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Home My WebLink AboutMiscellaneous - 27 FULLER MEADOW ROAD 4/30/2018 (2)ev North Andover Board of Assessors Public Access ,koRth Return to the Home page click on logo New Search Sales Summary Residence Detached Structure Condo Commercial Comparable Sales To,v,vn, of Worth AiWlover RooaN2 of Assessors Parcel ID: 210/104.D-0127-0000.0 SKETCH Click on Sketch to Enlarge Page I of I TMM" Property -4 Record Card Community: North Andover PHOTO .ocation: 27 FULLER MEADOW ROAD )wner Name: BARRETT, ROBERT N PAULA M BARRETT )wner Address: 27 FULLER MEADOW ROAD City: NORTH ANDOVER State: MA ZIP: 01845 qeighborhood: 7 - 7 Land Area: 2.51 acres Jse Code: 101 - SNGL-FAM-RES Total Finished Area: 2856 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR rotal Value: 681,500 618,800 3uilding Value: 432,900 396,500 Land Value: 248,600 222,300 vlarket Land Value: 248,600 'hapter Land Value: LATESTSALE ;ale Price: I Sale Date: 09/20/1984 krms Length Sale Code: F-NO-CONVNIENT Grantor: Cert Doc: Book:00066 Page:0121 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Thursday, March 27, 2008 1:32 PM To: 'r4b4@aol.com' Subject: 27 Fuller Meadow Road COC, and copy of Title 5 are included, per your request. Pamela Health Department Assistant ----- Original Message ----- From: noreply@yourcopier.com [mailto:noreply@yourcopier.com] Sent: Thursday, March 27, 2008 2:29 PM To: DelleChiaie, Pamela Subject: Message from KMBT-600 SKMBT600080327 13280.pdf n Town of North Andover Health Department Date: //x -I le9zla Location: (Indicate Address, if Residential, or Name �f Business);�, Check #: nTe of Permit or License: (Circle) > Animal $ > Dumpster $ > Food Service - Type.— $ > Funeral Directors $ > Massage Establishment $ > Massage Practice $ > Offal (Septic) Hauler $ > Recreational Camp $ > SEP77C PERM[TS: L) Septic - Soil Testing L3 Septic - Design Approval $ • Septic Disposal Works Construction (DWC) $ • Septic Disposal Works Installers (DW[) $ > Sun tanning $ > Swimming Pool $ > Tobacco $ > TrashlSolid Waste Hauler $_ > Well Construction $ > OTHER. (Indicate) - 3 5 r2. Health Agent Initials White -Applicant Yellow -Health Pink -Treasurer V%ORTFf ,%jo 06 0 0 PUBLIC HEALTH DEPARTMENT Community Development Division %-/ A—.P A- A_j 'L J—).L (vRT1(F1CArr('F O(F C09141D('T ONM /L As of-. January 11, 2007 This is to certify that the individua(su6surface di�sposafsystem receiveda S,4T1S,FACT0RT1YS(PECq70Yqf the: Component ftair —Septic TankandD-Box,. compfetedby ToddBateson A t: 27 TulTerVeadow Wpad Wap: 104.0 — Parce[127 %orth,Andover 9W.A 01845 'The Issuance of this certificate shaff not 6e construed as a guarantee that the system wiff function satisfactorily. Susan T Sauyer Pubfic Yfeafth Director 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fox 978.688.8476 Web www.townofnorthandover.com COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION kECEIVED DEC 15 2006 TOWN U� NOR ( H ANDOVER TITLE 5 1 HEALTH 6E� �ARTME�Nl OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 22 Fuller Road — North Andove!7- Owner's Name: —Bill Masterson Owner's Address: 22 Fuller Road — North Andover, MA 01845_ Date of Inspection: 10/27/2006 Name of Inspector: — Neu J. Bateson — Company Name: Bateson Enterprises Inc._ Mailing Address: —111 Argilla Road — — Andover, MA 01810 Telephone Number: _(978) 4754786_ CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper fimction and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: 10/27/2006 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 DER The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments: After permit from B.O.H., install new outlet tee with gas baffle & new d -box, inspection from 11.0.11, septic system now passes Title 5 Inspection. ****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. COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ]ENVIRONMENT T 00 j 13 2005 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 27 Fuller Meadow Road — North Andover— Owner's Name: —Robert Barrett— Owner's Address: 27 Fuller Meadow Road — North Andover, Ma 01845 Date of Inspection: _1/11/2006_ Name of Inspector: — Neu J. Bateson— Company Name: —Bateson Enterprises Inc._ Mailing Address: —111 Argills Road — Andover, Ma. 01R0 Telephone Number: _( 978 ) 475-4786_ CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper fUnction and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: Passes L)C Conditionally Passes Needs Further Evaluation by the Local Approving Authority ils 'I Inspector's Signature: (f -`�ate: 1/11/2006 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 DER The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments: ****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. Page 2 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 27 Fuller Meadow Road- - North Andover— Owner: Barrett Date of &spection—: 1/11/2006 Inspection Summary: Check AB,CD or E / ALWAYS complete aft of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 3 10 CMR 15.303 or in 3 10 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: X 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. Answer yes, no or not determined (Y,N,ND) in the for the following statements. If "not determined" please explain. Y 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. Septic Tank Leaking *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: N 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 distribution box is leveled or replaced ND explain: N The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed ND explain: Page 3 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: — 27 Fuller Meadow Road- - North Andover– Owner: Barrett Date of i-nspection–: 1/11/2006 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(l)(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 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 I 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 i7nvate water supply well". Method used to determine distance "This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Page 4 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 27 Fuller Meadow Road — North Andover— Owner: Barrett Date of Inspection: 1/11/2006 D. System Failure Criteria applicable to all systems: You must indicate "yes" or "no" to each of the following for all inspections: —No— Backup of sewage into facility or Ustem component due to overloaded or - clogged SAS or cesspool —No— Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool —No— Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool — No Liquid depth in cesspool is less than 6" below invert or available volume is V2day flow. —No— Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped —No— Any portion of the SAS, cesspool or privy is below high ground water elevation. —No— Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. — No Any portion of a cesspool or privy is within a Zone I of a public well. —No7 Any portion of a cesspool or privy is within 50 feet of a private water supply well. —No— 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] __No�_ (Yes/No) The system fails. I have determined that one or more of the above failure criteria exist as described in 3 10 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. You must indicate either "yes" or "no?' to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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 11 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 3 10 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Page 5 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 27 Fuller Meadow Road North Andover Owner: Barrett Date of &spection—: 1/11/2006 Check if the following have been done. You must indicate "yes" or "no?' as to each of the following: Yes No —Yes— — Pumping information was provided by the owner, occupant or Board of Health — —No— Were any of the system components pumped out in the previous two weeks ? —Yes— — Has the system received normal flows in the previous two week period ? — —No— Have large volumes of water been introduced to the system recently or as part of this inspection ? —Yes— — Were as built plans of the system obtained and examined? —Yes— — Was the facility or dwelling inspected for signs of sewage back up ? —Yes— — Was the site inspected for signs of break out ? —Yes— — Were all system components, excluding the SAS, located on site ? —Yes — — 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 ? —Yes— — 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: Yes no —Yes— — Existing information. —Yes— — Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [3 10 CMR 15.302(3)(b)] Page 6 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 27 Fuller Meadow Road- - North Andover– Owner: Barrett Date of iospectiou: 1/11/2006 FLOWCONDITIONS RESIDENTIAL Number of bedrooms (design): –4– Number of bedrooms (actual): –4– DESIGN flow based on 3 10 CMR 15.203 600 Number of current residents: Does residence have a garbage grinder (yes or no): NeSL 7 Is laundry on a separate sewage system (yes or no): –No– Laundry system inspected (yes or no): Seasonal use: (yes or no): –No– Water meter reading: –Yes_ Sump pump (yes or no): –No– Last date of occupancy: –Current– COMMERCIAL/INDUSTRUL Type of establishment: Design flow (based on 3 10 CMR 15.203): ___gpd Basis of design flow (seats/persons/sqft,etc.): Grease trap present (yes or no): _ Industrial waste holding tank present (yes or no): Non -sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: OTIIER (describe): GENERAL INFORMATION Pumping Records Source of information: –Pumped two years, owner Was system pumped as part of the inspection (yes or no): –No– If yes, volume pumped: _ gallons -- How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank, distribution box, soil absorption system Single cesspool _ Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be �b—tained from system owner) Tight tank — Attach a copy of the DEP approval Other (describe): _ Approximate age of all components, date installed (if known) and source of information: 22 years old, 7/16/1984, as built plan_ Were sewage odors detected when arriving at the site (yes or no): –No– -Page 7 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 27 Fuller Meadow Road– North Andover Owner: – Barrett– Date of Inspection: 1/11/2006 BUILDING SEWER – X – (locate on site plan) Depth below grade: – 30" Materials of construction: – X – cast iron –X 40 PVC —other Distance from private water supply well or suction line: Comments (on condition ofjoints, venting, evidence of leakage, etc.) J" Cast iron thru wall. 3" PVC in house, no leaks visible SEPTIC TANKS: –X Depth below grade: _18" Material of construction: –X– concrete — metal —fiberglass __polyethylene ____pther(explain) If tank is metal list age: _ Is age confirmed by a Certificate of Compliance (yes or no): (attach a copy of certificate) Dimensions: 10'x5'x49 Sludge depth: – 3 -- Distance from top of sludge to bottom of outlet tee or baffle: –21"— Scum thickness: –6"– Distance from top of scum to top of outlet tee or baffle: – 8" — Distance from bottom of scum to bottom of outlet tee or baffle: 1811 How were dimensions determined: Jape Measure _ Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc. _ Inlet tee ok. Outlet tee ok. Depth of liquid below outlet invert. Evidence of tank leaking. Liquid level I" below outlet invert._ GREASE TRAP: _(locate on site plan) Depth below grade: _ Material of construction: —concrete ____petal _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 (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Page 8 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 27 Fuller Meadow Road- - North Andover– Owner: Barrett Date of & spection: –1/11/2006 TIGHT or HOLDING TANK: _ (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: _ Material of construction: —concrete —metal —fiberglass ___polyethylene other(explain): Dimensions: Capacity: _____gallons Design Flow: Alarm present (yes or no): Alarm level: Alarm in working order (yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): DISTRIBUTION BOXES: Depth below grade —31_ Depth of liquid level above outlet invert: –0– Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.):–D-box empty. Septic tank leaking, no liquid going to d -box. PUMP CHAMBER: (locate on site plan) Pump in working order (yes or no): Alarm in working order (yes or no): Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Page 9 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 27 Fuller Meadow Road— North Andover Owner: Barrett Date of &specti;n-: — 1/11/2006 SOEL ABSORPTION SYSTER (SAS): _X_ (locate on site plan, excavation not required) If SAS not located explain why: Type leaching pits, number: leaching chambers, number: leaching galleries, number: leaching trenches, number, length: _X_ leaching field, number, dimensions: —1 field 201 x 451 overflow cesspool, number: innovative/altemative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): —Soil oL Vegetation oL No sign of ponding to surface. Camera leach pipe, no liquid in pipe. _ CESSPOOLS: Number and configuration: _ _ Depth — top of liquid to inlet invert: Depth of sludge layer: Depth of scum layer: _ Dimensions of cesspool: Materials of construction: Indication of groundwater Ofl-ow (yes or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIW: (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.): Page 10 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 27 Fafler Meadow Road- - North Andover— Owner: Barrett Date of &spection: 1/11/2006 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. • to Tank = 271511 • to D -Box = 301 B to Tank = 22'10" B to D -Box = 317" Page 11 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 27 Fuller Meadow Road — North Andover— Owner: Barrett Date of inspection: 1/11/2006 SnT EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water — 41 Please indicate (check) all methods used to determine the high ground water elevation: _X_ Obtained from system design plans on record - If checked, date of design plan reviewed: 5/19/1983 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: —Soil test pit data on design plan cma uj i 57 'Ja . .. .. . .... . CIC, uj- nm rAl6l rag on El Ani oi 2 SSSM�C=) C) s (N rj, (N jiLol �r cma uj i 57 'Ja UJ cc w Ln CXi" Gl 54 N, Z5 LLJ d), vj, UJ cc w Ln CXi" Gl 54 N, Z5 LLJ d), LU LLJ Tel: (978) 475-4786 Fax: (978) 475-5451 BATESON ENTE"FJSES, INC. Excavating -Water.& Sewer Lines -Septic Systems & Pumping Service I I I Argilla Road Andover, Mass. 0 18 10 Title 5 Inspection Report Property Address: 27 Fuller Meadow Road, North Andover Owner: Barrett Date of Inspection: 1/11/2006 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 systent keil . Batjxn Bateson Enterprises, Inc. I 'TA9 -Sv " vs 0 PUBLIC HEALTH DEPARTMENT (ommunity Development Division / // 191 /11� QNSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS:A!q�-, MAP- LOT: e��7 INSTALLER: DESIGNER: PLAN DATE: BOH APPROVAL DATE ON PLAN: 1111e WSPECTIONS 'TANKINSPECTION: �'44�x DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS El Existing septic tank properly abandoned El internal plumbing all to one building sewer Comments: 11 Topography not appreciably altered SEPTIC TANK E�/ Bottom of tank hole has 6" stone base Weep hole plugged E] 1500 gallon tank hlqz-bevri—in-sj�djed 10 loading onolithic construction 2---�W-ater tightnL4�'f-ta-nk-h-as==" / (Visual or Vacuum Test or Water held for 24hrs) [yg/ Inlet tee installed, centered under access port Outlet tee (gas baffle or effluent filter) installed, centered under access port 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fox 978.688.8476 Web wwtown0northandovemorn q,-,*-L� Comments: PUMP CHAMBER Comments: ' DISTRIBUTION -BOX =waft RTH 0 PUBLIC HEALTH DEPARTMENT (ommunity Development Division El 24" inch cover to within 6" of final grade installed over /one access port, must be over outlet of tank if effluent filter is present Hydraulic cement around inlet & outlet F-1 Bottom of tank hole has 6" stone base Weep hole plugged Combo Tank installed. Size: 1000 gallon Pump Chamber installed H-10 loading Monolithic construction) E] Inlet tee installed, centered under access port El Pump(s) installed on stable base 7 Alarm float working El Pump On/Off floats working E] Separate on/off floats Drain hole in pressure line El 24" inch cover to within 6" of final grade installed over pump access port Water tightness of tank has been achieved Visual testing E] Hydraulic cement around inlet & outlet E� Installed on stable stone base Ej Inlet tee (if pumped or >0.087foot) .Z-01 Hydraulic cement around inlet & outlets Observed even distribution Speed levelers provided (not required) 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fox 978.688.8476 Web www.townofnorthandover.com 61 0 C AIAXWIC. PUBLIC HEALTH DEPARTMENT (ommunity Development Division SOIL ABSORPTION SYSTEM (General) F-1 Bottom of SAS excavated down to 6 in into C soil layer, as provided on plan F] Size of SAS excavated as per plan Title 5 sand installed, if specified on plan F] 40 Mil HIDPE barrier installed Retaining wall (boulder concrete / timber/ block) Final cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel -less Chambers) F Brand and Model of Chamber Infiltrator Quick 4 El Number of chambers per row —9 E] Number of rows (trenches) _ 3 E] Laterals installed and ends connected to header (and vented if impervious material above) Elevations of laterals and chambers installed as on approved plan Comments: CONTROLPANEL Comments: E] Alarm & Pump are on separate circuits F1 Alarm sounds when float is tripped F� Location of control panel: F� Rated for exterior if placed outside F� Alarm signal located inside 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Th F -t / -,:." - .... ..— ' 0 C% - PUBLIC HEALTH DEPARTMENT (ommunity Development Division SYSTEM ELEVATIONS 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthondover.com INVERT INFIELD PLAN INVERT ELEV. Benchmark Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN Distribution Box OUT Lateral 1 INV Lateral 1 TOP Lateral 2 INV Lateral 2 TOP Lateral 3 INV Lateral 3 TOP Lateral 4 INV Lateral 4 TOP 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthondover.com e000�! 0 0 L 'I c c PUBLIC HEALTH DEPARTMENT (ommunity Development Division CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback 1 Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02). 3 As defined in 3 10 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA wetland bylaws 61 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.towoofnorthandover.com Tank SAS Sewer El Property line 10 10 0 Cellar wall 10 20 El Inground pool 10 20 El Slab foundation 10 10 [:1 Deck, on footings, etc 5 10 -- El Waterline 10 10 101 El Private drinking well 75 1001 50 0 Irrigation well 75 100 Surface Water 25 50 Bordering Vegetated Wetland Salt Marsh, Inland / Coastal Bank' 75 100 Wetlands bordering surface water supply or trib. (in Watershed) 150 150 El Trib. to surface water supply 325 325 0 Public well 400 400 El Interim Wellhead Prot. Area 0 Reservoirs 400 400 El Drains (wat. supply/trib.) 50 100 El Drains (intercept g.w.) 25 50 Ej Drains (Other) Foundation 10(5) 20(10) [I Drywells 20 25 1 Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance (NA 5.02). 