HomeMy WebLinkAboutMiscellaneous - 134 GREAT POND ROAD 4/30/2018 (2) 134 GREAT POND ROAD
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COMMONWEALTH OF MASSACHUSETTS
' Z EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
y
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: &Nb 120I}1>
NO�7W /q-�yDoV�&
Owner's Name: /l k �• _/f'j G14r'LE �OS�}A '�
Owner's Address:
Date of Inspection: .3
Name of Inspector: (please print) MJ+&T/M ���55� 1�E
Company Name: G141�/T01N4
Mailing Address: 349 OA-&I< '6 207E
Telephone Number:
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section 15.3.10 of Title 5(310 CIN1R 15.000). The system:
Passes
_ Conditional]\-Passes
Needs Further Evaluation by the Local:approving Authorit,,
Fails
Inspector's Signature: Date: 3 Z3 d 3
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving
authority.
Notes'and Comments
""This report only describes conditions at the time of inspection and under the conditions of use at that
time.This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page l
Page 2 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS T
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:. 114' 61204-7— PD N b k o.+,b
Nb&7lg /}-/y DOgm- .
Owner: C*EL E $Q 6 pFAk
Date of Inspection: ZS D
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
X I have not found any information which indicates that any of the failure criteria described in 310 CMR
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.
ISD explain,:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will .
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
2
Page 3 of 11
< OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: i-14- E,RPeg D 9 0*b
"40A72* 6-N
Owner: 49 . /YI c*e4 E- 1305 f}¢}k
Date of Inspection: 3 S 03
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 �N ithin 50 feet of a private"N-ater supply well.
_ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private grater supply xrell**. Method used to determine distance
"This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facilit; 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:
3
Page 4 of l l
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS .
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
^7 ''"IFICATION(continued)
Property Address: IJ+ J' oMb ROM>
NO2h-M "EI2
Owner: C ELE A 051}�!t
Date of Inspection: a
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No
_ �G Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
4 Discharge or ponding of effluent to the surface of the ground or surface waters du:to an o�erloaded or
clogged SAS or cesspool
L Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
�C 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.
__y Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
—)L- Any portion of a cesspool or privy is within a Zone 1 of a public well.
Any portion of a cesspooi 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 coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria
are triggered. A copy of the analysis mus:be attached to this form.]
�p (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as
7T 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 now of 10,000 gpd to 15,000
gpd•
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
— _ the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(I.nterim 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.
4
Page 5 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 134' 4;A"T PeW b ADA]>
n/oR.��
Owner: d1,/4A- d Inn cli-ELL, 1305#&/L
Date of Inspection: 3 /2 d/o 3
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 opine- ccupant, or Board of Health
Were any of the system components pumped out in the previous two weeks?
L _ 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)
y _ Was the facility or dwelling inspected for signs of sewage back up?
_ Was the site inspected for signs ::f break out?
'V}v ere all syste: 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?
_X-- _ Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of seg=ate disposal systems?
The size and location of the Soil Absorption System (SAS)on the site has been determined based on:
Yes no
Z _ Existing information.For example,a plan at the Board of Health. Previous rep"
Determined in the field(if any of the failure criteria related to Part
Cis at issue approximation of distance
is unacceptable) [3 10 CMR 15.302(3)(b)J lines FrO"
5
Page 6 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: /.3+ 6A4r 1_ 100Nb u4b
1010* �y7;�ovdrk
Owner 1.F !$0501 &
Date of Inspection: S
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): ¢ Number of bedrooms(actual):
DESIGN flow based on 310 CMR 5.203 (for example: 110 gpd x#of bedrooms):
Number of current residents:
Does residence have a garbage grinder(yes or no):-Xe 5
Is laund,—, on a separate sewage system (yes or no):_ [if yes separate inspection required]
Laundry system inspected(yes or no):_
Seasonal use: (yes or no):_Hp
Water meter readings,if available (last 2 years usage (gpd)): Q P hI��DnQ�
Sump pump(yes or no):—yes j
Last date of occupancy: 0 cc 0 P/4.-e1 C wa+e,r g� �n 9 R/s aro;I
COMMERCIAL/INDUSTRIAL `
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgfr,etc.):
Grease trap present(yes or no):_
Industrial waste holding tank present(yes or no):
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records n ,,_ _D t' / _ — �/ Va�K�-�"
Source of information: /" V M&a ]
Was system pumped as part of the nspection(yes or no):Jj�/p w •
If yes, volume pumped: gallons--How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
Septic tank,distribution box,soil absorption system
_Single cesspool
_Overflow cesspool
_Privy
_Shared system(yes or no)(if yes,attach previous inspection records, if any)
_Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
_Tight tank _Attach a copy of the DEP approval
Other(describe):
Approximate age ofall component . date installed(if known)and sour a of information: Lit) lkviow"
h o0rox,��l 1�� Go years ale 10
a -fit- �v►w.y�Z z y
Were sewage odors detected when arriving at the site(yes or no): �j
6
Page 7 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 134 6R- A'T PeNb R04b
NOR 7ff Awbova&
Owner: MA4Ak, 4. AJ1C-#A', t3054�4/t
Date of Inspection: ZI Z O
BUILDING SEWER(locate on site plan)
Depth below grade:
Materials of consnuction:_cast iron _40 PVC_other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints,venting, evidence of leakage, etc.):
SEPTIC TANK: > (locate on site plan)
Depth below grade: (5
Material of construction: Xconcrete_metal_fiberglass_polyethylene
_other(explain)
If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of
certificate) t it
Dimensions: $ Det S� f2 tt 7L a
Sludge depth: A l4 c h e S
Distance from top of sludge to bottom of outlet tee or baffle:
Scum thickness:----Trace
Distance from top of scum to top of outlet tee or baffle: �Q —'�' 14 Gk e,5
Distance from bottom of scum to bottom of outlet tee or baffle:
HoNv were dimensions determined: F/et A
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet irvert, evidence of.leakage, etc.):
v t I1 P d 7W b 4lood,XONS�
s 44)
h O e v� Q.y►�- lea Kam .
