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Miscellaneous - 55 VEST WAY 4/30/2018 (2)
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North Andover Board of Assessors Public Access ' e. t i NORTH Ot tt��o s1'�'O is e�ca. ."�. �• Ot ,STACOUS�S Click Seal To Retum Summary Residence Detached Structure Condo Commercial Page 1 of 1 roperty Record Card I Location: 55 VEST WAY MIDDLETON, ROBERT J Owner Name: LORETTA MIDDLETON Owner Address: 55 VEST WAY City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 7 - 7 Land Area: 1.13 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 2738 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 611,800 631,200 Building Value: 386,000 405,400 Land Value: 225,800 225,800 Market Land Value: 225,800 Chapter Land Value: LATEST SALE Price: 320,000 Sale Date: 01/24/1989 s Length Sale Code: Y -YES -VALID Grantor: HARRIGAN WILLIAM B Doc: Book: 02878 Page: 0105 http://csc-ma.us/PROPAPP/display.do?linkId=1464265&town=NandoverPubAcc 4/6/2009 Commonwealth of Massachusetts } = City/Town of 0 j ZU14 System Pumping Record TOWN Vl-Ni.1KINANDOVER ~ 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. A. Facility Information 1. System Location: Left/ Right front of house, Lefri ' t rear of Nous. ------)Left/ right side of house, Left/ Right side of building, Left / Right front of building, Left / Right rear of building, Under deck Address Citylrown U Qj State Trp Code 2. System Owner. Name Address ('d different from location) Citylrown stat Zip Code ��-�a� Telephone Number B. Pumping Record 1. Date of Pumping gate 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank El Tight Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yeas o If yes, was it cleaned? ❑ Yes ❑ No 5. Conditio 6. System Pumped By - Neil. Bateson Name Bateson Enterprises Inc Company 7. Locatio ere contents were disposed: ZSVLowell Waste Wz t5form4.doc- 06/03 F5821 Vehicle License Number Data System Pumping Record • Page 1 of 1 RECEIVED Commonwealth of Massachusetts _ City/Town of JUL .� 2013 System Pumping, Record TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Form 4 DEP has provided this form for us&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. A. Facility Information 1. System Location: Left / Right front of housea Rigtgjjar of h , Left/ right side of house, Left / Right side of building, Left / Right front of bul in , Left / Right rear of building, Under deck 9 9 9 9 9, Address�kjca-n City/Town State Zip Code 2. System Owner: Name Address (N different from location) City/rown relephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped; 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Other (describe): 4. Effluent Tee Filter present? ❑ Yes No 5. Conditi�n qf System: b`v C>- V< —CZA 6. System Pumped By: Neil Bateson Name Bateson Entemrises Inc Company C Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No. 7. Location where contents were disposed: Lowell Waste Water F5821 Vehicle License Number `-7 `3 Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of. Massachusetts AIMM City/Town of ° System Pumping Record y Form 4 Sy RECEIVED MAY 15 2012 TOWN OF NORTH ANDOVER 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. A. Facility Information 1. System Location: Left / Right front of house. / Rig a of hous , Left / right side of house, Left / Right side of building, Left / Right front of b ' Ing, Left Ig rear of building, Under deck Address ter^ p City/Town `v 2. System Owner: Name Address (if different from location) Cityrrown B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): Date Cesspool(s) State CWCA Zip Code State 11 � ` � _ Zip Com Telephone Number — 2. Quantity Pumped: eptic Tank b-*-"�- Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes LSO If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Locai qe contents were disposed: G. L SQ ,,/ Lowell Waste Water iuleq I Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 NOR7h Q�qt LSD O O \�q AOR�TEO APa`�•(� . PUBLIC HEALTH DEPARTMENT Community Development Division CE127IFICA7E OF' CO�I�.GIA9VC`� As of: ,dune 1, 2009 This is to cert that the individual subsurface dsposalsystem received a SA27SEAC70RT IXS(PEC 705V of the: emplacement of Oistri6ution BoX By: ArtkurMutton At: . SS Vest Way Wap —104. B; Parcel— 163 JVorth Andover, M,4 01845 The Issuance of this cert ate shaft not 6e construed as a guarantee that the system wiff function sAisfactoriCy. T Sawyer 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com t�A Commonwealth of Massachusetts RECEIVES . City/Town of APR 2 3 2009 System Pumping Record Form 4 TOWN OF NORTH ANDOVER 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. B. Pumping Record vU 1. Date of Pumping Date O Z. Quantity Pumped: Gallons 3. Type of system: Cesspool(s) _ eptic Tank Tight Tank p Other (describe): 4. Effluent Tee Filter present? L1 Yes M410 5. Condition of System: �s✓� taeu-vk � 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Location where contents were disposed: Sionafure of t5form4.doc• 06/03 ' Lowell Waste Water If yes, was it cleaned? p Yes Lj No F 5821 Vehicle License Number Date System Pumping Record • Page 1 of 1 A. Facility Information Important: When filling