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HomeMy WebLinkAboutMiscellaneous - 324 BERRY STREET 4/30/2018 10 fr A F I NO 0482 VADL IN U.S.A. {$ ESSELTE w w8 t-04 O wU . m m N o 0 N r"2i»� . _ 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. PHONE }� ASSESSORS MAP NUMBER 6C LOT NUMBER SUBDIVISION LOT NUMBER STREET 3 ���� �?Y S STREET NUMBER S a y OFFICIAL USE O Y �� 5C3pFzy ,RECOMMENDATIONS OF TOWN AGENTS Y � 1 DATE APPROVED CONSERVATION ADMINISTRATOR t DATE REJECTED CONDAENTS y-� DATE APPROVED TOWN PLANNER DATE REJECTED COMMENTS DATE APPROVED FOOD INSPECTOR-HEALTH DATE REJECTED C ` DATE APPROVED �/TEFR-C,INSPECTOR-HEALTH DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE i RESTRICTION The Restriction herein set forth shall.apply and be appurtenant to the following described property located at 324 Berry Street, North Andover, Essex County, Massachusetts, being more particularly described as follows: A certain parcel of land located in North Andover, Essex County, Massachusetts, on the easterly side of Berry Street and being shown as Lot B on a plan of land entitled, "Plan of Land in North Andover, Mass. Prepared for Barco Corp." Scale: 1"-40', Date: Jan. 29, 1979, Rev. March 19, 1979,by Frank C. Gelinas & Associates, Engineers &Architects, 451 Andover Street, North Andover, Massachusetts, said plan being recorded in said North Essex Registry of Deeds as Plan No. 8080. Reference is hereby made to said Plan for a more particular description of said Lot B. Being the same premises described in deed recorded with Essex North District Registry of Deeds in Book 1665, Page 153. 1. Maximum Number of Bedrooms At all times subsequent hereto, unless connected to an approved municipal sewer, the property described hereinabove shall be limited to use as a single family residence containing no more than four(4)bedrooms. This Restriction is being implemented due to the maximum capacity of the current septic system and the nitrogen loading restriction when a property is served by a well. 2. Prior to Sale The current owners, Edward C. Pedi and Linda D. Pedi, shall remove the wall between the storage and family rooms prior to any safe of the premises unless connected to municipal sewerage. 3. Enforceability These Restrictions may be enforced by the Town of North Andover,by action in equity in any Court of competent jurisdiction. Witness our hands and seal the " `I I h day of , 2000. Edward C. Pedi a Linda D. Pedi COMMONWEALTH OF MASSACHUSETTS Essex, ss 1c�t1>✓ , 2000 Then personally appeared the above named Edward C. Pedi and Linda D. Pedi and acknowledged the foregoing to be their free act and deed,b fore me. u � ota ublic art My fission Expires: I�oo� HAG7757\RESTRICTIONdoc. L. OT E L_ or e) 4 3, S6A. S.F. J r N 0 - V � o � J o .30 .S- HEREBY C6F' 'f Y THAT THE ' •;,.`ai�i= "` SHOWN Ott tAIS PLAN Ak�. bico LOCATED WWI' ,1N A FL04150 HA7ARD rd ZONP'AS Di 1.iNK_ATED ON THE MAP p , j>� iSTogr OF �4!�3�1ij # ZS c 4090 A �a woes N o R T-4 p tv o vv E R EFircCTl�l� J u E i0� (q14 _51 9'T — - BY THE AND U" SAN C'fur :NTJ EDERAL j INSUko,NCi A0Mkt4iS1 RA1 i(DN. rp "CERTIFICATION MADE TO THE BOSTON FIVE CENTS SAVINGS vv I P Lr r"tNG EASEhENT i 't .Ro BANK, AND EPS-ARD A 61. 5a \b45 s p F_ Signed AGE :3UrQ%%v-#EY PLAt& DONALD S• FOX- REGISTERED LANE) SURVE SUNSET ROAD • CARLISLE, MASS. LocATION: NORTAA A00_ovER `1As� ii_ Ihereby cer y that ta.buifdin9 shown ," _ 30, DATE. M ac ► 9�1 q cb3 —_ on fhls plan is tocatad on tha ground 0t5 SCALE • 1 Shown ond that if conformS t6fh¢Zonin9 PLAN REFERENCE: laws , rfhc 944-3 /Town of B¢inc3 Lot_B_ _ori a pion by — -- - NORTfi ANoovER _ pR.,NK c. GEL.ArvA5 g ASSoc. __ when con tructed. �QtQ _=_9,_ 9��►_ 01 1'QCO!^CjQd in Esse S iGNEO: Esse x _ County Reg iStrj of DCL¢ gook Na,_►4 �, ---Pdgd No. 3 c>___ z �l PLAN rlo. �o�p. TM �+ This plot plan was not' made 12430 1erT 0 from an instrument survey and a t1cTE: Is for the ass of the bank only. SoaN�� Propertyy (in a d streef lin-. o ir-S under no ckeumstancea am offsets shown or% this p1Gn card SpecifIca(ly forth¢ be used,ADr' �biWiment of datermin4+.ar of Zoning raquirern¢nts ohl�. 1181IJ646te, M,.S. q21 Qs-1 LAW OFFICES G C% GAG Gni o.Gyy 127 TURNPIKE STREET NORTH ANDOVER, MASSACHUSETTS 01845-5095 VICTOR L. HATEM (978) 685-3368 ALSO ADMITTED IN N.H. FAX: (978) 682-1712 JOSEPH V. MAHONEY PETER L. HATEM ALSO ADMITTED IN FLORIDA AND N.H. JOHN E. MAHONEY June 15, 2000 Board of Health Town of North Andover 27 Charles Street North Andover, Massachusetts 01845 Re: 324 Berry Street Dear Sir/Madam: Enclosed please find an original deed restriction signed by Edward C. Pedi and Linda D. Pedi. Please call if there are any questions. Sincerely, Jose V. Mahoney JVM/jmc Enclosures cc: Edward & Linda Pedi H:\G7757\Ltr to Board of Health NA 6-15-OO.doc RESTRICTION The Restriction herein set forth shall apply and be appurtenant to the following described property located at 324 Berry Street, North Andover, Essex County, Massachusetts,being more particularly described as follows: A certain parcel of land located in North Andover, Essex County, Massachusetts, on the easterly side of Berry Street and being shown as Lot B on a plan of land entitled, "Plan of Land in North Andover, Mass. Prepared for Barco Corp." Scale: 1"40', Date: Jan. 29, 1979, Rev. March 19, 1979, by Frank C. Gelinas & Associates, Engineers & Architects, 451 Andover Street, North Andover, Massachusetts, said plan being recorded in said North Essex Registry of Deeds as Plan No. 8080. Reference is hereby made to said Plan for a more particular description of said Lot B. Being the same premises described in deed recorded with Essex North District Registry of Deeds in Book 1665, Page 153. 1. Maximum Number of Bedrooms At all times subsequent hereto, unless connected to an approved municipal sewer, the property described hereinabove shall be limited to use as a single family residence containing no more than four(4)bedrooms. This Restriction is being implemented due to the maximum capacity of the current septic system and the nitrogen loading restriction when a property is served by a well. 2. Prior to Sale The current owners, Edward C. Pedi and Linda D. Pedi, shall remove the wall between the storage and family rooms prior to any sale of the premises unless connected to municipal sewerage. 3. Enforceability These Restrictions may be enforced by the Town of North Andover, by action in equity in any Court of competent jurisdiction. Witness our hands and seal they I�h day of J, 2000. Edward C. Pedi a Linda D. Pedi Essex, ss COMMONWEALTH OF MASSACHUSETTS �. —�q 2000 Then personally appeared the above named Edward C. Pedi and Linda D. Pedi and acknowledged the foregoing to be their free act and deed, before me. IMS ' zL of ublic / HAG7757\RESTRICTIONdoc. My mission Expires: NEW ENGLAND ENGINEERING SERVICES lk INC May 16, 2000 Sandra Starr, Administrator North Andover Health Department Town Hall Annex 27 Charles Street North Andover, MA 01845 Re: 324 Berry Street,North Andover Dear Sandra: Please accept this letter as a request to be included on the Board of Health agenda for the May 25, 200 meeting. The purpose of this request is to receive permission to construct an addition at 324 Berry Street. The house as it exists currently is a three-bedroom house. The owner would like to expand the home to include a total of 9 rooms, which as you know is considered a four- bedroom house. In order to construct the addition the owner would be willing to record a deed restriction on the property limiting the number of bedrooms to three. In addition, the. owner would be willing to upgrade the septic system to four bedrooms if the home is ever sold. I have enclosed plans of the proposed addition for your inspection. If you have any questions or need additional information please do not hesitate to contact this office. Sincerely, 02�r Benjamin C. Osgood, Jr., T President i 02G7 60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 "AY 17 STORAGE U . a ti FIRST FLOOR PLAN - N SCALES ~ (p J FAMILY ROOM X ); -j 0 2'-6• a L� A� T.V. ROOM a3 W LA r Q TREATED WOOD DECK wL M y L STAIRS uj< NEW STAIRWAY TO 2ND FLOORJ N DOWN w TO FINISH y X-0' v GRADE I I I A J ❑ N REMOVE EXISTING tiV vi i/yv rt d + UP n m ISTFL2 x EXISTING KITCHEN WC WINDOW TO REMAIN 1 D ATH Ala- EATING KITCHEN EXISTING BATHROOM FIXTURES TO REMAIN EXISTING CHI DINING R❑❑M LIVING ROOM SUPPORT MULLION .r .(TYPICAL) ZWALL N F ❑ ——— —— —— —— — —— — V1 a w_ (4 = EXERCISE z ZROOM o Z oCU u N m -- - -- ---- - -- - x Z N N SECOND FLOOR PLAN ti A COLLAR TIES AT Z a i SCALE, ❑ —— —— —— — — —— — —— oe V B A N RAILING DOVN 'o 14 R 13v 0 N m C i_ 2ND FL2 m 'D x � y N z REMOVE7EXISTINGWFOR REUSE , + V i IN EXISTING EXISTING z BEDROOM BATH 31- ay U .Z.w J 0 3V Mi as w w 0 x j w Zo ❑� U v EXISTING MASTER BEDROOM EXISTING BEDROOM EXISTING STAIRWAY TO IST FLOOR � t 17 01-01 STORAGE U • iO 0 fU IL FIRST FLOOR PLAN - - N O SCALES 10% -1 FAMILY ROOM x j J m � o i ' xA� in ROOM= ' W TREATED WOOD DECK w =3 col u L STAIRS w c NEW STAIRWAY TO 2ND FLUOR. _ _ J h DOWN w FINISH S7-0 v GRADE I C3 REMOVE EXISTING • � fINDOV. d + UP u �jj m ISTFL2 EXISTING KITCHEN WINDOW TO 6LWa_Vjj< 1p In cl H M EATING KITCHEN EXISTING BATHROOM FIXTURES TO REMAINI EXISTING CHIMNEY DINING ROOM LIVING ROOM i 4 SUPPORT MULLION WALL t r x = EXERCISE ROOM cu C.0 -- - X Z N I W COLLAR TIES AT N SECOND FLOOR PLAN SCALE, — — —— oe _ RAILING novN 14 R 70 -o 0 W m ey 2ND FL2 �o i N m X 1 yi REMOVE EXISTING WINDOW + i FOR REUSE AT LOVER FLOOR. 