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Miscellaneous - 1725 SALEM STREET 4/30/2018 (2)
N O North Andover Board of Assessors Public Access a Parcel ID: 210/106.13-0086-0000.0 SKETCH Click on Sketch to Enlarge f I Page 1 of 1 Community: North Andover PHOTO Ido Picture Available Location: 1725L -48B SALEM STREET Owner Name: HAMMER, LAURENCE D DIANA L HAMMER Owner Address: 1725 SALEM STREET City: NORTH ANDOVER State: MA ZIP: 01845 Neighborhood: 6 - 6 Land Area: 1.03 acres Use Code: 101- SNGL-FAM-RES Total Finished Area: 1560 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 490,300 456,800 Building Value: 280,200 262,400 Land Value: 210,100 194,400 Market Land Value: 210,100 Chapter Land Value: LATEST SALE Sale Price: 221,500 Sale Date: 08/22/1990 Arms Length Sale Code: Y -YES -VALID Grantor: DINEEN, RICHARD T Cert Doc: Book: 03151 Page: 0218 http://csc-ma.us/NandoverPubAcc/jsp/Home.jsp?Page=3&Linkld=808885 8/14/2006 Fat W W ,0 H T� U) }- c o U ` LU o -D Qitw US M Go T J 000 M N C O O r CO O H D mW oca0) U a maU = -o p v LQ 4 WCZff N Z U N W aQ z d a) V N a >� ao 0) C: 0 ch U) U) U) (D O J co O cn 00 T (D O o �HLr) 0 Y U N J0 Q m c c U U ii 3 m , m o 0 0 D��� 0 0 0 J_ m 0Ia m E E 0 U —I .l 0 R CD Z O o L � Q o co a cc CD oO D a M LLLLIZ V `j2 O J W W W Lu o VNQ C-4 a a g= z W —i w� as w V 2Z NUF cQQ otic 2 Q CL 3:Xa 0 Q • O O oot N N O M N V O cc J J Y Y i N O O Z 0� } Z N _3 ZN w _O J J 2z 0i O (`'f ON a` -o 0 Z No Maw� LL ?�O �+O U. (D Z O N 0 NN Ln N gg N It Q J 0)o) U 0 �mm m�c4Q 0000 Z (+i oc d O (O OLff 00O �ttY co CU - W p a O m m p Co H O Z cn U a I-. o O V- O N N N cn 00 In .M M 0 T Of N T N is ui Q O 7 N M O Q o �» o W LO m N _ J U CO E zQ 3 �,cncno t7 vai Z O O P oo 00 M N t 2 —N O Of o r T T T Q Q O LPA Q a Ixy (0 N w CD its = a) Li N W. Ln O Q a�0i oQ E na H Z cQQ` m'� oE0 Ll c LL,U kc L�.= o a W f6 p---aco af0i2 wUao o Z W ti-eNT HH �tnff Q cc frrr Ica cc (/� i� .. (0 u_ VCh y o0 W X iii i6 y iii ;ii - M Ow LL E Erwr 3 m mm ,;T ul 0L 0o nsm NUQ..2 0C9 M CL to a 2m°.�� �Y EEO HMLLMLuM W in co � N 0: M0 X U Z E R) F o iu y U = 2 mca a•CLUa H U C -0 0 oc a.. v W Q o X m O (D O Y .�.aa) m6ofwZu_ 2.u_w0 away U) Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. 4 reran Commonwealth of (Massachusetts CitylTown of North Andover f, stm Pumping Record Form 4 DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same asthat use. Thed here. SystemPumping re (ng this Record must be submitted to k with your local Board of Health to determine the for Y date in the local Board of Health or other approving authority within 14 days from the pumping accordance with 310 CMR 15.351. A. Facility Information 1. System Location: .' VPS 1'7Z5 &I.Qrn Address EACH North Andover state CityfTown 2. System (IOwner: P e�— Name Address (if different from location) 01886 Zip Code State Zip Code CitylTown Telephone Number B. Pumping Record 1. Date of Pumping Date 2- Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No 5. Condition of System: If.yes, was it cleaned? ❑ Yes ❑ No 6. System Pumped y: Vehicle License Number Name Stewart's Septic Service Company 7. Location where contents were disposed: Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 Signature of Hauler Date Date Signature of Receiving Facility t5form4.doc• 03/06 System Pumping Record • Page tAORTN Z. O O'C COCNIt�N Kx 1' PUBLIC HEALTH DEPARTMENT Community Development Division (-IER71FICA7E F �V�LIANCEO As o£ August 31, 2006 This is to cert that the individuaCsu6surface d4posafsystem received a SA` 1SFACT0RT1YS(ECTIONof the: Component Tspair — 5' Feet of piping for the Subsurface L►isposa(System repaired 6y: ToddBateson At: 1725 Safem Street Wap: 106.B — Parce[86 JVorth Andover, 911A 01845 The Issuance of this cert ate shad not 6e construed as a guarantee that the system wifC function satisfactorily. Susan T Sawyer Tu6C�c Yfeafth Director 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com r t d O _ w N N i o z fA m y D 3 Z a 3 d J G d J d O w w w N N d O iw N N o z fA m 0 z L p W o "O O c w d 02) Gol O y U a 1= H o = ll 10 N C •y , a y d a o E _� m w y d a c c J p 0 z 0 0 z z ` m m O y d v m m d � � o U G y a w; y 'a) m z z O iw o z 0 z 0 z L p W o "O 1= H o = ll N C •y , a y v o E o E _� m a p y d d c��n o U o U G y a w; O LL O LL 3 J d = °Do o d m O rL tp c a as as y a G d = y C7 V O O ►� v� C7 � I 10. COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: _1725 Salem Street —North Andover_ Owner's Name: Larry Hammer Owner's Address: _1725 Salem Street North Andover, MA 01845_ Date of Inspection 8/16/2006 Name of Inspector: _Neil J. Bateson_ Company Name: Bateson Enterprises Inc._ Mailing Address: _111 Argilla Road_ _Andover, Ma. 01810_ Telephone Number: ( 978 ) 4754786_ RECEIVE® SEP - 6 2006 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT CERTIFICATION STATEMENT 1 certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000 