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Home My WebLink AboutMiscellaneous - 515 BOSTON STREET 4/30/2018 (2) 515 BOSTON STREET J \ / 210/107.D-0094-0000.0 4 I t I i i i North Andover Board of Assessors Public Access Page 1 of 1 a ' yoRTy Town of Morth Artdover Hoard of Assessors j=°.-•. •'''0 of Property �+e�Tus Record Card Return to the}tome page click on logo Parcel ID:210/107.D-0094-0000.0 Community:North Andover SKETCH PHOTO New Search Click on Sketch to Enlarge Click on Photo to Enlarge Sales a Summary fi Residence Detached Structure Condo Commercial -. Comparable Sales 515 BOSTON STREET Location: 515 BOSTON STREET Owner Name: COCCOMA,JOSEPH P JUDITH A COCCOMA Owner Address: 515 BOSTON STREET City:NORTH ANDOVER State:MA ZIP:01845 Neighborhood:6-6 Land Area: 1.14 acres Use Code: 101 -SNGL-FAM-RES Total Finished Area:2648 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 605,900 643,500 Building Value: 396,200 411,500 Land Value: 209,700 232,000 Market Land Value:209,700 Chapter Land Value: LATEST SALE Sale Price:480,000 Sale Date:08/06/2000 Arms Length Sale Code:Y-YES-VALID Grantor:JAMES BABCOCK Cert Doc: Book:05827 Page:0278 http://csc-ma.us/NandoverPubAcc/jsp/Home.jsp?Page=3&Linkld=1182389 8/22/2008 t 1.AF.A�-�•:I s A.Y J�Ss�t.-A b Septic System Information 515 BOSTON STREET Printed On: Wednesday,August 20, 20 System ID: BHS-2002-0179 General System Information Latest Permit Information Calcaluted Design Flow: Test Pits Septic Tank Disposal Trench Design Flow: One Two Capacity: Number: Design Flow Provided: Minutes per inch: Width: Width: Total Flow: Depth: Length: Length: Seasonal: No No Depth to Water: Diameter: Leaching: Grinder: No No Soil Type: Depth: Laundry: No No Inspections: Inspected: Expires: Inspector: Status: 07/03/2008 Brian S. Murphy Passes a Comments: Title 5 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Page 1 of 1 Of NORTH 1.y 3424 t : Town of North Andover ` '•�,; o�. HEALTH DEPARTMENT ' ,SSACHUS�t . CHECK#: /S�� DATE: ;zltrl4"�46 LOCATION: H/O NAME: CONTRACT " R NAME: x;�Iw Type of Permit or License: (Check box) 0 Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type. $ ❑ Funeral Directors $ ` ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ . ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Ti/tle�5 Inspectorat $ ®,'T'itle 5 Report $ � ❑ Other:(Indicate) $ Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer Commonweal& of Massachusgtts -- - _ Title 5 official Inspection Formv�- M Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r.;K4Y_ 515 BOSTON STREET _ _ — Property Address JOSEPH COCCOMA Owner Owner's Name information is NORTH ANDOVER, MA. 01845 7/1/08 required for — – every page. Cityrr State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information ~ When filling out RECEIVED-) forms on the computer,use 1. Inspector: only the tab key 5 2008 to move your BRIAN S.MURPHY cursor-do not Name of Inspector r use the return TOWN B & D SEPTIC INSPECTIONS PART EONT�� key. Company Name P.O.BOX 47 Company Address HULL, MA. 02045 City/Town State Zip Code (781)290-9942 S13675 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 713/08 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. AdOO new title v report 2008.03/08 Title 5 Official Inspection Form:Subsurface sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts _-- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 515 BOSTON STREET Property Address JOSEPH COCCOMA Owner Owner's Name information is NORTH ANDOVER, MA. 01845 7/1/08 required for State Zip Code Date of Inspection every page. Cityrrown B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed new title v report 2008.03/OS Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 515 BOSTON STREET Property Address JOSEPH COCCOMA _ Owner Owner's Name information is required for NORTH ANDOVER, MA. 01845 7/1/08 -- every page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: I I ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: 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. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. new title v report 2008-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts -- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 515 BOSTON STREET Property Address JOSEPH COCCOMA Owner Owner's Name information is required for NORTH ANDOVER, MA. 01845 7/1/08 — — every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool E] ® 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 1:1or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow ❑ ® 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. new title v report 2008-03108 Title 5 Official Inspection FormSubsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts -- -- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments - 515 BOSTON STREET Property Address JOSEPH COCCOMA Owner Owner's Name information is required for NORTH ANDOVER, MA. 01845 7/1/08 _ every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. new title v report 2008•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts - :- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments - 515 BOSTON STREET Property Address JOSEPH COCCOMA _ Owner Owner's Name information is _NORTH ANDOVER, MA. 01845 7/1/08 required for — - — — every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. El ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] i new title v report 2008.03108 True 5 Widal Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts -- - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments - 515 BOSTON STREET _ Property Address JOSEPH COCCOMA Owner Owner's Name information is required for NORTH ANDOVER, MA. 01845 7/1/08 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 5 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d WELL(100+'- 9 ( Y 9 (gpd)): SAS) Sump pump? ❑ Yes ® No Last date of occupancy: PRESENT Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): new title v report 2008-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts -- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 515 BOSTON STREET Property Address JOSEPH COCCOMA Owner Owner's Name information is required for NORTH ANDOVER, MA. 01845 7/1/08 - — every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: SYSTEM LAST PUMPED 4/07 (HOME OWNER) Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: TANK = 30 YRS. INSTALLED 1977, D-BOX AND SAS 14 YRS. INSTALLED 6/04, LOCAL BOH RECORDS. Were sewage odors detected when arriving at the site? ❑ Yes ® No new title v report 2008-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 ' Commonwealth of Massachusetts 3. -- Title 5 Official Inspection Form — Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 515 BOSTON STREET Property Address JOSEPH COCCOMA Owner Owner's Name information is required for NORTH ANDOVER, MA. 01845 7/1/08 every page. Cityrr vn State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): 1001 Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 2" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- 1 O'X5'X5' ------------------------------------------------10'X5'X5' 1500 GAL. Dimensions: 1" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 32" 2° Scum thickness Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 16" MEASURED IN FIELD How were dimensions determined? new title v report 2008.03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M y 515 BOSTON STREET Property Address JOSEPH COCCOMA — Owner Owner's Name information is NORTH ANDOVER, MA. 01845 7/1/08 required for - every page. City/Town State Zip Code Date of Inspection I D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): TANK AND CEMENT BAFFLES IN GOOD CONDITION, LIQUID LEVEL WITH OUTLET, TANK APPEARS SOUND, NO SIGNS OF LEAKAGE. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: C Scum thickness i Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): i Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): new title v report 2008•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 t ' er Commonwealth of Massachusetts --- Title 5 Official Inspection Form Subsurface Sewage Disposal System Foran Not for Voluntary Assessments 515 BOSTON STREET Property Address JOSEPH C_OCCOMA Owner Owner's Name information is MA. 01845 7/1/08 required for NORTH ANDOVER, State Zip Code Date of Inspection every page. City/Town D. System Information (cont.) k Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: 3 1'X3'X75' ® leaching trenches number, length: @ ❑ leaching 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.): SOIL CONDITIONS NORMAL, NO SIGNS OF HYDRAULIC FAILURE, VEGETATION NORMAL. — Title 5 official Inspection Foran:Subsurface Sewage Disposal system-Page 12 of 15 new title v report 2008-03108 Commonwealth of Massachusetts w - - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,h 515 BOSTON STREET Property Address JOSEPH COCCOMA Owner Owner's Name information is required for NORTH ANDOVER, MA. 01845 7/1/08 — every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. aWELL 515 BOSTON ST. N.ANDOVER, MA. A-1 =1 6 ' B-1 =30 ' 6" A B A-2=23 ' 9" B-2=34 ' 4" A-3=23 ' 8" B-3=51 ' 1 3 2 new title v report 2008.03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 c 15 c Commonwealth of Massachusetts --- - - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 515 BOSTON STREET Property Address JOSEPH COCCOMA Owner Owner's Name required don is rfor NORTH ANDOVER, MA. 01845 7/1/08 requir - every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells 4' Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 5/23/94 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: GROUND WATER DETERMINED FROM DESIGN PLAN ON RECORD AT LOCAL BOH, SOIL LOG ON RECORD INDICATES WATER AT 4'. new title v report 2008.03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 FORM 4- SYSTEM PUMPING RECORD CURRIER SEPTIC & DRAIN SERVICE 107 FOREST STREET;MIDDLETON,MA 01949 (978)774-2772 COMMONWEALTH OF MASSACHUSETTS 4"Ue'r ;MASSACHUSETTS SYSTEM PUMPING RECORD SYSTEM OWNER: SYSTEM LOCATION:Coy � s 2,5- 3313 DATE OF PUMPING: ` S/ QUANTITY PUMPED: GALLONS CESSPOOL: NO 0 YES SEPTIC TANK: NO YES SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SERVICE CONTENTS TRANSFERRED TO: 6:-GS D DATE: INSPECTOR: �loi9 7'C,04 OF fjff i ANDOVER/ RD OF HEAL71 H FORM 4- SYSTEM PUMPING RECORD CURRIER SEPTIC & DRAIN SERVICE 107 FOREST STREET; MIDDLETON, MA 01949 (978) 774-2772 Sa MEAL HOF MASSACHUSETTS MASSACHUSETTS SYSTEM PUMPING RECORD SYSTEM OWNER: SYSTEM LOCATION: DATE OF PUMPING: _ l GJ QUANTITY PUMPED: ��5�`�V GALLONS CESSPOOL: NO '21 YES 0 SEPTIC TANK: NOE:] YES 2] SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SERVICE CONTENTS TRANSFERRED TO: �( ID DATE: INSPEC .,i;�.` r`y :! .er \•.. '.r. .``�,`�t. :atv ry�yy'[U7:h�'c:+yy_tl>>'t1i➢A:1 cJi...' .�t+.-i_;.11\:��1{.!'� it+-�l"i4:\��." .h:�[�p15'S`'�S: a\ r+x.,.!.a:yti"':*'�. '\) .^'�L '\; ...:'+ ( �. .'1 �.1,r... A�1C�•CY!`4 w +lr'.'. 151��RB ,y,t ?ti iahl'�'`::\S �a.S�.ay+t�i�`� �{ a\'.1{S2�M^i , 1 y 1:. - 11 4l �1 1 '! S C,� 1 ! �l Sf \l1•.) al�t. 4.� -�� 1p'�l )!_ 1N`, Form No.3 Town of North Andover, Massachusetts BOARD OF HEALTH NORTH • 3? a.t. 1c1lo 19 6 OL O 9 F ' �,'•°,,,,p,.