Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 11 BRIDGES LANE 4/30/2018
11 BRIDGES LANE 2101104.D-0063-0000.0 o f 10RT/ j 3927 r•1N 3?o�, .e •o0 a w Town of North Andover �s•„>.��� HEALTH DEPARTMENT s�cNuse CHECK#:—'�© DATE: LOCATION: H/O NAME: CONTRACTOR NAME: Type of Permit or License:(Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type. $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ TitleSInspector $ 0�Title 5 Report $ ❑ Other:(Indicate) $ C Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer RECEIVED Commonwealth of Massachusetts JUL 1 *12013 City 1/-�own of TOWN OF NORTH ANDOVER System Pumping Record HEALTH DEPARTMENT Form 4 DEP has provided this form for use<by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here.Before using this form,check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left/Right front of house, Left/ t f hous , Left/right side of house, Left I Right side of building, Left/Right front of building, Left/Right rear of building, Under deck Address Citylrown StateZip Code 2. System Owner. Name \Address(d rd different from location) Cityrrown State Zip �d�� Telephone Number B. Pumping Record 1. Date of Pumping Date ;Sepfic . Q ntity Pumped: Gallons 3. Type of system: E] Cesspool(s) Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No Ifes,was it cleaned? ❑ Yes ❑ No 5. Conditio- n Qf System- Y�� ' a" s 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company . 7. Location here contents were disposed: S. Lowell Waste Water Signitufe Haule Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 DEP has provided this form'for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left/Right front of house, Left/Right rear of house, Leff/right side of house, Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under deck c Address City/town State Zip Code 2. System Owner. RECEIVED ObIUCi.0 Name pp + Address(if different from location) TOWN OF NORTH ANDOVER City/Town HEALTH DEPARTMENT Zip Code Telephone Number B. Pumping Record 1. Date of Pumping _ 2. Quantity Date Gallons 3. Type of system: ❑ Cesspool(s) VSeptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ES/No If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: I 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. ZSigHaule a contents were disposed: Lowell Waste Water Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 y -4,'\\ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M ' 11 Bridges Lane Property Address Michael Hall Owner Owner's Name information is required for North Andover MA 01845 3/13/2009 every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Neil J. Bateson cursor-do not Name of Inspector use the return key. Bateson Enterprises Inc. Company Name -- 0 111 Argilla Road Company Address ((off Andover Ma 0 I IonCity/Town State Zipp Code 978-475-4786 S115 Telephone Number License Number B. Certification I certify that 1 have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 3/13/2009 In pe o s Signat Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 y .*;':; , Application for eptic Disposal System - -0 �r.! • �.,. o� TODAY'S DATE Construction Permit - TOWN OF '`;•,.M;;,e`f` 250.00-Full Rir ORTH ANDOVER, MA 01845 $ 25 00-Component Important: Application is hereby made for a permit to: When filling out ❑Construct a new on-site sewage disposal system* forms on the computer,use ❑ Repair or replace an existing on-site sewage disposal system* `= only the tab key to move your B Repair or replace an existing system component—What? - cursor-do not use the return key. A. Facility Information VAI Address or Lot# menr Cityrrown No, LHEALTH 5 2009 2.-*TYPE OF SEPTIC SYSTEM*: TH ANDOVER ❑ Pump cavity(choose one) ARTMENT ***If pump system,attach copy of electrical permit to application*** ❑ Conventional System(pipe and stone system) ❑ Infiltrator or Biodiffuser(Gravel-Less) (Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S.(No D-Box)(Attach Draft Maintenance Agreement) ❑ Pressure Dosed(D-Box Present).S.A.S. 2. Owner Information /41 Name Address(if different from above) Cityrrown State Zip Code a'9/� Telephone Number 3. Installer Information il•4 4-S c/✓ ,�f- _�ire . Name Name of Company Address -- -- �� /-r/,_j n4 Cityrrown State Zip Code Telephone Number(Cell Phone#if possible please) 4. Designer Information Name Name of Company Address CityrTown State Zip Code Telephone Number(Best#to Reach) Application forD4osal System Construction Permit•Page 1 of 2 ti Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form,check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. System Location: Left fron left rear eft sid ous fight front, right rear, right side of house. forms on the computer,use only the tab key Address �'^ � to move your ,' cursor-do not Cityrrown State Zi Code use the return P key. 2 System Owner: Rw� Name Address(if different from