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Miscellaneous - 229 GRAY STREET 4/30/2018
229 GRAY STREET T 210/107.D-0113-0000.0 r ''� f I ___ �. - _ __- North Andover Board of Assessors Public Access Page 1 of 1 'rOV T Or 14Qnh AlK10VOF Ko DrM� 4 Property sncl+vs Record Card Return to the Home page click on logo Parcel ID:21.0/107.D-0113-0000.0 Community:North Andover SKETCH PHOTO New Search Click on Sketch to Enlarge Click on Photo to Enlarge Sales k bm Summary t Residence Detached Structure JAI Condo Commercial Comparable Sales _ b2/05/2007 229 GRAY STREET Location: 229 GRAY STREET Owner Name: MURPHY,DAVID P GERALDINE R MURPHY Owner Address: 229 GRAY STREET City:NORTH ANDOVER State:MA ZIP:01845 Neighborhood:6-6 Land Area: 1 acres Use Code: 101-SNGL-FAM-RES Total Finished Area:2794 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 605,900 643,400 Building Value: 397,200 412,500 Land Value: 208,700 230,900 Market Land Value:208,700 Chapter Land Value: LATEST SALE Sale Price:290,000 Sale Date:03/03/1987 Arms Length Sale Code: Y-YES-VALID Grantor:ELITE CONSTRUCTION I Cert Doc: Book:02440 Page:0053 http://csc-ma.us/NandoverPubAcc/jsp/Home jsp?Page=3&Linkld=1182406 5/19/2008 ,J to --o LUQ Z O ® 66t N�P i flji / E x ll't 't `ZH SLOPE REOVIZEUENT v NSEN vs (-150) X - 150 = . .. . . . . . .. . . . . .... . . .. . . .. . DES/GN LC/ 4C/4T/ON .4T.. . . ... . . OF STONES kAt E_ EX/5RM!: aEVQTION .41 . . . .. .. . . 2EQU�,eEo FILL = Fl-EVOaRON5 oEs/Gw Qs 3011-T //l/ P/PE OUT OF 1-/OU"5c 8y,,j 7 c /NV P/PE /NT0 TgNK a,/,35SUB —St1�F�CC" �ISPDSQ�, /NV PIPE OUT Of T4NrY . 6100 8Y,37 /NV PIPE INTO D SOX 8 3,�O 31-400 //Vv !'/PE OUT OF 0 ,30X 83,73 33.17 1 /N $3,s� 83.5 /NV END OF PIPE Z 63, D g ,y /YO1 7�I-� /Qin I)OV r �i 63.5Z) 83. 5-5 ICOR LV,JTEie. EGE!/,4T/ONL / 7-4=, C0)\./ Ste' O C,n 0 j\/ 77 Sf� ,4VE2,46E 5TONE SCALE: /�r L/O DATE: 10110186 D67P7-1-1 ,47 ,OeO,3E C',�IRIST/,4NS4N , oFN61ME )e/N6, INC. (VOTE: 7-1115 PL,1N 15 /VDT ,4 kV,4,e. NTY X14 �E/VOZQ ,4 t/E.� ,�,�,41/E�E'�✓/L L, /Y1<l. Of T1/E SYSTEM BUT A YE,e1f1C,4T/ON Of TIVE I OC4T/ON OF TWE E,�,,5T1NC STeUCTU2ES. a ` + - } r t 7064 w Town of North Andover HEALTH DEPARTMENT ,SSACKU CHECK#: ,��� DATE: LOCATION: H/O NAME: ( } Ir— CONTRACTOR r--CONTRACTOR NAME: Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ v ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ y, ❑ Title 5 Inspector $ Title 5 Report ❑ Other. (Indicate) $ Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer 4 i Commonwealth of Massachusetts Title 5 Official Inspection Form P zs Subsurface Sewage Disposal System Form-Not for Voluntary Assessments It 229 Gray Street GA r Property Address r- .r✓tp y Glenn Holsten Owner Owner's Name information is North Andover MA 01845 3/31/2015 required for 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 Cityrrown State Zip Code 978-475-4786 S115 Telephone Number License Number r 1 B. Certification AM 08 201 1 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 an aintenance 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 ❑ ed Further Evaluation by the Local Approving Authority c D� ✓" 3/31/2015 Inspect is bignaturev Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 1 + y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 229 Gray Street Property Address Glenn Holsten Owner Owner's Name information is required for North Andover MA 01845 3/31/2015 every page. Citylrown 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•3/13 Title 5 Official Inspection Forth:Subsurface Sewage'Disposal System•Page 2 of 17 � I! 1 { N Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 229 Gray Street Property Address Glenn Holsten Owner Owner's e s Name information is required for North Andover MA 01845 3/31/2015 every 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: El 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 229 Gray Street Property Address Glenn Holsten Owner Owner's Name information is required for North Andover MA 01845 3/31/2015 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply 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: I i i 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 Y2 day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 229 Gray Street Property Address Glenn Holsten Owner Owner's Name information is required for North Andover MA 01845 3/31/2015 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: El ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 - 1 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 229 Gray Street Property Address Glenn Holsten Owner Owner's Name information is . required for North Andover MA 01845 3/31/2015 every page. Cityfrown 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? ® El available as built plans of the system obtained and examined? (if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 600 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Foam•Not for Voluntary Assessments "< 229 Gray Street Property Address Glenn Holsten Owner Owner's Name information is required for North Andover MA 01845 3/31/2015 every page. Citylrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonaluse? D Yes 0 No Water meter readings, if available(last 2 years usage (gpd)): Yes Detail: Town water for house usage, Sprinkler system on well water. 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 229 Gray Street Property Address Glenn Holsten Owner Owner's Name information is required for North Andover MA 01845 3/31/2015 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Pumped 2014, owner Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Measured tank Inspect tank&tees. Reason for pumping: Type of System: Y ® 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 229 Gray Street Property Address Glenn Holsten Owner Owner's Name information is required for North Andover MA 01845 3/31/2015 . every page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Septic tank& leach trenches are 29 years old, 10/10/1986, as built plan. D-box&outlet tee in septic tank was replaced 6/6/2008, certificate of compliance Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.3 feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): 4"Cast Iron through wall, 3" PVC in house, no leaks visible Septic Tank(locate on site plan): Depth below grade: .3 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) I If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10'x 5'x 4' Sludge depth: 2.. t5ins•3113 Title 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 229 Gray Street Property Address Glenn Holsten Owner Owner's Name information is required for North Andover MA 01845 3/31/2015 every 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 31" Scum thickness 2" 8" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? Tape Measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumped septic tank. Inlet baffle ok Outlet tee ok. Depth of liquid at outlet invert. No evidence of leakage. i I Grease Trap (locate on site plan): i 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 