HomeMy WebLinkAboutMiscellaneous - 195 FARNUM STREET 4/30/2018 r~ 195 FARNUM STREET 1�
i Ir 210/107.A-0277-0000.0
1 �
11 �
�y
• lv
MAP #_------- -- -- LOT #_.._....__.........y.__;..,..�..�..1_........�_A... ......_.T.. .......
PARCEL # STREET
CONSTRUCTION APPROVAL
HAS PLAN REVIEW FEE BEEN PAID? YES NO
PLAN APPROVAL: DATE _l_Z' APP. BY_.-_.--..._ ._...._......... _......... ......_. _. _.
....... ....
DESIGNER: PLAN
CONDITIONS_ LJUTY - V&P — �c V L�r't J `�� � . �G
WATER SUPPLY: TOWN WELL
L
WELL PERMITDRILLER..........__._....._ ...__ _. ..
WELL TESTS: CHEMIC�ALL / DAIE APPROVED...._„_....
....__.__._.._.......
BA�EAln I DA I E (11 3RUVED
H ' TERIA II DAFE APPROVED............_.........----.._------
COMMENTS:
...._COMMENTS:
FORM U APPROVAL: APPROVAL TO ISSUE YES
DATE ISSUED BY
CONDITIONS: ro
FINAL APPROVAL:
ALL PERMITS PAID F�10
WELL CONSTRUCTION APPROVAL Y NO
SEPTIC SYSTEM CONSTRUCTION APPROVAL YES IVC)
OTHER YES NU
ANY VARIANCE NEEDED YES NO
FINAL HOARD OF HEALTH APPROVAL: DATE: 91,4-. BY• <L J
SEPTIC SYS.TE�1__ N.ST._9.4,L.A.Z. _RN.
IIS THE INSTALLER LICENSED? YES NO
_ TYPE OF CONSTRUCTION: NEW REPAIR
NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW YES NO
CONDITIONS OF APPROVAL YES NO
(FROM FORM U)
ISSUANCE OF DWC PERMIT YES NO
DWC PERMIT N0. INSTALLER: ] --
BEGIN INSPECTION 6=NO: _��-- --
EXCAVATION . INSPECTION: NEEDED: q • Sr11 Aw
PASSED BY
CONSTRUCTION INSPECTION: NEEDED: .: .-._.......... _-
,
Al -DQ
AS BUILT PLAN SATISFACTORY:
APPROVAL" TO BACKFILL: DATE: _/ > SHY-.__.-,. !
FINAL . GRADING APPROVAL: DATE__ �� �I
FINAL CONSTRUCTION APPROVAL: DATE: � L� -
Commonwealth of Massachusetts
W City/Town of No andover s�,
w System Purliping Record '
T 0 W a 0 r�:Or�Te,f_.,0 X14 i
Form 4 HE&T.4 C�P.Fr.- z. J y
M
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 within 14 days from the pumping date in
accordance with 316CMR 15.351.
A. Facility Information
Important:When
filling out forms 1. System Location:
on the computer,
use only the tab 195 Farnum St
key to move your Address
cursor-do not No Andover - - - - - -MB
use the return
key. City/Town State Zip Code
2. System Owner:
VQ Rothchild
Name
renes
Address(if different from location)
City/Town State Zip Code
Telephone Number
B. Pumping Record
., ,, 'cam
adons
1. Date of Pumping Date a 2. Quantity Pumped: 0 -j
3. Type of system: ❑ Cesspool(s) IL, eptic Tank ❑ Tight Tank ❑ Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No
I
5. Condition of ;item:
6. System Pumped By:
Name Vehicle Li nse NLAKer
Stewart's Septic Service
Company
7. Location where ntents were disposed:
Stew re- ream Plant, 20 So. Mill Bradford, Ma 01835
Signature of Haule �-Dia-te-�
Signatur of Receiving Facility Date j
t5form4.doc•03/06 System Pumping Record•Page 1 of 1
.. r ` q ,h t r � t 317.}N../r �.a�F+.>t ✓ rl t r. +� t1_
V.,
sm
; .6f g RE,GEIVED .
' � � dOVER
11 Rec 0'rd ASSACH-USE
'KCrrlll��I,71,hN�,�r,��/,rJ•yl�l�„1rl�ll�r`/l�i,�Ir�,tra.Y�,�,;'iClrl�•.�',
O�p'h{I p10Yldrd ►SII Ip„� rp, `ao TOWN OFNORTHANDOVER
pe rv0/11J(IOd IO V11 IOC11801rc: c'r n / p'' ol a0a,C, A)THQEP RTMENT
A. Faclllty In(orm�Uor�
. .•^'� ; . r ;,. Sys;°m loca�lon,•
01-1
r•a .
i:J "'I1Y,'i(II'�y,',•v''I;r'�i'jr,l;l!Cv.l'.'„'Ir";d. 1 $111 t^----�..
' �.;� � rV,;'�!' � r�.�;sr�lrm Ownir•N,I'' .h ' .
. . v rl 1 , ��j�(.�:h/lljl•.1 I,.b u•rrr r• 'u�' '., •
'l�rtt'f••"r il'Y,�4r'.�',�,�L�•Ir�'d'��1'.li f�'I�•.
',r.' + '':;�I�t�;f''1�, ��'i'� +i1`I•Ir'•ll'yl'r�f, .,•.,
•' v �1 t I'h• Y'Ir. ��y�l u'•I,larl.; •,'•.
''' �•I;''/VOr►�l ( l ,Ir�nl ran buVon� ���
C4^o.1) r Jyy
;non1 n,rn0lr �C
-Pumping;�,, Q9,
14.
