HomeMy WebLinkAboutMiscellaneous - 23 SULLIVAN STREET 4/30/2018 (2) 23 SULLIVAN STREET t 1
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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
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D�te�dri 41 eZ:LE scnptlor�T f +17
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tj Flom . —_.To
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4 2)From To ry�rt
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' 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
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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
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rt ,k�yrs� a Z''l""^,i^ q! '�i1yP 1 argil•, r ir�tk'�fY y�.'s.�f ....
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SYSTEM P
UMPMG RECORD
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44
GO ON FULTOCOR
ROOTS BAFFLES IN PLACE
LEACHFIEID RUNBACKXCESSIVE SOLIDS
4 , FLOODED CARRYOTHER(ExPLAN)
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