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HomeMy WebLinkAboutMiscellaneous - 557 BOXFORD STREET 4/30/2018 557 BOXFORD STREET i 1� 210/105.C-0027-0ODO.O I ` fI 1 r North Andover Board of Assessors Public Access Page I of 1 Town of North A "over• z°�'• '� Board of Assessors Property B�rem$ TRecord Card Return to the Home page click on logo Parcel ID:210/105.C-0027-0000.0 Community:North Andover SKETCH PHOTO New Search Click on Sketch to Enlarge Click on Photo to Enlarge Sales Summary ) Residence !� Detached Structure Condo Commercial Comparable Sales 557 BOXFORD STREET cj Location: 557 BOXFORD STREET Owner Name: KIM,SANG GON&KIM,RAN Owner Address: 557 BOXFORD STREET City:NORTH ANDOVER State:MA ZIP:01845 Neighborhood:5-5 Land Area:4.64 acres Use Code:101-SNGL-FAM-RES Total Finished Area: 1930 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 463,300 484,300 Building Value: 238,300 247,400 Land Value: 225,000 236,900 Market Land Value:225,000 Chapter Land Value: LATEST SALE Sale Price:480,000 Sale Date:02/09/2005 Arms Length Sale Code:Y-YES-VALID Grantor:TOMPKINS,WILLIAM Cert Doc: Book:9343 Page:288 http://csc-ma.us/NandoverPubAcc/jsp/Home.jsp?Page=3&Linkld=1180815 8/22/2008 .. r ' SSPT3�SY&ZSM�NSIfl�I�BtQ�t ISTHE INSTALLER LICENSED? ` + ` �r YES NO TYPE. OF CONSTRUCTION NEW REPAIR CONSTRUCTION: CERTIFIED PLOT PLAN REVIEW- YES NO CONDITIONS OF..APPROVAL ` :�. YES NO (FROM FORM U) r ' ISSUANCE OF DWC PERMIT . .. ` YES NO DWC PERMIT' N0. _ INSTALLER: : HEGIN INSPECTION YES 0: ' ,+ _ EXCAVATION ,INSPECTION: : NEEDED: PASSED �G /: ��'� - .HY ' : .:CONSTRUCTION INSPECTIONS NEEDED: AS BUILT PLAN SATISFACTORY: : YES: APPROVAL TO BACKFILL: DATE: HY ' FINAL . GRADING APPROVAL: DATE HY ,FINAL CONSTRUCTION APPROVAL: DATE: BY 4, ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 557 Boxford Street Property Address Sang Kim Owner Owner's Name information is North Andover MA 01845 10/17/2015 required for every page. CitylTown State Zip Code Date of Inspection O 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 DECEIVED forms on the computer,use 1. Inspector: only the tab key to move yourNeil J. Bateson use the return QCT 2 6 2015 cursor- not Name of Inspector ER key. Bateson Enterprises Inc. '(OYVN OF NORTH DEPAR(MEW Company Name 111 Arg illa Road Company Address Andover MA 01810 X70 Cityrrown State Zip Code 978-475-4786 S115 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs F rther Evaluation by the Local Approving Authority 10/17/2015 Inspector s 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. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 1 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments * 557 Boxford Street Property Address Sang Kim Owner Owner's Name information is required for North Andover MA 01845 10/17/2015 every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 557 Boxford Street Property Address Sang Kim Owner Owner's Name information is required for North Andover MA 01845 10/17/2015 every page. City/rown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 557 Boxford Street Property Address Sang Kim Owner Owners Name information is required for North Andover MA 01845 10/17/2015 every page. CityfTown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than'/day flow l5ins•3/13 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 557 Boxford Street Property Address Sang Kim Owner Owner's Name information is required for North Andover MA 01845 10/17/2015 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered'yes"to any question in Section E the system is considered a significant threat, or answered"yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15-304.The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 557 Boxford Street Property Address Sang Kim Owner Owner's Name information is required for North Andover MA 01845 10/17/2015 every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks?. ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® Determined in the field (if any of the failure criteria related to Part C is at issue 11 approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 660 15ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 557 Boxford Street Property Address Sang Kim Owner Owner's Name information is required for North Andover MA 01845 10/17/2015 every page. Cityfrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available' last 2 ears usage On well water 9 ( Y 9 (gpd))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): --- Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3113 Title 5 ficial 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 557 Boxford Street Property Address Sang Kim Owner Owner's Name information is required for North Andover MA 04845 10/17/2015 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Pumped last year,owner Was system pumped as part of the inspection? ® Yes ❑ No If yes,volume pumped: 1000 gallons How was quantity pumped determined? Measured tank Reason for pumping: Inspect tank&tees 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-3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .'' 