HomeMy WebLinkAboutMiscellaneous - 132 DUNCAN DRIVE 4/30/2018 _ 132 DUNCAN DRIVE
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ACTION-KING ENTERPRISES,INC. +
� 26 LIVINGSLOWELLTMA 018ON ET
52
TEL:(508)452-7750
FAX:(508)459-0770
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIO, FO
PARTEA--,_
CERTIFICATION"
PROPERTY ADDRESS: ERIC TEITINEN
DATE OF INSPECTION: 4-1-96 AD OF OWNER:
NAME OF INSPECTOR: WALTER BREAULT JR. D FFERENT)
CERTIFICATION STATEMENT
I CERTIFY THAT I HAVE PERSONALLY INSPECTED THE SEWAGE DISP0VQ. SYSTEM AT THIS
ADDRESS AND THAT THE INFORMATION REPORTED BELOW IS TRUE,ACS`:-,1';?ATE AND COMPLETE
AS OF THE TIME OF INSPECTION. THE INSPECTION WAS PERFORMED BA 4:"')ON MY TRAINING
AND EXPERIENCE IN THE PROPER FUNCTION AND MAINTENANCE OF Old'-F,,.''E SEWAGE DISPOSAL
SYSTEMS. THE SYSTEM.
X PASSES
CONDITIONALLY PASSES
NEEDS FURTHER EVALUATION BY THE LOCAL A?" OVING AUTHORITY
FAILS
INSPECTOR'S SIGNATURE: HQA AATE: 41-96
THE SYSTEM INSPECTOR SHALL SUBMIT A COPY EfTHIS INSPECTION REPORT TO THE APPROVING
AUTHORITY 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 TO THE SYSTEM
OWNER AND COPIES SENT TO THE BUYER,IF APPLICABLE AND THE APPROVING AUTHORITY.
INSPECTION SUMMARY:
CHECK A,B,C,OR D.
A) SYSTEM PASSES:
NIA I HAVE NOT FOUND ANY INFORMATION WHICH INDICATES THAT THE SYSTEM VIOLATES
ANY OF THE FAILURE CRITERIA AS DEFINED IN 310 CMR 15303.
ANY FAILURE CRITERIA NOT EVALUATED ARE INDICATED BELOW.
B) SYSTEM CONDITIONALLY PASSES:
ONE OR MORE SYSTEM COMPONENTS NEED TO BE REPLACED OR REPAIRED. THE
SYSTEM UPON COMPLETION OF THE REPLACEMENT OR REPAIR,PASSES INSPECTION.
INDICATE YES,OR 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,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 CONFORMING
SEPTIC TANK AS APPROVED BY THE BOARD OF HEALTH.
PAGE 1
ACTION-KING ENTERPRISES,INC.
26 LIVINGSTON STREET
LOWELL,MA 01852
TEL:(508)452-7750
FAX:(508)459-0770
PROPERTY ADDRESS: 132 DUNCAN DRIVE NORTH ANDOVER,MA 01845
OWNER: ERIC T1 I T I jo E N
DATE OF INSPECTION:
ACTION KING ENTERPRISES,INC.HAS BEEN RETAINED BY THE OWNER TO PROVIDE AN INSPECTION
OF THE ON-SITE SEWERAGE DISPOSAL SYSTEM AS DEFINED BY 310 CMR 15.303.D.E.P.GUIDANCE
INSTRUCTS THE INSPECTOR TO MAKE AN EVALUATION OF THE SYSTEMS PERFORMANCE ON THE
DAY OF THE INSPECTION. THE TITLE 5 INSPECTION IS NOT DESIGNED TO PROVIDE INFORMATION
TO DEMONSTRATE THAT THE SYSTEM WILL ADEQUATELY SERVE THE USE TO BE PLACED UPON IT
BY THE NEW OWNER AS STATED IN 15302. THIS ISPECTION IS NOT A WARRANTEE OR GUARANTEE
OF THE SYSTEM FUTURE PERFORMANCE,AND DOES NOT EITHER EXPRESS OR IMPLY IT.
