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HomeMy WebLinkAboutMiscellaneous - 15 ENGLISH CIRCLE 4/30/2018 15 ENGLISH CIRCLE L' 210/038.0-0257-0000.0 i I i It i k i t � 4 MAP # 3� LOT # 3 PARCEL # 8 ". HOZ STREET .__ClerArs .__.__..... CONSTRUCTION APPROVAL HAS PLAN REVIEW FEE BEEN PAID' YES NO Sc�U.�ST PLAN APPROVAL: DATE--2"7 APP. BY. .._,_ _.. . DESIGNER: ��'1�-C.K� 1 -^----__-_ PLAN DA1 7/ q�41 f- CONDITION �� ON Loi L> t;EC S otL its~ —_ _ _ — ---- _ ..........._.._.... _.._.._.. - _._.._........._....... WATER SUPPLY: TOWN WELL WELL PERMIT DRILLER WELL TESTS: CHEMICAL DAIS BACTERIA I Dfll"E fll'PRUVED BACTER DA I E f=l1=PRUVED COMMENTS: FORM U APPROVAL: APPROVAL 1*0 E DATE ISSUEDBY CONDITIONS: ............. FINAL APPROVAL: ALL PERMITS PAID NO WELL CONSTRUCTION APPROVAL SEPTIC SYSTEM CONSTRUCTION APPROVAL NO OTHER YES Au ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: BY: . PERIN-3-Y-5-TEM_JN. .I9.1rl,.Rt�..QN IS THE INSTALLER LICENSED? YES NO •.,; .� _ TYPE OF CONSTRUCTION: NEW REPAIR NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW YES NO CONDITIONS OF APPROVAL YES NO (FROM FORM U) , r. ISSUANCE OF DWC PERMIT YES NO DWC PERMIT NO. INSTALLER: BEGIN INSPECTION YES EXCAVATION INSPECTION: NEEDED: PASSED Z3 BYAli oe CONSTRUCTION INSPECTION: NEEDEDa _ .__._-.............. etccI? 22��-f _ ___TO Y-6 AS BUILT PLAN S9TIS ACTORY: YES: _ Z F� APPROVAL.' TO BACKFILL: DATE: �lizi� FINAL GRADING APPROVAL: DATE BY.— �FINAL CONSTRUCTION APPROVAL: DATE:_ BY� -- DVIL ` COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS r d DEPARTMENT OF ENVIRONMENTAL PROTECTION 4 F A� Q O TITLE 5 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:_15 English Circle_ _North Andover_ A i+ J Owner's Name:_John Cammarata Owner's Address: 15 English Circle —North Andover,MA 01845_ Date of Inspection: 8/29/2003_ 4 Name of Inspector: Neil J.Bateson_ _--- Company Name: Bateson Enterprises Inc._ Mailing Address:_111 Argilla Road_ —Andover,Ma.01810 Telephone Number:_(978)475-4786 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X_ Passes _ Conditionally Passes Needs F er Evaluation by the Local Approving Authority Fai �?��--J Inspector's Signature: 4t -r Date: _8/29/2003_ The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments:After permit from B.O.H.,install outlet tee with gas baffle in septic tank,inspection from B.O.H.,septic system now passes Title 5 Inspection. ****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. ' COMMONWEALTH OF MASSACHUSETTS Z EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS e DEPARTMENT OF ENVIRONMENTAL PROTECTION � SVOv TITLE 5 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 15 English Circle _North Andover_ Owner's Name:—John Cammarata Owner's Address: 15 English Circle _North Andover,MA 01845 Date of Inspection:_8/16/2003_ D Name of Inspector:_Neil J.Bateson— Company u Company Name: Bateson Enterprises Inc._ Mailing Address:_111 Argilla Road_ _Andover,Ma.01810 Telephone Number:_(978)475-4786_ CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of 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 _X_ Conditionally Passes N Evaluation by the Local Approving Authority Fai Inspector's Signature: ` Date: _8/16/2003_ The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments: ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 1 r Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 15 English Circle_ _North Andover_ Owner:_Cammarata Date of Inspection:_8—/16/2003_ 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: _X_ 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. Outlet tee corroded off in septic tank Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. N 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 exfiltratiion or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: N Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: N The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: r Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 15 English Circle —North Andover_ Owner:_Cammarat_8/ Date of Inspection: 16/2003_ C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance__ "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 15 English Circle_ _North