557 Boxford Street Property Address Sang Kim Owner Owner's Name information is required for North Andover MA 01845 10/17/2015 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: Tank original, d-box&pits installed 4/13/1995 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.6 feet Material of construction: ®cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): 4"Cast iron through wall, 3"PVC in house, no leaks visible Septic Tank(locate on site plan): Depth below grade: 0.6 feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 7'x5'x4' Sludge depth: 2" t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 557 Boxford Street Property Address Sang Kim Owner Owner's Name information is required for North Andover MA 01845 10/17/2015 every page. Ciryrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 31" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? Tape Measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Pumped septic tank. Inlet baffle ok. Outlet baffle ok. Outlet tee ok. Deptic of liquid at outlet invert. No evidence of leakage. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts V .Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 557 Boxford Street Property Address Sang Kim Owner Owner's Name information is required for North Andover MA 01845 10/17/2015 every page. Cityrrown 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 t5ins•3113 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 557 Boxford Street Property Address Sang Kim Owner Owner's Name information is required for North Andover MA 01845 10/17/2015 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.): D-box level&distribution equal. No evidence of leakage. Evidence of light carryover Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 i Commonwealth of Massachusetts UTithe 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 557 Boxford Street Property Address Sang Kim Owner Owner's Name information is required for North Andover MA 01845 10/17/2015 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2 ❑ leaching chambers number: ❑ leaching galleries number: ❑ 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.): Soil Ok.Vegetation ok. No sign of ponding to surface. Camera inside of pits through outlets in d-box, no liquid to inverts. Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 557 Boxford Street Property Address Sang Kim Owner Owner's Name information is required for North Andover MA 01845 10/17/2015 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3113 Title 5 Official Inspection Fonn:Subsurface Sewage Disposal System•Page U of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 557 Boxford Street Property Address Sang Kim Owner Owner's Name information is required for North Andover MA 01845 10/17/2015 every page. City/town 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 tv ot;z�f G C) P� 2 L4 i D-.45G7` r-79 Ic D- /f t5ins•3/13 Title 5 Official Inspection Fort:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 557 Boxford Street Property Address Sang Kim Owner Owner's Name information is required for North Andover MA 01845 10/17/2015 every page. City/Town 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: 4 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: 5/23/1994 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: Design plan ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Test pit data on design plan Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 557 Boxford Street Property Address Sang Kim Owner Owner's Name information is required for North Andover MA 01845 10/17/2015 every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 6 Official Inspection Forth:Subsurface Sewage Disposal System•Page 17 of 17 : Commonwealth of Massachusetts City/Town of . System Pumping-Record Form 4 DEP has provided this form for usezby 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/ t of Hous Left/Right rear of house, Left I right side of house, Left I Right side of building, Left/Right front of building, Left/Right rear of building, Under deck Address 5;N- city/Town State - Zip Code 2. System Owner. P\A, Name Address(if different from location) Citylrown ' Stat ,zip Code ; i y1 Telephone Number • e i ` ------------- j �r .B. Pumping P.ecord 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type-of system: ❑ Cesspool(s) c ank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yeas L 'Ro If yes,was it cleaned?. ❑ Yes ❑ No 5. Condition of System: 6.. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Ina company 7. Locatioombere contents were disposed: G, S Lowell Waste Water 10A. Signible cl Haul Date t5formCdoc•06103 System Pumping Record•Page 1 of 1 COMMONWEALTH OF MASSACHUSETTS ` EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS h d DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:_557 Boxford Street_ —North Andover_ RECE! ✓ED Owner's Name:_Sang Kim Owner's Address:_557 Boxford Street _North Andover,MA 01845_ AU 18 2008 Date of Inspection:_8/1/2008 TOWN 01 NORTH ANDOVER Name of Inspector:_Neil J.Bateson HEALTH DEPARTMENT Company Name:_Bateson Enterprises Inc._ Mailing Address:_111 Argilla Road_ _Andover,MA 01810_ Telephone Number:_(978)4754786_ CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of 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 Needs Further Evaluation by the Local Approving Authority' Fail Inspector's Signature: Date: 8/1/2008fV _ 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. Notes and Comments: ****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. 1� Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_557 Boxford Street_ _North Andover_ Owner:_Kim Date of Inspection:_8/1/2008_ Inspection Summary:Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X 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 arc 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.Answer yes,no or not determined(Y,N,ND)in the for the following statements. 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. ND explain: 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 obstruction is removed distribution box is leveled or replaced ND explain: 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 obstruction is removed ND explain: Title 5 Inspection Form 6/15/2000 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_557 Boxford Street_ _ North Andover— Owner:_Kim_ Date of Inspection:_8/1/2008_ C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 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 and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Title 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_557 Boxford Street_ _North Andover— Owner:_Kim_ Date of Inspection:_8/1/2008_ D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: _No_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool — _No_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _No_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _No_ Liquid depth in cesspool is less than 6"below invert or available volume is''/2 day flow. _No_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _No_ Any portion of the SAS,cesspool or privy is below high ground water elevation. No_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _No_ Any portion of a cesspool or privy is within a Zone I of a public well. _No_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _No_ 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] No (Yes/No)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. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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 Il 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. Title 5 Inspection Form 6/15/2000 4 Page 5 of 11 i I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:_557 Boxford Street_ _North Andover_ Owner:_Kim_ Date of Inspection:_8/1/2008_ Check if the following have been done.You must indicate"yes"or"no,-as to each of the following: Yes No Yes Pumping information was provided by the owner,occupant,or Board of Health No_ Were any of the system components pumped out in the previous two weeks? _Yes_ Has the system received normal flows in the previous two week period? No Have large volumes of water been introduced to the system recently or as part of this inspection? N/A _ Were as built plans of the system obtained and examined?Old Title 5 Report Yes_ ` Was the facility or dwelling inspected for signs of sewage back up? _Yes_ _ Was the site inspected for signs of break out? Yes_ _ Were all system components,excluding the SAS,located on site? _Yes_ _ 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? _Yes_ _ 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: Yes No _Yes_ _ Existing information. _Yes_ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[3 10 CMR 15.302(3)(b)] Title 5 Inspection Form 6/15/2000 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:_557 Boxford Street T _North Andover— Owner:_Kim_ Date of Inspection:_8/1/2008_ FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_4_Number of bedrooms(actual):_4_ DESIGN flow based on 310 CMR 15.203_660_ Number of current residents:_3 Does residence have a garbage grinder(yes or no):_No_ Is laundry on a separate sewage system(yes or no):_No_ Laundry system inspected(yes or no): _ Seasonal use:(yes or no):_No Water meter reading:_Yes_ Sump pump(yes or no):_No_ Last date of occupancy:—Current_ COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203):_gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available:_ Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped 2005,owner_ Was system pumped as part of the inspection(yes or no):–Yes– If yes es_Ifyes,volume pumped:_1000_gallons--How was quantity pumped determined?