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Miscellaneous - 54 SPRING HILL ROAD 4/30/2018 (2)
ad Commonwealth of Massachusetts RECEI!!ED City/Town of System Pumping Record JUN 2 3 2014 Form 4 1'QWN OP MA Ri ANDOVER 4 DEPAR-rmEw DEP has provided this form for use-by local Boards of Health. Otherto—rm*may -1batlhb 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. A. Facility Information 1. System Location: Left/Right front of house, Left ear us Left/right side of house, Left/ Right side of building, Left/Right front of building, Left/Right rear of building, Under deck Address City/Town U{ Sta'►"Ate �J Zp Code 2. System Owner. Name V Address(if different from location) City/Town ' State q( de Telephone Number B. Pumping Record v t 1. Date of Pumping date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes No If yes, was ft cleaned? ❑ Yes M No. ' 5. Condition of System: 6. System Pumped By. Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location where contents were disposed: CS. Lowell Waste Water Sig Haulwo Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION h' ONE WINTER STREET. BOSTON. AtA 02108 611-:92•55'00 TRUDY CO\ WILLIAM F WELD Secreta. Governor ARGEO PAUL CELLUCCI DA%1D 8 STREP Lt.Govemor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commission PART A CERTIFICATION Is►operty Address: .S y SP'ti+'t( t ( a' ��e"L"�' Address of Owner: Daft of Inspection: �S� �-q� Y 'Yi LcI` (If different) Name of Inspector: t,� r t.L�_.— I am A DEP ap rove system inspector pursuaAN to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: d`t Mailing Address: d C-Z- Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true. accurate And complete as of the time of inspection. The inspection was performed based on my training and experience in the proper funcijon and maintenance of on-site sewage disposal systems. The system: Passes _ Conditionalk Passes _ Needs Further E%aluation 8% the Local Approving Authority _ Fads Inspector's Signalur , Date: The Svstem Inspector shall submit a copy of this inspe re o to the Approving Authority within thirty (30) days of completing this Inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system own4 And copies sent to the buyer, if applicable, and the approving authority•. IkSPECTION SUMMARY: Check A, 8, C, or D: Al SYSTEM PASSES: I have not found any informatioh which Indicates that the system violates any of the failure criteria as defined in 310 CMR 15.302 Any failure criteria not evaluated are indicated below. COMMENTS: A) SYSTEM CONDITIONALLY PASSES: One or more system components as described in the 'Conditional Pass" section need to be replaced or repaired. The system, up completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, no, or not determined (Y, N. or NO). Describe bastt of determination in all Instances. If'not determined", explain why not. _ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance iattachedl indicating that the tank was installed within twenty 1201 years prior to the dale of'the inspection; the septic tank, whether or not metal, Is cracked. structurally unsound, shows substantj Isr.F+�+= eartilr►)�tion.�of failure is imminent. the system will pass inspection if the existing septic tank is replace .QE as approved by the Board of Health. (revised 04/35/971 Fe*e 1 of to JUN i — a DEP an tris worn Wtds Web' ntto:/AVWW#1100^«stMe-ms.uWW i 1% prvd@d•M Recycled Paver SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: dale of Inspection: 91 SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed Pipets) or due to a broken. settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipets) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken nr obstructed-pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipets) are replaced obstruction is removed Cl 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 the public health, safety and the environment. b SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland.or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT.- The NVIRONMENT:The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supn'v well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well. unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm: Method used to determine distance (approximation not valid). 3) OTHER (ewiead`01/!!/:71 page i of 10 - � r SUBSURFACE SEIAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: `J r �,p itl��'L �i Owner: f �•f�C � Y/9�1 � ��C�,. A Date of Inspection: "" J D) SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of t e following: I have determined that.the system violates o or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. T Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No _ Backup.of sewage.into facility or sy em component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to t e surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static nquid level in the distribution ox above outlet invert due to an. overloaded or clogged SAS or cesspool. Liquid depth in cesspool is lest than " below invert or available volume is less than 1/2 day flow. Reouired pumping more than 4 times the last year NOT due to clogged or obstructed pipets►. Number of Mmes pumped Any porton of the Soil Absorption Syst m, cesspool or privy is below the high groundwater elevation. Anv ponion of a cesspool or privy is thin 100 feet of a surface water supply or tributary to a surface water supply. Any porton of a cesspool or privy is ithin a Zone I of a public well. Any portion of a cesspool or privy is ithin 50 feet of a private water supply well. Anv portion of a cesspool or privy is I ss than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If t e well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic co pounds, ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: You must indicate etcher "Yes" or "No" as to each of t following: The following criteria apply to large systems addition to the criteria above: The system serves a facility with a design flo of 10,000 god or greater (large System) and the system is a significant threat to public health and safety and the tnvironmen because one or more of the following conditions exist: Yes No the system is within 400 feet of a su ace drinking water supply the system is within 200 feet of a trib tary to a surface drinking water supply the system is located in a nitrogen sen itive area (Interim Wellhead Protection Area-IWPA) or a mapped Zone If of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. fr��►ira�d 0 /1!/!71 targe 3 of 10 u r SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART 8 CHECKLIST Property Address: �`� g 24 i Owner: Date of Inspection: 54 a� - g1� Check if the following have been done: You must indicate either "Yes" or "No" as to each of tho following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been Pum ped for at least two weeks and the system has been receiving normal flow rates during that period. large volumes of water have not been introduced into the system recently or as part of this inspection v _ As built plans have been obtained and examined. Note if they are not available with N/A. The facilim, or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. The site v.as inspected for signs of breakout. All s%stem components. excluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees. material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. ✓ The size and location of the 5o(I Absorption System on the site has been determined based on: The facility owner (and occupants, if different from owner were provided with information on the proper maintenance of Sub-Suriace Disposal System. _ Existin¢ information. Ex. Plan at B.O.H. Determined in the field ((f any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (15.302(3)(b)( (revised 04/23/11) Page 4 e! 