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Miscellaneous - 555 BOSTON STREET 4/30/2018 (2)
f 74 N O � O O O � O z o C) o m O -� North Andover Board of Assessors Public Access Page 1 of 1 a NORTH North Andover Board of Assess®rs ♦0°--1 r i �,S•ono r.RSS� SAGHUSE roperty Record Card Parcel ID :210/109.0-0044-0000.0 FY:2012 Community: North Andover PHOTO Click on Sketch to Enlarge Click on Photo to Enlar e 555 BOSTON STREET Location: 555 BOSTON STREET Owner Name: DUNN,JOAN V C/O MICHELLE LEE DUNN t Owner Address: 555 BOSTON STREET City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 6-6 Land Area: 0.84 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 2329 sqft 0 Total Value: 467,200 467,200 Building Value: 262,800 262,800 Land Value: 204,400 204,400 Market Land Value: 204,400 Chapter Land Value: Sale Price: 1 Sale 02/25/2000 Date: Arms Length Sale Code: F-NO-CONVNIENT Grantor: CHARLES DUNN Cert Doc: Book: 05684 Page: 0349 http://csc-ma.us/PROPAPP/display.do?linkld=1897172&town=NandoverPubAcc 6/27/2012 Residential Property Record Card PARCEL ID:210/109.0-0044-0000.0 MAPA09.0 BLOCK:0044 LOT:0000.0 PARCEL ADDRESS:555 BOSTON STREET FY:2012 PARCEL INFORMATION Use-Code: 101 Sale Price: 1 Book: 05684 Road Type: T Inspect Date: 03/03/2010 Tax Class: T Sale Date: 02/25/00 Page: 0349 Rd Condition: P Meas Date: 03/03/2010 Owner: Tot Fin Area: 2329 Sale Type: P Cert/Doc: Traffic: M Entrance: X DUNN,JOAN V Tot Land Area: 0.84 Sale Valid: F Water: Collect Id: RRC C/O MICHELLE LEE DUNN Address: Grantor: CHARLES DUNN Sewer: Inspect Reas: C 555 BOSTON STREET NORTH ANDOVER MA 01845 Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LP/o Indust-B/L% / Open Sp-B/L% / RESIDENCE INFORMATION LAND INFORMATION + Style: CP Tot Rooms: 7 Main Fn Area: 1530 Attic: Y NBHD CODE: 6 NBHD CLASS: 6 ZONE: R2 Story Height: 1.75 Bedrooms: 4 Up Fn Area: 799 Bsmt Area: 1466 Seg Type Code Method Sq-Ft Acres Influ-Y/N Value Class Roof: G Full Baths: 2 Add Fn Area: Fn Bsmt Area: 320 1 P 101 S 36590 0.840 204,391 Ext Wall: OT Half Baths: Unfin Area: Bsmt Grade: DETACHED STRUCTURE INFORMATION Masonry Trim: Ext Bath Fix: 0 Tot Fin Area: 2329 Foundation: CN Bath Qual: T RCNLD: 258766 Str Unit Msr-1 Msr-2 E-YR-Blt Grade Cond%Good P/F/E/R Cost Class Kitch Qual: T Eff Yr Built: 1980 Mkt Adj: PA S 512 0.00 1988 A A 50///50 4,000 Heat Type: HW Ext Kitch: Year Built: 1971 Sound Value: VALUATION INFORMATION Fuel Type: O Grade: G Cost Bldg: 258,800 Current Total: 467,200 Bldg: 262,800 Land: 204,400 MktLnd: 204,400 Fireplace: 1 Bsmt Gar Cap: Condition: AG Aft Str Val 1: Prior Total: 467,200 Bldg: 262,800 Land: 204,400 MktLnd: 204,400 Central AC: N Bsmt Gar SF: Pct Complete: Aft Str Val2: Att Gar SF: 576%Good P/F/E/R: /100/100/83 Porch Tvoe Porch Area Porch Grade Factor P 100 S 272 SKETCH PHOTO 16 272$ 17 q.Ft G FM/B 576 Sq.F FU'0.75/FM/B 15 300 Sq. 24 1066 Sq.Ft 30 28 20 100 Ft 5 24 555 BOSTON STREET Parcel ID:210/109.0-0044-0000.0 as of 6/27/12 Page 1 of 1 PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERTIFICATE OF COMPLIANCE As of: October 22, 2012 This is to certify that the individual subsurface disposal system received a SATISFACTORY INSPECTION of the: Complete Repair and Construction of an On-Site Sewage Disposal System By: Rob Daigle At: 555 Boston Street Map 109 Lot 44 rth Andover, MA 01845 T nce of this c ' i ate all not by construed as a guarantee that the system will function satisfactorily. i le Grant Public Health Agent 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 fax 978.688.8476 Web www.townofnorthandover.com M011T1� ii i ♦4„ �s RECEIVED QCT 2 2'2012 PUBLIC HEALTH DEPARTMENT TOWN OF NORTH ANDOVER Community Development Division HEALTH DEPARTMENT TOWN OF NORTH ANDOVER SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION The undersigned hereby certify that the Sewage Disposal System( )constructed;(Q repaired; By: fm -L- (Print Name) Located at: 5SS leo S-Ta,J S+�ZE i"I (Installation Address) Was installed in conformance with the North Andover Board of Health approved plan,originally dated -7 2 3 Zo,,2 and last revised on `�' Z�/L ,with a design flow of a/Lf© gallons per day. The materials used were in conformance with those specified on the approved plan;the system was installed in accordance with the provisions of 310.CMR 15.000,Title 5 and local regulations,and the final grading agrees substantially with the approved plan.All work is accurately represented on the As-built which has been submitted to the Board of Health. Bottom of Bed Inspection Dater 18 v r Engineer Representativ ignature) �C oz� c w..., � t✓S9yn cX �h— And—Print Name' Final Construction Inspection Date: B P�y 12 C v Engineer Represents (Signature) And—Print Name Installer: 1,t (Signature) Date: Id a a // And—Print Name Enginer: C V (Signature) Date: 10 /—)2 C Z 2 And—Print Name 1600 Osgood Street,North Andover,Massachusetts 0184S Phone 978.688.9540 Fax 978.688.8476 Web h"p://www.townofnorthandover.com 4 ` i f •' 1/y�ny�,1 • O� f ar 1�. 9 � V�-i► 1, TEED North Andover Health Department Community Development Division ONSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION ADDRESS: 5 j `� 05 3T MAP: LOT: INSTALLER: Zo-b Die I-e DESIGNER: p�5ovv PLAN DATE: a3 r BOH APPROVAL DATE ON PLAN: INSPECTIONS TANK INSPECTION: �•o�l c� DATE OF BED BOTTOM INSPECTION: `dD DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ❑ Contractor reports any changes to design plan ❑ Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer ❑ Topography not appreciably altered Comments: SEPTIC TANK ❑ Building sewer in continuous grade, on compacted firm base Cleanouts per plan Bottom of tank hole has 6" stone base S We bole plugged gallon tank has been installed loading d�� ►I' / Monolithic tank construction ct on ❑ Water tightness of tank has been achieved r� b y testing Inlet tee installed, centered under access port �t r ❑ Outlet tee installed, centered under access port (gas baffle/effluent filter) ❑ inch cover to within 6" of final grade installed over one access port ❑ Hydraulic cement around inlet & outlet Comments: PUMPCHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ gallon Pump Chamber installed ❑ loading ❑ Monolithic tank construction ❑ Inlet tee installed, centered under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off floats working ❑ Separate on/off floats ❑ Drain hole in pressure line ❑ cover at final grade installed over pump access port ❑ Water tightness of tank has been achieved by testing ❑ Hydraulic cement around inlet & outlet Comments: CONTROL PANEL ❑ Alarm & Pump are on separate circuits ❑ Alarm sounds when float is tripped ❑ Location of control panel: basement ❑ Alarm signal located inside: basement Comments: DISTRIBUTION-BOX ❑ Installed on stable stone base ❑ H-20 D-Box ❑ Inlet tee (if pumped or>0.08'/foot) ❑ Hydraulic cement around inlet & outlets ❑ Observed even distribution ❑ Speed levelers provided (not required) Comments: SOIL ABSORPTION SYSTEN YGeneral) Bottom of SAS excavated down to C soil layer, as provided on plan ❑ Size of SAS excavated as per plan ❑ Title 5 sand installed, if specified on plan ❑ 40 Mil HDPE barrier installed ❑ Laterals installed and ends connected to header (and vented if impervious material above) ❑ Elevations of laterals and chambers installed as on approved plan ❑ Retaining wall (boulder/ concrete /timber/ block) ❑ Final cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel-less Chambers) ❑ Brand and Model of Chamber: Standard Quick 4 Infiltrator Chambers ❑ Number of chambers per row: ❑ Number of rows (trenches): Comments: Total Chambers = BM = HR = HI = SYSTEM ELEVATIONS ROD AS-BLT INVERT DESIGN INVERT ELEVATION ELEV ELEV Benchmark Building Sewer OUT Septic Tank IN Septic Tank OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN Distribution Box OUT Lateral 1 TOP Lateral 1 INVERT Lateral 2 TOP Lateral 2 INVERT Lateral 3 TOP Lateral 3 INVERT Lateral 4 TOP Lateral 4 INVERT Lateral 5 TOP Lateral 5 INVERT Lateral 6 TOP Lateral INVERT Top of Chamber Bottom of Bed/Chamber i SKETCH PLAN h CRITICAL SETBACK DISTANCES Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ® Property line 10 10 -- ® Cellar wall 10 20 -- ® Inground pool 10 20 -- ® Slab foundation 10 10 -- ® Deck, on footings, etc 5 10 -- ® Waterline 10 10 101 ® Private drinking well 75 1002 50 ® Irrigation well 75 100 ® Surface Water 25 50 ® Bordering Vegetated Wetland , Salt Marsh,Inland/Coastal Banka 75 100 ® Wetlands bordering surface water supply or trib. (in Watershed) 150 150 ® Trib.to surface water supply 325 325 ® Public well 400 400 ® Interim Wellhead Prot.Area ® Reservoirs 400 400 ® Drains(wat. supply/trib.) 50 100 ® Drains(intercept g.w.) 25 50 ® Drains(Other)Foundation 10(5) 20(10) ® Drywells 20 25 1 Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance(NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10.54,and 10.30,respectively,pursuant to 15.211(3),also by NA wetland bylaws Grant, Michele To: plally@millriverconsulting.com Subject: 555 Boston Road Hi Pam, Please be advise that 555 Boston Road is ready for final construction.Thank you Michele E.Grant Public Health Agent Town of North Andover 1600 Osgood St I Suite 2035 North Andover,MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email marant(o)townofnorthandover.com Web www.TownofNorthAndover.com 1 CREATIVE BUILDERS, INC. Robert Daigle,Jr. P.O. Box 401 North Andover, MA 01845 978-423-6932 cell RECEIVE� August 30,2012 Department of Health Ms. Sue Sawyer 1600 Osgood Street North Andover, MA 01845 Re: Sand Sieve Analysis Dear Ms. Sawyer: Enclosed please find the sieve analysis for the septic system sand delivered to 555 Boston St. Please call my cell if you have any further questions. Thank you, Robert K. Daigle,Jr. Creative Builders, Inc. RKD/cd i SIEVE ANALYSISREC8 8/22/12 r ~ OF SAND KINGSTON MATERIALS SEP P5 i i� "a:t OF NORTH AP150 A Division of Torromeo Industries, Inc., P.O. Box 2308, Methuen, _ �std Kingston Plant at 18 Dorre Road, Kingston, NH Methuen Plant 93 OlRerWry oa thuen, MA ............... .....::. .;.... :.;:.;..:.;::. :::. ................................................ .. jiy ............................. t00.t T ......' .::::::........ ' ............ ................:. .. ....... . . f= ...... #rOIT2E'I'ACa: TAI�1�1�.... .. ::::>::>:::::<: 3/8" 0 0 0 100 100 TO 100 #4 0.3 0 0 100 95 TO 100 #8 77 9 9 91 80 TO 100 #16 135.8 16 25 75 50 TO 85 #30 151.5 181 441 56 25 TO 60 #50 232.7 28 71 29 10 TO 30 #100 163.4 20 91 9 2 TO 10 #200 63.9 8 98 2 0 TO 5 PAN 13.2 2 TOTALS 837.8 100 SIEVE ANALYSIS OF SAND -TOTAL%PASSING R••••MIN.DEVIATION .i....MAX.DEVIATION c� 120 ? 100 � 80 60 - 40 - 20 040 20 • � _� ;.. 0 1 2 3 4 5 6 7 8 SIEVE SIZES Sand Delivered to: 555 BOSTON STREET N.ANDOVER, MA DeleChiaie, Pamela From: Sawyer, Susan Sent: Friday, August 10, 2012 12:17 PM To: 'Osgood, Benjamin C.' Cc: DelleChiaie, Pamela Subject: 555 Boston Attachments: 20120810094618848.pdf Ben, Here is the approval for 555 Boston.Rob Daigle just came and pulled the permit.He said he is starting Monday. Thank you, Susan Sawyer Public Health Director Town of North Andover 1600 Osgood Street Bldg. 20,Unit 2035 North Andover,MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mailto:ssawyer@townofnorthandover.com Web www.TownofNorthAndover.com -----Original Message----- From:noreply@townofnorthandover.com[mailto:noreply@townofnorthandover.com] Sent:Friday,August 10,2012 9:46 AM To: Sawyer,Susan Subject: This E-mail was sent from"RNPOA428C" (Aficio MP C5000). Scan Date:08.10.2012 09:46:18 (0400) Queries to:noreP1 @townofnorthandover.com Y Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to:http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. i i 4 • 5�.��L'ED'7�' . • North Andover Health Department Community Development Division August 10, 2012 Michelle Dunn 555 Boston Street North Andover, MA 01845 RE. Re: Subsurface Sewage Disposal System Plan for 555 Boston Street (Map 109,Lot 44) Dear Property Owner, The North Andover Board of Health has completed the review of the septic system design plans, for the above referenced property, submitted on your behalf by Penoni Assoc. Inc., dated July 23, 2012, last revised on August 2, 2012 and received at the Health Dept of August 8, 2012. The design has been approved for use in the construction of a replacement, four bedroom(maximum 9 room home), on-site septic system. Generally,this plan is good for 3-years from the date of approval,however as this is a repair system Title V requires that the system be installed within 2 years. During this time, a licensed septic system installer must obtain a permit and complete this work, and a Certificate of Compliance be endorsed by the installer, designer and the Town of North Andover. In the event an imminent health problem such as sewage backup into the dwelling is occurring,the North Andover Board of Health may reduce the time period for which this plan is valid. This approval is also subject to the following conditions: 1. If site conditions are found in the field to be different from those indicated on the design plan and/or soil evaluation,the originally issued Disposal System Construction Permit is void, installation shall stop, and the applicant shall reapply for a new Disposal Systems Construction Permit(3 10 CMR 15.020(1)). 