HomeMy WebLinkAboutMiscellaneous - 29 COLONIAL AVENUE 4/30/2018I�j
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MAP # LOT #
PARCEL # STREET
. . ... ......
HAS PLAN REVIEW FEE BEEN PAID? YES NO
PLAN APPROVAL: DATE APP. BY -.,,M
1 244 . .....
DESIGNER: 17 /7 PLAN Dn'I'E,-------.
CONDITIONS
WATER UPPLY.
k"
WELL PERM�
WELL TESTS:
COMMENTS:
W�N� WELL
D R I LLE .......... ....
CHEMICAL DAIE APPRUVED
BACTER DAIE (IPPRUVED
BACTERIA II Al'E
FORM U APPROVAL: APPROVAL TO ISSIUE&YES NO
DATE ISSUED
CONDITIONS:
FINAL APPROVAL:
ALL PERMITS PAID
YES
NO
WELL CONSTRUCTION APPROVAL
YES
NO
SEPTIC SYSTEM CONSTRUCTION APPROVAL
YES
140
OTHER
YES
NU
ANY VARIANCE NEEDED
YES
NO
FINAL BOARD OF HEALTH APPROVAL:
DATE:,,.ZAi146
- BY:
qc
'-,::IS 4'THE' INSTALLER LICENSED? N, YES NO
..........
'REPAIR
OF-CONSTRUCTIOt�: NEW
?`---.-`NEW CONSTRUCTION::...; CERTIFIED PLOT PLAN REVIEW''"
YES----, NO
NO
CONDITIONS OF..APPROVAL
(FROM FORM U
ISSUANCE OF DWC PERMIT. NO
—INSTALLER: C
DWC PERMIT.NOQ
0,
BEGIN INSPECTION
�EXCAVATION.-INSPECTION: ;NEEDED:
4�7' 4.
BY -
P . AS
SED
.:CONSTRUCTION INSPECTIONa NEEDEDs
AS BUILT. PLAN SATISFACTORY:
Y
..,APP.ROVAL TO. BACKFILL: DATE:—
-BY
;:.FINAL.GRADING APPROVAL: DATE
FINAL CONSTRUCTION APPROVAL: DATE: /,?hK/4'—"'--.BY
Commonwealth of Mas'sachusefts
City/Town of
System Pumping, Record
Form 4 �.Jl , Z014
W � 'VER
DEP has provided this form'for us&by local Boards of Health. Other forms rn -b 'used,butth
ay - Ve
information must be substantially the same as that provided here. Before using Ahis 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.
A. Facility. Information
I System Location: Left / Right front of house, Left Right rear of house, Left. �ih ,sLide of �houw', Left
Ia.
Right side of building, Left I Right front of building, Left Right rear of building, Un �e
Address C-1
City/Town
2. System Owner
Name'
Address (if different from location)
City(Town State :�de
Telephohe Number
B. Pumping Record
1. Date of Pumping Quantity Pumped:
Date Gallons
Cesspool(s)
3. Type of system', Septic Tank Tight Tank
4.
Other (describe):
Effluent Tee Filter present? [I Yes 2 --No
5. Condition
6. System Pumped By. -
Nell. Batewn
Name
Bateson Enterprises Inc
Company
7. LocqVJon.*0erP, contents. were disposed:
/GaL Lowell Waste W.
If yes, was it cleaned? [3 Yes r-1 No.
F5821
Vehicle License Number
6Q—J—
ba—te
.&D � AR -V�,\
t5ibrm4.doe- 06M3
System Pumping Record - Page 1 of I
,%> I A r. f) r,
Town of North Andover
41
HEALTH DEPARTMENT
S COHU
CHECK#: DATE:
LOCATION:
H/O NAME:
CONTRACTOR NAME:
Type
of Permit or License: (Check box)
0
Animal
$
•
Body Art Establishment
$
•
Body Art Practitioner
$
0
Dumpster
$
•
Food Service - Type.-
$
•
Funeral Directors
$-
0
Massage Establishment
$
0
Massage Practice
$
•
Offal (Septic) Hauler
$
•
Recreational Camp
$-
0
Sun tanning
$
0
Swimming Pool
$
11
Tobacco
$
•
TrashlSolid Waste Hauler
$-
•
Well Construction
$
SEP71C Systems
•
Septic - Soil Testing
$
•
Septic - Design Approval
$
11
Septic Disposal Works Construction (DWC)
$-
0
Septic Disposal Works Installers (DWf)
$
0
1�
Title 5 Inspector
$
Title 5 Report
$
0
Other (Indicate)
$
Health Agent Initials
White - Applicant Yellow - Health Pink - Treasurer
Owner
information is
required for
every page.
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
VQ
n=
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
29 Colonial Avenue
I-roperty Address
Thomas Finos
Owner's Name
North Andover
Cityrrown
MA 01845 6/13/2013
State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
A. General Information
1. Inspector:
Neil J. Bateson
JUN 18 2013
Name of Inspector HEALTH DEPARTMENT
Bateson Enterprises Inc.
Company Name
111 Argilla Road
Company Address
Andover
City/Town
978-475-4786
Telephone Number
B. Certification
MA
State
S115
License Number
01810
Zip Code
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5 (310 CMR 15.000). The system:
E Passes El Conditionally Passes El Fails
E] Needs Further Evaluation by the Local Approving Authority
6/13/2013
InsI: Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DER The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time. This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 1 of 17
Owner
information i's
required for
every page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
29 Colonial Avenue
Property Address
Thomas Finos
Owners Name
North Andover MA 01845 6/13/2013
City/Town St—ate —iip Code -Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E / always complete all of Section D
A) System Passes:
Z I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CIVIR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
B) System Conditionally Passes:
El One or more system components as described in the "Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for "yes", "no" or "not determined" (Y, N, ND) for the following statements. If "not
determined," please explain.
The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is
structurally unsound, exhibits substantial infiltration or exffl tration 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.
[I Y El N F-1 ND (Explain below):
t5ins - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 2 of 17
Owner
information is
required for
every page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
29 Colonial Avenue
Property Address
Thomas Finos
Owners Name
North Andover
Cityrrown
B. Certification (cont.)
MA
OWL",
01845
Zip Code
6/13/2013
Date of Inspection
El Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
El 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):
El broken pipe(s) are replaced
El obstruction is removed
R Y [:1 N F1 ND (Explain below):
R Y El N F-1 ND (Explain below):
0 distribution box is leveled or replaced El Y [I N F-1 ND (Explain below):
The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if (with approval of the Board of Health):
0 broken pipe(s) are replaced El Y F� N El ND (Explain below):
F-1 obstruction is removed El Y F1 N El ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
El 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:
El Cesspool or privy is within 50 feet of a surface water
El Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 3 of 17
Owner
information is
required for
every page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
29 Colonial Avenue
Property Address
Thomas Fincis
Owners Name
North Andover MA 01845 6/13/2013
City[Town State Zip Code Date of Inspection
B. Certification (cont.)
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:
El 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.
El The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
El The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or "No" to each of the following for all inspections:
Yes
No
El
Z
Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
0
Z
Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
El
z
Liquid depth in cesspool is less than 6" below invert or available volume is less
than % day flow
t5ins - 3/13
Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 4 of 17
I �L\ Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
29 Colonial Avenue
Property Address
Thomas Finos
Owner Owner's Name
information is
required for North Andover MA 01845 6/13/2013
every page. Cityrrown -§tate Zip Code Date of Inspection
B. Certification (cont.)
Yes No
El 0 The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
El z The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the
questions in Section D.
Yes No
El 1:1 the system is within 400 feet of a surface drinking water supply
El El the system is within 200 feet of a tributary to a surface drinking water supply
El El the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area — IWPA) or a mapped Zone If of a public water supply well
If you have answered "yes" to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 5 of 17
Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped: _.
E] 0
Any portion of the SAS, cesspool or privy is below high ground water elevation.
El z
Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
El 2
Any portion of a cesspool or privy is within a Zone 1 of a public well.
E] 0
Any portion of a cesspool or privy is within 50 feet of a private water supply
well.
El 0
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory, for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
El 0 The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
El z The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either "yes" or "no" to each of the following, in addition to the
questions in Section D.
Yes No
El 1:1 the system is within 400 feet of a surface drinking water supply
El El the system is within 200 feet of a tributary to a surface drinking water supply
El El the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area — IWPA) or a mapped Zone If of a public water supply well
If you have answered "yes" to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 5 of 17
Owner
information is
required for
every page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
29 Colonial Avenue
Property Address
Thomas Finos
Owners Name
North Andover MA 01845 6/13/2013
Cityrrown State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate "yes" or "no" as to each of the following:
Yes No
Z El
Pumping information was provided by the owner, occupant, or Board of Health
1:1 0
Were any of the system components pumped out in the previous two weeks?
0 El
Has the system received normal flows in the previous two week period?
El Z
Have large volumes of water been introduced to the system recently or as part of
this inspection?
Were as built plans of the system obtained and examined? (if they were not
available note as N/A)
Z 1:1
Was the facility or dwelling inspected for signs of sewage back up?
Z 11
Was the site inspected for signs of break out?
Z 11
Were all system components, excluding the SAS, located on site?
Z El
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?
Z El
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:
Z
Existing information. For example, a plan at the Board of Health.
Z El
Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 4 Number of bedrooms (actual):
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms):
A
F FIU
t5ins - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 6 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
29 Colonial Avenue
D. System Information
Description:
Number of current residents:
6/13/2013
Date of Inspection
Does residence have a garbage grinder?
Is laundry on a separate sewage system? (include laundry system inspection
information in this report.)
Laundry system inspected?
Seasonaluse?
Water meter readings, if available (last 2 years usage (gpd)):
Detail:
Sump pump?
Last date of occupancy:
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow (based on 310 CMR 15.203):
Basis of design flow (seats/persons/sq.ft., etc.):
Grease trap present?
Industrial waste holding tank present?
Non -sanitary waste discharged to the Title 5 system?
Water meter readings, if available:
El
Property Address
No
Thomas Finos
Owner
Owners Name
information is
required for
North Andover MA 01845
every page.
Cityrrown State Zip Code
D. System Information
Description:
Number of current residents:
6/13/2013
Date of Inspection
Does residence have a garbage grinder?
Is laundry on a separate sewage system? (include laundry system inspection
information in this report.)
Laundry system inspected?
Seasonaluse?
Water meter readings, if available (last 2 years usage (gpd)):
Detail:
Sump pump?
Last date of occupancy:
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow (based on 310 CMR 15.203):
Basis of design flow (seats/persons/sq.ft., etc.):
Grease trap present?
Industrial waste holding tank present?
Non -sanitary waste discharged to the Title 5 system?
Water meter readings, if available:
El
Yes 0
No
El
Yes Z
No
El
Yes El
No
El
Yes 0
No
Yes
No
El Yes El
El Yes 0
No
Current
Date
Gallons per day (gpd)
El Yes El
No
El Yes El
No
El Yes El
No
t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System ForTn - Not for Voluntary Assessments
29 Colonial Avenue
D. System Information (cont.)
Last date of occupancy/use:
Other (describe below):
General Information
Pumping Records:
Source of information:
Was system pumped as part of the inspection?
If yes, volume pumped:
How was quantity pumped determined?
Reason for pumping:
Date
6/13/2013
Date of Inspection
Pumped eight years ago, owner
1500
gallons
Measured tank.
.Inspect tank, tees
I
Type of System:
E Septic tank, distribution box, soil absorption system
El Single cesspool
El Overflow cesspool
Privy
Shared system (yes or no) (if yes, attach previous inspection records, if any)
El Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract (to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
El Tight tank. Attach a copy of the DEP approval.
E] Other (describe):
t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 8 of 17
t-roperry Aaaress
Thomas Finos
Owner
Owner's Name
information is
required for
North Andover MA 01845
every page.
CityfTown State Zip Code
D. System Information (cont.)
Last date of occupancy/use:
Other (describe below):
General Information
Pumping Records:
Source of information:
Was system pumped as part of the inspection?
If yes, volume pumped:
How was quantity pumped determined?
Reason for pumping:
Date
6/13/2013
Date of Inspection
Pumped eight years ago, owner
1500
gallons
Measured tank.
.Inspect tank, tees
I
Type of System:
E Septic tank, distribution box, soil absorption system
El Single cesspool
El Overflow cesspool
Privy
Shared system (yes or no) (if yes, attach previous inspection records, if any)
El Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract (to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
El Tight tank. Attach a copy of the DEP approval.
E] Other (describe):
t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 8 of 17
. �L\' Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
29 Colonial Avenue
Property Address
Thomas Finos
Owner Owner's Name
information is
required for North Andover MA 01845 6/13/2013
every page. CityrTown
State Zip Code
Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
No as built plan, design plan date 10/3/1995
Were sewage odors detected when arriving at the site? D Yes M No
Building Sewer (locate on site plan):
Depth below grade: 1.8
feet
Material of construction:
EI cast iron [R 40 PVC El other (explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
4" PVC through wall. 3" PVC in house, no leaks visible.
Septic Tank (locate on site plan):
Depth below grade:
Material of construction:
0 concrete El metal
2
feet i
El fiberglass [I polyethylene El other (explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate)
Dimensions: 10'x 5'x 4'
Sludge depth:
51'
0 Yes [I No
t5ins - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 9 of 17
Owner
information is
required for
every page.
t5ins - 3/13
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
29 Colonial Avenue
Property Address
Thomas Finos
Owners Name
North Andover MA 01845 6/13/2013
City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank (cont.)
Distance from top of sludge to bottom of outlet tee or baffle 20"
Scum thickness
Distance from top of scum to top of outlet tee or baffle 811
Distance from bottom of scum to bottom of outlet tee or baffle 16"
How were dimensions determined? Tape 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.):
Pumped septic tank. Inlet tee ok. Outlet tee ok. Depth of liquid at outlet invert. No evidence
of leakage. Center cover has riser to grade, unable to remove steel access cover
Grease Trap (locate on site plan):
Depth below grade:
Material of construction:
El concrete El metal
Dimensions:
Scum thickness
El fiberglass
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:
feet
El polyethylene El other (explain):
Date
Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 10 of 17
Owner
information i's
required for
every page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
29 Colonial Avenue
ljropeny Aciaress
Thomas Finos
uwnerS Name
North Andover
MA 01845 6/13/2013
Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Matedal of construction:
n concrete [] metal El fiberglass
Dimensions:
Capacity:
Design Flow:
Alarm present:
Alarm level:
gallons
[I polyethylene El other (explain):
gallons per day
Ej Yes El No
Alarm in working order: El Yes El No
Date of last pumping: Date'
Comments (condition of alarm and float switches, etc.):
* Attach copy of current pumping contract (required). Is copy attached? [:1 Yes [I No
t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - page 11 of 17
Owner
information i's
required for
every page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
29 Colonial Avenue
Property Address
Thomas Finos
Owners Name
North Andover MA 01845 6/13/2013
Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert
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 Chamber (locate on site plan):
Pumps in working order:
0 Yes [:1 No -
Alarms in working order: El Yes r-1 No"
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
* If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 12 of 17
<C\ Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
29 Colonial Avenue
Property Address
Thomas Finos
Owner Owner's Name
information is
required for North Andover MA 01845 6/13/2013
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
El
leaching pits
number:
leaching chambers
number:
leaching galleries
number:
z
leaching trenches
number, length: 4 trenches 46'
long
El
leaching fields
number, dimensions:
11
overflow cesspool
number:
El
innovative/alternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Soil ok. Vegetation ok. No sign of ponding to surface.
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth — top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow
El Yes E] No
t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - page 13 of 17
Owner
information is
required for
every page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
29 Colonial Avenue
HrOPertY Address
Thomas Finos
Uwners Name
North Andover MA 01845 .6/13/2013
Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)'
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 14 of 17
<L
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
29 Colonial Avenue
Owner
information is
required for
every page.
Property Address
Thomas Finos
Owners Name
North Andover
MA 01845 6/13/2013
City/Town iiiate Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
Z hand -sketch in the area below
El drawing attached separately
�;z I
a 67
--5SJ "7
L4
MkA-�-
t5ins - 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 15 of 17
Owner
information is
required for
every page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
29 Colonial Avenue
t-roperty Address
Thomas Finos
Uwners Name
North Andover MA 01845 6/13/2013
City(rown State -Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
0 Check Slope
[9 Surface water
0 Check cellar
0 Shallow wells
Estimated depth to high ground water: >4
feet
Please indicate all methods used to determine the high ground water elevation:
Obtained from system design plans on record
If checked, date of design plan reviewed: 10/2/1995
Date
El Observed site (abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health - explain:
Design plan
El Checked with local excavators, installers - (attach documentation)
11 Accessed USGS database - explain:
You must describe how you established the high ground water elevation:
Test pit data on design plan.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 16 of 17
Owner
information is
required for
every page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
29 Colonial Avenue
Property Address
Thomas Finos
Owners Name
North Andover MA 01845 6/13/2013
Cityrrown State Zip Code Date of Inspection
E. Report Completeness Checklist
inspection Summary: A, B, C, D, or E checked
inspection Summary D (System Failure Criteria Applicable to All Systems) completed
Z System information — Estimated depth to high groundwater
Z Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 17 of 17
j
13
t5form4.doc- OW03
Commonwealth of Mas'sachusetts
City[Town of
System Pumping Record
Form 4
DEP has provided this form for usel 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.
A. Facility Information
1. System Location: Left / Right front of house, Left / Right rear of house, Left, Z*dde:of house Left
Right side of building, Left Right front of building, Left / Right rear of building, under deck
Address
. @ 9
Cityrrown State Zip Code
2. System Owner
V-) as
Name'
Address (if different from location)
cityfrown
B. Pumping Record
1. Date of Pumping
3. Type of system,.- [:]
0 Other (describe):
State Zip Code
08�7
Telephone Number
co \3 /,SZ2i__.,
Data 2. Quantity Pumped: Gallons
Cesspool(s) D-agfpti�c Tank ED Tight Tank
4. Effluent Tee Filter present? [] Yes 9_1q0___" If yes, was it cleaned? [] Yes [:1 No.
5. Cond'l'oq of §ystem:
/VR,M_k 4e� CA_\�)O><
6. System Pumped By:
Neil Bateson
Name
Bateson Enterprises Inc
Company
7. Location where contents were disposed:
F5821
Vehicle License Number
6
Date
System Pumping Record - Page 1 of 1
UB Mailina Index
Name/Address Type Loan Number Active/Inact. From Until
FINOS, THOMAS Payor
29 COLONIAL AVE
NORTH ANDOVER, MA
01845
UB Account Maint.
Account No Cycle
Bldg Id. 13232.0 - 29 COLONIAL AVENUE
2100017 02 Cycle 02
UB Services Maint.
Account No. 2100017
Service Code
MISCFEE ADMIN FEE
WTR WATER
UB Meter Maintenance
Account No. 2100017
. .........
......
Town of North Andover
YTD Cons
44103790 a Active
Tax Map # 210-1073-0123-0000.0
Date
Reading
Parcel Id 18236
64
2/4/2013
29 COLONIAL AVENUE
10/30/2012
52
FINOS, THOMAS
26
5/21/2012
29 COLONIAL AVE
5/21/2012
1543
NORTH ANDOVER, MA
1579
11/1/2011
01846
Class
101 Single Family
Property Type I Residential
Zoning2
1 Residential
ZonIng3 1 Residential
Size Total
0.5 Acres
MSG
FY
2013
1480
UB Mailina Index
Name/Address Type Loan Number Active/Inact. From Until
FINOS, THOMAS Payor
29 COLONIAL AVE
NORTH ANDOVER, MA
01845
UB Account Maint.
Account No Cycle
Bldg Id. 13232.0 - 29 COLONIAL AVENUE
2100017 02 Cycle 02
UB Services Maint.
Account No. 2100017
Service Code
MISCFEE ADMIN FEE
WTR WATER
UB Meter Maintenance
Account No. 2100017
Brand
Serial No Status
YTD Cons
44103790 a Active
b Badger.
Date
Reading
5/7/2013
64
2/4/2013
55
10/30/2012
52
8/1/2012
26
5/21/2012
0
5/21/2012
1543
2/1/2012
1579
11/1/2011
1569
8/3/2011
1519
MSG
0%
513/2011
1489
2/7/2011
1486
MSG
-36
11/2/2010
1480
8/2/2010
1426
5/5/2010
1398
2/2/2010
1390
11/3/2009
1384
8/6/2009
1351
5/1/2009
1330
2/2/2009
1325
11/5/2008
1318
8/5/2008
1305
5/1/2008
1290
2j1/2008
1282
11/5/2007
1278
8/1/2007
1220
5/2/2007
1194
2/28/2007
1189
Occupant Name Active/inactive
Last Billing Date 3/5/2013
Active
Rate Charge Multiplier/Users
0.635/8 7.82 1/
01 ALL METER SIZE 11.40 /1
Location
Brand
Type Size
YTD Cons
ERT
b Badger.
w Water 0.630.63
19
Code
Consumption
Posted Date
Variance
a Actual
9
216%
a Actual
3
3/13/2013
-89%
a Actual
26
12/13/2012
-20%
a Actual
26
9/26/2012
0%
n New Meter
0
6/20/2012
0%
r Replacement
-36
6/20/2012
-401%
m Manual estimate
10
3/14/2012
-80%
m Manual estimate
50
12/15/2011
70%
m Manual estimate
30
9/14/2011
824%
a Actual
3
6/13/2011
-43%
m Manual estimate
6
3/15/2011
-89%
a Actual
54
12/1312010
87%
a Actual
28
9/13/2010
262%
a Actual
8
6/9/2010
32%
a Actual
6
3/11/2010
-82%
a Actual
33
12/11/2009
71%
a Actual
21
9/11/2009
281%
a Actual
5
6/16/2009
-28%
a Actual
7
3/16/2009
-44%
a Actual
13
12/10/2008
-10%
a Actual
15
9/12/2008
76%
a Actual
8
6/18/2008
96%
a Actual
4
3/14/2008
-92%
a Actual
58
1/15/2008
111%
a Actual
26
9/14/2007
260%
a Actual
5
6/22/2007
-6%
m Manual estimate
10
3/23/2007
-79%
t
NoDate ..................................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
Thiscertifies that ........................................................................................ . .......
has permission to perform .......... ..................... . ..........................................
wiring in the building of .........
............................................................................
at ............... ......................................... I .............. , North.,kndover, Mass.
Fee:..:� ............... Lic. .....................
ELECTRICAL INSPECTOR
Check #
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
DATE:
TOMW OF J., AkAe�
SYSTEM PUMPING RECORD
OCT 2 4. 2005
SYSTEM OWNER & ADDRESS
P
SYSTEM LOCATION
(example: left front of house)
1�tj v C� 42 0-c-
06)v'sve'
–6---
DATEOFPUMPING: /()—'? -5 QUANTITYPUMPED:
CESSPOOL: NO L--�YES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOODCONDITION
HEAVY GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
FUL TO COVER
13AFFLES IN PLACE
LEACHFIEELD RUNBACK
FLOODED
OTHER (EXPLAIN)
SYSTEM PUMPED BY: Bateson Enterprises, Inc.
COMMENTS:
CONTENTS TRANSFEMIED To: G.L.S.1) L-'� Lowell Waste
GALLONS
official Usc Only
Pcrrnit No.
zpartnLenj
BOARD OF FIRE PREVENTION REGULATIONS 0ccuoarlcv alid Fee Checked
1 129] (1cave blank)
APPLICATION FOR PERMIT To PERFORM TRICAL WORK
All work to bc perf'ormcd in accordaticc will, tllc 1,vjas5QCl1USCtls ELEC
Elcvri=1 COdc (MEQ, 527 CMR 12.00
(PLE,4SE PRINT hV hVK OR TYPE,,ILL IM"01W. 1770,V) Da t e:
City or Town of: And over
By this application Uie uildersigfled,,_ To the InsI)ectol- of f.pij.0s..
I Z� ,Ivcs lioNce Of Ills or her mLe.2tlol, to Perform the e1ccrrical. wori�
Location (Street & Number) C-1 described below.
Owner or Tenant
Owner's Address . -Iom Telephone No. Ll cL=
Is t1l's Pcrlllit if' conjunction with a buildill" permit?
Yes N o
Purpose of Building P (Clieck Appropriatc Bo.-�)
Existill" Service Utility Authorizitiun No.
Amps ------------
Volls ON-Crilend El Undgru No. of,'�Jeters
New Service Amps Volts ON-Crile:ld Ell Und-rd E] No. of -Meter-s.
Number of Feeders and Arlipacitv
Location and Nature of Proposed Electrical Work:
No. of Recessed Fixtures
(-ummet!ott ot (;ie tabi
N` of Ccil-Susi). W:Icldle) Falls 'IN 0
NO. of Lialitinc, Outlets
t,
No. of I -lot Tubs
I
rr:
No. Of Lighting FixtulTs
S winin ADove
ling Pool El
0
uild. a T- il d.
Ba
No. of Receptacle outlets
11NO. of Oil Burners
IFII
No. of Switches
LINO. of C2s Burners
_0
N o - of Ran"es
I
No. of Air Cond. Total
Tons
IN 0.
No. of Waste Disposers
Heat Pdlll�l 'Number 'Tons I .
_---�__--_
Totals: I . ...... ...
"I I-
I
Det
o. or Dishwashers ISpacclArea
Heating K -w Lo(
,6N o . of Dryers
Heating Appliances I� V!,
sec
%11 .1 � VVI
ea te rs K Vv ill(). M
Sij!115 Ballusts
No. Hvd,-o!,n2ss_-,7e Bathtubs 11 . - -,
I.,u. oi , iotors Totai li?
OTHER:
mav bc Ivaivcll bv thc 111sr. cc.,01- or; Vires.
ul Tot�-I—
HISformers KVA
lerators
--T7E,---
o mergen—Ey Z -,g
ter -v Units
LE ALAR�i JS IN..
cEectiori and
Initiating DevicF�
1-�'�`A
ilia
Of Alerting Devices
7f�S�eif-contam,d
-ices
ection/Alerting De�
al [I Municipal
Connection D Otlie-
,r;"v systems:
NO.OfD0viC2sorEQU;-,-:!je!,.�
I-- I- . -
0. o f D evi c -, s
No. Or Devices or Ecfuiv�renl,
"Illach cciditiol?c" or ::s rcq_,:r,
ike
IIN"SUPLA,:�*CE COVEI�_AGE:
tile lic"sec cl-Ovidfs 01-0of of liabili-,/ iiisuraticc ltic!uding "comm!.z!d covc,-:I�!�_- or :ts S,!bstznial Tild
I - - , - .
urders 21-lc'4 ct�rtifles that slich covera2c is 1*li force, aiid has exhi'
ibited proof`o�szn-,e to ti,__ ::cr_ljit
CHECK ONE: INSUR-ANCE DiOiND F] OTHER F� (Snecir�.:)
X
Estmmt�!d Value of Elccirl"cal Work: (Wheri rcquired :-.,,unicipal pollcy.)
wo(-!%- to sia"t: 11lsDcctl01ls to be recuested in accordallc�, MEC Rull-, '0, alld uuo I
L n COMO e, . C
f CUI-tifY, tilt (let' ill e paillS all d 17CII allies u,"pelillrY, thart the information oil tft.i5 alTlication is true ail'
C L, r if C011110lete.
LIC
C�V--'n Cf -D W\ Si-lilatur 00SNO.: 155LIC
I r LIC. NO.: 00 11
(If appilic.-j-"ie, CnIc", ill file licellse Itumberlinc.)
