Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 54 LACY STREET 4/30/2018 (2)
54 LACY STREET _ 210/105.D-0050-0000.0 1 NOPTH 7226 Town of North Andover HEALTH DEPARTMENT ,SSACHUSt� CHECK#: DATE: LOCATION: n ell 4, H/O NAME: CONTRACTOR NAME: 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 $ ❑ TrashlSolid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ Title 5 Report $� ❑ Other. (Indicate) $ Health Agent Initials White-Applicant Yellow-Health Pink-Treasurer D.F.CLARK,INC. 40836 Town of North Andover 5/14/2015 54 Lacy Street, North Andover 50.00 r Checking-Institution of 50.00 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 54 Lacy Street t Property Address John and Mary Wallace Owner Owner's Name information is North Andover MA 01845 Aril 22, 2015 required for every p page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms RECEIVED on the computer, use only the tab 1. Inspector: MAY 8 2015 key to move your cursor-do not George F. Norris use the return Name of Inspector T. a1VVN OF NORTH ANDOVER key. D.F. Clark, Inc. HEALTH DEPARTMENT r� Company Name 22 Mitchell Road, PO Box 265 Company Address Ipswich MA 01938 Cityfrown State Zip Code (978) 356-5638 S14051 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 F: fww; � 1aal15 Inspector's ignature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 54 Lacy Street Property Address John and Mary Wallace Owner Owner's Name information is North Andover MA 01845 Aril 22 2015 required for every P 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: ® 1 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): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 54 Lacy Street Property Address John and Mary Wallace Owner Owner's Name information is required for every North Andover MA 01845 April 22, 2015 page. City/Town 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-3/13 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 wM 54 Lacy Street Property Address John and Mary Wallace Owner Owner's Name information is North Andover MA 01845 A rll 22, 2015 required for every p page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *' This system passes if the well water analysis, performed at a DEP certified laboratory, for 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: 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 Y day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 54 Lacy Street Property Address John and Mary Wallace Owner Owner's Name information is North Andover MA 01845 Aril 22, 2015 required for every P page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 54 Lacy Street Property Address John and Mary Wallace Owner Owner's Name information is North Andover MA 01845 Aril 22 2015 required for every p page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) (310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 600 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 54 Lacy Street Property Address John and Mary Wallace Owner Owner's Name information is required for every Northover AndMA 01845 April 22, 2015 page. City/Town State Zip Code Date of Inspection D. System Information Description: As per design plan Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d Well water 9 ( Y 9 (gP ))� Detail: Sump pump? ® Yes ❑ No Last date of occupancy: Currently occupied 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 54 Lacy Street Property Address John and Mary Wallace Owner Owner's Name information is required for every Northover AndMA 01845 April 22, 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: System was last pumped in the Spring of 2014 according to the 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 54 Lacy Street Property Address John and Mary Wallace Owner Owner's Name information is North Andover MA 01845 April 22, 2015 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: System as-built is dated 11/21/77 according to the North Andover Board of Health file. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.66 feet Material of construction: ® cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line. 25 feet Comments (on condition of joints, venting, evidence of leakage, etc.): Building sewer pipe is in good condition, there are no signs of leakage. Septic Tank(locate on site plan): Depth below grade: 1feet 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: 4 1/2'W x 8' L x 4' D Sludge depth: 2" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 54 Lacy Street Property Address John and Mary Wallace Owner Owner's Name information is North Andover MA 01845 Aril 22, 2015 required for every p page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 27" Scum thickness 0" Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A How were dimensions determined? Tape Measure and Sludge Judge 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 and outlet baffles are in place, liquid level is at the outlet invert, pumping is not required at this time, septic tank is in good condition. 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: Date t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 54 Lacy Street Property Address John and Mary Wallace Owner Owner's Name information is required for every Northp Andover MA 01845 April 22, 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No l5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 54 Lacy Street Property Address John and Mary Wallace Owner Owner's Name information is North Andover MA 01845 Aril 22, 2015 required for every P 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 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box is 12" below grade, distribution is equal, there are no signs of leakage or solids carryover, D- box is in good condition. 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.): * 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 54 Lacy Street Property Address John and Mary Wallace Owner Owner's Name information is North Andover MA 01845 Aril 22 2015 required for every p 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 leach field 20'W x 45' L ❑ 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.): SAS is under lawn area in the front yard, there are no signs of ponding or hydraulic failure, inspected SAS with inspection camera and found it working properly. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 54 Lacy Street Property Address John and Mary Wallace Owner Owner's Name information is North Andover MA 01845 Aril 22, 2015 required for every p 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts _ W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 54 Lacy Street Property Address John and Mary Wallace Owner Owner's Name information is North Andover MA 01845 April 22, 2015 required for every page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately Well—SAS = 160' A-1 = 18' B-1 = 14'6" Deck A-2 = 20'6" B-2 = 17'6" A-3 =26'2" O Water B-3 =24'4" Garage Sewr A # —Septic Tank( enter cover) # —Septic Tank Outlet cover) S e Wa #3 —D-box (un r walkway) l,�svrich, �� Paved driveway D.F. CLARK TITLE V SEPTIC SYSTEM PROFESSIONALS INC. rk 356.563 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments cw 54 Lacy Street M Property Address John and Mary Wallace Owner Owner's Name information is April North Andover MA 01845 A 22 2015 required for every p � , page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: .8 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 9/20/77 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: Joseph J. Barbagallo performed soil testing on 4/14/77, Groundwater was observed at.8' in hole TP2. According to design plan the bottom of SAS is 4' above the ground water in hole TP2. There is no new groundwater information in the area. At time of inspection a site exam was made, site was level, pond abutts the back edge of property, cellar was dry and has a sump pump, and no shallow wells were located. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 54 Lacy Street Property Address John and Mary Wallace Owner Owner's Name information is North Andover MA 01845 Aril 22, 2015 required for every p page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3113 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 17 of 17 J D.F. CLARK D.F. CLARK, INC. TITLE V SEPTIC SYSTEM PROFESSIONALS INC. May 13, 2015 RECEIVED MAY 18 2015 Mr. &Mrs. John Wallace TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 54 Lacy Street North Andover, MA 01845 RE: Title 5 Inspection 54 Lacy Street, North Andover Dear John & Mary: Please find enclosed the Subsurface Sewage Disposal System Inspection Report for the above referenced property. As noted on Part B (Certification) of the report, the system Passes the inspection criteria. This inspection is good for the next two (2) years; you may extend the life of the inspection to three (3) years by having the septic tank pumped annually (before anniversary date of inspection). Thank you for allowing us to be of service to you on this project. Please contact us if you have any questions regarding this matter. Sincerely, D.F. Clark, Inc. g FP George F. Norris Title 5 Inspector Enclosure cc: VNorth Andover Board of Health D.F. Clark, Inc. file 1 Y.. \I d PO Box 265 24A Mitchell Road Ipswich,MA 01938 978-356-5638 Fax 978-356.5500 Toll Free 888.1�F-CLARK Commonwealth of Massachusetts W City/Town of No.Andover System Pumping Record Form 4 M DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. �.� --A. Facility Information Important: (.� 4i "'" � When filling out 1. System Location- forms on the `Vv'� TOWN OF NORTW ANOOVIR computer,use R NT only the tab key Address to move your No.Andover Ma 0845 cursor-do not --- --— - --use the return City/Town State Zip Code key. 2. System Ojnj:), IC CC Name Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record / 1. Date of Pumping 2. Quantity Pumped: ! y0 0 Date Gallons 3. Type of system: ❑ Cesspool(s) 0"'Septic Tank ❑ Tight Tank El Grease Trap El Other(describe): 4. Effluent Tee Filter present? ❑ Yes Rfl�No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: 112Jk%' Name Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 Signat aul r Date Sign t e of kekeiving Facility Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 Commonwealth of.Massachusetts City/Town of No Andover System Pumping Record f�r�Y .l 4 2013 l Form 4 TOWN OF NORTH ANDOVER i lug HEALTH DFP/'PTf 1r:N DEP has provided this form for use by,local Boards of Health. Other forms may be used, b5u the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important:When filling out forms 1. System Location: on the computer, 3+ use only the tab La G�/ -r key to move your Address cursor-do not No andover Ma use the return City/Town State Zip Code key. 2. System Owner: wal 10, Name renin Address(if different from location) City/Town State Zip Code Telephone Number— _ B. Pumping Record N1 Gallon 1. Date of Pumping 2. Quantity Pumped: ` s ©� Date s 3. Type of system: ❑ Cesspool(s) JE�-Deptic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: C" 6. System Pumped By: 7/, 2 Name Vehicle License Number Stewart's Septic Service Company t 7. Location where contents were disposed: Stewart's Pre-treatmen t, 20 So. Mill Bradford, Ma Q1835 Signature Date Signa t a of ing Facili Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 7!'"t",�����• 'rYi: "ti{i��g{1~'iFsylt :i,;tili),;;, ,',,• �.•• � ,1h ply J:;• ,`�I,,.. .. •.gt'1{r..'r7�i.t�5.' ' Y�.17�.i�7+;'j Yj�t4 fr l��111. RECEIVED 't. Woo•. 4 C 0 6 05 J > f()WN OF NOR-I'll �NLX,.I T-Q NW FNOR OVER 11.E I'� !