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Miscellaneous - 20 ENGLISH CIRCLE 4/30/2018
20;NGL SH CIRCLE J 210/038.0-0162-0000.0 t MAP # � LOT PAR Cy"L CEL # STREET__ I ,.: • i, �f�Ns_LRUGT_xQf_�A�R_._QVf1� i HAS PLAN REVIEW FEE BEEN PAID? YES NO PLAN APPROVAL: DATE 4J (L'bl. APP. BY__ DESIGNER: _ E�'7 �i' ZAl� P DATE__ CONDITIONS �sG ' y 27�� _._._.-........_. WATER SUPPLY: TOWN WELL WELL PERMIT DRILLER WELL TESTS: #EMAL DATE APPROVED.-____ IA I DATE APPROVED....---..._..__._....._.....__... IA II DATE APPROVED.-----.- COMMENTS: FORM U APPROVAL: APPROVAL TO ISSUE" NO DATE ISSUED BY i CONDITIONS: FINAL APPROVAL: ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NO SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NO ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: BY: SEPTIC_SYSTEM-_jNSTBLLA_T. _O.N IS THE INSTALLER LICENSED? YES NO TYPE OF CONSTRUCTION: NIW REPAIR t• ry , NEW CONSTRUCTION: CERTIFIED PLUT- (ALAN REVIEW YL=S NU CONDITIONS OF APPROVAL YES NO (FROM FORM U) ISSUANCE OF DWC PERMIT YES NO DWC PERMIT NO. ?J INSTALLER:_,`LI BEGIN INSPECTION 6YE 0: EXCAVATION INSPECTION: NEEDED: . 4 i11 PASSED BY -- ------— -- +:, CO TION INSPECTION: NEEDED s: ---------- ...___._.__ AS BUILT PLAN SATISFACTORY: YES: .0.•!a•,' '• i ' ° APPROVAL TO BACKFILL: DATE: — _.BY_ FINAL GRADING APPROVAL: DATE —BY r FINAL CONSTRUCTION APPROVAL: DATE:_, ��_BY Residential Property Record Card PARCEL ID:210/038.0-0162-0000.0 MAP:038.0 BLOCK:0162 LOT:0000.0 PARCEL ADDRESS:20 ENGLISH CIRCLE FY:2015 PARCEL INFORMATION Use-Code: 101 Sale Price: 300,000 Book 05870 Road Type: C Inspect Date 05/15/2008 Tax Class T Sale'Date: 09/24/00 Page yce: X m EntranRd Condition: P Meas Date. 05/15/2008 Owner: To0196 SCHARFF,VIRGINIA J Tot Fin Area. 1944 Sale Type P Cert/Doc. Traffic: L t Land Area: 0.63 Sale Valid: Y - Water: _Collect ld: RRC Address: - - Grantor: ENGLISH CIRCLE REALT Sewer: y Inspect Reas: C .,• 20 ENGLISH CIRCLE ._ _® _ NORTH ANDOVER MA 01845 Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LP/o Indust-B/L% / Open Sp-B/L% / RESIDENCE INFORMATION LAND INFORMATION Style: CL Tot Rooms: 8 Main Fn Area: 936 Attic: NBHD CODE: 6 NBHD CLASS: 6 ZONE R3 y- Se _T `se Code TMethod S Ft Acres Iriflu-Y/N Value - Class Story Height:, 2.00 Bedrooms 4 Up Fn Area 1008 Bsmt Area 936 9 _ ,_ YP -.101-11- _S--1 - q- _�._.W. _._ .. _ �.__. 1 P __ 27361 0.630 197,010 Roof: G Full'Baths: 2 Add Fn Area: Fn Bsmt Area: Ext Wall:T FB Half Baths 1 Unfin Area: BsmtGrade:� MATT N _ _ --� _ _ -- �- _ - DETACHED STRUCTURE INFORMATION Mason Trim. Ext Bath Fix: 0 Tot Fin Area: 1944 Foundation: CN Bath Qual: M _ RCNLD: 243192 I Str _Unit Msr-1 Msr-2 E-YR-Blt Grade Cond%Good P/F/E/R Cost Class' - _ _.. _. - SE .__S_ - 10 14.00 2000 .-' A --- A ///93 _2,100- -1 Kitch Qual: M �Eff Yr Built:' 1994 Mkt Adj: Heat Type: HWExt Kitch Year Built: 1991 Sound Value: VALUATION INFORMATION Fuel Type: G_ _ Grade: G 'Cost Bldg: 243,200 Current Total: 442,300 Bldg: 245,300 Land: 197,000 MktLnd: 197,000 Fireplace: 1 Bsmt_Gar Cap: 2 Condition: G Att Str Val 1:__ Prior Total: 425,300 Bldg: 237,900 Land: 187,400 MktLnd: 187,400 Central AC:_ N Bsmt Gar SF: Pct Complete: Att Str Val2: Aft Gar SF: %Good P/F/E/R: ///91 Porch Type Porch Area Porch Grade Factor W 80 SKETCH PHOTO 77 W F: s, in Wf MrB 934 Sof L I Fu 2 20 ENGLISH CIRCLE f 72 S%Ft - Parcel ID:210/038.0-0162-0000.0 as of 7/20/15 Page 1 of 1 N Commonwealth of Massachusetts City/Town of System Pumping Record mziEU Form 4 DEP has provided this form for use by local Boards of Health. Otherorms may be used, but t information must be substantially the same as that provided here. B fYt�Islr �tEtf ,�l�ic with your local Board of Health to determine the form they use. The System P bmitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left front of house, right front of house, left side of house, " ht side of house eft rear of house, right rear of house, left side of building, right rear of building, under ec c. 0 ���� �a S�\ n VC\,e t�c� Cityrrown State Zip Code 2. System Owner:. Name V� Address(if different from location) City/Town State Q Zjp C e Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) �epficnk ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes Leo If yes, was it cleaned? ❑ Yes ❑ No 5. Conditionnof System- 6. System Pumped By: Neil J. Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc. Company 7. Loc where contents were disposed: .L.S.Dztov4l Waste Wine \ / R— Signaturefof Hfuly Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 310 CMR 10.99 Form 8 DEP File No. 242-497 1 no be brovioed by DEP) Commonwealth Cr(y town North Andover I of Massachusetts ADDthcant R.M.P. Properties English Circle Certificate of Compliance Massachusetts Wetlands Protection Act, G.L. c. 131 , §40 From NORTH ANDOVER CONSERVATION COMMISSION Issuing Authority To Tom Laudani 50 Copley Drive, Methuen, MA 01845 (Name) (Address) Date of Issuance November 261991 This Certificate is issued for work regulated by an Order of Conditions issued to Gene English dated 5/10/89 NACC and issued by the 1. $)K% It is hereby certified that the work regulated by the above-referenced Order of Conditions has been satisfactorily completed. f 2. Z It is hereby certified that.only the following portions of the work regulated by the above•reler- enced Order of Conditions have been satisfactorily completed: (If the Certificate of Compliance does not include the entire project, specify what portions are included.) 