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Miscellaneous - 165 BOSTON STREET 4/30/2018 (2)
! 165 BOSTON STREET 2101107.6-0047-0000.0 \ T A 50247-55166? C:AFFPE"I:, IL8-EPs:TN 0 21 96 17:25 Covenent in Renard to Septi; System t.F �cd J. ♦•' Oc,t'bei 3U" 1 ]� ► � -Y 3 t BUYERS/BQRRQWE : We,*l ric W. Lynch and Krista L. Lynch ADbRESS: 16'5 Boston St., North Andover, MA, 01845 We, the undersigned bL Yfft of property at 1.65 Boston Street, North Andove , Massachusetts, affim t iat We have been advised that the septic system to be installed on the property will have E capacity sufficient for a maximum of three bedroom We have been advised and we understand that the rules and regulations of thin Town of 4 , North Andover will not allow more than three bedrooms at this location unless more capacity is added to the;septic system or the area is serviced by town sewer. 'Ale also affirm that we have been advised and understand d-tiat it is the responsibility of the installer of the sept c system to provide a septic system conforming to Massachusetts Title V Regulations, th t the installer will provide for erosion control- and at final raking and seeding of e septic site shall be the responsibility of the buyers. I ! NOV 21 '96 AH9:56 I I his covenant may be rieleased by a vote of the North Andover BoaXd of Ile lth. Lric W. Lynch i - nista L. Lynch Witness to bath: +C0Im;NiA;LILTII OF MASSACHUSETTS Essex ; ss . I October 30; 1C96 Then persona IIY appeared the above-,lamed Eric 4V. I nc.;h and Krista. L. Lynch and acknowlk:dged the fore-going irist.�-unient L , tic the i r f re.e act and deed , befc_)re till Notary Pu')1 -c My CUIWTIi'j:-.iutl Exli : C'l�tt.�� r North Andover Board of Assessors Public Access Page 1 of 1 � A ' I NORTH North Andover Board of Assessors i f'r e', •eOp •i +x h' s"CM„se � roP er Record Card Click seal To Return Parcel ID:210/107.B-0047-0000.0 FY:2010 Community :North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlar e Search for Parcels Search for Sales Summary Residence „ Detached Structure Condo 165 BOSTON STREET Commercial Location: 165 BOSTON STREET Owner Name: LYNCH,ERIC W KRISTA L LYNCH Owner Address: 165 BOSTON STREET City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood:5-5 Land Area: 0.57 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 1268 soft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 297,800 304,800 Building Value: 106,300 119,000 Land Value: 191,500 185,800 Market Land Value: 191,500 Chapter Land Value: LATEST SALE Sale Price: 134,400 Sale Date: 10/30/1996 Arms Length Sale G-NO-PARTIAL Grantor: ARTHUR CHASE Code: Cert Doc: PROB Book: 04622 Page: 0182 89PO704EI http://csc-ma.us/PROPAPP/display.do?linkld=1519646&town=NandoverPubAcc 10/19/2010 Residential Property Record Card PARCEL ID:210/107.B-0047-0000.0 MAP:107.B BLOCK:0047 LOT:0000.0 PARCEL ADDRESS:165 BOSTON STREET FY:2010 PARCEL INFORMATION Use-Code: 101 Sale Price: 134,400 Book: 04622 Road Type: T Inspect Date: 06/17/2002 Tax Class: T Sale Date: 10/30/96 Page: 0182 Rd Condition: P Meas Date: 06/17/2002 Owner: Tot Fin Area: 1268 Sale Type: P Cert/Doc: PROB Traffic: M Entrance: X LYNCH, ERIC W 89P0704E1 KRISTA L LYNCH Tot Land Area: 0.57 Sale Valid: G Water: Collect Id: RRC Address: Grantor: ARTHUR CHASE Sewer: Inspect Reas: C } 165 BOSTON STREET NORTH ANDOVER MA 01845 Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LP/o Indust-B/L% / Open Sp-B/L% / RESIDENCE INFORMATION LAND INFORMATION Style: RN Tot Rooms: 5 Main Fn Area: 1268 Attic: NBHD CODE: 5 NBHD CLASS: 5 ZONE: R2 Story Height: 1.00 Bedrooms: 2 Up Fn Area: Bsmt Area: 960 Seg Type Code Method Sq-Ft Acres influ-Y/N Value Class Roof: G Full Baths: 1 Add Fn Area: Fn Bsmt Area: 1 P 101 S 25003 0.570 191,528 Ext Wall: FB Half Baths: Unfin Area: Bsmt Grade: VALUATION INFORMATION Masonry Trim: Ext Bath Fix: 0 Tot Fin Area: 1268 Current Total: 297,800 Bldg: 106,300 Land: 191,500 MktLnd: 191,500 Foundation: CN Bath Qual: T RCNLD: 106297 Kitch Qual: T Eff Yr Built: 1965 Mkt Adj: Prior Total: 304,800 Bldg: 119,000 Land: 185,800 MktLnd: 185,800 Heat Type: HW Ext Kitch: Year Built: 1953 Sound Value: Fuel Type: O Grade: A Cost Bldg: 106,300 Fireplace: 1 Bsmt Gar Cap: Condition: AG Aft Str Val1: Central AC: N Bsmt Gar SF: Pct Complete: Aft Str Va12: Aft Gar SF: %Good P/F/E/R: /100/100/74 Porch Upe Porch Area Porch Grade Factor ' P 48 SKETCH PHOTO 14 2 44 FM 308 Sq.F1 FM/B 22 20 960 Sq.R 24 4 14 4�Z.ft B — 32 I gigr. 165 BOSTON STREET Parcel ID:210/107.13-0047-0000.0 as of 10/19/10 Page 1 of 1 ✓. t i. Y ♦ Z ,, ,,, . i. .. S. : Y�. - � - '� .h'�� ,•. �`•I�}x. lrN. 