HomeMy WebLinkAboutMiscellaneous - 40 OXBOW CIRCLE 4/30/2018 (2) i
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Lot & Street — Map/Parcel /Q ,B //,=5�
CONSTRUCTION APPROVAL
Has plan review fee been paid: YES NO Permit#
Plan Approval: Date: JJ 7 Approved by: �/J/L
Designer: R64 P_(M AC Af Plan Date:
Conditions:
Water Supply: ow Well
ell Permit: Driller:
Well Tests: Chemica Date Approved
Bacteria I Da oved
Bacteria II Date Approve
Plumbing Sign-Off: Wiring Sign-Off. '
Comments:
Form"U" Approval: Approval to Issue: YES NO
Date Issued By:
Conditions:
D
Final Approval:
All Permits Paid? 'I5' , NO
Well Construction Approval? NO-
Septic System Construction Approval? NO
Certification? VS
NO
Other NO
Any Variance Needed? YES �NO
FINAL BOARD OF�ALHROVAL:
DATE:
APPROVED BY:
G
SEPTIC SYSTEM INSTALLATION
Is the installer licensed? YES NO
Type of Construction: REPAIR
New Construction: Certified Plot Plan Review NO
Floor Plan Review 57 NO
Conditions of Approval from Form U YES NO
Issuance of DWC permit: NO
DWC Permit Paid? YDS-' NO
DWC Permit #_Y2-L/-3 Installer: 42 , a-Z e ,L
Begin Inspection: NO
Excavation Inspection:
Needed:
Passed: fz
— By:
i
Construction Inspection:
Needed:
A Built n Sa iisfactory:
S: S Y�
pproval of Backfill: Date: By:
Final Grading Approval: Date: / By: -�
Final Construction Approval: Date: By:
Certificate of Compliance: Approval: Date/:
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COMMONWEALTH OF MASSACHUSETTS
I CIPI
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: "0 0 x eon. G N 2
No(ZTH AQ T>OuCa , ivl Pk
Owner's Name: Wiwi rtM s 1=e nl--�16R
Owner's Address: �4 0 fix v-30w < <2e
LC-
NDRTt1 hV DoQcr, Mh
Date of Inspection: &11'1)01
Name of Inspector:(please print) C 0s&w0--T-&
Company Name: 24A, .
Marling Address: .lo o
Telephone Number:
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 inspection.The inspection was performed based on my
training and elcperience 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
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: R C Date: (otqo/
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.
Notes and Comments
****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.
Page 2 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
'KUPIJKTY ADDKESS:4U Uxbow Cir. CERTIFICATION(continued)
North Andover,MA
OWNER William Feather
DATE OF INSPECTION: 6/19/01
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: r
B. ystem Conditionally Passes:
_ e or more system components as described.in'the"Conditio/nneedon need be replaced or
repaired a system;upon completion of the replacement or repair,ase d of Health,will pass.
Answer yes,no or no etermined(Y,N,ND)in the for the follo .If`Snot determined"please
explain.
The septic tankis metal an over 20 years old*or the septic tatal or not)is structurally
:-.unsound,exhibits substantial infiltra or:exfiltration`or-tank failureystem will pass inspection ifthe
existing tank is replaced with a complyin tic tank as approved the Board of Health.
-. *A metal septic tank will pass inspection if i . structurally noun not leaking and if a Certificate of Compliance.
indicating that the tank is less than 20 years old vailable.
ND explain:
Qbservation of sewage backupor break out high stat water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled or leven distributio x System will pass inspection if(with
approval of Board of Health):
brok pmpe(s)are replaced
obiction is removed
,distribution box is leveled or replaced
ND explain:
The system r ufre(d pumping more than 4 times a year due to broken or obstructed pipe(s).The system will
pass inspection if mth approval of the Board of Health):
broken pipe(s).are replaced
obstruction is removed
ND explain:
Page 3 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
'ROPERTY ADDRESS:au Oxbow Cir. CERTIFICATION(continued)
North Andover,MA
OWNER William Feather
DATE OF INSPECTION: 6/19/01
^ C. Further Evaluation is Required by the Board of Health:
Conditions exist which require fiuther evaluation by the Board of Health in order to determine if the system
is failing to tect public health,safety or the environment.
