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Miscellaneous - 247 FARNUM STREET 4/30/2018 (2)
F. t (Y� .VvOr\jS 4D North Andover Board of Assessors Public Access poR7y ort�7�.e ,� ryo Return to the Home page click on logo New Search Sales Summary Residence Detached Structure Condo Commercial Comparable Sales �� 0 Parcel ID: 210/107.A-0278-0000.0 SKETCH Click on Sketch to Enlarge Page 1 of 1 Property Record Card Community: North Andover PHOTO No P lGture Available Location: 247A FARNUM STREET Owner Name: DUNCAN, JOY ANNETTE DANIEL P HEYSTECK Owner Address: 247A FARNUM STREET City: NORTH ANDOVER State: MA ZIP: 01845 Neighborhood: 5 - 5 Land Area: 4.19 acres Use Code: 101 - SNGL-FAM-RES Total Finished Area: 2512 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 713,500 581,800 Building Value: 480,200 398,200 Land Value: 233,300 183,600 Market Land Value: 233,300 Chapter Land Value: LATESTSALE Sale Price: 425,000 Sale Date: 04/22/1999 Arms Length Sale Code: Y -YES -VALID Grantor: SUSAN PRESTIGIOVANNI Cert Doc: Book: 05408 Page: 0005 http://csc-ma.us/NandoverPubAcc/jsp/Home jsp?Page=3&Linkld=992842 7/11/2007 a N o � N h N � O O p d 4 c Q a D a W O x N z N 00 00 00 N N N 0 z o 0 0 o LC p V C C O C O O O CC a ti w O O i O I ra 0 3 A � s U (X • � C? O N i � W) O oIo r y y L A •W r+ y p au Q kn 3 0 v V p C CIl sem. C Cl �aA�'3aa:� CIO z q un o O O UO Q o C� G i Cl p o Ll�oo'0�r3 0 0 z o 0 0 W � s� �•.; � a m co m *� aw y +R h 4,k04 4 C S -- N va 00 N N N �� . It o O A U � 7a Y i O 3 w o •L c z 00 00 O z , C i kn�W) o 0 u O o •� N N S cn o _; x = � 3cv�l L U C G U a+ � � i U i I � L ! O O � +I U A L L o CA (A O 3 ce •a "p o U y y o w m Q o = z z U z W C41) V] Q7 � C:) ate+ O O N ti C A •� z W A V u o to U 7 Lr R y^ 0 I In o 0 0 � z c c •a •� N CD N 7 +. a d x x = co •r rr-- N �e a*r dor G O ti o N U C o ro a c o Y MAP # LOT PARCEL # STREET_ _.mow.... .--- .. -1- CONSTRUCTION APPROVAL HAS PLAN REVIEW FEE BEEN PAID? E5 NO PLAN APPROVAL: DATE �9 �� APP. DESIGNER: /y) 6"1M 19G/C PLAN DnTE. Bl/- CONDITIONS --- ------ WATER SUPPLY: TOWN WELL WELLPER T DRILLER._..._.._._._.__.._....__._....___.._........_. __._._.............____._... WELL TESTS: CHEMICAL DAIE OPPRUVEU C'TERIA I UA I E ()PPRUVED BACTERI -_II DATE APPROVED_____.._..___..__ COMMENTS: FORM U APPROVAL: APPROVAL TU ISSUE" � NO DATE ISSUED �' / l� � � BY CONDITIONS: FINAL APPROVAL:. ALL PERMITS PAID WELL CONSTRUCTION APPROVAL SEPTIC SYSTEM CONSTRUCTION APPROVAL OTHER ANY VARIANCE NEEDED FINAL BOARD OF HEALTH APPROVAL: NO YES NU YES NO YES NU YES NO DATE:. _.....__..._ BY:—. . 7088 •- r s Town of North Andover "�'••.,,,o .:`' HEALTH DEPARTMENT ,SSACNUS=4 ��I CHECK #: to ,DATE: LOCATION: H/O NAME: CONTRACTOR NAME: Tvve 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: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ itle 'Inspector $ itle 5 Report $� ❑ Other: (Indicate) Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer SERVICE PUMPING & DRAIN CO., INC. Town of North Andover Date Type Reference 4/23/2015 Bill 21910 4/23/2015 Original Amt. Balance Due Discount Payment 50.00 50.00 , 50.00 Check Amount 50.00 SP&D Checking Acct - 247 A Farnum Street North Andover 50.00 SERVICE PUMPING & DRAIN CO., INC. / 21910 Town of North Andover 4/23/2015 Date J Type Reference Original Amt. Balance Due Discount Payment 4/23/2015 Bill 50.00 50.00 50.00 \ / Check Amount 50.00 i SP&D Checking Acct - 247 A Farnum Street North Andover PRODUCT SSLT104 USE WITH 91663 ENVELOPE i 50.00 CO Owner information is required for every page. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. VQ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 247 A Farnum Street Property Address Joy Duncan and Dan Heystek Owner's Name North Andover MA 01845 4-7-2015 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. A. General Information 1. Inspector: Michael J Wood Name of Inspector Service Pumping & Drain Co., Inc. Company Name 5 Hallbera Park Company Address North Reading City/Town 978-276-0217 Telephone Number B. Certification MA State 5021 License Number 01864 Zip Code 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 S (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails RECEIVED ❑ Needs Further Evaluation by the Local Approving Authority APR 2 7 2015 4-13-2015 TOWN OF NORTH ANDOVER InspePs Signat ucAl TH DERART[ ENI 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 • 3H3 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 1 of 17 -- Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 247 A Farnum Street Property Address Joy Duncan and Dan Heystek Owner's Name North Andover City/Town B. Certification (cont.) MA 01845 State Zip Code 4-7-2015 Date of Inspection 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: 8) 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 Form: Subsurface Sewage Disposal System • Page 2 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 247 A Famum Street Property Address Joy Duncan and Dan Heystek Owner's Name North Andover MA 01845 4-7-2015 Cityrrown 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 ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 3 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 247 A Farnum Street Property Address Joy Duncan and Dan Heystek Owner's Name North Andover City/Town B. Certification (cont.) MA 01845 State Zip Code 4-7-2015 Date of Inspection 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: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than % day flow t5lns - 3/13 Title 5 official Inspection Form: Subsurface Sewage Disposal System • Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °e 247 A Farnum Street Property Address Joy Duncan and Dan Heystek Owner Owner's Name information is required for every North Andover MA 01845 4-7-2015 page. City/Town 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: ❑ ® 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 4 Commonwealth of Massachusetts Title 5 Official Inspection Form c Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 247 A Farnum Street Property Address Joy Duncan and Dan Heystek Owner Owner's Name information is required for every North Andover MA 01845 4-7-2015 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? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 660 GPD t5ins • 3/13 Title 5 Ofticlal Inspection Form: Subsurface Sewage Disposal System - Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form t Subsurface Sewage Disposal. System Form - Not for Voluntary Assessments 247 A Famum Street Property Address Joy Duncan and Dan Heystek Owner Owner's Name information is required for every North Andover MA 01845 4-7-2015 page. Cityrrown state Zip Code Date of Inspection D. System Information Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection D Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available ( last 2 ears usage (gpd))' 135 GPD average Detail: Water records were obtained from the North Andover Water Dept. Sump pump? Last date of occupancy: Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tank present? Gallons per day (gpd) ❑ Yes ® No currently occupied ❑ Yes ❑ No ❑ Yes ❑ No Non -sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5lns • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 247 A Farnum Street Property Address Joy Duncan and Dan Heystek Owner owner's Name information is required for every North Andover MA 01845 4-7-2015 page. City/Town state Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other (describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: Type of System: gallons ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Yes ❑ No ❑ 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): t51ns • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 8 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 247 A Farnum Street Property Address Joy Duncan and Dan Heystek Owner's Name North Andover MA 01845 4-7-2015 City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: This system is approximately 21 years old. It was installed in May 1994. Were sewage odors detected when arriving at the site? Building Sewer (locate on site plan): Depth below grade: Material of construction: ❑ cast iron 0 40 PVC ❑ other (explain): Distance from private water supply well or suction line: ❑ Yes ® No 48" feet N/A feet Comments (on condition of joints, venting, evidence of leakage, etc.): There are no visible signs of failure or leakage. Septic Tank (locate on site plan): Depth below grade: Material of construction: ® concrete ❑ metal ❑ fiberglass If tank is metal, list age: 36" feet ❑ polyethylene ❑ other (explain) years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: 10'xVx4' <3" t5ins • 3/13 Title 5 Official Inspection Forth: 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 247 A Famum Street Property Address Joy Duncan and Dan Heystek Owner Owner's Name information is required for every North Andover MA 01845 4-7-2015 page. Cityrrown 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 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 How were dimensions determined? >20 <1,r 911 20" tape measure/ sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): There are no visible signs of failure. Both inlet and outlet tees are intact and appear to be functioning as designed. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins • 3/13 Title 6 Official Inspection Form: 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 247 A Farnum Street Property Address Joy Duncan and Dan Heystek Owner Owner's Name information is required for every North Andover MA 01845 4-7-2015 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.): 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 Dimensions: Capacity: Design Flow: Alarm present: Alarm level: Date of last pumping: ❑ polyethylene ❑ other (explain): gallons gallons per day ❑ Yes ❑ No Alarm in working order: ❑ Yes ❑ No Date Comments (condition of alarm and float switches, etc.): * Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins • 3113 Title 5 official Inspection Form: Subsurface Sewage Disposal System • Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Insp Subsurface Sewage Disposal System Form F J 247 A Famum Street D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert at invert 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.): There are no visible signs of failure. 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 - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 12 of 17 ection Form - Not for Voluntary Assessments Property Address Joy Duncan and Dan Heystek Owner Owners Name information is required for every North Andover MA 01845 4-7-2015 page. Cityrrown 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 at invert 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.): There are no visible signs of failure. 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 - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 12 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form i; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 247 A Famum Street Property Address Joy Duncan and Dan Heystek Owner Owner's Name information is required for every North Andover MA 01845 4-7-2015 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system 3, 51' Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): There are no visible signs of failure. 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 • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 13 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 247 A Farnum Street Property Address Joy Duncan and Dan Heystek Owner's Name North Andover MA Cityrrown State D. System Information (cont.) 01845 4-7-2015 Zip Code Date of Inspection 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 • 3/13 Title 6 official Inspection Form: Subsurface Sewage Disposal System • Page 14 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 247 A Farnum Street Property Address Joy Duncan and Dan Heystek Owner's Name North Andover MA 01845 4-7-2015 City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand -sketch in the area below ❑ drawing attached separately t3G= 32��rr Aa= 140 t5ins - 3113 Title 5 Official Inspection Forth: 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 247 A Famum Street Property Address Joy Duncan and Dan Heystek Owner Owner's Name Information is required for every North Andover MA 01845 4-7-2015 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 4'feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 5/1994 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: Groundwater was determined by records available at the N. Andover BOH. 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 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 247 A Farnum Street Property Address Joy Duncan and Dan Heystek Owner's Name North Andover MA 01845 Cityrrown State Zip Code E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked 4-7-2015 Date of Inspection ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information — Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System •Page 17 of 17 Cb OF LU CD O a O ZAapp* > CO N Tc m O 0)X0 O O N -4 Dv znM (C — -•' X CD � =D' �y 61Z �r D ;u -0? 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IJ T �DD(�'(n"K� ,W�'W C co = = o�o'� n A(nU) z W3. o m W r N =0 3'D M �'�`Q,��. p m o m.n� co.m tli_ a'Dv N�...� :CD�FC'D Q i G' W n cnN NDN Z I 0 m W O �m 2 -� (n c v o�� C7 0 A iy v � p n of m /1 0o0 ,n � Cnrn 0 0 Q CD, z 00 CA CD 00 N ,7C O jV`� z D(n,C _ r n O fn 3 as D m= 2 a 0 CL tli t `. co cc r C) C„ ;am r r o w: (n Di D m D oo U� Cl) c)z m v� DiO ;uo� O z c �� Z yyr' N O oo Z a 0-n D.O c o'n NO 0 = m o C) Z E ic aaD to m D -6�-n 3 N-0'3f,.iya O Q_ Z O a NN) Z cD> Z ~a' 00 z ACOG WO CD N. ii -40 � r r Cn 0. C. o t N N N, -n al N � o y N 0 o y a O ZAapp* > 04@ DCCD x O O N -4 Dv znM (C — -•' X CD m =D' �y 210 �r D ;u -0? Z =C- - D 0 <� Dm�'CD c y� m� mZ m r o nz rn .4 Dm -n D m O Z1 o N A et D OD OD o O O z O o CD N 0) D) m N m m a ai O CCD CO CD "O — N 'O 7 n CD N CD 0 (] 0o N m N a N CD 0 0 C o n CD 0 cc N N D O x O O N CD (C — -•' X CD y 3N 210 a 'r Z)v 0 CO W Dm�'CD O CD n A W s N CDN O co p a CND CD N 0) D) m N m m Ei m m '0 <-i0T O O c 3 1 a CD CD iC A N 0 O CD y w o C-) o Z (Do M CD X D0 a o CDW00 C7 3 Ecom my a 3 m a O 63 o 1D p; U N Zoo 4 oA D 00 Co > z c CL CD CL 0 CA Nm�Doa ao =3-A X r ao m m o CD --i 0 W a ai O CCD CO CD "O — N 'O 7 n CD N CD 0 (] 0o N m N a N CD 0 0 C o n CD 0 cc N N 03/11/2014 BUTTERWORTH & O'TOOLE, INC. ADJUSTERS/APPRAISERS FOR INSURANCE COMPANIES ONLY P.O. BOX 8294 SALEM, MA 01971-8294 TEL. (978) 741-5731 FAX (978) 740-9109 claims@butterworthotoole.com FORM OF NOTICE OF CASUALTY LOSS TO BUILD UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B TO: Building Commissioner or Inspector of Buildings City/Town Hall ADDRESSES North Andover, MA 01845 RE: Insured: Daniel Hevstek Address: 247A Farnum Street i MAR 14 2014 x TOWNOF NORTH ANDOVER I v 4EALTH DEPARTMENT I Board of Health or Board of Selectmen Citv/Town Hall North Andover, MA 01845 North Andover, MA 01845 Policy No.: 2027512 Loss of: 02/20/2014 Ice dam File or Claim No.: 47-0323 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. If no reply is received from your office within ten days, we will assume you have no liens of any type against this property and we will recommend to the insuring company that this claim is paid. Member of Adjusters David Vincent Adjuster y BUTTERWORTH & 01TOOLE, INC. ADJUSTERS/APPRAISERS FOR INSURANCE COMPANIES ONLY P.O. BOX 8294 SALEM, MA 01971-8294 TEL. (978) 741-5731 FAX (978) 740-9109 clai ms(&butterworthotoo le. com 03/11/2014 FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B TO: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectmen City/Town Hall ADDRESSES North Andover, MA 01845 RE: Insured: Daniel Hevstek Address: 247A Farnum Street City/Town Hall North Andover, MA 01845 North Andover, MA 01845 Policy No.: 2027512 Loss of: 02/20/2014 Ice dam File or Claim No.: 47-0323 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 3B is appropriate, please direct it to the attention of the writer and include a -reference to the captioned insured, location, policy number, date of loss and claim or file number. If no reply is received from your office within ten days, we will assume you have no liens of any type against this property and we will recommend to the insuring company that this claim is paid. David Vincent Adjuster A Member of —� �---.s.T.dcncndcnt Insurances c� Adjusters ��,.- w a r COMMONWEALTH OF MASSACHUSETTS ' TRUDY COXE Secretary ARGEO PAUL.CELLUCCI DAVID B. STRUHS Governor' Commissioner . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIOMFORM PART A T CERTIFICATION Properq Addrase C� �l x`114. �i`""- ` Name of 0%~ C Yi r.S ���� /i�� ��Ad�d►ess of Owner: Y\y,-�vlti, Date of hspec;*m y PIC( ��5 0 14S m Nae of inspector. (Pla s" Print) ant a system inspect�-or ^ In Section 1 00 5.340 of Title 5 (310 CMR 15.0! Compartt► Narne: '�� � v� Telephone Numbar* r CERTIFi ON'sTATEMEI�iT . 1 certify that i have personally inspected the sewage disposal system at this address and that the Information reported below is true, accurate and eomplete'as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of do -site sewage poral systems. The system: Passes Conditionally Passes e Needs Further Evaluation By the Local Approving Authority F Inspeawa Srg Wwre: Date: _.- lo The System Inspector shell submit a copy of this Inspection report to the Approving Authority (Board of Health or DEP)within thirty (30) days of completing this inspection, if the system is n shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner ahall•submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS 0 Page i of 11 1 �� Printed on Recycled Paper C revised .9/2/98 Page 2of11 Tel: (978) 475-4786 Fax: (978) 475-5451 BATESON ENTERPRISES, INC. Excavating -Water.& sewer Lines -Septic Systems & Pumping Service 111 Argilla Road_._ _. ... __ _ Andover, Mass. 01810 Title 5 Inspection Report Property Address: �) y '7 Owner: Date of Inspection: Lj My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations,and I hereby disclaim any further operation of your current septic system. Neil J. Bateson Bateson Enterprises, Inc. "Data M SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM revised 9/2/98. page liorrt revised 9/2/98. C)C\QQ— Page 10 of 11 ft :.•? Solt (locar If 'not Jlliefl Comments, (note con itipn pits, number chambers, nymber:_ pelleriea number.__ ) `—rp—� �.i i I trenches,' number, length '`Y1 CY fields, number, dimensions. J cesspool, number: we system: Name gf,Technology: to11,::signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.) PRIVY:r �� (locate.on site plan) Materials of construction: Dimensions: Depth of solids: Comments: Inote condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) revised 9/2/98 page 9ortl Owoet' Date -of TIGHT' Ilocpt�.c Depth bi Material DISTRIBUTION BOXY pocate on,site_plan) Depth of liquid level above outlet Invert: � Gornments, p D- os, I�te if le 1 and distri on is equal, evidence of solids carry r, evi encs of le a into or cot box, etc.) Q CL1L < CSW F �� PUMP CHAMBER V\CNO (locate on site plan) �a Pumps In working order: IYes or No) "Alarms in working order (Yes or No) I Comments, - (note condition of pump chember, condition of pumps and appurtenances, etc.) revised 9/2/98 Page 9of11 � 1 revised 9/2/98 Page 3ofII revised .9/2/98 Nge4of 11 ttJosased86/Z/6 pasz.na,z h b 6l Q (ou jo soA) :0119 04l 1e BuIANJe u84M p01o01ep sropo Oft'"g :uollew,o;ul;o Ooinos pug (umou„ 11) polleisul slap lowouodwoa lje;o 3Od 31VWOCQ11ddV x0410 lsnolddV d3O;oAdo0 Val146LL laejluoo eoueu0lulew pug uonsiodo slap of do ;o Adoo 40RUV `oto ABolou4361 V!1 (Aug ;l 'spjooei uollo0dsul snolAeid yoeug 'seA 11). 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(•ola'a6s,loal;o QOUepine 'AluBalul p inloruls ')Jams! lalino of uope)ea ul lana) pinbil;o 41dep sag;eq ,o seal legno pus lalul;o uoplpuoa 'Buldwnd ,o; uollspuauuu,oas,) :aluswwoa :Buldwnd lsol;o aw(i :eg;eq Jb eel lalino;o wolloq of wnos;o wouoq uioJ; sauslsia :eg;aq Jo eel legno;o dol o1 tunas ;a dol W04 oauslsia :9seup14i wnag :suolsuewla (uleldxe)J94t0—aualAyleAlod ssesBieglj' lalaw eleAauoD— :uorlon4suoa;01e1494sw �:epeJ6. Mo{aq yldea (uald ally uo wool) `aVAC)"ZY'dV111.3SY3V9 l-� J 01e,'e8 sl ioa0Uas p`lnbl;o 41dep 'sysq "gpusalul;uohpu ldwd lo; uopapUQUJUAoosi)u6elu!!"maa to '1�anul Laino of uol ai ul side wwoa C11 n,s elaM suolsusw� cpaulw,elep p Mo1� :eg;eq Jo eei lepnb;o woupq of tunas ;o wouoq wou oauslala :ag;eq io asl lain ;o dot of wnos;0 dol wou'obusls!a r r „ :ss6u4*M wnb$ :ag;eq Jo eel laino;o wouoq o1 e6pnls;o dot wo4'ebusls1a LRdep eBpnlS (01V/seA),^ eauelidwoa;o eleoggJsa Aq paw,guoo 66e 91 009, laut al:lusl;l (ulaldxepstpo euslALIPAlod sssl6Jeglj— (alalu— elenuo — wo,Obntlauoo;o p pelow it 1 eps,6 Molaq 41dea (veld ells uo alsaog h�llNdt OuA3S TOWN OF NORTH ANDOVER of NORTH 7 Office of COMMUNITY DEVELOPMENT AND SERVICES �° p HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 ',.o�� 'SS,C�st' Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX October 11, 2004 Benjamin Osgood, P.E. New England Engineering Services, Inc. 60 Beechwood Drive North Andover, MA 01845 Re: 247A Farnum Street, Map 107A, Lot 278 Dear Mr. Osgood: The proposed septic system design plans for the above site dated September 20, 2004 and received on September 23, 2004 has been reviewed. Unfortunately, it cannot be approved until the following items are corrected. Each item is followed by the specific section in Title 5: 310 CMR 15.000, or North Andover regulations which is not met by this design. 1. A 3:1 slope is needed around the leach area between the contours 88 to 86. Given only 4' lateral separation between the 88 contour and the retaining wall, the wall may need to be raised. -255(2) 2. The impermeable barrier may trap ground water due to its depth. Please review and revise as necessary. 3. A notation is needed regarding the d -box outlet elevations. They must all be level. -232(3)(b) 4. Given that the septic tank is to be inspected and retained, the septic tank detail should not include notes associated with a new tank. Instead please list those items which are to be inspected and provided. 5. Regarding the effluent filter, the following must be provided: a detail, the brand and model, the filter type/name noted on manhole cover, and a filter, maintenance schedule. 6. The existing tank appears in the profile to be more than 36" below grade, yet there is a notation stating 36" max cover over the tank. If you are proposing that some of the soil above the tank be removed, please so specify. -221(7) 7. Please provide information to confirm the location of the waterline as depicted on the design plan. Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a septic system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincerely, '• usan Y. Sawyer, RE /RS Public Health Director cc: downer __rle �� Y, �;v" DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Wednesday, July 11, 2007 2:12 PM To: Osgood Ben (E-mail) Subject: 247A Farnum Street - Expired Plans Hi Ben, The above was approved for a septic plan in October 2004. The plans have now expired. FYI if you want to follow-up with the homeowner - Daniel Heysteck. 9100R¢0w�ds, Pufya04 A9,040MAW10 Health Department Assistant Town of North Andover 1600 Osgood Street Building 20, Suite 2-36 North Andover, MA 01845 5978.688.9540 - Phone A 978.688.8476 - Fax http://www.townofnorthandover.com healthdept@townofnorthandover.com FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT `************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT !DA-NWU kC fSTO(- LOCATION: Assessor's Map Number lont .4 ` SUBDIVISION STREET - PHONE �G64 Z IZD PARCEL O-Z��'V LOT (S) ST. NUMBER 2�7 *OFFICIAL USE ONLY ** RECOMMENDATIONS OF TOWN AGENTS: VVI4.7CI VAI IVN AUMIIVII I KATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER COMMENTS DATE APPROVED DATE REJECTED FOOD INSPECTOR-HEALT DATE APPROVED DATE REJECTED N P C INSPECTOR -H LTH DATE APPROVED I DATE REJECTED COMMENTS PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMEN�,rej a ✓7 RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm Clear Day �`} Page 1 of 1 Dellechiaie, Pam From: Sawyer, Susan Sent: Tuesday, July 20, 2004 1:02 PM To: Dellechiaie, Pam Subject: RE: 247A Farnum Street - 3rd Floor Addition - H/O stopped by Sensitivity: Private FYI, called Mr. Heystek back 12:35PM After discussion; told him it was ok to file for the dormer and attic stairway for heating system installation. Health would sign the form U for this only. Future applications to increase # of rooms would require upgrade of system as advised by Ben Osgood Jr. Pam, Please add this note to this file. Thanks -----Original Message ----- From: Dellechiaie, Pam Sent: Tuesday, July 20, 2004 11:49 AM To: Sawyer, Susan Subject: 247A Farnum Street - 3rd Floor Addition - H/0 stopped by Importance: High Sensitivity: Private Hi Susan, Dan Heystek of above address stopped by to see you. His number is: 978.687.2120. Just needed to run a couple more items by you before he submits formal Form U/Building application paperwork. He has spoken with you several times before. Pamela DelleChiaie, Health Dept Assistant Town of North Andover Community Development & Services 27 Charles Street North Andover, MA 01845 pdellechiaie@townofnorthandover. com Tel. 978-688-9540 Fax 978-688-9542 8/12/2004 Town of North Andover, Massachusetts Form No. 3 NORT#1 BOARD OF HEALTH 0 ha 19 DISPOSAL WORKS CONSTRUCTION PERMIT SgACHUSE Applicant u -a A -,o NAME ADDR SS TELEPHONE Site Location_ (_0T P" 1,t, Permission is hereby granted to Construct (,) or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. % CHAIRMAN, BOARD OF HEALTH Fee D.W.C. No. r - _--------- -- - - ---- 3� z�a�� ��� � v��, ���` �g�, �g to �t' .� 2�D,�`'' 1�� C � �c� Y p �lN✓�7 W f y o 93' \ r �•., LarA" g /78,s41sF, , cJ� EA,Sgj,jE�T /VdrE.' f Ou.�/DAT/O�l/ LGt.V 7�/O.t/ �iCOiY7 Nom/ B � 'r V"C,6Y CECT/FY TO Tye T/TGE /,VS6•eOW 4VO PL O % RL TT% T.Ve,0-4%4AAV /S COC.47EO ON T//E LOT AS ,SifC/Y,V ANO T//.4T?OG1r~5 G'D.dFG=PA/ //(/ 7 4'Al OF.ct� AvoDvEQ ZON/,vG �E6!/LAT,bt/S iQLt6vI.e0/NG SETBACit'S FE0�1 ST.PEETS { I.OT U�✓ES. '' ,y� /�O . �NOO ✓E�� ///A,S S . s F//,�Tif�E.P GE.PT/FY T/J.vT T.s�/S O�1✓ELL/N6 /SivOT LOG4TE0 /� T.yE FEOE.PAL F[ODO fi'i4Z.4C0 APER. OiPA!%�/V /=Ole �SyCWN DIV FEiN���l�9u_�y,MVN/TY P.INGL � Da TES N n 4-� ,an. Z 9SL ' ��.���•4!�,/ .t%'� PL.S GATE ,CST}, �`�. ;` '`"y BOvvo.Py AE'Tt�.e�f/:.rC.g��ov_ Boavo.ves� /ffE.P.P//tf•9Gf' E'.vG�•t/EE,P�.(�6 SE.Pi��G'ES ,47T/0•t/ 7;4.t'E.S/ F,Po.> Exrsrivc .ee-Do,Pos. 66 ��4�P.E� .ST.rEET A.t/O0l/E•C /f7.4SSAG,fU/SETTS O/8/O 0 o FORM U - LOT RELEASE FORD INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having j 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:0.rr��uv�'S1-� Phone LOCATION: Assessor's Map Number Parcel Subdivision 'A4 n, ��cn Q P+ Lot(s) Street St. Number V9 ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Conservation Administrator Comments Town Planner Comments Health Agent Comments Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date r- Sidney B Oolemaa '.�•– �� Farnham at. l/ APPLICATION FOR SEME DISPOSAL INSTALLATION HEALTH DEPARTP-M—NORTH ATMOVER, MASS. I hereby make application for a permit for a sewage disposal installation at ,"a rnham St. _ --4 I will install this system .in accordance 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 pipes the minimum diameter being 4 inches, and will maintain a minimum grade of 1% until 10 feet preceding the septic tankp where the grade shall not exceed 2%. I will install, a concrete septic tank of ? O ja2Z. 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 open jointed bell and spigot Ackron pipe at least 4 inches in diameter and laid in a series of trenches, the bottom of which will provide a minimum of „-168 lineal (QiiMK) feet of effective absorption area. The pipes will be laid on a 6 inch layer of washed gravel or crushed stone ranging in size from 3A 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't 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 in- stallation 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 officer, as provided below, and to incorporate any additional requirements that may be attached to the permit. Plot Plans must be submitted with application. 2 fttr hes DATE ' ' . 1-1 S Signature of Applicant I hereby issue the above permit for the Board of Health of the Town of North Andover, Massachusetts. DATE rLt� 1� l.' ! q .. �� d Sign tura of Health Agent I have inspected the uncovered system indicated above and find everything done as described. DATE Signature of Inspecting Officer Percolation Test Garbage Grinder " f (>' ,.it (. ,)C ,n (?- I J I Ad, BOARD OF HEALTH TOWN OF NORTH A.dDOITER, 14'lASS. qfo � � � %1 �Aj✓�l l � d � a N �1 (1 xo i I Z, NAIr'.E . 5 io�5f�(8 coy € m Ak rJ . .DATE SG Ste! . 2. ADDRESS F; eZ N V nn. . S -r.. LOT NO. TEL4 3 c8 3. NO. OF EEEDROODS DEN YES ✓. NO.. , 4* GARBAGE GRINDER YES . NO.. 5, SHOW DIT; ITSIONS OF HOUSE 6. SHOW DISTANCES OF HOUSE TO ALL PROPERTY LUES 7, SHOW DIIMSIOM OF LOT 8. SHOW LOCATION AND SIZE OF SEP'T'IC TANK OR CESSPOOL 9. NOTE LOCATION AND DISTANCE OF WELL FROTJ SEWERAGE SYSTEM ,l&,e 10, SHOW LOCATION OF BROOKSV STREAliS, DITCHES, LEDGE OUTCROP, ETC. ,vbvc 11. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULATION'S SHOULD EE READ CAREFULLY. rV Rif BOARD OF HEALTH TONN OF NORTH ANDOVER, MASS. 720 I. MAZE �l� c-,' 10. Com frf i1% . DATE Zz. S . � . % . . 2. ADDRESS .Z .7 r H N v 5�— LOT NO. :TEL. . 3. N0, OF BEDR00116 . . � ' . . DEN YES . ✓. NO.. . . . . 4- GARBAGE GRINDER YES NO.. . 5. SHOW DIMPTSIONS OF HOUSE 6. SHM DISTANCES OF HOUSE TO ALL PROPERTY LINES 7, SHOW DIPIIENTSIONS OF LOr S. SHOW LOCATION AND SIZE OF SEPTIC TANK OR CESSPOOL 9. NOTE LOCATION AND DISTANCE OF WELL FRO1,11 SEWERAGE SYSTEAY 10. SHOW LOCATION OF BROOKS i STF.EX.B, DITCHES s LEDGE OUTCROP, ETC. Il. SHOW DISTANCE OF SEPTIC TANK OR CESSPOOL FROM HOUSE NOTE: LOCAL REGULATIONS SHOULD EE READ CAREFULLY. TOWN OF NORTH ANDOVER f aORTa Office of COMMUNITY DEVELOPMENT AND SERVICES or HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 �'ssACHUg t� Susan Y. Sawyer 978.688.9540 — Phone Public Health Director 978.688.9542 — FAX October 25, 2004 Daniel Heysteck 247A Farnum Street North Andover, MA 01845 RE: Subsurface Sewage Disposal System Plan for 247A Farnum Street, Map 107A, Parcel 278, North Andover, Massachusetts Dear Mr. Heysteck, The North Andover Board of Health has completed the review of the septic system design plans, for the above referenced property, submitted on your behalf by New England Engineering Services dated September 20, 2004, last revised October 15, 2004. The design has been approved for use in the construction of an onsite septic system. This approval is valid for three years from the date of this letter and during this time a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance must be endorsed by the installer, designer and the Town of North Andover. This approval for a 5 -bedroom (or total of 11 rooms) house is subject to the following conditions: 1. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation, the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit (3 10 CMR 15.020(1)). 2. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission, Zoning Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you might have. Sincerely, Susan .Sawyer, REHS/ Pu' 'c Health Director cc: New England Engineering Services file Q� pORTM , TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 27 CHARLES STREET t NORTH ANDOVER, MASSACHUSETTS 01845 SACNUS`" Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — Fax bealthdgt@townofnorthandover.com www.townofnortbandover.com SAM Benjamin C. Osgood, Jr., EIT From: Pamela To: NEW ENGLAND ENGINEERING SERVICES, INC. 60 Beechwood Drive North Andover, MA 01845 978-685-1099 Pages: q Fax: C� 978-686-1768 Date: /v/aS/e� Phone: Septic Plan Response CC: File Re: ❑ Urgent x For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle • Comments: Attached is the response from the Health Agent regarding Septic Plans for the following property: A copy has also been mailed to the homeowner. Please call 978-688-9540 for assistance with any questions. Thank you. Cc: File Approved: Not Approved: Other: HP Fax K 1220xi o Q Log for NORTH ANDOVER 9786889542 Oct 25 2004 1:25pm Last 30 Transactions Date Time Typg identification Durati n Pages Result Oct 20 5:05pm Received 0:28 2 OK Oct 20 5:45pm Fax Sent 816179242286 1:39 6 OK Oct 20 5:52pm Fax Sent 89783276544 0:43 3 OK Oct 20 5:54pm Fax Sent 89783276544 0:19 1 OK Oct 20 7:45pm Fax Sent 816179242286 0:35 0 Error 387 Oct 20 7:50pm Fax Sent 816179242286 3:05 15 OK Oct 21 9:53am Received 617 983 6770 1:14 2 OK Oct 21 10:16am Received 1-888-449-5207 0:38 1 OK Oct 21 11:35am Received RightFax Norcross 1:17 4 OK Oct 21 2:59pm Received 9786850049 0:50 2 OK Oct 21 4:44pm Received 9783276544 0:21 2 OK Oct 22 12:47am Received FAX 0:55 1 OK Oct 22 9:19am Received 0:38 0 No fax Oct 22 12:04pm Received 0:38 0 No fax Oct 22 12:05pm Fax Sent 89784750699 0:27 1 OK Oct 22 12:06pm Fax Sent 89784750699 0:46 2 OK Oct 22 12:28pm Fax Sent 816033823492 0:51 2 OK Oct 22 12:49pm Fax Sent 89786860755 1:08 5 OK Oct 22 1:09pm Received 0:16 1 OK Oct 22 1:52pm Fax Sent 819786497582 0:50 2 OK Oct 22 2:49pm Received 0:15 1 OK Oct 22 3:40pm Received 9785560284 3:31 6 OK Oct 22 3:51pm Fax Sent 819787628748 1:09 2 OK Oct 22 10:58pm Received M.V.Cham 0:47 1 OK Oct 24 3:22pm Fax Sent 819785328410 1:09 4 OK Oct 25 10:21am Received 16038986036 0:40 2 OK Oct 25 10:23am Fax Sent 819784410555 0:35 0 Error 386 Oct 25 10:27am Fax Sent 819784410555 0:30 2 OK Oct 25 12:08pm Fax Sent 89786851099 3:41 5 OK Oct 25 1:08pm Received 9785578160 0:27 2 OK 0 O f �10RTN TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 27 CHARLES STREET , "^, _ 2 NORTH ANDOVER, MASSACHUSETTS 01845 �►s,,„��''��' s�CHus Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.9542 — Fax healthdept@townofnorthandover.com www.townofnorthandover.com FAX Benjamin C. Osgood, Jr., EIT From: Pamela To: NEW ENGLAND ENGINEERING SERVICES, INC. 60 Beechwood Drive North Andover, MA 01845 Fax: 978-685-1099 Pages: 02— Phone: ��/p 5 d / 978-686-1768 bate: Septic Plan Response CC: File Re: ❑ Urgent x For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle • Comments: Attached is the response from the Health Agent regarding Septic Plans for the following property: A copy has also been mailed to the homeowner. Please call 978-688-9540 for assistance with any questions. Thank you. Cc: File Approved: rte/ Not Approved: Other: NEW ENGLAND ENGINEERING SERVICES INC October 21, 2004 Susan SawyerV�D North Andover Board of Health 27 Charles Street To OCT 2 12004 North Andover, MA 01845 tiV NU 4 AST y DFp l T Re: 247A Farnum Street, North Andover Revised Septic System Design Dear Susan, The following plans and enclosures for the above refe. resubmitted for approval. 1. (3) Copies of the Revised Septic System Design Plans. Please note that the plans have been revised to address comments from your letter dated October 11, 2004. If you have any additional comments or questions please do not hesitate to contact this office. Sincerely, Steven E. Pouliot Project Manager 60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 O O TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, REHS/RS Public Health Director FAX Benjamin C. Osgood, Jr., EIT To: NEW ENGLAND ENGINEERING SERVICES, INC. 60 Beechwood Drive North Andover, MA 01845 NORTI� Cf „t1.•° l� 9 t �,SSACHUs 978.688.9540 — Phone 978.688.9542 — Fax healthdept -a townofnorthandover.com www.townofnorthandover.com From: Pamela Fax: 978-685-1099 Pages: Phone: Al 978-686-1768 Date: 1PA160 Septic Plan Response CC: File Re: ❑ Urgent x For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle • Comments: Attached is the response from the Health Agent regarding Septic Plans for the following property: / `*�G . A copy has also been mailed to the homeowner. Please call 978-688-9540 for assistance with any questions. Thank you. Cc: File Approved: Not Approv Other: Q HP Fax K1220xi Log for NORTH ANDOVER 9786889542 Oct 13 2004 4,32pm Last Transaction Dg Time Twe Identification Duration Pages R s Oct 13 4:29pm Fax Sent 89786851099 1:42 2 OK 0 q TOWN OF NORTH ANDOVER NORTa Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 27 CHARLES STREET• -r NORTH ANDOVER, MASSACHUSETTS 01845 'SSACBUSEt Susan Y. Sawyer, REHS/RS Public Health Director October 11, 2004 Benjamin Osgood, P.E. New England Engineering Services, Inc. 60 Beechwood Drive North Andover, MA 01845 Re: 247A Farnum Street, Map 107A, Lot 278 Dear Mr. Osgood: 978.688.9540 — Phone 978.688.9542 — FAX The proposed septic system design plans for the above site dated September 20, 2004 and received on September 23, 2004 has been reviewed. Unfortunately, it cannot be approved until the following items are corrected. Each item is followed by the specific section in Title 5: 310 CMR 15.000, or North Andover regulations which is not met by this design. 1. A 3:1 slope is needed around the leach area between the contours 88 to 86. Given only 4' lateral separation between the 88 contour and the retaining wall, the wall may need to be raised. -255(2) 2. The impermeable barrier may trap ground water due to its depth. Please review and revise as necessary. 3. A notation is needed regarding the d -box outlet elevations. They must all be level. -232(3)(b) 4. Given that the septic tank is to be inspected and retained, the septic tank detail should not include notes associated with a new tank. Instead please list those items which are to be inspected and provided. 5. Regarding the effluent filter, the following must be provided: a detail, the brand and model, the filter type/name noted on manhole cover, and a filter maintenance schedule. 6. The existing tank appears in the profile to be more than 36" below grade, yet there is a notation stating 36" max cover over the tank. If you are proposing that some of the soil above the tank be removed, please so specify. -221(7) 7. Please provide information to confirm the location of the waterline as depicted on the design plan. Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a septic system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincerely, usan Y. Sawyer, RE /RS r' Public Health Director cc: Owner File F Page 1 of 1 Dellechiaie, Pamela From: Dan Ottenheimer [info@millriverconsulting.com] Sent: Tuesday, October 12, 2004 3:55 PM To: amcbrearty@millriverconsulting.com; Lisa LaVasseur; 'Pamela Dellechiaie'; Susan Sawyer Subject: plan reviews Sue and Pam, Attached please find the plan reviews for 193 Lacy Street a d 247A F mum Street. Please call or write if any questions. - Dan I>Afill ver , cons ultin '`•... Daniel Ottenheimer, President Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.co dano@millriverconsulting.com 10/12/2004 Town of North Andover F a Q Health Department �Date: �4, Location: (Indicate Address, if Residential, or Name of Business) Check #: Twe of Permit or License: (Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service - Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal (Septic) Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: ❑ Septic - Soil Testing $ ��0 a�� Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ Trash/Solid Waste Hauler $ ➢ Well Construction $ ➢ OTHER: (Indicate) 212 Health Agent nitials Z White - Applicant Yellow - Health Pink - Treasurer Town of North Andover O HEALTH -DEPARTMENT 27 Charles Street North Andover, MA 01845 978.688.9540 healthdep aWownofnorthandover.com RECEIVED, SEP 2 3 ^^�a TOWN Ur HEALTH DEPAR( TENT SEPTIC PLAN SUBMITTAL FORM DATE OF SUBMISSION: 9- Z 3- d"I SITE LOCATION: 2417,E r?,fKyaw Ji�eei , Al,.,i tw6e ENGINEER: /VIOGil e/+1�1� NEW PLANS: YES V"� $225.00/Plan ✓ Check #: (Includes l Er and one Re -Review Only) REVISED PLANS: YES $ 75.00/Plan SITE EVALUATION FORMS INCLUDED: LOCAL UPGRADE FORM INCLUDED: Check #: 4�s D NO YES NO Telephone #: 91 Q) - (p acs - 1-7 (c 8 Fax #: Q 7 0 - & 9,(-- /y 7 q E-mail: NeESC-AW& Arx— corp-, IIOMEOWNER NAME: OFFICE USE ONLY When the submission is complete (including check): Dr stamp plans and letter 2.lete and attach Receipt ececpt 3.xopy File; Forward to Consultant 4. Enter on Log Sheet and Database NEW ENGLAND ENGINEERING INC September 23, 2004 Susan Sawyer North Andover Board of Health 27 Charles Street North Andover, MA 01845 Re: 247A Farnum Street, North Andover Septic System Design Dear Susan, SERVICES SEP 2 3 2004 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT The following plans and enclosures for the above referenced property are being submitted for approval. 1. (5) Copies of the Septic System Design Plans. 2. (1) Copy of the Form 11 Soil Evaluator Sheets. 3. (1) Copy of the Form 12 Percolation Sheet. 4. (1) Check for payment of the Town approval fee. If you have any comments or questions please do not hesitate to contact this office. Sincerely, Steven E. Pouliot Project Manager 60 BEECHWOOD DRIVE - NORTH ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 L10 No. /- FORM 11 - SOIL EVAIXATOR FORM Page I of 3 Commonwealth of Massachusetts Massachusetts Soil SuitaNlift Assessment for.. On-site Sewage isrncnj . ...... .... .. . -11<5wrlo col�z-fla-� Performed By: ....... C. Date: Witnessed By: Xt4lorp :i% jjl Lao,," A04,4ss of �-q-74owtv's Nome,z;> J A44(gil, OPO �Jew construction [7- Repair Fj 0mcc Review I Published Soil Survey Available: No D Yes Ycar Published Publication Scale Soil Map Unit Drainage Class .............. Soil Limitations ... .......... Surficial Geologic Report Available: No f4 Yes 0 Year Published Publication Scale Geologic Material (Map Unit) ... .... ........ - . .......... . .. ..... - Landform..... I .......... I .... . ... 