'rV-off. MAP # PARCEL # STREET - . . • • �ONSTRUCTIO.N Vo) HAS PLAN REVIEW FEE .BEEN PAID? YES NO PLAN APPROVAL: DATE pp. BY DESIGNER: ("AG co PLAN Dn*rE. CONDITIONS WATER SURREY: TOWN ] WELL WELL PERMIT DRILLER WELL TESTS: - CHEMICAL DAIE APPROVED BACTERIA I`w� _ DA I E. (IF-NRUVEU BACTERIA II DAI"E—OPPROVEll - COMMENTS: FORM U APPROVAL: APPROVAL 1'0 ISSUE YES NO DATE ISSUED BY CONDITIONS: FINAL APPROVAL: . ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NO SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NU ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: BY: �,'_rft.'- - - - •:; :��_'� . . �E��G�SY�•C�M.._�.NSSfl4L,.8�.QN • ' 'THE' INSTALLER JLICENSED? OF- CONSTRUCTION: ? NEW REPAIR NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW YES NO CONDITIONS OF...APPROVAL `•: ' YES NO (FROM -F0 RM U) ISSUANCEOF DWC PERMIT + l YES NO DWC PERMIT N0. INSTALLER-, BEGIN INSPECTION YES NO: :EXCAVATION , INSPECTION: ; NEEDED: . .. ..-.,..ice.•. _ . PASSED .. ;' HY AAti .' .-CONSTRUCTION INSPECTIONS =; NEEDED: ' AS BUILT PLAN SATISFAGTOR APPROVAL TO BACKFILL: DATE: Z& BY �LL " ..FINAL . GRADING APPROVAL: DATE BY FINAL CONSTRUCTION APPROVAL: DATE: BY i 5 3 s , •O Town of North Andover `�'••;;;o:: HEALTH DEPARTMNT ,SSACMUSf� I/ CHECK#: �� DATE.-,! LOCATION: Ste/ H/O NAME: r CONTRACTOR NAME: I Type of Permit or License:(Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type. $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ �itle5 Spector $ eport $ ❑ Other:(Indicate) $ Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer Commonwealth of.Massachusetts Title 5 Official Inspection F a Subsurface Sewage Disposal System Form -Not for Volunta As�"s 165 Boston RdDEC 1 ' 2010 Property Address Eric Lynch TOWN QIP NORTH ANIaQVER Owner Owner's Name HEALTH WARTM information is required for North Andover Ma. 01845 12-11-10 every page. 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. Important: When filling out A. General Information forms on the computer,use 1. Inspector: only the tab key to move your N. Timothy White cursor-do not Name of Inspector use the return key. Homepro Northshore Company Name t�Q 75 Glen St. ( P.O. box 101) Company Address Rowley Ma. 01969 City/Town State Zip Code ( 978-948-8428) S12015 Telephone Number License Number B. Certification 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 ❑ Needs Further Evaluation by the Local Approving Authority 12-11-10 Inspector's Sign ture 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 s � t t r � .. __ ,. ,., t r i; Is Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 165 Boston Rd Property Address Eric Lynch Owner Owner's Name information is required for North Andover Ma. 01845 12-11-10 every page. City/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: ® 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): na t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 t , Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 165 Boston Rd Property Address Eric Lynch Owner Owner's Name information is required for North Andover Ma. 01845 12-11-10 every page. CityTrown 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): na ❑ 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): na 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: ❑ p or Cesspool privy is within 50 feet of a surface water p ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 1 , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 165 Boston Rd Property Address Eric Lynch Owner Owner's Name information is required for North Andover Ma. 01845 12-11-10 every page. 