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Miscellaneous - 197 INGALLS STREET 4/30/2018 (2)
197 INGALLS STREET E .21.0/105.D-00810000.0 a I a Commonwealth of Massachusetts UTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 197 Ingalls Street Property Address Christine Haertigan Owner Owners Name information is required for North Andover MA 01845 9/22/2015 every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the RECEIVED computer,use 1. Inspector: only the tab key to move your Neil J. Bateson cursor-do not �P2 9 2m � use the return Name of Inspector key. Bateson.Enterprises Inc. TOWN OF NORTH ANDOVER Company Name HEALTH DEPARTMENT 111 Argilla Road Company Address Andover MA 01810 City/Town State Zip Code 978-475-4786 SI 15 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to'Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority JA 9/22/2015 Inspectors signature Date The system inspector shall submit y p m t a copy of this Inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""*"This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 J Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 197 Ingalls Street Property Address Christine Haertigan Owner Owner's Name information is required for North Andover MA 01845 9/22/2015 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: After permit from B.O.H., install new outlet tee with gas baffle, inspection from B.O.H., septic system now passes Title 5 Inspection. i B) System Conditionally Passes: I ® One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined," ex lease Iain. P P The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structural) unsound exhibits bets substantial infiltration or Y exfiltrafion or tank failure Is Imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ® N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 �S�gSL'ED7�6, . yr H2copy PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERTIFICATE OF. COMPLIANCE As of: 9/22/15 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Complete Repair Outlet Tee and Baffle By: Todd Bateson At: 197 In2alls Street Map 105.D Lot 0081 or th Andover, MA 01845 Thelsuance�of this certific.te-shall-hot he construed as a guarantee that the system will function satisfactorily. Y / Lele Grant �---�J Public Health Agent 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandaver.com • S �I>�D'g�6' . s � mo e�iwa 1'4 North Andover Health Department (ommunity and Economic Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 197 Ingalls St. MAP: 105.D LOT: 0081 INSTALLER: Todd Bateson DESIGNER: PLAN DATE: BOH APPROVAL DATE ON PLAN: INSPECTIONS TANK INSPECTION: 9/22/15 T-Baffle DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ❑ Contractor reports any changes to design plan ❑ Existing septic tank properly abandoned' ❑ Internal plumbing all to one building sewer Topography not appreciably altered Comments: SEPTIC TANK ❑ Building sewer in continuous grade, on compacted firm base ❑ Cleanouts per plan .. ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon tank has been installed H-10 loading ❑ Monolithic tank construction ❑ Water tightness of tank has been achieved by visual testing X Inlet tee installed, centered under access port X Outlet tee installed, centered under access port (gas baffle/effluent filter) ❑ inch cover to within 6" of finish grade installed over one access port ❑ Hydraulic cement around inlet & outlet Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon Pump Chamber installed ❑ H-10 loading ❑ Monolithic tank construction ❑ Inlet tee installed, centered under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off floats working ❑ Separate on/off floats ❑ Drain hole in pressure line ❑ cover at final grade installed over pump access port ❑ Water tightness of tank has been achieved by testing ❑ Hydraulic cement around inlet & outlet Comments: CONTROL PANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: basement ❑ Alarm signal located inside: basement Comments: DISTRIBUTION-BOX ❑ Installed on stable stone base ❑ H-20 D-Box ❑ Inlet tee (if pumped or >0.08'/foot) ❑ Hydraulic cement around inlet & outlets ❑ Observed even distribution ❑ Speed levelers provided (not required) ❑ Schedule 40 PVC Pipe Comments: , h Commonwealth of Massachusetts Map-Block-Lot 105.D0081 BOARD OF HEALTH Permit No North Andover -----------------------BHP-2o15-osis ., FEE $125.00 ----------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted Todd$ateson to(Construct)an Individual Sewage Disposal System. at No 197 INGALLS STREET as shown on the application for Disposal Works Construction Permit No. BHP-2015-037 d September 14,2015 ----------- -- - ------ - - P_Y__-------- Issued On: Sep-14=2015 BOARD OF HEALTH ............