_Measured tank Reason for pumping: _Inspect tank,baffles&tee_ TYPE OF SYSTEM X 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) _Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information_Tank original,d-box& pits installed 4/11/1995,info at B.O.H. Were sewage odors detected when arriving at the site(yes or no):_No_ Title 5 Inspection Form 6/15/2000 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) I Property Address:_557 Boxford Street _North Andover_ Owner:_Kim_ Date of Inspection:_8/1/2008_ BUILDING SEWER_X_ (locate on site plan) Depth below grade:_24"_ Materials of construction: _X_cast iron —X-40 PVC other Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.) _ 4"Cast iron thru wall,3"PVC in house no leaks visible SEPTIC TANK: X Depth below grade:_12"_ Material of construction: X_concrete—metal_fiberglass polyethylene _other(explain) If tank is metal list age:` Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 7'x 5'x 4' Sludge depth _4"_ Distance from top of sludge to bottom of outlet tee or baffle:_23"_ Scum thickness:_4" Distance from top of scum to top of outlet tee or baffle:- 8"-Distance from bottom of scum to bottom of outlet tee or baffle:_17"_ How were dimensions determined:_ Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc. Pumped septic tank.Inlet baffle ok.Outlet baffle ok.Outlet tee ok. Depth of liquid at outlet invert.No evidence of leakage._ GREASE TRAP:_(locate on site plan) Depth below grade:— Material of construction:_concrete_metal_fiberglass_polyethylene other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Title 5 Inspection Form 6/15/2000 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_557 Boxford Street _North Andover— Owner:_Kim_ Date of Inspection:_8/1/2008_ 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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX_X_ Depth below grade 24"_ Depth of liquid level above outlet invert:_0" Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.) _D-box level&distribution equal No evidence of leakage.Evidence of carryover.D-box cover broken,replaced it._ PUMP CHAMBER:_(locate on site plan) Pump in working order(yes or no):_ Alarm in working order(yes or no):_ Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Title 5 Inspection Form 6/15/2000 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_557 Boxford Street _North Andover— Owner:_Kim Date of Inspection:_8/1/2008_ SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type X Leaching pits,number: _2 Leaching chambers,number: Leaching galleries,number: _Leaching trench,number,length: Leaching field,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.):_Soil ok.Vegetation ok.No sign of ponding to surface.Camera inside of pits thru outlets in d-box,no liquid to inverts_ CESSPOOLS: Number and configuration:, Depth—top of liquid to inlet invert:_ Depth of sludge layer: Depth of scum layer:_ Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): 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.): 9 Title 5 Inspection Form 6/15/2000 Page 10 of 11 i OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:_557 Boxford Street _North Andover— Owner:_Kim_ Date of Inspection:_8/]/2008 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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 House To Well Driveway B Septic Tank l 2 Pit 1 D-Box Pit 2 AtoI=36' Ato2=41' A to D-Box=7812" Bto1=16' Bto2=18'5" B to D-Box=58'8" Title 5 Inspection Form 6/15/2000 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_557 Boxford Street_ _North Andover— Owner:_Kim_ Date of Inspection:_8/1/2008_ SITE EXAM Slope_No_ Surface water_No Check cellar _Yes_ Shallow wells No Estimated depth to ground water _4'_ Please indicate(check)all methods used to determine the high ground water elevation: X Obtained from system design plans on record-If checked,date of design plan reviewed:_5123/1994_ 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:_Test pit data on design plan_ Title 5 Inspection Form 6/15/2000 11 Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 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,aleck with your local Board of Heafth 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 Important: When filling out 1. System Location: forms the computer,use only the tab fey Address to nxNe cursor-do not N use the return C yfroam State Zip Code key. 2. System Owner. Name Address(if different from location) City/Town Stale 74P Code Telephone Number B. Pumping Record t /� 1. Date of Pumping 2. Quantity Pumped: Date Gallons 3. Type of system: ❑ Cesspool(s) 2-Sei—ptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Fitter present? ❑ Yes [' K If yes,was it cleaned? ❑ Yes ❑ No I, 5. Condition of System: 6. Sy P-e�� l�� Name Vehicle License Number Company 7. Locati where contents wgre disposed: L- ` �-t-��- Signituig of ler GDate t5fcnn4.doc•06/03 System Pumping Record•Page 1 of 1 Tel: (978)475-4786 Fax: (978)475-5451 BATESON ENTERPRISES, INC. Excavating-Water& Sewer Lines-Septic Systems&Pumping Service 111 Argilla Road Andover,Mass. 01810 Title 5 Inspection Report Property Address: 557 Boxford Street,North Andover Owner: Kim Date of Inspection: 8/1/2008 My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations,and I hereby disclaim any further operation of your current septic system. Neil J.Bateson Bateson Enterprises,Inc. x COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS r DEPARTMENT OF ENVIRONMENT� CTION �stlriG'.a '1 1 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address;- Owner s ddress•Owner's Name'', Owner's Address: Date of Inspection: ,tea Name of Inspector:(please print CA N-\ Company NameLS&Pk :x�zc C Mailing Address: d Telephone Number: — q 7 l CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of 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: P'-�ses \{Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: Al , - 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. Notes and Comments ****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. Tib 5 Inspection Form 6/15/2000 page 1 „$." 1Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:. Owner: ` Date of Inspectio : Inspection Summary:: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: S 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.;. . - y 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. Answer yes,no or not determined(Y,N,ND)in the 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 4 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. ND explain: 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 iQwith approval of Board of Health): broken pipes)are replaced obstruction is removed distribution box is leveled or replaced explain: t - 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 obstruction is removed ND explain: 2 3Page 3 of l l d. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:Z62 ©( r Date of Inspecti n: C. Further.Eval�uation is Required by the Board of Health: . f Conditions exist which require further evaluation by the Board of Health in order to determine if the system j is failing to protect public health,safety or the environment. 1' Systeinlivill'pass unless Board bf 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: _ Cess ool or privy is within 50 feet of a surface water Cess ol,or privy is within 50 feet of a bordering vegetated wetland or a salt marsh A 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 and volatileorganic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate`nitrogen is equal—Wor 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: 3 Page 4 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Addresa:.s n\ 'f �r Owner. Date of Inspecti6iF D. System Failuie Criteria applicable to all systems: You must indicate'"yes"or"no"to each of the following for all inspections: i Yes No _o. +*''rBackun of sewage;into facility or system component due to overloaded or clogged SAS or cesspool 'Discharge or ponding of eflfluetit to the surface of the ground or surface waters due to an overlolded or' clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. -"'iiquVI'depth in cesspool is less than 6"below invert or available volume is less than''/,day flow Le-Requi tdpumping 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.J (Yes/No)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. You must indicate either"yes"or"no"to eacli of the following: (The following criteria apply to large systems in addition to the criteria above) Oyes 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 I _ 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 i 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. 4 L Page 5 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address , - Owner Date of Inspe�- –a3 .i Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes. ' Pumpinjinformation was provided by the owner,occupant,or Board of Health ; _ ere any of the system components pumped out in the previous two weeks? Hasilge system received normal flows in the previous two week period? _ -"Hav "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: Ye 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)[3 10 CMR 15.302(3)(b)] 5 as Page 6.of 1 l a OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address• -4 Owner. i Date of Inspection: FLOW CONDITIONS RESIDENTIAL' Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): rp Q Number of current