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Home My WebLink AboutMiscellaneous - 481 REA STREET 4/30/2018 (2) 481 REA STREET 210/038.0-0254-0000.0 r r C� I i North Andover Board of Assessors Public Access Page 1 of 1 < pOR7" North Andover Board of Assessors Of t•�•o e'�q.� S"CHOSE property Record Card Click seal To Return Parcel ID :210/038.0-0254-0000.0 FY:2010 Community:North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlarge Search for Parcels r Search for Sales _ t , Summary Residence Detached Structure A§fir Condo 481 REA STREET Commercial Location: 481 REA STREET Owner Name: CONNELLY,MICHAEL C HEIDI A CONNELLY Owner Address: 481 REA STREET City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood:6-6 Land Area: 1.00 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 4268 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 723,700 767,400 Building Value: 516,800 558,700 Land Value: 206,900 208,700 Market and Value: 206,900 Chapter Land Value: LATEST SALE Sale Price: 415,000 Sale Date: 01/01/1997 Arms Length Sale Code: Y-YES-VALID Grantor: BUMBACCO, NICHOLAS Cert Doc: Book: 04666 Page: 0195 http://csc-ma.us/PROPAPP/display.do?linkId=1513317&town=NandoverPubAcc 12/7/2010 r :P,5 D P r .I, I f T JPIi; ��ai - i � S�T•ftED`�� . Talcopy PUBLIC HEALTH DEPARTMENT Town of North•Andover Community Development Division CE1�2I FICArIE O F CO�VlPL T gXCE As of: December 8, 2010 This is to cert that the individuafsu6surface disposaf system received a SA71S FACT0RT lYSTEMOY of the: o Lhstri6ution Bo andOutCet Zee ft&cementx f Foran On Site Sezvc a1DisposaCS stem y By. y�: ToddBateson t� 481 Rra Street Jalap-038.0-Parcel= 0254 210/038.0-0254-0000.0 i orth Andover, JK.A 01845 The Issuance of this certiftaie shaff not 6e construedas a guarantee that the system wifffunction satisfactorify. -S"n T. Sawyer (Pu6Cw Zeafth(Director 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.iownofnorthandover.com NORTH q O O awN , COCNIC NwKN V �9SSACHUS��y PUBLIC HEALTH DEPARTMENT (ommunity Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: � � MAP: LOT: INSTALLER: e DESIGNER: 7edc� �'�� PLAN DATE: BOH APPROVAL DATE ON PLAN: Q��'�� INSPECTIONS TANK INSPECTION: 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 ❑ Cleanouts per plan ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ gallon tank has been installed loading ❑ Monolithic tank construction ❑ Water tightness of tank has been achieved by 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.lowootnorthandover.com Inspection Form June 2008 pORTfy 0`�t LED 6 q.r0 6 OL nD COCNICNWKM 1e I 0"AT SSACHUS� PUBLIC HEALTH DEPARTMENT (ommunity Development Division 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 final 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 ❑ gallon Pump Chamber installed ❑ 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: CONTROLPANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: basement ❑ Alarm signal located inside: basement Comments: 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form lune 2008 e r►ORth q O �tyeo 6'b�O O O COCMIC Mt WKM y1. 'p4 \ �.9$°q�tEoCH $ 5 A V PUBLIC HEALTH DEPARTMENT Community Development Division DISTRIBUTION-BOX ❑ Installed on stable stone base [a' H-20 D-Box [], Inlet tee (if pumped or >0.08'/foot) [] Hydraulic cement around inlet & outlets ( f Observed even distribution [� Speed levelers provided (not required) Comments: �Q4UL_7 MVV—Vd SOIL ABSORPTION SYSTEM (General) ❑ Bottom of SAS excavated down to C soil layer, as provided on plan ❑ Size of SAS excavated as per plan ❑ Title 5 sand installed, if specified on plan ❑ 40 Mil HDPE barrier installed ❑ Laterals installed and ends connected to header (and vented if impervious material above) ❑ Elevations of laterals and chambers installed as on approved plan ❑ Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ❑ Brand and Model of Chamber: Standard Quick 4 Infiltrator Chambers ❑ Number of chambers per row: ❑ Number of rows (trenches): Comments: Total Chambers = 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 918.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 4 pORTH O��-f 16 6 V 6 OL O ID coc«a e'C.. 1. w¢«� . ��Ssgc►+us��5 � PUBLIC HEALTH DEPARTMENT (ommunity Development Division BM = HR = HI = SYSTEM ELEVATIONS ROD ELEVATION AS-BLT INVERT ELEV DESIGN INVERT ELEV Benchmark Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN Distribution Box OUT Lateral 1 TOP Lateral 1 INVERT Lateral 2 TOP Lateral 2 INVERT . Lateral 3 TOP Lateral 3 INVERT Lateral 4 TOP Lateral 4 INVERT Lateral 5 TOP Lateral 5 INVERT Lateral 6 TOP Lateral 6 INVERT Top of Chamber Bottom of Bed/Chamber 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 r '� NoR'rH O�,ct�au Ib��O O m O coc Mlc I... 1 C) SSACHUS�� PUBLIC HEALTH DEPARTMENT [ommunity Development Division SKETCH PLAN 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 v J %40RTH q O �t%ao 06� ti0 O