I. Oalo of Pvm •,
• , •5 r' 9InQ,. ot:l 2 ^•.'ar.'•'-/ %,. ;8r' �l�' G�,I�.S
J,' ;rYD:��j+.•''!'!"i1,,.•, ' 9 0 9$0PUC ren,
Qo of
( J• /Ib9)
Q ' ' Y ti '�ti''y�lr.'•r
pl'3ent7
(�
Y wlo
' ,';j,'•'r'��'i���m�!•l1'Y�( ��I�y�� r'I•'''' o�
' . r.11'I '�1111'1Ir;',i4,IIYdv1,1J'
0.;,, Sy PvmSS p#16 y
• r r
. ,1.,.•1',;•.1"1�'il''i I• 14
.,,i• f.II � V'I�`1�}�{' ,�' �1► ' 1 •y� { I �I c,, r `n 1, l rI
'i:, �'jr,•l��•i/,`;Ir�', ,/''i�;rr ` ' I' ) 'f,rr, I K 1(/Iu /r '�
' ' ' ;'�,•y'i,,l��.• 'r,l MVr1i41lliJ►ti�rl� r')1t�i���t,�r�rll:' � •
I t i I •1,+ .,
;•, �,.l
OCd Oar�'�101
. � f copl�nla,y�,a19 d(�Posoo;
� ,,•. ,r�t7rrl�lr/
,•� •r, i `CJ r
1I
r• 1 u
1 1'
,' ,. .'I11'!Jr//lr�'r�'.•'rl�l.11 I.I�r ,�,. --
... ;,• .,main or/d,�;' •r y/!r�r � 1
...,,, rrkx w t �� r,.. . 814r/e9�r9YaJa�lb/orms,n:�n,oi�!�o'ocl ., rl
S�IrcS•.ffr , \! ItZ�,s F-
. .t ; s chuelm
1r� s ; }Qf�'NORTAiVDOVER MASSA HUFxE
4 ri"fi: 4 • jSY��er»�Pump�t�g �ec�®'rd'` .
.I(• ,'! 1,k Mrd,,/ti 3 ir q'
�, MAY 1 0 2007
DEP has prov(ded this form for use by local Boards of Health. ThQTM must
be Submitted to the.local'Board of Health or other approving auth it
utr '
k :s
A Facility Information
f5mg out 1... System Location
•: .'computer,use; Ony—
only the tab key Address
to move Your
cursor-do not
use the return City/Town State Zip Code
keY. � 2 System Owner.
�A4r 1'•. .(;',rf ..� �-i��/�/ ///'''PPP /// / /////J .
, Name` , : //l(•+UV/jl'�^ �[ �Y
Address(If different from location)
I
City/rowrt
state
e'.�
Telephone Number
Pumping Record
,a ate of Pumpinge24 2. Quantity Pumped:
Data p Gallons
Type of system ❑ Cesspool(s) ptic Tank
❑ Tight Tank
❑ Other(descrlbe), ,
4 Effluent Tee F(Iter present?.❑ Yes No If yes, was it cleaned? [I Yes ❑ No
5 Condition of Systp7m
6 Sy ern.Pumped By "
h1v
r
; i - v fr, �rame•tiCl; ' r .v r
z,� r C';• 1) FyQ is ,`yl tr'tF ?+i,''d `,,'' .�,• •' ^V8t1ICi@ uCBn$8 Number
wJ
�Q��j�y t
;.�•T'l
' i •Y� rt , ,,.1•.4ri ry;'IF744`�W,',••.�f;i.7'.+,},�. iJri��.:t . : '::. .,
1 7 Location where contents Were disposed:
'l 1
lKi
a; lx;f Slynature of Hauler �� �.' Date
http.//www
mass.gowdepJwater/approvals/t5formsthtm#inspect
". t5fomA.doc--0&03 t
Sys em Pu
mping Record•Page 1 of 1
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
DATE: ) a
SYSTEM OWNER & ADDRESS SYSTEM LOCATION
(example: left front of house)
k,Sf
DATE OF PUMPING: ` /, QUANTITY PUMPED/6 GALLONS
CESSPOOL: NO I/ YES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE Is EMERGENCY
013SERVATIONS:
GOOD CONDITION FULL TO COVER
HEAVY GREASE BAFFLES IN PLACE
ROOTS LEACHFIELD RUNBACK
EXCESSIVE SOLIDS FLOODED
SOLIDS CARRYOVER OTHER (EXPLAIN)
i
SYSTEM PUMPED BY:
CO IMENTS:
CONTENTS I'ENTS TRANSFERRED "T'0:
Address ST Title of File Page of
Date File Open: Date file closed:
Doc Document/Action Title Date of Refer to other Purpose of Document/Action and notes
action Document/ document/
Num. Action Department
Board of Appeals - Board of Health -—Planning Board - Conservation Commission - Building Department
I
AS-BUILT CHECK LIST
and
FINAL INSPECTION
Proposed Elevations As-Built Elevation
House
Tank IN
Tank OUT l qq` A/ q9,11
D-box IN /q9l /� 19e %�
D-box OUT M-69 /qg; 7�
Trench Inverts
Line 1 g 6
_I
Line 2 /q 6 .4 Iq la, 77
Line 3 y y l9 41_A�21
Line 4lCf Z. Zo 1 ga, og
49 80
Bottom of Exc.
Stone OK? D-box checked? Pipes cemented? ��
!
i
k I
-
L..oGA-rEc� t U '1\I o. QND�l7ER
[ glllIgs
• Sc-a—r--r L.. G�tvE� 1�..L..S.
jY
• o.d � 46.88 _". ��3.12, �� oo
j Y
f ,
i
q ( l0 19?Z
IUV.ou'1"dF 4C-E 2o-ZJ3
'u 144.¢6
—rr TA-Z- 149.1 I tJJI
lu 13ox 198N4-
+&Z 146:7'7 Q
Y'3 144-.22
*4- 192.02
f +1-5 1 all.So
of x1115 �st�Sa< Co3' I
fj! 'r�+t✓ Goin QV�'1o�.1 ��- Z
M Au.p l=•uAt� C-'t2AC�Ur, A yyy�� / •
Acco2oAucr� IrH ii-
T1l Esi �C.SlG tJE,t2.5 _1 / 11. T.o.W QY.�.