�•�,� DISPOSAL WORKS CONSTRUCTION PERMIT 13 SACHUSEt . Applicant ADD 5 TELEPHONE NAME Site Location Permission is hereby granted to Construct ( ) or Repair an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. CHAIRMAN,BOARD OF HEALTH D.W.C. No. Fee ' N � 1 -- Pumping Record Commonwealth of Massachusetss _ Massachusetts System Pumoina Record R CEIVED NOV 16 2005 System owner System Location TOWN OF NOF TH ANDOVER HEALTH DUIARTMENT Type: Emergency Routine Cesspool: W E4Yes Septic tank: w Yes Date of Pumping: a q b/ Quantity Pumped: IS tJ i) Gallons System Pumped By: Wind River Enwhwwta/, LLC Permit#: Contents transferred to: East Fitchburg Mute . 2ar q-JL A• M ' Contents Disposed at: Date: Pumper Signature: Condition of System/Other Comments Dep Approved Form - 12/07/95 107 FOREST STREET FILE# 81799A MIDDLETON,MA 01949 (978)774-2772 SEPTIC & DRAIN CURRIEAL SERVICE SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PROPERTY OWNER'S NAME: BABCOCK PROPERTY ADDRESS: 515 BOSTON ST. N.ANDOVER,MA ADDRESS OF OWNER: SAME (IF DIFFERENT) DATE OF INSPECTION: 17 AUG 1999 -c VlnFiTH VIDOVER/ n f r'-`--ALTM J. . . - - -7 NAME OF INSPECTOR: THOMAS CHIGAS = 2 5 iggg * THE PROFESSIONAL EXPERTS IN THE SEPTIC AND DRAIN INDUSTRY 107 FOREST STREET FILE# 81799A MIDDLETON,MA 01949 (978)774-2772 SEPTIC&DRAIN SERVICE SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION PROPERTY ADDRESS:515 BOSTON ST. NAME OF OWNER: BABCOCK N.ANDOVER,MA ADDRESS OF OWNER: SAME DATE OF INSPECTION: 17 AUG 1999 NAME OF INSPECTOR: (PLEASE PRINT)THOMAS CHIGAS I AM A DEP APPROVED INSPECTOR PURSUANT TO SECTION 15.340 OF TITLE 5 (3 10 CMR 15.000) COMPANY NAME: CURRIER SEPTIC &DRAIN MAILING ADDRESS: 107 FOREST STREET; MIDDLETON MA 01949 TELEPHONE NUMBER: (978) 774-2772 CERTIFICATION STATEMENT I CERTIFY THAT I HAVE INSPECTED THE SEWAGE DISPOSAL SYSTEM AT THIS ADDRESS AND THAT THE INFORMATION REPORTED BELOW IS TRUE,ACCURATE AND COMPLETE AS OF THE TIME OF INSPECTION. THE INSPECTION WAS PREFORMED BASED ON MY TRAINING AND EXPERIENCE IN THE PROPER FUNCTION AND MAINTENANCE OF ON-SITE SEWAGE DISPOSAL SYSTEM. THE SYSTEM: YES PASSES CONDITIONALLY PASSES NEEDS FURTHER EVALUATION BY THE LOCAL APPROVING AUTHORITY FAILS 9 INSPECTOR'S SIGNATURE: DATE: 17 AUG 1999 THE SYSTEM INSPECTOR SHALL SUBMIT A COPY OF THIS SPECTION 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 GALLON 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,IF APPLICABLE,AND THE APPROVING. NOTES AND COMMENTS: N/A REVISED 9/2/98 PAGE 1 OF 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) PROPERTY ADDRESS:515 BOSTON ST. OWNER:BABCOCK DATE OF INSPECTION: 17 AUG 1999 INSPECTION SUMMARY: CHECK B, C, OR D: A. SYSTEM PASSES: YES I HAVE NOT FOUND ANY INFORMATION,WHICH INDICATES THAT ANY OF THE FAILURE CONDITIONS DESCRIBED IN 310 CMR 15.303 EXIST. ANY FAILURE CRITERIA NOT EVALUATED ARE INDICATED BELOW. COMMENTS: B. SYSTEM CONIDTIONALLY PASSES: NONE 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. INDICATE YES,NO,OR NOT DETERMINED(Y,N,OR ND). DESCRIBE BASIS OF DETERMINATION IN ALL INSTANCES. IF"NOT DETERMINED",EXPLAIN WHY NOT. N THE SEPTIC TANK IS METAL,UNLESS THE OWNER OR OPERATOR HAS PROVIDED THE SYSTEM INSPECTOR WITH A COPY OF A CERTIFICATE OF COMPLIANCE(ATTACHED)INDICATING THAT THE TANK WAS INSTALLED WITHIN TWENTY(20)YEARS PRIOR TO THE DATE OF THE INSPECTION;OR THE SEPTIC TANK,WHETHER OR NOT METAL,IS CRACKED, STRUCTURALLY UNSOUND, SHOWS SUBSTANTIAL INFILTRATION OR EXFILTRATION,OR TANK FAILURE IS IMMINENT. THE SYSTEM WILL PASS INSPECTION IF THE EXISTING SEPTIC TANK IS REPLACED WITH A COMPLYING SEPTIC TANK AS APPROVED BY THE BOARD OF HEALTH. N SEWAGE BACKUP OR BREAKOUT OR HIGH STATIC WATER LEVEL OBSERVED IN THE DISTRIBUTION BOX IS DUE TO BROKEN OR OBSTRUCTED PIPE(S)OR DUE TO A BROKEN, SETTLED OR UNEVEN DISTRIBUTION BOX. THE SYSTEM WILL PASS INSPECTION IF(WITH APPROVAL OF THE BOARD OF HEALTH). N BROKEN PIPE(S)ARE REPLACED N OBSTRUCTION IS REMOVED N DISTRIBUTION BOX IS LEVELLED OR REPLACED N THE SYSTEM REQUIRED PUMPING MORE THAN FOUR TIMES A YEAR DUE TO BROKEN OR OBSTRUCTED PIPE(S). THE SYSTEM WILL PASS INSPECTION IF(WITH APPROVAL OF THE BOARD OF HEALTH): N BROKEN PIPE(S)ARE REPLACED N OBSDTRUCTION IS REMOVED REVISED 9/2/98 PAGE 2 OF 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) PROPERTY ADDRESS:515 BOSTON ST. OWNER:BABCOCK DATE OF INSPECTION: 17 AUG 1999 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: N CONDITIONS EXIST WHICH REQUIRE FURTHER EVALUATION BY THE BOARD OF HEALTH IN ORDER TO DETERMINE IF THE SYSTEM IS FAILING TO PROTECT THE PUBLIC HEALTH, SAFETY AND THE ENVIRONMENT. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303 (1)(B)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRNONMENT: N/A CESSPOOL OR PRIVY IS WITHIN 50 FEET OF SURFACE WATER N/A 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 AND SAFETY AND THE ENVIRONMENT: N THE SYTEM 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. N THE SYTEM HAS A SEPTIC TANK AND SOIL ABSORPTION SYSTEM AND THE SAS IS WITHIN A ZONE I OF PUBLIC WATER SUPPLY WELL. N THE SYSTEM HAS A SEPTIC TANK AND SOIL ABSORPTION SYSYTEM AND THE SAS IS WITHIN 50 FEET OF A PRIVATE WATER SUPPLY WELL. N THE SYSTEM HAS A SEPTIC TANK AND SOIL ABSORPTION SYSYTEM AND THE SAS IS LESS THAN 100 FEET BUT 50 FEET MORE FROM A PRIVATE WATER SUPPLY WELL, UNLESS A WELL WATER ANALYSIS FOR COLIFORM BACTERIA AND VOLATILE ORGANIC COMPOUNDS NDICATES 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. METHOD USED TO DETERMINED DISTANCE_ . _ _ _ (APPROXIMATION NOT VALID). 3) OTHER: N/A REVISED 9/2/98 PAGE 3 OF 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) PROPERTY ADDRESS:515 BOSTON ST. OWNER:BABCOCK DATE OF INSEPCTION: 17 AUG 1999 D. SYSTEM FAILS: YOU MUST INDICATE EITHER"YES"OR"NO"TO EACH OF THE FOLLOWING: N 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 CONTRACTED TO DERTERMINE WHAT WILL BE NECESSARY TO CORRECT THE FAILURE. YES NO N BACKUP OF SEWAGE INTO FACILITY OR SYSTEM COMPONENT DUE TO AN OVERLOADED OR CLOGGED SAS OR CESSPOOL. N DISCHARGE OR PONDING OF EFFLUENT TO THE SURFACE OF THE GROUND OR SURFACE WATERS DUE TO AN OVERLOADED OR CLOGGED SAS OR CESSPOOL. N STATIC LIQUID LEVEL IN THE DISTRIBUTION BOX ABOVE OUTLET INVERT DUE TO AN OVERLOADED OR CLOGGED SAS OR CESSPOOL. N/A LIQUID DEPTH IN CESSPOOL IS LESS THAN 6' BELOW INVERT OR AVAILABLE VOLUME IS LESS THAN 'h DAY FLOW. N REQUIRED PUMPING MORE THAN 4 TIMES IN THE LAST YEAR NOT DUE TO CLOGGED OR OBSTRUCTED PIPE(S). NUMBER OF TIMES PUMPED N ANY PORTION OF THE SOIL ABSORPTION SYSTEM,CESSPOOL OR PRIVY IS BELOW THE HIGH GROUNDWATER ELEVATION. N/A ANY PORTION OF A CESSPOOL OR PRIVY IS WITHIN 100 FEET OF A SURFACE WATER SUPPLY OR TRIBUTARY TO A SURFACE WATER SUPPLY. N/A ANY PORTION OF A CESSPOOL OR PRIVY IS WITHIN A ZONE I OF A PUBLIC WELL. N/A ANY PORTION OF A CESSPOOL OR PRIVY IS WITHIN 50 FEET OF A PRIVATE WATER SUPPLY WELL. N/A ANY PORTION OF A CESSPOOL OR PRIVY IS LESS THAN 100 FEET BUT GREATER THAN 50 FEET FROM A PRIVATE WATER SUPPLLY 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 M INDICATES EITHER"YES"OR"NO"TO EACH OF THE FOLLOWING: THE OWING CRITRTIA APPLY TO LARGE SYSTEMS IN ADDITION TO CRTERIA ABOVE: N THE SYSTEM SER A FACILITY WITH A DESIGN FLOW OF 1 , 0 GPD OR GREATER(LARGE SYSTEM) AND THE SYSTEM IS A SIGNIF T THREAT TO PUBLIC HEAL ND SAFETY AND THE ENVIRONMENT BECAUSE ONE OR MORE OF THE FO WING CONDITION IST: YES NO N THE SYSTEM IS WITHIN 4 ET OF A ACE DRINKING WATER SUPPLY N THE SYSTEM IS WI 200 FEET OF A TRIBU Y TO A SURFACE DRINKING WATER SUPPLY N THE SYSEM I CATED IN A NITROGEN SENSITIV A(INTERIM WELLHEAD PROTECTION AREA-IWPA)O PPED ZONE II OF A PUBLIC WATER SUPPL LL THE OWNE OPERATOR OF ANY SUCH SYSTEM SHALL UPGRADE THE SYSTEM CORDANCE WITH 310 CMR 4(2).PLEASE CONSULT THE LOCAL REGIONAL OFFICE OF THE DEPARTMENT FO THER RMATION. REVISED 9/2/98 PAGE 4 OF 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INPSECTION FORM PART B CHECKLIST PROPERTY ADDRESS:515 BOSTON ST. OWNER:BABCOCK DATE OF INSPECTION: 17 AUG 1999 CHECK IF THE FOLLOWING HAVE BEEN DONE: YOU MUST INDICATE EITHER"YES"OR"NO"AS TO EACH OF THE FOLLOWING: YES NO Y PUMPING INFORMATION WAS PROVIDED BY THE OWNER, OCCUPANT, OR BOARD OF HEALTH. Y NONE ON 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 SYTEM RECENTLY OR AS PART OF THIS INSPECTION. Y AS BUILT PLANS HAVE BEEN OBTAINED AND EXAMINED.NOTE IF THEY ARE NOT AVAILABLE WITH N/A. Y THE FACILITY OR DWELLING WAS INSPECTED FOR SIGNS OF SEWAGE BACK-UP. Y THE SYSTEM DOES NOT RECEIVE NON-SANITARY OR INDUSTRIAL WASTE FLOW. Y THE SITE WAS INSPECTED FOR SIGNS OF BREAKOUT. Y ALL SYSTEM COMPONENTS, EXCLUDING THE SOIL ABSORPTION SYSTEM HAVE BEEN LOCATED ON THE SITE. Y THE SEPTIC TANK MANHOLES WERE UNCOVERED, OPENED, AND THE INTERIOR OF THE SEPTIC TANK WAS INSPECTED FOR CONDITION OF BAFFLES OR TEES,MATERIAL OF CONSTRUCTION,DIMENSIONS,DEPTH OF LIQUID,DEPTH OF SLUDGE,DEPTH OF SCUM. THE SIZE AND LOCATION OF THE SOIL ABSORPTION SYSTEM ON THE SITE HAS BEEN DETERMINED BASED ON: Y EXISTING INFORMATION.FOR EXAMPLE,PLAN AT B.O.H. Y 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)] Y THE FACILITY OWNER(AND OCCUPANTS, IF DIFFERENT FROM OWNER)WERE PROVIDED WITH INFORMATION ON THE PROPER MAINTENANCE OF SUBSURFACE DISPOSAL SYSTEMS. REVISED 9/2/98 PAGE 5 OF 11 SUBURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION PROPERTY ADDRESS:515 BOSTON ST. OWNER:BABCOCK DATE OF INSPECTION: 17 AUG 1999 FLOW CONDITIONS RESIDENTIAL: DESIGN FLOW:440G.P.D./BEDROOM. NUMBER OF BEDROOMS(DESIGN):4 NUMBER OF BEDROOMS(ACTUAL): 5 TOTAL DESIGN FLOW:440 i NUMBER OF CURRENT RESIDENTS: 2 GARBAGE GRINDER(YES OR NO): YES LAUNDRY(SEPARATE SYSTEM)(YES OR NO):NO;IF YES,SEPARATE INSPECTION REQUIRED LAUNDRY SYSTEM INPECTED(YES OR NO):NO SEASONAL USE(YES OR NO):NO WATER METER READINGS,IF AVAILABLE(LAST TWO YEAR'S USAGE(GPD):WELL ON SITE. SUMP PUMP(YES OR NO):NO LAST DATE OF OCCUPANCY: CURRENT COMMERCIAL/INDUSTRIAL: E OF ESTABLISHMENT:_ •. • _ DESI OW: GPD(BAESED ON 15.203) BASIS OF DESIGN FLOW:_ __ _ _ GREASE TRAP PRE (YES OR NO __ __ _ INDUSTRAIL WASTE HOL G K PRESENT(YES OR NO):_ _ _ _ _ NON-SANITARY WASTE D A D TO THE TITLE 5 SYSTEM(YES OR NO):_ _ _ _ _ WATER METER RED S,IF AVAILA LAST DATE OF O ANCY:_ _ _ _ _ OTHE ESCRIBE):_ _ _ __ L DATE OF OCCUPANCY:_ __ __ GENERAL INFORMATION PUMPING RECORDS AND SOURCE OF INFORMATION: SYSTEM PUMPED AS PART OF INSPECTION(YES OR NO):YES IF YES,VOLUME PUMPED: 1500 GALLONS REASON FOR PUMPING: INSPECTION TOO TANK. TYPE OF SYSTEM YES SEPTIC TANK/DISTRIBUTION BOX/SOIL ABSORPTION SYSTEM N SINGLE CESSPOOL N OVERFLOW CESSPOOL N PRIVY N SHARED SYSTEM(YES OR NO)(IF YES,ATTACH PREVIOUS INSPECTION RECORDS,IF ANY) N UA TECHNOLOGY ETC. ATTACH COPY OF UP TO DATE OPERATION AND MAINTENANVE CONTRACT TIGHT TANK COPY OF DEP APPROVAL OTHER:N/A APPROXIMATE AGE OF ALL COMPONENTS,DATE INSTALLED(IF KNOWN)AND SOURCE OF INFORMATION: INSTALLED 1984.OWNER SEWAGE ODORS DETECTED WHEN ARRIVING AT THE SITE(YES OR NO):NO REVISED 9/2/98 PAGE 6 OF 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(CONTINUED) PROPERTY ADDRESS:515 BOSTON ST. OWNER:BABCOCK DATE OF INSPECTION: 17 AUG 1999 HT OR HOLDING TANK: N(TANK MUST BE PUMPED PRIOR TO,OR A IME OF,INSPECTION) (LOC ON SITE PLAN) DEPTH BELOW E:_ MATERIAL OF CONST R ION: CONCRETE ME FIBERGLASS POLYETHYLENE OTHER (EXPLAIN)_ . _ _ _ DIMENSIONS: CAPACITY: GALLONS DESIGN FLOW: GALLON AY ALARM PRESENT:_ _ ALARM LEVEL: ARM IN WORKING ORDER: YES NO DATE OF PREVIO UMPING: COMMENTS: (COEDIT OF INLET TEE, CONDITION OF ALRM AND FLOAT SWITCHES,E DISTRIBUTION BOX: YES (LOCATE ON SITE PLAN) DEPTH OF LIQUID LEVEL ABOVE OUTLET INVERT: 0" DEPTH BELOW GRADE; 17" COMMENTS: (NOTE IF