HomeMy WebLinkAboutMiscellaneous - 103 VEST WAY 4/30/2018Ic
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Commonwealth of Massachusetts
City/ I own of
System Pumping Record
Form 4 SEP 2 9 2006
T�" :THF^!I] 1/
P has provided this form for use by local Boards of Health.. The System;Pumping_Re o must
be submitted to the local Board of Health or other approving authority.. '
A. Facility Information
Important:
When filling out 1. System Location:
forms the
computer, use
only the tab key Address t V A 1
to move your ,v
cursor - do not - s
use the return City/Town ate
key.
2, System Owner:
II� l
Name
reorn Address (if different from location)
Cityfrown
Zip Code
Zip Code
Via- 7
Telephone Number
B. Pumping Record
1. Date. of Pumping Date 2. Quantity Pumped
3. Type of system: ❑ Cesspool(s) Q—qeptiC Tank
❑ Other (describe):
Gallons
❑ Tight Tank
4: Effluent Tee Filter present? ❑ Yes PNo If yes, was it cleaned?
El Yet ❑ No
5. Condition of Syste
6. System Pumped By
Name Vehicle License Number
Company --
7. Locatio ere contents Wersposed:
S_.
Signatur of H 1 r Date
http://www.mass.gov/dep/water/approvals/t5foffns.htm#inspect
t5form4.doc• 06103 System Pumping Record • Page 1 of t
PIIICoIonw All of Massachusetts
, Massachusetts
System Pumping Record
System Owner
O�fl VA.6�1�
Date of i'umping: Q-- ate- c�/
Cesspool: No ( Yes 11
System Location
Quairtity Pumped:f tJ'� gallons
Septic Tank: No 11 Yes H��
System Pumped by: Fatedea Sd&m` �fti4P,a License #
Contents transferrred to : Greater Lawrence Sanitary District
Date:
Inspector
f
Commonwealth of Massachusetts
City/Town of
System Pumping Record OCT 0 2 19-013
Form 4 TC4m 0o VC—'TrVEZ
HEALTH DEPT
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 i ht front o hous Left / 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
to U�
Cityrrown
2. System Owner.
Name
Address (if different from location)
Citylrown
B. Pumping Record
1. Date of Pumping
3. Type of system: ❑
State Zip Code
hovu'_Ct YN
3
State � r , r de
Telep one Number
9
Date 2. Quantity Pumped
Cesspool(s) Septic Tank
❑ Other (describe):
4. Effluent Tee Filter present? ❑ Yes LJ" No
5. Condition of System: I
No_
6. System Pumped By:
Gallons
❑ Tight Tank
If yes, was it cleaned? ❑ Yes ❑ No.
Neil Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7. Locatio re contents were disposed:
G.I_ S. Lowell Waste Water
Date
t5form4.doc• 06/03 System Pumping Record • Page 1 of 1
r urr1 4
ORDER OF CONDITIONS
WETLANDS PR0T_E_C"T.I ON ACT
G.L. C-. 131, s. 40
__ and _under Town of North Andover By Law, Chapter 3 Section 3_5 A & B_________
CITY/TOWN NORTH ANDOVER
NAME Etal Realty Trust
CERTIFIED MAIL NUMBER
FILE NUMBER 242- 184
ADDRESS 754 Forest Street
No. Andover, IIA 01845
PROJECT LOCATION:
Address Lots 33A - 37A Vest Way
Recorded at Registry of' North Essex __, Book 15()8 ,Page 289
Certificate (if registered)
REGARDING:
Notice of Intent Dated February 23, 1983
and plans titled -and dated see condition twelve (12)
THIS ORDER IS ISSUED ON (date) March 18, 1983
Pursuant to the authority of G.L. c. 131, s. 40, the North Andover Conservation
Commission has reviewed your Notice of Intent and _plans identified above, an
has determined that 'the area on which the proposed work is to be done is
significant to one or more of the interests listed in G.L. c.. 131, s. 40. Town
of North Andover bylaws, Section 3.5 A & B Wetlands Protection. The North
Andover Conservation Commission hereby orders that the following conditions
are necessary to protect said interests and all work shall be performed in
strict accordance with them and with the Notice of Intent and plans identified
above except_where_such plans_are_modified by_said_conditions.
CONDITIONS
1. Failure to comply with all conditions stated herein, and with all related
statutes and other regulatory measures, shall be deemed cause to revoke
or modify this order.
2. This order does not grant any property rights or any exclusive privileges;
it does not authorize any injury to proviate property or invasion of
private rights.
3. This order does not relieve the permittee or any other person of the
necessity of complying with all other applicable federal, state or local
statutes, ordinances, by-laws and/or regulations.
4. The work authorized hereunder shall be completed within one (1) year from
the date of this order unless it is for a maintenance dredging project
subject to Section 5(9). This order may be extended by the issuing
authority for one or more additional one-year uper application
to the said issuing authority at least thirty �eriods
30) days prior to the
expiration date of the order or its extension.
UKll_".K 'Jt LU:YUIIlUtV� LV1V111Vt.LU
5. Any fill used in connection with this project shall be clean fill,
containing no trash, refuse, rubbish or debris, including without
limiting the generality of the foregoing, lumber, bricks, plaster,
wire,lath, paper, carboard, pipe, tires, ashes, refrigerators,
motor vehiclesor parts of any of the foregoing.
6. No work may be commenced until all appeal periods have elapsed from
the order of the Conservation Commission or from a final order by the
Department of Environmental Quality Engineering.
7. No work shall be undertaken until the final. order, with r.espect to
the. proposed project, has been recorded in the Registry'of Deeds.for
the district in which the land is located within the chain of title
of the affected -property. The Document number indicating such
recording shall be submitted on the -form at the end of -this order-
to
rder to the issuer-of-.thi.s order prior to commencement of work.
8. A sign shall be displayed at the site not less that two square feet
or more than three square feet bearing the works, "Massachusetts
Department of Environmental Quality Egnineering. Number 242- 184 '.'.
9. Where the Department of Environmental Quality Engineering is requested
to make a determination and to issue a superseding order, the Conser-
vation Commission shall be a party to all agency proceedings and
hearings before the Department.
10. Upon completion of the work described herein, the applicant shall
forthwith request, in writing, that a Certificate of Compliance be
issued stating that the work has been satisfactorily completed.
11.
This Order of'. Condi,,1 i s issued- in .eddit..,an- °-to= the-c-onditions set
underwFile:242-95 for Foster Street/Bridges and does not superceed
said Order.
12. The work shall conform to the following plans and additional conditions:
a. Notice of Intent and Environmental Data Form dated February 23, 1983,
submitted by Etal Realty Trust and proposed by Alfred A. Shaboo/
Flynn Assoc., P.C. Eight (8) sheets.
b. Plan entitled "Proposed Site Development at Vest Lay, North
Andover, MA. Prepared by Flynn Assoc., P.C., for Etal Realty
Trust, dated February 23, 1983, revised lurch 3, 1983, one (1)
sheet.
13. A row of staked hay bales as described in the Notice of Intent shall
be placed between all construction areas and wetland areas. This
row of hay bales shall remain intact until all disturbed areas have
been stabilized to prevent erosion.
-3 -
ORDER OF CONDITIONS: Lots 33A - 37A Vest'Way 242-184
14. All disturbed areas shall be graded,' loamed and seeded to
provide restabilization to disturbed areas. After restabil-
ization, hay bales shall be removed and sedimentation shall
be removed from areas of accumulation.
15. All erosion prevention and sedimentation protection measures
found necessary during construction by the North Andover
Conservation Commission will be implemented at the direction
of the NACC or Highway Surveyor.
16. Any changes in the submitted plans, Notice of Intent, or
resulting from the aforementioned conditions must be sub-
mitted to the NACC for approval prior to implementation.
If the NACC finds, by majority vote, said changes to be
significant and/or deviate from the original plans, Notice
of Intent or this Order of Conditions to such an extent that
the interests of the Wetlands.Protection Act cannot be protected
by this Order of Conditions and would best be served by the
issuance of additional conditions, then the NACC will call for
another public hearing within 21 days, at the expense of the
applicant, in order to take testimony from all interested
parties. Within 21 days of the close of said public hearing,
the NACC will issue an amended or new Order of Conditions.
17. Any errors found in the plans or information submitted by the
applicant shall be considered as changes and procedures
outlined for changes shall be followed.
18. The provisions of this Order shall apply to and be binding
upon the applicant, its employees, and all successors and
assigns in interest or control.
19. Prior to the issuance of a Certificate of Compliance, the
applicant shall submit a letter to the Conservation Commission
from a registered professional engineer certifying that the
work is in compliance with the plans referenced above and the
conditions stated above.
20. These conditions are issued in addition to those issued under
File 242-95 dated March 4, 1981 and any compliances sought on
Lots 33A - 37A will be required to satisfy both Order of
Conditions.
21. Members of the NACC shall have the right to enter upon and
inspect the premises to evaluate compliance with this Order
of Conditions.
