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HomeMy WebLinkAboutMiscellaneous - 125 REA STREET 4/30/2018 125 KA 61 t tt I - 210109�`w000•0 � � r COMMONWEALTH OF MASSACHUSETTS _ - EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS ti. DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B. STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION 1 e—N Property Address: ��� �,� T Name of Owner .A flaersart Address of Owner: Date of Inspection:Ak4WT- fq 2 w0 _kRK Name of Inspector:(Please Print) enn U. q,- I am a Wapproy systeminspectorpursuanttoSection15.340ofTrue5(310CMR15.000) Company NamecMarring Address: T 1•t(;. a(�4,5— Telephone Numb CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails n Inspector's Signature: Q< `�(q�. Date: Z7Z7 9 The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of'Environmental Protection. The original should be sent lavm system owner.and copies sent to the buyer,if applicable,and the approving authority. _ NOTES AND COMMENTS rel 4k� revised 9/2/98 Page Iof11 i� Printed on Recycled Paper i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ' CERTIFICATION(continued) Property Address: Owner: Date of 1�: -cRoo 0 INSPECTION SUMMARY: Check A, B, C, of D: A. SYSTEM PASSES: 1 have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria no evaluated ate indi ted below. . n COMMENTS: �ySTf yh 1S V11 vlc � r k 0301k idD,,ii� 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. Indicate yes, no,or not determined (Y, N, or NO). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) -�. or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). ✓ broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping-more than-four-times a year-due to broken or obstructed pipe(s)•. The-system vahmss^ inspection if(with approval of the Board of Health): -- broken pipe(s)are replaced obstruction is removed revised 9/2/98 Page 2of11 h i • I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A (� CERTIFICATION (continued) Property Address: las R�sxree I Owner::'Se'a c?• �SrC 9'o�o6a Date of Ins C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and 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.JMLL.PRQTECT THE PUBLIC HEALTH AND SAFETY AND.THE ENWBONMEN.T: Cesspool or privy is within 50 feet-of 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 AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone 1 of a public water supply well. :•.� _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis 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. Method used to determine distance (approximation not valid).- 3) OTHER rp, revised 9/2/98 Page 3of11 ' r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: la5b R(ra ST�°PC' Owner: TSeo6 C. Ar►d ,rave Date of Inspection: A�gU Jrq� a00o D. SYSTEM FAILS: You must indicate either "Yes" or"No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage irtEofeciRtywrs/stern component-due tto an overloaded orclegged-SASor 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 1/2 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 Soil Absorption System,cesspool or privy is below the high groundwater elevation. -- Any portion of a 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. If the well has been analyzed to be acceptable,attach copy of well water analysis for»coliform bacteria,volatile organic-compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: 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: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is-witbin.200 feet•of 846butary-to a eurfaoe.drir*4V 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) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4of11 h SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1a5 �ll`X't���`mer J Owner: � G nOL'r Jd Date of Inspection: Check if the following have been done:You must indicate either "Yes" or "No" as to each of the following: Yep No ✓ _ Pumping information was provided by the owner, occupant,or Board of Health. _ -None of the system components hawabeen puPMwdcforatleast two weeks and-thwaystem hasboeawceivingywsraal.flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _ As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. I _ The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. ✓/ _ All system components,excluding the Soil Absorption System, have been located on the site. v — The septic tank manholes were uncovered,opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions,depth of liquid,depth of sludge,depth of scum. The size and location of the Soil Absorption System orrthe site has been determined based on: t _ _ Existing information. For example, Plan at B.O.H. c /L Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) / [15.302(3)(b)) K - _ The facility owner.