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HomeMy WebLinkAboutMiscellaneous - 140 GRAY STREET 4/30/2018 (2) 140 GRAY STREET- / 210/107.=0.0 1 I k M f k t f ^ t MAP # ��7•LJ LOT # PARCEL # STREETLkA_.... ...`L.__.._....._..._.__...._.. CQNSTRUCTIQN APPRQVA HAS PLAN REVIEW FEE .BEEN PAID? YES NO PLAN APPROVAL: DATE �17 /5 APP. BY DESIGNER: �GU%� /GCS PLAN DATE:_________.__.___._...__ COND I T I ONS WATER SUPPLY: TOWN WELL WELL PERMIT_ _ DRILLER._....__.._.__.__...__..__._......_._....._............ _.._._._.._.. ................ WELL TESTS: CHEMICAL DA T E 11{-PRUVED BACT A I Ufa TE EIPPRUVED BACTERIA II DATE COMMENTS: FORM U APPROVAL: APPROVAL TO ISSUE NO DATE ISSUED �Z/ BY CONDITIONS: FINAL APPROVAL: . ALL PERMITS PAID NO WELL CONSTRUCTION APPROVAL NO SEPTIC SYSTEM CONSTRUCTION APPROVAL NO OTHER YES NO ANY VARIANCE NEEDED YES NO . ,��� FINAL BOARD OF HEALTH APPROVAL: � DATE•. _ _..a. .��...DY: .._,�1�-' THE INSTALLER LICENSED? NO (.•.i`' 1 , m ; h Wit... + �i J. -TYPE_. OF- CONSTRUCTION: N- REPAIR �. ; CONSTRUCTION: , .. CERTIFIED PLOT .PLAN •REVIEW • NO t + CONDITIONS OF..APPROVAL YES NO (FROM FORM U) } r ISSUANCE OF DWC PERMIT _ � .=� NO `DWC PERMIT N0. oZ 1 INSTALLER: : BEGIN INSPECTION N0: EXCAVATION . INSPECTION: NEEDED: Tvq .<i •�. ,Lai - ! .2 - '.•' t' - CASSE) HYD CONSTRUCTION INSPECTIONS NEEDEDs AS BUILT PLAN SATISFACTORY: ES= j APPROVAL TO BACKFILL: DATE B -- . .FINAL . GRADING APPROVAL: DATE �Dl SIG BY4X7�C/:✓Jl�-f�l�; '.: . , .. ,FINAL CONSTRUCTION APPROVAL: DATE: HY 11+11 + �� 1 \ •.• -.�. .. .. r _- .' .`•i•: .. . • ` ` • , ( TOWN OF NORTH ANDOVER SYSTEM PUMPING REC G DATE: '1�' Qu �kA SYSTEM OWNER &ADDRESS SYSTEM LOCATION vz (example: left front of house) f lLCo DATE OF PUMPING: `(,Ce_v QUANTITY PUMPED [ y GALLO S CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER 'OTHER (EXPLAIN) SYSTEM PUMPED BY: COMMENTS: CONTENTS TRANSFERRED TO: C' i 1 ` VA41 S i l xn71� j \I I to - _--- NJ -Jl ij i. �E i /i / i FORM U - LOT RELEASE FORM ' '" INSTFUCTICNS: -his form is used to verity that all necessary approvals/permits from- Boards and Departments having jurisdiction have been Obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. APPLICANT FILLS OUT THIS APPLICANT �y C IQ bo PHONE /1 LOCATION: Assessors Map Number O0 l7 FARCE_ (^J i SUECIVISION LOT (S) STREET '�� ��"1 I� ST. NUMEE:R—)-�'D OFFICIAL USc ONLY RECOMMENOA T IONS OF TOWN AGENTS: CONSERVATION ACMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS — i ' TOWN PLANNE ❑ATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATEAPPROVEO DATE REJECTEI SEPTIC INSPECTOR-HEALTH DATE APPROVED v� DATE REJECTED COMMENTS PUELIC WORKS -SENER/WATErR CONNECTIONS DRIVE-NAY PERMIT FIRE DEPARTMENT RECEIVED EY EUILDING (,iISPECTOR _ DATE Revized 9�9;Im Comm nwe th of Massachusetts Massachusetts System Pumying Record System Owner System Location t 4 Date of Pumping: � ���"��' Quantity Pumped: I� gallons Cesspool: No t-� Yes H Septic Tank: No Yes System Pumped by: arwort 51&1�wved License# Contents transferrred to : Greater Lawrence Sanitary District llate: _ Inspector- Tel: (978) 475-4786 Fax: (978) 475-5451 BATESON ENTERPRISES INC. Excavating-Water.& Sewer Lines-Septic Systems&Pumping Service 111 Argilla Road Andover, Mass. 01810 Title 5 Inspection Report Property Address: 140 Gray Street, North Andover Owner: Merrow Date of Inspection: 4/18/2000 My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic system Neil J. Bateson Bateson Enterprises, Inc. r T6V COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPABTMEriT OF ENVIRONM MAL PROTECTION ONE WINM STREET,BOSTON MA 02108 (617)292-5500 TRUDY CORE . 8ecretary ARGEO PAUL CELLU'CCI DAVID B.STRUHS Gomm SUBSURRMFACE SEWAGE DISPOSAL SYSTEM MISPECTION FOComms ower PART A CENT FICATION Pro Address:140 G Street,North Andover Name of Owner.Lucas Marrow Property A Gray t, Address of Owner:140 Gray Street,North Andover,MA.01810 Date of Inspection:4/18/2000 Name of Inspector:Nell J.Bateson 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name:Bateson Enterprises Inc. Mailing Address:111 Argilla Road Andover,MA 01810 Telephone Number:(878)475-4786 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 Slgnature! Date:4/18/2000 The System Inspector shrllcopy is 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 shad 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. NOTES AND COMMENTS revised 9/2/98 Page I of 11 Printed on Recycled Paper i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) ZDatoof dress:140 Gray Street,North Andover ow ection:411812000 INSPECTION SUMMARY: Check A, B, C,or D. A.SYSTEM PASSES: X 1 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 move system components as described in the'Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Indicate yes,no,or not determined(Y,N,or NO).Describe basis of determination in all instances.If"not determined",explain why not The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Hearth. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or rectthea d pipe(s) or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval 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 I(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed V revised 9/2198 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:140 Gray Street,North Andover Owner.Morrow Date of Inspection:411012000 C.FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: 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 PAIL 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 sal 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 sal absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and sal absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and sal 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 912/98 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:140 Gray Street,North Andover Owner.Merrow Date of Inspection:4118/2000 D.SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will,be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or dogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or dogged 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 dogged 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- 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 i 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 upgrade the system in accordance with 310 CMR 15.304(2).Please consult the local regional office of the Department for further information. revised 912/98 Page 4 of 11 ZASUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST ddress::140 Gray Street,North Andover Owner:Morrow Date of Inspection:4/18/2000 Check N the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No _X Pumping information was provided by the owner,occupant,or Board of Health. _X _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flaw rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. X _ As built plans have been obtained and examined.Note if they are not available with NIA. _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.