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Home My WebLink AboutMiscellaneous - 52 BANNAN DRIVE 4/30/2018 c on /�D) E cn 00 2) :rrt .o <' 3 i Residential Property Record Card#1 of 1 Parcel Year:2018 PARCEL—]D: 210/038.0-0111-0000.0 MAP 038.0 BLOCK 0111 LOT 0000.0 PARCELADDRESS: 52 BANNAN DRIVE as of:7/7/2017 PARCEL INFORMATION Use-Code: 101 Sale Price: 0 Book: 01318 Tax Class: T Sale Date: 1/1/1977 Page: 0021 Tot Fin Area: 2384 Sale Type: Cert/Doc: Tot Land Area: 0.71 Sale Valid: N Owner#1: CYR, DONALD J Grantor: Owner#2: CAROL ACYR Address#1: 52 BANNAN DRIVE Inspect Date: 5/27/2010 Road Type: T Exempt-B/L%: 0/0 Address#2: Meas Date: 5/27/2010 Rd Condition: P Resid-B/L%: 100/100 NORTH ANDOVER MA 01845 Entrance: X Traffic: M Comm-B/L%: 0/0 Collect ID: RRC Water: Indust-B/L%: 0/0 Inspect Reas: C Sewer: Open Sp-B/L%: 0/0 RESIDENCE#1 INFORMATION LAND INFORMATION NBHD CODE: 6 NBHD CLASS: 6 ZONE: R3 Style: CL Tot Rooms: 7 Main Fn Area: 1344 Attic: Seg Type Code Method Sq-Ft Acres Influ-1/2/3 Value Class Story Height: 2 Bedrooms: 4 Up Fn Area: 1040 Bsmt Area: 1320 Roof: H Full Baths: 2 Add Fn Area: Fn Bsmt Area: 1 P 101 S 30952 0.71 100/ 208539 Ext Wall: FB Half Baths: 1 Unfin Area: Bsmt Grade: Masonry Trim: Ext Bath Fix: Tot Fin Area: 2384 Foundation: CN Bath Qual: T RCNLD: 248506 Kitch Qual: T Eff Yr Built: 1978 Mkt Adj: Heat Type: HW Ext Kitch: Year Built: 1975 Sound Value: Fuel Type: G Grade: AG Cost Bldg: 248500 Fireplace: 1 Bsmt Gar Cap: Condition: A Att Str Val1: DETACHED STRUCTURE INFORMATION Central AC: N Bsmt Gar SF: Pct Complete: Att Str Val2: Str Unit Msr-1 Msr-2 E-YR-Blt Grade Cond %Good P/F/E/R Cost Class Att Gar SF: 576 %Good P/F/E/R: /100/100/78 PV S 648 1988 A A /50//42 13300 1 Porch Type Porch Area Porch Grade Factor SE S 96 1988 A A ///83 1400 1 W 120 VALUATION INFORMATION SKETCH Current Total: 471700 Bldg: 263200 Land: 208500 MktLnd: 208500 24 Prior Tot: 471700 Bldg: 263200 Land: 208500 MktLnd: 208500 C PHOTO -- - —. 576 Sq.Ft. i rr 24 24N1f��2 24 Sq.Ft.28 W 2 ,w F r 1x20 Sq.Ft. 10------------------------------------ i 24 12 FU FM/B 36 1040 Sq.Ft. 1320 Sq.Ft. 26 40 52 BANNAN DRIVE Commonwealth of Massachusetts Title 5 Official Inspection Form n. Subsurface Sewage Disposal System Form-Not for Voluntary Assessm 52 Bannon Drive Property Address Donald Cyr Owner Owner's Name information is required for every North Andover MA 01845 7-18-2017 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may rjqt be altered in any way. Please see completeness checklist at the end of the form. V LA0 Impg out When filling out forms A. General Information on the computer, �01� use only the tab p key to move your 1. Inspector: cursor-do not Neil James Batesonuse key the return Name of Inspector .� dr-� Bateson Enterprises Inc. lel Company Name 111 Argilla Road Company Address Andover MA 01810 City/Town State Zip Code 978-475-4786 SI-15 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 ❑ Nee Further Evaluation by the Local Approving Authority 1 /)/W7-18-2017- InsbeLvtori Signat 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 has a design flow.of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 52 Bannon Drive Property Address Donald Cyr Owner Owner's Name information is required for every North Andover MA 01845 7-18-2017 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: After permit from B.O.H., install new outlet tee in septic tank, new outlet pipe to d-box& new d-box, inspection from B.O.H., septic system now passes Title 5 Inspection. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): I t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 •, 5�T7�EDry��' wgcov PUBLIC HEALTH DEPARTMENT Town of North Andover Community and Economic Development Division CERTIFICATE OF COMPLIANCE As of: July 7, 2017 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: D-Box and Pipe Repair of an On-Site Sewage Disposal System By: Neil J. Bateson, Bateson Enterprises Inc. At: 52 Bannan Drive Map 38 Lot 111 North Andover, MA 01845 I e of this certificat all not be construed as a guarantee that the system will function satisfactorily. Grant Public Health Agent 120 Main St.,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.9542 Web www.northandoverma.gov I North Andover Health Department (ommunity and Economic Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 52 Bannon Drive MAP: 38 LOT: 0111 INSTALLER: Bateson DESIGNER: PLAN DATE: BOH APPROVAL DATE ON PLAN: INSPECTIONS TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: DATE July 17, 2017 D-Box and Pipe SITE CONDITIONS ❑ Contractor reports any changes to design plan ❑ Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer ❑ Topography not appreciably altered Comments: SEPTIC TANK ❑ Building sewer in continuous grade, on compacted firm base ❑ Cleanouts per plan ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon tank has been installed H-10 loading ❑ Monolithic tank construction Watertightness of tank has been achieved by visual testing ❑ Inlet tee installed, centered under access port ❑ Outlet tee installed, centered under access port (gas baffle/effluent filter) ❑ inch cover to within 6" of finish grade installed over one access port ® Hydraulic cement around inlet & outlet Comments: T in Tank, Replaced Pipe PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon Pump Chamber installed ❑ H-10 loading ❑ Monolithic tank construction ❑ Inlet tee installed, centered under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off floats working ❑ Separate on/off floats ❑ Drain hole in pressure line ❑ cover at final grade installed over pump access port ❑ Water tightness of tank has been achieved by testing ❑ Hydraulic cement around inlet & outlet Comments: CONTROL PANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: basement ❑ Alarm signal located inside: basement Comments: DISTRIBUTION-BOX ® Installed on stable stone base ® H-20 D-Box ® Inlet tee (if pumped or >0.08'/foot) ® Hydraulic cement around inlet & outlets ® Observed even distribution ® Speed levelers provided (not required) ® Schedule 40 PVC Pipe Comments: � I SOIL ABSORPTION SYSTEM (General) ❑ Bottom of SAS excavated down to C soil layer, as provided on plan ❑ Size of SAS excavated as per plan ❑ Title 5 sand installed, if specified on plan ❑ 40 Mil HDPE barrier installed ❑ Laterals installed and ends connected to header (and vented if impervious material above) ❑ Elevations of laterals and chambers installed as on approved plan ❑ Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ❑ Brand and Model of Chamber: Standard Quick 4 Infiltrator Chambers ❑ Number of chambers per row: ❑ Number of rows (trenches): Comments: Total Chambers = FINAL GRADE ❑ Loamed ❑ Seeded ❑ Cover per plan Comments: DOCUMENTS NEEDED ❑ Certification of Installation Form submitted By engineer and signed and dated by Engineer and installer ❑ As-Built Plan BM = HR = HI = SYSTEM ELEVATIONS ROD AS-BLT INVERT DESIGN INVERT ELEVATION ELEV ELEV Benchmark Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN Distribution Box OUT Lateral 1 TOP Lateral 1 INVERT Lateral 2 TOP Lateral 2 INVERT Lateral 3 TOP Lateral 3 INVERT Lateral 4 TOP Lateral 4 INVERT Lateral 5 TOP Lateral 5 INVERT Lateral 6 TOP Lateral 6 INVERT Top of Chamber Bottom of Bed/Chamber SKETCH PLAN Rj 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 10 101 ® Private drinking well 75 1002 50 ® Irrigation well 75 100 ® Surface Water 25 50 ® Bordering Vegetated Wetland , Salt Marsh,.Inland/Coastal Banka 75 100 ® Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ® Trib. to surface water supply 325 325 ® Public well 400 400 ® Interim Wellhead Prot. Area ® Reservoirs 400 . 