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HomeMy WebLinkAboutMiscellaneous - 120 GRANVILLE LANE 4/30/2018 r Y 120 GRANVILLE LANE 210/106.C-0072-0000.0 w { Residential Property Record Card PARCEL ID:210/106.C-0072-0000.0 MAPA06.0 BLOCK:0072 LOT:0000.0 PARCEL ADDRESS:120 GRANVILLE LANE PARCEL INFORMATION Use-Code: 101 Sale Price: 220,500 Book: 03869 Road Type: T Inspect Date: 12/15/2002 Tax Class: T Sale Date: 10/21/1993 Page: 0296 Rd Condition: P Meas Date: 12/15/2002 Owner: Tot Fin Area: 2578 Sale Type: P Cert/Doc: Traffic: M Entrance: X GALVIN, PETER D Tot Land Area: 1 Sale Valid: Y Water: Collect Id: RRC SHIRLEY A GALVIN Grantor: WILLER,WERNER Sewer: Inspect Reas: C Address: 120 GRANVILLE LANE Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LOM Indust-B/L% 0/0 Open Sp-B/L% 0/0 NORTH ANDOVER MA 01845 RESIDENCE INFORMATION LAND INFORMATION Style: CP Tot Rooms: 6 Main Fn Area: 2067 Attic: Y NBHD CODE: 6 NBHD CLASS:.6 ZONE: R2 Story Height: 1.5 Bedrooms: 3 Up Fn Area: 511 Bsmt Area: 240 Seg Type Code Method Sq-Ft Acres Influ-Y/N Value Class Roof: G Full Baths: 1 Add Fn Area: Fn Bsmt Area: 1 P 101 S 43560 1 209,959 Ext Wall: WS Half Baths: 1 Unfin Area: Bsmt Grade: VALUATION INFORMATION Masonry Trim: Ext Bath Fix: Tot Fin Area: 2578 Current Total: 497,600 Bldg: 287,600 Land: 210,000 MktLnd: 210,000 Foundation: CN Bath Qual: T RCNLD: 239698 Prior Total: 438,300 Bldg: 244,000 Land: 194,300 MktLnd: 194,300 Kitch Qual: T Eff Yr Built: 1980 Mkt Adj: 1.2 Heat Type: HW Ext Kitch: Year Built: 1978 Sound Value: Fuel Type: G Grade: G Cost Bldg: 287,600 Fireplace: 1 Bsmt Gar Cap: Condition: A Att Str Vail: Central AC: N Bsmt Gar SF: Pct Complete: Att Str Va12: Att Gar SF: %Good P/F/E/R: /100/100/87 Porch Tvoe Porch Area Porch Grade Factor E 168 P 56 W 216 SKETCH PHOTO 6 W 12 BM( 240 Sq..5 10 2 6 Sq R. Picture 0.5 FM R. 2082 Sq.R. 1�6 Sc 41l, 3� I 33 z3 552 Sq.R. 23 6 Asub. 2431 1 AV'Em itabiqu Parcel ID:210/106.C-0072-0000.0 as of 7/20/06 Page 1 of 1 Commonwealth of Massachusetts City/Town of System Pumping-Record Form 4 DEP has provided this forfn for use-,by local Boards of Health. Other forms may be used,but the information must be substantially the same as that provided here. Before using-this form,check with your local Board of Health to determine the form they use.The System_ Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left/Right front of house, Left/Right rear of house,rightIde of hous , Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under e Address4 1 o r/ � � A l City/Town W V` state ��f Zip Code 2. System Owner. Name Address(if different Cityfrown APR NOR TM pNpOVER HF1�lTH©EPARTMENT TOWN J Telephone Number r 3 . B. Pumping Record _ 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes LSO If yes,was it cleaned? ❑ Yes ❑ Na 5. Condition of System: _ Q 6. System Pumped By. Neil.Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Lo re contents were disposed: Lowell Waste Water Sin Haul 9 Date t6form4.doc-06/03 System Pumping Record•Page 1 of 1 r 7 650 Of NO oTM,'Y �.J / � S Town of North Andover �`�'• �� HEALTH DEPARTMENT ,SSAC NUSt1 CHECK#: 1 DATE: _5 3 LOCATION: Aranvilli I n , H/0 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 $ 0 Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ Title 5 Report $� ❑ Other. (Indicate) $ Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer Commonwealth of Massachusetts Title 5 Official Inspection Form • Subsurface Sewage Disposal System Form-Not for Voluntary Assessments v ( 120 Granville Lane v Property Address Mike McGone al �J iisOwner tion Owner's Name required for North Andover MA 01845 5/21/2013 every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important` A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Neil J. Bateson cursor-do not Name of Inspector use the return key. Bateson Enterprises Inc. Company Name 111 Argilla Road Company Address Andover MA 01810 City/Town State ��CEe 978-475-4786 S115 Telephone Number License Number MAY 2 B. Certification TOWN OF NORTH AP�UJVER HEALTH DEPARTMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ e Further Evaluation by the Local Approving Authority 5/21/2013 Inspecto s signatLW Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 i I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments V rV 120 Granville Lane Property Address Mike McGonegal Owner Owner's Name information is required for North Andover MA 01845 5/21/2013 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 120 Granville Lane Property Address Mike McGonegal Owner Owner's Name information is required for North Andover MA 01845 5/21/2013 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 120 Granville Lane Property Address Mike McGonegal Owner Owner's Name information is required for North Andover MA 01845 5/21/2013 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: '*This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 1 , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 120 Granville Lane Property Address Mike McGonegal Owner Owner's Name information is required for North Andover MA 01845 5/21/2013 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. t5ins•3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 120 Granville Lane j Property Address Mike McGonegal Owner Owner's Name information is required for North Andover MA 01845 5/21/2013 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 450 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 120 Granville Lane