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Miscellaneous - 5 CROSSBOW LANE 4/30/2018
5 CROSSBOW LANE 210/106.B-0213-0000.0 k i I i I 1 I j i I i I i 1� f, l V 'f I` Residential Property Record Card PARCEL 113:2110/1106.13-02113-0000.0 MAP:106.8 BLOCK:0213 LOT:0000.0 PARCEL ADDRESS:5 CROSSBOW LANE Inspect Date: 05/30/2002 Book: 05869 Road Type: T PARCEL INFORMATION Use-Code: 101 Sale Price: 1 Rd Condition: P Meas Date: 05/30/2002 Tax Class: T Sale Date: 09/21/2000 Page: 0024 Traffic: M Entrance: C Owner: Tot Fin Area: 2008 Sale Type: P Cert/Doc: Collect Id: RRC Water: LEONARD,JAN-LOUISE Tot Land Area: 1.02 Sale Valid: H Sewer: Inspect Reas: C Address: - - Grantor: DANIEL LEONARD 5 CROSSBOW LANE Indust-B/L% 010 Open Sp-B/L% 0/0 NORTH ANDOVER MA 01845 Exempt-B/L% / Re sid-B/L% 100/100 Comm-B/LOiA LAND INFORMATION I RESIDENCE INFORMATION NBHD CODE: 7 NBHD CLASS: 7 ZONE: R2 Class Style: CL Tot Rooms: 7 Main Fn Area: 1124 Attic: Seg Type Code Method Sq-Ft Acres Influ-Y/N u99 069 Story Hei ht: 2 Bedrooms: 4 Up Fn Area: 884 Bsmt Area: 1124 1 P 101 S 43560 1 94 rY 9 Fn Bsmt Area: 2 R 101 A 0.02 Roof: G Full Baths: 2 Add Fn Area: Bsmt Grade: Ext Wall: FB Half Baths: 1 Unfin Area: VALUATION INFORMATION Masonry Trim: Ext Bath Fix: Tot Fin Area: 2008 RCNLD: 218185 Foundation: CN Bath Qual: T Current Total: 439,200 Bldg: 240,000 Land: 199,200 MktLnd: 199,20 Kath Qual: T Eff Yr Built: 1987 Mkt Adj: 1.1 Prior Total: 419,900 Bldg: 230,300 Land: 189,600 MktLnd: 189,600 Heat Type: HW Ext Kitch: Year Built: 1983 Sound Value: Fuel Type: O Grade: G Cost Bldg: 240,000 Fireplace: 1 Bsmt Gar Cap: Condition: A Att Str Val 1: Central AC: N Bsmt Gar SF: 484 Pct Complete: Att Str Va12: 4 Att Gar SF: %Good P/F/E/R: /100/100191 Porch Tvoe Porch Area Porch Grade Factor W 606 PHOTO SKETCH 1W 9 P * CtUre 606 Sq.Ft. Nu 12 Rable FU V cpR4 Sq.Ft. [t2 26 Page 1 of 1 1 Parcel ID:210/106.13-0213-0000.0 as of 10/19/05 I -r 5 CROSSBOW LANE \ 210/106.6-0213-0000.0 2007 "."DoveR �T I 1{ I' I I CA _Szvc � lYa•�E1�:.1�_/_�Y�_n'1_�x s�. I!V�L M./�Fo/Y� �!9�.SS _'_ ..___..�_.�� _ 1itz 1 ! `s IAS /,v Grsv lir 9� 9-g .� �ONW E 4!T 10 O� si I 9C'540 i 9 i ti�� ST q. fREG 5 i SA—IV NiTAk\R E W�.�?_Q.u7_LST'..l_1.�.•-�Z . .._._ ._ � uktfc taNk �Cl i -Ex_� S `�yG � 1 1 s � o FORM 4 SYS TEiY1 P UMPTNG RECQRD Massachusetts Commonwealth of . �fG ro/d�'�s Massachusetts.. Sstert rn�rn .�_cord �yste n weer y%em Ocauon i A-41 Fq, 1 �zs S fir, IVCD 3117 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT . y PeED. Emergency Routine 7. D� Cesspc ok No ❑ Yes [.� Septic Tan1:: No ❑ Yes — ) uanciry Pumped: f Z ;gallons Date c . Pumping: Q � p RA-CZ , EK '7,; Permit.•. Svster•: Pumped by (Company): - Conic .ts transferred to: Cont: .)Ls disposed at. �S Da te . /&,- G_�i . Pumper Signaturet���P Con(:ition_ of system/ot.her comments; DE?AAPROVED FORM• 1:/07195 Commonwealth of Massachusetts Mgmz� SEP 1 0 2008 City/Town of NORTH ANDOVER MA SACHU . E, vvll v, _ -R System Pumping Record HEALTH DEPARTMENT Form 4 DEP has provided this form for use by local Boards of Health. The System PumpingRecord must be submitted to the local Board of Health or other approving authority. A. Facility information Important: When filling out 1. System Location: forms on the CSC rpt computer, use li��� �� X64 only the tab key Address to move your 1�r cursor-do not City/Town v v use the return y Stale Zip ode key. 2. System Owner: Name — Address(if different from lova ion) City/Town State Zip Code Telephone Number B. Pumping. Record 1. Date of Pumping Date a 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank t� ❑ !Other(describe): 4. Effluent Tee Filter present?� Yes ❑ No If yes, was it cleaned? Yes ❑ No 5. Condition of System:. i 6. S stem Pumped By: � Name Vehicle License Numbe Companyf 7. .Location where contents were disposed: ZS11ure =auler Date hftp://www.mass.gov/dep/water/approvals/t5forms,htm#inspect t5form4.doc•06/03 System Pumping Record•Page 1 of 1 I t10RT1i O� 16 - 6 0L N O C" K�wKw T A_ 4SSACNUSS� PUBLIC HEALTH DEPARTMENT Community Development Division C�1' �II�FICArrF 0 F C0�44,''.GIAj%(�E II As of., ,dune 16, 2006 This is to cert that the individuaCsu6surface disposal system was Fully repaired by. ,ion Wfiyman At: S Crossbow .Gane North Andover, 9YA 01845 'The Issuance of this certificate shall not he construed as a guarantee that the system will function satisfactorily. j AE. Grant 1Pu6lic Yfeafth Inspector 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fox 978.688.8476 Web www.townofnorthandover.com TOWN OF NORTH ANDOVER of NORTFf , Office of COMMUNITY DEVELOPMENT AND SERVICES �_•'��:' °gip HEALTH DEPARTMENT t . 400 OSGOOD STREET ` + • ;F; NORTH ANDOVER,MASSACHUSETTS 01845 ,wu 978.688.9540—Phone Susan Y,.Sawyer,REHS/RS 978.688.8476—FAX Public Health Director E-MAIL:healthdept&ownofnorthandover.com WEBSITE:hiip://www.townofnorthandov6r.com TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM - INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System( constructed; ( )repaired; by ✓� w �n �► °� REfDER (Print Name) 00JUNlocated at OFDOVER(lristallatlori AddreSS) HEALTENT I was installed in conformance with the North Andover Board of Health approved plan, originally dated -L� " - and last Revised on -3/,2 7 b , with a design flow of l% gallons per day. The materials used were in conformance with those specified on the approved plan;the system was installed in accordance with the provisions of 310 CMR 15.000, Title 5 and local regulations, and the final grading agrees substantially with the approved plan. All work is accurately represented on the As-built which has been submitted to the Board of Health. Bed inspection date: -Lo Engineer Representative(Signature) i Gr� And-Print arae Final inspection date: Engineer Rsfesentative(Signature) i And-Print- arae Installer: 611 Signature) Date: C5 _.)off And-Print Name Engineer: (Signature) Date: And-Print Name i Page 1 of 1 DelleChiaie, Pamela From: Marianne Peters [mpeters@millriverconsulting.com] Sent: Monday, June 05, 2006 5:15 PM To: Dan Ottenheimer; 'Lisa Kozel LeVasseur'; 'Marianne Peters'; Grant, Michele; DelleChiaie, Pamela; Sawyer, Susan Subject: 5 Crossbow Construction Notes Attached are the construction notes for 5 Crossbow Lane. Please call if you have any questions. Marianne Peters Mill River Consulting 2 Blackburn Center Gloucester, MA 01930 978-282-0014 ph 978-282-0012 fx i 6/6/2006 i tAORTfl ` O�,cti.eo 0 'q{, 6• A OL 0At A eyh 0�� 1 �A COCNICN WKN`y ��SSACHUs�t�� PUBLIC HEALTH DEPARTMENT (ommunity Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 5 Crossbow Lane MAP:106B LOT: 213 INSTALLER: John Whyman DESIGNER: Engineering & Survey Services PLAN DATE:3/30/06 BOH APPROVAL DATE ON PLAN: 4/10/06 INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: 10* DATE OF FINAL CONSTRUCTION INSPECTION: 5/24/06 DATE OF FINAL GRADE INSPECTION: cel 1 SITE CONDITIONS ❑ Existing septic tank properly abandoned ® Internal plumbing all to one building sewer ® Topography not appreciably altered Comments: SEPTIC TANK Bottom of tank hole has 6 stone base Weep hole plugged " ❑ 15 n tank has been installed e�� + H-10 load) Monolithic construction ❑ e� tness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ❑ Inlet tee installed, centered under access port j ❑ Outlet tee with gas baffle installed, centered under access port 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 fax 978.688.8476 Web www.townofnorthandover.com I II tAORTH i? 9�''- F •6 O * I T O�4 C6104 WKw`-A T ��SSACHUSy PUBLIC HEALTH DEPARTMENT Community Development Division ® Effluent filter installed? ® 24" inch cover to within 6" of final grade installed over one access port ® Hydraulic cement around inlet & outlet Comments: Existing septic tank re-used. PUMP CHAMBER Bottom of tank hole has 6" stone base Weep hole plugged Combo Tank installed. Size: ® 1000allon Pum Chamber installed g p H-10 loading Monolithic 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 ® 24" inch cover to within 6" of finalg rade installed over pump access port ® Water tightness of tank has been achieved Visual tost in B ® Hydraulic cement around inlet & outlet Comments: Liberty pump used, not Myers which was on plan. 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townafnorthandover.com t10RTfi Q�tt�eo b�ti Ococ.iiin46— A. 9SSACHUS�� PUBLIC HEALTH DEPARTMENT fommunity Development Division DISTRIBUTION-BOX ® Installed on stable stone base ® Inlet tee (if pumped or >0.08'/foot) ❑ Hydraulic cement around inlet & outlets ® Observed even distribution ❑ Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEM (General) ® Bottom of SAS excavated down to 6 in into 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 ® Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: Inspection ports were asked to be installed. SOIL,ABSORPTION SYSTEM (Gravel-less Chambers) ® Brand and Model of Chamber 241nfiltrator Quick 4 ® Number of chambers per row 15 ® Number of rows (trenches) 2 ® Laterals installed and ends connected to header (and vented if impervious material above) ® Elevations of laterals and chambers installed as on approved plan Comments: 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com NORT#1 q o tt�eo , '10. 