0 EXISTING EXISTING B A T N BEDROOM �W 3 _ a z ca i zr A �- EXISTING MASTER BEDROOM EXISTING BEDROOM EXISTING STAIeRVAY .f 310 CMR: DEPARTMENT OF ENVIRONMENTAL PROTECTION 15.213: continued (g) any portion of the soil absorption system that is within the velocity zone or regulatory floodway is a leaching bed or trench system or any other system constructed in accordance with the wetlands protection act and 310 CMR 10.00. 15.214: Nitrogen Loadine Limitations (1) No system serving new construction in Nitrogen Sensitive Areas designated in 310 CMR' 15.215 shall be designed to receive or shall receive more than 440 gallons of design flow per day per acre except as set forth at 310 CMR 15.216 (aggregate flows) or 15.217 (enhanced nitrogen removal). (2) No system serving new construction in areas where the use of both on-site systems and drinking water supply wells is proposed to serve the facility shall be designed to receive or shall receive more than 440 gallons of design flow per day per acre from residential uses except as set forth at 310 CMR 15.216 (aggregate flows) or 15.217 (enhanced nitrogen removal). (3) It shall be the duty of the owner of the system or proposed system to ascertain whether or not the facility to be constructed will be in a nitrogen sensitive area. The Department will prepare and make available at locations generally accessible to the public maps portraying designated nitrogen sensitive areas within the Commonwealth. I5.215: Desi nation of Nitrogen Sensitive Areas The following areas have been determined by the Department to be particularly sensitive to the discharge of pollutants from on-site sewage disposal systems and are therefore designated nitrogen sensitive. The necessity of providing increased treatment of pollutants and reduction in nutrients discharged from on-site sewage disposal systems, including nitrogen, nitrogen as nitrate, phosphorous and pathogens in these areas warrants the imposition of the loading restrictions set forth in 310 CMR 15.214. i (1) Interim Wellhead Protection Areas and mapped Zone IIs of public water supplies as set forth in 310 CMR 22.21; i (2) Nitrogen sensitive embayments or other areas which are designated as nitrogen sensitive for purposes of 310 CMR 15.000 shall be mapped based on scientific evaluations of the affected water body and adopted through parallel public processes in both 310 CMR 15.000 and in the Massachusetts Water Quality Standards - 314 CMR 4.00. 15.216: A e ate Deterntinarions of Flows and Nitrogen Loadings I I The 440 gallons per day per acre nitrogen loading limitations imposed by 310 CMR 15.214 may be calculated in the aggregate in the following situations: (1) in identified areas within regions or communities that have submitted to the Department a plan to protect surface and ground-water supplies within the community or those designated areas from pollutant and nutrient loading and a proposed mechanism for implementing the plan and where the plan has been approved in writing by the Department. For areas that include Zone IIs or Interim Wellhead Protection areas, the plan shall include, but not be limited to, a nitrate loading plan as specified in 310 CMR 22.21(2)(4); or 3/24/95 (Effective 3/31/95) 310 CMR - 514 Town of North Andover NORT OFFICE OF I0 COMMUNITY <e'I�OL COMMUNITY DEVELOPMENT AND SERVICES ° 27 Charles Street �° North Andover, Massachusetts 01845 �9`°�.�.°•01 WILLIAM J. SCOTT SSnCHU Director (978)688-9531 Fax(978)688-9542 March 13, 2000 New England Engineering Services, Inc. 60 Beechwood Drive North Andover, MA 01845 Re: 324 Berry Street Dear Mr. Osgood: I have reviewed your letter of March 9, 2000 concerning the size of the leach field at the above site. You concluded that the soil is a class 1 soil, however,there is no information in your letter to support this conclusion. Was an unofficial percolation test done on the site? Also, please bring to your client's attention the'regulations concerning nitrogen loading limitations in 310 CMR 15.214 (1-3). Depending on the size of the lot this may limit his ability to increase the number of rooms in his dwelling. I shall be contacting DEP for direction in this area and will be in touch with you as soon as I have spoken with them Sincerely, Sandra Starr,R.S., C.H.O, Health Director Cc: E. Pedi BOH W. Scott File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 G v�� LZ& - � 0 Town of North Andover f 40RTH OFFICE OF COMMUNITY roc COMMUNITY DEVELOPMENT AND SERVICES ° . . . 27 Charles Street `►c�9 ,��; North Andover, Massachusetts 01845 �,9"°q•�.o °°�t5 WILLIAM J. SCOTT SSACHUSE Director (978)688-9531 Fax(978)688-9542 March 13, 2000 New England Engineering Services, Inc. 60 Beechwood Drive North Andover, MA 01845 Re: 324 Berry Street Dear Mr. Osgood: I have reviewed your letter of March 9, 2000 concerning the size of the leach field at the above site. You concluded that the soil is a class 1 soil, however, there is no information in your letter to support this conclusion. Was an unofficial percolation test done on the site? Also, please bring to your client's attention the'regulations concerning nitrogen loading limitations in 310 CMR 15.214 (1-3). Depending on the size of the lot this may limit his ability to increase the number of rooms in his dwelling. I shall be contacting DEP for direction in this area and will be in touch with you as soon as I have spoken with them. Sincerely, -. &V4--X E�1 Sandra Starr,R.S., C.H.O, Health Director Cc: E. Pedi BOH W. Scott File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 NEW ENGLAND ENGINEERING SERVICES INC March 9, 2000 Sandra Starr, Administrator North Andover Health Department Town Hall Annex 27 Charles Street North Andover, MA 01845 Re: 324 Berry Street,North Andover, existing septic system location Dear Sandra: This office has conducted an inspection of the septic system at the above referenced property in order to determine the size of the existing system. The results of our inspection indicate that the size of the existing system is 20' x 45' or 900 square feet. The procedure used to determine the leach field size was to locate and expose the distribution box and snake the pipes from the distribution box to determine their length. The measurements obtained are detailed on the enclosed sketch. The assumption that the pipes are equally spaced in the leach bed, and that the distance from the center of the outside pipe to the edge of the leach field is one half the spacing of the pipes was used to determine the size of the leach field. Also, it was assumed that the leach lines end two feet from the end of the leach field. The purpose of this investigation is to determine the capacity of the existing leach field. The capacity of the existing leach field can be calculated as follows: Loading rate of Class I soil with a percolation rate of 5 min/inch= 0.74 gallons per square foot. Existing system size = 900 square feet. Capacity of system= 900 square feet x 0.74 gallons per square foot= 666 gallons 60 BEECHWOOD DRIVE-NORTH ANDOVER, MA 01845-(978)686-1768-(888)359-7845=fAX(978)685-1099 -`� PAGE 2 The resultant 666 gallon capacity of the existing system would allow the current owner to add an addition to the existing dwelling with a total allowed bedroom count of 6. If you have any questions or need additional information please do not hesitate to contact this office. Sincerely, Benja C. Osgood, Jr., EIS" C'c',zT7 r/4--'' i 7-LC -!9- -S,Y&-17-7,4-4 President - 1 i p i6T Rti e E S r 3Z,Y .,--r�2cr-T I �x�s��,v G- SE�'f7c sys TF,vI 1,cC gnCA/ ?4RIV i Ivor i ID S41449 bLs:TAIQCE SG/2�'ICtS s'�V: Town of North Andover t NORTH OFFICE OF 3?o`tt 5 0 do0 COMMUNITY DEVELOPMENT AND SERVICES p 27 Charles Street ° North Andover, Massachusetts 01845 �.y`°q,.° °"�<y WILLIAM J. SCOTT SSACHUS� Director (978)688-9531 Fax (978)688-9542 March 13, 2000 New England Engineering Services, Inc. 60 Beechwood Drive North Andover, MA 01845 Re: 324 Berry Street Dear Mr. Osgood: I have reviewed your letter of March 9, 2000 concerning the size of the leach field at the above site. You concluded that the soil is a class 1 soil, however,there is no information in your letter to support this conclusion. Was an unofficial percolation test done on the site? Also, please bring to your client's attention the'regulations concerning nitrogen loading limitations in 310 CMR 15.214 (1-3). Depending on the size of the lot this may limit his ability to increase the number of rooms in his dwelling. I shall be contacting DEP for direction in this area and will be in touch with you as soon as I have spoken with them. Sincerely, .