3- L It is hereby certified that the work regulated by the above-referenced Order of Conditions was never commenced.The Order of Conditions has lapsed and is therefore no lortper valid. No future work subject to regulation under the Act may be commenced without filing a nev: Nonce of Intent and receiving a new Order of Conditions. ...... ............. ............................... .. .......... ...................................... . .. .. .... ................. (Leave SDace Blank) _ } S- �viLi G ------ - v1r✓T"" `G -"���Tlo S.T, o z I D_�v�. . 7 2 ' �Z• rr '` DU7c �,eT;' L.- O.77 r !Z.16r--`1ie4ij_F'L•- Igdt4q 11 1( It r, It rr JR 2 Lz If Il It, f l TCt F—1-= '17 (;- t F 1'r C�i PFC� i ' )/L. �/,_t�✓cam t'tc.p f tL#.� �L=f��G3�.�`.� �I 1 HEREBY cERT1Ff Tl{AT 1 H�V� _ ,G UJSPECTEo THE comsmocnoo of 'rt115 fr ).r It It {{ r i TSL ZC�— l�f /. c 7 ; D15PoS&L. Sxs'MM ANU TH&T* THS C0USTRuGT10%.1 AWO J=10,LL 6IGsoI&j6 HISS VIEER uola+a J" Accoko,nl.6 w STH THE VLSWCmI4Sp`S (WtMT Aj4D T<A&T THE MATERIALS Meo co"Fo" lb THE pLa4 sPEc��ICAT1o�1J ANu `'3 (o GNtIE, 15.00' `' E7 =60.vo GAPgGE �` • i A-Bax , C' 1 o 1�1 AS 6U1 LT PLAN OF SUR'-jURFACE DISPOSAL SYSTEM LOCATED IN AS PREPARED FOR 11 OF DATE : >r' ': I f ��° � C. k SCALE: ( „� I � , g Vilma . Sel'r,. 9 199 t -- i I MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS I 66 PARK STREET 0 ANDOVER, MASSACHUSETTS 01810 4 TEL (617) I75-3533. 373-3721 S�un�e,,Q Commonwealth of Massachusetts h Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 English Circle Property Address Virginia Scharff Owner Owner's Name information is required for North Andover MA 01845 7/21/2015 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: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Neil J. Bateson cursor-do not Name of Inspector use the return key. Bateson Enterprises Inc. Company Name 111 Argilla Road Company Address Andover MA 01810 City/Town State Zip Code 978-4754786 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 ❑ e Furtr Evaluation by the Local Approving Authority MCEIVED aur 1 7 2015 7/21/2015 TOWN OF NORTH ANDOVER Inspe s ignatu Date "-""-' ' �r RI 1WENT 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. is 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 Commonwealth of Massachusetts Title 5 Official Inspection Form NEW- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 20 English Circle Property Address Virginia Scharff Owner Owner's Name information is required for North Andover MA 01845 7/21/2015 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 in septic tank, new outlet cover on septic tank& new d-box, septic sy�tem now passes Title 5 inspection. r B) System Conditionally Passes: I ❑ One or more system compone,is 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 structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tanki is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): i t5ins•3113 Title 5 Official inspection Forth:Subsurtaoe Sewage Disposal System•Pape 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 English Circle Property Address Vi inia Scharff L� Owner Owner's Name information is required for every North Andover MA 01845 6/13/2015 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:When filling out forms A. General Information RECEIVED on the computer, use only the tab 1. Inspector: key to move your JUN 3 0 2015 cursor-do not Neil J. Bateson key.use the return Name of Inspector TOWN OF Bateson Enterprises Inc. HEALTH DEPARTMENT Company Name 111 Argilla Road Company Address Andover MA 01810 City/Town State Zip Code 978-475-4786 S115 Telephone Number License Number { B. Certification s . Af` 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 o P n 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 4Signat 6/13/2015 Date The system inspector shall submit a copy of this inspection report to the Approving P p pp ng 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•3h3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ' 20 English Circle Property Address Viginia Scharff Owner Owner's Name information is required for every North Andover MA 01845 6/13/2015 page. Cityfrown 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 structurally unsound, exhibits substantial infiltration or exfiltration or tank failure.is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ® N ❑ ND(Explain below): t5ins•3113 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 English Circle Property Address Viginia Scharff Owner owner's Name information is required for every North Andover MA 01845 6/13/2015 page. City/Town 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 Title5Official Inspection Forth: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 20 English Circle Property Address Viginia Scharff Owner owner's Name information is required for every North Andover MA 01845 6/13/2015 page. City/Town 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 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 cover and outlet tee in septic tank, and d-box 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 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 '/day flow t5lns•3113 Title 5 Official Inspection Form: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 20 English Circle Property Address Viginia Scharff Owner owner's Name information is required for every North Andover MA 01845 6/13/2015 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) i 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. ❑ Z 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- 