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HomeMy WebLinkAboutMiscellaneous - 370 CANDLESTICK ROAD 4/30/2018WATER WELL PERMIT WELL TESTS: Y - COMMENTS: TOWN CHEMICAL WELL DRILLER.____-.__._______....__.__...__ �_.___.__........_._... DA I E APPRUV1=D._.--.� .--.-.-_._-- I BACTERIA II DO I E ( IPRUVED DA 1 E APPROVED- FORM'U APPROVAL: APPROVAL TU ISSUE ES NO DATE ISSUED BY CONDITIONS: FINAL APPROVAL:. ALL PERMITS PAIDYES NO WELL CONSTRUCTION APPROVAL S NU SEPTIC SYSTEM CONSTRUCTION APPROVAL Gf_E 1J0 OTHER YES NU ANY VARIANCE NEEDED FINAL BOARD OF HEALTH APPROVAL: YES 7 CNU_�� DA TE :I 1. �1q IIY : _ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE ;OF;. ENVIRONMENTAL AFFAIRS DEPARTMENT 01ENWRONME 4TALft- OTPCTION Tr, ;riiha hOR N ANDO,, ,. .. , . s = , .. _ , ; .. •�' ? r--�...�,d,UF HEALTH -OCT 8 20,92 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESS NTS—, -i SUBSURFACE SEWAGE DISPOSAL S`�STEM FORM PART A CERTIFICATION Property Address: _ 4e Owner'sName: VmacbCirXi- Owner's Address: .11\ MO Date of Inspection: Name of Inspector: (please print) Company NameSoucy' s Sewer Service..Inc. Mailing Address: 830 Li vi nqs nn S reef ' Tewks ury� MA 61R76 Telephone Number: q,� R 1 R S 1_ A8 -AQ CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the, mspection. 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 3 (310 CMR 1S."4 The system: asses Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails , Inspector's Signature: pa Date: _7a V,, The system inspector shall submi copy of this41;nl4ort to the Approbing 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 approviag authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the e6nditions of use at that time. This inspection does not address hpw the system will perform in the future under the same or different conditions of use. Title 5 inspection Form 6/15/2000 page I Page 2 of 11 OFFICIAL INSPECTION FORM- NOT' FOR VOLUNTARY ASSESSMENTS SUBSURFA CKSEW*QE. DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: per' l Inspection Summary: Check A,BrC,D or E / &&AYS complete all of Section D 2,Mve Pass@$: 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: 8. System Conditionally Pan": One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y,N,ND) in the for the following statements. If "not determined" please explain. The septic tank is metal and over 20 years old* or the ieptic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration 9f fxRltrx iozi or tank failure is imminent. System will pass inspection if the existing tank is replaced with a coamplymg'`eepuc'tank as approved by the Board of Health. •A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: . • " ' , ;,; w!u; 'fr! :•i.,! . .: u:'; Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or duce tQ a. broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s) are replaced a • , i r : ; • Obat<31Gt10n 1S retllOVOd , : v, t3 '; : . . „ djaWbudou lox is levelod.or"replaced •1 , 7{' ;yij{5 1. ;i�):r:� �tiii l, ,. ;�' �; i 1'.... a ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): broken piPe(s) are replaced obstraction is removed .i , ..,I;.JY;,. •: , (".Yti,ljl 19.12. •.., �'',f !U :ri . ND explain: Page 3 of I I OFFICIAL. INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART CERTIFICATION: (continued) 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 Ts failing to protect public health, safety or the environment. 1. System will pass Waleas Hard of Health determines in accordance with 310 CMR 15.303(1xb) that the system Is not functiaalug in a. meaner which will protect public health, safety and the environment: _ Cesspool or privy is within S0 feat ofa surface waw.!,. _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 3. 