&Vz Sandra Starr,R.S., C.H.O, Health Director Cc: E. Pedi BOH W. Scott File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 NEW ENGLAND ENGINEERING SERVICES INC March 9, 2000 Sandra Starr, Administrator North Andover Health Department Town Hall Annex 27 Charles Street North Andover, MA 01845 Re: 324 Berry Street,North Andover, existing septic system location Dear Sandra: This office has conducted an inspection of the septic system at the above referenced property in order to determine the size of the existing system. The results of our inspection indicate that the size of the existing system is 20' x 45' or 900 square feet. The procedure used to determine the leach field size was to locate and expose the distribution box and snake the pipes from the distribution box to determine their length. The measurements obtained are detailed on the enclosed sketch. The assumption that the pipes are equally spaced in the leach bed, and that the distance from the center of the outside pipe to the edge of the leach field is one half the spacing of the pipes was used to determine the size of the leach field. Also, it was assumed that the leach lines end two feet from the end of the leach field. The purpose of this investigation is to determine the capacity of the existing leach field. The capacity of the existing leach field can be calculated as follows: Loading rate of Class I soil with a percolation rate of 5 min/inch=0.74 gallons per square foot. Existing system size = 900 square feet. Capacity of system= 900 square feet x 0.74 gallons per square foot= 666 gallons 60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7845 z--FAX(978)685-1099 PAGE 2 The resultant 666 gallon capacity of the existing system would allow the current owner to add an addition to the existing dwelling with a total allowed bedroom count of 6. If you have any questions or need additional information please do not hesitate to contact this office. Sincerely, �5 lZ) Benja C. Osgood, Jr., EIfY C'e",2n rrG-'r� i TLE S s 4s ,�r s2-s��c7�� President 12 17 r p iSTAAj t-E5 I .� o& y 6 t}- U6 2S Ho ) U r . , �3Zy 9,rexy siz�c_7 I G- SEPr7c sysJF,v► , ),CC,gr7Cv 31810o NL2; '/-0 Sel4iE _ t5 1'V N�i2�! R�✓�ot�Ei? it�1fF G'i�yS NEW ENGLAND ENGINEERING SERVICES INC March 9, 2000 Sandra Starr, Administrator North Andover Health Department Town Hall Annex 27 Charles Street North Andover, MA 01845 Re: 324 Berry Street,North Andover, existing septic system location Dear Sandra: This office has conducted an inspection of the septic system at the above referenced property in order to determine the size of the existing system. The results of our inspection indicate that the size of the existing system is 20' x 45' or 900 square feet. The procedure used to determine the leach field size was to locate and expose the distribution box and snake the pipes from the distribution box to determine their length. The measurements obtained are detailed on the enclosed sketch. The assumption that the pipes are equally spaced in the leach bed, and that the distance from the center of the outside pipe to the edge of the leach field is one half the spacing of the pipes was used to determine the size of the leach field. Also, it was assumed that the leach lines end two feet from the end of the leach field. The purpose of this investigation is to determine the capacity of the existing leach field. The capacity of the existing leach field can be calculated as follows: Loading rate of Class I soil with a percolation rate of 5 min/inch=0.74 gallons per square foot. Existing system size=900 square feet. Capacity of system=900 square feet x 0.74 gallons per square foot=666 gallons 60 BEECHWOOD DRIVE-NORTH ANDOVER,MA 01845-(978)686-1768-(888)359-7645-FAX(978)685-1099 PAGE 2 The resultant 666 gallon capacity of the existing system would allow the current owner to add an addition to the existing dwelling with a total allowed bedroom count of 6. If you have any questions or need additional information please do not hesitate to contact this office. Sincerely, Benja ' C. Osgood, Jr., EI President j2 'V , S�CCS ►��,\BEV- �� 9157Am CES T 121 3- D5 r V4 S E; T y► 1 1 GDG� v F 3 Z y I �ws;�•v�- sE�nc s yS rte,,,, 8 00 Nva To sel-leE I — T»STA J BGNJ'A�w �' OSUovv 12 2` ASS�Mt� i(JEw EAfLrGf/�vi� Eit/(�-/�+/EC i2 r ti�G b l s"�'RN G E 0 3G-EewW000 D�2!uz�- L T EXISTING-BRICK CHIMNEY - - - - - - - - ------ -------------- ---- ------------ - ------- --- ----------------- --- ------- --- - - - - --- - - - - ---- - - - - - - - - - - -- -- - - - - -- --- - - - -- - - - - -- - -- - ----- -- ---------- - - - - - - - - - - - - - - -- -- - - -- - - -- - ----- - - - - -- --- - - - -- - - - - --- - - - - - -- - -- --- ---- -- - - - - - -- - - - - -- - - -- - -- - -- - - --- -- - - - - - -- - - - --- - - -- -- - - - -- - -- - --- - -- --------------------------------------- --- ------- - - - - -- ---- - - - -- - --- - - - - ---- -- - -- - - - - - - ---- - - - -- - - - --- - - - -- -- -- -- - --- -- - - ------- --------- ------------------------------------------------- ------- ---- - -- - - -- -- -- - - --- -- - - - - - -- -- - - - -- - -- -- --- - -- -- - - - - -- - - -- - -- - - -- - - - - -- - - ---------------- ---- --------- ---- --- ----------- - --- -------------- - - - - - - -- - --- --- ----------------- - ----- ----- ---------------- - --------- ----- ----- -- -- - -- - - -- - - - - - - - ---- - - - - - - -- - - -- -- -- - - - - -- -- -- - -- - - - --- - - - - - -- -- - - - - - - - - -- - ---- --------------- ----- ------------ ----------- ----------------- - ------- ---- - - - - - - - - - -- - - -- -- - - -- - -- - - - -- -- - - - - - - -- - -- - -- -- - --- - -- - --- - - -- - - -- - - -- - ------------------- ----- ----- ---- ----------------- --------------- - -- - --- - -------------- ------ --------- ----- ---------------- ------- -------- --- ------- -- - - -- --- -- --- - --- -- - - - - -- --- - --- - -- - ---- - -- -- -- - - --- --- - --- --- - - -- - -- - - ------- ------------- -------------- -- --------------- -------------- -- - - - - - - -------------- ------ --------- ----- ------------------------- LH H I 00 FINISH GRADE FRONT ELEVATION OFOOTING I - N & FOUNDATION SCALE, f 4 PEDIFRONTELl 201-01 10'-0' loo-of 3 c C3cqi o A Z STORAGE U = • A c co ^O cu 7'-0' 9#_5• N cl%cl' J FAMILY ROOM X ; --� 0 2'-6' N ¢ L_ o RAILING 30 Of T,V, Nx "m ROOM M 3 W a. 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Cc ................., ..................................::::::::::::::::::::::::............C':CCC:::::::::::::::::::::::::I - ...::::::::::::::::I ............. .................... � 'EK l S'T t NG �F2tiPGc�� ASP ALT SHINGLES IP ROOF RIDGE ENT SADDLE RD EXISTING Ch� X--- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ICE/WATER MEMBRANE - - - - - - - - - - - - - - - - - -- - - - - - - - -- - - - - - -- - - - AT ALL VALLEYS - - - - - - - - - -- ---- - - - - - - ----- - - - - - - ----- ----- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - EXISTING DWELLING FINISH 2ND FLOC FINISH IST FLO MATCH SIZE OF EXISTING BASED WINDOW I FINISH GRADE CONTINUOUS POUREDVMWRET-E- FOUNDATION I _ -CON RETE FOOTING RIGHT ELEVATION SCALEi 1/4' = 1'-0' OUTLINE OF ROOF SLOPE BEYOND CATHEDRAL CEILING ROOF--LINE GUTTER HORIZONTAL SIDIN HIP ROOF PORC EXISTING KITCHEN WINDOW TO REMAIN FINISH 1ST FLOOR " NEW TREATED WOOD STAIRS L RAILING TO FINISH RADE .[***..................... ***"**""'*'**'**"""*'*'*"*""****"***'* . ............................ .......... .......... ................................................................... ......................:........'.,...,, FINISH GRADE TREATED LATTICE ORK 12' DIAMETER I P ERS POURED CONCRETE REAR ELEVATION PEDIREARELI SCALES RIDGE VENT DOUBLE HEADER REUSE EXISTING SKYLIGHTS FROM MASTER BEDROOM 2 X 10 RAFTERS AT 16' O.C. 12 4 li R-38 INSULATION 2 X 8 AT 16' D.C. R-30 INSULATION PROVIDE 1' MIN. AIR SPACE USE 'PROPA-VENTS'OR EQUAL TRANSOM WINDOW UNIT , P DOUBLE HUNG WINDOW 1/2' GWB ON 1 X 3 FURRING AT 16' O.C. FLASH DECORATIVE WOOD 1 CONTINUOUS 2 X 10 LEDGER BOARD COLLAR TIES 1__ SECURE LEDGER BD. TO FRAMING MEMBERS IN WALL 3/4' TBG PLYWOOD NAIL a GLUE TO FRAMING • _ FINISH 2ND FLOOR • 11 7/8' TJI/25 AT 12. O.C. TYPICAL EXTERIOR WALL► CONTINUOUS HORIZONTAL WOOD SIDING DOUBLE 2 X 8 TYVEK OR EQUAL BUILDING WRAP 1/2' CDX PLYWOOD SHEATING 2 X 6 STUDS AT 16' O.C. R-19 FIBERGLAS INSULATION WOOD RAILING FINISHED WOOD POLY VAPOR BARRIER CEILING 1/2' GYPSUM WALLBOARD % N FINISH IST FLOOR TREATED WOOD STRINGERS WEATHER RESISTANT 11 7/8' TJI/25 AT 12. O.C. 2 X 6 AT 16. O.C. WOOD ECKING -19 INSULATION (6'--FIBERGLAS) FLASH L TREATED 2 X 8 SLOPE 1e. FINISH GRADE FINISH GRADE 4' CONCRETE LAB z z 0'-10' •: ------------- 0'-5' 12' DIA. POURED °D CONCRETE PIERS, : • . . :....... .. `. SECURE TREATED 4 X 4 USING GALVANIZEPOSTS COMPACAT'ED GRANULAR BASE c 1'-8' 0 TYPICAL CROSS SECTION SCALEi 1/4' = 1'-0' e, i -- 107 Forest St. FILE#� Middleton,MA 01949 (508)7742772 SEPTIC & DRAIN SERVICE SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PROPERTY OWNER'S NAME: PROPERTY ADDRESS: ,- 2q l�err�� Sf Al h)al6ver ADDRESS OF OWNER: (if different) DATE OF INSPECTION: Mia lL 9 9�j NAME OF INSPECTOR: Tf OIMAS r •THE PROFESSIONAL EXPERTS IN THE SEPTIC AND DRAIN INDUSTRY • COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION J 9N ONE WINTER STREET, BOSTON MA 02108 (617)292-5500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI Governor DAVID B. STRUHS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner PART A CERTIFICATION ' Property Address:3 �f &err ,,��11 ,, J �7 St �V' �i/�(JVer Name of owner_. h7 . Date of Inspection: % J �/ Address of Owner: Name of Ins pectora!Please Print):��rspantto 1amaDEP provedsyction 15,340 of Title 5(310 CMR 15.000) Company Name: Mailing Address: J Telephone Number: - ZZ -27-12 CERTIFICATION STATEMENT ! r 1 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 inspection. The inspection was performed based on my training and experience in the proper function and. maintenance of on-site sewage disposal systems. The system: Passes Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: 4V5 Date: 11477 The System Inspector shall submit a copof this inspection report to the Approving Authority(Board of Health or DEP)within thirty(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 Department of,Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable, and the approving authority. . NOTES AND COMMENTS i i i i • I revised 9/2/98 Page iorlt itPrinled on Recycled Paper 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION,FORM PART A CERTIFICATION(continued) Property Address: 3,Zy �3crrf s� Owner: �q�� ; Date of Inspection: �� 9� i INSPECTION SUMMARY: Check A, B, C, o/ A A. SYSTEM PASSES: I I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass"section need to be;replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health, will pass. Indicate yes no,or not determined(Y, N, or NO). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of 40 Compliance lattached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is,cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with'a complying septic tank as approved by the Board of Health. i tX- Sewage backup or breakout or high static water level observed in the distribution'box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pa s i action if 4with approval of the Board of Health)• (jaut �Ctfl Nt° S �� broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced JD-Box �s ,n p04 0, 6�„d 1p)fl - The system'required pumping more than four times a year due to b oke an obsttrGcted pipe(s). The system will pass! Inspection if(v�rith approval of the Board of Health): �/ broken pipe(s)are replaced obstruction is removed I� 1 i I I 1 f revised 9/2/98 Page 2of11 • t � SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner: , Date of Inspection C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: I Conditions exist which require further evaluation by the Board of Health in order to determine;if the system is failing to protect the public health,safety and 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 THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or pnvy is within 50 feet of a bordering vegetated wetland or a salt marsh. i I I 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 AND SAFETY AND THE 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. ! . Aff-f-v - The system has a septic tank'and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feat or more from a private water supply well, unless'a well water analysis for coliform bacteria and volatile organic compounds indicates that the well Is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). i 3) OTHER i ' t � revised 9/2/98 Page 3of11 i i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ' CERTIFICATION(continued) 1 i Property Address:,3z7 . Rerry s L owner: 1 Date of Inspection: 5 D. YSTEM FAILS: Yo ust indicate either"Yes" or"No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No/ . Backup of sewage into facility or system component-due to an overloaded or-clogged-SAS or-cesspool. I 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 1/2 day flow. _�• Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). / Number of times pumped V Any portion of the Soil Absorption System,cesspool or privyis below the high groundwater elevation. 9 Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. i /L Any portion of a cesspool or privy is within a Zone I of a public well. /JLC 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for -coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. 1 E. GE SYSTEM FAILS: You must icate either"Yes" or "No" to each of the foil ing: The lowing criteria apply to large systems i ddition to the criteria above: The syste serves a facility with a desig low of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and sa ty and the environmen ecause one or more of the following conditions exist: Yes No the system is i in 400 feet of a surface drinking water supply the system' withi 200 feet of a tributary to a surface drinking water supply •-•• - the s em is located in nitrogen sensitive area(Interim Wellhead Protection Area=IWPA)or a mapped Zone II of a public we r supply well) The owner or ope for of any such system shall up ade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the D artment for further information. i revised 9/2/98 Page 4of11 j SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST ! Property Address:3z 7 3err y S t Owner: Date of Inspection 'r yeg Check if the following have been done:You must indicate either "Yes" or"No" as to each of the following: Ye�v' No _ Pumping information was provided by the owner, occupant,or Board of Health. _ None of the system components have been pumped4orat4east'two weeks and s rates during that period. Large volumes of water have not been introduced into i hesystemsternhecently or aas-been- s part ving of this)flow Inspection. _ As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. _. The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. _ All system/ components,excluding the Soil Absorption p System,have been located on the site. —/ The septic tank manholes were uncovered, opened,and the interior of the septicAank was inspected for condition of baffles or tees,material of construction, dimensions,depth of liquid,depth of sludge,depth of scum. The size and location of the Soil Absorption System on-the site has been determined based on: _ Existing information. For example, Plan at B.O.H. _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation pp mation of distance is unacceptable) [15.302(3)(b)] The facility owner(and occupants,if different from,owner), rovi SubSurface Disposal Systems. p ded.wih information.on.the.properm�ntan �f I I ' I i i revised 9/2/98 i Page 5 of 11 , i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION 'roPerty Address:32y Berry s owner: I Date of Inspection RESIDENTIAL. FLOW CONDITIONS Design flow: g,p,d/bedro m. Number of bedrooms de ign): Number of bedrooms(actual): Total DESIGN flow Number of current residents: 21 Garbagegrinder(yes or no): Laundry(separate system) .(yes or no):Ab; If yes, separate inspection-required Laundry system inspected yes or no) Seasonal use(yes or no): Water meter readings,if available(last two year's usage(gpd): Sump Pump(yes or no): ��Q n ) �' i 23 Qwac I SA S Last date of occupancy: +' MMERCIAL/INDUSTRIAL: Ty of establishment: Design ow: gpd (B sed on 15.203) Basis of ign flow Grease trap sent:(yes or no) , Industrial Wast olding Tan resent:(yes or no)_ Non-sanitary wast ischar ed to the Title 5 system:(yes or no) Water meter readings,'f ailable: Last date of occupanc . OTHER:(Describe Last date of occ pancy: GENERAL INFORMATION PUMPING RECORDS and source of information: �- System pumped as part of inspection (yes or no) / If yes, volume pumped:' — gallons Reason for pumping: TYQE 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 I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed(if known)-and source of-information: .- Sewage odors detected when arriving at the site:(yes or no) I I i revised 9/2/98 Page 6 of 11 i i I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: I Date of Inspection:sA�99 BUILDING SEWER: (Locate on site plan) Depth below grade: Material of construction:-2/cast iron_40 PVC_other(explain) Distance from plivate water supply well or suction line Diameter Comme ( nd' o f joints,venting, eviden, of leakage C) e ©c o 0 SEPTIC TANK:AFT (locate on site an) r� Depth below grader Material of construction: concrete_metal_Fiberglass _Polyethylene_other(explain) If lank is metal,list age Js.age.confirmed by Certificate of Compliance — (Yes/No) Dimensions:G�,Z(3/7/X S LV WTL'Elr 1,9VF'L 0 1'W J01 Sludge depth: f,'r Distance from top of sludge to bottom of outlet tee orbaffle:_AIA Scum thickness:_?G Distance from top of scum to top of outlet tee or baffle: /(/A Distance from bottom of scum to bo 0 of outl t ntee,'or�affle: 6 How dimensions were determined:`������e ry Pr Comments: (recommendation for pumpin c ndition of inlet nd outlet to s or ba es, epth of liquid lev I i rel 'o utiet nvert,structural integrity, evi n e f leakage etc.) j ,. D Pei GREASE TRAP• ' cate on site plan) Depth slow grade: . Material f construction/Concrete_metal_Fiberglass _Polyethylene_other(explain) Dimensions: Scum thickness. Distance from to f scum to top of outlet tee or baffle: Distance from b tto of scum to bottom of outlet tee or baffle: Date of last p ping: Comment . (recom ndation for.pumping, ndition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, evide a of leakage,etc.) " I revised 9/2/98 Page 7of11 • I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Q Property Address: `•'2 &r�('ls� Ped, Owner: ,, Date of Inspection.S '/?/- 99 GHT OR HOLDING TANK: (Tank must a pumped prior to, or at time of, inspection) floc to on site plan) Depth b w grade:_ Material o onstruction:_concrete_metal„_Fiberglass_Polyethylene_,other(explain) Dimensions: Capacity: gal s Design flow: allons/day Alarm present Alarm level: A m in working order:Yes No Date of previous umping: _ — Comments: (condition o inlet tee,condition alarm and float switches,etc.) DISTRIBUTION BOX:/e rnenS I oat S (o•X !