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Miscellaneous - 49 CROSSBOW LANE 4/30/2018
49 CROSSBOW LANE 210/106.6-0210-0000.0 i Lot & Street ap/Parcel CONSTRUCTION APPROVAL Has plan review fee been paid: YES NO Permit# Plan Approval: Date: Approved by: Designer: Plan Date: /Z 0 6 Conditions: ly Town _ Well Water SuppWell Permit: Driller: Well Tests: Chemical Approved Bacteria I Date Aplaroved Bacteria II Date Approved_ Plumbing Sign-Off: Wiring Sign-off: Comments: Form "U"Approval: Approval to Issue: YES NO Date Issued By: Conditions: Final Approval: All Permits Paid? YES NO Well Construction Approval? YES NO Septic System Construction Approval? YES NO Certification? YES NO Other? YES NO Any Variance Needed? YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: APPROVED BY: .d _ Commonwealth of Massachusetts u City/Town of North Andover System Pumping Record Form 4 DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important:'When RECEIVED filling out forms 1. System Location- on the computer, use only the tab key to'move your Address -- cursor-do not North Andover TOWN OF NORTH ANDOVER use the return -- --- key. City/Town State -- raa 2. System Owner: Name mwn Address(if different from location)- ------- ----.__..__.......------------...—..---------- ----- — City/Town State Zip Code Telephone Number B. Pumping Record Cine �_____1S_�` 1. Date of Pumping ate - 2. Quantity Pumped: — ----- Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): --------- _----- -------- --- ---- ---- 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System.- 6 Name -e Number Stewart's Septic Service Company ---—... ---— 7. Location where contents were disposed: Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 Signature of Hauler Date Signature of Receiving Facility Date --- t5form4.doc•03/06 System Pumping Record•Page 1 of 1 Commonwealth of Massachusetts City/TownFw" of North Andover r � System Pumping Record VE Form 4 GSM DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important:When filling out forms 1. System Location: e ' CM—SNaiw on the computer, U Icin-e use only the tab key to move your Address cursor-do not North Andover Ma 01845 use the return City/Town key. State Zip Code 2. System Owne reb 'Erin hq m . Name ietron Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping /6 / / 2. Quantity Pumped: Date Gallons 3. Type of system: ❑ Cesspool(s) ,Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes No 5. Condition of System: 6. m Pumped y: Name Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: wart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 S' ure of auler �"—"�-., Date Signature of Receiving Facility Date&h 5-lid t5form4.doc•03/06 System Pumping Record.Page 1 of 1 ,''i; � rtlr�t,l�� ( , � , i,>i Y!`y�i i�,�a;'a h'� !�c,sl,'•rL,l' r,t. MASSACH{USE1—, ! ' r�.lr�/' i ��I '�r�r,r,�1���,r,� t!�''�r,,,,• , °rd RECEIVED ptQ' Of Jhl+ Iprrn for of I .bntllloC.lo �ltr I 6 Iry �y lo.;ol 8oelc 1 np1�� Q n(1Q ');"rl0, p ,8 A. CII101 p?,0 rinC 1•.lnpll �' Faclllty In[orm�llor� HEALTH ry '•;;.�•' a DEPARTMENT •!H) 1 n m ; ,CINTPm , Y''I;i;'i r'`.1Zlll,4i�111 X11• � .'(.�,.�. 1 _ y�,!.'•, ' �,,' }, r.r'Illlri;l�t�'' VJtI t', {llr'I'',�r l �1,; ,,,•,, i ,.,.,, ti '� ''•;,t ',{ ,i'�/1.f'rr',rru '�''I;irr�r��l�riili;' ' µ+ 0 trtnl ra'n buVvn) CG"fin r -' I/ ;Pr't u, P.11i"I g �a111,qo"rrd, mIl! , ' 1J osif of Pvrn ljm 2 ' ;' `'i '� r 'r r„ Oil ? n':dl",'r •, . ��� J Of 4( 1 Sepllc >• (descliDa1,�• j'I V.q J r%;'i'.'Yl�,''Niyi!r,►'r(r, , �{ r11 FSI I (t,,; In 1"'t Yo n o II ro). „-avaneo7 n — '� :ctll/,'•„r,r. ,1\.rAQl�ti l cn'c '9 " /11lr��dr r ///1 /,1/'� t r S _ I d;,;,IS'11'J'/�11'1,1'nn�ljlv'��"Iri��.'i ,Irr 111'{Ir'' r 11 .. •.'�}}r�',r'r,tl,,}�;'�rl�i •11�Ir�y' 1� '� ' 1� 1 ' • Illy I,r Iiri r 1 i V1' A / ' r•v11 • , . . I,. `'J'ryir✓�o;r{�r ` !' ",j!IfI}�'( %•+';(;'.,, (,�. �,I r«y�i�1 I`1i��ti'I���r�tl l) M�i;il�,;�,it.{It!!I:' to posao: �, 1lr 1'IrIfr1V IY4v r v z O Y/ d a e el ,. i fes' 0(/ , • , • ,,.r . . .. PP�4Y��a/141orm�,n.rrta�n��ocl . . • , . •. r , . 1, :r.. .c ;Ip 3 . d ORIT�I �� JDOVER,. ►�AS:S , $' a c�usErTy e c o'r d OCT — 9 2008 -DEP hal Provldad jtll+�Yllarr:, l r _ J O 1'_.^./l:', •� ;0 l.'1 9 10:8 r _ u, 1�: �- • �'"� ,A�v'DOVt�' v, 9:, .. Facility Informa cn —14 Lj YK I' �'� A4drei� {IICVf�rrnl rpm buucn� umping Regord - - •TY�B QI 8y319R1; � �©SS;^0" „� ?8!', _1 ♦Inn, T Effivanl Tea FUIe(.Pr�sen!? C)7� F v• S � Y 9C�B y e )'C' a,�•'�4'���lr�l��� I/f'' ,�r'��1 ,��II,J ��� J,,, ^ � � �Y4f11C.'4 .1Gd^►1 r+,. ,4' _... _ ' •- ;;; , ^ y;.�- -� �)�/sir. � '' ' , . oca on �,'n�era corllsnl� were c�sc�sac ry.rn83-3 OV/08,^./w8i9((8; YBf -- \ ommonwealth of Massachusetts ? City/Town.b- NORTH ANDOVER MASSACHUSETTS ' Sy-stem, Pumping Record Form 4 DEP has provided this form for use by local Boards of Health. The System PuMpjnQ ecoid mu; be submitted to the local Board of Health or other approvingy�t��,au io-ZS EIVED A. Facility Information Important: DEC 6 2006 When filling out 1. 'System Location: ,forms on the -119 TOWN OF NORTH ANDOVER computer,use Ln_Q�1 HEALTH DEPARTMENT only the tab key Address to move your . cursor- et not , "- State__. use the return Clty/Town Zip Code—� - key. 2. System Owner, _ Name Address(if different from location)--_-._.. City/Town ----___-- State —p------- Zip Code 9"5_ Telephone Number ----_ - B. Pumping Record 1. Date.of Pum i ��JD _ png Date 2• Quantity Pumped: Gallons 3. 3. 'Type of system: ❑ Cesspool(s) eptic Tank . ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yesa2g�No r. Condition of System: 6. Sy em Pumped By: ame _ 'CC Vehicle License Number (Jt O- d- L ' Company 7: Location where contents were disposed: _J Sf /%—=`"` i ature o Hau Date ------•—- http://www,mass.gov//dep/water/ provals/t5forms.htm#inspect t5rorm4,doc-06/03 System Pumping Record-Page 1 of 1 TOWN OF N RTH ANDOVE p, UA 11 SYSTEM PU PIN V Q� Q Rl~COKT, SYSTEM OWNER ADDRESS SYSTEM LOCATION 6UA �ra6 A6 . DATE OF PUMPf NQ 0SPOOL: Sap(ic Tank: NU ES N^ rURE OF SERVICE: KUUTI.Nk...._ _....EMERCIENC'1' U13SERVA'rIUN3: GOOD CONDITION P DEC 0 7 ....... FULL ' 200 .. ro c,ov�x 4 nAVY OREASE ._. BALES IN PLACE. ROOTg _. LgACNPIP.LD RUNBACK HEAL i ri )Lr r,r<TMENT;U, - ,,{rIDOVE FtOOT3 j _ YE SOLIDS FLOODED SOLID CARRYOVER, OTHER EXPLAIN system Pump4c l by Aff L'UMMENTS. _.._._....__............... _..._._.... CUN itN'I'S rKAN3F'ERK D fE) r , I � ' i _ :.:i:::,jr,�yljj�{{I'.,45t� '�;j��'�i,,�j�:lcitt{lt:�'`\'�'�'Ai''41t�'�` .: .�, r _•,t, r' _• •''•''•^I;fYI!�•,!a;„K'�G.1a:n.:':tlEl'.a,»7CYIIPI�r:ivi•.5,:::;.. �. 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I !'• .. r �.i,�r•.q,pT'�•Y�l'.S�I iri,t,p�a 1'.••I�. ,•�j':�'�.;: '`I% , �' 7r r'` 'Vii' ,',•' -1,•1;';��' `�' .. . •; ;1,;.1;:x': ..,;�,; r,�%'. :>''}:h'}:•�:t.t ,,.,I i,l,tlr> 11:1..::1' ,. . . .. i u�+ r..1�����•,. r?icif'.d. QIJ 1 h!.. •�'... 1 .r .,.. . ,,r•• '•� Illi'),4;h �� , �:, V' ly''. i• !I)�"��,';�' � ., � '-' rVi$ 0;j Filti►• OF fJE�ALI • ER/ NOV TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD l EM OWNER & ADDRESS SYSTEM LOCATION - �- f (�. ample' lef( from Uf hou r) I u.0 C OF PUMPINC: jb (QUANTITY PUMPED _C,a• i , , , NO " YES SEPTIC TANK : NO Y L 5 �1'UKE OF SERVICE• ROUTINE EMERCENCY ;.)ll>FRV TIONS: COOD CONDITION f" ULL TO COVC Z HEAVY CREASE BAFFLLS IN PL ACL' ROOTS LEACHFIELD RUNOACK... CXCESSIVE SOLIDS FLOODED � SOLIDS CARRYOVER Oj�HFR (EXPLAIN) > > > I LM PUMPED BY. /�� � Y'�, :71 i L u,l �-IrNTs u � I I:N rs TRANSFE IZRED TO: TOWN OF NORTH ANDOVER a SYSTEM PUMPING RECORD DATE: I 1 rj U I SYSTEM OWNER& ADDRESS SYSTEM LOCATION -� (example: left front of house) N, Q to ems' t DATE OF PUMPING: 10-17-t I QUANTITY PUMPED I SOV GALLONS CESSPOOL: NO YES SEPTIC TANK: NO Y �. ES T NATURE OF SERVICE: ROUTINE L- EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) _.._ SYSTEM PUMPED BY: Qd V�� l COMMENTS: CONTENTS TRANSFERRED TO: 1 i TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE: 5/25/00 This is to certify that the individual subsurface disposal system constructed O or repaired (X) by John Soucy at 49 Crossbow Lane has been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. i Board of Health Inspector Town of North Andover Sandra L. Starr Public Health Department Director 27 