PAGE 1-A
ACTION-KING ENTERPRISES,INC
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (CONTINUED)
PROPERTY ADDRESS: 132 DUNCAN DRIVE NORTH ANDOVER MA 01845
OWNER: ERIC TEITINEN
DATE OF INSPECTION: 4-1-%
B) SYSTEM CONDITIONALLY PASSES (CONTINUED)
NIA SEWAGE BACKUP OR BREAKOUT OR HIGH STATIC WATER LEVEL OBSERVED IN THE
DISTRIBUTION BOX IS DUE TO BROKEN OR OBSTRUCTED PIPES) 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 LEVELED OR REPLACED
THE SYSTEM REQUIRED PUMPING MORE THAN FOUR 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
C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
N/A 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 THAT THE SYSTEM IS NOT
FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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
APPROPRIATE)DETERMINES THAT THE SYSTEM IF FUNCTIONING IN A MANNER THAT
PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT.
THE SYSTEM HAS A SEPTIC TANK AND SOIL ABSORPTION SYSTEM AND IS WITHIN
100 FEET TO A SURFACE WATER SUPPLY OR TRIBUTARY TO A SURFACE WATER
SUPPLY.
THE SYSTEM HAS A SEPTIC TANK AND SOIL ABSORPTION SYSTEM AND IS WITHIN
A ZONE I OFA PUBLIC WATER SUPPLY WELL.
THE SYSTEM HAS A SEPTIC TANK AND SOIL ABSORPTION SYSTEM AND IS WITHIN
50 FEET OF A PRIVATE WATER SUPPLY WELL.
THE SYSTEM HAS A SEPTIC TANK AND SOIL ABSORPTION SYSTEM AND 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 THE 5PPM.
PAGE 2
ACTION-KING ENTERPRISES,INC.
D) SYSTEM FAILS:
N/A I HAVE DETERMINED THAT THE SYSTEM VIOLATES ONE OR MORE OF THE FOLLOWING
FAILURE CRITERIA AS DEFINED 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 FAILUR.
BACKUP OF SEWAGE INTO FACILITY OR SYSTEM COMPONENT DUE TO AN
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 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 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:
THE FOLLOWING CRITERIA APPLY TO LARGE SYSTEMS IN ADDITION TO THE CRITERIA
ABOVE.
VA THE DESIGN FLOW OF SYSTEM IS 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:
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(WPA) OR A MAPPED ZONE H OF A PUBLIC WATER SUPPLY
WELL.
THE OWNER OR OPERATOR OF ANY SUCHSYSTEM SHALL BRING THE SYSTEM AND FACILITY INTO
FULL COMPLIANCE WITH THE GROUNDWATER TREATMENT PROGRAM REQUIREMENTS OF 314 CMR
5.00 AND 6.00. PLEASE CONSULT THE LOCAL REGIONAL OFFICE OF THE DEPARTMENT FOR FURTHER
INFORMATION.
PAGE 3
ACTION-KING ENTERPRISES,INC.
PART B
CHECKLIST
PROPERTY ADDRESS: 132 DUNCAN DRIVE NORTH ANDOVER.MA 01845
OWNER:ERIC TEITINEN
DATE OF INSPECTION: 4-1-96
CHECK IF THE FOLLOWING HAVE BEEN DONE.
X PUMPING INFORMATION WAS REQUESTED OF THE OWNER,OCCUPANT,AND BOARD OF
HEALTH.
X_NONE OF THE SYSTEM COMPONENTS HHAVE BEEN PUMPED FOR AT LEAST TWO WEEKS AND
THE SYSTEM HAS BEEN RECEIVING NORMAL FLOW RATES DURING THAT PERIOD. LARGE
VOLUMES OF WATER HAVE NOT BEEN INTRODUCED INTO THE SYSTEM RECENTLY OR AS
X PART OF THIS INSPECTION.
X AS BUILT PLANS HAVE BEEN OBTAINED AND EXAMINED. NOTE IF THEY ARE NOT
AVAILABLE WITH N/A.
X THE FACILITY OR DWELLING WAS INSPECTED FOR SIGNS OF SEWAGE BACK-UP.
X THE SYSTEM DOES NOT RECEIVE NON-SANITARY OR INDUSTRIAL WASTE FLOW.
_X THE SITE WAS INSPECTED FOR SIGNS OF BREAKOUT.
X ALL SYSTEM COMPONENTS,EXCLUDING THE SOIL ABSORPTION SYSTEM,HAVE BEEN
LOCATED ON THE SITE.
