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HomeMy WebLinkAboutMiscellaneous - 300 RALEIGH TAVERN LANE 4/30/2018 (2) / - 300 RALEIGH TAVERN LANE Lane _ -- 210/107.A-0128-0000.0 r { ` V I L e 6 U ,-46 y ,I , f I � I I /vl l�G� / �-!� aDo(�, /K-G Cc✓� /�� 73 Y�YoYr> /r��h a�✓ v�✓- l�Gh 62 1c,/I e �7 Residential Property Record Card PARCEL_ID:210/107.A-0128-0000.0 MAP:107.A BLOCK:0128 LOT:0000.0 PARCEL ADDRESS:300 RALEIGH TAVERN LANE FY:2010 PARCEL INFORMATION Use-Code: 101 Sale Price: 100 Book: 10145 Road Type: T Inspect Date: 05/13/2004 Tax Class: T Sale Date: 04/27/06 Page: 1 Rd Condition: P Meas Date: 05/13/2004 Owner: Tot Fin Area: 3219 Sale Type: P Cert/Doc: Traffic: M Entrance: X MUNIZ,JOHANNE Tot Land Area: 1.03 Sale Valid: F Water: Collect Id: RB C/O BAY HOLDINGS,INC Grantor: MUNIZ,JOHANNE Sewer: Inspect Reas: S Address: 255 ALHAMBRA CIRCLE Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LP/o Indust-B/L% / Open Sp-B/L% / CORAL GABLES FL 33134-7411 RESIDENCE INFORMATION LAND INFORMATION t Style: RN Tot Rooms: 10 Main Fn Area: 3219 Attic: NBHD CODE: 7 NBHD CLASS: 7 ZONE: R2 ' Story Height: 1.00 Bedrooms: 4 Up Fn Area: Bsmt Area: 2939 Seg Type Code Method Sq-Ft Acres Influ-Y/N Value Class Roof: G Full Baths: 2 Add Fn Area: Fn Bsmt Area: 1918 1 P 101 S 43560 1.000 225,640 Ext Wall: FB Half Baths: Unfin Area: Bsmt Grade: 2 R 101 A 0 0.030 228 Masonry Trim: Ext Bath Fix: 0 Tot Fin Area: 3219 DETACHED STRUCTURE INFORMATION Foundation: CN Bath Qual: M RCNLD: 420595 Str Unit Msr-1 Msr-2 E-YR-BIt Grade Cond%Good P/F/E/R Cost Class,. Kitch Qual: M Eff Yr Built: 1983 Mkt Adj: PT S 384 0.00 1988 A A ///88 2,100 Heat Type: HW Ext Kitch: Year Built: 1974 Sound Value: PV S 612 0.00 1988 A A 50///50 13,100 Fuel Type: O Grade: G Cost Bldg: 420,600 Fireplace: 2 Bsmt Gar Cap: 2 Condition: G Aft Str Val 1: VALUATION INFORMATION Central AC: N Bsmt Gar SF: Pct Complete: Aft Str Val2: Current Total: 661,700 Bldg: 435,800 Land: 225,900 MktLnd: 225,900 Aft Gar SF: 600%Good P/F/E/R: /100/100/87 Prior Total: 661,700 Bldg: 435,800 Land: 225,900 MktLnd: 225,000 Porch Type Porch Area Porch Grade Factor E 150 W 335 - SKETCH PHOTO 4 1537 23 5 5 14 0 280 S . 235 Sq.R G FM fg � , 29 24 600 Sq 914 504 5 FA Q 11 25 21 57 -.w- - f 300 RALEIGH TAVERN LANE Parcel ID:210/107.A-0128-0000.0 as of 7/2/10 Page 1 of 1 i I SUMMARY OF INVERTS BUILDING TIES r� SEWER 0 FDTN. 97.12 BLDG. CORNER A B C OTE** THIS PLAN & CERTIFICATION IS NOT SEPTIC TANK IN 96.86 SEPTIC TANK 22.2 23.2 A WARRANTY OF THE SUBSURFACE DISPOSAL SEPTIC TANK OUT 96.60 PUMP TANK 14.9 32.7 SYSTEM. IT IS A RECORD OF THE LOCATION PUMP TANK IN 96.55 DIST. BOX 33.564.51 AND ELEVATION OF THE EXISTING SYSTEM DIST. BOX IN 98.46 COMPONENTS. DIST. BOX OUT 98.29 INV. IN CHAM. 98.18 BOTT. CHAM. 97.9 q 1 MNAII F LOT 41 1 N FMR oelw 1500 OAL t } 001PARrAW /u. SWIM TANK 47!'r7 i=t4 SM.IPw Ifow AANK k u LIACN FOLD M/ ;4 ib } CHAMBERS SP. J VUDf,Mi1R L.tv RALEIGH TAVERN LAW ® � 'c�� tiox f,l ST Ss��NAL ENS! AS BUILT PLAN OF SUBSURFACE DISPOSAL SYSTEM LOCATED IN >z� e&30 NORTH ANDOVER, MASS./300 RALEIGH TAVERN LANE #, AS PREPARED FOR ARVIND RAMANI TM: 107A M o DATE: 12-2-10TL 128rniii SCALE: 1"=40' 0 20 40 80 MERRIMACK ENGINEERING SERVICES 66 PARK STREET ANDOVER, MASSACHUSETTS 01810 I I f ' TOWN OF NORTH ANDOVER f NORTH 1 O ot,No ti0 Office of COMMUNITY DEVELOPMENT AND SERVICES of• ., ` °� HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 • •-=-- NORTH ANDOVER,MASSACHUSETTS 01845 �,SSACHUS 978.688.9540—Phone Susan Y.Sawyer,REHS/RS 978.688.8476—FAX Public Health Director E-MAIL:healthdept@townofnorthandover.com WEBSITE:http://www.townofnorthandover.com SEPTIC PLAN SUBMITTAL FORM -- Date of Submission: AUG10 1910 1 TOWN 0P NCRIW AN©QM Site Location: ZjQQ 16 VIE p—� LQLaftAl gN p � Engineer: H j�j H Cki New Plans? Yes ✓ $225/Plan Check# a (includes 1St submission and one re- review only) Revised Plans?Yes $75/Plan Check# Site Evaluation Forms Included? Yes No f 1 dour/IJr r✓�TE� /4 IJ Local Upgrade Form Included? Yes ✓ No ri Telephone#:(17107 95�5 Fax#: T E-mail: �� Homeowner Name: A 1Z�/ E�1'1- ?j OFFICE USE ONLY When the submiss' n is complete(including check): ➢ Date stamp plans and letter ➢ Complete and attach Receipt ➢ Copy File;Forward to Consultant ➢ Enter on Log Sheet and Database �O 0 v_ { r DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Wednesday, February 03, 2010 4:21 PM To: 'mariafreccero@comcast.net' Cc: Sawyer, Susan; Grant, Michele Subject: I.R. -300 Raleigh Tavern Lane-Septic and Property Ownership Informatio ' 1 >eptic-300 Raleighieptic-300 Raleigh300 Raleigh Tavern Tavern La... Tavern La... Lane-Prop... Reference: 978.423.9339 Hello Maria, Attached is the Health Dept File for 300 R.T. Lane. Before you close on the property n , t e mortgage company should require you to obtain a passing Title 5, as a property with a septic system cannot e sold without one. Please review the attached file with the information. According to my records, there is no current passing Title 5 in the file. The last one was failed in 2006, and then the property went into foreclo ure. I also printed the assessor information on the property, as well as the current bank owner as a reference. The foreclosure/deed documents were obtained from: www.lawrencedeeds.com. If you have any further questions,please call our office at: 978.688.9540. You can speak with Mic ele Grant, Health Inspector, or Susan Sawyer, Health Director for any septic related questions. FP.dr ;Vam "We can never see the path of our life if we are too busy focusing on the pebbles under our feet."-AnonymouJ Health Department Assistant TOWN OF NORTH ANDOVER Health Department 1600 Osgood Street Building 20;Suite 2-36 North Andover,MA 01845 978.688.9540-Phone � 1 978.688.8476-Fax pdellechiaie@townofnorthandover.com-E-mail http://www.townofnorthandover.com/Pages/index-Website Notes: If copied to BOH Members-Reference Copy Only-no response requested at this time 1 300 Raleigh Tavern Lane-as of: 11/15/2010-Monday DelleChiaie, Pamela From: Isaac Rowe[irowe@millriverconsulting.com] Sent: Tuesday, August 17, 2010 3:37 PM To: 'Daniel Ottenheimer'; Grant, Michele; irowe@millriverconsulting.com; 'Marianne Peters'; DelleChiaie, Pamela; 'Randy Burley'; Sawyer, Susan Subject: 300 Raleigh Tavern Lane Attachments: 300 Raleigh Tavern Lane- Disapproval leter 8-17-10.doc Susan, Please find attached the disapproval letter for the above referenced property. The only comment I had was minor, in regards to the scaled profile. The BOH regs require a vertical scale 1" =20' and he provided V=40'. The profile is fine but I pointed it out anyway. He seemed to put some thought into this design, looked good. Let me know if you have any questions. Thank you, Isaac Isaac M. Rowe,R.S. Project Manager Mill River Consulting 6 Sargent Street 1 { 300 Raleigh Tavern Lane-as of: 11/15/2010-Monday DelleChiaie, Pamela From: Sawyer, Susan Sent: Tuesday, August 17, 2010 8:45 AM To: 'ramani arvind' Cc: DelleChiaie, Pamela Subject: RE: 300 Raleigh Tavern lane The Health Dept. has 45 days maximum for the first review. Our reviewer generally gets them done within 2 weeks depending on their work load. A letter will be generated regarding the review when it is done.You will receive a copy. Susan Sawyer From: ramani arvind jrmailto:agramani@yahoo.coml Sent: Monday, August 16, 2010 9:25 AM To: Sawyer, Susan Subject: Re: 300 Raleigh Tavern lane Hi Susan, Bill submitted plan for approval on 8/6/10 and I like to know how long generally it takes ? Thanks Arvind From: "Sawyer, Susan" <ssawyer(5)townofnorthandover.com> To: ramani arvind <agramani@yahoo.com> Cc: "brdufresne0comcast.net" <brdufresne@comcast.net> Sent: Thu, July 29, 2010 12:11:58 PM Subject: RE: 300 Raleigh Tavern lane Arvind, Our newly revised regulations approved this year allow the use of older soil test data. The 2003 soil tests are fine if the leach field will be in that same area, and as long as Mr. Dufresne has the locations of those soils they can be used in the design plan. Sincerely, Susan Sawyer Health Dir. From: ramani arvind fmailto:agramani(a-)-yahoo.comt Sent:Wednesday, July 28, 2010 8:44 PM To: Sawyer, Susan Subject: Fw: 300 Raleigh Tavern lane Hi Susan, I contacted engineer who did the soil test in 2003 and following is his response question is... can we reuse the test results ? Thanks Arvind 1 300 Raleigh Tavern Lane-as of: 11/15/2010-Monday ----- Forwarded Message---- From: "brdufresneCakomcast.net" <brdufresne(c)_comcast.net> To: agramani(a-yahoo.com Sent:Wed, July 28, 2010 4:52:37 PM Subject: 300 Raleigh Tavern lane Ramani, I performed the soil testing in 2003 and the project was haulted by the owner, Stefanos Loisou. The town is the only one who can decide if the testing can be re-used. They have a requirement that the testing cannot be more than 2 years old, which this is, however they have the authority to waive that requirement. You need to check with Susan at the Board of Health. I am currently doing a septic design at 344 Raleigh Tavern Lane and will be conducting soil testing in the next week or 2 so if you do need to re- test, it would be an opportune time to do so. I am not trying to push, but you would have to engage my services soon in order to take advantage of that scenerio which could save you some cost. Please check with Susan Sawyer and get back to me as soon as possible. Thanks, Bill Dufresne