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Miscellaneous - 20 CHRISTIAN WAY 4/30/2018
20 CHRISTIAN WAY 210/104.D-0141-0000.0 r 3 CD MAR #__ __------- LOT # .. PARCEL # —�.- -- — ---_-- STREET...... /�1 CONSTRU.CTI.ON_..APR_ROVAL HAS PLAN REVIEW FEE BEEN PAID? YES NO PLAN APPROVAL: DATE---- .-- C?----_--_-- APP. BY ,._..L �...... .. _. DESIGNER: -5le, ckl E-�/ �.. c'" - PLAN DATE_--.--' CONDITIONS _ _...._... WATER SUPPLY: OWN' WELL WELL PERMIT_ ---.--_-.-- DRILLER_ . - WELL TESTS: CHEMICAL DA i E A1'PRUVED.. .. .... . ......_. BACTERIA I Dfl1E (11'PROVED BACTERIA II UA 1 E F)PPROVED COMMENTS: FORM U APPROVAL: APPROVAL 70 ISSUE YES NO DATE ISSUED_ DY_—____,__.___ . CONDITIONS: FINAL APPROVAL: ALL PERMITS PAID YES NU WELL CONSTRUCTION APPROVAL YES NO SEPTIC SYSTEM CONSTRUCTION APPRUVAL YES NO OTHER YLU NO ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: DAIL: . By �E,PT I C..._SYSTE.M_._I N5.TAL.L,A.T.Y_C�N. IS THE INSTALLER LICENSED? YES NO TYPE OF CONSTRUCTION: NEW�5 _ REPAIR NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW ESNO CONDITIONS OF APPROVAL c YES NO (FROM FORM U) mow ISSUANCE OF DWC PERMIT YES NO � �-�- DWC PERMIT NO. INSTAtLER:_i ` / - -- BEGIN INSPECTION ES�i0: [ XCAVATIO NSP TION: NEEDED: PASSED % BY__ CONSTRUCTION INSPECTION: NEEDED: • ?� r l�r�'� Lula ����,`� , � ��!�_.—.__ _—__.____�� 7 FiA)4 L --- �L1 AS BUILT PLAN SATISFACTORY: YES: APPROVAL TO BACKFILL; DATE- FINAL ATE: _ BY__. _...._.. FINAL GRADING APPROVAL: DATE Z CTF ..By - FINAL CONSTRUCTION APPROVAL: DATE:_ a _ Commonwealth of Massachusetts City/Town of No andover w° 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 he e. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important:When filling out forms 1. System Location: on the computer, use only the tab key to move your Address — cursor-do not No Andover , use the return key. City/Towlk State --- ---- Zip Code VQ 2. System Owner: Name enen Address(if different from location) City/TownT State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping -- - -- 2. Quantity Pumped: Date Gallons 3. Type of system: [] Cesspool(s) Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): \ ---- 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: �uD 6. System Pumped By: Name T_ Vehicle License Number Stewart's Septic Service _ Company v 7. Location where contents were disposed: Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 Signature of Hauler Date Signature of-4e.-ceiving Facility Date - t5form4.doc•03/06 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts City/Town of North andover 4° 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 within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important:When filling out forms 1. System Location: on the computer, S41cin use only the tab 6l_11 C{��1r key to move your Address cursor-do not N. Andover Ma use the return key. City/Town State Zip Code I&Q 2. System Owner: �I Name ream Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date NOV as 2. Quantity Pumped: Gauon1�0 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: ��nn 6. Syste_ .-Rurn ed By: Name Vehicle License Number Stewart's Septic Se Ice ' 5 Z13 Company 7. Location where contents were disposed: Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 Signature of Hauler Date Signature of Receiving Facility Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 DECEIVED A1IDOVER ASSAC 'Record RUSE '' :, '' •, job ��t �pc�r,� >�F�,.,,. ... MAY 0 6 2009 OEP.hoi Provided ;hli loan lo, TOWN OF NORTH ANDOVER p0 Iorr`Illod ,o uye local 8carc: pc°1 6oarcl ALTH RTMENT . .I .. ., OJ,Inp/ C1/10i ip?�O,in� � _tnpriry A. Facility —in f_o3'r-r _ location: ------------ IIs , SyJ(em OWner.. 15 ►1+ 0 9V1IIIA rpn buUon) Cq^o..n G itp. . . T��19r•Onr n,m01, — I.P,umIng Rekord 17 Ogle o! Pumping �.. X7:1 ? �:ar'.�r r• ;6,• 3 Type pl +yylam; Cl ' Ce99�001(9) SCJ Sop0c Tangy r1 Q�-O�ha� (descrlbe�: Errlvenl Teo FIIIe(.Pre�enr? r' Yo9 n'o q a) : aan `>'': ' l'•''.