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North Andover Board of Assessors Public Access
Parcel ID: 210/104.D-0062-0000.0
SKETCH
Click on Sketch to Enlarge
COMtniinitv- N.,, -+h A
PHOTO
"cation: 274 FOSTER STREET
Owner Name: ORLANDO, PHILIP A
BETHANY M ORLANDO
Owner Address: 274 FOSTER STREET
City: NORTH ANDOVER State: MA ZIP: 01845
lNeighborhood: 5 - 5 Land Area: 1.05 acres
Use Code: 101 - SNGL-FAM-RES Total Finished Area: 2400 soft
ASSESSMENTS
Total. Value:
Building Value:
Land Value:
Market Land Value: 182,300
Chapter Land Value:
CURRENT YEAR
473,500
291,200
182,300
PREVIOUS YEAR
442,400
273,600
168,800
Sale Price: 170,000 LATESTSALE
Sale Date: 08/14/1984
Arms Length Sale Code: Y -YES -VALID Grantor: ROMA REALTY TRUST
Cert Doc: Book:01853 Page: 0136
Page I of I
http://csc-ma.usNandoverPubAcc/jsp/Home.jsp?Page=3&Linkld=808164 11/2(
Telephone. Number
umping RecoF
N te 4— Quontity Pumpe
of Pumpino
I Typo of -5ystprr�!, -r'K j C
1 Qg�OPQQKIO $PAG TanR 0 Tight Ta Q r*P
$a Trpp
4. EffluientTe.eFilt rprp5q-
0 Ye's El NQ ifyes,wasitclearled? [I Y"S Q No
5. Condition of 9ystem:
6, System Pumped By:
Vehiclef-iwse urn et
$tewart's Se tiq Service
Company
7
Lopat'jon where contents were disposed:
Stewart's Pre-treatment Plant, 20 $-ot Mill Bradford, Ma 01835
Date
Worm44ope 0,105 Systern PumpinglRewrO T Ppg.e. 10 1
Commonw h of Massachusetts
City/Town f No.ANDOVER
REC
System Pumping Record
Q; 1014
Form 4
TTI�� V HT
M
D�P has provided this form for use by local Boards of Health. Other for s A'I'Spmb
informption must be sub antially the same as that provided here.
Before usin this for check with your
m
Board of Health to determine the form they use. The System
Pumping Re0ord must �e sul�mitted
the local Doard of Health Qr other approving puthority within 14 days from the pumping date in
accor0lance with 310 CIAR 15-3512
A. Facility Information
Importord: Whon
filling out fo!�ms
I t $ystem Location:
an thp cqmputer,
use only the tgb
3��4 F�OSTER ST
key to m' .9ve your
Addre*.5
cursor - do not
use the return
NO ANDOVER MA
-city—Itown
key,
State
iip 66de
2. System Owner:
MURRAY
Name
r i s �(lf diffeiri—nt fi; �rr� hx-iii"lon)
'�—K ta t e
Zip
Telephone. Number
umping RecoF
N te 4— Quontity Pumpe
of Pumpino
I Typo of -5ystprr�!, -r'K j C
1 Qg�OPQQKIO $PAG TanR 0 Tight Ta Q r*P
$a Trpp
4. EffluientTe.eFilt rprp5q-
0 Ye's El NQ ifyes,wasitclearled? [I Y"S Q No
5. Condition of 9ystem:
6, System Pumped By:
Vehiclef-iwse urn et
$tewart's Se tiq Service
Company
7
Lopat'jon where contents were disposed:
Stewart's Pre-treatment Plant, 20 $-ot Mill Bradford, Ma 01835
Date
Worm44ope 0,105 Systern PumpinglRewrO T Ppg.e. 10 1
of Massachusetts
City/Town of No andover
System Pumping Record
Form 4 6 2013
DEP has provided this form for use by local Boards of Health. Other fb,T'�,K, 1.1d,clyatithe
p use-
, yjp�
information must be substantially the same as that provided here. Befdr�,usingLt , S
_hj'4Y6rh eJk with your
local Board of Health to determine the form they use. The System Pumping Record must be submitted to
the local Board of Health or other approving authority within 14 days from the pumping date in
accordance with 310 CIVIR 15.351.
A. Facility Information
Important: When
filling out forms 1 -
System Location:
on the computer,
use only the tab
274 Foster St
key to move your
Address
cursor - do not
No andover
use the return
key.
City!'. owil
JF_� 2. System Owner:
Murray
Name
Address (if different from location)
City/Town
B. Pumping Record
1. Date of Pumping
3. Type of system:
El Other (describe)
Ma
3tate
State
Telephone Number
Zip C"ode
Zip Code
78/ 2. Quantity Pumped: L�W_
LJdL", S
El Cesspool(s) El Septic Tank El Tight Tank El Grease Trap
4. Effluent Tee Filter present? [] Yes Ej No
5. Condition of System:
If yes, was it cleaned? El Yes El No
6. System Pumped,By-.
Name Vehicle License Number
Stewarts Septic Service
Company
7. Location where contents were disposed:
Stewart's Prdtreatment Plant. 20 So. Mill Bradford. Ma 01835
Signature of
of Receiving Facility
Date
Date
t5form4.doc- 03/06 System Pumping Record - Page I of 1
Com*monwealth. of Massachusetts
I City/Town of
$ystem Pumping Record E D
COS
ForI 4
DEP has provided this form for use by local Boa ds oflQthl. 'Th'e"S'yste Pumping Record must
be submitted to the -local Bo g ut '0�j�'\
\,,, F_ R�
ard Of Health or othe Fapproving-authori jT
T='-To� 'T
ALT
EktARl!\A
HD
A. Facility Inform.ation
Important
When filling out 1. System Location -
forms on the
computer, use
only the tab key Address
to move your
cursor - do not, CityfTown
use the return Zip Gode
key.
2. System Owner:
de— _h
Name
Address (if different from locationy
m
Cityfrown
State iip �Cb&:
Tel hone Number
.13. POm
ping elcord.
1. D, 0 mp;ng
qte. f Pu.'..
Date Quantity Pumped,
Gallons
.3. Type of system: El. Cesspool(s)
eptic Tank El TightTank.
Ottler (descnbe)�
Effluent Tee Filter present? E] Yes it yes, was it cleaned?
Yes�� No
Condition of System:
�A_ _k�J�
6: System P mped By...
Na�e
Vehicle Lioame Number
Pompany 7
n osed:
7. Locati h 'e'conte IsWer"o
oa wher
;Signaiture,, f ul
r
Date
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Town of North Andover
HEALTH DEPARTMENT
C
CHECK#: W,;�r 4-17 Ue�
LOCATION:
H/O NAME:
CONTRACTOR NAME:-4,�,
URe
of Permit or License: (Check box)
0
Animal
$
0
Body Art Establishment
$-
El
Body Art Practitioner
$
0
Dumpster
$-
11
Food Service - Type._
$
13
Funeral Directors
$-
0
Massage Establishment
$
0
Massage Practice
$
0
Offal (Septic) Hauler
$
13
Recreational Camp
$-
0
Sun tanning
$
0
Swimming Pool
$
0
Tobacco
$
11
TrashlSolid Waste Hauler
$-
0
Well Construction
$
SEP7TC Sustems:
0 Septic - Soil Testing $
0 Septic - Design Approval $
13 Septic Disposal Works Construction (DWC) $
13 Septic Disposal Works Installers (DW) $-
0 Title 5 Inspector $
0,11�tle5 Report (4-15?7 1 )
0 Other (Indicate) $
2034
Health Agent Initials
White - Applicant Yellow - Health Pink - Treasurer
COMMONWEALTH OF MASSACHUSETTS
ExEcUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENvIRONMENTAL PROTECTION
?e,v, - 9 P L
TITLE 5
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 274 Foster Street
– North Andover–
Owner's Name: Phil Orlando
Owner's Address: 274 Foster Street
– North Andover, MA 01845
Date of Inspection: 11/10/2006
Name of Inspector: Neu J. Bateson–
Company Name: Bateson Enterprises Inc._
Mailing Address: –111 Argilla Road –
– Andover, NU 01810
Telephone Number: _( 978 ) 475-4786_
RECEIVED
DEC , 1 2006
TOWN U�- NORTH ANDOVER
HEALTH DEPARTMENT
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 15.00). The system:
Passes
—X— Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
U
Inspector's Signature: 4f "I -�� Date: 11/10/2006
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: , 274 Foster Street —
— North Andover—
Owner: — Orlando—
Date of Inspection: — 11/10/2006
Inspection Summary: Check ABCD or E / ALWAYS complete all of Section D
A. System Passes:
I have not found any information which indicates that any
of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated
are indicated below.
Comments:
B. System Conditionally Passes:
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 (YN,ND) in the for
the following statements. If "not determined" please explain . Outlet tee in septic tank.
N The septic tank is metal and over 20 years old*
or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infilmation or exfiltration or
tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as
approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
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: 274 Foster Street
— North Andover—
Owner: Orlando—
Date of inspection: —11/10/2006
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require firther 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 CAM 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 fad 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
private 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: 274 Foster Street
- North Andover -
Owner: - Orlando -
Date of Inspection: -I 1110t2006
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 system cMonent 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 1/2 day 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.
-No- 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 certilled 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 ails. 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 '�n6" 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 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 274 Foster Street
North Andover
Owner: —Orlando—
Date of ]Inspection: 11/10/2006
Check if the following have been done. You must indicate 'W' or "n&' as to each of the following: ,
Yes No
—Yes— — Pumping information was provided bytheowner, 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 Cis at issue approximation of
distance is unacceptable) t3 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: 274 Foster Street
– North Andover–
Owner: Orlando
Date of in-spection–: 11/10/2006
FLOW CONDMONS
RESIDENTLAL
Number of bedrooms (design): 4 Number of bedrooms (actual): –4–
DESIGN flow based on 3 10 Ckk-1 5.203 600
Number of current residents:
Does residence have a garbage grinder (yes or no): –No–
Is laundry on a separate sewage system (yes or no): –Nom -
Laundry system inspected (yes or no):
Seasonal use: (yes or no): –No–
Water meter reading: -Yes_
Sump pump (yes or no): _NCL
Last date of occupancy: –Current–
COMMERCLUANDUSTRUL
Type of establishment:
Design flow (based on 3 10 CMR 15.203): ___gpd
Basis of design flow (seats/persons/sqft,ete.):
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:
OTHER (describe):
GENERAL INFORMATTON
Pumping Records
Source of information: –Pumped this year, owner
Was system pumped as part of the inspection Cyes 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
obtained 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:– 25 years old, 5/4/1981,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: 274 Foster Street —
North Andover
Owner: Orlando
Date of &spection—: 11/10/2006
BUILDING SEWERS — X _ (locate on site plan)
Depth below grade: _18"
Materials of construction: X cast iron X 40 PVC other
Distance from private water Wply well or �ucTion line: —
Comments (on condition ofjoints, venting, evidence of leakage, etc.) — 4" Cast iron thru wall, 3" PVC in house.
No leaks visible.
SEPTIC TANKS: X
Depth below grade: —6" —
Material of construction: —X— concrete — metal —fiberglass _polyethylene
__other(expla
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'x4'
Sludge depth--j-
Distance from top of sludge to bottom of outlet tee or baffle: —25"
Scum thickness: —4"—
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: —17"—
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 needs replaced. Depth of liquid at
outlet invert. No evidence of septic tank leaking.
GREASE TRAP: _(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 (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: 274 Foster Street –
– North Andover–
Owner: – Orlando–
Date of Inspection: 11/10/2006
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: gallons/day
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 BOX -
Depth below grade –21_
Depth of liquid level above outlet invert: –0–
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of
leakage into or out of box, etc.):–D-box level & distribution equal. No evidence of leakage. Evidence of
carryover, pumped d -box to clean. _
PUMP CHAMEBER: (locate on site plan)
Pump in working order (yes or no):
Alarm in working order Cyes 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: 274 Foster Street
— North Andover—
Owner: — Orlando—
Date of Inspection: 11/10/2006
SOIL ABSORPTION SYSTEM (SAS): _X_ (locate on site plan, excavation not required)
Jf 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 20'x 45'_
overflow cesspool, number:
innovative/alternative system Typetname of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,
etc.): —Soil oL Vegetation ok. No sign of ponding to surface. —
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 Wflow (yes or no):
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.):
Page 10 of I I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 274 Foster Street
— North Andover—
Owner: Orlando
Date of &spection—: 11/10/2006
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 I = 30'9"
• to 2 = 40'8"
• to D -Box = 50'6"
B to I = 29'5"
B to 2 = 39'
B to D -Box = 51'
Page 11 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 274 Foster Street
– North Andover–
Owner: – Orlando–
Date of Inspection: 11/10/2006
SITE EXAM
Slope
Surfitce 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: 6/13/1977
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 ust describe how you established the high ground water elevation: –No water 81 deep. Into from d6sikn
Oilu
Summary Record Card generated on 11/2712006 2:11:18 PM by Elaine Barclay
Town of North Andover
Tax Map # 210-104.D-0062-0000.0
274 FOSTER STREET
ORLANDO, PHILIP A.
274 FOSTER STREET
N. ANDOVER, MA
01845
Page 1
Class 101 Single Family lim�prl�4yP� 1 Residential
Size Total 1.05 Acres
IFY 2007
LIB Mailing Index
Name/Address Type Loan Number ActivelInact. From Until
ORLANDO, PHILIP A. Payor
274 FOSTER STREET
N. ANDOVER, MA
01845
UB Account Maint.
Account No Cycle Occupant Name Activelinactive
Bldg Id. 17801.0 - 274 FOSTER STREET Last Billing Date 10/16/2006
3170466 03 Cycle 03 Active
UB Services Maifit.
Service Code Rate
MISCFEE ADMIN FEE 0.635/8
WTR WATER 01 ALL METER SIZE
UB Meter Maintenance
Serial No
Status
Location
13242497
a Active
ERT HH
Date
Reading
Code
9/13/2006
187
a Actual
6/13/2006
143
a Actual
3/7/2006
129
a Actual
12/22/2005
118
a Actual
9/20/2005
106
a Actual
6/28/2005
92
a Actual
3/2512005
77
a Actual
12/13/2004
67
a Actual
9/27/2004
59
a Actual
6123/2004
42
a Actual
4/12/2004
25
a Actual
Charge Multiplier/Users
7.82 1/
178.38 /1
Brand
Type
METE METE
w Water
Consumption
Posted Date
44
10/20/2006
14
7/10/2006
11
4/1712006
12
1/17/2006
14
10114/2005
15
7115/2005
10
4/512005
8
1/14/2005
17
10/8/2004
17
7/30/2004
25
5/17/2004
Size
0.630.63
YTD Cons
0
Variance
235%
-3%
14%
-23%
6%
61%
-6%
-41%
-25%
10%
0%
Tel: (978) 475-4786
Fax: (978) 475-5451
BATESON ENTE"MSES, INC.
Excavating -Water.& Sewer Lines -Septic Systems & Pumping Service
111 Argilla Road Andover, Mass. 0 18 10
Title 5 Inspection Report
Property Address: 274 Foster Street, North Andover
Owner: Orlando
Date of Inspection: 11/10/2006
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 fiu-ther
operation of your current septic system.
Neil J. Bateson
Bateson Enterprises, Inc.
'A 114 Commonwealth of Massachusetts Map -Block -Lot
104.D- 0062 -
0
iL-----------------------
;a2aw,%&L .
Board of Health Permit No
BHP -2006-0740
i. North Andover -----------------------
PA.
FEE
ts C WU F.I. $125.00
-----------------------
Disposal Works Construction Permit
Permission is hereby granted -Todd-Bateson ------------------------------------------------------------------------------------------
to (Repair) an Individual Sewage Disposal System.
atNo _27-4-F-0-STERSTREET
as shown on the application for Disposal Works Construction Permit No. BHP -2-006---074--- Dated --- November 20-,- 2006
-----------------------------------------------------------------
I ssued On: ov-20-2 006 Board of Health
14 K T"
* V& 1, - Commonwealth of Massachusetts Map -Block -Lot
0 104.D- 0062 -
Board of Health -----------------------
L_ North Andover
Certificate of Compliance
ACHUS
THIS IS TO CERTIFY, That the Individual Sewage Disposal System (Repair)
by ... Todd -Bates-on
Installer
at No - 2-7-4- F-0-STER STREET
has been installed in accordance with the provisions of TITLE 5 of the State Environmental Code as described in the
application for Disposal Works Construction Permit No. - BHP -20067074 - Dated --- November 29,_ 2006
-----------------------------------------------------------------
Printed-On: Nov -20-2-006 ------------------------------------------------ Board of Health
14ORTot
0
Town of North Andover
HEALTH DEPARTMENT
&S us
CHECK #: /aw
LOCATION: , 2 , �,3 / , & V�- Z
H/O NAME:
CONTRACTOR NAME: 7149
jyRe
of Permit or License: (Check box)
0
Animal
0
Body Art Establishment
$
0
Body Art Practitioner
$
0
Dumpster
$-
•
Food Service - Type:
$
•
Funeral Directors
•
Massage Establishment
0
Massage Practice
$
•
Offal (Septic) Hauler
$
•
Recreational Camp
$
0
Sun tanning
$
0
Swimming Pool
$-
0
Tobacco
$
0
TrashlSolid Waste Hauler
$-
0
Well Construction
$
SEP77C Sustems:
• Septic - Soil Testing $-
• Septic - Design Approval $
O�-Si�tic Disposal Works Construction (DWQ $
0 Septic Disposal Works Installers (DW) $
0 Title 5 Inspector $
0 Title 5 Report $
0 Other (Indicate) $
2001 el —IJ,
Health Agent Initials
White - Applicant Yellow - Health Pink - Treasurer
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
jLtem
)F
IF6011
zly�zln�
ib—CAY'S DATE
$ 250.00 - Full Repair
$125.00 - Component
Application is hereby made for a permit to:
El Construct a new on-site sewage disposal system*
El Repair or replace an existing on-site sewage disposal s7ystem�*
@4re'pair or replace an existing system component
A. Facility Information
I ') q Fo.5 4 t's
Address or Lot #
City/Town
2.- *TYPE OF SEPTIC SYSTEW:
El Pump El Gravity (choose one)
***If pump system, attach copy of electrical permit to application***
E] Conventional System (pipe and stone system)
n infiltrator or Biodiffuser (Gravel -Less) (Attach a copy of your certification to install this type of system.
F1 Pressure Distribution S.A.S. (No D -Box) (Attach Draft Maintenance Agreement)
[I Pressure Dosed (D -Box Present) S.A.S.
2. Owner Information
. 1p� L A —J o
Name
Address (if different from above)
Stat Zip Code
Te4bo4e NwAber
3. Installer Information
Name Name of Company
j 41-1�f ;//.4 BATEM4
Address 11 ArgiNa Road
I'M - dGAW, Kz"
1p
City/Town State
Telephone Number (Cell Phone # if possible please)
4. Designer Information
Name Name of Company
Address
City/Town
Zip Code
Telephone Number (Best # to Reach)
Application for Disposal System Construction Permit - Page 1 of 2
Application for Septic Disposal Svstem
Construction Permit - TOVN OF
NORTH ANDOVER
.3 MA 01845
PAGE 2 OF 2
TODAY'S DATE
$ 250.00 - Full Repair
$125.00 - Component
A. Facility Information continued....
5. Type of Building: 26sidential Dwelling or FlCommercial
B. Agreement
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 And6ver,_ap_y not to place the system in operation until a Certificate of Compliance has
been issued OyfiVis Board of Health.
"(�W - //_
Name Date
Applicat Approved !By�:t of Health Representative)
/N Ae' bate
Application Disapproved for the following reasons:
. ........... . . ......... ....... ... . .... ............ ...
For Office Use Only:
L Fee Attacbed?
2. Project Manager Obligation Form Attarbed?
Yes
Ye s
3. PumpSystem? Ifso, Attacb copy ofElectricalPermit Yes
No
No
No
4. Foundation As-Buift? (new construction ronly): Ye s No
(Same scale as approwdplan)
5. Floor Plans? (new construction only): Ye s No
SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS
As the North Andover licensed installer for the construction for the septic system for the property at:
� � q _S1
(Addres�of septic system) For plans by
I --
Relative to the application of / o t� f) p' -s" Ie a".,
(Installer's name)
Dated � — / 7— 0 4—
(I oday
And dated
With revisions dated
I understand the following obligations for management of this project:
(Engineer)
(Unginal date)
(Last revised date)
1. As the installer, I am obligated to obtain all. permits and Board of Health approved plans p or to
perforniing any work on a site. I must have the approved 121ans and the Vermi't on site when any work is
being done.
2. As the installer, I must call for any and all inspections. If homeowner, contractor, project manager, 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 coWletion of the items in accordance
with Title 5 and the Board of Health Reeulations may result in a $50.00 fine being levied agaWst me and/o
m3: co=any.
a. Botiom of Bed — Generally, this is the first'(1') inspection unless there is a retaining wall, which
should be done first. The installer must request the inspection but does not have to be present.
b. Final Construction Inspection — Engineer must first do their inspection for elevations, ties, etc.
As -built of verbal OK (or e-mail to: healthdel2t(2townofnorthandover.com) from the engineer must
be submitted to the Board of Health, after which installer calls for an inspection dine. Installer must
be present for this inspection. With a 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. Installer does not
have to be on-site.
4. As die installer, I understand that only I may perform the work (other than jimple excavation) and I am required
to complete the installation of the system identified in the attached application for installation. I further
understand that work done by others unlicensed to install septic systems in North Andover can constitute
easons for denial of the system and/or revocation or suspension of my license to operate *in the Town of
North Andover, sigWficant fines to all persons involved are also nossible.
5. As the installer, I understand that I must be on-site during the performance of the following construction
steps:
a. Determination that theproper elevation of the excavation has been reached.
b. Inspection of the sand and stone to be used
c. Final inspection by Board ofHealth staff or consultant
d InslaRation of tank, D -Box, pipes, stone, vent, pump chamber, retaining waff 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. Lyeneral contractor, or any other persons shall absolve
me of this obligation.