(and.occupants.if different frnm.owned-were-provided.with infwmatiomon.t)a4rnpw-maintenaaca-0f SubSurface Disposal Systems. ^�r revised 9/2/98 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION ' Property Address: Owner:Tmy iok A n&(Ma 1. Date of Inspection rl uSV1.-1 t x000 FLOW CONDITIONS RESIDENTIAL: Design flow: — g.p.d./bedroom. Number of bedrooms(design):_ Number of bedrooms(actual): Total DESIGN flow Number of current residents: Garbage grinder(yes or no): Laundry(separate system) (yes or no):V;, If yes,separateanspection,required Laundry system inspected (yes or no) Seasonal use(yes or no)- 1 Water meter readings,if•a.v�ilable(last two year's usage(gpd): � Sump Pump(yes or no): LSO Last date of occupancy:�TT COMMERCIALIINDUSTRIAL: Type of establishment: Design flow: apd (Based on 15.203) Basis of design flow Grease trap present:(yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system:(yes or no)_ Water meter readings,if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING R CORDS and source of information: System pumped as part ol inspection: (yes or no If yes,volume pumped: 1000 _gallons Reason for pumping: TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval I Other APPROXIMATE AGE of all components,date installediif known)-and source ofywformation: -- �3 � ,..... A-nsx� ca Sewage odors detected when-arriving at the site: (yes or no) ). revised 9/2/98 Page 6of11 H I I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ' ^ SYSTEM INFORMATION(continued) Property rePk ss• I�C5 Rec-'ST(YET Owner: G. Ar&`z-% Date of Inspection. VSUd r oI ��d BUILDING SEWER: (Locate on site plan) It Depth below grader Material of construction: cast iron_40 PVC_other(explain) Distance fromwrivate water supply well or suction line Diameter�_ Comment : (condition of joints,v ntin evidence of leakage,-etc.) 1 SEPTIC TANK-_ (locate on site plan) I( Depth below grade: Material of construction:,,concrete_metal_Fiberglass _Polyethylene_other(explain) If tank is(natal,hist age_ 1s.age.confirmed-by Certificate of Compliance_(Yes/No) Dimensions: l9' JA 0. ` Sludge depth: �� Distance from top of sludge to bottom of outlet tee orbaffle: _ Scum thickness:_ Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet or baffler ` How dimensions were determined:j�A�pctiyT ...r Comments: (recommendation for pumpin condition of inlet and outlet t es or-baffles,depth of liquid le I iq relatio to outlet invett, structure(-integrity, evidence of leakage,etc.) -Gam.at Jl ) j yt_�� �'and ix iH r `Oki ( M-.� c GSC c TIdK TGCn ` 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: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) revised 9/2/98 Page 7of11 N i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1,25 Req S-rter ti. Owner: 5atsG, Arron. Date of Inspecti : q �. t�a0OO TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or 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 Alarm level: Alarm in working order:Yes No Date of previous pumping: — _ Comments: (condition of inlet tee, condition of alarm and float switches,etc.) DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert: �..,i Comments: (note•if level qnd distribution is equal, eV enee of solids carryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER:_ (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) revised 9/2/98 Page 8of11 N i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 1 Property Address: Owner: J�.op� G. Ar> 'sah bate of Inspectioohh 1'J lT— i SOIL ABSORPTION SYSTEM(SAS):_ (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits,number:_ leaching chambers,number:_ leaching galleries,number:_ leaching trenches,number,length: leaching fields, number,dimensions: overflow cesspool,number:_ Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraupF failure,level y ism C of ding, dam soil, ond'tion of vege ation, etc. � f'1 •r on CESSPOOLS:_ (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(cesspool must be pumped as part of inspection) Comments: (note condition of soil,signs-of hydraulic failure,.level of.ponding,condition of.vegetation, etc.) PRIVY:_ (locate on site plan) Materjals of construction: Dimensions: Depth of solids: - Comments: (note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation;etc.) revised 