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HomeMy WebLinkAboutMiscellaneous - 225 CARLTON LANE 4/30/2018 (2) 225 CARLTON LANE 210l107.A-0209-0000.0 I / F d K f h' L 1 u nIN1��1 - IIINI - , IIINIIIIINNI � i'" Y- i- IIINEIN1�11 X111MEMO N ` - j !11 IIININIIIINI N - 111111111111111 1111111111111111 ,, 111111111111111mommummmoommm IMINII11111111 1111111 111111111111111 111111111111111111e 11uu11l1111�®111�11111l11!!!l1111 III!!!1!!lM isWA ,u�gill B!a III11I1 II IHEamI�a1IIM11111F111111111111 HIM I ' ' ` ` � ' `��''.'� " .'�'` ► "" MEMO III Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 41M Sye y`W 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. SysJ:em Location: on the computer, use only the tab CILE)im L.0 key to move your dr s cursor-do not Ma use the return key. CityrTow State Zip Code 2. System Owner: Name raRun Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record L—T 1. Date of Pumping Date 2. Quantity Pumped: 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: x so r 6. System Pumpe B Name Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: Stewart's Pre-treatment Plant, 0 So. Mill Bradford, Ma 01835 Signature of Hauler Date I i(n Signature of Receiving Facility Date f t5form4.doc•03/06 System Pumping Record•Page 1 of 1 ( ( b ORlT A1IDOVER. 'MASS To •'Record ACHUSETT, RECEIVED p!ovldad ;hli loan ror ,eo co �'.�mlllod !o r o:or 8oercr r npg the IOCeI BCerc: Cr noa cn pr Crnor �p rp;in Y A. Faclllty Infor�l�(lon • TOWN OF NORTH ANDOVER C)'S q^1 l OCBUQn; HEALTH DEPARTMENT C.;'�:,( � 00 SPI, ,.• �,%CSV. yaam Ownar, ! r,. X57 T��oDnOn� h'.m0�r - ,':Pumpin Re'?ord iii '�'�'ll;•�',, q;r, ,Ir;,rl„I,i� ca,a of Pum 8 3, Typo of ayslam;. 0 C699�001(y) Sap!!c Tens r7 , (dasCridaf, Emuenl Tae FIIIa(.Penl? [' Yoy o�„pIrm;'.4�r, II Y69. n8) ; C.'6ana0� Y@S _ .. . -•""� -6.,1`C.o�dl�lon'Q(:9yt,� , �.( • .; ";.fir .x;11:, ,�J/.Ir r,.�.(� ��:j i'�� Y�(;�., LlO _ 6•�. sy �m ed 8 P ' P �'c it r f, �' r .J J •!r�' y i ., . ;!'C�;,�j)f;�k� 1�� �l' ��1 ,�' � `� ''` C ' ,�e�/lcle�Jyo7on+� n�.•^:,er _. oni'r ,•..,.�,•. • .whera co�lenu',wera vlyposeo: �' j. ', •n �. .w.maw.g0Y/deF.�wa(sr/epproYa),V(6 torm5.n�mAln3p c! N Commonwealth of Massachusetts lop 0 Executive Office of Environmental Affairs Department of . R 2 s Environmental Protection - William F.Weld y Governor Trudy Coxe Secretary,EOEA David B. Struhs Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION /V Ayoor Property Address: „ Address of Owner: Date of Inspection: f�' ' r� (if different) Name of Inspector: �Chtl 6U 51-r Company Name, Address and Telephone Number: Cj, /!C_ !/7 CERTIFICATION STATEMENT 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: i Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this. inspection If the system � a shared system or has a design flu%% 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 ie ;he system owner and copies Sent to the buyer, if applicable and the appruVing authuiit�. INSPECTION SUMMARY: Check A, B, C, or D ,I/ A] SYSTEM PASSES: y C I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated/below. B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be re/placed 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 8/15/95) 1 One Winter Street Is Boston,Massachusetts 02108 a FAX(617)556-1049 a Telephone(617)292-5500 w i,Pnnled on Recycled Paper r� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) � �-L�� A f ��� �-I y��1�uvr Owner: ✓ Property Address: /SP"r b *vy Date of Inspection: B] 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: `A Conditions exist which require further 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 feei iu a surface water suppi'y UItrib'Aary 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 hay 