Undersigned Licensed Septic Installer: (Today's Date) 17— c�,' C�
(Name — Print) a — Signed)
TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
DATE: �3O —/
S Y S TE'11111
TS —S
/Xo,
SYSTEM—E-0—C—AT-1—O—N
(examPle: left front of house)
DATE OF PUMPING: —441�10f QUANTITY PUMPED /,PC> GALLONS
CESSPOOL: NO --K-C— YES ------- — SEPTIC TANK: NO -� YES
NATURE OF SERVICE: ROUTINE -LeL--' EMERGENCY
OBSERVATIONS:
GOOD CONDITION
HEAVY GREASE
ROOTS ----
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
SYSTEM PUMPED BY:
--OMMENTS:
ONTENTS TRANSFERRED TO:
FULL TO COVER
BAFFLES IN PLACE
LEACHFIELD RUNBACK
FLOODED
OTHER (EXPLAIN)
PO
TOWN OF NOR.TH ANDOVER
SYSTEM PUMPING RECORD
DATE NOV. I qto, 0
SYSTEM OWNER & ADDRESS
Or)ondo
SYSTEM LOCATION
A
DATE OF PUMPING V --d-3 —QUANTITY PUMPED i -e�o C)
CESSPOOL NO
YES SEPTIC TANK NO YES___V/
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION FULL TO COVER
BEAVY GREASE BAFFLES IN LACE
ROOTS LEACBFIELD RUNBACK
EXCESSIVE SOLIDS FLOODED
SOLID CARRYOVER, OTBER EXPLAIN
SYSTEM PUMPED
COMMENTS:
CONTENTS TRANSFERRED TO
TOWN OF NORTH AN
A 11. SYSTEM PUMPINQ 'DOvEl
"coRDL
/_U: .1t,
SYSTEM O"Ep
. & ADDRES�S- SYSTEM LOCATT
c;2
JAN 0 6 2005
H ANDOVER
'ARTiMENT
DATE OF PUWNQ: . .. . .. .. .. . .. .... . . . .. .....
'nT
.,_QUAN Y Kjwsi::,�_
7-7-9
�:WPOOL:
S00c Tank: NO.
NAruKE OF SERVICE: ROUTINE.k
UbSUAVATION&
OWD CONDITION Fu OVER
HEAVY OREASB B IN PLACL
ROOT3 LEACMUD KUNBACK
Bxcusivs SOLIDS FLOODED
-SOLID CAKRYOVFP,'—'"
.—OTHER EXPLAIN
, gre
VUMMENTS.
i'mrs rKANsFumD
w
k
* "41
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
0-�
Commonwealth of Massachusetts Dr-CE'vEL
CityfTown of NOR VER MASS U
TH ANDO §ITTSI
System Pumping Record JUN - 5 2006
Form 4
TOWN OF NORTH ANDOVER
j ,..UEALTg DEPARTMENT
DEP has provided this form for use by local Boards of Health. Th- 44111p,11V KeC= MU.'
be submitted to the local Board of Health or other approving authority.
A. Facility Information
1. System Location:
Address - — -------------------------
City/Town
2. System Owner:
imarne
Wd—dres`s(l —diff—erent from —location)
City/Town
B. Pumping Record
1 . Date of Pumping
3. Type of system: El
El Other (describe):
'zV-4'
State T(p —Co d e
State
I eleprione Number
D�V�—O"O— 2. Quantity Pumped
Cesspool(s) Xseptic Tank
Zip Code
-da-11ons—
El Tight Tank
4. Effluent Tee Filter present? Ej Yes 0�_No If yes, was it cleaned? F1 Yes n No
5. Condition of System:
6. SyAem Pumped By:
venicle License Number
Company
7. Location where contents were disposed:
— — I
ature of Ha I
SXA ul
hftp://www.mass.govi/dep/water/ Provals/t5forms,htm#inspect
t5form4.doc- 06103
Uate
6
System Pumping Record - Page 1 of 1
North Andover Board of Health
120 Main St.
North Andover Ma. 0 1845
Haul Lic. #151 -OOH
Install LIc. # 128-0
Date Name & Address
12/1/2000 Murphy - 16 Crossbow Lane
12/2/2000 Manzi -72 Foster St
-12/4/2000 Grifin - 240 Candlestick Rd
12/5/2000 Mcilvien - 57 So.Cross Rd
12/6/2000 Small - 440 Fosrer St
12/6/2000 Orlando - 274 Foster St,
12/7/2000 Weger - 29 Barco lane
12/8/2000 Walton - 161 Bridges Lane
12/11/2000 Coflan - 73 Christian Way
12/12/2000 Orlando - 7 Laconia Cir
12/12/2000 Fitzgerald - Sharpner Pond Rd
12/18/2000 Mangano - 324 Bradford St
12/19/2000 Galea — 1589 Salem St
12/19/2000 Johnson - 91 Boston St
12/22/2000 Senton - 1620 Turnpike St
JAN
Andover Septic
47 Railroad St.
Bradford Ma. 01835
Gallons Comments
1500
1000
1500
1500 Flooded
1000
1000
1000
1500
1500
1000
1500
1500
1000
1000
1250 Flooded
December 2000
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TRANSMISSION VERIFICATION REPORT
TIME
10/25/2006 10:37
NAME
HEALTH
FAX
9786888476
TEL
9786888476
SER.#
000B4J120960
DATEJIME
10/25 10:34
FAX NO./NAME
816179269277
DURATION
00:02:50
PAGE(S)
06
RESULT
OK
MODE
STANDARD
ECM
North Andover Health Denartment
1600 Osgood Street
Building 20, Suite 2-36
North Andover, MA 01845
978.688.9540 - Phone
978.688.8476 — Fox
healthilent0towpof
, parthandaver,cpm - E-mail
w�tw.toxnoLf.n.or.thando.ve.r...c.o.m - Website
Letter of Transmittal,
Page __/ of
f �7
DATE:
COMPANY:
FROM; Pamela DelleChicie, Health Department Assistant
Phone: e/51 11111ellol
RE:
Fox!