residents:_A Does residence have a garbage grinder(yes or no): ,y o 'Is laundry on a sepi$rate sewage system,(yes;or no)'4 [if es se crate ins ectionre utred - Y P P q ) Laundry system inspected(yes or no): Seasonal use:(yes or no): HO s- Water meter readings,if available(last 2 years usage(gpd)): I&e it o()PLS a u Sump Pump(Yes no): ►J u Last date of occu cy: COMMERCIAL/INDUSTRIAL Type of establishment: . : Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):— Industrial waste holding tank present(yes or no):— Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings,if available: Last date of occupancy/use: OTHER(describe):. GENERAL INFORMATION `Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): s If yes,volume pumped: 1EQ0 gallons--How was quantit�pumped determined? ye-( lge-A-y Reason for pumpin9 rA 1,Q, S 7.2(,c r&e TY�PE� YSTEM _`-•S"eptic tank,distribution box,soil absorption system _Single cesspool Overflow cesspool —ivy t—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) —Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): p 6 a Page 7 of I 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Addres Owner: Date of Inspectr n: BUILDING SEWER(locate on site plan) Depth below grade: �4 Materials of construction:—cast iront/40 PVC—other(explain): Distance from p 'vate water�supply wey or suction line: Comments(on'c�ndition f joints,venting,evidence of leakage,etc.): JUii�r Poon Nn I S e, p f• .' SEPTIC TAN (locate on site plan) Depth below de: Material of construction:_concrete metal fiberglass_polyethylene _other(explain) — — If tank is metal list age:— Is age confirmed med by a Certificate of Compliance(yes or no):_ certificate) (attach a copy of Dimensions: �0 �( Sludge depth: 31, Distance from top of sludge to bottom of outlet tee or baffle: , — Scum thickness: Distance from top o scum to top of outlet tee or baffle: '7 �y Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined:_f}.4 Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): GREASE TRAPk4(locate on site plan) Depth below grade: `' + 1 . Material of construction:—concrete metal fiberglass—polyethylene other (explain): — — — Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 I q (rage 8 of 11 e , OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Addres E� /V Ac�1/�S Date of Inspecti : 033-c?3 TIGHT or HOLDING TANK: 4 It (tank must be pumped at time of inspection)(locate on site plan) s Depth below grade: 1 Material of constructio : concrete metal fiberglass of eth lene_other ex lain — —, g —P Y Y ( P ) Dimensions: TP Capacity: _ gallons Design'.F1ow: '~T gallons/day Alarm present(yes o no):. Alarm evd a Alarm in working order(yes or no): Date of last pumping , Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX:JeS (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: uZ 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.): �J+ GOun C fria0i-r/.1/ /-4 slat PUMP CHAMBER:i4A (locate on site plan) Pumps in working order(yes or no):_ Alarms in working order(yes or no):— Commend(pote cohdiiidh of um chamber,_conditioh.of pumps and a enances:etc. : . P P P .:t ) If s 8 i ' -.z CPage 9 of 11 f , $ OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:.�fi�7 Owner: Date of In-sapectin-'—, in o3 SOIL ABSORPTION SYSTEM(SAS):`!ti (locate on site plan,excavation not required) If SAS not located explain why: Type eaching pits,number: 4 U7-u e.2 leaching clambers,number:_ eaach'4hing gall es,.number: r.,. eaching ttenthes,number,length: le _ mg fieldsl,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.): NOL/5N h 1411 atac1 /G 7 /,,- r 50/ � /I try f_, A d1f CESSPOOLS:A(cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction Indication of groundwater inflow(yes or io): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): /r PRIVY: (locate on site plan) Materials of construction: Dimensions: r Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page l0�of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: r Owner:` alb r` Date of Inspec ion: aLCZs� �3 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. b 6v /N lI` g `- ,Ie � D dot J 10 r, , gage 11 of 11 e ' OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART C SYSTEM INFORMATION(continued) Property Address: iatl?2_312 f g�� Fly Date o Date of Inspection SITE EXAM` Slope Surface water Check cellar ? Shallow wells � .,. 4 /J Estimated depth id ground'water �O feet ` � Sr^ "- - Pleaftained, indicate(bhecl)all methods used to determine the high ground water elevation: from ystem design plans on record-If checked,date of design plan reviewed: —�i edrsite abutting proper ylobservation 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: �� SPlurt� r.