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Home My WebLink AboutMiscellaneous - 301 SUMMER STREET 4/30/2018 r- 301 SUMMER STREET 210/107.A-01 70-OOC)O.o I .y 1 Lx Commonwealth,of Massachuse tts R CE9�! City/Town of I JUL 7.2006 System Pumping Record TOWN OF NORTH ANDOVER FOrm 4 MENT HEALTH DEPART DEP has provided this form for use by local Boards of Health. The System Pumping Record must be submitted to the local Board of Health or other approving authority. . A Facility Information Important: When filling out 1. SySte LOC8t10 r'^ forms the computer.use t only the tab key Address to move your cursor-do not use thereturn City/Town State Zip Code key. 2._ System Owner: ` 'Name renin Address(if different from location) City/Town StateZip�;:de f Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped. Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight.Tank 0 Other(describe): 4. Effluent Tee Filter present? ❑ Yes If yes, was it cleaned? ❑ Yet'❑ No 5. Condition of System: nc 6. System P roped By Name Vehicle License Number Company -- 7. Locat/i whe e co `nts e disposed: Sign ' re, ler Date http://www.mass.gov/deplwate/approvals/t5forms.htmAnspect t5form4.doc•06/03 System Pumping Record•Page 1 of 1 i• OMMON r ..1 EncuTr DEPARTI - ma c, r✓ .r � 5 P1 0 � 01 UIP, �� v � � r �Q OFFICIAL INSPECTION FO SUBSURFACE l G'1'�i — �U r✓G �� ' T r ]property Address: ;xstf :�:, tA Owner's Name: Glru i �t Owaer's-Address: r:Date of Iaspectton: —ted =� .. ;Name of inspector: lease print) Company Name: Mania Address: Telepboue Number: y'1p."'r� j-1 D 0 ,; CERTIFICATION STATEMENT- 1 TATEMENT•1 cer'that I have PersQnaJIY 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: r s :u ( ... ;:• a . . •, ... Passes Conditionally Passed`'. Needs Further Evaluation by the Local Approving Authority r ; Fails is T_� ' 'ti�f�i!!��`i�i iii S ; .'`'t F1ti�lS�f�r .2 t!•'�k�d lil r;�"'! ;s y ,'��- ` pedor,',;.�i:I g�ature• xM Date: The tem ! I sys inspector shall sub 't a co of this PY 4PectlOn port 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 ' f �. 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:andACommentsla•i�;:r ! ,...}.t.. *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. 00 Title 5 Ins pectiaa Form 6/15/2000 ' page 1 A r .. •. 3 a+ :. `.� it COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS ; DEPARTMENT OF ENVIRONMENTAL PROTECTION • " *.UIP, i. TITLE 5 OFFICIAL'INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION r Property Address: Jim :i•i ' '. ! •<J a i H�C', ` (�] Owner'#Name: Ad'��✓� �,�., 1. _? *` Ownerts-Address:•--- .� ._....�.7;,"-'.` .. _ . _...,.... *, . r Date of Inspection: —t9V t NAme of Inspector:(please print) Zh Company Name: ! Maillw.¢q A dress _ . ► t,7 C` �AnyLoov-; COtTIO fir,J,•. 'Telephone Number: '- y1D.1 y�0 CERTIFICATION"STATEMENT I rory 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 ; Fads f r: 41, � 73 �.ir ,l 't;J lit „" rs ' '!Jl+7!tl,S;t,,�",� 7•, f• a peatur's Signa g: Date: 1 t ^1 S-tea The system inspector shall sub it a copy of this pection port to the Approving Authority(Board of Health or i DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 '<;,rq`.y gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the a; DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving s authority. ..'.'..Not4C4nd C0mmenU(,,,14.!'.-;i 1, iJ'i if.`Its•. 'T!„�., •,! �{,1. .., ,r.r f• , .rt: ' '***This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address hpw the system will perform in the future under the same or different conditions of use. - :Title 5 Inspection Form 6/15/2000 page 1 ,;• Page 2 of 11 tiM OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM fi PART A :r } CERTIFICATION(continued) f Property Address: Owner: UA ia Date of Inspection: 1 R A,i Ippection Summary:'Check A,BlC,D or E/AL..—SYS complete all of Section D A", System Passes I have not found any information which indicates that any of the failure criteria described in 310 CMR x 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. ,Comments: � F 4 r B. System Conditionally Passes: Qne or mon system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please FIT explain. The'septic tank ismetal and ovei 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 they ; •existing tank is replaced with a complying septic tank as approved by the Board of Health. •A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: !,"lU.:it1 A ,j4iA %,:w' J' Observation of sewage backup or break out or high static water level in the distribution box due to broken or ' obstructed i •" p pe(s)Qr due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): fir r broken pipe(s)are replaced obstruction is removed ; } • distribution box is leveled or replaced 'ND explain: 1 . `• The system n9ed pumping more than 4 times r a year due to broken or obstructed pipe(s).The system will Pam inspection if(with approval of the Board of Health): ' broken pipe(s)are replaced a obstruction is re,- moved ' dFl��:rifi:.i 7G :"ttt>;�::.:r "!'t.t4tJ :'{t,fii� ' t�.i :.r (ir ! 'i,•it ND.explabn;. r 2 Page 3 of 11 ±� OFFICIAL°INSPECTION FORM' NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ` PART.A e CERTIFICATION(continued) x prp�:rty dress: e Owner: Kes ,Dote of Inrspection. =C. Further Evaluation Is Required by the Board of Health: r I' Cptlditions 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. f. 'Syste>st*4 pass ualesa Board of Realth determines in accordance with 310 CMR 15.303(l)(b)that the" i ,systf*is not functioning in a manner which will protect public health,safety and the environment: P r CMP0191,Pf 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 w ;}.dna l 0lili • r}j,rir i•,l!, '�;,ix:�[ �,:�.�t>`lay,ll t� '�'i,ra.:z.) • � �� F 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: • YJ '7111e.System has a septic tank and soil absorptionsystem(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 SASr is within a Zone 1 of a public water supply. The system has a septic taak and SAS and the SAS is within 50 feet of a private water supply well. ._'Tb,e system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a 'if"PTivate,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 5m provided that no other r`�e PP �P � • failure criteria are triggered.A copy of the analysis must be attached to this form. t' , C n •.other.- ''!~i�4��'k+x,fl'��.��f�(�� .,•fs:ll" 15, �a . .. i i,:', ,sw'lr` Ilii •:..i .. IrE �n t 3 t Page 4.of 1.1 s4 OFFICIAL-INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM r n_ PART A ; CERTIFICATION(continued) g j property•Address: rnm er��. .._ . .. IF ;l Date of InsPectionc _ 1 r } 41 r�€ "System Failure Criteria applicable to aU systems:' 2.011,iuidiCate"yes",or•f'no"to each of the'following for all inspections: 'yam. ` Yes l!1 �r'+ BACliup,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 I`r clogged SAS or cesspool . r ' Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or -a-- cesspool _tkiquid depth in cesspool is less than 6"below invert or available volume is less than'/z day flow i _. _✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructedpipe(s).N •.4.: of times pumped umber k Any Portion of the SAS,Cesspoolprivy ` Poo or is below.high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supplyor tributary to a surface ;. water Supply. :• ::: e , s Any portion.of a,eesspool or-privy is within a Zone I of a public well. •_,[ Any portion of a cesspool or privy is within 50 feet of a private water supply well. •Any portion of a cesspoolor privy vy 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 ��t .:are triggered.A copy of the analysis must be attached to this form.] ;s d (yes&The system fails.•I haveActermined'that one or more of the above failure criteria exist as s -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 failures;. saiw 1411;u.' 1fUi:fit I �,.0 J' E. LargeSystems:";;"" 14 ,rl,1 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: f •' (The following criteria apply to large systems in addition to the criteria'above) t ' Yin noth e system.is_within 400 feet of a surface drinking water supply i ' ,_,,,,,;ahe system is within 200 feet of a tribu urface gsupply '` -�-� Lary to a surface.drinking water -� z the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or.a mappgd L Zone II of a public-water supply well If you have answered"yes"toany 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 a, t 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. k 3. ` t ' 4' t ,•. r''.