out 1. System Location: Left front, left rear, left side of house. Right front rig #rear right sid of house. forms on the computer, use only the tab key to move your Address~ t 5— cursor - do not use the return City/Town State Zip Code key. 2. System Owner: Name Address (if different from location) City/Town St� Zip Code Telephone Number B. Pumping Record vU 1. Date of Pumping Date O Z. Quantity Pumped: Gallons 3. Type of system: Cesspool(s) _ eptic Tank Tight Tank p Other (describe): 4. Effluent Tee Filter present? L1 Yes M410 5. Condition of System: �s✓� taeu-vk � 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Location where contents were disposed: Sionafure of t5form4.doc• 06/03 ' Lowell Waste Water If yes, was it cleaned? p Yes Lj No F 5821 Vehicle License Number Date System Pumping Record • Page 1 of 1 �L\ Commonwealth of Massachusetts City/Town of a w° System Pumping Record G^ SVB" Form 4 DEP has provided this form for use by local Boards of Health. Other fo ms m�Me`ps60000t the information must be substantially the same as that provided here. Bef a using this form, check ith your local Board of Health to determine the form they use. The System PuI itted to the local Board of Health or other approving authority. A. Facility Information 1. System 'on: Left side of house, Right side of house, Left front of house, Right front of house, /te rear a s , ight rear of house. Left rear of building. Right rear of building. Address Citylrown - State 2. System Owner: Name Address (if different from location) Cityrrown B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): Date Cesspool(s) Zip Code Stat&�-7— ip Code Telephone Number 2. Quantity Pumped Er-S--eptic Tank Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No 5. ConditioA o�fjSyste 1,e, . ) v,.-- 6. System Pumped By: Neil Bateson Name Bateson Enterprises Inc Company 7. Location -Where contents were disposed: Lowell Waste Water of F5821 Vehicle License Number Date t5form4.doc• 06/03 System Pumping Record • Page 1 of 1 Commonwealth of Massachusetts te rI City/Town of r° System Pumping Record APR 26 2011 Form 4 TOWN OF NORTH ANDOVER " HEATH DEPARTMENT DEP has provided this form for use by local Boards of Health. Other forms may be used, but t e 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. t5form4.doc• 06/03 A. Facility Information 1. System Location: LefLfronLoLbouse, right front of house, left side of house, right side of house, Left rear of hous g t rear of houseDM side of building, right rear of building, under deck City/Town 2. System Owner: Name Address (if different from location) City/Towri B. Pumping Record 4--m 1. Date of Pumping 3. Type of system Date ❑ Cesspool(s) ❑ Other (describe): Zip Code State/'1� iZip Code Telephone Number — 2. Quantity Pumped Septic Tank 4. Effluent Tee Filter present? ❑ Yes [o 5. Condition of,DSy�sten^� tCsv� 6. System Pumped By: Neil J. Bateson Name Bateson Enterprises Inc. Company Gallons ❑ Tight Tank If yes, was it cleaned? ❑ Yes ❑ No UL'J'ao (� -13 F5821 Vehicle License Number System Pumping Record • Page 1 of 1 M /Commonwealth of Massachusetts Nv , Massachusetts System Pumping Record System Owner &A fi lidc�f� Date of Pumping: �� �- '-6?9 Cesspool: No [ Yes [I System Pumped by: Ta&40 t System Location 5-5- L) e4s+ ue,� Quantity Pumped: gallons Septic Tank: No [ ] License # Contents transferred to:_ Greater Lawrence Sanitary District Date: Inspector: Yes [-r' ��stem ���ner FORM 4 - SYSTEM PLAN-IL\G 2 X995 <VU� Comtnoni►-ealth of Massachusetts Massachusetts ,V System Pumping Record on S5 V Date of Pumping i a Quantity Pumped: C Cesspool: No ,tom Yes ❑ Sentir Tnnl-• XTr, Yes �(D� System Pumped by- License #: Contents transferred to: �/ • �' Date Inspector FORM - SYSTE.NI PLAWL\G RECORD Commonwealth of Massachusetts , Massachusetts &sfem-PumpLng Record }stem Owner Svstern Location. Date of Pumping ! Quantity Pumped: Cesspool: No ,� Yes ❑ Sentir Tnnt- kIn �] Yes System Pumped by: � - License #: Contents transferred to: Date Inspector s51 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. few ILEI Commonwealth of Massachusetts City/Town of System Pumping Record Rec�sv€� OCT 2 3 2007 Form 4 TOVNN OF NORTH ANDOVER HEALTH DEPARTMENT DEP has provided this form for use by local Boards of Health. Ot orms may 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. A. Facility Information 1. System Location, Address 2. System Owner: Y41 � Name Address (if different from location) Cityrrown B. Pumping Record 1. Date of Pumping 3. Type of system: ❑ ❑ Other (describe): Date Cesspool(s) Pe Zip Code StateZip Code Telephone Number — 2. Quantity Pumped eptic Tank Gallons ❑ Tight Tank 4. Effluent Tee Filter present? ❑ Yes [-No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: V, ILO� — Kle� 6. System u ZIT. Name�v� Vehicle License Number y'�Qf� . Company 7. Location/ere contents were posed: Date t5fomr4.doc• 06/03 System Pumping Record • Page 1 of 1 iA Commonwealth. of Massachusetts City/Town of I System Pumping Record Form 4 DEP has provided this form for use by local Boards of Health. The System Pumping Record must be submitted to the local Board of-Health or other approving authority. . A. Facility Information Important: When fining out 1. System Location:—� forms � �tL.