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Home My WebLink AboutMiscellaneous - 101 DUNCAN DRIVE 4/30/2018N ..a O NCD V u North Andover Board of Assessors Public Access KVRYy Return to the Home page click on logo New Search Sales Summary Residence Detached Structure Condo Commercial Comparable Sales • -47 a' • - - - • Parcel ID: 210/104. B-0187-0000.0 SKETCH Click on Sketch to Enlarge Page 1 of 1 71 Property Record Card Community: North Andover PHOTO Click on Photo to Enlarge 101 DUNCAN DRIVE Location: 101 DUNCAN DRIVE Owner Name: PARKER, GARY W MARCIA J PARKER Owner Address: 101 DUNCAN DRIVE City: NORTH ANDOVER State: MA ZIP: 01845 Neighborhood: 6 - 6 Land Area: 1.24 acres Use Code: 101 - SNGL-FAM-RES Total Finished Area: 2000 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 439,400 470,600 Building Value: 228,900 237,800 Land Value: 210,500 232,800 Market Land Value: 210,500 Chapter Land Value: LATESTSALE Sale Price: 134,000 Sale Date: 08/23/1983 Arms Length Sale Code: Y -YES -VALID Grantor: PIECEWICZ RICHARD W Cert Doc: Book: 1712 Page: 143 http://csc-ma.us/NandoverPubAcc/jsp/Home.jsp?Page=3&Linkld=1180374 3/10/2008 Commonwealth of Massachusetts City/Town of NORTH ANDOVER ��ti4 a System Pumping Record �� ovER Form 4 'IT t4 Ur "U Iti MENr �M HEATH DE DEP has provided this form for use by local Boards of Health. Other s 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. A. Facility Information Important: When filling out forms 1. System Location: on the computer, use only the tab 101 DUNCAN DRIVE key to move your Address cursor - do not NORTH ANDOVER use the return City/Town key. 2. System Owner: RALPH D'ATTORE Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 8/29/14 Date MA State State Telephone Number 2. Quantity Pumped: 3. Component: ❑ Cesspool(s) ® Septic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No 5. Observed condition of component pumped: GOOD CONDITION 6. System Pumped By: JAMES H CURRIER II Name J' SEPTIC & DRAIN Company 7. Location where GLSD -f� Signature of Hauler is were disposed: 01845 Zip Code Zip Code 1500 Gallons ❑ Grease Trap If yes, was it cleaned? ❑ Yes ❑ No H79 406 Vehicle License Number 8/29/14 Date Signature of Receiving Facility (or attach facility receipt) Date t5form4.doc• 11/12 Sys;:m Pumping Record • Page 1 of 1 Commonwealth of Massachusetts;_��.�-� - City/Town of `ti:...,... System Pumping Record JUN C 9 '1014 Form 4 TOWN OF NORIti ANDOVER HEALTH DEPARTMENT DEP has provided this form for useby local Boards of Health. Other forms may a use , e information must be substantially the same as that provided here. Before using.this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left kj ight front of hou -- eft / Right rear of house, Left / right side of house, Left / Right side of building, Left / Right front of building, Left / Right rear of building, Under deck Address I City/Town 2. System Owner. Name' U-0- Trp Code Address (If different from location) City/Town ' State /Zip Codg Telephone Number t B. Pumping Record 1 D t fP a e o umping 3. Type of system,- [I ystem: ❑ Other (describe): Date Cesspool(s) — 2. Quantity Pumped eptic Tank Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes If yes, was it cleaned? ❑ Yes ❑ No; 5. Condition of System: LAe� a i 1P 6: System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Locationhere contents were disposed: Lowell Waste Water Signitufe qt Haul Date t5fbrm4.doc- 06/03 System Pumping Record • Page 1 of 1 6519 of NORT :7y F _r 9 • . Town of North Andover `ti'•�;,::�` HEALTH DEPARTMENT ,S3�CHUSI IN tS CHECK #: DATE: LOCATION: Iy 1 bunan Y,, H/O NAME: CONTRACTOR NAME: Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector $ Title 5 Report $_��) ❑ Other: (Indicate) $ Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer Owner information is required for every page. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. ISI ISI Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 101 Duncan Drive l Property Address Francis Lane Owner's Name North Andover MA 01845 6/4/2013 City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: Neil J. Bateson Name of Inspector Bateson Enterprises Inc. Company Name 111 Argilla Road Company Address Andover City/Town 978-475-4786 Telephone Number B. Certification MA State S115 License Number JUN 10 2013 TOWN OF NORTH ANDOVER Zip Code I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection: The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority h1L A-" �- 6/4/2013 Insl Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 1 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 101 Duncan Drive Property Address Francis Lane Owner's Name North Andover MA 01845 6/4/2013 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for "yes", "no" or "not determined" (Y, N, ND) for the following statements. If "not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 2 of 17 N Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 101 Duncan Drive Property Address Francis Lane Owner Owners Name information is required for North Andover MA 01845 6/4/2013 every page. City/Town State zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins • 3/13 Title 5 official Inspection Form: Subsurface Sewage Disposal System • Page 3 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 101 Duncan Drive Property Address Francis Lane Owners Name North Andover MA 01845 6/4/2013 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than % day flow