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Miscellaneous - 44 EQUESTRIAN DRIVE 4/30/2018
44 EQUESTRIAN DRIVE 2101105.13-0134'0000.0 ..Ve —' 44 EQUESTRIANDRH E JS-2004-1177 Proied Detail Report Printed On:Thu Aug 17,2006 Project Name: GIS#: 6584 Project No: �JS-2004-1177 Owner of Record SARRO, RICHARD T&NANCY N a� AO T11 th Map_- �105.D Date Submitted: IJun-28_2004 - 44 EQUESTRIAN DRIVE 0 }: °cp Block: 0134 Status: Open NORTH ANDOVER,MA 01845 Lot: Work Category: Work Location: 44 EQUESTRIAN DRIVE ; Zoning: Proposed Use: District: �S34C„use land Use: 101 Proposed Use Detail — Subdivision - - Description ADDITION Comments: of Work- ------ --- --- Department Status GeoTMS Module: Status File No. Comments: LCDate: Board of Health GREEN FLAG BHJ-2004-0092 Health Dept.Signoff. Building,Electrical&Mechanical Permits GREEN FLAG BEM-2004-0911 Permit History Type: Permit No: Issue Date Status Work Category Contractor Project No: Description of Work: ` Building BP-2004-0887 Jun-24-2004 Expired Residential Alteration&Repairs JS-2004-1177 ADDITION DWC Component Repair- BHP-2006-0231 Jul-25-2006 SIGNED OFF JS-2004-1177 Form U Signoff-construct BHP-2004-0463 Jun-24-2004 SIGNED OFF JS-2004-1177 Dining Room/Kit Addition;Deck extension roof&sc Inspection History Inspection Type: Permit Type: Permit No: Insp Date: Status: Inspector: Project No: Comment: Outlet Tee&Pipe DWC Component Repair-Outle BHP-2006-0231 Aug-09-2006 FULL COMPLY Susan Sawyer JS-2004-1177 GeoTMS®2006 Des Landers Municipal Solutions,Inc. Page 1 of 1 Residential Property Record Card PARCEL_ID:210/105.D-0134-0000.0 MAPA05.D BLOCK:0134 LOT:0000.0 PARCEL ADDRESS:44 EQUESTRIAN DRIVE PARCEL INFORMATION Use-Code: 101 Sale Price: 320,900 Book: 04618 Road Type: T Inspect Date: 09/08/2005 Tax Class: T Sale Date: 10/24/1996 Page: 0251 Rd Condition: P Meas Date: 09/08/2005 Owner: Tot Fin Area: 2726 Sale Type: P Cert/Doc: Traffic: M Entrance: X SARRO, RICHARD T Tot Land Area: 3.2 Sale Valid: Y Water: Collect Id: SGC NANCY N SARRO Grantor: BAKER,RONALD Sewer: Inspect Reas: M Address: 44 EQUESTRIAN DRIVE Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LOW Indust-B/L% 0/0 Open Sp-B/L% 0/0 NORTH ANDOVER MA 01845 RESIDENCE INFORMATION LAND INFORMATION Style: CL Tot Rooms: 8 Main Fn Area: 1454 Attic: N NBHD CODE: 7 NBHD CLASS: 7 ZONE: R1 Story Height: 2 Bedrooms: 4 Up Fn Area: 1272 Bsmt Area: 1454 Seg Type Code Method Sq-Ft Acres Influ-Y/N Value Class Roof: G Full Baths: 3 Add Fn Area: Fn Bsmt Area: 900 1 P 101 S 43560 1 215,186 Ext Wall: FB Half Baths: 0 Unfin Area: Bsmt Grade: 2 R 101 A 2.2 10,340 Masonry Trim: Ext Bath Fix: Tot Fin Area: 2726 VALUATION INFORMATION Foundation: CN Bath Qual: T RCNLD: 372791 Current Total: 635,600 Bldg: 410,100 Land: 225,500 MktLnd: 225,500 Kitch Qual: T Eff Yr Built: 1987 Mkt Adj: 1.1 Prior Total: 562,300 Bldg: 352,900 Land: 209,400 MktLnd: 209,400 Heat Type: FA Ext Kitch: Year Built: 1986 Sound Value: Fuel Type: G Grade: GV Cost Bldg: 410,100 Fireplace: 1 Bsmt Gar Cap:2 Condition: G Att Str Val 1: Central AC: Y Bsmt Gar SF: Pct Complete: Att Str Va12: Att Gar SF: 728%Good P/F/E/R: /100/100/93 Porch Type Porch Area Porch Grade Factor S 144 W 72 SKETCH PHOTO 12 r W 6 14 �. 6 72S B/FM S 13182 Sq.1t. 13 12144 Sq.F1214 29; IR 3 3 14 728 Sq.R. 121g/Sq R. y 28 30 �z 44 L-12A EQUESTRIAN DRIVE Parcel ID:210/105.D-0134-0000.0 as of 6/29/06 Page 1 of 1 North Andover Board of Assessors Public Access Page 1 of 1 Parcel ID: 210/105.D-0134-0000.0 Community: North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlarge 44 L-12A EQUESTRIAN DRIVE � Location: 44 EQUESTRIAN DRIVE Owner Name: SARRO, RICHARD T NANCY N SARRO Owner Address: 44 EQUESTRIAN DRIVE City: NORTH ANDOVER State: MA ZIP: 01845 Neighborhood: 7- 7 Land Area: 3.2 acres Use Code: 101 - SNGL-FAM-RES Total Finished Area: 2726 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 635,600 562,300 Building Value: 410,100 352,900 Land Value: 225,500 209,400 Market Land Value: 225,500 Chapter Land Value: LATESTSALE Sale Price: 320,900 Sale Date: 10/24/1996 Arms Length Sale Code: Y-YES-VALID Grantor: BAKER, RONALD Cert Doc: Book: 04618 Page: 0251 http://csc-ma.us/NandoverPubAcc/j sp/flome.j sp?Page=3&Linkld=808496 6/29/2006 �t q �Lx Commonwealth of Massachusetts RECEIVE City/Town of I ,1uN 2 s 2006 System Pumping Record Form 4 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT DEP has provided this form for use by local Boards of Health.. The System Pumping Record must be submitted to the local Board of Health or other approving authority. . A. Facility Information Important: When filling out 1. Syste Location: forms the - -�v computer.use only the tab key Address to move your cursor-do not � `W� �✓ ` - use the return City/Tow State Zip Code .key. 2.. System Owner:- Name Address(if different from location) Cityffown State/ Zip Code" Telephone Number B. Pumping Record i. Date.of Pumping 6ate2. Quantity Pumped: Gallons 3. Type of system: El 3. eptic Tank ❑ Tight.Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes fr No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of Sty-�- r 6. Syste Pumped B Nam Vehicle License Number Company .7. L05aftn where con ent re disposed: Sig atur f auler Date http://www.mass.gov/dep/water/approvalt,/t5fon,ns.htm#inspect t5form4.doc•06/03, SystemPurliping Record•Page 1 of 1 ti Commonwealth of Massachusetts City/Town of System Pumping Record dForm 4 FSEP 2 2 2008 0'. ''DEP has provided this form for use by local Boards of Health.Other fy: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 Important: When filling out 1. System Locatn � �T� U forms on the computer, use only the tab key Address to move your cursor-do not Cityfrown State Zip Code use the return key. 2 System Owner: —I Name 11 Address(if different from location) Citylrown State Trp Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of System: ` 01 6. Syste Pu �ped,By. Name Vehicle License Number Company 7. Location wh e conten werrposed: Signature of 7urr Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts Map-Block-Lot • o:o��,.