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HomeMy WebLinkAboutMiscellaneous - 187 OLD CART WAY 4/30/2018 (2)9 I ro ro r ,-4 1-3 v o 60 n o a V ;O C'+ p m O H txjz WATER SUPPLY: TOW WELL WELL PERMIT \� DRILLER WELL TESTS: ..PHEMICAL DATE APPROVED BAC RIA I DATE APPROVED....---..._-._-.__-._-_. BACTE\IIDATE APPROVED. _ COMMENTS: FORM U APPROVAL= APPROVAL TO ISSUE YES NO DATE ISSUED.�Ii /o� r/�� BY 1 CONDITIONS: - FINAL APPROVAL: ALL PERMITS PAID c YES_: NO WELL CONSTRUCTION APPROVAL YES NO SEPTIC SYSTEM CONSTRUCTION APPROVAL C YES NO ..OTHER YES NO ANY VARIANCE NEEDED C7Y._NO FINAL BOARD OF HEALTH APPROVAL: DATE: ,•.;.� �EPTI�$_Y_S�.E.M_�.N.�.I9.4L.,.A�C�_QN. . JS THE INSTALLER LICENSED? YES-,) NO { - _ - TYPE OF CONSTRUCTION: - NEW REPAIR ., NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW �YFS_ NO CONDITIONS OF..APPROVAL ES NO (FROM FORM U) ISSUANCE OF DWC PERMIT . ___S J) NO "'DWC J INSTALLER:T PERMIT NO.q BEGIN INSPECTION YESES)N0: EXCAVATION�INSPECTION: NEEDED: 'PASSED BY CONSTRUCTION INSPECTION: NEEDEDz AS BUILT PLAN SATISFACTORY: APPROVAL TO BACKFILL: DATE: APPROVAL: DATE BYl�v__._:_� BY FINAL.GRADING FINAL CONSTRUCTION APPROVAL: DATE: By : Commonwealth of Massachusetts City/Town of RECEIVED System Pumping- Record Form 4 JUL I b 701� TOWN OF NORTH A' 00y'R DEP has provided this form for use -by local Boards of HeWCSn'tf1 �NM"ay be'used, but the information must be substantially the same as that provided here. Before using.this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility. Information 1. System Location: Left/ Right front of house, Left/ Righrea�f house, Left / h side of ho Left/ Right side of building, Left / Right front of building, Left Wight near of building, Under deck Address `! 7 Cityfrown State Zip Coale 2. System Owner. Name Do')_o �a Address (if different from location) Cilylrown � .. State _ ? Telephone Number B. Pumping ,Record 4a 1. Date of Pumping Date 2. Qua tity Pumped: Gallons 3. Type of system: E]Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes If yes, was it cleaned? ❑ Yes ❑ No, " 5. Condition of �ys�em: 6. System Pumped By: Neil. Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc- Company ncCompany 7. Location where contents were disposed: S: Lowell Waste Water Sign aqt HaulmUDate t5form4.doc• 06/03 . System Pumping Record •Page 1 of 1 r ` Commonwealth of Massachusetts \j ?� City/Town,"of NORTH ANDOVER MASSACHUSETTS - System• Pumping Record Form 4 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. DEP has provided this form for use by local Boards of Health. The System Pumping Record mu: be submitted to the local Board of Health or other approving author y. ,=ko - NED —I A. Facility Information 1. System Location: Address City/Town . —_ __•—_ 2. System Owner: � icy -Pam Name Address (if different from location) DEC 6 2006 TC��" '•' Jr 1� R H AND©VER Zip Code—�----'----._.. City/Town — _..'------- State -------- Telephone Number B. Pumping Record °��.Date of Pumping Date -- 2. Quantity Pumped: Zip Code Gallons 3. 1 Type of system: ❑ Cesspool(s) 'Septic Tank ❑ Tight Tank ❑ other (describe): -- --- - 4. Effluent Tee Filter present? ❑ Yes [�J No If yes, was it cleaned? Cy' Yes ❑ No r 5. Condition of System: 6. Sy em Pumped By: Name_ N _ ---- Vehicle License Number Company / 7. Location where contents were disposed: 107 Si ature of Hau — — _Jfh----- — --- --- — Date http://www,ma'ss-gov/dep/water/ provals/t5forms.htm#inspect t5form4.doa 06/03 System Pumping Record • Page 1 of 1 TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD � �1'EI1r1 OWNER & ADDRESS JAf� 0 2003 SYSTEM LOCATION ' (example; left front of house) LU \"I,E OF PUMPINC: Ion I QUANTITY PUMPED 1506 CALL0.', ;. 