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Miscellaneous - 32 SOUTH CROSS ROAD 4/30/2018 (2)
1 i 1 r I ` I North Ari oard of Assessors Public Access Page 1 of 1 '6 NORTH North Andover Board of Assessors f 'SS,cNuSes roperty Record Card Click Seat To Return Parcel ID:210/038.0-0177-0000.0 FY:2011 Community:North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlarge Search for Parcels i Search for Sales Summary un Residence. Detached Structure Condo 3zSOUTH CROSS ROAD Commercial Location: 32 SOUTH CROSS ROAD Owner Name: LECHLEIDER,MARTIN M. Owner Address: 32 SOUTH CROSS ROAD City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood:7-7 Land Area: 1.00 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 2792 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 571,400 594,800 Building Value: 345,800 369,200 Land Value: 225,600 225,600 Market Land Value: 225,600 . Chapter Land Value: LATEST SALE Sale Price: 298,000 Sale Date: 08/26/1992 Arms Length Sale Code: Y-YES-VALID Grantor: SOUTHCROSS REALTY Cert Doc: Book: 03532 Page: 0198 http://csc-ma.us/PROPAPP/display.do?linkld=1702326&town=NandoverPubAcc 3/24/2011 Residential Property Record Card PARCEL ID:210/038.0-0177-0000.0 MAP:038.0 BLOCK:0177 LOT:0000.0 PARCEL ADDRESS:32 SOUTH CROSSROAD FY:2011 PARCEL INFORMATION Use-Code: 101 Sale Price: 298,000 Book: 03532 Road Type: T Inspect Date: 05/15/2008 Tax Class: T Sale Date: 08/26/92 Page: 0198 Rd Condition: P Meas Date : 05/15/2008 Owner: Tot Fin Area: 2792 Sale Type: P Cert/Doc: Traffic: M Entrance: X LECHLEIDER,MARTIN M. Tot Land Area: 1.00 Sale Valid: Y Water: Collect Id: RRC Address: Grantor: SOUTHCROSS REALTY Sewer: Inspect Reas: C 32 SOUTH CROSS ROAD _ NORTH ANDOVER MA 01845 Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LP/o Indust-B/L% / Open Sp-B/L% RESIDENCE INFORMATION LAND INFORMATION Style: CL Tot Rooms: 8 Main Fn Area: 1468 Attic: NBHD CODE: 7 NBHD CLASS: 7 ZONE: R2 Story Height: 2.00 Bedrooms: 4 Up Fn Area: 1324 Bsmt Area: 1468 Seg Type Code Method Sq-Ft Acres Inf_lu-Y/N Value Class - 1 P 101 S 43560 1.000 225,640 Roof: G Full Baths: 2 Add Fn Area: Fn Bsmt�Area: Ext Wall: FB_ Half Baths: 1- Unfin Area: Bsmt Grade:- VALUATION INFORMATION Masonry Trim: Ext Bath Fix: 1 Tot Fin Area: 2792 Current Total: 571,400 Bldg: 345,800 Land: 225,600 MktLnd: 225,600 Foundation: CN Bath Qual: M , RCNLD: 345777 Prior Total: 594,800 Bldg: 369,200 Land: 225,600 MktLnd: 225,600 Kitch Qual: M Eff Yr Built: 1992 Mkt Adj: Heat Type: FA Ext Kitch: Year Built: 1992 Sound Value: Fuel Type: G Grade: V Cost Bldg: 345,800 Fireplace: 0 Bsmt Gar Cap: Condition: G Aft Str Vail: Central AC: Bsmt Gar SF: 492 Pct Complete: Att Str Va12: Aft Gar SF: %Good P/F/E/R: ///93 Porch Type Porch Area Porch Grade Factor P 296 E 144 SKETCH PHOTO 12 12 FM/B E/P 12 144Sq.IdZ 144Sq.ItL2 12 ' 7 FU/FM/B 26 1324 Sq.Ft 24 In 14 4 4 32 SOUTH CROSS ROAD Parcel ID:210/038.0-0177-0000.0 as of 3/24/11 Page 1 of 1 MAP # LOT # PARCEL # STREET S� 62��5 12th ---- --- -_. _............ _.. ._.. CON.STR.U.C_T I,ON.....APPR.OVA.L. HAS PLAN REVIEW FEE BEEN PAID? YES NO PLAN APPROVAL: DATE_ APP. 13Y ........ ...... :.. DESIGNER: l »- ----- PLAID9_------ CONDITIONSV. 6:4 E UA-1711 _p -7 WATER SUPPLY: TOWN WELL WELL PER DRILLER WELL TESTS: CHEMICAL DAIE BACT I Df)l E f11"PRUVED BA RIA II DALE Af PRUVEU__._..-........_.._..._.____._._ COMMENTS: FORM U APPROVALS APPROVAL I'D ISSUE YES NO DATE ISSUED_ ®Y---- ------- - - CONDITIONS: FINAL APPROVAL: ALL PERMITS PAID Y NO WELL CONSTRUCTION APPROVAL YES- NO SEPTIC SYSTEM CONSTRUCTION APPROVAL (-- Y-ES ---�' NO OTHER YES NU ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: DA'T E:.8` f 2.BY: t; �4Rri{t = IS THE INSTALLER LICENSED? YES NO k'vv`31 TYPE OF CONSTRUCTION: I& REPAIR NEW CONSTRUCTION: CERTIFIED PLOT PLAN REVIEWYES NO ! {1 J CONDITIONS OF Af='PROVAL YES NO (FROM FORM U) OF DWC PERMIT YES NO r f DWC PERMIT NO. INSTALLER:_._.__._— (e'.'!', YES N0: ,. BEGIN INSPECTION — ----- ------ .. EXCAVATION . INSPECTION: NEEDED: t i ! �.y7, •.)t to ,,' a _ . , PASSED BY --- _—__----_—__ — CONSTRUCTION INSPECTION: NEEDED:____•____._____.-_..______._.._._...._.._______...__.-_—.—_.__ r, fti• > f��11y..1,1 tN'•i3 AS BUILT PLAN SATISFACTORY: YES s '' s '1 ' � t_•r t i 1 •° S; ` { APPROVAL TO BACKFILL: DATE:. BY r` FINAL GRADING APPROVAL: DATE _ ij FINAL CONSTRUCTION APPROVAL: DATE:__ /_�fd tz_ 1 " F • SST �Dl . FILE COPY CH • �a PUBLIC HEALTH DEPARTMENT Town of North Andover (ommunity Development Division CEg2I EICA2E OT C09YPLIANCE As of: March 28, 2011 This is to cert that the individual su6surface disposalsystem received a SA` 1SFACT0RT19VSTEC2I0X of the: Insta&ttion of an M-20 oistri6ution Bo.7 for an On Site Sewage qxTosalSystem By ,john ,Soucy At: 32 South Cross Road Wap-038.0--Parcel-01 TT 210/038.0-0177-0000.0 9Vorth Andover, 90 01845 'The Issuance of this certificate shad not 6e construed as a guarantee that the system wid function satisfactori y. Si?6aW SauyerREYS146 S/ &6Csc Meafth Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com y . PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division C'TSII FI cA 2'E Off' C01' 4PL 14WCE As of: March 28, 2011 This is to cert that the individual subsurface disposal system received a SA`ITSFAC70R,`Y S(PEMONof the: Instalration of an YC-20 Distri6ution Box for an On Site Sewage 0 osaCSystem By ,john ,Soucy t. 32 South cross Road 5'Vap-038.0--Parcef-01 TT 210/038.0-0177-0000.0 i1 forth Andover, g1A 01845 The Issuance of this certificate shaff not be construed as a guarantee that the system wilrfunction satisfactori y. S;saW T. Sawyer RF? 146 &&rx Meafth(Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.fownofnorthandover.com • � i S�TT�Py . PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division (YFg?�I1IFIC rrT OE C09V1PGIAC'� As of: 911arch 28, 2011 ,This is to cert that the individual su6surface d4osal system received a SA2ISTACT0RT 1XSIT EM0N of the: Instalration of an M-20 V stri6ution Boal for an On Site Sewage 1Dis =fSystem By ,john Soucy - At: 32 South Cross Woad 9Yap-038.0--Parcel-01 TT 210/038.0-0177-0000.0 North Andover, 9W..A 01845 The Issuance of this certificate shaffnot 6e construedas aguarantee that the system wifffunction satisfactorify. St6anlT SauyerrREYCS146 - &6&Meafth(Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division C'EI 7II FIC,4�I� O F C0W(1JP- j1-.-P-z'1-LXff As of: March 28, 2011 This is to cert that the individuaCsubsurface disposaCsystem receiveda SATIS(FACT0RTIXSPECT10Yof the: Instalration of an M-20 Ustrid ution Box for an On Site Sewage OiTosa[System 0y: John ,Soucy At: 32 South Cross Woad 9Yap-038.0-'arcel-01 TT 210/038.0-0177-0000.0 �1 Forth Andover, 90 01845" die Issuance of this certificate shaff not be construed as a guarantee that the system wiCffunction satisfactori y. S? aWT!Sawyer, WXS/ &61rx Meafth(Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com pORTi4 q Q �TVlD �6l6�O0 LO r L Tyy � eb T T COC LAK MICh♦wKM y1' �•9 gDRATED �Pa�.