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Propertv Address: S 4 „L Owner. ' "-� Date of Inspection: Ki�n ,`-��'C �LL�q RESIDENTIAL: —A:�YFLOW CONDITIONS Design flow. ¢.p.d./bedroom for S.A.S. Number of bedrooms: Number of current residents:_ Garbage gEifoer (yes or no!:-&/- Laundry conned to syst m (yes or no): Seasonal use (yes or no►: Water meter readings, if ave able (last two (2) year usage (gpd): ht:E { Sump Pump (yes or no): Last date of occupancy COMMERCI kUlNOUSTRIAL: Type of establishment: Design flow:_ tallonsidav Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: wes or not hon-sanuan waste discharged to.the Title S system (yes or no)_ Water meter readings. 4 available Last date of oecupanc OTHER: (Describe Last date of occuoancy GENERAL INFORMATION PUMPING R RDS,ands urce of in' r at n: [� 7J System pumped as pan of inspection: Ives or no)A/ If yes, volume pumped: eallons Reason for pumping TYP OF SYSTEM Septic tank/distribution box/soil absorpnnn system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no) (revised 04/23/97) Page 5 of 10 r t a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: rJ'4j vL )�4 Owner: �,7�t Y /4• �l Date of Inspection: 1 .L(/ �`� BUILDING SEWER: (Locate on site plan) Depth below grade: Material of construction: _cast iron*_40 PVC_other (explain) Distance from private water supply well or suction hr.- Diameter omments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK:_ (locate on site plant y Depth below grader Material of construction: 4concrete _metal _Fiberglass _Polyethylene _other(explainl If tank is metal, Inst age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: SX I d 2- Sludge Sludge depth•,___(�� Distance from top of stud a to bottom of outlet tee or baffle:0 Scum thickness: 11"T Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How dimensions were determined: %78.,�3� Comments: (recommendation (rr pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invf rt, structural integrity, evidence of leakage, etc.) / /11-1 cc ti n GREASE TRAP: (locate on site plant Depth below grade- material of construction: _concrete _metal _Fiberglass _Polyethylene —.other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 04/31/97) page 9 01 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 'SYSTEM INFORMATION (continu Property Address: -L4 !y` 0 !-b Owner: �,e-v Date of Inspection: TIGHT OR HOLDING TANK: !Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _Polyethylene _,other(explain) Dimensions: Capacuv: gallons Design flow gallons/da% Alarm level Alarm in working order _ Yes; _ No Date of previous pumping: Comments: (condition of inlet tee. condition of alarm and float switches. etc.) 36 DISTRIBUTION BOX: (locate on site piani it Depth of liquid level above outlet inert: / Comments: (note if-level anq distribution is equal, evidence folids carryover, evide a of I kage int or out of box, etc.) NSA PUMP CHAMBER:_ (locate on cite plant Pumps in working order: (Yes or Not Alarms in working order (Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/21/971 page 7 of to SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM d) // INFORMATION (continue Property Address: (5 �4 1 -1, �c `/ '4) • �d1� Owner: ) A-V t. Date of Inspection: _ SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible; excavation not required, but may be approximated by.non-intrusive methodsl If not determined to be present, explain: Type: leaching pits. number:_ leaching chambers, number:` leaching galleries, number: T ��-jj leaching trenches, number length CSL© leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition soil, si��off hydraulic failure, level of pon ing, condition of vegetation, etc.) CESSPOOLS: _ (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert. Depth of solids layer: Depth of scum laver: Dimensions of cesspool Materials of construction: Indication of groundwater inflow (cesspool must be pumped as part of inspection) 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.) (revised 04/7s/97) Hage 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: S (� Owner: to 2(v, Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) -37 Ise 3 • (saviaed 04/25/971 Page ! of 10 t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: � Owner: Date of Inspection: 6-- Depth -Depth to Groundwater .16— Feet Please indicate all the methods used to determine High Groundwater Elevation- Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA maps Check pumping records Check local excavators, installers Use USGS Data `+ ab + e Describe in your own words how you established the High Groundwater Elevation. Musbe completed) /V1ke l� A1?