The system: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority a' Inspector's Signature: Date: _8/16/2006_ 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., replace collapse pipe, 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 Map -Block -Lot o •,..a ., �tiao 106.6- 0086 - Board of Health Permit No BHP -2006-0247 .. North Andover -------------------- °...:::.. •` ' P.I. FEE 'sSACMuSEF.I. $125.00 ----------------------- Disposal Works Construction Permit Permission is hereby granted Todd -Bateson to (Repair -5' OF PIPE) an Individual Sewage Disposal System. at No 1725 SALEM STREET as shown on the application for Disposal Works Construction Permit No. BHP -2006-024 Dated August -14, 2006 Issued On: Aug-14-2006 ----------------------------------------------------------------- ---------------------------------------------------------- Board of Health Commonwealth of Massachusetts Map -Block -Lot 0 a o •t<<° `_ °0 106.6- 0086 - Board of Health ------------------- North Andover -°•••��-`� Certificate of Compliance 1ssAcwu4�t THIS IS TO CERTIFY, That the Individual Sewage Disposal System (Repair -5' OF PIPE) by Todd Bates -on ---- ------------------------------------------------------------------------------------------------------------- Installer at No 1725 SALEM STREET has been installed in accordance with the provisions of TITLE 5 of the State Environmental Code as described in the application for Disposal Works Construction Permit No. -BHP-2006-024 _ Dated ___ August_14, 2006 .... ----------------------------------------------------------- Printed On: Aug -14-2006 Board of Health MORTEM Town of North Andover sa'•�;,;;::� HEALTH DEPARTMENT CHU CHECK #: LOCATION: H/O NAME: e�'21 t,,._., j CONTRACTOR NAME: Tvve 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 $ ❑ S tic -Design Approval $ Septic Disposal Works Construction (DWC) $ ❑. Septic Disposal Works Installers (DWI) $ ❑, Title 5Inspector $ ❑ Title 5 Report $ ❑ Other. (Indicate) $ s 1154 Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer Application for optic Disposal System Construction Permit— TO WN OF TODAY' DATE j, — - ,4 NORTH ANDOVER MA 01845 $ 250.00 — Re air '25.00 - Componen `SACHUSE Important: Application is hereby made for a permit to: When filling out ❑ Construct a new on-site sewage disposal system* forms on the computer, use * gepair air or replace an existing on-site sewage disposal system only the tab key I to move your or replace an existing system component cursor - do not use the return A. Facility Information tion �y key. �nC�' RiECEIVE® w AddressorLot # . �14- -�_-x�1 rob-= ____ rrNm City/Town TOWN OF NORTH ANDOVER — 2.- *TYPE OF SEPTIC SYSTEM*: HEALTH DEPARTMENT ❑ Pump Gravity (choose one) ***If pump system, attach copy of electrical permit to application*** ❑ Conventional System (pipe and stone system) ❑ Infiltrator or Biodiffuser (Gravel -Less) (Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D -Box) (Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D -Box Present) S.A.S. 2. U.G y'"A� \�� �rt Name t tl j t��n+��Q@ Address (if different from ab2l — --0_C---- City/Town Sta Zip Code 3 Telephone Number 3. Installer Infop4ation Name n t Name of Company Address J Cityfrown 4. Designer Information Name Address City/Town URIV State Zip Code Telephone Number (Cell Phone # if possible please) Name of Company State Zip Code Telephone Number (Best # to Reach) Application for Disposal System Construction Permit - Page 1 of 2 Z;o Z a6ed-;iwJad uoipni;suoo wa;sAS lesodsia jo; uoi;eoilddy ON —saA —off —sad —oN S 3 —off —sad —off —sad : (Aluo uoljonajsuoo Mau) z suvld ,toolI •s (uvld pazocddv sp alpos amus) :(A'luoa uoijonrlsuoo Mau) 2ilzng-sy uozlvpunoI •l, ;zuuag lvauIaal, o oa gaplly `os jl 2uua;s S ucnd- •f zpagaviiV uuol uozlr�zlgo .cagvuvN li load ,z ZpagvmV aa1 'I luo ash aoi}jo jo-4 :suoseaj 6ulmollol ayj JoJ panojddesia uogeogddy a;ea ;aweN Of l (anile;uasaadab y;leaH10 pJeog) :A8 pa Ao� dd�y oileoilddy a;ea aweN y;IeaH Jo PMO y; qp ssl uaaq sey eoueydwo� jo a;eo!j!pe� a Ir;un uo►;ejado ul wa;s�fs ay; eoeld o; jou pue - nopud WON jo uMol ay; io{ suopeln6aa lesodslQ aaepnsgng leoo� ay; se Ilem se `apoO le;uawuoJrnu3 ay; {o g aPU Jo suorsrAOJd ay; y;rM aouepioaoe uI wa;sAs lesods/p aBemes a;ls-uo paq►aosep-aaole ay; jo eoueua;ulew pue uol;onz;suoo ay; ernsue o; seeiBe pou8/s opun eyl IuauaaOJBV '8 leioj9wwoOE1 JO 6uy19nna leguapisa : ulpiln8 jo GdA.L '9 --panuiluoo uoi;ewiojul I!1!3el °d ZJOZ3Jdd ;uauoduzoa-00'9Z6$ 7Mjglo V )IIAO(INV HDI .sy �iedaa Iln� - 00'092 $ dO N&OJL - Ii31`da SAVGOl uaaad uoil3nilsuoa'w � ti �..4 W04s S peso sia 31100S aoI UOIJB31l d t : (Aluo uoljonajsuoo Mau) z suvld ,toolI •s (uvld pazocddv sp alpos amus) :(A'luoa uoijonrlsuoo Mau) 2ilzng-sy uozlvpunoI •l, ;zuuag lvauIaal, o oa gaplly `os jl 2uua;s S ucnd- •f zpagaviiV uuol uozlr�zlgo .cagvuvN