sl-
14' l l lTl�uT A.t a TNgT �l
TE•lt✓MA'TP��IALS 6
JSP C%vu Fo R r Z EW�•�U c �
FIGA'Ttox1 S
A l.,l D /v Glrt>✓. l S:oo«lo __ 3�-r __ 52,, N
t
i
S GEYfZ.T11=y THAT o{=FS�T� Slow t.l A2 E. �oTe_
THS d F'F SrcTs I SE, o f "t-v44F— t...)tt ir- t l..t q*_:, Z
l
aJ r-t-H TH E Z.oU I U G TDE•T E.2.t-�l 1.► AT I o V.,..1 p t..o$.JI 1 k�J CTs .��7'Z Y' 4
�7/ L.A�t1S {7v l✓ Co``�Fp2�M Ty 02. l lo►J G�owltroZ,,-, T,/
t
j46- ANDaV�R w N U C o AJ 5"C'�t)G.T�fl. ' tsar
07 �l2
• q tt 42
Town of North Andover, Massachusetts Form Nm 2 i
N°R*h BOARD OF HEALTH
c
DESIGN APPROVAL.FOR
ssCH SOIL ABSORPTION SEWAGE.DISPOSAL.SYSTEM
Applicant_�L 'lY Test No
Site Location
Reference Plans and Specs.
ENGINEER DESIGN DATE
Permission is granted for an individual soil. absorption sewage disposal em to b s d
in accorda�ncecee with regulations of Board of Health.
N,BOARD HE T
Fee &
Site-System Permit No.
TO DATE
' � ROM _ —.-------- _ .�—•-_-..r--:-- .. .- AREA CG'�F IME,-p-----,
OF
UJa_
cn
UJ
f PE 1/ SIGNED
- -- - ----1' —-„- I- ------
J.�K�o c u� �..«c e.,a:ea rs un ro II��11
�{ caf.� El tt;Gx L �ecAgt. �'�� 'D
AMPAD No.23-176-400 SETS NO.23-376-200 SETS
Town of North Andover, Massachusetts Form No. 1
NORTH 9BOARD OF HEALTH rr
32Oy�t�eo OL `��� f� � � I �I 19C"�
APPLICATION FOR SITE TESTING/INSPECTION
��SSACHUS���h
Applicant '
NAME ADDRESS TELEPHONE
Site Location
Engineer .[a)
NAME ADDRESS TELEPHONE
Test/Inspection Date and Time
CHAIRMAN,BOARD OF HEALTH
L..
Fee "50 Test No. `4
S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No.
FORM U
TOWN OF NORTH ANDOVER
LOT RELEASE FORM
SUBDIVISION FoIZ04
ASSESSORS MAP D -5— S y
SUBDIVISION LOT(S) ,A �
PERMANENT ADDRESS ASSIGNED BY D.P.W.
STREET
APPLICANT PHONE
DATE OF APPLICATION
TOWN USE BELOW THIS LINE
PLANNING BOARD
DATE APPROVED17
T N PLANNEDATE REJECTED
CONSERVATION COMMISSION
• E APPROVED
2
CONSERVATION ADMIN. DATE REJECTED
BOARD OF HEAWH
DATE, APPROVED Z
41EA-1,11C SANITARIAN DATE REJECTED
DEPARTMENT OF PUBLIC WORKS
DRIVEWAY PERMIT
HWER WATER CONNECTION$ Pp—
*�_i, ' �
FIRE DEPT.— ,-
RECEIVED
EPT. ,RECEIVED BY- BUILDING INSPECTION
DATE
This form shall be signed by the agents of the Planning and llealtli Hoards,
` the Conservation Commission prior to the issuance of any building permLts
for the subject lot. This form shall not releive the applicant from the
)mpliance of any applicable Town requirement or Bylaw.
p ,
1 N
+-.�54 � „�.; ! t.. ..t l' to .'! � L w'.1..A. .k r�'•w. � r?h� +�+ a J :.e,: -
TWO
VIE
/57
too
r. h,'x �'i". 6 �,'!'' �• '-� r�� R �ft. �. } �� 4 '�' rt aF,7� t ° y '
i; r ,�
HER
�.i w Vii. •r` t '"N{ F1- / K * .
zz
ti �•``;':1 s t 1•, i )'- rC�: 't a;"i �s !"l5' ` -J
cj
. r ;, r
i .
Vol
top
Cf
now
took
1 y r 4 �rM i +r r f l b
" too
�r q777.
��, r i li7' � as a r► 'r0 F � A.� � 1 � Y�� !� '
s w �
i r
1Z: v; tz_-
ale
--
to - - -- --_ _--
• a
At
r'
-- -- - - - ----------
I -
�J '..� yP`a":. S � tLh �'�4 1 :f•kJ Y=',P-�.'4 aY h t• 1....4 Fl .r. i �,1�' )
own
oto t:6.� t Er• t �C. t,
�, `r° S.tw: �a #. i .➢ )..:.1 s.tY `43': t ':r.&'F, 1 t •�
r.
MY,
,i a w A
;
Nf
a +. .�. ''tit t., �.;'l r 'w:'. ,!. } r t'•.
h''? k-: r#�t i
w
mot
ll , . y
31 ,K..: I (.4':.. , / ,.,'1., 'Yii" ..Y':,•: FI{`'r ::F� FF'
• 4�• 'R :a rJ+c ..rf..( .1,,� y,.,. rN,. ,, ,. .>
RIO
lawsFp::-."iu 7.
-.•s,.... ! j•�, ,,y,,..a :'1.}-`.,1 d. ..',:: r.,. :.�:. �;. �: '.=:::r h "4� 1 Y.' L ,4e
! Xot
AND Ii
`'h
•.P "€',y�
MqF:
ac "i`• ItA,yytT o-r: 'f�.-:e:. 1 .'d r a :.t '',
'f r -kt" P �:•• ;.• ♦ -1 1 .Y"<tl1 ik• Y �' i t t
vt: • P,:r.
t t. w.. r:"Y'r S. <i ♦ • 1 r' 1
�
•'�'�f,�y'r6%tsFa-F! -") s ;,1� 'Z-,i a i, ��1 :r;• t i. s f�r't",'� i.
TF c
t��-1i 4,. ��{,� g .e�•�S r✓5 ,:� v '�t r? 1 a a! ;t k r rt:
�,w: �• L{t� ;' .. M• ,Yc ,;,' : Tat,. :: b^,<. ..:r,., v...'" _ Xs 3,3.. t t, Y�,.,i.
a(.
r�r s {{
astt� n J i. �.
