HomeMy WebLinkAboutMiscellaneous - 136 Hay Meadow Road % I 136 Haymeadow Road �Y 1
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Commonwealth of Massachusetts
City/Town of
System Pumping Record
yForm 4
DEP 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. Facility Information
1. System Location: Left/Right front of house, Left jghtrear of hous,a�, Left/right side of-house, eft/
Right side of building, Left/Right front of building, Left/Right rear of building, der de'
Address
City/Town State Zip Code
2. System Owner. n� �
Name �►`�\ v
Address(if different from location)
City/Town RECEIVED state ^ -� zip co
Telephone Number tet'
11AY 2-3 2013
B. Pumping �hkbl oRT�t�NDav
3 1�
1. Date of Pumping Date �2. Pumped: Gallons
3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No
5. Condition ot System:
6. System Pumped By:
Neil Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7. Location where contents were disposed:
. S. Lowell Waste Water
Date
t5form4.doc•06/03 System Pumping Record•Page 1 of 1
SOIL PROFILE & PERCOLATION TEST DATA
North Andover.I.'lss. No.&Street eG��Ocj Lot No. �(o
Loc./Subdiv. C"iC,_l�mPf�.CiC�I.JfY„/1 Plan Owner! I--�,�C,e1nS
Investigator f___ Q)OIr-CaGc�`�n Observer �ow
J
SOIL PROFILES-DATE
1' Elev. ?' Elev. 3'
Elev. ±---Elev.
0 0 0 0
Ties to Test Pits
2 2 2 2
3 3 3 3 -----—
4 �,1 4 _ - - 4 4
5 112,0 - O� 5 5 5
6 6 6 6
7 7 7 7
8 8 8 8
9 --- 9 9 9
10 10 10 10 "
Benchmark Location
Elevation Datum
Percolation Tests-Date
Date----- f
Pit Number 1 2 3 4 S
Start Saturation
Soak-Mins.
Start Test-Time
Drop of 3"-Time -
Drop
"-Time -Dro of 6"-Time 3 ; 41
Mins . lst. 3"Dro _ h!)A.
Mins . 2nd 311Dro -
Percolation Rate
i
4
Notes & Sketches on Back .�,
Board of Health BEPTIC SISTEK
North An ver Hasa. INSTALLATICK CHECK LIST LOT
(NID DATE DT PROVED EXOAVATION OK FAIL
- easDns�
qOK:
1. Distance Tot
a. Wetlands
b. Drains
c. Well
2. Water Line Location y
3. No PVC Pipe
�. Septic Tank
a. _Tess --Length & To Clean Out Covers.
b. Cement Pipe to Tank Oa Both Sides of Tank
5. Distribution Box
a. Covers & Box - No Cracks
b. All Lines Flowing Equal Amounts
c. No Back Flow
6. Leach Field or Trench
a. Dimensions
b. Stone Depth
c. Capped 'Ends
d. Clean DoubleWashed atone
7. Leach Pits
a. Dimen ons
b. Sto Depth
c. ash Pads
e Cement Pipe to Pit - Both Sides.
` Clean Double Washed Stone
8. No Garbage Disposal
9. Final Grading Inspection
10. Barricading Covered System
11. As Built Submitted.. .:
a. Lot Location . -- -
b. Dimensions of System
c. Location xi.th Re
garc�to Pert Test
d. Elevations
e; Water Table
i
t
Board of �lth
North Andor,Mass
SUBSURFACE DISPOSAL DESIGN CHECK LIST
LOT
APPROVED DATE __._ DISAPPROVED DATE
Provided: Reasons:
4iell7l
L 4
Title 9 V FAIL Ojb
Reg 2.5 ubmitted plan must show as a minimum:
e lot to be served-area dimensions lot #,abutters
cation and log deep observation hoes-distance to ties
cation and results percolation tests-distance to ties
sign calculations & calculations showing required leaching area
cation and dimensions of system-including reserve area
isting and proposed contours
g) cation any eget areas within 100' of sewage disposal system or
disclaimer-check wetlands mapping
h) face and subsurface drains within 100+ of sewage disposal
system or disclaimer
(i) location any drainage easements within 100, of sewage disposal
rsgsteta or disclaimer-Planning Board files
j) Loos= sources of water supply within 200, of sewage disposal
�_ocation
ystem or disclaimer
of any proposed well to serge lot-1001 from leaching facility
cation of water limes on property-101 from leaching facility
ocation of benchmark
iveways
garbage disposals
no PVC to be used in construction
N
profile of system-elevations of basement, plumb, pipe, septic tank,
stribution box inlets and outlets, distribution field piping and
BtLer elevations
maximum ground water elevation in area sewage disposal system
S) plan must be prepared by a Professional Engineer or other
professional authorized by law to prepare such plans
Reg 6 She tic Tanks
a) apac t es- 5E?% of flow, water table, tees, depth of tees,
access, pumping
1 eanout
I
01 from cellar wall or inground swimming pool
51 from subsurface drains
Reg 10.2 istribution Boxes
ape greater 0.08
Reg 10.4 b} sump
Subsurface Desi Check List Pae 2
FAL OK
Leaching Pits -
Leaching pits are preferred the installation is possible
Reg 11.2 a) calculations of lase area-rd ni== 500 sq ft
11.4 b) spacing
11.10 c) surface drainage
11.11 d) cover mat;SD
i
e) 2.'x2'x4I. sh pad
f) tee at w
g) no ben in pipe from d-box to pipe
jal
eachin Fields
Reg15.1 o gree er tan 20 minutes/inch
rea-mini m 900 sq ft
15.4 onstruction of field
15.8 urface drainage 2 %
3.7 01 from cellar val.1 or inground sw.inmdxag pool
Leachin Trac s
Reg 14.1 1a) c on o r"�eaching area-min 500 sq ft
14.3 b) spacing- t min 6 ft with reserve between
14.4 c) limen ns
14.6 d) c ction
14.7 e) s ne
14.10 f) surface drainage 2%
3b Slo e
a) sop y x = to be shown)
b) y/ x 1 (to be shown)
Reg 9.1 a) app val
9.6 b) s d-by power
fr i
SOIL PROFILE & PERCOLATION TEST DATA
Idorth Andover Is ss. No.&Street Lot No. 36
Loc./Subdiv. VPlan Owner
Investigator Observer
dj000 7f SOIL PROFILES-DATE
1' tlev. Elev. 3.
Elev. -�—'Elev.
0 0 0 0
Ties to Test Pits
2 2 2 2
3 3 3 3
4 4 4 4
5 5 5 5
6 6 6 6
7 7 7 7
8 8 8 8
9 9 9 9
0 10 10 10
Benchmark Location
Elevation Datum
P rc lation Tests-Date
Date-
Pit Number 1 2 3 4 S
Start Saturation caa
Soak-Mins. IZII
Start Test-Time
Drop of 311-Time - A.
Drop of 61'-Time
Mins . l st. 3"Dro 6
Mins . 2nd 3"Dro -
Percolation Rate
Notes & Sketches on Back
f
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