•o .,•aao� 105.D-0134- Board of Health Permit No � • • BHP-2006-0231 North Andover -_-___- '�,^�....•'`'[�* P.I. FEE us�i F.I. $125.00 ----------------------- I Disposal Works Construction Permit I Permission is hereby granted Todd Bateson ---- ----- - - - - - I to(Repair-Outlet Tee&D-Box)an Individual Sewage Disposal System. at No 44 EQUESTRIAN DRIVE as shown on the application for Disposal Works Construction Permit No. BHP-2006-023 Dated July 25,2006 -------------- ------ --------- I ------------------ -- - --------------------------------- Issued On:Jul-25-2006 Board of Health - _.--- -- ............................................................................................................................................................................... """" Commonwealth of Massachusetts Map-Block-Lot O ...go .•.y0 0 105.D-0134- p Board of Health -------------------- North --- ----- ---------North Andover ` '��••�-.r �.,. Certificate of Compliance ,s3ACNUStt THIS IS TO CERTIFY,That the Individual Sewage Disposal System (Repair-Outlet Tee&D-Box) by Todd Bateson ------------------------------------------------------------- Installer at No 44 EQUESTRIAN DRIVE has been installed in accordance with the provisions of TITLE 5 of the State Environmental Code as described in the application for Disposal Works Construction Permit No. BHP-2006-023 Dated July 25,2006 - ---- - - ----------------- ---------- ---------------------------------- Printed On:Jul-25-2006 Board of Health Town-6f North Andover Health Department jy Date: Location: Z / (Indicate Address,if Residential,or Name of Business) Check#: �J Type of Permit or License:(Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service-Type. $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal(Septic)Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ eptic Disposal Works Construction(DWC)$ /a? ❑ Septic Disposal Works Installers(DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ TrashlSolid Waste Hauler $ ➢ Well Construction $ ➢ OTHER:(Indicate) Healt Agent Initials i6b5 White-Applicant Yellow-Health Pink-Treasurer ��N)h Application for Septic Disposal System ti �A Construction Permit - TOWN OF TODAY'S DATE — •�; ,. r, yNORTH ANDOVER, MA 01845 $ 250.00—Full Repair ,s ,�H�S�� $125.00 Component Important: Application is hereby made for a permit to: When filling out ❑ Construct a new on-site sewage disposal system* forms on the computer, use only the tab key ❑ Repair or replace an existing on-site sewage disposal system JUL 2 5 2006 to move your Repair or replace an existing system component cursor-do not use the return A. Facility Information TUHEALTH DEPARTvvi,4 OF NORTH MENT key. 41zl Cqu�s It A,� rab Address or Lot# enrn City/Town -- -- �-f--�—® 2 -- — -- -- --- -- 2.- *TYPE OF SEPTIC SYSTEM*: ❑ Pump ❑ Gravity (choose one) ***If pump system, attach copy of electrical permit to application*** ❑ Conventional System (pipe and stone system) ❑ Infiltrator or Biodiffuser(Gravel-Less) (Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D-Box)(Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D-Box Present) S.A.S. 2. Owner Information 9 C�'4��,i S9rt`O Name Address(if different from above) City/Town State Zip Code Telephone Number 3. Installer Information Name Nan e( mp '.t'-Sa�v - --- — Address A 4- City/Town State Zip Code Telephone Number(Cell Phone#if possible please) 4. Designer Information Name Name of Company Address City/Town State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit-Page 1 of 2 Application for Septic Disposal System Construction Permit - TOWN OF TODAY'S DATE ORTH ANDOVER, MA 01845 $ 250.00-Full Repair � $125.00 Component PAGE 2 OF 2 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 And r, d not to place the system in operation until a Certificate of Compliance has been is ed b his Board of Health. Name Date I Applicati Approved By: (Bo of Health Representative) Zb �� Mz N e Date-� Application Disapproved for the following reasons: For Office Use Only: 1. Fee Attached? Yes No 2. Project Manager Obligation Form Attached? Yes_ No 3. Pump System? If so,Attach copyo of Electrical Permit Yes_ No 4. Foundation As-Built?(new construction ronly): Yes_ No (Same scale as approved plan) 5. Floor Plans?(new construction only): Yes_ No Application for Disposal System Construction Permit•Page 2 of 2 INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the j�/ r� �s b�lative to the application property at - dated for plans by and dated with revisions dated�---- I understand the following obligations for management of this project: 1. As the installer I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer I must call for any and all inspections. If homeowner, contractor, project manger, or any other person n od with y company schedules an inspection and the system is not ready then itemrae shall 3. As the installer I am required to have the necgssary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Tile 5 and the Board of Health Regulations may result in a$50.00 fine being levied against my company. a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final