1r:. .r �t.,...I..y a, ..:,-,�" ,_fC !,: :,,:., @• ;y:v n ,::�.5 x'': r` f �t ,Y t
r .,s. 1:, ,r 1 :,,t r >s r>W :+a,�". '£ •,r ,d;v, i a a ,�h
f-d, L. I" ♦x.fi i),P° .4.
':�nfF,�.4",�,�'.:;a'.'t)k k.,r,I.r>>:.ai.�r,.'LY,,:.�,'!4'°ux�a..+•)�[<d,:#aaM'.i�@.,,i a.•.,,!da�3M,.�tA`.".,'.1,F,^.,..$i,m'.,.Ya!.:�...5A7'.xa..,.:Qtm X.4+'.,,"......_f,\t".... t."tr1..t r'r:e..,r:i...'.,:R,i«'v...�•tfd-r.-.V'F,-q,\....'...,:.,.-:.1,...,.-.,.9Fy q.:,ek:-.�..l,.•dA.ra;.-.,a�.z,�•:t{k a,.wa.,.:.b*b5-a..w.y':a,,./
":. w.b•. .Y{.S.f.:y_tr.y.l..',.'.''.t, ..l{.,....P,iiiSrt-.J t.q".,'L..,r:...;-:.'..':v.,Wry,a',s.:.f,L,.. _..Y.ry�aFn.,�.'$.-, :,n,„�r.v.4..a'„.•ld�.'.....,,s,Wr7"«�-?{',.t.-,`,,-',tt..',>.!>2l'(aaJa?'aL....4�..o3Y�.-�,,s,+".t`,1,.W(r.:,.An.d:v. }pkL.A_Nyy:W6t..w{.„.,.5.:!..i:..'.at.
�s
4
,
"Z
: maw..,,
A GM . „ s . .t', 43mot
'.�II' y•tt:•i. /S.•-�:
,.
a.
� yf)/•
,
A. .. ,- .. ,�.. ...r: 1....,�._a .... ;..r.:L.., '.:..,._i? -.....:r _ ,.-.. 'r . .,.p''+., P .e :aF ,,Ca.;b,. .z. .;. e•r ...d. . i n n „#:. 't
ai'.... .-, '.tt. ,.:.,. I,{s: .:'...... ;.eq ..,..:,..... ,..,..'t., -,..., � ,.. ., :� , ;•;•A: ,: ..F, �.. 4�a-Ft,'.( y•F -.5,- ..-'•t-,.. ':s.." ,z r i
.v t¢:t.y : a..... # ... ,.., ,:.•�y., r S. . ... '.._,. ....o-x.. ., ..z, .,M 7 + ..�. n,� '<.. .. a t'
.,4 � ,..... .3. ->Z,.a'r" ,.• �.:�. a ,,.., .r, : r... ,,... ..,.. i ... 4` , ,:.;, , ,.... s Jfry
1 .. .,... _ `ti.S .Y ..J ".r r.,. ,:.,: ,.. .,'r.,1. .t 7... ..'. ..:{ rte,. -r.".. i•.. „ .,.. r11 •srF'C.. m� 'Y. ..i..,. .1
.
a 1,. 6 �.
... '� *'Y.t E .r.: 1 a:' } is J .i ^J
�. .� 5 t:. 4. ..tt.. , w.4 �{ ,
` a,.. m.. ,.. ., wl•., >< r.,.• ,- e..,, fi.,;-., .. rr�..,,, ':r...,,C ;zTs. .,ri' :,�� I < c• 4
�i, :, >._:, ,. r 1- � .,� ,>, '... . ..3 ,, e. a :. ._ ,,.... .x a... �- ., d':'•+�•. ,.t .'*`f •`� -,�'. _ '"4 ,..�' s
:. z,... ., .. ,�r.,,..F..... :.. ft. ..'�'>•.. ,, ..Y1... ,- ,." ,, v ,:,,....SS ,e.,.. n 3-•f L t. ,t .;le „n., Jr;.
'� �'w r.t. i ,Y;' 4^,e �f ,, .,R n'4' „rc.:y� b.• A. � s�"„ ). '',, yr r,�
`i ..t�s r ;`� :d s... 3:h.f .:q. _ ..f : r'r ,1.'' 4 zt1 ;�• rr bSA,� {{,V•, ..t ,.)b aS: "a: �x r'
6
s;: !
...x r•d, r.
rr! ,r
n' r, 9 a,.
r£
.•f• r .t'N '.:'`i:: ..d• ,.�..p, Y' .A'. ,-fl[•' n ,�..
^T :"1, J Fm7
{ ! c4 ,s;+9 p1 T
J
!# �M •i WIN :(
r .,.... S I > ry
f G. 5 31 n. �. ki F,
�'.• h -,F':'•t 4},. +.X q=
,+'F.'�. '.( wr, !M"#": � 'l.� ''3 w` "fir `}d
Y' '.,: :b '7. � ELI!-
'p,
re £ q{r7t,.. 1,.. F'..
�" r t� ,Y ciw)lyr. F. s .a.
",L M( � ..Y r
y -!�' TR'. if• ri�t, l.a l+.,i i
'ro
ta,d.
r + ,
, :Yi.S,,✓.iPn .^t:. ,: t,� �' '.� ). 'J.
3 Ir Y ETA
...�
,.a,p .: :' r.rl, ., < ..,: t ,_ 4r'a'r rt,1 4',.w.r
_ ir.,. 1.. :..., s.�. ,4..t. .,. ". a I
.,. 'S`{. .,,,,. ,,.,,.. . ... ,,. �f ,.i.
i.,< w ..,�., 2c r,.y •r. y 9 t y, 1.-
,.t � .,r, ?eta; �
_rs -u sig.?. r,'. .,r'-Y.., S � `� e'. ,. �...;. ..r.;: r r . � 3., � ..4. {': .,�..,. ,. �� ���� �� a. .'�:. ".•.. ,-.. 'i� t'
:a... - .'.,,. p;.