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 taalc and'ioii absorption system (SAS) and the SAS is within 100 feet of a surface water supply, ur tributaty to. a surface .water supply.: ."5 l cJaie,i (iY :CJs .. 1i,�'1:�i :,, i) i•1.'•. .A;a.7 ;�)� . �":._. The syst¢m has s septic lttttic,a0:SAS and the SAS,is within a Zone 1 of a public water supply. a;! i': 6! _ The system has a septic And SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank alai SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply wall 100,. Method used to determine, distance "This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile. organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria aro triggered, A• cppy pf the analysis must.ba attacitod to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION, FORM •- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACESEWAOE DISPOSAL -SYSTEM INSPECTION FORM PARTAIA CERTIFICATION.(,continued) Property Address; Owner: Date of Inspection• 49L i D. System Failure Criteria applicable to all systems: You must indicate "yes" or !oto" to cub of the: following for j,inspections: Yes N Backup of sewage into facilityor system component due to overloaded or clogged SAS or cesspool Discharge of pooding:gf.offluentto dam. 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 +!k,;:,r a li;i, ;t .�,;tt . ,, :.., ,: .�.< < ,,�-,t,:;:;j a> r _ quid depth in cesspool is less than 6" below in or available volume is less than %, day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbs of times pumped Any portion of the SAS, cesspool or privy is below high ground water elevation. jr Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water aupply..,sab 0,,0iiIi ggu;�o1'.yr ;.!o.'sI Lai: ", :I, i, Any portion of acesspoolorpivyis within a Zona 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 pcivy;ia less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality.wWysis [This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that thevqff is: freefidomipollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen Is equal to or less than S ppm, provided that no other failure criteria are triggered. Atopy of the analysis must be attached to this form.] (Yes/No) The system Lj1h. I havedeteamined 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. ,, i76 t:.yi1.• ....:I, i'aJ `i.:�'..a ..:� l.;d , , ' 1`: a:� . '�:' .. ... .11.:,1; is �i4;4 ;U:•i: 3:13 ,. ,, ,.. ..: i�. It. .'ii E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either "yes" or "no" to each of the following: (The following criteria apply to large systems in addition to the criteria above) es no the system is within 400 feet pf g,3yrface.drjnkiag wAtec.,suPP1Y the system is within Z00 _€pd.9f #...Vt Mary W & siufa .chit kin 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. 4 Page 5 of 11 OFFICLA INSFEMON FORM.- NOT SOR VOLUNTARY ASSESSMENTS SUBSURFAC UMAGF .DISPOSAL SYSTEM INSPECTION FORM PART BR,,� CHECKLIST Property Address:. M� '•A. I .�. Q_ •-. !iii �Date of Inspection: Check if the following have been done. You moist indicate `y+es" or "no" as to each of the followine: Ye No 21"umping informal= 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 ? �i 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 zoe� bathes 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: Yes no Existing information. For example, a plan at the Board of Health. Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [3 10 CMR 15.302(3)(b)] 5 Page 6 of I 1 OFFICIAL INSPECTIONFORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE:SEWAGE DISPOSAL $YSTEM INSPECTION FORM PART V,•' SYSTEM INFORMATION Property Address: or+r in�Qqy Owner: 24.r ujfg. -V\TnA ' Date of Inspection: FLAW CONDITIONS RESIDENTIAL Number of bedrooms (design): Number of bedrooms(actual): DESIGN flow based on 310 Clot 15.203 (for example: 110 gpd x # of oms): Number of current residents:_ _ ,,,-n Does residence have a garbage grinder (yes or no): YZ *V/L kV Is laundry on a separate sewage.aystettt•(yea or ao):& [if yea see inspection required] Laundry system inspected (yes or no): q Seasonal use: (yes or no): AW r _ , , . Water meter readings, if available (last 2 years usage (gpd)): At kA&d0o Sump pump (yes or no): 10 Last date of occupancy: . . COMMERCIALIINDUSTRIAL Type of establishment: �al, ,. Design flow (based on 310 CMR 1- 5.203): �d Basis of design flow (seats/persotWsgR,etc.); _ , Grease trap present (yes or no): _,_, Industrial waste holding tank present (yes or no): o Non -sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER (describe): GENERAL INFORMATION Pumping Records --� Source of information: Was system pumped aso inspection a or no): _ If yes, volume pumped: ons --How was quantity pumped determined? Reason for pumping: L)IIIE OFSYSTEM Septic tank, distribution box, _ Single cesspool Overflow cesspool soil absorption system.,... , — Privy _ Shared system (yes or no) (if yes, attach previous inspection records, if any) _ Innovative/Alternative technology, Attach a copy of the current operation and maintenance contract (to be obtained from system owner) — Tight tank Attach a copy of the DEP approval Other (describe): Approximate age of all installed (if known) and source of information: Were sewage odors detected when arriving at the site (yes or no);& page 7 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE:.DISPOSAL°SYSTEM INSPECTION FORM PART C -. SYSTEM INFORMATION (continued) Date of Inspection:: g jai, 1W BUILDING SEWER (locate on site plan) Depth below grade: Materials of construction: _cast iron40 PVC mother (explain): _ Distance from private water supply well or suction line: 6 Comments (on condition of joints, venting, evidence of leakage, etc.): SEPTIC TANK:(locate on site plan) Depth below grade: Material of construction: concrete -metal __fiberglass polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance (yes or no): _ (attach a copy of certificate) Dimensions: Sludge depth: ' Distance from top of slydge to bottom of outlet tee or baffle: '36a` Scum thickness: Distance from top of"scwn to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee o baffle How were dimensions determined: e � `� '7lfP Comments (on pumping recommendations, inlet and outlet tee & baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): ��� n I � v1.�LvdY �--- v--,,// F GREASE TRAP;,��LCate on site plan) .::: . , Depth below grade: Material of construction: _concrete ___Metal fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL' SYSTEM INSPECTION FORM PARTZ, f' SYSTEM INFORMATION (continued) Property Address: -9,40g�, O1?q S - Owner: °, a9fS Date of Inspection• TIGHT or HOLDING TANK:A `tank must be pumped at time of inspectionxlocate on site plan) Depth below grade: Material of construction: concrete metal fiberglass ___.polyethylene other(explain): Dimensions' Capacity: �llppg Design Flow: AaUoos/day Alarm present (yes or no): Alarm level: Alarm in working order (yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): DISTRIBUTION BOX: (if present must be openedxlocate on site plan) Depth of liquid level above outlet invert: �— Comments (note if box is level and distribution to outlets leakage into or out of box, etc.): /n ;�4Is, f a, any evidence of solids carryover, any evidence of PUMP CHAMBERi/41 on site plan) Pumps in working order (yes or no).