6 O0 O p► Fy' c � ebh O`pA C""C tW Kw 01 1 ��SSAC HUS���� PUBLIC HEALTH DEPARTMENT (ommunity Development Division CONTROL PANEL ❑ Alarm & Pump are on separate circuits ® Alarm sounds when float is tripped ❑ Location of control panel: Basement ❑ Rated for exterior if placed outside ❑ Alarm signal located inside Comments: 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 wall 10 20 -- ❑ Inground pool 10 20 -- ❑ Slab foundation 10 10 -- ❑ Deck, on footings, etc 5 10 -- ❑ Waterline 10 10 1.0' ❑ 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 1 Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance(NA 5.02). 3 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 i t%ORTH q O St�to 1 .V ew 00 t0- 0 ey O ua CMNI[MIwKM CH PUBLIC HEALTH DEPARTMENT (ommunity Development Division ❑ Interim Wellhead Prot. Area El Reservoirs 400 400 El Drains(wat. supply/trib.) 50 100 Drains(intercept g.w.) 25 50 ❑ Drains(Other)Foundation 10(5) 20(10) Drywells 20 25 SYSTEM ELEVATIONS INVERT ON DESIGN PLAN FIELD INVERT ELEV. Building Sewer OUT 76.40 Septic Tank IN 76.00 Septic Tank OUT 75.75 76.74 Pump Chamber IN 75.70 76.62 Pump Chamber OUT 75.45 76.87 Distribution Box IN 78.42 78.99 Distribution Box OUT 78.25 78.41 Lateral 1 INV 78.17 78.41 Lateral 1 TOP 78.50 78.48 Lateral INV 78.17 78.19 Lateral 2 TOP 78.50 78.38 I ,I 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 918.688.9540 fax 918.688.8416 Web www.townofnorthandover.com �°. ,� Commonwealth of Massachusetts Map-Block-Lot �: ; '•. Q°� 106.6 -0213- o Board of Health Permit No North Andover BHP-2006-0097 e P.I. FEE ,JSACMUSt� F.I. $250.00 ----------------------- Disposal p sa Works Construction Permit Permission is hereby granted Jon Wh man - - ------------------ ----------------- - --------------------------------- to(Repair)an Individual Sewage Disposal System. at No 5 CROSSBOW LANE ------ ------------------------ as shown on the application for Disposal Works Construction Permit No. BHP-2006-009 Dated April 17,2006 i --------- ----- -- Issued On:Apr-17-2006 ' _- -------- ---------- - — -- Bq I th ............................................................................................................................ ...s...................................... * NORr" Map-Block-Lot ° ti Commonwealth of Massachusetts p- s .• •* A 106.B-0 21 3- . Board of Health it North Andover �'ss�cMus•`,y Certificate of Compliance THIS IS TO CERTIFY,That the Individual Sewage Disposal System (Repair) by Jon Whyman Installer at No 5 CROSSBOW LANE --------------- - ------------- ------------------ ---------------------- . --- ---- --------------- ------------------------- has been installed in accordance with the provisions of TITLE 5 of the State Environmental Code as described in the application for Disposal Works Construction Permit No. BHP-2006-009 Dated April 17,2006 Printed On:Apr-17-2006 - - - - -- -=------- - --- Board of Health J 1 A lb Townj North Andover �.. Health Department Date: � r do/ Location: (Indicate Address,if Residential,or Name of Business) Check#: f 1.9�/ Type of Permit or License:(Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service-Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal(Septic)Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ Q.,Sep ict Disposal Works Construction(DWC)$ ❑ Septic Disposal Works Installers(DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ TrashlSolid Waste Hauler $ ➢ Well Construction $ ➢ OTHER:(Indicate) 1 E i 7 Health Agent Initials . White-Applicant Yellow-Health Pink-Treasurer Application for Septic Disposal System TODAY'S DATE O.Construction'Termit - TOS OF . , NORTH ANDOVERMA 01845 , $ 250.00 Full Repair Component ��ACNUSk Important: Application is hereby made for a permit to: When fining out ❑ Construct a new on-site sewage disposal system* forms on the computer, use 6-ICepair or replace an existing on-site sewage disposal system* only the tab key to move your ❑ Repair or replace an existing system component cursor-do not use the return A. Facility Information key. "5— cS�cJO� rab Address or Lot endo City/Town —_— — 2, *TYPE OF SEPTIC SYSTEM*: ❑ Pump ❑ Gravity (choose one) ***If pump system,attach copy of electrical permit to application*** ❑ Conventional System (pipe and stone system) ❑ Infiltrator or Biodiffuser(Gravel-Less) (Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D-Box) (Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D-Box Present) S.A.S. 2. Owner Information Name Address(if different fir m above) ��OaI4(—o City/Town State Zip Code Telephone Number 3. Installer Information Name n Name oftompany Address ---� 65� I City/TownX State in Code Telephone Number(Cell Phone#if possible please) 4. Designer Information Name Name of Company Address City/Town State Zip Code Telephone Number(Best#to Reach) I Application for Disposal System Construction Permit•Page 1 of 2 O °�,�, Application for Septic Disposal System y!a a f ,..x c. �e�'t'� i . e `-Construction Permit - TOWN OF TODAY'S DATE *} NORTH AND MA 01845 250:OD— ull Repair �� : •':� + $125.00 -Component PAGE 2OF2 A. Facility Information continued.... 5. Type of Building: [residential Dwelling or ❑Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Name Date .+. Applicatio pproved By: (Board Health Representative) r" Name, Date •':' Mz• ,/Application Disapproved for the followg reasons: For Office Use Only: 1. Fee Attached? Yes No 2. Project'ect Mana er Obligation Form Attached? Yes �/ No g g —/ — 3. Pump System? If so,Attach copy o f flectr'ical Permit Yes ✓ No— ��>�!� ����$/I 4. Foundation As-Built?(new construction ronly): YesNo (Samescale as approved plan) 2 Yes �l� No S. Floor Plans. (new construction only): _ — Application for Disposal System Construction Permit•Page 2 of 2 i �' �' � �°� � . ��� � M INSTALLIR PROJECT MANAGEMENT OBLIGATIONS I As the North Andover licensed installer for the construction of the septic system for the property at /t��elative to the application i of dated for plans by and dated with revisions dated I understand the following obligations for management of this project: 1. As the installer I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer I must call for any and all inspections. If homeowner, contractor, project manger, or any other person 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, without completion of the items in accordance with Tile 5 and the Board of Health Regulations may result in a$50.00 fine being levied against my company. a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final inspection — Engineer must first do their inspection for elevations, ties, etc. As-built or - verbal OK from engineer must be submitted to Board of Health, after which installer calls for inspection time. Installer must 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. 4. As the installer I understand that only I may perform the work(other than simple excavation) required to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system, and/or revocation or suspension of my license to operate in the Town of North Andover; significant fines to all persons involved are also possible. 5. 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 or consultant. d) Installation of tank, D-box, pipes, stone, vent, pump chamber, retaining wall and other components. 6. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersig dJensed Sep ' Installer Date: 12- I Ia:mllely 71n+�agUwpV pYpu.11nA irI full VW.Ihn1111 fuOY.jaytuDmoµ)o Auu VIRI"DD Imtsm I„n'I WI.97 99M:U1I-gIlja:1 M1�I, 1,111!jA 7111.1.111 u0 SI W11J 011 yl Iwislhal ij;.jul 9111 At gpgl ID vR IMMI7I0Ia1 avpl” IIV 'A77llU[Plpl 17I71111PLp NI ILVM.t.'1lelNl IoJ IDAII 1nMaddl' d3II SUMIllauhro•IN alll Al t1p.I1 lkw aR Iualsds MIMI ,XULVILVINNI DID Dnlsw ''I II a!III sIILI."1111"R11d11 MIX1611I i7IVM7Mw vy+r-1.•1111 II61yAR aRUFAIa 1.1k 1-1:11,.9($jV1IJ,'il:fN1 rj1 11. .....miwlmn Dill Inj tiliI lllmlwl Iw itilm DID p7pplunv Apim ArIVpuc I^1 uop�xiryxv�1 xv�R•l.fl vnwdlriil xnr :Iuf11 AIIPvi uI n HILI. '•Nal ?W9.L1.I UtfnlrvW ivay sfprpllV - . OP11.10A 20-7 Voll VIN.nngvmJqu;) I a+f1L'Ald4ru IIIMS a p Cngi A.QIIwA NAI ARP'IRI fill P7mp PILI PD1aak WM alw.ulglia i.L.4'OOsI WID CI!.10 111VIy„lu iaaftll DID Ail yPDI liu n kslalapluY 'I'D"ov kowlipip plaufmop 84LVXL'1LINI mJ 1Dlfal JDAl-ddv d:p1 vlla7h11mrokoli s�il.'slmr"III AQ ltll IN W u lWR nlvAV IxInlRlry sYClf.vy,L'fI.-1NI Dill Irvl%rn w Pa11Uav fn Wl1pa7A 1 '9 1tl1i .0 JDWMA1x11M allG-Ih.A7)114{MAR laylutlyD:Ilallalgf mgpJ.y ;IkINI 71!J•1 111l ap >.I MOM llnne>< pvmllal alp pomdulm AProI:)prsyvy W4 xol77rhrl�'xgl ND�fM ', VLV�If11�waq['� . n w`lldrnrn .. I I CCLTEC. Inc. LM Bmokfi*ld. CT Thia lg M Clint y that f IIIv ` c""In the inswiietion of he eatlafacdcniy RECHA*rgR Tm CHAMBERS for COLT EC CpNrA CTORI a m in ecconfence with M H"I" use in oneloe dispose a h of MessachuseNa.Tifo 5:310 CMR. Coda for flee CommO au& w DATE )•'— — p�.CUI-Cln>'eC.wC. I I T 'd OEEbbEETBL uewflLIM uL{or dL0 :b0 90 BZ idd Commonwealth of Massachusetts PClllllt No. Department of Fire Servkes OCCupanc� and Fce Checked XV BOARD BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9 051 ,le,lle blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK N11'.1otk to hr performed in accordJ11Ce\lith the\lIl„ae'hll,ett, 1:1IC0 ic,tl Code(\IFC). i'-'C\IR 12.00 I'L E.ISE PRLS T ININK K OR TF .I L4, 1NFt)R.1 L I TION) Date: /t/ A0"e-'r z� v� Citv or Town of: r , ©t!