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Miscellaneous - 10 HAWKINS LANE 4/30/2018
w 0 Driving Directions from 400Z)-o od St, North Andover, MA to 10 Ha�j�i�ns Ln, North A... Page 1 of 3 �J Start: 400 Osgood St Nortb-A-ndover, MA -Q,1845-2909, 10 Hawkins Ln North Andover, MA 018 5-4906, us Nettlix Delivers DVD Rentals Only $999 a month Directions Distance 1: Start out going SOUTHWEST on OSGOOD ST toward MILL POND. 0.7 miles > 2: Turn LEFT onto MASSACHUSETTS AVE. 0.2 miles 3: MASSACHUSETTS AVE becomes SALEM ST. 2.5 miles 4: Turn RIGHT to stay on SALEM ST. 0.8 miles 0 5: Turn RIGHT onto GRANVILLE LN. 0.1 miles 6: Turn LEFT onto PATTON LN. <0.1 miles 7: Turn RIGHT onto HAWKINS LN. <0.1 miles gEi 8: End at 10 Hawkins Ln North Andover, MA 01845-4906, US Total Est. Time: 11 minutes Total Est. Distance: 4.62 miles http://www.mapquest.com/directions/main.adp?do=prt&mo=ma&2si=navt& 1 gi=0&un=m&... 7/6/2005 Driving Directions from 400 &od St, North Andover, MA to 10 Haw - ins Ln, North A... Page 2 of 3 Start: 400 Osgood St North Andover, MA 01845-2909, US � mid %E=E=90Of N o �s bra 133 � $ PO i �t p5t may, Notes: End: 10 Hawkins Ln North Andover, MA 01845-4906, US MAPOWESTe- -VL ;_2005_MapQaest.com, Inc._ _ _ MAVTEQ All rights reserved. Use Subiect to License�Copyright These directions are informational only. No representation is made or warranty given as to their content, road conditions or route usability or expeditiousness. User assumes all risk of use. MapQuest and its suppliers assume no responsibility for any loss or delay resulting from such use. http://www.mapquest.com/directions/main.adp?do=prt&mo=ma&2si=navt& 1 gi=0&un=m&... 7/6/2005 Park S ✓ A,°¢o t�. Stevens Cfassllngo �n eacot� I tsasr� n III 02005 Mepouest.com, Inc. ® 005-NAWE0' Notes: End: 10 Hawkins Ln North Andover, MA 01845-4906, US MAPOWESTe- -VL ;_2005_MapQaest.com, Inc._ _ _ MAVTEQ All rights reserved. Use Subiect to License�Copyright These directions are informational only. No representation is made or warranty given as to their content, road conditions or route usability or expeditiousness. User assumes all risk of use. MapQuest and its suppliers assume no responsibility for any loss or delay resulting from such use. http://www.mapquest.com/directions/main.adp?do=prt&mo=ma&2si=navt& 1 gi=0&un=m&... 7/6/2005 00 N N 0o U � O O O X w O ai0 (9 N y m 0 6 NVQ' L U C U U N 0 Lp O N C uaiac0i"0w a ��wU c O W o a V Pam p m Z USN C) C) 0 00 C ui .2 0 N N T� m o 0 0 LU c 0 `m o0 in Z @ L)43) m 3 7 git m ���ud), w J y Y Y 3 Z i 0') co O O a = oC O O - rl: C6 O Z N \ r U _ � c6 yQm mrncd@ 11 E U mdU _ U 2Z J oQ ON Q�N Z m Loo z N J Q' w O N O O U o o C, 2a �oG.LL0 o CL fa o U w a o c c O a `0F'> 0° •D O O O N 4) N m 5' a) (D fn !n !n Ln (D Q' 4) in Lo M J 0 LO M Go to oOR OH Q N M Ui �� J Q co m 0 m c c c6 a U m xw 0 m tO �HNH w O a Q OC Q C¢ C m 7 O E O Z H rr O 0 o O � Q LU O_'D w- O COO C .. � o CD (� H wiU` Un.o04 O 0LL O U OOMN� �2� Ln Z Z d' r J W H LLJ N U Q Y� QW JO ZZ X m LL s UkD N d Z YQ N L) U ��� i6 (0N N of C: cEo Too U) Q CL �v— �-°°t UY E EU -JS o ¢ �Z W o a V Pam p m Z USN C) C) 00 v• no N N r` OO m o 0 0 N U as co w J N " Y Y 3 122 i 0') co O O rl-o z - rl: C6 Z N 7 0N Z � _ � c6 yQm mrncd@ F- ' ' m ccc 2Z 0 ON Q�N Z m Loo z Z rz rl tO O M 0 M Cl) LL p .. 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F- L- iniiofw2= dW w l° T- LL U) 0 r N LT m 0- North Andover Board of AsseK"\:s Public Access QPage 1 of 1 Parcel ID: 210/106.C-0031-0000.0 Community: North Andover SKETCH Click on Sketch to Enlarge PHOTO Click on Photo to Enlarge Location: 10 HAWKINS LANE Owner Name: SMITH, MARK J LORI ANNE SMITH Owner Address: 10 HAWKINS LANE City: NORTH ANDOVER State: MA ZIP: 01845 Neighborhood: 6 - 6 Land Area: 3.86 acres Use Code: 101 - SNGL-FAM-RES Total Finished Area: 2908 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 545,200 515,000 Building Value: 337,500 317,000 Land Value: 207,700 198,000 Market Land Value: 207,700 Chapter Land Value: LATEST SALE Sale Price: 1 Sale Date: 03/18/2001 Arms Length Sale Code: F-NO-CONVNIENT Grantor: LORI SMITH/LMA Cert Doc: Book: 06051 Page: 0040 http://csc-ma.us/NandoverPubAcc/j sp/Home.j sp?Page=3&Linkld=467885 7/l/2005 North Andover Board of Asses Public Access Page 1 of 1 http://csc-ma.us/NandoverPubAcc/j sp/SaveSearch.j sp 7/l/2005 #--- No ................... . ......... LOT#_........_._.._4MAP NO YES STREET - -------- z ... ..... ...L. ... ...... YES PARCEL YES NO HAS PLAN REVIEW FEE BEEN PAID? � NO PLANAPPROVAL: APP' . ............................ . ........... . . . ..... ...... -a DESIGNER: --Z,Y %=7 PLAN DATE .......... .. .. ............. . .. 7V . ..... .......... WATER SUPPLY: WELL PERMIT,__, WELL TESTS: TOWN) WELL DRILLER CHEMICAL DAI-E (�lpi-',ROVED .... ......... ... ...... .... ... BACTERIA I veal E (11) P R E'UVL D DA I E AJ -PROVED.__ — COMMENTS: FORM U APPROVAL: APPROVAL TO ISSUE YES NO . . .... .. DATE ISSUED .........BY CONDITIONS: FINAL APPROVAL: ALL PERMITS PAID WELL CONSTRUCTION APPROVAL SEPTIC SYSTEM CONSTRUCTION APPROVAL OTHER ANY VARIANCE NEEDED FINAL BOARD OF HEALTH APPROVAL: No YES NO YES NO YES NO YES NO C104RD of M& -ll /IvaI�TM Au Pnvef� I MA . �-- SS DI S,�PPkUVED R�4SoNS SO PPLY -� WELL- Ap" SEPT i c SY STS ��i �� Dw� 1tiS��cr�oAj I tiSpFcrlon� 4PPROOED �4�J�IT�D�AL 1�51�j IOtis`, DiSAPMo\)F,P R��50 tis, i FRAL APPIZVAL DArC F4 1t - L1 �A SS cD D,orc APP►��v �� r v ;� fj� i ; y (R� of H� r >-eE WEL SS 5EP-FIG SySTEAAE-51C:,A lam. ,,Z----------- /PNoviNG Auiiioi�jry PCAA) 19E516A KO Z6 -K7 �I S,Q PPRO VED Oq � E 4;KgD F6i:;-4 v — Dw� StPT"t G Sy STEM 1 J SIA 1.LA i aAJ C- X/3VAT(C,A,) JNSP6S6 ► ion 94-rC I tiSPEcrlon� P( PE FRO, --N t-iou)6E � PP1�C�U�D J/JTC I, 1Jffi IoNj %hiy) DISAPf'KdvFID D,arC FVAL APPROVAL VAT -CL- Q P�5S CJ F-11 IL 1-0 -T/J O r !,1 �A 4)'r F//0)L APi'1Qovl1vG Aul-oofo i -T Commonwealth of Massachusetts City/Town of 0 System Pumping Record RECEIVED Form 4 JUN 16 2008 DEP has provided this form for use by local Boards of Health.a be used, b the information must be substantially the same as that provided her . Before`rT41i9\thft;: eck with your local Board of Health to determine the form they use. The System Pu pin ecoru�st _ submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. Sys em Location- --11CtJv�� forms on t use f�1c�vS� only the tab key Address I to move your 1 d�li(M� � ^¢ tin S �Q(�—t' `/V j� 6,Q—,t cursor - not �yrr� State Zip Code use the return key. 2 System Owner: Name 11 Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): State S ^ 3 Code Telephone Number Date 2. Quantity Pumped; Cesspool(s) D-5e-'ptic Tank l SZ�2clll Gallons ❑ Tight Tank 4. Effluent Tee Filter present? B-1� ❑ No If yes, was it cleaned? Yes ❑ No 5. Condition of System: 6. Systein Pumped By: Fla, Name Vehicle License Number Company 7. here cont is were disposed: , C,. . C). �I 30—C$ - Date t5form4.doc^ 06/03 System Pumping Record . Page 1 of 1 r �rl'•r1100 10 lhB IOC 11 80drC C'/ n• " v,,,r Va (n o/ 04n0/ ep?rO lli J S�l:d�l a A' Facility In(orM-,allon / ,•a ..:s/I/ 2'I .� e .;� ',;• r, y,l6m Orr+�6r %'.Q 141(i(itIVlf1nlf nY buUcn) Q ^ C.,n re•eDnOne n,m0„ v / / / Pu g mPl� Ra?,ord (• Ogle o' PumI� rY➢6 01 iys�6m,.. C69s�ool(9J $90l!C ign� , ^I ld^. Q'- O har (dascribs'1. a' EMVO/i( Too FII(o('pf,��enn r� Yv9 n'o 4 oridlyon Q(.9 �. ,ri�l illi ••��/Ilr�l ,l'1�; �:�y�'.�;:��tt'!I l.''' r+ �t ' '//• 1. �'; ��"'Y1. •.1' ..l /,/.1:1 l/ f I c, %I ;. 'S,•'y"'�, :. ��, �y.:l�li� (i:1 ,i:;1,t�4d�,!, '�!`�f j�;}jl�•.�.�'i,+,.. . .{, on. �vh6r�'�or�lenla',yrere p • .I.:, .1 dl' oleo: �: /�'.l. • '•r• ,:/�I v • :Illy,. �.m85J 0 Y/I 6 A,1v a 6118P P I 8J W 10(Tn7.1,,:rnNIn6C1 ^ I% P, M,410 mp"', I - �M )fl, r Commonwealth ®f Massachusetts = CitylTown of -North Andover System Pumping Record Form 4 ws 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. Beforeusing Chid must cbe heck with ted to local Board of Health to determine the form they use. The Systemp date in the local Board of Health or other approving authority within 14 days from the pumping accordance with 310 CMR 15.351. A Facility informati®n Ma 01886 State Zip Code �aA4 e�S� Address (if different from location) City/T State Telephone Number Zip Code &—Pumping Record /506 r ` 2. Quantity Pumped: Gallons 1. Date of Pumping Date L015 Tight Tank E] Grease Trap t t La 9' 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ 9 ❑ Other (describe): . 4. Effluent Tee Filter present? ❑Yes ❑ IfYes, was it clearied? ❑ Yes El No No .. 5. Condition of System: Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: Stewart's Pre-trg 20 So a 01835 Date Signature o r Signature of Receiving Facility Date System Pumping Record - Page 1 t5form4.doc- 03106 Important When 1. System Location! filling out forms on the computer, use only the tab key to move your Address cursor - do not North Andover use the return City/Town key. tcl 2. System Owner: ream Name Ma 01886 State Zip Code �aA4 e�S� Address (if different from location) City/T State Telephone Number Zip Code &—Pumping Record /506 r ` 2. Quantity Pumped: Gallons 1. Date of Pumping Date L015 Tight Tank E] Grease Trap t t La 9' 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ 9 ❑ Other (describe): . 4. Effluent Tee Filter present? ❑Yes ❑ IfYes, was it clearied? ❑ Yes El No No .. 5. Condition of System: Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: Stewart's Pre-trg 20 So a 01835 Date Signature o r Signature of Receiving Facility Date System Pumping Record - Page 1 t5form4.doc- 03106 Commonwealth of Massachusetts _ CitylTown of North Andover _ — a system Pumping Record Foam 4 wy 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. Beforeusing this (must check submitted o with your local Board of Health to determine the form they use. The System Pumping date in the local Board of Health or other approving authority within 14 days from the pumping accordance with 310 CMR 15.351. A. Facility Information Important When Tilling out forms 1. S stem Location:' Y , 1 on the computer, �� W Tt use only the tab key to move your — —• Address Ma 01886 cursor- do not North Andover State Zip Code use the return Cfijf'own key. 2. System Owner: bu,+� b %, . .0Q te Name Address ('rf different from location) State Zip Code CitylTown �� Telephone Number B. Pumping Record Q 9:: 2015 2. Quantity Pumped: 1. Date of Pumping Date Gallons r Gd Se tic Tank ❑Tight Tank P ❑Grease Trap � ,fps 3. Type of system: F1Cesspool(s) f ❑ Other (describe): Effluent Tee Filter present? ❑ Yes ❑ No If.yes, was it cleaned? ❑ Yes ❑ No 4. 