:'{ ,.3,.oY',� ..,�: 5 :Y, ,t;. r � .�l i �yr ,-a'.•, ➢"'.l '.+t ,;i{,'
nv
{r!:x a..'�kr3TS.a r�`-�bw.b+'1...t Ytt!.l.�r.!yd�..y,.�`J,i,;r Wee,..':tLS'y''Atra.1:1t.Y'S t.>wA. '.k�'��..,''.`1.,.r..r'' ; P'.v�, �.•�tt 7. l:.'ytV ''r:'S�A MBeaa 5,i r,`��'. `'a t I't t 1':';r:r!?v(.tt{.t;,WWa=,.sl. 3:-.„",w'-I,A+9."r1, r'. 't`k�' tSt:tF.�r...st..rrr�y,u.ba'.it,:'+.K�.,.3>rh.��a:''kt.' ,'''1�if'x.ra;:t it T vt•a..tL.`a 5i
� 4.
Af�;!Y'•�.'g.; ad� { .
Js
.yx,
r
S
nr' >• 7.. e' :T a, .;'� t af' 't ..r 1' a.r i
.,
N j aA r�1.k:5 rGa 3...kV',
ski
yy__
;'.°' dY'
Mz
.4:. �' t�°.., a .. ,,rv't�` :..,:...,, ,.; ,..,.,. Y.a:r• iC,..' r r.. .., .. .� ,., � .,. ,, r, u+✓� t ) s �'�,
. r,. , ,�1-. :•�.:. .i 'n .. .,..;�<. i..„ ,,. q.J, ,.moi..,. :. r.: _•', ,;. :,,. 7.y• a,- ',
w .•.d'• t•• t; e J t :e .:e. AS.. pAgo
'-r, .r.. ,r .\,-..♦ ,- .r:. .,. K ., e., ... ,'::,,. c ,.:a„ ..-` s ,i;_i ;_. ,.r.:.. ;.,' a ,::r°, ,I',.
01, not
,-(. - Y k.s., 13r.^ .,r .-.;{. _ :-.,: S , ra:,'. rt ? • :.v, Sy 1`:t,;
-.r��„a� th r.... � a. .c.7 A 1...,. F.... .... <., H.a. i _.... n:r �• ,.,.<. , a• :'f +, ,I
m: i di+..,.q., , �x..J. h, e,+. >„1. sii-. ... `.,.:._. ,\.. •} -, .$:� It ..S t'. ,
it
„, �yJ�{p r. G• aT''S' s:. a' t,�.. .! a: M a' ':• v...4.' .....,� .,.,. T ,t,:.i'k \J (.
b•. >'.i , ♦
b. .w+.�; r r.
4 k :°b '••>!, ,+,
160141 :1':'I 1..
- s Y `'alt
f'�
a ,
; �i r:' -�,,.. cY ,...'rr �':? i .:. ,t:. '✓r Ji" 1' }. �h C°- �4 h;Ys. i.t
1..�>•'ST �i, ;Pv .: .,, •r..fi. ;<fat .., .':� .,..
a� 1r r!A• ,"R. 1 .:ft... .:,:•, i:F;,. ..r,.,... 1.• �,: .1. I , '4 1r, .1.,
r r... It. a .,,.:}. .,,, ,.s.(.. ,+., :.-• .^r ,.:r J .' .�,vI:z
h..,..,U_`. I S�.'fi,f Sr-'rtr.Y'',ME',a.,5... :.0,at- •:l:.�4r `{'v „:.. ., .ro, .r ,7.,,.::'.4'-1.. i•;w.'::j:.r t ;�t, n. ,p':'rF WIT,�1' '0a �
r
'1 Sy s•.
t f �r,. .',.,,.. ': - .. �r; ,a. ,• `' `� �,, if h .l,
r r2 I
c ;
.ilk.. v., rsr� �.✓. ,.a ..,.�',• .. : :, :, ..,: 11 >. .. '; n1:1kt.
} t
Jlt
A.
Vit'' n. .,x': t, ,::a' ! �' :±✓t 1+
.t,.
y, 9
; NNW, w
t
J.!.;�1 ,,kr .',:•?r{ .-.r''. .. ;,', .. ::, ;A)Alr�y y@4r,,. ,^> n •.1c(�t'..c f: et 3 x' t,,,, w
� rP ` 4 t ,
u. P �C`s�� s", e;, � t;' k`r d 3 t ,!�,}' 1, ti .A i' `•I 1k.t ,t
'tGr,�:,�•:rtsr r" vv Y
,rr: � r' li s�: ,::? Y,
sSi,''?,. $.*'"^` } t •trn'N t :t.: f '.� ,,w ,
ISO
al
,
rrs�,, .,dt. ,•r , .1 r:. »�trc it t s "�•' 1 3
,u 5. J ,+ I •s :1 r I r igcl
i
Pon Q.
J
Loa
It AM A
L n y ,tatt`' Y T
I!9}'.,4wlt�'aL.g� 'ri7:. ra'si1d,�. hs«,k-e,,t':'hYhr,.,tF,,...Kfi�:.-'.;' rC ,4L. vt•r."�1 y ?s'•.-113"',1'.`t.r _I�..f Y ..1'x,;,.;t'.rs 'y;f >'�. q` {aRf'�,f-� �a't'.a`4.relJ +�_.,.�,,+1:^,f'.$r.5 et y 3,.2�-�a«;'"�:,.t r7a.t.;41y.a?;::.rY,'.l:,,;,,L I,a>a i'."J,a/•r'a 4\Lr vb 2.�(F3:� it, .I•�'
S.
r,r
,
.i �,1 ,r , tY = r _'...
f�" W;�r $•'�� ;f�I `°� %. . :,1 - 1 ..i`` z S
; t
5 £'
AxT
MAO
, 1a.r r` .ti•
.not •r Y. :f.: o l
it '1 v :r
i
` ,, ;;;. .,.. .,{,+.r. � k ;:,; :+.,}�,. 1'. .i R s. f.. ,,o. .,l a .':•i f g 'r., ,S t
-7,' .d,...t,,., .'�, d {,!r �, ,.rr. r t.,. t n^'.t: x 57 q •.r.. v ,t w 5 i
it ,s, ,7-,- 'k a;r. 9.,:�. 5,lak-. .,•t ,�' ) k') ..�' rF ,i J.;'-
�` .E.. < x R+a ��e f+,` 4, r.{., ,.,F,i„e 4, t, h-' ,u;fL,r: n `{'- r �.4."^ f:o'• .a i 9.. +r.
a
.a LG. _''� „ >r ,'}Y Yw.1r ni,„d f fr•t`r � ^'„ "c` a r. .r.
