HomeMy WebLinkAboutMiscellaneous - 144 CRICKET LANE 4/30/2018 144 Cricket Lane "mor
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SEPTIC SYSTEM INSTALLATION
Is the installer licensed? (-ES NO
Type of Construction: W p�
New Construction: -_._Certified Plot Plan ReviewYES, NO
-Floor Plan Review YES NO
_— Conditions of Approval from Form U YES NO
_Issuance of DWC permit: - NO
_DWC Permit Paid? -- YES NO .
---DWC-Permit# - = Installer:
- Begin Inspection:_ . YES NO
-Excavation Inspection:
-Needed-
Passed: By:
_.._Construction Inspection:
--Needed:
As-Built-Plan Satisfactory:
YES: 0)L"
_ Approval of Backfill: Date:
---Final Grading Approval: Date: ,
T �J
Final Construction Approval: Dater By: ,
Certificate of Compliance: Approval: Date:
s
00
Lot & Street LST („ C�fC��-���` Map/Parcel
CONSTRUCTION APPROVAL
Has plan review fee been paid: S , NO Permit-"' /C`5
-f 25 i
Plan Approval: Dat : Approved by: � /(�
Designer: /l�( —Plan Date:
Conditions:
Water Supply: Town Well.
Well Permit: _.Driller:
Well Tests: ChemicalDate Approved
Bacteria I Date-
Approved
Bacteria II Date�Approved
Plumbing Sign-Off: �, -Wiring Sign-Off:
Comments:
Form "U" Approval: Approval to-Issue: NO
Date Issued By:
Conditions:
Final Approval:
All Permits Paid? ( � NO
Well Construction Approval? YES - -N0—
Septic System Construction Approval? NO i
Certification? S NO I
Other YES NO
Any Variance Needed? YES
NO
FINAL BOARD OF HEA TH AP ROYAL:
DATE: 2j2—q1G'U
APPROVED BY:
r
Commonwealth of Massachusetts --
City/Town of
u
System Pumping-Record
Form 4 C; i `L C 2014
�' TOVvw ur r4uK1„ANDOVER
DEP has provided this form for use-by local Boards of Health. Other forms"maybe usedTb 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: Left/Right front of house, Left/Right rear of house, e /right side of house, Left/
Right side of building, Left!Right front of building, Left/Right rear of bui ing, Under deck
Address
Cityrrown State Trp Code
2. Sysm Owner.
tobtAlon
Nam V I Ca&J L4
Address(if d ,rreAnt fro location)
,1 BVI
sX_r
Ctty/Town State �Code
Telephone Number 6,
B. Pumping Record rr`�
1. Date of Pumping ate_ 1 2. Quantity Pumped: I SUU
Gallons '
3. Type of system: ❑ Cesspool(s)
"ptic Tank Tight
Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yeas CU/No if yes, was it cleaned? Yes M No
5. Condition of System:
►�orwwl
6. System Pumped By:
Neil Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc -
Company
7. Location where contents were disposed:
Ca.L S. Lowell Waste Water
Ba�
4 �I
Sig Haul Date
it
t5form4.doa 06/03 System Pumping Record•Page 1 of 1
N Commonwealth of Massachusetts
F City/Town of
W° System Pumping Record ME D
Form 4
,M CCS' -
DEP has provided this form for use by local Boards of Health. Other fo s may be used, but the
information must be substantially the same as that provided here. Befo 665M 19P) M ith your
local Board of Health to determine the form they use. The System Pu itted to
the local Board of Health or other approving authority.
A. Facility Information
1. System Location eft fro;ntof house, ight front of house, left side of house, right side of house, Left
rear of house, right rear ouse, a side of building, right rear of building, under deck.
kn*j"-
Cityrrown State Zip Code
2. System Owner:
Name
Address(if different from location)
City/Town StateZip d
q ( r
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? ❑ Yes o If yes, was it cleaned? ❑ Yes ❑ No
5. Conditio!n of,Sem:
6. System Pumped By:
Neil J. Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc.
Company
P Y
7. Location where contents were disposed:
.L.S. Owell Waste
4Water
Signature of H4uler Date
t5form4.doc•06/03 System Pumping Record•Page 1 of 1
Commonwealth of Massachusetts
RECEIVED
City/Town of
System Pumping Record OCT 2 2.2013
Form 4 `
TOWN OF NORTH ANDOVER
DEP has provided this form for us&by local Boards of Health. Other form HEALTH DEPART NT
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 Le ig on of house Left/Right rear of house, Left/right side of house, Left/
Right side of buil Left/Right front of building, Left/Right rear of building, Under deck
Address
Cityrrown (� v\ State Zip Code
2. System Owner.
Name
Address(if d-ifferent from location)
CitylrownState
. MP
c �.��
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? ❑ Yes No If yes,was it cleaned? ❑ Yes ❑ No:
5. Con iti n of System:
6. System Pumped By:
Neil Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7. Lo contents were disposed:
Cx.L S. Lowell Waste Water
J 's
Signitufe ct HaulerU Date
t5form4.doc•06/03 System Pumping Record•Page 1 of 1
tLORTIy
o N
�4p°q�rEo^pay y
�SSACHU`+�t
PUBLIC HEALTH DEPARTMENT
Community Development Division
December 4, 2007
Ronald Headrick
144 Cricket Lane
North Andover, MA 01845
Dear Mr. Headrick:
Please note that due to recent reviews of Title 5 Reports, your property has been identified as
maintaining a working garbage grinder that is being used in conjunction with a septic system.
The Health Department is concerned for the longevity of your septic system.
Garbage grinders are never recommended where septic systems are used, but if they are installed,
the system must be specifically designed to handle the waste from them; your system can not
handle the waste as designed. Please note that continued use of this grinder could quickly cause
a pre-mature failure of your septic system,resulting in a large expenditure to replace it. The
North Andover Health Department recommends that you remove it from your home as soon as
possible.
Some information regarding regular maintenance of your septic system is attached. Please call
the Health Department at 978.688.9540 if you have any questions, or e-mail your questions to:
healthdeptgtownofnorthandover.com.
Thank you for taking the time to consider the impact that your current setup has on your septic
system and the environment.
Sincerely
Susan Y. Sawyer, RENS/
Public Health Director
/pfd
Enc: Septic System Information: http://www.mass.gov/dep/water/wastewater/dodont.htm
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com
1viass lirr :: 1vtti lit;r Resource rrotection- Septic Systems/Title 5: information for hom... Page 1 of 1
v
How Do I as a System Owner Properly Care for my Septic System?
Conventional on-site septic systems can function very well with minimal care.In fact,most septic tanks will only
require an inspection and pumping out by a professional every three to five years if they are used properly.This does not
pertain to I/A_systems,which need more frequent oversight.
DO...
Do have the system inspected and pumped every 3 to 5 Do not use your toilet or sink as a trash can by dumping
ears.If the
y tank fills up with an excess of solids,the non-biodegradables(cigarette butts,diapers,feminine
wastewater will not have enough time to settle in the products,etc.)or grease down your sink or toilet.Non-
tank.These excess solids will then pass on to the leach biodegradables can clog the pipes,while grease can
field,where they will clog the drain lines and soil. thicken and clog the pipes.Store cooking oils,fats,and
grease in a can for disposal in the garbage.
M_o..re inform at_i_on on-purn ping
Do know the location of the septic system and drain Do not put paint thinner,polyurethane,anti-freeze,
field,and keep a record of all inspections,pumpings, pesticides,some dyes,disinfectants,water softeners,and
repairs,contract or engineering work for future other strong chemicals into the system.These can cause
references.Keep a sketch of it handy for service visits. major upsets in the septic tank by killing the biological
part of your septic system and polluting the groundwater.
Small amounts of standard household cleaners,drain
cleansers,detergents,etc.will be diluted in the tank and
should cause no damage to the system.