5. Condition of System: 6. S st ed By: Y L vehicle License Number N Stewart's Septic Service Company 7. Location where contents were disposed: Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 5i of Hauler Date Signature of Receiving Facility Date System Pumping Record • Page 1 t5form4.doc• 03/06 Commonwealth of Massachusetts _ w City/Town of no ANDOVER a System Pumping Record r� Form 4 a,%: t o 2014 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 CMR 15.351. 1. Date of Pumping z= 2. Quantity Pumped: Date Gallons 3. Type of system: C] Cesspool(s) /Q Septic Tank [] Tight Tank 0 Grease Trap F7 Other (describe): t✓ \ 4, Effluent Tee Filter present?Yes 0 No If yes, was it cleaned? (Yes El No 5. Condition of Sys m: _ \�- A� , E/ 0 6. System Pumped By; Name Vehicle License Number Stewart's Septic Service Company — 7. Location where contents were disposed: Stewart's Pre-treatment Plant. 20 So. Mi t5form4.doc• 03/06 Ma 01835 7 /) Date / -- Date System Pumping Record • Page 1 of 1 A. Facility Information Important: When filling out forms 1. System location: on the computer, use only the tab 10 HAWKIN.S LANE key to move your Address cursor - do not NORTH ANDOVER MA use the return key. _.. a _._ _ City/Town - state Zip Code 2. System Owner: ' BATTERSBY renin Name - Address (if different from location) City/Town. ^�� _ State � 779 Zip Code y 7� T Telephone Number B. Pumping Record 1. Date of Pumping z= 2. Quantity Pumped: Date Gallons 3. Type of system: C] Cesspool(s) /Q Septic Tank [] Tight Tank 0 Grease Trap F7 Other (describe): t✓ \ 4, Effluent Tee Filter present?Yes 0 No If yes, was it cleaned? (Yes El No 5. Condition of Sys m: _ \�- A� , E/ 0 6. System Pumped By; Name Vehicle License Number Stewart's Septic Service Company — 7. Location where contents were disposed: Stewart's Pre-treatment Plant. 20 So. Mi t5form4.doc• 03/06 Ma 01835 7 /) Date / -- Date System Pumping Record • Page 1 of 1 .13347 1* Town of North Andover HEALTH DEPARTMENT $A U T CHECK #: —Mkl DAT LP -A LOCATION: H/O NAME: -. CONTRACTOR NAME: Type of Permit or License: (Check box) 0 Animal $ 0 Body Art Establishment $ 0 Body Art Practitioner $ 0 Dumpster $ 0 Food Service - Type. $ 0 Funeral Directors $ 0 Massage Establishment $ 0 Massage Practice $ 0 Offal (Septic) Hauler $ 0 Recreational Camp $ 0 Sun tanning $ 0 Swimming Pool $ q 11 Tobacco $ 0 Tras4lSolid Waste Hauler $- 0 Well Construction $ SEPTIC Sustems: 0 Septic - Soil Testing $ 0 Septic - Design Approval 0 Septic Disposal Works Construction (DW0 $ 0 Septic Disposal Works Installers (DWI) $ 0 Title 5,1jispector $ 19"fitle 5 Report $ 0 Other (Indicate) $ Z Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer 0 0 a> m EL d w 0 0 G m v a <� G CD i a a a ti +� w m w w a 0 LO 00 y LG 0) m o 0 = a � � N N o e O Z w 0 0 ►� v 0 0 0 a> m EL d w m a CD a a Q N +� w as w w a 0 m Ol U � � o e O c9 N 0 0 a> m EL d O a a m � � e e w y Q ci w w w G p D CO) E O w m a a �O0 a� J z z z CL d Y Y C C �► v U U O y n n N Ri z z z w y to to o y 0 L o ,0 o -� m N = i► OI � N y a w o � 0 LL 3 e � U O 10 h G G d V l0 G 0 0 a> m EL COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRO TITLE 5 JUN 16 2008 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT e. rsl.-.-yv 1 t;t v�.�.•. �s OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 10 Hawkins Lane _ North Andover Owner's Name: _Dharmendra Agarwal Owner's Address: 10 Hawkins Lane _ North Andover, MA 01845 _ Date of Inspection: _5/30/2008 Name of Inspector: _Neil J. Bateson_ Company Name: _Bateson Enterprises Inc._ Mailing Address: _111 Argilla Road_ _Andover, MA 01810_ Telephone Number: _ (978) 475-4786 CERTIFICATION STATEMENT 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 Needs Further Evaluation by the Local Approving Authority ails Signature: Inspector's Si p g Date: _5/30/2008 _ 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. Notes and Comments: ****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. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 ` 0• O r OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 10 Hawkins Lane _ _ North Andover— Owner: _ Agarwal _ Date of Inspection: _5/30/2008 _ Inspection Summary: Check A, B, C, D or E / ALWAYS complete all of Section D A. System Passes: X 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. Answer yes, no or not determined (Y,N,ND) in the for the following statements. 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. ND explain: 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 obstruction is removed distribution box is leveled or replaced ND explain: 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 obstruction is removed ND explain: Title 5 Inspection Form 6/15/2000 Page 3 of 11 , a OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: _10 Hawkins Lane _ _ North Andover_ Owner: _Agarwal _ Date of Inspection: _5/30/2008 _ 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 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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: Title 5 Inspection Form 6/15/2000 Page 4 of I I C OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 10 Hawkins Lane_ _ North Andover_ Owner:—Agarwal_ Date of Inspection: _5/30/2008 _ D. System Failure Criteria applicable to all systems: You must indicate "yes" or "no" to each of the following for all inspections: _No_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _No— Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _No_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool No_ Liquid depth in cesspool is less than 6" below invert or available volume is''/z day flow. _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. No_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. No_ Any portion of a cesspool or privy is within a Zone 1 of a public well. _No_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. No_ 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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.] _No_ (Yes/No) 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. You must indicate either "yes" or "no" to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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. Title 5 Inspection Form 6/15/2000 Page 5 of 11 C, 01 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 10 Hawkins Lane _ _ North Andover _ Owner: _Agarwal_ Date of Inspection: _5/30/2008_ Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No Yes_ Pumping information was provided by the owner, occupant, or Board of Health No_ Were any of the system components pumped out in the previous two weeks? Yes_ Has the system received normal flows in the previous two week period ? No Have large volumes of water been introduced to the system recently or as part of this inspection ? Yes_ _ Were as built plans of the system obtained and examined? _Yes_ ` Was the facility or dwelling inspected for signs of sewage back up ? _Yes_ _ Was the site inspected for signs of break out ? _Yes_ _ Were all system components, excluding the SAS, located on site ? _Yes_ _ 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 ? _Yes_ _ Was 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: Yes No _Yes_ , Existing information. _Yes_ _ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [3 10 CMR 15.302(3)(b)] Title 5 Inspection Form 6/15/2000 Page 6 of 11 C OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 10 Hawkins Lane_ _ North Andover– Owner: _Agarwal _ Date of Inspection: _5/30/2008_ FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): _4 _ Number of bedrooms (actual): 3 _ DESIGN flow based on 310 CMR 15.203 _600 _ Number of current residents: _2 _ Does residence have a garbage grinder (yes or no): _No _ Is laundry on a separate sewage system (yes or no): _No _ Laundry system inspected (yes or no): _ Seasonal use: (yes or no): _No_ Water meter reading: _Yes _ Sump pump (yes or no): _No_ Last date of occupancy: _ Current _ COMMERCIAL/INDUSTRIAL Type of establishment: Design flow (based on 310 CMR 15.203): `gpd Basis of design flow (seats/persons/sqft,etc.): — Grease trap present (yes or no): Industrial waste holding tank present (yes or no): Non -sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER (describe): GENERAL INFORMATION Pumping Records Source of information: _Pumped March 08, owner_ Was system pumped as part of the inspection (yes or no): _Yes_ If yes, volume pumped: _1.500_ gallons -- How was quantity pumped determined? _Measured tank_ Reason for pumping: _Inspect tank & tees & clean filter TYPE OF SYSTEM X 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) _ Tight tank _ Attach a copy of the DEP approval Other (describe): _ _ Approximate age of all components, date installed (if known) and source of information _Septic tank & D -Box was replaced 4/22/2005. S.A.S. was installed 12/1992 Were sewage odors detected when arriving at the site (yes or no): _No_ Title 5 Inspection Form 6/15/2000 Page 7 of 11 a N OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 10 Hawkins Lane _ _ North Andover _ Owner: _Agarwal _ Date of Inspection: _5/30/2008_ BUILDING SEWER _ X _ (locate on site plan) Depth below grade: _18" _ Materials of construction: _ _ cast iron _40 PVC _other Distance from private water supply well or suction line: Comments (on condition of joints, venting, evidence of leakage, etc.) _ SEPTIC TANK: X Depth below grade: _6" Material of construction: X_ concrete _ metal _fiberglass ___polyethylene _other(explain) If tank is metal list age: _ Is age confirmed by a Certificate of Compliance (yes or no): _ (attach a copy of certificate) Dimensions: 10' x 5' x 4' Sludge depth 2"_ Distance from top of sludge to bottom of outlet tee or baffle: 25" _ Scum thickness: _411 _ 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: 17" How were dimensions determined: _ 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. Inlet