LEVEL AND DISTRIBUTION IS EQUAL,EVIDENCE OF SOLIDS CARRYOVER,EVIDENCE OF LEAKAGE INTO OR OUT OF BOX,ETC.) D-BOX IS LEVEL AND EQUALLY DIST.NO SIGNS OF FAILURE IN OR AROUND BOX SOILS WERE CLEAN AND DRY.THERE'S ONE INLET AND TWO OUTLETS SCH40 PVC AND IN GOOD CONDITION P CHAMBER: N_ (LO ON SITE PLAN PUMPS IN WO O (YES OR NO):. _ _ . . ALARMS IN WO ER(YES OR NO):_ _ _ _ _ COMMENTS: (NOTE CO IONS OF PUMP CH R, CONDITION OF PUMPS AND APPURTENANCES,ETC.) REVISED 9/2/98 PAGE 8 OF 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(CONTINUED) PROPERTY ADDRESS:515 BOSTON ST. OWNER:BABCOCK DATE OF INSPECTION: 17 AUG 1999 SOIL ABSORPTION SYSYEM(SAS): YES (LOCATE ON SITE PLAN,IF POSSIBLE;EXCAVATION NOT REQUIRED,LOCATION MAY BE APPROXIMATED BY NON-INTRUSIVE METHODS) IF NOT LOCATED,EXPLAIN:. . . -- TYPE: LEACHING PITS,NUMBER:. . . . - LEACHING CHAMBERS,NUMBER:. . . . . LEACHING GALLERIES,NUMBER:. . . . . LEACHING TRENCHES,NUMBER,LENGTH: TWO LINES 45'L+X YW APPROX LEACHING FIELDS,NUMBER,DIMENSIONS:. . . .- OVERFLOW CESSPOOL,NUMBER:- . . . . ALTERNATIVE SYSTEM: NAME OF TECHNOLOGY: COMMENTS: (NOTE CONDITION OF SOIL,SIGNS OF HYDRAULIC FAILURE,LEVEL OF PONDING,DAMP SOIL,CONDITION OF VEGETATION,ETC.) NO SIGNS OF FAILURE IN OR OUT,SOILS ARE CLEAN AND DRY NO SIGNS OF WETLANDS IN OR AROUND S A S NO SIGNS OF PONDINGS IN OR AROUND SYSTEM.LEACHLINES ARE SCH40 PVC AND IN GOOD CONDITION CESSPOOL: N OCATE ON SITE PLAN) NUMBE CoNFIGURATION: DEPTH-TOP O QUID TO INLET INVERT:- ---- DEPTH OF SOILD L R: DEPTH OF SCUM LAYER: DIMENSIONS OF CESSPOOL: MATERIALS OF CONSTRUCTION: _ INDICATION OF GROUNDWATE INFLOW(CESSPOOL ST BE PUMPE PART OF INSPECTION)- - - - - COMMEN . (NOTE NDITION OF SOIL,SIGNS OF HYDRAULIC FAILURE,LEVEL OF PONDIN ONDITION OF VEGETATION,ETC.) PRIVY: N (LOCATE ON SITE PLAN) MATERIA ONSTRUC DIMENSIONS:_ _ ___ DEPTH SOLIDS: COMMENTS: (NOTE CO ON OF SOIL,SIGNS OF HYD AILURE,LEVEL OF PONDING,CONDITION OF VEGETATION,ETC.) REVISED 9/2/98 PAGE 9 OF 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(CONTINUED) PROPERTY ADDRESS:515 BOSTON ST. OWNER:BABCOCK DATE OF INSPECTION: 17 AUG 1999 SKETCH OF SEWAGE DISPOSAL SYSTEM: INCLUDE TIES TO AT LEAST TWO PERMANENT REFERENCE LANDMARKS OR BENCHMARKS LOCATE ALL WELLS WITHIN 100' (LOCATE WHERE PUBLIC WATER SUPPLY COMES INTO HOUSE) REVISED 9/2/98 PAGE 10 OF 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(CONTINUED) PROPERTY ADDRESS:515 BOSTON ST. OWNER:BABCOCK DATE OF INSPECTION: 17 AUG 1999 SKETCH OF SEWAGE DISPOSAL SYSTEM: INCLUDE TIES TO AT LEAST TWO PERMANENT REFERENCE L NDMARKS OR BENCHMARKS LOCATE ALL WELLS WITHIN 100' (LOCATE WHERE PLIC E UPPLY COMES INTO HOUSE) +well . vw1ad I ��. Nouse G c� C3 71 �d O ULl � �- ` V ,r I � Il 4o T, 20 U T -23 9 REVISED 9/2/98 PAGE 10 OF 11 e(I � T Wi -D( /.�S" SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(CONTINUED) PROPERTY ADDRESS: 515 BOSTON ST. OWNER:BABCOCK DATE OF INSPECTION: 17 AUG 1999 NRCS REPORT NAMEN/A SOIL TYPE N/A TYPICAL DEPTH TO GROUNDWATER N/A USGS DATE WEBSITE VISITED OBSERVATION WELLS CHECKED GROUNDWATER DEPTH: SHALLOW N MODERATE DEEP SITE EXAM SLOPE SURFACE WATER CHECK CELLAR SHALLOW WELLS ESTIMATED DEPTH TO GROUNDWATER FEET PLEASE INDICATE ALL THE METHODS USED TO DETERMINE HIGH GROUNDWATER ELEVATION: N/A OBTAINED FROM DESIGN PLANS ON RECORD Y OBSERVED SITE(ABUTTING PROPERTY, OBSERVATION HOLE,BASEMENT SUMP, ETC.) Y DETERMINED FROM LOCAL CONDITIONS Y CHECKED WITH LOCAL BOARD OF HEALTH N CHECKED FEMA MAPS Y CHECKED PUMPING RECORDS N CHECKED LOCAL EXCAVATORS,INSTALLERS Y USED USGS DATA DESCIBE HOW YOU ESTABLISHED THE HIGH GROUNDWATER ELEVATION. (MUST BE COMPLETED) THE HOUSE HAS 8'FOUNDATION,AND BASEMENT WAS DRY.THERE'S NO SUMP PUMP OR SIGNS OF WATER IN OR AROUND HOUSE.THERE WAS NO SIGNS OF WATER TABLE IN OR NEAR SYSTEM NO SIGNS OF WETLANDS OR MARSHES.OR