Merrimack Engineering (978) 475-3555 x-20 (978) 502-6206 cell. 2 ` 300 Raleigh Tavern Lane-as of: 11/15/2010-Monday DelleChiaie, Pamela From: Sawyer, Susan Sent: Thursday, August 19, 2010 11:40 AM To: DelleChiaie, Pamela Subject: FW: 300 Raleigh Tavern Lane Attachments: 300 Raleigh Tavern Lane- Disapproval leter 8-17-10.doc Did we do anything with this while I was gone? If not, I might look at this one item and think about throwing him a bone and just telling him to do it in the future but not disapproving it. I am backed up on emails so just bring the file in to me when you get a chance if it hasn't gone out. Thx S From: Isaac Rowe [maiIto:irowe@millriverconsulting.coml Sent:Tuesday, August 17, 2010 3:37 PM To: 'Daniel Ottenheimer'; Grant, Michele; irowe@m ill riverconsulting.com; 'Marianne Peters'; DelleChiaie, Pamela; 'Randy �►Y Burley';'• Sawyer, Susan Subject: 300 Raleigh Tavern Lane Susan, in fin attached the disapproval letter for the above referencedproperty. The onl comment I had was minor, Please d a pp Y regards to the scaled profile. The BOH re s require a vertical scale 1" =20' and he provided V=40'. Theprofile is fine but I pointed it out anyway. He seemed to put some thought into this design, looked good. Let me know if you have any questions. Thank you, Isaac Isaac M. Rowe,R.S. Project Manager Mill River Consulting 6 Sargent Street 1 300 Raleigh Tavern Lane-as of: 11/15/2010-Monday DelleChiaie, Pamela From: ramani arvind [agramani@yahoo.com] Sent: Tuesday, August 24, 2010 3:47 PM To: DelleChiaie, Pamela Subject: Re: 300 Raleigh Tavern lane Thanks From: "DelleChiaie, Pamela" <pdellech@townofnorthandover.com> To: ramani arvind <aa ramani yahoo.com> Cc: "Sawyer, Susan" <ssawyer@townofnorthandover.com> Sent: Tue, August 24, 2010 2:42:17 PM Subject: RE: 300 Raleigh Tavern lane If you gave us the check we are all set. Thank you. From: ramani arvind (mailto:agramani(c)-yahoo.coml Sent: Tuesday, August 24, 2010 2:42 PM To: Sawyer, Susan Cc: DelleChiaie, Pamela Subject: Re: 300 Raleigh Tavern lane Susan, Thanks for the info As of today(8/24/10)check for the fee is not cash by the town so I want to make sure that town has everything needed for this Thanks Arvind From: "Sawyer, Susan" <ssawyer(-)townofnorthandover.com> To: ramani arvind <aaramani(a)-yahoo.com> Cc: "DelleChiaie, Pamela" <Pdellech(a)_townofnorthandover.com> Sent: Tue, August 17, 2010 8:45:18 AM Subject: RE: 300 Raleigh Tavern lane The Health Dept. has 45 days maximum for the first review. Our reviewer generally gets them done within 2 weeks depending on their work load. A letter will be generated regarding the review when it is done. You will receive a copy. Susan Sawyer From: ramani arvind fmailto:agramani(a--)yahoo.coml Sent: Monday, August 16, 2010 9:25 AM To: Sawyer, Susan Subject: Re: 300 Raleigh Tavern lane Hi Susan, Bill submitted plan for approval on 8/6/10 and I like to know how long generally it takes ? Thanks 1 300 Raleigh Tavern Lane-as of: 11/15/2010-Monday Arvind From: "Sawyer, Susan" <ssawver(a)_townofnorthandover.com> To: ramani arvind <agramani(a),vahoo.com> Cc: "brdufresne(a)_comcast.net" <brdufresne(aD_comcast.net> Sent: Thu, July 29, 2010 12:11:58 PM Subject: RE: 300 Raleigh Tavern lane Arvind, Our newly revised regulations approved this year allow the use of older soil test data. The 2003 soil tests are fine if the leach field will be in that same area, and as long as Mr. Dufresne has the locations of those soils they can be used in the design plan. Sincerely, Susan Sawyer Health Dir. From: ramani arvind fmailto:agramani(aDvahoo.coml Sent:Wednesday, July 28, 2010 8:44 PM To: Sawyer, Susan Subject: Fw: 300 Raleigh Tavern lane Hi Susan, I contacted engineer who did the soil test in 2003 and following is his response question is... can we reuse the test results ? Thanks Arvind ----- Forwarded Message---- From: "brdufresnea-comcast.net" <brdufresne(aD_comcast.net> To: agramani(cDvahoo.com Sent: Wed, July 28, 2010 4:52:37 PM Subject: 300 Raleigh Tavern lane Ramani, I performed the soil testing in 2003 and the project was haulted by the owner, Stefanos Loisou. The town is the only one who can decide if the testing can be re-used. They have a requirement that the testing cannot be more than 2 years old, which this is, however they have the authority to waive that requirement. You need to check with Susan at the Board of Health. I am currently doing a septic design at 344 Raleigh Tavern Lane and will be conducting soil testing in the next week or 2 so if you do need to re- test, it would be an opportune time to do so. I am not trying to push, but you would have to engage my services soon in order to take advantage of that scenerio which could save you some cost. Please check with Susan Sawyer and get back to me as soon as possible. Thanks, Bill Dufresne 2 300 Raleigh Tavern Lane-as of: 11/15/2010-Monday DelleChiaie, Pamela From: Sawyer, Susan Sent: Wednesday, August 25, 2010 9:31 AM To: 'Bill Dufresne' Cc: DelleChiaie, Pamela Subject: 300 Raleigh Tavern Lane Attachments: 20100825084439051.pdf Hi Bill, Please find the attached approval for 300 Raleigh Tavern Lane. The reviewer's only comment was minor, in regards to the scaled profile. The BOH regs require a vertical scale 1"=2' and he provided 1"=4'. The profile is fine however. Because it was only a single minor thing that will not hinder the installation, I am approving this plan instead of having more paper and more time,but would appreciate attention to it in the future. Your effort and thought on this plan did not go unnoticed, as I am sure it was a difficult location to work with. Thanks Susan -----Original Message----- From: noreplyktownofnorthandover.comjmailto:noreply(2townofnorthandover.coml Sent: Wednesday,August 25, 2010 8:45 AM To: Sawyer, Susan Subject: This E-mail was sent from "RNPOA428C" (Aficio MP C5000). Scan Date: 08.25.2010 08:44:38 (-0400) Queries to: noreplyktownofnorthandover.com 1 300 Raleigh Tavern Lane-as of: 11/15/2010-Monday DelleChiaie, Pamela From: ramani arvind [agramani@yahoo.com] Sent: Thursday, August 26, 2010 8:54 AM To: DelleChiaie, Pamela Cc: Sawyer, Susan; brdufresne@comcast.net' Subject: Re: 300 Raleigh Tavern Lane Attachments: 300 raleigh tavern rd.pdf Hi Pamela, Thanks for approving plan in short time frame One thing I noticed is following in the approval letter " ....septic system is for 4 -bedroom house(maximum 9 room) ... " no problem with#of bedroom but total#of room in the house is 10 (see attached town record), so can you correct letter from maximum 9 room to 10 room ? Thanks Arvind ----- Original Message---- From: "DelleChiaie, Pamela" <pdellech(Ltownofnorthandover.com> To: ramani arvind<agramani@vahoo.com> Cc: "Sawyer, Susan" <ssawyerktownofnorthandover.com> Sent: Wed, August 25, 2010 9:41:38 AM Subject: FW: 300 Raleigh Tavern Lane Dear Mr. Raman: Attached is your septic plan approval for 300 Raleigh Tavern Lane. A copy was also sent to Bill Dufresne. Please call the Health Department if you have any questions. Best Regards, Pamela DelleChiaie Departmental Assistant lCommunty Development I Health Department Town of North Andover 1600 Osgood StreetI BldgSuite 2-36 North Andover,MA 01845 20 � ph: 978-688-9540 fax: 978-688-8476 -----Original Message----- From: noreplyntownofnorthandover.comfmailto:noreply(Ltownofnorthandover.com] Sent: Wednesday, August 25, 2010 8:45 AM To: Sawyer, Susan Subject: 1 300 Raleigh Tavern Lane-as of: 11/15/2010-Monday i DelleChiaie, Pamela I From: Sawyer, Susan Sent: Thursday, August 26, 2010 3:43 PM To: 'agramani@yahoo.com' Cc: DelleChiaie, Pamela Subject: RE: 300 Raleigh Tavern Lane Hello, No, unfortunately I cannot increase the#of rooms. The size of the system is based on it. My first question is are we counting the rooms the same way? We only count bedrooms,kitchen, living room, study, etc.No hallways or bathrooms. If you still count 10 than the system may be undersized. Please tell your engineer if you believe he undersized the system and changes may need to be made. Thank you Susan. -----Original Message----- From: DelleChiaie,Pamela Sent: Thursday, August 26, 2010 9:02 AM To: Sawyer, Susan Subject: FW: 300 Raleigh Tavern Lane Hi Susan, Please see the request below from homeowner................ —P -----Original Message----- From: ramani arvind [mailto:] Sent: Thursday, August 26, 2010 8:54 AM To: DelleChiaie, Pamela Cc: Sawyer, Susan;brdufresne cgcomcast.net" Subject: Re: 300 Raleigh Tavern Lane Hi Pamela, Thanks for approving plan in short time frame One thing I noticed is following in the approval letter " ....septic system is for 4 -bedroom house(maximum 9 room) ... " no problem with#of bedroom but total#of room in the house is 10 (see attached town record), so can you correct letter from maximum 9 room to 10 room? Thanks Arvind 1 F 300 Raleigh Tavern Lane-as of: 11/15/2010-Monday ----- Original Message ---- From: "DelleChiaie, Pamela" <pdellech e,townofnorthandover.com> To: ramani arvind<aaramaniyahoo.com> Cc: "Sawyer, Susan" <ssawyerktownofnorthandover.com> Sent: Wed, August 25,2010 9:41:38 AM Subject: FW: 300 Raleigh Tavern Lane Dear Mr. Ramani: Attached is your septic plan approval for 300 Raleigh Tavern Lane. A copy was also sent to Bill Dufresne. Please call the Health Department if you have any questions. Best Regards, f Pamela DelleChiaie Departmental Assistant lCommunity Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover, MA 01845 ph: 978-688-9540 fax: 978-688-8476 -----Original Message----- From: noreplyktownofnorthandover.comjmailto:noreplyktownofnorthandover.coml Sent: Wednesday, August 25,2010 8:45 AM To: Sawyer, Susan Subject: This E-mail was sent from "RNPOA428C" (Aficio MP C5000). Scan Date: 08.25.2010 08:44:38 (-0400) Queries to: noreply@townofnorthandover.com 2 ' 300 Raleigh Tavern Lane-as of: 11/15/2010-Monday DelleChiaie, Pamela From: ramani arvind [agramani@yahoo.com] Sent: Thursday, August 26, 2010 4:41 PM To: Sawyer, Susan Cc: DelleChiaie, Pamela; brdufresne@comcast.net Subject: Re: 300 Raleigh Tavern Lane Susan, In reality house has following rooms (plus two bathrooms) 4 bedroom 1 kitchen 1 family room 1 game/exercise room 1 living room above garrage 1 main living room 1 dining room(this perticular room is right beside main living room and it do not have any wall with the main living room) so total# of rooms in the house is 10 if main living room and dining room count as a separate room even though there is no wall in between those rooms otherwise house will be 9 room house Considering this please let me know to see if change needed in the system Thanks Arvind ----- Original Message ---- From: "Sawyer, Susan" <ssawyergtownofnorthandover.com> To: "aaramanikyahoo.com" <a>?ramani@yahoo.com> Cc: "DelleChiaie, Pamela" <pdellech@townofnorthandover.com> Sent: Thu, August 26, 2010 3:42:36 PM Subject: RE: 300 Raleigh Tavern Lane Hello, No,unfortunately I cannot increase the#of rooms. The size of the system is based on it. My first question is are we counting the rooms the same way? We only count bedrooms,kitchen, living room, study, etc.No hallways or bathrooms. If you still count 10 than the system may be undersized. Please tell your engineer if you believe he undersized the system and changes may need to be made. Thank you Susan. -----Original Message----- From: DelleChiaie, Pamela 1 300 Raleigh Tavern Lane-as of: 11/15/2010-Monday Sent: Thursday, August 26, 2010 9:02 AM To: Sawyer, Susan Subject: FW: 300 Raleigh Tavern Lane i Hi Susan, Please see the request below from homeowner................ __p -----Original Message----- From: ramani arvind [mailto:] Sent: Thursday, August 26, 2010 8:54 AM To: DelleChiaie, Pamela Cc: Sawyer, Susan; brdufresnegeomcast.net" Subject: Re: 300 Raleigh Tavern Lane Hi Pamela, Thanks for approving plan in short time frame One thing I noticed is following in the approval letter " ....septic system is for 4 -bedroom house(maximum 9 room) ... " no problem with# of bedroom but total#of room in the house is 10 (see attached town record), so can you correct letter from maximum 9 room to 10 room ? Thanks Arvind ----- Original Message ---- From: "DelleChiaie, Pamela" <pdellechktownofnorthandover.com> To: ramani arvind<a>?ramani@ ahoo.com> Cc: "Sawyer, Susan" <ssaw townofnorthandover.com> Sent: Wed,August 25, 2010 9:41:38 AM Subject: FW: 300 Raleigh Tavern Lane Dear Mr. Raman: Attached is your septic plan approval for 300 Raleigh Tavern Lane. A copy was also sent to Bill Dufresne. Please call the Health Department if you have any questions. Best Regards, Pamela DelleChiaie Departmental Assistant lCommunity Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover, MA 01845 ph: 978-688-9540 fax: 978-688-8476 2 300 Raleigh Tavern Lane-as of: 11/15/2010-Monday -----Original Message----- From: noreplyntownofnorthandover.comfmailto:noreplygtownofnorthandover.coml Sent: Wednesday, August 25, 2010 8:45 AM To: Sawyer, Susan Subject: This E-mail was sent from "RNPOA428C" (Aficio MP C5000). Scan Date: 08.25.2010 08:44:38 (-0400) Queries to: noreplygtownofnorthandover.com 3 DelleChiaie, Pamela From: Sawyer, Susan Sent: Thursday, August 26, 2010 3:43 PM To: 'agramani@yahoo.com' Cc: DelleChiaie, Pamela Subject: RE: 300 Raleigh Tavern Lane Hello, No, unfortunately I cannot increase the#of rooms. The size of the system is based on it. My first question is are we counting the rooms the same way? We only count bedrooms,kitchen, living room, study, etc.No hallways or bathrooms. If you still count 10 than the system may be undersized. Please tell your engineer if you believe he undersized the system and changes may need to be made. Thank you Susan. -----Original Message----- From: DelleChiaie,Pamela Sent: Thursday, August 26, 2010 9:02 AM To: Sawyer, Susan Subject: FW: 300 Raleigh Tavern Lane Hi Susan, Please see the request below from homeowner................ __p -----Original Message----- From: ramani arvind [mailto:] Sent: Thursday, August 26, 2010 8:54 AM To: DelleChiaie, Pamela Cc: Sawyer, Susan;brdufresne@comcast.net" Subject: Re: 300 Raleigh Tavern Lane Hi Pamela, Thanks for approving plan in short time frame One thing I noticed is following in the approval letter " ....septic system is for 4 -bedroom house(maximum 9 room) ... " no problem with#of bedroom but total#of room in the house is 10 (see attached town record), so can you correct letter from maximum 9 room to 10 room? Thanks Arvind 1 ----- Original Message ---- From: "DelleChiaie, Pamela" <pdellech@townofnorthandover.com> To: ramani arvind<agramani@yahoo.com> Cc: "Sawyer, Susan" <ssawyer@townofnorthandover.com> Sent: Wed, August 25, 2010 9:41:38 AM Subject: FW: 300 Raleigh Tavern Lane Dear Mr. Ramani: Attached is your septic plan approval for 300 Raleigh Tavern Lane. A copy was also sent to Bill Dufresne. Please call the Health Department if you have any questions. Best Regards, Pamela DelleChiaie Departmental Assistant lCommunity Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover,MA 01845 ph: 978-688-9540 fax: 978-688-8476 -----Original Message----- From: noreply@townofnorthandover.com [mailto:noreply@townofnorthandover.com] Sent: Wednesday, August 25, 2010 8:45 AM To: Sawyer, Susan Subject: This E-mail was sent from "RNPOA428C" (Aficio MP C5000). Scan Date: 08.25.2010 08:44:38 -0400 Queries to: noreplygtownofnorthandover.com 2 p f � T DelleChiaie, Pamela From: Sawyer, Susan Sent: Tuesday, July 27, 2010 4:15 PM To: BeHee-hia're;-P��a Subject: C�Alz-30D-� Attachments: ~201 5906764.pdf This is the new owner. they will be doing soil tests. I sent this old Dufresne info. S -----Original Message----- From: Sawyer, Susan Sent: Tuesday, July 27, 2010 4:07 PM To: 'agramani@yahoo.com' Subject: 300 RTL Hope your engineer finds this helpful. All our applications are on the website for soils and plan submission. Best of luck Susan Sawyer Health Director 978 688-9540 -----Original Message----- From: noreply@townofnorthandover.com [mailto:noreply@townofnorthandover.com] Sent: Tuesday, July 27, 2010 3:59 PM To: Sawyer, Susan Subject: This E-mail was sent from "RNPOA428C" (Aficio MP C5000). Scan Date: 07.27.2010 15:59:06 (-0400) Queries to: noreply(a�townofnorthandover.com i 300 Raleigh Tavern Lane-as of: 11/15/2010-Monday DelleChiaie, Pamela From: MERRENG@aol.com Sent: Friday, November 12, 2010 1:47 PM To: DelleChiaie, Pamela Cc: Sawyer, Susan; argramani@yahoo.com Subject: 300 raleigh tavern lane Attachments: tavernlane.TIF Pam attached is a sketch plan of the revised tank locations as discussed with Susan this morning. Please print copy and put in file as Susan requested. Thanks Bill. Stephen E. Stapinski Merrimack Engineering Services 66 Park Street Andover, MA 01810 (978)475-3555 (978)475-1448 FAX merreng(a aol.com Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records.For more information please refer to:http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. 1 300 Raleigh Tavern Lane-as of: 11/15/2010-Monday DelleChiaie, Pamela From: Sawyer, Susan Sent: Monday, November 15, 2010 11:45 AM To: Grant, Michele Cc: DelleChiaie, Pamela Subject: 300 RTL Anyone have info.on this? Did Jim get a BoB yet on 300 Raleigh Tavern Lane? I know they had some problems with tank locations. Also, Pam did Kellett come in and pay for the rest of the 545 Winter St permit yet? 545's lawyer is asking about progress. thx Stwaa Sawye4 1600 Vag"d Stud t4 20,unit 2-36 .Ne 4A Qndare t,Ata 01845 o#tee 978 688-9540 fax 978 688-8476 All email messages and attached content sent from and to this email account are public records unless qualified as an exemption under the [ http://www.sec.state.ma.us/pre/preidx.htm ]Massachusetts Public Records Law. Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records.For more information please refer to:http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. 1 300 Raleigh Tavern Lane-as of: 11/15/2010-Monday DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Monday, November 15, 2010 2:29 PM To: Sawyer, Susan Subject: Septic-300 Raleigh Tavern Lane- Reference Attachments: RE: 300 Raleigh Tavern lane; 300 Raleigh Tavern Lane; FW: 300 Raleigh Tavern Lane; Re: 300 Raleigh Tavern lane; Re: 300 Raleigh Tavern lane; 300 Raleigh Tavern Lane; Re: 300 Raleigh Tavern Lane; RE: 300 Raleigh Tavern Lane; Re: 300 Raleigh Tavern Lane; 300 raleigh tavern lane; 300 RTL Here are the reference e-mails for 300 R.T. lane. Jim was issued the permit on Nov. 1, 2010. 1 do not see any notes in the hard copy file that a Bed Bottom Inspection was requested or done yet. feat Rigss6, Pamela DelleChiaie Departmental Assistant I Community Development I Health Department Town of North Andover 1600 Osgood Street I Bldg 20 1 Suite 2-36 North Andover,MA o1845 2 Office-978-688-9540 R Fax-978-688-8476 0 Email-pdellechiaieRtownofnorthandover.com `2S Website http://www.townofnorthandover.com/Pages/index "We can never see the path of our life if we are too busy focusing on the pebbles under our feet."