Forth:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 229 Gray.Street Property Address Glenn Holsten Owner Owners Name information is required for North Andover MA 01845 3/31/2015 every page. Cityrrown 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.): i i i 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 . i Commonwealth of Massachusetts NUM; Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 229 Gray Street Property Address Glenn Holsten Owner Owner's Name information is required for North Andover MA 01845 3/31/2015 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box level &distribution equal, has flow equalizers. No evidence of leakage. Evidence of carryover, pumped d-box to clean Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): "If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments s• 229 Gray Street Property Address Glenn Holsten Owner Owner's Name information is required for North Andover MA 01845 3/31/2015 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 2 trenches 46' 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.): Lawn covered in snow. No sign of ponding to surface. P 9 Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer. Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 229 Gray Street Property Address Glenn Holsten Owner Owner's Name information is required for North Andover MA 01845 3/31/2015 every page. Cityrrown 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 229 Gray Street Property Address Glenn Holsten Owner Owner's Name information is required for North Andover MA 01845 3/31/2015 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately ! W10 t IS' to 0-acs -,4 v t5ins•3/13 Title 5 Oficial Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 229 Gray Street Property Address Glenn Holsten Owner Owners Name information is required for North Andover MA 01845 3/31/2015 every 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 I 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: 3/20/1985 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Design Plan ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: As per test pit data on design plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts `title 5 Official Inspection Form Subsurface Sewage Disposal System Forth-Not for Voluntary Assessments °< 229 Gray Street Property Address Glenn Holsten Owner Owner's Name information is required for North Andover MA 01845 3/31/2015 every page. Cityrrown 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 Z Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file l t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 f Commonwealth of Massachusetts City/Town of . System Pumping-Record Form 4 DEP has provided this form for use-by local Boards of Health. Other forms may be used, but the information,must be substantially the same as that provided here. Before using.this form,check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left/Right front of house, Left/Right rear of house, Leftqn ;n ;f house LeftRight side of building, Left/Right front of building, Left/Right rear of buildic Address City/Town State Trp Code 2. System Owner. 464 sf-�e� Name' Address(if different from location) City/rown ' State Zip Code �a 7 Telephone Number B. Pumping Record Liv 1. Date of Pumping Date 2. Quantity Pumped: Gallons r 3. Type-of sYs.tem. ❑ Cesspool(s) LS iticTank El Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes 9'1qo if yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: � )OSAte ' , 6: System Pumped By: Neil.Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc- Company ncCompany 7. Location where contents were disposed: s• Lowell Waste Water SignHaule Date ' t5form4.doc•06/03 System Pumping Record•Page 1 of 1 s - - Summary Record Card generated on 3/23/2015 11:12:56 AM by Karen Hanlon Page 1 Town of North Andover Tax Map # 210-107.D-0113-0000.0 Parcel Id 18650 229 GRAY STREET HOLSTEN, GLENN A HOLSTEN, KERRY A 229 GRAY STREET NORTH ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 1 Acres FY 2015 UB Mailing Index Name/Address Type Loan Number Activellnact. From Until HOLSTEN,GLENN A Owner HOLSTEN,KERRY 229.GRAY STREET NORTH ANDOVER,MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id.22647.0-229 GRAY STREET Last Billing Date 2/10/2015 1090531 01 Cycle 01 Active UB Services Maint. i Account No. 1090531 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/1 WTR WATER 01 ALL METER SIZE 38.00 1/1 UB Meter Maintenance Account No. 1090531 Serial No Status Location Brand Type Size YTD Cons 36393570 a Active ERT HH b Badger w Water 0.63 0.63 227 Date Reading Code Consumption Posted Date Variance 1/30/2015 242 aActual 10 2/20/2015 -7% 10/24/2014 232 aActual 10 11/14/2014 -33% 7/25/2014 222 a Actual 15 8/13/2014 42% 4/24/2014 207 a Actual 10 5/15/2014 -8% 1/27/2014 197 aActual 12 2/14/2014 5% 10/23/2013 185 aActual 11 11/18/2013 -40% 7/23/2013 174 a Actual 18 8/15/2013 48% 4/24/2013 156 a Actual 12 5/20/2013 6% 1/25/2013 144 aActual 12 2/13/2013 -2% 1.0/23/2012 132 a Actual 12 11/9/2012 -1% 7/23/2012 120 a Actual 12 8/14/2012 -8% 4/23/2012 108 a Actual 13 5/9/2012 0% 1/23/2012 95 aActual 13 2/13/2012 22% 10/24/2011 82 aActual 11 11/14/2011 -29%. 7/22/2011 71 a Actual 15 8/15/2011 20% 4/22/2011 56 a Actual 12 5/16/2011 -17% 1/25/2011 44 aActual 16 2/11/2011 17% 10/21/2010 28 aActual 13 11/12/2010 -28% 7/22/2010 15 a Actual 15 8/16/2010 5/7/2010 0 n New Meter 8/16/2010 RECEIVED Commonwealth of Massachusetts JUN 2 0 2013 C ity/Town of �v� �y� ,,j�� �� TOWN OF NORTH ANDOVER ,1 �(�l(�/ HEALTH DEPARTMENT System Pumping Record Facility Information: System Location: Address �— City/Town State Zip Code System Owner: Name: Adress (if different from location of pump) City/Town State Zip Code q�6 - W67 -L16 Telephone Number Pumping Record Date of Pumping Quantity Pumped_ /, _ J� gallons Type of System /Septic Tank Grease Trap Other (what) System Pumped by: T kut Company: ROOTER-MAN 46 Portland Street Lawrence,MA 01843 Location where contents were disposed: Signature of Hauler Date <( . 