� computer, the �Zr, use only the tab Key Address j to move your `J All� , cursor - do not flown Cit use the7return y S e Zip Code key. _ M 2. System Owner: rf�"� VC] Name JUL 18 200 Address (if different from location) TQ'lNt\ ) a r ',iVDOV HE, iMENT CityfTown Stat ip. ode Telephone Number .B. Pumin9 Record 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 if yes, was it cleaned? ❑ Yes ❑ No 6. Conditioneof-s. .System: 6. Syst�Qumd-6y Name Vehicle Li'cen§e Number Company 7. Location w e contents were disp Signat of aul r Date http://www. mass.ggv/deptwater/approvals/t5forms. htrn#inspect t5form4.doc• 06103 System Pumping Record •Page 1 of 1 --a TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: 3� 3 SIR (example: left front of house) DATE OF PUMPING: D- " QUANTITY PUMPED L/``— GALLONS CESSPOOL: NO "---YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE OBSERVATIONS: GOOD CONDITION HEAVY GREASE ROOTS EXCESSIVE SOLIDS SOLIDS CARRYOVER SYSTEM PUMPED BY: COMMENTS: EMERGENCY FULL TO COVER BAFFLES IN PLACE LEACHFIELD RUNBACK FLOODED OTHER (EXPLAIN) -q—(CAA-� V\6 CONTENTS TRANSFERRED TO: 3. L.S�.C) PUBLIC HEALTH DEPARTMENT Community Development Division CER7IT7ICA7E OAF CO,14PLIA�VC`�E As of: ,dune 1, 2009 , 7Fiis is to cert that the individuaCsu6surface dzsposaCsystem received a SA7ISEACT0RTIWS(PEC71OTrof the: W§placement of Oistri6ution fox By: ArtFiurg[utton LP. SS Vest Way flap —104. B; Parcer-163 North Andover, WA 01845 The Issuance of this certificate shad not de construed as a guarantee that the system wid function sygisfactoriCy. `Y. Sawyer 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com TOWN OF NORTH ANDOVER f NOR7{ H Office of COMMUNITY DEVELOPMENT AND SERVICES o��`°teO HEALTH DEPARTMENT A «_ �# 1600 OSGOOD STREET; Building 2-36 NORTH ANDOVER, MASSACHUSETTS 01845 �9SS cHUSE``h Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.8476 — FAX ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: MAP: INSTALLER: DESIGNER: PLAN DATE: BOH APPROVAL DATE ON PLAN: q. INSPECTIONS ���0/� xv,!' a� TANK INSPECTION: DATE OF BED BOTTOM INSPECTION: DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS Comments: SEPTIC TANK LOT: ❑Existing septic tank properly abandoned ❑Internal plumbing all to one building sewer ❑Topography not appreciably altered ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ 1500 gallon tank has been installed H-10 loading Monolithic construction ❑ Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ❑ Inlet tee installed, centered under access port ❑ Outlet tee (gas baffle or effluent filter) installed, centered under access port ❑ 24" inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present ❑ Hydraulic cement around inlet & outlet Wastewater System Documentation - Feb 2006 �r Page 1 of 6 t- r:;,,14r:;,,14� 6 s TOWN OF NORTH ANDOVER f tiOR7H Office of COMMUNITY DEVELOPMENT AND SERVICES 3}Obst�eo 6pka0L HEALTH DEPARTMENT 1600 OSGOOD STREET; Building 2-36 NORTH ANDOVER, MASSACHUSETTS 01845 �9SSpcHuSE��h Susan Y. Sawyer, REHS/RS 978.688.9540 — Phone Public Health Director 978.688.8476 — FAX D -BOX Comments: SOIL ABSORPTION SYSTEM El Comments: Installed on stable stone base Inlet tee (if pumped or >0.08'/foot) Hydraulic cement around inlet & outlets Observed even distribution Speed levelers provided (not required) Bottom of SAS excavated down to soil layer, as provided on plan Size of SAS excavated as per plan Title 5 sand installed, if specified on plan 3/4-1 Y2" double washed stone installed 1/8-1/2" (peastone) double washed stone installed Laterals installed and ends connected to header Laterals vented if impervious material above Orifices @ 5 & 7 o'clock positions Gravel -less disposal systems: type, number and location as per plan Elevations of laterals installed as on approved plan 40 Mil HDPE barrier installed Retaining wall (boulder / concrete / timber/ block) Final cover as per plan Wastewater System Documentation — Feb 2006 Page 3 of 6 &O oTIW Commonwealth of Massachusetts Map -Block -Lot 104.8- 0163 - Board of Health Perm----------- a Permit No North Andover BHP-2009-0537----------------------- P.I. HP-Zoos-o537P.I. FEE �Ss�odNusa F.I. $125.00 ----------------------- Disposal Works Construction Permit Permission is hereby granted Arthur_Hutton ----------------------------------------------------------------------------------------------------- to (Repair -D -BOX ONLY) an Individual Sewage Disposal System. at No 55. VEST WAY ---------------------------------------------------------------------------------------------------------------------------------------------------------- as shown on the application for Disposal/Works Construction Permit No. BHP -2009-053 Dated June- 02,-2009-------- ------------------------ `'aUR ---------E of Health --y -------------- Issued On: Jun -02-2009 N°RT►, Application for Septic Disposal System Construction Permit - TO��N OF Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. rehon ORTH S �=le� TODAY'S DATE 01845— air $125.00 - Componen Application is hereby made for a permit to: ❑ Construct a new on-site sewage disposal system* ❑ Repair or replace an existing on-site sewage disposal syste � epair or replace an existing system component — What? o 60 A. Facility Information Address or Lot # V City/Town ' 2.