Do grow grass or small plants(not trees or shrubs)above Do not use a garbage grinder or disposal,which feeds
the septic system to hold the drain field in place.Water into the septic tank.If you do have one in the house,
conservation through creative landscaping is a great way severely limit its use.Adding food wastes or other solids
to control excess runoff. reduces your system's capacity and increases the need to
pump the on-site tank.If you use a grinder,the system
must be pumped more often.
Do install water-conserving devices in faucets, Do not plant trees within 30 feet of your system or
showerheads and toilets to reduce the volume of water park/drive over any part of the system.Tree roots will
running into the on-site system.Repair dripping faucets clog your pipes,and heavy vehicles may cause your
and leaking toilets,run washing machines and drainfield to collapse.
dishwashers only when full,and avoid long showers.
Do divert roof drains and surface water from driveways Do not allow anyone to repair or pump your system
and hillsides away from the septic system.Keep sump without first checking that they are licensed system
pumps and house footing drains away from the system as professionals.
well.
Do take leftover hazardous chemicals to your approved Do not perform excessive laundry loads with your
hazardous waste collection center for disposal.Use washing machine.Doing load after load does not allow
bleach,disinfectants,and drain and toilet bowl cleaners your septic tank time to adequately treat wastes and
sparingly and in accordance with product labels. overwhelms the entire system with excess wastewater.
You could therefore be flooding your drain field without
allowing sufficient recovery time.You should consult
your tan k__professional to determine the gallon capacity
and number of loads per day that can safely go into the
system.
Do use only septic system additives that have been Do not use chemical solvents to clean the plumbing or
allowed for usage in Massachusetts by DEP.Additives septic system. "Miracle"chemicals will kill
that are allowed for use in Massachusetts have been microorganisms that consume harmful wastes.These
determined not to produce a harmful effect to the products can also cause groundwater contamination.
individual system or its components or to the
environment at large.
http://209.85.165.104/search?q=cache:OSxS WhzZovAJ:www.mass.gov/dep/water/wastew... 1/22/2007
pORSM
"LTG q�
7 32 q11,,p h6.6 OL
SSACHU`+��
PUBLIC HEALTH DEPARTMENT
Community Development Division
December 4, 2007
Ronald Headrick
144 Cricket Lane
North Andover, MA 01845
Dear Mr. Headrick:
Please note that due to recent reviews of Title 5 Reports, your property has been identified as
maintaining a working garbage grinder that is being used in conjunction with a septic system.
The Health Department is concerned for the longevity of your septic system.
Garbage grinders are never recommended where septic systems are used, but if they are installed,
the system must be specifically designed to handle the waste from them; your system can not
handle the waste as designed. Please note that continued use of this grinder could quickly cause
a pre-mature failure of your septic system,resulting in a large expenditure to replace it. The
North Andover Health Department recommends that you remove it from your home as soon as
possible.
Some information regarding regular maintenance of your septic system is attached. Please call
the Health Department at 978.688.9540 if you have any questions, or e-mail your questions to:
healthdeptgtownofnorthandover.com.
Thank you for taking the time to consider the impact that your current setup has on your septic
system and the environment.
Sincerely
Susan Y. Sawyer, REHS/
Public Health Director
/pfd
Enc: Septic System Information: http://www.mass.gov/dep/water/wastewater/dodont.htm
1600 Osgood Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com
ivlaz)b Ll;r .. Lvrnl,r✓r resource rrotectnon- 6epnc systems/1rtle 5: informationforhorn... Page 1 of 1
r
How Do I as a System Owner Properly Care for my Septic System?
Conventional on-site septic systems can function very well with minimal care.In fact,most septic tanks will only
require an inspection and pumping out by a professional every three to five years if they are used properly.This does not
pertain to 1/A systems,which need more frequent oversight.
DO... I
Do have the system inspected and pumped every 3 to 5 Do not use your toilet or sink as a trash can by dumping
years.If the tank fills up with an excess of solids,the non-biodegradables(cigarette butts,diapers,feminine
wastewater will not have enough time to settle in the products,etc.)or grease down your sink or toilet.Non-
tank.These excess solids will then pass on to the leach biodegradables can clog the pipes,while grease can
field,where they will clog the drain lines and soil. thicken and clog the pipes.Store cooking oils,fats,and
grease in a can for disposal in the garbage.
More information on pum-ing
Do know the location of the septic system and drain Do not put paint thinner,polyurethane,anti-freeze,
field,and keep a record of all inspections,pumpings, pesticides,some dyes,disinfectants,water softeners,and
repairs,contract or engineering work for future other strong chemicals into the system.These can cause
references.Keep a sketch of it handy for service visits. major upsets in the septic tank by killing the biological
part of your septic system and polluting the groundwater.
Small amounts of standard household cleaners,drain
cleansers,detergents,etc.will be diluted in the tank and
should cause no damage to the system.
Do grow grass or small plants(not trees or shrubs)above Do not use a garbage grinder or disposal,which feeds
the septic system to hold the drain field in place.Water into the septic tank.If you do have one in the house,
conservation through creative landscaping is a great way severely limit its use.Adding food wastes or other solids
to control excess runoff. reduces your system's capacity and increases the need to
pump the on-site tank.If you use a grinder,the system
must be pumped more often.
Do install water-conserving devices in faucets, Do not plant trees within 30 feet of your system or
showerheads and toilets to reduce the volume of water park/drive over any part of the system.Tree roots will
running into the on-site system.Repair dripping faucets clog your pipes,and heavy vehicles may cause your
and leaking toilets,run washing machines and drainfield to collapse.
dishwashers only when full,and avoid long showers.
Do divert roof drains and surface water from driveways Do not allow anyone to repair or pump your system
and hillsides away from the septic system.Keep sump without first checking that they are licensed system
pumps and house footing drains away from the system as professionals.
well.
Do take leftover hazardous chemicals to your approved Do not perform excessive laundry loads with your
hazardous waste collection center for disposal.Use washing machine.Doing load after load does not allow
bleach,disinfectants,and drain and toilet bowl cleaners your septic tank time to adequately treat wastes and
sparingly and in accordance with product labels. overwhelms the entire system with excess wastewater.
You could therefore be flooding your drain field without
allowing sufficient recovery time.You should consult
your tank professional to determine the gallon capacity
and number of loads per day that can safely go into the
system.
Do use only septic system additives that have been Do not use chemical solvents to clean the plumbing or
allowed for usage in Massachusetts by DEP.Additives septic system. "Miracle"chemicals will kill
that are allowed for use in Massachusetts have been microorganisms that consume harmful wastes.These
determined not to produce a harmful effect to the products can also cause groundwater contamination.
individual system or its components or to the
environment at large.