��,!, ;j';" �, ,y ,, .•. a p Yes — .. � ='tl,` •b.r "C.o�dlyon'Q(:9yL�m;,.,�... • . SY Pvmpeunc d 8y t",1• i r,lr � '�J I �.. ,1�' ,I�rl�?r�'d,r i; y JunII h'l.T:1r — on.�her��CoRlanu'•were dlypos 9 j�Y,'818r18 fOYe sJlb/om17.r,:'naL�yPeC1 iiia;%• '1' 1 •.. . ....,,�.. ..;....., . 1{��'`,/{rt 44 �� y{ri•�I 1 .. 777tt �'�C"' rt fJ-`. 47LSjAy4444tUy,i•r4!?5.' r ,chusetts �, ORT �A [COVERT MASSACHUSE a�� ,.. Vit,:hum 1t�' Record TQC,��F •r t tr r D S'yl'1t y;lay�� ,1. ,j } r y 1;.::':rr NORTH AN OVER �ROrI ;`�; 'vi ,',Y.tt �� �J�titlet.'r.r HEALTH DEPART '�I,r,.. MENT +::r•1'�';l:�J:'7'-1 I I rr L." , t.<d•i)rdr'•i!'.t i.•,�•I."'P1'1'7'Ir!"1'.fJ"r r DEP•,haa provided xhls form for use b local board:of Health, f Y he System Pune Rec rd must be's,ubinl0d to the.local'6oard of Health or other approving au :a).:;+..:�< •.rrr pproV g horlty. .i�•• �tnre,:.t:h" :,'Y ti'i:;l'i:i:L{��!.tCi n• :A Facility Info�r�atlon t, ��.r.(m�p�t, `DOVER jyrrYVhen(I! OUt �� S Stem locatlOn, TDHt.. 1 T&ENT ' fun '.only the tab'key : Address to move your:.' - ausor•do not us*the return %' :,;:CitY/Town . ,' ' ?;, r: , State ZI p Code :it Ir i Y �Y�;:>•nils!•:!1 ,l at System R Owner, , .r �''�• ':4', iI' �Itr,S��.'i�b,.,+{j rpt' rl).'Miir •Il:it'��H,•it•4"Y�i �' .•S'r 'r:i•r!} :.1\y +:;i•i�fJ t Ir Name } 4, I •+ ,1,.. T .... `yi'. �•°'•'�t't7;jr:44:.•li.r;.;��)r v'.fy`t:•r, r �� .. Addreu(if different from low n) CltyRova Stats Zip Cod . 1,: '����'r•r' i vii�• .. Telephone Number '1>;I.:':i•.{•,f. t•:.R+,.., :'1.,111:.;t..' 1.,,!'.:, . ,,�.: . ; rP,um. I�g•�:R. dor r, •�,�ti: ',`i;'.�'r: :s�ti'fj�t�+:tl,f;ikft:.art;f/,y��cri:A}tt%!�{i'���tr�'1{.•i>,�' �_ Date°ofPumpin `.,.;..;., ,f' 2r Duan p tity Pumped: ' .. :.i• �;�••;.;:':•.;''',;;.'� . . . Gallons .;, Typo pt.ayatom;`. ❑ Cesspooi(s) eptic Tank ❑ Tight Tank jOther Wescrlbe) • ;.:' ,:i. .. �, .. 1. fl.:E:'^ 7illrYl,t'q.:r. ,•i ...,''• • 4 Effltont Toe Flite(presont? Yes N 0 ❑ o' If yes, was It cleaned? ❑ Yes ❑ No .1.. ;�y'` ,.. ...'r, a,,,.tr;1,tfifal�'•Ir,�"�•':li}'Lrlljy'.�flrtl. h;•.�';i"ai. ^ ndl �' ; • r•� 'rY,},'• )C•C.l�S7i;�,!•t r.�l' Ile 'r" t."'�,fr'!I�+�l•/71 iit Irdr.i7.�r1 H n1}7r:rn,�v.•: ' '•r• :a,`y i�hf� .fly' *••�'•r- yf4 (: dt 4i1i9"l::r'%Ir. I,,r.,�H,�, 1,,•,�.i•: .. �!l.1, 1,1 Y„ ,.,• .i. ,+,•':f•lf,� {•y)� v:�:��.:.:Ci•!t•.'I i.�la rl-�'ii s:. .. .. •r'i:'' t:.i,l%V.N.'Tjl'<.Tri:�'71�:i:.i•4T'�frdli�S�•i•.fi�lhLj'1,M. : )i•j:.oy,;ai+•}1T.'Ji:'!'' amalt ';;•�'' �' :r.' Vehicle Ucen ..::;::� , '�+� Iris.; �•(•• l��+'J" � fa � lir+.:;r'•?.. , ie Number ad •-rrit. ',(' ; � (jtAit,' �jt,/'•'.4h\, •"rl''�N��f��'il`) IiT�3lyhr 9�•.�ii:y'7;,:;: ' ::i:y. ,.. : •, + r n'6:., •.ij`gl 7+F5 1 'i h r, I ,9/`r�i•1r, Id:,..... , ' .t•'.': '),+'"t:rt•;y r';: r1'f � ty I r��y�il•.� i 1,,, , ...+iJ;i.: r'�{y�i.'.rrb;l• y.rj dl �!'/'r�J1. 1t,•Frf�j'a�7/Jr...A:'�:..: �n,where nt061:3'yre I Co,. e. .d pposed: f'1f+\•i,r.�%;.rr.711'•.,ry ri„.:%.:2ifd'!'`••il.....ri�'iG Y. r Jk �r}Jk ft1, rt,t • .. J 1 rfSrt)N } a t+. - L.y• .i..f�Lt' ..•;.'�, .r`t. �.1,, V• r .?f,�!(j}`Ir� �t.;r�;;• .� I• i, / J :i.: : +id:'i+•'��ii+1.LC Ili•��!�7irri•('i•l•;:r i�lr'f 11 i:,:�.�'�,•��'i••`'i' .1;1j•.."a.ii' , J :' .t � 1�� {. Y, t11, Irt t t�'►;I{11•.. •r+.,�Crr�;.Y.t:r1:r::.'r 1”r. � o� r ' L r it vv Y l i��i . . Slpnature of Haulerira ",r;w';.+.,.,'.. .:' Date :ht0J/www.mass.gov/dii l.water/app.rQVt)3A5t6rms,htm#Inspect t5fomf4.doceoQl03 Syttem Pumping Record Page 1 of 1 r �/.............. _a Date..... :.. . NORTH 3:°;,�``°.;•�"° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �,SSACHUSE� This certifies that /�-r S . has permission to perform 1 5 fes /v � ...... . .... .............................................................. wiring in the building of......... ..� . .................. ......... .................................. at...........................