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 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: X _ Existing information.For example,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) [I 5.302(3)(b)] X _ The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 912198 Page 5 of 11 / SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address 140 Gray Street,North Andover Owner.Merrow Date of Inspection: 4/18/2000 FLOW CONDITIONS RESIDENTIAL: Design flow_165 y .g.p.d./bedroom. Number of bedrooms(design):-4_ Number of bedrooms(actual_4_ Total DESIGN flow_660_ Number of current residents:_5_ Garbage grinder(yes or no):_No Laundry(separate'system)(yes or no):_No If yes,separate inspection required Laundry system inspected(yes or no) Seasonal use(yes'or no):_No Water meter readings.March 98 to March 00=11,900 ft'x 7.5=89,250Gals./730 Days=122 Gals./Day Sump Pump(yes or no):_No Last date of occupancy: Current COMM ERC W LI I N D U STRIA L: F Type of establishment: Design flow: gpd(Based on 15.203) Basis of design flaw 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 RECORDS and source of information:Never pumped,owner System pumped as part of inspection:(yes or no)_Yes_ If yes,volume pumped:_1500_gallons Reason for pumping:Never pumped.Inspect tank&tees. TYPE OF SYSTEM _X Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) 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 information:4 years old. 6/19/96.As built plan. Sewage odors detected when arriving at the site:(yes or no)No_ revised 9/2/98 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 140 Gray Street,North Andover Owner.Morrow Date of Inspection:4/1812000 BUILDING SEWER:X (Locate on site plan) Depth below grade:24" Material of construction: cast iron X_ 40 PVC _ other(explain) Distance from private water supply well or suction line: Diameter:4" Comments:4"PVC thru wall to septic tank.3"PVC in house. SEPTIC TANK:X (locate on site plan) Depth below grade:12" Material of construction_X concrete_metal_Fiberglass_Polyethylene_other(explain) If tank is metal,list,age_Is age confirmed by Certificate of Compliance_(Yes/No) Dimensions:1 O'x 6 x 4'x 7.5=1500 gallons Sludge depth:3' Distance from top of sludge to bottom of outlet tee or baffle:24" Scum thickness:2' Distance from top of scum to top of outlet tee or baffle:8" Distance from bottom of scum to bottom of outlet tee or baffle: 19" How dimensions were determined:Subtract scum&sludge depths to tee length. Comments:Pumped septic tank.Inlet&outlet tees ok.Depth of liquid at outlet invert.No evidence of leakage. GREASE TRAP:None (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: revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:140 Gray Street,North Andover Owner:Morrow Date of Inspection:4/18/2000 TIGHT OR HOLDING TANK:_None_ (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) E Dimensions: II Capacity:_gallons Design flow:_gallons/day i' Alarm present f Alarm level: Alarm in working order.Yes_No Date of previous pumping: Comments: DISTRIBUTION BOX.:_X_ (locate on site plan) Depth of liquid level above outlet invert:0 Comments:D-box level&distribution equal.No evidence of leakage. Evidence of carryover,pumped d-box to clean. PUMP CHAMBER:_None,gravity system_ (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order(Yes or No) Comments: r Revised 912198 Page 8 of 11 i E SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued)) /Data Address:140 Gray Street,North Andover errow nspection:4118/2000 SOIL ABSORPTION SYSTEM(SAS):X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: J {I Type: . ` leaching pits,number 1 leaching chambers,number: j leaching galleries,number leaching trenches,number,length:.2 Trenches 54'long. leaching fields,number,dimensions: overflow cesspool,number: ARemative system: Name of Technology: Comments:Soil ok.Vegetation ok.No evidence of ponding to surface. CESSPOOLS:None (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: PRIVY:None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: revised 9/2198 Page 9 of 11 I ! I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address':140 Gray Street,North Andover Owner.Morrow Date of Inspection:4/18/2000 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) House Garage Driveway Porch A Water Meter B 4Septic Tank 1 D- Box 54' A to 1 =45'3" A to D-box=46' B to 1 =52'5" B to D-box=677" revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 140 Gray Street,North Andover Owner:Morrow Date of Inspection:4118/2000 NRCS Report name Sal Type Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater 4 Feet Please indicate all the methods used to determine High Groundwater Elevation: --X--Obtained from Design Plans on record " —)_Observed Site(Abutting property,observation hole,basement sump etc.) —X--Determined from local conditions X 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) As per design plan revised 912/98 Page 11 of 11 I TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD MAR 2 0 2003 DATE. SYSTEM OWNER &ADDRESS SYSTEM LOCATION �c 0 ) (example: left front of house) IF t q c� DATE OF PUMPING: 3—fP-4jJANTITY PUMPED GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: COMMENTS: r CONTENTS TRANSFERRED TO: f�LZ CABG /o f4 o N Ti�f/5 14 0 7 -0 -J-Do A 71 r5 0K Th��Y cA� 14D� � s SEPTIC SYSTE IVI AS-BUILT.., CERTIFIED PLO1T,:PLAN I L�j�' 1 LOCATED IN NORTH,AND INA r— SCALE:1"= 40" DATE: `4/15/96 REV.,6/1,9/96 O —I Scott L..Giles R:P C.0 Frank S:'Giles 207,68, 50 Deer Meadb*,Rbad North Andover; Mass, 105.,5- TABLE 055,TABLE OF ELEVATIONS y INV.OUT HSE.