-/�. TO the h7S1!ec'I0r• o1 fb'ires: RE:NORTH IVE plication the undersigned gives notice of his or her intention to perforin the cicch ical fork desa ihed below. Locatio i(Street& Number) SC x-0SS OD �� 44-�a� — AP4 20btvner rTenant 1 Peen i-, Tclephone�o79133YZ Owner sAddress 9-4 Cr055(0 TOWN OF ;ANLI��bH ermit in conjunction with a building permit? Yes ❑ No (CheckAppropriate Box) HEALTPARTMEsNT Utility Authorization No. ur a of Building Existing Service AO Amps f,70/ Jh Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of:Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: X i2e4 OUite Pull &K "J- aro 0 S v ally C ('0mr h,tion tt/dit Jir/hrnino luhle llrul'he 11 LulILI l'1;!/le los'tI :r'W tl No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans °•° ota Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA ove In- No.u Emergency Lighting No.of Luminaires Swimming Pool ;,c.nd. rnd. BatUnits No.of Receptacle Outlets No.of Oil Burners i�FIRE ALARMS No,of Zones No.of Switches No.of Cas Burners No.oDetectawn an Initiatin Devices No.of Ran otal Ranges No.of Air Cond. No.of Alerting Devices g Tons No.of Waste Dis osers eat Pum mber Tons KW No.of.'el -Contame p Totals: aDetection/Alertin Devices No.of Dishwashers Space/Arca Heating KW Local❑ M unicipa El Other Connection No.of Dryers Heating Appliances Key Security Systeins T-- No.of Devices or Equivalent No.o aterKW o.o No.o Data Wiring: Heaters Signs Ballasts No.of Devices or EquivalenIt No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications miring: — No.of Devices or E q uivalen t OTHER: Ilrr,,:lr,o,l,lru,:ntl lrr,rrl IJ,It,rn'c,l. .;r ,ra rrlu,rc,/h1. ,irr I1011tu,,r R F,.timated Value of .lectrie 11 %V '2,, i A hen required by municipal policy.) \lurk to Start: S Inspections to be requested in accirrdance with \IEC Rule 10, and upon completion. INSLRANCE CO ERAC : Unless waived by the ulrncr. no permit fur the perl'urmance ufelectrical work may i:sue unl the licensee prm ides proof of liahiliN insurance including",.omplctcd operationcovera'_,e or its ul-,lantial ceµlie,rlcnt. �h 1;ndcr,kno.l certitie: that larch C nc•a-;e i_. in 11TCc. :111d hu,e• hihitcd Arnot t:t MIC to the permit i::.uirr (Iltlee. 111 CK OSE: I `;I R.\�.l'l t3t,�.1) ❑ ,l l!I.R ❑ ttipccilY:) - ✓ '('!'ll�ti, /11(�C'l(lll'tl(l.'Jl.�'•Il1l�l7N1Ti(I/!('.1' !f/7ePl)I/.j', ;(!t//rllt'r%1�01'!Un1N1N,;Il.IIIS i/)/)I!C[J�'I!/1 rJ:l'�tl'rli'(l t'N':!11.1sIN. IRNI N:VNIF: l t_ict/tsee: /�/�_ _ . ,.11.sort JAC;. Vel.:1-01 _ -- l: Sus. Trl. `;oA793376345' address: -� ti Al `, e- `Security sy'leal Contt;act Liccnse rc,lturc� Am this r,c,rk: it,rpplic.rh!e.enter the license nunlLcr here: OW NEWS INSLRANC E 'NNAIVER: I vn:tw;u•e that ahe I.i,:cn;ec,.l(...'”ncl h(rnr the liabihtl insur:rna_,:•7 •.r`t rn r m;tall icquired by law. m; acture below. I hcrcby '.raivc this, I'CLtuircnll.nt. 1 :un the( heck one)❑ ,.r.�ner uwnur':,•r,cr Owner/Agent iI - R� t - ' The Commonwealth of Massachusetts Department of Industrial:Iccidents Office of Investigations 600 Kashington Street Boston, 1M 02111 V, www.mass.guv/ilia Workers' Compensation Insurance Affidavit: BuildersiContractors/Electricians/Plumbers Applicantinformation Please Print Legibly Name (l3u>incss,l)r`�aniiatihnrin�livi�luall: Address: -- L, 1J rJ L J (1Vl 14 Phone 3 —2,-33 City state;zip: `7 Are you an employer'Check the appropriate b Type of project(required): i.❑ I am a employer with 4. lam a general contractor and 1 6 ❑ New construction to ees full, ,or art-time).* have hired the sub-contractors emp Y ( p 7. ❑ Remodeling 2.❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub-contractors have 8. E] Demolition working for me in any capacity. workers' comp. insurance. q. ❑ Building addition [No workers'comp. insurance 5• ❑ We are a corporation and its 10 ❑ Electrical repairs or additions required.] officers have exercised their right of exemption per MGL I I.❑ Plumbing repairs or additions 3.[] I am a homeowner doing all work g p myself.[No workers' comp. c. 152,31(4),and we have no 12.❑ Roo repairs I_ insurance required.]t employees.[No workers' 1Other .oo, comp. insurance required.] — `.\ny applicant that checks box A must also till out the section below:,howing their\Norkcrs conhpcntiation policy mtdmhation. Homeowners who subnm this affidavit Indicating they are doing all work and then hire outside contractors most,uhmit a new attidavit indicating:,uch. �4 Contractors that check this box must attached an additional:;hcet:showing the name of the sub-contractors and their workers'comp.policy inihnn1. ation. I ant an employer Hutt is providing workers'compensation insurance for my employees. Below is the policy and job site ( \ information. Insurance Company Name: _5"%;P100 ZiJ5LJ144.JtE Policy "-or Self-ins.Lic.'l:_ —___—__ Expiration Date:__ _—_.--- Job Site Address: Sr Crus-VG `.J (A0C Nd' AtJ U0 f=e City.'Stateizip:_ :attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of N,1GL c. 153 can lead to the imposition of criminal penalties of a Fine up to,$1,500.00 and;'or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine Of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. /Ito herehy cert/ under fife pains unci penalties of perjury that the it iwinalion provided tbove •trite unci correct ofnate: — (n1ficiai 11se a fly. Du aril write in chis area,io 8e completed by hit► rtr:utwr ri/Jiciul. City or Town: Permit/License d Issuing authority(circle one): I. Hoard of Health 1. Building Department 3.City/T,),n Cleric •l. Electr+cal Inspector Plumbing Inspector 6.Other Contact Person: Phone#: I ` TOWN OF NORTH ANDOVER NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES F ~ y HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 Susan Y.,Sawyer,REHS/RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX April 10, 2006 Jan Leonard CJ 5 Crossbow Lane North Andover, MA 01845 RE: Septic System Design, 5 Crossbow,North Andover,Map 106B, Lot 213 Dear Mr. Leonard, The North Andover Board of Health has completed the review of the septic system design plan for the above referenced property, submitted on your behalf by Engineering& Surveying Services, Inc. dated, February 15, 2006, last revision date March 30, 2006 and received April 3, 2006. The design has been approved for use in the construction of an upgrade onsite septic system. The 4-bedroom(9-room maximum) design has been approved for use in the construction of a replacement onsite septic system. This approval is valid for two years from the date of the approval in accordance with current local regulations and during this time a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover. This approval is subject to the following conditions: 1. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation,the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit. 2. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and municipal requirements are met. These may include review by the Conservation Commission, Zoning Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe or imply compliance with any of the aforementioned requirement 3. The plan does not show a diagram of a 3-float pump system within the pump tank. N. Andover requires a 3-float system for the pump on,pump off and alarm. 4. The N. Andover Health Inspector must observe the septic tank inspection process. Due to its precarious location this must be accomplished prior to the bottom of bed inspection. The purpose for this is that if the existing septic tank fails the required inspection,the new tank must;,be located> 5 feet from the columns of the existing deck. This will require direction by the engineer. 5. The plan does not call for the installation of a septic tank effluent filter but one is recommended. Please be advised that only certain brands of filters are permitted for use in �1 Massachusetts and each is required to follow certain approval criteria. Your designer or installer should work with you to assure a licensed brand is selected for use if you choose to install one. I Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you may have. Sincerely S an Yj Sawy er, REHS/RS Public Health Director I Encl: list of licensed septic system installers Cc: C layton Morin, Engineering& Surveying Services I I i i Apr 27 06 12: 30p John Why.man 7813344330 p. 2 �I p 1 4&L a W�iCv� atQFe. f RT.+2S "�� o S+7 , V��T� Com.I 1 �/ T�O+v� PQ�a►l �[ � S �--P_�-^.� d'Y` �L WL Cil �j •� ( 1 "� `I�Q. 1 �14Aj �"V 1 ti` y y Apr 27 06; 12: 30p John Whyman 7813344330 p. 1 Permission is hereby given for arty employee,Al l lall'rey, to sign any and all documents relative and pertaining to the daily operation of J. WhymaVhyman, J On this = 1 1-14ay or 20_ before mc, the undersigned notary public,personally appeared (name ofdocunient signer),proved to me through satisfactory evidence of identificafion,which were c . to be the person whose name is signed on the preceding or attached document in my presence. CC. ht (i n � l.Cf ),IR � My commi -cion expires CYNTHIA A. DEMATTEO I> NototV Public 11 COMMONWEALTH OF MASSACHUSETTS My comminw,Ewret January 05.2010 i w ACTIVITY REPORT i TIME 04/2712006 12:58 NAME HEALTH FAX 9786888476 TEL 9786888476 SER.