�1!x . /./f. /..v...U✓ ............. ,North Andover,Mass. Fee.... .......Q................. Lic.No.. ..... .... ............... .z.�l CTii// EL RICAL INSPECTOR V Check # ' Commonwealth of Massachusetts Official Use only/ -- - Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] (leave blank) M APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(M C),527 CMR 12.00 (PLEASE PRINT IN INK ORPE ALL INDate: �RMATION) o the Ins ecto of Wires: Ci or Town of: 2/t By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street& Number) Z O C44/5L^.) (.z/ G Owner or Tenant .� oTelephone No - - 0 Owner's Address Is this permit in conjunction with a buildigg ermit? Yes L%!!f No ❑ (Check Appropriate Box) Purpose of Building f ,„�� Utility Authorization No. Existing Service ZU0 A ps / OVolts Overhead ❑ Undgrd ❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity 4 Location and Nature of Proposed Electrical Work: t Completion of the following table may be waived by the Inspector of Wires. r No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets 'Z— No.of Hot Tubs Generators KVA No.of LuminairesSwimmin Above In- o.o Emergency Lighting g Pool rnd. ❑ rnd. ❑ Batter Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 2�_ No.of Gas Burners No.or-Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.ofSelf-Contained Totals: I Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection Heating Appliances Security Systems:'` No.of Dryers g PP K�'�' No.of Devices or Equivalent No.of Water Kms, No.o No.o Data Wiring: Heaters Signs Ballasts No.of Devices or E uivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:No.of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under the tins a p nalties of pier'ury,d t the inf anon on this application is true and complete. FIRM NA ✓ -1— l i LIC. NO.:'Zsc►�►'6/Z Licensee: / 4 „� ./A v Signature LIC. NO.: 0v;1 (If applicable, enter "e m t"int e licens be i e.) Bus.Tel. No.: - @/ Address: Y✓ � • Alt.Tel. N����3WOO V "Security System Contractor License fequired for this work; if applicable,enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the(check one)❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ Town of North Andover, Massachusetts Form No-1 ONORTH BOARD BOARD OF HEALTH 32 h�t`ED ib�4, 19 o :' m APPLICATION FOR SITE TESTING/INSPECTION TED ss HUS Applicant NAME ADDRESS TELEPHONE Ck-3RtSTVVJ LA Site Location Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee Test No. iv i8 S.S. Permit No. 3 j�_D.W.C. N .7.7.0 C C. Date Plbg. Permit No. TOWN OF NORTH ANDOVEP, SYSTEM PUMPING RECORD /►t'k YSTEM OVVN$R a AI}ORESS T�.' TEM AT�p DATE OF PVWNQ:_4/ -_QUA NnTY PUMPED;_( 5:m Ut�sPOOL: NO Y. �,_ . �.......... $g.. ...... Snptic Tank: NU, Y N^ rukrr OF SERVICE: Kou rt�r lrMIrRUIaN('} R ���!!E'� 0b3IrRVA'n0N3: MAY 0 6 2005 OOOD CONDIT UN U LL TYJ COVER H$AYY ORL'ASS E3,ttippL,gg IN PI,At;E. TOWN r tAER LTH DEP�ARTM NT ROOTS._. L6ACFQ'i$!.D RUNBACK . B�CCR38YV$SOLIDS wFLOODED .... .. 30LIpCARRYOYE;R ,_,OTHER EXPLAIN sy.►.m Pumpo'd by _. 2�5...... IG... WIVIMENTS. UUN I'�N'I'S 1'KANSF'taRRIiU I'tl TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD � 1 STEM OWNER & ADDRESS SYSTEM LOCATION (example; left front of house) i \"I E OF PUMPINC: QUANTITY PUMPED G' LLU'v) .)SPOOL: NO YES SEPTIC TANK: NO YES \ ATURE OFSERVICE: ROUTINE XEMERCENCY FRV.:\TIONS: GOOD CONDITION- FULL TO COVE; HEAVY CREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER 0,�HFR (EXPL A ..N) i l >'I'LM PUMPED BY: TRANSFERRED TO: NEW ENGLAND ENGINEERING SERVICES INC May 16, 1995 Board of Health Town Hall 120 Main Street North Andover , MA 01845 Attention: Sandy Starr RE: 20 Christian Way, North Andover Dear Sandy: Please accept this letter as confirmation of what was done to repair the failing septic system at the above referenced address. As you know the system was failed due to a leaky tank . To fix the tank we did the following ; 1 . Excavated to bottom of tank and determined that the leak was at the seam between the top and bottom half of the tank . 