HomeMy WebLinkAboutMiscellaneous - 29 JOHNNY CAKE STREET 4/30/20184 >
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Lot& Street A dn#,vp ychit��,, _ Map/Parcel
CONSTRUCTION APPROVAL
Has plan review fee been paid: NO Permit#_!?6z
Plan Approval: Date: Approved by: x
z ��a4t�)
Designer: ---Be4)
�b —Plan Date: 7A4
Conditions:
Water Supply-. Town Well
Well Permit: Driller:
Well Tests: Chemical --,,,Date Approved
Bacteria I OXe Approved
Bacteria 11 Date�r)roved
Plumbing Sign -Off -
Comments:
Form "U" Approval:
Date Issued
Conditions:
Final Approval:
Wiring -Sign-Off:
to Issue: YES NO
All Permits Paid? YES NO
Well Construction Approval? YES NO
Septic System Construction Approval? YES NO
Certification? YES NO
Other YES NO
Any Variance Needed? <ED NO
FINAL BOARD OF HEALTH APPROVAL:
DATE:
APPROVED BY:
SEPTIC SYSTEM INSTALLATION
Is the installer licensed? NO
Type of Construction: NEW c—RrP_A_IR____)
New Construction: Certified Plot Plan Review YES
Floor Plan Review YES
Conditions of Approval from Form U YES NO
Issuance of DWC permit: (3D�> NO
DWC Permit Paid? _�YE NO
DWC Permit # W Installer --BC—A) 0 5 0 !��)k
Begin Inspection, No
Excavation Inspection:
Needed:
Passed: 91'111"�17 By:
Construction Inspection. -
Needed:
As Built Plan Satisfactory:
YES. -
Approval of Backfill: Date: �/1-r?An' By:
I -
Final Grading Approval: Dateo/ By -
91,77
Final Construction Approval- Date- By
Certificate of Compliance: Approval: A4_ Date:- r-7
Commonwealth of Massachusetts
City/Town of
Sys'tem Pumping Record
Form 4
DEP has provided this form for us& by local Boards of Health. Other forms may be bsed, 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 houqC�Leight%gdib id �ous Left/
der decp�
Right side of building, Left / Right front of building, Left / Right rear of building, Under dec
Address
Cityrrown State
2. System Owner
Name
Address (if different from locafion)
Cityf rown
B. Pumping Record
1. Date of Pumping
M.
3. Type of syste . 1:1
El Other (describe):
Date
Cesspool(s)
Zip Code
StaterN Z' de
Telephone Number
2. Quanu Pumped
ateptic Tank
Gallons
El Tight Tank
4. Effluent Tee Filter present? E] Yes [Rlqo If yes, was it cleaned? 0 Yes F� No
5. Condition of S
ystem:
V\'
6. System Pumped By:
Neil Bateson
Name
Bateson Enterprises Inc
Company
7. Location where contents were disposed:
Lowell Waste Water
F5821
Vehicle License Number
q-z)g -(3
Date
t5form4.doc- 06/03 System Pumping Record - Page 1 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 Massachusqtts
CityfTown of 6 ��h
System Pumping Reco RECEIV
Form 4'
DEP has provided this form for use by local Boards of Health. h(r for s maV
Ot
information must be substantially the same as that provided here. Befo usin4tuf nr, with your
local Board of Health to determine the form they use. The System Pu 'WRecord must be submi d to
OF NORTH ANDOVER
the local Board of Health or other approving authority. 11 ALTH DEPARTMENT
A. Facility Information
1. System Location:
2.
Address (if different from location)
CityfTown
I
(A
State
Zip Code
Slate Zip Code
56 -'�67 - 9 7 L��
Telephone Number
B. Pumping Record /
1, Date of Pumping 2. Quantity Pumped: Gallons
3. Type of system'. Cesspool(s) tB,/�Septic Tank E] Tight Tank
n other (describe):
4. Effluent Tee Filter present? [] Yes n No if Yes, v;as it cleaned? E] Yes E] No
5. Condition of System:
6. s4stem_�umped By:
Vehide Lice Number
�mnee
Cbmpany
7.
t5form4.doc- 06103
System Pumping Record - Page 1 of I
A.
FOR
DA
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4�,.,�ONED
OF
RETURNED
PHONE
YOUR gALL
AREA CODE
NUMBER-,' EXTENSION
oc*,� 3 V Z, �l �-ASE CALL
MESSAGE—
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AGAIN
C AME TO
SEE YOU
�,,--f'WANTS TO
( I SEE YOU
Sl NED
ive '48003
" " il "r 114"n ]a A1,41j" V Im
HEALTH DEPARTMENT
27 CHARLES STREET
NORTH ANDOVER, MASSACHUSETTS 01.845
Sandra Starr, R.S., C.H.O. (978) 688-9540 - Telephone
Public Health Director (978) 688-9542 - Fax
TO:
Fax:
61�1 j - Y2-; �/
From:
Pages:
Phone: Date:
Re:
CC:
I -z
0 Urgent 0 For Review 11 Please Comment 0 Please Reply 11 Please Recycle
Please call 978-688-9540 for assistance with any questions. Thank you.
Xc: Address File
Chrono File
Town of North Andover
Office of the Health Department
0
Community Development and Services Division
27 Charles Street
North Andover, Massachusetts 01845 r"Lis
Sandra Starr
Health Director
April 16, 2003
Thomas McDermott
20 Wheeler Ave
Salem, NH 03079
Re: Application for an addition to an existing home at 29 Johnny Cake Drive
Dear Mr. McDermott:
Telephone (978) 688-9540
Fax (978) 688-9542
Your application for an addition at 29 Johnny Cake Drive has been reviewed by the Health Department. The
application was denied on April 16, 2003 for the following reasons:
1. Missing information
2. Passing Title 5 inspection of septic system may be required
3. Location of structure not acceptable
To address the problem(s):
If #1 is checked, please supply:
a. Floor plan of the existipg dwelling (all floors) including the back porch or sunroom. All
rooms must be accurately named;
b. Certified plot plan showing house, septic system and proposed project in scale, including any
associate grading.
If #2 is checked:
a. Have the septic system inspected by a certified Title 5 inspector to determine the size of the
system and whether it is operating properly: OR
b. Tie-in to municipal sewer.
If #3 is checked:
a. The proposed the project must meet all current Title 5 setbacks.
Please feel free to call the, Health Office at 978-688-9540 with any questions you may have.
Sincq�
;7
Ifrian 3"LaGrasse, Health Inspector
Cc: Building Department
File
Home owner, 29 Johnny Cake Drive, North Andover, MA 0 1845
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535
Town of North Andover
Office of the Health Department
0
Community Development and Services Division
4;29 A
27 Charles Street ------
Z.. .' t
North Andover, Massachusetts 01845 CHUS
Sandra Starr
Health Director
April 16, 2003
Thomas McDermott
20 Wheeler Ave
Salem, NH 03079
Re: Application for an addition to an existing home at 29 Johnny Cake Drive
Dear Mr. McDermott:
Telephone (978) 688-9540
Fax (978) 688-9542
Your application for an addition at 29 Johnny Cake Drive has been reviewed by the Health Department. The
application was denied on April 16, 2003 for the following reasons:
1. V Missing information
2. ,' Passing Title 5 inspection of septic system may be required
3. Location of structure not acceptable
To address the problem(s):
If #1 is checked, please supply:
a. Floor plan of the existing dwelling (all floors) including the back porch or sunroom. All
rooms must be accurately named;
b. Certified plot plan showing house, septic system and proposed project in scale, including any
associate grading.
