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Home My WebLink AboutMiscellaneous - 120 CRICKET LANE 4/30/2018 120 Cricket Lane O Ll ', II ,I i F i I i I i 1 Lot & Street ��j R exec-r�7— L Map/Parcel CONSTRUCTION APPROVAL Has plan review fee been paid: YES NO Permit# 1 9 Plan Approval: Date: / ��q Approved by:_�� Designer: fKrl mQ _ Plan Date: Conditions: — Water Supply- Town Well. _ Well Permit: - _.-Driller: Well Tests: Chemical �Dateved Bacteria I Date-Approved Bacteria H Date Approved Plumbing.Sign-Off. -Wiring Sign-Off: Comments: v Form"U" Approval: Approval to-Issue: S NO Date Issued By: Conditions: Final Approval: .All Permits Paid? _� NO Well Construction Approval? _—fig____ _ Np Septic System Construction Approval? NO Certification? YES NO Other YES NO Any Variance Needed? YES FINAL BOARD OF HEALTH APPROVAL: DATE: APPROVED BY: SEPTIC SYSTEM INSTALLATION Is the installer licensed? NO Type of Construction: REPAIR New Construction: --Certified Plot Plan Review YES NO -Floor Plan Review YES NO _— Conditions of Approval from Form U YES NO _Issuance of DWC permit: - NO -DWC Permit Paid? -- S �NO . --DWC-Permit 9 Installer- - -- Begiulnspection:- = YES NO - Excavation Inspection: Needed: , f3&- 4-xca l)(4-e A —Passed: By: - ..-Construction Inspection: Needed`: As-BuiltPlan Satisfactory: YES: V�ryll - - Approval of Backfill: Date: 'Z By: --Final Grading Approval: Date:�� (� 1Q By: Final Construction Approval: Date: By: Certificate of Compliance: Approval: Date: LRTMENT � • Commonwealth of MassachusettsCity/Town ofS stem Pum in RecordZ�13 Y p gForm 4 ANDOVER DEP has provided this form for use by local Boards of Health;..Other forms may be used, but the information must be substantially the some as that provided here. Before using this form, check with your local Board of Health to determine the form they use.The$ysty Pumping Record must be submitted to the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important:When fining out forms 1. System Location: '— on the computer, use only the tab key to move your Address cursor-do not use the return Cityrrown State Zi Code key. p m 2. System Owner T In e Ile Name ncm Address(d different from location) Cityrrown State' Zip Code DI4-1-75K—.�2912V Telephone Number B. Pumping Record 1. Date of PumpingDate 2. Quantity Pumped: 45-00 Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank '' ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: /f 6. System Pumped By: Name Vehicle License Number 30f6kV2k- Sea '►C Company 7. Location where contents were disposed: GLs� Signature of Hauler Date Signature of Receiving Facility Date t5fonn4.doc•03/06 System Pumping Record•Page 1 of 1 ORT BUILDING PERMIT O�"�� 6gtio TOWN OF NORTH ANDOVER ?4b` o� APPLICATION FOR PLAN EXAMINATION F Permit NO: Date Received �gssAc►+ us ��y Date Issued: IMPORTANT:Applicant must complete all items on this page V.1 <,„ `LOCATION 1f1;0 rCXuv � ll�"N,L� 'ti V}A1Gtov�R-= rt , t_ , } �pRORERTY'OWNER 1.Errz1 + -Print, �• ` - _ _ .;, MAP.'NO ,.,_PARCEL. ZONING DISTRICT_:` {Historic District' `, yes: n'o Machine Shop FVillage dyes no ; TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family -' Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other - Septic Well Floodplain Wetlands: Watershed District t Water"/Sewer - 4'4 DESCRIPTION OF WORK TO BE PREFORMED: t2 a(us i7�u25 Identification Please Type or Print Clearly) OWNER: Name: LO V.t U P_c r2— Phone: 2( 7�6 2 7S Address: P.hone. '�e.Z.� G7:Z CONTRACTOR 'Name: ` Address. t t .�._ 5 _ ._$ r. `�_• ,: , Supervisor's Constructio` n License: (d L Exp° �Date';'''S Home ImprovementoLicense .. 1.( 2(O Exp. Date, ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ [g ��• FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature.of contractor • Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on 5_hOl P, Signature COMMENTS 00 /,cz-xv\ 7— HEALTH Reviewed on Signature ` COMMENTS %`C- i � r 4 Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT Temp'Durripster on_site yes no Located at 124 Main Streef 1 Fire Department signature/date. ' , — COMMENTS '., TANK \ p—BOX ® \ \ TR #1 TR #2 I Q 2 LEACHING TRENCHES 2'W x 2'D x 62'L \ 0 WA TER"A/N w Cn C /CKE7' - , ANE AS— BUILT , Go OF SUBSURFACE DISPOSAL SYSTEM a rn LOCATED IN NORTH ANDOVER, MA. m l AS PREPARED FOR � ,(Vi OF Ss9� COPLEY DEVELOPMENT DANIEL yGcn 50 COPLEY DRIVE o Kar3Avos , CIVIL y -. - .. -" METHUEN, MA. 01844 No.37752 w _ �-- ---" "=20' V) _ SCALE: 1 s� w DATE: MAY 24; 2000u'�--- SUBDIVISION LOT #8 CRICKET LANE co MERRIMACK ENGINEERING SERVICES PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS 66 PARK STREET • ANDOVER, MASSACHUSETTS 01810 • TEL (978) 475-35559 FAX (978) 475-1448 f INVERT ELEVATIONS BUILDING TIES 4" PIPE Q FDTN. = 200.95 BUILDING CORNER A B SEPTIC TANK IN = 200.47 ' SEPTIC TANK OUT _ 200.36 SEPTIC TANK 16.2' 23 PUMP TANK IN PUMP TANK — — PUMP TANK OUT = — DIST. BOX 25.0' 25.0' DIST. BOX IN = 200.12 CORN. LEACH FIELD #1 28.0 21 .5 DIST. BOX OUT = 199.92 CORN. LEACH FIELD #2 88.5' 80.0' END LEACH LINE #1 = 199.44 CORN. LEACH FIELD #3 87.3' 82.7' END LEACH LINE 42 = 199.44 CORN. LEACH FIELD #4 25.0' 31.0' END LEACH LINE j3 = — END LEACH LINE 4#3 = — ROOF DRAIN \ SRC//V,gGE FNDTN. EACH PIT DRAIN OUTLET / �E\EEE & INV-188.0± �N T LOT 46,884 .F. - - — — - G ` DECK \ 31.8 2-112 �` ��``•� �`�. STORY W.F.D. B.M. TOP F7VDN.-203.86 .� B 0.94 cu ,q PORCD CH 1 'Jaya e .i " .3Y� O a I CONC. wALiC :. 3, O 1500– GAL–. – -- - - `.. "•.. e-r n TI/- Septic System Information 120 CRICKET LANE Printed On: Wednesday,August 20,20 System ID: BHS-2002-0405 General System Information Latest Permit Information Calcaluted Design Flow: Test Pits Septic Tank Disposal Trench Design Flow: One TWO Capacity. Number: Design Flow Provided: Minutes per inch: Width: Width: Total Flow: Depth: Length: Length: Seasonal: No No Depth to Water: Diameter. Leaching: Grinder: Yes No Soil Type: Depth: Laundry. No No Haulingl/Pumping Listin Quantity Tvpe System Type Pumped Pumped By Transferred To Disposed At Date Pumped allons Routine Septic Tank Bateson Ent GLSD 10/07/2005 1500 = Inspections: Inspected: Expires: Inspector: Status: 07/30/2008 Benjamin C.Osgood,Jr. Passes Comments: Title 5 GeoTMS®2008 Des Lauriers Municipal Solutions,Inc. Page 1 of 1 Of NOR7:,h / g 6 't O 0 v z Town of North Andover HEALTH DEPARTMENT ,SS4cHU`+t� CHECK#: -�L DATE: ds LOCATION: cAr te � 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: tems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approva l $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ itle 5 Report $ 5t2• 0.0 ❑ Other:(Indicate) $ He lfh Agent Initials White-Applicant Yellow-Health Pink-Treasurer Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 120 Cricket Lane Property Address Deane Dolben Owner Owner's Name information is required for No.Andover MA 01845 7/30/08 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Benjamin C. Osgood, Jr. cursor-do not Name of Inspector use the return key. New England Engineering Services, Inc. Company Name VkA 1600 Osgood Street Suite 2-64 Company Address No.Andover MA 01845 City/Town State Zip Code 978-686-1768 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 55(310 CMR 15.000).The system: 2 Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority /;, L -2 7)11 /JS Inspecto Signature Dam 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. TITLE 5 FORM MASTER.DOC•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 120 Cricket Lane Property Address Deane Dolben Owner Owner's Name information is required for No. Andover MA 01845 7/30/08 every page. City/Town 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: 5z"'I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑for the following statements. 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. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed TITLE 5 FORM MASTER.DOC•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 120 Cricket Lane Property Address Deane Dolben Owner Owner's Name information is required for No. Andover MA 01845 7/30/08 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. TITLE 5 FORM MASTER.DOC•08/06 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 120 Cricket Lane Property Address Deane Dolben Owner Owner's Name information is required for No.Andover MA 01845 7/30/08 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *"This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ d Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ 2 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 ❑ a Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow ❑ R Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ a Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ Ly-' Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. TITLE 5 FORM MASTER.DOC•08/06 Tice 5 Offidal Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 120 Cricket Lane Property Address Deane Dolben Owner Owner's Name information is No.Andover MA 01845 7/30/08 requiredd for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ 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. ❑ la**� 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.] ❑ Q. The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ [a- 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 ❑ 19 the system is within 400 feet of a surface drinking water supply ❑ Z the system is within 200 feet of a tributary to a surface drinking water supply ❑ Ea,, the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. TITLE 5 FORM MASTER.DOC•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 120 Cricket Lane Property Address Deane Dolben Owner Owner's Name information is required for No.Andover MA 01845 7/30/08 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 [J"" ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ (2"' 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? ❑ d 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) E ❑ Was the facility or dwelling inspected for signs of sewage back up? [✓� ❑ Was the site inspected for signs of break out? [✓f ❑ Were all system components, excluding the SAS, located on site? E( ❑ 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? Ei. ❑ 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: [g"' ❑ Existing information. For example, a plan at the Board of Health. ❑ [a/ 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)] TITLE 5 FORM MASTER.DOC•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 120 Cricket Lane Property Address Deane Dolben Owner Owner's Name information is required for No.Andover MA 01845 7/30/08 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): y 1/0 Number of current residents: -3 Does residence have a garbage grinder? Yes ❑ No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes [O"'No Laundry system inspected? ❑ Yes [ No Seasonal use? ❑ Yes No Water meter readings, if available(last 2 years usage(gpd)): Sump pump? ❑ Yes 2r No Last date of occupancy: ( rerx�' Date Commercial/Industrial 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: Last date of occupancy/use: Date Other(describe): TITLE 5 FORM MASTER.DOC-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 120 Cricket Lane .Property Address Deane Dolben Owner Owner's Name information is required for No.Andover MA 01845 7/30/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: dLT 2,0 0.5;' p 2 oc 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) ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: Fiy r L--r l ti ZQ�0o ,-E�_ft:S— I c.i Were sewage odors detected when arriving at the site? ❑ Yes Z[ No TITLE 5 FORM MASTER.DOC•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 120 Cricket Lane Property Address Deane Dolben Owner Owner's Name information is required for No.Andover MA 01845 7/30/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): � t Depth below grade: feet Material of construction: ❑ cast iron 5 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): f�1 E N6w 1 N &ASeAA&eV Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal listage: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: CsA-�o,v Sludge depth: Z`r Distance from top of sludge to bottom of outlet tee or baffle Z5 t1 Scum thickness 4) s Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle t e " How were dimensions determined? .t404!� y2- ST1 K TITLE 5 FORM MASTER.DOC•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 120 Cricket Lane Property Address Deane Dolben Owner Owner's Name information is required for No. Andover MA 01845 7/30/08 every page. City/Town 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.): SCK [N Crag ir-� C o!-,O til0'-�. AUC I�cS /N lrt0�e7 G£>ivp .it Jn AJO Fyt 0Q.1r6-7 Cpr �E�Ar�, ►4G 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 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): TITLE 5 FORM MASTER.DOC•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments G M 120 Cricket Lane Property Address Deane Dolben Owner Owner's Name information is required for No. Andover MA 01845 7/30/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) 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 Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet inverty 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.): ! ox ee, frov o G'vND t7�v►. iyo GytpPnf[% �� E�fK��F DMZ cs►/1/�ti o✓eC comm 2.6-p"IL cc o 05 tus�ccleAl, Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No TITLE 5 FORM MASTER.DOC•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 120 Cricket Lane Property Address Deane Dolben Owner Owners Name information is required for No. Andover MA 01845 7/30/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: © leaching trenches number, length: 2- 7-re 7-re vl c i4B S ❑ 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.): 01z uAi✓s,/,H` VGC-E'er TITLE 5 FORM MASTER.DOC•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 120 Cricket Lane Property Address Deane Dolben Owner Owner's Name information is required for No.Andover MA 01845 7/30/08 every page. City[rown State Zip Code Date of Inspection D. System Information (cont.) 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 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): TITLE 5 FORM MASTER.DOC•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 120 Cricket Lane Property Address Deane Dolben Owner Owner's Name information is required for No.Andover MA 01845 7/30/08 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. D�sTK�CcS µ00 SG t2 at u E 13 -T#:kjK, I� Z -ANIL 23 R. Pc 2G i-( A- T;>B b x Z 5 J) DB I l CaLC_I/,t-; LA,v� TITLE 5 FORM MASTER.DOC•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 120 Cricket Lane Property Address Deane Dolben Owner Owner's Name information is required for No.Andover MA 01845 7/30/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record ff l If checked, date of design plan reviewed: III( 4qc97Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Sus►c✓n c a-57 P-UC 14 P-,n"c &-120 TITLE 5 FORM MASTER.DOC•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 Page 1 of 1 DelleChiaie, Pamela From: Kimberly Brown [kbrown@neengineeringinc.com] Sent: Monday, July 28, 2008 1:25 PM To: DelleChiaie, Pamela I Hi Pam, Can you check when you get a moments for an as-built for: v11'20 Cricket Lane - Dolben 52 North Cross Road—Stachapoulos Thanks! Kim Kimberly Brown Office Manager New England Engineering Services, Inc. 1600 Osgood Street Suite 2-64 North Andover, MA 01845 978-686-1768 www.neengineeringinc.com No virus found in this outgoing message. Checked by AVG. Version: 7.5.524/Virus Database:270.5.6/1577-Release Date: 7/28/2008 6:55 AM 7/28/2008 Tel: (978) 475-4786 Fax: (978)475-5451 BATESON ENTERPRISES, INC. Excavating-Water.