GREASE TRAP:_(locate on site plan)
Depth below grade:
Material of construction:_concrete_metal_fiberglass polyethylene_other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
7
Page 8 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORUM
PART C
SYSTEM INFORMATION(continued)
Property Address: /34 6/2PeND R04D
Nb&7& 4-At 0ov&-X-
Owner: C.Ef-CLE /3D SW4'I'Z
Date of Inspection: Z 0 3
TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade.
Material of construction: concrete metal fiberglass_polyethylene other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches, etc.):
DISTRIBUTION BOX: *--(if present musts be opened)(locate on site plan)
Depth of liquid level above outlet invert: I/,O;CL f,eV�'t a+ &0tlL+ I
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.):
des4. b 0u.,, 3 0 �C" "t 6 fee'
��' /��•- /.:;gt /?6 cve aue•t e-L. Soli•
&rLeaka� gva.t at�sf►^��6� `~
J
PUMP CHAMBER: (locate or. 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.):
8 _
• Page 9 of 11 -
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYS i E INFORMATION(continued)
Property Address: 13+ G/Q. ArI' pDKllj k,041>
No/47ny , "Dovin'&
Owner: /YJ/C j-ALE 13 0S6 4-k
Date of Inspection: Z
SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required)
If SAS not located explain why:.
Type
leaching pits,number:_
leaching chambers,number:
leaching galleries,number: 8 -Fee O
C leaching trenches,number, length: S'
D- �a/d��')
leaching fields,number, dimensions: Geyy'S C 7'RCNcN'F s
overflow cesspool,number: R 6500" A7
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.):
Np
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 laver:
Depth of scum laver:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
PRIVY: (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
9
Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 13+ 4R-rd-T
NoR T� l!-N�ov6r�.
Owner:
Date of Inspection: Q
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.
(o ori C e,,4-e -5
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10
Page 11 of 11
y. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: _ /34 G/e eh-"r poAa> ROAD
,ISO VC
Owner: M / &K /Y ictieLi 6_051414/Z
Date of Inspection:
SITE EXAM
S lope
Surface water
)CCheck cellar
Shallow wells
Estimated depth to ground water feet
$�-CDk� S•!1�$. See c�escr�/��ioYt �ow -
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record-If checked,date of design plan reviewed:
K 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:
De,*e rm in-ed f rewt &ca.t c o"ch h 012 s
You must describe how you established the high ground water elevation:
a eS Y n c �, of c�
alp Do 3 ZS a
as
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p ro p*-r� 17t$W� i S 6*va+ec4 o f 1-fu t"314 �o/NSF•o s l're a*
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WATER BILLING HISTORY 2130323-BOSHAR, MARC F. METER #1: 2130323 -'
------------------- 134 GREAT POND RD
# CYCLE SERVICE PRIOR CURRENT USES' WATER SEWER FEES TOTAL Microsoft
... Outlook
1 2000-12 08/17/1999 1216 1407 191 521 .43 0.00 0.00 521 .43
. 2 2000-22 12/28/1999 1407 1444 37 101 .01 0.00 0.00 101 .01 °
3 2000-32 03/10/2000 1444 1454 16 27.30 0.00 0.00 27.30 or t.
4 2000-42 06/02/2000 1460 1466 6 16.38 0.00 0.00 16.38 50
5 2000-42F 04/14/2000 1454 1460 b 16.38 0.00 0.00 16.38
6 2001-12 08/22/2000 1466 1553 7 237.51 0.00 14.30 251 .81
7 2001-22 11/22/2000 1553 1595 42 114.66 0.00 14.30 128.96 �✓
0. 8 2001-32 '03/12/2001 1595 1613 \ 18 49.14 0.00 14.30 63.44 1
Copy h
9 2001-42 06/04/2001 1613 1727 y 1 311 .22 0.00 14.30 325.52; 'download:hdl
"110 2002-22 01/02/2002 2112 2401 289 1075.27 0.00 6.21 1081 .48.
x;;11 2002-32 03/28/2002 2401 2417 16 39.52 0.00 6.21 45.731.
# 12 2002-42 05/29/2002 2417 2437 20 49.40 0.00 6.21 55.61
13 2002-12A 08/17!2001 1727 2112 385 1554.95 0.00 6.21 1561 .16
}14 2003-12 08/21/2002 2437 2473 36 108.40 0.00 6.68 115.08
V15 2003-22 11/25/2002 2473 2500 27 71 .36 0.00 6.68 78.04 y Computer`
116 2003-32 03/03/2003 2500 2519 19� 45.22 0.00 6.68 51 .90
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General Maintenance Recommendations
Proper maintenance of your septic system can help prevent premature failure of
your soil absorption system.
DO PUMP your system ANNUALLY.
DO OPEN your D-Box every THREE TO FOUR YEARS.
DO ensure that your VENT PIPES are installed properly.
DO make sure you know where your TANK is LOCATED.
DO make sure you know where your LEACHING FIELD is LOCATED.
DO look for GREEN STRIPES over leaching field.
DO check to determine if you can smell any ODORS from field location.
DO bring your COVERS WITHIN 6" OF GRADE.
DO USE LIQUID DETERGENT.