9/2/98 Page 9of11 w • w , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Propa,1Y Address: a Owner: T.S2a G' �y�Qj'JQyt Date of Inspecti �vJT �,moa SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) Ivor l0 Rcmkf �- e; �6 0V 3� I � 4a. i i revised 9/2/98 page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) `I Property.Address: - 3 en— w�. owner: SasG G, Pn&MGA Date of Inspection: CI,R= NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep ^ SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater Feet v tJ�r- 7 Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed.Site(Abutting property, observation hole,basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators, installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) n S ire is evel tv1 SePTt c CLrek 1 S logiv(� (Ock-WIFC 1-4 `�ciJ�rro l s �fy uD rlo 1A7- o CJQVV) C1CSS D t' WO-Ter er Tly- Cell GLr lOdr� 1 S < P(OX 610 6 tmpnc ct JeA 0 -7 (016,1 -A 3 e 16 be - '4 revised 9/2/98 Page 11 of 11 Lot 12, Rea St. Shenrood flonres Inc. APPLICATION FOR SEWAGE DISPCSAL IMTALIATION HEA LTH DEPARTMENT - NORTH ANDOVER, MSS. I hereby make application for a permit for a sewage disposal installation at Lot 12 Ria St. I will install this system in ac- cordance with all the laws of the Commonwealth of Massachusetts and regulations of the Board of Health of the Town of North Andover. Further, I will construct the house sewer of bell and spigot pipe, the minimum diameter being 4 inches, and will maintain a minimum grade of 1/ until 10 feet pre- ceding the septic tank, where the grade shall not exceed 2%. I will install a con- crete septic tank ofL200_L'a1. in size. A manhole (s) permitting will be provided with removable cover (s) of iron or concrete within 12s inchesofthe ground surface. I will provide subsurface disposal field with 4 inch perforated or open jointed pipe and laid in a series of trenches, the bottom of which will pro- vide a minimum of XRT 200 lineal ( fie) feet of effective absorption area. The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging in size from 3/4 to 1-1/2 inches (dia.) and the pipes will be surrounded by similar material to a height of 2 inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench, 2 inches of gravel or stone 1/8" to 1/4" (dia. ) will be placed over the course gravel or stone. The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single tile line will exceed 100 feet in length and in any case, two lines of the will be installed. A minimum of 6 feet will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the installation will be less than 100 feet from any private water supply, 25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line. I further agree not to cover any portion of this installation until approved by the iMection officer, as provided below, and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application. DATE �'Gl Signat ", f Applicant r I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DA TE_�5 = - [� ignature of Health Agent I have inspected the uncovered system indicated above and find everything done as described. DATE ' . f Signature of, nspecting Office.,,, Percolation Test _� rain. Soil. sandy-clay Garbage Grinder No Connect-,Editl lermmai�Help WATER BILLING HISTORY 2100509—ANDERSON, JOSEPH G. � METER #1: 2100509 i -- --------------------- 125 REA ST � # CYCLE SERVICE PRIOR CURRENT USE WATER SEWER FEES TOTAL ,' • 1 2000-12 08/02/1999 117 142 25 68.25 0.00 0.00 68.25' `[✓ 2 2000-22 12/10/1999 142 193 51 139.23 0.00 0.00 139.23' . 3 2000-32 03/16/2000 193 223 30 81.90 0.00 0.00 81.90 4 2000-42 05/25/2000 223 253 30 81 .90 0.00 0.00 81.90 ,(F Y T -n . ® I - REVIEW CHOICE # or <ENTER> MORE HISTORY: I I r Q X0.1. K Start ;.q o y J A } Telne_ KVS T... lnbox CD Play .�Microso . ,> 1 32 PM ` , r 7 a� i SMUUB04A/CS/U05/L008 TOWN OF NORTH ANDOUER DATE: 08/01/00 TERMINAL NO: 000 CONSUMER METER F/M TIME: 12:01 :41 Acct: 01-2609000-0 ANDERSON JOSEPH G. 125 REA ST Meter No: 001 Reu Mtr/#: N 000 Book: 10 Page: 26090.00000 Meter Flg: 0 [1] Connector: ] Digits: 3] Dim Cd: A] Multiplier: ] Arb #: ] Manf Cd: ] Units: Pipe Size: ] Len: ] Type: ] Req: 00/00/0000 Inst: 00/00/0000 Cnct: 00/00/0000 Disc: 00/00/0000 Cd: 0] Wrk Cd: ] Mt Code: ] Met Loc: ] In/Out: ] Notes: 5/8 TRI ] Serial #• 0016427585 ] Bgn: Cur: 117 E Preu: 87 E 2nd Prev: 57 E [2] From: 02/05/1999 To: 04/22/1999 Curt: Preu2: Next: 00/00/0000 Cns Cr: Mth Bill: 03 User: ] -------------------------- Consumption