400 ® Drains (wat. supply/trib.) 50 100 ® Drains (intercept g.w.) 25 50 ® Drains (Other)Foundation 10(5) 20(10) ® Drywells 20 25 ' 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 i I/ Commonwealth of Massachusetts Title 5 Official Inspection Form [ r p � Subsurface Sewage Disposal System Form -Not for VoluntarYAssessme M s 52 Bannon Drive Property Address Donald Cyr Owner , Owner's Name information is North Andover MA 01845 7-5-2017 required for every page. Citylrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms \'4 on the computer, G use only the tab 1. Inspector: e 0 0 key to move your cursor-do not Neil J. Bateson use the return Name of Inspector key. fit► Bateson Enterprises Inc. Company Name 111 Argilla Road Company Address Andover MA 01810 Citylrown State Zip Code 978-475-4786 SI-15 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 ❑ Niftecd[A Furthe,, Evaluation by the Local Approving Authority 7-5-2017 Ins ct is ignature V 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 has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doe-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 s *. � r � . ��i Q �.,�� '"7 `:,�_, Commonwealth of Massachusetts • W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments •''� 52 Bannon Drive Property Address Donald Cyr Owner Owner's Name information is North Andover MA 01845 7-5-2017 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ® One or more system components as described in the"Conditional Pass" section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ® N ❑ ND (Explain below): l5ins.doq•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 52 Bannon Drive Property Address Donald Cyr Owner Owner's Name information is required for every North Andover MA 01845 7-5-2017 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ® N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ® N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ® N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ® N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ® N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.dog•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 52 Bannon Drive Property Address Donald Cyr Owner Owners Name information is North Andover MA 01845 7-5-2017 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health Land Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for 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 must be attached to this form. 3. Other: Outlet tee in septic tank, outlet pipe to d-box&d-box needs to be replaced. D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than /2 da flow Y t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 52 Bannon Drive Property Address Donald Cyr Owner Owner's Name information is North Andover MA 01845 7-5-2017 required for every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. El ® 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. ❑ Z 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. t5ins.dog•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 1 Commonwealth of Massachusetts u W Title 5 Official Inspe tion Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 52 Bannon Drive Property Address Donald Cyr Owner Owner's Name information is North Andover MA 01845 7-5-2017 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. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 52 Bannon Drive Property Address Donald Cyr Owner Owners Name information is North Andover MA 01845 7-5-2017 required for every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ® Yes ❑ No -lot Is laundryon a separate sewage system? (Include laundrys stem inspection El Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d Yes 9 � Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(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: t5ins.doe•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 52 Bannon Drive Property Address Donald Cyr Owner Owner's Name information is required for every North Andover MA 01845 