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HomeMy WebLinkAboutMiscellaneous - 11 APPLETON STREET 4/30/2018 (2) r11APPLETON STREET ;t 210/037.6-0048-0000.0 I f TYPE OF SEWARGE DISPOSAL Swimming Pools ❑ ; Tanning/Massage/Body Art ❑ Public Sewer ❑ Tobacco Sales Food Packaging/Sales ❑ Well ❑ Permanent Dumpster on Site ❑ Private(septic tank,etc. ❑ _ A NOTE: Persons contr ctin nyith un r re contractors do not �, jP/ Signature of Agent/6' Signa l� Plans Submitted ❑ Plans Waived ❑ Certified PlcApo THE FOLLOWING SECTIONS FOR O', INTERDEPARTMENTAL SIGN O, DATE REJECTED �! PLANNING & DEVELOPMENT ❑ []Water Shed Special j 1 ❑ Site Plan Special Pe_ ❑ Other COMMENTS DATE REJECTED DATE APPROVED dCONSERVATION ❑ ❑ COMMENTS J DATE REJECTED DATE PP VED / 1 HEALTH ❑ Qt '� " l � t COMMENT$ — 1` Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer connection signature&date Temp Dumpster on site yes_no Vire Department signature/date Building Permit Approved and Issued by: Paee 2 of-t i TYPE OF SEWARGE DISPOSAL Swimming Pools ❑ Tanning/Massage/Body Art ❑ Public Sewer �zl Well Tobacco Sales ❑ Food Packaging/Sales 1]- � �❑ Permanent Dumpster on Site ❑ Private(septic tank,etc. ❑ NOTE: Persons co"'/�VacunL� reg!contractors do not have access to the guarantyf nd Signature of Agent/OSignature of Contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ tamped Plans THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ i, ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED JCONSERVATION ❑ ❑ COMMENTS ' JDATE REJECTED DATE PP VED HEALTH ❑ �! i`f �� �-'� COMMENT f Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer connection signature&date Temp Dumpster on site yes_no_ ire Department signature/date Building Permit Approved and Issued by: Page 2 ol'-1 Apr 14 2006 10: 37AM Premier Properties, LLC 9786818952 p. 1 Andrew&Maureen Heinze 11 Appleton Street North Andover,MA 01845 918-681-8952 North Andover Board of Health Dept. North Andover, MA 01845 Attn: Michelle RE: Septic System Dear Michelle: We have recently connected to city sewer through our backyard to Anne Road. We are asking the board if we can utilize the existing septic system, tank and distribution system to disburse water from our basement sump pump. We believe this would greatly help us. Please call if you have any questions or comments. Thank you very much, Maureen Heinze i i I PLAN OF LAND IN NORTH ANDOVER, MA. APPLETON STREET OWNED BY ANDREW AND MAUREEN HEINZE SCALE: 1"=40' DATE. 4-/! 150' 01 40' 80' 120' Scott L. Giles R.P.L.S. Frank. S. Giles R:P.L.S. 50 Deer Meadow Road North Andover, Mass. ASSESSORS MAP 37B PARCEL 48 DEED BOOK 6172 PAGE 336 POND THE ZONING DISTRICT IS R-3. MANMADE 25,000 S.F.AREA 125FRONTAGE. PARCEL C 30'FRONT SETBACK. PLAN#6037 N.E.R.D. 20'SIDE SETBACK. w 30'REAR SETBACK. 73;000 Sfr4/- N TOTAL AREA 0 86,400+/- S.F. M THE PROPERTY LINES SHOWN ARE THE Ex�ST LINES DIVIDING EXISTING OWNERSHIPS,AND 21' D•SSE THE LINES OF STREETS AND WAYS SHOWN skis ARE THOSE OF PUBLIC OR PRIVATE STREETS c4k.r OR WAYS ALREADY ESTABLISHED,AND NO �' -NEW LINES FOR DIVISION OF EXISTING oC OWNERSHIP OR NEW WAYS ARE SHOWN. 1p WV1 H or F r38j2 C � IAND J �o 'THIS IS TO CERTIFY THAT I HAVE CONFORMED WITH THE RULES AND REGULATIONS OF THE REGISTERS OF DEEDS IN PREPARING THIS PLAN � Aos� I� ��C� � 25 EXISTING SEWE STUB f Y�At' �I�s 40 9�C4L 3 s .� .....;_ JAN 'ITOWN OF NORTH ANDOVEk SYSTEM PUMPINU R.ECOIZL, YSTEM OWNER dt ADDR1rSS SYSTEM LOCATION &12e . ,A'% DATE OF PUMP'iNq;,� � QUANTITY P LIMPED;..._._ ,Ided CtSSPOOL; N0,_. YES SOOC link: NU YES NA PURI; ON SERVICE, RUU'fINE../, trMERUENC'Y UbSERVATIUINS: 000D CONDITION FULL'M WvER HEAVY ORP.Agg BAFFLES IN PLACEROOT'S L EA,CHFIeL D RUNBACK SXCESSiVE SOLIDS_. BLOODED 10LIDCAKRYOYER_,,._.OTKER EXPLAIN System Pumpcd by __ _.TS,..... . . TJG. �'f>/CP.J VUMMENTS. 