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HomeMy WebLinkAboutMiscellaneous - 1510 SALEM STREET 4/30/2018 1510 SALEM STREET 210/106.A-0028-0000.0 - I TOWN OF SYSTEM PUMPING RECORD RECEIVED i DATE: NOV f8 2005 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT SYSTEM OWNER& ADDRESS SYSTEM LOCATION (example:left front of house) C J DATE OF PUMPING: ✓` QUANTITY PUMPED : G <��GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER(EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: G.L.S.D Lowell Waste Commonwealth of Massachusetts City/Town of `I System Pumping Record a` ° IVED Form 4 j NOV 14 2007 DEP has provided this form for use by local Boards of Health. Other orms may be used, but the information must be substantially theeres.that providedRIME ore using this form,check with your local Board of Health to determine the fo _ mping Record must be submitted to the local Board of Health or other approving authority. I A. Facility Information Important: When filling out 1. System cation: forms on the computer, use u�'�r� l��Gr( Y 1 only the tab key Address to move your cursor-do not I—,1 �'=`'�'^^ use the return Cdyrroam State Zip Code key. 2. System Owner: "ISI T(Ci�Cc� � lCt Name Address(if different from location) City/Town State Zip Code Telephoneet umber i B. Pumping Record 1. Date of PumpingDate�1 ^ 2. Quantity Pumped: Gallons' Secy 3. Type of system: ❑ Cesspool(s) 2 Septic Tank ❑ Tight Tank ❑ Other(describe): _ 4. Effluent Tee Filter present? [:1 Yes LTJ No If yes,was it cleaned? ❑ Yes E3No 5. Condition of System: 6. System P ped By: Name Vehicle License Number jf!SaA Company II 7. Location where contents were disposed: ied Signature of H uler Date t5form4.doc^06/03 System Pumping Record•Page 1 of 1 d PETER F. REILLY 136 ANDOVER STREET ANDOVER, MA 01810 (978) 375-3750 TITLE V OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART A - CERTIFICATION Property Address: 1510 Salem Street, North Andover, MA 01845 Name of Owner: Brian Otis Address of Owner: same Name of Inspector: Peter F. Reilly Company Name: same Mailing Address: 136 Andover Street, Andover, MA 01810 Telephone Number: (978) 375-3750 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) The system: ✓ Passes N/A Conditionally Passes N/A Needs Further Evaluation By the Local Approving Authority N/A Fails Inspector's Signature: Date: May 26, 2001 Peter P. Rei The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the 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 a the time of inspection and under 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 (See attached Disclaimer). ^^!r �qr u p to tV•tll�©Fltli.�'IIl Al`i1'aii•.t_.:;/, BQARD CSaF H.6A„i.T JUN 112001 r OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART A - CERTIFICATION (continued) Property Address: 1510 Salem Street, North Andover, MA Owner's Name: Otis Date o p f Inspection: 5/26/01 INSPECTION SUMMARY: A. SYSTEM PASSES: Check A, B, C, D, or E /ALWAYS complete all of Section D i ✓ I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: The system met the Pass Criteria of Title V. B. SYSTEM CONDITIONALLY PASSES: N/A One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no, or not determined (Y, N, ND). Describe basis of determination in all instances. If "not determined", explain why not) N The septic tank is metal, and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. *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 a sewage backup or breakout or high static water level in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if (with approval of the Board of Health): N/A broken pipe(s) are replaced N/A obstruction is removed N/A distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): N/A brokeni e(s) are replaced pp p N/A obstruction is removed c r OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART A - CERTIFICATION (continued) Property Address: 1510 Salem Street, North Andover, MA Owner's Name: Otis Date of Inspection: 5/26/01 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.3030)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: N/A Cesspool of privy is within 50 feet of a surface water N/A Cesspool or privy is within 50 feet of a bordering vegetated wetland or 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: N/A The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. N/A The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply well. N/A The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. N/A The system has a septic tank and SAS the SAS is less than 100 feet but 50 feet or more from a private water supply well.