http://209.85.165.104/search?q=cache:O SxS WhzZovAJ:www.mass.gov/dep/water/wastew... 1/22/2007
Septic System Information
144 CRICKET LANE
Printed On: Tuesday, December 04, 20
System ID: BHS-2002-0408
General System Information Latest Permit Information
Calcaluted Design Flow: Test Pits Septic Tank Disposal Trench
Design Flow: One TWO Capacity: Number: M
Design Flow Provided: Minutes per inch: Width: Width:
I
Total Flow: Depth: Length: Length:
Seasonal: No Depth to Water: Diameter: Leaching: `
Grinder: Yes No Soil Type: Depth:
Laundry: No No
Hauling/Pumping Listin Quantity
Type System Type Pumped Pumped By Transferred To Disposed At Date Pumped allons
Routine
Routine Septic Tank Bateson Ent10/29/2004 1500
'�
Routine Septic Tank Bateson Ent ,GLSD 11/12/2005 1500
Routine Septic Tank Bateson Ent GLSD 10/04/2006 1500
Comments: normal level in tank
Routine Septic Tank Bateson Ent GLSD 10/18/2007 1500
Comments: normal level
Routine Septic Tank Bateson Ent GLSD 11/14/2007 1500
Comments: Normal level-heavy solids
Inspections:
Inspected: Expires: Inspector: Status:
11/01/2007 Neil J.Bateson Passes
Comments: Title 5
i
GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Page 1 of 1
2874
Town of North Andover
` HEALTH DEPARTMENT
,SSACM�Stt
CHECK#: ATEam
LOCATION:
r i
H/O NAME: Y1 c,
CONTRACTOR
Type of Permit or License: (Check box)
❑ Animal $
❑ Body Art Establishment $
❑ Body Art Practitioner #-
❑ Dumpster $
❑ Food Service-Type: $
❑ Funeral Directors $
❑ Massage Establishment $
❑ Massage Practice $
❑ Offal(Septic)Hauler $
❑ Recreational Camp $
❑ Sun tanning $
❑ Swimming Pool $
❑ Tobacco $
❑ Trash/Solid Waste Hauler $
❑ Well Construction $
SEPTIC Systems:
❑ Septic-Soil Testing $
❑ Septic-Design Approval $
❑ Septic Disposal Works Construction(DWC) $
❑ Septic Disposal Works Installers(DWI) $
❑ TiTittlle�5-Inspector $
Title 5 Report $ �.
❑ Other:(Indicate) $
Health Agent Initials
White-Applicant Yellow-Health Pink-Treasurer
j .
COMMONWEALTH OF MASSACHUSETTS j Z-141
f EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
v
DEPARTMENT OF ENVIRONMENTAL PROTECTION
F
yY
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TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION RECEIVED
Property Address:_144 Cricket Lane_
_North Andover—
Owner's
o ��]
Owner's Name: Ronald Headrick_
Owner's Address:_144 Cricket Lane_ TOWN OF NORTH ANDOVER
_North Andover,MA 01845_ HEALTH m1=PA( fiMENT
Date of Inspection:_11/1/2007_
Name of Inspector: Neil J.Bateson_
Company Name: Bateson Enterprises Inc._
Mailing Address:_111 Argilla Road_
_Andover,MA 01810_
Telephone Number:J978)4754786_
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 15.340 of Title 5(310 CMR 15.000). The system:
X Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fail
Inspector's Signature: Date: -11/1/2007
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.
Page 2 of 1 I '
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:_144 Cricket Lane_
_ North Andover—
Owner:_Headrick_
Date of Inspection:_11/1/2007_
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 15.303 or in 310 CMR 15.304 exist.Any
failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components as
described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the
replacement or repair,as approved by the Board of Health,will pass.Answer yes,no or not determined(Y,N,ND)in
the for the following statements.If"not determined"please explain._
The septic tank is metal and
over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration
or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a
complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage
backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a
broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
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 1 t
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:_144 Cricket Lane_
_North Andover_
Owner:_Headrick_
Date of Inspection'11/1/2007_
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:
Page 4 of 1 T
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:_144 Cricket Lane_
_North Andover—
Owner:_Headrick _
Date of Inspection:_11/1/2007_
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
_ _No_ Backup of sewage into facility or system component due to overloaded or cloa�ed 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'/2 day flow. j
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 1 of a public well.
_ _No_ Any portion of a cesspool or privy is within 50 feet of a private water supply well.
_ _No_ 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 must be attached to this form.]
_No_(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 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.
Page 5 of 1 r
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:_144 Cricket Lane_
_North Andover_
Owner:_Headrick_
Date of Inspection:_11/1/2007_
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?
I
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?
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?
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes No
_Yes_ _ Existing information.
_Yes_ _ 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)]
I
I
Page 6 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address:_144 Cricket Lane_
_North Andover–
Owner:_Headrick_
Date of Inspection:_11/1/2007_
FLOW CONDMONS
RESIDENTIAL
Number of bedrooms(design):_4_ Number of bedrooms(actual):_4_
DESIGN flow based on 310 CMR 15.203_440
Number of current residents:_4
Does residence have a garbage grinder(yes or no): Yes_
Is laundry on a separate sewage system(yes or no): No_
Laundry system inspected(yes or no): _
Seasonal use:(yes or no):_No
Water meter reading: 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 2007,owner_
Was system pumped as part of the inspection(yes or no):_No_
If yes,volume pumped:_gallons--How was quantity pumped determined?_
Reason for pumping:
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)
Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be
-obtained from system owner)
Tight tank _Attach a copy of the DEP approval
Other(describe):__
Approximate age of all components,date installed(if known)and source of information 7 years old,8/17/2000,as
built plan._
Were sewage odors detected when arriving at the site(yes or no): No
Page 7 of 14
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued) j
Property Address:_144 Cricket Lane_
_North Andover_
Owner:_Headrick_
Date of Inspection:11/1/2007_
BUILDING SEWER_X_ (locate on site plan)
Depth below grade: 30"_
Materials of construction: _cast iron _X 40 PVC_other
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.) _4"PVC thru wall,3"PVC in house, no
leaks visible.
SEPTIC TANK: X
Depth below grade:_18"_
Material of construction: X concrete___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)
Dimensions:_10'x 5'x 4'
Sludge depth:—0"_
Distance from top of sludge to bottom of outlet tee or baffle: 7"_
Scum thickness:_0"_
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: 21"_
How were dimensions determined:_
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc_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 It
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:_144 cricket lane_
_North Andover—
Owner:_Headrick_
Date of Inspection:11/1/2007
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_X_
Depth below grade 26"_
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.Evidence of carryover,pumped d-box so
clean.No evidence of leakage._
I
PUMP CHAMBER:_(locate on site plan)
Pump in working order(yes or no):_
Alarm in working order(yes or no):_
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
Page 10 of•11 P.
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address:_144 Cricket Lane_
_North Andover–
Owner:_Headrick_
Date of Inspection:_11/1/2007_
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
Garage House
Driveway 14—Water Meter
Septic Tank
A to Tank=33'
A to D-Boz=38'
B to Tank=49'6"
D-Bog B to D-Boz=597"
` Page 11 of•11'.
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:_144 Cricket Lane_
_North Andover—
Owner:_Headrick_
Date of Inspection:_11/1/2007_
SITE EXAM
Slope_No_
Surface water_No_
Check cellar _Dry_
Shallow wells_No_
Estimated depth to ground water_>4'_
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:_8/11/1997_
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: No water 4' below trenches as per test
pit data on design plan_
Page
> • Summary Reu_'9 Card generated on 10/30/2007 3:06:58 PSA by Karon Hanbn
• Town of North Andover
Tax Map # 210-038.0-0327-0000.0
144 CRICKET LANE
HEADRICK, DIANNA& RONALD
144 CRICKET LANE
NORTH ANDOVER, MA
01845 _- —1 Residential
Class---- —101 Single Family-- ---- ---- --------— Property Type
Size Total 2.14 Acres -
FY 2007 ----------- --- — —
UB Mailing Index Active/inact. From Until
Name/Address Type Loan Number
HEADRICK,DIANNA&RONALD Payor
144 CRICKET LANE
NORTH ANDOVER,MA
01845
UB Account Maint. Occupant Name Active/inactive
Account No Cycle Last Billing Date 9/5/2007
Bldg Id. 13870.0-144 CRICKET LANE Active
2100711 02 Cycle 02
UB Services Maint. Charge Multiplier/users
Service Code Rate 9.18 1/
MISCFEE ADMIN FEE 1 1 182.40 /1
WTR WATER 01 ALL METER SIZE
UB Meter Maintenance Type Size YTD Cons
Location Brand 11 0
Status
Serial No ERT HH METE METE w Water Variance
16106670 a Active ReadiCode Consumption Posted Date 188%
ng
Date 40 9/14/2007 -20%
8/3/2007 655 a Actual 11 6/22/2007
5/4/2007 615 a Actual 21 3/23/2007 -29%
2/21/2007 604 a Actual 20 12/22/2006 -32%
11/3/2006 583 a Actual 43 9/13/2006 46%
-
8/21/2006 563 a Actual 13 6/20/2006 -46%
5/5/2006 520 a Actual 152 3/13/2006 2%
55%
2/8/2006 507 a Actual 25 9/20/2004
8/16/2004 355 a Actual 16 6/14/2004 13%
5/17/2004 330 a Actual 15 4/16/2004 0%
2/17/2004 314 a Actual 0 11/14/2003 0%
11/14/2003 299 n New Meter
Commonwealth of Massachusetts
City/Town of
System Pumping Record
` Form 4
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
Important:
When filling out 1. System Location,
forms on the
computer,use
only the tab keyAddress
to mmove your
cursor-do not City/Town State Zip Code
use the return
key. 2 System Owner:
VQ
ff Name
" Address(if different from location)
City/Town State Zip Code
� - 3 � Y
Telephone Number
B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped: Gallons
3. Type of system: ❑ Cesspool(s) ff Septic Tank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes L�'No If yes,was it cleaned? ❑ Yes ❑ No
5. Condition of System:
K C) 9��� _ � �
L o
6. System Pumpedi
Name CIS � Vehicle License Number
Company
7. Location where contents re disposed:
L__s (0_
Z// z
Signafuraulfer Date
t5form4.doc•06/03 System Pumping Record•Page 1 of 1
TOWN OF Ofd
SYSTEM PUMPING RECORD 3
DATE:
SYSTEM OWNER& ADDRESS SYSTEM LOCATION
(example:left front of house)
H:(-1qq
I � , �4�
IC
DATE OF PUMPING: O QUANTITY PUMPED : GALLONS
CESSPOOL: NO YES SEPTIC TANK: NO YES
7 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: Bateson Enterprises, Inc.