& Sewer Lines-Septic Systems&Pumping Service 111 Argilla Road Andover,Mass. 01810 Title 5 Inspection Report Property Address: 120 Cricket Lane, North Andover Owner: Norman Gill Date of Inspection: 10/7/2005 My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic system. ad,-j &&_—_ Neil J. Bateson Bateson Enterprises,Inc. COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION A C r+a• ..r�i OCT 1 2 2005 TITLE 5 rowN of ��u Ov HEALS n J� T OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY -SSESSIVYENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:_120 Cricket Lane_ —North Andover_ Owner's Name:_Norman Gill_ Owner's Address:_120 Cricket Lane _North Andover,MA 01845 Date of Inspection:_10/7/2005_ Name of Inspector: Neil J.Bateson Company Name: Bateson Enterprises Inc._ Mailing Address:_111 Argilla Road_ _Andover,Ma.01810_ Telephone Number:_(978)475-4786_ CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper fimction and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Is Inspector's Signature: Date: _10/7/2005_ The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments: ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:_120 Cricket Lane_ _North Andover— Owner:_Gill Date of Inspection:_10/7/2005_ Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired The system,upon completion of the replacement or repair,as approved by the Board of Health, will pass.Answer yes,no or not determined(Y,N,ND)in the for the following statements.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. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_120 Cricket Lane _North Andover_ Owner:_Gill Date of Inspection:_10/7/2005 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water — Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance_ "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other:_ Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_120 Cricket Lane_ _North Andover_ Owner:_Gill Date of Inspection:_10/7/2005_ D. System Failure Criteria applicable to all systems: You must indicate"yes"or`ho"to each of the following for all inspections: _ —No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool No Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _No Liquid depth in cesspool is less than 6"below invert or available volume is'/z day flow. _No Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped No_ Any portion of the SAS,cesspool or privy is below high ground water elevation. No_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. No Any portion of a cesspool or privy is within a Zone 1 of a public well. _ _No Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ —No— Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] No (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ — the system is within 400 feet of a surface drinking water supply _ — the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:_120 Cricket Lane_ _North Andover_ Owner:_Gill Date of Inspection:_10/7/2005_ Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No Yes_ — Pumping information was provided by the owner,occupant,or Board of Health No_ Were any of the system components pumped out in the previous two weeks? Yes — Has the system received normal flows in the previous two week period? No Have large volumes of water been introduced to the system recently or as part of this inspection? Yes_ _ Were as built plans of the system obtained and examined? _Yes — Was the facility or dwelling inspected for signs of sewage back up? Yes _ Was the site inspected for signs of break out? _Yes_ _ Were all system components,excluding the SAS,located on site? _Yes_ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _Yes_ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no Yes _ Existing information. _YesDetermined in the field(if any of the failure criteria related to Part C is at issue approximation of distance_ _is unacceptable)[3 10 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:_120 Cricket Lane _North Andover— Owner:_Gill Date of Inspection:_10/7/2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_4_ Number of bedrooms(actual):_4 DESIGN flow based on 310 CMR 15.203 Number of current residents: Does residence have a garbage grinder(yes or no):—Yes_ Is laundry on a separate sewage system(yes or no): No_ Laundry system inspected(yes or no): _ Seasonal use:(yes or no):_No Water meter reading: Yes_ Sump pump(yes or no):_No Last date of occupancy:— Current-COMMERCIAL/INDUSTRIAL Type of establishment:_ Design flow(based on 310 CMR 15.203):___gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no):, Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information:_Never pumped,owner_ Was system pumped as part of the inspection(yes or no): Yes_ If yes,volume pumped:_1500_gallons--How was quantity pumped determined?_Measured tank Reason for pumping: _Inspect tank&tees_ TYPE OF SYSTEM _X_Septic tank,distribution box,soil absorption system Single cesspool T Overflow cesspool Privy _Shared system(Yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval _Other(describe):_ Approximate age of all components,date installed(if known)and source of information: 5 years old,5/24/2000, as built plan_ Were sewage odors detected when arriving at the site(yes or no): No Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_120 Cricket Lane_ _North Andover Owner:_Gill Date of Inspection:_10/7/2005_ BUILDING SEWER_X_ (locate on site plan) Depth below grade: 21 _ Materials of construction: _cast iron —X-40 PVC other Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.) 4"PVC thru wall to tank.3"PVC in house,no leaks visible_ SEPTIC TANKS: X Depth below grade:_1'_ Material of construction: X_concrete_metal_fiberglass polyethylene _other(explain) If tank is metal list age:, Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 10'x 5'x 4'_ Sludge depth2"_ Distance from top of sludge to bottom of outlet tee or baffle: 25"_ Scum thickness:_3" Distance from top of scum to top of outlet tee or baffle:_8" Distance from bottom of scum to bottom of outlet tee or baffie:_18"_ How were dimensions determined:_Tape Measure_ Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc. Pumped septic tank.Inlet tee ok.Outlet tee ok.Depth of liquid at outlet invert.No evidence of leakage._ GREASE TRAP:`(locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_120 Cricket Lane_ _North Andover_ Owner:_Gill Date of Inspection:_10/7/2005_ TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOXES: X Depth of liquid level above outlet invert: _0" Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.):–D-box level&distribution equal.No evidence of leakage. Evidence of carryover,pumped d-box to clean._ PUMP CHAMBER:_(locate on site plan) Pump in working order(yes or no):— Alarm in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_120 Cricket Lane_ _North Andover_ Owner:_Gill Date of Inspection:_10/7/2005_ SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ leaching chambers,number:— leaching galleries,number: _X leaching trenches,number,length: 2 Trenches 62'long_ leaching field,number,dimensions:— overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.):_Soil ok.Vegetation ok.No ponding to surface._ CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration:__ Depth—top of liquid to inlet invert:_ Depth of sludge layer: Depth of scum layer:_ Dimensions of cesspool: Materials of construction: _ Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):_ PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_120 Cricket Lane_ North Andover Owner:_Gill_ — Andover— Owner: of Inspection:_10/4/2005 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. House Garage Driveway A B Water Meter Septic D-Boxes A To Tank=30'1" A to D-Box=38' B to Tank=23' B to