If #2 is checked:
a. Have the septic system inspected by a certified Title 5 inspector to determine the size of the
system and whether it is operating properly: OR
b. Tie-in to municipal sewer.
If #3 is checked:
a. The proposed the project must meet all current Title 5 setbacks.
Please feel free to call the Health Office at 978-688-9540 with any questions you may have.
Sincetf,�
e_1._�__-"V0C_7 �
4'rian 3"'LaGrasse, Health Inspector
Cc: Building Department
File
Home owner, 29 Johnny Cake Drive, North Andover, MA 0 1845
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535
oor-�VN
TOWN OFeNDOVER.
SEPTIC SYSTEM SERVICING
REPORT
D a t e : -A,
Homeowner: Pumper : Rci�er--
Street Address: �Q�-
Phone Phone : (joX—
Nature of S-arvice:
Observations:
Descript'Lon of Work.
�, c)[30 1 N -
Comments:
a
Routine
Emergency
Good Condition
Full to Cover
Baffles'in Place
Leachfield Runback
Excessive Solids
Heavy'Grease
Roots
Other (Explain)
NEW ENGLAND ENGINEERING SERVICES
INC
August 9, 1997
Sandra Starr
North Andover Board of Health
Town Hall Annex
School Street
North Andover, MA 0 1845
Re: 29 Johnnycake Street septic system repair
Dear Sandra:
Enclosed are three copies of the final plans for the septic system repair at29 Johnnycake Street, the fee for
review of the plans, and copies of the soil evaluator sheets. The owner of the property has moved, the
house is sold and the closing is awaiting the installation of the system. Your prompt review of these plans
would be greatly appreciated.
If you have any questions please do not hesitate to contact this office.
Yours truly,
B ?mi� e2ar?,�E I T
President
enclosures
33 WALKER RD. - SUITE 22 - NORTH ANDOVER, MA 01845 - (508) 686-1768
i&
.1
DATE: 40,9 - �2 19 9 7
f
.a? jo/
LOCATION: .It) Aj)l
ENGINEER:
BOH WITNESS:
PERCOLATION TEST #
BOTTOM DEPTH OF PERC TEST- L3
TIME OF SOAK: (At least 15 minutes long)
TIME AT 12" .5-3
TIME AT 9" /> 4�5
TIME AT 6"
OVERNIGHT SOAK
TIME STARTED
NEXT DAY SOAK:
TIME AT 12"
TIME AT 9"
TIME AT 6"
(At least 15 minutes)
11;-2,0 a, /Y1 -
11
"I LA�L%A JL%Al7X,0, 241�
26 LIVINGSTON STREET
LOWELL, MA 01852
TEL; (508) 452-7750 APR 1 1997
FAX: (508) 459-07710
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORIM
PARTA
CERTERCATION
PROPERTY ADDRESS: 29 HNNY CAKE ST NO. ANDOVER, MA 01845
DATE OF ENSPECTION; 4-11-97
NATUE OF INSPECTOR: WALTER BREAULT jR.
OVIDIMVII !fWn%T Q'r'4'PV'&ffVl%,rr
%IALIZAAL A_r ALWJ.I( ly A &x L A.
v
ADDRESS OF OWN121DU
ff DIFFERENT)
I CERTIFY THAT I HAVE PERSONALLY INSPECTED THE SEWAGE DISPOSAL SYSTEM AT THIS
ADDRES' S ANT T11AT THE INFORMATION RE, PORTED BELOW IS T-IRITT, ACCtTIATE AND COINIPLVTEI,
IN7
AS OF THE TIME OF INSPECTION. THE INSPECTION WAS PERFORMED BASED ON MY TAR A ININN G A. D
EXPERIENCE IN THE PROPER FUNCTION AND MAINTENANCE OF ON-SFi-E SEWAGE DISPOSAL SYSTEMS. T—ti-11
SYSTEM.
—PASSES
C 0 INT D rL rL AT. 0 ITNT A. L AT. IV P A SOS AV! I S
NEEDS FURTHER EVALUA71ION BY THE LOCAL APPROVING AU—MORI—If
X FAILS
THE SYSTEM INSPECTOR SHALL SUBMIT A COW OF THIS INSPE. r -TION REPORT TO THE. APPROviNG AUTHORITY
WHIIINKT11IRTY (30) DAYS OF COMPLE, TING TMS INSPECTION. IF TIIESYSTEM 1-3 ASMk�,VDSYSTE�ll OR MAS A
DESIGN FLOW OF 10,000 GPD OR GREATEP., THE INSPECTOR AND THE SYSTEIML OWNER SHALL SUBMIT THE
REPORT TO THE APPROPRIATE REGIONAL OFFICE OF THE DEPARTMENT OF ENVI—RONMEN TAL PROTECTION.
THE ORIGINAL SHOULD BE SENT TO THE SYSTEM OWNER AND COPIES SENT TO THE BUYER, IF APPLICABLE
AND THE ArrRONING AUTHORITY.
[NSPECTION SUMMARY:
CUE, CK A, B, C, OR D.
A) SYSTEM PASSES:
N/A I HAVE NOT FOUND ANY INT, ORMATION WHICH 11NDICATES TILAT ME, SYSTEM ViOLsk-TES
ANY OF THE FAILURE CRITERIA AS DEFINED IN 310 CAIR 15.303.
ANY FAILURE CRITERIA NOT EVALUATED ARE INDICATED BELOW.
B) SYSTE M CONDITIONALLY PASSES;
Nhk ONE OR MORE SYSTEM COMPONENTS NEED TO BE REPLACED OR REPAIRED. THE
SYSTEM UPON COMPLETION OF THE REPLACEMENT OR REPAIR, PASSES INSPECTION.
"inyr, A XrVa r%D ?.Tf% r'bD ItTr%71 "V'"D%xT%TVT% V - 1-%D NT"'% 13 A QTQ f%V T%Vl'V'DT.4TV 14 qrTnYkT TNT A T T
LLl"A%M A. A!dkY, WAX L'R%.Fl %J&% IN W A. "A!, A. A;,JL%lTJLJU'4A!,JLl k A. , it, %JLX Ll All. %J& AJAL, A. 11,JAMALICL & L%JL'q &IN CLJUA,
INSTANCES. IF "NOT DETERMINED EXPLAIN WHY NOT.
THE SEPTIC TANK IS METAL, CRACKED, STRUCTURALLY UNSOUND, SHOWS SUBSTANTIAL
INFILTRATION OR E XFILTRATION, OR TANK FAILURE I'S nmmm mr. TuE SYSTEM WILL, mss INsPECTION -m
THE EXISTING SEPTIC TANK IS REPLACED WITH A CONFORMlNG
SEPTIC TANK AS APPROVED BY THE BOARD OF HEALTH.
PAGE I
ACTION -KING ENTERPRISES, INC.