li load ,z ZpagvmV aa1 'I luo ash aoi}jo jo-4 :suoseaj 6ulmollol ayj JoJ panojddesia uogeogddy a;ea ;aweN Of l (anile;uasaadab y;leaH10 pJeog) :A8 pa Ao� dd�y oileoilddy a;ea aweN y;IeaH Jo PMO y; qp ssl uaaq sey eoueydwo� jo a;eo!j!pe� a Ir;un uo►;ejado ul wa;s�fs ay; eoeld o; jou pue - nopud WON jo uMol ay; io{ suopeln6aa lesodslQ aaepnsgng leoo� ay; se Ilem se `apoO le;uawuoJrnu3 ay; {o g aPU Jo suorsrAOJd ay; y;rM aouepioaoe uI wa;sAs lesods/p aBemes a;ls-uo paq►aosep-aaole ay; jo eoueua;ulew pue uol;onz;suoo ay; ernsue o; seeiBe pou8/s opun eyl IuauaaOJBV '8 leioj9wwoOE1 JO 6uy19nna leguapisa : ulpiln8 jo GdA.L '9 --panuiluoo uoi;ewiojul I!1!3el °d ZJOZ3Jdd ;uauoduzoa-00'9Z6$ 7Mjglo V )IIAO(INV HDI .sy �iedaa Iln� - 00'092 $ dO N&OJL - Ii31`da SAVGOl uaaad uoil3nilsuoa'w � ti �..4 W04s S peso sia 31100S aoI UOIJB31l d Z , e INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at `�Ja S C �P��� S relative to the application 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 obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer I must call for any and all inspections. If homeowner, contractor, project ciated with my company schedules an inspection and the manger, or any other person not asso system is not ready then item three shall be applicable. icable 3. As the installer I am required to have understand the necqssar that rrequ k comsting aetedm inspect oor to n,p w without inspections as indicated below. 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 wail which should be done first. Installer must request the inspection but does not have to be present. b) Final inspection — Engineer must first do `their inspection for elevations, ties, etc. As -built or verbal OK from engineer must be submitted to Board of Health, after which installer calls for inspection time. Installer must be present tfor this inspection. o work and alarm to f With pump system all electrical work must be ready and able to causep p n. c) Final Grade — Installer must request inspection when all grading is complete. Does not have to be on site. perform the work (other than simple excavation) 4. As the installer I understand that only I.may p required 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 to operate in the Town of North Andover; significant fines to all persons involved are also possible. 5. As the Installer I understand that I must be on site during the performance of the following construction. steps: a) Determination that the proper elevation of the excavation has been reached. b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff or consultant. d) Installation of tank, D -box; pipes, stone, vent, pump chamber, retaining wall and other components. 6. As the installer I understand that I am solely responsible for the installation of the system as per the approved pians. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersigne 5 ensed Septic Installer Date: isposal Works Construction Permit # a to s; ori O 2 0 0 G CO) � cyp 0 � (D a a o = is cQ y 3 -n 3 O O 1 3 00 nPO n y 3 O CD fp C 2 (n 4 y O ZZ Z O O O V! � Z m• y CD O ai 0 0 0 r �D 3 O 3 01 n Cn d o CDCD a CL s a o a y d C O a to s; i O r r i O a v CD CD E AONTN ,. " ... Town of North Andover HEALTH DEPARTMENT ,s'SAC14 CHECK #: 00� 4/0v� LOCATION: H/O NAME:-�,L��ZG'�-� CONTRACTOR NAME:c�'/a,44& 69' Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ 'S ❑ 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) $ ❑ Title 5 Inspector $ LC7-O`I'itle 5 Report $ ❑ Other. (Indicate) $ 1755 Health Agent Initials White - Applicant Yellow - Health Pink - Treasurers, Y , W COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: _1725 Salem Street —North Andover_ Owner's Name: Larry Hammer Owner's Address: _1725 Salem Street North Andover, MA 01845_ Date of Inspection 8/3/2006 Name of Inspector: Neil J Bateson_ Company Name: Bateson Enterprises Inc._ Mailing Address: _111 Argilla Road_ _Andover, Ma. 01810_ Telephone Number: _( 978 ) 475-4786_ RECEIVED AUG 1 1 2006 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 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 Tide 5 (310 CMR 15.000). The system: Passes X Conditionally Passes Needs Further Evaluation by the Local Approving Authority aUs Inspector's Signature: &1&7ate: 8/3/2006_ 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. y 1/4,t. Page 2 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1725 Salem Street _ North Andover_ Owner: —Hammer— Date HammerDate of Inspection: 8/3/2006 _ 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. Answer yes, no or not determined (Y,N,ND) in the for the following statements. If "not determined" please explain . Replace crushed outlet pipe. 