****"*.........*'*'*............. .......... ............ .........**** ........................................................1 "'..............**.............*.........*...... 197 INGALLS STREET Reference No: BHJ-2015-000053 ................................... Permit No: BHP-2015-0379 Department: ................................... North Andover BOARD OF HEALTH ......................................................................... Account No: 1001001.1.5.0510.00 Fee Type: . .................................... DWC-Component Repair PERMIT Receipt No: REC-2016-000330 ......................................................................................... .................................... Paid By:. Paid in Full On: Mon Sep 14 2015 Todd Bateson .................................... ......................................................................................... Check No: 8901 Received By: .................................... Susan Sawyer ......................................................................................... Amount: DEPARTMENT'S COPY $125.00 . ........................... ........................................................................................................................................................................... P � ' Pic) Appt.�cation for Se�trc disposal System TODAY'S DATE Cons.,tucNon_Per" it:- TOWN OF 250':00'—Fuil Re $ pair NORTH ANDOVER, MA, 01845 $425.00 Component Important: Application Is hereby made for a permit to: When filling out ❑Construct a new on-site"sewage disposal system* forms on the computer,use ❑Repair or replace an existing on-site sewage disposal'system' only the tab key "e � to.move your L1J-�ePair or replace an existing system component—What. cursor-46 not use the return A. Facility Information key. 1 /97 1-a✓�°I a l�5 - Address or Lot# ab ®E ilk i City/rown d v.efL SEP 12 2015 .2.-*TYPE OF SEPTIC SYSTEM*: Q pump &MVIty(choose one) TOWN OF NORTH ANDOVER —*If pump system, attach copy of electrical permit to application""' HEALTH DEPARTMENT ➢ ®'Go ventional System (pipe and stone system) ➢ Q infiltrator or Biodiffuser(Gravel-Less)(Attach a copy of your certification to in this type of system.) ➢ Q Pressure Distribution S.A.S.(No D-Box) ➢ Q Pressure Dosed(D-Box Present)S.A.S. ➢ Q Does the system require an effluent filter? Yes No If yes, does plan specify make and model of filter? YES=(no further info.needed) WO=(installer must specify brand of filter before DWC issuance) What is the Make? [khat is dre Mo&Ay 2. Owner Information Name g, °..t :v9,ol/s 57i Address(if different from above) n /till Cityrrown State Zip Code Telephone Number 3. Instatler Information Name Name of Com plIAyf'ESON ENTERPRISES,INC. 111 ARCM a ROAD Address n L ANDOVER,MA 01810 J City/Town State Zip Code 78 $1S—a7a3 Telephone Number(Cell Phone#ifpossible..p/ease) 4. Desi_gner'information Name Name of Company Address I I I City/Town State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 I f dRTN AppliGat:i�on..for Septic Disnosel astern �'-l(-`s .. TODAY'S DATE �C.onstruction Parmit = TO'R'N OF � .'� .ORTH ANDOVER, MA 01.845 $:25..00 Fuii Repair 'ss��.w• $135.00-Component PAGE 2 OF 2 A. Facility. nformation continued.... S. Type-of BuMin esidential Dwelling or[]Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system In accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover,and not to place.the system In operation unfll a Certificate of Compliance has been Issued Is Board of Health. Name Date Application Approved By: (Board of Health Representative) Name Date Application Disapproved.for the following reasons: For Office Use Only: 1 ''Fee Attached? Yes No i 2-- Prolect Afldager Obliga ron Form Attached. Yes No 3, Puma Svsten�? Ifso,Attach co�y ofE7ectrical Permrt'. Xes No A FouadatrovAs Built.?(hew construction-ronly), Yes No (Same scale as approyedpLw) 5. FloorPlmv?(new construction,only): xes_ No•— r4pplic�ttdn for•pisppsal. yatetii': onstrgcflori F'ennft Rage 2 of 2 SBP'C SYSTR11'I IN ' ! 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YP 'i' 't (e m )4ndl Arioq*ed '��piete• ,��t ���ribzidet�dlatioa:; T. . tl�iaaelltet��I ander�taaii ,I �y� sx-of tb�£o8�ttg caastt+hcfion. s: 1?et�lnQtfamr t�r�t.�tte peer edron�aiftlre e�etcss�v,6�s�eac � Plail���y �.�leRltLrerl�fforcaoa . d .