/ / ` 5 Y 9'T'�?l�•i p O�},t p N U �,��` HEALTH DEPARTMENT ZZ �s )vuuC I'cn� n; NA rvKu ON nAyleg; x(>vriNr 000d coUflrriuN • . • Y� •vu. r-v v ,� �YY 0�4;8 rx KOM ; dr�YY�,8J iN PLn�.t • gXC�98rY8.30l,lpe .,•... ���t�.o KUNSn���. SOL moom rD CA XA Yp Y�iC o rNeR X P ,� N t'VMMrrNT�. Vnr�rrr� tx�rryr�Xx�v r� TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD SYSTEM OWNER& ADDRESS SYSTEM LOCATION 10, BopIRID. No- 10 IV6 V ek4 y�)a DATE OF PUMPING:-6----(fF-i2Fyl ---QUANTITY PUMPED: CESSPOOL: NO--X-__,_YES _ Septic Tank: NO____ YES_ NATURE OF SERVICE: ROU TIN E-V_EMERGENCY__ OBSERVATIONS: GOOD CONDITION FULL TO COVER 14EAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDSFLOODED SOLID CARRYOVER—OTHER EXPLAIN System Pumped by COMMENTS: CONTENTS TRANSFERRED TO Commonwealth of Massachusetts City/Town of No Andover I"AY 19 2014 System Pumping Record Form 4 ' 1OWN U=KQURIMANDOVER d HUALTI l E3triz,�R DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important:When filling out forms 1. System Location: on the computer, use only the tab key to move your Address cursor-do not No Andover use the return Ma key. City/Town State Zip Code , 661r� 2. System Owner: Name ((� ieaon Address(if different from location) City/Town State Zip Code Telephone Dumber B. Pumping Record � I 1. Date of Pumping pate L�uanaw umped:tity P Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: , wluj 6. stem Pumped y: C' Name Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 Signatur Date Signature of Receiving Facility Date - t5form4.doc-03/06 System Pumping Record•Page 1 of 1 a � . - PLA�c./ sNOrr/iwC ,tjOTE b _ -' PROPOSED SZ18SueF46E SEWAGE h15Pl-5 61 cy5TEM pleloAodelo Z07- BE�aRE CoN57,pUC?//✓ ABSo�PT/C/tlo V BEP 5CAGE : I"=40' 2)4rE = FEB. /S, /977 QEY/SED, �� ,clo 6'A/L-3AGE !J/.S�DS�IL l�1AY /.3E /N.S7.4GLED OGtlAmse: �5',cor7' P�oPE�ET/E,s . /,cl Tye P,�'OrDGt5E73 !J tt/ELG/<vG. ,�,5 CE�tlTE ? cTi ' �T o`oe-L LOT- BE N/yAPk: )'/l/ET /A/ BLZ)J'. 47- L4Cy 5T, raRFs-r ST. , EC. 127-14 5 LDCAT/oti1: Com•`" . LACY' 57: . ' tTOSEPN cT AARSAGALL.-0 / 1/tlEs7rt�ArC'A « of rrriaam I} fat � 3 Itfo . I�EA�/Mf7 MASS. n TES. . �� �-�983 `►�`,'�� 30 WLT 7 IS AREA TO t�e FiLLE L`� 1 f DE516.0 l DA TA ': ` TYPE OF 8C1/C D/A/G: . 4 $.,Okoo P O W64 L IA.14 / GARAGE• O CEGLAR PUTAISWy 4CAC/L17-/ES= "Dl.l46 / SE6!/ACE FLOW EST/MATE: .Cr4nC� IS.la 10. X 1•0 �g F = Coo,S•r' SEPTIC- rq�v,� : /4300 C.�Ae-e-OA X ©ttl�'L� ABsoeP r-Io�v .4reEA ; .�G3 D cStS?. �'a:' / PERCOGAr,(0A. .0 DATE /Z-/-7G \ /s, Nr 11 TUP ELE�/.4TlaN j/C-3, Xt��. _ _. . _ _` _ '` ,BOTTOiLJ ELEvi4'7'lC1N //�,2 • !� +�sav _ Q .��E �A11!D•� 1� 1 r /f� _ .�/`°�', LI cSAT11W,4 r/DA/ 9A_! Q.F_ .�!31 1 !� ` ./2ro 9" DRA11AA OP �l•T/N. tili,�1 Miiv o Al u 9".ro 6" ORoP M/.v. M!n/. � 1 CCPEeGOGA TloN RArE A Cl TEST PITS DATEV11YZ7 TOP ELE1/AT/6Af PON1fGRZADe jQ Is a SO/L TYRES SA&14) 1Nr! 7 AND cooC40AR ' ,SE �'•ra C F�c.��'P 11_C7F WATER TABLE 4A,%jp V GOcAT/oN A/0 WATT 119-AIL 6)((ST, &Q405- BorTOM E[Eu•4rroN r TESTS COA/DUC TED BY J'OSEON T. �54eBA6AL L O , R.S. ` TEST.s W/TNESSEb BY : Ale. A"t)OVEr- HEALT"N DEPT- , o • �� PG.4/cl e DEs/�Al Ciel rE�el.�t �S'�EET / oF' 2 r � ` Pr i7ITc H Z �S'EAcED �/�v r , P/PE Cope Ea 411 VALE o a c i >>� 6 s s o • e . e e v o c - CAPPED C.i(!DS v o - � �oe Ec?L//vALEIVT) PART/,4L .BED Eti/D -SECT/D AJ , cSCALE �2-_� -D �I,eE.4 = 9OD�s h N �Fo� SPEC/F/CAT/O�t/S SEE ECTIOA-1 OW25e/�NT) - . I�.��reiavr�ov �x /DOO Q.4L. CO,,VC0E7_;S SEPT/C TANS ¢5' "� SOG/1J .Q C'. SEAGED Jo/NTS = qc" [�4 13 =.00- S v ALG A/GG MUST ExTEk/D 25' 45' A FRom 7NE BED AT 6e-. /z3.$' `C 4fb TN6V SGME /. / 7Z) aR.4. E. ECT _ PJZOG SEALED DwEL. /•"int. ,TOIn/r, BACKFlC.L Ole ¢ 25' -C+1U/•[� -e e weP /�RADE TD 3/8' Gl/45HED IL STO P�E�� _ e • A �O Dpd.,, o •eo a .i_ Ya a e`faeoaa •' ' e o � ege e e e P"v PEo d• o e o e o e Y / BEMW6 AGL 70A.2M 4( iyIGCR� SAAJO IAI c//t/,4G E"ti/T � 4,t--A A"a �2EPLAcc Wi'r�l �' PYC Q d OCD 1' l32Av6L TO EL. /ZZ•O 1 1 9 �eVSNEv ST � Q O wouBGE vt✓AS E RAoe y fi O //y U to Z +. $ H BSDi2PT/Ott/ BED cS�ECT/DA1 �.2oFi�E LOT -;'¢ — Zoe ST,CEE T SC.44E /'���• ! �/- gO [/E�2T. ���-g ��OF/GE ANV r'rBS�.ePT/Ong 8E� 1LAn1 A"z) SECTloIVS 51-1,E,S 7 7 2- of 2 NORTH ANDOVER B03-RD OF H-I AU,TH INST.,�LLLA 103 C=,K LIST _ _r _ a EXCAVATION OK APPROVED � DISIiP�R OVED EXCAV _..