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HomeMy WebLinkAboutMiscellaneous - 340 FOREST STREET 4/30/2018LU gLU cn w L N LU Q C Q O 0 �a N REC E Commonwealth of Massachusetts City/Town of OCT 213 Sstem Pumping Record TOWN OF NORTH ANDOVER Y p g HEALTH DEPARTMENT 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. A. Facility Information 1. System Locatiot : Leig ont of house Left / Right rear of house, Left / right side of house, Left / Right side of bui Inld' g, Left / Right front o uilding, Left / Right rear of building, Under deck Address Citylrown \` State Zip Code 2. System Owner. 4 VUR\ --V Name Address (if different from location) City/Town B. Pumping Record 1. Date of Pumping 3. Type of system- ❑ State/j �jp Code Telephone Number Date 2. Quantity Pumped: Gallons Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes Leo 5. Conditiop of System: If yes, was it cleaned? ❑ Yes ❑ No; 6. System Pumped By. Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc- Company ncCompany 7. Location where contents were disposed: G L .D Lowell Waste W. t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 4 H Permit NO: Date Issued - TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received6/2//�� IMPORTANT: Applicantmust complete all items on this imae Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other iflmP, tic;We-F0 0Filoodplaini �OjWetland$3 DJ VV,atershed 4;istr ct3 „QkWater/SN' Poet? DESCRIPTION OF WORK TO RF PF-Pv0-P T7n- )WNER: Name: %ddress: 3� 'ONTRACTOR Name: address: supervisor's Construction License: lome Improvement License: Please;fype okprint Clearly) Exp. Date: Exp. Date: �RCHITEC —1/ENGINEER Phone: Phone: DJr' Phone: address: Reg. No. FEE SCHEDULE. BOLDING PERMIT. • $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. otal Project Cost: FEE: $ 'heck No.: Receipt No.: OTE: Persons contracting withXunrwgister d contractors do not have access to the guaranty fund ignatures6fAgent/40wne� Signature�oftcontractor� .T 0 w O a Q w H 0 LU U LU 3 LU ry LU Q 0 H z LU a 0 W W 06 0 z z w O (D 0 W U) O I— z w O CO H W O 0 a� a E 0 Q U c O �U a) C ._ 0 N 0 c a) E E 0 U 0 z c 0 a aS U c (0 � o Q �U Q (L) 4— 0 o -a a m 0 00 m cm •E n3 N0 a ami E ; > 0 o , 0 I� $M4 Q 4-4 H g i lb C40 CCS N Ooo H -rOG OG /41400 �ys�� f3sj Commonwealth. of Massachusetts City/Town of 1 System Pumping Record Form 4 EIVED JUL -7Z0k I* TOWN OF NORTH ANDOVER HEALTH DEPARTMENT DEP has provided this form for use by local Boards of Health.. Thi s em umping Record must be submitted to the local Board of Health or other approving authority. . A Facility Information .Important: When filling out 1. System Location: forms on the computer, use only the tab key Address to move your��Q��- cursor - do not use the retum Cityrrown Atate Zip Code key. 2. System Owner: S �Ao Name Address (if different from location) Cityfrown . State Zip Code Telephone Number B. Pumping Record -T-c f .Date, ofPumping Date 2. Quantity' Pumped: Gallons 3. Type of system: ❑ Cesspool(s)Septic Tank El Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes �� If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: U uL425� i� 6. System Pu ped B Name Vehicle license Number Company 7. LnPen wh re cora w Isposed:. 1_ Si at o Hauler Date h.4p://www.mass.gqvidep/water/approvalt,/t5forms.htm#inspect t5form4.doc• 06103 System Pumping Record • Page 1 of 1 ',Y-241104 15:43 Dennis L Bedrosian Superintendent August 6, 2004 89786889575 Ms. Alice Schellhorn 340 Forest Street North Andover, MA 01845 Dear Ms. Schellhorn: NO ANDOVER WTP Town of North Andover DRINKING WATER TREATMENT PLANT 420 Great Pond Road North Andover, Massachusetts 01845 PAGE 02 Telephone (978) 688-9574 Fax (978) 688-9575 70 a r' Please find below the results of bacteriological analysis conducted on one sample collected from you private well at 340 Forest Street on August 5, 2004. Total Coliform Bacteria: Positive E CDIIl Negative please supply us with another well sample, collected a few days after chlorinating your well, and we will perform another bacteriological analysis. Please do not hesitate to contact us at 978/ 688-9574 if you have any further questions. Sincerely, Amy Planz Senior Water Analyst North Andover Water Treatment Plant MA Certification # for Bacteriological Analysis: MA 20154 a �f )6I2M4 15:43 89786889575 Nath Andaer Wdw Ti omw% PIaR 420 Grog Part Roel J40M AndoW MA 01845 Fhons: (978) "84574 Fee WO6=4*75 NO ANDOVER WTP PAGE 01 NORTH A ' ): • VVTF Notch Andover Wader Tr e&nenc Platt Fmoa Fam (978) 6888575 Pt1Of1°` Phone: (978) 8889574 PRO": c: ❑ U.1mtt Oror RevleW X Please comment ❑ Please Reply a Please Recycle • Cat+rnt.,nt� NEW ENGLAND ENGINEERING SERVICES INC December 24, 1996 1 1 DtG 3 ® 19% North Andover Board of Health Town Hall Annex --- 148 Main Street North Andover, MA 01845 RE: TITLE V REPORT Enclosed is the Title V report for 340Forest Street, North Andover, MA. The system passed the inspection. If there are any questions please call me at my office, 686-1768. Yours truly, Benjamin C. Osgood Jr. President 33 WALKER RD. - SUITE 22 - NORTH ANDOVER,. MA 01845 - (508) 686-1768 William F. Weld Covemor Argeo Paul Celluccl LL Govsmor ..may ��� /'•� 14 � �_I Commonweatth of Mossochusetfs �'�— QCT ExecuWe Office of Environmental Affairs Department of Environmental Protection" ect�on�' �1 Trudy Coxe Secmary David S. Struhs CommWelotitir SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address- 3 'yU "-6 rC s.T ST BEET /1J. V /.! p Ovt fez Address of Owner. Date of Inspection: t -q'q I q & (If different) Name of Inspector. Benjamin C. Osgood Jr. Connpany Name, Address and Telephone Number. New England Engineering Services, Inc. 33 Walker Road, North Andover, Ma 01845 CERTIFICATION STATEMENT Tel. 508-686-1768 Fax. 508-685-1099 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 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: &—, e a";J Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within t hi inspection. If the system is a shared system or has a design flow of 10,000 gpd or y (30) days of completing this report to the appropriate regional office of the De greater, the inspector and the system owner shall submit the Theo ' Department of Environmental Protection. original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: Al SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 3 Any failure criteria not evaluated are indicated below. 10 CMR 15.303. B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not) The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, . imminent. The system will pass inspection if the existing septic tank is replaced with a Fonforming sor tank failure is eptic tank as approved by the Board of Health. (revised 11/03/95) One Winter Street • Boston, Massachusetts 02108 • FAX (617) 556-1049 • Telephone (617) 292.5500 ii Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: ?� y v Fore T S h A). O— 9 o e2 AAC, Owner. 5 c ,l e 2 Date of Inspection: I4� B] SYSTEM CONDITIONALLY PASSES (continued) 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): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced 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): broken pipe(s) are replaced obstruction is removed Cl 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES 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 a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DE'T'ERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for 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. S) OTHER (revised 11/03/95) I Property Address:- Owner. ddress:Owner. Date of Inspection: D] SYSTEM FAILS: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) 3110 Fc, 1-I ANSC-LL(t ST. N. A,v0 ovG 2 I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. & Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. L✓ 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. .L 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. 