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. D] SYSTEM FAILS: 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 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. (revised 8/15/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: _ /A /� + Date of Inspection: /�f°y h-fi✓,ii=7 D] SYSTEM FAILS (continued): /q` ' 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. E] LARGE SYSTEM FAILS: 4,4 The following criteria apply to large systems in addition to the criteria above: The design floe of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive ares (interim Wellhead Protection' Area (IWPA) or a mapped Zone II 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 8/15/95) 3 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address. Owner: G1 h r,5 Date of Inspection: r/ * I? Check if the following have been done: mping information was,requestOd of the owner, occupant„and Board of Health. / fNone 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. V/The facility or dwelling was inspected for signs of sewage back-up. ,/The system does not receive non-sanitary or industrial waste flow `/The site was 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 o,.ncr (and occupants, if different from owne-) were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 8/15/95) 4 w SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C J� SYSTEM INFORMATION Property Address: ` � t - ' l�llve v—eG Owner: ` Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: gallo� Number of bedrooms: � / Number of current residents: L( Garbage grinder (yes or no):�:Yf s Laundry connected to system (yes or no):_ r Seasonal use,(yes or no):_ r/ �+ Water.meter readings, if;available: �� f'� &V rG1.w r [e,���D rv'✓ Last date of occupancy://("('cp(e, COMMERCIAUI NDUSTRIAL: Type of establishment: Design flow:_gallons/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 RECORDS and source of information: System pumped as part of inspection: (yes or no)_ If,yes,_volume pumps(! ¢,allons Reason for pumping. TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other (explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no)_ (revised 8/15/95) 5 s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C n SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: SEPTIC TANKJPS (locate on site plan) q Depth below grade: G Material of construction: —concrete _metal _FRP—other(explain) Dimensions: t /0m ► Sludge depth: C�r Distance from top of sludge to bottom of outlet tee or baffle:_ 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:--/%t 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.) It'AFG-e t 9'6 0 o P'Gti//?1 T/a Kf GREASE TRAP:_ (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP —other(explain) Dimensions: Scum thickness. Distance from top of scum to top of outlet tee or baffle: Distance from hottom ro <rt,m t" hnttnm of outlet tee or battle Comments: (recommendation for pumping, condition o(inletand outlet tees'or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 8/15/95) 6 t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C /Y SYSTEM INFORMATION (continued) Property Address: l �/ 4/- , AAm 0 w �� Owner: Date of Inspection: y- 7,V— TIGHT OR HOLDING TANK:_ (locate on site plan) /�, Depth below grade: Material of construction: _concrete _metal _FRP—other(explain) t Dimensions: t Capacity: gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOXJ� (locate on site plan) Depth of liquid level above outlet invert: �� / Comments: n f emir c ? (note if le-,c! and distrb;:�:,_., �� eq;::', e�.id^.•ce e i c..,n,rn-Pr, PvidPnce of leakage into or out of box, etc) / U na cc)'41 PUMP CHAMBER:_ (locate on site plan) / Y , Pumps in working order.