10,000gpd. ❑ ® 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 or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. f51ns'3113 Tide 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 20 English Circle Property Address Viginia Scharff Owner Owner's Name information is North Andover MA 01845 6/13/2015 required for every" page. City/Town 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 ❑ ® 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): 3 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 450 1:51ns•3113 Title 5 official Inspection Forth:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 English Circle Property Address Viginia Scharff Owner Owner's Name information is required for every North Andover MA 01845 6/13/2015 page. Cityfrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection E1 Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(Iast 2 years usage (gpd)): Yes Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Current 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.•3/13 Tide 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 English Circle Property Address Viginia Scharff Owner Owner's Name information is required for every North Andover MA 01845 6/13/2015 page. City/Town 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 four years ago, owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ 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 of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3f13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 20 English Circle Property Address Viginia Scharff Owner Owner's Name information is required for every North Andover MA 01845 6/13/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate'age of all components, date installed(if known) and source of information: 34 years old, 9/9/1991, as built plan Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.4 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"PVC through wall to septic tank, 3"PVC in house. No leaks visible. Septic Tank(locate on site plan): Depth below grade: •4 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'x4' Sludge depth: 3" t5ins-3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Y 20 English Circle Property Address Viginia Scharff Owner Owner's Name information is required for every North Andover MA 01845 6/13/2015 page. City/Town 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 3" Distance from top of scum to top of outlet tee or baffle N/A= Outlet tee corroded off 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.): Inlet tee ok. Outlet tee corroded off, needs to be replace. Outlet cover broken, needs to be replaced Depth of liquid level at invert. No evidence of leakage. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts two Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 English Circle Property Address Viginia Scharff Owner Owner's Name information is required for every North Andover MA 01845 6/13/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site 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 20 English Circle Property Address Viginia Scharff Owner Owner's Name information is required for every North Andover MA 01845 6/13/2015 page. Cityfrown 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 cover broken, replaced it. D-box level &distribution equal. Evidence of carryover. No evidence of leakage. D-box has bad corrosion, needs to be replaced. Pump Chamber(locate on site plan): Pumps in working order: El 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 Oficial Inspection Form:Subsurface Sewage Disposal posal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 Fnglish Circle Property Address Viginia Scharff Owner Owner's Name information is required for every North Andover MA 01845 6/13/2015 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: 3 trenches 42'long ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): 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•3H 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 I " Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 20 English Circle Property Address Viginia Scharff Owner owner's Name information is required for every North Andover MA 01845 6/13/2015 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°3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System°Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 English Circle Property Address Viginia Scharff owner Owners Name information is North Andover MA 01845 6/13/2015 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below Q drawing attached separately torr Lq t7 aC�tgrr Djpb�, �E2'4 `r t5ins•313 Title 5 Oficial Ins pectlon Form:Subsurface Sewage Disposal System•Paye 15 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 English Circle Property Address Viginia Scharff Owner owner's Name information is required for every North Andover MA 01845 6/13/2015 page. Cityrrown 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: 4 feet 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: 5/14/1987Date ❑ 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 wN . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 English Circle Property Address Viginia Scharff Owner owner's Name information is required for every North Andover MA 01845 6/13/2015 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 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Summary Record Card generated on 6/9/2015 8:47:01 AM by Karen Hanlon Page 1 Town of North Andover Tax Map # 210-038.0-0162-0000.0 } Parcel Id 12951 20 ENGLISH CIRCLE SCHARFF, VIRGINIA 20 ENGLISH CIRCLE N.ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Zoning21 Residential Zoning3 1 Residential Size Total 0.63 Acres FY . 2015 UB`Mailinq Index Name/Address Type Loan Number Active/Inact. From Until SCHARFF,VIRGINIA Payor 20 ENGLISH CIRCLE N.ANDOVER,MA 01845 UB Account Maint. Account NoCycle Occupant Name Active/Inactive Bldg Id.16093.0-20 ENGLISH CIRCLE Last Billing Date 4/16/2015 3160135 03 Cycle 03 Active UB Services Maint. Account No.3160135 Service Code Rate Charge Multiplier/Users MISCFEEADMIN FEE"• 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 38.00 /1 UB'Meter Maintenance Account No.3160135 Serial No Status Location Brand Type Size YTD Cons 32707826 a Active 00 b Badger w Water 0.63 0.63 683 Date Reading Code Consumption Posted Date Variance 6/3/2015 865 a Actual 22 115% 3/4/2015 843 a Actual 10 4/28/2015 -14% 12/5/2014 833 aActual 12 1/15/2015 -76% 9/4/2014' 821 a Actual 49 10/15/2014 304% 6/4/2014 772 a Actual 12 7/16/2014 9% 3/5/2014 760 aActual 11 4/11/2014 9% 12/4/2013 749 aActual 10 1/17/2014 -78% 9/5/2013 739 a Actual 46 10/15/2013 221% 6/7/2013 693 a Actual 14 7/24/2013 -6% 3/11/2013 679 aActual 16 4/22/2013 -20% 12/6/2012 663 a Actual 18 1/9/2013 -56% 9/11/2012 645 aActual 46 10/15/2012 336% 6/7/2012 599 a Actual 10 7/16/2012 -9% 3/8/2012 589 a Actual 11 4/14/2012 -66% 12/8/2011 578 aActual 32 1/17/2012 -68% 9/8/2011 546 a Actual 108 10/13/2011 802% 6/2/2011 438 a Actual 11 7/20/2011 8% 3/4/2011 427 a Actual 10 4/13/2011 -51% 12/6/2010 417 aActual 22 1/12/2011 -74% 9/3/2010 395 a Actual 83 10/15/2010 703% 6/2/2010 312 a Actual 10 7/15/2010 43% 3/4/2010 302 a Actual 7 4/14/2010 -48% 12/4/2009 295 a Actual 14 1/12/2010 -60% 9/2/2009 281 a Actual 35 10/15/2009 179% 6/2/2009 246 a Actual 12 7/20/2009 41% 3/612009 234 a Actual 9 4/29/2009 -21% 12/3/2008 225 aActual 11 1/20/2009 -76% 9/4/2008 214 a Actual 47 10/10/2008 550% 6/3/2008 167 a Actual 7 7/16/2008 -21% {TL'ED'I COPY PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERTIFICATE OF COMPLIANCE As of: 7/22/15 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Repair of D-box and outlet tee By: Todd Bateson At: 20 English Circle Map 038.0 Lot 0162 North Andover, MA 01845 ` The Issuance of this�cert cate shall not be construed as a guarantee that the system will function satisfactorily. Michele Grant Public Health Agent 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com M.- 4t II`� 61 .A • Pak t 7,ae� HCl' �Wd."�a: �� Y' (>,• LL • .. �• � ���'d��(��;�5`i� e4f F{,:..' _ �-.��J�� '�f"a�,g S :C� _, ' ,�rJ`,�xt�'� .� •��%s3��r y -r�, ��� ��� ,� � �}(�iji. � '+a. �v...rt,j t��Y��{b�4t. .��i`+�'' .,,,��.,� �t.?r.�,,� '�a .�,�ar � ^! f�}� r r i"�' x'�'" •�w�.k_t 4 ���':.!s,�,P .� �� ��� ,,;�f,.,. fir• -,� �x � ��,, , ' ''` ���. .�.. #� x> r ` � .� � � w �„ �� rla ��' � e•/i "9['rryf'� v� ,' i .�t ,�-• #r...� r 5 � { � � � �.1�•=.n r +k c. ld' 3 •r r'� .+ 1 i A � •!t Z 1'?i"• '•'4 •J K r, q•.' _,�(Y°•�'-• � .,.�� '/. _ '$�!l�f'•,yr �:�?"i �' ••�Af,+},r',�a Vyt. ��� - ,. .'� to �( +• ��.. a� t ,� ..e *+ ,�. r.. ''} 1 .rig. J r�,yx 7,1 �r �, .�\.e� ��07��� •'ti. 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D '� 'a` a ee 1'._: � »„ r"' ! :. ,, * �, L ��,. q � _ • �J Y� Y���y it, t 1�•.. f 1 tl �;"�T?' ,�.�. .�� S 4+Pn • 4 •. t4C16�y , Commonwealth of Massachusetts Map-Block-Lot �4 . 038.00162---------- BOARD OF HEALTH Permit No North Andover BHP-2015-0304 FEE $125.00 ----------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted Todd-------------Bateson--------------------------------------------------------------------------------------------------- to(Repair)an Individual Sewage Disposal System. at No 20 ENGLISH CIRCLE ---------------------------------------------------------------------------------4ki-c*_ t��---------------------------------- as shown on the application for Disposal Works Construction Permit No. BHP-2015-030 Dated July-13,.2-01-5 py [FaILEC ------ Issued On:Jul-13-2015 OF HEALTH f x r Application for Septic.Disposal System TODAY'S DATE Construction Permit — TOWN OF $230:00'—Full Repair NORTH ANDOVER, MA 01845 $125.00-Component Important: Awlication 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-eite sewage disposalsyste,Ajm,*� J. . only the tab key pair or replace an existing system component-What? {`�W/�T�. t)-8,4 w � to move your "'--T�-TTT��" s cursor-do not use the return A. Facility Information key. Address or Lot# RKECEIVEU tt Cityfrown v , ,,,4 v--.e 2 j47,4 JUL 13 2015 2:*TYPE OF SEPTIC SYSTEM*: TOwN OF NORTH ANWVeR ➢ ❑Pump cavity(choose one) KEAI HDEPAKb`ENT ***If pump syst attach copy of electrical permit to application— ➢ BTonventional System(pipe and stone system) ➢ ❑Infiltrator or Biodiffuser(Gravel-Less)(Attach a copy of your certification to install_this type of system.) ➢ ❑Pressure Distribution S.A.S.