4UN PEN'I'S PKANSFERRfiD I'U TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD i Sl STEM OWNER & ADDRESS SYSTEM LOCATION ` ` (example: left front of house) I v. D:- 'TE OF PUMPING: �7��2 '�'� QUANTITY PUMPED 100D GALLONS C'1:551 OOL. NO L-/YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES 1N PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) S'Y'STEM PUMPED BY: COMMENTS: cONTE'N"I'S TRANSFERRED TO: Address 11, AAN-gp>/a sT Title of File Page of Date File Open: Date file closed: Doc Document/Action Title Date of Refer to other Purpose of Document/Action and notes action Document/ document/ Num. Action Department Board of Appeals — Board of Health — Plannang Board — Conservation Commission — Building Departrmer,t P - PF Poo---- TOWN OFj ANDOVER SEPITIC SYSTEM SERVICING REPORT - 7 Date: � Homeowner: ��r Pumper cove( Street Address: kQ. F-. ZX-,N,,-)-k- fib. , Phone Phone (off' \�P • I Nature of S-arvice: Routine Emergency Observations: Good Condition Full to Cover Baffles in Place Leachfield Runback Excessive Solids Heavy Grease Roots' Other (Explain) i I i Description of Work: Comments: w PETER F. REILLY AFFILIATED WITH F.P. REILLY AND SONS, INC. 206 ANDOVER STREET, SUITE 11 ANDOVER, MA 01810 (978) 475-4370 TITLE V OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART A - CERTIFICATION ' Property Address: 11 Appleton Street, North Andover, MA 01845 Name of Owner: Earle Sears Address of Owner: same Name of Inspector: Peter F. Reilly Company Name: F.P. Reilly & Sons c/o Peter F. Reilly Mailing Address: 136 Andover Street, Andover, MA 01810 Telephone Number: (978) 475-4370 / (978) 375-3750 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 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 N/A Conditionally Passes N/A Needs Further Evaluation By the Local Approving Authority N/A Fails Inspector's Signature: Date: April 7, 2001 Petr F. Reilly The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) 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 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 a the time of inspection and under 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 (See attached Disclaimer). '140A of 5. BOAR �pR 1 9 2001 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART A - CERTIFICATION (continued) Property Address: 11 Appleton Street, North Andover, MA Owners Name: Sears Date of Inspection: 4/7/01 INSPECTION SUMMARY: A. SYSTEM PASSES: Check A, B, C, D, or E /ALWAYS complete all of Section D ✓ I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: The system met the Pass Criteria of Title V. B. SYSTEM CONDITIONALLY PASSES: N/A 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). Describe basis of determination in all instances. If "not determined", explain why not) N The septic tank is metal, and over 20 years old* or the septic tank (whether metal or not) is 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 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 a sewage backup or breakout or high static water level 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 ass inspection if with approval of the Board of Health): 1 1 P P PP N/A broken pipe(s) are replaced N/A obstruction is removed N/A distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): N/A broken pipe(s) are replaced N/A obstruction is removed OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART A - CERTIFICATION (continued) Property Address: 11 Appleton Street, North Andover, MA Owner's Name: Sears Date of Inspection: 4/7/01 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 the public health, safety and environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.3030)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: N/A Cesspool of privy is within 50 feet of a surface water N/A Cesspool or privy is within 50 feet of a bordering vegetated wetland or 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: N/A 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. N/A The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply well. N/A The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. N/A The system has a septic tank and SAS the SAS is less than 100 feet but 50 feet or more from a private water supply well.