1:�S1'00L: NO YES SEPTIC TANK: NO YES � ATURE OF SERVICE: ROUTINE & EMERGENCY l)13>FRV.:\TIONS. GOOD CONDITION_ HEAVY CREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER i PUMPCD BY: c UM,I FNTS: � UNI I:'NTr tlZANSFEIZRED TO: FULL TO COVE, k BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED Oj�HFR (EXPLAIN) 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: 187 Old Cart Way f North Andover, MA Owner's Name: Santos AUG 2 5 2003 F Date of Inspection: 8-18-03 .y 1 Name of Inspector: John Soucy Company Name: Soucy Sewer Service, Inc. Mailing Address: 830 Livingston Street Tewksbury, MA 01876 Telephone Number: 978-851-8839 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: Inspector's Signature: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails /^ Date: 8-18-03 The system inspector shall submit opy of this ijqbction rep rt to the Approving Authority (Board of Health or DEP) within 30 days of completi4 this inspection. f the systeh4s 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. Page 2 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Property Address: Owner: Date of Inspection: PART A CERTIFICATION (continued) 187 Old Cart Way North Andover, MA Santos 8-18-03 Inspection Summary: Check A,B,C,D or E / ALWAYS complete all of Section D A. System Passes: _X_ 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. Answer yes, no or not determined (Y,N,ND) in the 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. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is leveled or replaced ND explain: 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 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address 187 Old Cart Way North Andover, MA Owner: Santos Date of Inspection: 8-18-03 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: _ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: 187 Old Cart Way North Andover, MA Santos 8-18-03 D. System Failure Criteria applicable to all systems: You must indicate "yes" or "no" to each of the following for all inspections: Yes No _ X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X 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 _ X Liquid depth in cesspool is less than 6" below invert or available volume is less than'/2 day flow AP p�Q \— X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _ X Any portion of the SAS, cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ X Any portion of a cesspool or privy is within a Zone 1 of a public well. _ X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] NO (Yes/No) The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either "yes" or "no" to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area – IWPA) or a mapped Zone 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: 187 Old Cart Way North Andover, MA Owner: Santos Date of Inspection: 8-18-03 Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes No x _ Pumping information was provided by the owner, occupant, or Board of Health x Were any of the system components pumped out in the previous two weeks ? x ` Has the system received normal flows in the previous two week period ? x Have large volumes of water been introduced to the system recently or as part of this inspection ? x _ Were as built plans of the system obtained and examined? (If they were not available note as N/A) x _ Was the facility or dwelling inspected for signs of sewage back up ? x _ Was the site inspected for signs of break out ? x _ Were all system components, excluding the SAS, located on site ? x_ 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 ? x _ 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 x _ Existing information. For