inspection — Engineer must first do"their inspection for elevations, ties, etc. As-built or verbal OK from engineer must be submitted to Board of Health, after which installer-calls for inspection time. Installer must to causepresent amp to work and alarm to Withfunctpump system all electrical work must be ready and P c) Final Grade—Installer must request inspection when all grading is complete. Does not have to be on site. 4. As the installer I understand that only I.may perform the work(other than simple excavation) required to complete the installation of the system identified in the attached application for installation, I further understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system, and/or revocation or suspension of my license to operate in the Town of North Andover; significant fines to all persons involved are also possible. I must be on site during the performance of the following 5. As the Installer I understand that construction.steps: a) Determination that the proper elevation of the excavation has been reached. b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff or consultant. d) Installation of tank, D-box, pipes, stone, vent, pump chamber, retaining wall and other components. 6. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersigned ens Septic Installer Date: Disposal Works Construction Permit# TOWN OF NORTH ANDOVER f NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 NORTH ANDOVER, MASSACHUSETTS 01845 �'�Ss'„CH„5 Susan Y. Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978 688 8476—FAX ^� ONSITE WASTEWATER SYSTEM CONST /60N NOTES LOCATIONINFO MATIO I ADDRESS:-MAP: LOT: INSTALLER: 3 y s DESIGNER: PLAN DATE: " BOH APPROVAL DATE ON PLAN: INSPECTIONS TANK INSPECTION. DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ❑Existing septic tank properly abandoned ❑Internal plumbing all to one building sewer ❑Topography not appreciably altered Comments: SEPTIC TANK ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon tank has been installed H-10 loading Monolithic construction ❑ Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) /-�yt`t- ❑ Inlet tee installed, centered under access port rP ❑ Outlet tee (gas baffle or effluent filter) installed, centered under access port u ❑ 24" inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present ❑ Hydraulic cement around inlet & outlet Wastewater System Documentation—Feb 2006 Page 1 of 6 i �7 TOWN OF NORTH ANDOVER t NORTa Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT ~ ` A 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36 NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y. Sawyer, REHS/RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX D-BOX PI-___'Installed on stable stone base ©� let tee (if pumped or >0.08'/foot) [Hydraulic cement around inlet & outlets Observed even distribution ❑ Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEM ❑ Bottom of SAS excavated down to soil layer, as provided on plan ❑ Size of SAS excavated as per plan ❑ Title 5 sand installed, if specified on plan ❑ 3/4-1 Y2" double washed stone installed ❑ 1/8-1/2" (peastone) double washed stone installed 0 Laterals installed and ends connected to header ❑ Laterals vented if impervious material above ❑ Orifices @ 5 & 7 o'clock positions ❑ Gravel-less disposal systems: type, number and location as per plan ❑ Elevations of laterals installed as on approved plan ❑ 40 Mil HDPE barrier installed ❑ Retaining wall (boulder/concrete /timber/ block) ❑ Final cover as per plan Comments: Wastewater System Documentation—Feb 2006 Page 3 of 6 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Wednesday, August 09, 2006 12:09 PM To: Sawyer, Susan; Grant, Michele Subject: 44 Equestrian Drive- D-Box Inspection Hi, Can one of you squeeze in a D-Box inspection this afternoon into your schedule? Todd Bateson called to request it. Please call him at 978.85.2703, and let me know. Thanks!! 8agf Ragands, AM*Aew 27040.0 W,01e Health Department Assistant Town of North Andover 1600 Osgood Street Building 20, Suite 2-36 North Andover,MA 01845 978.688.9540-Phone 978.688.8476-Fax http://www.townofnorthandover.com healthdept@townofnorthandover.com 1 V Septic System Information 44 EQUESTRIAN DRIVE Printed On: Thursday,June 29, 2006 System ID: BHS-2002-0598 General System Information Latest Permit Information Calcaluted Design Flow: Test Pits Septic Tank Disposal Trench Design Flow: One Two Capacity: Number: Design Flow Provided: Minutes per inch: Width: Width: Total Flow: Depth: Length: Length: Seasonal: No No Depth to Water: Diameter: Leaching: Grinder: No No Soil Type: Depth: Laundry: No No Inspections: Inspected: Expires: Inspector: Status: 06/21/2006 Neil J. Bateson Conditionally Passes Comments: Title 5 -_�-- s GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Page 1 of 1 Town of North Andover Health Department Date: Location: (Indicate Address, if R tial,or Name of Business) Check#: Type of Permit or License:(Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service-Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal(Septic)Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC)$ ❑ Septic Disposal Works Installers(DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ TrashlSolid Waste Hauler $ ➢ Well Construction � / $ ➢ OTHER:(Indicate)'` Health Agent Initials 1639 White-Applicant Yellow-Health Pink-Treasurer �5 Town of North Andover Health Department Date: fI� Location: (Indicate Address,if Rq6tlential,or Name 'offBusiness) Check#: ��� / Type of Permit or