1. System will s unless Board of Health determines in accordance with 310 15
C9C .303(1)(b)that the
system is not fun 'oning in a manner which will protect public health,safe nd the environment:
_ Cesspool or privy is 'thin 50 feet of a surface water .•
_ Cesspool or privy is wi ' 50 feet of a bordering vegetated wetlan or a salt marsh
2. System mill.fail unless the Board of Health(a Pab c Water Supplier,if any)Aetermines that the
system is functioning m a manner that protects the is health,safety and environment:
The-system has a septic tank and soil abso ion em(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface ter supply.
The system has a septic tank and S S and the SAS is wi a.Zone l.of a public water supply.
The system has a septic tank d SAS and the SAS is within 50 eet of a private water supply well.
The system has a septic and SAS and the SAS is less than 100 but 50 feet or more from a
private water supply well' .Method used to determine distance
"This system pas the well water analysis,performed at a DEP certified la tory,for coliform
bacteria and volat' the
compounds,indicates that the well is free fr9m polluti from that facility and
the presence of onia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, ovided that no other
failure criteri are triggered.A copy of the analysis must be attached to this form.
3. ther:
• . .47 ,.
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Page 4 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
YKUYI;KI Y AVOK SS:4U Uxbow Ur.
North Andover,MA
OWNER William Feather
DATE OF INSPECTION: 6/19/01
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
X 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 V2 day flow
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped
_ Y Any portion of the SAS,cesspootor privy is below high ground water elevation.
it 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*DEP certified laboratory,for coliform bacteriwand volatile organic compounds '
r ;: .indicates that-,the well is free from pollution from that facility and the presence of ammonia
:,,' ;nixrogen and nitrate,nitrogen;lis equal to or less than 5 ppm,provided that no other failure,criteria`,f
are triggered.A copy of the analysis must be attached to this form.]
(Yes/No)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. rge Systems:
c
To be 'dered a large system the system must serve a facility with a d
1'�
K 'gn flow of 10,000 gpd to 15,000
You must indicate eith "or no"to each of the following:
(The following criteria apply to stems in addition to criteria above)
yes no
_ the system is within 400 feet of a drin ter supply
_ the system is within 200 f a tributary to a surface drinkin er supply
the system is located• a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone 11 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 consideredhi
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.
Page 5 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
'ROPERTY ADDRESS:40 Oxbow Cir.
North Andover,MA
OWNER William Feather
DATE OF INSPECTION: 6/19/01
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 inspectedfor the condition
of the bales 6r 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.
-XDetermined 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(3xb)]
i
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Page 6 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C a
SYSTEM INFORMATION
3ROPERTY ADDRESS:40 Oxbow Cir.
North Andover,MA
OWNER William Feather
DATE OF INSPECTION: 6/19/01 r.
n LOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): Number of bedrooms(actual): + _
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): L4 (7
Number of current residents: _
Does residence have a garbage grinder(yes or no): 1W
Is laundry on a separate sewage system(yes or no):Q [if yes separate inspection required]
Laundry system inspected(yes or no):=
Seasonal use:(yes or no): I o ..
Water meter readings,if available(last 2 years usage(gpd)):
Sump pump(yes or no): No
Last date of occupancy: &UT
COMMERCLAIJINDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR.15.203): gpd
Basis'of design flow(seats/persons/sgft,etc.):
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/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: Oc i pe-- (2- ow njj q_
Was system pumped as part of the inspection(yes or no): N O
If yes,volume pumped: gallons—How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
X 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)
Tight tank _Attach a copy of the DEP approval
_Other(describe):
Approximate age of all components,date installed(if known)and source of information:
ec.RS
Were sewage odors detected when arriving at the site(yes or no):_LVO
• —'. .... ......._«.. .ter. .. .. _ KiN., .,ypr...�,�,.
Page 7 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C » .
SYSTEM INFORMATION(continued)
eROPEKI•Y ADDRESS:4U Oabow Cir.
North Andover,MA
OWNER William Feather
DATE OF INSPECTION: 6/19/01
MBUELDING SEWER(locate on site plan)
Depth below grade:
Materials of construction:_cast iron _40 PVC_other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK:_(locate on site plan)
Depth below grade: 4„
Material of construction: crete_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 sludge to bottom of outlet tee or bade: 33"
Salm thickness: k1"
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle: 13`t
How were dimensions determined: m R 5 o 2 E 5 M C J 4,
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
ag mat-A to outlet invert,evidence of leakage,etc.):
T1�11�K 1 nJ G-oo p CZ.)N O 1 rt o Aj 5C H Lio Py c- TM S 1 ti (sO�p COP\p
GREASE TRAP: (locate 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.):
J k : '.re
Page 8 of 11 Y
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
'ROPERTY ADDRESS:40 Oxbow Cir.
North Andover,MA
OWNER William Feather
DATE OF INSPECTION: 6/19/01
TIGHT or HOLDING TANK:U&(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/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.):
DLSTRIBUTION BOX: (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: O
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.):
r/c:K lei, &rOCIV. C�A:�\i\�N• DIS{2\ (3Cit1JN �Q�I�� NJ �;Jl '�C�
C A(L-a A0�eJL t,./ 0,2 0�3r
PUMP CHAMBER:N}t(locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
Page 9 of 11 Y ±'
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
PROPERTY ADDRESS:40 Oxbow Cir.
North Andover,MA
OWNER William Feather
DATE OF INSPECTION: 6/19/01
I
---3` M—AX0ftV ION SYSTEM(SAS): (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits,number:_
leaching chambers,number:
leaching galleries,number:
leaching trenches,number,length: Z 1 rrc nc to 6 s- y5 t-o tt L�
leaching fields,number,dimensions:
overflow cesspool,number:
innovative/alternative system Typetname of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,
etc.):
'l'(Ze} pl= Sys M f-fio►LS ,VO&AAANJ St oU (r
O1}nnP SGML. y 12 QA-)-S-)4 VECTC -Yt'I-1JA>-
CESSPOOLS: N R (cesspool must be pumped as part of inspectionxlocate on site plan)
Y
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):
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY:ALL(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.):
Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
'ROPERTY ADDRESS:40 Oxbow Cir.
North Andover,MA
OWNER William Feather
DATE OF WSPECTION: 6/19/01
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 where public water supply enters the building.
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Page 11 of 11 =,
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS u "
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM :{
PART C
SYSTEM INFORMATION(continued)
PROPERTY ADDRESS:40 Oxbow Cir.
North Andover,MA
OWNER William Feather
DATE OF INSPECTION: 6/19/01
STTE EXAM
Slope Flo
Surface watere-
Check cellar ,vim w rkrt 2
Shallow wells N
Estimated depth to ground water fo feet
M
Please indicate(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 150 feet of SAS)
Checked with local Board of Health-explain:
Checked with local excavators,installers-(attach documentation)
x Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
1), v — wA-TFA ';r
?) nes:c,ni ?LAvs CArt 6Zi �v�..
TOWN OF NORTH ANDOVER
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
DATE OF COMPLIANCE:
06/22/99
This is to certify that
the individual subsurface disposal system
constructed (X) or repaired ( )
by
Charles Zaher
at
Lot 25 Oxbow Circle
has been installed in accordance with the provisions of Title V of the State Sanitary Code
and with the North Andover Board of Health regulations as described in the Design
Approval Site System Permit# 967 dated 09/08/97.
The Issuance of this certificate shall not be construed as a guarantee that the system will
function satisfactorily.
Board of Health Inspector
TOWN OF NORTH ANDOVER
SEWAGE DISPOSAL SYSTEM
INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System onstructed; ( )repaired;
by �'1 1�S �- i314 c—
located at c5 T
was installed in conformance with e.North Andover Board of Health approved plan, System
Design Permit# dated L 5B with an approved design flow of---�–✓/
gallons per day. The materiars were in conformance with those specified on the approved
plan;the system was installed in-accordance with the provisions of 310 CMR 15.000,Title 5 and
local regulations, and the final grading agrees substantially with the approved plan. All work is
accurately represented on the As-built which has been submitted to the Board of Health.