=214.42 to INV. IN TANK =213.93 ti OUT TANK=213.63 ui IN D.BOX=213.52. CC) OUT D.BOX=213.36/2 ,END LINE#1=212.96 END LINE#2=212.96. ro �0� C 62.2' t /Y i 13�, 52 5 LOT 2 48,867 S.F. � co 0 vo -STELLA. TOWN OF NORTH ANDOVER/ BOARD OF HEALTH : .... ,...gay:.. .;:. . ! 19 CERTIFY THAT OFFSETS SHOWN ARE FQP I HE USE tN'. THE OFFSETS 10 OF THE BUILDING ,,gSrEC"i OR ONLY � SHOWN COMPLY AND SUCH USE IS FOR THE WITH THE ZONING DE t'ERMINATION OF ZONING � BY LAWS OF NORTH ANDOVER,MA. CONFORMITY OR NON-CONFORMITY WHEN BUILT. WHEN CONSTRUCTED. 61 E COMMONWEALTH OF MASSACHUSETTS 9 EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS v d d DEPARTMENT OF ENVIRONMENTAL PROTECTION SV TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION v Property Address:_140 Gray Street _forth Andover_ MAR Z 0 2003 Owners Name:_Lucas Merrow j Owner's Address:_140 Gray Street 01845 ❑J � i J I O C 1-- O j 25 0 ul Q Z r 0 cn>- O W zi..l CJ�IW>- }-} Q vJ z CLQ J�� QW aW LL W W o � m A F- z sewage disposal system at this address and that the information reported a W time of the inspection.The inspection was performed based on my a and maintenance of on site sewage disposal systems.I am a DEP coon 15.340 of Title 5(310 CMR 15.000). The system: W � w m Q 'asses z nditionally Passes Further Evaluation by the Local Approving Authority Cl Date: 3/17/2003_ W Cl Uj a is inspection report to the Approving Authority(Board of Health or tion.If the system is a shared system or has a design flow of 10,000 2 mer shall submit the report to the appropriate regional office of the C30 Q 0 owner and copies sent to the buyer,if applicable,and the approving 0 CO (n 0 IL W LL 0 d ****This report only describes conditions at the time of inspection and under the conditions of use at that p Y time.This inspection does not address how the system will perform in the future under the same or different conditions of use. j I Page 2 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) i Property Address:_140 Gray Street_ _North Andover i — Owner: Merrow Date ! Inspection:_3/17/2003_ Inspection Summary: Check AAC,D or E/ALWAYS complete all of Section D A. System Passes: _X I I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: I 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. * leaking an if a Certificate of Compliance 11 soon not ea d A metal septic tank will ass inspection if it is structure d, g p ep P P Y indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed 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: page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_140 Gray Street_ _North Andover— Owner: Merrow Date of Inspection: 3/17/2003_ C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**.Method used to determine distance **This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: ' I Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_140 Gray Street_ _North Andover_ Owner: Merrow Date of Inspection: 3/17/2003 D. System Failure Criteria applicable to all systems: You must indicate"yes"or`no"to each of the following for all inspections: Yes No _ —No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool —No Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool No_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ No Liquid depth in cesspool is less than 6"below invert or available volume is less than'/2 day flow No Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _ No Any portion of the SAS,cesspool or privy is below high ground water elevation. No Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _No_ Any portion of a cesspool or privy is within a Zone I of a public well. _ _No_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. No An portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water Y P p P �'Y 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 fromP ollution 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 I are triggered.A copy of the analysis must be attached to this form.) (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply _ the system is within 200 feet of a tributary to a surface drinking water supply _ — the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:_140 Gray Street_ _North Andover— Owner: Merrow Date of Inspection: 3/17/2003_ Check if the following have been done.You must indicate"yes"or"no"as to each of the following: i Yes No Yes _ Pumping information was provided by the owner,occupant,or Board of Health _ No Were any of the system components pumped out in the previous two weeks? Yes_ _ Has the system received normal flows in the previous two week period? _ No Have large volumes of water been introduced to the system recently or as part of this inspection? Yes _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _Yes _ Was the facility or dwelling inspected for signs of sewage back up? Yes' Was the site inspected for signs of break out? Yes — Were all system components,excluding the SAS,located on site? _Yes_ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _Yes— _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? i The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes 'no Yes _ Existing information.For example,a plan at the Board of Health. I No Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[3 10 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:_140 Gray Street _North Andover_ Owner: Merrow Date of Inspection: 3/17/2003_ FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_4_ Number of bedrooms(actual):_4_ DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):_660 Number of current residents: Does residence have a garbage grinder(yes or no):—No_ Is laundry on a separate sewage system(yes or no): No_ [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no):_No Water meter readings: Yes_ Sump pump(yes or no): No_ Last date of occupancy:— Current-COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(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 Source of information:_Pumped 4/18/2000,owner_ Was system pumped as part of the inspection(yes or no):—Yes_ If yes,volume pumped:_1500_gallons--How was quantity pumped determined?