_6 CtZ L--J (sorisod 04/23/97) Page 10 of 10 Commonwealth of Massachusetts City/Town of SEP 2 9 2010 System Pumping Record Form 4 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT I 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 tQ determine the form they use. The System Pumping Rec6rd must be submitted to the local Board of Health ouottter approving authority. A. Facility Information 1. S n: Left side of house, Right side of house, Left front of house, Right front of house, Left rear of n-6�usa Right rear of house. Left rear of building. Right rear of building. Address Citylrown State Zip Code 2. System Owner: Name Address(if different from location) City/Town State ip de Telephone Number B. Pumping Record o C 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) W,,Sreptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes o If yes, was it cleaned? ❑ Yes ❑ No 5. Condit' n of Syst� 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. L Ion. ere ntents were disposed: G.L.S.D Lowe Waft Water Signature/of F Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 / L/VESf I•yi`}2 h C��� ��� i No • R Eiy_7) r S N G R o N ! f — I SE ln/E �2 Gcc t �a CAMM04* 9R�gN S113S�� I I f ! I i E,e ,s -- I 4 f /Sao G-19 7`9IVAI f i Lo 7 i I i FORM U - VERIFICATION FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant,,fills out this section***************** APPLI CANT: —i)4u e .+ A vkt P l r_/ Phone LOCATION: Assessor' s Map Number Parcel Subdivision Lot (s) Street S C� � Pmaf St. Number _ ************************Of 'ial Use Only************************ RECOMMENDATIONS OF T WN A / S: Date Approved Conservation Admi istra or Date Rejected Comments Date Approved Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected Date Approved 1 eptic Inspector-Health Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date M1 152.56' LOT 11 LOT 10 LOT 12 150. 00 � ia� ro �AMG HIL L ROAD � U r L1�~ 4;\t' 1 INCH 50 FEET 50 0 50 100 150 200 RELOCATE EXI5TNJ6 F.H.W.. U „ BASEBOARD HEATER ' „ KTTGHEN �T�IING ROOM CONNECT TO j EXISTING FAMILY ROOM EXI5TIN6 IN6 TO REMOVE EXI5TIN6 WINDOWS O O ;� J 4 WALL SECTION 4 FRAME , FOR NEW SLIDINGDOOR ' o 3 - 2x4 BUILT-UP POST IN EXI5T�46 WALL 5EE HEADER DETAIL TH5 PAGE ` --" - REMOVE EX15TiN6 BAY WINDOW j TO 5UPPO9T NEW RID6E BEAM. PROVIDE DINING ROOM 1 O O 4 FRAME NEW OPENIN& PATCH-7 GONTINllOUS 5UPPORT TO FOUNDATION. EQ' EQ' WALL TO MATCH 5URROUNDIN6 REMOVE EXI5TN6 PATIO DOOR REMOVE EXISTING -4 FRAME NEW-ORENN6,.-PATCH j BASEBOARD HTR. 1 �. / WALL5 TO MATCH SURROUNDtN6 C 6' 4' 2' 4' 2' C 6' i i —� _ t -:1 ...... .... F i _ At 0' x 6' 6' GASED OPENING'. _ � t Ily 4' 1 . _ DECK Z' - ra 1 -- .... 5/4xb 5TK ZEDAR DEGK11�1G"- _ - UJ - - DEGK _ . . ._..._.. - SELEGTED RAMIC BYY .OWNER R. -- - - _ v PLY`OOD NU DERLAYMENT SW4 � A O Oi .: O _ ;O a0 { .- 5UNROOM OSKYLIGHT OVER �'B - -RTD. POST5DN 1 FACED r/ *2 PINE 4 ql - BOARD m HANDRAIL TO 36' �6• _ _ _____ ___ UNDERLA MENT UNDER i 1 UN • . ABOVE DEGKIN6 ao - GERAMIG TILE FLOORING '--" - -- - I UNDER p N CORNER ----------- 1-------• WOOD STOVE ; i d JOTUL WOOD STOVE 1 I I I I j I 4 b V/ REAR 4 BOTTOM HEAT 5HELD5 TO BE O CONCRETE PAD 2' SUPPLIED BY OWNER\-� ; '^ UNDER 5TEP5 r� - �' 30: 3/8' 30 3/9' 30 3/9' ' , : W3 W3 W4 W4' DALGO Y I I I - _ - i .________--_�__—____. I { 1 — — _ I I { . . ... . . . I 10- 0. IO' O' 4' 6' �. 4' 6' -1 4 6' 4 6' � e APPROXIMATE LOCATION 1 1 I OF SEPTIC TANK 20, 01 I 1 B' 5 1/2' �L 2' OF. r 1 1 t 3' OF 4' 9 7/9' 4' 9 7/9' 4' 9 7/9' 4' 9 719' 3' 0' 1 i 1 i 5T FL-,00R f if• 25' 3 112• �t 5CAL-E 1/4' - 1 ' 0' e PERFORMANCE INSULATION 6LA55, �4 HARDWARE, DIVIDED L16HT GRILLES, 1 t� LAK THRESHOLD 4 EXTERIOR SELL ' PF-RFORMANGE INSULATION 6LA55, N5EGT SCREEN DR16HT BRASS s = 4 HARDWARE, DIVIDED LIGHT 6RILLE5, EXISTING GATZAGE }' OAK THRESHOLD 4 EXTERIOR SILL r _[E'zFl1DkJnr,rF in{alu ATINfi r�_A55, NoI�TN" A'V IPOVE.I-� MA, w , - sS ►2 5 SCPr�c sy s��� v�stc� .AurhORiTy C©A)PITIOA�5: DISAPPR�VEp D��E kQsoNs Dw� ScPI (C sy5T EM I•i s 1i0"T►OAJ Z``X/M-►(CVJ )A. )'l^-Pt�-G►Ian -2s F4'L- QP�i�c�v�D �i,TC �-�� �� ��+�r�pv►/vG ,��r+to+�►TyG D�S��PP�vvEV D,a rC R�/JSo NS FKAL APPF�DvAL D�0 -104b APPRwvJ esu aioRI ./ BOARD OF HEALTH No.Andover, Mass . r SUBSURFACE DISPOSAL DESIGN CHECK : IST LOQ' APPROVED DATE DISAPPROVED DATE Provided: Reasons: JIK' 6 Title V FAIL OK Reg 2.5 The submitted plan must show as a minimums a) the lot to be served-area,dimensions lot #,abutters b location and log deep observation hoes-distance to ties c location and results percolation tests-distance to ties d design calculations & calculations showing required leaching area (e) location and dimensions of system-inc'uding reserve area f) existing and proposed contours (g) location any wet areas -Athin 1001 of sewage disposal system or disclaimer-check wetlands mapping (h) surface and subsurface drains within 1)01 of sewage disposal system or disclaimer (i) location any drainage easements withir 1001 of sewage disposal system or disclaimer-Planning Board fi '.es (�) known sources of water supply with? � 2t,01 of sewage disposal a system or disclaimer (k) location of any proposed well to serve li,'--1001 from leaching facility (1) location of water lines on property-101 from leaching facility (m) location of benchmark (n) driveways (o) garbage disposals (p) no PVC to be used in construction (q) profile of system-elevations of basement, plumb, pipe, septic tank, distribution box inlets and outlets, distribution field piping and other elevations (r) maximum ground water elevation in area sewage disposal system (s) plan must be prepared by a Professional Engineer or other professional authorized by law to prepare such plans Reg 6 Septic Tanks (a) capacities-150 of flow, water table, •.ees, depth of tees, access, pumping (b) cleanout (c) 101 from cellar wall or inground swimm'ng pool (d) 251 from subsurface drains Reg 10.2 Distribution Boxes (a) s ope greater than 0.08 Reg 10.1 (b) m M TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: � �— SYSTEM OWNER&ADDRESS SYSTEM LOCATION (example: left front of house) b 0-A vo �Pf� vJ1 DATE OF PUMPING: lb—S-0 QUANTITY PUMPED GALLONS CESSPOOL: NO / YEs SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: COMMENTS: CONTENTS TRANSFERRED TO: t TOWN OF _ lvnr SYSTEM P PING RECO LVED MAY 2 5 2005 DATE:"© TOWN Gh N HEAORTH ANDOVER LTH DEPARTMENT SYSTEM OWNER & ADDRESS SYSTEM LOCATION (example:left front of house) rL�-e� DATE OF PUMPING: _ S QUANTITY PUMPED : 1;.dgb-O GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS . - FLOODED SOLIDS CARRYOVER OTHER(EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: 116 CONTENTS TRANSFERRED TO: G.L.S.D Lowell Waste b, '? KOZDRAS. JGK . I ff ,PA `s $ s " ° � :� A ' 38T sCJ' 1 d?. j17d FNDL - � .. r ' . .J .. - .. \,dam • �. * Fi. ., e n S.40*oj'1.6 � 02 1So.00" : t s C40 } f F ' .`aft .''< _ y K.Lr � .mss. `� - .,. N e��.�- �� $ y Ls �. r �!'•l ,.�/Sf/J. t S4©'44'17" r 53 ' Y , S42 D7 S40 fi 4r. +4 .. •."«'R.'"'""-�.—_` ► A , ,`-i. �a18# � 16..7723. 53��s. 3a.v EASEME 8C. 19F8 P + Ia ��.� t • // .r..r—.,.._. ...�.s.w'..�.:..`.ri1w,..,i:'....>,r,..,,,..........^..-..• ...,a.'.,:.�.�.:,.�.... ....�c•v._+w+.,.ry..>.�.,.,:.,. >�,:�v.:.r..r', '..le9M•.,.:y:-.tea,.--,+er`,'7S'��,.ten,--,.r... ..w,�,wa.f• }. �,.n .. 4.95. r i 9!! t at4f,t 45 w 11. � N404S 54 t;21:9a' 1 11 40r' -� jr LOT ' � _ '�' `n. t6+� ` 1f. _ 1'. 9w k _ - • .,L 0 T . P, .. 'e•.s ,%k :y ,7 4, ar C §i 1.:St .•• - w - 445,630 '� Gi per+ ,� ,+ � . .p, �"� '� F �•��,� s � Z « � # �'+�,' r. . * Z -#"{kS - ''ti( � �...,y'.�? t n• ..,. ..r...C�,...z , - y / .r , :,,,r t,R},,»1.ms7,..C.5.:'<s.h3 TY 1°tYx,s„-e,av`er.a�,.� .. (�y„y �w`+.•�'w_t .'iff�-�;; R�..: ,� ✓ - S,.- «_rw,z# ''-v`'*!:t�s:r�ta•,d*.�..s...,!r.3�}`;r;w.Fdr!` :^±}}b,r'� AREA ir�fa' EY•T ar wrfiB .B,g y1r 0475 A130,680 S.F a 4cv4 •44 7 HAREA5S� GREATER3.0000 ACRES 1.381Ya 8j500 # , E.-.. -z .�'i .f.-�':' �("t .:F•{ �.SC7VR+• S 75GREA TER THA xs c., - d '4� - - '.,y,.. s z �F'^' tt,� .....-••^ fy \ � .4 ,i>. .t.:' a ..f' ..:; :.,;..., a. ,.... .., _ 494/ - :a- d f .•++' �_,.. �' � *-e„- .,.. .1 's..a f;. +-f, t �:�'' t+ :-.r �:. •+{+� ' ,.r •r .. s 5a �E � •"�,#y, t�.�.,.." r, yy Ps f rtF' rr :f. - „s • "u- „ s '?:.: i s -�� jj? p 1 } ^ g, � ,�• ., ly��.. VV9,Y' • . •�.. 4'.i'x. . r .., +r -i,Cg 'aRT u:fr,a_.c:'cr..,rk.:vt.4yi .,*,.y,t•..y,,u -.u�+:.u,'..'.r. `:n ..,(-.• y..,t"CS ,m'Yr,f�.uc4{7} 6-05 /✓ LW h 92.43 952Z3 •„,f;,.�. L1�.4y;,a.k:., �'� ¢,'�^"!' ..�fix'.:4r�t• ;�` ” »x •_� £ 548 , '543, ���yy, .qy Pff J r•ti `t•• / _ / ACMR ' y r) JAMES LISAAp AM S= KRAMER x F BOOK 5754 PAGE 51 F ' 5 •,1 T MARC SUZANNE F�P iold �,aF 2�z � c ��f �t�7 �� �� 40' JOSLOW - 83.'+ 'r49 PA GE 176 rr 170 ; ; , 8 G A� ' 0 TOWN OF NORTH ANDOVER f gORrp Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT a p 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 �9SSACHUs Susan Y. Sawyer,REHS,RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX healihdept(ct�,townofnorthandover.com www.townofnorffiandover.com APPLICATION FOR SOIL TESTS DATE:March 9,2004 MAP&P CEL: M-38 L-42 Summer St. &M-65 L-91 Molly Towne Road LOCATION OF SOIL TESTS:—Lots 1 and 2 OWNER: William&Lynne Gillen Contact#: 978-682-4927 I APPLICANT:ABOVE Contact#: ADDRESS: 54 Spring Hill Rd.N. Andover ENGINEER: Christiansen&Sergi Haverhill Contact#: 978-373-0310 CERTIFIED SOIL EVALUATOR: Gene Willis Intended Use of Land: Residential Subdivision 2 Single Family Home Commercial Is This: Repair Testing: Undeveloped Lot Testing:_X Upgrade for Addition: In the Lake Cochichewick Watershed? Yes No X THE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership(Tax bill,or letter from owner permitting test) ➢ 8.5"x 11"Plot plan&Location of Testing(please indicate test nit sites on the plan) ➢ Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$225.00 per lot for repairs or upgrades. GENERAL INFORMATION ➢ Only Certified Soil Evaluators may perform deep hole inspections. ➢ Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. ➢ At least two deep holes and two percolation tests are required for each septic system disposal area. ➢ Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. ➢ Full payment will be required for all additional tests within two weeks of testing. ➢ Within 45 days of testing,a scaled plan(no smaller than 1"-100')shall be submitted to the Board of Health showing the location of all tests(including aborted tests). ➢ Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line e �- N.A. Conservation Commission Approv Date:_&f I Signature of Conservation Agent. ) Date back to Health Department: (stamp in): Received, May-12-00 14: 17 trom 508 bbb y542 4 U Kaye z May-12-00 14:08 North Andover Com. Dev. 508 688 9542 P. 02 P t p BOARD OF HEALTH NORTH ANDOVER, MA 01845 978-688-9540 APPLICATION FOR SOIL TESTS DATE: Ni.-.P & PARCEL: f LOCATION OF SOIL TESTS: //.. '' II I OWNER: Gyi/(14.t lyiwie C, 11q ,TEL. NO.: Y7S� ADDRESS: ENGINEER: (� ji r 15, /i,L q � �'� TEL. NO.: 20 3 7 3 CERTIFIED SOIL EVALUATOR: Ct'y-c 5 Intended Use of Land: Residential Subdivision Cu�gle Family Homme Commercial Is This: Repair Testing: Undeveloped lot testing: l� In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST 13E INCLUDED WITH THIS FORM 1. Proof of land owners`ip (Tax bill, or letter from owner permitting test) I Plot pi n Location of Testing 3. Fee of S per 16 for new construction. T"nis covers the minimum two deep holes and t,,,,-o p o atia s quired for each disposal area. Fee of$75.00 per lot for repairs or upgrades. GENE L ATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only?Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests axe required for each septic system disposal area. 4. Repairs require at least two deep holes and at Fast one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan(no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval: Date Received: Check Amount: Ch ' k Date: i TOWN OF NORTH ANDOVER BOARD OF HEALTH za Location .. Permit Food Service Retail Food Limited Retail $ Seasonal $ Disposal Works Installers $ Disposal Works Construction $ �M Soil Testing Design Approval Permit $ Dumpster Permit $ Burial Permit $ Swimming Pool Permit $ Animal Permit $ Recreational Camp Permit $ 1 Well Construction Permit $ Funeral Directors Permit $ Massage Establishment License $ Massage Practice License Suntanning Establishment $ offal/Trash Hauler $ Other Q _. Health Agent White - Applicant Yellow - Dept. Pink - Treasurer ' 3 BOARD OF HEALTH '1 NORTH ANDOVER, MASS. 01845 978-688-9540 APPLICATION FOR SOIL TESTS DATE: MAP&PARCEL: LOCATION OF SOIL TESTS: OWNER: TEL.NO.: ADDRESS: ENGINEER: TEL.NO.: CERTIFIED SOIL EVALUATOR: Intended use of land: Residential Subdivision Single Family Home Commercial Is This: Repair testing Undeveloped lot testing Upgrade for addition In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership(Tax bill,deed,or letter from owner permitting tests) 2. Plot plan 3. Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$360.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing,a scaled plan(no smaller than 1"-100')shall be submitted to the Board of Health showing the location of all tests(including aborted tests). 7. Within 60 days of testing soil evaluation forms.shall be submitted. Please Do Not Write Below This Line N.A.Conservation Commission Approval: Date Received: Check Amount: Check Date: O t n Christians 160 Summer,Street Haverhill, MA 01830 Phone: (978) 373-0310 Fax: (978) 372-3960 Transmittal Sheet To: North Andover Board of Health From: Gene Willis Company: Date: March 5,2004 Address: Charles St. North Andover Pages: 2 Re: soils tests application for 2 lots CC: ❑ Urgent ❑ For Review ❑ Please Comment ❑Please Reply ❑ Per Your Request -Comments: Please find attached and application and site plan for testing soils on two lots for RSDS design. The lots are referenced on the attached plan as lots 1 and 2. The land owner will be delivering the required fee to-your office. Thanks Gene Millis CC. file:97066 - - - { i , :. +mK. 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R , TOWN OF NORTH ANDOVER BOARD OF HEALTH 775�D Location- Permit # Food Service <-Y4 745Z Retail Food $ Limited Retail $ Seasonal $ Disposal Works Installers $ Disposal Works Construction $ Soil Testing $ Design Approval Permit $ Dumpster Permit $ Burial Permit $ Swimming Pool Permit $ Animal Permit $ Recreational Camp Permit $ Well Construction Permit $ Funeral Directors Permit $ Massage Establishment License $ Massage Practice License $ Suntanning Establishment $ Offal/Trash Hauler $ Other $ r1 74u9 Health Agent r White - Applicant Yellow - Dept. Pink - Treasurer Received Aay-1�-00 14: 17 t rom 508 bbd 954Z -+ U Ndye z � May-7s2-00 14:08 North Andover Com. Oev . 508 688 9542 P.02 BOARD OF HEALTH NORTH ANDOVER, MA 01845 978-688-9540 APPLICATION FOR SOIL TESTS Summo_rS DATE: MAP &I P ARCEL:� /�"_f _ 4 Ei 4 LOCATION OF SOIL TESTS: © I / J �'�``� OWNER: G )//// M f �jLrh� (� 4-JEL.NO.: Y7� - 7 I '� ADDRESS: S t ,, ENGIvEER• xr1 slg qL:Qse;-� TEL. NO.: ,,7S ' 3 73d 3 G CERTIFIED SOIL EVALUATOR: Czf K c GJ>//>5 Intended Use of Land: Residential Subdivision Commercial Is This: Repair Testing: undeveloped lot testing: In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM � 1. Proof of land owners`ip (Tax bill, or letter from owner permitting test.) Z. PloAoadoo.a'is con of Testing 3. Feeper to for new construction. This covers the minimum two deep holes and two quired for each disposal area. Fee of 75.00 per lot forrenairs or upgradeGENE ��►TION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at