��� (locate on site plan) _1 , 241 Depth of liquid level above outlet invert:_ ,omments: (note if level and distrilaption is equal, eviden of soli s car yo er evidence of I kage irlto or out ofbox t ir _. Y BER: e plan) rking Ord :(Yes.or No) rking er(Yes or No) o f pump chamber,condition of pumps and appurtenances,etc.) I i i i revised 9/2/98 Page 8 of 11 f • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) hoperty Address: Peon' Owner: , Date of Inspection: SOIL ABSORPTION SYSTEM(SAS) (locate on site plan,if possible;exca ation not required,location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits,number:_ leaching chambers,number:_ leaching galleries,number:_ leaching trenches,number,length: leaching fields, number,dimensions: QW x 301L overflow cesspool,number:_ i Alternative system: Name of Technology: Comments: snot co dition•of soil, signs of hydraulic failure,le el of pon 'n , damp soil, co dition of vegetation, etc.) f There CESSPOOLS ( ate on site plan) Numbe nd configuratio Depth-top liquid to i et invert: Depth of soli layer. Depth of scum I e Dimensions of ce ol: Materials of co tructj : Indication of oundwate in w(cesspool st be pumped as part of inspection) Com ants: (n a condition of soil,signs of hydrauli failure,level of ponding, condition of vegetation, etc.) I V*5ds: e plan) onstr tion: Dimensions: s:o oil;signs of hydraulic failure,level of ponding, condition of vegetation;etc.) I. I i revised 9/2/98 Page 9of11 f • • 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ` 1 SYSTEM INFORMATION(continued) 'roperty Address:,-Zi v SL Owner: �J Date of Inspection?eA SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supplyco s into use) %% � 1 � J low � C Y4 I I I A NDUSP, r � j root JUL o� 12- -Berry A � T-) I _,�6 , revised 9/2/98 Page 10 of 11 well kA -/V Y 1 � c- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropertyAddress."32y &ffy st Owner: t' J Date of Inspection: 3 NRCS Report name A. Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep _ SITE EXAM Slope F14� S1�r tcCe , Surface water pVpn Check Cellar Y�Si�r t/ Shallow wells a /•y/ �( Estimated Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed.Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions Checked_with local Board of health Ves Checked FEMA Maps Checked pumping records Checked local excavators,installers Used USGS Data Describe how you established the High Groundwater Elevation. {Must be completed) `T�>°- d' '�����, /yd s�� �'� � • �se�c��, Q sa Aiq A) y b�tfil �ro�e t.�!js- w{ , ik) Na we,414 or xu9/,Sh�s w i��r*! y , revised 9/2/98 Page norn f 107 FOREST STREET FILE# 3059A MIDDLETON,MA 01949 (978)774-2772 SEPTIC & DRAIN CURRlEA-t'-..',-".... SERVICE SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PROPERTY OWNER'S NAME: PEDI PROPERTY ADDRESS: 324 BERRY ST. NORTH ANDOVER, MA ADDRESS OF OWNER: SAME (IF DIFFERENT) DATE OF INSPECTION: MARCH 5,1999 -1O N OF f ORTH ANDOVER/ BOARD OF HEALTH NAME OF INSPECTOR: THOMAS J. CHIGAS 61999 * THE PROFESSIONAL EXPERTS IN THE SEPTIC AND DRAIN INDUSTRY f 107 FOREST STREET FILE# 30599A MIDDLETON,MA 01949 (978)774-2772 SEPTIC&DRAIN SERVICE SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION PROPERTY ADDRESS:324 BERRY ST. NAME OF OWNER: PEDI NORTH ANDOVER,MA ADDRESS OF OWNER: SAME DATE OF INSPECTION: MARCH 5,1999 NAME OF INSPECTOR: (PLEASE PRINT)THOMAS J. CHIGAS I AM A DEP APPROVED INSPECTOR PURSUANT TO SECTION 15.340 OF TITLE 5 (3 10 CMR 15.000) COMPANY NAME: CURRIER SEPTIC & DRAIN MAILING ADDRESS: 107 FOREST STREET; MIDDLETON MA 01949 TELEPHONE NUMBER: 978 774-2772 CERTIFICATION STATEMENT I CERTIFY THAT I HAVE INSPECTED THE SEWAGE DISPOSAL SYSTEM AT THIS ADDRESS AND THAT THE INFORMATION REPORTED BELOW IS TRUE,ACCURATE AND COMPLETE AS OF THE TIME OF INSPECTION. THE INSPECTION WAS PREFORMED BASED ON MY TRAINING AND EXPERIENCE IN THE PROPER FUNCTION AND MAINTENANCE OF ON-SITE SEWAGE DISPOSAL SYSTEM. THE SYSTEM: YES PASSES CONDITIONALLY PASSES NEEDS FURTHER EVALUATION BY THE LOCAL APPROVING AUTHORITY FAILS INSPECTOR'S SIGNATURE: DATE: MARCH 5,1999 THE SYSTEM INSPECTOR SHALL SUBMIT A COPY OF THIS INSPECTION REPORT TO THE APPROVING AUTHORITY(BOARD OF HEALTH OR DEP) WITHIN THIRTY(30)DAYS OF COMPLETING THIS INSPECTION. IF THE SYSTEM IS A SHARED SYSTEM OR HAS A DESIGN FLOW OF 10,000 GALLON GPD OR GREATER,THE INSPECTOR AND THE SYSTEM OWNER SHALL SUBMIT THE REPORT TO THE APPROPRIATE REGIONAL OFFICE OF THE DEPARTMENT OF ENVIRONMENTAL PROTECTION. THE ORIGINAL SHOULD BE SENT TO THE SYSTEM OWNER AND COPIES SENT TO THE BUYER,IF APPLICABLE,AND THE APPROVING. NOTES AND COMMENTS: MARCH 5,1999 REVISED 9/2/98 PAGE 1 OF 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) PROPERTY ADDRESS:324 BERRY ST. OWNER:PEDI DATE OF INSPECTION:MARCH 5.1999 INSPECTION SUMMARY: CHECK tO B, C, OR D: A. SYSTEM PASSES: YES I HAVE NOT FOUND ANY INFORMATION,WHICH INDICATES THAT ANY OF THE FAILURE CONDITIONS DESCRIBED IN 310 CMR 15.303 EXIST. ANY FAILURE CRITERIA NOT EVALUATED ARE INDICATED BELOW. COMMENTS:D-BOX AND OUTLET TEE W/GAS BAFFLE REPLACED BY CURRIER SEPTIC WORK WAS CHECKED BY THE HEALTH DEPT. B. SYSTEM CONIDTIONALLY PASSES: N 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. INDICATE YES,NO,OR NOT DETERMINED(Y,N,OR ND). DESCRIBE BASIS OF DETERMINATION IN ALL INSTANCES. IF"NOT DETERMINED",EXPLAIN WHY NOT. N THE SEPTIC TANK IS METAL,UNLESS THE OWNER OR OPERATOR HAS PROVIDED THE SYSTEM INSPECTOR WITH A COPY OF A CERTIFICATE OF COMPLIANCE(ATTACHED)INDICATING THAT THE TANK WAS INSTALLED WITHIN TWENTY(20)YEARS PRIOR TO THE DATE OF THE INSPECTION;OR THE SEPTIC TANK,WHETHER OR NOT METAL, IS CRACKED, STRUCTURALLY UNSOUND, SHOWS SUBSTANTIAL INFILTRATION OR EXFILTRATION,OR TANK FAILURE IS IMMINENT. THE SYSTEM WILL PASS INSPECTION IF THE EXISTING SEPTIC TANK IS REPLACED WITH A COMPLYING SEPTIC TANK AS APPROVED BY THE BOARD OF HEALTH. N SEWAGE BACKUP OR BREAKOUT OR HIGH STATIC WATER LEVEL OBSERVED IN THE DISTRIBUTION BOX IS DUE TO BROKEN OR OBSTRUCTED PIPE(S)OR DUE TO A BROKEN, SETTLED OR UNEVEN DISTRIBUTION BOX. THE SYSTEM WILL PASS INSPECTION IF(WITH APPROVAL OF THE BOARD OF HEALTH). N BROKEN PIPE(S)ARE REPLACED N OBSTRUCTION IS REMOVED N DISTRIBUTION BOX IS LEVELLED OR REPLACED N THE SYSTEM REQUIRED PUMPING MORE THAN FOUR TIMES A YEAR DUE TO BROKEN OR OBSTRUCTED PIPE(S). THE SYSTEM WILL PASS INSPECTION IF(WITH APPROVAL OF THE BOARD OF HEALTH): N BROKEN PIPE(S)ARE REPLACED N OBSDTRUCTION IS REMOVED REVISED 9/2/98 PAGE 2 OF 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) PROPERTY ADDRESS:324 BERRY ST. OWNER:PEDI DATE OF INSPECTION:MARCH 5.1999 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: N CONDITIONS EXIST WHICH REQUIRE FURTHER EVALUATION BY THE BOARD OF HEALTH IN ORDER TO DETERMINE IF THE SYSTEM IS FAILING TO PROTECT THE PUBLIC HEALTH, SAFETY AND 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 THE PUBLIC HEALTH AND SAFETY AND THE ENVIRNONMENT: N/A CESSPOOL OR PRIVY IS WITHIN 50 FEET OF SURFACE WATER N/A CESSPOOL OR PRIVY IS WITHIN 50 FEET OF A BORDERING VEGETATED WETLAND OR A SALT MARSH. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER, IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: N THE SYTEM 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. N THE SYTEM HAS A SEPTIC TANK AND SOIL ABSORPTION SYSTEM AND THE SAS IS WITHIN A ZONE I OF PUBLIC WATER SUPPLY WELL. N THE SYSTEM HAS A SEPTIC TANK AND SOIL ABSORPTION SYSYTEM AND THE SAS IS WITHIN 50 FEET OF A PRIVATE WATER SUPPLY WELL. N THE SYSTEM HAS A SEPTIC TANK AND SOIL ABSORPTION SYSYTEM AND THE SAS IS LESS THAN 100 FEET BUT 50 FEET MORE FROM A PRIVATE WATER SUPPLY WELL, UNLESS A WELL WATER ANALYSIS FOR COLIFORM BACTERIA AND VOLATILE ORGANIC COMPOUNDS NDICATES THAT THE WELL IS FREE FROM POLLUTION FROM THAT FACILITY AND THE PRESENCE OF AMMONIA NITROGEN AND NITRATE NITROGEN IS EQUAL TO OR LESS THAN 5 PPM. METHOD USED TO DETERMINED DISTANCE (APPROXIMATION NOT VALID). 