Address: tL3t3 V�05t SA � � ;,� Bus. Tel. NoA_7T- &S7 -0qL46
k � VYV t (IcIp u5,
Alt. Tel. No.: 9 1Y --1_43 -q -75q
O%�`NER7S ENS U R.A."' CE %i'AIVE R: f am aware df�v the Licttnset! (yo(!s jjo,,.!rve tile ilability iiisurarIce cO%*,-,-a,_7e -.Or-M'a1lv
requlrc� by law, By :,,li slc_nfaLLll'C beio%v, I hercby %v:i*,,-,- tills requ:.rcmc:!(. I aln !ht (Chcck 011c) 11 owiler El O%vnc.-'s
Owiier/Agent
Silo�flatul*c T01cphol"o '�,�V_ Pi;_RJf1T ITE, E. : S
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Town of North Andover, Massachusetts Form No.2
I&ORTif BOARD OF HEALTH
I -
DESIGN APPROVAL FOR
4CMUS SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
Applicant a- C, jest No.
Site Location- J c)-1— L4
Reference Plans and Specs.—(t��A-'o
Permission is granted for an individual soil absorption sewage disposal system to be installed
in accordance with regulations of Board of Health.
!A� ri
Feez'n ,
CK)URMAN, BOARD OF HEALTH
Site System Permit No. ?3 C)
.-t
Town of North Andover, Massachusetts
BOA RD OF HEALTH
Form No. 3
0 19 9'e"
0
. .... DISPOSAL WORKS CONSTRUCTION PERMIT
A US
Applicant � W-, 5�7
NAME ADDRESS TELEPHONE
Site Location— 47— AZ- -Z / 4-11:!E
Permission is hereby granted to Construct (U-Y-6--r�Repair an Individual Soil Absorption
Sewage Disposal System as shown on the Design Approval S.S. No.--ZL-3�
F e e ;f4 . 1� 6
CHAIRMAN, BOARD OF HEALTH
D.W.C. No. &�fl
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SCALE- I" = 40'
RZAN OF LANL
IN
A ND 0 VER,
IM YES k-NOINEERIN0, INC.
tN /,iAm7mz
SSI -
0
CIWL SNGINEERS &
LAND SURViXORS L. "-QQ6'
CfRflFY THAT THIS FOUNDA77ON /S LOCATED ON 77 -IE GROUND AS SHOWN, AM��e7-
CONFORMS 70 THE ZONING 8Y -LAWS OF 77 -IE 700N OF NORTY ANDOVER / F 0
0
7HAT TYIS PROPERTY DOES NOT LIE WITHIN A FLOOD HAZARD AREA (ZONE A R 100
SHOWN ON a000 INSURANCE AX7F MAP COMMUNITY PANEL NUMBER 250098 0016
EFFECT'VE" D,4TF- JUNE 15, 1983
DA 7Z:- SVIL kao,%-b%.
----------- --- ---- ----------
PROFESSIONAL LAND SURVEYOfi
QN
rq
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LOT 4
1� 1, 930 5. F
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R=175. 00
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PLA N OF LA ND
IN
NO. ANDOVER, UASS.
I
SCALF- I' = 40' IUNE' 17, 19.96
1,M YES ENGINEERIN0, INC. 60LJ -54LEM SI-RSET
CIWL ENGINEERS & WAKERZELD, MASS. 01880
LAND SURVEYORS F�5 rfL. (617) 246-2800
/ CER77f Y THA T THIS FOUNDA 77ON IS Z OCA TED ON 774F GROUND AS SHOWN, AND rHA T IT
CONFORMS rO T%E ZONING 8Y -LAWS OF THE TOWN OF NORTH ANDOVER / fURTHER CER77FY
rHAr THIS ARopfwy Dois Nor LIE WlrHIN A cZ000 H4ZARD AREA (ZONE A OR V) AS
SHOWN ON a000 INSURUNCE AA7F UAP COMMUNIrY PANEL NUMBER 250098 0010 8.
EfFECRVE D47F- JUNE 15, 198J
\A OF k4,T
DA7F.- t'ooj%':b9(, PETER
----------- ---------
J.
PROfESSIONAZ LAND SURVEYOR OGREN
#33604
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FRONT = 20'
FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary
approval s/permits from Boards and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state law,
regulations or requirements.
****************Applicant fills out this section*****************
APPLICANT: At. 6VMW-(L Phone _495,13Z_
LOCATION: Assessor's Map Number Parcel
Subdivision 0101*4 llk5 Lot (s)
Street c4kAk�,+ St. Number
************************Official Use Only************************
RECOMffMATIONS OF TOWT/ AGENTS:
Conservation Administrator
Comments 2S
I% r.,..L e A
�( P)
Town Planner
Comments
Food Inspector -Health
"'i A :��
Septic Inspector -Health
Comments
Date Approved
Date Rejected
S144W4 0 d -4*j - - f
101111 i45W lt�Nklt k V4)
Date Approved
Date Rejected
Date Approved
Date Rejected
Date Approved
Date Rejected
Public Works - sewer/water connections
- driveway permit
Fire Department:
Received by Building tnspector Date
no
HAYES ENGINEERING, INC.
603 SALEM STREET
WAKEFIELD, MA 01880
TEL.: (617) 246-2800
FAX : (617) 246-7596
TO o A t� 90 V _& A W Of 064 CQ4
1/7-0 lem 14A Fj 5--r
No' 6000\)Ey,- Wk o]84 -S
GENTLEMEN:
WE ARE SENDING YOU
[-] Shop dra wings
E] Copy of letter
Attached E] Under separate cover via
y 941
E] Prints (11 Plans
E] Change order F�
LEINER 00 IF 7HANONYVAL
DATE 10 — I ) - ILIS0
I JOB NO.N C)A 004 -
NO.
RE:
�07
the following items:
Ej Samples [-] Specifications
COPIES
DATE
NO.
