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Building Permit #1047 - Exception 12/22/1998
Lot & Street 'WT (.� Map/Parcel CONSTRUCTION APPROVAL Has plan review fee been paid: YES ' NO Permit—it' 1 b q 7 Plan Approval: Date: �? Approved by:_, & Designer: / _Pian Date: Conditions: Water Supply- Town -._ - WelI - - Well Permit: _.Driller: —^ Well Tests: Chemical Date Approved Bacteria I Date-Approved Bacteria II Date Approved - Plumbing•Sian-Off, Wiring Sign-Offi Comments: v Form"U" Approval: Approval to-Issue: YES NO Date Issued - i_ _g /• By: Conditions: i Final Approval: All Permits Paid? YES NO Well Construction Approval? _ ; NO Septic System Construction Approval? S NO Certification? NO Other S NO Any Variance Needed? YES NO� FLNAL BOARD F HEALTH APPROVAL: DATE: APPRO VED B v SEPTIC SYSTElY1 INSTALLATION Is the installer licensed? Type of Construction: 0 NO New Construction: -.__Certified Plot Plan Review REPAIR -Floor Plan Review NO _ Conditions of App roval from Form U , NO -Issuance of DWC permit: - YES NO _DWC Permit Paid? YES NO --DWC Permit I - - Installer: YES NO - -- -- --- _Begin-Inspection:_ - NO _ I -Excavation Inspection: -Needed: , ---Passed.- By: -- --Construction Inspection: Needed: As-Built-Plan Satisfactory: .. YES.- t:- Approval of Backfill: Date: By: / G , --Final Grading Approval: Date: B / / ` ' etc, y: Final Construction Approval: Date: Lf _ / By: Certificate of Compliance: Approval: 9 Date: i Aventis Pasteur Aventis i/►--..-rte� �a.�/ ��..a.� �..,�,«-- : X1,5 ( 1' � s Aventis Pasteur Inc. Discovery Drive•Swiftwater PA 18370 www.us.aventispasteur.com MKT6072 Telephone 1-800-VACCINE(1-800-822-2463) { Of NORTN 7046 4. o 110 Town of North Andover ; HEALTH DEPARTMENT i CHECK#: DATE: -� 1 LOCATION: 5,r7) oil H/O NAME: CONTRACTOR NAME: 1Ype of Permit or License:(Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ DumP sten $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTICSystems : ❑ Septic-Soil Testing $ j ❑ Septic-Design Approval $ 1 ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ T' le 5 Inspector $ Title 5 Report $ ❑ Other. (Indicate) $ Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer Commonwealth of Massachusetts Title 5 Official Inspection Form RECO Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 135 Candlestick Road rN"0`V 0 3 2014 �L Property Address TOWN OF Nr 8-fh AlVd� 7 John Whidden Owner Owner's Name information is required for North Andover MA 01845 10/22/2014 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Neil J. Bateson cursor-do not Name of Inspector use the return key. Bateson Enterprises Inc. Company Name VQ 111 Argilla Road Company Address Andover MA 01810 City/Town State Zip Code 978-475-4786 S115 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Need urther Evaluation by the Local Approving Authority 10/22/2014 Insp ct rs ignature 1. Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 1 of 17 1' Commonwealth of Massachusetts ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 135 Candlestick Road Property Address John Whidden Owner Owners Name information is required for North Andover MA 01845 10/22/2014 every page. Cityfrown State Zip Code Date of Inspection i B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D i A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 r Commonwealth of Massachusetts ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .'' 135 Candlestick Road Property Address John Whidden Owner Owner's Name information is required for North Andover MA 01845 10/22/2014 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): I C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 135 Candlestick Road Property Address John Whidden Owner Owner's Name information is required for North Andover MA 01845 10/22/2014 every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 135 Candlestick Road Property Address John Whidden Owner Owner's Name information is North Andover MA 01845 10/22/2014 required for every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments j 135 Candlestick Road Property Address John Whidden Owner Owners Name information is required for North Andover MA 01845 10/22/2014 every page. Cityrrown State Zip Code Date of Inspection j C. Checklist Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? I ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ElWas the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 135 Candlestick Road Property Address John Whidden Owner Owner's Name information is required for North Andover MA 01845 10/22/2014 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: i I Number of current residents: 5 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d Yes 9 ( Y 9 (gP ))� Detail: I Sump pump? ® Yes ❑ No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ..' 135 Candlestick Road Property Address John Whidden Owner Owner's Name information is required for North Andover MA 01845 10/22/2014 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) I Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Pumped 2009, owner Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Measured tank Inspect tank&tees Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach,a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 135 Candlestick Road Property Address John Whidden Owner Owner's Name information is required for North Andover MA 01845 10/22/2014 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 15 years old, 5/27/1999, as built plan Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 5 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): 4" PVC through wall, 3" PVC in house no leaks visible Septic Tank(locate on site plan): Depth below grade: 4 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10'x 5'x 4' Sludge depth: 3" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 ' I Commonwealth of Massachusetts j T Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 135 Candlestick Road I Up. Property Address John Whidden Owner Owner's Name information is required for North Andover MA 01845 10/22/2014 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 30" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 12" How were dimensions determined? Tape Measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumped septic tank. Outlet tee ok. Depth of liquid at outlet invert. No evidence of leakage. Center cover has riser 8"deep. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene y El other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 135 Candlestick Road Property Address John Whidden Owner Owner's Name information is North Andover MA 01845 10/22/2014 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): i "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 135 Candlestick Road Property Address John Whidden Owner Owner's Name information is required for North Andover MA 01845 10/22/2014 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box level &distribution equal. No evidence of carryover. No evidence of leakage. i i Pump Chamber(locate on site plan): Pumps in working order: ® Yes ❑ No* Alarms in working order: ® Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Pump ok. Alarm ok. Alarm has both audible&visual. *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): i If SAS not located, explain why: t5ins•3113 Tdle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 I Commonwealth of Massachusetts • ` Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments I 135 Candlestick Road Property Address John Whidden Owner Owner's Name information is North Andover required for MA 01845 10/22/2014 f every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: i ❑ leaching chambers number: I ❑ leaching galleries number: ® leaching trenches number, length: 3 trenches 45' long ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil ok. Vegetation ok. No sign of ponding to surface. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts U Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 135 Candlestick Road Property Address John Whidden Owner Owner's Name information is required for North Andover MA 01845 10/22/2014 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts • Title 5 Official Inspection Form Subsurface Sewage Disposal System Forth-Not for Voluntary Assessments 135 Candelstick Road Property Address John Whidden Owner Owner's Name information is required for North Andover MA 01845 10/22/2014 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately o (1)A,,, - I - �. i t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 135 Candlestick Road Property Address John Whidden Owner Owners Name information is required for North Andover MA 01845 10/22/2014 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar i ® Shallow wells Estimated depth to high ground water: 4 feet Please indicate all methods used to determine the high ground water elevation: i ® Obtained from system design plans on record If checked, date of design plan reviewed: 10/15/1998 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: Design plan Checked with local excavators installers❑ a ers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: As per test pit data on design plan I Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 t Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 135 Candlestick Road Property Address John Whidden Owner Owner's Name information is required for North Andover MA 01845 10/22/2014 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file j i I I I t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Commonwealth of Massachusetts . City/Town of . System Pumping-Record 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/ ►g ar ouse Left/right side of house, Left/ Right side of building, Left/Right front of building, Left I R-IgWrear of building, Under deck Address state Trp code 2. System Owner. Name ° Address Cd different torn location) c4frown Staff Zip Code ; z Telephone Number c7[1 ,16;- B. Pumping Record 1. Date of Pumping I q �2uanft Pumped: oanons �—D —' 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yeas No if yes, was it cleaned? ❑ Yes ❑ No. ' S. Condition of System: 6. System Pumped By: Nell.Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc- Company ncCompany 7. Lo ere contents were disposed: 3 Lowell Waste Water Sig Haul Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 NEW ENGLAND ENGINEERING SERVICES INC December 17, 2004 Susan Sawyer North Andover Board of Health 400 Osgood Street North Andover, MA 01845 Re: 135 Candlestick Road, North Andover As-Built Plan Pump Relocation Submittal Dear Susan: The following As-Built Plan Pump Chamber Relocation plan for the above referenced property is being submitted for approval. Enclosed are the following: 1. (3) Copies of the As-Built Plan Pump Chamber Relocation. 2. Copy of Designer's/Installer's Certification Form. Please contact this office with any questions or concerns. Sincerely, BenjaminC. Osgood, , PE President 60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 TOWN OF NORTH ANDOVER Koa7y , . Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT " 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 ��ss/1CHUSEtty Susan Y. Sawyer,R.EHS/RS 978.688.9540-Phone Public Health Director 978.t88.9542-F SEPTIC SY M CO STIR CTION NOTES ADDRESS:/3.5 �, w�l lr -�-��� MAP:_ LOT: INSTALLER: DESIGNER: PLAN DATE: BOH APPROVAL DATE ON PLAN: l ? DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SELECT SYSTEM TYPE GRAVITY DISTRIBUTION PRESSURE DISTRIBUTION PRESSURE DOSING HOLDING TANK ADVANCED TREATMENT OTHER — Cry �G�� �Uk44%- . COMPONENT SUMMARY FROM PLAN GALLON TANK = LOADING OF SEPTIC TANK = GALLON PUMP CHAMBER = LOADING OF PUMP CHAMBER = TYPE OF SAS = DIMENSIONS AND DETAILS OF SAS: SITE CONDITIO ❑ Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer ❑ Topography not appreciably altered Comments: Page 1 of 2 TOWN OF NORTH ANDOVER NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES 04M1V °. ,4F0 ,61yo` ? ,Io HEALTH DEPARTMENT m 27 CHARLES STREET NORTH ANDOVER,MASSACHUSETTS 01845 �'qS R^nv "EttZ SCHUs Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX SEPTIC TANK //� GL` C - — Q ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ gallon tank has been installed (H-10 or H-20) (monolithic or 2 piece) ❑ Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ❑ Inlet tee installed, under access port ❑ Outlet tee (gas baffle or effluent filter) installed, under access port ❑ 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 ❑ gallon Pump Chamber installed (H-10 or H-20) (monolithic or 2 piece) ❑ Inlet tee installed, under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off float working ❑ Drain hole in pressure line ❑ inch cover to within 6" of final grade installed over one access port ❑ Water tightness of tank has been achieved Visual or Vacuum Test or Water held for 24 hrs ❑ Hydraulic cement around inlet & outlet Comments: s7- 1) P"pe-- s pip=.-I �sf.?- ` We 2 of 2 TOWN OF NORTH ANDOVER f F raRry 1 Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET *", . .