to A O Coe-IWKM y7 p�RATED SSAC HUSH PUBLIC HEALTH DEPARTMENT Community Development Division CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ® Property line 10 10 Cellar -- ® ll 2 wall 10 0 -- ® Inground pool 10 20 -- ® Slab foundation 10 10 -- ® Deck, on footings, etc 5 10 -- Waterline 10 10 101 ® Private drinking well 75 1002 50 ® Irrigation well 75 100 ® Surface Water 25 50 ® Bordering Vegetated Wetland , Salt Marsh,Inland/Coastal Banka 75 100 ® Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ® Trib.to surface water supply 325 325 ® Public well 400 400 ® Interim Wellhead Prot.Area ® Reservoirs 400 400 ® Drains(wat. supply/trib.) 50 100 ® Drains(intercept g.w.) 25 50 ® Drains(Other)Foundation 10(5) 20(10) ® Drywells 20 25 1 Suction line 222(2) 2100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance(NA 5.02). s As defined in 310 CMR 10.55, 10.32, 10.54,and 10.30,respectively,pursuant to 15.211(3),also by NA wetland bylaws 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Inspection Form June 2008 Commonwealth of Massachusetts Map- 038.000254254 Lot ----------------------- Q a Board of Health Permit No " North Andover BHP-2010-0777----------------------- FEE HP-2010-0777FEE CMU $125.00 -------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted Todd Bateson - - - -------------------------------------------------------------------------------------------- to(Repair-D-BOX&OUTLET TEE ONLY)an Individual Sewage Disposal System. at No 481 REA STREET ---------------------------------------------------------------------------------------------------------------------------------------------------------- as shown on the application for Disposal Works Construction Permit No. BHP-2010-077 Dated December 07,2010 ------------------------ ------------------------------ ------------ Issued ----------------------------- -Issued On:Dec-07-2010 oo ealth �' -------------------------------------- Application for Septic Disposal System 'A Construction Permit = TOWN OF TO°Ars DATE °•' , .f ORTH ANDOVER, MA 01845 $250.00-Full Repair + $925.00-Component Important: Application is hereby made for a permit to: When fining out F] Construct a new on-site sewage disposal system* forms on the computer,use ❑ Repair or replace an existing on-site sewage disposal system* only the tab key e� to move your air or replace an existing system component—What?- D— Qa x. A 0 T'l�/-.c cursor-do not use the return key. A. Facility Information I� Address or Lot# Cityrrown d 2.-*TYPE OF SEPTIC SYSTEM*: ❑Pump 9,115ravity(choose one) ***If pump system,attach copy of electrical permit to application*** onventional System(pipe and stone system) ❑Infiltrator or Biodiffuser(Gravel-Less) (Attach a copy of your certification to install this type of system. C Pressure Distribution S.A.S.(No D-Box)(Attach Draft Maintenance Agreement) ❑Pressure Dosed(D-Bax Present)S.A.S. 2. Owner Information l41 �� L (Y- Name Address(if different State Zip Code Telephone Number 3. Installer Information Name 11 Name of Company y 11 ES INC. AR Address - 4!gln City/Town State Zip Code Telephone NumberCell Phone e#if possible please) 4. Re-siciner 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 AConstruction Permit TOW. OF TODAY'S DATE ORTH ANDOVER MA 01845 $.250.00-Full Repair .. r $125.00-Component PAGE 2OF2 A. Facility.Information continued.... 5. Type of Building: esidential 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, and not to place the system in operation until a Certificate of Compliance has been issued is Board of Health. Name Date Application A �v, �By: (Board of Health Representative) Name , Date Application Disapprovefor the following reasons: For Office Use Only: 1. Fee Attached. Yes `� No 2. Project Manager Obligation Form AtlachedP Yes No 3. Pump-System.? Ifso..Attach co,2v of Electrical Permit�Yes= ----_ NL 4. Foundation As-Built. (new construction ronly). Yes (Same scale as approved plan)5. Floor Plans?(new construction only). Yes Application for.Disposal System Construction Permit Page 2 of 2 • SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS i As the North Andover licensed installer for the construction for the septic system for the property at: (Address of septic system) For plans by (Engineer) Relative to the application of (Installer's name) And dated (unginai aa Dated A—I`/O (lioday's ate With revisions dated (Last revised date) 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 allinspections. If homeowner,contractor,project manager, or any other person not associated with my company schedules an inspection and the system is not ready,then item three shall.be applicable. 3.` As the installer, I am required to.have the necessary work completed prior,to the applicable inspections as indicated below. I:understand that requesting an inspection, out completion of the items in accordance with Title 5 and the Board of Health R'eg gaations may result in a$50.00 fine being levied against me and/or my eompan� a:. Bottom of Bed-Generally, this is the first.