License:(Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service-Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal(Septic)Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC)$ ❑ Septic Disposal Works Installers(DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ TrasWSolid Waste Hauler. - $ ➢ Well Construction � $ ➢ OTHER:(Indicate) G39 Health Agent Initials i White-Applicant Yellow-Health Pink-Treasurer COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS v a d DEPARTMENT OF ENVIRONMENTAL PROTECTION S� TITLE 5 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:_44 Equestrian Drive_ ZOFN North Andover_Owner's Name: Richard Sarro Owner's Address: 44 Equestrian Drive _North Andover,MA 01845Date of Inspection: 6/21/2006VER Name of Inspector: Neil J.BatesonT Company Name: Bateson Enterprises Inc._ Mailing Address:_111 Argilla Road_ _Andover,Ma.01810 Telephone Number:j 978)4754786_ 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 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 _X Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: 6/21/2006_ 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 CERTIFICATION (continued) Property Address:_44 Equestrian Drive_ _North Andover_ Owner•_Sarro_ Date of Inspection:_6/21/2006_ 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: X 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.Outlet tee in septic tank&d-bog needs replaced. N 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: N 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: N 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: Page 3 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_44 Equestrian Drive_ _North Andover— Owner: Sarro Date of In_spection:_6/21/2006_ 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 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 su_rface 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 44 Equestrian Drive_ _North Andover— Owner:_Sarro Date of Inspection: 6/21/2006_ D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no?'to each of the following for all inspections: _ No_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _No_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool No Liquid depth in cesspool is less than 6"below invert or available volume is'/z day flow. _No_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _ No Any portion of the SAS,cesspool or privy is below high ground water elevation. _No_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. No Any portion of a cesspool or privy is within a Zone 1 of a public well. _ _No Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ _No_ 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 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.] _No_(Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 31.0 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 following criteria apply to large systems in addition to the criteria above) 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 Il 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. Page 5 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 44 Equestrian Drive_ _North Andover_ Owner:_Sarro Date of Inspection: 6/21/2006_ Check if the following have been done.You must indicate`yes"or"no"as to each of the following: Yes No Yes_ _ Pumping information was provided by the owner,occupant,or Board of Health _No Were any of the system components pumped out in the previous two weeks? Yes_ _ Has the system received normal flows in the previous two week period? No Have large volumes of water been introduced to the system recently or as part of this inspection? _Yes — Were as built plans of the system obtained and examined? _Yes_ — Was the facility or dwelling inspected for signs of sewage back up? Yes Was the site inspected for signs of break out? _Yes_ _ Were all system components,excluding the SAS,located on site? _Yes_ _ 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? _Yes_ _ 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 _Yes_ Existing information. _Yes_ Determined in the field(if any of the failure criteria related to Part Cis at issue approximation of distance is unacceptable) [3 10 CMR 15.302(3)(b)] . Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 44 Equestrian Drive_ _North Andover– Owner:_Sarro_ Date of Inspection: 6/16/2006_ FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_4_ Number of bedrooms(actual):_4_ DESIGN flow based on 310 CMR 15.203_600_ Number of current residents:_5_ Does residence have a garbage grinder(yes or no):_No_ Is laundry on a separate sewage system(yes or no): No_ Laundry system inspected(yes or no): _ Seasonal use:(yes or no):–No– Water o_Water meter reading: Yes_ Sump pump(yes or no):_No_ Last date of occupancy:_Current_ COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203):___pd 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:_Pumped one&half years ago,owner_ Was system pumped as part of the inspection(yes or no):–Yes– If es_If yes,volume pumped:_1500_gallons--How was quantity pumped determined?