•" NORTH ANDOVER,MASSACHUSETTS 01845 �RSSACNUSEt�� Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX D-BOX ❑ Installed on stable stone base ❑ Inlet tee (if pumped or >0.08'/foot) ❑ Hydraulic cement around inlet & outlets ❑ Observed even distribution ❑ Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEM ❑ Bottom of SAS excavated down to soil layer, as provided on plan ❑ Size of SAS excavated as per plan ❑ Title 5 sand installed, if specified on plan ❑ 3/4-11/2" double washed stone installed ❑ 1/8-1/2" (peastone) double washed stone installed ❑ laterals installed and ends connected to header(and vented if impervious material above) ❑ Orifices @ 5 & 7 o'clock positions ❑ Gravelless disposal systems: type, number and location as per plan ❑ Elevations of laterals installed as on approved plan ❑ 40 Mil HDPE barrier installed ❑ Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: PRESSURE DISTRIBUTION ❑ inch manifold ❑ laterals installed with end sweeps size: material: ❑ Squirt test ft in height ❑ Equal distribution to all laterals ❑ orifice size inch as per plan Comments: Page 3 of 3 TOWN F Office of COMMLN TY EV ELp ANDOVER PMENT AND SERVICES 3 of ttORTy•q U HEALTH DEPARTMENT j kM1TLfD �h 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS H* Susan Y. Sawyer,R.EHS/RS 01845 *��°M1rec.r}y',. Public Health Director SS�CHUSE�`h 978.688.9540—Phone 978.688.9542--FAX CONTROL PANEL 11 Alarm & Pump are on separate circuits 0 Alarm sounds when float is tripped El Location of control panel: Comments: Rated for exterior if placed outside SYSTEM ELEVATIONS Benchmark: Rod at Benchmark: Height of Instrument: INVERT ON DESIGN PLAN ELEV@ TOP OF PIPE INVERT ELEVATION Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN D-Box OUT Manifold Lateral 1 HIGH Lateral 1 LOW Lateral 2 HIGH Lateral 2 LOW Lateral 3 HIGH Lateral 3 LOW Lateral 4 HIGH Lateral 4 LOW Lateral 5 HIGH Lateral 5 LOW Page 4 Of 4 Dellechiaie, Pamela From: Sawyer, Susan Sent: Monday, December 13, 2004 9:28 AM To: Dellechiaie, Pamela Subject: RE: Bottom Of Bed Inspection -889 Johnson Street&Tank Inspection - 135 Candlestick Sensitivity:Confidential set for this AM @10:30. 1 called him Susan -----Original Message----- From: Dellechiaie,Pamela Sent: Friday, December 10,2004 12:38 PM To: Sawyer,Susan Cc: Grant, Michele Subject: Bottom Of Bed Inspection-889 Johnson Street&Tank Inspection- 135 Candlestick Importance: High Sensitivity: Confidential Hi Susan, Ralph Simard is requesting a BB inspection for 889 Johnson Street on Monday. Please call him with a time. Also, needs tank inspection for Candlestick. He has pulled the tank and relocated. The electrician is pulling a permit on Monday a.m. to do his part. Please call him at 508.958.2002. Thanks, P Tbwn of`North Andover /Z 11��4 Health Department Date: Location: (Indicate Address, if Residential,or Name of Business) Check#: Type of Permit or License: (Circle) Animal $ ➢ Dumpster $ f ➢ Food Service-Type. $ r ➢ Funeral Directors $ e ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal(Septic)Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ Sptic Disposal Works Co cti n DWC)$ ❑ Septic Disposal Works Inst� DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ Trash/Solid Waste Hauler $ ➢ Well Construction $ ➢ OTHER(Indicate) Health Agent Initials 30-13 White-Applicant Yellow-Health Pink-Treasurer TOWN OF NORTH ANDOVER NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES 0 HEALTH DEPARTMENT 27 CHARLES STREET �, r NORTH ANDOVER, MASSACHUSETTS 01845 �9SSAC NUS �� Susan Y.Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX bealth fttCd4ownofnorthandover.com www.townofnorthandover.com APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE:—/)-- 2-0' LOCATION: P (_ole//►1i r f�c LICENSED INSTALLER NAME: ��y�// ��►, PLEASE PRINT SIGNATURE: TELEPHONE# CHECK ONE: FULL SYSTEM REPAIR: ($250) COMPONENT REPAIR(indicate what parts): c-A,4- ($125) * NEW CONSTRUCTION: * If NEW CONSTRUCTION, please attach the Foundation As-Built Plan. $250.00 q Lr$1�25 _ee Attached? Yes No Project Manager Obligation From Attached? Yes No J g g Foundation As-Built? Yes No Floor Plans? Yes No Approval of Health Agent �i2 to r INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at—8 (Iic 4 relative to the application of/35/ph fry/] dated for plans by I and dated /I1✓ e- °" with revisions dated 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 approved 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 manger, 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 necgssary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Tile 5 and the Board of Health Regulations may result in a$50.00 fine being levied against my company. a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final inspection — Engineer must first do their inspection for elevations, ties, etc. As-built or verbal OK from engineer must be submitted to Board of Health, after which installer calls for inspection time. Installer must be present for this inspection. With 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. Does not have to be on site. 4. As the installer I understand that only I may parform the work (other than simple excavation) required to complete the installation of the system identified in the attached application for installation. I further understand that work 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. b) 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 plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer Date: Disposal Works Construction Permit# I NEW ENGLAND ENGINEERING SERVICES lk INC November 9, 2004 ' Nov _ Susan Sawyer r«. 2D04 North Andover Board of Health �_�Q ,� N AND 400 Osgood Street LzpAf? 4 0PFR North Andover, MA 01845 Re: 135 Candlestick Road,North Andover Pump Chamber relocation Dear Susan: Enclosed are 5 copies of a pump chamber relocation plan for the above referenced property. This plan is being submitted for approval. I The owner of the property would like to add an addition to the rear of his home. In order to add the addition where desired, the pump chamber has to be moved so the Title 5 offsets are met. This office has used existing information on file here as well as updated survey information showing the pool that was installed since the original house construction to depict where the pump chamber is proposed to be installed. The proposed relocated pump chamber meets all of the requirements of Title 5. Hopefully all of the information you need is shown on the plan. If you have any questions, or need additional information, please do not hesitate to contact this office. Sincerely, C0I �/— Benjamin C. Osgood, Jr.,P.E. President 60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does no the applicant and/or landowner from compliance with any applicable or requirements.t relieve APPLICANT FILLS OUT THIS SECTION APPLICANT 0/-/P vc C,,,Q AJ PHONE ) -7 LOCATION: Assessor's Map Number I D 6 3 PARCEL 10`� SUBDIVISION (\ LOT (S) )4 STREET ST. NUMBER r-33— OFFICIAL 33— OFFICIAL USE ONL RECOMMENDATIONS OF TOWN AGENTS: V% CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD IN16 ECTOR-HEALT DATE APPROVED f :' DATE REJECTED EPT`IC INSPECTOR= TH DATE X PROVEDDATE JECTED R COMMENTS a PUBLIC WORKS -SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE RsvlsW 9197Im • Town of North Andover °f NORTIt Office of the Health Department Community Development and Services Division 400 OSGOOD STREET +� ,�••�:�. .r • North Andover,Massachusetts 01845 �CHU Susan Y. Sawyer,REHS/RS 978.688.9540-Phone Public Health Director 978.688.8476-Fax CWq ; FICArI E O FC09WIDrIA�VC2 As of: ,dune 9, 2005 This is to cert that the individual subsurface disposal system Constructed(-- or Repaired— Pump c� Tank Relocation(-4) by Rafph ,Simard at 135 Candfestick AV North Andover, gv q 01845 has been installed in accordance with the provisions of Titre v of the State Sanitary Code and with the North Andover hoard of Yfealth regulations. The Issuance of this certificate shalt not 6e construed