Charles Street (978)688-9540 �9SSACHUS S North Andover, Massachusetts 01845 Fax 978-688-9542 Board of September 18, 2000 Appeals (978) 688-9541 Daniel&Janine Bowes 20302 Stone Lane Circle Building Tomball, TX 77375 Department (978) 688-9545 Re: 49 Crossbow Lane North Andover,MA Conservation Department (978) 688-9530 Dear Mr. &Mrs. Bowes: Health Department According to our records, specifically the approved plan and the septic As- (978)688-9540 Built Plan,the septic system installed at the location referenced above was installed according to the approved plan. Please see the enclosed Installation Certification Public Health Form signed by both your engineer and installer that certifies same. The only Nurse difference, and it is insignificant relative to the intent of the plan and the septic (978) 688-9543 g p p system's functioning, is that it is located slightly more to the west than is shown on the approved plan. This slight alteration is addressed on the As-Built Plan as is Planning Department required by the Town of North Andover Minimum Requirements for the Subsurface (978) 688-9535 Disposal of Sanitary Sewage, Section 8.05 and 310 CMR 15.000. If you have any specific questions or concerns, please do not hesitate to address them to me at 27 Charles Street,North Andover, MA 01845. Sincerely, Sandra Starr,R.S., C.H.O. Health Director tr r_ TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System ( ) constructed; epaired, by �ti - located at (5\). was installed in conformance with the North 4dover Board of Health approved plan, � Svstem Design.Pe.Tut "Zdated y !L with anapproved design flow of V gallons'P day.da . The materials used were in conformance with those s e..�tzed on the an "'roved plan; the system was installed in accordance with the provisions P . P P � Y of 10 CNIR 15.000, Title 5d local regulations, and the final grading agrees substantially with the approved plan.. All work is accurately represented on the As-built which has been submitted to the Board of Health. Bed inspection date: Engineer Reoresentative Final inspection date: Engineer Representative Installer: Date: It lole-, P OF Design En/nee Aa � Date: ) WILG HOLT 9 NO. 1161.. cis PQ \\ ED SP�� I FARM 3A - CERTIFICATE:OF COMPLIANCE 140. r . COMMONWEALTH OF MASSACHUSETTS Board of Health, P Jog7aA Ark DOy !t,4 .MA. CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) :'►Complete System The.undersigned hereby certify that the Sewage Disposal System; constructed ( 1. Repaired (:), Upgraded $ Abandonipd ( ) by o qrA Sa�tSS at: C SSS Sow t,Ant► has been installed in accordance with the provisions of 310 CMR 15.00 (Title S) and the approved design plans/as-built plants relating to application No. dated ASN oved Design Flow (gpd_) WILLIAM Installer G. T NO. 1161 Q Designer: Inspector Date The issuance of this permit ''shall not be construed as a guarantee that the sysfiern will function as-designed, i 2 4 ® . .�w •wwwn..r n�nw.. �Ml I i i Town of North Andover NORTIy OFFICE OF 3�o't °16 0 COMMUNITY DEVELOPMENT AND SERVICES A 27 Charles Street North Andover,Massachusetts 01845 �gSSACMU00, s�.�ty WILLIAM J. SCOTT Director (978)688-9531 Fax(978)688-9542 January 18, 2000 Daniel Bowes 49 Crossbow Lane North Andover,MA 01845 RE: Letter of Noncompliance -Notice of Septic System Failure Dear Mr. Bowes: The North Andover Health Department has received and reviewed the Title 5 Inspection Report that was generated from the inspection of your septic system on January 5, 2000. Your inspector has determined that your septic system is failing to protect public health or the environment according to Title 5 of the State Sanitary Code. You are hereby required to retain the services of a Massachusetts licensed professional engineer(P.E.)or Massachusetts registered sanitation(R.S.)to design a new septic system in compliance North Andover Board of Health regulations. Please be advised that you with Title S and No An gu have two years from the inspection date to complete the necessary upgrade work. It is recommended that your hire a septic hauler to periodically pump your septic tank until such time as as repair can be completed. The Board thanks you for your willingness to help protect the environment,the ground water and public health. Please do not hesitate to call the Health Department office at the number below if you have any questions. Sincerely, Sandra Starr,RS., C.H.O. Health Director Encl. P.E. list Hauler list Financial assistance info. Brochure Cd: File i BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 NORTl� Town Of North Andover Community Development & Services William J. scop � : 27 Charles Street Director (978) 688-9531 " ° <-�=�• North Andover, Massachusetts 01 845 Fax 978-688-9542 Boardpls April 18, 2000 (978)688-9541 Building Department Mr. William Holt (978) 688-9545 Professional Land Services, L.C. 61 Garrison Street Conservation Groveland, MA 01834 Department (978)688-9530 Re: 49 Crossbow Lane, No. Andover Health Department (978)688-9540 Dear William: Public Health This is to inform you that the revised septic system plan dated 4/17/00 for the site NuNurse s)688-9543 referenced above has been approved. Planning If you have any questions, please do not hesitate to call the Board of Health Department Office at 978-688-9540. (978)688-9535 Sincerely, Sandra Starr,R.S., C.H.O. Health Director SS/smc cc: Bowes File 20302 Stone Lane Circle Tomball, TX 77375 September 7, 2000 North Andover Board of Health 30 School Street N. Andover,MA 01845 RE: 49 Crossbow Lane Dear Sir/Madam: Please explain why the septic system installed at the above-referenced address was not completed in accordance with the plan approved by the Town of North Andover in April 2000. A response would be appreciated within thirty(30) days. Thank you for your attention to this matter. p s,t! r - 6 i TOWN OF NORTH ANDOVER SEWAGE DISPOSAL SYSTEM INSTALLATION CERTIFICATION o The underr signed herr eby certify that the Sewage Disposal System ( ) constructed; epaired' by o h J i located at cA) was installed in conformance with the North dover Board of Health approved plan, System Design Pe.,nit ��LL�r, dated y I L with an approved design flow of�Qallons per day. The materials used were in conformance with those specined on the approved plan; the system was installed in accordance with the provisions of 310 CNIR 15.000, Title 5 and local regulations, and the final grading agrees with the a y substantially h pproyed plan.. All work is accurately represented on the As-built which has been submitted to the Board of Health. Bed inspection date: Engineer Representative r V Final inspection date: EnQineer Representative Installer: : Date: Gia ��,'ZN of Design En neer: o� Date: 3WILLIAM � Z� G. cn MOLT pnC NO. 1161._ is �Q \0 Town of North Andover, Massachusetts Form No.2 f AORTh � BOARD OF HEALTH �✓' 7 00 O L A DESIGN APPROVAL FOR ss CM°SES SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant Test No. Site Location_ 71 p Reference Plans and Specs. , �j- I � � ENGINEE DEIGN DATE Cn Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. CHAIRMAN,BOARD OF H EA-UrH Fee r Site System Permit No. 1115 y CrJ C) O Ci zCA �4 H "ZZZ t) Via , � APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERiNET ft DATE: 17 66 CURRENT LNSTALLER'S LICENSEr — LOCATION: 1� LICENSED INSTALLFM b ac,LAc SIGNATURE: o TELEPHONEn '� �� C CHECK ONE: REPAM: NEW CONSTRUCTION: IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BURT. Administrative Use Only 575.00 Fee Attached? Yes No Foundation As-Built? Yes No Floor Plans? Yes No Approval Date: IVA2 1�AR r- INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at T� �(,w-�, relative to the application of sfO Wre K elzrK G dated for plans band dated :3' f 00 with revisions dated f�lldcr> I understand and agree to the following obligations for management of this project: 1. As the installer I am obligated to call for any and all inspections. If homeowner, contractor, project manger, or any other person not associated with my company schedules an inspection and the system is not ready then item two shall be applicable . 2. 