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Miscellaneous - 124 COLONIAL AVENUE 4/30/2018
11 \ 124 COLONIAL AVENUE �1 210/1077-0000.0 / a 1 A ry� G n 5.-..'C .F{r ..�X h `�' i '� -, ti� � y. ,.• ,%l r a ,5 1 r y„u rri�s:Y. ll t,.�,�` LOT.:_:# x, �Vt `• _ —.�'f MAPx # k PARCEL # rSTREET ML �ONSTRUCTION_APPROVA.L, HAS PLAN REVIEW FEE .BEEN PAID? NO PLAN APPROVAL: &Ppp. DATE ` BY DESIGNER: PLAN DAME: r CONDITIONS WATER SUPPL OWN WELL WELL PERMIT DRILLER.-____' _-_ WELL TESTS: CHEMICAL DALE APPROVED.__-_-.-.--_ BAC- A I UA t E (IPPRUVED BACTERIA II DATE APPRUVEll- ___ COMMENTS: FORM U APPROVAL: APPROVAL TO ISSUE YES NO DATE ISSUED BY CONDITIONS: FINAL APPROVAL: . ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NO SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NO ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: DATE:. - � G-rSY�tM _05I8.LMA '''='p � , t '•. .•''• •..T; �T. Ai r fit, \ t �'.��^•�:' } }•' • • • NO - 'vt, , .� f _ t, ; ,;: .:'::,•, ,,::. . ;a YES ' nr NSTALLE IR LICENSED? ' tx IS THE REPAIRNE ' :TYPE. OF. CONSTRUCTION: - NO NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW_ YE5 NO CONDITIONS OF..APPROVAL (FROM FORM U) ,.: y S NO ','ISSUANCE, OF DWC PERMIT z;,�• PERMIT N r INSTALL ER DWC t O. 1BEGIN, INSPECTION YES NO• :VNSRECTION: NEEDED: -_- EXCAVATION}I 74 • - PASSED ' ... . .•. .`� ' . . _ ' BY NEEDE : CONSTRUCTION INSPECTIONS , ,'•, : YES:' AS BUILT PLAN SATISFACBY TflRY� APPROVAL. TO BACKFILL: DATE:f� FINAL-GRADING APPROVAL: DATE DATE: I� BY f .. ' : FINAL CONSTRUCTION APPROVAL. . North Andover Board of Assessors Public Access Page 1 of 1 NORYH r 3o' ,,,,,,,,Q,.,iy.Worth t1 {�v r 3?m•.. ..,.,. ^ of 'gees ' of Assessors 71 Property Record Card Return to the Home page click on logo Parcel ID:210/107.B-0137-0000.0 Community:North Andover SKETCH PHOTO New Search Click on Sketch to Enlarge Click on Photo to Enlarge -, Sales Summary Residence Detached Structure Condo Commercial L Comparable Sales 124 L-17 COLONIAL AVENUE J Location: 124 COLONIAL AVENUE Owner Name: D'URSO,JODI KATHRYN D'URSO Owner Address: 124 COLONIAL AVENUE City:NORTH ANDOVER State: MA ZIP: 01845 Neighborhood: 8-8 Land Area: 0.5 acres Use Code: 101 -SNGL-FAM-RES Total Finished Area: 2604 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 676,900 611,500 Building Value: 453,500 412,600 Land Value: 223,400 198,900 Market Land Value:223,400 Chapter Land Value: LATEST SALE Sale Price: 419,900 Sale Date: 06/04/1998 Arms Length Sale Code: Y-YES-VALID Grantor:A C BUILDERS Cert Doc: Book:05076 Page: 0087 http://csc-ma.us/NandoverPubAcc/jsp/Home jsp?Page=3&Linkld=991827 1/2/2008 Grant, Michele From: George Zhang Ugzhang0724@yahoo.com] b Z 1 Sent: Thursday, June 24, 2010 3:41 PM To: Grant, Michele Subject: RE: 124 Colonial Ave �� v sure, f✓� v 978-289-0724 --- On Thu, 6/24/10, Grant,Michele<mgrant@townofnorthandover.com>wrote: From: Grant, Michele<mgrant@townofnorthandover.com> a�� r- Subject: RE: 124 Colonial Ave To: "George Zhang" <jgzhang0724@yahoo.com> Date: Thursday, June 24, 2010, 3:06 PM Hi Mr. Zhang, Could you please send your phone number, so as we can have more discussion. Many Thanks Michele 978-688-9540 North Andover Health Department From: George Zhang [mailto:jgzhang0724@yahoo.com] Sent: Thursday, June 24, 2010 1:34 PM To: Grant, Michele Subject: 124 Colonial Ave Hi, Attached is the map for our upstairs. I am referring bedroom#2 in the layout. please confirm it is ok to close the suite and have a door open as indicated in the layout attached. Kind regards, 1 Grant, Michele From: George Zhang Ugzhang0724@yahoo.com] Sent: Thursday, June 24, 2010 1:34 PM To: Grant, Michele Subject: 124 Colonial Ave Attachments: Layout 124 Colonial Ave.pdf i Hi, Attached is the map for our upstairs. I am referring bedroom#2 in the layout. please confirm it is ok to close the suite and have a door open as indicated in the layout attached. Kind regards, George Zhang, i 8'4° 1'0' l'O' 1'134' 5'4�h1 5'2' 2'101 5'6' = O o _ Ir BEDROOM #4 WALK-IN o r �o CL Za OSET 10 2' 30' � 2'4' 2'4' 2-30' 'U CLOSET cq CLOSET � s o - ° n 26 1 � � 4 Q Cloeet floor elopes 2'4' to maMtaln headroom BEDROOM #3 For eta"beI= M BE #1 8'2%t 3'b' BED #2 O in it 4'0' 6161 3'6' 6'0' 6101 3'6' 6'b' 4'0' 1410' 12'0' 14'0' 4010' SECOND FLOOR PLAN iL V4•:IV 11418 - 4 16'13ji' 20'2v,2" 5'b° 14'14° 3'0' 2'b' 5'0' 2'b' 3'f4' 3'1114' 9'6' b'94s' 219" 2'9' 1'0' 6'0'SLIDING I I O 1 FAMILY 5RKFST KITCHEN � � STUDY o o (vaulted) 0014 ——— 2'4" I acu+el e�tst layout 1 O O in roy VMS I in m Er4� I Y0' I 3W 2-2,6" 0 'l E iTE 4'0' 11 3'9' 1 3'4/4' - v --------- - ---- ------- 1'�i 2'6' 3'0' ' h h � - 0 fn::- - -------- ----- --------- 7 ------- ----- --------- Q r � m o 7- 17 UP 0 DINING FOYER LIVING 2'0' 3'0' 2'0' CL CL. 4'b' 1'0' 4'6' 16'O' 4'0' b'6' 3'b' 3'0" 3'0' 3'0" 3'O' 3'b' 6'6' 4'0' FIRST FLOOR PLAN Wo, 12'0' ��. 