tee ok. Outlet tee ok. Clean outlet filter. Depth of liquid at outlet invert. No evidence of leakage. _ GREASE TRAP: _(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _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: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Title 5 Inspection Form 6/15/2000 Page 8 of 11 EO OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 10 Hawkins Lane _ _North Andover— Owner: _Agarwal _ Date of Inspection: _6/5/2008 _ 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/day Alarm present (yes or no): Alarm level: Alarm in working order (yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): DISTRIBUTION BOX_X_ Depth below grade ,4' _ 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 leakage. Evidence of carryover, pumped d -box to clean. _ PUMP CHAMBER: _ (locate on site plan) Pump in working order (yes or no): _ Alarm in working order (yes or no): Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): _ Title 5 Inspection Form 6/15/2000 Page 9 of 11 � o OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 10 Hawkins Lane _ North Andover— Owner: _Agarwal_ Date of Inspection: _5/30/2008_ SOIL ABSORPTION SYSTEM (SAS): X_ (locate on site plan, excavation not required) If SAS not located explain why: Type _ Leaching pits, number: _ Leaching chambers, number: Leaching galleries, number: _X Leaching trench, number, length: _3 trenches 90' long_ Leaching field, 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: Number and configuration: _ Depth — top of liquid to inlet invert: Depth of sludge layer: Depth of scum layer: _ Dimensions of cesspool: _ Materials of construction: _ Indication of groundwater inflow (yes or no): _ 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.): Title 5 Inspection Form 6/15/2000 0 Page 10 of 11 N OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 10 Hawkins Lane _ _ North Andover_ Owner: _Agarwal _ Date of Inspection: _5/30/2008_ SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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 Title 5 Inspection Form 6/15/2000 10 Page 11 of l l OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 10 Hawkins Lane _ _ North Andover_ Owner: _Agarwal _ Date of Inspection: _5/30/2008 SITE EXAM Slope _ No _ Surface water _ No _ Check cellar _ Yes _ Shallow wells No Estimated depth to ground water _ 4'_ Please indicate (check) all methods used to determine the high ground water elevation: _X Obtained from system design plans on record - If checked, date of design plan reviewed: _9/6/1989_ Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health -explain: _ Checked with local excavators, installers- (attach documentation) Accessed USGS database -explain: _ You must describe how you established the high ground water elevation: _ As per design plan_ Title 5 Inspection Form 6/15/2000 11 " , Summary Record Card generate,5/28/2008 3:00:50 PM by Karen Hanlon Tows, -:if North Andover Tax Map # 210-106.C-0031-0000.0 Parcel Id 17665 10 HAWKINS LANE DHAR AGARWAL 10 HAWKINS LANE NORTH ANDOVER, MA 01845 class -1 01 Single Family -- Property Type 1 Residential Size Total 3.86 Acres FY 2008 UB Mailing IndexLoan Type Number Active/lnact. From Until NamelAddress DHAR AGARWAL Owner 10 HAWKINS LANE NORTH ANDOVER, MA 01845 SMITH, MARK Previous Customer Inactive 5/9/2005 P.O BOX 213 NO. ANDOVER, MA 01845 UB Account Maint.Active/inactive Account No Cycle Occupant Name Last Billing Date 3/28/2008 Bldg Id. 17371.0 - 10 HAWKINS LANE Active 3170041 03 Cycle 03 UB Services Maint. Charge Multiplier/Users Service Code Rate 0.63518 7.82 1/ MISCFEE ADMIN FEE 01 ALL METER SIZE /1 WTR WATER UB Meter Maintenance Type size YTD Cons Serial No Status Location Brand b Badger g w Water 0.63 063. 32772623 a Active ERT HH Consumption Posted Date Variance Date Reading Code 0 4111/2008 -100% 3/7/2008 190 a Actual 20 1/22/2008 12/10/2007 190 a Actual 88 10/12/2007 1 26% 9/4/2007 170 a Actual 7 7/20/2007 143% 6/14/2007 82 a Actual 3 4/16/2007 -79% 3/13/2007 75 a Actual 13 1/19/2007 -70% 12/6/2006 72 a Actual 43 10!20/2006 172% 9/812006 59 a Actual Trouble Code:03 16 7/10/2006% 6/12/2006 16 a Actual 0 4/17/2006 -100% 3/15/2006 0 n New Meter 5 4/17/2006 -81% 3/15/2006 1760 rReplacement 15 1/17/2006 -81%12/21/2005 1755 a Actual Trouble Code:03 77 10/14/2005 2678% 9/14/2005 1740 a Actual Trouble Code:03 1 7/15/2005 -66%6/9/2005 1663 a Actual 4 5/5/2005 18% 5/5/2005 1662 f Final Bill 7 4/5/2005 -25% 3/18/2005 1658 a Actual 8 1/14/2005 -76% 12/9/2004 1651 a Actual Trouble Code:03 42 10/8/2004 -25% 9/15/2004 1643 a Actual Trouble Code:03 34 7/30/2004 396% 6/10/2004 1601 a Actual Trouble Code:03 0 0 Commonwealth of Massachusetts City/Town of System Pumping Record Foinn 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 forth they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When fining out Rpm on the 1. Sy em Location: --11 e CC�vQ computer, use only the tab O move yourAddress ' © l T(/L/v�� �`-Q S `"� " ` ` ��' 4 " ` + �J✓" v' cursor - do not use the return City/Town State Zip Code kms`' VQ 2. System Owner: Name Irl Address (if different from location) CityfTown State 35- 8�� code Telephone Number B. Pumping Record 5 -30 -©g ls�� 1. Date of Pumping Date L. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) [-tic Tank ❑ Tight Tank ❑ other (describe): 4. Effluent Tee Filter present? ❑<es ❑ No If yes, was it cleaned? p Yes ❑, No 5. Condi System: t t 4'� �� 6. Systein PUrn By - N me NaVehicle License Number Company 7. LocatioP-Where cont is were disposed: (n . L, , Date t5form4.doc- 06/03 System Pumping Record • Page 1 or 1 0 BATESON ENTERPRISES, INC. Excavating -Water& Sewer Lines -Septic Systems & Pumping Service 111 Argilla Road Andover, Mass. 01810 Title 5 Inspection Report Property Address: 10 Hawkins Lane, North Andover Owner: Agarwal Date of Inspection: 5/30/2008 Tel: (978) 475-4786 Fax: (978) 475-5451 My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic system. Neil J. Bateson Bateson Enterprises, Inc. Commonwealth of Massachusetts City/Town of System Pumping Recon Form 4 DEP has provided this form for use by local Boards of Health. Otherorms1 ajf'.be�used'-,tlJut the information must be substantially the same as that provided here. B fore using this form, check with your local Board of Health to determine the form they use. The System Pt,mpingJRg, d �tttaLst,�e su mitted to the local Board of Health or other approving authority. or 11 Uuu�� A. Facility Inf6rmation VHEALTHVDEPARTMENTL Important: When filling out 1. System Location: forms on the computer, use only the tab key Address/ to move your cursor - do not City/Town Sta a V Zip Code use the return key. 2. .System Owner: Name Address (if different from location) City/Town State Zip Code Telephone Number B. Pumping Record // 1. Date of Pumping Dat Ir Qu tity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes6 No 5. Condition of System: 6. Systeai Pumped By: N e ompmpa y 7. Location t5form4.doc• 06/03 were disposed: If yes, was it cleaned? ❑ Yes ❑ No Vehicle License Number Date System Pumping Record • Page 1 of 1 WILLIAM J. SCOTT Director (978)688-9531 Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES October 2, 2000 27 Charles Street North Andover, Massachusetts 01845 " 4 To: Robert Nicetta, Building Commissioner Alison Lescarbeau, Chairman, Planning Board Gayton Osgood, Chairman, Board of Health William Sullivan, Chairman, ZBA From: Brian LaGrasse, Acting Conservation Administrator Vb At our Conservation Commission meeting held on September 20, 2000 the following decisions were approved: 242-1028 r—Hawkins Lane 0 Fax (978) 688-9542 The NACC approved construction of a single family house, driveway, grading and associated appurtenances within the Buffer Zone to a Bordering Vegetated Wetland (BVW). The Order of Conditions included: A row of double staked hay bales backed by trenched siltation fence to be placed between all construction areas and wetlands. A minimum of 15 extra hay bales and sufficient stakes for staking these bales. A check payable to the Town of North Andover in the amount of $3,000 as a Bond. There were no waivers on this Order of Conditions. The As-Builts will have the engineer's and land surveyor's signatures. 242-1011 Boston Ski Hill This NOI was approved for the construction of a roadway, two condominium buildings, the demolition of existing structures and a 25' No Disturbance restoration within the Buffer Zone to a Bordering Vegetated Wetland (BVW). The Order of Conditions included: In order to prevent any alteration of wetland resource areas a 25' NDZ and a 50' NCZ shall be established from the edge of the adjacent wetland resource area except for the demolition of existing structures and the 25' NDZ restoration. The NACC found the applicant's proposal for 13,675 s.f. of wetland restoration to be adequate. A minimum of 200 extra hay bales covered on site and sufficient stakes for staking these bales (or an equivalent of silt fence). BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 C' C` Decisions from Conservation Commission Meeting of 9/20/2000 (2) A check payable to the Town of North Andover in the amount of $61,025 as a Cash Bond and due to the combination of Paxton soils, steep grades and shallow ground water with the close proximity to a highly sensitive Riverfront area, a $125,000 Surety Bond shall be provided to the Town of North Andover. The applicant shall designate a professional Wetland Scientist as an "Erosion Control Monitor" to oversee any emergency placement of controls and regular inspection or replacement of sedimentation control devises. Credentials of said Erosion Control Monitor (prior to designation) shall be Submitted for review and subsequent approval by the NACC or an Agent thereof. This person shall be given the authority to stop construction for erosion control purposes. At least once per day during which construction activities occur on-site and for as long thereafter as ground remains unstabilized, the "Erosion Control Monitor" shall contact the NACC or agent thereof and verbally submit a daily update. At least once during each week in which construction activities occur on-site and for as long thereafter as ground remains unstabilized, the applicant shall submit a written report from the "Erosion Control Monitor" to the NACC at the end of each week certifying that, to the best of his/her knowledge and belief based on a careful site inspection, all work is being performed in compliance with the Order of Conditions and that approved setbacks are being adhered to. All catch basins shall contain oil/gasoline traps and Cascade Covers. As soon as the drainage system is on line, bi-annual (April 1St and October 1 S) inspection reports must be submitted by a Registered Professional Engineer. There shall be no stockpiling of soil or other materials within 25' of any resource area. The toe of any stockpile of soil shall be no closer in distance to the NDZ than the total height of the stockpile itself measured from the toe to the crest. No trash dumpsters will be allowed within 50' of areas subject to protection under the Act or local ByLaw. An annual Affidavit that the O&M Plan has been carried out, including proof such as invoices of catch basin cleaning and street sweeping shall be submitted to the NACC by no later than April 1St. This shall be a perpetual condition. The NACC also agreed that the Order of Conditions be incorporated into the Condo Documents. If you would like a copy of the Order of Conditions please contact the Conservation Department. CC: Scott Masse, Chairman, Conservation Commission Heidi Griffin, Town Planner "Sandra Starr, Board of Health Administrator 10 TOWN OF NORTH ANDOVER T11 Office of COMMUNITY DEVELOPMENT AND SERVICES .0 ;`�"oop HEALTH DEPARTMENT 400 OSGOOD STREET `► �, . +� NORTH ANDOVER, MASSACHUSETTS 01.845 �,SSwCMUS Susan Y. Sawyer, REHS/RS Public Health Director 978.688.9540 — Phone 978.688.9542 — FAX SEPTIC SYSTEM CONSTRUCTION NOTES ADDRESS: MAP:_ LOT: INSTALLER: moi' DESIGNER: 7�'/ PLAN DATE: BOH APPROVAL DATE ON PLAN: -- DATE OF INSPECTION: r� DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SELECT SYSTEM TYPE GRAVITY DISTRIBUTION PRESSURE DISTRIBUTION PRESSURE DOSING HOLDING TANK ADVANCED TREATMENT OTHER 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 CONDITIONS Comments: W ' oj,t4 il"� '-/ ' J " 0 5 '::� I I 1()rl( ❑ Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer ❑ Topography not appreciably altered Page 1 of 4 TOWN OF NORTH ANDOVER Ot NORT{r Office of COMMUNITY DEVELOPMENT AND SERVICES b ` 9 HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSAC14USETTS 01845 ��Ss C14U Susan Y. Sawyer, REHS/RS �6't'� A 978.688.9540 — Phone Public Health Director 30 978.688.9542 — FAX PTIC TANK � �Bottom of tank hole has 6" stone base (,�ac.5 'n04 ( W ( Weep hole plugged-Q--Q� IJ as been installed H-10 o H- (monolithic or 2 piece) tness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) Ell' tee installed, under access port El Outlet tee (gas baffle or effluent filter) installed, under ` access - port �j 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: 00 PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base C� Weep hole plugged ❑ gallon Pump Chamber installed Id(H-10 or H-20) (monolithic or 2 piece) Inlet tee installed, under access port Ell/ 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: Page 2 of 4 o 0 TOWN OF NORTH ANDOVER f NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES Fr �'�D''��°aA HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 CHU Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX D -BOX 1 L✓J Installed on stable stone base ° Inlet tee (if pumped or >0.08'/foot Hydraulic cement around inlet & outlets LCd Observed even distribution ❑ Speed levelers provided (not required) �1 Comments: SOIL ABSORPTION SYSTEM El R Comments: PRESSURE DISTRIBUTION El El Comments: 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 3/4-1 Y2" 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 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 Page 3 of 4 O 0 TOWN OF NORTH ANDOVER OE NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES �r •y _ .• Op HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01.845 3�Ss"C'°'�<� wcHus Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX CONTROL PANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: ❑ Rated for exterior if placed outside Comments: 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 c "0 Commonwealth of Massachusetts Map -Block -Lot 0 106.C- 0031 - Board of Health Pennit No BHP -2005-0158 North Andover PA. FEE F.I. $125.00 Disposal Works Construction Permit Permission is hereby granted Robert K. Daigle, Jr. to (Repair -TANK & D -BOX ONLY) an Individual Sewage Disposal System. atNo 10HAWKINSLANE as shown on the application for Disposal Works Construction Pen -nit No. BHP -2005-015 Dated June 13, 2005 Issued On: Jun- 13 -2005 Board of Health;, - 04, . 60 Ail Commonwealth of Massachusetts Map -Block -Lot 0 0 106.C- 0031 - Board of Health North Andover Certificate of Compli ' THIS 1S TO CERTIFYThat the Individual S e Disposal System (Repair -TANK & D -BOX ONL "" " "'0 '�L "' by Robert K. Daigle, Jr. Installer atNo 10HAWKINSL has been installed cordance with the provisions of TITLE 5 of the State Environmental Code as described in the applicatjga-fi5f isposal Works Construction Permit No. BHP -2005-015 Dated June 13, 2005 Printed On: J un- 13 -2005 Board of Health w 00 0 0 O C, 0 0 0 a 0 0 0 0 CD +v p o eC NO N o e, y N O C a 00 10 n 00 - o 0 0 0 0 N N E d C. a m m C r - a n U o ;; 3 3 F 0 � 0 tdover Z -'I" "Or" S-,- Td:lth";epart Pate: Location: Z6-11 (Indicate Address, if Residential, 6rName Check #: A//1 Type of Permit or License: (Circle) > Animal > Dumpster $ Food Service - Type. $ Funeral Directors Massage Establishment $ > Massage Practice $ A > Offal (Septic) Hauler $ > Recreational Camp $ > SEP77C PERMITS: Ll Septic - Soil Testing Ll Septic - Design Approval $ F ;I -w- �i Disposal Works Construction (DWO $ q�a��tic Ll Septic Disposal Works Installers (DWI) $ > Sun tanning $ > Swimming Pool $ > Tobacco > TrashlSolid Waste Hauler $ > Well Construction $ OTHER- (Indicate) A HeaYth Agent InitiaJs 821 White - Applicant Yellow - Health Pink - Treasurer �.J 0- iOWN OF NORTH ANDOVER NORTFI Office of COMMUNITY DEVELOPMENT AND SERVICES 3: ,�,,r .. •. oo� •1 HEALTH DEPARTMENT p 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 B�cHu$ 978.688.9540 — Phone Susan Y. Sawyer, REHSIRS 978.688.9542 — FAX Public Health Director healthdeptgtownofnorthandover.com - e-mail www.townofnorthandover.com - website APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: LOCATION: / 0 /% �S 2 LICENSED INSTALLER NAME: eal l' Q )- PLEASEPIRINT /'S'A' SIGNATURE: -e�/� TELEPHONE# � CHECK ONE: FULL SYSTEM REPAIR: 9 ,v -COMPONENT REPAIR (indicate what parts): 1� fi * NEW CONSTRUCTION: * If NECONSTRUCTION, please attach the Foundation As -Built plan. $250.00 or $125 Fee Attached? Yes ✓ No Project Manager Obligation From Attached? Yes No Foundation As -Built? Yes No Floor Plans? Yes No Approval of Health Agent Date: ,i INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at l0 relative to the application of dated 4/7/05- for plans by and dated with revisions dated I understand the following obligations for management of this project: I . 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 necessary 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. Undersign . d ensed c nst ler -b Date: Disposal Works Construction Permit # 0 0 Town of North Andover BEAVER COMPLAINT DATA SHEET Complaint # Date Received: %/ /9 Name: � /1� /ow Tel #: Day Address: /��(J/%%f= Tel #: Night Complaint Location:---k/L-b&?Ovt- �a Map: Parcel: Type of Complaint: (Check all that -apply).- 0 pply): ❑ Property flooding ❑ Road flooding Tree e dama j' ❑ Crop damage ❑ S tic ste g ❑Property damage sY ❑ W ter supply ❑ Other Q/1 016 Response: Check all that apply) ems/ Performed Site Visit ❑ Referred to DFW ❑ Referred to DEP (water supply) Site Visit Information Date Inspector `P� 61 ��DJZ �u�vi ❑ Other: Comments (gas ak moo( r" �211 Axa fi moo( t wi �n e �{ a7tic�ffi I F fid ��f tvlk0 P�vt dtCCL'Y- btu, f�Gt�(�On �-t�t� �r SIS �O-� v 'Clb�• Y - w -t -(;A �34ci • 4n � � NA � fi� jt -Mrvi (oww -f`►� Tw, wit( spcA •K wy 12k �, (( ►� ovrto out i z- 1 vS • i,�� 4( CGS ��- Cbw��l u l �tt��it, CAMy Documents\Anima1\2001'Beaver complaints form 10 17 2001 SS/aem (over) Page 1 of 2 0 Disvosition: (Check all that avvl Notified Conservation Commission Technical Advice Beaver Destruction Permit Permit # Dam Breach Permit Permit # Pipe Installed Permit # Referred to trapper- Name: Other C:\AIy Documents\Animal\2001Teaver complaints form 10 17 2001 (over) ss/aem Page 2 of 2 Town of North Andover 0Office of the Health Department Community Development and Services Division 400 OSGOOD STREET North Andover, Massachusetts 01845 Susan Y. Sawyer, REHS/RS Public Health Director 978.688.9540 - Phone 978.688.8476 - Fax C��r�rCA2� o� �oa�t�GrAarCE As of: ,duly 25, 2005 This is to cert that the individualsu6surface d�Iposafsystem 12epair/RepCacement Septic 7anka� lnistri6ution fox (X) 6y 12g6 lnaigle .At 10 Yfawkins Lane Xorth Udover, 911A 01845 j .Ifas 6een instaCled in accordance with the provisions of Tjt[e v of the State Sanitary Code and with the XorthAndoverOoardof7feafth regulations. The Issuance of this certfiicate shall not be construed as a guarantee that the system will function satisfactorily: S an T ,Sawyer, 1R; (Tu6tic Yfeatth Director BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 MERRIMACK ENGINEERING SERVICES C. Engineers • Surveyors • Planners 66 Park Street ANDOVER, MASSACHUSETTS 01810 (978) 475-3555 Fax (978) 475-1448 TO WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ DATE 7 I ` 5- Z.