_Measured tank Reason for pumping: Inspect tank&tees_ 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:_21 Years old,4/24/1988 as built plan_ Were sewage odors detected when arriving at the site(yes or no): No_ i Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 44 Equestrian Drive_ _North Andover_ Owner:_Sarro Date of Inspection: 6/21/2006_ BUILDING SEWER_X_ (locate on site plan) Depth below grade:_18" Materials of construction: _X_cast iron _X_40 PVC_other Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.) _4"Cast iron thra wall,3"PVC in house with no leaks visible_ SEPTIC TANKS: X Depth below grade:_6" Material of construction: X 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: 10'x 5'x 4' Sludge depth 4"_ Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness:_6"_ Distance from top of scum to top of outlet tee or baffle: N/A N/A=outlet tee corroded off Distance from bottom of scum to bottom of outlet tee or baffle: N/A_ 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:Pumped septic tank.Inlet tee ok. Outlet tee corroded off: Outlet tee needs replaced.Depth of liquid at outlet invert.No evidence of septic tank leaking in or out. 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.): Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 44 Equestrian Drive- - North Andover— Owner:_Sarro Date of Inspection: 6/21/2006 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/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: X Depth below grade _121;- Depth 12"Depth of liquid level above outlet invert: 0" Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.):_D-Boz level&distribution equal.Evidence of carryover.Evidence of leakage, bad corrosion holes in d-bog.D-Boz needs replaced. PUMP CHAMBER:_(locate on site plan) Pump in working order(yes or no): Alarm in working order(yes or no):_ Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 44 Equestrian Drive_ _North Andover_ Owner:_Sarro Date of Inspection: 6/21/2006_ SOIL ABSORPTION SYSTEM(SAS):_X (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: _ leaching chambers,number: leaching galleries,number: _X leaching trenches,number,length: 2 trenches 40'long_ leaching field,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: Number and configuration: Depth—top of liquid to inlet invert: Depth of sludge 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: (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) Property Address: 44 Equestrian Drive _North Andover_ Owner:_Sarro Date of Inspection: 6/2112006_ 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. House Garage A TZ Water Meter Driveway A to 1 =2014" 1 Ato2=26'5" A to D-Box=42'9" Septic Tank B to 1=31'4" Bto2=35'3" 2 B to D-Box=4814" D-Box Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_44 Equestrian Drive_ _North Andover— Owner:_Sarro Date of Inspection:_6/21/2006_ SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water _4'_ Please indicate(check)all methods used to determine the high ground water elevation: X_ Obtained from system design plans on record-If checked,date of design plan reviewed:_4/24/1985_ 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) Accessed USGS database-explain: You must describe how you established the high ground water elevation: As per design plan_ Summary Record Card generated on 6/19/2006 11:48:38 AM by Elaine Barclay Page 1 Town of North Andover Tax Map # 210-105.D-0134-0000.0 44 EQUESTRIAN DRIVE SARRO, RICHARD & NANCY 44 EQUESTRIAN DRIVE N. ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Size Total 3.2 Acres FY 2006 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Until SARRO, RICHARD &NANCY Payor 44 EQUESTRIAN DRIVE N.ANDOVER, MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 17535.0-44 EQUESTRIAN DRIVE Last Billing Date 4/10/2006 3170205 03 Cycle 03 Active UB Services Maint. Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 83.70 /1 UB Meter Maintenance Serial No Status Location Brand Type Size YTD Cons 29484574 a Active ERT HH b Badger w Water 0.63 0.63 Date Reading Code Consumption Posted Date Variance 3/6/2006 186 a Actual 23 4/17/2006 1% 12/21/2005 163 a Actual 28 1/1712006 -6% 9/20/2005 135 a Actual 32 10/14/2005 0% 6/13/2005 103 a Actual 29 7/15/2005 -1% 3/15/2005 74 a Actual 30 4/5/2005 -35% 12/13/2004 44 a Actual 44 1/14/2005 228% 9/16/2004 0 a Actual 9 10/8/2004 -100% Skip Code:01 7/19/2004 0 n New Meter 0 10/8/2004 -100% 7/19/2004 1851 r Replacement 9 10/8/2004 19% 6/22/2004 1842 a Actual 19 7/30/2004 -12% 4/15/2004 1823 a Actual 38 5/17/2004 0% 12/17/2003 1785 n New Meter 0 12/17/2003 0% Tel: (978) 475-4786 Fax: (978) 475-5451 i BATESON ENTERPRISES, INC. Excavating-Water.& Sewer Lines-Septic Systems&Pumping Service 111 Argilla Road Andover, Mass. 01810 Title 5 Inspection Report Property Address: 44 Equestrian Drive, North Andover Owner: Sarro Date of Inspection: 6/21/2006 My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations, and I hereby disclaim any further operation of your current septic system. ei J. Bateson Bateson Enterprises, Inc. HQFtTH ACTH TOV�BOa RD OF H Commonwechrh of Massachusetts X996 Executive office of Environmental Affairs May 3 `- ®epartraea-A of Environ ,' ,.uxtal Protection j� •,y William F. Weld Gowmor Trud Coxe �: 3 Secn,s, 'ECE4 David B. SVuhs =r i Commissioner > SUBSURFACE SENVAGE DISPOSAL SYSTEM INSPECTION FORM PART A / CERTIFICATION Property Address: t� VIA—,�Str(�'� ✓J ��l `'. Address of Owner. Date of Inspection: 3 (if different) Name of Inspector: l.lC�� Company Name, Address and Telephone umber: �7uA C LAIN �y '•Prnir. �' S1 3cayCERTIFICATION ATEMENT certify that I have personally inspected the sewage disposal s,stem at this address and that the n e information reported below is true, accurate and complete as of the time of inspection. The inspection wa performed based on my training and experience in the proper function and maintenance of on-site s ge disposal systems. The system: V Passes Conditionally Passes NeVde, Evaluation by the Lore; .-\pproving Authority Fai Inspector's Signature: ' Date:The System Inspector shall copy this inspe ion report to the Approving Authority within thirty (30) days of completing this inspection. If the system isasared system or has a design flu-, of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Depa-tm,en, of Environmental Protection. The original should be sent to the system owner and cu:),,- to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check B, C, or D: - A) SYSTEM PASSES: _ZI have not found any information which indicates th it the system violates any of the failure criteria as defined Any failure criteria not evaluated are indicated belov:. e ned to 310 CMR 15.303. B) SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe iasis of determination in all instances. If"not determined", explain why not) _ The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 8/15/95) One Winter Street 0 Boston, Massa husatu, 0::108 0 FAX(617) 556-1049 • Telephone (617)292-5500 lr 4 ,5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A t� CERTIFICATION (continued) Property Address: q,-( ueS�fLI�N �, �lrtdOV�, '� Owner: ROY1M t�vl Date of Inspection: B] SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed' pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the, Board of Health): %s broken pipe(s) are replaced ' obstruction is removed ? ; distribution box is levelled or replaced The system required pumping more than i.ur 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 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool.or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank ano soii absorption system and is within 60 fee( to a surface water supp;y or tributary to a. surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water . supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well Is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. D) SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. (revised 8/15/95) 2 t • 4 V SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM •?~" PART A CERTIFICATION (continued) Property Address: U' RIS / } "�v10�(/l t (ti14, Owner: �ov� 0 Ve/q Date of Inspection: W 4=f. D]SYSTEM FAILS (continued): :•;, Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. _ Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. { Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). wn Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 I 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety' and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA) or a mapped Zone II of a public water supply well) Y, K The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. •.M1'. ;s4. IN- (revised (revised 8/15/95) 3 N .SY i•r T AY 1 • tom. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: f_ Y Owner: Date of Inspection: ap, Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. / None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates ✓ /during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. —/The facility or dwelling was inspected for signs of sewage back-up. ✓ The system does not receive non-sanitary or industrial waste flow ✓The site was inspected for signs of breakout. V All system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. ,/The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. —/The facility owner (and occupants, if different frim owner) were provided with information 14i Pon the proper maintenance of Su�Er,°+c:;,. Surface Disposal System. ..,.�(,'"' Vit;`•. • (revised 8/15/95) 4 err •t i t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: /v o�2 tam voe. Owner: v h V�jUt eq Date of Inspection: 3 RESIDENTIAL: FLOW CONDITIONS Design flow: all ns s Number of bedrooms: i Number of current reside ts:� Garbage grinder(yes or r;: Q Laundry connected to s stem �e or no):•-,�PD Seasonal use (yes or &SQ + Water meter readings, if available: ���� 'rr9p Last date of occupancy:CU2r?o�,t ' COMMERCIAUINDUSTRIAL• :t Type of establishment:_ Design flow: eallons/day � ,, _, •' Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no) Water meter readings, if available: '•ice' Last date of occupancy: P n'' rr.: 3 OTHER: (Describe) Last date of occupancy; - ; GENERAL INFORMATION PUMPING RECORDS and source of informan n: .' System pumped as part of inspection: (yes or no) Pi� If yes, volume pumped. n Reason forum in P P g� t.R�Q,,u+"r c�cD n.��•'f nnn-I•�l.,ry�L i TYPE OF SYSTEM S` Septic tank/distribution box/soil absorption system ,:. '`';• `. Single cesspool .:. Overflow cesspool •.r;'',.: - Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other(explain) I= c� p6APPROXIMATE AGE of all components, date installed (if known) and source of information: I 15 { Sewage odors detected when arriving at the site: (yes or no) b y+.t�•i fir• e. (revised 8/15/9s) 'f`'' h: t A SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C. SYSTEM INFORMATION (continued) Property Address: E Ve&4-y?-cA t n7 Oleg N ✓� t (/ ` Owner: dV\d1�c ( ��1 r. Date of Inspection: SEPTIC TANK: ✓ °:'• +.z (locate on site plan) Depth below grade: Material of construction: _ oncrete _,metal _FRP `other(explain) Dimensions: .f Sludge depth:_ Distance from top of sludge to bottom of outlet tee or baffle: t_ Scum thickness: 1 �� Distance from top of scum to top of outlet tee or baffle:_ Distance from bottom of scum to bottom of outlet tee or-baffle: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles depth of liquid level in relation to outlet invert, str aural integrity, evidence of leakage, etc.) – Ll 6,t GREASE TRAP: . 