` ? Page S of 11s�. t�1 fY OF ' CIAL INSPECTION FORM—,NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM P ART B ,`CHECKLIST CHECKLIST ° 4 Property Adanss: Owner. Date of Inspect i0 Check if the following have been done.You must in "yes"or"no��h of the following 1 No Pumping idOrmation Was provided by.the owner,occupant,or Board of Health z:'.�; ✓ Were any of the system components pumped out in the previous two weeks? t -Has the system received normal flows in the previous two weekBrio '• Have large volumes of water P d? / been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not available note as N/A) :r Was the facility or dwelling inspected for signs of sewage back up? ^� Was the site inspected for • '1. ---- -- pe signs of break out? V/_ Wereall system components,excluding the SAS,located on site? Were the septic tank manholes uncovered,opened,and the interior of the tank inspected of the bafltles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of the Was the facility owner(and occupants if different from owner)provided with information on thero er maintenance of subsurface sewage disposal systems? P P The size And location of-the Soil Absorption System(SAS)on the site has been determined based on: ` .,.._ F,xisting 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 approximatiop of distance is unacceptable)[3 10 CMR 15.302(3)(b)] '• inti IYJ'+ f^.II`iJit•Jz ;a',,{�`:1' r! ',i` 1`f};i''I�•�(, ,t.t'; •14;' ty - ' ,ny,.-_ r.t :({ ,IiUI•'•,•7lti•{'i ..'7•:.'i`1:1flii i' , ' • t Page b of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C r,•x SYSTEM INFORMATION Property Address: _ a N, "dAjjjr .O/ 4er. -lJ . iia :. Date of Inspection. }; 'FLOW CONDITIONS RESIDENTIAL f Number of bedrooms(design): ' ( gn):-, +n 0 Number of bedrooms(actual): DESIGN'flow based on 310 CMR 15.203(for example: 110 gpd x#of Id—rooms): , Number of current residents: _ Does residence have aba a ��` Sar g grinder(yes or no): " )'1ti► — �'� 2 � f 4Q Is dry on a separate sewage system(yes or no): ►O 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)):'Ra- Sump Pump(yes or no):D0 Last date of occupancy CAaam COMMERCIAL/INDUSTRIAL r • Type of establishment: Design flow(based on 310 CMR 15.203): _ gpd Basis of design flow(seats/persons/sgketc.);. ; Grease trap present(yes or no): Industrial waste holding tank present(yes or no): . . Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meterti readings,if available: Last date of occupancy/use• h1W. 1"1613�i t,1_+.1' t•.t'. .:; .:! !s f 13.a.rt`i�ri 'fv tC 1aFr '`ul�S; ;i;[ GENERAL INFORMATION FORMATION { as Source of information: '.a :... Wass tempumped Ys p um ped as part of the inspection(yes or no): ` If yes,volume p�Ped:l gallons—How was quaati pumped determined? Reason for pumping: n% , OF SYSTEM Septic tank,distribution box,soil absorption systemSingle cesspool : ••' , Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Altemative'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 r�A Other(describe): Approximate age of all components,date installed(if known)and source of information: , Were sewage odors detected when arriving at the site(yes or no): 6 , k` Page 7 of 11 r n• OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS c f, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM.INFORMATION(continued) Property Address: I x� raes�f_ 1air, IMA =q5 k Owner' �Date of Inspection: BUILDING SEWER(locate on site plan) r`;. .Depth below grade: t G Or ' Materials of construction: z ,; 40 PVC ^oth cast iron ,I: er explain): Distance from private water supply well or suction line: 14 `' z Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC;TANK: '! -(locate on site plan) ' Depth below grade: _ Material of construction: V concre ' to n4etal 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) ' nasions: Sludge ud g depth: Distance from topof sludge to bottom of outlet tee or baffle: _ Scum thickness:` Ajor -' • Distance from top of scum to top of outlet tee or baffle: lrn Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determinedA- - Comments(on pumping recommenclati6m,inlet and outift tee or baffle condition structural integrity, as related to outlet invert,evidence of leakage,etc.): liquid levels �., e 1 • .I. , GREASE TRAP. onsite plan).�:�: ., . 1:I ., ,. ' Depth below grade �,._.. i..._.. _.... .. .._......_. ._.. .. .- /;<< Material of construction:_concrete�_�metal _fiberglass_ polyethylene_other (explain): ; Dimensions: ; `Scum thickness: _ I Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: —' x 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.): , 7 Page g of 11 i OFFICIAL•INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM q PART C SYSTEM INFORMATION(continued) Property Addrsss: S E Owner: Date of Inspection: I ..�". TIGHT or HOLDING TANK: . /V (tank must be pumped at time of inspection)(locate onsite plan) 4 , r below grade; - Material of construction: concrete metalfibe ass rgl _polyethylene other(explain): Dimensions: ` vacitr —gallons * 4 Design Flow: ons/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.): • 7.� r;;,�... .1: . .. � 1,. .. .. . .. til; DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: D 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.): PVW CHAMBER- locate on site plan) Pumps in working order ` ', Alarms'in working order(yes or no): Commeuts(note condition of pump chamber,condition of pumps and appurtenances,etc.): • �� /'71 fjlu}11 ,�t1, •utlrt ft,-- 1 ::Uc 'Sr °1.r;.• .•t/, '!':1: :, .. 1 ,b. Wage 9 of 11 � OCTAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C =A SYSTEM INFORMATION(continued) ` :4 Property Address: Owuen ` Date of Inspection:=?M17 100 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS noZ Joeateti eXplain why. Type leaching pits,number:_ leaching chambers,number: g galleries,number. J leaching trenches,number,len leaching fields,number,dimensions: a D' y r overflow cesspool,number: iunovative/alternative system Typetname of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, ' etc.): • � CESSPOOLS: ,"•�`� ,4(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 co nshvction: z. Indication of groundwater inflow(yes or no): iF Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): y' v l- ` PRIVYz (locate on site plan) Materials of construction: x Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): h •:1 9 . _ .Page 10�11 � •,►+.' ' •'_ OFFICIAL"TNSFECTION FORM-"NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ,'• PART C SYSTEM INFORMATION(continued) r,t dad Md Q1% 9 /'Y + 'M'r►F1 ,...Aso of IRS OF SEWAQ J SPQSAh,SYSTEM�'�` _ Pmvi&A slwWh of the sewage g , $ disposal system including ties to at least two permanent reference landmarks or ' benchmarks.Locate all wells within 100 feet.Locate when public water supply enters the building. t 1 i V� .9 A - ��.>�va-+��cam. � � • Wv OM 9W QE Nie IAI,yV,�D`O� INTD Ts1.ItiL >l .�D -.. wo.,.,„.: . ...,�,. .�.o_.. � �•�, ,Ci UXQE INV D�pE IN= ;c``l;a►►�{j��t� ,�! t,(;.. , I.hiu M Gn 41la_ N ►a�- Etin 9E21EE w . _ 10 hge l l.of 11 ' OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C y SYSTEM INFORMATION(continued) ProPerAf r Ala A y-ec M/9 R46 Owuer. Date of J=pectious p srrE EXAM Y < Slope Surface water f g" Check cellar a Shallow wells f 'Estimated depth to ground water feet Please indicate(check)all methods used to determine the hi gh ground water elevation: • Obtained from system design --,� Y gn plans on record-If checked,date of design plan reviewed: Y 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: ' " m L • I .Rat , 1 - ZZ r Q Ism { r ` Q a _ o c 0 0 - � o c 0 ?4 r m WATER BILLIMC HISTORY 2160244-BRAHCB, MARY METER 81: 2160244 -------------------- 272 S11MMFR STREET °D m 8 CVCLE SERVICE PRIOR CURRENT USE WATER SEWER FEES TOTAL m 1 2006-12 96/15/1999 943 946 3-,i 8.19 10.60 0_80 8.19 2 2800-22 12/116/1999 946 975 - 79.17 COR 0.00 79.17 3 2600-32 93/08/2000 975 994 -19 51_67 9.00 -8.08 St_e7 4 2800-42 05/111/20011 996 1006 32_76 11.00 18.00 32.7 5 2906-SF 07/26/19" 917 943 70.98 0.SO 0.40 70. 6 2901-12. 118/1'1/2800 4006 1129 23 62.79 8.90 11.00 73.7 0 a � j' C.�flit i 1 IREUI EMI CNOI_CE 9 or <ENTEV> MORE HISTORY: Post4t"Fax Mote 7671 �1e le 7°es► TuFrom � `its GL ? _ Phalle 6 Phan►f Fax 7 Fax J ,t _/ f� 0 0 0 '< xj e• _ ,I,�:.t�,J• ;r.!:;�Slyt?'.i" ,�,r�,+r•.�::�;''"L:�;�Lc;.�,i�. i!'-.,Ai •'t"�"'(i� I l,','��::� i, •I If'�p LF�i�i!' .L. "'� ��p�r, I Id � �•�*}y��, 'r- ly R �:h.'r e�� I r s(�'�1� ^Tr )�rl •I',�1�„�,;,;� I`d �_s+�l;'^'J Fid ';,f' �T,},' ,,: � �, ,• ,r `` I;r�.� w �� , f i stilt ## I !f,I � ,y+{y Neta '�,l r-,a,lti-^IjT ��:1 t ,D ;. 1Y � I rl •., , ;� li � h!