Andover— Owner:_Cammarata_ Date of Inspection:_8/16/2003_ D. System Failure Criteria applicable to all systems: You must indicate"yes"or`no"to each of the following for all inspections: Yes No No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool No Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool No Liquid depth in cesspool is less than 6"below invert or available volume is less than %day flow _No_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped T —No_ Any portion of the SAS,cesspool or privy is below high ground water elevation. _No_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. No Any portion of a cesspool or privy is within a Zone 1 of a public well. _No_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _No_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] No (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Page 5 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 15 English Circle —North Andover— Owner:_Cammarata_ Date of Inspection:_8/16/2003_ Check if the following have been done.You must indicate`yes"or"no"as to each of the following: Yes No Yes _ Pumping information was provided by the owner,occupant,or Board of Health No Were any of the system components pumped out in the previous two weeks? Yes _ Has the system received normal flows in the previous two week period? No Have large volumes of water been introduced to the system recently or as part of this inspection? Yes_ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) Yes _ Was the facility or dwelling inspected for signs of sewage back up? Yes— _ Was the site inspected for signs of break out? Yes_ — Were all system components,excluding the SAS,located on site? _Yes_ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _Yes_ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no _Yes_ _ Existing information. _No_ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[3 10 CMR 15.302(3)(b)] r Page 6 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 15 English Circle –North Andover– Owner:_Cammarata Date of Inspection: 8/16/2003_ FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_4 Number of bedrooms(actual):_4_ DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):_600_ Number of current residents:_4 Does residence have a garbage grinder(yes or no):_No_ Is laundry on a separate sewage system(yes or no):_No_ Laundry system inspected(yes or no):_ Seasonal use:(yes or no):_No Water meter readings: Yes_ Sump pumps(yes or no):_No_ Last date of occupancy: Current COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no):— Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information:_Pumped 2 years ago,owner Was system pumped as part of the inspection(yes or no): Yes_ If yes,volume pumped:_1500_gallons--How was quantity pumped determined?_Measured tank Reason for pumping:_Inspect tank&tees_ TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) —Tight tank _Attach a copy of the DEP approval Other(describe):_ Approximate age of all components,date installed(if known)and source of information:_12 years old,8/20//1991, As built plan_ Were sewage odors detected when arriving at the site(yes or no):_No Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_15 English Circle —North Andover_ Owner:_Cammarata_ Date of Inspection:_8/16/2003_ BUILDING SEWER(locate on site plan)X Depth below grade:_18"_ Materials of construction:__cast iron _X_40 PVC other _ Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.):_4"PVC thru wall to septic tank. 4"PVC in house,no leaks. SEPTIC TANK: X locate on site plan) Depth below grade:_6"_ Material of construction:—X—concrete_metal_fiberglass__polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions:_101x 5'x 4' Sludge depth:_7"_ Distance from top of sludge to bottom of outlet tee or baffle:_N/A Scum thickness:_12" Distance from top of scum to top of outlet tee or baffle:_N/A_ N/A Outlet tee corroded off. Distance from bottom of scum to bottom of outlet tee or baffle:_N/A How were dimensions determined:_Difference in sludge&scum depth to tee length_ Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Pumped septic tank.Inlet tee ok.Outlet tee corroded of� needs replaced.Depth of liquid at outlet invert.No