- Alarms o):Alarms in working order (yes or no): Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): 3 Page 9 of 11 . OFFICIAL INSPECTION FORM - NOT, FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART:O . SYSTFA INFORMATION (continued) Property Address: Owner: Date of SOIL ABSORPTION SYSTEM (SAS): y{ i 01 (locate on site plan, excavation not required) If SAS not locate¢ explain why., Type caching pits, number: leaching chambers, number: t+v� leaching galleries, number: leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number: innovativelalternative system Typetname of technology: Comments 7,—J9 condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): -14%— L, i. CESSPOOLSa,A-- (cesspool must be pumped as part of inspectionxlocate on site plan) Number and configuration: Depth — top of liquid to inlet invert: Depth of solids layer: Depth of scum layer. Dimensions of cesspool: Materials of construction: Indication of groundwater inflow (yes or no): Continents (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIW (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.): 9 Page 10 of l l OFFICIAL 1NSPECTI0N'-F0RM".:NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE S AOE'DISPOSAL SYSTEM INSPECTION FORM PART:0 ' SYSTEM INFORMATION (continued) Property Address:;iC9h Owner:Vxix '' Ol$Ll� Date of Inspection. SKETCH OF SEWAGE DISPOSAL SYSTEM"__.._._...... Provide a sketch of the sewage disposal system including des to at least two ...., benchmarks. Locate all wells within 100 feet. Locatc..WbW public water gupp mtm the building landmarks or 5"uS 'r44 3 =t741 •?p°?i Ron ^Oi Land North Andover, floss. �MN19 "As -Stilt Sanitary Disposal Syst, Lot 79A — CmxSestrci, Flood two Pray wow For tJ+.evrshe.. Robw! a Java, Ave ; Scl�dwe of T . . L ®d to ,r J M fbwAbw► low. .0 N7.M' i� I �g� L of ?0A Lot 19A 10 ,d t,��4►ac+�; Ao . 044' Ar - 409fr AV • . dr . too' ADO . wE• AN•SeI' AN J� 04 • SO, av 4p Nage i 0 rW1M** . of 40 A* 0 fast #sits'? OW . ei SS. Ike 0 C-1 - eWX Y�w►e 0 6-1 - P&P t+lrore ® C»! is 1f?it W+ va Mr &W yn�orer w N1. pr d .�w� Alr "�fa�` aM4iNMr M �eeer� �a�ef ey�r/rw Jre�1 s► N Page 10 of I l OFFICIAL INSPECTION FORM 'NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SRWAGEDISPOSAL SYSTEM INSPECTION FORM Pm7c: SYSTEM INFORMATION (continued) Property Address: Owner: VT.,vn%*]a Ol$u� Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM—' — Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate w•bere public water supply eaters the building. 10 Page 11 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:�. L�� er • 1 9e D" • 11 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water Int Piease in ' to (check) all methods used to determine the high ground water elevation: Obtained from system design plans on record - If checked, date of design plan reviewed: � Observed site (abutting property/observation hole within ISO feet of SAS) Checked with local Board of Health -explain: Checked with local excavators, installers- (attach documentation) Accessed USGS database -explain: II 4s N ,%It; O m Q V w � N ti4p� ici �A *let b o oC2 � (n NM �m 1 0 r � `4v I J � Q ,%It; O m Q V r�p0 ti4p� ici �A *let � f o (n NM �m ,%It; O m Q � f o 0� d� 1 0 r � `4v ,%It; + e f Rf IIi�ii N /A N • in I" V. 