11415 - 3 V '0'4'"I �� North Andover Board of Assessors Public Access Page 1 of 1 t. 0 o - Property Batton to the Homo page click on logo T-4 Record Card Parcel ID:210/107.B-0137-0000.0 Community:North Andover New Search SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlarge Sales Summary Residence Detached Structure Condo _ Commercial Comparable Sales 124 L.17 COIANIALAVENUE Location: 124 COLONIAL AVENUE Owner Name: D'URSO,JODI KATHRYN D'URSO Owner Address: 124 COLONIAL AVENUE City:NORTH ANDOVER State:MA ZIP:01845 Neighborhood:8-8 Land Area:0.5 acres Use Code: 101-SNGL-FAM-RES Total Finished Area:2604 sgft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 676,900 611;500 Building Value: 453,500 41.2,600 Land Value: 223,400 198,900 Market Land Value:223,400 Chapter Land Value: LATEST SALE Sale Price:419,900 Sale Date:06/04/1998 Arms Length Sale Code:Y-YES-VALID Grantor:A C BUILDERS Cert Doc: Book:05076 Page:0087 http://csc-ma.us/NandoverPubAce/jsp/Home jsp?Page=3&LinkId=991827 1/2/2008 .o,ob .ort .ou A,4t ,O,r r9,9 .9,fi ro,9 r0,9 r9E ,9,9 At Z# V 39 a W W OONCMG W .a£ mw�i sloe S# WOONCa; S02I I t.. O" Alt rrx r n r9x Llml� N � rox rcr��bm to = O O '�# WOON(339 As As Air's AL rt.4 rrgq�q ,rl V� T Septic System Information 2125 TURNPIKE STREET Printed On: Tuesday,July 24,2007 System ID: BHS-2002-0109 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 Hauling/Pumping Listin QuantitV Type System Type Pumped Pumped By Transferred To Disposed At Date Pumped (gallons) Routine Septic Tank Andover Septic 06/22/2002 1500 Routine Septic Tank Andover Septic 20 So. Mill Street, Bradford 12/29/2006 1500 Comments: xxx solids bottom Inspections: Inspected: Expires: Inspector: Status: 07/24/2007 Benjamin C.Osgood,Jr. Passes Comments: Title 5 i rk t�� GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Page 1 of 1 i � t Septic System Information 2125 TURNPIKE STREET Printed On: Tuesday,July 24,2007 System ID: BHS-2002-0109 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: A Grinder: No No Soil Type: Depth: Laundry: No No Haulinq/Pumping Listin Quantity Tvpe System Type Pumped Pumped By Transferred To Disposed At Date Pumped (gallons) Routine Septic Tank Andover Septic 06/22/2002 1500 Routine Septic Tank Andover Septic 20 So.Mill Street, Bradford 12/29/2006 1500 Comments: xxx solids bottom Inspections: Inspected: Expires; Inspector; Status: 07/24/2007 Benjamin C.Osgood,Jr. Passes Comments: Title 5 GeoTMSO2007 Des Lauriers Municipal Solutions, Inc. Page 1 of 1 . Commonwealth of Massachusetts C- -Fa H Title 5 Official Inspection Form L ' w`s5 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1171t9Y ,M 124 Colonial Avenue Property Address Jodi Matthews Owner Owner's Name information is required for North Andover MA 01845 11/06/07 every page. Clty/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: When filling out A. General Information forms on the RECEIVED computer, use 1. Inspector: only the tab key to move your Albert Innamorati DEC 0 6 2007 cursor-do not use the return Name of Inspector key. Abbey Inspection Services Inc. TOWN OF NORTH ANDOVER Company Name P.O. Box 477 Company Address South Lancaster MA 01563 City/Town State Zip Code 978-371-7014 s1863 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority IL"t- 11/07/07 spector's Signature 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. t5inspNAndoverREV.doc-08106 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 wM 124 Colonial Avenue Property Address Jodi Matthews Owner Owner's Name information is required for North Andover MA 01845 11/06/07 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: ❑ 1 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 t5inspNAndoverREV.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 t t ' Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage disposal System Form - Not for Voluntary Assessments ,M 124 Colonial Avenue Property Address Jodi Matthews Owner Owner's Name infoatiis North Andover required uired fo for MA 01845 11/06/07 every page. City/Town 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. t5inspNMdoverREV.doc•08/06 Title 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 124 Colonial Avenue Property Address Jodi Matthews Owner Owner's Name information is required for North Andover MA 01845 11/06/07 every page. City/Town 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 ❑ ® 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 '/z day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the 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. t5inspNAndoverREV.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 t Commonwealth of Massachusetts a W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 124 Colonial Avenue Property Address Jodi Matthews Owner Owner's Name information is North Andover required for MA 01845 11/06/07 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. ❑ E 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. ❑ z 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. t5inspNAndoverREV.