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Miscellaneous - 42 VEST WAY 4/30/2018 (2)
I I � •- I 1 N QO O A � o.m co �•D � O O O i : Commonwealth of Massachusetts City/Town ofRECEIVED 4System Pumping- Record - Form 4 JUL 2 8 2015 SV' VIN OF NORTH F�P.DOVER T DEP has provided this form for use by local Boards of Health. Other �orms; may b�Tll, but the information must be substantially the same as that provided here. Before using -this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted ;to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left ight fron�of eft / Right rear of house, Left/ right side of house, Left / Right side of building, Le Ight front building, Left / Right rear of building, Under deck Address L4 � . , 1 ec W � City/rown �j State Zip Code 2. System Owner. V" \ Name Address (if different from location) City/rown e State �. Z, stater Telephone Number B. Pumping record 1. Date of Pumping Date 2. Quantity Pumped: Gallons t 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑Ye s B -No If yes, was it cleaned? ❑ Yes ❑ No: 5. Condition of System: 6. System Pumped By: Neil. Bateson Name i Bateson Enterprises Inc Company 7. Locatioq#herA contents were disposed: G-6,9 j� / _ _Lowell Waste Water l V Ll� _ T f� —1 F5821 Vehicle License Number Date t5formCdoc- 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts City/Town of RECEIVED System Pumping Record Form 4Lf `i 20 14 T©WN OF N'r...r_. DEP has provided this form for us&by local Boards of Health. Other fI ems*rx1ay;be used but'the information must be substantially the same as that provided here. Before 31 1% check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility. Information 1. System Location: Left fight front of hous eft / Right near of house, Left / right side of house, Left / Right side of building, L fight front of building, Left/ Right rear of building, Under deck Address + r� D�� City/Town - State Trp Code 2. System Owner. Name Address (d different from location) City/TownState Zip Code Telephone Number _ t °s B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons -;i 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes Leo If yes, was it cleaned? ❑ Yes ❑ No: '5. Condition of st m: 6. System Pumped By. Neil. Bateson Name Bateson Entemnses Inc- Company nc Company 7. Locatio LWhere contents were disposed: S. Lowell Waste Wz F5821 Vehicle License Number Data 1 t5form4.doc- 06103 System Pumping Record • Page 1 of 1 PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division r,® CERTIFICATE OF'��-"-' COMPLIANCE As of: 2/12/13 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Repair of D -Box By: Todd Bateson At: 42 Vest Wav Map 104B Lot 0167 Orth ''Andover, MA 01845 of this e ; is te' shall 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 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com •;��'�� Commonwealth of Massachusetts Map -Block -Lot 104.80167 BOARD OF HEALTH - • ---------------- Permit No North Andover BHP-2014-0415 FEE ares, At^f� $125.00 ---------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted Todd Bateson ----------------------- to - - to (Repair) an Individual Sewage Disposal System. at No 41 VEST WAY as shown on the application for Disposal Works Construction Permit No. BHP -2014-041 Dated January 27, 2014 -- ------------------ ------ -- Issued On: Jan -27-2014 " ;` RSD OF HEALTH �' T NORT 6380 Ct :1M Town of North Andover HEALTH DEPARTMENT ,SSACMUSf� CHECK #:1 DA E: t LOCATION: H/O NAME: CONTRACTOR NAME: Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ****XSeptic Disposal Works Construction (Dwsc, ❑ Septic Disposal Works Installers (DWI) r $ ❑ Title 5Inspector $ ❑ Title 5 Report $ ❑ Other. (Indicate) Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. V�_Aoji Application for Septic Disposal System j - d V - /2-/ Construction Permit —TOWN OF TODAY'S DATE , 25 Repair NORTH ANDOVERMA 41845 $oo - Full Application is hereby made for a permit to: ❑ Construct a new on-site sewage disposal system* ❑ Repair or replace an existing on-site sewage disposal system* B'111epair or replace an existing system component - What? �o Y A. Facility Information N Address or Lot # _ ✓1/d - /l -tit 2.- *TYPE OF SEPTI SYSTEM*: JAN 20 14 ➢ ❑ Pump ravity (choose one) TOWN Dr N( r,.iri Kj,;j)vvER ***If pump sysqt m, attach copy of electrical permit to application*** HEALTH DEPARTt,:EI`IT & ➢ Conventional System (pipe and stone system) ➢ ❑ Infiltrator or Biddiffuser (Gravel -Less) (Attach a copy of your certification to install_ this type of system.) ➢ ❑ Pressure Distribution S.A.S. (No D -Box) ➢ ❑ Pressure Dosed (D -Box Present) S.A.S. ➢ ❑ Does the system require an effluent filter? Yes No If yes, does plan specify make and model of filter? YES = (no further info. needed) NO = (installer must specify brand of filter before DWC issuance) What is the Make? What is the Model. 