lust one percolation test, at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing, a scaled plan(no smaller than 1"-100') shall be submitted to the Board of Health showing the location of all tests (including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A. Conservation Commission Approval: Date Received: Check Amount: Check Date: f I BOARD OF HEALTH NORTH ANDOVER, MASS. 01845 978-688-9540 APPLICATION FOR SOIL TESTS DATE: MAP&PARCEL: LOCATION OF SOIL TESTS: OWNER: TEL.NO.: ADDRESS: ENGINEER: TEL.NO.: CERTIFIED SOIL EVALUATOR: Intended use of land: Residential Subdivision Single Family Home Commercial Is This: Repair testing Undeveloped lot testing Upgrade for addition In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM: 1. Proof of land ownership(Tax bill,deed,or letter from owner permitting tests) 2. Plot plan 3. Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$360.00 per lot for repairs or upgrades. GENERAL INFORMATION 1. Only Certified Soil Evaluators may perform deep hole inspections. 2. Only Mass.Registered Sanitarians and Professional Engineers can design septic plans. 3. At least two deep holes and two percolation tests are required for each septic system disposal area. 4. Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH representative. 5. Full payment will be required for all additional tests within two weeks of testing. 6. Within 45 days of testing,a scaled plan(no smaller than 1"-100')shall be submitted to the Board of Health showing the location of all tests(including aborted tests). 7. Within 60 days of testing soil evaluation forms shall be submitted. Please Do Not Write Below This Line N.A.Conservation Commission Approval: Date Received: Check Amount: Check Date: Christiansen & Sergi, Inc. 160 Summer Street Haverhill, MA 01830 Phone: (978) 373-0310 Fax: (978) 372-3960 Transmittal Sheet To: North Andover Board of Health From: Gene Willis Company: Date: March 5,2004 Address: Charles St. North Andover Pages: 2 Re: soils tests application for 2 lots CC: ❑ Urgent ❑ For Review ❑ Please Comment ❑ Please Reply ❑ Per Your Request •Comments: Please find attached and application and site plan for testing soils on two lots for SSDS design. The lots are referenced on the attached plan as lots 1 and 2. The land owner will be delivering the required The to your office. Thanks Gene Alis CC. file:87066 KZDRAS - } ,BOOK 1857 PAGE 252 � 5 d � AP 3B L07 }4 _.a _' GRAM . . 1 SG. DRIVE 50 P , i i i • , r , , 02 _ r ; f - i ry �1F 50.001e O cl 'URILL CN t .. - N SCT { ,. 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THAN yy5� +a i 4 ae20 $rRu a 92.43'95 d S48@0 • f N48 44493 14 +d.- NR3" I JAMES & LISA KRMER NIF BOOK 5754 PAGE 31 F21 2 NNE Jost ow � i �. ` " 3 At t7 t" • 96 PAGE t 71i 1dPf3_L01 17GM y + _ + , `. i TOWN OF NORTH ANDOVERof Pr„7 Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT •i •x 27 CHARLES STREET `�* • •�' NORTH ANDOVER,MASSACHUSETTS 01845 CHU Susan Y.Sawyer,RENS,RS 978.688.9540—Phone Public Health Director 978.688.9542—FAX healthdep A ownofnorthandover.com www.townofnorthandover.com APPLICATION FOR SOIL TEOT DATE:March 9,2004 MAP&PAR L: -38 L-42 Summer &M-6 L-91 Molly Towne Road LOCATION OF SOIL TESTS: Lots 1 and 2 OWNER:William&Lynne Gillen Contact#: 978-682-4927 APPLICANT:ABOVE Contact#: ADDRESS: 54 Spring Hill Rd.N. Andover ENGINEER: Christiansen&Sergi Haverhill Contact#: 978-373-0310 CERTIFIED SOIL EVALUATOR:Gene Willis Intended Use of Land: Residential Subdivision 2 Single Family Home Commercial Is This: Repair Testing: Undeveloped Lot Testing:_X Upgrade for Addition: In the Lake Cochichewick Watershed? Yes No X THE FOLLOWING MUST BE INCLUDED WITH THIS FORM ➢ Proof of land ownership(Tax bill,or letter from owner permitting test) ➢ 8.5"x 11"Plot plan&Location of Testine(please indicate test pit sites on the plan) ➢ Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$225.00 per lot for repairs or upgrades. 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