Property Address Mike McGonegal Owner Owner's Name information is required for North Andover MA 01845 5/21/2013 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d Yes 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Current 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: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments i 120 Granville Lane Property Address Mike McGonegal Owner Owner's Name information is required for North Andover MA 01845 5/21/2013 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Pumed 2011, owner Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1000 gallons How was quantity pumped determined? Measured tank Reason for pumping: Inspect tank&tees Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments I 120 Granville Lane Property Address Mike McGonegal Owner Owner's Name information is required for North Andover MA 01845 5/21/2013 j every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 36 years old, tank& pits, 10/15/1977, as built plan, d-box&outlet tee in septic tank was replaced 2006, Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): 3"Cast iron through floor. 3" PVC in house, no leaks visible. Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Tx 5'x 4' Sludge depth: 4" t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts mp Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 120 Granville Lane Property Address Mike McGonegal Owner Owners Name information is required for North Andover MA 01845 5/21/2013 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 23 Scum thickness 4" Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 17" 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 baffle ok. Outlet baffle ok. Outlet tee ok. Depth of liquid at outlet invert. No evidence of leakage. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 120 Granville Lane Property Address Mike McGonegal Owner Owner's Name information is required for North Andover MA 01845 5/21/2013 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of lastum in p p g Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 120 Granville Lane Property Address Mike McGonegal Owner Owner's Name information is required for North Andover MA 01845 5/21/2013 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box level&distribution equal, has flow levelers. No evidence of leakage. Evidence of solid carryover, pumped d-box to clean. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 120 Granville Lane Property Address Mike McGonegal Owner Owner's Name information is required for North Andover MA 01845 5/21/2013 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 3 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil ok.Vegetaion ok. No sign of ponding to surface. Camera inside of pits, no water to inverts. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form la Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y 120 Granville Lane Property Address Mike McGonegal Owner Owner's Name information is required for North Andover MA 01845 5/21/2013 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 14 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r< 120 Granville Lane Property Address Mike McGonegal Owner Owner's Name information is required for North Andover MA 01845 5/21/2013 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ❑ drawing attached separately 0-90'r- Lt5a It a= �a � a , � L 0 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 t ' I a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments i r( 120 Granville Lane Property Address Mike McGonegal Owner Owners Name information is required for North Andover MA 01845 5/21/2013 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: >4 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 7/12/1977 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Design plan ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: As per test pit data on design plan no water found Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 120 Granville Lane Property Address Mike McGonegal Owner Owner's Name information is required for North Andover MA 01845 5/21/2013 every page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Summary Record Card generated on 5/16/2013 2:37:45 PM by Karen Hanlon Page i Town of North Andover Tax Map # 210-106-C-0072-0000.0 ' Parcel Id 17707 120 GRANVILLE LANE MICHAEL MCGONEGAL 120 GRANVILLE LANE NORTH ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 1 Acres FY 2013 UB Mailinc Index Name/Address Type Loan Number Active/Inact. From Until MICHAEL MCGONEGAL Owner 120 GRANVILLE LANE NORTH ANDOVER,MA 01845 GALVIN, PETER Previous Customer Inactive 8/15/2006 52 MILLPOND NO.ANDOVER,MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/inactive Bldg Id. 17393.0-120 GRANVILLE LANE Last Billing Date 4/10/2013 3170063 03.Cycle 03 Active UB Services Maint. Account No.3170063 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 15.20 /1 UB Meter Maintenance Account No.3170063 Serial No Status Location Brand Type Size YTD Cons 32772944 a Active ERT HH b Badger w Water 0.63 0.63 2q1 Date Reading Code Consumption Posted Date Variance 3/11/2013 410 a Actual 4 4/22/2013 _27% 12/7/2012 406 A Actual 5 1/9/2013 -38% 9/12/2012 401 a Actual 9 10/15/2012 61% 6/8/2012 392 a Actual 5 7/16/2012 _20% 3/14/2012 387 a Actual 7 4/14/2012 -29% 12/9/2011 . 380 a Actual 9. 