22. Accepted engineering and construction standards, and procedures
shall be followed in the completion of the project.
4
ORDER OF CONDITIONS: Lots 33A - 37A Vest Way 242-184
23. Issuance of these conditions does not in any way imply or
certify that the site or downstream aeas will not be subject
to flooding, storm damage, or any other form of damage due to
wetness.
24. There shall be no encroachment on the area below elevation
136'.
The Applicant, any person aggrieved by this order, any owner of land
abutting.the land upon which the proposed work is to be done, or any.ten
residents of the city or town in which such land is located, are hereby
notified of their right to appeal this order of the Department of Environ-
mental Quality Engineering, provided the request is 'made in writing and
by certified mail to the Department within ten (10) days from the issuance
of this order.
ISSUED BY
NORTH ANDOVER
CONSERVATION COMMISSION
On this 18th day of March 1983 , before me personally
appeared AnthonyGalva na to me
known to be the person described in, and who executed, the foregoing
instrument and acknowledged that he executed the same as his free act and
deed.
My Commission expires
DETACH ON DOTTED LINE AND SUBMIT TO THE ISSUER OF THIS ORDER PRIOR TO
COMMENCEMENT OF WORK.
To NORTH ANDOVER CONSERVATION COMMISSION (Issuing Authority)
PLEASE BE ADVISED THAT THE ORDER OF CONDITIONS FOR THE PROJECT AT
FILE NUMBER 242 -
REGISTRY OF
HAS BEEN RECORDED AT THE
ON (DATE)
If recorded land, the instrument number which identifies this transaction
is
If registered land, t e document number which identifies this transaction
is
Signed
Applicant
cvan �
4
MIJU DS PROTEC'T'ION ACT J �;
MASSACMS .. G.L. C. 131 s. 40
NOTICE OF IN=
All parts of this form and the attached Eaviroraental Data Fora shall be ccaaleted
ander the pains and penalties of perjury. Incomplete filings may be rejected.
DATE: Fehrua'rri 23, '19;;,3 •
Coasarvatioa Commission of (City/Town) : ! o r t 1, EA n .J o v e r ,
1. Notice is hereby given,in accordance with the provisions of Massachusetts G.L. .
c. 131, s. 40 that the proposed activity described herein is within the jurisdiction
of
(City/Town) ort!, n i1 r f at I -" 1 J.1 1 - " " street
most recent recording at the Registry of ; o r t 1, EE ; X , Book 1 !l 1
Page- 1v) 4 ,
Certificate (if registered)
2. The land on which the work is proposed to be done is owned bp:
NAIM(s) ':ta-1 11ea1ti Tru ,t ADD88SS V5 ZI Forest )t., Jo, E;n(iover
The Applieaat submitting this Notice is:
NAME Jt{me, J, :'1)iI ,in, Truster ADDRzss 7511 Forest "trent, do, Andover
. TELEPHONE f) i- t I J J
(Optioual)The following person is hereby designated to represent the
applicant in matters arising hereunder:
Flynn As,oc,
NAMW N 1-frer! A ;haboo Address 'J•J. 'ox :; J, laistoi�, a,N.
Talephon! G - 3 r? or (J J) 112 - 5 r) 3 1
4. Plans describing and defining the work, included herewith and made a part hereof,
we titled mad dated: •
1)r01)01,eri `;itp IPk/rIo, nrnt by F1 .inn ls,oc, !',C',, F�;rruaril J, 1`J"!3
Identical material has been submitted by certified mail as follows: ;
,
Original to Conservation Commission (Date) F n ', . � 3 ,
These copies to appropriate regional office of the Department of Eaviroamental
Qualit7 Engineering (see map for regions and addresses) . Date F e . 31 1 ? ., 3
__ Northeast Southeast Central Wescarn
-2-
3
6. Bas the required $15.'T fi in fee, payable to the city or town, been included
with the submission to -the Conservation COm:mission? P'
7. Bas the Enviromaental Data Form been completed and submicted with each copy? VP`'
8. Bis a loess map •(8h" z 11" copy of U.SGS topcgraph'.c sheet with the site marked) been
included with each copy? 'JPs
9. a '
(A)Mme all obtainable permits, variances, and approvals required by local by -lav been
obtained? ?Jo, subsurface Uisposal Uesirjns ,endinq spring, testinn.
(B)If they have not been gbtained, have they been applied for? JPs
If yes, include with this Notice of Intent any information which has been submitted
with such applications which is necessary to describe the effect of the proposed
activity an the environmeIIt. sre ;clan,.
10.
(A)Is the site of the proposed work subject to a wetland restriction order recorded
pursuant to G.L. c. 131, s. 40A, or G.L. c. 130, s. 105, by the Department of
Environmental. Management? Yes No x Do not know
(B)Is the site of the proposed work in, or within 100 feet of: a coastal duce 10 ;
coastal bank •; coastal beach salt marsh land under the ocean
-0 ;
a Balt pond , aaadromons/catadromaoas fish run do not k __?
lI. Sigaatssrt(s) of owner(s) of the Isad (if by agent or option holder, written authori-
zation must be attached)
IZ. M%at is the purpose of the' proposed project?
To construct.a'65L' + feet common driveuaq and Town water service main
around adjacent wetlands to service lots J311' - 37A 'lest 1'.1ay. All suf:)-
surface disc;osa1 5tjstem9 and dwe11.-ings on 1.ot9 3 3 A - 36A will be located
at distances greater than I'll' from wetlands.
13. I SEMI C=IiT UNDER TRE PALMS AND PE.'"iALTIES OF PE.RJURT THAT THE FORGOING NOTMCr
OF II'RSPi't AND A=WAJttINC MVIRONME= DATA FORM ARE TRUE AND L-Zllp=.
4
�' ss mtt!�ti of Applicant ���' Date
(Form 3, conti=ed) 3
-3-
WETLAND PROTECT :ON ACT
ZNVZRONMF�iT,\L DATA ?CAM
1. All parrs o: this fo::a are to be filled out by the applicant
or his
agent under the provisions of G.L. C. 131 .s. 40.
2. where a section is not relevant to the application in question, the
words "Not Applicable" should be entgred on the appropriate line.
NAM OF APPLICANT J<3mes J. IlhiIhin, Tru,tee
ADDRSSS OF APPLICANT
MMICIPALITIZ5 VrMRE ACTIVITY IS PROPOSED AND NOTICE IS FILM .v o r t h Andover
DESCRL9TION OF PROPERTY nW.CLVM IN Lot 3 3 A - 1n9, 2 6 s, f. , Lot 34A -
APPLICATION (including the dimensions , ,t „ s . f . , Lot 35A - 691955 s . f . ,
of any existing buildings, decks, marinas, Lot 36A - 69,n4l s.f., Lot 37A -
existing cesspools) Za 5 , 9 ' 5 , , f .
DESCRIPTION OF MODIFICATIONS PROPOSED
ON THE SITE, including grading, dredging, ,re at plan.
removal, of vegetation, etc.
.A. SOILS '!IC rledisar!rists, deep,NcE
1
Laxton extremely stony fine—
Agriculture
ine . United States "Department Of s a n dy 1- o a n, 2 5 - 4 5� ; s l o p e s
Agriculture Soil Types (show an man)
2. P43=Gabilit7 of soil an the site. (Dates of testing)
No tests con duLted.
n.6 - 6.0 In./H r. from 1I50A Soil_ Surve,l
3. Rate of percolation of Water through Testi to he conducted in
the sail. (Dates of testing) s:;rinri. ;J t h e r tests t o
arra indicotr r - 1min. /ill.
a. SURFACE WATERS
1. Distance of site from nearest
surface water (Date of measurement)
v J
4
2. UCU Cas Of CUnOfs Water 1,rectation and snow melt.
1. :�.s exist:nr elevation on site + 2 116 '
1. *N��+* existinq elevation on site + l d /a '
3. YA%i=zm proposed elevation of site + 2y6
4. Minim= proposed elevation of site a- 13 V
i
To
S. DescriptIcn of proposed Change in topography accommodate dwellings,
iirivetua is 2 related gradtng.
�Pe -I1.an
I. Minimum depth to water table On sit! (at time of film) - Hands
2. Maxim= depth to water table on site (at titan Of 1411M) ' n k n c w n
3. seasOnil maxi= t—_ M=d tjltpr mP1 avx t i nn ll n k n o u n. To h e ri t d r n i n e d
if rinr. 191;3
Exi stin•q
Proposed'
3.
Rate of runoff f_ -cm tre site ,a 39-1), c -F s
q I . ",c f s
(411 1) 1 U9.5 cfs
52.(1 c f s �
4.
Destination o: r=cf: water
I1djaq,ent wet lands
S.
Ch mical additives to r=off
Water On the site
done anticipated
C. GZL ED =VER
1.
EXtent of existing imperviolus
!round cover . on the site
N o n e
Z.
r=ent of proposed im`aervio"
Common it r i v e, d w e l l i n g s and
ground cover an the sit&
� r i v e w a i.i s, a p p r o `r..
