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Home My WebLink AboutMiscellaneous - 1475 TURNPIKE STREET 4/30/2018N H Ft�:�-k North Andover Board of Assessors Public Access Parcel ID: 210/107.B-0065-0000.0 SKETCH Click on Sketch to Enlarge Community: North Andover PHOTO. No Pict ures Avaw&ilable Location: 1475 TURNPIKE STREET Owner Name: HUGHES, THOMAS V Owner Address: 1020 RIVERSIDE DRIVE City: METHUEN State: MA ZIP: 01844 Neighborhood: 5 - 5 Land Area: 1.01 acres Use Code: 101- SNGL-FAM-RES Total Finished Area: 960 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 250,800 233,600 Building Value: 123,000 115,300 Land Value: 127,800 118,300 Market Land Value: 127,800 Chapter Land Value: LATEST SALE Sale Price: 0 Sale Date: 12/31/1972 Arms Length Sale Code: N -NO -OTHER Grantor: Cert Doc: Book: 01230 Page: 0660 http://csc-ma.us/NandoverPubAcc/j sp/Home.j sp?Page=3 &Linkld=809560 Page 1 of 1 11/13/2006 Owner information is required for every page. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Aaron Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1475 TURNPIKE STREET Property Address ANDRE BALATKA Owner's Name NORTH ANDOVER City/Town MA 01845 10/4/16 State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information REctIVED 1. Inspector: JAMES H CURRIER II TOWN OF NORTH ANDOVER Name of Inspector J'S SEPTIC & DRAIN Company Name 131 FOREST ST Company Address MIDDLETON City/Town 978-774-6685 Telephone Number B. Certification MA State S12327 License Number 01949 Zip Code 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: ® Passes ❑ Conditionally Passes ❑ Fails 0 Needs Further Evaluation by the Local Approving Authority 10/4/16 Inspector's Signature Date 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. ****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. t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 1 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9.17r, TI IRAIPIKG CTRFFT Property Address ANDRE BALATKA Owner's Name NORTH ANDOVER MA 01845 10/4/16 Citv/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System Passes: ® 1 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: SYSTEM WORKING PROPERLY B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need tG be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for "yes", "no" or "not determined" (Y, N, ND) 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. ❑ Y ❑ N ❑ ND (Explain below): t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 2 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1475 TURNPIKE STREET Property Address ANDRE BALATKA Owner's Name NORTH ANDOVER MA 01845 10/4/16 City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ Y ❑ N ❑ ND (Explain below): ❑ Y ❑ N ❑ ND (Explain below): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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 t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 3 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1475 TURNPIKE STREET Property Address ANDRE BALATKA Owner's Name NORTH ANDOVER MA 01845 10/4/16 City/Town State Zip Code Date of Inspection B. Certification (cont.) 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 G 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 fecal coliform bacteria indicates absent 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: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to 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 u� than '/z day flow t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments •''tr 1475 TURNPIKE STREET Property Address ANDRE BALATKA Owner Owner's Name information is NORTH ANDOVER MA 01845 10/4/16 required for every page. City/Town SatetZip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ [V�< Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ 01� Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ❑fie` 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. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® 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. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 00 feet of a surface drinking water supply ❑ ❑ the system is within 00 eet 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. t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 5 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1475 TURNPIKE STREET Property Address ANDRE BALATKA Owner Owner's Name information is NORTH ANDOVER required for every page. Cityfrown C. Checklist MA State 01845 Zip Code 10/4/16 Date of Inspection Check if the following have been done. You must indicate "yes" or "no" as to each of .he following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ 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: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 330 GPD t5ins • 3113 Title 5 Official Inspection Form: S, ,bsurfaoe Sewage Disposal System • Page 6 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1475 TURNPIKE STREET Property Address ANDRE BALATKA Owner Owner's Name information is NORTH ANDOVER required for every page. Cityrrown MA 01845 State Zip Code 10/4/16 Date of Inspection D. System Information Description: Sump pump? ❑ Yes ® No Last date of occupancy: CURRENT Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day (gpd) Number of current residents: 5 Grease trap present? ❑ Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Disposal System • Page 7 of 17 Laundry system inspected? r ` ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 ears usage 9 Y 9 (gpd))� 219.87 GPD Detail: Sump pump? ❑ Yes ® No Last date of occupancy: CURRENT Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day (gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non -sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: (Sins - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments •''� 1475 TURNPIKE STREET _ Property Address ANDRE BALATKA Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 10/4/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Other (describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: Date LPD- 3/3/16 OUR RECORDS gallons ❑ Yes ® No Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal %stem - Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1475 TURNPIKE STREET Property Address ANDRE BALATKA Owner Owner's Name information is NORTH ANDOVER required for every page, City/Town MA 01845 State Zip Code 10/4/16 Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: C.O.C. FOR NEW SEPTIC SYSTEM DATED 12/12/06 Were sewage odors detected when arriving at the site? Building Sewer (locate on site plan): 1' Depth below grade: feet Material of construction: ® cast iron ❑ 40 PVC ❑ other (explain): PUBLIC H2O Distance from private water supply well or suction line. feet Comments (on condition of joints, venting, evidence of leakage, etc.): PLUMBING IN GOOD CONDITION. NO EVIDENCE OF LEAKAGE. Septic Tank (locate on site plan): Depth below grade: Material of construction: ® concrete ❑ metal T-3" feet ❑ Yes ® No ❑ fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10'6" X 68" - 1500 GALLONS Sludge depth: 14" t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �h 1475 TURNPIKE STREET Property Address ANDRE BALATKA Owner Owner's Name information is NORTH ANDOVER required for every page. City/Town t5ins - 3/13 MA 01845 State Zip Code 10/4/16 Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 22" Scum thickness 0 Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? SLUDGE JUDGE & TAPE MEASURE 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 AND OUTLET TEES IN PLACE, OUTLET HAS ZABELL FILTER WHICH WE CLEANED. LIQUID LEVEL CORRECT, NO EVIDENCE OF LEAKAGE. TANK IS ALMOST READY FOR PUMPING.. Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal )rE-11fi erglass 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: feet ❑ polyethylene ❑ other (explain): Date Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1475 TURNPIKE STREET Property Address ANDRE BALATKA Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 10/4/16 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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 Dimensions: Capacity: Design Flow: Alarm present: Alarm level: gallons ❑ polyethylene ❑ other (explain): gallons per day ❑ Yes ❑ No Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 11 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °« 1475 TURNPIKE STREET Property Address ANDRE BALATKA Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 10/4/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate 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.): BOX IS LEVEL AND WORKING PROPERLY, NO EVIDENCE OF SOLIDS CARRYOVER, LIQUID LEVEL CORRECT. BOX IS 6" BELOW GRADE. NO EVIDENCE OF LEAKAGE, Pump Chamber (locate on site plan): Pumps in working order: ® Yes ❑ No* Alarms in working order: ® Yes ❑ No* Comments (note condition of pump chamber, condition of pumps ansa appurten-nces, etc.): PUMPS, FLOATS, AND CHAMBER ALL APPEAR TO BE IN GOOD WORKING ORDER. * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1475 TURNPIKE STREET Property Address ANDRE BALATKA Owner Owner's Name information is NORTH ANDOVER required for every page. City/Town t5ins - 3/13 MA 01845 10/4/16 State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: (30) INFILTRATORS ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ 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.): SOILS DRY, NO SIGN OF HYDRAULIC FAILURE, VEGETATION NORMAL. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth — top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Title 5 Official Inspection Form: Subsuriace Sewage L`isposal System - Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1475 TURNPIKE STREET Property Address ANDRE BALATKA Owner Owner's Name information is NORTH ANDOVER required for every page. City[Fown MA 01845 10/4/16 State Zip Code Date of Inspection D. System Information (cont.) 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.): t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °y 1475 TURNPIKE STREET Property Address ANDRE BALATKA Owner Owner's Name information is required for every NORTH ANDOVER MA 01845 10/4/16 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ® hand -sketch in the area below ❑ drawing attached separately �0 l It a=tO'S D- ,31 C +V -`-ox aa' t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 15 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 1475 TURNPIKE STREET Property Address ANDRE BALATKA Owner Owner's Name information is NORTH ANDOVER required for every page. City/Town D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells MA 01845 State Zip Code 10/4/16 Date of Inspection 4' Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: 0 Obtained from system design plans on record If checked, date of design plan reviewed: 7/31/06 Date 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: TEST PIT DATA ON FILE WITH B.O.H., TEST PITS PERFORMED 7/31/06 Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 16 of 17 Summary Record Card generated on 9/20/2016 9:32:32 AM by Tara Hurley Page Town of North Andover Tax Map # 210-1073-0065-0000.0 Parcel Id 18178 1475 TURNPIKE STREET BALATKA, ANDRE, LUIZ Since Jan 2015 1475 TURNPIKE STREET NORTH ANDOVER, MA 01845 Class 101 Single Family property Type 'Cr s"( Zoning2 1 Residential Zonin93 Size Total 1,01 Acres FY 2017 _ 2 + 4 -+a'� J UB Mailing Index , ,.. Name/Address Type Loan Number Active/lnact. — ' + j u ANDRE BALATKA Previous Customer 2 cj .� 1475 TURNPIKE STREET NORTHANDOVERMA 01845 2 + ?'J HUGHES, THOMAS Previous Customer Inactive 2 + 7 . 1020 RIVERSIDE DRIVE } 27 " METHUEN, MA 01844 j t JIMMIE RUCKER Previous Customer Inactive 1475 TURNPIKE STREET ' J NORTH ANDOVER, MA 01845 CAROLINE BOUDROW Previous Customer Inactive 1475 TURNPIKE STREET NORTHANDOVER MA 01845 FANNIE MAE Previous Customer Inactive C/O KODY & COMPANY, INC, 60 ASHLAND STREET NORTH ANDOVER MA 01845 UB Account Maint. 730 a Account No Cycle Occupant Name Bldg id. 13224.0 - 1475 TURNPIKE STREET Last Billing Date 9/12/2016 2 1 2100009 02 Cycle 02 UB Services Maint. 0 J 0 Account No. 2100009 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.63518 7.82 1/ WTR WATER 01 ALL METER SIZE 148.15 /1 UB Meter Maintenance Account No. 2100009 Serial No Status Location Brand Type Size YTD Cor 16748865 a Active ERT b Badger w Water 0.63 0.63 51 Date Reading Code Consumption Posted Date Varlanc 8/1/2016 1228 a Actual 33 9/21/2016 22' 5/2/2016 1195 1168 aActual _ 27 27 6/21/2016 3/28/2016 3' 1' 2/1/2016 10/30/2015 1141 aActual r a Actual _ 25 12/30,12015 8/3/2015 1116 1087 a Actual 29 aActual 24 9)14/201513' 6122/2015 5/1/2015 214!2015 1063 11/4/2014 1038 aActual 25 aActual _ 24 3/20/201 1211 4 VVV (� ` 2' -100' 8/6/2014 1014 0 aActual7110/2014 9/11/120120/ 7/10/201 - 10 -100 1014 5/9/2014 1014 f Final t3ill0 a Actual 0 6/12/201 -100' 2/3/2014 1014 a Actual 0 3/17/2014 -100' F�- Owner information is required for every page. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. ICI t5ins • 11/10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments >r� 1475 Turnpike Street v Property Address James Rucker Owner's Name North Andover MA. 01845 4/5/2013 City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: Neil James Bateson Name of Inspector Bateson Enterprises Inc.. Company Name 111 Argilla Road Company Address Andover City/ Town 978-4754786 Telephone Number B. Certification MA 01810 State Zip Code S115 License Number 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 m F sewage disposal systems. I am a DEP approved system inspector pursuant to ect Title 5 (310 CMR 16.000). The system: ® Passes ❑ Conditionally Passes . ❑ Falls APR 16 2013 TOWN OF NORTH ANDOVER ❑ Needs Further valuation by the Local Approving Authority 4/5/2013 Insp"orsSgnature Date 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. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 1 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1475 Turnpike Street Property Address James Rucker Owner's Name North Andover MA 01845 4/5/2013 Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System Passes: ® 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. Check the box for "yes", "no" or "not determined" (Y, N, ND) 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. ❑ Y ❑ N ❑ ND (Explain below): t5ins • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 2 of 17 Owner information is required for every page. Commonwealth of Massachusetts 'title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1475 Turnpike Street Property Address James Rucker Owner's Name North Andover MA 01845 4/5/2013 City/Town State Zip Code Date of inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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 ora salt marsh t5ins • 11110 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 3 of 17 I Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1475 Turnpike Street Property Address James Rucker Owner Owner's Name information is required for North Andover MA 01845 4/5/2013 every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) 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 fecal coliform bacteria indicates absent 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: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to 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 '/z day flow t5ins • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 4 of 17 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. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. 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. t5ins • 11/10 Title 5 official Inspection Form: Subsurface Sewage Disposal System • Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1475 Turnpike Street Property Address James Rucker Owner information is Owner's Name required for North Andover MA 01845 4/5/2013 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® 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. For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the questions in Section D. 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. t5ins • 11/10 Title 5 official Inspection Form: Subsurface Sewage Disposal System • Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1475 Turnpike Street Property Address James Rucker Owner Owner's Name information is required for North Andover MA 01845 4/5/2013 every page. Citylrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ 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: ❑ Existing information. For example, a plan at the Board of Health. ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 330 t5ins • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection. Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1475 Turnpike Street Property Address James Rucker Owner Owner's Name information is required for North Andover MA 01845 4/5/2013 every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: Does residence have a garbage grinder? Is laundry on a separate sewage system? [if yes separate inspection required] Laundry system inspected? Seasonal use? Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? Last date of occupancy: Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq.ft., etc.): Gallons per day (gpd) El Yes ® No ❑ Yes ® No ❑ Yes ❑ No ❑ Yes ® No Yes ❑ Yes ® No Current Date Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non -sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins • 11/10 Title 5 Official Inspection form: Subsurface Sewage Disposal System - Page 7 of 17 �L\ Commonwealth of Massachusetts Title 5 Official Inspection Form 's Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1475 Turnpike Street Property Address James Rucker Owner information is required for every page. Owner's Name North Andover Citylrown D. System Information (cont.) Last date of occupancy/use: Other (describe below): Pumping Records: Source of information: MA 01845 State Zip Code General Information Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: Date 4/5/2013 Date of Inspection Pumped two years ago, owner 1500 gallons measured tank inspect tank , tee & filter Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy E Yes ❑ No ❑ 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) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): t5ins • 11/10 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System • Page 8 of 17 Owner information is required for every page. Commonwealth of Massachusetts 'title 5 Official Inspection f=orm Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1475 Turnpike Street Property Address James Rucker Owner's Name North Andover MA 01845 4/5/2013 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 7 years old, 12/8/2006, as built plan Were sewage odors detected when arriving at the site? Building Sewer (locate onsite plan): Depth below grade: Material of construction: ® cast iron ® 40 PVC 1 feet ® other (explain): Copper ❑ Yes Z No Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): 4" cast iron through wall . 4" cast iron in house, 2" cooper in house, no leaks visible Septic Tank (locate on site plan): Depth below grade: Material of construction: ® concrete ❑ metal .2 feet ❑ fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) Dimensions: 10'x 5'x 4' Sludge depth: 3" ❑ Yes ❑ No t5ins - 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 9 of 17 Owner information is required for every page. t5ins - 11110 Commonwealth of Massachusetts "title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1475 Turnpike Street Property Address James Rucker Owners Name North Andover Cityrrown D. System Information (cont.) Septic Tank (cont.) MA 01845 State Zip Code Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle 24" 3" 91 Distance from bottom of scum to bottom of outlet tee or baffle 18" 4/5/2013 Date of Inspection How were dimensions determined? Tape Measure 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. Outlet filter clogged, clean same. Depth of liquid at outlet invert. No evidence of leakage. Inlet cover & outlet cover has metal extension riser Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal Dimensions: Scum thickness feet ❑ fiberglass ❑ polyethylene ❑ other (explain): 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: Date Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 10 of 17 Owner information is required for every page. Commonwealth of Massachusetts `title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1475 Turnpike Street Property Address James Rucker Uwners Name North Andover Cityfrown State 01845 Zip Code 4/5/2013 Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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 per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): * Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 11 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1475 Turnpike Street Property Address James Rucker Owner's Name North Andover MA 01845 4/5/2013 Citylrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate 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 carryover. No evidence of leakage. Pump Chamber (locate on site plan): Pumps in working order: ® Yes ❑ No Alarms in working order: ® Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Pump cycled on then off. Alarm has both audible & visual. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins - 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ` 1475 Turnpike Street Property Address James Rucker Owner Owner's Name information is required for North Andover MA 01845 4/5/2013 every page. Cityfrown D. System Information (cont.) Type: ❑ leaching pits ® leaching chambers ❑ leaching galleries ❑ leaching trenches ❑ leaching fields State Zip Code number: number: number: Date of Inspection number, length: number, dimensions: 30 Infiltrators ❑ 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.): 5 rows of six chambers. Soil ok. Vegetation ok. No sign of ponding to surface Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth — top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins - 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments " 1475 Turnpike Street 4/5/2013 Date of Inspection D. System Information (cont.) 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.): t5ins • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 14 of 17 Property Address James Rucker Owner Owner's Name information is required for North Andover MA 01845 every page. Citylrown State Zip Code 4/5/2013 Date of Inspection D. System Information (cont.) 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.): t5ins • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 14 of 17 Owner information is required for every page. t5ins • 11/10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1475 Turnpike Street Property Address James Rucker Owners Name North Andover MA 01845 4/5/2013 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ® hand -sketch in the area below ❑ drawing attached separately Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 15 of 17 Commonwealth of Massachusetts Ui; Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1475 Turnpike Street Property Address James Rucker Owner Owner's Name information is required for North Andover MA 01845 4/5/2013 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water Z Check cellar ® Shallow wells Estimated depth to high ground water: 4 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 7/31/2006 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health - explain: Design plan ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: Test pit data on design plan. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins • 11/10 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System • Page 16 of 17 Commonwealth of Massachusetts up Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1475 Turnpike Street Property Address James Rucker Owner Owners Name information is required for North Andover MA 01845 4/5/2013 every page. CityfTown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information — Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins • 11/10 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 17 of 17 Summary Record Card generated on 3/20/2013 2:48:47 PM by Karen Hanlon Page 1 Town of North Andover Serial No Status Location Tax Map # 210-107.