�• ..St�. '��. .?.,,.
,. ,.,.,,... at-�:. S :.,. '��,..f• ., :. .��.�t"k:2. ...,. •, ., =C ' '�,' f�'�twki,' t SI.;T.r o... 4£
:�,•'.,.
' -,�.� f:•' ,..t �' x , *z' ! ;S�ryr. �"J'" �:sr, ;siy...r � ,fY;� tt � r,� '� ,t�
�",:.. °. `:.,: •�'+""4�.� �',o:J.. r. .� .'tlr-i.^. �rt x. ',r .,'�,. :',<3"'' 1 a �S,U �}'-,;fir, Y;Fr wt,;. �'.
t
-i
�W?:l'n�
t
� ytm
„lel i
}
,
ayr�aua� lUF - .�... •ry ua-YM ON oOw
- ,.. �. kotwgf�J.'w c�rvrxaN �++•. . ' ' :P!
'P.. 1 S Ntl1X2l I'd L LZ
tt'�Li•e� ! .. •• 0'087 . • oo'{�clJn1 sby { '��
r, '1
'.'�.-. D (� �•��" ��; �; � Vii.: ,f�.
�� /fin �` ..- � � \.' :�i�,y, '`� �• :!. �:/
vGia � �',� : •'fir!
rn
low
ve
r9[irl441kolix LH
x
19
ii
I - b—d�\j
GOWGOVA-fiG) W I ®V �'\Q A L
Town of - ,Andover
No.
IVEWAY ENTRY PERWITss'69- 1 twj
er, Ma
_Jr
a0" A
BOARD OF HEALTH
L 0 z
PERMIT
Ile0
T .. ............ ......... ... ... ...............................
THIS CERTIFIES aTHA BUILDING INSPECTOR
411.
...4#:".Fbuildingson .....J.7% RQC901'
has permission toe 0
Chimney
to be occupied as.....%V*4-jrt6V..... •.....
Final
provided that the person accepting this permit shall in every respect conform to the terms of the application on file in INSPEC R
this office,and to the provisions of the. Codes and By-Laws relating to the Inspection,Alteration and Construction of
Buildings in the Town of North Andover. 7r
PERMIT FOR FOUNDATION ONLY Final
REG;�U "TED BY PARA: 112.7 S.B.C.
VIOLATION of the Zoning or Building Regulations Voids this Permit.
-S I NTI FEE PAI ELECTRI L SPECT90JR
PERMIT EXPIRE I SDAT 2 Dk2__
Rougro
UNLESS CONST CTIO ARS Service
PERMIT FOR FRAME/BUILDING Final
DATE: FEE PAID: 59p' GAS INSPECTOR
Rough
Occupancy Permit Required to Occupy Buildin
DG.PERMIT FEES Final
LESS FDA FEE 100, CIO
Display in a Conspicuous Place on the PreFWSQRME PERMIT$ a, a0
FIRE DEPT.
Do Not Remove Burner
No Lathing to Be Done Until Inspected and Approved by Smoke Det.
Building inspector
/Za�c�
MAnaACHUSSM QUITCLAIM Da[D SHORT FORM (INDIVIDUAL) fatal
Francesca Nicolosi, Trustee of Elio Realty Trust u/d/t dated
said Trust being recorded with Essex North District Registry of Deeds herewith
Instrument No.
Of. 95 Piedmont Street, Methuen, Essex County,Massachusetts,
btirW:Ac ,for consideration paid,and in full consideration of $249,000.00
grant to Kenneth L. Degan and Pamela J. Degan, husband and wife as
V� s .
Of 195 Farnum Street, North Andover, Massachusetts with 4Uttrlixbn plMtpipltg
The land with all improvements thereon situated in North Andover, Essex County,
Massachusetts being more particularly bounded. and described as follows:
That parcel of land shown as Lot 1 and as containing 43,698 square feet on
a plan entitled "Plan of Land in North Andover, .Mass. owned by. Adele L. Coleman"
dated February 2, 1992, by Scott L. Giles, R.L.S., recorded with Essex County
North District Registry of Deeds as P1an.No. 12006.
Said premises are conveyed subject to and with the benefit of any and
all easements, restrictions, reservations and conditions of record, if any,
insofar as the same are in force and applicable and do not affect the use of.
the premises for single family dwelling purposes.
This conveyance is made with the following restrictions which shall be
binding upon the Grantee, its successors .and assigns: no in-ground swimming
Pools shall be constructed upon Lot 1 around the area where the septic system
is located, nor shall there ever be a change ingrading or elevation on or
around the area where the septic system is located. These restrictions apply.
only to the septic area and shall not apply to other portions of Lot 1.
i
Meaning and intending and hereby conveying the same premises conveyed to .
the grantor by deed of Messina Development Company, Inc., dated March 23, 1992
recorded with Essex North District Registry of Deeds At Book Page
liitlteNB ....my......hand and seal this....... ................ day of.....
.............19.92..
...............................................
.................
]?rancesca Nicolosi, Trustee
tIIhr Q�nmmname�Itq of �ulllrita
Essex, ss.
19
Then personally appeared the above named Francesca Nicolosi, Trustee as aforesaid
and acknowledged the foregoing instrument to be their. free act and deed before me
.......................................................
Notary Public—Justice of the pact
My commission_expires 19
(*Individual—Joint Tenants Tenants in Co(nmon.)
CHAPTER 183 SEC.6 AS AMENDED By CHAPTER 497 OF 1969
Every deedresented for record shall contain or have endorsed upon it the full name,residence and post olhce address of the grantee
and a recital oftheamount of the full consideration thereof in dollars or the nature of the other consideration therefor,if not delivered
for a specific monetary sum.The full consideration shall man the total price for the conveyance without deduction for any liens or
encumbrances assumed by the grantee or remaining thereon. All such endorsements and recitals shall be recorded as part of the deed.
