HomeMy WebLinkAboutMiscellaneous - 19 CANDLESTICK ROAD 4/30/2018 (2) 19 CANDLESTICK ROAD O ad
210/106.A-01140000.0
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MAP # LOT # Zd
PARCEL # 114' STREET CAN LE STIGIL e0
CONSTRUCTION_APPROVAL
jo HAS PLAN REVIEW FEE BEEN PAID? ES NO
Qw
1 PLAN APPROVAL: DATE_- Z �� APP. BY...,
DESIGNER: _ 54q?win l0 __._...__. PLAN DATE,..,__.._
CONDITIONS- PG-F-k 6---_ 'w vti
WATER SUPPLY: TOW WELL
WELL PERMIT ._ _..__.._._._._.._..._.. DRILLER._..........._......._. .................... . .
WELL TESTS: CHEMICAL DATE APPROVED
BACTERIA I DATE APPROVED
BACTERIA II DATE APPROVED
COMMENTS:
FORM U APPROVALi APPROVAL TO I E NO
DATE ISSUED-_-.10 � _�_
CONDITIONS:
FINAL APPROVAL:
ALL PERMITS PAID YES NO
WELL CONSTRUCTION APPROVAL YES NO
SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO
OTHER YES NO
ANY VARIANCE NEEDED YES NO
FINAL BOARD OF HEALTH APPROVAL: DATE:..................................BY._..._._........._......._..._.
SEPTIC SYSTEM-_I NSTALL6-T_I ON.
IS THE INSTALLER LICENSED? e- ES NO
TYPE OF CONSTRUCTION: NEW REPAIR
NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW YES NO
CONDITIONS OF APPROVAL NO
(FROM FORM U)
ISSUANCE OF DWC PERMIT YES NO
DWC PERMIT NO. INSTALLER:.-MY04)
......Covtv
...................
BEGIN INSPECTION ( YES)NO:
EXCAVATION INSPECTION: NEEDED: ------ .................................
.............................................................. ...................
PASSED.
.......... ......... .........
/_ � n .....-_...._..._...
.....................
41Z
CONSTRUCTION INSPE&ION: NEEDED: 7
......................................................................................................................
PIS To
.................... ..........
OIGSEi_ L1^{= _T +./l� TJ - ,c _ ►tion c .n- C. .t _(yG�T..,
............................
........... - -------- ...........................................................
AS BUILT PLAN SATISFACTORY: YES: ............... ...... ...........................
.......................... ........ . ..........................
APPROVAL TO BACKFILL: DATE: BY
.. ............. ................... .............
FINAL GRADING APPROVAL: BY._____..__.. ...... . ... .... ...... ................
FINAL CONSTRUCTION APPROVAL: DATE:......�/_fw........BY......... ... ... .........
NW
Commonwealth of Massachusetts
City/Town of
System Pumping-Record NOV 14
ovviv
Ti r i
Form 4 AN
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 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/Right rear of house, Left/right side of house, Left/
Right side of building, Left/Right front of building, Left/Right rear of building, Under deck
Address �[
Cityfrown State Zip Code
2. System Owner.
Name
Address(if different from location)
CitylTown State Cede_
Telephone Number
t
B. Pumping Record
I
Lr— f
1. Date of Pumping r 2. Quantity Pumped:
Date Gallons
3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes No If es was it cleaned?
yes, E] Yes ❑ No:
' 5. Condition ofSy stem:
6: System Pumped By.
Neil Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7. Lo ere contents were disposed:
Gi.�.S'. Lowell Waste Water
f
Sign Haul pate
t5form4.doc-06/03 System Pumping Record•Page 1 of 1
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I
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued:
IMPORTANT: Applicant must complete all items on this page
44A'. LOCATION 1�2Y 1�fi
PROPERTY OWNER –�� Pri � Qr�
Print 100 Year Old Structure yes no
- _
MAP NO: .__ PARCEL: ZONING QISTfRICT: :Historic District yes ,no
;Machine Shop Village yes no
.TYPE OF IMPROVEMENT. PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition 11 Two or more family El Industrial
ElAlteration No. of units: ❑ Commercial
,Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other _
_ _-
pSeptic ❑Well s D Floodplain ❑Wetland"s. El Water-shed District
❑Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
aq 10--C1rs-&&c.L k 9 0&441
SUvf aS `ty1 5CY-dV1)rt Q S)vh k-
Please T pe or Print Clearly)
OWNER: Name: Adentification
iEltS 1 dII,aws Phone: q70�a�5"off la
Address: �-- 4UVW t vlPlIq 0195
CONTRACTOR Name: _ __- .Rhone: _- -
Address:
Supervisor's Construction License. Exp pate: :t
Home Improvement License; _ _- _ _ Exp Date: _ _
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature�,offAgent/Owner.;__, _
Signatureof contractor
4._v.
Plans Submitted Lj Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
. �6.
t: Plans-Submitted ❑ Plans-Waived--EL,- ..!_.Certified Plot Plan ❑ Stamped Plans ❑
1 YP1 01{:SEWERNGEDISPOSAL"
Public Sewer ❑ Tanning/Massage/BodyArt ❑. . Swimming Pools ❑
Well ❑. Tobacco.Sales ❑
•Food Packaging/Sales ❑
private-,(septic tank,etc:_ . ❑.- _: permanent DiAmpster on=Site ❑
--------------
-THE_.:FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE,REJECTED: DATE:APPROVED
PLANNING & DEVELOPME5N-r ❑
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on �- � � ! Si nature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: :Comments
Water.& Sewer Con nectionlS_ignature& Date Driveway Permit
DPW Tows: Engineer: Signature:
Located 384 Osgood Street
FIRE O P RTKE-.NT.=-�Ternp Dumpsfer on site yes no
Located7bt 124;Mairi Street:.
-Fire Depa'mine,it,signature/date:'-':..
'COMMENTS
i Giov c04k L'• --��
I�4�I•O SEPT I G TA hl l� '� .
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TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD ���'=�`��-�
OCT 2 4 2005
DATE: "'
TOWN OF NOR-H ANDOVER
HEALTH DL'ART'iIENT
SYSTEM OWNER &ADDRESS SYSTEM LOCATION
(example: left front of house)
ca vitc
DATE OF PUMPING: I o—d-VOS QUANTITY PUMPEDjl �pc-) GALLONS
CESSPOOL: NO YES EPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION FULL TO COVER
HEAVY GREASE BAFFLES IN PLACE
ROOTS LEACHFIELD RUNBACK
EXCESSIVE SOLIDS FLOODED
SOLIDS CARRYOVER OTHER (EXPLAIN)
SYSTEM PUMPED BY:
COMMENTS:
CONTENTS TRANSFERRED TO:
Form of Notice of Casualty Loss to Building
Under MASS. GEN. LAWS, Ch. 139, Sec. 3B
To: Building Commissioner or
Inspector of Buildings
North Andover, MA 01845
RE: Insured: Scott and Elisabeth Williams
Property Address: f19 Candlestick Road, North Andover, MA 01845 1
Policy Number: XH5075
Date/Cause of Loss: 12/2/2004, Water Damage
File or Claim Number: 14098-W
Claim has been made involving loss, damage or destruction of the above captioned property,
which may either exceed $1,000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER
143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL LAWS,
CHAPTER 139, SECTION 313 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.