}• � i,7 ~ ;I L �`ti-s 1iJ; *i�= L �,'1�S rt1, �� .i! 4 t JGI _t i��a�'^�--x.`Ft��+ ��y(,LFy(1,�1? nl,ryi. t «t•�1 OW fg11- .r �IU i,�� in� r y� , t��j �, oar j,� seNG� •• { �,I �f� til ' , `1'f.. �h .. �I, �v�'• ' h��.l {I� lI � �'{;;- ��+'a1� ¢y'"�i'�'�Y 1��',A'�' Itl�7. 1• V� Ij ,PM1It�` .�1�1 }}�,•-; �44rf{> f�(y �t�'k r� Y'a�x'gy>" ,1`.L—.,y'; p r . l �1Y ,' t�h!�J(�1 , , {r, r• ,�y, � M �y µt�ttt.fj•ma.,1 .{ Im- ��1l�ji�'s,"d;••SS ..o ,ytia� ,�F}�•{,,t.�� w a� , s f;P h{INS �,.�. � '• i t,n�,�l't�w 112.1 M J' '�"51t J1� (l I'�•,L� ' ,' a r � , �'1'41n�''• 4' ��y= t�;P Ar ,r,k�'i�y�•�� v I r r�� av A I �j�d I %40RTHd ,/ _ 0t4S.90 16;4�0 *w�O' cecXAw�wK■ 7 p°'P. �SSACHUstit PUBLIC HEALTH DEPARTMENT (ommunity Development Division ��I � . C�R2IFICA�I� OF CONI .� CE As of: February 2, 2007 This is to cert that the ind4 i uaCsu6surface d4osaCsystem received a SA`7STAC`r01RT.rYS(EM0Yof the: Repair of a Complete Septic SodAbsorption System By. ,Mike Reilly At: 301 Summer Street North Andover, 911A 01845 die issuance of this certificate shalt not 6e construed as a guarantee that the system will function satisfactoriCy. rS an T Sawyer Pu6Cu.7CeaCth Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com c'�, NORrp 1 M 14 �4Ssa01tj s PUBLIC HEALTH DEPARTMENT FEB 0 2 2007 Community Development Division -FO'WN OF NORTH ANDOVER 'HEALTH,DE-PARTNIENT TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System( )constructed;(repaired; By:.. �`'I ( 1!�-E E 1 U Z (Print Name) Located at: /,� G71-4 tj H (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan,originally dated Co^ y!o and last revised on with a design flow of gallons per day. The 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: 131 u [2a FiEngineer Representative(Signature) r And—Print Name Final Construction Inspection Date: Z � � F2I 1,L= Engineer Repr entative(Signature) �i �F s��_�__ And—Print Name Installer• ` (Signature) Date: '/ And—Print Name Enginer: t/C 4a'Aaf l/f&2k1F4/0,- (Signature) Date: ©2 �' 20a 7 V 1,A v 1 1-1 1 �Z I.J E �-j 6jA I^ ►-I 0 k,- And 1And—Print Name 1600 Osgood Street, North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com ¢ tkORTh O M �0 N 4 � O rP ^ATlD fc SACHUS PUBLIC HEALTH DEPARTMENT (ommunity Development Division CE(, TIFICA�IE OF C0�41W T 3Y(E As of: February 2, 2007 rAi s is to cert that the indtWuaCsu6surface disposal system received a SAVS(FACYI0IRT lYST ECI710Y of the: Repair of a Complete Septic SoilA6sorption System 'By. Mike Reilly At: 301 Summer Street North Andover, WA 01845 The Issuance of this certificate shall not 6e construed as a guarantee that the system wilt function satisfactorily. S an T Sawyer &ic Yfealth Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com a0'��a�n y�ye �9SSacWu5 FFEB o 2 2007 PUBLIC HEALTH DEPARTMENT fommunity Development Division TOV,YN OF NORTH ANDOVER HEALTH DEPiaRTME TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System( )constructed;(repaired; By: E C I L.I, `1' j (Print Name) 2 Located at: _ %� 111-4 H jZg 7r2 e: C l' (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan,originally dated and last revised on a--3 0 with a design flow of 4-ktO gallons per day. The materials used were in conformance with those specified o pe n 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 Repr entadve(Signature) 12a F_►2g z, ) l And—Print Name Installer• (Signature) Dater �� ', And—Print Name Enginer: VC 4,01Af f/f c*1604t, (Signature) Date: OZ 1 26D7 V L A E) i r-I I E2. And—Print Name 1600 Osgood Street, North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web htt : ww .town f w p// o northandover.com k NORtk O ,iau ®e h0 o FFEB 2 2007 PUBLIC HEALTH DEPARTMENT (ommunity Development Division TOWN OF NORTH ANDOVER .,_.._ ..HEALT.H..DEP.ARTMENT TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System( )constructed;(repaired; By: C I L.L (Print Name) Located at: 01 �Z u.1-4. (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan,originally dated (r�^ ©& and last revised on 1 p•- z,v —c> Ca ,with a design flow of gallons per day. The 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: -z- Engineer Repr entative(Signature) And—Print Name Installer: Q (Signature) Date: And—Print Name Enginer: V"DIA61f l/�'�2G��t' i7/0� (Signature) Date: ©Zl71"� 2aD7 VL.ARil--14Z I.J � NIGN � ►�lU � And—Print Name 1600 Osgood Street, North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web http://www.townofnorthandover.com SUMMARY OF INVERTS BUILDING TIES �� SEWER 0 FDTN. 97.73 BLDG. CORNER A B C D Nv1" 0 THIS PLAN & CERTIFICATION IS NOT SEPTIC TANK IN 97.36 SEPTIC TANK 43.7' 22' A WARRANTY OF THE SUBSURFACE DISPOSAL SEPTIC TANK OUT - IPUMP TANK 44.7'24.6' SYSTEM. IT IS A RECORD OF THE LOCATION j PUMP TANK IN - IDIST, BOX 48.7'29.9'1 AND ELEVATION OF THE EXISTING SYSTEM DIST. BOX IN 98.21 COMPONENTS. DIST. BOX OUT 98.03 END DIST. LINE 97.82 " 2 97.82 n » 3 97.82 " 4 97.82 n » 5 » » 1 I 1 N i Z LOT 7A (47,861 S.F.) ' 1; WETLAND i � 1 pnStNG � 4A 0 J N, CLEAN OUT w COMBO 1 16A O SEPTIC/PUMP s>, TANK 'S6 DIST. BOX T 2/ I LEACH T-I b^ FIELD Ah 41.71 53.04 34.59 SUMMER STREET Aw I O �i•i`` � v,f ' i Vietri#( 'rte/-G`" AS BUILT PLAN OF SUBSURFACE DISPOSAL SYSTEM RECEIVED LOCATED IN FEB 0 2 2007 NORTH ANDOVER, MASS. /301 SUMMER STREET AS PREPARED FOR TOWN OF NORTH ANDOVER HEALTH DEPARTMENT JACK SWIFT 'SATE: JANUARY 17, 2007 TM 107A SCALE: 1"=40' TL 170 0 20 40 80 MERRIMACK ENGINEERING SERVICES 66 PARK STREET ANDOVER, MASSACHUSETTS 01810 VkORT1t 'UID $6'q�r'16 0 O 4 O n * �, , ° COCMIC M! �SSACHUS�� PUBLIC HEALTH DEPARTMENT (ommunity Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 301 Summer Street MAP: 107A LOT: 170 INSTALLER: FP Reilly DESIGNER: Merrimack Engineering PLAN DATE: 8-16-06 Rev 10-30-06 BOH APPROVAL DATE ON PLAN: 10-30-06 qq 1 , INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: C DATE OF FINAL CONSTRUCTION INSPECT DATE OF FINAL GRADE INSPECTION: P" SITE CONDITIONS ® Existing sel ® Internal plus ® Topography_,-._._ Comments: SEPTIC TANK ❑ Bottom of tank hole has 6" stone base ® Weep hole plugged ❑ 1500 gallon tank has been installed H-10 loading Monolithic construction ❑ Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ® Inlet tee installed, centered under access port ® Outlet tee (gas baffle or effluent filter) installed, centered under access port 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 fax 978.688.8476 Web www.townofnorthandover.com fAORT►i O�AS�tD 16�ti Oto 5 D'pA COCNICM K.`y7 ORATED ►'P` '(5 �SSACHUS�� PUBLIC HEALTH DEPARTMENT (ommunity Development Division I ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 301 Summer Street MAP: 107A LOT: 170 INSTALLER: FP Reilly DESIGNER: Merrimack Engineering PLAN DATE: 8-16-06 Rev 10-30-06 BOH APPROVAL DATE ON PLAN: 10-30-06 INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: 12-19-06 DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ® Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: SEPTIC TANK ❑ Bottom of tank hole has 6" stone base ® Weep hole plugged ❑ 1500 gallon tank has been installed H-10 loading Monolithic construction ❑ Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ® Inlet tee installed, centered under access port ® Outlet tee (gas baffle or effluent filter) installed, centered under access port 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com i tAORT11 q O tt�ao 06� ti0 OL O ti A 0° lb [O[NI[NIWKN 1' q°R�reo �Pay(5 �SSACHUS�� PUBLIC HEALTH DEPARTMENT Community Development Division ® 24" inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present ® Hydraulic cement around inlet & outlet Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ® Weep hole plugged ® Combo Tank installed. Size:1500/500 ❑ 1000 gallon Pump Chamber installed H-10 loading Monolithic 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 ® 24" inch cover to within 6" of final grade installed over pump access port ❑ Watertightness of tank has been achieved Visual testing ® Hydraulic cement around inlet & outlet Comments: DISTRIBUTION-BOX Z Installed on stable stone base ® Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ❑ Speed levelers provided (not required) Comments: 1600 Osgood Street,North Andover,Massachusetts 01845 j Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com i NORTil q O ,t.