6.3
3.
Lxtent of*existing vegetative
,
caves oa t#G sit!
1riF) medium - heavy
woods.
4.
Zxtent of proposed vegetative
A n p r o x. 9 3. 7"; o f ;
h i c h n !�"' w i I 1
eaver on the site'
remain wooded.
n. :0
.
1. :�.s exist:nr elevation on site + 2 116 '
1. *N��+* existinq elevation on site + l d /a '
3. YA%i=zm proposed elevation of site + 2y6
4. Minim= proposed elevation of site a- 13 V
i
To
S. DescriptIcn of proposed Change in topography accommodate dwellings,
iirivetua is 2 related gradtng.
�Pe -I1.an
I. Minimum depth to water table On sit! (at time of film) - Hands
2. Maxim= depth to water table on site (at titan Of 1411M) ' n k n c w n
3. seasOnil maxi= t—_ M=d tjltpr mP1 avx t i nn ll n k n o u n. To h e ri t d r n i n e d
if rinr. 191;3
_s
3
WATIR SUPPLY 3
illunicipal
1. The source of the water to be provided to Vhe site 5 e e 7, t a n .
2. The expected .rater requirements (q.p.d.) for the site 3nnn 9pd '
3. The uses to which water will be but F,esidential
G. ,WAGE DISPOSAL •
1. Sewage disposal system (description Subsurface disposal.
and location on•the site, of system) see lan..
2. Expected content of the sewage
eftlaents (human waste, pesticides, lo nie,5 tic o n i t, .
detergents, oils, heavy metals,
other chemicals)
3. Expected daily volume of sewage n -, ,„ i
F�. SOLID WASTE
1. Estimated quantity of solid waste
' to be developed on the site e r `' a''
2. Method for disposal of solid waste ,Uniai al
3. Plans!for recycling of solid waste lunici^al.
I.• BOAT YARDS, D=S, MARMS
1. Capacity of marina (number of / a
boats, running feet)
2. Description of docks and floats
(sit*, dimensions)
3. Description of sewage pumpout `
facilities (type of waste disposal) /a.
4. Description of fueling facilities
and fuel storage tanks
S. Description of :Uel spill prevention
measures and equ#Ment "
J. WALT OF PRCPCMM ACTION APPLLD FOR
IinimaI Un1y that required for proposed
:.. E1feets on plant species dev2To4onent, All disturbed areas •
(upland and marine) excIudinrl dwellings 2 driveways will be
replanted with grasses.
2. Effects on marine species (Shellfish, finfish) None anticipated.
3• Effects on drainage and runoff. `,1i,ht incrrro - r clue to rIrwP1.(3pmr.nt.
'IinimaI flay Ual.e Pro sion checks
4. Effects an siltation- of surface waters to he emptoled hetwPPn disturbed
area s " rtIand5',tn rem,)in until ,tal)iliz ition of disturbed areas.
''I
S. Effects on groundwater quality u .) n n t i r i p a t e d .
s
`,surfacP dPsirin wi11 mP.Pt Itt1P_ U
`� inimaI d u c ,to nature of
6. Effects on surface water quality ) r, ,,1- o p n r n t.
Uthrr then no rleve1, 1mrnnt, any use
�. ALTERNATIVES ,TO PROPOSED ACTION Li a >• I c w o i n z« rdii i , r e cl di n i ons .
. ri)in�1" s vi_ ion esiq allowed
for deveIopmPnt o these lots.
L. Describe alternatives to the
requested action
2. Describe the benefits of the requested
action over the alternatives
a,
I nahiIiti;
to d e v R I o p ujouId crPatP undue economic hardshi,i on owner,
Tost tax
revenue to Torn and an unmaintained "and possibly unsafe tract
of
land in an
othPrcrise deveT0r,ec) ar-a.
b,
An.l other
use !)'.I zoning, would have no less an environmental impact
anri cjnuld
bre irnharnonious with the �iesthPtic, of the s u r r o u n d i n n areas.
•a.
(�rirlina1
1rrliminar11 5 i t r rlrarJinrl ; lan shour,l r comn'on.driwPetny that
u a s al rax,
J_Il'1' Ion;rr than that r rosPd, ! Il dwr?1.1inn ? subsurface
Jnosal
scls;trm incl rivPcrag locations and trades are intended +to
o; timizr
environmental and a t h e t i c critria whi1_.e satisfying edicts
of
other governin,i
agencies (e !'ui)Tic :Io rk, 11ir;huay 1,,ur11ei.lor, Fire
I;epartnPnt,
` oard of 11rralth, E ,nx Count ; Grrenhe1-t.)
• O � :� \ + 0 �, U 1'+ \ •IIA - -
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ells °
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BALED HAY OR STRAW EROSION CHECKS
22.
RECEIV
JOYCE BRAyme
NORTR kfiffiniANDA R
Town of North Andover
of the Zoning Board of Appeals
ty Development and Services Division
27 Charles Street
North Andover, Massachusetts 01845
1001 MAY 16 p 2;
D. Robert Nicetta
Building Cornnlissioner
Telephone (978) 688-9541
Fax (978) 688-9542
Any appeal shall be filed Notice of Decision
within (20) days after the Year 2001
date of filing of this notice
in the office of the Town Clerk. Property at: 103 Vest Way
NAME: Mark &Amy Mellman DATE: 5/9/2001
ADDRESS: 103 Vest Way PETITION: 011-2001
North Andover, MA 01845 HEARING: 5/8/2001
The North Andover Board of Appeals held a public hearing at its regular meeting on Tuesday, May 8, 2001
at 7:30 PM upon the application of Mark & Amy Mellman,103 Vest Way, North. Andover; MA
requesting a dimensional Variance from Section 7, Paragraph 7.3 of Table 2 for relief of a right side & rear
setbacks and for a Special Permit from Section 9, Paragraph 9.2 to allow for the extension of a proposed
one story great -room on a non -conforming lot within the R-1 Zoning District.
The following members were present: William J. Sullivan, Walter F. Soule, Raymond Vivenzio, Ellen
McIntyre, George Earley.
Upon a motion made by Raymond Vivenzio and 2°d by Walter F. Soule the Board voted to GRANT a
dimensional Variance for relief of 5' for a side setback, and relief of 23' fbr a rear setback and that the
granting of these variances will not adversely affect the neighborhood or derogate from the intent and
purpose of the Zoning Bylaw. The Board voted to GRANT a Special permit to allow for the extension of
a proposed one story great -room on a non -conforming lot. In accordance with the Plan of Land by: Scott
L. Giles, PLS, #13972, 50 Deermeadow Rd., North Andover, MA, dated: 3/29/2001. Voting in favor:
WJS/WFS/RV/EM/GE.
The Board finds that the applicant has satisfied the provisions of Section 9 Paragraph 9.2 of the zoning
bylaw and that such change, extension or alteration shall not be substantially more detrimental than the
existing structure to the neighborhood.
Furthermore, if the rights authorized by the Variance are not exercised within one (1) year of the date of the
grant, it shall lapse, and may be re-established only after notice, and a new hearing. Furthermore, if a
Special Permit granted under the provisions contained herein shall be deemed to have lapsed after a two (2)
year period from the date on which the Special Permit was granted unless substantial use or construction
has commenced, it shall lapse and may be re-established only after notice, and a new hearing.
Town of North Andover
Board of Appe s,
William J. Suit an, Chairman
Ml/Decisions2001/14
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANING 688-9535
-
RAGGS, INC.
Subsurface Soil Disposal
Inspection Report
In Accordance With
Title 5 (310CMR 15.000)
e'ving you Since
16'v
P. O. Box 1027, Concord, MA 01742
(508) 369-1100 / (800) 287-5541
FAX (508) 897-3848
RAGGS, INC., P. 0. Box 1027, CONCORD, MA 01742
(508) 369-1100
OFFICIAL CERTIFICATION
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION
IN ACCORDANCE WITH TITLE 5 (310 CMR 15.000)
CERTIFICATION PREPARED FOR
ADDRESS OF PROPERTY:
DATE OF INSPECTION:
RESULTS:
Lisa and Stephen Rhodes
103 Vest Way
North Andover, MA 01845
April 1 and 18, 1996 and May 10, 1996
X This property has PASSED the criteria set
forth in 310 CMR 15.000.
This property has CONDITIONALLY PASSED
the criteria set forth in 310 CMR 15.000.
This property has NEEDS FURTHER
EVALUATION BY THE BOARD OF HEALTH
according to the criteria set forth in
310 CMR15.000.
This property has FAILED the criteria set
forth in 310 CMR 15.000.
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742
(508)369-1100
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
ADDRESS OF PROPERTY: 103 Vest Way
North Andover, MA 01845
OWNER'S NAME: Lisa and Stephen Rhodes
DATE OF INSPECTION: April 1 & 18, 1996 and May 10, 1996
PART A
CERTIFICATION
Name of Inspector: Wendy Diotalevi, R. S.