Wade Anderson
On this date, I caused copies of this Notice to be sent to the person named above at the
addresses indicated above by First Class Mail.
ignature and Date
ANDERSON ADJUSTMENT CO., INC.
54 Stiles Road, C-106
Salem, NH 03079
RECEIVED
DEC 14 2004
BUILDING DEPT.
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TOWN OF
SYSTEM PUMPING RECORD
DATE:
1
SYSTEM OWNER& ADDRESS SYSTEM LOCATION`
(example: left front of house)
avis t�
4�� 1
DATE OF PUMPING: QUANTITY PUMPED : ) j b() GALLONS
CESSPOOL: NO YES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION FULL TO COVER
HEAVY GREASE BAFFLES IN PLACE
ROOTS LEACIIF'IELD RUNBACK
EXCESSIVE SOLIDS FLOODED
SOLIDS CARRYOVER OTHER(EXPLAIN)
SYSTEM PUMPED BY: Bateson Enterprises, Inc.
COMMENTS:
CONTENTS TRANSFERRED TO: �
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
DATE:
SYSTEM OWNER &ADDRESS SYSTEM LOCATION
(example: left front of house)
e� t
=�-�� ��
l � 12� ,
DATE OF PUMPING: QUANTITY PUMPED GALLONS
CESSPOOL: NO YYES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE YEMERGENCY
OBSERVATIONS:
GOOD CONDITION FULL TO COVER
HEAVY GREASE BAFFLES IN PLACE
ROOTS LEACHFIELD RUNBACK
EXCESSIVE SOLIDS FLOODED
SOLIDS CARRYOVER OTHER (EXPLAIN)
SYSTEM PUMPED BY-
COMMENTS:
CONTENTS TRANSFERRED TO:
FORM 4-SYSTEM PUMPING RECORD
C ER
SEPTIC & DRAIN SERVICE
1 FOREST STREET; MIDDLETON,MA 01949
(978)774-2772
COMMONWEALTH OF MASSACHUSETTS
MASSACHUSETTS
SYSTEM PUMPING RECORD
SYSTEM OWNER: SYSTEM LOCATION:
v A
12
All TSU/c�
DATE OF PUMPING: QUANTITY PUMPED: GALLONS
CESSPOOL: NO YES F7 SEPTIC TANK: NO YES
SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SERVICE
CONTENTS TRANSFERRED TO:
-
DATE: / - INSPECTOR:
Ycvwr�F saoRz� arab^��:�i
OAR OF
^�'Ay 1 1 199:`
----
Town of North Andover, Massachusetts Form No. 1
rAORTHAA-- BOARD OF HEALTH
�+ 193� y� 46 OL
°� °°< <Ew° ''"" APPLICATION FOR SITE TESTING/INSPECTION
7 •u RATED PPR�.�S
SSACHUS�
Applicant
NAME ADDRESS TELEPHONE
Site Location �
Engineer—4 4 44"110
NAME ADDRESS TELEPHONE
Test/Inspection Date and Time
CHAIRMAN,BOARD OF HEALTH
Fee Test No.
AIECP
S.S. Permit o. 90 D.W.C. No. C.C. Date Plbg. Permit No.
D
Town of North Andover, Massachusetts Form No. 1
ONORTfj AA BOARD OF HEALTH
3� ° �t`ED Ib�YOL
19
APPLICATION FOR SITE TESTING/INSPECTION
�M'Ss CHUs���h
r�
r
Applicant — �' - r _y= ENGCpni7� DESIG✓-6ytcp
pp NAME_, _ / ADDRESS TELEPHONE
Site Location
r
l f C r
Engineer
NAME r ADDRESS TELEPHONE
Test/Inspection Date and Time
CHAIRMAN,BOARD OF HEALTH
Fee `� Test No.
S.S. Permit �6 3 W.C. No. C.C. Date Plbg. Permit No.
' Town of North Andover, Massachusetts Form No. 1
NORTH AA.. BOARD OF HEALTH
01AZ IED ib q.YO
6 0� 19
0 m
*�,Q 6DAATEDWPPP\y'�y* APPLICATION FOR SITE TESTING/INSPECTION
{SSACHUS�
Applicant
NAME / ADDRESS TELEPHONE
Site Location
ol
Engineer
,NAME // ADDRESS TELEPHONE
Test/Inspection Date and Time
CHAIRMAN,BOARD OF HEALTH
f� f
Fee t" Test No. '-
S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No.
1 64
Conutli►n%cea1111 of Plassrichuselts
Massachusetts
TOWN OF NORTH ANDOVER'
BOARD OF HEALTH
�S'►�ster�i I'u»ip
Record
27199 71995
�stciil'UCCTi% s em oca 101
c
Date of t'urllping z - Quantity Pumped: t
Cesspool: tics 1�°i Yes LJ �rnlir 'rAnl t`�•• �] Yes
�
S%•slellt Pumped b%•: --Y License #: [ 6
Contents transferred Ir:
Date Inspector
L
AddreA CA:- i c, k '?o Title of Fide
Page of
Date f=ile Open: Date File closed:
Doc Document/Action Title Date of Refer to other
action Document/ document/ Purpose of Document/Action and nates
Num. Action Department
--------------
Board of Appeals — Board of Health Planning Board_ Conservation Commission — Bui ddin D
� epartnilen,t --
6
Commonwealth of Massachusetts
Massachusetts
System Pumping Record
System Owner System Location
Date of Pumping: C:' � � Quantity Pumped: AS7` allons
Cesspool: Nom Yes LJ Septic Tank: No L..J Yes
System Pumped by: Fctlre4oa License#
Contents transferrred to : Greater Lawrence Sanitary District
llate: _ Inspectors
�VIDJO
l3riasm ISI.Gaff QhP� HEWLETT
Components Engineer '— _. PACKARD
Syot
Medical r deu ntss Group..,
Imaging
I Hewlett-Packard Company _ �
3000 Minuteman Road �S 7�
Andover,MA 01810-1099 t
508 687 1501, Ext 2781
Fax 508 686 7262 Y"`o
� a
July 10, 1990
P.O. Box 577
Swampscott, MA 01907-3577
I
Mr. Joseph J. Barbagallo, R.S.
1 Westward Circle
North Reading, MA 01864
Dear Joe:
I have conferred, today, via telephone, with Mr. Michael J. Rosati
of the Board of Health regarding the revised septic system design
proposed for "Lot 24 Candlestick (Spinning Wheel Estates) " in North
Andover, MA. Mr. Rosati indicated the following changes should be
made on the present design to render it acceptable:
1. . The final 11142" contour (within the present
wetland) must be moved to maintain a one
hundred foot distance from the closest edge of
the leaching field.