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TRANSMISSION VERIFICATION REPORT
TIME
10/25/2006 10:41
NAME
HEALTH
FAX
9786888476
TEL
9786888476
SER.0
000B4J120960
DATEJIME
10/25 10:38
FAX NO./NAME
816179269277
DURATION
00:02:49
PAGE(S)
06
RESULT
OK
MODE
STANDARD
ECM
North AndioVel man D tment
r Health-ummg
1600 Osgood Street
Building 20, Suite 2.36
North Andover, MA 0 1845
978.688-9540 - Phone
978.688.8476 — Fax
h_ea.l.1.hdeRt@townof orthando er.com -E-mail
www-to_wnofhqahqq&g&m . ebsite
Letter of. Transmi.ttal,
Page _-Z —of
� ral"'
T G.- DATE:
COMPANY — FRO M: Pamela DellaChiaie, Health Department Assistant
Phone- 61711C1,41'r
Fox;
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NO'rth Andover Health Department
1600 Osgood Street
Building 20, Suite 2-36
North Andover, MA 01845
978.688.9540 - Phone
978.688.8476 — Fax
healthdept(d-townofnorthandover.com - E-mail
www.townofnorthandover.com - Website
1__? —
Letter of Transmittal
Page __Z of
0* tAORTH
0
eg'_ Coc..Ci-I-K.
TO:
DATE:
COMPANY:
FROM: Pamela DelleChiaie, Health.Department Assistant
Phone: 6,7
RE:
Fax: 4�11 17"
COPY TO:
We 7re se,767qyou: 06pyofLetter L7PI,7,7s 00ther(fillkhelow)
These are transmitted as che(ked below:
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REMARKS:
COPY TO:
COPY TO:
SIGNED:
COPY TO:
1.
North Andover Board of Assessors Public Access
Parcel ID: 210/104.D-0062-0000.0
SKETCH
Click on Sketch to Enlarge
Community: North Andover
P110TO
Location: 274 FOSTER STREET
Owner Name: ORLANDO, PHILIP A
BETHANY M ORLANDO
Owner Address: 274 FOSTER STREET
City: NORTH ANDOVER State: MA ZIP: 01845
Neighborhood: 5 - 5 Land Area: 1.05 acres
Use Code: 101 - SNGL-FAM-RES Total Finished Area: 2400 sqft
ASSESSMENTS CURRENT YEAR PREVIOUS VEAR
Total Value: 473,500 442,400
Building Value: 291,200 273,600
Land Value: 182,300 168,800
Market Land Value: 182,300
Chapter Land Value:
LA-rESTSALE
Sale Price: 170,000 Sale Date: 08/14/1984
Arms Length Sale Code: Y -YES -VALID Grantor: ROMA REALTY TRUST
Cert Doc: Book:01853
Page: 0136
Page I of I
http://csc-ma.usNandoverPubAcc/jsp/Home.jsp?Page=3&Linkld=808164 10/25/2006
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3M,>TIC SYSTEM
INSTAMATICK CHBOK LIST
F . V &_
LOT
I. Distance Tot
a. Wetlands
b. Drains
0. Well
Water Line Location
3. No PVC Pipe
4. Septic Tank
a. -Tees �.-_Length & To Clean Oat Covers.
b. Cement Pipe to Tank.- on Both Sides of Tank
5. Distribution Box
a. Covers & Box - No Cracke
b. All Lines Flowing Equal Amoimts
C. No Back Flow
6e Leach Field or Trench
a. Dimensions
b. Stone Depth
a, Capped 'Bads
d: Clean Double- Washed Stone'
7. Leach Pits
a. Dimsns a
b. Ston Depth
3h 3
0
Pit�
s
S on D
sh Pa
t7
c. Sp sh Pads
d T s
6: ement Pipe to Pit - Both 'Sides.
f. Clean Dou ble Washed Stone
8. No Garbage Disposal
9. Final GrAAing Inspection
3.0. Barricading Covered System
32. As Built Submitted-
- a. Lot Location.
b. Dimensions of System
c. Location with Regard -to Pere Test
d. Elevations
e 0' Water Table
�,ard c�f Health
�orth )An42YOr a38 -
AM DATE
FAIL
OK
a
3M,>TIC SYSTEM
INSTAMATICK CHBOK LIST
F . V &_
LOT
I. Distance Tot
a. Wetlands
b. Drains
0. Well
Water Line Location
3. No PVC Pipe
4. Septic Tank
a. -Tees �.-_Length & To Clean Oat Covers.
b. Cement Pipe to Tank.- on Both Sides of Tank
5. Distribution Box
a. Covers & Box - No Cracke
b. All Lines Flowing Equal Amoimts
C. No Back Flow
6e Leach Field or Trench
a. Dimensions
b. Stone Depth
a, Capped 'Bads
d: Clean Double- Washed Stone'
7. Leach Pits
a. Dimsns a
b. Ston Depth
3h 3
0
Pit�
s
S on D
sh Pa
t7
c. Sp sh Pads
d T s
6: ement Pipe to Pit - Both 'Sides.
f. Clean Dou ble Washed Stone
8. No Garbage Disposal
9. Final GrAAing Inspection
3.0. Barricading Covered System
32. As Built Submitted-
- a. Lot Location.