location) Cityrrown State Zip Code 6 &r7 Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: Lj Cesspool(s) eptic Tank El Tight Tank Other(describe): 4. Effluent Tee Filter present? Yes . I90 If yes,was it cleaned? Yes No 5. Condition of System: 6. System Pumped By: Neil Bateson F 5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location where contents were disposed: L. Lowell Waste Water "KIN n--- I a -C-,' igna ure of H u r Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 TOWN OF NORTH ANDOVER N°R*M Office of COMMUNITY DEVELOPMENT AND SERVICES 0f°6""� h°°� HEALTH DEPARTMENT 1600 OSGOOD STREET;Building 2-36 NORTH ANDOVER,MASSACHUSETTS 018459.gssC""°U tt� � HS Susan Y. Sawyer,REHS/RS 978 88.9540—Phone Public Health Director / J 97 .688.8476—FAX ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: MAP: LOT: INSTALLER: d DESIGNER: PLAN DATE: BOH APPROVAL DATE ON PLAN: INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ❑Existing septic tank properly abandoned ❑Internal plumbing all to one building sewer ❑Topography not appreciably altered Comments: SEPTIC TANK ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon tank has been installed H-10 loading Monolithic construction �' ❑ Watertightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ❑ Inlet tee installed, centered under access port ❑ Outlet tee (gas baffle or effluent filter) installed, centered under access port ❑ 24" inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present ❑ Hydraulic cement around inlet & outlet Wastewater System Documentation—Feb 2006 Page 1 of 6 . TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES or HEALTH DEPARTMENT 1600 OSGOOD STREET;Building 2-36 NORTH ANDOVER,MASSACHUSETTS 01845 �'Ss�CHO Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ Combo Tank installed. Size: ❑ 1000 gallon Pump Chamber installed H-10 loading Monolithic construction) ❑ Inlet tee installed, centered under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off floats working ❑ Separate on/off floats ❑ Drain hole in pressure line ❑ 24" inch cover to within 6" of final grade installed over pump access port ❑ Water tightness of tank has been achieved Visual testing ❑ Hydraulic cement around inlet & outlet Comments: I ADVANCED TREATMENT TECHNOLOGY ❑ Type of treatment device: ❑ Installed per manufacturers requirements ❑ All components working in accordance with manufacturer's requirements Comments: Wastewater System Documentation—Feb 2006 Page 2 of 6 TOWN OF NORTH ANDOVEROf pORTI,4 Office of COMMUNITY DEVELOPMENT AND SERVICES 3 `,, .b hO� HEALTH DEPARTMENT b - 1600 OSGOOD STREET;Building 2-36 . . +' NORTH ANDOVER,MASSACHUSETTS 01845 �'S8 CHU Susan Y.Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX D-BOX ❑ Installed on stable stone base ✓� Inlet tee (if pumped or >0.08'/foot) /1( � [[� Hydraulic cement around inlet & outlets [`Observed even distribution © Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEM ❑ Bottom of SAS excavated down to soil layer, as provided on plan ❑ Size of SAS excavated as per plan ❑ Title 5 sand installed, if specified on plan ❑ 3/4-1 Y2" double washed stone installed ❑ 1/8-1/2" (peastone) double washed stone installed ❑ Laterals installed and ends connected to header ❑ Laterals vented if impervious material above ❑ Orifices @ 5 & 7 o'clock positions ❑ Gravel-less disposal systems: type, number and location as per plan ❑ Elevations of laterals installed as on approved plan ❑ 40 Mil HDPE barrier installed ❑ Retaining wall (boulder/concrete/timber/block) ❑ Final cover as per plan Comments: Wastewater System Documentation—Feb 2006 Page 3 of 6 TOWN OF NORTH ANDOVER a NORTH 1 Office of COMMUNITY DEVELOPMENT AND SERVICES o:°`yf���' a°oma HEALTH DEPARTMENT 1600 OSGOOD STREET;Building 2-36 NORTH ANDOVER,MASSACHUSETTS 01845 j Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX PRESSURE DISTRIBUTION ❑ -- inch manifold ❑ laterals installed with end sweeps size: material: ❑ Squirt test ft in height ❑ Equal distribution to all laterals F-1orifice size inch as per plan Comments: CONTROLPANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: ❑ Rated for exterior if placed outside Comments: i Wastewater System Documentation—Feb 2006 Page 4 of 6 • TOWN OF NORTH ANDOVER f NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT a 1600 OSGOOD STREET;Building 2-36 NORTH ANDOVER,MASSACHUSETTS 01845 �ASS,CNUss� Susan Y.Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ❑ Property line 10 10 -- ❑ Cellar wall 10 20 -- ❑ Inground pool 10 20 -- ❑ Slab foundation 10 10 -- ❑ Deck, on footings,etc 5 10 -- ❑ Waterline 10 10 101 ❑ Private drinking well 75 1002 50 ❑ Irrigation well 75 100 ❑ Surface Water 25 50 ❑ Bordering Vegetated Wetland , Salt Marsh,Inland/Coastal Banka 75 100 ❑ Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ❑ Trib.to surface water supply 325 325 ❑ Public well 400 400 ❑ Interim Wellhead Prot.Area ❑ Reservoirs 400 400 ❑ Drains(wat. supply/trib.) 50 100 ❑ Drains(intercept g.w.) 25 50 ❑ Drains(Other)Foundation 10(5) 20(10) ❑ Drywells 20 25 I ' Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance(NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54,and 10.30,respectively,pursuant to 15.211(3),also by NA wetland bylaws Wastewater System Documentation—Feb 2006 Page 5 of 6 A TOWN OF NORTH ANDOVER NSR*M Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET;Building 2-36 NORTH ANDOVER,MASSACHUSETTS 01845 "SSACNUS S�`' Susan Y.Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX SYSTEM ELEVATIONS INVERT ON DESIGN PLAN FIELD INVERT ELEV. Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN Distribution Box OUT Lateral 1 HIGH Lateral 1 LOW Lateral 2 HIGH Lateral 2 LOW Lateral 3 HIGH Lateral 3 LOW Lateral 4 HIGH Lateral 4 LOW Lateral 5 HIGH Lateral 5 LOW I i i I Wastewater System Documentation—Feb 2006 Page 6 of 6 . Commonwealth of Massachusetts LH `����City/Town of System Pumping-Record VIj NjKl X014Form 4 LTH DEPARTMENT R DEP has provided this forfn for use by local Boards of Health.Other forms may be'used,but the information must be substantially the same as that provided here. Before using.this form,check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left/Right front of house, Left i ht�qg�ar Left/right side of house, Left/ Right side of building, Left/Right front of building, Left uilding, Underdeck Address C �-es:, k-&� Cityfrown State Zip Code 2. System Owner. H els b -A� Name' Address C9 different from location) Cityrrown McLclnde Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons --? 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes Ld-O If yes,was it cleaned? ❑ Yes ❑ No, 5. Condition of Sy tem: +z,(,-4� 6. System Pumped By.- Nell y:Neil.Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc- Company ncCompany 7. Locatio re contents were disposed: t.S. Lowell Waste Water Sign qtHauleV Date I t5form4.dor~06103 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts RECEIVED City/Town of OCT 2 0 2009 System Pumping Record �,� Form 4 TOWN OF D THAN OVER 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 tQ determine the form they use.The System Pumping Record must be submitted to the local Board of Health of-othet approving authority. A. Facility Information 1. System Location: Le . e of hour€ side of house, Left front of house, Right front of house, Left rear of hou Right rear of house ear of building. Right rear of building. -r 1, Address (N City/Town v State Zip Code 2. System Owner: Name Address(if different from location) City/Town. State Zip Code p 2 Telephone Number B. Pumping Record 1. Date of Pumping --�� ( SC)b DateGallons 3. Type of system: ❑ Cesspool(s) Septic�2uantity Pumped:Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? LlYes No If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location wh7 contents were disposed: G L. Lowell Waste Water 'F---�d — Signature f Hauler Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts City/Town of NORTH ANDOVER, MASSACHUSETTS System Pumping Record Form 4 Fyst&m,, 1DEP has providedthis form for use by local Boards of Health. The41r�'� cord ust be submitted to the local Soard of Health or other approving autho ll a 7 2006 A. Facility Information TOWN OF NORTH ANDOV�ft HEALTH DE7pARTMZ Important: MWT When tilling out 1. System Lodation: forms on the t computer,use only the tab key Address , „ P to move yourAnd o" }� C tet _ cursor-do not CitylTown State Zip Code use the return key. 2. System Owner: { Name Address(if different from location) City/Town state Zip Code Telephone Number B. Pumping Record f c ,I 1. Date of Pumping �`�' `� 2. Quantity Pumped: P� Date Gallons 3. Type of system: ❑ Cesspool(s) [0 Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: N e Vehicle License Number C_L L)alta r.� Company 7. Location where contents were disposed: '�. 1 �_ �° Signature oT Hauler Date http://www.mass.gov/dep/water/approvals/t5forms.htrn#inspect t5form4.doc•06103 System Pumping Record•Page 1 of 1 Commoffwealth of Massachusetts a,,,,j Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments v 11 Bridges Lane Property Address ti Michael Hall Owner Owners Name information is required for North Andover MA 01845 2/13/2009 every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important: A. General Information When filling out RECEIVED forms on the computer,use 1. Inspector: only the tab key to move your Neil J. Bateson cursor-do not use the return Name of Inspector F M key. Bateson Enterprises Inc. TOWN Company Name HEALTH DEPARTMENT +� 111 Argilla Road Company Address Andover Ma 01810 Cod Bnn City/Town State ZippCode 978-475-4786 SI15 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ® Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 'JA.