__. -- _--_ d Date: (1 Date: t1-7A Reason: 7. AsBuilt Submitted Check: Lot location, dimensions of system, location in regard to percolation tests, depth of system, water table Distance to Wetl.nd Areas, Drains, Street & House, Drainage Easement and Wells. Water Line Location No PVC Pipe 5. Septic Tank - Tees, Cement-Pipe to Tank-joints on both side of Tank. 6. Distribution Box - No cracks in box or cover, all 1' flow er._ually from box. 7. Leach Fields - D3�ensions, Ston epths, Cappe ds, Clean doubt i.7ashed stone k 8. Leach Pits - Dimensions, Depth of Stone, Splash pad7tees, Cement-pipe to tank- joints on both sides of tank, Clean double-t,-asked stone 9. N Garbage Disposals , 10. F Grading ("barricading of sub-surface system) 0 TO: NORTH ANDOVER, MASS 1112,1 19 77 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 �c' 7` ell Z/1 C y S" - North Andover, Mass. SITE LOCAT ON The grades and construction are as specified in my plans and specifications dated 19 / eg. jVV g neeF R ' anitarian .M �" rf cP;� O r R Z34eRl -7Z SC4LE 4-1a 4,41 oma m Py v,l ,LA € SEGyER_ +�.f�✓Y-�[aL-.,.z„r1fG��.-sll�..:....-�.�.��.�. /� � } .�P� `^rr�i..� A 10 4-cRE s A cv,e TNG dao S F- t3ED 0 n `,Sir- - Ex A R RF k s=� . s 1 PLA IV sf�/OWIlvc� �7✓ 7` ?c �j✓S� e TEi z P�DPO.SED SU511�' 6FAGE SEWA*e b15�-S9L cSYSI"EM r� F 'O�t15''!''.'(1G"�i/✓ / Sc? f l�f�/ 9Q XAID . Q . • --: �p P�E'oPoSED dor. aRAb/A1G %3E /A/.5r.444.EZ? t � l r� scA'LE / - �D'` 1�Ar� F�. /S 1977 iti T//� P,�o�GLsc"Z3 v!!t/ELG I<vG. 3 �� 'f7,� PE�%rE... s •. /7 -CO T`T LOrr _ BE uCN�yA � rvlr E7- 1,V B-4 4T 4,QCv S r -aREs7 . S-7,711 EL. 1z � �r.s,G.s• es LOCAT/o Al; -� , p `t «. .J ,a,, j y st t i x .A /tfo EAO/Alfa , MASS P$ AlZeA f . ,:: : , f - y k : _ . ' TSL. , �� �•—X983 `:�4,$� ,,�, . :�y{; :;`' Or =� ISS/[z�tJ DA,TA OF A AG $.464"g r L P N / , L.4 U / F /_. SEGUACE FLOW EST/MATE• ' . ?: L , x TAf< EQ tllGfABSOPT'%ON .4RE.4. JCS s -.... i PE GDG4 •%QKL.?`E y ,r R T STs. � z3 ¢ DATE , D ,Z 1Wj4/• 1 e r"rr �f SW?CjA rioA/ � -+� : . � •. ,.. .. ,,�, �� :- - _w •/z' DROP AT/A/ - - . ti '',,-� :, '� ►��, >_ -..may, �i�;..�!1t�'� �° A �•v�,? lfiJ/N. iTi1/n1. M1AI. G4 x. rio�v RATE 4 Z- .e . TEST P/Ts /. -lyz - ti.;. \� � . T$`�� •1' �... .� TOP'ELEIjAT/DSV 1/. / c �' �O. !b TYPES. sQ�!!3 ).,I o14 r N. i s^ AA/D 6O cclAR !I .,Z O 000* WATER 7 6E 3Hti LOCA]T/Q.il/ A10 wl4 : &&VAT%ON TESTS CGK/Oac TE;C� BY = -722.5Eoy T. -B4RBA.GAL d TEST > .GtI/TA/ESSED BY. : -Ak/ .`,A"1)0VE-,C !-/EALTh! AD6pT- P1cr ` Des lf�A!^ C.2/rE�ejA cS'HEET' /. nF' 2 .. `s wr ai--. _o-a_ _. a: . ... _.a.- - .,:....«.:_.c.-.,._aa s.. ,....._.,a..•.zr . _Si1r __ z..�p._ .... _..- _.- __._ _ '+1 •/.. Q -..M,,,- f g,,� UEQLED VC�!/�!r c��L/D r= •;L' PIPE — - _ - - -- -FtTC N �OR Eau/YALE�/T-J v �• /E.e,4 o,e Qu/vAGE�T�E f� � A 7-6D I . IDA,2T/AL BED EVD SEC-7-10/V �FOe SPEC/F/CA7-16AA5 - S'EE SECT!©RJ AT LOWER )E'/G.X47-) I>��rei�ur�o�v �x ¢" CAST L2Dc/, s OZ 4> DODO 67,42. foAlce&r•,� 56o7-lC TAAJ,� 45 ¢„� PERF. x'' , s=,oas ,�IBSo.ePT/oAj UES /ZDL-AAJ ►3k /VOT TO cS ALE ALG F/'GC MUJ7- ExTEx/a 25” 45 i-RoAf 7ME 4kS4 AT EL.•. lzs,S RAID rMSV QRAA-. 1 t2� sEA ED SEG EGT ' ?RDS L oT � 13 �• GYAS e • o .k� oe>' • v o �eo• C�U.$f��� -57 hIE o. . 08�49.S •¢ a�aae e• m U dC JJJc?:o oo J¢ mo•va - ¢"�PE,elORATED d- QEMDUE ALL 'MA'-Q*t P4C462) SAwJO /NO ECJcJ/t/.<7L ENT a6V 4r2EA A"6' REPLACE WiTN ^ O ,Q2A//6L TD EL. 12Z. C:) � ` -f-- 3/¢..ro /� WISHED Q (\j E L.9 • � � /G�USNEC7 STONE Q O ' DoUBC E WAS/+�ED WAT E rFiD 119. �s To -" - ,4 BSo,eP T/oiy BES cS�EC 7-/0 A-1 � ni O � p SCALE _ Q�� '411 ZOT � — �A� 57PYSE 7 �.eOF/G E CA ���. l��- gD lGE�T. ��� >°�20F/G E ANv ABSD.2PT/O�v BES �LA�t1 AA/v SEC 7-loNS �f SEE 7- of /�GGESS MAhlr!DC ESR To G,e4DE /A/• O,Q LESS) ell0 4 �.��.o LEl/EL L,cuu.p THE DE rA/L S SPOW,v /Off LEVEE Oat T41s PLAN 5PEE7 ° e ACE '7 Ypl(AAL- .DE7,,4/L s OF A C'E2TA/A-/ 104,</- .T'eo.,-/ TEE O a '• rZeo�c/ TEE ° C/FACT-/.eO.e. CQ[!i VA- 6. LEAvr R4Y a• 3,¢•• tl 3�43'14 3'�4 'BF .SUf3Sr/TUTEI� 4 Qvc y uJi rti TyE • ° c APP.2o!/AL Oma- ,STN 4 v. AAvo THE I�Esic,vE,e. v _ n•• "D V •• .Gl. d' •t1. '' G1 .tl. _ .. 4 p. p.. 0 ..4 0 ,Q '. - ",14flA!. -RAVEL' �5416-BAsE - 1 /Z /Z ' - •. ' . . _ �5'EPr/G TANS cSECT/oN .4 A ,vor ro scAe-E _ SEPT/G TA�/K - SEC-7 B-B ,voT ro c5'<::Z4C c .4', �' "_".a u - u _ u' _u 'v'.