Installer: Lic.#: Date:
Design Engineer: Z-11 4s- Date: Oc - 1-5041
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Town of Andover
a m
No. .3/c;L
dover, Mass.,
2 �/ 19
0 - LAKE
'flQ;CO CHICHEWICK
TED P'
�G BOARD OF HEALTH
RMIT T D Food/Kitchen -7
Septic System -PE
/ ��L�ING INSPECTOR
THIS CERTIFIES THAT................................. /... . l
i....... ..(........Q.I ,... ..................................................
Foundation
has permission to erect......................(................ buildings on .....11)............ ., ..C�. .............c .[f ,.� Rough _,9y/l�'�c��- t J/,3 178
to be occupied as.............................................. ./�?, �..F�.a.�.E.............. l.gt4l Chimney
P t�. . ... . :... .. ........................................... .
provided that the person accepting this permit shall in every respect conform to the terqfs of the application on file in Final
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover. PLUMBIN9 INS ECIOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. g �
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRIC R
UNLESS CONSTRUCTION START ough ja
$ L ING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove Rough
P Y P Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector.
Burner
Street No.
Smoke Det.
27 Charles Street
North Andover,MA 01845 North Andover Telephone#(978)688-9540
Fax#(978)688-9542 Board of Health
i
Fmc
To: Pf�':t-e- From:
Fax �7 Pages:
Phone: Date:
Re: �S k,7 c1 l �o-.-2 5 �ac.�C:
❑ Urgent ❑ For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle
• Comments: p /�
plea -se c� v<s ek � s -L/ -�
�' � . ,--/—
� Or
M45 LETTER OF TRAMONTML
HAYES ENGINEERING, INC.
603 SALEM STREET
WAKEFIELD, MA 01880 NANTUCKET, MA 02554 DATE v 108 NO
(781)246-2800 (508)228-7909 ATTENTION '
FAX(781)246-7596
TO Nom-- /'��1DoyAz \.NP+R-O llT RE
No. �iioev�.. MA o�a4s
GENTLEMEN:
WE ARE SENDING YOU K Attached ❑ Under separate cover via the following items:
❑ Shop drawings [X Prints ❑ Plans ❑ Samples ❑ Specifications
❑ Copy of letter ❑ Change order ❑
COPIES DATE NO. DESCRIPTION
57Z/1 I lqq ��� 2S 4� ( w CA2 S- v,Ir
THESE ARE TRANSMITTED as checked below:
❑ For approval ❑ Approved as submitted ❑ Resubmitcopies for approval
❑ Foryouruse ❑ Approved as noted ❑ Submit—copies for distribution
C As requested ❑ Returned for corrections ❑ Return corrected prints
❑ For review and comment, ❑
❑ FOR BIDS DAUE^ 19 ❑ PRINTS RETURNED AFTER LOAN TO US
REMARKS:
Alze Piz,',Q--S o's Triyz t"c ZS
Oy-bOw GP-LILL: h►e c)v�_--y_ 85-$v I L.-r Fi-Prk�. Pi_ep,� Dd Nr
ty 5EL_F Co?- J
o S is L- 'f i�i15i' TfjAT' -1yy W LL
1 0 Q fiv- -AXAL 2 j?-f 0 5E .
1N L
T3_,,so
COPY TO: .�'�1ri LE f7•l I-LL,9a5
SIGNED
If enclosures are not as noted,kindly rronfy us at once.