X THE SEPTIC TANK MANHOLES WERE UNCOVERED,OPENED,AND THE INTERIOR OF THE
SEPTIC TANK,WAS INSPECTED FOR CONDITION OF BAFFLES OR TEE,MATERIAL OF
CONSTRUCTION,DIMENSIONS,DEPTH OF LIQUID,DEPTH OF SLUDGE,DEPRTH OF SCUM.
X THE SIZE AND LOCATION OF THE SOIL ABSORPTION SYSTEM ON THE SITE HAS BEEN
DETERMINED BASED ON EXISTING INFORMATION OR APPROZIMATED BY NON-INTRUSIVE
METHODS.
X THE FACILITY OWNER AND OCCUPANTS,IF DIFFERENT FROM OWNERS WERE PROVIDED
WITH INFORMATION ON THE PROPER MAINTENANCE OF SUB-SURFACE DISPOSAL SYSTEM.
PAGE 4
ACTION-KING ENTERPRISES,INC.
SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM
PART C
SYSTEM INFORMATION
PROPERTY ADDRESS: 132 DUNCAN DRIVE NORTH ANDOVER,MA 01845
OWNER:ERIC TEITINEN
DATE OF INSPECTION: 4-1-96
RESIDENTIAL:
DESIGN FLOW: 440 GALLONS.
NUMBER OF BEDROOMS: 4
NUMBER OF CURRENT RESIDENTS: 2
GARBAGE GRINDER(YES OR NO) NO
SEASONAL USE(YES OR NO) NO
WATER METER READINGS,IF AVAILABLE: WELL WATER LAUNDRY CONNECTED TO SYSTEM
LAST DATE OF OCCUPANCY: OCCUPIED
COMMERCIAL/INDUSTRIAL:
TYPE OF ESTABLISHMENT: N/A
DESIGN FLOW: GALLONS/DAY
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 DAY OF OCCUPANCY:
OTHER: (DESCRIBE)
LAST DAY OF OCCUPANCY:
GENERAL INFORMATION
PUMPING RECORDS AND SOURCE OF INFORMATION.
9 YEARS/OWNER
SYSTEM PUMPED AS PART OF INSPECTION(YES OR NO) YES
IF YES,VOLUME PUMPED 2500 GALLONS.
REASON FOR PUMPING INSPECT FOR CRACKS AND BAFFLES
TYPE OF SYSTEM
X SEPTIC TANKIDISTRIBUTION BOX/SOEL ABSORPTION SYSTEM
SINGLE CESSPOOL
OVERFLOW CESSPOOL
PRIVY
SHARED SYSTEM(YES OR NO)(IIS'YES,ATTACH PRVIOUS INSPECTION RECORDS,IF ANY)
OTHER
(EXPLAIN)
APPROXIMATE AGE OF ALL COMPONENTS,DATE INSTALLED(IF KNOWN)AND SOURCE OF
INFORMATION. 15 YEARS/OWNER
SEWAGE ODORS DETECTED WHEN ARRIVING AT THE SITE.(YES OR NO) NO
PAGES
i
ACTION-KING ENTERPRISES,INC.
PART C
SYSTEM INFORMATION(CONTINUED)
PROPERTY ADDRESS: 132 DUNCAN DRIVE
OWNER: ERIC TEITINEN
DATE OF INSPECTION: 4-1-96
SEPTIC TANK: YES
(LOCATE ON SITE PLAN)
DEPTH BELOW GRADE: 6"
MATERIAL OF CONSTRUCTION: X CONCRETE METAL FRP OTHER
(EXPLAIN)
DIMENSIONS: 12'X 6'X 5'
SLUDGE DEPTH: 12"
DISTANCE FROM TOP OF SLUDGE TO BOTTOM OF OUTLET TEE OR BAFFLE: 18"
SCUM THICKNESS: 6"
DISTANCE FROM TOP OF SCUM TO TOP OF OUTLET TEE OR BAFFLE: 4"
DISTANCE FROM BOTTOM OF SCUM TO BOTTOM OF OUTLET TEE OR BAFFLE: 18"
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.)
GREASE TRAP: N/A
(LOCATE ON SITE PLAN)
DEPTH BELOW GRADE:
MATERIAL OF CONSTRUCTION: CONCRETE METAL FRP 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:
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.)