�AtrCr 11 SENDER: 3 • Complete items 1 and/or 2 for additional services. I also wish to receive the .y • Complete items 3,and 4a&b. mfollowing services (for an extra v y • Print your name.and address on the reverse of this form so that we can tt return this card to you. fee): > • Attach this form to the front of the mailpiece,or on the back if ace 1. ® p E3 Addressee's Address r does not permit.-. N ® • Write"Return Receipt Requested"on the mailpiece below the article number. p • The Return Receipt will show to whom the article was delivered and the date 2 ❑ Restricted Delivery C delivered. 4111 v o Consult postmaster for fee. m 3. Article Addressed to:. 4a. Article Number. ,a Mr. & Mrs. William Tompkins P 273 797 689 c 557 Boxford Street 4b. Service Type North Andover, MA 01845 ❑ Registered ❑ Insurea N Certified ❑ COD c W 9X ❑ Express Mail Return Receipt for 03 Merchandise Q 7. D f Delivery w `. ' o 5. Signature (Addressee) 8. Addressee's Address Only if requested - Lu and fee is paid) C c 6 ature (AgenrY ------ �,� r t— m IPS-Form 3811,December 1991 U.s.c.P.o.:199z-3107-530 DOMESTIC RETURN RECEIPT P 273 797 659 Receipt for Certified Mail M No Insurance Coverage Provided Do not use for International Mail ,05TALSER-E ISee Reverse) Sent to Mr. Mrs. Tompkins Street and No. P.O.,State and ZIP Cede NQ t--h- Aandqvii Postage $ 2.29 Certified Fee Special Delivery Fee Restricted Delivery Fee Return Receipt Showing a) to Whom&Date Delivered Return Receipt Showing to Whom, e Date,and Addressee's Address 7 TOTAL Postage $ 2. 29 C &Fees 0 Postmark or Date M sent 8/15/94 0 A < pORTN 1 . 3?0`t, o1.00 k_ omT BOARD OF HEALTH Y . °9 120 MAIN STREET TEL. 682.6483 SSS^CMUSES `y NORTH ANDOVER, MASS. 01845 Ext23 Date: August 12 , 1994 Mr. & Mrs. William Tompkins 557 Boxford Street North Andover, MA 01845 Dear Mr. Tompkins: In May of 1994 a site inspection was conducted of your property at 557 Boxford Street, North Andover. The inspection revealed the sewage disposal system discharging to the surface of the ground in violation of 105 CMR 420.300 and Title 5 of The State Environmental Code 310 CMR 15. 02 (20) 310 CMR 15.02 (20) Discharge to Surface of Ground No sanitary sewage shall be allowed to discharge or spill onto the surface of the ground or to flow into any gutter, street, roadway, or public place; nor shall any such material discharge onto any private property. On May 23, 1994, accompanied by an engineer hired by you, Board of Health personnel witnessed soil tests preparatory to the design and repair of your septic system. To date no plan has been received by the Board of Health and no repair has been effected. You are hereby ORDERED to: - submit a proposed septic system plan for review to the Board of Health within fourteen (14) days of receipt of this order letter. - arrange for an acceptable repair of the system as soon as plans have been approved and to commence this repair no later than thirty (30) days of receipt of this order letter. Failure to comply with this order letter may result in legal action issued against you in the Lawrence District Court and may result in the assessment of a fine. You have the right to be heard by the Board of Health if you feel this order should be withdrawn or modified. To obtain a hearing, you must file a written petition with this office within seven (7) days of receipt of this letter. You also have the right to inspect and obtain copies of all relevant inspection or investigation reports, orders, notices, and other documentary information in possession of the Board of Health; and that any affected party has a right to appear at said hearing. Please feel free to contact this office with any questions you may have. Sincerely, Sandra Starr, R.S. Health Administrator cc: Karen Nelson, Dir. PCD R. Pica File Town of North Andover, Massachusetts Form No.2 ; 0 , BOARD OF HEALTH I. a a15 199� DESIGN APPROVAL FOR k sSACMuStt SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM. Applicant /V/LC Test No. Site Locationeb 51— Reference Plans and Specs.-WQA-J�TI13 ENGINEER DESIGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. CHAIRMAN,BOARD OF H ALTH Fee Q L / Site System Permit No, i PITS I MIN 660 LEACHING L"'./ MIN 1 (131x16' ) PIT V MANHOLE/PIT GW MIN 4 ' BELOW BOTTOM �~ EXC 2x EFF W OR D I/" , 12"-48" STONE BOT + SIDE 176 � fix. LOAD = TOTAL �0 775 (L x W x #) (2x(L+W)xD x #) (G/ft2) CHAMBERS MIN 660 LEACHING GW MIN 4" BELOW COVER >3 FT - VENT MANHOLES 12"-48" STONE ✓ SPLASH PADS --- SLOPE .005 BED/TRENCH (Bed max. 60 ' X 601 ) MIN 13 ' X 16 ' PIT BOT + SIDE X LOAD = TOTAL (L x W X #) (2 x (L+W)xD x #) (G/ft2) FIELDS MIN 660 GPD 900 ft2 BED PERC RATE FASTER THAN 20M/IN GW MIN 4 ' BELOW BOTTOM OF FIELD PIPE ENDS JOINED? 4" PEA STONE? DIST LINE SLOPE . 