AS-BUILT CHECKLIST
LOT NUMBER, STREET NAME
r�
ASSESSORS MAP & PARCEL NUMBER
LOT LINES & LOCATION OF DWELLINGS
LOCATION & DEMENSIONS OF SYSTEM,
INCLUDING RESERVE
TIES TO LOT LINES & DWELLING, WELLS
a. FROM SEPTIC TANK
b. FROM LEACH AREA
LOCATIONS OF DEEP HOLES & PERE
TESTS
✓ ELEVATIONS OF DISPOSAL SYSTEM
TOP OF FDN ELEVATION
LOCATIONS OF WELLS, DRAINS, WATERCOURSES
W/IN 150' OF SYSTEM
LOCATION OF WATER, GAS, ELECTRIC LINES, CABLE
DISTANCES FROM CORNERS OF HOUSE TO CENTER OF
/ TANK & D-BOX
V STAMP & SIGNATURE
INTERVIOUS AREAS - DRIVEWAYS, ETC.
\/ NORTH ARROW
F-INAL--CONTOI RS-
LOCATION & ELEVATION OF BENCHMARK USED
LOCUSPLAN
AS-BUILT CHECKLIS
LOT NUMBER, STREET NAME
ASSESSORS MAP &PARCEL NUMBER
LOT LINES & LOCATION OF DWELLINGS
(� LOCATION &MENSIONS, F SYSTEM;
INCLUDINGT�ERVEC_XD�
TIES TO LOT LINES &DWELLING, WELLS
a. FROM SEPTIC TANK
b. FROM LEACH AREA
LOCATIONS OF DEEP HOLES & PERC
TESTS
ELEVATIONS OF DISPOSAL SYSTEM AOT GoMPA,2D w/PP_4�
TOP OF FDN ELEVATION
? LOCATIONS OF WELLS, DRAINS, WATERCOURSES
W/IN 150' OF SYSTEM
✓ LOCATION OF WATER; GAS, ELECTRIC LINES, CABLE
L/' DISTANCES FROM CORNERS OF HOUSE TO CENTER OF
` TANK& D-BOX
t/ G' STAMP & SIGNATURE
IMPERVIOUS AREAS -DRIVEWAYS, ETC.
NORTH ARROW
FINAL CONTOURS
LOCATION & ELEVATION OF BENCHMARK USED
LOCUS PLAN
i
North Andover Health Department
27 Charles Street
North Andover,MA 01845
(978)688-9540
> > `
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To: Peter Blaisdell,Jr Fax: 781246-7596
From: Susan Ford,Health Inspector Date: May 19, 1999
Re: Lot 25 Oxbow Pages: 2
CC:
❑Urgent X For Review ❑Please Comment ❑Please Reply ❑Please Recycle
IV s;;:;:I:iW.n sending you a copy of the new as-built check list for Lot 25 Oxbow in North
Ias-built,
dated M 11 1
a 999 still has some missing items as well as others that
Y g
ereE »:.
J- .the first one we received last year. Thank you
Y
no
HAYES ENGINEERING, INC.
603 SALEM STREET
WAKEFIELD, MA 01880 NANTUCKET, MA 02554 DATE JOB NO.
(781)246-2800 OA 2
(508)228-7909 ATTENTION
FAX(781)246-7596
C RE:
TO �.7�-��� �� �l�-cN �IJS��EL�DiZ
Flo - A4 0VQ2 �-n-� Darr'.
No - Koove�_ I M A o 1X45
GENTLEMEN:
WE ARE SENDING YOU ®.Attached ❑ Under separate cover via the following items:
❑ Shop drawings K Prints ❑ Plans ❑ Samples ❑ Specifications
❑ Copy of letter ❑ Change order ❑
COPIES DATE NO. DESCRIPTION
Lor 26- bw Olz Alb, Aa,,&jz
THESE ARE TRANSMITTED as checked below:
❑ For approval ❑ Approved as submitted ❑ Resubmit copies for approval
❑ For your•use ❑ Approved as noted ❑ Submit copies for distribution
As requested ❑ Returned for corrections ❑ Return—corrected prints
❑ For review and comment. ❑
❑ FOR BIDS DUE _19 ❑ PRINTS RETURNED AFTER LOAN TO�U,_S
REMARKS:— 1 -E0�5� 4;cu- W=gal �� C��T�-'r �y60_C— OV— Pgj. / L�W
'rte 5 W rO TI-Qu S4;P'u- ?-;,e mac._ -YOU R- I?va4 s�-
TCvV�I OF NnRTH ANDf7�ER/
COPY TO:
SIGD:
It endosures are not as noted,kindly notify us once.