(P)inspection unless.there is a retaining wall,which should be.doiie:first. The installer must request the inspection but does not have to be present. b. Finaf-Construction Inspection—Engineer must firstdo their inspection for elevations;ties, etc. As-built of verbal OK(or e-mail to:.healtl deptnu ttownofnorthandover com).from the engineer must be submitted to.the Board of Health,after.which.installer.calls for an inspection time. Installer must be present for this inspection. With a pump system, all electrical workmust be ready and able to cause pump to work and alarm to function.. c. Final Grade—Installer must request inspection when all grading is complete: Installer does not have to be on-site. 4. As the installer,I understand that only I may perform the work(other than:simple excavation)and I am required to complete the installation of the system identified in.the attached application for installation: '..I further understand that work done by others urilicensed.to install se tics stems 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 And significant fines to all persons involved are also possible 5. As the.mstaller, I understand that I mustbe on-site during the.performance.of the folio steps: wing construction, a. Determination that.the proper elevation of the excavation has been reached. A Inspection of the sand and stone to be used. c. Final inspection by Board ofHealth staffor consultant. d. Installation of tal*D-Box,pipes, stone, vent,pump chamber, retaining wall and other components. 6. As the installer. I understand that I.a n solely res onsible for the installation of the s stem as er the Q12roved plans. No instructions by the homeowner, eneral.contractor.oran .other. ersons shall absolve me of this obligation. Undersigned Licensed Septic Installer: (Today's Date) �(/ 7^y1 (iv ame Fr E) e 1e i Commonwealth of Massachusetts v W Title 5 Official Inspection For f Subsurface Sewage Disposal System Form-Not for Voluntary Ass sments .{ 010 14 1010 �M 481 Rea Street Property Address I TOM OP WTH Michael Connelly L SOH MPAMEMf Owner Owner's Name information is required for North Andover MA 01845 12/7/2010 every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: When filling out A. General Information forms on the computer,use 1. Inspector: only the tab key to move your Neil J. Bateson cursor-do not Name of Inspector use the return key. Bateson Enterprises Inc. Company Name 111 Argilla Road Company Address Andover Ma 01810 Citylrown State Zip Code 978-475-4786 S115 Telephone Number License Number B. Certification 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 ❑ Needs Further valuation by the Local Approving Authority ' 12/7/2010 lnsptct4fs 01lture 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 y p g 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 Y PP pp g au h t orlty. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.Thisinspectiondoes not address how the system will perform in the future under the same or different conditions of use. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 -..� Commonwealth of Massachusetts 4 Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 481 Rea Street Property Address Michael Connelly Owner Owners Name information is required for North Andover MA 01845 12/7/2010 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 outlet tee&d-box, inspection from B.O.H., septic system now passes Title 5 Inspection. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiitration 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): 15ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 481 Rea Street Property Address Michael Connelly Owner Owner's Name information is North Andover MA 01845 11/22/2010 required for every page. 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. 'mp°rt`'"`` A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Neil J. Bateson cursor-do not use the return Name of Inspector key. Bateson Enterprises Inc. Company Name 111 Argilla Road Company Address Andover Ma 01810 'BR41 Cityfrown State Zip Code 978-475-4786 S115 Telephone Number License Number B. Certification 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 ❑ Needs Further Evaluation by the Local Approving Authority 11/22/2010 I specto Signature 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 i Commonwealth of Massachusetts ' . W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 481 Rea Street Property Address Michael Connelly Owner Owner's Name information is required for North Andover MA 01845 11/22/2010 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 an information which indicates❑ y c tes 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 481 Rea Street Property Address Michael Connelly Owner Owner's Name information is required for North Andover MA 01845 11/22/2010 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 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 � p Y e water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 481 Rea Street Property Address Michael Connelly Owner Owner's Name information is required for North Andover MA 01845 11/22/2010 every page. City/Town State Zip Code - Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water ' supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: '*This system passes if the well water analysis, performed at a DEP certified laboratory, for 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: Outlet tee in septic tank& D-box needs to be replaced. D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No El ® 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 Y2 day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 481 Rea Street Property Address Michael Connelly Owner Owner's Name information is required for North Andover MA 01845 11/22/2010 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 Y the 11 El the is within 200 feet of a tributaryto a surface drinking water supply El Elthe 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 • Commonwealth of Massachusetts u r Title 5 Official Inspection Form _ a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments •'a 481 Rea Street Property Address Michael Connelly Owner Owner's Name information is required for North Andover MA 01845 11/22/2010 every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C,is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 600 t5ins•09/08 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 w 481 Rea Street Property Address Michael Connelly Owner Owner's Name information is required for North Andover MA 01845 11/22/2010 i every page. Citylrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage Yes 9 ( Y 9 (gPd))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow etc.,(seats/persons/s .ft. : q ) Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 481 Rea Street Property Address Michael Connelly Owner Owner's Name information is required for North Andover MA 01845 11/22/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Pumped 2009, owner Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Measured tank Reason for pumping: Inspect tank&tees. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the UA system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts u W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 481 Rea Street Property Address Michael Connelly Owner Owner's Name information is North Andover MA 01845 11/22/2010 required for every page. Cityrrown State Zip Code - Date of inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: House built 1988.Home owner No date on as built plan. Were sewage odors detected when arriving at the site? ❑ Yes ® No a Building Sewer(locate on site plan): Depth below grade: 2 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 thru wall. 3" PVC in house. No leaks visible. Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10'x 5'x 4' 11 Sludge depth: 2 L l5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 481 Rea Street Property Address Michael Connelly Owner Owner's Name information is required for North Andover MA 01845 11/22/2010 every page. City/Town State Zip Code -- Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle N/A Scum thickness 2" Distance from top of scum to top of outlet tee or baffle N/A 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 needs to be replaced. Depth of liquid above outlet invert. Pipe to d-box broken. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene y ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts H Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 481 Rea Street Property Address Michael Connelly Owner Owner's Name information is required for North Andover MA 01845 11/22/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 481 Rea Street Property Address Michael Connelly Owner Owner's Name information is required for North Andover MA 01845 11/22/2010 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-Box cover broken. Replaced it. D-box badly corroded needs to be replaced. D-box level&distribution equal. No evidence of leakage. Evidence of carryover 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts H Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM 481 Rea Street Property Address Michael Connelly Owner Owner's Name information is required for North Andover MA 01845 11/22/2010 every page. Cityrrown State Zip Code - Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ;t ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 1 field 30'x 56' ❑ 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 evidence 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 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 or 17 Commonwealth of Massachusetts N W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 