evidence of leakage._ GREASE TRAP: (locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): r Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15 English Circle North Andover_ Owner:_Cammarata_ Date of Inspection:_8/16/2003 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass,polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: X (if present must be opened)(locate on site plan) liquid Depth of level above outlet invert: _0_ Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.):_D-box level&distribution equal.No evidence of leakage.Evidence of carryover._ PUMP CHAMBER: locate on site plan) ( p ) Pump in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15 English Circle —North Andover— Owner:_Cammarat Date of Inspection:_8/16/2003_ SOIL ABSORPTION SYSTEM(SAS):_X (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: leaching galleries,number:_ X leaching trenches,number,length: 3 trenches 32'long leaching fields,number,dimensions: overflow cesspool,number: innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.):—Soil oL Vegetation ok.No sign of ponding to surface. CESSPOOLS: (cesspool must be pumped as part of inspectionxlocate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.).- PRIVY: tc.):PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15 English Circle_ _North Andover_ Owner: Cammarata_ Date of Inspection: 8/16/2003 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. Driveway Water Meter Garage A B A to Tank=42'6" A to D-Boz=51110" B to Tank=42'8" B to D-Boz=40'4" SeptiTank D-Boz 32' r Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15 English Circle_ —North Andover— Owner:_Cammarata_ Date of Inspection:_8/16/2003 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water_4 Feet Please indicate(check)all methods used to determine the high ground water elevation: _X_Obtained from system design plans on record-If checked,date of design plan reviewed:_5/14/1987_ Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain:_ Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: As per test pit data on design plan._ i 0 .......... . N -- - . En 0 t �5 t'- Dep Dell <.. ;;: '- •- Symantec Acrobat 1,EnZip 3,00, 0 Documents Accessories,,,i pcAnywhere Reader 4.0 ; '" ;; _ •• M r e�:::S�tiY:i -?[Z::j'aGYt4t•.-E3 ';ii?ll�.:-•:-.... • �w ModemT Connect Edit Terminal Help x WATER BILLING HISTORY 3160133-CAMMARATA, JOHN METER tri : 3160133 rCn ;; ------------------- 15 ENGLISH CI tt CYCLE SERVICE PRIOR CURRENT USE WATER SEWER FEES TOTAL Dell SupE .hdl1 2000-13 10/01/1999 428 466 38 103.74 0.00 0.00 103.74 ...:.....::::. : - 2 2000-23 01/06/2000 466 489 23 62.79 0.00 0.00 62.79 3 2000-33 03/27/2000 489 504 15 40.95 0_00 0.00 40.95 ` �J 4 2000-43 06/09/2000 SO4 519 15 40.95 0.00 0.00 40.95 - 5 2001-13 09/05/2000 519 544 25 68.25 0.00 11 .00 79.25 Interne 6 2001-23 12/07/2000 544 560 16 43.68 0.00 11-00 54.68 32 Explore 7 2001-33 03/21/2001 560 574 14 38.22 0.00 11.004 9.22 8 2001-43 06/14/2001 574 590 16 43.68 0,00 11 .00 54.68 . t 9 2002-13 08!30/2001 590 613 23 60.17 0.00 5.55 65.72 10 2002-23 01/22/2002 613 641 28 69.16 0.00 5.55 74.71 Shortcut 11 2002-33 04/05/2002 641 656 15 37.05 0.00 5.55 42.60 `� Printke 12 2002-43 06/O5/2002656 668 12 29-64 0.00 5.55 35.19 N 13 2003-13 09/13/2002 668 698 30 81 .34 0.00 5.97 87.31 14 2003-23 12/12/2002 698 717 19 45.22 0.00 5_97 51 .19 :Ou11oo:15 2003-33 03/07/2003 717 729 12 28.56 0.00 5.97 34.53 Q -Expies,16 2003-43 06/06/2003 729 741 12 28.56 0.00 5.97 34_53 oft lop ...... . ... ... REVIEW CHOICE tt or <ENTER> MORE HISTORY: Nett N eight: Ci to :gm Sbwt Telnet- 10.1.71.55 ` ` ���= � 10:04 AM r Tel: (978) 475-4786 Fax: (978) 475-5451 BATESON ENTERPRISES, INC. Excavating-Water.& Sewer Lines-Septic Systems&Pumping Service 111 Argilla Road Andover, Mass. 01810 Title 5 Inspection Report Property Address: 15 English Circle, North Andover Owner: Cammarata Date of Inspection: 8/16/2003 My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic sstem. Such report issued herewith is merely based upon my observations, and I hereby disclaim anYfrther operation of your current septic system Neil J. Bateson Bateson Enterprises, Inc. . y Town of North Andover o, N �, ORTH Office of the Health Department 0? � `�� °p Community Development and Services Division # i y 27 Charles Street Heidi Griffin North Andover, Massachusetts 01845 'SSgc►+us�� Acting Public Health Director Telephone (978)688-9540 Fax (978)688-9542 TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE 9/3/03 This is to certify that The Outlet T and Gas Baffle constructed () or repaired (X) by Todd Bateson at 15 English Circle has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. 