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Num. Action Department
Board of Appeals - Board of Health - Planniing Board - Conservation Commission - Building Department
73
APPLICATION FOR SEWAGE DISPOSAL INSTALLATION
HEALTH DEPARTMENT - NORTH ANDOVER, MASS.
I hereby make application for a permit for a sewage disposal instal ion at
I will install this system in ac-
cordance ith 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 1% until 10 feet pre-
ceding the septic tank, where the grade shall not exceed 2q. I will install a con-
crete septic tank of lt-71!: 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 laid in a series of trenches, the bottom of which will pro-
vide a minimum of 4 Ci lineal (square) 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 1/8" to 1/4" (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 any portion of this installation until approved 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.
DATE �� 1-7 1�
Signature of Applicant
I hereby issue the above permit for the 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 of Inspecting Officer
Percolation Test
Garbage Grinder C
u
qL
J J
BOARD OF $EALTH
TOWN OF NORTH ANDOVER, MASS.
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1. NAME /i 2C°c, a R DATE
2. ADDIMSS F—o'r re s r S 1` LOT_NO. / TEL.
3. NO. OF BEDROOMS DEN YES NO �--
4. GARBAGE GRINDER YES NO Z--
5. SHOW DIMENSIONS OF HOUSE l--
6. SHOI•! DISTANCES OF HOUSE TO ALL PROPERTY LINES
7. SHOW DIMENSIONS OF LOT L,-
8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL C_-
g. NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM
10. SHOW LOCATION OF BROOKS, STREAMS, DITCHES, LEDGE OUTCROP, ETC. lVou,c
.r
11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE c---
NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY.