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HomeMy WebLinkAboutMiscellaneous - 23 SULLIVAN STREET 4/30/2018 (2) 23 SULLIVAN STREET t 1 1 -- 21 G/1 G7.B-GG9MOGG.G { S 'vr • MAP # LOT # 3 PARCEL # STREET CO,NSTR,UCT.I.O.N-_..APPROVA.. HAS PLAN REVIEW FEE BEEN PAID? YES NO PLAN APPROVAL: DATE_7 271 APP. HY....._-'- --........._........_....._....._. _._. DESIGNER: _ — PLAN DATE ---- CONDITIONS 4:,Q5ev»en1 Qo/re-er06W-1 _hcor�_S1,7,4_-o ......__......... 6,e scI146 1 WATER SUPPLY: TOWN =WELL WELL PERMIT DRILLER._...._...JLG.L/ (/ aS........._._....... WELL TESTS: CHEMICAL DAIE fPPRUVEU._. 7 Q BACTERIA I DfAlE M-14RUVEv BACTERIA II DATE APPROVED COMMENTS: FORM U APPROVAL: APPROVAL TO ISSUE NO DATE ISSUED ��� �� BY CONDITIONS: FINAL APPROVAL: . ALL PERMITS PAIDE hlO WELL CONSTRUCTION APPROVAL ES NU SEPTIC SYSTEM CONSTRUCTION APPROVAL YES II.10 OTHER YES NO ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: DALE: Ely- SEPTI_ _ _Y_SZ R.J.4N. IS THE INSTALLER LICENSED? YES NO _._. TYPE. OF CONSTRUCTION: EW REPAIR NEW CONSTRUCTION: CERTIFIED PLOT PLnN REVIEW Y_l._:> I'lo CONDITIONS OF APPROVAL YES NO (FROM FORM U) ISSUANCE OF 'DWC PERMIT YES NO DWC PERMIT NO. INSTALLER: BEGIN .INSPECTION ES NO: EXCAVATION . INSPECTION: NEEDED: PASSED Py BY ^��---- --------- CONSTRUCTION INSPECTION: NEEDED: AS BUILT PLAN SATISFACTORY: . . 11 APPROVAL TO BACKFILL: DATE: V Zl BY—__—.____._._._—_______..___ FINAL GRADING APPROVAL: DATEABY—� _—____—___�_ FINAL CONSTRUCTION APPROVAL: DATE:__^_____,DY___.______ __ LOT 3 SULLIVAN ROAD ► SUBSURFACE DISPOSALSYSTEM ASBUILT NORTH ANDOVER, MA I PREPARED FOR:WHITE BIRCH CONST. CO. INC: 380 ESSEX ST. SUITE I l �yh LAWRENCE MA. 01841 DATE :MAY 2211993 ` . s ' SCALE: NTS' PREPARED BY : ENVIRONEERS, INC. - P. 0. BOX 516 f ! N0, ANDOVER, MA. 01845 i�. INVERTS E�EV TIONS a. DWELLIRG OUTLET I 3 TANK INLET 17557 TANK OUTLET 175.30 D BOX INLET . 172.64 i D BOX-OUTLET 172.50 ('.HA MRF R INLET 172.24 ' BOTTOM OF CHAMBER 170.24 1 7' -' NOTE: FOR PROPERTY DESCRIPTION SEE N.E.R.D. # 12101 Wed I I � LI r, TVAP/I� U ' dJ a t i t � ,VG : Iz?— L.. T IN J - v Z , 5� , � 0T R , , s CSL. AN i : E o1:E4�gpO mit tv(tJon of y�ter Fta [�11111t ''�, P1Q,1 u+�� �. G�zq�c�l�!;�•�Ic��scnl�'r!o IV dr v,r�•: 7f ^i ri r s Nr�il I ' `W 41t 6osrd w!klegtth'poinnt °` Ycr :;?)Fno. rntcrsect, w/1� f l f f, ! �� (road)'• tt ;� < WELL;IJS ;::ati:y,.};n,lt^� ,1., `�r; WELD ATA.st.`+, ' Dprne PWWI, {t{tiat 4 }ts�7.. rtrt . ; }Arri aY Mnitonn ' Otttar ''• ' �' � pth'lo Ucdrpck' rL ti fR 1Srt:: a1 S Wat ,bcnn g rockhrnconsolidated matcrlai ' ell>_o� j•1 ) '' `"`k' , r, ,': .,� (/f�+•��—t�-^,��.•r. J' c .i•„y t !(' Q D�te�dri 41 eZ:LE scnptlor�T f +17 /p�,. A. Waicl-bsaring zone" s:'''•: ( r tj Flom . —_.To lr Ty 4 2)From To ry�rt ?o r CIM Yl ' Len th i to beds c rrn !t x N Gravel pack well d,r '�, �� f�i�r• �;,r k "�,!yh�'�-;s Scrccn � , d{a *'`' ',' �'"�4'si G out❑ _' Other ' l,; -Slot length . from:to Y' S`rACtC WAYEA L1:VEL. �: L �.P;;rr s».�r ,� ..S r;',.. , •l r t ,I-'•'(x Slatlpwotar level bel,,ow tmdlsurtaeo ='`ft` .; Onto_. WELL7S 7� .ur { rr.cirk '! S*.. r M1 I a1 �y9p1r t 1'� y � 1 }',7 7'2•"' �� Y CYf!?t(7"�"y�'.•µ. .1 -h' S is i�'i_. , PFOVMowt Mt'Y�„ftof,oS,Pumpfng hr min a •� `^ ' ,+.(�E;r .t'2:Yty ,{li,J �1�!'1+ °ir,�S,ly)'. +►iM ,�rtrnpa !TI �',fYt C `r !j]]ow•rye lvAt E;ec y�)�r�' �t ti .sttor_ _hr, min. LOG o &�'!FORMATIONS'-:,z COMMENTS •:',:,•1:;k4�d;.,•: .;:�:•.; 'M�,n�,.y,1,3'%�yi�ti �� ';;L,,�::.•..:��]�'''�.''-� .f,( 5� ,� ) Idalerlah�'I'7• From Te �� "�Y+wf-V�'. .7.!, :',� .I IQN Ii/iYt 5.:• _ 51•r ,tf, ,,t/ 'Ci:•J.j•'�tgi"' ::'1 l,': � �.�:,:•r;;Y� ',:,7.;.: , ? � � `C ''Mast .,tiz'. �. A fir• `'• tr,�,Gw• :, :( c:1 -r�_�,.'d' �,r�.'`..,J�.ti ,k..r. _ Fip�y�+�1 t(l (' �t:•�.' r i•-•: :�I�; t' . ^ '1 �.,.{ '+'•) J. .•'1 ....'.'�, aClr.'.yf,'� :.�r;M.... ��h//(�i �; � •�rLr�'i'•tr}'" I y .r'n,:. a 1yV!is ,•'^ <•r,• ,I . vka�'f:'r:3: � •bi1�; >��x'�:IT ',Addlei � •. I. •• iY 1'Ge..: r. F •h i'�''%`G YrSl• � ) :.+. •t,•..• .A.., .y ii f ,. AF '`'� ;:1;'! :fY,Cs`,P°:^lSpl tl,'t•,f1':�a�Ik[',�ir'n4r •�r,1tY(T'��r1'J���,�--='1r o11,.y''�" � � a. nafrrn c urpuris ng rr0J1(In 11 VNl rr `Pn�,.panrrrmry.,y BOAR,D.:O HIrAi.TH•;COP ,,• 5rhoutewev ,C'akiratoey, enc. 66-UTTL£TON ROAD WESTFORD. MA 018$6 '.. (508) 692.8395 FAX (508) 692.0023:, ,•:: ,. 1;800.644-TEST ; - Report Number: C-6284, Report Date: July 24,1992 " Client: Sample Taken At: Mr. Roger Skillings : White Birch Construction Skillings and Sons: Lot 3 Sullivan Rd. 269 Proctor Hill Rd. - N.Andover,Mas8 Hollis NH 03049 Sample Taken By: SKS Staff On: July .22, 1992 `TEST .PARAMETEit• -??+�a�+- � 4 EPA:Max- .RESULTS`�• •,. _ UNITS�-._ ;rx„- ,;,� _ �D.^i::` .?, M'}','-''�l.'�.�c'1!c,6''i . ' .` _ •.Y. ,- ,4 .dFh'JG{-w•4. ...i: .I`•, T ,Coliform _ 0- - Per=:100:n1< "kt .Calcisim:` -'sx 421 Nomf h 4 ���• ;•,,'' x '. �►* Q. �. �«22.:3: ,2:;: ' :<'mo/L ..• '" ,e `Copper.,,.(S} ,-*''..y�tif. �#��R y �'�� ��'�' �"f �'::r..a.�'i3.: T�ti:•;;`' �,Iflg/L � v4� ,.,- �:�- • rl -Iron. (J) a7`'�r`•!ti • {!y,r� Q'i ;, .-s-�{ �Q',0�;v%'� ,R ....0/L' l_{.:t c�. �'�Y, ti, ..a f Magnesiwn 'r r% NO Sy}TAtrt;. qtr �4i1`M;.2.7 Y ? .Manganese (S)+ fl.05 ,�� 4 0 �� ._...: , Sodium h �� 20 13:6ing/T� ` Potassium (S) l No,,.i,imiz ?n 2.2 ".m8/1;:':-; ' S�• t r, Alkalinity (S) = Na Limzt `4 79 a�g/lrr V Y Ammonia 6 Limit': <0.03 mg/7J rChloride (S) 250 3.8ms f Chlorine (total} 0 7 r <O:C2 mg�L'r - Color (S) "a 0 - Conductivity y No Limit 180 'iimhos/czn ,tr J a Hardness Na Lzmit h Nitrates(ai'., ) P) 10 0.02 mg/L' Y Nitrites(as ,N) l <0:01` :4 �8.0�,''L ,, :y X14 c•:. .SL .•;:. �.;t:.r' •� .:Odor.'(S).,�<3.�>•�'c���T`....., ' ...._. ,Sulphates .(S) 250 Turbidity 5 - Z:7 � r Sediment pos/neg n6 -_ K NT'=Not Tested, J� -Value`-'Exceeds `EPA STDs_ TNTC=Too Numerous to Count _ Bacicgroiard `Bacteria%Noted, EPA Advisory Limit i , =E'ceeds EPA Adv' sory :Limit r - err/r: ;:�.;.:.'""': .. ::•, .:' , '�-;•- (P)=•Primary,;.EPA..Standard, (S)-Second"ar9 EPA•Stand"ard (may_ affect- aesthetics of drinking gaster i e, taste, color., etc'..) _,. ti�.:a� Thzs water sample'; as tested, meets or erceefls EPA -health standards x k for the parameters listed above'::.The quality""of this: water is , �r .r . . 'r accepted as;.POTABLE according to:EPA Standards. �lassachuaetts' State Ceztif_ied 14�ch P:' arlson, fo= M. Testing LaboraCory.`VII.A04S ':Thorstersen Laboratorylnc. ________________________________________________________.__-______-_____________- A It 12 192 07:59:59 _ r' f 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 local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: U(M (�-P I Fr Al'i IA AJr-i -C R T Y C o(k P Phone 6 Z A-"oc. LOCATION: Assessor's Map Number Parcel Subdivision K1,ozit, "A Lot(s) � Street 37St. Number z' ************************Official Use Only************************ RECOMEENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments -J-,-/t L� Date Approved Health Agent Date Rejected Comments Public Works - sewer water connections. driveway permit �440;4 ad (0-d ,4f /tel FireD partment Received by Building Inspector Date P1 z c� NEW ENGLAND ENGINEERING SERVICES INC June 18, 1999 North Andover Board of Health Town Hall Annex 27 Charles Street North Andover, MA 01845 RE: TITLE V REPORT: 23 Sullivan Street,North Andover Enclosed is a copy of the Title V report for the above referenced property. The systemap sses our inspection. If there are any questions please call me at my office, 686-1768. Yours truly, Benjamin C. Osgood President TOWN OF NORTH ANDOVER/ ROARO OF HEALTH . UPJ 2 1s 2 99 33 WALKER ROAD-SUITE 23-NORTH ANDOVER, MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 I TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B. STRUHS Governor Conunissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: d3 Suu-1 V,4N ST. !N 4i itcuE,2 Name of Owner �t4(Z t �I�LTZ�N / Address of owner: � 3 S.-ILS-1y�Nl 5i. � N•f�NoavE�' Date of Inspection: �f l S/ Name of Inspector:(Please Print) Benjamin C. Osgood, Jr 1 am a DEP approved system inspector pursuant to Section 15.340 of Tide 5(310 CMR 15.000) company Name: New England Engineering S rvi c s Inc. Mang Address: 33 Walker Rd. , S ,_ i rt_ P ?1, North Andover, MA 01845 Telephone Number: 978-686-1768 CERTIFICATION STATEMENT I certify that 1 have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: _Y Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: Date: In The System Inspector shall submit a copy of t is inspection report to the Approving Authority (Board of Health or DEP)within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should,be sent toZhe system owner and copies sent to the buyer, if applicable,and the approving authority. NOTES AND COMMENTS revised 9/2/98 Page I of 11 A `.* Primed on Recycled Paper i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A A, CERTIFICATION(continued) Property Address:J`3 Jvi a ti ww Owner:Ctjjz�S U14i-1-014 _ Date of Inspection: (�o//5199 INSPECTION SUMMARY: Check A, B, C, o/ D: A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 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. 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, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank, whether or not metal, is cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. _ 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 pumpirtg-Tnore than four-times a yeardue to broken or obstructed pipe(s). The system will Fess-- inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed revised 9/2/98 PvBe2oru I I i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: a3 suU4 v.4N J%r, N• Ambew Q- Owner:C 4 M ILA L-ioiO Date of Inspection: 61 f 5/99 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH iDETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICHYaLLPRQIECT THE PUBLIC UEALTIIAND SAFETY.ANQ THE ENWBONMENI: Cesspool or privy is within 50 feet-of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. W SUPPLIER,IF ANY DETERMINES THAT THE SYSTEM IS 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SU L ) i FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: - The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or'less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER I revised 9/2/98 Page3orii SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Z 3 S u L_'� A N S i. N•/�N JOV F/� Owner: (`t¢Q"f 1 Date of Inspection: Co//5/9 9 D. SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: I have determined that one or more of the following failure conditions exist as described 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. Yes No Backup of sewage into{ecility-or-v"tern component duet o an overloaded or cieggodSAS-0r•cesspool. �- Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is-within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well,water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. I E. LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system ie-within 200 feet of a Esi H ry4o-a eurtaoa d«niaiwg water-suppllr --• -- •• -— 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) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. i revised 9/2/98 Page 4orii SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner: cr41Z1� w�LToN Date of Ins Dat Pachon' 99 Check if the following have been done:You must indicate either "Yes" or "No" as to each of the following: Ye' No Pumping information was provided by the owner,occupant,or Board of Health. None of the systemsompopwiu.harwl»an prratiped4oratJeast two aweaks an&she'systam hasAmmomacaiaiwgwaa nal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this / inspection. y _ As built plans have been obtained and examined. Note if they are not available with N/A. Y _ 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 orr the site has been determined based on: Existing information. For example, Plan at B.O.H. Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) / (15.302(3)(b)) v _ The facility owner(and.occupants.if different tram-o caner),were-prnvided.with infntmation.vn.theproper xnain* n-Q of SubSurface Disposal Systems. revised 9/2/98 page 5orn SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART C SYSTEM INFORMATION Property Address:Z ,Sul-LI Vel Owner:CaM% W AOW Date of Inspection: (0 FLOW CONDITIONS RESIDENTIAL: Design flow: g.p.d./bedroom. Number of bedrooms(design):_ Number of bedrooms(actual): Total DESIGN flow Number of current Tesidents.L Garbage grinder(yes or no):—" Laundry(separate system) lyes or no):-4/0; If yes, sepacatainspection required _ Laundry system inspected lyes or no) Seasonal use (yes or no):—Mb Water meter readings,if available(last two year's usage(gpd): IJ GLL Sump Pump(yes or no):_ 140 Last date of occupancy:_LI2_?,Zli-tr I— COMM ERCIALfINDUSTRIAL: Type of establishment: Design flow: qpd ( Based on 15.203) Basis of design flow 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 pumped: gallons 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,ii any) 1/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installediif known)-and source of•iMormation:. Sewage odors detected when arriving at the site: (yes or no) ND i revised 9/2/98 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C r r SYSTEM INFORMATION(continued) Property Address: 2 Zl S U 1-L I VA( ST, 1 Owner: C-ok!i u k:L D N Date of Inspection: 15 I q9 , . 1 BUILDING SEWER: (Locate on site plan) Depth below grade:_ Material of construction:_cast iron_40 PVC_other(explain) Distance from r private water supply well or suction line Diameter 4 Comments:(condition of'oints, venting, evidence of leakage,-etc.) _•- . (��P� i..noK-� �t�> ►!r $RSErin.E 1�7r SEPTIC TANK:— (locate on site plan) Depth below grade:IE3 Material of construction:_concrete_metal_Fiberglass _Polyethylene_other(explain) If tank is(metal,list age_ Js.age.confirmed by Certificate of Compliance_(Yes/No) Dimensions: /500 �y�gtL-CN 5 Sludge depth: Distance from top of sludge to bottom of outlet tee orbaffle:Z(� Scum thickness: I/ Distance from top of scum to top of outlet tee or baffle:[ Distance from bottom of scum to bottom of outlet tee or baffle:1� How dimensions were determined: Comments: (recommendation for pumping, condition of inlet and outlet tees or-baffles, depth of liquid level in relation to outlet invert, structurel4ntegrity, evidence of leakage, etc.) GREASE TRAP: (locate on site plan) Depth below grade:---- Material rade:_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: 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.) i revised 9/2/98 Page 7ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C �+ SYSTEM INFORMATION(continued) Property Address:Z'� Suwlu" Jt. I Date G 1 IP S� 6115101cl TIGHT OR HOLDING TANK: JVr' (Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_Fiberglass_Polyethylene_other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm present Alarm level: Alarm in working order:Yes_ No_ Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches,etc.) DISTRIBUTION BOX: 13ox NOT Fo�')N> (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) — —— /3 ;K /c«leU t ry0�2 dr'IvE PUMP CHAMBER: NA (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) revised 9/2/98 page 8orii SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: "JdLL(vRni Si N AAJI^ R- Owner:C:wi� WAM/4 Date of Inspection: SOIL ABSORPTION SYSTEM(SAS):_ (locate on site plan,if possible:excavation not required,location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number:_ leaching chambers,number:_ leaching galleries,number:_ leaching trenches,number, length: leaching fields, number, dimensions: overflow cesspool,number:_ Alternative system: Name of Technology: Comments: (note condition of soil, i gns of hydraulic failure,level of ponding, damp soil, condition of vegetation, etc.) 3&'4 OF Pin, 1,00K Cf-UOs� d T&.JEs�sTf—1 P2^r31 0 w -Tr► A A)9A' Doti N " 5-.,-P"V&----- SI v.v c- WAS CLEAN A1J�� !�2Y CESSPOOLS: (locate on site plan) Number and configuration:. Depth-top of liquid to inlet invert: Depth of solids'layer: Depth of scum layer: Dimensions of cesspool: Materiels of construction: Indication of groundwater: inflow(cesspool must be pumped as part of inspection) 4 Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of-vegetation, etc.) I PRIVY JY.tI (locate on site plan) Materjals of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation;etc.) revised 9/2/98 Ps e9orIi SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C r SYSTEM INFORMATION(continued) Property Addre : Z3 JULn_)V YU S,_.) N NDDV�R ss owner: cq�t� Ml.7" $ Date of Inspection: (p r,5 10M SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) ►4005 E i ti 13.5 3g.5 ,.r 35 58 \"`� 1-o ccc� u✓l: �..;l.ele. s y s�wl s �n e C� f> nal revised 9/2/98 Page 10 or II L w rjy' .r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: C t'hz15 Date of hupection: e/l /9q NRCS Report name L X cu" ry KL) Soil Type_ Typical depth to groundwater 7(G�•O' USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope > �� Surface water Check Cellar Shallow wells Estimated Depth to Groundwater .Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed.Site(Abutting property, observation hole, basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators,installers _Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) \ti-i7I !rR1 - L F9(moi Ile v_ .+JF 2 Z J S s c S I A> 7•C A TZ-S tom, q-rz i2 revised 9/2/98 page ttorn ,.Lv7 3 5�c�✓.9�/ AS-BUILT CHECK LIST and FINAL INSPECTION Proposed Elevations As-Built Elevation House 4(:P- Tank IN Tank OUT f7`1- Os_ 7� D-box IN 7�. G f 7 D-box OUT 7a Trench Inverts Line 1 /Pa,67 f7v� Line 2 Line 3 Line 4 Bottom of Exc. 176-07 X 7o, 4 Stone OK? D-box checked? Pipes cemented? PLANNING...- r"'""-CONSERVATION _ FINAL SEWER/WATER �j s���IrINAL own ® N :® �9/ ndover No. DRIVE AY ENTRY PERMIT-' ortA,KAa' er, Masse, ® 9yex NA Cu H ME wiCn\ V �i O' r pP f, BOARD OF HEALTH RMI PE 11 1 LD /663 THIS CERTIFIES THAT.W.A.I.r.Seles.A.eo.w...: •�r ^V.q�................ BUILDING R ILD INSPECTOR CTO has permission to erect .:: . .. mldings on ... .. .... .. .. ... .... ... Rough e4 it/( ` r Chimney to be occupied as. � � . .� ~� � Final provided that the person accepting this permit shall in every respect conform to the terms of the application on file in ''! PLU BIN INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of oufi�� , PERMIT FOR FOUNDATION ONLY Buildings in the Town of North Andover. REGULATED BY PARA. 1.14.8-S. B.C. Fin '11, v VIOLATION of the Zoning or Building Regulations Voids this Permit. ELECTRICAL IN_SP CTOR PERMIT EXPIRES IN 6 M6.A1tf y'° ', ' FEE PAI o ) " '�'EESS CC�(�S�(�I?LJ�:TI®f� ST/�RT:� �'`�;:>>: � ,� Rough e�9 eolC- . PERMIT FOR FRAME/B�1ILDIN� Final Q •• ' DATE: FEE PAID:___ •BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough I Final Display in a Conspicuous Place on the Premises FIRE IL DEPT �1�.