**'Method used to determine distance N/A This system passes if the water well water analysis, performed at a certified DEP 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. A copy of the analysis must be attached to this form. 3. Other N/A OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART A - CERTIFICATION (continued) Property Address: 11 Appleton Street, North Andover, MA Owner's Name: Sears Date of Inspection: 4/7/01 D. System Failure Criteria applicable to all systems: You must indicate "Yes" or "No" to each of the following for a//inspections: Yes No No Backup of sewage into facility or system component due to an 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. N/A Liquid depth in cesspool less than 6" below invert or available volume <'/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: once No Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. N/A Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. N/A Any portion of a cesspool or privy is within a Zone I of a private water supply well. N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well. N/A 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 laboratory,for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen is less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form). N/A The system fails. I have determined that one or more of the above failure criteria exist as defined in 310 CMR 15.303,therefore the system fails. The property owner should contact the Board of Health should be contacted 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 a large system in addition to the criteria above) N/A The design flow of system is 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No N/A The system is within 400 feet of a surface drinking water supply N/A The system is within 200 feet of a tributary to a surface drinking water supply N/A The system is located in a nitrogen sensitive area (Interim Wellhead 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 such 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. OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART B - CHECKLIST Property Address: 11 Appleton Street, North Andover, MA Owner's Name: Sears Date of Inspection: 4/7/01 Check if the following have been done. You must indicate either "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 flow in the previous two week period ? No Have large volumes of water been introduced to the system recently or as part of this inspection ? N/A Were as built plans of the system obtained and examined ? (If they were available note as N/A) Yes Was the facility or dwelling was inspected for signs of sewage backup ? Yes Was the site was inspected for signs of breakout ? Yes Were all system components, excluding the SAS, have been located on the site ? Yes Were the septic tank manholes uncovered,opened and the interior of the septic tank inspected for condition of baffles or tees, material of construction dimensions depth of liquid, depth P q p of sludge, depth of scum ? Yes Was the facility owner (and occupants of if different from the owner) provided information on the proper maintenance of subsurface sewerage 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. For example, a plan at the Board of Health. (owner's plan) N/A 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)]. OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART C - SYSTEM INFORMATION Property Address: 11 Appleton Street, North Andover, MA Owner's Name: Sears Date of Inspection: 4/7/01 FLOW CONDITIONS RESIDENTIAL: Number of bedrooms (design): N/A Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms: N/A Number of Current residents: 2 Does the residence have a garbage grinder (yes or no): yes Is the laundry on a separate sewerage system (yes or no): no (if yes, separate inspection required) Laundry system inspected (yes or no): N/A Seasonal use (yes or no): no Water meter readings, if available (last 2 years usage [gpd]): about 100 god Sump Pump (yes or no): yes Last date of occupancy: current COMMERCIAL/INDUSTRIAL: Type of Establishment: N/A Design Flow gpd (based on 15.203): N/A Basis of Design Flow (seats/persons/sq.ft., etc): N/A Grease trap present (yes or no): N/A Industrial waste