2 . The final edge of the wetland (after filling)
must be denoted and added to the plan. (I
believe this would be the region bounded by a
portion of the existing wetland edge, the
final 11142" contour and the replication area. )
3 . A dimension showing the one hundred foot
distance between the final edge of the wetland
and closest edge of the leaching field must be
shown.
Please forward a copy of the updated plan to me at the address
above.
Thank you for your assistance.
Very truly yours,
Brian M. Gaff
cc: Mr. Michael J. Rosati
1 9
July 16, 1990
P.O. Box 577
Swampscott, MA 01907-3577
Mr. Joseph J. Barbagallo, R.S.
1 Westward Circle
North Reading, MA 01864
Lear Joe
I have one follow-up comment regarding the septic system design
proposed for "Lot 24 Candlestick (Spinning Wheel Estates) " in North
Andover, MA. As I mentioned to you several weeks ago, I intend to
increase the grading of the subject lot to values in excess of the
minimums specified on your design. I have discussed this with Mr.
Michael J. Rosati of the Board of Health and he has informed me it
may be necessary to include additional covers or vents in the
system if the grading over the system is substantially increased
from the minimums shown on your design.
It is my intention to adjust the final grading of the majority of
the rear yard to a level of "152. " This grade will completely
encompass the proposed location of the entire septic system. I do
not intend to modify any of the elevations you have specified for
the components of the septic system. Mr. Rosati's comments,
however, suggest the increased quantity of fill over the septic
system will require special venting or access components. I would
appreciate it if, in your redesign to satisfy wetland setbacks, you
add the necessary venting and access components to account for the
additional fill.
Thank you for your assistance.
Very truly yours,
Brian M. Gaff
cc: Mr. Michael J. Rosati
NORTH{ ■■
Qt SLfO 9�1 5
O . BOARD OF HEALTH
L
FA
120 MAIN STREET
�,s AA'ID�•�`<y NORTH ANDOVER, MASS. 01845 TEL
Ext632 or 33
SACHUS t
June 28, 1990
Mr. Brian M. Gaff
PO Box 577
Swampscott, MA 01907-3577
Dear Mr. Gaff:
I have reviewed the resubmission of the plans for lot 24
Candlestick Road in No. Andover dated 6/18/90. All the comments
of my approval letter dated 6/1/90 have been addressed to my
satisfaction except for #4 . The Town of North Andover Board of
Health requires a 100ft. setback with a leachfield and the edge
of wetlands. It is unclear from the plans submitted as to how
close the leaching field will be from the edge of wetlands. I
have taken the time to obtain a copy of the latest plan submitted
to the Conservation Commission for this lot. This plan shows the
wetland only 90 ft. from the septic system.
Please be advised that this plan cannot be approved by the
Board of Health until the septic system is relocated or
reconfigured to be at least 100 ft. from the edge of wetland (the
final edge of wetlands) , or the Notice of Intent is modified to
show more wetland fill to provide the required 100 ft. setback.
Should you have any questions, please do not hesitate to
call. -�
Very truly yours//
Michael J. Rosati
Acting Health Agent
MJR/rel
t V
i
Y
July 30, 1990
P.O. Box 577
Swampscott, MA 01907-3577
9 0 - a
Board of Health
Town Hall
120 Main Street
North Andover, MA 01845
Gentlemen:
Enclosed are three copies of a revised septic system design
developed by Mr. Joseph Barbagallo for "Lot 24 Candlestick
(Spinning Wheel Estates) " in North Andover, MA.
This design has been updated by Mr. Barbagallo to address the
concerns of Mr. Michael J. Rosati of the North Andover Board of
Health (specified in a letter to me dated June 28, 1990, and in a
telephone conversation on July 10, 1990) .
Please review this updated septic system design for compliance with
Mr. Rosati's requests as well as all standards and requirements in
effect in North Andover. Forward all correspondence to me at the
address above. A copy of the certificates previously issued is
attached.
Thank you for your assistance.
Very truly yours,
Brian M. Gaff
Town of North Andover, Massachusetts Form No. 1
NORTH BOARD OF HEALTH tt
3�Og tt,ED "'6 0 ' ` 19YO
O ^
O m 70
� -t APPLICATION FOR SITE TESTING/INSPECTION
A-qq cx w�P
9SSACHUS��
Applicant>� � `�•
AME ADDRESS TELEPHONE
Site Locationa1 �`�
./�3'I_-
f�
Engineer--•-� NAME � � ADDRESS TELEPHONE
Test/Inspection Date and Time e 7 9 9e
CH IRMAN,BO RD P F�1 ALTH
Fee Test No. �
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Forth 6 DOE File No.[:2:42--453
Ito be provioed by DEOE)
North Andover
Commonwealth City/Town --
,Z, of Massachusetts Applicant New England DestRa-Bui1d
>• Lot 24 - Candlestick Road
Order of Conditions
Massachusetts Wetlands Protection Act
Q.L. c. 131 t §40
sand under the Town of North Andover Bylaw,.Chapter 3.5 A 6 B
From North Andover Con e
•
To New England Ae ign Buil
(Name of Applicant) (Name of property owner)
128 Warren St. ,
Address
Lowell, HA 01852 Address Sam
This Order is issued and delivered as follows,
O by hand delivery to appiioant or representative on (date)
V by certified mall,retum recelpt requested on February 17, 1988 _ (date)
This project is located at Lpt 24 -
The property is recorded at the Registry ofNorthern-Ke4Y �--,—- — --
1142 Page 392
Certificate(if registered)
The Notice of Intent for this project Weis f8ed on, te..i,a.v 5, gg i (date)
The public hearing was closed on January 27. 1988 (date)
Findings
The North Andover Conservation iesion.—has reviewed the etiove-referenced Notice of
intent and plans and has held a public hearing on the project.Based on the intorrttatlort available to the
_ NACC et this time,the NACC has determined that
the area on which the proposed work is to be done Is significant to the following Wgrssts in accordance with
the Presumptions of Significance set forth.fin the regulations for each Area Subject 10 Protection Under the
Act(check as approprI411e):
1� Public water'Suppfy �) Flood control C3 Land containing shellfish
Private water supply �& .Storm damage prevention Q Fisherles
Ground water supply 99 Prevention of pollution 0 Protection of wildlife habitat
5-i
Z� ,e
F, S0 U T H U 1 1 4 P4 Candlestick Road
late,ilio,, NACC 'hereby lind�that the foltowinp conditions aro
sary,In bccordance,with the Performance Standards sot forth in the regulations, to protect those inter•hecked above.The ..Ar orders that oft work shalt be¢ertormed ,
In accordance with said conditions and with the Notice of intent referenced above,To the extent that the fol-
lowing conditions modify or differ from the pians;spocificallons'or other proposals submitted with the Notice
of Intent,the conditions shall Control.
Gcnatal Conditions
1. pailuro to comply with alfcondilions stated 110(01,and with all related statutes and other regulatory meas-
ures,shall be dperned causo to revol o or modify chis,Order.