Information ----------------------------- --- First 12 Billing Months ------[3] 1------ Last 12 Billing Months -------[4] 06/1999 30E 12/1997 39AI 06/1996 25E 12/1994 34C 03/1999 36E 09/1997 26EI 03/1996 25E 09/1994 25E 12/1998 30E 06/1997 19CI 12/1995 26E 06/1994 24E 09/1998 29E 03/1997 26CI 09/1995 17C 03/1994 24E 06/1998 41C 12/1996 28EJ 06/1995 26E 12/1993 30E 03/1998 27E 09/1996 43CI 03/1995 25E 09/1993 30E First 12 Total: 368 1 Last 12 Total: 311 <ESC> to Enter New Meter Number <M>odify, <D>elete or <N>ext a� � YWade r � w r � Y v FORM - U LOT RELEASE FORM i INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT Q R` O Ll�,K\N-�'� Q CSA PHONE ASSESSORS MAP NUMBER LOT NUMBER SUBDIVISION LOT NUMBER STREET STREET NUMBER gnome .......................... OFFICIAL USE ONLY....�:::`�:�::.:�.....a y of RECOMMENDATIONS OF TOWN AGENTS / . . mass ■.t....■ SN*ft-NI DATE APPROVED Z 7 t C NSERVATION ADMINISTRATOR DATE REJECTED COMMENTS /-�S S I t — ^ 3L�C / �,✓--� i DATE APPROVED TOWN PLANNER ! DATE REJECTED CON RENTS DATE APPROVED FOOD=OR DATE REJECTED DATE APPROVED O )( S. E OR-HEALTH E / DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS i-lopcbtu ILA DRIVEWAY PERMTI DATE APPROVED 4- S FIRE DEPARTMENT DATE REJECTED / S COMMENTS RECEIVED BY BUILDING INSPECTOR DATE NM V7 lsrx3 �`6Zi'b-tr 00, one . 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COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET,BOSTON MA 02108 (617)292-5500 TRUDY CORE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION /� Property Address: �� HML`iTY'C�T Name of Owner Ara (,,,TP�so� Address of Owner: A aorei Date of Inspection:�t� �� R 000 Name of Inspector:(Please Print) K�� W.� . 1 am a D appro)Rd system inspector pursuant to Section 15.340 of Tide 5(310 CMR 15.000) Company Mang Address:441Z14-allaT Telephone Number: - CERTIFICATION STATEMENT 1 certify that 1 have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails Q Inspector's Signature: a<�J� \1Cy._ Date: I ` The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Envirorimental Protection. The original should be sent tavm system owner-and copies sent to the buyer,if applicable,and the approving authority. - NOTES AND COMMENTS revised 9/2/98 Pagel of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: t��SSr � Owner: �rsavl Date of Insp� �Jt-1 r a Q 0 0 INSPECTION SUMMARY: Check A, B, C, o/ A A. SYSTEM PASSES: _ I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria noiLevaluated ale in ted below. n COMMENTS: Systr tS ;r,rfnul�vtG �iv� Co�lSif ��hc Cl�-P 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. Indicate yes,no,or not determined(Y,N.or ND). Describe basis of determination in all instances. If "not determined",explain why not. _ The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of ' Health). w broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced The system Yequired pumping-mom thawfourtimes a-yeardue to broken or obstructed pipe(s1. Thesystem wtltImsr— inspection if(with approval of the Board of Health): -' broken pipe(s)are replaced obstruction is removed revised 9/2/98 Page 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A f CERTIFICATION(continued) Property Address: 'as Rei sxree l Owner:' $e �.► Apc-SO+�1 Date of Ins : Aurp.1C 9,golsb C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and 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.PRQTECT THE PUBLIC HEALTH AND SAFETY AND.THE ENVIRONMEHL- Cesspool or privy is within 50 feet-of 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 AND SAFETY AND THE ENVIRONMENT: - The system has a septic tank and soil absorption system ISAS)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 soil absorption system and the SAS is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis 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. Method used to determine distance (approximation not valid).- 3) OTHER y✓' All revised 9/2/98 Page 3of11 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) E, (� JT - Property Address: Ic�1215RWA Owner: T3eoti a. Afvle sa✓c Date of Inspection: Av swx-41, a4Oo D. SYSTEM FAILS: You must indicate either "Yes" or"No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of-sewage into facili"u-system component-duetto an overloaded ormleggedSAS orTesspool. 