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 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 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: na 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 %day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 165 Boston Rd Property Address Eric Lynch Owner Owner's Name information is required for North Andover Ma. 01845 12-11-10 every page. City/Town 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•09/08 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 M 165 Boston Rd Property Address Eric Lynch Owner Owner's Name information is required for North Andover Ma. 01845 12-11-10 every page. City/Town 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): 110-330 gpd t5ins-09/08 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 ;M 165 Boston Rd Property Address Eric Lynch Owner Owner's Name information is required for North Andover Ma. 01845 12-11-10 every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 5 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)) 08 & 09 105,750 gal = 144 gpd Detail: Sump pump? ❑ Yes ® No Last date of occupancy: still occupied 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: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments GSM 165 Boston Rd Property Address Eric Lynch Owner Owner's Name information is required for North Andover Ma. 01845 12-11-10 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): na General Information Pumping Records: Source of information: last pumped Oct 10 2010 information from owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: 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-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °wM 165 Boston Rd Property Address Eric Lynch Owner Owner's Name information is required for North Andover Ma. 01845 12-11-10 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 14 years old Information from owner Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 32 in feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 28 ft from incoming water line to outgoing sewer line Comments(on condition of joints, venting, evidence of leakage, etc.): joints &venting good condition - no evidence of leakage Septic Tank(locate on site plan): Depth below grade: 26in with riser&cover at grade feet Material of construction: ® concrete ❑ metal ❑ 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 long- 5ft wide wide-5ft deep 1500 gal Sludge depth: 2in t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 'M 165 Boston Rd Property Address Eric Lynch Owner Owner's Name information is required for North Andover Ma. 01845 12-11-10 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 34in Scum thickness lin Distance from top of scum to top of outlet tee or baffle 7 in Distance from bottom of scum to bottom of outlet tee or baffle 14in How were dimensions determined? rulers&measuring rod Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): tank does not need to be pumped -inlet tee good condition -rear tee good condition - tank structural integrity good - liquid at bottom of outlet invert-no leakage in or out of tank Grease Trap(locate on site plan): Depth below grade: feet 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: Date t5ins-09/08 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 �M 165 Boston Rd Property Address Eric Lynch Owner Owner's Name information is required for North Andover Ma. 01845 12-11-10 every page. Cityrrown 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.): na 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.): na *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09/08 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 165 Boston Rd Property Address Eric Lynch Owner Owner's Name information is required for North Andover Ma. 01845 12-11-10 every 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.): d-box was level -distribution was equal- no evidence of any solids carryover-no sign of leakage in or out of d-box-d-box 16in below grade size 2202 inside depth 16 in 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&alarm