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, without completion of the items in accordance with Title 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 BOH,after which installer calls for inspection time. Installer must be present for this inspection. With pump system all electrical work must 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. Does not have to be on site. 3. As the installer I understand that persons or companies not associated with my company may not perform the work required by my company 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 in the Town of North Andover plus significant fines to all persons involved. 4. As the Installer I understand that I must be on site during the performance of the following 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. d) Installation of tank,D-box,pipes,stone,vent,pump chamber,retaining wall and other components. 5. 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. i Under ' ed Licens�f Septic Installer Date:7/' t i J - Form NO.s Town of North Andover, Massachusetts - --- NORTH BOARD OF HEALTH : �'s°^••��•"t�" DISPOSAL WORKS CONSTRUCTION PERMIT SACHUSE Applicant _ t �(f E ADDRESS TELEPHONE Site Location Permission is hereby granted to Construct ( ) or Repair ( anlncliviclual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. U/5� CHAIRMAN, BOARD OF HEALTH Fee D.W.C. No. ��(o .professional Land services, L. C . ENGINEERING & SURVEY SERVICES 61 GARRISON STREET GROVELAND, MA 01834 TEL (978) 373-9950 FAX (978) 373-4190 4/13/00 "town of North Andover Board of Health-Ms. Sandra Starr 27 Charles Street North Andover,MA 01845 RE: 49 Crossbow Lane,North Andover Applicant: Bowes Dear Ms. Starr, We have received your letter dated April 27, 2000 in regards to the above mentioned address. We have made revisions to the enclosed plans with the following comments: 1. We have eliminated the need for a retaining wall at the site with additional grading. Should you have additional que ' ns or comments please contact us. or- Sincerely, WUJAM ` G N H01.T NO. 1161 r William G. Holt, P.L.S.,R.S. Professional Land Services, L.C. APR 14 ; � } i P � S INSPECTION CHECKLIST FOR SEPTIC SYSTEMS Yes NO Init�a --� � -)S A. Bottom of Bed 1. Excavation to proper depth / '� 2. With trenches,sides of excavation are beneath B horizon 3. Edge of excavation specified distance from foundation,etc. - Comments: 15"L5 �ej B. Retaining Wall 1. Wall height and width as sped 2. Waterproofed 1 _ 3. Wall minimum 10'to leachin; 4. WalI meets specifications of p i Comments: i C. Building Sewer o I. Pipe diameter minimum 4" 2. Schedule 40 pipe Z \ •o 3. Watertight joints 4. Inlet to tank cemented c u W "" as 5. Slope minimum 0.01 or I/8 Pe � 6. Pipe properly set on compact fn o 0 0 � V v -• 7. Pipe laid on continuous grade m 8. Cleanouts precede all change in 9. Manholes at any 90°change 6S 10. 10' minimum offset to water lull �"ro. Comments: p o 0 J y � D. Septic Tank or ep 1. Level V y 2. 1,500 gal minimum M••� L, to 4 �" L a. 3. Gas baffle present on outlet a N 0 a 4. Manhole to grade V N 2 5. Manholes over center and each tel V O 6. 3-20"manholes �14 Q Q 7. Inlet tee minimum 12"under inve 8. Outlet tee minimum 14"under inN 9. Outlet line cemented '`� �. z 0 a 10. Air space 3"above tees ! C7 O o 11. 2 -3 drop from inlet to outlet U .a 12. Pipe set 4 a z 0 3 'p 'U- W 13. Compact base with 6"of/<"crush E-� p., W (7 °o„ 14. Tank is watertight U 5 W W40 � Comments: O w� H Yes NO E. Pump Chamber 1. If separate from tank,compact base with 6"of stone underneath lr 2. Minimum 2"pipe to d-box if gravity system �j '3. 20"access manhole 4. Tank level 5. Watertight 6. Tank size agrees with plan specification 7. Manhole to grade 8. Check valve and bleeder hole present 9. Alarm in building on separate circuit ✓ 10. Alarm functions 11. Manual operating switch t/ 12. Pump delivers liquid to d-box Comments: F. Distribution Box 1. D-box level ✓ 2. Minimum 0.IT'(2")drop from inlet to outlet 3. Minimum 6"sump 4. Outlet pipes show equal distribution 5. Compact base with 6"of stone beneath box ✓ 6. Box is watertight 7. All lines cemented with hydraulic cement •-1� 8. Schedule 40 pipe ✓ Comments: G. Soil Absorption system 1. All stone double-washed-3/4"-- 1 ''/z" ✓ -pea stone Bucket test done? 2. Minimum 2".of pea stone above distribution lines 3. Minimum 6"stone beneath pipe 4. Distribution lines capped or connected together 5. Grading meets 3:1 slope 6. Minimum of 9"of fill graded over system 7. Toe of slope stops minimum 5' from edge of property;if not,then swale. Comments: H. Leach Trenches 1. Minimum 2 trenches 2. Length of trenches agree wi Ian. (Max. length 100') 3. Width of trenches agree with pl -Minimum 2';maximum-4'. 4. Vent present if<50 feet or specified 5. Distance between trenches minimum 4' maximum of 6' 6. Minimum distance between trenches 10' 7. Pipe slope minimum 0.005 or 6"per 100' 8. Depth of trenches below outlet invert minimum of 6". i u Yes NO 9. Pipes set on stable base. Comments: i 1. Leach Field 1. Maximum length of field 100' 2. Pipe slope minimum 0.005 or 6"per 100' ✓ /// 3. Separation between pipe 6'maximum 4. Pipes connected at end 5. Separation between adjacent fields 10'minimum 6. Pipes set on stable base 7. Maximum 4' separation from edge of field to first line 8. Minimum two distribution lines 9. Maximum perc rate 20 mpi Comments: J. Leaching Pits 1. Minimum inlet pipe 4" 2. Pits of concrete 3. Sidewall between 12"and 48"wide ` 4. Access manholes on each pit 5. Pipes cemented with hydraulic cement Comments: ` K. Final Grade 1. Slope over soil-absorption system minimum 0.02 2. All system components covered by at least 9"soil 3. Cover soil free of stones larger than 6" 4. Grading slopes away from dwelling 5. No areas over system that may pond Town of North Andover t HORTM OFFICE OF 3�°��,,to ,to " 6 o°c COMMUNITY DEVELOPMENT AND SERVICES ° . 27 Charles Street WILLIAM J. SCOTT North Andover, Massachusetts 01 845 "SSgCHUStit�y Director (978)688-9531 Fax (978)688-9542 April 7, 2000 William Holt Professional Land Services, L.C. 61 Garrison Street Groveland, MA 01834 RE: 49 Crossbow Lane, North Andover Dear Mr. Holt: This is to inform you that the proposed plans for the repair of the septic system located at 49 Crossbow Lane, North Andover, have deficiencies which must be addressed before plans can be approved. These deficiencies are as follows: 1. A poly-liner has been proposed instead of a poured concrete retaining wall to make d breakout. (NA 9.02) ,,A `D-box missing baffle and specification of 6" stone base. (3 10 CMR 15.221(2) j,-T.- Missing abutters. (NA 8.02j) 44: Distribution lines missing specifications of 4" Schedule 40 PVC. (NA 10.01) b,6"Pump alarm not specified as being located inside the building. (3 10 CMR 231(9) [,-6' Manual operating switch specification missing. (NA 15.01) ,--7'''bistribution lines not specified as being connected with solid pipe. (NA 15.01) 8. Elevations of the top and bottom retaining wall missing. o,< Please be advised that all plan resubmittals require a$60.00 fee. If you have any questions, feel free to contact the Health Department at 978-688-9540. Sincerely, Sandra Starr,R.S. Health Director Cc: D. Bowes File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Apr-04-00 08: 25A Paul D. Turbide, PE/PLS 978-465-0313 P.02 I April 4, 2000 Sandra Starr North Andover Board of Health Administrator Office of.Community Development and Services 30 School St. North Andover, MA 01845 RE: Title V review for 49 Crossbow Lane Dear Sandra, Enclosed find the"Checklist for North Andover Septic System Plans" for the review of the above-mentioned site. The following is a list of all the `Problem' areas and deficiencies Port Engineering has found. ❑ Dbox must have baffle because of pump ❑ Dbox must have 6" stone base. 310 CMR 15.221(2) ❑ Abutters must be shown. NA 8.02j ❑ Distribution lines must be perforated 4" Schedule 40 pvc pipe NA 10.01 i ❑ Pump alarm must be located in building. 