**Method used to determine distance N/A This system passes if the water well water analysis, performed at a certified DEP 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. A copy of the analysis must be attached to this form. 3. Other N/A c OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART A - CERTIFICATION (continued) Property Address: 1510 Salem Street, North Andover, MA Owner's Name: Otis Date of Inspection: 5/26/01 D. System Failure Criteria applicable to all systems: You must indicate "Yes" or "No" to each of the following for a//inspections: Yes No No Backup of sewage into facility or system component due to an 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. N/A Liquid depth in cesspool less than 6" below invert or available volume <Y: 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: once No Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. N/A Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. N/A Any portion of a cesspool or privy is within a Zone I of a private water supply well. N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well. N/A 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 laboratory,for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen is less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form). N/A The system fails. I have determined that one or more of the above failure criteria exist as defined in 310 CMR 15.303,therefore the system fails. The property owner should contact the Board of Health should be contacted 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 a large system in addition to the criteria above) N/A The design flow of system is 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No N/A The system is within 400 feet of a surface drinking water supply N/A The system is within 200 feet of a tributary to a surface drinking water supply N/A The system is located in a nitrogen sensitive area (Interim Wellhead 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 such 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. f OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART B - CHECKLIST Property Address: 1510 Salem Street, North Andover, MA Owner's Name: Otis Date of Inspection: 5/26/01 Check if the following have been done. You must indicate either "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 flow in the previous two week period ? No Have large volumes of water been introduced to the system recently or as part of this inspection ? N/A Were as built plans of the system obtained and examined ? (If they were available note as N/A) Yes Was the facility or dwelling was inspected for signs of sewage backup ? Yes Was the site was inspected for signs of breakout ? Yes Were all system components, excluding the SAS, have been located on the site ? Yes Were the septic tank manholes uncovered, opened and the interior of the septic tank inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum ? Yes Was the facility owner (and occupants of if different from the owner) provided information on the proper maintenance of subsurface sewerage disposal systems ? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: P Y Yes No Yes Existing information. For example, a plan at the Board of Health. N/A Determined in the field if any of the failure criteria related to Part C is at issue (approximation of distance is unacceptable) [1 5.302(3)(b)]. OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART C - SYSTEM INFORMATION Property Address: 1510 Salem Street, North Andover, MA Owner's Name: Otis Date of Inspection: 5/26/01 FLOW CONDITIONS RESIDENTIAL: Number of bedrooms (design): UNK Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms: LINK Number of Current residents: 2 Does the residence have a garbage grinder (yes or no): no Is the laundry on a separate sewerage system (yes or no): no (if yes, separate inspection required) Laundry system inspected (yes or no): N/A Seasonal use (yes or no): no Water meter readings, if available (last 2 years usage [gpol): about 100 gpd Sump Pump (yes or no): yes Last date of occupancy: current COMMERCIAL/INDUSTRIAL: Type of Establishment: N/A Design Flow gpd (based on 15.203): N/A Basis of Design Flow (seats/persons/sq.ft., etc): N/A Grease trap present (yes or no): N/A Industrial waste holding tank present (yes or no): N/A Non-sanitary waste discharged to the Title 5 system (yes or no): N/A Water meter readings, if available: N/A Last date of occupancy/use: N/A OTHER: (Describe) N/A GENERAL INFORMATION PUMPING RECORDS Source of Information: owner- about 4 years Was system pumped as part of inspection (yes or no): no if yes, volume pumped (gallons): N/A How was quantity pumped determined ? N/A Reason for pumping: N/A TYPE OF SYSTEM ✓ Septic tank/distribution box, soil absorption system Single cesspool Overflow cesspool Privy NO Shared system (yes or no) (if yes, attach previous inspection records, if any) Innovative /Alternative technology. Attach a co of the current operation and maintenance contract 9Y PY P (to be obtained from the 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: Original system - about 17 years. Were sewerage odors detected when arriving at the site (yes of no): no OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART C - SYSTEM INFORMATION (continued) Property Address: 1510 Salem Street, North Andover, MA Owner's Name: Otis Date of Inspection: 5/26/01 BUILDING SEWER: (locate on site plan) Depth below grade: about 24" Materials of construction: cast iron ✓ 40 PVC other (explain) Distance from private water supply well or suction line N/A Diameter: 4" Comments: Condition of joints, venting, evidence of leakage, etc.) Building sewer was watertight and appeared sound at foundation. SEPTIC TANK: ✓ (locate on site plan) Depth below grade: about 16" - 18" Material of construction: ✓ concrete metal Fiberglass Polyethylene other (explain) If tank is metal, list age N/A Is age confirmed by Certificate of Compliance N/A (Yes/No) Dimensions: rectangular - 1,500 gallons Sludge depth: 1"-2" Distance from top of sludge to bottom of outlet tee or baffle: 28" Scum thickness: 1"-2" Distance from top of scum to top of outlet tee or baffle: 7" Distance from bottom of scum to bottom of outlet tee or baffle: 16" How dimensions were determined: observation / estimation Comments: (on pumping recommendations, of inlet and outlet tees or baffle condition, structural.integrity, liquid level as related to outlet invert, evidence of leakage, etc.) Tank was watertight and appeared to be functioning properly. Tank was pumped following inspection. Outlet baffle was replaced following inspection. GREASE TRAP: N/A (locate on site plan) Depth below grade: material of construction: concrete metal FRP other (explain) Dimensions: N/A Scum thickness: N/A Distance from top of scum to top of outlet tee or baffle: N/A Distance from bottom of scum to bottom of outlet tee or baffle: N/A Date of Last Pumping: N/A Comments: (on pumping recommendations, of inlet and outlet tees or baffle condition, structural integrity, liquid level as related to outlet invert, evidence of leakage, etc.) N/A OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART C - SYSTEM INFORMATION (continued) Property Address: 1510 Salem Street, North Andover, MA Owner's Name: Otis Date of Inspection: 5/26/01 TIGHT or HOLDING TANK: N/A (tank must be pumped at time of inspection) (locate on site plan) Depth below grade: N/A material of construction: concrete metal Fiberglass Polyethylene other (explain) Dimensions: N/A Capacity: N/A gallons Design Flow: N/A gallons per day Alarm Present (yes or no): N/A Alarm level: N/A Alarm in working order (yes or no): N/A Date of last pumping: N/A Comments: (condition of alarm and float switches, etc.) N/A