4rnian Board of Health Inspector BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 A.M. FORS -' ~~ DATE TIME P.M. M OF PHONED RETURNED PHONED YOUR CALL AREA CODE EXTENSION MESSAGE PLEASE GAIL WILL V c �'r l S� ��' I1 J c AGAIN CALL T�(L) tY``S �c►1T� CAME TO SEE YOU WANTS TO SEE YOU SIGNED MY niversal'48003 I Town of North Andover, Massachusetts Form No.3 : t 40RTH BOARD OF HEALTH DISPOSAL WORKS CONSTRUCTION PERMIT SSACHUSE� ffI I Pp A I icant �G � . NAME ADDR 5 TELEPHONE _ : Site Location 5� Permission is hereby granted to Construct ( ) or Repair ( n Individual Soil Absorption : Sewage Disposal System as shown on the Design Approval S.S. No. CHAIRMAN, BOARD OF HEALTH Fee D.W.C. No. 5 �� - _ Recreational Camp Permit Z� Well Construction Permit $ _ NO Funeral Directors Permit $ No � Massage Establishment License $ Massage Practice License $ NO Suntanning Establishment $ Date: �� G Offal/Trash Hauler $ Other $ Health Agent 6Nlhi.te - Applicant Yellow - Dept. Pink - Treasurer !I i cow C)0\1 �s ;' TOWN OF NORTH ANDOVER BOARD OF HEALTH S �� Location Permit # Food Service $ Retail Food $ Limited Retail $ Seasonal $ Disposal Works Installers $ n /S Disposal Works Constructio Soil Testing (((/// / $ Design Approval Permit $ Dumpster Permit $ Burial Permit $ Swimming Pool Permit $ Animal Permit $ Recreational Camp Permit $ Well Construction Permit $ Funeral Directors Permit $ Massage Establishment License $ Massage Practice License $ _ Suntanning Establishment $ Offal/Trash Hauler $ Other $ 71: 0 Health Agent White - Applicant Yellow - Dept. Pink - Treasurer S i v APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: 0 CURRENT INSTALLER'S LICENSE# LOCATION: LICENSED INSTA - R: /d j'j' �i9 �6✓ SIGNATURE: v TELEPHONE# CHECK ONE: REPAIR: // NEW CONSTRUCTION: IF NEW CONSTRUCTION,PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only $i 75 M-Fee Attached? Yes `'' No Foundation As-built? Yes No Floor plans o ile Yes No Approval Date: 04G II I� II ' INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North.Andover licensed installer for the construction of the septic system for the property at .S �f 5 w'� relative to the application l/ of Aj��&;L ed �� !3 for plans by �"` and dated �- with revisions dated I understand the following obligations for management of this project: 1. As the installer I am obligated to call for any and all inspections. If homeowner, contractor, project manger, or any other person not associated with my company schedules an inspection and the system is not ready then item two shall be applicable. 2. 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 Tile 5 and the Board of Health Regulations may result in a$50.00 fine being levied against my company. a) Bottom of Bed - generally-first inspection unless there is a retaining wall which should be done first. Install must request the inspection but does not have to be present. b) Final inspection — Engineer must first do their inspection for elevations, ties, etc. As-built or verbal OK from engineer must be submitted to Board of Health, after which installer calls for inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. c) Final Grade'—Installer must request inspection when all gradifig is complete. Does not have to be on site. 3. As the installer I understand that persons or companies not associated with my company may not perform the work required by my company to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to install .septic systems in North Andover can constitute reasons for denial of the, system,-and/or revocation or suspension of my license in the Town of North Andover plus significant fines to all persons involved. 