310 CMR 231(9) ❑ Pump must have manual operating switch. NA 12.01 ❑ Distribution lines must be connected with solid pipe. NA 15.01 ❑ Elevation of top and bottom of impermeable wall must be listed. The design shows an impermeable wall consisting of a 40-mil poly liner. North Andover Regulation NA9.02 requires impermeable walls to be reinforced concrete. Thus the design will require a variance from the local regulation. If you have any questions or comments please feel free to contact me. Sincerely Carlton A. Brown, PE/PLS Crossbow49.doc PORT ENGINEERING Civil Engineers& Land Surveyors One Harris Street Newburypurl,NIA 01950 (978)465-8504 i i No. THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH OF A/#/Ty /9�✓QOI�iC2- APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair (,)6 Upgrade ( ) Abandon ( ) - Complete System ❑Individual Components U055430 W 4 A^.Jf yAA///fG J.9,V/W /.3 v AM S Location Owner's Name -rA>c SAP z/0 _/,o T Map/Parcel# Address Lot# 10A)CITE'010Ah9(_ L 91V/)Telephonesele V/aj-0 4.414. Installer's Name Desiver's Name Address � - � le`�r�ess Telephone# Telephone# Type of Building: 1263 Lot Size �� �0 Sq.feet Dwelling—No.of Bedrooms Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min.required) S� gpd Calculated design flow 5.0 gpd Design flow provided gpd Plan: Date 3f/3 /ad Number of sheets Revision Date Title 34N/7-9aY &5,005.94- SySirn UAG&AD/s Ay,0-,J , Description of Soil(s)_ 64455 ZT S,914- Soil O/LoSoil Evaluator Form No. Name of Soil EvaluatorT0�RASSO Date of Evaluation 3/f/v O DESCRIPTION OF REPAIRS OR ALTERATIONS e49m ���� A+/A .�/'�Si�LL �✓��✓ %!!UO 6�►f /AGM p LNAn 6�2- The undersigned gr es to install t e above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further gre s not to plat system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date /mL Inspections FORM 1 APPLICATION FOR DSCP DEP APPROVED FORM 5/96 ------------------------------------------------------------------ No. THE COMMONWEALTH OF MASSACHUSETTS FEE /f/DLTN AWNY'&L BOARD OF HEALTH CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) A Complete System The undersigned hereby certify that the Sewage Disposal System;Constructed( ),Repaired( ),Upgraded( ),Abandoned( ) by: at CAossAw 6A^jk has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. dated Approved Design Flow (gpd) Installer Designer: Inspector Date The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 ----------------- �► FORM 11 - SOEL EVALUATOR R w.:: Page 2 On-site Review Deep Hole Number .. .Z. Date: 31 g.�OG Time: �� AM Weather V4 AY Location (identify on site plant .........5...F.........Pc.......4 4/......... .. .......... ...... Land.Use ...-.G.-A�✓.✓.......................... Slope (°�6) .".3..... Surface Stones VO........... ......... ........................................ Vegetation ..:................................................... . ....................... ...... .... Landform .....:.... ../�/L,f/�'iL/�.._.. ................ ..._.- ...... ........ ... ..... Position on landscape (sketch on the back) .$ .._ LR•U ............. Distances from: Open Water Body 7../.d.v feet Drainage way feet Possible Wet Area ...7.16.0 feet Property Line 7 D feet . Drinking Water Well 71.00 feet Other . _...... DEEP OBSEARIVATION HOLE LO Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other (Inches) (USDA) (Munsell) (Structure, Stones, Boulders, Consistency, %Gravel! 0 - 34- G -- j7Sy& ¢.-4° A v F.. s-�. /P yA- 3/Z lgalvV -+8 S.Go Art 1DyA 41; 64-107 4 Parent Material (geologic) ..._.....__.........._.QVr4v. j9 S H ..-..------------------------_......--......--................. Depth to Bedrock: .........................g Depth to Groundwater: Standing Water in the Hole: _44-.--. Weeping from Pit Face: --......¢--_- Estimated Seasonal High Ground Water: --..:.... .1`� L r. - . •. : ;Determination �fo� �e�onal� :1�'i;�h Wafer Fable Method--Used- ` �]. Depth observed standing in observation We... inches =[] Depth weeping from side.of observation hole inches ®, Depth to soil mottles ....f . inches Z Ground water adjustment feet Index:Well Number .........._...... Reading Date .................... „ Index -well level .............. Adjustrnen actor .....:.....:..... Adjusted ground water:leve( .......;............... ........... Depth of NaturaFly Occurring Pervious Material. Daes=at least four feet of naturall',y occurring pervious material exist in all areas observed throughout.the area proposed for the soil absorption system? yfi�S It not; what is the depth of naturally occurring pervious material? Certification: 1 certify that on 0.6 r ;9� (date), I have passed`the examination ap o-ved•by'tbe Department of:Environmental Protection and.'that the 'above analysis was performed by me consistent with:the required training, expertise and experience dje�ciftbed in 310 CMR, 15.017. Signature Date 3 A/0 .,cam _ �. _ `i 4_� jar r_? r -_ lC^{SfX"+� ,-- -•'Y ' Y welr W. - Location- Address or Lot-No. GAo5--s go w. COMMONWEALTH OF. MASSACHUSETTS Massachusetts =Percolation Test` Date: ... 3 /5 l d o Time: Observation Hole I Depth-of-Perc Start Pre-soak 19 ` End-Pre-so* ak ' Time -at =12" /- .Time -0.9" /2 " Z 8 Time at 6" 0/ ,' /3 , Time:(9"-" 45 -Rate Min./Inch' ' Minim of 1 percolation test must be, performed in both the primary area AND reset ea. Site Passed Site Failed -n ..................... . .................................... ...... .. . .....................:.......... Nwfoirned,8y. )C 0,96 .T ;orruneats: ��'_,t•��(� ��< fvg S f`<` - .A"' r+�F f°�j�',�r��(.S �t ..e�.�f,. ,�- ,IS.i,_�,1' ,�lt �' 'S'4 a:c .v._ "''r.i + .}Y'WsFC+t e!+jr����`s.i�y!}4.�+ `'il��j&c- .ry;!..1a.'!.� t� a rr-"'�; ad^?(�"�, •tFy t+l k�°� et+'.. MY 1�} M1 ! i-N� '4,k,K i l� � - . 1. _ .: .. •.:'�. �. � � . , . � - FOR11�I 11•- SOIL EVALUATOR F��:•�• _,;, Page 1 0 3 No. ........'....._.......:.......:...... ate . ' Oa i ' Commonv�ealth 6f.Massachusetts .'6*yp� Massa usetts Soil SuitabiW-Assessment.for On-site Sewa 'a .Disposal o �r ... - Performed By: :....._.. ...gl ..... .............�T.........................._.... ..... .L-..5. . .......... Witnessed By: .::. . SA�✓o S..TflR ,:- 13 O.H. :4 9 L'�oSS BO� �A ,E pAw/EC I JAMA/ SOWS S L«i TAX MAP . Z:IU Ld T 1060jT f 4y --c)6 si347W .h�E AA I9N0011644,. A?JO. ' New Constru.ctipn ❑ Repair Office Review' Published Sbil:Survey Available: No ❑ Yes- FA: Year Published...1.19/. Publication Scale .-.P5�°� Soil Map Unit 5��¢ - S�db��y Drainage Class Soil Limitations N14,4 vatr'Cn 1,461'E ��A y fu-357Ro7vn. Surficial Geologic Report Available: No 0 Yes ❑ Year Published gip..,. Publication Scale ,vA Geologic Material (*: p ::Ugit) ..NA_ .. ... LandfofM .........../.7/ur ........:.....- 0 v w4s H Flood Insurance Rate M_ap;°' Above 500 year flood bouhdary No ❑ YesFA Wi<thiri 500 year flood boundary. No © Ye's ❑ • Withid 100 year flood boundary No 0 Yes •❑ Wetland.Area; , National Welland,Inventory Map (map unit) ._.. .............. ...................._.___..._.......------...._.._._...-- •--.......... .Wetlands Conservancy Program Map (map unit) .. Current Water Resource Conditions (USGS): Month ..-_....�....� Range-: Above Normal ❑ Normal ® Below Normal ❑ Other References Reviewed.:', . U.S.6.S.. Q✓.�►O� �Er -4' 4ec S"014-S FORM 11 - SOIL EVALUA?�OR Page 2 On-site Review Deep Hole Number ..:.. �.. Date: 3f A9-0 Time: -0�1 Weather 3v.4 Location (identify on site plan) PLA' S1-�... .................. Land.Use ......:L..AA✓nl...................................... Slope (%) ./.'.-j..... Surface Stones N. .......... ................................................ Vegetation ..:...................G2ASS.....................................................:. Landform .....:...._....OWOA74/�_............_............ ... ......._.. _.. ... Position on landscape (sketch on the back) .��!' .... •t/ ........... Distances from: Open Water Body ..40-0feet Drainage way feet Possible Wet Area ...7.lb.a feet Property Line 7A feet Drinking Water Well 7�. d feet Other DEEP OBSERVATION HOLE LO Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other (Inches) (USDA) (Munsell) (Structure, Stones,Boulders, Consistency, % Gravel) 0 -3<- G - Sy2 3/¢ flz 31,t Parent Material (geologic) ........... D1/7^�''�s Depth to Bedrock: !� ....................._... Depth to Groundwater: Standing Water in the Hole: .... ..._. Weeping from Pit Face: ...... Estimated Seasonal High Ground Water: ...z. ...It ... U _"1 L' I- 1/1 )lJ nl - tll �u <i <i I � I � 1 1- \ 00 cf M 4 I is LiJ v �. •O V il. \<- _l. �_ 1 iu i(� AL U <l L-1J — !