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 15 1 t f , Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 124 Colonial Avenue Property Address Jodi Matthews Owner Owner's Name information is North Andover MA 01845 11/06/07 required for 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)] t5inspNAndoverREV.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 124 Colonial Avenue Property Address Jodi Matthews Owner Owner's Name information is North Andover required for MA 01845 11/06/07 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (if yes separate inspection required] ❑ Yes No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): see attached Sump pump? ❑ Yes ® No Last date of occupancy: 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): t5inspNAndoverREV.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 ' t . � r Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM •'` 124 Colonial Avenue Property Address Jodi Matthews Owner Owner's Name information is required for North Andover MA 01845 11/06/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: never pumped: owners Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? truck gage Reason for pumping: general maintainance 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: 1997 June-owners records and permit Were sewage odors detected when arriving at the site? ❑ Yes ® No t5inspNAndoverREV.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 124 Colonial Avenue Property Address Jodi Matthews Owner Owner's Name information is North Andover required for MA 01845 11/06/07 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 16 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 1010 feet Comments (on condition of joints, venting, evidence of leakage, etc.): all piping functioning as intended Septic Tank (locate on site plan): Depth below grade: 1' to tank top-6" risen in center 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: 9.6' x 5'x 5' Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 5 Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 20 How were dimensions determined? observations t5inspNAndoverREV.doc-06/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments aM 124 Colonial Avenue Property Address Jodi Matthews Owner Owner's Name information is required for North Andover MA 01845 11/06/07 every page. Cityrrown 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.): 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): t5inspNAndoverREV.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 Commonwealth of Massachusetts H W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 124 Colonial Avenue Property Address Jodi Matthews Owner Owner's Name informationis North Andover required uired fofor MA 01845 11/06/07 every page. Cityrrown 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 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.): working order, all lines are at working level and at equal flow, no carry over observations Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5inspNAndoverREV.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 1 . Commonwealth of Massachusetts ' W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 124 Colonial Avenue Property Address Jodi Matthews Owner Owner's Name information is required for North Andover MA 01845 11/06/07 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 at 40' 0" ❑ 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.): no vegetation observed at leach area, no dampness observed at present, no signs of hydraulic failure t5inspNAndoverREV.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 r Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 124 Colonial Avenue Property Address Jodi Matthews Owner Owner's Name information is North Andover required for MA 01845 11/06/07 every page. City/Town 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.): t5inspNAndoverREV.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 • u Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 124 Colonial Avenue Property Address Jodi Matthews Owner Owner's Name information is required for North Andover MA 01845 11/06/07 every page. City/Town 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. 124 Colonial Avenue 34'-6" 22'-0" 20'-3" 35-0" 38'-0" septic tank distribution box 9"deep w/2 risers 58'-0" Septic Tank 6" deep to center riser SAS 2 @ 40'-0" 0 vent t5inspNAndoverREV.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 `• �. Commonwealth of Massachusetts u - Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 124 Colonial Avenue Property Address Jodi Matthews Owner Owner's Name information is North Andover required for MA 01845 11/06/07 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 If checked, date of design plan reviewed: reviewed 11/02/97 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health - explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: per plan-test hole at 90" estimated high ground water elevation 154.6 on 06/06/96 t5inspNAndoverREV.