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 exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: y 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): Y 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: Page 3 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: _1725 Salem Street- - North Andover— Owner: _Hammer_ Date of Inspection: 8/3/2006 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 fat 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: _1725 Salem Street _ _ North Andover— Owner: _Hammer_ Date of Inspection: 8/3/2006 _ D. System Failure Criteria applicable to all systems: You must indicate "yes" or "no" to each of the following for all inspections: _ _No_ Backup of sewage into facility or system component due to overloaded oroggedAS clSor 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'h 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 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 YYou must indicate either `yes" or "no" to each of the following: (Tile following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply _ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: _1725 Salem Street _ _ North Andover _ Owner: _Hammer_ Date of Inspection: 8/3/2006_ 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? Yes Was the facility or dwelling inspected for signs of sewage back up ? Yes Was the site inspected for signs of break out ? Yes Were all system components, excluding the SAS, located on site ? _Yes_ _ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum ? _Yes_ _ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems ? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: Yes No _Yes_ _ Existing information. _Yes_ _ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] Page 7 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _1725 Salem Street _ North Andover _ Owner: _Hammer_ Date of Inspection: 8/3/2006 BUELDING SEWER _ X _ (locate on site plan) Depth below grade: _18" _ Materials of construction: _X_ 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 " Cast iron thru wall, 3" PVC in house no leaks visible SEPTIC TANKS: X 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: _10' x 5' x 4' Sludge depth 4"_ Distance from top of sludge to bottom of outlet tee or baffle: 23" _ Scum thickness: _4" Distance from top of scum to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: _17"_ How were dimensions determined: _Tape Measure _ Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc Inlet tee ok. Outlet tee ok. Depth of liquid above outlet invert. Found collapsed section of pipe. No evidence of septic tank leaking in or out. GREASE TRAP: (locate on site plan) Depth below grade: _ Material of construction: _concrete _metal _fiberglass polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Page 8 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _1725 Salem Street_ _ North Andover— Owner: _Hammer_ Date of Inspection: 8/3/2006_ 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 BOXS: _X_ Depth below grade _ 18"_ Depth of liquid level above outlet invert: _0"_ Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.):_ D -box level & distribution equal. No leafage. Light carryover _ PUMP CHAMBER: _ (locate on site plan) Pump in working order (yes or no): _ Alarm in working order (yes or no): _ Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Page 9 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _1725 Salem Street _ _ North Andover— Owner: _Hammer_ Date of Inspection: 8/3/2006 SOIL ABSORPTION SYSTEM (SAS): R (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: 5 trenches 32' long_ — leaching field, 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 oL No sign of ponding to surface._ CESSPOOLS: Number and configuration: _ Depth — top of liquid to inlet invert: Depth of sludge 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: (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 O FFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1725 Salem Street _ North Andover— Owner: _Hammer_ Date of Inspection: 8/3/2006_ 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 Page 11 of 11 + OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _1725 Salem Street _ _ North Andover_ Owner: _Hammer_ Date of Inspection: 7/21/2006 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water _ 4' _ Please indicate (check) all methods used to determine the high ground water elevation: X Obtained from system design plans on record - If checked, date of design plan reviewed: _6/30/1982_ 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: _ Original design plan _ Summary Record Card generated on 7/18/2006 1:31:06 PM by Lisa Warren Page 1 Town of North Andover Tax Map # 210-1063-0086-0000.0 1725 SALEM STREET LAWRENCE D.HAMMER 1725 SALEM STREET N. ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Size Total 1.03 Acres FY 2006 UB Mailing Index Name/Address Type Loan Number LAWRENCE D.HAMMER Payor 1725 SALEM STREET N. ANDOVER, MA 01845 UB Account Maint. Active/Inact. From Account No Cycle Occupant Name Bldg Id. 17467.0 - 1725 SALEM STREET Last Billing Date 7/5/2006 3170137 03 Cycle 03 UB Services Maint. w Water Consumption Service Code 23 Rate MISCFEE ADMIN FEE 4/17/2006 0.635/8 WTR WATER 75 01 ALL METER SIZE UB Meter Maintenance 7/15/2005 Serial No Status 4/5/2005 Location 13242661 a Active ERT HH Date Reading Code 6/13/2006 277 a Actual 3/6/2006 254 a Actual 12/21/2005 243 a Actual 9/14/2005 210 a Actual 6/9/2005 135 a Actual 3/9/2005 122 a Actual 12/13/2004 108 a Actual 9/15/2004 85 a Actual 6/21/2004 37 a Actual 4/12/2004 19 a Actual 12/11/2003 0 n New Meter Active/Inactive Active Charge Multiplier/Users 7.82 1 / 80.34 /1 Brand Type METE METE w Water Consumption Posted Date 23 7/10/2006 11 4/17/2006 33 1/17/2006 75 10/14/2005 13 7/15/2005 14 4/5/2005 23 1/14/2005- /14/200548 48 10/8/2004 18 7/30/2004 19 5/17/2004 0 12/11/2003 Size 0.63 0.63 Until YTD Cons 0 Variance 58% -56% -56% 447% -13% -37% -54% 117% 66% 0% 0% 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: 1725 Salem Street, North Andover Owner: Hammer Date of Inspection: 8/3/2006 My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic system. Neil . B eson Bateson Enterprises, Inc. SALEM CP✓aL-Ic - TRELT S 4Z*- 09!ZO-E — - -- .. -- , . L. it 1.74' 150.00` +i �1 mI ,� X IQ 725' �_ T 5-1 � Z- L,� T 0 50 cc i .09 Aa. 1.0 5 Ac. 7 L -n N y�y To `� T � ►'t' A,G.Il� Z r 3 i�° � op �� < 0 L�,- S 0 ok Q � N 0 t3 0 mffrJI;I'Iw�m- I&o 00� N 4t�-09- JGa ORGG N >j w/►NpA f�.rea 11 F. in A i � Q �s aw tA a _o G F q L c r s- t X4,-1 4 , . FORM 4 hr ORDER OF CONDITIONS .:_ WETLANDS PR0T.E_C-T.I ON ACT G.L. C. 131, s. 40 and under Town of North Andover By Law, Chapter 3 Section 3_5 A & B_______-_. CITY/TOWN NORTH ANDOVER NAME George Farr CERTIFIED MAIL NUMBER , 9. PROJECT x Address LOCATION:- Lot -48A Salem -Street Recorded at Registry of Certificate (if registered) REGARDING: - FILE NUMBER 242- 185 ADDRESS 263 Raleigh Tavern Ln. North Andover, MA North Essex , Book 1087 page 314 Notice of Intent Dated February 18, 1983 and plans titled and dated see condition eleven (11) THIS ORDER IS ISSUED ON (date) April 5, 1983 Pursuant to the authority of G.L. c. 131, s. 40, the North Andover Conservation Commission has reviewed your Notice of Intent and plans identified above, an as determined that the area on which the proposed work is to be done" is significant to one or more of the interests listed in G.L. c.. 131, s. 40. Town of North Andover bylaws, Section 3.5 A & B Wetlands Protection. The North Andover Conservation Commission hereby orders that the following conditions are necessary to protect said interests and all work shall be performed in strict accordance with them and with the Notice of Intent and plans identified above except_where_such plans_are modified by_said conditions. CONDITIONS 1. Failure to comply with all conditions stated herein, and with all related statutes and other regulatory measures, shall be deemed cause to revoke or modify this order. 2. This order does not grant any property rights or any exclusive privileges; it does not authorize any injury to proviate property or invasion of private rights. 3. This order does not relieve the permittee or any other person of the necessity of complying with all other applicable federal, state or local statutes, ordinances, by-laws and/or regulations. 4. The work authorized hereunder shall be completed within one (1) year from the date of this order unless it is for a maintenance dredging project subject to Section 5(9). This order may be extended by the issuing authority for one or more additional one-year uper application to the said issuing -authority at least thirty �eriods 30) days prior to the Pxpi.ration date of the order or its extension. :h -OF CONDITIONS CONTINUED - 2 - FILE NO. 242- 185 Any fill used in connection with this project shall be clean fill; containing no trash, refuse, rubbish or debris, including without -limitingthe generality of the foregoing,lumber bricks lasfer, 8 Y � , P , wire,lath, paper, carboard, pipe, tires, ashes, refrigerators,. motor vehicles or part's of any of the foregoing. 6°. No work may be commenced until all appeal periods have elapsed from the order of the Conservation Commission or from a final order by the Department. of Environmental Quality Engineering. 7.. No work shall be undertaken until the final order, with respect to the proposed project, has been recorded in the Registry of Deeds for the district in which the land is located within the chain of title _ of the affected property. Thi Document number indicating such recording shall be submitted on the -form at the end of this order ._. to the issuer of -this order prior to commencement of work. 8. A sign shall be displayed at the site not less that two square feet or more than three square feet bearing the works, "Massachusetts Department of Environmental Quality Egnineering. Number 242- 185 ". 