DO USE NON-ABRASIVE HOUSEHOLD CLEANING PRODUCTS.
DO USE ENVIRONMENTALLY SAFE PRODUCTS.
DO INSTALL WATER SAVING DEVICES, where appropriate.
DO USE SMALL AMOUNTS OF BLEACH when cleaning toilets, etc.
General Maintenance Recommendations (con'd)
DON'T DISPOSE anything NON-BIODEGRADABLE IN TOILETS:
(i.e.: cigarettes, sanitary napkins)
DON'T use caustic CHEMICALS.
DON'T wash paint brushes used in latex or oil PAINT.
DON'T allow any PAINT, THINNERS to go down sink or toilets.
DON'T allow ANY GREASE or FAT to enter system.
DON'T DISPOSE BONES, EGG SHELLS, COFFEE GROUNDS„ etc. when
using a garbage disposal
DON'T use powdered detergents with phosphates.
DON'T use any DRAIN CLEANERS.
DON'T use any ENZYMES.
DON'T use any GREASE DISSOLVERS.
DO NOT ADD ANY ADDITIVES TO YOUR SYSTEM FOR ANY REASON.
In the event of a clog or other plumbing problem, contact your local
plumber, rooter or pumper.
DON'T PLANT any trees or shrubs OVER THE LEACHING FIELD.
DON'T ALLOW SPRINKLER SYSTEMS or other WATERING DEVICES
OVER THE LEACHING FIELD.
DON'T DRIVE any VEHICLES or place any HEAVY OBJECTS ON TOP OF THE
LEACHING FIELD.
r
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENvIR.ONM ENTAL PROTECTION
ONE WINTER STREET,BOSTON MA 02108 (617)292-5500
TRUDY COXE
Secretary
DAVID B. STRUHS
ARGEO PAUL CELLUCCI Commissioner
Governor
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
r./o&719 AAIJ V tR- .17 ESN/s �/c�iSFi✓vs ��
Property Address: X34- GREhwT Pogo OAD Name of Owner
�r S RVQ y 9 f 2 00 O Address of Owner:
Date of Inspection. 'I) p.�.
Name of Inspector:(Please Print) M AA T/nl ^' �� S S! r
1 am a DEP approved system inspector pursuant to Section 15.340 of Trtle 5(310 CMR 15.000)
Company Name: -CA R170L Ey4V/2.ON f►')I�NT14L t N6/r/���lN¢
Marring Address: 348AAK 5 07E �PAL7
Telephone Number- _77B 66 4
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:
X Passes
_ Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
_ Fails
Inspector's Signature:
• Date: .2 p r da tell ZOO O
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 to Vm
system owner.and copies sent to the buyer,if applicable, and the approving authority.
NOTES AND COMMENTS
1
revised 9/2/98 Page Iof11 FEB ZZ 2()N1
;� Printed on Recycled Paper
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
g4 &AEh-r FOND Vo kr# OA) Do✓ER_
Property Address. � N/S C ++✓�Sj R
v p
Owner:
Date of Inspection: x /09/O
INSPECTION SUMMARY: Check a B, a or D:
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 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.
II 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)
The system will ass inspection if(with approval of the Board of
v distribution box. P
or due to a broken, settled or uneven Y
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 The
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
CERTIFICATION (continued)
GREAT pox(D ReAb I NORM# 19 A' rZ
Property Address: 34 J7 E-*i ql S MC N AAW S ) ITR
Owner: 4'01>17-4
Date of Inspection: g /O 9
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(11(b)THAT THE SYSTEM
IS NOT FUNCTIONING IN A MANNER WHICH.WILL PROTECT THE PUBLIC HEALTH.AND SAFETY AND THE ENVIRONMEKT:
_ 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 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
I
revised 9/2/98 Page 3of11
4
f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
l3`1" CVREfi'r pomb AW Doves llZ
Property Address 1v p/7W
Owner:
Date of Inspection: Z A
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 intofecilityror system component-due•to an overloaded orclogged-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 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-within 200 feet 4fa-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)
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
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:
134 6/MJ?-T- Po�D R 40#D MOP-7'�
Owner: J v DI7-/�- N1 c M/Q-1VU S/ .�IQ
Date of Inspection:
Check if the following have been done:You must indicate either "Yes" or "No" as to each of the following:
Yes No
ZC _ Pumping information was provided by the owner, occupant, or Board of Health.
- _ None of the system components kau&bean pumped*EoiratJeast-two weeks and•the-systam has.been•-scewingvensal-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.
_ The system does not receive non-sanitary or industrial waste flow.
X _ The site was inspected for signs of breakout.
_ All system components, excluding the Soil Absorption System, have been located on the site.
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:
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)]
26 _ _ The facility owner(and occupants.if different from..ownerL.weraprovided.with information on.thaprnper.maintenanc of
Subsurface Disposal Systems.
revised 9/2/98 Page 5ofl
1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
i 3 4- G�e.r-,9-r POND Roav, NO&V +PDOV R&
Property Address: EN N!s INI c M/9,Nv5� JQ
Owner: .T 01)r #
Date of Inspection: Z/p q A6
FLOW CONDITIONS
RESIDENTIAL:
Design flaw: g.p.d./bedroom.
Number of bedrooms (design): Number of bedrooms(actual):_
Total DESIGN flow !