481 Rea Street Property Address Michael Connelly Owner Owners Name information is required for North Andover MA 01845 11/22/2010 every page. Cityrrown State Zip Code - Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 481 Rea Street Property Address Michael Connelly Owner Owner's Name information is required for North Andover MA 01845 11/22/2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately ra o � g��tl J U t5ins•09/08 Title 5 Official Inspection Form: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 481 Rea Street Property Address Michael Connelly Owner Owner's Name information is required for North Andover MA 01845 11/22/2010 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 6 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 9/24/1987 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Design plan ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Test pit data on design plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-09/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 481 Rea Street Property Address Michael Connelly Owner Owner's Name information is required for North Andover MA 01845 11/22/2010 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Commonwealth of Massachusetts City/Town of a System Pumping Record Form 4 M 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 front of house, right front of house, left side of house, right side of house, `eff r-ofi 1�su `,�right rear of house, left side of building, right rear of building, under deck. r � - � � Cityrrown State Zip Code 2. System Owner: Name Address(if different from location) City/Town Stat Z' Code Telephone Number B. Pumping Record 40 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes 01146 If yes, was it cleaned? ❑ Yes ❑ No 5. Condi 'on f STSte��C�l \kA— c� U 6. System Pumped By: Neil J. Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc. Company 7. Loc ) ere contents were disposed: .L.S.D.+ L II WasteAAr Signa re o a er Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 Summary Record Card generated on 12/2/2010 3:11:10 PM by Karen Hanlon Page ` Town of North Andover Tax Map # 2107038.0-0254-0000.0 Parcel Id 11636 481 REA STREET CONNELLY, MICHAEL C HEIDI A CONNELLY 481 REA STREET NORTH ANDOVER, MA 01845 Class 101 Single Family Property Type .. 1 Residentia Size Total 1 Acres FY 2011 UB Mailing Index Name/Address Type Loan Number Active/Inact. From Unti CONNELLY,MICHAEL C Owner HEIDI A CONNELLY 481 REA STREET NORTH ANDOVER,MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id.21575.0-481 REA STREET Last Billing Date 10/7/2010 3160550 03 Cycle 03 Active UB Services Maint. Account No.3160550 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/1 WTR WATER 01 ALL METER SIZE 168.43 1/1 UB Meter Maintenance Account No.3160550 Serial No Status Location Brand Type Size YTD Con! 34644464 a Active ERT HH b Badger w Water 0.63 0.63 33S Date Reading Code Consumption Posted Date Varianct 9/7/2010 412 a Actual 37 10/15/2010 60i 6/3/2010 375 a Actual 33 7/15/2010 130i 3/4/2010 342 a Actual 28 4/14/2010 13°x. 12/7/2009 314 a Actual 27 1/12/2010 -330r 9/3/2009 287 a Actual 39 10/15/2009 60/ 6/3/2009 248 a Actual 34 7/20/2009 240i 3/10/2009 214 a Actual 31 4/29/2009 40i 12/4/2008 183 a Actual 28 1/20/2009 -260r 9/5/2008 155 a Actual 39 10/10/2008 -110Y 6/4/2008 116 a Actual 43 7/16/2008 20j 3/5/2008 73 a Actual 42 4/11/2008 -360i 12/5/2007 31 a Actual 31 1/22/2008 10/23/2007. 0 n New Meter 1/22/2008 ACTION-KING ENTERPRISES,INC. 26 LIVINGSTON STREET LOWELL,"01852 .�---^y- TEL:(508)4524750 i` TO OF v! FAX:(508)459-0770 + laopao C ' 2 01 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - � rART A 03 CERTIFICATION PROPERTY ADDRESS: 481 REA STREET NORTH ANDOVER,MA 01845 DATE OF INSPECTION: 11-15-9 NAME OF INSPECTOR: WALTER BREAULT JR. ADDRESS OF OWNER;- (IF WNER:(IF DIFFERENT) CERTIFICATION STATEMENT T CERTIFY THAT I HAVE PERSONALLY INSPECTED THE SEWAGE DISPOSAL SYSTEM AT THIS ADDRESS AND THAT THE INFORMATION REPORTED BELOW IS TRUE,ACCL'ItATE AND COMPLETE �S OF THE TIME OF INSPECTION. THE INSPECTION WAS PERFORMED BASED ON MY TRAINING AND EXPERIENCE IN THE PROPER FUNCTION AND MAINTENANCE OF ON-SITE SEWAGE DISPOSAL SYSTEMS. THE SYSTEM. X PASSES CONDITIONALLY PASSES NEEDS FURTHER EVALUATION BY THE, LOCAL APPROVING AUTHORITY FAILS VECTOR'S SIGNATURE; DATE: ll-i5_96 SYSTEM INSPECTOR SHALL SUBMIT A COP OF THIS INSPECTION REPORT TO THE APPROVING AUTHORITY THIN THIRTY(30)DAYS OF COMPLETING THIS INSPECTION. IF THE SYSTEM IS A SHARED SYSTEM OR HAS A MGN FLOW OF 10,000 GPD OR GREATER,THE INSPECTOR AND THE SYSTEM OWNER SHALL SUBMIT THE PORT TO THE APPROPRIATE REGIONAL OFFICE OF THE DEPARTMENT T E ORIGINAL SHOULD BE SENT TO THE SYSTEM OWNER AND COPIES ENT TO THE BUYER,IF APPLICABLE D THE APPROVING AUTHORITY. 