3 As defined in 3 10 CMR 10.55, 10.32, 10.54, and 10.30, respectively, pursuant to 15.211(3), also by NA wetland bylaws 61 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.towoofnorthandover.com A VJ0PT#q Commonwealth of Massachusetts 0 Board of Health North Andover P.I. emu F.I. Map -Block -Lot 104.D- 0127 - ----------------------- Permit No BHP -2006-0058 FE E $1 25 .00 Disposal Works Construction Permit Permission is hereby granted Todd -Bat e -son ----------------------------------------------------------------------------------------- to (Repair) an Individual Sewage Disposal System. atNo - 27 FULLER- MEADOW -ROAD as shown on the application for Disposal Works Construction Permit No. BHP -2006-005 Dated March 0 1, 2006 ------------------------ --------- -------------------- ------------ ------------------- Issued On: Mar -01-2006 Board of Health -- - ------------------------------------------ Map-Block-Lot + Commonwealth of Massachusetts 104. D- 0127 - ---- ---------------- Board of Health N North Andover 0 0 a r h A 0 nd e 0 a ve r rt C Certificate of Compli Di THIS IS TO CERTIFY, That the Individual S ge sposal System (Repaitr) ------- -------- ----- -- by ... Todd -Bateson ------------------------------ --- Instal - ler ---------------------------------------------------------------------------- at No 27 FU LLER has been installed in ac( application for Djg�sa, K. Feb -27-2006 ---------------------- ��MEAD93WROAD---------------------------------------------------------------------------------------- --- a-nce with the provisions of TITLE 5 of the State Environmental Code as described in the Works ConstructionPermitNo. _13HP-20067005 Dated --- March -0-1,2006 ----- -------------------------------------------------------- Board of Health I ... .......... r Town of North Andover Health De0aitinent Date.. Location: (Indicate Address, if Residential, or Name I of Business) Check #: xj,�t /<d Type of Permit or License: (Circle) > Animal $ > Dumpster $ > Food Service - Type. $ > Funera I Directors $ > Massage Establishment $ > Massage Practice $ > Offal (Septic) Hauler $ > Recreational Camp $ > SEPTIC PERMITS: Ll Septic - Soil Testing $ Lj Septip, Design Approval OStic El'... Disposal Works Construction (DWO $ u Septic Disposal Works Installers (DWF) $ > Sun tanning $ > Swimming Pool $ > Tobacco $ > TrashlSolid Waste Hauler $_ > Well Construction $ > OTHER- (Indicate) A L " 0 1; 1 �,x J1. 1424 Health Agent Initials White -Applicant Yellow -Health Pink -Treasurer -4 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. M Application is hereby made for a permit to: El Construct a new on-site sewage disposal system* 4 � � �la I � 7, /w" TODAY'S DATE $2 _jj9_ffl=1uU_Re i pair 0 -Com =�-O�� [:1 Repair or replace an existing on-site sewage disposal system* ,��Cepair or replace an existing system component A. Facility Information Address or Lot # City/Town 2.- *TYPE QUEPTIC SYSTEW: El Pump ZGravity (choose one) ***If pump system, attach copy of electrical permit to application*** P�Conventional System (pipe and stone system) n Infiltrator or Biodiffuser (Gravel -Less) (Attach a copy of your certification to install this type of system. Pressure Distribution S.A.S. (No D -Box) (Attach Draft Maintenance Agreement) Pressure Dosed (D -Box Present) S.A.S. 2. Owner Information Name Address (if differeAt from above) r 44 CityfTown State Zip Code Installer Information Name Acldres� A 'r;'T—A0 V k City/Town 4. Designer Information Name Address City/Town Telephone Number Nami'-o-f Company /';�f State e /W 0 Zip Code Telephone Number (Cell Phone # if possible please) Name of Company State Zip Code Telephone Number (Best # to Reach) Application for Disposal System Construction Permit - Page 1 of 2 PAGE 2 OF 2 A. Facility Information continued.... 5. Type of Building: J;4/Residential Dwelling or FCommercial B. Agreement TODAY'S DATE $ 250.00 - Full Repair $125.00 - Component The undersigned agrees to ensure the construction and maintenance of the afore -described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North A ,nd"er, and not to place the system in operation until a Certificate of Compliance has been ' sue by this Board of Health. �rs "7 — Na Date 710" Application Approved By: (Board of Health Representative) Name Date Application Disapproved for the following reasons: For Office Use Only: 1. Fee Attached? Yes Z No 2. Project Manager Obligation Form Attached? Yes No 3. PumpSystem? If so, Attach copy of Electrical Permit Ye s No 4. Foundation As -Built? (new construction ronly): Yes No (Same scale as approwdplan) 5. Floor Plans? (new construction only): Ye s No Application for Disposal System Construction Permit - Page 2 of 2 INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at � 7 F,. 1�fi:, Xo, , relative to the application of—A,V dated J- — X � —d6 for plans by I ------ __ and dated — with revisions dated '-- I understand the following obligations for management of this project: I . As the installer I am obligated to obtain all pen -nits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer I must call for any and all inspections. If homeowner, contractor, project manger, or any other person not associated with my company schedules an inspection and the system is not ready then item three shall be applicable. 3. As the installer I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Tile 5 and the Board of Health Regulations may result in a $50.00 fine being levied against my company. a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final inspection — Engineer must first do their inspection for elevations, ties, etc. As -built or verbal OK from engineer must be submitted to, Board of Health, after which installer calls for inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. c) Final Grade — Installer must request inspection when all grading is complete. Does not have to be on site. 4. As the installer I understand that only I may perform the work (other than simple excavation) required to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system, and/or revocation or suspension of my license to operate in the Town of North Andover; significant fines to all persons involved are also possible. 