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Home My WebLink AboutMiscellaneous - 39 PADDOCK LANE 4/30/2018 (2) 39 PADDOCK LANE 210/107.D-0106-0000.0 � I f f 1 I i • S�TTLED�� . • � b PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERTIFICATE OF COMPLIANCE As of: 5/9/16 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Repair of D-Box and Tank By: Todd Bateson At: 39 Paddock bane Map 107.D Lot 0097 ,� North Andover, MA 01845 The Issuance of this c ific—ate�hall not be construed as a guarantee that the system will function satisfactorily. Michele Grant Public Health Agent 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com • S�.�TtiED idyc • North Andover Health Department (ommunity and Economic Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 39 Paddock Lane MAP: 107.D LOT: 0097 INSTALLER: Todd Bateson DESIGNER: PLAN DATE: BOH APPROVAL DATE ON PLAN: INSPECTIONS Tank and D-Box INSPECTION: 5/9/16 DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ❑ Contractor reports any changes to design plan X Existing septic tank properly abandoned, ❑ Internal plumbing all to one building sewer ❑ Topography not appreciably altered Comments: SEPTIC TANK ❑ Building sewer in continuous grade, on compacted firm base ❑ Cleanouts per plan X Bottom of tank hole has 6" stone base X Weep hole plugged X 1500 gallon tank has been installed H-10 loading X Monolithic tank construction ❑ Water tightness of tank has been achieved by visual testing ❑ Inlet tee installed, centered under access port ❑ Outlet tee installed, centered under access port (gas baffle/effluent filter) ❑ inch cover to within 6" of finish grade installed over one access port ❑ Hydraulic cement around inlet & outlet Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon Pump Chamber installed ❑ H-10 loading ❑ Monolithic tank construction ❑ Inlet tee installed, centered under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off floats working ❑ Separate on/off floats ❑ Drain hole in pressure line ❑ cover at final grade installed over pump access port ❑ Water tightness of tank has been achieved by testing ❑ Hydraulic cement around inlet & outlet Comments: CONTROLPANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: basement ❑ Alarm signal located inside: basement Comments: DISTRIBUTION-BOX X Installed on stable stone base X H-20 D-Box X Inlet tee (if pumped or >0.08'/foot) X Hydraulic cement around inlet & outlets X Observed even distribution X Speed levelers provided (not required) X Schedule 40 PVC Pipe Comments: °' Commonwealth of Massachusetts Map-Block-Lot � 5�� mss • 107.D0097 ---------------------- BOARD OF HEALTH Permit No North AndoverBHP-2016-0104 ----------------------- P.I. FEE F.I. $175.00 ----------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted Todd-Bateson to(Repair)an Individual Sewage Disposal System. at No 32 PADDOCK LANE -- ------------------------------------ ------ ----------- -- . as shown on the application for Disposal Works Construction Permit No. BHP-2016=010 Dated May 62,2016 l Issued On:May-02-2016 BOARD OF HEALTH t : Application for S,eptic.Disposal .System TODAY'S DATE Construction;Permit -TOWN OF $2501:00—Full Repair NOR'T'H ANDOVER, MA. 01845 $'425.1o�o�com onelot Important Application is hereby made for a permit to: AP't p When filling out ❑Construct a new on-site sewage disposal system' Q 16 forms on the computer,use ❑Repair or replace an existing.onsite sewage disposalsystem_ TOWN OF NORTH ANDOVER only-the tab key ff Repair or replace an existing system component—What? l f►.✓�—C d� k�QEPARTMENT to move your cursor-do not nI use the-return A. Facility Information key. Address or Lot# as City/Town d- y4.St I`14_ 'e l ilhr3� 2:*TYPE OF SEPTIC SYSTEM*: ➢ ❑Pump B Grravity(choose one) *'*If pumps ttach copy of electrical permit to application'*' ➢ Conventional System (pipe and stone system) ➢ ❑Infiltrator or Biodiffuser(Gravel-Less)(Attach a copy of your certifrcadon to install this We of system.) ➢ ❑Pressure Distribution S.A.S.