HomeMy WebLinkAboutMiscellaneous - 175 OLYMPIC LANE 11/24/2015 I
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North Andover Health Department
(ommunity and Economic Development Division
ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES
LOCATION INFORMATION
ADDRESS: 175 Olympic Lane MAP: 106.6 LOT: 0131
INSTALLER: Todd Bateson
DESIGNER:
PLAN DATE:
BOH APPROVAL DATE ON PLAN:
INSPECTIONS
Pipe INSPECTION: 11/23/15 Broken pipe from house to tank replaced
DATE OF BED BOTTOM INSPECTION:
DATE OF FINAL CONSTRUCTION INSPECTION:
DATE OF FINAL GRADE INSPECTION:
SITE CONDITIONS
❑ Contractor reports any changes to design plan
❑ Existing septic tank properly abandoned
❑ Internal plumbing all to one building sewer
❑ Topography not appreciably altered
Comments:
SEPTIC TANK
❑ Building sewer in continuous grade, on
compacted firm base
❑ Cleanouts per plan
❑ Bottom of tank hole has 6" stone base
❑ Weep hole plugged
❑ 1500 gallon tank has been installed
H-10 loading
❑ Monolithic tank construction
❑ Water tightness of tank has been achieved by
visual testing
❑ Inlet tee installed, centered under access port
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❑ Outlet tee installed, centered under access port
(gas baffle/effluent filter)
❑ inch cover to within 6" of finish grade
installed over one access port
❑ Hydraulic cement around inlet & outlet
Comments:
PUMP CHAMBER
❑ Bottom of tank hole has 6" stone base
❑ Weep hole plugged
❑ 1500 gallon Pump Chamber installed
❑ H-10 loading
❑ Monolithic tank 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
❑ cover at final grade installed over pump
access port
❑ Water tightness of tank has been achieved by
testing
❑ Hydraulic cement around inlet & outlet
Comments:
CONTROL PANEL
❑ Alarm & Pump are on separate circuits
❑ Alarm sounds when float is tripped
❑ Location of control panel: basement
❑ Alarm signal located inside: basement
Comments:
DISTRIBUTION-BOX
❑ Installed on stable stone base
❑ H-20 D-Box
❑ Inlet tee (if pumped or >0.08'/foot)
❑ Hydraulic cement around inlet & outlets
❑ Observed even distribution
❑ Speed levelers provided (not required)
❑ Schedule 40 PVC Pipe
Comments:
Installer
at 175 MPIC- --ANE---- ------------------------------- --- ---------------- ---------- ------------ -------------------
---- ------------- --- -----------
a s descri ed
tll' n'iro. t'
5 t�M ------------- _
-- ---------
No -j7 V,
ha5 e instalf1dinaccor ancewithth pro isionsofTIT E 5 o theState En iromn tal Code sdescri edinthe
al�plicat n for Disp al rks Construc 'o Permit No. _B____-___15-091_-- Dat d--- --oyq-mber-1- 201
------------ ---------------------- -- --------------------------
Printed On:Nov-19-2015 BOARD OF HEALTH
—--------------------------------- --------------------
Commonwealth of Massachusetts Map-Block-Lot
---- --106.BO131
----
BOARD OF HEALTH Permit No------------
North Andover BHP-2015-0911
-----------------------
FEE
$125.00
-----------------------
DISPOSAL WORKS CONSTRUCTION PERMIT
Permission is hereby granted Todd Bateson
--------------------------------------------- ------------------------------------------------------------
to(Repair)an Individual Sewage Disposal System.
atNo --1-7-5--OLYMPIC-LANE--------------------------------------------------------------------------------------------------------------------
as shown on the application for Disposal Works Construction Permit No. BHP-2015-091 Dated November 19,2015
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----------------------- ------------------------------
----------- -- - ---- -- ------
Issued On:Nov-19-2015 BOARD 0 F HEALTH L'THi"
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Applicat ion 1 fA tem
. > TODAY'S DATE
Construction rm it - TOWN
230.00—Full Repair
NORTH ANDOVER, MA 0184 $425.00-Component
Important: Application is hereby made fora permit to:
When filling out ®Construct a new on-site sewage disposal system*
farms on the
computer,use ❑Repair or replace an existing on-site sewage disposal system* /l
only the tab key epair or replace an existing system component—What? /7r1 7ry,,rk x )6"`s`)� -
to move your
cursor-do not
use the return A. Facility Information
key. .4 st✓ "
Address or Lot#
City/Town FIECE I D
` 2.-*TYPE OF SEPTIC SYSTEM*:
➢ ❑ Pump ®-G=ravity(choose one) application' �+O I �9 " I '1
''`lf pump systg�n attach copy of electrical permit es system) of our certifrcano
➢ � onventional System (pipe and stone system), 0 � F
➢ ❑Infiltrator or Biodiffuser(Gravel- es )( copy y r( 1�t �tlsystem.)