Company Name: Raggs, Inc.
Company Address: P. 0. Box 1027, Concord, MA 01742
Certification Statement
I certify that I have personally inspected the sewage disposal system at this address and that
the information reported is true; accurate and complete as of the time of inspection. The
inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
PASSES
CONDITIONALLY PASSES
Inspector's Signature
Wendy Diotalevi, Registered Sanitarian #942
NEEDS FURTHER EVALUATION BY
THE LOCAL APPROVING AUTHORITY
FAILS
Raggs, Inc. certifies that all work performed on the aforementioned property was done in
accordance with the guidelines set forth in Title 5 (310 CMR 15.303).
Fred T. Fish, President
Raggs Septic Service, Inc. d/b/a E. A. Comeau
File No.: 96-9368/RHODESSTEPH
Copies to: Payer of inspection
Local Board of Health or its agent
Date
RAGGS, INC., P.O. SOX 1027, CONCORD, MA 01742 (5081369-1100'
96-9368/RHODESSTEPH
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
INSPECTION SUMMARY
A. System passes:
X I have not found any information which indicates that the system violates any of the
failure criteria as defined in 310CMR 15.303 Any failure criteria not evaluated are
indicated below.
B. System Conditionally Passes:
One or more system components need to be replaced or repaired. The system,
upon completion of the replacement or repair, passes inspection.
Septic tank is: Metal: Cracked: Structurally unsound:
Substantial infiltration: Substantial exfiltration:
Tank failure imminent: Tee(s) missing:
The system will pass inspection if the existing septic tank is replaced with a
conforming septic tank as approved by the Board of Health.
Sewage backup or breakout or high static water level observed in the distribution box
is due to a broken or obstructed pipe(s) or due to a broken, settled or uneven
distribution box. The system will pass inspection if (with the approval of the Board of
Health):
Broken pipe(s) are replaced:
Obstruction is removed:
Distribution box is levelled or replaced:
The system required pumping more than four 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:
2
RAGGS, INC., P O BOX 1027, CONCORD, MA 01742 (508369-1100
96-9368/RHODESSTEPH
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
INSPECTION SUMMARY continued
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, and the
environment.
1. System will pass unless the Board of Health determines 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
appropriate) determines that the system is functioning in a manner that will
protect public health, safety, and the environment.
The system has a septic tank and soil absorption system and is within 100 feet to
a surface water supply or tributary to a surface water supply.:
The system has a septic tank and a soil absorption system and is within a Zone 1
of a public water supply well.:
The system has a septic tank and a soil absorption system and is within 50 feet of
a private water supply well.:
The system has a septic tank and soil absorption system and is less than 100
feet but 50 feet or more from a private water supply well, unless a well water
analysis for coliform bacteria and volitale organic compounds indicates that the
well is free from pollution from that facility and that the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm.:
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (508)369-1100
96-9368/RHODESSTEPH
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
INSPECTION SUMMARY continued
D. System Fails:
I have determined that the system violates one or more of the following failure criteria
as defined in 310CMR 15.303. The basis for this determination is identified below.
The Board of Health should be contacted to determine what will be necessary to
correct the failure.
Backup of sewage into facility or system component due to an 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 cesspool.:
Liquid depth in cesspool is less than 6" below invert or available volume is less
than 1/2 day flow.:
Required pumping more than four times in the last year NOT due to clogged or
obstructed pipe(s):
Number of times pumped:
Any portion of the Soil Absorption System, cesspool or privy is below the high
groundwater elevation.:
Any portion of a 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 I 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. If
the well has been analyzed to be acceptable, attach copy of well water
analysis for coliform bacteria, volitale organic compunds, ammonia nitrogen
and nitrate nitrogen.:
RAGGS, INC., P.O. SOX 1027, CONCORD, MA 017421508)369-1100
96-9368/RHODESSTEPH
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
INSPECTION SUMMARY continued
E. Large System Fails:
The following criteria apply to large systems in addition to the citeria listed above:
The design flow of the system is 10,000 gpd or greater (Large System) and the
system is a significant threat to public health, safety and the environment because
one or morer of the following conditions exist:
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):
The owner or operator of any such system shall bring the system and facility into full
compliance with the groundwater treatment requirements of 314 CMR 5.00 and 6.00. Please
consult the local regional office of the Department of Environmental Protection for additional
information.
5
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (5081369-1100
96-9368/RHODESSTEPH
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B CHECKLIST
The following have been done -
1. Pumping information was requested of the owner, occupant, and Board of Health: Yes
2. None of the system components have been pumped for at least two weeks and the system
has been receiving normal flow rates during that period. Large volumes of water have not
been introduced into the system recently or as part of this inspection: Yes
3. As -built plans have been obtained and examined: Yes
4. The facility or dwelling was inspected for signs of sewage back-up: Yes
5. The site was inspected for signs of breakout: Yes
6. All system components, excluding the SAS, have been located on the site: Yes
7. The septic tank manholes were uncovered, opened, and the interior of the septic tank was
inspected for condition of baffles or tees, material of construction, dimensions, depth of
liquid, depth of sludge, depth of scum: Yes
8. The size and location of the SAS on the site has been determined based on existing
information or approximated by non -intrusive methods: Yes
9. The facility owner (and occupants, if different from owner) were provided with information
the proper maintenance of SSDS: Enclosed with report
C.1
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (508)369-1100
96-9368/RHODESSTEPH
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
FLOW CONDITIONS
Residential: design flow: 600 gallons number of bedrooms: 4
number of current residents: 2 garbage grinder: yes
laundry connected to system: yes seasonal use: no
Water meter readings: see Appendix D private well: no
ILast date of occupancy: occupied
Commercial / Industrial: Type of Establishment: n/a
design flow: grease trap:
industrial waste holding tank -
non -sanitary waste discharged to the Title 5 system:
Water meter readings:
Other: n/a
Last date of occupancy:
Last date of occupancy:
GENERAL INFORMATION
Pumping records and source of information: see Appendix A; Homeowner
System pumped as part of inspection: yes Volume pumped: 1,500 gallons
Reason for pumping: Examination of the structural integrity of the tank
Type of system -
Septic tank/distribution box/soil absorption system: yes
Single cesspool:
Overflow cesspool:
Privy:
Shared system:
Other:
Approximate age of all components: 13 years
Date installed: October, 1983
Source of information: As -Built plan by Flynn Assoc., Plaistow, NH
Sewage odors detected when arriving at the site: no
7
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (5081369-1100
96-9368/RHODESSTEPH
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION continued
SEPTIC TANK (locate on site plan) -- see page 11 and Appendix B
Depth below grade: 7' to top of tank, cover built to within .7' of grade
Material of construction - Concrete: X Metal: FRP: Other:
Dimensions: 10' X 6'X 4.4' with 14" cast in place tee
Sludge depth: .8'
Distance from top of sludge to bottom of outlet tee or baffle: 2.4'
Scum thickness: A'
Distance from top of scum to top of outlet tee or baffle: .3'
Distance from bottom of scum to bottom of outlet tee or baffle: 1.1'
Recommendation for pumping: annually
Condition of inlet and outlet tees or baffles: intact
Depth of liquid level in relation to outlet invert: level
Structural integrity: good Evidence of leakage: none
Recommendation for repairs: Replace existing discharge pipe with Schedule 40 pipe
(Note: Discharge pipe to d -box was exposed to locate d -box.
The pipe was Schedule 20 and was buried to a depth
exceeding 8. It was crushed in several places.)
GREASE TRAP (locate on site plan) -- n/a
Depth below grade:
Material of construction - Concrete: Metal: FRP: Other:
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:
Recommendation for pumping:
Condition of inlet and outlet tees or baffles:
Depth of liquid level in relation to outlet invert:
Structural integrity: Evidence of leakage:
Recommendation for repairs:
E:1
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (508)369-1100
96-9368/RHODESSTEPH
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION continued
TIGHT OR HOLDING TANK (locate on site plan) -- n/a
Depth below grade:
Material of construction - Concrete: Metal
Dimensions:
Capacity: Design flow:
Condition of inlet tee:
Condition of alarm and float switches:
Recommendations:
DISTRIBUTION BOX (locate on site plan) --
Depth of liquid level above outlet invert
FRP: Other:
Alarm level:
see page 11 and Appendix B
zero
Level and distribution are equal: yes Evidence of solids carryover: no
Evidence of leakage into or out or box: moderately corroded - no leakage
Recommendation for repairs: Replace d -box with H2O loading d -box and vent S.A.S. through
d -box. (Slime mold was noted in leach lines. System is approx.
9'-10' below grade.)
PUMP CHAMBER (locate on site plan) -- n/a
Pumps in working order:
Condition of pump chamber:
Condition of pumps and appurtenances:
Recommendation for maintenance or repairs:
9
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (508)369-1100
96-9368/RHODESSTEPH
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION continued
SOIL ABSORPTION SYSTEM (SAS) -- see page 11 and Appendix B
(locate on site plan, if possible; excavation not required, but may be approximated by non -
intrusive methods).