�i `•l Do Not Remove Burner 4-1` I No Lathingto Be Done Until Inspected and Approved b �'� P PP Y Smoke Det. Building Inspector TOWN OF NORTH ANDOVER BOARD OF HEALTH Location (,DT*3 Permit # 4 9 2- Food Service $ Retail Food $ Limited Retail $ Seasonal $ Disposal Works Installers $ Disposal Works Construction $ Soil Testing $ L(�— Design Approval Permit $ Dumpster Permit $ Burial Permit $ ;r Swimming Pool Permitylolf' Animal Permit Recreational Camp PermitZ Well Construction Permit' $ yF. Funeral Directors-Permit $ Massage Establishment License $ Massage Practice License $ Suntanning Establishment $ offal/Trash Hauler $ Other $ 0 013 Health Agent White - Applicant Yellow - Dept. Pink - Treasurer Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH APPLICATION FOR SITE TESTING/INSPECTION �q A�AATED SSACHUS� Applicant✓� NAME ADDRESS TELEPHONE Site Location Engineer--C�Y1n 1✓��k.Q� QqI o f � 3�as 1. NAME ADDRESS i TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee < Test No.-4c) S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No. 1 NORTty BOARD OF HEALTH Hyl h �N APPLICATION FOR SITE TESTING/INSPECTION �9SsacHUS���y Applicant0 NAME } ADDRESS TELEPHONE Site Location Engineer �i`�1 ' ' TELEPHONE NAME ADDRESS Test/Inspection Date and Time 1� CHAIRMAN,BOARD OF HEALTH Fee CID Test No. {_J_ 0. ?" S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. a Q u t�. r � ASS IATO ING � March 20, 1992 J � / Board of Health Town of North Andover 140 Main Street North Andover, MA 01845 Re: Perc Tests at Route 114 and Sullivan Street Angus Realty Trust Gentlemen: We are requesting to be scheduled for perc tests and groundwaters on Lot 3 at the above referenced location. Please find attached a print of a Plan of Land in North Andover which you require be submitted prior to scheduling. Ken Yameen will bring you a check in the amount of $150.00 on Monday. I will be calling you Monday to confirm your receipt of both and to set up a date for the tests. Thank you very much for your attention to this matter. Very truly yours, THOMAS E. NEVE ASSOCIATES, INC. l Linda Morkeski cc: Ken Yameen • ENGINEERS • • LAND SURVEYORS • • LAND USE PLANNERS • 447 Old Boston Road U.S. Route #1 Topsfield, MA 01983 (508) 887-8586 FAX (508) 887-3480 i i Town of North Andover, Massachusetts Form tim 2 BOARD OF HEALTH O��►s f� '�' - t 'DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant 1 Test No Site Location_ �[4z 3 _�. ►�rn Reference Plans and Specs, Y 1 a, .,t_ ,rr , ENGINEER DESIGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health.; CHAIRMAN,BOARD OF HEALTH Fee L {` Site System Permit No. S NUMBER FEE THE COMMONWEALTH OF MASSACHUSETTS $25. 00 TOWN Of NORTH ANDOVER ..................... This is to Certify that ...........§�killincrs & Sons ..................................................................................................... NAME .......2-6.9...Pxac t a r... Road'—.H.Qllis . ADDRESS IS HEREBY GRANTED A LICENSE For .............................Well. . . Drilling Permit Lot #3 Sullivan Road ......... ..... .............. .............. .. -------- .... ...... ............. ..... ..-- -•••...••-••••---••••--••••-••••.••---•-•--••---••...--•---•-•-----••---•••••--••-•••-•--•--•-••••••------•-•-••---•-••-••••-•••--••••••-•---••••••--•--••--•••••-•-•-•-... ............................................................................................................................................................................ ............................................................................................................................................................................ ............................................................................................................................................................................ This license is granted in conformity with the Statutes and ordinances relating thereto, and expires.........De-c-e.mke-r....3.1......1-9.9.2-.... 