113 Of ,ORT" 3368-y ` Town of North Andover HEALTH DEPARTMENT ,SSACNUst4 2a � a 0,8' CHECK#: DATE: LOCATION: H/O NAME: ._ F '7 ' CONTRACTOR NAME: Type of Permit or License: (6heck box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ j ❑ Food Service-Type " $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $. ❑ Offal(Septic)Hauler $ i ❑ Recreational Camp $ ' ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ j ❑ T/itllee.51nspector $ �] Title 5 Report $ ❑ Other:(Indicate) $ HeaItA Agent Initials White-Applicant Yellow-Health Pink-Treasurer r r Commonwealth of Ma6aacl setts °p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ° 229 Gray Street Property Address David Murphy Owner Owner's Name information is required for North Andover MA 01845 5-21-08 every page. City/rown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: When filling out A. General Information forms on the comonly the tab key r,use 1. Inspector: RECEIVED to move your James Wright cursor-do not Name of Inspector use the return JUN 0 2 2008 key. Asen Environmental Company Name TOWN OF NORTH ANDOVER 270 Lawrence Street HEALTH DEPARTMENT Company Address Methuen MA 01844 City/Town State Zip Code 978-681-5023 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 [2-.Needs Further Evaluation by the Local Approving Authority pecto re Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title v Inspection Form•08/06 Title 5 Official Inspection Form:Subsurface Sewage pecN g Disposal System•Page 1 of 15 + T Commonwealth of Mat sachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 229 Gray Street Property Address David Murphy Owner owner's Name information is required for North Andover MA 01845 5-21-08 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: ❑ 1 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 b � NN Y the Board of Health, will pass. Answer yes, no or not determined(Y, N, ND) in the ❑ 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. ND Explain: ❑ 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 ❑ obstruction is removed Title v Inspection Form•08M Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 ' r Commonwealth of Massachusetts = Title 5 Official Inspection f=orm Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 229 Gray Street Property Address David Murphy Owner Owner's Name information is required for North Andover MA 01845 5-21-08 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): distribution box is leveled or replaced ND Explain: 2 - i�L�✓ ❑ 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 ❑ obstruction is removed ND Explain: i 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 mannerwhich will protect public health, safety and the environment: I ❑ Cesspool or privy is within 50 feet of a s ace water ❑ Cesspool or privy is within 50 fe of a bordering vegetated wetland or a salt marsh 2. System will fail unless the B rd of Health (and Public Water Supplier, if any) determines that the system i unctioning in a manner that protects the public health, safety and environment: ❑ The system has septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface ater supply or tributary to a surface water supply. ❑ The syste as a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The,s tem has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. Title v Inspection Form•OM Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 1 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 229 Gray Street Property Address David Murphy. Owner Owners Name required fo is North Andover MA 01845 5-21-08 required for every page. City/Town State Zip Code Date of Inspection B. Certification cont. C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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**. I i Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for 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: D) System Failure Criteria Applicable to All Systems: i 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 ❑ 2 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Ey-- - Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow ❑ n Required pumping more than 4 times in the last year NOT due to clogged or tom"' obstructedNum Number i e s . p p b of times pumped: ❑ L� 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. Title v Inspection Form•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments F 229 Gray Street Property Address David Murphy Owner Owners Name information is required for North Andover MA 01845 5-21-08 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure criteria Applicable to All Systems(cont.): Yes No ❑ Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ [�, Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEI'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 the following, in addition to the i questions in Section D. Yes No I ❑ ❑ the Sys is within 400 feet of a surface drinking water supply ❑ ❑ e 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 If you ha 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 P system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Title v Inspection Form•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �Y 229 Gray Street Property Address David Murphy Owner Owners Name Information is required for North Andover MA 01845 5-21-08 every page. Cityrrown 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) ltd' ❑ Was the facility or dwelling inspected for signs of sewage back up? i Lam" ❑ 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: ❑ EKI 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)] Title v Inspection Form•06/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments " 229 Gray Street Property Address David Murphy Owner Owner's Name Information is required for North Andover MA 01845 5-21-08 every page. Cityfrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder? ❑ Yes Is laundry on a separate sewage system?(if yes separate inspection required] ❑ Yes No Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes No Water meter readings, if available(last 2 years usage(9Pd)): �� f Sump pump? ❑ Yes 9--go ., Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM 203): Gallons per day(gpd) Basis of design flow(se persons/sq.ft., etc.): Grease trap prese ❑ Yes ❑ No Industrial wa a holding tank present? ❑ Yes ❑ No Non-sa 'pry waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): Title v Inspection Forth-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °< 229 Gray Street Property Address David Murphy Owner Owner's Name information is required for North Andover MA 01845 5-21-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: i 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): i Approximate age of all components, date installed (if known)and source of information: 15 ,t�dJ� d y p Were sewage odors detected when arriving at the site? ❑ Yes P Igo Title v Inspection Form•08106 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "< 229 Gray Street Property Address David Murphy Owner Owners Name information is required for North Andover MA 01845 5-21-08 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: feet � ;Mat�e�nalir(f construction: n ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.) Septic Tank(locate on site plan): .r Depth below grade: feet Material of construction: oncrete ❑ 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: �� i Sludge depth: 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 e/ Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Title v Inspection Form•08106 Title 5 Official Inspection form:Subsurface Sewage Disposal System-Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 229 Gray Street Property Address David Murphy Owner Owner's Name information is required for North Andover MA 01845 5-21-08 every page. Cityrrown State Zip Code Date of inspection D System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): i Soil Absorption System(SAS) (locate on site plan, excavation