Number of current residents:
Garbage grinder(yes or no):_:xES
Laundry(separate system) (yes or no);ffD; If yes, separate inspectiomrequired
Laundry system inspected (yes or no)
Seasonal use(yes or no):__SO \ /� Lid Ov+
Water meter readings,if available(last two year's usage(gpd): ��'� � L Iu.sC
Sump Pump (yes or no):_—YE5
Last date of occupancy: OC G UP/ED
COMMERCIAL/INDUSTRIAL:
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
PUMPING
PUMPING RECORDS and source of information: pum pep �/#IJV
System pumped as part of inspection: (yes or no)_—NO
If yes, volume pumped: gallons
Reason for pumping:
TYPE OF SYSTEM
>I— 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 installed{if known)-and source of•;r,forrnation: y- k-��wN "4oRl-4/NIL
_fit►pv56' twavxImo-tra ty 49 ye#xS cib. PREsew-r ?4t yii ,*&S
Sewage odors detected when arriving at the site:(yes or no)-&0
revised 9/2/98 Page 6of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
134- GR
Property Address.
Ownertile: ,
N/S 1�c1�?/�-�✓v s �Rpo✓�
owner. .TVP/7-H
Date of Inspection:
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 _.._
Comments: (condition of joints, venting, evidence of leakage,-etc.)
SEPTIC TANK._
(locate on site plan)
Depth below grade:_
/gcke3
Material of construction: kconcrete_metal_Fiberglass _Polyethylene_other(explain)
If tank is metal,list age_ Is.age-confirmed-by Certificate of Compliance_(Yes/No)
Dimensions:
8.a x s-2 ,� .�'-8 '' - /� coo 9 dit.-t( &R s
Sludge depth: l VlGLl L3 —
Distance from top of sludge to bottom of outlet tee orbaffle: 2 S
Scum thickness:__I-me'Q— N f
Distance from top of scum to top of outlet tee or baffle: za
Distance from bottom of scum to bottom of outlet tee or baffle:_
How dimensions were determined:
Comments:
(recommendation for pumping, condition of inlet and outlet tees or-baffles, depth of liquid levee relatio to outlet invert, ru �raHntegrity,
evidence of I akage, etc.) V Yr1 n Q S
t 1� C �
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
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued) j
l3 R.�9-T Po lb R-6 a 1�DR�7S� R-XDoYEk,
Property Address:
owner: k%m s
.wDI•�{ .� L
Date of Inspection: /d I O O
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:
Llv tD LC—VEL- RT OV TL ET ✓Scims
Comments:
(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) -—
a F V46 oAu o — o e
v ! FVAQ 91 V I D MEM c 0o �/4
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
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
X 34 GREAT POND RQA-b J NOR-'W AA)Do✓&'7�
Property Address:
vD M c t`Jt�+uvs �R
Owner: � Tib De) J
Date of Inspection:
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:_ / G�— 0'x'1 C
leaching trenches,number,length: �J 3 /too �Qb !�/ 09rS
leaching fields, number,dimensions: TrC nCk4P—1 5 065s
overflow cesspool,number:_
Alternative system:
Name of Technology:
Comments:
(note condition of soil, signs of hydraulic failure,level f pon 'ng, damp soil, diti n�vegetation, etc.) ,
)VbsJ �s O.C. .1 fie
o
CmIllm
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)
Materials 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 F Page 9of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
34 6ke'A.-r POND R O-0 w p--r#
Property Address: �w Dir/y Al k/s e- NAN v.S) �k
Owner:
Date of Inspection:
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)
P I p{'�fyP�
. o
�ARI� '`�
S�pT/G
T��K
I
i •_
Z;y.re
IF 7- .
revised 9/2/98 , Page 10 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
�- Property Address: !3�• GAN, -r PouDt"�oAD/ 9OR7-0 1A-/J•DOV'7Z
Owner: �v D1TjyF E'NN/s M c �-t n, a sj je
Date of Inspection:
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
X Check Cellar
Shallow wells �•__ J
Estimated Depth to Groundwater_Feet $Q�o(,v $•/��$. •- d-0 Sc r#,P
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
L Observed.Site(Abutting property, observation hole,basement sump etc.)
C 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) $Q•sej, on p vor T/ �
xn s pcc c
i#�- 1-t.s },..,a..e� `E•t,x �n s�a.e�f��/ `}'(,t y re.,.,.d ...:.�. a-.o.Y a ro v K.�
Soil absorp �+,. sysfw.,`�A•S� was cua�PGbc�� �re3'�.�• 7XL
ptold arf� ifsel� .as s.f�o,d:e! •��- K.sL k,q.tc poirl7—un
II /,',--ee�3 R
r<c �-�n_r l S 3 Own G� � h
6�' � �t 9 rvo KdPy �
_.2 e 5•A•5• �f' ftj_ rc—r 4- .(af"j t c nafvr.- g►Qd-2
i drops e s� �� f-o a /tv'-( /ear-
5•17' s• TLce .S�wlo �,t cel/mss^
f '`"4- "-1 P r�x r x��� !D �e.'{• h.�(o� 9 ra�c•/P c c o7'��",7
1 o w��r .�%� kms bc�yt �Y c�vr r K3 post Zo yes
kk Z/i r-ec�e } y¢ctr5 I `tee 1n-9 Pav+vl SWrwt ►yrK� yomo�
��w t!too5; 0,,A s�Pfr� $'�-w k wc,5 ref--,r-e4. AID
1
!o f.cr�
ex�avu.�ro,. wo-t_ sZ-rade det was rya, . Dor,:,2
/;-� w' ripi4 -Q pro b e)-1 s
w r 1�,Q_ 5•/},5•� cct,,,�_ oys�4 co% c,iv--e. je,. -
c{oYrri� 9rovxJ wa,4,
revised 9/2/98 Pagellorll
TCRP21/CS/V03/L012 Town of North Andover Date: 02/04/00
germinal No: 000 Account History Report Time: 13:08:22
DETAIL Page: 1
Range = From Year: 1900 To: 2099 From Seq: 00 To: 99
Account #: 0135370000
Yr: 1999 Seq: 01-UB Bill: 1074 Bank