• :u'. .Q .U. a. 4. . C '. _ .'o.' o •i' .'c ?'o 'c. o `• _T 3'1+"14- ° y 77 Z'' Z'• _t ' � 2 fA GRAVEL •Q G2Al/EL .Brie-BAs h/ST,e/BUT/oAj ..._� �_Sola-aasE 3�4 e v' 2¢� # BOX u L 13 D/STRlsurloN BOX SEGr/DA/S See SCALE cSEP T/G TAMC PL A AJ ` A107— TO cSCAG E DE7-A/L 5 Foie DODO GAG . Can/C. SEPr/C 7A411< Co/vc. DSTR1aur1OAI Box SHEET 2 oF.3 i. F A B 1 t Sc�aY , S1�c� l lce v cue � 1 t�d+- th 0,0 (!uGr1-�- G n A, 6�) � LGA S� o� MASS. EMPLOYMENT/BOARD OF REVIEW P.01 r' Ivisory,Council Meeting 2, 1996, 7;30 a.m. 4orth Andover, MA enforcement"radar to deter speeders. Safety •e speed limit from 40 mph to 35 mph from make the speed limit on Salem Street uniform. it late spring. In the meantime Officer Driscoll hem of the course of action. )n Abbot at Salem Street. )n Summer at Salem Street. Cen.lightneeds signage �m Sutton Street are being confused by the iicles have activated the trip pad. Officer report back to the council on possible rtcnent to ascertain why the lights are not set to y agreed. tmen action on these items. Officer Driscoll and the subsequent rejection by the State to the n Street and Abbot Street. y r �,. f1 •xp;1.17 i�� y r �L � .t �t�??,�1♦�41•!rF 1h,fF� .It�.,� � "�Y I r'l'fM�(n I�., 1 - � �. 1 ... , r\!y� '1.f r! r r /E,,n,I+ 1 � - � , 141•f �r • i `y ��i�r +I�f! , � , N ,• •t 1y:,.,� • �}`I+f�L k111�. ��P y� � ti S,S�-.x � ,r ��- s 'r � ! ! ••f.�� '�r"l j�k Il<,i ri j y yf E�S 4ft� fn t � ! 4v.:. I j .. TOWN OF NORTH ANDOVER .SYSTEM PUMPING RECORD � 7 �,' �•_{ �:..rr 0"N'IL ;l t � `to lyY'��{` i'.a6 r{�11 n' a r ' r . SY$TEM O r &ADDRESS SYSTEM LOCATION (eawluple ieft•froat of house) 6 � �'�i�eC'phi.}�tY4� �e�.//(.�/+/ . 'i ��'• '- •'` �, .... r �/�.'• ! t t. , lh }'41CaP4' +� � �K.�v<�jt�t�R�+t��_ � y, ' ,� s j" ����rk. e•Yy f, ,.. QUANTITY PUMPED GALLONS t 1, SEPTIC TANK: YES '\ NO 1 +1� f 11 kti�,,r'y�✓} I (fie i,.. 1 � �'!r�'�y�r'�" , k)yB.j i.''�4� .d'f •a! ( s. i ry�-.1" " 1, 1 •AT ER�CE ROUT 'T EMERGENCY } 1 '"t���'lJl!!�"�21 !'l`�, ,Y"h �''�tnr�-i r ;� rl � '7.. Tom^ �dF 6 :! •�� CONDITION' ak r w-. .ls r 1 HEA �� Vy FULL TO COVER ,►:,, t3,_.;;,;,p,l. GRFASE BAFII'LES IN P ROOTS LACE _ LEACHFIELD RUNBACK CESSIVE SOLIDS —..�,.. FLOODED SOLIDS CARRYO O ' VER THER(Ef.PLAIN) ����,�'QI�-hl�q'�`.,�.,4�I `��1•,�+�:!1`lk; 6_ r`1,' t�>�.rt1.?' +k _��y k,4��;.) � - ..J .. �if''k4 rf�i� �lai myi`f, •#•n �r-5�,�' y �...'�7Y> r �, .. rM'r b F i f1 n"+f J+n.�✓ t 4 � ��� aM�1h P:i•.v �•a.:l -a 1� I_ t x+. 1 1 • Y,ii•It' Tom.�� �. .k F t ' a M a � � , s 51 �fz 9 4 tiTSm Fl y)il ����c� �� � � ��,� �s p � �� �,e�N r �� � �� s4 t Mr. &Mrs.John W.Wallace 54 Lacy Street North Andover,MA 01845 November 1, 1996 Mrs. Sandra Starr Department of Health Town of North Andover 146 Main Street North Andover,MA 01845 Mrs. Starr, Enclosed with this letter is a copy of the plot plan for our house at 54 Lacy Street. Based on telephone conversations with Department of Health personnel it is our understanding that we must first obtain a permit to have a new artesian well dug on our property. This well is needed to replace our current 30' "shallow well" which does not function adequately. In fact, it currently produces an amount of rust and sediment which is unacceptable for us. Shown on the plot plan are: the current septic tank and leach field,the house,the proposed new well,the current well, and the pond to the rear of our property. Based upon the previously mentioned telephone conversations, it is our belief that the location of the new well, as well as the current one, are within the distances required by the Town. The measurements on the plot plan show that the proposed well site is more than 100'from the leach field,and more than 25'from the pond. Also.enclosed is a check for $100 to cover the cost of the permit. Thank you for your assistance in the matter. Sincerely, ,0 John W. Wallace Enclosure s 4 LAC-L) �S2 - 05�• WrA Pf lD tar-5.. i ... �." WELL y 1 o,�` 104 : Deed Reference: 8k. 77 Pg. 197 scale AVO Deb of irxpecbon �'-/•90 Cera No. Plan Reference: PI.No, 73 SS Date of Plan e•t- DO I i NUMBER � FEES v 1 THE COMMONWEALTH OF MASSACHUSETTS TOWN of NORTH ANDOVER IJV • . • . . •.................•---•------•-- This is to Certify that ............................Viers _Well Company _ NAME ........253...Andoue-r...Street.,....Geors etnwn.,...X&...Q12.3.3.....--••--------------------------•------••----. ADDRESS IS HEREBY GRANTED A LICENSE For Well Pe.rmit - 5.4....Lacey Street. , North Andover, MA •.............. . ... .... ......................-•------. --_.-----•- ........---•----. ...... ............................................................................................................................................................................ ............................................................................................................................................................................ ..---•-•----...----•----•--.........-•---•------•----•.......................•-------•-----•-----....---•------------------...........--- This license is granted in conformity with the Statutes and ordinances relating thereto, and expires...December__-3.1_, 1996_______________unless sooner a spended or revoked. Y ...---N4Yember...,13 --•-•----••----19-----9 6 � 7�zft, ' =..... �Z, =................. K . e......,------ --------- _ ,------- FORM 499 �,, r' t/t H&W HOBBS&WARREN TM �q�r r NORTH ANDOVER SUBSURFACE DISPOSAL SYSTEM HECK LI n I. General Information Reg. 2. 5 The submitted plan must show as a minimum: 1-27-7) W d) -the lot to be served ),# location and dimensions of the system (including reserve area) (c)01_ de n calculations (d) o„calculations showing required leaching area (e)()c existing and proposed contours (f)of- location and log of deep observation holes - distance to ties (g)tt- location and results of percolation tests - distance to ties (h),� location of any wet areas within 100' of the sewage disposal system or disclaimer (i)(c surface and subsurface drains within 100 ' of the sewage disposal system or disclaimer (j ) location of any drainage easements with' 100 ' of the sewage disposal system o disclaime (k)pL known sources of water supply within o the sewage disposal system or disclaimer M c4 location of any proposed well to serve the lot (m) eLlocation of water lines on the property ( maximum ground water elevation in the area of the sewage disposal system (o)6,4a profile of the system _:P(p)**rio PVC is to be used in construction (q)oLlocation of benchmark (r)DI-plan must be prepared by a Professional Engineer or other professional authorized by law to(-prepare such plans. II. Garbage Disposers oL III. Septic Tanks Reg. 6.1 (a)oLCapacities - 150% of flow Reg. 6. 7 (b) o44ater table Reg. 6.8 (c) oc.Tees Reg. 6.9 (d)oA.Depth of tees Reg. 6. 12 (e)6&Access Reg. 6. 18 (f)6< Pumping (g)pg_ Cleanout IV. Pumps Reg. 9. 1 (a) Approval Reg. 9.6 (b) Stand-by power K� 9 . V. Distribution Boxes Reg. 10.2 (a) Slope greater than 0.08 Reg. 10.4 (b) Sump VI. Leaching Pits Leaching pits are preferred where the installation is possible. Reg. 11.2 (a) Calculations of leaching area (minimum 500 S.F. ) Reg. 11.4 (b) Spacing Reg. 11.10 (c) Surface drainage 2% Reg. 11.11 (d) Cover material VII. Leaching Fields Reg. 15.1 (a) Greater than 20 minutes/inch Reg. 15.1 (b) Area (minimum 900 S.F. ) Reg. 15.4 (c ) Construction of field Reg. 15.8 (d) Surface drainage 2% IX. Downhill Slope , (a) Slope y/x = (to be shown) / (b) y/x X 150 = (to be shown) 0\ SOIL PROFILE & PERCOLATION TEST DATA Town/('ts/w No.&Street ,G, Q Lot N o. Loc./Subdiv. / Plan Q�vr . Owner Investigator 1 Observer_ SOIL PROFILES-DATE 3' Elev. ?' E1 3' Elev. 4'Elev. 0 0 dye,1 1 1 1 \ � 2 2 2 3 3 3 3 4 4 4 4 V5 5 5 5 C� b G G © O G 7 7 7 8 8 8 8 9 g 9 9 10 10 10 10 Benchmark Location Elevation Datum Percola i n Tests-Date Pit Number 1 2 3 4 5 Start Saturation Soak-Mins° Start Test-Time h Drop of 3"-Time Dro of 6"-Time Mins.lst "Dro Mins.2nd 3"Dro Notes & Sk tc es 013oBack Fr n Co Gelinas & Assoc'ates, North And. L O A R - ... CS ETA .