26 LINT�T
.GSTON 51RFIElT
LOWELL, MA H852
TE L: (508) 452-7750
FAX: (508) 459-07 110
DDl-%l)V-Drry 4TNT'IDVQQ: 10 Tnl3-%TTkTV il A TTV, Qlr- WTI'% A?.Mi-%V'rD A94 AiQAZ
L "WL A2,L%L L L-L""L%A!,00 I..' d%JJLAl%L I L %-CLML, 3 L. OW* LlLll"%-O V JLUL%q OLCL VLU"W��
OWNER. VEUKATR-AM-AN SWAINUNATT[AN
DATE OF INSPECTION: 4-11-97
t TN'
ACTION KING ENTE RPRI-SES, INC. HAS BEEN RE, TALNE D BY THE OWNER TO PRO11M AINT IN, 3 r -E, 1 -1 (-- - . () - � ' r n
- T T 4 li-V -,'XrQ . ruTTi-- r Q:- , 7 - T. f V
..7 JL JL:,Lv CLS " r &L N &I, " 0A.V %yu ZLLI%_A:,
Ql SEYwE GEDISPOSALSYSTEM" ID %7 All,7LL%%J%-k0 LJL-L&:,
ly,TEQu%w RAG DISI S
INSPECTOR TO MAKE AN EVALUATION OF THE SYSTEMS PERFORMANCE ON THHE DAlf OF TiiL, !NSFECTIO,-"�-
THE TITLE 5 INSPECTION IS NOT DESIGNED TO PROVEDE INFORNIATION TO DEMONSTRATF THAT TIMES I'STE'N't
WILL ADEQUATE, LY SERVE THE USE TO BE PLACE D UPON IT BY THE NEW OWNER AS STATE D -'-Y%' 15311021. TRIS
ISPECTION IS NOT A WARRANTEE OR GUARAINT E E 0 F T H E S Y S T E 1%1 F U T U R E PER F 0 &-� IA Lwl'C'E , Alv,'DIDO ES) Ni 0 T
EITHER EXPRESS OR IMPLY IT.
PA GGE I -A
ACTION -KING ENTERPRISES, INC.
SUBSURFACE SE WAGE DISPOSAL.SYSTE M INSIE CITON FORM
PARTA
CERTIFICATION (CONTINUED)
PROPERTY ADDRESS: 29 JOHNNY CAKE STREET ANDOVE, R, Iffit OlIU45
OWNER.- VEUKATRAIVL4,N SWAMINATHAN
DATE OF INSPECTION: 4-11-97
B) SYSTEM CONDITIONALLY PASSES (CONTINUED)
N/A SEWAGE BACKUP OR BREAKOUT OR HIGH STATIC WATER LEVEL OBSERVED IN THE
DISTRIBUTION BOX IS DUE TO BROKE N OR OBSTRUCTED PIPE (S) OR DUE TO A BROKE, Np
SETTLED OR UNEVEN DISTRIBUTION BOX. THE SYSTEM WELL PASS INSPECTION IF (WITH
APPROVAL OF THE BOARD OF HEALTH).
BROKEN PIPE(S) ARE REPLACED
OBSTRUCTION 0 RE, MOVE D
DISTRIBUTION BOX IS LEVELED OR REPLACED
THE SYSTEM REQUIRED PUMPING MORE THAN FOUR TIMES A YEAR DUE TO BROKEN OR
OBSTRUCTE D PIPE (S). THE, SYSTE M WILL PASS INSPE C -TION IF (WrIll APPROVAL OF TUE
BOARD OF HEALTH).
BROKEN PIPE(S) ARE REPLACED
OBSTRUCTION IS REMOVED
C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
N/A —CONDITIONS EXIST WHICH REQUIRE FURTHER EVALUATION BY THE BOARD OF HEALTH
LTE TB If'- 11
IN ORDE R TO DE TE RMINE IF TlIE, SYSTE M IS FAILING TO PROTECT T 1 Pt LIC r A -LT
SAFETY AND THE ENVIRONMENT.
SYSTEM WELL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT
FUNCTIONING IN A AL4,NNT, R WIIICII WILL rRoTE, cT nm, ruBuc nrALTu AND,,-RAFE, Ty
'IT:
AND THE ENVIRONMEN
WATE
CESSPOOL OR PRIVY IS WITHIN 50 FEET OF A STU L Ek
CESSPOOL OR PRIVY IS WITHIN 50 FEET OF A BORDERING VEGETATED WETLAND
OR ASALT MAILSH.
2) SYSTEM WELL FAIL UNLESS THE BOARD OF HEALTU (AND PUBLIC WATER SUPPLIER, IF
APPROPRIATE) DETERMINES THAT THE SYSTEM EF FUNCTIONING IN A MANNER THAT
PROTECT THE, PUBLIC HEALTU AND SAF E, TY AND THE, Et NVIRONMENT.
THE SYSTEM HAS A SEPTIC TANK AND SOIL ABSORPTION SYSTEM AND IS WITHIN
100 FEET TO A'SURFACE WATER SUPPLY OR TRIBUTARY TO A SURFACE WATER
SUPPLY.
THE SYSTEM HAS A SEPTIC TANK AND SOIL ABSORPTION SYSTEM All" -D IS NITIHIN'
A ZONE I OF A PUBLIC WATER SUPPLY WELL.
THE SYSTEM HAS A SEPTIC TANK AND SOIL ABSORPTION SYSTEM AND IS WITHIN
50 F E ET OF A PRIVATE WATE, R SUPPLY WE LL.
THE SYSTEM HAS A SEPTIC TANK AND SOIL ABSORPTION SYSTEM AND IS LESS
THAN 100 FEET BUT 50 FEET OR MORE FROM A PRIVATE WATER SUPPLY WELL
UNLESS A WELL WATER ANALYSIS FOR COLEFORM BACTERIA AND VOLATILE
ORGANIC COMPOUNDS INDICATE 8 THAT THE WE, LL IS FIRE E FROM POLLUTION
FROM THAT FACILITY AND THE PRESENCE OF AALNfONIANITROGEN AND
NITRATE NITROGEN IS EOUAL TO OR LESS THE SPPrVL
PAGE 2
AClTOlN.,KM-rr ENTE, -RPR-TR- ES, -TNC,
D) SYSTEM FAILS:
x I HAVE DE 77 RMV4ED TIIAT THE SYSTE Al VIOLATE, 8 ONE, OR MORE OF THE F OLLOWING
FAELURE CRITERIA AS DEFINED IN 310 CMR 15.303. THE BASIS FOR THIS DETERMINATION
IS IDENTIFIED BELOW. THE BOARD OF HEALTH SHOULD BE CONTACTED 'TO DETERMINE
WHAT WELL BE NECESSARY TO CORRECT THE FAILUP,
BACKUP OF S EIVAGE 0T, 0 FACILITY ORSYS TLx,'.r CrL,%MLDONENT DUE TO M"If
OVERLOADED OR CLOGGED SAS OR CESSPOOL
x DISCHARGE OR PONDING OF EFFLUENT TO THE SURFACE OF THE GROUND OR
SURFACE WATE, ILS DUE, TO AN OVE RLOADE D OR ClOGGE, D SAS OR CESSPOOL.
T
V A,, L%_p
STATIC LIQUID LEVEL IN THE DISTRIBUTION BOX A' BOVE MERT D TE TO
AN OVERLOADED OR CLOGGED SAS OR CESSPOOL
LIQUID DEPTH IN CESSPOOL IS LESS THAN 6" BELOW INVERT OR AVAILABLE
VOLUME 0. LESS THAN 1/2 DAY FLOW,
REQUIRED PUMPING MORE THAN 4 TIMES IN THE LAST YEAR NOT DUE TO
CLOGGED OR OBSTRUCTED PIPE(S).