(y SSACHUS� PUBLIC HEALTH DEPARTMENT Community Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: S � Ad. MAP: LOT: INSTALLER: DESIGNER: PLAN DATE: BOH APPROVAL DATE ON N: 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: J SEPTIC TANK ❑ Building sewer in continuous grade, on compacted firm base ❑ Cleanouts per plan ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ gallon tank has been installed loading ❑ Monolithic tank construction ❑ Water tightness of tank has been achieved by 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.towoofnorthandover.com Inspection Form June 2008 ttORTH 16 OL O 1� * ` lb OQA COCNit M1wNN`y1• °RATED F`PP�,�S SSACHUS� PUBLIC HEALTH DEPARTMENT (ommunity 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: 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 Fox 978.688.8476 Web www.townofnorthondover.com Inspection Form June 2008 o� t%O RTF qt" qtL 16' •rO o COCNt lwKN%V1 �•9 p0 ATIE SSACHUS� PUBLIC HEALTH DEPARTMENT Community Development Division DISTRIBUTION-BOX ❑ nstalled on stable stone base s&/V� � r H-20 D-Box ❑ Inlet tee (if pumped or >0.08'/foot) Hydraulic cem�9u.a.d_inJet_ outlets O even distribution ❑ Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEM (General) ❑ Bottom of SAS excavated down to 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 ❑ Laterals installed and ends connected to header (and vented if impervious material above) ❑ Elevations of laterals and chambers installed as on approved plan ❑ Retaining wall (boulder/ concrete/timber/ block) ❑ Final cover as per plan Comments: 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 Fax 978.688.8476 Web www.townofoorthandover.com Inspection Form June 2008 NORTij q Q �tLED 16 O f� F i iL 49 O CO-CMCWKK 1 A- 7 ADR�T[D 9SSACHUS�� 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 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com Inspection Form June 2008 VtORTi4 OL O T O COCMCKCwKKArED 1' ��SSACHUs���y PUBLIC HEALTH DEPARTMENT fommunity Development Division SKETCH PLAN 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fox 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 r it NORTH O� LED 0 q� 67 O C � i >f 0 �4 COCMICMCWKM`y1' �•9 DaATED �'Pa,�'(5 SSACHUS� PUBLIC HEALTH DEPARTMENT Community 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) 2100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance(NA 5.02). s 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.lownofnorthandover.com Inspection Form June 2008 32 SOUTH CROSS ROAD JS-2011-000360 Project Detail Report Printed On:Thu Mar 24,2011 Project Name: GIS#: 2158 Project No: JS-2011-000360 Owner of Record LECHLEIDER,MARTIN M f pb�fiM 4 Map: 038.0 Date Submitted: Mar-23-2011 32 SOUTH CROSS ROAD U afLsa .•�a0 a� *' ' ° Block: 0177 Status: Open NORTH ANDOVER,MA 01845 a .�' w Lot: Work Category: Work Location: 32 SOUTH CROSS ROAD Zoning: Proposed Use: District: •. twus'�t� land Use: 101 Proposed Use Detail Subdivision n Description Septic System-H2O Distribution Box Comments: :It of Work: Department Status GeoTMS Module: Status File No. Comments: LCDate: Board of Health YELLOW FLAG BHJ-2011-000010 3/24/2011-(Thurs)-Title 5 Report received. Gave report and file to Susan with application for review and sign-off. John called and asked to get the permit ASAP as the homeowner is closing on the property in a couple of days,and he has to get the work done before that. I told him I would let Susan know.--p.d.(9:45 a.m.) 3/24/2011-(Thurs)Matt from John Soucy's office called at 9:05 a.m.and asked to scan and email Title 5 report-p.d: 3/23/2011(Wed)-John Soucy dropped off DWC application for an H-20 Distribution Box. No Title 5-He will drop off tomorrow.-p.d. w GeoTMS®2011 Des Lauriers Municipal Solutions,Inc. Page 1 of 1 32 S Cross Rd,North Andover, MA 01845 - Google Maps Page 1 of 1 q.,,.,o de maps 3/24/2011 -32 South Cross Road for Distribution Box Inspection -John A Soucy 3/24/2011 -32 South Cross Road for Distribution=Inspection / Soucy r y , Jt T�Taki' Pizza tit al fi st� � _ .� 01 �Foxd' A , Pwooidl /I r . t t� 500 ft 1 200 m I 020 Google-`Map data©2011 Google-Terms of Use rig http://maps.google.com/maps?fid&source=s d&saddr=North+Andover,+32+South+Cross... 3/24/2011 f &OR rot Commonwealth of Massachusetts Map-Block-Lot 038.00177 ----------------------- Board of Health �— Permit No b. + North Andover BHP-2---- 66 .• • P.I. FEE �SS�t+Nust� F.I. $125.00 -------- ----- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted John SVuqy--------------------------------------------------------------------------------------------- to(Repair-REPLACEMENT OF H-20 DISTRIBUTION BOX)an Individual Sewage Disp at No 32 SOUTH CROSS ROAD as shown'on the application for Disposal Works Construction Permit No. BHP-2011-056 Dated-__March-2-4,29-1-1 ----------- ------'---------- ay Issued On:Mar-24-2011 , arEi Of H elth ---------------------------------------------------------------------------------- s+ w w4Rty Commonwealth of Massachusetts Map-Block-Lot '." •� °4 038.00177 Board of Health O p North Andover res••��P•�� CERTIFICATE OF COMPLIANCE 3+Oc m THIS IS TO CERTIFY,That the Individual Sewage Disposal System (Repair-REPLACEMENT OF H by John Souc Installer at No 32 SOUTH CROSS ROAD ---------------------------------------------------------------------------------------------------------------------------------------------------------- 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-2011-056 Dated March 24,2011 ----- ----- ------------------------------- Printed On:Mar-24-2011 Board of Health Of NOFT1r 1 { 5292 O Town of North Andover HEALTH DEPARTMENT ."tCHUSt CHECK#: �11p DATE: LOCATION: H/O NAME: CONTRACTOR A ' Type of Permit or Licen�K(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/� ,/0 0-"Septic Disposal Works CGnstruction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other:(Indicate) $ ealth Agent Initials White-Applicant Yellow-Health Pink-Treasurer 1 • A A r Application for Septic Disposal System 61f #Construction Permit - TOWN OF AY E ORTH ANDOVER, MA 01845 $250.00—Full Repair $,�-Component SACMU50 Important: Application is hereby made for a permit to: When filling out ❑Construct a new on-site sewage disposal system* forms on the computer,use key ❑ Repair or replace an existing on-site sewage disposal system�only T to move your Repair or replace an existing system component—What? O k cursor-do not use the return A. Facility In<� 0formati Jn ��S key. ,,�� c� S �Cx� rd Address or of# City/Town 2.-*TYPE OF SEPTIC SYSTEM*: ❑ Pump ❑Gravity(choose one) ***If pump system,attach copy of electrical permit to application*** `; ❑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. �d 2. Owner Information ;I/ ^^,, �e Name Address(if different from above) City/Town State Zip Code / Telephone Number 3. Installer Information c� L'L C_q div 1 Name Name of Com ny �v U Addres � II rr� AG.�l City/Town Stat Zip Code (elet—pho"eumk4r(de1i_Phone#if possible lease) a. Designer Infor ation Name V tr I Name of Company Address City/Town State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 dam.of MORTq Application for Septic Disposal System r a TOErP&'SbAfq o * Construction Permit - TOWN OF ''�' •� ' ORTH ANDOVER MA 01845 $250.00-Full Repair +a•��^ �c� $125.00-Component s�ewus •----� PAGE 2 •F2 A. Facility Informatio • continued.... 5. Type of Building: ftesidential Dwelling or❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-sites a e disposal system in accordance with the provisions of Title 5 of the Envir men I Code,as well as the Local Subsurface Disposal Regulations for the Town of No Ando er, and not to place the system in operation until Certificate of Compliance has b en issue by this Board Health. ame- Date Ap licatio Ap bved By: (Board of Health Representative) 3 Nam Dat�T plica ion Disapp oved for the following reasons: For Office Use Only: v 1. FeeAttachedP Yes {� No 2. Project Manager Obligation Form Attached. Yes n' 'J No 3. Pump Svstem? Ifso,Attach cogE ofElectrical Permit Yes No 4. Foundation As-Built?(hew construction ronly): Yes No (Same scale as approved plan) 5. Floor Plans?