If not determined to be present, explain:
Type:
Leaching pits and number:
Leaching chambers and number:
Leaching galleries and number:
Leaching trenches, number, length: 3 trenches, each approx. 55' long
Leaching fields, number, dimensions:
Overflow cesspool, number:
Condition of soil: normal Signs of hydraulic failures: none
Level of ponding: none Condition of vegetation: normal
Recommendations for maintenance or repairs: vent S.A.S. through d -box
CESSPOOLS (locate on site plan) -- n/a
Number and configuration:
Depth -top of liquid to inlet invert:
Depth of solids layer: Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow:
(cesspool must be pumped as part of inspection)
Condition of soil: Signs of hydraulic failure:
Level of ponding: Condition of vegetation:
Recommendations for maintenance or repairs:
PRIVY(locate on site plan) -- n/a
Materials of construction:
Dimensions:
Depth of solids:
Condition of soil: Signs of hydraulic failure:
Level of ponding: Condition of vegetation:
Recommendations for maintenance or repairs:
10
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (508)369-1100
96-9368/RHODESSTEPH
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION continued
SKETCH OF SEWAGE DISPOSAL SYSTEM
* Include ties to at least two permanent references, landmarks or benchmarks
* Locate all wells within 100 ft.
T
4
J�v �
� rID3
3 s,kir.uTir,%.
o x.
TA0K,
DEPTH TO GROUNDWATER: 4'
METHOD OF DETERMINATION OR APPROXIMATION: System installed in 1983 in
accordance with Title 5 (1978). Refer to as -built dated 10/17/83
by Flynn Associates, Plaistow, NH.
11
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 15081369-1100
96-9368/RHODESSTEPH
APPENDIX A:
HISTORICAL
PUMPING RECORDS, REPAIR RECORDS
12
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (5081369-1100
96-9368/RHODESSTEPH
103 Vest Way, North Andover, MA 01845
Prior to inspection, system was pumped in
August, 1994 by Soucy's Sewer Service.
Source of information: Homeowner
13
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (508)369-1100
96-9368/RHODESSTEPH
APPENDIX B:
SITE PLAN / AS BUILT PLAN
14
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-DESIGN DATA$ .
TYPE OF BUILDIN6tSINGLE FAMILY DWELLING
BEDROOMS;4XI50GA` GAL
"l5BRMD4Y DAY
SEPTICTANK GOOX211200GAL.MIN,
USE 1500 GALTANK ' .
ABSORPTION AREA SEE SHEET 2
NOTE 4NO GARBAGE DISPOSAL.
2•SURFACEvmTER WITHIN 100 OF SYSTEMS NONE
&SURFACE OR SUBSURFACE DRAINS OR DRAIN
EASEMENTS WITHIN 100 OF SYSTEMS NOKIE
4 -WELLS WITHIN IOU OFSYSTEM9 NONE
-%WATER SUPPLYS MUNICIPAL
NOTES;
I,1 I-"OPEHTYL.INESFROM NERA07o
2.) COMMON DRIVEWAY, CONTINUATION OF FINISHED
CONTOURS AND RELATE[) INFORMATION FROM,
.CONTOURS
SITE D£VELOPMENT'BY FLYNN ASSOC.
P. C• REV. J
3.)BE.NCHMARK SPIKE IN18PINE EI_EV.155,02.
PROPOSED SUBSURFACE SEWERAGE
DISPOSAL SYSTEM
OWNER.ETAL PFALI•Y TRUST
LOCATION o LOT 35 A VEST WAY
DATE'. 4-1-53 SCALE. -1-'40'
HEV. 4-I 1-s33
PREPARED BY--
FLYNN ASSOC.P.C.
PQBOX559
PL-IISTOW, N�f-la n3865
SKEET IOF2
202 1�jylOSQ,
202
/0
zoo
`\'n�\\ `
383
~ 19,9
-DESIGN DATA$ .
TYPE OF BUILDIN6tSINGLE FAMILY DWELLING
BEDROOMS;4XI50GA` GAL
"l5BRMD4Y DAY
SEPTICTANK GOOX211200GAL.MIN,
USE 1500 GALTANK ' .
ABSORPTION AREA SEE SHEET 2
NOTE 4NO GARBAGE DISPOSAL.
2•SURFACEvmTER WITHIN 100 OF SYSTEMS NONE
&SURFACE OR SUBSURFACE DRAINS OR DRAIN
EASEMENTS WITHIN 100 OF SYSTEMS NOKIE
4 -WELLS WITHIN IOU OFSYSTEM9 NONE
-%WATER SUPPLYS MUNICIPAL
NOTES;
I,1 I-"OPEHTYL.INESFROM NERA07o
2.) COMMON DRIVEWAY, CONTINUATION OF FINISHED
CONTOURS AND RELATE[) INFORMATION FROM,
.CONTOURS
SITE D£VELOPMENT'BY FLYNN ASSOC.
P. C• REV. J
3.)BE.NCHMARK SPIKE IN18PINE EI_EV.155,02.
PROPOSED SUBSURFACE SEWERAGE
DISPOSAL SYSTEM
OWNER.ETAL PFALI•Y TRUST
LOCATION o LOT 35 A VEST WAY
DATE'. 4-1-53 SCALE. -1-'40'
HEV. 4-I 1-s33
PREPARED BY--
FLYNN ASSOC.P.C.
PQBOX559
PL-IISTOW, N�f-la n3865
SKEET IOF2
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DATE 9-13-80
�:�----'-hyo
.................. ... _..... __.
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LOCUS SCALES I-
-DESIGN DATA$ .
TYPE OF BUILDIN6tSINGLE FAMILY DWELLING
BEDROOMS;4XI50GA` GAL
"l5BRMD4Y DAY
SEPTICTANK GOOX211200GAL.MIN,
USE 1500 GALTANK ' .
ABSORPTION AREA SEE SHEET 2
NOTE 4NO GARBAGE DISPOSAL.
2•SURFACEvmTER WITHIN 100 OF SYSTEMS NONE
&SURFACE OR SUBSURFACE DRAINS OR DRAIN
EASEMENTS WITHIN 100 OF SYSTEMS NOKIE
4 -WELLS WITHIN IOU OFSYSTEM9 NONE
-%WATER SUPPLYS MUNICIPAL
NOTES;
I,1 I-"OPEHTYL.INESFROM NERA07o
2.) COMMON DRIVEWAY, CONTINUATION OF FINISHED
CONTOURS AND RELATE[) INFORMATION FROM,
.CONTOURS
SITE D£VELOPMENT'BY FLYNN ASSOC.
P. C• REV. J
3.)BE.NCHMARK SPIKE IN18PINE EI_EV.155,02.
PROPOSED SUBSURFACE SEWERAGE
DISPOSAL SYSTEM
OWNER.ETAL PFALI•Y TRUST
LOCATION o LOT 35 A VEST WAY
DATE'. 4-1-53 SCALE. -1-'40'
HEV. 4-I 1-s33
PREPARED BY--
FLYNN ASSOC.P.C.
PQBOX559
PL-IISTOW, N�f-la n3865
SKEET IOF2
inai wHIJUCTEO BY:A.SHABOO KE, TEST WITNESSED BY% M.ROSATI
3
4
0 PERC TEST 1
2
DATE 9-13-80
TOPELEVATION tS3A.
.................. ... _..... __.
._.-...- ..._....
SOTTOM'ELEVATION 1495`
:4>►!" .
' � .;`,�'�•.J� �"� `
--
- - - —
•�' � t:';
--- — -- -- ---
SATURATION IS
--- -
H..:., .',��- �'f .o. v^ ,�:•
fir, � ' � ,»
9T06�R�p ` 24
-�
–
PERC RATE s
B TEST PIT 41.2
_`A
3 4
DATE
5-�b-e0
3-x83'----.
--_._--
TOP ELEVATION 153.0
1519
TOPSOIL
62,
0'-2'
SUBSOIL
SOIL 2' BONEY TILL
ENCOUNTERED WATER (2 5`
2'-S'SANDYFINE
5" 12'GIWEL WATER
WATER TABLE ELEK 148,0
1479 I(b 139.9)
-- – -- - - -- --
jC SOIL OBSERVATION BYIJ.BARBAGALLO_VI.–ITNESSBT.MURPHY
-DESIGN DATA$ .
TYPE OF BUILDIN6tSINGLE FAMILY DWELLING
BEDROOMS;4XI50GA` GAL
"l5BRMD4Y DAY
SEPTICTANK GOOX211200GAL.MIN,
USE 1500 GALTANK ' .
ABSORPTION AREA SEE SHEET 2
NOTE 4NO GARBAGE DISPOSAL.