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TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: 3- a4tt� (example: left front of house) 3�Zc� DATE OF PUMPING: 0"3- uANTITY PUMPED GALLONS CESSPOOL: NO YES SEPTIC TANK: NO NATURE OF SERVICE: ROUTINE ' EMERGENCY OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER SYSTEM PUMPED BY: YES FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) TG��►� OF NORTH ANDON. BOARD OF HFALT14 COMMENTS: '-L1301 CONTENTS TRANSFERRED TO: Lou -,e# a�zo� �l I a� o 14- SZ SZ Q I (o o ooll jUC�C� aCiQ��o ~O(oQoo I ,W V 0t ^V )�a�) �F- v 4-1 ru T LL 0 v 7H 1— f� ma CD o IDc go V, a� o � c a o � ooa O 1- r O Q i Z U O C .1161 r) O Q"' ON 1-4 O z c w w • x z W x �. co GOD m CDc O co o o III: Z o .f Q rn w Oct • Z O cm c CL. =E o u o p O v a, Gq '°aov c Cv O �+, � O C ►Wj-'sem'' W : 'S m ` Oi y C m O c � Ca c 0 p �w cn w, u. w 04 : cn w w CZ-1-0Co O z Cf) C/) C9 � Z m W Q LA- C= O 1-- LA - LU 93- M N F` c C3 Col cd CD C N �. co --�5= m CDc O co o o III: Z o .f Q �.: o 0 0, - o ca Z O cm c CL. =E Q :ac ev cc m a m c i mca = o om ouj _ O N O ca Cf) C/) C9 � Z m W Q LA- C= O 1-- LA - LU 93- M N F` Col C E CD C N �. co --�5= m CDc O Z co LU c� Q �.: o 0 0, - z id± O cm c CL. =E Q -4: m a W -> i mca D CL _ O N O ca CD L MO a a CMC co C O y A c V'C N CD O O u.. 0 CD 0 Citi. D i m -CO W h co¢ � C z z acr o� mm z aW W z �Ccm O ' CO d 0 C Q V m �m=z,.. m y nt..p •o = - NCL co yR c y m CD L m W C � r C r=... •.� O C Vf at Z W C3 m CO. C COD CL o Z eC i y O O �=�a*mom Cf) C/) C9 � Z m W Q LA- C= O 1-- LA - LU 93- M N F` Col C E Z �. co --�5= O Z co LU Q O O c z z id± O W Q Q co 'E Cw m m z W -> i � �U D CL _ O CD CD L MO a a CMC y C O C Cc J V'C z .52 O u.. Z O Z CD y CT's Citi. m W h C.3 C z z z aW W w � r z or °-� ❑ < w Z J Q a � coc Z LL LL o 44 z w ¢ Elw ' J Q U ❑ 4 '� � O Z a 2riuiiiu%QC71u amozw 2w20 M W C c Z O 2 I Q EC31,w O n G J N "/ LL W J N rjW W o (1 w > U CCM F- U O G Q W C Q ` W H O Q = z � LL p b4 c O S Q U v -C Y �Q ce N� z 0 p o = m o J o C 0 p ► l In a� W T LA Z y N -C �! N o 0,40 a� a� aU d N ll C.Aq� m OA -NI LIU FORM U - LOT RFJ EASE FOgM 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: l�i?1'lzii�tl�3ru'1r�D &iL4X,,�Y ) Phone ./'/J LOCATION: Assessor's Map Number & 4 Parcel 3 -orl%A� Subdivision J� i41) �C � Lot (s) I -FA Street 37cq St. Number 370 ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved / Conservation Administrator Date Rejected Comments ff - 17 �� rte- lt(� Tom/17A4 Date Approved Town Planner Date Rejected Comments Food Inspector -Health Septic Inspector -Health Comments Date Approved Date Rejected Date Approved - Date Rejected Public Works - sewer/water connections - driveway permit / �- Fire Department Received by Building Inspector Date PLAN REVIEW CHECKLIST ADDRESS Z /W �,?i^/� �,�ST/C� ENGINEER GENERAL 3 COPIES STAMP L/ LOCUS C/ NORTH ARROW L---' SCALE CONTOURS L/ PROFILE C/ SECTION �� BENCHMARK j SOIL & PERC INFO ELEVATIONS WETS, DISCLAIMER WELLS & WETLANDS ✓ WATERSHED?,,L/a DRIVEWAY C--�(Elev) WATER LINE �--� FDN DRAIN SCH40 [/ TESTS CURRENT? %989 9- 11?V ', SEPTIC TANK MIN 1500Gy .17 INVERT DROP v GARB. GRINDER(+200% EDF) 25' TO CELLAR MANHOLE TO GRADE' ELEV GW D -BOX SIZE # LINES FIRST 2' LEVEL STATEMENT INLET/(p 2, f/ - OUTLET /�;?, a = rz (2" OR . 17 FT) TEE REQ' D?/0- LEACHING ` / MIN 660 GPD? ✓ RESERVE AREA %' 4' FROM PRIMARY? ` 2%.SLOPE_ 100' TO WETLANDS 0- 100' TO WELLS4' TO S.H.GW 35' TO FND & INTRCPTR DRAINSt/'325' TO SURFACE H2O SUPP 4' PERM. SOIL BELOW FAC ITY MIN 12" COVER FILL? G� (25' if above natural ele t- �101iflow) BREAKOUT MET? TRENCHES MIN 660 gpd SLOPE (min .005 or 6"/1001) SIDEWALL DIST. 2X EFF. W OR D (MIN 61) TRENCHES? IN FILL? MUST BE 10' MIN. >3'COVER?-VENT IS RESERVE BETWEEN 4" PEA STONE? BOT X LDNG + SIDE X LDNG = TOT (L x W x #) (G/ft2) (DxLx2x#) (G/ft2) Copyright © 1993 by S.L. Starr r PITS MIN 660' -LEACHING 11 MIN 1 (131x16') PIT 41__/ MANHOLE/PIT " GW MIN 41 BELOW BOTTOM_ EXC 2x EFF W OR D 1211-4811 STONE— / 1, +� SIDE />� ' `� — BOT ��9 � x LOAD = TOTAL (L x W x #) (2x(L+W)xD x CHAMBERS MIN 660 LEACHING ✓ GW MIN 411 BELOW f COVER >3 FT - VENT MANHOLES C---' 1211-4811 STONE L./ SPLASH PADS -L SLOPE .005 BED/ RENO , / (Bed max. 601 X 601) MIN 131 X 161 PIT BOT�91q+ SIDE l g/ 3� X LOAD = TOTAL 7LIXI' (L x W x #) (2 x (L+W)xD x #) (G/ft2) FIELDS MIN 660 GPD 900 ft2 BED PERC RATE FASTER THAN 20M/IN GW MIN 41 BELOW BOTTOM OF FIELD PIPE ENDS JOINED? 