4. As the Installer I understand that I must be on site during the performance of the following construction steps: a) Determination that the proper elevation of the excavation has been reached. b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff. d) Installation of tank,- D-box, pipes, stone, vent, pump chamber, retaining wall and other components. 5. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersi d censed Septic Installer Date: Disposal Works Construction Permit# ' Commonwealth of Massachusetts Map-Block-Lot 038.0-0257- Board Of Health ----------------------- Pem it No North Andover BHP-2003-0263 ----------------------- P.I. FEE F.I. $250.00 ----------------------- Disposal Works Construction Permit Permission is hereby granted Todd-Bateson to(Repair)an Individual Sewage Disposal System. at No 15 ENGLISH CIRCLE as shown on the application for Disposal Works Construction Permit No. BHP-2003-026 Dated Au-gust-25,-20-03 ----------------------------------------------------------------- Issued On: Aug-26-2003 Board Of Health ............................................................................................................................................................................... Commonwealth of Massachusetts Map-Block-Lot 038.0-0257- Board Of Health ----------------------- North Andover Certificate of Compliance THIS IS TO CERTIFY,That the Individual Sewage Disposal System (Repair) by ToddBateson ------------------------------------------------------------------------------------------------------------------------------------------------------------ Installer at No 1-5-ENGLISH CIRCLE - ---------------------------------------------------------------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of TTME 5 of the State Environmental Code as described in the application for Disposal Works Construction Permit No. BHP-2003-026 Dated August_25,-2003- ----------------------- ------ -- Printed On: Sep-09-2003 ----------------------------------------------------------------- - ---------------------------------------------- Board Of Health ............................................................................................................................................................................... Commonwealth of Massachusetts Map-Block-Lot 038.0-0257- Board Of Health ------------------- Permit No North Andover BHP-2003-0263 ----------------------- FEE $250.00 ----------------------- Disposal Works Construction Permit Permission is hereby granted Todd Bateson to(Repair)an Individual Sewage Disposal System. at No 15 ENGLISH CIRCLE as shown on the application for Disposal Works Construction Permit No. BHP-2003-026- - Dated August-25,2003 ----- - ---------------- ------------- ---------------- --------------------- ssu n: Aug-26-2003 Board Of Health Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH O LED SI �� 3� yet 6460 Z 190 \ APPLICATION FOR SITE TESTING/INSPECTION TEDy vc r+us��� Applicant RV CC;ht � NAME ADDRESS TELEPHONE Site Location_ L T 3 YEA l.iS V\ a. -c P Engineer -2 YY i ANAXX1.2 -,V%cl i io-Ce—y-4 �D NAME ADD ESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee-1-0 be— PPri L, I�' Test No.�O _ S.S. Permit Noir & ( D.W.C. No. C.C. Date Plbg. Permit No. RAYMOND A. VIVENZIO ATTORNEY AT LAW 89 MAIN STREET NORTH ANDOVER,MASSACHUSETTS 01845 Board of Health Town of North Andover 120 Main. Street North Andover, MA 01845 RAYMOND A. VIVENZIO ATTORNEY AT LAW 89 MAIN STREET NORTH ANDOVER,MASSACHUSETTS 01845 (508)686-4041 FAX(508)794-0890 February 8 , 1991 Board of Health Town w of North Andover 120 Main Street North Andover, MA 01845 Dear Sir/Madam: I represent R.M.P. Properties , Inc. , proposed purchaser of the three (3) lot English Circle subdivision. Kindly be advised that , at closing, appropriate easements over Lot A will be obtained in order to implement sloping and grading requirements . Additionally, it is my clients ' intention that when the individual lots are sold off, i . e. Lots 1 , 2 and 3, appropriate easements will be retained for the same purposes . Thank you for your attention to this matter. Sincerely Raymond A. Vivenzio RAV/lsg i FEB-14-91 FRI 10:30 JEPSKYKSACK 7-1 f9 MAtOACHUM rT• QUITCLAIM DEED INDIVIDUAL (LANG rallM) $69 Gane L. English, Trustee