2. Had Shea Concrete Company lift the top half off of the bottom half. 3. Applied a new tar seal to the joint . 4. Reassembled the tank and backfilled . The tank is now functioning properly, and the system meets all of the Title V inspection criteria . Yours truly, Benjamin C. Osgood , Jr . Copy Hagitl in 20 Christian Way North Andover , MA 33 WALKER RD. - SUITE 22 - NORTH ANDOVER, MA 01845 - (508) 686-1768 s 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address of property 2© w nA"V ocvc-f- yq, Owner's name p�u �1N� H0G 1,v Date of .Insp.ection. 5 2 i qs APART .A CHECKLIST Check if the following have been,. done: V Pumping information was requested of the owner occupant,/. p , and Board of Health. v ,-None of the system components have beenum ed .for P P at least two weeks . and :the system has been receiving normal flow rates , during that pe`riod.. Large volumes of: water have `not been introduced into the system recently, or as . part, of ,this inspection. 'X's built plans have been obtained and examined.". Note if they are not. aVailable with N/A. The facility or dwelling was_. in petted, for_.,.signs.-of sewa .a back-up. P Z^ The site was inspected for signs of breakout. X111 system components, excluding the SAS, have been. located on the site: The septic tank, manholes were uncovered, opened- :and the interior of thre septzc dank 'was . inspected for condition of.' baffles or tees,` 'mat,erial of construction, dimensions-, depth of liquid, -depth. of sludge, depth of scum. The 'size and location of the SAS on thesite has been determined based onexisting in,formation'' or approximated by non-intrusive methods. . , The facility owner (and occupants, if different from owner) were provided with information=on .the proper maintenance of SSDS. 8 h1l.L �9S�6 SUBSURFACE SEWAGE DISPOSAL .SYSTEM INSPEC..TION- FORM .`.PART 8 . : SYSTEM INFORMATION FLOW CONDITIONS If residential L_,Number of bedrooms :number, of: current residents garbage 'grinder,. yes .or no laundry connected to •system, ,Xes or no seasonal used .,`Yes. -or no If nonresidential , calculated flow Water meter zeadings, if available: 20,5 Nireti Last date of occupancy . GENERAL INFORMATION Pumping records. and source of information. LZ System pumped as part of inspection, yes or no . i,f yes, volume pumped 0 Reason for pumping:. Type of system Se ptic' tankjdis.tribution box/soil absorption system Single 'cesspool.. Overflow , cesspoal Priv.Y hired system (yes or no) (i�f. yes; attach previous inspection r..ecords; f any) Other (explain) . Approximate age of al I components Date installed, if known. Source of infprmation ;A)5i. �0 A0— Sewage odors detectedwhen arriving at the site, yes, or no SUBSURFACE SEWAGE DISPOSAL SYSTEM . INSPECTION FORM PART :B SYSTEM INFORMATION continued SE.PTIC. .TANK.;:: (1�acate on" site plan-) ` depth below.' grade: " w materiai of construction: concrete metal FRP other(explain) dimensions: 15'a0 ,� to ti m�iL sludge depth. 15". :distance from' top of sludge to bottom of outlet tee or. baffle �c :scum thickness di, stance from-:top. of scum to top. of outlet tee or baffle distance from bottom of scum to bot.tom. of outlet tee oar baffle Comments. (recommendation. for ''pumping, condition-.'