t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 4 of 17 ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form u"( Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 101 Duncan Drive Property Address Francis Lane Owner information is Owner's Name required for North Andover MA 01845 6/4/2013 every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 5 of 17 J Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 101 Duncan Drive Property Address Francis Lane Owner Owner's Name information is required for North Andover MA 01845 6/4/2013 every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ 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? ® ❑ 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: ❑ ® Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 600 t5ins - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 6 of 17 Commonwealth of Massachusetts l Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 101 Duncan Drive Owner information is required for every page. Property Address Francis Lane Owner's Name North Andover Cityrrown D. System Information Description: State 01845 Zip Code 6/4/2013 Date of Inspection Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Yes Detail: Has well for outside water usuage. Sump pump? Last date of occupancy: Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tank present? Non -sanitary waste discharged to the Title 5 system? Water meter readings, if available: Gallons per day (gpd) ❑ Yes ® No Current Date ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No t5ins - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 7 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 101 Duncan Drive rroperry Aaaress Francis Lane Owner's Name North Andover MA 01845 6/4/2013 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Other (describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: Date Pumed 2012, owner 1500 gallons Measured tank. Inspect tank & tees Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ® Yes ❑ No ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 8 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 101 Duncan Drive Property Address Francis Lane Owner's Name North Andover Cityrrown D. System Information (cont.) MA 01845 State Zip Code 6/4/2013 Date of Inspection Approximate age of all components, date installed (if known) and source of information: 30 years old, 4/8/1983, as built plan Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer (locate on site plan): Depth below grade: 11_6 feet Material of construction: ® cast iron ® 40 PVC ❑ other (explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): 4" Cast iron through wall 3" PVC in house, no leaks visible. Septic Tank (locate on site plan): Depth below grade: Material of construction: ® concrete ❑ metal 0 feet ❑ fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) Dimensions: 10'x 5'x 4' Sludge depth: 1" ❑ Yes ❑ No t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 101 Duncan Drive Property Address Francis Lane Owner Owner's Name information is required for North Andover MA 01845 6/4/2013 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 26" Scum thickness 1" 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 20" How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumped septic tank. Inlet tee ok. Outlet tee ok. Depth of liquid at outlet invert. No evidence of leakage. Grease Trap (locate on site plan): Depth below grade: feet 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: t5ins - 3/13 Date Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 10 of 17 Commonwealth of Massachusetts JD Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 101 Duncan Drive 6/4/2013 Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Capacity: Design Flow: Alarm present: Alarm level: gallons gallons per day ❑ Yes ❑ No Alarm in working order: Date of last pumping: Date Comments (condition of alarm and float switches, etc.): ❑ Yes ❑ No * Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins • 3/13 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System • Page 11 of 17 Property Address Francis Lane Owner Owner's Name information is required for North Andover MA 01845 every page. City/Town State Zip Code 6/4/2013 Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Capacity: Design Flow: Alarm present: Alarm level: gallons gallons per day ❑ Yes ❑ No Alarm in working order: Date of last pumping: Date Comments (condition of alarm and float switches, etc.): ❑ Yes ❑ No * Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins • 3/13 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System • Page 11 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 101 Duncan Drive Property address Francis Lane Owners Name North Andover MA 01845 6/4/2013 City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D -box level & distibution equal. No evidence of leakage. Evidence of carryover, pumped d -box to clean. Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins • 3113 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System - Page 12 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 101 Duncan Drive Property Address Francis Lane Owner's Name North Andover MA 01845 6/4/2013 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 14 of 17 STD' Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 101 Duncan Drive Property Address Francis Lane Owners Name North Andover MA 01845 6/4/2013 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand -sketch in the area below ❑ drawing attached separately t5ins - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 101 Duncan Drive Property Address Francis Lane Owner Owner's Name information is required for North Andover MA 01845 6/4/2013 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: >4feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 5/22/1981 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health - explain: Design plan ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: As per test pit data on design plan. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 16 of 17 Commonwealth of Massachusetts ugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 101 Duncan Drive l E. Report Completeness Checklist 6/4/2013 Date of Inspection ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information — Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 17 of 17 Property Address Francis Lane Owner Owner's Name information is required for North Andover MA 01845 every page. Cityfrown State Zip Code E. Report Completeness Checklist 6/4/2013 Date of Inspection ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information — Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 17 of 17 Summary Record Card generated on 5/22/2013 11:12:23 AM by Karen Hanlon Town of North Andover Tax Map # 210-1043-0187-0000.0 Parcel Id 16509 101 DUNCAN DRIVE FRANCIS R. LANE III 101 DUNCAN DRIVE NORTH ANDOVER, MA 01846 Page 1 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 1.24 Acres FY 2013 UB Mailina Index Name/Address FRANCIS R. LANE III 101 DUNCAN DRIVE NORTH ANDOVER, MA 01845 PARKER,GARY 101 DUNCAN DR NORTH ANDOVER, MA 01845 UB Account Maint. Account No Cycle Bldg Id. 17954.0 - 101 DUNCAN DRIVE 3170626 03 Cycle 03 UB Services Maint. Account No. 3170626 Service Code MISCFEE ADMIN FEE WTR WATER UB Meter Maintenance Type Loan Number Owner Previous Customer Active/Inact. From Inactive 6/16/2008 Occupant Name Active/Inactive Last Billing Date 4/10/2013 Active Rate Charge Multiplier/Users 1 1 9.18 1/ 01 ALL METER SIZE 81.17 /1 Until Account No. 3170626 Serial No Status Location Brand Type Size YTD Cons 17526732 a Active ERT HH METE METE w Water 1 1 343 Date Reading Code Consumption Posted Date Variance 3/14/2013 736 a Actual 21 4/22/2013 3% 12/12/2012 715 a Actual 20 1/9/2013 9% 9/13/2012 695 a Actual 19 10/15/2012 -3% 6/12/2012 676 a Actual 19 7/16/2012 -3% 3/14/2012 657 a Actual 21 4/14/2012 27% 12/9/2011 636 aActual 15 1/17/2012 -1% 9/13/2011 621 a Actual 17 10/13/2011 -6% 6/7/2011 604 a Actual 17 7/20/2011 -3% 3/7/2011 587 a Actual 17 4/13/2011 -4% 12/8/2010 570 a Actual 18 1/12/2011 3% 9/9/2010 552 a Actual 18 10/15/2010 -7% 6/8/2010 534 a Actual 19 7/15/2010 6% 3/9/2010 515 a Actual 18 4/14/2010 -1% 12/8/2009 497 a Actual 19 1/12/2010 17% 9/4/2009 478 a Actual 15 10/15/2009 -7% 6/8/2009 463 a Actual 16 7/20/2009 -14% 3/13/2009 447 a Actual 20 4/29/2009 1% 12/9/2008 427 a Actual 19 1/20/2009 25% 9/10/2008 408 a Actual 15 10/10/2008 -39% 6/13/2008 393 f Final Bill 26 6/13/2008 -3% 3/11/2008 367 a Actual 26 4/11/2008 32% 12/11/2007 341 aActual 21 1/22/2008 141% 9/5/2007 320 a Actual 7 10/12/2007 -59% 6/19/2007 313 a Actual 21 7/20/2007 -26% 3/14/2007 292 a Actual 27 4/16/2007 21% 12/12/2006 265 a Actual 22 1/19/2007 118% Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 DEP has provided this form for use -by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using.this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility. Information 1. System Location: Left Leftigg eft / Right rear of house, Left / right side of house, Left / Right side of building, ing, Left / Right rear of building, Under deck Address Citylrown 2. System Owner. Name Address (if different from location) 6c,t� Dr. Ak)-64'�.. #,-.e state Zip Code Cityrrown State Code Telephone Number B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): 6-1(- ' Date t3 2. Quantity Pumped; Cesspool(s) eptic Tank /Is—cle/ Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ YesLT No If yes, was it cleaned? ❑ Yes ❑ No 5. Conditionsof ys n� V\ 4_Z!�r 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc' Company 7. Location where contents were disposed: Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 P , . 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: _101 Duncan Drive_ North Andover Owner's Name: _Gary Parker_ Owner's Address: _101 Duncan Drive —North Andover, MA 01845_ Date of Inspection: 3/11/2008_ Name of Inspector: _Neil J. Bateson_ Company Name: Bateson Enterprises Inc._ Mailing Address: _111 Argilla Road_ _Andover, MA 01810_ Telephone Number: _ (978) 475-4786 RECEIVED APR 2 2008 70HSDANDOVER ETH ARYM 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 F' i Inspector's Signature: Date: 3/11/2008 _ 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: After permit from B.O.H. install new outlet tee with gas baffle, septic system now passes Title 5 Inspection. ****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. k rv�Z « m�\ � CO) Q § i0 Q § Q \ , ® � R ( � a a � ■ b § ¢ § § � \ « ■ � CO) Q § Q § Q \ R 2 k B \ CL ■ � R a \ § \ ( / 2 a \6 � 2 IOU � 2 /k m I � \ 2 2 e § F a o / 2 p k p 2 c B§\ § CL .