2•SURFACEvmTER WITHIN 100 OF SYSTEMS NONE
&SURFACE OR SUBSURFACE DRAINS OR DRAIN
EASEMENTS WITHIN 100 OF SYSTEMS NOKIE
4 -WELLS WITHIN IOU OFSYSTEM9 NONE
-%WATER SUPPLYS MUNICIPAL
NOTES;
I,1 I-"OPEHTYL.INESFROM NERA07o
2.) COMMON DRIVEWAY, CONTINUATION OF FINISHED
CONTOURS AND RELATE[) INFORMATION FROM,
.CONTOURS
SITE D£VELOPMENT'BY FLYNN ASSOC.
P. C• REV. J
3.)BE.NCHMARK SPIKE IN18PINE EI_EV.155,02.
PROPOSED SUBSURFACE SEWERAGE
DISPOSAL SYSTEM
OWNER.ETAL PFALI•Y TRUST
LOCATION o LOT 35 A VEST WAY
DATE'. 4-1-53 SCALE. -1-'40'
HEV. 4-I 1-s33
PREPARED BY--
FLYNN ASSOC.P.C.
PQBOX559
PL-IISTOW, N�f-la n3865
SKEET IOF2
164 ►� 2 +1— 2
4'PERFORATEDPV[,s PIPE+ f C
ISEALEDJOINTS)
• 162 T
BACKFILL MATEWALI12MIN.COdER)--
OF1 TO3IH'CI4kJSHEUSTONF. I�
r— li `F',IaT01112"•^..Ri!E,NFUSTUTIF 160
� \
,l "SOLID PVC. PIPE 15d ' _
(ScALFD JOINTS)
1 F
c'"IIIiSH GPIPE EXISTIh',
' 15
,HO IND
154
0,005. — — ---
15
_ S4
I_GH :ITUDINAL ECTION SEALED ENDS
148
tALL CRUSHED 57QNC.
MUST BE 1)0,113LE WASHED TO MEF.T A AS H 0 SPEC T -I ['GO --
* *AtL PVC PIPING MUST 6E. 4 d SCHEDULE 40 PT.R ASTM P-2241
ABSORPTION SECTION
CAST IRON FRAME AND COVER
ACCESS MANHOLE TO GRADE OR WITHIN
4!OFGRADE FINISH GRADE
EAAIOT+ LAW
7
1,25 GALS'4mCI1NLET 4!OPVC OUTLETtt�FiFAt_ O•G'_ f,,A1.F_�... ' RE.QUIL HESX S4=
o
• p
�' 'In
^ a m CAST IN PLACE
CAST IN PLACE TEE ^I
v CONCRETE TEE � '^
p . 31/2` p p o 0
3 I F2
0 e
�IeMIN GRAVEL�SUBBASE I AS REQUIRED)
1500 GALLON CONCRETE SEPTICTANK SECTION
SCALE If2•-1'0'
s
J� = _ ACCESS MANHOLE I
p 1241 FIC p
I M 3gEXTENSION 1 I 0
p �
li II
0 0
p / I 1
-► I p
-� 0
3 1
I 2• p
o
12�CLEANOUT
31 12 CLEANOUT
ENER YREDU
4"P'VG1 TEE
PLA
CONCRF
SC,
►I+ 2 +1+ 2 •}� 2�}.F 2 +I� 2 ►� 2 2-�i "
I
I '
- I � � �o--2S� -►I
IV I 1
,5,4 INV I I I'm IN. S I
L j IS1►.3 30 -- 1
�q INV 152.9 I.
151.4 El„ 15x1
4'
R�jh!UVE TOPAND SULiSOIL AND
- REPI.ACEWITH SOIL SIMILAR
TO PARENT SOIL
END SECTION I=4
— 171 - T TOP FNUI70-0
16'
T,
167 HOUSE
N1 BOX
ABSORPTION PLAN
ALL CRUSHED STONt MUST BE DOUBLE WASHED To MEET AASHO SPECT 11-60
- -- --
PROFILE „
SCALEI,HORIZ'. 1=20
VERT! I 4'
147
DISPOSAL SYSTEM
LOCATION: LOT 35 VEST WAY
DATE: 4-1-81 B3 SHEET20F2
REV
PREPAREDFLYNN ASSOC. P C
2�.
D-ROX INVEIJS
BOT FM�s
INLE f 15680
159
161
OI ITLLT IS5.65
15➢
\
15.5
SEPTIC TANK INVERTS
I
----- '---- 'I�MIN,
INLET 16005
I
_..----- - ..__-_:---•------_._�
OUTLET 169.80
---
TRf'tdCH" h4T ro M 151:.9 END OF fRFNCIi
I51INV"152AO
BEGINNING
OfTRENQI q
153.1: 1
147.9
147
DISPOSAL SYSTEM
LOCATION: LOT 35 VEST WAY
DATE: 4-1-81 B3 SHEET20F2
REV
PREPAREDFLYNN ASSOC. P C
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (5081369-1100
96-9368/RHODESSTEPH
15
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (5081369-1100
96-9368/RHODESSTEPH
APPENDIX C:
LISTING SHEET
16
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 X5081369-1100
96-9368/RHODESSTEPH
103 Vest Way, North Andover, MA 01845
No listing sheet was provided for this property.
17
RAGGB, INC., P.O. BOX 1027, CONCORD, ISA 01742 (5081369-1100
96-9368/RHODESSTEPH
Appendix D:
Water Usage
Documentation
MI
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (5081369-1100
96-9368/RHODESSTEPH
103 Vest Way, North Andover, MA 01845
Meter Reading:
3/17/94-1363
11/3/95 -1561
Approximately 260 gallons per day
19
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (508)369-1100
96-9368/RHODESSTEPH
Appendix E:
Recommendations:
Repair, Pumping, & Maintenance
20
RAGGS, INC., P.O. BOX 1027, CONCORD, MA 01742 (508)369-1100
Recommendations
for
103 Vest Way, North Andover, MA 01845
1. Replace d -box and install and H2O loading d -box.
2. Vent system through d -box.
3. Pump system annually.
21
96-9368/RHODESSTEPH
*.1119
Sinc, you e
IV`
General Maintenance Recommendations
Proper maintenance of your septic system can help prevent premature failure of your
soil absorption system. RAGGS, INC. recommends the following:
DO PUMP your system ANNUALLY.
DO OPEN your D -Box every THREE TO FOUR YEARS.
DO ensure that your VENT PIPES are installed properly.
DO make sure you know where your TANK is LOCATED.
DO make sure you know where your LEACHING FIELD is LOCATED.
DO look for GREEN STRIPES over leaching field.
DO check to determine if you can smell any ODORS from field location.
DO bring your COVERS WITHIN 6" OF GRADE.
DO USE LIQUID DETERGENT.
DO USE NON-ABRASIVE HOUSEHOLD CLEANING PRODUCTS.
DO USE ENVIRONMENTALLY SAFE PRODUCTS.
DO INSTALL WATER SAVING DEVICES, where appropriate.
DO USE SMALL AMOUNTS OF BLEACH when cleaning toilets, etc.
DO AVOID having roof gutters and downspouts DRAIN ONTO the LEACHING FIELD.
RAGGS SEPTIC SERVICE, INC.
d.b.a. E.A. COMEAU SEPTIC
e
* >' 00
ng you Sing
4G Vq%
GS,
General Maintenance Recommendations (con'd)
DON'T DISPOSE anything NON -BIODEGRADABLE IN TOILETS.
(i.e.: cigarettes, sanitary napkins, diapers)
DON'T wash paint brushes used in latex or oil PAINT.
DON'T allow any PAINT, THINNERS, OR ANY OTHER TOXIC OR CAUSTIC LIQUIDS
to go down sink or toilets.
DON'T allow ANY GREASE or FAT to enter system.
DON'T DISPOSE BONES, EGG SHELLS, COFFEE GROUNDS,OR FIBROUS MATERIAL,
etc. when using a garbage disposal
DON'T use powdered detergents with phosphates.
DON'T use any DRAIN CLEANERS.
DON'T use any ENZYMES.
DON'T use any GREASE DISSOLVERS.
DO NOT ADD ANY ADDITIVES TO YOUR SYSTEM FOR ANY REASON.
In the event of a clog or other plumbing problem, contact your local
plumber, rooter or pumper.
DON'T PLANT any trees or shrubs WITHIN 10 FT. OF THE LEACHING FIELD.
DON'T ALLOW SPRINKLER SYSTEMS or other WATERING DEVICES OVER THE
LEACHING FIELD.
DON'T DRIVE any VEHICLES or place any HEAVY OBJECTS ON TOP OF THE
LEACHING FIELD.
DON'T INSTALL a swimming pool, a patio, or a driveway over the tank or leaching field.
DON'T CONNECT a basement sump pump to a household drain.
RAGGS SEPTIC SERVICE, INC.
d.b.a. E.A. COMEAU SEPTIC
Town of North Andover. NA
Watershed Septic System
Servicing Report VbNNN O
Date: 51 �Q_
HomeownerPumper
Street : X)I N C SA Address�--4�
Phone Phone :7
Nature of Service:
Observations:
.