-of inlet and outlet. tees or baffles; depth o- liquid level" in relation to .outlet invert, structural integrity, evidence of, leakage, recommendations for repairs, etc. ) ` Ln w VC K I ti 0 1 fl ".Z E2 i,L,_ Lj y a DISTRIBUTION BOX: (locate;on -site plan) O '. depth of liquid level abo"ve outlet invert Comments: (note• if level and distribution is equal, -.evidence of solids carryover, evidence of 'leakage` into or_ out, of box, recommendation for repairs, etc. ) d V t N L = c5 COWI AJ �� ^� PUMP CHAMBER . ("Locate;',,on .site--plan) pumps in working order . yes or 'no Comments: (note condition of pump chamber,_ condition of pumps and appurtenances, recommendations for maintenance or repairs,etc. ) 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B. SYSTEM-INFORMATION, ontinu.ed SOIL' ABSORPTIONSYSTEM (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: leaching pits and number , leaching chambers and number leaching galleries and number l.eachtrenches, number, length' leaching fields; :number'; dimensions _j r-1 ems© moo` x overflow cesspool. number. comments. -(note ,condition .of .soilsigns "off hydraulic failure, .. evel of ponding,- condition of. vegetation :.recommendations for maintenance. or' repairs,,etc. ) s nJo Ly Fl. c0 S7 LG 1. 1�E N& yV CESSPOOLS (locate on site plan) number:,'.-andconfiguration 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 .ofinspection)''` Comments: (note condition of soil. signs of. hydraulic.-failure, level 'of ponding,. condition of 'vegetation, recommendations for:maint.enance or. repairs,etc. ) pRTVY (locate on :site- plan) materials of construction dimensions depth'; of, solids Comments t (note condi tion,of-soil signs of hydraulic failure, - 1,evel of ponding, I condition of. vegetation, recommendations for maintenance or repairs"etc. ). SUBSURFACE SEWAGE DISPOSAL ,SYSTEM INSPECTION PORM PART B SYSTEM :INFORMATION continued SKETCH.•OF SEWAGE DISPOSAL SYSTEM: include. ties to .at least two permanent -references landmarks or benchmarks . locate all wells within 100:' N. s t-ln�se Goa DTPA;)K 0. AjOri � 2Ec7Y A-QTA-CeNT i� . . DEPTH.' TO GROUNDWATER �—� depth,`, e th to groundwater ' method of- determination •or'.approximations 12 SUBSURFACE `SEWAGE. DISPOSAL SYSTEM' INSPECTION FORM PART C FAILURE CRITERIA Indicate yes, no, or. not, 'determined (Y,"-;N; or ND.) . Describe basis of determination. in all instances'. , If.. "not determined" , explain why not) Backup of sewage, into facility? *,. Discharge or ponding of effluent to the surface of, theround or surface waters? g .`Static liquid levelin the distribution box .above outlet invert? Liquid depth in cesspool '<6'" below invent or. available volume< 1/2 day flow? Required pumping 4 times or more in the last year? number of times pumped c� Septic tank is metal? ' cracked?° structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? �^ ! Is any portion of the SAS, cesspool:. or privy;' 1�C_._ below,the: high groundwater elevation? Al _ within 50 feet of assurfaoe water? At within . l00 feet 'of a, surface water'.supply or tributary to a surface water supply? within a Zone I of apublic well? /V within 50 ;feet -of a bordering wetfetat�d wetand'.'or salt marsh (cesspools and privies only, `not 'the SAS) ? With 50 feet, of a - - private water supply well. less than 100 feet, but greater .than 50 .feet:•from` a private water -supply well .with no acceptable water.,, quahity .an ' lysis? If -the well . has ,`been, analyzed to be: acceptable," attach 'cQpy of well water analysis for coliform .bacteria., volatile organic compounds, ammonia nitrogen and nitrate' nitrogen 13 SUBSURFACE SEWAGE DISPOSAL-S-YSTEK-INSPECTION. FORM PART D CERTIFICATION Name. of Inspector Company Naive Company Address Certi`fi.cation Statement I 'Certify that I have personally inspected the sewage;disposal .system at this .address' and �that the information."reported is ;true, accurate and complete as of the. time of inspection. Th inspection was performed and any recommendations regarding upgrade, �maintenance and repair are consistent with my. training and experience in the proper function and manit;enance of on-site sewage disposal systems. Check one: I have not found any information which indicates :that the system fails to a'dequately. pr.otect .public` health or the environment as defined in .310 " CMR . 15;. 303 . Any.:failure criteria not evaluated are as , stated in the FAILURE CRITERIA section. of this form. ::; _ I `ha.ve. determined that the system fails to ,protect 'public health and the environment as defined in 310 CMR 15. 