«f ■ a z m ` K / co cri z z z U) m % §42[ d 2 C� 2 0 a 7 r f c ■ E k 1 a co 2 8 k f 2 ° % $ ■ \ k 0 ° § § § j ° § CO) ° ° 4 & ~ 2 \ / § _0 0 k / ■ ; 2 k k k k\ 12 B \ CL Type of Permit or License: (Check box) ❑ Animal $ Town of North Andover Body Art Establishment $ ❑ Body Art Practitioner HEALTH DEPARTMENT CMUSt� / CHECK #: �/ DATE: LOCATION: $ H/O NAME: Funeral Directors r / r CONTRACTOR NA E: Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type. $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Sustems: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector $ itle 5 Report $ __J ❑ Other. (Indicate) $ Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer 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: _101 Duncan Drive_ _ North Andover_ Owner's Name: _Gary Parker_ Owner's Address: _101 Duncan Drive —North Andover, MA 01845_ Date of Inspection: 2/27/2008_ Name of Inspector: _Neil J. Bateson_ Company Name: _Bateson Enterprises Inc._ Mailing Address: _111 Argilla Road_ _Andover, MA 01810_ Telephone Number: _ (978) 475-4786 iyiAR 1 0 2008 TGN% or f i 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 X Conditionally Passes N eds Further Evaluation by the Local Approving Authority F s Inspector's Signature: Date: _2/27/2008 _ 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. Page 2 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: _101 Duncan Drive_ _ North Andover— Owner: _ Parker _ Date of Inspection: 2/27/2008 _ Inspection Summary: Check A, B, C, D or E / 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. Answer yes, no or not determined (Y,N,ND) in the for the following statements. If "not determined" please explain. Outlet tee in septic tank needs replaced. _ N 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: _101 Duncan Drive_ _ North Andover— Owner: _Parker_ Date of Inspection: _2/27/2008 _ 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: Page 4 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: _101 Duncan Drive_ _ North Andover— Owner: _Parker _ Date of Inspection: _2/27/2008 _ 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'/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 _ 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. Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: _101 Duncan Drive _ _ North Andover _ Owner: _Parker_ Date of Inspection: _2/27/2008 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 Cis 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: _101 Duncan Drive_ _ North Andover - Owner: _Parker _ Date of Inspection: _2/27/2008 _ FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): _4_ Number of bedrooms (actual): _4 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 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_ COMIVIERCIAL/MUSTRIAL Type of establishment: Design flow (based on 310 CMR 15.203): _gpd Basis of design flow (seats/persons/sgfl;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 Oct 2006, owner _ Was system pumped as part of the inspection (yes or no): Yes_ If yes, volume pumped: _1500_ gallons -- How was quantity pumped determined? _Measured tank_ Reason for pumping: _Inspect tank & tees_ 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 _25 Years old, 4/8/1983, 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: _101 Duncan Drive_ _ North Andover _ Owner: _Parker _ Date of Inspection: _2/27/2008 BUILDING SEWER _ X _ (locate on site plan) Depth below grade: _20" Materials of construction: _X_ cast iron _X_ 40 PVC _other Distance from private water supply well or suction line: Comments (on condition of joints, venting, evidence of leakage, etc.) _ 4" Cast iron thru wall, 3" PVC in house, no leaks visible SEPTIC TANK: X Depth below grade: _8" 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 —6" _ Distance from top of sludge to bottom of outlet tee or baffle: N/A _ Scum thickness: _4" Distance from top of scum to top of outlet tee or baffle: _N/A N/A Outlet tee badly corroded. Distance from bottom of scum to bottom of outlet tee or baffle: _N/A_ 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 badly corroded, needs replaced. Depth of liquid at 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.): Page 8 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _101 Duncan Drive _ _ North Andover— Owner: _Parker _ Date of Inspection: _2/27/2008_ 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 ,18"_ 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.) __P -box level & distribution equal. No evidence of leakage. Light carryover. D -box cover broken replaced it. _ 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.): Page 9 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _101 Duncan Drive _ _ North Andover— Owner: _Parker_ Date of Inspection: _2/27/2008_ 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: —Leaching trench, number, length: _ _ X_ Leaching field, number, dimensions: _1 field 20' x 45'_ 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.):—Snow cover above field. 