-0065-0000.0 Type 16748865 a Active ERT b Badger w Water Parcel Id 18178 Reading Code Consumption 1475 TURNPIKE STREET 2/1/2013 997 a Actual JIMMIE RUCKER 3/13/2013 10/30/2012 985 1475 TURNPIKE STREET 15 12/13/2012 8/1/2012 NORTH ANDOVER, MA 01845 a Actual 20 Class 101 Single Family 5/1/2012 Property Type 1 Residential Zoning2 1 Residential 6/20/2012 Zoning3 1 Residential Size Total 1.01 Acres 11 3/14/2012 11/1/2011 FY 2013 a Actual 14 12/15/2011 UB Mailino.lndex 901 a Actual 15 Name/Address Type Loan Number Active/Inact. From Until JIMMIE RUCKER Owner 217/2011 876 1475'TURNPIKE STREET 13 3/15/2011 11/2/2010 NORTH ANDOVER, MA 01845 a Actual 14 12/13/2010 HUGHES, THOMAS Previous Customer Inactive 12/1/2007 30 1020 RIVERSIDE DRIVE 5/5/2010 819 a Actual METHUEN, MA 6/9/2010 2/2/2010 808 01844 12 3/11/2010 11/3/2009 NEW OWNER CALLED a Actual 12 12/11/2009 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 13224.0 - 1475 TURNPIKE STREET Last Billing Date 3/5/2013 2100009 02 Cycle 02 Active UB Services Maint. Account No. 2100009 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 45.60 /1 UB Meter Maintenance Account No. 2100009 Serial No Status Location Brand Type 16748865 a Active ERT b Badger w Water Date Reading Code Consumption Posted Date 2/1/2013 997 a Actual 12 3/13/2013 10/30/2012 985 a Actual 15 12/13/2012 8/1/2012 970 a Actual 20 9/26/2012 5/1/2012 950 a Actual 24 6/20/2012 2/1/2012 926 . a Actual 11 3/14/2012 11/1/2011 915 a Actual 14 12/15/2011 8/3/2011 901 a Actual 15 9/14/2011 5/3/2011 886 a Actual 10 6/13/2011 217/2011 876 a Actual 13 3/15/2011 11/2/2010 .863 a Actual 14 12/13/2010 8/2/2010 849 a Actual 30 9/13/2010 5/5/2010 819 a Actual 11 6/9/2010 2/2/2010 808 a Actual 12 3/11/2010 11/3/2009 796 a Actual 12 12/11/2009 8/5/2009 784 a Actual 15 9/11/2009 5/1/2009 769 a Actual 12 6/16/2009 1/30/2009 757 a Actual 14 3/16/2009 11/5/2008 743 a Actual 17 12/10/2008 8/5/2008 726 a Actual 17 9/12/2008 5/1/2008 709 a Actual 15 6/18/2008 2/6/2008 694 a Actual 15 3/14/2008 11/1/2007 679 a Actual 29 1/15/2008 8/1/2007 650 a Actual 36 9/14/2007 5/2/2007 614 a Actual 12 6/22/2007 2/16/2007 602 a Actual 16 3/23/2007 Size 0.63 0.63 YTD Cons 288 Variance -23% -23% -18% 123% -23% -5% 39% -12% -12% -55% 182% -9% -1% -15% 18% -19% 4% 0% 14% -51% -20% 147% 6% -15% i Commonwealth of Massachusetts x 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 1. System Location: Left / Right front of house, Left i ht rear Qf hou _ , Left / right side of house, Left / Right side of building, Left / Right front of building, Left / Right rear of building, Under deck Address � j r � 15—.T � � Vstate 1-1Cityrrown ZiP Code 2. System Owner. Address (if different from location) My/Town StateZI t� p, -- `� p3`� p 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 5. Condition of Svstem- P A . _ i ,. f 6. System Pumped By.- Neil y:Neil Bateson Name Bateson Enterprises Inc Company 7. Loc contents were disposed: If yes, was it cleaned? ❑ Yes ❑ No F5821 Vehicle License Number t4r —S�— L3 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 11 4 BT E : -N ftp PLea�.j # GC &-n F IGA-rT& ;l 1-S, U bT A �,IA�,c.�.a-rY 0fI4E i%J65Li94w-9 �11Fo-r.L. t,Ye,TEr1. TT ►s A ZL ww OF 1'4& LaArvo A uo I; LE vArr►od of -r,.4 e4_1 yT 1 NA tires-, 4*HFOWL6 4 fti, 71 TAt.►IG m L W4 \ (3o u-tAngEmS� r Tu V_N► 1�,g AS �11LT PLAN OF SUBSURFACE DISPOSAL SYSTEM LOCATED IN �] ne-r-1 A w D ov Eft 6 AS PREPARED FOR .DATE: 20- 00 --1� H t ®� e SCALE: s � � q 'G' L. & e IH OF REQ`' iVE® ��,P�-r,�� s VLADIM1Fi L. �yG NEMCHENOK DEC 1 1 2006 ; tleAS"V _/v TOHEAut- NORTH LTH DEPARTMENT �� SS��NAL ENG MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS 66 PARK STREET 0 ANDOVER. MASSACHUSETTS 01810 or TEL (617) 475-3355, 373-5721 v'tt�ao �s�''VO 0r PUBLIC HEALTH DEPARTMENT Community Development Division CE127IFICArrCF O�F'COWPGIA9VCrE As of: December 12, 2006 This is to cert that the individuafsubsurface disposa(system received a SATISTACTORT IM(PEMOY of the: EudSeptic System Repfacement (By. Druce Yfoehn At: 1475 Turnpike Street North Andover, 914A 01845 r1he Issuance of this certificate shaff not 6e construed as a guarantee that the system wiff function satisfactorify. 4 us `Y. Sawyer Tu6fic Yfeafth Director 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Of ,40RTil qy 0 � 9s`sAClkti`�Ej PUBLIC HEALTH DEPARTMENT Community Development Division DEC 1 1 2006 w'_,ri �,1 ANDOVER TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM — INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System (Jjconstructed; ( ) repaired; By: 13 w LdGE oe, 1A0 ( WAL.,-[c6 1771 1�:' ESQ'CAi VA -T -10G Located at: 1475 _Fi� K -K) P t Ie (Installation Address) .has installed in con.o,:rance with Che NOrLi Andover Board of Health approved pian, originally dated AUC, 00� and last revised on (��'� 2,2, , '��'j'/> , with a design flow of 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. Bottom of Bed Inspection Date: ( t T51 LA, r2w And — Print Name Final Construction Inspection Date: I [—Z`j -ccp rJI LL 9 LA r- F,!�2 k5i�!' And — Print Name Installer: (Signature) Engineer Representative (Signature) Engineer Representative (Signature) Date: ,R Uc i- /�o% A / �) And — Print Name Date: /Z -11-2,906 VZq-oiAzc1_ A1CA�_ejyE 0X - And — Print Name 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com r DEPT. of HEALTH DEC -5-2006 N.ANDOVER, MA TO WHOM THIS MAY CONCERN. WE, JIMMIE AND AUDREY RUCKER, AGREE TO ACCEPT THE RESPONSIBILITY OF RE- SEEDING AND MAINTAINING THE GROWTH OF NEW GRASS AT 1475 TURNPIKE STREET, N.ANDOVER, MA. WHERE A NEW SEPTIC SYSTEM HAS BEEN INSTALLED. THE CONTRACTOR WILL BE RESPONSIBLE FOR GRADING AND REMOVING ALL LARGE ROCKS AND STONES AND ADDING A LAYER OF TOP SOIL FOR THE SEEDING AREA. SINCERELY Z-") JIMMIE RUCKE��,�>��-�..�,/� �77"� AUDREY RUCKER / RECEIVE DEC 5 2006 TOWf�I OJ N/O'R' � AltIC10VER HEALTH DEPARTMENT f FINAL GRADE INSPECTION Date: L . Address: b-'IrOAMED? ❑ SEEDED? — ` COVER PERT-�PAN l 4z-�U t A: TOWN OF NORTH ANDOVER pt NORT11 Office of COMMUNITY DEVELOPMENT AND SERVICES o HEALTH DEPARTMENT :� 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 • "�, .��:�..� + NORTH ANDOVER, MASSACHUSETTS 01845 �'' s�cNUs Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.8476 — FAX ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: /,, 'S MAP: /,9 7 /j LOT: L S INSTALLER: Y�aee DESIGNER: _S4,5 -- PLAN DATE: BOH APPROVAL DATE ON PLAN: l D�zv/o INSPECTIONS / y TANK INSPECTION: fl DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ❑Existing septic tank properly abandoned ❑Internal plumbing all to one building sewer ❑Topography not appreciably altered Comments: SEPTIC TANK of tank hole has 6" stone base t15Bottom Weep hole plugged 1500 gallon tank has been installed H-10 loading Monolithic construction ❑ Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ❑ Inlet tee installed, centered under access port ❑ Outlet tee (gas baffle or effluent filter) installed, centered under access port ❑ 24" inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present ❑ Hydraulic cement around inlet & outlet Wastewater System Documentation — Feb 2006 Page 1 of 6 TOWN OF NORTH ANDOVER NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES ❑ HEALTH DEPARTMENT «� 1000 gallon Pump Chamber installed 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 NORTH ANDOVER, MASSACHUSETTS 01845 �� Sq�HUg t� Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.8476 — FAX Comments: PUMP CHAMBER r/li��' Bottom of tank hole has 6" stone base Weep hole plugged ❑ Combo Tank installed. Size: ❑ 1000 gallon Pump Chamber installed H-10 loading Monolithic construction) ❑ Inlet tee installed, centered under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off floats working ❑ Separate on/off floats ❑ Drain hole in pressure line ❑ 24" inch cover to within 6" of final grade installed over pump access port ❑ Water tightness of tank has been achieved Visual testing ❑ Hydraulic cement around inlet & outlet Comments: ADVANCED TREATMENT TECHNOLOGY ❑ Type of treatment device: Comments: ❑ Installed per manufacturers requirements ❑ All components working in accordance with manufacturer's requirements Wastewater System Documentation — Feb 2006 Page 2 of 6 TOWN OF NORTH ANDOVER M°RTM Office of COMMUNITY DEVELOPMENT AND SERVICES a HEALTH DEPARTMENT a 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 �' S`g NORTH ANDOVER, MASSACHUSETTS 01845 s;;CHU Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.8476 — FAX D -BOX Comments: SOIL ABSORPTION SYSTEM