�u[ ofmalc,la- esng ,stone,�r ptrt»pCA , sa�otliet M Commonwealth of Massachusetts JD Title 5 Official Inspection Form /) Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 197 Ingalls Street �12�/,- Property Address Christine Hartigan Owner Owners Name information is required for North Andover MA 01845 .8/17/2015 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: When filling out A. General Information forms the RECEIVED computer, r,use 1. Inspector: Q�� only the tab key AUG 2 4 2015 U ' to move your Neil J. Bateson _ cursor-do not Name of Inspector use the return 'TOWN OF NORTH key. Bateson Enterprises Inc. HEALTH DEPARTMENT Company Name 111 Argilla Road Company Address Andover MA 01810 'ar7A Cityrrown state Zip Code 978-475-4786 S115 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ® Conditionally Passes ❑ Fails ❑ NeeAs Further Evaluation by the Local Approving Authority 8/17/2015 Inspector Signatu Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface SewageDisposal posal System•Page 1 of 17 Commonwealth of Massachusetts " Tithe 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 197 Ingalls Street Property Address Christine Hartigan Owner Owner's Name information is required for North Andover MA 01845 8/17/2015 every page.. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ® One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is structural) unsound exhibits substantial infiltration tration or exfiltra i ton or tank failure is imminent. System will pass inspection if the existing n tank i replacedlaced 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 20Y ears old is available. ❑ Y ® N ❑ ND(Explain below): l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal 9 Po System•Page 2 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 197 Ingalls Street Property Address Christine Hartigan Owner Owners Name information is required for North Andover MA 01845 8/17/2015 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ® N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ® N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ® N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health ❑ broken pipe(s) are replaced ❑ Y ® N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ® N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Tdle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 197 Ingalls Street Property Address Christine Hartigan Owner Owner's Name information is required for North Andover MA 01845 8/17/2015 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply pp y 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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Outlet tee in septic tank needs to be replaced. D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: _ Yes No ❑ Backup of sewage into facility or system component due to overloaded ed or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid p d E] ® ui level el In the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins-3/13 Title 5 Official Inspedion Forth:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 197 Ingalls Street Property Address Christine Hartigan Owner Owners Name inf rm i o at Is fo required for North Andover MA 01845 8/17/2015 . every page. City1rown state Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10j000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner oroperator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 197 Ingalls Street Property Address Christine Hartigan Owner Owner's Name information is required for North Andover MA 01845 8/17/2015 every page. Citylrown State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health r ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 600 t5ins•3/13 Title 5 official Inspection Form Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts U Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 197 Ingalls Street Property Address Christine Hartigan Owner Owner's Name information is required for North Andover MA 01845 8/17/2015 every page. Citylrown state Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 ears usa e d : (9p )) Y 9 On well water Detail Sump pump? ❑ Yes Z No Last date of occupancy: Vacant one year Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3113 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 197 Ingalls Street Property Address Christine Hartigan Owner Owners Name information is required for North Andover MA 01845 8/17/2015 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Pumped six years ago, owner Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Measured tank. Reason for pumping: Inspect tank&tees Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection ection p of the I/A system b system operator under Y Y p e contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts 9197 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Ingalls Street Property Address Christine Hartigan Owner Owner's Name information is required for North Andover MA 01845 8/17/2015 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 27 years old, 6/30/1988, as built plan Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.8 feet Material of construction: ® cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): 4"Cast Iron through wall, 3"PVC in house, no leaks visible. Septic Tank(locate on site plan): Depth below grade: 0.8 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ .Yes ❑ No Dimensions: 10"X 5'X 4' Sludge depth: t5ins•3/13. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts .UVTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 197 Ingalls Street Property Address Christine Hartigan Owner Owner's Name information is required for North Andover MA 01845 8/17/2015 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle N/A Scum thickness 6" Distance from top of scum to top of outlet tee or baffle N/A= Hole in outlet tee Distance from bottom of scum to bottom of outlet tee or baffle N/A How were dimensions determined? Tape Measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumped septic tank. Inlet tee ok. Outlet tee has hole, needs to be replaced. Depth of liquid at outlet invert. No evidence of leakage. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene El other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 197 Ingalls Street Property Address Christine Hartigan Owner Owner's Name information is required for North Andover MA 01845 8/17/2015 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations inlet and outlet tee or baffle condition structural integrity, ty, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate onsite plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 197 Ingalls Street Property Address Christine Hartigan Owner Owner's Name information is required for North Andover MA 01845 8/17/2015 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box level&distribution equal. No evidence of leakage. Evidence of carryover, pumped d-box to clean. D-box cover broken, replaced it. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 197 Ingalls Street Property Address Christine Hartigan Owner Owner's Name information is required for North Andover MA 01845 8/17/2015 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 1 field 20'x 45' ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil Ok. Vegetation ok. No sign of ponding to surface. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions.of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Tithe 5 Official. Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 197 Ingalls Street Property Address Christine Hartigan Owner Owner's Name information is required for North Andover MA 01845 8/17/2015 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts UTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 197 Ingalls Street Property Address Christine Hartigan Owner Owner's Name information is required for North Andover MA 01845 8/17/2015 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ng ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in.the area below ❑ drawing attached separately 10J4 i 1 = 3 a 's cr 100 tt t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal posal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 197 Ingalls Street Property Address Christine Hartigan Owner Owner's Name information is required for North Andover MA 01845 8/17/2015 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: >4feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 4/23/1988 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Design plan ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: As per test pit data on design plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts R Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 197 Ingalls Street Property Address Christine Hartigan Owner Owner's Name information is required for North Andover MA 01845 8/17/2015 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I i i i t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 : Commonwealth of Massachusetts City/Town of . System Pumping.Record Form 4 DEP has provided this form for use-by local Boards of Health.Other forms may be'used,but the information,must be substantially the same 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. stem Location: Left/System ht front of hou Left/Ri ht rea f g r o house, Left/right side of house, Left/ Right side of building,left/Right front of building, Left/Right rear of building, Under deck Address cwrown State Zip Code 2. System Owner. Name 4c) Address Cd different frorrl loptC n ct Civrown State e <--�3 Telephone Number , a i i I ' B. Pumping Record 1. Date of Pumping P g Date 2- Quantity Pumped: Gallons y 3. Type-of stem: YP system. ❑ Cesspools) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes [a-*O--, if yes, was it cleaned? ❑ Yes ❑ No • 5. Condition 6.. System Pumped By. Neil.Bateson - F5821 Name Vehicle License Number Bateson Enterprises Inc Company I 7. Locatio contents•were disposed: S: Lowell Waste Water Com- J5 Sign a Haul Date ` t5form4.doc•06/03 System PumpingRecord•P age 1 of 1 Department of Environmental Man agement/D!vision of Water Resources " WELL COMPLETION REPORT WELL LOCATION Addres$ GEOGRAPHIC DESCRIPTION C, N S W of ✓ .: (feet) (circle) City/Town t" G.