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.): Page 10 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: _101 Duncan Drive _ _ North Andover— Owner: _Parker _ Date of Inspection: _2/27/2008_ 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 A to Inlet = 43' cutlet = 49' 3 -Box = 60' Inlet =12'4" cutlet =19' 3 -Box = 32'8" nk ♦— Vent Box Page 11 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _101 Duncan Drive _ _ North Andover— Owner: _Parker_ Date of Inspection: _2/27/2008 _ SITE EXAM Slope _ Slight _ Surface water _ No _ Check cellar _ Dry _ 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: _5/22/1981_ 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: No water found 4' below system as per test pit data on design plan _ Important: When filling out fors on the computer, use only the tab key to move your cursor - do not use the return key. ISI Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to detem-dne the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: �-\ 9 V -\'A- jPCC---'\-- d 4-- 11 Address / c' ! � V�CCt►'1 City/rows 2. System Owner: Name Address (if different from location) City/rownZip Code B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): V (2 - State Zip Code o,,�- ��e— State q j � Telephone Number Date 2. Quantity Pumped: Gallons Cesspool(s) Septic Tank ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes E4 -K;- If yes, was it cleaned? ❑ Yes ❑ No 5. Con i ion of System: cmc- wt 1-ey,e� e 6. System qurgped W. NameGVH ��Vehide license Number Company 7. Location where contents werIsposed: (,. S , I� Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Class 101 Single Family Size Total 1.24 Acres FY 2008 UB Mailing Index Name/Address PARKER, GARY 101 DUNCAN DR NORTH ANDOVER, MA 01845 UB Account Maint. Account No Cycle Bldg Id. 17954.0 - 101 DUNCAN DRIVE 3170626 03 Cycle 03 UB Services Maint. Service Code MISCFEE ADMIN FEE WTR WATER UB Meter Maintenance —j -aa nm oy mren Hanlon Town of North Andover Tax Map # 210-1043-0187-0000.0 101 DUNCAN DRIVE PARKER, GARY 101 DUNCAN DR NORTH ANDOVER, MA 01845 -- - .-. - - — Property Type Type Loan Number Payor Active/Inact. From Occupant Name Active/Inactive Last Billing Date 1/15/2008 Active Rate Charge Multiplier/Users 1 1 9.18 1/ 01 ALL METER SIZE 75.39 /1 Serial No Status Location Brand 17526732 a Active ERT HH METE METE Type Date 12/11/2007 Reading Code Consumption w Water Posted Date 9/5/2007 341 320 a Actual a Actual 21 1/22/2008 6/19/2007 313 a Actual 7 10/12/2007 3/14/2007 292 a Actual 21 7/20/2007 12/12/2006 265 a Actual 21 4/16/2007 9/12/2006 243 a Actual 22 1/19/2007 6/14/2006 233 a Actual 10 10/20/2006 3/7/2006 210 a Actual 23 7/10/2006 12/22/2005 189 a Actual 21 4/17/2006 9/20/2005 169 a Actual 20 1/17/2006 6/13/2005 159 a Actual 10 10/14/2005 3/30/2005 145 a Actual 14 7/15/2005 12/9/2004 116 a Actual 29 4/5/2005 9/24/2004 103 a Actual 13 1/14/2005 6/10/2004 90 a Actual 13 10/8/2004 4/13/2004 78 a Actual 12 7/30/2004 12/15/2003 44 n New Meter 34 5/17/2 004 5/17/22003 0 Size 11 Page 1 1 Residential Until YTD Cons Variance 141% -59% -26% 21% 118% -52% -17% 30% 113% -46% -29% 53% 39% -41% -27% 0% 0% Tel: (978) 475-4786 Fax: (978) 475-5451 BATESON ENTERPRISES, INC. Excavating -Water& Sewer Lines -Septic Systems & Pumping Service 111 Argilla Road Andover, Mass. 01810 Title 5 Inspection Report Property Address: 101 Duncan Drive, North Andover Owner: Parker Date of Inspection: 2/27/2008 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 RCI!! City/Town of System Pumping Record h AR 26 2013 Form 4,p TOWN OF NORTH ANDOVER HEALTH DEPARTMENT DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using Ahis form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left / d front of house, Left / Right rear of house, Left/ right side of house, Left / Right side of building, Left / Righ ron o uilding, Left / Right rear of building, Under deck Address C DU V\6��\ bcCity/Town 2. System Owner. Name State Zip Code Address (if different from location) CitylTown State � � Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes 0-Iq—o If yes, was it cleaned? ❑ Yes ❑ No 5. Condition i3f System: \ LA, 6. System Pumped By: �1 Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location w ere contents were disposed: G L S. Lowell Waste Water Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. VQ Commonwealth of Massachusetts City/Town of System Pumping Record WAR 7 n 2 8 Form 4 TO'.,,ti , t _ r. y DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Address ` d -O L?hC �%t�'1 C� i V (2 A-)cN-4-L-, Cdy/Town state Tp Code 2. System Owner: Address (if different from location) c yrrown rj. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): State Zip Code Telephone Number Date 2. Quantity Pumped: Gallons Cesspool(s)ErSeptic Tank ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes [I -Wo - 5. Conn of System: ' l 0 �- A".— e,-� f eu,P� If yes, was it cleaned? ❑ Yes ❑ No 6. System Uutm1ped Py- -1 y : Name - -� is -aa r Vehicle Lie Number Company 7. Location wh a contents wer Isposed: 7,L,.S, I .- Date a 7--4f �El t5fom>4.doc• 06/03 System Pumping Record • Page 1 of 1 RTN , Commonwealth of Massachusetts Map -Block -Lot F:o+,•••� +. tioLp 104.6- 0187 - Board of Health Permit BHP -2008-0011 No North Andover --------------- -- `�+� P.I. -- FEE 'Is 34 WU F.I. $125.00 ----------------------- Dis osal Works Construction Permit Permission is hereby granted Todd Bateson to (Repair) an Individual Sewage Disposal System. I at No 101 DUNCAN DRIVE as shown on the application for Disposal Works Construction Permit No. BHP -2008-001 Dated March 03, 2008 ------------------------------ ---- ----------------------------- -- - --------- I ssued -------Issued On: Mar -03-2008 Board of Health ------------------------------------------------------------------------------- µORTM Map -Block -Lot Commonwealth of Massachusetts .,,, Lp 104.13- 0187 - • i� Board of Health North Andover iL ��.,; •..,.:r�� Certificate of Compliance THIS IS TO CERTIFY,That the Individual Sewage Disposal System (Repair) by __Todd Bateson Installer at No 101 DUNCAN DRIVE has been installed in accordance with the provisions of TITLE 5 of the State Environmental Code as described in the application for Disposal Works Construction Permit No. BHP -2008-001 Dated March -03, -2008---- --------------------------------- -------------------- ---- --- -------------------- Printed-On: ----------------- PrintedOn: Mar -03-2008 Board of Health NO DTM r • _ Town of North Andover `'•�;,;,;:.: HEALTH DEPARTMENT �SS�CHU CHECK #: LOCATION: H/O NAME CONTRACTOR NAME: Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ TrashlSolid Waste Hauler $ ❑ Well Construction $ SEPTIC Sustems: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ g' -septic Disposal Works,Construgtion (DWCa— $ f ' 5- 0 ❑ Septic Disposal Works"Af fa is' (DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other: (Indicate) $ Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer °RThApplication for Septic Disposal System .