Comments: Installed on stable stone base Inlet tee (if pumped or >0.08'/foot) Hydraulic cement around inlet & outlets Observed even distribution Speed levelers provided (not required) Bottom of SAS excavated down to soil layer, as provided on plan Size of SAS excavated as per plan Title 5 sand installed, if specified on plan 3/4-1 Y2" double washed stone installed 1/8-1/2" (peastone) double washed stone installed Laterals installed and ends connected to header Laterals vented if impervious material above Orifices @ 5 & 7 o'clock positions Gravel -less disposal systems: type, number and location as per plan Elevations of laterals installed as on approved plan 40 Mil HDPE barrier installed Retaining wall (boulder / concrete / timber/ block) Final cover as per plan Wastewater System Documentation — Feb 2006 Page 3 of 6 TOWN OF NORTH ANDOVERc� NORTM Office of COMMUNITY DEVELOPMENT AND SERVICES o `��O l p . a • _ ••. �e O HEALTH DEPARTMENT '° 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 ",.. NORTH ANDOVER, MASSACHUSETTS 01845 �9SS CMust�' Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.8476 — FAX PRESSURE DISTRIBUTION ❑ -- inch manifold ❑ laterals installed with end sweeps size: material: ❑ Squirt test ft in height ❑ Equal distribution to all laterals ❑ orifice size inch as per plan Comments: CONTROL PANEL Comments: ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: ❑ Rated for exterior if placed outside Wastewater System Documentation — Feb 2006 Page 4 of 6 .. TOWN OF NORTH ANDOVER NORTN Office of COMMUNITY DEVELOPMENT AND SERVICES cE 1 HEALTH DEPARTMENT Property line 10 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 ❑ NORTH ANDOVER, MASSACHUSETTS 01845 �'Ss;CHU Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.8476 — FAX CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback ' Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA wetland bylaws Wastewater System Documentation — Feb 2006 Page 5 of 6 Tank SAS Sewer ❑ Property line 10 1.0 -- ❑ Cellar wall 10 20 -- ❑ Inground pool 10 20 -- ❑ Slab foundation 10 10 -- ❑ Deck, on footings, etc 5 10 -- ❑ Waterline 10 10 10' ❑ Private drinking well 75 1002 50 ❑ Irrigation well 75 100 ❑ Surface Water 25 50 ❑ Bordering Vegetated Wetland , Salt Marsh, Inland / Coastal Banka 75 100 ❑ Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ❑ Trib. to surface water supply 325 325 ❑ Public well 400 400 ❑ Interim Wellhead Prot. Area ❑ Reservoirs 400 400 ❑ Drains (wat. supply/trib.) 50 100 ❑ Drains (intercept g.w.) 25 50 ❑ Drains (Other) Foundation 10 (5) 20 (10) ❑ Drywells 20 25 ' Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA wetland bylaws Wastewater System Documentation — Feb 2006 Page 5 of 6 TOWN OF NORTH ANDOVER NORTN Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT A 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 NORTH ANDOVER, MASSACHUSETTS 01845 �gSSgCHU t� Susan Y. Sawyer, .REHS/RS 978.688.9540 — Phone Public Health Director 978.688.8476 — FAX SYSTEM ELEVATIONS Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN Distribution Box OUT Lateral 1 HIGH Lateral 1 LOW Lateral 2 HIGH Lateral 2 LOW Lateral 3 HIGH Lateral 3 LOW Lateral 4 HIGH Lateral 4 LOW Lateral 5 HIGH Lateral 5 LOW INVERT ON DESIGN PLAN FIELD INVERT ELEV. Wastewater System Documentation — Feb 2006 Page 6 of 6 .J ,,oRtW Commonwealth of Massachusetts o,,..p •.,etioo Board of Health North Andover Map -Block -Lot ---------------------- Permit No BHP -2006-0733 ----------------------- FEE m+ *. • P.I. •-»-'-••� $250.00 --------------------- ��Ss�crNUS�� F.I. Disposal Works Construction Permit Permission is hereby granted _BRUCE A ------ HOEHN------------------------------------------------------------------- to (Repair) an Individual Sewage Disposal System. at No 1475 Turn-----------------------------------ike Street -- ---------------------------------------------------------------------------- - ------------------ as shown on the application for Disposal Works Construction Permit No. BHP -2006-073_- Dated _ _November 13, --------------------------------------------------- - Issued On: Nov -13-2006 Board of Health --------------- ---------------------.o�®- „�� m�... Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. tenon Application for Septic Disposal System . r Construction Permit - TOWN OF ORTH ANDOVER. MA Application is hereby made for a permit to: ❑ Construct a new on-site sewage disposal system* Repair or replace an existing on-site sewage disposal system* ❑ Repair or replace an existing system component — What? A. Facility Information Address or Lot # / City/Town 2.- JfYPE OF SEPTIC SYSTEM*: Pump ❑ Gravity (choose one) ***If pump system, attach copy of electrical permit to application*** Y- / 3 - oci TODAY'S DATE 250.00— L it $125.00 - Component ❑ Conventional System (pipe and stone system) ❑ Infiltrator or Biodiffuser (Gravel -Less) (Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D -Box) (Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D -Box Present) S.A.S. 2. Owner Information Name _ &76 Address (if different from aboyn Telephone Number 3. Installer Information Azv Name Name of Company 4. h Zip Code State Zip Code Telephone Number (Cell Phone # if possible please) Name of Company State Zip Code Telephone Number (Best # to Reach) Application for Disposal System Construction Permit • Page 1 of 2 o� NORTM Application for Septic Disposal System 4t�a° r°qq.A �Monstruction Permit —TOS OF ORTH ANDOVER, MA 01845 9SSACMUSeA PAGE 2OF2 A. Facility Information continued.... 5. Type of Building: gResidential Dwelling or ❑Commercial B. Agreement TeDAY.QATE $ 250.00 - Full Repair $125.00 - Component The undersigned agrees to ensure the construction and maintenance of the afore -described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. ZA-0ce, // /3 - Name Date natio Approve y: oa of He lth Representative) N me ate Application Disapproved for the following reasons: For Office Use Only: 1. Fee Attached. Yes J No 2. Project Manager Obligation Form Attached. Yes " 3. PumpSystem? If so, Attach coDv ofElectrical Permit Yes 4. Foundation As -Built? (new construction ronly): Yes (Same scale as approved plan) No hm No 5. Floor Plans? (new construction only): Yes No Application for Disposal System Construction Permit - Page 2 of 2 SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: /x/7.5 7_0 400,01/ L CSJ�" (Aof septic syste ) For plans by L� ,!'�` fve& (Engineer) Relative to the application of �� /��l. (Installer's naTme) And dated ngma ate Dated /� ® � fay s ate With revisions dated (Last revised date) I understand the following obligations for management of this project: 1. As the installer, I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer, I must call for any and all inspections. If homeowner, contractor, project manager, or any other person not associated with my company schedules an inspection and the system is not ready, then item three shall be applicable. 3. 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 me and/or MY company a. Bottom of Bed — Generally, this is the first (1`� inspection unless there is a retaining wall, which should be done first. The installer must request the inspection but does not have to be present. b. Final Construction Inspection — Engineer must first do their inspection for elevations, ties, etc. As -built of verbal OK (or e-mail to: healthdept&townofnorthandover.com) from the engineer must be submitted to the Board of Health, after which installer calls for an inspection time. Installer must be present for this inspection. With a 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. Installer does not have to be on-site. 4. As the installer, I understand that only I may perform the work (other than simple excavation) and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done 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 to operate in the Town of North Andover, significant fines to all persons involved are also possible. 5. 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 ofHealth staff or consultant. d. Installation of tank, D -Box, pipes, stone, vent, pump chamber, retaining wall and other components. 