holding tank present (yes or no): N/A Non-sanitary waste discharged to the Title 5 system (yes or no): N/A Water meter readings, if available: N/A Last date of occupancy/use: N/A OTHER: (Describe) N/A GENERAL INFORMATION PUMPING RECORDS Source of Information: owner- 11/00 Was system pumped as part of inspection (yes or no): no if yes, volume pumped (gallons): N/A How was quantity pumped determined ? N/A Reason for pumping: N/A TYPE OF SYSTEM ✓ Septic tank/distribution box, soil absorption system Single cesspool Overflow cesspool Privy 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 the 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: Replacement SAS - 1985 Were sewerage odors detected when arriving at the site (yes of no): no OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART C - SYSTEM INFORMATION (continued) Property Address: 11 Appleton Street, North Andover, MA Owner's Name: Sears Date of Inspection: 4/7/01 BUILDING SEWER: (locate on site plan) Depth below grade: about 36" Materials of construction: ✓ cast iron 40 PVC other (explain) Distance from private water supply well or suction line N/A Diameter: 4" Comments: Condition of joints, venting, evidence of leakage, etc.) Building sewer was watertight and appeared sound at foundation. SEPTIC TANK: ✓ (locate on site plan) Depth below grade: about 30" Material of construction: ✓ concrete metal Fiberglass Polyethylene other (explain) If tank is metal, list age N/A Is age confirmed by Certificate of Compliance N/A (Yes/No) Dimensions: cylindrical - 1,000 gallons Sludge depth: <1" Distance from top of sludge to bottom of outlet tee or baffle: 28" Scum thickness: <1" Distance from top of scum to top of outlet tee or baffle: 7" Distance from bottom of scum to bottom of outlet tee or baffle: 16" How dimensions were determined: observation / estimation Comments: (on pumping recommendations, of inlet and outlet tees or baffle condition, structural integrity, liquid level as related to outlet invert, evidence of leakage, etc.) Tank was watertight and appeared to be functioning properly. GREASE TRAP: N/A (locate on site plan) Depth below grade: material of construction: concrete metal FRP other (explain) Dimensions: N/A Scum thickness: N/A Distance from top of scum to top of outlet tee or baffle: N/A Distance from bottom of scum to bottom of outlet tee or baffle: N/A Date of Last Pumping: N/A Comments: (on pumping recommendations, of inlet and outlet tees or baffle condition, structural integrity, liquid level as related to outlet invert, evidence of leakage, etc.) N/A OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART C - SYSTEM INFORMATION (continued) Property Address: 11 Appleton Street, North Andover, MA Owner's Name: Sears Date of Inspection: 4/7/01 TIGHT or HOLDING TANK: N/A (tank must be pumped at time of inspection) (locate on site plan) Depth below grade: N/A material of construction: concrete metal Fiberglass Polyethylene other (explain) Dimensions: N/A Capacity: N/A gallons Design Flow: N/A gallons per day Alarm Present (yes or no): N/A Alarm level: N/A Alarm in working order (yes or no): N/A Date of last pumping: N/A Comments: (condition of alarm and float switches, etc.) N/A DISTRIBUTION BOX: ✓ (locate on site plan) 0" depth of liquid above outlet invert Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, recommendation for repairs, etc.) D-box was level. No evidence of solids carryover. One line leaving d-box to a "Y" that feeds a 2 leaching trenches per owner's plan. Extensive excavation revealed no d-box in area of SAS. PUMP CHAMBER: N/A (locate on site plan) Pumps in working order (yes or no) N/A Alarms in working order (yes or no) N/A Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) N/A OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART C - SYSTEM INFORMATION (continued) Property Address: 11 Appleton Street, North Andover, MA Owner's Name: Sears Date of Inspection: 4/7/01 SOIL ABSORPTION SYSTEM (SAS): ✓ (locate on site plan, if possible; excavation not required) If SAS not located, explain why: N/A Type leaching pits, number