3) OTHER: N/A REVISED 9/2/98 PAGE 3 OF 11 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) PROPERTY ADDRESS: 324 BERRY ST. OWNER:PEDI DATE OF INSEPCTION:MARCH 5.1999 D. SYSTEM FAILS: YOU MUST INDICATE EITHER"YES"OR"NO"TO EACH OF THE FOLLOWING: N I HAVE DETERMINED THAT ONE OR MORE OF THE FOLLOWING FAILURE CONDITIONS EXIST AS DESCRIBED IN 310 CMR 15.303. THE BASIS FOR THIS DETERMINATION IS IDENTIFIED BELOW. THE BOARD OF HEALTH SHOULD BE CONTRACTED TO DERTERMINE WHAT WILL BE NECESSARY TO CORRECT THE FAILURE. YES NO N BACKUP OF SEWAGE INTO FACILITY OR SYSTEM COMPONENT DUE TO AN OVERLOADED OR CLOGGED SAS OR CESSPOOL. N DISCHARGE OR PONDING OF EFFLUENT TO THE SURFACE OF THE GROUND OR SURFACE WATERS DUE TO AN OVERLOADED OR CLOGGED SAS OR CESSPOOL. N STATIC LIQUID LEVEL IN THE DISTRIBUTION BOX ABOVE OUTLET INVERT DUE TO AN OVERLOADED OR CLOGGED SAS OR CESSPOOL. N/A LIQUID DEPTH IN CESSPOOL IS LESS THAN 6' BELOW INVERT OR AVAILABLE VOLUME IS LESS THAN '/z DAY FLOW. N REQUIRED PUMPING MORE THAN 4 TIMES IN THE LAST YEAR NOT DUE TO CLOGGED OR OBSTRUCTED PIPE(S). NUMBER OF TIMES PUMPED N ANY PORTION OF THE SOIL ABSORPTION SYSTEM,CESSPOOL OR PRIVY IS BELOW THE HIGH GROUNDWATER ELEVATION. N/A ANY PORTION OF A CESSPOOL OR PRIVY IS WITHIN 100 FEET OF A SURFACE WATER SUPPLY OR TRIBUTARY TO A SURFACE WATER SUPPLY. N/A ANY PORTION OF A CESSPOOL OR PRIVY IS WITHIN A ZONE I OF A PUBLIC WELL. N/A ANY PORTION OF A CESSPOOL OR PRIVY IS WITHIN 50 FEET OF A PRIVATE WATER SUPPLY WELL. N/A ANY PORTION OF A CESSPOOL OR PRIVY IS LESS THAN 100 FEET BUT GREATER THAN 50 FEET FROM A PRIVATE WATER SUPPLLY WELL WITH NO ACCEPTABLE WATER QUALITY ANALYSIS. IF THE WELL HAS BEEN ANALYZED TO BE ACCEPTABLE,ATTACH COPY OF WELL WATER ANALYSIS FOR COLIFORM BACTERIA,VOLATILE ORGANIC COMPOUNDS,AMMONIA NITROGEN AND NITRATE NITROGEN. E. LARGE SYSTEM FAILS: U MUST INDICATES EITHER"YES"OR"NO"TO EACH OF THE FOLLOWING: THE FOLLOWING CRITRTIA APPLY TO LARGE SYSTEMS IN ADDIT TO THE CRTERIA ABOVE: N THE S M SERVES A FACILITY WITH A DESIGN FL��LTHAN661'SAFETY 00 GPD OR GREATER(LARGE SYSTEM) AND THE SYSTEM SIGNIFICANT THREAT TO PUBLIC AND THE ENVIRONMENT BECAUSE ONE OR MO THE FOLLOWING COND NS EXIST: YES NO THE SYSTEM IS WIT EET OF A SURFACE DRINKING WATER SUPPLY THE SYSTEM I THIN 200 FE F A TRIBUTARY TO A SURFACE DRINKING WATER SUPPLY THE SYS S LOCATED IN A NITRO SENSITIVE AREA(INTERIM WELLHEAD PROTECTION AREA-IWP A MAPPED ZONE 11 OF A PUBLIC TER SUPPLY WELL THE 0 OR OPERATOR OF ANY SUCH SYSTEM SHALL UPGRAD HE SYSTEM IN ACCORDANCE WITH 310 CM .304(2).PLEASE CONSULT THE LOCAL REGIONAL OFFICE OF THE ARTMENT FOR FURTHER FORMATION. REVISED 9/2/98 PAGE 4 OF i I SUBSURFACE SEWAGE DISPOSAL SYSTEM INPSECTION FORM PART B CHECKLIST PROPERTY ADDRESS:324 BERRY ST. OWNER:PEDI DATE OF INSPECTION:MARCH 5,1999 CHECK IF THE FOLLOWING HAVE BEEN DONE: YOU MUST INDICATE EITHER"YES"OR"NO"AS TO EACH OF THE FOLLOWING: YES NO Y PUMPING INFORMATION WAS PROVIDED BY THE OWNER, OCCUPANT, OR BOARD OF HEALTH. Y NONE ON THE SYSTEM COMPONENTS HAVE BEEN PUMPED FOR AT LEAST TWO WEEKS AND THE SYSTEM HAS BEEN RECEIVING NORMAL FLOW RATES DURING THAT PERIOD. LARGE VOLUMES OF WATER HAVE NOT BEEN INTRODUCED INTO THE SYTEM RECENTLY OR AS PART OF THIS INSPECTION. N/A AS BUILT PLANS HAVE BEEN OBTAINED AND EXAMINED.NOTE IF THEY ARE NOT AVAILABLE WITH N/A. Y THE FACILITY OR DWELLING WAS INSPECTED FOR SIGNS OF SEWAGE BACK-UP. Y THE SYSTEM DOES NOT RECEIVE NON-SANITARY OR INDUSTRIAL WASTE FLOW. Y THE SITE WAS INSPECTED FOR SIGNS OF BREAKOUT. Y ALL SYSTEM COMPONENTS,EXCLUDING THE SOIL ABSORPTION SYSTEM HAVE BEEN LOCATED ON THE SITE. Y THE SEPTIC TANK MANHOLES WERE UNCOVERED, OPENED,AND THE INTERIOR OF THE SEPTIC TANK WAS INSPECTED FOR CONDITION OF BAFFLES OR TEES, MATERIAL OF CONSTRUCTION, DIMENSIONS,DEPTH OF LIQUID, DEPTH OF SLUDGE, DEPTH OF SCUM. THE SIZE AND LOCATION OF THE SOIL ABSORPTION SYSTEM ON THE SITE HAS BEEN DETERMINED BASED ON: Y EXISTING INFORMATION. FOR EXAMPLE,PLAN AT B.O.H. Y DETERMINED IN THE FIELD(IF ANY OF THE FAILURE CRITERIA RELATED TO PART C IS AT ISSUE, APPROXIMATION OF DISTANCE IS UNACCEPTABLE) [15.302(3)(b)] Y THE FACILITY OWNER(AND OCCUPANTS, IF DIFFERENT FROM OWNER)WERE PROVIDED WITH INFORMATION ON THE PROPER MAINTENANCE OF SUBSURFACE DISPOSAL SYSTEMS. REVISED 9/2/98 PAGE 5 OF 1 I SUBURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION PROPERTY ADDRESS:324 BERRY ST. OWNER:PEDI DATE OF INSPECTION:MARCH 5.1999 FLOW CONDITIONS RESIDENTIAL: DESIGN FLOW: 440 G.P.D./BEDROOM. NUMBER OF BEDROOMS(DESIGN):4 NUMBER OF BEDROOMS(ACTUAL):4 TOTAL DESIGN FLOW:440 NUMBER OF CURRENT RESIDENTS: 2 GARBAGE GRINDER(YES OR NO):NO LAUNDRY(SEPARATE SYSTEM)(YES OR NO):NO;IF YES, SEPARATE INSPECTION REQUIRED LAUNDRY SYSTEM INPECTED(YES OR NO):NO SEASONAL USE(YES OR NO):NO WATER METER READINGS,IF AVAILABLE(LAST TWO YEAR'S USAGE(GPD): WELL ON SIGHT. SUMP PUMP(YES OR NO):NO LAST DATE OF OCCUPANCY: CURRENT MERCIAL/INDUSTRIAL: TYPE ESTABLISHMENT: DESIGN FL GPD(BAESED ON 15.203) BASIS OF DESIG OW: GREASE TRAP PRESE YES OR NO): INDUSTRAIL WASTE HOLD TAN SENT(YES OR NO): NON-SANITARY WASTE DISCH D TO THE TITLE 5 SYSTEM(YES OR NO): WATER METER REDAING AVAILA LAST DATE OF OCC CY: OTHER CRIBE): LA ATE OF OCCUPANCY: GENERAL INFORMATION PUMPING RECORDS AND SOURCE OF INFORMATION: SYSTEM PUMPED AS PART OF INSPECTION(YES OR NO):NO IF YES,VOLUME PUMPED: 1500 GALLONS REASON FOR PUMPING: REPLACEMENT OF D-BOX AND OUTLET TEE. TYPE OF SYSTEM YES SEPTIC TANK/DISTRIBUTION BOX/SOIL ABSORPTION SYSTEM N SINGLE CESSPOOL N OVERFLOW CESSPOOL N PRIVY N SHARED SYSTEM(YES OR NO)(IF YES,ATTACH PREVIOUS INSPECTION RECORDS, IF ANY) N UA TECHNOLOGY ETC.ATTACH COPY OF UP TO DATE OPERATION AND MAINTENANVE CONTRACT TIGHT TANK COPY OF DEP APPROVAL OTHER:N/A APPROXIMATE AGE OF ALL COMPONENTS,DATE INSTALLED(IF KNOWN)AND SOURCE OF INFORMATION: 15 YRS;OWNER SEWAGE ODORS DETECTED WHEN ARRIVING AT THE SITE(YES OR NO):NO REVISED 9/2/98 PAGE 6 OF 11 SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART C SYSTEM INFORMATION(CONTINUED) PROPERTY ADDRESS:324 BERRY ST. OWNER:PEDI DATE OF INSPECTION:MARCH 5.1999 BUILDING SEWER: (LOCATE ON THE SITE PLAN) DEPTH BELOW GRADE: 9" MATERIAL OF CONSTRUCTION: YES CAST IRON 40 PVC OTHER(EXPLAIN) DISTANCE FROM PRIVATE WATER SUPPLY WELL OR SUCTION LINE: 123' DIAMETER:4" COMMENTS: (CONDITION OF JOINTS,VENTING,EVIDENCE OF LEAKAGE,ETC.) NO SIGNS OF LEAKAGE IN OR OUT SOILS WERE CLEAN AN DRY. SEPTIC TANK: YES (LOCATE ON SITE PLAN) DEPTH BELOW GARDE:2" MATERIAL OF CONSTRUCTIOMYESCONCRETE METEL FIBERGLASS POLYETHYLENE OTHER (EXPLAIN): IF TANK IS METAL, LIST AGE N/A IS AGE CONFIRMED BY CERTIFICATE OF COMPLIANCE(YESINO) DIMENSIONS: 101 X 5'W X 5'H OUTLET INVERT @ 4'4"= 1500 GAL SLUDGE DEPH:N/A DISTANCE FROM TOP OF SLUDGE TO BOTTOM OF OUTLET TEE OR BAFFLE:N/A SCUM THICKNESS:N/A DISTANCE FROM TOP OF SCUM TO TOP OF OUTLET TEE OR BAFFLE:N/A DISTANCE FROM BOTTOM OF SCUM TO BOTTON OF OUTLET TEE OR BAFFLE:N/A HOW DIMENSIONS WERE DETERMINED: COMMENTS: (RECOMMENDATION FOR PUMPING, CONDITION OF INLET AND OUTLET TEES OR BAFFLES, DEPTH OF LIQUID LEVEL IN REALTION TO OUTLET INVERT,STRUCTURAL INTEGRITY,EVIDENCE OF LEAKAGE, ETC.)THE TANK WAS PUMPED @ TIME OF REPAIR NO SIGNS OF LEAKAGE IN OR OUT INLET TEE BAFFLE IS IN GOOD CONDITION,THE OUTLET WAS REPLACED WITH SCH 40 TEE BAFFLE THE LIQUID LEVELIS n NORMAL HIGHT THE STRUCTURAL INTEGRITY IS IN FAIR CONDITION. ASE TRAP: N_ (LOCA N SITE PLAN) DEPTH BELOW E: MATERIAL OF CONST ION: CONCRETE ME FIBERGLASS POLYETHLENE OTHER (EXPLAIN) DIMENSIONS: SCUM THICKNESS: DISTANCE FROM TOP OF SCUM T P OF OU TEE OR BAFFLE: DISTANCE FROM BOTTOM CUM TO BOTTON OF LET TEE OR BAFFLE: DATE OF LAST PUMP COMME ( MENDATION FOR PUMPING,CONDITION OF INLET AND OUTLET TE BAFFLES, DEPTH OF LIQUID EVEL IN REALTION TO OUTLET INVERT, STRUCTURAL INTEGRITY,EVIDENCE O KALE,ETC.) REVISED 9/2/98 PAGE 7 OF 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(CONTINUED) PROPERTY ADDRESS:324 BERRY ST. OWNER:PEDI DATE OF INSPECTION:MARCH 5,1999 M_HT OR HOLDING TANK: N_(TANK MUST BE PUMPED PRIOR TO,OR AT TIME OF, INSPECTION) (LOCA ON SITE PLAN) DEPTH BELOW G E: MATERIAL OF CONSTRU N: CONCRETE METAL FIBERG POLYETHYLENE OTHER (EXPLAIN) DIMENSIONS: CAPACITY: GALLONS DESIGN FLOW: GALLONS/DAY ALARM PRESENT: ALARM LEVEL: A IN WORKING ORDER: YES DATE OF PREVIO UMPING: COMMEN . (CO ION OF INLET TEE, CONDITION OF ALRM AND FLOAT SWITCHES,ETC.) DISTRIBUTION BOX: YES (LOCATE ON SITE PLAN) DEPTH OF LIQUID LEVEL ABOVE OUTLET INVERT: 0" DEPTH BELOW GRADE: 24" COMMENTS: (NOTE IF LEVEL AND DISTRIBUTION IS EQUAL,EVIDENCE OF SOLIDS CARRYOVER,EVIDENCE OF LEAKAGE INTO OR OUT OF BOX,ETC.) D-BOX WAS REPLACED,WITH 6 OUTLET H-10 LOADING . CHAMBER: N_ 7(NO ON SITE PLAN) IN WORK (YES OR NO): MS IN WO O (YES OR NO): ENT ONDITIONS OF PUMP CHAMB ONDITION OF PUMPS AND APPURTENANCES, ETC.) REVISED 9/2/98 PAGE 8 OF I 1 a ` SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(CONTINUED) PROPERTY ADDRESS:324 BERRY ST. OWNER:PEDI DATE OF INSPECTION:MARCH 5,1999 SOIL ABSORPTION SYSYEM(SAS): YES (LOCATE ON SITE PLAN,IF POSSIBLE;EXCAVATION NOT REQUIRED,LOCATION MAY BE APPROXIMATED BY NON-INTRUSIVE METHODS) IF NOT LOCATED,EXPLAIN: TYPE: LEACHING PITS,NUMBER: LEACHING CHAMBERS,NUMBER: LEACHING GALLERIES,NUMBER: LEACHING TRENCHES,NUMBER,LENGTH: LEACHING FIELDS,NUMBER,DIMENSIONS: 1 LEACHBED 20'W X 301 OVERFLOW CESSPOOL,NUMBER: ALTERNATIVE SYSTEM: NAME OF TECHNOLOGY: COMMENTS: (NOTE CONDITION OF SOIL,SIGNS OF HYDRAULIC FAILURE,LEVEL OF PONDING,DAMP SOIL,CONDITION OF VEGETATION,ETC.) THERE WAS NO SIGNS OF HYDRAULIC FAILURE THE SOILS AROUND S.A.S. IS CLEAN DRY.THE YARD SHOWS NO SIGNS OF WETLAND VEGETATION.THE SANDY SOILS IN FIELD WERE CLEAN DRY. POOL: N_ (LOCA N SITE PLAN) NUMBER AND CO GURATION: DEPTH-TOP OF LIQUID LET INVERT: DEPTH OF SOILD LAYER. DEPTH OF SCUM LAYER: DIMENSIONS OF CESSPOOL: MATERIALS OF CONSTRUCT INDICATION OF GRO ATER: INFLOW SPOOL MUST BE PUMPED AS PAR INSPECTION) COMMENTS: (NOTE CONDITION OF SOIL, SIGNS OF HYDRAULIC FAILURE,LEVEL OF PONDING,CONDITI N OF VEGETATION,ETC.) Y:N_ (LOCA SITE PLAN) MATERIALS OF CONST ION: NSIONS: DEPTH SOLIDS: COMMENTS: (NOTE CONDITION 0 L,SIGNS OF HYDRAULIC F LEVEL OF PONDING,CONDITION OF VEGETATION,ETC.) REVISED 9/2/98 PAGE 9 OF 11 O SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 'roperty Address:,&?