good working order-pump chamber 29 in below grade with riser&cover 2 in below grade Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 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 wM 165 Boston Rd Property Address Eric Lynch Owner Owner's Name information is required for North Andover Ma. 01845 12-11-10 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 4 trenches 50 ft long each E-11000 sq ft of leaching fields number, dimensions: leaching ❑ 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.): dry sand soil -no hydraulic failure-no ponding-system was under upper side lawn 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•09/08 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 165 Boston Rd Property Address Eric Lynch Owner Owners Name information is required for North Andover Ma. 01845 12-11-10 every page. City/Town 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.): na 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 165 Boston Rd Property Address Eric Lynch Owner Owner's Name information is required for North Andover Ma. 01845 12-11-10 every page. Citylrown 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 s I C - r-' 33' I 3 'I t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 165 Boston Rd Property Address Eric Lynch Owner Owner's Name information is North Andover Ma. 01845 12-11-10 required for State Zip Code Date of Inspection every page. City/Town D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells eshgw 40 in Estimated depth to high ground water: 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: 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: from plans test pit#t1 esh w at 40 in in from orig nal grade- system is raised t"$N Before filing this Inspection Report,please see Report Completeness Checklist on next page. Title 5 Official Inspection Form:Subsurface Sewage Disposal system-Page 16 of 17 t5ins•09/08 + e Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 165 Boston Rd Property Address Eric Lynch Owner Owner's Name information is North Andover Ma. 01845 12-11-10 required for State Zip Code Date of Inspection every page. City/Town 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 t5ins•09108 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION 16 -> Prm* PROPERTY OWNER �T► iti k4 c� Print - MAP NO:Lt)q,APARCEL&d,-L ZONING DISTRICT: Historic District yes Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other r-.. ''m"�`�'" r..- _..'- _ti •rxs� Efi�_;S-, `"'F - .,:-.g �_,�;�,�r .a.,c.�s ..a a'�-�4 z-.s-: ®lSeptic� ®tWell� ®Floodplain) ®)Wetlands) , Di V�;atershedDstr4ict� =e. O Water/Sewers R - DESCRIPTION OF WP RK TO BE PERFO D: wow G� C.�. f�,-C SrLGvI 4i`� ' J4��`.i'�'� � __ ��C.'�C -�`C�O ��<< (1 c„� oe /S��J�e�. � 1' ✓-��- l �� � ,��9 -�-,, i�'t�� • �� ��ces�`v..,t .��� pr���.. off' G•dsSe (Identification Please pe or Print Clearly) OWNER: Name: /,1yt) /iicw U t1 Phone: (%1 7) '7781 -3 71f Address: �� 14111/�ti CONTRACTOR Name: Ak lolwb C rt S ft�4/U o 6�I tLo Phone:/ 5 17t- 7q Address: Supervisor's Construction License: '�/q '70 Exp. Date: 3 Home Improvement License: �� ��,2 Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ t 9610a& FEE: $ `7 Z�Q Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guar ty fund Slgnafure�of'Agent/Owner" _ Signature.of_corrtract&;,` y.. a Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody Art ❑ Swimming Pools 0 Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ l COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Si natur COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW'Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS f--------------- Walk In I Walk in I by p ? Close.{ r 7,� =E t5�7 Bedroom #Z Bedroom ( 1 C4 � 1l _ - - �2D0 Data 1 Nov 2Ot0 AM ptaaeorkw Mmt Es e 7 �� y�, -py n 'fmvbd By caute egg Mw&.Zm*hg+Haw Hasa ✓ � Fhet cky EMwHprmn pxs� �� 6ppmaA By Tee�rinme ownar. `i Boston ,Street 'M flo zeirb a affn517c," �aeae peens Bot 4h Be copk d op Dated A4 Mp Wu"&,&Wut'YrlLfso pb=mApulon w `r .Pr .,. P Fr�Aa � o M k 14 Existing 1st Part City De velopmen t NS a Floor Flan Design Build 59 Ashland Street o Newburnort MA 01950 43 Q) qC � a LO IEEEJo ® ® ® OD mom ODro M W � 9CALJU 2/8 1, — O" ON14 A S'oom Y ++-- �W 2 NOV BOLO Lynch Residence �!m�m��� YerSSed By Lbntroefer. Ow,Snslagt Dave Seen r;rrG Clty De=ai rnu hem pnnolde8 EaSdtru Pdm dpproved By The rdome oraer. to Ib.m uaee sneer t3efr cert U 165 Boston Street Nem V.Beer� f Owhuw!