9. Where the Department of Environmental Quality Engineering is requested to make a determination and to issue a superseding order, the Conser- vation Commission shall be a party to all agency proceedings and hearings before the Department. 10. Upon completion of the work described herein, the applicant shall forthwith request, in writing, that a Certificate of Compliance be. issued stating that the work has been satisfactorily completed. 11. The work shall conform to the following described plans and additional conditions: a. Notice of Intent dated February 18, 1983/prepared for George Farr/prepared by :Kaminski, Gelinas and Assoc./Seven (7) pages. b. Llan titled "Subsurface Dispdsal System Design for Lot 48A Salem Street."/Prepared for George Farr/Prepared by Kaminski, Gelinas and Associates, Inc./Dated November 15, 1982 and revised January 3, 1983/One (1) sheet. 12. n double rot, of stalked hay bales shall be placed between all construction areas and all wetland areas as delineated on the above referenced plan. This row of hay bales shall also be placed between any stockpiled material and wetland areas, as delineated on the above referenced plan. This hay bale barrier shall be erected prior to the commencement of any work, and shall be inspected and approved by at least two Co«uaission menbers prior to the co d-nencement of any work. - 3 - ORDER OF CONDITIONS: 242-185 13. Upon completion of construction and grading, all areas shall be stabilized permanently against erosion. This shall be done either by sodding, mulching according to Soil Conservation'Service standards, or by loaming and seeding. If the latter course is chosen, stabilization will be considered once the surface shows complete vege- tative cover has been achieved. 14. Once stabilization has occurred, the hay bale barriers may be removed and utilized as.additional mulch, or removed from the site. 15. All erosion prevention and sedimentation protection measures found necessary during construction by the North Andover Conservation Commission will be implemented at the direction of the NACC or Highway Surveyor. 16. Any changes in the submitted plans, Notice of Intent or resulting from the aforementioned conditions must be sub- mitted to the NACC for approval prior to implementation. If the NACC finds, by majority vote, said changes to be significant arid/or deviate from the original plans, Notice of Intent or this Order of Conditions to such an extent that the interests of the Wetlands Protection Act cannot be pro- tected by this Order of Conditions and would best be served by the issuance of additional conditions, then the NACC will call for another public hearing within 21 days, at the ex- pense of the applicant, in order-.ta;take testimony from all interested parties. Within -21 days,of the close of said public hearing, the NACC will issue an amended or new Order of Conditions. 17. Any errors found in the plans or information submitted by the applicant shall be considered as changes and procedures outlined for changes shall be followed. 18. The provisions of this Order shall apply to and be binding upon the applicant, its employees, and all successors and assigns in interest or control. 19. Prior to the issuance of a Certificate of Compliance, the applicant shall submit a letter to the Conservation Commission from a registered professional engineer certifying that the work is in compliance with the plans referenced above and the conditions stated above. - 4 - ORDER OF CONDITIONS: 242-185 20. Members of the NACC shall have the right to enter upon and inspect the premises to evaluate compliance with this Order of Conditions. 21. Accepted engineering and construction standards and procedures shall be followed in the completion of the project. 22. Issuance of these conditions does not in any way imply or certify that the site or downstream areas will not be subject to flooding, storm damage, or any other form of damage due to wetness. I V .`(`� F• C�.. CONDITIONS C0'%'TTtiL1Fn :The P.pplicant, any person aggrieved by this order, any owner of land 44 `4s utting.the land upon which the proposed -work is to be done, or any .ten Asi.dents of the city or town in which such land is located, are hereby n"btifi.ed of their right to appeal this order of the Department of Environ- mental Quality Engineering. provided the request is made in writing and by certified mail. to the Department within ten (10) days from the issuance of .this order. ISSUED BY NORTH ANDOVER CONSERVATION COMMISSION ��l.S�ll�ii!Il✓/��JQJSsr s�ii i i On this 5th day. of April 1983 , before me personally appeared Anthony Galvagna to me known to, e t e person described in, and who executed, the foregoing instrument and acknowledged that he executed the same as his free act and deed. My Commission expires�j/,. DETACH ON DOTTED LINE AND SUBMIT TO THE ISSUER OF THIS ORDER PRIOR TO COMMENCEMENTOF OF WORK. To NORTH ANDOVER CONSERVATION COMMISSION (Issuing Authority) PLEASE BE ADVISED THAT THE ORDER OF CONDITIONS FOR THE PROJECT AT FILE NUMBER 242 - REGISTRY OF HAS BEEN RECORDED AT THE ON (DATE) If recorded land, the instrument number which identifies this transaction is If registered lands t e document number which identifies this transaction is Signed Applicant TRANSMISSION VERIFICATION REPORT TIME 0710512006 09:57 NAME HEALTH FAX 9786888476 TEL 9786888476 SER.