2. Owner Information Name k -4s l "way Address (if different from above) ' - City/Town State Zip Code 9Zy.S.s-7 — 5G33 7 Telephone Number 3. Installer Information Name l J 1 /4 r q ; / n /�¢ ray • Name of ComENTERPRISES, INC. 111 ARGI LLA ROAD ANDOVER. MA 9181 Address Cityrrown State Zip Code Telephone Number (Cell Phone # if possible please) 4. Designer Information Name Name of Company Address Citylrown State Zip Code Telephone Number (Best # to Reach) Application for Disposal System Construction Permit • Wage 1 of 2 TFOIRApplication for Septic Disposal Svstem q— TODAY S DATE Construction Permit - TOWN OF NORTH ANDOVER, MA 01845 $ 250.00 - Full Repair 1W$125.00 -Component PAGE 2OF2 A. Facility Information continued.... 5. 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 provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover. I understand that until a final Certificate of Compliance has been issued by this Board of alth, the installed system is not approved. Name Date cati n Approved Board o Health Represen�ahve) do ame Date— Application ate Application Disapproved for the following reasons: For Office Use Only: 1. Fee Attached.? Yes No 2. Project Manager Obligation Form AttacbedP Yes No 3. Pump System? Ifso, Attach copy ofElectrical Permit Yes_ No 4. Reviewed approvalletter, all paperwork received. Yes No 5. Foundation As -Built. (new construction only): Yes_ No (Same scale as approved plan) 6. Floor Plans? (new construction only): Yes No Application for Disposal System Construction Permit • Page 2 of 2 SEP'xIC SYSTEM..INSTALL.EK'PR0jECr MAN&GEMEN'r OBLIGATIONS As the North Andover.licansetl uistaller for the Wnstructiotifor:the septic system -for the �propeity at For plans by (Address of septic system) /� 1 Relative to the.application of (i'n'atalleis name) Atld dated Dated , -' With revisiot "(1 o a s ar(;j- I understand the following obligations for management of -this project: i 1. As the installer, I am .obligated to obtain. all perpits and Board of Health approved plans to ;perfo=ing any work on a site: I mut have the approved flans and the peimit: on site when any work is bsng-ds� ' 2. As the installer, -I must any and aliinspe'ct'ions: If homeowner, contractor,.project manager, or any other person not associated with my company schedules'an inspection and the systema is not ready, then item three -shall b4 applicable. .`' As •t>i :iFtstalltr, I ata req»ired to. have .the zrecarss ty work'compladd,piio .to the .applicable inspection s as indicated belom r ,;raaeftr69;0* without completioi .-bf the itenss in accortiane Bo'tiomtf I3.ed•enemly, this"is the first 1' en's eotlom unless:there is a 'retaining Wall, vixlich ac: P •. . shou`li ,be-,doneArst: TheJAstaa0.- 1WrFquW the ins, ectida but sloes not have to be present.. b. Fin bff6ti Iti�ppection — Engfaeer mus't'firs do theim� utspection for cTevations,. fres, etc. As-ttii _t" of verbal OK'(cr a -m otio.1 eaitlidpa�to 0 otthanclober.com)from the emigineer must be stibititEed-to':ltlie.Board'ofHealtb,, ahex'•wliiCl msth11e;.calls for -an iinspectipn time. 'Instatler must bepresent for this.inspection, With •a piimp system,: ail• electrical •wotk:must :be ready and able to . ' 'cause :putmip •to �arork arid; alarm".to fitti�tion.. .: • • • ' ' • C. •Fin ' �Gftde-1hgtaller must request' inspection wheii 011'grading-p` complete., .Installer'does not Nave to be •on=site. ' 4. As -the installer; I ani dstand that only I-puy petfomm the voik(other than iiVle excavation) and Tata required to complete the •uistallatibn of the system identfficd in thit attached.applieation for idstallationtide� 5.. ,As the.instOcr,'I understand that'.I m u t'be•oa-site', U=, the•pem�=ziance-of the followconstruction steps: . a: Det atiori that.thcplioperefet' don of the'ercaastron has been reached - A Inspection of the sand aad stone to be used. " c. Feral inspecdoa by Boa& ofHealth suffor consultant. d..Irrstallation.,oftank, D -B, oxf pipes, stone, vent, pump chamber, reta riirrg waff other components. G. Undersigneducens tic.Iastallet: (TQday's Datej l ` y �� j'i-IF Commonwealth of Massachusetts Map-Black-Lott.n "rte • 104.60167 ,.,.• BOARD OF HEALTH Permit No - North Andover BHP -2014-0415 'l P.I. FEE ' renx F.I. $125.00 ----------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted Todd -Bate -son to (Repair) an Individual Sewage Disposal System.��OPY at No 42 VEST WAY ------------------------------------------------------------------------------------------------------------------------------- as shown on the application for Disposal Works Construction Permit No. BHP -2014-041 Dated January 27, 2014 ----------- --------------------- --- Issued On: Jan -27-2014 BOARD OF HEALTH V y' • TED North Andover Health Department (ommunity Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 42 Vest Way MAP: 104B LOT: 0167 INSTALLER: Todd Bateson DESIGNER: PLAN DATE: BOH APPROVAL DATE ON PLAN: INSPECTIONS TANK INSPECTION: 2/12/14 DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ❑ Contractor reports any changes to design plan ❑ 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 El Cleanouts per plan ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged 1500 gallon tank has been installed H-10 loading ❑ 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 ❑ Watertightness