° rYeee Pleas Net Rb Be Cepted or la s2ele!!ea or Our CmtnaeG �!� Repavduced*fb°u!Nr!lten PexmLaf°a i 4 �3 q lam ® ® ® IIHI DD OD . aW 0 w OCAZZ s/a„ � s• _ o•• � soxa A Foam Date t Nov Q020 L, c �eS�denc� � Y.AtLd By Caateaetor. 4A...Ilrardagi ffiw Hca Part Cky Deved�parm=t A..Fanalded °R Pb� Al-11 By 7Yre Ilam°owner. m De u.se wader tas CamCnot 165 Boston Street m° B°°r�°�W"'r°'"t. U°'°''�°P'"° � Not &,%Captad w m de7.iloa o!Oetr ContractX�, Repmduaed nittm t Prlttea Permfasfoa a • a -- ® Existing �4 (d 4 Bedroom ,ya e+lVj , > Kitchen Dining Room ir Fomfly Room El j v Llvfng Room Existing yJ Bedroom to V W to 114 i- W W SCALY! FOIVSS s!r A Fbdw i Date 2 Nov 2020 ��,� Malt ft Lynch Residence e@—@tnr pa&mO !lase Dns3cB+Na*o Bow W to coed oader[Asir CmsGaot ��@ By 1Le Roma wer. 165 Boston Street le, �"we�"o Net 7b 8e Ccpte@ or m vt�ltoa of Rur Coatt+st Datsk Nspmduaad wttAov[Nrltiea PexWsefea Form No.4 ti Town of North Andover, Massachusetts BOARD OF HEALTH December 24996 CERTIFICATE.OF COMPLIANCE This is to certify that the Individual Soil Absorption Sewage Disposal System constructed ( ) or repaired � ) by Benjamin Osgood, Jr. INSTALLER at 165 Boston Street SITE LOCATION has been installed in accordance with Board of Health Regulations as described in the Design Approval Site System Permit No. dated Oct- 30 , 1 9_26 The issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. BOARD OF HEALTH TOWN OFo a BOARD OF HEAD , _ SOIL EVALUATOR FORM e Page 1 of 3 OCT 16 1996 No. Date: /a/ 9� Commonwealth of Massachusetts If Massachusetts Soil Suitability Assessment for Qn-site Sewage Disno,sat Performed By: ....................�................................................ . .: � `/ 9,6 ....................... Date Witnessed B �� x c ,,�-, - _ _._._.. _ y. �/ .. .... /............: t outioo Address orOwrct'.Name#JT¢ taY I Address.sa0 Tekphafe I / z-,/ ew Construction ❑ Repair i`llv Office Review Published Soil Survey Available: No ❑ Yes ❑ Year Published .............. Publication Scale �` ��.` ..` � Soil Map Unit fib. .__.... Drainage Class Gl/',c� % i�� v. Soil Limitations � :....•..: �/_ -"� Surficial Geologic Report Available: No 0 Yes ❑ Year Published Publication Scale _ Geologic Material (Map Unit) .......................................... . Landform ....... .............................................................................. Flood Insurance Rate Map: Above 500 year flood boundary No ❑Yes Q Within 500 year flood boundary No ❑Yes ❑ Within 100 year flood boundary No ❑Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) .............................................................._.._...._._.....- Wetlands Conservancy Program Map (map unit) ..............................................._._.._........ Current Water Resource Conditions(USGS): Month Range :Above Normal ONormal ❑Belch Normal ❑ Other References Reviewed: Dg'A"RO VE D FORM-12AW% , FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. 165- =?� 7 On-site Review Deep Hole Number Date: lc27117� Time:/'�%' fid Weather--Ze-1--/DY-. �0.0 Location (identify on site plan) .................. Land Use Slope (%) �la Surface Stones Vegetation Landform ........ Position on landscape (sketch on the back) Distances from: Open Water Body feet Drainage way feet Possible Wet Area IZO . . feet Property Line feet Drinking Water Well 7. feet Other DEEP OBSERVATION HOLE LOG* Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(Inches) (USDA) (Munsell) Mottling (Structure,Stones,Boulders,Consistency, % Gravel) /0 YIC— 1Z-'C1,4/ y Z:> IT- Qig-"7Q 75 '7-5-Y7Z Z, y MINIMUM OF 2 HOLES REQUIRED AT EVERY PR - -kL AREA ParentDepthtoBadrock: Depth to Groundwater: Standing Water in the Hole: J Weeping from Pit Face: Estimated Seasonal High Ground Water: DEP APPROVED FORM-12107195 FORM 11 - SOIL EVALUATOR FORM . Page 3 of 3 Location Address or Lot No. /�S -=r ,v n/o.,�i i 14,4 ,determination r Seal nal High Water Table Method Used: ❑ Depth observed standing in observation hole............. .... inches ❑ Depth weeping from.side of observation hole................... inches © Depth to soil mottles 40:M.