6. As the installer, I understand that I am solely responsible for the installation of the system as per the approved Mans. No instructions by the homeowner, General contractor. or anv other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: ll' `3. C (T /R(JC-v z'i�isr� (Name — PrTrTtT arae —Signed) Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 7��ryr� Occupancy and Fee Checked [Rev. 9/051 leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: \� -- 2 O — o (O City or Town of- NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) Owner or Tenant Owner's Address Is this permit in conjunction with a building permit? Ye—s—'`'] Purpose of Building��"��\�rp� Existing Service Amps / Volts Overhead New Service Amps / Volts Overhead NOV 2 0 2006 No ❑ (Check Appropriate Box) Utility Authorization No. ❑ Undgrd ❑ J: Undgrd ❑ Date..f./.:..d �:��.... y WN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that ..............:.......:.........................................:. has permission to perform ........... ........,1 1!'.,j ........................ wiring in the building of ..... !. ' 1'1...t (✓,`%f'S............................................ at .....1..S .f/. ................... North Andover, Mass. Fee' '' '"' '.... Ltc. No ..1.Ze...................., f ..: ELECTRICAL INSPECTOR Check N 41-16 No. of Meters No. of Meters table may be waived by the Inspector of Wires. if desired, or as required by the Inspector. of Wires. ••,...11 rc:Muucu uy a tInicipal policy.) Work to Start: \\-• 24 Olo Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: '—` c ' L LIC. NO.: Licensee: �1��t��aa.�.�'a�lex�r-�ev-� Signatur LIC. NO.: g345'R (If applicable, enter "exempt" in the license number line.) 1 Bus. Tel. NoApb*a4lNf06kS1 Address: r �t Nr�• •Alt. Tel. No.: *Security System Contractor License required for this ork; if applicable, enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. FPERMITFEE. $ No. of Total Transformers KVA Generators KVA ❑o. of Emergency Lighting Battery Units FIRE ALARMS No. of Zones No. of DR-e—ction an Initiating Devices No. of Alerting Devices No. of Self -Contained Detection/Alerting Devices Local❑ unlclpa Connection El Other Security ystems: No. of Devices or Equivalent Data Wiring: No. of Devices or uivalent Telecom munlcatlons Wiring: No. of Devices or E uivalent if desired, or as required by the Inspector. of Wires. ••,...11 rc:Muucu uy a tInicipal policy.) Work to Start: \\-• 24 Olo Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: '—` c ' L LIC. NO.: Licensee: �1��t��aa.�.�'a�lex�r-�ev-� Signatur LIC. NO.: g345'R (If applicable, enter "exempt" in the license number line.) 1 Bus. Tel. NoApb*a4lNf06kS1 Address: r �t Nr�• •Alt. Tel. No.: *Security System Contractor License required for this ork; if applicable, enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. FPERMITFEE. $ .N Page 1 of 5 9A - APPLICATION FOR LOCAL UPGRADE APPROVAL Commonwealth of Massachusetts North Andover, Massachusetts Application for Local Upgrade Approval Title 5, 310 CMR 15.000 DEP approved form required by 310 CMR 15.403(1) RECEIVED OCT 3 12006 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT To be submitted to Local Approving Authority/Board of Health: For the upgrade of a failed or non -conforming system with a design flow of <10,000 gpd, where full compliance, as defined in 310 CMR 15.404(1), is not feasible. To be submitted to DEP: For the upgrade of a failed or non -conforming system with a design flow of 10,000 up to 15,000 gpd and/or for upgrade of state or federal facility, where full compliance, as defined in 310 CMR 15.404(1), is not feasible. NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of new design flow to a cesspool or privy or the addition of new design flow above the existing approved capacity of a system constructed in accordance with either the 1978 Code or 310 CMR 15.000. 1) Facility/System Owner: Name: `. k( r4 ��© �'�i►��; ��Ld L1,1 AM -5 Address: Lskiv rC-��GE �i-r►2�ET • �A EM �,�),� t°�hc�`i Phone #: (joo i) V!14- S2CPr Address of facility: I y ? &; Tu a4,9,p 1 LZ 7_170 -Cc 2) Applicant (if different from above): Name: 6 Int 1-41 L LtA,y-'I Address: �l I I .min.° �'1.�r�'CE .Srr y�c L -LH Phone #:--I �V"7) 0,9!4- I 3) Type of Facility: ✓Residential Commercial School Institutional (Specify) 77 i;?7-V t2w t; IL- I a16 Page 2 of 5 4) Type of Existing System: _privy cesspools) conventional system other(describe) (Type of soil absorption system (trenches, chambers, pits, etc.) 5) Design Flow Based on 310 CMR 15.203: a) Design flow of existing system u p1;L I gpd Approved: _yes Approved date: b) Design flow of proposed upgraded system gpd c) Design flow of facility _gpd 6) Pro osed upgrade of existing system is: a) Voluntary Required by order, letter, etc. (attach copy) Required following inspection required by 310 CMR 15.301 (provide date inspection form was submitted to the approving authority) (date) b) Describe the proposed upgrade to the system: —O eLJ i 5Ck-> C -AA- *PVC- -rA QIG, AJC 14MO- C n L eu a-Iy 'T�cnafG D. IAF 5 t rvY pLeZ 4E r "t . 1_ c) Which of the following are applicable to the proposed upgrade? /Reduction of setback(s) (list) (setbacks to be reduced with proposed setback o distances). pig YQC-E �►2� 1 5,�5. �t� (��,�vJ F wi � 4v Zig Percolation rate of 30-60 minutes per inch (state actual perc rate). _— Up to 25% reduction in subsurface disposal area design requirements (state required & proposed size). Relocation of water supply well (identify well, describe relocation). ti Page 3 of 5 Other requirements of 310 CMR 15.000 that cannot be met (specify sections of the code). System upgrades that cannot be performed in accordance with 310 CMR 15.404 & 15.405, or in full compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410 - 15.417. 7) If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the high ground water elevation pursuant to 310 CMR 15.405(1)(i)(1). The evaluator must be a member or agent of the local approving authority. Distance from soil absorption system to high groundwater feet. As determined by: Evaluator's Name: Evaluator's Signature: Date of Evaluation: 8) Notice to Abutters: No application for upgrade approval in which the setback from property lines or a private water supply well is reduced shall be complete until the applicant has notified all abutters whose property or well is affected by certified at least ten days before the Board of Health meeting at which the upgrade approval will be on the agenda. Such notice shall include the date, time and place where the upgrade approval will be discussed. If the Department is the approving authority, then such notice to abutters must be completed prior to the date of submission of the application to the Department. The notices to abutters shall include a copy of the completed application form and shall reference the standards set forth in 310 CMR 15.402 through 15.405. A 'v List of affected abutters: Abutter's Name Address Abutter's Name Address Abutter's Name Address Page 4 of 5 Date notified Date notified Date notified 9) Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible (each section must be completed): a) kX VLorc.il nn%[5! oro !krrE toa te—t+ t -i 12 "i`F A#,j !iQ F--' Peter( EW, W. b) An alternative system approved pursuant to 310 CMR 15.288 is not feasible. c) A shared system is not feasible. d) Connection to a sewer is not feasible. 10) An application for a disposal system construction permit, including all required attachments (e.g. plans & specifications, site evaluation forms), must accompany this application. Is the DSCP application attached? yes ✓ no �L � �7riCGlF-U--A-rI0rQ�Wtc� Page 5 of 5 11) Certification "I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my knowledge and belief, are true, accurate, and complete. I am aware that there may be significant consequences for submitting false information, including, but not limited to, penalties or fine and/or imprisonment for knowing violations." 