2. Th+s Order docs not 0 bnt any property rights or any exclusive privitcpes' it does not authorize any Injury.
to private property or invasion of i)dvate rights. ,
3; 'This Order does not relieve tho peimilteo or any other person of the necessity of complying with all
othor(lpplicul)lo fcddfill, slato Or 19e11.s1,111tloS,orctirutnces, by-laws or regulattohs',
4. The Work suthor{zea hereunder shnn be Complotod within throo yenrs from the dzlo of this Order unless
either of ilio following apply:
(a) the work is a maintenance dredoing project as provided for In the Act;or
(b) the Vmo for completion has been extended to a specified date moro than th'reo years,but less that
live years, from ilio data of Issuance and both thnt ditto and the SpCciai circ�mstances warranting
the extended tltne period are-cot forth in thls Order.
S. Thi,Order tray be ax1anded by Ilio irstdno authority for ono or toore periods of up la6three years each
upon application to tho issuing Oulhorlty At tons!30 mays prior to ilio expiration data of Ilio Order.
S. Any fill used in connoction with this project uhntl ho clean fill,eonlainitio no IrasA;retuso rubbish or de•
bels,including but not limited to timber,bricks,plaster•wiro, lath. paper,cardboard, pipe,tires.ashes. ,
refrigerators, motor vehicles or parts of any of ilia foregoing:
7,. i4o work shall be undertaken until all adrninistralivo appeal perlods•f rom,lhis Order have elapsed or, it
Such an appeal has been iiled,until ail proceodlnos before ilio Dopartrrient have 6eeri completed.
8. No work shall be undertaken until Ilia Ficial Order lies boon recorded in the Repislry of Deeds or the land
Court for the district in which the land is located,within Ilya chain of title of the adected property. In the
case of recorded land, the Final Order shad also be noted in ilio negistry's Grantor Index under the name
of the owner of the land upon which the proposed work Is to be done. In the Cas$of registered land, the
Final Order shalt also be noted on the land Court Coriillcato of Title of the ownerof the land upon which
the proposed wont be done.The recording information shall be'submitted Iq the ACC
on the form at tho end of this Order prior to comrtloncement of the work.
9. A sign shall be displayed at the site not fess than two�quaro feet or mo to than three square feet in'size
bearing the words,"Massachusetts Dopartmont of Environmental Oustity Cnglneering,
file Number 242. 453 ,
10,Whero Ina Deparlmenl of Environmental Oualily Cnglncoring is roquested to make a delefminalion and
to issue a Superseding Ordor,the Conservallon Commission shall be a party to Alagency proceedings
• and hearings before IN Department. r
11.Upon complclion of tho work doscribed li�('dirt,Ilia applicant shod forthwith requbct to writing that a
Certificate of Complianea bo.issuad stalinfl that the work has boon satisfactorily completed,
12.The work shall conform to tho lotiowing pt.1hS;1nd SPOCI.11 COM;tions;
r 2 w
ru 4 i :i
� Page 3
Order of Conditions Lot #24 - Candlestick Road D.E.Q.E.0242-453
12. The work shall. conform to the following plans and additional
Conditions:
a. Notice of intent submitted by New England Design
Build, 128 Warren Street, Lowell, Mass., prepared
by 'Cuoco & Cormier, Inc., 170 Main Street,' Unit 112, '
Tewksbury, Mass., dated December 30, 1987 and received
by the NACC on January 3, 1988.
b. Plans entitled "Wetland Notice of Intent Plan,
Candlestick Road, North Andover, Mass.," prepared
for New England design Build by Cuoco & Cormier
and dated December 22, 1987.
13. The following wetland resource areas are affected by the proposed
work, banks, land under water, bordering land subject to flooding,
And bordering vegetated wetland. These resource areas are signifi-
cant to the interests of the Act and Town bylaw as nbted above.
These resource areas are also significant to the wildlife and rec-
reation interests of the Bylaw. The applicant has n6t attempted to
overcome the significance of these resource areas to the identified
interests.
.14. The NACC agrees with the applicant's delineation of. the wetland
resource areas at the site.
is. Prior to any activity on the site, the applicant shall provide the
NACC with plans for a Board of Health approved septic system situated
outside the 100 ft. buffer tone to the wetlands remaining on the site
after approved filling.
16. In advance of any work on this project, the applicafit shall notify the
NACC, and at the request of the NACC, shall arrange.an on-site conference
among the NACC, the contractor and the applicant to Onsure that all of
the Conditions of this Order are understood. This Order also shall be
made a part of the contractor's written contract.
17. The applicant, or its successors, shall notify the NACC in writing of
the identity of the on-site constructionsupervisor hired to coordinate
construction during the work on the site and to ensure compliance with .
this Order.
18. Commencing with the issuance of this Order, and continuing through the
existence of some, the applicant shall submit to the 'NACC a written
progress report every 4 months detailing what 'work bis been done in or
near resource areas, and what work is anticipated to be done over the
next period.
19. Prior to any activity on the site, a filter fabric fence or a double
row of staked hay bales shall be placed between all Construction areas
f Page 4
Order of Conditions Lot #24 - Candlestick Road D.E.Q.E. #242-453
19. (Continued). . . . .
and wetland areas per Soil Conservation Service or D,.B.Q.E. Standards.
THIS BARRIER SHALL BE INSPECTED AND APPROVED BY THE NACC PRIOR TO THE
START OF CONSTRUCTION. This row of hay bales of filter fabric shall
remain intact until all disturbed areas have been mulched, seeded, and
stabilized to prevent erosion. A snow fence shall be erected between
the erosion eontrol' barrier and the construction area.
20. The applicant shall have on hand. at the start of any soil disturbance,
removal or stockpiling, a minimum of thirty (30) hay bales and exiffi.cient
stakes for etalcing these balsa. Said bales shall be uaed only for the
control of erosion, as.described in the Erosion Control Plan submitted
with the Notice of Intent or the hay bale barrier described in Condition
#+18.
21. Upon completion of construction and grading, all disturbed areas located
outside resource areas shall be stabilized permanently against erosion.
This shall be done either by sodding, or by loaming, seeding, and mulching
according to Soil Conservation Service standards. If the latter course
is chosen, stabilization will be considered once the surface shows complete
vegetative cover has been achieved.
22. After proper grading, all disturbed areas located within a resource area
which will not remain as wetland areas, shall be loamed and seeded with
not less than four (4) inches of good quality loam. ' tefors seeding,
ground limeotono eholl be applied at a rate oufficicnt to bring the ooll
test to pH 6.5. In addition, 10-6-4 fertilizer, or its equivalent, shall
be applied at a rate of fifteen (15) pounds per one-thousand (1000) square
feet, in accordance with Soil Conservation Service guidelines. All dis-
turbed areas located within wetland resurce areae which are to be only
temporarily disturbed during construction, shall be restored to their
original grade using as topsoil the original wetland. soil, soil removed
from other permanently filled wetlands, or at least four (4) inches of
good quality loath, and then seeded or planted with compatible wetland
species and mulched with hay.