of Salem Street, Porth Andover Trs , u/ddated August PagsQ 70 5 , 1988, recorded with the Essex Porth District Registry oftin�o�ty� Ivi27820u Book pag of Woburn, Middlesex bving anmwied for coasideradon Pala,and in full consideration of Two Hundred Forty Thousand and 00/100 ($240,000.00) Dollars d and wife, as tenants by ggrant to Joseph W. Gerety and Julie A. Cerety, husband the entirety 521 Salem Street, North Andover, Essex County, MA with qui#rlahn 001UNat of y )the kdntkW [peiedption sad eammbmw.If enyl A certain parcel of land with the buildings and improvements thereon situated in North Andover, Essex County, Massachueett0n shown as Lot "A" on a plan of land entitled, Subdivision l ENGLISH CIRCLE In NORTH ANDOVER, MASS. Drawn For Gene L. English(' , Scale 1" s 40 ' , Dated August 1989, Revised September 1989 by Merrimack Engineering services 66 Park Street, Andover , Massachusetts 01810 and recorded with the Essex North District Registry of Deeds on January 23, 1991 as Plan # 11878 , to which reference is hereby made for a more particular description. Said Lot "A" contains ?'3, 000 S.F. , according to said plan. The Grantor reserves for himself, his successors and assigns the fee in English Circle, as shown on said plan, however, there is hereby granted to the Grantee, their heirs, successors and assigns the right to use English Circle for all purposes for which streets and ways are commonly used in the Town of North Andover in Common with all others entitled thereto. The Grantor reserves for himself, his successors and assigns an easement for one year from the date hereof over portions of Lot "A" for the purpose of grading and sloping the topography of portions of Lot "A" as per plans approved by the North Andover Planning Board on February 15, 1990 for the development of the English Circle subdivision. Grantor shall have the right to ranter Lot "A" and to fill portions of Lot "A",, successors and assigns a The Grantor reserves for himself, his 4 of removing temporary orar easement for the purpose g the barn located on p Y "A' shall be removewithy Said barn English Circle, a portion of which is located on Lot in one year from the date hereof. a d w 1 r Win" .m.Y.........hod and $eal this.......14th............. day of....February........... .,,tg9..... e Al ... ...................... ........................................ ....... ............................................I...........I......... ...... ,... .. ..............,.................................................... .. . .. .... ...... ....... ....................... . .................A II1in MnrnnwnmM4 ni 118"uhtlextto Essex as. February 14, 1991 Then personally appeared the above nanic(i Gene L. English, Trustee as aforesaid sod acknowledged the foregoing instrument to he his free a.ct,and deed, befor .'�.c:............................. ,..... ......._.........,. William D. Sack Notary Publlc--,jWid'"6)d 1W My eommt+sEon "piret.....M Y..16. ................. 19 91 i r ✓+ AORTH OtSt�ao �°q1•° - 32 BOARD OF HEALTH 120 MAIN STREET TEL. 682-6483 �SSACHUS NORTH ANDOVER, MASS. 01845 Ext. 32 or 52 MEMORANDUM TO: Zoning Board of Appeals FROM: Board of Health RE: Application for Special Permit 15 English Circle - Lot #3 DATE: August 13 , 1991 The Board of Health has no objection to issuance of the above mentioned Special Permit. However, it appears that an ejector pump will be required inside the dwelling to accommodate the plumbing for the accessory unit. This will require written approval by the Massachusetts Department of Environmental Protection (310 CMR 15. 06 (18) ) . The Board of Health is willing to provide a favorable recommendation on this special permit, contingent upon compliance with the above mentioned egulation. ACC/cjp cc: Robert Nicetta, Building Inspector 310 04R: DEPARTMENT OF ENVIRONMENTAL QUALITY ENGINEERING • 15. 