Owner: MCMANUS, JR., DENNIS J. Id:
Loc: 134 GREAT POND
Original Amt: $0.00
--------------------------------------------------------------------------------
Inst Date Purpose Type Rec/Ref# Charge Payment Balance
--------------------------------------------------------------------------------
1 12/23/97 WATER CHG 400.89
1 03/20/98 WATER CHG 99.60
1 04/03/98 WATER PAYMT 16464 400.89
1 06/25/98 WATER PAYMT 25699 99.60
1 09/15/98 WATER CHG 332.80
1 12/17/98 WATER CHG 8.17
1 WATER PAYMT 33270 332.80
1 01/06/99 WATER CHG 109.20
1 01/11/99 WATER CHG
1 WATER PAYMT 34422 117.37
1 04/14/99 WATER CHG 141.96
1 04/22/99 WATER PAYMT 40428 141.96
1 06/15/99 WATER CHG 27.30
1 06/23/99 WATER PAYMT 46668 27.30 $0.00
*** Total WATER $1,119.92 $1,119.92 $0.00
*** Bill Total $1,119.92 $1,119.92 $0.00
---------------------------------------------------------------------------------
Grand Totals for Account # in Selected Range
*** Total WATER $1,119.92 $1,119.92 $0.00
*** Total $1,119.92 $1,119.92 $0.00
*** End of Account ***
Per 71c 4 1p*,�a-r- •j Kckr"P 91 ZOO'
12 97 —� 12-If7 Ls96o0 t•#'.) He-r
A 748
I�2. 513Z .70-110,7g , f
Jts/ie4 by i yeeir3 ( 73,0014Y-S)
(� 7vr gallons per dal,
o0
S p f
r
I
General Maintenance Recommendations
Proper maintenance of your septic system can help prevent premature failure of
your soil absorption system.
DO PUMP your system ANNUALLY.
DO OPEN your D-Box every THREE TO FOUR YEARS.
DO ensure that your VENT PIPES are installed properly.
DO make sure you know where your TANK is LOCATED.
DO make sure you know where your LEACHING FIELD is LOCATED.
DO look for GREEN STRIPES over leaching field.
DO check to determine if you can smell any ODORS from field location.
DO bring your COVERS WITHIN T OF GRADE.
DO USE LIQUID DETERGENT.
DO USE NON-ABRASIVE HOUSEHOLD CLEANING PRODUCTS.
DO USE ENVIRONMENTALLY SAFE PRODUCTS.
DO INSTALL WATER SAVING DEVICES, where appropriate.
DO USE SMALL AMOUNTS OF BLEACH when cleaning toilets, etc.
General Maintenance Recommendations (con'd)
DON'T DISPOSE anything NON-BIODEGRADABLE IN TOILETS.
(i.e.: cigarettes, sanitary napkins)
DON'T use caustic CHEMICALS.
DON'T wash paint brushes used in latex or oil PAINT.
DONT allow any PAINT, THINNERS to go down sink or toilets.
DON'T allow ANY GREASE or FAT to enter system.
DON'T DISPOSE BONES, EGG SHELLS, COFFEE GROUNDS„ etc. when
using a garbage disposal
DON'T use powdered detergents with phosphates.
DON'T use any DRAIN CLEANERS.
DON'T use any ENZYMES.
DON'T use any GREASE DISSOLVERS.
DO NOT ADD ANY ADDITIVES TO YOUR SYSTEM FOR ANY REASON.
In the event of a clog or other plumbing problem, contact your local
plumber, rooter or pumper.
DON'T PLANT any trees or shrubs OVER THE LEACHING FIELD.
DON'T ALLOW SPRINKLER SYSTEMS or other WATERING DEVICES
OVER THE LEACHING FIELD.
DON'T DRIVE any VEHICLES or place any HEAVY OBJECTS ON TOP OF THE
LEACHING FIELD.
Z)FLA-) ���5
J
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
�) DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET. BOSTON. NIA 02108 617-292-5100
WILLIAM!F.WELD TRUDY CORE
Governor
Secretarn
ARGEO PAUL CELLUCCI DAVID B.STRUHS
Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner
PART A
CERTIFICATION
Glt"T f oND IZ' oAD, �O�TN ANOovG1�
Property Address: SANU4A )4- )?78 Address of Owner:
Date of Inspection: y 1 (If different)
Name of Inspector: 02.4kT/N w ar/Ss 1 p'6.
1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000)
Company Name: GA/*/TDL IE'NV11tCQMe14Y*L - WHOAHAFOX/NSP
Mailing Address: 6 *&F*,COnl 67•0 BOS7a& I' A OW-06
Telephone Number: Ms 7) 367 ; mol O
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:
)C Passes
_ Conditionally Passes
_ heeds Further Evaluation By the Local Approving Authority
_ Fails
Inspector's Signature: Date: �//QAJt��ay �2� 1998
The System Inspector shall submit a copy of this 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, 8, C, or D:
1/ A] SYSTEM PASSES:
1 have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
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, upo
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; c
the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tan' .
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.
(revised 04/25/97) Pay 1 of 10
DEP on the World Wide Web- http.Nwww.magnel.state ma.usldep
0 Printed on RecycJed Paper
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: /34 GRE&-r AoAiD R0" H-4 NAOVE/Z
Owner: SN D I-rq :3�e"NiS /IG/y ANiviS �R
Date of Inspection: //1,F/98
B] SYSTEM CONDITIONALLY PASSES (continued)
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). Describe observations:
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 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:
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 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 to 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 th<
the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to c
less than 5 ppm. Method used to determine distance (approximation.not valid).