# 000B4J120960 NO. DATE TIME FAX N0./NAME DURATION PAGE(S) RESULT COMMENT 04107 15:10 9788375065 39 01 OK RX ECM 04110 09:16 6177133410 23 02 OK RX ECM 04110 10:11 02:27 04 OK RX ECM #438 04110 10:24 89788518547 22 01 OK TX ECM #439 04110 14:44 89782582682 14 01 OK TX ECM #440 04110 15:17 817812467596 26 02 OK TX ECM 04110 17:17 9782583466 37 02 OK RX ECM 04111 10:46 14 01 OK RX ECM 0411'2 08:04 30 00 NG RX 0441 04112 14:52 816179836363 31 02 OK TX ECM 04113 09:07 800 350 0566 19 01 OK RX ECM #442 04113 10:47 819787710019 00 00 BUSY TX #443 04113 14:26 819787710019 00 00 BUSY TX #444 04113 16:38 819787710019 00 00 BUSY TX #445 04114 10:03 819786238320 36 01 OK TX ECM #446 04114 10:04 819786238320 31 01 OK TX ECM 04114 10:35 9786818952 19 01 OK RX ECM #447 041;14 12:01 819787830019 05:22 10 OK TX ECM #448 04114 14:29 89784703670 11:00 04 OK TX 04117 09:55 978 688 9603 41 04 OK RX ECM 04117 15:27 78 383 0108 57 04 OK RX ECM #449 04/17 20:37 819784091269 44 03 OK TX #450 04/17 20:53 819784753555 00 00 BUSY TX #451 04/17 20:58 819784753555 00 00 BUSY TX #452 04118 12:28 89784096122 13 01 OK TX ECM 04/19 11:20 18 01 OK RX ECM #454 04/19 15:22 819784751448 01:04 02 OK TX ECM 04/20 08:44 17 01 OK RX ECM #455 04/20 14:41 819784751448 01:07 02 OK TX ECM 04/20 16:12 978 725 8181 01:08 04 OK RX ECM #456 04/21 08:34 816172467696 34 03 OK TX ECM 04/21 08:40 2 14 01 OK RX ECM #457 04/21 08:46 819786826660 22 01 OK TX ECM #458 04/21 09:17 819784751448 01:05 02 OK TX ECM #459 04/21 12:26 819786888344 40 01 OK TX ECM 04/21 14:28 9786677846 24 01 OK RX ECM #460 04/24 09:53 819784091269 44 02 OK TX 04/24 10:41 30 00 NG RX #461 04/24 10:48 89782582682 22 02 OK TX ECM 04124 10:53 14 01 OK RX ECM #462 04/24 14:02 816038947067 28 03 OK TX ECM #463 04/24 14:45 89786898051 53 03 OK TX ECM #464 04124 16:08 818884868823 22 01 OK TX ECM E 04/25 11:16 28 02 OK RX ECM 04/25 11:41 15 01 OK RX ECM 04/25 12:40 9783276827 42 02 OK RX ECM 04/26 09:10 14 01 OK RX ECM 04/27 10:50 7813344330 01:43 00 NG RX ECM 04127 12:54 7813344330 01:43 00 NG RX ECM 04/27 12:56 7813344330 01:43 02 OK RX ECM BUSY: BUSY/NO RESPONSE NG POOR LINE CONDITION ! OUT OF MEMORY CV COVERPAGE POL POLLING RET RETRIEVAL PC PC-FAX i .a Engineering & Surveying Services 70 Bailey's Court Haverhill Ma 01832 (978) 556-0284 i April 3,2006 _ To: Susan Y. Sawyer Public Health Director APR 0 3 2006 RE:15 Crossbow Lane TON HDEPARTMENT O NNDOVeR Dear Susan The design plan has been revised as follows j . The proposed trenches have been revised to a 10' spacing. ,--"'2-. The existing 1,500 gallon septic tank is not monolithic. That is why it weighs less than the proposed 1,000 gallon pump chamber.If the existing septic tank does not pass inspection, a monolithic septic tank is proposed. (See attached) �3. Grading has been revised. L,,,-4. A 40mil HDPE Barrier has been added at the edge of sand fill to eliminate a potential break out problem if Ingalls Road is widened Thank you for your attention in this matter. I Sincerely, - I Greg Saab Engineering& Surveying Services TOWN OF NORTH ANDOVER OfrJce of COMMUNITY DEVELOPMENT AND SERVICES � p HEALTH DEPARTMENT 400 OSGOOD STREET 221-4 Tfe NORTH ANDOVER, MI ASSACHUSETTS 01845 sccxdec 978.688.9540—Phone Susan Y.sawyer,REHS/.RS 978.688.8476—FAX v m Public R ealtlr,Director E-MAIL:h�ealthde to, wnofnorthando er,co WEBSIT>r http•//wmy townofnorthandover.corn March 27,2006 Claylob A.Morin,P.E. Engineering&Surveving Services 7013ailey Court Haverhill,MA.01832 Re:Proposed Subsurface Sewage 1?ist7osal S sty em plan for 5 Crossbow Lane Ma 1068.1rot 213 Dear Mr. Morin: The proposed wastewat.e}•system design plans for the above site dated February 15,2006 and received on February 17,2006 hss been reviewed. Unfortunately,they cannot be approved until the folio,ing items are corrected. ire specific section in Title 5: 31.0 CMR 15.000,or North Andover regulation that is not met by this design follows each. it.em. 1. The trench spacitrg is not 1.0' apart per North Andover Local requirements for spacing of trenches in fill (NA i4,01) 2. Please verify buoyancy calculations for the pump chamber ar,.d the septic tF?rk. Calculations show that: /2 tl�e 1,000 gallon pump chamber�oeislis 111017e.than a 1,500 gallon septic tank. 3. Given that this is a trench configuration,using the bottom of the trench i.s not reasonable for breakout determination, The loading for a trench.assumes a sidewall allowance of V and so breakout should be 0.67'above the bottom of the trench. 4. It is not clear that grading for the purposes of the soil absorption system can or should.be placed inside the existing roadway widening easement. In the event the rights in this easement are exercised it may impair the ability of the soil absorption system to properly function. Please clarifi,this matter wifh additional information or system re-design. Additionally,you mi.gh t wish to consider using an effluent filter in the primary(septic)tank and increasing the dosing rate to two or more doses per day. Please feel free to contact the office with any questi.ms you may have. We Look forward to working with you to obtain a wastewater treatment and dispersal,system which will be in compliance with all regulations and assure protection of public health and the environment of.North Andover. Sincere , Sus n.Y.Sawyer,REHS/.RS Public Health Director ca: File ➢ Homeowner tkism d 2/t7100 2:24 AM I l 10'-6" IfI -!=_i----------—-------—--------------------T--------------------- 20" DIA CLEANOUT COVER 3 PLACES 's ' t � t 5'-8" t I i i i T l PLAN VIEW 1" TAPER 4" TOP (6" H-20) PLASTIC PIPE SEALF �• �•' • - .� , : .. a PLASTIC 4" DIA, PIPE SEAL INLET ' -` 4" DIA OUTLET LIQUID LEVEL ��; l f: .::n p.. %, : L c" iA m SEE NOTE 5 4._4" I 3" 4" WEIGHT SECTION VIEW ITEM NO. TK-1500 STANDARD 11,670 TK-1500 H-20 13,135# TK-15002C STANDARD 12,930 NOTES: TK-15002CH H-20 14,395# 1; CONCRETE: 4.000 PSI MINIMUM AFTER 28 DAYS. 2. DESIGN CONFORMS WITH 310 CMR 15.00, DEP �A TITLE 5 REGS, FOR SEPTIC TANKS. tEW T ,t�T3. ALL REINFORCEMENT PER ASTM C1227-93. EN�iLtilvD 4 4. BAFFLE WALL OPTIONAL FOR TWO COMPARTMENT TANKS. CONCRETE PRODUCTS INC. S. TEES AND GAS BAFFLE SOLD SEPARATELY. SEPTIC TAN K 6. TONGUE & GROOVE JOINT SEALED WITH BUTYLE RESIN. 1500 GALLON 7. ALSO AVAILABLE IN H-20 LOADING. WILMINGTON, MA (978) 658-2645 -- AMESBURY, MA (978) 388-1509 PAGE 81.4 NOTTINGHAM, NH (603) 942-5668 F.A"OwAf" t 1 00 9:40 AM - J 1 ! --1 I --------------------------------- - 24" DIA � i ACCESS COVERS i 5'-0" t , , 1 L---�1_- ---------- ---------------- ----------- ----------- T_�-----J PLASTIC PIPE SEAL TOP VIEW 4' DIA INLET 6" (OPTIONAL 10" TOP FOR BUOYANCY PLASTIC _ PIPE SEAL Sn4" DIA OUTLET 5'-10" 5,-5„ ;. r 5" 2 � SECTION VIEW TAPER WEIGHT: BOTTOM = 1`1,250# 10" TOP = '5,960## 6" TOP = '3.575 ITEM NO. PC1000 STANDARD (6" TOP) PC1000H H-20 (6" TOP) PC1000HT10 H-20 (10 TOP) NOTES: 1. ;CONCRETE: 4,000 PSI MINIMUM AFTER 28 DAYS. 2. i DESIGN CONFORMS WITH 310 CMR 15.000 S d DEP TITLE 5 REGS, FOR PUMP CHAMBERS. jvEW ENGLAND 3. ALL REINFORCEMENT PER ASTM C1227-93. CONCRETE PRODUCTS INC. 4. ALSO AVAILABLE IN H-20 LOADING. 5.I JOINT SEALED WITH BUTYL RESIN. PUMP CHAMBER MONOLITHIC 6. PUMPS AND ACCESSORIES OPTIONAL. OOO GALLON WILMINGTON, MA (978) 658-2645 -- AMESBURY, MA (978) 388-1509 PAGE 12. 1 NOTTINGHAM, NH (603) 942-5668 W 1 i !,f I Infiltrator Modified Certification for General Use Page 5 of 8 Table 4.Effective Leaching Area for Bed or Field Configuration Effective Model Leaching' Area SFILF ualizer 24 2.08 Quick4 Equalizer 24 2.23 Equalizer 36 3.05 Quick4 Equalizer 36 3.05 Standard Chamber 4.72 Quick4 Standard 4.72 Infiltrator 3050 or 4.25 StormTech SC-740 High Capacity Chamber 4.72 Quick4 High Capacity 4.72 1. Effective Leaching area is equal to 1.67 times bottom width only. 2. Effective leaching area for Infiltrator 3050 or StormTech SC-740 is equal to 1.0 times the bottom width. 10. The System, when installed in a bed or field configuration without aggregate on remedial sites, shall utilize the effective leaching areas presented in Table 4 above or additional reductions in soil absorption system area approved by the approving authority in accordance with 310 CMR 15.284. In no instance shall the reduction in the soil absorption system area required in 310 CMR 15.242 exceed the maximum reduction allowed for alternative systems approved in accordance with 310 CMR 15.284. 11. The System, when installed as specified in 310 CMR 15.253: Pits, Galleries, or Chambers, shall have an aggregate base and/or be surrounded by aggregate and shall be sized as specified in 310 CMR 15.253 (1) (a)and(b). Effective depth can be increased up to two feet with the corresponding addition of up to 14 inches of base aggregate. Bottom width can be increased by two to eight SF/LF with the corresponding addition of one to four feet of aggregate per side. 12 When the System is installed as specified in 310 CMR 15.255: Construction in Fill, the finished 15 foot horizontal separation distance, item (2), shall be !f measured from the bottom outside edge of the chamber. IlI. General Conditions 1. The=provisions of 310 CMR 15.000 are applicable to the use of the System,except those that specifically have been varied by the terms of this Certification. 2. The facility served by the System, and the System itself, shall be open to inspection and sampling by the Department and the local approving authority at. all reasonable times. Page 1 of 1 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Thursday, February 02, 2006 9:44 AM To: 'Jan Leonard' Subject: RE: septic system Importance: High Hello, I have not received any septic plans for this address yet. Soil tests were done on 11/8/05. It appears that Greg Saab was the Soil Evaluator. I have not received his soil evaluator submission sheets yet, and no plans. Please contact Greg Saab to see where he is at with this. Once we receive the plans, we have 45 days to review them. The septic season is closed until March 1 st, or weather depending, so for a full system replacement, the actual III construction would not happen till after that time. Please see our approved septic system installer list on our website: www,townofnorthandover.com-town offices-community development-health - upper left box-forms and regulations-see section under septic. Call me regarding the installer list. 978.688.9540. [Dellechiaie, Pamela] -----Original Message----- From: Jan Leonard [mailto:jicleonard@comcast.net] Sent: Wednesday, February 01, 2006 3:50 PM To: DelleChiaie, Pamela Subject: Re: septic system Hi Pam, have you heard from my engineer in the past week? thanks. Jan Leonard 5 Crossbow Lane -----Original Message----- From: DelleChiaie, Pamela To: Jan Leonard Sent: Wednesday, January 25, 2006 1:02 PM Subject: RE: septic system Your engineer submitted a soil test application, and soil testing was completed back in October. I have not received anything else to date, such as a septic plan for review. Please contact your engineer and ask him what the status is. i -----Original Message----- From: Jan Leonard [mailto:jlcleonard@comcast.net] Sent: Tuesday, January 24, 2006 8:07 PM To: DelleChiaie, Pamela Subject: septic system My name is Jan Leonard, 5 Crossbow Lane. I am working with Jon Wyman Construction to fix my septic system. Has it come befoe the board and what were the results? Thanks for your help. . i 2/2/2006 r 4 TOWN OF NORTH ANDOVER NORTH Office of COMMUNITY DEVELOPMENT AND SERVICES o?•`>� °°A HEALTH DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER,MASSACHUSETTS 01845 CMusct 978.688.9540—Phone Susan Y.Sawyer,REHS/RS 978.688.8476—FAX Public Health Director E-MAIL:healthdept c(iltownofnorthandover.com WEBSITE:http://www.townofnorthandover.com March 27,2006 Clayton A.Morin,P.E. Engineering&Surveying Services .70 Bailey Court Haverhill,MA 01832 Re:Proposed Subsurface Sewage Disposal System plan for 5 Crossbow Lane,Map 106B,Lot 213 Dear Mr.Morin: The proposed wastewater system design plans for the above site dated February 15,2006 and received on February 17,2006 has been reviewed. Unfortunately,they cannot be approved until the following items are corrected. The specific section in Title 5:310 CMR 15.000,or North Andover regulation that is not met by this design follows each item. 1. The trench spacing is not 10' apart per North Andover Local requirements for spacing of trenches in fill. (NA 14.01) 2. Please verify buoyancy calculations for the pump chamber and the septic tank. Calculations.show that the 1,000 gallon pump chamber weighs more than a 1,500 gallon septic tank. 3. Given that this is a trench configuration,using the bottom of the trench is not reasonable for breakout determination. The loading for a trench assumes a sidewall allowance of 8"and so breakout should be 0.67' above the bottom of the trench. 4. It is not clear that gading for the purposes of the soil absorption system can or should be placed inside the existing roadway widening easement. In the event the rights in this easement are exercised it may impair the ability of the soil absorption system to properly function. Please clarify this matter with additional information or system re-design. Additionally,you might wish to consider using an effluent filter in the primary(septic)tank and increasing the dosing rate to two or more doses per day. Please,feel free to contact the office with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincere , Sus n Y. Sawyer,REHS/RS Public Health Director cc: ➢ File ➢ Homeowner I Page 1 of 2 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Tuesday, February 21, 2006 9:34 AM To: 'Jan Leonard' Subject: 5 Crossbow Lane-Septic System Importance: High Yes�-a plan was dropped off by one of Jon Whyman's workers. Please note that all items relating to soil testing, and plans should be handled by the engineer you have contracted with - Engineering &Surveying Services, 70 Bailey Court, Haverhill, MA 01832 -978.556.0284, Attn: Clayton Morin; drawing completed by Greg Saab. Just1so you know, Whyman submitted an incorrect application, with incorrect information, and I had to request him to resend the correct application (Still with wrong information -Pam Learned was listed as the homeowner). Perhaps it would be better to have the engineer handle everything until the plan has been approved and ready for installation? As I understand it, Whyman is the installer you hired, but he should not really be involved in the process at this point. In any case, I have submitted the plan to our consultant, who has 45 days to review it. However,we do usually get them back sooner than that time frame. Sometimes there are issues that need to be resolved, and the engineer must submit a revised septic plan. That process would only take a week or so. You, and the engineer will be notified directly of a plan approval or disapproval. I'm not sure what else has been told to you at this point, so please let me know if you have any further questions. Pamela -----Original Message----- From: Jan Leonard [mailto:jlcleonard@comcast.net] Sent: Friday, February 17, 2006 9:52 PM To: DelleChiaie, Pamela Subject: Re: septic system Hi Pam, did you receive plans on Friday 2/17/06? thanks. Jan Leonard 5 Crossbow Lane -----Original Message----- From: DelleChiaie Pamela. To: JanLeonard Sent: Wednesday, January 25, 2006 1:02 PM Subject: RE: septic system Your engineer submitted a soil test application, and soil testing was completed back in October. I have not received anything else to date, such as a septic plan for review. Please contact your engineer and ask him what the status is. -----Original Message----- From: Jan Leonard [mailto:jlcleonard@comcast.net] Sent: Tuesday, January 24, 2006 8:07 PM To: DelleChiaie, Pamela Subject: septic system 2/21/2006 Page 2 of 2 My name is Jan Leonard, 5 Crossbow Lane. I am working with Jon Wyman Construction to fix my septic system. Has it come befoe the board and. what were the results? Thanks for your help. G i i i i 2/21/2006 Town of North Andover ' Health Department, Date: a, Location: (Indicate Address, if Residential,or Name of Business) Check#: /L/ 0 Type of Permit or License:(Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service-Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal(Septic)Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: ❑ Septic-,Soil Testing $ 0-'Septic-Design Approval $ G �. ❑ Septic Disposal Works Construction(DWC)$ ❑ Septic Disposal Works Installers(DWI) $ ➢ Sun tanning $ ➢ Swimming Pool $ ➢ Tobacco $ ➢ Tras4lSolid Waste Hauler $ ➢ Well Construction $ ➢ OTHER:(Indicate) Health Agent Initials v White-Applicant Yellow-Health Pink-Treasurer Feb 17 06 01 : 36p John Wh�jman 7813344330 p. 1 y IN j S � I SEPTIC PLAN SUBMITTAL FORM Datc of Submission:_.. " - .,� — Site Location.—, New Plans? Yes-/$225/Plan Check# r(inclndes 1'` submission and one re-- review only) Revised Plans?Ycs_..`$75/Plan Check# .T S��hit t)"n 'Site Evaluation Forms Included? Yes No., Local Upgrade Form Included'? Yes. No _.. Telephone#:._ �, .: .. �i ,_l;ax#: Homeowner Name:..:. Q'FFIC.F,Kff QNL Whenthe submission is complete(including;check): __✓ Date stamp plans and letter y► _ '� _Complete and attach Receipt Copy File;Forward to Consultant f Enter on Log Sheet and Database • Date No.,. Crnonwealth of Massachusetts ✓+� ,� e , Massachusetts Site Suitability Acsacsment for Ori-site Sewage j2isposal Certification Number: __.... . Performed By: ...... e--~......�_� 1........ �. ._..~_............................ ~.. . _._ vrltrieswi By: Loaaaen Address or Lot No. owroar•s Name.AAdrsss and Ts1. s 5 C 2oSS New Construction ❑ Repair Lam' Qffice Review Futillshed Soil Sur,.!Vy Available: No ❑ Yes . ear Published �`� t Publication Scgle .... . ...... Soli map Unit . Soil Limitations ..... :..........1 -r.. ` U-........ .._.._....__......,......-_._....�.............. O'rainage Class ........ .. ❑ Surficial,Geologic Report Available: No L Yes Year Published Publication Scate Material (Ma Unit) ... — Geologic M p Landform . Flood Insurance Rate Map: Above 500 year flood boundary No ❑,/ Yes 500 year flood boundary No LJ Yes ❑ . Within, Y ,...,,/ Within 100 year flood boundary No Lel Yes Wetland Area: Ma (ma unit) . ......