005? >31COVER-VENT SCH 40 MIN 12" COVER RATE LDG X 660 = = TOTAL ft2/G REQ'D (ft2) LXW DOSING TANKS AND PUMPS DIMENSIONS X X = PUMP CAPACITY Spm L W D Vol. DISCHARGE SIZE DISCHARGE RATE DISCHARGE TIME 9Am MANHOLES TO GRADE ALARM SEP. CIRC. GW (Min. 1' below inlet) HWL LWL CHECK VALVE BLEEDER HOLE MANUAL OP. SWITCH Copyright 0 1993 by S.L.Starr (603)382-6166 119 NEWTON ROAD (ROUTE 108) PLAISTOW, N.H.03865 April 19, 1995VER/ TOW BOARD 0f A APR 2A Ms. Sandra Starr R.S. Health Administrator North Andover Board of Health 120 Main St. North Andover, MA 01845 Dear Sandra: Please find enclosed as-built plans for Mr. & Mrs. Tompkins of 557 Boxford St. It was a pleasure working with you this project and if you require any additional information please contact me at my office. Very truly yours, Ronald J. Pica P.E. RJ PICA ENGINEERING CO. , INC. CIVIL&STRUCTUAL DESIGN SITE DEVELOPMENT&PLANNING • CONSTRUCTION MANAGEMENT •TRAFFIC IMPACT STUDIES SEPTIC SYSTEM DESIGN • SITE ASSESSMENTS I In 1FV-r' V�I PLAN REVIEW CHECKLIST ADDRESS C5�7 j�p�jJ % ENGINEER GENERAL 3 COPIES �� STAMPy� LOCUS �� NORTH ARROW SCALE �- CONTOURSPROFILE °`� SECTION BENCHMARK a'� SOIL & PERC INFO ELEVATIONS WETS. DISCLAIMER WELLS & WETLANDS / WATERSHED? � DRIVEWAY (Elev) WATER LINE FDN DRAIN SCH40 TESTS CURRENT? SEPTIC TANK MIN 1500G .17 INVERT DROP GARB. GRINDER(+200% EDF) 25' TO CELLAR MANHOLE TO GRADE ELEV GW D-BOX SIZE # LINES FIRST 2 ' LEVEL STATEMENT INLET - OUTLET = (2" OR . 17 FT) TEE REQ'D? LEACHING MIN 660 GPD? RESERVE AREA 4 ' FROM PRIMARY? 2% SLOPE 100' TO WETLANDS 100' TO WELLS 4 ' TO S.H.GW 35 ' TO FND & INTRCPTR DRAINS ✓325' TO SURFACE H2O SUPP 4 ' PERM. SOIL BELOW FACILITY C------MIN 12" COVER --- FILL? (25' if above natural elev; 101if below) BREAKOUT MET? TRENCHES MIN 660 gpd SLOPE (min .005 or 611/1001 ) >31COVER?-VENT SIDEWALL DIST. 2X EFF. W OR D (MIN 6' ) IS RESERVE BETWEEN TRENCHES? IN FILL? MUST BE 10' MIN. 4" PEA STONE? BOT X LDNG + SIDE X LDNG = TOT (L x W x #) (G/ft2) (DxLx2x#) (G/ft2) Copyright©1993 by S.L.Starr NEW ENGLAND CLAIMS SERVICE, INC. ReplyTo ❑ Reply To p y Reply To ❑ P.O.BOX 345 100 CONIFER HILL DRIVE, SUITE 308 P.O. BOX 578 MANSFIELD,MA 02048 DANVERS,MA 01923 SHREWSBURY,MA 01545 TEL. (508) 337-8058 TEL. (978) 777-9900 TEL. (508) 842-3995 FAX(508)339-5835 FAX (978) 774-9296 FAX (508) 842-7510 Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch. 139, Sec. 3D TO: Building Commissioner or Board of Health or Inspector of Buildings Board of.Selectmen Tow addresses RE: INSURED PROPERTY ADDRESS 'S S"7 �ox�- ► ��' POLICY NO.: l I+al 006 aA1� LOSS OF: G 3 0 /o FILE OR CLAIM NO.: S3os 3k���`S Claim has been made involving loss,damage or destruction of the above-captioned property which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 3D is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. TITLE On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. `� ry o3 SIGNATURE AND DATE cc: Fire FORM - U - LOT RELEASE FORM sj INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT PHONE ASSESSORS MAP NUMBER 4 C LOT NUMBER 2- 7 ,K ( 315 SUBDIVISION LOT NUMBER STREET q, O 1.�'k.e e—T STREET NUMBER 7 googol OFFICIAL USE ONLY ................................................................... ■ now RECOMMENDATIONS OF TOWN AGENTS DATE APPROVED CONSERVATION ADMINISTRATOR DATE REJECTED COMMENTS j DATE APPROVED TOWN PLANNER DATE REJECTED CONIIAENTS 4.: DATE APPROVED FOOD INSPECTOR-HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR-HEALTH I) DATE REJECTED II COMMENTS 611 VC 01 PIVI CC IV L2. J,--56- be 1I ;CL) V 70 (517z" 0:5,e 0'a muu,5c CCS G� �_✓�✓ ;I ; PUBLIC WORKS—SEWER/WATER CONNECTIONS DRIVEWAY PERNIIT DATE APPROVED FIRE DEPARTMENT ` I' DATE REJECTED i CON&MI NTS RECEIVED BY BUILDING INSPECTOR DATE o' v r N *9—A lo��7—A �5/ low," r . ;' o 0x. SILT SILT FENCE AND HAYBALF LINE TO \ ' _ BE INSTALLED AT LIMIT OF WORK Ir ` A WELL �o 0�r CASING y repo ,00 PROPOSED 16'x24' Lu U / ) ABOVE Z / GROUND / , ! POOL -_'= } r f; 36' �� • DE k / Q Y' r LANDSCAPING 1 H IF i EOR I N0 P` ,X77- R WFrA I I& S�PSO WALL r N/F `' o �3 NA� TOMPKINS �. 4.64± ACRES ei1E /6.�/ SOXFORD ROA D 1. THE WETLAND BOUNDARY AS DEPICTED HEREON WAS DELINEATED BY WETLANDS & WILDLIFE, INC. ON SEPTEMBER 9, 2000. 2. THE LOCATION OF THE PROPOSED ABOVE GROUND POOL WAS PROVIDED BY OF GIBRALTAR PROP SED POOL WITHENDORSEMENT WITH RESPECT COMPLIANCE NORTH ANDOVERZONINGREGULATIONS.. SAIDGRAPHIC SCALE 3. PROPERTY LINES AS DEPICTED HERE ON HAVE BEEN COMPILED FROM VARIOUS t o Is ao so SOURCES AND DO NOT REPRESENT THE RESULTS OF A COMPREHENSIVE PROPERTY LINE RETRACEMENT SURVEY. CONSEQUENTLY, THE ENDORSING PROFESSIONAL LAND SURVEYOR BEARS NO RESPONSIBILITY FOR IT'S DEPICTION HEREON. ( IN FEET ) 4, CONTOURS DEPICTED HEREON ARE BASED ON AN ASSUMED DATUM. BENCHMARK IS i inch = 30 ft. TOP OF WELL CASING, ELEV=100.0'. WETLAND LOCATION PLAN 557 BOXFORD STREET PREPARED FOR: PREPARED BY: NORTH ANDOVER, MA 01945 GIBRALTAR POOLS WETLANDS & WILDLIFE, INC. DATE: SEPTEMBER 15, 2000 428A BOSTON STREET 55 SOUTH MAIN STREET REVISED: JUNE 17, 2001 TOPSFIELD, MA 01983 MIDDLEBORO, MA 02346 SCALE: 1"=30'