FORK U - LOT RELEASE FORK
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 fillut this section*****/***G*********
APPLICANT: A • C. VUI ldtr5 Inc,..! Phone t��J -835o
LOCATION: Assessor's Map Number Parcel
Subdivision Wood (pod ESTuTt5 Lot(s) r�5
Street St. Number
************************Official Use Only************************.
RECOMMENDATIONS OF TOWN AGENTS:
Date Approved
Conservation Administrator Date Rejected
Comments
Date Approved
Town 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
Received by Building Inspector Date
Town of North Andover F NORTH ,
OFFICE OF 3?°�`"e o �o°L
COMMUNITY DEVELOPMENT AND SERVICES °
30 School Street
North Andover Massachusetts 01845
'/q Q09TE0 EfE',` 5
WII.LIAM J. SCOTT SSACHUS�
Director
September 25, 1997
Aurele Cormier
AC Buiilders
33 Walker Road
North Andover, MA 01845
RE: Woodland Estates
Dear Aurele:
This letter is to inform you that the proposed septic plans for Lot 17
Colonial Drive and Lot 25 Oxbow Circle have been approved.
If you have any questions, please do not hesitate to call the Board of
Health office at the number below.
Sincerely,
.Sandra Starr, R.S.
Health Administrator
cc: Wm. Scott, Dir. CD&S
File
CnNSERVA770N 62R-9510 H;AT.TH 68R-9540 P1,1*TNTNG 6SR-95'5
// PLAN REVIEW CHECKLISTy��
ADDRESS-Z6 ,7-6,7- d�0 OX O ENGINEER
GENERAL /
3 COPIES STAMP L--- LOCUS 4"� NORTH ARROWy SCALE
CONTOURS PROFILE �Sc) SECTION �� BENCHMARK SOIL &
PERCS ELEVATIONS L�- WETS . DISCLAIMER WELLS & WETS
WATERSHED?,/1/6 DRIVEWAY L--'- WATER LINE (--� FDN DRAIN ��' M&P �--�
SCH40 L"" TESTS CURRENT? SOIL EVAL B/LZ
SEPTIC TANK
MIN 150OG . 17 INVERT DROP �� GARB. GRINDER/l/6 (2 comps +200 )
101 TO FDN LII-*� MANHOLE Z--' ELEV ` — GW ## COMPS . GB 4-�
D-BOX ��JJ
SIZE ## LINES d` FIRST 2 ' LEVEL STATEMENT
INLET &4.97 - OUTLET X64.7 _ (2" OR . 17 FT) TEE REQ 'D? �U
LEACHING
MIN 440 GPD?`" RESERVE AREA � 4 ' FROM PRIMARY? � 2% SLOPE
0
100 ' TO WETLANDS x_100 ' TO WELLS L--' 4 ' TO S .H.GW k--- ( 5 ' >2M/IN)
20 ' TO FND & INTRCPTR DRAINS C-- 400 ' TO SURFACE H2O SUPP
4 ' PERM. SOIL BELOW FACILITY MIN 12" COVER FILL? y ( 15 ' )
BREAKOUT MET? ��
TRENCHES V/
MIN 440 gpd SLOPE (min . 005 or 6"/1001 ) SIDEWALL DIST. 3X EFF.
W OR D (MIN 61 ) � RESERVE BETWEEN TRENCHES? IN FILL? 'MUST
BE 10 ' MIN. �4" PEA STONE? VENT? y ( >3 ' COVER; LINES >50 ' )
BOT SOV + SIDE d = X LDNG '7f7- = TOT _
( L x W x #) (DxLx2x##) (G/f t2 )
Copyright 0 1996 by S.L. Starr
SITE SYSTEM PERMIT
DESIGN APPROVAL FOR
SOIL ABSORPTION SEWAGE '
DISPOSAL SYSTEM
i
lite System No. Fee AZS
ame /Ly15�P5 `
site Location
form No. 2 �9� :.