2. It is the responsibility of the applicant and/or the applicant's septic system designer, septic system installer or other representative to ensure that all other state and Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover,MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 � 555 Boston Street August 10, 2012 municipal requirements are met. These may include review by the Conservation Commission, Zoning Board, Planning Board, Building Inspector, Plumbing Inspector and/or Electrical Inspector. The issuance of a Disposal System Construction Permit shall not construe and/or imply compliance with any of the aforementioned requirements. Your effort to provide a properly functioning septic system for your dwelling is greatly appreciated. The Health Department may be reached at 978-688-9540 with any questions you might have. yin , Sa er, RE /RS Public Health Director cc: Ben Osgood, P.E. List of local licensed septic installers file Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 TOWN OF NORTH ANDOVER PERMITTED SEPTIC INSTALLERS-RENEWED FOR 2010 Contact SORTED BY TOWN Doin Business As Mailing Phone City 1 John T. Shaw III (978)474-8088 ANDOVER,MA 01810 2 Joseph Watson (978)475-8581 ANDOVER,MA 01810 3 Michael W.Reilly (978)375-4811 ANDOVER,MA 01810 4 Todd Bateson (978)815-2703 ANDOVER,MA 01810 5 Philip A.Busby,Jr. (603)362-6015 ATKINSON,NH 03811 6 Robert L.Innis (978)663-6006 BILLERICA,MA 01821 7 David A.Kindred (978)265-7641 BOSTON,MA 02110 8 Charles Zaher (978) 804-7786 CHELMSFORD,MA 01824 9 James Hartigan (978)766-0087 DANVERS,MA 01923 10 David V.Zaloga,Jr. (603)765-9296 EXETER,NH 03833 11 Daniel R.Briscoe (978)372-2200 GROVELAND,MA 01834 12 Timothy Quinlan (978)457-0528 HAVERHILL,MA 01830 13 Bruce Hoehn (978)697-3490 HAVERHILL,MA 01832 14 John L.DiVincenzo (978)372-7471 HAVERHILL,MA 01835 15 John B.Hayes (207)439-1989 Kittery,ME 03904 16 Serge R.Beaulieu (603) 893-9189 LONDONDERRY,NH 03053 17 James Kellett (781)953-7146 LYNNFIELD,MA 01940 18 Arthur F.Hutton (978)685-2667 METHUEN,MA 01844 19 Bill Hall (978)689-3711 METHUEN,MA 01844 20 Stephen Iacozzi (978)479-4407 METHUEN,MA 01844 21 James H.Currier (978)774-6685 MIDDLETON,MA 01949 22 Daniel A.Giard (978)686-7653 NORTH ANDOVER,MA 01845 23 Peter Breen (978)265-7580 NORTH ANDOVER,MA 01845 24 William(Tom)Sawyer (978)360-7832 NORTH ANDOVER,MA 25 Angelo Petrosino (978)664-2030 NORTH READING,MA 01864 26 Craig Waelty (978)664-2126 NORTH READING,MA 01864 27 Warren Pearce,Jr. (978)664-5264 NORTH READING,MA 01864 28 Kevin Coyle (603)944-8501 PLAISTOW,NH 03865 29 lCharles Beshara (603)893-2229 SALEM,NH 03079 30 John J.Soucy (603)216-7175 SALEM,NH 03079 31 Joseph Surianello (978)458-9117 TEWKSBURY,MA 01876 Pennoni PENNONI ASSOCIATES INC. CONSULTING ENGINEERS RECEIVED AUG 9 2012 August 2, 2012 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Susan Sawyer, Agent North Andover Health Department 1600 Osgood Street North Andover, MA 01845 Re: 555 Boston Street(Map 109, Lot 44) Revised Plans Dear Susan: I am . esponding mmresponding to your letter dated July 31, 2012: 1. The front stone wall has been shaded back; the street line is the front boundary. The side stone wall is the lot line, it has been noted as such and the drill holes (D.H.) found have been labeled. The remaining property lines are correct in their portrayal. 2. A.new benchmark has been located in a tree within 75' of the proposed facility. 3�IVo effluent filter is proposed and note #5 has been removed from the "Tank Notes" L4�Manhole covers are shown and noted to be within 6" of finish grade. `�5. The soil logs have been corrected. 6. The location of the inspection ports have been indicated on the plan. 7. Construction Notes have been amended to include #19 indicating the proper � abandonment of the existing septic tank. 8. The scaledrofile now shows risers on both the septic tank p pt c to and d-box. If you have any questions regarding .this information please do not hesitate to contact this office. Sincerely, PENNONI ASSOCIATES, INC. Benjamin C. Osgood, Jr. P.E. Sr. Engineer cc: File MDUN1201 100 Burtt Road • Suite 120 Andover MA 01810 Tel: 97 . e 8 749.9929 Fax: 978 749 9920 93 Stiles Road • Suite 201 Salem, NH 03079 . Tel: 603.226.1950 . Fax: 603.226.3235 www,pennoni.com ,//-- /-,0",Y1,gz � S�TTtiED 16g6 • North Andover Health Department Community Development Division July 31, 2012 Benjamin Osgood, P.E. Pennoni Associates, Inc. 100 Burtt Road, Suite 120 Andover, MA 01810 Re: 555 Boston Street (Map109,Lot 44) Dear Mr. Osgood: The proposed wastewater system design plan for the above site dated July 23, 2012 and received on July 26, 2012 has been reviewed. Unfortunately,the plan cannot be approved until the following items are corrected. The specific section in Title 5: 310 CMR 15.000, or North Andover regulation that is not met by this design follows each item where applicable. 1. Please show the full legal boundaries; it is unclear between the linetype on the front, rear and right side if the stone wall on the left side is the property line. (3 10 CMR 15.220(4) NA 3.2)). 2. The benchmark is greater than 75 feet from the proposed facility. Please provide a benchmark with 75 feet of the proposed facility (3 10 CMR 15.220(4)(q)). 3. In the "Tank Notes", note 5 indicates there is to be an effluent filter inside the proposed septic tank. Please indicate to the model to be used. 4. If an effluent filter is proposed in the septic tank then an access manhole cover is required to be at finish grade (3 10 CMR 15.227(7)). 5. There are discrepancies between the soil logs indicated on sheet and the soil logs recorded by the Board of Health representative. A copy of the field notes is included with this letter for your review. Please revise your soil logs on the plan and on the DEP soil evaluation forms accordingly. 6. Please indicate an inspection port location on the site plan (3 10 CMR 15.240(13)). 7. Please note the proper abandonment of the existing tank/system. (310 CMR 15.354)(NA 3.2). 