{4eD 06 ti KI 4h D(IA COCMICMIWK.M V^• DAATED 01 �y �SSAC HUS�� PUBLIC HEALTH DEPARTMENT (ommunity Development Division SOIL ABSORPTION SYSTEM (General) ❑ Bottom of SAS excavated down to 6 in into C soil layer, as provided on plan ® Size of SAS excavated as per plan ® Title 5 sand installed, if specified on plan ® 40 Mil HDPE barrier installed ❑ Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: I CONTROL PANEL ® Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ® Location of control panel: utility room ❑ Rated for exterior if placed outside ® Alarm signal located inside Comments: i i I 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com tAORT1y O neo $ '9 is 6. O a 0 O ♦wML COCMIL MI WKR V AORArea �SSACHUS�� PUBLIC HEALTH DEPARTMENT (ommunity Development Division SYSTEM ELEVATIONS INVERT IN FIELD PLAN INVERT ELEV. Building Sewer OUT 97.81 98.10 Septic Tank IN 97.37 97.60 Septic Tank OUT Pump Chamber IN Pump Chamber OUT 97.21 Distribution Box IN 98.20 98.19 Distribution Box OUT 98.03 98.02 Lateral 1 Beg. INV 98.01 97.99 Lateral 1 End INV 97.82 97.80 Lateral 2 Beg. INV 98.04 97.99 Lateral 2 End INV 97.82 97.80 Lateral 3 Beg. INV 98.01 97.99 Lateral 3 End INV 97.82 97.80 Lateral 4 Beg. INV 98.00 97.99 Lateral 4 End INV 97.82 97.80 i i i 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com r10RT11 1?O6. f - . 16 0 O A� yr d T C'0 COCMICwKl wKw y7 �.9 A�RATtO rPP��y 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 ' 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 Fox 978.688.8476 Web www.townofnorthandover.com T Serving Andover and Vicinity Since 1947 December 27,2006 North Andover Health Dept. 1600 Osgood Street Building 20; Suite 2-36 North Andover, MA 01845 To Whom It May Concern: After speaking with conservation,F.P. Reilly and Sons, Inc.has decided to put down a nice layer of hay mulch in order to lift the erosion control at 301 Summer Street. This property has already been fertilized and seeded- In the spring,we will return to the property and stabilize with seed if necessary. If you have any questions please do not hesitate to,call me at(978)475-1237. Sincerely, a. Michael Reilly President 2U 3 Andov,-,r Street 5uire 11 Andover, Massachusetts 0IS 10 • Tel: 978-475-1237 Fax: 975-475-3102 e-mail: fl�reillvandsons(ri,coTncast.ner Z'd ZOt£-9ZV-9M 4!92j 'M 19B40!W 'aW 899:60 ZO CO ue 10 FAX COVER SHEET Date: Fax To: Company: Fax Number: 1 ? 6' 'J 00 4'1_76, '1e f From: Mwe fie-dl� #of pages(including cover) Subject: Please call(978)475-1237 if you do not receive this transmission in full. Thank-you. W,. ....:Y..:.'T }1)yy.^ :`�:I....�. ti'_,I:.^- i.i. � C:[i Ci!)l.•��?•. !l'...,:;S,1C it LtScL' D7?�i.J _T_-_,: ,.- .. .,. .. .. .... ._-..._;il: "_-BICC.II��. 2XtC1.SL•1":3Cr`.`:O'?.-_1SY.!tiCC 6'd AIIPa J 'M PegOIW 'JN 899:60 LO CO oaf Page 1 of 1 f 4 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Wednesday, January 10, 2007 1:06 PM To: 'Marianne Peters' Subject: RE: Final inspection-301 Summer St sched for tomorrow 12/19 Importance: High Hi Marianne, I did not receive the final report on this one. Mike Reilly's office wants me to send a letter stating that this site was inspected satisfactorily, so could you send it asap? Thank you. -----Original Message----- From: Marianne Peters [mailto:mpeters@millriverconsulting.com] Sent: Monday, December 18, 2006 4:15 PM To: Dan Ottenheimer; 'Lisa Kozel LeVasseur'; Marianne; Grant, Michele; DelleChiaie, Pamela; Sawyer, Susan Subject: Final inspection-301 Summer St sched for tomorrow 12/19 Final inspection @ 301 Summer Street with Mike Reilly scheduled for tomorrow, 12/19 @ 9:00 a.m. Mill ` ' r consulting Marianne Peters Mill River Consulting 2 Blackburn Center Gloucester, MA 01930 978-282-0014 ph 978-282-0012 fx www.millriverconsultinq.com l i 1/10/2007 _Q MERRIMACK I ENGINEERING SERVICES INC. L [EVV19G3 Engineers • Surveyors • Planners 66 Park Street ANDOVER, MASSACHUSETTS 01810 DATE JOB NO. U-- ' (978) 475-3555 ATTENTION Fax (978) 475-1448 TO t 2l VL-rz- ev WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via the following items: ❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION ,;�p h yam body HEALTH DEPARTMENT THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ Approved as submitted ❑ Resubmit copies for approval L /Forour use ❑ Approved pproved as noted ❑ Submit copies for distribution > ❑ As requested ❑ Returned for corrections ❑ Return' corrected prints i ❑ For review and comment ❑ I ❑ FORBIDS DUE ❑ PRINTS,RETURNED AFTER LOAN TO US REMARKS oj COPY TO SIGNED: If enclosures are not as noted,kindly notify us at once. RECEIVE® Nov 29 06 10:44a NOV 9.29 2001,. TOWN OF NORTH ANDOVER HEALTH DEPARTMENT November29,2006 To whom it may concern, It is our desire that F P.Reilly and Sons company be allowed to continue and complete the replacement of the septic system at 301 Summer Street.It would be most advantageous that the system be co mpteted before the winter. Thus far,we are forMnate to be enjoying favorable weather_ Construction is now underway at the Property,and if allowed to proceed,the system would be completed before the weather toms inclement. Please grant yowr approval to F P.Reilly and Sons so that they may complete the project. Sincerely, u1 John A.Swift 1 1 f I l Z-d Z06M-9Lt?-9L6 AII!92j -M IBeuoIW 'an eg9:06 90 6Z ^cN RECEIVE® Nov 29 06 10;44a d NOV 8-29 TOWN Or NORTH ANDOVER HEALTH DEPARTMENT November 29,2006 To whom it may concern, It is our desire that F P.Reilly and Sons company be allowed to continue and complete the replacement of the',septic system at 301 Summer S'sreet.It would be most advantageous that the'system be completed before the winter_ Thus far,we are fortunate to be enjoying favorable weather_ Construction is now underway at the Property,and if allowed to proceed,the system would be completed before the weather tions inclement. Please grant your approval to F P.Reilly and Sons so that they may complete the Project. Sincerely, John A.Svs+ift Z,d Z06£-9L'V-9Z6 Allpa 1 'M lee4c!W -in 899:06 90 6Z AcN 4 1 xrirg�4ndover ana��cir,ify use-ilG7 FAX COMER SBEET Date: I I b Fax To Glf'Y) Company_ .f Fax Number b " From: T #of pages('uicludiug cover) Subject:_ 3C)l -on iu fiill. Thank-you- And hank ou. 475-1237 if you do not receive this ssi y Please call(978) '_t3fi ;�nCic�vrr Street Suite 21 " Anc?Over-xrlassachusetts 01820 ' Tei: 97.3-= e-m- l: fpreillyandsons@comcast.net 6'd Z068-9Lti-8L6 A!I!G2J 'M I8e4OIN 'JN e99:OL 90 6Z AON t "SPIT",� Commonwealth of Massachusetts Map-Block-Lot 107.A-0170- Board of Health Permit No North Andover BHP-2006.0728 P.I. �, °.. �°• '4g FEE ?Ss�caus� F.I. $250.00 ----------------------- Disposal Works Con.s+r, ,^};��_ .- Permission is hereby granted Mike Reilly-----_----------, to(Repair)an Individual Sewage Disposal System. at No 301 SUMMER STREET . as shown on the application for Disposal Works Construction Permii Issued O--Nov-02-2006 Commonwealth of Mas; It.rao Board of Healt North Andover , � ugE`� Certificate of Con,,N,,a -�>✓ C THIS IS TO CERTIFY,That the Individual Sewage Disposal System (Repair) by ----Mike Reilly------------------------------------------------- il Installer at No ----301----------SUMMER-------------STREET------------------------------------------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of the State Environmental Code as described in the application for Disposal Works Construction Permit No. BHP-2006-072 Dated---November 02,-2006 ----------------------- Printed On:Nov-02-2006 ----------------------------------------------------------------- Board of Health N 0" Commonwealth of Massachusetts Map-Block-Lot 107.A-0170- ----------------------- Board of Health PermrtNo o North Andover BHP-2006-0728 PI .. FEE �SSAcwustt F.I. $250.00 ----------------------- Disposal Works Construction Permit Permission is hereby granted Mike_Reilly----------------------------------------------------------------------------------------- to(Repair)an Individual Sewage Disposal System. at No 301 SUMMER STREET ---------------------------------------------------------------------------------------------------------------------------------------------------------- as shown on the application for Disposal Works Construction Permit No. BHP-2006-072 Dated November 02,2006 ------------------------ ----------------------------- --------------LJF ---------------------------- --------------L.J-- IUP'- ------------------ I ssued On:Nov-02-2006 Board of Health Commonwealth of Massachusetts Map-Block-Lot 170 107.A-0 - .