NUMBER OF TIMES PUMPED
x ANY PORTION OF THE SOIL ABSORPTION SYSTE, M, CE SSPOOL OR PRIVY IS BELOW
THE HIGH GROUNDWATER ELEVATION.
ANY PORTION OF A CESSPOOL OR PRIVY IS WITHIN 100 FEET OF A SURFACE
WATER SUPPLY OR TRIBUTARY TO A SURFACE WATER SUPPLY.
ANY PORTION OF A C -E SSPOOL OR PRIVY IS WnMIN A ZONE, I Or' A PUBLIC WELL.
1D T -W 7 A 'ry
jo WJLUJU, V MID
A %TY u RTIOINTOF A CE 'Q'DnOLf%13'.DILT�7Y!S%,IT!Hnu�f'c FEETOITA L%LvrLAf'
'L"' 'L 'L 0 Im %1"00A. w wav
WATER SUPPLY WELL
ANY PORTION OF A CESSPOOL OR PRIVY IS LESS THAN 100 FEET BUT GREATER
THAN 50 FEE, T FROM A PRIVATE WATER SUPPLY WELL Wrrll NO ACCEPTABLE
WATER QUALITY ANTALYSIS. IF THE WELL HAS BEEN ANALYZED TO BE
ACCEPTABLE, ATTACH COPY OF WELL WATER ANALYSIS FOR COLIFORM
BACTERIA, VOLATILE ORGANIC COMPOUNDS, AMMONIA NITROGEN AND
NITRATE NITROGE, N.
E) LARGE SYSITTV! FAIL`,):
THE F O-LLOWING CRITERIA APPL'11' TO LARGE SYSTEMS IN, 'ADD !!'!ONTO I A
A IDoXrE
t%" , , .
NT/A THE, DESIGN FLOW OF SYSTEM IS 1.0,000 GPI) OR GREATER (11-A R -C -F. SYSTIF-11-11, AND THE
SYSTE"i'll IS A SIGNTIFICANT THREAT TO Pll"T'D L D' E A LT Ill. A!N' D S A F E -'ri" A N D T IT E
E'l TNU I I IV 0 1% 11
LIN 10"'MENTT BECAUSE OINT OR MORE, OF THE FOLLOWING CONDITIONS EXIST:
THE SYST EM IS WITHIN 400 FEET OF A. SURFACE DRINKING WATER SUPPLY
THE, SYSTE M IS WIT—Tlr�r 200 FrET OF A TRIBUTARY TO A,151"'ItFAC-E
WATER SUPPLY.
THE'S,YSTEIM IS LOCATED FN A NITROGEN SENSITI-VEARE.4, (UNTERRivi WELLUE.kD
PROTECTION AREA (WPA) OR A MAPPED ZONE 11 OF A PVRT:l-(7 W.-% TER SITP-vLv
WELL�
' L ' i i , ' I
i i F 0-;-V -NE R OR OPE it4T 0 R 0 FkN Y �s ijcii 15 l-'--lT E -)"i S ijA LL BRIN (; Tlill S li-ff
I -T N
"I
'()N!PlJANTCF WITH TITT. GRO 1. D
I- A,".-, C"NSULT'll".? VOCA Y., rn-
I � A (-J' I
ACTION -KING ENTERPRISES, Txc.
PARTB
CHECKLIST
A XT"0171
A"DRESS: 29301ITNNY CAKFS' �'p
OWNER: VE-UKATRANDiN SWAMINATHA_l'q
01-TINTSPECTY NT: '-'1-97
CTIECK IF THE. FOLLOWING HANT BEEN DONE �
�v DrrAfMvi� TV' vi_tWiix 4 T IV li Q i -lo _Fff'c' ;' 7;�— !-'r' 4 -r"r� 'r
Z% L u lv Lk JU I -Y " 11: %J &�T "_x k &%� I I V v X V0 Lx'" V u �0 L.' " L L L LA:, %J I T L � L:� 4 �v V�
HEALTH.
All N -1 � � , I . 1, -
NONE OF TDE.SYST f ('()%I %T'I',S RIVENT I I" I V 1 f I e 1 J i' 1 4 , I Y, �� , ,
J,
-c r, T7U T -Vg— —i7CT 4 -r r, Er, Ti-. r. T 4 D f- T -
THE SYS-LEM HAS BEEN RECEB7PiGINORI'VUL FLONIV Put-Ifl-S Ll V L%Al I ky L Ljxv L L Ll' i.%A,-" Liviffl_
VOLUMES OF WATER HAVE NOT BEEN INTRODUCED INTO THE SYSTEM RECEN-fLY ol'(As
PART OF THIS INSPECTION.
T%T i 4 4 Q 1DTrTT 'r UT A XTS IT I Iry BEEN 013" A ITNTED I T%Tn ry 4 I%AFTT%Tr.r. 7Ji_._._v T_u _ruT"'ir A 1L)v i%_ii_Vr
LlltlL Z-113 JJ%J AJU L L 1,&&LXlY LAL-L V A!, "AAL:,Il %-PLJ LCLAUNC, Mil " JL:,Z%Z&IVLLIlJL�LA. 11 " L 11. LL L &RAI, A. L-&X%A:, il" L
AVAILABLE 'WIT-li N`iA.
* Tilrl-.ri-ACyfM'ORD"Y"P'ELL-!,!�TG WAS IN, TS PLECTED FOR SIGNS OF SEW Al G-Ell"DA C Xl- TUIPI
* THE SYSTEM DOES NOT RECEIVE NON -SANITARY OR INDUSTRIAL WASTE FLOW.
X OF BREAKOITT,
X ALLSYS—IEMCOMPONENTS, EXCLUDEiGTHE SOIL ABSORPTION SYSTEM. ffiltv"E, BEEN
LOCATED ON THE SITE.
v I ITT -
X THE oQ EPTL I C TANW N 1AIN H 0 L E S W E R E UNT C 0 IV E I AR E I D, 0 P ENT, D, A 71 1 D T H E IINT T E R 10 'A 3% 0 L' T L A - A
SEPTIC TANK WAS RiSPECTED FOR CONDITION OF BAFFLES OR TEE, MATERIAL OF
CONSTRUCTION, DIMENSIONS, DEPTH OF LIQUID, DEPTH OF SLUDGE, DEPRTH OF SCUM7
v 7
LM Sr7V- A 16TTN T fNf- 4 JOILT f%F THE QnTT A DQOD
'pTr
.OlkT QyQ'rvlkx r.XT 'r. v QTrrv. IT 4 19 I3'r'v_r%7
.m &ZEAND jLj%-.,%,AT N 0 OWLA, CLA11Y Ll &Y LO L"LVL %-$III LLAX� OLL" LLLO JL#Aldl;,Il
DETERMINED BASED ON EXISTING INFORMATION OR APPROZINIATED BY NON -INTRUSIVE
METHODS.
, v i -rr
X THE FACILITY 01117NER AND OCCUPANTS, IF DIF.FFERENI-T FRONI PROVIMUL V
WITH IN -FORMATION ON THE PROPER MAINTENANCE OFSUB-SURFACE DISPOSALSYSTE.M.
PAGE 4
ACTION -KING ENTERPRISES, E'qC.
SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM
PART C
I.IVQ,rvy*g TxTrrbDTg
0 L,J JL&:,LFL
PROrERTY ADDRE SS-- 29 JOIINITNY CAKE. ST. NO, ANDONT1,R; MA 01845
OWNER. VEUKATRAZN SWAr*flNATHAN
DATE OF INSPECTION: 4-11-97
RESIDENTIAL-
DESIGIN FLOW; 440 GALLONS,
A
,NTLT,A, I B" E LOX 0 F D" E , D R 0 0, w,',r S: I
N17NMER OF CUIRRENT RESIDENT S: 4
GARBAGE GRINDER (YES OR NO) YES
SEASONAL USE (YE, S OR NO) 'NO
WATER METER READINGS, IF kNTAIL,"LBLE: 3.010100 P Ei'm 100 C.F.
LAST DATE OF OCCtTJ_ANCY; 0CCUr_T,.D
COMMERCIAL/INDUSTRIAL
TYPE OF ESTABLISHMENT: N/A
DESIGN FLONV: GALLONSMAY
'YES 00 " )
GREASE TRAP PRESETIR X, t &.7 &V 1.110
INDUSTRIAL WASTE HOLDING TANK PRESENT: ('fESORNO')
NON -SANITARY WASTE DISCILkRGED TO THF TITLE 5 SYSTEM- (YES, OR NOI
""'tITE R METER RE, ADINGS, II? Al"AILABLE;
LAST DAY OF OCCUPANCY:
OTHER; (DESCRIlRE)
LAST DAY OF OCCUPANCIL":
GENERAL INFORMATION
PUMPING RECORDS AND SOURCE OF INFORMATION.
11/2 YEARS (11ONEEOWNER)
SYSTEM PUMPED AS PART OF INSPECTION (YES OR NO) ITS
IF w S, N"OLIT'AlE PUMPED 2000 GALLONS.
D V A Q 1-%7.T Ur.D DT -i% grpffG fTViQlDUlllrfnwr
X%Jt!,M0%JL'q &:%-YAL% JL UIVIL LlIq k7L 1:1%1 L JLX..#Llq
TYPE OF SYSTEM
x SEPTIC TAN"KIDISTREDUTION BOX/SOIL ABSORPTION SYSTEM
SINGLE CESSPOOL
OVERFLOW CESSPOOL
PRIVY
SIIARED SYSTEM (YES OR NO) (IF YE S, ATTACH PRVIOUSS VINSIVE CTION
OTHER
(EXPLADO
A 1.17ATt 4 N" Qnr,.Di-r i -%r
APPROX51A TE "..'GE, OF C-01%vill'O'INTNTS3, D' ATE,
INFORMATION.
10 YEARS (HOMEOWNER)
SEW.41LGE ODO' RS' DETECTED WHEN ARRArING AT THE SITE. (YES OR NO)___,�TO
PAGE 5
ACTION -KING EN UiERPRISE -S, lNC-
PART C
SYSTE M INF ORMATION (CONTOW, ED)
PROPER 71f ADDRESSk 29 jOHNN-f CAKE, ST. NO. ANDOVER, MA 0 i845
OWNER: VEUKATRAMANSWAMINATHAN
DATE, OF rl 48PE, M -ION -1-11-97
iEPTl lC TANK: x
(LOCATE ON SITE PLAN)
r'brulpir DVT rtx'17 fln A T%V: I I
L.#L',L L LL AJA!,L,%.P V9 %ffL%CLMXl k
MATERL41 OF CONSTRUCTION: x CONCRETE METAL FRP OTHER (EXPLk-LIN-)
DIMENSIONS; i0l x 61 x 51
SLUDGE DEPTH: 1233
DISTANCE FROM TOP OF SLUDGE TO BOTTOM OF OUTLET T EE OR BAFFLE: 20**
SCUM THICKNESS: 291
DISTANCE FROM Tor OFSCUM TO TOP OF OUTLET TE E OR BAFFLE:
DISTAINICE FRO!'VIBOTTOM OF SCUM TO BOTTO!"I OF OUTLET TEE OIRBAFFLE: 24"
COMMENTS:
Arl"ill"01. DF111TIT OF 1.10,11111.1
(RE, COALMENDATITONTF OR rumPING, COND11102STOF VINLET AND OUTLET 11ES oil B
JDlr Q-PIDYT P.17 T r 4, V- I 1--V U-T-1-
I"E"VEIA 0"RELATION TO .0 UTLEIT !NTVE...,,, . ,,,,CTTjRA,,.L UNTE'G.11.11.1.7, L: A- JL A--. I
TANK OVERFLOWING - HEAVY WATER RUNNING BACK FROM I. -EACH ARF -A
r,r)V- I QVI I�D 4 D. VIA
iNfm
(LOCATE ON Sri—t PLAY)
DErTIl BELOW GRADE;
MATE,UL,41, OF CONSTRUCTION:— C %ni INTCRETE LE I cLL A: L%.L 0 T ff E il Lax ( Ell a" r P., A - L N
DE%4FNSIONS:
SCUM TIIICKT�Tl SS-.
ID A VVT V.
DISTANCE FROl'y I TL 0 P 0 F I S C'U'Nir T 0 T 0 P 0' 170 Ul T L V,,,Lr Tic, *lE 0 11 ",-LX V A-JJL!, I
DISTANCE FROM BOTTOM OF SCUM TO BOTTOM OF OUTLET TEE OR BAFFLE:
'CONIN, ff-iXTS:
T T L, —ld
-RECO',N k H LILQ
. IMENDATIONIFOR PUMPI?NG, CONDITION OF ViLET CALIND OUTLET TEES OR By IMF. LEIS, DAELDT OF
LEVEL IN RELATION TO OUTLET INIVERT, S TRUCTURAL UiTEGRITlf, EVIDENCE OF LEAKAGE.
ETC.)
Pz'lLGE 6
ACTION -KING ENTERPRISES, INC.
SfTnSTTRFArf SEWAGE T)TSPOSAT, SVSTENf WSPECTTON FOR N11
D A IDIr 0
L rL&% L �—
SYSTEM INFORMATION (CONTINUE D.)