3) OTHER
(seviaad 04/25/97) Pay 2 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 6/4607 P*Ab RoAb� J - RAOOVE�Q
Owner: SVD/V t-PA'"4/S /VG MAWU.$1
le-
Date of Inspection: I/�IK/g8
D) SYSTEM FAILS:
You must indicate either "Yes" or "No" as to each of the following:
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 correc
the failure.
Yes No
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 boa 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 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 nc
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.
EJ LARGE SYSTEM FAILS:
You must indicate either "Yes" or "No" as 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 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 11 of a
public water supply well)
The owner or operator of any such system 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.
(revised 0{/2S/97) Page 3 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: /34' GARRT fi0t4b R*4D, A/' /4Nbotlle 2
Owner: JV.Di 7W .E ;P0"'l/S /We-IV,' NAI5,J`��c •
Date of Inspection:
Check if the following have been done: You must indicate either "Yes" or"No" as to each of the following:
Yes No
Pumping information was provided by the owner, occupant, or Board of Health.
_ None of the system components have 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 part of this inspection.
�•A' 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.
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.
�•, _ 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:
The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of
Sub-Surface Disposal System.
Existing information. Ex. Plan at B.O.H.
X _ 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)J
(revised 04/25/97) Pago 4 of 10
, I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
d SYSTEM INFORMATION
Property Address: /3T
Owner: -TVD/TP It PEA41 S WC N AvV V SJ 1Q'
Date of Inspection:
FLOW CONDITIONS
RESIDENTIAL:
Design flow: A.p.d./bedroom for S.A.S.
Number of bedrooms:-411— 8Number of current residents:_
Garbage g•,:der (yes or no):_yE$
Laundry corrected to system (yes or no):-1�16.5
Seasonal use tyes or no):—b(o
Water meter readings, if available (last two (2)year usage (gpd): 7 T-'K*AZ PAINT 00T- /99G�/99j
Sump Pump (yes or no): Yr—.S S60 /`-�
S�r.rffCWf"' sY�av! IrJC�IJc���•
Last date of occupancy: OC G V /O/rD
COMMERCIAUINDUSTRIAL:
Type of establishment:
Design flow: gallons/day
Grease trap present: (yes or no)_
Industrial Waste Holding Tank present: lyes or no)_
Non-sanitary waste discharged to the Title 5 system: (yes or no)_
"later meter readings, if available:
Last date of o•-cupancy:
OTHER: (Describe`
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
pvw,y0,01> r►?�y
System pumped as part of inspection: (yes or no)_H0
If yes, volume pumped: eallons
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. Copy of up to date contract?
Other
APPROXIMATE AGE of all components, date installed (if known) and source of information: UNIt/1lOW�/ `• OIQ.�6/A!/�(.
µ0056 /3-PP1201t• 60 y/164ILS O&.D• Pa45e'N7 0(0f40/Z : Z Z f" YEP?JE5
Sewage odors detected when arriving at the site: (yes or no)
(revised 04/25/97) Pay S of 10
1•
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 134-4- GAC&&- p0/4D P'd) 5Q/�'N�VE/�
Owner: T of TM• #' J> a1i/Y/S 0C.
Date of Inspection:
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 lir-e
Diameter
Comments: (condition of joints, venting, evidence of leakage, etc.)
SEPTIC TANK: >41
(locate on site plan)
Depth below grade: G �n C-4eS
Material of construction: )C4oncrete _metal _Fiberglass _Polyethylene _other(explain)
If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No)
IVDimensions:
Sludge depth: 3 — 3 A GHo.J 3Z
Distance from top of sludge to bottom of outlet tee or baffle:
Scum thickness:-----&—*3
Distance from top of scum to top of outlet tee or baffler
Distance from bottom of scum to bottom of outlet tee or baffle:--/.6 4 1 +'IC44 S
How dimensions were determined: FICA-Z
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, s uctural
integri evidence of leakage, etc.) HJ9 v G a 7WE3
4'/ 0/C
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 04/3S/97) Page 6 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)_
Property Address: �34 �7�,c or POUb P-04b Q N�✓��
Owner:
Date of Inspection:
TIGHT OR HOLDING TANK: ( ank 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/da�
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) D vTG& T
�
Depth of liquid level above outlet invert:
Comments:
(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.)
1,gA6ei V167,0fd 13c)T/OAJ $OK — /FPRAx• 3D 'tet K ro �'�
� E v
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.)
(zevioed 04/25/97) Page 7 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 134' 45-ed!*r 1"J-4b R0gD1 At' 'it"PovEAL
Owner: Jv D/TIS t jpea ic1,/S
Date of Inspection: /f /1"As.
SOIL ABSORPTION SYSTEM (SAS):_
(locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods)
If not determined to be present, explain:
Type:
leaching pits. number:_
leaching chambers, number:—
leaching
umber:leaching galleries, number: rs
lengt
leaching trenches, number, h: !//fit S/ �DD 7'"'^ • '�
leachingfields, number, dimensions: 50A7es��
overflow cesspool, number:
Alternative system:
Name of Technology:
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
15/O 6!&A.) I(. v
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)
Materials of construction: Dimensions:
Depth of solids:
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
(r*vimad 04/25/97) Tay a of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
/34 4R 9*7' Pof4b 0*4b� 14.*AlPe,V�A-
Owner:
Property Address: ��NlS
�v D�T�-
Date of Inspection: /,9.9
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
6 en c4L, -ar s
(f P).,
0
0
I
i
BARN '�•e, '
K —_--- x
SepT/G
TA4 K
s
7
Sr'Rt'r'T
(revised 04/25/97) Page 9 of 10
r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
e SYSTEM INFORMATION (continued)
Property Address: /,74 �0� Po'qA RoAb/ 14, 4xDvvCA,
Owner: .rL�D/M le Xx
Date of Inspection: /
l X98
Depth to Groundwater _ Feet �i7��Ow 5'�J•' ��- r
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
Observation of Site (Abutting property, observation hole, basement sump etc.)