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 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(sY. Number of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. - Any portion of a 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 I 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. If the well has been analyzed to be acceptable,attach copy of well water analysis for -coliform bacteria,volatile organic-compounds,ammonia nitrogen-and nitrate nitrogen. - E. LARGE SYSTEM FAILS: - 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: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is-witWn.200 feet of-e-tfibutaryAo a eurfao"rinkingawater-supply- the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area=IWPA)or a mapped Zone 11 of a public water"supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 P2ge4of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: `p�5 '7�C� � Owner: 3'6.SeQk G J)Aenjo l Date of Inspection:pov2 .ct, Check if the following have been done:You must indicate either"Yes"or"No" as to each of the following: Yes No f _ Pumping information was provided by the owner,occupant,or Board of Health. _ -None of the system�composents haveJman pumped4or-atleast two weeks an&the-system has�b"a=csiaiagarrsMW,flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _ As built plans have been obtained and examined. Note if they are not available with N/A. V/ _ The facility or dwelling was inspected for signs of sewage back-up. yL _ The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. ✓/ _ All system components,excluding the Soil Absorption System,have been located on the site. y _ The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees, material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. The size and location of the Soil Absorption System on-the site has been determined based on: Existing information. For example,Plan at B.O.H. _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) (15.302(3)(b)] The facility owner.(and.occupaats.if different from.owner)_ware.prnvided.with information-nn th 4mopm-maintena2cA-0f SubSurface Disposal Systems. revised 9/2/98 Page 5of11 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION sw _J't `Property address: 1`a5 reeC owner:z0- U,0k G, An&-(*\SCVL Date of Inspection: n V1T�r C J FLOW CONDITIONS RESIDENTIAL: Design flow: — g.p.d./bedroom. Number of bedrooms(design): Number of bedrooms(actual): Total DESIGN flow Number of current residents: Garbage grinder(yes or no): Laundry(separate system) (yes or no):V—;- If yes,separate inspection.required Laundry system inspected- {yes or no) Seasonal use(yes or no): Water meter readings,if av ilable(last two year's usage(gpd):�` 50-1. Sump Pump(yes or no):-0 Last date of occupancy: COMMERCIALIINDUSTRIAL: Type of establishment: Design flow: qpd ( Based on 15.203) Basis of design flow Grease trap present:(yes or no)_ Industrial Waste Holding Tank present:(yes or no)_ Non-sanitary waste discharged to the Title 5 system:(yes or no)_ Water meter readings,if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION r PUMPING R CORDS and source of information-. System um ed as art o inspection:(yes or no) Y ' ' * ' Y If yes,volume pumped: 1000 gallons Reason for pumping: 1 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) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components,date installed4if known)-and source ofwrformation: - C41�(ItQI %nSVCA1�ca 1163 .... - Sewage odors detected when-arriving at the site: (yes or no) O. revised 9/2/98 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) ��Sz rce'r Property A ess %a5 owner: e: , Date of Inspection. 19QsVjt- BUILDING SEWER: (Locate on site plan) Depth below grade: Material of construction: cast iron_40 PVC_other(explain) Distance from�private water supply well or suction line Diameter Comment :(condition of Joints.v tin evidence of leakage,-etc.) - - No �eakur�, Mt�tch SEPTIC TANK:_ (locate on site plan) I( Depth below grade: Material of construction:•concrete_metal_Fiberglass _Polyethylene_other(explain) If tank is(petal,//list age 1_ 1s_age_confirmed by Certificate of Compliance_(Yes/No) Dimensions: Sludge depth: I J& Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: to �� Distance from top of scum to top of outlet tee or baffle:_ tr Distance from bottom of scum to bottom of outlet tee or baffle:.�M How dimensions were determined:Alesaunaepja by-["a�p Comments: (recommendation for pumping, condition of inlet and outlet totes or.baffles,depth of liquid leyql iq relatioq to outlet invett, structural-integrity, evidence of leakage,etc.) P� 1 h Srt�td C_wA lTklNl. �1QL)1A (S � 10Q'' EX t T('dK91 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: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) revised 9/2/98 Page 7of11 e SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 7"^ Property Address: 1a5 h� S-rceer Owner: 1 G, �nderso� Date of Inspectr'dn: q(, ,s.