8. On the scaled profile please show at least one riser on the septic tank(to grade if there is an effluent filter or within 6"of grade if not) and a riser on the d-box to within 6" of final grade (3 10 CMR 15.221 (13)) Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035 North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 i Please feel free to contact the office with any questions you may have. We look forward to working with you to obtain a wastewater treatment and dispersal system which will be in compliance with all regulations and assure protection of public health and the environment of North Andover. Sincerely /Su an Y. Sa er, RE Public Health Direc or Page 2 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035 North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 i � d7 Al i ` k r G7e!i r , I � I � I � � � ` J• f1 �� tiva J - r DeHeChiaie, Pamela From: Randy Burley[rburley@millriverconsulting.com] Sent: Tuesday, July 31, 2012 9:26 AM To: 'Daniel Ottenheimer'; Grant, Michele; 'Isaac Rowe'; 'Marianne Peters'; DelleChiaie, Pamela; Sawyer, Susan Subject: 555 Boston Street Attachments: Ben Osgood Disapproval Letter-7-31-12.doc; 555 Boston St Soils.PDF Dear All, In general Ben's plan is good; it is basically notes and minor edits. I re-included in this email my soil notes as they are different from the plan notes; it will not affect the design. Feel free to contact me with any questions or concerns. Randy Burley,Project Manager Mill River Consulting,Inc. 6 Sargent Street Gloucester,MA 01930-2719 978-282-0014 fax: 978-282-1318 www.miliriverconsultinp-.com rburley@millriverconsultinp-.com a o >Mil lV cons ulti ng Ctvil tngmerein,g i Lnuir4ncirntal Ptrin tling municip'll Enuironrnrntal 14r.tlrts Gan;utCin Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records.For more information please refer to:http://www.sec.state.ma.us/ore/oreidx.htm. Please consider the environment before printing this email. 1 DelleChiaie, Pamela From: Marianne Peters[mpeters@millriverconsulting.com] Sent: Tuesday, July 10, 2012 1:22 PM To: DelleChiaie, Pamela Cc: Sawyer, Susan; 'Rand urley'; Grant, Michele Subject: RE: Soil Test Applica ion -555 Boston Street, North ndover, MA 01845 All set; soil testing is scheduled for next Monday, July 16th @ 1:00 with Randy; it's the earliest Ben could actually do. From: DelleChiaie, Pamela jmailto:pdellechCabtownofnorthandover.com] Sent: Tuesday, July 10, 2012 11:28 AM To: 'Daniel Ottenheimer'; 'Isaac Rowe'; Peters, Marianne; 'Randy Burley' Cc: Sawyer, Susan; Gaffney, Heidi; 'Osgood, Benjamin C.' Subject: Soil Test Application - 555 Boston Street, North Andover, MA 01845 Hi there, Ben Osgood is requesting that this 555 Boston Street be put on the fast track if possible. Heidi in Conservation has already signed off on it. Please call Ben to schedule at your earliest convenience. Thanks so much! @ Pamela DelleChiaie Health Department Town of North Andover 1600 Osgood Street I Bldg.20 1 Suite 2-36 North Andover,MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email pdellechiaie@townofnorthandover.com Web www.TownofNorthAndover.com Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records.For more information please refer to:http://www.sec.state.ma.us/ore/oreidx.htm. Please consider the environment before printing this email. 1 4 1 TOWN OF NORTH ANDOVER Office of COMMUNITY DEVELOPMENT AND SERVICES 3: HEALTH DEPARTMENT V r 1600 OSGOOD STREET;BUILDING 20;SUITE 2-36 4"°. - NORTH ANDOVER,MASSACHUSETTS 01845s"AM I 978.688.9540—Phone Susan Y.Sawyer,REHS/RS 978.688.8476—FAX Public Health Director E-MAIL:healthdept(@townofnorthandover.com WEBSITE:hgp://www.townofnorthandover.com SEPTIC PLAN SUBMITTAL FORM '",,:, Date of Submission: 7-24-12 �� ,, I Site Location: 555 Boston Street "f WN OF Nle AN OV9M Engineer. Pen noni Associates, Ben Osgood Jr. � �� ��► g New Plans? Yes X $225/Plan Check# (includes Ist submission and one re- review only) Revised Plans?Yes $75/Plan Check# Site Evaluation Forms Included? Yes X No Local Upgrade Form Included. Yes No N/A Telephone#: 978-749-9929 Fax#: 978-749-9920 E-mail: bosgood@pennoni.com Homeowner Name: Michelle Dunn I OFFICE USE ONLY When the submission is complete (including check): ➢ 41 Date stamp plans and letter ➢ ,/ Complete and attach Receipt Ll Copy File; Forward to Consultant Enter on Log Sheet and Database I I I i Commonwealth of Massachusetts - City/Town of North Andover - �� Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal - A. Facility Information Michelle Dunn Owner Name 555 Boston Street Map 109 Lot 44 Street Address Map/Lot# North Andover MA 01845 City State Zip Code B. Site Information 1. (Check one) ❑ New Construction ❑ Upgrade ® Repair 1981 2. Published Soil Survey Available? ® Yes ❑ No If yes: 1:15,840 WrB Year Published Publication Scale Soil Map Unit Woodbridge High Water table Soil Name Soil Limitations 3. Surficial Geological Report Available? ❑ Yes ® No If yes: Year Published Publication Scale Map Unit Geologic Material Landform 4. Flood Rate Insurance Map Above the 500-year flood boundary? ® Yes ❑ No Within the 100-year flood boundary? ❑ Yes ® No Within the 500-year flood boundary? ® Yes ❑ No Within a velocity zone? ❑ Yes ® No 5. Wetland Area: National Wetland Inventory Map Not Available Map Unit Name Wetlands Conservancy Program Map Not Available Map Unit Name 6. Current Water Resource Conditions (USGS): June 2012 Range: ❑ Above Normal ❑ Normal ® Below Normal Month/Year 7. Other references reviewed: t5form11.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 1 of 8 Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (minimum of two holes required at every proposed primary and reserved disposal area) Deep Observation Hole Number: TP 1 7/16/12 1:00 Sunny/Hot Date Time Weather 1. Location Ground Elevation at Surface of Hole: 90.5 Location (identify on plan): Rear Right 2. Land Use lawn none 5 (e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) grass Drumlin Slope See Plan Vegetation Landform Position on Landscape(attach sheet) 3. Distances from: Open Water Body >150 Drainage Way >150 Possible Wet Area >150 feet feet feet Property Line e0t Drinking Water Well 150feet Other feet 4. Parent Material: Glacial Till Unsuitable Materials Present: ❑ Yes ® No If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 5. Groundwater Observed: ❑ Yes ® No If yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: 42" 87.0 inches elevation t5form 11.