__......_....__...............�.. National Wetland inventory P p ~-~ ~ """"-"'"- Wetl ' Wetlands Conservancy Program Map map unit) . •��• ••� �•� ' Current Water Resource Conditions (USGS): Monte Range : Above Normal ❑ Normal Below Normal ❑ Other References Reviewed: ...... • . ' � r.y.;:`7?'"",Y��:�a �^�"a.•3� k ,w'"^w'ff ' "`'.""'a.'+P','�t* t'i.+i1Y"" :q,"A,r. W. �ia•r ,n.,i ,� N'"; 'r. w. r +d,�.,w ,^';--� -._ 3se-N x& q'S 31 q". r. +..:,t�,.� a + a ..L r '7 "t; i.. •:Y.«k la �ti., `� '*r • FORh1 11 SOIL EVALUATOR FORA1 Wr e - 7M S �.f ♦ :7 i f i:'.4i �' {.` G K!A ai4 Yr ,'• ,� : �, ,� ,�� �,f� Pagc�2�of 3 �w Location Address or Loi No. d �D On-site Review Deep Hole Number Date:..I I•l(•4b5 Time: -I ' Weather Location (identify on site plan) �_.�. . . �.. . .�... ,. v ... Land Use p�,xn�C '-�S • • Slope M A -50%0 Surface Stones . . Vegetation .( .r...G•r5 .`j v.,.... . . ,. .. . ...._ . . . .. Landform _.. Position on landscape (sketch on the back) . •:.. Distances from: Body Open Water Bod 'j,DD°(' feet Drainage way /d . feet P - Possible Wet Area 1�7p t feet Property Line .... feet Drinking Water Well 'LoD i�- feet Other _..�...._... DEEP OBSERVATION HOLE LOG Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (Inches) (USDA/ (Munsell) Mottling (Structure,Stones,BouldGraveers, Consistency, % P II � rbf�5.�� • moo, MINIMUM 0174 r%VLr-O nr-'.AIJI Parent Material(geologic) J Nf) OepthtoBedrocic: Depth to Groundwater: Standing Water in the Hole: 1r Weeping from Pit Face: �02 Estimated Seasonal High Ground Water: i DEP APPROVED FORM-12/07/95 i A ata-.•'�. d; # „' 5 r ;_1" ` ',`4"4'Ti"rp°err.., '$'••.•,:.: ,^ ;� f FORM 11 SOILk"EVALUATOR•H'ORNi I r " f kx w43:. Y rye tr„t,; Pagc'2 of Location Address or Lot i�io. 5. !c�5 5 �cxAv On-site Review �a Deep Hole Number . ,.N .. Date:.C (.v(••r Time: 43 U Weather Location (identify on site plan) Land Use _(J .�'-L�i"`� Slope M 2-9fo Surface Stones . . Vegetation ti landform ... ,.... Position on landscape (sketch on the back) Distances from: Open Water Body 2COt feet Drainage way !cw feet Possible Wet Area -Zp.D-i" feet Property Line ���. - feet Drinking Water Well .-ZP6.1'" feet Other DEEP OBSERVATION HOLE LOG* Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(Inches) (USDA) (Munsell) Mottling (Structure,Stones,Goulledlrs,Consistency, % 2 2,� F� 1k l°ft-312 0 Li L10. 23_Y 3 -7,J_y,e Parent Material(geologic) '�7 gt_)J DepthtoBedrock- from Pit Face: Death to Groundwater: Standing Water in the Hole: g� f Weeping p g /y rf Estimated Seasonal High Ground Water: I DEP APPROVED FORA!-12/07/95 .f FORM 1 I - SOIL. L•VALUATOR hO J Page 3 of g=l L,ocatiiott Address or Lot No. 5 � r^� -S Det rjttitr trot ,dor , ea ojtcrl Ali �r a e �'• . . e taod t�sed,� . ❑ Depth observed standing in observation hdle inches ❑ pth weeping from side of observation'hole inches P g c es r—v� " h �_ .. �.. depth to soil mottles `�Ce inches �6> 'Y' 1 ❑ Ground water adjustment ... ......... feet y Index Well Number . ............. . Reading Date ... . ....... Index well levet .. . ..... .. Ad' =• �usti-rlent factor .... .... Adjusted ground water level NpLuralO,,rtr.ring• perviops Material Does at least four feet of naturally occurring pervious material exist in all areal observed throughout the area proposed for the soil absorption system? � If not, what is the depth of naturally occurring pervious material? `': - ..,�. .3 : ` rtifica��n I certify that on (date) 1 have passed the soil evaluator exaMinatiob. approved by the tment of Environmental Protection and that the above 6nalysls. was performed by me consistent with the required training, expertise and experlehce described in 310 CMR 15.017. Signature _ ate V1 1• °��' i1 w.. - : �: DEP AS'rF:OVED FORM 11:07,95 a r�.�a z�i e-� , 't�7i �" 'k' �•�+ ws ���.,� kzv% � K�r �'� x�r. r s. v yi .rC+h �°vv^;°.v � _.s+*,i;w �: Tq Mt,3r1 m7�.._ ^'•raeYw�r e s ".•." :. k �.y, n t � 111 ka't '�}T•� . +''f °•r € `y�`�C� v �g;'S�F•�. ��Te .r y, k �'�..? fi af.. � i...*.., t. :r�r as �� ,y q,.4 .�}`4 �-�ya{6��{.�� `.+.c �Y iffy 4.^�N-x�'�{�a' .�s �k'°k„� °S3�tir >4 w i ,°�dic yrsf,�f1 �a T .y `}� f� °S° y. �°..�. i• "'a 4k f� ,`�y 4+.a ~ 1.,���•�x .i ��1",�3!.. �'.�' .'�k•S T ,�• "`^;Ji�'r �f•3 ''Pr�'� to T..v .,f' 4'" ,11'.Vrr tw,x r•.. r,yj. .:f � a'[•{��`^�•}�+�. �2.. �t yt '�'"�f .l.,S''' �N 4 r�*y., •s "an, 'c's r{`y l:`r :f, t f =<•,r, «S, k t. -r.T t. r�. { S v :.i .►•` ,•� ;�.. sat. �. „r- �' 4R"ii L - RCQLA,TION . . ' Gocatio'' Addrass.or. Lot No. COMMONWEALTH OF TVIASSACf,,'US TS � ET Ado P� Massac:iuSe P�COIadoia Test I Oeste: ` , ;j irme- Abse vaticr, t;ole.,� Ceram,lof . dart Fire-soak End PreL-sa- l���v� 1 Tame at 12" I J --fi--- -FL me at °" -- 3 I T ime a Ei- REM Mjil-Anch : NUITanzirn of Lperc�tatiori Dist must be erf reserve area_ P orm>`d ;n both If:c primary area AND Site Passed ., ate wed ❑ 4 Pert armed By: G--�- > Whnessed Sr4 Comments: �'� I Page 1 of 1 i 1 ' DelleChiaie, Pamela From Sawyer, Susan Sent:l Monday, October 17, 2005 4:35 PM To: Lisa LeVasseur Cc: Del iaie, Pamela Subject: RE-17rossbow Lane I just got a call from Ben Osgood about 6 Crossbow. Wrong engineer. It is not NEES. Please check with Pam or refer to the application if Pam sent you one. I think it is Barbagallo and Wyman. Susan --'--Original Message----- From: Lisa LeVasseur [mailto:lisal@millriverconsulting.com] Sent: Monday, October 17, 2005 1:29 PM To: rburley@adelphia.net Cc: Sawyer, Susan; amcbrearty@millriverconsulting.com; DelleChiaie, Pamela; dano@millriverconsulting.com Subject: 6 Crossbow Lane Has been moved from Wednesday, 10-26 to Tuesday, November 8. same time. Lisa LeVasseur Mill River Consulting Your Complete Source for Onsite Wastewater Management 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 WWW.m_illriverconsulting.com i i I i 10/18/2005 Page 1 of 1 ' ` 1 i T DelleChiaie, Pamela r From: Lisa LeVasseur[lisal@miliriverconsulting.com] Sent: Monday, October 17, 2005 1:29 PM To: rburley@adelphia.net Cc: Sawyer, Susan; amcbrearty@millriverconsulting.com; DelleChiaie, Pamela; dano@millriverconsulting.com Subject: 6 Crossbow Lane Has been,moved from Wednesday, 10-26 to Tuesday, November 8. same time. Lisa LeVasseur Mill River Consulting Your Complete Source for Onsite Wastewater Management 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsulting.com 10/18/2005 Page 1 of 1 t DelleChiaie, Pamela From: Lisa LeVasseur[lisal@millriverconsulting.com] Sent: Friday, October 14, 2005 12:47 PM To: Sawyer, Susan; amcbrearty@millriverconsulting.com; DelleChiaie, Pamela; dano@millriverconsulting.com Subject: 6,Crossbow Lane Can you tell it's Friday?????? Soil test for 6 Crossbow Lane is confirmed with JOHN WHYMAN for Wednesday, October 26 at 9:30. Lisa LeVasseur Mill River Consulting Your Complete Source for Onsite NIastewater Management 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriv erconsulting.com I� I i i 10/14/2005 .._ // f j � �✓ V 4_�...�-_..-> L__ 1 i "� _J"_" - - - ._ Page 1 of 1 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent:I Friday, October 14, 2005 12:28 PM To: 'Lisa LeVasseur' Cc: Sawyer, Susan; Grant, Michele Subject: RE: Crossbow Lane Hi Lisa, This is the one from Jon Whyman. His assistant, Al Halfrey has called 2x today about this. Please do not bend your schedule if it is inconvenient for you. Just ask them when they are available, and schedule with your people accordingly. Jon is one who does not follow the rules and procedures, so don't let him hassle you in any way. They did not indicate an engineer on their original application (TBD), but I hear that they have hired Joe Barbagallo. However, per AI's message, please call Jon Whyman at 781.334.2323 to confirm everything. Thanks!! Susan & Michele-FYI only -----Original Message----- From: Lisa LeVasseur [mailto:lisal@millriverconsulting.com] Sent: Friday, October 14, 2005 11:09 AM To: DelleChiaie, Pamela Subject: 6 Crossbow Lane Hi Pam, I emailed you last week that I'm waiting for confirmation from Randy but it's tentatively scheduled for 10-20. Thanks! Lisa Lisa LeVasseur Mill River Consulting Your Complete Source for Onsite Wastewater Management 2 Blackburn Center Gloucester, MA 01930-2259 978-282-0014 or 1-800-377-3044 fax: 978-282-0012 www.millriverconsultinR.com I i 10/14/2005 Town o.'t North Andover Q� Heaf6 Department Date: Location: (Indicate A l ress,if Residential,or Name of Business) Check#: Type of Permit or License: (Circle) ➢ Animal $ ➢ Dumpster $ ➢ Food Service-Type: $ ➢ Funeral Directors $ ➢ Massage Establishment $ ➢ Massage Practice $ ➢ Offal(Septic)Hauler $ ➢ Recreational Camp $ ➢ SEPTIC PERMITS: 6— Septic-Soil Testing $ � ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC)$ ❑ Septic Disposal Works Installers(DWI) $ ➢ Sun tanning $ ➢ Swimming Pool /L'��'' $ ➢ Tobacco ➢ TrasWSolid Waste Hauler $ ➢ Well Construction $ OTHER:(Indicate) Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer LETTER OF TRANSMITTAL NORTH North Andover Health Department pE s�.o • X1,1, 400 Osgood Street �? �!