'LCTION SUMMARY: CHECK A,B,C,OR D. SYSTEM PASSES: X I HAVE NOT FOUND ANY INFORMATION WHICH INDICATES THAT THE SYSTEM VIOLATES ANY OF THE FAILURE CRITERIA AS DEFINED IN 310 CMR 15.303. ANY FAILURE CRITERIA NOT EVALUATED ARE INDICATED BELOW. 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. 'ATE YES,OR NO,OR NOT DETERMINED(Y,n,OR ND). DESCRIBE BASIS OF DETERMINATI :ANCES. IF"NOT DETERMINED EXPLAIN WHY NOT. ON INALL _ THE' SEPTIC TANK IS METAL,CRACKED,STRUCTURALLY UNSOUND,SHOWS i.TRATION OR EXFII.TRATION,OR TANK FAILURE IS SUBSTANTIAL IMMINENT. THE SYSTEM WILL PASS INSPECTION IF EXISTING SEPTIC TANK IS REPLACED WITH A CONFORMING SEPTIC TANK AS APPROVED BY THE BOARD EALTH. PAGE i ACTION-KING ENTERPRISES,INC. 26 LIVINGSTON STREET LOWELL,MA 01852 TEL:(508)452-7750 TAX. (508)459-0770 'ROPERTY ADDRESS: 481 RE STREET NORTH ANDO«R;MA 01845 )WNER:NICHOLAS BUM 3ACCO )ATE OF INSPECTION: 11-15-96 WTION KING ENTERPRISES,INC.HAS BEEN RETAINED BY THE OWNER TO PROVIDE AN INSPECTION OF THE ON- SITE SEWERAGE DISPOSAL SYSTEM AS DE � �D BY 310 CAIR 15.303.D.E.P.GUIDANCE INSTRUCTS THE ]INSPECTOR TO MAKE AN EVALUATION OF THE SYSTEMS PERFORMANCE ON THE DAY OF THE INSPECTION. THE TITLE 5 INSPECTION IS NOT DESIGNED TO PROVIDE INFORMATION TO DEMONSTRATE THAT THE SYSTEM WILL ADEQUATELY SERVE THE USE TO BE PLACED UPON IT BY THE NEW OWNER AS STATED IN 15.302. THIS ISPECTION IS NOT A WARRANTEE OR GUARANTEE OF TUE SYSTEM FUTURE PEIRFORIMANCE,AND DOES NOT EITHER EXPRESS OR IMPLY IT. PAGE 1-A AC-ifON-MNG ENi��:ri PRISES,INC. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPE FOItM PART A CERTIFICATION (CONTINUED) PROPERTY ADDRESS: 481 REA STREET NORTH ANDOVER,MA 01845 OWNER:NICHOLAS BUM 3ACCO DATE OF INSPECTION: 11-15-96 B) SYSTEM CONDITIONALLY PASSES (CONTINUED) N/A SEWAGE BACKUP OR BREAKOUT OR IIIGII STATIC WATER LEVEL OBSERVED IN THE DISTRIBUTION SOX 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). BROKEN PIPES)ARE REPLACED OBSTRUCTION IS REMOVED DISTRIBUTION BOX IS LEVELED OR REPLACED THE SYSTEM REQUIRED PUMPING MORE THAN FOUR 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: N/A CONDITIONS EXIST WHICH REQUIRE FURTHER EVALUATION BY THE BOARD OF HE,ALTH 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 HEALTII DE IE RICIMT,S 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 WIIIIILN 50 FEET OF A BCRDERIw+i IG VEGETATED WETLAND OR A SALT MARSH. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(ANI)PUBLIC WATER SUPPLIER,IF APPROPRIATE)DETERMINE THAT THE SYSTEM IF FUNCTION+'TG IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT. THE SYSTEM HAS ASEPTIC TANK AND SOIL ABSORPTION SYSTEM AND IS WITHIN 100 F EET TC A SURFACE«'ATER SUPPLY 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 Sy Yi AND I"5►fjl in 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 COLIFCItM 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 THE 5PPM. PAGE 2 ACTION-KING ENTERPRISES,INC. D) SYSTEM FAILS: N/A 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 DETERIMINATION IS IDENTIFIED BELOW. THE BOARD OF HEALTH SHOULD BE CONTACTED TO DETERMINE WHAT WILL BE NECESSARY TO CORRECT THE FAILUR. 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. STATIC LIQUID LEVEL IN THE DISTRIBUTION BOX ABOVE 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 TINIES IN TUE LAST YEi-AR NOT DUE TO CLOGGED OR OBSTRUCTED PIPE(S). NUMBER OF TIMES PUMPED ANY PORTION OF THE SOIL ABSORPTION SYSTEM,CESSPOOL OR PRIVY IS BELOW THE IIIGII GROUNTI)WATER ELEVATION. ANY PORTION OF A CESSPOOL OR PRIVY IS WITHIN 100 FEET OF A SURFACE WATER SUPPLY OR TRIBUTARY TO A SURFACE WATER SUPPLY. A_NY PORTION OF A CESSPOOL OR PRIVY IS WITHIN A ZONE I OF A PUBLIC WELL. ANY PORTION OF A CESSPOOL OR PRIVY IS WITIIIN50 +ET OF A PRI`:ATE 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. N/A 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 CONDITIOr:S 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(WPA) OR A MAPPED ZONE R OF A PUBLIC WATER SUPPLY WELL. THE OWNER OR OPERATOR OF ANY SUCHSYSTEM 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. PAGE 3 AMON-KING ENTERPRISES,uvC. PART B ` CHECKLIST PROPERTY ADDRESS:481 REA STREET NORTH ANDOVER,MA 01845 ?WNER:NICHOLAS BUMBACCO DATE OF INSPECTION: 11-15-96 'IIECK IF TIE FOLLOWING HAVE BEEN DONE. X PUMPING INFORMATION WAS REQUESTED OF THE OWNER,OCCUPANT,AND BOARD OF HEALTH. X NONE OF THE SYSTEM COMPONENTS HHAVE 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 TIIIS INSPECTION. X _AS BUILT PLANS HAVE BEEN OBTAINED AND EXAMINED. NOTE IF THEY ARE NOT AVAILABLE WITH N/A. X THE FACILITY OR DWELLING WAS INSPECTED FOR SIGNS OF SEWAGE BACK-UP. X THE SYSTEM DOES NOT RECEIVE NON-SANITARY OR INDUSTRIAL WASTE FLOW. X THE SITE WAS INSPECTED FOR SIGNS OF BREAKOUT. X ALL SYSTEM COMPONENTS,EXCLUDING THE SOIL ABSORPTION SYSTEM,HAVE BEEN LOCATED ON THE SITE. X THE SEPTIC TANK MANHOLES WERE UNCOVERED,OPENED,AND THE INTERIOR OF THE SEPTIC TANK WAS INSPECTED FOR CONDITION OF BAFFLES OR TEE,MATERIAL OF CONSTRUCTION,DIMENSIONS,DEPTH OF LIQUID,DEPTH OF