15.06: continued (15) Backfill. Backfill around the septic tank shall be placed in such a manner as to prevent damage to the tank. (16) Clean. Septic tanks should be inspected and cleaned at least annually (17) Ground Water. The invert elevation of the septic tank outlet shall be aTt one foot above the maximum ground water elevation. (18)".Pumpin to Septic Tank:"•Pumping_:of sewage to-a—septic tazikw . shall not be owed wi out the written_approval. of.the Department of / Environmental Quality Enginerrinq 15.07: Dosing Tanks (1) General. A dosing tank shall be provided for Leaching Chamber andEa—c=g Field s73tems when the volume of waste to be disposed of is in excess of 2000 gallons per day. (2) Alternation. Dosing shall alternate when the total volume of waste to be disposed of exceeds 1.000 gallons per day. Alternating siphons and pumps shall discharge to separate disposal areas of equal size. AM (3) Caoacit7. Dosing tanks shall have capacity to discharge a volume adequate to cover the dosed leaching area to a depth of at least 1 inch, in not over 15 minutes. .._ • (4) Construction: Dosing tanks shall be constructed of concrete or other material—as approved by the Department of Environmenw Quality Engineering and conform with 310 CMR 15.06(7) and shall be cast without Joints and watertight if installed below ground water level. (5) Base. Dosing tanks shall be constructed on a level stable base that knot settle. (6) Ventilation. Dosing tanks shall be constructed in a manner that +I will permit venting through the building sewer or other suitable outlet. 1 (7) Ground Water. The invert elevation of the inlet shall be at least • 1 foot azsove maxunum ground water elevation and the tank shall be waterproof and watertight. . i (8) Manholes. To provide access and to facilitate repair or adjust- menr of the siphons or pumps, dosing tanks should be provided with manholes at least 24 inches in diameter with metal frames and covers to grade over each pump or siphon. i (9) Inspections. Annual inspections are recommended to determine if the pumps or siphons are in working order. 15.08• Stohons (1) Construction. Siphons shall be constructed of cast-iron or other material approved by the Department of Environmental Quality Engin- eering and shall be installed in strict conformance with the manufac- turers specifications. 15.09: Pumas a (1) Location. Pumps shall not be installed prior to a septic tank without Lhe approval of the Deparunent of Environmental Quality Engi- > '-"UBLIC SCHOOLS TEL No . 508-358-7728-----201 Aug 13 ,91 11 :49 No .005 P .02 er, c6-D&M111i91?uwa1,(W,- 14-A&jxc-luejetlu i� �� �xe�'u�'ue � rca o �itui�atnten�a:°� airy t+ � ��a�lmanl o��ntrt�onmealal�iia�l� r�n�tneevcn�c .,�.,. �:_,. Thornas C. McMahon rcirrsiasa o� i�are�� �"ollrlia�t Tp�rttr[�l `~ ws s*li- V488t, awon, ..Kahl. 0,!!08 TITLE 5 POLICY MEMORANDUM 87-6 TO: Boards of Health SUBJECT: Sewage Pumping to Deputy Regional Engineers Septic Tank Program Managers "^ 01 FROM: Mark K. Pare, P.E. ' Chief, Ground Water Regulation Section The Department may consider a proposal for the use of a pump to discharge sanitary sewage to a septic tank provided that only a small portion of the total sewage flow to the septic tank is pumped _and_ that the pump used for such pumping is of a low volume capacity. Written approval of the Department is required (310 CMR 15.06(18)). �� MKP/RJW/wp r FOI(H U TOWN OF NORTH ANDOVER LUT RELEASE FUIU-1 SUBDIVISION �4G(.I ASSESSORS MAP SUBDIVISION LOT(S) PERMANENT ADDRESS ASSIG ED BY D. P.W. STREETLJCL Ol'FE� S APPLICANT M A. 1'IIONE DATE OF APPLICATION i 3 Y TOWN USE BELOW '1111S LINE PLANNING BOARD DATE, AI'1'HOVI:D TOWN PLANNER DATE !(EJECTED CONSERVATION COMMISSION eit DArE APHIUVI"D 2 13 CONSERVATION ADMIN. DATE REJECTED BOARD OF HEALTH DATE AI'I'ROVED Z3 pl HEALTH i ' 1 DA f E RI:J ECTED I DEPARTMENT OF PUBLIC WORKS DRIVEWAY PER11IT SEWER/WATER CONNECTIONS FIRE DEPT. RECEIVED BY BUILDING INSPECTION DATE _ This form shall be signed by the agents of the 1'131,11111!; anal Ilealth 11c,arcis, the Conservation Commission prior to the i!;suance of any bul.l�lln;; permlts for the subject lot. This form shallnot releive the applicant from the compliance of any applicable Town requirement or Bylaw. Steps You. Can Take T® ]prevent West Nile � Virus Encephahtls &A'-e6-4 f-7e . 