)L Determine it from local conditions
Check with local Board of health
Check FEMA Maps
Check pumping records
Check local excavators, installers
Use USGS Data
f•
Describe in your own words how you established the High Groundwater Elevation. Must be completed)
t T 1 - *- /►'�5/040}1 ctt cj ro Q.lro 0
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SAW*" 12"-aY �y'o"%-L tt%k tii o i.R.
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(revised 04/25/97) Page 10 of 10
:..• :s -..j-•_i s:y. .• !:-gyp, 1!•.Lw �'^i:..•i1l:::i�.' 1 a{-'.L r..:'�' �l
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:... _<t:�;:: - DATE: Oi/15/ x'
S14UUBQ4A/CS/U 04/L 019 FO41N OF NORTH A
CONSUMER MEIER F/NDOU£R TIME 08.33: :'x;:
TERMINAL 1i0: 040 M
Acct : 01-35376N#7l. MCMAtjU� .IR DENNIS 1- 134 GRIT POND RD`i;.
Meter Ma: 001 Rev Mtr/S: M 009 Book: 13 Page: 35370.00900 Meter Flg: 0
Connector: ] Digits: 4] Din Cd: C] Multiplier: ] Orb 8: 4;
Maaf Cd: ] Units: Pipe Size: j Len: ) lypr: �•
Req: 80/®0/o0 Inst: 05/94/95 Cnct: 00/90/09 disc: 00/00/00 Cd:
Wrk Cd: j Mt Code: j Met Loc- ] In/Out:
NDtes 1 TR[ 1® ENiC
I Serial 0: 39546192
Bgn• Cur: 946 A Preu: 785 A 2nd Prev. 627 A [2 .
From: 97/11/97 70: 11/25/97 Curt:
Preu2: `` =
Next: 9®1/00/04 Cns Cr: Mth Bill: 93User:
Consumption Information ----------------------_-_-
--------------------------
--- First 12 Billing Hon s ------(3] 1------ Last 12 Billing Months -------( . -:
12/97 166 A 86/96 4`, A 112/94 41 E 06/43 •717 46 A
�� 09/97 158 A 03/96 A 109/94 43 E 83/93 40 A
06/97 12 A 12/95 142 A 106/94 4 40 E 12/92 40 B
03/97 13 A 99/95 266 A 103/94 49 E 99/92 4&,60 A
12/96 21 A 016/95 �l 24 A 112/93 49 E 93/92 39 A
09/96 18-1 A 03/95 241 A 99/93
First 12 Total 1219 1 Last 12 Total: 4$2-
<ESC> to Enter New Meter Number
<M>odify, <D>elete or <NDext
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ff
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::L 5
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aii
•.
•"�,:i iG.LA' - - _ - `Y ,.�„ Y.�f'i..at�f •r!•..v�"• 0." _�'r1J-•
General Maintenance Recommendations
Proper maintenance of your septic system can help prevent premature failure of
your soil absorption system.
DO PUMP your system ANNUALLY.
DO OPEN your D-Box every THREE TO FOUR YEARS.
DO ensure that your VENT PIPES are installed properly.
DO make sure you know where your TANK is LOCATED.
DO make sure you know where your LEACHING FIELD is LOCATED.
DO look for GREEN STRIPES over leaching field.
DO check to determine if you can smell any ODORS from field location.
DO bring your COVERS WITHIN 6" OF GRADE.
DO USE LIQUID DETERGENT.
DO USE NON-ABRASIVE HOUSEHOLD CLEANING PRODUCTS.
DO USE ENVIRONMENTALLY SAFE PRODUCTS.
DO INSTALL WATER SAVING DEVICES, where appropriate.
DO USE SMALL AMOUNTS OF BLEACH when cleaning toilets, etc.
General Maintenance Recommendations (con'd)
DON'T DISPOSE anything NON-BIODEGRADABLE IN TOILETS.
(i.e.: cigarettes, sanitary napkins)
DON'T use caustic CHEMICALS.
DON'T wash paint brushes used in latex or oil PAINT.
DON'T allow any PAINT, THINNERS to go down sink or toilets.
DON'T allow ANY GREASE or FAT to enter system.
DON'T DISPOSE BONES, EGG SHELLS, COFFEE GROUNDS„ etc. when
using a garbage disposal
DON'T use powdered detergents with phosphates.
DON'T use any DRAIN CLEANERS.
DON'T use any ENZYMES.
DON'T use any GREASE DISSOLVERS. '
DO NOT ADD ANY ADDITIVES TO YOUR SYSTEM FOR ANY REASON.
In the event of a clog or other plumbing problem, contact your local
plumber, rooter or pumper.
DON'T PLANT any trees or shrubs OVER THE LEACHING FIELD.
DON'T ALLOW SPRINKLER SYSTEMS or other WATERING DEVICES
OVER THE LEACHING FIELD.
DON'T DRIVE any VEHICLES or place any HEAVY OBJECTS ON TOP OF THE
LEACHING FIELD.