Failure to comply with this section shall not affect the validity of any deed. No register of deeds shall accept a deed for recording unless
it is in compliance with the requirements of this section.
r
--m C>
'. � L..oGA'T'Et� t►,..I .�o.",:I�N17dVECz .• !
Q (!! �9'L 1
r
-
i
1 t
i. I •*
q t to r9e- DoT- z_
tUv.cvTel= NSEt2o2'f3 4-3�648 S,t-- �
'u rq..t IG I44.q.-6
ou'f'TA�..t� 144•t I Sa`�
1u L3oX 198A4� {I
o�sr'Box 148:7�o p 5 (�
+�5 t a4.So
f —14A— IGgs�rti r 0
of THIS DIST�oSAc..� _ Co3' _ �
TH Orr-
T++e GouS,-rLv�-te.� it .•• 'e�T 2' �
AccoFzt�Auct✓ �Irt•1 n' �, 2h
'. THE. �ei�jIGUL3.CZ"`�
TNS MATP��'�AC_S 8 low
To 'T'f�F T-�C_A U " ��•Fro m
co
s:
t t
GE,Q-r1T=y THAT o i<FS�TS S�1aw►J A1;E �otz. T�dre,
THE. o F"FStc.Ts IJSE, e�F' T't-kE. �u ct.�t►.1� Z u SPEc'Tb �.��*�l� Of
' �rc.-r-�2 t-rt t w:i AT t o►.3 d t= �o I� r r.,.►Cs S .S
W tT>-+ THE.Zol..l IU Cz .13972 0
o2., 1.1o►u ColuF-oQ�I'IfTS/
{ �. aNp4V�2 � N E,u C o►.,,1 s-r e.uc.-r-�r�. /'�,FA�stt��s��`"
LL
V7 4Z
Q tt 2
�G
0
All Commonwealth of Massachusetts
Executive Office of Environmental Affairs
Department of
Environmental Protection
TOWN OF NORTH ANDOVER/
Wiliam F.Weld BOARD OF HEALTH
Governor
Trudy Coxe
S .y.EOEA
David B.Struhs
Cornrnisaion�r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ---
PART A
CERTIFICATION
Property Address: 195 Farnum St . n,Andover Address of Owner:
Date of Inspection: 10-31-96 Of different)
Name of Inspector:
Company Name, Address MW66nlrG40r:
RLI ggCorp.
CERTIFICATION STATEi1TENgton Rd. Blllerica , . Ma . 01821
. certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
Passes
_ Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
"Fails
Inspector's Signature: .-• Date: /0 l3//9G.
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this
inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit
the report to the appropriate regional office of the Department of Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority.
INSPECTION SUMMARY:
Check A, B. C, or D: ..
A] SYSTEM PASSES:
_ I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
Any failure criteria not evaluated are indicated below.
B] SYSTEM CONDITIONALLY PASSES:
One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair,
passes inspection.
Indicate yes,"no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not)
The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiitration, or tank failure is
imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as
approved by the Board of Health.
(revised 8/15/95) 1
One Winter Street is Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500
w
Ci Pnnted on Recyded Paper
v
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 195 Farnum St . N.Andover
owner: MR . & Mrs . Degan
Date of Inspection: 10-31-96
B] SYSTEM CONDITIONALLY PASSES (continued) royal of the
or hi h static water level observed in the distributionyPasbs�Spection broken(with app obstructed
Sewage backup or breakoutg
pipe(s) or due to a broken, settled or uneven distribution box. The system
Board of Health): broken pipe(s) are replaced
obstruction is removed
_ distribution box is levelled or replaced The system will pass
The system required pumping more than four times a year due to broken or obstructed pipe(s). .
inspection if(with approval of the Boardare replaced
_ broken pipe(s)
obstruction is removed
Cl FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:of Health in order to determine if the system is failing to protect the
Conditions exist which require further evaluation by the Bo
public health, safety and the environment.
�) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NO7 FUNCTIONING IN A MANNER
WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface waer wetland or a salt marsh.
N— Cesspool or privy is within 50 feet of a bordering vegetated
SUPPLIERP IF APPROPRIATE)
2) SYSTEM WILL FAIL UNLESS
THE BOARD OF HEALTH (AND PUBLIC WATER HEALTH AND SAFETY AND THE
DETERMINES THAT
THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC
ENVIRONMENT:
t or tributary ,to a
The cvctem nas a septic tanK and soli-absorption system and is within i00 feet t°° surface tic water supply`^�ei(•
surface water supply.
N stem and is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and is within a Zone t o a public rivaie:vvatet
The system has a septic tank and soil absorption system tc compounds indicates that the well is
feet.
The system has a septic tank and soil absorption systebmaa�'a less
septic ile0orgart but'S0 fent.or more uama c less than 5
IT- supply well, unless a well water analysis for co few a of ammonia nitrogen and nitrate nitrogen is eq
free from pollution from that facility and the p
PPM.
DI SYSTEM FAILS: failure criteria as defined in 310 CMR 15.303. Thecoo ism
1 have determined that the system violates one or more of the following contacted to determine what will be necessary o
for this determination is identified below. The Board of Health should be
the fail ure. � SAS or cesspool•
Backup of sewage into facility or system component due to an overloaded or clogg
�
rs due to an overloaded or cogged SAS or
Discharge or ponding
of effluent to the surface of the ground or surface wate
cesspool.
2
(revised 8/15/95)
t
r
f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 199 Farnum St . N. Andover , Ma .
Owner: MR . & MRS . Degan -
Date of Inspection: 10-31-96
D] SYSTEM FAILS (continued):
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
„ Any portion of the Soil Absorption System, cesspool or privy is below the.high groundwater elevation.
—NA Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
..A Any portion of a cesspool or privy is within a Zone I of a public well.
*A Any portion of a cesspool or privy is within 50 feet of a private water supply well.
ZA 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. if the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E] LARGE SYSTEM FAILS: NA
The following criteria apply to large systems in addition to the criteria above:
The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety
and the environment because one or more of the following conditions exist:
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 11 of a
public, water supply welC.