(No D-Box) ➢ ❑Pressure Dosed(D-Box Present)SAS. ➢ ❑Does the system require an effluent filter? Yes Na If yes, does plan specify make and model of filter? YES=(no further info.needed) NO=(Installer must specify brand of fr►ter before DWC issuance) What is the Make? What is the Modc t: 2. Owner Information Name Address(if different from above) _ City/Town State etet Zip Code Telephone Number 3. Installer Information ,——IAP Name Name ofN ENTERPRISES,INC. h/ �`� /�� 111 ARG ILLA ROAD Address Cityrrown State Zip Code Telephone Number(Cell Phone#if possible please) 4. Designer'lnfornution Name Name of Company Address City/Town State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 T;:,e APpilGati-ori..for Septic pis;posalystem ILI-ly—ice TODAY'S DATE Construction Permit = TOW OF $.250.00-Full Repair ORTH .STD OVER, MA 01845 $125.00.-Component PAGE 2 OF 2 A. FaWlity..lnformation continued.... S. Type-of Building: ❑Residential Dwelling or[]Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system In accordance with the provislons of Title 5 of the Environmental Code,as well as the Local Subsurface Disposal Regulations for the Town of North Andover,and not to place the system In operation until a Certificate of Compliance has been Issue y this Board of Health. 1.3 Name Date Appli on App v y: ( oard of Health Representative) I Name Date Appli tion isapproved,for the following reasons: For Office Use Oniy: 1 "Fee Attached? Yes No Z. PtojectAfadaget Obli tion Form Attached. Yes V No 3.: Ifso) f 1 1P rt`„ Yes No 4. FouadatiorsAs Built.?(hew consfructi ronly); Yes No (Same scale as apptoyedplan) S. FlootMwsp(hew construction-only): Yes_ No Appircatlon for•p(spp5al�yaterli:tronstfncflori pemttt Rage 2 4f 2 ' � sgP'�`IC's`�'Y`x�:n+�'�'�•�ot ' .�r�t�►��•x�Br�ra,�tn�s As OWN9 Andover li setl hjbd t fns t#tab�ttitactupign f�•themptic vot em far tht�rep p s (Ad4ft,otP'ce picas b9 RqW"to*upp mdou of Jdl 1 ,a4e.50A.X lXmdtces name Abd lobed Dated ZT : e mit rtvt &Md, • . . s+�ised dsoej .�'' I uadetotand the foYtoVVhW obligat3ojW form tagement of ibis pngectt i. As the iaetxltet7 I�m.oblipW to 6bt d s eIIpemnb sadof Health nppsovW Platte o0 epetbo�ttg tmp.' cia.s s� .I"=t:at=t:hlt in my tmdi�A�� Uhcm6wnek contmcm4pinjeamana^ Y area p t o�s�ed mp°°aaPmP •sa#aqYfttlm end the apatefa is notxeack d34ft `..` A#46 tao bsvre e . . .. Ded b •' MP � . MY 1"1111 A"W ' . a�raYdb�dan�' �� tea•notbave to btr pr�sGat•. 6. sttrFmrt�io•ttap for a 'i�dtbA'L OI�'(or a ttx frim the eea tmust be ttibtriitted•� ha.8attsd of "' - 6e Hem few en eciipn.t+tne. IaabdAe=must ' •� •atnsep•to•loo'orY 1156d.vle�i6 fi4cu .#�datt'aPQtk�at be' �Able ttf C. MU ". Fenutpltte:, Irish«does got ' hive#o be .• � .� 4. Ar*e forte lw I uuu�dut aaly hamomm r)4MI At i• . ed io ate thaw oft= -ib Comte bilh mi� spsbGgif�i�#iitspt�t�ed�r� iiaa ~ • •• •S J�"., �ll thaer,Y ti�dr�tiin� .1 �•p_etx'�f tbE'{^�'`p`,`'�'',`�',�const;+hcliDn, . A �C �thiJt.�ep�rrcde�eala�a��lQtt�'�bea•Ar s+eocbe+d- , 1� Ias�re+dnfoa aftlre't�ad�ead exo U mad , cot `P�lArar offbjrBouOM *'mogfforccWaAft x d �� a�trraty�-.