COMMENTS:
CONTENTS TRANSFERRED To: G.L.S.Dj Lowell Waste
�CN Commonwealth of Massachusetts
City/Town of
System Pumping Record
Form 4 OCT .,1.1 2006
DEP has provided this form for use by local Boards of Health..The`System Pumping Record must
be submitted to the local Board of Health or other approving auihority.'
A. Facility Information
Important:
When filling out 1. SySteLOCa C�ZJ
forms the
computeto r,use �' l
only the tab key Address � Co G�
to move your
cursor-do not City/Town � r
use theretum State Zip Code
key.
2. System Owner:
Name
Andress(if different from location)
CityfTown State
�� Zip Code-
. la r
Te ,p one Number
B. Pumping .Record
1. Date of Pumping Quantity Pumped:
Date tyum p Gallons
3. Type of system: ❑ Cesspool(s) QL_SeftC-Ta_�k. ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System:
6. Syste P p d By ._.`
Name Vehicle License Number
Company -- .
7. Location a contents we dispo
Signa re a ler Date
hftp://www.mass.govi/de4a
t5form4.doc•06/03 System Pumping Record•Page 1 of 1
Town of North Andover � koRTN
OFFICE OF 3�°•' a�,4, L
COMMUNITY DEVELOPMENT AND SERVICES ° . A
27 Charles Street
North Andover, Massachusetts 01845 M 44°q,r„ •,r
WILLIAM J. SCOTT 9SSACHU5�'
Director
(978)688-9531 Fax (978) 688-9542
March 25, 1999
e
Les Godin
Merrimack Engineering
66 Park Street
Andover, MA 01810
Re: Lots 1-10 Cricket Lane, North Andover
Dear Sir:
This letter will serve as your notification that the proposed septic plans for
the lots specified above have been approved for dwellings with a maximum of
nine (9) rooms.
If you have any questions, please do not hesitate to contact this office.
Very truly yours,
Sandra Starr,
Administrator
SS/gb
cc: Copley Development
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
TOWN OF I Ld0 \JY-(
SYSTEM PUMPING RECORD
DATE: �v�
SYSTEM OWNER & ADDRESS SYSTEM LOCATION
t4oActtk (example:left front of house)
tqq C((,CvrA+
DATE OF PUMPING: q-0 QUANTITY PUMPED : tv 5-00 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: Bateson Enterprises, Inc.
COMMENTS:
coNTErrrs TxANSFERREn TO: (7-
J `�
xafion ]R(4.,to- ra
documentation:required foi every
record. The will record:what
ame of the-company that made--the
id title of the erson:-w56 ' aye,- the -
the:document..number andthe date = -
hei date the VIlVI was given to
3e print) - -
Birth date.:
rice number._._ F
�5
� � s
TOWN OF
RECEIVED
SYSTEM PUMPING RECORD
NOV 1'8 2005
DATE: 1. TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
SYSTEM OWNER& ADDRESS SYSTEM LOCATION
(example: left front of house)
DATE OF PUMPING: v --o UANTITY PUMPED : l ALLONS
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(EXPLAIl-4)
sYsTEM PUMPED BY: Bateson Enterprises, Inc.
COMMENTS:
CONTENTS TRANSFERRED TO: G.L.S.D Lowell Waste
`f ti
SEPTIC PLAN SUBMITT FORM
LOCATION: Lcr (vft
NEW PLANS: YES $125.00/Plan
REVISED PLANS: YES $ 60.00/Plan
SITE EVALUATION FORMS INCLUDED: YES NO ry0�
DATE:
DESIGN ENGINEER: Le
DATE TO CONSULTANT: '
*If you want your plans expedited, please submit four plans and included a stamped
envelope with the correct amount of postage to mail plans to Port Engineering.
When the submission is all in place, route to the Health Secretary.
I
i
INVERT ELEVATIONS
GILDING TIES 4" PIPE @ FDTN. = 184.20
BUILDING CORNER A B SEPTIC TANK IN = 183.86
SEPTIC TANK 36.3 18.9' SEPTIC TANK OUT = 183.64
PUMP TANK IN
PUMP TANK
PUMP TANK OUT
DIST. BOX 38.0' 33.8'
83.50
CORN. LEACH FIELD 1 37.9 39.6' I T X I = 1
' DIST. BOX OUT = 183.33
CORN. LEACH FIELD #2 40.3' 29.0'
END LEACH LINE 1 = 183.09
` CORN. LEACH FIELD #3 90.5' 77.5' JEND LEACH LINE #2 = 183.08
CORN. LEACH FIELD #3 91 .6' 72.7'
�o
t
h
\ I
d��'1 l EG►� y w 8�0
BJ1.01
! R /
8•M• / u,
s
0,
4> 9NOs O F c�9ti�'1'C
vp
0 ET ELECTRIC TRANSFORMER PAD
DE ELECTRIC BOX \
OT TELEPHONE BOX
0 C CABLE TELEVISION BOX \ \
UE UNDER GROUND ELECTRIC
AS-BUILT PLAN NOTE: THIS PLAN & CERTIFICATION IS NOT
� OF
A WARRANTY OF THE SUBSURFACE DISPOSAL
SYSTEM, IT IS A RECORD OF THE LOCATION
SUBSURFACE DISPOSAL SYSTEM AND ELEVATION OF THE EXISTING SYSTEM
N LOCATED IN COMPONENTS.
NORTH ANDOVER, MA.
AS PREPARED FOR uW
Sy� ,
P RICK WELCH ;23 ��` Mq6s
tkolgy m "
N 42 KINGS ROW �, p rmro m
m NORTH READING, MA 01864
LL. SCALE: 1"=40'
DATE: AUGUST 17, 2000
N TAX M. #38, PAR. 38,44,45,46: TAX M. #107A, PAR. 217
SUBDIVISION LOT #68 CRICKET LANE
MERRIMACK ENGINEERING SERVICES
PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS
66 PARK STREET • ANDOVER, MASSACHUSETTS 01810 • TEL. (978) 475-3555• FAX (978) 475-1448
Address 'c � of File
Page — of
Date f=ile Open:
Date file closed:
Doc Document/Action Title Date of
action Refer to other Purpose of Docume t�, /A�.O1 nand nates
Nlun�. Document/ docutruent/ ---
Action De artment
------------
Board of Appeals — Board of Heal h Plannin-g Board ; Cons
ervatiionCommission — Building Departrnen;t
Town of North Andover, Massachusetts Form No.2
Of NOR7I* BOARD OF HEALTH r4
K }
DESIGN APPROVAL FOR
ss�cNusEt
SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
Applicant
Test No.