1/17/2012 -16%9/12/2011 371 a Actual 12 10/13/2011 _8% 6/6/2011 359 a Actual 12 7/20/2011 30% 3/8/2011 347 a Actual 9 4/13/2011 -5% 12/10/2010 338 a Actual 10 1/12/2011 3% 9/8/2010 328 a Actual 10 10/15/2010 23% 6/4/2010 318 a Actual 12 7/15/2010 goo 3/8/2010 306 a Actual 11 4/14/2010 9% 12/10/2009 295 aActual 12 1/12/2010 -4% - 9/ 9/2009 283 a Actual 15 10/15/2009 polo 6/4/2009 268 a Actual 13 7/20/2009 _6% 3/12/2009 255 a Actual 16 4/29/2009119% g% _ 12/5/2008 239 a Actual 18 1/20/2009 9/8/2008 221 a Actual 29 10/10/2008 32% 6/4/2008 192 a Actual 23 7/16/2008 _7% 3/7/2008 169 a Actual 25 4/11/2008 9% 12/10/2007 144 a Actual 27 1/22/2008 -24% 9/4/2007 117 a Actual 30 10/12/2007 17% 6/14/2007 87 a Actual 29 7/20/2007 8% 3/13/2007 58 a Actual 28 4/16/2007 12/6/2006 12% 30 a Actual 22 1/19/2007 4% , Commonwealth of Massachusetts 19 City/Town of --'System Pumping Record Form 4 DEP has provided this form for use-by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left/Right front of house, Left/Right rear of house,/righ i e of house Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under ec Address City/Town state Zip Code 2. System Owner. � Qc Name Address(if different from location) City/Town stat�g�_ �` � �fCode Telephone Number C�l B. Pumping Record SIC, 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) 016eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No: 5. Condition of System: 6. System Pumped By. Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location_rhere contents were disposed: S• Lowell Waste Water Sign Haule Date I t5fortn4.doc•06103 System Pumping Record•Page 1 of 1 Septic System Information 120 GRANVILLE LANE Printed On: Thursday,July 20, 2006 System ID: BHS-2002-0843 ` 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: No No Soil Type: . Depth: Laundry: No No Inspections: Inspected: Expires: Inspector. Status: 06/23/2006 Neil J. Bateson Conditionally Passes Comments: Title 5 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Page 1 of 1 Town of North Andover Health Department Date: �0 Location: (Indicate Address,if Residential,or Name of Busine Check#: Type of Permit or License:(Circle)/� W. ➢ Animal (, ➢ Dumpster $ ➢ Food Service-Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal(Septic)Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC)$ ❑ Septic Disposal Works Installers(DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ TrashlSolid Waste Hauler $ ➢ Well Construction $ ➢ OTHER:(Indicate) Health Ag t I • •als 1666 White-Applicant Yellow-Health Pink-Treasurer o COMMONWEALTH OF MASSACHUSETTS F EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS p d DEPARTMENT OF ENVIRONMENTAL PROTECTION A Y N yyA� V� TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 120 Granville Lane ^_North Andover_ Owner's Name:_Peter Galvin Owner's Address:_120 Granville Lane _North Andover,MA 01845_ Date of Inspection:6/23/2006_ Name of Inspector: Neil J.Bateson_ Company Name: Bateson Enterprises Inc._ Mailing Address:_111 Argilla Road_ Andover,Ma.01810 Telephone Number:_(978)4754786_ CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000 The system: Passes X Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: cm Date:_6/23/2006_ 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. ` T Page 2 of 11 , r OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:_120 Granville Lane_ North Andover_ Owner:_Galvin_ J Date of Inspection: 6/23/2006_ Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which c indicates that any o f the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: X One or more system components as described in the"Conditional Pass"section need to be replaced or repaired The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain.Outlet pipe to d-bog&d-bog needs replaced. N The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: N Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: N The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: i Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_120 Granville Lane_ _North Andover_ Owner: Galvin_ Date of Inspection:_6/23/2006 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: rt 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 su_rface 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: i I i Page 4 of 1 l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_120 Granville Lane_ _North Andover_ Owner:_Galvin_ Date of Inspection:_6/23/2006_ D. System Failure Criteria applicable to all systems: You must indicate"yes"or`ono"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 Granville Lane_ _North Andover_ Owner:_Galvin_ Date of Inspection: 6/23/2006_ 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 bales 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.Owner had design plan,town didn't _Yes_ _ Determined 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 1 l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:_120 Granville Lane North Andover– Owner:_Galvin_ Date of Inspection:_6/23/2006_ FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3Number of bedrooms(actual): 3_ DESIGN flow based on 310 CMR_15.203_450_ Number of current residents:_2_ Does residence have a garbage grinder(yes or no):_No_ Is laundry on a separate sewage system(yes or no):–No– Laundry system inspected(yes or no): es or no : No Seasonal use:(y ) –No– Water _ 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(Y or no)es : Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no):— Water meter readings,if available:_ Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information:_Pumped three years ago,owner_ Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons--How was quantity pumped determined?