Description of Work:
Comments:
Routine
Emergency
Good Condition
Full to Cover
Baffles in Place
Leachfield Runback
Excessive Solids
Heavy Grease
Roots
Other (Explain) i0
Board of HealthMaas.
`gorth Ancjnverz BEPTIC SISTEK
INSTALLATICK CHECK LIST LOT j 1�E'ST
CNED D DISAPPtROPID EXCAVATICK OK FAIL
eaonsi �S gU/GT
3 1i �plw/ x/94
1. Distance Tot
a. Wetlands
b. Drains
c. Wen
2.
Water Line Location
3•
No PPC Pipe
}�.
Septic Tank -
a. -Tess -_Length & To Clean Ont Covers.
b. Cement Pipe to Tank - On Both Sides of Tank
5.
Distribution Box
a. Covers & Box - No Cracks
b. All Lines Flowing Equal A=Unts
'
c. No Back Flow
,,
6.
Leach Field or Trench
a. Dimensions
b. Stone Depth -
c. Capped Ends
d. Clean Double Washed Stone
7•
Leach Pi
ao si no
b. Sto a Depth
c. Sp ash Pads
do ees
e. ement Pipe to Pit - Both Sides
f. Clean Double Washed Stone
8.
No Garbage Disposal
9.
Pinnal Grading Inspection
10.
Barricading Covered System
11.
As Built Submitted
_
a. Lot Location
b. Dimensions of System
c. Location with Regard -to Perc Test
d. Elevations
e: Water Table
«r
Board of Health
Hort-::.ndover,masa
SUBSURFACE DISPOSAL DESIGN CHECK LIST
LOT 19-54 ✓Es T
APPROVID
Dig D SAPPROVED DATE ��
Reasons:
Provided: / ,�� �
Title V FAIL OK
Reg 2.5 The submitted plan must show as a minim=!
✓ a) the lot to be served -area, dimensions lot #,abutters
b location and log deep observation Mes-distance to ties
c location and results percolation testa -distance to ties
d design calculations & calculations showing required leaching area
e) location and dimensions of system -including reserve area
W existing and proposed contours
g) location any wet areas within 100' of sewage disposal system or
disclaimer -check wetlands mapping
(h) surface and subsurface drains within 100' of sewage disposal
system or disclaimer
(i) location any drainage easements -.thin 100' of sevage disposal
system or disclai.sr—er-Planning Board files
(j) know► sources of -ester supply vitMn 2001 of sewage disposal o _
system or disclaimer
() location of any proposed well to serve lot -100' from leaching facilit.
location of water lines on property -101 from leashing facility
IV location of benchmarkrl� ,
driveways
rq)
garbage disposals
no PVC to be used in construction
profile of system -elevations of basement, plumb, pipe, septic tank.,
distribution box inlets and outlets, distribution field piping and
other elevations
(r) maxiu<am ground -�,ater elevation in area sewage disposal system
plan must be prepared by a Professional Engineer or other
professional authorized by law to prepare such plans
Reg 6 Septic Tanks
(a) capacities -150% of flow, nater table; tees, depth of tees,
access, pumping
cleanout
) lot from cellar -.-all or inground scimidng pool
(d) 251 from subsurface drains
Reg 10.2 Distribution Foxes
-,/1(a) s ope greater than 0.08
Reg 10.4 1 b) sum O
Show D�G-p Nol,£ ► o� 'PI�"� Vpaa.�1°tit�
FV
Tto •56
t
POOL4 NsT &tom 43 v)�c, none
Marc D:: { Cbe^I- Liet
I FAn, I Og
leg 15.1
15.4
15.8
3.7
Seg 1.4.1
14.3
14.4
3-4.6
14.7
14.10
Reg 9.1
9.6
Page 2
Leaching Pits
Leaching pits are preferre mere the installation is possible
a) calculations of leac area-minizm= 500 eq ft
b) spacing
C) Mwface 2%d) cover materi
e) k'�'x1sA sh pad
f) tee at w
g) no ben in .pipe from d -box to pipe
Leaching Fields
a) no greater t 0 minutes/inch
b area- sq ft
c� construc n of field
A) sarfac irainage 2 %
e) 201 m cellar va11 or inground swimming pool
Leashing Trenches
.a)—Calculations of leaching area -min 500 sq ft
b) spacing -4 ft min 6 ft with reserve between
.e) dimensions
A) construction
e stone
f) surface drape 2%
DounhM Slope
a) slope y x -tto be shown)
y/x x 150 = (to be shown)
jE�M
a) b) power
SOIL PROFILE & PERCOLATION TEST DATA
North Andover, Mass. Street No 'J C—S'i W P-1-( Lot No
Loc/Subdiv. " t �2 � V(A &S Pland Owner
Investigator C> Observer Wl �-
SOIL PROFILE DATES
1.'Elev 2.Elev 3.Elev 4.Elev
% k G/�- (p I E50
0, 0 j 0 . n
.I�
2L
31
4
V1 ACT
1 1
T'�. S
2 2
3 3
4
5
6
1
2
3
4
5
6
7 7 7
8 1 8 8 8
3 4
9 9 9
0 10 10 10
Benchmark Location
Elevation Datum
PERCOj,ATION TESTS
DATES
Tiles Test
Pits
Pit Number
5
2
3
\� 6
Start Saturation
5
6
1
2
3
4
5
6
7 7 7
8 1 8 8 8
3 4
9 9 9
0 10 10 10
Benchmark Location
Elevation Datum
PERCOj,ATION TESTS
DATES
Tiles Test
Pits
Pit Number
1
2
3
4
Start Saturation
Soak -Minutes
Start e
Drop of 3" -Time
Drop of 6" -Time
M ms-lst 3" drop
Mins.2nd " Drop -
Percolation
k-0 e..b, .,rGc> l w
Tia"
r
l C�1 o w
c»alvJ N��
®uC bpp.
WILLIAM F. WELD
Govemo:
ARGEO PAUL CELLUCCI
Lt. Governor
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECT '�qN
ONE WINTER STREET. BOSTON. MA 02108 61 i-292-5500 :
�,• ;` E,tQ,�i41
UDY CORE
Secretary
DAVID B. STRUHS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIO Commissioner
PART A
/
CERTIFICATION
Property Address: /to 3 llT r f Address Owner:
Date of Inspection: /rO( v (If different)
Name of Inspector: ! J
I am a DEP approved system inspector pursuant to Section 15.340 of Title $ (310 CMR 15.000)
Company Name: `'1 i�'C�4f �?.✓- �- i`-1 tob t'�' SC►�'"�i-j-( C,,,,
Mailing Address: P, a 1 t. 14y¢f't "3 F,
Telephone Number:
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 inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewagg,disposal systems. The system:
Passes
_ Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
Fails f �^
Inspector's Signature:'( Date:
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (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 Department of Environmental Protection. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
INSPECTION SUMMARY: Check A, B, C, or D:
A] SYSTEM PASSES:
I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR
Any failure criteria not evaluated are indicated below.
COMMENTS:
15.303.
B] SYSTEM CONDITIONALLY PASSES: fiA
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.
Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not.
_ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or
the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank
as approved by the Board of Health.
(revised 04/25/97) Pago I of 10
DEP on the World Wide Web http:/hvww.magnet.state.ma.us/dep
0 Printed on Recycled Paper
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: / Q $ �'r/,� i �`-��14
�-l0 p (f -e
Owner:
Date of Inspection: � 19 4eta 'OV e l 49 s
B] SYSTEM CONDITIONALLY PASSES (continuedksta-t/ic'1wqater
Sewage backup or breakout or high level observed in the distribution box is due to broken or obstructed
pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if (with approval of the
Board of Health). Describe observations:
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four 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
C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: f r 14
Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 APPROPRIATE) DETERMINES THAT
THE SYSTEM 15 FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or
tributary to a surface water supply.
The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well, unless a _well water analysis for coliform bacteria and volatile organic compounds indicates that
' the well is free`from pollutiori ffom that'f icility and the- presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm. Method used to determine distance (approximation not valid).
3) OTHER
(revised 04/25/97) Page 2 of 10
6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: �b �5►�' �-� �`f. PIDOV-eAl
Owner:
Date of Inspection:
D] SYSTEM FAILS: 4
You must indicate either "Yes" or "No" as to each of the following:
I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis
for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct
the failure.
Yes No
Backup of sewage into facility or system component due to an 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 1/2 day flow.
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 Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a 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 I 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E] LARGE SYSTEM FAILS:
You must indicate either "Yes" or "No' as toeach of the following:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to
public heaktr and safety and the environment because ore or more of the following conditions exist:
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)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 04/25/97) Page 3 of 10
e
0
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: �� U -ep/
Owner:
Date of In %�i�- — ka /�I
Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following:
Yes No
Pumping information was provided by the owner, occupant, or Board of Health.
_ None of the system components have been pumped for at least two weeks and the system has been receiving normal
i
flow rates during that period. Large volumes of water have not been introduced into the system recently or
as part of this inspection.
As built plans have been obtained and examined. , Note if they are not available with N/A
The facility or dwelling was inspected for signs of sewage back-up.