�yfi� ter—r�73 -7 Well owner <1_;21d 1_;21d7"L v r Address N (DS E W of .,7 (circle) Board of Health permit obtained: yes no ❑ intersect, 5� ' WELL USE (road) WELL DATA Domestic 1� Public❑ Industrial❑ Total well depth ft. Monitoring❑ Other Depth to bedrock r ti� �-- Water-bearing rock/unconsolidated material: Method drilled J) s- - Description_M-P-T)f t)vet // Date drilled— rte' Water-bearing zones: CASING --® t) From -3 v f TO Type &2-6 2) From ZZ 11; To Length ft. Dia(I.D.) In. 3) From To Length into bedrock l_7/� ft. Gravel pack well: dia. Protective well seal: Screen: dia. Grout ❑ Other--Lp_ Slot# length from_to— STATIC WATER LEVEL (all wells) j Static water level below land surface—L ft. Date 1_2`_ "'-Oc) f WELL TEST(production wells) 0 1 Drawdown 5- ft. er pumping hr. 0 min. at r/ f 9Pm e How measured t IKIFIL Recoveryf ft. after .1 hr. / min. LOG of FORMATIONS COMMENTS Materials From To ° l ► L_ U r[fir � �. Q;>►«:.S�4)tJl7 / 3g,,Driller oC.K 3 n Yd Firm— G1 X 17 i Address —�7r.d ,o� i City/Town Supervisi9 Driller Reg.# ,,- Please pt firmly t Sigria(ure of supervising registered well driller rin COPY BOARD OF HEALTH �s g I pe NORTh , • `o I••tip d' s s • o J '►�'° ••.°•'''�h BOARD OF HEALTH 7 as ss"`wase NORTH ANDOVER, MASS. D r py S APPLICATION FOR WELL AND PUMP PERMIT Permit # Date // _2- "^ A permit is requested to: drill a well install a pump \< LOCATION: j 7 /J C..4 LLS Lot # Y A Ownerf+` M-9,S ►J Address 5T- '9i9 tQ,1f,e(;1 d✓� t4 Tel q? b�- 7-7 -7 Well Contrctr CP 0. 0-OUI-tW✓S 6t) Add. 11g 1 "Rd. VAt4,Tel Pump Contrctr Add. Tel WELLS (To be completed at time of pump test. ) Type of wellUse Diameter of well lv Size of casing Depth of bed rock 0�3` y Depth casing into bedrock I Seal been tested? Yes O No (_) Date of test��-/- Depth of well ���v� Water-bearing rock t� . � 1-' Depth to water Delivers /'Y2_ GPM ,for (how long?) Drawdown feet after pumping hours tL_4__GPM Date of completion Signature ojrAell contractor PUMPS (To be filled in before installation. ) Name & size of pump (semv S (Z ,f` Type Sao rA-'4_12 5 1 a u4e_% Size of tankPump delivers GPM Pipe used in well: Cast iron (_) Galvanized (_) Plastic ( k ) 6 C1 Sleeve used to protect pipe? Yves (_) No (Y) Type well seal �-AV,1240-' LJ Date � '" 1 -��� w.�. SignatuET of pump installer Date water analysis report submitted to Board of Health ` Plumbing inspector Wiring inspector Board of Health CHARLES M. ROLLINS CO. 9788879491 P. 02 12/13/2000 07:40 9786920023 THORSTENSEN LAB PACE 91 66 Lrrn pN ROAD,WESTFORD,MA 01966 (978)692.8395 eAX(978)692-0023 1-800-649-TEST Report Number 52401 Report Date: 12/12100 Client: Sample Information: C.M.Rollins Jim Hartigan 129 Depot Road 197 Ingalls St. Boxford MA 01921 N.Andover,MA I Sampled by: Client Date Received: 12/6/00 Date Sampled: 12/6/00 Certificate of A.ni ftl T_eg Parameter EPA Lail esvlts Units Total Coliform tI') 0 0 per100tttl Fecal Coliform/E.coli(P) 0 0 per100mi Calcium No Limit 7.0 mg/L Copper(S) 13 <0.02 In Iron(S) 03 # 0.94 mg/L Maguesium No Limit 0.8 Manganese(S) 0.05 <0.01 mg/L Potassium, No Limit 0.4 mg/L Sodium See Note ' 61.2 mg/I. AlkahniryS) No Limit its /L m � g Ammrnua-N No Limit <0.03 mg/L Chloride(S) 250 16.9 mg/L Chlorine No Limit 13 Mg/1' B Color(S) 15 # 25 CPU Conductivity No Limit 336 urnhosicni Hardness No Limit 21 mg/L Nitrate-N(P) 10 0.26 m8/L Nitrite-N(P) 1 <0.01 mg/L Odor 3 # 4 TON pH(S) 6.5-8.5 8.5 SU Sulphate(S) 250 15.5 mg/L Turbidity Not spec. 3.7 NN Sediment pos/neg pos Legends: (P)=Primary EPA Standard,(S)=Secondary EPA Standard,#--Exceeds EPA Lixtlit, TNTC=Toa)Numerous to Count,*=Background Bacteria Noted,'=Exceeds Advisory Limit Sodium Advisory Limits,Mass.=20,NH-250. Thi9 water sample as submitted is considered SAFE to drink according to EPA guidelines. However,one or more parameters exceeds secondary limits as denoted by the#sign. Massachusetts 2,0 .tts Certtfication#MA048 lViichael P.C rlson,for New Hampdh rc Certification#2739 Thorstensen Lwbomtory Inc. • I FEE NUMBER df� THE COMMONWEALTH O MASSACHUSETTS of --- .... . ------- ap., . -- .N. ... ._..... .................