` +_ '�`'• 00 North Andover, MA 01845 �o ••~•' p 978.688.9540- Phone - - .._. __ i � C '" •" 978.688.8476 - Fax �1 AoA� healthdept(atownofnorthandover.com - E-mail T�o 1SSA�Nt15t� www.townofnorthandover.com - Website Page / of TO: DATE: � Daniel Ottenheimer COMPANY: FROM:Pamel DelleChiaie,`Health Dept. Assistant Mill River Consulting 1 RE: Phone: 1.800.377.3044 or 978.282.0014 Fax: 978.282.0012 We, are sending you: oil Test OPlans or Review OOtherill in below) These are transmitted as checked below: 0For Review and comment OAs Requested OAs Required OFor Your Use REMARKS: COPY TO: COP TO: COPY TO: SIGNED: IvVo L;cok V� C . XL as �u ala �u�k� srt tp N�C,c • • k, . • 'sv{V, t,✓� i�`wiT i t��yaJ V I`* ��i.� s. J"�, .,�,1�r ^� �a 1 L^/r s. t..fes` ��l . r i f 'r �� �6. '�-� � ��in' t � t _ •� �'�',l�li�,�1, t;{ �t.� 'i 1�,}„�� 7i �i ��.���1��.�„ �'.y,..�,. � ��1 ' flu _ r p...s � .� � ,, M; ` '/ � 1`�'�I',F '�../;i �'�/�` !\+���y J321 �� � ��./'�',! V`��{,r.4''���'a.\����.i,� rN�.o fhb �����,, . l .. � J } i I TRANSMISSION VERIFICATION REPORT TIME 10/06/2005 14:18 NAME HEALTH FAX 9786888476 TEL 9786888476 SER.# 000B4J120960 DATE DIME 10/06 14: 14 FAX NO./NAME 819782820012 DURATION 00:00:59 PAGE(S) 03 RESULT OK MODE STANDARD ECM I, i t TOWN OF NORTH ANDOVER °f NORTH , Office of COMMUNITY DEVELOPMENT AND SERVICES o?°�� 6 HEALTH DEPARTMENT t 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 �'sS�nHus Susan V.Sawyer, REHS, RS 978.688.9540—Phone Public Health Director 978.688.8476—FAX healthdeptc townofnorthandover.com www.townofnorthandover.coni APPLICATIO FO SOIL TESTS DATE: VO MAP&PARCEL: LOCATION OF SOIL TESTS: C.." O.S'.P l0 OWNER: O/y Contact#: •33xI0zcy" APPLICANT: 111dye Contact#: ADDRESS: 1 Q �� ENGINEER: 0,e Contact#: CERTIFIED SOIL EVALUATOR: Intended Use of Land: Residential Subdivision Single Family Home Commercial Is This: Repair Testing: L'10e Undeveloped Lot Testing: Upgrade for Addition: In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM rl 1 1 ➢ Proof of land ownership(Tax bill,or letter from owner permitting test) > .5"x 11"Plot plan&Location of Testing lease indicate test it sites on the lan) Fee of$425.00 per lot for new construction. This covers a minimu two deep holes and two percolation tests required for each disposal area. Fee $360.00 pe lot for repairs or uperades. GENERALINFOR ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. �11 payment will be required for all additional tests within two weeks oftesting.Z> F Withm 4�da s of to—f stin ,a scare an nos o sma erli—tl-ian T - ' shall be submitted t�the oard of Health Y g cTpl�— _ e location of alt tests(includin aborted tests . ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line , N.A. Conservation Commission Approv ate:_ h Signature of Conservation Agent: Date back to Health Department: (stamp in): (-3V LA) L11-612rrv, W+0lK a[s Sfi t,.'xtll, ova l oc)'V iVtAU v�.ccel Fi f� lCDa4 o K AJ 0l W/" N�"�— Oct 06 05 12: 45p John Whyman 7813344330 p. 1 luct UU u6 n9:03a ` 979-Gn3-6023 p_3 MAR-93-99 00:54 AM 9 K 9URvt1r• seat^�a405 n_a2 Y MORTGAGE PLOT FLAN EK SURVEY INC. ��'� a fro PIC R TGACOR MAO � DEEB RER yk PC. al r. A RE0 OF PRINCIFLZ BUILDING PLAN REF, r�A dig DAlt Ory NpPEC7l0N AW Z3 Z , 4' wry � h`a SKS � ti 3 ! r 5��43 1 i f N01L Thu map*avan on PMWpryd � 1 FJRTMFJt SA,79'MAT IM MY PRCF99I0FIAI maK tCdly for Oedp putyowll and A not to OPINION bM pr apes v vvWn/r and aamiory beM.d upe�N bs n a 14�y1 6!(AatVEY oodotr Vpi� outD44d tlgk " ani ra ant im mn iauenfh q, MA y imar4o a' X�ae.00 ""Ing�m�with ths Cpl ORO lam+A no Oma r6domrtb rMA t q•tl+�M a to 6414 martpaw. AC It of mo)w lnpravwlanQ 6ltRar troy oarva6 canACAnaN Net A ww"Ifh«Ntaapt a �4o.n. AGE AlSOCT•ATRS INC. 1. PMPettlr fA eat In o F166d H-UM Ar 1hh" ois t6 4od aeon the Ma�la can o1 0"WI n Preperq u h e fiaad Ncwd ArM of athoh, and On not r morWWt a pr a+ty t>hwlapa a I�farmotlen h lnxMdw*to�►Metripf6 Rood Ham-d, 0(tNU shown not to bo omd far the 6,Wblltihrl6nt p} F:aat 1�emdrd detolwrl�.4 ttOfN kltyt F-4" rlow Ar�Y Imo, I In6utaRp Rdto M§p P&Mj I t r tlIL - {. SEE PLAT NO.-105D RA 4.•105DRA :I L '- -sc+, f' n '' :>``` -, �' '�' • N .y c�!�l •1t � .�', - �sa ti 'r■ t'it�• •�jo�'r.�Gb+U s b ♦�°4��i K ,(It r' ac c� �-Fs -� -�!°t c �. JF 1 Srl��, i Ra*+►+�ri ;•''gyp; �ti° 0 y� - t =: � , p�. '! � tit �E' QKI� �■�. �wa"►.■ >� ('1 .S� � s. +t[' .•i y� e: qy s;7 ' ; , r�. rr9 ey ri g •r �L+L'� _ '�•L=•�'+, �ysa i t s• �N s .ti3 ' + 1 3. It ►�l. Cd a'�a`o° ■ °�' . Dx +, ^ w F T•• q Z 0 *� 7F. + e{' s �!� tYs. kit&ti f e++>YN. f�a. ►S" +a . r $ 1 3 • I K►�-r o a s ate' ) O �J �' 4� 2 1� {� ti0 �Q :19 ?aaG. tee Mti „)5+as O VF J IPA owD A. S•YY J53 . n c U�j a >;. li�ir .aJ.r ► R 4, _�'f / ! F a! }b }4� �*] (y i °a y1., s R `•c 1i ��� mf�a L! 9 1• tT �•� ( AUN J. ) �+4.� tt. O '`_ ios ata i.0 �� r Ye ��• * �jSt'�0. S- b ': ��i,S3 yDRaeS S.T 1 a,`137 y � Vii•:.� w. ` r. 4 {� � (,\ � ��C Q r E �' sSDs/ 5.r ` !r a .11 a) D L y .,�{ ➢v ��. ' 3f� ■�O u•„ � pAv. �.1f=.yi7 e.x �4 1•�Y •`. —r. 9" S1 � [� i �9- � • .�•s�vx� 't1, s {�'"3 �' ,- „'t1O IYtrL � �a}, t • Si 's' b,. � •'� .� � a � a O r r ? S L+-t._ ;„n� 'fii� t b• It �a r +i c • ° r y am) \LM jF t sJ �°`'�” tQ'ti sr. OL,-d aJ ; • - *' p. 5a ylar •k,-i S , J. • V �a'���'t, ,L �� ,�►'�4s Fe* a o `+tic-�' "'�tir'1����y�S/,'�e� •'�� a .�,Y-4iS�ils I! Nr,� ,� � + 1 .,sa r*s yb i�a'r 4r'i Sl+ Vii} Atli w. r�, i nes sem^ � �ti,`• b _ 4r»tsj ,.Qr.,�I 2y► a �N5 tr s v e i`via r tyi+.l+o •�� � IIS ;• it4 \�' •�■ tt�,lrary I�,� r - 1� j• ���� � � it Jlc. �• � s � •,•r• �•�� •�' � �Jc• `' „r,�r.. ti r r{}iL� IS n ,`}1.`o L 'AASC: � '�� J1�{4 �_{•4t s+ jr a !"`a�L' {]yi`e , y ,1 °g•�3e 4�� IL1 50 � .R �" rYY' '�_�p•�•.r� -!� u+e 1� _ ` ■ + IF i 2S s �Lt h - r-rs •� �+.i 1�•�„! 'a�i+-'� tv s� sS• L �Gam' �,i' i *� *• +{S'� nr [',-."= l:.J>� d>°`` •S S � a„p�,� E3 y•-' J, ti' (1l •t-Y* ts. .. �.MV•�� !'-:•,,- �,t•4,�', c•e~ j{J��:,�'� *�, (,• Y,sS.■C "- t Ss ` •; fi�$4' , .�F •r t4tL i`Ia�`*�M..'"f=� tsu O t . 1 C µ� Y(�•� \• "'1�' a 1�.'��, .I �R'71 7r 7 �4i � {�'c.! !D O C L a3 i C Sa a� �s- - a res as U, V - - - - V c 4 k e ,1'# 41 �ij/ +h ur{� - �ywi a Vi. o�, rod Pm rvw� /Q Z 0 6 1 `yif�� Vt.- - ' r ut� io : 3 o•1 Z i9 rf%lei`/U✓VC�Z !'a� /o.�3 ,,,tit�iT ?o• �,2 C SG �-s'Y6�.?.y syr sib i o-a Z . ,z,•rr - zz • 3 o ' axy V5 a �k�;ll�it ?yN. COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION DEAN G. LUSCOMB TI & SONS P.0. BOX 135 MIDDLDTON, MA 01949 1-978-774-4065 TITLE S OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A JJ CERTIFICATION Property Address: Cross ow zatw, Owner's Name; Owner's Address:�i+y . Date of Inspection: nzQP C2 Name of Inspector:(please print)Aran G-.-.Luscomb II Company Name: b I I & Sons Mailing Address:F-p- Box 1 3 5 _ Mi 949 Telephone Number: 978-774-J06 5 r CERTIFICATION STATEMENT I certify that i have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of TlUe 5(310 CMR 15.000), Tho system: 1 � , Passes _ Conditionally Passes Needs Furthcr Evaluation by the Local Approving Authority Fails Inspector's Signature:4L&-e�� Date: 2066 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 otTee of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments F6# ki/` �0 j;)p-bc *. None iy rave r" ` ""This report only describes conditions at the time of inspection and'under the conditionsof ase at thak time.This inspection action doe p snot address how the system wQl perform is the tutureoder the same conditions of use, 4 e or different � 1 T o 'd 990b bLL 8L6 aWOOS1l1 1 NV311 Wd bb: Z T L00Z-90-Njk$ Wealth Department utin SC — Forwarded 6y Tamefa Tease return after review. Thank yOZI. R `^*^ rp , Date: :. 2' ... SEP 16 2005 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT RE: ➢ Susan: ➢ Michele Health Calendar Updated? ❑ Yes .❑ No ❑ n/a RETURN TO PAMELA ❑ File: ❑ Dispose NOTE: � ' A r FILE# /'��1 r��c 91460 .l TITLE V INSPECTIONS Dean G. Luscomb II & Sons RE��.9�'�D P.O. Box 135 RECEIVED Middleton, MA 01949 SEP 16 2005 978-774-4065 TOWN OF NORTH ANDOVER Licensed Plumber#20285 1 HEALTH DEPARTMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM INPSECTION FORM PROPERTY OWNERS NAME T,n keUr1 ar-A PROPERTY ADDRESS 5 C rOSSbG W L0-A e- d d J, Andover Me-, 018 4 5 ADDRESS OF OWNER(if different) DATE OF INSPECTION S�Z+erv�,�.(�r'- 14 200 NAME OF INSPECTOR C1.r c,7' S Co r n QUALITY IS NUMBER ONE TO US COMMONWEALTH OF MASSACHUSETTS s EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS 4 W w a DEPARTMENT OF ENVIRONMENTAL PROTECTION F DEAN G. LUSCOMB II & SONS 5V P.O. BOX 135 MIDDLETON, MA 01949 1 -978-774-4065 TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:5 Crossbow LQne N. A r,doyer. Owner's Name:Ja r) Lep r)0 rd AA RECEIVED Owner's Address:GQYY1Lp- SEP 16 2005 Date of Inspection:6 -p+e.ryke?r I q 0100 TOWN OF NORTH ANDOVER Name of Inspector:(please print) Dean G. Luscomb II HEALTH DEPARTMENT Company Name:Dean G. Luscomb II & sons Mailing Address:p_0_ Box 1 3 5 Mi cjr11 Pton, MA 01 949 Telephone Number: 978-774-4065 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: ADate: �.,�a� W 200 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments /an cam` �n �� 4 Ood 544.10-e olrnVC n ****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. i 1 VliUll V. 1..I llU 1.Vlll.