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 2 of 8 Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: TP 1 Redoximorphic Features Coarse Fragments Soil Horizon/Soil Matrix:Color- (mottles) Soil Texture %by Volume Soil Soil Depth(in.) Layer Moist Munsell USDA Structure Consistence Other Y (Munsell) (USDA) Cobbles& Depth Color Percent Gravel Stones (Moist) 10 A 10YR 3/3 SL M F 46 Bw 10YR 5/6 SL M F 96 C 5Y 4/4 42" 10YR 5/8 .15 Loam M F Additional Notes: t5form11.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 8 Commonwealth of Massachusetts �. -- City/Town of North Andover - Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: TP 2 7/16/12 1:00 Sunny/Hot Date Time Weather 1. Location Ground Elevation at Surface of Hole: 90.00 Location (identify on plan): Rear Center 2. Land Use Lawn None 5 (e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%) Grass Drumlin Slope See Plan Vegetation Landform Position on Landscape(attach sheet) 3. Distances from: Open Water Body >150 Drainage Way >150 Possible Wet Area '150 feet feet feet Property Line e0t Drinking Water Well f et0 Other feet 4. Parent Material: Glacial Till Unsuitable Materials Present: ❑ Yes ® No If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 5. Groundwater Observed: ❑ Yes ® No If yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: 35" 87.08 inches elevation t5form11.doc•rev. 1/10 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 4 of 8 Commonwealth of Massachusetts �. City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: TP 2 Redoximorphic Features Coarse Fragments Soil Horizon/Soil Matrix:Color- (mottles) Soil Texture %by Volume Soil Soil Depth(in.) Consistence Other Layer Moist(Munsell) (USDA) Cobbles& Structure Depth Color Percent Gravel (Moist) Stones 10 A 10YR 3/3 SL M F 46 Bw 10YR 5/6 35" 10YR 5/8 >15 SL M F 96 C 5Y 4/4 Loam M F Additional Notes: t5form11.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 5 of 8 Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal D. Determination of High Groundwater Elevation 1. Method Used: ❑ Depth observed standing water in observation hole A. B. inches inches ❑ Depth weeping from side of observation hole A. B. inches inches ® Depth to soil redoximorphic features (mottles) A. 42" B. 35" inches inches ❑ Groundwater adjustment(USGS methodology) A. B. inches inches I 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material a. Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? ® Yes ❑ No b. If yes, at what depth was it observed? Upper boundary: 10 Lower boundary: inches inches t5form11.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 6 of 8 I Commonwealth of Massachusetts City/Town of North Andover HEW Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal F. Certification I certify that I am currently approved by the Department of Environmental Protection pursuant to 310 CMR 15.017 to conduct soil evaluations and that the above analysis has been performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. 1 further certify that the results of my soil evaluation, as indicated in the attached Soil Evaluation Form, are accurate and in accordance with 310 CMR 15.100 through 15.107. 7/23/12 Signature of Soil Evaluator Date Benjamin C. Osgood, Jr. SE1818 Nov 1995 Typed or Printed Name of Soil Evaluator/License# Date of Soil Evaluator Exam Randy Burley Mill River Consulting for North Andover Name of Board of Health Witness Board of Health Note: In accordance with 310 CMR 15.018(2)this form must be submitted to the approving authority within 60 days of the date of field testing, and to the designer and the property owner with Percolation Test Form 12. t5form11.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 7 of 8 Commonwealth of Massachusetts City/Town of North Andover Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Field Diagrams Use this sheet for field diagrams: t5form 11.doc•rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 8 of 8 i Commonwealth of Massachusetts City/Town of North Andover Percolation Test Form 12 ,r Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal. 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 the local Board of Health to determine the form they use. Important:When filling out forms A. Site Information on the computer, use only the tab Michelle Dunn key to move your Owner Name cursor-do not 555 Boston Street use the return Street Address or Lot# key. North Andover MA 01845 „y City/Town State Zip Code Contact Person(if different from Owner) Telephone Number B. Test Results 7-16-12 1;55 Date Time Date Time Observation Hole# TP 1 Depth of Perc 48/16 Start Pre-Soak 1:55 End Pre-Soak 2.10 Time at 12" 2:10 Time at 9" 2:42 Time at 6" 3:40 Time(9"-6") 58 Min Rate(Min./Inch) 20 Test Passed: Test Passed: Q Test Failed: Q Test Failed: Benjamin C. Osgood, Jr. Test Performed By: Randy Burley for North Andover Board of Health Witnessed By: j Comments: i t5form 12.doc•06/03 Perc Test•Page 1 of 1 A • yw IXI) �. Commonwealth of Massachusetts Map-Block-Lot • 109.00044 BOARD OF HEALTH ----------------------- Perm it No North Andover BHP-2012-0708 P.I. ----------------------- FEE F.I. $250.00 DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted Robert K._Daigle, Jr. to(Repair)an Individual Sewage Disposal System. at No 555 BOSTON STREET ------------------ ------ as shown on the application for Disposal Works Construction Permit No. BHP-2012-0 Q,—Dated CO-August 4 2012 '-- - � . ' ------------ ------ ----------------- ssued On:Aug-14-2012 - - ---------------------------------------- BOARD OF HEALTH . j 7 N°Rr� Application for Septic Disposal System 11olla TODAYA3 DTE pConstruction Permit — TOWN OF ORTH ANDOVER, MA 01845 $250-00- 250.00-Full Repair X-Ac �SSACµUsts � $125.00-Component Important: Application is hereby made for a permit to: When filling out ❑ Co struct a new on-site sewage disposal system* forms on the computer,use Repair or replace an existing on-site sewage disposal system* only the tab key to move your ❑ Repair or replace an existing system component-What? cursor-do not use the return key. A. Facility Information Q Address or Lot# IVI I Citylfown 2.