not required): I If SAS not located, explain why: i i Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: leaching trenches number, length: ❑ 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.): i Title v Inspection Form•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 229 Gray Street Property Address David Murphy Owner Owner's Name information is required for North Andover MA 01845 5-21-08 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch 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. I I i i I -2-"-,9 ���y � � 77 Title v Inspection Form•08MS Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '( 229 Gray Street Property Address David Murphy Owner Owner's Name information is required for North Andover MA 01845 5-21-08 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: Check Slope Surface water j Check cellar ❑ Shallow wells Estimated depth to ground water: 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: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Tide v Inspection Form•08M Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 I Page 1 of 3 SUMMARY OF GROUND-WATER LEVELS APRIL 2008 PROVISIONAL (NOTE: Wells with * also available in real-time at top of Ground-Water Data page; OWc, monthly measured value used in high ground-water level estimation report, USGS Open-File Report 80-1205.) WELL L START NET CHANGE DEPARTURE WATER LEVEL T I YEAR IN MONTH IN ONE FROM BELOW LAND- 0 T OF YEAR MONTHLY SURFACE P H RECORD MEDIAN DATUM 0 O (OWc) (FEET) (FEET) (FEET) (FEET) DAY MASSACHUSETTS ACTON 158 * TS 1965 - 0.20 - 0.95 + 1.17 16.31 23 ANDOVER 462 VS 1968 - 0.36 - 0.81 - 0.07 14.20 23 ATTLEBORO 83 VS 1964 - 0.51 - 0.69 - 0.38 3.83 23 BARNSTABLE 230 FS 1957 - 0.28 - 0.28 - 0.02 22.70 30 !, BARNSTABLE 247 FS 1962 + 0.13 + 0.28 + 0.35 23.25 30 BECKET 12 TS 1986 - 0.55 - 0.72 - 0.60 3.72 22 BLANDFORD 9 VS 1986 - 0.26 ----- + .0.08 1.97 22 BOURNE 198 FS 1962 - 0.32 - 0.37 + 0.15 32.00 30 BREWSTER 21 FS 1962 + 0.16 - 0.89 + 0.45 9.09 22 BREWSTER 22 * FS 1962 + 0.18 - 0.38 + 0.75 29.53 22 CHATHAM 138 FS 1962 + 0.19 + 0.11 + 0.01 23.31 22 CHESHIRE 2 HT 1951 - 2.17 - 1.95 - 2.54 4.66 21 CHICOPEE 95 TS 1984 - 0.03 + 0.45 + 0.68 20.39 21 COLRAIN 8 VS 1965 - 0.28 - 0.33 + 1.24 15.26 21 CONCORD 165 TS 1965 + 0.73 + 0.08 + 1.99 39.45 21 CONCORD 167 TS 1965 - 0.52 - 0.25 + 0.42 5.63 21 CUMMINGTON 13 VS 1986 + 0.17 - 0.36 + 0.65 2.88 21 DEDHAM 231 ST 1965 - 1.42 - 1.63 - 1.37 6.01 21 DEERFIELD 44 VS 1965 - 0.03 - 0.15 + 0.06 2.51 21 DOVER 10 TS 1965 - 0.46 + 0.04 + 0.23 31.42 21 DUXBURY 79 * VS 1965 - 0.52 - 1.16 - 0.11 7.96 23 DUXBURY 80 VR 1965 0.51 - 1.26 + 0.20 21.26 23 EAST BRIDGEWATER 30 HT 1958 - 1.23 - 2.00 - 1.13 6.15 23 EDGARTOWN 52 VS 1976 + 0.77 - 1.66 - 0.95 18.29 29 FOXBOROUGH 3 TS 1965 - 0.50 - 0.88 - 0.53 18.51 23 FREETOWN 23 TS 1964 - 0.31 - 1.79 - 0.55 13.37 23 GEORGETOWN 168 VS 1965 - 0.46 - 0.84 - 0.94 4.88 23 GRANBY 68 VS 1954 - 1.58 - 0.38 + 0.05 6.18 21 GRANVILLE 5 TS 1965 + 1.16 + 0.12 - 0.07 32.18 22 GRANVILLE 6SS 1965 - 0.92 - 1.26 - 0.95 4.30 22 GREAT BARRINGTON 2 VT 1951 - 0.76 - 1.11 - 0.83 8.77 21 HANSON 76 VS 1964 - 0.13 - 0.62 - 0.36 4. 65 23 HARDWICK 1 TS 1965 ----- ----- ----- ----- HAVERHILL 23 TS 1960 - 1.16 - 1.21 + 0.49 8.90 23 HAWLEY 8 ST 1986 - 0.14 - 0.12 + 0.48 2.31 21 LAKEVILLE 14 * TS 1964 - 0.78 - 3.10 + 0.21 12.45 23 LEXINGTON 104 VS 1965 - 0.66 - 0.89 - 0.25 2.43 23 MASHPEE 29 FS 1976 + 0.01 - 0.73 + 0.12 7.72 30 MIDDLEBOROUGH 82 VT 1965 - 2.30 - 3.49 - 1.06 5.93 23 MONTGOMERY 19 SS 1986 - 0.36 - 0.58 + 0.30 0.28 22 NANTUCKET 228 FS 1976 + 0.87 - 0.25 - 0.41 24.94 30 NEW BEDFORD 116 VS 1964 - 0.48 - 0.54 - 0.30 4.15 23 NEWBURY 27 VT 1965 - 1.01 - 1.33 + 0.90 4.1023 NORFOLK 27 * VS 1965 - 0.47 - 0.53 - 0.10 5.92 23 NORTHBRIDGE 54 VS 1984 - 0.39 - 0.81 + 0.05 3.69 21 NORTON 37 FS 1964 - 1.72 - 1.97 - 0.34 6.32 23 ORANGE 63 TS 1985 - 0.63 + 1.47 + 1.97 4.44 > 21 OTIS 7 VS 1965 - 1.35 - 1.65 - 0.13 7.41 22 PELHAM 23 * SR 1981 - 0.63 + 0.30 - 1.70 14.02 21 PELHAM 24 * SS 1984 ----- ----- ----- ----- http://ma.water.usgs.gov/current-cond/data/2008-04.txt 5/27/2008 Page 2 of 3 PETERSHAM '19 ST 1964 - 4.97 - 2.82 - 0.36 11.35 21 PITTSFIELD 51 * VS 1963 - 0.79 - 0.39 + 0.41 13.91 23 PLYMOUTH 22 TS 1956 - 0.18 - 0.80 - 0.07 22.90 23 PLYMOUTH 494 SS 1985 + 0.03 - 1.43 + 1.36 27.79 23 SANDWICH 252 FS 1962 - 0.03 - 0.20 + 0.07 46.88 30 SANDWICH 253 FS 1962 + 0.13 - 1.24 + 0.84 48.57 30 SEEKONK 275 VS 1964 - 0.29 - 0.35 + 0.24 5.65 23 SHEFFIELD 58 FS 1987 ----- ----- ----- ----- SOUTHBOROUGH 12 HT 1990 - 1.11 - 1.28 - 0.60 3.43 21 STERLING 1 ST 1947 - 0.23 - 0.34 + 0.38 2.69 21 STERLING 177 SS 1995 - 0.68 - 0.89 - 0.13 13.93 . 21 SUNDERLAND 7 SS 1957 - 0.23 + 0.25 + 1.60 8.39 21 SUNDERLAND 68 VS 1983 - 0.69 - 0.16 + 0.23 1.88 21 TAUNTON 337 TS 1964 - 0.85 - 1.03 - 0.05 8.13 23 TEMPLETON 3 VS 1957 - 0.44 - 0.37 - 0.07 3.37 21 TOPSFIELD 1 HT 1936 - 2.49 - 2.50 - 0.67 9.93 23 TOWNSEND 13 TS 1965 + 1.45 + 0.05 + 1.65 10.13 27 TRURO 89 TS 1962 - 0.14 - 0.07 + 0.08 11.56 22 WAKEFIELD 38 * FS 1965 - 0.39 - 0.96 - 0.07 6.05 23 WARE 43 VS 1965 ----- ----- ----- ----- WAREHAM 51 TS 1959 - 0.58 - 1.54 - 0.93 6.97 23 WAYLAND 2 TS 1965 - 0.47 - 0.47 + 0.02 15.04 21 WEBSTER 1 HS 1958 - 1.45 - 0.97 + 0.64 12.42 21 WELLFLEET 17 VS 1962 + 0.34 + 0.14 - 0.04 9.90 22 ! WENHAM 76 VS 1965 - 0.42 - 0.74 + 0.01 2.20 23 WEST BOYLSTON 26 SS 1995 - 1.51 - 1.70 - 0.44 3.96 21 WEST BROOKFIELD 2 TS 1959 + 0.33 - 0.21 + 0.61 17.72 21 WESTHAMPTON 20 SS 1986 ----- ----- ----- ----- WESTFIELD 62 SS 1957 - 1.01 - 0.78 + 0.03 5.82 21 WESTFIELD 152 TS 1986 - 0.36 - 0.56 + 0.50 2.68 21 WESTFORD 160 VS 2001 - 0.40 - 0.80 - 0.14 10.66 22 WEYMOUTH 2 FT 1965 - 1.65 - 3.77 - 1.69 9.49 23 WEYMOUTH 3 VS 1965 - 0.56 - 0.94 - 0.25 4.88 23 WEYMOUTH 4 TS 1965 ----- ----- ----- ----- WILBRAHAM 55 TS 1965 - 3.97 - 0.42 - 0.09 35.48 21 WILMINGTON 78 * FS 1951 - 0.97 - 0.90 + 0.05 6.61 23 WINCHENDON 13 ST 1939 - 0.36 - 0.37 - 0.20 3.70 21 WINCHESTER 14 ST 1940 - 1.68 - 2.35 - 0.52 9.38 23 RHODE ISLAND BURRILLVILLE 187 TS1968 - 0.43 - 0.83 - 0.46 14.43 25 BURRILLVILLE 395 UT 1992 + 0.61 - 0.83 - 0.34 6.39 25 BURRILLVILLE 396 VT 1992 + 0.58 - 0.94 - 0.40 5.30 < 25 BURRILLVILLE 397 HT 1992 - 0.78 - 3.22 - 1.31 11.55 25 BURRILLVILLE 398 HT 1992 + 0.19 - 2.21 - 0.79 7.59 25 CHARLESTOWN 18 FS 1946 - 0.73 - 3.13 - 0.56 16. 