�/ Fed J SZ Owner: ?e�1_)i Date of Inspection. SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into tiquse) l� C c 0° - fA tla�se ' Je' i 0 �w� 4-n T i Irz revised 9/2/98 Page 10 of 11 Lc'4C'll SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(CONTINUED) PROPERTY ADDRESS:324 BERRY ST. OWNER:PEDI DATE OF INSPECTION:MARCH 5,1999 NRCS REPORT NAMEN_ SOIL TYPE SANDY TYPICAL DEPTH TO GROUNDWATER NONE USGS DATE WEBSITE VISITED OBSERVATION WELLS CHECKED GROUNDWATER DEPTH: SHALLOW N MODERATE DEEP SITE EXAM SLOPE SURFACE WATER CHECK CELLAR SHALLOW WELLS ESTIMATED DEPTH TO GROUNDWATER 8'+APDX FEET PLEASE INDICATE ALL THE METHODS USED TO DETERMINE HIGH GROUNDWATER ELEVATION: N/A OBTAINED FROM DESIGN PLANS ON RECORD Y OBSERVED SITE(ABUTTING PROPERTY, OBSERVATION HOLE,BASEMENT SUMP, ETC.) Y DETERMINED FROM LOCAL CONDITIONS N CHECKED WITH LOCAL BOARD OF HEALTH N CHECKED FEMA MAPS Y CHECKED PUMPING RECORDS N CHECKED LOCAL EXCAVATORS,INSTALLERS Y USED USGS DATA DESCIBE HOW YOU ESTABLISHED THE HIGH GROUNDWATER ELEVATION. (MUST BE COMPLETED) THE HOUSE HAS AN 8'FOUNDATION WITH NO SUMP PUMP IN BASEMENT BASEMENT IS DRY.THERE'S NO SIGNS OF PONDING IN OR AROUND SYSTEM WHILE DIGGING IN YARD n DEPTHS OF 4'TO 6'THERE WAS NO SIGNS OF WATER TABLE.NO ABUTTING PROPERTY'S WELLS WITHIN 100'FROM SYSTEM REVISED 9/2/98 PAGE 11 OF 11 0 V, wo✓l�, ( i1Ct_ -b know iP H of kovC kao( q., Llkaace -�n Wof V- on, cal cA ai)0✓tS 'Eor OM1 fCD1 c sySTCwl I rC4a1rd�l r'7 a V%1 a S a w � v «1-t ,1 4 J o n j 3 �CClyadVVLI h a tiv qho( Sc�vtfc. was O�GfrCVt 10 `/ QJ y L►. �� a u v nTck Av, odd cc t o c1 a.t A n e— rn o m b Z-O( rydrn d�0 rl I ek cis S'-S S C ink at L J' vtti (.,jai SPLy�c�ti r +Li �la a rt ve- A JS 4 L-IT 'vC /o JT o n e Ll Q f / t.r a�i 1`CGc d G n dL Ccr cE h'l-i�S o�S C ^ �t rtwl W o r w. h d bt/ 1 ca,4-1 fi t/1C, pett'Lt -/-z 9,1 10( fyo n . d v GL a "Ad —60--f w-11 rht rP�T cLgp rt � I VvpJko, Vtf'!, Q Cc( o✓�E✓ R, 90J 16 t yi, yrt v &L ea 3 c) r y �� Abl- ✓ter /�l�'o�au. C -}- J I6zl4__ wJ V►1 �an i.•wr41 �A- v Gt- ! > dow ✓t %. FORM 4-SYSTEM PUMPING RECORD CURRIER SEPTIC & DRAIN SERVICE 107 FOREST STREET; MIDDLETON,MA 01949 (978) 774-2772 COMMONWEALTH OF MASSACHUSETTS L.l ��/L'� ,MASSACHUSETTS SYSTEM PUMPING RECORD SYSTEM OWNER: ' SYSTEM LOCATION: DATE OF PUMPING: vg QUANTITY PUMPED: /6V& GALLONS CESSPOOL: NOF7YES SEPTIC TANK: NO a YES SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SERVICE CONTENTS TRANSFERRED TO: (:�51/sD DATE: ����- �� INSPECTOR: ��4 TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE: 04/21/99 This is to certify that the individual subsurface disposal system constructed ( ) or repaired (X) by David Currier at 324 Berry Street has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations. (Distribution box only) The Is4e of this certificate shall not be construed as a guarantee that the system will fund jpq sRtisfactorily. Board of Health Inspector Town of North Andover, Massachusetts Form No.3 BOARD OF HEALTH 40RTH 19 r o 9 � '�•,,,o •`� DISPOSAL WORKS CONSTRUCTION PERMIT - ,SSACHUSEt Applicant NAME ADDRESS TELEPHONE Site Location Permission is hereby granted to Construct ( ) or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. -I �i CHAIRMAN, BOARD OF HEALTH Fee l't7S D.W.C. No. / �—S APPLICATION F l OR DISPOSAL WORKS CONSTRUCTION PERMIT U g'�I DATE: CURRENT INSTALLER'S LICENSE# LOCATION: y LICENSED INSTALLER: SIGNATURE( �'_ �TELEPHONE# CHECK ONE: REPAIR: [/ NEW CONSTRUCTION: (Le-ffac - E)-^6ox wl L, u- x U'oJie- /T!QLpQ�/��r IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only $75.00 Fee Attached? Yes No Foundation As-Built? Yes No Floor Plans? Yes No Approval / ) Date: 0 Ir r Town of North Andover of `o NORTH , OFFICE OF ",�ot COMMUNITY DEVELOPMENT AND SERVICES p 27 Charles Street North Andover, Massachusetts 01845 WILLIAM J. SCOTT 9SSACHUS�� Director (978)688-9531 Fax (978)688-9542 March 25, 1999 Ed Pedi a24 Berry Street North Andover, MA 01845 Dear Mr. Pedi: Since I have been unable to reach by telephone, this letter comes to inform you of the status of pernuts for your septic system repair. A permit has not been issued to repair the d-box because Health Department staff have been informed that: • You intend to put an addition on your house. • The septic tank has not been inspected and may need some repairs. If a permit is issued only for d-box repairs and there needs to be work done on the septic tank, another pernut, with another fee, will have to be applied for and issued. In addition,the entire system may have to be investigated relative to its size and capability if an addition is proposed. Doing these things separately is more costly. In order to move forward,please contact me about a meeting, or if you already know what you intend to do on the site, send in copies of existing and proposed floor plans for review. At that point we can look at the project as a whole and recommend an appropriate course of action. I hope to hear from you soon. Sincerely, Sandra Starr, R.S. Health Agent Cc: File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 d WINDOW TO REMAIN UP ID TY x q ALIGN WALLS WC D Z BATH <01 KITCHEN W EATING s i ! I EXISTING BATHROOM ' FIRST FLOOR PLA N FIXTURES TO REMAIN SCALES 1/4-4= (`�- Oct � I EXISTING CHIMN Cal LIVING ROOM ► DINING ROOM 1STFL2 oft 1 1Zo 1' � � x � G _� � 2ND FL2 cu z REMOVE EXISTING WINDOW m FOR REUSE AT LOWER FLOOR, + cul NEW WALL TO MATCH EXISTINGo EXISTING B ST u `O L3 BEDROOM11-1 ay Li o� I y, V Z w L3 A HA Of Z Ld 2E►+ = X O Q v ZC3 A U s' MASTER BEDROOM EXISTING BEDROOM ISTING STAIRWAY ST FLOOR SECOND FLOOR PLAN SCALES I - 324 Berry Street February 23, 1999 Discussion with Ed Pedi, property owner and Susan Ford, Health Inspector 686-6535 In regard to questions about a possible addition to the structure at the above address the following issues were raised. ■ There is no septic design or information of any kind in the present files of the Health Department. Possibly lost in the moves. ■ Mr. Pedi stated that he would like to add 2 or 3 rooms. ■ In conversations with Sandy Starr, it was determined that a Title V inspection would have to be done to establish the integrity of the system, its location on the lot and the capacity it was designed for. ■ It was suggested that a perc test may be an option during the time of inspection to assist in the determination the flow rate. ■ Advised the owner to contact this department when the inspection date was set. �r II ,, , /ice' ` � C 3 14, 4 • Y Y A PA ---'- Vol lv�d mag/ sIs Form 4 -- System Pumping Record Commonwealth of Massachusetss : Massachusetts System Pumping Record System Owner System Location s 2 , EFPRY ST Type: Emergency Routine Cesspool: W Yes Septic tank: W Yes Date of Pumping: r i Quantity Pumped:! Gallons System Pumped By: Wind River Environmental, LLC Permit#: Contents transferred to: Contents Disposed at: Date: Pumper Signature: Condition of System/Other Comments C Dep AA"ved from - 12/07/95 f l nn 4 -- System Pumping Record Commonwealth of ssaAM EIVED / Massae setts y �� ,i S stem Pu L — 9 2 04 $ TOWN OF NORTH AN OVER HEALTH DEPARTM T System Owner ,' System Loeation Type: Emergency Routine Cesspool: Nb Yes Septic tank: W EDYes Er Date of Pumping: 66-0 -C Quantity Pumped: I —Gallons System Pumped By: Wind River Enwinwwwnto% LLC Permit#: i Contents transferred to: Contents Disposed at: Date: Pumper Signature: Condition of System/other Comments Dep Approved Form - 12/07/95 -,C-\ Commonwealth of Massachusetts City/Town of System Pumping Record NORTH ANDOVER Form 4 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 within 14 days from the pumping date in accordance with 310 CMR 15.351. RE l I- A. Facility Information JUL - 7 2010 Important: When ruing out 1. System Location: TOWN OF NORTH ANDOVER forms on the ��1 zu-f- �� _ HEALTH ERAREN,F—_ -------- -- computer,use only the tab key Addre s -1 r �,A to move your p(�� ��_C.�OfC�`1 _______ _'`_'`_ _ _ —._ a g --- cursor-do not -City/Town State Zip Code use the return key. 2. System Owner: F-8 OQ v-8 Name Address(if different from location) City/Town --- ——_--- --tate --- - Zip ode ——" � b86- b53� ephone8 ' Number B. Pumping Record 1. Date of Pumping Datei o 2. Quantity Pumped: GalloI S00 ------ 3. Type of system: ❑ Cesspool(s) lav Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): -- -- --- --- -- — — -- 4. Effluent Tee Filter present? ❑ Yes VNO If yes, was it cleaned? ❑ Yes M/No 5. Condition of System: GOCKA 6. System Pumped By: 766-7 9 Gaktn Na a Vehicle License Number VCX Company 7. Location where contents were disposed: Signature of Hauler Date Signature of Receiving Facility — Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 Of NORTH O F w \ 9 - , Town of North Andover HEALTH DEPARTMENT cwust� CHECK#: � / DATE: y LOCATION: /J H/O NAME: CONTRACTOR NAME: Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type.