-7-4-5- JOB NO. ATTENTION RE: ieO-Ng RECEIVED TOWN OF NO;: i H ANDOVER T r -r the following item �{/� ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION THESE ARE TRANSMITTED as checked below: ❑ For approval F&I,-(or your use ❑ As requested ❑ For review and comment ❑ FORBIDS DUE REMARKS COPY TO ❑ .Approved as submitted ❑ Approved as noted ❑ Returned for corrections ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US ce) rt, to'��� �� q5g- SIGNED: If enclosures are not as noted, kindly notify us at once. p tt�[o �6 NO BOARL v -HEALTH 120 MAIN STREET TEL: 682-6483 NORTH ANDOVER, MASS. 01845 Ext. 32 or 33 June 12, 1990 Design Engineering, Inc. PO Box 516 No. Andover, MA 01845 Re: Lot 1 Hawkins Rd. No. Andover, MA 01845 Dear Al: As per your request, I have reviewed the subsurface disposal design on file at the Board of Health. The approved plan shows the westerly end of the leaching facility to be 50 ft. from the southerly lot line. IT is my understanding that your client would like to move the end of the structure closer to the southerly lot line to accomodate a different house location. I do not have a problem with this, provided a deep observation hole is conducted at the relocated end of the leaching facility prior to the installation of the house foundation. Should the results of the deep hole reveal conditions different than assumed in the approved design, the design shall be modified to meet local and state regulations in addressing the actual conditions. Please be advised that if the leaching facility is placed in the location shown on the approved plans, then a deep observation hole will not be necessary. Also, our records show that $210.00 in permits are outstanding for this lot and will need to be paid prior to any additional permits being issued. Should you have any questions regarding this matter, phase.,,- donot hesitate to call. Very truly youYs, Michael Rosati Acting Health Agent MKR/rel Design Engineering, Inc. PO Box 516 No. Andover, MA 011845 Res Lot 1 Hawkins Rd. No. Andov Dear Al: Asp r yo design file the end of understanding structure clos this provided relocated end of the house reveal conditi the design sh in addressing June 12, 1990 er, MA i ur request, I ave reviewed thera rface disposal at the Board of Health. The ved plan shows the leachi g �p ft from the oine. It is my that your c lent would like to move the end of the er to the lot line to accomodateamu em with a deep observation hole is conducted at the of the leaching facility prior to the installation 4 foundation. Should the results of the deep hole ons different than assumed in the approved design, O all be modifed to meet local and state regulations r the actual conditions. Please be advised that if the leaching facility is placed in the location shown on the approved plans then a eep observation hole will not be necessary. 4(5,c, .D,u�2 W O& S4ow n��- 21o.00 IN P LTJ b4 � Ov T `st ,1 p I A � 'Fo2 eta S � 4' W t I I L� ECD To PJB 1"�ia p nA'%ouFdyyhave• any�qui� sVr�egarding this matter, please do not hesitate to call. MR/rel 6/ Very truly yours Michael Rosati Acting Health Agent De -5 t Ai! j letl �r�' 't.l �G�' /J`-1 L po e$oyc. S7(o (& �?,o 2tJ �OT 1 4,oW k►mss aD V4. &tAoov6R- TxA2 QG o,s petz. yours. Zeczj esT -t)E-st4,rl S1 i5 OtA G-t4c-) off' -R- E �,C�.G� I N� $ FT is �1 YoviL- Cll eo�.1T w ool"o 4" To Hoye �� .? Cl bg Erb 4, hil 1.1,1 DEP t r, 'I: rF : " •1}6"'1•:; V'Irl�)''01'!�'/•�,',::.r •' ', � • .. • ' EPhas provided 0 form for use b " 'be:ubmi ed to y q%MPW ,8 f��alth,• The System Pumping Recon tt the.local'Board of Heal h gtl®gSrri8 autorlty, A; .Facility .lnforrtlon Rortanu lin .•J4'TWhen(a�rip out .1;. System Location t^y.,,,ithe ttab ke Addras'' / to move goura4 w14 vL,d I Rowe ' `us�'th�'retum y,'.' i lv: - .: tY., , ,r, •,.. 1 �1.. Z1P Code ;r.Y'; a .c •}.y����:;;.,.;a.2.,i:' System owner; •f; ..1' ; �,1 ..•r'�C• 1 F�.e'.. . r.Y �.'�it J:.'i•' 'ii .. .. :::.:'r': ih.. 'y�:i t'S ": �';,,56'p.r r.4'. •: i; �.,or,'• � (�I^ / / / /7� •� :t. ;;.� . .wA as ,� �`�' � ••:.` Vii' , vto++ �♦ Iditforent from wcauon) --� State Od — ,.`..,,,f• „ Telephone Number :.•",; ..,G', um.plllg''.�V(/,ord;.., r .,l .l• • ~, y��l,.:iJi,:.;.;i�,isi'�'rii.:':;r/,1p,.;.:r)i4rl�'{i9!ai,�'..f� . '' , �•� 1 Date of Pumpin9'I' ()al 2. Quandty Pumped "TYP,9 9 .aystsm,', ❑ Cesspool(s) .,Oth�er(descritiej ---- YIN:. r':''E\i�fliute,n't T(r'rai:eFr�lil!„et♦{riasen•,t?-.•] Yes, ®�lo i <�,,'. ;,. , ,u !1'fi ",�fh�/i rTT'��:r.l.•f.. �t.vl ,t J♦•al:•'�. �'� ''` .. 1. ,... �, tv11iJ'.li• drl;�:'YjYl�r •I;r//)li l�"�y,; }.;. t` ._. '. .'lir,• „ lti•tT.;'.�+u�.'io,%. Ii I: t�'ti,li .l;\'�•�'t,''r: . .;�;`•r`' � : 6':;i:Sy •P.umped 6yr'�� �� � •.�. .`.; C•l.?, ;..: b �'1'; ,,`. :t :�ia�li�.�.i yil�,%)I�n � 1 �� ,1 •Gil \ �r/J'r.ifl•'�N,t••;:v ^ ` �''r t7., . � is 1I7,r,�k�•�1gyqy.�•t1,• IiJ' "��- ' .v;x- • � i <� ,a rJ .•:f :•, y,'• `�., :r. i��'�Li14��:.r,�tD,r1i irf�'it'!j!I"�y' S ypif!"�':I I�VS�� •''.)'+:'; ,{ � �i� �f('fi� i r•�yl� w'i�t>,�5 �1�)"l?:•:'r1r. !�Irl�'i•.S"' . 1� �+, s: ; f;•,,;;,;j:, ;.�:'7r. Coca on.where contents re dl ,W,e., 0posed: rJ: ` ''1,1..b 'ia%:.IP;'i'�'•r'�1't•''•.,,�� .1 t� t .w�..,g.�''�J''' ..�., •�'.�:i:::i`:rj.•: „'.:i:i,.;, •..,;'tljP':%.1+�,}':t,:r',; �Y�� ,r i•;. y ;I• .• •' / 4.r II ,li+'.�•' 1•,. �� ✓'! 'iii„�C :'♦� t l'H l'r ba'Y , ' ''.' `:i l'.' :}'.�'•`.i7i •:. .: Y .j1,^ t ,t,r 1,,"�'1 ��7J•, r.,1!,i), + rl;: :• '"' ,. , • �,,;:';:•.:•;,.�.:,?/j'i':�:.,x:ry';"r••',:;�;.SIQn!<lureo�Hiul4(a�+�::;'irJ;Y•"',:�•:•,:. tit#pJ/vnvw,mass,9oV/dsp%wafa�/apprCva�s%t6forms,ht n#Inspect . , t5form4,doa;ONQ3 ' y.. �eptlo Tank If yes, was It gleaned? ❑ Ye�No System Pumping Record ' P;ye ; ' �PJHOAIE CALL) FOR �/J`OAT�- MZ1 !7�/ TIM M PHONED OF 4 RHONE Z Z AREA CODE NUMBER EXTENSION MESSAG AGAIN SEE YOU ME TO SIGNED CILV I I W .2iversal' 48003 p . _ � � ,. �� - - - --_ ._ �� i ('� ---- - _ =-C- ^_-- _. \�� .� � ` � � '� p . _ � � ,. �� - - - --_ ._ �� i ('� ---- - _ =-C- ^_-- _. \�� .� Page 1 of 2 Dellechiaie, Pamela From: Andy McBrearty[amcbrearty@millriverconsulting.com] Sent: Friday, April 15, 2005 12:32 PM To: Sawyer, Susan Cc: healthdept@townofnorthandover.com; 'Daniel Ottenheimer (E-mail)'; 'Lisa LeVasseur (E-mail)'; Grant, Michele Subject: Soil testing at 10 Hawkins Hi Susan, The following is a summary of the events at 10 Hawkins Lane: Background: Existing system was constructed in 1990 (I believe) and consists of a septic tank, d -box, and 3ea 90' leaching trenches. The system failed inspection (unclear whether this was unofficial or not) because water in D -Box was 1" over the outlet at time of inspection. Engineer did not have inspection results, so the assumption was that failure was due to a flooded leaching field. Thursday (4/14) soil testing: Soil testing showed very rocky soils and when digging the second test pit, excavator hit the trench. We noticed that the trench was dry and the stone was clean. Engineer felt that the inspection failure was in question (as did I) since a flooded field should have a very heavy biomat and drain water freely when breached. Engineer excavated the d -box and it did have water over outlet inverts which confirmed the findings of the first inspector. While I was at another site, the Engineer called a different septic inspector to use a camera to view the lines. This Inspector rwported to Engineer that the lines were not level and he saw solids in the lines (he suggested a garbage grinder may be in use in house). I do not recall whether the inspector stated there was standing water in the leach lines. Full details should come from Bill Dufresne, as I did not talk with inspector. I returned to the site as the Engineer decided to proceed with soil testing. Shallow depth to ledge was encountered when excavating on the low -side (near hill edge) outside of the system. Engineer then decided to excavate between the trenches to see what soil was below the system - assuming that we would find adequate soil in area of existing system. When digging test pit between 2nd and 3rd leach trenches (1 st being on up -hill side and hit in earlier testing) very clean septic sand was encountered. Because it was sand and unstable, the hole extended in width to the second trench. When the piping and stone of the middle trench was exposed, there was no standing water and the stone and sand showed no evidence of biomat - it was as if the trench had not recently been exposed to effluent. Findings: Given the situation in the field, the Engineer decided to leave the trench exposed, and investigate the possibility of investigating and then perhaps simply repairing the components leading to the field - the tank, dbox & piping. Based on observed site conditions, I feel that the leaching field is likely not in failure, and that component repair may the the most prudent course of action. A competent DEP- licensed septic inspector working with a designer or surveyor to check elevations and the existing water 4/15/2005 Page 2 of 2 Y table could likely determine if this system can be repaired rather than replaced. -andy 4/15/2005 ToWn of North Andover Health Department Date: �,5 Location: Za (Indicate Address, if Residential, or Name of eu�siness) Check Ty2e of Permit or License: (Circle) > Animal $ > Dumpster $ > Food Service - Type: $ > Funeral Directors $ > Massage Establishment $ > Massage Practice $ > Offal (Septic) Hauler $ > Recreational Camp $ SEF I I C PERMITS: .4a__S;;tic Soil T6ting CFO S J4��O - El Septic - Design Approval $ C3 Septic Disposal Works Construction (DWO $_ L) Septic Disposal Works Installers (DWI) $ > Sun tanning $ > Swimming Pool $ > Tobacco $ > TrashlSolid Waste Hauler $ > Well Construction $ > OTHER- (Indicate) 7 4 Health Agent Initials White -Applicant - Yellow -Health Pink -Treasurer pORTi ' C -D TOWN OF NORTH ANDOVER Community Development & Services Division p HEALTH DEPARTMENT 400 OSGOOD STREET s�CHUS NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 - Fax II DanielOttenheimer From: Pamela To: Mill River Consulting Fax: 978.282.0012 Pages: l./ 1.800.377.3044 or Date: Phone: 978.282.0014 (� Request for Soil Testing or CC: Re: Septic Plan Reviewer r ❑ Urgent x For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle • Comments: Septic Plan Review Soil Test -I OTHER Address: Please call 978-688-9540 for assistance with any questions. Thank you. Cc: File TRANSMISSION VERIFICATION REPORT TIME 03/0712005 15:28 NAME HEALTH FAX 9786888476 TEL 9786888476 SER.# 0004J120960 DATE DIME 03107 15:18 FAX NO./NAME 819782820012 DURATION 00:00:36 PAGE{S} 03 RESULT OK MODE STANDARD ECM C3 BOARD OF HEAL. NORTH ANDOVER, MASS. 01 978-688-9540 APPLICATION FOR SOIL TE DATE: �j — �� MAP & PARCEL: TI --1 I D LOCATION OF SOIL TESTS: 10 U,&1J L, , j S L.