of tank has been achieved by testing ❑ Hydraulic cement around inlet & outlet Comments: CONTROL PANEL ❑ 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 ❑ , Installed on stable stone base H-20 D-Box Inlet tee (if pumped or >0.08'/foot) Hydraulic cement around inlet & outlets Observed even distribution R/Speed levelers provided (not required) Comments: CE MO RTM 7y 6706 Town of North Andover ',�'••,, o .: HEALTH DEPARTMENT CNU`+E4 CHECK #:� ATE: LOCATION: H/O NAME: CONTRACTOR NAME: Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service - Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Sustems: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector $ Y\ Title 5 Report $� ❑ Other: (Indicate) $ (6 Health Agent Initials White - Applicant Yellow - Health Pink - Treasurer Owner information is required for every page. Important., When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. ILEI Commonwealth of Massachusetts Title 5 Official Inspection Form,--, Subsurface Sewage Disposal System dorm Not for Voluntary Assessments�s,, 42 Vest Way >7 r - Property Address w V Richard Lee I -TOWN I uF , Owner's Name �AL; North Andover MA 01845 2%12/2094'` City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: Neil J. Bateson Name of Inspector Bateson Enterprises Inc. Company Name 111 Aroilla Road Company Address Andover City/Town 978-475-4786 Telephone Number B. Certification MA state S115 License Number 01810 Zip Code I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑UsFurt r Evaluation by the Local Approving Authority 2/12/2014 Insbe ori Signat rpi 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 r. Commonwealth of Massachusetts Tithe 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r< 42 Vest Way Property Address Richard Lee Owner Owner's Name information is required for North Andover MA 01845 2/12/2014 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: After permit from B.O.H., install new d -box with risers, 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 • 3113 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 2 of 17 Owner information information is required for every page. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. ISI ISI %oommonweaitn or massacnuaet,L* Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Asses; 42 Vest Way Property Address Richard Lee Owner's Name North Andover'::;r City/Town MA 01845 State Zip Code ,F IED eI /AN 2 1 2094 I i)uvly Uw NC IR i'H AND 0( HEALTH DEPARTMENT 1/10/2014 '` Date of Inspection X -y Inspection results must be submitted on this form. Inspection forms may not be altered in way. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: Neil J. Bateson Name of Inspector Bateson Enterprises Inc. Company Name 111 Argilla Road Company Address Andover City/Town 978-475-4786 Telephone Number B. Certification MA State S115 License Number 01810 Zip Code I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ❑ Passes ® Conditionally Passes ❑ Fails ❑ Nee Further Evaluation by the Local Approving Authority ' 1/10/2014 InsoedoesISignatureU 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 � t Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 42 Vest Way Property Address Richard Lee Owners Name North Andover MA 01845 1/10/2014 City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System Passes: ❑ 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): t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System . Page 2 of 17 t Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 42 Vest Wa Property Address Richard Lee Owner's Name North Andover MA 01845 1/10/2014 Cityrrown 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 Official Inspection Form: Subsurface Sewage Disposal System • Page 3 of 17 _moi_ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 42 Vest Way Property Address Richard Lee Owner Owners Name information is North Andover MA 01845 required for every page. Cityrrown State Zip Code B. Certification (cont.) 1/10/2014 Date of Inspection 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: D -box with a riser needs to be 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 Y day flow t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 4 of 17 ❑ ® 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 Forth: Subsurface Sewage Disposal System • Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 42 Vest Way Property Address Richard Lee Owner Owners Name information is required for North Andover MA 01845 1/10/2014 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 Forth: 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 42 Vest Way Property Address Richard Lee Owner information is required for every page. Owner's Name North Andover MA 01845 1/10/2014 City/Town 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? Z ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): 600 t5ins • 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 42 Vest Way Property Address Richard Lee Owner Owner's Name information is required for North Andover MA 01845 every page. Cityfrown State Zip Code D. System Information Description: Number of current residents: 1/10/2014 Date of Inspection Does residence have a garbage grinder? Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) Laundry system inspected? Seasonal use? Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? Last date of occupancy: Commercial/industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tank present? Non -sanitary waste discharged to the Title 5 system? Water meter readings, if available: Gallons per day (gpd) ❑ Yes ® No ❑ Yes ® No ❑ Yes ❑ No ❑ Yes N No Yes ❑ Yes ® No Current Date ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No t5ins - 3/13 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System - Page 7 of 17 Owner information is required for every page. Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 42 Vest Way Property Address Richard Lee Owners Name North Andover Cityrrown State D. System Information (cont.) Last date of occupancy/use: Other (describe below): Pumping Records: Source of information: 01845 1/10/2014 Zip Code Date of Inspection Date General Information Was system pumped as part of the inspection? If yes, volume pumped: How was quantity pumped determined? Reason for pumping: Pumped last year, owner gallons Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Yes ® No ❑ 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 a , Commonwealth of Massachusetts Title 5 Official Inspection Form 8 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .'" 42 Vest Way Property Address Richard Lee Owner information is required for every page. Owner's Name North Andover Cityrrown D. System Information (cont.) MA 01845 1/10/2014 State Zip Code Date of Inspection Approximate age of all components, date installed (if known) and source of information: 31 years old, 10/13/1983, as built plan Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer (locate on site plan): Depth below grade: 3.5 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: Material of construction: ® concrete ❑ metal 2.5 feet ❑ fiberglass ❑ polyethylene ❑ other (explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) Dimensions: 10' x 5'x 4' Sludge depth: 2" ❑ Yes ❑ No t5ins • 3113 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System • Page 9 of 17 Owner information is required for every page. t5ins • 3/13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 42 Vest Way Property Address Richard Lee Owner's Name North Andover MA 01845 1/10/2014 Citylrown State Zip Code D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 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 31" 2" 8" 13" Date of Inspection 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 ok. Depth of liquid at outlet invert, no evidence of leakage. Center cover has riser 6" deep. Grease Trap (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal Dimensions: Scum thickness ❑ fiberglass 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: feet ❑ polyethylene ❑ other (explain): Date Title 5 official Inspection Form: Subsurface Sewage Disposal System • Page 10 of 17 A Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 't 42 Vest Way Property Address Richard Lee Owner Owner's Name information is required for North Andover MA 01845 1/10/2014 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: Date of last pumping: Date Comments (condition of alarm and float switches, etc.): ❑ Yes ❑ No * 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 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 42 Vest Way Property Address Richard Lee Owner's Name North Andover City/Town D. System Information (cont.) MA 01845 State Zip Code Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 1/10/2014 Date of Inspection 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 equal. Evidence of carryover. Evidence of leakage, corrosion at liauid level in d -box. 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 U Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 42 Vest Way Property Address Richard Lee Owner information is required for every page. t5ins - 3113 Owner's Name North Andover City/Town State Zip Code D. System Information (cont.) Type: 1/10/2014 Date of Inspection ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields 1 field 26' x 41' 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. 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 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 42 Vest Way Property Address Richard Lee Owner information is required for every page. t5ins - 3/13 Owner's Name North Andover Cityfrown MA 01845 1/10/2014 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.): Title 5 Oficial Inspection Form: Subsurface Sewage Disposal System • Page 14 of 17 Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 42 Vest Way Property Address Richard Lee Owner's Name North Andover Citylrown MA 01845 State Zip Code 1/10/2014 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 I%- ec,-Y` 3 1 .f:� t t5ins - 3113 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System • Page 15 of 17 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 