4" PEA STONE? DIST LINE SLOPE .005? >31COVER-VENT SCH 40 MIN 1211 COVER RATE LDG X 660 = ft2/G REQ1D (ft2) DOSING TANKS AND PUMPS DIMENSIONS X L W DISCHARGE SIZE MANHOLES TO GRADE inlet) HWL OP. SWITCH Copyright© 1993 by S.L. Starr Q1 D Vol. DISCHARGE RATE = TOTAL LXW PUMP CAPACITY gpm gpm DISCHARGE TIME ALARM SEP. CIRC. GW (Min. 11 below LWL CHECK VALVE BLEEDER HOLE MANUAL DATE Sheet of BOARD OF HEALTH TOWN OF NORTH ANDOVER SUBSURFACE DISPOSAL DESIGN REVIEW FEE 1 PERMIT # DATE RECEIVED APPLICANT BOA �J ��/C}S ASSESSOR'S MAP ADDRESS ENGINEER ADDRESS PLAN DATE PARCEL # LOT # Jq%� STREET C/�NDGGST/CK -� REVISION DATE CONDITIONS OF APPROVAL:_ f�;F d b APPROVED DISAPPROVED Z, iE/uGl� mea l< — �� /�2oviD �lT/�" Av �Di i. a� LvcIVr JG9a GBs�,���3riox� >�iT5 f NOR7M o � p t � �ss�cNusf'�h Town of North Andover, Massachusetts BOARD OF HEALTH �Ll_ 19 Form No. 2 DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant n Test No. \ Site Location—LA-3z l q Reference Plans and Spec DESIGN Z4, Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. Fee CHAIRMAN, BOARD OF HEALTH Site System Permit No VS -3 C) co C) o � < k U) ME cc: tr LL; > Ir 0 j < 0 Z < lin 44bl�5 DATE 4/30/1z, BOARD OF HEALTH Sheet / of TOWN OF NORTH ANDOVER SUBSURFACE DISPOSAL DESIGN REVIEW FEE &o PERMIT # DATE RECEIVED APPLICANT 94AIUS-Z- ASSESSOR'S MAP ADDRESS ENGINEER ADDRESS PLAN DATE CONDITIONS OF APPROVAL: APPROVED DISAPPROVED 9 PARCEL # LOT # lot Ar STREET TD�to.� p CD�,apL� sTtc.lG� REVISION DATE l5e4W ID 13e -?U%llvcQ U:;kV�%O so of Sye DATE l30 gZ Sheet / Of / BOARD OF HEALTH TOWN OF NORTH ANDOVER SUBSURFACE DISPOSAL DESIGN REVIEW FEE &o r PERMIT # _ 7O% DATE RECEIVED APPLICANT ASSESSOR'S MAP ADDRESS PARCEL .# LOT # 1ck Ar ENGINEER AQ)STREET CAS snLv-� ADDRESS PLAN DATE REVISION DATE CONDITIONS OF APPROVAL: APPROVED DISAPPROVED $ ��i✓1-lL "ID �1Gi �IZ.o V t 17C'C� ��'�1���,J 00n EQ Sb FC of sye %*-t s,1 --e�E �l ,�), aotsle�vn.-� we-eow* 6t -j i -a, vcie� Corip("vr�cf,- A,)4e- i lo, 7 tivc I c O�p corf hd 1 O,e �—iG U 10IVUS Z �S yu 113 a_ ClAa 01,4 4v /,017 ,�► , "AX4 ev 'f-� za-llw� - 1 _� I �R� Op'- J a.TH IV01�Tr QIDOvEI-�, NIA: S5-1(,26) ER SOPPL7 L-01 3 A QPU C0 1_ -)Aij-5 z ,.i. 1 r -i ,,.r . . APRZouW6 Auuloi�ITy PLAN 1z_Z- D15APPRovEp Cn��lr�o�s "QSoNS DwC Sc�-I � SySTEr� 1 � 5 ►A l�,,QTio�.l C`x 4v4T(ovJ )NSPt�-6►-(oma I Q5P6—�-TloA 4 PFRC)VE,D 94 Tc' El 0455 Q FC]IL P(PE FROxA t-w� i"v TJ Or L1 Pry SS �[] FIX Pi3TC APr'r�)v►n)G AUFHo/-��Ty I NS %�I i r-9 AWTIOMAL. AJ5Fb-,�., j0NS ( I p--- DiSAPP)�o\j u I?�OSo tis �, 0 DarC FML APPIZVAL pkr ,. APPRWrA)6 13u Moi; i i `y lk I -, NORTH. s' ott��ao BOARD OF HEALTH 120 MAIN STREET NORTH ANDOVER, MASS. 01845 November 20 1989 Neve Associates 447 Old Boston Road Topsfield, Mass. 01983 Re= Lots 18,19 Jerad 2 I have reviewed the plans for lots 18 and 19 on Candlestick Road. I rejected both plans for insufficient breakout fill around the leach areas. Sincerely, Sanitarian Board of Health CC= Robert Janusz 40 Sunset Rock Rd. Andover, Mass 01810 TEL: 682-6483 Ext. 32 or 33 VESt`FD ,6 •ryOD BOARD OF HEALTH 120 MAIN STREET NORTH ANDOVER, MASS. 01845 TEL. 682-6483 Ext. 32 or 52 8:15 P.M. - TOM NEVE - JERARD PLACE II - VARIANCE TO NORTH ANDOVER BOARD OF HEALTH'S REGULATION - 1.06: Mr. Robert Janusz, owner, was present along with Tom Neve, his Engineer. Mr. Neve stated that there were sixteen (16) lots designed, completed, and approved. A few have expired