- *TYPE OF §gPTIC SYSTEM*: ❑ Pump ravity (choose one) ***If pump system, attach copy of electrical permit to application*** [Conventional System (pipe and stone system) ❑ Infiltrator or Biodiffuser (Gravel -Less) (Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D -Box) (Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D -Box Present) S.A.S. 2. Owner Information 1- m aL. e- ! 7` 4L /✓1 e— -r- Name oy Name Address (if different from above) City/Town State 3. Installer Information' 14 q Name Address M c Yi u r — City/Town 4. Designer Information Name Add ress City/Town Telephone Number Name of Company Zip Code M 4/OP7 y4z' State Zip Code Telephone Number (cell Phone # if possible please) Name of Company State Zip Code Telephone Number (Best # to Reach) Application for Disposal System Construction Permit • Page 1 of 2 A"✓ '1 N ,tORTH Application for Septic Disposal System OF reo i°ANO °r�AConstruction Permit -TOWN OF ORTH ANDOVER, MA 01845 PAGE 2OF2 A. Facility Information continued.... 5. Type of Building: Residential Dwelling or ❑Commercial B. Agreement TODAY'S DATE $ 250.00 — Full Repair $125.00 - Component The undersigned agrees to ensure the construction and maintenance of the afore -described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. P&I 4.v c Name Date Application roved By: (Bo d of Health Representative) 61 Z C' Zme Date plicati n Disapproved for the following reasons: For Office Use Only: Z Fee Attached. Yes ✓ No 2. Project Manager Obligation Form Attached.? Yes /j�' No 3. Pump Svstem? Ifso, Attach copy ofElectrical Permit Yes No 4. Foundation As -Built. (new construction ronly): Yes No (Same scale as approved plan) 5. Floor Plans? (new construction only): Yes_ 1 No Application for Disposal System Construction Permit • Page 2 of 2 For owner Information Is required for every page, Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. CO 151n6.09i09 N Commonwealth of Massachusetts Title a Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 55 Vest way_._, Property Address Loretta and Robert Middleton owner's Name North Andover City/rown — REVISED REPORT— MA 01845 06/18/09 _ _ ...— 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 and of the form. A. General Information 1. Inspecb)r: James Wright Name of Inspector Awn Environmental Services LLC— Company Name 270 Lawrence St Company Address Methuen r„ _MA _ 01844 Cltilfown -- --- — State N Code 978-681-5023 _ _ 2035 Telephone Number License Number B. Certification 1 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 6 (311) CMR 15.000). The system: ® Passes [] Conditionally Passes ❑ Fails ❑ IAe�ds Further Evaluation by the Local Approving Authority 06/18/09 Revised Report 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,A00 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 thePuyer, 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 Insp$ction does not address how the syste� will perform In the future under the same or different conditions of use. 1.We 6 orB61e1 *4pedon Fam: eubsurrM sewe0e Olepoel System' poo 1 or 17 Ed Wd8T:ET 600E 8T -unr 9601.2-898-6: 'ON Xtid : WOad '.T -P Owner Information is required for every page. 15M • 0910b Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 56 Vest Way _ __ _ REVISED REPORT. Property Addrel.s Loretta and Robert Middleton Owner's Name North Andover . �__. _ MA 01845. _ 06/18/09 Nh No A State u Zip Code vete of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C:,D or E / always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure cHterla described in 310 CMR 15.303 or In 310 CMR 15.304 exist. Any failure crlteria not evaluated are indicated below. Comments: Distribution Box was installed with Riser 13) System Conditionally Passes: ❑ One or more system componNnts 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 "riot 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 [j ND (Explain below): Ed Wd8i:ZZ 6002 BZ 'unf Title 5 Mild kw"Cllon Form: "aurieee Sewage Olepoaal System. page 2 of 1 % . 9604L89846: 'ON Xdd i WO8j il" Z. '? "" G -v —&=i:. FAX COVER SHEET ASPEN ENVIRONMENTAL 270 Lawrence Street, Unit 2 Methuen, MA 01844 Fax Number 978-687-7096 Phone Number 978-681-5023 Date: TO: e- FROM: RECIPIENT'S FAX NUMBER: A,v0ji -�) 4e - M110. OF PGS. INCLUDING COVER SHEET: .3 MESSAGES:..,_.._ Td WdBZ:Zl 600E 81 'unt 960LL898L6: 'ON XUJ : wod-d Owner information is required for every page. Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. tab ieaon Commonwealth..of."V'.assachusetts®� Title 5 Official Inspection Form '51 55 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments / 55 Vest Way Property Address Loretta and Robert Middleton Js J�e Owner's Name North Andover MA 01845 4/14%09 City/Town State Zip Code Date of1nspection 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. A. General Information 1. Inspector: Name of Inspector Aspen Environmental Services LLC Company Name 270 Lawrence St Company Address Methuen City/Town 978-681-5023 Telephone Number B. Certification RECEIVED HEALTH MA 01844 State Zip Code 2035 License Number 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 s Further Evaluation by the Local Approving Authority 4/14/09 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 • 09/08 TIOe 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 55 Vest Way Property Address Loretta and Robert Middleton Owner Owner's Name information Is required for North Andover MA 01845 4/14/09 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for "yes", "no" or "not determined" (Y, N, ND) for the following statements. If "not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exMtration 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 • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 2 of 17 .<L'1\ Commonwealth of Massachusetts Title 5 Official Inspection Form i; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments "( 55 Vest Way Property Address Loretta and Robert Middleton Owner Owner's Name information is North Andover required for MA 01845 4/14/09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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 replaced' lr" 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 b e -Board of Health in order to determine if the system is failing to protect public healt ety or the environment. 1. System will pass unless _Bnafdof Health determines in accordance with 310 CMR 15.303(1)(b) that the sy,s�te{n is not functioning in a manner which will protect public health, safety and thee'envir66ment: ❑ssc� pool 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 • 09/08 Title 6 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 re 55 Vest Way Property Address Loretta and Robert Middleton Owner Owner's Name information is North Andover required for MA 01845 4/14/09 every page. Cityrrown 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 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 ❑ 0 Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ E1 Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ a Static liquid level in the distribution box above outlet invert due to an overloaded /or clogged SAS or cesspool ❑ Q,, -Liquid depth in cesspool is less than 6" below invert or available volume is less than % day flow t5ins • 09/08 Title 5 official Inspection Form: Subsurface Sewage Disposal System • Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 55 Vest Way Property Address Loretta and Robert Middleton Owner Owner's Name nformation is North Andover required for MA 01845 4/14/09 every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ 0•� Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ E2 Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ [1" 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.] ❑ E 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 w' 400 feet of a surface drinking water supply ❑ ❑ they em 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 • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 5 of 17 i 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 w' 400 feet of a surface drinking water supply ❑ ❑ they em 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 • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 5 of 17 Owner Information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 55 Vest Way Property Address Loretta and Robert Middleton Owners Name North Andover MA 01845 City/Town State Zip Code C. Checklist 4/14/09 Date of Insaection Check if the following have been done. You must indicate "yes" or "no" as to each of the following: Yes o ❑ 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? 0 ❑ 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 r.❑ Was the facility or dwelling inspected for signs of sewage back up? , % E3/'/' I3' ❑ Was the site inspected for signs of break out? L�' ❑ 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 Li ❑ been determined based on: Existing information. For example, a plan at the Board of Health. El El Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): —-- Number of bedrooms (actual):-- DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms): t5ins • 09108 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 6 of 17 a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments p 55 Vest Way Property Address Loretta and Robert Middleton Owner Owners Name Informationrequired is North Andover re wired for MA 01845 4/14/09 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: Does residence have a garbage grinder? Is laundry on a separate sewage system? [if yes separate inspection required] Laundry system inspected? Seasonal use? Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? Last date of occupancy: Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Industrial waste holding tan present? fes,. Non -sanitary ' to discharged to the Title 5 system? Water meter readings, if available: ❑ Yes 2- o ❑ Yes ❑' No ❑ Yes ®''Flo ❑ Yes ©-'No_ ❑ ❑ Yes No Date ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No t5ins • 09/08 Title 6 Official Inspection Form: Subsurface Sewage Disposal System • Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 55 Vest Way Property Address Loretta and Robert Middleton Owner Owners Name Information is required or North Andover MA 01845 4/14/09 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Other (describe below): General Information Pumping Records: Source of information: Date Was system pumped as part of the inspection? ❑ Yes ©- o 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 • 09108 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page a of 17 Commonwealth of Massachusetts = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 55 Vest Way Property Address Loretta and Robert Middleton Owner Owner's Name Information is North Andover required for MA 01845 4/14/09 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: 11-1'1, -- o.'_3 c, // Were sewage odors detected when arriving at the site? 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 line: ❑ Yes i feet feet Comments (on condition of joints, venting, evidence of leakage, etc.): 6'V '4-7--s A Septic Tank (locate on site plan): Depth below grade: Material of construction: concrete M metal If tank is metal, list age: fe tt ❑ fiberglass ❑ polyethylene ❑ other (explain) years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No _ •a Dimensions: .aC ` e-, Sludge depth: t5ins • 09108 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 0 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments t " 55 Vest Way Property Address Loretta and Robert Middleton Owner Owner's Name Information is North Andover required for MA 01845 4/14/09 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 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 How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related tp outlet invert, evidence of leakage, etc.): _ Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ��___ El concrete ❑ metal ❑ fib l�❑ 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 • 09/08 Title 6 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 55 Vest Way Property Address Loretta and Robert Middleton Owner Owner's Name information atiis North Andover required for MA 01845 4/1.4/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet -and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invertevldence 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 Dimensions: Capacity: Design Flow: Alarm present: Alarm level: Date of last pumping: ❑ fiberglass ❑ polyethylene ❑ other (explain): gallons gallons per day ❑ Yes ❑ No Alarm in working order: ❑ Yes ❑ No Date Comments (condition of alarm and float switches, etc.): * Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 55 Vest Way Property Address Loretta and Robert Middleton Owner Owner's Name Information is required for North Andover MA 01845 4/14/09 every page. City[rown 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 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.): Pump Chamber (locate on site plan): Pumps in working order: / '" ❑ Yes ❑ No Alarms in working order: / ❑ Yes ❑ No Comments (note condition of pumpcKamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins • 09108 Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 55 Vest Way Property Address Loretta and Robert Middleton Owner Owner's Name nformation is North Andover required for MA 01845 4/14/09 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: —❑ leaching galleries number: k leaching trenches number, length: =' ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): _ S /' 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 ce s pool Materialsogconstruction Indication of groundwater inflow ❑ Yes ❑ No t5ins - 09108 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 13 of V I 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 ce s pool Materialsogconstruction Indication of groundwater inflow ❑ Yes ❑ No t5ins - 09108 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 13 of V Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments "< 55 Vest Way Property Address Loretta and Robert Middleton Owner Owner's Name required Information is North Andover re wired for MA 01845 4/14/09 every page. Citylrown 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.): 15ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 14 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 55 Vest Way Property Address Loretta and Robert Middleton Owner Owner's Name Information is North Andover required for MA 01845 4/14/09 every page. cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: hand -sketch in the area below ❑ drawing attached separately t5ins - 09108 Tile 5 Official Inspection form: Subsurface Sewage Disposal System - Page 15 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Foran - Not for Voluntary Assessments rf 55 Vest Way Property Address Loretta and Robert Middleton Owner owner's Name information is North Andover required for MA 01845 4/14/09 every 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: 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: 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: f— i Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5ins • 09/08 Title 6 Official Inspection form: Subsurface Sewage Disposal System • Page 16 of 17 Owner Information Is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 55 Vest Way Property Address Loretta and Robert Middleton Owner's Name North Andover MA 01845 4/14/09 Cityrrown State Zip Code Date of Inspection t. Keport completeness Checklist Inspection Summary: A, B, C, D, or E checked Inspection Summary D (System Failure Criteria Applicable to All Systems) completed 3/System Information — Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins • 09/08 Title 5 Official Inspection Form: Subsurface Sewage Disposal System - Page 17 of 17 49 12:42P DPW 9786889573 P.1 Svilmery Raeord Card generated on 4IM2009 12:41:32 PM by Usa Evans Page 1 Town of North Andover Tax Map # 210-104.6-0163-0000.0 Parcel Id 16485 q�g r,.. 70'Fk 55 VEST WAY MIDDLETON, ROBERT 55 VEST WAY N. ANDOVER, MA 01845 Class 101 Single Family Property Type 1 Residential Size Total 1.13 Acres FY 2009 UB Mailing Index Name/Address MIDDLETON, ROBERT 55 VEST WAY N. ANDOVER, MA 01845 UB Account Maint. Account No Cycle Bldg Id. 17811.0 - 55 VEST WAY 3170476 03 Cycle 03 UB Services Maint, Account No. 3170476 Service Code MISCFEE ADMIN FEE WTR WATER , UB Meter Maintenance Account No. 3170476 Serial No Status 0027905738 a Active Date Reading 3/18/2009 3765 ACTUAL SAYS 3721 12/8/2008 3755 MSG m Manual estimate 9/812008 3728 MSG m Manual estimate 6/6/2008 3678 3/10/2008 3665 12/12/2007 3651 9!6/2007 3624' 6/20/2007 3570 3/15/2007 3531 12/13/2006 3519 9/13/2006 3507 6119/2006 3477 3/9/2006 3462 12/2212005 3453 9/20/2005 3434 6/28/2005 3381 3/30/2005 3376 12/14/2004 3356 9/29/2004 3336 6/23/20.04 3314 41162004 3296 12/17/2003 3276 Type Loan Number ActivelinaeL From Payor Occupant Name Activellnactive Last Billing Date 1/13/2009 Active Rate Charge Multiplier/Users 0.635/8 7.82 1/ 01 ALL METER SIZE 102.52 /1 Until Location Brand Type Size YTD Cons Y ENC F.L. w Water 0.63 0.63 90 Code Consumption Posted Date Variance m Manual estimate 10 -66% m Manual estimate 27 1/2012009 -44% m Manual estimate 50 10/10/2008 260% a Actual 13 7/16/2008 .6% a Actual 14 4/11/2008 -43% a Actual 27 1/22/2008 -60°% a Actual 54 10/12/2007 72% a Actual 39 7/20/2007 208% m Manual estimate 12 4/16/2007 -1% a Actual 12 1/19/2007 -62% a Actual 30 10/20/2006 137°% a Actual 15 7/10/2006 261/16 a Actual 9 4/17/2006 -43% a Actual 19 1/17/2006 -68% a Actual 53 10/14/2005 1036% a Actual 5 7/15/2005 -71% m Manual estimate 20 4/5/2005 -28% m Manual estimate 20 1114/2005 17% a Actual 22 10/8/2004 -15% a Actual 18 7/30/2004 60% m Manual estimate 20 5/17/2004 0% n New Meter 0 12/17/2003 0% " , . \ � \ ' ( [ ^ r �. . ' " ./ � . ^ � T�pFOUNDATION 17Q3 HOtf] OUTLET 167.35 Sep ICTANKJN�fT 16602 PVC TANK OU� VE30X INLET 166A9 D -BOX OUTLET 166Z6 � 109.0 4��oiob, ^ VE,ST WAY - � mw^Em CE-fRTfJ (THAT THE SEPTIC SYSTEM .~.�~� . ' � , � / � ~ � THIS PLAN fS NOT INTENDED AS A WAR THE-SYStEM6 OW -PLAN SH ING SUBSURFACE SEWERAGE'^ fROM NERD PLAN18012 WA ` ' ^ \ / � <' PREPARED FL A I Niv It ssoc. P. c. ^ > �~ BOX569PL4, ^ ' � 7 ~~l . ^ ' ~~~ ° "� ^ ~° ~° �~ ~� -_ -- _ ° � � . � . . ` � ` 1 / / / At %l. 2u6 -v0 _ \ LOT��� ��� ^� 49,39/l�� .7A � ^ ` 3/ E ST xISTING FOUNDATION . � 'TOP FOUNDOION 171.13/ � ' _ � _ ` '~`^"""~LE ) ' --`~ OF ^ i � 108000, -VEST WAY N OTE -al CERT(,� Wt f SEPTIC SYSTEM WAS INSTALLED AS SHO' tHl LAN IS NOT INTENDED AS7, A tPANT, ;OF THE SYSTEM -t, NOTE41PROPERTY DESCRIPTION FROM NERD PLANs8012 -Dl`$MSAL`$YST-r BUILT 'PAOPERTY LINE SURVEY BY'F.CeGELI NAS MD ASSOC. '4 DAT 82 PARED t3Y;- YA . At FLYNN ssoc.p, Cc' P �, 5 69 PLA[STOW) NB, 5 r � � w� FORM U - IAT RELEASE 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***************** J ,� , j APPLICANT: 1?o6,rz ; Ltt / //� cto� Phone age -�•Z9 LOCATION: Assessor's Map Number Subdivision Street Parcel Lots) 3 St. Number_ ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Conservation Administrator Comments Town Planner Comments Food Inspector -Health Septic Inspector -Health Comments Public Works - sewer/water connections - driveway permit Fire Department Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected % Date Approved Date Rejected Received by Building Inspector Date 44 N, Irdi �,-,'OTF 0 LOT LUC,(FION ANC PREVIC)Lj,,; P SUIL -A YF. GELINA-S ASSC,,-, 'A�f[) L, 4)TES*r HOLE DATL 307 ELEVATION iribm5 SATURATION l WM. jito 12M I N. Wmm- W.90 *kT f OL ► DATE 169600 I0N170x0' Std. EI y N T E �0 S 'SON TILL NIOWqER I I I& SANDY GLAOAt TILL ROWATER E V-___-€ 164#0 ST CON OUCTEDBY.Qa4%AGAUO J�— TEST �WITf,41 -MURPHY A.SH ASOO. - J,CuS�h 7g I i i; I.N k "I fU !Ni4 Vli� .41 FS z:e, Aj T0: NORTH ANDOVER, MASS. —Dec. 3, '1982 BOARD OF HEALTH ----------------- FROM: Alfred A. Shaboo, P.E. DESIGN ENGINEER Re: Soil Absorption Flynn Assoc. P.C. Sewage Disposal System This is to certify that I have inspected the construction materials of said disposal system at ------ Lot—_#39 VestW a y —_--_ Site location North Andover, Mass. "ie grades and construction materials are as specified int he ahe p ns and specifications dated --July-27,--, 198'1 and As—BUi Nov 2, X19 82 Reg. Prof. Engi.nee SOIL PROFILE& PERCOLATION TEST DATA 6//G11:92- / North Andover, Mass. Street No VCS G —Lot No Loc/Subdiv. Pland Owner Investigator �00 Observer ✓ ' SOIL PROFILE DATES 1.tlev 2.Elev 3.Elev 4.Elev 0 'S10, 0 0 N� 1 �G (J l 1 1 0's ' Behchma Elevation E 3 5 � 6 7 8 9 10 ��a� DATES K, 3 4 5 6 7 9 10 Location Datum PERCOLATION TESTS 2 3 4 5 6 7 8 9 10 Tiles t% Test Pi s Pit Number 1 2 3 4 Start Saturation Soak -Minutes Start e Drop of 3" -Time Drop of 6" -Time Mins.lst 3" drop Mins.2nd " Drop Percolation SOIL PROFILE &PERCOLATION TEST DATA e ldort5 Andover,liass. Nn.