- f
t� ..
IY�'
I k.
I
tij
SEPTIC PLAN SUBMITTALS
LOCATION: rJ L11 Ca` re A,
NEW PLANS: YES G/ $60.00/Plan I----
REVISED
/REVISED PLANS: YES $25.00/Plan
DATE: 7 ��
DESIGN ENGINEER: h f e ka ra tj&'�-s
When the submission is all in place, route to the Health Secretary
Town of North Andover, Massachusetts Form No.2
f NORTq BOARD OF HEALTH
O't .o; 1yO r
O �
� w
p
—!r , ' DESIGN APPROVAL FOR
•A"D
7ysAC"usE`� SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
Applicant Test No.
Site Location ZDT AJ' 64L /ACL
Reference Plans and Specs. /9�,P�//Y1RC�C•
ENGINEER DESIGN TE
Permission is granted for an individual soil absorption sewage disposal system to be installed
in accordance with regulations of Board of Health.
CRXrRMAN,BOARD OF HEALTH
Fee Site System Permit No. Q� 7
Town of North Andover, Massachusetts Form No.3
of PpoTH� BOARD OF HEALTH
19�—
''s°^,••��•'� DISPOSAL WORKS CONSTRUCTION PERMIT
SAGHUSE
Applicant_ C.*A ,l� �� J
NAME ADDRESS TELEPHONE
Site Location
Permission is hereby granted to Construct or Repair ( ) an Individual Soil Absorption
Sewage Disposal System as shown on the Design Approval S.S. No.
CHAIRMAN, BOARD OF HEALTH
YJ
Fee D.W.C. No. f d
APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT
DATE: `I �(O��'16 CURRENT INSTALLER'S LICENSE#
LOCATION: L o4- A Ei b, c,�f
v
LICENSED INSTALLER: (Laf 1es 2�L-
SIGNATURE: TELEPHONE#
CHECK ONE:
REPAIR: NEW CONSTRUCTION:
IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT.
Admin* rative Use Only
$75.00 Fee Attached? Yes No
Foundation As-Built? Yes No
Floor Plans? Yes No
Approval Date: /f
Town of North Andover, Massachusetts Form No. 1
01 N '9�O ;
NORTH -1 OF HEALTH �• n (�
-2 4
OL 17
or^. . ...
APPLICATION FOR SITE TESTING/INSPECTION
TEO S
��SSACHUS���
Applicant l�• �` L.t`�v^- --Ci'`�`�-t
NAME ADDRESS �_ __ TELEPHONE
Site Location_ Lcr �S &0 8k ` p
Engineer
NAME ADDRESS TELEPHONE
Test/Inspection Date and Time
CHAIRMAN,BOARD OF HEALTH
Fee . Test No.
S.S.
o.S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No.
Town of NoAth ndover, Massachusetts Form No. 1
NORTH A OF HEALTH
° `V F
°� °° ° w •,^' APPLICATION FOR SITE TESTING/INSPECTION
7 AoOATED PPP (h
�SSACHUSE�
Applicant
NAME ADDRESS i TELEPHONE
Site Location ] VT-:tk- EA I C'7X 106-1`2 C
Engineer .�
AME a ADDRESS TELEPHONE
Test/Inspection Date and Time
CHAIRMAN,BOARD OF HEALTH
Fee Test No. r7 3?
S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No.
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FORM 11 - SOEL EVALUATOR FORT
Page 1
No. ............... .. Date .........
Commonwealth of Massachusetts
WoF-TVI AwwicZ, Massachusetts
Soil Suitability Our—site SewapDisposal
Performed By: ....W..uli-AM D-u-F7,eS-41.j.e......................... -Z Li-17
...................
Witnessed By: ..................
.............
...................................................................................................................................................................................................................................................................
Location Address or 0--'s Na-'A.C. BuitDEP-5; IWC-.