(No D-Box) ➢ ❑Pressure Dosed(D-Box Present)S.A.S. ➢ ❑Does the system require an effluent filter? Yes No If yes, does plan specify make and model of filter? YES=(no further info.needed) NO=(installer must specify brand of filter before DWC issuance) Whstis the Make? [ghat is the ModWV 2. Owner Information V1 ra�/V:� -�►� rFF Name J�N�I l�5�—► G;2 Address(if different from above) Cityrrown State Zip Code 4. Telephone Number 3. Installer Information Name Name of C a�ny�©N E NTERPRI Address + � ' o! ANDOVER, LARo MA of 10 Citylrown State Zip Code !22Y 1;l, 203_ Telephone Number(Cell Phone#if possible please) 4. Desi. ner Information Name Name of Company Address City/Town C State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit-Page 1 of 2 r T`,�,o. Aqg icaffon..for Septic_ Disposal :System ��^ Y'S DATE Monstruction Permit = TONT OF 'ORTH ANDOVER, MA 018 $.250.06-Full Repair cNusc� 45 $725.00,-Component PAGE 2 OF 2 A. Facility.Information continued.... S. Type of Buildin-q esidential Dwelling or(]Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system In accordance with the provisions of Tlt/e 5 of the Environmental Code,as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the system 1n operation until a Certificate of Compliance has been Issued. this Board of Heath. Name . Date A plication Appr d By: Board of Health Representative' CA Name i 15 Date Application Disapproved.for the following reasons: For Office Use Only: I. Fee Attached? ~ Yes No 2.. ProlectMariager Obligatroa Form Attached? YiS2 3.: Puma System? Ifsoj Attacfi_cony ofElect cal Permrt`. Xes ' No 4. Fou-0datiouAs-guilt, thew construction-ronly); Yes (Same scale as spprovedplan) No S. FloorPlans?(hew construction only): No Applfcatton for.Disppsal 5ysteril: 6n*uctioh Permft%Page 2 02 —.•---tea T, j _ _ _ , d ita Mi �� I "� r`!4TiLYl�r'V�i.1iLTAtLlV1��7 An Elie•N�Aadcvrrlice�ta,ezi�iad�Il�tfo�#�e�"atnt "fd�••#��eptice�yat�•fdtth+GP�e►prttY:o {Ads�otart dtari sem} Acm pLm by Re]itiva m tl�pp]fr�dan of��.,PDQ ,r�-e�� � • RandW5 a—=--OF AM dated Dated tevidom dated ate) I nndethe following obligations fart menagemeat of his ppgect: I. As the iasmlter,i am.obllgated tp 6bu&r3peapol andBoad of Health appvwcd pl,pft t' lPet6mfg any.worh da a aitr..I marc haeme thi mmud a 4 m aim ts$ o mzzwk fl, 2. Asda :I ifiatealtM,,gq andlih oa not xs ted not o�c Q;p�ect=wAset,or sway whh my p�•an kg6cdoa and the sps It=tbta on"Imbeta is notnady,then `� �; to hsv�e a ltd tcy We& � �' v i• .. vff • � -�' ahom�i� ao. i��-�ae�y,t�ia� �i"��p - :t���•s�ctai�{ag . '.6 �s1�rC �t�aii� •aotht;ve t�bt�scti�t•. .. • a �►irsb OI�'(as email taftp c�c. • �ba fgbmittied•tn etc-Bcrtad•of.Ilea�,aft: '_ €ca••iii�pectipn tipae.•lm�lter iriiist be Lady actable to" c ,— tlkramec�ogrn `i= earoavvhell , hi:va be nota. g iC°�sP %sts a doci scot 4. 1 a•the ipamlSm'I tama3�that Cidy �*O was)�I a as plene $e�jastall�d.. t ofh the cited t • •��#�,`,ltd 4 f�i0�t ma�A�II::,�,�. ird J�.. Ab thiin I,Y tmdesat {� CC'Df t A Dv*mrkadm &w.dwpmp&, &ws-dvim arf,�c ftme. bee=p grad b. &9pv&iCf0a aftW8m?djwdm9�ic-m M 1rcd : co �NlNl��pn �OQlA� dlf 'Ot t b. At�1G T �ra*a�J4/fit T•�aw d�twl�r �. • ��•�b;it�eMT�������1l�LAfl�L�1t�`�iF�� Rd�ft�[�as� .• UadeeeidlauedS�pdc.I� (gip Sawyer, Susan From: Sawyer, Susan Sent: Tuesday,July 21, 2015 10:17 AM To: 'Deery, Margus' Subject: RE:20 English Circle Title 5 Attachments: 201507210901.pdf Dear Ms. Deery, I have reviewed the file for 20 English Circle,as it relates to the question regarding the existing subsurface waste disposal system. Please see the attached section of the approved systemlan dated April 1991. p P The important pieces are; -The plan was approved for 3 bedrooms(maximum 8 room home)at 150 gallons per day,which equals a total of 450 gallons.This was the standard in 1991. -Today's standard is 110 gallons per day,which is significantly less than in 1991. -A 4-bedroom home (maximum 9-room home) built in 2015 would require 440 gallon per day septic system design. -As 450 is greater than 440; 20 English Circle has a septic system that can accommodate a 4-bedroom home (maximum 9-room home). (note that this does not including bathrooms or non-habitable rooms) I hope this answers your question.A copy of this email will be included in the property file at the Health Department. Thank you, Susan Susan Sawyer Public Health Director Town of North Andover 1600 Osgood Street Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mailto:ssawver@townofnorthandover.com Web www.TownofNorthAndover.com -----Original Message----- 1 From: Deery, Margus [mailto:margus.deery nemoves.com] Sent: Monday,July 20, 2015 3:49 PM To:Sawyer,Susan Subject: 20 English Circle Title 5 Hi Susan, As we discussed on the phone today,the property at 20 English Circle has passed the Title 5 however the original design plan for the septic system states the system is for a 3 bedroom home.The property was built in 1991 with 4 bedrooms. It appears this was an oversight and an error in recording the original design plans. Neil Bateson from Bateson Septic has certified that the actual septic system is a 450 gallon per day system which he states exceeds the current requirements for a 4 bedroom home.Can you confirm this? What are the number of bedrooms allowed given 450 gallon per day capacity? Thank you for your assistance with this. Regards, Margus Deery Margus Deery Realtor, Coldwell Banker 978-337-0769 The information in this electronic mail message is the sender's confidential business and may be legally privileged. It is intended solely for the addressee(s).Access to this internet electronic mail message by anyone else is unauthorized. If you are not the intended recipient, any disclosure,copying,distribution or any action taken or omitted to be taken in reliance on it is prohibited and may be unlawful. The sender believes that this E-mail and any attachments were free of any virus,worm,Trojan horse,and/or malicious code when sent.This message and its attachments could have been infected during transmission. By reading the message and opening any attachments,the recipient accepts full responsibility for taking protective and remedial action about viruses and other defects.The sender's company is not liable for any loss or damage arising in any way from this message or its attachments. Nothing in this email shall be deemed to create a binding contract to purchase/sell real estate.The sender of this email does not have the authority to bind a buyer or seller to a contract via written or verbal communications including, but not limited to, email communications. 