(new construction only): Yes No Application for Disposal System Construction Permit•Page 2 of 2 DelleChiaie, Pamela From: SoucySewer@comcast.net Sent: Thursday, March 24, 20119:31 AM To: DelleChiaie, Pamela Subject: Title V for 32 s. cross St. Attachments: 32 S. Cross St. N. Andover 11.jpg; 32 S. Cross st. N. Andover 12.jpg; 32 S. Cross st. N. Andover 13.jpg; 32 S. Cross st. N. Andover 14.jpg; 32 S. Cross st. N. Andover 15.jpg; 32 S. Cross St. N. Andover 16.jpg; 32 S. Cross St. N. Andover 17.jpg; 32 S. Cross st. N. Andover 1.jpg; 32 S. Cross st. N. Andover 2.jpg; 32 S. Cross st. N. Andover 3.jpg; 32 S. Cross st. N. Andover 4.jpg; 32 S. Cross st. N. Andover 5.jpg; 32 S. Cross st. N. Andover 6.jpg; 32 S. Cross St. N. Andover 7.jpg; 32 S. Cross st. N. Andover 8.jpg; 32 S. Cross St. N. Andover 9.jpg; 32 S. Cross st. N. Andover 10.jpg Pam, attached is the Title V for 32 s. cross st. conditional pass so John can come in and get the permit for the D box. I apologize that each page is attached separately. I couldn't get it into one file. Thanks, Matt Soucy's Septic 603-898-9339 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. c 1 { Commonwealth of Massachusetts , - Title 5 Official Inspection 1=o�m Subsurface Sewage Disposal System Form -Not for Voluntary Assessme s MQi 1 'TOWITO NQRTMANDOVE:R Property Addr � HEALTH DEPARTMENT Owner Owner's Name information is 01,W5- required 1�� _ required for every -Pt '�— "State Zip ode Dat of tnspec n page City(rown Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not use the return Name of Inspector key. r� Company Name Company Address Ci lTow State � ^ � Zip Code lep ne Number License NubSr L. Certification 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 appro d system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passes Conditionally Passes ❑ Fails ❑ Need urther Evaluation by the Local Approving Authority � �- Date - I ector' gn u The s em inspector shall sub it a copy of this inspection report to the Approving Authority (Board of He th or DEP)within 30 days of completing this inspection, If the system is a shared system or has 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. ****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. Tale 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 t5ins•09108 Commonwealth of Massachusetts ta= - Title 5 Official Inspection Form Subsurface Sewage Disposal System Forms Not for Voluntary Assessments Property Address Owner Owner's Name information is /V (jw �/ l _ required for every _— V 11state"— zip�oae Date off pe on page. City/Town B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) Syst 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. Check the box for"yes", "no or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. F1 Y ❑ N ❑ ND (Explain below): p Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 2 of 17 t5ins•09108 Commonwealth of Massachusetts Title 5 Official Inspection Form 51 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address nn Owner Owner's Name � o information is /Vo V _0 � �f required for every —j-- -A44 page. City/To in State Zip Code Date of I,s ectio B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): Vdistribution. bstruction is removed ❑ Y ❑ N ❑ ND (Explain below): box is leveled or replaced Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection it(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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 determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh Title 5 Official Inspection Form.Subsurface Sewage Disposal System-Page 3 of 17 t5ins•09/08 Commonwealth of Massachusetts Tide 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Owner Owner's Name information is ) !AL( ��=/ - ��, "u=a required for every _n_—/r�—� (�! tate Zip ode Date of p to page. City/Town B. Certification (cont.) Z. System will fait 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 indicates absent and the,presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ®/ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ E2/ Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow_ _ Title 5 official Inspection Form Subsurface Sewage Disposal System-Page 4 of 17 sins-09103 Commonwealth of Massachusetts R; 6a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments Property r SS �w Owner Owner's Name information is � ion /� required for every page. City/Town State Zip Code Date of Inspe B. Certification (cont.) Yes No ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ Any portion of cesspool or privy is within 100 feet of a surface water supply or EV tributary to a surface water supply. ❑ Q/ Any portion of a cesspool or privy is within a Zone 1 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 cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ L�' The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ The system fails. i have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ 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 ❑ Cl Area system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well 1f 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. - Title 5 Officrat Inspection form Subsurface Sewage Disposal System•Page 5 of 17 151ns•09108 Commonwealth of Massachusetts Tithe 5 Official Inspecti®n Form I� Subsurface'Sewage Dispo sal System Form -Not ffforrXVoluntary Assessments Property 3 s ' .. Owner Owner's NaNO — information is _ ��required for every = --� State Zip Code Date of sp tion page. City/Town C. Checklist Check if the following have been done. You must indicate"yes' or"no"as to each of the following: Yes No Lid' ❑ 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? ❑ Have large volumes of water been introduced to the system recently or as part of this inspection? Q Were as built plans of the system obtained and examined? (If they were not available note as N/A) [� ❑ Was the facility or dwelling inspected for signs of sewage back up? Q Was the site inspected for signs of break out? ❑ Were all system components, excluding the SAS, located on site? ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? 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: [ ❑ Existing information. For example, a plan at the Board of Health. Q Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): G�---- Number of bedrooms (actual): ---f DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): !--0 Title s Official Inspection Form Subsurface sewage Disposal System•Page 6 of 17 tsms•09108 Commonwealth of Massachusetts Title 5 Official Inspection Form Ifi Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property A&ress � /� .. n 4- e �4t Owner Owner's Name information is required for every — - �--- 1 �"— Zip page. City/Town State Code Date o /speicti n D. System Information Description: Number of-current residents: Does residence have a garbage gander.7 6qcoM /-e W cu"L6 (Yes C] No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes Vo Laundry system stem ins ected? El Yes VNo Y P Seasonaluse? ❑ Yes VNo i Water meter readings, if available(last 2 years usage (gpd)): — Detail: Yes�o Sump pump. ❑ Last date of occupancy: Da� �e Commerciallindustrial Flow Conditions: Type of Establishment: T Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Tale 5 Official inspection Form.subsurface Sewage Disposal System•Page i of 17 t5inS•09108 Commonwealth of Massachusetts IRS Title 5 Official Inspection Form Ir Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ?ropePM-ri s ff JJ Owner Owner's Name / } information is /,fits ✓ {,. _ required for every —�+ - �L r State Zip Code Date I specti. n page. City/Town D. System Information (cont.) Last date of'occupancy/use: Date _ Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes V/No If yes, volume pumped: gallons Mow was quantity pumped determined? U(© Q Reason for pumping: Type of S tem: Septic tank, distribution box, soil absorption system Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Title 5 Official Inspection Form:Subsurface sewage oisposai system Page 8 of 17 t5ins•09108 s Commonwealth of Massachusetts =I19 Titre 5 Official inspection Form r� =' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u _ Property AefdTess Owner Owner's Name information is required for every � page. City/Town State Zip Code Date o I spect n D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes (�No Building Sewer(locate on site plan): Depth below grade: feWet Material of constructioV40 cast iron PVC ❑ other(explain): Distance from private water supply well or suction line: feetN� i Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: feet Material of construction. Vncrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: Title 5 official Inspection form.Subsurface Sewage Disposal system Page 9 of 17 t5ins•09108 Commonwealth of Massachusetts Title 5 Official Inspection Form ' - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 0 Propert d r ss Le Owner Owner's Name information is required for every !