` 1,i P - RECEIVED MAR - 7 2005 WN OF NORTH ANDOVER HEALTH DEPARTMENT OWNER: [--LASi'L(G t=j Inj TEL -NO.: ADDRESS: 10 0 A 1,x.1 IC 1, 11 5 LA o e ENGINEER:1A C-W,j, "=1::::� EIJrp- grip :til6. TEL. NO.: +7 r2 CERTIFIED SOIL EVALUATOR: El W, .21.xo Intended use of land: Residential Subdivision Is This: Repair testing j Undeveloped lot testing In the Lake Cochichewick Watershed? Yes Si a Home Commercial THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: Upgrade for addition No 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of $425.00 per lot for new construction. This covers the minimiun two deep holes and two percolation tests required for each disposal area. Fee of $360.00 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. Please Do Not Write Below This Line N.A. Conservation Commission Approval: Date Received: Check Amount: Check Date: C3 '-55& 4113 scAu r 4-o DEEP 800-K AREA PLAN ASSESSOR MAP BLOCK LOT i , o 3y bLqLT PLAN IN AS DRAWN FOR T PACE LA., I LoT R.A.M. ENGINEERING 160 MAIN STREET elo scAu r 4-o DEEP 800-K AREA PLAN ASSESSOR MAP BLOCK LOT i , o 3y bLqLT PLAN IN AS DRAWN FOR T PACE LA., I LoT R.A.M. ENGINEERING 160 MAIN STREET TOWN OF NORTH ANDOVER Community Development & Services Division p HEALTH DEPARTMENT 400 OSGOOD STREET 1`4SACMl1a NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, REHS/RS 978.688.9540 - Phone Public Health Director 978.688.9542 -Fax EW Daniel Ottenheimer To: Mill River Consulting From: Pamela 978.282.0012 _ Pages: Fax: U 1.800.377.3044 or Date: Phone: 978.282.0014 JX %� Request for Soil Testing or CC: Re: Septic Plan Review ❑ Urgent x For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle • Comments: Septic Plan Review Address: %9, Soil Test '� OTHER Please call 978-688-9540 for assistance with any questions. Thank you. Cc: File _ F 0 0 BOARD OF HEATH RECEIVED NORTH ANDOVER MASS: 018 5 978-688-9540 MAR = `7 2005 rXi 1 JLll�r& 11V1\ i' Vl\ ►JV1L i .•.v WN OF NORTH ANDOVER HEALTH DEPARTMENT DATE: �i=—"�L_ MAP & PARCEL: C LOCATION OF SOIL TESTS: 10 1A AIJ L:ip 1 S P - ADDRESS: 10 0 A W V It S L.A N 6 ENGINEER: 1A eke,4 K E 06I,n.SL EJe�p d_ TEL. NO.: +7 6 —:!> 5!5S CERTIFIED SOIL EVALUATOR: F i w Intended use of land: Residential Subdivision Is This: Repair testing i Undeveloped lot testing In the Lake Cochichewick Watershed? Yes _ Si a Famiiy Home Commercial THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: Upgrade for addition No , 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of $425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of $360.00 per lot for repairs or uprg ades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. RECEIVED Please Do Not Write Below This Line MAR 2,8 N.A. Conservation Commission Approval: HEALTH DEPARTMENT Date Received: Check Amount: Check nate.' 0 0- 515M 11, 3 6-4 C�d Ta Az O Lar 1(ob, 319 S F 5. Sfo-a.t. DULT PULN IN AS DRAWN FOR IC4,F�,).Jcck�� scALa r L IDT - Ow BOOK PAGE i(:) 4AMINIS LA��_ AMA 3-560Loxwu, Mt,, PLAN I I c411-7 ASSUSOR MAP BLOCK LOT 0 R.Q.M. ENGINEERING 160 MAIN STREET 5 t f xF ytY R' SK �TTw Nf {2L"ii i [� fin^ � Aloft"' 'F' a ^t t k#�}! q6€ }ls:e r� a"`_ �y f p�� n ( Y ) `y }��,'Y'^t r� if �3raa1'S 9 ;" iy vaY �.i.Fsta -k{�,`'. b' s '�i ,'':tf.., L p..y..w # 71 Ya tk. 6t:.'`' 9MOMS,,± kris k`, 3j 't 7 +st' ♦ •F -".$`t t % } § �� I. � �s' } t � t`s 11,. s"t '�`�''•a t e ¢ T I .. � xWON i4'sIN >Y iii t i b A �t d "Am 11`.' �ft r��a r1"�a, f� t } '.�S:!y:«s4�r .ak 1 »1 k �y.X a f4I ti Yv. IM +.F a%#i� r� �""� 4'"+ Ye °� �"� �' yi 1 `tr �PS°H 't" ps''"+.3' � t.`rr Ef rs :s 1 nra doy'��'�" rF ".d w�^i ��C'.Y'4'w° �, #o-' ,{"'+P +.< �,1� Ft'$�« 7�. ,,c a' nt a•�. M*�p%gl.r�wpw �'� f+:a3.y,.,'«pY'�'c�w�,t'*,��Y�,`�,'.w'i,'��• �'. w'�', � ... r a', -rk�`e _ ..-..._.,-:-.-.-- _ - J � y�'t I i I iw I I i i I .. .I I_ i .. W i I I I I .. . i BOARD OF HEALTH No.Andover, Mass. APPROM DATE Provided: 1r Title V Reg 2.5 Reg 6 Reg 10.2 Reg 10.4 MU SUBSURFACE DISPOSAL DESIGN CHECK )SST LOT j DISAPPROVED DATE__ Reasons: The submitted plan must show as a ad nimum: a) the lot to be served-area,dimensions lot #,abutters b location and log deep observation hoes -distance to ties c location and results percolation tests -distance to ties d design calculations & calculations showing required leaching area e) location and dimensions of system -including reserve area f) existing and proposed contours g) location any wet areas-3.thin 100' of sewage disposal system or disclaimer -check wetlands mapping h) surface and subsurface drains within 'AO' of sewage disposal system or disclaimer i) location any drainage easements withi1,.3.00, of sewage disposal system or disclaimer -Planning Board f:llles J) known sources of water,supply within -:001 of sewage disposal e . system or disclaimer k) location of any proposed well to sere, lot -1001 from leaching facility 1) location of water lines on propert -U I from leaching facility m) location of benchmark n) driveways o) garbage disposals p no PVC to be used in construction .� ,q) profile of system -elevations of basement, plumb, pipe, septic tank, distribution box inlets and outlets, distribution field piping and Otter elevations 'r) mwdmum 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 Septic Tanks a) capacities -15076 of flow, water table, tees, depth of tees, access, pumping b) cleanout c) lot from cellar wall or inground swir sing pool d) 251 from subsurface drains Distribution Boxes a) pe greater than 0.08 b) ,atiitQ Miami IS 4R. r/l 1 T 1p J'7 �A � N Lf\ V1 I - C�. tj\ G,- V U'l V'l Z�o Ij SN 1-1�1"-T-T ti IF 1 1 T 1p t 1 I a s � f I -!- _ �QSP -!- s � Important When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. ., rL��I Commonwealth of Massachusetts E City/Town of NORTH ANDOVER MASSAC USETTS System Pumping Record A - 2010 Form 4 TH TOWN OF OR DEPARTMENT ANDOVER DEP has provided this form for use by local Boards of Health. The ecord must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: A r ss -Ai0dovf City/Town State Zip Code 2. Sy=stem Owner: Name Address (if different from City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping p 2. Quantity Pumped: Gallons O 3. !Type of system: ❑ Cesspool(s) LI Septic Tank ❑ Tight Tank Other (describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: % 'qwj 6. System Pumped By: Apple Vehicle License Number Y/ c r . Company 7. Location where contents were clisnnsarf- http://www.mass. t5fonn4.docc 06/03 System Pumping Record • Page 1 of 1 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 10 Hawkins Lane_ _ North Andover_ Owner's Name: — Mr. & Mrs. Mark Smith_ Owner's Address: 10 Hawkins Lane_ North Andover, MA 01845 Date of Inspection: 4/22/2005_ Name of Inspector: Neil J Bateson Company Name: Bateson Enterprises Inc._ Mailing Address: _111 Argilla Road_ _Andover, Ma. 01810 Telephone Number: _( 978) 4754786 CERTIFICATION STATEMENT 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 fimction 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 X Conditionally Passes Needs Further Evaluation by the Local Approving Authority ils Inspector's Signature: Date: _412212005 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. Notes and Comments: ****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. Page 2 of 11 OFFICIAL. INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 10 Hawkins Lane- - North Andover— Owner: _Smith_ Date of Inspection: 4f22/2005_ Inspection Summary: Check A,B,C,D or P / ALWAYS complete all of Section D 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: X 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. Septic tank leaking &d -box leaking. Answer yes, no or not determined (Y,N,ND) in the for the following statements. If "not determined" please explain. Y 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. ND explain: N 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 obstruction is removed distribution box is leveled or replaced ND explain: N 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 obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 10 Hawkins Lane _ North Andover— Owner: _Smith Date of Inspection: 4/2212005 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 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 surf_ ace 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 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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: Page 4 of i l OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 10 Hawkins Lane _ _ North Andover— Owner: _Smith_ Date of Inspection: _4f22/2005 D. System Failure Criteria applicable to all systems: You must indicate `yes" or `no" to each of the following for all inspections: _No_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _No_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool No Liquid depth in cesspool is less than 6" below invert or available volume is 1/2 day flow. _No_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _ No Any portion of the SAS, cesspool or privy is below high ground water elevation. _No_ Any portion of cesspool or privy .is within 100 feet of a surface water supply or tributary to a surface water supply. _No_ Any portion of a cesspool or privy is within a Zone 1 of a public well. _No_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _No_ 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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.] _No_ (Yes/No) The system fails. I have determined that one or more of the above failure criteria exist as described in 31.0 CMR 1.5.303, 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- You must indicate either"yes" or `bio" to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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 11 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. Page 5 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 10 Hawkins Lane _ _ North Andover— Owner: _Smith _ Date of Inspection: _422/2005 Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No _Yes_ _ Pumping information was provided by the owner, occupant, or Board of Health No Were any of the system components pumped out in the previous two weeks ? Yes _ Has the system received