Site Location i
Reference Plans and Specs. c��//LJ,Q�,� d
ENGINEER DESIGN
DATE
Permission is granted for an individual soil absorption sewage disposal system to be installed
in accordance with regulations of Board of Health.
—����� t�
CH RMAN,BOARD OF HEALTH
Fee
Site System Permit No._
Ajadov. er
JL oqvxvTn of
1 . Mimi
dover, Mass., 2 2
COC MIG. Wilr �
�ADRATED PPS\ ,�5
BOARD OF HEALTH
Food/Kitchen
Septic Syste
PERMIT T D
Y�D
UIL G_INSPECTOR
THIS CERTIFIES THAT...... <<. r. .� a .k.
has permission to erect..............I.............. ....... buildin s on . �40.k. / �AUL .....>�/" .. ... .. ...... .. Rough il{ /,3—e►X7
' 1hney
r o
to be occu ied as. r1. . .��1►.. .1 ''1, .e .. ... .� ... A .....................
p
provided that the person accepting this permit shall In every respect conform to the terms of the applica ion on file in Final
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of p`
Buildings in the Town of North Andover. �, PLUMB G IN
VIOLATION of the Zoning or Building Regulations Voids this Permit.
erin �` 3
PERMIT EXPIRES IN 6 MONTHS ,
ELECTRI 1NSP
UNLESS CONSTRUCTION T S
1
................... Service
BUILDING INSPECTOR
Fi
Occupancy Pe mit Required to Occupy Building GAS ."nvs>PECTo
------- Rough �.� '
Display in a Conspicuous Place on the Premises �- Do Not Remove
No Lathing or Dry Wall To Be Done TIKE D AURTIAHW
Until Inspected and Approved by the Building Inspector. Burner
L29 t'ts'%- ..r-*, � ��h„� Street No. {y�_
SEE I,.; I a Smor:c l7er. v ,
_-----�
INVERT ELEVATIONS
BUILDING TIES 4" PIPE @ FDTN. = 184.20
BUILDING CORNER A B SEPTIC TANK IN = 183.86
SEPTIC TANK 36.3' 18.9' SEPTIC TANK OUT = 183.64
PUMP TANK PUMP TANK IN
DIST. BOX 38.0' 33.8' 1 PUMP TANK OUT
CORN. LEACH FIELD #1 37.9 39.6' DIST, X IN = 1
83.50
CORN. LEACH FIELD #2 40.3' 29.0' DIST. BOX OUT = 183.33
CORN. LEACH FIELD 3 90.5' 77.5' END LEACH LINE 1 = 183.09
CORN. LEACH FIELD 3 91.6' END LEACH LINE 2 = 183.08
G 9��F�cy� `�`�i�yar ✓'`•
10
IRS -74
0.
NC`O T
J
c
azo t�Z 5 F E�EV• -. ..
C�po
I
0"
T
lliAclinl:o
❑ET ELECTRIC TRANSFORMER PAD
OE ELECTRIC BOX
Cl T TELEPHONE BOX \\
o C CABLE TELEVISION BOX
UE UNDER GROUND ELECTRIC
s
e
AS—BUILT PLAN NOTE: THIS PLAN & CERTIFICATION IS NOT
OF A WARRANTY OF THE SUBSURFACE DISPOSAL
SYST . IT IS A RECORD OF THE
SUBSURFACE DISPOSAL SYSTEM AND ELEVATION OF THE EXISTING SYSTEM LOCATION
N LOCATED IN COMPONENTS.
NORTH ANDOVER, MA.
AS PREPARED FOR "MQ
RICK WELCH �� A��s9� n
3 F AN'fHoNy `
0-
'1' 42 KINGS ROW 2 <(o DoNATO
m NORTH READING, MA 01864 <, U N 40" .
� � -�
� SCALE: 1"=40'
M DATE: AUGUST 17, 2000e
i TAX M. #38, PAR. 38,44,45,46: TAX M. #107A, PAR. 217
cn
SUBDIVISION LOT #6A CRICKET LANE
o MERRIMACK ENGINEERING SERVICES
i
PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS
66 PARK STREET • ANDOVER, MASSACHUSETTS 01810 • TEL. (978) 475-3555• FAX (978) 475-1448
i
FORM U - LOT RELEASE FORM :
f
�I
INSTRUCTIONS: This form is used to verify that all necessaryapprovals/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 SECTION-k**"*****
APPLICANT Cr,c V,_ 1, Douckf!)1 ^_� L_i,C PHONE �i?? '�6`-�
LOCATION: Assessors Map Number 0 A, PARCEL
SUBDIVISION L"Stn��- �•a�e LOT (S)
STREET Cr,.`K c-fir ST. NUMBER 144
OFFICIAL USE ONLY**************
RECOMMENDATIONS OF TOWN AGENTS:
kz-
S
CONSERVATION ADMINISTRATOR DATE APPROVED
DATE REJECTED
COMMENTS y
r'PIANNER DATE APPROVED
DATE REJECTED
COMMENTS
FOOD INSPECTOR-HEALTH DATE APPROVED
DATE REJECTED
SSE? C 1ECTOR-HEALTH DATE APPROVED I Z>1>C>
DATE REJECTED
COMMENTS C-1 �•.t ��►rn.> ?Cam 9 raa• s
ct
PUBLIC WORKS -SE14ERIWA i ER CONNECTIONS l�
o� r
DRIVEWAY PERMIT
G�iGt_
FIRE DEPARTMENT L
RECEIVED SY BUILDING ills? CTCR DATE
Re-ised 9197 im
APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERNET #17
DATE: d=Z Z CURRENT INSTALLER'S LICENSE"
LOCATION; Com.C�,e r
r
LICENSED L`NSTALLER: /lip �✓ e ri'C10 �xC�r/a�/S .�,ir
SIGNATURE: TELEPHONE" 0/,#5 //3
CHECK ONE: �
REPAIR: NEW CONSTRUCTION: l�
IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT.
Administrative Use Only
S75.CO Fee Attached? Yes No
roundation As-Built? Yes NO
Floor Plans? Yes
Approval Date: ��`
INSTALLER PROJECT MANAGEMENT OBLIGATIONS
As the North Andover licensed installer for the construction of the septic system for the property
�41n I
at�f Cr�te�' relative to the application of1
dated 700d for plans by n�e �17ao4� and dated /—<9-99 with
revisions dated S- Y-g Y 2 -a".2`xno
I understand and agree to the following obligations for management of this project:
1. As the installer I am obligated to call for any and all inspections. If homeowner, contractor,
project manger,or any other person not associated with my company schedules an inspection
and the system is not ready then item two shall be applicable .
L. As the installer I am required to have the necessary work completed prior to the applicable
inspections as indicated below. I understand that requesting an inspection, without completion
of the items in accordance with Title 5 and the Board of Health Regulations may result in a
$50.00 fine being levied against my company.
a) Bottom of Bed-generally first inspection unless there is a retaining wall which should be done first. installer
must request the inspection but does not have to be present.
b) Final Inspection-Engineer must first do their inspection for elevations,ties,etc. As-built or verbal OK from
engineer must be submitted to BOH,after which installer calls for inspection time. Installer must be present
for this inspection. With pump system all electrical work must be ready and able to cause pump to work and
alarm to function.
c) Final Grade-Installer must request inspection when all grading is complete. Does not have to be on site.
t,f
3. As the installer I understanid that persons or companies not associated with my company may
not perform the work required by my company to complete the installation of the system
identified in the attached application for installation. I further understand that work by others
unlicensed to install septic systems in North Andover can constitute reasons for denial of the
system, and/or revocation or suspension of my license in the Town of North Andover plus
significant fines to all persons involved.