— U ('1 L1J U.I W W U1 111 LIJ 1.1.1 UJ <t O 7 O 11.1 O Z Z LIJ Z c� U.) (1_l IJ_ (LJI— Post-It-brand fax transmittal memo 767^1 #of pages ► TO _JO c� From-:S. Co. J� Co. Dept. Phone# Fax# ,27J 1(l Fax# } ,j r iii•. 4 .i.l � .r k I f +tlt 1 i "��J,1 Z U. �10l a r ,ri,•e ii� � I G I y•Vi'':'i�'.1 i 11t�i::5� •�JJ4 { I y � � I i C � Imo( r� -•y 45- r tj u i ,I CIVY 40 OLF'S i I� I � � .0 M , r ca r F4 F u^ ip4 t t UU t •y w 5 2F1 AF, a :3 1 ! K. Fjt�S�FFA, +4 c /y �t �/V• l 1 � �� � ��I�t L�i��k t i �x � 1 I 79 I �'j", r 41 Fdr7 f 4ali dl!,.{ Fs. ii 1s. r t t` R• s r {T4 {i S• i^ t � 'Is. �t fl I v1t' v �1 t{ 1r tYd i s y tt s.F �1 Af ,,� � y ri F{telli1 i r i 9�-tr+�tti d It rT t Vr ; O57 �I L► [J�/Q\ p,c t,t43}b t�rnr}Ft� rf-��9�tY�'1.1.� ; / i I,r r� i iiF i, d Ali i'ta' �41�•!;�'t 41 4 9/ f/ "� •t t tt F 'F 17t"T ai tat{ 3Yi CCC ✓✓/ 4 x s r' tisi IpS'Fi i, �; ; iyr ai 3 t < � lit, 1, r- 1p 1� } I<` i F r,#y Min ,3it dd 4t�ri 1�ni•1 t d r>.�;�,. � `++,: f , . r �,lS"art Yt. t r B.'t G.'h d:`3 # w.� r. .. .•� t i Town of North Andover, Massachusetts Form No. 1 NpRT b BOARD OF HEALTHaD10 * c m� *'�RADgATED y* APPLICATION FOR SITE TESTING/INSPECTION SS CRUS Applicant -!�M);EL' &WES NAME L/a / ADDRESS TELEPHONE Site Location 31- ( ?8155j ,OUJ /L/AQF_ Engineer ! LL l�-3l�IDL NAME ADDRESS TELEPHONE Test/I nspection Date and Time ✓ CHAIRMAN,BOARD OF HEALTH Fee Test No. � S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No. 1 NORTH A BOARD OF HEALTH Q�'(t LED 16�•Y� 19 APPLICATION FOR SITE TESTING/INSPECTION ��SSACHUS���� Applicant NAME ADDRESS TELEPHONE Site Location Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time CHAIRMAN,BOARD OF HEALTH Fee Test No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. � I I _... ------- - - . . - -- � -- f�ei�'I fv �e / �Psr f i�� �/�/ � � 2-�f /YIP.SSc�e 8 � �' ��� JAN-10-2000 MON 06.02 PM FAX NO. P. 01/02 BOARD OF HEALTFI NORTH.ANDOVER, MASS. 01845 �- 978-688-4540 6PPLICATION FOR SOIL TESTS DATE: MAP&PARCEL: 0aX-4�; I U LOCATION OF SOIL TESTS: ll Y1 1VLitts • ��15[,r�r_ V ?ANz/i/�_ j,�cl���� TFL, NO.: el;c�;�. � E'NGIN'EER: TEL.NO.: ?c1 S CERTIFIED SOIL,EVALUATOR: W t t.t..t Intended use of laud; Residential Subdivision eSQle Familily Commercial Is This: Repair testing Undeveloped lot testing In the Lake Cocluchewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: I 1. 'roof of land o.wriership (Tax bill., deed, or letter from owner permitting tests) 2. Plot plan 3. Fee of$275.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$75.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing,a scaled plan(no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7, Within 60 days of testing soil evaluation forms shall be stibmitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval: _ Date Received: Check Amount: Check Date: COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION A ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B. STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: U � Name of Owner Dck I-� Go r. AkAddress of Owner. 96d iM R , Date of Inspection: 1 S( 2-000 Name of Inspector:(PleaseQ SA A� S 1 vv\ ws a� I am a DEP approved system i pursuant to Section 15.340 of TWe 5(310 CMR 15.000) Comparry►Name: T- S Mating Address- U Telephone Numbdr: 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 completwas 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: _ Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority `s Inspector's Signature: Date- i a S A o O The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,ff applicable,and the approving authority. NOTES AND COMMENTS 1001. i O revised 9/2/98 Pagel of 11 s I INSPECTION SUMMARY: Check A, B, C, or A A] SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions de ribed in 310 CMR 15.303 exist.. Any failure criteria not evaluated are indicated below. COMMENTS: 81 SYSTEM CONDITIONALLY PASSES: One or more system components as described in the"Conditional Pass"s 'on need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of He h,will pass. Indicate yes,no,or not determined(Y,N.or ND). Describe basis of determine' n in all instances. If"not determined",explain why not. _ The septic tank is metal,unless the owner or operator has rovided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was instal d within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,struc rally unsound,shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if a existing septic tank is replaced with a complying septic tank as approved by the Board of Health. SUBSURFACE SEWAGE DIS SAL SYSTEM INSPECTION FORM PART A CERTI CATION(continued) Property Address: Owner: Date of Inspection: B]SYSTEM CONDITIONALLY PASSES(continued) _ Sewage backup or breakout or hi h static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or u van distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observation broken pi e(s)are replaced obstruc' n is removed distrib 'on box is levelled or replaced _ The system required pu ping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with app oval of the Board of Health): br ken pipe(s)are replaced struction is removed C] FURTHER EVALUATION IS R IRED BY THE BOARD OF HEALTH: Conditions exist which equire further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety a d the environment. 1) SYSTEM WILL PAS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)Ib)THAT THE SYSTEM IS NOT FUNCTIO NG 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. 21 SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS i revised 9/2/98 Page 2of11 FUNCTIONING M A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE EN RONMENT: I The system has aseptic tank and soil absorption system(SAS)and the SAS is withi 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and the SAS is within one I of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS is withi 0 feet of a private water supply well. _ The system has a septic tank and soil absorption system and the SAS is less an 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteri nd volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammoni nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approxi ation not valid). 3) OTHER f. f I revised '9/2/98 Page 3of11 v SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: q 4 crb s 6 ow i fjo 1r-' k Owner. B O We ]� J� Date of Inspection: 5 l Z O O V D] SYSTEM FAILS: You must indicate either"Yes" or"No" as to each of the following: I have determined that one or more of the following failure conditions exist as described 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. Yes No 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 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 112 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. 17 _ 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 1 of a public well. t 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: You must indicate either"Yes" or"No" as to each of the following: _/e he following cr ria apply to large systems in addition to the criteria above: The system rves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health an afety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well) Th owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional o ce of the Department for further information. t revised 9/2/98 Page 4of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: C.C�SS )3L.� W`� e ) ` 0 r+ ` AV 4_bV,*_e 1 wkr^, Owner: BOW Je > Date of Inspection. t i fl La 0 o Check if the following have been done:You must indicate either."Yes" or"No" as to each of the following: Yes No ,K _ Pumping information was provided by the owner,occupant,or Board of Health. X _ 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. 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. I The size and location of the Soil Absorption System on the site has been determined based on: _ Existing information. Ex. Plan at B.O.H. i C Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) (15.302(3)(b)) _ The facility owner(and occupants,if different from owner)wee provided with information on the proper maintenance of Sub-Surface Disposal System. I F I revised 9/2/98 Page 5of11 I 1 t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION t� Property Address: qc( C N 5S 6-0-iJ Q 7 .