1-11 .. .. ........................... . . ....... Flood Insurance Rate Map: Above 500 year flood boundary No 17Yes Within 5G0 year flood boundary No 1-1Yes Within 100 year flood boundary No Dyes E-3 Weiland Arca, National Wetiand Inventory Map (map unit) ...... Wetlands Conscrvancy Pro&Tajn Map (map unit) Current Water Resource Conditions (USGS)- Month(/aclf Range :Above Normal 13Norma, 0Bek' -,, Normal 0 Other References Reviewed: &)FP APPROVED rorlm 1 12/07195 09 /-'09'/2004.:. `16 ;1.3 17811134131v Ta1GARDR . P4GE' DORM 1.1 - SOIL EVALUATOR FORM Pagel of 3 location Address or Lot A. �'�7� ��7NvNO Ori -sate Review Soil Horizon Soil Texture (USDA) Deep Hole NumberDate: / Other .r (Structure, Stones, Boulders, Consistency, % Gravel) Time: Location (identify on site plan). ..- Land Use �,� Slope ;%? Surface Stones Vegetation C.g Landform Position on landscape fZ)—.C= -,�;reav Distances from: Open Water Body feet Drainage way1� c— feet Possible Wet Area 440�C2 feet Property Line / a feet Drinking 'Water Well ZZ -b feet Other a Weather DEEP OBSERVATION HOLE LOG l I Depth from Surface (inches) Soil Horizon Soil Texture (USDA) Soil Cofer (Munsell) So+I Mvnling Other .r (Structure, Stones, Boulders, Consistency, % Gravel) I a � V i Parent Material (geologic) G�� ..r GC. DspthtoSodrock Depth to Groundw3TV; Standing Water in the Hole: Weeping from Pit Fnce C°.timated Seasonal High Ground Water:� .�.,_ __._,•_,_,,� _._ �..,.�..,, ..__...._ .. iiDEP APPRONTI) FORAT • 12107/!5 E�9/01"2004'' .".,1�. i 3 17>3133 5 TANGARDR : PAGE . +0 FORM 11 • SOIL EVALUATOR FORM Page '> of 3 Location Address or L t Qn -Srte Review Deep Hole plumber Date:% Timer • �a Location (ideEltify on site plan! land U5p�'/2J�-�t17%,�lG- Slope (°1a1 Surface Stones Vegetation Landform Position on landscape ✓��� Dis;an.es frorn: Open Water Body//�'-t= feet Drainage way feet Possible Wet Area 40t!P feet Property Line 2�"' feet Drinking Water Well 6�7o feet Other DEEP OBSERVATION'HOLE LOG a Weather,R//7— , 3K ` Depth from I Surface (Inches; Soli Hcriton Soil Texture (USDA) Soil Color (Munrtll) Soil Mottling Other (Structure. Stones, Souiders, Consistency. % Gravel) I 4-5 i i s i 4........�. j Parent Material (geologic) G"'�_� I l C DepthtoSadroCk: �` depth to Groundwater; Starding Nater in tha, Hole: — Weeping from Pit Face: tr >;sjimated Seasonal High Ground Water: -tet'.?10 UP,P a.PPROWn FOP hl - 12:0719$ r'Uy? kUr•4; 'ltt;'i :3 1 r'_.;�tb l`raN �F RSR0 FORM. II - SOIL LVALUATOR FORM page 3 of I Location Address or Lot No. Defenni itwtiyn for Seasonal hTigh Water Table Method_Used: El Depth observed stranding in observation hole ... inches C Depth weeping from side of observation hole inches Depth to sail mottles �'�� inches 4d � L ] Ground water adjustment...........— feet Index Well Number Reading Date Index well level Adjustment factor ..-........ Adjusted ground water level .......... Depth of Naturals Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in a areas observed throughout the area proposed for the sail absorption system? If not, what is the depth of naturally occurring pervious material? Oertiflcation I certify that on date? I have passed the soil evaluator examination approved by theapartment of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 OMR 15 7. -� Signatur Date JfO*Ie2� "F APPP.OM PORN - 12/07/45 Commonwealth of Massachusetts City/Town of Percolation Test Form 12 '4M Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. �emm Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal. 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 the local Board of Health to determine the form they use. A. Site Information Daniel Heystek Owner Name 247A Farnum Street Street Address or Lot # North Andover MA 01845 Cityrrown Contact Person (if different from Owner) B. Test Results Observation Hole # Depth of Perc Start Pre -Soak End Pre -Soak Time at 12" Time at 9" Time at 6" Time (9"-6") Rate (Min./Inch) State Zip Code 978-687-2120 Telephone Number 8/24/04 1:30 Date Time PT1 58"/18" 1:37 1:52 1:52 2:02 2:21 19 min. 7 Date Time Test Passed: ® Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ Benjamin C. Osgood, Jr., P.E. (NEES) Test Performed By: Andrew McBreartv (Mill River Consultinq) Witnessed By: Comments: t5form12.doc• 06/03 Perc Test • Page 1 of 1 company Alamo � _ ��' G-. 11 6g Addrap: 1 f`'%q . n ($) C7 Tdophone Number: CERI srarelwlertT 1 certify that l have persopally 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 sew/age�' mesal systems. The system: Passes Conditionally Passes — Needs Further Evaluation By the Local Approving Authority — F Inspector'a'Sg+woues: Date:— The System Inspector shall submits copy of this Inspectionreportto the Approving Authority (Board of Health or DEP)within thirty (30) days of completing this inspection, .If the system is s shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office .of the Department of Environmental Protection. The original should be sent to the n system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND,COMMENTS , revised 9/2/98 Page 1 of 11 0 Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM a„ ,. PART A lam, CER711CATON (co ntinued) Property Address,:1% Fcuc 1111Q Vv` N ( "UQ-IC Owner. C►CV's S Data of Inspection; + ' 10, © n NSPECTM SUMMARY c :. Cboc C,or D A. SYS-RNP8 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 NO).. 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 tankwasinstalled firithin 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 pipets) or due to a broken, settled or uneven distribution box. The system will pass inspection if (with approval of the Board of Health). broken pipets) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more then four times a year due to broken or obstructed pipets). The system will pass inspection if (with approval of the Board of Health): broken pipets) are replaced obstruction is removed ft revised 9/2/98 Page 2of11 n SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A a CERTIFICATION (continued► Property Address:Q r7 �' 1' �1! Owrbr � --,' C3� :y 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 DETERMINES IN ACCORDANCE WITH 310 CMR 15.303 (111(b) THAT THE SYSTEM IS NOT FUNCTIONINGN A'MANMBt WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cess I or poo privy is' within 60 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) <SYSTEM' WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER. IF ANY) DETERMINES THAT THE SYSTEM IS FUNCTIOMG IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: t , 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 feat 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 Sppm.o Method used to determine distance lapproximation not valid). 3) OTHER reprised 9/2/98 Page 3 of 11 e SUBSURFACE SEWAGE DISPOSAL SYSTEM! INSPECTION FORM PART A . CERTFICA71ON leontinued) s PropertMAddress .� owrrar - Dade of irispecRion , 0., SYSTEM FAILS:% You must Indicateeither "Yos", 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 We below: The Hoard of Health should be contacted to determine what will be necessary to correct the failure. Yes N , Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or C6431;10011, 11 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. LIQmiid depth in cesspool is less than 6" below invert or available volume is less than 112 day flow. Required pumpini more than 4 times in the last year NOT duly to clogged or obstructed pipe(s). Numberof 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. d _ Any portion of a cesspool or privy Is within`50 feet of a private water supply well. pny 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 becteria,'volatile organic compounds, ammonia nitrogen and nitrate nitrogen. I- LARGE SYSTEM! FAILS: You must Indicate. either "Yes" or "No"- to each of the following: Ti►e following criteria apply to large systems in addition to the criteria above: The system serves'a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes. No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area =1WPA) or a mapped Zone 11 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 inforgriation. revised .9/2/98. Page 4oftl SUBSURFACE SEWAGE DISPOSAL SYSTEM NSPECTiOIN FORM . PART B . , CHECKLIST e Pmp�wtvAddress: Q1 �I f T. 10 Date of Mrapeeliarls (� S Check if the following have been done: You must indicate either. "Yes" or "No" as to each of the following: _ Pumping information was-provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and