(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 8/15/95) 7 r - r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (cont' ued) 7fi c,/ `N /! L/bO V-°1, Property Address: � � yy Owner: ✓."t S P`�1 lJ f'✓ Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; exca if�-not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: y, leaching pits, number: leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: — LJG r leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) 6 4 0s GF S /1—L. 4107— 1 A0 r/6`1 CESSPOOLS: _ (locate on site plan) ' 7 • . 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.) #W 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 8/15/95) 8 .r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) r Property Address: d� a S v1 `' �/ ��/to f V e. Owner: �r f E„�� h p✓ `� Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' t7 9 1 f � - 31 dz e C, DEPTH TO GROUNDWATER I Depth to groundwater: ) rfeet method of determination or approximation: N U lu N r c v V v* j. «C-rGLf! .►.f /1 y `/ !i '�F'? ./fc; �oGay- S /'/LF'ef GPf✓f (revised 8/15/95) 9 ' b�WN OF NORTH'A(� DOV � R SYSTEM PUMPINGC,ORD 14114 sc�s �1 5'I'EM UwNER & ADDRESS SYSTEM LOCATION, - - � (eq m�le ,lefl fF ni of ho , I �/W QUANTITY PUMPED ' 1500 I,o0L. NO YES SEPTIC TANK NO Y Li x.-\TUKE OF SER YICEr ROUTINE. �/ EMER0ENCY r.RYATI0N ;C,UO.D°.C.0QITI0N, NLL TO COY Ck XYY'O;EtEA C, ' l3AFFLLS' IN P'l,ACI; -- - RUOTS LEACHFIELD IWNOACK . _ CXCESSI'YE SOLIDS FLOODED 50LI CA;R'RYOYER., O�HFR (EXPLA.IN) -- - `y •�I !. l � t�„y:rr yY S'rr�< . y }ll �t�. i .,. r --____ s 0."ITk'.N'I'S' 1'IZA1NS'. GI I ED '1'U; Date.... .... .................... TOWN OF NORTH ANDOVER .0 0, PERMIT FOR WIRING "I IFMAW CHU This certifies that ................ ......................................... has permission to perform ..... . ...../.k. . .... . ........ wiring in the building of................. ........ ...........6Z4 ....... ..................Aorth Andover,Mass. Fee...Y Lic. ............. ..4'4� B Check # "T-7 / I Calltt�rartwaa[�t Q��'Jadeac�n3n�i Official Use Only Permit No, f �. vUaparfnwrsf a�.�`ira Jaruicaj ' Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.j/a7] Ocaveblank) --_ APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK AlI%vork to be performed in accordance wlih the Massachusetts Eleclricol Code C),S'7 CMR 12.00 (PLEASE PRNT flV ffl OR nT ,iLL F IRI L1T10N, Date: ► City or Town ok 0 Qua rL To the 14 for f ji ws�, By this application the undersignedTn a of is or her iat�to pe orm the electrical work described below. Location(Street&Number) J Owner or Tenant Edic- F-2 n Aerz5 Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ NoLy (CbecIc Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Molts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhand❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity ` Location and Nature of Proposed Electrical Work: I Ore Cont IetlOn Qjdle fQ110101 table teay be waived by the Lis eclat o/IT'ires. No.of Recessed Luminaires No.of Ceil.-Susp,(Paddle)Fans otal- No. TNA No. of Luminaire Outlets No,of Hot Tubs Generators ICVA No.of Luminaires Swimming Poal Above ❑ In- ❑ o.n mergency ig ing rnd. rad. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.of Detection nn InitiatingDevices No.of Rnnges No.of Air Cond. Total Na.of Alerting Devices Tons g No.of Waste Disposers 13entPump umber Tons IC o.of elf- ontatneH Totots: Deiection/Alarting Devices No.of Dishwashers Space/Aren Heating 1(W Local❑ Munle pal El Other Connection No.of Dryers Heating Applinneas I0y Security Systems: No.of Devices or Equivalent 140.of alar ICW No.of No.of Data Wiring: Heaters Si ns Ballasts No.of Devices or I; uivnlent No.Hydromassage Bathtubs No.of Motors Total HP Teleeommunientions VVirin No.of