>PQ b'r V-P—C, , Owner: ig OL.)e S Date of Inspection: l l 51 ZOO D FLOW CONDITIONS RESIDENTIAL: Design flow: g.p.d.lbedro m. Number of bedrooms(design): Number of bedrooms(actual):- Total DESIGN flow Y-0 Number of current residents:_L-- Garbage.grinder(yes or no)-_11 0 w Laundry(separate system) lyes or no):!`+; If yes,separate inspection required Laundry system inspected (yes or no) }}i? Seasonal use(yes or no)--60 v A p Water meter readings,if availal)le(last two(2)year usage(gpd): `� OW r/r` 1 Sump Pump(yes or no): (\ U � `WW Last date of occupancy:—C k r� COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: apd (Based n 15.203) Basis of design flow Grease trap present:lyes or no)_ Industrial Waste Holding Tank prese :(yes or no)_ Non-sanitary waste discharged to a Title 5 system:(yes or no)_ Water meter readings,if available Last date of occupancy:_ OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and ource of information: t'Q p��-� hm..�,-c b PLA W\,PAA \ System pump d as part of inspection:(yes or no)--.nJ If yes,volume pumped: gallons Reason for pumping: TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool. Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components,date installed(if known)and source of information: Sewage odors detected when arriving at the site:(yes or no) 0 , revised 9/2/95 Page'6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C i SYSTEM INFORMATION(continued) Y- ,/� �p A Property Address: q-� SS yJ L)A,3 t..B.N�k 0 c-4A "\L&v-e-p Owner: a0w Q-S Date of Inspection: BUILDING SEWER: I I` (Locate on site plan) (( Depth below grade. Material of construction: cast iron _40 PVC_other(explain) Distance from private water supply well or suction line Diameter _ Comants:(condoqq o�f joints,venting,evidence of lialijige,etc.) n Ja l I t1l1l.v. Lk O�- I T? o Ca !� SEPTIC TANK: — (locate on site plan) Depth below grade: O jf Material of construction:Xconcrete_metal—Fiberglass _Polyethylene_other(explain) If tank is metal,dist age s'Is age confirmed by Certificate of Compliance_(Yes/No) x s' Dimensions: s' x Sludge depth:_ Distance from top of slud a to bottom of outlet tee or baffle: Scum thickness: j . I �) Distance from top of scum to top of outlet tee or baffle, f Distance from bottom of scum to bottom of outlet tee or baffle: How dimensions were determined:_�pq PA S16.r e J, , Comments: (recommendation for pumping,condition of inlet a d o flet tees or baffles,de th of liquid lav relation outlet invert,structural' tegrity, evidence of leakage,etc.) 8 f -� SQ 0 0 Aa ro GREASE TRAP• �- (locate on site plan) I Depth below grade: Material of construction:_co Crete_metal_Fiberglass _Polyethylene_other(explain) Dimensions: Scum thickness: Distance from top of scu to top of outlet tee or baffle: Distance from bottom of cum to bottom of outlet tee or baffle: Date of last pumping: 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 leakag etc.) revised ;9/2/98 Page 7of11 J 9 , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION icorrtinued) Property Address: C N S S to o� �-� ►^k Owner: It v e S Date of Inspection: ( j S1 20a10 TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade: Material of construction: oncrete metal_Fiberglass_Polyethylene_other(explain) Dimensions: Capacity:yet gallons Design flgallons/day Alarm levAlarm in working order_Yes; _No Date of png: Comment (conditioncondition of alarm and float switches,etc.) I DISTRIBUTION BOX:_ (locate on site plan) ((�� Depth of liquid level above outlet invert: 2-- T� Comments: (Rote if level and distribution ij equaV evidence of solids carryover,evidenc of leakage into or qut of box, tc.)• v ,Lf IC , W VV 111 A, [ o t r I S,A .— ^r-,- %4.01L��- ( �—:6 r� 10 40 A 3-- rte x ►�l�I-� 1 — PUMP CHAMBBt• (locate on site pla Pumps in wo ing order:(Yes or No) Alarms in rking order(Yes or No) Commen : (note c ndition of pump chamber,condition of pumps and appurtenances,etc.) i i i I I revised 9/2/98 Page 8of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 1 Property A : �{-� c f sc �� C'-`�1 IQ t> r +k � d,v -v; 6A a, Owner: WTS Dane of Inspection: , 15 L Z 0 uo SOIL ABSORPTION SYSTEM(SAS):_ (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If no located,explain: L'o c �-e Type: leaching pits,number:_ leaching chambers,number: leaching galleries,number: > > leaching trenches,number,length: leaching fields,number,dimension S overflow cesspool,number: Alternative system: Name of Technology: Comments: (note condition of soil,signs of ydraulic failure,level of pondig, damp soil,condition of veget tion, etc.) T)_v LiS CESSPOOLS• . (locate on site Ian) Number an configuration: Depth-top f liquid to inlet invert: Depth of ollds layer: Depth o scum layer: Dimen to of cesspool: Mate als of construction: Ind! tion of groundwater: inflow(cesspool must be pumped as part of inspection) i Comments: (note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.) PRIVY: (locate on site plan) Materials of cions ction: Dimensions: Depth of solids: Comments: (note conditio of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.) revised 9/2/98 Page 9of11 3 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: c.fb s 0 ) !� h d 0(/`ems, 1�-• Owner: _j S Date of Inspection: IIs40oo SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate iall wells within 100'(Locate where public water supply comes into house) CA St S(�R nn 0 ' 5�k� La+�11h F � i L� t Sin ce. S l lo` ! A- F C, = adz ' I revised 9/2/98 Page 10of11 i s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) __ � Property Address: Owner: 1BO W(S Date of Inspection: NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells i .- Estimated Depth to Groundwater `F SFeet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site(Abutting property,observation hole,basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators,installers Use USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) �bv.V\K t� G.J t A• , W P,S In k4CVA, 1 A�.C1�. J LI—V d +- arc -4-0 lie A IL-1 C_M s h �ti S �-! �—ann ) e �1 av i1/1(q r6 k CV-1a S, In revised 9/2/98 Page 11 of 11 1 FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This. does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. I ****************Applicant fills out this section***************** APPLICANT: Phoner� %� LOCATION: Assessor's Map Number Parcel Subdivision Lot(s) Street C.ZG�s ��.i St. Number icia1 Use Onl RE DATIONS OF TOWN AGENTS: Date Approved K/_ ._ Conservation Administrator Date Rejected Comments 1)(76 .(76 l Date Approved pp ed , Town Planner Date Rejected Comments Date Approved Food Ins ector-Health Date Rejected L/ Date Approved 6 7 7 nspector-Health Date Rejected Comments 1'L sti D r .g—� S ✓� yLv iyt v r� C r• �oL.� Public Works - sewer/water connections driveway permit Fire Department Received b Building ldin Inspector 9Date ..�� C"/ LABS TEL No .508-975--7881 Jun . ,97 8 : 19 P .01 +.—' —.�ssr rw.�.-..MM.1• .... .....r......... _.��-._.r....._,_. _ ..._..,.....•.......- -�.�-.-_�_.._............. .___.�.__... ....-..�..wr.'.........._T � t Of OSEPH P.,' BAAi aGa«o �• N0.464 ISTS —40 , CF . 1A Tl 0` i i a fff i FORNII I - SOIL EVALUAT(m moon! if TOWN OF NORTH ANDOVER/ BOARD OF HEALTH No. I'M `/ SEP - 5 I99 <,tc: % $ COnitrton,cealtll of Ainss,hipsefts �l/o,2TW 4d4c1✓e?0\ , Massachusetts Soil Suitability Assessment Or Oil-site Setyae hisnosal Perfamted by: ... c ........../9 Os ..................... .. Sq� Witnessed by. ........................�....SFIIP�..�� ........... - � I l ea�tee Addrcil ur �/9 44, S &d CAN Mrvr't N.�e. 130td 6S AMm.ud ygtAxVIE e,, 1-V tcitplKne / 41'? a O3WAW GQ Lf= eW Cbnstructivn U. Repair Office Review { Published Soil Su Vent Published W W Z Z Drainage Class `9 = = 5�... 7S W W SurficielOeoioga LL O1 J `- w w Vear Published ~ ~ d Geologle Material Q z Landrotm = o z o z Flood Insurance F, p o N Ix w bb Above 500 year f w m ~ Within 500 year f Q s z � U Within 100 year 1 N = Q _z = Wetland Atea: JLn L " rz ww ce a W ° National Wetland ; _ o Wetlands Consew -0 o Q ,� Q Q V) Current Wafer ate o 0 O � Range !Above No 000 z o Other References 3 Q� 0 � v �_ 0 U - a c Q w w � g � OBER ** Z Z ° ?