�mg , ��PAF mer,��aaB other tt of"Worwn ' Undm.lpg Ilona Sepde.IWAU= : PO -I% Y• �, } �\ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Forth-Not for Voluntary Assessments 39 Paddock Lane Property Address Larry Ragone Owner Owner's Name information is North Andover MA 01845 5/9/2016 required for every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: When filling out A. General Information forms on the RECEjV computer,use 1. Inspector: �® only the tab key MAY 2 4 to move your Neil J. Bateson cursor-do not Name of Inspectoruse 2016 key. return Bateson Enterprises Inc. TOWN NORTHgNDOVE Company Name NT 111 Argilla Road Company Address Andover MA 01810 �O Citylrown State Zip Code 978-475-4786 S115 Telephone Number License Number B. Certification I certify that 1 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 ❑ N111.eed§ Further Evaluation by the Local Approving Authority -�C�-� /VWJ( 5/9/2016 Inspector's Signature U Date The system 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 perform in the future under the same or different conditions of use. t5ins•3/13 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 y` 39 Paddock Lane Property Address Larry Ragone Owner Owner's Name information is required for North Andover MA 01845 5/9/2016 every page. City(rown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: After permit from B.O.H., install new septic tank&d-box, inspection from B.O.H., septic system now passes Title 5 Inspection. 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. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 — 33 1 f P Cf `lD le y� It Commonwealth of MassachusettsV lip �� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 39 Paddock Lane Property Address Larry Ra one Owner Owner's Name information is d North Andover MA 01845 /2015 required for N _6/4 every page. Citylrown State Zip Code Date of Inspection t Ib d 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: Wfilling When fillinA. General Information RECEIVED forms on the computer,use 1. Inspector: JUN 15 only the tab key 2015 to move your Neil J. Bateson cursor-do not Name of Inspector TOWN OF NQRTH ANDOVER use the return HEALTH DEPARTMENT key. Bateson Enterprises Inc. Company Name 111 Argilla Road Company Address Andover MA 01810 Crty/rown State Zip Code 978-475-4786 S115 Telephone Number License Number B. Certification I certify that I have personally inspectedlhezewage�disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ® Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 6/4/2015 Ins e r ignature Date The system 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 perform in the future under the same or different conditions of use. t5ins•3/13 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 39 Paddock Lane Property Address Larry Ragone Owner Owner's Name information is required for North Andover MA 01845 6/4/2015 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes:, ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 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. 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): Tank leaking out t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal system Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 39 Paddock Lane Property Address Larry Ragone Owner Owner's Name information is required for North Andover MA 01845 6/4/2015 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. 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-3/13 Title 5 ficial Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts low Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 39 Paddock Lane Property Address Larry Ragone Owner Owner's Name information is required for North Andover MA 01845 6/4/2015 every page. Cityrrown 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 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 must be attached to this form. 3. Other: Tank& D-box needs to be replaced 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 '/day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 39 Paddock Lane Property Address Larry Ragone Owner Owner's Name information is required for North Andover MA 01845 6/4/2015 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments . ' 39 Paddock Lane Property Address Larry Ragone Owner Owner's Name information