303 , The basis for this determination is provided in the FAILURE CRITERIA section of this form Inspector's Signature Date ...Original 'to system owner Copies to:. Buyer` (if applicable) Approving authority /address b �ST1A4 W6:Y Tittle of File P.age of Date File Open: Date file closed:_ Doc Document/Action Title Date of _ action Refer to other Purpose of IaocumecntJAction and notes Document/ doeunroent/ IW u m. Action --� De artment Board of Appeals — Board of Heal h Planniing Board _ Canse rvati"on commission – Bu- ilding- Departm, en;t �— 4 NORTH q 3�°`s,,IoZ. BOARD OF HEALTH 120 MAIN STREET * « TEL: 682-6483 CHU`' NORTH ANDOVER, MASS. 01845 Ext. 32 or 33 October 18, 1990 Mr. Al Shaboo Design Engineering 168 Pleasant St. No. Andover, MA 01845 Dear Mr. Shaboo: As per your request on October 18, 1990, I visited Lot 6 Christian Way. I found that a portion of the required top and subsoil excavation required by your septic system design has been conducted and filled with a gravelly material. An inspection of the material cases me some concern. It would appear to me that the fill material placed in the area may not meet the fill material requirements set forth in the State Sanitary Code. Therefore, I must require that the material placed in the area be removed along with the additional top and subsoil excavation required by your design. Different fill material should be used unless it can be demonstrated that the existing material meets the specification of replacement material as outlined in the State Sanitary Code. Should you have any questions regarding this matter, p_.jease do not hesitate to call. Very 1 yoyt�,s,� cha J. os i Health Agent MJR/rel 5I.. C,IS rZ, "-LE-A N IIT L F L ID Cz-- I,-x, �Z4' S -STt��P-,\ To x-a-urv. I St.. 0 VII, N �NSTA LL W A A T6 to, As As _ _ 13Z•a� \ 1 LOT 6 e s � , 81a s.F• _ a T � a .�+ sr zz ' �- � � � �NVBRT ELGVA.TION ® E4EVATioN DW4 LL�Na p,frLS.r a SgQTlC TANK S¢ �C"ruK OuTLGT /S6•SG (n , 4 � p-Boh rNL-aT /6 s.e9 3 = O.T,-6T m / G) �'tlNk;gAo / lot �yJ i . y IS Q rS SS To}iI�r= CS'RTiFY TtIAT SZ . S. D. 5. AsS-BUI LT PLAN HI-111\1 THP- CUNSM"C-rloN LOT Co CHRISTIAN WAY, N.ANtaVE'R,MA. _OF TH.e. SAID Dls�osAl- (Sys TL"M LocATED AT .NGRTt-I Q ' NI)ovau , MA • T+-Ip- �r{AaaS _JC.�A.LE� 1 °=�Q �,4T� � NOV.� V2y, )�90 ..... f - ARS As $Y .�esiy� Grrsi7iCer/7L1� PL-AMs Att'D SPECI RICATIONS Pv, ac r, I#8 0/8yS DAT-.a jUL`< 27 , !9 8 7. CEf►'% FOUNDA7 0AI PLAN LOCATED IN t-loma H SCA LE.I"=—,I s,—' DATE ' ,: S.L.GILES R.L.S. LAWRENCE 8 NORTH ANDOVER 1� 40 I -711 � /,40 c 4!I I f� I 0 U I � a � a 1 / 0 / CER, /FY THAT TH OFFSETS SHOWN ARE FOR THE USE OF00 UFFSE TS ;'f/OWN THE BUIL DING INSPECTOR ONL Y, 8 SUCH ,91 .'s CON,`0 -lM I".) THE USE IS FOR DETERMI NA TION OFZON/NG 4> " 13@72 �C1ytEnEc �'' ' Z;WN/ _7 Y L A L1' JF CONFORM T Y OR NON C ONFORMI T Y WHEN CONSTRUCTED h(iS(4o F-IO()IR ofHFJoI.i'i- �T /� CH 1S 71,c pi Nol�Th Au Dnve)- , MA, APPS t CQry T ( qTG►� s�Pt-Ly 6wnl �J UJELL- ,�P oucDlY�TG SS 3fFs StPT'i c SY S i�M vES�C� D,4rt -13-�� �Pr vIN� 3urho�)-ry PCAnJ DE516�J c K �I�PPI�VED Co�olr��JS = R>~45oNS Ti w� 3ZU _ st�'(C SYSTEM 1 A LLQ"j►oiU 4Fx4v4T(al-) )����>EG►�D�U ���C 1--/)V5 Q F�4►1_ �PPI�C�VE1� D/3TC /SPi21�0v1n)G AU'FHo►��ry, ���IT�p�AL �nJ51�.j(oNs X11=,o►�y) DISAPt'IZUv�f� D,arC R�/j5a tis•, FML APPIZVAL DA�� ,. APP��ov�G �v i Nod► ►�/ CERT/F/Ev FOUIDAT/ON PLAN LOCATED IN KIoT?