro-
vide a minimum of 111 ,�'J lineal (square) feet of effective absorption area.
The pipes Will be Ta—ld 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 1/41, (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 an portion-of- this installation until ap roved by-the
insvection 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
LL_
ignature ofi/Applicant
I hereby issue the above permit for h el Board of Health of the Town of North
Andover, Massachusetts.
DATE
Signature of Health Agent_
I have inspected the uncovered system indicated above and find everything done
as described�
DATE
Signature off In p cting Officer
Percolation Test w,
Garbage Grinder
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BOARD OF HEALTH
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TOWN OF NORTH ANDOVER, MASS.
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1. NAME .... l y '.c < � �.,� .. e DATE
2. ADDRESS LOT NO♦ TEL.
3. NO. OF BEDROOMS .... DEN YES NO
4. GARBAGE GRINDER YES NO
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 A/,
10. SHOW LOCATION OF BROOKS, STREAMS, DITCHES, LEDGE OUTCROP, ETC.
11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE w..-..
NOTE; LOCAL REGULATIONS SHOULD BE READ CAREFULLY.
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BOARD OF HEALTH OF NORTH ANDOVER ) MASSACHUSETTS
i
SEWAGE DISPOSAL
DATE , 1
NAME OF APPLICANT . a . ao Ql r or .f i D
LOCATION j,gj. ,#j Brsc "c ,�c3,
Address of lot no®
BUILDING: Dwelling Other
SYSTEM: New Y Repair
GENERAL DESCRIPTION OF LAND b1 . h
SUBSOIL: Clay__Z Gravel Sand
PERCOLATION TEST 12 minutes per inch.
MINIMUM INSTALLATION RECOMMENDATIONS
CONCRETE SEPTIC TANK 1 pgg gallon capacity.
LEACH FIELD 18 0 lineal feet of drain pipe.
William J. D i o"ll ) Engineer
Board of Healbil
SEPTIC SYSTEM INSPECTION FORM
ADDRESS i ?� � G I (c_'
DATE INSPECTED '
PROPERLY FUNCTIONING? > N
WEATHER CONDITIONS
COMMENTS :
a
WA^► E Z OVALI T Y TES T E'b f� JZEsOL'TSS
DYE TEST PERFORMED? Y N
DATE?
SKETCH:
Insurance Adjustment Service Inc.
435 Wng Street . Second Floor
Littleton, MA 01460
978-952-5966 o Fax 978-952-2459
Email: iaslittleton @netlplus.com
Date: /,? rp -
Board of Health: / , ,,.✓ , ,.�
Building Inspector: +«.
Fire Department:
Re: Insured:
Location: - , ~ M.,, 7, . ..
Claim Number: -
Policy Number:
Our File Number: w° .
Cause of Loss: .,,,
Date of Loss:
A
Dear Sir/Madam:
A claim has been made involving loss, damage or destruction of the above
captioned property which may either exceed $1,000 or cause Massachusetts
General Laws, Chapter 143, Section 6 to be applied.
If any notice under Massachusetts General Laws, Chapter 139, Section 313 is
appropriate, please direct that information to my attention and include a
reference to the captioned insured, location, date of loss and file number.
Thank you for your cooperation.
Very truly yours,
>
Scott O'Neil
Adjuster
Ext. Jr 29
1: J9
WATERSHED RESIDENTS QUESTIONNAIRE
1. Name
2. Street Address
3. How many members are in your household?
4. What type of sewage disposal system do you have?
❑ cesspool
[J septic 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 [�3 do not know
6. How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years Er 11-20 years
❑ over 20 years ❑ do not know
7. Has your sewage disposal system been rebuilt or repaired?
❑ yes 0' 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
[Y 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 V dishwasher garbage disposal
dehumidifier drain sump pump toilet _
roof/pavement drains shower/bathtub
11. Please state the brand and type (liquid or powder) of detergent you use for:
dishwasher
clotheswasher
12. Does your property have a lawn? [Z yes ❑ no
If yes, approximately what size? y/
❑ less than 1/4 acre El 1/4 acre 1 J 1/2 acre ❑ 3/4 acre ❑ 1 acre
❑ more than 1 acre (Specify) acres
13. How often do you fertilize your lawn?
No. of applications per year
Season(s) of the year
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
❑ Check here if your lawn is maintained by a professional landscape contractor.
Torn of North Andover, MA
Watershed Septic Syiste�a
lt r�� �'�rr��� �
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Servicine exaortu
Date:
Homeowner: Pumper wart's Septic Tank Svc.
Street : ,° "� 'm ��: -w� p �, Address: 47 Railroad St., Bradford
: / Phone ; 508-372-7471
Phone
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Nature of Service: Routine Lvv)e ,-ede
Emergency
Observations: Good Condition 2 ':
Full to Cover
Baffles in Place M—firfc---
Leachf ield Runback +
_ Excessive Solids
Heavy Grease 7r �
Roots
Other (Explain)
Description of Work:
Pump septic tank �� w, � � °���° ���.. ���.. ' � °���
Comments:
This is not a septic certification Should not be used to provide at closings.
That is an additional fee.
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