23. No earthen embankment in the buffer zone shall haves slope steeper than
2:1.
24. All erosion prevention and sedimentation protection 'measures found
necessary .during construction by the NACC will be implemented at the
direction of the NACC.
25. There shall be no stockpiling of soil or other materiels within twenty-
five (25) feet of any resource area.
26. During and after work on this project, there shall be' no discharge or
spillage of fuel, oil, or other pollutants into any resource area.
i
' Page S
Order of'Conditions Lot #24 - Candlestick Road D.E.Q.E. #242-453
27. Any changes in the 'submitted 'plans, Notice of Intent, or resulting
from the aforementioned Conditions must be submitted to the NACC for
approval prior to implementation. If the NACC finda, by majority
vote, said changes to be significant and/or to deviate from the
original pians. Notice of Intent or this Order of 6onditions to such
an extent , that the interests of the Wetlands Protection Act and
Bylaw cannot be protected by this Order of Conditions and would beat
be served by the issuance of additional Conditions then the NACC
willcall for another public hearing within 21 days, at the expense
Of the applicant, in order to take teatimony .from all -interested
parties. Within 21 days of the e2oae of said publJd hearing, the
NACC will issue an amended or new Order of Conditions.
28. Any errors found in the plans or information submitted by the
applicant shall be considered as changes, and procedures outlined
above for changes shall be followed.
29. The NACC shall be notified in writing of any lot line or lot number
changes with a copy of a plan showing these changes prior to any
work on these lots.
30. Members of the NACC shall have the right to enter upon and inspect
the premises to evaluate compliance with this Order of Conditions.
31. Accepted engineering and construction standards and procedures shall
be followed in the completion of the project.
32. Prior to the issuance of a Certificate of Compliance, the applicant
shall submit a letter to the NACC from a registered professional civil
engineer certifying that the work is in compliance With the plans
referenced above and all the Conditions hereof.
33. The provisions of the Order shall apply to and be binding upon the
applicant, its employees, and all successors and assigns in interest
or control.
34. 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.
33. A proper bond or. & deposit of money or negotiable securities running
to the Town of North Andover shall be provided in the amount of
12,1000.00, which shall be in all respects satisfactory to Town Counsel.
Town Treasurer, and the NACC, and shall be posted with the Treasurer of
the Town of North Andover before commencement of watt . Said bond or
deposit of money shall be conditioned on the completion of all Conditions
hereof, shall be signed by a party or parties aatisfactory to the NACC
^ I .�. .. .. lR-✓i w:1�1{ref ..
• - Page 6
35. • (Contined).. . ,
and Town Counsel, and shall be released after completion of the
project, provided that provision, satisfactory to the NACC, has
been made for performance of any Conditions which are of a contin-
uing nature. This Condition is issued under the authority of the
Town of North Andover Wetlands Protection Bylaw.
36. The utilities for this house shall not be constructed so as to
pass under or through any wetland areas on the site.
37. No underground storage of. fuel oils shall be allowed within one-
hundred (100) feet of any wetland resource area. This Condition
shall survive this Order of Conditions, and shall run with the
title of the property.
• e a * e s +e * e e s
I ' l: ~2bZ-453 -,- ut' Z C ndteat d , .. :!��:'�. r- - 4a
• Conservallon Commission
Issued 8y North
Blpnature(s) �+
. r.
Thiel Ordor must bo signed by a majority of the Conservation Commission. . ;
• On this 10th day of JobXuary 19' - as - beforo mo
—_,--
Jack._.Lindon -,to me known to be the
pereona4ly appearod.....,� �.._... -- ----- --
de cribed in Ind who*! uted.the foregoing Instrument Ind acknowledged thgt he/she executed
Ihelse s as htolhar tree d sed.,
• September 9, 1994
Notary Public f My commission expires'
The spptiCu+t,the owner,any person aggrWod by this Order,any owner of lend ebuttlnp the land upon which the props ed work Is to
be done or any ten residents or the city or town In which such tend Is located era hereby nolifled ol'thetr dijht to request the Oepb.Vncnt
or 6nvfrohmentof Ouslity Engineering 10 Issue a 8uperaedtng odor,providing tho request Is made by cortiUed mail or hand dctiv"to'
the Oepsitmont within ton days from the dole or issuance of thlo odor.A copy of li,o reggoit e110'6i 1110 sarno time be sent by certirtd
mallor hand delivery to the conservation Commission and the applicant.
If you wish to appeal this decision Older the Town By Law, 'a complaint must be
filed In -Superior Court.
Deloch on dotted line and submit tethe NAC C — — --- prior to ton►mentoTent e1 wort.
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—'ts sving Authority
phots be edvtsed fhat the Order of Cendltion.q lot the project,atr._..
j
• fle Nobw...4Z- =end
b"been noted In the chain of see of ft affected property In accordance with Oaneral Condition a on _.._.t e..._.
it recorded land,the Instrument nut►tser wNcA ldentitles this transection Is -----------
I teglslertd land/the docurpent amber whkh tdentiths this transection Is -----
Applicant
:t ,
June 11, 1990
P.O. Box 577
Swampscott, MA 01907
Joseph J. Barbagallo, R.S.
1 Westward Circle
North Reading, MA 01864
Dear Joe:
Per our telephone conversation this morning, I have enclosed a copy
of the letter I received from Mr. Michael J. Rosati, Acting Health
Agent, Town of North Andover, MA, regarding the septic system
design proposed for Lot 24 Candlestick Road (Spinning Wheel
Estates) .
Please review Mr. Rosati's concerns and adjust the septic system
design for compliance. I have also enclosed a copy of the original
site plan as developed by Cuoco & Cormier. You will note your
septic system design includes an additional contour (at 140 feet)
within the wetland replication area. This was not included on the
original site plan and I would appreciate it if you would remove
it from the septic system design.
Please forward a copy of the updated plans to me at the address
above.
Thank you for your assistance.
Very truly yours,
Brian M. Gaff
cc: Mr. Michael J. Rosati )
(w/o enclosures)
HORTN ..
Ot`.,•.,
3� ryc. BOARD OF HEALTH
120 MAIN STREET TEL: 682-6483
9 ACHUS
ss S �y NORTH ANDOVER, MASS. 01845 Ext. 32 or 33
�
41 .1
June 1, 1990
Mr. Brian M. Gaff
P. O. Box 577
Swampscott, Mass. 01907-35.77
Re: Lot 24 Candlestick
North Andover, Mass.
n.'
Dear Brian,
I have completed a review of the plans submitted for Lot
#24 Candlestick Road. Before approval can be given, the plans
must be revised to show and address the following:
1. A description and location of a benchmak should be
r
shown, preferably along Forest Street. Since the topography
has changed from the original sur`vr. y, I must insist that
this benchmark be set prior to approval.