PROPEtRTYADDRE,$S;29JOIE,�-M'C.AKEf ST. NO.ANDONTMMA018-45
OWNElb VEUKATRAMAN SWAMINATE[Al�T
DATE OF INSPECTION: 4-11-97
TIGHT OR HOLDING TANK: NIA
(LOCATE, ON SIn, PLAN)
DEPTH BELOW GRADE:
rvIATERIAL OF CONSTRUCTION- -CONCRETE METAL FRP—.-OTTTER (EXPLAIN)
DIMENSIONS:
CAPAC.r-rV--. GALLONS
DllTrlN FLOW: l%-.ALLONoS',DAY
A!117L%Y
,kLARM LEVEL
CONIEWENT;
VT n A 'r, Q%rl I 1-urvQ V'ril
(COIN L L 1. k tLXrr% V AU%J4-1 L 13
' w TITION Or INLET TEE, COIND Lr FL L () x1lT OF AUTIAIRINF f' I I -J
DISTREBUTION BOX:- x
(LOCATE ON!RFM, rf,AN.T)
DEPTH OF LIQUID LEVIEL ABOVE OUT -LET ViVERT: -
COiNBLIE
IS---LITI,-.N TQ
Q71 -T I T r�U T T 4rr 4 r�r
L &AJLLP w U LILA,, A"'.y cl Ll" L:, T A"A!,Ll%--C. ',IL'
OTE IF LEVEL ANT) D E E-V7H)ENCE OF SOL-- C; RRY OVER
EliTO OR OUT OF BOX,
�*-VgTEM B A CICLNG UP - RUTNTIN Ri G B A CIZ' P,T 0 T A N K
IYAO ex
PUMP CHAMBER:
(LOCATE ONSM PLAN)
PUMPS IN WORKING ORDER (YES OR NO NIA
C 0 IN, f IN f E N'T S;
(NOTE CONDITION OF PU` NIP CHAIMBER, CONDITION OF PU-NfPS ATND APPLTITENANCES, ETC.)
PAGE 7
ACTION,KlN`G ENTERPRISES, INC..
PROPERTY ADDRE SS; 29 JOHN .NY CAKE ST. INTO. ANDONER, NLA 01845
OWNER. N;"ELKATRAAtJ"vN SWAN fflNATH,..N`
DATE OF INSPECTION: 4-11-97
SOTT, ABSOR.PTION SYSTEM A S); X
(LOCATE ON SITE PLANT, IF POSSIBLE, EXCAVATIOZNTTNTOT REQLUZED, Bl% -Jr -1 1111'r%. YA BE A LD P LVOXPOTA T. E'D "l-
INWRSIVE MTT HODS.).
W !, �TOT DETERM VINED TO BE PRESENT, EXPLAP, �-,
e M V P- e- LO lq b E
TYPE;
LEACHING PITS, NUMBER.
LEACIJING CffAMBER, NUMBER-
LEACIIIING GYALLERIE S,NUNILBER:
LEACHIN' G TRENCHES,' NUMBER LENGTH: (3) X 40'
LEACHING FIELDS, NUMBER, DUviENSIONS:
OVERFLOW CESSPOOL NUMBER:
ST T.TQ nV U-VTND A TTY Tl- V A rr TTDV T UNrVT r.V
C 01', f IN M N T.QJ: ,-,NOTE C1011llDrr.O,l,,T ()IF 653,1011.1j, LIG'.... .. JLL L L.0L%tlL%JLjL%_- L'LikAJ�%jiMJ�d, IjL�, T &�,Aj %JL' k Wi I" Al I %�Y, %,%-JL I" LLL%
VEGETATION,
ETC.)
CESSPOOLS: N/A
(LOCATE. ONTSITE PLAN)
NUMBER AND CONFIGURATION:
DEPTH -TOP OF LIQUID TO INLET INVERT:
DEPTH OF SOLIDS LAYER:
DEPTH OF SCUM LAYER:
DUVIENSIONS OF CESSPOOL:
MATERIALS OF CONSTRUCTION:
11NDICATION OF GrROUNDWATER;
TrQrr DU IDTT1�f
DIT' d-1
'4 ED A Q P 111 017 INSPETry'"'T"
%-, VT k�_CIOOL %_.' A, lyf%J,7 & "AZI & vLfLp CL17 L ry L�
T
COM1NILEN'IN; (NOTE, COINDIT ION OF SOIL, SY2NTS OF HYDRAULICA R, AIT XTRE, LEVEL or ro!V.DING, C(ANDITIf INNO
_F
VEGETATION, ETC.)
11
1. Lxrv-y: NZIA
(LOCA HIL ON SIT E PLAN)
M-ATETRIALS OF CONSTRUCTION; DIN
DEPTH OF SOLIDS:
COMMENTS: (NOTE CONDITION OF SOIL, SIGNS OF HYDRAULIC FAILURE, LEVEL OF PONDING, CONDITION OF
VEGETATION, ETC.),
PAGE 8
A CTION-KING ENTERPRISES, INC.
d"airror 4 e"r arvu 4 rir nrcue%cA r everuxv ryciDri—rmv unT37.T
"WLWOCLA, OLO&L'LVA. LLUYL&,%--LLW0 rwL%ITL
PART C
SYSTENI INFORMATION (CONTINUED)
PROPERTY ADDRESS: 29 JOHNNY CAKE ST. NO. ANDOVER, MA 01845
OWNER% VEUKATRAMANSWAMINATH-ALN
DATFO INTSrEC-110INT; 4-11-97
F
SKETCH OF SEWAGE DISPOSAL SYSTEM:
T%TdONT TrT'sr rrTVQ 'ri-*s A rr TVA Q'r "Un lDrvT4f4?*TrT'Tlr IDVIUVIDUNTO�ve T 4lV"lkAr4ov-Q i -%D
LAX,0 LW M& A4&,M0L A TV%.Y LA�k%OLCIAILL,11 L &%Ail&: AZdL%A!Wl%-X,4J JUMLlAJqlV"LVL%�3 %-,'L%
COAT ALL WELLS WITHIN 100'
DEPTH TO GROUNDWATER
(A' r7i-A �j 6 s
f Te- t-0 A M
DEPTH TO GROUNDWATER- 31
,--fE( THOD OF DETI CIRMINATION OR
APPROX51ATION:
OBSERVATION
NOTE: SYSTEM INSPECTED (TITLE V) 8-9-95 - SYSTEM PASSED INSPECTION AT THAT TIME - UNSPECTION P-0AN-r. BY
!,%T,'W ENGLAND ENGINEERING P.O. BOX 336 NORT1lANDO%Tfj;�Nlj-A.
INSTALLED INT 3-95 - GROUND WATER AT 9'
PAC�El 9
T6��Of. �Nort�h Andover,
Watershed SepticiMtem
servicinq Rep:)rt
Date:—
Homeowner;
Pumper
Street Address:
Phone
--7-' Phone
Nature of Service: --Routine,'
Eme.i. gency
Observations: Good Condition
Full to Cover
Baffles 'in Place
Leachfield Runback _elfl()
Excessive Solids
Heavy Grease
Roots A-10
Other (Explain)
Description of Work:
------------- --
Comments:
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Town of North Andover, Massachusetts
BOARD OF HEALTH
October 9,
CERTIFICATE OF COMPLIANCE
Form No.4
97
19—
This is to certify that
the Individual Soil Absorption Sewage Disposal System constructed or repaired (x
by Ben Osgood Jr.
INSTALLER
at 29 Johnny Cake Street
SITE LOCTTION
has been installed in accordance with Board of Health Regulations as described in the Design
961 ? August 11 97
Approval Site System Permit No. dated 19
The issuance of this certificate shall not be construed as a guarantee that the system will
function satisfactorily.
NORTH ANDOVER BOARD OF HEALTH
DESIGN REVIEW REPORT
DATE
FEE: PERMIT #,
DATE RECEIVED
APPLICANT MAP PARCEL
ADDRESS LOT # STREET #
ENG.---'OeA) 06(snoz STREET
ENGINEER'S ADD.