b. Dimensions of System
c. Location with Regard -to Pere Test
d. Elevations
e 0' Water Table
SU3.S_-,0i,1ACE DISPOSAL SYSTEM CHECK L11ST
ol-, k-1
NORTH ANDOVER BOARD OF HEALTH a74�1�
�PX,G� ED DkTE PROVIDED DISAPPROVED DATE TIME REASON
_W4
31131-"
Ti,oe '5
Reg. 2.5 Fail OK T submitted plan must show as a minumum:
> (a the lot to be served (area,dimensions,lot //,abutters)
(Planning Board files)
location and log of deep observation holes -distance
s
a
to ties
location and results of percolation tests -distance
to ties
(d),, design calculatio-ns'& calculations showing required
leaching area
(e location and dimensions sf system (including reserve
area)
existing and proposed contours
"g location of any wet areas within 1001 of the sewage
disposal system ot-disclaimer (check wetlands mapping)
(h)lsurface and subsurface drains within 1001 of sewage
disposal system or disclaimer
(i) location of any drainage easements within 1001 of
s61age disposal system or disclaimer (planning board
"files)
known- -sources of water supply within. 2001 of sewage
isposal system or disclaimer
L Q �Iocation of any proposed well to serve the lot (1001
11 X0 -
from leaching facility)
(1)) location of water lines on property (101 from.leaching
facilities)
(m,`��lodation of benchmark
a, -6n) driveways
L_>I(o)--�arbage disposers
Ll_�'P)I_nO PVC is to be used in construction
,,_-(-q-) a profile of the system (elevations of basement, plumbE
,pape septic tank, distribution box inlets and outle-,.-s,
distribution field piping and any other elevations)
U -'(r) maximum ground water elevation in area of sewage dispoE
system
s plan must be prepared by a Professional Engineer or
other professional authorized by law to prepare such.
plans
Septic Tanks
Reg. 6 1,, "�
(aa) Capacities - 150% of flow, water table, tees, depth
of tuees, access, pumping,
J�pb -'Cleanout
c) 101 from cellar wall or inground swimming pool
C)
(d) 25' from subsurface drains
No Andover Subsur-Irace disposal system check list - Page 2
R&g. 10. 2
Reg.10.4
Reg. 11 .2
Reg.11.4
Reg.11.10
Rxe g. 11 11
Reg.15-1
Reg. 15.1
Reg. 15. 4
Reg. 15. 8
Reg. 3.?
,Reg.14.1
Reg.14.3
Reg.14.4
14.5
Reg.14.6.
Reg. 14. r?,
Reg.14.10
Reg. 9.1
Reg. 9. 6
I�istribution Boxes
k'a' Slope greater than 0.08
(b� Sump
Leachip& Pits
Leaching pits��. -6 �pref erred where the install I ation is
possible
qa Calculations of leaching area (minimum 500 S.F.)
b "Aspacing
Surface- drainage 2%
d� Cgver material
-re r w c -I I o
baching Fields
,a,)-NIDGreater than 20 minutes/inch
,b-)' Ared'(minimum-900 S.F.)
,e�Coristruction of field
A� Surface drainage 2%
e� 201 from,cellar wall or inground swimming pool
LeachinR Trenche
(a) Calcul-a-fions of leaching area (min. 500 S.F.)
(b) -S_p�clng (4 ft. min. 6 ft. with reserve between)
mensions
(d C6nstructi-on-
(e�--Stone
(f) Surface drainage 2%
Downhill Slope
(a) Slope 7x = to be shown
(b) y/x V150 = �to be shown�
Pump's
N(a Approval
Stand- power
z
y
F,,D s -T E P,
E L.F-VA-r i a N�5.
Z -7-
L DT.
4 5-, 5,�? 1 s F
GAL
4e
2-7
E E--ir-
4.
I WV, PIPE OUT Ofr H SE,
I my_ PIPE INTO
I KIV pleF
=OU3:OFT-AMV 4 5 Dieo Pow
I bGQ 0. ap-x 'rOY45-r E:M
I,-, U C
E�NIID or-:* Pi PE 14 t 71
I rQ
"A RT I
15 CA. Le I lqo
3
A,
E L -F- VA -r i a r-4 �5.
RJE-�-, V Q:F 0
buiLT
-P-P-F--1 -NTO
4)tA L�
57 F::�m
L
EA- 1 �-4
SOIL PROFILE & PERCOLAT_jQN TEST DATA
C e Lot No.
Tow &I–t-L xo.&Stre t
Loc./ Subdiv. Owner
Plan
.,j Investigator ZO �22 //(g Observer
4V1191_77, SOIL PROFILES .. MTE
1. 2' Elev. Elev. *Elev.
— Elev.
0
0 0 0
2
3
4
5
6
7
8
- 9
2
3
4
5
RE
7
EM
RE
2
3
4
5
6
7
a
a
10.t 10 10 10
Benchmark- Location
Elevation Datum
Percol2tion Tests -Date
S -W _- _>V" -V
PJA Number 1 2 3 4 5
Start Saturation
Soak-!��ins.
Start Test -Ti -me
Drop of 311 -Time
Drop: .of -.b !!-Time
Mins.lst 3"Drop
Mins.2nd 3"Drop
Notes & Sketches on Back Frank C. Gelinas & Associates, North And.
V
L
11
41
4
L
------- - ----------
Ao
'iq
I)o,"*74loot v &.Rv4 of Ae&/A
TO:
'C' (
NORTH ANDOVER, MASS. C4 19 C)
BOARD OF HEALTH _J
FROM:Fva-,�7k 4�'- &ell'k7 -9 6 !115SOC, 0A4,DESIGN ENGINEER
Re: Soil Absorption
Sewage Disposal
System
This is to certify that I have inspected the construction materials of said
disposal system at— Zo7- ;c-651ev 64-� -
SITE LOCATION
North Andover, Mass.
The grades and construction materials are as specified in my plans and
specifications dated IVAPr-14 6- 19 72
Reg. Prof. Engineer/Reg.o$Kanitarian
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 274 Foster Street
- North Andover -
Owner's Name: - Phillip Orlando
Owner's Address: 274 Foster Street
North Andover, MA 01845
Date of Inspection: 11/30/2006
Name of Inspector: -Neff J. Bateson -
Company Name: Bateson Enterprises Inc,
Mailing Address: 111 Argilla Road
Andover, MA 01i10
Telephone Number. _( 978 ) 475-4786_
RECEIVED
JAN 10 2007
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
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 fimcdon and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section 15-W of Title 5 (310 CMR 15.000). The system:
Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
F il
Inspector's Signature a, /�Q a7c�-ate: 11/30/2006
t—V I
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 Commen : After permit from B.O.H., install new outlet tee with gas baffle in septic tank, inspection
from B.O.EL, 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.