5. As the Installer I understand that I must be on site during the performance of the following construction steps: a) Determination that the proper elevation of the excavation has been reached., b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff or consultant. d) Installation of tank, D -box, pipes, stone, vent, pump chamber, retaining wall and other components. 6. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve ine of this obligation. Undersignpl;Licensed Septic Installer Date: 'YPE OF SEWERAGE DISPOSAL lublic Sewer Veil rivate (septic tank, etc. Tanning/Massage/Body Art Swimming Pools Tobacco SalFs Food Packaging/Sales Permanent Dumpster on Site F1 Electric Meter location to project_ rg wi I IOTE: Persons contracd NA, tfi unregistered contractors do not have access to the guarantyfund ignature of Agent/Own Signature of contractor 'Allived lans Submitted Plan aived Certified Plot Plan Stamp Plans THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED LANNING & DEVELOPMENT 11 )MMENTS INS DATE APPROVED DATE REJECTED DATE APPROVE )NSERVATIO;P I? - i VAI PROVED JALTH 1MMENTS /'5 /0 �' O� % &'%� tE DEPARTMENT - Temp, Dumpster on site yes no ,e Department signature/date MMENTS ng Board of Appeals: Variance, Petition No: ------Zoning Decision/receipt submitted yes _ iing Board Decision: ervation Decision: Comments Comments L 'er & Sewer Connection/Signature & Date Driveway Permit Permit NO: Date issued: TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION IMPORTANT: Date ReceivedJLA-01�— i�u-stcomplete all items on this PROPERTY OWNE Print MAP NO.: c2/40,(-`>/ARCEL:-6Q �_0&00,0 ZONING DISTRICT: - TYPE AND USE OF BUILDING TYPE OF IMPROTEM-ENT 0 New Building El Addition �Alteration [3 Repair, replacement El Demolition [I MovinL(relocation) El Foundation only. HISTORIC DISTRICT PROPOSED USE Residential ,19,One, family 'family 0 Two or more No. of units: 0 Assessory Bldg 0 Other DE§FRIPTION OF WORK TO BE PREFORMED < —, 1-7 J I /F -T- AAJ 6 ? C— A-) OWNER: Name: Address: I z57 Identification Please Type or Print Clearly) k YES 0 10 4100 0�--! T- 2-1.- F -P - , � 13" Non- Residential 0 Industrial 0 Commercial 0 Others: I Pho CONTRACTOR Name: Address: )"'i (b tt Supervisor's Construction License: Exp. Date: Home Improvement License / 3 �- / Exp. Date: ARCHITECT/ENGINEER — Name: Phone: �- 7-2- Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: SIZOO PER S1000.00 OF THE TOTAL ESTIMATED COST BASED ON S125.00 PER S.F. Total Project Cost:$ - - I FEE:$ ao H ,— Check No.: Receipt No.: Page I of 4 4,749 PUBLIC HEALTH DEPARTMENT Community Development Division Robert and Paula Barrett 27 Fuller Meadow Road North Andover, MA 0 1845 December 21, 2006 Re: Application for: deck Dear Mr. And Mrs. Barrett, This is a follow-up to a conversation held at the Health Department between Mrs. Barrett and myself in regard to the application for a building permit. In addition to our conversation, a written request was received from you, asking that the deck be given approval to be built prior to the repair of the septic tank. The request is similar to one that was granted to you in regards to the finishing of the basement I I months ago. At that time you submitted a cost estimate of $5690 by Bateson Enterprises and stated that the work would be completed in the spring of 2006. A permit to replace the leaking septic tank was issued in February, however according to you, this work was not completed due to necessary structural work on a leaky window that was unexpected, but necessary, and you were unable to afford both projects. The Health Department is charged with protecting the health and environment. Your septic system is currently not protecting either. The septic tank is cracked. Therefore, for at a minimum of one year now, and likely many more, the effluent (the liquid portion) of human waste has been seeping into the ground around your septic tank. This in effect makes it a cesspool as the field that was designed to treat the effluent from the septic tank is sitting dry and idle. The N. Andover Department of Public Work's records indicate that your water consumption is on average 320 gallons a day. This means that over the past I I months 106,964 gallons of wastewater have entered the ground 10 feet from your foundation. That is a hazard to the ground water. To recap, the first project was done at a cost of $23,000, the window replacement was $5,700, and this new deck project is estimated to be $17,000. The cost of correcting this health hazard, 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com by replacing the septic tank, was estimated at $6,000. However, be reminded that there is also the requirement that a complete Title V be done six months from the replacement of the septic tank. This is to ensure that the septic field, that was not being utilized, is in fact functioning properly, if it is not, the possible cost of a required septic field replacement could be over $20,000. It is the Health Department's purview to ensure compliance to the MA DEP Subsurface Disposal regulation and the local septic regulations. We would be remiss to allow you to begin additional projects if you have not complied with previous agreements. In fact, if this hazard is not corrected in a timely manner there could be additional action by the Health Office. Therefore, it has been determined that to allow you to move forward on the deck project you must supply Mr. Bateson with a substantial deposit and schedule a date for excavation by January 10, 2007. 1 believe your proposal was a $2,000 deposit. This would show good faith to this office that your are committed to completing this task. This good faith effort would be the minimum acceptable to this office. Until such time that this issue is addressed the building permit will be denied. Upon receipt of proof of the above items, the Building Permit Form U will be signed and forwarded to the Building Department. 56san Sawyer, I Health Director Cc: Building Department File 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Dee 22 06 11:29a P.1 Summary Record Card generated on 12/2212006 9:16:36 AM by Lisa Warren Town of North Andover Tax Map # 210-104.D-0127-0000.0 27 FULLER MEADOW ROAD BARRETT, ROBERT N. 27 FULLER MEADOW ROAD N. ANDOVER, MA 01845 Class 16-1 �a'mil-y Size Total 2.51 Acres FY 2007 UB Mailing Index Property Type NamelAddress Type Loan Number Activelinact. From BARRETT, ROBERT N. Payor 27 FULLER MEADOW ROAD N, ANDOVER, MA 01845 UB Account Maint. Account: No Cycle Occupant Name Activelinactive Bldg Id. 21634.0 - 27 FULLER MEADOW ROAD Lost Billing Date 10/16/2006 3160281 03 Cycle 03 Active UB Services Maint. Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.63 5i8 7.82 1/ WTR WATER 01 ALL METER SIZE 285.24 /1 UB Meter Maintenance Serial No Status Location 32939023 a Active ERT HH Date Reading Code 12/5/2006 129 a Actual 9/6/2006 103 a Actual 6/12/2006 -37 a Actual 3117/2006 10 a Actual 1/31/2006 0 n New Meter 1/31/2006 4606 r Replacement 12/16/2005 4592 a Actual Trouble Code:09 9/14/2005 4540 m Manual estimate MSG 6/7/2005 4490 m Manual estimate 3/512005 4450 m Manual estimate MSG 1218/2004 4405 a Actual Trouble Code:09 9/15/2004 4.350 m Manual estimate 6/9/2004 4310 a Actual 4115/2004 4281 a Actual Page 1 1 Residential [grim Brand Type Size YTD Cons b Badger w Water 0.630.63 Consumpp"an— Posted Date Variance -62% CE6610/20/2006 147% 27 7110/2006 40% 10 4117/2006 -100% 0 4117/2006 -100% -47% 52 1/1712006 12% 50 1011412005 19% 40 7/15/2005 -18% 45 4/512005 -21% 55 1/14/2005 60% 40 1018/2004 -23% 29 7/3012004 36% 51 5117/2004 0% Y,c-44tz- r, I -r December 14, 2006 Town of North Andover Health Department North Andover, Mass. 0 1845 Attached are the forms showings the location of our septic system in the front of the house and also the location of the deck which is in the rear of the house. We are planning on doing the Title five work on the septic in the spring of 2007. There was a delay this spring due to unforeseen circumstances. Now that it is December we would like approval to have the deck done during the winter because of a huge cost savings to us (winter discount) and the timely manner which is of benefit to our schedule of our future planned renovations of our home. Thank you for your consideration in this matter. Sincerely, Robert and Paula Barrett 27 Fuller Meadow Rd. North Andover, Mass. 0 1845 978-794-9717 )l " CO LL 1 0 001—B a Am -9 (3 A 01 (J7 71 C- P, Zo EASEWNT'C' Z) 0 441\ WT 4G, 109,470 d VIA ROAD i:7R FULL— EASE.MENT D' PLA N. � H 0 WN- G SUB SURFAC E �S E �IEBAGE DISPOSAL SYSTEf, AS -BUILT OWNER LYNC.0-0 �&LTY TRUc,-,T 'LOCATION LIDT49 FUl I ER MFAD0V,,l RD. DATE 7-16-84 SCAll 46 PRE -PARED BY C-77 v. Ile ELEVATIONS TOP FND 141.00 HOUSE ()LfTLEr 1,38.40 S T INLET IZ S�Z5 ST OUTLET 13 1� D BOX INLET L!, 4 - D BOX ODITLET 134-80 ENI),flELD 124,60 I CEViTIFY7HAT 'T'HE SF_PTIC SYSTEM %VAS I WS—ALLED AS (,ROWK�144SPUANIS NOT INTEWEDASAWARRANTIC)FTHF `YSTEM,PRoPEkTYQEXRJPTI0N FPOM NERL PLAN 36903 J. FUJNLATION CERTIFICATION ANDLOCATION OY RF KAfrllN9Q 4 ASSOCo EASE.MENT D' PLA N. � H 0 WN- G SUB SURFAC E �S E �IEBAGE DISPOSAL SYSTEf, AS -BUILT OWNER LYNC.0-0 �&LTY TRUc,-,T 'LOCATION LIDT49 FUl I ER MFAD0V,,l RD. DATE 7-16-84 SCAll 46 PRE -PARED BY C-77 v. Me We! '1. 11 - -_ 1.11 - 11 0 PUBLIC HEALTH DEPARTMENT Community Development Division Date: December 11, 2006 Address: 27 Fuller Road Re. Applicadonfor. deck Dear: Mr. And Mrs. Barrett Ir C—.FX Your application for a deck at has been reviewed by the Health Department. The application was denied on, December 11,2006 for the following reasons: I - x Mssing information 2. x Passing Title 5 inspection of septic system required 3. 0 Location of structure not acceptable 4. 0 Undersized septic system To address the problem . (sj� If #1 is checked, please supply: a. Floor plan of existing and proposed addition — all rooms b. Certified plot plan showing house, septic system and proposed project in scale N #2 is checked: a. Have the septic system inspected by a certified Title 5 inspector to determine whether it is operating property: Please note that the Title V Inspection is the result of a prior agreement with the Health Department. (see attached) b. Tie-in to municipal sewer If #3 is checked: a. Relocate the project If #4 is checked: a. Provide additional information proving that the e2dsting septic system meets current capacity requirements. Please consult an engineer to deterrame the flow capacity of the septic system. 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688,9540 Fax 978.688.8476 Web www.townofnorthandover.com Please feel free to call the Health Office at 978-688-9540 with any questions you may have. As soon as these items are cleared up, we will be able to sign off on the building application. Sincerely, Sawyer, REHS/RS Director Cc: Building Department File 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Rermeadow Lane 'arreft Residence inuary 24, 2006 1 spoke to Mrs. Barrett on 27 rmeadow Lane. Mrs. Barrett would like to enter into an agreement with the Health Dept. regarding per I Me v (Conditional Pass). Mrs. Barrett would like to go forward with refinishing her basement and needs sign off from the Health Dept. and would like to fix her cracked Septic Tank in the spring. Barrett will need to provide the Health Dept. with the following 1. Written estimate from a Licensed Septic Installer 2. Written commitment between Installer and Homeowner with financial deposit. 3. Title.V re -inspection 6 months after the agreement has been signed. Cc: Building Department 6"XI COMM onwealth f Massachusetts 7M 0 �4WBIOC (-Lot k Board of Health 104.D- 0127. ----------- P.J. orth Andover permit No F.I. BHP -2006-0058 ----------- --------- FEE DisPosal Work ------------ $1 - 25 - .00 - Permission is hereby . grante s ConstruCtion Perrhit -- --- d _Todd.Bateson to (Repair) an Individual S ----------- ------------ _ --------------------- e*age Disposal System. --------- ---------- at No __ 2 - 7 Tq4ER _M94POW-ROAD -------------- as shown On the application for Disposal Work ----------- ------ ------- ----------------- --------- s Construction Permit ---------------------------------- Dated, March 0 1, 2006 r7m Issued On: Mar -0 1 .20'06 -------------------- -------------- .... ----------- ------------ ------ ........ ------------- -- ---- ----- Oflt Board f ------- Ingalls .... a ... 