- $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑XTitle pector $ eport $ J ❑ Other. (Indicate) $ Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer Commonwealth of Massachusetts Form W Title 5 Official Inspectiono Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 325 Berry Street Property Address Paul Burke Owner Owner's Name information is required for North Andover MA 01845 3/29/2011 every 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: A. General Information - When filling out forms on the � ^ computer, use 1. Inspector: only the tab key to move your Gregory A Fuller cursor-do not use the return Name of Inspector key. Wind River Environmental Company Name f� 163 Western Avenue Company Address Gloucester MA 01930 reran City/Town State Zip Code 800-499-1682 S14986 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 aluation by the Local Approving Authority Insp toy n t re Date stem inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the 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 o' future under the same or different conditions of use. l5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GSM , 325 Berry Street Property Address Paul Burke Owner Owner's Name information is required for North Andover MA 01845 3/29/2011 i every 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: ® 1 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) 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. i 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 i Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 325 Berry Street Property Address Paul Burke Owner Owner's Name information is required for North Andover MA 01845 3/29/2011 every 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): ❑ distribution 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 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 Commonwealth of Massachusetts N Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 325 Berry Street Property Address Paul Burke Owner Owner's Name information is required for North Andover MA 01845 3/29/2011 every page: City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ 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 ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1h day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts P� 51F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 4M SVey`'v 325 Berry Street Property Address Paul Burke Owner Owner's Name information is North Andover MA 01845 3/29/2011 required for every page. Cityrrown State Zip Code Date of Inspection 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 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 i ' I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 325 Berry Street Property Address Paul Burke Owner Owner's Name information is North Andover MA 01845 3/29/2011 required for every page. City/Town State Zip Code Date of Inspection C. Checklist i 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 N Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 325 Berry Street Property Address Paul Burke Owner Owner's Name information is North Andover MA 01845 3/29/2011 required for every page. City/Town State Zip Code Date of Inspection D. System Information Description: i i I I Number of current residents: 2 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 Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d Well 9 ( Y 9 (gp ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 3/29/2011Date 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 325 Berry Street Property Address Paul Burke Owner Owner's Name information is required for North Andover MA 01845 3/29/2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: The owner was the source of information Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? The quantity pumped was determined by a measured pump truck. The reason for pumping was to check the tank's Reason for pumping: structural integrity. 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) ❑ 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•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 325 Berry Street Property Address Paul Burke Owner Owner's Name information is required for North Andover MA 01845 3/29/2011 ' every 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: This septic system was installed in July of 1990. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 1' 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.): The system had clean joints, good venting, and there was no evidence of leakage. i Septic Tank(locate on site plan): 1'6" 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: 10'6" L x 5'8"W x 5'8" D Sludge depth: 14" t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts N Wrz Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 325 Berry Street Property Address Paul Burke Owner Owner's Name information is required for North Andover MA 01845 3/29/2011 every page. Cityfrown 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 30" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Sludge judge, rod, ruler Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I recommend having the system serviced annually. The inlet and outlet baffles are both in good condition. The tank is structurally sound. The liquid level is at 0"to the outlet invert. There was no evidence of leakage of any kind. 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 N Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 325 Berry Street Property Address Paul Burke Owner Owner's Name information is required for North Andover MA 01845 3/29/2011 every 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 Commonwealth of Massachusetts N Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 325 Berry Street Property Address Paul Burke Owner Owner's Name information is required for North Andover MA 01845 3/29/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): 0.. 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.): The distribution box is level. The distribution to the outlets is equal. There was minimal carryover. There was no evidence of leakage into or out of the distribution box. The distribution box is 24" below grade. 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 325 Berry Street Property Address Paul Burke Owner Owner's Name information is required for North Andover MA 01845 3/29/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The soil is clean and dry. There were no apparent signs of hydraulic failure and no ponding. The vegetation condition was normal over the field. 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 325 Berry Street Property Address Paul Burke Owner Owner's Name information is required for North Andover MA 01845 3/29/2011 every 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 N Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 325 Berry Street Property Address Paul Burke Owner Owner's Name information is required for North Andover MA 01845 3/29/2011 � every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately l5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts 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 Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where ublic water supply enters the building. Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately 0 � r X-C= f -�� r PU P - C fJ £.t? l5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GSM 325 Berry Street Property Address Paul Burke Owner Owner's Name information is required for North Andover MA 01845 3/29/2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope j ❑ Surface water ® Check cellar ❑ Shallow wells 4' 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: 7/12/1990 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: i You must describe how you established the high ground water elevation: The high ground water elevation was established by soil logs, a peep hole test, and percolation tests that were dated 5/17/1990 and 7/12/1990. Three tests were performed. OP12 -elevation 102.57". The water was found at 96", percolation 90-16 at 60". OPM-elevation 104.50". Established water table at 72". Percolation 90-18 at 48". Rate less then or equal to 2 minutes an inch. OP4A-elevation 106.77". Estimated water table at 72". Percolation 90-17 at 48". Rate 8 minutes an inch. Top of foundation is at 105.00". Leach chambers bottom at 98.57". SHGW water at elevation 94.57". There have been no changes or construction to this area. Water table at 72". Seasonal high ground water listed at 94.57". Wetlands at back of property withstanding water approximately 8' below grade of yard. 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 325 Berry Street Property Address Paul Burke Owner Owner's Name information is required for North Andover MA 01845 3/29/2011 every page. City/Town 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 <L Commonwealth of Massachusetts RECEIVED AM City/Town of V��t0 / 2015 NORTH ANDO System Pumping Record Twyl�tOFNORTH AhCO`JER ti Form 4 BATH 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 within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility information Important: 1 System When thing out � Location:Y ^ n forms on the ' -/)t computer,useMJ0Y!(/(- only the tab key Address `^ �/�/�to move your Q� l ..... L'. — cursor-do not City(Town Slate Zip Code use the return key. 2. System Owner: Name Address(if different from location) ----–— — State p Code CityfTown Telephone Number — B. Pumping Record 1500 1. Date of Pumping —k 17_--�I ---- 2. Quantity Pumped: GallonsOate 3_ Type of system: ❑ Cesspool(s) ❑ Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No if yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: -� m Callan 931A3 Name Vehicle License Humber _�n�. ;vc -Enui Tvn mc4u Company 7. Location where contents were disposed: Signature of Hauler Date Signature of Receiving Facility Date 15form4.doc•03106 System Pumping Record•Page t of t