4. As the Installer I understand that I must be on site during the performance of the following
construction steps:
a) Determination that the proper elevation of the excavation has been reached.
b) Inspection of the sand and stone to be used.
c) Final inspection by Board of Health staff.
d) Installation of tank,D-box,pipes,stone,vent,pump chamber,retaining wall and other components.
5. As the installer I understand that I am solely responsible for the installation of the system as per
the approved plans. No instructions by the homeowner, general contractor, or any other persons
shall absolve me of this obligation.
Undersigned Licensed eptic Installer
�leDate: 4—2 'Y-209PO
Town of North Andover, Massachusetts
Form No.3
f &ORT#1 BOARD OF HEALTH
• opt+ .o ,s�tio
3? e.�. O
O h`
L
F
A
DISPOSAL WORKS CONSTRUCTION PERMIT
S�CMUSE
Applicant
NAME / ADDRESS
Site Location
V TELEPHONE
A Ll
Permission is hereby granted to Construct ( or Repair ( ) an Individual Soil Absorption
Sewage Disposal System as shown on the Design Approval S.S. No._��,j/7
CHAIRMAN, BOARD OF HEALTH
Fees
D.W.C. No. /�
TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM
INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System (instructed;
( ) repaired:
by-- �U� j.! et'�j
located at Leq- &A GitICVe-7- La)F
was installed in conformance with the North Apdover Board of Health approved plan,
System Design Permit #Ze�'"7 dated z -A>o with an approved design
flow of*40 gallons per day. The materials used were in conformance with those
specified on the approved plan; the system was installed in accordance with the provisions
of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees
substantially with the approved plan. All work is accurately represented on the As-built
which has been submitted to the Board of Health.
Bed inspection date: 7' 31"o-o aL2,
Engineer Representative
Final inspection date: 3"
Engineer Representative
Installer. i Lic.#: Date:
Engineer: Date: . C
CIVIL
No.40`706
r1,
„. ,sALt�C7q.
MERRIMACK ENGINEERING SERVICES, INC.
PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS
LVI 1 66 PARK STREET•ANDOVER,MASSACHUSETTS 01810•TEL(978)475-3555,373-5721 •FAX(978)475-1448•E-MAIL:merreng@aol.com
February 7, 2000
Ms. Sandra Starr
Town of North Andover
Board of Health
27 Charles Street
North Andover, MA 01845
RE: Lot 6A Cricket Lane
Current Owner: Richard Welch
Dear Sandy:
Enclosed are plans revised as follows:
1. Revised house footprint and location.
2. Slight change in leaching area location.
3. Revised finish grading.
4. Revised lot line 6A/7A
Please call me should you have any questions or comments.
Very truly yours,
MERRIMACK ENGINEERING SERVICES
Les Godin
Project Manager
cd
cc: Mr. Rick Welch
rim 1
s
AS-BUILT CHECKLIST
LOT NUMBER, STREET NAME
i/ ASSESSORS MAP &PARCEL NUMBER
LOT LINES &LOCATION OF DWELLINGS
LOCATIONS &DIMENSIONS OF SYSTEM,
INCLUDING RESERVE
TIES TO LOT LINES & DWELLING, WELLS
a. FROM SEPTIC TANK
b. FROM LEACH AREA
LOCATIONS OF DEEP HOLES &PERC
TESTS
ELEVATIONS OF DISPOSAL SYSTEM
TOP OF FDN ELEVATION
LOCATIONS OF WELLS, DRAINS, WATERCOURSES
WITHIN 150' OF SYSTEM
L/ LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE
DISTANCES FROM CORNERS OF HOUSE TO CENTER OF
TANK&D-BOX
ORIGINAL STAMP & SIGNATURE
IMPERVIOUS AREAS - DRIVEWAYS, ETC.
v NORTH ARROW
V LOCATION&ELEVATIONS OF BENCHMARK USED
FAX COVER SHEET
KAREN L. SPRINGER,R.SJR.E.H.S.
7 Fabeme Sweat
Smigus.MA 01906
(781)233-9386
FAX M 781-233-8386
DATE: 3
TO: U
SUB1ECr., ko 6
D w
���
��� 13��
7 Fabow Strout
Saugus,MA
• 01906
• (781)233-8386
Kawn L. C
.
1.•:,�.,.:C.ti.::�..�::u�:::J:1`:L:1'. .............. .............................. ... .�.L. ...._.'..,,...L.rJ.P.L:.....:.:I.:J:.
August 24,2000
Ms. Susan Ford
North Andover Health Department
27 Charles Suet
North Andwar,MA 01845
RE: Lot 6 Cricket Lane
Ie! usan:
?kidding for the lot mentioned above was inspected and found to be i n oo
;. ;aplianoe. if You
11,01
ona please contact me.
i'` ten L. Springer,RSJR.E.H.S.
Environmental Consultant and Trainer
SEPTIC PLAN SUBMITTAL FORM '
LOCATION:1-0-1�
NEW PLANS: YES $125.00/Plan
REVISED PLANS: YES $ 60.00/Plan
SITE EVALUATION FORMS INCLUDED: YES LNO
DATE: -S_ - l
DESIGN ENGINEER: b aZ l M A G k� E5JJ61 JJ i✓6CJ -C6
DATE TO CONSULTANT:
*If you want your plans expedited, please submit four plans and included a stamped
envelope with the correct amount of postage to mail plans to Port Engineering.
When the submission is all in place, route to the Health Secretary.
SEPTIC PLAN SUBMITTAL FORM k
LOCATION: CX7JC '-T` LIALi'E EL/ALjJgT— P,i66rr—
NEW PLANS: YES` $125.00/Plan t,�
REVISED PLANS: YES $ 60.00/Plan
TOWN OF NORTH ANDOVER/
BOARD OF HEALTH
SITE EVALUATION FORMS INCLUDED: YES NO
DATE: - 01 `�'� 2 6
DESIGN ENGINEER: j1QZyr C6
DATE TO CONSULTANT: a// Iq
*If you want your plans expedited, please submit four plans and included a stamped
envelope with the correct amount of postage to mail plans to Port Engineering.
When the submission is all in place, route to the Health Secretary.
L��w
-* FORM 11 - SOIL EVALUAXOR FORA1
Page 1
�- N. VER/
No. ...................................... BOARD OF HEALTH
Commonwealth of Massachusetts
WozT14 ANoovER , Massachusetts
. . Assessment foL O e D'
Performed By: ....k. JIL,IAM........pV..F -SW.- Is................
Witnessed By .t 1:I :A......STNRR. :.:::.:: ..:.... ....:.:::::.::.::::A::.::H.
:...:.::..::..:::::.:..:.:. :: ....v.v......:...
• .......................................................................................................................
...........................:.....................................................................................
L=tW ed&ess or o.m'.Nam.
wo die/Gk`r—"r LA J.tE AkphaK r WW
$d C'oPcos-(
A
New Construction Repair ❑
Office Review
Published Soil Survey Available: No ❑ Yes
Year Published ...1.4.S-)- Publication Scale .1.•..1576q0 Soil Map Unit 8
Drainage Class .....f�....... Soil Limitations ......M DEAR' ..............................•.......................� NTo.
Surf icial Geologic Report Available: No ❑ Yes ❑
Year Published Publication Scale
GeologicMaterial (Map Unit) 777777..............................................................................................................................
Landform ..................................................................................................
. ........................................................................................_......................