�'r �dittR as Board of Health -- ---- - -------- North Andover Certificate of Compliance �SSAGNUgEt THIS IS TO CERTIFY,That the Individual Sewage Disposal System (Repair) by ---Mike Reilly-------------------------------------------- Installer at No 301 SUMMER STREET ---------------------------------------------------------------------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of the State Environmental Code as described in the application for Disposal Works Construction Permit No. BHP-2006-072 Dated---November 02,2006 ----------------------- ----------------------------------------------------------------- Printed On:Nov-02-2006 Board of Health AORTH 0 9 Town of North Andover + '•C,,i,,-:: HEALTH DEPARTMENT, � O� ,sSACMUStS CHECK#: �/JQ LOCATION: H/O NAME: CONTRACTOR NAME: Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑• Septic-Design Approval $ e)0_,,Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other:(Indicate) $ .,�10 Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer F. P. REILLY &SONS, INC. 2801 4OV11N OF NORTH ANDOVER 11/2/2006 i a 301 Summer Street-Septic Permit 250.00 I New Northmark Chec 301 Summer Street 250.00 i TOWN OF NORTH ANDOVER cE HOpTi, Office of COMMUNITY DEVELOPMENT AND SERVICES a?,•`; �o`A HEALTH DEPARTMENT 1600 OSGOOD STREET;BUILDING 20; SUITE 2-36 NORTH ANDOVER,MASSACHUSETTS 01845 ��s°"•tea•"' SACHUS 978.688.9540–Phone Susan Y.Sawyer,RENS/RS 978.688.8476–FAX Public Health Director healthdept@townofnorthandover.com-e-mail www.townofnorthandover.com-website APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: af�Dlo LOCATION: _ r HOMEOWNER NAME: Nara `_Ta � LICENSED INSTALLER NAME:—M/Mad � PLEN SIGNATURE: TELEP] � CHECK ONE: FULL SYSTEM REPAIR: COMPONENT REPAIR(indicate what parts): ($125) * NEW CONSTRUCTION: * If NEW CONSTRUCTION,please attach the Foundation As-Built Plan. $250.00 or$125 Fee Attached? Yes No Project Manager Obligation From Attached? Yes No Foundation As-Built? Yes No Floor Plans? Yes No Approval of Health Agent /v Date: l ; �7 J roi i ' TOWN OF NORTH ANDOVER `KuarM Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 NORTH ANDOVER,MASSACHUSETTS 01845 978.688.9540—Phone Susan Y.Sawyer,REHS/RS 978.688.8476—FAX Public Health Director healthdept@townofiiorthandover.com-e-mail www.townofnorthandover.com-website APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: a��O LOCATION: t �S lain m-er S� HOMEOWNER NAME: LICENSED INSTALLER NAME: /vl �C�C!�l )?e k PLEASE PRIKT SIGNATURE: tArLak—" TELEPHONE# CHECK ONE: l FULL SYSTEM REPAIR: ($250) COMPONENT REPAIR(indicate what parts): ($125) * NEW CONSTRUCTION: * If NEW CONSTRUCTION,please attach the Foundation As-Built Plan. $250.00 or$125 Fee Attached? Yes No Project Manager Obligation From Attached? Yes No Foundation As-Built? Yes No Floor Plans? Yes No Approval of Health Agent Date: t7 SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: ,301 U-n' IT)V Sh-eek (.'tddress of septic sgst=) For plans by � ! l j ' (Engineer) Relative to the application of (Installer's name) And dated nginal date Dated With revisions dated (10(lays ate (I..ast revised date} I understand the following obligations for management of this project: I. As the installer, I am obligated to obtain all permits and Board of Health approved plans prior to performing any wort on a site. I must have the approv d plans and the hermit 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 com lesion of the items in accordance with Title 5 and the Board of Health Regglations m2,result in a$50.00 fine being levied against me and or My company_. a. Bottom of Bed—Generally,this is the first (V" 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: hea.lthdept@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 s_stems in North Andover can constitute reasons for denial of the system and/or revocation or susl2ension of m•license too erate 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 tanl D-Box,pipes, stone, vent,pump chamber, retaining wall and other components. 6. As the installer,I understand that I am soler_responsible for the installation of the system as per the a1212roved plans. No instructions by the homeowner, general contractor or=other persons shall absolve me of this obligation. f Undersigned Licensed Septic Installer: Ij ) � {Today's Date) //,/, ^ � / / �] 1 G .7 .� X / (Name—Print) (Name—Signed) \J L'd AII!a21 'M 18,3401W 'aW B£t:Ol 90 Co ^oN TRANSMISSION VERIFICATION REPORT TIME 10/31/2006 11:07 NAME HEALTH FAX 9786888476 TEL 9786888476 SER.# 000B4J120960 DATE,TIME 10131 11:06 FAX NO./NAME 819784751448 DURATION 00:01: 23 PAGE(S) 03 RESULT OK MODE STANDARD ECM ver Health De ortmient �► lip North Ando o� a°A � pati {'+ art 8 1600 Osgood Street Letter �� Transmittal Building 20, Suite 2.36 'b North Andover, MA 01845 yy � e h... T •p eeew�ew...sr, 978.688.9540 - Phone pogo—j^of �'qs";*•o"�'k 978.688.8476 Fox Accu �althdeptt,.@ ownofnorthauod_over.com-E-mail ww.townofno t andover.ca .Website To: WILLIAM(BILI)DUFRESNE,PROJECT MANAGER DATE: COMPANY: MERRIMACK ENGINEERING SERVICES FROM: Pamela DeileChiaie,Health Department Assistant Re: cJ of Phone: 478.47S.3555 Fax: 978.475.1448 We are sw idin our �f view Latter PPROV,D L7 wrAPPROVEP 5y L7 System Construction follow-Up p Other These are transmitted as checked below; 0A Required CCAs Requested El for your File REMARKS: (OPY To: Homeowner Fax# Or North Andover Health Department NORTH q 1600 Osgood Street3?�•t``eO . 6��OL Building 20, Suite 2-36 Letter of Transmittal 6" •-` North Andover, MA 01845 y 978.688.9540 - PhoneO1 4 � � c«wtiwK. �• OF 978.688.8476 — Fax Page�L of— ��ssgCHus�� healthdept(CD-townofnorthandover.com- E-mail www.townofnorthandover.com-Website TO: WILLIAM(BILL) DUFRESNE, PROJECT MANAGER DATE: COMPANY: MERRIMACK ENGINEERING SERVICES FROM: Pamela DelleChiaie,Health Department Assistant 22 Phone: 978.475.3555 Re: j X- rJO� Fax: 978.475.1448 We are sending you: /8P an fleview Letter �'fiPPBOVEO O NOT APPROVED O System Construction follow-Up O Other These are transmitted as checked below: ❑As Required ❑As Requested ❑For your File REMARKS: COPY TO: Homeowner Fax# Or Mailed COPY TO: Fax# Or Mailed COPY TO: Fax# Or Mailed TRANSMISSION VERIFICATION REPORT TIME 10/31/2006 15:42 NAME HEALTH FAX 9786888476 TEL 9786888476 SER.# 000B4J120960 DATE DIME 10/31 15:42 FAX NO. /NAME 817812720759 DURATION 00:00:39 PAGE(S) 03 RESULT OK MODE STANDARD ECM North Andovor H tilth_.Departmient °e j�f%. e H bQQ Osgood Street 's 'b if Building 20suite 2-36 ��tt�� o� Transmittal -,. North Andover, VIIIA 01845 y 978.688.9540 - Phone Page ,of _ _. ' � °DAVID r+Pr��•(g 978.688.8476 — fax $ACHU healthdopt(&-townofnorthandover_;com•E-mailMINH www.townofporthandover.com.Website NTIA[ TO: DATE: , , o✓ .SCJ cf COMPANY: FROM; Pamela DelleChiaie,Health Department Assistant Vy RE: ,},,{{y� Phone: 107e, !��• 63,15-4V,/ Fax: We are sendin vu: l�of Letter O Plans 0 Other fill in below 9'Y PY ( 1 These Ora transmitted as checked below: > L7 Maud > C7&4gcn d > ©Rmdwn t_ _ & ➢ > Ohr&kwaldawnw olgaraw►�f > ➢ ©rarrarlit ➢ nStorlri► __- REMARKS:REMARKS: COPY TO: w w, North Andover Health Department NORTH 1600 Osgood StreetX ,� °46 °o_ Letter ®# Transmittal Building 20, Suite 2-36 °� North Andover, INA 01845 * _ �� .� � 978.688.9540 - Phone Page / of KM` A�gArea 1�pPy�� 978.688.8476 — Fax SSACHUS�� healthdept(CD-townofnorthandover.com-E-mail CONFIDENTIA1www.townofnorthandover.com-Website T0: DATE: COMPANY: / FROM: Pamela DelleChiaie,Health Department Assistant / � RE. Phone: Fax: We are sendingyou.- C@'o of Letter O Plans O Other fill in he%w Y PY � ) These are transmitted as checked below: ➢ O Nnfed ➢ akrAgmrovd ➢ L7&u * q*faw i ➢ AsIP ➢ L7krRe►xwardmnvwff apprerd ➢ L7*Requhd ➢ Okw vowi&e ➢ L7&" cgaissfar&t. REMARKS: COPY TO: COPY TO: COPY TO: SIGNED: I 14ORTH �A� KL6P 1 6 a. ® noyh GOC.GwtwlwKw V^ PUBLIC HEALTH DEPARTMENT Community Development Division October 30, 2006 Nancy and Jack Swim 301 Summer Street North Andover, MA 01845 RE: Septic System Design, 301 Summer Street, North Andover, Map 107A, Lot 170 Dear Homeowner, The North Andover Board of Health has completed the review of the septic system design plan for the above referenced property, submitted on your behalf by Merrimack Engineering Services, dated, August 16, 2006, last revision received October 30, 2006. The design has been approved for use in the construction of an onsite septic system. The 4- bedroom(9-room maximum)design has been approved for use in the construction of a subsurface disposal system. The time period for which this plan is valid is reduced to two years from the date of a septic system inspection that did not meet the acceptable criteria in the state regulations. 