� ._,_. .........._-,. .,_._,.. � (F N LOT R,E, A Ali A- V I c F7 c O(D z C) PCs E L 0 0 7- ..REA- 0 G,.q 0-5 A D, JD� 6,5 o ;30 . 4- Z- 0 L-0 L (D T # l Y. S+d.nL�.i`!714;:,1�,r•.it�;'..,.•.i i. ,:ii�i:•.1,;• �' � R( 6. , MASSACHUSE pin` "R or.d' :I•. t'4j y•;y;l:r. ttJl��(,yt.l .J ti Al lYatil�::NjlPiytit'ir',r 11:,41, n.liirlba•'' DEP,.has provided 04.form for us ea The Sys ' be subinI4t d to the.local'Soard bf ealth c=- ving Y tam Pumping Record r , uthority, A; gclllty lnforril'Ptlon DEC '0 7 2007 '`f�T (wY19�OUt' :1.. System location'` . -;;IOr(ili,011..t)1e. r W OF ORTH ANDOVER. only the tab keyf Addre. AL EPARTMENT to move your:*;do Pot ty/Towm Stat yu,l4 w\';;;',;;.,.;:` ' `;(',,:1,r;'.;,,r:'•';'. :: •.�:i; .. e U Coda ;Yi,A. '�J.J ,(j4i' •;{.,., owner,-,-.-",,.:. , P :•''rel.. �j?.. '.2., System owner; ' .,!`'' ra:;ri •: 1 .•. ,f' .:�:,;'+::.,.:�. ,..�J�,,.rl;I:;�.r,..,�A��r:•r:�iLJ•.:'•�:•i�:;is ""' i r Address(If different from tocatlon) ; 1!, C •R r' �Ilp Telephone Number : .'Tu'tn.p1 Re.r{ord: g' a 1 Dats of PumpinqDat 2, QuantJty Pumped: .; 3 TYP,e vf,systen):, ❑ Cesspools) Septic Tank ❑ Tight Tank (.Other(descrlbej; ..: . ' ffluerit Tea Fllta r 4, �"�E sent?..❑ Yes No' If :, : •',:•,,;;;1 i; "'� .:....,�,, f.R.. yes, was It cleaned? Yes / 1 .:i�. '.,�;,�'r• •.yr. r..•rr'.14qi!•,r[,•.'..�i'�''�'i;!'a'It{yilu!2. I On'... '' lt'i1�t.r:'.;;. ;:5r:}•C,otid tl' of,BY.$t`R],rri.i'"'::; .. ... .. ,•.{.':,`:Y!^."!•V'.!i \i•�•j'J r.�', +i}!:+'ii r.i,✓,,it..rl'.111W. ''",�,•':r.,., .. .,. j' .J i ,L%`,,/���5r-,i:^�.yifl•7�:la�i',�y t•� r 'j'..\`'id', �_. � :.'''' �':,�'.,. %!r.';.((1'(Tr;1"15J;{W.%lhli7.ll'f'(:lt°1.\',•"+."l'�' Vl .� . .. 1., ..;,,• �. . Pumped Number �:.C:J•.y.'� �,.;:�f:�'iyy��"a��ib,�:.i��%lu•iri5•, - •i., s Ar .�]+r"'.�,,}, �. 41'•1.: i' •':Y.;'' ';� .(.'•1ti!,�+ 11LOw4 .n..t:.�ry( ,`7;�.O:l t•::.1: on.where conte .:;: ntsly✓ere:dlsposed; •M{:_ ,1:.•L: 44� s4+'.�bJjir,{�... i �� 1t' "'�r• rl'4.1'Jr si'„ ;: $::,h'�'•r; rr;�'~r:,,;..Slpnalur0 of a c .:., 1•':;,;fr Date hUpJJ`www,mass,gov/ ep/vrafar/a pp�pvaJs%t5forms,htm �: .� .. .�. pact '.. ,:��� I'.i Vic:�'. :•,1�`:. .+�.;' tbforrn4,doa,O&Q3 '` ;' System PUMPln9 Record Page t .!'• _ �.,IH��� Sl ey„l+.1 1�I•`rrl 'Y I' l.'.4 t ! •• k; � 7 II',',',lyy��'fJlys r�•� \ 1 II E T-7 v IV F ! 2008 D�P,hI I DIOYId10 N)hl/ lolls �, I Vb/Ill orpI Q1 InV, i"" '"•o S / CII,pr Ipa I,Q - I n(� Itv c,x=NORTH�41JDbNV�/�R 'I rm�(Ion, HE��+ �I'';•. ''' �� ;%I�II•I:,;l1i%''� �r,l'',r%;i'I'''Ir'yI''•l l: dlµl ( 4 111 n1 las buVon� _ Cq^O.r} mping.�, Q ord ',,S rYP+ 41 ►y>'(em,., POC T80., Ise, rd., (desc/iDe�.� m�fnI;rel FIIIe(,pr9„3onR o ,ti'h:O1{'IJ'v (j,” II'LV1'il' r,�Sy R(►1 Pyr�pl0,8y'' ' n II r ',' ;lll''1�,;I✓ir11�Ir`'I "`'(IG' ''i �r,�i/ { j r� ti' (� 1 Y • 1.r����,'I r(/r_�1'/ ' ,'(7�' { SII' ' \1. l,��IGII ylWIr • '`,�'1'��`%l;��� Iw, .��'� oc� on,wharf Go 1'i•r l', , •I I,,I,I I,I, AIbn4� y�o/o dl�posoa: ,. ��1'''I'�I',1'�J,��li ,•�'IljYl�iti�l"i/'�., ,, �.ma,�,porldep�dlei/e PPr9Ya��ll blorm f,rl,nafn��ocl � Commonwealth of Massachusetts � � � � City/Town of DEC 16 MO System Pumping Record TOWN OF NORTH ANDOVER Form 4 HEALTH DEPARTMENT DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351, A. Facility Information Important: When filling out 1. System Location: forms onn the computer,use 1111 only the tab key Address to move your North Andover ma 01886 cursor-do not City/Town State Zip Code use the return key. 2. System Owner: fm _ Name Address(if different from location) Cityrrown State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date •2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped B . ZC� Name I Vehicle License Number Stewart Septic Service Company 7. tion where contents were disposed: a Pre treatment Plant 20 So. Mill St, Bradford Ma 01835 • ) b ign of Hauler Date Signature of Receiving Facility Date t5form4.doc-03/06 System Pumping Record•Page 1 of 1