11 88 sooner suspAnded revo ------ -- -------- .... ............... . .......... ... ...... ---------------- July..AP-1..................19. 92 ----------- .......... ... . ................................. ------- ---- .... . ... .... . ..... ............. FORM 433 HOBBS & WARREN, INC. ......... ...... `•. . . .................... DATE ojl Sheet of BOARD OF HEALTH TOWN OF NORTH ANDOVER SUBSURFACE DISPOSAL DESIGN REVIEW FEE � PERMIT # DATE RECEIVED 4� Z 9� APPLICANT /7 ASSESSOR'S MAP ADDRESS PARCEL # LOT # ENGINEER STREET ADDRESS PLAN DATE I-IRA V-7 REVISION DATE CONDITIONS OF APPROVAL: f/SC SG, �� 7 11/t'UD6T APPROVED ?---� DISAPPROVED Department of Environmental Management/Division of-Water Resources WATER WELL COMPLETION REPORT WELL L_QCJ GEOGRAPHIC DESCRIPTION t dr ss 10o " N S Q) W of (feet) (circle) City/Town _ 16 Well owner (road) 1H Ad ass N S E W of e Q, / (ml.in tenthsl p� klrcle) Board of Health permit: yes 12 no ❑ intersect. w/ls�"� I`q (road) WELL USE WELL'bATA DomesticPublic❑ industrial E] Total well depth ft. Monitoring❑ Other Depth to bedrock /� ft. Water-bearing rock/unconsolidated material: Method drill �"e�� ��" vescription Date drilled ` Water-bearing z CASING ones: 3 �/ ( Q 1} From /:!� To 2) From—To Length It. Dia(I.D.}�_in. 3) From To Len6th i to bedrock _ft. Gravel pack well: dia. Prote e+J .4 � Screen: dia. G,Pout_❑ Other Slot _ length from_to j STATIC WATER LEVEL ` Static water level.beiow land surface._ft. Date Z- A WELL TESTS �� DFawdovvi1 /U ft. after pumping-?—hr. - min.at ' gpm �=su a Rec y ft. after—hr. min. 0 LOG of FORMATIONS COM ENTS Materials From To C��"'Vf/�� ! iFtV7 �►i Q Driller Mass. Re do L� Fir Addres ,,�// City/Town r nature of srrpervisln re istera ell dr/l/er Passe print firmly BOARD O HEALTH COPY •. BOARD OF HEALTH f Town of North Andover ,Mass . D to 7' d 19 !rmit # APPLICATION FOR WELL & PUMP PERMIT �plication .is hereby made for permit to drill a well . Application is ide to install ( a pump system. • �.,. . :)cation: 'Address • • Lot It aner Address q/-: 7�r� ' - 3 ( � Te1429'- 211 fontractor - ddress ' imp Contractor Address--2 �` -°�' Tel . Co ELL CONTRACTOR (To becompletedat time of pump test ) ype of Welles Well used for iameter of Well Size of Casing epth of Bed Rock `� Depth casing into Bed Rock 'ias Seal Tested? Yes M No (—) Date. of Testing `7 A (� i - � 1 'epth of ��Ie=l — Well Ended in Wha-t- Material �epth to Water_ �� Delivers Gals . I'er Min . for 4 hours lrawdown ,?�/o feet after pumping _hours- at _-J�GI'F'• _!)ate of Completion gna ure 0 1I Co r c or 'UMP INSTALLER (To be'• ftlled in bcf rc insta]_lati_on ) size & Name Pump 3/ __ ____ ____.__Pump Type Used 'later Pump Delivers �GPM Size of Tank GL . Wipe Material Used in Well : Cast Iron (_) Galvanized (_) Plastic Jell Pit (_) or Pitless .Adapter ( C.Y Jas sleeve used to protect pipe? Yes (_) No(�ype or Name Well Seal�it/l )ate 7 . �1 J ;i;, , , ,,, , ..,. . :: I Date Water analysis repor-t• 'submitted to Itoard of health__ Date release given tD owner of record & Bldg . Insp Health Inspector PLAN REVIEW CHECKLIST ADDRESS I ENGINEER GENERAL 3 COPIES C/ STAMP C/ LOCUS SCALE CONTOURS L� PROFILE �'✓ SECTION i/- BENCHMARK ELEVATIONS `� SOIL & PERC INFO WETS. DISCLAIMER WELLS & WETLANDS ✓ DRIVEWAY WATER LINE ✓ DRAINS WATERSHED DISTRICT RESERVE AREA i/ SCH40 SLOPE SEPTIC TANK MIN 1500G. C,, . 17 INVERT DROP GARB. GRINDER.YZ)- (+200 EDF) 25' TO CELLAR ✓ MANHOLE TO GRADE L--' ELEV GW D-BOX C # OUTLETS FIRST 2' LEVEL STATEMENT INLET - OUTLET/7,?,-4. = o�0 (2" OR . 17 FT) LEACHING / 100' TO WETLANDS ✓ 1001 TO WELLS/ 325' TO SURFACE H2O SUPP 351 TO FND & INTRCPTR DRAINS 4/'' 41 TO S.H.GW L,- " 2% SLOPE 4' PERM. SOIL BELOW FACILITY ✓ MIN 12" COVER c/ FILL? (25' if above natural elevation; 101if below) TRENCHES MIN 660 FT2 SLOPE (min . 