Devices or 1C uivnent 4 OTHER- _ d each additional detail ijdesired,or as required by the Inspector of nliras. Estimated Value of EI trical Worlc '�! (When required by municipal policy.) Work to Start: inspections to be requested in accordance with MEC Rule 10,and upon completion. =:= -==_==INSURANCE=C GE:=Unless-waived-by-the=o3vner rio permit=far tile=perFormunce rat~electrical iivorlc=rrtay=issue uriless the Iicensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies thatsuch cov ge is in farce,and has exhibited proof ofs tope pe i issuing nffi e_ CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) Oe� � � �/ I certify,tinder the pair Iti erju that the t artnatip1t.Qa i1 isZPDPD�11cation is rite and c upite. I FIRM NAN= U ��(r t C LTC.NO.: Licensee: ie i^ -Jb -6 Signature LIC.NO.: (IQPPlicable, enter" alpf"inhrysel true er1' e.} l Ue Bus.Tel.No.t Address: 111 CCC��� Alt.Tel.No: *Per M.O.L.c. 147,s.57-61,security work requires Depaiinent ofPublic Safety"S"License: Lic.No. Al OWNER'S INSURANCE WAIVER: I am aware that the Licensee does nal 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 FEB.-S AddressPv`'-?-� (Z-40-9TL�,/X, 4 til Title of File Page of Date File Open: Gate die closed Doc Document/Action Title Date of Refer to other Purpose of©ocun�e�nt/ ion and no.Act action Document/ document/ notes Num. Action De artment I Board of Appeals — Board of Health = planmmng Board _ Cons- ervation Commission — 6�ildin De — � partrr�en,t I FORM U - LOT RELEASE FORM INSTRUCTIONS: This form 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 or requirements. *****************************APPLICANT FILLS OUT THIS SFC T ION***********-r"1** APPLICANT Aupcb- PHONE LOCATION: Assessor's Map Number ! n l /'t' PARCEL a© SUBDIVISIONS _ LOT (S) �— STREET CA�- ST. NUMBER U S c RECOMMENDATIONS OF TOWN AGENTS: 9 -i- to CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED /3 9 DATE REJECTED COMMENTS PUBLIC WORKS -SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED EY BUILDING !NSPECTCR DA.Tc -- Revised 9197 im BAY STATE SURVEYING ASSOCIATES INC. 100 CUMMINGS CENTER, SUITE#316J, SEVERLY,MA., 01915 LOCATION • N2i2.Z.H A/ULOVF(� N!A NOTES: "' "" ""... """""" "' '"" "'� 1)This Is a mortgage Inspection survey and not an q Instrument survey,therefore this plot plan is for SCALE : 1" _ � DATE :....... .....(............. mortgage Inspection purposes only. Z)This survey is based on survey marks of others. REFERENCE • �'K. 37 911 ��?:.��q 3)Bushes.scrubs,fences and tree lines do not . ........................................ ....�• .. ...... necessarily Indicate property linea. ...'................ 4)Whenever an offset is 1'+r or less,an instrument ....................................................• survey Is recommended to determine property TO:. �.!(?, ... ► C 1 LRt//cFS 6 lines.and� possible encroachments. approximate,and are to be The location of the building(s)as shown.either used only for the dstumtnatton of zoning,Not to complied with the local zoning setbacks at the time of be used to establish property ilnes. construction or is exempt from violation enforcement action 8)In my professional opinion the buildings)are not under Mass.G.L.Title VII Chapter 40A Section 7 located in the spacial flood hazard zone,as defined by H.U.D.MAP* �s 10,4 v s� .yJ\ C' LOT 14 OF AOGLtRT T1 CS .. No.280 9FC/STIE � AI LAND SVQ / GR d(.Alvd IDLa. Qax Oc�.