42 Vest Way Property Address Richard Lee Owner information is required for every page. Owner's Name North Andover MA 01845 1/10/2014 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated de th to hi In round water >4 F g g feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked date of desi n Ian reviewed 5/26/1980 to p Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: Desiqn plan ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: As per design plan test pit data Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins - 3/13 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 16 of 17 Commonwealth of Massachusetts JD Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r� 42 Vest Way Property Address Richard Lee Owner Owner's Name information is required for North Andover MA 01845 1/10/2014 every page. Cityrrown 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 • 3/13 Title 5 Official Inspection Forth: Subsurface Sewage Disposal System • Page 17 of 17 Summary Record Card generated on 1/14/2014 11:22:40 AM by Maureen McAuley Page 1 Town of North Andover Tax Map # 210-1043-0167-0000.0 Parcel Id 16489 42 VEST WAY RICK & VALERIE LEE 42 VEST WAY NORTH ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 1.03 Acres FY 2014 UB Mailind Index Name/Address Type Loan Number RICK & VALERIE LEE Owner 42 VEST WAY NORTH ANDOVER, MA 01845 EAGAN, JEFFREY & CHRISTINE Previous Customer 42 VEST WAY N. ANDOVER, MA 01845 UB Account Maint. Account No Cycle Bldg Id. 17834.0 - 42 VEST WAY 3170499 03 Cycle 03 UB Services.Maint. Account No. 3170499 Active/Inact. Inactive Occupant Name Last Billing Date 1/7/2014 Service Code Rate MISCFEE ADMIN FEE 0.635/8 WTR WATER 01 ALL METER SIZE UB. Meter:Maintenance Account. No. 3170499 Type b Badger Serial No Status Consumption Location 33605706 a Active .1/17/2014 ERT HH Date Reading Code 12/12/2013 547 a Actual 9/12/2013 528 a Actual 6/11/2013 499 a Actual 3/14/2013: 474 a Actual 12/12/2012 448 a Actual 9/12/2012 420 a Actual. 6/12/2012 392 a Actual 3/13/2012 367 a Actual 12/12/2011 345 a Actual 9/13/2011 330 a Actual 6%7/201.1 309 a Actual 3/7/2011 290 a Actual 12/8/2010 274 a Actual 9/9/2010 259 a Actual 6/8/2010 230 a Actual 3/10/201.0 210 a Actual 12/11/2009 192 a Actual 9/8/2009 175 a Actual 6/9/2009 157 a Actual 3/.16/2009 142 a Actual 12/8/2008 124 a Actual 9/8/2008 108 a Actual 6/6/2008 93 a Actual 3/10/2008 76 a Actual 12/12/2007 60 a Actual 9/6/2007 38 a Actual From Until 4/26/2007 Active/Inactive Active Charge Multiplier/Users 7.82 . 1/ 72.20 /1 Brand Type b Badger w Water Consumption Posted Date 19 .1/17/2014 29 10/15/2013 25 7/24/2013 26 4/22/2013 28 1/9/2013 28 10/15/2012 25 7/16/2012 22 4/14/2012 15 1/17/2012 21 10/13/2011 19 7/20/2011 16 4/13/2011 15 1/12/2011 29 10/15/2010 20 7/15/2010 18 4/14/2010 17 1/12/2010 18 10/15/2009 15 7/20/2009 18 4/29/2009 16 1/20/2009 15 10/10/2008 17 7/16/2008 16 4/11/2008 22 1/22/2008 23 10/12/2007 Size 0.63 0.63 YTD Cons 471 Variance -33%. 11% -1% -8% 1% 11% 15% 43% -22% 4% 15% 8% -47% 40% 10% 12% -9% 12% -4% 4% 10% -17% 7% -21% -23% 22% I. of H,* COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION 0 Property Address: 42 Vest Way North Andover, MA 01845 NOV — 7 700 Owner's Name: Jeff Eagan Owner's Address: 42 Vest Way North Andover, MA 01845 L N OF NORTH ANDOVER Date of Inspection: October 20, 2006 ALTH DEPARTMENT Name of Inspector: (please print) Benjamin C. Osgood, Jr. Certified Title 5 Inspector Company Name: New England Engineering Services Inc. Mailing Address: 1600 Osgood Street Building 20 Suite 2-64, North Andover, MA 01845 Telephone Number: 978-686-1768 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 experience in the proper function and maintenance of the on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15340 of Title 5 (3 10 CMR 15.000). The system: Inspector's Signature: 1/ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails The system inspection 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. 2of1V' OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 42 Vest Way North Andover, MA 01845 Owner's Name: Jeff Eagan Date of Inspection: October 20, 2006 Inspection Summary: Check A, B, C, D or E/ALWAYS complete all of Section D A. System Passes: `�- iS 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: V42 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 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. ND explain: 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 Obstruction is removed Distribution box is leveled or replaced 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 Obstruction is removed ND explain; 3of11" OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 42 Vest Way North Andover, MA 01845 Owner's Name: Jeff Eagan Date of Inspection: October 20, 2006 C. Further Evaluation is Required by the Board of Health: IVO 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 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 (SAS) Soil Absorption System and the (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 the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance ** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organize 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 5ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 4.ofIf- OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 42 Vest Way North Andover, MA 01845 Owner's Name: Jeff Eagan Date of Inspection: October 20, 2006 D. System 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 overload or clogged SAS or cesspool. ✓ Static liquid level in the distribution box above outlet invert due to an overload or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Ls 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrogen is equal to or less than 5ppm, provided that no other failure criteria 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. 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 followingcriteria apply to large systems in addition to the criteria above) Yes No The system is witlan 400 feet of a surface drinking water—supply The system is within 200 eet of a tributary to--a"surface drinking water supply The system is located in a of a public water supply m (Interim Wellhead Protection Area — IWPA) or a mapped Zone II If you answered "yes" to a y -question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has ed. 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. 5ofII' OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 42 Vest Way North Andover, MA 01845 Owner's Name: Jeff Eagan Date of Inspection: October 20, 2006 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 V' 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 an 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 ? V Was the site inspected for sign of break out? 4Z Were all system components, excluding the SAS, located on site? Were all 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 difference from owner) provided with information on the proper maintenance of the 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. V 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(3)(b)] ,6 of 11, OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 42 Vest Way North Andover, MA 01845 Owner's Name: Jeff Eagan Date of Inspection: October 20, 2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design) Number of bedrooms (actual): DESIGN flow based in 310 CMR 15.203 ( for example: _ 110 gpd x # of bedrooms) Number of current residents: Does residence have a garbage grinder (yes or no): .A/ Is laundry on a separate sewage system (yes or no): .4,10 [if yes separate inspection required] Laundry system inspected ( yes or no): Seasonal use: (yes orno): NO Water meter readings, if available (last 2 years usage (gpd): ; Sump Pump (yes or no):�'t rr Last date of occupancy --& :� r�. COMMERCIAL/INDUS TRIAL 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: d ` %. r PC -,2- Was system pumped as part of the inspection (yes or no): _/V G 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) Tight tank Attached a copy of the DEP approval Other (describe): Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected wen arriving at the site (yes or no): %Vt % 7of11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 42 Vest Way North Andover, MA 01845 Owner's Name: Jeff Eagan Date of Inspection: October 20, 2006 BUILDING 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: 2- 1 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: /.15 cj,--) �, �c i ; _aa s Sludge depth: 41 Distance from top of sludge to bottom of outlet tee or baffle: 31i h Scum thickness: Li Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle / 7 How were dimensions determined: ,v E6-5-, 12,i Vie" V - Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): -t'AA1l4, l'/� 15 -Ll a.-. -P,T 104. fu 1&Z- /"I—' C.2 cs [_0 -a C1c.,aJ, GREASE TRAP: (locate on site plan) Depth below grade: Materials 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 sludge 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. �ofII OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 42 Vest Way North Andover, MA 01845 Owner's Name: Jeff Eagan Date of Inspection: October 20, 2006 TIGHT OR HOLDING TANK: /V 1 (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Materials 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.): DISTRIBUTION BOX: 0 (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 4? Comments ( note if box is level and distribution to outlets equal, any evidnence of solids carryover, any evidence of leakage into or out of box, etc.): i1 n IL. CJ ^.i f> : j 1:� y,^ « iZ; it Z. > 1� t`� i;7 %�s t -V `7�/-i f i✓ f L PUMP CHAMBER: /vi (locate.on sire 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.): 9 of I,'. OFFICIAL INSPECTION FORM — NOT. FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 42 Vest Way North Andover, MA 01845 Owner's Name: Jeff Eagan Date of Inspection: October 20, 2006 SOIL ABSORPTION 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 in length ✓ leaching fields, number, dimensions: X Z (- 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) ryC, l�A'�'�/� SJi`. Ci/L i PI:ti�J,�L L`( C- L-` (/0 ✓y� CESSPOOLS: !V A (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 or no): Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIVY: A/14- (locate on site plan) Material of construction: Dimensions: Depth of solids: Comments (note condition of soil signs of hydraulic failure, level of ponding, condition of vegetation, etc. 10 ofl,l: OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 42 Vest Way North Andover, MA 01845 Owner's Name: Jeff Eagan Date of Inspection: October 20, 2006 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. 