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 y Summary Kecord�Uara gener'atea on iuri�uu,irio:so ,m oy Waren narnon oya ` Town of North Andover Tax Map # 210-1073-0137-0000.0 124 COLONIAL AVENUE JODI MATTHEWS 124 COLONIAL AVE NORTH ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Size Total 0.5 Acres FY 2007 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until JODI MATTHEWS Payor 124 COLONIAL AVE NORTH ANDOVER,MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 14092.0-124 COLONIAL AVENUE Last Billing Date 9/5/2007 2100031 02 Cycle 02 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 259.82 /1 UB Meter Maintenance Serial No Status Location Brand Type Size YTD Cons 43993574 a Active EN F.RT. NEPTUNE NEPTUNE w Water 0.63 0.63 0 Date Reading Code Consumption Posted Date Variance 11/5/2007 3399 a Actual 109 91% 8/1/2007 3290 a Actual 54 9/1)4/2007 -100% 5/2/2007 3236 c Correction 0 6/26/2007 -100% 2/28/2007 3236 m Manual estimate 15 3/23/2007 -93% 11/2/2006 3221 a Actual 141 12/22/2006 `� 23% Trouble Code:03 8/21/2006 3080 a Actual 138 9/13/2006 1285% Trouble Code:03 5/25/2006 2942 a Actual 12 6/2b/2006 16% Trouble Code:03 2/8/2006 2930 a Actual 9 3/13/2006 -90% Trouble Code:03 11/8/2005 2921 a Actual 86 12/1+4/2005 -73% Trouble Code:03 8/10/2005 2835 a Actual 344+ 9/12/2005 . 951% Trouble Code:03 c 5/5/2005 2491 a Actual 27 6/8/2005 324% 2/14/2005 2464 a Actual 7 3/15/2005 -1° /o Trouble Code:03 11/18/2004 2457 a Actual 8 12/17/2004 -90% Trouble Code:03 8/10/2004 2449 a Actual 72 9/20/2004 547% Trouble Code:03 5/14/2004 2377 a Actual 11 6/14/2004 30% 2/17/2004 2366 a Actual 10 4/16/2004 0% 11/6/2003 2356 n New Meter 0 11/6/2003 0% DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Thursday, October 08, 2009 11:02 AM To: 'zhang 124@comcast.net' Subject: I.R. -Septic- 124 Colonial Drive- Health Department File Attachments: SKMBT_60009100810440.pdf Importance: High Attached is a copy of your Health Department file as you requested. Please call the office if you have any further questions. Enjoy your day. Best regards,X1'1"&" Pamela DelleChiaie Health Department Assistant TOWN OF NORTH ANDOVER Health Department 1600 Osgood Street Building 20;Suite 2-36 North Andover,MA 01845 978.688.9540-Phone 978.688.8476-Fax pdellechiaie@townofnorthandover.com-E-mail http://www.townofnorthandover.com-Website Notes: If copied to BOH Members-Reference Copy Only-no response requested at this time From: noreply@townofnorthandover.com [mailto:noreply@townofnorthandover.com] Sent: Thursday, October 08, 2009 11:45 AM To: DelleChiaie, Pamela Subject: I.R. - Septic- 124 Colonial Drive - Health Department File 1 110 Septic System Information 124 COLONIAL AVENUE Printed On: Wednesday,January 02, 2 System ID: BHS-2002-0524 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: 11/07/2007 Albert Innamorati Passes Comments: Title 5 GeoTMSO 2008 Des Lauriers Municipal Solutions, Inc. Page 1 of 1 B B E Inspection Services Inc. A Y p ALBERT INNAMORATI JANE.K. INNAMORATI, Esq. Certified Home Inspector Real Estate Conveyancer RE_Title 5 Certification in North Andover MA _ FREM December, 4 2007 7 Board Of HealthOVER RE: Title 5 Certification NT Property Address: 124 Colonial Ave, MA Enclosed is the document for the Certification on the above property. I had recently installed d-box risers and am now ready to issue the final draft. I also included a sketch of the riser provided on this property for the Boards information and clearification. Than e nna o ABBEY Inspection Service Inc. P.O. Box 477 So.Lancaster,MA 01561 TEL: (978) 368-4207 FAX: (978)'368-8568 (800)755-4677 E-mail: abbeyinsp@mediaone.net - P , Commonwealth of(Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 124 Colonial Avenue Property Address Jodi Matthews Owner Owner's Name information is required for North Andover MA 01845 every page. City/Town 11/06/07 State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: When filling out A. General Information forms on the RECEIVED computer, use 1. . Inspector: only the tab key to move your Albert Innamorati DEC 0 2007 cursor-do not use the return Name of Inspector key. Abbey Inspection Services Inc. TOWN OF NORTH ANDOVER Company Name m6 P.O. Box 477 Company Address South Lancaster MA 01563 �RA1 City/Town State Zip Code 978-371-7014 s1863 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 11/07/07 Aspectoesignature 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. t5inspNAndoverREV.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 • Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 124 Colonial Avenue Property Address Jodi Matthews Owner Owner's Name information is required for North Andover MA 01845 11/06/07 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: ❑ 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 t5inspNAndoverREV.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 t ,r ' Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M " 124 Colonial Avenue Property Address Jodi Matthews Owner Owner's Name information is required for North Andover MA 01845 11/06/07 every page. Cltyrrown 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. t5inspNAndoverREV.