--Anonymous 1 Common'Wealth of Massachusetts City/Town of North Andover y Form 9A - Application for Loc I = �&& A roval pp J VIM DEP has provided this form for use b local Boards of Heal . N � � p y � r�ql@ , but the information must be substantially the same as that provided ore using this form, check with your local Board of Health to determine the form they use. Form 9A is to be submitted to the Local Board of Health for the upgrade of a failed or nonconforming septic system with a design flow of less than 10,000 gpd, where full compliance, as defined in 310 CMR 15.404(1), is not feasible. System upgrades that cannot be performed in accordance with 310 CMR 15.404 and 15.405, or in full compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410 through 15.415. NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of a new design flow to a cesspool or privy, or the addition of a new design flow above the existing approved capacity of an on-site system constructed in accordance with either the 1978 Code or 310 CMR 15.000. A. Facility Information Important: When filling out 1. Facility Name and Address: forms on the computer,use Arvind Ramani Residence only the tab key Name to move your 300 Raleigh Tavern Lane cursor-do not Street Address use the return key. North Andover MA 01845 CitylTown State Zip Code t4Q 2. Owner Name and Address(if different from above): SAME Name Street Address Cityrrown State (603)233-1426 Zip Code Telephone Number 3. Type of Facility(check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Describe Facility: 4 Bedroom House 5. Type of Existing System: ❑ Privy ❑ Cesspool(s) ® Conventional ❑ Other(describe below): 6. Type of soil absorption system (trenches, chambers, leach field, pits, etc): Unknown t5form9a.doc•rev.7/06 Application for Local Upgrade Approval*Page 1 of 4 Common*ealth of Massachusetts City/Town of North Andover Form 9A - Application for Local Upgrade Approval M DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. A. Facility Information (continued) 7. Design Flow per 310 CMR 15.203: Design flow of existing system: Unknown gpd Design flow of proposed upgraded system 440 gpd Design flow of facility: 440 gpd B. Proposed Upgrade of System 1. Proposed upgrade is (check one): ® Voluntary ❑ Required by order, letter, etc. (attach copy) ❑ Required following inspection pursuant to 310 CMR 15.301: date of inspection 2. Describe the proposed upgrade to the system: Complete Replacement, See Attached Plans 3. Local Upgrade Approval is requested for(check all that apply): ® Reduction in setback(s)—describe reductions: Distance from s.a.s. to fdtn. from 20 ft. to 15 ft. and the distance from the s.a.s. to the street property line from 10 ft. to 5 ft. ❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction ❑ Reduction in separation between the SAS and high groundwater: Separation reduction ft Percolation rate min./inch Depth to groundwater t5form9a.doc•rev.7/06 Application for Local Upgrade Approval*Page 2 of 4 Commom�realth of Massachusetts City/Town of North Andover Form 9A - Application for Local Upgrade Approval 5 y DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. B. Proposed Upgrade of System (continued) ❑ Relocation of water supply well (explain): ❑ Reduction of 12-inch separation between inlet and outlet tees and high groundwater ❑ Use of only one deep hole in proposed disposal area ❑ Use of a sieve analysis as a substitute for a perc test ❑ Other requirements of 310 CMR 15.000 that cannot be met—describe and specify sections of the Code: If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the high groundwater elevation pursuant to 310 CMR 15.405(1)(h)(1). The soil evaluator must be a member or agent of the local approving authority. High groundwater evaluation determined by: Evaluators Name(type or print) Signature Date of evaluation C. Explanation Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible. (Each section must be completed) 1. An upgraded system in full compliance with 310 CMR 15.000 is not feasible: Limited space on lot and existing conditions such as wetlands 2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible: NA t5form9a.doc•rev.7/06 Application for Local Upgrade Approval*Page 3 of 4 Common4vealth of Massachusetts City/Town of North Andover Form 9A - Application for Local Upgrade Approval M DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. C. Explanation (continued) 3. A shared system is not feasible: NA 4. Connection to a public sewer is not feasible: None available 5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the appropriate boxes): ❑ Application for Disposal System Construction Permit ® Complete plans and specifications ❑ Site evaluation forms ❑ A list of abutters affected by reduced setbacks to private water supply wells or property lines. Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2). ❑ Other(List): D. Certification "I, the facility owner, certify under penalty of law that this document and all attachments, to the best of my knowledge and belief, are true, accurate, and complete. I am aware that there may be significant consequences for submitting false information, including, but not limited to, penalties or fine and/or imprisonment for deliberate violations." 4G��— 8-5-10 Facility is Signature Date Arvin Ramani Print Name Bill Dufresne/Merrimack Engineering 8-5-10 Name of Preparer Date 66 Park Street Andover Preparer's address City/Town MA/01810 (978)475-3555 State/ZIP Code Telephone t5form9a.doc•rev.7/06 Application for Local Upgrade Approval* Page 4 of 4 Commonwealth of Massachusetts � City/Town of North Andover Local Upgrade Approval Form 913 DEP has provided this form for use by local Boards of Health if they choose to do so. The Local Upgrade Approval is to be completed by the local Board of Health and a signed copy provided to the system owner. A. Facility Information Important:When filling out forms 1. Facility Name and Address on the computer, use only the tab Arvind Ramani key to move your Name cursor-do not 300 Raleigh Tavern Lane use the return key. Street Address North Andover MA 01845 1y t� City/Town State Zip Code 2. Owner Name and Address (if different from above): Name Street Address City/Town State Zip Code Telephone Number 3. Type of Facility(check all that apply): ® Residential ❑ Institutional ❑ Commercial ❑ School 4. Design flow per 310 CMR 15.203: 440 gpd 5. System Designer: Vladimir NemchenokName ❑ PE ❑ RS 66 Park Street North Andover MA, 0184 Address City/Town State,ZIP B. Approval 1. Local Upgrade Approval is granted for: ® Reduction in setback(s)—specify: Distance from SAS to Foundation from 20 feet to 15 feet Distance from SAS to Street from 10 feet to 5 feet ❑ Reduction in SAS area of up to 25%: SAS size,sq.ft. %reduction 300 Raleigh Tavern Lane 913 8.25.10•rev.7/06 Local Upgrade Approval* Page 1 of 2 Commonwealth of Massachusetts City/Town of North Andover Local Upgrade Approval Form 9B mac, GSM ;ve.e� B. Approval (continued) ❑ Reduction in separation between the SAS and high groundwater: Separation reduction ft Percolation rate min./inch Depth to groundwater ft ❑ Relocation of water supply well (explain): ❑ Reduction of 12-inch separation between inlet and outlet tees and high groundwater ❑ Use of only one deep hole in proposed disposal area ❑ Use of a sieve analysis as a substitute for a perc test List local variances granted not requiring DEP approval per 310 CMR 15.412(4): List variances granted requiring DEP approval: North Andover Health Department Approving Authority /f Susan Sawyer, Health Director � KAccu ust 25, 2010 Print or Type Name and Title /Si nature Date 300 Raleigh Tavern Lane 9B 8.25.10•rev.7/06 Local Upgrade Approval* Page 2 of 2 r V►ORTFt Q*�t►.ED 16�•rO 'I l L O 1� 'f o cosh c: K« a * f 'QA `V 5 �.95 RATe. S ACHU PUBLIC HEALTH DEPARTMENT Community Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFOR TIO ADDRESS: 3o O ,' ( � „n MAP: LOT: INSTALLER: ��( DESIGNER: TU,.eoc,(�OL PLAN DATE: S'a , to BOH APPROVAL DATE ON PLAN: au to, ad 10 INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ❑ Contractor reports any changes to design plan ❑ Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer ❑ Topography not appreciably altered Comments: SEPTIC TANK c d �� ��, ❑ Building sewer in continuous grade, on compacted ti, 1 �+ra ✓ ,`�' �a ' , firm base t i Cleanouts per plan �. . � Bottom of tank hole has 6 stone base v 'Atli '❑ Weep hole plugged -t 1�" ❑ gallon tank has been installed �a� tjC+ loading Monolithic tank construction ❑ Watertightness of tank has been achieved by of 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 1 c� V ` � �� �� 1 i i ,� �. pORTi4 Q� I(LE° 16""� (L y •. 