_Measured tank._ Reason for pumping:_Inspect tank&tees._ TYPE OF SYS'T'EM _X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Altemative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: 7 years old. 6/19/1996 As built plan. Were sewage odors detected when arriving at the site(yes or no):_No Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) I Property Address:_140 Gray Street _North Andover— Owner: Merrow Date of Inspection:_3/17/2003_ 1 BUILDING SEWER(locate on site plan)X Depth below grade: 24"_ Materials of construction:_cast iron _X_40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.):_4"PVC thru wall to septic tank.3"PVC in house.No leaks. SEPTIC TANK: X locate on site plan) Depth below grade:_12"_ Material of construction:—X—concrete_metal fiberglass_polyethylene _other(explain) If tank is metal list age:, 1s age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions:_10'x 5'x 4' Sludge depth:T3"_ Distance from top of sludge to bottom of outlet tee or baffle: 24"— Scum thickness:_1" Distance from top of scum to top of outlet tee or baffle:_811 _ Distance i from bottom of scum to bottom of outlet tee or baffle:_2011 _ How were dimensions determined: Subtract scum&sludge depth to tee length._ Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.):_Pumped septic tank Inlet tee ok.Outlet tee ok.Depth of liquid at outlet invert.No evidence of leakage._ GREASE TRAP: (locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_140 Gray Street North Andover— Owner: Merrow Date of Inspection: 3/17/2003_ 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.): 1 DISTRIBUTION BOX: X (if present must be opened)(orate on site plan) ) Depth of liquid level above outlet invert:_0_ Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.):_D-box level&distribution equal. No evidence of leakage. Light solid carryover._ 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.): Page 9 of 11 ORM— OFFICIAL INSPECTION F NOT FOR VOLUNTARY ASSESSMENTS O SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_140 Gray Street _North Andover Owner:_Merrow_ Date,of Inspection:_3/17/2003 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: _X_leaching trenches,number,length:_2 trenches 54'long_ leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): No sign of ponding to surface. Vegetation oL CESSPOOLS: (cesspool must be pumped as part of inspectionxlocate on.site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth,of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes 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.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_140 Gray Street_ _North Andover— Owner: Merrow Date of Inspection: 3/17/2003_ SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or water supply enters the building. benchmarks.Locate all wells within 100 feet.Locate where public t pp y g ' House Garage Driveway A Water Meter Septic Tank D- 54' Bog A to Tank=4513" A to D-Bog=46' B to Tank =52'5" B to D-Bog=677' ' III Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_140 Gray Street_ _North Andover— Owner: Merrow Date of Inspection: 3/17/2003_ SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 4 feet Please indicate(check)all methods used to determine the high ground water elevation: _X Obtained from system design plans on record-If checked,date of design plan reviewed:_8/4/1994_ Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: As per design plan_ I i 0 0 _ co ZF E t*'1 r Ql° D - � : - s -z - - 'e - OC - - �eT� - - - - ' - r - �i_ -`3 o - _ _ _ _ _ _ 1._• •[61' .esE�� I00 " - - Go �x.�t=,:_.. -�_?' _ y..4<' <a_'' _ .-•.,. �•., e,- ��-:: ------- '- 00 00 S-I..... h.-, Y3 _:T.� +.�:.•�. -._iL.Sv .^_��--._. -__ - ' i c DeltSuppa: hors tMTER BILLING H I STORY 109©396-QIERROf�, LUCAS G ROBY" METER q1 : 1990396 ch. -------------------- 140 CRAY ST L>Y G p CYCLE SERUICE PRIOR CURRENT USE WATER SEWER FEES TOTAL _ .'{Y �• i 1 1999-100 07!15/1999 2.61 0.00 0.00 2.61 2 1999-130 05!15/1999 0.00 0_00 0.00 0.00 3 1999-160 02/06/1999 0.00 0.00 0.00 0.00 �~ ����oe(g•,�ece�vt; a3 z 4 1999-190 12!24!1998 0.00 0_00 0.00 O.Oe -'s 5 2000-1 07/011/1999 240 277 37 101 .01 0_00 0_00 101.01 6 2000-21 11/15/1999 277 300 23 62.79 0.00 0.00 62.79 7 2000-31 03/92/2000 300 322 22 60.06 0.09 0.00 60_06.. z d -p , 8 2000-41 05/10/2000 322 335 13 35.49 0.00 0.00 35.49 9 2001-11 07/31/2000 335 357 22 60_06 0.00 11 .00 71.06tri `' "I-- r`• `10 2001-21 11/9612080 357 379 22 60.06 0.00 11 .00 71 .Ok 111 2001-31 02/12/2001 379 399 20 54_60 0-00 11.00 65.6 Oiil[aok _.-12 2001-41 05/07/2001 399 418 19 51_87 0.00 11 .00 62.87. is. 13 2002-11 07/25/2001 418 454 36 106.84 0.00 5.55 112.39 rY 114 2002-21 11/16/2001 454 489 35 103_25 0.00 5.55 108.88 15 2002-31 03/11/2002 489 520 31 81 .05 0.00 5.55 86.6 . 1116 2002-41 05/10/2002 520 531 11 27.17 0.00 5-55 32.72 . '17 2002-CRO 11/17/2001 489 489 p -8.96 0.00 0_00 -8.96 ss:'ereer99an°" 18 2003-11 07/2b/2002 531 548 17 40.46 0.00 5.97 46.43. 3REUIEW CHOICE q or <ENTER> MORE HISTORY: 0 . � o O W r m - - t*i z - Cfi� --- - r -Dell, Pc -- - - D marit � es Esr z - e. - Tlie ��fi - 4�ces n ':= c flies - - - daiaiie P RNA - -- ` taii: 4lfec�o[ ' FT `O u1onC i ow: s: . _ rare: yJ� -:t�o�►eriTesF:;.-:j�riveia`_spc__=CRri��I§�g. �,--- --- - - - - _ e - cc Go 1��t—�� ;::'i ...rid:'' --•�z�:�•� - r --- WATER BILLING HISTORY 1090396-MERROW, LUCAS rx ROBYN METER q1 : 1090396 CA Dell: tapQot. , ----------- 140 CRAY ST 8 CYCLE SERUICE PRIOR CURRENT USE WATER SEWER FEES TOTAL _ 1 2003-21 18/28/2002 548 593 45 139.76 0.00 5.97 145.73 =y 2 2003-31 01/24/2003 593 607 14 33.32 0_00 5.97 39.29 . _ ��lOr�Cl��L1, rrtkey = _ �=utlook• �= =: : `' REUlE10 CHOICE a or <ENTER> MORE HISTORY: : FIX 'A : 1-12 NEF. _ - � - - --- - _ sv +fir - - - - - _:^"'�• - _- - :.1�2.�+...v.—:.. __ - -- _" 2 -.. ._ - n _-_� �-•.__ _ _ _ _ _ _.�_r__..�____..-_________.� _______ s- -�—mow- - a�-._--c •--d'cia3���iu�� , a Tel: (978)475-4786 Fax: (978) 475-5451 BATESON ENTERPRISES, INC. Excavating-Water.