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 s 5 t • Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 124 Colonial Avenue Property Address Jodi Matthews Owner Owner's Name information is required for North Andover MA 01845 11/06/07 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 ❑ ® 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 Y2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the 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. t5inspNAndoverREV.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 A Commonwealth of Massachusetts w - Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 124 Colonial Avenue Property Address Jodi Matthews Owner Owner's Name information is required for North Andover MA 01845 11/06/07 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. ❑ Z 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. t5inspNAndoverREV.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 15 S 1 • Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .124 Colonial Avenue Property Address Jodi Matthews Owner Owner's Name information is required for North Andover MA 01845 11/06/07 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) Z ❑ 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)] I I t5inspNAndoverREV.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 I . Commonwealth of Massachusetts w - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 124 Colonial Avenue Property Address Jodi Matthews Owner Owner's Name information is required for North Andover MA 01845 11/06/,07 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedroomsdesi n : 4 3 ( 9 ) Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter-readings, if available(last,2_years usage (gpd)): see attached Sump pump? ❑ Yes ® No Last date of occupancy: 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): t5inspNAndoverREV.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 124 Colonial Avenue Property Address Jodi Matthews Owner Owner's Name information is required for North Andover MA 01845 11/06/07 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: never pumped: owners Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? truck gage Reason for'pumping: general maintainance 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: 1997 June-owners records and permit Were sewage odors detected when arriving at the site? ❑ Yes ® No i t5inspNAndoverREV.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 - �S Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° M "< 124 Colonial Avenue Property Address Jodi Matthews Owner Owner's Name information is required for North Andover MA 01845 11/06/07 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 16 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 1010 feet Comments (on condition of joints, venting, evidence of leakage, etc.): all piping functioning as intended Septic Tank (locate on site plan): Depth below grade: V to tank top-6" risen in center 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: 9.6'x 5'x 5' Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 5" Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 20" How were dimensions determined? observations t5inspNAndoverREV.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 1 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 124 Colonial Avenue Property Address Jodi Matthews Owner Owner's Name information is required for North Andover MA 01845 11/06/07 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.): 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 F-1 other(explain): t5inspNAndoverREV.doc-06/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 Commonwealth of Massachusetts H - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments •''• 124 Colonial Avenue Property Address Jodi Matthews Owner Owner's Name information is required for North Andover MA 01845 11/06/07 every page. Clty/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 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.): working order, all lines are at working level and at equal flow, no carry over observations Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5inspNAndoverREV.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 124 Colonial Avenue Property Address Jodi Matthews Owner Owner's Name information is required for North Andover MA 01845 11/06/07 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 at 40' 0" ❑ 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.): no vegetation observed at leach area no dampness observed at present no signs of hydraulic failure I t5inspNAndoverREV.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 rt °Y r • S • Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 124 Colonial Avenue Property Address Jodi Matthews Owner information is Owner's Name required for North Andover MA 01845 11/06/07 every page. City/Town 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.): t5inspNAndoverREV.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 re ?