is required for North Andover MA 01845 6/4/2015 every page. Cityfrown State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 600 t5ins•3/13 Title 5 Official Inspection Form:Subsurface S • swage Disposal System•Page 6 of 17 Commonwealth of Massachusetts fm o U Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 39 Paddock Lane Property Address Larry Ragone Owner Owner's Name information is required for North Andover MA 01845 6/4/2015 every page. Cityrrown State Zip Code Date of inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): on well water Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Current Date 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•3113 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 ' 39 Paddock Lane Property Address Larry Ragone Owner Owner's Name information is required for North Andover MA 01845 6/4/2015 every page. City/Town 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: Pumped 2014, owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 39 Paddock Lane Property Address Larry Ragone Owner Owners Name information is required for North Andover MA 01845 6/4/2015 every page. Cityrrown State Zip Code Date of Inspection, D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 31 years old, 5/30/1984, as built plan Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.6 feet Material of construction: ® cast iron ® 40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): 4"cast iron through wall 3" PVC in house, no leaks visible Septic Tank(locate on site plan): Depth below grade: .5 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'x 5'x 4' Sludge depth: 0 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,. 39 Paddock Lane Property Address Larry Ragone Owner Owner's Name information is required for North Andover MA 01845 6/4/2015 every page. Cityrrown 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 31" Scum thickness 1 Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet tee ok. Outlet tee corroded off. Depth of liquid 2" below invert, evidence of leakage. Inlet cover has riser to grade. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene El 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 39 Paddock Lane Property Address Larry Ragone Owner Owner's Name information is required for North Andover MA 01845 6/4/2015 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•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 39 Paddock Lane Property Address Larry Ragone Owner Owner's Name information is required for North Andover MA 01845 6/4/2015 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box level&distribution not equal. Evidence of carryover, outlet tee off in septic tank. Evidence of leakage. D-box cover broken replaced it. D-box needs to be replaced Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No" Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 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 39 Paddock Lane Property Address Larry Ragone Owner Owner's Name information is required for North Andover MA 01845 6/4/2015 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2 ❑ leaching chambers number: ❑ 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.): Soil Ok. Vegetation ok. No sign of ponding to surface. Leach pits has risers to grade. no liquid to inverts 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 <L . Commonwealth of Massachusetts UW, Tithe 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 39 Paddock Lane Property Address Larry Ragone Owner Owner's Name information is required for North Andover MA 01845 6/4/2015 every page. Cityfrown 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 �. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 39 Paddock Lane Property Address Larry Ragone Owner Owner's Name information is required for North Andover MA 01845 6/4/2015 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 -to WC.