ABUTTING PROPERTY'S WELLS WITHIN 100'FROM SYSTEM REVISED 9/2/98 PAGE 11 OF 11 Commonwealth of Massachusetts City/Town of NORTH ANDOVER, MASSACHUSETT System Pumping Record _ ;\ o Form 4 RECEIVED DEP has provided this form for use by local Boards of Health. Th SystATTurrt��irnUicor must be submitted to the local Board of Health or other approving auth rity. A. Facility Information HEALTH DEPARTMENT Important: When filling out 1. System Location: forms on the .i computer,use only the tab key Addrss to move your Oak cursor-do not 6 - a use the return City/TowT State Zip Code key. 2. System Owner: N — Name Address(if different from location) City/Town State �+~� Zip Code _ _ 1 _lU — J > >- 5 Telephone Number B. Pumping Record Q r 1. Date of Pumping 2. Quantity Pumped: Date Gallons 3. Type of system: ❑ Cesspool(s) 0 eptic Tank ❑ Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: �c5o 6. System Pumped By: C--U Na�$Ah � Vehicle License Number Company G.!L•S•D. 7. Location where contents were disposed: , Sign uorauDate http://www.mass.gov/dep/wp t5form4.doc-06/03 System Pumping Record•Page 1 of 1 RECEIV"D Commonwealth of Massachusetts CitylTown of NOV -7 Z U 11 System Pumping Record NORTH ANDOVER LUH OWN C?F NORTH ANDOVER Form a l.��FhPEPRRTMENT DEP has provided this form for use by local Boards of Health,Other forms may ,Check with your inform card of Health to detehe same as rmine the form they that-provided Th eSystem Before fmping(Record ng this m st be submitted to local B the local Board of'Heatth or other approving authority within 14 days from the pumping data In accordance with 31 a CMR 15.351. A. Facility Information ft t"rp°R'IkI aut 1. System Location: on term th /— When or the O 7rJI` .c e S~r/5'^_ � S • - .� - r• _..—--•---• - /� �fjc� compweruse oroyfttabkey Adareis / C/lfcls to move yawn _/�/ r ."4, •State Zip code cursor-do not cityaown use the velum key 2. Sys ldm owner, ne zip code ceyrro�rn - 5�s3 7ewl on—Nur � B.Pumping Record /�� Quantity Pumped: G 1, Date of Pumping pate Gallons 3. Type of system: ❑ Cesspool(s) tjc Tk Cjr Tight Tank ❑ Grease Trap ❑ Other(describe): -- — - - 4. Effluent Tee Filter present? 0 Yes ❑ No If yes,was it cleaned? Yes ❑ No S. Condition of SyJ" 6 System Pumped By: ( _� - VehiGe License Number - Name Company 7. Location where contents were disposed: - -- - - -- •• --.. - Oate SgailurC of Hauler •-- --- ..--- --- •-. - Signature of Receiving faWity System PwmpirV Record•Page t of t sStormb.doe•07rQ6 QE,0N5rrVLC:r i z SY5 r�r1 F¢orl —, Hr, Fou No ATIo,,► T I `ro T HI E LEA" P 16LV. T 1{c OU J-L ET 4EsjEz:.f-)PE ay r1cN AS zq" rb,4jtkC- OL< r1AI0-rhIWIJra 1.0' oG CoVErt Cu'fs IOL TOE' i OLy14PA�f1aI�1 IJAU- s�{y -rNE 0I(TL.ET rife U0 leJ ITLI A FilaNb-r LESS . �recwrt 5} y T�►AO Z%• �I<v 2.) rTtc -rAt4r, I-IAY 6 IoZ et-ulW2 IF I'>` Irks a Hlt. j ►-JaH Ga?ACIZy OF 1000 GALS 'i"11E -AML S►-1al.<, t36 �rl P60 AND T►-1 E �FGI.ES rsE 10*r6CTFv ANP Q-6rLACW -110,01�c�1i�.1C� T�QEIJGN�S `74AL. L- Ot (�2ov1�ED� EAcM : -7� ' Loora, ;;' W10f � LOT A-! I' BEEP, ' � 5,) Lc�c.►� �I�I E5 �-i1-I�•t.L. P� �F" �e�FoQ� M P6 �I /l 1 p �'r �S EJ•�?�/O. l ti E IT Yr. �E �lp SBevrio t3Ew1�� j•� lll-11.E55 D1'1_11;2W 15E 4jPCG1�iEDf "i�i-�C N �,,.!►T►a 'f I'f L� 'Q � 'iµ� '(-o x,11.{ o F o ' p)e vrlj 6,1 Dc tcj.. t4 Eta L,..?rl 1%6ULt rIOQ�F, 7,) 'rof SIL ' 5v(�j4olt- SNhLa- ►�E `7T�I�J��E� z 10 of 'TltC4 4445 If 10' 1%Li1 A2WL V Y 37't �/Fb A u p �! Pt6GrD I�1{ f1a G4��khl `�11i1L�Q �►F►L�55 o-t�1 ��J►5>; SPEC-1 f gyp. c is'• o E,rIsT $err- fIN. G«or I 1 A ' FILL riew l _ IZ� -(y Pi EN -12 PL,..A d F SUBSURFACE DISPOSAL. SYSTEM LOCATED IN AS PREPARED FOR J O N tJ DATE: H,6,Y SCALE: ilk I gyp ' 06 MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS i 66 PARK STREET • ANDOVER, MASSACHUSETTS.01810 TEL (617) 475-3533, 373-3721