— Reason for pumping: _ TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool_Overflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank `Attach a copy of the DEP approval _Other(describe):_ Approximate age of all components,date installed(if known)and source of information:-29 Years old,10/15/1977, as built plan_ Were sewage odors detected when arriving at the site(yes or no): No_ Page 7 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 120 Granville Lane_ North Andover_ Owner:_Galvin_ Date of Inspection: 6/23/2006_ BUILDING SEWER_X_ (locate on site plan) Depth below grade:_24" Materials of construction: _Xcast iron _X_40 PVC_other Distance from private water supply_ well or suction line: " " Comments on condition ofjoints,venting,evidence of leakage,etc. 3 Cast iron thru floor,3 PVC in house ( J g, g � ) _ with no leaks visible_ SEPTIC TANKS: X Depth below grade:_12"_ 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: T x 5'x 4' Sludge depth —4"_ Distance from top of sludge to bottom of outlet tee or baffle: 23"_ Scum thickness:_6"_ Distance from top of scum to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: 15"_ 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:Inlet baffle ok.Outlet baffle ok.Pipe to d-box is broken, needs replaced.Depth of liquid at outlet invert.No evidence of septic tank leaking in or out. GREASE TRAP: (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_120 Granville Lane _North Andover— Owner:_Galvin_ Date of Inspection:_6/23/2006 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX:_X_ Depth below grade _16" Depth of liquid level above outlet invert: ,0" eP q _ Commentsnote if box is level and distribution to outlets an evidence of solids carryover,any evidence of ( y leakage into or out of box,etc.):_D-Boz level&distribution equal.Evidence of carryover.Evidence of leakage, has corrosion holes in d-box.D-box needs replaced._ 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.): 1 Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_120 Granville Lane_ _North Andover– Owner:_Galvin_ Date of Inspection:_6/23/2006_ SOIL ABSORPTION SYSTEM(SAS):_X (locate on site plan,excavation not required) If SAS not located explain why: Type X_ leaching pits,number: 3_ leaching chambers,number:— leaching galleries,number: _ leaching trenches,number,length: leaching field,number,dimensions: overflow cesspool,number: innovativelalternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.):_Soil oL Vegetation ok.No sign of ponding to surface. Camera inside of pits thru outlets in d-box,no liquid to inverts of pits._ CESSPOOLS: Number and configuration:_ Depth–top of liquid to inlet invert:_ Depth of sludge layer: Depth of scum layer:_ Dimensions of cesspool:_ Materials of construction: _ Indication of groundwater inflow(yes or no):— Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): .1 Page 10 of l l ' - OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_120 Granville Lane _North Andover– Owner:_Galvin_ Date of Inspection:_6/23/2006_ 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 AtoI =37' A to 2=42'8" A to D-Boz=45'9" Water Meter —� BtoI=9'9" Bto2=14'4" B to D-Boz=23'9" A B Septic Tank Driveway 1 2 Pit# 1 D-Boz Pit# 3 Pit# 2 Page l l of l l " OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_120 Granville Lane_ _North Andover— Owner:_Galvin_ Date of Inspection:_6/23/2006_ 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:_7/12/1977_ 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,no water found _ . ; Summary Record Card generated on 6/1/2006 2:28.56 PM by Lisa Warren Page 1 1 _ Town of North Andover -Tax Map # 210-106.C-0072-0000.0 120 GRANVILLE LANE GALVIN, PETER 120 GRANVILLE LANE N. ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Size Total 1 Acres FY 2006 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until GALVIN, PETER Payor 120 GRANVILLE LANE N. ANDOVER, MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/inactive Bldg Id. 17393.0- 120 GRANVILLE LANE Last Billing Date 4/10/2006 3170063 03 Cycle 03 Active UB Services Maint. Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 37.29 /1 UB Meter Maintenance Serial No Status Location Brand Type Size YTD Cons 0023178125 a Active ENC REAR ? w Water 0.63 0.63 0 Date Reading Code Consumption Posted Date Variance 3/7/2006 2650 a Actual 11 4/17/2006 9% 12/21/2005 2639 a Actual 13 1/17/2006 -57% 9/14/2005 2626 a Actual 30 10/14/2005 133% 6/9/2005 2596 a Actual 11 7/15/2005 9% 3/18/2005 2585 m Manual estimate 12 4/5/2005 -14% 12/9/2004 2573 a Actual 12 1/14/2005 -24% 9/15/2004 2561 a Actual 18 10/8/2004 22% 6/10/2004 2543 a Actual 9 7/30/2004 23% 4/12/2004 2534 a Actual 16 5/17/2004 0% 12/5/2003 2518 n New Meter 0 12/5/2003 0% Tel: (978) 475-4786 r 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 Granville Lane, North Andover Owner: Galvin Date of Inspection: 6/23/2006 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. z• Neil . Bateson Bateson Enterprises, Inc. Town of North Andover �/ Health Department Date: Location: � � (Indicate Address,if Residential,or Name of Busme Check#: Type of Permit or License: (Circle) ➢ Animal ➢ Dumpster $ ➢ Food Service-Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal(Septic)Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC)$ ❑ Septic Disposal Works Installers(DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ i ➢ Trash lSolid Waste Hauler $ ➢ Well Construction $ c06-2-V. ➢ OTHER:(Indicate) ' Health Agent I ' 'als 1666 White-Applicant Yellow-Health Pink-Treasurer COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION A H ti VQ. IQ V�v I TITLE 5 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:_120 Granville Lane _North Andover_ Owner's Name:_Peter Galvin Owner's Address:_120 Granville Lane North Andover,MA 01845_ Date of Inspection:7/17/2006_ J U L 2 5 2006 Name of Inspector: Neil J.Bateson :OVER Company Name: Bateson Enterprises Inc._ iENT Mailing Address:_111 Argilla Road_ _Andover,Ma.01810_ Telephone Number:_(978)4754786_ CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: _X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: - ate: _7/17/2006_ The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments:After permit from B.O.H.,install new outlet tee with gas baffle,pipe to d-box&d-box, inspection from B.O.H.,septic system now passes Title 5 Inspection. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. RECEIVED ,CN Commonwealth of Massachusetts City/Town of JUL 18 2007 System Pumping Record TQWN OF NORTH ANDO.\e Form 4 M DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. System LQCatiOf -A— � forms on the 1l�/}Y V computer,use only the tab key Address� to move your C cursor-do not City/Town state Zip Code use the return key. 2. System Owner: Name ISI Address(if different from location) City/Town Stateyl o C 0 9 SQ Telephone Number 6 B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: I �� 6. Syste P ped By: Name "--� Vehicle License Number Company 7. Locatio err • � e contents disposed: t d ILLa Sign auler Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 a •r' �°atti , Commonwealth of Massachusetts Map-Block-Lot 0•_�` 6..+ � 106.C-0072- ----------------------- - Board of Health Permit No • BHP-2006-0217 i 1 i North Andover ----------------------- P.I. _ FEE t334CHustt F.I. $125.00 ------------------ Disposal Works Construction Permit Permission is hereby granted Todd-Bateson to(Repair)an Individual Sewage Disposal System. at No 120 GRANVILLE LANE as shown on the application for Disposal Works Construction Permit No. BHP-2006-02121e J 17 2006 ------------- � �� -------------------------------- Issued On:Jul-17-2006 Board of Health ............................................................................................................................................................................... H°RTM Map-Block-Lot Commonwealth of Massachusetts p ? •• °° 106.C-0072- I a Board of Health North Andover 3 +,,.••�•4� Certificate of Compliance CHU THIS IS TO CERTIFY,That the Individual Sewage Dispos stem (Repair) by ToddBateson ---------------------------------------------------------------------------- ------------------------------------------------------------------------ alter j at No 120 GRANVILLE LANE has been installed in accordance with provisions of TITLE 5 of the State Environmental Code as described in the application for Disposal Wor onstruction Permit No. BHP-2006-021 Dated July , ----------------------- ------- 17 2006--------- -------- --------- ---------------------------------- ---------- Printed On:Jul-20- 6 ----- -------------------------------- ---------------------- Board of Health ............................................................................................................................................................................... �s Q � i i hwn"of Noah Andove alth 6epartment ate: D Location: 14& IPY, (Indicate Address,if Residential,or Name of Bust a s) Check#: Type of Permit or License: (Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service-Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal(Septic)Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: ❑ Septic-Soil Testing $ ❑ ,S,epptt Septic-Design Approval $ 31.1 tic Disposal Works Construction(DWC)$ � ❑ Septic Disposal Works Installers(DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ TrasWSolid Waste Hauler $ ➢ Well Construction $ ➢ OTHER:(Indicate) L-ZVi Health Agent Initials i b 7 3 1 ef White-Applicant Yellow-Health Pink-Treasurer Application for Septic Disposal System y Construction Permit - TOWN OF TODAY'S DATE $ 250.00—Full Repair NORTH ANDOVER MA 01845 0 y $125.00 Component Important: Application is hereby made for a permit to: When filling out ❑ Construct a new on-site sewage disposal system* forms on the computer, use ❑ Repair or replace an existing on-site sewage disposal system* only the tab key � to move your ['Repair or replace an existing system component cursor-do not use the return key. A. Facility Information crab Address or Lot# P tl City/Town A6? 2.- *TYPE OF SEPTIC SYSTEM*: ❑ Pump Ptiavity (choose one) ***If pump system, attach copy of electrical permit to application*** �nventional System (pipe and stone system)4� 3 c�3 -V We. ❑ Infiltrator or Biodiffuser(Gravel-Less) (Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D-Box)(Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D-Box Present)S.A.S. 2. Owner Information b Name _lad G P•irat, IZe Address(if differe`nt�rom above) ----- -- P", A—J `_'_7_,_�_ , - © 1 sem/v --- City/Town State Zip Code Telephone Number 3. Installer Information 1 /e .ove _ Name Name of Company Address City/Town / State Zip Code Telephone Number(Cell Phone#if possible please) 4. Designer Information Name Name of Company Address City/Town _ State Zip Code I Telephone Number(Best#to Reach)X__ fl Application for Disposal System Construction Permit•Page 1 of/ i µ°k,�r Application for Septic Disposal System ort p Construction Permit - TOS OF TODAY'S DATE , MA 01845 $ 250.00-Full Repair NORTH ANDOVER .:.f $125.00-Component PAGE 2OF2 A. Facility Information continued.... 