•+ a;• O Construction Permit -TOWN OF ORTH ANDOVER. MA 01845 'o...... .A a.b Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. TODAY'S DATE $ 250.00 — Full Repair $125.00 - Component Application is hereby made for a permit to: ❑ Construct a new on-site sewage disposal system* ❑ Repair or replace an existing on-site sewage disposal system* K?Ke'pair or replace an existing system component — What? 0w41AT T..2-e— A. Facility Information l� � �c1 h C_ ^f Address or Lot # City/Town o J.�.Z EHEALTH �% UU 2.- *TYPE OF SEPTIC SYSTEM*: RTH ANDOVER EPARTMENT ❑ Pump ❑ Gravity (choose one) ***If pump system, attach copy of electrical permit to application*** ❑ Conventional System (pipe and stone system) ❑ Infiltrator or Biodiffuser (Gravel -Less) (Attach a copy of your certification to in this type of system. El Pressure Distribution S.A.S. (No D -Box) (Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D -Box Present) S.A.S. 2. Owner Information Name fD 1 ��cor� D2 Address (if different from above) D "✓..ems D t' LlS City/Town State Zip Code Telephone Number 3. Installer Information Name N me of Company /l l q l �� XJ Address ' 014 . o City/Town 4. Desigi Name Address City/Town JU a State Zip Code FlS - J'7o 3 Telephone Number (Cell Phone # if possible please) Name of Company State Zip Code Telephone Number (Best # to Reach) Application for Disposal System Construction Permit • Page 1 of 2 OF ^NaoT;�ti Appl cation for Septic Disposal System - L4 off' Construction Permit —TOWN OF TODAY'S DATE ORTH ANDOVER, MA 01845 $ 250.00 - Full Repair �' ^ ^•°''"� $125.00 - Component PAGE 2OF2 A. Facility Information continued.... 5. Type of Building: N41 �esidential Dwelling or ❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore -described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover, d not to place the system in operation until a Certificate of Compliance has been issue thi Board of Health. ?—o s/ Name Date Applicatio pproved By: $ard of Health Representative) cj Nap 6 Date n For Office Use Only: the following reasons: L Fee Attached. Yes No 2. Project Manager Obligation Form Attached. Yes No 3. Pump SXstem? If so, Attach copy ofElectrical Permit Yes No 4. Foundation As -Built. (new construction ronly). (Same scale as approved plan) Yes No 5. Floor Plans? (new construction only). Yes No Application for Disposal System Construction Permit • Page 2 of 2 • SEP'T'IC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: �D Out A6,4N DR (Address of septic system) For plans by (Engineer) Relative to the application of �° Ct,��5V N (Installer's name) And dated qq ^ nguia ate Dated — C7' / — o ay s ate With revisions dated I understand the following obligations for management of this project: (Last revised date) 1. As the installer, I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer, I must call for any and all inspections. If homeowner, contractor, project manager, 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 Title 5 and the Board of Health Regulations may result in a $50.00 fine being levied against me and/or my company. a. Bottom of Bed — Generally, this is the first (1'D inspection unless there is a retaining wall, which should be done first. The installer must request the inspection but does not have to be present. b. Final Construction Inspection — Engineer must first do their inspection for elevations, ties, etc. As -built of verbal OK (or e-mail to: healthde-t(a townofnorthandover.com) from the engineer must be submitted to the Board of Health, after which installer calls for an inspection time. Installer must be present for this inspection. With a 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. Installer does not have to be on-site. 4. As the installer, I understand that only I may perform the work (other than simple excavation) and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done 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 ofHealth 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 Mans. No instructions_bv the homeowner, Qeneral contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: (Today's Date) rf —d 7—a V p � l � Sd�/✓ ame —Print) a —Signed),,---' r Q PA-6-4R_4Ho,4//o 1 7" fA/AR_. h _ELEYELT/ON /NVERr5 _ r4AL4 .t_.? l _T Nk OtitT' /A.._Z .2_4t, i• pa / zs•• 8/ • W ELL P c�.l. � T• /Yi L A iR E ANDOVE',k /i9AS S - 4-8-83 �COMMph� C y v f a p v y a 4 9R�AN S�1�' SEPTY'- 61.0 iAN,k 900 S•F• 8E0 _ TO: NORTH ANDOVER, MASS 19PR / L e 19 (2.3 BOARD OF HEALTH FROM: DESIGN ENGINEER Re: Soil Absorption Sewage System Inspection This is to certify that I have inspected the construction of the said disposal system at L c i 3 ,D %r h/('iI A! J)R / 1�E North Andover, Mass. SITE LOCATION The grades and construction are as specified in awyL plans and specifications dated ..