&Street Lot No. r Loc./Subdiv. Q Plan Owner Investigator Observer ✓ �. SOIL PROFILES -DATE 3' Elev. 3' Elev. 3' Elev. 4'Elev. v 0 0 I I 1 Ties to Test Pits Benchmark Elevation 2 1 2 3 2 5 2 3 Soak -Mins. 3 3 -- 4 4 Drop of 311 -Time - "-Time-Dro 4 5 6 7 8' 9 10 5 6 7 8 9 10 Location Datum Percolation Tests -Date 5 6' 7 8 9 10 • LG.Vo----- Pit Number 1 2 3 4 5 Start Saturation - Soak -Mins. A16 - Start Test -Time a :Z Drop of 311 -Time - "-Time-Dro Drop of 6" -Time 2 Mins.lst.3"Dro Mins.2nd 3"Dro - Percolation Rate Motes & Sketches on Back 4 eaiL Check FML I OK Reg 15.1 15.4 15.8 1.7 L&Ie 2 Leaching Pits Leaching pits are preferred inhere the installation is possible a) calculations of leaching area -minimum 500 sq ft b) spacing cl surface drainage 2% d cover material e) 29%2'x4" splash pad f) tape at elbow g) no buds in pipe from d -box to pipe L eahirg Fl�lds a) no greater than 20 minutes/inch b) area-minimm 9W sq ft c construction of field A) surface drainage 2 % e) 209 from cellar1 or inground ewirgdng pool Leaching Trenches Reg 14.1 a) FiTculations oTleaching area-mn 500 sq ft 14.3 b) spacing -4 ft rin 6 ft with reserve between 14.4 c) disions 14.6 d.) constraction 144 18) stone s.10 f) surface drainage 2% Do ill Slope a) ae ypx = to be shown) b) Sr/x % 154 = (to be shown) EMS Reg 9.1 a) approval 9.6 __ b) stand -bar power L.) a _i .f` r FM M SEPTIC MTM' IpSTALLATION CHECK LIST oo 71 eauDnst z/'/ V ����L� ►� �cSt7- LOT X AVATICI OI PAIL 1. Distance Tot a. Wetlands _ b. Drains c. Well 2. Water Line Location 3. No PVC Pipe Septic Tank a. __Tees -_Length & To CleanUat Covera b. Cement Pipe to Tank On Both' Sides of Tank 5. Distribution Box a. Covers & Box-- No Cracks ... _- - b. All Lines Flowing Equal Amounts c. No Back Flog b. • Leach Field or Trench a. Dimensions 'b, Stone Depth ce- Capped Fids - d. Clem Double Washed Stone ?. Le/jh a.b.h c.sd. Cement Pipe to Pit Both Sides f. Clean Double Washed Stone 8. No Garbage Disposal 00V 9. -Final Grading Inspection lo. Barricading Covered system 1 11. As Built Submitted a. Lot Location . b. Dimemsions of System c. Location with Regard_to Perc Test d. Elevations e; Water Table Board of Health *North Andover,Mllass SURMRFACE DISPOSAL DESIGN K LIST .�.� LOT #,�/�✓Al APPRO7M DATE DISAPPROVED Di VDUE.°_ Provided: Reasons: 9 � Title V AIL Rog 2.5 The submitted plan Mast show aq a s a) the lot to be served-area,dianensid s lot #, abutters b location and log deep observation hoes -di stance to ties c location and results percolation tests -distance to ties d debign calculations do calculations shad g mired leaching arca (e) locations and dimensions of system -including reserve area f) existing and proposed contours (g) location any wet areas Athi°n 100' of sewage disposal system or disclaimer -check wetlands upping (h) surface and subsurface drains TAtbin 1001 of sewage disposal system or disclaimer (i) location any drainage easements within 1001 of semge disposal system or discla r;° -Planning Board files (3) knom sources of suer supply within 2001 of sewage disposal system or disclaimer (k) location of my iar€aposed well to sem lot -1001 from leaebing 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 -elutions of basest, plumb, pipe, septic tank, distribution box inlets and outlets, distribution field piping and Others elevations (r) maxiv m ground water elevation in area sevne disposal system (s) plan vast be prepared by a Professional. Engineer or other professional authorized by law to prepare such plans Reg 6 SE tic Tanks - (a) capac t es- % of flow, water table, tees, depth of tees, 1access, pumping (b) clout (c) 101 from cellar wall or inground su,Umdng pool (d) 251 from subsurface drains Reg 10.2 Distributions Boxes (a) s ope greater than 0.08 Reg 10.4 b) sump 0746 tS WEM4CR UtilCOMMOW NOR lU c6NFl. cT WITH TtTLG 57 AcovsD . ("DSD SLOPE CONTOUR 6W NtOFCLF_., 'IZc ,b• �fi � ' �' ''.. .. it . .r ir:r?I�. :• r I r I I tL rn • ' �if!� 1 •"�: _•rp' _ � / Ifo( / � 2� � t , 3 • UJ LOT (0 1?.155) / 170 I '. rhe • ��...' 1 1 W LWJ -Tl up 4- `a �� Fi2BSFrtf ri �� of •�'. ; o'a , '�. �-.�. /J {� ° /150 {- �•�`• 'rE�7T 6Y: �. t?r�GI��E � ME�Z¢lMACI� �, /r. e _1_ � '., •.fir:' -:F;,:.' - "f OJ Pyn K�c�U, !1i'• I - 2=d G.Z10 I' /L= CIO /sem % cisz i ' � � y[ , ti's .` Y,• t: — -- -- �` It DATA D Fi `� �►h.� ptrZ.Ai E : I& �f; I.: z�1 tZ,Te, PLA de790 L N� �+ ♦ `r4k w, 1W IT 1 rf^L � V 2•N t� 5 t P'rdfbsEO 2E ,¢vOLVA haza 4 . V6 >TLl A Y • r 1 . i �qY k t' 5:��ti' �rti?i��S I'( y r -�D��� �•w(pit £Y�;r .. �64414e..• jF' FF •l. • , �.���.,. ��l DD�t' 4r((�V is T r n� {,r calkt,4; t , r t r' .• +` � �r z f"� BIZ I M4GIL E 6r nlra �� z Y PIPI-1611 & rip - E e7 4�4 d -I�sl qolv- q Lo^n PLA �9 LJ t -J Ab VC L LOW Lj A 'Y Lp^m Lvb I No WSW'-" I 4 i2r. iLLy will 5 V> e C-1 152 Co cc) froz Oo / DATA i+ co PIPI-1611 & rip - E e7 4�4 d -I�sl qolv- q PLA �9 LJ t -J IZ61�i2V9 LZAIC4 Lj A 'Y N oov E rl k55, aZ- T� h W 6 04 A t44