A ❑Pressure Distribution S.A.S.(No D-Box)
➢ ❑Pressure Dosed(D-Box Present)S.A.S.
➢ ❑ Does the system require an effluent filter? Yes No
If yes, does plan specify make and model of filter? YES=(no further info.needed)
NO=(installer must specify brand of filter before DWC issuance)
What is the Maker' whatis thcmodcAl
2. Owner Information
*lame
Address(if different from above) >
Cityfrown vo „ State Zip Code
� G n --
Telephone Number
s. Installer Information
Name Name of Comp f;ON r- F.'9, M. .
/,// A c�`t�e4- 111 ARC!LLA I
Address 0 i 61 U
CitylTown State Zip Code
Telephone Number(Cell Phone#If possible please)
4. Designerinformlabon
Name Name of Company
Address
City/Town State Zip Code
Telephone Number(Best#to Reach)
Application for Disposal System Construction Pettit•Page 1 of 2
�✓ �..�.
AoMficatighfor Septic Disposal System
�w.
.on tru tin , rmit ® T TODAY'S DATE
? >•...Etts..a � T 01845 $:250.00®Full Repair
sAeaus OVER, $'125.00 Component
. PAGE 2 OF 2
A. Fadiffly.Information continued....
5. TVpe'of Building: Wesidential Dwelling or®Commercial
B. Agreement
The undersigned agrees to ensure the construction and maintenance of the afore-described
on-site sewage disposal system In accordance with the provisions of Title 5 of the
Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of
North Andover, and hot to place the system 1n operation until a Certificate of Compliance has
been Issue Py this Board of Health.
Name Date
p C � p rove
/A d ( oar,
ti O Health Representative) � ,. ,..•
Na a Date
Application Disapproved.for the following reasons:'
For Of'de Use Only:
1. 'Fee Attached? Yes No
I. Ptolectl f".iger 0hEfgatron Form Attached., Yes No '
31: ,l'runS ? Ifso)Attach copy ofElecttrcal Permrt`, 'es No
4. FOund2donAs Burlt.?(hew construction ronly); Yes. No
(Same scale as approved plan)
S. F1oorPlans?(hew constructlonr only). Y.es_ No
Applfb tfdn'far-plsppsal 0ystdm%0®nMrucflon Permit Rage 2 oft
1
NT'PPL rjAATIQM
As Qic•N /i= et1 f�s��#e f �heseeptaceyv °tsx.the�p +p at:
1� .�.° /�/yam►;cm. �,.� '
(A ofl*dcsptaa) . --Aerplamby t
Rtb i"to ti Ap of
(3aii g>tamc Aid dated
Dated
s a Wink iivWora dated
f aed date)
I undentod the followlAg 0119at low for monagement of ihla protect: f,.
1. As the la I pwa.obligaW to 6bWsmffpem3lft aad'$oard 4Health+ppxow4 pkwptim on
aap: ciao R e�#e. I rrmarhr —,�.�lla�;'e.aedtt�a: its men ova °fs
2. At I III fox
die b� . . and &- I£ contmbQ4 p�rojectmaa� r,ar nny
*Oiapenontn�ifot oc&ted a�my compiq gdmh�xa�p�c�t andf7�c is notrcadp tha
dhtea AWLbi�plkabl& y
1!b f i pnd ltsrve; e y -pdalo the.ap Hcable 3tt et s� as
thil .
a b dan Cot Thb i �t ecd4 not have to bop sat .
b. t dart fitap cut&Z avri#blma;t ,etc.