2. The plan proposes distribution pipes 6 ft. apart with 3
„ .' 1/2 ft. of stone around the edges. Under this type of
configuration, a maximum of 3 ft. of stone is allowed at the
edges of the leaching field. I would suggest adding another
line and separating them by 5 ft. with 2 1/2 ft. around the
edges.
3. The side slope grading is incomplete at the south side
of the house. A 142 ft. contour is missing and needed. Ii' a
20 ft. level and 7 1/2 : 1 downhill slope was used, I believe
the 142 ft. contour could be placed in the appropriate
location to meet slope requirements and keep the fill on the
lot.
'1 4. It appears that the septic system is 100 ft. from the
However-, the proposed edge of
proposed edge of wetlands.
wetlands should be shown on the plan.
5. The plan calls for a top of foundation grade of 152. 0
with a foot of cover over the tarjlc (E1 = 151. 4) the grade
over the tank will be higher tljan the grade at the
foundation (EL = 151. 0 +) . This may cause water to dr-ain
toward the foundation. I would suggest raising the house
elevation to allow for water, to drain away from the house.
6. The D-Box should be raised to allow for at least 1/2%
slope for the distribution lines. I would suggest raising
the inverts of the D-Box 0. 15 feet.
Thank you for your cooperation in ttiir matter. A resubmittal
fee is not required. Should you have any questions, please do not
hestitate to call.
Very truly yours,
MARCH I NDA/&� 'SOC I S, I
Michae J. Rosati
Acting Health Agent
I, .
d v
May 17 , 1990
P.O. Box 577
Swampscott , MA 01907-3577
Board of Health
Town of North Andover
120 Main Street
North Andover , MA 01845
Gentlemen:
Enclosed are three copies of a septic system design developed by
Mr . Joseph Barbagallo for "Lot 24 Candlestick (Spinning Wheel
Estates )" in North Andover , MA.
Please review this plan for acceptability in accordance with the
standards and requirements in force in North Andover .
Note fees for Site Testing/Inspection and Design Approval were
paid. Copies of the certificates issued are attached.
If problems develop , please telephone me at 508/687-1501 ext .
2781 during the day. All correspondence should be addressed to
me at the address above .
Thank you for your assistance .
Very truly yours ,
Brian M. Gaff
Town of North Andover, Massachusetts Form No, ,
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BOARD OF HEALTH
120 MAIN STREET TEL: 682-6483
�SSACNUSES NORTH ANDOVER, MASS. 01845 Ext. 32 or 33
August 7, 1990
Mr. Brian Gaff
PO Box 577
Swampscott, MA 01907-3577
I ,
Dear Mr. Gaff:
Please be advised that the septic system plans for Lot 24
Candlestick Road in No. Andover, dated 7/23/90 have been approved
by this office.
This approval will expire two years from the d e
approval .
Very tr y o
Michael J. Rosati
Acting Health Agent
MJR/rel
F-IURD of H6;a--I-H I.oT Z -44jl.%55AiGr 1.
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SS StPT'I SY S T�,� T�rrS�c�J
zz 48-
�� APR�o /unyot-�lry
PLA 1 FaA,) DAT 7-20 �7
DI SAPPR�VEp �1 E _
R�ASoNs - .
Dw� 5r SyST W STA LLATIOA J
Y
V4 Ti JN P6-.6T( �J M-rc- Q 1" �( F41
�iNA� I VSP rlonj PI PE FE-iocJS z.� T/J 0) � P S5 `Q I'�IL
/6PFRC) 1> P4TC �6PPt�7vtivG ,�vr o��rry
I NsT��,i Grp
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DtSAPi7j?ovF, DrC'
FINAL APPI�OVAL
Ncrtl: :,ndover,Mass.
SUBsgRFACE DISPOSAL DESIGN CHECK LIST
K t LOT # Z4 4W01i'-W61C
' DI SAPPRUM DATE
—
Reasons:
��� Reasons:
Provided:
Title Q FAIL CK
Reg 2.5 e submitted plan must show as a ui im=:
the lot to be served-area,dimensions lot # abutters
location and log steep observation holes-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
f) existing and proposed contours
g) location any wet areas within 100' of serge disposal system or
disclaimer-check wetlands mapping
(h) surface and subsurface dra_ims vithin 100' of sewage disposal
/ system or disci ai -er
✓ (i) location any drainage easeents within 100' of segage disposal
ry
system or disclaimer-Planning Board files
0). kno= sow of tater suzply within 2001 of se -ge dispo�l a
system or disclaimer
( ) kation-of any- proposed veil to serve lot-100rim leaching facili'
cation of water lines on property-101 from leaching facil3 Y�
location of benchmark
ive-6ay-s
garbage disposals
) no PVC to be used in construction
q) profile of system-elevations of basement, plunb, pipe, septic tank.,
distribution box inlets and outlets, distribution field piping and
0'ler elevations
(r) ma-X ymm ground -�.ater elevation in area sewage disposal system
J (s) plan roust be prepared by a Professional Engineer or other
professional authorized by tau to prcpare such plans
Reg 6 Septic Tanks
(a) capacities-150 - of i10k, vater table, tees, depth of tees,
access, pining
cleanout
c) 101 from cellar vel l or ingr ound s ng pool
d) 251 from subsurface drains
Reg 10.2 Distribution Faxes
Nb)
s ope greater than 0.08
Reg 10.31 ( stiff -E
o F L, —t'e�
"1Kjeee- 0ro SIGN $ �
�4 --..11"TCK t-'eer fv(,oP� (2�2�► r.t E��"S
SOIL PROFILE & PERCOLATION TEST DATA
North Andover, Mass. 'Street No �`-'01� `��'��'�- Lot No Z4
Loc/Subdiv. ' Pland Owner
Investigator 1"'%EeJ2.tMbt-_ Observer 1�'\
SOIL PROFILE DATES
l.)Elev 2.Elev 3.El.ev 4.Elev
0 0 Z' 0 3 0
1 1 1 1
S "r'i
Timms Pits est
2 2 2 2 _
3 3 3 3
4 Sr�tiY 4 44
5 5 5 5 VjGnt.V-C& tom+HELL
6 6 6 6 IrcS1-1CA(._
7 7 tt0�s s�. 7 7 �-s
8 8 8 8 �t
9 9 9 9
10- 10 10 J 10
Benchmark Location
Elevation Datum
PERCO;,ATION TESTS
DATES Zt 'ej3
Pit Number 2 -3`12 3 4 3
Start Saturation 11 ?2, 11: SCP
Soak-Minutes b�;3 W. Ss
ar e 1 1,1
Drop of 3"-Time 11: Z,: o a
Drop of 6"-Time 2:o t:1 2.:
Moms-lst 311. drop 1p iS _
Mins.2nd " Drop kk 1 (0
Percolation g. to
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LLS/G,c! DATA
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22 �
/add re2ss C4-RI6 Title of File
Page of
Date File Open: nate ale Closed:
Doc Document/Action TitleDate of Refer to other Document/Action oDocument/Action and notes
action Document/ document/
Num. Document/
Department
--------------
------------
Board of Appeals - Board of Health Planning_Board - Conservafion Commission - Buildingar De
p trnen,t --
G.