-*TYPE O EPTIC SYSTEM*: 1� ❑ Pump E Gravity(choose one) tI� ***If pump system,attach copy of electrical permit to application*** ❑ Conventional System (pipe and stone system) MI'n-filtrator 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 & �� Name Address(if different from above) City/Town State Zip Code Telephone Number 3. InstaMer Information Na Name of Company %2C) 47 G A(Ad ;V r City/Town State, Zip Code FF1 3720 j A�� Telephone Number(Cell Phone#if possible please) 4. Designer Information NA/ cx � icy Na a of Company Ad ss City own State Zi Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 r i Application for Septic Disposal System o Construction Permit - TOWN OF TOA ' DTE '� •`` ORTH ANDOVER, MA 01845 $250.00-Full Repair ` $125.00-Component ,SSACKO PAGE 2 OF 2 A. Facility Informationcontinued.... 5. Type of Building: UIResidential Dwelling or❑Commercial B. Agreement 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 jM the Local Subsurface Disposal Regulations for the Town of North Andover,and n to pl a the system in operation until a Certificate of Compliance has been iss b this oa d o Health. N e Date Application Approved By: (Board of Health Representative) Name Date Application Disapproved for the following reasons: For Office Use Only: 1 Fee Attached. Yes No 2. Project Manager Obligation Form Attached? Yes No 3. Pump System? If so,Attach copy ofElectrical Permit Yes No 4. Foundation As-Buift?(new construction ronly): Yes No (Same scale as approved plan) 1 ^II 5. Floor Plans?(new construction only): Yes r" No I I Application for Disposal System Construction Permit•Page 2 of 2 I� i I n , ry�01LUED Commonwealth Cif Massachusetts Map-Block-Lot L J 109.00044 BOARD OF HEALTH ----------------------- • Permit No North Andover -BHP-2012-0676---------------- ------ P.I. FEE F.I. $125.00 ----------------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted Robert K._Daigle,_Jr_____________________ to(Repair-D-BOX&OUTLET PIPE)an Individual Sewage Disposal System. at No 555 BOSTON STREET as shown on the application for Disposal Works Construction Permit No. 13HP-2012-067 Dated June 27,2012 ----------------------------------------------------------------- Issued On:Jun-27-2012 BOARD OF HEALTH r 0 pplication for Septic`Dis6oaal System TODAY'S DAT AConstruction Permit — TOWN OF 4r.0 t * ORTH ANDOVER, MA 01845 $ 250.00—Fop Re SS^CHUS� Important: Application is hereby made for a permit to: When filling out ❑ Construct a new on-site sewage disposal system* forms on the computer,use ❑ Repair or replace an existing on-site sewage disposal system* only the tab keyls to move your Repair or replace an existing system component—What? cursor-do not use the return A. Facility Information key. Addressor Lot# SSJr City/Town TOWN OF NORTH ANDOVER 2.-*TYPE OF SEPTIC SYSTEM*: HEALTH DEPARTMENT VConventional mp Gravity (choose one) If pump system, attach copy of electrical permit to application*** 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 e 14`P 60,14 Name Address(if different from above) City/Town State Zip Code Telephone Number 3. Installer Information 41�& Q' L 'i't- e7j(& Jz�e Zz Name Name of Company Address Aa� C3 CitylT� State ��� ��Cod� Telephone Number(Cell Phone#if possible please) 4. Designer Information Name Name of Company Address City/Town State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit-Page 1 of 2 N° A lication for Se tic"Dis p osal System TODAY'S DATE F pConstruction Permit -.TOWN OF $250.00-Full Repair ORTH ANDOVER; MA 01845 $125.00 -Component S�cHuse PAGE 2OF2 A. Facility Information continued.... 5. Type of Building: ❑Residential Dwelling or❑Commercial B. Agreement 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 ns for the Town of North Andover, and not to place 10- system in operation until a Certificate of Compliance has been issu by this Boar TI 1, 6, oa/ Namev Date Application ro d By: (Board of Health Representative)), l �_ 4� c Name Date Application Disapproved for the following reasons: For Office Use Only: / 1. Fee Attached. Yes v No 2. Project Manager Obli anon Form Attached. Yes / No b' Y 3. Pump S sv tem? If so,Attach cogv ofElectrical Permit Yes No 4. Foundation As-Built?(new construction ronlY): Yes I/ No (Same scale as approved plan) 5. Floor Plans?(new construction only): Yes No Application for Disposal System Construction Permit•Page 2 of 2 r TOWN OF NORTH ANDOVER f N°RTM Office of COMMUNITY DEVELOPMENT AND SERVICES °L HEALTH DEPARTMENT _ p 1600 OSGOOD STREET;BUILDING 20;SUITE 2-36 NORTH7ANDOVER TTS 01845 C,;,;5 ' RE Susan Y.Sawyer,REHS,RS978.688.9540—Phone Public Health Director 978.688.8476—FAX � alt de t townofnorthandover.com 3� www.townofnorthandover.com TOWN OERT APPLICATION FOR SO DATE: July 9, 2012 MAP&PARCEL: map 109 Parcel 44 LOCATION OF SOIL TESTS: 555 Boston Street, North Andover OWNER: Joan Dunn Contact#: APPLICANT: Michelle Dunn Contact#:978-685-8152 ADDRESS. 555 Boston Street, North Andover, MA ENGINEER: Pennon) Assoc Contact#: 978-749-9929 CERTIFIED SOIL EVALUATOR: Benjamin C. Osgood, Jr. Intended Use of Land: Residential Subdivision Single Family Home Commercial Is This: Repair Testing Undeveloped Lot Testing Upgrade for Addition:Q In the Lake Cochichewick Watershed? Yes No _ 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$3.60,00 per lot for repairs or uaar des. 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 N.A. Conservation Commission Approval ate: /'/'Q Signature of Conservation Agent: �Y Date back to Health Department: (stamp in): GRA Y ti k I-c,.,y Alo,' - , ra 129 AL P*,- ---------------- �NDO Bu,td vz-,-, va/ �FCF�vl�,-CC71 D.H. AM,4--v-5--19 st Cl 7LorZ - VA PCU -ro, 0,9 N PLAN OF LAND DH "i AND VAf2 �'./VOR 7-/--/AIVOO V=11? 7-)y u-,s,7- #1:37 k-l Residential Property Record Card PARCEL ID:2101109.0-0044-0000.0 MAP:109.0 BLOCK:0044 LOT:0000.0 PARCEL ADDRESS:555 BOSTON STREET FY:2012 PARCEL INFORMATION Use-Code: 101 Sate Price: 1 Book: 65684 Road Type: T inspect Date: 03/03/2010 Owner: Tax Class: T Sale Date: 02/25/00 Page: 0349 Rd_EogAgon: P Was Date: 043103/2010 DUNK,JOAN V Tot Fi- Area: 2329 Sale Type: P Cert/Doc: Traffic. M Entrance: X DU MICHELLE LEE DUNN Tot Lan_d Area: 0_.84_ Sale Valid: F Water. Collect td: RRC Address: Grantor. CHARLES DUNN Sewer: trispee!Reas: G T 555.BOSTON STREE EExempt.B/L% / Resid-B/L%o 1001100 Comm-B/0/6 Indust-B/L% / Q n Sp-6ll% % NORTH ANDOVER MA 01845 RESIDENCE INFOIt111IATI014 LAND INFORMATION. Style: CP Tot Rooms: 7 Main Fn Area: 1530 Attic: Y NBND.CODE: fi NBHD CLASS:fi ZO.N :R2 Story Height: 1.75 Bedrooms: 4 Up Fn Area: 7.99_ Bsmt Area: 1466 Seg Type Code Method Sq-Ft Acres lnflu-Y/N Value Class Roof: G Full Baths: 2 Add Fn Area: Fn Bsmt Area: 32.0 1 P 101 S 36690 0.840 204,391 Ext Walt: OT Half Baths: Unfin Area: Bsmt Grade: DETACHED STRUCTURE I�iEO-RMAIIOIII - N