7-5-2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Pumped this year, 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): t5ins.dor•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 52 Bannon Drive Property Address Donald Cyr Owner Owner's Name information is North Andover MA 01845 7- -2 required for eve 5 017 4 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 42 years old, 8-20-1975 as built plan Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.3 feet Material of construction: ® cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): 4"cast iron through wall, 3" PVC in house, no leaks visible Septic Tank(locate on site plan): Depth below rade: 0.3 p g feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 7'x 5'x 4' Sludge depth: 1" t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form u � Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 52 Bannon Drive Property Address Donald Cyr Owner Owner's Name information is North Andover MA 01845 7-5-2017 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 31" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Tape measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet baffle ok. Outlet baffle ok. Depth of liquid at outlet invert. No evidence of leakage. Outlet pipe to d-box has dip in it, needs to be replaced Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 52 Bannon Drive Property Address Donald Cyr Owner Owner's Name information is North Andover MA 01845 7-5-2017 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons i Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts H W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 52 Bannon Drive Property Address Donald Cyr Owner Owner's Name information is North Andover MA 01845 7-5-2017 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert -1/2 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box cover broken, replaced same. D-box badly corroded, holes in same. D-box liquid level 1/2" below inverts of pipe, evidence of leakage. Evidence of carryover. D-box 16" deep. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): i * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.docr-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 52 Bannon Drive Property Address Donald Cyr Owner Owner's Name information is North Andover MA 01845 7-5-2017 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 1 field 20'x 45' ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil ok. Vegetation ok. No sign of ponding to surface. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins.dog•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 52 Bannon Drive Property Address Donald Cyr Owner Owner's Name information is required for every North Andover MA 01845 7-5-2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doy•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts u Tale 5 Official Inspection F 0 rm Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 52 Bannon Drive Property Address Donald Cyr Owner Owner's Name information is required for every North Andover MA 01845 7-5-2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: Z hand-sketch in the area below drawing attached separately 4O C�ce ' 3P ri t L4 w� �� ✓ tat t5ins.doe•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 52 Bannon Drive Property Address Donald Cyr Owner Owner's Name information is North Andover MA 01845 7-5-2017 required for every page. Cityrrown 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: 3-27-1975 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Design plan ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: As per test pit data on design plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.do¢•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 52 Bannon Drive i Property Address Donald Cyr Owner Owner's Name information is North Andover MA 01845 7-5-2017 required for every page.e. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked Z Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface •Sewage Disposal System Page 17 of 17 P Y 9 Summary Record Card generated on 5/22/2017 2:41:00 PM by Karen Hanlon Page 1 Town of North Andover - Tax Map # 210-038.0-0111-0000.0 Parcel Id 10414 52 BANNAN DRIVE CYR, DONALD J. 52 BANNAN DRIVE N. ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Zoning2 1 Residential Zoning3 1 Residential Size Total 0.71 Acres FY 2017 UB Mailing Index Name/Address Type Loan Number Active/lnact. From Until CYR,DONALD J. . Payor 52 BANNAN DRIVE N.ANDOVER,MA 01845 UB Account Maint. Account No Cycle Occupant Name Active/Inactive Bldg Id. 16103.0-52 BANNAN DRIVE Last Billing Date 4/6/2017 3160145 03 Cycle 03 Active UB Services Maint. Account No.3160145 Service Code Rate Charge Multiplier/Users MISCFEE ADMIN FEE 0.635/8 7.82 1/ WTR WATER 01 ALL METER SIZE 45.60 /1 UB Meter Maintenance Account No 31_601.45 601.45 —Serial No Status Location Brand Type Size YTD Cons 32707824 a Active 00 b Badger w Water 0.63 0.63 487 Date Reading Code Consumption Poste6Date Variance 3/3%2017 585 a Actual 12 4/12/2017 2% 12/5/2616 573 aActual 12 1/23/2017 -35% 9/6/2016 561 a Actual 19 10/24/2016 98% 6/6/2016 542 a Actual 10 8/2/2016 -15% 3/2/2016 532 a Actual 11 4/22/2016 11% 12/3/2015 521 a Actual 10 1/20/2016 1% 9/3/2015 511 a Actual 10 10/16/2015 -1% 6/3/2015 501 a Actual 10 7/24/2015 -18% 3/4/2015 491 a Actual 12 4/28/2015 -48% 12/5/2014 479 aActual 24 1/15/2015 60% 9/4/2014 455 a Actual 15 10/15/2014 83% 6/4/2014 440 a Actual 8 7/16/2014 -26% 3/6/2014 432 aActual 11 4/11/2014 -3% 12/4/2013 421 aActual 11 1/17/2014 25% 9/6/2013 410 a Actual 9 10/15/2013 -3% 6/7/2013 401 a Actual 9 7/24/2013 8% 3/11/2013 392 aActual 9 4/22/2013 -19% 12/6/2012 383 aActual 10 1/9/2013 -63% 9/11/2012 373 aActual 30 10/15/2012 159% 6/7/2012 343 a Actual 11 7/16/2012 0% 3/8/2012 332 a Actual 11 4/14/2012 -52% 12/8/2011 321 aActual 23 1/17/2012 55% 9/8/2011 298 a Actual 16 10/13/2011 63% 6/2/2011 282 a Actual 9 7/20/2011 -12% 3/4/2011 273 a Actual 10 4/13/2011 -29% 12/6/2010 263 aActual 15 1/12/2011 -56% 9/3/2010 . 248 a Actual 36 10/15/2010 109% 6/3/2010 212 a Actual 17 7/15/2010 87% 3/4/2010 195 a Actual 9 4/14/2010 -16% F Of MORTol 7935 O; Town of North Andover SACHUS��' HEALTH DEPARTMENT f, CHECK#: /_ DATE: 7 - 7 -,AO l F LOCATION: Sa., Aa on 1-1/0 NAME: Cu CONTRACTOR NAME: AlLO/? Type of Permit or License: (Check box) ❑ 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(DWG) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector I $ Title 5 Report �O nom! 0 S $ 50 ❑ Other:(Indicate) $ Healt Agent Initials White-Applicant Yellow-Health Pink-Treasurer Ma Block-Lot . MI)II�: , Commonwealth of Massachusetts P opt 038.00111 BOARD OF HEALTH C Permit No North Andover `` �S,�E. BHP-2017-0503 P.I. FEE F.I. $175.00 DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted Todd-Bateson to(Construct)an Individual Sewage Disposal System. at No 52 ------BANNAN-------------------DRIVE--------------------------------------------------------------------------------------------------------------------------------- as shown on the application for Disposal Works Construction Permit No. BHI'-2017-0S Dated Jul 17 7 ----------- Issued On: Jul-17-2017 BO OF HEAL Application for Septic Disposal System 7- 1,3s /7 Construction Permit - TOWN OF TODAY'S DATE NORTH ANDOVER, MA 01845 $250;00-Fall Repair - $425.00-Component _Application is hereby made for a permit to: ❑Construct a new on-Rite sewage disposal system' ❑Repair or replace an existing on-site sewage disposal'system; / .� [Rje� or.replace an existing system component—What? i�DX ,,t' d<1/4/ . I �+ A. Facility Information Address or Lot# Cityfrown 1 2:*TYPE OF SEPTIC SYSTEM*: ➢ El Pump cavity(choose one) "If pump sys em,attach copy of electrical permit to application='"' SOF O�Pg ➢ ETConventional System (pipe and stone'system) ➢ ❑Infiltrator or Biodiffuser(Gravel-Less)(Attach a copy of your certification fo install this type of system.) ➢ ❑Pressure Distribution S.A.S.