SLUDGE,DEPRTH OF SCUAi. X THE SIZE AND LOCATION OF THE SOIL ABSORPTION SYSTEM ON THE SITE HAS BEEN DETERMINED BASED ON EXISTING INFORMATION OR APPROZIMATED BY NON-INTRUSIVE METHODS. X THE FACILITY OWNER AND OCCUPANTS,IF DIFFERENT FROM OWNERS WERE PROVIDED WITH INFORMATION ON THE PROPER MAINTENANCE OF SUB-SURFACE DISPOSAL SYSTEM. PAGE 4 ACTION-KING ENTERPRISES,INC. SUBSURFACE SEWAGE DISPOSAL INSPECTION FOltM D A Drr ft 1 t&L%1 %- SYSTEM INFORMATION PROPERTY ADDRESS: 481 REA STREET NORTH ANDOVER.MA 01845 OWNER:NICHOLAS BUMBACCO DATE OF INSPECTION: 11-15-96 RESIDENTIAL: DESIGN FLOW:_ 440 GALLONS. NUMBER OF BEDROOMS: 4 NUMBER OF CURRENT RESIDENTS: 2 GARBAGE GRIlYDER(YES OR NO) YES SEASONAL USE(YES OR NO) NO LAUNDRY CONNECTED TO SYSTEM WATER METER READINGS,IF AVAILABLE: 100+FEET AWAY LAST DATE OF OCCUPANCY: $m c! Pica COMMERCIAL/INDUSTRIAL- TYPE OF ESTABLISIIMENT: a N'A DESIGN FLOW: GALLONS/DAY GREASE TRAP PRESENT,(YES OR NO) INDUSTRIAL WASTE HOLDING TANK PRESENT: (YES OR NO) NON-SANITARY WASTE DISCHARGED TO TUE TITLE 5 SYSTEM: (YES ORNO) WATER METER READINGS,IF AVAILABLE: LAST DAY OF OCCUPANCY: OTHER: (DESCRIBE) LAST DAY OF OCCUPANCY: GENERAL I YFORMATION PUMPING RECORDS AND SOURCE OF INFORMATION. 5-96 (HOMEOWNER SYSTEM PUMPED AS PART OF INSPECTION(IT,S OR NO)---!El S IF YES,VOLUME PUMPED 2000 GALLONS. REASON FOR PUMPING INSPECT TANK AND BAFFLES TYPE OF SYSTEM X SEPTIC TANK/DISTRIBUTION BOXISOH.ABSORPTION SYSTEM SINGLE CESSPOOL OVERFLOW CESSPOOL - - PRIVY SHARED SYSTEM(YES OR NO)(IF YES,ATTACH PRVIOUS INSPECTION RECORDS,IF ANY) OTHER (EXPLAIN] APPROXIMATE AGE OF ALL COMPONENTS,DATE INSTALLED(IF KNOWN)AND SOURCE OF INFORMATION. 9 YEARS (HOME,OWNER) SEWAGE ODORS DETECTED WHEN ARRIVING AT THE SITE.(YES OR NO) NO PAGES ACTION-IQNG ENTERPRISES,INC. PART C SYSTEM INFORMATION(CONTINUED) PROPERTY ADDRESS: 481 RE,A STREET NORTH ANDOVER.MA 01845 OWNER: NICHOLAS BUM 3ACCO DATE OF INSPECTION: 11-15-96 SEPTIC TANK; lTS (LOCATE ON SITE PLAIN) DEPTH BELOW GRADE: 6" MATERIAL OF CONSTRUCTION: X CONCRETE METAL FRP OTHER(EXPLAIN) DIMENSIONS: 10'X 6' X 4.5' SLUDGE DEPTH: 4" DISTANCE FROM TOP OF SLUDGE TO BOTTOM OF OUTLET TEE OR BAM(< E: 20" SCUM THICBINESS: O DISTANCE FROM TOP OF SCUM TO TOP OF OUTLET TEE OR BAFFLE: 7" DISTANCE FROM BOTTOM OF SCUM TO BOTTOM OF OUTLET TEE OR BAFFLE: 24" 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 LFAKaG E,ETC-) NO SIGNS OF BACKUP IN TANK GREASE TRAP: NIA (LOCATE ON SITE PLAN) DEPTH BELOW GRADE: MATERIAL OF CONSTRUCTION: CONCRETE METAL ERI' OTHER(EXP LA0) DIMENSIONS: SCUM THICKNESS: DISTANCE FROM TOP OF SCUM TO TOP OF OUTLET TEE OR B < <ILE: 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,STRUCTURAL INTEGRITY,EVIDENCE OF LEAFAGE. ETC.) PAGE 6 ACTION-KING ENTERPRISES,INC. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(CONTIN`ED) PROPERTY ADDRESS: 481 REA STREET NORTH ANDOVER,MA 01845 OWNER: NICHOLAS BUMBACCO DATE OF INSPECTION: 11-15-96 TIGHT OR HOLDING TANK: N/A (LOCATE ON SITE PLAN) DEPTH BELOW GRADE: MATERIAL OF CONSTRUCTION: CONCRETE METAL FRP OTHER(EXPLAIN) DIMENSIONS: CAPACITY: GALLONS DESIGN FLOW: GALLONSMAY ALARM LEVEL COMMENT: (CONDITION OF INLET TEE,CONDITION OF ALARM AND FLOAT SWITCHES,ETC.) DISTRIBUTION BOX:- YES (LOCATE ON SITE PLAN) DEPTH OF LIQUID LEVEL ABOVE OUTLET INVERT: 05 ' COMMENTS: (NOTE IF LEVEL AND DIST UBUTION IS EQUAL,EVIDENCE OF SOLIDS CARRY OVER,EVIDENCE OF LEAFAGE INTO OR OUT OF BOX, ETC.) PUMP CHAMBER: (LOCATE ON SITE PLAN) PUMPS IN WORKING ORDER(YES OR NO) NIA COMMENTS: (NOTE CONDITION OF PUMP CHAMBER,CONDITION OF PUMPS AND APP:TRTENANCES,ETC.) PAGE 7 ACTION-1UNG ENTERPRISES,PiC. PROPERTY ADDRESS: 481 REA STREET NORTH ANDOVER,AIA 01845 OWNER:NICHOLAS BUMBACCO DATE OF INSPECTION: 11-15-96 SOIL ABSORPTION SYSTEM(SAS): X (LOCATE ON SITE PLAN,IF POSSIBLE,EXCAVATION NOT REOUIRED,BUT MAY BE APPROXIMATED BY NON- INTURSIVE METHODS). IF NOT DETERMINED TO BE PRESENT,EXPLAIN: TYPE: LEACHING PITS,NUMBER: LEACIIING CHAMBER,NUMBER: LEACHING GALLERIES,NUMBER: LEACHING TRENCHES,NUMBER LENGTH: LEACHING FIELDS,NUMBER,DIMENSIONS: (1)56' X 30' SEE PLANS OVERFLOW CESSPOOL.NUMBER: COMMENTS: (NOTE CONDITION OF SOIL,SIGNS OF HYDRAULIC FAILURE,LEVEL OF PONDING,CONDITION OF VEGETATION, ETC.) CESSPOOLS: N/A (LOCATE ON SITE PLAN) NUMBER AND CONFIGURATION: DEPTII-TOP OF LIQUID TO INTLET IlNTVERT: 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 HYDRAULICA FAILURE,LEVEL OF PONDING,CONDITION OF VEGETATION,ETC.) PRIVY: N/A (LOCATE ON SITE PLAN) MATERIALS OFF CONSTRUCTION: DIMENSIONS: DEPTH OF SOLIDS: COMMENTS: (NOTE CONDITION OF SOIL,SIGNS OF HYDRAULIC FAILURE,LEVEL OF PONDING,CONDITION OF VEGETATION,ETC.), PAGE 8 ACTION-KING ENTERIME$INC. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(CON`IlNLED) PROPERTY ADDRESS: 481 REA STREET NORTH ANDOVER MA 01845 OWNER:NICHOLAS BUMBACCO DATE OF INSPECTION: 11-15-96 SKETCH OF SEWAGE DISPOSAL SYSTEM: INCLUDE TIES TO AT LEAST TWO PERMANENT REFERENCES LANDMARKS OR BENCHMARKS COAT ALL WELLS WITHIN 100 t SEE ATTACHED PLANS DEPTH TO GROUNDWATER DEPTH TO GROUNDWATER: 6 TO 7 FEE!' METHOD OF DETERMINATION OR APPROXIMATION: SEE PLANTS PAGE 9 FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This"does not relieve the applicant and or landowner from compliance with any applicable requirements. ............................................................................ APPLICANT f%t L.cACa-v42 ( PHONE 7 q 9^ 4 17 ASSESSORS MAP NUMBER LOT NUMBER SUBDIVISION LOT NUMBER STREET ��'"`' S �'` � STREET NUMBER ............................................................................ OFFICIAL USE ONLY ............................................................................ RECOMMENDATIONS OF TOWN AGENTS DATE APPROVED 29% /�� CONSERVATION ADMINISTRATOR DATE REJECTED 9 COMMENTS DATE APPROVED TOWN PLANNER I DATE REJECTED COMMENTS i DATE APPROVED I FOOD INS CTOR-HEALTH DATE REJECTED " DATE APPROVED a P C SPECTOR-HEALTH04 DATE REJECTED COMMENTS / `I Ll S 1-15:Le AIL 2Cs PUBLIC WORKS—SEWER/WATER CONNECTIONS DRIVEWAY PERMIT s DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE . _ . - : , 2� , ," _ t, . - I -. .. . i . a 1 _ 1 T .I . 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P4- 0 r IpIG:.r4 AI tdT-'-SO "�LLai� is �atrf i'p Ji�7�.V Y'ii/diC Yai w.y SJP�°'.�.'..r,vc�,�-'C.•E'i��it✓0 �t'�.�'�i.`'-r '.e,,, -r. ,'//{✓ qr Jt ".�-•� -.r ca�.rrr.�r ya►s.r radr c+�artr� s,,roY /1.��.-�_;;'��/G:7 i'�,L"�/`�� i%`'J/� 's�,+�+e.,tir Y��.r-,� .�, e• •'°'c .��e�+ .�s.�..�en ,.e.:�.�-�• ;�,,P.�dr;;•t/ .�'�,�► N }'F r9° 4 Mir 3r•„ .. i ..Pu { aDME'File No. 242-428 (To be provided by DEOE) �\ Commonwealth CityRown North Andover F of Massachusettsapplicant JOHN B. TODD i SAFE "N" SOUND MINI STORAGE Order of Conditions Massachusetts Wetlands Protection Act G L. c. 1319 §40 and under the Town- of North Andover Bylaw, Chapter 3.5 A & B From NORTH ANDOVER CONSERVATION COMMISSION. JOHN B. TODA ABC BUS CO To (Name of Applicant) (Ns ne of property owner) 15 Winward Rd. , P.O. Box 596, Address Lowell MA 01852 Address 8 Adrian St. , N. Andover, MA This order is Issued and delivered as follows: ❑ Iby hand delivery to applicant or representativKSeptember (date) by certified mail, return receipt requested on 29, 1987 (date) This project is located at LOT 1-B Salem Turnpi The property is recorded at the Registry of Northern Essex Book 1312 Page 19 Certificate (if registered) The Notice of Intent for this project was filed on August 3 a 1987 (date) The public hearing was closed on September 23, 1987 (date) Findings The North Andover Conservation Commission has reviewed the above-referenced Notice of Intent and plans and has held a public hearing on the project. Based or the information available to the NACC at this time, the NACC has determined that , the area on which the proposed work is to be dons Is significant to thefrollowing Interests In accordance with -the Presumptions of Significance set forth in the regulations for.each Area Subject to Protection Under the Act(check as appropriate): 0 Public water supply II Storm damage prevention &� Private water supply N Prevention of pollution' I" Ground water supply ❑' Land containing shellfish 01 Flood control ❑ Fisheries _ 1 _ ply �� ate►� � �� -a� � �� s � 11 �--� f 7AF r ___Loi kvA 141 f l-or oRV S t 'Nod j�'M /�^��UEI�► Nl.t�. � P�� CAti� �, �� at/�3 ..` t Wqt Fri Sv PF'Ly - wnl ❑ I,UEELL- AP ouCD lYJ i C 55 ' ��57 SEPC"iG SYS 1M Urv'SIC: ._. �FTi�ovt�l7 D,4r�` 11 Wil- 7 ApRzoUING AUTtlol?ITy � �r.�nl DSS, GivC�: ^/IcR915 �L�N PATE ti._ y �i-54PPP4v5D Co,�plr�a>JS Uig 0A-15 oy--TH659 5Z,�LJ5��;� 0142A C�'�'SrtL 61,zi Y 6=x,..,V,4s OC' of f"�4TLC� DJC,410_ �,Q(��\ o4rrL� PAw G G /Jti� GU .QT HCl i� DoT cyv Dw� St( j t SYSTEM 1 J STA LL.47'l OA J FAIL- FINAL I -FINAL I VSpF�rlo� r QPPROVED 61 DtSAPt't�ov�� D,arC f RAL APPNDVAL DACE EOGINEER'S CERTIFICATE • /6 curt Map 3,9 w n Lp? �U r RE: LOT NUMBER v<D�� STREET ' T04R•1 b• /� x OWNER A�Q�i/2 y . A Registered Sanitarian/Engineer, duly licensed by the Commonwealth of Massachusetts, .License Number Q;I fill , certify that I have visually inspected .the construction, alterations or repairs, to the individual sewage disposal system at the above referenced location and certify to the best of my knowicclge and belief all work has been completed in accordance with the terms of the permit and in accordan:e'with the approved plans and that the system as constructed, altered, or repaired complies with the provisions of Title 5 of the Massachusetts Environmental Code (310 021 15.00) and all applicable Local Regulations. DATE: '416y ' — OFMS Engineers Seal: �v O •..Jw G� z NU.c121J NO.610 o, • F�Jsr:�� s' `S�.YtT Allk i 4, -744 try .� Inc i9?` �':3` / • " 9 2 �Y OTOS. /594 36 "1inf V %1�'.�: i CIS 340 j 1 r s; SIA ; . 4 0. co l AipA i 'E+-fes: ��1 —Y t ell-SoC V.:!57. .�. 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