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 8/15/95) 3
s
,r•'
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 195 Farnum St . N. Andover, Ma .
Owner: MR . & Mrs . Degan
Date of Inspection: 10-31-96
Check if the following have been done:
}_Pumping information was requested of the owner, occupant,.and Board of Health.
X_ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates
during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection.
As built plans have been obtained and examined. Note if they are not available with N/A. -
_The facility or dwelling was inspected for signs of sewage back-up.
-R_The system does not receive non-sanitary or industrial waste flow
The site was inspected for signs of breakout.
X—All system components, excluding the Soil Absorption System, have been located on the site.
.The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or
tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on existing information or
approximated by non-intrusive methods.
X The facility o%vrer (and occupants,_if different from owner) were provided with information on the proper maintenance of Sub.
Surface Disposal System.
I
(revised 8/:Si95) 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 195 Farnum St . N . Andover , Ma .
Owner: MR. & MRS . Degan
Date of Inspection: 10-31-96
FLOW CONDITIONS
RESIDENTIAL:
Design flow: gallons
Number of bedrooms: 4 _
Number of current residents:--4—
Garbage
esidents:Garbage grinder (yes or no): y S
Laundry connected to system ( es or no):--ye S
Seasonal use (yes or no):
Water meter readings, if a� i bie: ,
Last date of occupancy:_ present
COMMERCIALANDUSTRIAL• N/A
Type of establishment:
Design flow:__gallons/day
Grease trap present: lyes 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:
OTHER: (Describe)
Last date of occupancy:_.
GENERAL INFORMATION
PUMPING RECORDS and source of information:
System pumped as part of irispection: yes r no
If yes, volume pumped: gallons
Reason for pumping:
TYPE OF SYSTEM
Septic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system (yes or no) (if yes, attach previous inspection records, if any)
Other (explain)
APPROXIMATE AGE of all components, date installed (if known) and source of information:
year s
Sewage odors detected when arriving at the site: (yes or no>�
5
(revised VIS/W
Y
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 195 Faznum St . N. Andover , Ma .
Owner. MR . & Mrs . Degan
Date of Inspection: 10-31-96
SEPTIC TANK:_
(locate on site plan)
Depth below grade- 1 q
Material of construction: concrete _metal _FRP—other(explain)
Dimensions:
Sludge depth:n A..
Distance from'top of sludge to bottom of outlet tee or baffle: 2 rr
Scum thickness: 211
Distance from top of scum to top of outlet tee or baffle: 41,
Distance from bottom of scum to bottom of outlet tee or baffle: )r
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integrity, evidence of leakage, etc.) Tank shoia1dbe, pumped._and a i4ger ifith a manhe±e _
op tanx cover close to surface .
tnspected rEom center opening in tank.
GREASE TRAP:_
(locate on site plan) N/A
Depth below grade:
Material of construction: _concrete _,,,,metal _FRP —other(explain)
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
0!r ta-ce trorn rmao ` n• .rv-, r- onwvn, c' out e! it-t- 0! Va!!:C'
Comments:
(recommendation for pumping. condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integrity, evidence of leakage, etc-.i
(revised 9/:5/95) 6
i
y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 6
PART C i
SYSTEM INFORMATION (continued)
Property Address: 195 FARNUM St . N . Amdover ,, Ma . .
Owner: Mr . & Mrs . Degan
Date of Inspection: 10-31-96
TIGHT OR HOLDING TANK:_ N/A
(locate on site plan)
Depth below grade:
Material of construction: _concrete__metal _FRP—other(explain)
Dimensions:
Capacity: gallons ,
Design Flow: gallons/day
Alarm level:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX:_
(locate on site plan)
Depth of liquid level above outlet invert:_
Comments:
(note ii level and distribution. i;equal, evidence of solids carm-orer, evidence of leakage into or out of box, etc.)
PUMP CHAMBER:_
(locate on site plan) N/A
Pumps in working order:(yes or no)
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
7
(revised 8/15/951
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 194 Farnum S t . N. Andover , Ma .
Owner: Mr . & Mrs . Degan
Date of Inspection: 10-31-96
SOIL ABSORPTION SYSTEM (SAS):_
(locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods)
If not determined to be present, explain:
Type:
leaching pits, number:_
leaching chambers, number:_,_,
leaching galleries, number: .
leaching trenches, number,length:_=_ c i trenches
leaching fields, number, dimensions:
overflow cesspool, number:
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.)
System is ander CL ciTUPtIly frUnC Ldwn, no p n ing or evi ence ot breaRUTE
CESSPOOLS:
(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 (cesspool must be pumped as part of inspection)
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
PRIVY: �
(locate oliti plan)
Materials of construction: Dimensions:
Depth of solids:
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc)
(revised 8/15/95) 8
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner. 195 Farnum St . N. Andover, Ma .
Date of Inspection:Mr . &Mrs . Degan
10-31-96
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
��D r
40
DEPTH TO GROUNDWATER
Depth to groundwater ra _feet
method of determination or approximation:
(revised 8/15/95) 9
. I
TOWN OF NORIT ANDOVER
jj SYSTEM PUIe!t.Pf G RECORD
1-5 In
PN c
SYSTEM OWNER& ADDRESS YS'i'EM LOCATION OF 0(o ...�'�
DATE OF PUMPING,;,._.�-f 7�`�... -- -QIJAN PITY PUMPED:
CESSPOOL: NO L--� Y1 S _ .._\.._... Se�,i.ii Tank: NO YES
NA'I'LIRE OF SERVICE: ROUTINk `- I MLRGt:NCY
OBSERVA PIONS:
GOOD CONDITION C/F'ULI.,To COVER
HEAVY GREASE BAFFLES IN PLAC:I.
ROOTS _ LEACHFIELD RUNBACK.
EXCESSIVE SSI E SOLIDS FLOODED
SOLID CARRYOVER OTHER EXPLAIN
System Pumped by el-
__
_._ °� ,��/
COMMENTS.
CONTENTS TRANSFERRED` O _ p7D_._._J_l
I
i
�f
I