�1
r r
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
d DEPARTMENT OF ENVIRONMENTAL PROTECTION
F
C
J
♦v
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 19 Candlestick Road
North Andover,MA 01845
T JidOFrlOF�iH�9NitL
Owner's Name: Elisabeth&Scott Williams BOARD bF"•EAJH
Owner's Address: Same
Date of Inspection: 02-23-2004 FEB
2 5
Name of Inspector: (please print)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 t0►e information reported
below is true,accurate and complete as of the time of the inspection.The inspection was perf®rmed 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(31.0 CMR 15.000). The;system:
X Passes
Conditionally Passes
Needs Further Evaluation by the Local Approvimg Authority
Fails
Inspector's Signature: Date: L9
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 applicab de,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.
I
i
r �
Page 2 of 11
I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 19 Candlestick Road
North Andover,MA 01845
Owner's Name: Elisabeth&Scott Williams
Date of Inspection: 02-23-2004
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 nait)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 insipection 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 pte(s).The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
f
Page 3 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 19 Candlestick Road
North Andover,MA 01845
Owner's Name: Elisabeth&Scott Williams
Date of Inspection: 02-23-2004
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 CMIR 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 environnnent:
_ The system has a septic tank and soil absorption system(SAS)and the SAS is widhin 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,1provided 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: 19 Candlestick Road
North Andover,MA 01845
Owner's Name: Elisabeth&Scott Williams
Date of Inspection: 02-23-2004
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 dine to an overloaded or
clogged SAS or cesspool
X 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 t1han'/2 day flow
X Required pumping more than 4 times in the last year NOT due to clogged or obsttructed 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 welft.
X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet fpm 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 on•ganic compounds
indicates that the well is free from pollution from that facility and the presemce 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 I0A00 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 accomdance 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: 19 Candlestick Road
North Andover,MA 01845
Owner's Name: Elisabeth&Scott Williams
Date of Inspection: 02-23-2004
Check if the following have been done.You must indicate"yes"or"no"as to each of the Mowing:
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'tthiis inspoo en?
x _ Were as built plans of the system obtained and examined?(If they were not avaikable 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 off::sludge and depth of
scum?
x ` Was the facility owner(and occupants if different from owner)provided with infbnmafiun andie pr per
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: 19 Candlestick Road
North Andover,MA 01845
Owner's Name: Elisabeth&Scott Williams
Date of Inspection: 02-23-2004
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: 5
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 require(q
Laundry system inspected(yes or no): no
Seasonal use:(yes or no): no
Water meter readings,if available(last 2 years usage(gpd)):see attached
Sump pump(yes or no): no
Last date of occupancy:_recent
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):no
If yes,volume pumped: 1500 gallons--How was quantity pumped determined?Not p d
Reason for pumping: Tank was already_pumped 9/8/2003.
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 maintenarnce contract(to be
obtained from system owner)
_Tight tank _Attach a copy of the DEP approval
_Other(describe):
Approximate age of all components,date installed(if known)and source of information:
12 Years
Were sewage odors detected when arriving at the site(yes or no):No
Page 7 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 19 Candlestick Road
North Andover,MA 01845
Owner's Name: Elisabeth&Scott Williams
Date of Inspection: 02-23-2004
BUILDING SEWER(locate on site plan)
Depth below grade: 18"
Materials of construction: X cast iron _40 PVC_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:
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'x11'
Sludge depth: 0"
Distance from top of sludge to bottom of outlet tee or baffle: 40"
Scum thickness: 1/2"
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: 14"
How were dimensions determined: Tape&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:T ___Metal concrete _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: 19 Candlestick Road
North Andover,MA 01845
Owner's Name: Elisabeth&Scott Williams
Date of Inspection: 02-23-2004
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 Tothea(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: a ual
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 Okav
PUMP CHAMBER: (locate on site plan) N/A
Pumps in working order(yes or no): n/a
Alarms in working order(yes or no): n/a_
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
• Page 9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 19 Candlestick Road
North Andover,MA 01845
Owner's Name: Elisabeth&Scott Williams
Date of Inspection: 02-23-2004
SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required)
If SAS not located explain why:
P Y
Type
leaching pits,number:
leaching chambers,number:
leaching galleries,number:
leaching trenches,number,length:_
X leaching fields,number,dimensions:.Leaching Field 24'x60'
overflow cesspool,number:
innovative/alternative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,corwdition 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 ve=getation,etc.):
PRIVY: (locate on site plan) N/A
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of ve=getation,etc.):
Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 19 Candlestick Road
North Andover,MA 01845
Owner's Name: Elisabeth&Scott Williams
Date of Inspection: 02-23-2004
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 bufding.
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Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 19 Candlestick Road
North Andover,MA 01845
Owner's Name: Elisabeth&Scott Williams
Date of Inspection: 02-23-2004
SITE EXAM
Slope '
Surface water
Check cellar x
Shallow wells
Estimated depth to ground water 3 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 reviewedi:
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:
Test pit 5-21-1987,plan date 7-23-1990
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DdSuppait _ _ -----_-_ 19 CANDLESTICK RD
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1 2009-13 19/91/1999 1319 1448 129 3S2.1I 8.00 9.00 352.17