D-Box=25' Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_120 Cricket Lane_ _North Andover_ Owner:_Gill Date of Inspection:_10/7/2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water _4'_ Please indicate(check)all methods used to determine the high ground water elevation: X Obtained from system design plans on record-If checked,date of design plan reviewed:_8/11/1997_ Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain:_ Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation:_As per design plan_ TOWN OF SYSTEM PUMPING RECORD DATE: OCT 1 2 2005 TOWN OF NC`.;'N, -JVER HEALTH DF SYSTEM OWNER& ADDRESS SYSTEM LOCATION \ (example:left front of house) Lyse DATE OF PUMPING: — l —61�QUANTTTY PUMPED : 1 S�GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE �— EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACIOULD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER(EXPLAE-4) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: G.L.S.D Lowell Waste TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE: 5/31/00 This is to certify that the individual subsurface disposal system constructed (X) or repaired () by Tom Sawyer at Lot 8 (120) Cricket Lane has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Board of Health Inspector TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System constructed,- ( ) repaired: by 1 y6V, located at WT S was installed in conformance with the North Andover Board of Health approved plan, System Design Permit # , dated ' with an approved design flow of 6A40 gallons per day. The materials used were in conformance with those specified on the approved plan; the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As-built which has been submitted to the Board of Health. Bed inspection date: Engineer Rep sentative Final inspection date: Engineer Representative Installer: - Lic.#: //y-0 Date: .sem.?d-7090 Design Engineer: Date: . ��w 26 AS-BUILT CHECKLIST LOT NUMBER, STREET NAME ASSESSORS MAP &PARCEL NUMBER LOT LINES & LOCATION OF DWELLINGS LOCATIONS & DIMENSIONS OF SYSTEM, INCLUDING RESERVE TIES TO LOT LINES & DWELLING, WELLS a. FROM SEPTIC TANK / b. FROM LEACH AREA LOCATIONS OF DEEP HOLES &PERC TESTS ELEVATIONS OF DISPOSAL SYSTEM TOP OF FDN ELEVATION LOCATIONS OF WELLS, DRAINS, WATERCOURSES WITHIN 150' OF SYSTEM LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE X DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK&D-BOX ORIGINAL STAMP & SIGNATURE ✓ IMPERVIOUS AREAS - DRIVEWAYS, ETC. v NORTH ARROW LOCATION&ELEVATIONS OF BENCHMARK USED INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at 1,1,y relative to the application of dated /1?O/Gfi Zo for plans by and dated „J pTq g, with revisions dated — -�� I understand and agree to the following obligations for management of this project: 1. As the installer I am obligated to call for any and all inspections. If homeowner, contractor, project manger, or any other person not associated with my company schedules an inspection and the system is not ready then item two shall be applicable . 2. As the installer I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a $50.00 fine being levied against my company. a) Bottom of Bed—generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final Inspection—Engineer must first do their inspection for elevations,ties,etc. As-built or verbal OK from engineer must be submitted to BOH,after which installer calls for inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. c) Final Grade—Installer must request inspection when all grading is complete. Does not have to be on site. 3. As the installer I understand that persons or companies not associated with my company may not perform the work required by my company to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system, and/or revocation or suspension of my license in the Town of North Andover plus significant fines to all persons involved. 4. As the Installer I understand that I must be on site during the performance of the following construction steps: a) Determination that the proper elevation of the excavation has been reached. b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff. d) Installation of tank,D-box,pipes,stone,-vent,pump chamber,retaining wall and other components. 5. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor,or any other persons shall absolve me of this obligation. Undersigned Licensed Sep c Installer j' Date: /92 tG ' I 0 : ,� APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: f/Into. 1p Y : c ca CURRENT INSTALLER'S LICENS& -1 LOCATION: L,,, r i LLP �.0►..1 P LICEvSED L`tSTALLER. y fjArco S \ ,�IGNATUR.E: r TELEPHONE 5= S"II CHECK ONE: / REP. : NEW CONSTRUCTION: V IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only rf 5.00 Fee Attached? Yes � No Foundation As-Built? Yes—Z No F:cor P'.a.ns? Yes '� No Approval� �� , Date: �254—::Z�� *RI V Town of North Andover, Massachusetts F°""No.3 • NORTH BOARD OF HEALTH 49 FO F 4,;:0 .: �. DISPOSAL WORKS CONSTRUCTION PERMIT SSACHUSE Applicant NAME ADD SS TELEPHONE Site Location - Permission is hereby granted to Construct ( Or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. la 01—O1 a• ��7- O '-',f�9'�?'� �l��ply`.�• ✓�.... CHAIRMAN,BOARD OF HEALTH • l Fee �� D.W.C. No. FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. / APPLICANT FILLS OUT THIS SECTION******** APPLICANT Wa�iVa- IIJ CZ •6?1✓ ,L L C . PHONE 72 4� a- c?2,5'7 LOCATION: Assessor's Map Number,! �' PARCEL- SUBDIVISION W6= NGS, D( c LOT (S) STREET �2/�h G z(5z r✓e.- ST. NUMBER �z? OFFICIAL USE ONLY********'r**********�"`************** RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED P ItrSOE&ORTHEA H DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS -SEWER/WATER CONNECTIONS DRIVEWAY PERMIT `� (0 FIRE DEPARTMENT � i�� G� �i�C�' � C �FJ �,/?-�glllno RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 im L0+8 Town of North Andover - f NORTk OFFICE OF 3r° <"" °•do COMMUNITY DEVELOPMENT AND SERVICES ° . to It 27 Charles Street North Andover, Massachusetts 01845 `°q,r °•''`t� WILLIAM J. SCOTT 9SSACHus�t Director (978)688-9531 Fax (978)688-9542 March 25, 1999 Les Godin Merrimack Engineering 66 Park Street Andover, MA 01810 Re: Lots 1-10 Cricket Lane, North Andover Dear Sir: This letter will serve as your notification that the proposed septic plans for the lots specified above have been approved for dwellings with a maximum of nine (9) rooms. If you have any questions, please do not hesitate to contact this office. Very truly yours, Sandra Starr, Administrator SS/gb cc: Copley Development BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 February 25, 1997 North Andover Board of Health 146 Main Street North Andover, MA 01845 Dear Board Members, I, Veronica Mandry, give permission to employees and contractors of Copley Development Corporation of Methuen MA for various soils tests on land currently owned by me. It is understood that this testing will be performed before June 15, 1997 and that, after the tests, Copley Development Corporation shall return the property to its condition prior to the tests. Sincerely, Veronica Mandry 213 Summer Street North Andover, MA 01845 (508) 687-2926 °-d $ 1�5 � NORTH AAr Of 44�t° e.e SOL L ndaver A W n g Nor ot o EgVICES To�CE T AND E�LppNiEN les Street M�SSACHUS� �r COMMv l`ITY D 21 Chat assts 45 018 9542 Massachuset91 g)688- North Andover, Fax( J SCOTT I Wil Dl eY ctor (91 s)688-95'l February 25, 1999 LesG�a k Englneering I lvie 66 Park Street 01810 Andover,l Lots 1-10 Cricked-ane for the �' vstems propo$ed e septic Sys following reasons: Dear-�A Godin: t the ply's for the for the tha disapproved 1 ThiS is to inform d e have been i rn of 10 inches Walnut Ridg inim subdlVlSion of ending e minimum oVe the tees � (310 show the inlet tee eXt detail does not needs to be a 3 inch P The Septic tank d nor that there he septic systems. 