2 1Y .1 a A101fT11 "DOI A1114St5, AS SPARED FOR MARIE Alj/l A DDDOWED DATE , o4.4 ll 1,,Vfl TOW AP, LST tt /} SU IVIS V 1oOT L ,u7y:i. . .� r✓K ,/� 'IERRIMA,CX ENGINEERING SERVICES, kt ' PROFESS1014AL ENGINEERS 0 LAND SURVEYMS O PL AIQ"+t0S;., s P bb PARit ST11EEf e ' ANaOVER, MASSAC14USE OIt110 o TEL. 1�"1 � 175-35S's 373-57.2 1 NOTES:.` ae -1;-THE DESIGNENGINEER MUST BE-'NOTIFIED PRIOR TO PLACEMENT OF FILL TIS¢INSPECT THE BOTTOM OF EXCAVATION;AND PRIOR TO FINAL 13A(K, FILLING FOR -INSPECTION AND PREPARATION OF AN AS-BU ILT PLAN AS REQUIRED BY THE ' WARD OF HEAL 1'H'. 2-ALL I"ILL TO BE CLEAN SAND OR GRAVEL HAVING A PERO DLAT10N, RATE P. OF,LESS THAN OR, EQUAL TO 2MIN /INCH AFTER BEING 'PLACED 4ND . :JPROPERLY COMPACTED, A PERCOLATION TEST IS TO BE CONDUCTED � • '► ; h, W TNESSEO,BY THE LOCAL HEALTH AGENT FOR VERIFICATION. 3-A STONEJO BE WASHED'AS NECESSARY TO REMOVE FINE$ •[ Ts° 4•THI8-8YSTE,M'IB NOT ;DESIGNED FOR THE USE. OF A GARAGE GRINDER.' ,.. # A 5.'REMQVE ALL TOPSOIL, ROOT'S AAND'SUBSOIL &REPL.ACE �i .ITH CI SPE F. IIID, F�L`L; WITHIN � OF SYSTEM D AS s�rO otq' PL 6-COVER M4*t-ER1AL OVER THE SYS fi EM SHALL BE FREE OF LA RGE' ET N'_E%. MASONRY, ST'U NIP S 014 WASTE CONSTRUCTION MATER IAL.. !`HE TOP " . ." SHALL BE LOAMED AND SURFACE SEEDED. MACHINERY WHICH WAY •CRUS.H• OR 019Th THE• ALIGNMENT OF 'T IE =PIPES IN THE DISPOSAL ;AREA. SHALL hOT BE ALLOWED.. 7 FOUNDATION DRAINS ARE NOT TO BE WSTALLED W 1 TN I t4 051 T D ILEI CAL SIL ATIO ' s DESIGN FLOW='8 SEDROOMS 9150'+GAL. DAY =`( AL /11AY DESM FERC RATE =I Z MN/IN. DESIGN FOR LEACH. jNGTRENCHES SEE DETAIL)WIDTH=�S�� EFFECT /E DEPTH = I-�!r e s INLET INt�'< SIDEWAL: CAPACITYqP,4Z SF/FLT x—S&GAL/SFS AL./FT 'BOTTOM ,CAPACITY= 3.0 SF/F.T: x-TO CAL.1`SI -t:SUGA'../F,T: VERALL CAPACITY= _ J21"nal tom , TT -CARA�TTT* �0 SFT-FT--R.'0GA!. / F13AL.f F= #T _ � -• ZRALL�CAPACl1'Y=� -�,5'-GAL/F.T. �� ! 4 0GAL:./3,58GAL./FT 1�Ca FT. OF TRENCH RE.CUIRED. USE TRENCHES AT4?, F,T.- 1 c-F T. OF TRENCH PROVIDED. � orI TR' SaI MR, i , `KCAL E LCE • DETAIL OFR. 2�'MIN. Y9;#1..!;My, _ . ... , Tp6dE 7Rf�s If;P,' 540 �r �. CAP PIPE ENDS---"/ � ELS �. C �- ? TYP . '. 1197 ' +�f�! `1� tV /z !�'2 II . 4 71 a � JJL3�5MLHMARK- 1:�oljKoWr F401,-VT Eta 203 65 { i I i L C LIS ' I P , { t .SCAL f.l 1 `/CC O':t E , r APR 2 8 CO'vi? ONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPART'ViENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET. BOSTON. NSA 02109 617-292-5500 WILUA%!F VELD TRUDY CORE Govcmo: Scacur% ARGEO PAUL CELLUCCI DAVID B.STRUHS Lt.Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner PART A CERTIFICATION I,-` ` Address of Owner. erty PropAddress: /Yl.arlc - 51-ro '�i C- 20 Es t C 2 e (I( different) D ,3 ate of Inspection: AYIZ [Q ! Name of Inspector. BENJAMIN C. OSGOOD JR. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: NEW ENGLAND ENGINEERING SERVICES, INC. Mailing Address: 33 WALKER ROAD, NORTH ANDOVER, MA 0 184 5 Telephone Number: 508-686-1768 CERTIFICATION STATEMENT 1 certify that 1 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: vserasses ~ &ndtttonall% Passes 1 Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date: d 1441 AV << The Svstem !nspector shall submit a copy of this inspection report to the Approving Authority within thirty(30) days of completing this inspection. If the system is a shared system or has a design flow of 10.000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the bt{yer, if applicable, and the approving authority I INSPECTION SUMMARY: Check A, B, C, Or D: Al �SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure crite::a as dtffined in 310 CZAR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: BI 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. Indicate yes, no, or not determined (Y. N.or ND). Describe basis of determination in all instances. 1('not determined, explain why not. The ieptic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance lattachedl indicating that the tank was installed within twenty(20) years prior to the date of the inspection; or the septic tank, whether or not metal, is 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. (r.vid.04/2S/77) tail. 1 or 10 s --------- ----- i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Zo t C, r-c�e , /lJ. (F}„00'C Owner: 01a/LK Sir�wS�c Date of Inspection: 'l 1Z3)c28 B] SYSTEM CONDITIONALLY PASSES (continuedi 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;. Describe observations: 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) s - s broken pipe(s) are replacer cbstruction is removed Cl FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which reouire iunher 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 ieet of a surface water !i _ 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 PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: , The system has a septic tank and soil absorption system (SAS) and the SAS is within t00 feet to a surface water supply or tributary to a suriace water