06 Health pro# .............. C...... Ommonwealth of Mal ssachusetts ]Wal)-fflock-Lot 4j Board of' Health 104.D. 0127- 4.41 North An'dove ---- ------------ rr Certific a le of Compil THIS IS TO CERTIFY, That the by, Todd Individual s eD isposal -------- ----------------- System (Repair) ------------- I - ------- TPLLER MEAD Instaiier OAD-------- I -------- ---------- been installed in a --------------------- -------- has applic i- 15��ce with the provisi --- ation for D1 a Ons Of TITLE 5 of the S. r -------------------------------- -------- .11rint e I Works Construction Permit No. tate Environmental Code as described in the __ 1: =eb-27.2001s6, Dated _ ------------------------- _ ------------------- ------------- > OTHER-(1iditNt "I, ......... ................ ------- ------------ __ --------- .... Board of Health --------------------- ............. vate-U01.4 ............... ....... Health Agent Initials ....... 424 White -Applicant Yellow -Health Pink -Treasurer 4. Designer Information Name Address City/Town — /171f State e / V. -I C) Zip Code Telephone Number (Cell Phone # if possible please) ............. Name of Company State Zip Code Telephone Number (Best # to Reach) Application for Disposal System Construction Permit - Page 1 of 2 FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or !landowner from compliance with any applicable or requirements. APPLICANT FILLS OUT THIS SECTION APPLICANT 41-6� (Ze'e/w( , 95F PHONE LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT (S) STREET FlyttCf X16-1i�l�e) 6Rd 'ST. NUMBER_2.a- OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS: DATEAPPROVED DATE REJECTED DATEAPPROVED DATE REJECTED DATEAPPROVED DATE REJECTED_ DAT"PPKbVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWERMATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE CONSERVATION ADMINISTRATOR COMMENTS "-TOWN PLANNER COMMENTS F099, INSPECTOR-HEACTH All XSE INSPECTdR-H'-EAd W DATEAPPROVED DATE REJECTED DATEAPPROVED DATE REJECTED DATEAPPROVED DATE REJECTED_ DAT"PPKbVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWERMATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE TOWN OF NORTH ANDOVER BMW% DEPARTMENT APPLICATION TO CONSTRUCT,! RENOVAT!6 OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERM NUMBER DATE ISSUED: SIGNATURE: Building Commissioner/12g=tor of Buildings Date SECTION 1- SITE INFORMATION I 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 27 FouxieMami Rogo A AmDeff*, Map Number Parcel Number tre 1.3 Zoning Information: 1.4 Property Dimensions: -7-Amin&District Proposed Use Lot Area (sf) 1.6 BIJUDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide ESj�red= Provided Regpired, Provided 1.7 Water Supply AGI -C.40. § 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System ublic 0 Prhrue 0 Zone -_ -_ _ Outside Flood Zone 0 1 Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSEEIP/AUTHORIZED AGENT Historic District: Yes No 2.1 Owner of Record RAU&r Name (Print) Address for Service-. 7cf- 71q- I 9/� Signatu-rt------- Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 0 0 -,/ occF--4)" Licensed Construction Supervisor: 72q?q,? 7.-�WehtegRdFl- A4iW A& ozo-Z License Number W421-4060 Expiration- Date 955 Telephone 3.2 Registered Home Improvement Contractor Not Applicable 0 - & 16 ) q V-3 Company Name AJ R4strafion Number Add - Expiration Date atty Telephone 0 I SECTION 4 - WORKERS COMPENSATION MG.L. C 152 6 25c(6) I Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildiug permit. Signed affidavit Attached Yes ....... 2' No ....... 0 SECTION5 Descriptiono Proposed Work (check applikable New Construction 0 Existing Building 0 Repair(s) 0 Perations(s) PK Addition 0 Accessory Bldg. 0 Demolition. 0 Other 0 Specify Brief Description of Proposed Work: FJ"[.SJq 5ST Ster ?_0 X?Sf A(01&,CC-JLJ.4J(5 6,41J.4 ffedxffin 7 1/ 900on 7V 96 U36P Ar & Fammki Room SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical (HVAC) 5 Fire Protection 6 Total (I+T3+4+5) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, Aag r7 as Owner/Authorized Agent of subject property Hereby authorize._.. L'�(VW4WI ou r. &*46Jr_5�/Jon to act on My be al ill-inatters relative to work authorized by this building pen -nit application. Signatu&605kiiler Date' V SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I 1, -PAAVV_ ic, —,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief P�ri A�ai n e i atur &&AKt Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TITVMERS 2 ND 3 FJ) SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHDANEY IS BUUDING ON SOLID OR FELLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE W February 2, 2006 Attn: Michele Grant North Andover Board of Health 400 Osgood Street North Andover, MA 01845 Dear Ms. Grant, Per our conversation, this letter is to inform you of our intent to replace our septic tank and D -Box. We have received and accepted an estimate for this work from Bateson Enterprises (attached). This work will be performed as soon as possible in the spring, after the snow melts and the ground thaws. Sincerely, Paula M. Barrett Robert N. Barrett 27 Fuller Meadow Road North Andover, MA 0 1845 978-794-9717 .1 BATESON ENTE"RISES. INC I I I I Argilla Road Andover, MA 0 18 10 Phone: (978) 475-1474 Fax: (978) 475-5451 Mr. Robert Barrett 27 Fuller Meadow Road North Andover, IMA 01845 RE: Quote, Septic Tank & D -Box Replacement.. 1) Permit. 2) Remove Brick Walk Section. 3) Remove Shrub Over Tank. 4) Pump Septic Tank & D -Box. 5) Remove Existing Septic Tank & D -Box. 6) Install New 1500 Gallon Septic Tank. 7) Install 24" Access Cover To Septic Tank. 8) Install New 6 Hole D -Box. 9) Install New Pipe From Tank To D -Box. 10) Backfill & Subgrade Areas Of Excavation. 11) Remove Any Excess Material. 12) Loam, Seed, & Fertilize Areas Of Excavation. 13) Repair Walk Section. February 1, 2006 $5690. Todd Bateson Bateson En )$rises, Inc. Thank You For The Opportunity To Quote 2 7 Fullermeadow Lane The Barrett Residence On January 24, 2006 1 spoke to Mrs. Barrett on 27 Fullermeadow Lane. Mrs. Barrett would like to enter into an agreement with the Health Dept. regarding her Title V (Conditional Pass). Mrs. Barrett would like to go forward with refinishing her basement and needs sign off from the Health Dept. and would like to fix her cracked Septic Tank in the spring. Barrett will need to provide the Health Dept. with the following 1. Written estimate from a Licensed Septic Installer 2. Written commitment between Installer and Homeowner with financial deposit. 