Town of North Andover. MA
a �
Watershed Septic System D
Servicing Report`
Date:
L DANIEL A. GIARD
Homeowner: G _ Pumper SEPTIC SERVICE
Street : 13q Address: NO. ANDOVER, MA
Phone 6aos i 3 Phone
Nature of Service: Routine
Emergency
Observations: Good Condition ✓
Full to Cover
Baffles in Place
Leachfield Runback
Excessive Solids
Heavy Grease
Roots
Other (Explain)
Description of Work:
q
Comments:
APPLICATION" FOR SEWAGE DISPOSAL INSTALLATION �7
HEALTH DEPART11,1ENT_-N()fir H ANDOVER, MASS.
I hereby makZe plicat'on for � ermtt for a sewage disposal
Wil' at . I will install this
system in accordance wit a the Qaw: of the Commonwealth of
Massachusetts and regulations of the Board of Health of the Tovm
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 preceding the septic tank, where
the grade shall not exceed 2%. I will install a concrete septic
tank of in size. A manhole (s) permitting easy clean-
ing will e�proo ed with removable cover (s) of iron or concrete
within 12 :finches .of the ground surface. I will provide subsurface
disposal field with open jointed bell and spigot Ackron pipe at
least 4 inches in diameter and laid in a series of trenches, the
bottom of which will provide a minimura of _�, Lineal
( ) - 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 be-ore filling the trench, 2 inches of gravel
or stone 1/$17 to 1/4" (da. ) 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 tale 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 cove an of this installation
until apLF ,fir tae-ins�ec;i�on o finer, as prov�decf eTow, awn '
to ricorporate any as t on-nal�requ rements that may be attached to
the permit. Plot Plans must be submitted with application.
DATEgy -30,
� r
gnature o App cant
I hereby issue the above permit for the Board of Health of the
Town of forth Andover, Massachusettso _
Date `2=
Signatpre of HealthAgent
a
I have inspected the uncovered system indicated above and find
everything done as described.
Date
Ignature oc nspecting Officer
Percolation Test
Garbage Grinder
r
ly/f
a
0
N �
COMMERCIAL N. F. • ICETT®` PARKING AREAS
BUILDING DRIVEWAYS
CONTRACTOR WALKS
STONE. CEMENT AND 51 THORNDIKE ROAD
BULL-DOZER AND
BRICK WORK NORTH ANDOVER, MASS. ROLLER SERVICE
TELEPHONE 4806
r „ -
July 22, 1955
Mr. ,kdwin C. Murphy /
13L Creat Pond Road
North Andover, Nassachusetts
Bear Rr, Hurphy:
The State Department of Public Health has recently completed
a sanitary survey of the watershed of Lake Cochichewick, the
source of grater supply for the town of North Andover. This
report states that on your premises 'one pipe at the
and of the leaching field is overflowing onto the ground,
a violation of Rule 3. A copy of the Rules and Regulations
adopted by the State Department of Public Health in 2912
for the purpose of preventing the pollution of the waters
of ?rake Cochichewick is enclosed.
You are hereby notified to correct the violation.
Should you care to discuss the matter further of obtain any
additional information heretofore, please consult the Porth
Andover Board of Health.
Yours very truly,
By— Mary F. Sheridan, Agent
R _
ARTHUR D. WESTON
511A Y,-a �4,6V/ / July 22, 1941
CHIEF ENGINEER
Board of Health
North Andover, Massachusetts
Gentlemen:
Enclosed for your information is a copy of
a communication sent under date of July 15, 1941 to
the Board of Public Forks, North Andover, Mr. William
B. Duffy, Superintendent, relative. to an examination
of the premises of Mr. D. J. Murphy, Great Pond Road,
North Andover.
Very truly yours,
NMD Chief Engineer
Enc.
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October 4j 1955
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Mr. L.nic" :i ar-d*,y, Jr.
174 Great F nd Road
North Andover, Massachusetts
Dear Hr. Murphy:
On ,gay 27, 1"'55, the Board of Heath notified you of a
violation of th:: IbAcs and Regulations adopted by the State
Department of Public Health in 1912 for the purpose of
preventing the pollution of the waters of sake: Cochichewick.
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You are hereby notified to remedy the condition na-madl
within ten days of the no:Ace-#*- rt,
a-pl�rr for-oval - o this dep/ar ent. f 1 r�r��
If at the expiration of time allowed, the plans have not
been received and no cause aforesaid be shorn, such
further action as the law requires will be taken.
Yours very truly,
BOAR) OF HEALTH
By,
?nary F. Sheridan, Agent
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May 27p 1955#
Lir, Daniel J, Mi rpByp Jr,
174 great Pond Road,
North Andover, Massachusetts.
Dear :Ir. Hurply t
In connection rith a sanitary survey noir being conducted on they
watershed of Lake Cochichowickp the source of slater supply for
the town of North Andover, a septic tank on your premise was
found to be overflowing, You are hereby notified to remedy the
nui saner e within a week*
The overflow of sewage from these septic tanks constitutes a
violation of the rules and regulations adopted by the State
Department of Public Health in 1912 for the purpose of preventing
the pollution of the slaters of sake Cochichowick.
Before you begin the correction on the pystemo the Hoard of Health
requires you to obtain a permit from thV departments which permit
is granted only after the necessary tests have been done by our
Sanitarian and a plan submitted by you has been accepted,
Should you care to discuss the matter further or obtain any
additional information heretofore, please consult the North Andover
Board of Health,
Very truly yours,
By • Mary F. Shoridanp AGENT
BOARD OF HEALTH
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