DISTRIBUTION BOX: ✓ (locate on site plan) 0" depth of liquid above outlet invert Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, recommendation for repairs, etc.) D-box was level. Three leaching trenches were accepting effluent. No evidence of solids carryover. PUMP CHAMBER: N/A (locate on site plan) Pumps in working order (yes or no) N/A Alarms in working order (yes or no) N/A Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) N/A OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART C - SYSTEM INFORMATION (continued) Property Address: 1510 Salem Street, North Andover, MA Owner's Name: Otis Date of Inspection: 5/26/01 SOIL ABSORPTION SYSTEM (SAS): ✓ (locate on site plan, if possible; excavation not required) If SAS not located, explain why: N/A Type leaching pits, number N/A leaching chambers and number N/A leaching galleries and number N/A ✓ leaching trenches, number, length 3 trenches 50 feet long each per Design Plan leaching fields, number, dimensions N/A overflow cesspool, number N/A alternative system (name of technology) N/A Comments: (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.) Soils in area of SAS looked good, no evidence of ponding, damp soil, or breakout. CESSPOOLS: N/A (locate on site plan) Number and configuration N/A Depth-top of liquid to inlet invert N/A Depth of solids layer N/A Depth of scum layer N/A Dimensions of cesspool N/A Materials of construction N/A Indication of groundwater inflow (cesspool must be pumped as part of inspection) N/A Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs, etc.) not applicable PRIVY: N/A (locate on site plan) Materials of construction N/A Dimensions N/A Depth of solids N/A Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs, etc.) not applicable OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART C - SYSTEM INFORMATION (continued) Property Address: 1510 Salem Street, North Andover, MA Owner's Name: Otis Date of Inspection: 5/26/01 SKETCH OF SEWAGE DISPOSAL SYSTEM: Provide a sketch of the sewerage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100'. Locate where public water supply enters the building. fiff w Sv c Ae-a e }�ou se- J 0 Isov,941 f� g �eC 1G:i i G �I $ePtrc�-aelc REAR YRRD I bob 5RS 3 tr.cnttS SEPTIC TANK TIES: A to Inlet (1) 33'0" B to Inlet 42'0" A to Center (C) 36'6" B to Center 43'0" A to Outlet (0) 40'4" B to Outlet 43'6" D-BOX TIES: A to Box 123'6" B to Box 87'0" NOTE: The system is in the rear yard. OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART C - SYSTEM INFORMATION (continued) Property Address: 1510 Salem Street, North Andover, MA Owner's Name: Otis Date of Inspection: 5/26/01 SITE EXAM Slope mostly flat in area of system wetland area well beyond system to side and rear Surface water none observed Check cellar dry Shallow wells none observed Estimated Depth to Groundwater > 1 " (below bottom of SAS) Please indicate (check) all methods used to determine the high ground water elevation: Y Obtained from Design Plans on record - if checked, date of design plan reviewed: 1985 Y Observed site (abutting property, observation hole within 150 feet of SAS) N Check with Local Board of Health - explain: Y Check local excavators, installers - (attach documentation) N Accessed USGS Database - explain: 10/31/00 / Wilmington well / moderate depth I You must describe how you established the high ground water elevation.* No groundwater per 1985 design plan. Substantial grade drop in rear yard behind system. Grade changes and soil conditions indicate no groundwater in the SAS. However, this cannot be determined for certain without a soil evaluation test. *Inspector's Note: Soil Evaluation is the currently recognized method for determining or establishing the high groundwater elevation. Since I am not a licensed or certified soil evaluator, I am not qualified to determine or establish the high groundwater elevation beyond the public information available, such as recent design plans of the site or the nearby area. My estimation of the high groundwater elevation is based on a due diligence effort to obtain all available information