\\ r3 0 I a r[0 r �- �1 ti t t �� to �t Lf t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 or 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 39 Paddock Lane Property Address Larry Ragone Owner Owner's Name information is required for North Andover MA 01845 6/4/2015 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: '4 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: 6/11/1982 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: Design plan ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Test pit data on design plan shows no water 4'deep. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3113 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 39 Paddock Lane Property Address Lary Ragone Owner Owner's Name information is required for North Andover MA 01845 6/4/2015 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH 0L 14 - A APPLICATION FOR SITE TESTING/INSPECTION ��SSACHUS��y NAME ADDRE �T �LEPHE Site Location�� qja&a�, V, an ')Rk4-� QLt c " Enginee +Q, NAMED RESS TELEPHONE Test/Inspection Date and Time ° CHAIRMAN,BOARD OF HEALTH Fee Test No. 1033 " S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. BOARD OF HEALTH NORTH ANDOVER, MA 01845 978-688-9540 APPLICATION FOR SOIL TESTS DATE: 02 MAP &PARCEL: MA< 107 1) - PaCei 10(e LOCATION OF SOIL TESTS: q �ct�cQoc 1< L-aKe OWNER: 2bG� s I-awRevtc� �a��h� TEL. NO.: Gj 7 8 - q�,l— ADDRESS: _361 Pct cQ c14, t-Grit A-)a 2TN AN Po,e� ENGINEER: Ncw EA,&-„ Ani, tr��r�e2`�K� TEL. NO.: 1`1>79- 6,96- /7& 6 CERTIFIED SOIL EVALUATOR:V�c R o C , e:� Intended Use of Land: Residential SubdivisionSingle Family Hom Commercial Is This: Repair Testing: Undeveloped lot testing: In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM 1. Proof of land ownership (Tax bill, or letter from owner permitting test) 2. Plot plan & Location of Testing 3. Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$200.00 per lot for repairs or upgrades. (If time is not critical, fee for repairs is $75.00) GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan(no smaller than 1”-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below T ine N.A. Conservation Commission Approval-__ (� 74mg;,&x ;� Date Received: " ! Check Amount: Check Date: i I,/F STELLA LEA--" FITS Woo sep- lr- LOT 12 A A� R• Lo-r .I 5� • LOT 10 A L-40 S , qb ', E L�vA�r � o r•� 5. � ��/ F DE SI G,N AS b%+l4T PE a VT OF HSE. 18!012 15co•75 A E-) U ILT w'To t85.9r3' I SCP-43 G E TOFT 18g 18!0.05 J Ve) -S U a.. ��+E D 15 POSAL. 1 w v Vi v %NTo P. o t as.s� 155:42 SY S T E M INV PIPE T 185,40 Ieaft o f 55.04 185.ZO 1 IQ w TEM EL AVEW-A 4 E STO�►L F SAM VA'GATA 5 G e.L E 1 " = 4O' DATE; MAY .a0 1984. �IGNDIZD F IC_.,CaM I �.I S�.I d,iJ� QSSOGId'TES �NG . Et�1GINEE�S � d2-CI-IITEGTS � l_d.t�1C7 PLdNNE2.S�QND Su�.vEYOI�S ti.Jb�TN dNDovtiw2 01=1=10E PA.�-�- w o>Z'T N M A. . ` SUBSURME D1SP`,.',.J- �; 2rrgr✓514� -- 11B D' DISAP, A: Reaso.i s: q , V R Th; TbrAtted plan mug- a) '. lot to be serve l-ar _ } � < _�,cr_tion and log dam+ : o • � • _ .. . . l r-.:-ation and result-, p e .-Agn calculations I,. ,atioa -end dimens-10»s � f) s,.-1.sting end propos^u cf 1 g !