Address,and '33 WAI-Vff�f& eoAD
)—OT Z5, ox( Je Telephone I
Woi;Z-rj4 PozoverZ, MA,
DigNS
W4)c)D1.A W—D E�S-rATSS
New Construction Repair ❑
Office Review
Published Soil Survey Available: No ❑ Yes
Year Published A.q.0). Publication Scale g-94 0 Soil Ma Unit
.. ►............
Drainage Class ...5..... . Soil Limitations ...... .. ........................................................................
Surficial Geologic Report Available: No EJ Yes El
Year Published Publication Scale ................
GeologicMaterial (Map Unit) .. ....................................................................................................................................
Landform . . ........ . ............................................................................................................................................... ..................................
Flood Insurance Rate Map: +1 7,S'D 0-16 DO l0 B
Above 500 year flood boundary No 1:1 Yes
Within 500 year flood boundary No Yes El
Within 100 year flood boundary No Yes El
Wetland Area:
National Wetland Inventory Map (map unit) .............. .........
Wetlands Conservancy Program Map (map unit) ...................................................--................I....................
Current Water Resource Conditions (USGS): Month Jv4-`/
Range Above Normal D Normal 2"" Below Normal El
A S S L)r--,r-p
Other References Reviewed: V S U.S . MfkPc;
FORM It - SOIL EVALUATOR FORM
ReviewPage 2
Deep Hole Number AAZ..... Date: Time: Weather VVeathar �
Location (identify on site plan) ...... ...................................................................................................................................
Land Use S46 JFA�1�-�� �� �� u��
Vegetation 4L0AW����--\j���� "?eov�)......-........................... -.......................................................................................
--�
�*�
Landformn --.=^��z�-.............................................................................................................................................................................................................
Position on landscape (sketch nnthe back) ..... ------------------------------------'
Distances from:
Open Water Body '. feet Dreinagavxoy'.-Z.��.t. feet
Possible Wet Area feet Property Line -l0 T7' feet
�
Drinking Water Well i(u?t feet Other ----.. �--� ---'
DEEP OBSERVATION HOLE LOG
Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other
(inches) (USDA) (Munsell) (Structure,Stones,Boulders,
Consistency, % Gravel)
�
'
�
'
pmrart K8atmha| (geologic) - .m,---7-ttrr-L.----------------- Depth to Bedrock:Depth to Groundwater: ---�
Standing VVutar in the Hole: ~---` Weeping from Pb Face:
Estimated Seasonal High Ground Water: ��������
`
FORM 11 - SOM EVALUATOR FORM
Page 3
Determination or Seasonal High Water Table
Method Used:
❑ Depth observed standing in observation hole inches
❑ Depth weeping from side of observation hole .. .......: .... inches
LJ Depth to soil mottles W./..qO"inches
❑ Ground water adjustment feet
Index Well Number ................... Reading Date Index well level ...................
Adjustment factor ...........�... Adjusted ground water level ......................................................
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas
observed throughout the area proposed for the soil absorption system?
I
If not, what is the depth of naturally occurring pervious material?
Certification
I certify that on F-2-1<i_ (date) I have passed the examination approved by the
Department of Environmental Protection and that the above analysis was
performed by me consistent with the required training, expertise and experience
described in 310 CMR 15.017.
Signature ate
FORh7 12 - PERCOLATION TEST
COMMONWEALTH OF MASSACHUSETTS
�JDM &Ltbovf5lZ , Massachusetts
DoT ZS ox L. ) c_(¢.Gce,
Percolation Test
Date. ..... ...ZS 9. .... Time.
...................
Observation Hole #
P- 1 P-2
Depth of Perc
�b +2Z ' 92
Start Pre-soak
End Pre-soak Z;
Time at 12" �
ZS GA(. ZS GAL .
Time at 9"
Time at 6"
Time (9"-6")
Rate Min./Inch
t`'t i Jlt I Z M� lu I
Site Passed LJ Site Failed ❑
Performed By: S
Witnessed By: Lj SA 0 F� VD
Comments: _......._ .. . _ _ . . ......
.................................................... .................................................................