�- ��apoo TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or 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 Alarm level: Alarm in working order:Yes_ No_ Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert: CD �4 v, Comments: (note.if level end distribution is equal, e4i enee of solids carryover,evidence of leakage into or out of box, etc.) Rnv - PUMP CHAMBER:_ (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) revised 9/2/98 P2ge8of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION INFORMATION(continued) ^� ME Property A�Idress d1� ,� _ L , bate of ITczs ohnuw .10('jp SOIL ABSORPTION SYSTEM(SAS):_ (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: Type: leaching pits,number:_ leaching chambers,number:_ leaching galleries,number:_ leaching trenches,number,length: leaching fields, number,dimensions: ( `otO XSO overflow cesspool,number:_ Alternative system: Name of Technology: Comments: (note condition of soil,signs of hydrauk failure,level of ponding, damp soil, and-tion of vegetation, etc. , � �/ eC�►'IL"/�TL'�/iCv CESSPOOLS:_ (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimension's of cesspool: Materials of construction: Indication of groundwater: inflow(cesspool must be pumped as part of inspection) 0 Comments: (note condition of soil,signs of hydraulic failure,-level of.ponding, condition of.vegetation, etc.) PRIVY:_ (locate on site plan) Materjals of construction: Dimensions: Depth of solids: Comments: (note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation;etc.) Ail I i revised 9/2/98 Page 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: to Owner: �os� G- Date of Inspecti �vs� SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) i0 .�e r I I _ revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address- Owner: Date of lnspectiion: NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells u w-- 7 'PT'+�1# !f-e cd Ll �e't4.,t vt C.�X��" f gov r - Estimated Depth to Groundwater_Feet U "(""' "" Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed-Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators, installers Used USGS Data Describe how you established the High Groundwater Elevation. (Most be completed) S ire i s (euwj i ,j sepTi r- cLrea,_ t s lo��� c34- ivx �� �e 7.' lS nd s t g� o e� TG, "10�c-er,o�- i s j ry Lot t I� no p' naS Of- Wer envy- Cello, 0060` 1'S (:��rox le �� 610('j d o� 6ed c roue o Lr�,��(' �o TtGV►'► O rz) be -q r �,. Ail revised 9/2/98 Page 11 of 11 II�+ Lp �.. ! .. f ■ f■ LP ,a 041 = Telnet -10.1.71.55 .xx-. a .x 4�Conrieck� Edit Terminal��Helps,�,; '^'�. n ": ,�;�:.; r���� , _ ,;�*��.' :�f,,. .:���..r<of'�,� 4��'•}s, `;�k:,� �'� ' " j��, L. i,..e.w,�"aa<<t„'a,.,,,;;..�,. .J:xc;F ...y!._z.....�,. ., •.w..r�s:...`x< .yk:haa>.,.r c r�. WATER BILLING HISTORY 2100504-ANDERSON, JOSEPH G. METER #1 : 2100509 --------------------- 125 REA ST # CYCLE SERUICE PRIOR CURRENT USE WATER SEWER FEES TOTAL e 1 2000-12 08/02/1999 117 142 25 68.25 0.00 0.00 68.25 �✓' 2 2000-22 12/10/1999 142 193 51 139.23 0.00 0.00 139.23' i 3 2000-32 03/16/2000 193 223 30 81 .90 0.00 0.00 81 .9©' 4 2000-42 05/25/2000 223 253 30 81 .90 0.00 0.00 81 -90, l'La . s t _ a ®` REUIEW CHOICE # or <ENTER> MORE HISTORY:. ` v.• nw i.j ■ 1 }�S EarC �� � �, ;�'�»�'�, 1'elrie... � INS T � I ribox � ('�CD Flay i�Microso ,�� � ,��`” 1. ��� � ¢1 32 Pf•A KVS Intomation Systems, Inc. E' X: SMUUB04A/CS/U05/L008 TOWN OF NORTH ANDOVER DATE: 08/01/00 TERMINAL NO: 000 CONSUMER METER F/M TIME: 12:01 :41 Acct- 01-2609000-0 ANDERSON JOSEPH G. 125 REA ST Meter No: 001 Reu Mtr/#: N 008 Book: 10 Page: 26090.00000 Meter Flg: 0 [1] Connector: ] Digits: 3] Dim Cd: A] Multiplier: ] Arb #: ] Manf Cd: ] Units: Pipe Size: ] Len: ] Type: ] Req: 00/00/0000 Inst: 00/00/0000 Cnct: 00/00/0000 Disc: 00/00/0000 Cd: 0] Wrk Cd: ] Mt Code: ] Met Loc: ] In/Out: ] Notes: 5/8 TRI I Serial #: 0016427585 1 Bgn: Cur: 117 E Preu: 87 E 2nd Preu: 57 E [2] From: 02/05/1999 To: 04/22/1999 Cur2: Preu2: Next: 00/00/0000 Cns Cr: Mth Bill: 03 User: ] -------------------------- Consumption Information ----------------------------- --- First 12 Billing Months ------[3] 1------ Last 12 Billing Months -------[4] 06/1999 30E 12/1997 39AI 06/1996 25E 12/1994 34C 03/1999 30E 09/1997 26EI 03/1996 25E 