5. Type of Building: �esidential Dwelling or ❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the system in operation until a Certificate of Compliance has been issued t s Board of Health. Name Date Applicatio/Arp5poved By: (Board of Health Representative) y� Nam Date ' o Application Disapp ved for the following reasons: For Office Use Only: y L Fee Attached? Yes No 2. Project Manager Obligation Form Attached? Yes No 3. Pump System? If so,Attach cop, offlectrical Permit Yes_ No 4. Foundation As-Built?(new construction ronly): Yes_ No (Same scale as approved plan) S. Floor Plans?(new construction only): Yes_ No 4. J +� y Application for Disposal System Construction Permit•Page 2 of 2 i +r 4 r INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at Cf`+sN �'��� L"~ ' relative to the apQkication and OT / of ,,� I 745.a. "6ated — 7— 6�'6 for plans by dated with revisions dated I understand the following obligationsfor management of this project: l. As the installer I am obligated to obtain ustll permits the approved plans Health and the permit s•�e to performing any work on a site. I when any work is being done. project 2. As the installer I must call for any and all inspects hOhedules an inspection and the manger,or any other person not associated with mycompany sc system is not ready then item three shall be applicable. cable 3. As the installer I am required to have the erst understand that necqssary rrequesPieted ng an prior inspect inspection, without inspections as indicated below. completion of the items in accordance with Tile 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. or ir b) Final inspection en ineeremust must e submi subfirst do mitted inspection of Health, after which installers allstfor verbal OK from g 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. er than 4. As the installer I understand that only of the syI may stem rn rm ithe work(oth dentsf ed in the attached simple pplscadon for required to complete the install 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 to operate in the Town of North Andover; significant fines to all persons involved are also possible. 5. As the Installer I understand that I must be on site during the performance of the following construction steps: a) Determination that the proper elevation of the excavation has been reached. b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff or consultant. d) Installation of tank, D-box, pipes, stone, vent, pump chamber, retaining wall and other components. system 6. As the installer I understand that I am solely responsible for the installation of the any they as per the approved plans. No instructions by the homeowner, general persons shall absolve me of this obligation. Undersigned Li s Septic Installer Date:pi� sposal Works Construction Permit# TOWN OF Al�ff_ SYSTEM PUMPING RECORD DATE: Cp 02 03 h li 1 6 2003 SYSTEM OWNER& ADDRESS SYSTEM LOCATION (example:left front of house) `I 0 �f �% L� DATE OF PUMPING: ^U QUANTITY PUMPED : ()O D GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES 7 NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER(EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: F o_.$- ria t2�•9 r'/' - --- � Q ! A!F F �+ /q//D o V,614, /'1 lq.5 " /JN1! PITA 70 7.09 INV c � I If ACRE • r r 44I I r { RROPO.SE6 SUSSUl2TALE SEWAe E I�15 cS' h'? ✓ `� G� AaS4L YS TEM /_ Aaio ,-Vor, An Z07- aR,4,b1A1C7 ` �' J � e QG` [ �Z'/f � 7��•� �CALE /'r' P L ole DATE - 7-UNE f� ! 7! Ow vE,e GEORGE- FARR A281? S ALE11 STREET . NORTH ANOO E Rj MA �pCAT/oN . � : ...` LOT Via, GRANVIL LE L41VE NOPTH AND0Vb R, IMSS. � DES/G wER 4 ,/�- tTOS EPH cT %XSETTS ti �¢ r ESTGt/ARd L'(RCGE f /too. A76Ao/RvG , MASS. ;ice 1 -% -,_....�-=. � . ,� TEL. �� � ¢983 �� • ��`'� 9 sly o, , TYPE OF BU/G a/MG 3 ,BE'D 80014 D W, 4 L//I/G ! yjk !aARABE CE44.49 PLUMB1,V4� FAC/L/T/ES= Alt)Nf- 9,eWAfE FLOW ESTIMATE: .300 SEPT/G TANf< /00(� GAL ! f/BS�iePT/ON AiE'E.4 q00 S.� 13 �j / \ ♦ �PERG�LIl T/O�c/ Tesrs -al A4 r6— TOP ELE11,4r10^l <`, ,� - ~`�.... . .✓" -,✓` r. . I ( (a .Qorroxi ELEVA r�0.v O "' -• £! t w�. qtr. «,•..✓' # g" ra 4; DROP _ (o N. AoIlA/. M/�v. N!/.�/. D PL TEST PTTs / #z #.3c.-NANVILF Z14 N-F DA rE #¢ TOP ELEt/A7•/6A/ STK C>t•4 7Q+:.S sLlBso r:. SD/6 TYPES E(.. ?SIZJ RAID 0oAlE''7•' -r/LL , WATER TABLE 70 r,4 NOT LOCA•rio N ,4,/D WA n�2 �j•� A/0 i';4RA5,46,C DI-Sp S4� c� NA Y- BE IN-5TAL LED 1 N 6o rroM E�EUArioN g�,y- Tff E PR D V46'Z441-IN6 TESTS COA/DaC 745 BY : 722.5EP1-1 T. e4R,5ACA4 G O , R.S. TESTS W1 rNES.SEd SY : Ak% ANvO 1/E,e k• ,EGILTN DEPT. PZA A 4eD /Gti/ CRl 74-�e/A cS'HEET / OF Z doe EQuivgr "7 CAPPED �,(!DS U C) f� /oE2Fo�QA TES P yC. P�P� < �O.e EG7c//vAL EN 7"J ZD' " P,42T/AL BED EA./z) SEGT/D/V cS(fAL.E �I,eEa = 900s� h N SPEGF/CAT/Oh/S S'EE SIOCT/6A/ .4T LOWE,e ,e/raNT) DI.Sl",e/BUT t/ &X _ a /DOO 441-. CONC2ETE SEPT/G TANK f"P�-SOG/0 O(/.C,.SEALED TO/NTS e. �BSO.QPT/D/V E� G'AAJ 1Q(o /UDT TD cSC4LE AILL p«rEts/N6 \ SEALED <SEG E`G7' /JJ A7� so/nor, CKFILC_ SOC./O P OE N \• no • Gf/ASHED e �oe�. O neo :L •cs •e o. C.eUSNGr� STO�/E—. oee�e o��'• e •o e���� : c O CF=g S/ `> 3/¢r.rD XZ" WASHED � lv / i ; �t�0[IBGE lrf�ASN�l3 1 r TO`MEET A.A•5 H:O. ,Qaso/ePT/OAl , 94SEI SECT/o/y SCA G E -7- 1 E,2T E 4,vn ABS<.ef'T/Dev BEC> Re-Ail Aolb Scc-r/ONS , - PLA IQ WIAJ6 PC'OPOSED Su6Sl/,eF4GE SEWA47E hlS�SQL SYSTEM PR O oO A6eO Zo r cS'CALE• • f " //0' ADATE - 7UNL,= 77 . '" Z& CDWA2E/e EOR G E F-i4R ' 'S" L41VE r. NORTH At1 D0VER, lv,4s5. • � DES/C/VE•R 9 �osEPH CT BARB' AGG. G�vs�ns �b Ara , � rd WE.57-WA/2d l'' VO . AEAblAle, MASS- TEG ��. io X / UPA got \ A a r RAGE CELLAR PLUMB/.VCS FAC/G/T/ES /II D/�/E ,. SEGU.4GE FLOW EST/MATE- . CLQ G.PD. y _ -. DA SEPT/G -4 7 ".AC /000 CS,44 00 F '"�•.. /�t hG, Y / �/ .4BsoeP rio�v A�eEA �9 C�Q S. xS. ' `` ti ..,,.. ,! ter' ,s� '" s r• ' (.