example, a plan at the Board of Health. x Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [3 10 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 187 Old Cart Way North Andover, MA Owner: Santos Date of Inspection: 8-18-03 FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): _4_ Number of bedrooms (actual): _4_ DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 440 Number of current residents: _3 Does residence have a garbage grinder (yes or no): no Is laundry on a separate sewage system (yes or no): no [if yes separate inspection required] Laundry system inspected (yes or no): no Seasonal use: (yes or no): Water meter readings, if available (last 2 years usage (gpd)): See Attached Sump pump (yes or no): no Last date of occupancy: current COMMERCIAL/INDUSTRIAL N/A Type of establishment: Design flow (based on 310 CMR 15.203): gpd Basis of design flow (seats/persons/sgft,etc.): Grease trap present (yes or no): _ Industrial waste holding tank present (yes or no): Non -sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER (describe): GENERAL INFORMATION Pumping Records Source of information: Home Owner Was system pumped as part of the inspection (yes or no): yes _ If yes, volume pumped: 1500 gallons -- How was quantity pumped determined? Gauge on truck Reason for pumping: maintenance and inspection of tank interior. TYPE OF SYSTEM X Septic tank, distribution box, soil absorption system _ Single cesspool Overflow cesspool Privy _ Shared system (yes or no) (if yes, attach previous inspection records, if any) _ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) Tight tank _ Attach a copy of the DEP approval Other (describe): Approximate age of all components, date installed (if known) and source of information: 1995 Were sewage odors detected when arriving at the site (yes or no): No Page 7 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 187 Old Cart Way North Andover, MA Owner: Santos Date of Inspection: 8-18-03 BUILDING SEWER (locate on site plan) Depth below grade: 25" Materials of construction: _cast iron _40 PVC –x—other (explain): Distance from private water supply well or suction line: N/A Comments (on condition of joints, venting, evidence of leakage, etc.): SEPTIC TANK: x (locate on site plan) Depth below grade: _3'_ 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: 6'x 11' Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 38" Scum thickness: Distance from top of scum to top of outlet tee or baffle: 7" Distance from bottom of scum to bottom of outlet tee or baffle: 14" How were dimensions determined: tope & sludge tool Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): GREASE TRAP: _(locate on site plan) N/A 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: 187 Old Cart Way North Andover, MA Owner: Santos Date of Inspection: 8-18-03 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) N/A Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain):. Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present (yes or no): Alarm level: Alarm in working order (yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): DISTRIBUTION BOX: x (if present must be opened)(locate on site plan) 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.): flow checked okay PUMP CHAMBER: (locate on site plan) N/A Pumps in working order (yes or no): Alarms in working order (yes or no): Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Page 9 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 187 Old Cart Way North Andover, MA Owner Santos Date of Inspection: 8-18-03 SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan, excavation not required) If SAS not located explain why: Type leaching pits, number: leaching chambers, number: leaching galleries, number: x —leaching trenches, number, length:_ (3)3'x33' leaching fields, number, dimensions: overflow cesspool, number: innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No Sign of Hydraulic Failure. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) N/A Number and configuration: Depth — top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow (yes or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIVY: (locate on site plan) NIA 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 I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 187 Old Cart Way North Andover, MA Owner: Santos Date of Inspection: f —Ir — 03 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. A5 311ILT ELEIIIT�oNS: ZIILi1lIYt �J. ..1�.r In�P = \f�(e•1J . .ISL' _EI�U't A) t3St�-r• . 1`1'•1.7 J-0.SC1110 PIPL INV. P Q,Loc, 19 .1 SL" 40 PI le 1Nv %W E- ST, c 175, vt" 9 c0 BCH )O PI^(- 114V 01;'0 G7-, _ /7J./L o rivr /Nv /.v -,,-) u- P -ox -1`1'� 4"Of5::H40 1'/•'E /A'v v✓r• 0 ti-CoX_ 1'7V.-76 t�J'�f;�• 'C/1 10 /Nd cl'cvv rer/ = P,s: 6.3 9'r0 << //-,•_> fi /t/t H% /N L. 7/ �.: 1"73.31 } p1 _"•C/ -t,' 'i:r%" //Vv rJ 6-N7TiC.'Z' =/7.13 P/.�/ /rid F' ;'-IV Tv7C'' r` I 'r /3u/c EAS Fr1FN7_ E ('-, r%— �o1,�ING i�' I • v x L ,•, � Com►-z.E- w,9. , Page 11 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 187 Old Cart Way North Andover, MA Owner: Santos Date of Inspection: 8-18-03 SITE EXAM Slope Surface water Check cellar X Shallow wells Estimated depth to ground water 10' feet plus. Please indicate (check) all methods used to determine the high ground water elevation: Obtained from system design plans on record - If checked, date of design plan reviewed: May 1995 X 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: Dug test hole in low drop off area with auger. 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V— A Z -07-#B_ D 75,539-S. F. C� �0 D -07- 75- 0 .3 o w, DE C) .A/0 13 z -,o 1* EQ _ �C� � U 2: fy' 7— E 0 S -T vt4 G 1600 C-nzzolv 7/c 7-w'Alk� I'S G 27'X P�71 N G 60(/T 1-6-7- -lD 7. c)X Cfig7 AS BUILT PLAN OF SUBSURFACE DISPOSAL SYSTEM LOCATED IN /L N f)-FTH ANDR AS PREPARED FOR... '-To --S-A N l 0 5 DATE: SCALE : J 0 rs�) oc 0 -.Lo--r we- OL T) -c- nit MERRIMACK ENGINEERING SERVICES, INC. to PROFESSIONAL ENGINEERS 0 LAND SURVEYORS 0 PLANNERS. m 66 PARK STREET 0 ANDOVER, MASSACHUSETTS 01810 0 TEL. (660) 475-3555, 373-5721 E, PHONE CALL /`/� A.M. FOR \ DAT / IME�Plfvt. M O ' PHONED PHO Ine Cry % �� 7 � cx ' �'�1q% Y2gU RETURNED AREA DE MB ' LEASE CALL MESSAGE SEE MERRIMACK ENGINEERING SERVICES INC. Engineers • Surveyors • Planners 66 Park Street ANDOVER, MASSACHUSETTS 01810 (Off) 475.3555 WE ARE SENDING YOU ?( Attached ❑ Under separate cover via_ ❑ Shop drawings ❑ Prints Qj Plans ❑ Copy of letter ❑ Change order /❑- ATTENTION �;.. NO. DESCRIPTION tA ❑ As requested ❑ For review and comment ❑ FOR BIDS DUE following items: ❑ Samples ❑ Specifications COPIESA'+ DATE[ NO. DESCRIPTION tA ❑ As requested ❑ For review and comment ❑ FOR BIDS DUE THESE ARE TRANSMITTED as checked below: ❑ For approval For your use tA ❑ As requested ❑ For review and comment ❑ FOR BIDS DUE REMARKS COPY PRODUCT 240-2 171 , DmIm, Mass 01471. ❑ Approved as submitted ❑ Approved as noted ❑ Returned for corrections ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints 19 ❑ PRINTS RETURNED AFTER LOAN TO US SIGNED' It enclosures are not as noted, kindly not sat onee. _ 4 MWil 1 N V 1 u o. S-7-, INV ou-T s -f : = -/_7.S- /Z _ oa 7 _1r6--- ' 9� -/j_\ZL1 t'>l i Gb a MUSMN G �R • EOSTING 1 Soca 6-/92LOiy AS BUILT PLAN � OF SUBSURFACEODISPSAL SYSTEM LOCATED IN OFT H Fl NM,L'' j, V ASPREPARED FOP .