(No D-Box) ➢ ❑Pressure Dosed(D-Box Present)S.A.S. ➢ ❑ Does the system require an effluent filter? Yes No If yes, does plan specify make and model of filter? YES=(no further info. needed) NO=(installer must specify brand of rilter before DWC issuance) What is the Make? What is the ModcV' 2. Owner Information Mame Address(if different from above) `^'Y JU-9 City/Town State Zip Code Telephone Number 3. Installer Information `T� ��-fe.fid/✓ Name Name of CompiRATEdON ENTERPRISES,INC, 111 A Gil iARC)AE) Address - DOVER,MA eiaip Cityrrown State Zip Code 97? ?/S-J1/"-3 Telephone Number(Cell Phone#if possible please) 4. Designer Information Name Name of Company Address City/Tom State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 AP, Bat On for Septic Disposal SVs ern -/3 ' ,�+. �,• � _ ---�--,;, .TODAY'S DATE ` Constructlon Permit = TO'C T O * �► .!" $:250.00 T Full Repair OV M, 01845 s125.60.Compon'ent SwcNus PAGE 2 OF 2 A. Facility. Information continued.... S. Type'of Building; BlIesidential-Dwelling or❑Commercial B. Agreement The underslgned agrees to ensure.the construcdon 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 D/sposal Regulations for the Town of North Andover,and not to place;the system 1n operation until a Certificate of Compliarfce has been issue this Board of Health. Nams Date atlApprove d of He Ith epresentativ ame - [late Application Disapprov . edfor following reasons:- For Office Use OMv 1 -FeeAmcbed? . Yes No 2- ProjectMariager Oblrgatron Form Attached? Puma Spck,„? jfs6)A�vv ofEle�r�rical Permrt'.,i Xes No l/ 1 4. Foundation As BidW?(hew construction ronly); :y (Same scale as aPP Y P ro ed Ian No ). • S. FloorPLws?(hew colistruction•only). y NO - flpplfcatidn{or.p(sppsai 5ysterfi: onstMdIOh Permft�Rase 2 nt 7 I i SEP' `IC S`i $"Y' •i�T " '�lt,�;, SRO, '.['iV�A'�T�!►�GMMNT'�t38 ,iGd3'It}fifS As flic•N Aadovrr lioc€csetl�ietxllCt frsF#itmtntcdgzr f�thasegtic apetc fc2.thaprcretrp s� AA1 AJAi,T (Ad*race of s6t ��) ph"by AM dftd Diftd — l3—[ s A wft ievidom dated sed dsce) I understand the following ikbligatiojn fot mmtagemcat of+tbis pp#cct: 1. As the latbuC4 I am.ob2pted to obWasff aad'Board ofZ3 sPP pimom to aap.'aa�t cm R es#e: I moat havt�� a CAM . • mM 2. As die it huer;,I.=ifat mot=7 and aIUVW io" Rhofk��' 4t�itrParaort scot�ioc�'ai�ed� a m OOg��s Q��mattAget,or nap •ibem tlu+ea•ahalLh��g�Catble. � � md the spsttia is notundy,tkci! 3 As tai x atu. 4D bav+ee ted9 eted pi o #ti the applts bje ittapect s as a�oa'1i btsdaa, :i t= Ise. fct ## fat a ffi`sp=404 t 4c etflot hm to b4 pmsca�t . b. OAKtfmrfdatfisap far a•�idrbit�Ifi•(ar e•�1 trx Srotn dte . . . . •ecu inust ba ftibmitted trs 8 ofH . for•,16 tt<fctr . -1h dine.'ji�smltae�riu$t . •_ 6ep ,� �;��'�tk�st be sesdy sad able to . . .. •eatud gw�p.to�cr3c��Iaurixo : . . . • ` C. Emust roque msp ion evhs i tll$r�dbt a entrap C: InsmlIer data dot liave to be vafute.' 4. As•tbe iustdim'I an d that 11:41 S c'(etbsrr6c�r �� I is MFIete,•die-jasszenaftta of the srtet}i � � atzi'teq�tired d i ed hfsv&tloa: . 5.. Ab tb •I tm� t�. cx•�f tfie�lio ca�astoa, Via: Detral�atit�tt.d ,p�c+sperrkr�r�daoa crft�e pari 1 ,Ger s+e�cbeal InspetiYacoftice mdmd CIDU used .' Q 'Finalaapeadoa by8o�of aleAltLr st 'ort � d hwiMaMIA ofunk DI-4aJ911PA sftm pmt PSP bei g 'untl otJru �. camper ffie -• •bli4lf ��A}fM7rffAAt S�'�fi �t.CO� /yn� �+•�ir• ! .r s e 7� �4ffOmg .. 'd Undersd'Ice�udSpdc.I I e T 7949 Of SNO e�q9 � . . O O< 9 Town of North Andover ' '•�,; o:: ,' HEALTH DEPARTMENT ,SSACHU CHECK#: DATE: 7 / 10/7 LOCATION: J`�Z.