310 C� below the flo`'',liana 15.227(�l) thin 7 5 feet of t CIv1R 15.22o(benchmarks shows'w1 1 There are n 15.220(q)) for Lot 1. (310 CMR An addition, A 8.02}) 'Nall ale missing are not show11 retaining fications for the proposed Abutters' names 'Oesign speer I 15.255(2))• to be located in the 1 chamber is not specified as For Lot I. for the pump e water 231(9)) 310 CMR 15'255(2)) at mirnrn�l abaffl The high ° and consider a Lot 4. � of$�° aired from will be in excess please house. (310 ent is req ower trenches 15.232(3)(x)) em wo l es. slope lop of the twose the velocity. (e�0 C er trench I The ecrea e high end of th IS required to d velocity reducer at th 9540 PLANNIN O 689-9838 iiEALTIi 688- CONSERVATION �---- -� B�LDINc* 688-9545 688-9530 - _ - - ----- BOARD OF APPEALS 688-9541 Lot 4: • Please note that the septic tank is drafted incorrectly. Lot 5 and Lot 6: • Scale of the Plan view is not shown. Lot 7: • The scale of the Plan view is not shown. • Pump Note #4 neglects to state that the high water alarm is to be located in the house. (3 10 CMR 15.231(9)). Lot 8: • The estimated seasonal high water elevation-has not been adjusted to the highest existing grade. This results in the leaching area being less than 4 feet to groundwater. (31 0 C'NIR 15.212 a&b). Lot 9: • Slope easement required from Lot 10. (3 10 CMR 15.255(2)) • Slope to d-box exceeds 8%, therefore, at minimum, a baffle is required. (310 CMR 15.232(3)(a)) Lot 10: • Fill around system runs to property line of abutter. Toe of slope required to be 5 feet off the lot line. (3 10 CMR 15.255(2)) • Trenches #1 and#1 do not show 4 foot separation to groundwater. (3 10 CMR 15.212 a& b). Please feel free to call the Health Office with any questions you may have. Sincerely, Sandra Starr,R.S. Health Administrator Cc: W. Scott File Mar-23-99 10:26A Paul D. Tui-bide, PE/PLS 508-465-0313 P_05 March 22, 1999 Sandra Starr North Andover Board of Health Administrator Office of Community Development and Services 30 School St. North Andover,MA 01845 RE: Title V second review for.Lot 8 Cricket Lane Dear Sandra, I find that all the concerns outlined in my report of February 5, 1999 have been addressed except the following: • 310 CMR 24 7(2) states that for a minimum of 2" of 1/8 to Yz inch stone is to be placed on the top of the leaching bed. The plan design calls for a layer of filter fabric to be laid on top this stone. There is no regulation that I could find that allows filter fabric to be laid over the peastone, and therefore I would recommend that the filter fabric be removed from the design. If you have any questions or comments please feel free to contact me. Sincerely Carlton Town,PE/PLS PORTit it ENGINEERING Civil Engineers& land Surveyors One Harris Street Newburyport,MA 01950 (978)465-8594 L Feb-05-99 O9:38A Paul D. Tuvbide, PE/PLS 508-465-0313 P.O6 February 5, 199-9- Sandra 999Sandra Starr North Andover Board of Health Administrator Of rice of Com alunity Development and ScPwic es 30 School St. f� North Andover,Mtn u 1945 I RE: Title V review for Lot 8 Cricket Lane Desr Sandra; Enclosed find the"Checklist for North Andovet Septic System.Plans" for the above- mentioned site. TIM following is a list of all the `Problern' areas and deficiencies Port Engineering has%u d. • the estimated seasonal high water elevation nes not been adjust i tv the high st existing grade. The highest existing grade under the proposed ieaching trenches is scaled on the plan as 197'. If ESHW is assumed to be 36 inches(from the closest Test Pit,#112)below this,then ESHW elevation would be 194'. The elevation shown on the design plans is 2.6 feet lower than this(design plans show ESHW at 191.4'). • -11.0 Cts 247(2)states that for a m;nilnum of 2" of 1/8 to 1/2 inch stone is to be plated on the top of the leaching bed. The plan design calls for a layer of filter fabric to be laid on tap this stone. There is no regulation that 1 could find that allows filter fabric to be laid over the pea tone, and therefore I wvald re:,cmn;€end that the filter fabric be removed from the design. • The septic tank detail should show that the inlet tee is to extend a minimum of 10 inches below the flow line(227(6)), and that there is to be a 3 inch air space above the inlet and outlet tees(227(4)). • Note 13 states that benchmarks are to be placed within 75 feet of the disposal area before construction. A condition of approval of this design should be that the benchmark will be set as noted. i If you have any questions or comments please iecl free to contact i<ie. Sincerely �fA POIFT; Carlton A.Brown,PE/PLS INGINFEB1NG Civil Enginters& Land Surveyors One iat':ia Suet. Ne.burypert,MA. 01950 (978)465.8594 I� I � LJ INVERT ELEVATIONS BUILDING TIES 4" PIPE @ FDTN. = 200.95 BUILDING CORNER A B SEPTIC TANK IN = 200.47 SEPTIC TANK 16.2' 23' SEPTIC TANK OUT = 200.36 PUMP TANK — _ PUMP TANK IN = — DIST. BOX 25.0' 25.0' PUMP TANK OUT = — CORN. LEACH FIELD 1 28.0 21.5 DIST. OX IN = 200.12 CORN. LEACH FIELD 2 88.5' 80.0' DIST. BOX OUT = 199.92 1 = 199.44 CORN. LEACH FIELD 3 87.3' 82.7' END LEACH LINE CORN. LEACH FIELD 4 25.0' 31 .0' END LEACH LINE 2 _ 199.44 END LEACH LINE 3 — END LEACH LINE 43 = — o, � `O ROOF \ \ �Rq/NgGE FNDTN. 1 LEACH DPITIN DRAIN OUTLET i DRAIN INV=188.0± ANT LOT #8 46,884 F. G -.. DECK � I 31.8 2-112 STORY -, ..b�• W.F.D. \4 ` 4 BDRM. B.M. TOP FNDN.=203.86' ` 0.9',,ti ~ B PORCH N �► 000 NC. WALK 3' O I 1500 GAL. _,t, 1_•.. ,"..,, . I .. SEPTIC I Q X41 TANK O \\ ` D—BOX \ \ TR # TR #2 V i Q Gj VENT •,, cn Q 1 I �� \ Q 2 LEACHING TRENCHES 2'W x 2'D x 62'L \ 15' W WA TERMAIN cn W � —L—A NE AS— BUILT o OF r SUBSURFACE DISPOSAL SYSTEM LOCATED IN NORTH ANDOVER, MA. I AS PREPARED FOR iNOFMgs COPLEY DEVELOPMENT s9°yam s DANJEL m 50 COPLEY DRIVE N�CIVILos METHUEN, MA. 01844 °•37752 n SCALE: 1"=20' A�b, �rsYEP / `LJ sr m DATE: MAY 24; 2000 Y, 2 SUBDIVISION LOT #8 CRICKET LANE _ MERRIMACK ENGINEERING SERVICES �_ -- PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS - - 66 PARK STREET • ANDOVER, MASSACHUSETTS 01810 • TEL (978) 475-3555• FAX (978) 475-1448 l »OR71y Of „1O ,ti0 BOARD OF HEALTH n 146 MAIN STREET TEL. 688-9 540 cmuS�` NORTH ANDOVER, MASS. 01845 APPLICATION FOR SOIL TESTS DATE: G"— 2 — 97 LOCATION OF SOIL TESTS: sit �,�, ¢rt, T, C/,// zaf) Assessor's map & parcel number: MQ,o jr,, ',,,, e js j8,' 4S; 1(�c OWNER: ye C-' OU TEL. NO.: ADDRESS. 213 S« m e S % �oizT� �a✓�� ENGINEEREL. NO.: CERTIFIED SOIL EVALUATOR: Imo, //,r.,,7 .0" Intended use of land: residential subdivision, single family home, commercial )(Fe's THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of$175.00 per lot for new construction. This covers the two deep holes and two percolation tests required for each lot. Fee of$75.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Town of North Andover, Massachusetts Form No. 1 NORTH A BOARD OF HEALTH 01�"ED �6�'VO "6 0� 19 0 APPLICATION FOR SITE TESTING/INSPECTION ��SSACHUs��y Applicant NAME ADDRESS TELEPHONE Site Location Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH°c °��tLED '660 �'y`"'� 190 6 o ., A APPLICATION FOR SITE TESTING/INSPECTION ��SSACHUS��S Applicant NAME ADDRESS TELEPHONE Site Location "SIX P 2 ySi Engineer`-"1 A � �-��1��-� �p J4(' NAME UADDRESS TELEPHONE Test/Inspection Date and Time 4t)n IV CHAIRMAN,BOARD OF HEALTH Fee Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No.