PAGE 6
ACTION-KING ENTERPRISES,INC.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(CONTINUED)
PROPERTY ADDRESS: 132 DUNCAN DRIVE NORTH ANDOVER.MA 01845
OWNER: ERIC TEITINEN
DATE OF INSPECTION:4-1-%
TIGHT OR HOLDING TANK: NIA
(LOCATE ON SITE PLAN)
DEPTH BELOW GRADE
MATERIAL OF CONSTRUCTION: CONCRETE METAL FRP OTHER
(EXPLAIN)
DIMENSIONS• NIA
CAPACITY: GALLONS
DESIGN FLOW: GALLONS/DAY
ALARM LEVEL
COMMENT:
(CONDITION OF INLET TEE,CONDITION OF ALARM AND FLOAT SWITCHES,ETC.)
DISTRIBUTION BOX: YES
(LOCATE ON SITE PLAN)
DEPTH OF LIQUID LEVEL ABOVE OUTLET INVERT: O
COMMENTS:
(NOTE IF LEVEL AND DISTRIBUTION IS EQUAL,EVIDENCE OF SOLIDS CARRY OVER,EVIDENCE OF
LEAKAGE INTO OR OUT OF BOX,
ETC.)
PUMP CHAMBER:
(LOCATE ON SITE PLAN)
PUMPS IN WORKING ORDER(YES OR NO) N/A
COMMENTS:
(NOTE CONDITION OF PUMP CHAMBER,CONDITION OF PUMPS AND APPURTENANCES,
ETC.)
PAGE 7
ACTION-KING ENTERPRISES,INC.
PROPERTY ADDRESS: 132 DUNCAN DRIVE NORTH ANDOVER,MA 01845
OWNER: ERIC TEITINEN
DATE OF INSPECTION: 4-1-%
SOIL ABSORPTION SYSTEM(SAS): YES
(LOCATE ON SITE PLAN,IF POSSIBLE,EXCAVATION NOT REQUIRED,BUT MAY BE APPROXIMATED BY
NON-INTURSIVE METHODS).
IF NOT DETERMINED TO BE PRESENT,EXPLAIN:
TYPE:
LEACHING PITS,NUMBER:
LEACHING CHAMBER,NUMBER:
LEACHING GALLERIES,NUMBER:
LEACHING TRENCHES,NUMBER LENGTH: FIVE 2Ca,15' 2(a,40' la,20'
LEACHING FIELDS,NUMBER,DIMENSIONS:
OVERFLOW CESSPOOL.NUMBER:
COMMENTS: (NOTE CONDITION OF SOIL,SIGNS OF HYDRAULIC FAILURE,LEVEL OF PONDING,
CONDITION OF VEGETATION,
ETC.)
CESSPOOLS: NIA
(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 HYDRAULICA FAILURE,LEVEL OF PONDING,
CONDITION OF VEGETATION,ETC.)
PRIVY: N/A
(LOCATE ON SITE PLAN)
MATERIALS OF CONSTRUCTION: DIMENSIONS:
DEPTH OF SOLIDS:
COMMENTS: (NOTE CONDITION OF SOIL,SIGNS OF HYDRAULIC FAILURE,LEVEL OF PONDING,
CONDITION OF VEGETATION,ETC.),
PAGE 8
e
• ACTION-KING ENTERPRISES,INC.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(CONTINUED)
PROPERTY ADDRESS: 132 DUNCAN DRIVE NORTH ANDOVER,MA 01845
OWNER: ERIC TEITINEN
DATE OF INSPECTION: 41-96
SKETCH OF SEWAGE DISPOSAL SYSTEM:
INCLUDE TIES TO AT LEAST TWO PERMANENT REFERENCES LANDMARKS OR BENCHMARKS
COAT ALL WELLS WITHIN 100
132 DUNCAN DRIVE NORTH ANDOVER,MA C IE.5
0
re'
a5na Sege �e
DEPTH TO GROUNDWATER
DEPTH TO GROUNDWATER: 81+
METHOD OF DETERMINATION OR APPROXIMATION: CATCH BASIN
PAGE 9
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Date ZIA, ����
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
SACHOS
This certifies thatI. .11 . . . . . . . . . .
has permission to perform ,. j . . . .
plumbing in the buildings of . . ^��
at 1! 41 North Andover, Mass.