09/1994 25E 12/1998 30E 06/1997 19CI 12/1995 26E 06/1994 24E 09/1998 29E 03/1997 26CI 09/1995 17C" 03/1994 24E 06/1998 41C 12/1996 28EI 06/1995 26E 12/1993 30E 03/1998 27E 09/1996 43CI 03/1995 25E 09/1993 30E First 12 Total: 368 1 Last 12 Total: 311 <ESC> to Enter New Meter Number <M>odify, <D>elete or <N>ext � /CF �7' G � s ei7�r � ��� Lot 12, hea St. Sherwood Homes Inc. APPLICATION FOR SEWAGE DISPCSAL INSTALIATION HEALTH DEPARTMENT - NORTH ANDOVER, NASS. I hereby make application for a permit for a sewage disposal installation at Lot 12 Rra St. . I will install* this system in ac- cordance with all the laws of the Commonwealth of Massachusetts and regulations of the Board of Health of the Town of North Andover. Further, I will construct the house sewer of bell and spigot pipe, the minimum diameter being 4 inches, and will maintain a minimum grade of 1% until 10 feet pre- ceding the septic tank, where the grade shall not exceed 2%. I will install a con- crete septic tank ofL000 gal. in size. A manhole (s) permitting easy cleaning will be provided with removable cover (s) of iron or concrete within 12 inches of the ground surface. I will provide subsurface disposal field with 4 inch perforated or open jointed pipe and laid in a series of trenches, the bottom of which will pro- vide a minimum of X 200 lineal ( me) feet of effective absorption area. The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging in size from 3/4 to 1-1/2 inches (dia.) and the pipes will be surrounded by similar material to a height of 2 inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench, 2 inches of gravel or stone 1/8" to 1/4" (dia. ) will be placed over the course gravel or stone. The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single tile line will exceed 100 feet in length and in any case, two lines of the will be installed. A minimum of 6 feet will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the installation will be less than 100 feet from any private water supply, 25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line. I further agree not to cover any portion of this installation until approved by the inspection officer, as provided below, and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application. DA TE Signat f Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts DAZE_ " Sig-nature of Health Agent I have inspected the uncovered system indicated above and find everything done as described. DAM Signature 0nsp'e6ting Office Percolation Test 5 min. Soil sandy-c7.ay Garbage Grinder No " ' W ——> FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT �?C_>>_��1��'CZ C� � �'C�1 PHONE �7 �' 1 ASSESSORS MAP NUMBER LOT NUMBER P � SUBDIVISION LOT NUMBER STREET � 1= � STREET NUMBER �.....■.......... ......................................■................... .......................... OFFICIAL USE ONLY RECONM4ENDATIONS OF TOWN AGENTS C rz -e— �► 2�fes'` X ,' 7;na DATE APPROVED CONSERVATION ADMINISTRATOR DATE REJECTED CONMIENTS DATE APPROVED TOWN PLANNER DATE REJECTED CON RENTS DATE APPROVED FOOD INSP OR- DATE REJECTED DATE APPROVED S. EC OR-HEALTH DATE REJECTED 7 COMMENTS a/C�LlI/ <. l v t e-f, PUBLIC WORKS—SEWER/WATER CONNECTIONS i DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED 3 I � COMMENTS i RECEIVED BY BUILDING INSPECTOR DATE i i ,I N �- ••\ �ltt l��tt�-b O OC) / \ �i 1 O stt 0 M - °et \ y Z —.. Oset w NMV7ts�i wee,t-b ek oet \\ Oe. OEt ere -- ° \ het ee V°ac°•tlar ai � 9fO��n I n \ d°° °°C°44 G°°°C°°° Oe°°e° a°p°e°O° °° eap ae Qeea ° aaQoa Qe<AGAaQ°QQa °,,Q + AG° °4 OAee ° ° ° e°4leeo °ee°°Qa a° °°Oenc. I f-.t.0 �setpQee °eaoQ4, e v Q ° e °° °°e ° v I O °°°°°°°°e ° 4 44 4 1,34ape 4. ° °°°°a (O O \ �l N1 1S/X3 Q I Z • Sit° ° .4-- 4° ° °° p ° a °° ee° e °°Oe 4aaQ4aO °°° ° MN5zt# a a° ° °o° ee °4 °a° eNMV7 44ea ° e° °e . / ab z4aetOepe4a°QooQaQOoaaoe° , ot II Z_b tO�e N7VM 1S1X3 yy�sor7�iyj 6set °°°e e "4444°°°°°°o°° IO I W ��d °°°°°°° ° °°°° e°e °°° °° °4°°°e°°° ,%44444 IW / D ,., I °,°°eo°°,°°° 44 .4 Lu N p e . /A set 9e. ° cv '!OBS*yet opQ �410 °o ° ° ea e °° °°p ° �O Q) NM V7 o°e e°°°a°e / by se 06 19,0,> / °a° °°" / e �9 9et I' o a a44 aea �b tet °G°0e S °c°°°eea 100'00& 3„L5,09o9L N 13381S V38 F 2.27 00 228 co 0 O �� 22s1$ • �_ v FpGi!