4 � 9 fsl --] . -1 1 Massachusetts Department of Public Wealth, 305 South Street, Jamaica Plain, MA02130 How can I protect myself and my family from mosquito bites? There is no vaccine for West Nile virus(WNV). The only way to protect yourself is to keep mosquitoes from biting you. Follow these steps every summer if you live in or visit an area with mosquitoes: • Avoid outdoor activities between dusk and dawn,if possible, since this is the time when mosquitoes are most active. • if you must be outdoors when mosquitoes are active,wear a long-sleeved shirt and long pants. s Use a mosquito repellent that contains DEET(the chemical N N-diethyl-meta-toluamide) and follow the directions on the label. DEET can be toxic if overused. Never use DEET on infants. Avoid using repellents with DEET concentrations above 10-15%for children and with concentrations above 30-35%for adults. Cream,lotion or stick formulas are best. Avoid products with high amounts of alcohol. • Most mosquito repellents will remain effective for many hours,so it is not necessary to reapply the repellent. Once inside,wash off insect repellents thoroughly with soap and water. • Take special care to cover up the arms and legs of children playing outdoors. When you bring a baby outdoors, cover the baby's carriage or playpen with mosquito netting. • Fix any holes in your screens and make sure they are tightly attached to all your doors and windows How can I reduce the number of mosquitoes around my home and neighborhood? To reduce mosquito populations around your home and neighborhood, get rid of any standing water that is available for mosquito breeding. Mosquitoes will breed in any puddle or standing water that lasts for more than four days. Here are some simple steps you can take: • Dispose of or regularly empty any metal cans,plastic containers,ceramic pots,and other water-holding containers(including trash cans)on your property. • Pay special attention to discarded tires that may have collected on your property. Tires are a common place for mosquitoes to breed. • Drill holes in the bottom of recycling containers that are left outdoors,to let water drain out. • Clean clogged roof gutters;remove leaves and debris that may prevent drainage of rainwater. e Turn over plastic wading pools and wheelbarrows when not in use. • ' Do not allow water to stagnate in birdbaths;aerate ornamental ponds or stock them with fish, •. Keep swimming pools clean and properly chlorinated; remove standing water from pool covers. • Use landscaping to eliminate standing water that collects on your property. I, April 2000 I � � � _ �o���'�- 2!� ' � s � � � � �� � s � 2 '! _� � � v' � � � � Address 1 6�j aL& a—w �c R; � Title of File Page of Date File Open: Date file closed: Doc Document/Action Title Date of Refer to other Purpose of Document/ 'on and notes action Document/ document/ Num. Action Department Board of Appeals — Board of Health — Planning Board — Conservation Commission — Building Department LpGv7'i4V zS Giro S G, I = o.5-73 9 g � t1- \ N _ zo lf.-7&� 2 uT c Ex�sri cis '�ou,y0q 7ipN d 04.01 oat r eoo. 5.4 !j -'s 44.37' S,3• S c AJ191-1,5171 S •NEREeY re 7//-Y 7,7 TyE T/TLE/.t/SU.�D.�q,VO R1. or RL Apt/ 7V rMe 4ff4N.('TWAT TWE OwELutfi /S CACATEG O.1/ T//E eor.fS.S.6t wv. ,vp TiWT/T OAFS L0.1/FAC1! AV A,lr* TINE TOwN of NOzE6i/l-4newS ,r / . Wd"-00/Ms f LOT [IVES.11 1le-or;WMe CE.PT/.e T T.�'/,S GW2�LL/N6 /SiVOT / cncorEo /N TWE aoo .s%vz.��o ,e,PE.a. O.PA/1�iV fO,P StJew�!10/v 1114"✓e JTEP.y `. 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PLAN OF SUBSURFACE DISPOSAL SYSTEM U)CIATED IN nn dd r Qf a AS PREPARED FOR �11 H- Aet E R7DC-CHE:Ze- RomaQATE: a� ¢� Av..4uzr 1 qa1 SCALE: r'` 40 WZE _ MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS 66 PARK STREET o ANOOVE& MASSACHUSETTS 01810 TEL (din 475.3US. 3MSM,. R?' OVER MASSACHUSETTS �;.ILFP.hoi pr1/''bl'i!'V,q,�,:� I,t• "I�.lC�, �.r:: 4o*,,.,.`�,r RECEIVED � ovld0 014 loan r71 eo y tocol Board o! Io the 10cal8o8rc r! n OjIIn 0, clnal pal „c JAN�Ib"8 2009 A. FacIIIty Inf07—t0 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT -'�•? '•"'011.ldi �"^161! (�tt' /A lM gym nim �'.. , r•� .o •�' tiddr►�v (114Vferl►nl r ," om'buVen 0� 'Pumping Req'ord Oa(o of pumping' ? r)'.ar. •�. 3. Type of eyslam:..' C699p001 y I$6pLC Tangy !� , im T8-4 Ocher (describe 1� Emuonl tea Fl►lo(,P(q)onr? C Yo9 Q No �l . 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