„._.. «.,..,...... _TU L.'�A I 0 r DATE :717A 1 -22,19.9S SCALE: _77�i�` f MAY4Fcc _Low es_ OL.o CPh'T-141,4 MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS. 66 PARK STREET 0 ANDOVER, MASSACHUSETTS 01810 0 TEL. (5*) 475 .3555, 373.5721 V,_ a SO'uiioEv I 2S �Gv.oE : /d cuT' �� �ASFME',vT'S 1N0 BU/CD��'AS6ir7�cN� A 4p \ •r .iQs� ExiJTi,V� • �N jL=/ZS• oo � � L=//6.4Z� -- -- 0� �2 f/ERE�Y C'E.�T/FY TO TyE T/T(� /,�/SU.NO.! ANO TD Tf/E B.4.V.r T.VgT T,fiE O�✓EGG/.csG /S GOC.4TE0 O.c/ Me Lor AS .s WIVIV ,4.1110 oars eav otaew T//E Tac.. ✓ O/r No. AVOO- ZON/.vG c�E6//LAT.bdS ,QL�6.�.e0/.W JET?.IC.t'S FEO.fI JT•PEET,S ,! GDT Li�vE9. "' s F(/,nSyE.� LE.rT/FY THAT T.y/S O.Y'ELL/N6 /S �t/OT LOG4TE0 /N Tif�E FEOE,P,4L FCOioo /Y.4Tr4•�0 A.PE.4. SyawN o�v FEi�eta4��Mt/NiTy P.rNGL '� -" OF M4444N 2S0o 98 OOC}�G' OorEA 6�2/g3 Z �eernev 1+ i P.L.S. o /N O.PAiriV fO.P �OrSEP,v� SA.V roS % : .. ""�v s�,z lE'�°� .voT Fa,P /1lE.P.P/r�f.4Gf' E.vGidEE,P�.v6 SE.P�/CES Bovvoesi cE /oto BO!/.VOA.PY /.f/FO.P�•f' AT/O.v I—Xee--V AeW, 7 Exrsrit/c eE-cveos. 6G �.4.P,(� .ST.rEET A1AS-V 4LWl/.SETT.S' o/8/D :Z-'ii,•: J )d' t f Form No. 3 Town of North Andover, Massachusetts BOARD OF HEALTH • AORTH 19_ - • p<tt�ao ,a'�A•O O p DISPOSAL WORKS CONSTRUCTION PERMIT • ,SSACMUSES Applicant NAME ADDRESS TELEPHONE • Site Location ��')T Permission is hereby granted to Construct or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. � 6 CHAIRMAN, BOAR�DO'Fl EALTH • � D.W.C. No. Fee . s FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: —j7o�;)1l r L,�,r�� e+ �f-�_ iQ '„� Phone jF V - LOCATION: Assessor's Map Number Parcel Subdivision ( 1' Lot(s) c��� Street �--� iii( I 1���`+' St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Food Inspector -Health Septic Inspector -Health Comments Public Works - sewer/water connections - driveway permit Fire Department Date Approved Date Rejected Date Approved Date Rejected Received by Building Inspector Date BO -ARD OF HEALTH 120 MAIN STREET NORTH ANDOVER, MASS. 01845 ' + ' 39W January 22, 1993 JAN 2 5 i rf i4l04l.L vfl 'i PY:]' 1 Les Godin Merrimack Engineering Services, Inc. 66 Park Street Andover; MA 01810 Dear Les: TEL. 682-6483 Ext. 32 This is to confirm that at the Board of Health meeting held on January 21, 1993, the Board granted variances to North Andover regulations: 2.14-4, minimum design flow for single family dwellings, for Lots 1 and 18 Old Cart Way; 17.03, spacing between leach trenches for Lots 8, 10, 11, and 14 Old Cart Way; 4.18 distance to a catch basin for Lot 5 Old Cart Way; 4.14 to allow a twenty minute design rate. With these variances, all current lots on Old Cart Way have been approved, specifically, Lots 1, 2, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 and 21. If you have any questions, please do not hesitate to call. Sincerely, L � Sandy Starr r DATE Z9-1191 Sheet of BOARD OF HEALTH TOWN OF NORTH ANDOVER SUBSURFACE DISPOSAL DESIGN REVIEW FEE ( PERMIT # 484-' DATE RECEIVED APPLICANT a. ; ,e/ ADDRESS ENGINEER /j%P,P//yI/,�CC' 6 ASSESSOR' S MAP_ /Q -& PARCEL # LOT # STREET o4z Clv,4;,I- Lc�Ay ADDRESS �fl/,,/C 5T. A /VDDL�U PLAN DATE �//hREVISION DATE CONDITIONS OF APPROVAL: G'D�US>�UcTati' �� -D-AOX rdGG APPROVED I------. DISAPPROVED � NORTq O't.�te �a',•1.0 o � F w 1 t • • �o i ;,SSACHUs t� Town of North Andover, Massachusetts BOARD OF HEALTH Form No. 2 DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant S 1 - JOV% i/Y1STal.d� Test No. Site Location 10T 4 1� W(1nmrn Loh-ct_ ( Reference Plans and Spec Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. 