N/A leaching chambers and number N/A leaching galleries and number N/A ✓ leaching trenches, number, length 2 trenches 75 feet long each per owner's plan leaching fields, number, dimensions N/A overflow cesspool, number N/A alternative system (name of technology) N/A Comments: (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.) Soils in area of SAS looked good, no evidence of ponding, damp soil, or breakout. CESSPOOLS: N/A (locate on site plan) Number and configuration N/A Depth-top of liquid to inlet invert N/A Depth of solids layer N/A Depth of scum layer N p u aye A/ Dimensions of cesspool N/A Materials of construction N/A Indication of groundwater inflow (cesspool must be pumped as part of inspection) N/A Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs, etc.) not applicable PRIVY: N/A (locate on site plan) Materials of construction N/A Dimensions N/A Depth of solids N/A Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs, etc.) not applicable 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART C - SYSTEM INFORMATION (continued) Property Address: 11 Appleton Street, North Andover, MA Owner's Name: Sears Date of Inspection: 4/7/01 SKETCH OF SEWAGE DISPOSAL SYSTEM: Provide a sketch of the sewerage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100'. Locate where public water supply enters the building. App• w+r 2- Sfory porck f9pt� l,aysc (carafe A B c Scp�i L tcnk shed d D-box RERR yHRD App. beg wv-d o c SA 7s, sqs SEPTIC TANK TIES: A to Inlet (1) N/A B to Inlet N/A A to Center (C) 41'4" B to Center 28'0" A to Outlet (0) N/A" B to Outlet N/A D-BOX TIES: A to Box 51'0" B to Box 40'6" BEGINNING OF SAS: C to Line 84'0" D to Line 33'0" NOTE: The system is in the rear yard. The "D" tie is the corner of a tool shed in the rear yard. 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART C - SYSTEM INFORMATION (continued) Property Address: 11 Appleton Street, North Andover, MA Owner's Name: Sears Date of Inspection: 4/7/01 SITE EXAM Slope mostly flat in area of system Surface water none observed Check cellar dry Shallow wells none observed Estimated Depth to Groundwater > 1 " (below bottom of SAS) Please indicate (check) all methods used to determine the high ground water elevation: N Obtained from Design Plans on record - if checked, date of design plan reviewed: N/A Y Observed site (abutting property, observation hole within 150 feet of SAS) N Check with Local Board of Health - explain: Y Check local excavators, installers - (attach documentation) N Accessed USGS Database - explain: 10/31/00 / Wilmington well / moderate depth *Could not update - website was down on 4/9/09. You must describe how you established the high ground water elevation.* Nearby wetland area is significantly below grade of the bottom of the SAS. Grade changes and soil conditions indicate no groundwater in the SAS. However, this cannot be determined for certain without a soil evaluation test. *Inspector's Note: Soil Evaluation is the currently recognized method for determining or establishing the high groundwater elevation. Since I am not a licensed or certified soil evaluator, I am not qualified to determine or establish the high groundwater elevation beyond the public information available, such as recent design plans of the site or the nearby area. My estimation of the high groundwater elevation is based on a due diligence effort to obtain all available information both on and off the site and my experience as a certified subsurface disposal system inspector. (see attached Disclaimer) DISCLAIMER This passing septic inspection under Massachusetts Title V is in no way a guaranty or warranty of the inspected septic system. The inspection is a "snapshot in time" and does not constitute a complete assessment of the quality or potential longevity of the septic system. The pass/fail criteria are specific and outlined in detail in this report. Under the limited criteria of a Title V inspection, it is impossible to determine how long any septic system will last. The inspector made a diligent effort to certify the septic system based on