&1�� 2/13/2009 fn4ebors Sign a Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 j Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 11 Bridges Lane _ Property Address Michael Hall Owner Owner's Name information is required for North Andover MA 01 B45 2/1312009 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary:Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ® one or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ NO(Explain below): t5ins•09108 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 2 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Bridges Lane Property Address Michael Hall Owner Owner's Name information is required for North Andover MA 01845 2/13/2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ NO(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ NO(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ NO(Explain below): 4 times a year due to broken or obstructedpipe(s). The ❑ The system required pumping more than t me y system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ NO(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ NO(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Bridges Lane Property Address Michael Hall Owner Owner's Name information is North Andover MA 01845 2/13/2009 required for — every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: k�This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Outlet tee in septic tank&D-Box needs to be replaced. D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than'/2 day flow t5ins•09/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Bridges Lane Property Address Michael Hall Owner Owner's Name information is North Andover MA 01845 2/13/2009 required for -- — every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS,cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. t5ins•09108 Us 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Bridges Lane Property Address Michael Hall Owner owner's Name information is required for North Andover MA 01845 2/13/2009 every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner,occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 600 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 11 Bridges Lane Property Address Michael Hall Owner Owner's Name information is required for North Andover MA 01845 2/13/2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: 4 Number of current residents: Does residence have a garbage grinder? Z Yes ❑ No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Yes Detail: Sump pump? ❑ Yes 9 No Last date of occupancy: Current Date Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09108 Title 5 Oficial Inspection Forth:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 11 Bridges Lane Property Address Michael Hall Owner Owner's Name information is required for North Andover MA 01845 2/13/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner had tank last pumped in June 2008 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank,distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Bridges Lane Property Address Michael Hall Owner Owner's Name information is required for North Andover MA 01845 2/13/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed(if known)and source of information: 25 years old 11/26/1984 as built plan Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: fleet Material of construction: ❑cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting, evidence of leakage,etc.): 4"PVC thru wall. No leaks visible. Septic Tank(locate on site plan): 1 Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) Outlet tee partially corroded off, needs to be replaced. Deptth of liquid at outlet invert, no evidence of leakage If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No 10'x5'x4' Dimensions: 2" Sludge depth: t5ins-09/08 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Bridges Lane Property Address Michael Hall Owner Owners Name information is required for North Andover MA 01845 2/13/2009 every page. CityfTown State Zip Code Data of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle NIA Outlet tee partially corrodded 211 Scum thickness 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 How were dimensions determined? Tape Measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Oulet tee partially corroded off, needs replaced. Depth of liquid at outlet invert No evidence of leakage Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•09108 rdle 5 otfiaal Inspection Forth:S ftm-ew Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Bridges Lane Property Address Michael Hall Owner Owners Name information is required for North Andover MA 01845 2/13/2009 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches,etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09108 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Bridges Lane Property Address Michael Hall Owner Owner's Name information is required for North Andover MA 01845 2/13/2009 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover,any evidence of leakage into or out of box,etc.): D-box cracked needs to be replaced. Evidence of carryover. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Soil Absorption System(SAS)(locate on site plan,excavation not required): If SAS not located,explain why: t5ins•09108 Title 5 Official Inspection ronn:Subsurface Sewage Disposal System•Page 12 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form rd Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Bridges Lane U — Property Address Michael Hall Owner Owner's Name information is required for North Andover MA 01845 2/13/2009 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 3 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): Camera inside of leach pits thru outlets in d-box. No liquid at inverts Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-09108 Title 5 Official Inspection ronn:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y� 11 Bridges Lane Property Address Michael Hall Owner Owners Name information is required for North Andover MA 01845 2/13/2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Bridges Lane Property Address Michael Hall Owner Owner's Name information is required for North Andover MA 01845 2/132009 every page. City/town State Zip Code Date of inspection D. System Information (cont.) Sketch Of Sewage Disposal System:Provide a view of the sewage disposal system,including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately bwaft<-Mc�er -- ��� i /4 -Vo bin _ HPS �r o `�>_ P 15x17 t5iru•09M Title 5 Offidal Inspection Form:SubauAara Sewage D1 System age Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Bridges Lane Property Address Michael Hall Owner Owner's Name information is required for North Andover MA 01845 2/13/2009 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: >6feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked,date of design plan reviewed: 3/5/1984 Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: Essex County Soil Map You must describe how you established the high ground water elevation: Essex County Soil Map. Sheet#30, Canton Soil,Water>6' Deep. Design plan test pit data shows no water 5'below pits Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins-09108 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 16 of 17 i . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Bridges Lane Property Address Michael Hall Owner Owner's Name information is required for North Andover MA 01845 2/13/2009 every page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Summary Record Card generated on 2119/200912:43:39 PM by Karen Harlon Page 1 Town of North Andover Tax Map # 210-104.D-0063-0000.0 Parcel Id 16750 11 BRIDGES LANE HALL, MIKE& DARLENE 11 BRIDGES LANE NO.ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Size Total 1.03 Acres FY 2009 UB Mailing Index Name/Address Type Loan Number Activennact. From Until HALL,MIKE&DARLENE Payor 11 BRIDGES LANE NO.ANDOVER,MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/inactive Bldg Id.17741.0-11 BRIDGES LANE Last Billing Date 1/13/2009 3170407 03 Cycle 03 Active UB Services Maint. Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 44.07 A UB Meter Maintenance Serial No Status Location Brand Type Size YTD Cons 35341148 a Active ERT HH b Badger w Water 0.63 0.63 29 Date Reading Code Consumption Posted Date Variance 12/8/2008 13 a Actual 13 1/20/2009 -100% 9/23/2008 0 n New Meter 0 10/10/2008 -100% 9/23/2008 2749 r Replacement 16 10/10/2008 -21% 6/5/2008 2733 m Manual estimate 16 7/16/2008 3% MSG 3/10/2008 2717 a Actual 16 4/11/2008 0% 12/11/2007 2701 a Actual 17 1/22/2008 55% 9/6/2007 2684 a Actual 9 10/12/2007 -32% 6/19/2007 2675 a Actual 16 7/20/2007 -22% 3/15/2007 2659 m Manual estimate 20 4/16/2007 -3% 12/12/2006 2639 a Actual 20 1/19/2007 27% 9/13/2006 2619 a Actual 15 10/20/2006 -23% MSG ACTUAL SAYS 619 6/19/2006 2604 a Actual 23 7/10/2006 -9% 3/912006 2581 aActual 19 4/17/2006 -1% 12/22/2005 2562 a Actual 23 1/17/2006 52% 9/21/2005 2539 aActual 14 10/14/2005 -26% 6/28/2005 2525 m Manual estimate 20 7/15/2005 -6% 3/30/2005 2505 a Actual 25 4/5/2005 2% 12/14/2004 2480 a Actual 18 1/1412005 23% 9/27/2004 2462 a Actual 18 10/8/2004 -25% 6/23/2004 2444 a Actual 17 7/30/2004 9% 4/16/2004 2427 a Actual 28 5/17/2004 0% 12/16/2003 2399 n New Meter 0 12116/2003 0% FORM U - VERIFICATION FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills o t this section***************** APPLICANT: Phone LOCATION: Assessor's Map Number a b b`7 Parcel Subdivision R1(�, J_,U _Ak0L,_L Lots) q Street ,r l- St. Number i ************************Official Use Only************************ RECOMIENDATIONS OWN AGENTS: Date Approved C Co ation ldministrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Date Approved Food Inspe�c-to�r-Health Date Rejected Date Approved Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date BUYER: Michael D. & DarlPno M Nall !or 7 A Lq 4A_A, 4r.?