µ inches ❑ Ground water adjustment ................... feet Index Well Number .................. Reading Date ................... Index well level Adjustment factor ............_..... Adjusted ground water level .............................................._........ Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? -i If not, what is the depth of naturally occurring pervious material? — Certification I certify that on $:rf (date) I have passed the soil evaluator -examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15 17. Date Signature 9 DEP APPROVED FORM-12107/95 L 53-7058/2113 ]RS 887807675 NEW ENGLAND ENGINEERING SERVICES, INC.33 WALKER RD., STE. 23 PH. 508-686-1768NORTH.ANDOVER, MA 01845 DATE PAYTOTHEORDEROF� IPSWICH SAVINGS BANK IPSWICH,MASSACHUSE7-CS 01938NP MEMO �' LL370587�: 88780767 511' . 2 -- 7 5- "------- TOWN OARD OF LT AVER! SEP 11996 •5 :.11^ , y.. i Ii;J f ��,::�\i_e fir'; �.t`a.:'�� �,�. �')f. � l. t .'. I .t u.tl._Y i. DATE: �� �O ��, CUR2EN T LNST ALLERI S LICENSE#_��--� LOCATION:—)Ls- Vjz, LsCENSEII INSTALLER:- � �saoo�52 SIGNATURE: TELEPHONE# 686,–/7663 CHECK ONE: REPAIR:__ NEW CONSTRUCTION: IF NEW CONSTUCTION, PL EASE ATTACH FOUNDATION AS-BUILT. Administrative ative Ilse Only $75.00 Fee Attached? Yes_�� No Foundation As-Built? Yes `' No Approval Date: (� _p'�n.CY�`P^;"qA �":. _ 'q..� -.� w�^4's. .=�?'d'k`v^`�.ab'r »M•� w,r,w'2 All 7 t rim f N 1 � ? Y� «� 41. Tlim�n�tr � [i VA i"gi 5 1 M yj73 t Ali ot kpm 3jTM�P��'k q4 . �J e W _ .��'$2�L'di4plrM?PM4�,s. r`A�Sa,�.tlhlFd..:s�Jli�k7i ,2' '� f<� %� xr...ky.a,. .. ,yy� �ar^�1Wq„'�,- ;n wr,.r .�>�+Ag � e�°„ •+�.K-r... .ro.. we .. a -?tfiP w "rte x` s � 7s'Y r Jj- f; 14' i fff r , is x jf r r, '*"•"."�'-'Y.^,r i f .L < - , 4 ei•P." ?7 Mrsc � r- t ), "t r. ,c-2 1 t j ., � r t_ t { f � .�iwtcs. t r�hi•7✓ rr. r°;'T tl 'TS r e......�,,._ -,-,...,,.�,_....-::u F--�..,� _..J. q d3.- } „+e - �',w,V cam-. ��F� �•r r t 'T .s r. lMrf�lru�r , Will TPFTF 71 HIM , _ , t � VC J Cal 4- 1 a ---__ — ! y w , — 7 e �K -- . . . . . . . . / #.9 I r C-. s` 11 - MIR— 'rt ............. h cxr �xc rx x F �L F t �- ,,iice� -•-{• a �,a.39 - d-ynzi,;�.'.ur' t � C E•! �..t�`S ,`T tY�.. f... 1 . ' .. ... '.. yv wY :l':� i�" }.�..kl"'+"+{b3-4"w•f%^�T� iv 3-s:.-:. #S+ 'R^fA^ �..�! .':T... - - ... Town of North Andover, Massachusetts Form No. 1 NORTH AA BOARD OF HEALTH 3� y� OL 19 APPLICATION FOR SITE TESTING/INSPECTION Q�Rq TED PPa\,�� ACHUSE� Applicant NAME ADDRESS TELEPHONE Site Location Engineer ' NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee Test No. ' S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. 7.' L A T, 7- H E LTH C)E'CJQ "A I hereby ra e C' TI f -% El Der71.11 4 3,2 n s a a o n at ,Scali U c=rdR7133-� wltn Eno NF-v, the �'03'irDnmvaal system, in a M-assachuse-tts and r e z1_1 a tL J r.,3 os' ,el 'moa.r d of Health ow f the Ton of North Andover—® L P s- � n 'bell an'4 pipe, the h es miniml-ma grade ol' 1% •�)'qtil _10'fee.i-A preced-Lng t La selptic -ark., the grads' onlal.1 not • tp 1-7-4 a, tank of y;ov 4oj in -,,iiIih romol�ab.le cover (s) i r, or coi ing Wi"11- ro within 12 :"Lnch--o of `;hte grou.,. d Sfa O1 ac provide pigot Lkron pip,) at- disDosal field -iiith open bel> and a least 4 ina.hes In dirinuet.- and 1ad. i n -a sa6ri:-2s of "La enches , the bottom of which -vrill roe'id a :,vi P,i I-I I-;.1 Ti of Lin--�al rv) feet of em.-Cfectiv-v a'03orption area. -be "Lal-.i". on a 6 inch layer of Tw-ashed -vraval or crush,ad stoil a ranging in Size from "A to 1 1123 (dia. ) nnd the DIDQ3 ,-�Tili be surrounded by situf.1a.- innat.