14 (locate on site poir) Depth below grade: Material of construction: _concrete _metal _FRP —other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom ni From in bonom of ou!!e! IPP or oanle Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level'in relation to outlet invert, structural integrity, evidence of leakage, etc.) I (revised 8/15/95) 6 ' V.t 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM' 4' PART C Jr SYSTEM INFORMATION (continued) Property Address: 4R CQ'I �/t C�✓�1 (N� Owner: U go ker? Date of Inspection: TIGHT OR HOLDING TANK:�1�I�} le (locate on site plan) • Depth below grade: Material of construction: _concrete _metal _FRP _other(explain) M. 1 Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) a: DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above oell utlet invert:_ Comments: (note if level nd distr equal, e',idence o` >o: d> c/arryover, evidence of le kage into or out of box, etc.) OI�✓�- �VG�CSC�Z.,P/l ✓� .{�S-F G .4 /G '� t / . PUMP CHAMBER://�/}- (locate on site plan) Pumps in working order•(yes or no) Comments: (note condition of pump chamber, condition ofum s and a } P P appurtenances etc.) •"'�� ;' 01 (revised 8/15/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) p Property Address: LI (),2 S 4-'Ca t Nl/�,�', /U r �/i�v�'1, VIP ' Owner: pvc,"I Date of Inspection: . SOIL ABSORPTION SYSTEM (SAS): G (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: sf j Type: leaching pits, number:_ f; leaching chambers, number:_ leaching galleries, number: / t leaching trenches, number,length: Dw A) 460 leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) CESSPOOLS: /N- (locate on site pla ) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) 4t,•Yi PRIVY: �f (locate on ite plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 8/15/95) $ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: /�� Owner: 6 , � Date of Inspection: J f/ 5/3 SKETCH OF SEWAGE DISPOSAL SYSTEM: y include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' rA V. L3 X 3 . . DEPTH TO GROUNDWATER Depth to groundwater: feet r method of determination or approximation: (revised 8/is/9s) 9 44. .w--� MORrG/� E sURv Y PLAN LOCA TRO /N SCALE'/ OATS' �a 3 ,� � 4i•s S.L.GILES NORTH ANOOI/ER, MASS. W Y Y a I �. 4 TO�A��aF n)d 12 & ITS TrrLE INSURER, THIS LUI.AY +�— - /N A LLOUO H LgR17 ZONE. CERTIFY THAT THE OFFSETS SHOWN ARE FOR THE PURPOSE OFFSETS SHO 411V OF QRTRRM/N/NG ZONING CONFORM/TY CONFORM TO THE" OR NON CONFUFr ml7-Y WHEN CONSTRUCT' ZONING BY LAW C1F ANDA RE NO T TD BE"USEO 70ES TA PROPE1?TY L1NES. I tg -SMUUB34/CS/VO4/LO10 TOWN OF NORTH ANDOVER DATE: 05/06/961 TERMINAL NO: 046 MUNICIPAL AUTOMATION SYSTEM TIME: 11:59 :00 SERVICE HISTORY DISPLAY Acct : 01-4652000-0 BAKER, RONALD 44 EQUESTRIAN DR Status : 0 From: 01/01/01 To: 12/31/99 Date Svc Type Current Delinquent Overpay Total Usage Reference 021194 100 PAYM 0 .05- 104 .33- 104 .38- 021194 *** PAYM 0 .05- 104 .33- 104 . 38- 033194 100 BILL 93 . 31 107 .40 200 . 71 31 E 94010004683 033194 *** BILL 93 . 31 107 .40 200 .71 94010004683 052594 100 BILL 81 .27 200 .71 281 . 98 27 A 94010010334 052594 *** BILL 81 .27 200 . 71 281 . 98 94010010334 060994 100 PAYM 107 .45- 107 .45- 060994 *** PAYM 107 .45- 107 .45- 071394 100 PAYM 0 .05- 93 . 26- 93 . 31- 071394 *** PAYM 0 .05- 93 . 26- 93 .31- 090294 100 BILL 105 . 35 81 .22 186 .57 35 A 94010016019 090294 *** BILL 105 .35 81 . 22 186 .57 94010016019 092194 100 PAYM 0 .05- 81 . 22- 81 .27- 092194 *** PAYM 0 . 05- 81 . 22- 81 .27- 112194 100 BILL 87 .29 105 . 30 192 . 59 29 A 94010.021947 112194 *** BILL 87 .29 105 . 30 192 .59 94010021947 0.21795 100 BILL 57 .19 192 .59 249 . 78 19 A 95010004699 021795 *** BILL 57 .19 192 .59 249 . 78 95010004699 022295 100 PAYM 105 .35- 105 .35- 022295 *** PAYM 105 . 35- 105 . 35- 051595 100 BILL 69 .23 144 .43 213 . 66 23 A 95010010690 051595 *** BILL 69 .23 144 .43 213 .66 95010010690 061295 100 PAYM 144 .43- 144 .43- 061295 *** PAYM 144 .43- 144 .43- 081695 100 BILL 108 .36 69 .23 177 .59 36 A 95010016727 081695 *** BILL 108 . 36 69 .23 177 .59 95010016727 082995 100 PAYM 69 .23- 69 .23- 082995 *** PAYM 69 .23- 69 .23- 103195 100 PAYM 108 .36- 108 .36- 103195 *** PAYM 108 . 36- 108 .36- 111795 100 BILL 78 . 26 78 .26 26 A 95010022845 111795 *** BILL 78 .26 78 .26 95010022845 122995 100 PAYM 78 .26- 78 .26- 122995 *** PAYM 78 .26- . 78 .26- 022996 100 BILL 84 .28 84 . 28 28 A 96010004838 022996 *** BILL 84 .28 84 .28 96010004838 040596 100 PAYM 84 .28- 84 .28- 040596 *** PAYM 84 .28- 84 .28- <ESC> Return, <F1> Page Forward, <F2> Page Back Ctrl-Break to exit, SysRq for DOS . NUM LOCK CAPS LOCK Jun 22 Q4 12: 05p NORTH ANDOVER 9786889542 p. 1 TOWN OF NORTH ANDOVER Q pORTFI O i,w y H Office of COMMUNITY DEVELOPMENT AND SERVICES o: ° HEALTH DEPARTMENT 27 CHARLES STREET ---- '�l w°wwno^•4h NORTH ANDOVER.MASSACHUSETTS 01845 'SSwcHos�s 978.688.9540-Phonc Susan Sawyer,RENS/RS 978.688.9542-FAX Public Health Director heal tlidentCtownoborthandowncom www.townofnorthandover.coni FAX TO: �— From: `z Fax: c, � � s Z Pages: ��... Phone: Date: Re: CC: ❑Urgent ❑For Review ❑Please Comment ❑Please Reply O Please Recycle Please contact the Health Department at the above numbers for further assistance. Jun-,Z2 CMZ} 12: 05p NORTH RNDOVER 9786889542 p• 2 /LIDR7"G/4GE SURI/ Y PLAN :.: r.. LCCA TED /N PsCI-rj4 SCALE/"= 4G� OATE' NORr- ,•1 A1V00VER, IWAS'S. 4 ^� IS i . 7 \ a/b C/-( ma L0-7 2 1. 4 M LZ ro�a F �a /rs THIS /NA f'LUIJD rfDUNE. / CERT/FY THAT TN,E OFF"S'67 5 SyowIV ARE- FOR THE/�URPOS OFFSETS SHoi4//V OF �0E7-, ,'?M'iV/NG 2O/VLNri CONFORIYI/TY CONFORM TO TH,5- OR NON CONFORM 1;rY WHE/V CONSTi4UCTE � ,i zoNrnrG eYL,Q�ypF AND ARENor T08EUSE0 roEsrA8LISH _ - PROPERTY LIMES. ' �.tAORTANT MESSA 1 For V p\ A.M. Day 04 A/" Ti e A.M. M Qn cSA `—+e1Y'o t Of FAXe S �eru ^ Extension MOBILE— -/17rG(a Area Code Number Extension Telephoned Returned your call RUSH Came to see you Please call Special attention Wants to see you Will call again Caller on hold Message :1 iaivO h 4A IM e —�✓ )e� c fin r � u Signed universal'48023 IN U.S.A. 1.4 P1 1 g OD tE S T -= Lo ?I ��``•---�.