• Commonwealth of Massachusetts Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 124 Colonial Avenue Property Address Jodi Matthews Owner Owner's Name information is required for North Andover MA 01845 11/06/07 every page. City/Town 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. 124 Colonial Avenue 34'-6" 22'-0" 35'-0" 20'-3° 38'-0" septic tank distribution box 9"deep w/2 risers 58'-0" Septic Tank 6" deep to center riser SAS 2 @ 40'-0" O vent i I I t5inspNAndoverREV.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 a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 124 Colonial Avenue Property Address Jodi Matthews Owner Owner's Name information is required for North Andover MA 01845 11/06/07 every page. Cltyrrown 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 If checked, date of design plan reviewed: reviewed 11/02/97 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: per plan-test hole at 90" estimated high ground water elevation 154.6 on 06/06/96 t5inspNAndoverREV.doc•06/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 ,. i I Summary Record Caro generateo on i Inzuur IZno:J°t-M Dy r aren manion .U. , ` Town of North Andover Tax Map # 210-1073-0137-0000.0 124 COLONIAL AVENUE JODI MATTHEWS 124 COLONIAL AVE NORTH ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Size Total 0.5 Acres FY 2007 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until JODI MATTHEWS Payor 124 COLONIAL AVE NORTH ANDOVER,MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 14092.0-124 COLONIAL AVENUE Last Billing Date 9/5/2007 2100031 02 Cycle 02 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 259.82 /1 UB Meter Maintenance Serial No Status Location Brand Type Size YTD Cons 43993574 a Active EN F.RT. NEPTUNE NEPTUNE w Water 0.63 0.63 0 Date Reading Code Consumption Posted Date Variance 1175/2007 3399 a Actual 109 91% 8/1/2007 3290 a Actual 54 9/1'4/2007 -100% 5/2/2007 3236 c Correction 0 6/26/2007 -100% 2/28/2007 3236 m Manual estimate 15 3/23/2007 -93% 11/2/2006 3221 a Actual Trouble Code:03 141 12/22/2006 `� 23% 8/21/2006 3080 a Actual 138 9/13/2006 1285% Trouble Code:03 5/25/2006 2942 a Actual 12 6/2b/2006 16% Trouble Code:03 2/8/2006 2930 a Actual 9 3/13/2006 -90% Trouble Code:03 11/8/2005 2921 a Actual 86 12/T4/2005 -73% Trouble Code:03 8/10/2005 2835 aActual 344* 9/12/2005 . 951% Trouble Code:03 ! 5/5/2005 2491 a Actual 27 6/8/2005 324% 2/14/2005 2464 a Actual 7 3/15/2005 -1% Trouble Code:03 11/18/2004 2457 a Actual 8 12/17/2004 -90% Trouble Code:03 8/10/2004 2449 a Actual 72 9/20/2004 547% Trouble Code:03 5/14/2004 2377 a Actual 11 6/14/2004 30% 2/17/2004 2366 a Actual 10 4/16/2004 0% 11/6/2003 2356 n New Meter 0 11/6/2003 0% 7(- TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System( constructed; ( )repaired; by located at was installed in conformance with the.North Andover Board of Health approved plan, System Design Permit#-f4oz' dated Z7 with an approved design flow of gallons per day. The materials use were in conformance with those specified on the approved plan;the system was installedin-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. Installer: Lic. #: Date: / /S Design Engineer: 2�O Date: Town of North Andover, Massachusetts Form No.3 HpRTh BOARD OF HEALTH 1-7r'� 01 L H A DISPOSAL WORKS CONSTRUCTION PERMIT 9SSACHUSE� • Applicant �� �`�'_—l�� �:��. r, NAME ADDRESS 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. CHAIRMAN,BOARD OF HEALTH Fee D.W.C. No. APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: j CURRENT INSTALLER'S LICENSE# LOCATION: U ( C- 11d16 6 LICENSED INSTALLER: LER: SIGNATURE: clzz y' 7 ` TELEPHONE# cJ CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUII.T. 315 Administrative Use Only $75.00 Fee Attached? Yes No Foundation As-Built? Yes L� r No Floor Plans? YesL No Approval2 Date: I I tz FORK 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 local or state law, regulations or requirements. ****************Appli cant fills out this section*****I*t*********** APPLICANT: A • (. 1 A L r Inc,n G Phone LOCATION: Ass essor's Map Number Parcel Subdivision IQAJ ESI AILS Lot(s) Street _C0 I011 i U I R Je- St. Number 17-4 ************************Official Use Only************************ RECO ATI_ S AGENTS: Date Approved 41101% Conservation Administrator Date Rejected Comments Y\`l Date Approved Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected Date Approved Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections - driveway permit ire Department C1 - Received by Building Inspector Date Town of North AndoverE NORTH , OFFICE OF �?o`t�. 16 10 COMMUNITY DEVELOPMENT AND SERVICES �O 9 t s 30 School Street �9 , North Andover,Massachusetts 01845 ��'°4•..