•-------•-... This is to Certify that ..... ............... ...ka-t_ t :. ............. ADDRESS IS HEREBY GRANTED A LICENSE For --------------................ L� " -.- ..... /------- .:.............. ..�-u- ................................. ...................................................---•-•--•-------••-........................... This license ij gra ted in conformity with the Statutes and ordinances relating thereto, and �� 3/.. �T'�J unlessaooner suspended or revoked. expires-----••... 111 ---- --- 1 j - ✓ TM FORM 433 H&W HOBBs&WARREN k l cfs 'gFr._x ?`5 z�J•fir' s •"i- t :;;,��= �+'' s= i. • ;`?;SAMP.�:�DENTIFICA7ON�iNF�O�iINI/�tiOlie µ t' `. Elio •• • COMMENT` 3 ±s .t r.' 1 � s t� ..,k.. .-. _ .. .l:::. _=Y. -..�.._. 's:L :i`• c _�.='-.�...+....:,.}d .�, _1�a_'a`.r:-'L .S' .1. id,�ut� -5ht,..�.x�'3r a ':':rr?ve1::4�k .f,'��•s -ai `"t _,�' „• -, a v va,..�-�.- -y. ?,.,k�.. .. k' >, � �- .y.�.� 7 r .0 r krx, •4's�. '�'>= .9�--'> - '3•.'�:sr� .a.. ,�'`{sir.{u? t.3 .1 • ;� - ; .,•.,. �.-r�-•fib.. .•, .*..�; � 4TS.? _'�st,UNiTS�z �:�. ETECTION,�MIT� �� `�'> �ETI�OD �?�� �"�"5 r �+.""�'^+" `�5:. „4r-Y .r.g....rw' , :��' .r';, .3;mL,.x.. ' C' FrRESU a-,.:.} -* µ4: *�'=.r',f ,. -;, .#x ;_ 4 �;a,.•,._' "�• - � .-�3?-- � _sit: ;r -Er _� L ,.k'?.i .,..f!S�t' S:y,7.-. .t...t :t- isii. ,.c =3y •5�.. ..,_,.; 3 r .y., t. rdF,t�e iy +Y,"�` est • --', � 3'` 3� j, �+, �fr ��� �i� i • � • 'Y"�2 r -•fit✓a<a M2YA J N'1 .•��g� .. i-p R S. t a, 4 i l ',!•rte;... ,"�i.*."+�. DRINKING WATER LABORATORY — CERTIFIED — .�j4 Quick Results, Sample Pick-Up 36 Pelham, Rd. (603) 898-2504 -Salem,-.-NH 03079 (603) 898-1329 Laboratory Number: 4031A Sample Date: 12-6-90 6 90 Submitted By: Mr. James Hartigan Sample Source:` Ingall Road. North Andover, MA Analysis: According to Standard Methods of Water & Wastewater Analysis, 15Th Ed. EPA results Your results Total Coliform . . . . . . . . . . . o, ner•loo, mq/1, • • • 0 per 100 ml 250 mg/l Chlorides . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 mg/L 6. 5 to, 8. 5 ma/1 PH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. 49 I Hardness . . . . . . . . . . . . . . . o . . ma/1. . . . . . . . . . . log mg/L i Manganese . 0 . . . . . . . 000 . . . . . . . . o . . 0. 10 mg/L ** Sodium . . . . . . . . . . . . . . . . . 250 mg/10 . . . . . . . . . . . 38 mg/L ** ,:Iron . . . . . . . . . . . . . . . . . . . . �.'.©3 .mg/1. . . . . . . . . .0. 9 mg/L Nitrate . . . . . . . . . . . . 10 mg/l. . . . . . . ... . . . . 0 . 0 . . . . . . . . . 1. 0 mg/L Nitrate . . . . . . . . . . . . . . . . . . 1°. mal. . . . . . . . . . . . 05 mg/L 0. 05ma/l Arsenic 0 0 0 0 . . . , , , 0- 01 v7pl.p• ma/1 Comment: * The tested parameters meet current .primary standards for drinking, water, but exceed somesecondary parameter standards . ** Denotes parameters that exceed secondary standards 'An iron and mana_ anese .filter is recommended. Analyst i C 'nartment of Environmental Management/Division of Water sources WATER WELL COMPLETION REPORT - (�WELLALOCATIO1N Address LO f n�.Qi1 s/reef City/Town l V o rrY`h Ane6ver G.S.Quadrangle Map Grid Location Owner N+ A -— C�MeNa r I j an t5 Address f4 IPHr4LlUCSS A Lr+lle. S, i mi Srl'�j MA WELL USE CONSOLIDATED WELL Domestic[B/Public ❑ Industrial ❑ Type of Water-bearing Rock Other Water-bearing Zones Method Drilled �_i(1(( y"Tl t) From 3 To 2) From-To- Date romToDate Drilled / 1 3) From To 4) From To I ,CASING /r Depth to Bedrock Length Diameter TypeCfAr r / � UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing Materials Feet below land surface/ q Sand: fige❑ medium❑ coarse❑ / Date measured 1'0 1 1 Gravel: fine❑ medium❑ coarse❑ a , GRAVEL PACK WELL Screen: Yes No Slot# length from to ❑ ❑ Split Screen (or 2nd screen) WATER QUALITY TESTS MADE Slot# length from to Chemical ❑ Biological � Depth To Bedrock PUMP TEST Drawdown /0 //feet after pumping_days hours at GPM. How measured V A., M to Recovery -/ feet aftero/ _ .houfs. LOG of FORMATIONS COMMENTS: (On well or water) Materials From To Cb `rte rp fd - DRILLER ��y l lb lb Firm G , '.. uu y' `°•' ( 0 Address �� —Pal City S Ale M I YU'r�i 1 Registration No. L 1C. 1 perato fs' ignature rase print tirmly BOARD OF HEALTH COPY 25M-10-85-807101 DRINKING WATER LABORATORY — CERTIFIED — } 36 Pelham, Rd. Quick Results, Sample Pick-Up (603) 898-2504 Salem, NH 03079 (603) 898-1329 Laboratory Number: 5075 Sample Date: Submitted By: rir. James Hartigan 12-3-90 0 Sample Source: new well / lot#4 Ingalls Road N. Andover, MA Analysis: According to Standard Methods of Water & Waotewater Analysis, 15Th Ed. FFA standards your results Total Coliform . . . . . . . . . Q. per ioo, mg/1 . . , , , , o per 100 ml Chlorides . . . . . . . . . . . . . 