-05zLo tA R I w rn r 57 Lilo i Al /99 A/ 6 L rte' /f- -8�-- CUP r , tv gg 1 I b j 3 e 1 RECEIVED TOWN OF NORTH �t�t�:�v�r;. JUL - 6 2005 UA 1 t _ TOWN OF NORTH ANDOVER HEALTH DEPARTMENT YST$M OWNER A ADDR.ES5 73 DATE OF PVWN Q tS��JL: No _ a_ Yl<s 50 � rpt. r tis V SeRYt ;tp: K(?Cl'€`ENk t;vtFU ' �'1 Ub AYA'd'1um; HEAVY B3 _..s E) .AF1. A $$ 1N Pt,hLt. MUMS SOLIDS��__ FLOODED LBAChTIEt.C� �E�_v5A: $0VIDCAIAdI Y0YZ?, _.()TMER EXPLAIN � _`.,."-'��.-...i.:r--�c�'.•--_-�..__ rte':.. . � �i<:i \ ..tS^'� r •. tt •,y, i SOIL PROFILE & PERCOLATION TEST DATAzq Town/City No.&Street ✓1`e�- � ' Lot No. ` f Loc./Subdiv. o�-,� 1(J/,,,' Plan Owner -4,Lape - v Investigator G�--�C�} //d Observer SOIL PROFILES-DATE 1' E ev. �' Elev. 3' Elev. 1-Elev. 0 (� /3 77 - 0 0 0 - 2 2 2 2 3 3 3 3 4 4 4 4 =_ 5 5 5 _ 5 - 6 � 6 6 G \7 a 7 7 7 s 8 ,. 8 8 9 9 9 9 10 10 10 10 Benchmark Location Elevation ' 'Datum Percol tion Tests-Date Z Z 77 Pit Number 1 2 3 4 S ` Start Saturation YG8 Soak-Mins. - Start Test-Time Drop of 3"-Time L 9 Drop-,,of, 6"-Time : 3 7 Mins.lst "Dro Mins.2nd -3"Dro g Motes & Sketches on Back Frank C. Gelinas & Associates, North And. Nor`uh _ over Subsurface d jsposal system check list-Page 2 w Fail, 0 istr—'.�hS_uttion Boxes R eg.10.2' " (a) Slope greater than 0.08 Reg.lO.�i (b) eaching Pits Leaching pits are preferred where the installation is possible Reg.1112 - (a) Calculations of-leaching area (minimum 500 S.F.) Reg.11:4 Spacing Reg.11.10 .Surface drainage 2% Reg.11.1 rd�Cover material each# Fields Reg.15.1 (a) Greater than 20 minutes/inch Reg.l 5.1 (b) Area (minimum 900 S.F.) Reg.15.4 (c) Construction of field Reg 15 8 Y,) Surface drainage 2% Reg.3•( ) 201 from cellar wall or inground sirimming pool *mhill Slope ,�(a) Slope y/x = (to be sho,m) (b) y/x X 150 = (to be shoim) I I i 1 . i ,1 NORTH A1,MVF�4 BOARD OF HEALTH- Y SUBSURFACE D POSAL;SYSTEM CHECK LIST r APPROVED PROVIDED �. DISAPPROVED" 3,ty•)�i General Information Reg. 2.5 Fail 0 The submitted plan must show as a minimum: a-`(a) the lot to be served (area,dimensions, lot ; , abutters) 'b) location and dimensions of system (including reserve area) {c) design calculations )calculations showing reouired leaching area existing and proposed contours location and log of deep observation holes-distance to ties g location and results of percolation tests-distance to ties )A location of any wet areas within 100' of the sewage disposal system or disclaimer �rface and subsurface drains within 100' of sewage disposal system or disclaimer U`)"location of any drainage easements within 100' of sewage disposal system or disclaimer �) knoun sources of T,,sater supply within 200' of sewage disposal system or disclaimer �) location of any proposed well to serve the lot(100' from leaching facility) m} location of ;,rater lines on property (10' from leaching facilitijs) maxiiriam ground water elevation in area of setirage disposal system (o) location of benchmark }151an must be prepared by a Professional Engineer or other professional authorized by law to prepare such plans q driveways Tl)garbage disposers profile of the system (elevations of basement, plumbers pipe septic tank, distribution box inlets end ,outlets, distribution ' field piping and any other elevations) no PVC is to be used in construction Sfatic Tanks Reg. 6.1 (a) Capacities - 150% of, flow Reg. 6.7 (b) `eater table Reg. 6.8 (c) Tees Reg. 6.9 (d)'Depth of tees Reg. 6,1 (d) Access Reg. 6.1 (f) Pumping �• (g) Cleanout Reg 3.7 (h) 10' from cellar wall or inground swimming pool (i) 25' from subsurface drains Puy' s Reg: 9.1 ! Approval Reg. 9.6 (b) Stand-by porter p i TO- NORTH ANDOVER, MASS Ab.Y 19 ,741 BOARD OF HEALTH Re:.Soil Absorption Sewage `' FROM: DESIGN ENGINEER System Inspection This is to certify that I have inspected the construction of the said disposal system at G p f _ � Rn �� 5. L N North Andover, Mass. SITE LOCATION . The grades.a'nd construction are as`speclfied,in my plaits and specifications dated Z4 C) COA44fo A <� tv A O �cg. n er/3e ni lain r v F a �a }oa'rd of Health . k r- ilY5PQSA� DESIGN CHECK Irl tit. LOT DATE - - - -- yi SAPPP~GiTF..D --DATE A��'.I�OLID DATE - - — T% - J?^asonss y ,'F IA/ `l e D FAIL. .5 _ . r, must CLOW as a mia3auim: R. 2 a >rr., . • ;t�, t,` ��r�e�i-area,dimensions In-; ;,,at-- C t-"` C-; . o Beep observation=hoes s � ts pereolation,tests-'` stanc 4 1 •` �, y � � on k ca3cnl-ations=ah�:' g re;=: ' c`'� _ ki .. - - ` tc} :►r j r• t it (.'men6'icns- of "SgB eTt+=iTlC�tiC' g rF-. _i f� x Vr� c. k11 oSCd contonrS 4 14� S s :t Gi'• t_8T68S. t =t�.