41 Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. .L Any portion of a cesspool or privy is within a Zone I of a public well. L Any portion of a cesspool or privy is within 50 feet of a private water supply well. N 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. El LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: — 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 11 of a public water supply well) The owner or operator of any such system shall bring the system and facility into fun compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 11/03/95) 3 Property Address: Owner. Date of Inspection: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST 3 `10 Fo res -r st r-ec-f- HGAv. se)e(Z. t2.[q )q( - Check if the following have been done: A) - R nc06'j eIL Pumping information was requested of the owner, occupant, and Board of Health. None of 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 system recently or as part of this 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. ,ZThe system does not receive non -sanitary or industrial waste flow _ZThe site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. 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 existing information or approximated by non -intrusive methods. YThe facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub. Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 3 Lich Fo �e sT Owner. Date of Inspection: FLOW CONDITIONS RESIDENTIA U Design flow:gallons Number of bedrooms: V Number of current residents: 3 Garbage grinder (yes or no):.dZQ Laundry connected to system (yes or no) Seasonal use (yes or no):_,Jh Water meter readings, if available: WC L L Last date of occupancy: L V r/ e r} COMMERCIAL /INDUSTRIAL: Type of establishment: Design flow:------gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)— Non-sanitary waste discharged to the Title 5 system: (yes or no) Water meter readings, if available:_ Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: 0 System pumped as part of inspection: (yes or nos If yes, volume pumped: tE2 c gallons Reason for pumping: .-r„ 1 N s o r r l- +, — U 'TYPE QF SYSTEM Septic tsnk/distnbution box/soil absorption system Single cesspool Overflow cesapool Privy Shared system (yes or no) (if yes, attach Previous inspection records, if any) Other (explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: /o u eu rS Sewage odors detected when arriving at the site: (yes or no) -/ 0 (revised 11/03/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (oontinued) Property Address: 3 4 O F:o r`e z;— S 1 rc e+- /U o r f 1, A-Zo , t4, Owner. Mc,eueter Date of Inspection: SEPTIC TANK:_ (locate on site plan) Depth below grade.-LL.- Material raderMaterial of construction: ✓concrete _metal _FRP —other(explain) Dimensions: /SOD U rr L. -L :, C o ,1 c 'e -5-1 Sludge depth 3 " Distance from top of sludge to bottom of outlet tee or baffle: 301 Scum thickness: G V" H Distance from top of scum to top of outlet tee or baffle:_ Distance from bottom of scum to bottom of outlet tee or baffle: 15 �� Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) _ ITA-) &-00 P c ,j n t r -t o ,.i . e C— TG p a G 'v i"f c- t-t,f s S L D _.►4,E rxF L- ,, r 2, 0 17-4 c® P E tiI N (,s c r{ � L A ,-r a L/ ro ers e-- ndE'0 To LAJ ,THw 12 o � =1i✓1 C' V1 0C GREASE TRAP:_ (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP —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: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 11/03/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 3'10 !'v r e s i S'fi Al. 4A. Io o,. e 2 Owner. /{ l`& Date of Inspection: TIGHT OR HOLDING TANK:_ (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP —other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert: (� I Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER_ (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Addresx Ja qC Fo (-csT ST. Owner.