11 25 CHARLESTOWN 586 VT 1992 + 1.10 - 0.26 - 0.08 3.56 25 CHARLESTOWN 587 ST 1992 - 3.27 - 3.40 - 1.49 7.71 25 COVENTRY 342 VS 1991 - 1.54 - 2.15 - 0.83 8.23 25 COVENTRY 411 SS 1961 - 0.76 - 1.60 - 0.31 20.46 25 COVENTRY 466 VT 1992 + 0.51 - 0.33 - 0.29 2.86 25 CRANSTON CITY 439 ST 1992 ----- ----- ----- ----- CUMBERLAND 265 SS 1946 - 0.77 - 1.68 + 0.10 11.77 25 EXETER 6 VS. 1948 - 0.86 - 1.32 - 0.29 5.14 25 EXETER 158 ST 1991 - 1.44 - 1.84 - 0.42 6.49 25 EXETER 238 FT 1991 - 0.73 - 1.03 - 0.41 11.91 25 EXETER 278 HT 1991 - 1.91 - 1.83 - 0.30 8.54 25 EXETER 475 VS 1981 - 0.56 - 1.34 - 0.36 13.07 25 EXETER 554 SS 1988 - 0.48 - 0.63 - 0.19 9.11 25 FOSTER 40 HT 1991 - 1.13 - 1.49 - 1.12 4.94 25 FOSTER 290 HT 1992 - 0.04 - 2.12 - 1.19 5.39 25 ' HOPKINTON 67 ST 1991 - 1.54 - 4.78 - 1.90 13.75 25 LINCOLN 84 VS 1946 - 0.99 - 2.16 - 0.40 4.81 25 LITTLE COMPTON 142 ST 1992 ----- ----- ----- ----- http://ma.water.USgS.gov/current-cond/data/2008 04.txt 5/27/2008 Page 3 of 3 NEW SHOREHAMw258 UT 1991 + 0.11 ----- - 0.56 11.01 28 NORTH KINGSTOWN 255 VS 1954 - 0.94 - 2.98 - 1.16 8.27 25 NORTH SMITHFIELD 21 TS 1947 - 0.89 - 1.79 - 0.52 7.07 25 PORTSMOUTH 551 HT 1992 - 3.34 - 5.06 - 0.95 33.14 25 PROVIDENCE 48 TS 1944 - 0.42 - 0.88 + 1.76 4.06 25 RICHMOND 417 VS 1976 - 0.48 - 1.20 - 0.38 6.42 25 RICHMOND 600 * TS 1977 - 0.20 - 0.84 - 0.14 33.14 25 RICHMOND 785 FS 1989 + 0.52 - 3.48 - 1.96 24.33 25 SOUTH KINGSTOWN 6 VS 1955 - 0.53 - 1.49 - 0.13 10.93 25 SOUTH KINGSTOWN 1198FS 1988 - 0.92 - 1.85 - 0.75 7.43 25 WARWICK 59 ST 1991 - 0.51 - 0.44 - 0.21 4.97 25 WESTERLY 522 FS 1969 - 0.86 - 1.34 - 0.56 11.96 25 WEST GREENWICH 181 US 1969 - 1.12 - 2.01 - 0.14 15.12 25 WEST GREENWICH 206 ST 1991 - 0.24 - 0.36 - 0.30 4..06 25 ------------------------------------------------------------------------------- >> SET NEW HIGH OR EQUALED HIGHEST RECORDED WATER LEVEL FOR PERIOD OF RECORD > SET NEW HIGH OR EQUALED HIGHEST RECORDED WATER LEVEL FOR END OF APRIL << SET NEW LOW OR EQUALED LOWEST RECORDED WATER LEVEL FOR PERIOD OF RECORD < SET NEW LOW OR EQUALED LOWEST RECORDED WATER LEVEL FOR END OF APRIL ------ - DATA NOT AVAILABLE TOPOGRAPHIC (TOPO) SETTING: F=FLAT, G=FLOOD PLAIN, H=HILLTOP, S=HILLSIDE, T=TERRACE, U=UNDULATING, V=VALLEY, W=UPLAND DRAW LITHOLOGY (LITHO) : G=GRAVEL, R=ROCK, S=SAND, T.=TILL CONTENTS OF MAJOR RESERVOIRS (ESTIMATED END OF MONTH READINGS) (MILLIONS OF CUBIC FEET) MONTH-END PERCENT OF PERCENT RESERVOIR CONTENTS AVERAGE FULL BORDEN BR + COBBLE MTN RES, MA 3191 105 94 QUABBIN RESERVOIR, MA 55108 --- 100 SCITUATE RESERVOIR, RI 5024 105 103 STREAMFLOW FOR SELECTED INDEX STATIONS (CUBIC FEET PER SECOND) MONTHLY PERCENT MAXIMUM DATE MINIMUM DATE STREAM MEAN MEDIAN FOR MONTH FOR MONTH CHARLES RIVER, MA 388 72 537 07 198 27 E. BR. HOUSATONIC RIVER, MA 340 157 736 02 108 27 PAWCATUCK RIVER, RI 263 82 401 06 163 27 WARE RIVER, MA 340 89 ---- -- ---- -_ ------------------------------------------------------------------------------- A MONTHLY REPORT PREPARED BY THE U.S. GEOLOGICAL SURVEY MASSACHUSETTS-RHODE ISLAND WATER SCIENCE CENTER 10 BEARFOOT ROAD, NORTHBOROUGH, MA 01532 IN COOPERATION WITH THE MASSACHUSETTS DEPT. OF CONSERVATION AND RECREATION, MASSACHUSETTS DEPT. OF ENVIRONMENTAL PROTECTION, CAPE COD COMMISSION, RHODE ISLAND DEPT. OF ENVIRONMENTAL MANAGEMENT, AND THE PROVIDENCE WATER SUPPLY BOARD I I, http://ma.water.usgs.gov/current cond/data/2008�04.txt 5/27/2008 -tment of Environmental Management/Division of Water Resources WATER WELL COMPLETION REPORT WELL LOCATION I ry!�f rrRv St No.Andover, Mass bangle Map cation Flite Const . Inc !SS. 22 Kenmar Drive SellerieR, ��IaSs WELL USE CONSOLIDATED WELL Domestic a Public ❑ Industrial ❑ Type of Water-bearing Rock Other Water-bearing Zones Method Drilled Rotary 1) From To 2) From To Date Drilled 11/5/86 3) From-Tc- 4) romTc4) From-To- CASING romToCASING Depth to Bedrock Length 51 Diameter--6 TypeSteel UNCONSOLIDATED WELL -STATIC WATER LEVEL Water-bearing Materials Feet below land surface Sand: fine❑ medium❑ coarse❑ Date measured Gravel: fine❑ medium❑ coarse[] Screen: GRAVEL PACK WELL Slog length from to Yes ❑ No Split Screen(or 2nd screen) WATER QUALITY TESTS MADE Slog length from to Chemical ❑ Biological ❑ Depth To Bedrock PUMP TEST Drawdown feet after pumping days hours at 50 GPM. How measured Recovery feet after hours. LOG of FORMATIONS COMMENTS: (On well or water) Materials From To 'tock 40' 150' n' m PRI LERcb c }a WUL CO. o Firm � . X dFi Address ^+ City SSR260hat, R.A. 02804 Registration No. l ferator s ig'� nature Please pant rrm y BOARD OF HEALTH COPY 25M-10.85-807101 I' �i FAX COVER SHEET ASPEN ENVIRONMENTAL 270 Lawrence .street` Unit 2 Methuen, MA 01 844 Fax Number 978-6$7-7096 Phone Number 978-681-50.23 pate: 6 -:'" doTO- fL FROM: 2 RECIPIENT'S FAX NUMBER: 7t� NO, OF PG`6, INCLUDING COVER SHEET:— . ^, J Td WdZO:tiT 800E �Z .unf 960r_L898L6: 'ON XUA bU=idd a tr �. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Forma Not for Voluntary Assessments 229 GraY.Strvet, .. ..........Property Address David Owner owner's Name Information Is North Andover MA 0'1045 06/2308 requires for ..� ._..-- --.. T_. every,page, cityrrown estate Zip Cad® Date of Inspection Insp ec #ion results must be submitted on this form. Inspection forms may not be altered In any way. important: A. G@tl@r@l Itliot°Il"iigtl When filling g out forms on the computer,use Inspector. only the tab key to move your .lames Wrlfiht .cursor-do not T----... •---._.------Name of Inspector '- use the return Inspector key. Asen Lnvinanmental - Company Name VQ270 t_awrence Street company Address 01844 - Methuen MA Zip Code +�+ C1ty/T'oWn`"'_ State 978-681-5x23 Telephon8 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 irraining and experience in the proper function and maintenance of on site sewage disposal systems. I air,a IEP approved system inspector pursuant to section 15.340 of Title 5(310 CMR 16.000).Th(.-i system: Passes ❑ Conditionally Passes Fails [] Needs Further E-vaiva3tion by the Local-Ap roving Authority - 06/23/08 ---.. _... ns Sign Date Ste inspector shall submit a copy of this;inspection report to the Approving Authority(Board of Health or©EP)within'eta 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 co>7ditIona of use at that time.This Inspection does not address holm the system will perform in the future under the same or different conditions Of use. TAI°6 otricial Inbpeulon Farm:wmurfi- sewage olepoeal Sy%tem-page 1 or to 229 pray St Nod i.An oar-06106 Zd WU2-0:TT 800E ZF .unf 9602-1'8986: 'ON : H.J 6J0�� 08/2p/208 44:41 FAX 9789768017 nnviv 1) RIMY rant PUBLIC l rum DEPARTMENT Community Drielopment Division OT 034, RT AcS of: June 6, 2,008 (,7Ris i.g to certify that the ind-widuafsu6szr.rfrtre rCisplv afsyctern receiwd a S�°7 'OlXT rXS�,t�I'( T7OW the: . �p 4 ) n (BQ� LHmfSept TankOutre 117a S �c'hn O"M we � �9 I : a .107.q rce .1 3 NbrtC. rTdaver- !YJ 0184.5 qie issuance of this certOct;le sh"r not bs commued as a -rantee that the system cviCC frrractiorti 5a �fictaricy. r Susan ,Sawyer tt�tttiftc�lea�"tFi Vrectar Ospod Stresi,North Andover,MOS$01hUS805 01845 Phodo 978.688,9S40 Fox 978.688.8476 Web www.t(lw ofnorih0ndov8r.cOm Ed WHA 0:L Z GOOF mac. •unlHFia J --� - i r r� i TRANSPMI=Djg—! 'VERIFIC:ATION REPORT TIME 05119/2008 14:50 NAME HEALTH FAX 9786888476 TEL 9786888476 SER.# 000B4J120960 1 P DATE.TIME 05119 14: 48 FA=; HO./`l-,A-ME 97868 X096 DURATION! A0: 01: 2)9 PAGE-S, 05 RE=ULT OK MODE STANJDARD ECM .'tiLI� � � i��},��i•�� r1Lr�><i tl ti' r ',j` .'1/,. s �UrtTh �dl�,' }�-7„} Chi ,'i , �y1 r! 1RQfr o��i '•� �5b'v�;rn'%:.�;Fhjxr}_.`;^ 6fy,'vt;{�,�;1. i„'.,f•,, i,z.• •gid r. •�re + J• 1 G1j(a��'(�"S.ri .'..• "it,11".'