� / Thr�-..'�,�,. `" ..,� � ' Itp NT Alv, t TANK 7!5 ! t 1 NEW LEACH TRENCH .SYSTEM WITH 100% FUTURE RESERVE AREA 4, � YI I MORTGAGE,SURV Y PLAN LOCA T�5-D /N SC,4 E../ ' DATE -: = 6 S.L.GILES R.L.S. Fr NORT1Y A/VOOVER, MASS. •F`. tip.` IS •� W� SVY 4-1, 4 M 1 T03A.��o� Co -AC--12 d ITS 7-ITLt THIS LO/'IS'.y-o'r //V A ,L:L()UD4RU ZONE. / CERT/FY THAT T,4/E OFFSETS S1-/OWN ARE FOR rHE PU "�• OFFSETS Sh'OGF'N �OF Q6 7--�-R�y/N/NG ZONING EPOS /NG CONFORM/T Y f. CONFORM TO THE OR NON CONFORM17-Y WHEN CONSTRUCTE' ZONING BY LAW OF AND ARE No T TO BE USED 7Z7 _ ESTABL ISH R�., -\•ter. PROP4�'RTY '� :..• MORTGAGE 5URV4-Y PLAN LOCATED /N N� VC-9 SCALE'/��-- 46' DATE S.L.G/LES R.L.S. NORTH ANDOVER, MASS. o�Q o �v s OuT \ ° n } N 0 Ex IST SND. t 4� r � r T- I3 A. (4-1,44- TO 41,4 -TO B ITS TITLE INSURER, THIS LOT/S uaT'/N A FLOOD HAZARD ZONE. / CERT/FY THAT THE OFFSETS SHOWN ARE FOR THE PURPOSE OFFSETS SHOWN OF DETERMINING ZONING CONFORM/TY . r CONFORM TO THE OR NON CONFORMITY WHEN CONSTRUCT£ ZONING BYLAW OF ANO ARENOT TORE USED TO ESTABL/SH •-.> . PROPERTY LINES. Addtts i, l b e Title of File Page of Date File Open: Date file closed: Doc Document/Action Title Date of Refer to other Purpose of Document/Action and notes. action Document/ document/ Num. Action Department Board of Appeals — Board of Health — Planning Board — Conservation Commission — Building Department ------------- Nb(- TOWN OFAANDOVER SEPTIC SYSTEM SERVICING REPORT, fiomeowner:_�A�� Street �,� Pumper Phone Address �DS�o Phone VIA Nature S �rvice: Routine / Emergency Obs er•vat:ion; : Good Condition Full to Cover Saffles in Place Leachfield Runback — Excessive Solids Heavy Grease — Roots Other (Explain) --- Descript.ior. of Work.: Comments: TOWN OF SYSTEM PUMPING RECORD n .. DATE: NOV 2 6 2003 Y SYSTEM OWNER & ADDRESS SYSTEM LOCATION (example:left front of house) W-00 1.1 l 6_wL4ow -�1 -` DATE OF PUMPING: - 9 QUANTITY PUMPED : C7 GALLONS CESSPOOL: NO YES EPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACEIFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTTER(EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: G.L.S.D ✓ Lowell Waste W TGiZ S��I'L�' wEl� J c�UA A_ �7 APPRovED DIYE5 CINd �bpp, D,4rt' 1-z�- /PRzovPJ6 /urhoi?)Ty ���PPRvvE� DgiE R�4�oNS PLO (t '5 Pr(c SYSTEM i j ST.4 I. 4Tiotil C-YCA ;'/JT ,-"J ltiSP�.0►i0� U/Jr� J?-J'� 1�/JSS [� Fid►(_ �rNAi.. ltiJpEGrlonJ- � �,�,�, �p f2130vEJ> Q/JTC 0wr/ �1 DIT�p�AL 1,�J .SF6 (oti �. �,Mr S ���--,may) FML OPiZpvaL D,Orc - APP13ovv,)G /3v ihoRi r/ r 44 EQUESTRIAN DRIVE .7S-2004-1177 Proiect Detail Report Printed On:Mon Jun 28,2004 Project Name: GIS 16584 Project No: JS-2004-1177 Owner of Record SARRO,RICHARD T&NANCY N Map: 105.1) Date Submitted: Jun-28-2004 44 EQUESTRIAN DRIVE Block: 0134 Status: Open NORTH ANDOVER,MA 01845 Lot: Work Category: Work Location: 44 EQUESTRIAN DRIVE Zoning: Proposed Use: District: land Use: 101 Proposed Use Detail Subdivision Description ADDITION Comments: of Work: Department Status GeoTMS Module: Status File No. Comments: LCDate: Board of Health GREEN FLAG BHJ-2004-0092 Health Dept.Signoff. Building,Electrical&Mechanical Permits GREEN FLAG BEM-2004-0911 Permit History Type: Permit No: Issue Date Status Work Category Contractor Project No: Description of Work: Building BP-2004-0887 Jun-24-2004 OPEN Residential Alteration&Repairs JS-2004-1177 ADDITION Form U Signoff-construct BHP-2004-0463 Jun-24-2004 SIGNED OFF JS-2004-1177 Dining Room/Kit Addition;Deck extension roof&sc GeoTMS®2004 Des Lauriers Municipal Solutions,Inc. Page I of 1 D e C V- e Vt4151 u- FORM U - LOT RELEASE FORM *-SC-hp,e" eictS 1),ec t�_ 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 or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** r APPLICANT �C� �C� ( �'� .)G`ro PHONE LOCATION: Assessor's Map Number /4 5 PARCEL SUBDIVISION LOT (S) STREET ���� ��I(J�S �"n r� ' ST. NUMBER ******* ******** ************* **** *OFFICIAL USE ONLY******** ************* RECO ENDATIONS OF TOW AGENTS: �C I ONSrZRVATION ADMINIST OR DATE APPROVED 1 DATE REJECTED , COMMENTS I,L W-,,t5 /00 TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED S OTIC INSPECTOR-HALTH DATE APPROVED f' DATE REJECTED COMMENTS PUBLIC WORKS -SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm JUII LC U•f 1e: U'P IlUK 1 n HIIUUVtK P. 2 MORTGAGE+SURV Y PLAN I LOCA Ti-D /N ch�c-fZ • � I1VO1?7;•Y.41YOOVER, /LIASS. 4 Alt 0 a• `•�,.: ,h/� ,��i?p �'��(� Mau L07- �. 4 4 4- TobA-JI6 of c� a /Ts T1; c THISDUNE. / CERT/FY THAT PIF OFFSETS SfiOWN ARE FOR THE PURPOS OFFSETS SHOLt�N OF A4T---R W 11V/NG ZON/NG CONFORM/TY CONFORM TO TNS- OR NON CONFORMITY WHENCONSTRUCTE ZON/NG BY L4W OF •" AND ARENOT TORE USED ro ESTABLISH ' '. ' __ PRORERTY L INES. . Jun Ge u- 1e: ubp NUN I H HI'IUUVEK b*/8bUti554e P. 1 TOWN OF NORTH ANDOVER ;T:,h Office of COMMUNITY DEVELOPMENT AND SERVICES a� HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER. MASSACHUSETTS 0184.5 's&AcHus�4 978.688.9540-Phone Susan Sawyer,REELS/RS 978.688.9542-FAX Public Health Director healtlidepL@Lownofnorthandover.coni www.towno Cnoi-thandover.coni FAX From: c Fax: "� d s Z.._. f — �� 7 0 y Pages: Phone: Date: Re: CC: O Urgent O For Review 0 Please Comment 0 Please Reply 0 Please Recycle Please contact the Health Department at the above numbers for further assistance.