Masonry Trim: Ext Bath Fix: 0 Tot'Fin Area: 2329 Str Unit Msr-1 Msr-2 E-YR-Btt Grade Cond%Good PIFIE1R Cost Class .Foundation: CN Bath Qual: T RCNLD: 258766 -- -v Kitch Qu-al: T Eft Yr Built: 1980 Mkt Adj: PA S 512 0.00 1988 A A 50///50 4,00,0 Heat Type: HW Ext Kitch_: Year Built: 107t Sound Value: VALUATION:INt:ORMATiON Fuel Type: O Grade: G` Cost Bldg: 258,800 Current Total: 467,200 Bldg: 262,800 Land: 204,400 .MctLnd: 204,400: Fireplace: 1 Bsmt Gar Cap: Condition: AG All Str Vail: Prior Total: 467,200 Bldg: 262,80.0 Land: 20.4,400 MktLnd: 204,40,: Central AC: N Bsmt Gar SF: Pct Complete: Att Str Val2: Alt Gar SF: 576%Goode P/F/E/R: /100/100/83 Porch Tvne Porch Area Porch Grade Factor P 100 S 272 SKETCH PHOTO 16 17 272s " t . tl,Ft G - FM�B 576 S%F FU"0.751FM/B 15 30 Sq• 24 r 1066 Sq.Ft 30 2671) ` 100 Ft 5 s . _ M 555 BOSTON STREET Parcel ID:210/109.0-0044-0000.0 as of 7/9/12 F?90e 1 Of�. ` JAMES P.CLEARY III& JOSEPH A CLEARY.P.C. � A2TDRNEYS AT LAW . � 1� 345 MAIN STREET E,K jEl0 �1, 349 .�' w7� P.O.Box 730 HAVERHILL,MA 01831.1303 QUITCLAIM DEED We, Charles E. Dunn and Joan V. Dunn, husband and wife, both of North Andover, Essex County, Massachusetts f For less than One Hundred and 00/100($100.00)dollars Consideration Paid Grant to Joan V. Dunn, of 555 Boston Street, North Andover, Massachusetts 01845, WITH QUITCLAIM COVENANTS The land with the buildings thereon, and having a street address of 555 Boston Street, North Andover, Massachusetts 01845, situated in Andover and North Andover, Massachusetts on the Northerly side of Boston Street and being shown as Lot #1 on 'Plan of Land in Andover and North Andover, owned by Graymoor Trust, dated April 27, 1971, Hayes Engineering, Inc.", duly recorded with North District of Essex Registry of Deeds as Plan No. 6398, said lot being more particularly bounded and described as follows: SOUTHERLY one hundred fifty feet by the Northerly line of Boston Street; WESTERLY in three courses, one hundred eleven and 29/100 feet; one hundred sixty-six and 56/100 feet and thirty-nine and 02/100 feet by land now or formerly of Carl J. Capobianco, et al; C; NORTHERLY one hundred forty-five and 86/100 feet by Lot#2, as shown on said plan; and EASTERLY two hundred eighty-four feet by Lot#2, as shown on said plan. FEB r25'00 pmn,:15 Containing 44,056 square feet, more or less. a For back title reference see deed to Allen E. Hartford and Jeanne C. Hartford to Charles E. Dunn and Joan V. Dunn dated April 22, 1972, and recorded with the Essex North District Registry of Deeds at Book 1192, Page 41. NO TITLE EXAMINATION REQUESTED. a, WITNESS our hands and seal this 14'day of February, 2000. � c .v � Charles E. Dunn by Joan V. Dunn, hfsv Attorney-in-Fact under Durable Power of Attorney dated December 3, 1999 oan V. Dunn i I BK 5684 PG 350 COMMONWEALTH OF MASSACHUSETTS Essex, ss. February 14, 2000 Then personally appeared the above named Joan V. Dunn, Attorney-in-Fact as aforesaid, and acknowledged the foregoing instrument to be her free act and deed, before me My Commission expires: Xames P. Cleary III, o blic May 18, 2001 COMMONWEALTH OF MASSACHUSETTS Essex, ss. February 14, 2000 Then personally appeared the above named Joan V. Dunn and acknowledged the foregoing instrument to be her free act and deed, before me My Commission expires: es P. Cleary III, Notary is May 18, 2001 { DelleChiaie, Pamela From: Randy Burley [rburley@millriverconsulting.com] Sent: Tuesday, July 17, 2012 1:48 PM To: 'Daniel Ottenheimer'; Grant, Michele; 'Isaac Rowe'; 'Marianne Peters'; DelleChiaie, Pamela; Sa er, Susan Subject: 5 Boston Street Attachments: 555 Boston St Soils.PDF Soil was not great(perc'd at 20 min/in)but I'm sure Ben will do a fine job designing a new system. Best, Randy Burley,Project Manager Mill River Consulting,Inc. 6 Sargent Street Gloucester,MA 01930-2719 978-282-0014 fax: 978-282-1318 www.miliriverconsultiniz.com rburley@millriverconsultinp_.com m,II R1 con suIti ng< Crwtl rngrnr.crmy,, €nv rrrn+na ntpl Rermtfiing I%Auntcip.o Enyrronmrntal rle,ililr Consumng Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records.For more information please refer to:hftp://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. 1 . a I T t t � r ' I -(g 7 '+ +-4 - - - _ ri —07 I � i � _►L�-S o:�:� �� __. --- -- 1S , mss _ o �q r' �` — + e — — — — i l J�Yy >V q,�---- Commonwealth of Massachusetts Title 5 Official InspectionForm _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 555 Boston Street t"�� ` 7:) Property Address Michelle Dunn V- Owner Owner's Name information is required for North Andover MA 01845 6-15-12 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the " computer,use 1. Inspector: only the tab key to move your Benjamin C. Osgood, Jr. cursor-do not Name of Inspector H use the return key. none Company Name Q 16 Hillside Avenue, Unit 3 Company Address Amesbury MA 01913 City/Town State Zip Code 978-834-6585 870 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 5(310 CMR 15.000).The system: ❑ Passes ® Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority C.� 6-17-12 Inspector' Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. REGdM.C-NO re-w. dt QG�INS�oCeTE'p g Ra Ke-- f'Pe y � I . " 1 .� � R ~ . r + T l i ` .. � .Y t .. 1 � ^"� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,..'y 555 Boston Street Property Address Michelle Dunn Owner Owner's Name information is required for North Andover MA 01845 6-15-12 every page. Citylrown 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," lease explain. , P p The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): �. - - ' , . r ,.: i I� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 555 Boston Street Property Address Michelle Dunn Owner Owner's Name information is required for North Andover MA 01845 6-15-12 every page. Cityrrown 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 or replaced ❑ Y ❑ N ❑ ND(Explain below): Pipe between tank and d-box broken causing backup in to septic tank. ❑ 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 i Required t s equ red by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh - P .a it .. i .. +. . t � � - �+' � - J � .. _ i !" !� .. � ..tom,,;. � �I'T i L� •lir` ., �., �" . �. . i , ! ... r` tea, i •� ( r _ r: t �, .. ! 1 + v, Y� f 1 pi i.+e `' � .. ��r w 1 :-'.��i;. w .I ij-. ��'+ � 1 7 ..>t r.e � ... 4+s„py 4+ fi' J7.1� .'