10 -a 7- Facilfty Ownel"s`gignature Date e'5;E066z WiuIACA-7 Print Name P4 u, 12a E W0291U X4-1 92M4 a ACAC C06.1 �� Name of Preparer Date Telephone # & Address of Preparer NOTE: Title 5,310 CMR 15.403(4), requires the system owner or operator to submit to the Department a copy of the local upgrade approval upon issuance by the Board of Health and prior to commencement of construction. v SD 16t•NO� �WW � bye yy� `T 4AN! T/ '�_ totwtM wvtM _ 9• PUBLIC HEALTH DEPARTMENT Community Development Division October 30, 2006 Estate of Thomas V. Hughes 1475 Turnpike Street North Andover, MA 01845 RE: Septic System Design, 1475 Turnpike Street, North Andover, Map 107B, Lot 65 Dear Homeowner, The North Andover Board of Health has completed the review of the septic system design plan for the above referenced property, submitted on your behalf by Merrimack Engineering Services Inc., dated, October 30, 2006 last revised October 23, 2006. The design has been approved for use in the construction of an onsite soil absorption system (S.A.S.). At a regularly scheduled Board of Health meeting, held on October 28, 2006, the board voted unanimously to allow the variances as listed on the plan. 1) Distance from S.A.S. to wetland from 100 feet to 36 feet 2) Distance from septic/pump tank to wetland from 75 feet to 30 and 28 feet (NA 5.02) 3) Local upgrade approval for a distance from S.A.S. to wetland from 50 feet to 36 feet. This plan is valid is valid for two years from the date of a septic system inspection that did not meet the acceptable criteria in the state regulations. During this time a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover. In the event an imminent health problem such as sewage backup into the dwelling is occurring, the North Andover Board of Health may reduce the time period for which this plan is valid. This approval is subject to the following conditions: 1. The attached DEP Form 9b must be submitted by the homeowner to the appropriate Regional Office of the Department of Environmental Protection; Bureau of Resource Protection, Mass DEP NERO, 205B Lowell Street, Wilmington, MA 01887 2. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation, the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit. 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web wwwjownofnorthandover.com 3. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission, Zoning Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe or imply compliance with any of the aforementioned requirement. Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you may have. amcer �y, t usan Y. Sawyer, REHS/RS ; Public Health Director Encl: list of licensed septic system installers Form 9b Cc: Merrimack Engineering Services 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Commonwealth of Massachusetts City/Town of Local Upgrade Approval Form 913 DEP has provided this form for use by local Boards of Health if they choose to do so. The Local Upgrade Approval is to be completed by the local Board of Health and a signed copy provided to the system owner. The system owner shall provide a copy of the Local Upgrade Approval to the appropriate Regional Office of the Department of Environmental Protection, Bureau of Resource Protection, Title 5 Permitting Program, upon issuance by the local approving authority and before commencement of construction. A. Facility Information When filling out 1. Facility Name and Address forms on the computer, use The estate of Thomas V. Hughes Go George Williams only the tab key Name to move your 1475 Turnpike St cursor - do not use the return Street Address key. North Andover MA 01845 d`—� City/Town State Zip Code 2. Owner Name and Address (if different from above): Name Street Address Cityfrown State Zip Code Tefephone Number 3. Type of Facility (check all that apply): X Residential ❑ Institutional ❑ Commercial ❑ School 4. Design flow per 310 CMR 15.203: 330 gfu 5. System Designer: Steven Erikson Name 66 Park Street Andover Address Citylrown B. Approval 1. Local Upgrade Approval is granted for: Reduction in setback(s) — specify: for a distance from S.A.S. to wetland from 50 feet to 36 feet ❑ Reduction in SAS area of up to 25%: PE x RS MA State, ZIP SAS size, sq. ft. % reduction 1475 Turnpike st 9B.doc • rev. 5/02 Local Upgrade Approval- Page 1 of 1 Commonwealth of Massachusetts City/Town of Local Upgrade Approval Foran 9B B. Approval (continued) ❑ Reduction in separation between the SAS and high groundwater: Separation reduction Percolation rate Depth to groundwater ❑ Relocation of water supply well (explain): ft. minAnch ft. List local variances granted not requiring DEP approval per 310 CMR 15.412(4): Distance from S.A. S. to wetland from 100 feet to 36 feet 2) Distance from septictpump tank to wetland from 75 feet to 30 and 28 feet (NA 5.02) List variances granted requiring DEP approval: Print or Type N me and Title 1475 Turnpike et 9B.doc • rev. 5/02 4i Date Local Upgrade Approval• Page 2 of 2 —M MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS LAND SURVEYORS PLANNERS 66 PARK STREET • ANDOVER, MA 01810 • (978) 475-3555, 373-5721 • FAX (978) 475-1448 • E-MAIL Info@merrimackengineering.com October 24, 2006 Susan Sawyer Public Health Director 1600 Osgood Street Building 20, Suite 2-36 North Andover, Ma. 01845 RE: 1475 Turnpike Street Dear Ms. Sawyer: RECEIVED OCT 2 4 2006 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT We have received your review letter dated 10-23-06 for the above referenced site. We have revised the plan with regards to items 1,2,3,6,7, & 8 of your letter. With regard to item 4, the plan view shows finish spot grades, the end section shows finish spot grades, and the profile shows minimum and maximum cover over the distribution box, we feel this is more than adequate verification that adequate cover is proposed over the distribution box. With regard to item 5, the control panel should be installed per the pump notes and the manufacturers specifications as we are not electrical or pump engineers. With regard to item 10, the plan does clearly depict this in the septic tank details. With regard to item 11, and as we continuously make this argument, trenches when constructed in fill do not function as the code intends as they are not constructed in naturally occurring soil. Additionally they are not an economical or practical design because they take up more space and cause more horizontal disruption to the property. In this case, the proximity of work to the surrounding wetlands would be even closer. Lastly, this plan does propose an effluent tee filter at the outlet of the primary septic tank contrary to the reviewers comment. We feel the plan, as revised, addresses your concerns and we respectfully request the plan be approved as revised. Very truly yours, MERRIMACK ENGINEERING SERVICES, INC. William Dufresne, Project Manager V►ORTH F y .• A �1SS�CHUS t Health Department October 23, 2006 Steven Eriksen Merrimack Engineering Services 66 Park Street Andover, MA 01810 Re: Proposed Septic Design for 1475 Turnpike St, Map 107B, Lot 65 Dear Mr. Eriksen: The proposed septic system design plan for the above site dated August 30, 2006 and received on September 13, 2006 has been reviewed. Unfortunately, the plans cannot be approved as submitted. The following items are in need of attention prior to approval, with the section of Title 5 (3 10 CMR 15.000) or the North Andover Board of Health regulations noted: 1. Please identify the location of the existing waterline on the property — 310 CMR 15.220 2. Please provide the inlet invert to the distribution box 3. Please provide volume calculations for the dosing of the system which include flowback volume and head determination. 310 CMR 15.220, 254, 231 4. Please verify that the finished grade provides adequate cover over the distribution box 5. Please specify the pump control panel that is to be used and the associated features — 310 CMR 15.220 & NA 12.01 6. Please include the buoyancy calculations for the primary (septic) tank — only the pump chamber calculations are provided — 310 CMR 15.221 7. Please provide detailed information on the vent (i.e. that it is to be protected from animal entry and precipitation) — 310 CMR 15.241 8. Please provide a design plan which is in compliance with setback standards in state regulations or request a variance or Local Upgrade Approval accordingly. It appears the setback distance between the soil absorption system and the wetland resource area does not comply 9. Please indicated the required placement of magnetic marking tape or comparable means around the on-site wastewater system — 310 CMR 15.221 10. The septic tank detail does not depict that the inlet and outlet tees are to be located underneath an access port. This is important for maintenance purposes and should be clearly shown for the Disposal Systems Installer - 310 CMR 15.227 11. Trenches are to be used as the soil absorption system mechanism whenever possible. 