- /.X�.n/�ci✓n �r`i lie.. 7 H/O NAME: ► CONTRACTOR NAME: Type of Permit or License: (Check box) s ❑ Animal $� ❑ Body Art Establishment $ ❑ Body Art Practitioner $ t ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational.Camp $ 0 Sun tanning $ ' ❑ Swimming Pool $ ❑ Tobacco $ y ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval (40,; 6( '$ fgJ Septic Disposal Works Construction(DWC) $ 7 S 13 Septic Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Othen(Indicate). -$ 0j th'Agent Initials White-Applicant Yellow-Health Pink-Treasurer North Andover Health Department Community and Economic Development Division 07/05/2017 Address: 52 Bannon Drive All North Andover Residents with Septic Systems and Garbage Disposals Please note that due to a recent review of a Title 5 Report,your property has been identified as maintaining a working garbage disposal that is being used in conjunction with a septic system. The Health Department is concerned for the longevity of your septic system. Garbage disposals are never recommended where septic systems are used, but if they are installed, the system must be specifically designed to handle the waste from them; your system can not handle the waste as designed. Please note that continued use of this disposal could quickly cause a pre-mature failure of your septic system, resulting in a large expenditure to replace it. The North Andover Health Department recommends that you remove it from your home as soon as possible. Some information regarding regular maintenance of your septic system is attached. Please call the Health Department at 978.688.9540 if you have any questions, or e-mail your questions to: healthdept@northandoverma.gov. Thank you for taking the time to consider the impact that your current setup has on your septic system and the environment. Sincerely, B 'an L rasse, CEHT Director of Public Health 120 Main Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.9542 Web http://www.northandoverma.gov Town of North Andover Massachusetts Fo-;m No. 1 BOARD OF HEALTH s� AORTy, - -19 /9 / t F. Avn1L7T" .� } APPLICATION FOR SITE TESTING/INSPECTION Applicant Lx-o-� NAME n A D D R E TELEPHONE Site Location r Engineer NAME ADDRESS TELEPHONE Test/Inspection Date and Time 17-J A RMAN, BOARD OF HEALTH Fee— Z ao Test No. e3 3 9 t :C. tp Plb . Permit No. g S.S. Permit No D.W.C. No. _ r 3 TO: NORTH ANDOVER, MASS ALk 19 7� BOARD OF HEALTH FROM: DESIGN ENGINEER Re: Soil Absorption Sewage System Inspection This is to certify that I have inspected the construction of the said disposal system at J9A /Y/V/I-/u b/R North Andover, Mass. SITE LOCATION The grades and construction are as specified in my plans and specifications dated 75� SN OF Mgss �2 JOS GH eg. ��W Re nitarian � of FWSJ � NALQ ��' 6UN..r • t` 447 o BAn.?I LL`s ISTEt ,�`w SSIONAISP 4 tZ- Zg71 ,39 Zoo.cac.J G 30143 F z 5x-TIEOT o:F- LU CAI f ' 4o 4- 32 `A5.00 N At L 10 T,P, too Tc�o t l.c.. SrT 00 L OTr : t� . to Joseph j. barbacgallo, r.s. 1 westward circle no. reading mass. r , �•��, a �.M �� _j 3"WA Fi�CF'EAjTTJ!IC �/�u�3j�.: L4 F'Frit"kAlZL)�jAAP� C)E St o Et)T tn:E�'y�-1°d2 �.. ` e2d ABSORPTIOx(i BED END SECTION z J. t AN -zg ear 7. 99-PJ DISPOSAL SYSTEM FR0FI! I FILL 25' ALL Y711'-+�-TI nN S J _ � x., 45 -E Ir i ABSORPTION 8PED FLAN f` 7,S MoUg ALL ML.L � 6Q0)*5oIL.° FL.1.. To I 0135. HOL C r �°� }!:,�� FEIRC. R X-E TEST DATE= 15 HIM O1 mop 6/7,-7h 5- 2 FILL `} 4 P LE I-C TEST 1,2 11 TaP 4 SUBSOIL a !:-;aTTJFkAmD 131410 " v J.y 1 wAr1=K 11/74. WA11511) 9 ,o 3/2.-7/75 ,� �, r � �_ �9 �� 5d.l-UVAI\I 94�1 )l-40"AL410 , Cv H IIA'Yfgyj N�� t'�i�lar`�It��► h'1/.�`.sa �4�9P�`� lit-401 Syl frs �{fir I r t l!J i � xA � 11 0'titi 1 oG • ►JAIL IU rL-t,p�„�It C � Cb•M. •IOD+O �N NdN Pr` ]I v /►FTW-3 Fiu, HAO P.: ' OU cam. Address , �a- 6"Allj-tif Title of File Page 9 of Date File Open: Date file closed: DocDocument/Action Title Date of Refer to other Purpose of Document/Action and notes: action Document/ document/ Nun Action Department — I Board of Appeals - Board of Health - Planaing Board - Conservation Commission - Building De artrnerA p t G