1 I of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 42 Vest Way North Andover, MA 01845 Owner's Name: Jeff Eagan Date of Inspection: October 20, 2006 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water �0 feet 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 excavator, installers — (attach documentation) Accessed USGS database -explain: You must describe how you established the high ground water elevation: nn� STC r✓'i C�wS i� Q`� �-�� J�- L.Sti'-`-'✓ h./j�+� fit/ i�}-C� .('` p lr t 4� i "^ �c`i v✓' �� ka� L.Rr - Y� �L� e_� C�S(s5 /fir,09-PS 8.jD: A - TT or A` oU0 OF qP-2Dr t O v w c O w i Q w a A z z Ac O w O w 42 Q w a A z z ayi = d ami o y a cep m e O 0 O w H d v � 42 Q a A z z ayi = d ami o y a cep Cl) E o ,o LL Sal m CL o Lq O y O J z z z Q U V E d � y N � m 0 O H d v � c`0 z z z w W 3 o ,o LL Sal C) c O 2, O �l w o E m h 0 3 a 3 O O v E 0 cq a o 0 LL 3 m y 3LL O C `� w d m G m a to ,g) 1p O y O a C (� C9 0 0 a 0 Town of North Andover �s HEALTH DEPARTMENT I' CHECK #: %fpS .LOCATION: K - r`, H/O NAME: �'Yrf%�✓Y CONTRACTOR NAME:�`�`-���-� ;V f Type of Permit or License: (Check box) -. ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ � ❑ Food Service - Type. $ kk�V' ❑ Funeral Directors $ t.> : ❑ Massage Establishment $ kj~ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ¢' ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ' ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: r ❑ Septic,- Soil Testing $ Q Septic - Design Approval $ w. ❑ Septic Disposal Works Construction (DWC) $ °- ❑ Septic Disposal Works Installers (DWI) $ ❑ Tit/le 5 Inspector $ [a"fitle 5 Report $ ❑ Other: (Indicate) $ 1952 Health Agent Initials `' White -Applicant Yellow -Health Pink - Treasurer, RO=CEIVE® Commonwealth of Massachusetts City/Town of JUN $ 2013 TOWN System Pumping Record FiEALDF NORTHTHDEPgRTMENTER Form 4 DEP has provided this form for use -by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using.this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location: Left Right front of hou e, Left/ Right rear of house, Left/ right side of house, Left/ Right side of building, Le on of building, Left / Right rear of building, Under deck Address City[Town 2. System Owner. Name Address (if different from location) Citylrown State Zip Code State ^ ` r — G L',ip Code f '709 Telephone Number B. Pumping Record 1. Date of Pumping ��� Date ty p 2. Quantity Pumped 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes No 5. Conditi nSystem: U.,Aj C/C 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Location contents were disposed: LS.> - Lowell Waste Water Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No, F5821 Vehicle License Number Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 n Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. I Commonwealth of Massachusetts EIVED City/Town of NC)M AN,�� MAY 0 6 20 System Pumping Record TOWN OF NORTH ANDOVER Form 4 HEALTH DEPARTMENT DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information 1. System Location: Ila Ad= a ' Cityrrown State Zip Code 2 System Owner: LI°� 1l k& Name 41 U Il.i Address (if different from locati ) /Un rkL, lA City/Town B. Pumping Record 1. Date of Pumping 3. Type of system: Date A 0(84 - State Zip Code C7?8-S 5 ?- S 63 7 Telephone Number s ov 2. Quantity Pumped: Gallons ❑ Cesspool(s) [ Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes L1 No 5. Condition of System: C•0101 If yes, was it cleaned? ❑ Yes ❑ No 6. System Pumped By: A86- 0-7 Name Vehicle License Number Company 7. Location where contents were disposed: 1pswich Water `F reren�.� It'll..... a. Signature of Hauler akDate Ipswich, MA 01938 Signature of Receiving Facility Date t5form4.doc• 03/06 System Pumping Record • Page 1 of 1 Y . 1. Y J E r O IsadQ IrjF�O 17't c� rr ttS £ r r,()Af W � � W IV � / J �p Lo -V'43 N 44,960 �p t,'T 1Z t PLOT PIAN :,,•'NoTE-- ` ` U� LANA UN YES) I WAY !) DESIGN GNF1ELOCHANGEDFROM SSOSDESIGNBYF.C•GELINASAND AS80C. OMER •�-4 TNt ,)i`�'.: %I, -DATED 7-2?81TOACCOMODATE EXISTING CONDITIONS. DATE'10"13-83 SCALE ~4O` 2•) DESIGN CHANGE BY SHABOQP.EgAPPROVED BYKR- OSATI F-S.BASED ON: PERC RATE 8 MINhN-YIEL;DS '500 GALS X 1.6_1� '9606 REQUIRED GAL: PREPARED BY—• - 26X41 -LEACH BED, 1064SUPPLIED 341 CF..RT1F Y THAT THE MATERIALS USED WERE FER TiTLE �S ANC?ii=lATTHE ' FL_..Y1 "V NSSOC. P Co SYSTEM INSFAIAMASSHOWN. P OX569 P�'ST ow o l.I--. 3865 1 Q.EVATI BNS TOP FOUNDATION : 140.20 DWELLING OUTLET: 13&00 SEPTI; TANK = INLET = 137080 OUTLET . 