15 pb Fee 6o CHAIRMAN, BOARD OF HEALTH Site System Permit No. y ?Lj PLAN REVIEW CHECKLIST ADDRESS 4,-,g (064 &,1A Y _ENGINEER %V&1"/ e//96 -C '(- GENERAL 3 COPIES L/ STAMP v LOCUS C/ NORTH ARROW 4---- SCALE �--� CONTOURS /; t 7 SOIL & PERC INFO ELEVATIONS WETS. DISCLAIMER C-- WELLS & WETLANDS L/ WATERSHED? 1410 DRIVEWAY L/(Elev) WATER LINEt/ FDN DRAIN SCH40TESTS CURRENT? I'X96gy SEPTIC TANK MIN 1500G. .17 INVERT DROPy GARB. GRINDER_k(+200% EDF) 25' TO CELLAR A--"" MANHOLE TO GRADE(,-' ELEV GW D -BOX SIZE &B #-,go # LINES FIRST 2' LEVEL STATEMENT INLET/74,'Z - OUTLET / 7 , _ 17 ( 2" OR .17 FT) TEE REQ' D? LEACHING / RESERVE AREA,, -'4' FROM PRIMARY?100' TO WETLANDS 2% SLOPE. 100' TO WELLS 11"� 35' TO FND & INTRCPTR DRAINS?'-'- 4' TO S.H.GW6--"*� 325' TO SURFACE H2O SUPP,(�-'" 4' PERM. SOIL BELOW FACILITY MIN 12" COVER LZ FILL? (/ (25' if above natural ele; 10'i below) BREAKOUT MET? ✓ TRENCHES MIN 660 gpd_Z SLOPE (min .005 or 6"/1001) ✓ >3' COVER? - VENT - SIDEWALL DIST. 2X EFF. W OR D (MIN 61)IS RESERVE BETWEEN TRENCHES? -,-Z IN FILL? L-� MUST BE 10' MIN.—'Y 4" PEA STONE?� BOT X86 X LDNG�\+ SIDE 19 Z X LDNG� = TOT (L x W x #) (G/ft-) (DxLx2x#) 21URD of Nom.i"�-1..L-,nT -L oo t6l4y z� Nal�TN 4& DOVEI,�, MA, ' �yr ApP�� SS ,�P�o�CD 1Y1�C StPtl c Sy sT VE516A3 J PCAnJ DESS GAvCR _ FGQlv D.47i� ��S��P�vE� Co�►p�r�o�s R�4SoNS D��`rPT"c � SYSTEM t � siA �.1�4T�o�.1 cY 4V4T(O J JtiSPt�-GTIOAJ 94rC D 1-4SS [] FAIL 1 tiSPEcrlon) P(PE jAI\ Hv f-0 T/J Ll PrJ S5 `D F4)L APPROVED QIJTC /SPr'ia7vuvG �1�i�tor�rry 4WITJD�1- 1A15F6z�) IpN� NSTifl�LG(i --_ S (1p may) DtSAP'j;�ovF,D DAT -C RC450 tis FML APPROVAL D,o-E APP ovvJ6 /3u iHopi � , I•j .•.,•�::.::�a i • I.�•`:� �;1.''.I �.II��i•:.� fl� �•.��!i �• 1 ,� �:•�,•�• • • ' .`w' � •jib �•��i 0� � 1I • • � �: iii ""/ ;.�11' �,�� ,�1i A'• '� �,,.�+� i(�.,�•'rlil�i� �•.l df...�r'�u.11 ;, • � • IN ILI ✓fn -- vlOf. ' ;2''':Sya(9m own ar, .. '/�?dr►►J (IldVfullnl Ivn {ouVon) 07—N 7 •� I'�'u{,{�InB na�ora, 3. Typo 91+y)(om;..'L7Ca�s�ool(s) v' Q O'hor (doscIIvoj e7 �; Emuon! Too Flllo('P(p,ionr? [' Yo9 n'o Nit '' i. r� i.,, f it . '�', y:+li" •• V �. ' ..;'�7;�1 loci 'n �'� ,•,'.,.��•. ,.., 10. IN on.�r ors oor�lenla;were d►sposo Hl V4 •'.,n,.ma,J.por/doFiyrelsi/e�D�oYa/s%Ib/orms.n:malnypeC1 if yo, es c aanav7 r res _ Vlhlclf Uc4nil—�'�, � ', /7'�� Commonwealth of Massachusetts FRECEIVEDCity/Town of No.AndoverSystem Pumping Record 'I0Z Form 4 TH ANDOVER DEP has provided this form for use by local Boards of Health. Other forrds, a sbciused=but`the"— information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. City/Town Ma State State Telephone Number Zip Code Zip Code B. Pumping Record CIJ f,ax�) 1. Date of Pumping Date 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: 6. �umped By:Nam r OC Stewart's Septic Service Company Location where contents were disposed: �Iewart's Pre-treatment_Pjant, 20 So. Mill Signature of Hauler Signature of ReceiviAvacility If yes, was it cleaned? ❑ Yes ❑ No Vehicle License Number Ma 01835 Date Date VV t5form4.doc• 03/06 System Pumping Record • Page 1 of 1 A. Facility Information Important: When filling out 1. System Location: forms the computer, use _ F only the tab key Address to move your No Andover cursor - do not City/Town use the return key. 2. System Owne . ],,) Name Address (if different from location) City/Town Ma State State Telephone Number Zip Code Zip Code B. Pumping Record CIJ f,ax�) 1. Date of Pumping Date 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: 6. �umped By:Nam r OC Stewart's Septic Service Company Location where contents were disposed: �Iewart's Pre-treatment_Pjant, 20 So. Mill Signature of Hauler Signature of ReceiviAvacility If yes, was it cleaned? ❑ Yes ❑ No Vehicle License Number Ma 01835 Date Date VV t5form4.doc• 03/06 System Pumping Record • Page 1 of 1