� ssa sr O O ry o •� Z N U « O , V U L Q E a V1 so- ^ o� W, CO N .lYLi Moi ** a +- C y vi Q cn LLl F- LL. c/7 r�fr� •°, ,' • � i VORNI 11 - SOIL I;VAi,t1i� 1 cl'tt t tittnl _ - hope rfl .1 Location Address or Lot No. Y9 Lriyi'S b�«J zlei'`'i A 1U4idc1- 0 -site Review beep Hole Number #�. brats:. �/!19L Mine: j Z'yi��f 1Neolher �.S�e�•� Ltitallnn (identlfy bn 0110 PIWI) LOW Usl1 Slope to/of c�- 3�d Sutlsce Stctih§ VO�rstOtidn .. ��..i�s5 1'o01t10h on la 660 0 c Len form (, p (OketCli on the back) • . .y bl0tlirtoelt (rottit Open Water Body feet brahaage ways/au/ feet Possible Wet Aree 7T_ct/ feet hroperty Line 5i,;!. feet btInklttg Wster Well'?Icod feet Other f S1! - Dern 011SNIVATION NOLs LOG' t beplh(loin y Soil Mouton Soll texture Soli color Soil oll, §Utlbc611t1oheal IUSonI (MuMotif moltlind (Sltue(M.Sloh6i, bOUlJerit, t 0h§1slnncv, V. drgveli • C'"'7 'fee J . • � Y-0 n. � L-; y j Sym'/ 7�— G �Z SSC L�Q�, /! / /li¢ss•�v�,wr/� z��-�q�.,�� sMinot 6? nbagrimm rit*n;F"6rt3SF6 615 S - RE ' f Stant Meterlel Ipeoloplcl T 11 _ bepthtog�drack� /�CsG C� �6~ _ f)epth In ttroundweltlr; Sl<fridlrig Wetbt fn thb Nofet ez�� Moping from hit('Ace! EAtlntAlAd 9e09onel Nigh tlround WM01 ac/ `� -•-_--..._. .. J 10 OPRuvl n toRbl- 12/014.4 O •-•----� it//'' i r/Mi Si It P/4N.SEE :tll"Ilr 1ks,9� �y sew lA,>✓��,� . th � I ' 6o - v/4 o E I I N.,s. 14)RA1 t I Stili, I,V/\LU/A 1 No. cit 1 Lacnllnn Addrt•ss of Lt►1 Nn. C'i�s s .� ��,t ,rp vel- j Determination Seasonal M I1'ater I able Mathnd Used; d booth obsowed stattding (tr obsetvatlon hole........ .. ... Ihcltss d boptli weeping (toter sido of obsetvaliori hole ... iriclte§ bopth ttl sell ltittllles ?��� Inches ' atound water odjuMmertt ................... feet ' Indox Well Nuntbet .................. fiegding bete ................. Index well level .... ... . .,. Adjuotmont ttictot .................. Adjusted gtound water level ..............,................................. beetit of Natutelly dccu►tirtg hetvlous Material r boos tit least tout feet of ntitutoily occurring petvlous Motorial escist Ili till titotis Obsowed throughout tlm woo proposed tot thti sail obsotpilon gyst"1tq It hot, what Ig tho depth of rratuttilly occurting potvioua lttateritill t;ertity that nn (dote) I Bove passed tho sell evaluator exentilletlbn hppteved by thg Deptitt►11ent dl E11001011e111a1 ptntectidn mild thtit the ebbue onelysis wag potftlttnodNclimllo cslstetit wltll tho toqulrtid ttolrllrrg, expertise died opoiletito dwilbed lit 3m 15,017, . i 15h, Signature bale bth Ahranvr:a taaAf.uer,�s FORM I I - SOIL EVALUAT(M I mml OWN OF NORTH AN � T BOARD OF HEALTH No. 9`/9 G W 'P� z SEP - 51996 Uhl e. Comillotm-enItil of 1hssncttuse(Is �o�T������ ► i��as�s�a�ltusetts Soil Suilability AsseSsment ,rot- Ott-site Seivae Uisnosal Performed fly: .A�a/�iei�<S�� ... ..... ... .... ............................... . Whhessed dy: ....., 4- k0l..sT% .... L[mu1ton AU ti.i a �'9 C'ros sdo�[moi�7'C /,Weil e C AAArot,.�d .l /fi_9,�pd v Cry /1q/�5 S rdt���t Y9 doss lxc� Lgrf L eW Coh5tfuctloil d Repair office Review Published Soil Survey Available: No Yes '"a �4 s Year published l f��%.. Publicnlion Scale Soil Moll Unit t)A Drainage Class VPO...... Soil Limitations (''`�G^'� �rtisc S'6s Q 6 .,; �'���s"C 4 ,tee,-h ................ ..... : .. �.... Surricial geologic Report Available: Nov Yes El Yens Published Publication Scale GeologicMaterial (Map Unit) ....................................................................................................I.............. .. '.. .._........... .. Landform C Mood Insurance hate Map: Above 500 year flood boundary No d Yes Within $00 year flood boundary Now Yes_. d - Within 100 year flood boundary No W Yes d Wetland Area: / v� National Wetland Inventory Map (map unit) Wetlands Conservancy Program Map (map unit) ................................................... .... .................. .... .... Current Water Resource Condillons (USGS): Month Range ;Above Notmal nA Nonnal U Beic w Normal 0 Other' Reverences Reviewed: a i bEh Af•raoven�oant•Itro�ros I � . FORM II SOIL, I;�rAI,U�1'I'Ott ht>tltnl y `Y LocnUon hddr"t cit Lot Oo. C'�'osS�iJ Lqh�° /�/,r��/��Ue Cert-silly Review beep Nolo Numbor . .�Z bete:. `�/`��� 111110: -3a/ � VVoetitet �v, S`�lrfy LdCr:llieri ({detlNfy bn t;th plan) 7 / LOW Lige ...:. ,�cS%�c.��r'F� Slope 1%l d-37a Surface S10110 ScK�rcit.� Vegettttlon .. ..: . ../Q s 5 Lendlotm poolt)on on lotidocepe (sketch ort the beck) bll;tenr;el� (rtlln: Open Willer hodyy Z cel feet bralnago woy >t.i'G� loot possible We( toot aropetly Lina s4 feet brinkind WOW Well :7/u--i feel Other DEEP ORSMATION NOLt LOG' booth hot" toll Horltoh Soil Texluto toll color Soil uIlIfir Sur1Aco(Int:hAot (UsvAl 1Munselll Mottling (Sttucfu16,ttongA, PouldetA, tornsklency, 1% tlrlrvel) I r. it r io I A' /1•rc��'ty'SG117 � yS �c2 S^ r � Cci el 76"-/o�� iwle L r.+ Ae K� ly i f- Et IIEEiililfE6 VEIfPtstiaFaS 6-13151rUM- n POW MOW11111106010glo) f7o1,rVS T Depth to drnundwAler! SlAnding WAI&In th6 l-1ofa: 77 t� Wrlrlbind from Pit hecA! _:571/Ir _ tAtIrttAlAd 9096nal High ObUnd WAI&I .nEr�rrl<ovt:n�oant.t:,ei,ss K�o �� I �y syw „✓,��,� 60+ pill/ t I �1 I a � NT s, _�` I�Uit111 t 1 - 4011, LVALUA't't it -.- ) I-111thl �. 11ILt, .1 tit 1 Lopitfloo Addi-w oi- Lol No. y, de'sSd« l , /.. 1;116 rVe12 Petetliuttation tot- Seasonal I It 1,11ater Table Method Used; i d bopth observed stonding in ebsetvotioti holo......... ... 111clies d bo th wee In how silo of ob etv iii ( i p p g 5 al d 101e .... (1CheS Depth to soli ttiottles /. (fiches i woutid wator odlummetit ................... feet Indett Woll Number .•.......:........ hooding bete .................. judex well level .... ... . .. Adjuttmotit factol• ................... Adjusted ground woler level ........ ....................................... bealh of NritutalIv accurtlrid etvlous Material boos of lonst four toot of witutolly occuttir►g petvloUO-v►o(etlel eklst W rill oloaa obsotvod thtou pout tho oroo r g p oposed tot ll►o sbii absorptlori syslelN? It tlbt What� I t 15 the depth of rtoturolly occutHrig pr#tvious itietetioP '' Cof1111Ctlllbtt �, I t,ettlly that dr1 %' �. doto) I hove ►assod tho sail ovnIonlot wittiiriotloti opptbvoci by the be ottrtit-A d1 milt owilorit"0 Nottit 11ott "rid 0,tit rho hbovo hiiblysls wos porfuttrtod by ltio Cotlsisew with tho ttlqultod t "itiing, oxpotUso raid oRpollotito deoctibod Itt 310 CMh 15.017, Sigri"lulu Neto � R!,Whovin tuhnr:1Mutt I F' TOWN ONORTH AND ALTH ., 1 ' + ,015-014——I��SOtt, EVALUAT01t Wim 5EQ 51996 1No$ Coiauttolovealth of Massachusetts �ii�Pr///� , IVlassgchusetts Soit Suitability Assessment,for Otuife Savage Disposal performedpy; .,.... .................................................................. .... ...... ....... ate: Rr Sy s' Witnessed I3y; ... ... LA�IeM AAdrts!at Y� bwrcr'f Name, �� �rG S Stilt/Gq<�� �O lt/c AdAres+,ud /1K4U,001e -, /12✓As S T����n��► Y9 L'rossd d� L � ew Constructiotl CI kepair Cl ' dtYice nevlew NUc1 ( "J 1. big./L.310> . Published Soil Survey Available: No Yes Year Published x,1 1... 1'ubiic6tion scale �. /..f�yo Soil Map Unit �ll� btainage Class \f. .I ... Soil Liriritations C�...aK�....,c�� .t ....S�- srr ..�.. ....f? �«�r.lS Sutiicial Geologic Report Available: No V Yes d Peat Published ..:..:.:.::. Publication Sole Geologle Material (Map Unit) ...... ......................................................................................... ........................... ......... _... .....__.. ... T�i��� Landlotin ...............................................................................................................:.............................................. ............. ...... Mood Insurance hate Map; Above 500 year flood boundary No d Yes Within 500 year flood boundary No WYes d - Within 100 year flood boundary No MYes U Wetland Area: > me'l National Wetland Inventory] Map (map unit) ..........................................:.................................... ..........:............... Wetlands Conservancy program Map (map unit) ................................................................................................... Current Water Resource Conditions (USGS): Month Range ;Above Normal twNormal 1-1 13elci i Normal d , OtheP,References Reviewed: //S C� bt r Arrrtoft aoml.IMI/04 1`0101 11 SUIT, I;VALOATOR i�tlftnt - I'Sige 2 tit Loentinrt Address tri (.,ot No. /moi //I -ss- Ou-rile Review . beep Hole Number�-�. . bbtt;:. y/�� tirrrn: 230 Pmt� Wegtlrer v . San•'• '� Ldeatlmn'lidehtlfy en slid plartl a Land Use . 