supply. I The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS 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 irom pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal. to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER I page 2 of 10 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Zo v,�1,s C. rt�� JU- A4 0,C C. AA sA Owner: Date of Inspection: DJ SYSTEM FAILS: You must indicate either -Yes- or-No-as to each of the following: 1 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 conx-a the failure. Yes No 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 a i Static liquid level in the distribution boa 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 tomes pumped_. Any porton of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Am• ponion 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. Am porton of a cesspool or privy is within 50 feet of a private water supply well. Am•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 cohiorm baa ria, volatile organic compounds, ammonia nitrogen and nitrate nitro en. E) LARGE SYSTEM FAILS: I I You must indicate either 'Yes- or -No-as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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 11 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 04/2S/17) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Zc ) C"t-1-1c M_ 49.^1 j Vt AAA Owner: 1'1'lca/LY. -St/r+nJc i L Date of Inspection: . Li l a3)wa Check if the following have been done:You must indicate either "Yes"or-No'as to each-of the following: Yeses No ✓ _ Pumping information was provided by the owner, occupant, or Board of Health. 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 pan of this inspection, _ ✓ _ As built plans have been obtained and examined. Note if they are not available with N/A. ✓ _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. it . The site was inspected o signs of breakout _ All system components. excluding the Soil Absorption System, have been located on the site. The septic tank manhole( were uncovered, opened. and the interior of the septic tank was in1pected 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: _ The facility owner(and occupants, if different irom owners were provided with information on the proper maintenance of Sub-Surface Disposal System. ✓� _ Existing information. Ex.iPlan at B.O.H. _ Determined in the field (d any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (15.302(3)(b)) I (r.vi..d o4/25/17) p.qe 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION-FORM PART C SYSTEM INFORMATION Property Address: 2p Evl�t,s C���c A-1. Owner: M-2V. 5t/ Yt5 i Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow:-&4o .p.dJbedroom (or S.A.S Number of bedrooms: Number of current residents: 3 Garbage grander(yes or no): Al \ Laundry copnected to system (yes or no) Seasonal use (yes or no):(� Water meter readings, if available (last two (2)year usage (gpd): .Sump Pump (yes or nol:,N_ Last date of occupancy: Cis rvw� i COMMERCIAIJINDUSTRIAL- Type of establishment: Design flow: t allons/dav Grease trap present: (yes or no)_ , Industrial Waste Holding Tank present: Ives or no)_ Non-sanitary• waste discharged to the Title i system: lyes or not_ Water meter readings, if available Last date of o-cupanq: t OTHER: (Describe) Last date of occupanq•. GENERAL INFORMATION PUMPING RECORDS and source of information v n(.cotes System pumped as pan of inspection: tyes or not_ Ifsvolume Ye , pumped: Ped: Gallo s Reason for pumping TYPE OF SYSTEM 0V 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) VA Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all'components, date installed (it known) and source of information: L4 ff Sewage odors detected when arriving at the site: (yes or no)L (r0vis*d 04/25/37)� /37) T•v 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Zp k ks C;,Y C • N. VL Owner: 1�11cr/L tri Sfir�c.n�+G Date of Inspection: '-I �3 ly BUILDING SEWER: (Locate on site plan) Depth below grade: !2 Material of construction: _cast iron ✓40 PVC_other(explain) Distance from private water supply well or suction lirc AIAL: Diameter (•1•` Comments: (condition of joints, ventin • evidence of leakage, etc.) SEPTIC TANK:_ (locate on site plana a Depth below grade: Material of construction: concrete _metal _Fiberglas; _,Polyethylene —other(explain) If tank is metal, list age _ Is age confirmed by Cendficate of Compliance _(Yes/No) Dimensions: ►.S-yc) Ls-/}+-Ldp+ S Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or bafflte: Zb ) Scum thickness:_y['•_ Distance from top of scum to top of outlet tee or baffle: ,r Distance from bottom of scum to bonom of outlet tee or baffle: How dimensions were determined: tr✓t ccrsvre s nC V Comments: (recommendation for pumping.umpin , condition of inlet and outlet tees or b ffles, depth of liquid level in relation to outlet invert, stru,4�ural integrity, evidence of leakage, etc.) n/r )•v v Go�.9 fiJj. oz,�+��G�C b Le Tees JC. J.n cY•IS e on lG ' n se- -re- GREASE 'GGREASE TRAP: I�/t+- (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _,Polyethylene —other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bonom of outlet tee or baffle: Date of last pumping: 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.) (reviped 0{/2S/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Z p Er251z'.k C<<t�c /V. 14,J(DJ-e& , AAA Owner: mc.