as a guarantee that the system wilt function satisfactorily. us 2'. Sawyer Pu6fic Yfealth Director BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Town of North Andover f N°R*M Office of the Health Department Community Development and Services Division + - 400 OSGOOD STREET * ,e�„s'�•°�+ North Andover,Massachusetts 01845 cNusc i Susan Y. Sawyer,RENS/RS 978.688.9540-Phone Public Health Director 978.688.8476-Fax i CE�'�I2�'ICA�E Off' CO�Vl'1'. jA.1-L CE As of: ,dune 9, 2005 Thiir is to cern that the individual su6surface d7sposafsystem Constructed(-� or Repaired— Pump c� Tank Relocation by Ralph Simard at 135 Candlestickad Xorth Andover, (R,4 01845 has been instaffed in accordance with the provisions of Tj�tfe v of the State Sanitary Code and with the North.Andover(BoardofYfeafth regulations. The Issuance of this certificate shaft not 6e construed as a guarantee that the system wiff function satisfactorify. us 7 Sawyer TO&Yleafth Director BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 LETTER OF TRANSMITTAL North Andover Health Department a� ND1R0T 6 400 Osgood Street North Andover,MA 01845 0 �•�'"' 978.688.9540 - Phone 978.688.8476 - Fax healthdept(i ,townofnorthandover.com - E-mail www.townofnorthandover.com -Website Page of AGHUS TO: DATE: Benjamin C. Osgood, Jr., P.E. COMPANY: FROM:Pamela DelleChiaie, Health Dept. Assistant New England Engineering Services, Inc. RE: Phone: 978.686.1768 Fax: 978.685.1099 We are sending you: OPlan Review Letter OAPPROVED ONOT APPROVED �ystemConstruction Follow-Up OOther These are transmitted as checked below: or your File OAs Required OAs Requested OFor Your Use REMARKS: COPY TO: Fax# or Mailed COPY TO: Fax# or Mailed COPY TO: Fax# or Mailed TRANSMISSION VERIFICATION REPORT TIME 06/10/2005 12:17 NAME HEALTH FAX 9786888476 TEL 9786888476 SER.# 000B4J120960 DATE DIME 06/10 12:16 FAX N0./NAME 89786851099 DURATION 00:00:54 PAGE(S) 03 RESULT OK MODE STANDARD ECM Y - TOWN OF NORTH ANDOVER SEW ;GE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System( )'constructed; located at 1 L � C��P i e was installed in conformance with the North Andover Board of Health approved plan, System Design Permit-# .plan dated- 'Of with a design flow gallons per day. The mat&usod were in conformance with those spocifid the - aPproveclplan;tl�e system waas instfficd in a&or&,djm.� �e provisions of'310. -CM-15.000,Tits 5 and local»egulations,.and the final • grading agrees-substantially with the.npproved plan. All work is:aocarately represented on the As built which has been subniittdto�the Board of health.. AW inspection date: • - . Engineer Representatiye Final inspection date: Engineer Representative • Installer. ` r' . Date• OF Engineer. ti Date:_l2/t��5 A INC CIVIL ; NO.46891 FFGISTERti� t OD i zo Ln Y- 1tii!f.'^'t;-C�_1•'C.�ti-•-� .�J,.R i �..YR 7i-3+..i�:�.. i.'jl�f`�..�`.� •- t'.>•.v:�� .1ih Y .V. .. ... -+ N U7 ;..-- ra a L 01— IL IC Cul 4 Le M, L,=.==� b - nl lt�lF51i7 7'A• 1 I I t]•aJ V N 1 I 1 � i I >v 1 I f 1 ! I �VhVV+I"l�3 � axr I r 4--0' Ra• ac e� rw a<^ N I I t eao• O 1 � Z � N a f f I 4 T J#WOOMI19 9 y s� ~kcal MmNd � c WON A- 1 pp �•� y� I � I � � �Q. A 0���a� � v � .os 1 ..a,c sa.1 .rricr.a �1 .►ar.a .. 1 3 - i .3 � ►v_t A , 1 '1 i � � � -- non 1 '- �• O 81d WOl%s(ly EI �, f; .�ner.►rcrt � 0 1 cv Win, � 1 i 11 co Ln Ln i 00i co l3� Address 2 Title of File Page of Date File Open: Date fele closed: . Doc Document/Action Title Date of Refer to other Purpose of©ocumeEnt/Action and note action Document/ document/ Num. Action De artment ------------- _ Board of Appeals - Board of Health Planning Board - Conservation Commission - Buiidin De -- �- g partnlent /_0 FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT i- a�� �i d� PHONE ASSESSORS MAP NUMBER 10 LOT NUMBER Q l SUBDIVISION LOT NUMBER STREET d Pot-- t� —t7 o_k �e„ STREET NUMBER 35 ........i.................................................................0 OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENIvan 01 TS o� now DATE APPROVED CONSERVATION ADMINISTRATOR DATE REJECTED COMMENT'S 6 W E��h,^�S �.�/i-, 1 (3o TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS DATE APPROVED FOOD INSF�O?A- EALTH DATE REJECTED DATE APPROVED o V CTOR-HEALTH DATE REJECTED COMMENTS /1-, 1 L-,sc� PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMTf FIRE EPid4 DATE APPROVED DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE & LOUIS SCUTELLARO __EV. T 4 (--'A N D L'_STJ"K R(_ AD aSSPESS0RS MAP 106A PARCEi- 1104 44 1 ODr7l ISONTRENCH #,3 —TRENCH #2 DIST 7 Z:� # ,—TRFNCH 2- SCH. 40 P'.V.e- P.T. R16 U TO N _0RCE MAIN r N Box P 0 Z P. #2_ �4 # A 0 - 0 0 y --7L- DCC ---- PUMP CHAVE 1500 GALT-ON PUMP CFJ,,4MKF )NNECTELI VENTED. VENT C6 397. 99� N44031 07 E N/F THOMAS & KATHLEEN WILLIAMS AOR i'� - D of 0� dover No. �'-i�A 000�,�Q dover, Mass., a V 0 R9TED Cl BOARD OF HEALTH PERMIT T D Food/Kitchen Septic Syste �� 9, �M�r 11♦S �� r 0 nN B �r P Akjjj*ovL ING INSPECTOR THIS CERTIFIES THAT............................................................................. ... .............................................. 11 ""' (/' ' Foundation has permission to erect.........'.............................. buildings on ..h� ...�.y.... .�.�5....CA0410?A�l�l` Rough g to be occupied as ....................... ��� Y m b�i1 �� ,� �� �R M y . ............................. .................................................................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS VTHS Final UNLESS CONSTRUC_jqN ST P�R J ELECTRICAL INSPECTOR Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE: 06/02/99 This is to certify that the individual subsurface disposal system constructed (X) or repaired ( ) i by Raymond Fraser at 14 Candlestick Road has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations as described in the Design Approval Site System Permit# 1047 dated 12/22/98. i The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Board of Health Inspector FORM U - VERIFICATION FORM ` INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant. and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: �� J! .)!� %� ' ii r/ Phone LOCATION: Assessor' s Map Number /0 6, Parcel S11bd1V1SlOri _ ��/�'��✓� �L�r� �-"/..,�' �-' � � Lot(s) Street �� i���� N , r r - // l� ` � l�- St. Number - J� ************************Official Use Only************************ RECO NDATION 'OF TOWN AGENTS: //1 � � � Date Approved 12- ? Conservation Administrator Date Rejected Comments y- Date Approved ! Town Planner Date Rejected Comments Date Approved Food Inspec�toHealth Date Rejected z J� Date Approved Septic nspector-Health Date Rejected Comments Public Works - sewer/water connectionsw driveway permi 1-11�,, —2 Fire Department Received by Building Inspector Date APPLICATION FOR DISPOSAL WORKS PERMIT -ow 55 DATE: CURRENT IJ LOCATION: L67 14 CAA)D.ESTrCK LICENSED INSTALLER: /�j9yr1/fj),(,D % SIGNATURE: TELEPHONE# 9�78 "�YV 814& CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTA 2T. G U � � � G s� - .