•;.;'_;i�. •j:'+' y•.',,{; ttS1�E �':IUTASSAGHUETTS r rJ 1 in...i: r i it � 'T. �i��V����4t•' , . ,.A^ � '' t ; '�;tl� Y �t i'1'''�.tF1'gi'ei� .?�.�e:Li'�:!'',�J�^:��� ' - � �• � Y ' .f h m Y�]L�Js t ' ''ti"• 't.tv�i' •�;?, �I�J ;"i'nt��i�h�.r';�r�^N J.�,:•_Ir1..,,; i+rif," .:Iv}..ir{y;p�.�V0�{'��xcli.j,br�l�l,+�${3;;1;7v}l,v,��1�1�1�i�1�}fti; 'Vn Jl.r1•}h'a"tl'! ,.J - +� F,hsa prt�vlded�itli•form for usi by IOCAI Boards of HWtti. T s Sys �u"mpTnIj gg Reno d mu; be submI id to thee,Ioca�'�oard of Health a�other a ro In „+ pP Y g, Out orlty. '.t,i' .�:Jf*"T'''i'Gq.��til+Jl"•:Vi'p�lt7i a,.Yii:6��efr.1'yl.,eh' `A Facility ,lnformltion � ,=tir> rt rit;i'.: "' t: .','J.t%a.r,..''':,,• t'r.:.. :;;' ,i_;:.`",'';:y r, Tp' „r +,i.?-,TH ANDOVER. ::x� WhenNu+iOout, '1:'i System I.GC tlott:' rte,,--riI i_t'� ARTMENT, oh ►W r tory the tab xey adores, ' •,' to move your , :. • ' •.. -'�.: , . oj ;.: use'the' �': ,.. •return' J: :a• ,,:n, ��' ;,:;', �;tJ.:-,f*,!.:: $tate `.; ..;;,'• ;,,.�';t, r.. p Code- r ,: 41"'J• Or"'�' '.i Hyl i, �': ",:•''' • •.✓:i•i�!` `4r--y..�J••r's,r:��yi„ .i .•t• ,.,L,t•Jt,�:��t•h,,,d„f�i�y"�..,t'" �, rJ•:ti,�,,,yi'11� .;4'r'�J'i;�hl,'.:j;i,�►C�a�irXle;,•,i'.M1,,,,:t..,,y.,�i.•+.f,r,,,:,t;,,.,,•;,r; ' r 1.'` ft J ,� �. TJ it 'J':Y,r v,A R.��} tl sJ •.7;, , ...i.l:.. rit'r l:.� 4S .lad.. lye �\'r •t.�J }Ir ,� r•.ilY�,f t �1!, , � �-•..•...,•r i •�r� (1[dlfferint from(4Cnilpn' .J (' 3tst • :!s.�.,..,a�JJ'r,a.., � JP Cod; • •, � r' ., %.V a q. Telephone Number III ii :•r::'`'' :;::;�'i,: .,`,t�. i r- -• ,ia.',f•rlt�.,l.�;v''{��,.:rj,r:,`` d '':p:;°•,,.t• , itv'go. .0rd..! t,J`��1� ' . M•,;J,, h'�tY.:J y17�. Jr"�•':"t::'I•,,5, r. r ��' „Dat01 of Pumolng• �'��•gyp• �--'- 2, Quantity Pumped; '.L•-,r. ,ir.l•i', ;4 r•:P':•. s"r';,�.?i; ;tc:"t�• Galion* J,. ,''°.Type ptaiys# m,,:..I r,❑' Cesspodl(s) Septic Tank ❑ Tight Tank Other(descri'bal' { '•�y'�a '•Jl' •J,•"•�',`f'n,;r r kr}tq•,� "(t.N';:: M'T ' J w,.i `tr iir fd'1"'l1 a' �(„ �... ,;•.r, :i'' ••r;.,r., F}?J:r�',.St.ai;�i,�.H,�'J{,+:i.r.y`;_;1!�It�'j,p•r,i�ti•.• Qht Tee Filter preserrt7':G7 Yes No If yes,was it�Iea' ❑ Yes t:• +�ti ' 't +' ttit ,,,{L %�'i 'i;''.r.;4'u<,iur, Jf'frf ; ❑ No a., s..�L,.,r n � ,•7,(� v � rrsJ,n,,r j��:.'•�ru,l'tnyl;}1,�'h� u,<�� 'r , :.�� >,•i•,,. •,,��,•sy, •.,p,.�ar �r.•;�•. I 1 Y.'..},,. � , Jrl,f'Y'.�. :'p. Sy3 '. .. ...�" t ..J.:`r' (3{;t i.' )frr 1ii�d i�•isi,�, t�+,;i..�.�.'+.. ,'J r �•. � _ � � ,r i :i 7' 1'i�.:� •,y u. ...�( 4 hK,y'P J. t.s• 'nr-,s,\�� 7 7. _ � 11 _ , ,Sy i rl•.ktr+1 .. t J ,��.•,:;;.;i;'+>`.,.. hUsetts 'p", r ir.v,' n`1.,,.r .,.0' '1 r ! 1r•'.i:<;7d'.y'1.. ' y, RT �A DOVER MASSASCHUSETTS ' �"�: 'fir ..•I�.y r ``,..�i, a� uyrrmpin' Record Or��'+' �y�'1�t'Y1r�K�t'�' .:�� il+ r -• ,f�f1�, oYa7 ED r`Ct:in;ll��!�.��,7i'�,:��;,���'v � T�l,<,1u,.d•r�'•i�•��t t F t 11�ir•1;+{•.f�,',�K�,." ' 'DEP hai provided thls•form torose by local Boards of Health, The System Amping Reco d must stfubml ed to yy , ` the.local:Board of Health or other approving autl tority, — 4 71107 .-A Facility.Information l(T1Orhrlt:i ;•.?;.i. d:; a TC. t? TH ANDOVERj�TWr>en' out 1:`:; System LOCBtlonl: h� ar�TMENT• only the tab:key Address to move your':, cursor.do pot . .1h ,City/Town State7JP Pods •:,,.;�`'.�`�;t�''SysteM • � •'",:,;,;;,' � .. - �r Owner;•.;' ..�-'. ' •�r'/• ..,,.� �. 1 :+IVi•.i tM.. �.1�f,.'., 1,,:'Yi 'It;.,:d�H''i 6.Yr 1'� _': 'S;,•';°'';;it:. :: ,Ir.';.None,..',,,;;,,,; ,,,,,,,,,;' >' l f r u , R1r'r,,,r',.. r r •,`, jay . . ""' :Address(If dlffennt from bcatton), . State Zlp Code Telephone Number ':.t`:• {.',:+°'°frig+.IG.r; ',,c•,a.: ;t�;,,;�;:.i. .. • • -.�.� ��-:; �:;;:.,: :r B;":P,um:plt�g•�..Re.�ord: � .1. ,,..,• ' ,,. .., .;.. // :N�ti.+;t;a.,;;./.l4•i.�,�4•l�;�i'H.(:i:?;�;�Jj•;•;:• ,:{• `/�/�J �s^-/•� ///�1��(f)���/// i:.. i.l�.''1•h /I 1,4'1.•.: ..:� �": ! I �� r•� ;` Date 2, Quan pa tity Pumped: Gauons `.Tj+pe pf,:yatem;t, ❑ Cesspooi(s) Septic Tank ❑ Tight Tank ( (Other(describel- • ;,r; ,: •'i!;'r,5',r,'.t,l��i.1 ' 'r t'1'jl..iYlyii'y":+J' Tea Filte(;present?:❑ Yes No If yes was It cleaned? ❑ Yes ❑ N ;<�i: ',!':i. '•'ry',ti;L:y'S(•;i)y�j',',:,..� ,.µJ'Niini5':.:� ;�.f: ,°,'�. �•.; ..p%•I lif•i[.,i'�u.'�C,;.i:�i''rl ifat'' 7:,; �'�:: t :,. .:4�:61:= Co dl+ion ofSya{ .. .. .. ..i ;rn^.r;=s%r'jir.++y.'Ii:ji�'t.+r • 'i„nn:+..,lt:,.li�.�r,;..::;,•:'_ ' ti1,•y:\�f ' :v' f?/QAiM. n Q , ... '�r• t"�f1 i i 7. }ui,?,`' 1 ,, ''.1'!I J7� t"•1,�,j,:.. � .. 11 ,''•�.. .': './t .I r N til a '"!�l 5:.�� rf r;i>,'14 t f,ft1 y't s' Pumped B 1,. G . .. %3;c''Sti9' amalJ. �� ='r VehIG i� Oak: ';,i `rM.' 4 e Umcsnnsse Number ' ”/.T•'+ P T.�Y1 ,�tjr 7X'. r �r}�l�t t 5 7 Ma• r �Sti� 1 rthy>f '. �t/(r'N`Sr}rr1.f1' 1 1►+ > i {y ��l,�•tp�,�yrpr �i'"d�/�1►il 111 J;. �.�„Il,.1 w1„•v„fl��J;y)p.;t •.r}.I .�!5+•i ,IVL ��C+1/t�'��,�y.VJ1�•:.�;..t” , • t`f: �•�",i � t o o contents ere'.dl .osed: :.- ,.�.•,F,,; ;;:;}.7..t>:L•oca n,wHer ,W... ;3P �..•,'.,�'•.:i ':.•l:f •,•,':,',•r;:•t'..,::�1i;.:i�.itjfdi.'•,Ol..,.y'r�•:t V.• '!�f�•�:' ..►�'i /' . 1r 1 p '• // 4IV lU ,^fit `;L• 1 li;tls+llNl�.�4���,)1r r ,}i.l,.�;V„^•'•'��1'r'`�4 11�� .IYaa:•,' � 'd:.�^ "'a.1;lt';.Y4...} 'c :�..,:'�rf7i:'(�.',.�1'., •i,i!yf 7`1,;,.:,r..ir�;.:• �i�'...i ';:x: , ,i.: :• 'r�%.,,:;�ii1L•.tri•.'.•i'�1'JA•ki,i';"'',!,1,�:r . .:.:�;. -:iC �':�) Y:•i�':..Irb 2.i.N 1!.,'ii'4 r' Date httpJlwww,mass.gov/des!water/e pprova)s/t6forms,htm#Inspect „ . ..tt.,, •r t5f0rrr*doc,-Wffi3 ,:,. System Pumping Record Page 1 of t tilb S j ' kNNv t OF SER-`rIC `Z Pill ��f I J: .. NORTH O��tLED OL O A� F- 70 ��SSACHUS PUBLIC HEALTH DEPARTMENT Community Development Division CFRT FICA�I'E OF CO (0 CI. 0 NCE As of.- June f:June 6, 2008 rlhis is to cert that the individual subsurface disposal system received a S3T1SFACyI0RT1NS(ECTI03rof the: Repair of1Distribution Bo.-and Septic Tank Outlet "T' By- John (DiVincenzo At: 229 Gray Street Wap, 107.D; Parcel113 North Andover, W,4 01845 The Issuance of this certiftate shall not be construed as a guarantee that the system will function satisfactorily. Susan 7 Sawyer (Public Yfealth Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com '1 TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: SYSTEM OWNER & ADDRESS SYSTEM LOCATION (example: left front of house) �s Z�" —° PUMPEDy DATE OF PUMPING.