PLAN DATE REV. DATE
CONDITIONS OF APPROVAL
APPROVED
DISAPPROVED —11��
REASONS FOR DISAPPROVAL:
AL-
PLAN REVIEW CHECKLI ST
ADDRESS Jc0Pk)lJXlf,4K_C —ENGINEER
GENERAL
LOCUS
3 COPIES STAMP,/ _Z NORTH ARROW 1,� SCALE
CONTOURS L," PROFILE V"�(Sc) SECTION Z -f'- BENCHMARK L----- SOIL &
PERCS L-" ELEVATIONS
WATERSHED? -.4/a DRIVEWAY
SCH40 TESTS CURRENT?
SEPTIC TANK
WETS. DISCLAIMER — WELLS & WETS `--�
WATER LINEA� FDN DRAIN — M&P
SOIL EVAL -Z7_,qkf,�,Q4
MIN 150OG .17 INVERT DROP
10' TO FDN MANHOLE ELEV
D -BOX
GARB. GRINDERIVO (2 comps +200)
GW # COMPS. GB
SIZE # LINES FIRST 2' LEVEL STATEMENT
INLET OUTLET = , �� (2" OR .17 FT) TEE REQ'D?h
LEACHING
MIN 440 GPD?�T RESERVE AREA — 41 FROM PRIMARY),�-"\ 1/ 2% SLOPE
100' TO WETLANDS -Z 100' TO WELLS 4' TO S.H.GW L-�(5'>2M/IN)
20' TO FND & INTRCPTR DRAINS �--�400' TO SURFACE H20 SUPP L--
4' PERM. SOIL BELOW FACILITY
BREAKOUT MET?
MIN 12" COVERL----- FILL? _�
(15')
TRENCHES
MIN 440 gpd4' SLOPE (min .005 or 6"/100')_z_,SIDEWALL DIST. 3X EFF.
W OR D (MIN 61 L----- RESERVE BETWEEN TRENCHES? t-'_ IN FILL?_Z MUST
BE 10' MIN -Y 4" PEA STONE? tl� VENT) (>31 COVER; LINES >501 )
BOT :�66 + SIDE
(L x W x #)
;4 4 -
Copyright 0 1996 by S.L. Starr
15:z 6 =
(DxLx2x#)
ZS
ZY0 X LDNG TOT tt4L'_53,ro' 4 4c�o'
(G/ft2)
7-�(f�
FORM 11 - SOIL* EVALUATOR FORM
Page 3 of 3
Location Address or Lot No. %D, Ale. 4�Qy)cvv�,C 1W
7
Determination for Seasonal—H—igh Water Table
Method Used:
11 Depth observed standing in observation hole ........ .. inches
E-1 Depth weeping from side of observation hole ............ inches
KI Depth to soil mottles inches
El Ground water adjustment ................... feet
Index Well Number .................. Reading.Date ................... Index well level ..............
Adjustment factor ................... . Adjusted ground water level .......... .............................................
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas
observed throughout the area proposed for the soil absorption system?
If not, what is the depth of naturally occurring pervious material? —
Certification
I certify that on 0/17/Zf (date) I have passed the soil evaluator examination
approved by the Department of Environmental Protection and'that the above analysis
was performed by me consistent with the required training, expertise and experience
described in 310 CMR 15.017.
Signatur '1a4W4rDate '��Illhv
f
aDEP APPROVED FORM - 12107/95
i
FORM 11 - SOIL 'EVALUATOR FORM
Page 2 of 3
Location Address or Lot No. ��,Z -,ED, Alz�! 094
On-site Review
Deep Hole Number Date: Time:.A�-*41�,4K Weather
. . ...... ... ....
Location (identify on site plan)
Land Use 77
.W,4 Slope M ��74i-0 Surface Stones
Vegetation
Landform ...............
Position on landscape (sketch on the back)
Distances from:
Open Water Body /,:?00 feet Drainage way feet
Possible Wet Area �� . feet Property Line . feet
Drinking Water Well �Y6*0 feet Other..
DEEP OBSERVATION HOLE LOG
Depth from
Surface (inches)
Soil Horizon
Soil Texture
(USDA)
Soil Color
(Munsell)
Soil
Mottling
Other
(Structure, Stones, Boulders, Consistency, %
Gravel)
Z -
k//2
6e"�7!� IOZ9
Z- 5
7-
- MINIMUM Ut- Z HVI-tO MtUUIMtU A I rVrnT rnurvaru IJ1Z)rV0MLAnCM
Parent Material (geologic) "14 Z— DepthteBedrock:
Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face:
Estimated Seasonal High Ground Water:
TOP OF TEST PIT ELEV = 103.11 E.S.H.G.W. = 98.94
DEP APPROVED FOPW - 12107/95
FORM 11 - SOIL EVALUATOR FORM
Page I of, 3
— " `0�-/ Date:
No V-;)7 -
Commonwealth of Massachusetts
l(lax* Massachusetts
aw A --~vn%44n*2jt Anr 11#2-Cito R.OW170P
Date:
Performed By:
........................... .... I ......................
A .........................
... . . .......... ....... ......... I ...........
Witnessed BY:
L.9i. Add,.
A; � 4 Addros, and z
Tekphom I
e w construction El Repair
Office R vie
.t�
Published Soil Survey Available: No 0 Yes
year Published ./12� .............. Publication Scale Soil Map Unit
Drainage Clas$44z..1 Soil Limitations
Surficial. Geologic Report Available: No El Yes
Year Published . .... . ... Publication Scale
GeologicMaterial (Map Unit) ......................................................... ...........................................................
Landform ................... .....
...............................................................
Flood Insurance Rate Map:
Above 500 year flood boundary No Dyes 21
Within 500 year flood boundary No []Yes 0
Within 100 year flood boundary No Dyes n
Wetland Area: . ........
.............. - ............ - .......
National Wetland Inventory Map (map unit) ....... ....... t ...... I .. ..............................
Wetlands Conservancy Program Map (map unit) . ................ . ............................................................ ... . ..............
Current Water Resource Conditions (USGS): Month
Range :Above Normal �QNormal Ehelc.w Normal D
Other References Reviewed:
aDEF ArrROVED FORM - 12/07/95
De
ol
i
NEW ENGLAND ENGINEERING SERVICES
INC
July 21, 1997
North Andover Board of Health
Town Hall Annex
School St.
North Andover, MA 0 1845
Re: 29 Johnnycake Street
Dear Mr. Chairman
Tcy
10C WER
1997
Please accept this letter as a request to be included on the July 24, 1997 Board of Health agenda
for the above referenced septic system repair. The reason for the request is to consider the
following:
Two local bylaw variance:
1. Reduction of separation distance between trenches from 10' to 6'.
2. Reduction of setback to a wetlands from 100 feet to 50 feet.
I will be at your meeting to discuss these issues.
Yours Truly,
Benjamin C. Osgood, Jr.
33 WALKER RD. — SUITE 22 — NORTH ANDOVER, MA 01845 — (508) 686-1768
Applican
Site Location
Engineer
Town of North Andover, Massachusetts Form No.1
BOARD OF HEALTH
.19
APPLICATION FOR SITE TESTING/INSPECTION
Test/I nspection Date and Time
s� )-S
Fee—
CHAIRMAN, BOARD OF HEALTH
Test No—
S.S. Permit No.—D.W.C. No.—C.C. Date—Plbg. Permit No.