250 mg/1. . . . . . . . . . . . . 46 mg/L PH . . . . . . . . . . . . . 6. 5 to 8 . 5 Hardness . . . . . . . . . . . . . 75, to 150. mg/1• . . . . 123 mg/L Manganese . . . . . . . . . . . 0.,05.mcr/1 . . . . . . . . . . . 0. 07 mg/L Sodium . . . . . . . . . . . . . . . 20 to 25o mg/1. . . . . . 12. 0 mg/L Iron . . . . . . . . . . . . . . . . . . .0:3. ma /l . . . . . . . . . . . . 0. 50 m9/L 10 mg/l Nitrate 1. 0 mg/L Nitrate . . . . . . . . . . . . . . . . 10 .mg� l. . . . . . . . . . . . . 0. 05 mg/L Arsenic . . . . . . . . . . 05 mq/l 0. 02 ma/1 Comment: The tested parameters meet current ?primary standards for drinking water, but some secondary parameters exceed, standards. * denotes parameters that exceed, secondary stand.ard.s , DOES MOT ' FAIL TEST r Analyst RCH ASSOCIA'T'ES, ITC. ENVIRONMENTAL CONSULTING, PLANNING, & WATER ANALYSIS c 26 FENNO DRIVE ROWLEY, MASSACHUSETTS 01969 (508) 948.2449 DATE : 9/7/90 INVOICE NUMBER: 1983 PO n 014 Jim Hartigan 15 Appaloosa Lane Hamilton, Ma. 01936 WATER CLASSIFICATION: XXX THIS SAMPLE, FOR THE PARAMETERS TESTED, IS DRINKABLE ACCORDING TO STATE AND FEDERAL PRIMARY CRITERIA FOR DRINKING . SAMPLE INFORMATION : sample taken by above date : 9/4/90_ r. sample type : well faucet_x_municipal new well 1 swimming pool raw surface other__ SITE INFORMATION : Lot `4 - ' 197 Ingalls No . Andover, Ma. BACTERIAL TEST INFORMATION : aliquot total* Illi coliform bacterial results stated as 50 0 number L 100 ml *Standard - 1/100 ml Water quality may change quickly . If you notice an odor or staining , do not hesitate to call us . Mass . Ce.rtificatiorl ttMA096 �' a �:r•�� • ;�; ` ,� � �T`�'Y1t��.;ID'1�"�k�� ACCC/.IJNT _ C0�7iE P 3 'A �.�, -�. �. • ;�,.SA,MP�1pEN7�,IFIC'ATION,INF,�QRIVlAt10N � ����' -�ti � � All + •. � • #CCLLECIEQ'� �RBCEIVED �gEpgpTED�{ �` � � �,� �,.� 3 5EORT 1' n 1 9• k $ 1 A RESULTS.f UNITS': ,:DETECTION;LIMIT,IP: METHOb,-, . _ # R;`# � '�.- cb:-. •'L+' Y;r hea. xj/—� F 1 r•.R,w t 'L k ei v - • • la • f i 1 1 1 :��';''`'S�y mt ,� ''�•`gym s s ♦ ,S Si N 5N 03-1 R,„ JN YF'S 'K 4 t _9 , • • <y > f „. 41 "iSit -®R x y. gg�� 0 p a s 4 °~� '�� BOARD OF HEALTH �,'7 SSACHusE NORTH ANDOVER, MASS. o pti 5 APPLICATION FOR WELL AND PUMP PERMIT Permit # Date 6 A permit is requested to: drill a well install a pump \ LOCATION: / Lot # Y fid Ownerl;^'�S 4 &01=, r rJ Address r t7r'1 r�,��r S� di'r t4 Tel 17 - -7-7 Well Contrctr C� 0. 0' L=L t WS C'OAdd. (�`� Il ,r �d . i/vI O. Tel 7-7?- Pump -7 Pump Contrctr ^ LA4 Add. Tel k�ek�eie�ele�eIekkE4rk�e�e�e�cleir9e�eIrIrkF4r4r�r4e�elr�eIrIe�e�e*�r�e�r�eie�e* Irk�r*�et�e* IrF4e�eIr�e�e�c�e�rilrIr�cF*** WELLS (To be completed at time of pump test. ) Type of well Use Diameter of well Size of casing Depth of bed rock Depth casing into bedrock Seal been tested? Yes (_) No (_) Date of test Depth of well Water-bearing rock Depth to water Delivers GPM for (how long?) Drawdown feet after pumping hours t GPM Date of completion __5�`��-�`' Signature oZ4ell contractor PUMPS (To be filled in before installation. ) Name & ,size of pump Type Size of tank Pump delivers GPM Pipe used in well: Cast iron (_) Galvanized (_) Plastic (_) i Sleeve used to protect pipe? Yves (_) No (_) Type well seal Date Signature of pump installer Date water analysis report submitted to Board of Health . Plumbing inspector Wiring inspector Board of Health w Z � i _ pip Ln c 'C JAG'•� ! ���•�`�. \ ��A�,� ! VJ L j 1 � 4 !3 C 3 a c ' U a , C5vP� do, . 1 ER1..,mL I �Qf 3�9 .(Z, t i r � r t a y F 9 ` ✓,K • fta # V v a csG� Q'm� '00, -- FiN�sh _• . ,/�„/o 1.4 V/N'�o r L 27& ,L�L. TSL i4� .ii L •_�/�[ pl�.a��.,..,...-......s,.y-w .�.....-.-. .,....,...,.+...�� t .. . .. .. . .. . a S r 300 E L� Il � o r t '00, � 4 Al a . a i' M K RFs i , I �- ex i 5 f i,��. a fi y o J' : '._:.r. ..,�!k:+f1l�1MM1NM.•.wn,..,:+Msn ....::� �', ,,.;,APkw�h}Alw,ars.- ...+d+�'AIMSs•.nm:l�w.n��wna�.yvMvw�wrn.�ww...wwwn.�w..,. r, J TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD t 1�r�1�I,I,{� �'t'�i a +ia 5 � �4 j s i • , � j1 1' + y � ly t j,N 1 I DA TE• vZ j{}s y i Y a nit Cn)S}sr SYSTEM OWNER&.ADDRESS SYSTEM LO ' CATION Ar.- Oor (example: left front of house) 4Is .r 1 t •— - _ �y^ /..1W �� .moi -qtr ji 115 la •�` °;{ I' �jj��..�n O,/_ __ I l! A/C✓ f✓�y PUMPING;OF, S' QUANTITY PUMPED GALLONS I � r.,a CESSPOOL: NO YES_ SEPTIC TANK: NO YES LI +�R�lrl�aj�tj - a NATURE OF SERVICE: ROUTINE EMERGENCY QSERVATIONS: F3_l,, .. GOOD CONDITION HEAVY GREASE FULL TO COVER BAFFLES IN PLACE .ROOTS '_"__"" — h , + , LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER(EXPLAIN) J `SYSTEM PUMPED BYs �b`v pp u I - 3tk9e.tPf7�,"{�1����id I r � gPJt - tri f r YC �� N � 4? � 7t ���� I`R:,,M ()MNiENTS: a '�y +'"fin r 7 I I Ir i r •+ ( \��( M7k16 , (; I77, t } l�Tl]i l` ( '. .. U LI V •^.