W R.I.— I"'.)
n9pecord':
RECEIVED
PRIP
On.A*'�,'Ajl
2007
DEP,haj OW ded thliform for use by local Boards of He -JUL-0
be submitted to thi.lo alth. I he -System Pumping Recc rd must
cal' Board of Health or other approving au
'hWit
Y4 OF NORTH ANDOVER
HEALTH DEPARTMENT
:.'.'A., FaC111ty.Inforrh
pition
-44*0111169 Systei� L6caUon:'..:.
L
?4
only the tab key
to move your
....,.curwr! do pot
Cirown
.�--'Use aretum-
ke
ZIP Pode
y
0'
ysern wner,',
j:
WA
Addre" (if dIfferent from locauon)
City/Tow.,
state - .
ZJp Code
0 ep one umber
ng
ate.,oi Pu'm'pl ���7_ 10 51 2. Qua'nflty Pumped:
Der
Gallon$
Cessoobl(s)
ly' 0 of.. iysj4m-":` 0 G-liptic Tank Tight Tank
Jother (describ6�:
4,.,. Effiden r
s if yes, was It cleaned? El Yes No
ee ter p *qq. 13 Ye a Ko*
..........
Pumped 8
&Mo.
Vehlcle Ucen*e Number
d1oposed:
ocd�h.w`h'eire contents e
W r�.
j'.
SWwwo 9T Hauler,
.'.11""', �p� t -, . : Date
' OJ t5forms,htm#lnspect
To lop hWoneN_umte,_�
21
Date
t]5f0MA.do"(;**.-0&q3..1'�
System Pumping Record - Page 1 of i
�L\ Commonwealth of Massachusetts
City/Town of
System Pu mipling Record
Form 4
ortwit
M ffling out
is on the
ptw use
do tab key
iove your
or - do not
the return
J-4
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use. The System Pumping Record must be submitted to
the local Board of Health or other approving authority within 14 days from the pumping date in
accordance with 310 CMR 15.351.
A. Facility Information
North Andover ma 01886
City/Town
2.' System Owner
Address (if different from location)
Cityrrown
State
AUG -5 ZU11
TOWN OF NORTH ANDOVER
state Zip Code
Telephone Number
- B. Pumping Record / /5W
1. Date of Pumping Date 2. Quantity Pumped: Gallons
3. Type of system: Cesspool(s) &-Septic Tank [I Tight Tank 0 Grease Trap
n Other (describe):
4. Effluent Tee Filter present'? [I Yes 0 No
5. Condition of System:
6. ^qt�em f ympjejj3F,
If yes, was it cleaned? 0 Yes [I No
Name Vehicle Ucense Number
Stewart Septic Service
Company
7. Location where contents were disposed:
/qpwa rFrre treatment Plant 20 So. Mill St, Bradford Ma 01835
Signature
Date --7/
Date
xm4.doc- 03106 System Pumping Record - Page 1 of I
�L\ Commonwealth of Massachusetts
D�
City/Town of No Andover
o System Pumping Record
Form 4
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use. The System Pumping Record must be submitted to
the local Board of Health or other approving authority within 14 days from the pumping date in
accordance with 310 CM R 15.35 1.
A. Facility Information
Important: When
filling out forms I . System Location,
on the computer,
use only the tab
key to move your Address
cursor - do not No Andover
use the return Ma 01845
key. Cityn-own -S—tate Zip Code
2. System Owner:
Name
Address (if different from location)
CityfTown State Zip Code
Telephone Number
B. Pumping Record
1 . Date of Pumping Quantity Pumped:
-L-ns
3. Type of system: El Cesspool(s) Vseptic Tank Tight Tank Grease Trap
El Other (describe):
4. Effluent Tee Filter present? El YesxNo If yes, was it cleaned? Ej Yes El No
5. Condition qj/Systern:
6. System Pum
Name
Stewart's Septic Service
Company
-� &�� -5�
Vehicle License Number
7. Location where contents were disposed:
Stgyart's Pre-treatment Plant, 20 So., Mill Bradford, Ma 01835
Facility
Date
Date
t5form4.doc- 03/06 V System Pumping Record - Page I of 1
Important: When
filling out forms
on the computer,
use only the tab
key to move your
cursor - do not
use the return
key.
Commonwealth of Massachusetts RECEIVED
City/Town of North Andover
FEB 14 7017
System Pumping Record
Form 4 -MWCj:W9MAW0*M
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use. The System Pumping Record must be submitted to
the local Board of Health or other approving authority within 14 days from the pumping date in
accordance with 310 CMR 15.351.
A. Facility Information
System Location:
a 71 q -
Address '
North Andover
City[rown
ff 2. System Owner:
VVE-A
411 Ar
Name
Aaaress (it aitterent trom location)
CityfTown
C
State
State
Telephone Number
Zip Code
Zip Code
B. Pumping Record
1. Date of Pumping . . I Quantity Pumped:
Date Gallons
3. Component: Cesspool(s) - ZSeptic Tank El Tight Tank El Grease Trap
El Other (describe):
4. Effluent Tee Filter present? El Yes �Y`No
5. Observed condition of onent pumped:
'4�� comq
V -r --f -Se ) - js
If yes, was it cleaned? El Yes E] No
6. System Purripe
Name Vehicle LicenseNumber
Stewarts Septic 58 So Kimball St Bradford Ma
Company
7. Location where contents were disposed:
20 so rnfll st bradford ma,
ole -3
Sign5ture of Hauler
Signature of Receiving Facility (or attach facility receipt)
/� ��/- 7
Date
Date
t5form4.doc- 11/12 System Pumping Record - Page I of 1