�U Q�TTO/y ECEYA T/O.VO SATU.eAr/OA. /.S" MIA.1 A111-1. AV".. " ,; ." ,. ..../'... "". �',•"'",,.w-',, ••"' �, /Z ro 9 0.2oP M /lel/N. ctrl/a/ MSN. /N, `` •- -• ...._ w,.. ..: -••`'"+,•-'" 9." ro 4:9 (a l . /moi/.�.DP v. . AL �g . 0 TEST PITS -46/ z 13 4 CPA A/V/� 4 NE ... -/0 1�k 6 LY Z TDP EGEVATI.OtV 12 STK ot4 TQE so/� T YPEs scae�c/t. wAmR TABLE 7z:57= OTEC+" NO S,4RBA64C DISPOS41- BOTTOM ELE(/A7 / �. f €✓ � ,G� aG, �BE IN TESTS COVV DaC 7-eFD BY : �TD�EPH' .T. � , 4RSAGA4 6 0 , te.5• TESTS W/TNESSED BY /t10. .4R/[)O I/E�2 HEAL T,�I DEPT. AZA Al e Des/4,v C.e/rE,elA �S'/vEEr- / of 2 • _ �"� �S'EAcEp S/�clr, �So� o {�I%C: PiPE • - . - . - - • , _ .... _ -_ . - . . - - �. . •. - - • _ �DR Ear/vALEwrJ m a n o s . • e e - - �' 6 e e CAPPED �itlDS U � . S=d" o S=0" 2 �" � ��E,eFoeArEp R�L'. p/PE �o,e E�.7uivA�Eil/r'J 1DAez-/AL SE.D EA./z) SECT/0 ti/ E /D — EC / NT �FD.2 SP C/F/CAT it1S SEE s T/ON AT LOWE2 ,E' �a h N r¢" CAST I,PD,V, S=02.0 +%DOD QAL. CONC,2ETE SEPT/C TANK ¢Jc _ �""f'Jr'OL/O �'U.C., SEALED TO/NTS - • ' / A-107- Td, cS n-dL.E p>"'£L4/NG SEfJLEl� cSE[.CC-7- d GRADE - soc io N IV PPE , r \ 1• Q g�• �:L_ •Q e o• G,eusHEa STOnIE o. . 0•.9.; e + . e��q,'' Od o o`b•ew e e •e - _ e • e / ! o • o 4 v�C. RIPEOle D o a o 0 0 0 EQc/i v.9L EA/T Q� / ( I' �� G,e[/SNEt7 STONE Q \ i ( � �vOUBLE l,1iAS</ED f Ta' MEET A.A•S.N:o. 0 o .� 4550RP7/0/t/ BEL) cS'EC T/o/t1 I i13 i► `i PROF/L E �r � � 4"Df�B5�,2PT/On/ BE L� /ILA,t/ AN[) SEC T!ONS �h/EE T o� V � � t 4r '1 ' �� � ,. �,,� � ile �� . -� SOIL PROFILE & PERCOLATION TEST DATA Town/City Dov No.&Street��--r o,'Ile ? - Lot No. o Loc./Subdiv.L ��r � ✓"��/ Plan Owner 12a Investigator/� QIGi (',clC� Observer J 917 4 SOIL PROFILES-DATE 3' Elev. 3' Elev. 3' Elev. Elev. 0 0 0 0 "IQ 11.11 2 2 2 e c � a � 3 3 3 3 N 4 4 4 4 ` \p NJ 5 5 5 5 6 6 6 6 1 o � v £3 8 8 B 9 9 9 9 i o. lU 10 10 10 O Eenchmark Location M Elevation Datum Percolation Tests-Date Pit Number /U /J 7.1 1 2 3 4 5 f 4F Start Saturation Soa'c-Mins e Start Test-Time Drop of 3"-Time 171, / Drop of 6"-Time :3 Mins.lst 3"Dro 2/� •i Mins. 2nd 3"Dro -Notes & Sketches on Back Frank C. Gelina.s & Associates, North And. r _� L� *70 ;� # � z, : - - , :__ - •PLA Ic_.! s�/Du/�w� P�E'OPOSED SUBSU,E'FgGE cSEK/AUE hlsPOs4c. SY57-eM i PRD POSEh Lo r Ua Wr s Ev /'777 k o c�CAGE // Z/ 1f TE - TCQE f /? 7 31? SALE1Y STREET NOPTIV ANDOL VER / '1A J TOGA r'/oAl, _ - L E NORT ANDOVFR IMSS. �t�rs ' f cT©sEPH cT. BA42BAl�AGC.o , iP.�. �yQ�� dd 6 WESTcuARd CIRCCE IECo: REAZVfvG AIA sS S. rte' - r ; e . - 983 AES/G.AJ DATA -TYPE 0r QU/L 41AI4 RO0 so P� _ � EG(Jf}UE FGOW EST/MATE: S ~ �` ' f .. SEPT/G Tgitlk �C�Uf 6,44 ,� � � � �Bso.2P r/oar AREA q,9 Y 5.l+ - -... }. PN T ' ERGO AT/D EZ5 7VA7 EGEvA7%oil/ V *•. "yam `.-,;,w,,,h '".., •• '. may''. ,.,,'".-. ,.M. �,„".., ....~....—.i ..-w*' /Z"ry 9" 'DROP , . / � /V//N. I Miv. M/A_1. -•--• ----�• �..� +..�„ ....•'r" 9" re 6" DROP 4 7� r`"�.r"'4"M-.)11V.. """'uyj.. ..�,6r..r..-• ..� ,,,,,.. .,..,,.,..•"'"'":. '" 000.4 rioN�RArE X3.3�1/,�.1/,v. M,A.I IN, /Y//N/IN /✓//N IA/. TEST'-P/TS 0)9A J /Z F Z14NO77" . TOP E-LE!/AT/OA/ Bor W7- /I �3•M. " / " Thr /g,, o� 2 -P/PZ- . aW D F ' 0;76 ' VA S,�a��i l B .�",,�rr RICI� . SO/G TYPES .dND su p 3� .4n/D AiV/i �ti ' bt 4MR 7-AacE �2 " �o�t/Y COCA 7-/0 N -r-14 4 IVo WA eel NO 6✓A7'-Z 1 907-7041'666-VA 711VAl TESTS COA/DUC TEP BY = ,72%5Eo1-1 T, 64RBACA4 L O , R.S. TEST !d//T/VESSED' BY /C/D. ANL)0 V6-r- NELf L 7TH DEPT. PLA/tl e DESIC C-RI nole/A OF r YENT t` ACCESS n1ilAit!lfOGE Pn2ECA5T Cc�/tlG 2ETE -�SEEPAI'E PIT AcEss NIAwNa6� ` To r,eADE e, W/T//l A/ 44 O�C -A[�E� : ,B. To'3 8 l�t�A3<1ED C�USNED pro -. / •• /.,. - _, TO .l2ADE. D2. Gt//T�//�l/ 3/¢'"ro/�Z' lit/ASNED C 'US�1ED S0AIE µ CDOUBLE WASNE1> -,4,45140 SPEC. 7- -,:6U� IlVe E-7- 1Z"MAX_ . 'VE i- 0 - .o p a or. o O o 2`X 2'X 3" COnt/CeE7� Q: O O �. 33'� vPL,4.5H PAD - O O, Qcl • co �- /i' v � cep o 1 Z � /¢, �'� , cSEE 'A T - EcrioA! Q-A ` �EEP.RC�E P/T- cSEGT/OrC! B=B ¢r, CRSTleD�cl, S;= "Q.2.4 SEEPAar= P/T ` . n'OO D COAL. A/C 2 45 SEPT/G TA SdLiD pv C n SEAL'S .TDi,UrS S oi0 14 {— v v`'HAL O W 6S L E"EP,46E P/Ts /,V4 GST-a ,J' J i Aoff, e�r �� ,hod #Yrovr)t 4r SEES-'AG`E PI-7 _••y,.r.' P��I �C•4LE Alone: /i/= ¢� �E.2T. l ��" lP�'O�/LE cEEP ! E ".F�17= . PG:d Rl '�ih%p° cS} C7-LG> /<S' ,• f� ET � " - • — - ACCESS /�ANHOLES TO �7RADE �.� BECOW 6/eiyDE �¢/N. OiQ LESS 0 4 �/amu/a LEl/EL L/cau/O THE DETA/LS Sf owv /� LE✓E� o ON TH/s PLAN SHEET a AkE TYP/CAL DE-7,41L S ¢ � /� OF A CE,e7,4 10441- IROAJ TEE O d o. ¢"�CAST Zee TEE ° C/F.4C TL/.e0�2. 60 U/✓� - ` ° LEit/T �iPO�UCTS MqY BF Su,6s7-1 Te-/rFD 6• 4 Qv� y W17-1-1 THE n n l�PP.eO!/�IL OA 0711 4" THE �q RO OP f�EALTI•1 a 4 4/V4) 714,-- 7 7-1E.v. ; 'o• /Z" M/N. • . . -+� -BASE ) c5'EPT/G TA�l/k — cS'EcTlo v 4-A 5 60 AA/o7- ro cscAc.E Sep T/G TA vl< — MSEC T/o v IU07- ro csCAc.E e A a' - - ,y - - - u - _ '._u.-.-. .-'may •ca'.•' to•.: A -• - ca. Q.