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. On October 28, 2006 the North Andover Board of Health approved the following local regulation variances. N.A. 8.02(3) 1) The Soil Absorption System distance from a wetland to be reduced to 100 ft to 54 feet 2) The septic tank distance from a wetland from 75 feet to 52 feet 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 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com wr 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. 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. Sincerel , 1 r' usan Y. Sawyer, ltEH[S/IZS Public Health Director Encl: list of licensed septic system installers Cc: Merrimack Engineering Services 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com VAORT14 O�4-0-90 #6n,N0 :+.. ,t . 3? �e•t •- 6 oL Y O ti O tocwunwKx yq� 41 01V 00' ��SSACHuS��g PUBLIC HEALTH DEPARTMENT Community Development Division October 30, 2006 Nancy and Jack Swift 301 Summer Street North Andover, MA 01845 RE: Septic System Design, 301 Summer Street,North Andover, Map 107A, Lot 170 Dear Homeowner, The North Andover Board of Health has completed the review of the septic system design plan for the above referenced property, submitted on your behalf by Merrimack Engineering Services, dated, August 16, 2006, last revision received October 30, 2006. The design has been approved for use in the constructions of an onsite septic system. The 4- bedroom(9-room maximum)design has been approved for use in the construction of a subsurface disposal system. The time period for which this plan is valid is reduced to two years from the date of a septic system inspection that did not meet the acceptable criteria in the state regulations. 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. On October 28, 2006 the North Andover Board of Health approved the following local regulation variances. N.A. 8.02(3) 1) The Soil Absorption System distance from a wetland to be reduced to 100 ft to 54 feet 2) The septic tank distance from a wetland from 75 feet to 52 feet 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 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com lectrical Inspector. Board, Planning Board, Building Inspector, Plumbing Inspector and/or E The issuance of a Disposal System Construction Permit shall not construe or imply compliance with any of the aforementioned requirement. Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health]Department may be reached at 975-658-9540 with any questions you may have. . Sincerel , f,. usan Y. Sawyer,REHS/R.S Public Health Director Encl: list of licensed septic system installers Cc: Merrimack Engineering Services 1600 Osgood Street,North Andover,Mussochusens 01845 Phone 978.688.9540 fox 978.688.8476 Web wwwjownofnorthandover.com 1 MORTM Of.. w,010 • Town of North Andover ',�'•�;,:,;:.� ,` HEALTH DEPARTMENT ,SSACNUst� CHECK#: LOCATION: 1,fe1"1 rWCJ/7 H/O NAME: CONTRACTOR NAME: Type of Permit or License:(Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type. $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ .❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ TrashlSolid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems ❑ Septic-Soil Testing $ ff Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other:(Indicate) $ 1779 Hea th Agent Initials White-Applicant Yellow-Health Pink-Treasurer } ,AORTH F?f.r • Lp Town of North Andover `+�'•�,;;o:• ,' HEALTH DEPARTMENT �SS�cNust4 CHECK#: ,AB/19 LOCATION: Q/Jl!/�J/�' U✓� H/O NAME: " CONTRACTOR NAME: 06/ c-� Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ 'Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing Septic-Design Approval $ ozzg6-er" ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ .❑ Title 5 Report $ ❑ Other. (Indicate) $ 1 �0 7 7 9 Hea th Agent Initials White Applicant Yellow-Health Pink-Treasurer TRANSMISSION VERIFICATION REPORT TIME 09/2612006 12:00 NAME HEALTH FAX 9786888476 TEL 9786888476 SER.# 000B4J120960 DATE,TIME 09126 11:58 FAX NO./NAME 819784751448 DURATION 00:01:50 PAGE{S} 04 RESULT OK MODE STANDARD ECM North Andover Flea.1th_Oepartmentc� �a pTN, �,� 1600 Osgood Street Letter of Transmittal �� ¢`�"- . 'e•� Building 20, Suite 2-36 �° f North Andover, MA 01845 h 978.688.9540 - Phonetoe page.. Of ,AA4R�r�a 978.688.8476— Fax ss04r4o � healthdeat�iownofnarthndov®r.com-E-mail www.toMinofnorthandov®r.com-Website TO: WILLIAM(BILL)DUFRESNE,PROJECT MANAGER DATE: COMPANY: MERRIMACK ENGINEERING SERVICES FROM; Pamela DelleChinie,Health:Department Assistant Re: 7 Phone: 978.475.3555 ✓/ Fax: 978.475.1448 We are sending you: OP/an Review fetter 17APPROVED 1-7NOTAPPROVED 0 System Construction Fol/ow-Up D Other These are transmitted as checked below: ❑As Required ❑As Requested E3 For your File REMARKS: COPY T0: Homeowner Fox# Or North Andover Health Department NORTH16 q 1600 Osgood Street ° ttteD Letter of Transmittal o �``'` °�� Building 20, Suite 2-36 �- North Andover, MA 01845 _ y 978.688.9540 - Phone o q Cecwl[ IwKw Page of 978.688.8476 — Fax SSACNus� healthdept(cDtownofnorthandover.com-E-mail www.townofnorthandover.com-Website TO: WILLIAM(BILL) DUFRESNE, PROJECT MANAGER DATE: 14, le& COMPANY: MERRIMACK ENGINEERING SERVICES FROM: Pamela DelleChiaie, Health Department Assistant �1 n Phone: 978.475.3555 Re: ✓��J Fax: 978.475.1448 We are sending you. O Plan Review Letter OAPPROVED O NOT APPROVED O System Construction follow-Up O Other These are transmitted as checked below: 0 A Required 0 A Requested []For your File REMARKS: COPY TO: Homeowner Fax# Or Mailed COPY TO: Fax# Or Mailed COPY TO: Fax# Or Mailed Page 1 of 1 DelleChiaie, Pamela From: Lisa LeVasseur[lisal@millriverconsulting.com] Sent: Friday, August 18, 2006 1:00 PM To: dano@millriverconsulting.com Sawyer, Susan; Marianne Peters; DelleChiaie, Pamela; dano Y @ Subject: Soils for 301 Summer Street i Please note on the sketch the possible wetland areas Lisa LeVasseur Mill River Consulting j Your Complete Source for Onsite Wastewater Management 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriv_erconsulting.com 8/18/2006 3Ov ►� Q,t ,fit. _ / r Pita V5— X6 IL Imy GQ - t20 C .SL y?.S'Ys� wear s lv , SYgl2 D y 3 Q go r-,'ill /q, ,x I , 60 wee in®t I f I ' TOWN OF NORTH ANDOVER 6�rarem+.A Office of COMMUNITY:DEVELOPMENT AND SERVICES `� •` w . HEALTH DEPARTMENT 400 OSGOOD STREET * " �h1 NORTH ANDOVER, MASSACHUSETTS 01845 'ss�TIN 1�P 978.688.9540 - Phone Susan Y.Sawyer,REHS/RS 078.688.8476 FAX Public Health Director E-MAIL:healthdept(a-),townofiiorthandover.com _WEBSITE:h4p:Hwww.townofnorthandover.com SEPTIC PLAN SUBMITTAL FORM [HtLTH .EIVED Date of Submission: C, 2 9 2006 Site Location: 'L U U'6 � 17�r� JFt TH ANDOVER EPARTMENT Engineer: Iii r1UK4 Pke4C- FA6►.� '1�6 New Plans? Yes ✓ 225 an Check# � (includes 1"submission and one re- review only) Revised Plans?Yes $75/Plan Check#/ Site Evaluation Forms Included? Yes ✓ No Local Upgrade Form Included? ts&6,Yes No Telephone#: �� y ' �� Fax#: E-mail: k►6 Homeowner Name: OFFICE USE ONLY When the submi ion is complete(including check): ➢ Date stamp plans and letter ➢ Complete and attach Receipt ➢ Copy File;Forward to Consultant ➢ Enter on Log Sheet and Database Location: b e V PA Y"l4 67 Owner's Name~ 4 w! Mapmarcel: 1 O 7.A Address: OV v kj Iastailt:r: Tel!'./a New MsoL_,Repair 1 Date: �' wedands done II_Sall Symbol jj, _Sol&me Deep Observation Hole Logs' Eletiation Depth Son H rimn Soil Testae Son Color Son Mottling % Gravel,Ston e;ett: rl LL, {, `f In-tEeS� w t ,Y gy G/7 Parent Matelot. tI LL 1)eptt�to&dt+dc,,,_ &Mdbkg w"wja then �Ii, lroml9t Fa l " T,: :rxry'r t Aad r Lamt Msterial ,, �D Pfhtolam : _6tudingWSW jat!ulmet�wft t4=!teaIltFaa42GLM V ?solation Tests obsen-ationHole p` Depth of Pere x Stat Pre-sail: Time at 12't o,t Time at 9" 2 . Time at 6" Time(9"-Rate MkOncch•- Performed Bs: , Witnessed Br. +� TOWN OF NORTH ANDOVER rORT,, Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 X C" 978.688.9540 Phone Susan Y.Sawyer,RENS/RS 978.688.8476 FAX Public Health Director E-IMAIL healthdept((-)to 4 wndhort hand over.coni WEBSITE: http://NN,ww.tocvnol-northandover.com SEPTIC PLAN SUBMITTAL FORM Date of Submission: AUG 2 9 2006 Site Location: L4 G-t V-le, �Iec 1, TO'..,'VN A J\j f",0 L Engineer: P1 W I"tlkeG -JAI Q�"N L:yj New Plans? Yes -// $225 an Check# (includes I"submission and one re- review only) Revised Plans?Yes $75/Plan Check# Site Evaluation Forms Included? Yes t""' No Local Upgrade Form Included? N-A,Yes No Telephone#: Fax#: J�LO) jf-j C,,- I ct"fe5 E-mail: Ll A,ol c.-op-4 Homeowner Name: I rT- OFFICE USE ONLY When the b ion is complete (including check): );I' Date stamp plans and letter > 1'/ Complete and attach Receipt //Copy File; Forward to Consultant > Enter on Log Sheet and Database Location: dt v m�n, ��. owner's Name: MaplPamel• 1 .0 7A_r ( � ,%7 Address: �)e?l =, Installer: c f� New pu4 'lleplir i Date:,- n Wdljmds ne IISall symbolSotl Rime : h Soli Qll DeeP Observation Hole Logs Elm-atfon Dcpth Soil a Soil Testare Soil Calor Soil hiottlia e . /. Gntv4 Stone;etc,: � # 5y 6ly _ . Parent t►Sated 1 U.