� Of 8: ���FE G{' Y:If tlandB_p[{ pp ng . f!'1::*- �z face dra4 ns` *3 thin 1�}ti i of s - }a .Z aiL^3z. C , s, z i, . r { em a nage easents-il:thin 1^C' of e . t, ::.2_jrer-PIG_:nr ing-hoard fil f S -, of .a.ter simply within 2G. E of t' Pmpo6ed �-e _to $erv_e�_ ..tlOrt 4 ' iex lines on proporty-1..0s Chmark s T PV'C to „ Ut ed in construction -- .j; t� o�`i1e o�` v ,en--el�a4ions of base*zrYz',; lu" y �vbox inlets and autlets, di.Rt- bu" P=. aster elevation in area - - pa-epared by a Protession.sl ,t n, l o tre , J 'A E'. r. `' "'.1 thA2'2 Z� by law P D�'-�' .t s - 6 - of flow, sorter table, t,:. :, d vall or i groid s - P n. -race drains F n 10.2 _T?, . fir.;�.� ;Wes C. ( o I T 0.08 ' F 10.4 Board of Health SEPTIC SZSTEK � ,North And,over'Maas. IN STAILATI OK CHBC% LIST LOT'j ,�_ A _ VPICNED DATE DISAPPRCTM EXCAVATIN O& EUL easunss Fin OK I. Distance Tot a. Wetlands b. Drains Co. Well . 2. Water Line Location 3• No PVC Pipe 4. Septic Tank ------ a. -Tees --Length k To Clean Out Covers © b. Cement Pipe to Tank On Both Sides of Tank 5. Distribution Box a. Covers.& Box - No Cracks b. All Lues Flowing Equal Amounts _---— c. No Back Flow b. Leach Field or Trench a. Dimensions b. Stone Depth c. Capped Ends d. Clean Double Washed Stone 7. Leach Pits a. Dimensions b. Stone Depth c. Splash Pads d. Tees M e. Cement Pipe to pit Both Sides f. Clean Double Washed Stone 8. No Garbage Disposal 9. Final Grading Inspection 10. Barricading Covered System 11. As Built Submitted a. Lot Location b. Dimensions of System c. Location with Regard_to Pere Test d. Elevations e. Water Table YJa/kJ5/'Y]kJtJ lb: b ebb / bbll b I Lw9w I/ANDU'Vtl? PAVE bl AJD41 AIVLbver• 2.n. µ, SMOT'S SEPTIC T�W SMVICE Na ihh A ndove� 47 GAD STREZT u! L c ►5�_per µ FORD, Mk 0I835 Ll- 978-372-7471 MGM. OF C cC /1 g�-�� Mnt"HT,Y REPORT rnR TOWN OF � V DATE ---^ ADDRESS--�---------� _ S - --�- _ GALwW -- "'---^------- _ TI'S 80 ISS �_ tt Address � 1_8k i OG 6s Title of File Page of Date File Open: Date file closed: Choc Document/Action Title Date-OfRefdocument/ to other Purpose of Qocurnernt/Action and notes action Document/ Num. Action Department Board of Appeals — Board of Health — Planning Board — Conservation Commission — Building Departrnent Town of North Andover Of,,Lao a�pito Office of the Health Department a _ _ o� Community Development and Services Division p 27 Charles Street il0���+ North Andover,Massachusetts 01845 4ssgCKusE�h Sandra Starr Telephone(978)688-9540 Health Director Fax(978)688-9542 May 29,2002 Mr.Michael Hall 11Bridges Lane North Andover,MA 01845 Re: Application for an addition to an existing home Dear Mr. Michael Hall: Your application for an addition at 11 Bridges Lane has been reviewed by the Health Department. The application was denied on May 29,2002 for the following reasons: I. X Missing information 2. X Passing Title 5 inspection of septic system may be required 3. X Location of structure not acceptable To address the problem(s): If#1 is checked, please supply: a. Floor plan of the existing dwelling and the proposed addition; b. Certified plot plan showing house,septic-system and proposed project in scale,including any associate grading. If#2 is checked: a. Have the septic system inspected by a certified Title 5 inspector to determine the size of the system and whether it is operating properly: OR b. Tie-in to municipal sewer. If#3 is checked.- a. hecked:a. The proposed project may cover part of the system and cannot be determined without a certified plot plan showing the locations of the system and the addition. Please feel free to call the Health Office at 978-688-9540 with any questions you may have. Sinter , i /Bfri4al.radrasse,Health Inspector cc: Building Department File BOARD OF APPEALS 688-9541 BUILDING 688.9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 TOWN PYNOUH ANDOVER{ SYSTEM PUWIN4 RECORD DATE q a 7 0 _-- SYSTEM OWNER&ADDRESS SYSTEM LOCATION )4a LL a1� l� Glao, veil , a DATE OF PUMPING} `1 O L QU,4N I'ITYPUMI�ED lCj CESSPOOL N041�S SEPTIC TANK NO YES NATURE OF SERVICE;:.RQ.yTINE ' EMEROENCY OBSERVATIONS; 0001 CONDITION: FULL TO COVER HEAVY GREASE : BAFFLES RfJACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS--FLOODED ,SOLID CARRYOVER_ OTHER EXPLAIN SYSTEM PUMPED BY COMMENTS.- CONTENTS OMMENTS;CONTENTS TRANSFERRED To,." '.,.� 1 ` P.QECAST CONGQETE SEEPAC��. P1T _ . �B"Tv 3B« WASHED C�GCS'NED .57b/� • �Z- WASHED C21/SNED .STONE /Z" �AXlil�lU/v! C�VE� �} �GaUBCE if�ASNEY>-sjASHo .SPK. T-//-.Ga) mle-ET PIPE �w/TN TEED � I8".NAX. FO p p p d O p 2'x z'x 3" CD.vc'eE7� o O o o O .33`" o p p p d cSPLA.?sr`� PA D O O •O O O O O VEEnAGE PT - 51crwy AQ A - cSEEPAGE P/T- cSECTIot/ B-B - c 'fJGE c.SCAGE 6 EPAGE AREA = 3 0$ P,--.e- P/T. /,$bfl COAL. GDAuG2 ETE SEPT/G TA itll�. __ �� • �(4.Sd�/D RUC•, $EAGER TD/A/rS, S=.00s /¢ 1 �_ 3 SHALLOW SEEPAGE PIT 7.