✓ y� '14 1` t� iAc 'z YCONTENTS T SF �, � ERRED,TO: >b , ii 7 9 a g �Z���� jg r /�///� y .. dd+`4 j?Ir �a. tN ' xr .111 {fry R /DI. .r l / �•� ( I �. . t ":r,?d " PL.4�c./ sNDwiw� ALO-l41Y—I�iCE//S_F�11 1t�'3 oR-1�1�E'fL�R�s/ __�.�soiz` 0. /_� p_' o ' s EP..f• --- o _----- PeoPo3ED .S41&s/eFAGw ,SEwAbs bi5mac. ESTE• f N - P,eO�cUED LOT �,�Ad/NG 1 OwwER Rev• �{ - c s '� - J LOC.4Tiow: " CO M RApN LEES/G�vER � �o�a �Fq / cTC�SEA�+I cT �A-eSA6►ALL o s . r z , Ala. /QEAC✓A/h , MASS. �a IN ELS Q65/GAJ DATA = T YPE of aalz ✓Alco: 4 8,R, •�w � fle iv G I a4gAGE if Ce4".,C PLUMB/,c/C. F4C/4/r/ES :1VW, :r / a SE1Gf�GE FL.OW:,E.ST/MATE: 6o a Cr p•D o t SEPT/G 14AZAC l d ao, G,9 A A � / �� ,4esctieor-iow .IKEA :9d o .S•.r d E� ►�® U oPf.,er.CxAT/OAJ 7VSr3 ad/ 1 ''. Lures 7-.25 -8 3 TAP 54EAI.47 Ori / 17, y f J � r 1 •,� BormM EcE�'.1 T,aw /� �. •o O�� ( Y S.IrutArio�/ 15 M/A./. I Q !'s G• ORaw / C ,c//N. MSN ,HM/i Miw. !�o• �` AW.lL'GKA f/oN R4TZ & 7,-7/,j. ,L M,•• / ,11,,,r itv MrK 1•.. ® TEST PITS at/ rL 10'3 � ,...•�.. .. i o DArL 3 �,+ TDP ELFYAT/ I �7• liG •o �.S_O�S ' 6 S o G1�� 0 1 G a J T a jo/c rYPEs , 01wNER�h �P ._..-• ® \ .t,vo L GY0.VEL_ S G1-av-�cL LOCArio,v �ii3.9) /i5•S� 13 -M 121.07 .DA!1% BOTTOM ELEI/AT• l09• 9 /oO ,D (,U DUC rE0 6Y TOSEFN T B4,4BA6A000 , R S Ex Is / /G 7EST3 wi rA/ES.SE 0 SY : Mux to A t P44AZ t B6SlerAr GelTE'CIA c�NEE'T / OF Z iI I I I I I f c .. i I i i i � � : t I �� ����� � SEAGED C.&A/r, soZ-io Pl/C. PIPE p 7CY CAPPEC 6AIDS ON low0E�FA2ATEp eloe E�?vivACENr) t 1�A.eT/AL BED EiVD ECT/O/V _ � .n (FOR SPEC/F/C.47-/0.VS - SEE &SECT1,0 .4T LOWE.Q .elaaA17-) AREA ` 9Q a cS 7� �"► � � �45'Ti2 JBUT/D�tJ C..L.+S r /SOO. Q4L. CONGeETE SEPT/G TANK ¢'� 5'G�/� Pl/C.,SEAGEO SO/NTS - ¢"� FE,eF aye. , TV.40� , j �BSo ePT/ON .UES �LAiI/ �j A107- To cSCAGE r cSEC.E'C T socio ' C -F&Z _ !�� -sem •' �/e"raj/e" rw.vsHEo - �' .!� •S / �S :z_ C.E'US•NED STONE •• • •� �cS „ - -12 e •' - T1s _. /e /�// P. V•G. -/PC O.@ e e _ _ • _ '- EOc//✓AL ENT _ --- `lt'7 v r LL ` S / NE' -WovE � O N �, sr .ra s � CaotiacE was,vFc Q � � �.. N -- - H• w //S• s �s...� /4/L�o_p� s1t_��oJ��1�E1�__��EE?_�•C.i-cs_�S'�/� R// �BSO.�PT/D�/ BEl� SEC T/O A.14--5X /SiD.._.¢- cc__ . fEx/S �/tiG, F/L E '!L' y0'e. /"_ E'er' /ya¢ PRDF/L E /�h✓U ABS�PT/Ow BEZ> / LAR/ QA/D SECT/ONS SHEE T . Z OF 21URD of �NC✓JGLS v 1 Noll TH /�n�POVEI, MA, r f A PPL I _- EL,C_ AP�ourD G SS —gz 5EP rl c Sy STS M vEs►�J � . . �6 PP;�ov tw /pftupJ6 Aurtioi?iTy - C041 TI NJ5 r re-vcSr Ov, doT �I S,Q PR1zp VEp� D I E R�4SoNS E f P 1 D 4� StPT"t C SYSTEM i STA ll.,dTIOAJ cYG! v4T(o'�j FINAL IVSpe,�1-10A) �4�DIT(D�AL 1�51�.j(oN 5 Cis may) pwL F-ItL w/ Loi S G DtS�C1 Pt'►�ov�D D,a rC 4 ,i FwAL /JPPI,�OVAL �A�E APP3wtn-)613v iHogi i`/ t t if li Worth PzdovPr,,Mss r SUB FACE DIITOSAL DESIGN COCK LIST LOT APPROVID DATE DISAPPROVES DATE Provided: /� Reasons: Title V ISL Reg 2.5 a submitted plan mist show as a minimum: a) the lot to be served-area,dLmensione lot #sabutters b location and log deep observation hoes-distance to ties location and results percolation tests-distance to ties design calculations & calculations showing required leaching area r e) location and dimensions of syster,-including reserve area f existing and proposed contours g) location any wet areas %It n 1001 of sewage disposal system or disclaimer-check wetlands rapping (h) :surface and subsurface drains within 1001 of sewage disposal system or disclalzer (i) Ic-cation any drainage'easements within 1001 of sewge disposal e systtm or discl :er-Pl mning Board files �) Imo= sources of water supply within 2001 of sewage disposal a A system or disclaimer W location of any_proposed well to serve lot-1001 from leaching facility (,1) location of water lines on property-101 from leaching facility fmn) location of benchmark (fi) driveways (o garbage disposals (p� no PVC to be used in construction (q) profile of system-elevations of baseuncnt, plumb, pipe, septic tank, distribution box filets and outlets, distribution field piping and Other elevations (r) maxi ground water elevation in area sewage disposal system (s) plan zzst be prepared by a Profes,,zional Engineer or other professional authorized by law to prepare such plans Reg 6 Septic Tanks (.a) c5pac t' es- 5D% of flow, water table, tees, depth of tees, access, ping (b) cleanout L/:(6) 10' from cellar wan or inground s-A=dng pool - d) �5, from subsurface drains Reg 10.2 Distribution Poxes (�) slope greater than 0.08 Reg 10.4 b) sump