both on and off the site and my experience as a certified subsurface disposal system inspector. (see attached Disclaimer) dr I DISCLAIMER This passing septic inspection under Massachusetts Title V is in no way a guaranty or warranty of the inspected septic system. The inspection is a "snapshot in time" and does not constitute a complete assessment of the quality or potential longevity of the septic system. The pass/fail criteria are specific and outlined in detail in this report. Under the limited criteria of a Title V inspection, it is impossible to determine how long any septic system will last. The inspector made a diligent effort to certify the septic system based on the criteria required under Title V. Under Massachusetts Title V, soil evaluation is the accepted method of determining the high groundwater elevation. This inspector is not a certified soil evaluator and is therefore not qualified under Title V to determine or establish the high groundwater elevation. The method used to estimate the high groundwater for this inspection was based on the public records and methods of observation described on the previous page. Groundwater levels can vary greatly from season to season, year to year and soil evaluation is considered the most reliable method of groundwater determination under Title V. Peter F. R illy Inspector May 26, 2001 TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: SYSTEM OWNER &ADDRESS SYSTEM LOCATION D� (example: left front of house) DATE OF PUMPING:_ QUANTITY PUMPED GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: :-, COMMENTS: r CONTENTS TRANSFERRED TO: �, �' �oard of Health SEPTIC STSTEK North Andover-IM"5. INSTA'_.I.ATI(X4 CHECK LZ 3T LOT •J�.���' OVE DATg DISUPHOVED X AVA2'IC12I OK FAIL 44 - — – ea�nst 23 &n AD OO LT S FAIL bK 1. Distance Tot a. Wetlands b. Drains c.. Well 2. Water Line Location 3. No PVC Pipe Septic Tank a. ..Tess --Length & To Clean Ont Covers. b. Cement Pipe .to Tank On Both Sides of Tank 5. Distribution Box a. Covers.& Box - No Cracks b. All Lines Flowing Equal Amounts C. No Back Flow 6. Leach Field or Trench a. Dimensions b. Stone Depth c. Capped Ends d. Clean Double Washed Stone 7. Leach Pits a. Dimensions b. Stone Depth c. Splash Pads d. Tees e. Cement Pipe to Pit - Both Sides ------- f. Clean Double Washed Stone 8. No Garbage Disposal 9. Final Grading Inspection 10. Barricading Covered System 11. As Built Submitted - a. Lot Location b. Dimensions of System c. Location with Regard-to Perc Test d. Elevations e: Water Table Board of Health --------- _ � 11 /NorV',.,in&-ver,Mass SUBSURFACE DISPOSAL DESIGN CHECK LIST LOT f-13 �S _4:P� APPROVED DATE (2 2-Ftl DISAPPROPID DATE_ Provided: Reasons: Title V FAIL 09 Reg 2.5 The submitted plan must -show as a minimuM: a) the lot to be served-area,diiensions lot #,abutters b location and log deep observation hoes-distance to ties c location and results percolation tests-distance to ties d design calculations & calculations showing required leaching area (e) location and dimensions of system-including reserve area f) existing and proposed contours (�) location any wet areas-,-Athin 100' ofsewage disposal system or ---- disclaimer-check wetlands mapping_._ (h) surface and subsurface drains within 100' of sewage disposal system or .disclaimer (i) location any drainage easements withiti� 1001 of sewage disposal system ordisclaimer-Planning Board files (3) known sou.rtof water supply'Vithin 200' of•sewage disposal a system or disclainer (k) location of any proposed .well to serve lot-1001 from leaching facilit; (1)., location:of water lines on property-101 from leaching facility (m) location of benchmark (n) driveways' (o) garbage disposaY (p) no PVC to .be used in construction (q) profile of systdm-elevations' of basement, plumb, pipe, septic tank, distribution box inlets and ,putlets, distribution field piping and Other elevations (r) maximam ground water .elevation in area sewage disposal system (s) plan mast ,be .prepared by 'a Professional Engineer or other professional authorized by law to prepare such plans Reg 6 Septic Tanks (a) capacities-150,% of flow, water table, tees, depth of tees, access, pumping (b) cleanout _ __ --Vic.)