(L)A. S�navt9i Date of Inspection: y�23j�$ TIGHT OR HOLDING TANK:/V//9-,Tank must be pumped prior to,or at time,of inspection) (locate on site plan) Depth below grade: Material of construction: _concrete _metal_Fiberglass _Polyethylene —other(explain) Dimensions: Capacity: gallons Design flog,.• gallon/da% _ Alarm level Alarm in working order_ Yes. _ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_ (locate on site p)ani Depth of liquid level above outlet inven: 0. Comments: (note ii level and distribution is equal. evidence of solids carryo+er, evidence( of leakage into or out of box, etc.) � AD D z .i. 611% L �•f7 J.e /f/� Qe c a1' car.r.c) 3Z Oar �S S " ..., 7� of? (rn���a r!'J✓e1` w�S e� «�Q a �– �`.-.su�ct)ov I I I PUMP CHAMBER:AY" (locate on site plan) Pumps in working order: (Yes or Not Alarms in working order(Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/25/97) Paga 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: aO shy 1,5 t' C�.r(c r A). )��a,.1t, A4#4 Owner: M A 2 K ST'e 14n."61 r'' Date of Inspection: ylza lea -. SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number:_ leaching chambers, number:_ leaching galleries, number: 1 leaching trenches, number.length:_3 10. -A-> leaching fields, number, dimensions:_ overflow cesspool, number: Alternative system: Name of.Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) C rtr� e -co•l Abs��r �71 J S.a s icev� lo�(� y)o/�rn•► • t 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 pan of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:(L� (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (rsote condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) 04/2s/97) Pay• • of 20 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 'jp �hS�iSv� C<�.c,�,t /l�, fT�JuCC /«�}' • Owner: Maw S fi Date of Inspection: "`e l �3IQ ' SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) 2( I i i (r•vi••d 04/2S/971 P•q• 9 of 10 . f SUBSURFACE SEWAGE OISPOSAt SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 20 F.Z�t 5� C:.rc(e �T�^cYJv CG, �4 Owner: M Date of Inspection: McrQp. �1123��g Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record j _ Observation of Site (Abutting property. observation' hole, basement sump etc.) Determine it irom local conditions Check kv!th !o_a! guard of health Checi. FEMA maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation.,(Must be completed) ►), Dom;,_ P l�w� 5 1•w.,. t,,,� s:� k.-r, w� ��s 10 Z'. Sr IC Y�+� �jEtr� (�G.ISeJc ►„� ��Gi- 1��� � t`"L r 1 (r�via-d 04/75/97) P-q. 10 of 10 I N E,vGciS.c/ C/PCGE' r '3p o14,� ,e=64.o0 tTHt M r S ti ?7/ 361 s�,r. = D. 6081 Ae. pip 234.97 r k' Tj i o s•P. o: A( ON kS/.rE : .t"os..vo.orio,/ Lo<gTio.✓ �.Coi» .4v ivs�.PvmE�T .Svev�Y, 's M"68r C'E.crWY rte r d- r-17eX iaSel ,4V5P Rz o T 1b XAW A"-V!'M-47 rvE AftVWe[.~AS CAC.•IrEO O.t/ rw cor.#s Awww Avv rwrir,pace eew~M /it/ .jWAAIWAV JfrJW.VS AW4W JrAw49rrs I cor C/.vEJr" N.eT,�/ �Q,vO a✓ /�AS i 6'� S solie.v,v ae FAMSAI t A4 s 0410'AeOAPYlt�iloE.��� .4rnw r.4 .y feria r�Mr .elrt�Kt�� 44 LLC!'J724ffc? . s Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH 3�0�s�`ED 6'�h�� I 1 9 C� 1 o ^ 1 w 1 p°� <°° °w°•� APPLICATION FOR SITE TESTING/INSPECTION 79 ADRATED SSAC14US� Applicant I C. �^►C NAME ADDRESS TELEPHONE Site Location Lb L5 h C Y C ME 121211 mo-x'- kc �� f rr� Engineer � � C"" ''"'I NAME 'ADDRESS TELEPHONE Test/Inspection Date and Time rl f CHA1RMAN!B'OA-R-D OF,HEA"LL,T//H Fee Test No. S.S. Per it No.v k D.W.C. No.--C.C. Date Plbg. Permit No. i� FORM U TOWN OF NOR111 ANDOVER LOT RELEASE FORM SUBDIVISION 67v ASSESSORS MAP 2f j • SUBDIVISION LOT(S) PERMANENT ADDRESS ASSIGNED BY U. P.W. STREET sf,2 L L-xf S 7- APPLICANT APPLICANT �� ���c -iE3 -T�. PHONE DATE OF APPLICATION TOWN USE BELOW 1111S LIIIE PLANNING BOARD DATE. APPROVI.D TOWN PLANNER DATE REJECTED CONSERVATION COMMISSION uA•Tc APPROVI.D r q CONSERVATION ADMIN. DATE REJECTED BOARD OF H TN SA i ' DA'1E REJECTED DEPARTMENT OF PUBLIC WORKS DRIVEWAY PERMIT SEWER/WATER CONNECTIONS FIRE DEPT. RECEIVED BY BUILDING INSPECTION DATE This form shall be signed by the agents of the Haniiing and Ilrnitlt Hu;irrl�i, the Conservation Coirunission prior to the issuance of any buticllns; prtmlts for the subject lot. This form shall not reteive the applicant troll] the compliance of any applicable Town requirement or Bylaw. oa FORM U - LOT RELEASE FORM INSTRUCTIONS: This fora is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: Phone 7� 63 q LOCATION: Assessor's Map Number Parcel Subdivision Lot(s) Street C St. Number r Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date AAmroved Conservation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Date Approved Food Ins ctor-Health Date Rejected Date Approved S _ t ' c nspector-Health Date Rejected Comments ."L.s-71- 40 �,•�,.._ S? Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date T 124H-�//17 CoPct F— e, 0 ----------- M0.77 E714[�TVtf 0 vrLp- 1) ox, 2- II 1 1k 1AEPE0Y C-ERTIF'f THAT I RL\)E WsMtrsO rvis com-srvartoo of T-HIS I q7. 07 V15POS&L S <S-MM AI�M TH&T- THra It f-Z- COQSTRL)c-Tto►J kWo flQ,&L &IcAot4& I. HAS f1mg Dc*iw- '" &ccOKOANcE wt-rH THE 0L'SWC1'4LrIeS 110t9T AqD TlAxT THE M.&TYRtALS used Coi4Fb" sreciric-pmos-As ANO `310 ji.od" �tCC��-�f � 3s�I wzt 130.40 mF. A 6APAevE Wr- UPYrl- �Z Box r,1(7 L rC 'TA AS BUILT PLAN OF SUBSURFACE DISPOSAL SYSTEM LOCATED IN AS PREPARED MR o0 OF DATE : I q q I RWRT C. DALEY c' rti SCALE: CIVIL too MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS 0 LAND SURVEYORS 0 PLANNERS " PARK STREET 0 ANDOVER, MASSACHUSETTS 01g10 Q TEL (6)7) 473-3553, 373-Sni