--rial- to a Ihoizg-ht of 2' incha.s abov-i the, crown of the pipe. "Ii "fie ion-,',s of these Di-o2s will be Drotec-led from clogging 8 to (d-a. ) w . - and be"'ore filling the trer' c�q l , 2 inc--"Ies of gravel or stone `11 be P-,aced og ver the course ravel - or stone. The disposal field will be installed at a grade 63f L. to 6 inches/loo feet. Nc single tile line `=rill axi.,eed 100 feet in length and in any case, -twc lines of t2la w-111 be installed. A minimum of 6 feet wi.!!- be -_-.7iaintain-ed betw,_Qen the center limes o-.--' the disposal field trenches and the alrerage depth of trench ,hall not exceed 36 inches. INc pa pt of tlfle in-s-II.-allat-ion will be less than 100 feet from any priva-',e water supply, 25 feet from any stream, 20 feet from any dwelling or 10 fee .-from any property line. I fiirther F:.�_ ee nc,�g to cover any por".*io-yi of this ins t;a--' until rove the, ins pe_C;2._o_n _p7fTj-7r,—asprovIde=6=n, UnT_ to incorporate anyaddT-t—io—i-i-a7--requ7-r7-.7--,e7i '�s --,hat may be attached`- to the permit. Plot Plans mus-%-, be submitted with application. DATE 19-JAX.S_- Sig.rnaturA of App1jai t I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. Date 3-1.g I have inspected the umcover,.)d system indicated above and j"J..nd everything done as described. Date 7gnatura' of Percolation Test Garbage Grinder i o S i i i 41 w T ~� w N 1 od BUTTERWORTH & O'TOOLE, INC. ADJUSTERS/APPRAISERS FOR INSURANCE COMPANIES ONLY claims@butterworthotoole.com SALEM,MA OFFICE DOVER,NH OFFICE P.O.BOX 8294 P.O.BOX 734 SALEM,MA 01971-8294 DOVER,NH 03821-0734 TEL. (978)741-5731 TEL. (800)298-5330 FAX (978)740-9109 FAX (603)218-6760 REPLY TO: ❑X REPLY TO: ❑ July 18, 2008 FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B TO: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectmen City/Town Hall City/Town Hall ADDRESSES North Andover, MA 01845 North Andover, MA 01845 RE: Insured: Eric and Krista Lynch Address : 165 Boston Street North Andover, MA 01845 Policy No. : HP36790453 Loss of : 07/17/08 File or Claim No. : 083-0740 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1, 000 . 00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. If no reply is received from your office within ten days, we will assume you have no liens of any type against this property and we will recommend to the insuring company that this claim is paid. Paul Trainor Adjuster & y Xv M. 3 Member of National Association of Independent Insurance Adjusters BUTTERWORTH & O'TOOLE, INC. ADJUSTERS/APPRAISERS FOR INSURANCE COMPANIES ONLY claims(n),butterworthotoole.com SALEM,MA OFFICE DOVER,NH OFFICE P.O.BOX 8294 P.O.BOX 734 SALEM,MA 01971-8294 DOVER,NH 03821-0734 TEL. (978)741-5731 TEL. (800)298-5330 FAX (978)740-9109 FAX (603)218-6760 REPLY TO: ❑X REPLY TO: ❑ July 18, 2008 FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B TO: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectmen City/Town Hall City/Town Hall ADDRESSES North Andover, MA 01845 North Andover, MA 01845 RE: Insured: Eric and Krista Lynch Address : 165 Boston Street North Andover, MA 01845 Policy No. : HP36790453 Loss. of : 07/17/08 File or Claim No. : 083-0740 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1, 000. 00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. If no reply is received from your office within ten days, we will assume you have no liens of any type against this property and we will recommend to the insuring company that this claim is paid. Paul Trainor Adjuster Member of National Association of Independent Insurance Adjusters APPILICATION FOR SUIACI DTSFOSAL IN3TALLATI-'B HEALTH ANDOVER) MASS. I hereby make ,pp ica lop 1, ti f or a permit for a sewage disposal installation atI will install this system in accordance with a4l :�qthe lv.wi7_oif the CommDnwealth of Massachusetts and regimlations of the Board of Health of the Town of North Andover. Further, 1 will corastruct the house sewe'C of bell and spigot pipet the minimum diameter being k `,.nchea, -and will maintain a minimum grade of 1% until 10 feet preceding the septic tank, when the grade shall not exceed 2%. 