° °" <y WILLIAM J. SCOTT ssACHUS Director September 25, 1997 Aurele Cormier AC Buiilders 33 Walker Road North Andover, MA 01845 RE: Woodland Estates Dear Aurele: This letter is to inform you that the proposed septic plans for Lot 17 Colonial Drive and Lot 25 Oxbow Circle have been approved. If you have any questions,,please do not hesitate to call the Board of Health office at the number below. Sincerely, .Sandra Starr, R.S. Health Administrator cc: Wm. Scott, Dir. CD&S File ro vCrRVATION 6M9530 HRAI.TH 698-9544' PT,ANNMG X88-9L5 Town of North Andover oNORTH OFFICE OF �� '`'"`o "1�0L COMMUNITY DEVELOPMENT AND SERVICES ° . A 146 Main Street • i North Andover, Massachusetts 01845 y� ";,,o.••'`�5 WILLIAM J. SCOTT SSgcHus�t Director October 31, 1996 Mr. Aurele Cormier AC Builders 33 Walker Road North Andover, MA 01845 Re: Lots 27, 28, & 29 Colonial Ave. Dear Aurele: This is to notify you that the septic plans for Lots 27, 28, & 29 Colonial Ave. have been approved. The system for Lot 15 Puritan Ave and Lot 16 Colonial Ave. cannot be approved until waivers from the Planning Board for the 50 foot buffer zone have been granted. Lot 17 Colonial Ave. needs additional soil testing at the south end of the system. Any questions, please do not hesitate to call me at the number below. Sincerely, �_.........�j . �. . .. 0 Sandra Starr, R.S. Health Administrator SS/Cjp cc: Ed Stearns, Hayes Engineering BOARD OF APPEALS 688-9541 BUILDING 688-9543 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Town of North Andover Of 40RTH '1 ,,to OFFICE OF 3? g< COMMUNITY DEVELOPMENT AND SERVICES ° A s o 146 Main Street Q4AT{O "`S5 North Andover,Massachusetts 01845 9SSACMUS�t (508) 688-9533 February 29, 1996 Hayes Engineering 603 Salem Street Wakefield, MA 01880 Re: Lot #17 Colonial Drive To Whom it May Concern: This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: 1) Soil evaluation sheets missing. 2) Soil tests out of date. 3) Please specify 3 - 20 inch manholes on septic tank. 4) Tank walls must be a minimum of 4 inches thick unless reinforced. Where are specs? 5) Assessor's map & parcel missing. If you have any questions, please do not hesitate to call the Board of Health Office at the number below. Sincerely, jl�j, , Sandra Starr, R.S. Health Administrator SS/cjp BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Julie Parrino D.Robert Nicetta Michael Howard Sandra Starr Kathleen Bradley Colwell DATE o� Sheet of BOARD OF HEALTH TOWN OF NORTH ANDOVER / SUBSURFACE DISPOSAL DESIGN REVIEW FEE_ l� PERMIT # DATE RECEIVED_,/� �� APPLICANT ACU/cpS ASSESSOR'S MAP ADDRESS PARCEL # LOT # 1 ,7 /f ENGINEER �5 STREET ff J ADDRESS PLAN DATE 7� REV7 Lb CONDITIONS OF APPROVAL: Z67T `7 Q�l APPROVED DISAPPROVED _ (cl�l Sf�/L. Cl/�LUI�1/6.0 3/fEc�T� G?, Z" SG�c TESTS 60 OP b ,97-6- �y,U� GtJ 114&e-,5 /j�Usi Z-7- 60-1 ''jU � Town of North Andover, Massachusetts Form No.z ' f AORT1yBOARD OF HEALTH 1 a °� 2L 3� � . , oat F w . �^'tom' -"�• s °• -"=4�=Y DESIGN APPROVAL FOR "5``� SOIL ABSORPTION SEWAGE-DISPOSAL SYSTEM -_ Applicant s "]Jl-(�l � JL^ -- Test No. Site Location \ _ Reference Plans and Specs. �S - --!/';' — 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. ' CHAIRMAN,BOARD OF HEALTH rvJ - IIA'L4 a Fee _ Site System Permit No. r4OR T ® of 4 over 01 _ _ No. dover, Mass., 19 9,;' OCLAKE OCHICHEWICK 0 qr 4'r E D �l �G BOARD OF HEALTH PERMIT TFood/Kitchen //�f Septic Syste'rl �!�; / :� /� THIS CERTIFIES THAT............................P"f,.... ..�.............. �!4.�..1..�1�. .5................................... BUILDING INSPECTOR Foundation has permission to erect......................(................. buildings on .......... ..........C-616- U.l..4... ....... � ou t0 b8 occupied as /..,t~+..�, -!. �...4. Chimney ..................................................... . . . . . .. .................................. provided that the person accepting this permit shall in every respect conform to the terms of a 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. PERMIT EXPIRES IN 6 MONT HS ELECTR7/d SP UNLESS CONSTRUCTION ST � .................................... ... ....... ............... ..INSPECTOR Fina Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RougFinal 2' Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. J y�s ( G% Z 0 ------------------ ,9/9- 3 , I I i I i IM i i � I f �-- µ'- �1• � ill g� _ T TOWN OF NORTH ANDOVER i BOARD OF HEALTH i Location (j Permit 4 Food Service $ Retail Food Limited Retail $ Seasonal $ x Disposal Works Installers $ Disposal Works Construction Soil Testing $ f Design Approval Permit �• ;-j $ r kDumpster Permit $ I Burial Permit $ Swimming Pool Permit $ -.E Animal Permit $ 'f r. Recreational Camp Permit $ o Well Construction Permit $ f Funeral Directors Permit $ # Massage Establishment License $ C F �. Massage Practice License Suntanning Establishment $ ^ r 10 f Offal/Trash Hauler $ Other $ M l 61 Health,Agent White - Applicant Yellow - _ f D - ePt Pink Treasurer E OIL111 I 1 SOIL LAALUATOR 1'ocall(M dcjlc<s of I.trl ` I CQl(cslyL0-0 w " z FILE On-SIZE' Review Deep Hole Number ,� Date: _l� .�� T me: ��'r:<l •'',': Location (identify on site plan) _. ... Land Use .. .. __ -. . .. Slope (°b) . .. Surface Stones Vegetation... -._ .. . .. .. . ._. _ Landform ... .