�, $75.00 Fee Attached? Yes Foundation As-Built? Yes Floor Plans? Yes Approval Date: APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT C SGL q7g-8�2-,Roo l DATE: CURRENT INSTALLER'S LICENSE# LOCATION: LO? 14 CA�DGEbTiCK 1'DA LICENSED INSTALLER: fPOY /fOI)b l F1f' , SIGNATURE: TELEPHONE# 9'78 CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only G $75.00 Fee Attached? Yes `� No Foundation As-Built? Yes •� No Floor Plans? Yes No Approval Date: Town o NortF€ Artcover, Massachusetts Form No.3 �� � �� ICAID HEALTH 19 CHU$� DISPOSAL WORKS CONSTRUCTION PERMIT Applicant NAME ADDRESS Site LocatiOri TELEPHONE Permission is hereby granted to Construct ( or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. /0q 7 CHAIRMAN, BOA RDOF HEALTH Pee_ z. w. of INVOICE (?r,T 23 I J Date: October 22, 1998 To: Town of North Andover Board of Health 30 School Street North Andover, MA 01845 Attention: Sandra Starr, Administrator Summary of Bills Attached: Boxford Street Retest $ 250.00 205 Forest Street 100.00 1468 Salem Street 100.00 Bradford Street 250.00 135 Foster Street 45.00 10 Duncan Street 250.00 1175 Turnpike Street 45.00 114 Penni Lane 100.00 Lot 14 Candlestick Lane 350.00 227 Berry Street 100.00 Lot 17 Boston Street 100.00 Current Total $ 1,690.00 Prior Balance Due 3,940.00 Total Now Due $ 5,630.00 PORT _____= ENGINIMING 1 Civil Engineers& Land Surveyors One Harris Street Newburyport,MA 01950 (978)465-8594 � sa INVOICE i Date: October 22, 1998 I To: Town of North Andover Board of Health 30 School Street North Andover, MA 01845 Attention: Sandra Starr, Administrator Re: Lot 14 Candlestick Lane For Professional Services Rendered: Soil Testing and Two Extra Holes As Per Proposal $ 350.00 PORT MINEEHING Civil Engineers& Land Surveyors One Harris Street Thank you for having us attend to this matter for you. Newburyport,MA 01950 (978)465-8594 Town of North Andover t NORrk , OFFICE OF �?o�` 6 6h°0 COMMUNITY DEVELOPMENT AND SERVICES ° :' p 27 Charles Street North Andover,Massachusetts 01845 �4SSgCHUS�`�y WMLIAM J. SCOTT Director (978)688-9531 Fax(978)688-9542 Mark Rea Belford Construction -- �� 1049 Turnpike St. North Andover, MA 01845 Re: Lot 14, Candlestick Lane Dear Mr. Rea: On October 15, 1998, the Lot referenced above underwent soil testing which was witnessed by Port Engineering. Because (2)two additional holes were witnessed which were not covered by the original fee,there is an outstanding balance of$100.00. Please remit a check for this amount ($100.) to the North Andover Board of Health and reference the additional work. Please call the office at the number listed below if you have any questions. Sincerely, Sandra Starr, R.S. Health Administrator BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 i TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System constructed; ( )repaired; by (f6,v b I located at Loi � was installed in conformance with the North Andover Board of Health approved plan, System Design Permit#1P y -, dated with an approved design flow of y410 gallons per day. The materials used w e in 6odormance with those specified on the approved plan;the system was installed in accordance with the provisions of 310 CMR 15.000,Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented o U'lt which has been submitted to the Board of Health. Installer: Lic. #: Date: ;///?/a Design Engineer Date: ' bpi C Town of North Andover, Massachusetts Form No.2 NORTH BOARD OF HEALTH aS o?•'�' ' °0 19 F w ' t � DESIGN APPROVAL FOR *I,b��ne,,A•`,�j HU SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant Test No. Site Location �� 1 �-( CJZ Reference Plans and Specs. N C)S C�s'� /'o.�� • ENGINEER ) DESKIN U DATA Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. r j — CHAIRMAN,BOARD O"EALTH ' Fee Site System Permit No. fb AS-BUILT CHECKLIST LOT NUMBER, STREET NAME ASSESSORS MAP & PARCEL NUMBER / LOT LINES & LOCATION OF DWELLINGS t/ LOCATION & DEMENSIONS OF SYSTEM, INCLUDING RESERVE TIES TO LOT LINES & DWELLING, WELLS a. FROM SEPTIC TANK b. FROM LEACH AREA LOCATIONS OF DEEP HOLES & PERC TESTS ELEVATIONS OF DISPOSAL SYSTEM IX TOP OF FDN ELEVATION LOCATIONS OF WELLS, DRAMS, WATERCOURSES W/IN 150' OF SYSTEM _V LOCATION OF WATER,--GAS, ELECTRIC LINES, CABLE DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK & D-BOX IJ STAMP & SIGNATURE IMPERVIOUS AREAS - DRIVEWAYS, ETC. C/ NORTH ARROW car FINAL CONTOURS LOCATION & ELEVATION OF BENCHMARK USED LOCUS PLAN NEW ENGLAND ENGINEERING SERVICES INC H AHO SOWN OF��of HEALTH BOA OEO 1 g 199$ December 18, 1998 San dra Starr, Administrator North Andover Health Department Town Hall Annex 27 Charles Street North Andover, MA 01845 Re: Lot 14 Candlestick road septic tic desi n p g Dear Sandra: i In a conversation with Susan Ford yesterday she conveyed to this office two small changes that needed to be made to the above referencedlan. They y are as follows: 1. Note 6" of stone under the septic tank and pump chamber. This was done on the previous plans on the details on page 2. The note referred to 12"compacted p ted ravel. The note has been changed to read 6 compacted stone. 2. The distance from the septic tank to the house was noted as 15 feet on the plan view and 10 feet on the profile view. The profile feet. p p ile view was wrong and has been changed to 15 These two changes should complete this submittal and allow the plans to be approved. Unless I hear otherwise, I will assume a letter of approval will be forthcoming. If you have any questions or comments please do not hesitate to contact this office. Sincerely, Benjamin C. Osgood, Jr., EIT President 33 WALKER ROAD-SUITE 23-NORTH ANDOVER, MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 SEPTIC PLAN SUBMITTAL FORM LOCATION: I NEW PLANS: YES $125.00/Plan REVISED PLANS: YES $ 60.00/Plan SITE EVALUATION FORMS INCLUDED: YES NO DATE: ZI S L2<<, DESIGN ENGINEER:�e�it/ �,�/a ;•'�5r P�'/z�f-r ��^�C�s In DATE TO CONSULTANT: oZ 7 1 When the submission is all in place, route to the Health Secretary. • .x 1 Town of North Andover t HORT1y , OFFICE OF 3?O ett�t o ti0 COMMUNITY DEVELOPMENT AND SERVICES0 to 27 Charles Street " North Andover, Massachusetts 01845 �9`°q•ro�P"'`cy* 9Ssq WILLIAM J. SCOTT CN us�� Director 978 688-9531 Fax (978)688-9542 December 23, 1998 Ben Osgood, Jr. New England Engineering 33 Walker Road, Suite 23 North Andover, MA 01 845 Re: Lot 14 Candlestick Road Dear Ben: This is to inform you that the proposed plans for the site referenced above have been approved. If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Since ely, o ✓ Sandra Starr, R.S. Health Administrator SS/cjp BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Dec-06-98 09: 26P Paul D. Turbide, PE/PLS 508-465-0313 P.03 December 6, 1998 Sandra Starr North Andover Board of Health Administrator Office of Community Development and Services 30 School St. North Andover,MA 01845 RE: Title V review for Lot 14 Candlestick Road Dear Sandra, Enclosed find the"Checklist for North Andover Septic System Plans"for the above- mentioned site. We did find the following problem areas or deficiencies. 