• QUANTITY GALLONS_ CESSPOOL: NOy 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: I i CONTENTS TRANSFERRED TO: i. i John Segadelli Lot 11 Gray St. APPLICATION FOR SEWAGE DISPOSAL INSTALLATION HEALTH DEPARTMENT - NORTH ANDOVER, MASS. I hereby make application for a permit for a sewage disposal installation at Lot 1, Gray St. . I will install this system in ac- cordance with all the laws of the Commonwealth of Massachusetts and regulations of the Board of Health of the Town of North Andover. Further, I will construct the house sewer of bell and spigot pipe, the minimum diameter being 4 inches, and will maintain a minimum grade of 1% until 10 feet pre- ceding the septic tank, where the grade shall not exceed 2qo. I will install a con- crete septic tank of 1000 gals in size. A manhole (s) permitting easy cleaning will be provided with removable cover (s) of iron or concrete within 12 inches of the ground surface. I will provide subsurface disposal field with 4 inch perforated or open jointed pipe and laid in a series of trenches, the bottom of which will pro- vide a minimum of 180 lineal 9"Wfeet of effective absorption area. The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging in size from 3/4 to 1-1/2 inches (dia.) and the pipes will be surrounded by similar material to a height of 2 inches above the crown of the pipe. The joints of these pipes will be protected from clogging and before filling the trench, 2 inches of gravel or stone 1/8" to 1/4" (dia.) will be placed over the course gravel or stone. The disposal field will be installed at a grade of 4 to 6 inches/100 feet. No single tile line will exceed 100 feet in length and in any case, two lines of tile will be installed. A minimum of 6 feet will be maintained between the center lines of the disposal field trenches and the average depth of trench shall not exceed 36 inches. No part of the installation will be less than 100 feet from any private water supply, 25 feet from any stream, 20 feet from any dwelling or 10 feet from any property line. I further agree not to cover any portion of this installation until approved by the inspection officer, as provided below, and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application. DATE JUN '2 7 1963 e Si ature o pplicant I hereby issue the above permit for the Board of Health of he Town of North Andover, Massachusetts. JUN 2 7 1963 DATE nature of Health Agent I have inspected the uncovered system indicated above and find everything done as described DATE w Signatureof Inspecting Offi er Percolation Test 6 miff. Soil: Clay-gravel Garbage Grinder No e 'z'"z j�z BOARD OF HEALTH TOWN OF NORTH ANDOVER, MASS. 7 r ti VIP `df -7-7Z N i- -n gg � 1. NAME .L C ' DATE 6 i f 2. ADDRESS d y� yi� � „�a s t`y LOT NO. TEL 3. NO. OF BEDROOMS DEN YES NO 4. GARBAGE GRINDER YES NO 5. SHOW DIMENSIONS OF HOUSES�j("�4 6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LINES 7. SHOW DIMENSIONS OF LOT 8. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL 9. NOTE LOCATION AND DISTANCE OF WELL FROM SEWERAGE SYSTEM ,A 10. SHOW LOCATION OF BROOKS, STREAMS, DITCHES, LEDGE OUTCROP, ETC. 11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE /O NOTE: LOCAL REGULATIONS SHOULD BE READ CAREFULLY. 1 4i�1� OPHF4l.T F� Lor 1 Y 5 zz� ti a (, Aa E-S sO PPL7 p rb Cl WELL- APPRO QD D C - stPT'ic sY s T� vEs�c,�J b ovt� DArt' APRzovPJ6 /urho,?iry 1 CNATINJ5 mowcki SYSTEM I N STA u-.4TI OA J Ex4V4TO,J 1tiSPI�-.6TtOti1 D/JrG Q ►�iJSs [� FAIL- FINAL 1,�5pFGrlonJ r-12 ,�PP(�OVE,I� �i�TC In-�� -g� i6PPl�V�n�G �(1�T+t0��►ry 49P(TjoMA(- 115 .j fDNs SIF= o►-�y) D�S�CiPr'�dv 1� DArC R�050 NS' Ru4L APPROVAL D,o�E APP)3ovvJG I'eq�e5-rcd addrlewul caPIO- y. _... �:� _� _. �, �. _ - ` TOWN OF NORTH ANDOVER NORTFj Office of COMMUNITY DEVELOPMENT AND SERVICES Fr°•'°� � HEALTH DEPARTMENT At 1600 OSGOOD STREET; Building 2-36 NORTH ANDOVE ,MASSACHUSETTS 01845 'ss„CHus"t Susan Y. Sawyer,.REHS/RS 978.688.9540—Phone Public Health Director �y Q �03� 978.688.8476—FAX D-BOX ����--- ❑ Installed on stable stone base ❑ Inlet tee (if pumped or >0.08'/foot) ❑ Hydraulic cement around inlet & outlets Observed even distribution Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEM ❑ Bottom of SAS excavated down to soil layer, as provided on plan ❑ Size of SAS excavated as per plan ❑ Title 5 sand installed, if specified on plan ❑ 3/4-1 Y2" double washed stone installed ❑ 1/8-1/2" (peastone) double washed stone installed ❑ Laterals installed and ends connected to header ❑ Laterals vented if impervious material above ❑ Orifices @ 5 & 7 o'clock positions ❑ Gravel-less disposal systems: type, number and location as per plan ❑ Elevations of laterals installed as on approved plan ❑ 40 Mil HDPE barrier installed ❑ Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: Wastewater System Documentation—Feb 2006 Page 3 of 6 Of"O o' 3340 O F 9 Town of North Andover HEALTH DEPARTMENT ,sSACNUStS CHECK#: DAT P LOCATION: - H/O NAME: CONTRACTOR NAME: Type of Permit or License:(Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: Q Septic-Soil Testing $ ❑ Septic-Design Approval $ @ S�tic Disposal Works Construction(DWC) $ � 5 ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other:(Indicate) $ Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer f 1 A Commonwealth of Massachusetts Map-Block-Lot ."'`O ..«X00 107.D-0113- # Board of Health ----------------------- o - Permit No ` North Andover ----------------------- PA. BHP-2008-0107 ---- BHP-2008-0107 8-01 7 FEE P.I. �SSACNUSt� F.I. $125.00 ----------------------- Disposal Works Construction Permit Permission is hereby granted John D1Vincenzo - - - - - ----------------------------------------------------------------------------------------- to(Repair-Outlet Baffle&D-Box Possible Line)an Individual Sewage Disposal System. at No 229 GRAY STREET as shown on the application for Disposal Works Construction Permit No. BHP-2008-010 Dated June 03,2008 -------------- d Issued On:Jun-03-2008 L4o olLhE.------------------- -- Commonwealth of Massachusetts Map-Block-Lot 107.D-0113- - O Board of Health ----------------- ! eA ; . North Andover Certificate of Compliance sACWust THIS IS TO CERTIFY,That the Individual Sewage Disposal System (Repair-Outlet Baffle&D-Box by John DiVincenzo ---------------------------------------------------------------------------------------- ----------------------------------------------- ------ ----- I Installer I at No 229 GRAY STREET has been installed in accordance with the provisions of TITLE-5-of the State Environmental Code as described in the L application for Disposal Works Construction Permit No. BHP-2008-010 Dated Printed OJun-03-2008 June 03,2008 - ------------------ -------------------------------------- ------------------ -- Board of Health 06,1/0312008 10:07 FAX 978 373 6611 J AND S DE17LCIPMENT la002 tic Dis �j�Stell TODA*Dt tr °+ OF Construction Permit b Sooj� � �� $250-00-Full Repair ° _ ( �,A����Jl�e MA. Q� $125.00-Component y--°.,,,,,, r,.,�-r ix�gcu,S� important: Application IS hereb made fora Bellmit to: Whon filling out a Construct a new on-site sewage disposal systetxl* forms on the /' j cpinputor,use [] Repair or replace an existing own-site sewage disposal system" only the tab kcy �) to move your �ir or replace an existing system component—What) cumor-do not yy Lisa the return A Facil1t/Information (Ire, key. Address or Lot# -'--- " — CitylTown Z.--TYPE OF SEPTIC SY�7E{VI*: [] ity(choose one) n*'If pump system,attach copy of electrical permit to application" F]Conventional System(pipe and stone system) [] Infiltrator or Biodiffuser(gavel-Less)(Attach a copy of your certification to install this type of system. D Pressure Distribution S.A.S.