the system hes been•receivft normat flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this Inspection. / a built plana have been obtained and examined: Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. d 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 kor too$,'Material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. size and location of the Soil Absorption System on the site has been determined based on: Existing information. For example, Pian at B.O.H. Determined In the field (if any of the failure criterie'related to Part C is at issue, approximation of distance is unacceptable) ;z '115.302(3)(b)1 .. The facility owner land occupants, if different from owner) were provided with information on the proper maintenance of SubSurface Disposal Systems.. r SY57HU NFORMATRIN �S- Owner-, Date of Inspection: ROW CONDITIONS REsI71AL. f Design flow.g p.d:/bedroom. Number of, bedrooms design):, Number of bedrooms (actualQ Total DESIGN flory Number of cuirent residents:' Garbage grinder (Yes Laundry Is6parate system).' (yes or no)•NOt If yes, separate inspection required Isund syste ins ectad' yes or no) Seasanal use (Yes Or no)- W. 17D I. J Water meter ,fesdings, if ppilabie (last two year's usage (gpd): Lsit date,of occupancy: Mix COMMERCIAUINDUSTRIAL: Type of establishment. Design"flow:: apd I Based on 15.203) w Basis of design flow .' Grease trap presents (yes or no)_,. Industrial Waste Voiding Tank present: lyes or no)�_ ` Non -sanitary Waste discharged to the Title 6 system: (yes or no)_ Water meter readings, If available: Last data of.occupancy; OTHii: (Describe)Last date of occupancy.,- ccupancy:GENERAL GENERALINFORMATION PUMP111110 S and source of information: System pumped as part of inspection: lyes or no) volume pp ng: 46 or 1 s 'Reason for pumping: �� Reason TYPE OFA- 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) I/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 installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no) 0 reViSed 9/2/98 Page 6of11 %9 9 (-F •- R • ,G 10. A Distance from private water supply well or suction line Diameter.—Zi ,.it Comme .Icon an o points venting, evidence of leakage, etc.) SEPTIC TANKz, (locate on site plan) Depth below grade 1:h 1l C`4 Material of construction:ons trete—rrletal—Rbergiass _Polyethylene other(explain) If tank is metal, lis; age Is age confirmed by Certificate of Compliance —,(Yes/No) Dimensions: LQ t Sludge depth:. q Distance from top of sludge to bottom of outlet too or baffle: Scum thickness: " p Distance from top of scum to top of outlet tee or baffle: O r Distance from bottom of. scum to bottom of Qutlet tee or baffle: q How dmenWons were determined: 'J�y Q v Comments:' (recommendation for pumpin ndition f isle an Dolle a or baffl s, depth of liquid level in relption to outlet invert, curd tog ' , evidegc of Is�ge;.etc.) �j- l� v GREA$E'fiRAP:,�v1� ' (locate on site plan) Depth below grade: Material of construction: _concrete __metal_Fiberglass _Polyethylene—other(explain) Dimensions Scum thickness: Distance from top .of scum to top of outlet tee or baffle: - Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) revised 9/2/98 Page 7 of 11 n SUBSURFACE SEWAGE DISPOSAL SYSTEM NSPECTION FORM " PART C ,r. SYSTEM WFORMATION (candmied) hap"Address:.N©�1A a t�-q` TIGHT OR HOLDING TANK: ��'PfTank must be pumped prior to, or at time of, inspection) (locate an site plan):: , Depth below grade Material of, construction; concrete _metal _Rberglass _Polyethylene _otherlexplain) Dimensions; Capacity: gallons Design flow: gallons/day Alarm present Alarm level; Alarm in working order: Yes No_ - - - - Dste,of previous pumping: Comments,' (condition of inlet.tes, condition of alarm and float switches, etc.) . Dl$TRIBUYION.IBOIC:�./. (locate on site plan) Depth of 4quid level above outlet invert: 0 PUMPCNAMBERACW- IQ pumps(locate onsite plan) Pumps In working order; IYes or No) Alarms in working order (Yes or No) Comments: lnote, condition of pump chamber, condition of pumps and appurtenances, etc.) m revised 9/2/98 Page 8of11 b SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM -PART C SYSTEM NFORMATION (eondraned) .. "7 LFA D inapecharn iJt� .., o SOI. ABSORPTION SY 131 ISAS1 •-�"" ` Ilocate on site plan, if possible, excavation not required, location may be approximated by non -intrusive methods) if .not located, explains Type:: iseching .pits, numbs, leaching chambers, nymbsr leaching trenches, number. �..., (, _Q-� si i leaching trenches," number, length: -'t"-t Om leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (nVq con tion a}} soil; signs of hydraulic"failure, level of ponding, damp soil, condition of vegetation, etc.) CWPOOLS: )locate on site pian) Numbei snci cpnflguratian: Depth-top''of`liquid to inlet invert: Depth of solids layer: Depth of icum layer. Dimension pf cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as pert of inspection) comments:... Inote condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVYX—• �[. (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.) reV sed. 9/2/98 Papoor11 04 A Page 10 of 11 n revised 9/2/98 Rage 11 or 11 Tel: (978) 475-4786 Fax: (978) 475-5451 BATESON ENTERPRISES, INC. Excavating -Water.& sewer Lines -Septic Systems & Pumping Service 111 ArgiHa Road_..: __ -_.._ Andover, Mass. 01810 Title 5 Inspection Report Pro Address: Ll 7 A TVLCnU'v` S-- 4�b Property Owner:— S Date of Inspection: Ll — My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations,and I hereby disclaim any further operation of your current septic system. Neil J. Bateson Bateson Enterprises, Inc. Town of North Andover, Massachusetts Form No. 2 N°RTh BOARD OF HEALTH O t�s � 1ti 19- DESIGN 9 DESIGN APPROVAL FOR ss"C""5`` SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant RAKa^N Test No. Site Location Reference Plans and Specs.- hO f"-AA'.w'A-tJL- 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. Fee --d. A)�4� CHAIRMAN, BOARD OF HEALTH Si te System Permit No. tj1A ' 0 0 PLAN REVIEW CHECKLIST ADDRESS 16T/� �i—M I/UD ENGINEER 1%% /e/?/1n1961<- GENERAL 3 COPIES t/ STAMP Cr LOCUS NORTH ARROW �� SCALE e-- CONTOURS 1 PROFILE SECTION 1 BENCHMARKS SOIL & PERC INFO ELEVATIONS ✓ WETS. DISCLAIMER�i WELLS & WETLANDS v WATERSHED?_,JL DRIVEWAY I/ (Eley) WATER LINE L� FDN DRAIN SCH40 ✓ TESTS CURRENT? SEPTIC TANK MIN 1500G. 1 .17 INVERT DROP (/ GARB. GRINDER(+200% EDF) 25' TO CELLAR MANHOLE TO GRADE �/ ELEV_�C. GW D -BOX SIZE LINES FIRST 2' LEVEL STATEMENT_ INLETp3/ 42 - OUTLET /. _ -l% (2" OR .17 FT) TEE REQ'D?/Vo LEACHING/ / OK RESERVE AREA V 4' FROM PRIMARY?_z 100' TO WETLANDS 1,"""2% SLOPE 100' TO WELLS 1 35' TO FND & INTRCPTR DRAINS f--� 4' TO S.H.GW 325' TO SURFACE H2O SUPP 4' PERM. SOIL BELOW FACILITY MIN 12" COVER ✓ FILL?x(25' if above natural elev; 101 i below) BREAKOUT MET? ✓ TRENCHES MIN 660 gpd v SLOPE (min .005 or 611/1001)_z >3' COVER? - VENTS SIDEWALL DIST. 2X EFF. W OR D (MIN 61) IS RESERVE BETWEEN ©� TRENCHES? C/ IN FILL? MUST BE 10' MIN.L--' 4" PEA STONE?, BOT ���% X LDNG v'�8y + SIDE 366 X LDNG,�&,-)- = TOT (a 71 plod (L x W x #) (G/ft 2 ) (DxLx2x#) O-I�AIA I �C) FORM L 0 REFERRAL FORM Preliminary Plan Definitive Subdivision Special Permit Site Plan Review R2,v' C � ommon -Nve tooQ1 7 Fayn U rn � � l� North Andover, Massachusetts 19C Sup't/Highway, Utilities & Operations Director of Engineering 6 Administration Fire Chief Conservation Commission Inspector of Buildings Board of Health Police Chief Planning Board A Public Hearing has been scheduled for 9) p.m. on a 3 to discuss these plans. (Preliminary plans do not need public hearings.) May we have your comments and recommendations concerning these plans no later than 30 ct Thank you, P-704 WE M '"A N I —Arm FA/ 70 1 Clerk, Planning ffice w: - Page 1 of 1 Dellechiaie, Pamela From: Dan Ottenheimer [info@millriverconsulting.com] Sent: Tuesday, August 24, 2004 4:23 PM To: Susan Sawyer; amcbrearty@millriverconsulting.com; 'Pamela Dellechiaie' Subject: 247A Farnum Street Sue and Pam, Attached please find soil and perc test results for 247A Farnum Street. I understand the owner has been in to meet with you and has some grand plan. This is deemed new construction as they wish to add a bedroom to the house. New England Engineering only performed one perc test and two deep holes as it was envisioned this would be designed as trenches with a reserve area in between (plus we