`i"Ction any vet ar,-, I disclaimer-check _tl arv' _ >` A . (hl [,,face -and substzrf F_c8 t of r 6-. stem or disclaiM-F ncation any L; z' I s� ,stem or disclaim-• -M - } i � sources of k`�r' ' c� •;r c,: b:,tem or disclaiT'i > P I ;e-cation of uster m) -ation of benchza c. 3 veiways po) g. rbage disposals , ) 1.0 PVC to be used 3n cc. , I (q) p:-ofile of systems-e, c;--- - d d3.stribution box i-r le s ' c `= P - �StLer elevations , r) y• Am= ground w tax' ell. (s) p7 an rest be prepay_t,_d b- p,, p,, ofessional authoI 1 7,e-,' - Sf -)tic Tanks (a c ..:cities-lM6' of flo ac.cecsj pumping , -anout l o t from cellar vs, G' -, I d) t from subblirfac r� •? Tri s tribution Boxes a) pe greatsr truer, C>C� b) p " Subsur'ace Design Check List Page 2 ' FAIL Cg Leaching Pits Leaching pits are preferred Hhe;�-, the installation is possible Reg 11.2 a) calculations o eaching area-r..l•ib•2m 500 eq ft 1.1.4 b) spacing 11.10 c) surface a 2% 11.11 d) cove terial e) 21 'A" splash pad f) a at elbow no beads in pipe fyrom d-box to pipe Leaching Fields Reg 15.1 a) no greater than 20 Utes/inch b) area-mi.nimuz sq ft 15.4 c) constructio f field 15.8 d) s 6face e 2 % 3.7 e) 201i v, cellar 11 -n}or ingrownd sig pool chi__n��H'rmches teg 3.4.1 calculateons of leaching area-nin IbO sq ft 14.3 spacing-h ft min 6 ft with rese.7;a beta een 14.4 dimensions..-- - - 3-4.6 ) construction 14.7 ) stone f) surface drainage 2% _ - -- -- ---- _ Downhill,. Slope ,- )i she y/X :_(-to' be-shown)T - - b) y/x_X-150_=_(to=be-sholih - feg 9:1 _ a) approval -- 9.6 _stand-by poser = _ Bbarti of Health Nar+4h ',ndover,Yasa FACE DISPOSAL DBSIM CHH-']K LIST �� ,/• LOT B 71by�c l� DISAPPROVED DATE APPROVED Provided:-' % ' - Reasons: ,7�n /, Title V FAIL OK Reg 2.5 e submitted plan tsast show as a mini==: the lot to be served-area,di-mensions lot #,abutt.ers cation and log deep observation hoes-distance to ties 1 cation and results percolation tests-distance to ties sign calculations & calculations showing required leaching area ocation and dimensions of system-including reserve area ea35ting and proposed contours (g cation any wit areas 16thin 100' of sewage disposal system or disclaimer-check watlands mapping (h face and subsurface drains within 100' of se-w-age disposal system or disclaimer - (i} 1 cation any dramas& easements -,thin 100' of selage disposal system or disclainer-Planning Board files 3) kno sources of xater simply vith3n 2001 of B6,;ag6 disposal e stem or disclainer cation of ring proposed �:-eell. to serve lot-100' from leaching facile 1 cation of water lines on prope±ty-10 I from leaching facility (m cation of benchmark _ iFew-ays l o arbage disposals no PVC to be used in construction q) profile of systen elevations of basezmemt, plumb, pipe, septic tangy:, distribution box inlets and outlets, distribution field piping and _ OtLer elevations *s) maxin- n ground mater elevation in area se age disposal system plan waist be prepared by a Professional weer or other professional authorized by law to prepare such_ plans Reg 6 Septic Tanks (a capacities-150% of flow, water table, tees, depth of tees, access, pu, ing cleanout ool c 101 from cellar -.-all or inground0 -6. g p d) 251 from subsurfa.-ce drains Reg 10.2 Distribution Foxes s ope gr eater than 0.08 Reg 10.4 I b} sump i icy Subsurface Design Check'List Page 2 FAIL OK -T Leaching Pits Leaching pits are preferred where the installation is possible Reg 11. i2 ) calculations of leaching area-=ntram 500 sq ft u,4 spacing 11.10 surface drainage 2% 11.11 cover material 21x.21x.4" splash pad f) toe at elbow g) no bends in pipe from d-box to pipe Leaching Fiel Reg 15.1 a) no greater an 20 minutes/inch b) area- .tet 900 sq ft 15.4 c) con cti.on of field 15.8 d) face dr,.inage 2 % 3.7 201 from cellar vs11 or inground siduTdng pool Leaching Rlz c cha Reg 14.1 a)—calculaons 'leaching area_min 500 sq ft 14.3 b) spacing-4 ria 6 ft with reserve betwen 14.4 c) dir _ u, s ]..1;.6 d.) cons ction 14.7 e) s e 1l,..10 f) surface drainage 2% Do i*r h l 1 Slone Ad) s ope y x = to be b) y/x Z 150 = (to be sho�„n) PIUM' s Reg 9.1 a) aprov 9.6Pb) s -by power f E- l tem SUBSURFACE•DISPOSAL DESIM CH`Jr. X LIST LOT 118 P&DOOC-L IN APPROVED DATE DISAPPROVED DATE 1C>1" &_L- Provided: Rea.s s: 00 I'LNJ - (No Title V F Ob _ Reg 2.5 The submitted plan must show as a minimum: a) the lot to be served-area,dimensions