DESCRIPTION
�07
57ge-0
THESE ARE TRANSMITTED as checked below:
YFor approval Ej Approved as submitted
OForyouruse E] Approved as noted
F1 As requested
7 For review and comment
F� FOR BIDS DUE—
REMARKS:
F-1 Returned for corrections
LE
E] Resubmit— copies for approval
Ej Submit —copies for distribution
E] Return —corrected prints
19 — F] PRINTS RETURNED AFTER LOAN TO US
COPY TO:
SIGNED, F—,d
If �closums am not as noted, kindly notity us at once.
V �'
Ta"PrR
HAYES ENGINEERING, INC.
603 SALEM STREET
WAKEFIELD, MA 01880
(617) 246-2800
FAX (617) 246-7596
October 3, 1995
Mr. Richard A. Colantuoni
Building Inspector
Town Hall
146 Main Street
North Andover, MA 01845
RE: Woodland Estates - Test Hole Information
Dear Mr. Colantuoni:
REFER TO FILE # NOA-0042
In accordance with our discussions back a couple of months ago, I have conducted the required test
holes and inspected the soils on Lots 1, 2, 4, 5 and 6 Colonial Avenue in the Woodland Estates
subdivision in North Andover. The procedure used was to excavate a test hole at each end of the
proposed dwelling, determine the type of soil, and also estimate the seasonal high groundwater
based on soil mottling. In addition, a comparison was made to the highest groundwater elevation of
any nearby test hole conducted for the purposes of septic system design. Based on the highest
groundwater encountered in the area, I recommended a cellar floor elevation at least two feet above
the highest elevation. My conclusion is that underdrains are not necessary under the Mass.
Building Code on Lots 1, 2, 4, 5 and 6 Colonial Avenue.
I trust this information is suitable for your purpose, and, by means of this letter, am requesting you
to notify Sandy Starr, Health Agent for the Town of North Andover, so that permits may issue on
these lots.
Ve truly yours,
�11 OF
K= J.
PEI J.
OMEN
Peter J. Ogren, P.E., *33604
President
SUR 0q; At.
PJO/dab
Enclosure
cc: A.C. Builders, Inc.
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DATE /��
Sheet of
BOARD OF,HEALTH
TOWN OF NORTH ANDOVER
SUBSURFACE DISPOSAL DESIGN REVIEW
FEE PERMIT # DATE RECEIVED-�
APPLICANT ASSESSOR'S MAP
ADDRESS PARCEL #
LOT #
ENGINEER 11/9 Ye -,5 STREET
ADDRESS Ae!�)L-3 3P&4�qt4 k-- ro
PLAN DATE REVISION DATE
CONDITIONS OF APPROVAL:
APPROVED
DISAPPROVED A—
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Town of North Andover Of AORTH -1 k
OFFICE OF , 4"to
0 to
COMMUNITY DEVELOPMENT AND SERVICES
146 Main Street
KENNETH R. MAHONY North Andover, Massachusetts 0 1845 "�SACHUS
Director (508) 688-9533
July 31, 1995
Hayes Engineering, Inc.
603 Salem Street
Wakefield, MA 01880
Re: Lot #4 Colonial Drive
To Whom it May Concern:
This is to inform you that the proposed plans for site
referenced above have been disapproved for the following reasons:
1) No deep holes in system - those in the area out of
date
2) Tank not 25 feet from foundation
3) Leach area not 35 feet from foundation
4) Please show benchmark on plan
5) Please show width & depth of trenches on cross
section
6) What are the perc test elevations?
7) Must be 15 feet of fill around leach area - see 310
CMR 15.255(l) and (2)
If you have any questions, please do not hesitate to call the
Board of Health Office at the number above.
Sincerely,
7
Sandra Starr, R.S.
Health Administrator
SS/cjp
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
Julie Parrino D. Robert Nicetta lvfichael Howard Sandra Starr KatWeen Bradley Colwefl
No................ . .......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..7 .. �0,(A) --- W .......... OF ...... P.Q ........ kWC)o V 64-
.........................................
Appliration for Disposal Warks
Fzz ..............
...... &Jt5om
Application is hereby made for a Permit to Construct or Repair �-e �Dis o�l
System at: G
................ . . ...... . ............ W .. ....... 1N.1) . . ........ ........................... L ........ 4 .........................................
C t 1,.t No
12
.. ...........
..... ..... 1�
................ Ak-C ...... ... oil:�5 ......
Owner Address
Installer
Address
Type of Building Size Lot.. ..... U ...... S f t
Dwelling—No. of Bedrooms ............ . ........................ Expansion Attic ( ) Garbage Grindet
Other—Type of Building ............................ No. of persons ............................ Showers — Cafeteria
Otherfixtures ...................................................................................................... ----- , .... * ------------------
Design Flow ................ 5,5 .. gallon per person per day. Total daily flow .......... r .... . .......................... gallons.
allons Length ............... Width. .... Diameter ................ D th
Septic Tank —Liquid capacity,15 P9V s
--- ep ----------------
-i — No . ....................
Disposal Trencl Width .4 ......... Total Length ..... 4 .. �o ..... Total leaching area .... V.10.+sq. ft.
Seepage Pit No ..................... Diameter ............. ...... Depth below inlet .................... Total leaching area .................. sq. ft.
Other Distribution box Dosingt k
Percolation Test Results Performed b, ................... ..........
Test Pit No. I ................ minutes per inch Depth of Test Pit .................... Depth tu ground water ........................
Test Pit No. 2 ................ minutes per inch Depth of Test Pit .................... Depth to ground water ........................
----- 15 ............. 4 .. ..... ; .......... 6-W ----- - ---------------------------------------------------------
Descriptionof Soil ............... .. W .... &.t . ..... .................. i�� ..........................................................
.......................................................................................................................................................................................
Nature of Repairs or Alterations — Answer when applicable ..............................................................................