normal flows in the previous two week period ? No Have large volumes of water been introduced to the system recently or as part of this inspection ? Yes _ Were as built plans of the system obtained and examined? Yes Was the facility or dwelling inspected for signs of sewage back up ? Yes_ _ Was the site inspected for signs of break out ? _Yes _ Were all system components, excluding the SAS, located on site ? _Yes_ _ 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 ? _Yes_ _ Was 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: Yes no _Yes_ , Existing information. _Yes_ _ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [3 10 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 10 Hawldns Lane _ North Andover– Owner: _Smith _ Date of Inspection: 4/22/2005_ FLOW CONDITIONS RESIDENTIAL 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): _600_ Number of current residents: _0 Does residence have a garbage grinder (yes or no): Yes_ Is laundry on a separate sewage system (yes or no): _ No_ Laundry system inspected (yes or no): Seasonal use: (yes or no): No_ Water meter reading: Yes 165982Ft3 Sump pump (yes or no): No Last date of occupancy: _House Vacant CON MERCULANDUSTRIAL Type of establishment: _ _ Design flow (based on 310 CMR 15.203): ___.gpd Basis of design flow (seats/persons/sgft,etc.): Grease trap present (yes or no): _ Industrial waste holding tank present (yes or no): Non -sanitary waste discharged to the Title 5 system (yes or no): _ Water meter readings, if available: — Last date of occupancy/use: OTHER (describe): GENERAL INFORMATION Pumping Records Source of information: Pumped last year, owner Was system pumped as part of the inspection (yes or no): _No_ If yes, volume pumped: _ gallons -- How was quantity pumped determined? Reason for pumping: _ TYPE OF SYSTEM X 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) _ Tight tank _ Attach a copy of the DEP approval — Other (describe): _ _ Approximate age of all components, date installed (if known) and source of information: 13years old, 12/1992, as built plan _ Were sewage odors detected when arriving at the site (yes or no): _No Page 7 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _10 Hawkins Lane— Owner: _Smith_ Date of Inspection: _4/22/2005_ BUILDING SEWER _ X _ (locate on site plan) Depth below grade: —22"— Materials 2"_Materials of construction: _ cast iron _40 PVC _other Distance from private water supply well or suction line Comments (on condition of joints, venting, evidence of leakage, etc.) SEPTIC TANKS: X _Finished cellar unable to see piping._ Depth below grade: _10"_ Material of construction: X concrete — metal _fiberglass _polyethylene _other(explain) If tank is metal list age: ` Is age confirmed by a Certificate of Compliance (yes or no): _ (attach a copy of certificate) Dimensions: _10'x 5' x 4' Sludge depth: _0"_ Distance from top of sludge to bottom of outlet tee or baffle: _26" _ Scum thickness: _0" _ 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: _21" _ 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.)_ Inlet tee ok. Outlet tee partially corroded off. Depth of liquid 4" below outlet invert. Evidence of tank leaking out. _ GREASE TRAP: _(locate on site plan) Depth below grade: _ Material of construction: _concrete _metal _fiberglass _polyethylene _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: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Page 8 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 10 Hawkins Lane_ _ North Andover_ Owner: _Smith_ Date of Inspection: _4/22/2005 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/day Alarm present (yes or no): Alarm level: Alarm in working order (yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): DISTRIBUTION BOX: X Depth of liquid level above outlet invert: –I,,— Comments 1"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. Evidence of leakage. Evidence of solid carryover. _ PUMP CHAMBER: — (locate on site plan) Pump in working order (yes or no): — Alarm in working order (yes or no): Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): _ N Page 9 of 11 X OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 10 Hawldns Lane_ _ North Andover _ Owner: _Smith_ Date of Inspection: 4/22/2005_ SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan, excavation not required) If SAS not located explain why: Type _ leaching pits, number: _ _ leaching chambers, number: leaching galleries, number: _X leaching trenches, number, length: —3 trenches 90' 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 sludge layer: _ Depth of scum layer: _ Dimensions of cesspool: Materials of construction: . Indication of groundwater inflow (yes or no): _ 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.): Page 10 of 11 UBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 10 Hawkins Lane_ _North Andover— Owner: _Smith _ Date of Inspection: _4/22/2005_ SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. House Water Meter Driveway Tank D Box A to Tank = 31'3" A to D -Box = 41'3' B to Tank = 37'7' B to D -Box = 47'3' Page 11 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 10 Hawkins Lane_ _ North Andover— Owner: _Smith_ Date of Inspection: 4/22/2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water _6.5' _ Please indicate (check) all methods used to determine the high ground water elevation: X Obtained from system design plans on record - If checked, date of design plan reviewed: _5/5/1989_ Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health -explain: _ Checked with local excavators, installers- (attach documentation) Accessed USGS database -explain: You must describe how you established the high ground water elevation: _ As per design plan_ Tel: (978) 475-4786 Fax: (978) 475-5451 BATESON ENTERPRISES, INC. Excavating -Water.& Sewer Lines -Septic Systems & Pumping Service 111 ArgilIa Road Andover, Mass. 01810 Title 5 Inspection Report Property Address: 10 Hawkins Lane, North Andover Owner: Smith Date of Inspection: 4/22/2005 My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic system. J Neil J. B teson Bateson Enterprises, Inc. 0 TOWN OF8NDOVFR SEPTIC SYSTEM SERVICING Date:_ Homeowner: Street Phone ; REPORT Pumper ; Address: �. Phone Nature Of S'rvice: Routine Emergency Obser•vat:.ions : Good Condition (/ Full to Cover Baffles in Place Leachfield Runback _ Excessive Solids Heavy Grease Roots Other (Explain) Description of Work: Comments: 22 Z��%IG2G Form 5 oEaE File W,'+ 242-38 -* (To be provided by DEOE) 6 l� North Andover !�� Commonwealth City/Town - _ = of Massachusetts Applicant Geo. H. Farr Hawkins Lane - Lots 1-5 Addendum to Order of Conditions Massachusetts Wetlands Protection. Act G.L. c. 131, §40 ,and under the Town of North Andover's Town Bylaw, Chapter 3.5 A&B North Andover Conservation Commission C.P. McDonough Construction Corp., (Name of Applicant) 100 Ainsworth Road Wilmington, MA 01887 Address SAME (Name of property owner) Address SAME This Order is issued and delivered as follows: 0/ by hand delivery to applicant or.represenlative on January 25, 1989 (date) O by certified mail, return receipt requested on This project is located at Lots 1-5 Hawkins Lane The property is recorded at the Registry of Northern Essex Book 2699 Page Certificate (if registered) 125 (date) The Notice of Intent [or this project was filed on February, t 9B7 (date) The public hearing was closed on February 18, 1987 (date) Findings The North Andover Cnncervation CDMM as; nn has reviewed the above -referenced Notice of Intent and plans and has held a public hearing on the project. Based on the information available to the NACC at this one, the NAC -C has determined that the area on which the proposed work is to be done is significant to the following interests in accordance with the Presumptions of Significance set forth in the regulations acrd precedent and practice under this Town's ByLaw for each area subject to protection under the Act and ByLaw: Ll/ Public water supply&�,//Flood control ❑/ Land containing shellfish kPrivate water supplyUv,/Storm damage prevention L�]/ Fisheries L9/ Groundwater supply LAS Prevention of pollution Protection of wildlife habitat 5.1 .F1fPrtivw 11 / 1 /87 " L Hawkins Lane D.E.Q.E. #242-388 L Issued By North Andover Conservation Cornrnisslon Slpnature(sl ihls Order must b© signed by a majority of Ilia Conservation Commission, On this 18th} day of January 1989 , before mo personally appeared Guillermo J. Vicens , to me kno\Vn to be the perso ascribed In and who executed the foregoing Instrument and acknowledged that he/she executed the saT e as hls/her free ac d deed. September 9, 1994 _ N ary public My cornrnlsslon expires The applicant, the owner, any person aggrieved by this Order, nny owner of land ebulting the land upon which file proposed work Is to be done or any len residents of the city or town In which such land Is located are hereby notified of their rigtit to request Itis Department of Environmental Ouality Engineering to Issue a Superseding Ordor, providing the request Is made by cerlilied mail or hand delivery lo" the Department within ten days from the dale of Issuance of this Order. A copy of tiro requosl shall Of lite samo time be sent by certified mall or hand delivery to the Conservation Commission and Itre applicant. If you wish to appeal this decision under the 'Town By Law, a complaint must be _filed in 'Superior Court. Detach on dotted line and submit to the NACC prior to commencement of work. «........».............................».....»...»