1 ri'll install a concrete septic tank ofct in size. A manhole (S) permitting easy clean- ing willbe pa. with removable cover (s) of iron or concrete within 12 inches of the ground surface. I will provide subs urfac(:., disposal field with open jointed bell and spigot Ackron pipe at least 4 inches in diameter and laid in a series of trenches, the bottom of which will provide a minivium of Lineal (squarr) feet of effective absorption area_. IA-pipes .,,ill be la ,d on a 6 inch layer of washed gravel or crushad stona ranging in size from A 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 !/41? (ds. ) 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 the 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 o--" the disposal field trenches and the average depth of trench shalll 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 fee-i from any property line. I further agree not to cover any R2EtiQn of this instpallatf"Lon until — rove -=teq insRectJJ.;on-3I'f!-(7r, as ProVi_deTTeIo=, jr_RT--- 01_ re dd a requir7emenis --hat may be attached to to=ncorporate any, a---- 3.—tionar V the permit. Plot Plans must be submitted with application. DATE S7i n t urA g a t ur.4—�;'f_Ap`Dp=iC a n t I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. Date ealt Agent 5Kgn9:E5i7P. o I have inspected the uncovered system indicated above and fJ_nd everything done as described. Date --Till /in U:Lgnature oF nepect"ing Office:.- Percolation Test Garbage Grinder �f 30 f N I� Town o. f North Andover, MA Watershed Septic System ;Iervicing Report n D Homeowner': ��rCLc�ox- _ — Pumper — � Street f � tQi� Address: /2 Phone 0' -�./1 Phone Nature of Service: Routi:ie Emerg•:ncy. i Observat-.ons : Good :ondition I Full :o Cover Baffl.as in Place Leach :ield Runback Exces-3ive Solids Heavy Grease Roots — Other (Explain) F Descript::on of Work- Comments : orkComments : s PLAN REVIEW CHECKLIST- ADDRESS- V� /��� �` ENGINEER (-i S G66 GENERAL 3 COPIES STAMP LOCUS NORTH ARROW SCALE CONTOURS PROFILE �. SECTION ✓ BENCHMARK `SOIL & PERCS ELEVATIONS WETS... DISCLAIMER WELLS WETS WATERSHED? /f& DRIVEWAY (Eley) WATER LINE FDN DRAIN- SCH40 TESTS CURRENT? ` :'SOIL EVAL D 1 G K SEPTIC TANi{ MIN. 1500G Y'" f : 17 INVERT DROP .. • GARB: . GRINDER(-2 comps; .+200). J .- 10-l ' TO FDD ; MANHOLE ELEV . GW # COMPS µ GB D-BOXe. SIZE # LINES FIRST 2 ' LEVEL STATEMENT.. �S INLET MA q/ OUTLET /�� O ' i {Z OR,' 17 .'FT). TEE.REQ D? /•C LEACHINGf'' p x ' MIN 4-GPD? RESERVE AREA -'�"'4' FROM PRIMARY? 2-o SLOPE 100' TO WETLANDS L�100 ' TO. WELLS`- 4!: T04 S.,H.GW.. `(5 `>2M/IN) 20 ' TO FND & INTRCPTR DRAINS ' X400 ' 'TO SURFACE H20SUPP 4 ' ~PERM. SOIL BELOW FACILITY MIN 112 11 COVER f FIL'I;'� BREAKOUT MET? . TRENCHER eMIN 4gpdSLOPE (min :00.5 or 6"J100 ' ) SIDEWALL: DIST. 3X EFF. M. OR. D,.(MIN 61 ) i/ RESERVE B.ETtn�EEN '�'R.ENC iES? IN FILLS MUST BE 10' MIN. V 4" PEA STONE?� VENT? ✓ (>3' COVER, LINES ,>50 ' ). BOT sf9 + SIDE X LDNG `3 TOT C3 8� ,. (L x W x #) (DxLx2x#) (G/ft2) . Copyright -1996 by S.L. 'Starr - � other forms may be used.but the r w.111 Health. DEP has.provyded this form for use-by lotia�rd at provided hereBelo a using this form, heek with i t d to information must be sUb.stantiaily the same vocal Board of Health to determinethe formoauthority within they use.The 14 days from stem pnthe Record mrRi q date irtu the local Board of Health or oth pP accordance with 310 CMR 15.351, _ A. Facility lrifoyrmation Important: 1 System Location: When filling out forms on the — tompuier,use- PAd �2s5 only the tab keytomove your Stale Zip Cade cursor•do,mt y/Town ljse'the ratum key. 2• S stem Owner: VQ Name . — . _ - Address(irdirferenl from location? - - — - _ _ •. Stale p Zip Cade CilVrTown Tel one Number B, pumping Record 2 Quantity Pumped: Gallons 1. Date of Pumping Date 3. Type of system; Cesspool(s) Septic Tank 0 Tight Tank [] Grease Trap � . fl fJfhe.,r(describe). .. - _ — -- •' 4_ Effluent Tee Filter present? Yes ,U No If yes, was it cteaned? Yes NO 5; Condition of Systenc�— - 6. System Pumped By; - _ ��'' vehicie License N-umter Nome �� _. _ s._ .. — —• - company 7. Location where contents.were disposed; max .' Date. -- $Ignature of.Hauier S�gnatum of Receivinacility pate g F System pumping,Repoyd•Page t or f t5tormCdoc•03106 I I