�- / L8•�o Eti GtAt AL G g•o� s Aj �Iti 00 � Beard of Health Hctr. :`,ndovertMasa r SUBSURFACE DISPOSAL DESIGN CHECK LIST LOT # y/ C/�l�L7dti� P APPROTED DATE-� DISAPPROVED DATE Provideds Reasonss Nc-uf A ROVED -5_95 Title VF AIL Reg 2.5 The submitted plan must show as a minimums v a) the lot to be served-area dimensions lot #'abutters b location and log deep observation holes-distance to ties 1, c location and results percolation tests-distance to ties d design calculations & calculations showing required leaching area C e) location and dimensions.of system-including reserve area f) existing and proposed contours ,i(g) location any wet areas within 1001 of sewage disposal system or disclaimer-check wetlands mapping (h) surface and subsurface drains within 100' of sewage disposal system oi- disclaimer i) location any drainage easements vithin 3J00' of sewage disposal system or disclaimer-Planning Board files W knoun sources of water supply within 2001 of sewage disposal d system or disclaimer ZQ 1location of any proposed well to serve lot-1001 from leaching facility ) location of water lines on property-101 from leaching facility m) location of benchmark In) driveways o) garbage disposals p) no PVC to be used in construction 3(q) profile of system-elevations of basement, plumb, pipe, septic tank, distribution box inlets and outlets, distribution field piping and Other elevations (r) maximum ground water elevation in area sewage disposal system ly(s) plan must be prepared by a Professional Engineer or other professional authorized by law to prepare such plans Reg 6 _Septics Tanks (a) capacities-150$ of flow, water table, tees, depth of tees, access, pumping (b) cleanout P101 from cellar wall or inground swimming pool 251 from subsurface drains Reg 10.2 Distribution Boxes (a) pe greater 0.08 Reg 10.4 b) sump TO: NORTH ANDOVER, MASS `4 ! r i9 �� BOARD OF HEALTH FROM: DESIGN ENGINEER Re: Soil Absorption Sewage System Inspection This is to certify that I have inspected the construction of the said disposal system at Z-1 /9 9L /y M 4E, North Andover, Mass. SITE LOCATION The grades and construction are as specified in m*y plans and specifications dated L r Ilf1 �1�C'� 23 19 �ty 6 y �V-tvA ASSaC,(a I.e5 COM tv eg. n er/ e ni ian �P/�N S 113S,a'a� Board of Health SEPTIC SYSTEM North Andave:rZN.aaa. . INSTAMATIQQ CHECK LIST LOT `U�_ OVED DATE DISAPPRUM AVATIC�J Old FAIL Y-( ' FM OK - cC 1. Distance Tot OJJ a. Wetlands b. Drains c.. Well 2. Water Line Location 3. No PPC Pipe 4. Septic Tank a. Tees -_Length do To Clean Out Coverr b. Cement Pipe to Tank - Oa Both Sides of Tank 5. Distribution Box a. Covers k Box - No Cracks b. All Lines Flo;,dng Equal Amounts C. No Back Flow 6. Leach Field or Trench a. Dimensions b. Stone Depth c. Capped Inds d. Clean Double Washed Stone 7. Leach Pits a. Dimensions b. Stone Depth c. Splash Pads d. Tees e. Ceraent Pipe to Pit - Both Sides ----- - f. Clean Double Washed Stone 8. No' Garbage Di spo sal 9. Final Grading Inspection 10. Barricading Covered System 11. As Built Submitted a. Lot Location b. Dimensions of System c. Location with Regard-to Pere Test d. Elevations e: Water Table i ' NOR1ti AR�Ov TO+�BOARO OF HEAL TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: SYSTEM OWNER & ADDRESS SYSTEM LOCATION (example: left front of house) /A DATE OF PUMPING: /--;t-2-d o`L. QUANTITY PUMPED,S d-0 GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE _ EMERGENCY OBSERVATIONS: GOOD CONDITION ✓ FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: COMMENTS: CONTENTS TRANSFERRED TO: TOWN OF NORTH AN-DOVEP, SYSTEM PUMPING "Copp Sy EM OWNtK& ADDRESS ISYSTEM L0C—ATIQN DATE OF PUMPiNQ: 05 ...._.......__.._QUANTITY PUMPED: �'tSSPOOL; NO_ YES .... .... .. Sdpcic 1'&nk: NO Y ES N^ DUKE OF SERVICE: KUUTINIrX ..bMEROENC'Y V�SERVA'flUN9; OOOD CONDITIONXFUL L 'W CovER RECEIVED HEAVY ORP.ASE _� BAAPLES IN PLACC. ROOTS _ ._. LEACFMeLD RUNBACK APR 4 2005 "CBSSIVE SOLIDS ..._.. FLOODED SOLID CARRYOVER, O1"rfER �XPLA IN TOWN OF NORTH ANDOVER System Pump"d by I .....HEALTH DEPARTMENT G.. So//. VUMMENTS• ��-