Flood Insurance Rate Map: 'Z!0016 C,
Above 500Y ear flood boundary No ElYes
Within 500 year flood boundary No Yes ❑
Within 100Y ear flood boundary No L✓J Yes El
Wetland Area: '
National Wetland Inventory Map (map unit) .......01�.1...... .►.I .....D�luE "ri off}................
Wetlands Conservancy Program Map (map unit)....................................................................................................
Current Water Resource Conditions (USGS): Month AJV.4-,Q!rr
Range : Above Normal ❑ ormal Below Normal El
(aSSUme-
Other References Reviewed: V.!;, 6.S . MAPS
FORM It - SOIL EVALUATOR FORM
Page 2
On-site Review
Deep Hole Number .1.11h.i.120A Date: Weather Ak4-4%j.....v
Location (identify on site plan)
PKA..................................................
Land Use .. Slope ...Z2.. Surface Stones ....MA.W- .......................................................
Vegetation ....W.O.O.D.�. ...............................................................................................................................................................................F................
Landform ......NO-VAlUe................................................................................................................................................................................................
Positionon landscape (sketch.on the back) .........................................................................................................................................................
Distances from:
Open Water Body1.1�v.'Oeet Drainage way 1.00-t feet
Possible Wet Area1061-f feet Property Line .....10--:... feet
Drinking Water Well feet Other .........................................
DEEP OBSERVATION HOLE LOCY
Depth from Surface Sol[Horizon Soil Texture Soil Color Soil Mottling Other
(inches) (USDA) (Munsell) (Structure,Stones,Boulders,
Consistency, %Gravel)
AP
t- 1.0 vlz 4/4-1.
Ilk
Z
V.6 PA V•
I I-z-
LC-
A t--\ -7/44 (ro'
V. 6VAV'
Parent Material (geologic) ................................................... Depth to Bedrock: 441A.............
Depth to Groundwater: Standing Water in the Hole: MA...... Weeping from Pit Face: I-J'./A......
Estimated Seasonal High Ground Water:
•f " . FORM 11 - SOIL EVALUATOR FORM
Page 3
Determination for Seasonal High Water Table
Method Used:
❑ Depth observed standing in observation hole --inches
❑ D pth weeping from side of observation hole inches
Depth to soil mottlesinches
❑ Ground water adjustment feet
Index Well Number Reading Date Index well level ...................
Adjustment factor .--.. Adjusted ground water level .............—:.............................
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious materiel exist in all areas
observed throughout the area proposed for the soil absorption system? —
If not, what is the depth of naturally occurring pervious material?
Certification
I certify that ons (date) I have passed the examination approved by the
Department of Environmental Protection and that the above analysis was
performed by me consistent with the required training, expertise and experience
described in 310 CMR 15.017.
Signature Date g' _
V i
FORNI 12 - PERCOLATION TEST
COMMONWEALTH OF MASSACHUSETTS
WoM 141. WVaE , Massachusetts
Percolation Test
Date: Time: ...... ...........
Observation Hole #
�- 1
Depth of Perc -ro
`71 Tv i `7�1
Start Pre-soak
End Pre-soak
Time at 12" 10 , 2 ,
Time at 9"
Time at 6"
Time (9"-6")
Rate Min./Inch
Site Passed LTJ Site Failed ❑
�.
Performed By: (1F9 (aG�ir`i
Witnessed By: �'(A �j[w A
Comments: ..... ..........I............................
...........TU........ ��....... ........
..........................................................._.................
TOWN OF e � ' "CEIVED
SYSTEM PUMPINdRECORD Nov - 2 2004
` WN OF NORTH ANDOVER
DATE: 7 TOHEALTH DEPARTMENT
SYSTEM OWNER& ADDRESS SYSTEM LOCATION
��GL
(example:ted front of hour
DATE OF PUMPING: � ��iY QUANTITY PUMPED : GALLONS
CESSPOOL: NO__ �YEa SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION FULL TO COVER
HEAVY GREASE BAFFLES IN PLACE
ROOTS LEACERULD RUNBACK
EXCESSIVE SOLIDS FLOODED
SOLIDS CARRYOVER OTHER(EXPLAIN)
SYSTEM PUMPED BY: Bateson Enterprises, Inc.
COMMENTS:
I
CONTENTS TRANSFERRED TO: G.L.S.D_ Lowell Waste
Town of North Andover f AORTH 1
OF C.E OF ��Octi�to ie.41
COMMUNITY DEVELOPMENT AND SERVICES p
27 Charles Street
North Andover, Massachusetts 01845 '� '°�•.s° "'`cy
WILLIAM J. SCOTT 1SSAcwUs�t
Director
(978)688-9531 Fax(978)688-9542
February 25, 1999
Les Godin
Merrimack Engineering �►
66 Park Street
Andover, MA 01810
RE: Lots 1-10 Cricket Lane
Dear Mr. Godin:
This is to inform you that the plans for the septic systems proposed for the
subdivision of Walnut Ridge have been disapproved for the following reasons:
• The septic tank detail does not show the inlet tee extending a minimum of 10 inches
below the flow line, nor that there needs to be a 3 inch space above the tees. (3 10
CMR 15.227(6)and 15.227(4)).
• There are no benchmarks shown within 75 feet of the septic systems. (3 10 CMR
15.220(q)).
In addition, for Lot 1:
• Abutters' names are not shown. (NA 8.02j)
• Design specifications for the proposed retaining wall are missing. (3 10 CMR
15.255(2)).
For Lot 3:
• The high water alarm for the pump chamber is not specified as to be located in the
house. (3 10 CMR 15.231(9))
• Slope easement is required from Lot 4. (3 10 CMR 15.255(2))
• The slope of the two lower trenches will be in excess of 8% and at minimum a baffle
is required to decrease the velocity. (3 10 CMR 15.232(3)(a)) Please consider a
velocity reducer at the high end of the two lower trenches.
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
Lot 4:
• Please note that the septic tank is drafted incorrectly.
Lot 5 and Lot 6:
• Scale of the Plan view is not shown.
Lot 7:
• The scale of the Plan view is not shown.
• Pump Note 94 neglects to state that the high water alarm is to be located in the house.
(310 CMR 15.231(9)).
Lot 8:
• The estimated seasonal high water elevation has not been adjusted to the highest
existing grade. This results in the leaching area being less than 4 feet to groundwater.
(3 10 CMR 15.212 a&b).
Lot 9:
• Slope easement required from Lot 10. (310 CMR 15.255(2))
• Slope to d-box exceeds 8%, therefore, at minimum, a baffle is required. (310 CMR
15.232(3)(a))
Lot 10:
• Fill around system runs to property line of abutter. Toe of slope required to be 5 feet
off the lot line. (3 10 CMR 15.255(2))
• Trenches #1 and#1 do not show 4 foot separation to groundwater. (3 10 CMR 15.212
a& b).
Please feel free to call the Health Office with any questions you may have.
Sincerely,
Sandra Starr,R.S.
Health Administrator
Cc: W. Scott
File
Feb-05-99 09:38A Paul D. Tuvbide, PE/PLS 508-465-0313 P.04
February 5, 19,099
i� Satiura 5411—a
i ` r �' alil ridiiiiri3�tratvr
! NcSi'�lt t3nuCtYei ISC)arU Oi
Office of Community Deveivpment and Services
30 School St.
i North Andover, MA 01845
1
[ RE: Title V review for Lot 6 Cricket Lane
Dear Sandra,
Enclosed find the"Checklist for North Ardover Septic System Plans" for the above-
nientior ed site. The full.—W:ng is a list of all the `Problem' areas and.deficiencies Pon
Engineering has found.
• 310 CIVSR 247(2) states that for a minimum of 2" of 1f1;to t/3 inch stone is iii be
placed on the top of the leaching bed. The plan design calls for a layer of filter
fabric to be laid on top this stone.There is no regulation that 1 could find that allows
filter fabric to be laid over the peastone,and therefore I would recommend that the
filter fabric be removed from the design.