but they were all once approved under the old local regulations. Mr. Neve stated that there are new local regulations and we are subject to comply to these new regulations. What Mr. Neve is asking is to allow them to comply as much as they can to the new local regulations to the extent that the lot does not become unbuildabe or usable and to allow the Health Agent, at the time he reviews the septic plan, to apply the regulations as much as he can to the point where the lot will become buildable as a result. Mr. Neve stated that in every case we will meet the 165 gallons per bedroom per day, the 35 feet from the foundation walls for foundation drain, 25 feet for septic and any other criteria involved. Dr. MacMillan stated that the Board can't give a blanket approval without individually discussing each lot and how it meets the requirements, not necessarily the new regulations but will it be buildable. He stated that the Board does not want to make the lot unbuildable if the Board can give you a variance for a few feet. Mr. Osgood stated that it seems to him that there are two different types of lots - one being lots that had a lot of work done such as designed systems and then there are lots with raw land with no designs. Mr. Rosati stated that how he understands it is that Mr. Neve does not mind trying to meet the regulations for each lot, his problem is that for each lot that he may not be able to meet one of the requirements he must come back before the Board for appropriate variances and Mr. Neve was wondering if this can be done in house between Mr. Neve and himself. Mr. Osgood stated that this waiver only applies to lots that were approved through the Board of Health Office. Mr. Neve stated that he is asking for all of the lots that were part of the original subdivision which was approved in 1988. Mr. Rosati stated that he would not feel comfortable in doing that. On a motion by Mr. Osgood, seconded by Dr. Rizza, the Board voted unanimously to grant waivers between new and old local regulations subject to Mr. Rosati's approval on each specific design and if any problems arise the Board request Mr. Neve come before them. f MORTI, C.tt�.a ,�',•�C F w F Town of North Andover, Massachusetts BOARD OF HEALTH Form No. 2 DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant Test No. .� _ _ Site Location Reference Plans and Specs._ E DESIGN Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. Fee CHAIRMAN, BOARD OF HEALTH Site System Permit No. Commonwealth of Massachusetts City/Town of NORTH ANDOVER, MASSACHUSETTS System Pumping Record Form 4 DEP has provided this form for use by local Boards of Health. The*em Pum in Record must be submitted to the local Board of Health or other approving a C�� A. Facility Information JUL 0 7 2008 Important: When filling out forms on the computer, use System Location: Q l /�/^r � t`�� TpWN'�F NORTH:AI�IC�D`uER NT HEALTH "DEPAR f, 't only the tab key to move your Address,^� A t� uv�i` v � '�- I /�" Cf 6 6 cursor - do not t"l _ � „ City/Town t' State Zip Code use the return key. 2. System Owner: jj W r'') 6 Name Address (if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): 41 2. Quantity Pumped: Date Gallons Cesspool(s) Septic Tank ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes ❑ No 5. Condition of System: If yes, was it cleaned? ❑ Yes ❑ No 6. System Pumped By: N Vehicle License Number '&LL Company 1-3 7. Location where contents were disposed: Signature of H�u�er http://www.mass.gov/dep/water/approvals/t5forms. Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 o 1-4 —W CO CD G) tn -f- N) C) co 00 .1-4 C) I"N C-,� x 0 CL o CA in 0 or. 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