� ^1 r'�wf�A�S V February 25, 1997 North Andover Board of Health 146 Main Street North Andover, MA 01845 Dear Board Members, I, Veronica Mandry, give permission to employees and contractors of Copley Development Corporation of Methuen MA for various soils tests on land currently owned by me. It is understood that this testing will be performed before June 15, 1997 and that, after the tests, Copley Development Corporation shall return the property to its condition prior to the tests. Sincerely, Veronica Mandry 213 Summer Street v North Andover, MA 01845 (508) 687-2926 Town of North Andover E NORTH OFFICE OF 3�0 4t,,to �O L COMMUNITY DEVELOPMENT AND SERVICES p 27 Charles Street North Andover, Massachusetts 01845 �9Sof AT*OEt�y WILLIAM J. SCOTTSACHUS Director (978)688-9531 Fax (978)688-9542 February 25, 1999 Les Godin Merrimack Engineering 66 Park Street Andover, MA 01810 RE: Lots I-10 Cricket Lane Dear Mr. Godin: This is to inform you that the plans for the septic systems proposed for the subdivision of Walnut Ridge have been disapproved for the following reasons: • The septic tank detail does not show the inlet tee extending a minimum of 10 inches below the flow line, nor that there needs to be a 3 inch space above the tees. (3 10 CMR 15.227(6) and 15.227(4)). • There are no benchmarks shown within 75 feet of the septic systems. (3 10 CMR 15.220(q)). In addition, for Lot 1: • Abutters' names are not shown. (NA 8.02j) • Design specifications for the proposed retaining wall are missing. (3 10 CMR 15.255(2)). For Lot 3: • The high water alarm for the pump chamber is not specified as to be located in the house. (3 10 CMR 15.231(9)) • Slope easement is required from Lot 4. (3 10 CMR 15.255(2)) • The slope of the two lower trenches will be in excess of 8% and at minimum a baffle is required to decrease the velocity. (3 10 CMR 15.232(3)(a)) Please consider a velocity reducer at the high end of the two lower trenches. BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 ; w Lot 4: • Please note that the septic tank is drafted incorrectly. Lot 5 and Lot 6: • Scale of the Plan view is not shown. Lot 7: • The scale of the Plan view is not shown. • Pump Note#4 neglects to state that the high water alarm is to be located in the house. (3 10 CMR 15.231(9)). Lot 8: • The estimated seasonal high water elevation-has not been adjusted to the highest existing grade. This results in the leaching area being less than 4 feet to groundwater. (3?0 CMR 15.212 a&b). Lot 9: • Slope easement required from Lot 10. (3 10 CMR 15.255(2)) • Slope to d-box exceeds 8%, therefore, at minimum, a baffle is required. (3 10 CMR 15.232(3)(a)) Lot 10: • Fill around system runs to property line of abutter. Toe of slope required to be 5 feet off the lot line. (3 10 CMR 15.255(2)) • Trenches#1 and#1 do not show 4 foot separation to groundwater. (3 10 CMR 15.212 a& b). Please feel free to call the Health Office with any questions you may have. Sincerely, Sandra Starr,R.S. Health Administrator Cc: W. Scott File Mar-23-99 10:26A Paul D_ Tuvbide, PE/PLS 508-465-0313 P_05 All March 22, 1999 Sandra Starr North Andover Board of Health Administrator Office of Community Development and Services 30 School St. North Andover,MA 01845 RE: Title V second review for Lot 8 Cricket Lane > Dear Sandra, I find that all the concerns outlined in my report of February 5, 1999 have been addressed except the following: 310 CMR 24 7(2)states that for a minimum of 2" of 1!8 to t/z inch stone is to be placed on the top of the leaching bed. The plan design calls for a layer of filter fabric to be laid on top this stone. There is no regulation that I could find that allows filter fabric to be laid over the peastone, and therefore I would recommend that the filter fabric be removed from the design. If you have any questions or comments please feet free to contact me. Sincerely Carlton Town/,JPE/PLS P011Titi ENGINEERING Civil Engineers& Lend Surveyors One Harris Street Newburyport,MA 01950 (978)465-8594 L Feb-05-99 O9:38A Paul D. Turbide, PE/PLS 508-465-0313 P.O6 February 5, 1999 r,.„A C Sa ura utc t'1 14otiii Andover Board of Health Administrator Office of Ct mn-tunity Development grid SO-vices 30 School St. North Andover,MA 01845 RE: Title V review for Lot 8 Cricket Lane Dear Sandra. F*sclos d find the"Checklist for Forth Ardover Septic System Plans”for the above- me,n tivrned- site. The following s a list of all the`Problem' areas and deficiencies Port Engiucering;has found. The estimated seasonal high water elevation has not been 4usted to the highest existing grade. The highest existing grade under the proposed leaching trenches is scaled on the plan as 197'. If ESHW is assumed to be 36 inches(from the closest Test Pit,9112)below this,then ESHW elevation would be 194'. The elevation shown on the design plans is 2.6 feet lower than this(design plans show ESHW at 191.4'). 310 CM—R-247(2)states that for a m-Mumum of 2" of 1/8 to 1/2 inch stone is to be placed on the tap of the 1r chicia bed. The plan design calls for a layer of filter abrc to be lard on top t,11J stoi=f`. 7'. ere 1S nC regulation.0-11=jld find that allows filter fabric to be laid over the pcaStone, and therefore;wovlu rewir. nd that the filter fabric be removed from the design. The septic tank detail should show that the inlet tee is to extend a minimum of 10 inches below the flow line(227(6)), and that there is to be a 3 inch air space above the inlet and outlet tees(227(4)). • Note 13 states that benchmarks are to be placed within 75 feet of the disposal area before construction. A condition of approval of this design should be that the vencl.*riark will be set as noted. If you nave any questions or commenis please feel free to wntact rite. Sincerely PO!FT Carlton A.Brown,PE/PLS ENGINFIRIE Civil Enginters& Land Surveyors One Harria Street Newburyport,MA 01950 (978)465.8594 FORM 11 - SO11L EVALUATOR FORT%i Page 1 rjD ,Atq....lj� No....................................... TOWN 0 NORTH ANqQ OQV�ER Commonwealth of Massachusetts BOARD OF HEALTH-I W9114 Awwvr--R , Massachusetts 2 61999 0 'I SuitaNjIty e t r 0 Assess Do Performed By: ....Wj.LLI.A.M........DUFSW-S................ Witnessed By: ................. .............................................................................................................. ................................................................................................................................... tAndon Address or oww's Hm. L-AWE. Ad m. wo SZ> C-10KE-( Tekphm 0 HCST14 V e-NJ A 044 New construction Repair El Office Review Published Soil Survey Available: No ❑ Yes Year Published ... Publication Scale .11-157940 Soil Map Unit Drainage Class .....f............ Soil Limitations ........".RA9?n61.'.F.................................................***'**( ............... Surficial Geologic Report Available: No ❑ Yes El Year Published Publication Scale .................. GeologicMaterial (Map Unit) 7777777.............................................................................................................................. Landform ............................................................................................................................................................................................................. Flood Insurance Rate Map: 2500616 � L � <��2`�J Above 500Y ear flood boundary No ❑ Yes Within 500 year flood boundary No Yes ❑ Within 100 year flood boundary No Yes El Wetland Area: National Wetland Inventory Map (map unit) ........0. J...... ................ Wetlands Conservancy Program Map (map unit)....................................................................................I.............. Current Water Resource Conditions (USGS): Month NV.605T- Range Above Normal Elormal I Below Normal ❑ UASsuMED Other References Reviewed: . V.S- 6.S A P-S - FORM 11 - SOIL EVALUATOR FORM Page 2 On-site Review Deep Hole Number Date: Time: Weather Location (identify on site plan) .....�VT. .......D... r..1.M: v.Z........ ......P.4. A J�.j................................................ Land Use Slope M Surface Stones .... I k4y.. ....................................................... Vegetation ....W-0 D.EFZ................................................................................................................................................................................................. Landform ......maizAtwF:................................................................................................................................................................................................. Positionon landscape (sketch.on the back) ......................................................................................................................................................... Distances from: Open Water Body .......1.00 iteet Drainage way...1.0.0.-.t feet Possible Wet Area .....IXt feet Property Line ......1.P......+... feet Drinking Water Well J.0ot feet Other ..................................... DEEP OBSERVATION HOLE LOG Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other (Inches) (USDA) (Munsell) (Structure,Stones,Boulders, Consistency, %Gravel) Ap (C 2,di) 6'4 A SYLI C-f-, ------------- V.4eAW,L,S- k'" 100 C-7- -Z,S;,t�;jL( '-7.Y-(l S�j 6 0"Yo A m G. <, (!�N iO I Parent Material (geologic) .................................................. Depth to Bedrock: ............ pe3th to Groundwater: Standing Water in the Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water: Lo N b 4r FORM 11 - SOIL EVALUATOR FORM Page 3 Determination for SeasoRd-Hj9 Water Table Method Used. ❑ Depth observed standing in observation hole......`... inches ❑ D pth weeping from side of observation hole inches Depth to soil mottles .�. inches ❑ Ground water adjustment feet .. Index Well Number . Reading Date Index well level ................. Adjustment factor Adjusted ground water level .............. Death of Naturally Occurring Per yon s Material Does at least four feet of naturally occurring pervious material exist in all.areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious materiel? Certification I certify that on l (date) I have passed the examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent.with the required training, expertise and experience described in 310 CMR 15.017. Signature _ Date ' —�— FORNI 12 - PERCOLATION TEST COMMONWEALTH OF MASSACHUSETTS Woe'rk AJWVaE , Massachusetts Percolation Test Date: .... .-.�..�(.�.c�. Time: ... .................... Observation Hole # --------------- � I Depth of Perc ZI C� -f-2c• = �C ��'� -1- Start Pre-soak3'C 3= 0 ) End Pre-soak 3-kI (� Y Time at 12" r 3 =Time 9" ZL- � z2 Time at 6" 3` 30 Time (9"-6") 6 Rate Min./Inch , Site Passed Site Failed ❑ Performed By: Witnessed By: Comments: ............................... .................... ........................................................................................................................................ SEPTIC PLAN SUBMITTAL FORM LOCATION: 607- A; e Eie,k.6 I I-Ali (I.cJIaL�LIu f ��Y�� S�y@t7� NEW PLANS: YES $125.00/Plan ►� REVISED PLANS: YES $ 60.00/Plan SITE EVALUATION FORMS INCLUDED: YES NO r roe"' `�NORTH ANDOVER/ BOARD OF HEALTH DATE: �— ZS--`�� EJAA 6 1999 e DESIGN ENGINEER: h--IA 6L �u�a, Sf✓�y�Gl✓ _ DATE TO CONSULTANT: 02// *If you want your plans expedited, please submit four plans and included a stamped envelope with the correct amount of postage to mail plans to Port Engineering. When the submission is all in place, route to the Health Secretary. : Town of North Andover, Massachusetts Form No.s f MORT h BOARD OF HEALTH19 O � r p t Vii # DESIGN APPROVAL FOR ,SSACMUSEt� SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM • Applicant. ��l`)/�� Test No. 77� Site LocationZ-67— Reference -6TReference Plans and Specs. 11 6:,,-e 2lmwe_- ENGINEER DESIGN ' DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. CHAIR AN,BOA RO OF HEALTH : Fee Site System Permit No. /G�9 SEPTIC PLAN SUBMITTAL FORM a LOCATION:LoT O f fl e Kyr Z A AJ>✓- NEW PLANS: YES $125.00/Plan REVISED PLANS: YES $ 60.00/Plan SITE EVALUATION FORMS INCLUDED: YES NO DATE: 3 - l I—6 DESIGN ENGINEER: b f5M l M A G k—" F514 04 05,Z1" DATE TO CONSULTANT: v �� *If you want your plans expedited, please submit four plans and included a stamped envelope with the correct amount of postage to mail plans to Port Engineering. When the submission is all in place, route to the Health Secretary. i i i NORTH To ..'r:, , ofAndover 0 o dover, Mass.,_/v COC MIC ME WICK C� �1 ADRATED P � S BOARD OF HEALTH PERM T T D Food/Kitchen Septic SystemJ� THIS CERTIFIES THAT... �4� V .......A.� ..e• . ��' � � � BUILDING INSPECTOR Foundation has permission to erect...............I..................... buildings on .A.0*....�'....4..f 070....jc .!I c kw 1* ',*1A"C Rough ��/1�1�I��''�3/zb V0 CC.— tobe occupied as....a..............:......... ../.� A.-A3.40.. ......3....4.....................A.. ............................! I v provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. bough (4 -1611 3 $ PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION TART k2�� ELE ICAL INSPECTOR ............................ ... ........IN ... .. 11 • BUILDING INSPECTOR Fl s �37v Occupancy Permit Required to Occupy Building GAS IN VJffQR ugh J Display in a Conspicuous Place on the Premises — Do Not Remove ,Roo 0 c. No Lathing or Dry Wall To Be Done FIRE PARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. f�J� l 7-e,el SEE REVERSE SIDE smoke Det, 7 Address Title of File Pageof Date File Open: Date file Closed: Doc Document/Action Title Date of ' action �tefer to other Purpo fpseocume t� /Action end notes fWum. Docu°ment/ document/ -- Action De artment Board of Appeals — Board of Health Planning Board ; Cons ervatiion Commission - Building pepartm, eR,t ---__ Summary Record Card generated on 10/7/2005 10:59:05 AM by Lisa Warren Page 1 Town of North Andover Tax Map # 210-107.A-0288-0000.0 120 CRICKET LANE NORM GILL 120 CRICKET LANE NORTH ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Size Total 1.07 Acres FY 2006 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until NORM GILL Owner 120 CRICKET LANE NORTH ANDOVER, MA 01845 PETTAKELLI, RON Payor 120 CRICKET LANE NORTH ANDOVER, MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 13875.0- 120 CRICKET LANE Last Billing Date 8/31/2005 2100705 02 Cycle 02 Active UB Services Maint. Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 1 1 9.18 1/ WTR WATER 01 ALL METER SIZE 183.56 /1 UB Meter Maintenance Serial No Status Location Brand Type Size YTD Cons 16106713 a Active ERT METE METE w Water 1 1 0 Date Reading Code Consumption Posted Date Variance 8/4/2005 706 a Actual 42 9/12/2005 45% 5/3/2005 664 a Actual 24 6/8/2005 -1% 2/15/2005 640 a Actual 29 3/15/2005 -51% 11/15/2004 611 a Actual 58 12/17/2004 -21% 8/16/2004 553 a Actual 73 9/20/2004 149% 5/17/2004 480 a Actual 29 6/14/2004 -7% 2/17/2004 451 a Actual 33 4/16/2004 0% 11/14/2003 418 n New Meter 0 11/14/2003 0% Curran, Bernadette From: Rubina Hendley[rubinahendley@yahoo.com] Sent: Sunday, January 06, 2008 4:04 AM To: cdoherty@andoverliving.com Cc: Santilli, Ray; Daley, Lincoln; Hmurciak, Bill; Curran, Bernadette Subject: [BULK] 120 Cricket Ln, NA Importance: Low Dear Mr Doherty, As displayed above, I have copied this communication to various departments at the Town of North Andover, for reasons that will become evident below. I am co-owner, with my husband Willis, of 101 Cricket Ln, which is the pale grey house diagonally across from 4120. Our home, as well as#120, is part of the Walnut Ridge subdivision. I wish to make you aware of a potentially serious problem at#120 that appears to have put a cloud on the title to thatproperty, of which I believe you(or the homeowners)may not be aware. It is similar to a problem that. occurred at our property, that affected not just us, but also the homeowner adjacent to � us at#115 and cost both sets of homeowners (via our respective RE attorneys) considerable expense and inconvenience to correct. The