�v - ANO o . e. R M d) 14A n95 C Lr 12 Date of Inspection: 12-11 ) a, L SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible; excavation not required, but may be approximated by non -intrusive methods) If not determined to be present, explain: Type: leaching pits, number:_ leaching chambers, number:_ leaching galleries, number leaching trenches, number,length: a S O' j g C j C E{ r s leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation etc.) 0A t= A n r s 14 TL M e 'S Cr -o c,' ,D CESSPOOLS: _ (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 (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY- _ (locate on site plan) Materials of construction: Depth of solids: Dimensions: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 11/03/95) u SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (oontinued) Property Address: 3 i{ o ro r e 5 T .0 o v /L. Owner. f 2e, to Date of Inspection: KIR n1 S C L r (Z SKETCH OF SEWAGE DISPOSAL SYSTEM; include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' /20 WELL- Depth ELL DEPTH TO GROUNDWATER Depth to Vvundwater.--�--feet method of determination or approximation: _ Z'� p tit / fs I it/ /¢ L (revised 11/03/95) 9 k�. 7-e Air Ao AC I fS le rs 7-,,"e7 /,204R, mt lZa k�. a) m LL v- O (1) 4-1 '\t V1 1c a) E �--r ru CL Q) 0 cn c m t c 0 .V) V) 0 u c O fu L Q) O U I E O m C ru d t !p Q) 2 O F1 c fV m _o Q 0 E u a w 0 m N O OL L L O O C � v .� _ N O E a m Oi D O Q Ol I i.+ C _a Q t a7 � a U O O C 1c a) E �--r ru CL Q) 0 cn c m t c 0 .V) V) 0 u c O fu L Q) O U I E O m C ru d t !p Q) 2 O FORM U - VERIFICATION FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: Phone LOCATION: Assessor's Map Number Parcel Subdivision Lot(s) Street I CJC ( St. Number -34Q ************************Official Use Only************************ REC7,;T/� NSF AGENTS: Date Approved Conservation Administrator Date Rejected V I0Vk ���� w, �Iz Comments _ Town Planner Comments Date Approved Date Rejected Date Approved Food Inspector -Health Date Rejected „/> Date Approved Septic Inspector Health Date Rejected Comments _POGe Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date WELL DATABASE ADDRESS: U �� AGE OF WELL: WELL DRILLER: WELL PERNUT 3 Y2_ WELL LOCATION: ..WELL PERMIT DATE: % �- zL - 5'S� DEPTH OF TYPE OF WELL:a.. DRILLED b. DUG TYPE OF WATER BEARING ROCK. '� WATER ANALYSIS DATE: J — 1 Y MG. HIGH IRON: Y O ,1 OT R C. NTANE WELL DATABASE MANGANESE: Y (N ANTS: Y ADDRESS: AGE OF WELL: / WELL DRIVER: WELL PERMIT 9: y WELL LQ ATION: ©��; `✓� -� u^'`'�" l WELL PERMIT DATE: I v .�S EPTH OF WELL: f?-'� TYPE OF WELL: a.. DRIL f DUG c. LNKNI OWN TYPE OF WATER BEARING R K: WATER ANALYSIS DATE: - - HIGH MANGANESE: Y CN HIGH IRON: U IV OTHER CONTAMINANTS: Y,) N - L I1 f 6_ !. A tip OP HC70LTH" N��iTH Atit:�VE1�, NIA. ` c - (.v�1�'ER L -OT Fogesi ST 61-�KXLc w i / p Ta�u,�,J �oUC.D -fn-,-1E5 F NC7 SEPTI c sy sTE,-1 vEs1c5J Abrrl<,ovuv �Z-�- s APRfiOVJ�v6 �urho�,ry CoNf)IToti5 ➢ISAPP�vE� IATE R�4SoNS SCPT'c c SY:MM7 l J SiA LLATI OAJ eX4V4TrdllJ. 1tiSP6--6i Io&j s p F�4►� T tioTE _RMT Srov,_- (5 FINAL W5p6crloo 0i3TC AVDITIOMAL (A15FbC:.j (oN5 DtSAt��Zdv�l7 FwAL 16PPROVAL ,�PPI�vwG AUTHOI?? -/ APMo,1r&)6 /m ii+ogi r/ ORDER OF CONDITIONS: LOT 12 SALEM STREET a. Notice of Intent of Forbes Realty Trust/Prepared by Christiansen Engineering, Inc.,/Dated July 1, 1985/Eight (8) pages. b. Plan titled "Subsurface Disposal System" Lot 12 Salem Street, North Andover, MA/Prepared by Christiansen Engineering, Inc./Dated April 30, 1985, revised June 25, 1985/Two (2) sheets (1 of 3 and 2 of 3). 13. The NACC has determined that the plans submitted under this filing, and also under filings for Lots 9,10,11,13,8 and 14 contained certain inaccuracies which make it difficult for the NACC to evaluate the pro- posed work (i.e., inconsistent delineation of wetlands and buffer zone). Therefore, prior to any work being done on this lot, the following shall be submitted to the NACC for its approval. a. Revised plans, drawn accurately, and to scale,so that the NACC can match the plans for all the above mentioned lots in"order to determine the overall wetlands configuration, flow direction, and size. b. Or, one plan, combining all lots, with wetlands and buffer zone delineated, as well as houses, drives, and associated appurtenances. c. And a plan and calculations, showing how the applicant intends to decrease, or maintain at zero, the rate of runoff, for this individual lot. i d. Or, rather than item 13c, the applicant may provide an overall plan, and calculations, showing lots 8 - 14 (inclusive), and those measures uthich will be employed to maintain at zero, or decrease, the change in the rate of runoff for the entire area (lots 8 - 14 inclusive). 