� 14 0 o a Tol m t7 L/gy L/-7 -14, w Ex • G�p • - 144 1 ♦i L.4 cSEEPA6E PIT- -- Pe ,4AJ -31 44 ':c r se-?LE H0.2. JEr2T6SE . �'/'¢ /`"ie'�F"/LE -" SEPAGP/T" PLAID A Al QcSECT(OrllS v ' -_No W,E T4R1v..D o R -Df,9ilvS wl r-A/iv /u a ' 0,- -Z� -.j rs ash t sys rF.s� PL.4/C! �.Sh/QW//V�7 _ TEST Loc /9 7/6,,v S` by s�n.rT. _G_-!�f,$ d,-F. ToP� 61Y G-E e"" j wc� . . P�DOOSED SUBSae-cAGE 56-WAe S h/Sft���L •S�STEM ANG Lor aRAb/iVG• E_oT /s�x3 = yc� x •.S"S - = a-S4•lo G•P•,p ' L aX-JT-4 A.3.- 4 G 1 X i - 4 a'0 G P•d r- IP,a. OWAIEe= REVISE A 4-�-- -94 _ - � GS f/i/Js/oE Rd• _No' RNZ4 V46R/../3.109$5 M ckxsEPH cT BAesAc5.4Lz-D , iQ.s• �� !`� L XP / �'• � � N�ESTK/ARd ClRCc.� �° r 1!;;�_�•_� � ,�•' 10 ITO ��'� --• �s'4 _3�s-� � 9 � � ' � � �� TEG. GG ¢ -41983 � �`''�c � ,;�, ' w "�► TYPE of BU/44/A/4= q is•R, :Dw- ,,� i / l3ARAGE O CE4L.4R PKUMBl.V6 FAC/G/TIES=/u ,,4 4;ELu.4GE FLOW EST/MArj-c7: g,a a C SEPT/G TANK : J-rd a --4 t t 4 �. ~s o• 1 , < .4Q5eR,07"/0N AREA - 7 !4 4 \ '� ♦ i = j i Q5PERC,M-Ar10AJ 7MST.S dE/ ar Z sf .tea � � ` �-� r ,�, f � � TZ:1P ECEf/AT/o�./ /S 3• v 1 S y . � rS4TL/i2AT/OA/ /S Af/•/ I S' AVAI /2-ro 9^ DROP 7 M/N: ! t7 4f/A.I. MiN. Mery f` 9"rb G DRoP/ io 3 0 ,tf/N. a MSN MIN M/n' / ! � �PCOL�t T/ON RATL� ,ems Miv. Iry 7 Mi��/ Af, 1AI TEST" PITS ¢/ z -....� -.,... _' _._ a '8' S .�w.,._...r....-..._.._..�-•-.-�,••---.._.. :� %� TDP ELEi/AT/�/ I s3 •o 0 3a"Y4P -t ,�h -BIV. C�" . .--- = .+ ._ ... SO/e- TYPES Sr.t 6 S o i L Q./H_..►3 9 33 R/M a p t', WATER TABLE >ii— ' 40C4 -/,0 N i W ArER /O �of f BoTTpN1 EGE1/Aro�v /3 C� d � s -_--- �.,a f TESTS t,--OV&AU TEG /w 4 A 6,9 6 a9/Aj TESTS wirti,`ESSEO Y M l kF Ro f P44 A,' e re-R/•4 �w.�ItMwW .!B('N1AFlMMFL!'ItWtRf�OnC AapbAi2trpYli�gtr�•ow:etc�anxtu.ucr�Isai..•aevs+w'awaw.M.^fnfi ww..orartae�xw:.nroJr�a+.l.rlroe e.+lUtF.t-xra.+n+aawNs rwYvaaxesriYMrW.ruU•una w�nw,ux.rr4urw•.�wnrr.r.... .,.........�..�.•..wriwxw.rawr w«.a..n..n..,e.�...n:.....«asw,....•.�,. v.<•m.::�-u•,••••*••••+r• 1 -A Q _ 5x j � 1 YI s c B c-,;3 S U S cy- 5 -1 A-r L' J�T L.0 C C.S S tsg ELF-\,/ 1 54 . 0sl ' 1 v° << 1 �l 1 Z. S , 5 Z l 's ' ul �.t V lG i.r 'SOM GAL 0 < v 44 14'2- -ROAD 42-ROAD SLOPE EnnT E E T j �N� j:�r�i��Ac�; stis-rEt.n� 1�oTE5 i LF-GEND - }. No sURCACE WATF-R W(Tt4iKA 100` 01` S-�S-rF-M . 2 NU SUR1^AcS DRt.l S UB5URFAC F DRAiN4 0R DRAIN EASE MEr173 W l'[411'4 loo' OF �E�co'�AT1chu w i=5+ 3`-C-op S(4ALL Q E REMO�IED FST C15 1 tiC.� Cc�rLT'OU LG ACHING AREA AWD �pR A PER(MF-7-E-R OF kO (W ALL DIREC-T`(OMS AND REPLACEI; '%441T:4 G RAV E L. G,dFBASC--E C-R4NDER sHA( L i3E USED. _� CTtvE LE ACI-4�NC� Et.tC4-( -(LL S.H(-)WN FOR C-PALS iN<*- ONLY . "D4,4',! 04 SUE SU ZP-ACE D15PoSALSYS7-CV, I DoT_Ro .4A (TAREaM. LST (J o,9-7 L�RIDG-mss Lr�lr.tiE __ 40 i Pam E t o� DF-SIGN DATA CALCULA-'IONS SbtL QSSEFtVATIONS BY: T• 'QARQAGALL0 _ WtTNE55 .-7• CUS411�1C�• f PERCOLAT 10N FEST No. 1 1 2 3 4 S- DATE 613 1l ; t - + iTOP-ELEVATION i 444, 50' . ' BOTTOM- ELEVA-110N 141 . S0'i + S)XTURATioN -MINS. t _ DRO P- MI N5 D ROP -M 1 N5. + i + `FERC . 1ZATE -MIN .�IN. I CS � i T� O%L PROFILE-DEEP PtT No. I t 2 3 f 4 1 5 DATE � (13 ''17 Top-ELEVATION 14 4.SO ToPSolL SUBSOIL PARENT So1L 1� WATER TABLE 61_3,. GRAVEL . 71 LL MATER WATER-TABLE ELEVATION 1 BOTTOM ELEVATION BUILDtNG7`(PE_ _bWELL(WC� --- - B.R.,OR X SCa GAL. IU NIT - �0p GPD FLow �w GPD FLow x f5o',=_ 9OU GPD USE_ t S�0 GAL.S EPT%C TANK LEACI.IINCr AREA G-Po FLOW x SF�GAL.= _ SF BE�z USE.-- _P_I_T S_. TYPE j MvP, (TY P,) SIDEWALL AREA _SF x_ _GALsIs F: _ GPD BOTTOM AREA _SF x _ _GALS f SF GPD TOTAL PIT LEACH I NCi CAPACITY _ _ GPD /'PIT _GP D FLov i = - GPD/PIT= PITS READ, USE _ PITS 7RF-LACHES SIDEWALL AREA SO -SF/LF-g 4 83 _ C--ALs SF = _ 2•� GAL.JLiN.FT, 30TTOM AREA 2 . OU SF/LF x_ GALS SP = 4 . S4• GAL./ LIN.FT, _TOTALTRENCt-i LEACNING CAPAC.ITy 4• 2-9 GAL./ LIN.F7 O O GPD FLOW -=-_4, 2��Ial �U11.P1 = 4 O L F TRF Mr-HES REq'D. USE CSO L.F NOTES R EKICHES 2- ' VJIDE W1' 9 "STONE U MDER PERF p(Pf ELEVATION SCHEDULE. IB rr " EN�N MAR! LOC E CSC3 S'i'd �� 154_05' �� �" ELEvATto�.iS t¢EF E[Z i>�vE`2,T JR PTE . PLUM61•�S PIPE (!Z-DWELL. t44-30r Q SE PTI C -TANK -INC-ET S OPTIC TANK-OUTLET D DIST. BOX TNLET _ l4e)AS' �i 7-RENCH NO. 15-C 13 ox OUTLET14$,28 ' Z 3 4- r -•F Et�iD O_F PE R�' PIPE t 4-1 .04` �4�, S0 14�'. OQ _ 143" Od G - 207TOM `OF TFtEmcN_ 14-1. 2S' 145,?S- 4� f4 ,2S` �(�oTE i S1~as•HIC-4-t,WATERTA(SLE 143.25 141 ,15 140 S' t X8.25 i k0+S:I - Sots PRO PI,I-E _TAK Cz q AT 7F(S_NX64 MO.4 , WATER _TA,'MLS C4-sktA P-,F- E y PECTED 'To �o�Lovu TkkE c_G' LToUR �F TME L hd►�3. G `- 3 P.SEL+� E.'XtSTC- .C-rRA1`?E . d —,4GCES5 MAX+HO LES _M wt7N1N 4 OP F04IS14 gRADE lr1 Q `F:CT, ISO 6 MkI4, —SLOPE VARIES LAYER UwTFttrATE-c 4"C.2 TEES S+E'�Er 3 . BUILDING PAPER . S 02 Mitt.--� 1 4„CS PtF'E - F.` a 1z” MtN, COVER T .O c-tox 1y2' STOV-A E CoAmse l S OOGAL . SEPTICT•ANK' G ' F ALL STONE S•"ALL BE WA$HED . (a �` i 40(` O m � TYPIc�t_ IEA�Ntllti�?ENc�•1 PROFILE — o Ido SCALE 11 RATE :s 1v4e tATtc pntLY - %K SITE LA.-IOUT SEE PC; 1