• The septic tank detail should show that the inlet tee is to extend a minimum of 10
inches below the flow lire 1227(6)), and that there is to be a 3 inch air space above
the inlet and outlet t:s,(�2?r4)1
�� t „-
•
Note i3 states that benchmarks-are to W ply.; within 75 fect o!the dispo€,al area
I before construction. A condition of approval of this design should be that the
benchmark will be set as noted.
{ • The scale of the Plan view is not shown.
If you have any questions or comments please feel free to contact me.
�
Sincerely � �
Carltor:A. Brown,PALS
PODMI
it
ENGINEERING
Civil Engineers&
Land Surveyors
One Harris Street
Newburyport,N
01950
(978)465-8599
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
DATE: 9—IV-01
SYSTEM OWNER &ADDRESS SYSTEM LOCATION
C-� (example: left front of house)
DATE OF PUMPING: Q'«-0i QUANTITY 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: �� R 6(
COMMENTS:
CONTENTS TRANSFERRED TO: L
Commonwealth of Massachusetts R `
City/Town of
System Pumping Record OCT 2 3 2007
Form 4
TOWN OF NU '
HEAI_7 H DEF
DEP has provided this form for use by local Boards of Health. er 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
Important:
When filling out 1. Syste LovaC;
forms on the ������
computer,use
only the tab key Address / `-� l /
to move your CL��
cursor-do not City/Town State Zip Code
use the return
key. 2 System Owner:
Name
Address(if different from location)
CitylTown State Zip Code
6�& 5= � ��
Telephone Number
B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped: Gallons
3. Type of system: ❑ Cesspool(s) E�' 5 ptic Tank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes No If yes,was it cleaned? ❑ Yes ❑ No
5. Condition of S VC)
6. System Pumped By:
Name Vehicle License Number
Company
7. Location ere contents a disposed:
Sign r auler Date
t5form4.doc-06/03 System Pumping Record-Page 1 of 1
Commonwealth of Massachusetts
City/Town of -
?` System Pumping RecordoCT - 9 2008
Form 4
,,A- -OVER
DEP has provided this form for use by local Boards of Health. Other form&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
Important:
When filling out 1. System Locatio . Left front left rear, left side(oANous . Right front, right rear, right side of house.
forms on the
computer, use
only the tab key Address L p f ( G� /
to move your `tel
cursor-do not City/Town State Zip Code
use the return
key.
2. System Owner:
Name
Address(if different from location)
City/Town Stat Zi
Telephone Number
B. Pumping Record
C'O
1. Date of Pumping Date 2. Quantity Pumped: Gallons
3. Type of system: El Cesspool(s) _ Septic Tank 0 Tight Tank
0 Other(describe):
4. Effluent Tee Filter present? 0 Yes la-11�1 o If yes,was it cleaned? Yes No
5. Condition oBVe`/
V L
6. SystemPumped 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
igna ure of H"r Date
t5form4.doc•06/03 System Pumping Record•Page 1 of 1
-�LN Commonwealth of Massachusetts
City/Town of
System Pumping Record
RECEIVED
Form 4 OCT 2 0 2009
wM
DEP has provided this form for use by local Boards of Health. Other forms mai AUT ut the
information must be,substantially the same as that provided he& e"AFe"d&n-U4' ;farm, check with your
local Board of Health tQ determine the form they use. The Sys -P�R coy must be submitted to
the local Board of Health or-other approving authority.
A. Facility Information
1. System Location: Left side of house, Right side of hous Leftfrdht
e, fight front of house,
Left rear of house, Right rear of house. Left rear of buildinl ding.
Address r c "
Citylrown [ State Zip Code
2. System Owner:
Name
Address(f different from location)
City/Town State r ^ Zip r�e
Telephone Number
i
B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped: Gallons
3. Type of system: ❑ Cesspool(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. Loc here contents were disposed:
G.L.S.D Lowell Waste Water
Signature of Hauler Date
t5form4.doc•06/03 System Pumping Record•Page 1 of 1
UIVED
Commonwealth of Massachusetts OCT
TI 201Q
City/Town of
TOWN OF NORTH ANDOVER
System Pumping Record HEALTH DEPARTMENT
w Form 4
M
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 tQ determine the form they use. The System Pumping Record must be submitted to
the local Board of Health owother approving authority.
A. Facility Information
1. System Location: Left side of house, Right side of hous Le front of hou fight front of house,
Left rear of house, Right rear of house. Left rear of building. ig t rear of building.
Address c + r r L^r A A n
City/Town State Zip Code
2. System Owner:
Name
Address(if different from location)
City/Town Stye ( Zi de
O
Telephone Number
B. Pumping Record
1. Date of Pumping 2. Quantity Pumped: s
Date Gallons
3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes to If yes, was it cleaned? ❑ Yes ❑ No
5. Condition of System:
-�- jl-'�0j U-6-zji
6. System Pumped By:
Neil Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7.7G.
i re contents were disposed:o II Waste Water
SignDate
t5form4.doc•06/03 System Pumping Record.Page 1 of 1
Sy:CSD IZZ
CONSERVATION DEPARTMENT
Community Development Division
January 21, 2015
Michelle &Taylor Robinson
144 Cricket Lane
North Andover,MA 01845
RE: Pruning of one (1) tree within the buffer zone to Bordering Vegetated Wetland associated
with a Certified Vernal Pool.
This is a follow up letter pertaining to your request to prune/remove one (1) tree which
overhangs the driveway and garage at 144 Cricket Lane. The tree was identified during a site
visit by the Conservation Department on December 22, 2014. Removal of vegetation, including
pruning and cutting, is prohibited within the 50' No-Disturbance Zone (Ephemeral
Pool/Habitat) except in rare circumstances, such as for safety.
Due to the potential danger imposed by the tree the Conservation Department will permit the
removal to prevent possible injury or property damage. These cutting activities shall be limited
to the tree identified at the site visit and shown in the attached photo with a red bow.
The approved cutting will be subject to the following conditions:
❖ The wetland marker on the tree shall be moved to a nearby tree.
•:� Machinery shall be staged in the driveway and shall not enter the 50' No Disturbance Zone
beyond the limits of the driveway.
❖ Work occurring within the 50' No Disturbance Zone is to be completed by hand (hand held
chainsaws are allowed).
No work shall occur in resource areas.
❖ All tree limbs, brush, and other debris materials shall be taken off site and disposed of
properly.
❖ The stump of the tree shall not be removed and shall be left in place. The stump may be
ground down or cut flush with the landscape.
❖ Care shall be taken to prevent damage to surrounding trees during removal of the approved
trees.
•'• Upon completion of the tree removal, all disturbed areas shall be properly stabilized.
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9530 Fax 978.688.9542 Web www.townofnorthandover.com
•
• • • • • • • • • • • •
•
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ill 1 ilii i ii i t I i�
Commonwealth of Massachusetts ... ..... _...,
City/Town of RECEIVED I.
j
System Pumping Record
Form 4 OCT 1 E 20112
TOWN OF NORTH ANDOVER 7
DEP has provided this form for use by local Boards of Health. Other forms may6W" ftrENT
information must be substantially the same as that provided here. Before usingthis form check with our
Y
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 Locatio Le /Rig fron of ho Left/Right rear of house, Left/right side of house, Left/
Right side of buirdifg, Left/Right front of building, Left/Right rear
of building, Under deck
Address t L-
Citylrown State V V Zip Code
2. System Owner.
Name (�
Address(if different from location)
Citylrown State 74eAode
L4 c a —3c)73 �
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? ❑ Yes a No If yes,was it cleaned? El Yes No
5. Condition of
",�,A
6. System Pumped By:
Neil Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7. Loere contents were disposed:
G.L S. Lowell Waste Water
Sign toe I Haule Date
t5form4.doc•06103 System Pumping-Record•Page 1 of 1