�' A4� -42 \ .4'9�24so \ —.. —.. - 224 —.. —.. _.. _ .. — Pp'gRC ZAN 56 292 223 ab S 76050'50" W 175.28' " Lot 12, Rea St. Sherwood Homes Inc. APPLICATION FOR SEWAGE DISPCSAL INSTALIATION HEALTH DEPARTMENT - NORTH ANDOVER, MSS. I hereby make application for a permit for a sewage disposal installation at Lot 12 Rea St. . I will install this system in ac- cordance with all the laws of the Commonwealth of Massachusetts and regulations of the Board of Health of the Town of North Andover. Further, I will construct the house sewer of bell and spigot pipe, the minimum diameter being 4 inches, and will maintain a minimum grade of Vo until 10 feet pre- ceding the septic tank, where the grade shall not exceed 29. I will install a con- crete septic tank ofL000 ga.l. in size. A manhole (s) permitting easy cleaning will be provided with removable cover (s) of iron or concrete within 12 inches of the ground surface. I will provide subsurface disposal field with 4 inch perforated or open jointed pipe and laid in a series of trenches, the bottom of which will pro- vide a minimum of AW 200 lineal (ire) feet of effective absorption area. The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging in size from 3/4 to 1-1/2 inches (dia.) and the pipes will be surrounded by similar material to a height of 2 inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench, 2 inches of gravel or stone 1/8" to 1/4" (dia. ) will be placed over the course gravel or stone. The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single tile line will exceed 100 feet in length and in any case, two lines of tile will be installed. A minimum of 6 feet will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the installation will be less than 100 feet from any private water supply, 25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line. I further agree not to cover any portion of this installation until approved by the inspection officer, as provided below, and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application. DATE G _ Signat -e -f Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DA TE_'3 - q - (� 3 signature of Health Agent I have inspected the uncovered system indicated above and find everything done Y Y g as described. DATE 41', 14 , �Jf Signature off Yns'p'661'1n9 Office Percolation Test 5. min. Soil sandy-c]. Garbage Grinder No ` " FORM U - LOT RELEASE.FORM _�_ -y-- FF INSTRUCTIONS: This form is used to verify that all'necessary approvals/permfts,from� Boards and Departments having jurisdiction have"been' obtained. This does.not felieve`. the applicant and/or landowner from compliance`With-any applicable or requirements. ' ***************_*****APPLICANT FILLS OUT THIS SECTION*********************** ARPLICANT- PHONE � f ' LOCATION:- Assessor's Map Number - 0q PARCEL SUBDIVISION. LOT (S) STREET ST. NUMBER USE ONLY***** RECOMMENDATIONS OF TOWN AGENTS: ('o,,� UC p CotKlfRVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS_u L�rnn. AJ Q- N "" C)C---- �xo j zZ, — yaek +v �_Ie AJ 0_—_u TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED h� COMMENTS PUBLIC WORKS -SEWERIWATER CONNECTIONS DRIVEWAY PERMIT �\ FIRE DEPARTMENT i: --n dQ•� ✓� RECEIVED BY BUILDING-INSPECTOR DATE r Revised 9\97jm 18A'BE I.NS.PECTI0N PLAN s�J 1tr%Tone= ------------ -' °.Oates scale:---! o !ER _.0vnerr ------- Buyers Deed tet. Z9o. ..1�-«_..-3/�-LLQ--__- Plan N Dravn per CitylTovn of ___r�:Jjf, Tax Assessors Map. ----------- '�1�F R l GSS I X15, 292 . S i" St= + 0 J F S u M to � 0 M {^2.�—•� sHco vT 1 i 2 STo fZy, �N �-n To:_ �TEf=?.f�� � 10N��L --------- ---- ------------ ----------- I -hereby certify .that the above Mortgage Inspection Plan vas prepared for use in connection vith a Rev Mortgage and is not Intended or represented to be a property line or land survey. It cannot be used for establishing fence, hedge , valls or building lines. No responsibility is extended herein* to the land ovner or occupant. The location of the original building(s) as shove herein vas in compliance vith the local' applicable zoning bylays in effect4tft constructed, vith respect to horizontal ai.aneiM„s 10t.11nes or is exemot from violation enforcement action under Mass G.L. Title VII, Chap. 40A, Sec. C VAX P � IO ,s i E y Jr 44 h.�5. FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: �SPK ��tk11 �n� Sr/1 Phone LOCATION: Assessor' s Map Number Ole Parcel lel Subdivision to Lot(s) # la StreetSt. Number 1dJ ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: 4 Date Approved Conservation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected ✓ L� z�'����' Date Approved Septic Inspector-Health Date Rejected Comments t—Public Works - sewer/water connections ( - dr�iermit LF"ire Department Received by Building Inspector Date