� £ C 2 19�?. 8 y. /V E V F IJ SSv C «I TCS SNC ,Reg. Kofi ngireer R& Sanitarian ✓. Commonwealth of Massachusetts RECEIVED City/Town of System Pumping Record OCT 2 4 2006 Form 4 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT DEP has provided this form for use by local Boards of Health. a System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. System Locat* fomes on the (' computer, use only the tab key Address to move your IL cursor - do not use theretum City/Town r State Zip Code key. 2. System Owner: Name Address (if different from location) City/Town State Zi —ode Telephone Number B. Pumping Record 1. Date. of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes [l—lqo--- If yes, was it cleaned? ❑ Yes ❑ No 5. Condition System: 6. Syste P m ed By: Name Company -- 7. Locate where content re d' )://www.mass.gov/dep/Water/approvalt,/t5forms.htm#inspect 14.doc• 06103 Vehicle License Number System Pumping Record • Page 1 of 1 10. 0 Dellechiaie, Pamela From: Pam Dellechiaie[pdellechiaie@townofnorthandover.com] on behalf of Dellechiaie, Pamela Sent: Wednesday, December 08, 2004 3:43 PM To: Sawyer Susan (E-mail); Grant, Michele Subject: Complaint: Somewhere on Duncan Drive - Housing -Septic Importance: High Sensitivity: Confidential Here's another one for you. Same procedure It's feast or famine.... P COMPLAINT FORM -Housing-Septic... Town of North Andover — Health Department COMPLAINT FORM DATE: Wednesday, December 08, 2004 Time of Report: 3:25 p.m.. Report taken by: Pamela DelleChiaie TYPE OF COMPLAINT: Housing/Septic COMPLAINTANT NAME: Anonymous ADDRESS: n/a PHONE: n/a COMPLAINT AGAINST: past 100 Duncan Drive — cul-de-sac road — probably on the left hand side. ADDRESS: past 100 Duncan Drive — cul-de-sac road — probably on the left hand side. PHONE: Not given COMPLAINT: Terrible smell, especially when wind blows. Has been going on since end of September. Not sure of exact address, but left hand side. Thinks someone has a ces pool/failed septic. ACTION: s Aum Gc� u� QS' :Sta!4uL Andover,Fazs. 5�tF" ;iIC SIBTt'�'— INSTALLkTICN CiHB','K LIST IjF- Ll 1A - LOT XCAVATIC� 0� FX.IL 1. Distance Tos t tea. Wetlands iii. Drains _ C. Well ( lv``=it�� jf z%1gi 2. Nater Line Location 3• - No PPC Pipe % Septic Tank = _ t3 E �� •.'� • a.. -Tess -_Length & To Clean Out Covers b. Cement Pipe to Tank On Both Sides of Tank 5. Distribution Box a. Covers & Box - No Cracks b. - All Lines Flooring Bqual Amounts C. No Back Flow b. * Leach Field or Trench a. Dimensions b. Stone Depth c. Capped Ends d. Clean Double Washed Stone 7. Leach Pit no ions b. Sto a Depth c. ash Pads d. ees e. Cement Pipe to Pit - Both Sides f. Clean Double Washed Stone 8. No Garbage Disposal 9. -Final Grading Inspection 10. Barricading Covered System 11. As Built Submitted _ a. Lot Location b. Dimensions of System c. Location with Regard -to Pere Test d. Elevations e: Water T le P4 MBS�-LACE DIS'OSfLL D"ILSiO:i CEL.%I, LIST APPROVED DATEDISAPPROVED DATE I a� Provided: Reasons: LOT # �-� �� ..� c'�t.i J P - Title V Fes+ 09 Reg 2.5 The submitted plan must show as a minimum: a) the lot to be served-area,dimensions lot #,abutters b location and log deep observation hoes -distance to ties v c location and results percolation tests -distance to ties d design calculations & calculations shaming required leaching area e) location and dimensions of system -including reserve area. f) existing and proposed contours g) location any vet areas -Athin 100' of sewage disposal system or disclaimer -check wetlands mapping (h) surface and subsurface drains within 1001 of sewage disposal system or disclaimer (i) location any drainage easements within 1001 of sejaage disposal system or disclairer-Planning Board files (j) known sources of water supply witbin 2001 of sewage disposal e system or disclaimer location of any proposed well to serve lot -1001 from leaching facilit; location of water lines on property -101 from leaching facility location of benchmark driveways (o garbage disposals 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 OtBer elevations maxim= ground water elevation in area se -,age disposal system s) plan mast be prepared by a Professional Eagineer or other professional authorized by law to prepare such plans Reg 6 Septic Tanks �Ca) capacities -50% of flow, water table, tees, depth of tees, access, pumping cleanout 101 from cellar wall or inground swima3.ng pool d) 251 from subsurface drains Reg 10.2 Distribution Boxes slope greater than 0.08 Reg 10.4 b) SUP f • � C n T r r C. .,._ T t r b ": 2 �r Leac" Pits Leaching pits are preferred where the installation is possible Reg 11.2 a) calculations of ping area-adnimum 500 8q ft 11.4 b) spacing 11.10 c) surface a 2`% 11.11 d) cover /elbow al e) 2 1 a2' xplash pad f) tee a g) no ds in pipe from d -box to pipe Leaching Fields Reg 15.1 no greater than 20 minutes/inch area -n ni =m 900 aq ft 15.4 Td) construction of field 15.8 surface drainage 2 % 3.7 201 from cellar wall or inground swimming pool Reg 14.1 14.3 a)yCialculats o eaching area -min 500 sq ft b)t min 6 ft with reserve between 14.4 c)14.6 114.7 d)n e)11a.1�0 f)inage 2% ;j, , No IZU, C -061M%-, Dofmhill Slop e [a) slope y x to be shown) rb '8r b) y/x Z 150 = (to be shown) o L ' PUT Reg 9.1 9.6b) a) appVal s d -by power i --atdE R- EFA5 gCr N V -E -- k_0R -A vF �.aT 413 CtxN'01, No T 'k, 0a.7 Lo r Z ♦ � /a ��=Q-� 6 A.