_ 10' from cellar wall or inground swimming pool (d) 251 from subsurface drains Reg 10.2 Distribution Boxes (a) slope greater than 0.08 Reg 10.4 (b) sump SOIL PROFILE & PERCOLATION TEST DATA _ Jt?— Lot,No North Andover, Mass. Street No ��(�itit Tt / ` Lpc/Subdiv. Pland Owner �`i��y Investigator- _,�W7 , � Observer SOIL PROFILE DATES l:�lev 2.Elev 3.Elev �F.Elev 0 r r7 0 7J 1 1 1 1 �—.— Ties to Test Pits 2 2 2 2 tyD V 3 3 3 3 5 5 5 -/ 5 - A I ,v . P 6 6 6 --:1-I�- 6 8 8 8 8 9 9, 9 9 10, 10 10 _ 10 Bencrunark - Location Elevation Datum _ - - PFRCOTATION TESTS DATES — Pit Number Start Saturation Soak--Minutes eta—t l e"stt--' ne___ — Drop of 3"-Tune Drme M6!^ls.�_st 3" drop Mins.2nd J" :rop___ _ WA�� G� ilz 4L4 s' rip l�� 1)r ohn engineers aIIaha, n s s o c i a t e s surveyors 166 No. Mai n St r I I t AndovIr, Massachusetts -. 01810 / 617 475 .0606 planners DEEP WATER, Test Boring Report. TO John T. Dolan "r.1U 5/14/84 ,lob No .83-18 ' 1514 Salem t. No. Andover MA Fc.11 (, _ ft . l itllrc in J. i,.;llt l.l;.111d colrlllnl indical riumher of blows required to drive i nCll :;,-.fill,-1. if,", .;prod 1 Crin t , is i ;1,T -l.b. weight failing ' O iTlchc :; . Open pit excavations(,via a backhoe) wer used. i T �1'I1�'G T-6 P01,J';G ;' DORTNG # Ll ( V . 0 L1 c Elev. dark loam & subsoil -- -- - - --- 12' fine sandy clay W/ gravel pockets & embed- ded stones' - - - - - --- - 66' gravelly silty clay & stones, tight *High water table @ 4.0' i } RL14ARK S : !.;:, to 1 ON-e I indict t ed "Ire oh z(: .rved ;) t l hc, CoIIII)letion of each bCll'lili; f ; ncl lin Tlof `C ( .;::iT" i lj.. rcj l' `b;r'Jlt pt,tII1,-Ilel)t � rot-iiid wate.r , level.s . t 4i11.:: JO-1/0 � i �ec..vnJ .Su45� 1 5�0� f p�(I, A- 100c:'i.''c--T l'I;Rr_()l_,V1'1C?N1_ 'I_l'_S"i_ R1_Sifi TS 1111 I.ol. Nu . �� o"O, Lnkon try ; - - -- Trnrisi im,cn Town ivG /?.l��C'v _-_� ltoclniarr --- Date or 'fest : Z " Wi tli this form si.rt>m.i. t :r topot;r..iplry of t.lrc ni na s}how.i ng the major changes in ccnto>>rs . Locate exisf.inf; draircr.rr c systems incl.i.rdi-ng brooks and water Iinr,s rrnct water service to Iiom(, , 1)riv,rte wells watlri_n 150 feet of' }rouse , otlie.r leaching wrens in f.he vicinity . Be sure to get a sill elevation and cellar floor , as well as a location and elevation of top of each test I So/C CLAs51Fic,97-10lV Tl,-ST ling;\ rp hoIc �E v.= I l�.-- �> I I 1 1 t cc :,I:., I ch :;Icow I nr;. 1 Ic I �I:Irr.Ny ��. .V , of' c:+cli Dryer w.i.tl, description of F soi- l. in eaclr layer use correct ter•rns ) -- i f yorl cnrrno t Classify d F soil. , bring a good sample back to r /2 Min. i office . K Ilot. torn el evat. i.on = 1dnt;er table elevation `I3c� Leclgc� e 1 evzr t:i on = Ito i t om te,a t_-observe f, c on bol-c• P1,.I?C01,AT I ()ar lt1•;F111,,T5 Tftn(� of percolation pi t; satur it.i.on I j minutes Time For 12"-()" drop in water level 7-0 mi.n u t e s Time for 9" -0" drop in water Level `1 5 minutes if 1 ?" -cl" or �" _(," drop recliifres mora tlian 30 mill . read ins tract. i oris for further tes O P1?RCOLATTON PATE E = t ime for c)" -(," drolr I j nii.n/i.nch I cerl. i fv tlrn f 1.11i s tes t; lies heerirform(,d ;wcor•d i ng to t;he standards of thc- *Massachusetts lic: rrrrt.ment. of' Public 1 c 1 u .�.l is lloa]. f.h and the result-9 are accurate to the bust of my knowledge . Subordinate to Registered Eiic inee.r Registered Engineer Chief of Party : �P��ii0F ss cL- (Q _ T)rrtc Date A LAHAN U h 0 2161 � 101iN CAI ' ',:irnv ASSM'1 �r , 0 o. 2 Pro Foss i ()ri:, 1 i nr, i c,r,,,c• : _ :,cr.�,,,�.�r : I„ir Oc�YGrSTE 10() 'or•Ih INIrrin Street �SONAL Andover , 1`lass . AMDO01= lZ- PERM-) ,ATION TEST lil`_SMITS -ca Z • l..ot No . � _ 'I'r.5t; t�ll.en by 15� Chief : S B�R/`I�IS e. ctreI. 5�� _EM -- i ---- - Trrinsi trnan _ Town0 U L Rodill;111 u Date of Test : With this form silbmit a topogrs>phy of the area showing the major changes in ccntours . locate exist:i.nf; drvinrige systems incll.lding brooks and water lines and water service to home , private wells within. 