0 to V SSACHUS� PUBLIC HEALTH DEPARTMENT Community Development Division testing ❑ Inlet tee installed, centered under access port ❑ Outlet tee installed, centered under access port (gas baffle/effluent filter) ❑ inch cover to within 6" of final grade installed over one access port ❑ Hydraulic cement around inlet & outlet Comments: QOOO �j� �»�l �� �0o0 Pu Vn P+&A b PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ gallon Pump Chamber installed ❑ loading ❑ Monolithic tank construction ❑ Inlet tee installed, centered under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off floats working ❑ Separate on/off floats ❑ Drain hole in pressure line ❑ cover at final grade installed over pump access port ❑ Water tightness of tank has been achieved by testing ❑ Hydraulic cement around inlet & outlet Comments: CONTROL PANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: basement ❑ Alarm signal located inside: basement Comments: 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.towoofnorthandover.com Inspection Form June 2008 NORTH % 3?Oh�tf�eo Fe16�O0 O * O COCMI<MlwKM y7' �40RATE 9SSAC Huse PUBLIC HEALTH DEPARTMENT Community Development Division DISTRIBUTION-BOX ❑ Installed on stable stone base ❑ H-20 D-Box ❑ Inlet tee (if pumped or >0.08'/foot) ❑ Hydraulic cement around inlet & outlets ❑ Observed even distribution ❑ Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEM General) z Bottom of SAS excavated down to C oil layer, as provided on plan Size of SAS excavated as per plan 60 Title 5 sand installed, if specified on plan r%n 40 Mil HDPE barrier installed Laterals installed and ends connected to header (and c vented if impervious material above) i^" �❑ Elevations of laterals and chambers installed as on approved plan ❑ Retaining wall (boulder/concrete /timber/ block) w ❑ Final cover as per plan 6omments: SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ❑ Brand and Model of Chamber: Standard Quick 4 Infiltrator Chambers ❑ Number of chambers per row: ❑ Number of rows (trenches): Comments: Total Chambers = 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fox 978.688.8476 Web www.townofnorfhandover.com Inspection Form June 2008 NORTF� Ot 3r t..; QL Q ° CO[MI[MIwKR y1' �SSACHUS�� PUBLIC HEALTH DEPARTMENT fommunity Development Division BM = HR = HI = SYSTEM ELEVATIONS ROD ELEVATION AS-BLT INVERT ELEV DESIGN INVERT ELEV Benchmark Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN Distribution Box OUT Lateral 1 TOP Lateral 1 INVERT Lateral 2 TOP Lateral 2 INVERT . Lateral 3 TOP Lateral 3 INVERT Lateral 4 TOP Lateral 4 INVERT Lateral 5 TOP Lateral 5 INVERT Lateral 6 TOP Lateral 6 INVERT Top of Chamber Bottom of Bed/Chamber 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 . t►ORT11 d O�If%-RD 16 3? �+�:�� 6 OL O � t � 40 NrEu T ° tOGMK!wK•v^ SSACHUS� PUBLIC HEALTH DEPARTMENT (ommunity Development Division SKETCH PLAN 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 i t%ORTFr O� TLE° 06 '1 6'1 6 0o AI >f ° coca A°R^rEo �ea�45 SSACHUS� PUBLIC HEALTH DEPARTMENT (ommunity Development Division CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ® Property line 10 10 -- ® Cellar wall 10 20 -- ® Inground pool 10 20 -- ® Slab foundation 10 10 -- ® Deck, on footings, etc 5 10 -- Waterline 10 10 101 ® Private drinking well 75 1002 50 ® Irrigation well 75 100 ® Surface Water 25 50 ® Bordering Vegetated Wetland , Salt Marsh,Inland/Coastal Banka 75 100 ® Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ® Trib.to surface water supply 325 325 ® Public well 400 400 ® Interim Wellhead Prot.Area ® Reservoirs 400 400 ® Drains(wat. supply/trib.) 50 100 ® Drains(intercept g.w.) 25 50 ® Drains(Other)Foundation 10(5) 20(10) ® Drywells 20 25 1 Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance(NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54,and 10.30,respectively,pursuant to 15.211(3),also by NA wetland bylaws 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 FINAL GRADE INSPECTION Date: Address: Qo l / . o' LOAMED? u-"SEEDED? ❑ COVER PER PLAN? Other: r Map-Block-Lot Commonwealth of Massachusetts 1-07.A0128 ---------- - ----------- Permit No f Health Board o BHP-2010-0754 ry - _ p ------------------ North Andover � , FEE Z -V $250.00 P.I. �ss.,twu�� F.I. DISP OSAL Y�ORKS CONSTRUCTION PERMIT' Permission is hereby granted James Kellett------ --------------------------------------------------- to(Repair)an Individual Sewage Disposal System. at No 300 RALEIGI TAVERN LANE ----------- -- d --------- be --- - 010 - --- -------- --------------------- -- ---------------- - ------------------ - -- -- Works Construction Permit No. BHP-20 _0 0.7,5- Ca ,November O1,-20_--- as shown on the application for Disposal ----------- LLE -- - - __ -------------- Board of Health Issued On:Nov-01-2010 • 1 0 ,. ° •�;�, Application for Septic Disposal System TODAY'S DATE -Construction Permit — TOWN OF • �. ORTH ANDOVER, MA 01845 $250.00-Full Repair +as4rob � $125.00-Component Important: _Application is hereby made for a permit to: When filling out ❑Construct a new on-site sewage disposal system* forms on the g p y computer,use XRepair or replace an existing on-site sewage disposal system* only the tab key to move your ❑ Repair or replace an existing system component-What? cursor-do not key the return A. Facility Information Y C>c---" RAI,C 1 G 1 _rQVzRN L ANtr —t� Address or Lot# 1� City/Town 2 /� `;'J` 2. TYPE OF SEPTIC SYSTEM*: /* Pump ❑ Gravity(choose one) TOWN OF NORT ***If pump system,attach copy of electrical permit to application** HEALTH OEPA�M NT R ❑Conventional System(pipe and stone system) Infiltrator or Biodiffuser(Gravel-Less)(Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D-Box)(Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D-Box Present)S.A.S. 2. Owner Information A INn RAM ANI Name S Address(if different from above) CityFrown State Zip Code 60 - 233— /`f 2,. Telephone Number 3. Installer Information U C�_ Name Name of Company 400 SA urvA s-t-. Address L'ro 0 t=!n-) City/Town State Zip Code Telephone Number(Cell Phone#if possible please) 4. Designer Information I LL V GS N �e.,` C I -� L X12! HAC/G Name Name of Company I (,,,6 Address AN)0U e' L- City/Town State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 • ao� °Rrh Application for Septic Disposal System ,f....••',�o o�Construction Permit - TOWN OF TODAY'S DATE s 250. - ...__... $ 00 Full Repair ORTH ANDOVER MA 018 �� P 4c -$125.00 Component swust PAGE 2 OF 2 A. Facility Information continued.... 5. Type of Building:XResidential Dwelling or❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of No Andover,and of -place the system in operation until a Certificate of Compliance has e issued by thi Bard of Health. Date Applica ' n Approved B . (Board of Health Representative) aA, ` Date pplication Disapproved for the following reasons: For Office Use Only: / L Fee Attached. Yes'`� No 2. Project Manager Obligation Form Attached? Yes"' No 3. Pump Svstem? If so,Attach copy ofElectrical Permit Yes No 4. Foundation As-Built?(new construction ronly): Ys No (Same scale as approved plan) 7 5. Floor Plans?(new construction only): Yes No Application for Disposal System Construction Permit•Page 2 of 2 b 1. or `' . . *14 SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: 'Z-AL F 16,tf -F,, \) C/-OV L A,+vE (address of septic system) For plans by -�' (Engineer) Relative to the application of 1 V k K I (Installer's name) And dated y �. -- (Originalate Dated �d ��LA � � � o ay s ate With revisions dated /V V/Vc_ (Last revised date) I understand the following obligations for management of this project: 1. As the installer, I am obligated to obtain all permits and Board of Health approved plans prLor to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer,I must call for any and all inspections. If homeowner,contractor,project manager,or any other person not associated with my company schedules an inspection and the system is not ready,then item three shall be applicable. 3. As the installer,I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a$50.00 fine being levied against me and/or my company. a. Bottom of Bed—Generally,this is the first(V5 inspection unless there is a retaining wall,which should be done first. The installer must request the inspection but does not have to be present. b. Final Construction Inspection—Engineer must first do their inspection for elevations,ties, etc. As-built of verbal OK(or e-mail to: healthdept(@townofnorthandover.com) from the engineer must be submitted to the Board of Health,after which installer calls for an inspection time. Installer must be present for this inspection. With a pump system,all electrical work must be ready and able to cause pump to work and alarm to function. c. Final Grade—Installer must request inspection when all grading is complete. Installer does not have to be on-site. 4. As the installer, I understand that only I may perform the work(other than simple excavation)and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system and/or revocation or suspension of my license to operate in the Town of North Andover, significant fines to all persons involved are also possible. 5. As the installer,I understand that I must be on-site during the performance of the following construction steps: a. Determination that the proper elevation of the excavation has been reached. b. Inspection of the sand and stone to be used. c. Final inspection by Board of Health staff or consultant. d. Installation of tank, D-Box, pipes, stone, vent,pump chamber, retaining wall and other components. 