-�-� tic ; 1, fid' ��=�-1 1�-'-o ' _s n u tJ cc e.o r vP GX Ccs: • raJ =�-�s�(t �,� �; l5 IV C :. T� S Z � 1.i �n �y0 t..cT ' :.] l.u►:• tea= � C:J ce"� I! r�-_-t.�, ��..� � � 3 Ute• � �, t� � uAT53 F:-� S'�STG-rpt 8a45V"J Aj_ OF' TO Le-A'QC w MA.f > X-2- CJl,92 SOIL PROFILE & PERCOLATION TEST DATA North Andover, Mass. Street No /10 t+ j�C,1.�7 rrc , ,��e--i -J`- Lot No Loc/Subdiv. Pland Owner Investigator Gtr- �'r.'c�fiU _ Observer 0 1 3 4 5 6 7 8 2.Elev � � 0 1 2 90i Benchmark Elevation -S/ 1 DATES P3 4 5 6 7 8 9 10 3.Elev 0 1 2 C 4 5 6 7 8 9 10 4. Eley Ties Phs est Location Datum - PERCOj,ATION TESTS 4 Pit Number 1 2 3 4 5 Start Saturation Soak -Minutes J - art, rest --prime Drop of 311 -Time ` , • , Drop of 6" -Time MCDns.Ist 3" drop Mins. 2nd " Drop/.5 Percolation S 40 ;7 Cz lei I our-, oo J, -toll 0 LIST 'Eu.iP.CE '01 -ACL LOT .TPRGI-ZD R:29 Di S:X1- LI nz- wig Pro -AR:.: sass -74 ell Title V Ali cc Reg 2.5 Tife b-abmittwd plan mat chow %a a n4n:L, zFjm*. a) no lot to be lot #.,aLattsrB b ocation t-nd log d--,zp obi; -,x -vu -Eon Pe3-dizt.-ace to ties c location and ramps paivolation tests -distance to ties d3sign calculations & calcr-Utions sLowing required leaching rtma location and dimensions of system --including reserve area existing md proposed contoursrea location ony -L-.t as -14thin 1001 of savage disposal oyst-vu or disclaim,3r-check v:3tlLmndB rapping (h) wtwface and subsurface drains within 1001 of so-"ge disposal sy;3t--,n or discleimsr location tinny&7aina-3 1001 of t=- or r-o��-d fl -les j L,-rMOCs of ,--,tcr wc,,�?3,y vitWn 200t of dispom:�e"�<- / or discleoisr (k� location of VW pxoposod t:1.1to vca-m lot -1001 from leaching facility location of writer Iinus on prqpewty-101 A -on levzhIug facility ,location of benchmark a driviawVa '.trarbagoe disposals no PVC to be used in conotAmetion (q) p%-ofile of systsm-elvvatioas of baseii =-t.. plumb., pipe., acptic t=k', distribution box inlets and outlets, distribution field piping and Onar elevations h(r) D.,T-xL!=m ground tmtc-r elevation in r-rca sc-�r,.Ze eIrposal system s plan rirlst be prepared by a Prof assiaiz-2 -,��r or other A prof3uuional authoriz--d by Uw to pr -pare w pleas Reg 6 Septic Tr-nks of flor, -watsr ttblos tecst &-pth of toas., access, pu:.r?:Lng LAI) 01'=L out �(e) 101 ilxom callar v: --U or fz,--ouad miL-7zlng pool (d) 251 f-,vm sabwwfa-.-e &-,.ins-Ins Reg 10.2 Mctribution Boxes -1 6) 1 apegrcviii thin O.08 Reg 10.4 --- L�7-](b) v�p S'Libmirfr ;3 r -trn C�+�ck Lint P^ _ _ ;e 2 Lcr-chingg Pits Le.&ching pita r a�p� f �: d -moi; t: the i.nst%lati.on is pasz3.ble Reg 31.2� a) c."i c7aatioaff of 1:^";125� 500 &,q ft 11*4 b) Lpacizg 11.10 c •vurface &- gige 2% 11.11 dl covor rsterial e) V=2140 L jl Wsh pad _ -- f) t'.* at .bow ro !;,-.:ids in pipe fl on d-b:;x to pipe Lacking Fields Reg 15.1 no ;mater thm 20 r mutos/Inch w ca- ii Yui 9W cq ft 15.4c conatractian of fi.a? d 15.8 mwface dxv. sre 2 % 3.7 e) 20t from cellar -w-All or 3nground € wi=ring pool Reg 1.4.1 14.3 1.4.4 14.6 1.4.7 -1.10 Reg 9.1 9.6 �_ a) c^ cta�` go; ecebing aroa-rin 500 sq ft b up=:Lag vi -4 ft iAn 6 ft i th res�� bets Hca c� dk:=si ops 1d) ccma"tion iia) strne: f) sarf�ce �r a.;e 2% - �* Slcpe sJ.o x =� o be rlxom b) y/x X 156 _ (to be sho€m) pml a) epproval b) st:tnd-by power Ja) __ Commonwealth of Massachusetts ® City/Town of System Pumping Record APR 4. X012 Form 4 TOWN OF NORTH ANDOVER DEP has provided this formlor use by local Boards of Health. Ot EALTH DEPARTMENT the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Le I htR' f�ont�of house Left /Right rear of house, Left /right side of house, Left / Right side of building, Left / Right ronf nt of building, Left / Right rear of building, Under deck City/Town 2. System Owner. Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): State Zip Code 5ta a—. Zip Code Telephone Number L+ Date 2. Quantity Pumped: Cesspool(s) Septic Tank Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes El -1 of - If yes, was it cleaned? ❑ Yes ❑ No 5. Condition o, f Sjrsteo j� C oA— J J V1,, 4v�^J� 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Location. where contents were disposed: G. Lowell Waste Water F5821 Vehicle License Number Q—( (�- ca Date t5form4.doc• 06/03 System Pumping Record •Page 1 of 1 <CN Commonwealth of Massachusetts City/Town of a° System Pumping Record APR � �p;� Form 4 Tom 09 V10. =NM DEP has provided this form for use by local Boards of Health. Oth he information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left side of house, Right side of house, Left front of house, i ht front of house Left rear of house, dight rear of house. Left rear of building. Right rear of building. Address Cityrrown 2. System Owner: Name Address (if different from location) Cityrrown State Zip Code State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping �2uantity Pumped, Date 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Other (describe): Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes [g No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: omm— = 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Location whore contents were disposed: D —,,h „ Lowell Waste Water of F5821 Vehicle License Number Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 WELL DATABASE ADDRESS: AGE OF WELL: t c�=� WELL DRILLER: r, WELL PERNET .T: ` WELL LOCATION: / C U WELL PERMIT DATE: DEPTH OF WELL: --TYPE OF WELL. a.. DRILLED ? b. DUG c. OWN TYPE. OF WATER BEARING ROCK- ? WATER ANALYSIS DATE. HIG MANGANESE: Y N HIGHIRON: Y N O -CONT ANTS: Y N