................................................................................................................................................... Issuing Authority Tt;, please be advised that the Order of Conditions for the proloct e File Number 242--388 hat been recorded el the Ile gletry of and has been noted In the chain of flit@ of the affected property in accordance with General Condition a on If recorded land, the Instrument number which Identilles this transection is It registered land, the document number which Identities this transaction Is _ Applicant. Signature Lots 1-5 Hawkins Lane Addendum to Order of Conditions C' DEQE 4242-388 43. The North Andover Conservation Commission finds the Hawkins Lane crossing of Boston Brook as presently installed will not match the flow characteristics of the original crossing restriction. The NACC finds that the present configuration provides for high flow passage during infrequent storm events. NACC further finds that the culvert allows too much flow at frequent storm events and may contribute to additional flooding downstream. The NACC is not persuaded that the one -hundred (100) year flood flow has been determined. Therefore, the culvert at the Hawkins Lane crossing of Boston Brook shall be redesigned and reconstructed as necessary to accommodate the one -hundred (100) year flood flow as determined by the fema study currently being executed and expected to be completed in March 1989. The new culvert shall also be designed to match the flow characteristics of the original culvert up to a twenty-five (25) year storm flow. The culvert redesign shall be submitted to the NACC for review and approval within two months of the availability of the fema data, and that culvert modified within three (3) months of approval. The applicant shall furnish the NACC with a performance bond conditioned upon compliance with this addendum. IL Commonwealth of Massachusetts City/Town of North Andover RECEIVED System Pumping Record OCT 1 a ioi1 r ^M Form 4 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. *C] DEP has provided this form for use by local Boards of H ms-may-Die'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 CMR 15.351. A. Facility Information 1. System Location: Address No.Andover ma 01845 City/Town 2. System Name Address (if different from location) City/Town State State Telephone Number Zip Code Zip Code B. Pumping Record 1. Date of Pumping / 2. Quantity Pumped: Date Gallons 3. Type of system: ❑ Cesspool(s) ❑ Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No 5. Condition of System: 6. Sy tem P meed V'z� Name Stewart's Septic Service Company If yes, was it cleaned? ❑ Yes ❑ No Vehicle License Number 7. Location where contents were disposed: WArt's Pre-treatment Plant, 20 So. Mill Bradford. Ma 01835 SiOatyr aule� `� Date - - --- - - 9- Signature of Receiving Facility Date t5form4.doc• 03/06 System Pumping Record • Page 1 of 1 ti 2 2 — — — `'i�'' ` • � * \ , � ` ` � \ � A leo �z i� ! vV r , � � • ^moi? �`.. 'lam• �� \ l� � ,►V � ♦ �� O 3,c) - t iF �e ��� L 6 NN 1 � ,: • �-fit- 2 � ~ �� � "� •, NEW LEACH TRENCH STEM w�1�0e� FtSTrr1R� %3 IR Oxilot, or %lo N i k omomLJB Mq S 6 N N l Li 0 THOMAS E. NEvE- / `S50ClA"TE5, } NG. ENCaiNEERS L)NNO USE PLANNER` dam-► r„ n ra r%ST4t.! .Mnk&ft - i ) .S ROU"M * i Cit scALz r 40 Dew B(.%CA AREA • 5 L, 4-C PLAN 'J 9 1 ASSESSOR MAP.'� BLOCK LO -t 1; F PAGE j bill -T PLAN 114 AS DRAWN FOR OF Ausys WYS 474 RAM. ENGINEERING 160 MAIN STREET HAVERNI-L, MA. G f1,,-j&L)ozs d - 4�117cli jrad.e NO House Tank IN Tank OUT D -box IN D -box OUT Trench Inverts Line 1 Line 2 Line 3 Line 4 AS -BUILT CHECK LIST and FINAL INSPECTION ;ed Elevations /a,5 -,a 7 0 As -Built Elevation /,;Z 7. 9 6 /, 7T66 /a 4.92 / 94, 7a � Bottom of Exc. //g..j-10 Stone OK? 41.� D -box checked? Pipes cemented? c-- - 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 not relieve the applicant and/or landowner from compliance with any applicable or requirements. APPLICANT FILLS OUT THIS SBCTION*'**"'**" APPLICANT AUK S/Vl Zk LOCATION: Assessors Map Number l PARCE: L ` SUBDIVISION �— LOT S STREH7 H14— Y.. � /-J S. Z A - ST. NUMEER_/0 OFFICIAL USE ONLY RECOMMENDA T IONS OF TOWN AGENTS: /8 K3 S Fi4 ; a kr 110M o� CONScRVAT10N ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS - TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE RE=JECTED_ DATE APPROVED DATE REJECTED PUELIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT 50• RECEIVED EY EUILDING i,ISPECTOR DATE Revised 9197 im c PLAN IN NORTH ANDOVER, MASS. REID LAND SURVEYORS 365 CHATHAM ST., LYNN, MASS. TO POWDER HOUSE MORTGAGE COMPANY. INC., MARK J. & LORI A. SMITH AND THE TITLE INSURANCE COMPANY INSURING THE PREMISES. I CERTIFY THAT THE DWELLING IS LOCATED AS SHOWN AND CONFORMED TO THE ZONING SET BACK REQUIREMENTS OF THE TOWN OF NORTH ANDOVER WHEN CONSTRUCTED, OR IS EXEMPT FROM VIOLATION ENFORCEMENT UNDER M.G.L. TITLE VII CH. 40A SEC. 7. 21.86' 9.74' C N/F FARR I OT 1 1 68,319±S.F. N /F :4 COMMON1Nt-gL OF MASSACHUSETTS 30-3a e v DRAINAGE .� EASEMENT 209.51'----- QQ" 30.92' DRAINAGE EASEMENT ��'• 61.52' 121.78' 108.98' 10 HAWKINS LN. "1, HEREBY, CERTIFY TO THE BEST OF MY KNOWLEDGE THAT THE DWELLING SHOWN ON THIS PLAN IS NOT LOCAT- ED WITHIN A SPECIAL FLOOD HAZARD AREA AS DELINEATED ON THE MAP OF COMMUNITY #250 PREPARED BY THE FEDERAL EMERGENCY MANAGEMENT AGENCY OR IT'S SUCCESSORS DATED 6/2/93, PANEL 9 , ZONE X 1 FURTHER CERTIFY THAT THIS INSPECTION WAS PER- FORMED IN ACCORDANCE WITH THE "TECHNICAL STAND- ARDS FOR MORTGAGE LOAN INSPECTIONS" AS ADOPTED BY THE MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS. THIS CERTIFICATION DOES NOT INCLUDE SHRUBS, WALLS, VENCES OR DRIVEWAYS AS THEY DO NOT ALWAYS INDICATE PROPERTY LINES. SHED •�O. 2 STORY 50 #10 1� LOT 2 NOTE: THIS PLAN WAS PREPARED FROM A TAPE SURVEY AND IS INTENDED FOR MORTGAGE PURPOSES ONLY. OFFSETS SHOW ON OR SCALED FROM THIS PLAN, ARE APPROXIMATE ONLY AND SHOULD NOT BE USED TO DETERMINE PROPERTY LINES. SCALE; 1" = 100' DATE: OCT. 20, 1998 BOOK: 4832 PAGE: 58 CERT.# CONTROL #.-P98-1561 L SLS 98--305 Ft.jIL-p 1 j6 -T-1540 �L'r;,4, Gm rGtD �Q A 3-7,-' N Tme HH.4r2-Y Or TPVFP� c—("Q,r't 1 12.x,1 %Ej�1 �► ,�N��,-r L - �2� .� 4v-g�- F LAC -g App P►� E pE u Eve 1�e2e�, rJ A 2 rza c1I D7 Dp�/e9- f e,•p• H '0%5 1R ►yE5 U 4T OF A. GoiJD4T10i-1�L p'``^ -ri-as 6 SNy[�EL-I'IOtJ ¢Epo2T gY I�JB►L ��►'^�� bI�TED �-IZ-Oi, 91 �O'rr I iZ'41.7 APPROVED BY BOARD OF HEALTH NAME DATE os- W/or" L p oc we„r POT, 0*4 . 15oo 64L. , t; iT "�E�4Y yrPT► r�N� ; �. t� is "4% �`17►ZiuE� 111�F,',,L1. 136 r20,I 4lJ X -K `7 p� L.L LOO yT lay �'E O►.sI PL -� ?-'! t �"( caP T1 �S E'1`G• Li GO �' fro 12 1-4NGS Ic1 Y rk-{ i'lT L C IJ D �'� rs �s Iso ►'LE: yPoN �►► p,H Ltr`f � � 'f�t� � Go�DtT"IoN v -r� ► E Ee- 1ST of G. Gio4 1, A g5rp I. P -rt gp�l 4 ?s-TrE-I OF SUBSURFACE LOCATED IN Ovai-l� Allr>mVI='CL, AS PREPARED FOR DATE:-Z2—D SCALE: I It= 40' CRAG a,64 6 `p LA 13 DISPOSAL SYSTEMA io 4At-�Ll-iLls TSI I o (o G 4E5WD OVF NORTH ANDOVER HEALTH DEPARTMENT MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS 0 LAND SURVEYORS • PLANNERS "PARK STREET 0 ANDOVER. MASSACHUSETTS 018.10 0 TEL (617) 473=3553, 373-5721 FuII.C2I16 -1—`6,50 L- r,74 G- EZN eQ A R 1�ePrtU �I,�� 3�,�' 'I 5, 0 e`er: l,�` 476' I,>04 I E,Gt'� 1 • Tn e,' 110' Low c -T�N1�"It'L 1 127, 1 '25 %E ri e N ��T (-2-("v ,G► I APPROVED BY BOARD OF HEALTH NAME DAT -xv.jJ"f L'c4 Apo' �Ge l�I., `•�i4.aIG A t7 12-a4;10 &f TSE Dt-Ar E 9- I �.�, N � 'NS A P-65 u I -T DF A G oiJ DI'i'1D�.1 C. L �5`i "rITL � 6 SN �P'ELTIOtiJ QEPo2T gl' IJEII. !ZA'i6:Gt.L i7oT6D �-Z2-OS, 15oo 6AL. r; IT yrr-rt G cpac. �-"^ �`t71�ivE� Fj PES `�Mhfct L 13E fL�PL,p+GEC) F-1 �jEGT{G�IJ x 'oe Ert^1.1 oa,rjoVE 3•� oe-, LL rlPIdCn `2H* -L -L 424.1 4P PIG. ALL L00 '7Ta U'1"'O►.l r 'T of "-FrS > ETIr' L Lr p, I L1 GD 0' Fd I2 U pA �� IJ rl H "'t-rL >; E5 ^00 -I'N v, ,aQ coV 6 2 3.x.4 -k• 9.66 Ut-A-n P LA.0 1_� J(.-Lns t-I� t7r�►—I �►�T►�N dP¢. �-� >✓s �o ►2� yPoN s� ►� U� � � T�t� Ga►�QrrtoN o � '1'.t+ E �� I ST I ►..l G. �o� L �'t g5a IZ P'r"1®� �s �'ST'l�l . OF SUBSURFACE LOCATED IN �d2�I.a �olJt7d��dE'f�, AS PREPARED FOR H & rel, ��-1 rr�q DIATE: SCALE: I 401 P5� ci. 6A aOICV CLv = I'jl, IBJ �- IA- r2-' �p IA G DISPOSAL SYSTEM AETM�D �a TOW UN 1��0�2005�.p/ �ORTH ANDOVER I HEALTH DEPARTMENT MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS 0 LAND SURVEYORS • PLANNERS 66 PARK STREET • ANDOVER. MASSACHUSETTS 01810 • TEL (617) 47544, 3M5721 II E1 4* L4 0 SSDWJ ,g Pr,, fe 12'7.7 *4 it r, stiG 3r -✓.2 38. SyzrTert • S7 I* A r -f ee a VP %& La. rb►J �Er-nc' T.• ►.5r_ zN ��u..l v v• 6 I Ft: 06 I FIz `n-� -r t G rza d I� fi.�N� a N� -rN F•�'�°��� i�a� . r, r G IrrL l --rw E 15 U N IGN ow N , („p�Tt o IJ D � T}{ � E>G ►�T'� a1 G, S,C..S. G.� a pi � p E-�r� ►►Sep 4._ �i Tik G_ itc _ rs;, Y i r -T' Dl�r� n►.1 )^, LE wrr. I 'rt i; Q:A • 7�.0•►-}. �p\N �>�N AS BUILT PLAN OF LOCATED IN AS PREPARED FOR lil.� ►ZIG Lj � 1� DATE: 106, G SCALE : It' z4o l PL.4, ►ma c RECEIVED JUL 2 2 2005 I TOWN OF NGRTH ANDOVER I HEALTH DEPARTMENT MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS LAND SURVEYORS • PLANNERS 66 PARK STREET • ANDOVER, MASSACHUSETTS 01610 or TEL (617) 475-3553. 373-5711 # k 4\ ��u�• \� i. �, \�\ Y 1 •I �'.L ZCOE File No. (To be provided by OEOE) North Andover, Commonwealth city/Town of Massachusetts George H.--4-arr Applicant Order of Conditions Massachusetts Wetlands Protection Act G.1_. c.131, §40 and under the Town,•of North Andovex Bylaw, .Chapter 3.5.A & B From. North Andover Conservation Commission George H. Farr To (Name of Applicant) 216 Raleigh Tavern Lane Address North Andover, MA 01845 Same (Na ne of property owner) Address Same This Order is'issued and delivered as follows: 0 `by hand delivery to applicant or representative on l�—�� (date) .by certified mail, return receipt requested on April 14, 1987 (date) This project is located at Lots 1-5 Hawkins Lane - Salem Fotest III The property is recorded at the Registry of Northern Essex Book 1087 314 Page Certificate (if registered) The Notice of Intent for this project was filed on February 5,'.1987 = (date) The public hearing was closed on February 18, 1987 (date) Findings The North Andover Conservation Comm.. has reviewed the above -referenced Notice of .Intent and plans and has held a public'hearing on the project. Based or •th.e.information.available to the - NACC at this time, the NACC has determined that the area on which the proposed work is to be done is significant tti the f bilowing. Interests in accordance with the Presumptions of Significance set forth in the regulations for each Aka Subject to Protection Under the Act (checkasappropriate): [11/Public water supply V Stormdamage prevention G' Private water supply lid' Prevention of pollution' V Ground w .. -supply ❑ Land containing shellfish Flood control III/Fisheries - 1 -