5/Ue�!%�� §lope ld/ol 0'3X SUrIOCO SfOhe§ ScQllu�el { VOgatatlon . L§hdfdrtrt .. ]''cele L Posltldn ori landscape (sketch oh Ute back) 'blstancett Irdn�: Open WOO "ody,7ZXIc,� feet bmihnge way>/ea� feet Possible Wet Atea">?or✓/ feel Properly Line so -el brlhking Weler Well feet Other Noth from Sotl fronton Solt textuto Soil Color Soil bthnt NtlBco Ilnchos) (USDA) (Montell) mottling (Sltuelure,Monok bnulJO. Co"Ottoney, 4% Ur6ve1) n . 0- 7 ( 71 61 r � ' y 75)el -(4* Zu7 / Nau(2., 3)1"k,les'5 5'/•94 9,4g; Ii ! Z3F- S-nE(U nE6- V[ 1i Pt3SEG 61917USAVAt% f eterit Mot (Utolopic) 5/2 � �� � 04"/i4,05w bebtlhtododrock: / Ids'� _ birth to Utoundwatot; Stonding W6let In 1116I1ole! �p WHeping(roto hlt heco� Sell totimolod Sootonat Nigh ground WAtor: I tier ArrgOVtD t0an1.1110ts! (10 i 260 I $'i IE P14A-1 SEE Sc/�✓ir z * /o� E 6o { V/W Of� 911 h , n I NTS.S. Pr RAI 11 - 8011, LVALUA-hitt rcfttni 4e 3 Lotallun Addttm4 et Lot No. �� L�tisS�w ��ae, /�/. ,�•l<�✓e2 cI'll It to ,wr Seasonal M h 1,11atei• Wle Method Used., bepth ubsetvod standing in ubso►votloti Bolo......... .. laches LJ bepth weeping Itow side of ubsotvatioii I1010 . . cliches bepth to sull mottles :ja!� taches Mound vete► adjusititent ................... feet Indic woll Number .................. hboditig bele hldex well lev61 ........ AdjuMntnnt lactot ......:..:...:.... Adjusted gtoulid wotot level ................................................ . booth Of NetutalN OCCUttina f Otvlvus Mittellyl boos ht longi lout feet e1 mitutelly orcuttiriq petvbus friotetiel eklst Iti ( tt3es tibsetVnd tiitoUghoUt the tltea ptoposod lot Ilio still tibsntptlon sy0610 It trot, Whet Is the depth of natutally occurting potvlous motedtill Ctl tl Cftt tltl . I Cattily that dfi � (date) I have passod tics still eVnItIO(ot @xOttillldlidti hpptbund by tl �inpntt► ntit of �nVitun►tielltnl htol"0ieti otid that the h6vo "tiolysis wag petlotniOd byItis t;ot1sis(tint with the tetiultnd ttoltillig, OxpattisO f lid t;xpnliatice : dafrt;rib�d IN �1d CMI 1�,b � . Signnluta bath 10 APMtatt O too#.1110104 i 't F£ 1111111111111111111111111 111 � � - • 1111111 11111111111 /11/11111 1 111111111111111 1111111111111 . . ., . 111111111111111 /1111111 111 1 ' ' � 'w - , 1►111 call 111111111c�i° 0 _ LIi111 IIIIIIIIIIII�ir��� � i fel _ � = I 1 11111 111111111� �� oE �i 1 1 111 1 1 111!E �1 1 � ► �, 11 1111 11 111 11 11 . � � Is 11 11 1111 1111111 _ . 11i� 11 1 1 1 � �, 1ZLIi1e� Iii1�'11 � C �� 11 11 1111111 _ . • a 119R c=144 LaM=L-- S��-�lL a E A i/vim, /� �.s• �NZ c_ _SEWE,c� OU7N0F `��7'' /I ¢•_ / ����tMgs N �cs 2 /^/ //4. 4/ o JOSEPH Al O L.4 -YL // d. -V J. BARBAGALLO y No.46 4 0 = t Q aX Ot.�7- //1.3� ,- //.x•33 —�I�•3� TE���`\P lip r� • _/._SQ..CL_GA.C.SEP..ttc._.7._RdK� i li . i � G C R� s s 6°w b. 1 ALLEN RODMAN, P.C. ATTORNEYS AT LAW i ONE MALDEN SQUARE BUILDING 442 MAIN STREET MALDEN,MASSACHUSETTS 01148 TELEPHONE(617)322-3720 � ALLEN RODMAN ELECOPIER(617)324.6906 I ROBERT M.PEYSER t RICHARD M.SANDMAN* SEVEN I;RODMAN i DOUGLAS W.SEARS DANIEL MALIS *ALSO ADMiiED W PA&RI August 30 , 19 91 i Michael Rosati Health Agent/Inspector North Andover Board .of Health -.- 120 Main Street North Andover , MA 01845 Re : 49 Crossbow Lane North Andover, MA 01845 Dear Mr . Rosati : I am writing to you on behalf of Dan and Janine Bowes with regard to their claim for repair costs in excess of $3 , 200 . 00 resulting from your faulty approval of inadequate septic system pipe at the above-referenced address. To obviate the need for me to commence legal proceedings , kindly contact me within ten ( 10 ) days from your receipt of this letter to discuss the possible resolution of this matter . Thank you for your cooperation. Very truly yours, ALLEN RODMAN, P.C. i Steven J Rodman SJR/b v i:,.8 y a tY� a -.'• - ,�,v',s •' ..; ,}''�++*fm t -� p i<x +,.r• r �+; t .r F• �,. .:'' , .a/: p`t r,;<4 P.jy Ger 441 :.r •:Y+.aS.Y.{..�'1.i''• qF d...,;r,y '�+«:ct;`>�`. ..,ev,"'.s ••'�,.. " •',u`.€.' l;:''hk" -I. 1 a, y TO: NORTH ANDOVER, MASS `S� 19 ' BOARD OF HEALTH aRe: Soil Absorption Sewage - FROM: DESIGN ENGINEER System Inspection This is to certify that I have inspected the construction of the said disposal system at Lo 7- S' CR,a-SS/o w L /7 NE North Andover, Mass. SITE LOCATION The grades and construction are as specified in my plans and specifications dated u I-y 16— 19 d y g E ,".@e R . nitarian r , I I., r RLP f � �' � �- �.e� C � � � /3 �3Rowiy Sf- �• _ LE F}-r/a i-� OF MasIAI LLs JosEPN yG� AO Y //yBARBAGALLO H / ��aNo. 464 .o- -X-o.�7`- 1��•3� � 3 ����srER��"�� SLY /I Al 4 ao.� _72o_S•A-. i_SQa GA L SEP..tt C..._.7_RNK _ i E W � N . G I6�8 jq( 1�1111i %(�Vj lull , or- Uo6 -p�Ar -CNS SoKf�tla2 (I�tl� � �vN(P� 1�1G 0r- PA- ��s ill �; i 61A)6 AimOvC: �iJ�q Sin�C� �(`S G�b2CGc.\�.f � E� i..Jr}-x.4� K6 la � j��s fv,�- So�tE���oIJ . �L of:::- ��Z 5 (.off' {piLc� 7Z' lac [?&., 1D d-tE rN &DGQ0k�- 'Pi Pt ? A-4AA w A-� IT (t:c---k�. f (�qulli ! CidJ o plcsS N LGA tic OkD rT*.4j L,,,— CoT ter A il6 x-70 zx-- SENDER: ,s • Completc:items 1 and/or 2 for additional services. I also wish to receive the • Complete items 3,and 4a&b. following services (for an extra • Print your name and address on the reverse of this form so that we can fee): return this card to fcu. • Attach this form to the front of the mailpiece,or on the back if space 1. ❑ Addressee's Address does not permit. • Write"Return Receipt Requested"on the mailpiece below the article number j 2. ❑ Restricted Delivery • The Return Receipt Fee will provide you the signature of the person delivered to and the J6% of delivery. Consult postmaster for fee. 3. Article Adressed to: 4a. Article Number tow7cS P 844 208 165 ��l • �_== Ify 4b. Service Type • E33'Crossbow Lane E Registered 7 Insured North Andover, MA 01845 4�1 Certified ' COD ID Express Mail ❑ Return Receipt for Merchandise 7. Date of DS!iyery —_-� s--- 5. Signature (Addressee) 8. Addressee's Address(Only if requested and fee is paid) 6. Signature (Ag t PS Form 387 , November 1990 *U.S.GPO:1991-287.088 DOMESTIC RETURN RECEIPT UNITED STATES POSTAL SERVICE . (1 1 Official Business PENALTY FOR PRIVATE' USE, $300 Print your name, address and ZIP Code here N. ANDOVER BOARD OF HEALTH 120 MAIN STREET N. ANDOVER, MA. 01845 i 844 2D8 165 Certified Mail Receipt TM NO-Insurance Coverage Provided Do not use for International Mail (See Revers ) Sent to ��� 0 Mr. rCtNo. Crossbow Lane P.O.,State&ZIP Code Postage Certified Fee Special Delivery Fee Restricted Delivery Fee Return Receipt Showing 0) to Whom&Date Delivered rn Return Receipt Showing to Whom, c Date,&Address of Delivery TOTAL Postage Q C &Fees $ 2 . 29 00 Postmark or Date M E sent 5/21/91 a a® � 6 � � s os k . ¥ %« « %°/# s \0 k ® so % t} a% 7 � %%+ s5 �k t�w k% co kn *% \ t° -ps . /k k� � Z0� \t k% k \ CA.� +* j5-,% lw % %* \\ ° §mak �5 '40 �� cr. a $ ,& 06; ° k ° $r t■ k% #� \�k t� k % \� % &# » ` st &« � t� \f\ t $� %% \% % s� \�% \id \%\� s\ \\ 3\ a« ¥# ¥s% ®■ % '9 � && \%# ±7 $ �- � . � t r10RTH 1 0 it�.o ,6 ti ?..y�,� yob O To BOARD OF HEALTH 120 MAIN STREET TEL. 682-6483 �9SSACHUSNORTH ANDOVER, MASS. 01845 Ext. 32 or 52 May 21, 1991 Mr. Daniel Bowes 49 Crossbow Lane North Andover, MA 01845 Dear Mr. Bowes: On May 21, 1991, an inspection at 49 Crossbow Lane revealed the sewage disposal system discharging to the surface of the ground in violation of 105 CMR 420. 300 and Title 5 of The State Environmental Code 310 CMR 15. 02 (20) 310 CMR 15. 02 (20) Discharge to Surface of Ground No sanitary sewage shall be allowed to discharge or spill onto the surface of the ground or to flow into any gutter, material discharge onto any private property. Please arrange for an acceptable repair of the system to commence within thirty (30) days of receipt of this order letter. You may contact this office if you have any questions relative to arranging for the repair. Failure to comply with this order letter may result in further action being taken by the Board of Health. Your cooperation in this matter is appreciated. I am available to take your calls on Tuesday and Thursday. Very truly your Michael J. Rosati Health Agent MJR/cj p