have the soils information for the existing leach area). Dan Mill TM consulting Daniel Ottenheimer, President Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsultinR.com info@millriverconsultin_g.com 8/25/2004 vp C-4 �© ...s i 0 D Page 1 of 1 Dellechiaie, Pam From: Dan Ottenheimer [info@millriverconsulting.com] Sent: Tuesday, August 10, 2004 9:42 AM To: Susan Sawyer; amcbrearty@millriverconsulting.com; 'Pamela Dellechiaie' Subject: soil tests Sue and Pam, We have arranged soil•ffs—ling with Joe Serwatka for vacant lot on Gray Street and with New England Engineering Services for 247A Farnum Street. oth are on Tuesday 8/24, first to Gray Street, then to Farnum Street in afternoon. �- Dan Min Move' r consulting Daniel Ottenheimer, President Mill River Consulting Septic System Management Services 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com info@millriverconsulting.co 8/12/2004 0 Towh of North Andover Health Department Date: Location: a r, �/ ; ze (Indicate Address, if Residential, or Name of Business) Check #:S?O (:9 4� / 1 Type of Permit or License: (Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service - Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal (Septic) Hauler $ ➢ Recreational Camp $ ➢, SEPTIC PERMITS: C�._5'eptic - Soil Testing $�'� ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ TrashIsolid Waste Hauler $ ➢ Well Construction $ ➢ OTHER: (Indicrdte) f 1 7 1 Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer TOWN OF NORTH ANDOVER HEALTH DEPARTMENT A 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845CH �,s R•''�<y sacHusk Susan Y. Sawyer, REHS/RS 978.688.9540 - Phone Public Health Director 978.688.9542 - Fax FAX Daniel Ottenheimer To: Mill River Consulting 978.282.0012 Fax: 1.800.377.3044 or Phone: 978.282.0014 From: Pamela Pages: Date: Request for Soil Testing or CC: Re: Septic Plan Review ❑ Urgent x For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle • Comments: Septic Plan Review Soil Test OTHER Note: For plan reviews, this is notification only. Plans will be mailed or arrangements made to pick them up as requested. Please call 978-688-9540 for assistance with any questions. Thank you. Cc: File - Address Q � AHP Fax K1220xi Log for NORTH ANDOVER 9786889542 Aug 05 2004 2:20pm Last Transaction Date Time Identification Duration Pages Result Aug 5 2:16pm Fain Sent 819782820012 3:46 4 OK O BOARD OF HEALTH�) NORTH ANDOVER, MASS. 01845 978-688-9540 APPLICATION FOR SOIL TESTS DATE: ®�t-� 0 MAP & PARCEL: 1 o7 A Lo -r 2--79, LOCATION OF SOIL TESTS: FR()K(-F OWNER: Dxl"� TEL. NO.: ADDRESS: 2--+-7 A 1 ARt,1.V iM ST(Z �— ENGINEER: NrGw ea (TCA'D -9(,'1V6WJ M (T SUCS TEL. NO.: °I `7 Qs — (mob% CERTIFIED SOIL EVALUATOR: TATK I Oscry TiZ P. E. Intended use of land: Residential Subdivision Single Family Home Commercial Is This: Repair testing Undeveloped lot testing Upgrade for addition _ X In the Lake Cochichewick Watershed? Yes No A THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of $425.00 per lot for new construction. This covers the minimum two deep required for each disposal area. Fee of $360.00 per lot for repairs or upgrades. GENERAL INFORMATION RECEIVED AUG 0, 4 2004 HEALTH 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval: Date Received: Check Amount: Check Date: ;) 3 0 eat %/ e06 2°\i$ L E of U) LU ■ F- U) 2. 2 \G ■ GS / L. 6 < « .. 3 0 07% N coo § % I § ƒ /{ < c \@ § 9 L\ g2/\ O Ba a0—* 2%+e;==@§� « a2e>2E\Et® (D(D(D�%��E,§ f ,FFc�x�o7� 0000 WWo_o C14 cli3 CD §§ Ci EM gg 0 « 2 ke\ aao�o CD / 0 d\ o § - O B�� k ]�<c too Qoƒ] a)m2�¥ « ��__ _M_-_ ) j/// /§w0 C . � U O -i _ Q \ - A /\ k SS 3 k2 � . 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F- k a)6 ° 3 0- b# CL CL e a e t�k\ \\/k (//]]2 f223 U) \ VLU l I a� ESZ X150 rSZ if L R i - °w% OSZ A ` L t 6rz liz i7 I YYL zi Orz�r°p Jl Oi U: Wt ti t° Ip` SLZ! 'VO 01-Z 91Lp� 6E K -D1 k 01 K 69Z nga'i n9"1 y 11 GpC � 61 GI OOZ n(t'0 •Kt �./ � .f. ec '0 t0.4p n�C'p -ct'o ..t. z.i .t•1 x nl e< 1 QLZ [0' CL OC) ci-$0Q bf L J. W,VC Mt pLY J 14 SOZ V' as. o� 1t1 Cu j PaZ -.w �o otr.t ZOl It n lOw. DM Doth tats t01 610 W4,04 ys DOOM 96 LG 6 001 c. C ZE R IG 811 IC g�c Dow rG L I e c pc LII tort. Ia+ -9rt 6i 011 tza'M oor" 1t` 1 Sat [L .6rlt •: r` VIM S1 npt a; Oj IN tot KI K 56.•ct .tr•r° 801 El Lt B q 601 tl tl la1tM �, -trl MKc t1 Ell ZZl L; y ..69; 4 ZI cw'M n Z'- ar" [ll 91 Gtyy r 9L tar" G: ) — L, 81 _ rZi zli ` IfI°Z rr cf tact0 i7j z L1 o rct c 6I 1I rr9r a x na'ar eI on'et ' Y \ Oct °j SZI r: III e r at l: of D DIIfI•M 7� Wit tZj .�� OI ZW91 Oil ` 6Zi6L r: nrM i zt urw 61 V It 8Z1 LZl 1: 0' — 6W'M 'p Y OZ I:9'LZ VLZ1 al t 0' TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, REHS/RS RECEIVED 978.688.9540 - Phone Public Health Director AUG 0 5 2004 978.688.9542 - Fax NORTH ANDOVER CONSERVATION COMMISSION FAX DanielOttenheimer From: Pamela To: Mill River Consulting 978.282.0012 Pages: Fax: 1.800.377.3044 or Date: Phone: 978.282.0014 Request for Soil Testing or CC: Re: Septic Plan Review ❑ Urgent x For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle • Comments: Septic Plan Review Soil Test '-' OTHER Note: For plan reviews, this is notification only. Plans will be mailed or arrangements made to pick them up as requested. ,�� XZ/17W ';1 Please call 978-688-9540 for assistance with any questions. Thank you. Cc: File - Address i ra BOARD OF HEAL NORTH ANDOVER, MASS. 01845 978-688-9540 APPLICATION FOR SOIL TESTS DATE: 8!L+1 04 MAP & PARCEL: 107 A LOT `i-7 LOCATION OF SOIL TESTS: FRc�rt�'r j,4��7 OWNER: DA i\,k E } rG�1S'j�_K TEL. NO.: ADDRESS: 2 `+ 1 A F A R hl V IM 5 rE( i� ENGINEER:_ f4;W �-;0trcpojb +r r�4 rr�k !a(� S143, TEL. NO.: cl `7 '7&8 CERTIFIED SOIL EVALUATOR: -&-N 7-4-,vt I G USC-xv 0 I -p- P. Intended use of land: Residential SubdivisionSingle Family H Commercial Is This: Repair testing Undeveloped lot testing Upgrade for addition _ x_ In the Lake Cochichewick Watershed? Yes No A THE FOLLOWING MUST BE INCLUDED WITH THIS FORM 1. Proof of land ownership (Tax bill, deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of $425.00 per lot for new construction. This covers the minimum two deep required for each disposal area. Fee of $360.00 per lot for repairs or upgrades. RECEIVED AUG 0 4 2004 HEALTH GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan (no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. N.A. Conservation Commission Approval: Date Received: Check Amount: d' Check AUG 0 9 2004 TOWN OF NORTH DEPARTMENT ANDOVER I" rn Ho m _ N a1 ►-a� �o5(DC �n N�ii 5 E N O T � C mU3 m co a°�i-din W W H W Z co Q 3o 000 z z LL Li Q Q 0 O �. 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LL cQ c mm :- oD LL cLL }` a cc a) CL C p a) m o t 2z)QZ)F W>- 0 C m Oet N •- HH LO a X NLL U cn E E M to ,-f0 ` `L 00 m 0 m M l9OO OO m O m o ID =: v mw 3c U) wV {- mLL=WmYW [COQ ONC9Q�U U -O ->- E rn Ho m _ cis U ��ya zM 2 N c �;ow83�vC �o5(DC �n N�ii 5 T ii 00 �LO Omm Q Woo W N N Z co M O�� m m J X00 CIJ 04 00 LOU) �0 0 o� ~ O 'C a) a U VLU l K \ „v,c "CoI hil £f •'ro, SSI r w.uo OSl 6LZ r oU A� 4l1 A4� r,0', S9 SE r I 99 , 6 I 9R weC[ / 15 tee" 6ZZ rr z �p0RTF A o �1LED �646"YQ h� Town of North Andover, �achusetts BOARD OF HEALS N APPLICATION FOR SITE TESTING/INSPECTION Form No. 1 19 Applicant NAME ADDRESS TELEPHONE Site Location Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time Fee CHAIRMAN, BOARD OF HEALTH Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. I --1"" 1--2 7 /0.4 , ��1 Til ■ 1 11 1 1 111 1�1� �'lllllllllll 1� � �� �lZ•, 1;:19 1. nl IL 11 .�I�111111 1111111111 �aeaee� 1!1 11 11 �Gllnl ; 1�11�lII�ISI!Il!lIIJII 1111 -11111111 11111111111111111111111 1111111111111111 1 1111 11 111 11111 1111 1 1111 �1 IL� 11 11 ®11111 1 11111111 ow , .r- �;h�!qlf#{R4p1tl{�`�d�;i�9iylu',Iwtl4'G1'f'hf1'; ,':#i, t1k ! ir'�ri; t+I+�Y valf,ys; ;i'?f��. �Sa l fiFk ii 11j d 7 3 a� 7 ���Pi✓u�� Si. i Com of Massac litisetts f '; . a CST IES_, SEPTIC & DRAIN SERVICE 107 FOREST STREET; MIDDI,ETON, MA 01949 (978) 774-2772 FORM 4 - SYSTEM PUMPING REC010 COMNIOMVEALTH OF RJASSACHUSETTS A MASSACHUSETTS SYSTEM OWNER: ,910 SYS -Tr., A /I P UA IPIN G R E C 0 J? D Z13 0 SYSTEM LOCATION: lef � 211dr ---- -� ' 7 DATE OF PUMPING:-J�, ) QUANTITY PUMPED:. GALLONS CESSPOOL: 'NIO[ I YES 7 F SEPTIC TANK: NO F7 YES SYSTEM PUMPED BY: CUIRWE R SEP'l[C DRAIN' SERVICE CONTENTS TRANSFERRED TO: -- DATE: INSPECTOR: Tc"V,0F �!ORTH�AN6-0--V_=-�,i POARDOFjr:ALTH' -elm