6. As the installer.I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner,general contractor,or any other persons shall absolve me of this obligation. Un de signed Licensed Septic Installer: f Q V-- (Today's Date) a — runt (Name— igne R;EEED O1U TOWNTMENT ANDOVER �J► commonw Ith of MaSWCA191=9 o °fea1 use Department of Fire Services Permit No' q 7f1`, Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS ev. m7] ierro blan>< APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work w be perferraW in mea wM the Massachusetts El CWWl Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPEALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Impeetor of Wires: By this applies don the undersignedgivehs notice of his or intention to perform a electrical w,**described below. Location(Street&Number) t tl %�67 Z �v Owner or Tenant R Telephone No. Owner's Address Is this permit in conjefictlen with■bulidlug permit' Yea E] No (Check Appropriate Box) orm ion No. No.at Meters 9 gird❑ Na of Meten Date ......................... ,AORTi{ TOWN OF NORTH ANDOVER bewared tbaln awe wens. - p PERMIT FOR WIRING Tnmsformen KVof A ." l Generators KVA .` D.O Morgan" �SS.ICMUSES %: Batts Units FIRE ALARMS No.of Zones This certifies certifies that .... ................................... ,h o InitlatLe Drvkes has permission erform . `.�.P........................ No.of Alerting DSm r p p No.of SaIMANtainslil wiri e-buildirrWDetsctiodAkrW Dsvleea ......................... .................................................... Local❑ Cons maims ❑ Ogter at:. 1�4M.M. L'`�'r'`"�.... North Andover, � �� � No.of Dsviees or 1E uivalest Fee ................ Lic.No. .. .. .. � � r2 ' .: h. Data Wirm=. ELECTRICAL INSPE OR Na o! arFivivalent :4 eommru hose Check # Na of Deviance or oivs � lntd.or as nqukvd by Ox Iaspeeerr of Wins. Work to Start Inspections to be requested in aowrdancc with MEC Rule 10,and upon completion. INSURANCECOVERAGE¢Unless waived by the owner,no permit for the performance 0e1e0trical work may issue unless the licensee provides proof of liability insurance Including"completed operation"coverage or its substantial equivalent The undersigned certifies that such coverage is in force,and has exhibited proof of some to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I cop*.under Ae awilpenallies ofpeduty,flim dk wwslomm on ids applWadon is tate acid ewmpteia FIRM NAME: AVS a U3 Molnar /� LIC.NO.: A 1 1 a Ueeiaee.• Si►Ilyu. S attire "R LIC.NO.: l i a rp - pfapplitak "sera rn�ire license Humber f Ines Sea.Tel.No.• a er Addrew: tito�te be. bac HA• 004o Alt.TeL No.• '* � t 'Per M.G.I.c. 147,s.57-61,sedurity work requires Department of Public Safety"S"License: Lic.No. i OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does no have the liability insurance coverage normally required by law. By my`signstum below,I hereby waive this requirement, 1 Am the(check ons)❑owner Q owner's Agent. Owner/Agent Telephone No. PERMIT FEE:5 J Q �tLeD �6♦ �{rO i ti Q C/�c^ / y J i PY 0 [O[MC lwKa yq' 4Q�RATED �SSACHUS�� PUBLIC HEALTH DEPARTMENT (ommunity Development Division August 25, 2010 Arvind Ramani 300 Raleigh Tavern Lane North Andover, MA 01845 RE: Re: 300 Raleigh Tavern Lane Map 107A Lot 128 Dear Mr. Ramani The North Andover Board of Health has completed the review of the septic system design plans, for the above referenced property, submitted on your behalf by Merrimack Engineering Services, dated August 2, 2010. This plan has been approved. The approval includes a Local Upgrade approval granted by the North Andover Health Department for the distance from the soil absorption to foundation from 20 feet to 15 feet and the distance from the s.a.s. to the street property line from 10 feet to 5 feet. Please keep a copy of this approval with your household records. The design has been approved for use in the construction of an onsite septic system for a 4- bedroom house (maximum 9-room). In accordance with state regulation this plan approval is good for 3 years, however it is reduced to two years since this installation is the result of a failed Title V inspection. During this time, a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover. In the event an imminent health problem such as sewage backup into the dwelling is occurring, the North Andover Board of Health may reduce the time period for which this plan is valid. This approval is subject to the following conditions: 1. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation, the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit. 2. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission, Zoning Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe or imply compliance with any of the aforementioned requirement. / To: 30o Raleigh Tavern Lane SAS approval letter 8/25/2010 Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you may have. Since, , Susan Y. Sawyer, REHS/ 'Ile Public Health Director Encl: list of licensed septic system installers Form 9B Cc: Merrimack Engineering Services MASS- t'N OF 4 As{..,. ERNEST :n ® F. a ROMANO s No.451 o a �FG�:TerF.V�, tt �1TAfk r d` t 4 f F 4e G iv ` i9 - S E i 7 . Pr is I j,—.w-�j J Ldp L O Aj « cpm N1 s`` 4 i t � U C' l _ 3 £„ GAA 1 II l 7-3 61473 t I • PUBLIC HEALTH DEPARTMENT Town of North Andover fommunity Development Division CEq?g-ITICA MF O F COgVIpGA-1-L (CSE As of.- February f:February 14, 2011 This is to cert that the indi'vidualsudsurface duposafsystem receiveda 5.,q?1'S(,gCT0RTIJVS(PECr 0Wof the: Installation of an Inarividual On-Site Sezvag►e DisposaCSystem By., games lis ett 300 Qakigh tavern .Gane flap-10 T..A,-Partce-0128 210/107.A-0128-0000.0 jlorth ndover 0184.5 , 9W The Issuance of this certifkate shaffnot be construed as a guarantee that the system wiCCfunction satisfactorily. -`S an e!S er, /qu M&Yrwafi Director 1600 Osgood Street,Horth Andover,Massachusetts 01845 Phone 918.688.9540 Fox 918.688.8416 Web www.lownofnorthandover.com -y0RT/1 .. OF 1,.aa r"kti0 O � y t i 4 �9S SRC u"15E�9RE 1 PUBLIC HEALTH DEPARTMENT F EU .I U Z V ti q 1 (ommunity Development Division I TOWN 01 NORTH ANr? FR HtLTM DEPARTMENT TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System(instructed;( )repaired; By:_ ,]',P, LL[:-�-T- (Print Name) LAO n C% Located at:� L OQ ���,(-f ��� ` (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan,originally dated �-7- ' 10 and last revised on ,with a design flow of 444? gallons per day. T'he materials used were in conformance with those specified on the approved plan;the system was installed in accordance with the provisions of 310.CMR 15.000,Title 5 and local regulations,and the final grading agrees substantially with the approved plan.All work is accurately represented on the As-built which has been submitted to the Board of Health. Bottom of Bed Inspection Date: Engineer Representative(Signature) And—Print Name Final Construction Inspection Date: Engineer Representati a(Signature) And—Print Name Installer: (Signature) Date: •� // j And—Print Name Enginer: Vc`Apl/4 ti4UZWA/4 C (Signature) Date: l,�t p I t✓i t2� ��r�N E I�0� And—Print Name 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com SEC. �! �Eb ,I u,lANDOVI I AS-BUILT C CKL T TOWN OF NOR ER HEALTH DEPARTMENT/ t/ LOT NUMBER, STREET N •-"'� ASSESSORS MAP &PARCEL NUMBER LOT LINES &LOCATION OF DWELLINGS LOCATIONS &DIMENSIONS OF SYSTEM --INCLUDING RESERVE-� TIES TO LOT LINES &DWELLING, WELLS a. FROM SEPTIC TANK b. FROM LEACH AREA t/ LOCATIONS OF DEEP HOLES &PERC TESTS V ELEVATIONS OF DISPOSAL SYSTEM TOP OF-FDN ELEVATION LOCATIONS OF WELLS,DRAINS, WATERCOURSES WITHIN 150' OF SYSTEM LOCATION OF WATER, GAS,ELECTRIC LINES, CABLE DISTANCES FROM CORNERS OF HOUSE TO CENTER OF TANK&D-BOX ORIGINAL STAMP& SIGNATURE IMPERVIOUS AREAS -DRIVEWAYS, ETC. NORTH ARROW . r LOCATION&ELEVATIONS OF BENCHMARK USED i {n.; Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection � o TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION - Property Address:300 Raleigh Tavern Ln.North Andover MA 01845 i Property Owners Address:300 Raleigh Tavern Ln.North Andover MA 01845 =�' LL3 Owner.Stephanous Loisou Date of Inspection: 11/04/2003 Name of Inspector:(please print)Bruce Butterworth Company Name:_ Wind River Environmental Mailing Address: 577 Main St.Suite 110 Hudson MA 01749 Telephone Number:978-562-4500 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(3 10 CMR 15.000).The system: tl Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: / ® ? . 03 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 repot—o the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,,and the approving authority. Notes and Comments: ****this report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not addrgss how the system will perform in the future under—same or different conditions of use. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:300 Raleigh Tavern Ln.North Andover MA 01845 Owner:Stephanous Loisou Date of Inspection: 12/0812003 Inspection Summary:Check A,B,C,D or E ALWAYS complete all of Section D System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired The system, upon completion of the replacement or repair,as approved by the board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the`please explain The septic tank is metal and over 20 years old or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by:he Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: _Observation of sewage backup or break out or high static water level m the distribuijon box due to broken or obstructed pipe(s)or due to a broken,shifted or uneven distribution box.System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced for the following statements.If not determined' ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): _broken pipe(s)are replaced obstruction is removed Not Determined explain: OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION(continued) Property Address:300 Raleigh Tavern Ln.North Andover MA 01845 Owner.Stephanous Loisou Date of Inspection: 12/08/2003 Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not hinctioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System Will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well Method used to determine distance *this system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from said facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. Other: OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:300 Raleigh Tavern Ln.North Andover MA 01845 Owner:Stephanous Loisou Date of Inspection: 12/08/2003 System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _ x Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool x Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _ x Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool x Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/4 day flow __x__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 SAS,cesspool or privy is below high ground water elevation. _ x Any portion of cesspool or privy is within TOO feet of a surface water supply or tributary to a surface water supply. _ x Any portion of a cesspool or privy is within a Zone I of a public well. — x Any portion of a cesspool or privy is within 50 feet of a private water supply w(—. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well'water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] No (Yes or No)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 falls.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either yes"or no"to each of the following: ('The following criteria apply to large systems in addition to the criteria above)yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-DEP)or a mapped wetland _Zone II of a public water supply well if you have answered"yes"to any question in Section E the system is considered a significant threat,or answered'yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:300 Raleigh Tavem Ln.North Andover MA 01845 Owner:Stephanous Loisou Date of Inspection: 12/08/2003 Check if the following have been done You must indicate yes'or no as to each of the following: Yes No x _Pumping information was provided by the owner,occupant,or Board of Health _ x Were any of the system components pumped out in the previous two weeks? x _Has the system received normal flows in the previous two week period? _ x Have large volumes of water been introduced to the system recently or as part of this inspection x Were as built plans of the system obtained and examined?(If they were not available note) x J Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? X Wcrc all system components,excluding the SAS,located on site. xor _Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles tees,material of construction,dimensions,depth of liquid,depth)f sludge and depth of scum? x _Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption.System(SAS)on the site has been determined based on: Yes no X _Existing information.For example,a plan at the Board of Health. Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[3 10 CMR 15-302(31)(b)] i OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATIONFLOW CONDITIONS Property Address:300 Raleigh Tavern Ln.North Andover MA 01845 Owner:Stephanous Loisou Date of Inspection: 12/08/2003 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 god Number of current residents: 2 Does residence have a garbage grinder(yes or no): Yes Is laundry on a separate sewage system yes or no): No (if yes separate inspection required) Laundry system inspected(yes or no): No Seasonal use:(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no): No Last date of occupancy: Currently Occupied COMMERCIALANDUSTRIAL . Type of establishment: Design flow(based on 310 CMR 15.203): Basis of design flow(seats/persons/sqfi,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no):No-Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Owner supplied pumped yearly Was system pumped as part of the inspection yes or no): Yes If yes,volume pumped:gallons 1000 gallons How was quantity pumped determined?Sight tube on trick Reason for pumping:To check the condition of the tank TYPE OF SYSTEM X Septic tank,D-Box,and soil absorption system Single cesspool _Overflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 30 Years.The soure of the information was a plan dated 10/15/73 Were sewage odors detected when arriving at the site yes or no): No OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) I Property Address:300 Raleigh Tavern Ln.North Andover MA 01845 Owner:Stephanous Loisou Date of Inspection: 12/08/2003 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: cast iron 40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:(locate on site plan) Depth below grade: 12" Material of construction: X concrete_metal_fiberglass or polyethylene other(explain) tank is metal list age: copy of certificate) Dimensions: 1250 gal Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle:no sludge _ Scum thickness: no scum Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structure integrity,liquid levels as related to outlet invert,evidence of leakage,etc.):Tank condition good.Inlet and outlet tee's intact.liquid level equal with outlet invert.No evidence of leakage. Is age confirmed by a Certificate of Compliance(yes or no): No (attach a copy) GREASE TRAP: (locate on site plan) Depth below grade:_ Material of construction: concrete metal fiberglass polyethylene other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:300 Raleigh Tavern Ln.North Andover MA 01845 Owner:Stephanous Loisou Date of Inspection: 12/08/2003 TIGHT or HOLDING TANK (tank must be pumped at time of inspection)(locate ori site pian Depth below grade: Material of construction: concrete metal fiberglass polyethylene____other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present yes or no): Alarm level: Alarm in working order(yes or no):_ Date of last pumping: Comments(condition of alarm and float switches,etc.): I DISTRIBUTION BOX: Yes (if present must be opened and 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.):Box level,distribution equal,no sign of solid carryover,no evidence of leakage PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): Alarms in working order yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:300 Raleigh Tavern Ln.North Andover MA 01845 Owner:Stephanous Loisou Date of Inspection:12108/2003 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required if SAS not located explain why. Type leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: X leaching fields,nwnber 1,dimensions:96$X 54$. _overflow cesspool,number:_ 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 is course.No signs of hydraulic failure now or in the past.vegetation normal CESSPOOLS: _(cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): OFFICIAL INSPECTION FORM-NOT FOR VOLINTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INFO FORINT PART C System information(continued) Property Address:300 Raleigh Tavern Ln.North Andover MA 01845 Owner:Stephanous Loisou Date of Inspection: 12/08/2003 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the seu age 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 tie building. 777 Y r 4. pr-z H y /F MAcg . ! 7 f I ,r S sri g b a tM t r F 1 £p r!. �5'3'{+�' wm k, N04 ,60.r a r !+ � T F 3J v a � 5 , - �..: 5•Lq�'1 x f,� � ?�"� '� �]• 5 =•. "y�x yFt: f�Sg h 4016 r rs t Wyyk ` f _ r Y' Yfn r ^t h . y OFFICIAL INSPECTION FORM-(NOT FOR VOLUNTARY ASSESSMENTS) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:300 Raleigh Tavern Ln North Andover MA 01845 Owner:Stephanous Loisou Date of Inspection: 12/08/2003 SITE EXAM Slope Medium slonc Surface water None Check cellar Dry no sump pump Shallow wells None Estimated depth to ground water 6& Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: x Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) x Accessed USGS database-explain: I accessed USGS database You must describe how you established the high ground water elevation: I took the high ground water level from the USGS web site.I also angered a hole 4 feet below the field and no ground water was encountered. Title 5 Inspection Form 6/15/2000 DEPARTMENT OF ENVIRONMENTAL PROTECTION NOTE TO FILE RE 300 Raleigh Tavern Lane: • Called by Neil Bateson on June 25, 2003 for SSDS inspection on conditional pass. With Neil inspected site and asked homeowner to expose two lines that were doubtful and let me know when done. • Saw ad for house— 12 rooms! Far exceeds design capacity. • Neil called 7/2/03, reporting that standing water at level of pipe. Went out, inspected and told homeowner that with size of house and standing water where there should be none, that system appears to be failed. Explained process, (hire engineer;do soil tests;have plan designed;obtain approval;hire installer; construct system;get inspections done; obtain CoC.) and apologized for giving bad news. S. Starr _ A COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS a g DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:300 Raleigh Tavern Lane North Andover, MA 01845 Owner's Name:�Iohanne Muni z Owner's Address:300 Ralei-gh Tavern Lane FEB; 4 In Nori- An rirA , MA 