Feiv��. .Lie. No.. . . •. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
/ PLUMBING INSPECTOR
Check
5 & 31
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)
/ y d/—jA Ald6 Iy if ' Mass. Date 7 Permit #
i Buliding Location 0 h
L) / r a.ri. -i've_ Owner's Name__
Type of Occupancy Residential
H
New ❑ Renovation ❑ Replacement N Plans Submitted: Yes❑ No ❑
FIXTURES
H N N O 2 ~
W YJ N > V a N 7 L7 p[
cc
to Cr m H 3w 2 1- a w x ¢ a t7 a a cU 73 gal
x aJ
2 w F- ►' w a N Q a J N 6 J Z p C O LL xi Q
w = a x 3 3 O z s X a O. F-
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a ~ a x � V) a a 0 a J J a x a a a o
3 Y
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SUB—BSMT.
BASEMENT
IST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
TTHF.L02A
STH FLOOR
Installing Company,Name_Heritage Htg. &P1g. Co. Inc.' Check one: Certificate
Address '. 35 Pleasant -Street IX Corporation 714
Stoneham,` Ma 02180 L.1 Partnership
Business Telephone—f. 781 -4 3's—7 7 7 6 F1 Firm/Co. i
Name of Licensed Plumber ' Gordon Switzer
INSURANCE COVERAGE:
I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142
Yes 91 No ❑
If you have Checked yes; please Indicate the type coverage by checking the appropriate box. t
'A liability Insurance policy IN Other type of Indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Owner ❑ Agent❑
Signature of Owner or Owner's Agent
I hereby certify that all of the details and information i have submitted(or entered)in above application are true and accurate to the best of my
knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all .
'pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
BY
r si ature of censed Plumber
title_
I Type of License: Master[g Journeyman[j
City/Town 8 3 2 2
i APP license Number
{
BELOW FOR OFFICE USE ONLY
FINAL INSPECTIONS SKETCHES PROGRESS INSPECTIONS
FEE
NO.
APPUCA,rION-FOR PERMIT TO DO PLUMBING
I NAME&TYPE OF BUILDING
i -
f LOCATION OF BUILDING
PLUMBER
'i
PERMIT GRANTED
f - .
` DATE 19
1 -
�j PLUMBING INSPECTOR
j
Y � �
/address_-=� Title of File Pa
9e of
Date File Open: Date file closed:
Doc Document/Action Title Date of Refer to other Purpose of Document/Action and notes
action Document/ document/
Num. Action Department
Board of Appeals - Board of Health - Planning Board - Conservation Commission- Building Departrner-t
� G
-. /01/96 ACTION-KING ENTERPRISES, INC. page - 1.
DISPOSITION REPORT - NORTH ANDOVER, MA
Service period; 04/,01/96 - 04/30/96
to Customer Destination Est. Gals
------- ----------------------------------- -------------------- ---------
/Oi./96 ERIC TEITINEN LOWELL 2500 - 00
132 DUNCAN DRIVE
: /11/96 AVLOCKE LTD FITCH131JRG 1200 . 00
HOLLY RIDGE AND JOHNSON ST
This is PROPRIETARY and CONFIDENTIAL information which may be
used only by the Board of Health for regulatory purposes .
TOWN OF NORTH ANDOVER/
BOARD OF HEALTH
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TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
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TEM OWNER & ADDRESS SYSTEM LOCA�TION ----- -_ —
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Ll
L) OF PUMPINC: /� DZ� (QUANTITY PUMPCDl�G'G� ( „
�SI'O0L NO ✓ YES SEPTIC TANK : NO YEJ _
4
A-I'URE OF SERVICE: ROUTINE l/ EMCRC ENCY
fel>FRV \TIONS:
C OOD CONDITION FULL TO COVC�t
HFAVY CREASE BAFFLLS IN I'LAC1'
ROOTS LEACHFIELD Rl'l�!3ACK ,.
EXCESSIVE SOLIDS FLOODED
SOLIDS CARRYOVER Oj�HER (EXPLAIN)
L'M PUMPED BY
u 1 11N ('J I RANSFCIZIZLD TO:
Boards of Health
North An42veriHa.ss. 3EMC STSTEK t
INSTALLATION. CHBCR LIST LOT ,► .
C1V HATS I7ISAPPRC/4ED AVATI(7di Ob FAIL
s
' Ba8_Di13!