--rH Lz MASS SCALE./"- 4� DATE- S.L.G/LES R.L.S. LAWRENCE 8 NORTH ANDOVER 1 �1 _ J I 51 cfl8 5.F � J V I i r \� 11 j � Q I V 1 1 'n i CFR,-IFY 7" ,AT 7*HE OFFSETS SHOWN ARE FOR THE USE OF ✓FFSE T`,• i�,�wN THE BU/LD/NG INSPECTOR ONL Y, a SUCH C'C'I'' = �; :' ; 'HE USE IS FOR DET-ERM/NATION OFZOiWIVG 4; �� CONFORMITY OR VON COiVFORIWITY F ' :NHEN WNSTRUCTED Commonwealth of Massachusetts EEL Executive Office of Environmental Affairs Tavuii of "QRTH AXIGOV Ri BO;.RC 0� -iFa'TH Department of 02 Environmental- -protect on J12 8 ISflo W 111am F.Weld Goarna rudy Foxe Arg" Paul Celiucci LL Govsmor _._ uhs • Commisabnar SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A 1 CERTIFICATION ProPerty Address p° O e ,Pf s 7�i4 V Cb*y j /00-v# 6404 1U fre l Ivs4_ Date of Inspection: Address of Owner. Name of Ina of different) i��r Benjamin C. Osgood Jr. Company Name,Address and Telephone Number. New England Engineering Services, Inc. 33 Walker Road, North Andover, Ma 01845 CERTIFICATION STATEMENT Tel. 508-686-1768 Fax. 508-685-1099 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 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: ��s Date: The System Inspector shall sub -t 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 appopriate 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: AI SYSTEM PASSES: I have not found any information which indicates that the systemvio]ates any of the failure cri Any failure criteria not evaluated are indicated below, terra as defined in 310 CMR 15.303. 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 exfiltration,.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 11/03/95) 1 One Winter Street • Boston,Massachusetts 02108 o FAX(617) 556-1049 a Telephone(617)292-5500 w i1 Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Addre" C79b C- �,Q%s1`i%�/G ��1, /�v•�f do✓��, r/lt}�, Owner. Date of Inspection: BJ SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require,fti ther evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT 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 water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. 9) OTHER (revised 11/03/45) 2 ` 0 L SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A G ,( CERTIFICATION(continued) Property Addreaa p�b (.pS1';o4w �� �/, �d�f/7 Owner.. (5 9.,,eQ / Date of Inspection: G/ass A DI SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded.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 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. Any portion of a 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 I 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. 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. EI'LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000BPd ter_. .or gran_ (Large System)and thesystemis 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 12 of a public water supply well) 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 11/03/95) 9 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Addreax0 Owner. Owne /��� Date of Inspeotion�eoy(�- `3, Check if the following have been done: Pumping information was requested of the owner,occupant, and Board of Health. Y 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 f The facility or dwelling was inspected for signs of sewage back-up. `The system does not receive non-sanitary or industrial waste flow "The sitewas inspected for signs of breakout. '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. The facility owner(and occupants, if different from owner) were provided with information on the proper maintenance of Sub. Surface Disposal System. (revised 11/03/95) 4 ,yg SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM s PART C SYSTEM /INFOR/MATION Property Address: p?d G �L e< �I4441ele Owner. K PeotionDate of I 6411 61 AP ay FLAW CONDITIONS Design flow:_ - Mons Number of bedrooms:, Number of current residents:. Garbage grinder(yes or no):__,y Laundry connected to system(yes or no): Seasonal use (yes or no):_j( ) Water meter readings, if available: d /,(t�t,�q Last date of occupancy:_ Q�,'f COMMERCIAL/INDUSTRIAL Type of establishment: Resign flow: pttons/day Grease trap Present: (yes or no) Industrial Waste Holding Tank present: (yes or no) Non-sanitary waste discharged to the Title 5 system: (yes or no)� Water meter readings, if available: Last date of occupancy: OTHER:.