lot i#,abuttera jfdjlocation and log deep observation hoes-distance to ties location and results percolation tests-distance to ties design calculations & calculations showing required leaching area ) location and dimensions of system-including reserve area existing and proposed contours ) location any wet areas within 1001 of sewage disposal system or disclaimer-check wetlands mapping (h) surface and subsurface drains within 100' of sewage disposal system or disclaimer (i) location any drainage easements within 100' of sewage disposal system or disclaimer-Planning Board files (3) known sources of Water supply within 2001 of sewage disposal e system or disclaimer %tlocation of any proposed well to serve lot-1001 from leaching facility i) location of water lines on property-101 from leaching facility (m) location of benchmark n) driveways (o garbage disposals no PVC to be used �n construction V? ) profile of system-elevations of basement, plumb,, pipe, septic tank, distribution box inlets and outleta, distribution field piping and other elevations (r) maximum ground water elevation in area sewage disposal system (s) plan must be prepared by a Professional Engineer or other professional authorized by lax to prepare such plans Reg 6 Septic Tanks (a) capacities-15076 of flow, water table, tees, depth of tees, access, pumping cleanout 101 from cellar wall or inground swimming pool (d) 251 from subsurface drains Reg 10.2 Distribution Boxes (a) slope greater than 0.08 Reg 10.4 b) sump Cr.::L List Pt?e 2 FAIL OK Leaching Pits Leaching pits are prefox-red where the installation is possible Reg 11.2 ✓ a) calculations of leaching area-lai ni maim 500 sq ft 11.4 ) spacing 11.10 ) surface drainage 2� 11.11 V ) cover material kox2sx4p splash pad tee at elbow g) no beads in pipe from d-box to pipe Leaching Fields Reg 15.1 a) no gree er t minutes/inch b area-M T__-i� a4 ft -.. 15.4 c� constructi of eld ` 15.8 d} sarface e:2 % 3 7 e) 20 cellar 11 or inground awxLmmdng pool teaching Tren s Reg 14.1 a)—calculations. o eaching area-min 500 eq ft 14.3 b) spacing-4 min 6 ft with reserve between 1.4,4 c) dime:nsio 14.6 d) contra on �.7 e) stone 14.10 f) surf ce drainage 2% W-.=hill Slope ) slope y x = to be shown) b) y/x X 150 = (to be shown) Reg 9.1 a) roval 9.6 1b) tand-by power Board of hoaltft SEPTIC SISTEK North An ver s• INSTALI.ATICK CHECK LIST LotPwb4C9=,,<t AVATICH OK FAIL DI SAPPHOVED easanst, v ' FAIL OK Distance To: a. Wetlands b. Drains . c.. Well Water Line Location 3• No PPC Pipe ?�. Septic Tank a. _Tees Length & To Clean Out Cowers b. Cement Pipe to Tank -- Gln Both Sides of Tank _ �. Distribution Box a. Covers & Box - No Cracks b. All Lines FloAmg Equal Amounts c. No Back Flort 000 6. - Leach Field or Trench a. Dimensions b. Stone. th c: Capped.-Eads _ �d:�Clean Double-Washed Stone 7. Leach Pits _ ' a. Dimensions b. Stone Depth 01 -Splash Pads d. Tease -� e. Ce*mt Pipe to Pit. - Both Suedes ,ter f. Clean Double Washed Stone 8. No Garbage Disposal 9. -Anal Grading Inspection 10. Barricading Covered System 11. As Built Submitted a. Lot Location _ b. Dimensions of System c. Location with Regard-to Perc Test ' d. Elevations ` e. Water Table F t FORM U - LOT RELEASE 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: ��.u�� c�17� Phone LOCATION: Assessor' s t Map Number /0 7 ID Parcel I Subdivision PAc�r�i 16L Lot(s) Street St.' Numbercl _ ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: �� • �. Date Approved Conservatioii-Idministrator Date Rejected Comments tck Date Approved y 4 own Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected Date Approved / Septic Inspector-health Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Department fz �� r Received by Building Inspector Date FORM U .