(No D-BOX)(Attach Draft Maintenance Agreement) []Pressure Dosed (D-Box Present)S.A.S_ 2. owner Information Game r Address(if different from above) — _ .' ... -`"—'- —- stat ? ... /�-J]— Zip Gode `wry+ Cityl-Town -72 Telephone Number 3. Installer Information Ner'nG of company r+{+t V Ad {f y I Code - GityfTown State Telephone Number(Leff Fbane#if possible please) 4. t7esi �r IrtfDrir9�ttiort Name of company -- _ Address — ..__..._....._.._�.. -- State Zip Code pityaown Telephone Number(e ast a to R9ach) Application for Disposal system construction Permit•Page 1 of 2 o 0 a PAGE 2 OF 2 Y A. Facifily Information continued.... a, type of Building: ResidentiaE Dweiiing of ❑Commerdal B. Agreement { w The undersigned agrees to ensure the construction and maintenance of the afore-described T a on-site sewage disposal system in accordance with the provisions of Title 3 of the 'J a Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of aPorth Aqnd ver, and n to place the system in operation until a Cert�ca#e of Compliance has twee iss d by t -sr,8 rd of Health. Na Date tl/? Applioat ,.r Approved By; (,Boar. ealth Representative y�fne .Date Application Disapproved for the following reasons: h c'p x n G T ti 0 x CJ BOARD OF HEALTH ` f No.Andover, Mass . SUBSURFACE DISPOSAL DESIGN CHECK LIST LOT # Gl Yyr ST APPROVED DATE .S DISAPPROVED DATE Provided: Reasons: /� 9 '361 Title V FAII, Reg 2.5 The submitted plan must show as a minimum: a) the lot to be served-area,dimensions lot C abutters b location and log deep observation hoes-distance to ties c location and results percolation tests-distance to ties d design calculations & calculations showing required leaching area e) location and dimensions of system-including reserve area i(f) existing and proposed contours (g) location any tet areas within 1001 of sewage disposal system or disclaimer-check wetlands mapping (h) surface and subsurface drains within 1001 of sewage disposal system or disclaimer (i) location any drainage easements within 1001 of sevvge disposal system or disclaimer-Planning Board files (J) kno= sources of water supply within 2001 of sewage disposal e system or disclaimer (k) location of any proposed well to serve lot-1001 from leaching facility (1) location of water lines on property-101 from leaching facility (m) location of benchmark (n) driveways (o) garbage disposals (p) no PVC to be used in construction (q) profile of system-elevations of basement, plumb, pipe, septic tank, distribution box inlets and outlets, distribution field piping and Other elevations (r) maximam ground water elevation in area sewage disposal system (s) plan mast be prepared by a Professional weer or other professional authorized by law to prepare such plans Reg 6 Septic Tanks A (a) capacit es- 50% of flow, water table, tees, depth of tees, access, pupping (b) cleanout (c) 101 from cellar wall or inground suL=dng pool (d) 251 from subsurface drains Reg 10.2 7 Distribution Boxes , (a) slope greater 0.08 Reg 10.4 (b) sump r � r ,� _ ' OFFICES OF: o Town Of 120 Main Street -: North Andover, API EALS :o .:r; NORTH ANDOVER BUILDING Massachusetts O 1845 COIVSEf2VATIGV sg„"�sQs DIVISION OF (6 17)685-4775 HEALTH PLANNING PLANNING & COMMUNITY DEVELOPMENT KAREN H.P. NELSON, DIRECTOR April 14 1987 s Charles Foster Building Inspector re- 229 Gray Street Lot 1 The owners of this house plan to install a swimming pool in there back yard. Since the Septic System is out front it should present no. obstacle to the pool and we have no objection as lum.g as the installation does not interfere with "the well, which is in the back yard. Sincerely Inspector Boara or He—a-HR-� cc- ZZ aGrrayetS , rht. mg1gc I �U�(�h'It r�� � r i' �� •' •• •� ' � � J c- � t } 1 999 �t'�fr�'' ,r3:1_• .'' , ;�,r •' �a�IK, b ( F-1 I'► LJIO mb, AC Y =t'r�`�•�;! �s,- s1Y,,�1°..r�•,.i, lY ,, '� / Record MAYA 9 2008 'y:) �` ;, , .fit J�,;II. �J•lr. Svy �Y'�`'1'll'i'd!1.: ' jr9 f j[Ijrrj�l' < 4 IVtt)v Y'.;r; . .:I'• d'{t'..•11 VVfY Y)'r''�I,�,,�11 �1 P:s: � 1 i;, n,IG'C�.V•!, 111 t „l,,,Illr,'i$J,y1i;J{ti 1•':v•wtr(,I:�f•:`,' • ' D1=P..ha� provided jhla (orm for use by local Boards of H I �F'`��TH ANDOVER be aubmlrtad to the local Board of Health -ThwlS j� Racc T or other appro Mor ty, - :„ A,,.FacIIIty,,Inforii ptlon �a Wb �y koy Address a move your.. — ;y` ;.wY';.r,.�,,,y'�'r•'„ .,. ;,:. ��. :.. '.•sk �;..,,'•• .'�.�;,' • , .., Code em QWnelr ,{• •�: ,r,�)1;' t l,`?'i N,..tp•3•,Ir'{.'U l,'i ,,w�l,''V��'id,t,', ,, J.•.:; .., ,.:�;/,,..111�y.1...,'.,•.r'..:iiti J:.'�� ';: _ :yJ'Add(e" {If dU(er�nl rcvn buUon) Clty/Town Slele - Up Coca 7410phone Number t (I {11.,u�:r lir ,,�1�' '.�I!+•I1 ,rY•. .. .. % Yr B� Pumplg ,;� i I%I {,V.Ifni'�'fii��r,rr,ll'l.,r:r)il%J�'{d�,ll�• l� �510-- p�6Coii,:ly2, Quantity Pumped: .,. ' •� r', ,',. ' Dole "Typ.e P1'.ayalem,, ', ❑ Cesspool(s) Septicenk T ❑ Tight Tank •' J'{�411�1t1''i/Jy�r�',,+f+i"�l,•:''� fl�""1tr•1" 1♦ " ffluan,� Tae ❑Filta�: ry (.pnk?., Yes ❑ No If :;:,I •,.,,,;;�,` a ;�r :?;'�;;, ''"' ,•���! yes, was If cleaned? Yes 111� dlpon�Q'GsY.;�„►n;,'1`.;,• .r •..f ,\i �t.l�} ��1'Jf l,�f r 4 dr;.l'''l;'�i!�.�'J}�L'i..., _ .1111 C la�v \I .1•. (, ,• ' '.,•,`'' .:�!/' 'r ry,,l .. .r:`Il��. X11' ,1�i1{1J. �•I�I.�'/,1i 'Y 1 I ,•tll'1I. Yll'1:�44•'(ill/.'11•}.�J�t t� l I1: \ r��,+(r� /.4.••11 ,1 r r { 9 l ; .i" art} \•�'ll ;••• ' ' f, .;�,1 •r, ,I,J .jl�'•''„,; ;.,� Vehld �� Number Nr:� �j'r��-,:1�` ?`r, Fvlf#�� �C:.i• .47;x�. �' '' /1 ,IC6n • •,C yi ' S\r ri%'1' ) ,�•,'i�(Yv�•,� 'rt11{1�nb Jh{1�111h',1 11Yr i J 7 ��`� �!.(t ( '•J�14'fH�)I�a�i r ( �� ,•;,,;,. ..,.7;�1',.l�oca on.wh@re co1r�lenks,were di�posad: 1 111 ,.�, ,``r .} r I ' . •'��1'::i'(7.{�,1II,1,��'�}�•y��•.:::;, ''-, ''.: :;'�;�:'..';'j,;r+„lr:•1.'J' Sbnatw�o(H�ule ' 1`J'r. •r;.'1,.11.n ,1,•I ..���I'�tilj�l.p...,.;..,.1'.•. r ht>pJrl, tivw,mass,8ov%deyp!vraler/apprCvaj&1(&forms,hfm#Inspact Syc(am Pumping Rawm June 20, 1963 Miss Mary Sheridan R. N. Health Agent Board of Health North Andover, Mass. Dear Miss Sheridan R. N. : An examination was made as requested in order to determine the suitability of the soil for the subsurface disposal of sewage on the proposed Gray St . (Lot #1) building site of J. J. Segadelli. The land in general is high. The subsoil in the area was of clay-gravel content and a 6-minute percolation test was .conducted. It is recommended that a 1,000 gallon concrete septic tank be installed together with 180 lineal feet of drain pipe. Very truly yours, 4'Vvilliam J. riscoll VVJD:hd Rece.IWO ti'OV 224'-,UiI Commonwealth of Massachusetts TOWN OFNORThiANDOvER 1- HEALTH DEP City/Town of N o r-I+ -ArdWle I ARTMENT System Pumping Record Facility Information: System Location: 'S+ Address City/Town State Zip Code System Owner: Name: I Adress (if different from location of pump) City/Town State Zip Code be,-7-00 yrs' Telephone Number Pumping Record Date of Pumping 14-1 111 Quantity Pumped 1.4 S—D gallons Type of System_�Septic Tank Grease Trap Other (what) System Pumped by: � af,l Company: ROOTER-MAN 46 Portland Street Lawrence, MA 01843 Location where contents were dig osed: � Signature of Hauler Date 01-7,111