14. Upon receipt of the above required information, the NACC, if necessary shall issue, within 21 days, additional conditions necessary to adequately protect - adjacent wetland areas. 15. The provisions of this Order shall apply to and be binding upon the applicant, its employees, and all successors and assigns in interest or�control. 16. Prior to the issuance of a Certificate of Compliance, the applicant shall submit a letter to the Conservation Commission from a registered professional engineer certifying that -the work is in compliance with the plans referenced above and the conditions stated above. 17. Members of the NACC shall have the right to enter upon and inspect the premises to evaluate compliance with this Order of Conditions. 18. Accepted engineering and construction standards and procedures shall be followed in the completion of the project. k4*4 I , I 10 Nj Nj Ln I , I 10 e e A Stevens Water Analysis 38 Montvale Avenue • Stoneham, MA 02180 • Mass. (617) 438-6114 • Salem, N.H. (603) 893-3106 LABORATORY NUMBER: 162193 SUBMITTED BY: Romas Brickus 741 Canton Avenue Milton, MA 02186 SAMPLE DATE: 2/18/86 SAMPLE SOURCE: Well/collected from pumn - #33828-A (LC) - Lot #1 Romas Brickus, No. Andover, MA ANALYSIS: According to Standard Methods of Water and Wastewater Analysis, 15th Ed. Total Coliform . . . . . . . . 0 per 100 ml Chlorides. . . . . . . . . . . 20 mg/L pH . . . . . . . . . . . . . . 7.0 Hardness . . . . . . . . . . . 176 mg/L Manganese. . . . . . . . . . . 0.06 mg/L Sodium . . . . . . . . . . . . 5.4 mg/L Iron . . . . . . . . . . . . . 2.88 mg/L Nitrate. . . . . . . . . . . . less than 0.10 mg/L Nitrite . . . . . . . . . . . . less than 0.10 mg/L COMMENT: The results of these analyses meet the required federal and state standards for drinking water. However, the iron and manganese concentrations exceed the recommended standards. Although iron and manganese are not harmful to your health, they can affect the taste, color and odor of your water. If desired, iron and manganese can be removed with filters sold by water treatment specialists. Water quality can vary significantly from time to time due to various local conditions. It is•advisable to have your water tested in approximately six to twelve months to determine any change in_water quality. Chemist/Microbiologist TOWN OF SYSTEM DATE: SYSTEM OWNER & ADDRESS 7F0 G RECORD REC 1vE eD jUj_ _ g 2004 SYSTEM LOCATIO O y',—1 (example: left front of b DATE OF PUMPING: — -� QUANTITY CESSPOOL: NO YES EPTIC NATURE OF SERVICE: ROUTINE OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER PUMPED: _�� GALLONS TANK: NO YES EMERGENCY FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: G.L.S.D J Lowell Waste TOWN OF SYSTEM DATE: 6,16) 5-0 G RECORD SYSTEM OWNER & ADDRESS SYSTEM LOCATION (example: left front of house) S4. �L(b DATE OF PUMPING: S d QUANTITY PUMPED : GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: G.L.S.D Lowell Waste Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Q Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 R `v A r JUL 1 3 2007 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. Sy$tem L� ';� —�%— Address City/Town 2. System Owner: Name Address (if different from Cityrrown State B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): ---? — 10-07 Date Zip Code State^�� Code Telephone Number 2. Quantity Pumped: Gallons Cesspool(s) Septic Tank ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes E No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: ` � J � � � _ t V-")C''k ` --� 6. Systerp Pvm�ed By: Name Vehicle License Number Company 7. cont is ndisposed: t5form4.doc• 06103 System Pumping Record • Page 1 of 1