__ _.... ... .. ..._ _ .. -- -- -- - Position on landscape (sketch on the back) Distances from: Open Water Body feet Drainage way feet Possible Wet Area. .. . . . ... feet Property Line feet Drinking Water Well. feet Other DEEP OBSERVATION HOLE LOG* Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (Inches) (USDA) (Munsell) Mottling (Structure, Stones, Boulders, Consistency, % 1 Gravel) /2� C s ]12,n0l�'7,51 wt.� MINIMUM OF L L t Parent Material (geologic) DepthtoBedrock.. Depth to Groundwater Standing Water .n the Hole Q -//�� Weeping from Pit Face Estimated Seasonal High Ground Water 7'D 16) 0� � - UJ DI-Y AN'RONTI)FORM - I2%071:9� HAYES ENGINEERING, INC. FOR11\1 1 1 - S011, F\ A 1.1 ATOU 1'OIZ:\1 603 SALEM STREET I�,t I or f , WAKEFIELD, MA 01880 (6t 7)246-2800 � "'��~ TOWN OF R�'0�2FHFALTHN�p�R%+ FAX(617)246-7596 B0ARt)p No. JU�J 2 1 1996 I ),t1 JOB FILE — - Coin monNdealth of Massachusetts } North Andover' Massachusetts Soil Suitability Assessment for On-site Sewage Disposal Performed By: -_ rdon .Rogerson--- -- -- -- ---- -------- ---------- ---- --- --- Witnessed BY: .-Susan Ford-- -- I-- Ford... ..I — eco 15-1 On aA.C. BUILDERS No. Andover, Mass. ew construction ❑ Repair ❑ Office Review Published Soil Survey Available: No ❑ Yes Year Published ._.___________________ Publication Scale_._.__.__._________. Soil Map Unit Drainage Class-_____________._. ...__. Soil Limitations Surficial Geologic Report Available: No ❑ Yes ❑ Year Published Publication Scale Geologic Material (Map Unit) .. .... . ...................________..__._.__.__._____ ____ Landform.-------------_._.. Flood Insurance Rate Map: ._ .. - -... .. . . . .. . . Above 500 year flood boundary No ❑Yes ❑ Within 500 year flood boundary No ❑Yes ❑ Within 100 year flood boundary No ❑Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) ... ..... .......... Wetlands Conservancy Program Map (map unit) .. .. .. .. ...... .. _ _.. ..... Current Water Resource Conditions (USGS): Month Range :Above Normal ❑Norma': [113clu% Normal Other References Reviewed: Df.-1'A1T, 9'KO� D F0KM 1'1071!95 SEPTIC PLAN SUBMJITTALS LOCATION: Zd� NEW PLANS: YES $60.00/Plan REVISED PLANS: YES $25.00/Plan o2.5��� 7Z)& DATE: / -X /t 7 DESIGN ENGINEER: #Q ves 'En- When the submission is all in place, route to the Health Secretary I I ' i 7 ;. I, lig �, 1 I r% J -- --- ` 7-67W Form No.4 Town of North Andover, Massachusetts BOARD OF HEALTH May 5 19 98 CERTIFICATE OF COMPLIANCE This is to certify that the Individual Soil Absorption Sewage Disposal System constructed (X) or repaired ( ) �y Charles Zaher INSTALLER at Lot 17 Colonial Ave. SITE LOCATION has been installed in accordance with Board of Health Regulations as described in the Design _ Approval Site System Permit No. 862 dated 9/25/97 19 . The issuance of this certificate shall not be construed as a guarantee that the system will . function satisfactorily. BOARD OF HEALTH Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH °0 19 FO A i ' °� APPLICATION FOR SITE TESTING/INSPECTION 7 Q�AATED PPP\'Ly �SSACHUS�S Applicant NAME ADDRESS TELEPHONE Site Location Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN, BOARD OF HEALTH Fee Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No. 1 NORTH H BOARD OF HEALTH 32Oy�,T�eo ,6f6h�0 t 1. - 19 i 1 y # °R APPLICATION FOR SITE TESTING/INSPECTION ��SSACHU$���h Applicant NAME ADDRESS TELEPHONE Site Location .+7 {J �� �1- %'t ;� -�. r:'.1,;- h Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee ' � Test No. ' '.- S.S. 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;L q 19�� * V 0 "' -c 1 APPLICATION FOR SITE TESTING/INSPECTION SSACHus���y Applicant_ F11 � .w UC LkA NAME ADDRESS TELEPHONE Site Location LLT *" `1 A LaAt-� Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH FeeTest No. Z-/ S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. 1 Al T,�iG Sri-ra. n145r77777 i - PLAN REVIEW CHECKLIST ADDRESS �/� Cv�a.c�/ ENGINEER GENERAL 3 COPIES STAMP �� LOCUS �� NORTH ARROW �'� SCALE �--� CONTOURSe-' PROFILE SECTION BENCHMARK `"'� SOIL & PERCS ELEVATIONS WETS . DISCLAIMER ��' WELLS & WETS DRIVEWAY -- (Elev) WATER LINE ✓ FDN DRAINd WATERSHED?Ie�)-- SCH40 ✓--' TESTS CURRENT? _ SOIL EVAL �-y''r SEPTIC TANK MIN 150OG 4, / . 17 INVERT DROP GARB. GRINDER VD (+200o EDF) 25 ' TO CELLAR94 MANHOLE ELEV GW # COMPS . D-BOX �4 SIZE # LINES ` FIRST 2 ' LEVEL STATEMENT INLETIol.3. OUTLET /63.79= 17 (2-1 OR . 17 FT) TEE REQ 'D? LEACHING MIN 660 GPD? y RESERVE AREA L,`�4 ' FROM PRIMARY? !-1 20 SLOPE 100 ' TO WETLANDS 100 ' TO WELLS " 4 ' TO S . H. GW C.._---- (5 ' >2M/IN) 35 ' TO FND & INTRCPTR DRAINSnj — 325 ' TO SURFACE H22O�SUPP C--'- 4 ' PERM. SOIL BELOW FACILITY `/ MIN 12" COVER � FILL? (25 ' if above natural elev; 101if below) BREAKOUT MET? TRENCHES � / MIN 660 gpd SLOPE (min . 005 or 6"/ 1001 ) v SIDEWALL DIST. 3X EFF. W OR D (MIN 61 ) ` I--- RESERVE BETWEEN TRENCHES? �� IN FILL? MUST BE 10 ' MIN . L---'- 4" PEA STONE? VENT? L- (>3 ' COVER; LINES >501 ) BOT ��(06 + SIDE `� X LDNG ry = TOT 6 7,3 - d (L x W x #) (DxLx2x#) (G/ft2) Copyright© 1995 by S.L. Swrr