-- page. City/Town Sae Zip Code date of En echo D. System Information (cont.) Septic Tank(cont.) n e from to bottom of outlet tee or baffle b Dista top p of sludge g Scum thickness r� 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? `7 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: feet 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: Date Tale 5 official inspection Form Subsurface Sewage Disposal System•Page 10 of 17 t5ms•09!08 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form •Not for Voluntary Assessments Property Address Owner Owner's Name information is required for every / — -- page. City/Town State Zip Code Date of Ins pe tion Q. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): � Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches; etc.): Attach copy of current pumping contract(required). Is copy attached. ❑ Yes ❑ No Tale 5 Official Inspection Form.Subsurface Sewage Disposal System•Pape 11 of 17 t5ins•09108 Commonwealth of Massachusetts -- Title 5 official Inspection Form — `s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owner's Name information is c required for every "' l—T�"� , _ page. CitylTown State Zip Code Date of Ins ection D. System Information (cont,) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): 3 Pump Chamber(locate on site plan): /1/4 Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (,locate on site plan, excavation not required): If SAS not located, explain why: Title 5 offidal Inspection Form.Subsurface Sewage Disposal system-Page 12 of 17 t5ins-09108 Commonwealth of Massachusetts M - Title 5 Official Inspection Form % Subsurface Sewage Disposal System Foran -Not for Voluntary Assessments Property Addres 4-1 Owner Jwner's Name — information is 444-required for everyL — —_'`�� Y- page. City(Pown State Zip Code Date of r;Aul D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: — ❑ leaching trenches number, length: 'J [� leaching fields number, dimensions: -F3 ❑ 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 er y Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•09108 Title 5 official Inspection Form.Subsurface Sewage Disposal System•Page 13 of 17 s t Commonwealth of Massachusetts =r Title 5 Official Inspection Form ,sl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �� Property A dre Owner Owner's NaryTe information is required for every page. City/Town State Zip Code Date of Inspecti D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Titie 5 Offiaal Inspection Form,Subsurface Sewage Disposal System-Page 14 of 17 t5ins•09108 Commonwealth of Massachusetts = — Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Prope OwnerrT-'s dress Owner Os Name `information is d ll required for every State Zip Cade Dateof In p..i n page. 5 fTown D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet, Locate where public water supply enters the building. Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately got i. WV 31 .01 v N F•'rp. .,N , ,J. f 1..•s w. ' 3a�',4lx�we �/� � h`A • �.7E,Pr-tc art„ t+k�tUe-- •. 111 amp* 1466.-0 (a Cis t twttta'rV WV.s 46 s em.. ty'r0 bow a 1•?J r _ to tt,rr- llboKa ri�Ld Z .er✓ aiy �Ar (�vre.. m �gS ter. 4 wspa,c., Tr+twE. CawsL^rTiL�teze'tea.i op' REQ (3) 17?itt. 'T^El.t S t71 t?biL " >YT-6.t� Ru a'►'�+�*r �y m tt3f:Y�. . �ti•t� C+�.t reT+s�.t�cs't oy Aiwa t-> t;t.s a 4 "''�It ull0 S ® tOL45 Gt�.aeyt�t4's Hag '_��i.t A-Gc:,oP—t3��►G�i ® tOLT�. twJ 1-14 n-14,ft— 1D�.�g tG�.f�"fL'Sa t,.i'Y�+ ^, A.iG�'TNt�'r T�+'"° R'-'1�►raw.Ct�A4LS �`L+GSa • Cnw.,tt=a+�C.l(.'�v'�'M� RAw( L'SPIt�./FtGAt7"tovS � /� 1q� '. 44-4 C+ 164 d cr—tjz.list Op 1 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 15 of 17 t51ns•09/08 ..+o-,s F. .M!: d ...w. yss .r-••,. ' t Commonwealth of Massachusetts t� Tide 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Oropertylddri_, _ Owner Owner's Name information is ___ _6�- (T required for every -r— b - - page. CitylTown 0_�. State zip God Date of In ctl n D. System Information (cont.) Site Exam: LD' ck Slope 7Suyf`ace water ❑ C ck cellar Shallow wells / Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: ' Date C/ 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: �i� D� •_�!!kit,_�_�-"�- ---�"►- ��"��"�. V � Before filing this inspection Report, please see Report Completeness Checklist on next page. Title 5 Official Inspection Form Subsurface Sewage Disposal system-Page 18 of 17 t5ins•09/08 p l Commonwealth of Massachusetts tar _ - Title 5 Official Inspection Form i( t Subsurface Sewage Disposal System Form Not for Voluntary Assessments s rrj Property Address�A Owner Owners information is required for every _l ' 7ik -Q�— � 1 page. CitylTown State Zip Code Date of fn ection E. Report Completeness Checklist � In 11 spection Summary: A, B, C, D, or E checked pection Summary D (System Failure Criteria Applicable to All Systems) completed ElSystemInformation—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09108 Title 5 Official Inspection Form.Subsurface Sewage Disposal System-Page 17 of 17 .. s t obi f � - : ;✓t .�.n ti v.t4 t...i,i C tL -r .,. .... ��-.;� ___. _ Gommonwealth of Massachusetts • ,;` A� :c47own'bf NORTHANDOVER, MASSACHUSETT • System'Pumping Record S . w: For 4 DEP has provided this form for use by local Boards of Health, The System p be submitted to the local Board of Health or other approving au f ori umpirig Record mu; tyDEC 6 2006 A. Facility Information TOWN OF NORTH ANDOVER Important: HEALTH DEPARTMENT When filling out 1, System Location: forms on the computer,use only the tab key Address to move your cursor•do not use the return City/Town State �— -- -- - key. Zip Code V 2. System Owner: Name --_.-------------.__--- --- .. Address(if different from location)-�_•�- --'-'---'--'-'--•-•�-----•--•-----------------.-_ City/Town -------- State ---------- Zip Code - TelephoneNumber B, Pumping Record - Date.of Pumping pate -- 2. Quantity Pumped: `5 U Gallons Type of system: ❑ Cesspool(s) � eptic Tank ❑ Tight Tank Other(describe): 4, Effluent Tee Filter present? ❑ YesIA'No If yes, was it cleaned? ❑ Ye so r 5. Condition of System: 61 Sy em Pumped By: --- aLme _ Vehicle License Number — - - Company 7. Location where contents were disposed: f Aw Si atura of Hau Date hap://www.mass.gov/dep/water/ provals/t5forms.htm#inspect t5form4.doc-06/03 System Pumping Record-Page 1 of t FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT I- l. t�\ CSL:'+ PHONE ASSESSORS MAP NUMBER 36 LOT NUMBER /" SUBDI STREET ��' d' s S s STREET NUMBER OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS 17 f °'1r` `7' DATE APPROVED CONSERVATION ADMINISTRATOR DATE REJECTED COMMENTS V.t? DATE APPROVED TOWN PLANNER DATE REJECTED CON RENTS DATE APPROVED FOOD INSPECTOR-HEALTH DATE REJECTED DATE APPROVED S S C SP R- LTH DATE REJECTED COMMENTS / l�51�j L•��- d-Y`«. �7 - �t f� �v-C � PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMNIEENTS RECEIVED BY BUILDING INSPECTOR DATE i /GE�f"l�'1 EO �oV u L�T�oil RSA+..i l_.c�C-AT -'G.• n �.0 �OQ.TLI plraol� D �AS� �1 o tiZ•T F-1 A �...fl o..��, l•rt a�. C Soc�TH Ce.oSS Lor ¢ i d � Spa 1 CL= f26• ,+w, ✓ Zaoo�l N a v � vk / 07013 ',4 bo y �.A m pati H of sco TQC.= IBLS7 l-IAVE. 72 4 m Isl.-t+ Pl-c•c rE,D Ttia C�.� of �¢.saoI Pl.ia� .�� 1-14 ��. I.� Ai (,Aqo ® Ivr.9s w :rH "Tl•+� Dres.G,y G2.• .�- C� -r"csr- -r4+E..c-•�,�s,- ® 1041. 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'Foto T�-lE f�`��s THs� CSF-FS�TS USE. oF" 'T4-F�. �UIl..L7t�.1C-� ZuSPEG?b �"�fCr'k�- �-�'�n OU�y Aa--iP c LGH USE l S Fo�� Ili �;• S>rt a w►._1 Got-�tPLy {"`+ S �,i �rc.T��eel 1 w t AT t o>_1 C7 F" �,o t.