The system does not receive non -sanitary or industrial waste flow.
The site was inspected for signs of breakout.
All system components, excluding the Soil Absorption System, have been located on the site.
_ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of
baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on:
The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of
Sub -Surface Disposal System.
Existing information. Ex. Plan at B.O.H.
Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is
unacceptable) [15.302(3)(b)J
(revised 04/25/97)
Page 4 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: J b 0 v -e V
Owner:
Date of Inspection: /l.• I /,, y^ �✓
BUILDING SEWER:
(Locate on site plan)
4'
Depth below grade:
Material of construction: _ cast iron 1-104#40 PVC _ other (explain)
Distance from private water supply well or suction hr.E
Diameter
Comments: (condition of joints, venting, evidence of leakage, etc.)
SEPTIC TANK:�1` 4
(locate on site plan)
Depth below grader
Material of construction:Crete _metal Fiberglass _Polyethylene _other(explain)
If tank is metal, list age _ Is age confirmed by Certificate of Compliance _ (Yes/No)
Dimensions: i a /-J 0 ,1 f
Sludge depthlb If r�
Distance from top of sl dge to bottom of outlet tee or baffle:_
Scum thickness:] "
Distance from top of scum to top of outlet tee or baffle:. 2!
Distance from bottom of scum to bottom of outlet tee or baffler
How dimensions were determined: 61' A/ S/ r z
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integrity, evidence of leakage, etc.)
JC/ -1c -a "e L) n ice Al n 1 01 w-/ ./'r) e- -e
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:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integrity, evidence of leakage, etc.)
__(revised 04/35/07) Page 6 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
f
Property Address: /03 lleS y ,/�! AVO 0
Owner: j f� g 9
Date of Inspection: /! 'k-) h, /S
TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection)
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal Fiberglass _Polyethylene —other(explain)
Dimensions:
Capacity: gallons ✓ r,: t
Design flow: gallonsMay
Alarm level's ' Alarm in working order _ Yes; _ No
Date of previous pumping:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX: Y-03
(locate on site plan)
Depth of liquid level above outlet invert:Go�
Comments:
(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.)
Q- o* Corn Cdxi D i fir;M ,+`-fu s'''e
PUMP CHAMBER:_
(locate on site plan) /� r
Pumps in working order: (Yes or No)
Alarms in working order (Yes or No)
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
(revised 01/25/97) Page 7 of 10
a
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: �Q �QS'i�l�/ ay
ly , f-% 4 G► v e
Owner: //��!'
Date of Inspection: �/ 1,\�ncltOT
SOIL ABSORPTION SYSTEM (SAS):
(locate on site plan, if possible; excavit onn of required, but may be approximated by non -intrusive methods)
If not determined to be present, explain:
Type:
leaching pits, number:_
leaching chambers, number:
leaching galleries, number: /
leaching trenches, number,length: s f Pole lt"" S
leaching f;fields, number, dimensions: i F
overflow cesspool, number:
Alternative system:
Name of Technology:
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
CESSPOOLS:
(locate on site —plan) t �,
Number and configuration:
Depth -top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater:
inflow (cesspool must be pumped as part of inspection)
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
PRIVY: _ H. A.
(locate on site plan)
Materials of construction:
Depth of solids:
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
(revised 04/25/97) Page a of 10
Dimensions:
t�
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued) .
Property Address: (0 //��^�" (,1% y I /� ,t/�0 J
Owner: `T
Date of Inspection: �f,• �/ ..`I
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
(revised 04/25/97)
� r +
Page 9 of 10
r
Ir r
Property Address:
Owner:
Date of Inspection:
+
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Depth to Groundwater Feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
Observation of Site (Abutting property, observation hole, basement sump etc.)
Determine it from local conditions F r•
Check with local ,Board of health
L�
Check FEMA heaps
Check pumping records
Check local excavators, installers
Use USGS Data
Describe in your own words how you established the High Groundwater Elevation. Must be completed)
(revised 04/25/97) Page 10 of 10
DATE:
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
/o., S-Dzv \
HILO�
l03 vo-s� U"cn
OCT 2 5 2001
1
(example: left front of house)
DATE OF PUMPING: (d 5--C)1 QUANTITY PUMPED bo/
CESSPOOL: NO,r_ YES
NATURE OF SERVICE: ROUTINE
OBSERVATIONS:
GOOD CONDITION
HEAVY GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
SYSTEM PUMPED BY:
COMMENTS:
SEPTIC TANK: NO
EMERGENCY
CONTENTS TRANSFERRED TO:
GALLONS
YES
FULL TO COVER
BAFFLES IN PLACE
LEACHFIELD RUNBACK
FLOODED
OTHER (EXPLAIN)
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
DATE: T 10 -boa,
F17
A 4 w1
wwN
X03 44 UJI,y
(example: left front of house)
�'A �otA—k- vouse-
DATE
OF PUMPING: - 1.0 "6o2 QUANTITY PUMPED 159e
CESSPOOL: NO /YES S PTIC TANK: NO
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION
HEAVY GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
SYSTEM PUMPED BY:
COMMENTS:
GALLONS
YES
FULL TO COVER
BAFFLES IN PLACE
LEACHFIELD RUNBACK
FLOODED
OTHER (EXPLAIN)
CONTENTS TRANSFERRED TO: (2,L-5 L
0
TOWN OF �J- "L)zly
SYSTEM PUMPING RECORD
DATE.
q")5'-3
SYSTEM OWNER & ADDRESS
SYSTEM LOCATION
(example: left front of house)
J
G)
DATE OF PUMPING: 3 QUANTITY PUMPED : GALLONS
CESSPOOL: NO YES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION
HEAVY GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
FULL TO COVER
BAFFLES IN PLACE
LEACHFIELD RUNBACK
FLOODED
OTHER (EXPLAIN)
SYSTEM PUMPED BY: Bateson Enterprises, Inc.
COMMENTS:
CONTENTS TRANSFERRED TO: G.L.S.D v Lowell Waste
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key-
4:1 I1
raun
Commonwealth of Massachusetts
City/Town of
System Pumping Record
Form 4
OCT 15 200 �
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:C, "hq:n't
+C_ �,1 ou,.�
Address /Citylrown ate
2. System Owner:
Name
Address (if different from location)
City/Town
B. Pumping Record
1. Date of Pumping
3. Type of system: ❑
❑ Other (describe):
Zip Code
State Zip Code
Telephone Number
Ga 3--U-7
Date 2. Quantity Pumped:
ls�
Gallons
Cesspool(s) Q'S We Tank ❑ Tight Tank
4. Effluent Tee Filter present? ❑ Yes B- If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System: �
� (A- 4z=--r�
6. System
l C}
Name Vehicle License Number
r- -3 �,
Company
7. Location were coptents
Date
t5form4.doc• 06/03 System Pumping Record • Page 1 of 1
Commonwealth of Massachusetts
City/Town of
° System Pumping Record
w Form 4
RECEIVED
SEP 2 8 2009
DEP has provided this form for use by local Boards of Health b �';o qr )RI
"ANDOVER but the
information must be substantially the same as that provided Before using thiS Torm, 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 hou �Rightf f house,
Left rear of house, Right rear of house.
- A
Address 103
City/Town
2. System Owner:
Name
Address (if different from location)
City/Town
Zip Code
State—�Zia � t vCode
V�
Te ephone Number
B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped:
3. Type of system: ❑ Cesspool(s) Septic Tank
❑ Other (describe):
Gallons
❑ Tight Tank
4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No
5. Condi 'n of Ttern,
6. System Pumped By:
Neil Bateson
Name
Bateson Enterprises Inc
Company
7.
contents were disposed:
Lowell Waste Water
Vehicle License Number F5821
Date
t5form4.doc• 06/03 System Pumping Record • Page 1 of 1
Commonwealth of Massachusetts FHEALTH
L �""
City/Town of 16 2010
W° System Pumping Record
Form 4 RTH ANDOVER
EPARTMENT
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 front of hou
rear of house, riqht rear of house,
left side of house, right side of house, Left
4 roar of k...IA;-- .....J... A --I.
( 013 �j Nozz�
City/Town State Zip Code
2. System Owner: Ke�V
Name
Address (if different from location)
City/Town
B. Pumping Record
1. Date of Pumping
3. Type of system: ❑
Stat � Zid
Telephone Number
k-- C_ ( 0
Date 2. Quantity Pumped
Cesspool(s) Septic Tank
❑ Other (describe):
4. Effluent Tee Filter present? ❑ Yes No
C�
Gallons
❑ Tight Tank
If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of Sytem:
Q � �
�-
6. System Pumped By:
Neil J. Bateson
Name
Bateson Enterprises Inc.
Company
7. Location where contents were disposed:
D. o II Waste Water,
" ryl,_-LU (,_=. c�( �(— (-- CC)
Signature of
F5821
Vehicle License Number
Date
t5form4.doc• 06/03 System Pumping Record • Page 1 of 1