�- TOWN OF NORTH ANDOVER LOT RELEASE FORM SUBDIVISION ASSESSORS MAP SUBDIVISION LOT(S) PERMANENT ADD E ASSIGNED BY D.P.W. A1STREET3CI 0 11_611:L ZZ-4C` APPLICANT PHONE —� Z DATE OF APPLICATION TOWN USE BELOW THIS LINE PLANNING BOARD DATE APPROVED TOWN PLANNER DA'Z'E REJECTED r CONSERVATION COMMISSION DATE APPROVED CONSERVATION ADMIN. - TE REJECTED BOARD OF HEALTH DATE APPROVED g D li Ii SANITARIAN— DATE REJECTED DEPARTMENT OF PUBLIC WORKS DRIVEWAY PERMIT A, SEWER/WATER CONNECTIONS FIRE DEPT. RECEIVED BY BUILDING INSPECTION DATE This form shall be signed by the agents of the Planning and Health Boards, the Conservation Commission prior to the issuance of any building permits for the subject lot. This form shall not releive the applicant from the compliance of any applicable Town requirement or Bylaw. Ij JS 61/c G/ C�� ,�� zit/ ZiCIs/`-7/t/�- <Sy Strve-/ �ldl� ih �s k� �o�e` Gl�� 1 ��. �cLO� �� / 'irw. � —fa S� � � wm� -�� /iz`�✓ ✓ c/� �vw, U � v �cn it Stu VLUT PLAN .. ............. APR 15 1994 N n 0 ' Y 4. • 61, 1E><,ST,nc� f•�awtOrtilcrv� . e�•" J$Ir'� I 0 s�. v W'ELL-% o I I ' I oo: .� SOIL PROFILE & PERCOLATION TEST DATA North Ana----- ,• -. rt„_ Nn. l � Loc./Subdiv._ Plan Owner S� 6\nne 5 Investigator Vl Observer, Fo lila I SOIL PROFILES-DATE 1- Elev. Elev. Elev. 2' 3' 4"Eley. 0 0 0 0 1 1 1 1 Ties to Test Pits 2 2 2 2 3 3 3 3 -- -_ 4 4 + 4 4 5 5 5 5 �v 6 6 6 6 7 7 7 I Z 7 — Ou 8 8 8 8 �a��o 5S-1k l 9 — 9 9 9 °O Y' V 1w-o .0 10 10 10 Benchmark Location Elevation Datum 113 A Percolation Tests-Date Pit Number 1,�� 2 3 4 5 Start Saturation Soak-Mins- Start Test-Time Drop of 311-Time . i0:4D D Drop of 6"-Time i 6.0 Mins . 1st . 3"Dro Mins. 2nd 3"Dro Percolation Rate Notes & Sketches on Back SOIL PROFILE & PERCOLATION TEST DATA North Andover, Mass. Street No �� WW Lot No Loc/Subdiv. Pland Owner Investigator�Glr/ /U Observer lit i i r? SOIL PROFILE DATES l.'Elev 2.Elev3.Elev 4.Elev 0 �� 0 0 0 Ties P1 1%q s est 2 \� 2 �� 2 2 3 3 3 3 4 4 4 4 5 5 � 5 5 6 6 6 6 7 N 7V 7 B N. 8 n8 8 a 9 9 9 !n' 10• 10 110 10 Benchmark »b � er�7 Location Elevation Datum PERCOLATION TESTS DATES Pit Number 1 2 3 4 Start Saturation Soak-Minutes Start Drop of 3"-Time Drop of 6"-Time Mmms.Ist 3" drop Mins.2nd " Drop Percolation I,/F STELLA d � C9 1500 GAL' 3EPTlC: TAMC LOT IQ A 3 N LOT I I '� o � 8G,3G9 S.Ff � 9 4 i LOT 10 A �O LZ bb oo. C E L E VA-r DES14N AS e2.vi\,.T IDE e7 VT OF HSE. 18G•75 A El) U I LT IVjv PIP NTo �85.9r3 18G.45 lt,jvE UTOFT 185.73 ISCo.05 CJ U QZ I V IP INTO D. 185.57 155.40 LIGE D I S t�OSAI_. INV PIPLE OUT P.aoX , 185.40 Ia5.23 SYST EM o , 18s.014 195.ZO l I rel WAX E2 EL I`!0. &MC)OvF.W. AvErz A 4 E gZ-ow►E FCPFrr-ro rz H SAM CSA'GATA 5 G A LE = 40' P4-r E; MAY 30 1984 �IGI 10t2L? F 1,- 5 v 1 4tip dSSOCIdTES =�►JG E"GIME-EE-S � a�Gl-IITEGTS � ' L�.h-I L7 PLdNNE2.S�dND SU2.�/ E�p�S � �� p�� i �� . IZICNAl-D F. K AM I N 5K-i A1.1D ASSOc I A-(�S, G. ►�I O rZTH A w�C��/E2. � MA. �. A A ! S,y}p!� 4 •mak 4/ STS E.LLA � E S-TELLA - s V N ' N �Q, r0 3 LOT I OA►. b � 8Co,3Co9 S.F. �� T - -4sA o �, / 0 O° / o m a LOT 12 A / TOP OF SILL 'a �' EL�vnTtOt-1 18$.83 f TJVi _ ,k Z m Pizopev.T`( LINE A-wo `JT2EET LIN>_ OFr-se-TS , I�i�EPe D 1=02: S.1�A G �iTA SUOwN ONTI4P5 PLA.W ADZE SPEGIFICiaLLY For�T>-�E Dt=TE2M11.lATIO►.1 of Zow,mr, I-EQUIR.I=MENTS Ot.4LY. 1 LOCATION: Lo-rlls Papvoc� LA►.►E THE FOUNuA"riow LoCATEo 0" LATI j SCALE-1`-- 8c DA&TE= FES. ICoa 198d IIe> IS I.IOT LOGdTED WITF-1 w ZOWE r 0, x' A(, P-F-AOF 100 YE a2>=Looe) As is �LAu 2EPSea CE: � DAVID A. 9y' OKI N.U.D. F12.M COMKAUU[TY3 ' (a Is WEBBER Cl- r->&"E-L NO. 250098.4 GATED 6U"E ' s 6!<IUG LoT- ON A PL e N E3Y 15 1983 �rLou� C GEL I►J,&E A Aiss oc.IorE s ZtJc. '� X0. 30757 y �A�TE[7: v/i4h81 <o A�t'41I? VEC0iz peg 1141 �'F��ST.F ��I 00 T1�iS PLT 15 LOGgI ED 0 1F�E Gtzf31J�}p E 5 S>=X cou"TY �'� ' �0 SUR`it� �sSt1o�JI� A�D'(HA'( I