& Sewer Lines-Septic Systems&Pumping Service 111 Argilla Road Andover, Mass. 01810 Title 5 Inspection Report Property Address: 140 Gray Street, North Andover Owner: Merrow Date of Inspection: 3/17/2003 i a guarantee of future usage and the functionality of the existing My repot contained herein does not constitute guar g y g septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic system. Neil J. Bat son Bateson Enterprises, Inc. i 'O• COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WDMR STREET,BOSTON MA 02108 (617)2924500 TRUDY COXE ARGEO PAUL CELI.UCCI DAVID B.STRUHS Governor Commissioner . SUBSURFACE SEWAGE DISPOSAL SYSTM MISPECTION FORM PART A CERT RCA71ON Property Address:140 Gray Street,North Andover Name of Owner:Lucas Morrow Address of Owner: 140 Gray Street,North Andover,MA.01810 Date of Inspection:4/18/2000 Name of Inspector:Neil J.Bateson I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name:Bateson Enterprises Inc. Mailing Address:111 Argilla Road Andover,MA 01810 Telephone Number:(1 978)475-4786 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 aluation By the Local Approving Authority 4copyis Inspector's Signature: Vrfti , Date:4/18/2000 t' The System Inspector,shall 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 the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS revised 9/2/98 Page I of 11 Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 140 Gray Street,North Andover Owner:Morrow Date of Inspection:4/18/2000 INSPECTION SUMMARY: Check A, B, C,or D. A.SYSTEM PASSES: _X 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 move system components as described in the'Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Indicate yes,no,or not determined(Y,N,or NO).Describe basis of determination in all instances.If"not determined",explain why not. The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is 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 revised 9/2/98 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:140 Gray Street,North Andover Owner:Morrow Date of Inspection:4118(2000 C.FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: 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 sal absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and sal 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 revised 912198 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:140 Gray Street,North Andover Owner:Morrow Date of Inspection:4118/2000 0.SYSTEM FAILS: You must indicate either"Yes"or"No"to each of-the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into 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 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 112 day flow. Required pumping more than 4 times in the last year NOT due to dogged 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- 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 rt 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 upgrade the system in accordance with 310 CMR 15.304(2).Please consult the local regional office of the Department for further information. revised 912198 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:140 Gray Street,North Andover Owner:Marrow Date of Inspection:4/18/2000 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No ` _X Pumping information was provided by the owner,occupant,or Board of Health. _X 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. _X As built plans have been obtained and examined.Note if they are not available with NIA. _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.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 tees, material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. The site and location of the Soil Absorption System on the site has been determined based on: _X Existing information.For example,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) [I 5.302(3)(b)) _X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 912198 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:140 Gray Street,North Andover Owner:Merrow Date of inspection: 4/18/2000 FLOW CONDITIONS RESIDENTIAL: Design flow_165_ .g.p.d./bedroom. Number of bedrooms(design):-4_ Number of bedrooms(actual-4— Total actual4Total DESIGN flow_660_ Number of current residents: 5 Garbage grinder(yes or no):_No Laundry(separate system)(yes or no):_No If yes,separate inspection required Laundry system inspected(yes or no) Seasonal use(yes or no):_No_ Water meter readings.March 98 to March 00=11,900 fe x 7.5=89,250Gals.!730 Days=122 Gals./Day Sump Pump(yes or no):_No Last date of occupancy: Current COMMERCIALIINDUSTRIAL: Type of establishment: Design flow: gpdd(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 RECORDS and source of information:Never pumped,owner System pumped as part of inspection:(yes or no)_Yes_ If yes,volume pumped:_1500_gallons Reason for pumping:Never pumped.Inspect tank&tees. TYPE OF SYSTEM X Septic tankldistribution boxlsoil 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 information:4 years old. 6/19/96.As built plan. Sewage odors detected when arriving at the site:(yes or no)_Nc revised 9/2/98 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:140 Gray Street,North Andover Owner:Morrow Date of Inspection:4/1812000 BUILDING SEWER:X (Locate on site plan) Depth below grade:24" Material of construction: cast iron_X 40 PVC other(explain) Distance from private water supply well or suction line: Diameter:4" Comments:4"PVC thru wall to septic tank.3"PVC in house. SEPTIC TANK:X (locate on site plan) Depth below grade: 12" Material of construe ion:_X concrete_metal_Fiberglass_Polyethylene_other(explain) If tank is metal,list age_Is age confirmed by Certificate of Compliance_(Yes/No) Dimensions: 10'x 5'x 4'x 7.5=1500 gallons Sludge depth:3" Distance from top of sludge to bottom of outlet tee or baffle:24" Scum thickness:2"' Distance from top of scum to top of outlet tee or baffle:8" Distance from bottom of scum to bottom of outlet tee or baffle: 19" How dimensions were determined:Subtract scum&sludge depths to tee length. Comments:Pumped septic tank.Inlet&outlet tees ck Depth of liquid at outlet invert.No evidence of leakage. GREASE TRAP: None (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: revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 140 Gray Street,North Andover Owner:Morrow Date of Inspection:4/18/2000 TIGHT OR HOLDING TANK:_None (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: DISTRIBUTION BOX'.:_X_ (locate on site plan) Depth of liquid level above outlet invert:0 Comments:D-box level S distribution equal.No evidence of leakage. Evidence of carryover,pumped d-box to clean. PUMP CHAMBER:—None,gravity system_ (locate on site plan) Pumps in working order.