........................................................................................................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environment de — e und t -ed- further agrees not to place the
Ii &d
)mp i f I
system in operation until a Certificate of Q -n lian a en i 6b bard of health.
.. . ...............
. ........................
Signed ... .... ............... ...... .......
4V�
ApplicationApproved By ...................................................................................................................................................... ........................................
Da e
Application Disapproved for the following reasons: ............................................................. ..........................................................................
.................................................................................................... ........................................................................................................... ........................................
Date
PermitNo . .................................................................... Igsued .................................................. __ ............
Date
------------------------------------------------ — ----------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.............................................. OF --------------------------------------------------------------------------------------------------
10-lertifirate of (fantylianre
THIS IS TO CEIJTIFY, That the Individual Sewage Disposal System constructed or Repaired
by......................................
Installer
at.............................................................................. .................... I ....... ............................................................................................ I ........... I .................................
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 . ................................................ dated ................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE
Inspector .....................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.......................................... OF .....................................................................................
No......................... FEF ........................
Disposal Works Tonstrurtion frrwit
Permission is hereby granted ........................................................................................................................................
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System
atNo ...............................................................................................................................................................................................
Street
as shown on the application for Disposal Works Construction Permit No ..................... Dated ..........................................
.........................................................................................
Board of Health
DATE................................................................................
Form 1255 (�H&WD Homs &WARREN TM Publishers
14
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No............... . ....... Ficis ............... ..... . ........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
L.,-)-. o .......... OF ....... P.9 ....... PAIR'DO'd 161L
..... ....... * -- ---- ----- ** ---------------- * ...........
Appliratiou for llhipniial Workii Tonstrurtiott ramit
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System at: Go
................ . .... . . . ............ ........ ........................... L .-T ........ 4 .........................................
'33 2 Lot No..
�4�1.L Z_ CIL
................. 6.1::� ...... -%, tic,. r . ....... LQ .. ............ ..................... q
Owner Address
Installer Address
Type of Building 441 Size Lot..Z19.3.0 .... Sq. feet
Dwelling — No. of Bedrooms ................ ........................ Expansion Attic ( ) Garbage Grinder
Other—Type of Building .............. ............. No. of persons ............................ Showers — Cafeteria
Otherfixtures ------------------------------------------------------ ----------------------------------------------- ------------------------------
.... .. ................. gallons.
Design Flow ................. 5"5 .. -:---gallons per person per day. Total daily flow....
..... ep ................
Septic Tank —Liquid capacity- j'allons Length ................ Width ................ Diameter ........... D th
Disposal Trench — No . .................... Width ..... -4 A ......... Total Length ..... 4.��n .... Total leaching area .... 1.10.41 -sq. ft.
Seepage Pit No ..................... Diameter .................... Depth below inlet .... ............... Total leaching area .................. sq. ft.
Other Distribution box ( ) Dosinj tank (
Percolation Test Results Performed by_..�A_M . ...... �i� ..................... Date..5_-i::3. 1. -'J. �( .........
Test Pit No. I ................ minutes per inch Depth of Test Pit .................. .. Depth to ground water ........................
Test Pit No. 2 ................ minutes per inch Depth of Test Pit .................... Depth to ground water ........................
. ................. i ---------------------------- i .......... I ............... .........................................................
Description of Soil ................ 5.�o /). L!6� ...... 4�, OG
..... 5W .......... :3 .... ...........................................................
........................................................................................................................................................................................................
Nature of Repairs or Alterations — Answer when applicable .................................. ............. ..............................................
........................................................................................................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code — The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been issued by the board of health.
Signed....................................................
ApplicationApproved By ........................... ..................................................................
Application Disapproved for the following reasons: ....................................
........................................... ..... I ...................................................... I ------------------------------------------
PermitNo . ....................................................................
...... .... ..................................
Date
.................................................... ...........................
Date
Bsued............. ................................ _ ...................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.............................................. OF --------------------------------------------------------------------------------------------------
(gertifirate of (foutlatianre
THIS IS TO CEIJTIFY, That the Individual Sewage Disposal System constructed or Repaired
by...... _ .......
....................................... -
Installer
at....... ...................................... -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
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 . ............... _ ............. ................ dated ................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE........................................ ............................................................... Inspector
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.......................................... OF .........................................
PAIMM
FzE........................
Uisvaoal Marks Tonstrurtion rrrmit
Permissionis hereby granted ..............................................................................................................................................
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System
atNo ...............................................................................................................................................................................................
Street
as shown on the application for Disposal Works Construction Permit No ..................... Dated ..........................................
DATE............ ---------------------- ..........................
Fbrm 1255 CH&WD HOBBS& WARREN T" Publishers
Board of Health
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Town of North Andover, Massachusetts
BOARD OF HEALTH
MAPPLICATION FOR SITE TESTING/INSPECTION
Form No.1
19
Applicant NAME ADDRESS TELEPHONE
Site Location
Engineer NAME ADDRESS TELEPHONE
Test/inspection Date and Time
CHAIRMAN, BOARD OF HEALTH
Fee
S.S. Permit No.—D.W.C. No. C.C. Date
Test No,
Plbg. Permit No.
Town of North Andover, Massachusetts Form No.1
,40RTH BOARD OF HEALTH
"'E. " '6 0 19
V 0
APPLICATION FOR SITE TESTING/INSPECTION
Applicant n 0— &�� I 8AA� , '4xn C -
NAME ADDRESS- TELEPHONE
Site Location Lo= * L4 I (a,� -Uz6�
Engineer NAME ADDRESS TELEPHONE
Test/Inspection Date and Time
Fee
CHAIRMAN, BOARD OF HEALTH
Test No. 4L4 I
S.S. Permit No.-D.W.C. No. C.C. Date-Plbg. Permit No.