► t+� G. °,°? o. 13972 f W IT!-4 TN E Z.oU IU G {• Coto F o 2�'1 CTY ►-�c�r-�+ Au c�yE e.}�f A. \Ad t`t G-U C o u s-t e. c,,- '��,�� •,S° ,,,� 4-1ao 9-L •'��:�/yr,n,u}.isl'DSII..EI�t4�Y�lly�.lI .N1.1 ' �.tY•i1J�j1Y�;L51 I�l:(Ja�,r�5':�'4��iN'lr l`l�'�i!".1":+ti:., :r.*: l .•1.`!1. .'Ii%:iN.lyll'��Y''lyl,':'.i•,,,'.. RECEIVED ."Moo ,r '. DEC 0 6 2005 TOWNU�' NOV ANLX,,) ; TOWN OFNO.RTHANDOVER � U-AI't /� A ✓ JY81"�1L1 PIJMPINU Rf?C`.0Iti HEALTH DEPARTMENT ..., iY51'6M OtiYNQR � ��pRBss ' _��..""__._'�s--,eM I:�l.:. •;L:,•:;_._._.. . .......... ._. � ....... , 7T, IF "'• )vauc I NA rUKb 01' J�RvI(,� ='.r,,, �nlGKub!vL , Vti�tlJi � � d�b��01'rIU YVLL tV trY)Yrx Kom.! _..._ �1•YP185 IN Fl��.� • 8XC�9SrY6 301,1 .".�, �Ei�tCFfXtE1,Q RVNB,,�•�, 30LCD OAMYOY>r�,....,C1'FfER'�XPI.SIN t'VMM�NT�. vN I'�N 1'v r yr GK 1't , y FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/perrr is from j Boards and --partments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements, APPLICANT FILLS OUT THIS SECTION APPLICANT Lr 67K:5 . 6,4c& PHONE -/ —�-- q LOCATION: Assessor's Map Number PARCEL I SUBDIVISION LOT (S) � I STREET .SI- �5a= C rvs 5 ST. NUMBER.3 L '* OFFICIAL USE ONLY RECOWA9NDATIONS OF TOWN AGENTS: • _ I CONSERVATION ADMINISTRATO DATE APPROVED �3 DATE REJECTED I COMMENTS TOWN PLANNER DATE APPROVED IDATE REJECTED COMMENTS FOOD INSP 50R-HEALTH DATE APPROVED DATE REJECTED !C TOR-HEALTH DATE APPROVED C DATE REJECTED COMMENTS PUBLIC WORKS -SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT I � RECEIVED BY BUILDING INSPECTOR DATE �r Foto u C A t o P,..1 SGAlrrc.:1"s � SATE. : 4-1 Zo/g2 aj SpUT H C ep sS i off` � � .- �•�o � � - 5v L= Ig6. o-r / aC GT S V Q r 3SS*S.� �a' -• 28.,5_• J Gni q r a6' 1 r / l h.01 SE>�Ic As t�lu- CO OF si0 `'T6TA�fC= cBL.4Z 3 o.srT-P-4 r- Ia zs7 1ti ro 15'x a (Bu-1 q Q N I v�r OoK a 16,Z Zd Z ay C'E•iLTI��TF-FAT=Nqv� 7/. 7'1 4/ m laL4¢ TN15 (]15 SAL ���3ST2JCTla.f of REQ �i CD 18!•45 c.¢co,.iG HaS �I�A� �l UgOS Q 110(.9s A a TN -r-Q�cS IOL Cou�-.c��e- �+E�C••'1RTaW sa C...g �.+sGp To THQ �qy SFNES<J�!GEiT1oUS A�.o 310 4`-l.Fz. rs:oo [ (s (qZ- T GE-�.-TI1✓y THA o F'FSE�T� S+-lo..�U Aim ='T�- - THS oF"FSrc.Ts USE, ot~ Tl-+E, aU1�Gl►.iG = �gPECTC) F.. ta �- <;" �cJ TFi THE z_oUIUG ��T�2t- l%N1 ATIo� IE�>y L AvU S a 13872 CiouFp U Cor..l�`o WN �U Ucz-r-c- Co► ISTe - ten. Town of North Andover, Massachusetts Form No.3 f NORTH, BOARD OF HEALTH o do d° 19 1 H 9 DISPOSAL WORKS CONSTRUCTION PERMIT CHU �Ynar- Applicant J 'Q'C .q 100 8O/' NAME ADDRESS TELEPHONE Site Location rl`e3� J� ��(��c_j C D. 2 i Permission is hereby granted to Construct ( ) or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. CHAIRMAN,BOARD OF HEALTH _ `fes et Fee D.W.C. No. 3 NORTN o�t �+ 3? BOARD OF HEALTH • ,' • 120 MAIN STREET TEL. 682.6483 'SSACNUSE� NORTH ANDOVER, MASS. 01845 Ext. 32 MEMO DATE: April 21, 1993 TO: Karen Nelson FROM: Sandy Starr RE: 32 South Cross - DEP testing This morning I met with Gayton Osgood and Joanne Fagan of DEP at 32 South Cross to investigate the complaint about leakage at the site. A test for volatiles was made on site and was found to be negative. As I previously mentioned to you, a test for fecal contamination has already been made. The consensus is that the discoloration is being caused by the breakdown of organics in the soil. �Q A1'ti' F I N A L P L A N AL AL N own o 5 n over No. 143 ' "JRiVEVVAY ENTRY PERMIT E irer, MassQM Z 19?2 C _ICK I 0R PI; RUIT T BOARD OF HEALTH ��� // THIS CERTIFIES THAT... .............. ..... ................ ................................... BUILDING INSPECTOR ..has permission to ���uildings on .'4'v.oz.....���. . . .S.4%... Rought/'�" -� to be occupied as.... .!�I�C .I .... .. Chimney o &10.Final provided that the person accepting this permit shall in every respect conform to the terms of the application on rile in PLUMBI EC this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Ru Buildings in the Town of North Andover. PERMIT FOR FRAWBUILDING ( 19 VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES f 6 MONTHUTE: z9 Z FEE PAI .;E ELEC I ECJPR �N R -Rough PERMIT FOR FOUNDATION LESS CON RU N T ServiceN REGULATED BY PARA:• 112.7 S.R,C. Final FEE PAID:/0 0- cc) . .... .. .. DATE/ BUILDING I GAS INSPECTOR Occupancy Permit Required to Occupy Buil&g pER N F 2 9t-6-, Rough L V EE LESS DA FEE - Z&O &a.* Display in a Conspicuous Place on thep&ml4s: PERMIT $ 4-FS100 FIRE DEPT. Do Not Remove Burner NoJathing to Be Done Until Inspected and Approved by Smoke I it.-V Building Inspector '11 1• Folin U TOWN OF NORTH ANDOVER LOT RELEASE FOM ,..SUBDIVISION. �. 'ASSESSORS MAP 'M A,V 3 SUBDIVISION LOT(S) Lc� PERMANENT ADDRESS ASSIGNED BY U.P.W. STREET ' •APPLICANT ���R�� �(`".,r ��`~ ` PHONE L� �p ,DATE OF APPLICATION b TOWN USE BELOW THIS LINE PLANNING BOARD DATE APPROVED .TOWN PLANNER DATE REJECTED . i ' CONSERVATION COMMISSION DATE APPROVED , CONSERVATION ADMIN. DATE REJECTED . I BOARD OF HEALTIi DATE APPROVED 3Z-7/ ,hHSA 1TARIAN DATE REJECTED �'W,511115( �P;E ARTIIENT OF PUBLIC WORKS ,DRIVEWAY PEMIT 'li3 �, z/WATER CONNECTIONSM q ok FIRE DEPT. i RECEIVhD BY BUILDING INSPECTION DATE This form shall be signed by the agents of the Planning and llealth Boards , the Conservation Commission prior to the issuance of any building; permits for the subject lot. This form skull not releive the applicant from the -- 14nnr+ra nF anv nnn1 '1rnh1.e Town requirement or Bylaw. ;i r. _ flu ------------ ti�� sn _lp- - � t v -13 Wim.z4 --- - w � 13 - '000�� SOIL PROFILE ': PERCOLATION T ST DATA Town/City - lqo.&Street 0 JB e*012o Lot Loc. /Subdiv : _ MM Plan _ Owner'Tnvestigator *XX Observer -; SOIL PROFILES-DATE, 1 • 2 . G' 3 . 4 . —, Elev. — Elev. --- Elev. —Elev . 0 0 p 2 2 r�S 2 2 3 • 3 3 3 +4. 4 4 4 L or 5 s s s Ir 6. 6 6 6 c.7� Cj2QFjS 7, 7 . 7 7 8 8 8 �Aw� ._ 8 9 10 10 10 Benchmark Location ,Elevation Datum Per o]_ation `i'e.,i.-s-Date _pit Number �! ]- � 2 4 S . Start Saturation i Soak-Mills.Start- '.Gest-Time Dr.op of 3"-'1'ltne 11. OIL _ - --- Dro -) of 6"- 'i_me -'lL', lliri. 1st 31,Drop-. _- _ Mins . 2nd 3"Drop rAlt I � Notes & Sketches on Back L ` .............................. THE COMMONWEALTH orMASSACHUSETTS U����� |��� ������" ~�� OF � �kT OF-_.. � v'v--- Applira�on for Dispoiial Works To�� n'&s�WT�rur�+tio~an--- ramlt ' Aoolicuduo is haz6n/ made for a Permit to Construct ( () or Repair ( ) an Individual Sewage I>iopoxu Svstem at � -�~-~�-----'-' = ------------------------------------------ _--- _ � - - _ --- --^---�-�- --- or � Nol- C ' - ~~ � ' �w� Adir-e-s'sl--'---'---__-'---_---'~ ---'---'-------'----'-----------------'------'-'---- ---'--'----------'----------------------'-'-------' zns*o= Address - Type ofBuilding Size Lot. feet Dwelling—No. of Bedrooms.--_----'�][...................Expansion Attic ( ) Garbage Grinder ( ) [)duer--Ivne of Building ............................ No. ofpersons............................ Showers ( \ -- Cafeteria ( ) P4 Other fixtures ~� -. Seepage Pit No-----.--. Diaozetec.----.--' Depth below iolet---------. Iotu leaching urou-------'ml. f t. Z Other Distributionbox (V) Dosi ~~ Percolation Test ........ 7=A ~~ ��I�a� ��t �- y�c��6 Zco16 of Test �d--' '-- D5�oth to ground ~otcc.' ....1 1^ _ Tea P� No.���-�1.�ioo�s per inch Depth of TestP�..-''��'--- Depth to ground watcr-ao............ � ~ � ' ----------'------'--'----------------------'---------------'---------''--'---'-------'-'----- ''"'-_-__. The undersigned agrees to install the aforedescri6ed Individual Sewage Disposal System in accordance with the provisions of]IT LZ 5 o the State Sanitary Code— The undersigned further agrees not to place the system in operation nodl u Certificate of Compliance has been issued hvthe board ofhealth. Sigoed-'----------------------------------..----- ----.--.-----'--- »*" AonicubuoApproved By.................................................................................................. ........................................ u"m Application Disapproved /or the following reasons:................................................................................................................ ......................................................................................................................................................................................................... Date PermitNo--------------------------------------------------------- Isvo«d'....................................................... Date ~^^^^^^^^^^^^^^^`^^^^^^^^^^^^^^^^^^^^^^^^^^^^~^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^~ THE ooMmowvvEALr* OF MAesAonussrrS BOARD OF HPAL�H ---~~--.------' -' -~����_--_`-_'_'_ _---_---' Trrfixira4r of Tantliti*&uur THIS lST0 CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired / ) bv.................................................................................................................................................................................................... Installer at..................................................................................................................................................................................................... been installed in accordance with the provisions of TITLE 5o{ The State Sanitary Code an described in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE OF THUS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.-----__----_----------_---------_-----' Inspector.................................................................................... ^^^^^^^^^^^^^^^^~^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^°^^^^^^^^^^^^^^^^^^^^^^,^^^^^^^^^^^^^,,°^^^^^^^^^^^~^^^,^^^^,^^^^^^^°^^^^^^" THE COMMONWEALTH mFMASSACHUSETTS BOARD OF --�����«����----'��F-.+���/���'�L.^����..�W[�������----' No......................... FEE........................ Ropmal Vorko Tomitrurtion �� r��ft Permission ishereby granted----------_------'_-_--------------'----..----------.----...-------- to Construct ( ) or Repair ( ) an Individual System atNo............................................................................................................................................................................................... Street uashown oothe application for Disposal Works Construction Permit No..................... Dated.......................................... ----------`--------`----'-----`---`-------- o=aofomu -`----------'----------------------''-----` ronM 1255 A. m. suLx/w. eosrow No........................ Fxs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARDWO H A TH ;.nj �f............OF...... . . ��'.. ......... f..',t ........ Appliration for Disposal Works Tonstrnr#inn Frrntit Application is hereby made for a Permit to Construct (�}� or Repair ( ) an Individual Sewage Disposal SM7, at .. ._ k'5......... ..... .........................:.�'a. ... ..... ?......--------•-----••--..............--•---. L,{ocatio�..,4\4Adress J�.) �[ r or Lot No.3L /" �y,p' :..a........ ....7�:.. ... lA. �.i �^�. - .�IimlYl.. ...... _ ...... ..er........i......_.. Owner Address W Installer Address Type of Building Size Lot..r. 6.r:;"5.'7....Sq. feet U Dwelling—No. of Bedrooms......................,....................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures .-------•-----------------•-•-....................._...... Design Flow.............. '`= --. gallons per person per day. Total daily flow................... .......gallons. G: Septic Tank—Liquid capacity/Z. 4_gallons Length..../P._�... Width y�1.:.. Diameter................ Depth-.a:/7. ..'� Disposal Trench— e..._....�r ....... Width•--..j�-)j..... Total Length....,5-5....... Total leaching area. .0-sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (�) Dosing tank ) ,D , '-' Percolation Test Results Performed by__ .. f�Pditl�_...lt /ei.��affg�._..-_. Date.. _:��-� �l.L____.__.... . +. F rJ -- ¢ a Test Pit No. minutes per inch Depth of Test Pit--------- _. e th to ground water_.___.____�.4_._.. ..1 /� P P ' P fi, Test Pit No.sc..... _minutes per inch Depth of Test Pit........ . ... Depth to ground water.___: ......... xDescription of SoilJW.----U".Z ""'I U 440 IF �) , r v —1................... VNature of Repairs or Alterations—Answer when applicable......................... ..................................................................... ---------------------------•-----...._......---------------------••-----------------------.....----•---•••-------•-•--••--•-----------••-•-•--••••-•---•---•---•--•••-•---------••--•••-----•-••---... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLL 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed...............................................•---------...-••----•---•---••-----•-•• ..........................-.... Date ApplicationApproved By....................-•-••-•••---••----------------•---------------•------......................-• ........................................ Date Application Disapproved for the following reasons:-------•------------------------------------------------------••--------------....•-•••••....---••••......_..•-- •-•-...-•----------------------------•--•-•--•-•....•-•••-•-------•--------------•.._........•------•----........•••••--••----•------••-•-•---•-•----••-•--------•---------•-•••--...•••-•-•-••-•----.•-- Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF 7LTH ..............OF....,r .... j..s r. ...../.,...:............. (9rrtifiratt of Tompliattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Installer at..................................................................................................................................................................................................... has been installAd in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated___.___--_..._.___-----_........................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS ��,,.�+ BOARD Of H// LT / .ft .>? ..............OF...... LA ...:c...a.!L`�.d �Y.. . .. ._....... ....... ... ..... No......................... FEE........................ Disposal Works 'W"krrnstrnrtuan "prrntit Permission is hereby granted....................................................................................._...•--•--•-•-•-••--........-•--•-...................•... to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo............................................................................................................................................................................................... Street as shown on the application for Disposal Works Construction Permit No....................• Dated.......................................... ............................•---......----------•------------------------•--•--------•........-•--•----•- Board of Health DATE................................................................................ FORM 1255 A. M. SULKIN, BOSTON . N ' Ot NORTH 14, )5379 0 • • oy Town of North Andover � ' HEALTH DEPARTMENT ssCHUSt CHECK#: 4 D TE: LOCATION: W H/0 NAME: CONTRACTOR -AM /P 1 71 ' 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 $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title Inspector $ Title 5 Report $ .6 ❑ Other:(Indicate) $ � v Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer . O JU F p Town of North Andover ��'•.,,,o:: �' ITEALTH DEPARTMENT ,SSACHUSt� ' . CHECK#: _�% aD TE: LOCATION: H/O CONTRACTOR •AM 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 $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title,5Inspector $ Title 5 Report $ �/ J ❑ Other:(Indicate) $ v Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer ♦ _ RECEIVED ' Commonwealth of Massachusetts OR W 112011Title 5 Official Inspection Form "s Subsurface Sewage Disposal System Form - Not for Voluntary AssessLfiH pEPpARfiME T R 32 S. Cross Rd. Property Address Marty Lechleider Owner Owner's Name information is required for every N. Andover MA 01845 03/28/2011 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not John Soucy use the return Name of Inspector key. Soucy's Sewer Service, Inc. 2 Company Name 78 N. Broadway Company Address Salem NH 03079 City/Town State Zip Code 603-898-9339 13397 Telephone Number License Number B. Certification 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 ❑ Fails ❑:,Needs Further Evaluation by the Local Approving Authority j: z 2 ! 