(Yes or No) Alarms in working order(Yes or No) Comments: Revised 912198' Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued)) Property Address:140 Gray Street,North Andover Owner.Morrow Date of Inspection:4/18/2000 SOIL ABSORPTION SYSTEM(SAS):X (locate on site plan,if possible;excavation not required,location may be approximated by norHntrusive methods) If not located,explain: Type: leaching pits,number leaching chambers,number: leaching galleries, number: leaching trenches,number,length:2 Trenches 54'long. leaching fields,number,dimensions: overflow cesspool,number: Alternative system: Name of Technology: Comments:Soil ok.Vegetation ok.No evidence of ponding to surface. CESSPOOLS:None (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: PRIVY:None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: i i revised 912198 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:140 Gray Street,North Andover Owner.Morrow Date of Inspection:4/18!2000 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) House Garage Driveway Porch A Water Meter B Septic Tank 1 D- Box 54' A to 1 =45'3" A to D-box=46' B to 1 =52'5" B to D-box=677" revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:140 Gray Street,North Andover Owner:Morrow Date of Inspection:4/18/2000 NRCS Report name Sal Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater 4 Feet Please indicate all the methods used to determine High Groundwater Elevation: —X—Obtained from Design Plans on recons _X Observed Site(Abutting property,observation hole,basement sump etc.) X Determined from local conditions X 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) As per design plan revised 912198 Page 11 of 11 Tel: (978) 475-4786 Fax: (978) 475-5451 BATESON ENTERPRISES, INC. Excavating-Water.& Sewer Lines-Septic Systems&Pumping Service 111 Argilla Road Andover, Mass. 01810 Title 5 Inspection Report Property Address: 140 Gray Street, North Andover Owner: Merrow Date of Inspection: 4/18/2000 My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system Such report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic system. s Neil J. Bateson Bateson Enterprises,Inc. NURT1y F Town of over � o - Lrt `' dower, Mass., 19 COCHICHEWICK �t ADRATED 5 BOARD OF HEALTH PERMIT T Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT .............................. ... . ............... Foundation has permission to erect......... . ........ buildings on .. . .....`7... .......... - (.�............. .............. �Roug tobe occupied as ................ ........... .... . . ... ......... ...................................................................... Chimney provided that the person accepting this mit shall in every respect con rm to the terms of the application on file in Final this office, and to the provisions of the odes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBIYG INSPECTOR VIOLATION of the Zoningor Building Regulations Voids this Permit. oug `� 9 9 PERMIT EXPIRES IN 6 MONTHS `na 6 UNLESS CONSTRUCTION STAR �1 ELECT ICAL NSPE 10, V Service ING INSPECTOR .01 ina Occupancy Permit Required t0 Occupy Budding GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not -Final a - - - - - No Lathing or Dry Wall To Be Done FIRE DEP RTME T Until Inspected and App ilding Inspe or. Burner 40 16p, Street No. , rl Smoke Det. I I I { I Town of North Andover, Massachusetts Form No.3 NORrti .7 BOARD OF HEALTH � 1 3? i . 0 l . p 19 41 /Yu • * ��+tetra<ittiwt.-' : } . DISPOSAL WORKS CONSTRUCTION PERMIT .... SACMUS Applicant_ I�i��n� ��L NAME XODORESS TELEPHONE Site Location_ Permission is herebyranted to Construct g {f) or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. `-ay CHAIRMAN, BO RD OF HEALTH i Fee : .;:. -.:.,:...,...:•.; :::. „_ D.W.C. No. J�TOWN OF W�RTP A��U:: " B0ARD OF HEAD `i JUN - 31996 CERTIFIED PLOT PLAN LOT 1 LOCATED IN NORTH ANDOVER, MA SCALE:1"= 40" DATE: 4/15/96 REV:5130/96 --I Scott L. Giles R.P.L.S. w 1 50 Deer Meadow Road 207.68 North Andover, Mass. M 105 5' j p 0) co / T � 62.2' c 0 D.BOX 6686' R PROP. NEW LOT 2 ----_- LOCATION 48,867 S.F. rn 0 00 N/F STELLA F�� 9 I CERTIFY THAT OFFSETS S HE USE THE OFFSETS OF THE BUILDING INSPECTOR ONLY j SHOWN COMPLY AND SUCH USE IS FOR THE WITH THE ZONING DETERMINATION OF ZONING BY LAWS OF NORTH ANDOVER, MA. CONFORMITY OR NON-CONFORMITY WHEN BUILT. WHEN CONSTRUCTED. 4/15/96 TOWN OF RTHAPD(ER/ BOARD OF HEALTH 'o h1AC CERTIFIED PLOT PLAN LOCATED IN NORTH ANDOVER, MA T SCALE:1"= 40" DATE: 4/15/96 REV. 5/30/96 Scott L. Giles R.P.L.S. S 207.68' North Andover, Massa 1 1p5.5o cfl �. Q 7 W f T / _ 62.2'. . o0 h 0� �� 1G 0 90 � o �. D.BOX 6686' \ PROP. NEW LOT 2 LOCATION 48,867 S.F. X C) 00 � F J— N/F STELLA I CERTIFY THAT OFFSETS SHOWN ARE FOR THE USE THE OFFSETS OF THE BUILDING INSPECTOR ONLY SHOWN COMPLY AND SUCH USE IS FOR THE WITH THE ZONING DETERMINATION OF ZONING BY LAWS OF NORTH ANDOVE MA. CONFORMITY OR NON—CONFORMITY R, WHEN BUILT. WHEN CONSTRUCTED. 4/15/96 TOWN Oti N)RTr H +�_(. BOARD OF','F" F"IN tt _ --� CERTIFIED PLOT PLAN E LOCATED IN NORTH ANDOVER, LOT 1 0 ER, MA. 0 SCALE:1"= 40" DATE: 4/15/96 REV. 5/30/96 —I Scott L. Giles R.P.L.S. CA) 50 Deer Meadow Road 207.68, North Andover, Mass. r 105 5' o y. LO co ti y 00 / \ \ \ V +/� .0 4401 c 62.2' a° 0 D.BOX 6686' PROP. NEW LOT 2 LOCATION 48,867 S.F. 7 � C c N/F STELLA I CERTIFY THAT OFFSETS SHOWN ARE FOR THE USE THE OFFSETS OF THE BUILDING INSPECTOR ONLY SHOWN COMPLY AND SUCH USE IS FOR THE WITH THE ZONING DETERMINATION OF ZONING BY LAWS OF NORTH ANDOVER, MA. CONFORMITY OR NON-CONFORMITY WHEN BUILT. WHEN CONSTRUCTED. 4/15/96 CERTIFIED PLOT PLAN LOCATED IN NORTH ANDOVER, MA. LOT 1 SCALE:1"= 40" DATE: 4/15/96 Scott L. Giles R.P.L.S. w 50 Deer Meadow Road 207.68, North Andover, Mass. i LO y � co ori 0 _ .92.6' , .0p . co w �S '90 16 � S s68s, LOT 2 48,867 S.F. N(1RSr ar'� TOw BC► Rte- �~ rn c0 NSF STELLA I CERTIFY THAT OFFSETS SHOWN ARE FOR THE USE titN ►' THE OFFSETS OF THE BUILDING INSPECTOR ONLY SHOWN COMPLY AND SUCH USE IS FOR THE WITH THE ZONING DETERMINATION OF ZONING LAWS OF CONFORMITY OR NON-CONFORMITY NORTH ANDOVER, MA. �L� WHEN BUILT. WHEN CONSTRUCTED. FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: _�i�.t/�9L.0 �.vrTo�✓ Phone(�ad'� a,� - /G/g LOCATION: Assessor's Map Number Parcel Subdivision Lots) Street G/>,v 17' 62— St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation( Administrator (' (� Date Rejected Comments QL 1g �-D Date Approved ZZ Town Planner a Date Rejected Comments Date Approved Food Inspector-Health Date Rejected CR--- Date Approved �a I� Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date Town of North Andover, Massachusetts Form No.2 OORTh BOARD OF HEALTH 0 �t o � A DESIGN APPROVAL FOR ss�C"US6t SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant Test No. Site Location ;L • Reference Plans and Specs. - ENGINEER GN DATE : Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. CHAIRMAN,BOA RVOT HEALTH Fee Site System Permit No. �-� Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH * hp?P' m �RQpR4TEDWPPay^`5* APPLICATION FOR SITE TESTING/INSPECTION �SSACHUS�� i Applicant NAME ADDRESS TELEPHONE Site Location t ' Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time i CHAIRMAN,BOARD OF HEALTH Fee Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. pORTF� . O 3? 