.y �,+ ''i' Rik';. � '3' Ii' 'f 's+ �q +.:5.' a° r �i „,jou., r , i :!i:i^, . . LS n,. .f J ?:... Commonwealth of Massachusetts . i Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments rY 555 Boston Street Property Address Michelle Dunn Owner Owner's Name information is required for North Andover MA 01845 6-15-12 every page. City/Town state Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow r r J J 7 ar i- y r • .� f �' r r ri.� `c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �r 555 Boston Street Property Address Michelle Dunn Owner Owner's Name information is required for North Andover MA 01845 6-15-12 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ® the system is within 400 feet of a surface drinking water supply ❑ ® the system is within 200 feet of a tributary to a surface drinking water supply ❑ ® the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. i 'I F iri ♦i 1 �'�. .. 4 ' aJ I tJ ir .4 A r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 555 Boston Street Property Address Michelle Dunn Owner Owner's Name information is required for North Andover MA 01845 6-15-12 every page. Citylrown State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): N/A Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): N/A a �.. � r '; , i � ` �t 1 ' .,r :.t -. .! ":i�:3i.`.. ' . � . . , � ��� I7�1:, - 'ill. ..it n , • � .. :rs� „�;a� '°i�.. Ott 'i.� ti �`1'^L. ..z ,i �:_ :.' i, i'• , , t _ .. {.. � ,la +. - 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �< 555 Boston Street Property Address Michelle Dunn Owner Owner's Name information is required for North Andover MA 01845 6-15-12 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 1 Does residence have a arba a grinder? ❑ Yes ® No 9 9 Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Well Detail: Sump pump? ❑ Yes ® No Last date of occupancy: currentDate Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: R � FY +i� ♦ 7 • i d ! {f. �� ..+ ,. � � .. � 1F i. '.y �� �. � 1 � � , t� .. � �. ' Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '< 555 Boston Street Property Address Michelle Dunn Owner Owner's Name information is required for North Andover MA 01845 6-15-12 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Pumped 2 years ago per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): i .. �t � I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 555 Boston Street Property Address Michelle Dunn Owner Owner's Name information is required for North Andover MA 01845 6-15-12 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed(if known)and source of information: Built approximately 1975 per owner Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5' feet Material of construction: ® cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: N/A feet Comments(on condition of joints, venting, evidence of leakage, etc.): Pipe looks good in basement Septic Tank(locate on site plan): 4" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallons Sludge depth: 1" 1`�- .�'^ ,.t., .. i, .. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 555 Boston Street Property Address Michelle Dunn Owner Owner's Name information is required for North Andover MA 01845 6-15-12 every page. CitylTown 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 N/A Scum thickness 1" Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A How were dimensions determined? measure tape Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank in good condition. Outlet tee missing and requires replacement. Line from tank to d-box requires replacement Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date . Pr. '� 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 555 Boston Street Property Address Michelle Dunn Owner Owner's Name information is required for North Andover MA 01845 6-15-12 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Commonwealth of Massachusetts I Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 555 Boston Street Property Address Michelle Dunn Owner Owner's Name information is required for North Andover MA 01845 6-15-12 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box not found. Should be located and inspected when pipe is replaced. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: .r .. ._ .� ! � J. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .r 555 Boston Street Property Address Michelle Dunn Owner Owner's Name information is required for North Andover MA 01845 6-15-12 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 1 20 x 45 ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Area of field is grass and looks normal. No evidence of ponding, damp soil, or unusual vegetation. Probing and digging in to stone indicates that it is clean and dry Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration — Depth to of liquid to inlet invert P P q Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 555 Boston Street ,p Property Address Michelle Dunn Owner Owner's Name information is required for North Andover MA 01845 6-15-12 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 3-al �,�g NVI�ly1�y a ¢ pi 'Yo Novi 1� ±A ltoD_=_ o _4e fj Le x ice'i LdD �s• �� 14 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �< 555 Boston Street Property Address Michelle Dunn Owner Owner's Name information is required for North Andover MA 01845 6-15-12 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: I ® hand-sketch in the area below ❑ drawing attached separately ' I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 555 Boston Street Property Address Michelle Dunn Owner Owner's Name information is required for North Andover MA 01845 6-15-12 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: 3 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 Wealth-explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: You must describe how you established the high ground water elevation: System bottom 2' below existing grade. USGS maps and inspector knowledge indicate water is > 3 feet below grade. Before filing this Inspection Report, please see Report Completeness Checklist on next page. � � ' •� i ,.�,. .. I ,�- 1 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 555 Boston Street Property Address Michelle Dunn Owner Owner's Name information is required for North Andover MA 01845 6-15-12 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file 36 Alo- d,—b!& M t 1 �s 1Al rx !iool - c S NVI y S N r a. A 13fo C p 0X //,/ _ 9S47 1 ���� r. -- t_._ __ ...�.... __�.._�.______..__ Y._ _ _________ �._. .��-- __ _.