3. Title V re -inspection 6 months after the agreement has been signed. Cc: Building Department m 0 F T E - � =074 1 M E Z, � f --' J\ El �AX ON L��TLE� eel m No"[-L,]L� . — 0 �t p � nIp � Veod H-, PC, 4e, P?i 1), � ma V, I Town of North Andover tkaRTFt 6 1,20 Community Development and Services Division 0 Office of the Health Department flassachusetts 01845 North Andover, I\ 4L 400 OSGOOD STREET S -ver, RF"IfS/RS _,usan Y. Saw, Public Health Director Date: 0-V �./'y 700S Address: Yea , North Andover, MA 01845 Re: Application for: 6obe,-4- Dear: Your application for at Department. The application was denied on, I . V/ issing information 2. ��Paissing Title 5 inspection of septic system required 3. 0 Location of structure not acceptable 4. 0 Undersized septic system To address the problem(s): (978) 688-9540 - Phone (97/8) 688-9542 - Fax has been reviewed by the Health 2004 for the following reasons: If #1 Is checked, please supply: Floor plan of existing and proposed addition — all rooms Certified plot plan showing house, septic system and proposed project in scale If #2 ISP�cked: Ua Have the septic system inspected by a certified Title 5 inspector to detennine the size of the system and whether it is operating properly: OR b. Tie-in to municipal sewer If #3 is checked: a. Relocate the project If #4 is checked: a. Provide additional information proving that the existing septic system meets current capacity requirements. Please consult an engineer to determine the flow capacity of the septic system. Please feel free to call the Health Office at 978-688-9540 with any questions you may have. Sincerely, <1 L'n ke �a R'e'viewer J ' Cc: Building Department File e,,, e,, 77 � 13(),%.RD ( )I APITA( �; 'M-0�41 1 il A I )1 15 c' f18:4-1)"43 !TANNIN6 Oli-1. ) �31 JAN 05,2006 07:41A Owens Corning Basement S 9788512944 � 7 1--',UU-C-X M&Mtd 44, N � RW&ta low page 1 Board of Health North Andover'M�SB.' jLrMUV r -LU RekAMMSt OK BEpne MTEK INSTALLATICK CHECK LIST LOT EXCAVATION OK /7, 1. Distance Tot no Wetlands b. Drains c.. Well 2. Water Line Location 3. No PVC Pipe Septic Tank a. -Tees � �.__Length. & To cl - ean out Covers. b. Cement Pipe to Tank On Both Sides of Tank - 5. Distribution Box a. Covers & Box - No Cracks b. A21 Lines Flowing Equal Amunts c. No Back Flow 6.- Leach 11eld or Trench a. Dimensions b. Stone Depth a*, Capped 'Ends d. Clean Double-Washed.Stone' 7. Leach Pitts a. Dinensions b. Stone Depth c. Splash Pads d. Tees e. Cement Pipe to Pit Both Sides f, Clean Double Washed Stone .8, No Garbage Disposal 9. -nnal Grading I �Spection 10. Barricading Covered System 11. AS bUIJLT, 0'UDM-L'ULVU 'Te%+ Tnn-ntion b. Dimensions of System c. Location with Regar&to Pere Test d. Elevations a.' Water Table Boara of Eealth !,ndover..MaBS APPROM DA VIY7 SUBSURFACE DISPDSAL DEsIM CEECK LIST DISAPPROM DATE— ReaBons: I .LOT f-,A&t NAG9 MeWT%d Title V FAn CK Reg 2.5 e submitted plan mu-st show as a nini-numi ters the lot to be Berved-area.,dimensions lot #,,abrat location and log deep observation Oes-distance to ties LA -1 -distance to ties location and results pemolation tests s Bhowing rwuired leaching area -alations & calculation design calc location and dimensions of system-inclu ding reserve area - 10� e-dsting and proposed contours -page disposal system or f g) -4thin U)01 of Be location any vot area disclaimer -check wetlands napping -wage disposal 0 (h) surface and subsurface drains vithin 1001 of Be system or -disclaimer disposal /I(J) location any drain -age easements v6thin 1001 of Be -age -r-Planning-Board files system or disclair� ter supply Vithin 2001 of sew--ge disposal a (j). Imo= sources of wa system or disclainer sex -M. lqt��jcqt f�om leaching facil -WW-Pr'OP __ 8�� o sed _I_tO — — _ir cation of ,;ater lines -on proPertY-101 from Itaching �jocation of. benchmark o garbage -disposals-�_ PVC-to.-�be used An -construction -pipe, septic t-ank,3 q) --profile of Eystr--m...,�evations�,of-�basem--nt.,.plunb., distribution.box inlets-�and- outlets., distribution field piping and OtLer -el6vations - __maTJ_imm.gromd--,;ater. elevation -in area sej,,agedisposal system (S plamc must -be prepared by a Professional Ragineer or other- - thori - -to Prepare such Plans professional au zed -by law P,eg 6 Leati—C Tanks -flow - �Nr e.- tees., depth -of -tees3 a) capacities -15U_ of ate -r- tabl acce - rs, purping cl eanout. �9 PC�01 ;w --lot prom cellar v-sil. or-IxLg-round si. �,, c) ins d� 251 from subsurface dral Distribution Boxes - Reg 10.2 Ofe sfo—p—e_-eater than 0.08 _g, Reg io .4 b) SOIL PROFILE & PERCOLATION TEST DATA North Andoverg Mass. Street No 1=0 ti C—Z Lot No LOC/Subdiv. Pland Owner Investigator Observer SOIL PROFILE DATES l.Elev 2.Elev 3.Elev 4.Elev 11 0 1 2 3 4� 5 6 7 8 9 10 A-1 Benchmark Location Elevation Datum PERCO;ATION TESTS 1( Ti -es to Test Pits Pit Number -3- 1 -3- 2 4-1 JA - Start Saturation UF-� LeA.15 Soak -Minutes Start Test=xlme Drop of 311 -Time Drop of 6" -Time M6ms-lst 3" drop Mins.2nd 31' Drop Percolation I p, I EASEWNT 'C' 0. OR 4A-% A2 LOT 49 109,470 1 Ex',t,nt,G FNI), ELEVATIONS TOP FND 141.00 HOUSE OUTLET 138.40 S T INLET 17 S -S5 ST OUTLET 135-15 0 BOX INLET 04-90 D BOX OUTLET 134-80 END FIELD IZ.4.60 I CERnFY7HAT THE SEPTIC SYSTEM WAS I NSTALLE(), AS SHOWN -THIS PLAN IS NOT INTENDED AS A WARRANTY OFTHE SYSTEM -PROPERTY DESCNPTION FROM NERD PLAN 36903 J o 32' FOUNCATION CEPTtrICATION AND LOCATION 13Y RF KAMINsm 4 ASSOCo FOLLEP( MEADOW POAD 11 EASEMENT D Pt -AN CoHOWING 5UBSURFACE 5EWEPOGE D I SPOSAL SYSTEM AS -6 U I LT OWNER LYNCO REALTY TRUST LOCATIal LOT49 FUl I ER MEADOW RD. DATE 7-16-84 SCAJE I �'4d PREPARED BY C F-L/)�"Nh o Po Oo 8.) OA 5- 6 9 p 1oVV ['\iv a) cn (U CL Ul) -2 U 44-- 0 (1) 4-J 2 i -1 Q) 0 V) H Q) 4-J _0 < E L- ro CL C: A M. L) 0 4- o E a 0 m 0 :Lj CL 0 < 0 4-1 co 0 Em u 0 u .2 -bi 0 U a fo Z E L- ro CL C: A M. L) 0 rl i LOT 49 109,470 j pvio' EASEMENT \C' j 44,k MFA[)O\, plAD 11 TOP FND HOUSE OUTLET 5 T INLET ST OUTLET D BOX INLET D BOX OUTLET END FIELD ELEVATIONS 141.00 138.40 IZI, 5 .) 5 135-15 134-OWD 134-80 I-"4'vGO I CERTIFY7HAT THE SEKIC SYSTEM. NAS INSTALLED AS C,Jj0WNJfflSKAf4IS NOT INTENVEDASAWARRM-1YOFTHE SYSTEM,,PROPERTY OESMPTION FPOkA NERO PLA N %%3. J PW N UAT 10 N CERT I F ICAT I ON AN D LOCATI 0 N 5 Y P. F KA M I N—' -kJ ASSOCo EASEMENT D JPLAN �HOWING 5UBSURFACE 5FEWERAGE DISPOSAL SYSTEM, AS -6 U I LT OWNER LYNCO REALTY TRUST LOCATION LDT49 FUl I ER MEADOW RD. DATE 7-16-84 SCALE 1'� 4d PREPARED Of -- D F—LYNN C. Po Ov BOA -1/ 569 n �865 PLAIS Wo w i v