c 2 29@0-23 01/97/2880 1448 148S 37 101-01 9.90 fl.09 191.01
Wund 3 2900-33 03/31/2009 1485 1505 29 54.60 0.99 9.99 54_62
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e 72091_33 03/29/2991 1595 1619 24 65.52 0.90 11.09 76.52
�Stu"to- I 8 2091-43 96/20/2901 1619 1656 37 191-91 0.90 11.00 112.01
Fc 9 2fl92-13 09/24/2901 1656 1726 79 228_99 9.99 5.55 234.05
19 7902-23 91!31/2092 1726 1769 43 117-41 9.00 5.55 122.96
r _r 11 2092-33 94/99/2802 1769 1789 29 49.49 0.00 5.55 54.95
D Wook r12 2992-43 96/11/2902 1789 1851 22 56.58 0.09 5.55 62.1
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= 14 2983-13 09/17/2002 1811 1889 78 254.48 9.00 5.97 265.45
- ' 15 2993-23 12/16/2002 1889 1923 34 199.8® 0.90 5.97 196.77 :: y-
16 2903-33 03/14/2903 1923 1962 39 119.89 0.39 5.97 125.77
4962 199.5 33 7-011 9.99 5.97 192.97
17 2003-43 06119!208 1995 2839 44 • 128_12 0.90 7.42 135.54 _l
Netw0d< 18 2984-13 09116/2
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Commonwealth of Massachusetts ��1D
City/Town of
System Pumping Record .1uL 0 7 2008
g
Form 4 TOWN C ANDOVER
HEAL N T'w1ENT
DEP has provided this form for use by local Boards of Health. Other forms may be used;b ie
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
Important:
When filling out 1. System Location:
fomes to the
computer,use
only the tab key Address .1
to move your L q
cursor-do not Cityrrown Stat Tip Code
use the return
key. 2. System Owner:
Name
ISI Address(if different from location)
City/Town State � Zip Code
Telephone Number
B. Pumping Record �SUv
1. Date of Pumping Date 2. Quantity Pumped: Gallons
3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank
❑ Other(describe): ,�
4. Effluent Tee Filter present? ❑ Yes L -KO- If yes,was it cleaned? ❑ Yes ❑ No
5. Condition of System: � �� _ � V1\n F��
6. System P�� t By:f—)
�C
Name Vehicle License Number
Company
7. Locatio/�y��/ji��ere conte s isposed:
Signatu of a er Date
t5form4.doc•06/03 System Pumping Record•Page 1 of 1
Commonwealth of MassachusettsEI -
City/Town of
System Pumping Record OCT 25 2012
Form 4
TOWN OF NORTH ANDOVER
DEP has provided this form'for use by local Boards of Health. Other fo HEA TH DEP T T
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 Righfjijr of h Left/right side of house, Left/
Right side of building, Left/Right front of building, Left/Right rear of building, Under deck
Address
City/Town State Zip Code
2. System Owner:
Name
Address(if different from location)
City/Town State ftp Code
Telephone Number
B. Pumping Record
1. Date of Pumping Date 2• Quantity Pumped: Gallons
3. Type of system:yp y ❑ Cesspool(s) eptic Tank El Tight Tank
El Other(describe):
4. Effluent Tee Filter present? ❑ Yes D—IVo If yes,was it cleaned? ❑ Yes ❑ No
5. Condition of/�System-
6. System Pumped By:
Neil Bateson F5821
Name Vehicle License Number
Bateson Enterprises Inc
Company
7. Location a contents were disposed:
GMeH
L SLowell Waste Water
Sig Date
t5form4.doc•06/03 System Pumping Record•Page 1 of 1
g
sof Health SSPTIC 3YSTEti ,
,. -Andover,Naas. INSTALLATICN CHECK LIST LOT # io
Y
ED DATE DI PROM AVA '-OK--
eascnst
`FAIL
1.- Distance TO:
t / a. Wetlands
L _ b. Drains
C. Well
2. Water Line Location
3• No PPC Pipe
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 Flowing Equal Amounts
c. No Back Flow
6. Leach Field or Trench
a. Dimnsions
b. Stone Depth
c. Capped Eads ����'�
d. Clean Double Washed Stone
7. Leach Pits
a. Dimngions
b. Stone Depth
c. Splash Pads
d./Cees
e. ment Pipe to Pit - Both Sides
f. Clean Double Washed Stone
c! 8. No Garbage Disposal
9. Final Grading Inspection
10. Barricading Covered System
11. As Built Submitted
a. Lot Location
b. Dimensions of System
c. Location with Regard-to Pere Test
d. Elevations
e: Water Table
SUBSURFACE DISPOSAL SYSTEM CHECK LIST
�4 NORTH ANDOVER BOARD OF HEALTH
c'
APPROVED DATE PROVIDED DISAPPROVED DATE TIME REASON
Title 5
Reg. 2. 5 Fail OK Thesubmitted plan must show as a minumum:
a the lot to be served (area,dimensions,lot //,abutters)
(Planning Board files)
location and log of deep observation holes-distance
to ties
location and results of percolation tests-distance
to ties
(d) design calculations & calculations showing required
leaching area
—location and dimensions sf system (including reserve
area)
existing and proposed contours
ocation of any wet areas within 100' of the sewage
disposal system or- disclaimer (check wetlands mapping)
surface and subsurface drains within 100' of sewage
disposal system or disclaimer
location of any drainage easements within 100' of
sewage disposal system or disclaimer (planning board
files)
known sources of water supply within 200' of sewage
disposal system or disclaimer
location of any proposed well to serve the lot (100'
from leaching facility) .
ocation of water lines on property (10' from. leaching
facilities)
location of benchmark
driveways
garbage disposers
no PVC is to be used in construction
a profile of the system (elevations of basement , plumber
pipe septic tank, distribution box inlets and outlets,
distribution field piping and any other elevations)
maximum ground water elevation in area of sewage disposa
system
(s) plan must be prepared by a Professional Engineer or
other professional authorized by law to prepare such
plans
Septic Tanks
Reg. 6 (a) Capacities - 1500 of flow, water table , tees, depth
f tees , access, pumping,
AcCleanout
) 10' from cellar wall or inground swimming pool
(d) 25' from subsurface drains
North Andover Subsurface disposal system check list - Page 2
` Pail OK Distribution Boxes
Reg.10.2Slope greater than 9.08
Reg.10.4 H �(bf Sump
Leaching Pits
Leaching pits are preferred where the installation is
possible
Reg.11 .2 (a) Calculations of leaching area (minimum 500 S.F.)
Reg.11 .4 (b Spacing
Reg.11 .1 (c) Surface drainage 2%
Reg.11 .11 d Cgver material
2f� ¢ S fa-sk
V e.
� dA(( t; �t
Leaching Fields
Reg.15.1 (a) %G ater than 20 minutes/inch
Reg.15.1 (b Area (minimum 900 S.F.)
Reg.15.4 Construction of field
Reg.15.8 d) Surface drainage 2%
Reg. 3.`7 (e 20' from cellar wall or inground swimming pool
Leaching Trenches
Reg.14.1 (a) Calculations of leaching area (min. 500 S.F.)
Reg.14. 3 (b Spacing (4 ft. min. 6 ft. with reserve between)
Reg.14.4 (c Dimensions
14. 5
Reg.14.6 (d) Construction
Reg.14.7 (e) Stone
Reg.14.1 (f) Surface drainage 2%
Down I'll Slope
a) Slope y/x = (to be shown)
(b) y/x X 150 = (to be shown)
Pumpe
Reg. 9.1 (a) Approval
Reg. 9.6 (b) Stand-by power
i
ti SOIL PROFILE & PERCOLATION TEST DATA
k Town/City No.&Street ,/��Z Lot No. /(J
Loc./Subdiv. ✓ �' ,� �'�, 60,4-re/Plan Owner 7-
Investigator_ eA0,1_, Observer
SOIL PROFILES-DATE -
v
1" E ev. 2' Elev. 3" Elev. 4"Elev.
0 �0 77 0 0 0
�2 2 2 2
3 3 3 3
4 4 4 4
5 _ 5 5 5.
f\6 6 6 6
7 7 : 7 7
O
8 8 8 8 -
-9 9 9 9
10 10 10 10
Benchmark Location
Elevation Datum
Percolation Tests-Date
(91,22177
Pit Number 1 2 3 4 S
Start Saturation :U Z-
Soak-Mins.
Start Test-Time
Drop of 3"-Time :Z7
Drop of 6"-Time 2
Mins.lst 3"Dro p
Mins.2nd 3"Dro
Notes & Sketches on Back Frank C. Gelinas & Associates, North And.
A�
xve