1. The septic tank and dosing chamber both need 6 inches of stone base. 310 CMR15.221(2)and 310 CMR 15.228(1) 2. The plan shows the septic tank being 15 feet away from the foundation, while the System Profile shows it being 10 feet away. 3. 310 CMR 220(4)(q)states: "Every plan...shall include depiction of... the location and elevation of one benchmark within 50 to 75 feet of the facility..."The plan does not show such a benchmark. However,Note#20 of the design plan states: "Benchmark to be set by engineer prior to construction within 50' of proposed �j system."Therefore,approval of this plan should be made subject to the condition shown on the plan in Note 920. If you have any y questions or comments please feel free to contact us. J Sincerely, Carlton A. Brown,PE/PLS P PT 01ti ENGIN��flING Civil Engineers& Land Surveyors One Harris Street Newburyport,MA 01950 (978)46S-8594 Town of North Andover < NORTH 1 OFFICE OF 3�° •° a°o COMMUNITY DEVELOPMENT AND SERVICES ° 30 School Street ; x WRLIAM 1. SCOTT North Andover, Massachusetts 01845 S^CNUSE��� Director OUTSIDE CONSULTANT ESCROW AGREEMENT NORTH ANDOVER BOARD OF HEALTH Agreement is made this _ between the Town of North Andover and 4A PLAJZX�R of for Soil Tests, Plan eview 1 ` KNOW ALL men by these present that the Applicant hereby provides the Town of North Andover with a check in the sum of $ , to be deposited in an escrow account for the Town of North Andover and has deposited in an interest- bearing account as designated by the Town Treasurer to be expended by the North Andover Board of Health to insure payment to any outside consultant (s) for Soil Tests, Plan Review for the above referenced project . This agreement shall remain in full force and effect until the specified project has reached completion , i Board of Health Chairman Applicant or Agent i I NEW ENGLAND ENGINEERING SERVICES, INC. 53-7058675 887807675 2918 918 33 WALKER RD., STE. 23 PH. 978-686-1768 NORTH ANDOVER, MA 01845 DATE PAY TO THE /' ORDER OF___1 WA r $: �J DOLLARS 8 IPSWICH SAVINGS BANK IPSWICH,MASSACHUSETTS o193S MEMO , A. 2 1 1 3 70 S8 71: 88 ?80 76 7 So - ' 9535 L8 "BUILDUNUurrTi—r,-kms,°) ,,- __. JAIN STREET NEW ENGLAND ENGINEERING SERVICES INC November 25, 1998 NORTH ANQOV�R/ TOW�Qp,RD OF HEALTH Sandra Starr, Administrator North Andover Board of Health 27 Charles Street North Andover, MA 01845 RE: Lot 14 Candlestick Rd. I Dear Sandra: i Enclosed are the following documents relative to the above referenced property: 1. 5 copies of the subsurface disposal design. 2. 3 copies of the soil evaluator sheets. 3. Application for review and the fee. I If you have any questions regarding this submittal please do not hesitate to contact this office. Sincerely, Benizin C. OsgoocY;9, EIT President 33 WALKER ROAD-SUITE 23-NORTH ANDOVER, MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 3 rcA FORM 1,1 - SOIL EVALUATOR FQRIk ,: p ' Page l:of 3�t; i Date:: . Z; Commonwealth.Qf Massaphusett Massachusetts. • ssessment r 4n- rte ewa e' Mama[ Sort. Suit bah Performed By: .. Witnessed.By: .. . ts t Owrcrs .I2c�l Tn�sT !Dation nddrus a �07 d/"l n Address.ud 1« /1<< >r/ J VC2, '.. 0J99S 'ftesone r � �. GiA[ an'ell�� 'T•vs 8 07e,0 09L ew construction. [T' epalr ❑ Office Review ubllshed Soil Survey Available: No "❑ Yes . C b e P Unit 0 '1 M . r.. Solap Year Published �S�oP ..... Drainage. Class B S'I Lim tations j 1c Ite rt Available: No Yes . 'al Geologic port 1c1 S u1f g Year Published Publication Scale . .:. .................................... .. Geologic Material (Map Unit) Landform ........ .. .... .................. Flood Insurance.Rate.Map: . Above 500 year.flood boundary No ❑Yes U _ Within 500 year flood boundary No .❑Yes ❑ . Within 100.year flood boundary No ❑YeS Wetland Area: ............... Ma ma unit ........ ...................... . .............. . . .. . National.Wetland Inventory.Map p ) ......................... ........ ............ . Wetlands Conservancy Program Map (map unit) s,o.u.rce Con. ditions N" SGS): Month Current.Water Re � Range:Above Normal . IYJNormal Q Belcw Normal ❑ g Other References Reviewed: DEP APPROVED FORM 12107!95 FORM 11 - SOTY, EVALUATOR:F,ORM- Pagc*:2 of 3� No. 0 I �onGtl��7c /}•�c3�Dve/L f cation Address o rLotl � �' � On-site Review Deep Hole Number TP.,l Date:.-/V* "" 044, Weather i Location (identify on site plan) S ' Land Use .r�ead'...:..:.: ..::.. ... Slope (%) Surface Stones Vegetation .:: ::..co. Landform .:.:.. v...ra�.. .e...:.: ............:..:. . :.:...:.:::.. . Position on landscape (sketch on the back) Distances from: Open Water Body .7'1-Ob feet Drainage way 74,-:10`'.0 feet Possible Wet Area /.2,c - feet groperty Line feet ) Drinking Water Well feet Other .................. ...... ..... .................. DEEP OBSERVATION HOLE LOG` Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(Inches) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, Consistency, % Gravel) 4JU 1 VC i 3L �0yR/e ,sal_ w c0"rix w O,sT myss 1-� A UpMIN s �// )J Parent Material(geologic) /fJ(AT7cY� %l� DepthtoBedrock: Depth to Groundwater: Standing Water in the Hole:* Weeping from Pit Face: Estimated Seasonal High Ground Water: DEP APPROVED FORM-12/07/95 FORM 11 - SO1Y EVALUA NJ r Location Address or Lot fro. 07� �'`/ CGf .✓. i .' On-site Review : nsite R 2 ��./iS/Q v Time:.:.lc�.��' Weather ✓.a.-if, 1 i Deep Hole Number TI,.A..,..Z Date:.:::.:::.. ,. . - Location (identify on site Olan) ------F?lwf ::....:.::.::.:_::.:::...:... .. . _�......:.i:M..w .:... ...,.,..: . .K:. ;. .� . �. Land Use ..:::. b7 M.:.: :.::.. . Slope M Surface Stones Vegetation :.:..1w.. .ksQ ..:..:... . . . Landform ..:.. :. t'n0/Yi.i..aG..:..:..: .. .:. ..::.::...:...::..:.. Position on landscape (sketch on the back) S < lGK Distances from: Open Water Body . 7J/00 feet Drainage way >1oo feet I Possible Wet Area 11YO...... feet qroperty Line feet Drinking Water Well .::` feet Other � � I DEEP OBSERVATION HOLE LOG* Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(Inches) (USDA) (Munsell) Mottling (Structure,Stones,Bounders.Consistency, % Grav ZS (1dl GLS 0 6 d1 C5 32 rJw 3Z /o�� Cit z��= s ti"v _ CZ " roc� � 7 nLyyl. Parent Material(geologic) /7f�l�l c'n I DepthtoSedrock: /� I Weeping from Pit Face: Death to Groundwater: Standing Water in the Hole: P g _ Estimated Seasonal High Ground Water: '92 -- DEP APPROVED FORM-12/07/95 FORM 11 - SOl"L EVALUATOR FOR"M- Pagc:2 ofl..: Location Address or Lot NO. of /' C'a, �tsfi�� ti A-rvov" 0n site Review 0 Deep Hole Number T :...J? Date:..�vis 9� Time:.:��... .v Weather �> Location (identify on site plan) mac. �►�'3.: . :.:�:......,..,....�A,..w:..::...:::...:: ...�....,,.:.....:. ::.......I _ .w 1.5...,:::..::�.:..�::_ . ..... ..... . ,:.... Land Use .� !�� � :.. . Slope (%) . ...� Surface Stones :..:...:... .....:. . .:. Vegetation .:...:...::.,:::fit .::..:::. .:::.... ::. :..:...: .::..:.:.:.. .. Landform Position on landscape (sketch on the back) jcc Distances from: Open Water Body .7 YpO feet Drainage way .7/.00 feet I Possible Wet Area ./ys: feet Rroperty Line ..vr^o.. feet I i Drinking Water Well ::::. feet Other :.:..:.. .:::..:::::::. j I DEEP OBSERVATION HOLE LOG` Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface.(inches) (USDA) (Munsell) Mottling (Structure,Stones,Boulder`s, Consistency,% Gravel) ` u `R 3�Z �gs1;�G, J�il'Al�lt 1 p _ g S,/, / ^53f61c , �riC4 n lD� 6c✓l cY�r2s, �a�� s;v.�s © •�n v /Ot .STb Ac> e119 MINIMUM OF 2 HOLETREQUIRED AT ERY PROPOSED AREA Parent Material(geologic) s�t�/rr A opt /// DepthtoBedrock: ��t Depth to Groundwater: Standing Water in the Hole:' Weeping from Pit Face: Estimated Seasonal High Ground Water: 3 ti DEP APPROVED FORM-12/07/95 FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 ! Location Address or Lot No. Determination fot Seasonal High Water Table Method Used: f ❑ Depth observed standing in observation hole............... . inches M epth weeping from side of observation hole........... ... inches Depth to soil mottles ,.- , inches ❑ Ground water adjustment ................... feet NZ 3z T��3 3-Y Index Well Number .................. Reading Date ................... Index well level ................. Adjustment factor ................... Adjusted ground water level ........................................................ Depth of Naturally Occurring Pervious Material Does at least four fest of f natural) occurrin pervious material exist in all areas g observed throughout the area proposed for the soil absorption system? _H s If not, what is the depth of naturally occurring pervious material? Certification I certify that on 1vy `l.� (date) I have passed the soil evaluator examination � /q n that the above analysis ent of Environmental Protection and Y approved b the Department , pp Y p was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature C,% Date DEP APPROVED FORM-12107/9S Y - FORM 1,1' - SOILEVALUATOR Page No. its—�•t 3. Commonwealth of.Massachus.0 MassachusettS... Sort_ ��tRhzlzty ssessinent r On- rte' ewa e Drs rz.. . �/ s /o w y Performed- By: .. �' �: •.... _ Vii!:......: .....:.. 8 ..�.. . Witnessed By:.:...... 1` f owMri Name. —Jz> J2Cul T"V ST !.=anon Address a t!G� "( �d&css.and /V, f a VCR-, 0 8 yS 711 piwre i/►►q l an ell�r ICG Alel1✓C ew'construction. 9epalr. ❑ s Office Review Published Soil Survey Available: No ❑ Yes . Year Published'.. f 9 Publica �; Lc�,.�o il Map Unit. C d C tion Scale So Drainage.Class 8 ., ... Soil Limitations .. .op.e Surficial Geologic Report Av..ailable:'I*lo Yes ❑ Year Published Publication Scale -' ............................:... ................... .. . Geologic Material.(Map Unit) Landform ...................... ............ ................... Flood Insurance.Rate.Map:: Above 500 yearflood boundary No ❑Yes U . Within 500 ear flood boundary No .D Yes ❑ y . Within 100.year flood'boundary No. ❑Yes ❑ Wetland Area: National.Wetland Inventory Map (map unit .. ......:..:............................. .... .......... Wetlands Conservancy Program Map (map unit Current.Water Resource Conditions (USGS): Month Range :Above Normal:. lJE'JNormal ❑gelcw Normal ❑ Other References Reviewed: DEP APPROVED FORM 12107!95 FORM 11 = SOrL EVALUATok FORM Pagc 2Y0 3 Location Address or Lot 110. On-stte Review 0,.15. 8 Time•.:. ..t).�Do r9w1, Weather •S�.+ Deep Hole Number T.n...l Date:-./Q /9 / '� .. ..-.-. Location (ident'fy on site plan) .......:.:::..:::..:.,:. ::.::...,::...;::::....::::.......,.:......: .::.... . ....... :.:.:.,. .:... Land Use :.:. :�esd'::::..:.: ..::.. Slope M Surface Stones Vegetation :.: ...W.,oa: sc:.:: ...:::.:.... ::. Landform ..:.:.. v...r�c1..n e.....: :...:...:. . :.... ...:: Position on landscape (sketch on the back) Distances from: Open Water Body .7Yoc, feet Drainage way 7/".1 feet I Possible Wet Area feet groperty Line feet Drinking Water Well feet Other DEEP OBSERVATION HOLE LOG* Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(Inches) (USDA) (Munsell) Mottling (Structure,Stones,Boulders,Consistency, % Grav` S.-. c o„•►Ar� p,>T.. mtiss i•-� 31 �j'bl3 i // )) Parent Material(geologic)jP9lAT7Jv� %�� DepthtoBedrock: 96 Depth to Groundwater: Standing Water in the Hole:' Weeping from Pit Face: Estimated Seasonal High Ground Water: DEP APPROVED FORM-12107/95 • FORM 11 - SOrL E A1� J , � Location Address or Lot No. /.of /y ek-l' esA /v ,V." On-site Review 4 . 2 /� iS/q�, Time::..4c.-`' Weather Deep Hold Number T�1,,.....Z Date:.::.:.::.,. .:.. . f Location (identify on site plan) 5..����:....,� ^: : ...:.:::...:::.:. .,,....:...:::...:.:� �,..:,......Mw �.... ..... �,.,.:....., :,:::. Slope :..: ... (%) Surface Stones Land Use :. . '>rw... :. .....:.. Vegetation Landform ,.--..,-4714.l71k;a.c......... . . Position on landscape (sketch on the back) _ ..Sec 121Go Distances from: Open Water Body . 7J/00 feet Drainage way >/vo feet I Possible Wet Area ./Y'2 feet Rroperty Line �3S'..... feet Drinking Water Well feet Other --.::.:::::::::... DEEP OBSERVATION HOLE LOG` Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(Inches) (USDA) (Munsell) Mottling (Structure,Stones,Bou eders,Consistency, % Gra i � I Z c7L _ -- 32 k' `S/e i'!'l"s•&c 1C1.w�►lc. �f ZS� lju✓I dlr�t.� ' 3 Z� - Sibs � F !(�4�Q '/ raw i3 tv 72 " Parent Material(geologic) Ally/7 EDepthtoBedrock: /�y in Depth to Groundwater: Standing Water in the Hole: Wee v P 9 from Pit Face: .a Estimated Seasonal High Ground Water: 3 Z DEP APPROVED FORM-12/07/95 FORM 11 - SOrL F,VALUATOR FOKIVi Page�2of3.;. l . Location Address or Lot fro. -Aiof On: site Review io,�� Deep Hole Number Tlx.: ,3 Date... 98 Time::.. ..: . Weather ���> :...... Location (idem fy on site plan) S.«=..::... ....°"'j. Land Use fo_res7`.....:.: Slope (%):. -S— Surface Stones Vegetation .... Landform ... :. ..........: ::..............: Position on landscape (sketch on the back) ,See /'/A4.> Distances from: Open Water Body .7YpO feet Drainage way ..?/90 feet I Possible Wet Area ./yS. feet Rroperty Line feet I Drinking Water Well . feet Other DEEP OBSERVATION HOLE LOG* Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface.(inches) (USDA) (Munsell) Mottling (Structure,Stones,Boulders,Consistency, % o - 0 14 s ivl /�,,-,1�P�2s 10l S�-ans 13 w Z,57 ^ss��� 4 y 3Z`- g CzQ IL s 3 10Y 14"/�" Io`,, su s el v,s� SAL AREA 9R4NUm-0T-T-ROLES REG' Pan 151SPO Parent Material(geologic) ���<:I1 sa DepthtoBedrock: ��t Depth to Groundwater: Standing Water in the Hole:• Weeping from Pit Face: Estimated Seasonal High Ground Water: 3 y 4 • I DEP APPROVED FORM-12/07/95 FORM 11 - SOIL LVALUATOR FORM Page 3 of.3 j Location Address or Lot No. Determination ,dor Seasonal High Water Table . Method Used: ❑ Depth observed standing in observation hole............... . inches epth weeping from side of observation hole........... ... inches Depth to soil mottles -., z-I. inches �I�¢� 3L' El Ground water adjustment ................... feet 32- -7-,,P# 2- TO#3 X31/ . Index Well Number .................. Reading Date ................... Index well level ................. Adjustment factor ................... Adjusted ground water level .............................