• - q. _ 4 .p .p- ••Q •y .•e o•o b. a 3�� ► 3 /4 a• p' Z rr a' q, Z' TN T e c e 1' � •p e' c ' c o. c. / U' GR4vEG SUB-B�ts� 6RAVEL T',e/B1JT/D.0 3 l¢ 3/¢" I DISTRIBUTION BOX SEC-T/Oti/S /'-O'� SS�EPT/G TANfC PLA AJ A107- TO cS-C.qG E / s FDR S /C T 1k D/STR/BUT/ON SOX SHEETDZ �F Address 00-4-Nuc" ",-/J Title of File Page of Date File Open: Date file closed: Doc Document/Action Title Date of Refer to other PurPose of Document/A ' p e / coon and notes action Document/ document/ filum. Action Department Board of Appeals - Board of Health - Planning Board - Conservation Commission - Building Department Commoilwqjth of Massachusetts v• 441,."<Massachusetts System Pumping Record System Owner System Location 1c� V\ (Vac 6L_V,_ Date of Quantity Pum uantit Pumping: � /02�gallons P ed: Cesspool: No Yes [] Septic Tank: No [] Yes System Pumped by: 64&4" 46a&vvz&W License# Contents transferred to: Greater Lawrence Sanitary District Date: Inspector: TO: NORTH ANDOVER, MASS BOARD OF HEALTH FROM: DESIGN ENGINEER Re: Soil Absorption Sewage This is to certifySystem Inspection that I have inspected the construction of the U said disposal system at " sir LOCATION North Andover, Mass. The grades and construction are as specified in m � y plans and specifications dated N n 1 9 tD � 3 ys l'JN0/SS S/ �Od A? eg. P eg itarian N o HdSOf , /! �6ssb1N I0 CD C W E:1Q v R- ►C ac C� y ` a Commonwealth of Massachusetts ED City/Town of RZmusnifted System Pumping Record 5 Form 4 JU DEP has provided this form for use by local Boards of Health. Other f r ,i1 information must be substantially the same as that provided here. Be ith your local Board of Health to determine the form they use. The System Pumping Reto the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. System Locatiaqaeft fron rear, left side of house. Right front, right rear, right side of house. forms on the computer,use [_e1 only the tab key Address to move your � cursor-do not City/Town State Zip Code use the return key. 2. System Owner: Name Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of PumpingDate--l9 ` 2. Quantity Pumped: Gallons 3. Type of system: Cesspool(s) — Septic Tank El Tight Tank Other(describe): 4. Effluent Tee Filter present? 0 Yes _M/No If yes, was it cleaned? 0 Yes r] No 5. Condition of System: 6. System Pumped By: Neil Bateson F 5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Locatio _ re contents were disposed: Lowell Waste Water q \ igna ure of H u r Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts r1® City/Town of �pp� System Pumping Record � Form 4 1WNo1-No DEP has provided this form for use by local Boards of Health. he s may be used, but the information must be substantially the same as that provided he efore using this form,check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. SyStT LOCa n forms on the computer,use only the tab key Address to move your cursor-do not Cityrrovm State Zip Code use the return key. 2 System Owner: reb CSV `�fl C:L-z Name 1�1 Address(if different from location) City/Town State/o �— , 6zip Code Telephone Number B. Pumping Record 1. Date of Pumping2 Date . Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes,was it cleaned? ❑ Yes ❑ No 5. Condi "onof System- - v�—)' � /\, 6. Syste PurpecLBy�� l \ Name Vehicle License Number Company 7. Locatio r contewernposed: Signatur or er Date t5form4.doc-06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusett City/Town of RECEIVED System Pumping Record COT - Nio Form 4 " TOWN OF NORTH ANDOVER DEP has provided this form for use by local Boards of WiM&TZAMM99ay-lbe used, but the information must be,substantially the same as that provided here. Before using this form,check with your local Board of Health tQ determine the form they use.The System Pumping Record must be submitted to the local Board of.Health or other approving authority. A. Facility Information 1.. System Location: L ft side of house Right side of house, Left front of house, Right front of house, Left rear of house, Rig o Ouse. Left rear of building. Right rear of building. Address ��l / e W6)-(4t"- City/Town (� State Zip Code 2. System Owner: Name Address(if different from location) City/Town StajayqT—de (�/`► Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee'Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Conditio l ,L� 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Locati rre ntents were disposed: G.L. L ell aste Water Signatur of11 ule Date l t5form4.doc•06/03 System Pumping Record.Page 1 of 1 Commonwealth of Massachusetts City/Town of RECEIVED System Pumping Record SEpForm 4 TOWN OF H ANDOVER DEP has provided this form for use by local Boards of Health. Other for ninformation must be substantially the same as that provided here. Before sing Is check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left front of house, right front of hous e s , right side of house, Left rear of house, right rear of house, left side of building, right rear of building, under deck. Cityrrown State Zip Code 2. System Owner. �✓( � �C���� Name Address(if different from location) City/Town Sta Zip Code --o Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantit..Pumped: Gallons 3. Type of system: Cess ool(s) Se tic Tank El Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Neil J. Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc. Company 7. Lo�inre contentswere disposed: Lqkell Wase Wa Signature of aul@r Date t5form4.doc•06103 System Pumping Record•Page 1 of 1