o ,aEb QIC'(at amail{ra< p ; from the edgioerr p3apt
Abe itii )Word-to ACS 8oard`ofHealft amt: foi ii dine.'Iastallaz insist
6epreit fcr t at p ;! eltt:tt be Y
*ad able to
eauae puuap.tti Aviorh mid
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oath-
'S.. 1Sb tite.�nat�Itt�.X c�iderat�aa� ,�wvb �?c•oh'►dt�dt ���►_ c+e•pf t�foIl t�cfirm. ,
�: Det�ra}aa 'tka�t thr�t.t&a ptoprr�edeat aft&e• au�+�•+��s+errabea�E- _. '
b, Impoeitaa oif tk4wd,aad av-m U used
� 'PiailLaap�ot.ion'by,haw.crrla�"�Ierilt�rar�`'dreoa�trf�t�.
d Irutttota ofmsek, D-. eryp",JvftW,Croat,P!mp bri.t rtUnatf ot�ier .
carRAPaaeaO
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Commonwealth of Mas sachusetts
= CityfTown of North Andover
Pumping R ecord
Form 4 w DEP has provided this form for use by local Boards of provided re. Before us g thisuform,bcheck with your
information must be substantially the same as that proved Record must be submitted Lo
local Board of Health to determine the form they use. The System Pumping n date in
the local Board of Health or other approving authority within 14 days from the pumps g
accordance with 310 CM 15.351.
A. Facility information
important:When
511ing out forms 1. System Location: ��N"ia� Lowy
on the computer, , r
use only the tab
key to move your Address �11a 01886
cursor-do not North Andover Zip Code
use the return State
C-fiy/Town
key.
2. System Owner:
Name
Address(if different from location)
State Zip Code
City i ovvn
' Telephone Number
B. Pumping Record
1. Date of Pumping
2. Quantity Pumped: Galions
pate
3. Type of system: E] Ti ht Tank ❑ Grease Trap Cesspool(s) Septic Tank ❑ 9
❑ Other (describe):
4. Effluent Tee Filter present? ❑ Yes ❑ No if.yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System-.
6. System Pumped By:
Vehicle License Number
Name
Stewart's Septic Service
Company
7. Location where contents were disposed:
Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835
Signature of Hauler Date
Signature of Receiving Facility Date
System Pumping Record-Pag
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NA T'I„)RE O SERVICE; ROUTINE � EWRGE Nt'`r' ._
OBSERVATIONS
CCft71D CONDITION ._ ._._. FULL TU covIt
HEAVY ORRAS.L _._ BAFFLES IN PLACE
ROOT$
XCES"SIVF,SOLIDS,
O L IDS LEACI°1FEI:LD RUNBACK
SOLID CARRYOVER OTHER EXPLAIN
Syawsni Pwnpod by
e
COMMENT'S
CON ItN'I;S I"RANSt'tAR,ED 10
1
TOWN OF`NOZTH ANDOVER
SYSTEM PUMPING RECORD
DATE
SYSTEM OWNER&ADDRESS SYSTEM LOCATION
i .7 6 oly� pi 6 La
DATE OF PUMPING3 QUANTITY PUMPED
1 � a
CESSPOOL NO .�.NIES SEPTIC TANK NO YES
NATURE OF SERVICE;;RQUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION FULL TO COVER
HEAVY GREASE BAFFLES IN LACE
ROOTS LEACHFIELIJ RUNBACK
EXCESSIVE SOLIDS__T__-FLOODED
SOLID CARRYOVER OTHER EXPLAIN
SYSTEM PUMPED BY / r
COMMENTS;
CONTENTS TRANSFERRED TO �;
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�L\ Commonwealth of Massachusetts REC
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Cityfrown of 1 C-1 7,01(1
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System Pumping Record
0 NO AN' VER
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_�ALT 7�
DEPARTMENT
TOW14 OF NORT H ANDOVER
Form 4 HEAUTH DEPARTMENT
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 within 14 days from the pumping date in
accordance with 310 CIVIR 15351,
A. Facility Information
Important:
When filling out 1. System I-olation.
forms on the
computer,use C'
only the tab key Address 'J
to move your North Andover ma 01886
cursor-do not City/Town State Zip Code
use the return
key. 2, System Owner: V
Name
Address(if different from location)
City/Town state Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped: Gallons
3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Grease Trap
❑ Other(describe).
4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System:
hel�-4 1/y
6. Sy4tem Pumped By:
Name Vehicle License Number
Stewart Septic Service
Company
7. I-ol ion where contents were disposed:
ew
ew rj§ Pre treatment Plant 20 So. Mill St, Bradford Ma 01835
Sibnat-u-&MrHauler Date
Signature of Receiving Facility Date
t5form4.dDc•03/06 System Pumping Record•Page 1 of 1