the criteria required under Title V. Under Massachusetts Title V, soil evaluation is the accepted method of determining the high groundwater elevation. This inspector is not a certified soil evaluator and is therefore not qualified under Title V to determine or establish the high groundwater elevation. The method used to estimate the high groundwater for this inspection was based on the public records and methods of observation described on the previous page. Groundwater levels can vary greatly from season to season, year to year and soil evaluation is considered the most reliable method of groundwater determination under Title V. '14� Peter F. Rilly Inspector April 7, 2001 Town of North Andover, Massachusetts Form No.3 • BOARD OF HEALTH NORTI DISPOSAL WORKS CONSTRUCTION PERMIT Applicant � �- NAME Z" ADDRESS cc ,, TELEPHONE Site Location '�e : Permission is hereby granted to Construct ( ) or Repair ( an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. CHAIR N, BOARD OF HEALTH ej Fee D.W.C. No. _.. aSroN SA.5 62 sc ✓ ����U V y 4- 'I/V N 71 , d C TOWN OFn NDOVER SEPTIC SYSTEM SERVICING REPORT Date: Qj Homeowner:_ q�-� Pumper - VA. Street _ \ Address: tL-- }+ Phone N Phone Nature of S-=_rvice: Routine Emergency Observations: Good Condition Full to Cover Baffles in Place Leachfield Runback Excessive Solids Heavy Grease Roots Other (Explain) Description of Work: _ ... TOS Comments :- ���gaoj Town of-North Andgver, MA 4�sr s Watershed Septics stem } Servicing Report Date: Homeowner Pumpe.r Street Address: Phone 7173 Phone Nature of Service: Routine Emergency Observations: Good Condition X Full to Cover Baffles in Place Leachfield Runback Excessive Solids Heavy Grease _ Roots Other (Explain) Description of Work: Comments: .rs a Please forward us as much of the follow;`- inform..tion that is Possible I. Type of system /J C/II"J 3. L:oca_tionf ,�jQC y�r1 d 4 - Miiintenance records and date of list pumping out e Bocumt:nt�. ti. on ofrepairs and reconstruction C/) 15�s /,096. Site conditions 7. Builder of system 8. Enzineer who approved', Site — S_ys t ems 9 , Installation Procedure 10. Problems t� q If r � SEPTIC SYSTEM INSPECTION FORM ADDRESS DATE INSPECTED PROPERLY FUNCTIONING? & N WEATHER CONDITIONS COMMENTS : a WATER QUALITY TES T Ets o� lZeSoL7S? DYE TEST PERFORMED? Y N DATE? SKETCH: _ . WATERSHED RESIDENTS QUESTIONNAIRE 1. Name 1 14 Te o "` 2. Street Address 3. How many members are in your household? i 4. What type of sewage disposal system do you have? E❑ cesspool septic tank and leaching area ❑ connection to municipal sewer ❑ other (describe) ❑ do not know 5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health? ❑ yes ❑ no % do not know 6. How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years ❑ 11-20 years L] over 20 years ❑ do not know 7. Has your sewage disposal system been rebuilt or repaired? V yes ❑ no ❑ do not know If yes, approximately how long ago? Z years. What was done? a / 8. How frequently is your sewage disposal system pumped out? l� annually ❑ every 2-4 years ❑ every 5-10 years ❑ over 10 years ❑ never 9. Have you had any problems with your sewage disposal system? 2/ yes ❑ no If yes, what problems? Wd , ❑�1 repeated pump-outs needed SIrtC Y 4i system clogs, backs up, or drains slowly ❑ odors ❑ sewage surfaces through ground 10. How many of each appliance are connected to'.your sewage disposal system? washing machine 1,�` r - dishwasher garbage disposal _; dehumidifier drain _ sump pump toilet roof/pavement drains — shower/bathtub 11. Please state the brand and type (liquid or'powder) of detergent you use for: dishwasher e A 42.3.'�f clotheswasher Sr_l = ! � 12. Does your property have a lawn. Yes El no If yes, approximately what size? 4 less than 1/4 acre ❑ 1/4 acre ❑ 1/2 acre ❑ 3/4 acre ❑ 1 acre Ill more than 1 acre (Specify) acres 13. How often do you fertilize your lawn? t- No. of applications per year Season(s) of the year 14. Please state the brand and type (liquid or granular) of lawn fertilizer you use: sCt� i ❑ Check here if your lawn is maintained by a professional landscape contractor.