01 845 1 N Date of Inspection: 1 2 7 O b �' i R HE e. nT Name of Inspector: (please print) James wri ght- Company Name: g`J_ In"ect i ons,— Inc. Mailing Address:_One nggnad Street Methuen. MA 01844 Telephone Number: g7B—hg1 —875 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes � Needs Further Evaluation by the Local Approving Authority 1/Fails Inspector's Signature: Date: o?7 The system inspector s�ta1f submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. T) OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) .Property Address: 300 Raleigh Tavern Lane North Andover, MA 01845 oivner: �Iolaanne Muni i 7 Date of Inspection:1-/7/0 6 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: 1 have not found any information which indicat at any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure eria not evaluated are indicated below. Comments: B. System Conditionally Passes: _ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in thee for the following statements.If"not determined"please explain. The septic t ank is metal and over 20 years old or the septic tank(whether metal or not)is structural)} unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complyingc tank as approved septic P pp by the of Health. *A metal septic tank will pass inspection if it is structurally so of leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is av ' e. ND explain: Observation of sewage ba p or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a ken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 pa`:;e. ; of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 300 Rat e -gh Taizern T ane North AndnVor- MA 0184-5 Owner: Jc)hannD wz-1ni� Date of Inspection:1 /206 C. .Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health de mines in accordance with 310 CMR .15.303(l)(b) that the system is not functioning in a marine ich will protect public health,safety and the environment: Cesspool or privy is wt�n 50 feet of a surface water Cesspool or privy is'within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 1.00 feet of a surface water supply or tributary to a surface water sup 1 _ The system>aseptic ic tank: S and the SAS is within a Zone 1 of a public water supply. _ The system 'c tank and SAS and the SAS is within 50 feet of a private water supply well. The system- tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 3 • Pale 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 300 Raleigh Tavern Lane North Andover, MA 01845 Owner':J_ohanne Muniz Date of Inspection: 1 /2 7/0 6 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: ___ acktrp of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or / clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or e5spool __ quid depth in cesspool is less than 6"below invert or avail bl:volume is less than '/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 Xny portion of the SAS, cesspool or privy is below high groundwater elevation. Any portion of cesspool or privy is within 100 feet o ater supply. f a surface water supply or tributary to a surface 1 �A�y ly portion of a cesspool or privy is within a Zone I of a public well. y portion of a cesspool or privy is within 50 feet of a private water supply well.portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply with no acceptable waterquality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] Yz (Yes/No)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. You must:indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addid to the criteria above) yes no the system is within 4 eet of a surface drinking water supply the system is thin 200 feet of a tributary to a surface drinking water supply the sys in is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA) or a mapped Zone I 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 1 5.304.The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:300 Raleigh Tavern Lane North Andover, MA 01845 Owner: Johann M gni Z :Date of.Inspection: 1127/06 Check if the following have been done.You must indicate`�,es" or"no"as to each of the following: o Pumping information was provided by the owner, occupant, or Board of Health Were any of the system components pumped out in the previous two weeks Has the system received normal flows in the previous two week period H ve 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 the were not available note as N/A) P Y ( Y / Was the facility or dwelling inspected for signs of sewage backup'? Was the site inspected for signs of break out'? Were all system components, excluding the SAS,located on site? i/ 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 liouid, depth of sludge and depth of scum ? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes rtm Existing information.For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] 5 i laoe. (; of1 ] OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOPM PART C SYSTEM INFORMATION Property Address: 300 Raleigh Tavern Lane North Andover, MA 01845 Owner-: Johanne Muniz Date of inspection: 1 /2 7/0 6 FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): Number of bedrooms(actual): DESIGN flow based on 310 CN UL-1.5.203 (for example: I10 gpd x#of bedrooms): Number of current residents: _ Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no):;tV[if yes separate inspection required] Laundry system inspected(yes or no):_ Seasonal use: (yes or no): Water meter readings, if available(last 2 years usage(gpd)): Sump pump (yes or no): /L/- Last date of:occupancy: COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/perso etc.): Grease trap present(yes o _ Industrial waste hol g tank present(yes or no): Non-sanitary w to discharged to the Title 5 system(yes or no):_ Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping;Records _ Source of information: Was system pumped as part of the inspection(yes or no):_ y� If yes; volume pumped: gallons--How was quantity pumped determined? _ Reason for pumping: TYPE OF SYSTEM _v<<Ptic tank,distribution box, soil absorption system _Single cesspool Overflow cesspool Priory Shared system (yes or no)(if yes, attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _ Tight.tank _Attach a copy ofthe DEP approval f Other(describe).- .Approximate describe):.Approx.imate age of all components, date installed (if kluown)and source of information: Were sewage odors detected when arriving at the site(yes or no): 11111-e�/ 6 pa,e 7 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 300 Raleigh Tavern Lane North Andover, MA 01845 Owner: Johanne Muni z Date of Inspection: 1 /27/o6 BUILDING SEWER(locate on site plan) Depth below grade.- Materials rade:Materials of construction:_cast iron _40 PVC_other(explain): Distance from private water supply well or suction line: Comments (on condition of joints,venting,evidence of leakage, etc.): SEPTIC TANK:_(locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene --other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scurn thickness: Distance fi-om top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scuta.. op of outlet tee or baffle: Distance from bottonfo'i scum to bottom of outlet tee or baffle: Date of last pumI54 Comments (on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 7 i Page S of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 300 Raleigh Tavern Lane North Andover.,_ MA 01845 Owner: Johanne Muni z Date of Inspection:j /2 7/0 6 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below ;rade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: _ gallons/day Alarm present(yes&no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: l�— Comments(note if box is level and distri ution to outlets equal,any evidence of solids carryover, any evidence of leakage into or out of box,etc. : PLIIVIP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes no): Comments (note condi' of pump chamber,condition of pumps and appurtenances, etc.): 8 i Page 9 of 11 t OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM f PART C SYSTEM INFORMATION(continued) Property Address: 300 Raleigh Tavern Lane North Andover. MA 01845 Owner: Johanne Muniz Date of Inspection: 1 .127.1o6 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type. _ leaching pits,number: leaching chambers,number: leaching galleries,,number: _aching trenches, number, length: (� leaching fields,number,dimensions: _ overflow cesspool,number: _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.): CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth- top of liquid to inlet invert'. Depth of solids layer: Depth of scum layer Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments (note co ition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 9 'Page 10 of 11 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 300 Raleigh Tavern Lane North Andoiver, MA 01845 Owner:�LQhanneM Ln i z Date of inspection:_142_71 0 6 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. s h. jo 4 � rh 4 p � � fix; � ..� � •. . a :A w , .,tips.. • w T. i 3 t >: Paine 1 l of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 300 Raleigh Tavern Lane North Andover, MA 01845 Owner: j hanne Muniz Date of Inspection: 1 /2 7/0 6 SITE' EXAM Slope Surfac water .heck cellae Sha c-17oi wells 2 / Estimated depth to ground watereet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: _ Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: 77 1]