# 000B4J120960 DATE DIME 07105 09:55 FAX NO./NAME 89786873125 DURATION 00:01:49 PAGE(S) 09 RESULT OK MODE STANDARD ECM North Wooer Health benartment 1600 Osgood Street Building 20, Suite 2.36 North Andover, MA 01845 978.688.9540 - Phone 978.688.8476 — Fax heolthde townof o thandover'co - E-mail www-toymofnorthandov_er.com - Website Letter of Transmittal page /_ of TO: DATE: COMPNY:7FROM: Pamela DelleChiaie, I Phone: Fox: WO are sending you: O Cagy ofletter ON= G7 other f It by helowj These are transmitted as checked below: Department a Q9_C awe w , R �a311 a� F ©l �i� apiefw ➢ Mff rawlfw ➢ Os mp s rafst, TRANSMISSION VERIFICATION REPORT TIME 07/05/2006 09:54 NAME HEALTH FAX 9786888476 TEL 9786888476 SER.# 000B4J120960 DATE DIME 07/05 09:54 FAX NO./NAME 89786873125 DURATION 00:00:00 PAGE{S} 00 RESULT BUSY MODE STANDARD BUSY: BUSY/NO RESPONSE North Andover Health De artrnent 1600 Osgood Street Building 20, Suite 2.36 . North Andover, MA 01845 978.688.9540 - Ph6ne 978.688,8476 — Fax ealthd®t ow ofnort andave .com . E-mail ►u�ww.t0wnofno_rMAndover.eom ► Website Letter of Transmittal Page_, of� 4 W0 ore sending you.• 1,7 Copy of Letter, 17plans O drhertrill is 6elowl These are transmitted as checked below: ➢ 174 ➢ X > 0AsAgAnd TO: ➢ Okrlkvaew*dwMMw A L7&ror & a for qpva North Andover Health Department 1600 Osgood Street Building 20, Suite 2-36 North Andover, MA 01845 978.688.9540 - Phone 978.688.8476 — Fax healthdeat D-townofnorthandover com - E-mail www.townofnorthandover.com - Website TO: COMPANY: 0 Phone: �� /, Fax: Letter of Transmittal Page _/ of _ V"000, � < .ti `� O ♦wK. _ 'per COCKICKIWK• • DATE: S ®b FROM: Pamela DelleChiaie, Health Department Assistant RE: We ore sending you: O Copy of Letter O Plans O Other (fi// in below) These are transmitted as checked below: ➢ O oNofad >* ➢ D*Reow ➢ OkrlPe►aewanr/ainu�erri ➢ L7Pmuk* w* for qpv"i Ororrowym ➢ OSubiif apiesforaist. REMARKS: COPY TO: COPY TO: COPY TO: SIGNED: TO: NORTH ANDOVER, r-IASS . BOARD OF HEALTH FROM: DESIGN ENGINEER Re: July 30 1984 Soil Absorption Sewage Disposal System This is to certify that I have reviewed the construction materials of said disposal system at Lot 48B Salem �trAA� Site Location North Andover, Mass. The grades and construction materials are as specified in the plans and specifications dated January 3 19 83 and As -Built July 27 19 84 Reg.Prof 0 . vuaal t-U11CG 11 � lw Al OT 41A, taw, I. W;Ll fAMM PLACE MIL NO. 3 ST EL VAT . Lt�V. PiPG lj-r OF H -T /JQ 4!tl L - lwy. P-)P.f= ktQ-ro -t�- V4 uTOP v�91e'F—O,thWV_ j�Oj ;,67 U; k— 6 'Dl �E -NV ViVE iNTO P. �O p- p I AtjL>C>V E V, MA, 40 3� Qo 26, _*;oo o C oQ FAP -e' PC J.'N-r tS, I Q F -E- e. S , 2 C T 5- zl� 41 C' E L E VAT % 0" 5 . Ile 514N Afo eWrt LT ue,G n LOT .4I'A >, , 'Ir` ' ���,ry��".._. `•f � Air ry t, WILLIAM 'i ACF. amu+ CIV,L, �. et ,d, 5 E) U I.L-T 5 U5'u rz.E p s voSA --- CYST EM ,Nj I vr; TH APD 01./Ei2 NAA; �crz fig 12 Widen k Mr�'j k'_, L�N17 PLONNE.25 ,QND SU0� Ei -"rn C- b, t -j (7 Q \./ E -dr-.Iao\./EPf:IGE 'Pl\-e_IL i gnu NEW WORM ■ .. ;Z%■ ■ n LOT .4I'A >, , 'Ir` ' ���,ry��".._. `•f � Air ry t, WILLIAM 'i ACF. amu+ CIV,L, �. et ,d, 5 E) U I.L-T 5 U5'u rz.E p s voSA --- CYST EM ,Nj I vr; TH APD 01./Ei2 NAA; �crz fig 12 Widen k Mr�'j k'_, L�N17 PLONNE.25 ,QND SU0� Ei -"rn C- b, t -j (7 Q \./ E -dr-.Iao\./EPf:IGE 'Pl\-e_IL i E LEVAT+ 0" 5. DES %' 4 t+ A S 6 %--t I " V OI DP � 0 T OF NSE ,^S-`7- J04.71 LOT A -7 A PEACE CIVIL ,A S ED U 1 i_. -i. SyE5- S U RZ P',Ax,-F. D I S` vosAt_._ SY�5T EM - - - --- f�1o2?.H A"D'OvE� F c cz K.i f dKj I1TE1 =h ��rfp Pt Or.1`�tE2- �\aND Su2vEYC�� `� NG�TI-4 QNV0GE MWAS1121 i ' OWN LOT A -7 A PEACE CIVIL ,A S ED U 1 i_. -i. SyE5- S U RZ P',Ax,-F. D I S` vosAt_._ SY�5T EM - - - --- f�1o2?.H A"D'OvE� F c cz K.i f dKj I1TE1 =h ��rfp Pt Or.1`�tE2- �\aND Su2vEYC�� `� NG�TI-4 QNV0GE North An ver Haas. SEPTIC SISTkA IN STALLATIOM CHECK LIST LOT' i ;,4e �✓L�f . CNID DATE DIWPRGM — — ATI(�i OK FAIL FM OK _ v^ 1. Distance Tot /tfv7- AD a. Wetlands b. Drains C.. Well 2. Water Line Location 3-- No PVC Pipe 4. Septic Tank - a. _Tees -_Length & To Clean Out Covers.... b. Cement Pipe to Tank - On Both Sides of Tank -- _ 5. Distribution Box - a. Covers & Box - No Cracks b. All Lines Flo OM9 Equal Amolmts c. No Back Flow Leach Field or Trench • a. Dimensions b.. Stone- Depth ---- -Ce Capped .Ends _ . d.