03/28/2011 J% I'nspectofs ig at Date T�e system inspector shall subit 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. ****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. I t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M40 32 S. Cross Rd. Property Address Marty Lechleider Owner Owner's Name information is required for every N. Andover MA 01845 03/28/2011 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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: 13) 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. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 32 S. Cross Rd. M Property Address Marty Lechleider Owner Owner's Name information is required for every N. Andover MA 01845 03/28/2011 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): I/W_A—distribution box is leveled or replacetVA,'�X❑ N ❑ ND (Explain below): Replaced "D" box-See attached permit pmt vi -)-z> �f!V ra.rci Oma✓r l spa.� a— �'Ol 1�` 4v�a--►' `, L�''�T ' � ! f ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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 determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 r I` Commonwealth of Massachusetts - w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 32 S. Cross Rd. Property Address Marty Lechleider Owner Owner's Name information is required for every N. Andover MA 01845 03/28/2011 page. CityTrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ 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 indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No Backupof sewage into facility or stem component due to overloaded or 9 Y Y P clogged SAS or cesspool 99 p ❑ ® 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 cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 32 S. Cross Rd. Property Address Marty Lechleider Owner Owner's Name information is required for every N. Andover MA 01845 03/28/2011 page. City/Town State Zip Code Date of Inspection a. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 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 cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone 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. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 32 S. Cross Rd. Property Address Marty Lechleider Owner Owner's Name information is required for every N. Andover MA 01845 03/28/2011 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ 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? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ 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: ® ❑ 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(5)] D. System Information Residential Flow Conditions: 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 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 32 S. Cross Rd. M Property Address Marty Lechleider Owner Owner's Name information is required for every N. Andover MA 01845 03/28/2011 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 3 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: See attached Sump pump? ❑ Yes ® No Last date of occupancy: CurrentDate Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 32 S. Cross Rd. Property Address Marty Lechleider Owner Owner's Name information is required for every N. Andover MA 01845 03/28/2011 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: current Date Other(describe below): General Information Pumping Records: Source of information: Owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Gauge on truck Reason for pumping: pumped Nov 2010 see slip Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) I ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts uv� . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 32 S. Cross Rd. Property Address Marty Lechleider Owner Owner's Name information is required for every N. Andover MA 01845 03/28/2011 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1992 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 12" Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: N/A feet Comments (on condition of joints, venting, evidence of leakage, etc.): Proper slope Septic Tank(locate on site plan): 9.. Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 6'X11' Sludge depth: U. t5ins•09/08 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 32 S. Cross Rd. M Property Address Marty Lechleider Owner Owner's Name information is N. Andover MA 01845 03/28/2011 required for every page. CityTrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 10" 0.5" Scum thickness 8.. Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? tape &sludge tool Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump tank every year. Recommend garbage disposal removal. Grease Trap (locate on site plan): Depth below grade: feet 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: Date t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 32 S. Cross Rd. Property Address Marty Lechleider Owner Owner's Name information is required for every N. Andover MA 01845 03/28/2011 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GSM 32 S. Cross Rd. Property Address Marty Lechleider Owner Owner's Name information is required for every N. Andover MA 01845 03/28/2011 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Some solids carry over(normal due to age) T" box has been replaced. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 32 S. Cross Rd. M Property Address Marty Lechleider Owner Owner's Name information is required for every N. Andover MA 01845 03/28/2011 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 24'X50' ❑ 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.): no signs of hydraulic failure. 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 ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 • Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 32 S. Cross Rd. Property Address Marty Lechleider Owner Owner's Name information is required for every r N. Andover MA 01845 03/28/2011 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 • Commonwealth of Massachusetts H Title 5 Oficial Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 32 S. Cross Rd. Property Address Marty Lechleider Owner Owner's Name MA 01845 03/28/20_ 11 —— information is N. Andover required for every State Zip Code Date of Inspection page. City/Town D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent referencead ng Check onerks. Locate of the boxeslbelowwithin 100 feet. Locate where public water supply enters the bu ❑ hand-sketch in the area below ❑ drawing attached separately L _J0 _ `.'7 S , • 3'1' �. A/' ` tea a�oyc3o'�46ou� yam`, �A b`a`ld or M c- ( 4 . H 5 • a ,�m to 3,rc ? 8Co �� rat'rb'rAvIC.= ISZ„Q2 � � y• �•--r�C= !8 Lg7 T�rS C51S�b�gL a e_c�crt� off- 72 p`r+Ten u�T'to►-P A..sQ t O -t-µ�� I QF.� ISf.QS t�..tt afcS 'M�° �Q�q.10E �t�AQro �otia -1-a-t csr-rtl�r-�s,r A r�'"r.�.sr • l� tvL4S .�-cti--¢-rt�� s � a ia.4t,r A•1 0 3 t o C-+�,t.le.r A�-1 .Spc��'c,aTto+✓S r. tS I I Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 t5ins•09108 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 32 S. Cross Rd. Property Address Marty Lechleider Owner Owner's Name information is required for every N. Andover MA 01845 03/28/2011 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: Z Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 5 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® 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: Dug hole with auger in low drop off area. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 a Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 32 S. Cross Rd. Property Address Marty Lechleider Owner Owner's Name information is required for every N. Andover MA 01845 03/28/2011 page. Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 03/2-4/261.1 E9:15 19786889573 P.Qa s summary Record Cold ganQT2Wd on 5/74/2011 10:17:22 AM by Li.o FVQ M Town of North Andover Tax flap # 210-038.0-0177-0000.0 Parcel ld 13248 32 SOUTH CROSS ROAD LECHLEIDER, MARTY 32 SO, CROSS RD NO. ANDOVER, NIA 01845 _ Property Type 1 Residential Class 101 Single Family Size Total 1 Acres FY 2011 _.. _. UB Mailing IndexUntil NamelAddress Type Loan Number ACtivellnact, From LECHLEIDER,MARTY Payor 32 SO.CROSS RD NO.ANDOVER,MA 01845 UB Account Maint. ActNeltnactive Account No Cycle Occupant Name Bldg id,13992.0-32 SOUTH CROSS ROAD Last Billing Date 3/2/2011 Active 2100544 02 Cycle 02 US Service, Maint. Account No.2100544 Charge Muitiplierlusers Service Code Rate MISCFEE ADMIN FEE 0,$35(8 7.82 1! WTR WATER 01 ALL METER SIZE 60.80 li UB Meter Maintenance Account No.2100544 Brand Type Size YTD Cans Serial No Status Location b Badger w Water 0.63 O.fi3 82 36388069 a Active ERT HH Consumption Posted Date Variance Date Reading Code 16 311512011 66% 213/2011 65 a Actual 9 12113/2010 -450/0 11/112010 49 a Actual 17 911312010 -24% 615/2010 40 a Actual 23 6/9/2010 -100%n 51512010 23 a Actual 0 3/11/2010 -100% 1/3012010 0 n New Meter 17 311112010 -3% 1/30/2010 2110 r Replacement 18 1211112009 -30% 11/312009 2093 a Actual 26 9!1112009 `4% 8/512009 2075 a Actual 18 6/16/2009 1�" -1 5/6/2009 2049 a Actual 18 3/16/2009 2/4/2009 2031 m Manual estimate MSO 18 12/10/2006 25°10 11/412008 2013 a Actual 24 9/1212006 10010 815/2008 1995 a Actual22 6118/2008 15% 137°10 5/6/2008 1971 a Actual 19 3/14/2008 2/4/2008 1949 a Actual 8 1115/2008 -77% 11/5/2007 1930 a Actual 35 911412007 -10% 8/6/2007 1922 m Manual estimate MSG 29 6/22/2007 237% 5/7712007 1887 a Actual 15 3!2312007 -37% 1858 m Manual estimate •26% 2128/2007 15 121222006 11/3!2006 1843 aActual 24 9/1312006 0% 8(2112006 1828 a Actual 13% 29 612012006 512512006 1604 m Manual 0timate -36% 29 3,r1312 MSG 006 218/2006 1775 a Actual 44 12114/2005 16.00; 11/812005 1746 2 Actual w i 0' ` 0 S�'4'sLSD fQ,6; e • h PUBLIC HEALTH DEPARTMENT H Town of North Andover Community Development Division � � i i As of-. arch 28, 201. < This is to cert that the individual subsurface disposal system received a S.g2ISTACT0R.T1XSITEC 70%of the: In ad ation of an 9T-20 Oestri&ton Bo., for an On Site Sewage ' osadSystem By John Soucy At: 2 south cross &4 i Wap-03 8.0— rce 0177 21,1,/038.0-0177-0000,0 Xorth,Andover 01845 The Issuance of this certificate shaffnot be construecfas aquarantee that the system wilffunction satisfactotif. i Sari T Sawyer, /ASF `Ouffiw 9feafth(Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.4540 Fox 478.688.8475 Web www.townofnorthondover.com i 603-02,- 5/4/3� 6/7- 6.2; -03-6 i TOWN OF NO TH ANDOVF;?; uA I.F SYSTEM PU P1NQ UCORI) SYSTEM OWFR ADDRESS SYSTEM LZg� OCAT70N 0' " l� �O vv� 1,e-,4-7'' d Y,::�' �jGvs �i DATE OF PUMPING: ._..._ _..._QUANTITY PUMPED: c bsSPOOL: NO. YES _ .... Sopcic Tank: NU. YES.� N,A rURE Or SERVICE: ROU'rl.Nk EM1✓RUEiN('1' DEC 0 7 2004 C)bSERVATIUNS: TOWN Or"'INTh ArCOVER EACpg OOOD CONDITION N PULL 'lam COVER LTH ERTMENT COVER HEAVY ORF-ASE _._.. SAMES IN PLACE. ROOTS , _• LKACHPIELD RUNBACK 13XCUSIVE SOLJDS -- FLOODED SOLID CARRYOVER_.........O'TH'ER EXPLAIN system Pwnpcd by - ... �'UMMENTJ. UN l!rN l'S rKANSYtRR.ED 1,0 TO WN OF N 0 R T H AND0VER _�,.. ,,-.�-, 515/ SYSTEM PUMPING RECO [ZD„�'�`; I Efv1 OWNER & ADDRESS SYSTEM LOCATION (example: Icf( froni Uf house) �C'h Eder i 3 a 30 Cr6ss St' .vo An b U I C OF PUMPINC: (QUANTITY PUMPCD /5Z6 ��I UUL NO X, YES SEPT]CTANK : NO YES Y 4 �1'UflE OF SERVICE: ROUTINE - EMERGENCY )ll>r« V �TIoNS: C OOD CONDITION FULL TO COVE'!z HFAVY CREASE BAFFLES IN P[.ACL' ROOTS LEACH FI CLD lZU.N( ACK .. CXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER Oj�HER (EXPLAIN.) �i � LM PUMPCD [3Y : '� ('� Y' 7 INlFNTS: T) ANSFEIzIzED TO: OP MA, (L)4-16S SUPPL-t bW�I_ D WLU- AP OUCDlYJT'C SS 5cpflc Sy s i& ,tJ --�, bPP��ovED D,4rt' 1jpfT<ovj6 Auvt}oK►Ty P(An) DES+ GN I RO kA �_ �v D.4 / DI�PPk�V�pCo�p[t�o�5 ; � -k8- rIS 70 ��- RmsoNs = w4w po;� 3 1� c.v bjZ� �F-' S YSrc�l _ COW - D S5fprf L SY5T'EM !J SiA IL AT10-AJ ,6X444 T(o,I,J Q 1=)QIL- W S��rlon� PI PL- t JOtt -F(,) TA L� ?A SS 1-7 RJL- 1�PPj�dVE1� Ui3TC I NS%iOl�Gt=; (Oti'j Op,wY) --- ---- �IS��P�►��vE� D,a rC Fk)4 L A PPi�jva L D "E ,. APNovv)G /j u ainRI r/ Commonwealth of Massachusetts EM = City/Town of System Pumping Record JUN Form 4 k'� DEP has provided this form for use-,by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left/Right front of house, Left/Right rear of hous , Le rigKs"eck Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Un Address7 Cityrrown State Zip Code ' 2. System Owner. Name Address(if different from location) City/Town Stat f , r� ZipG��� Telephone Number C� B. Pumping Record 1. Date of Pumping � 2. Quantity Pumped: ll Date Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No. 5. Condition of Sy e m: 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Loca ' here contents were disposed: G LS-Q LS-QLowell Waste Water 13 SignAtule I HauleV Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD I � DATE: SYSTEM OWNER & ADDRESS SYSTEM LOCATION (example: left front of house) c� � C �e /o.S` o, 3w-5slu /va DATE OF PUMPING: 1-5 '-O t QUANTITY PUMPED /500 GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: i GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) i SYSTEM PUMPED BY: COMMENTS: CONTENTS TRANSFERRED TO: yrs` U L.0 UUI I .f .• , ,`tt k,,v.dcyxJa� Y r" '' r 1"/ SY "' t , l f ' +,, Nl�>h�t+t t7}f`�Id`'�v'�d� k:-t § 1. y � A��r1j.+`} , yr. tr t '.t 'ti - , '�1 Y 't , f'"•��'' t`' �7'� X, r: TOWN OF`N0ZTH ANDOVER. , SYSTEM PUMPING RECORD DATE N o V• I SYSTEM OWNER&ADDRESS SYSTEM LOCATION a s. CrosS 11�tCNt�aver ----------------; DATE OF PUMPING QUANTITI'PUMPED d ' CESSPOOL NO YDS _ < SEPTIC TANK YES NO n 4 NATURE OF SERVICE;,�iQ,UTIIgE EMERGENCY OBSERVATIONS: C300D CONDITION FULL TO COVER HEAVY GREASE ::::BAFFLES IN LACE ROOTS `LEACHFIELD RUNBACK EXCE3SIVE,SOLIDS FLOODED : SOLID CARRYOVER OTHER EXPLAIN SYSTEM , Y M P^ UMP ED BY COMMENTS- 4.1 CONTENTS TRANSFERRED TO r .. ORT ANDOVER" MASSACHUSETTS 'S 09.T.. ' e ,1, . �i r �,. � ` ��!��8;�►,:°�' ,� 1, cord' <r rm �• '1.�r t �yR''�'y,;..,: '� '.�, Ir!1 r1 f., f1.-,:7•t�j�{ �r':1,�'r.j+�i,�,Y•1+{,�1'le!Qe`1'(1'i a.�l."'� .. • ':''filar.,,.w{'•l. t �`, J, }'F!''1 Y:'.;A:•fi� : "n.lial'.4'.• y i f tJ � P V•.S !' X1..1 1r:w'.:'I,''a' „Y�,:..� , F DEP..has prov(ded this form for use by LocahBoards'o'f%Heal . The System Pumping Record must be s"ubmitted to the.local'Board oHealth or other approvin� authority, A Facility"Inforth:Oon . IVU r1 L TOWN OF NORTH E'.r.�)OVER s+,i+Wi10n' Un;out ��. SYStem l.ocatlon,�: -;EALTH DEPARTiv- NT }�...� W key, Address" �Jw A to move your.; `// r air:or•do pot . `usithe"retum'•� ` CltyTown State Zip Code Stem OWner'.'''I>,�t: ,. J :;: J' ..�:y�r� :Y„.{�i''%te;I• �Tfro„�:`C.'r:'.,:il.,�i';+��r,;7{ha�y?',i '•i':rC<.Name ;.:•..,.:• ,. ;i;; ,c. w., �/y� Address(If different from location); • Clty/Toum;.:4 State ode Telephone Number "of Pum In /sT�� r. }• Date p Date 2. Quand Pumped: r - ty p Gallons =3.: ,Type pf.system,". Cess o ) e tic k 1^, ❑ p ol(s p Tan ❑ Tight Tank •_ ;��].fOther(descrfbej;:: 4 Effluent Tee Flltee present?.❑ Yes, No If yes, was It cleaned?s 1 c can ❑ Yes ❑ No +;`Sli,'C011dIt191'Q.;S,y :.h•'�+.�t�Yr:,�"� tJ iY'l�y�:1Fi.�iii�!I',�i•��:•%f{fl'I�iiJ�•/:i.�lli�r'l i"•i'!•!"' .. .�., L,_�jr.4:;+711•::Y.•. 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