Town of North Andover, Massachusetts
BOARD OF HEALTH
,ED ,
0
APPLICATION FOR SITE TESTING/INSPECTION
Form No.1
19
Applicant NAME ADDRESS TELEPHONE
Site Location
Engineer NAME ADDRESS TELEPHONE
Test/l nspection Date and Time
Fee
CHAIRMAN, BOARD OF HEALTH
Test No.
S.S. Permit No.—D.W.C. No._C.C. Date—Plbg. Permit No.
. ri
BOARD OF HEALTH
1+6 MAIN STREET TEL. 688-9 540
NORTH ANDOVER, MASS. 01845
APPLICATION FOR SOIL TESTS
DATE: S- I Z7 117
LOCATION OF SOIL TESTS: 2q k t(e- -5:�+
Assessor's map & parcel number:
OWNER:_. TEL. NO.: -6 8 q - -3 6
ADDRESS:
ENGINEER:A, Frgl.JF�,, TEL. NO.: ; 6-08 -
CERTIFIED SOIL EVALUATOR:
Intended use of land: residential subdivision,(,:]�-2�21e fa'mily E`om commercial
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM:
1. Proof of land ownership (Tax bill, deed, or letter from owner permitting
tests)
2. Plot plan
3. Fee of $175.00 per lot for new construction. This covers the two deep holes
and two percolation tests required for each lot. Fee of $75.00 per lot for
repairs or upgrades.
GENERAL INFORMATION
1. Only Certified Soil Evaluators may perform deep hole inspections.
2. Only Mass. Registered Sanitarians and Professional Engineers can design
septic plans.
3. At least two deep holes and two percolation tests are required for each septic
system.
4. Repairs require at least two deep holes and at least one percolation test, at
the discretion of the BOH representative.
5. Full payment will be required for all additional tests within two weeks of
testing.
6. Within 45 days of testing, a scaled plan (no smaller than 1 "-100') shall be
submitted to the Board of Health showing the location of all tests (including
aborted tests).
7. Within 60 days of testing soil evaluation forms shall be submitted.
vtORTN
01 to
0
0
41
ACHU
Town of North Andover, Massachusetts
DrN A Q n r*% 1: U C A I TW
Form No.2
921-G I // 19-1Z
DESIGN APPROVAL FOR
SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
'5L)AMI TestNo.
Applicant
Site Location
0 IqIVA) Y C /9 e C -
Reference Plans and Specs--�& k) 05
DESIGN
N
Permission is granted for an individual soil absorption sewage disposal system to be installed
in accordance with regulations of Board of Health.
"ERHAIRMAN, BOARD OF HEALTH
Fee *06
Site System Permit No. ��/
CN
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310 CMR 1Q.99
Form 8
DEP File No
242— 115
4y 7S�- 'e, no be Drovioed by DEP)
6,1, 10wr North Andover
i� Commonwealth
V
of Massachusetts Amitcarl, Desun Corporation
Lot 3 Johnnycake Street
Partial Certificate of Compliance
Massachusetts Wetlands Protection Act, G.L. c. 131, §40
From NORTH ANDOVER CONSERVATION COMMISSION Issuino Authority
To Joan C. McElwain
(Name)
Date of Issuance February 28, 1991
29 Johnnycake Street, North Andover, MA 01845
(Addi ess)
This Certificate is issued for work regulated by an Order of Conditions issued to Desun Corporation
dated 12/21/82 and issued by the NACC
1 . 171 It is hereby certified that the work regulated by the above -referenced Order of Conditions has
been satisfactorily completed.
2. It is hereby certified that only the following portions of the work regulated by the above-refet-
enced Order of Conditions have been satisfactorily completed: (If the Certificate of Compliance
does not include the entire project. specify what portions are included.)
Lot 3 Johnnycake Street ONLY .....
3. D It is hereby certified that the work regulated by the above-relerenced Order of Conditionq was
never commenced. The Order of Conditions has lar)sed and is therefore no lorioer valid No future
work subject to regulation uncier the Act mav be commenced without filino a nev.- Notice of Intent
and receivinc; a new Order of Conditions.
......................................................................... I ... (-Lealv-e-
a
This certificate shall be recorded in the Registry of Deeds or the Land Court for the district in
4. �
which the land is located. The Order was originally recorded on (date)
Deeds, Northern Essex 1454 198
at the Registry of Book page
1456 92
5. The following conditions of the Order shall continue: (Set. forth arly conditions contained in the
Final Order, such as maintenance or monitoring, which are to continue for a longer period.)
Issued by NOR
Signature(s)
OVER CONSERVATION COMMISSION
When issued by the Conservation Commision this Certificate must be signed by a majoiity of is mettibers.
On this 5th day of December 19 90 before rrie
personally appeared Paul L. Tariot , to me, known to be the
acknowledged that he/she executed
person described in and who executed the foregoing instrument and
the s�me as his/her free act and deed.
i�i v September 9, 1994
N tary Public Marie L. Boudrot tvly commission expires
Detach on dotted line and submit to the
..................................................................................................................................................................................................................
To NACC lssumr7 Authority
Please be advised that the Certificate of Compliance lor the J)rolect at Lot 3 Johnnycake St., No. Andover
File Numoer 242— —has been recorded at the Registry of Deeds, Northern Essex
Lot 3 Johnnycake Street ICA
and has oeen noted in the Chain of title of 'he affected vrcceriy on
it reccraea land. :ne insitumeni numoe� wniccri joentoies
-3c:iori:-
If registered land. the cocument numoer which identiftes inis unn
ACE&II'Cani
Signature
MIA
' Health
pdo"r..Mass
�11 I SUBSURFACE DIEPOSAL DFMGN CHEICK LIST,
APPRCVED DATE_
Provided:
DISAPPROVED DATE
Reasons:
LOT
06
Title V FAIL OK
Reg 2.5 The submitted plan must show as a minimum:
:a) the lot to be served-area..dimensionig lot #..abutters
'b location and log deep observation Mea- listance to ties
��c location and results percolation tests-e,.stance to ties
di design calculations & calculations a! wi.�g required leaching area
(e) location and dimensions of system-irLutA ug reserve area
(f) existing and proposed contours
—'(g) location any vet areas idthin 1001 of sewage disposal system or
disclaimer -check wetlands mapping
(h) surface and subsurface drains within 1001 of sewage disposal
system or disclaimer
f(i) location any drainage easements within 1001 of sewage disposal
system or disclaimer -Planning Board files
10) known sources of water supp17 within 2001 of sewage disposal a
system or disclaimer
(k) location of any proposed well to serve lot -1001 from leaching facilit7
(1) location of water lines on propert7-101 from leaching facility
(m) location of benchmark
(n) driveways
(o) garbage disposals
(p) no PVC to be used in construction
(q) profile of system-elevatione of basemen� 0 plumb., pipe,, septic tank.,
distribution box inlets and outlets,, dir tribution field piping and
Mer elevations
(r) maximum ground water elevation in area b wage disposal system
(s) plan must be prepared by a Professional 440neer or other
professional authorized by law to prepar i such plans
Reg 6 Septic Tanks
(a) capacities -150% of flow.* water table., tet i, depth of teesv
access.. pumping
(b) cleanout
(c) 101 from cellar wall or inground swimming pool
(d) 251 from subsurface drains
Reg 10.2 Distribution Boxes
(a) Mpe greater than 0.08
Reg 10.4 1 [77](b) sump
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