- DP%to NdrocIC—VAWft WNWIR the H —�' eepbt=le+onePUFaee 1� gsg�� _A Pxreat MaterW_=�"t�.�.. Depth a Beind�6e�=�atala the Rota r' W eepte=tress Pk Faee _FS81;tiY= Dart: ` — ,,_ o�_ Percolation Tests ObseriationHole# " Depth of Peu Stut Pre-sosl; Time at 121f l Time at 9" 1 O ; .:W ' ' Time at 6" o Time(V_61� t� Rate Miallnch - Performed 8�: ?-.-1�, Witnessed Br. Page 1 of 1 1: DelleChiaie, Pamela From: Marianne Peters [mpeters@millriverconsulting.com] Sent: Monday, July 24, 2006 11:38 AM To: Dan Ottenheimer; 'Lisa Kozel LeVasseur'; Marianne; Grant, Michele; DelleChiaie, Pamela; Sawyer, Susan Subject: Soil Testing; 301 Summer; Aug 1 st @ 9:00 Soil Testing for 301 Summer Street with Merrimack Engineering is scheduled for August 1St at 9:00 a.m. X i Marianne Peters Mill River Consulting 2 Blackburn Center Gloucester, MA 01930 978-282-0014 ph 978-282-0012 N 7/24/2006 i '1 North Andover Health Department � NORTN q 1600 Osgood Street 32� eO.°6`b�ooL Letter of Transmittal O � Building 20, Suite 2-36 North Andover, MA 01845 , ey 978.688.9540 - Phone Page of J �i9A°R4reo'wKw`� * 978.688.8476 — Fax SsgCNus� healthdept(a?_townofnorthandover.com- E-mail www.townofnorthandover.com-Website TO: DANIEL OTTENHEIMER DATE: �y�Q COMPANY:MILL RIVER CONSULTING FROM: / Pamela DelleChiaie,Health Department Assistant Re: Phone: 1.800.377.3044 or 978.282.0014 Fax: 978.282.0012 We are sending you. P340im Test Application O fins for l Pe view O Other These are transmitted as checked below: ❑As Required []As Requested REMARKS: COPY TO: Homeowner Fax# Or Mailed COPY TO: Fax# Or Mailed COPY TO: Fax# Or Mailed i TOWN OF NORTH ANDOVER rORfy Of.t ro •�y Office of COMMUNITY DEVELOPMENT AND SERVICES n Z"" `"•°�� HEALTH DEPARTMENT 400 OSGOOD STREET `S -- NORTH ANDOVER,MASSACHUSETTS 01845 ass^ u EIVED i Susan Y.Sawyer,REHS,RS 978.688.9540 Phone Public Health Director 978.688.8476—FAX JUL 2 Q 2006 healthde t ia)townofnorthan over.com ` ww.townofnorthandover. (3VvVn!OF W)!A TH ANr)0\IER 1—HEAL-1H CF::F'A,RTP/E4*IT APPLICATION FOR SOIL TESTS m DATE: f"' I`� 'G'' MAP&PARCEL: I D��' 1-70 LOCATION OF SOIL TESTS: OWNER: __ 00 JQ Contact APPLICANT:J4o �71, P-r Contact#: ADDRESS: ENGINEER: — tie Contact#: CERTIFIED SOIL EVALUATOR: Intended Use of Land: Residential Subdivision S' a Famil ome Commercial r Is This: Repair Testing: aof Undeveloped Lot Testing: Upgrade for Addition: In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM[ ➢ Proof of land ownership(Tax bill,or letter from owner permitting test) ➢ 8.511x 11"Plot plan&Location of Testine(please indicate test pit sites on the Plan) ➢ Fee of$425.00new er lot for construction. This p �• s covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$360.00 per lot for repairs or upgrades. GENERAL INFORMATION i Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. Full payment will be required for all additional tests within two weeks of testing. Within 45 days of testing,a scaled plan(no smaller than 1"-100')shall be submitted to the Board of Health showing the location of all tests(including aborted tests). ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line it N.A. Conservation CommissionApZrl Date: Signature of Conservation Agent: q— A Date back to Health De rtment: (stamp in): WA rv(5 on i d,,l KUWW Jul-14-98 06.17P John Yorks 603 744 6690 P-02 _ ASC File# I'5Ceo7 MORTGAGE INSPECTION PLAN for mortgage purposes only I 1 � 1� jai -7 A, � �- 1 a a_ e L J� 4O � da'Ye�'Y �µa.�o• m s tt 3O� ' 1 i N cam. •-- ��,,;, �3.04 ; X4.59 r ' OF `3�I J" W. Yom s 'Cert cation is hereby made to CITY OR ,ak TOWN f.Io, .�,e.�pC�V Ear ,IMA thei the existing structures shown on this plan are DAT i�i- situated on the lot daslgnated In compliance with the setback requirements of the applicable Zoning bylaws SCALE: 1 inch of the municipality when constructed,or are exempt from violation enfcrcertlent action under M.Q.L.Title DEED AND PLAN REFERENCE: VII,Chapter 40A,Section 7. l S3+ar't �'��' T"t� Registry Of Deeds 'Ceruficallon Is hereby made that the exi*ung dwelling or principal structure shown on IN$plan Deed BooJc ! 2'1 1 Page Plan Back _% p 1• v/s nol shunted within a Special Flood Hazard Area 2•--..,..1'situated within a Sp90W Flopd Hazard Area 'G�NE�NOTM 3'---infQ�llon Is insuMcient to make determination. A confirmatory Survey is advised when structures An elevation Survey Is advised are shown to be Quoted at 1 foot or less from prey fine*or. as deGneeted on the FIRM Flood Insurance Rate Map required setback line$,or when potential encroachments are noted. No responsibility Community No_26c.098 a o 0 6 c Is herein extended to the property owner or occupant. Effective Dale:_ ~' 9 --- Cecatiorrs and repreaentaflons are on the basis of thy knawiedge,information and belief. ALPHA SURVEY CORPORATION 12(le Pleasant Valley St.-Suite 7-Math,)an,MA 01844 ireao Telephone(878)975-9100-Facsimile(870)875.0135 L- - Town o �. f 1!I ortli Andover Health Department Date: Location: �-fOl ��— ! (Indicate Address,if Residential,or Name of Business) Check#: Tvwe of Permit or License: (Circle) -)I- Animal ➢ Dumpster ➢ Food Service-Type.., „ $_ ➢ Funeral Directors I ➢ Massage Establishment ➢ Massage Practice Offal(Septic)Hauler Recreational Camp SEPTIC_JVL,RMITS: eptic-Soil Testing ✓� $ L7 ❑ Septic-Design Approval ❑ Septic Disposal Works Construction,(DWC) ❑ Septic Disposal Works Installers(DWI) $ ➢ Sun tanning ➢ Swimming Pool ➢ Tobacco $ ➢ Trash/Solid Waste Hauler ➢ Well Construction ➢ OTHER(Indicate) Health Agent Initials 677 White-Applicant Yellow-Health Pink-Treasurer North Andover Health Department NORTH q 1600 Osgood Street o`�t�to °O Letter of Transmittal o Building 20, Suite 2-36 North Andover, MA 01845 p conICA.-. ■ 1 978.688.9540 - Phone Page ,/ ofSAreD'P��Q�* 978.688.8476 — Fax SACHUS healthdept@townofnorthandover.com-E-mail www.townofnorthandover.com Website TO: DANIEL OTTENHEIMER DATE: COMPANY:MILL RIVER CONSULTING FROM: Pamela DelleChiaie, Health Department Assistant Re: !� Phone: 1.800.377.3044 or 978.282.0014 Fax: 978.282.0012 We are sendin 9you.- o�A /ication O Plans for Review O Other PP These are transmitted as checked below: 0 A Required 0 A Requested REMARKS: COPY TO: Homeowner Fax# Or Mailed COPY TO: Fax# Or Mailed COPY TO: Fax# c / Or Mailed ` TRANSMISSION VERIFICATION REPORT TIME 07/20/2006 16:11 NAME HEALTH FAX 9786888476 TEL 9786888476 SER.# 000B4J120960 DATE DIME 07120 16:10 FAX NO./NAME 819782820012 DURATION 00:00:37 PAGES? 03 RESULT OK MODE STANDARD ECM North arty Andover Wealth De ent C lute rI' qti 6 Letter of Transmittal 4... 0 1600 Osgood Street Building 20, Suite 2.36 North Andover, MA 01845 * �� 978.685.9540 - Phone Page of �9�'►+r.o X ` * 978.688.8476— Fax SACHU healthdent@townofnorthandoyer.com-E-mail �wy1w,townaf northandover.com.Website TO: DANIEL OTTENIIEIMER DATE: COMPANY:MILL RIVER CONSULTING FROM. / Pamela DelleChiaie,Health Department Assistant Re: r� Phone: 1.800.377.3044 or 978.202.0014 Fax: 975.282.0012 We are sending You, o'S i/Tesf APp/icatioft L7 Plans for Review .O Other These are transmitted as decked below: 0A Required OAS Requested REMARKS: COPY TO: Homeowner Fax# Or TOWN OF NORTH ANDOVER M�axy Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 400 OSGOOD STREET � . E. LVED NORTH ANDOVER, MASSACHUSETTS 01845 STs, ° Susan Y.Sawyer,RE HS,RS 978.688.9540.—Phone Public Health Director 978.688.8476—.FAX JUL 2 0 2006 healthdept@,townofnorthan over.com wvw,w.townofllorthandover.�6S3 WN OF NORTH ANDOVER HEALTH DEPARTMENT APPLICATION FOR SOIL TESTS DATE: '7' 1-1 "-a C, MAP&PARCEL: 10-7 A- 1-7 0 LOCATION OF SOIL TESTS: `401 !�!U w wfng' i2Gl:� OWNER: LI�I�F� Contact#:�� -� J.p � APPLICANT: 0 e71,4 I Contact#: ADDRESS: I ENGINEER: Contact#: ,"► `�� CERTIFIED SOIL EVALUATOR: `,,( Intended Use of Land: Residential SubdivisionSii a Famil ome Commercial Is This: Repair Testing: ✓ Undeveloped Lot Testing: Upgrade for Addition: In the Lake Cochichewick Watershed? Yes No t� THE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership(Tax bill,or letter from owner permitting test) ➢ 8.5"x 11"Plot plan&Location of Testing(please indicate test nit sites on the Plan) ➢ Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$360.00 per lot for repairs or upgrades. GENERAL INFORMATION ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. ➢ Full payment will be required for all additional tests within two weeks of testing. ➢ Within 45 days of testing,a scaled plan(no smaller than 1"-100')shall be submitted to the Board of Health showing the location of all tests(including aborted tests). ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval Date: Signature of Conservation Agent: t r Date back to Health Department. (stamp in): Jul-14-98 06:17P John Yorks 6(?3j,744 6690 P.02 _ • r ASC File# I-.t)6,03 MORTGAGE INSPECTION PLAN for mortgage purposes only \ a t3 1 � N L-o-T 7 A � L oT 4r—A - Z , w 'A y R \ i X4.59 OFr `.�u l� C W. YOM s *Certification is hereby made to CITY OR TOMA 0 !amu oovtr LAw eC,�ce Sav,aq� that the existing stnictlrfes shown on this plan are DATE -/1'x-6 8 situated on the lot designated In trompltanoe with the SCALE: 1 inch= setback requirements of the applicable zoning bylaws Of the municipality when constructed,w are ezampt DEED AND PLAN REFERENCE: from violation snforoemani action under M.G.L.Title V11,Chapter 40A,Section 7. �5-x� � T� T Registry of Deeds *Certification Is hereby made that the existing dwelling Dead Book—9 2'1 or principal structure shown on this plan Page 3 o Plan Book Plan -tom_. 1. ✓s not situated within a Special Flood Hazard Area •GEMERAL NOTES: 2.,,"„`is situated withinna SPeOtal Flood Hazard Area A confirmatory survey is advised when structures 3.__ __iAn elevation n lnrvey Is d to make determination. are shown to be situated at 1 foot or less from An elavalfon survey{s advised. property hnes or required setback linea,or when as delineated on the FIRM Flood Insurance Rale Me Potentlai encroachments are noted. No responsibility Community No: 2 50 09 8 0 o c b c P Is herein extanded to the property owner or occupant. Effective Dale: -r- q Certifications and representations are on the basis Of MY kno"Medge,information and belief.'ItElvia . ALPHA SURVEY CORPORATION ^ „ v.n•,ro, 128a Pleasant Valley Si.-Suite 7-Methuen,MA 01 B44 'telephone(978)975-sloo-Facsimile(976)875.0135 �U Memorandum .......................................... To: He CC: Sandra Starr From: Susan Date: June 8, 1998 Re: 301 Summer Street i This memo is in regards to the request for a professional opinion concerning the ....... proposed issuance of a building permit for an addition at the above mentioned lot. k ::Health Department has no information on this property's subsurface disposal This includes location size or age. Due to the lack of information it hadi� teee renin e ed that the following contingencies will be placed on this request. ' ': ; :g: ff heproperty's septic c s stem must ass a Title V inspection, and an ot 1A .;;,;uo scale, must be submitted to this department. In addition floor Tans of P P tee n .re;house includingthe addition are to be supplied. PP I 'lvs eci i n h s o as been made in accordance with Title V, which endeavors to safeguard the public and the environment at large. A conversation was held on June 8i', 1998 with, Mr. Joe Levis, the applicants representative. He stated that he would relay o his clients. a this information t s cli ts. Oq 00, a � t r aw S i ck- b y 1 G 3-- ----- rw► z Memorandum To: File CC: Sandra Starr From: Susan Date: June 8, 1998 Re: 301 Summer Street This memo is in regards to the request for a professional opinion concerning the proposed issuance of a building permit for an addition at the above mentioned lot. The:Health Department has no information on this property's subsurface disposal system This includes location, size or age. Due to the lack of information it hacr been determined that the following contingencies will be placed on this request. lunar to� n off, the property's septic system must pass a Title V inspection, and an As Butlt,to scale, must be submitted to this department. In addition, floor plans of the tit'. e:.house, including the addition are to be supplied. Thts decision has been made in accordance with Title V, which endeavors to safeguard the public and the environment at large. A conversation was held on June 8a', 1998 with, Mr. Joe Levis, the applicants representative. He stated that he would relay this information to his clients. 10, 1 ` �oR t�oRTCxQ PUPPOSESE`t'- V, 1�5E o1•tL`(� ADD 'es S. ; �t� �ca Mtn�K. S�' uO TLS•N ��v�c2., • MO•��C'Cs/S,GOR : _�� ►r,t `<<• c w tom-[ vtrl4rj - - -6drD6 -h 6irzWYL, F S41 PoRT f o-tJ O � f L OT I � N. � s A V cr . . ,, ... •- n o�9'�� j` Vii•. .. _ .� � _,�fig'-�• .. SZALE..t = 40 DA'T'E.: a6�ZSf fi= • wVt�lE¢(��. ��t�e��eEZ tylt..� ,_ :�� G:�.RT•t�' h-��:a`C"�_.� :. slio wn hereon u��.tsYcztir: . .��Nd�-ru i Q 5 , _ u, �x�J � � TOWN OF EHEA CEIVED SYSTEM PUMPI G RECORDY 2 5 2005 r- / j/p F NORTH A(vUOVER DATE' / TH DEPARTMENT SYSTEM OWNER& ADDRESS SYSTEM LOCATION (example:left front of Louse) '3 kou DATE OF PUMPING: QUANTITY PUMPED: GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER(EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: G.L.S.D Lowell Waste TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: 3 SYSTEM OWNER &ADDRESS SYSTEM LOCATION (example: left front of house) DATE OF PUMPING: 1� �"'� QUANTITY PUMPED ��"�� GALLONS CESSPOOL: NO L----YES SEPTIC TANK: NO YES NATUREERV F O SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: 4 1306 ID 0 COMMENTS: CONTENTS TRANSFERRED TO: ('011111 onw alth of Massachusetts 0� Massachusetts System Pumping Record System Owner System Location wN'w 2—r Date of Pumping: —`®1� � Quaff City Pumped: `'� "' gallons Cesspool: No Yes U Septic Tank: No Ll Yes L� System Pumped by: Fctt`ejea 5II&r,64ae4 License# Contents transferrred to : Greater Lawrence Sanitary District Date: _ Inspector: i Commonwealth of Massachusetts Massachusetts System Pumping Record System Owner System Location iii/l' F'T- 0 V S T Date of Pumping: Lf �. h Quantity Pumped: / ®�a gallons Cesspool: No ❑ Yes ❑ Septic Tank: No ❑ Yes X System Pumped by: F4&&W 541 v� License# Contents transferrred to : Greater Lawrence Sanitary District Date: Inspector: FORM 4 - SYSTEM PL1iPL\G RECORD p !1 A►Npp�R/ Commonwealth of Massachusetts Massachusetts JUL 2 1995 System Pumping Record N'stem Uwner System Location Date of Pumping: S Quantity Pumped: ILI, dgallons Cesspool: No es ❑ Septic Tank: No ❑ Yes e System Pumped by: License #. Contents transferred to: L Date Inspector i Collinionwipaidt of Massachusetts r Massachusetts Svstem Pumping Record System Urvner System Location BC) Sj o-k vu, Date of Pumping.umui > >• b. — L4 — Quantity Pumped: gallons Cesspool No Yes L..l Septic Tank: No Yes System Pumped by: t5cti'w r6 gK&,� ftaej License# Contents transferrred to : Greater Lawrence Sanitary District -- Date: Inspector: TOWN OF NORTH ANDOVEWTOWV OF NORTH A,NQOi rR, E BOARD OF HEALTH SYSTEM PUMPING RECORD DATE: ✓ -�� — _ SYSTEM OWNER &ADDRESS SYSTEM LOCATION C kA q--v— y— (example: left front of house) DATE OF PUMPING: P QUANTITY Q LIMPED GALLONS CESSPOOL: NO -AYES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: COMMENTS: CONTENTS TRANSFERRED TO: �' _ f TOWN OF �o j SYSTEM PUMPING RECORD. ��T H ,1" ` DATE: b`� A SYSTEM OWNER& ADDRESS SYSTEM LOCATION (example: left front of house) 0 �VKAf 1110 DATE OF PUMPING: QUANTITY PUMPED : 0 z GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER(EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: G.L.S.D Lowell Waste Co onwealth ®f Massachusetts RIVE Ci /Town of Po rq-h �� R'I System Pumping Record JUN 14 2010 YAWN OF NORTH ANDOVER HFALTHZEM Facility Information: MINT System Location: 3o Address City/Town State Zip Code Systema Owner: ve (0 C' Name- Adress (if different from location of pump) City/Town State Zip Code Lq 79, 1&� - x'380 Telephone Number Pumping Record Date of Pumping 6-110 Quantity Pumpedg albons Type of System—X—Septic Tank Grease 'trap Other (what) System Pumped by: VL :rtl Company: ROOTER-NM 12 East Dracut Rd., Methuen, MA 01844 Location where contents were disposed: ji )) Signatu e of Hauler Date O c Commonwealth of Massachusetts � REIVE® City/Town of Af nCb\ e UN 19 2012 System Pumping Record ` TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Facility Inform- atlon: System Location: Address 6 ' X &dw-A A4A- City/Town State Zip Code System Owner: ^ tL Name: Adress (if different from location of pump) City/Town State .Zip Code 0>6- 76( - 5-36 U Telephone Number Pumping Record Date of Pumping f!! Quantity Pumped__ .off!( gallons Type of System Septic Tank Grease Trap other (what) System Pumped by:—La-if, e- !A4::,c Company: ROOTER-MAN 46 Portland Street Lawrence, MA 01843 Location where contents were disposed: I7/-4'D Date Signature of Hauler -- : l2–