-.......................... Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? 2 If not, what is the depth of naturally occurring pervious material? Certification I certify that on Nou (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature Date �r -- DEA APPROVED FORM-12107!95 Y - Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH 19 * O APPLICATION FOR SITE TESTING/INSPECTION /,9 AERATED PPR��S SSACHUS, Applicant NAME ADDRESS TELEPHONE Site Location ' Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. �U � IY � V e I. ... . . . �_ 74 tit I .. _, t I I jt t 7 I t I t - 10 t 3 0 I u. I I I t t 03, �_.., I I,I I ul' „ i Ili i 1*7 "410 P I SOFT _ — 17 vt �Oi list ISO JIM LAW AWl TOOK— , ........ _a .. ......_ ., I BOARD OF HEALTH TEL. 688-9540 NORTH ANDOVER, MASS. 01845 APPLICATION FOR SOIL TESTS i DATE: z R 1 LOCATION OF SOIL TESTS: Assessor's map & parcel number: /Dl 2 16v- OWNER: ateOWNER: ? TEL. NO.: ADDRESS:� /��D,ea ENGINEER: C=N6/Auo�.eiy,9 TEL. NO.: tiv g g/7&1 CERTIFIED SOIL EVALUATOR: _'-B&,k? 65660A. Je Intended use of land: residential subdivision, in le fam'y ho , com ial Repair testing Undevelo e g N. A. C s ry tion ov 12 AWAMIM ale THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting . P 9 tests) 2. Plot plan 3. Fee of$275.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$75.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. J i d ,1 BOARD OF HEALTH TEL. 688-9540 NORTH ANDOVER, MASS. 01845 � i APPLICATION FOR SOIL TESTS 24 DATE: ;R I LOCATION OF SOIL TESTS: l W 6111lP4-L Assessor's map & parcel number: (t9(., ¢} Pa f1Ce 10 4 OWNER: Lo3o Q�,�{,� (rv,� " TEL. NO.: ADDRESS:_ AteAX AA 4- ENGINEER:_ 5,egyy ce5 .1,,c, TEL. NO.: E,8 CERTIFIED SOIL EVALUATOR: Intended use of land: residential subdivisio single family home commercial Repair testing Undeveloped lot testing THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: I 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of$275.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of $75.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to I the Board of Health showing the location of all tests (including aborted tests). { 7. Within�60 days of testing soil evaluation forms shall be submitted. i i i I September 22, 1998 2 To whom it may concern: I Joseph Giallanella of Lo Jo Reality Trust, grant my permission that Mark Rae of Belford Construction Inc may enter lot #14 Candlestick Road, a/k/a lot #14 Spinning Wheel Estates, for the purpose of any work necessary to obtain a building permit for the town of North Andover. T nk You �L. Joseph Giallanella UG. I, Joseph Giallanel"'--'* of North Andover, Essex tt being urtrrrJriried,f %are a pu�,vaaa�wbhJZl oaasidentioa of $1.00 ~ 1 -Ralph Giallanella and Angela Giallanella,Trustees of Lo-Jo Realty Trust ! gnats to under a D_claration of Trust dated January 17 , 1984 and recorded here- ., ere- •. ':with in Essex North District Registry of Deeds WRice Avenues Medford, MA with qutlrlatm rnotrinub' j x the land lit at lot 14, Candlestick.Road, North Andover, MA is w (Daaipdaa rod mcvmbmwm if aorl the land in North Andover, shown as Lot #14 on Plan of Land entitled "As-Built Plan - I{ a Spinning Wheel Estates, D.finitive Subdivision Plan, Candlestick Road, North Andover, !' c`$ Mass., dated April 11, 1977, Charles E. Cyr, C.E. Owners: Joseph J. Flym and Pauline i c F. Flynn", recorded with said North Essex Registry of Deeds as Plan No. 7724. Plan ;! u No. 7724 modifies a prior Subdivision Plan No. 6127, dated May S, 1969. Reference is made to said Plan for a more particular description of said Lot #14 <? which contains approximately 44,131 square feet, more or less, according to said n plan. q This conveyance is made with the right to use the streets and ways as shown on said plan, in carrion with all others entitled to the use thereof, for all purposes which such streets and ways are ramonly used in the Town of North Andover. !{ The fee and soil in said Candlestick Road is not included in this conveyance. J� This conveyance ace is made subject• o 1. Jj Yt all easements, conrrenants and restrictions of + record insofar as in force and applicable, to the extent he j Pp . t same affect the premises described above and is also sub ect to t a protective j pro ve covenants and restrictions recorded '1 in Book 1320, Page 554.: •, j Being the same premises conveyed to the within Grantors by deed of Charles Nigrelli, et ux dated July 29, 1982 and recorded with Essex North District Registry of Deeds. 8 ry i i • i' 3Butans..my....ham and seal dm....��......... day of lana 19..84.. g' ....................................................................... ►A/ ........... oseph Cialidneila ............................. ........................................................................ ........................................................................ ........................................................................ fblit ffammanmtaliq of liiaariarlTuaelia r(,�fdr?qtr January 7 7 19 84 Thea permnally appeared the above named Joseph Giallanella i t and acknowledged the foregoing instrument to be his It an fore rJ«,ry 1 wodo�8wt Ks [; r p F' Recorded Jan.18,1984 at 10:28M #846 M commis�ioa� .m . I 1 1 �F I' ��5 y j: r :� sir ?k Al All QRTH � n ANDOVER SYSTEM PUMPING RECORD _ i" b' 41 'S'a h ty,r"P j' $$Spp $#aglC r i `f f ! .. • , $•� �er��� iy ., �.$� �« ! "!^ .3t*` t ,a # SVSTEM •. v. ... � LOCATION smPic'. Aims t of ") � uk !�&e g� k t 5 ¥$*d 3r � ^ 1 M ##� "xa p , • i ¢ •' .. •1' . . eJ if ! I•� rw n P ED $� U GALLONS Y M * r Th X'R 4".g C T '. YES L EMERGENCY 7711 ITO COVER _ IN PLACE M d SOLU)sRUNBA,C { t� $ FLOODED OTHER /L i } C t PI iffi y t!i aP I,,, AL$¢ uti" vw•. ; ' $ '� ��•�k g aka d k pp + .. . . i NOR wt 77 em a v"R v':! �� '*^<°>� t §itis i .$#x,• i a° ,'v w!r , - ,.- y,d "R� 7 R�t� �4 "^ v I 2• ICN- Commonwealth of Massachusetts RECEIVED City/Town of �J System Pumping Record DEC 15 2009 Form 4 TOWN OF NORTH ANDOVER H ALTH DEPARTMENT DEP has provided this form for use by local Boards of Health. t the information must be,substantially the same as that provided here. Before using this form, check with your local Board of Health tQ determine the form they use. The System Pumping Record must be submitted to the local Board of Health mother approving authority. A. Facility Information 1. System Location: L ht side of house, Left front of house, Right front of house, Left rear of Ihouke, Right rear of ho Left rear of building. Right rear of building. !, Address City/Town State Zip Code 2. System Owner. Name VU Address(if different from location) City/Town State ip Code Telephone Number i I B. Pumping Record 1_ Date of Pumping Date Quantity 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 of stem: 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Locati ere contents were disposed: G.L.S. Lowell Waste Water Signature of Hauler Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1