137.52 D -Box INLET'., 136.73 OUTLET = 136160 END OF.Ftt' . ` 136:21 801TOM BED ` 135.0 1 i # �_ �*y i 0 t f. • 140.20 z' j ^ # �_ �*y i 0 t tD 460n . ELEVATIONS f. • 140.20 z' 7 " SEPTIC TANK -' INLET = 137.80 OUTLET *, 137.52 ,D -BOX i tD 460n . ELEVATIONS TOP FOUNQATION 140.20 DWELLING OUTLET: 13MO SEPTIC TANK -' INLET = 137.80 OUTLET *, 137.52 ,D -BOX ML.7 r 136.73 OUTL:ET,l- 1363 ENCS OF REL.D : 1,315.2-1BoTrOM BED : 1351.0 {� LOT 43 N I J 44,960 P �t - • ' f l .PLOT PIAN � •.NOTE-�- • OF LAND ON VEST 1Y "I.').C)ESiGN FIELD6NAN5EDFROhASSDSbESIGNBY F-C�EUNASANDASSOCa OWNER� W, ti_ rtit DATED 7-27-8I TO ACCOMODATE EXISTING CONDITIONSe . a 0-I378 • I - Q 2.) DESIGN GiANGE 13Y SHABOO,P.E. APPROVED BY M.ROSATI M.BASED ON; FERC RATE 6 MIN JIN YIELDS 600 GALS X,1.6_0 - 960 6 REQUIRED GAL, PREIRED BY- - 2C X41'LFAACH BED, 1064SUPPUED 3•) 1 I CERTIFY THAT THE MATERIALS USED WERE PER TITLE 5 ANDTHFLYNN Y�l I N SCo SYSTEM VAS 1NSTA M AS,SHOWN o POBOX5b,:) P1 AIs o W, /Vil 03865 t )lard of Health Drth Ant_D9er_x'1&II3- . " Fly/ ir FM 9i OK ea3nnst SZSTEH IN STALLATICK1 CHBCB LIST 17121 LOT Vel I 1016AVXTI�OH OF FAIL 1. Distance To: a. Wetlands b. Brains c. Well 2. Water Line Locati 3- No PPC Pipe Septic Tank a. -Tees --Length do To Clean Out Covers - j14 b. Cement Pipe to Tank On Both Sides of Tank 5. Distribution Box a. Covers & Box - No Cracks b. All Lines Flowing F4ual Amounts c. No Back Flow. 6.. Leach Field or Trench a. Dtimensions _ .. 7: b. Stone Depth . c. ' Capped ids d. Clean Double Washed Stone 7. Leach Pits a. Di=nsion b. Stone th C. SP1 Pads d. s e Ceaaent Pipe to Pit -Both Sides Clean Double Washed Stone 8. No Garbage Disposal /l� P/ 9. F nal Grading Inspection r� 10. Barricading Covered System 11. As Built Submitted_ a. Lot Location b. Dimensions of System c. Location with Aegard_to Pere Test d. Elevations e.' Water Table Title/V' Reg 2.5 Peg 6 P IXT _tea Jl �,. The submitted plan must show as a r -4 -rd mum: a) the lot to be served -area, d..mensicne lot #, abutters h location and log deep observation hoes -distance to ties C location and results percolation tests -distance to ties design calculations & calculations showing required leaching area e) location and dimensions of system -including eeserve area f) existing and proposed contours g) location any that areas Athin 1001 of sewage disposal system or disclaimer -check wetlands mapping h) surface and smbsurface drafts within 1001 of sewage disposal tt ,L) system or disclaimer ircat1li -.d yhiln 1ye of ati t- 1' 'n:a.1 �rystA-, or files J) know= sources of vaLer siyply within 200E of di_,po sl system or disclaimer k) location of any proposed well. to serve lot -1001 from Teaching faclli 4, 1) location of water lines on prvperty-101 from leaching facility m) location of benchmark n) driveways o) garbage disposals p no PVC to be used in construction q) profile of system- e a evations of basement, plumb, pipe, septic tank, distribution box inlets and outlets, distribution field piping and Other elevations r� r^,a xi.mam ground water elevation in area se -age d spo w al syri te'M s) plan must be prepared by a Professiorml. Ingi.ne3er or ot.-her professional authorized bar Law to pxvpare such plans Septic Tanks a) capacities -150% of flow, water table, toes, dwpth of tees, access, pumping b) cleanout c) 101 from cellar wall or -i.vromd s%U=Lng pool d) 251 from subsurface dxai.ns i eg 10.2 Distribution Foxes I(a) slope greater than 0.08 Reg 10.4 b) wup Q O6F,atCj..t MARK A oDF_D ?Q (�taT Ut�1C�MPAocv 4WD No cd(JFLICT" W1 C'(rLE S isi-P'Mp A Siq. At>QF-o Reg 11.2 1i.4 11.10 11.11 Reg 15.1 15.4 15.8 3.7 Reg 14.1a) 114.4 14.3jf) 14.6d) 14.7 1E} `LL'@.rCheck ge L,±.G''s..,'Par+.+w...� »... -,.-...,.......�.......-.,..,.+......�,..o,..w..,,.,..,..+�-...« .. «.,.,..�.,-.�.......�....,.. Le:iA LL3 Pits Leaching pits are preferred where the installation is possible a) calcul.at, o,is of leaching areawmLaim m 500 sq ft b) spacing c) -surface drainage 2% d) cover material e) 21a2 tx4l, splash gad f) tee at elbow g) no bends in pipe from d -box to pipe Leaching Fields a) no greater thin- 20 minutes/inch b) area-� 900 sq ft 0 constriction of field d) surface drainage 2 % e) 20 from cellar wall or inground mdw!a ng pool L!!ching�Trenches -- calculations of%aching area -min 500 sq ft b) spacing -4 ft min ft with reserve between dimensions constriction e) stone sa rface drainage 2% FAIL OK ....w_c) Dowahill_Slop _e.. a) slopes y x = t to be shown) b) y/x x 150 (to be shown) EMS Reg 9.1 a) approval 9.6 b) stand-by power i Commonwealth of Massachusetss : Massachusetts System Pumana Record Form 4 -- System Pumping Record System Owner System Location Anthony J del Moral Anthony J 42 vest, way 42 Vest Way North Aodover, MA 01845 Horth Andover, MA 01845 (978) 577-3000 (978) 977-3000 x3134 work X3134 work Type: Emergency Routine Cesspool: No Yes Date of Pumping: d) System Pumped By: Wind River Environmental, LLC Contents transferred to: Contents Disposed at: Date: of System/Other Comments Pumper Dep Approved Froin - 12/07/95 Septic tank: No Yes z' Quantity Pumped: Ions Permit Jt: BOAR Y JUN "' 7 200( 1