150 feet of }rouse , other leaching areas in the vicinity . Be sure to get a sil-1 elevation and cellar floor,, as well a.s a location and elevation of top of each test SOIL CLAS51FICATIOAI TEST 1 un 1 A TphC/C EQV.= ,C, l' il l irl slt(, fc:)r sliowlnr• 1.111cl<noH4 of' each layer wi.tl, description of so.i. l. iii each layer (use correct terills You crifill ot classify b Fsoi. .l. , bringa good sample back to /2 Min. grnpi i 1 n < � o.ff.ice . flot f orn elevation = Wn i;er tab.l e el evati.ott = 3�% = t7 1,cdf;o elevation = _ 1lotAom test--observation ho1.c l'l,'P :Ol,AT I ON RES111,TS Time of percolation pit. s;it.urati.on IS minutes Time for 12" Q drop :ill water leve] 10 minutes Time for 9"-61, drop in water level ZC minutes ( if 12"-Q" or 9"-6)" drop r"e(lllires more than 30 ruin . read inst.rllct: ions for f'urtlrer test ) PERCOLATTON PATE' = time for 9"-6" drop -J min/i.nch I cerci fy thnt. this test; bns been J)0T•fornled acC.ordi11 ,to t,llc: standards of . the Massachusetts Department; of Pub 1 l c lleal th and the resul. is are accurate to the best of my knowl.edf;e . Subordinate to Registered linjrineer Regis ;ng.i.nee.r P�ZH OF Mq Chief of Party : Jo cyG 11I CSC h, c / D.r tc- I �N o./! slz A J01IN CA '.IT )O('. GIST. Q l nN ns� T� �F �r r•. rr�-r �•nt-..--1,;i l ss ►�A• E r IhrNor-t:h Nrt.in Street AIId0V0T• , N<1s,s } CERTIFIED FOUNDATION PLAN } LOCATED IN , a• SCALE.%"- �' DATE u� t3 eA- � S,L.G/LES R.L.S. ° L AWRENCE Q. NORTH ANDOVk t { a t „ i Pi r, r $ 5 Aft + i ■. .!" Lem T In s. ., t - g *`{ , s 41 NA X - d O '• - �' - �IG f115 L7tJlt,.'� � n S$ a q / C4-RT/FY THAT TH OFFSETS SHOWN ARE FOR THE USE OF �4�� r •,tike,..._� { M OFFSE TS SHOWN THE BUIL DING INSPECTOR ONL Y, a SUCH CONFORM TO THE USE IS FOR DETERM/NA/ION OFZON/NG N ' yrs y : "o A: r ZONING B Y L AW OF CONFORM/T Y OR NON CONFORM/TY tl1aR.-rM WHEN TAKEN. u1 1f FORN4 4 - SYSTEM PUNIPL\G RECORD e n 0 rOW OF Of HEAD HVER� Commonwealth of Massachusetts Massachusetts APR 19 System Pumping Record System Owner System Location r Date of Pumping: Quantity Pumped: /_�gallons Cesspool: No Yes ❑ Septic Tank: No ❑ Yes System Pumped by: _ License #: Contents transferred to: 62, Date Inspector 1 • 1 LiilulUn11111N1111 bt Alasrdr1111s�11i1 ,�=OFN'-',R � WTH ANDOVi R/ F HEALTH 1 ' JUL. ` 1996 J l i ll'n • �f�lalmvunur j � � 1 i o 1 ` ��.;( X11 1 i 1 �i1d11111�1 IIu1Hli1e11 i ' r U�le uP 11011111111 rX' 1'r1 �...� fir11111� '1•diii 1 �ir1 � 1 . 1�ts � � r t ��.1 i. �•�sgluull h�1 1�. ;, i r , r ' lulu uJ 1►rt r , , � � , 1 st•skul 1 I r: � , �i h 1 Cunlrllls.11a1isleitell 1�1f � , 1 5 Ime , y 1 , , 1 1 / 1 i 1 1 n . , 1 1 t A E ,+ TOWN OF II , 4-LIAojer SYSTEM PUMPING RECORD -= - DATE• 5 `� 3 2 g 2003 SYSTEM OWNER & ADDRESS SYSTEM LOCATIONFCMCO A (example:left front of house) 0a Noose DATE OF PUMPING: '" " 3 QUANTITY PUMPED : O O GALLONS CESSPOOL: NO_ YES SEPTIC TANK: NO YES_ NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER(EXPLAIN) Bateson Enterprises, Inc. SYSTEM PUMPED BY: Ba � P COMMENTS: D TO: V L. CONTENTS TRANSFERRE Commonwealth of Massachusetts City/Town of LRECEVEI System Pumping Record Form 4 2 6 2009 RTH NDOVER DEP has provided this form for use by local Boards of Health. Other � 1theinformation must be substantially the same as that provided here. Borm, check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. System Location: Left frontysft/f ear side of house. Right front, right rear, right Sid ouse. forms on the V computer,use only the tab key Address to move your. cursor-do not City/Town State Zip Code use the return key. 2. System Owner: Name Address(if different from location) City/Town State Zi Code Telephone Number B. Pumping Record 1. Date of Pumping2. QuantityPumped: s Date p Gallons 3. Type of system: 8 Cesspool(s) eptic Tank [j Tight Tank Other(describe): 4. Effluent Tee Filter present? 0 Yes M--4o If yes, was it cleaned? Yes No 5. Condition of System: 6. B System Pumped : Y P Y Nil _ e Bateson F 5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. L0 h,ge contents were disposed: S.D �• Lowell Waste Water igna ure of H u r Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1