✓ 1.1. U VVaawJ P.O. Box 135 Paget of 11 Middleton, Mk 01949 1 -978-774-4065 4 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 5 C r 0 S bol i La r)e N. A-redo»ex M o� Owner: 1...20no rd 'Date of Inspection: q- )� -O5 Inspection Summary: Check A,B,Coor E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. 10 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. NSD explain: /U Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced i ND explain: jThe system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 uearl u. l.iuscutiu 11 a outtti Page 3 of l I P.O. Box 135 Middleton, MA 01949 1-978-774-4065 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Crossbow Lane N . iAndDUe.ri MA .Owner: Le o n o r d Date of Inspection: G- I A4- Q5 i C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine.if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. A` The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply. AThe system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. I s I tf The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. I � 3. Other: � I I 3 I P.O. Box 135 ,Page 4 of 11 Middleton, MA 01949 1-978-774-4065 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 5 Crossbow Lane N, Andouer.MA 'Owner• e.O n d rd Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: e . No _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or — clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool " n da flow Liquid depth in cesspool is less than 6 below invertor available volume is less than_ y 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. V Any portion of a cesspool or privy is within 50 feet of a private water supply well. ) Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and 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.] &YINo)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be-considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd- You must indicate ' qr`�"yes"or"no"to each of the following: h following i large systems in addition to the criteria above) T e fo o criteria a o a e s s .- ( '� g Y g PP yes no -'r the system is within 400 feet of a su drinking water supplyI w u the system is within 200 feet of a tributary to a sur king water supply y the system is located in a nitrogen sensiti rea(Interim Wellhead Protection Area–IWPA)or a mapped Zone 11 of a public water supply If you have answered"yes"to question in Section E the system is considered a significant threat,or answered " ' large system considered a es in Section D above hilar e system has failed.The owner or operator of an Y � g Y P Y g Y significant threat undefSection 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. 4 P.O. Box 135 Page 5 of I I Middleton, MA 01949 1-978-774-4065 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: S Crossbow Lane N. A')doge r, V!^ Owner• LCC)n a rd Date of Inspection:A- 1 q -Q 5 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 th previous ? _ y e p ous 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) 611— 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: Y_eK'no V_ — Existing information.For example,a plan at the Board of Health. (l Determined in the field(if an of the failure criteria related to Part Cis at issue approximation of distance — Y PP is unacceptable)[3 10 CMR 15.302(3)(b)] I i 5 i P.O. Box 135 Page 6 of 11 Middleton, MA 01949 1-978-774-4065 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:5 C.rossbDLx) Lane N. AndbUc_ri Y\AA Owner: Leon Q rgi Date of Inspection: q- 14-Orj FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): // Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):AY19 4" PLO-- Number of current residents: Does residence have a garbage grinder(yes or&: Is laundry on a separate sewage system(yes or 6)-pLk [if yes separate inspection required] Laundry system inspected(Yes or ' Seasonal L— use:(yes or 0: Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes orog Last date of occupancy: u r Leh OMMERCIAL/INDUSTRIAL Ty f establishment: .Design o ased on 310 CMR 15.203): gpd Basis of design flo ats/persons/sqft,etc.): Grease trap present(yes or Industrial waste holding tank prese or no):_ Non-sanitary waste discharo the Title 5 (yes or no):_ Water meter readings,iY'available: Last date of occup ncy/use: i OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Fz'tjtV__j I *-r'et. e Was system pumped as part of the inspection(yes ot-if�?�110 If yes,volume pumped: 156V gallons--How was quanyV pumped determined? Reason for pumping: 43z4 pt,k, '1104en C'gT rAJr-y 4-ye �� i TYPE OF SYSTEM ,/Septic tank,distribution box,soil absorption system _Single cesspool Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes ort!Z�.�V i 6 P.O. Box 135- ' Page 7 of 11 Middleton, MA 01949 f - 1-978-774-4065 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: S C r o5S J:) LCt he N. A hdoa-�NA Owner: Y' Date of Inspection: - 15- ©5 BUILDING SEWER(locate on site plan) I u Depth below grade: Z Materials of construction t iron _40 PVC_other(explain): Distance from private water supply well or suction line: gomments(on condition of joints,venting,evidence of leakage,etc.): " n t✓, N-Cask Q r og D sign S Ci '���t� GP� SEPTIC TANK: Yf-3(locate on site plan) i Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene ther(explain) fiT,¢� C&Lg"- �o nC rtA::Poc If tank is metal list age:�}� Is age confirmed by a Certificate of Compliance(yes orig AP(attach a copy of certificate) Dimensions: 6�peop KS�Gv Sludge depth: -e I" Distance from top of sludge to bottom of outlet tee or baffle:�� Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle:--Z6 How were dimensions determined: a� ;G.C.$ tuy Comments(on pumping recommendati s,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leaka e,etc.): r t.rt i! a o 1 / (aJo r r 1 1.�7 56' i!/D%13 Q Pic,I �e^J�.�'7`p � GREASE T/RAP:p=locate on site plan) Depth below grade: Material of construction:— — —concrete metal fiberglass_polyethylene_other (explain): /' Dimensions: Scum thickness: Distance from top of scum to top of outlet tee affle: Distance from bottom of scum to bottom outlet tee or baffle: Date of last pumping: Comments(on pumping reco endations,inlet and outlet tee or baffle condition,structur grity, liquid levels as related to outlet invert idence of leakage,etc.): J I 7 P.O. Box 135 Page 8 of 11 Middleton, MA 01949 1-978-774-4065 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 5 Cr SS ou.) Lane u MA Owner: D►7 t' Date of Inspection: - 14 , Q TIGHT or-TOLDING TANK:L(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: con a metal fiberglass_polyeth other(explain): Dimensions: Capacity: :9a'l alons Design Flow: lons/day Alarm present(yes or no):Alarm level: Alag order(yes or no): Date of last pumping: Comments(conditi alarm and float switches,etc.): �f c& DISTRIBUTION BOX:/e-S (if present must be opened)(locate on site plan) -1?o X13 l �o t-, f� Depth of liquid level above outlet invert: 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.): Z 6a cLe1',i!,: -6 G A� PUMP.CHAMBER:Ny (locate on site plan) Pumps in working order(yes`ol-ne Alarms in working order(yes or no): _ '""J Comments(note cond�putnp-eharecbecondition pus and appurtenances,etc.): I 8 P.0. Box 135 • Page 9 of I I Middleton, MA 01949 1-978-774-4065 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C �\ SYSTEM INFORMATION(continued) Property Address:5-Crossbow Lahe N. r NA Owner: Laoh h 0 rd Date of Inspection: Cl- 14 •aS SOIL ABSORPTION SYSTEM(SAS): AS (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ leaching chambers,number: leaching galleries,number: leaching trenches,number,length: ]Zleaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): /7 CESSPOOLS:&—)P (cesspool must be pumped as part of inspection)(locate on site plan) Number and congrail Depth–top of liquid to inlet invei Depth of solids layer: Depth scum Dimensions cesspool: of cesspool: Materials of construction: Indication of groundwater infl es or no): Comments(note con¢itioll o soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on siteplan)A Materials of construction: Dimensions: Depth of solids: �,w Comments(note condition of soil,si p5.of- draulic failure, level of ponding,condition.of vegetation,etc.): i a P.O. Box 135 Page 10 of 11 Middleton, MA 01949 1-978-774=4065 4 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 5Crossbow r-3e C�-aSS�O�✓ Zone, n MA , Owner• r)o r Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two pi rmanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water Supp y enters the build`ing. Front a +kc Rous—, l E�f 5 Cross bow Gane 14 rdo'e-r MCL. c.k Sepnc Tank �T Q 13foD " �° i 10 i Page 11 of 11 P.O. Box 135 Middleton, MA 01949 1-978-774-4065 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 5 Crossbow Lane N• Andoue.r. MA Owner: Leo h Q rd Date of Inspection: 0 S PTE EXAM Slope Le.,,+e,ll —gurface water V)eo� Check cellar br'Y shallow wells /J0iw Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: f Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: f � t oS ��t.e_v� Checked with local excavators,installers-(attach documentation) � "Accessed USGS database-explain: l a�syice_a I You must describe how you established the high ground water elevation: l o ar _kecords Veiled ) _ 'z 1&/©w grmcP- -ITS S, X4,Y, U 1? GL t•ci i SQ eaf' r" Gr.. i i 11