005 or 6"/1001 ) >3 ' COVER? - VENT SIDEWALL DIST. 2X EFF. W OR D (MIN 6' ) IS RESERVE BETWEEN TRENCHES? IN FILL? MUST BE 10' MIN. BOT X LDNG + SIDE X LDNG = TOT (L x W x #) (G/ft2) (DxLx2x#) Ili PITS MIN 660 LEACHING GW MIN 4' BELOW BOTTOM MANHOLE/PIT EXgAV 2x EFF W OR D 12"-48" STONE SURROUNDING z/ 6 6�C BOT + SIDE 7pZ x LOAD = TOTAL FIELDS Foo MIN LEACHING PERC RATE FASTER THAN 20M/IN GW MIN 4' BELOW BOTTOM OF FIELD PIPE ENDS JOINED W/NON-PERF. PIPE? DIST LINE SLOPE . 005? >3 ' COVER - VENT SCH 40 MIN 12" COVER L x W = T x LDNG > DESIGN FLOW? I �I 111111 IIIIIAi111�I1111111lIIIIIII 11 111 1 11 �illl��lllllll II�11111 11 1111 11 l: �s�®Illllle 1�1 Ile 1111111 Illli '�IRIIIIIIIIIl1l 1 1 11111111111 11�! 11111111�11111 I - IIIIIIIIIIIl11�li�� llllllllll11111 11111111111(�II11�1�111111�1111111 1111111111E 1111111Ir1111111 IIIIIIMINE Qlimll 1111111111111 IRI 11111111II 1411111111111 r 3��III1lIl�ll..l1®111111111 1111 1 11 1 ®Q®�11111Mllllll 111 1111 1 it dM IIiiM 1 �1 111111 11 lell 0ml Esee NO 11 ee�e� it �Ili 11i11lIlls A III it �111.I. 1�!!� 111 1NCIQQ1i �Rh III 1!111 WINE III IIl!1I�IIIII Illlfi 12.11111 Iii 1115goi11111 Ili111 SUN I11eGLIMIN III 11lill�l1I/�1111 �ii��ii1 1��7Q1111 III1�1I1111 IIIIUI!111 !1��1I1111 NINElllll 1111®1111111IM1111111 1111111111111111®1 IIIIIIIIellllli Town of North Andover, Massachusetts Form N0.3 NORTH BOARD OF HEALTH Of t.�c ;s'1q,0 OL 19 93 O DISPOSAL WORKS CONSTRUCTION PERMIT S$ACMUSEt Applicant_ .. Y .n o 1-4jJ NAME ADDRESS TELEPHONE Site Location ,n „,, �. . Permission is hereby granted to Construct ( or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. 'r CHAIRMAN, BOARD OF HEALTH Fee D.W.C. No. (aa(-0 �°u ix• rt rpt=' . ,, ,. .._...,__-__ _.... i .w'. rt ,k�yrs� a Z''l""^,i^ q! '�i1yP 1 argil•, r ir�tk'�fY y�.'s.�f .... rs �'rs (,1 i1_ �U��rs�{Yl� i�;f,� �1V��ri �f+Nh pS �nR;l. �S t ri r-�s • t �flbri`"•-iTt, x t, �N,+',+rtMk e�{If , �tY; yM+r : t91• �Y �>, r � r t I� . � ��, .t" �i '•4rS1t , , iw 1 t,�r • 11 1''f t. q. ti , I , .. Y 5, ¢ 'w;y'4� �'i� rt f.klt'•rla� �}, ,n -� 1 .r •, +' �irti�i x try q�f� '0 K!<7rx. •r TOWN OF �TpRTH ANDOVER SYSTEM P UMPMG RECORD w 1 r iJ t«n t 11 t�ws1� �,se '�•f�1y4`•ryv�ri►�.t�'•��.a r,A�4�,y1r`r'.ii 1J�+1txjYM,,•l)�iJ�,'s{''r�';°.�:'+,��Y.'aM,,'ta'�1'{�•'5�r�t k,,r�yy�l7 x����J�NP�t,t.ttr{��r l3'td,J11 r�p=Ij=�•.,>�j�i;(r.rt+,��I4.ad','>rT':ipr:iifi.j"•11c=+�r.��`N�d,i l5�4fit',{���A'Ir,.4�S�c `��t�r,t�ya1�sy1t•r!ykl��.ar�t',�r�4,r'l p�i«r ltt,,�.)e'frd.}1T•'x!x'5t���FrM{jGrA�ti��4.b��i:�l•:i�}.�.�i.,:;�w xJD1{{{°xvr,�t r F��t=i,r,t�i^1't���sk�1+a�r.1,a}1�t�T¢1(,�r�"Ii;-t7,tt4��k�tN,L4 r5''r"1�4'���,aj'r.1tirrFf_r�tr.I++'.,le'vR.�''�� x,4'i,'i.�/+��':t9'I�?t.�:.�rty.y'.I$•z/?•�':,J,��r;X' 3yxviaiS0Isk4ht]i,'�yErt�iTlxss����R>n14 P'�•*4{rrl P{.ig.O��yi.a.o-f�))14 I)'t��.1rI��'ljfVt:;.O�"i.k�l;.•�;(y�11�t:...ql�.,,q{MrNi tify{N ?L'.i-.f�-.��,ei.ir-�12'.tIta f!i E,GV'{l L Y�il r!t+4IA��,.• t. slLt f.,�.r�1ra,S•frM,ia'e..:.:•e::E.t:;sr�y�,j„'.^.>8�)*r.4!erYj {I- ✓Y'i�,r�atr{r I4�Er,+r5',;.v1•L��-'i,I,'°,�`—s .'rs.+t.Yt1-.'n..,f!,.•x,:_`K'.ar.r1}�t@t4+'.1 P¢t`S,Ct,' ti'1I R�yi�✓�rF(V.+y':'�'t...T�.�'}�:'i.I wf , ... +; •�EM `I'_.� r. p. Ci, T I OYST Miti OQ!JANIIY PUMPED WN ” _ G AL� ON- S SEPTIC TAW: NS 0YES4 OFSRUTIECdERGENCY 44 GO ON FULTOCOR ROOTS BAFFLES IN PLACE LEACHFIEID RUNBACKXCESSIVE SOLIDS 4 , FLOODED CARRYOTHER(ExPLAN) O 771 F AIM, "DSS . • •. .' �a �TI'th�" l- ��,. '!'T ' , 74'1 T r ni •. ,. �. x - ..• d7tt c St T•�,ktr,9r a v f r ..e ,,ays,.,r I , • r, ! / �'� •t', . N t {a}a t.a�l ll t, 4i' s� CJrri000, 1 t, e� iy r�1 Y 1 ri)'►p,ah,.'t_�At.I$�tl l ♦. d. "R ,.61 t• ` n,r x a/ t11 'g'f+ • �>r���r�3,`�}�rtr��i,s i r't�{Il�:;hj tE•�./fw/ '/w/ .. y ..