(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECOAPS and source of information: System P=Pea as part of inspection: (yes or no If Yes,volume pumped: _�BT� gallons Reason for pumping-. 1 TYPE O _SYSTEM SePtic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Sbarsd 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: Sewage odors detected when arriving at the site: (yes or no) (revised 11/03/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: /c�O � �!/Qi 5 0n Owner. Cr'4� �itQ� Date of Inspection: SEPTIC TANK:_ (locate on site plan) Depth below grade:�–� Material of construction: s oncrete metal FRP—other(explain) Dimensions: /i-04 6741, Sludge depth: f 14 Distance from top of sludge to bottom of outlet tee or baffle: /5 Scum thickness: O Distance from top of scum to top of outlet tee or baffle:. /D " Distance from bottom of scum to bottom of outlet tee or baffle: " 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.) 417/i 4-O'f- / k di leg Les e C .0 s!2 ree T O K %� GREASE TRAP:_ (locate on site plan) Depth below grade: Material of construction:,_concrete_metal_FRP_other(explain) Dimensions: Scum thiclmess: Distance from top of scum to top of outlet tee or baffle: - Distance from bottom of scum to bottom of outlet tee or baffle: 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.) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Aadrese: vP o C he,,5 Av/f, 694Y, 14/oelV A 40e-ev wie- Owner.. 6 z pG Date of Inspection: 64k- TIGHTOR HOLDING TANK (locate on site plan) Depth below grade: Material of construction:_concrete_metal_FRP wother(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee,condition of alarm and float switches, etcJ DISTRIBUTION BOX:` (locate on site plan) r. Depth of liquid level above outlet invert: a Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) o x 0/v o A, eo.k e 4 Dre 2 Na 17w. D 9,7 c PUMP CHAMBER (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised- 11/03/95) 7 96 •�� w .�� t� ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: ,40 r`7-0"S 1,fAC• �i�}�, /�/o�f f�i A*Q ere f, 04, Owner, Date of Inspection: `1 /5 SOIL ABSORP'T'ION 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: leaching fields, number, dimensions: a C Se G overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) �e� !,`c ' CESSPOOLS:_ (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(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 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.) (revised 11/03/95) 8 • qt6 �✓' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 1 SYSTEM INFORMATION//(oontinued) Property Addroea: �` O &14'5TI!fn k� Y j�/a �! �dd-e-MI-01 Owner. iC'1�G13�QO Date of Inspection: SEMB OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' . 41 ^ ' 23,y' f 1 010t �^ DEPTH TO GROUNDWATER Depth to groundwaterr, l9 feet _ method of determination or approximation: T e Ow, A, O 0 {revised 11/03/95) 9 TOWN.OF NORTH SYSTEM PUMPING RECORD t _ J-ii � a fW YM • r.t{Y,,, ti�i !rth-tb�+i?>,f�"�a ! a!:, 1 M OWNER&ADDRESS SYSTEM LOCATION s ; �, r' (° ►- (exargph:le4 front of house) yt{E yL y, t SATE:OF PpgPING: ' QUANTITY PUMPED GALLONS � � 9a;' Iktls' ,_' ,CESSPOOL: NO YES SEPTIC TANK. NO YES !� !,I }I q Ija b , �ir {iplKrti Pj .NATURE OF SERVICE: JROUTINE EMERGENCY � >.7�� ! {l�(jv�'�IA�r�f��j'I^y�w 11C�jTtff(-))i.t, I• � / - ....wh�i ' + f ?{ .�� FFFf,Cl,;1�a 1 s• ' ,t !11 ... 1 �:t 1 .. . .... . . , MIRVATIONS:� lGOO D CONDITION.. HEAVY GREASE FULL TO COVER BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS � FLOODED SOLIDS CARRYOVER OTHER(EXPLAIN) v�, X Ar ,? I) .. I SPED RV Xyy �,t<aE1 7�.ui.SY 1 T'r{ :Yt7k'F dM.t, T�!• � fit! '{,,t L�f�i; i.QlC Y($Q�.� ' I`Iy 1 � 1� !• VIP ilk 41-'l v y 44+r•yap, 6 J t tii I 1 F r i`• f" 1,�1�,141.r�{��li{r t.11r ,��r' L'• �'r, jt • C 5, ! 411 44 }`�ff,} 1+ { 1 i �Ir Yf1• 1 tel`! ' w , t • 1�iKLj 1t e FpA'Aff ot _"