- Clean Double Wa hed_Stone: - - - - ?• Zeach,..-Pit's- ' a. = Diiasnsions - ` 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. ^ glnal Gradin Inspection _- - T -- - _ 10. Barricading Covered. System ` _. 71. - As Built Submitted_ - - - a. Lot Location - - b. Dimensions of System - - c. Location jtLth HegarcLto Perc Test _ -- - d. Elevations - e. Water Table - - - i i rc. of Et nl" SUBS7i RFACE DISPOSAL DES M CHWK LIST` LOT Skee A --ir, , APPROM DATE i2 B2 1 DISAPPROM DATE________ Provided: ` Reasons: 1 Usoa� pig, ' �ct/l� GRID oo& 5r 5 5 Z Z Title V FAIL CK ,i� P��''fs� 9�1 Cwv (oo't -9bw�4 Reg 2.5 a submitted plan must show as a minimum: the lot to be served -area, dimensions lot #,abutters location and log deep observation hoes -distance to ties location and results percolation tests -distance to ties design calculations & calculations showing required leaching area ,location and dimensions of system -including reserve area existing and proposed contours g) cation any wet areas within 100' of sewage 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 within 100' of sewage disposal system or disclaimer -Planning Board files (j) known sources of water supply within 200' of sewage disposal tl system or disclaimer () location of azW. proposed well to serve lot -100' from leaching facilit; location of water lines on property -IA' from leaching facility cation of benchmark rq) driveways I disposals no PVC to be used in construction profile of system -elevations of basement, plumb, pipe, septic tank, distribution box inlets and outlets, distribution field piping and other elevations r) maximum ground water elevation in area sewage disposal system (s) plan must be prepared by a Professional E gineer or other professional authorized by law to prepare such plans Reg 6 Reg 10.2 'leg 10.4 Septic Tanks a) capacities -15U of flow, wester table, tees, depth of tees, access, puaping cleanout 10' from cellar wall or inground swimming pool d) 25' from subsurface drains Distribution Boxes slope greater than 0.08 SUM r 2,b �� �v f 'SIL !'Ace Ur :;I Cher? FAIL 0K Reg 11.2 11.4 11.10 1i.n Reg 15.1 15.4 15.8 3.7 Reg 14.1 14.3 14.4 1.4.6 14.7 14.10 Reg 9.1 9.6 List P4^e 2 Leaching Pits Leaching pits are preferred where the installation is possible a) calculations of 1 g area-minimnm 500 eq ft b) spacing c) surface a 2% d) cover mate al e) 2' x:2' x4" splash pad f) tee a elbow g) no ds in pipe from d -box to pipe /L chingFie_lddss greater than 20 minutes/inch minirmiat 900 aq ft ¢construction of field face drainage 2 % e) 20' from cellar wall or inground swimming pool Leaching Trmche a) calculations eaching area -r n 500 aq ft b) spacing -4 min 6 ft with reserve between c) dimensi0 �rface drainage 2% Dowahi.11 Slope x slope y - to be shown) y/x X 150 = (to be shown) a} roval b stand-by power SOIL PROFILE & PERCOLATION TEST DATA North Andover, Mass. Street No /G, -Y7 Lot No 48• Loc/Subdiv. Pland Owner r Investigator Z<22=j66tn /,�_ Observer SOIL PROFILE DATES 1.tlev 2.Elev 3•Elev 4.Elev Benchmark Elevation 1 2 \9f Q �3 4 5 6 7 8 Z 0 1 2 3 4 5 6 ii 0 1 2 3 4 5 6 7 8 Tiesto Test Pits 1 9 9 9 10 10 10 s• S��� Location � , A Datum PERCO;,ATION TESTS �ji2 s1r�r `1 DATES /3/A 7 Pit Number J 0� n, n Benchmark Elevation 1 2 \9f Q �3 4 5 6 7 8 Z 0 1 2 3 4 5 6 ii 0 1 2 3 4 5 6 7 8 Tiesto Test Pits 1 9 9 9 10 10 10 s• S��� Location � , A Datum PERCO;,ATION TESTS �ji2 s1r�r `1 DATES /3/A 7 Pit Number Start Saturation • - 11'li!1i6�!'�'11 � � ALMS �l�l,■'ll�'1�1"l� Lia-' • • of • 11 'MW AV Percolation SOIL PROFILE & PERCOLATION TEST DATA North Andover, Mass. Street No =1ee7-j Lot N62,50 - Loc Subdiv. Pland Owner 7r Investigator A�ap Q /d Observer—2 ✓ SOIL PROFILE DATES l..tl.ev I 2.Elev_ 3.Elev 4.Elev � 1 D� 2 3 Y4 5 6 7 8 9 10 Benchmark Elevation 01 E C' 4 5 �u 6 7- 1 2 3 4 5 6 7 8 Ties Pits est 1- � 3 9 9 a/d ys y to to Location sviL i7oN ' rT �C l� Datum T/ L J PERCO;ATION/ TESTS DATES 0/3/AI'L-11Olt/ Pit Number Start Saturation ... „- MAN .. � +' .. Percolation J �- C Commonwealth. of Massachusetts _ City/Town of ! RFCEI System Pumping Record SEP - 679nn\� Form 4 TOWN OF NORTH ANDOVER DEP has provided this form for use by local Boards of Health.. ILtt:yiste`t%)?2iN rd must be submitted to the local Board of -Health or other approving authority. . X Facility Information Important: When filling out 1. System Location: (� fomes the compute r, use ' only the tab key Address to move your L e��J- `= e ' " • ty cursor - do not � use the return City/Town State Zip Code key. 2. System Owner: B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons I Type of system: Q Cesspools) eptic Tank ❑ Tight Tank ❑ Other (describe)` 4. Effluent Tee Filter present? ❑ Yes Q -W If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: http://www.mass.gov/dep/Water/approvals/t5forms.htm#inspect t5form4.doc• 06103 System Pumping Record • Page 1 of 1