primary culprits (sadly, there is no better way to describe them) involved in this mess that we faced include the Town of North Andover, the developer(s) of the subdivision, and the land engineers for the subdivision. I have decided to bring the situation to your attention as a result of a series of events over a period of five years that recently culminated in a prospective buyer directly asking me i f I was aware ofa m y problem" with#120. I answered in the affirmative, and whether or not you have a personal or business relationship with any of the public or private entities involved, you and the homeowners,to whom you owe a fiduciary duty, need to know. The situation at#120 has remained both unaddressed, uncorrected, AND concealed for long enough, despite the fact we have alerted officials within the town on numerous occasions both verbally and in writing. Ours were not mere unsupported allegations; they were backed up with full support from documents from the public record for this subdivision, as well as relevant state/local regulations, and confirmed to us by numerous respected RE attorneys, including that for the homeowner who recently contacted me; as well as by other land engineers. Recently, we had two prospective buyers contact us (by initially knocking on our door)regarding properties that are currently for sale in the newer end of our street. Both buyers asked if we would be willing to talk to them about the neighborhood, and we let them know we would be glad to let them have our impressions. One of these buyers was interested in #93 (adjacent to our house), and spoke with my husband; the second in#120, who spoke with me. This latter buyer informed me he had "heard" we had had "problems"that the town had made us correct, at which point I informed him I was only willing to talk to him if he allowed me to place the whole trauma we endured into context, and not based on any gossip, nor piecemeal information he had received. He indicated he was willing to do this because, as he informed me, he wondered why there were three properties (#93,#120, and#144) all remaining unsold for many months in our street, that he did not believe was just due to a depressed market. I informed him that although there were homeowners with potential serious uncorrected problems in the subdivision, our investigations had revealed that#93 and #144 did not appear to be affected, but that#120 was. i I also detailed how unconscionable events within the town(documented incompetence, documented negligence, and our direct exposure to serious ethical misconduct)prevented us from occupying our property for five years, during which we also discovered the town's failure to act upon potentially serious deviations from approved plans/regulations adversely affected other homeowners in this subdivision, of which the developer(s) and various licensed contractors, including the land engineers, are also aware. To cut a long story short, this is the source of the problem that we believe still exists at 4120: it involves the septic system grading easement appurtenant to 4110 that is located on#120. Reasons for the problem: 1. This septic easement is deeded for use by#110 in connection with the installation,repair, and maintenance of the septic system located on#110, and associated grading and re-grading, which may involve the addition and/or movement of soil; 2. A large portion of this septic easement falls right over the existing driveway for 4120; 3. Since#110 is at a considerably higher elevation than#120, use of the septic easement as deeded could result in a significant section of the driveway for #120 being submerged/altered,thus making the current access to the garage(s) restricted, or inaccessible; 4. The septic easement for#110, as well as for other properties in Walnut Ridge, were recorded at Northern Essex Registry of Deeds, Plan#13636; this plan being a bare-bones one depicting lot lines and easement locations only, and conveniently excluded actual structures (such as houses, driveways) on any of the lots; 5. It was mandatory for these septic easements to be disclosed and depicted on the Definitive Plan (and other required plans) submitted for evaluation at the pre-approval stage for this subdivision---for obvious reasons that I will not labor to explain; 6. 5 above was never done by the developer(s), nor their land engineers; 7. Various town depts were aware of the existence of these septic easements, but none questioned why they did not appear on the Definitive Plan; 8. Construction then proceeded at all lots; 9. Numerous septic easements became compromised as a result of ostensibly permanent structures being located on them; 10. Numerous other significant deviations from the so-called approved plans occurred, such as those involving elevations and locations of structures; 11. Numerous significant deviations from accepted land(and septic) engineering practice also occurred; 12. The land engineers, and other licensed contractors, had a professional responsibility to inform/alert various town officials of significant deviations, but there is no public record for many (if not most) of the significant deviations that occurred(however, we directly learnt that one significant deviation reported to a senior official at the town was concealed by this official); 13. Town officials had a responsibility to ensure the developer(s) and other licensed parties followed approved plans (even though the so-called approved plans were fundamentally flawed by the omission of the septic easements), but instead allowed various significant deviations to remain unaddressed and uncorrected; 14. Town officials were supposed to remain impartial and objective, but we have personal experience and evidence of bias and favoritism towards the developer(s) in particular•, 15. We have informed countless officials at the town specifically with regard to the non-disclosure of these easements, and of their being compromised thereafter, but have never received any acknowledgment of any kind to our concerns; these officials included Ms Rosemary Smedile,the Town Manager's office, the former Director of Community Development, various former Directors of Planning, the former Chairman of the Planning Board,the former Building Inspectors, DPW, Health, and Conservation. 2 This communication to you has been at great personal expense to me, since I, more so than my husband, have suffered considerable retaliation at town level. This will, no doubt, continue to be the case, but I remain undaunted. In conclusion, I am glad to report there have been some personnel changes for the better within the town. If you care to follow up the situation at#120, 1 recommend speaking to the new head of the Building dept, Mr Brown, whom I have found to be professional, and considerate. Sincerely, Rubina Hendley Never miss a thing. Make Yahoo your homepage 3 Commonwealth of Massachusetts Form 4--System Pumping Record Massachusetts System Pumping Record F, RECEIVED 4006 System Owner rti i t p. r., i : r.r, System Location TOWN OF NORTH LVER HEALTH DEPART r. � }. ry r .r. � � i�t� rrlC ' �: ,I ! tr r.l 't.r �� 1, ;r• .`r Type: Emergency Routine Cesspool: No Yes Septic Tank: No Yes Date of Pumping: Quantity Pumped: /50 Gallons System Pumped By: Wind River Environmental,LLC Permit#: Contents Transferred to: Contents Disposed at: East Fitchburg Waste Water Plant, IVIA- Date: Pumper Signature: Condition of System/Other Comments Dep Approved Form-12/07/95 IMPORTANT MESSAGE For Day Time P.M. Mt1 Phone FAX Area Code Number Extension MOBILE Area Code Number Extension Telephoned Returned your call RUSH I Came to see you Please call Special attention Wants to see you Will call again Caller on hold Message 112 Ile M E'ss, Signed vniversal-48023 LITHO IN U.S.A. / 'o (�g M h,Iz- s - i