1600 Osgood Street HEALTH DEPARTMENT Page 1 of 1 Building 20; Suite 2-36 E -Mail: healthdept@townofnorthandover.com North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 Please use trenches in this instance or explain why they cannot be utilized - 310 CMR 15.240 Additionally, you might wish to consider specifying an effluent filter in the primary (septic) tank. Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a replacement on-site wastewater system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. an Sawyer. Public Health Director cc: Homeowner File .`d TOWN OF NORTH ANDOVER aF µoQ7.�ti� Office of COMMUNITY .DEVELOPMENT AND SERVICES ? by HEALTH DEPARTMENT k 400 oseooD sTRrrr '7y ew+.ao .Mv� NORTH ANDOVER, MASSACHUSETTS 0184.5 �SsAcHuSE< Susan Y. Sawyer, KLFIS/RS 078.688.9540 Phone.978.688.8476-.. FAX Public Health Director L -NIHIL: healthdept@to,,vnofilorthandover.com WEI3SITE: http://,Aww.townotnorthandover.coni SEPTIC PLAN SUBMITTAL FORM Date of Submission: 9 — �; —C -,)G Site Location: 1W76 'T4-K-fJ F9t K6' '5�fk'L 76'1_ Engineer: �I I:1'Lit,l a -i G� 0ly C f W 0 0{j &6 New Plans? Yes t/ $225/Plal� review only) Revised Plans?Yes $75/Plan Site Evaluation Forms Included? R77' ="`_ SEP 13 2006 TOWN OF NOR- ri ANDOVER HEALTH DEPARTMENT Check # (includes 1" submission and one re - Check # f' Yes f No Local Upgrade Form Included? cvA Yes No Telephone #: (el 70) `'t7C,-'3j5;�;;_5 Fax #: 4-7(; IgLte E-mail:_ f3 "Ll F12e5Ni✓ 0 Cc,-," C� 51 � 00 -r - Homeowner Name: �S'r�-��' T 1 --t �/r %i u -61-4e9 el® O;V19 5;w rrA -91 Lam- J w_e xx-_i eP- 0�77 OFFICE USE ONLY When the sub)iion is complete (including check): ➢ 1z Date stamp plans and letter ➢ ZZ _Complete and attach Receipt ➢ I, Copy File; Forward to Consultant ➢ Enter on Log Sheet and Database Kr %0 tm.+ 8 V ik- ..v ,141_ 17 2006 TOWN OF NORTH ANDOVER Towf,ilfcs I n,rr� /jENT �lT Office of COMMUNITY DEVELOPMENT AND SERVI HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 'S�rHUs� Susan Y. Sawyer, RE US, RS 978.688.9540 --- Phone Public health Director 978.688.8476 - FAX health dept&townofn orthan dov er.com www.town ofiiortliandover.coni APPLICATION FOR SOIL TESTS DATE: 10-1'� —49(e MAP & PARCEL: 1 0? 0, , & LOCATION OF SOIL TESTS: I GI'l15 Tu / OWNER: ��, r �4-�c►�l i �. UA Cz Id�ontact #: l 7 ; 1 Z� P.�-aft APPLICANT: �..zr p12 a& W nj.4 Ar -4!5j Contact #: � �j� ��z- I?�1 Z ADDRESS: q1 LA i-4 IG4!%xE rZc Ar7 r SA L6 1-, QW . 0-7707-' ENGINEER: Contact#:6/7"?jj� CERTIFIED SOIL EVALUATOR:` 1.��1� E y�l✓ Intended Use of Land: Residential Subdivision Ingle e Commercial Is This: Repair Testing: GeUndeveloped Lot Testing: Upgrade for Addition:_ In the Lake "Cochichewick Watershed? Yes No ✓' THE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership (Tax bill, or letter from owner permitting test) ➢ 8.5"x 11 "Plot plan & Location of Testing (please indicate test nit sites on the Dlan) ➢ Fee of $425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of $360.00 per lot for repairs or upgrades. GENERAL INFORMATION ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. ➢ Full payment will be required for all additional tests within two weeks of testing. ➢ Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Signature of Conse Date back to Health Department: (stamp in): bvhaw( 1 V�Ws1- -F-� Lq Nom. 0 1/1 V9.Q06,flR 9:37 FAX iy4 Merrimack Engineering FrtANC(:s o. 6600wug N Ad' ;0-7A.7' W ApprAco ob ETLAOM s Owe. fill G � 3 u*Y X1003; 003 36 old. h NaYT 3A e 4j 2 w �F Gooauu� Q e� SALEM 0 # Co 4, / 1 75 ti •s b / c 1h/ f _ _ P • y ' MNm,...... 752.80 `t'6 M.H.S. TilRt4PIKF. PLAN OF L A N 1::p s rl NOQTH A %a, MASS. owNr:0 ¢y FRANces 0, G000wum Sceo.Lr r*=50 ` PLANING BUM APPPOVAL OlOrl suBniv.sin convaoL LAo Un R�QiUrRED FLA142130 BO ARD Of �+IPt27H Au�7ov�K�iAO�SS. D2n,sstffun ASsocton cs 8q 1 c. r Y S -r'. WAvar2F►{"� M4.SS. sw�a�s► I II F Frreeman, Bussell Lot 2, 1arnnike St. APPLICATION FOR SEWAGE DISPOSAL INSTALLATION HEALTH DEPARTMENT - NORTH ANDOVER, MASS. I hereby make application for a permit for a sewage disposal instal la ion at Lot 2, Turnpike at. . I will install this system in ac- cordance with all the laws of the Commonwealth of Massachusetts and regulations of the Board of Health of the Town of North Andover. Further, I will construct the house sewer of bell and spigot pipe, the minimum diameter being 4 inches, and will maintain a minimum grade of 1% until 10 feet pre- ceding the septic tank, where the grade shall not exceed 2%. I will install a con- crete septic tank of 1000 gal. in size. A manhole (s) permitting easy cleaning will be provided with.removable cover (s) of iron or concrete within 12 inches of the ground surface. I will provide subsurface disposal field with 4 inch perforated or open jointed pipe and laid in a series of trenches, the bottom of which will pro- vide a minimum of 180 lineal (xq) feet of effective absorption area. The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging in size from 3/4 to 1-1/2 inches (dia.) and the pipes will be surrounded by similar material to a height of 2 inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench, 2 inches of gravel or stone 1/8" to 1/4" (dia.) will be placed over the course gravel or stone. The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single tile line will exceed 100 feet in length and in any case, two lines of tile will be installed. A minimum of 6 feet will be maintained between the center lines of the disposal field trenches and the average depthof trench shall not exceed 36 inches. No part of the installation will be less than 100 feet from any private water supply, 25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line. I further agree not to cover any portion of this installation until approved by the inspection officer, as provided below, and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application. DATE Dec. 43 1964 J11 - Signature of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DATE Dec. 14, 1964 0 Signature of Health Agent. I have inspected the uncovered system indicated above and find everything done as described. DATE �, J Signature a nspecting Officer Percolation Test 7 min. Soil: clay Garbage Grinder No BOARD OF HEALTH TOWN OF NORTH ANDOVER, MASS. 1. NAME DATE 2. ADDRESS LOT NO. TEL. 3. NO. OF BEDROOMS 3 DEN YES NO 4. GARBAGE GRINDER YES NO� 5. SHOW DIMENSIONS OF HOUSE b. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES 7. SHOW DIMENSIONS OF LOT 8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL 9. NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM 10. SHOW LOCATION OF BROOKS, STREAMS, DITCHES, LEDGE OUTCROP, ETC. 11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY. 3 cta BOARD OF HEALTH OF NORTH ANDOVER, MASSACHUSETTS SEWAGE DISPOSAL DATE December 5, 1964 NAME OF APPLICANT Freeman, Russell LOCATION# 2 Lot, Turnpike Street Address of lot no. BUILDING: Dwelling X Other SYSTEM: New X Repair GENERAL DESCRIPTION OF LAND High SUBSOIL: Clay_ Gravel_ Sand PERCOLATION TEST 7 minutes per inch. MINIMUM INSTALLATION RECOMMENDATIONS CONCRETE SEPTIC TANK 1,000 gallon capacity. LEACH FIELD 180 lineal feet of drain pipe. William J. lakiscoll, Engineer Board of Health U BOARD OF HEALTH OF NORTH ANDOVER, MASSACHUSETTS SEWAGE DISPOSAL DATE December 5, 1964 NAME OF APPLICANT Freeman, Russell LOCATION# 2 Lot, Turnpike Street Address of lot no. BUILDING: Dwelling X Other SYSTEM: New X Repair GENERAL DESCRIPTION OF LAND High SUBSOIL: Clay_ Gravel_ Sand PERCOLATION TEST 7 minutes per inch. MINIMUM INSTALLATION RECOMMENDATIONS CONCRETE SEPTIC TANK 1,000 gallon capacity. LEACH FIELD 180 lineal feet of drain pipe. William J. lakiscoll, Engineer Board of Health Q � •AS �V V l� ~I r 1 I` b L` 4 1 /F" `. 1V F� I - L G CY a i a . r 1 +I 1 r