0 0 BOARD OF HEALTH x . . " S. 120 MAIN STREET TEL. 682-6483 �SSNCHUNORTH ANDOVER, MASS. 01845 Ext23 July 6, 1995 Mr. Scott Giles 50 Deer Meadow Road North Andover, MA 01845 Re• � Lot 2 Gray ra Street Dear Scott: This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: 1) No P.E./R.S. stamp. 2) Waterline missing. 3) Insufficient leach area - calculated incorrectly. 4) Three 20 inch access manholes required for tank, plus gas baffle at outlet. 5) Change fill note to refer to 15. 255 (3) of Title V. 6) Vent missing (required if lines over 50 feet) . If you have any questions, please do not hesitate to call the Board of Health Office at the number above. Sincerely, Sandra Starr, R.S. Health Administrator SS/cjp i PLAN REVIEW CHECKLIST ADDRESS 7� 6,e1l y 7' ENGINEER I GENERAL 3 COPIES' STAMP/Z LOCUS NORTH ARROW SCALE C� CONTOURS (/ PROFILE(/ SECTIONS BENCHMARK fig SOIL & PERCS ELEVATIONS WETS. DISCLAIMER WELLS & WETS �- WATERSHED? DRIVEWAY Q (Eley) WATER LINE FDN DRAIN L/ SCH4 0JCZ TESTS CURRENT? SOIL EVAL 3 SEPTIQ TANK MIN 15OOG L,,-' . 17 INVERT DROP (/ GARB. GRINDER& (+200 EDF) 25' TO CELLARMANHOLE ELEV GW # COMPS. _ D-BOX SIZE # LINES FIRST 2 ' LEVEL STATEMENT INLET I OUTLET 17 (2" OR . 17 FT) TEE REQD?A/0 LEACHING MIN 660 GPD?X RESERVE AREA v 4 ' FROM PRIMARY? SLOPE d� 100 ' TO WETLANDS/ 100' TO WELLS L/ 4 ' TO S.H.GW (--' (51>2M/IN) 35 ' TO FND & INTRCPTR DRAINS L,-'- 325' TO SURFACE H2O SUPP� 4 ' PERM. SOIL BELOW FACILITY C/ MIN 12" COVER C----� FILL? (25 ' if above natural elev; 101if below) BREAKOUT MET. TRENCHES MIN 660 gpd z SLOPE (min . 005 or 611/1001 )_ SIDEWALL DIST. 3X EFF. W OR D (MIN 6 ' ) Q----- RESERVE BETWEEN TRENCHES? t,�— IN FILL? MUST BE 10 ' MIN.-LI 4" PEA STONE?y VENT? X000, (>3 ' COVER; LINES >501 ) BOT 330 + SIDE a7A U X LDNG / 6� = TOT 330'L 6 6 (L x W x #) (DxLx2x#) (G/ft2) 3aa -<-f'z 0,73, 4.46 7// Copyright© 1995 by S.L.Stan I DATE 7z�-� Sheet of ��� BOARD OF HEALTH TOWN OF NORTH ANDOVER SUBSURFACE DISPOSAL DESIGN REVIEW FES �•v PERMIT # `a� 7 DATE RECEIVED.c-'5-/, 4 A_P 7ICAITT -1-bu Jo ASSESSOR' S MAP 1�7� ALDRESs PARCEL # Civ LOT # STREET co 7F AsD�sss �d D��,� /►'I��Dow REVISION DATE C:,:;DIT:C:%S OF APPROVAi,: A.PROVED DISAPPROVED A)0 moi. %2. S , 6 7W/4P 1-14 Cc113T�•e L/N� /t%1/55 SNC T�4�VK/ f - r e 7:7 A)0 Tc /67 �M/ 7 V vv�&A-Z-Gr I til j C1 ,+ � L D; 2.e 9 37 t L" S 2 l, ; ZZ.3 LM r i 4e 3 b t-p4-k -7 Z: // .'07 � Zr - I1 , 2Z -+` Z 9 s L A 7 op if � I 4 I I � i ' '� � � i i �� ;�= ���'..7 �'i-7c_ -f..�-i •� . amu"' — �,� - I i Uf "Y 2./ / ,. I A 71 � d-_7���'=757'C7 ��''Y' ' fes-' C7�/ .•` (y��T�CL- C.W 61 — �� 7 tlx: -_ � I I/ ZAP FS 1 Q T Walter S. Mari d dl is BOSTON y�I-dV rchont AQCE: L • Q � �, n cL5 tt In Coburn A Sm'Ith f�� v{,„•s _:-We, Nancy Houghton,'Robert Houghton, Jeannette Davisonand Annie H. Houghton, 8'7 heirs of Joseph H. Houghton Of North Andover Essex County.Massachusetts, i being nnmenied,for consideration paid,and in full consideration of One (;1.00) Dollar .i grant to .Annie M. Houghton pf 305 Boston St., North Andover, MA with rlutltlaint tnBttiHIi21 all our right, title and interest in thelandla North Andover, with any and all buildings thereon, bounded and described as follows: W urlpdoa and tncumbruua,U say) Beginning at a point and a stone wall on the easterly side of Boston Street, North Andover, F.asox County, Maesachunetts, be land now or formerly of Mildred Marchant thence running by a wall and said Boston Street in a northeasterly direction three � � �• hundred fifty-five fiv e (355) feet more or lase to another atone wall, thence turning and rennin n i a south easterly'- g e ly direction along a atone wall two hundred ninety- tow (292) feet more or less to another stone wall; thence turning and running It along a curved stone wall in an easterly direction one hundred seventy-four and five tenths (174.5) feet more or leas to another atone wall; thence turning and }} running in a southerly direction by said stone wall four hundred five (405) feet more or less to another atone wall and land owned now or formerly by said Marchant; t( thence turning and running in an easterly direction along said stone wall and land .'J of Marchant two hundred thirty-one and five tenths 231.5 feet t , ( ) et more or lees to t another stone wall; thence rennin in a R northerly direction along a atone wall and land of Marchant two hundred thrity-one and five tenths5. 231 ( ) feet more or less and another atone wall; thence turning and running in an easterly direction by a ` stone wall one hundred sixty-five (165) feet more or lees to the point of beginning. All of said bounds are as shown on a plan drawn by Ralph B. Brasseur C.E. which plan is recorded 1 nthe P North District Essex Registryof Deeds as Plan No. 1896 Said tract , ct contains approximately 3.40 acres more or lees and is a portion of the remises that were conveyed l P yed to Raymond W. Boughton by deeds of Joseph H. Houghton and Annie M. Houghton datod June 28, 1948 recorded in said Registry in Book 712, Page 363, nod an-thgr deed from said Houghton® dated Septets?ar 13, 1948 recorded in Boo;c 715, Pagu 39u. Said premises are convoyed subject to and with the benefit of easements and restric- tions of record, if any, insofar as the same may now be in force and applicable. gam,•:.:;.... . _4��-,�Keaning and intending to convey and hereby conveying the premises conveyed to H. Houghton and Annnio M. Houghton by deed dated October 17, 1957 and re- :,.corded with said Registry at Book 863, Page 178. r hands and seals. this.........aaNQ day of....Se tember .......... ............ ........... ..................................... ............................................................. ........................................................................ ... ZCllt (bututrrttl uto of 1lthe Mlddlaux p, September .72� 19 88 . �eft personally appeared the above named Nancy Houghton, Robert Houghton, Jeannette Dayiaon and Annie M. Houghton vse �edged the fore in Instrument to be their go 8 free act and deed before me III %.,Q ►10.�-0?t.0 i; 2::• 1. W_01”loo 4010- 8 f:'�'�:4 fD ;'t�y C. 20. 988 at 9:49ANM #30718 :.a�; Q•e. -�r `� ';. wdon (or my Iseas or A s PoA of the doed. deed for nmtdtoa uWm 360 :. DEED V19 Section 4: The Board of Directors shall have the general care and management of the Club and the control and disposal of all corporate i property. Article Vll, Section 1: The Club shall have a corporate seal which shall be in such form as may be determined by the Board of Direc- tors. The seal shall be afi'ixed to all instruments requiring a seal, except that the Board may adopt and use any other seal for any particu- lar instrument when the corporate seal is not obtainable. Article Vll, Section 2: All deeds and contracts of the Club shall be made by the Board of Diractors, or under their authority, and if in writing shall be signed by the President or other person specifically authorized ther - unto by the board. 2) That the s;:al of tho corporation is at present un obtainable, having been lost, destroyed or mislaid. 3) That Frank E. dallwork, Jr.,is the President of the corporation, having been duly el- ected to that office and never resigned or been removed therefrom,and his term as such not having expired. Herbert S. Stillings, Clerk. The North Andover Club. Subscribed and sworn to, before me, Charles W.Trom-I bly, Notary Public. (Notarial Seal)." "sex,ss.Heceived June 28,1948 at 23m past 3P.M.Recorded and Examined. I _ Gray I, Nellie N. Gray of North Andover, Essex County, Massachusetts, being to unmarried, for consideration paid, grant �o Joseph H. Houghton and An- HouShton nie 14. Houghton, husband and wife, as joint tenants and not as tenants et ux in common nor as tenants by the entirety of North Andover with QUITCLA _ covenants a one half undivided interest in a certain parcel of land sit uated in North Andover in said County and Commonwealth and BOUNDED and See Plan #1896 described as follows: Two certain parcels of land in North Andover Mass achusetts, shown on a plan of land in North Andover, Massachusetts,scal� t.� 1 inch equals 100 feet, dated November 15, 1947, drawn by Ralph B.Bras-le c, yi:lJni9to seur, C.E., of Haverhill, Massachusetts to which reference may b e made for a more particular description, said plan being recorded herewith: (1) A certain parcel of land on the westerly side of Boston Street,show as Parcel 1 on the above menticned plan, bounded and described as fol- lows: Beginning at the northeasterly corner of the herein described pa cel at a point in the westerly side of Boston Street, at land now or fo - merly of vialter S. and Mary A. Holden, thence southwesterly,by the west erly line of uoston Street, 537 feet to land of Frank Travers; thence northwesterly, in two courses as the wall acid fence stands, 518.5 feet to a point in the easterly line of Gray Street; thence northeasterly-, by various courses by the easterly line of Gray Street, 582 feet to lana of "alter 6. ancillary A. Holden; thence southeasterly, by land of saia Holden, 349 feet to the point of beginning containing 4.4 acres, more or less. (2) A certain parcel of land I P on the easterly side of Bos i Commonwealth of Massachusetts City/Town of v �.C'.-I!!I- a System Pumping Record Form 4 SEP 16 2008 -_ , � u� DEP has provided this form for use by local Boards of Health. t '�rL#o,n TH aNDov rr i � ay�befM5'> Jut the information must be substantially the same as that provided h4e�efra"� i tlils'#orm, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. System Locat' n Left fro , left rear, left si a of house. fight front, right rear, right side of house. forms on the computer,use only the tab key Address ( � � J to move your ( ( O Sf— Y`� cursor-do not City/Town State Zip Code use the return key. 2. System Owner: Name Address(if different from location) Cityrrown StateCode �` - � Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: © Cesspool(s) eptic Tank [] Tight Tank Other(describe): 4. Effluent Tee Filter present? Q Yes 0.Ko If yes,was it cleaned? p Yes No 5. Condition of System: �-AA� 6. System Pumped By: Neil Bateson F 5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location where contents were disposed: L.S.D Lowell Waste Water Aignaur Date t5form4.doe•06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts City/Town of REC System Pumping Record AUGS' 2010 Form 4 N TOWN OF NORTH ANDOVER DEP has provided this form for use by local Boards of Health. Other for Dom' information must be,substantially the same as that provided here. Before using this form,c ec w your local Board of Health tQ determine the form they use. The System Pumping Record must be submitted to the local Board of Health oirott*r approving authority. A. Facility Information 1. System Location: Left side of house, Right side of house, Left front of hous ht front of house, Left rear of house, Right rear of house. Left rear of building. Right rear of building. Address 40� Cityrrown State Zip Code 2. System Owner: NameV`-- Address(if different from location) City/Town Stater � �,��i Code Telephone Number B. Pumping Recor,, 1. Date of Pumping Date )2Quantity Pumped: Gallons ' 3. Type of system: ❑ 0ess`pool(s) ❑ Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location where contents were disposed: G.L.S.D Lowell Waste Water Signature of Hauler. Date I t5form4.doc+06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts ECEIVED . City/Town of System Pumping Record OC1 2012 Form 4 TOWN of NEJMAMOt� M yV v` HEALTH#DEPART[ EI DEP has provided this form'for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: L fight �ofhLeft/Right rear of house, Left/right side of house, LeftRight side of building, ilding, Left/Right rear of building, Under deck Address `-� i Citylrown State Zip Code 2. System Owner. Name Address(if different from location) CitylTown State � ZJD Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2• Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Tank p a tic Tight Tank ❑ g ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc j Company 7. a contents were disposed: !,S. 7 Q Lowell Waste Water Signitufe Haule Date t5form4.doc•06103 System Pumping Record•Page 1 of 1