FAIL OK
1. Distance Tot
a. Wetlands
b. Drains
c. Well
2. Water Line Location
-� 3. No PVC Pipe
h. Septic Tank - =
a. _Tess --Length do To Clean-oat Cowers.
b. Cement Pipe to Tank On Both Sides of Tank
5. Distribution Box
a. Covers & Box - No Cracks
b. All Lines Flowing Bgnal Amounts
C. No Back Flow
b. . Leash Field or Trench
a. Dimensions
b. Stone Depth
c. Capped 'Ends "
d. Clean Double Washed Stone'
7. Leach Pits
a. Dimgnsi
b. Stonepth
c. splash Pads
d.r''Tees -
Cement Pipe to Pit - Both Sides.
f. Clean Double Washed Stone
Be No Garbage Disposal
9. Final Grading Inspection _
10. Barricading Covered system
ll. As Built Submitted_
a. Lot Location
b. Dimensions of System - -
t' c. Location Frith Regard-to Perc Test
d. Elevations
e: Water Table
r"
TO: N c�C'.`�br �� + NORTH ANDOVER, MASS. 19
A(L� ��P BOARD OF HEALTH
FROM: I S DESIGN ENGINEER Re: Soil Absorption
.r,. Sewage Disposal
System
This is to certify that I have inspected the construction ,materials of
said disposal system at Lc)- 4 -L-) \�Q C_-N'Vj r
Site Location
North Andover, 14A.
The grades and construction m terials are as specified in my plans and
specifications dated - 1 3 198\ and I � ( � 19 9(
I '
Reg. Prof. Engineer/Reg. Sanitarian
I`
I
RECEIVED
OCT 0 5 2004
TOWN OF r�rORZ'H ANDUVf.k,
SYS PUMPINO RECORD
U,�I�k TOWN OF NORTH ANDOVER
"• •-�� HEALTH DEPARTMENT
SYSTEM OWNER& ADDRESS SYSTEM LOCATION
DATE OF PLJM?iNo: ...... .. __
:.. .... _
...._QUANTITY PUMPED: p
_. .. -L5 ,.._._....._..... . ..... . .. .. .
Snpuc Tank: NO YES
NA rURh OF SERVICE: KUUTINE �MERGENC ),
UbSERVATIONS:
GOOD CONDITION 4/ PUL,t, 'IY)COVER
HEAVY ORR,ASE BAFFI,.ES IN PLAU,
ROOTS _ LEACHPIELD RUNBACK _..
EXCESSIVE SOLIDS FLOODED
SOLID CARRYOVER'*.��.OTHER EXPLAIN
System Ptunpcd by
CPO. x
L•UMMENTS.
L'UN I EN I'3 rKANSF'ERRED I"o
�� ,0 t '�? •; ORT; zANDOVER ' MASSACHUSETT
.a;,. R@co d
Pumping
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- DEP.has provided th[s form for use•by-locai:Boards;of He Ith. The System Pumping Record must
be submitted to the local Board of Health-br other approving authority,
A. Facility InformationLNOV 0 '5 2007
�,,,yNtien fililnfl out 1 : • System Location N OF NC'{rH ')OVER
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Address(if different from location) ,
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Telephone Number
Pumping Record: �','•'' ,
r•� >• `. Date of Pumping date 2. Quantity Pumped:
Gallons
ype of system;. ❑ Cesspools) ptic Tank ❑ Tight Tank
[] ,,Other(describe);
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4 Effluent Tea Filter present?..❑ Yes, If yes, was it cleaned? ❑ Yes []' No
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httpJ/www.mass.gov/depJwater/approVels/t5forms,htm#Inspect
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:,:•.,. Syatem Pumping Record•Page 1 of 1
WELL DATABASE
-� ,�
ADDRESS: op�
AGE OF WELL:1�_ WELL BILLER:
WELL.PERMIT,,: WELL L O ATION:
WELL;PERMIT DATE: DEPTI-�'eFWELL:
TYPE OF WELL: a- DRILLED b. DUG c. UN�NOWN
TYPE OF WATER BEARING ROCK: ^
WATER ANALYSIS DATE. ? HIGH MANGANESE. Y N
HIGH IRON: Y N OTHER CONTA 4I TANTS: Y N
1n6
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l:
WELL DATABASE
ADDRESS:
AGE OF WELL: WELL DRILLER.-
WELL PERMIT : LL LOCATION"
WELL PERMIT DATE: �DEPOF WELL:
TYPE OF WELL: a.. DRILLED b. DUG- c. UNKNOWN
TYPE OF WATER BEARING ROCK:
WATER ANALYSIS DATE: HIGH MANGANESE: Y N
HIGH IRON: Y N OTHER CONTAIMNANTS: Y N
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